With two people involved, once the initial tension between them is dealt with, the learning and improvement process can be really fast and couples often come to find it very enjoyable.
Work starts with an assessment. Working out what each partner wants takes a little time, and there can sometimes be a lot of anger and tension in the room. But if your therapist can manage this early stage of the process successfully, most couples move quickly on to practical work to address whatever their problems.
When I work with a couple in sex therapy it's very similar to the pattern of working with an individual. But it differs because there are more people involved; there's the two partners and the therapist. So there are three of us working in the room. So there is not just one person's point of view and one person's problem to explain and hear, but two people's issues and both of those points of view can be very different. So it can take some time when starting couples therapy to enable both partners to tell their story about why they have come to where they are and what they want to do about it.
Often in the early stages I will ask the partners to come separately, because sometimes it is difficult for one partner to say something that they may be embarrassed or ashamed about in front of the other. In the early stages this can often be the case, but in the long term I would hope that they could share things completely. But initially they may share things separately and their confidence in having taken that step is respected. One of my jobs in the early part of the work is to make sure that what one client has told me is not divulged to the other. But this usually works fairly smoothly, and once we have an idea of where both of them are coming from, it is then possible to start working on the issue they want to sort out.
And then, just as working with an individual, I will move a couple to working as quickly as possible with practical exercises which could be exercises to work with a practical sexual problem, but it could also be an exercise to enable them to become more comfortable with intimate contact with one another, with touching one another, sharing information or communicating with one another. These techniques can be used to work not only with sexual problems but also the wider problems that couples face, difficulties of communication, differing agendas in the relationship, etc.
As with individuals the most important thing is that this work is positive and fun. The potential for turning the process of learning and therapy into something fun and pleasurable is much easier if you are working with a couple. The couple can take away a massage exercise or a mutual masturbation exercise and turn it into their own thing and be creative with it. So although couples therapy can often be quite difficult because there is often a lot of anger and tension in the room when you start working, if you can gain the trust of both sides and enable both parties to regain trust and intimacy with one another, and you can do that in a fun way with practical exercises, then it can start to become easier to make the experience both more effective and more enjoyable.