Maybe you've been thinking about sex therapy for a while, but the name alone makes you hesitate. What actually happens in sex therapy? Will you have to talk about everything on the first day? Does anything physical happen? These are common worries, and the real answers are much calmer than most people imagine. This guide explains what happens in sex therapy, from the first session to the work you do between sessions, so you can decide whether it might help you or your relationship.
This post is general information, not medical advice. It is non-explicit and written for adults.
What sex therapy is, in plain terms
What is sex therapy? It's a form of talk therapy that focuses on sex, intimacy and relationships. The Cleveland Clinic describes a sex therapist as a licensed professional who helps with the mental and emotional side of sex-related concerns, using psychotherapy to help people work through them.
The most important thing to know is that nothing physical happens in a session. Nobody undresses, there's no touching and there's no sexual activity. The Cleveland Clinic states clearly that sex therapy sessions don't involve any physical contact or sexual activity between you and your therapist. You sit and talk, just like in any other counselling session.
What does a sex therapist do?
A sex therapist listens, asks questions and helps you understand what's getting in the way of the intimacy you want. Our sex therapists talk about sex in an open, nonjudgmental way, while staying professional and paying attention to your comfort level.
In practice, that might mean:
helping you put words to things that feel hard to say
exploring how stress, shame, expectations or past experiences affect your sex life
improving communication about sex with a partner
offering education and fresh ways to think about pleasure and connection
suggesting practice between sessions, tailored to your goals
You stay in charge of what you share and when.
What happens in the first session
The first session is mostly about getting to know you. Your therapist will usually ask what brings you in, what you'd like to be different and a little about your relationship and history, at a pace that feels okay to you.
You don't have to share everything at once. You can say "I'm not ready to talk about that yet," and a good therapist will respect it. You can also ask questions of your own, such as how they work, what sessions will look like and how confidentiality works. Many people leave the first session surprised by how ordinary it felt.
Going alone or as a couple
Sex therapy can help individually or as a couple, and it's often added to couples counselling. Both work well, depending on your goals.
Coming alone can be a good fit if you want to explore your own feelings, history, identity or confidence. Coming as a couple helps when the concern lives between you, like different levels of desire or trouble talking about sex.
What does a sex therapist do for married couples? Often, they help partners talk about sex without blame, understand each other's needs and rebuild closeness step by step. If your partner isn't ready to come, you can still start on your own. Our couples counselling can also support the wider relationship.
How does sex therapy work over time?
After the first session or two, you and your therapist agree on goals and a rough plan. Sessions usually build on each other: you talk about what came up since last time, what felt easier or harder, and what to try next. Some people come for a handful of sessions to work on one concern. Others stay longer to work through deeper patterns. You can review progress together at any point and change direction if your goals shift.
Between sessions: play assignments and practice
This is where much of the change happens. Sex therapy often includes "play assignments" between sessions, tailored to your goals. The Cleveland Clinic also notes that sex therapists may suggest activities and exercises to do in the privacy of your own home.
These might be communication exercises, ways to reduce pressure, or gentle, private activities that help you reconnect with your body or your partner. They happen at home, never in the session, and you always set the pace. If something doesn't feel right, you say so and your therapist adjusts.
What people bring to sex therapy
People come to sex therapy for many reasons. Some of the concerns we help with include:
boredom or burnout in a long-term relationship
differences in desire or preferences between partners
difficulties with arousal or orgasm
performance anxiety
sex-related shame and guilt
improving communication about sex
self-esteem and confidence in the bedroom
sexual orientation and identity
kink and BDSM-related concerns
exploring consensual non-monogamy
concerns about sex or porn addiction
healing from experiences of sexual abuse
Differences in desire are especially common. Sex & U, from the Society of Obstetricians and Gynaecologists of Canada, notes that many sex therapists say it's the problem they see most often.
If you're healing from sexual abuse, our page on support for survivors of violence explain how we can help. If you're in danger now, call 911. If you're thinking about suicide, call or text 9-8-8 any time.
Is sex therapy effective?
Research is encouraging. A 2013 review of 20 randomized studies, published in the Archives of Sexual Behavior, found that psychological treatments improved both symptoms and sexual satisfaction for people with sexual difficulties, while noting the evidence is stronger for some concerns than others.
Progress looks different for everyone. For some, it's feeling less anxious. For others, it's finally being able to talk openly with a partner, or feeling more at home in their own body. We can't promise a specific result, but many people find the process itself a relief.
Common worries, and is sex therapy worth it?
"It'll be embarrassing." Most people feel nervous at first. Sex therapists talk about these topics every day, and the awkwardness usually fades quickly.
"It's only for couples in crisis." Not at all. People come to understand themselves, improve something that's okay or take a good sex life to the next level.
"I'll be judged for my identity, preferences or relationship style." Kink, non-monogamy, sexual orientation and identity are all welcome topics.
"Is sex therapy worth it?" If something about sex or intimacy is weighing on you, talking with a trained professional can save years of guessing and worry. A free consultation is a low-pressure way to find out.
Sex therapy at Transformation Counselling
We offer sex therapy for individuals and couples at our Kitchener-Waterloo, Cambridge and Ottawa offices, and online anywhere in Ontario on a secure, encrypted video platform. Online sessions can feel more comfortable for some people, since you talk from the privacy of home. For couples, both partners need to be in Ontario during an online session.
Sessions with our therapists range from $130 to $200, depending on the clinician.
Depending on your plan, insurance may cover some or all of the cost. Coverage varies, so check your plan.
We accept Health Spending Accounts (HSAs).
We can direct bill many insurers, including for sessions with a Registered Psychotherapist (Qualifying). Desjardins is the exception: through TELUS eClaims, we can direct bill Desjardins for sessions with an RSW, RP or psychologist, but not for an RP (Qualifying).
Book a free 15-minute consultation with our admin team. You don't need to explain details. "I'm interested in sex therapy" is enough.
If you're in crisis: if you or anyone else is in immediate danger, call 911. If you're having thoughts of suicide or self-harm, call or text 9-8-8 any time, day or night. Our crisis lines page lists both.
Last reviewed: October 2026
Sources
Cleveland Clinic, Sex therapist: what they do and when to see one
Frühauf S, et al., Archives of Sexual Behavior (2013), Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis
Sex & U (Society of Obstetricians and Gynaecologists of Canada), Concerns and sexual problems