Sex and Relationships Therapist
Provide specialist psychosexual and relationship therapy for people experiencing sexual difficulties, intimacy problems, and relationship challenges — a COSRT-accredited profession working in NHS psychosexual services and private practice.
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Prior counselling qualification (2–3 years) + COSRT specialist training (2–3 years part-time); total pathway: 5–7 years from starting initial counselling training
Prior BACP or UKCP counselling/psychotherapy qualification (Level 4/5 Diploma or PgDip) required; COSRT-accredited postgraduate training in psychosexual and relationship therapy (PgDip or MSc, typically 2–3 years part-time); COSRT Accredited Practitioner status and PSA-accredited register entry is the recognised professional standard. Not statutorily regulated by HCPC.
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What you do
Sex and relationships therapists — also called psychosexual therapists or psychosexual and relationship therapists — work with individuals and couples presenting with sexual difficulties and relationship problems. Common presentations include erectile dysfunction, vaginismus and genito-pelvic pain/penetration disorder, low libido, anorgasmia, sexual anxiety, sexual trauma recovery, compulsive sexual behaviour, sexual function following illness or surgery, and relationship and intimacy difficulties. You use an integrated approach combining cognitive-behavioural techniques, systemic thinking, psychodynamic understanding, and sensate focus (a behavioural therapeutic technique developed by Masters and Johnson) to address both psychological and relational components of sexual difficulty.
Therapists work in NHS psychosexual medicine clinics and genito-urinary medicine (GUM) services, NHS fertility clinics, cancer survivorship services (addressing sexual function after oncology treatment), and in private practice. COSRT (College of Sexual and Relationship Therapists) is the specialist professional body, maintaining an accredited register of psychosexual and relationship therapists recognised by the Professional Standards Authority. Training is typically a postgraduate specialist qualification undertaken after an existing counselling or psychotherapy qualification.
Why this career is resilient
Sexual health is recognised as a component of overall health and wellbeing, and NHS psychosexual services exist in most NHS trusts, funded through sexual health commissioning. The sensitivity and intimacy of the subject matter makes this a field that requires a skilled, trained human practitioner — the therapeutic relationship and the ability to work with shame, vulnerability, and embodied experience are not amenable to automation or digital replacement. Cancer survivorship services are an expanding area of NHS provision, and the impact of oncology treatment on sexual function is increasingly recognised as a quality-of-life priority.
COSRT accreditation and inclusion on the PSA-accredited register provide a quality kite-mark that distinguishes accredited practitioners from unqualified individuals. Private practice is a well-established and viable income model for experienced psychosexual therapists, given the sensitivity of the work and the reluctance of many clients to seek NHS referral.
A typical day
Morning: NHS psychosexual clinic at a sexual health centre — two individual therapy sessions and one couples session. Individual work with a man with performance anxiety following erectile difficulties, exploring psychological maintenance factors and introducing behavioural elements. Couples session with a couple experiencing discordant desire and relationship tension; beginning a sensate focus programme and exploring communication patterns. Afternoon: two private practice sessions from a consulting room, followed by a COSRT-approved supervision session via video call. Complete clinical notes and renew consent documentation.
Routes in
Full-time college course
Study full-time at a further education college, usually for 1–2 years. You will need to fund yourself or apply for a student loan (available for Level 4+ courses).
Pay and costs
Earning potential: NHS psychosexual therapist: Band 7 (£46,148–£52,809) or Band 6 (£37,338–£44,962) depending on NHS service. Voluntary sector: £30,000–£42,000. Private practice: £80–£150/session; a full private caseload can generate £40,000–£65,000/year in higher-demand areas.
Training costs: COSRT specialist training: approximately £5,000–£12,000; student loans may apply for postgraduate study. Prior counselling qualification: £3,000–£10,000. COSRT membership and accreditation fees — check COSRT website. Personal therapy during training is typically required.