Welcome to Ask a Cleveland Sex Therapist. Want to ask Matt a question that could be tackled in a future column? Click here. Now, onto this week’s topic.
Hey Matt,
I am curious about what makes sex therapy different from working with another therapist. I assume you work more with sex, but do you also work with other mental health issues like depression and anxiety?
Sex therapy is such an interesting field. Most people have absolutely no idea what I do. While yes talking about sex is a central part, a lot of what I am doing is very similar to my professional peers who don’t have my specialty. Interestingly, I have had some people ask if I have sex with my clients and that always shocks me because how one makes that sort of logic jump really shows that the moment you put the word sex in front of therapy, people assume all ethics somehow go out the window. I am not here to turn you also into sex-crazed freaks, intent on taking over the world (unless you want that). A lot of the work I do is similar to what other therapists do: create insight, reduce shame, and hopefully empower the people who come into my office. One of the main differences between me and your regular therapist is my training. So, for today’s post, let’s talk a little bit more about when you should enlist someone like me, a sex therapist.
As a Licensed Professional Clinical Counselor and Supervisor, I am trained to work with most mental health concerns (e.g. depression, anxiety, identity, relationship issues, grief, stress, and the many emotional and psychological experiences that show up in everyday life). Sex therapy is not a separate kind of therapy; it is a specialization within therapy. So yes, I work with the same mental health issues you’d bring to any therapist, with the additional training and competence to address the sexual, relational, and intimate areas of your life that most clinicians were never educated in. If a client comes to me and she is depressed because she has difficulty orgasming, I don’t just teach her techniques to help her achieve one, I unpack the potential sadness and hopelessness as well.
I believe one of the most important aspects about being a therapist is knowing your competency areas. I will be the first to tell you that if you’re looking to do some deep trauma work, or want to work on your substance use concerns, I’m not the right person for that. I have some basic training, sure, but I would never take a client into unpacking those experiences because doing so outside my scope would be unethical. When it comes to sex, most therapists receive little to no formal training in it. I remember having a course in graduate school called, “Human Sexuality,” and I thought it was cool and informative, but that I would never use it. You see, I was also stuck in the trap of sex negativity and assumed talking about sex with a client would be too invasive. Once I became licensed, I found the American Association of Sexuality Educators, Counselors, and Therapists, and underwent the extensive training that allows me to call myself a specialist in the field, today.
When people ask what makes sex therapy different, they often imagine it’s just “talking about sex.” While that’s certainly part of the work, it’s only a fraction of what actually happens in the room. Sex therapy is about exploring the following: intimacy, connection, desire, communication, embodiment, shame, identity, relational patterns, and the stories we’ve inherited about who we’re allowed to be as sexual beings. One of the most common reasons people reach out is because something in the bedroom has shifted. Desire changes, novelty fades, stress comes crashing in, and suddenly sex feels pressured or nonexistent. Arousal and desire are not linear, they ebb, flow, stall, and reignite throughout the lifespan. Sex therapists are trained to understand these dynamics and help people reconnect with them. We normalize what people think is “broken,” explain the real science behind desire, and help couples, individuals, and polyamorous folx create new ways of experiencing connection.
Sexual concerns like pain, difficulty with arousal, orgasmic challenges, erectile struggles, or changes in desire are far more common than people realize. Although the DSM has a list of “sexual dysfunctions,” I detest the language because it implies there is one correct way a body should function. Bodies are diverse and ever-changing. My job is to help people understand what they’re experiencing, collaborate with medical providers when necessary, and create a shame free place to explore what might actually be happening.
Another major component of the work is sex education. Most people received abstinence-only messaging, religious shame, or a brief, confusing lecture in middle school. I have mentioned this before, but I truly do not remember any sex education coming from my grade school (St. Ann School) or high school (St. Edward High School). Many adults are left piecing together information from porn, the internet, or social media, and understandably feel lost (NoFap is something, for goodness sake). Part of sex therapy is helping people rewrite what they were taught, challenge the sex negativity they absorbed, and create a healthier, more grounded understanding of intimacy and pleasure. This is especially true for my queer clients, people raised in purity culture, or anyone who grew up without affirming information (so, most of us).
Outside of shame being one of the biggest issues plaguing my clients, exploration of kink is also incredibly common. Everyone has kinks. Yes, everyone. They might be subtle, like enjoying hair pulling or talking dirty, or they might be more structured, like rope play or power dynamics. Kink is one of the most misunderstood areas of sexuality, and many people fear that their desires mean something is “damaged” about them, but that couldn’t be farther from the truth. Sex therapy helps people understand that consensual exploration is healthy, normal, and often deeply connective. As long as it’s safe, consensual, and grounded in communication, there is nothing pathological about kink.
This isn’t an exhaustive list by any means, but one of the last areas I help clients with is consensual non-monogamy (CNM) and polyamory. While monogamy is amazing for some, it is not for everyone. Our culture teaches toxic monogamy scripts that many people don’t even realize they’ve internalized (e.g. ideas about ownership, jealousy, control, or what a relationship “should” look like). For clients exploring polyamory, open relationships, or solo poly structures, I provide education, tools, and a nonjudgmental understanding of what these relationship styles actually entail. Competent support is crucial here because not all therapists understand CNM, and many unintentionally shame or pathologize their clients.
As I wrap up, I want to drive home one point: as an AASECT Certified Sex Therapist, my work is grounded in a core ethical responsibility to do no harm. Not every therapist is trained, or should be trained, to unpack the complexities of human sexuality with their clients. Through my specialty and lens, I can, and truly love what I do. This is the work I’m trained for, and it’s the work I show up for every day. So, if you’re curious, confused, feeling stuck, or simply want a healthier relationship with your sexual self, don’t hesitate to reach out to me or anyone on my team for a consultation. We are here to help.
Matt Lachman is a Licensed Professional Clinical Counselor and Supervisor, AASECT Certified Sex Therapist, and owner of Cleveland Sex Therapy, located in the heart of Gordon Square. Since opening Cleveland Sex Therapy in 2019, Matt has been dedicated to promoting sex positivity and inclusivity in his work with individuals, couples, and polyamorous relationships. When he’s not helping clients navigate their sexual and relational journeys, you can find him enjoying a cold brew at Gypsy Beans, sipping a cocktail at Luxe, or relaxing on his couch watching reruns of Happy Endings. Ask a question of your own here.
Disclaimer: The advice provided in this column is intended for generalinformational purposes only and should not be considered a substitute for professional therapy or mental health treatment. Each individual’s situation is unique, and the insights offered here may not address the complexities of your specific circumstances. If you’re experiencing challenges related to your mental health, relationships, or sexuality, I strongly encourage you to reach out to a licensed therapist or mental health professional for personalized support. You’re not alone—help is available.
Subscribe to Cleveland Scene newsletters.
Follow us: Apple News | Google News | NewsBreak | Reddit | Instagram | Facebook | Twitter | Or sign up for our RSS Feed