A significant number of men develop impotence from psychological causes that can be overcome. For such people sex therapy is advised. When a physiological cause is treated, subsequent self-esteem problems may continue to impair normal function and performance. Qualified sex counselors, psychotherapists work with couples to reduce tension, improve sexual communication, and create realistic expectations for sex, all of which can improve erectile function. Psychological therapy may be effective in conjunction with medical or surgical treatment. Sex therapists emphasize the need for men and their partners to be motivated and willing to adapt to psychological and behavioral modifications, including those that result from medical or surgical treatment.