Sex Therapy Therapy and Counseling in Michigan

If you’re reading about sex therapy, there’s a good chance something feels confusing, tender, or hard to name—maybe for you, your partner, or your child. Many people carry quiet worry about whether what they’re feeling is “normal,” whether it will ever change, or whether seeking help makes it real. Sex therapy is not about judgment, pressure, or performance. It’s a specialized form of mental health care designed to help people understand themselves, reduce distress, and build safer, more satisfying relationships with their bodies and with others.

What sex therapy supports—and what it isn’t

Sex therapy is psychotherapy focused on sexual health, sexual functioning, intimacy, identity, and relationships. It addresses the emotional, relational, cognitive, and behavioral factors that influence sexuality across the lifespan. A licensed clinician trained in sex therapy helps clients explore concerns with clarity and care, using evidence-based approaches and a trauma-informed lens.

Sex therapy is not sexual coaching, explicit instruction, or anything involving physical contact between therapist and client. Sessions are talk therapy. When exercises are recommended, they are educational or relational practices to explore privately (for example, communication scripts, mindfulness practices, or graded intimacy exercises), always tailored to values, consent, and safety.

Why sexual concerns are often mental health concerns

Sexual symptoms rarely exist in isolation. Anxiety, depression, stress, grief, chronic pain, body image distress, trauma history, neurodivergence, relationship conflict, and medication side effects can all affect desire, arousal, orgasm, and comfort with intimacy. Sometimes sexual struggles are also an early indicator of broader emotional overload or relational disconnection.

Sex therapy makes space for both the practical and the deeply personal: how your body responds, what your mind predicts, what your history taught you, and what your relationships need in order to feel safe and connected.

How concerns can look different across stages of life

Sexual development and sexual wellbeing show up differently depending on age, context, and life transitions. A skilled sex therapist adapts the work to your stage of life—whether you’re parenting a child, supporting a teen, navigating adulthood, or re-learning intimacy after change or loss.

Children: supporting healthy development and safety (without shame)

Parents and caregivers often seek guidance when they feel unsure how to respond to sexual behaviors or questions. Many behaviors in childhood are developmentally typical, yet certain patterns warrant professional support—especially when there are signs of distress, coercion, exposure, or trauma.

• Common caregiver concerns may include persistent boundary-testing, exposure to sexual content, repeated “sexualized” play that doesn’t respond to guidance, or intense shame or fear around bodies.
• Warning signs can include age-inappropriate sexual knowledge, compulsive sexual behaviors, behaviors that are forceful or coercive, significant anxiety about body care, or sudden behavior changes following an event.
• What therapy often focuses on includes body safety education, consent and boundaries, emotional regulation, family communication, and caregiver coaching to respond calmly and consistently.

When children show sexual behavior problems, effective treatment often includes the family. Caregivers are supported in setting clear limits while also offering empathy—reducing fear-based responses that can increase secrecy or shame.

Teens: identity, consent, digital life, and anxiety about “being normal”

Adolescence is a period of rapid brain development, identity formation, and social pressure. Teens may present with confusion about orientation or gender, anxiety about sexual performance or porn-influenced expectations, difficulty asserting boundaries, or distress after unwanted experiences. Others may avoid dating entirely due to panic, sensory sensitivity, or fear of judgment.

• Signs a teen may need support include persistent shame, obsessive checking or reassurance-seeking, drastic shifts in mood related to relationships, self-harm connected to sexuality or identity distress, or fear of intimacy that interferes with daily functioning.
• Therapeutic priorities often include consent education, self-esteem and body image work, healthy relationship skills, coping with social media pressures, and trauma-informed support when needed.

When parents are involved, therapy carefully balances safety and privacy. Teens often need a protected space to speak honestly, while caregivers need enough information to keep their child safe and supported.

Adults: desire, arousal, orgasm, pain, and intimacy after change

Adult concerns range from low desire and mismatched libido to sexual anxiety, erectile difficulties, orgasm challenges, pain with sex, compulsive sexual behaviors, and distress related to identity or relationship agreements. Life events such as childbirth, parenting stress, medical changes, menopause, erectile changes, infertility, grief, or trauma can alter sexual connection in ways that feel sudden and disorienting.

• Common experiences include “I used to want sex, and now I don’t,” “I can’t get out of my head,” “I shut down when we try,” “I feel pressured,” “I can’t orgasm,” or “I feel ashamed of what I want.”
• Clinical red flags can include panic-like symptoms during intimacy, dissociation, flashbacks, chronic avoidance that strains a relationship, or compulsive behavior that causes impairment.

Sex therapy supports the whole person: emotions, health factors, relationship patterns, and the meaning sex and intimacy hold in your life.

