Roger Libby, Ph.D., L.M.H.C.

Who is Most Qualified to Treat Sexual Problems?

Author: Roger Libby, Ph.D., L.M.H.C.

Posted on September 08, 2017


Sexual issues are addressed by a variety of therapists, but the American Association of Sex Educators, Counselors and Therapists (AASECT)  certified sex therapists and counselors are the most qualified to effectively treat sexual problems. This includes dealing with those who are out of balance or out of control about sex.

A certified sex therapist has a background in sexology, which is interdisciplinary and thorough in diagnosing, studying and treating sexual concerns. Whether a client has low or inhibited desire, orgasm difficulties, pain during intercourse or arousal issues such as E.D. or limited female arousal, a real sex therapist is the appropriate choice to diagnose and treat these and related problems.

Unfortunately, therapists can call themselves sex therapists without certification or training, which leaves consumers confused. Florida is the only exception, but there will be more states passing appropriate laws. There are clear concerns with scope of practice. It is unethical to go beyond one’s scope of practice to address problems a therapist is not qualified to diagnose and treat.

This does not mean that marriage counselors should not deal with sex, but most of them are lucky if they had a course or two in the subject, and if the issue is beyond their understanding, they should refer to a real sex therapist. The AAMFT has been slow to integrate sex and training to deal with sexual issues.

Instead, the American Association for Marriage and Family Therapy (AAMFT) has continued to recognize and even support sex addiction as a valid concept. This is bound to change, but if a discipline is not evidence based, how can we expect valid treatment approaches? By contrast, AASECT has wisely taken a formal position against sex addiction, and the DSM-V soundly rejected both sex addiction and hyper-sexuality because of a lack of empirical verification and conceptual clarity, and to date the ICD has not included sex addiction as a diagnosis either.

Part of the AASECT statement follows: “AASECT 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.”

Every city has plenty of Certified Sex Addiction Therapist (CSAT) counselors, those who claim to be sex addiction therapists. In patient clinics charge $30,000 to $40,000 or more a month to treat Tiger Woods, Anthony Weiner and others deemed to be sex addicts. Armed with 12-step programs, inpatient and outpatient counselors cannot claim this approach is therapy at all. It fails to get at internal locus of control. It does not work. It is not evidence based.

A valid sex therapist usually sees a couple to improve their sex life. Sex addiction counselors are typically not trained to do this. In place of the disease model, sex therapists utilize sex research and Cognitive-Behavioral Therapy (CBT) or a related approach to help couples and individuals. Unlike sex addiction counselors, sex therapists do not shame clients or view sex as pathology.

As I was quoted in The New York Times, it is semantic sophistry to say that a person can be addicted to her or himself. Sex is part of us. Addiction is when there is an external substance such as alcohol or a drug that can cause a dependency.

Many Christian counselors push sex addiction as a way to argue that anything short of monogamous marriage is sinful. Unsuspecting religious clients take it all hook, line and sinker, which leaves them feeling shame, guilt and embarrassment about their supposed addiction to sex.

All of this is a thinly disguised war against sex—particularly lusty and casual sex. Swingers are admonished for being sex obsessed, and those into anything kinky are put down for their weaknesses.

As a sex therapist and couples counselor, I often see couples who first went to a sex addiction counselor, with no relief whatsoever. Similarly, a variety of sex coaches claim to be qualified to treat sexual issues, but their training is meager to none, and they are not licensed. I view this as an "end run" around what it takes to be a valid sex therapist.

It is essential that therapists and counselors be sex-positive rather than sex-negative. I coined the term sex-positive in 1976 with now deceased Unitarian Reverend Ronald Mazur (my 1980 university human sexuality text, Sexual Choices, with Gilbert Nass and Mary Pat Fisher was dedicated toward a sex-positive society), and it is now used and sometimes misused by therapists and others. The sex addiction model is sex-negative with lots of shame and moralizing. A real sex therapist approaches sex from a positive, consensual, equalitarian, informed model that encourages sexual pleasure and enthusiasm with caring and concern.

A balanced therapist needs a sense of humor and a treatment plan that works. Both are more likely with a real sex therapist than a "fake news" approach such as sex addiction!

Roger Libby, Ph.D., LMHC

Dr. Roger Libby is a sexologist and a certified sex therapist with a practice in Seattle and Poulsbo. He has been on The NBC Nightly News and Oprah Winfrey (twice). For three years, he hosted a highly rated (Arbitron) radio show “The Pleasure Dome.” He has given talks at many universities.

A 1964 graduate of WWU, he was a professor at The Univ. of Mass., Syracuse Univ. and the Univ. of Georgia. He is an adjunct faculty at The Institute for the Advanced Study of Human Sexuality in San Francisco.

He is a Fellow of the Society for the Scientific Study of Sex and a Charter Member of the International Academy of Sex Research, and he is board certified by the American Association of Sex Educators, Counselors and Therapists, The American Academy of Clinical Sexologists, The American Board of Sexology and the American College of Sexology.

Dr. Libby is widely published. He co-authored an award-winning college text, Sexual Choices in 1980, which was dedicated “Toward a Sex Positive Society.” He coined the term “sex positive” in 1976. He wrote The Naked Truth about Sex for young adults, and a humor book, Sex from Aah to Zipper, and he hosted the original Better Sex Videos. His TED talk on “We Need a Sex-Positive Revolution” is on his homepage,

Also see Dr. Libby's article "Are You Struggling With What Some Call A Sex Addiction?"


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