Psychosexual therapy


1 October 2026


Since Masters and Johnson, psychosexual couple therapy has largely been about behavioural change. Sensate focus, a graduated programme of mindful touching, aimed to reduce sexual anxiety step by step.


A psychodynamic approach starts somewhere else. Instead of trying to quell the anxiety, it asks: what is this anxiety saying, and what is it doing?


Freud came to see anxiety as a signal of approaching danger, and the symptom as

what spares us from facing it. A loss of arousal, or an erection that fails at the decisive moment, can be heard this way: as an inarticulate form of speech, and as a way of avoiding something that would make us more anxious still.


Hearing it means listening for where the desire of others (parents, family, society, and now our partner) has become tangled with our own. In my experience, sexual anxiety is less often about fear of abandonment than fear of closeness. Really, these are two sides of the same uncertainty. One is the fear that a partners desire will be withdrawn. The other is the fear of what that desire is when its fully present. Both come down to not knowing what we are to the other person.

Lacan located anxiety precisely here: not in loss, but in the moment another person comes too close and we can't read what they want of us. The bedroom is where a partner's desire is most present and hardest to read.


Couples often try to settle this uncertainty by asking for proof: tell me you want me. But desire cant be guaranteed, so the reassurance never quite holds.The work, then, isnt to remove the uncertainty. Its to help each partner tolerate not knowing the others desire, and to stop needing that guarantee before risking their own.

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