Sex Therapy and Affirming Care
Across Michigan
Thoughtful, clinically grounded therapy for individuals and couples navigating sexuality, identity, and intimacy. Fully virtual. Available statewide.
Schedule Your Free ConsultationDoes any of this sound familiar?
If something brought you here, that's usually enough to start.
Schedule a Free Consultation- You've been waiting for the right time to deal with this. There hasn't been one.
- Sex is painful. You've been working around it for long enough that it's started to feel normal. It isn't.
- Desire has dropped off, and you don't know if it's your relationship, your body, or something else entirely.
- You survived something in your relationship. The relationship survived too, technically. But you're still in it.
- You want an affirming therapist, one who understands your identity and relationship structure are the starting point, not something you have to explain first.
- You've been managing this privately for a long time. You're tired of managing it alone.
You don't have to have it figured out to begin
If you're here, something in your intimate life isn't sitting the way you hoped it would. Maybe it's a distance between you and your partner that keeps widening no matter how much you love each other. Maybe it's something you've never said out loud to anyone — questions about desire, about your body, about who you are or what you want. Maybe it's pain that nobody has taken seriously, or a relationship that doesn't fit the mold and deserves real support anyway.
You don't need the right words for it before you call. You don't need to justify why it matters or worry about what I'll think. Whatever brings you here, nothing requires an explanation or an apology before we begin.
I work with individuals and couples — including LGBTQ+ folks, people in ENM, kink, and polyamorous relationships, and women whose OB/GYNs have referred them for sexual health support. All sessions are fully virtual and HIPAA-compliant, so you join from wherever feels most comfortable.
Specialized training. Genuine affirmation.
Sex Therapy as a Specialty
Sex therapy is a distinct clinical field, and it is the center of my practice, not an add-on. I hold active certification through IAPST and IBOSP as a Certified Sex Therapist, and I incorporate Brainspotting when trauma or emotional blocks are part of the picture.
Actually Affirming
LGBTQ+, ENM, kink, polyamorous, mixed-orientation — these are not edge cases here. You won't spend session time educating me on your relationship structure or defending its validity. We can get to the actual work.
Telehealth Across Michigan
All sessions are fully virtual and HIPAA-compliant. Detroit, Ann Arbor, Grand Rapids, the Upper Peninsula — wherever you are in Michigan, access is the same.
Medication & Sexual Health
SSRIs, antidepressants, and other medications commonly affect desire, arousal, and the ability to orgasm. If your sex life changed when your prescription did, that's not in your head — and it's rarely addressed in a 15-minute medical appointment. This is exactly where that conversation belongs.
Read more about this →What therapy with me actually looks like
Sessions are private, talk-based, and fully confidential. This is a space where you can say the thing you haven't been able to say anywhere else — without managing my reaction or preparing a justification for it first.
What sex therapy actually is — because most people aren't sure
Sex therapy is entirely talk-based. There is no physical contact, no nudity, and nothing that looks different from any other therapy appointment on a video call. What makes it different is the focus and the depth of training behind it.
Sessions start with what's actually going on — not the version that's easiest to say, but the real one. From there the work is specific and goal-oriented: building language for what you need, practicing clearer communication with the people you're close to, and making real changes in how you experience intimacy. Depending on what we're working on, sessions often include education, structured conversation, and practices to try between appointments that we process together.
For most people, being at home for this kind of conversation turns out to be exactly right. There's no waiting room, no commute, no performance. You're in your own space talking about the things that actually live there.
Getting to what's really going on. Not the surface version — the thing underneath it. Shame, grief, avoidance, disconnection. We work with what's actually true, and we do it with care.
Building language for the hard things. Communication isn't just conflict resolution. It's being able to ask for what you need, hold your limits without guilt, and stay in honest contact with the people you're close to.
Creating change that holds. Not a way to get through the week. Real shifts in how you relate to yourself and the people you love.
Serving Michigan clients from Detroit to the UP
Wherever you have privacy and a connection.
