Sex Counselor & Therapist – Career, Salary & State Licensure
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The experience of sex and sexuality is one that touches each and every human alive. Although sexual health, sexual identity, and sexual pleasure can be a monumentally joyful, connective, fun, and exciting aspect of humanhood, it can also be the home for intensive and consuming confusion, struggle, misinformation, mystery, and trauma. To confront the latter sexual issues in order to move into peace, understanding, or to cultivate a healthier relationship to sexuality, sex counselors and sex therapists can be helpful.
According to the Mayo Clinic, sex therapy is a specialized type of psychotherapy provided by licensed mental health professionals who have advanced training in issues related to sexuality. Sex therapy and sex counseling utilize the same methodologies for intervention as other forms of therapy or counseling, but in a way that is especially suited to sexual issues. Unlike sexual surrogates or sexual bodyworkers, sex therapists help clients to heal or handle sexual issues without ever physically touching a client. Just like therapists or counselors who work with other mental health issues, sex therapy and counseling are generally talk-based.
Mental health or medical professionals best suited to sex therapy or sex counseling are those who are willing to do the work of examining their own cultural biases regarding sex and sexuality, developing comfort in discussing a wide range of sexual issues, and those who are also willing to train beyond what is offered in classic mental health or medical programs.
In addition, many sex therapists or sex therapists will practice sex therapy within a certain niche (e.g., in communities of color, LGBT communities, trans issues, women’s issues, couple’s therapy, etc). To prove this basis of quality in work, some sex therapists will choose to pursue certification from the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) —the gold standard for sex therapy certification in the US.
For those interested in sex therapy, the following details one pathway a professional can take to become a certified sex therapist, what these high-qualified professionals do, earning potential for sex therapists and counselors, and other helpful resources for those looking to break into sex therapy or sex counseling.
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How To Become a Sex Counselor or Certified Sex Therapist
The following guide will provide one pathway that someone could take to become a sex counselor or sex therapist, with emphasis put on becoming certified by AASECT.
Step 1a: Earn a Bachelor’s Degree in the Humanities (Four Years)
The first step on the road to becoming a sex therapist is to create a foundation of knowledge rooted in the disciplines sex therapists use on a regular basis. Because sex therapy is a profession that requires post-master’s training, there is a wide range of options for bachelor’s degrees that a future sex therapist could pursue. Generally, choosing a bachelor’s degree that focuses on people or services provides an appropriate beginning to the formalized training required to become a sex therapist.
The following is a list of bachelor-level degrees that an aspiring sex therapist could choose to pursue:
- Social Work
- Sexuality Studies
- Gender Studies
- Asian Studies, African American Studies, Latinx Studies, Native American Studies, etc.
- LGBT Studies, Queer Studies, etc.
- Interdisciplinary Studies
Since certification requires a minimum of a master’s degree, those interested in sex therapy can benefit from looking up admissions requirements for different master’s degrees to see which bachelor’s degrees qualify them for acceptance into master’s programs.
Step 1b: Take Human Sexuality Coursework
Regardless of which bachelor’s degree a future sex therapist chooses, taking human sexuality coursework is essential to cultivating the comfort around and knowledge about sexuality required to become an effective counselor or sex therapist. In addition, AASECT certification for sex therapy requires a broad knowledge of human sexuality issues, and the earlier one starts, the more prepared one will be when pursuing certification.
Step 2: Earn a Master’s Degree, Preferably with Clinical Requirements and Psychotherapy Training (Two to Three Years)
At the master’s degree level, the choices for discipline narrows. Those interested in becoming AASECT certified sex therapists should choose accredited master’s programs that include clinical hours and training in psychotherapy. To practice as a licensed therapist who offers sex therapy services, psychotherapy training is not required. However, to become an AASECT certified sex therapist, a counseling professional must be able to practice psychotherapy independently in their state of practice.
