Many times, couples with sexual and general relationship and communication problems have to decide whether to begin with a sex therapist or to begin with a generalist couple therapist, and then switch to a sex therapist.

The thing that people do not understand is that sex therapists are already trained as couple therapists. In my opinion, if you have sexual and general relationship problems, it is best to start off seeing a well-trained sex therapist.

Unless you’re in a situation where you have a discrete sexual problem in the context of an otherwise almost perfect relationship, there’s a lot of overlap between the work that a couple therapist and a sex therapist do.

In my practice, I always give people a questionnaire that assesses how each of them feels about their relationship in general. Part of my process in working with clients is to first assess and unravel all their general issues with power and control, trust, grudges, conflicts over family relationships, love languages, affection or no affection, fighting styles, issues over how much time is spent connecting with each other versus being oriented outside the family, etc. I need all this information to get at some of the more subtle sexual dynamics. For a lot of people, old resentments and feelings about not being valued and understood have a major role in whether they have sexual motivation or sexual desire.

If you start out with a generalist couple therapist who is not trained in sex therapy, you will do a lot of work on the important issues covered in the questionnaire. But the problem is that once you are done with the couple therapist, you will have an issue with knowledge transfer to the sex therapist. There is no way that an hour consultation between the general therapist and your new sex therapist can really impart all of the insights that your old couple therapist has gained into your relationship dynamic.

Essentially, then, going initially to see someone trained in both couples’ and sex therapy makes more sense. You’ll save time, effort, and money.