The Difference between Therapy and Sex Therapy

How I find Sex & Relationship Therapy differs from regular Psychotherapy

Does Sex & Relationship therapy really differ from regular psychotherapy? My sense, is that it does and it doesn’t. Since this statement is rather unhelpful I’m going to try to explain using analogies.

So you mean like plumbing?

I recall interviewing plumbers about installing central heating in my house many years ago. I knew that central heating was a system of pipes bringing hot water from a boiler and there were various options available. After feeling rather frustrated with the information I was getting from the plumbers it was suggested that what I really needed was a heating engineer. I didn’t know such people existed but when I found one it was a revelation. The engineer was an experienced expert who could advise on aspects I didn’t even know were aspects. When the system was eventually installed it was nevertheless done using plumbing.

In one to one sexology work we have specific information that can be offered to a client to help them understand what might be going on for them. The client’s material is typically extremely sensitive, socially taboo, often misrepresented in the media, and usually laden with shame. It seems to help clients to learn that they are not alone with their worries, unusual in their choices, or as deviant in their predilections as they feared. The subject matter is specialised, but the disposition needed to facilitate the sessions doesn’t seem to me to be different from that required in ‘regular’ psychotherapy.

So here is the first point of difference: Sex & Relationship Therapy is a specialism that requires extra training. Even with all that training, I am still sitting in front of other individuals and being what I understand a psychotherapist to be.

So you mean like coal mining?

Another difference that I am aware of is the ‘time to coal face’ aspect. Let’s see if I can make the coal mining analogy work.

If I am hoping to mine some valuable coal I have to decide to start digging and then carefully shore up the workings, install lighting and an air supply. There might be some hints as to where to coal resides, but there are no guarantees. I may have to try a number of avenues before the earth is willing to give up its treasure. This is rather like building a working alliance with a psychotherapy client. They want a way to keep their house warm. They don’t necessarily know about coal, and the digging can be uncomfortable, so they need to become convinced that I am actually capable of helping them.

With a sexology client they know what coal is and they tell me exactly where the seam is.

There, although Freud might have something to say about this analogy, I think it has done the job.

But aren’t relationships complicated?

Working with relationships brings up the next point of difference which is the increased level of complexity. One extra person does not simply mean twice as complicated. It feels more like the complexity of one person raised to the power of two. We have all the facets of personhood for each individual, their circumstances, manifestations, capacities, beliefs, values, identity, disposition (or personality), autobiography, world-view, attachment style, preferences and hopes. Added to this matrix are the further complications of their level of personal development, differentiation, sexual template and shadow self. Where it gets exciting is that all these facets and proclivities intertwine with their partner’s unique individual matrix, and if you thought that was complicated enough, it’s really just the start. This is a structured dynamical system that is influenced by, and responsive to, the ecology of the clients. I am using the term ecology to refer to all the external factors that bring influence to bear on the relationship, such as children, family, sexual satisfaction the economy, the weather and the price of fish. All of this must be framed within the stated objectives of the therapy participants and those objectives can evolve, coalesce and diverge as the process unfolds.

As the TV infomercial then says “But that’s not all!” On top of all this there are the therapeutic relationship dynamics of transference, counter-transference, triangulation, boundary flexing and all my dents and scratches that get bruised in the process (the ones I know about at least).
This is a decent portion of interdependent variables. Certainly beyond the capacity of any known device to get to grips with, including the most majestic of them all – the human brain.

So it’s an enigma then?

If we choose to frame this as a complexity problem then we do have some things to help us, and I will extract an analogy from the work of Alan Turing and his team at Bletchley Park, who found a way to crack the ‘unbreakable’ Nazi enigma code. In pure cryptographic terms, the enigma code was not uncrackable but it would have taken centuries to try every option until the right one was found. What Turing and his team did was use ‘cribs’ to give them a head start. A crib is a reasonable guess at how messages might start (like Good Morning or Weather Report) combined with an understanding of how letters are most likely to be arranged when being used to construct language (you don’t find so many zzztqrrs as you do ands or buts).

Luckily for us, people offer us ‘cribs’ in their patterns of behaviour, their unconscious ‘leaks’ and our learnings about the common features of personhood. Perhaps more importantly we are working in collaboration to pursue a common objective so we get feedback.

Shall we dance?

I feel a need to step back from this analogy because it implies a mechanistic process requiring a clever therapist. My sense is that it is not like this, but more like a dance, drawing on the alliance of more than one brain deploying all their collective wisdom, experience and capacity for relevance realisation. The dance is the movement between overview, fine detail and alternative perspectives, with the therapist providing the gentle but reassuring lead that allows the client(s) to express themselves. The same dance happens in regular psychotherapy. What differs is the complexity of the choreography.

Cheesy as it may seem, the only word I can find to describe this exquisite process is love (or agape to be more accurate). I have a go at explaining a bit more about love in another blog.

And by the way, you don't need to wait for a crisis.

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