The seven things only a sex therapist will tell you

If your sex life is awkward, unenjoyable or simply non-existent, a sex therapist shares her top tips to improve intimacy

As a sex therapist, I make space for people to let go of what they think should be happening and move towards what they truly desire. I often see clients who are stuck in their sex lives, or not having the kind of pleasure they want. There are seven key things I have learnt in my time as a sex therapist that can help individuals break free and improve their sex lives. 
It’s so common for people to be avoidant about the topic of sex that the underlying reasons for it are rarely even considered. I have found that at the root of any avoidance or awkwardness there is usually something the individual has catastrophised. They avoid talking about sex as, unconsciously, they believe that doing so could reveal catastrophic truths, such as that their partner totally fantasises about someone else or that others are far more competent in the bedroom than they are. These unexamined worst fears are rarely the reality. 
A client may say “I think he really doesn’t find me attractive anymore, since I’ve given birth” and my response is “OK, but what makes you think that, have you asked him? Have you asked what might be going on with him, or been curious about the changes in your sex life?” 
If I could give only one piece of advice, it would be to let go of assumptions and expectations and find out what is going on with your partner.
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Individuals often carry unconscious shame, which can greatly impact desire. Feelings of shame may be linked to negative sexual experiences but shame can date back to childhood. It can be surprising for people to realise that their sex life is being affected by beliefs and feelings originally unrelated to sex. For example, a child may have learnt to be ashamed of their own needs if they were expected to suppress them in favour of other people’s. As an adult, this may cause them to focus only on their partner and to totally disconnect from their own pleasure and enjoyment. In therapy, this relates to what we call conditions of worth: believing that we are worthy only if we meet certain conditions. Unpicking these conditions of worth can pave the way for far greater passion.
One particular client, a single woman in her 30s, was struggling with sexual shame. We talked about a difficult sexual experience and she came to the realisation that the experience had not been consensual. Once she was able to see this for what it actually was, and to think about how her body had felt, the shame began to dissipate. She then reframed the experience as sexual assault. It was a tough realisation, but this alignment was ultimately incredibly freeing for her.
Many aspects of a sexual relationship can be transformed by therapeutic work. A mismatched libido is very common but there is great potential for sex drives to become more in sync. There is a playful erotic exercise which can be really helpful: the couple ‘show and tell’ by demonstrating to each other what they like through self-pleasure. Couples find this game-changing for increasing their desire and libido and I highly recommend anyone in a trusting partnership try this exercise.
Similarly, people may have a fixed way to reach orgasm, but this too can change. By spending time focussing on their senses and exploring touch, they may discover, for example, that they can orgasm from nipple play.
A recently divorced woman in her 50s came to see me because she was feeling lost within her sexual self. She had been a wife and a parent for more than half her life and was keen to enter into a new form of relationship and sexual adventure but didn’t know where to start. After working on self pleasure and becoming more aware of her body’s responses, she found that she had a new fantasy life, focussed on being dominant rather than submitting. She went from low confidence and self-worth to loving her body and feeling empowered about having choices; she was reminded that her relationships, and her life, were in her control.
Goal-orientated pressure can really diminish sex. This can be particularly apparent for clients who are trying to conceive, as the pressure of timing can lead to difficulty maintaining an erection. But striving to ‘achieve’ can cause psychosexual issues in many other scenarios. People who experience issues such as vaginismus, erectile dysfunction, delayed, early or absent ejaculation will often be feeling a great deal of pressure – from a partner, societal norms, or themselves. 
People would be far less concerned about achieving certain sexual goals if they knew the wide variation in people’s experience and knowledge. Some women are unfamiliar with their own genitals; some married couples have never had sex; some men do not know how to perform penetration. I see couples, for example, who have been to the doctors for their struggle with conception; yet when they come to see me and we talk it becomes apparent that penetration isn’t actually occurring. Little to no sexual experience is far more common than many would assume.
People tend to expect that there should be total spontaneity in their sex life; that they should be having unpredictable sex every other day of the week, on the kitchen counter; and that it should all just ‘happen’. However, for most people, life simply gets in the way. The expectation of spontaneity also means that sex isn’t talked about beforehand; couples assume they should be completely aligned and just know what each other wants. But this is unrealistic. 
People are usually resistant to planning sex, but it can be very sexy and erotic – communication throughout the day about the where and the when can build up the arousal. Equally, deciding in advance not to have sex, feels so much better than one person spontaneously initiating, only to have the other person turn away.
Planning sex was transformative for a couple in their 30s who, when they first came to see me, thought they would never be able to have sex again. The woman had MS, the man had painful arthritic hips, and every time they tried to have sex one or both of them would be in pain and take days to recover. Attempting to have sex had become a tense and sad experience. Initially we worked on building intimacy and connection through non-penetrative exercises, then we thought carefully about their bodies and came up with different sexual positions for them to try including the use of supportive cushions. They were delighted to be able to be intimate in these new ways.
So many people, regardless of gender, have negative feelings about their body, worry about their appearance or about being ‘enough’ for their partner. But it’s not looks that make a satisfying sexual connection: it is feelings – genuine and authentic feelings. Authenticity is the antidote to shame and insecurity and the key to intimacy. 
If people are struggling with insecurity we can look at the relationship; whether they are accepted for who they are, and whether they take pride in all that their body does for them. Working with people around their truth, their authentic self, is powerful.
Sex homework can involve journaling, self exploration exercises or whole body massage. But a classic sex homework task is to temporarily avoid penetration. This removes the perceived goal from sex and allows for more focus on sensations and emotions. This can be transformative for people, even if they’ve been having sex together for years.
It is my hope that, regardless of where they are now, people can release fear and shame and experience more joy and pleasure. Which is often easier than they think!
Katie Bottle is a senior accredited BACP therapist and qualified supervisor, working in the NHS and in private practice. She is a fully qualified and experienced psychosexual and relationship therapist and fertility counsellor.
As told to Liberty Guthrie 
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