Feeling nervous is normal
Most people feel some anxiety before their first appointment, and more so when the subject is sex. The American Psychological Association notes that nervousness about contacting a psychologist is perfectly normal, and that psychologists understand how hard the first contact can be. The ISSM similarly observes that many people find it awkward to talk about sex with a stranger, and that therapists who work with these concerns recognize this and try to help clients feel comfortable.
Before the first session
The first step is a phone call or message. You do not need to explain everything. The APA notes it is enough to say you are interested in knowing more about therapy, and a short description such as "an intimacy concern in my marriage" or "anxiety about sex" is plenty. You can use that call to ask about availability, fees and insurance, and whether individual or couples sessions make sense for your situation.
Dr. Lehmann sees clients at her office in Franklin, in Oakland County, and by telehealth for clients who are located in Michigan at the time of the session. Appointments are during the day, Monday through Thursday. New client paperwork is available on the Forms page, and the APA suggests that a short list of your own questions, plus any medications you take, can help you make the most of the first visit.
The first few sessions
Early sessions are mostly about understanding. Expect questions about what brought you in, how long it has been going on, what you have already tried, your health and any medications, your relationship, and the wider context of your life. The ISSM notes that therapists working with sexual concerns often ask about health and sexual background, sex education and beliefs about sex.
You set the pace. Many people start by talking about the relationship or their feelings in general and come to specifics later. You do not have to describe anything in graphic detail, and you can say "I'm not ready to talk about that yet" at any point. How to Talk About Sex in Therapy When It Feels Embarrassing has more on finding the words.
What therapy for sexual concerns does not involve
- No physical contact or sexual activity between you and the therapist. The ISSM and Cleveland Clinic both state this plainly.
- No physical or genital examination; that belongs with a physician.
- No pressure to share more than you are ready to.
- No judgment about your orientation, relationship, beliefs or experiences.
Cleveland Clinic adds that if anything about therapy ever makes you uncomfortable, you can tell the therapist, stop seeing them, and file a complaint. Speaking up is always appropriate.
How the work unfolds
The NIMH describes psychotherapy as a set of treatments that help a person identify and change troubling emotions, thoughts and behaviors, most often one-on-one with a licensed mental health professional. Within that, therapists differ in how they work. The APA explains that some approaches are more structured, with tasks or practice between sessions, while others focus more on talking, including about earlier experiences, and that many therapists blend elements of several. Some sex therapists, for example, assign private exercises for clients to do at home.
Dr. Lehmann's approach is insight-oriented and integrative. That means looking at personal history, family patterns and current functioning to understand where a difficulty comes from, together with practical feedback and coping strategies for what is happening now. In the context of intimacy, that might include:
- Understanding how stress, mood, past experiences or beliefs about sex feed into the problem
- Noticing the cycle that keeps it going, such as worry, avoidance and distance
- Finding words for needs and fears that have been hard to say
- Practicing ways to talk with a partner about sex without blame
- Making sense of how a medical change has affected confidence or closeness
If a specific structured method is important to you, ask Dr. Lehmann about her approach when you call.
Between sessions
Talking about something long kept private can stir things up. Some people feel lighter after a session; others feel tired or raw for a day or two, or find old memories and feelings surfacing. Both are common, and both are worth mentioning at the next appointment. Many people also notice small changes at home before anything shifts in the bedroom: a conversation that goes a little better, less dread, or a moment of closeness that does not feel loaded.
If you are coming as a couple, it helps to agree not to replay or argue over a session afterward. Bringing a strong reaction back into the room, where it can be talked through with support, usually works better.
Working alongside medical care
Psychotherapy and medical care often work best together. A physician, gynecologist or urologist handles pain, function and medication questions; therapy addresses the emotional and relationship side. With your written permission, providers can share information so their work fits together. Medication changes should always go through the prescriber.
How long it takes
There is no standard length. The ISSM notes that session frequency and length usually depend on the client and the type of problem being addressed. Some people come for a focused stretch around one concern; others find it connects to wider patterns they want to explore. You can talk about goals and progress with Dr. Lehmann at any point, and you are free to pause or stop.
For details on fees, insurance and scheduling, see the Fees & Insurance page and the therapy for intimacy and sexual concerns service page.