The conversation you keep not having.
Most couples who reach me have been circling this for years. Not arguing about it — circling it. If some part of you has been waiting for it to settle down on its own, I can tell you what’s actually happening between you, and why waiting was never going to be the thing that fixed it.
One of you started going to bed earlier.
Not dramatically. Just twenty minutes, then an hour, then it was simply how the evenings went. And the other one of you noticed, and said nothing, because what exactly would you say?
That’s usually how it starts — not with a refusal, but with logistics. Somebody’s tired. Somebody has an early meeting. The reasons are all perfectly true, and none of them is the reason.
By now there’s a whole grammar to it. A hand that rests a beat too long gets gently moved. A hug ends on a particular kind of pat that means this is a hug and nothing more. Neither of you decided any of this. You worked it out between you, without a word, the way people do.
And the strange part is that everything else is fine. You’re kind to each other. You manage the money, the school run, the visiting relatives. Nobody looking in would spot a thing, which is exactly why it’s so hard to describe — including to each other, including to yourselves.
Underneath it sits a subject you’ve both quietly agreed not to open. Not because it doesn’t matter. Because the last few attempts ended with one of you hurt, one of you defensive, and the two of you further apart at midnight than you’d been at nine. So it stays shut. And it gets heavier every month it stays shut.
If that’s roughly the shape of your house: nothing has gone wrong with either of you. You’ve built a pattern I can describe from beginning to end — which is the first evidence that it can be taken apart.
The Sexual Avoidance Cycle
This is the pattern I named in Sex Without Stress, and some version of it turns up in nearly every couple I’ve sat with. It isn’t a flaw in either of you. It’s a machine — and once it’s assembled, it runs without anybody operating it.
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Only one thing counts as sex
Somewhere you both picked up the notion that sex means one particular act, done a particular way, finishing a particular way. Everything else is a preamble or a consolation prize.
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So every time becomes an attempt
If there’s only one destination, then you’re not doing something together any more. You’re travelling somewhere, and either you arrive or you don’t.
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And an attempt can be failed
Which introduces a right answer and a wrong one into something that used to be play. Nobody performs well once there’s a score.
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Now it means something about you
Whether you’re wanted. Whether you’re enough. Whether the marriage is all right. That’s a colossal amount of freight to load onto one act, and it makes the act far too important to relax into.
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Bodies don’t cooperate under audit
Anxiety and arousal want different conditions, and anxiety generally wins. So the exact thing you’re worried about becomes likelier, which gives you more to be worried about next time.
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So you begin steering around it
Sensibly. If something reliably ends in disappointment or a difficult conversation, of course you learn to route around it. Avoidance isn’t laziness or indifference. It’s self-protection, and it works.
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And the steering spreads
This is the part nobody sees coming. It doesn’t stay in the bedroom. The kiss goodbye gets shorter. Nobody sits close on the sofa. Ordinary affection disappears too — because any of it might be read as an opening bid, and neither of you wants to be the one who started something or the one who turned it down.
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Until it’s the thing nobody can mention
The one who wants it less is carrying guilt. The one who wants it more is carrying rejection, and shame about minding so much. Both of you are frightened of what the whole thing signifies. None of it gets said aloud, and all of it is enormous.
Here’s the unfair part. All that guilt and shame and fear makes sex heavier still — which drops you back at step four with more weight than you had before. The cycle doesn’t merely continue. It tightens. Every year it runs, it runs harder. Which is why waiting it out has never once worked for anybody.
You’re each dreading a different sentence.
In a first session I can usually feel it — two people sitting very carefully, each waiting to discover whose side the therapist is on. You aren’t afraid of the same thing at all. Let me deal with both now, before you book.
If you want sex less
You think I’m going to find something wrong with you.
That your desire, or your body, or your history is the fault in the system. That you’re the reason this marriage is in difficulty and everyone has been too well-mannered to name it.
And beneath that, the larger one: that therapy is simply a device for getting you to have more sex than you want. That you’re about to be outnumbered.
Neither happens here. Low desire is rarely a malfunction — far more often it’s an entirely sensible response to the pressure that’s built up. And more sex is never the goal I’m working toward. Nobody gets talked into anything in my sessions.
If you want sex more
You think I’m going to tell you to live with it.
That your partner is simply made this way, and maturity means accepting a marriage without sex. Or the other version: that if you did more around the house, listened harder, became more something, they’d want you again.
And underneath, the fear you probably haven’t said out loud — that it’s specifically you they’ve gone off. That they closed the whole thing down privately and never mentioned it.
I won’t be telling you to settle for a sex life that makes you unhappy, and I won’t be handing you a list of chores. Wanting your partner is not a character defect and it is not pressure. What reads to you as rejection is nearly always the cycle talking, not a verdict on you.
