Sexual Self-Help vs. Sex Therapy: Which Works Better?
When self-help works, people have no reason to consult sex therapists
I’ve written three sexual self-help books, the most recent, Sizzling Sex for Life: Everything You Need to Know to Maximize Erotic Pleasure at Any Age. Many sex therapists are very supportive of self-help approaches. Some have written self-help books themselves, and many recommend books (“bibliotherapy”) and other self-help resources. Studies show that 88 percent of people with sex problems try some form of self-help before consulting a professional—almost nine out of ten.
But some sexuality professionals disparage the self-help genre as cookbook, simplistic, and ineffective. I have tremendous respect for sex therapy and often recommend it, but at one national sexology conference, I heard a prominent sex therapist insist that self-help books were useless, that his practice overflowed with couples who’d gained nothing from them. Duh! When self-help works, people have no reason to consult sex therapists.
Studies That Indicate Self-Help Improves Lovemaking
In addition to being myopic, this gentleman had also failed to keep up with sexology research. Many studies show that self-help improves lovemaking:
• Dutch researchers divided men with premature ejaculation or erectile dysfunction (ED) into two groups, wait list or self-help. The latter explored a Website that presented standard sex-therapy recommendations. After six months, the wait-list group reported scant improvement, but among the self-helpers, the majority reported substantial benefit.
• This same team offered other men with PE or ED twelve weeks of web-based sex information and brief e-mail Q&A. Months later, two-thirds reported significant improvement.
• Then these same investigators recruited 117 women suffering vaginal muscle spasms that make intercourse painful or impossible (vaginismus). They were randomized to a wait list, a self-help book, or professional therapy (ten two-hour group sessions). After a year, no one in the wait-list group improved. But the inexpensive self-help book worked almost as well as much more costly professional therapy.
• German researchers assigned 70 women with vaginismus to a wait list or to a website that provided information and other recommendations. After six months, the self-help group reported significantly less discomfort and more enjoyable sex.
• One of women’s leading sexual complaints is little or no libido. University of Florida researchers placed 22 such women on a wait list and gave 23 others a self-help book, A Tired Woman’s Guide to Passionate Sex by sexologist Laurie Mintz, Ph.D. It presents a self-help version of sex therapy for low libido. In the wait-list group, 5 percent reported increased desire, among the book users, 54 percent.
Among low-desire women, sex therapy usually helps some 50 to 60 percent while, depending on the study, drug treatment (flibanserin) helps 15 to 50 percent. The self-help book was approximately as effective as the drug or professional therapy—but cost less and caused no side effects.
• Finally, researchers at Concordia University in Illinois analyzed 70 studies of self-help for all sorts of problems. It showed little benefit for weight loss and drug addiction, but remarkable effectiveness for sex problems.
It’s no surprise that sexual self-help usually works. A great deal of sexual misery stems from lack of information and mistaken beliefs. When authoritative information corrects mistaken beliefs, many people benefit quickly.
Professional Therapy Can Work Somewhat Better Than Self-Help
It’s also no surprise that professional therapy works somewhat better than self-help. Sex therapy is tailored to individual needs, and many studies show that, independent of the therapy itself, a supportive, face-to-face relationship with a trusted professional is beneficial. But in a nation of 325 million, sex therapists and coaches number only a few thousand, and their services cost more than many can afford. Self-help books work almost as well for the price of a large pizza.
Self-help books provide substantial benefit to around two-thirds of those who use them. For the other third, sex coaching or therapy help about two-thirds. This leaves around 10 percent of sexual issues resistant to therapy—usually because of severe medical conditions or psychological problems.
What Should A Person Do?
If you have a sex problem:
• Think twice before giving much credence to Internet sex information. Some is accurate, but much is not, and it can be difficult to distinguish the good from the bad. Look for research citations—and not just one study, but several.
• Next, try a self-help book or two. Many provide practical, reasoned, research-based information, but some are wanting, especially books about curing alleged sex/porn addiction. Again, look for citations. My book, Sizzling Sex, is entirely evidence-based. I cite more than 2,500 research papers.
• After trying self-help, if difficulties persist, consult a coach or therapist, or a sexually informed medical provider. To find a sex coach near you, visit the World Association of Sex Coaches. To find a sex therapist, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology. To find a sexual medicine specialist, visit the Sexual Medicine Society of North America.
[scroll down for related Questions & Answers]
References
Marrs, R.W. “A Meta-analysis of Bibliotherapy Studies,” American Journal of Community Psychology (1995) 23:843.
Mintz, L.B. “Bibliotherapy for Low Sexual Desire: Evidence for Effectiveness,” Journal of Counseling Psychology (2012) 59:471.
Palaniappan, M. et. al. “Skills Vs. Pills: Comparative Effectiveness for Low Sexual Desire in Women,” Journal of Sex and Marital Therapy (2018) 44:1.
Van Diest, S.L. et al. “Sex Therapy Through the Internet for Men with Sexual Dysfunctions: A Pilot Study,” Journal of Sex and Marital Therapy (2007) 33:115.
Van Lankveld, J.J. et al. “Cognitive-Behavioral therapy for Women with Lifelong Vaginismus: A Randomized Wait-List Controlled Trial of Efficacy,” Journal of Consulting and Clinical Psychology (2006) 74:168.
Van Lankveld, J.J. et al. “Internet-Based Brief Sex Therapy for Heterosexual Men with Sexual Dysfunctions: A Randomized Controlled Pilot Trial,” Journal of Sexual Medicine (2009) 6:2224.
Van Lakveld, J. “Self-Help Therapies for Sexual Dysfunction,” Journal of Sex Research (2009) 46:143.
Van Lankveld, J.J. “Bibliotherapy in the Treatment of Sexual Dysfunction: A Meta-Analysis,” Journal of Consulting and Clinical Psychology (1998) 66:702.
Zarski, A. et al “Internet-Based Guided Self-Help for Vaginal Penetration Difficulties: Results of a Randomized Controlled Pilot Trial,” Journal of Sexual Medicine (2017) 14:238.
Questions & Answers
I’ve answered more than 12,000 sex questions from people around the world, of all ages, for free. Here are a few that relate to the topic of this post. If you’d like to ask me a question of your own, please go to GreatSexGuidance.com.
Over the last dozen years or so, my wife of 22 years has slowly withdrawn from sex. We used to do it twice a week. Now we’re down to once every few months. I can’t stand it. I’ve tried everything, but she just doesn’t seem interested. I considered leaving her, but we have a family, and except for the way sex has poisoned our relationship, we have a good marriage. Read more and my response…
My husband and I, 35 and 29, have been happily married for thee years, but have always struggled with intimacy. From the start, my husband has always been pretty happy just cuddling in bed with occasional sex here and there, like about once every month or two. I on the other hand, prefer to have sex more often about once weekly. We have been able to compromise with the frequency of sex, but one issue has remained. He does not seem very “in tune” to me while we’re being intimate. For example, while I give him oral sex, most times he lays there and doesn’t put a single finger on my body. I look up at him from time to time and he looks like he’s in another world. Read more and my response…
We met three years ago. I recall he had some degree of difficulty with erection on our first night together. I thought it was performance anxiety and didn’t pay much attention to it. We dated long distance for a while, and when together, he seemed as much interested in sex as me, disregarding occasional issues with erection. He moved in with me and that was the end of it. All of a sudden it seemed that he couldn’t care less about sex. Nothing turned him on. No sexy lingerie, no sexual innuendos. We fought and jeopardized the relationship over this but instead we got married and now have a baby. I married under the condition that we’d see a counselor, which we did for the past 10 months. As things improve between us, erections worsen. Read more and my response…