Concerns sex therapy commonly treats

People seek sex therapy for many reasons, and it can be helpful even when you’re not sure what the “problem” is yet. Clarifying the concern is often part of the work.

• Desire concerns: low desire, desire discrepancy between partners, desire that feels “shut off” after stress, resentment, parenting, or medical changes.
• Arousal and performance anxiety: difficulty with arousal, erectile challenges, premature or delayed ejaculation, anxiety that leads to avoidance or pressure cycles.
• Orgasm difficulties: inability to orgasm, delayed orgasm, orgasm that feels emotionally disconnected.
• Sexual pain and fear: pain with penetration, pelvic floor anxiety, fear of penetration, conditioned tightening, or pain linked with trauma or medical issues.
• Trauma-related sexual distress: triggers, flashbacks, dissociation, numbness, compulsion, or difficulty trusting.
• Compulsive sexual behavior: repetitive behaviors that feel out of control and lead to distress or functional impairment.
• Identity and values conflict: shame, internal conflict, minority stress, or navigating sexual orientation and gender identity.
• Relationship and communication difficulty: conflict about frequency, interest, pornography, boundaries, betrayal, or differing expectations.
• Life transitions: postpartum changes, infertility, aging, disability, chronic illness, and medication effects.

How a licensed sex therapist approaches assessment with care

Sexual concerns can feel intensely vulnerable, so a strong therapeutic process begins with pacing, consent, and respect. A licensed clinician will gather information in a way that protects dignity and avoids assumptions. Assessment may include:

• Clinical interview: a careful history of symptoms, relationships, stress, mood, trauma, medical factors, and cultural or spiritual values.
• Screening for anxiety, depression, PTSD, and substance use: because these often influence sexual functioning.
• Relationship assessment: communication patterns, attachment needs, conflict cycles, and emotional safety.
• Behavioral tracking: identifying triggers, avoidance patterns, and the thoughts that intensify distress.
• Collaboration with medical care when appropriate: for pain, hormonal concerns, medication side effects, or other physiological contributors.

In some cases, specialized psychological assessment can be clinically useful—such as evaluating obsessive-compulsive patterns (when intrusive sexual thoughts resemble OCD), trauma symptoms, ADHD, or autism spectrum features that may influence sensory experience, communication, or routines around intimacy. The goal is not to label, but to guide a treatment plan that actually fits.

Evidence-based approaches used in sex therapy

Effective sex therapy is often integrative, drawing from well-established modalities while tailoring interventions to your comfort, identity, and relationship structure. Evidence-based approaches commonly include the following.

Cognitive Behavioral Therapy (CBT) for sexual anxiety and unhelpful beliefs

CBT helps identify specific thoughts and predictions that intensify sexual distress: fears of failure, catastrophizing, rigid “shoulds,” or internalized shame. Treatment may involve cognitive restructuring, exposure to feared sensations or situations in gradual steps, and skills for shifting attention away from performance-monitoring.

• Helpful for: performance anxiety, avoidance, shame-based beliefs, intrusive worries, body image concerns.
• What it can look like: learning to notice the moment anxiety spikes, practicing new self-talk, and building a stepwise plan that restores confidence without pressure.

Dialectical Behavior Therapy (DBT) skills for emotion regulation and boundaries

DBT skills can be essential when sexual distress is tied to intense emotions, impulsivity, dissociation, self-harm urges, or destabilizing relationship conflict. Clients learn distress tolerance, mindfulness, interpersonal effectiveness, and emotion regulation.

• Helpful for: high-conflict cycles, trauma-related overwhelm, compulsive patterns, difficulty saying no, or difficulty asking for needs.

Trauma-informed therapy for reclaiming safety

When sexual concerns are connected to trauma, treatment prioritizes safety, choice, and stabilization. The pace is collaborative, and the focus is on helping the nervous system learn that the present is different from the past. Trauma-informed approaches may include grounding skills, parts work, or carefully paced trauma processing when appropriate.

• Helpful for: triggers during intimacy, dissociation, fear responses, numbness, or shame rooted in past experiences.

Mindfulness-based and somatic strategies for reconnecting mind and body

Many sexual difficulties are maintained by disconnection from bodily cues—either through anxiety-driven overthinking or trauma-related shutdown. Mindfulness-based interventions help clients notice sensations without judgment, improve present-moment focus, and reduce “spectatoring” (watching oneself perform).

• Helpful for: low desire, orgasm difficulty, anxiety during sex, chronic tension, and stress-related shutdown.

