Howard was a 34-year-old virgin suffering from bipolar disorder and severe ADD. When we began our sessions, Howard had little sense of his own agency. He had a job, but he still lived with his parents, who dispensed his medications and micromanaged most aspects of his life. They (and he) didn't think he could survive any other way. After six months of weekly two-hour sessions with me and weekly sessions with his therapist, Howard took charge of his own medications, got his own apartment, and started dating.

But Howard didn't see me, initially, to help him move out of his parents' house. His therapist referred him to me to help him develop the social and sexual skills he needed to have satisfying relationships. While many of my clients are, like Howard, virgins over 30, most are high functioning in almost every aspect of their lives except sex. Rick, 45, is a graphic designer with severe performance anxiety. Nora, 51, is a corporate lawyer who has never reached orgasm and wants to learn how...