So, you’re thinking about how to be a sex therapist. It’s a job that makes people lean in at dinner parties, or maybe lean away, depending on how repressed they are. Most people think it’s all about talking about wild positions or fixing "broken" libidos. Honestly? It’s mostly about anxiety, trauma, and the really boring ways humans fail to communicate. You’re essentially a high-level specialized plumber for the human soul’s most sensitive pipes.
It's a long road.
Don’t let the Instagram "sex coaches" fool you. There is a massive, legally-binding difference between being a coach and being a licensed sex therapist. If you want the title, you need the degrees. You’re looking at years of school, thousands of hours of supervision, and a lot of uncomfortable self-reflection. But if you’ve got the stomach for it, it’s one of the most rewarding ways to spend a career.
The Academic Grind is Real
You can’t just declare yourself a sex therapist because you’ve read a lot of smut or have a great sex life. In fact, your personal sex life is almost entirely irrelevant to your ability to treat a client with vaginismus or a couple struggling with mismatched desire.
First step: Get a bachelor’s degree. Usually in psychology, sociology, or social work.
Then comes the master’s. This is non-negotiable. To be a therapist, you need a graduate degree in a clinical field like Marriage and Family Therapy (MFT), Clinical Social Work (LCSW), or Professional Counseling (LPC). You’ll spend two to three years learning general mental health—diagnosing depression, handling crisis intervention, and understanding the DSM-5-TR. You have to be a therapist first. You become a "sex" therapist second.
Expect to write papers. Lots of them. You’ll be studying the works of researchers like Masters and Johnson or Helen Singer Kaplan. You'll need to understand the physiological side—how blood flow works, how medications like SSRIs can absolutely tank a person's ability to climax, and how the endocrine system dictates mood.
Getting Certified by AASECT
Once you have your license to practice general therapy, the real specialization begins. Most professionals in the US and Canada look to the American Association of Sexuality Educators, Counselors and Therapists (AASECT).
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Becoming AASECT certified is the gold standard.
It requires an additional 150 hours of specialized education. You’ll take classes on everything from "Sexual Diversity" to "The Socio-Cultural Factors in Sexuality." Then there’s the SAR—the Sexual Attitude Reassessment. This is a trip. It’s a seminar designed to push your buttons, force you to confront your own biases, and make sure you don't judge a client who walks in with a kink you find "weird." If you can't talk about BDSM, polyamory, or fetishism without blinking, you're in the wrong room.
You also need 300 hours of clinical experience specifically focused on sex therapy, supervised by an AASECT-certified supervisor. This isn't free. You'll likely pay your supervisor for their time. It’s an investment in your expertise.
Why You Can't Skip the Medical Stuff
You’re going to work closely with doctors. Period. If a client comes in with painful intercourse (dyspareunia), you can talk about their childhood for ten years, but if they actually have undiagnosed endometriosis or a pelvic floor issue, you're failing them. A good sex therapist has a Rolodex full of pelvic floor physical therapists, urologists, and gynecologists.
You need to know when the problem is in the mind and when it’s in the tissue.
The "Ick" Factor and Personal Bias
Let’s be real. Can you talk about fecal play without shaming a client? Can you help a person who has committed sexual offenses (if that’s the niche you choose) with a neutral, clinical perspective?
Self-awareness is your biggest tool. If you grew up in a high-control religious environment, those "purity culture" echoes might still be rattling around in your head. You have to clear that out. Clients sense judgment like sharks sense blood. The moment they feel you flinch, the therapeutic alliance is dead.
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What a Typical Session Actually Looks Like
It’s less "Eyes Wide Shut" and more "Let's talk about why you feel like crying when your partner touches your shoulder."
You’ll see a lot of "Dead Bedrooms." This is often just code for "we stopped liking each other three years ago and now we don't know how to be naked." You’ll deal with erectile dysfunction that is 90% performance anxiety and 10% high blood pressure. You’ll help people navigate life after sexual assault, which is delicate, slow, and heavy work.
- Assessment: The first few sessions are basically an intake. You're looking at their sexual history, their family's attitude toward sex, and their current relationship dynamic.
- Education: A lot of sex therapy is just "Sex Ed 2.0." You'd be shocked how many grown adults don't know where the clit actually is or how the refractory period works.
- Behavioral Homework: You don't watch people have sex. Ever. That’s a massive ethical violation. Instead, you give them "homework" to do at home, like Sensate Focus exercises—a technique developed by Masters and Johnson to reduce performance pressure by focusing on non-genital touch.
Misconceptions That Could Ruin Your Career
People think sex therapy is spicy. It’s not. It’s clinical. It’s professional.
If you’re entering this field because you have a "passion for sex," you might actually be a bad fit. The field needs people with a passion for therapy. If you have unresolved sexual issues of your own and you're trying to "heal" them by working with others, you're going to burn out or, worse, cause harm.
Ethical boundaries are everything. The power imbalance in a therapist-client relationship is intense. When sex is the topic, those boundaries need to be made of reinforced concrete.
The Business Side: Making a Living
Can you make money? Yeah.
Private practice is where most sex therapists end up. Since it's a niche, you can often charge more than a generalist. In cities like New York or San Francisco, specialized sex therapists might charge $200 to $450 per session. But remember, insurance is tricky. Many insurance companies don't have a specific code for "sex therapy," so you often bill under "adjustment disorder" or "relationship distress."
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Many therapists opt out of insurance altogether (private pay) because it allows for more privacy and fewer bureaucratic headaches for the client.
Finding Your Niche
Don't just be a "sex therapist." Be the person who helps:
- LGBTQ+ couples navigating transition.
- Men dealing with compulsive sexual behavior (often incorrectly called "sex addiction").
- Post-partum mothers reclaiming their bodies.
- Individuals with physical disabilities seeking sexual fulfillment.
The more specific you are, the easier it is for your "ideal client" to find you.
Transitioning from Other Careers
Maybe you’re 40 and tired of marketing. Can you switch? Yes. In fact, older therapists often have an easier time because they bring "life mileage." Clients often find it easier to talk about sexual dysfunction with someone who looks like they’ve lived through a few things.
You still have to do the master's degree, though. There are no shortcuts.
Actionable Steps to Start Today
If you’re serious about how to be a sex therapist, stop googling and start doing.
- Audit your own history. Start your own therapy. If you want to hold space for others' sexual trauma and joys, you need to know where your own "stuff" is buried.
- Research accredited Master's programs. Look for Council for Accreditation of Counseling and Related Educational Programs (CACREP) or Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) schools. This ensures your degree will actually lead to a license.
- Join AASECT as a student. It’s cheaper. You’ll get access to their journals and newsletters, which will give you a feel for the current clinical debates in the field.
- Read "The State of Affairs" by Esther Perel. She’s the most famous face in the field for a reason. Her work on infidelity and desire is a masterclass in how to think about modern relationships.
- Volunteer at a crisis center. If you can handle a four-hour shift on a sexual assault hotline, you have the temperament for the "heavy" side of this work.
This career isn't about being "sex-positive" in a vacuum; it’s about being "human-positive" in the most vulnerable area of people's lives. It takes grit. It takes a lot of boring paperwork. But helping a couple rediscover intimacy after years of silence? That's a hell of a way to make a living.