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An illustration of a male therapist looking straight forward. Either side of him are two speech bubbles with question marks insideBBC Three / Vicky Leta

How it feels to be a sex therapist

Sex therapy is often linked with older couples but almost half of clients are under 35

Warning: adult themes

Like all sex therapists, Peter Saddington’s discussions with his clients are confidential and he wouldn’t break their trust by talking about them. His client stories are just inspired by work he has done with young people over the course of his years as a therapist.

I talk to people about their most intimate secrets but they know next to nothing about me - and that’s the way it has to be.

I’m a sex therapist, so people come to me for help with everything from erectile dysfunction to painful sex to vaginismus, a condition which makes the vagina tighten when penetration is attempted. If a client asks me ‘Are you married?’ I’ll tell them I am, because it would be strange to hide it but, beyond that, I keep things professional. I’m talking to these people as a therapist, not as a friend. Obviously, you build up a bond with some clients but it’s all part of the process of helping them overcome their issues.

In the clinic where I work, the therapy rooms are kind of like sitting rooms in a house where no one actually lives. There are three comfy chairs - one for me and two for clients. I don’t have family photos or personal trinkets on display, which helps me keep a distance.

I see couples and individuals - who can be either single people or someone with a partner who wants to be advised alone. A few years ago, a 29-year-old man called Rob came to see me on his own because he was feeling anxious about his performance with his new, more experienced girlfriend. He didn’t want to involve her in therapy because he was embarrassed about feeling that way.

During a session, I asked Rob whether a lack of experience would make him see Kelly any differently, if the roles were reversed. Of course, he quickly began to realise how unimportant that was, and he asked her to join him. As soon as Kelly started taking part, Rob’s confidence returned. The thing that made the difference was him being honest about his anxieties rather than trying to pretend that he knew more than he really did.

My clients are usually in their late 20s to early 40s but younger people aren’t as afraid of seeking sex therapy as you might expect. In fact, I’ve noticed an increase in the number of younger clients coming to see me over the 15 years I’ve been doing the job, as well as the number of much older people who are now getting into new relationships later in life.

 

BBCThree Sex Therapy - Elephan...Vicky Leta

Sexual problems are far less taboo now and, because of the effects of porn and changing expectations around sex, I think people are experiencing different kinds of problems and coming up against them younger. I have clients as young as sixth-form age coming to see me with issues ranging from concerns about losing their erection to confusion about their sexuality. And according to Relate, the organisation I work for, more than 42% of people who attended sex therapy at one of their centres in 2018 were under 35.

At the other end of the scale, my oldest visitor has been 89. That was a man who had been in a new relationship for a couple of years. Unfortunately, though, he and his new partner were struggling to have sex. They’d gone to the GP together but felt like the doctor was shocked they were still having sex at their age. Which, of course, was no help at all - so they came to see me.

Many people who seek sex therapy have already tried going to a doctor. Often, they just want a chance to talk about the problem in detail with someone. Most people are nervous - some couples even think they have to demonstrate their sexual issues in the room in front of me. That is obviously not the case!

One of my youngest clients was a 17-year-old boy who’d been having trouble with his erection. He and his girlfriend had tried to have sex and he’d lost it. They eventually broke up and he blamed it on his problem. He’d tried casual hook-ups and calming his nerves with alcohol but nothing had worked and he didn’t know what to do. Now, there was a girl he fancied in his class, who seemed to like him too, but he was scared to make a move after what had happened.

He’d been to his GP to ask for advice and was told that he was just young and the problem would work itself out. While he was there, he spotted a leaflet about sex therapy and decided to give it a go. When he came to see me for his initial assessment, I could tell he was nervous - he was bright red in the face for the entire session!

Every sex therapy session is different and, in this case, the work we did was mostly sex education. We looked at anatomical drawings and talked about how you get and keep an erection. I helped him understand that, for him, it was anxiety that was creating the problem.

BBCThree Sex Therapy - Homewor...Vicky Leta

I gave him homework to get an erection and then lose it three times in a row to help his belief that he could get it back. Gradually, he started feeling more confident, and it only took seven sessions for his issue to be resolved. About a month after finishing therapy, he called in to the centre and left a little note saying he was going out with the girl from his class now, and that he thought they’d be able to have sex soon.

