Sex therapy has often been characterized as a set of specialized skills revolving around an understanding of dysfunction and specific techniques that hold the key to change. While not discounting the importance of specific knowledge and understanding, this article contends that those factors need to be integrated with new understandings of relational patterns and unconscious processes. The author highlights the usefulness of an integrative approach that employs appropriate permissions and information but posits these in a wider relational context. The predisposing factors for the development of sexual patterns are seen as both biology and constructs from our early relational needs. A relational paradigm is used to examine their maintenance within a couple or interpersonal setting as well as implications for the therapeutic relationship. These ideas are developed with several case studies.
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