Reader Question: What Is Gender Fluidity? (Part 2)

My question has to do with gender fluidity. I understand that we all have male and female within. But somehow I’m finding this concept, when taken to dressing, acting out the parts, and expecting others to respond accordingly, as ridiculous. I feel as if I’m being really old fashioned and very judgmental.

(This is part 2 of a series–check out part 1 of What Is Gender Fluidity? here.)

Imagine being born intersex, with some combination of male and female body parts and/or chromosomes. This describes between .05 and 1.7 in 100 people, depending on how you assess. Your parents would probably have chosen your gender for you, arbitrarily, at birth, obviously without consulting you. You might have been subjected to surgery so your pelvic organs and genitalia more closely “matched” a  binary mold. Your hormones might have been adjusted in puberty to maintain the gendered outward presentation your parents chose.

When you imagine being in that situation, does it seem possible that your parents might have guessed wrong about how you would perceive your own gender? What if you aren’t born intersex, yet still the gender you were assigned at birth doesn’t match your own internal sense of knowing? Would you be likely to assimilate, or differentiate? And might you want a therapist who could help you work through the complexity of thoughts/feelings/beliefs with as little bias as possible?

Now imagine being a person who doesn’t have an internal sense of being male, or female. Or who identifies as all genders simultaneously. Or on some days one, and other days another. Or on some or all days somewhere in between. It might be difficult to find people who could relate, or be of support. You might get tired of explaining this potentially complicated and private aspect of yourself to people who don’t get it. You might get annoyed when people address you with binary pronouns like he and she, because it reminds you of just how invisible and culturally unacceptable your identity is. Gender neutral pronouns do a better job of honoring the authenticity of diverse identities, even though all pronouns will always fall short of the mark–there is a LOT of gender diversity.  

As a therapist, my work is helping my clients identify their internal sense of knowing, and then take steps to align their internal sense of themselves with their external actions and choices. There is a certain kind of authenticity that comes from congruency. From this standpoint, it is natural that I would work with gender diverse clients; to me it makes perfect sense that a person would strive for congruence between body, mind, internal sense of knowing, and external expression of gender. This is easy for some, but it’s not so easy for those who don’t congruently fit with the assigned mold, and are subject to marginalization for being different.

I was born in 1961. I didn’t know there were same sex couples, had no idea there was such a thing as dissonance between sex characteristics and internal understanding of gender, and certainly had no idea there was such a thing as non-binary gender identity or fluidity. I learned about same-sex attraction relatively early on. I learned there were trans people and identity perhaps two decades after that. I don’t know exactly when I became aware that not everyone felt congruent with a binary gender identity; it was relatively recent. Our culture, or at least my little sliver of it, has been blind to this aspect of diversity for a long time. So as I see it, we’re playing catch-up and things are moving fast. It isn’t comfortable, but I think I owe clients, friends, and family support for the development of their congruent selves, no matter what their path looks like.

Here are some suggestions for clinicians who work with a gender diverse population:

  • Don’t have checkboxes for male/female gender on your intake forms. Instead ask for gender and provide a write-in line. How a person self-identifies when given unlimited options is very important. Also, gender non-conforming people will feel seen.
  • Consider including a question about preferred pronouns on your intake form. Again with a write-in line. There are a lot of gender-neutral pronouns and a lot of ways to present gender so don’t guess. I have some clients who don’t have any idea what this question is about or how to answer it, but my gender non-conforming clients appreciate feeling seen. Knowing that, I think it’s important that I refer to them with the pronouns that are most comfortable for them. A person sometimes refers to themselves with different pronouns on different days, or changes pronouns during therapy. The client will let you know, or you can ask.
  • Get good at making a repair. When you work with marginalized populations, you are working with people who have been hurt many times. You obviously are trying hard not to add more hurt, yet nobody is perfect and I predict the occasional error. (Ask me how I know.) If you take a misstep, and you will, thank them for being brave enough to tell you, take the feedback gracefully, and make a sincere apology. Then go read a book or consult with someone who can help you understand anything you’re not clear on about that interaction.
  • Gracefully adopt and understand your clients’ evolving language. Language expressing gender diversity is evolving quickly; there is variation between communities, regions, and individuals. If I don’t understand a term, or think we might be thinking of two different things, I ask the client for their definition/meaning.