Disciplines that an aspiring sex therapist could choose for their master’s program include:
- Social Work
- Marriage and Family Therapy (MFT)
Some programs in these disciplines offer a direct step into sex therapy, while others will require students to pursue education beyond the master’s in order to gain the expertise needed to pursue sex therapy. For example, North Central University offers a master of art in marriage and family therapy with the option to specialize in systemic sex therapy. A program like this is designed to prepare students for a career in MFT focused on easing sexual dysfunction—a direct pathway to sex therapy.
If a future sex therapist were to pursue a master of social work (MSW), like the online program offered by the Tulane University School of Social Work, there are no sexuality-specific courses and no psychotherapy-focused coursework. Aspiring sex therapists choosing this path may need to earn a second master’s, a post-graduate certificate, or a PhD in order to move into sex therapy.
Step 3: Obtain an Associate License from the Local State Board (Timeline Varies)
In order to practice mental health services in most states before full licensure, recent graduates must obtain an associate license. This license clears the graduate to practice under supervision in order to gain the full number of hours required to become a licensed mental health professional.
As an example, here are the requirements to apply for an associate license in marriage and family therapy from the Board of Behavioral Sciences in the state of California:
- Completed application
- $75 fee
- Transcripts & Degree Program Certification
- Background Statement
Step 4: Practice and Collect Supervision Hours in Sex Therapy, If Possible (Two Years Minimum)
At this step, aspiring sex therapists must begin to accrue the experience needed to earn the mental health licensure to practice independently in their state. The number of supervised hours varies from state to state, and so it is important that a professional visit their local board’s website to understand the exact requirements for mental health practice licensure.
AASECT certification and education beyond a master’s degree are not necessary in most states to practice as a mental health professional who provides sexuality services. As this is the case, a prospective sex therapist who does not plan to advance their education should seek out supervision opportunities with a mental health professional in their field who provides sexuality counseling, therapy, or services. Mental health professionals who are seeking AASECT certification (see step 7) should seek clinical supervisors who are already AASECT certified.
Important note: Supervision hours require a mental health associate to pay a licensed mental health professional. Rates for supervision vary but are often the licensed professional’s billable rate.
Step 5: Become a Licensed Mental Health Professional (Timeline Varies)
This step will vary quite widely depending on the discipline a prospective sex therapist chooses for their master’s program and the state in which one practices. It is important that those applying for licensure do their due diligence in understanding the requirements specific to their state and their discipline.
Common licensures that an aspiring sex therapist may pursue include:
- Licensed Clinical Social Worker (LCSW)
- Licensed Professional Clinical Counselor (LPCC)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Educational Psychologist (LEP)
- Licensed Independent Social Worker (LISW)
- Licensed Mental Health Counselor (LMHC)
The following is an example of the requirements to become an LMFT through the Board of Behavioral Sciences in California:
- A master’s degree from a nationally accredited university.
- Registration as an associate marriage and family therapist (AMFT).
- Criminal background check.
- Passing score on the California law and ethics exam.
- 3,000 supervised hours accumulated over 104 weeks (minimum).
- Passing score on the LMFT clinical exam.
- Complete initial license request for $130.
Step 6: Earn a PhD or Post-Graduate Certificate (One to Six Years, Optional)
Aspiring sex therapists whose master’s program did not provide sexuality training and/or psychotherapy training, or who are looking to specialize or deepen expertise can engage in further formalized training by participating in a PhD program or by enrolling in a post-graduate certificate program. Choosing between a PhD or post-graduate certificate will depend deeply on the aspirations and goals of the aspiring sex therapist.
Because the journey to becoming a sex therapist is not straightforward, having a PhD can increase patient and employer feelings of trust and buy-in. This requires the trade-off of longer training thresholds, higher tuition, and the need to complete a dissertation and/or capstone project. Post-graduate certificates require a less intensive time commitment, a cheaper price tag, and a broader range of disciplines, but don’t hold the same cultural gravitas as a PhD.