What I actually do is treat the pattern as the problem rather than either of you. That’s not diplomacy to keep the peace in the room. It’s that I’ve watched two thoroughly decent people construct this thing together, without either intending to, more times than I can count.
What actually happens in a session.
People carry some odd assumptions about sex therapy, and one or two of them stop couples booking at all. So, plainly:
Does anyone take their clothes off?
No. Never. Sex therapy is talking therapy that happens to be about sex. You are fully dressed, on a video call, having a conversation. There are no surrogates, no demonstrations, and nothing physical happens in a session at any point.
Are you going to send us home and tell us to do it?
No — and this is the worry I hear most often. Being thrown into the deep end is precisely the thing that doesn’t work. It’s what the two of you have already tried, more than once, and it’s what taught you that trying makes it worse.
We start in water so shallow it feels faintly ridiculous. That’s deliberate, and it’s the whole reason it works.
Will we have to describe our sex life?
Yes, and in more detail than you’re expecting. Early on I’ll usually take you through what I call your dance around sex: who moves first, what the other one does, what each of you concludes privately at every step, and the precise point at which it comes apart. Properly play-by-play.
It sounds mortifying. It very rarely is — partly because I keep it matter-of-fact rather than exposing, and partly because you’re both describing choreography you already know by heart. And it earns its place: once the whole sequence is laid out where all three of us can see it, what needs to change stops being a matter of opinion.
Is there homework?
Yes, and it’s where the change actually occurs. Sessions are for making sense of things; the structured experiences you do at home between them are the work itself. They begin small on purpose, nothing is sprung on you, and you’re never given something you haven’t agreed to first.
Is one of us going to get blamed?
No. I work on what happens between you, which means each of you gets to find your own part in it — not as an accusation, but because your own part is the only piece you have any power over. That’s not a consolation. That’s the leverage.
What if it’s been years?
Then you have a great deal of company, and it matters less than you’d think. I’ve worked with couples at one year, at five, and at considerably longer. How long the drought has run is not what predicts whether this works.
Some of the ground we cover.
- Desire that doesn’t match
- Sex that has stopped altogether
- Avoiding touch of any kind
- Little or no desire
- Sex that hurts
- Erection difficulties
- Trouble reaching orgasm
- Performance anxiety
- Life after a baby
- Menopause and hormonal change
- Bodies changed by age, illness or disability
- Sex after cancer treatment
- Rebuilding after an affair
- Disagreements about porn
- Kink, and differences in what you want
- Monogamy you don’t define the same way
- Never having learned how to talk about any of it
- Shame carried out of childhood or religion
- Trauma that gets in the way of closeness
- Living like roommates
Can this actually be fixed?
Yes — provided there’s love and goodwill still in the building. That’s the one requirement, and there isn’t a second.
I couldn’t keep doing this work if I didn’t watch it happen. Two people who care about each other can arrive at a physical relationship that genuinely suits them both. Not a truce where somebody quietly gives up what they wanted. Something that actually works for the two of you.
It generally asks for two changes, and neither of them is how much sex either of you wants.
The first is loosening what counts. If exactly one activity qualifies, you’ve given yourselves a single narrow door, and it’s frequently locked. Widen the definition and there turn out to be a dozen ways to be close to someone.
The second is dismantling the expectations that turned sex into an examination in the first place. Those expectations are the actual problem. Not your desire, not your body, and not your partner.
That’s the work. It’s more interesting than it sounds, and for most couples the overwhelming feeling at the end of the first session is relief.
The practical shape of it.
The two of you, every session
I don’t run individual sessions alongside couples work, and I don’t hold information from one of you on behalf of the other. It keeps everything even, and it’s one reason people settle faster than they expect to.
Months, not years
Three to six is typical. Some couples arrive with one specific knot, untie it, and finish quickly. Others want a thorough overhaul and stay longer. You aren’t committing to anything open-ended, and we’ll be honest with each other about where you are as we go.
By video, right across New Mexico
Everything happens on HIPAA-compliant video — Albuquerque, Santa Fe, Las Cruces, Farmington, Taos, anywhere in the state. You need a connection and a camera. Sit together on your own sofa, or join from two places if that’s the kind of week it is.
AASECT-certified
Only one state in the country regulates the term “sex therapist” — Florida. In New Mexico, as almost everywhere, anyone may use it. Certification through AASECT takes more than 160 hours of specialized coursework, 50 hours of supervision, and several hundred clinical hours spent on sexual concerns.
You’ve read the pattern. Recognize it?
Then you already know more about what’s happening between you than you did ten minutes ago. Three short questions to check we’re a fit, and then the request form.