Friends, it has been a tough—what? I was going to say several years, thinking back to 2020 and how the pandemic forced us to quickly and dramatically pivot how we practiced. But in reality, I think it has been a tough last decade. Between political turmoil, social unrest, economic uncertainty, and more, there is no shortage of current national and international events that affect us all to one degree or another. And I am writing this in early June 2025 with what appears to be a very turbulent summer ahead of us.

This brings me right to my point. Graduate schools and internships trained us to help our clients. But what if it is we who need the help? In our 21st-century world, we are not sitting on the sidelines, unaffected by the issues many of our clients come to us for support with.

I work with a lot of monogamous couples in sexless marriages. And when I say sexless, I mean couples who have not had intercourse or any other sexual/erotic activity for 5, 10, 15, or 20 years. It is not uncommon for me to see a couple who has not had any type of sexual or erotic touch between them for 25 or 30 years. I am talking no orgasms, no sex of any kind.
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Some of these couples report zero touch between them, while other couples report giving and receiving other forms of affectionate touch to each other, like holding hands, hugging, long kisses, holding and caressing each other naked, even showering together. Couples’ behaviors run the gamut and what they do and don’t do are unique to each couple.

Let me tell you about a former client of mine.
They were a couple married for almost 40 years, with grown children who had successfully launched. They were both in excellent physical health and were active in their various communities. They reported parenting their children cohesively with only rare episodes of differing parenting philosophies, were almost always financially stable, handled each’s aging parents with compassion and healthy boundaries, and enthusiastically supported each other’s careers and personal hobbies. They were excited about a new phase of their lives: they had young grandchildren, and he was close to retirement.

As a sex therapist, many of my clients sheepishly admit they have never really talked about sex in a “grown-up” way. Meaning maybe they have made jokes, used innuendo, or used slang to talk around sex. I think this is fairly common, and so, of course, I hold no judgment. For some folks, it is pretty daunting to show up to sex therapy and be asked to participate in a respectful dialogue about sex. So, I want to address one important sexual conversation folks should have. Because, in my professional opinion, having this conversation with a potential sexual partner might lead to some really great sex.

​I wrote this blog over two years ago and it is by far my most viewed blog. I continue to receive attention for it. I have had both colleagues and the general public reach out to me from around the world because of it. (Hello Canada, hello Australia, hello Hong Kong, and hello Bermuda!) It has been inspiring to see how far it has reached. Members of the general public, mainly wives and girlfriends, consistently say it has helped them gain a new, usually more compassionate, perspective on their husband’s or boyfriend’s “porn problem.” Colleagues have said it has helped them both better conceptualize the issue of a “porn problem” with their individual and couples clients, and they have also referred their clients to read it as a way to further the psychotherapeutic process they are engaged in. I am so happy it has been helpful to so many.

I​ have been a licensed psychotherapist working full-time in private practice for 17 years—and practicing longer than that if you count my time working as an intern therapist at a few agencies and clinics. While I do not keep track of the number of clients I have worked with, it has been a lot. So, I think it is safe to say I have observed a few things about intimate human relationships. While some issues are unique to the couple I’m working with, there are others that are universal to all couples. There are some things I wish I could tell every young (in age or length of relationship) couple at the start of their relationship. 

While I have written about the topic of sexual responsibility before, the issue has been coming up a lot recently with my private practice clients, so I think it is worthwhile not just to revisit the topic but also to take a deeper dive.
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Twice in the recent past, different clients have said the following to me: “We are still processing something you said to us a little while ago.” Of course, this piqued my interest, so I asked what I said that had an impact on them. “You said, ‘An erection is not a call to action.’” Ah, yes.

It's finally here!

As a sex therapist for years now I realized that there was all this talk about the need for porn literacy…yet no one was actually creating such material.  So, after lots of work, I have created an online course called Porn Literacy 101​.

This course is for everyone (not just therapists, although if you are a therapist you are highly encouraged to watch it too, you just won’t get CE’s for it) and is about precisely that: how to think about and relate to porn in a more nuanced, 21st century way.  ​

​One of the more common problems a couple has who seek out a sex therapist like myself is what is clinically referred to as a "low-sex" or "no-sex" marriage. My colleague Barry McCarthy defines a low sex marriage as having sex less than 10 times a year.

What I see commonly happen in sessions is that many partners take this situation personally. They also tend to assume a lot.

Have you ever felt about sex: “I want my partner to want it. Because when they do, the sex for us both is so much better.”
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As a sex therapist, this is a common sentiment in long-term, monogamous relationships and one I hear often (Note: this is different than saying, “I want my partner to want me sexually.” Another topic for another time.) There’s a lot going on in this statement and this is a short space to discuss it, so let’s get to it

In that day’s sex therapy session, the topic was body hair. But the process was about something else entirely. As we like to say in therapy, it is and isn’t about the content—and with this couple, the content was the heated topic of body hair.
Let me first explain some things. Therapy is about both content and process. Content is the what you talk about while process is how you talk about it. Any good therapist understands that powerful and effective therapy involves toggling between content and process, but ultimately, healing occurs on the process level.

In a recent sex therapy session, the client, a heterosexual couple, asked for some help. They had not had sex in a period of time that felt long for them, and so, while both partners were interested in getting back up on that horse, they both expressed some worries. Worries like: what if it feels awkward (it will and that’s OK and most likely will be short-lived); what if he orgasms sooner than he would like (it’s possible and also OK, so how about prioritizing pleasure over performance); and so many other expectations and hopes and fears.

They also asked for specific guidance on how to give feedback, both positive and negative, to each other. This is not the first time I have been asked this by a client. I file this under “sexual relationship skills” which are necessary for any sexually active adult to know.

There is a curious cultural debate happening now. Let me summarize it like this: when it comes to interpersonal interactions, impact trumps intention. Meaning that, regardless of what Person A’s intention was behind what they said or did, the only thing that matters is how their actions impacted Person B. The reasoning for this, as proponents say, is to prioritize the harmed party's pain and the damage caused. This assumes there is a Victim and a Perpetrator, whereby the Perpetrator is harming the Victim. Advocates say only when you prioritize the painful impact can repair happen.

Myself and most of the couples therapists I know disagree with this. Strongly.​

Sex has been a taboo subject for so long that only in the last few decades has there been an ability to research different aspects of it. Comments abound, such as, “Why would you want to research that?” or on finding grants and funding, “Who is going to fund that?” and even personal attacks on the researcher, “Why would you want to study that?” have been barriers. Thankfully, all this is changing. But sex research can create clinical complications for us sex therapists.

I was asked recently, “How long does it take a woman to orgasm?” And I sighed. Because, while this may appear to be a straightforward question to answer from a sex research perspective, it is not a simple or straightforward question to answer from a sex therapy perspective.

I was reminded of this piece of data recently: that self-identified heterosexual women watch and enjoy lesbian porn yet they do not seem to identify as lesbian, bisexual, or even bi-curious. That watching lesbian porn is not incorporated into the women’s sexual identity and they maintain their (presumed) heterosexuality. And the people around them allow them to watch lesbian porn without challenging their sexual identity or orientation. There have been many articles written about why this may be: that mainstream porn provides for the male gaze and that women are allowed more sexual fluidity are the commonly cited reasons. But I believe this is really just an example of an often-overlooked part of a person’s sexuality: one’s erotic interests.