Working With Sexual Aversion

I’m continuing my series responding to the answers my readers sent me in response to the question, “What is your biggest challenge working with sex issues in therapy?” This week, I’m discussing a really challenging one: sexual aversion.

Understanding a little about the Dual Control Model of sexual arousal will help you begin to approach sexual aversion with more confidence. The Dual Control Model was developed by Jansson and Bancroft from the Kinsey Institute. Emily Nagoski’s excellent book Come as You Are presents the model accessibly and in depth, if you want more information. 

The Dual Control is useful in understanding lots of sexual dynamics. The idea of the Dual Control Model is that sexual arousal isn’t an on-off switch. It has two components–excitation and inhibition, which Nagoski frames as being like an accelerator and a brake. That is to say, things that turn you on hit the accelerator, and things that turn you off hit the brake. The point is, you can stomp on the accelerator all you want, but if something’s holding down the brake, you’re not going to get anywhere.

With sexual aversion cases, generally what’s going on is that something is holding down the brake, hard. No matter what your client or their partner might do to increase stimulation (or hit the accelerator), nothing is going to improve in any substantial way unless they figure out how to let up the brake. Your job as a therapist is to help them identify what’s hitting the brake, and how to let it up.

Anxiety is the biggest brake ever. Sexual aversion is a form of anxiety, or even panic. Aversion sometimes results from a history of trauma, or from untreated sex pain, or a subtle (or overt) feeling of coercion or pressure around sex, but there isn’t always an obvious cause. If you think of it as anxiety, you’re more likely to get to the bottom of it. There might be subtle but pervasive shame about sex, for instance, or body image issues. Start with the Will Lily brief assessment to make sure you are targeting your questions and not missing anything crucial. (Spoiler alert: don’t forget to ask if any kind of sexual contact is uncomfortable or painful!)

Regardless of cause, there are some skills that usually require strengthening in order to resolve an aversion. These include: 

  1. Help them get control over the situation. Your client must feel in control, at all times, when in sexual contexts. It is extremely helpful if their partner is on board with taking a supportive role until the aversion resolves. The role of the partner is so important to this treatment plan, because aversion is an entirely systemic phenomenon. Any little hint of external or internal psychic pressure about sex will have to be addressed. If this is an individual client, see if you can have the partner come in every now and then so you can see the dynamics between them, and strengthen the collaboration and teamwork. It is also very helpful to have both partners in the room for complicated psychoeducation that requires a perspective shift, as is often true when discussing sex pain, psychic pressure about sex, sexual pleasure (which can really increase desire!), and sexual differentiation of self. The partner of someone with a sexual aversion probably also could really benefit from some support; it is an extremely difficult situation to be in! It would be fabulous if you could support them both as they learn to work together and heal this dynamic around sex. They have a lot to gain.
  2. Build their ability to identify desires, set boundaries, and hold those boundaries. Without the ability to identify desires, preferences, and boundaries, communicate them, and back them up with action, it will not be possible for the client to really feel in control.
  3. Diagnose physical problems. Painful sex will make aversion worse, guaranteed. Absolutely get any sex pain diagnosed and treated. While that is under way, the client will need to completely abstain from any painful type of contact.
  4. Practice relaxation or mindfulness. Once safety and control are in place, the linchpin of your treatment plan will be teaching the client, and their partner, how to relax in sexual situations and enjoy sex for the purpose of pleasure, rather than performance. This is a lot easier to do in a relational therapy where you have both partners in the room. Consider bringing in the partner for a few sessions if this is an individual client.
  5. Explore intrapsychic blocks. Ambivalence about sex is worth a deep dive. Look for signs of past or current trauma, including psychically “benign” sex pain, but don’t forget to look for subtle shameful messages about sex, which are extremely pervasive. What were they taught about sex? About themselves sexually? About people who enjoy sex? Are they able to enjoy pleasure in any aspect of their life? How about sexual pleasure? You can identify blocks by having a client talk you through a sexual interaction, step by step. Ask what occurred, but also what they were feeling, and what they were thinking. At the first little sign of anxiety, which might be merely a body sensation, delve into the multiple messages they are telling themselves in that moment. “What are you telling yourself to make yourself feel anxious?” “What are you telling yourself to make yourself feel scared?” Chair work can be very helpful in both uncovering and treating blocks of all types.
  6. Keep your client’s goals front and center. Don’t forget: Having sex is not a requirement of life. It is possible your client is asexual, or just not very interested in sex. Before you really dig into treating an aversion, ask where your client would like to get. There is no point in working toward a goal that your client isn’t interested in meeting. That said, if they have the type of aversion that comes with a big “ick” reaction or panicky feelings, they might want to resolve the negative feelings. But having anxiety-free sex is not the only possible positive outcome. Being in control of what they choose to do, even if that means being able to feel good about themselves while saying “no” to sex forevermore, would also be a great outcome.
  7. Refer or consult if necessary. If you don’t find your treatment plan progressing, a sex therapist can probably help. You might choose to refer the client, for a time, or permanently. You could also consult with a specialist every now and then as the treatment evolves, while continuing to do the therapy yourself.

