Q&A with sex therapist Dr. Misty Smith


CW / Grace Schepis

Grace Schepis | @GraceSchepisCW, Staff Reporter

Dr. Misty Smith is a licensed sex therapist who currently operates out of Vestavia, Alabama. Throughout her career, Smith has treated patients who travel from all around the regional area for her services. Smith appears on Good Day Alabama with the segment “Where is the Love?” and runs columns in multiple magazines related to her field. 

Q: How did you get your start in the profession of sex therapy?

A: My journey started in middle school when I was sort of the peacemaker of my friends, the one they came to for advice, so I knew exactly what I was going to do when I went to college. I’ve now been counseling for over 20 years, but I did a variety of counseling at first and didn’t really know what I wanted to do. I did mental health counseling, and I ran a group home and took a little bit of time off while I was finishing up my Ph.D. because I didn’t want to be miserable. I would go to people’s houses, work with a lot of couples, parents and kids. I saw all kinds of really unfortunate circumstances and met a lot of different kinds of people. One gentleman came in for sex addiction issues, and after treating him, he told me that I should consider becoming a sex therapist. There weren’t any in Birmingham, but the only thing that I could find was like a Christian sex therapy certification. I didn’t feel like that was right, though I’m a Christian, to hold others to my own morals and values. I found a site with a different kind of certification, and I loved the group and kind of what they stood for, and so I started working on the certification, which took a couple years. I got that certification four years ago and have not regretted that decision since.

Q: What exactly do you do as a sex therapist?

A: I don’t usually start out with sex therapy. I have some clients that don’t have any

major diagnoses, just general stress about their relationships. I also meet with people who have depression and anxiety, and things that people typically think about when it comes to counseling. I also work a lot with individuals who have sexual dysfunctions, both male and female, and a lot of times that can be related to desire discrepancy [meaning when one partner has a much higher or lower sex drive than the other]. There are also those who struggle with their own sexual identity and are just moving into those phases of life. It’s always interesting. 

Q: What is the age range of your patients?

A: I have a pretty large population of 20-something-year-olds. And then I also have a really large population of, I would say, that 35 to 55 range. Those in their 20s may have a sort of sexual dysfunction and don’t understand why, especially with the guys. A lot in that age range that are girls are those who have gotten married, maybe waited to have sex until they were married and are now dealing with so much pain or struggle with having sex that they end up here in my office to try to work through a possible psychological thing that is affecting them and not allowing them to physically cooperate. Usually it’s a psychological or emotional struggle, but it has manifested in a sexual way. 

Q: How has the field changed in the last decade?

A: Short answer, but I think that sex therapy, and therapy in general, has become more respected over the last decade, primarily because it’s become more acknowledged. Even though sex therapy has been around since the ‘70s, it is something that most people are more willing to discuss now than they were back then. I mean, we had Dr. Ruth [Westheimer, one of the first popularized sex therapists] for forever. Thanks to her, and how completely adorable and hilarious she is, I think she has kind of paved the way for sex therapy – like, “OK, that actually does exist.”

Q: Where do you see the field heading?

A: So first of all, in Alabama, there will be a lot more sex therapists because of there just being more awareness and more people who are interested in it. We’re more open to discussing sexual topics these days, and it has created the possibility for a generation of counselors who are

more open to talking about sexual issues. I’m about to start training two young women who want to get their certification, which makes me so excited. I also think there’s gonna be a lot more awareness for the transgender community and a lot more openness to sexual issues, as well as a lot more awareness from gynecologists that sex therapy is a part of that process as well. 

Q: What is one thing you feel like you are always telling your patients? 

A: ‘Nothing is normal, and everything is normal.’ The reality is that everybody thinks that they are alone, that they are the only person out there going through what they are going through. But you are not alone. You are experiencing something that many, many other people experience. This especially happens with young girls, and they just don’t know where to go.

Q: Do you believe there is ever a right or wrong time to seek counseling?

A: I think it’s important for people to go see a counselor at the very first sign of trouble or miscommunication. I don’t think that there is a wrong time to do it, but I definitely think that people should go to counseling before it goes too far. I’ve seen people come back from the worst situations, but it’s better to not be too late. I think we should go as individuals, too, just to work on knowing who we are and what we want in life. 

Q: What commonly holds people back from seeking therapy?

A: I would love to say that there is no stigma involved, but people are worried about what others will think about why they’re going to therapy. It’s difficult for someone to come to therapy when they’re married because when they go home, they’re going to get all these questions about it. You know, if you tell your friends that you’re going to therapy and you’re in college, what are they going to ask you? And what are you going to tell them? 

Q: How have hookup or dating apps changed the way people form relationships?

A: There is this obsession with the next best thing. There’s so many options for people within the dating apps, and it’s easy to do. People will start dating someone and not delete these kinds of apps, and then occasionally go back on the dating app. If there’s something that looks a little bit better, they’re kind of drawn to that. Then there’s the sex. I mean, I would encourage everybody to be really cautious in today’s world. Really, it’s important to just be honest. Because if you’re in it for a long-term relationship, really make sure that that’s for sure what you’re putting out there. If you’re in it for a hookup, just put that out there, too. I sit in conversations with my singles that are on dating apps, and we address how it would be really great if there were a dating app that was for people looking for real people. 

Q: What advice do you have for college students in regard to your work?

A: Because of our lovely dating apps, people are not very safe. When you go get tested for STDs, it never covers everything. You have to request to be tested for certain things, such as herpes. So when someone asks if you have been tested lately, you probably weren’t actually tested for those things they care about. There is, of course, the emotional trauma of finding out that you have something, and for some people, they would rather not know. Many people are willing to take the risk of acquiring whatever their partner may not even know they have. You can go get the test yourself, and make sure they get the test and that everything is tested. Do not just assume that someone’s telling you the whole truth. I mean, I could say it all day long: They’re not going to tell you that because it’s going to prevent them from getting to have sex with you, unfortunately.

Q: Any other pieces of advice?

A: A lot of people don’t think that counseling is covered by insurance, and they think that they’re gonna have to pay for it. Never assume that. And the things you discuss in counseling are confidential. A lot of college students are still on their parents’ insurance, and their parents might see that they go into a counselor, but everything that happens in the office is confidential. In Alabama, if you’re 14 or over, we can’t disclose anything to the parents, unless there is a fear of security or something like that.