Heather Evans Editorial

Depth psychology and sex therapy have nothing in common…right?

Juliane Maxwald would disagree. 

A psychoanalyst and certified sex therapist in New York, Juliane found that modern sex therapy wasn’t enough to help her reach her clients. However, by combining her expertise in psychoanalysis with her role as a sex therapist, she could help individuals and couples to decode the unconscious narratives behind their sexual concerns.

In her groundbreaking new book, Psychoanalytic Sex Therapy: Exploring the Unconscious Life of Sexuality, she explains why treating intimacy issues as symptoms to fix misses the emotional unpinning behind the problem.

But, how does this work? I spoke with Juliane to find out more.

Why did you write your book, Psychoanalytic Sex Therapy?

I wrote this book because I saw a gap in the field. Sex therapy has historically focused on behavior and technique, while psychoanalysis has often avoided the body and the erotic altogether. Yet, in my clinical work it became impossible to separate the two. 

Sexual struggles almost always contain unconscious meaning linked to attachment, trauma, conflict, and longing — and those deeper layers were not being adequately addressed in existing models. I wanted to offer a framework that brings these worlds together: a psychoanalytic understanding of desire and inhibition, paired with the practical tools of sex therapy and the embodied sensitivity of trauma work. 

The book emerged from decades of listening to how sexuality functions as a language — one that reveals what people can’t always say in words. I wrote it for clinicians who want to do deeper, more meaningful work with sexual concerns, and for anyone curious about the emotional and unconscious life beneath sexual symptoms.

What main issues does psychoanalytic sex therapy help with?

Psychoanalytic sex therapy is particularly effective for problems that have emotional, relational, or unconscious roots, including desire discrepancy, low or inhibited desire, difficulty with arousal, orgasm or erections, shame-based sexual issues, compulsive sexual behavior (including pornography overuse), infidelity and repair, BDSM and kink dynamics, and conflicts arising in monogamy, non-monogamy, or other open arrangements.

At the core, this approach helps people understand why symptoms exist — not just how to change them. It treats sexual struggles as meaningful signals and messages, rather than failures or dysfunctions.

How does psychoanalytic sex therapy work?

It works by exploring sexuality on three interconnected levels: 

1. The Intrapsychic Level: What unconscious beliefs, fears, fantasies, or internalized voices shape a person’s sexual life? Here we explore early attachment, shame, trauma, desire, inhibition, and the symbolic meaning of symptoms.

 2. The Relational and Intersubjective Level: How do partners trigger each other’s attachment histories? Sexual symptoms often appear between partners — not just inside one of them. We look at repetition, enactments, pursue–withdraw cycles, and the roles each partner unconsciously adopts.

3. The Embodied Level: Sex happens in the body, not the mind. We integrate somatic awareness, nervous system regulation, and trauma-informed work so that clients can actually tolerate intimacy, pleasure, and vulnerability.

Most importantly, psychoanalytic sex therapy is not passive or purely interpretive.
It combines curiosity, relational attunement, and practical interventions — sensate focus, communication tools, behavioral shifts, and embodied grounding, within a depth-oriented framework.

Why can working with the unconscious help couples in their sex lives?

Because the unconscious is already shaping their sex life — whether they know it or not. When couples struggle sexually, it’s rarely about technique. It’s about fear of exposure rejection, or losing control, old attachment wounds, internalized shame, conflicting desires, fantasies they don’t know how to talk about, the longing to be recognized, and the fear of what that recognition might expose.  

Sex is where intimacy and vulnerability converge, and that often awakens old emotional conflicts. Working with the unconscious helps couples understand the meaning beneath the symptom. For example, why does one partner pursue and the other withdraws? Why does desire shut down under pressure? Why does orgasm feel elusive? Why does porn become a private escape? Why do fantasies feel dangerous to share?

Once partners understand these unconscious forces and learn to communicate from a place of curiosity rather than fear, sexual connection becomes safer, more playful, and more authentic.

What advice would you give to couples struggling with intimacy issues?

Here are some fundamental guiding principles: 

1. Slow down.

Most couples try to fix the problem too quickly. Intimacy grows when we create enough space to notice what’s happening emotionally and physiologically.

2. Shift the focus from performance to presence.

Good sex is not about getting it right. It’s about staying connected, to yourself and to your partner.

3. Get curious about the cycle, not the person.

The pursue–withdraw pattern is universal. Your partner is not the problem; the cycle between you is.

4. Honor the nervous system.

Desire cannot flourish in a body that feels unsafe, overwhelmed, or ashamed.

5. Talk openly about what’s hard.

Silence around sex creates more shame.Simply naming the difficulty often brings relief.

6. Seek depth, not just tools.

Techniques are helpful, but lasting change comes from understanding the emotional meaning behind the struggle.

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If you found the information in this article helpful, you can read more about Juliane’s work on her website, Instagram, and LinkedIn.

Register for her virtual book launch and workshop with the Institute of Contemporary Psychotherapy (ICP) on 8th January 2026.

Buy her books Psychoanalytic Sex Therapy: Exploring the Unconscious Life of Sexuality and Talking About Sex here.

About Juliane

Juliane Maxwald, MA, LP, CST, is a psychoanalyst, couples therapist, and AASECT-certified sex therapist in New York City. Her work brings together psychoanalysis, trauma theory, and modern sex therapy to help individuals and couples understand the unconscious patterns shaping their intimate lives. She teaches, supervises, and consults nationally across psychoanalytic, trauma, and sex therapy communities, and is the author of Psychoanalytic Sex Therapy: Exploring the Unconscious Life of Sexuality (Routledge, 2026) and Talking About Sex

Hi, I’m Heather – an award-winning book editor and content writer specialising in mental and sexual health. If you enjoyed this post, you can support this series by contributing to a coffee, or hiring me for my blog writing or editing services: