Why psychosexual and relationship therapy matters

How often do sex and relationships find their way into your therapy room? Even when the focus of therapy is not directly on these factors, relationship issues, sexual concerns, or both often find their way into therapeutic conversations. Intimacy, in all its forms, can be one of life's greatest sources of connection, but when difficulties arise, it can leave people isolated, stuck, and hurting.

Psychosexual and relationship therapy offers a way through. It brings people back to themselves, to each other, and to a sense of belonging. It's a field full of challenges, richness, and reward, where therapists get to support healing, growth, and sometimes even transformation.

At COSRT – the College of Sexual and Relationship Therapists – we champion this work. We believe in the power of healthy relationships and sexuality to change lives. And we support therapists every step of the way.

What makes this work so unique?

Working with relationships means working with the "space between" people: that delicate, complex space where hopes, fears, hurts, and fantasies live. It's where connection can either flourish or wither. Helping people tune into that space, heal old wounds, and find new ways to relate is at the heart of relationship therapy.

Psychosexual therapy is no less rich. Here, biology meets psychology. Whether it's helping someone navigate painful sex, erectile difficulties, lost desire, or the legacy of sexual trauma, psychosexual therapists are guides through some of life's most vulnerable territory.

Often, these worlds overlap. A "lack of sex" might mask deeper relational hurts. A relationship crisis might expose hidden sexual anxieties. Skilled therapists know how to listen between the lines and follow where the real work is needed.

The call to this work

So why do people choose to specialise here? Because they want to make a difference where it matters most. Because they aren't afraid to sit with vulnerability. Because they believe that intimacy, connection, and sexual health deserve the same care and attention as any other part of life.

Training in psychosexual and relationship therapy is a journey in itself. COSRT-accredited courses foster deep personal growth. In addition to academic study and supervised clinical practice, therapists must explore their own histories, biases, and beliefs, building the emotional resilience needed to hold clients' most personal stories with respect and steadiness.

How COSRT helps

COSRT has been at the forefront of developing the specialised disciplines of psychosexual and relationship therapies for decades. These are not simply extensions of general psychotherapy – they are distinct specialisms that require dedicated training. COSRT plays a central role in ensuring that training for these specialisms meets the highest possible standards. Our focus is on two key areas: Integrated psychosexual and relationship therapy (PRT) and focused relationship therapy (RT).

COSRT holds the UK’s first voluntary public registers for psychosexual and relationship therapists, which provides an open, public record of therapists who meet our exacting quality and training standards. These standards cover areas like accredited training and qualifications, ongoing clinical supervision, and continuing professional development.

All registered therapists are required to uphold COSRT’s code of ethics and practice and are subject to our conduct procedure. They are required to renew their registration annually and are subject to audit, helping to ensure continued accountability and professional integrity. In addition, COSRT also offers an accredited status – a category for therapists who have attained a particularly high level of expertise and experience, and it represents the gold standard for the profession.

COSRT also plays an important role in advancing the field through academic research. Our peer-reviewed journal, Sexual and Relationship Therapy: International Perspectives on Theory, Research and Practice (SRT), is published quarterly by Taylor and Francis and brings together high-quality theory and evidence on sexual and relationship issues from around the world.

Because COSRT focuses solely on psychosexual and relationship therapies, we're uniquely positioned to advocate for the field, promote excellence, and protect the public.

The diversity of the work

Those who feel called to the work of psychosexual and relationship therapy often describe it as a vocation. It’s a field that asks you to be present, curious, and brave – to sit with people in their moments of greatest vulnerability, and to believe in their capacity for healing and growth.

There's no "typical" day for a psychosexual or relationship therapist, and one of the most fascinating aspects of the work is the sheer variety of presentations that come through the door. One session might involve helping a couple reconnect emotionally after cancer treatment has changed their physical intimacy. Another might support someone working through shame after early sexual experiences. Another still might help partners break painful cycles of argument, withdrawal, and loneliness.

Therapists must be comfortable navigating complex emotional landscapes, cultural differences, and the messy, challenging realities of human lives.

Take, for example, the couple who've drifted apart after years of raising a family, discovering that lost intimacy is less about technique and more about finding their way back to each other. Or the young professional overwhelmed by fear and shame around sex after one difficult encounter. Or the woman facing terminal illness, grieving not just for lost health but for her stolen sense of sensuality and desirability.

Relationship therapy demands a special sensitivity to the dynamics between people. It's not about "fixing" individuals but about nurturing the space between them – a space that can hold love, resentment, grief, and hope all at once. Helping clients slow down their communication, hear what is truly being said beneath the surface, and rebuild connection is delicate, skilled work.

In psychosexual therapy, issues may present more as physiological or functional concerns. But even here, the emotional dimension is rarely absent. A man struggling with erectile dysfunction, for example, may need both medical evaluation and careful therapeutic exploration of his self-esteem, relational dynamics, and stressors. A woman experiencing pain during sex might require sensitive psychoeducation, emotional support, and step-by-step guidance toward body awareness and comfort.

The work sometimes demands collaboration with medical professionals when necessary, ensuring clients receive holistic support. Therapists must be skilled at recognising when physical health issues underlie sexual problems, and just as adept at helping clients understand how emotional well-being and relational security impact physical intimacy.

The COSRT community 

Being part of COSRT means working alongside others who believe in this field. It means having access to vital training, professional resources, ethical guidance, and a vibrant community.

It means committing to the highest standards – for yourself, your clients, and the field as a whole.

Psychosexual and relationship therapy is not for the faint of heart. It asks a lot. But it gives back even more. If you feel the pull toward this work, know that COSRT is here to help you.

To find out more about training, membership, and upcoming events, visit cosrt.org.uk