The clue that points here
If you consistently wake with erections, or get them easily on your own, but lose them with a partner, the hardware is working. That pattern points strongly toward anxiety, relationship dynamics, or depression rather than blood flow, and it is the pattern most likely to respond quickly.
The reverse pattern — gradual loss everywhere, including morning erections — points toward the physical causes covered elsewhere on this site. Most men over 50 have some of both.
Check your medication list first
Depression and its treatment both affect erections, which makes this genuinely tricky. SSRIs are among the most common medication causes of ED and delayed orgasm. So are some blood pressure drugs — older beta blockers and thiazide diuretics in particular — along with finasteride, some antipsychotics, and certain antihistamines.
Never stop a prescribed medicine on your own. Bring the list to the prescriber and ask whether an alternative within the same class is an option. Switching an SSRI, or moving from a thiazide to a different blood pressure agent, resolves this for some men entirely.
What therapy actually involves
Less couch, more homework. A sex therapist typically works on breaking the performance loop — often by temporarily taking intercourse off the table so that the pressure to perform is removed, and rebuilding from there.
Bringing a partner into at least some sessions consistently improves results. That is a difficult ask for a lot of men, and it is also the single change that most reliably shortens how long this takes.
Look for a therapist certified by AASECT, the professional body for sex therapy in the US, or a clinical psychologist with specific experience in sexual health.
Common questions
Is it not just in my head then?
That framing is the problem. Anxiety produces adrenaline, and adrenaline physically constricts the arteries that need to open. The mechanism is as physical as any other on this site.
Can I do both therapy and take a pill?
Yes, and it is often the fastest route. A few successful experiences with a pill can break the anxiety cycle, and therapy is what stops it re-forming.