How an Existential Sex Therapist Prepares for a Couples Therapy Session

I am often asked by other therapists how one prepares for sex therapy sessions as an existential sex therapist. I understand the reason for the question since existential therapists are not known for following the garden variety therapeutic script. In short, we prepare our mindset without an agenda. Existential sex therapy is grounded in the principle that therapists do not enter sessions with predetermined goals or techniques to impose on clients. Instead, preparation focuses on cultivating presence, openness and relational attunement (Cooper, 2016; Spinelli, 2007). Below is an integrated explanation of how existential sex therapists prepare for couples sessions while maintaining an agenda-free stance.

1. Grounding in Presence, Not Goals

Rather than planning interventions, existential therapists prepare by regulating themselves—through mindfulness, breathwork or reflective pauses—to enter the session with emotional steadiness and psychological availability (Yalom, 1980; Cooper, 2016).
This creates a state of “therapeutic presence,” which research identifies as central to existential and experiential therapies (Geller & Greenberg, 2012).

They intentionally release preconceived notions about the couple. This practice reflects the phenomenological attitude of bracketing assumptions so the therapist can meet the clients freshly (Spinelli, 2007). In short, I practice mindfulness for at least a few breaths before each session, even if the sessions are scheduled back to back with only moments between them.

2. Preparing a Stance, Not a Strategy

Existential therapists prepare their therapeutic stance, rather than specific interventions. The stance includes:

Authenticity

Therapists orient themselves toward congruence and transparency, a core existential value (van Deurzen, 2012).

Openness to the couple’s lived meaning

Phenomenology requires setting aside theory long enough to let the couple’s unique meaning-making emerge (May, 1983; Spinelli, 2007).

A non-pathologizing frame

Sexual difficulties are approached not as dysfunctions but as expressions of human struggle, choice, fear or longing, which is consistent with existential thought and contemporary sex therapy scholarship (Levin, 2019; Kleinplatz, 2012).

3. Reviewing Threads—Lightly, Not Prescriptively

Before the session, the therapist may briefly review:

• ongoing themes (e.g., autonomy, desire, fear)

• emotional patterns

• previous reflections or experiential practices

This supports continuity while still avoiding prescriptive direction (Cooper, 2019). The goal is to remain sensitized, not scripted, so the therapist can follow the emergent process.

4. Attuning to the Relational Field

In couples work, the “client” is the relational field itself (Buber, 1970/1996; Mearns & Cooper, 2005).
Preparation includes:

• Holding awareness of relational patterns

Such as attachment wounds, avoidance or pursuit/withdraw cycles—without deciding ahead of time how to intervene (Johnson, 2019).

• Monitoring countertransference

Existential sex therapists view self-awareness as essential to preventing reenactments and maintaining authenticity in the encounter (Yalom, 1980; Schneider & Krug, 2017).

5. Preparing to Sit With Sexual Themes Without Reducing Them to Techniques

Existential sex therapy emphasizes depth over technique, holding that sexuality reveals core concerns around vulnerability, identity, mortality and relationality (Kleinplatz & Ménard, 2023).
Thus, preparation involves orienting toward:

• Willingness to sit with shame, silence or exposure

Existential therapists practice “tolerance for uncertainty,” resisting the impulse to prematurely fix or soothe (May, 1981).

• Curiosity about meaning

Questions such as “What does desire symbolize?” or “What does avoidance protect you from?” reflect existential inquiry into sexual meaning (van Deurzen, 2012; Kleinplatz, 2012).

6. Ethical and Professional Preparation Unique to Sex Therapy

Even without an agenda, therapists prepare to engage sexual topics responsibly, consistent with AASECT’s competency guidelines (AASECT, 2014). This includes:

• Reflecting on personal biases and assumptions

Self-examination supports a nonjudgmental stance toward diverse sexual expressions (Kleinplatz & Ménard, 2023).

• Preparing to normalize sexual diversity

A grounding in sexological education allows the therapist to confidently hold conversations around desire differences, arousal, anatomy, kink or trauma with clarity rather than reactivity (Levin, 2019).

7. Preparing the Physical and Psychological Space

Therapists curate the environment to support safety and vulnerability, an essential foundation for existential exploration (Cooper, 2019).
They also prepare to act as a stabilizing presence who is ready to hold intensity, de-escalate conflict and invite deeper contact (Buber, 1970/1996).

8. Letting Go Right Before the Session Begins

The final step is a conscious release of:

• theory

• expectations

• desire to fix

• attachment to outcome

This mirrors foundational existential attitudes of “not knowing” and meeting the Other as they are (Spinelli, 2007). From here, the session unfolds through encounter rather than agenda.

In the end….

Preparation in existential sex therapy is internal, not prescriptive. The therapist centers themselves, attunes to meaning, monitors countertransference and prepares to meet the couple openly—while avoiding any predetermined direction (Cooper, 2016; Spinelli, 2007; Kleinplatz, 2012). This allows the session to unfold organically through presence, authenticity and relational depth.

Reference List

AASECT. (2014). AASECT sexuality education guidelines. American Association of Sexuality Educators, Counselors, and Therapists. https://www.aasect.org

Existential Sex Therapy

Buber, M. (1996). I and Thou (W. Kaufmann, Trans.). Simon & Schuster. (Original work published 1970)

Cooper, M. (2016). Existential psychotherapy and counselling: Contributions to a pluralistic practice. SAGE.

Cooper, M. (2019). Integrating existential and relational practices. Routledge.

Geller, S., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. American Psychological Association.

Johnson, S. (2019). Attachment theory in practice: Emotionally focused therapy (EFT) with individuals, couples, and families. Guilford Press.

Kleinplatz, P. J. (2012). New directions in sex therapy: Innovations and alternatives (2nd ed.). Routledge.

Kleinplatz, P. J., & Ménard, A. D. (2023). Better sex through mindfulness and meaning: An existential–humanistic approach. Routledge.

Levin, R. J. (2019). Human sexuality: A biopsychosocial overview. Springer.

May, R. (1981). Freedom and destiny. W. W. Norton.

May, R. (1983). The discovery of being: Writings in existential psychology. W. W. Norton.

Mearns, D., & Cooper, M. (2005). Working at relational depth in counselling and psychotherapy. SAGE.

Schneider, K. J., & Krug, O. T. (2017). Existential–humanistic therapy (2nd ed.). American Psychological Association.

Spinelli, E. (2007). Practising existential psychotherapy: The relational world. SAGE.

van Deurzen, E. (2012). Existential counselling and psychotherapy in practice (3rd ed.). SAGE.

Yalom, I. D. (1980). Existential psychotherapy. Basic Books.