The fighting wasn’t getting any better so you went to couples therapy. After a few sessions, sex came up and your therapist suggested you see a sex therapist too.
You’re now making two appointments, paying two fees, telling your story twice to two people who have never met.
This is one of the most common things New York couples tell me about when they come in for help with their relationship and sex life. It is almost never anyone’s fault and it is almost always preventable.
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Why Two Therapists for a Couple?
Couples therapy and sex therapy are different disciplines and most clinicians are trained in one or the other.
There is no medical reason for the split. In the professional training literature, clinicians have argued that the two disciplines are taught separately only because they developed separately, not because the problems they treat are separate.
The result goes directly to the customers. A couples therapist who is not trained in sexual issues will refer them out, and a sex therapist who is not trained in couples work will most likely want the relationship handled somewhere else.
Neither referral is negligent. “Every clinician is practicing within their competence, which is the right instinct. The problem is what happens to the couple in the interim.
Couples Therapy vs Sex Therapy: What’s the Difference?
Couples therapy is a type of treatment that focuses on the relationship between two partners. It can involve communication, conflict, trust and emotional connection.
Sex therapy is talk therapy that addresses sexual issues such as desire, arousal, pain, sexual function and sexual communication. “It is conversation and structured homework between partners, no physical exam or contact of any kind.
An AASECT Certified Sex Therapist is a licensed mental health professional who has completed advanced coursework, supervised clinical hours and certification through the American Association of Sexuality Educators, Counselors and Therapists (AASECT).
They tend to be pitched as an either-or. In fact, couples seldom come with a problem that clearly falls on one side or the other of that line.
What to Expect When Therapy Is Split Between Two Therapists
Couples frequently describe the same set of frictions once care is divided.
- The story gets told twice, and the two versions are never quite the same.
- The two therapists work from different models and sometimes give contradictory guidance.
- Each clinician sees half the picture, so neither can tell whether this week’s distance is about the argument on Tuesday or the sexual disconnection underneath it.
- Scheduling two weekly appointments around two careers is often what causes couples to drop one of them.
- Costs roughly double.
A common pattern therapists see is that the sexual work quietly stalls. Sexual concerns are hard to raise even once, and couples who have to raise them in a second setting, with a second stranger, frequently do not go.
What About Couples Where Each Partner Has Their Own Therapist?
This is the other version of the same problem, and it is especially common in New York, where many people were already in individual therapy before the relationship struggled.
Individual therapy is valuable, and it is not a substitute for couples work. Each therapist is hearing one partner’s account of the relationship, which is the nature of individual treatment.
Over time, two well-meaning therapists can end up reinforcing each partner’s side of the same argument. Neither clinician is doing anything wrong, and no one in the system is treating the relationship itself.
Are Emotional Connection and Sex Actually Separate Problems?
No, and this is the reason splitting them creates trouble.
Emotionally Focused Therapy (EFT) is an evidence-based couples therapy, grounded in attachment science, which holds that partners need to feel safely connected before they can be open with each other.
Sex is one of the places that safety is most visible. When partners feel unseen or criticized, desire usually drops; when sex becomes a source of failure or pressure, the emotional distance widens.
EFT researchers have examined this link directly, including a two-year follow-up study in the Journal of Couple and Relationship Therapy that looked at how attachment change during EFT related to sexual satisfaction over time.
Treated as one system, an argument about the dishes and a months-long absence of sex are often the same cycle showing up in two rooms. Read more about Emotionally Focused Therapy.
When Does Seeing Two Therapists Make Sense?
Sometimes it is the right call, and it is worth saying so plainly.
- When one partner is managing a significant individual concern, such as depression, trauma, or addiction, that needs its own treatment alongside couples work.
- When a sexual concern has a medical component, since a physician or pelvic floor physical therapist may need to be involved.
- When one partner wants a private space to work on something before bringing it into the couple.
The distinction is between deliberate coordination and accidental fragmentation. Two providers who communicate with each other, with the couple’s consent and a shared plan, are a team. Two providers who have never spoken are not.
What Should New York Couples Ask Before Starting?
A few questions early will tell you whether you are about to be referred out later.
- Are you trained to work with sexual concerns, or would you refer that out?
- What is your specific training in couples therapy, beyond general clinical licensure?
- If we need both, does that happen with you or with someone else?
- If we are already seeing individual therapists, how would you coordinate with them?
Asking about sex in a first consultation feels awkward. It is considerably less awkward than discovering six sessions in that your therapist is not comfortable with the subject.
How Does Telehealth Change This for New York Couples?
It opens up the pool. Not all clinicians are trained in couples and sex therapy and outside of New York City, the local options can be few and far between.
If a therapist is providing services to a person who is located in New York, the therapist must have a New York license or other authorization to practice in New York. Under that rule, a couple in Buffalo, Albany or the Hudson Valley could work with a practice anywhere in the state.
That is most relevant for those couples described in this article, because integrated care is what tends to be missing locally.
How to Begin With Integrated Couples and Sex Therapy in NYC
CICC was built around treating emotional connection and sexual connection together rather than referring one of them out. Our founder, Mark Goldberg, LCMFT, AASECT Certified Sex Therapist and EFT Certified Couples Therapist through the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT), holds both credentials, and that integrated model shapes how our clinical team works.
We see couples throughout New York State by secure video. You do not need to know in advance whether what you are facing is a relationship problem or a sexual one; sorting that out is part of the work.
A free 15-minute consultation is available to help determine the right fit and starting point with our clinical team. Learn more about our sex therapy services or schedule your consultation today.
