Psychosexual Counselling

Many couples struggle on with sexual problems for many years, even though psychosexual counselling is available to help them. Often there is embarrassment at the idea of having to ask for help with sexual problems or fears about what the counselling will involve. However, the counsellor should quickly put them at ease. It is natural to worry that it will be difficult to talk to a stranger, but people quickly realise that their problem is not nearly as unusual as they imagined.

Common problems include:

  • Problems getting/maintaining an erection 
  • Finding penetration painful or impossible
  • Ejaculating sooner than desired 
  • Pain during intercourse
  • Not being able to ejaculate when desired 
  • Not being able to orgasm
  • Loss of desire; often after having a baby or during times of work stress, for instance, people get out of the habit of making love and it can be hard to get started again -- one or both of the couple just may not feel like it.


These days, there may be additional issues such as use of internet pornography which can really strain a relationship, and couples may need some general counselling as well as help to get over their sexual problem.

Nothing sexual ever happens during counselling itself. Couples — or single people if they are not in a relationship or want to learn more before attending together -- are often given exercises to do at home, but there is no undressing or sexual behaviour during counselling. Usually, counselling begins with a general chat with the couple to explain the counselling process and for the counsellor to get an idea of how the couple see the problem. A thorough assessment follows, when couples are seen individually, so that the counsellor can work out what the problem seems to be, what each of the couple want to change, and the best way to help.
After this, the couple and counsellor meet to discuss the issues raised by the assessment and to agree realistic achievable goals. Initially, they will be set individual exercises and exercises to do together, aimed at improving intimacy rather than being sexual together right away. They will build up to this gradually, in small manageable steps, taken at the clients’ pace. Learning to relax and to manage worries often becomes just as much a part of the treatment as the shared exercises, which are meant to be enjoyable, not a chore. Couples are never asked to do anything they aren’t happy about, so there is no need to worry about being coerced into something you won’t like.

Some people don’t come for help because they are taking medication and worry that it will interfere. Obviously, counsellors do take medical treatment into account in their assessment and will consider any physical reasons for what’s happening or whether a different sort of counselling is more appropriate first. Sometimes they will ask people to have a check up with their GP, depending on what the difficulties are. Their aim, though, will be to make some improvement within the limitations of the client’s condition.

Sometimes people don’t seek help because they feel their problem is too big or small, yet while they mull this over couples could be getting the help they need. Similarly, they worry that they are too old or young or have the wrong sort of problem. Yet psychosexual counsellors see all sorts of people, with a variety of problems and sexual orientations, not just straight married couples, and will do their best to find the best and most appropriate way to help whoever they see.

Counselling Directory is not responsible for the articles published by members. The views expressed are those of the member who wrote the article.

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Written by Cate Campbell MA, MBACP (Accred), AccCOSRT, EMDR Europe Accredited, MAFT

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