Let’s Talk About Sex (Therapy)

Even carrots need a cuddle sometimes.
Even carrots need compassion. And cuddles.

As an alumna of Barnard College, I have the pleasure of knowing many strong, beautiful Barnard Women who are taking life by storm. Rosara Torrisi is one of them. Voted 2015 Best Sex Therapist on Long Island, Rosara is an AASECT Certified Sex Therapist with graduate degrees in both social work and human sexuality. In short, there’s a good chance she knows more about sex – and how to make it better – than you do.

I’ve invited Rosara to tell us about her work here because pelvic floor therapists, who primarily deal with bladder, bowel and sexual dysfunction, are sometimes the first practitioners to whom a patient opens up. It makes sense: if every time you sneeze, you can’t keep urine stored in your bladder where it belongs, your PT will find out how it is impacting your social, sexual, and emotional health. It might be first time you tell anyone about how embarrassing or frustrating the whole situation is. But while PTs can improve the condition you’re dealing with by working on the musculoskeletal side of things, we’re not in a position to coach you through the complicated emotional stuff. Feelings are sticky. Thus, we harness the power of wonderful people like Rosara.

So, Rosara, what does sex therapy actually entail? Why does someone go to sex therapy?  

People often ask what a client might expect from sex therapy at the Long Island Institute of Sex Therapy (LIIST). Funny story: When I was first setting up my office, a close family member asked me if I was going to need a mattress in my office, supposedly for demonstrations. The need for a mattress in my office is quite far from the work I do as a sex therapist.

Sex therapy is talk therapy with behavioral components. What that means is, in the office, we talk. As a therapist, I never engage in physical contact with you. At first we talk about the history of who you are as a person, your family history, your dating/relationship history, your sexual history, and then the history of this problem in particular. With talk therapy, we work through any of the underlying psychological causes of your sexual difficulties. With behavioral therapy, we give you guided activities to do at home either with or without a partner. These activities start out very “low impact” and gradually work their way up to your goal. Each step is met with success before moving on to the next one. Especially throughout this process, your feedback is essential to customize your treatment to you.

Most people start off with weekly appointments for about 2-3 months and then move to every other week appointments for another 2-3 months, then either end therapy or move to monthly maintenance sessions for a few months, with the possibility of progressing to maintenance sessions every 3 months, or annual check-ins if desired.

Not that you’re in *any* way biased, but what do you think are some advantages of working with a sex therapist as opposed to a “regular” therapist on these issues?

A sex therapist is a general therapist (someone with either a PhD or Master’s degree in a mental health field). Each branch of mental health has its own perspective of the needs and treatments for clients, though at the end of the day we are all more similar than different. I often explain the need for sex therapy as similar to the need for a dermatologist or urologist—Sure, urologists are general MDs, but they’ve gone beyond their basic training to gain experiences and knowledge as a specialist. Sex therapists are specialists in the mental health field.

One of the unique features of a sex therapist is how they work with relationships. Many sex therapists treat people’s relationships from a framework that describes sex as an inherently important part of most adult relationships. With this in mind, we remedy issues with sexuality in order to help to bring the remainder of the relationship into balance. Most other therapists will completely ignore the importance of sexuality in a relationship or be unaware of how to help their clients develop a healthy sexuality.

Now let’s say there’s a woman who has been struggling with bowel and bladder issues since the birth of her children. Her partner no longer wants or seeks physical intimacy. Would they be candidates for sex therapy? Should she show up on her own first and figure out how to talk to her partner about what she is feeling?

This is a common issue we see at LIIST, especially because of our highly coordinated care with pelvic physical therapists, urologists and gynecologists. With a team-based approach, clients are able to find relief of bowel and bladder as well as pelvic pain issues resulting from childbirth.

In sex therapy, we talk through any of the underlying psychological and relationship causes of your ongoing sexual difficulties and we give you guided activities to do at home either with or without a partner. All activities are coordinated with your team of healthcare providers (I’ve even spent time coordinating care with Rabbis). We also assist couples in redefining their sexual and romantic relationship post-baby with a focus on developing accurate empathy and greater levels of respect, commitment, trust and kindness.