Willingness is Enough

If you move in sex-positive and/or feminist spaces, you may have heard the term “enthusiastic consent.” Enthusiastic consent is the idea that consent requires the presence of a “yes,” not just the absence of a “no.” The enthusiastic consent movement is doing a lot of important work reframing our cultural dialogue around sex and fighting against coercion and assault. However, sometimes I think the term “enthusiastic consent” can obscure something important—namely, that sometimes willingness is enough to engage in a sexual encounter.

Some people experience desire spontaneously. That is, they’re going about their day, and then all of a sudden they think, “Wow, I’d like to have sex”–and then, perhaps, they act on that desire in some way. This way of experiencing desire is what we tend to think of as the “normal” way. But it’s far from the only way, and in reality, it’s no more normal than any other experience.

Other people tend to experience more responsive desire. That is, they start to actively desire sex only after a sexual encounter is underway. They start with willingness, and their desire blooms as the encounter continues. This is a perfectly normal and healthy way to experience desire.

Because we tend to think of spontaneous desire as the norm, people who more frequently experience responsive desire may be pathologized as having low desire, or even NO desire. They may think of themselves as lesser or broken. Their partners may fear that they are not attracted to them, because they don’t tend to initiate sex. All of these problems could be avoided with the understanding that all ways of experiencing desire are normal.

Recognizing that willingness can be enough to begin a sexual encounter is an important way of validating and normalizing responsive desire. We can fight for the importance of affirmative consent, and work to eliminate even subtle forms of coercion, while recognizing that there are many healthy reasons to say “yes” to sex besides having an explicit experience of wanting. Here are a few:

  • To experience connection and closeness with your partner
  • Because you know desire will bloom as the encounter continues
  • To relieve menstrual cramps
  • To attempt to get pregnant
  • To enjoy giving your partner pleasure

 

In your own life, and for your therapy clients, how can you validate different ways of experiencing desire, and multiple reasons for having sex, while still addressing the issue of coercion?

Helpful Links

I started blogging in 2016. Now, two years later, I’ve amassed a pretty significant backlog of posts, each of which strives to provide something of value to therapists and individuals: useful tips about building fulfilling relationships, sorely-needed little-known facts about sexuality, answers to pressing questions from my subscribers and students.

When my course started at the beginning of this month, I received tons of questions from my new students–and realized that a good many of them related to topics I have written about here. I write about these topics because I want therapists to have access to thoughtful, high-quality information and advice about how to handle sex issues in therapy, and I want that information to be easy to access whether or not you take my course. For that reason, I thought I’d put together a guide to the topics I’ve covered before on my blog, so that you can easily find answers to your questions if I’ve addressed them before here.

As I wrote in the very first post on this blog, I’m on a mission to change the culture of therapy regarding sex, to create a world in which every therapist feels confident addressing sex issues, and every person struggling with a sex issue can access the help and healing they need. A big part of that mission is making sure that therapists and individuals have access to the information they need. This compilation is one small step in the direction of making that kind of information more readily available and easy to find for you and your colleagues.

Thanks so much for being part of that mission; I wish you much success!

Martha

 

Desire Discrepancy

One Question You Can’t Fail to Ask Your Clients

What Do You Do When There’s Love But No Lust?

