As a clinical psychologist who specialises in sex, I'm used to people talking to me about their private lives. Outside of my practice, when people ask me what I do for a living, they often can't resist telling me their own stories. We are so conditioned to think of sex as a taboo topic that hearing my job title often gives them permission to reveal all.
Often they want reassurance that what is happening in their bedroom is normal, and the gap between what they know and what they should know, combined with the fact that 34 per cent of women in the UK are concerned about their desire, is what inspired me to write my new book Mind the Gap.
In my practice, clients often feel that they are bringing something unusual to me, but the reality is there's not much I haven't heard before. It's never a struggle to remain professional as I'm always listening, thinking and considering which therapy technique or bit of science to bring in next.
My office is quite minimalist, with a selection of sofas and armchairs so couples can choose to sit next to each other or apart, depending on how they are feeling. I have plenty of plants and pictures – no nudes though – partly because many people find it hard to make eye contact when talking about sex, so it can be useful for them to have something to look at.
One of the first things I ask a new client is, "How are you feeling about being here?" to get a sense of how uncomfortable they are, so I can adapt my style accordingly. I also make sure I find out more about them because it's important for people to know that you see them as more than the sex or relationship problem they have come with. Often I reassure them that it's difficult for us to talk about sex as it's how we've been conditioned as a society, and that it's my job to help them with that. For many people, talking about sex is not only embarrassing but also involves saying words they've never said aloud. Sometimes I need to give them the language, by saying certain words first, just to get them out there.
Marco* (34), is a recent client. He was struggling to have consistent erections with a partner and was worried that it's connected to his porn habit. It turns out that his problems with erections predate his porn use, but porn has become a stress-free way to enjoy sex and, after relying on it for so long, he's lost confidence in even trying with a partner. Marco has had lots of experience of sex with people he's not that attracted to, and felt pressured to instigate, partly because of preconceptions about masculinity and dating. Marco left his first session with me with reassurance that porn is not the enemy, and with some sex therapy exercises to allow him to practice tuning into his body, and understanding his conditions for good sex.
Jody (26) and Sam (31)* have been together for four years and came to me because they were struggling to maintain their sexual connection since moving in together. They may seem young but most of my clients are in their twenties. In our sessions, Sam described how Jody seems to have "gone off sex". They are getting married this year, but not if this isn't resolved, Sam said. Much of what they need to know is about how desire works and how to maintain it, which is exactly what I write about in my book.
People often say to me, "You're younger/friendlier/more down-to-Earth than I was expecting". I think people have stereotypes of therapy needing to be a difficult or uncomfortable conversation based on what they see on TV, but it really doesn't need to be.
One thing that has changed that is the Netflix show Sex Education which has just been renewed for a third series. I get compared to Gillian Anderson's character Dr Jean F Milburn all the time, which I'm not unhappy about. She is a great example of what sex therapy can be like. Like Jean, I also run "vagina workshops" as well as "erection workshops" and, like Otis, my sons will probably know more about sex than their peers in senior school.
Working with sexual problems is incredibly rewarding due to the complexity of piecing together the picture of physical and psychological influences, and facilitating a problem-solving environment where there may have previously been tension and blame. It's not always serious though, particularly when couples try to illustrate their progress by saying to me "We were having sex and we thought of you ...".
*cases anonymised and amalgamated to protect confidentiality
