Sex Therapist or Intimacy Coach? How to Choose
I'm going to do something slightly against my own interest here and tell you plainly when you should hire someone other than me.
The reason is simple: the most common thing that goes wrong in this field isn't bad practitioners. It's good practitioners working with people who needed a different kind of help. That wastes money, costs months, and leaves people believing nothing works — when what actually happened is a mismatch.
So here's the honest version of the landscape, including where I sit in it.
The three categories
A licensed therapist — in Tennessee, that's typically an LMFT, LPC-MHSP, LCSW, or a licensed psychologist — holds a graduate degree in a clinical field, completed supervised clinical hours, passed a licensing exam, and is accountable to a state board. They can diagnose and treat mental health conditions. They're bound by legal confidentiality requirements and can often bill insurance.
A certified sex therapist is a licensed therapist with additional specialized training in human sexuality. The recognized credential in the U.S. is AASECT certification, through the American Association of Sexuality Educators, Counselors and Therapists. It requires significant coursework in sexuality, supervised hours specific to sexual concerns, and ongoing education. A Certified Sex Therapist is a clinician first and a sexuality specialist second.
A sex and intimacy coach — my category — is not a licensed mental health provider. Coaching is an unregulated field. That's a plain fact and you should know it before you hire anyone, including me.
Here's where I'm coming from: I hold an M.S. in Sport Psychology and an MBA, I'm the founder of a guided intimacy app, and I've spent years working on this subject in my own marriage and in my professional work. I am not a licensed therapist and I am not AASECT-certified. I don't diagnose, I don't treat mental illness, and I don't practice therapy.
What the difference actually means in practice
The cleanest distinction I know is this: therapy tends to work backward, coaching tends to work forward.
Therapy is built to address what happened to you — trauma, depression, anxiety, a diagnosable condition, a pattern whose roots are in your history. It has the clinical depth and the legal framework to go there safely.
Coaching is built to address what you want to build from here — skills, communication, a practice, a different pattern starting now. It's present and future oriented, more structured, usually shorter, and more directive.
Both are legitimate. They're answering different questions.
When you should see a licensed therapist, not me
I want to be unambiguous about this list. If any of these describe you, a licensed clinician is the right call, and I'll tell you so on a discovery call:
Sexual trauma or abuse history that is still active for you. Processing trauma is clinical work requiring clinical training. The risk of doing it badly is real.
Active depression, anxiety disorder, PTSD, OCD, or another diagnosable condition that's affecting your relationship. Treat the condition with someone qualified to treat it.
Compulsive sexual behavior that you can't stop and that's damaging your life.
Active addiction, including alcohol.
Any violence or coercion in the relationship. Couples work of any kind is contraindicated here. Please get individual support from someone trained in this.
A relationship in acute crisis — a recently discovered affair, an imminent separation, one partner already out the door. That's a job for a couples therapist, often one trained in a specific model like EFT or the Gottman Method.
A medical question. Pain during sex, erectile difficulty, a hormonal concern, a medication side effect. Start with a physician or a pelvic floor physical therapist. Nashville has good ones.
You want insurance to cover it. Coaching isn't billable. Therapy sometimes is.
None of those are me being modest. They're the boundaries of what I'm trained to do, and you deserve to know them before you spend money.
When coaching may be the better fit
Nothing is wrong, exactly, and that's the problem. You're not in crisis. You like each other. Intimacy has just gone flat and predictable. Therapy can feel like bringing a mild complaint to an emergency room — and a lot of couples in this situation bounce off therapy because there's no pathology to treat.
You want skills and a practice, not insight. Plenty of people understand their patterns perfectly and still can't change them. If you've already done the understanding, more understanding isn't the bottleneck. Structure is.
You want to talk about sex directly, in detail, without easing into it. Not every generalist therapist is comfortable here, and some couples spend months circling. Specialists of either kind go straight at it.
You want something shorter and more structured. Coaching engagements are typically a defined number of sessions with specific work between them.
You've finished therapy and want to build. This is one of my favorite situations. The clinical work is done; now you want to actually construct something. That's a coaching question.
You're exploring rather than repairing. Figuring out what you want, what your partner wants, how to ask. That's development, not treatment.
Questions to ask anyone you're considering
Whichever direction you go, ask these before you pay anyone:
What exactly is your training and credential? A clear, specific answer. Vagueness here is the single biggest red flag in the coaching world.
Are you licensed? By whom? Can I verify it? Tennessee license status is publicly verifiable.
What do you not work with, and who do you refer to? Anyone who claims they can help with everything is telling you something important.
What does an engagement look like? Length, frequency, cost, what happens between sessions.
Is there physical contact of any kind? This one matters. My practice involves none — ever. Talk-based only, and any physical practices happen privately between you and your partner. "Somatic" and "hands-on" mean different things to different practitioners, and you are entitled to a direct answer before you book.
How do you handle it if I'm not the right fit?
My actual recommendation
If you're unsure, the cheapest diagnostic available is a conversation. Most therapists and most coaches, including me, offer a free consult. Do two or three of them and notice which one leaves you feeling like the person understood the actual problem.
And if that turns out to be a therapist rather than me, that's a good outcome. I'd much rather refer you well than take on work I'm not the right person for.
If you want to figure out which kind of help you need, book a free discovery call. If coaching is the right fit, we'll talk about what that looks like. If it isn't, I'll point you somewhere better — that's a normal and useful outcome of these calls.
And if you'd rather start with something you can do privately at home, Coelle offers guided audio intimacy experiences for couples — no practitioner involved, just the two of you and a structure to follow.
Scott Schwertly is a Nashville-based sex and intimacy coach, founder of Coelle, and co-host of Do You Feel That? with his wife Brittney.
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