After Will Lily: How to Use What You Learn in the Brief Assessment (Pt 2)

In my last post, I discussed how Will Lily fits into a treatment plan. I explained how the pieces of Will Lily work together to disentangle the factors underlying a complicated issue, like low desire. Now, I’m going to dive into the specifics of how to follow up on Will Lily. This guide will help you explore the issues that were revealed in the assessment in more depth and detail.

When I follow up on Will Lily, I prioritize the most pressing issues. If there is a problem with willingness, arousal, or pain, it is particularly concerning, because it indicates a serious risk for your client’s health and safety. However, I will follow up on anything that seems concerning.

There’s nothing particularly surprising about what I do to follow up. I’ll bet the kinds of questions I ask would come naturally to you. Your instincts as a therapist can guide you here.

Here are a few example of good follow‐up questions to inspire you:

    • When did it start?
    • How has it changed over time?
    • What is your theory about what is going on?
    • Specifically, where/when do you experience the problem?
      • If the symptoms are specifically sexual, you will be having a detailed conversation about body parts and sexual interactions. That’s ok. You can do it. You won’t be able to tell what’s going on (or ask me!) unless you know a fair amount about specifics.
    • Are there ever any exceptions?
    • How do you and your partner handle it when this issues arises?
      • This is the intersection between relational interactions and sex issues; you might want to refer to my blog post “When Sex Doesn’t Go As Planned.”
    • Are you taking any medications?
      • Many medications have sexual side effects. You should be able to google this quite easily; I encourage you to do so with every medication your client takes, because you might be surprised by how common these side effects are.

Once you have more of an idea about what is going on, particularly regarding the 3 categories that are potentially pressing (willingness, pain, & arousal), you can refer back to the assessment video for next steps. If you don’t find the answer there, err on the side of caution and consult.

I hope you get a ton of use out of my assessment tool, and I hope these ideas for how to follow up help you further uncover the tool’s potential as you grow more and more practiced and confident using it.

After Will Lily: How To Use What You Learn in the Brief Assessment

If you don’t know my Will Lily assessment tool yet, it’s a sequence of questions designed to open up a thorough, comfortable dialogue about sex with your client, and sort out multiple factors that tend to affect sexual pleasure and function. If you want to learn more, I share the whole assessment at no charge in my 2 part video workshop. You can sign up here.

Today, I want to share some context for Will Lily in order to help you make better use of it in your own therapy room. This blog post is the first in a two‐part series. The first post will give some larger context, describing how Will Lily can guide your treatment planning, and the second will dive into the specifics of how to follow up on the information you get from Will Lily.

I use Will Lily as a screening tool in the intake session. In addition to opening and normalizing the topic of sex, it efficiently narrows the field regarding which systems might be involved in any sex issue that might come up. If there are several sex issues involved, it helps distinguish between more and less pressing issues.

Once you’ve gone through Will Lily, you will know where the problem is and what you are actually treating. You will be able to focus your efforts, which will make you much more effective at helping. That’s why it’s important that you ask every question in Will Lily. If you skip one, you won’t get a complete picture of the issue.

For instance, if I spent the whole session discussing my client’s distress over low desire, I might not hear about arousal issues, like changes in erectile function. I might miss an important health issue that must be addressed immediately in order to prevent harm. (By the way, if you haven’t heard about the relationship between arousal signs and heart failure, you can read more about it here—it’s incredibly important, and more people should know about it.)

Will Lily helps clarify multiple aspects of any sex issue, but it really shines when a client has desire issues. Desire is so multifactorial! Just about everything affects desire. Will Lily is designed with that complexity in mind. The six questions cut through the tangle of overlapping factors to sort out what is affecting desire.

Here are some ways the different pieces of the brief assessment relate to desire:

  • A lack of willingness to engage in a sexual encounter is likely to affect desire. If a person feels any little bit of internal or external pressure, that can devastate desire. So can other factors that affect willingness, like fear of becoming pregnant, or contracting a sexually transmitted infection.
  • Pain can clearly affect desire, because nobody wants to have unintentionally painful sex, and nobody thinks it’s hot for their partner to experience that, either.
  • Erectile issues, which indicate problems with physiological arousal, are potentially early warning signs of life-threatening illness, and also wreak havoc with desire. The person with ED can develop low desire via performance anxiety, aversion to the drama that ensues with their partner, or any number of other reasons. The partner of  the person with ED can develop low desire too, for similar reasons.
  • Difficulty reaching orgasm can create internal or external pressure, performance anxiety for either partner, guilt, and deception. Sometimes it makes people think “I just don’t see what’s so great about sex,”  which, naturally, leads to a lack of desire for sex.
  • A sense of dissatisfaction after sex for any reason indicates a level of distress that is very likely to affect desire.

I hope this context helps you use Will Lily to illuminate underlying issues and develop a sound, strategic treatment plan. In part two of this series, I share examples of good follow up questions to build on what you learn from Will Lily. You can read it here