Therapy for Sexual Issues in Washington, DC

Psychoanalytic therapy treats sexual difficulty as part of an emotional life rather than as an isolated malfunction. I am a licensed clinical psychologist and board-certified psychoanalyst in Washington, DC, and I have worked with these difficulties, individually and with couples, for over fifty years. Sessions are held online by secure video.

Sexual problems are among the most common reasons people seek treatment and among the least often named at the first appointment. They surface three months in, once it is clear the room can hold them — which is itself worth knowing, because the difficulty in speaking is frequently part of the difficulty itself.

The presenting forms vary: desire that has gone, desire that never matched a partner's, difficulty with function, arousal that depends on something a person feels ashamed of, sex that has become a negotiation, or intimacy that stalls whenever it becomes real.

I see these difficulties in individual therapy and in couples work, and I have treated them long enough that very little is unfamiliar.

“What cannot be said in the bedroom usually cannot be said elsewhere either.”

What people bring

Loss of desire, in yourself or a partner
A long-standing mismatch in wanting
Difficulty with arousal or function
Sex that has become an obligation or a negotiation
Shame about what arouses you
Intimacy that stalls as it deepens
The aftermath of an affair

The problem

When the problem is not really about sex

Sexual symptoms are unusually literal. Desire that disappears in a marriage where anger cannot be expressed is not a coincidence; nor is arousal that returns immediately outside it. The body is often stating a position that has not yet been put into words, and treating the statement as a mechanical fault misses what it is saying.

This is why technique-based advice has such a mixed record. It can help — sometimes a good deal — but where the difficulty is carrying a conflict, better technique simply relocates the trouble. Function is restored and desire stays gone, or desire returns and something else in the relationship deteriorates.

The other obstacle is shame. Most people arrive having never said these things out loud to anyone, and having decided in advance what a listener would think. That expectation is itself part of the material, and it is usually the first thing that turns out to be mistaken.

The method

How psychoanalytic therapy treats sexual difficulties

We work out what the symptom is expressing. That means talking about it plainly and without hurry — the history of it, when it began, what was happening in your life and in the relationship at the time, what it would mean if it changed. It is difficult for perhaps two sessions and then largely stops being difficult, which surprises most people.

Frequently what emerges is a conflict rather than a dysfunction: anger with no permitted expression, guilt attached to pleasure, a wish regarded as unacceptable, or an old fear of being fully seen. Once those become speakable, the symptom often has considerably less work to do.

Where the difficulty clearly sits between two people, couples sessions may be the better instrument, alone or alongside individual work. I do not assign exercises or homework; this is psychoanalytic treatment rather than behavioural sex therapy, and where the latter is the better fit I will say so.

Which treatment fits

Which treatment fits sexual difficulty

Some of this work is better done alone, some with a partner present, and sometimes both run alongside each other. We decide in the free consultation.

Couples therapy

Ninety minutes with both people present, when the trouble lives between you rather than inside one of you.

Psychoanalytic psychotherapy

Once or twice a week at a fixed time. Where most people begin, and enough for a great many difficulties.

Psychoanalysis

Three to five sessions a week. The more thorough instrument, for difficulties that have returned after previous treatment.

Expected results

What this work can and cannot promise

No honest clinician can promise a particular outcome here. What I can describe is what tends to shift.

It becomes speakable

The first change is usually that the subject stops being unmentionable, which alone changes a good deal.

Shame loses its grip

What was rehearsed as unspeakable turns out to be ordinary human material, and stops organising your choices.

The symptom becomes legible

Loss of desire or difficulty with function acquires a context, and often a timing you had not noticed.

Intimacy widens

For couples, what can be said in the bedroom generally expands what can be said everywhere else.

An honest caveat: sexual difficulties frequently have physical causes, and some of them matter medically. Erectile difficulty, pain during sex, and a sudden loss of desire all deserve a proper examination by a physician — medication side effects, hormonal changes and vascular disease are common contributors. I would rather you rule those out first than spend a year treating something psychologically that has a physical explanation.

Your therapist

About Dr. John J. Hartman

Dr. John J. Hartman, licensed psychologist offering online therapy for sexual issues in Washington, DC

I have practiced psychotherapy and psychoanalysis for over fifty years, and have spent much of that time teaching it — at UCLA, Michigan, and the University of South Florida, where I am currently Adjunct Professor of Psychiatry. As a Training and Supervising Psychoanalyst at the Florida Psychoanalytic Center, I am one of the analysts responsible for training other analysts.

A.B. Harvard College, magna cum laude with highest honors, Social Relations
Ph.D. University of Michigan, Clinical Psychology
Certificate Michigan Psychoanalytic Institute
FABP Board-certified psychoanalyst, American Board of Psychoanalysis
Training & Supervising Analyst Florida Psychoanalytic Center
Licensed Washington, DC (PSY200001229) · Florida · Michigan
PsyPact Telehealth authorized in participating PSYPACT jurisdictions, including Maryland and Virginia

Full credentials and appointments · scholarship and publications

Fees

What treatment costs

Individual sessions are $325 for 50 minutes; couples sessions are $475 for 90 minutes. The first 15-minute consultation is free and carries no obligation, and a sliding scale is available — ask whether you may be eligible.

Payment by cash, check, Venmo, Zelle, or wire. I do not bill insurance, but if your plan covers out-of-network mental health care you may be able to submit my bills to your insurer for reimbursement. Office hours are Monday to Friday, 10:00 am to 5:00 pm, by arrangement. Full fees and insurance details.

Common questions

Questions about therapy for sexual issues

Are sexual problems psychological or physical?

Often both, and the sensible order is to check the physical first. Medication side effects, hormonal changes, vascular disease and pain conditions all produce symptoms that look psychological. Where a medical cause is found, emotional work still helps with what has grown up around the problem — the avoidance, the resentment, the loss of confidence.

Do I need to come with my partner?

No. A great deal of this work is done individually, and some of it is better done that way. Where the difficulty clearly lives between two people, couples sessions are usually more direct, and the two can run alongside each other.

Is this sex therapy?

Not in the behavioural sense. I do not assign exercises or homework. This is psychoanalytic treatment aimed at what the difficulty is expressing rather than at retraining the response. Both approaches have their place, and if a behavioural sex therapist suits you better, I will say so.

How confidential is this?

Entirely, within the ordinary legal limits that apply to all psychological treatment. Sessions are held by secure video, nothing is billed to an insurer, and in couples work I do not carry secrets between partners — a rule I explain at the outset precisely because it makes the work safer for both people.

It is easier to say out loud than you expect.

The first 15-minute consultation is free and carries no obligation. Online sessions only, for residents of Washington, DC, Florida and Michigan, and — through PsyPact — participating PSYPACT jurisdictions including Maryland and Virginia.

Call (813) 787-2048 Prefer to write first? Email Dr. Hartman

Online Therapy for Sexual Issues in Washington, DC