Today I visited the website of the Board of Behav. Health of California which licenses and regulates, among others, marriage and family therapists. I had a narrow task visiting the website so I did not browse around; however, when I was looking for the page I needed, I came across the mention of "online therapy". Could you engage a California therapist over Skype? at least it is worth finding out.

I thought more of your many troubles and it seems that you are like a child who cannot tolerate delayed gratification and who wants reality to mold to him.

Example of inability to tolerate delayed gratification: You want medication to solve ALL the problems.

Example of wishing that reality molded to you: you want the frequency of sexual encounters with the wife be sufficient for YOU just because such frequency might be sufficient for others.

The issue with accepting reality might be solvable with DBT=Dialectical Behavior Therapy. DBT teaches radical acceptance. DBT also teaches distress tolerance skills. I think it is right up your alley. DBT might equip you with enough new skills to unlearn wanting instant gratification, too. DBT is fairly well vetted as a treatment modality so if you go that route, you would get the benefit of a toolkit that has been proven helpful to many other folks. Most importantly, DBT is comprehensive - it would help you address MOST of the issues in one fell swoop. Many of the DBT approaches are universal - you simply adjust them based on your situation.