When couples reach out for support, they often ask:
“Do we need sex therapy or couples therapy?”
“Aren’t they the same thing?”

The short answer: no—and also, sometimes yes.

As an existential sex therapist, I see how emotional disconnection and sexual disconnection often overlap—but they are not always the same thing. Understanding the difference between sex therapy and couples therapy can help you find the right kind of support for where you are, and where you want to grow.

Couples Therapy: The Relationship as the Client

In couples therapy, the focus is on the emotional, psychological, and relational dynamics between two people. The therapist helps partners explore how they communicate, manage conflict, navigate life stressors, and stay (or get back) emotionally connected.

Couples therapy often addresses issues like:

Chronic conflict or emotional shutdown
Betrayal, mistrust, or unresolved resentment
Parenting struggles, life transitions, or external stressors
Feeling emotionally distant or “more like roommates”
Power dynamics, unmet needs, and communication blocks

An existential lens adds depth to this work by encouraging partners to explore not only their behavior—but their being in the relationship. We ask:

Are you showing up as your full self?
Are you choosing each other, or just surviving the routine?
What does love mean to you now, and has it changed?

Sex Therapy: The Erotic as a Window Into the Self

Sex therapy, on the other hand, focuses more directly on concerns related to sexual functioning, desire, identity, and intimacy. It can involve individual or joint sessions, depending on the nature of the issue.

Common reasons people seek sex therapy include:

Low or mismatched desire
Pain during sex, performance anxiety, or erectile challenges
Sexual avoidance, shame, or trauma
Desire to explore kink, non-monogamy, or changing identities
Feeling disconnected from one’s body or sexual self

From an existential perspective, sexuality is not just physical—it’s a space where questions of freedom, vulnerability, identity, and meaning come alive. When something feels “off” sexually, it often reflects deeper emotional or existential questions:

Do I feel safe enough to be seen?
Am I performing, or truly expressing myself?
Is this version of sex still aligned with who I am?
What role does sex play in how I connect or protect myself?

As a sex therapist, I help clients explore not just how to "fix" sex, but how to relate to it with more awareness, honesty, and intention.

Advantages of Seeing a Sex Therapist vs. a General Couples Therapist

Understanding the distinct advantages of each type of therapy can help you decide which is the best fit for your needs:

Focus of Expertise

Sex Therapist: Specializes in sexual health, function, desire, identity, and intimacy. Provides targeted interventions for sexual concerns, blending biological, psychological, and relational knowledge.
General Couples Therapist: Focuses on the broader relationship dynamics such as communication, conflict, and emotional connection. Less specialized in sexual issues unless additionally trained.

Depth of Sexual Exploration

Sex Therapist: Creates a safe, nonjudgmental space to explore sexual identity, fantasies, fears, and concerns with specialized knowledge and techniques.
General Couples Therapist: May address sexual issues within the context of overall relationship health but usually with less detailed sexual education or intervention.

Approach to Desire and Function

Sex Therapist: Offers specific strategies for challenges like low desire, pain, or performance anxiety, considering physical and emotional factors.
General Couples Therapist: Works on improving relationship satisfaction broadly, which can indirectly improve sexual intimacy.

Individual and Couple Work

Sex Therapist: Often works with individuals and couples, addressing personal sexual healing and couple intimacy.
General Couples Therapist: Primarily focuses on couples' relational patterns and communication.

Comfort Discussing Sexual Topics

Sex Therapist: Trained to discuss sexual matters openly and sensitively, reducing shame and stigma.
General Couples Therapist: May have variable comfort levels and training regarding explicit sexual issues.

Where They Overlap: The Emotional + The Erotic

In practice, couples therapy and sex therapy often intersect—because emotional intimacy and sexual intimacy are deeply connected.

For example:

A couple may fight constantly, but sex still feels like a place of connection.
Another may be emotionally close, yet avoid sex entirely.
One partner may want more sex, while the other feels pressured or shut down.
Both may want to rekindle connection, but don't know where to start.

In cases like these, integrative therapy—drawing from both couples work and sex therapy—can help uncover the full picture. As an existential sex therapist, I guide partners to explore both the emotional story and the erotic subtext—with compassion, curiosity, and depth.

It’s Not Either/Or—It’s Where You Begin

You don’t have to choose perfectly between sex therapy and couples therapy. The real question is:

Where is the disconnection showing up most clearly? Emotionally? Sexually? Both?

Start there.

Whether your relationship is struggling with desire, conflict or silence, therapy can help. And when your therapist holds both the emotional and erotic aspects of your relationship with care, growth becomes more than possible—it becomes meaningful.

Considering Therapy? Let’s Find the Right Fit

As an existential sex therapist, I work with couples and individuals to explore the deeper layers of intimacy, desire and emotional connection. Whether you’re seeking sex therapy, couples therapy, or a blend of both, we can begin by slowing down, tuning in, and getting honest—together.

Couples Therapy vs. Sex Therapy: What’s the Difference?