Question: I've never been in therapy before. What do I need to know, or what should I expect?

Answer: Well, this is a wonderful question. What you should expect is good, open, and authentic conversation with someone who will do their very best to understand you and thereby help you understand yourself. Awareness of our internal processes is everything. Through awareness we have choice and then through choice we can change. All I ask of you is that you are present and are willing to engage. Perhaps there is also something to think about when it comes to the subject of psychological suffering and the process of healing, which I have adapted from the writings of the psychoanalyst, James Hollis:

You may have to deal with your core issue/concern for the rest of your life. You may even start to win more of the battles you have in your ongoing conflict with yourself. Decades from now you will be fighting on your familiar battlefields, although the terrain may have shifted so much that you bearly recognise the same old, same old.

You will probably have to disassemble some of the many forces you have gathered to defend yourself against your wound. It is likely that your defences, not your wound, cause the problem and hinder your journey. However, removing defences means you may have to feel the discomfort of that wound again. Then the process of healing can begin as you re-experience the wound in the safety of the healing relationship with your therapist and as you construct and tell a new narrative for your life.

You will not be spared psychological pain, granted extraordinary wisdom, or be graciously given exemption from future suffering, although you might be armed with far better tools for regulating your emotions and keeping yourself grounded in the future.

This is at the heart of what it means to be human. We are in a constant and ever changing subjective relationship with ourselves, in our environment. It takes an enormous amount of courage to engage in psychotherapy - but let's be honest, what's the alternative?



Question: What if my partner doesn't want to come for therapy. Can you help us with our relationship if only one of us engages?

Answer: Usually, yes. Naturally, it would be ideal if both of you were able to attend, but I appreciate it's not always possible. The two people in a relationship are both responsible for the relationship they've created. You taking responsibility and dealing with your part of the relationship can have a dramatic impact on your partner and on the relationship. It also means you get to grow and develop and become a better version of yourself in the process. Your growth and development will not go unnoticed by your partner and who knows what affect it will have on them?


Question: Why do you focus so much on penises? Don't you care about vulvas and vaginas?

Answer: I care very much about vulvas and vaginas and I enjoy working with their owners. However, there are not many male psychosexual therapists and many men who need this type of help, often find it easier with a male therapist, which means the majority of my clients just happen to be male. But I also work with females too.


Question: How do I/we know if you can fix me/us?

Answer: This is a great question. We often think like this, don't we, because our day-to-day experience is that we go to the doctor with a problem and he 'fixes' it. Actually, if we look closer, that's not quite true. Our broken leg doesn't get fixed by the doctors, nurses, radiographer, and orthopaedic plastering technician. The team all work together to provide the attention and create the necessary environment for your body to do the actual healing of the bone. They treat it, but you heal it. And you do the healing in your own time, outside of the time you spent in the emergency department. Psychotherapy is similar. I may be seen as 'treating' your concern but actually in the time we have together I am providing the attention and creating the necessary environment for you to do the healing. The healing of your broken leg is dependant upon you resting it in the following months. If you walk on it every day, it's not going to mend well. In the same way, you need to attend to the work we do together in therapy. I will provide the space and the context and 'hold you' whilst you do your healing.


Question: What if I don't know what my problem is called?

Answer: That doesn't really matter. We like labels and an accurate diagnosis, don't we? Penis issues like Erectile Dysfunction, Premature Ejaculation, or Delayed Ejaculation; and indeed vulva and vagina issues like Vaginismus, Vulvodynia, and Dyspareunia, often have some overlap and they're not always as clearly defined as we'd like them to be. If I am in any doubt about your condition, I will send you to the appropriate doctor to get checked out anyway. If the doctor is of the opinion that the root of your condition is not physical, then I will use my working definitions of what Premature Ejaculation is, for example, even if it doesn't match perfectly with what the diagnostic manuals and guidelines suggest.


Question: I/We need to see you urgently, do you have space?

Answer: I generally have limited space but I will try and work with you and my schedule is often changing and evolving anyway. Please contact me and I will do my very best. If I am unable to see you, I will gladly refer you to a colleague whom I trust.


Question: I cannot commit to weekly therapy, can I see you on an ad-hoc basis when I need it?

