What Is Psychosexual Therapy?

What Is Psychosexual Therapy?

Psychosexual therapy is a specialist form of psychological therapy that addresses sexual difficulties which have a psychological, emotional, or relational component. It is a distinct clinical discipline, separate from general counselling or psychotherapy, delivered by therapists with specialist postgraduate training and professional registration with the College of Sexual and Relationship Therapists (COSRT) — the UK's professional body for sexual and relationship therapy.

Sexual difficulties are common and can arise at any stage of adult life. They may be lifelong or acquired — present from the start of sexual experience or developing after a period of satisfactory sexual function. They may be situational (occurring only in certain contexts or with certain partners) or generalised. The BACP and COSRT both recognise that sexual difficulties rarely have a purely physical cause; psychological, relational, and contextual factors are almost always involved to some degree.

Psychosexual therapy does not involve any physical contact or examination. Sessions are fully clothed and take place in a standard consulting room. This is frequently misunderstood, and clarifying it at the outset is important: psychosexual therapy is talking therapy applied to sexual difficulties, not a physical treatment.

Raymond holds COSRT registration — the specialist credential for psychosexual therapists in the UK. COSRT registration requires specific postgraduate training in psychosexual and relationship therapy, ongoing supervision, and continuing professional development. When seeking psychosexual therapy, COSRT registration is the appropriate credential to look for, rather than general counselling or psychotherapy qualifications alone.

What Issues Does Psychosexual Therapy Address?

Psychosexual therapy addresses a wide range of sexual difficulties in individuals and couples. The common feature is that the difficulties have a psychological, emotional, or relational component — which is true of the vast majority of sexual difficulties, even those with an underlying medical contributor.

• Erectile difficulties — problems achieving or maintaining erection, whether lifelong or acquired
• Premature or delayed ejaculation — difficulties with ejaculatory timing that cause distress
• Low sexual desire or desire discrepancy — either partner experiencing reduced interest in sex, or a significant mismatch in desire levels between partners
• Vaginismus — involuntary contraction of the vaginal muscles preventing penetration, whether during intercourse or medical examination
• Dyspareunia — pain during sexual activity, where medical causes have been investigated
• Orgasmic difficulties — difficulty achieving orgasm, or significant changes in orgasmic experience
• Sexual performance anxiety — anxiety about sexual performance that disrupts sexual functioning
• Impact of trauma on sexual functioning — difficulties with intimacy, arousal, or safety in sexual contexts following sexual trauma or abuse
• Relationship-based sexual difficulties — differences in sexual preferences, desire, or experience that are creating relational tension
• Identity and orientation exploration — therapeutic support for questions around sexual identity or orientation

How Does Psychosexual Therapy Work?

Psychosexual therapy combines three main elements: talking therapy, psychoeducation, and, where clinically appropriate, structured behavioural exercises.

The talking therapy component explores the psychological and relational context of the sexual difficulty — its history, associated thoughts and feelings, relationship dynamics, any past experiences that may be relevant, and the meaning the difficulty carries for the individual or couple. This is not a mechanical process; it draws on the same relational and exploratory approach used in high-quality counselling and psychotherapy.

Psychoeducation provides accurate, clinical information about sexual anatomy, physiology, and response cycles where gaps in knowledge or misinformation are contributing to the difficulty. Many sexual difficulties are maintained by unrealistic expectations or misconceptions — for example, about what constitutes normal sexual function, or what physical arousal actually involves. Accurate information delivered in a non-judgemental therapeutic context can itself be significantly therapeutic.

Structured behavioural exercises — most commonly a programme based on sensate focus, developed by Masters and Johnson — may be introduced where clinically appropriate. Sensate focus is a graduated programme of physical exercises conducted by the individual or couple between sessions, designed to reduce performance anxiety, rebuild physical awareness and connection, and gradually reintroduce pleasurable sexual activity without the pressure of performance goals. The exercises are discussed and agreed in the session before being undertaken, and are reviewed in the following session. They are not compulsory and are introduced only where they are clinically indicated and both parties have fully consented.

BACPand COSRT guidelines emphasise that psychosexual therapy must be conducted within a framework of informed consent, professional boundaries, and clinical supervision. This means your therapist will not proceed with any element of the work without your clear agreement and understanding of what is involved.

What to Expect in a Psychosexual Therapy Session

The first session of psychosexual therapy is an assessment session. Your therapist will take a detailed history — including the nature and history of the sexual difficulty, your relationship situation, relevant medical history, and any prior treatment. This may feel like a clinical interview in its structure, but it is also the beginning of a therapeutic relationship, and your therapist will work to create a warm, professional, and non-judgemental space from the outset.

