What is Sex Therapy?

This article was updated on September 21, 2026.

Sex therapy is a specialized form of professional psychotherapy—commonly referred to as talk therapy—where a certified clinician focuses explicitly on the sexual health, intimacy, and relationship challenges of individuals and couples.

Modern sex therapy goes beyond addressing dysfunction; it provides a safe space to cultivate joyful communication, deep connection, and emotional intimacy.

Crucially, there is absolutely no physical exam, nudity, or physical touch involved between the sex therapist and the clients during any clinical session (see my article: What Are Common Misconception About Sex Therapy?)

Modern sex therapy involves a compassionate, holistic exploration of the physiological, emotional, relational, and psychological factors that may be preventing an individual or a couple from experiencing a pleasurable, fulfilling sex life (see my articles: What is Your Erotic Blueprint? - Part 1 and Part 2).

Modern Sex Therapy for Contemporary Issues

The field of sex therapy has evolved dramatically over the last few decades. Historically, many practitioners operated under a "neat and clean" model—a term coined by sex therapist and researcher Dr. Jack Morin in his seminal book, The Erotic Mind. This legacy framework assumed that improving a couple's sex life simply required resolving physical dysfunctions, improving basic communication, and boosting romance.

While that classic strategy works for some, contemporary clinical data shows it fails many others. In fact, countless couples experience no structural sexual dysfunction, communicate exceptionally well, and love each other deeply—yet still struggle to cultivate great sex together (see my article: What is Good Sex?).

Pioneering contemporary therapists like Dr. Esther Perel, author of Mating in Captivity: Unlocking Erotic Intelligence, helped revolutionize the field. Today, modern sex therapy proudly addresses pleasure, desire, and sex positivity. 

It provides an inclusive, affirming space for heterosexual, gay, lesbian, bisexual, transgender, queer, polyamorous, and ethical nonmonogamous (CNM) dynamics, as well as other diverse, non-heteronormative sexual expressions. 

What Issues Are Addressed in Sex Therapy?

People seek sex therapy for a wide variety of reasons. Below is a categorized directory of the most common issues addressed in modern clinical practice:

Desire, Arousal & Orgasm Challenges

• Low Libido & Low Desire: Resolving suppressed desire, often rooted in unmet needs during partnered sex or manageable stressors.
• Lack of Initial Interest: Using clinical tools to spark desire 
• Arousal Nuances: Mastering physical arousal patterns (see my articles: Understanding Your Sexual Accelerators and Brakes).
• Arousal Nonconcordance: Navigating the disconnect between physical responses and mental desire (see my article: What is Arousal Nonconcordance?)
• Ejaculatory Variation: Navigating delayed or unpredictable ejaculation during intimacy.

Relational Discrepancies & Communication

• Sexual Desire Discrepancy (SDD): Balancing mismatched sex drives between partners (see my article:  Mismatched Desire in a Relationship is a Relational Problem--Not An Individual Problem).
• Communication Gaps: Learning safe ways to vocalize erotic needs (see my article: How to Talk to Your Partner About Sex).
• Stale Intimacy Routines: Unpacking and modernizing old sexual patterns (see my articles: What is Your Sex Script?).

Confidence, Shame & Psychological Blocks

• Sexual Performance Anxiety: Overcoming mental pressure in bed (see my article: What is Performative Sex?).
• Body Image Concerns: Healing vulnerabilities that block physical connection (see my article: Is a Negative Body Image Ruining Your Sex Life?).
• Deconstructing Sexual Shame: Aligning fantasies with your internal worldview (see my articles: Your Sexual Fantasies Don't Always Match Your Values and Beliefs and That's Normal).
• Pain, Trauma & Relationship Structural Shifts

• Painful Intercourse: Managing somatic issues like vaginismus or dyspareunia (see my article: Getting Help in Sex Therapy For Painful Sex).
• Infidelity & Betrayal: Rebuilding safety and erotic trust after a breach (see my article: Learning to Trust Again After Infidelity).
• Ethical Nonmonogamy (ENM): Safely exploring open structures or polyamory (see my articles: What is Ethical Nonmonogamy?).
• Kink & BDSM Affirmation: Safely integrating power play, fantasies, or role-play (see my articles: What is Kinky Sex?).
• Sexual Trauma Recovery: Processing historical wounding to safely reclaim pleasure (see my article: Overcoming the Trauma of a History of Sexual Abuse).

• Aging & Fluidity: Navigating physical changes over time or shifts in attraction (see my articles: Overcoming Sexual Boredom in Long Term Relationships).

What Happens During a Sex Therapy Session?

Even when individuals or couples willingly seek out a sex therapist, talking openly about sex can initially feel incredibly uncomfortable. This hesitation is completely normal and often shaped by family upbringing, cultural messaging, or religious backgrounds. A skilled sex therapist will explicitly normalize these feelings, co-creating a conversational pace where everyone feels secure.

