Mention sex therapy and most people would think it’s all about having better sex, such as how to experience better orgasms or improve their bedroom performance.

Sex therapist Tammy Fontana insists that this couldn’t be further from the truth.

She explains, “Sex therapy is not really about how you do it ― the most important aspect is one’s relationship with their spouse. Sex has to do with power dynamics in the relationship, and how people conceptualise and think about sex. 

She adds, “Nobody is going to be having sex in a relationship where there’s lots of conflict. So, relationships and sex go hand-in-hand and aren’t separate.”

Fontana, a certified sex therapist at All in the Family Counselling for eight years, helps couples achieve a healthy sex life by breaking down misguided ideas and beliefs about sex.

“Nobody is going to be having sex in a relationship where there’s lots of conflict... Sex therapy is really about relationships, and what couples need to do to maintain a good relationship, thereby improving intimacy.

She says, “I get people coming to me because for 25 years, they were told sex is dirty and shameful. And then when they get married, that belief system doesn't go away. Subsequently, they have a marriage problem because it’s been drilled into their head that sex is something negative.”

Fontana tells SmartParents about her vocation, which includes dealing with common sex issues and how parents can talk to kids about this tricky subject.

Why did you choose to be a sex therapist?

I want to help couples, and sex is a part of every grown-up relationship. Many marriage therapists are not clinically trained in sex therapy, so there’s this whole area of a relationship that gets left out.

In order to provide my clients with the best possible care and outcome, we need to be able to talk about sex. Even when couples come in with non-sex-related issues, they need to have proper information, understanding and tools about sex.

How do you become a clinical sex therapist?

You first need your basic master’s degree. You also need ongoing training in various theories and therapies, such as cognitive behavioural therapy, systemic therapy and trauma therapy. And all this time, you need to have a senior therapist oversee your work until you get enough hours and experience in clinical work.

Once you have sufficient clinical experience, you need specialised training. I’ve been engaged in five years of continuous private training with more experienced therapists. So it’s an ongoing process, where you’re working with clients and doing case consulting with a senior therapist.

How do you describe sex therapy to people who haven’t heard of it?

I wouldn't necessarily call it sex therapy. I would just say, If you're not having the life that you want and are frustrated with the quality of your relationship (one aspect being sex), I can help you with that.

In adult relationships, things that have nothing to do with sex affects sex. If you’re not cleaning the house or helping with the kids, these are things that I’m not going to find very attractive. Or if you’re yelling at me all the time or irresponsible with finances, this kills my sexual desire for you. Sex therapy is really about relationships, and what couples need to do to maintain a good relationship, thereby improving intimacy.

Are Asians more conservative when talking about sex than their Western counterparts?

In general, people are uncomfortable talking about sex ― Asians aren’t any different. There may be more sexualisation in Western cultures, but that doesn’t mean people are necessarily comfortable talking about sex ― even with the person they're having sex with! People have a hard time articulating what they like or don’t like in the bedroom, or admitting they are sexual.

Do you see patients singly or in pairs? What if one person wants sex therapy and the other doesn’t?

I see both individuals and pairs. I advise couples not to force their other half to come for therapy if they don’t want to. If you want to work on your marriage, you can come in and do so on your own. You have 100 per cent control over your half of the marriage. Don’t make this into a power struggle ― where you refuse to work on your marriage unless the other person does.

What common sex issues do you handle?

Conflicts in communication, mismatch in sexual desires, not knowing how to adjust one’s sex life following the birth of children.  Also, not knowing how to handle initiating sex and dealing with turning down sex.

Other issues include being unable to relax and enjoy sex, fear of orgasm, vaginismus, not being able to maintain an erection, and other fertility issues that change one’s sex life.

How do you address the issue of pain during sex?

Vaginismus is usually related to anxiety, a fear of pain and negative beliefs around sex. Addressing it is a fairly lengthy process ― we address the negative beliefs, as well as learn how to relax. Sometimes, people use dilators as well.

Treatment is customised based on the individual ― and will differ based on a person’s mental flexibility and their motivation to work and change.

