Both formats are common
There is no single right way to bring a sexual concern to therapy. The ISSM notes that some people attend sessions for sexual difficulties alone while others bring a partner. Its guidance on orgasm difficulties mentions counseling either alone or with a partner, and the NIDDK notes that a counselor working with erection problems may ask a partner to join sessions for support.
The American Psychological Association suggests asking yourself, before choosing a therapist, whether you want to work on your own, with your partner, or with family. For sexual concerns, that question usually turns on where the difficulty seems to live and who is ready to take part. This article applies that question to intimacy specifically; for relationship concerns in general, see Individual Therapy vs. Couples Therapy.
When individual sessions may fit
- You are single, dating, or between relationships
- The concern feels deeply private, such as shame, body image, or questions about orientation or faith
- Past experiences, including sexual trauma, are part of the picture and you want room to go at your own pace
- Anxiety, low mood or stress seem to be driving the difficulty
- You want to understand your own feelings before raising them with a partner
- Your partner is not willing or not ready to come
Individual therapy is not a lesser option. Changes in one person, such as less anxiety, clearer words for what they want, or less shame, can shift the dynamic in a relationship even when only one partner attends. When Your Partner Won't Come to Therapy About Sex looks at that situation.
When couples sessions may fit
- The difficulty mainly shows up between you, such as a long-running difference in desire
- A cycle has formed: one partner initiates and feels rejected, the other avoids and feels pressured
- Conversations about sex end in hurt, silence or the same argument
- Trust has been damaged, for example after an affair
- One partner's medical or physical change has affected both of you
- Both partners want to work on it and can speak honestly without fear
The ISSM suggests that when a desire difference is a consistent issue, it can help to consult a therapist who specializes in sexual issues or in couples therapy. In couples sessions, the focus is the pattern between partners rather than one person's "problem," which many couples find a relief. Both people get to describe their experience, and the therapist is not on either side.
Combining the two
Formats can change as the work goes on. Some people begin individually, then invite a partner in once they feel clearer. Some couples find that one partner benefits from separate support for something personal, such as grief, anxiety or a past experience, alongside the couples work. Others start as a couple and later continue on their own. How a therapist handles these combinations varies, so it is a good question to ask at the start. It also helps to agree with your partner on what each of you is hoping for, since one person may want fewer arguments while the other wants more closeness, and both goals deserve room.
Questions to help you decide
If you are unsure, a few questions can clarify where to start:
- If I imagine talking about this with my partner in the room, do I feel relieved, or do I hold back?
- Is this mostly about my own history and feelings, or mostly about what happens between us?
- Is my partner asking to work on this too, or would they be coming reluctantly?
- Is there anything I am not ready for my partner to hear yet?
- Do we both feel safe disagreeing with each other?
There are no wrong answers. Mixed feelings are common, and a therapist can help you sort them out in a first conversation.
When couples sessions are not the right place
Couples work depends on both people being able to speak freely. If you feel pressured, guilted or forced into sex, or you are afraid of how your partner will react to what you say, start with individual support. The National Domestic Violence Hotline describes sexual coercion as ranging from persistent pressure and guilt to force, and lists making someone feel they owe sex because they are in a relationship as one example. Your safety, and your right to say no, come first.
What to ask when you call Dr. Lehmann
Dr. Lehmann is a licensed clinical psychologist who sees adults for individual therapy and partners for couples therapy, in her Franklin office or by telehealth for clients located in Michigan at the time of the session. Intimacy and sexual concerns can be part of individual therapy or couples therapy, as described on the intimacy and sexual concerns service page.
Which format fits depends on your situation, so the simplest step is to ask Dr. Lehmann when you call. A brief description is enough: whether you are in a relationship, whether your partner wants to be involved, and what you would most like to change. If you would like to know how she handles moving between individual and joint sessions, or how couples sessions are scheduled and billed, ask about that too.