The assessment session also gives you the opportunity to ask questions about the therapeutic approach, how sessions are structured, what exercises might be involved, and anything else you want to understand before deciding to proceed. There is no expectation that you will commit to a full course of treatment on the basis of a single session.

Subsequent sessions are typically 50 minutes. The frequency is usually weekly in the early stages of treatment, though this may adjust as the work progresses. Sessions involve open discussion of your experience — how you have been feeling, what has arisen between sessions, any exercises undertaken, and the psychological and relational themes that your therapist identifies as relevant to the difficulty.

Confidentiality is maintained throughout. Nothing discussed in sessions is shared with your GP, partner, or any third party without your explicit consent, except in the limited circumstances defined by professional ethical guidelines (such as a serious risk of harm). Your therapist will explain the limits of confidentiality clearly at the outset.

Both individuals and couples are seen. Individual sessions focus on the individual's experience, history, and psychological relationship with their sexuality. Couples sessions address the relational dimensions of the difficulty alongside individual factors.

Who Can Benefit from Psychosexual Therapy?

Psychosexual therapy is appropriate for any adult experiencing a sexual difficulty that is causing them distress or affecting their quality of life or relationship, regardless of age, gender, sexual orientation, or relationship status.

Both individuals and couples can benefit. Some sexual difficulties are primarily individual — rooted in personal history, psychological patterns, or individual physiology — and are most effectively addressed in individual therapy. Others are primarily relational — shaped by the dynamics between two partners — and benefit from couples-based work. Many involve both dimensions simultaneously.

Where a sexual difficulty may have a medical or physiological contributor, a GP assessment is a sensible first step. Erectile difficulties, for example, can be associated with cardiovascular disease, diabetes, or hormonal factors, and these should be investigated medically. Psychosexual therapy and medical treatment are not mutually exclusive — they often work well in parallel — but identifying any medical factors first allows the therapeutic work to proceed on an accurate foundation.

Psychosexual therapy is conducted within COSRT and BACP professional frameworks, which means it is delivered within a structure of ethical guidelines, clinical supervision, and continuing professional development. You should expect your therapist to be professionally registered, to practise within clear ethical boundaries, and to be open about their qualifications and professional affiliations.

Psychosexual Therapy vs Relationship Counselling

Psychosexual therapy and relationship counselling are distinct but overlapping disciplines. Understanding the difference can help you identify the most appropriate form of support.

Relationship counselling — or couples therapy — focuses on the relationship system: communication patterns, conflict, attachment, trust, and the dynamics between two partners. Sexual difficulties may arise as a topic within couples therapy, but the primary focus is the relationship as a whole, and the therapist may not have specialist training in psychosexual assessment and treatment.

Psychosexual therapy focuses specifically on sexual functioning and satisfaction. A COSRT-registered psychosexual therapist has specialist postgraduate training in sexual difficulties, their psychological and physiological mechanisms, and the structured assessment and treatment approaches specific to this area. Where a sexual difficulty is the primary presenting concern, a specialist psychosexual therapist is the more appropriate referral.

In practice, psychosexual therapy almost always addresses relational dimensions alongside the sexual difficulty itself — particularly where both partners attend. The two disciplines are complementary, and it is not uncommon for a couple to be engaged in both general relationship counselling and psychosexual therapy either simultaneously or sequentially, depending on the nature of their presenting difficulties.

The key practical distinction when seeking help: if the primary concern is a specific sexual difficulty, seek a COSRT-registered psychosexual therapist. If the primary concern is the relationship more broadly, relationship counselling may be the more appropriate starting point, with psychosexual therapy introduced if specific sexual difficulties become the focus.

Summary

Psychosexual therapy is a specialist clinical discipline addressing sexual difficulties with psychological or relational components. Delivered by COSRT-registered therapists, it combines talking therapy, psychoeducation, and structured exercises within a professionally supervised, ethically grounded framework. Sessions are fully clothed and office-based. Both individuals and couples are seen.

A typical course is 8–16 sessions. The approach is evidence-based, governed by BACP and COSRT professional standards, and appropriate for a wide range of sexual difficulties across all ages, genders, and orientations.

If you are experiencing a sexual difficulty that is causing you distress or affecting your relationship, contact Raymond to arrange a confidential initial consultation. Raymond holds COSRT registration — the UK specialist credential for psychosexual therapists. The first session is an assessment and an opportunity to ask questions; there is no obligation to proceed beyond it.