The initial phase of therapy focuses on gathering a comprehensive sexual history for both the individuals and the relationship. Many modern sex therapists draw from advanced clinical frameworks, such as Dr. Suzanne Iasenza’s book Transforming Sexual Narratives, to explore questions like:

• What is the presenting problem as each person uniquely experiences it?
• When did this challenge first manifest, and what coping efforts have been tried?
• What are your earliest memories or messages regarding sexuality?
• Are there any underlying medical or health concerns intersecting with your sex life?
• How do you uniquely define "sex" versus how your partner defines it?
• What initially attracted you to your partner, and what emotional blocks are currently restricting your pleasure?

Clinical Feedback, Collaborative Goals, and Home Assignments

Expert Feedback & Cycle Tracking

Once the initial assessment is complete, the therapist provides target feedback. For instance, if the clinician is trained in Emotionally Focused Therapy For Couples (EFT), they will help the partners identify the systemic "negative cycle" that keeps them stuck, highlighting relationship strengths while plotting a path out of emotional gridlock.

Setting Cohesive Clinical Goals

Following history taking, the therapist guides clients in mapping out specific, measurable goals. Rather than simply discussing whatever happens to be top-of-mind each week, establishing structured goals gives the therapy clear direction. This allows clients to collaboratively track their progress and dynamically adjust their therapeutic roadmap over time.

Structured Out-of-Office Assignments

Because lasting change requires real-world practice, sex therapists utilize custom take-home assignments between clinical sessions. As highlighted in sex therapist Dr. Ian Kerner’s book, So Tell Me About the Last Time You Had Sex, many of these practices are designed to be playful, communicative, and deeply connecting.

These home practices are entirely voluntary and tailor-made for your specific pacing. If an assignment ever feels emotionally complex, physically uncomfortable, or stalls at home, it simply provides valuable data to explore with your therapist during your next office visit, allowing you to safely unpack the block without judgment.

Get Help from a NYC Certified Sex Therapist

While traditional talk therapy provides vital cognitive insight, it often skims over the complex somatic and relational mechanics of physical intimacy. 

Working with a certified sex therapist offers a holistic, bottom-up path to sexual confidence and relationship vitality.

Rather than struggling through intimacy challenges alone, seek out specialized support to transform your sexual narrative and step into a deeply fulfilling life.

About Josephine Ferraro, LCSW

I am a licensed New York psychotherapist, hypnotherapist, and an advanced practitioner in EMDR, AEDP, EFT For Couples, Parts Work, Somatic Experiencing, and I am a Certified Sex Therapist. 

I am also an experienced Trauma Therapist.

For many years, I have helped individuals and couples dismantle intimacy blocks, heal sexual trauma, and achieve genuine relational freedom.

I offer a complimentary 15 minute phone call before setting up an appointment.

I see clients online throughout New York State and in person at my private office in Greenwich Village, New York, NY 10011.

I offer a free 15-minute phone call before scheduling your initial appointment.

Contact Information

• Website: Visit Josephine Ferraro, LCSW - NYC Psychotherapist to learn more about my practice.

• Email: Reach out confidentially via email at josephineferraro@iCloud.com.

• Phone: Call me directly at (917) 742-2624 during standard business hours.

How is Sensate Focus Used in Sex Therapy?

Before I discuss how Sensate Focus is used in sex therapy, I want to define what sex therapy is because there are many misconceptions about sex therapy in the general public and even among psychotherapists who don't practice sex therapy.

What is Sex Therapy?

Sex therapy is a specific type of psychotherapy for individuals and couples to address sexual problems (see my article: What is Sex Therapy?).

Sensate Focus is a Component of Sex Therapy

There is no physical touch, physical exam, sex or nudity during sex therapy sessions.  Everyone in the room remains fully clothed just like they would in any other type of talk therapy session (see my article: What Are Common Misconceptions About Sex Therapy?

Sex therapy addresses physical, emotional and psychological factors that might be getting in the way of sexual fulfillment.

As a sex therapist, I help clients with a variety of sexual problems, including:

• Low Libido/Sexual Arousal/Sexual Desire
  

• Mismatched Sexual Desire Between Individuals in a Relationship

• Sexual Communication

• Sexual Boredom

• Erectile Problems

• Sexual Performance Anxiety
  

• Painful Sex

• Orgasm Problems
  

• Sexual Guilt and Shame
  

• Sexual Self Esteem

• The Sex Script of a Couple

• Sexual Abuse/Trauma

• Age-Related Sexual Problems

• Body Image

• The Unconscious Meaning of Sexual Fantasies

• Kink, BDSM , Eroticized Power Play 

• Transgender Issues

• Consensual Nonmonogamy
  

• Compulsive Use of Pornography or Out of Control Sexual Behavior

As well as other sex-related issues (see my article: What Kinds of Problems Are Addressed in Sex Therapy?).

A sex therapist might refer a client to various other health care practitioners to either rule out or overcome related medical or physical issues that could be part of the problem.  

