Evolution of Sex Therapy Fact Sheet


by David Piltz, MA, MFT


            Fascination with sex is as old as the Bible. In Genesis Chapter 4 from the NIV translation it is written that Adam and Eve lay with each other and conceived a child. Since that dawning of time, ancient civilizations concerned themselves with sexual issues in a variety of ways such as but not limited to aphrodisiacs, sex manuals and the notion of erotica and erotic experiences (Goodwach, 2005). When the issue of uncovering the reason why there was sexual issues, the ancients attempted to describe the issue in terms of physical, metaphysical, biological and spiritual terms but lacked the comprehensive knowledge of the psyche (Berry, 2013). As discussed by Berry (2013), a brief timeline of sex therapy would begin with the ancients in before the common era time (B.C.E) and the same framework (as just described) continued until the middle ages.  Between the middle ages and the Renaissance Period (1600s-1700s) the church was a focal point of sex education and solutions to sexual issues. The Renaissance Period began to lay the framework for understanding sex and sexual issues through the lens of the psyche. In the late 1800s and the early 1900s psychiatry focused on sexual issues and minds like Freud and his contemporaries took charge of explaining how childhood experiences are rooted in sexual development. In the early twenty century Masters and Johnson with their cognitive behavior approach and their contemporaries used psychological interventions to help individuals with sexual issues. As systems approaches to therapy became researched an understood in the twenty-first century, a biosocial systems approach was applied to sexual issues and was naturally integrated into the Marriage and Family systems approach.

Key Facts of the Evolution of Sex Therapy

            Krafft-Ebing. Focused on the role of biology in explaining, diagnosing, and solving sexual issues. He believed that sex and sexual issues were a connection between the somatic and the mind in essence affirming the importance and impact of unconscious processes on behavior (Berry, 2013).

Freud. Created a model that explained sexual issues in youth, young adult, and adult lives based on early childhood experiences. These early childhood experiences formed an individual’s understanding of sexuality through the interaction of the three erogenous zones (mouth, anus, and genitals). How development occurred and what stunted development described later issues dealing with sexuality (Goodwach, 2005).

Havelock Ellis. Promoted the biopsychosocial model of explaining and understanding sexual issues. This begins the framework of the systems approach in which there is more than one component of a person’s life (biology, social, psychology, family, etc.) that explains current concerns. This framework suggests the explanation lies in the interconnectedness of all elements of the system (Berry, 2013).

Alfred Kinsey. Used surveys to conduct the largest survey of human sexual behavior and legitimized the female experience. The results began a revolution around sexual behavior and began to open the lens of the meaning of sexual behavior (Goodwach, 2005).

Masters and Johnson. Pioneered the use of cognitive behavior therapy interventions into working with sexual issues while Helen Singer Kaplan combined cognitive behavior therapy with psychoanalytic principle (Berry, 2013).

Systems Approach. Currently there is much emphasis in using a systems approach to understand, discuss and help with sexual issues. This systems approach is similar to the systems approach used in Marriage and Family therapy (Weeks, Gambescia, & Hertlein, 2015).

As a Marriage and Family Therapist I view sex therapy in the following way:

  • It is critical to understand one’s own sexuality beliefs and where they originate from. If this understanding doesn’t exist the likely hood of transference and countertransference is high and could damage the therapeutic alliance.
  • A deeper knowledge of sexuality is needed. Prior to becoming a therapist, I had worked in fields dealing with sexuality that used Masters and Johnson’s material, the Kinsey Institute. In addition, I read books like Extended Sexual Orgasm and learned about Tantric Sex. This deepened my understanding of sexuality.
  • As a Marriage and Family therapist I deeply believe in the systems approach and therefore sexual issues would not be different. Working with an individual or couple needs to be within a systems frame.
  • Over the years, sexuality is being discussed in more complex and complicated ways and therapists must adapt so they can create an effective therapeutic alliance with their clients.


Weeks, G., Gambescia, N., & Hertlein K., (2015). Sex therapy: A panoramic view. In Gambescia, Weeks & Hertein (Eds). Systematic sex therapy, 2nd Edition (pg. 276-298). New York: Routledge

Berry, M. D. (2013). The history and evolution of sex therapy and its telationship to tsychoanalysis. International Journal Of Applied Psychoanalytic Studies, 10(1), 53-74. doi:10.1002/aps.1315

Berry, M. D. (2013). Historical revolutions in sex therapy: a critical examination of men’s sexual dysfunctions and their treatment. Journal Of Sex & Marital Therapy, 39(1), 21-39. doi:10.1080/0092623X.2011.611218

Goodwach, R. (2005). Sex therapy: Historical evolution, current practice. Part I. Australian & New Zealand Journal Of Family Therapy, 26(3), 155-164.