Attachment- and relationship-focused therapy for intimacy and repair

When sex is strained, it often mirrors deeper relationship needs: feeling chosen, safe, respected, or emotionally close. Couples or relationship therapy may focus on repair after conflict, renegotiating expectations, strengthening friendship and affection, and addressing resentment or emotional withdrawal.

• Helpful for: desire discrepancy, conflict about initiation, navigating parenting stress, rebuilding trust, and improving communication.

Sex therapy-specific interventions and sensate focus (graded intimacy)

Sex therapy often includes structured, non-demand intimacy exercises that rebuild connection and reduce pressure. These are not “assignments to have sex.” They are usually stepwise, consent-based practices that help partners re-learn touch, communication, and arousal without performance goals.

• Helpful for: anxiety, pain-related fear, avoidance cycles, and reconnecting after long periods of disconnection.

What it feels like to do the work: the therapeutic process in real life

Sex therapy is often a blend of relief and vulnerability. Many clients feel a surge of hope simply from speaking openly with someone trained to respond without shock or judgment. At the same time, discussing sex can stir grief, anger, embarrassment, or fear. A good therapist will normalize these feelings and help you move at a pace that is challenging but not overwhelming.

Therapy sessions may include education about sexual response, exploration of identity and values, communication coaching, and skills practice for anxiety management. You may develop a plan for talking with a partner or co-parent, boundaries around digital content, or ways to rebuild trust after ruptures. If you’re working as a couple, the therapist will help each person feel heard while also protecting the relationship from blame and escalation.

When parents and caregivers are part of sex therapy support

For minors, caregivers are often essential to progress. Therapy can help adults respond to sexual development with steadiness rather than fear, and to create a home environment where kids and teens can ask questions safely. Depending on age and clinical needs, sessions may include:

• Caregiver coaching: how to set boundaries, supervise appropriately, and talk about bodies, consent, and privacy.
• Skill-building for the child or teen: emotional regulation, impulse control, social skills, and safety planning.
• Family communication: reducing secrecy and shame while maintaining healthy limits.

Caregivers often need support for their own emotional reactions, too—shock, guilt, fear, or anger can be intense. A strong therapeutic approach makes room for these feelings while keeping the focus on safety, accountability, and developmentally appropriate education.

How sexual concerns ripple into daily life, relationships, and family dynamics

Sexual distress can quietly shape a household. Adults may become irritable, withdrawn, or preoccupied. Partners may fall into painful patterns: one reaches while the other avoids, one feels rejected while the other feels pressured. Over time, ordinary affection can feel risky because it might “lead to something,” and both people may start protecting themselves instead of connecting.

For parents, the impact often shows up as depleted patience, conflict about values, worry about a child’s future, or fear of “saying the wrong thing.” When a teen is struggling, caregivers may feel shut out or unsure when to intervene. Sex therapy helps families and couples name these patterns compassionately, so intimacy and safety stop feeling like competing priorities.

What to look for in a qualified sex therapy clinician

Because sex therapy requires specialized training and a steady, nonjudgmental presence, it’s worth choosing a clinician carefully. Consider looking for:

• Licensure and scope of practice: a licensed mental health professional who provides psychotherapy.
• Specialized training in sex therapy: coursework, supervision, and experience with sexual health concerns across diverse identities and relationships.
• Trauma-informed competence: the ability to recognize trauma responses and prioritize nervous system safety.
• Comfort discussing sexuality directly and clinically: clear language, strong boundaries, and respect for consent.
• Collaboration: willingness to coordinate with medical providers when needed, especially for pain, hormonal issues, or medication side effects.

You also deserve a therapist who can work within your values—whether your goals are to increase desire, reduce anxiety, heal after trauma, clarify identity, rebuild trust, or create a relationship agreement that feels honest and sustainable.

Common fears that keep people from getting help

Sexual concerns are often treated as private burdens. Many people wait years before reaching out, not because the problem is small, but because the shame feels so large.

• “My concern isn’t serious enough.” If it’s affecting your wellbeing, it’s worth support.
• “The therapist will judge me.” A trained sex therapist expects a wide range of experiences and responds clinically, not morally.
• “If we talk about it, it will get worse.” Avoidance often strengthens anxiety. Gentle, structured conversations typically reduce distress.
• “This is just how relationships are.” Long-term intimacy does change, but ongoing pain, fear, or disconnection can be treated.

Reaching out for sex therapy is often an act of protection—of your mental health, your relationship, and your ability to live with more ease in your own body.

If you’re ready to move from uncertainty to clarity, you don’t have to do it alone. A licensed sex therapist can help you name what’s happening, reduce shame, and build practical steps toward safety and connection—at a pace that respects your boundaries and values. Find a therapist near you.