What really changes in therapy?
CBT, Meaning-Making, and Sex Therapy
When people come to therapy, they often arrive with a clear wish: “I want this to stop.”The anxiety. The compulsive behaviours. The loss of desire. The shame around intimacy. Often, therapy does help reduce these symptoms. But over time, another question tends to surface: Even if this stops, will I feel different about myself? Different therapeutic approaches answer that question in very different ways.
CBT: Change Through Skills and Symptom Relief
Cognitive Behavioural Therapy (CBT) focuses on identifying and changing patterns of thinking and behaviour that maintain distress. It is structured, practical, and often highly effective in reducing anxiety, panic, and avoidance.
In sex therapy, CBT is frequently used to:
Reduce sexual anxiety and performance pressure
Interrupt shame-based thinking
Address compulsive or avoidant sexual behaviours
Restore a sense of control and safety
For many people, this work is invaluable. When someone feels overwhelmed, CBT tools can create stability and relief. But symptom relief isn’t always the same as deeper change.
When Symptoms Improve but Something Still Feels Stuck
In longer-term work — especially where trauma, attachment wounds, or sexuality are involved — symptoms may lessen while deeper patterns remain unchanged. Someone may function better, yet still feel unsafe, disconnected, or unworthy. This is where meaning-based approaches offer a different lens.
Meaning-Based Therapy: Change Through Reconstruction
From a meaning-based perspective, distress isn’t just about faulty thinking. It reflects the ways we’ve learned to understand ourselves, our bodies, and our relationships. Symptoms are signals that these meanings no longer fit our current lives. Change, then, isn’t about correcting thoughts, but about reworking the stories we live by.
In sex therapy, this often means exploring:
What sexuality has come to represent (connection, danger, obligation, control)
How early experiences shaped comfort with intimacy
The relationship between desire, safety, and self-worth
Rather than asking “How do I fix this?”, the question becomes:“What does this experience say about how I relate to myself and others?”
Sex Therapy as a Bridge
In practice, sex therapy often brings these approaches together. CBT helps create safety and reduce overwhelm. Meaning-based work allows space for deeper exploration of identity, attachment, and embodiment. Together, they support change that is both stabilising and transformative.
What This Means for You
Therapeutic change can happen at many levels:
Learning skills
Regulating emotions
Shifting self-talk
Rewriting personal meaning
CBT often supports the first steps. Meaning-based approaches help with the deeper ones. Sex therapy frequently requires both. If you’re struggling with anxiety, intimacy, or sexuality, the most important question may not be what technique will fix this, but: What kind of change do I actually want?