You can find general advice about seeking help for sexual issues here, and information about the different kinds of professionals who are available here. In this section we focus on the different kinds of approaches that therapists and counsellors, in particular, have to their work.
One thing that can make finding a therapist or counsellor tricky is that they often have quite different kinds of approaches or styles. It can be hard for people who don’t know much about psychotherapy to realise this and to find someone with an approach that suits them.
It is vital to find somebody who you can have a good rapport with, and whose way of understanding your issues makes sense to you.
Here we give a brief outline of some of the main forms of therapy. Reading through these can help you find an approach which fits with your own way of understandings things. When you see a practitioner you can then check out which approach they come from.
You may find a therapist or counsellor combines two or more of these approaches. If they have an approach that isn’t listed here (or even one that is) it is always good to ask them to explain it. You could also look it up on the internet for more information.
Cognitive Behavioural Therapy (CBT)
(sometimes just called Cognitive Therapy)
Practitioners using the CBT approach generally think that we get into habits of behaviours or ways of thinking that aren’t helpful to us. They try to help people to identify these behaviours or thoughts and then to change them.
CBT therapists and counsellors are likely to use techniques or exercises. For example if you’re getting anxious a lot they might ask you to note down each time you get anxious during a day and record what you were thinking just beforehand.
If you are referred to NHS therapy (such as IAPT) it is likely to be CBT based.
In Sex Therapy examples of the kinds of things a CBT therapist might do include using relaxation exercises if you’re feeling anxious about sex, or helping you to explore what kind of thoughts you are having and change them for more useful thoughts.
For more information see http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
(sometimes called Humanistic or Client-Centred Therapy)
This kind of therapy is focused on the client talking and the practitioner listening and concentrating on understanding how the client is feeling: seeing things through their eyes. The therapist or counsellor tries to be as non-judgemental and understanding as possible.
The idea is that we all know what is best for ourselves but quite often we lose track of that because of all the messages we get growing up and from the world around us about what we should be like. Having a space and time to talk about this with a therapist who has your best interests at heart can help you to feel safe enough to tune in to what is best for you and what you want to be doing.
In Sex Therapy this might involve you thinking about all the ideas you have about what makes a good relationship or a good sex life. Which of those do you really agree with and which of them are unhelpful messages which actually make you feel bad about yourself? For example some people might think that they have to have sex a certain number of times a week even if they don’t feel like it and Person-Centred Therapy might help them to focus on what they really enjoy.
For more information see http://en.wikipedia.org/wiki/Person-centered_psychotherapy
(sometimes called Psychoanalytic Therapy)
Like Person-Centred Therapy, Psychodynamic Therapy is largely based on the client talking and the practitioner listening and encouraging. Psychodynamic therapists believe that many of the troubles we experience are because we hide some things from ourselves: they are ‘unconscious’. The aim of therapy it to help clients to be more open with themselves about these things.
Psychodynamic therapists help clients to explore their feelings and to consider that they might be due to different issues that they first appear. They may also draw links between how a client is in therapy, how they are in the rest of their life, and how things were for them in childhood.
For example, in Sex Therapy a therapist who has talked with a client for some time might say ‘it seems like you are anxious about having sex but I wonder if what really scares you is being vulnerable in front of another person?’ or they might say ‘I notice that you pause for a long time before you tell me something important, and you also say that you partner complains that you don’t tell him important details about your life. I wonder if that links back to how you say your parents didn’t listen to you as a child. Perhaps it’s hard to trust that people will listen to you now’.
For more information see http://en.wikipedia.org/wiki/Psychodynamic_therapy
(sometimes called Phenomenological Therapy)
This kind of therapy generally believes that a lot of people’s problems are because we get stuck in certain ways of seeing things. Probably these ways were useful at one point in time, but they are not so useful now. Existential Therapy helps people to challenge themselves and explore their options.
Like Person-Centred Therapy, Existential Therapy believes that people can help themselves and the therapist spends a lot of time listening to the client and trying to see the world through their eyes. Like Cognitive Behavioural Therapy it challenges unhelpful ways of thinking. But Existential Therapy believes that there are always good and sensible reasons for the ways that we are thinking and behaving, just that they might not be so useful to us now.
An existential therapist believes that all humans have difficult times including the therapist! It is normal to struggle and useful to listen to the difficult feelings and find out what they have to tell us. For example, a couple might be struggling to have sex and realise that one of them is doing it mostly because they’re scared that they will lose the relationship if they don’t, while the other one is doing it mostly because they think that being able to give another person pleasure is the sign that they are successful. Perhaps if they can reassure each other of these things in other ways then they will be able to enjoy sex more easily.
For more information see http://en.wikipedia.org/wiki/Existential_therapy
(sometimes called Family Therapy)
Systemic therapy looks as people as part of a relationship, family, or network. Problems are seen as part of the ‘system’ rather than as an individual with a problem. In Relationship Therapy, people in couples often see the problem as one person’s ‘fault’ whereas a Systemic Therapist would see the problem as something that happens between them.
For example, it is not unusual, when one person is struggling to get sexually aroused for both people in a relationship to blame themselves. The person who is unaroused feels that their body isn’t working right and they should be able to fix it, the other person worries that they might not be attractive enough. The Systemic Therapist would help them to express these worries and see how that anxiety, and not speaking about it, might be making the problem worse.
Alternatively in a relationship people might blame each other. One person might complain that the other never tidies up, whilst the other might complain that their partner is always nagging. A Systemic Therapist would help them see the dynamic between the two of them, whereby the first person feels unappreciated when their partner leaves them to do all the housework, whilst the other person feels useless when their partner complains about their behaviour. It is no one person’s ‘fault’.
For more information see http://en.wikipedia.org/wiki/Systemic_therapy