Michigan clients come from across the state: metro Detroit and the suburbs — Ferndale, Royal Oak, Birmingham, Macomb County, Oakland County; Ann Arbor and Washtenaw County; Grand Rapids and West Michigan; Lansing, Kalamazoo, Traverse City, and the Upper Peninsula. Telehealth means geography isn't the obstacle it used to be — you're not limited to whoever happens to have an office nearby, and in a state where affirming, specialized care can be hard to find, that matters.
The people I work with in Michigan come for a lot of different reasons. Some are navigating desire discrepancy or sexual disconnection that's been quietly straining a relationship for years. Some are women dealing with painful sex, postpartum changes, or perimenopause-related shifts in desire that their doctor mentioned but didn't have time to address. Some are in relationships that don't fit a standard template — ENM, kink-aware, mixed-orientation, or same-sex partnerships — and they've spent too long trying to find a clinician who doesn't need a lot of explaining to. Michigan has fewer affirming specialists than either coast, and that gap is real.
Paula Kirsch, LCSW, CST
I became a sex therapist because it's where the most important — and most avoided — conversations happen. Sexuality, intimacy, identity, and desire sit at the center of how we experience ourselves and our closest relationships. Most people never get a real place to talk about any of it.
I'm a Licensed Clinical Social Worker licensed in New York, Connecticut, and Michigan, and a Certified Sex Therapist through both IBOSP and IAPST. I'm currently a PhD student in Sexology at MSTI, which keeps my clinical work grounded in current research. I also incorporate Brainspotting when trauma or emotional blocks are part of the picture.
My practice is genuinely affirming of LGBTQ+ identities, ENM, kink, and polyamorous relationships — not as a specialty niche, but as part of how I work every day.
Book Your Free 15-Minute Consultation
We'll meet for a free 15-minute consultation to make sure this is the right fit. Most new clients are in session within a week. You'll complete intake paperwork through the secure client portal before we begin.
Meet Online
I'll send you a secure link. All you need is a private space and an internet connection.
Do the Real Work
We start where you actually are — not where you think you should be. Sessions are substantive from the first appointment.
Start with a free 15-minute consultation.
We'll make sure we're a good fit before you commit to anything. With compassion and without judgment. Nothing requires an explanation or an apology before we begin.
Schedule Your Free ConsultationA few things people ask before starting
Is this practice actually affirming, or just inclusive-sounding?
Actually affirming. LGBTQ+ identities, kink, ENM, polyamory, and non-traditional relationship structures are not edge cases to navigate around — they're part of the everyday practice. You won't need to spend session time explaining why your relationship is valid.
Does sex therapy involve any physical contact?
No. Sex therapy is entirely talk-based. Sessions focus on conversation, psychoeducation, and skill-building. There is no touching, no nudity, and nothing that resembles what people sometimes imagine when they hear the words "sex therapy." It is clinical work, conducted the same way any other therapy is.
My medication changed and so did my sex life. Can sex therapy help?
Yes. SSRIs and other medications — antidepressants, hormonal treatments, blood pressure medications — commonly affect desire, arousal, and orgasm. This is one of the most undertreated issues in sexual health because it rarely gets adequate attention in a medical setting. Sex therapy addresses both the physical reality and the relational impact it often creates.
What kinds of issues does this work address?
Desire discrepancy, vaginismus, painful sex, sexual trauma, low libido, arousal difficulties, intimacy avoidance, communication breakdown, infidelity recovery, identity exploration, and the complexity that comes with kink, ENM, or non-traditional relationship structures.
How do virtual sessions work in Michigan?
Sessions are held via a secure, HIPAA-compliant platform. You'll need a quiet space, a device with a camera, and a reliable internet connection. Many people find that attending from home makes it easier to get into the deeper material, faster.
Do you work with women's sexual health issues?
Yes. I work with a range of women's sexual health concerns, including vaginismus, painful sex, low desire, and postpartum sexual changes. I collaborate closely with OB/GYNs and pelvic floor physical therapists to provide coordinated, whole-person care.