All Levels of Desire Are Normal

Shifting an Unhelpful Dynamic in Desire Discrepancy

Why Desire Discrepancy is So Tough

Desire Discrepancy Lesson #1: Normalize Variation

Desire Discrepancy Lesson #2: Look for the Blocks

 

Consent

Modelling Consent in the Therapy Room

Nuances of Consent: The Therapist’s Side

When Consent Isn’t Simple

 

Managing Conflict in Relationships

How to Keep Fights From Damaging Your Relationship

10 Calming Strategies for Managing Conflict

7 Steps to Stay Steady in Tough Conversations

Don’t Let Strong Emotions Control You

Don’t Try to “Win” A Fight With Your Partner

The Case for Going “Slow and Steady” to Resolve Couple Conflict

The Key to Resolving Couple Conflict? Uncovering Internal Motivation to Change

Addressing the Issues Without Getting Swept Up in Emotion

Promoting Healthy Differences of Opinion Between Partners

 

Differentiation of Self

How to Build a Long-Term Relationship with Courage and Compassion

3 Ways to Handle New Relationship Bliss that Support a Long-Term Healthy Relationship

Sex and Differentiation of Self

The Discovery That Turned My Practice Around

Better Than “Better Half”

Sexual Intimacy and Vulnerability: Paths to Personal Growth

When Partners Encourage Each Other To Lie

Stop Negative Meaning-Making In Its Tracks

Helping Your Clients Find the Courage to Make a Vulnerable Disclosure

The Power of Checking Your Assumptions With Your Partner

Why Helping Your Clients Find the Joy is a Crucial Part of Couples Therapy

Differentiation of Self is the Key to Keeping Things Sexy in a Long-Term Relationship

Why I Hate the Concept of “Compromise”

What Kind of Partner Do You Aspire To Be?

 

Relationship Agreements

There’s No Such Thing as a One-Size-Fits-All Relationship Agreement

Making Relationship Agreements that Support Growth

What If One Partner Wants an Open Relationship, and the Other Isn’t So Sure?

Rules for Poly Relationships? It’s Not That Simple.

 

Building A Flexible, Resilient Sexual Relationship

When Sex Doesn’t Go As Planned

Beyond Communication Skills: What DOES Improve Intimacy?

Postpartum Low Desire: Improving Intimacy and Strengthening Relationships

Postpartum Low Desire: Emotional Causes

Sexual Intimacy and Vulnerability: Paths to Personal Growth

Willingness is Enough

What To Do When You Don’t Have an Orgasm With Your Partner

What Makes Good Sex Good?

Getting What You Really Want Out of Sex

Good Sex Over a Lifetime

 

Pleasure

Are Vibrators Habit-Forming?

7 Tips For Getting Creative: A Sex Therapist’s Guide to Trying New Things

How (and Why) to Talk About Self-Pleasure in Therapy

 

How and Why To Talk About Sex In Therapy

What Terms Should I Use When Talking About Sex in Therapy?

3 Reasons Therapy Clients Need to Discuss Sex, Not Just Connection

I’m On A Mission–To Change the Culture of Therapy Regarding Sex

After Will Lily: How to Use What You Learn in Brief Assessment (Part 1)

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

How Asking About Satisfaction Can Guide Your Treatment Plan

Putting Clients At Ease With Sensitive Topics 

 

Unscripting Sex

When Sex Doesn’t Go As Planned

Unscripting Sex for More Connection and Pleasure

Flexibility is the Key to a Satisfying Sex Life

Good Sex Over a Lifetime

 

Non-Normative Sexualities

Reader Question: What is Gender Fluidity? Part 1 and Part 2

Reader Question: Is Abstaining From Sex Healthy?

 

Polyamory

Rules for Poly Relationships? It’s Not That Simple.

Should Polyamorous Couples Share Everything?

What If One Partner Wants an Open Relationship, and the Other Isn’t So Sure?

What Polyamory Can Teach Us About ALL Relationships

Poly 101: Working With Jealousy

Discussing Poly in the Aftermath of an Affair Part 1 and Part 2

Working With Secondary Partners

A Common Dynamic that Causes Problems in Primary/Secondary Poly Relationships

 

Health and Physiology

Orgasm and Heart Conditions

How To Set Loving Goals for Lifestyle Change

Body Positivity and Health Consciousness

Life After STIs: The Therapist’s Role

How to Talk About STIs With Your Clients

Postpartum Low Desire: Physical Causes

Mindfulness: A “Magic Bullet” for Building a Healthy Sex Life

Having a Satisfying Sex Life on Antidepressants

Why I Teach Anatomy to My Clients

Facts About Anatomy that Your Clients Need

Facts About Anatomy that Your Clients Need, Part 2

 

Body Positivity

How To Set Loving Goals for Lifestyle Change

Body Positivity and Health Consciousness

Resolution: Start Loving Your Body, Today

How You Can Help a Client With Negative Body Image