This session of our Sex Plus Symposium covered the topic of rewriting sexual scripts with Ian Kerner, Ph.D., LMFT.

Dr. Kerner is a licensed psychotherapist and nationally recognized sexuality counselor who specializes in sex therapy, couples therapy and working with individuals on a range of relational issues that often lead to distress. 

Kerner is regularly quoted as an expert in various media, with recent features in The Atlantic, The New York Times, The Economist and NPR among others. He contributes regularly on the topic of sex for CNN Health. He also lectures frequently on topics related to sex and relationships, with recent presentations for the Psychotherapy Networker Symposium, Ackerman Institute, Tony Robbins, Goop and TED 2021. 

Kerner is the New York Times best-selling author of She Comes First which has been translated into more than a dozen languages. In addition to being a Clinical Fellow of the American Association of Marriage and Family Therapists (AAMFT), Kerner is certified by the American Association of Sexuality Educators, Counselors and Therapists (AASECT) and is also a member of the American Family Therapy Academy (AFTA) and the Society for Sex Therapy and Research.

Read on to learn what Dr. Kerner shared with us for demystifying sex therapy and writing sexual scripts. 

Demystifying Sex Therapy

Often patients know what they’re experiencing with sexual dysfunctions, but they often don’t know why. 

Couples or individuals come to therapy with symptoms such as low libido, a discrepancy in sexual desire, performance anxiety, sexual function issues, erotic control, sexual trauma or a sexual secret. 

At times, people can be ashamed of what they’re experiencing and hide behind another diagnosis.

It requires looking at different sexual issues with a biophsychosocial magnifying lens to get to the bottom of an issue. This means looking from a biological perspective for factors such as age, exercise and diet, a psychological/sociological lens with factors like education, economic status and sexual openness and taking into consideration relational factors such as relationship history, gender roles and desire discrepancies.

It comes down to starting with a simple “tell me about the last time you had sex” during therapy to work on a solution.

Sex in Action

Beginning treatment for any sexual issue with the open question about the last time a couple had sex allows for the understanding of sex in action between two individuals. 

To start, answer some of these questions:

• How did you decide to have sex?

• Who initiated?

• When and where did it occur?

• How did you generate sexual excitement — with your bodies? With your minds?

• How did you amplify and intensity the arousal?

• What behaviors did you engage in?

• What behaviors didn’t you engage in?

• What was off-limits? Why?

• Who had orgasms? Who didn’t?

• What was the emotional and psychological impact of the experience? 

• Did sex leave you motivated to have more?

Cognitive and psychological rigidity can make it very hard to overcome different sexual issues. 

Deciding that an individual is the “problem” with a sexual relationship due to a dysfunctional issue such as premature ejaculation is not the answer in a monogamous relationship. Between a couple, a sexual event that doesn’t focus on one individual’s issue is needed.

There is a narrative to a sexual event with a sequence of interactions. There is a beginning, middle and end. A person begins in a non-aroused place and sex happened. There are interactions that are physical, emotional and psychological. 

Together, these interactions write the “sex script”. 

In part two of our session with Dr. Ian Kerner, we’ll explore the different phases of a sex script and why having one matters for a meaningful sexual experience.