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.

Frequently Asked Questions About Sex Therapy

What is the Biggest Misconception About What Happens in a Sex Therapy Session?
The most common misconception about sex therapy is that it involves physical touch, nudity, or medical examinations in the office. I want to explicitly clarify that sex therapy is entirely a specialized form of talk therapy. There is absolutely no physical contact or exam permitted between the sex therapist and the clients during any session. Our work takes place entirely through collaborative, confidential conversation in a secure clinical setting to safely explore and untangle the psychological and emotional blocks holding you back.

How Does Modern Sex Therapy Differ From Older Relationship Approaches?
Historically, older models assumed that fixing a couple's sex life simply meant resolving a physical dysfunction or improving basic communication. Contemporary sex therapy goes far deeper by taking a sex-positive, inclusive approach that addresses desire, pleasure, and somatic awareness. In my Greenwich Village private practice, I help individual adults and people in relationships look beyond surface-level symptoms to map out the complex psychological dynamics and unconscious defense mechanisms that trap them in a cycle of worry or emotional distance.

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.

To Improve Intimacy in Your Relationship, Get Off the Sexual Staircase

This article was revised on September 14, 2026.

In their book, Desire - An Inclusive Guide to Navigating Libido Differences in Relationships, Lauren Fogel Mersey, PsyD and Jennifer A. Vencill, PhD., discuss the "Sexual Staircase" to describe the kind of routine, goal-oriented sex that people engage in when they're having sex with their partner (see my article: Understanding Your Sex Script).

What is the Sexual Staircase?

According to Mersey and Vencill, the Sexual Staircase, which is a metaphor, is how most people think sex is "supposed to be."

Improve Intimacy in Your Relationship

The Sexual Staircase is a list of hierarchical steps that usually start at the bottom of the staircase with foreplay and ends with sexual intercourse and orgasm.

Depending upon the couple, the sexual acts between foreplay and intercourse can include kissing, caressing, genital touch, oral sex, and so on.

For many people in long term relationships these steps don't deviate. They engage in the same steps in the same way most or all of the time.  

After a while, people in long term relationships often skip some of the steps as they prioritize a goal-oriented approach that always ends with penetrative sex and strives for orgasm.  

Having sex the same way all the time becomes boring after a while (see my article: What is Sexual Boredom in Long Term Relationships?).

What's the Problem With the Sexual Staircase?

If you and your partner enjoy doing the same thing, the same way all of the time and neither of you have a problem with it, then there's nothing wrong with the Sexual Staircase for you.

But many people find this approach to be too routine and unfulfilling.  The problem is that they think this is the way they're supposed to do it, so they just keep doing it the same way.

People who find the Sexual Staircase boring, sexually unfulfilling or not applicable to them often have the following problems with it:

• It's a heteronormative sex script that focuses on cisgender heterosexual men. For heterosexual men, sexual intercourse is one of the most reliable ways to have an orgasm, but this isn't the case for most women (see below).

• It assumes that most people want penis-in-vagina sex even though there are many people who don't want it or it doesn't work for them because of problems with dyspareunia (persistent or recurrent genital pain that occurs during penetrative sex) or erectile unpredictability (a persistent or recurrent problem with getting and maintaining an erect penis) or because they're not heterosexual (see below).

• Sexual intercourse is the least reliable way for most women to have orgasms because they need direct clitoral stimulation, which they often don't get from sexual intercourse or clitoral stimulation is skipped altogether (see my articles: Closing the Orgasm Gap - Part 1 and Part 2).

• The Sexual Staircase emphasizes goal-oriented, performative sex instead of focusing on sexual pleasure (see my article: What is Performative Sex and Why Is It a Problem?).

• In many long term relationships, the Sexual Staircase gets shorter and shorter over time so that there is little or no foreplay, which has a negative impact of women's sexual pleasure. The focus becomes getting sex over and done with it as quickly as possible because it's unsatisfying.

• In addition to problems with painful sex and erectile unpredictability, penetrative sex isn't always possible for a variety of reasons, including childbirth, certain disabilities, age-related physical limitations, surgery or other types of problems.

• When penetrative sex isn't possible (for whatever reason), many couples skip having sex altogether because penetrative sex is the only way they know how to have sex.  Over time, one or both of them become frustrated and dissatisfied.

• The heteronormativity of this model isn't useful for LGBTQ people, as previously mentioned. Many LGBTQ people assume that since they're not having penis-in-vagina sex, they're not having "real sex," which, of course, is false.  This often leads to feelings of shame, guilt and self consciousness about their sexual orientation.

The Wheel Model

The authors of Desire cite the Wheel Model, which was inspired by Robert T. Francoeur in his book, Becoming a Sexual Person (1991).

Picture a wheel that's divided into different sections with sexual activities represented in a non-hierarchical way.  

Rather than the linear, hierarchical model represented in the Sexual Staircase, in the Wheel Model none of the sexual activities has a higher priority over any of the others.  Other than sexual pleasure, there are no goals, which usually means less pressure for both people and more enjoyment.

In addition, with the Wheel Model, people can engage flexibly pick and choose what they like, in whatever order they like without being constrained to the rigid model of the Sexual Staircase.

The authors provide an example of what sexual activities might be included in the Wheel Model:

• Kissing
• Caressing
• Touching
• Massaging
• Using a sex toy
• Showering together
• Cuddling
• Oral sex
• Orgasm
• Penetrative sex
• Manual stimulation

And more.

The sexual activities included with the Wheel Model are only limited by your imagination.

But this is not to say that you and your partner should engage in the activities they write about or that you should stop having sexual intercourse if it's enjoyable to both of you.  You can do whatever you both enjoy.

The Wheel Model helps to dispel the myth that there's one right way to have sex or that everyone should have the same predetermined sex script.  

Making Changes to Your Sex Script

Once again, I want to reiterate that if you and your partner are happy with your sex script, you can continue using it without a problem.

But if you're stuck in a routine and you're getting tired of doing the same thing over and over again, consider how you can work towards making changes in your sex script (see my article: Changing Your Sex Script).

As Emily Nagoski, PhD., sex educator and author of the book, Come As You Are, says, "Pleasure is the measure."

This means "good sex" is what's pleasurable for both of you.

Getting Help in Sex Therapy

A skilled sex therapist can help you to overcome sexual problems.

Sex therapy is a form of talk therapy where the focus is on sex and relational problems getting in the way of sexual enjoyment (see my article: What is Sex Therapy?).

Individuals and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

There is no nudity, physical exam or sex during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?)

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

Contact & Consultation Information

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 introductory phone call before scheduling your initial appointment.

• 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.