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Module 1 — Your First Sex Therapy Session
What to expect, and what never happens, when you first talk about sex.
Most people have never talked about sex with a therapist, and many couples put it off for years. This module walks you through a first session about sex with us, so you know what you are likely to be asked and what will not happen.
A framework, not a script. This is one way a first session can go. Every therapist at our center is an experienced clinician with their own way of working, and yours will shape the session to the two of you. It may run in a different order, or go somewhere else entirely, and that is how it should be.
Your first session about sex
Summary: what usually happens in the session
1 Your therapist says what will not happen. Nothing sexual happens in the session, and nothing happens at home that you have not both agreed to.
2 Your therapist gives you both a way to stop. Three words that pause anything, and permission to pass on any question.
3 You each say what brings you here. In your own words, out loud or written down first.
4 Your therapist asks about your body and health. Medications, sleep, pain and hormones, because many sexual problems have a physical side.
5 You name what the two of you already do well. Neurodiverse couples often bring strengths that standard advice misses.
6 Your therapist says where you will start. With a conversation about what it is like to talk about sex.
One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working.
Step 1. Nothing sexual happens here
Many people arrive worried that sex therapy means being asked to do something, or to describe things they are not ready to say. It does not. Everything in the session is talk. Nobody undresses, nobody is touched, and nobody is asked to show anything.
Nothing at home without two yeses. Anything you try between sessions is something you have both agreed to in the room first. The pace is set by whichever of you needs it slower. Nothing sexual needs to happen until both of you feel safe, clear and unpressured.
How your therapist opens. Everything we do in our sessions is talk. Nothing happens at home unless you have both said yes to it here first, and we go at the speed of whoever needs it slower.
Step 2. You both get a way to stop
Sex is the subject people most often go quiet about in therapy. So before any questions, your therapist usually gives both of you a way to stop. You can also pass on any question, with no reason given, and come back to it later or not at all.
You can always say it. If any of this starts to feel like too much, you can say I am uncomfortable. That is a complete sentence. Nobody has to explain it or defend it. We stop, we look together at what is happening, and we decide as a group whether to stay with it or to understand first what is getting in the way.
In a session about sex, most people wait too long to use it, because they do not want to seem fragile. Using it early is a sign the room is working. It takes a second to say and saves a much longer silence.
Passing on a question. You can pass on anything I ask. Just say pass. We can come back to it another time, or not at all.
What stays in the room. The same rules as the rest of your therapy with us. What you say stays between the three of you, with the few exceptions the law sets.
Step 3. What brings you here
Your therapist will usually ask each of you, in turn, what you would like to be different. Take your time before you answer. If it is easier to write it down first and read it out, that works too. Many of the people we work with find writing easier than speaking on this subject.
Often one of you arrives lonely, feeling unwanted or turned down one time too many. The other arrives feeling pressured, or unsure what is expected, or ashamed of not wanting what they are supposed to want. Both experiences are real, and both get room. Neither of you is the problem to be fixed.
Each row on the right is a module in this course, so you can read ahead on the one that fits.
Neurodivergence is part of it from the start. In a review of studies, many autistic adults reported wanting sexual contact.1 What gets in the way is more often practical: the senses, energy, hints that get missed, and how a request or a refusal lands. Your therapist will ask how each of these plays out for you, and How Neurodivergence Shapes Sex goes into them in detail.
The first question. What would you like to be different? Take your time. You can say it, write it, or tell me you are not sure yet.
Step 4. Your body and health
Your therapist may ask some practical questions: about medications, sleep, pain, hormones and any recent health changes. Many medications, including several common antidepressants, can lower desire or change how the body responds. So can poor sleep, stress, perimenopause and a long list of health conditions.
A medical check first, where it fits. If sex hurts, if erections, arousal or orgasm have changed, or if desire has dropped suddenly, your therapist will ask you to see a doctor as well. That runs alongside therapy, not instead of it. Some problems also need a specialist, such as a pelvic floor physical therapist, and your therapist will help you decide.
Many sexual problems have a physical side and a relationship side, so we look at both at the same time.
If you do not feel safe. This work is for relationships where both of you can say yes, no, wait or stop without being punished for it. If sex has happened under pressure, or if either of you is afraid of the other, tell your therapist on your own. Work on sex pauses while that is looked at. Your safety comes first.
Step 5. What you already do well
Before the hard part, your therapist may ask what already works. Most writing about neurodiverse relationships lists the problems. The couples we see also bring strengths that standard advice misses, and those strengths are what the work gets built on.
Most couples recognize two or three of these straight away, and find another once they look.
Neither of you needs a personality overhaul. A sex life that looks broken is often one that has not been designed yet.
The strengths question. Tell me one thing about how the two of you are together that you would not want to lose.
