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Who Are Sex Therapists and What Do they Do?

Posted Aug 24 2008 1:49pm
DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. The topic today is sex therapy. You may have heard about it, but how much do you really know about it? A lot of people seek sex therapy when they think their sex lives aren't going the way they'd like them to be or they may be having some problems. We're going to discuss the topic of sex therapy. Joining me are a couple of experts from the medical field. On my left is Dr. Robert J. Filewich. He's a clinical psychologist specializing in anxiety disorders. He's also the Executive Director for the Center of Behavior Therapy in White Plains, New York. Sitting next to Dr. Filewich is Dr. Ken Rosenberg. He's a psychiatrist affiliated with New York Presbyterian Hospital and Cornell University Medical Center. He's also in private practice in New York. He specializes in substance abuse and sexual disorders. Gentlemen, thanks for joining us on the webcast. Dr. Filewich, let's start with you. Give us the definition. What is a sex therapist? What do they do?

ROBERT J. FILEWICH, PhD: It's a licensed, qualified health professional that will go ahead and help people who have sexual problems, either in their relationship with their partner or sexual problems that are interfering with their life in such a way that it's creating a lot of uncomfortable and serious problems.

DAVID FOLK THOMAS: Dr. Rosenberg, how do you become a sex therapist? Are they licensed?

KEN ROSENBERG, MD: Hopefully they're licensed, and people can be licensed in a variety of ways, but unfortunately, it's not like become a psychologist or a psychiatrist where you have boards and you have 10 million people watching you and exams and a whole protocol. Someone can call themselves a sex therapist if they take a weekend seminar or if they're at a several a year study course at Cornell University, where we're at.

ROBERT J. FILEWICH, PhD: In the State of New York there's really no law that really prohibits people from calling themselves a therapist of any kind, including a sex therapist.

KEN ROSENBERG, MD: So you try to find a good therapist, a good psychiatrist, a good psychologist who has some specialties in sexual disorders, because you don't know who you're going to see if you just find someone who just calls themselves a sex therapist.

DAVID FOLK THOMAS: And patients who go to see sex therapists, what are the reasons they go there?

KEN ROSENBERG, MD: So many. The most common reason for men is probably, right now, erectile dysfunction. Impotence is a major reason why men seek help, especially with all the publicity around Viagra and that sort of thing.

ROBERT J. FILEWICH: That and premature ejaculation. Those are probably the two major ones.

KEN ROSENBERG, MD: Yes, the most I see. A lot of women come because of anorgasmia, and a lot of couples come because they are just looking for better sex.

DAVID FOLK THOMAS: Explain, then, if somebody were to go to a sex therapist, is that something that they decide on their own, or are they usually elbowed on by their partner? How do they motivate?

ROBERT J. FILEWICH, PhD: It goes many different ways, probably both ways. It depends on the situation at hand, but it is you're prodded because you're too embarrassed about talking to someone about it and someone who you trust who you know cares about you a lot really goes ahead and pushes you along, nudges you along, or you have the insight yourself to realize that if you don't do something about this soon it's going to create even further problems in your life and you want to go ahead and stop it right away.

DAVID FOLK THOMAS: I've heard about sex surrogates. Is that the same as a sex therapist, and if not, what's the difference?

KEN ROSENBERG, MD: Well, I'm a sex therapist but not a sex surrogate, I'm pleased to report. Sex surrogates are really people who have sex with their clients, patients, whatever, and some sex therapists do refer some patients to surrogates. I actually do not because I find that if you don't have someone to have sex with it's probably because you have intimacy problems and interpersonal issues that need to be addressed, and I also am terribly afraid of sexually transmitted diseases and don't want to do anything to encourage my patients to contract sexually transmitted disease with a professional who sees lots of folks.

DAVID FOLK THOMAS: That almost seems like an oxymoron, a professional sex surrogate.

KEN ROSENBERG, MD: There are people, lovely women -- I've met a number of them at conferences and meetings --- who are sex surrogates.

DAVID FOLK THOMAS: What is the goal if somebody goes to see a sex therapist? Take us through -- when they get there, what are they hoping to achieve?

