Will We Have to Talk about Sex during Couples Therapy?

Kate McNulty, LCSW: Whatever style of therapy you seek out, you should expect your therapist to exercise tact and sensitivity in getting to know you. Skilled therapists understand that sex is an uncomfortable topic for many people, and will not expect you to discuss anything you don’t want to in your initial sessions.

Your family history may preclude you addressing intimate matters with a stranger, even though it is in a professional context. Some cultures speak frankly about sex and others are more reticent. Some people in therapy may have hurtful or disappointing sexual experiences that can be difficult to explain.

We realize many people in therapy may not readily approach intimate matters, and we want you to take your time. Occasionally, we talk with a person once or twice and then never hear from them again. It is always troubling to think they may have said more than they really wanted to and then were hesitant to return due to feeling exposed. We want to avoid unfortunate incidents that result in people leaving therapy before they got sufficient help.

While the therapist may take the lead, especially in the first visit or two, when it comes to self-disclosure you can set your own pace. It is always appropriate to say, “I’d like a little more time to get acquainted before we discuss that.” You should experience respect and support from your therapist when you set boundaries in this way.

Jill Denton, MFT, CSAT, CCS: Absolutely not! Surprisingly, most therapists don’t have much training, experience, or comfort talking about sex. In fact, in my neck of the woods (California Central Coast), many marriage therapists don’t work a great deal with couples. This is why I went back to do postgraduate study as a sex therapist, in addition to my training as a marriage therapist.

It’s never easy talking about sex, and some couples that begin work with me because I’m a clinical sexologist feel more comfortable at first discussing intimacy issues that are peripheral to sex.

And, of course. some couples don’t feel that sex is particularly relevant to what they want to work on, so it might not be mentioned at all. The majority of couples that do want to improve sexual intimacy will contact me because I’m extremely comfortable talking about it.

I frequently hear from people I work with from a distance that they’re far more comfortable talking about sex over the phone. Right now I’m working with couples in New England, the Caribbean Islands, and Las Vegas. I guess for many folks it’s easier knowing we’ll probably never clap eyes on one another.

So, if you go to a sex therapist, expect to talk about sex at some point, but if you go to a marriage or couples therapist, it may never come up.

Anne Brennan Malec, PsyD, LMFT: As a clinical psychologist and marriage and family therapist, I work with couples on a daily basis. The problems and issues that couples bring to therapy really depend on the couple.

While I do not believe that talking about sex or intimacy is mandatory, I do regularly inquire about sexual activity and satisfaction. While I recognize that not every couple is comfortable discussing this with a third party, I know that dissatisfaction with frequency of sex can and does create feelings of resentment within a couple. If I raise the issue of satisfaction with intimacy, I can generally read body language to determine if both members of a couple are comfortable with the topic. If one partner is more comfortable than the other with discussing sex, and sex appears to be a problem for the couple, I will ask if they are comfortable discussing the issue in a non-detailed manner, so as not to make one of the partners embarrassed or uncomfortable. If discomfort is an issue, I then offer my beliefs about what I consider to be a healthy sexual relationship for couples.

Generally, I provide what is referred to as psychoeducation for couples about sex. What I mean is that I share with them my knowledge, professional experience, and expertise about couples intimacy.

First and foremost, sex should be seen as a method of healthy couple communication and connection. When a couple takes marriage vows that they will be faithful to one another, to me, this means that a couple will not only remain true to one another, but that they agree that sexual intimacy will be a part of their relationship.

I normalize the need to be more creative when it comes to planning or arranging for intimacy after a couple has children. I speak of the role that testosterone and estrogen play in creating and maintaining sexual desire, and the importance of physical attraction in keeping a strong sexual relationship. Maintaining one’s physical health and fitness is also important in setting the stage for a healthy sex life. I have found that my own comfort with providing this psychoeducation for couples can foster a safe environment for couples who were at first uncomfortable to open up and talk about sex in a way that can enhance the couples therapy.