“A lot of people think therapy is advice-giving, and that I'm like Google telling them what to do. Eventually, I do. But in order to get to that stage, we have to build a relationship where we get to know and trust one other.”

Do you help couples who can’t conceive because of sexual issues? 

We can’t use sex therapy as a shortcut to getting pregnant. If couples want to work on their sex life, we can work on that. But focusing on conceiving is best left to an obstetrician.

Sex therapy is about pleasure and enjoyment when having sex. In contrast, getting pregnant is work. Conceiving is not the same as having an enjoyable sex life.

How exactly do you carry out your treatment?

A lot of people think therapy is advice-giving, and that I'm like Google telling them what to do. Eventually, I do. But in order to get to that stage, we have to build a relationship where we get to know and trust one other.

Then, I start to learn how people think, what their beliefs are and how they approach things. I can then hold up a mirror to help them become aware of self-limiting behaviours. And as mentioned, everything is customised because people have different skill sets and levels of emotional development.

What frustrates you about your patients?

Nothing really! My clients are often teaching me things, too. It’s amazing to see how resilient and brave people are. Therapy is very, very hard work. Very few people will engage in it because it requires people to grow and develop. That is challenging and very few people have the courage or stamina for it.  I’m always impressed by my clients and the team that we form.

Any tips for parents on how to explain sex to their kids?

I do help parents develop the skills to explain to kids about sex. Because if you're not comfortable with sex and sexuality, you will transmit that to your children. We have to give healthy messages about sex, but aligned with proper values like responsibility in order to keep kids safe.

Parents need to be very solid on their own understanding of sex. And they need to have clinically factual information. Also, they should be okay with their own sexuality and calling body parts by their name. If they're not, they should get educated on that.

It’s been said that the brain is the most powerful sex organ. Do you agree?

Absolutely. That’s where sex and sexuality lie. The genitals are very simple organs. But what gets in the way of sex is relationships and how the other person makes me feel (mentally and emotionally). If I don’t feel respected, safe or trusted, this is not going to turn me on.

What gives you satisfaction about this job?

Working with clients, helping them grow and seeing them get better lives. For example, better relationships with their partners, with themselves and their children.

Have you ever had to give up on a person or couple during treatment?  

No, I’m always there for the long haul. It’s usually the clients who will make that decision. My focus is always about building the relationship with them ― so, we’re a team addressing difficulties, setbacks and frustrations together.  

“Sexuality is in your mind, it’s not something that you can buy.”

How do you keep abreast of your profession and new developments in the industry?

I'm constantly doing training multiple times a year. I also continue to work and consult with other therapists as well. For me, training is a huge part of what I do and essential for becoming a good therapist.  

Has the digital age made it easier for you, work-wise?

It makes it much easier, especially now with the pandemic. I've actually been doing online therapy for over five years with clients around the world. What you need in therapy is regular weekly sessions. So, with clients who are travelling or live far away, we can constantly meet through the use of the technology.

Any useful sex advice to offer to couples?

If you're not happy with your sex life, seek professional help. Your beliefs (the negative associations) about getting help is the thing that’s stopping you from having a better life.

Please complete these sentences….

The most overrated aphrodisiac is… All of them! Sexuality is in your mind, it’s not something that you can buy.

My favourite way to unwind is… Cycling.

My favourite holiday spot is… Zagreb, Croatia.

My favourite TV show is…I don’t really watch TV ― I prefer reading, especially poetry.

My go-to recipe is… Eggs with red cabbage ― I always eat very healthy.

If I were not a therapist, I would be a…Probably still involved in therapy! I used to do technology sales many years ago.

The most useful app on my phone is… Zoom!

The one thing I struggle to do most is… I don’t think I really struggle with anything ― I’m a pretty determined, highly motivated, disciplined individual.

If I could travel to another time period, it would be… Anytime before the pandemic! I don’t think I would want to go back to any historical period ― it wasn’t such a good time for women then.

I would love to have a meal with… Probably my great, great grandparents. I'd love to meet them and hear about what their life was like.

The most encouraging advice you would give to patients… Don’t let your fear of failure and rejection stop you from achieving what you want.

Photos: Tammy Fontana and iStock

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