What Happens in Sex Therapy – From A Real Sex Therapist

Sex therapy is for everyone.

But don't take our word for it—Nicoletta Heidegger, a licensed marriage, family and sex therapist, sex educator and podcaster with a sex-positive and shame-free approach, talks openly about why and how sex education and therapy aren't just for solving crises and conflict. Instead, Heidegger maintains that sex education and sex therapy are about maximizing your pleasure and fostering a healthy self-image and relationships.

Intrigued? Us too.

That's why we sat down with Heidegger to talk about sex therapy, what to expect when seeking support and how to know if sex therapy is right for you.

Here's what we learned:

READ: Hiring a Sex Coach Was the Best Thing I Did for My Sex Life.

For those who aren’t familiar with you or your work, can you introduce yourself?

Nicoletta Heidegger: I’m a marriage and family therapist specializing in sex therapy and equine-assisted psychotherapy. I’m currently pursuing my PhD in human sexuality; and I received my bachelor's degree in psychology from Stanford University, my master's in clinical psychology from Pepperdine University and my Master of Education in human sexuality from Widener University.

I see clients in private practice at my unique ranch office. When not working with clients, I teach seminars and classes to help others learn about sexual and mental health. For example, I lead the human sexuality training with the Department of Children and Family Services (DCFS). I also have my own podcast, "Sluts and Scholars," where I talk about issues relating to sexuality and mental health and contribute regularly to other columns, podcasts, and blogs about sex, relationships, and mental health. In my self-care time I enjoy biking, hiking, being with my animals and loved ones and playing the drums in a band.

What kinds of issues, concerns and topics do you explore in sex therapy?

NH: Unfortunately, most therapists get little to no training in human sexuality and sex therapy.

Because of that, there is a specialization within the field of psychotherapy that helps folks deal with issues relating to sex, relational and intimacy concerns. Sex therapy is a form of talk therapy where we cover issues having to do with sex, sexuality, pleasure, intimacy, relationships and gender. Some sex therapists have a specific focus within the realm of sex and sexuality. But in general, here are some of the presenting concerns I work with:

• Partners with differing desire levels.
• Partners who are not having sex or the kind of sex they want to be having.
• Folks with pelvic pain or pain during sex.
• Sexual trauma.
• People wanting to have better sex and more pleasure.
• People who have never had an orgasm.
• People who are exploring their own gender or sexuality.
• People who want to open up their relationship or explore non-monogamy.
• People who are exploring or want to explore kink and BDSM.
• Folks who have troublesome turn-ons that are bringing them shame.
• Persons who are feeling out-of-control in or with their sexual behavior.
• Folks struggling with shame or body confidence.
• People struggling with a lack of desire or arousal difficulties.

I believe in a biopsychosocial approach to sex therapy. Sex is something that affects many areas of our life and, in turn, biological, psychological and sociocultural factors affect our sexual identitiy. The way that I practice sex therapy looks like:

• Exploring your sexual and relational history. This can help you figure out your sexual scripts, hangups and narratives around sex and sexuality and how that affects how you show up in relationships.
• Helping connect clients to doctors and specialists who have expertise in sexual medicine. Many doctors, even OBGYNs, do not have in-depth human sexuality training. It is important that folks know how they are doing in their physical bodies (i.e., with hormones, pain levels and sexual health). For that, I will often refer folks to specialists to rule in, or out, any physical issues that may be cause for concern or getting in the way of pleasure. I often work in collaboration with a variety of practitioners in a team approach. For example, if someone is experiencing pelvic pain, they will usually be working with me, a pelvic floor therapist (PT for your pelvic region), and an OBGYN or urologist who has a specialization in sexual medicine.
• Giving and utilizing referrals to things like interactive homework, classes, retreats, videos and bodyworkers so folks can really integrate what they are working on with me. Many of these are resources that folks have been dying for but didn't even know they existed or where to look/start.

READ: 4 Things You Learn When You Attend a Sex Toy Conference.

• Psychoeducation. A lot of folks have never learned about sex or have learned things that are incorrect or shame-based. I spend a lot of time educating clients about sex, sexuality, anatomy and what is “normal.” I also teach a lot about the nervous system, the mind-body connection, erotic styles and identities.
• Giving permission to talk about and have the sex you want!
• Offering tools and tips in a safe, non-judgmental space where folks can explore a stigmatized topic—maybe for the first time.
• Supporting clients in reconnecting (or connecting for the first time) with themselves and others.

How does someone know when they need to see a sex therapist?

NH: For any type of therapy or mental health [support], I like to encourage folks not to wait until things are in crisis.

If you are wanting to experience more pleasure in your life or your relationships, sex therapy can be a great tool. I believe that pleasure is a human right and most of us were not taught about sex or given comprehensive sex education. I believe that we all deserve the tools to maximize our relationship with ourselves and others and to expand our pleasure potential. Everyone deserves sex therapy!

READ: Better Sex: 10 Things to Start Doing Right Now.

While there is a certification board in California and most other states, a therapist does not need to have a specific training or certification to call themselves a sex therapist. So, it is important to ask someone what their qualifications and trainings are in terms of sex therapy.

I would also not recommend going to someone who labels themselves a "sex addiction therapist." "Sex addiction" is not a recognized diagnosis in the DSM, by the WHO or by the American Association of Sex Educators Counselors and Therapists (AASECT). Historically, a "sex addicton" approach is based in shame, control and the belief that there is one “healthy” way to have sex.

You may want to find someone who is AASECT-certified, as it does help ensure that they have had extra training in the field of sex therapy.

You also don’t have to be ready and comfortable to talk about sex; sex therapy is a place to practice communicating about these sensitive topics.

How do perceptions around sex and sex therapy need to change?

NH: Many of us are taught that sex is natural and should be spontaneous. But sex does not always come naturally; great sex takes work, effort, education, commitment and willingness.

We go to driving school to learn how to drive; but when it comes to sex some think that needing to learn means that they have failed at being a human. This is my field and I am still learning and practicing!

READ: The Key to Good Sex Isn’t Spontaneity - It’s Proper Planning.

On your podcast "Sluts and Scholars," you focus on shame-free, sex positive education. Can you talk about why you decided to do a podcast and how it’s developed?

NH: I always knew I wanted to diversify my work and not just do private practice. I love working with clients but it can be isolating. I started this podcast as a way to reach a wider audience and learn from [and] connect with others in my field.

The topic came from some experiences I had about being judged for my chosen profession and for my interest in sex and sexuality. I was at the spa with my friend and colleague, performer and educator Nina Hartley, and we were lamenting about how she isn’t able to educate younger folks because of her past in pornography—to which I responded that we should be able to be sluts and scholars, able to be sexually free as well as taken seriously as professionals.

This podcast came from a desire to showcase that intersection and to hopefully help others to celebrate their sexualities as well—to become scholars of their own sexuality, bodies and pleasure.