Answer: Unfortunately not. When I reserve a slot in my schedule, it's yours for the same time every week. Rhythm, consistency, and the depth of our relationship are important in psychotherapy, and we simply cannot build the type of relationship that is necessary for it to be therapeutic, if I see you sporadically.


Question: Is it true you have a thing about Rubik's cubes?

Answer: Yeah, I do. Who told you? My personal best is 22.24 seconds. The majority of my solves are under 30 seconds, which is slow by today's standards.


Question: Do you show couples how to have sex?

Answer: No, I don't do that. If you need guidance, perhaps a sex coach might be better for you?


Question: Will you need to physically examine me?

Answer: No, that is not necessary. Depending on your issue, it is likely that I might refer you to a doctor who can do the necessary checks.


Question: What's the weirdest sexual thing someone has ever told you?

Answer: I rarely hear anything weird, actually. Or maybe nothing seems weird to me any longer. Or perhaps I just can't say. :)


Question: Why do I sometimes feel aroused in my mind but my genitals don't appear to have got the memo?

Answer: Males and females can experience what we refer to as Arousal Non-Concordance. This is when the genitals and the mind don't appear to be in agreement about arousal. The reverse can also happen when the genitals appear to be aroused, but the mind isn't.


Question: Is it possible to have good sex in a long term relationship?

Answer: Absolutely, and many people do. It takes energy, commitment, imagination, and creativity. Above all though, it takes a desire to want to nurture this aspect of your relationship. Esther Perel is superb on this topic and her wonderful book Mating in Captivity should be on every couple's bookshelf.


Question: Are my sexual desires normal?

Answer: I'm not too keen on words like 'normal'. Your sexual desire may be common or uncommon - but either way, unless it's illegal, or unless it's causing you distress or concern, then try and embrace it. Please contact me though if it's something you want to discuss.


Question: Is my penis too small?

Answer: Too small for what? To see from space? Yes! To have a sexually fulfilling relationship? Definitely not.


Question: Is my vulva normal?

Answer: Vulvas come in a huge range of shapes, sizes, and fabulous colours, and they are all wonderful. Check out the amazing art project THE GREAT WALL OF VAGINA. Google it.


Question: I have never had an orgasm. What's wrong?

Answer: This is fairly common and we sometimes refer to the condition as anorgasmia. There is often a psychological reason for both men and women. Please contact me to discuss.


Question: Is it possible for us to rebuild our relationship after an affair?

Answer: Yes, it is very possible. However, it takes a desire for change, a willingness to look at why the rupture occured in the first place, and a commitment to do the hard work of forgiveness so that we can rebuild trust and then develop new foundations for the relationship. This is very much a process of building a new relationship, not necessarily restoring the old.


Question: Can you change my sexuality or orientation?

Answer: No, I cannot do that, and neither would I want to. If your sexuality, gender, or sexual orientation is a source of distress for you, then please contact me.


Question: Can open relationships or ethically non-monogamous relationships work?

Answer: Yes, they can. However, in my experience, their success rate is fairly small. Many couples experiment and find this lifestyle to be unsustainable or unsatisfactory in the long term. Many couples also find it fun and thrilling in the short-term and it may inject a new sense of life or vitality into the sexual relationship. My advice would be to discuss, discuss, and discuss. Then discuss it some more. Open and honest conversation about your fears, concerns, or anxieties, as well as establishing clear and firm boundaries is crucial.


Question: Will you watch us have sex and then tell us what we're doing wrong?

Answer: That's very generous of you. However, it's not necessary. I can get a full picture of your sex life through honest dialogue in therapy. Thanks for the offer though.


Question: What do you think about kinks, fetishes, BDSM, and paraphilias? Do you work with them?

Answer: It's a fascinating subject and I am open to the entire range of sexual experiences. I may not have direct experience of your particular interest, but I have a good understanding of these subjects and the psychology that perhaps drives some of them. If you have an interest that is bothering you and causing you distress, please contact me. Be aware that there are some practices that are illegal, however, and I am obliged by a stric code of ethics, to act appropriately and professionally within the law.


(c) 2019 - Steven Hayward for