KEN ROSENBERG, MD: The first thing a sex therapist does is does a very thorough examination and, believe it or not, most doctors most don't talk about sex at all with their patients. Something a sex therapist can offer is a rational, intelligent, well-educated person to talk to about sex in an open way. That's the first and, I would say, the most therapeutic thing a sex therapist has to offer. They can offer medication. They can do blood tests. They can check testosterone, prolactin. They can send you to a urologist. They can know when to send you and where to send you. But the most important thing, in my view, is that they could really let you just talk in a rational and reasonable way about sex and about everything, about when you masturbate and who you fantasize with and how you learned about sex, things that we, as individuals, never get an opportunity to speak about to nearly anyone.

ROBERT J. FILEWICH, PhD: But one of the major reasons why people come or why they have erectile dysfunction, the inability to become erect, one of the major underlying reasons is that they have this sense that they have to perform, and they have a lot anxiety in that. Their main focus is to reach that orgasm, and they feel that in doing so they'll be able to not only please themselves but please their partner. They put so much pressure on actually achieving orgasm that they forget and the lose sight of the fact that they should be focusing in on the whole entire experience, their partner, the sensations, the pleasures.

DAVID FOLK THOMAS: So if, say, a patient comes to a sex therapist, is it just all about talking? Is there any medication, or what are the techniques used to effect the change?

ROBERT J. FILEWICH, PhD: One is the sensate focus. Another one is sexual education. A lot of people think that they have to go ahead and perform and be a certain way. They don't understand that there's a lot more to sex than achieving an orgasm. One of the things that sensate focus does is through stages and processes they go ahead and have the couple learn to go ahead and focus on other things besides the actual orgasm, to actually get enjoyment out of pleasuring each other. It's a graduated system all the way up to the point where you're now naked together and having intercourse. Prior to that, you're really focusing in on what the main thing is, and that is their relationship and communication skills. Cognitive restructuring is another technique that people can use to go ahead and restructure their thoughts about the situation.

DAVID FOLK THOMAS: Does this happen with couples that have been together a long time, or is it maybe if you've just started dating somebody?

KEN ROSENBERG, MD: It really varies and depends on the individual. By and large, you don't want to see a brand-new couple, because they're dealing with too many issues to get immersed in sex therapy. On the other hand, some couples have such severe problems and they're at a crossroads in the relationship, even early on, because of sexual problems. They really have to get some sex therapy. I'm thinking about a case I've seen recently, a man who wasn't able to have intercourse at all. So as soon as he got into a relationship, his partner had him get engaged in sex therapy so they could have a meaningful relationship together. For other couples, there are problems that occur later on in the relationship, and they can occur for any number of reasons -- cultural, psychological and biological -- and a sex therapist could do any number of things, as I say, from behavioral techniques like Dr. Filewich was discussing to prescribed medications, depending on the situation. The first thing, of course, all therapists do is diagnose the situation and try to diagnose it properly and then treat it accordingly.

DAVID FOLK THOMAS: Very quickly -- this might be backtracking a little -- how many people think, "Well, we've been together" -- Maybe the guy thinks, "Well, I'm just not aroused by my wife anymore." Can they usually get aroused by other images, other people?

ROBERT J. FILEWICH, PhD: Yes. Then you have to explore the issue is there. Maybe it's a commitment phobia that's going on, and every time they go ahead and become erect, that means they're going to now become closer and more intimate, it puts more stress and pressure on him and he begins to feel that he's going to now be connected in a closer way, and he starts to feel pressure about feeling responsible for her emotional welfare and he loses his erection.

DAVID FOLK THOMAS: Is this covered by insurance, seeing a sex therapist?

KEN ROSENBERG, MD: It can be. The problem with insurance is really formidable. It can be covered. I mean, these are bona fide medical conditions that should be covered by insurance. They sometimes are, sometimes are not.

DAVID FOLK THOMAS: And I know nothing about that. You ought to ask somebody else about that. Thank you very much, Dr. Robert J. Filewich and Dr. Ken Rosenberg. You've been watching our webcast on sex therapists. I hope you've learned something. I'm David Folk Thomas. We'll see you next time.

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