Sex-ist: Sex Therapy 101
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Sex-ist: Sex Therapy 101

We talk with a sex therapist about what it takes to resolve people's most intimate concerns.

Each month, Sex-ist looks at topics relating to sex and sexuality in and around the GTA

couple therapy

We have a pretty cut-and-dried relationship with our bodies. If you break your leg, you would see a doctor. If you can’t get an erection, that same doctor might give you a little blue pill. But what if the problem doesn’t stop there? What if those little blue pills cause you some angst or anxiety? What if they make your partner feel sad or uncomfortable? You might want to call up your friendly neighbourhood sex therapist.

Joan Marsman is such a therapist. She’s been practicing family and marriage counselling for thirty years, and at 55, she’s utterly comfortable working with clients on topics as diverse as BDSM, pain during intercourse, and sexually transmitted infections. She handles the emotional element of sexual problems, working towards “tools and strategies” to help people get the most pleasure out of their sex lives. A typical round of treatment for a couple might take eight to twenty bi-weekly sessions, and Marsman also sees an equal number of single men and women.

Marsman began her sexual counselling career by working with pregnant teens. “I was brought in, at that time, to do what they call reduce recidivism, which was basically ‘don’t let them get pregnant again.’ My job was to work with these young women, do some counselling, introduce sexuality to them,” Marsman explains. She worked at Planned Parenthood for nearly a decade, leaving in 1991 when she realized that wouldn’t ever be able to work with anyone older than 25. She’s still a member of the planning committee for the Guelph Sexuality Conference, and a member of the Board of Examiners in Sex Therapy and Counsellors in Ontario, a professional association for therapists.

Our interview with Marsman—about the difference between a doctor and a sex therapist, how Ashley Madison has changed her work, and the importance of Meet the Fockers—is below.

Torontoist: How did you get interested in sexuality as a topic? What made you decide to launch your own practice?

Joan Marsman: I haven’t been able to find any deep, dark reason. It’s fun, it’s interesting. I come from a time when sexuality was very repressed. A good friend did become pregnant in high school, and I saw how poorly she was treated. I was a budding feminist. I wanted to help people, and I was certainly going in that direction. I was raised in a home with very traditional values around mens’ and womens’ roles, and I wasn’t happy about that. I thought my brother should do the dishes too. In little ways, I was a little bit angrier, and a little bit pissed off about some of the gender constrictions. If I was going to reach for a way of busting out, why not go for sex? Nobody wants to talk about that. When I moved to the University of Guelph, I was like, Really? You can take courses in human sexuality? Sign me up!

There are really no jobs for sex therapists, so if you want to work in this field, you pretty much have to be in private practice. It was convenience as a new mom to develop a practice. I had young children, and I could stay home and make money and be very family-based. If I wanted to do this kind of work, I was going to have to figure it out myself.

What kind of issues do you cover in your practice? What’s the spectrum, and what types of things do you see most often?

The gamut of traditional sex therapy would be pain issues, such as pain with intercourse—I specialize somewhat in that; orgasm difficulties; erectile difficulties; lack of sexual desire, which is huge; desire discrepancies between couples; affairs are big.

It’s changed. Nowadays, a lot of it is about desire, and concern that one partner is not interested in sex. Affairs have always been there. More men are comfortable calling and coming for therapy. I think men have evolved. I think men have become more comfortable asking for help. That would be a generational thing. It’s more likely to be men below the age of fifty. I get people calling in their twenties and thirties, saying, I have this sexual issue, and it’s affecting my relationship. Women are more empowered, so they’re saying that they’re not going to deal with it. You have a problem, you should get that fixed! They’re more empowered, more comfortable with their own sexuality, more willing to say they want to have a good sex life.

Say I’m a member of a couple, and I had an affair and we want to come in and see you. What kinds of things would we talk about in our first session?

Initially, people would come in and introduce me a little bit to their relationship: how long have they been together? What’s their relationship status—dating, living together, married, whatever—and how they met. And what’s going on? The person will take time to tell me that story. I’ll want to hear from each of them. Then we’ll wrap up with what people are trying to accomplish. I’ll ask a bunch of questions in between. The initial appointment is bringing me up to speed, and talking about what they’re hoping will happen by coming to see me.

