What to Expect in Your First Sex Therapy Session
For a lot of people, the biggest barrier to starting sex therapy isn't the topic itself — it's not knowing what actually happens in the room. Uncertainty tends to make anything sound more intense than it is. Here's a clear, practical walkthrough of a first sex therapy session.
First: What Sex Therapy Is Not
Before getting into what happens, it helps to rule out common misconceptions:
There is no physical exam. Sex therapists are mental health clinicians, not medical providers.
There is no nudity or sexual activity in session. Sex therapy is talk therapy, the same as any other form of psychotherapy.
You will not be asked to talk about anything you're not ready to discuss. Pacing is set collaboratively, not imposed.
What Happens in the First Session
1. Intake and background. The therapist will ask about what brought you in, along with relevant history — relationship history, health history, and any prior therapy experience. This is a conversation, not an interrogation; you share what you're comfortable sharing, and depth builds over time.
2. Understanding the current concern. You'll talk through the specific issue in more detail — when it started, how it shows up, what's been tried already, and how it's affecting you or your relationship.
3. Clarifying goals. A good first session ends with some shared sense of what you're working toward, even if it's broad at first ("I want to feel less anxious about intimacy" or "we want to feel like a team again").
4. Logistics. The therapist will typically cover practical details: session frequency, format (individual or couples), telehealth vs. in-person options, and cost.
What You Might Be Asked
Questions in an intake vary by therapist and situation, but commonly include things like:
What's the concern bringing you to therapy, and how long has it been going on?
Is this something new, or has it been present for a long time?
Are you currently partnered, and if so, would you like your partner involved in sessions?
Are there relevant medical factors, medications, or health conditions?
Is there a trauma history relevant to the concern?
You're not required to answer everything in detail in the first session — pacing is up to you.
Individual or Couples: What If Only One Partner Wants to Start?
It's common for one partner to be more ready than the other to begin therapy. Starting individually is a valid path — working through your own history, anxiety, or communication patterns often shifts the relationship dynamic even before a partner joins, and some people choose to continue individually rather than in a couples format.
How Many Sessions Will I Need?
There's no fixed number — it depends on the concern, its history, and each person's goals. Some people come with a fairly specific, contained issue; others are working through something multifaceted. A therapist should be able to give you a general sense of scope after the first one or two sessions.
Frequently Asked Questions
Do I need to bring anything to my first session? No. Some therapists provide intake paperwork ahead of time, but you don't need to prepare anything beyond being ready to talk about what brought you in.
What if I'm too embarrassed to talk about it? This is extremely common, and experienced sex therapists are used to creating a low-pressure space for exactly this reason. You're allowed to say "this is hard to talk about" out loud — that's a normal part of the process, not a failure of it.
Is everything I say confidential? Yes, with the standard legal exceptions that apply to all licensed therapy (such as imminent risk of harm), which any therapist should explain clearly during your first session.
Getting Started in Ann Arbor
Sarah Cissell, LMSW and AASECT-Certified Sex Therapist, offers free consultations before your first full session, so you can ask questions and get a feel for fit before committing. She sees clients in person in Ann Arbor and via telehealth across Michigan and Florida. Schedule a free consultation or learn more on her therapist profile.