Here are examples of PhD programs that can move a licensed medical health professional toward a career as an AASECT-certified sex therapist:
- International Institute of Clinical Sexology – Clinical Sexology PhD
- The American Academy of Clinical Sexology – Clinical Sexology PhD
- California Institute of Integral Studies – Human Sexuality PhD
- Widener University – Human Sexuality Studies PhD
- Atrium Health – Psychiatry Residency (For Medical Doctors)
The following examples of post-graduate certificates include those specifically designed to push licensed medical health professional toward sex therapy, and those programs that could help aspiring sex-therapists to train with the intention of carving out a therapeutic niche:
- University of Michigan School of Social Work – Sex Therapy Certificate
- University of Minnesota Medical School – Human Sexuality Certificate
- The New Earth Institute of Southwestern College – Human Sexuality Certificate
- Northcentral University – Certificate in Gender Diversity
- Alliant International University – Certificate in LGBT Human Services and Mental Health
- The George Washington University – Psychiatric Mental Health Nurse Practitioner
Step 7: Apply for AASECT Certification in Sex Therapy (Optional, Timeline Varies)
The following are the requirements for becoming an AASECT certified sex therapist:
- Membership in AASECT
- Adherence to the AASECT code of ethics
- A master’s degree and two years post-degree clinical experience, or a PhD and one year of experience
- A valid state license to practice psychotherapy independently in psychology, medicine, social work, counseling, nursing, or marriage and family therapy
- Ninety clock hours of academic coursework in human sexuality that cover 16 core knowledge areas
- Sixty clock hours of sex therapy training, 30 of which must be in-person hours
- Ten clock hours participation in AASECT sponsored or approved sexuality attitude readjustment (SAR) experiences
- Three-hundred hours of AASECT supervised clinical treatment, 50 of which must be with an AASECT certified supervisor of sex therapy
- $300 application fee and application requirements (application, official transcripts, copy of mental health license, supervision endorsement, proof of SAR experience, CV)
AASECT certification must be renewed every three years.
What Do Sex Therapists and Sex Counselors Do?
Sex therapists and sex counselors are mental health professionals who treat sexual dysfunction and encourage open, honest conversations around sexuality with clients. While there is an emphasis on sex and sexuality in the practice of a sex therapist or counselor, some duties are the same as counselors in other disciplines. Sex therapists will encourage discussion of emotions and experiences with clients, help clients to process life changes, guide clients through future decision making, and help clients to develop coping strategies and adaptive behavioral changes.
What differentiates sex therapists and counselors from mental health professionals in other disciplines is that they have undergone advanced training to provide effective help to those struggling with or exploring sexuality. Toward this end, sex therapists do deep personal work to understand their own values and opinions regarding sexuality, how these values and opinions affect the way they practice, and how these values and opinions set them up to successfully work with certain demographics (or not). In addition, sex therapists often obtain a comprehensive scientific understanding of human physiology and psychology in regard to sex and sexuality.
On a day to day basis, sex therapists may assist clients with struggles including:
- Sexual identity
- Body dysmorphia
- Overcoming and/or managing the impact of sexual trauma
- Overcoming the impact of sexual shame
- The impact of race on the experience of sexuality
- Differential levels of desire in couples
- Physiological sexual struggles (erectile dysfunction, delayed ejaculation, orgasm struggles, post-disease sex, etc.)
- Porn and/or sex addiction
- Sex and faith
Sex therapists can be self-employed, work in counseling groups, outpatient care centers, hospitals, government agencies, or a combination.
Sex Therapy Professional Associations & Resources
- American Association of Sexuality Educators, Counselors, and Therapists (AASECT)
- American Board of Sexology (ABS)
- International Association for the Study of Sexuality, Culture and Society (IASSCS)
- Commission on Accreditation for the Marriage and Family Therapy Education (COAMFTE)
- International Institute for Trauma and Addiction Professionals (IITAP)
- International Society for Sexual Medicine (ISSM)
- Sexuality Information and Education Council of the United States (SIECUS)
- Society for Sex Therapy and Research (SSTAR)
- Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues
- Society for the Advancement of Sexual Health (SASH)
- Society for the Scientific Study of Sexuality (SSSS)
- World Professional Association for Transgender Health (WPATH)