As a therapist, my task is to encourage you to have safe and purposeful conversations, where you share how you truly feel about your relationship and identify what it is you need and want to change.

Conversations evolve over time towards the goals you’re looking for, but several elements help the process succeed:

Safety
Listening to your partner without interrupting and expressing what’s important to you without disrespecting or hurting your partner. 

Begin therapy sooner rather than later
Reluctance to address difficult topics causes delay in starting therapy. Unattended, difficulties compound with resentments or distance and become more complicated to sort through. So don’t wait for the problem to solve itself, its better to come in sooner rather than later.

Focus on your own challenges
Maintain focus on yourself and what you can do towards positive change, rather than on your partner’s shortcomings. This does not preclude your own feelings about what’s emotionally difficult for you.

Give it your best effort
A genuine effort will energize the therapy and contribute to its momentum. This means making yourself available physically and emotionally to participate and extract value from the conversations.

Follow up at home between sessions
In the office, we will identify things that may be helpful to try at home. But it’s important to follow up on suggestions between sessions. This will integrate what was addressed in the session and will turn understanding into practical change outside of therapy.

Allow for ambivalence
It’s OK to have ambivalence about your partner, your own commitment or ability, and about therapy itself. Making room for how you really feel is the first step in engagement. 

Have patience with the process
Respecting that change is a process and sticking with it will give you the best chance to bring about the changes you want, as well as leave you feeling good about the effort you made.

Final thoughts
Almost always at the end of the first couples counseling session, people express relief for having opened up the conversation, this alone seems to bring hope for change. Hope, even if there’s much work to be done, shifts how people feel about their difficulties and about each other. A feeling of being a team returns.

When the main symptom is sexually focused, such as difficulty with climax, penetration, pain during intercourse, low desire, lack of arousal, premature or delayed ejaculation etc. Sex therapy is the right resource to address these problems. A sex therapist is trained to help you identify contributing factors, establish whether there’s a need to refer to a Urologist or GYN to rule out or establish a medical concern, address the psychological factors that accompany the issue and restore the impact of the sexual issue on the relationship.

Even though the origin of the problem may be with one partner, it’s helpful to work on sexual difficulties together, because regardless of the origin of a problem, both partners are struggling and can learn to understand, cope, strategize and support each other to overcome difficulties.

Sometimes sexual issues are a result of relationship stress. Couples counseling is sufficient to deal with challenges a relationship is facing, but it is rarely the case that what happens in the relationship dynamic doesn’t also affect the sexual relationship. For example, difficulty talking openly, inability to share insecurities or ask for what you want, having resentment or distrust, all cause emotional and sexual distance.

It is sufficient to go to couples counseling so long as the issues do not originate or affect the sexual realm of the relationship. Even when the sexual issue is secondary, meaning that it has more to do with how you are getting along, it would be better to work with a sex therapist who can tend to your relationship dynamic along with your particular sexual obstacles.

Yes! Many things affect desire, and identifying what they are, is the first step to addressing the issue. Factors include: Medical conditions, hormone levels, side effects of medications, depression, anxiety, history of trauma, stress, tension in the relationship, negative beliefs about sex, lack of familiarity with one’s body, pain, lack of satisfaction, and fatigue, to name a few.

Once causes are identified, we will create a plan for you to make changes, try things at home, and follow up on your progress. While desire is an exciting and easy way to engage sexually, spending time arousing one another, can bring about desire, secondarily, rather than relying on desire to be the primary driving force for sexual engagement.

Communication about the lack or discrepancy of desire, can help you work as a team, to address expectations and make improvements, with both partners extending consideration for each other’s needs.

Quite a bit, it turns out. Who we are, is in many ways a product of the environment we come from; this includes ideas from our parents as well as religious messages about what is OK and what is not. Religion, which aims to uphold important values, also conveys explicit and implicit messages about sex. Young adults who internalize ideas about abstaining from dating and sexual exploration, often find themselves inexperienced, unprepared and insecure in adulthood about their own sexuality and how to go about it in a partnership.

Perhaps most importantly, this creates conflicting feelings about having or enjoying sex. Being able to talk about these influences now in adulthood, can help you get past feelings of embarrassment and inadequacy and sort conflicting feelings about sex. Once you are open about your difficulties, you can discuss them, become a problem-solving team and acquire helpful information that will set you on a positive path forward.

After two or three decades of raising children, working hard at home and at the office to take care of everything and everyone, its now just the two of you again.

A lot has happened and you are not the same individuals, or the same couple. With all that life’s demanded of you, its common to lose sexual intimacy, as well as emotional closeness. You may find yourself saying that you’re more like roommates now. Getting along, but not feeling involved or in love. What to do?

You have a rich history and your finances are better together than apart, and it will be nice to enjoy future family get-togethers under the same roof. At the same time, the reality of later age, makes it all the more important to live meaningfully. Now that so much has been accomplished, emotional closeness is where it's at, if only you could tap back into it.

There may be things in your shared past, that would be helpful to address. There are also physiological changes that contribute to feeling like you’ve lost something that you had. Productive conversations can help you update expectations, and create a shared vision for how you want to be together now. Talking openly, will bring you closer, copiloting your new adventure and enjoying a more connected relationship.