For instance, if a man is experiencing erectile problems, a sex therapist often refers the client to a medical doctor who specializes in erectile problems to determine if the problem is medical.  Once a medical problem has been ruled out or addressed, a sex therapist can help the client with the emotional or psychological issues involved.

Another example of a possible referral is if a woman is experiencing pain during intercourse. A sex therapist often refers the client to a gynecologist who specializes in painful sex problems to either rule out or address the problem. Subsequently, a sex therapist can also refer the client to a physical therapist who is a pelvic floor specialist while the sex therapist simultaneously helps the client with the emotional or psychological issues involved.

What is Sensate Focus?

Sensate Focus is one component of sex therapy among many.

Sensate Focus is a behavioral technique that was originally developed by Masters and Johnson. 

Sensate Focus is a Component of Sex Therapy

Sensate Focus involves a series of behavioral exercises that a couple does together to help them to enhance their emotional and sexual connection.

The behavioral exercises are done as part of sex therapy homework in the privacy of their home.  They are not done in front of the sex therapist.

When I work with couples who want to improve their emotional and sexual connection, I provide them with psychoeducation about Sensate Focus and how it can be helpful.  Then, I tailor the homework to the needs of the particular clients. 

For instance, if they are in a long term relationship where there has been either infrequent or no sex for a while and they are apprehensive about Sensate Focus, I collaborate with the clients to see where they each feel relatively comfortable to begin.  

I stress to couples that Sensate Focus is a behavioral mindfulness technique and, as such, it's a non-demand exercise. 

The non-demand aspect of Sensate Focus means there is no expectation of sex. 

In fact, the exercise won't go beyond what has been agreed upon in advance by each member of the couple.

Sensate Focus is a Component of Sex Therapy

For example, with couples who haven't touched each other in a while, I might ask them to start by setting aside two times between weekly sex therapy sessions where they each take turns touching the other partner's hands for 2-5 minutes without any talking (this is to avoid the possibility of criticism which could make one or both people want to stop).  

During initial Sensate Focus exercises, I usually recommend that the couple is fully clothed when they do their homework assignment and that they do the exercise with lights on. There is no music or anything else that would indicate the expectation of sex.

By starting at a point where both people feel comfortable, Sensate Focus helps to remove stressful aspects of sexual and emotional connection that the couple might be struggling with. In fact, most people find Sensate Focus relaxing.

Sensate Focus is a Component of Sex Therapy

If one of the partners is uncomfortable with how the other partner is touching them, they can show them by lifting the partner's hand and demonstrating how they would like to be touched.

When the couple returns to their next sex therapy session, assuming they did the exercise, they each talk about their individual experience with the exercise.  

If they didn't do the exercise, I facilitate a discussion as to what got in the way of doing it.  Beyond giving reasons that they were busy or tired, this helps the couple to explore and understand unconscious issues involved with why they might have avoided doing the Sensate Focus exercise and how they can overcome these issues.

Overcoming obstacles to Sensate Focus also reinforces the idea that there is mutual responsibility for sexual and emotional connection. 

In other words, it's not the job of any particular person to be "in charge" of the exercises, so I usually recommend that each individual take turns reminding the other partner about the exercise and initiating.  

So, if Person A is the reminder and initiator on Day 1, Person B is the reminder and initiator on Day 2.

From there, I continue to collaborate with the couple on how to proceed to the next step in Sensate Focus. 

Based on the clients' mutual agreement, Sensate Focus progresses to include different types of touch as the exercises progress.  Once again, the exercises are highly individualized for the particular couple.

What is the Foundation of Sensate Focus?

There are several elements that serve as the foundation of Sensate Focus, including:

• Providing sexual information and education to both partners about sexual function and activities

• Establishing mutual responsibility between partners for addressing sexual communication, sexual needs and concerns of each partner

• Helping couples to communicate effectively about sex without guilt or shame

• Being willing to change sexual attitudes that are getting in the way of sexual fulfillment

• Overcoming sexual performance anxiety, including guilt and shame

• Overcoming issues related to sexual roles in the relationship

• Giving behavioral homework assignments for couples to improve their sexual and emotional relationship

When is Sensate Focus Used?

Sensate Focus is used for a variety of sex-related problems, including but not limited to:

• Sexual Arousal Problems

• Sexual Desire Problems

• Erectile Problems, including premature ejaculation, delayed ejaculation, erectile unpredictability

• Painful Sex

• Sexual Anxiety

• Other Sex-Related Problems

Conclusion

Sensate Focus is a well-researched, effective component of sex therapy.

Sensate Focus helps to enhance emotional and sexual intimacy with behavioral exercises for couples to do privately as part of their homework.

Sensate Focus is beneficial for couples of any age, race, gender or sexual orientation, including heterosexual couples or LGBTQ+ couples.

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy for individual adults and couples.

If you're struggling with sexual issues, you could benefit from working with a skilled sex therapist.

Rather than struggling on your own, seek help from a sex therapist so you can lead a more fulfilling sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex-positive therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.