Sex Therapy in Los Angeles

Sex is rarely just about sex.

For many people, what gets in the way of a fulfilling sexual life isn't a lack of knowledge or technique. It's something psychological — shame that has never been examined, a history that shows up uninvited, anxiety that takes over at the wrong moment, or a disconnection between what someone wants and what they allow themselves to have.

Behavioral approaches to sex therapy have real value. But for some people they don't go far enough, because the obstacle isn't just behavioral. It's deeper than that.

Depth-oriented sex therapy in Los Angeles works differently. Rather than focusing primarily on what to do differently, the work explores what's actually getting in the way — the thoughts, feelings, and histories that shape someone's relationship to sexuality and intimacy. When that underlying terrain shifts, behavior tends to follow. Sex therapy at Beacon Psychotherapy is provided by Jack Irmas, LCSW, who completed a year-long postgraduate training in couples and sex therapy through the American Association of Couples and Sex Therapists (AACAST). His approach integrates psychodynamic and relational thinking with behavioral interventions when they are useful.

Beacon Psychotherapy Office — Carthay Square, Los Angeles

When Sex Feels Like a Source of Pain

For many people, sexuality is accompanied by feelings that are hard to talk about — anxiety before or during sex, shame about desires or about what isn't working, or a quiet sadness about an area of life that feels closed off or out of reach. These feelings are often carried alone, in silence, because sex remains one of the most difficult things to bring into a room and talk about honestly. It might look like mismatched desire in a relationship, difficulty with arousal or erection, avoiding sex altogether, or a distance that settled in after a baby, an affair, or years of routine.

That silence has a cost. What goes unexamined tends to stay stuck.

What Can Sex Therapy Help With?

People come to sex therapy for many different reasons. Sometimes there is a clear problem; other times there is simply a sense that sexuality has become anxious, distant, confusing, or less alive than they want it to be.

Sex therapy can help with concerns including:

  • anxiety or pressure around sex, including performance anxiety

  • shame, inhibition, or difficulty feeling comfortable with desire

  • low or changing sexual desire

  • differences in desire between partners

  • difficulty with arousal, erection, orgasm, or staying present during sex

  • avoiding sex or feeling disconnected from one’s sexual self

  • difficulty knowing, expressing, or asking for what you want

  • loss of sexual or emotional intimacy in a relationship

  • sexual concerns connected to trauma or earlier experiences

  • changes in sexuality following infidelity, childbirth, or other major relationship transitions

  • questions about fantasy, desire, sexual identity, and what a fulfilling sexual life might actually look like

These concerns are not always problems to be “fixed” in isolation. Often they make more sense when understood in the context of a person’s relationships, history, and emotional life.

What Depth-Oriented Sex Therapy Actually Does

Sexual concerns rarely exist in isolation. They emerge from somewhere — from a developmental history, from what was learned early about bodies, desire, and intimacy, from experiences that left a mark. Sometimes there is explicit trauma. More often there is something subtler: a pattern of shutting down, a difficulty staying present, a persistent anxiety or shame whose origins aren't immediately obvious.

This work pays close attention to what's happening underneath the surface — not just what someone does or doesn't do sexually, but what they feel, what they avoid feeling, and what their sexuality is expressing or protecting against. That kind of attention, sustained over time, tends to open things up in ways that behavioral approaches alone cannot.

When behavioral interventions are indicated, they have a place in this work. But they land differently — and work better — when the psychological terrain beneath them has been addressed.

Sex Therapy for Couples

Sexual difficulties often live between two people, not inside one of them. One partner wants more, the other pulls away, and both end up feeling rejected. In couples sex therapy, the work looks at what each partner brings — their histories, fears, and expectations — and how those meet in the relationship. Learn more about couples therapy.

Sex Therapy for Gay Men and LGBTQ+ Clients

Sexual concerns for gay men and other LGBTQ+ clients can involve more than what is happening in the bedroom. Shame, body image, sexual scripts, relationship expectations, experiences of secrecy or difference, and questions about what intimacy and commitment are supposed to look like can all become intertwined with desire.

Therapy offers room to examine those experiences without imposing a particular model of sexuality or relationship. The aim is to understand what gets in the way of a sexual life that feels freer, more connected, and more genuinely your own.

Common Questions about Sex Therapy

  • No. Many people come on their own.

  • Sessions are talk therapy. Nothing physical happens in the therapy room. When surrogate work is relevant, it happens separately and is discussed with you first.

  • Sometimes it is, and often it’s both. Erectile difficulties, pain, or changes in desire can have physical causes. When that’s a possibility, I’ll suggest seeing a physician alongside our work, and I’m glad to coordinate with your doctors.

  • Many approaches focus mainly on exercises and techniques. Those can help, and they have a place here. This work also looks at what’s underneath: the anxiety, shame, or history that keeps the same difficulty coming back.

  • In select cases, and with careful clinical judgment, sex therapy can include collaboration with an intimate partner surrogate—a trained professional who works alongside the therapist to help a client translate psychological understanding into lived experience. This is a structured, boundaried process that takes place separately from therapy and is discussed openly when it may be relevant.

About Jack Irmas

Jack Irmas, LCSW — Psychodynamic Therapist in Los Angeles

Jack Irmas, LCSW is a psychotherapist and sex therapist based in the Carthay Square neighborhood of Los Angeles. He completed a year-long post-graduate training in couples and sex therapy through the American Association of Couples and Sex Therapists (AACAST), with a focus on InterAnalytic Couples Therapy — an interpersonal and psychoanalytic model that integrates psychodynamic thinking with the treatment of sexual concerns. He has experience working with sexual issues in both individual and couples therapy, and has collaborated with intimate partner surrogates. He founded Beacon Psychotherapy to offer a different kind of clinical experience — one oriented toward depth, genuine change, and the kind of work that actually gets at what's underneath the surface. He is also Core Faculty at the Wright Institute Los Angeles, where he teaches clinical thinking and technique to the next generation of therapists. You can find out more about his work here.

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Getting Started

If this approach resonates, the next step is a brief phone consultation.