Step 6. Where you start
The first invitation is not to do anything sexual. It is to have a conversation about what it is like to talk about sex: what shows up in your body when the subject comes up, what you were taught about it, and what feels embarrassing. That conversation alone usually shifts the room.
Your therapist sets it up at the end of this session, and you have it together in the next one, with your therapist there. It is the subject of Talking About Talking About Sex.
Before the session
The workbook below is for before your first session about sex. Fill it in on your own. It takes about five minutes, and most of it is picking the closest option from a short list.
After the session, leave yourselves some quiet time. A first conversation about sex can leave people tired, raw or oddly relieved, sometimes all three. None of that means it went badly. If one of you wants to go over it once the call ends and the other does not, most couples find it easier to leave it for the next session.
If this is hard to do. If the thought of this session is too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard: embarrassment, worry about what will come up, or fear of letting the other down. That conversation is already part of the work, and you can bring it with you.
Will we have to do anything sexual in sex therapy?
No. Everything in the session is talk. Nobody undresses, nobody is touched, and nobody is asked to show anything. Anything you try between sessions is something you have both agreed to first, and the pace is set by whichever of you needs it slower.
What if I cannot answer a question about sex out loud?
You can take your time, write your answer down first and read it out, or pass on any question with no reason given. Many autistic and ADHD clients find writing easier than speaking on this subject. Either of you can also stop anything at any point.
Why does the therapist ask about medications and health?
Many sexual problems have a physical side. Some medications, including several common antidepressants, can lower desire or change how the body responds, and so can poor sleep, stress and perimenopause. If sex hurts or something has changed suddenly, your therapist will ask you to see a doctor as well, alongside therapy.
Will my session follow these steps exactly?
No. The module describes one way a first session can go, not a script. Every therapist at our center has their own way of working and shapes the session to the two of you, so yours may run in a different order or go somewhere else entirely.
Your workbook
Your answers save to this device only - we cannot see a word of what you write. Fill this in BEFORE your first session about sex.
Before you go in
Answer these on your own. There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact.
Right now, how easy is it for you to talk about sex with your partner? — Easy, Fairly easy, Hard, Very hard
Which is closest to why you are here? — Sex has disappeared, Touch feels hard, Rejection keeps blowing things up, Pain is involved, Talking is the problem, We want to design our own approach, Something else
How would you rather answer hard questions in the session? — Out loud, Written down first, Not sure yet
If a question is too much, do you think you will be able to pass or stop? — Yes, Probably, Probably not, No
Has anything changed in your health, medications, sleep or hormones in the past year that might matter here? — Yes, No, Not sure
Two things to bring
Write them here and, if you can, say them early in the session. If something is about your safety, tell your therapist privately instead.
One thing you would like your therapist to know before you start
One thing about the two of you that you would not want to lose
Where this comes from
Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson.
Research discussion
The shape of this session comes from our clinical work with neurodiverse couples. It has not been tested in a formal trial. The one research finding in the lesson comes from a review of 27 studies of autism and sexuality,1 in which many autistic adults reported wanting sexual contact. Those studies were mostly surveys of people who chose to take part, and none of them studied couples.
The point about medications and health is standard medical guidance rather than a finding of ours. It is why we ask you to see a doctor whenever your body may be part of the picture.
Who this research was done with. The studies behind this module, none of them of neurodiverse couples, drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you.
Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 5, 2026
Peer-reviewed research
1. Pecora LA, Mesibov GB, Stokes MA (2016) Sexuality in high-functioning autism: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 46(11), 3519-3556. https://doi.org/10.1007/s10803-016-2892-4 Systematic review of 27 observational and cross-sectional publications, nine of which were eligible for meta-analysis. Females reported higher levels of sexual understanding yet more adverse sexual experiences than males and than non-autistic comparisons; males reported greater desire for and engagement in solitary and dyadic sexual contact. The authors describe the findings as an initial characterization requiring further research. Limitation: cross-sectional and largely self-selected samples throughout; no couples data.
Further reading
• Neurodiverse Couples Counseling Center (2026) Neurodiverse Sex Therapy: a guide for neurodiverse couples on sex, desire and intimacy. Practice materials, Neurodiverse Couples Counseling Center. https://www.neurodiversecouplescounseling.com/sex The practice's guide this course is built from: the strengths many neurodiverse couples bring, the six common starting points, pacing, and the rule that the tools are for relationships where both partners can say yes, no, wait or stop. Limitation: clinical material developed in use, not a study.
Sex therapy for neurodiverse couples, at your pace
The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including on sex, desire and touch. Nothing sexual happens in our sessions, and nothing happens at home without two yeses. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing.
Up next
Module 2 — Talking About Talking About Sex