About Sex Therapy

Sex matters. Good sex makes you feel good about yourself and your partner. When sex isn’t good, other aspects of your relationship may suffer. Sex finds us at our most vulnerable, and sexual problems can be extremely discouraging.

The decision to consult with a professional about a sex or relationship problem is never made lightly. It’s often filled with uncertainty, since it involves communicating your deepest concerns to someone you hardly know.

Finding an AASECT-certified sex therapist in NYC with the right experience and credentials isn’t easy. People coming for a first appointment usually wonder, “Is this the right person to help me? Does he have the right skills? How will I know?”

Over the last 25 years of practice in Manhattan, I have developed new and better approaches to sex therapy and sex counseling for menwomen, and couples. I offer brief consultations as well as longer-term treatment. I’ve helped over 1,500 individuals and couples improve their sex lives and relationships, and I can’t imagine any more fulfilling kind of work.

Unlike most sex and couples therapists, I am also an M.D.  This can be important because sexual issues often involve both the mind and the body.  I am often asked to consult in situations where both therapy and medication may need to be considered, or where therapy or medications may have had adverse effects.


Getting Started With Sex Therapy

Viewing a website is no substitute for an in-person consultation. But this website will get you started. Browse through it and you’ll learn some basic things about how I work.

There’s a search function in the upper right corner of this page, which you can use to find pages or articles that deal with your specific concern.  Please also see Frequently Asked Questions  for more information about my approach to sex and relationship counseling.

Everyone is nervous on a first visit. I understand how sensitive this subject is, and I have many years of experience helping people feel more comfortable expressing themselves.  Call me or email me to discuss what you need, and how I might be able to help.

All services are self-pay. I don’t participate with any insurance plans or Medicare. I will provide you with an insurancecompatible billing statement  to submit to your insurer for reimbursement.  You may want to check with your insurance company to determine how outpatient mental health care is covered, and what if any pre-authorization is needed.


What Is Sex Therapy?

Sexual feelings are something of a mystery to most people. An important part of sex therapy is learning how to communicate effectively about what’s really going on in your sexual mind.  

Many people think that sex therapy consists of  behavioral “homework assignments” for individuals and couples to do at home. That’s the way Masters and Johnson practiced when they invented the field 50 years ago.  But what’s more central for most sex therapists nowadays is to understand how each person’s erotic mind works. Few sex therapists these days consider ‘homework” to be as crucial.

Ever since Freud discovered that psychological symptoms in adults are often linked to childhood experience, there’s been a tendency among psychotherapists to go hunting in a person’s early life in search of the keys to their adult problems. But the therapeutic results of this kind of “uncovering” therapy are often disappointing.

We shope springsex therapists often refer to the original sources of sexual problems (for example, a harshly critical mother) as “remote causes.” Remote causes can be extremely important if they get in the way of treatment, but they’re not where sex therapy starts.

Instead, sex therapy starts with what’s called “immediate causes” — things people do in the here-and-now that get them in trouble sexually. Common examples include:  preoccupation with negative self-talk, cutting foreplay short in order to hurry penetration, or  making love when one is really not very aroused. A big part of the first consultation with an individual or couple is often taken up with searching for immediate causes.

Many common sexual problems are due to ignorance. Most individuals and couples don’t know, for example, that sexual response is part of the relaxation response. Or that a certain kind of passionate selfishness in bed tends to be more erotic than simple generosity.  Or that orgasm is the usually the least important part of sexual response.  Sex therapy gives individuals and couples the opportunity to discover those things for themselves.

Most people find it weird to think about or talk about sex. But after someone does learn to talk about sex, they often find the skill very useful and gratifying in the bedroom.

Sex therapy has to take account of the fact that men and women tend to be different. Both men and women have brains and minds, but only one has a penis and only one has a vagina.  Neither men nor women have any idea really what it’s like to be the other gender.  We’re all ultimately just using our imaginations.  

In addition to the obvious anatomical differences, men and women tend to be quite different in their sexual feelings. Gender differences in the erotic realm are the subject of endless debate at sex therapy meetings. But whether due to nature or nurture, I think it’s safe to say that differences in sexual feelings are among the ways that men and women most differ the most  from each other psychologically.

Women tend to be more mindful of whether they feel attractive or not, and to get a greater erotic charge out of feeling sexually desired. Men tend overall to be more sex-positive, and women to be more sex-neutral (unless they’re in the “limerent” stage of a new relationship). And women have an overall greater tendency to seek professional help. (I’m frequently called by women asking for help for their male partners, but rarely the other way round).  

Of course there are exceptions to all these generalizations. Many people are “gender-benders” in ways large or small, and such differences from the average can be extremely important.  

Sex is perhaps the realm of human life where the mind and body are most intimately linked.  How you feel in bed is likely to be immediately registered in your body’s arousal response (or lack of it).

The body is as honest as a young child. The sexual body never learns how to lie. Sex has to be simple and straightforward, or else it doesn’t work.  All the subtleties and complexities, and all the stories we tell each other about ourselves, count for very little in bed. The body knows no such subtleties. It only knows whether something feels good or not.

    CBS This Morning 8 5 13 Jackson still of Snyder 450 pixelThe main reason anyone comes to see a therapist of any kind is because they’re in emotional pain. But there’s something about sexual problems that makes people feel particularly discouraged and alone. Sexual difficulties make people feel very bad about themselves.

The sexual self is ordinarily rather immature and lacks frustration tolerance.  As a consequence, sex therapy differs from traditional psychotherapy in that it must be results-oriented from the start. 

A sex therapist should give couples tools that they can use right away. The negativity that accompanies sex problems can take months or years to go away. But if a person or couple sees practical results quickly, this can give them inspiration for the road ahead.

When an individual or couple comes to see me for the first time, I assume they’ve done everything else they could think of to solve the problem. It’s extremely important that a patient or couple leave my office after a first session with a greater sense of hope—having learned at least one thing they didn’t know before, and feeling eager to learn more.

For this reason, I generally set aside an hour and a half for a first consultation. Sexual problems tend to be complex. I almost always find I need lots of time to hear about the problem, time to ask question, and finally time to give an individual or couple feedback and to introduce what I think are likely to be the best strategies for improving things.


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