Psychosexual therapy in London: what it is and who it helps

Of all the reasons people come to therapy, sexual difficulties are the ones most often carried in silence. People will discuss grief, money, even the end of a marriage more readily than they'll say out loud that desire has faded, or that something in their intimate life has quietly stopped working. Many wait years, convinced it's too embarrassing to raise, or that it's just how things are now.

I'd like to take some of the fear out of it. Psychosexual therapy in London is, in the end, simply a confidential, professional space to talk about desire, intimacy and sex, no more awkward, once you begin, than any other honest conversation about something that matters to you. Here is what the work actually involves, and who it tends to help.

Let me start with the reassurance most people are quietly waiting for: psychosexual therapy is talking therapy. It is a conversation.

But it isn't only a conversation about mechanics. Sex is never purely mechanical, which is why treating it as a machine to be fixed so rarely helps. The poet Octavio Paz described eroticism as something uniquely human, our biology transformed by imagination into something closer to poetry than to plumbing. The therapist Esther Perel writes in a similar spirit about desire as bound up with aliveness, curiosity and play, rather than mere function. So psychosexual therapy is far more often about understanding what desire means for you, and what has come to stand in its way, than about correcting a technique.

What that looks like in the room: someone might sit down and say, "Everything works, technically. But I feel nothing, and I honestly don't know when that happened." That sentence isn't a plumbing fault. It's a question about connection, or safety, or who they've become, and that is the territory we actually work in.

People bring an enormous range of concerns, and in plain terms these are among the most common:

Desire discrepancy, where one partner wants sex more often, or more urgently, than the other. This is perhaps the single most common reason couples come, and it's worth saying clearly: it is not a flaw in either person. Two people rarely want exactly the same thing at the same intensity forever, and the gap between them can be understood rather than judged.

Loss of desire, for a particular partner, or more generally: after having children, during illness or menopause, under stress, on certain medications, or simply with the passing of years.

Difficulties with arousal, pain, performance or reaching orgasm, including erectile difficulties and the anxiety loop that so often makes them worse, where the worry about it becomes the very thing that gets in the way.

Rebuilding intimacy after betrayal, finding a way back to a sexual relationship after an affair.

Shame, the messages from upbringing, religion or culture, or from past experiences, that made sex feel frightening, forbidden or unspeakable.

What that looks like in the room: a couple often arrives saying some version of, "We love each other, we're good friends and good parents, but the sex has quietly disappeared, and neither of us knew how to bring it up." This is the everyday material of the psychosexual difficulties I work with, and none of it is too small, or too much, to bring.

You can see the wider range of difficulties I work with.

Both work, and which suits you depends on what you're carrying. Individually, we might look at your own relationship to your body and your desire, a history that often predates any current partner, or a shame you've never said aloud to anyone. As a couple, we look at the dynamic between you, because desire lives in the space between two people as much as it does inside either one. Sometimes we begin individually and later invite a partner in; sometimes it's the other way around.

What that looks like in the room: on your own, it might be trying to understand why closeness has always felt faintly dangerous, long before your present relationship. As a couple, it's often two people slowly learning to say what they each want without it landing as a criticism of the other.

What you say stays in the room. Confidentiality is held within the usual professional limits I set out in the therapy agreement at the start, for instance, where there's a risk of serious harm, and beyond that, this is a private, non-judgmental space. I promise you that nothing you bring will shock me; this is my field, and I have heard, without flinching, the things people are most afraid to say.

In terms of structure, we simply talk. We begin with what's brought you, a little of your history, and what you'd hope might be different. From there we move at your pace. Occasionally I might suggest something to reflect on, or to try privately at home between sessions, but nothing is ever done in the room itself; it remains a conversation throughout. Individual sessions run 50 minutes and couples sessions a little longer. Most people find the first ten minutes the hardest, and then are quietly surprised to find it becoming, of all things, an ordinary conversation.

Relationship and psychosexual work is a particular focus of mine, not an add-on. Alongside my core psychotherapy training I hold a Diploma in Psychosexual Therapy, and I work integratively, drawing on psychodynamic, existential and cognitive behavioural ideas, precisely because sexual difficulties usually sit where the body, personal history and questions of meaning all meet. I'm a registered member of the BACP.

If any of this feels familiar, you don't have to keep carrying it quietly. Psychosexual therapy, in English or French, in person across London or online, is simply a confidential place to understand your desire and intimacy, and to change what isn't working. You're welcome to arrange a free 15-minute introductory call; there's no pressure, and no need for embarrassment.

You can read more about my training and accreditations.