Then I like to see each of them individually for a session. That’s to get some background so I can know them a little bit as a person, and know what life experiences have influenced them. I find out what their family constellation was—I’m trained in systems theory, so people are part of larger systems in my outlook. It’s an opportunity to have a candid discussion without worrying about the reaction of their partner. I’m also looking for motivation to do the work, and if it’s safe for them to do the work. You don’t want to get vulnerable in a session and then go home and have big fights or repercussions afterwards. You want to know that they’re going to be able to respect each other as they do the work. And I want to make sure that couples therapy is going to be helpful. Are there any individual issues that need to be sorted out first? Are there any secrets that will block the therapy from moving forward?

That example was kind of emotionally driven, so how does the process change when the concern is something physical, like erectile dysfunction?

I do the same thing. I do the whole sexual history with that person. In sex therapy, in that when there’s a sexual issue, I’m going to include a sexual history: sexual development, what sex education they’ve had, and how they’re sexual experience have unfolded. I’m looking to whether that was a positive unfolding, or were there any negative influences. I really want to take time to hear that person’s story. It’s usually really unique for someone to come in and do that. People don’t usually sit down and talk about how they learned about sex, and how they learned where babies come from, and who did or didn’t tell them about masturbation. It’s a unique and rich opportunity for people to consider what’s influenced their sexual development.

In the case of something that is physically driven, do you have partners in the medical community? Can you say to a client, “I think this part of it might be psychological, but for this other part, check with your doctor”?

Absolutely. Why come for hours of therapy if there’s a medical solution or a medical cause? And there could be a medical cause, but because their sexual functioning is affected, there is also an emotional component I still end up talking to that person about. How do they navigate the quality of life around their sexuality? For example, if you have pain with intercourse, sometimes that creates a tensing-up in the genital area. We can teach women how to relax, but there might be relationship stuff, like fear of pregnancy. Working through the emotional issues really helps, but in that instance, I work with a physiotherapist. The physiotherapist will work with the muscles and the body, and I’ll work with the mind.

You’ve been a therapist for thirty years. What’s changed since you began?

What’s shifted is seeing couple that have really nice relationships and good marriages, and no sex: the “roommate” situation. It’s probably been around over the five or ten years, and we’re talking more about it. We have books out there now, like The Sex-Starved Marriage, and we’re recognizing the loneliness. Having affairs have been a solution for lots of men, but women are empowered. We have women now who openly enjoy sex, who want sex, who want it to be part of their relationships, and they’re speaking up more loudly. I think the newer trend has been influenced by the internet. Emotional affairs, betrayals, or deceptions, by use of chat rooms, websites like Ashley Madison, or getting hooked on porn. We didn’t have that thirty years ago in grad school. Talking about BDSM and kink in sex therapy is different. I was not having those conversations ten years ago, but now people talk about it as part of their sexual practices. It’s coming into the mainstream.

How do you think the medical community, and society at large, perceives your work?

I think societally, the information is out there. Sex therapists have been on Oprah. Or in Meet the Fockers, which wasn’t the best representation, but that character did turn to the other mother-in-law and say, “What about your pleasure?” Those are the kinds of conversations that are good. I think people are more open, there’s more on TV, and there are a lot more books with good sex ed out there in the general culture. We’ve moved from sensationalism to good information.

In terms the medical community, there is the need for more crossover. There are people who do sexual medicine, and they probably know about sex therapists. There are doctors that are comfortable with patients who have sexual issues. Baby boomers are aging, and Viagra gave doctors a tool that they didn’t have before, and drug companies wanted the doctors to be trained so they could prescribe it. That set off a lot more doctors getting sex education. They could then ask the proper questions, make the proper diagnosis, and prescribe the appropriate medication. That was a big change. The newer doctors are from a generation that’s more open and more comfortable. I’ve been invited to some of their consultation groups, and it’s been interesting to be invited and it’s great see this openness.

How has your work as a sex therapist has an impact on you? How do feel about what you do?

I love what I do. It’s certainly broadened my experience. I grew up in a very white, WASP-y, middle-class community. This has really opened my mind to the variety of ways that people are sexual, and the lifestyles they have. I’m working with people who want to be married and have better marriages and better relationships. Who want to be sexual and have better sex. That’s a nice kind of work to do.