When people ask Juliet Grayson, author of "Landscapes of the Heart: The working world of the sex and relationship therapist" what her job is like, she replies, "It's great! I get to be a detective."
One symptom, for example erectile dysfunction, can have many different causes - part of what Juliet does is find the cause specific to that person.
Using this one symptom as a starting point, Juliet Grayson explains why being a sex and relationship therapist is really all about being a detective:
Working with working with Dave and Caroline required a bit of careful sleuthing before I could help them;
Dave (aged 28) was tall, dark, and had erectile dysfunction. He'd been seeing Caroline, blonde, gorgeous and slim, aged 35, for two years. They had been living together for six months. His erection had begun to fail about five months ago. They still enjoyed oral sex and masturbating each other.
"I lose my erection as soon as I start to penetrate. I don't know why." Dave sounded confused. "It's horrible. I've withdrawn emotionally. I just can't handle it, so I pull away. Caroline is kind, but I hate it, it makes me angry."
I found out that Caroline was the proactive one. She had instigated them living together, even though Dave hadn't really felt ready. He told me, "I love Caroline, and didn't want to lose her. She can be very persuasive. But I wasn't sure about moving in, and all that comes with that."
I thought I understood, but I checked. "What does come with that?"
He seemed anxious, and looked around the room as if seeking an escape route. He said in a worried voice, "Children?"
I decided to tackle this head on. "Do you want children?"
He looked around the room again. He had almost stopped breathing. He's really scared, I thought. Caroline was looking furious. Dave focused on me, and avoided looking at her. I noticed his foot had started to jiggle. He wants to run away.
"Not quite yet. One day soon."
From his words alone, I would have guessed he was considering it, and might have wanted children in the future. However, by paying attention to his non-verbal signals, I learned a completely different story. I decided to name this discrepancy.
"It's interesting, because although you indicate you are thinking about having children, and might be ready soon, when I pay more attention to your body language and to the tone of your voice than to your words, I get the feeling that you really don't want children right now."
Dave turned, and held me with such an intense gaze that it was as if he and I were in a parallel universe. I recognised this - it happens occasionally when a person feels truly seen.
He paused, breathed out, and slowly said, "You are spot on, but I hadn't really realised that." A part of him hadn't been able to admit it until now. His body was responding to his fear of Caroline
becoming pregnant. Losing his erection on penetration was the best contraception he could use!
Yet the same symptom, erectile dysfunction, in another person, can have a completely different cause.
For example, with students Eddie (aged 23) and Frankie (aged 20) the problem was Eddie's use of pornography for three to four hours most nights. Having grown up using pornography for arousal, he found it difficult to get hard with a real woman.
On the other hand, for Gary, a successful 45-year-old lawyer, it was long hours in a pressurised environment. And for Henry, a builder aged 50, blood tests revealed it was low testosterone.
I find it fascinating that there can be so many different causes for the same symptom. My job as a sex and relationship therapist is to make enquiries, sift through information, and listen carefully. By paying attention to what my clients are saying, as well as to subtle hints and unconscious clues, I can often find the underlying issue(s). Having found the cause(s), the therapeutic work can begin, through supporting, challenging, cajoling, and confronting, using various therapeutic techniques to bring healing, resolution and new perspectives.