Work starts with an assessment, but quickly moves on to practical work that can be fun, particularly if a client can get their partner involved.
When working with an individual, I always start with an assessment session. The client explains the problem they have come to work on, their concerns about the problem, any other anxieties they might have, and what they want to achieve from the work.
On the basis of that we put together a plan as to how we are going to work, how long it might take, and what the objectives and goals will be. Once that is in place it is then possible to work with the client to go back over their personal and sexual history, to see whether there are any elements in their upbringing, their family structure or their general past which might be causing the problem they have come to sort out or might be contributing to it.
This process can take a number of sessions and it might require going back in quite a detailed way into a client's childhood or their adolescence. However, that work is then very quickly balanced by getting the client to do some very practical work to actually deal with the causes of theproblem and that work is done in exercises that I explain to the client in the session and then get them to take home and do in their own time.
For example, for a man who comes with erectile difficulties - erectile dysfunction - we might start by looking at his sexual history, his sexual confidence and his self-confidence in general. However, we would also start doing practical exercises that he can take home that will give him a chance to get in touch, perhaps for the first time, with sensations in his penis, to work out what gives him pleasure and what doesn't. And we use that sort of exercise to gradually enable the client to get, not jsut a feeling of where the problem comes from, but also what new strategies he can put in place to sort it out.
In the case of a female client who is experiencing pain during intercourse - often known as dyspareunia or vaginismus - we would probably start working in the sessions on what her fears and anxieties are, if they are a prime driver of the problem she has got. We would also use practical exercises, perhaps using vaginal trainers to get her used to relaxing the muscles in her vagina.
In both cases, whatever the sex of the client, you can give them exercises that they can take home and do on their own. But if they have a partner it is going to be even better because they can do the exercises with the partner at home, or the partner could join the session, hear an explanation of the exercises, understand the context, and then fully participate in helping the client deal with that problem.
It may be the client comes with a wider confusion or anxiety about sex or sexuality rather than a particular problem. We would then spend more time talking about sexual history etc. until we get a chance to focus on practical exercises.
One thing to take away from this work in terms of the practical exercises that a sex therapy may recommend that you do, is that these exercises can be really good fun. Rather than having a homework that is quite onerous, these exercises involve being massaged by your partner, masturbating in new ways, performing new sexual acts with your partner. There's a whole range of new experiences that can be both fun and pleasurable. So although the things that bring us to sex therapy initially may be very painful and require exploration of difficult feelings we have about our past and our family histories. The next step that we go to is much more fun and is based around practical exercises and doing sexual things that are pleasurable. This will not only sort out the problems you came with but also give you a more fulfilling sex life.