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.

It's Common and Normal to Have Fantasies

In prior articles, I've discussed many different aspects of romantic and sexual fantasies (see my articles: The 7 Core Sexual Fantasies and Exploring and Normalizing Sexual Fantasies Without Guilt or Shame).

Fantasies Are Common and Normal

The current article focuses on how and why sexual fantasies are normal and common.  

What Are Fantasies?

There are many definitions for fantasies.  

Basically, fantasies are imaginary scenarios that people play out in their mind.  Sometimes these fantasies are new or recurring scenarios and/or they might be based on memories.

Many fantasies are never acted upon, but they can still be enjoyed in your mind.

In general, fantasies can be about anything, including but not limited to:

• Imagining winning the lottery
• Thinking about what it would be like to be famous
• Imagining what it would be like to travel around the world
• Imagining being someone else--either someone you know in real life or a character in a TV program, movie or book
• Imagining having certain super powers
• Having thoughts about having an affair you have no intention of doing real life
• Imagining being in a more interesting job
• Entertaining yourself while you're bored
• Playing with "what if...." scenarios in your mind: "What if he likes me the way I like him?" or "What if I accept that new job offer?" or "What if I take a risk?"
• Imagining what you would do in a worst case scenario as a form of mental rehearsal
• Imagining what you might have said or might say to someone in a conversation
• Imagining how you'll feel if you accomplish a goal that's important to you
• Having thoughts about what your life might be like under different circumstances

And so on.

What Are the Benefits of Fantasizing?

In general, there can be many benefits to having fantasies whether they are enacted or not.

Fantasies Are Common and Normal

Here are just a few:

• Helping you to get to know yourself better by seeing yourself in new and unfamiliar situations
• Helping you to see alternatives to the way you are now
• Coming up with creative solutions to problems
• Using a fantasy as a mental rehearsal before acting on it in real life
• Acting as a compensatory wish you derive satisfaction from--even though you won't do it in real life
• Boosting your mood
• Getting yourself out of a rut
• Becoming open to new experiences
• Providing you with a temporary escape from your current situation
• Energizing you mentally, emotionally and physically

Why Are Some People Afraid of Their Fantasies?

From an early age, many people are taught (implicitly or explicitly) that fantasizing, in general, is wrong.

For instance, young students are often scolded for not paying attention in class if they're daydreaming.  And, although it's important that students learn their lessons in class, it's also important for young minds to explore and create in their fantasies.  After all, play--whether it's children's play or adult play--is about being creative.

Many people are taught at a young age that having daydreams and fantasies are a waste of time.  They're taught that actively doing is more important than imagining. 

While it's true that if you only daydream about your hopes and dreams and never do anything to bring them to fruition you won't get very far, the seeds of creative ideas often begin with a daydream or fantasy that can be the start of fulfilling your dreams.

Why Are Some People Afraid Specifically of Their Sexual Fantasies?

Having sexual fantasies is common and normal as I have been reiterating.  In fact, research on sexual fantasies has revealed that 3 out of 4 people have sexual fantasies.

So, if sexual fantasies are common, why are some people uncomfortable with the idea of them?

Discomfort and fear of sexual fantasies are often based on certain religious, cultural or familial prohibitions that indicate that sex in general shouldn't even be thought about--much less engaged in--before marriage.  

However, these prohibitions can have a lasting effect.  For many people it's not like flipping a switch after they get married to suddenly feel comfortable with sex and sexual fantasies.  They might still have a vague feeling that it's wrong.

For many people sexual fantasies can cause fear, confusion, anxiety, guilt, shame and ambivalence.  On a certain level, some people might enjoy a sexual fantasy--even one they have no intention of carrying out--but on another level they feel bad about it.

On the other hand, other people find it exciting to engage in sexual fantasies that are taboo, so it depends on the individual (see my article: A Cornertone of Eroticism: Violating Prohibitions By Breaking the Rules).

What Are the Benefits of Sexual Fantasies?

As mentioned earlier, fantasies are normal and common.

The mind is creative and exploratory, so having fantasies, sexual or otherwise, is one way that people can satisfy their needs and wants.

Fantasies Are Common and Normal

People have sexual fantasies regardless of gender, sex, sexual orientation, age, race, marital status, ability/disability or other factors.

Sexual fantasies often help to promote sexual arousal.  

For instance, if you and your partner have scheduled time to have sex in a few days, having fantasies about it can help to build sexual anticipation and excitement (see my article: Creating Sexual Desire Using the Sex Drive Simmer Technique and Anticipation and Longing as an Erotic Aphrodisiac).

Sexual fantasies can also help to boost sexual confidence in many ways, including having a fantasy of being able to initiate and enjoy sex.

Should You Share Your Sexual Fantasies With Your Partner?

Sharing a sexual fantasies with a partner can be empowering and fun if your partner is open to talking about fantasies.

Typically, sharing sexual fantasies can strengthen the bond between partners.  

However, if your partner tends to be judgmental or unsure, it could have the opposite effect.

Sometimes the problem is with the word "fantasy" so, instead, you can ask what your partner might be curious about sexually (see my article: Substituting the Words "What's Your Fantasy?" With "What Are You Sexually Curious About?").

What Can You Do and Your Partner Aren't on the Same Wavelength About Sexual Fantasies?

Some people like sharing their fantasies with their partner and others like to keep it private.  

If you do want to share your sexual fantasies, be aware that it's not unusual for individuals in a relationship to have differences when it comes to sexual fantasies.

Just like anything else, including the kinds of food you each like, sexual fantasies can be unique for each person.  

What one person enjoys, the other person might not.  Or one of you might have a rich sexual fantasy life and the other might not be comfortable with sexual fantasies at all.

Others might want to talk about their fantasies, but they don't know how (see my article: How to Talk to Your Partner About Sex - Part 1) and Part 2).

If you feel the differences between you and your partner are getting in the way of having a pleasurable sex life, these differences can often be negotiated and worked out in sex therapy.  

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy for individuals and couples (see my article: What is Sex Therapy?).

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

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

If you're struggling with sexual issues, you could benefit from seeking help in sex therapy to have 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 work 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.