Even when clients are in a relationship, they will often attend therapy as an individual. This can happen for many reasons and it is always at the discretion of the client who they might bring in to therapy with them. Therapy is a vulnerable process and due to past hurts it can be difficult at first for individuals to feel comfortable inviting their partner in to this space with them. It’s a general rule that after an individual sees a therapist on their own for some time, the therapist will refer a couple to another therapist for couples therapy. Part of this has to do with alliance building. After some time, a therapist might become allied with an individual, which would make the therapist unhelpful to a couple. A therapist working with a couple isn’t actually allied with a particular person in the relationship. Instead, what’s so unique about couples therapy, is that the therapist is working in the best interest of the relationship, not any one of the individuals in the relationship.

Is any topic too taboo for sex therapy?

There is nothing off limits for conversation in sex therapy. Many people begin therapy with me and ask, “Is this going to weird you out?” The answer is always “No.” I have seen and heard most things, and there is very little that is entirely new to me. You might be experiencing something that you feel alone in, but I can almost guarantee you that you are not the only person who has experienced this issue. With that in mind, if there are others who have gone through this before, that means sex therapists know how to help you and that help is available.

What should someone look for in a sex therapist?

If you’re looking for a sex therapist, I strongly recommend finding an AASECT Certified Sex Therapists or someone who is under the direct supervision of one.

Psychologists have PhDs or PsyDs in Psychology, Social Workers have MSWs and varying levels of licensure that change from state to state, Mental Health Counselors have MHC, and Marriage and Family Therapists have MFTs. Each of these branches of mental health has their own perspectives about psychology and treatment, though they are more similar than different.

As a social worker, I enjoy a perspective that is heavy on developing an integration of a whole person, within the context of your individual needs, the importance of your family, the impact of your community, and the structures in society that play a role in your lived experiences. As a sex therapist, I find that my social work background fits beautifully into treatments that aim to assist a person in developing balance between their mind, body, heart and spirit.

Is there an online directory of sex therapists to which PTs and other healthcare professionals could direct their patients?

Yes! To find an AASECT Certified Sex Therapists near you, visit this link: http://www.aasect.org/referral-directory.

Does insurance cover sex therapy?

Any insurance that has mental health coverage has the ability to help you with affording therapy. Many therapists, including sex therapists, are “out of network” which means your insurance does not pay them directly. Instead, it is likely that you will pay your therapist for the sessions and apply for reimbursement from your insurance company. Most insurance companies do not reimburse you for the entire cost of a session, only a percentage. Therapists and doctors chose to be out of network for many reasons. At LIIST, because we are out of network providers, we will work with clients to figure out an affordable rate.

How should someone prepare for their first session with a sex therapist?

First things first, find a Certified Sex Therapist near you, visit their website, find their Psychology Today page, and see if you like what they have to say. Then make a phone call (or send an email; though I definitely prefer a phone call so I can better discuss what’s going on, how we might be able to help you, and to schedule an appointment).

Some general information we are likely to ask you over the phone is your name, your age, whether you’re currently in a relationship, if you have any children, a very brief summary of what it is you’re seeking help for, your phone number, and your availability. You can also ask some questions yourself, such as insurance and payment related concerns, though remember that this initial phone call is not your first therapy session. More conversation can happen later.

On the LIIST website, we have an initial form you can fill out before heading in. If you’d like, you can complete this online and email it to us or scan and email us a copy ahead of time. Other sex therapists are likely to have the similar forms available for you on their websites. This helps save your session time for you and not your paperwork.


Thank you, Rosara, for your insights and expertise! For those who are interested, you can contact Rosara here, or to find a certified sex therapist in your area, click here. And if you’re struggling with bowel, bladder, or sexual dysfunction and think a pelvic floor or women’s health physical therapist might be able to help, use this link to find one in your area.

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