Online Sex Therapy & Couples Therapy in California


For individuals and couples struggling with desire mismatch, intimacy breakdowns, performance anxiety, betrayal repair, and sexual disconnection.

Dr. Adrian Scharfetter, PhD, LMFT, CST-S
License # 113824

intimacy issues

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mixed libido

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communication issues

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sexual health

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Desire Mismatch

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Decreased sexual function

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BDSM and kink affirming

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Boundaries

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intimacy issues ◇ mixed libido ◇ communication issues ◇ sexual health ◇ Desire Mismatch ◇ Decreased sexual function ◇ BDSM and kink affirming ◇ Boundaries ◇

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Couples Sex and Intimacy Therapy

Intimacy doesn't collapse all at once. It erodes slowly, through unspoken frustrations, avoided conversations, and the quiet accumulation of distance. By the time most couples reach out for help, they've been navigating this alone for months or years, unsure how to talk about what's not working without making it worse.

If you're here, you've likely recognized that something fundamental in your intimate connection needs attention. Maybe sex has become infrequent or mechanical. Maybe one of you wants it and the other doesn't, and that difference has become a source of tension neither of you knows how to address. Maybe there's been a breach of trust, or life circumstances have shifted everything, and you're trying to find your way back to each other.

I work specifically with couples navigating sexual and intimacy challenges, not as a generalist who occasionally sees couples, but as a specialist who understands the complex dynamics between desire, communication, emotional safety, and physical connection. Whether you're in San Francisco, Palo Alto, Los Angeles, or San Diego, my practice provides structured, confidential space to address what's been difficult to name.

What Couples Work on in Intimacy Therapy:

  • Emotional disconnection and growing distance

  • Desire discrepancy and mismatched libidos

  • Rebuilding closeness after infidelity or broken trust

  • Intimacy avoidance and physical withdrawal

  • Navigating changes after pregnancy, illness, or major life transitions

  • Shame or anxiety around sexual needs and desires

  • Learning to initiate and communicate about sex without conflict

  • Addressing patterns where sex has become obligatory rather than connecting

You may be a strong fit if…

  • You and your partner love each other but feel sexually disconnected

  • One of you wants more sex and the other avoids it

  • You’re dealing with ED, performance anxiety, or sexual shutdown

  • You’re recovering from betrayal or trying to rebuild trust

  • You’re a high-functioning professional whose relationship looks “fine” from the outside but feels strained privately

  • You want a therapist who is sex-positive, kink-affirming, and comfortable with complexity

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Not sure if therapy is the right fit?
We’ll talk briefly about what’s going on, what you’re hoping to change, and whether I’m the right therapist for your needs.

  • 10 minute chat

  • No pressure

  • For California residents only

  • Online only

See If We’re a Fit

MY services:

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Schedule a Free Consultation

Reaching out for therapy can feel vulnerable. Initial consultations are simply a conversation to see whether working together feels like a good fit.