Sex Therapy- FAQs with Dr. Ashley Sweet

  • Sex therapy is a specialized form of talk therapy that focuses on sexual health, intimacy, and relationship dynamics. While regular therapy may touch on sex, as an AASECT Certified Sex Therapist, I have advanced training in the biological, psychological, and social aspects of sexuality.

    • Note: I never use touch in sessions; our work is strictly conversational and educational.

  • Selecting a sex therapist is a deeply personal decision. You aren't just looking for a clinician; you’re looking for a space where your identity is respected and your pleasure is prioritized. Here is what sets my approach apart:

    1. A Feminist & Systemic Lens

    Traditional therapy often looks at sexual issues as "mechanical" failures. I view them through a feminist lens, acknowledging how societal power dynamics, gender roles, and cultural expectations impact your intimacy. We don't just fix a "symptom"; we address the system that created it.

    2. Beyond "Function" to Fulfillment

    Many providers focus solely on "sexual functioning" (the ability to perform). My goal is sexual fulfillment. Being "functional" is the baseline; being empowered, embodied, and joyful in your sexuality is the destination.

    3. Specialized Expertise (AASECT Certified)

    "Sex therapist" is a title many use, but few have the rigorous training required for AASECT certification. My background in reproductive health and clinical sexology ensures that your care is grounded in the latest evidence-based practices, blending psychological insight with biological understanding.

    4. De-programming the Shame Cycle

    I specialize in the "silent" work of dismantling sexual shame. While others might offer surface-level tips, we go deep into the de-programming of unhelpful scripts. I provide a "shame-free zone" where no topic—from kink and non-monogamy to religious trauma—is off-limits or judged.

    Visualizing the Transformation

    Clients often come in feeling stuck in a "Performance/Shame" loop. My work moves you into a "Pleasure/Connection" loop.

  • Differences in desire—often called "desire discrepancy"—are the most common reason people seek sex therapy. This is rarely about one person being "broken." Instead, we look at the "dual control model" of desire (accelerators and brakes) and move from a model of spontaneous desire to one of responsive desire.

  • Not at all. Sex therapy is highly beneficial for individuals wanting to explore their sexual identity, heal from trauma, or address physical concerns like erectile dysfunction or painful sex before entering a new relationship.

  • Yes. While I always recommend a medical check-up to rule out physical causes, most performance concerns have a significant psychological component (performance anxiety). We can use techniques like Sensate Focus and mindfulness to take the pressure off "performance" and return the focus to pleasure and connection.

  • Difficulty with orgasm (anorgasmia) is often linked to "spectatoring"—which is monitoring yourself during sex rather than feeling the sensations. In our sessions, we use a pleasure-positive framework to dismantle the "orgasm-as-a-goal" mindset, which actually makes reaching orgasm more likely.

  • Sex should never be painful. Whether you are dealing with vaginismus, dyspareunia, or postpartum changes, we work together to understand the body’s "no" response. My approach integrates education and mindfulness to help you reclaim your body as a source of safety and pleasure.

  • Being a feminist therapist means I recognize how societal expectations, patriarchy, and gender roles impact your sex life. A pleasure-positive approach means we shift the goal of sex away from just reproduction or "keeping a partner happy" and toward your own authentic entitlement to pleasure and bodily autonomy.

  • I see the impact of sexual shame in my practice very frequently; it is often the underlying cause of challenges like low desire, erectile difficulties, or an inability to reach orgasm. Shame acts as a chronic "brake" on the nervous system. When your brain is busy processing guilt or "shoulds," it cannot stay present in the body to experience pleasure. This internal conflict often manifests as physical disconnection or avoidance.

  • Our work involves de-programming the unhelpful, restrictive messaging you may have received from culture, religion, or family. We then move into re-programming more empowering narratives and authentic sexual scripts. Instead of following a "script" written by someone else, we collaborate to build a sexual identity based on your values, your consent, and your right to pleasure.

  • Absolutely. My practice is identity-affirming and "kink-aware." I provide a non-judgmental space for folks exploring polyamory, consensual non-monogamy (CNM), and diverse sexual identities. You won't have to spend your session time "educating" me on your lifestyle.

  • The length of treatment is highly individualized and depends on your specific goals, history, and the complexity of the concerns we are addressing. On average, clients find that 6 to 12 months of consistent work allows for deep, sustainable change—moving beyond quick fixes to true "re-programming" of sexual scripts.

    We typically begin with weekly sessions. This initial frequency is vital for building momentum, establishing a safe therapeutic relationship, and diving into the "de-programming" phase of our work.

    As you begin to see progress toward your goals and feel more confident in implementing new tools, we will naturally taper to every-other-week sessions. This transition allows you more time between meetings to practice new skills, integrate insights, and inhabit your empowered narrative in "real-time" before we check back in.

  • This is a choice I’ve made to ensure the highest quality of care and absolute privacy for my clients. There are three primary reasons why I operate as a private-pay practice:

    • Clinical Autonomy: Most insurance companies do not reimburse for sexual health diagnoses. Even when they do, they often require a "medical necessity" model that dictates how many sessions you can have and what our goals should be. I believe that you—not an insurance adjuster—should be the one in charge of your healing journey and the pace of our work.

    • Privacy & Reduced Stigma: To use insurance, I am required to provide a formal mental health diagnosis that becomes a permanent part of your medical record. Many of my clients prefer to keep their sexual health and personal growth entirely private, avoiding the "paper trail" and potential stigma associated with clinical diagnoses.

    • A Focus on Wellness, Not Just "Disorder": Insurance is built on a "sickness model." Sex therapy is often about optimization, empowerment, and pleasure—things insurance rarely views as "medically necessary." By staying out of the insurance network, we can focus on your actual goals rather than fitting your experience into a restrictive diagnostic box.

    Hot Tip: If you have out-of-network benefits, I can provide you with a Superbill (a detailed receipt) that you can submit to your insurance company for potential partial reimbursement. I recommend calling your provider to ask about their "out-of-network behavioral health" coverage.