Before becoming a therapist, I worked in a residential school for children with special educational needs. I could see how much pressure finding the right school and doing right by their child put on some couples’ relationships, and I wished I could do more to support them. I spent two years training as a couples counsellor alongside my day job, before going full time.

When I was helping couples with their relationship issues, it would sometimes become obvious that their problems were sexual, as well as emotional. So, I decided to train in sex therapy so I could help them on all levels.

One couple I saw soon after I qualified as a sex therapist, who had a strong bond emotionally but needed help with their sex life, were Matt and Alex, who were in their early 20s and early 30s respectively.

In our first session, they both seemed really shy, shifting around in their chairs and avoiding answering my questions. They were hesitant talking about explicit sexual things with me, like anal sex, and seemed worried I wouldn’t accept them because they were gay. I had a hunch the problem might be erection-based, so I brought it up in passing - I wanted to let them know it was ok to talk about sex in an open and honest way.

Erectile problems and premature ejaculation are the most common reasons that men come to see me. In gay relationships, where there may be an expectation for both partners to have erections, there can be even more pressure to perform. Whereas, with a heterosexual couple, there’s nothing for the man to directly compare to in the moment, at least.

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I set Matt and Alex a touching exercise to take the pressure out of intimacy. Each partner had to touch the other for half an hour - explore their body and work out what gave them pleasure. They were naked but weren’t allowed to touch each other’s genitals - it’s not about foreplay, but rather focusing on the sensations.

Eventually, they moved on to touching all over and understanding how to arouse each other, before building up to penetration. They put a lot of effort in and treated these sessions like a date night, with candles and romantic music. Happily, Matt’s confidence soon increased.

After about 15 weeks of therapy, Matt and Alex had penetrative sex. A few weeks later, they told me that sex worked every time. They came back to see me again three months after therapy ended for a follow-up session, and they were really affectionate towards each other. They also told me they were getting married! It was such a great feeling to hear that they were happy and doing well.

My friends find my job fascinating. People are interested when you tell them you’re a counsellor - but there’s a whole different kind of intrigue when you say you’re a sex therapist! Some friends won’t talk about anything to do with sex and are even a little uncomfortable around it. Others, though, happily tell me about their sexual problems. Some friends have asked if they can see me professionally, as they’d feel more confident talking to someone they know but I’ve had to turn them down. It’s important that I don’t take my work home with me and you can't have a therapeutic relationship with a friend or family member.

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Often, sexual problems are related to a past trauma like sexual assault or abuse. One female client, who was struggling with vaginismus, had overheard her mum nearly die while giving birth to her younger brother. In our second session, we did what I call a 'history-take', where I ask a client about their childhood, family background and early sexual experiences. Mary told me about that trauma and that, as a little girl, she’d heard her mum screaming and her other relatives talking about how she might not make it.

To help Mary overcome her issues around penetration, we did a lot of Cognitive Behavioural Therapy (CBT), which explores our automatic reactions to things. I taught her to relax her pelvic floor muscles, and encouraged her to practise penetrating herself using what are known as trainers. These are smooth, tampon-shaped objects that come in different sizes and help someone get used to putting something in their vagina.

If I hadn’t learnt to compartmentalise fairly early on, I wouldn’t have survived in this job. I can hear some difficult and distressing stories. I have to be able to put those things to one side because otherwise I’d be ineffective - feeling sad or sorry for the client isn’t helpful.

But for every sad moment, there are happy ones too. Sometimes, I’ll get messages and cards from couples after therapy is over saying, 'Thanks for all your help - we're pregnant!' In fact, there’s one couple that I get an annual postcard from, even after 12 years, letting me know about how they’re doing. They named one of their children after me, which was an honour!

In a way, because you don’t earn big money for doing this work, there has to be another reason why you do it. Seeing people making use of your advice and start to turn their lives around is an incredible feeling.

As told to Natasha Preskey 

Sex on the Couch is is available now on BBC iPlayer