Why desire discrepancy is so tough to treat

Exploring the multifactorial nature of desire

Last fall, I wrote to every therapist on my mailing list and asked them to tell me what sex issues they found particularly challenging. The most common answer, by far, was desire discrepancy. On top of that, I also noticed that many of the therapists who wrote to me were beating themselves up about it, saying things like “I feel like I shouldn’t struggle with this, but I do.”

In other words, if you struggle with tackling desire discrepancy issues as a therapist, you’re far from alone. But why, exactly, is it so tough?

 The truth is, desire is highly multifactorial. There is no one cause for desire discrepancy, and in any given case, there will be multiple different layers of intersecting dynamics to untangle, each of which presents its own challenges:

Physiological factors – Most therapists haven’t received any training about how body systems of pleasure and arousal actually work, and the truth is, you actually do need some grounding in physiology  in order to effectively assess and conceptualize a desire discrepancy case. This might include understanding elements like sex pain, anatomy of pleasure, erectile function, overall body system function, physiological changes over the lifespan, the impacts of postpartum, and more. 

Emotional factors – While these tend to be our wheelhouse as therapists, that also means we’re well aware of just how complex this element can be! This encompasses everything from body image to trauma to meaning-making to spiritual aspects and beyond.

Relational factors –  It is completely normal and expectable for people in a relationship to have different levels of desire – in fact, it would be more surprising if they didn’t. However, the stress and discomfort surrounding a desire discrepancy often creates entrenched relational feedback loops that serve to worsen the discrepancy and prevent the partners from connecting. For example, when the lower-desire partner feels pressure for sex — whether subtle or overt, internal or external — this diminishes desire and introduces conflict. These dynamics can build over the span of decades until what was once a small difference becomes an incredibly loaded topic and a source of deep disconnection. 

Social/cultural factors – Our broader context delivers us constant messages about how we should look, what we should want, how our relationships ought to be, what sex means, who is sexy, and more, and all of these inform our sense of who we are sexually, and what is both expected of us and available to us. In this arena, factors like marginalization, intergenerational trauma, family history, and cultural context all come into play. Truly rich ground for therapy. 

I think a lot of therapists come to train with me hoping that there will be a quick fix or a one-stop cure for desire discrepancy, but the truth is, there just isn’t. Don’t get me wrong — there is definitely a treatment plan. It’s just not a quick one, and it requires a good deal of patience, knowledge, and curiosity, from both therapist and clients.

Sound daunting? That’s understandable; it’s a lot! But the truth is, although it might require a bit of a continuing education journey, it’s not really any more complex than any of the other issues we work with everyday. Our work is all about diving into the tough stuff. You’ve got this.

That said, there’s another issue many therapists face — simply because we haven’t had training on this topic, a lot of us don’t know the right questions to ask, or the most effective course to take when we begin treatment.

Speaking of continuing education, if you would like to learn the right questions to ask, the most effective approach in early treatment, and much more about how desire discrepancy works, including how to help, I’ve got a free training series designed to help you get a strong start with desire discrepancy cases. You’ll learn some common missteps to evade, key questions to ask, and some essential concepts to focus your treatment.

Originally published on Psychology Today.