Three labels that overlap
People looking for help with a sexual concern often run into three labels: psychologist, couples therapist and sex therapist. They are not three separate professions. One is a state license, one describes who is in the room, and one describes a specialty. A single clinician can fit more than one of them, and the label alone does not tell you whether someone is a good fit for your concern.
Psychologist
"Psychologist" is a licensed profession. The American Psychological Association explains that psychologists typically spend an average of seven years in graduate education and training to earn a doctoral degree (a PhD, PsyD or EdD), complete a supervised clinical internship, and must be licensed by the state where they practice. It notes that licensure laws are meant to protect the public by limiting licensure to people qualified to practice psychology as defined by state law.
In Michigan, psychology is regulated by the Michigan Board of Psychology and the Department of Licensing and Regulatory Affairs (LARA) under the state's Public Health Code and Psychology General Rules. LARA's psychology page lists separate licensing paths for a doctoral-level Psychologist and for a master's-level Limited Psychologist (LLP), and the LARA website offers a way to verify a licensed professional.
A psychologist's training covers assessment and psychotherapy for a wide range of concerns, and sexual and relationship problems are often part of that work. How much specific training in sexuality a given psychologist has varies, which is one reason to ask.
Couples therapist
"Couples therapist" describes the kind of work a clinician does, not a single license. Psychologists, licensed marriage and family therapists, licensed counselors and clinical social workers may all see couples. Some have specific graduate training in marriage and family therapy. The focus is the relationship itself: the patterns between partners, how conflict and distance build, and how each person's history shapes their reactions.
Many sexual concerns are tied up with the relationship, such as mismatched desire or a cycle of pursuit and avoidance, so couples work and sexual concerns often overlap. Individual or Couples Therapy for a Sexual Concern looks at which format may fit.
Sex therapist
Cleveland Clinic describes a sex therapist as a licensed professional, such as a social worker, physician or psychologist, who has specialized training in sexual health and sexual problems and uses talk therapy to help with the mental and emotional sides of them. Sex therapists may see people on their own or with a partner. Cleveland Clinic stresses that sex therapy sessions involve no physical contact or sexual activity between client and therapist, and that sex therapists do not treat physical conditions such as low testosterone.
What AASECT certification means
The best-known credential in the United States comes from AASECT, the American Association of Sexuality Educators, Counselors and Therapists. AASECT describes its Certified Sex Therapists as licensed mental health professionals trained to provide in-depth psychotherapy who have specialized in treating sexual issues and concerns.
According to AASECT's published requirements, applicants must, among other things:
- Hold an advanced clinical degree that included psychotherapy training, with two years of post-degree clinical experience after a master's degree or one year after a doctorate
- Hold a valid state license or certificate to practice psychotherapy independently in a discipline such as psychology, medicine, social work, counseling, nursing, or marriage and family therapy
- Complete at least 90 clock hours of sexuality education and 60 clock hours of sex therapy training
- Complete at least 50 hours of supervision with an AASECT-certified supervisor, and agree to AASECT's code of conduct
AASECT certification is a professional credential granted by a national association. It is not a state license, and it sits on top of one: a certified sex therapist is also licensed in a profession such as psychology or social work. Many licensed clinicians who help with sexual concerns are not AASECT-certified, and certification is one signal of specialized training rather than the only one.
How to choose
Start with what you need. Some people want a structured, sex-specific approach and prefer a certified sex therapist. Others find the sexual difficulty is woven into anxiety, grief, past experiences or a strained relationship, and want someone who will look at the whole picture. Medical questions belong with a physician first; Who to See for a Sexual Problem maps those roles.
Training is only part of the decision. The American Psychological Association calls good chemistry with your psychologist critical and encourages people to interview potential therapists about their training, clinical expertise and experience with problems like theirs, whether by phone, in a brief consultation or at a first session. Feeling at ease enough to be honest about something as personal as sex often matters as much as the title on the door.
Questions to ask any therapist:
- What is your license, and in which state?
- What training or certification do you have in sexual concerns specifically?
- How often do you work with problems like mine?
- Do you see people individually, as couples, or both, for this kind of concern?
- What does your approach look like in practice?
Dr. Lehmann is a licensed clinical psychologist in Michigan, with a doctorate in clinical psychology and a master's degree in marriage and family clinical psychology. Her therapy for intimacy and sexual concerns is psychotherapy with an insight-oriented, integrative approach, not a certified sex therapy program. If specific sex therapy training matters to you, ask her about her training and approach when you call.