The therapy space can be such unknown territory due to the legal requirements of confidentiality and the sheer variety across every clinician. Every clinician is as unique as there are stars in the sky and we each bring different theories, frameworks and toolboxes that align with our personal experiences and philosophies. This gap makes it very difficult and sometimes anxiety-producing and inaccessible when we want to start the therapy process but have no idea what to expect, what to look for or what's going to come out of it.
There's a million different acronyms to decode, like CBT (not cock and ball torture), ACT, IFS or EMDR. There's many different types of rebates available, many waiting lists that can be months long, a huge range of session rates and also often needing to take a gamble on whether your clinician is affirming of your identities like queer, non-monogamy or neurodiversity. Then we add on sexual concerns or sex therapy into the mix where there is minimal regulation in Australia. It's tough out there!
With the much-needed increase in awareness and conversations about mental health, therapy is also quickly becoming the blanket suggestion for many struggles. I often see it toted as this cure-all, magic fix. A few sessions and you'll never feel anxious again! This very capitalistic model of mental health is problematic and can set unrealistic expectations around what this space is actually for.
With the current popularisation of therapy, we're seeing more of a fly-on-the-wall, voyeuristic perspective of therapy through television and media, for example Esther Perel's infamous podcast, Where Should We Begin, and SBS series, Couples Therapy. We're starting to get consumable bite-sized snippets of this intimate space and a deeper understanding of what therapy can offer and how simultaneously awkward and vulnerable it can be. However, there remains this final hurdle with sex therapy and the emerging field of sexology, and there can still be some confusion about what it actually entails, what's considered fair game to talk about or the kind of homework tasks that can be set.
So what can you actually expect from your first sex therapy session?
The structure and approach differs from therapist to therapist, but the bare bones and basics will generally remain the same. The point of the first session is to get to know you, what you're seeking support for and making sure we're on the same page about what we're working towards. There will be lots of questions about your medical and mental health, sexual history, previous/current relationships, family and cultural background and so on. Remember there's truly no such thing as TMI in sex therapy.
Often by the time people finally get to a sex therapy session, they will have already been experiencing their concern for years, if not their entire life. Morale is low and this is a last resort, so it's tempting to expect a magic fix by the end of the first session. 99.9% of the time this will not happen (if ever), so again temper your expectations accordingly. Therapy won't fix you because you are not a problem to be solved. Many people especially attend sex therapy in particular for low/lack of sexual desire, and bring this expectation that there is this secret formula or magic pill that you can take and you can get your sweet honey-moon passion and New Relationship Energy back. I can save you the money right now and tell you that won't happen.
Sex therapy is a non-judgemental, supportive and comfortable space for you to get a better understanding of yourself and everything that can come under that umbrella: your sexuality, your relationships, your body, your background and your beliefs. Depending on the concern that has brought you in, there can be elements of coaching, for example, taking you through exercises and assigning homework.
Unless you're working with someone who offers bodywork, there should not be any physical touch, examination or nudity. In terms of what to look for, make sure your therapist has training in sex therapy or sexual health. The field of sexology is still minimally regulated in Australia, so anyone can call themselves a specialist or an expert!
Within the actual session, I suggest seeing it as a vibe check. Research has shown that the most powerful component of therapy isn't some secret technique or formula. It's the relationship between therapist and client. It's important that you feel like this person can support and hold space for you in all your complexity. So ask yourself:
Do you feel reasonably comfortable?
Do you feel heard?
Do you feel supported?
Do you feel like they can meet you where you're at?
Do you feel like they can push you?