All Levels of Desire Are Normal

When therapists work with desire discrepancy, they sometimes fall into a counterproductive trap–identifying one partner as “high” or “low” desire, and trying to “fix” that partner’s desire level.

“High desire” and “low desire” are comparative terms. What standard are you comparing against? Is there such a thing as “normal desire” or “abnormal desire”?

I say no. Everyone’s level of desire is unique, and there is no reason to think a particular level of desire is “more correct” or “more healthy”.

As a therapist, you are in a uniquely powerful position to normalize any level of desire. The problem resides in the meaning each partner makes about their own desire level, or that of their partner, not in the level itself.

If a client were interested in shifting their own level of desire, it would only be possible in a very emotionally safe environment. Trying new things and stretching for challenging growth does not work when one feels pressured, pathologized, bad, wrong, or inadequate.

We would do better to celebrate difference in desire as expression of the uniqueness of each partner (that nonetheless can create tension), rather than pathologizing it.

Your clients probably have worked through desire issues in other areas of their lives. We all have desire differences in our relationships, whether they be about how much money to save, how clean to keep the house, or, in my house, how many cats is the right number. (When it comes to cats, I’m definitely the higher-desire partner.)

Making room for partners to hold the tension of being different from one another, and to find ways to work collaboratively with their unique differences, is both the work of couple therapy and the work of being in a long term relationship.

Here are some questions for your (and your clients’) consideration:  

  • What are your beliefs about desire? Do you believe there is a “right” amount of desire?
  • What does it mean, about you, and about your partner, that you are the higher or lower desire partner?
  • Where did you learn these beliefs about desire?
  • What other desire discrepancies have you and your partner worked through successfully?
  • What if you believed every level of desire is normal? How would that change things for you?


Desire is such a complicated issue because it has roots in every aspect of the relationship and of the self. That’s why treating desire discrepancy is so difficult. Reframing how you talk about desire discrepancy is a powerful first step towards freeing your clients from damaging habits and setting them on a path of personal growth.

Beyond communication skills: What DOES improve intimacy?

Last week, I showed you why focusing solely on couple communication in therapy won’t fix sexual intimacy issues. This week, I’m building on that theme and asking the question: where DOES couple connection fit in the conversation about sexual intimacy? You might be surprised by the answer.

As therapists, we work very hard to build couples’ communication skills. We help our clients learn to listen to one another, reflect back what they’re hearing, check their assumptions, stay curious about their partner’s viewpoint, and make good repairs when necessary. But when these skills aren’t enough, we’re left wondering: why is it that couples with good communication don’t always have satisfying intimate encounters?

Here is where improving connection fits into therapy about intimacy: your clients must make strong choices right in the middle of a disappointing and possibly embarrassing moment. They must choose connection over performance as a measure of success. Your role as a therapist is to support this growth stretch, and it can be a very challenging learning curve.

First, we have to get at the root of the issue. We have a deeply embedded cultural mythology about what a “good” intimate interaction looks like. People judge themselves and their partners against these myths–and when they don’t measure up, the emotional consequences can be devastating. As a therapist, you are also a myth-buster–uniquely positioned to help your client understand why these cultural assumptions aren’t realistic expectations for themselves or their partner.

Unfortunately, understanding that mythology isn’t enough to end the trouble. You have another key role: drawing out and supporting your clients’ values-led goals. You can help them work through emotional blocks and unruly feelings that arise when intimate interactions don’t go as planned. You can help them check their assumptions, and begin to choose to stop judging by performance and start being a good teammate.

Read last week’s post here, and make sure to check out  my blog post titled “When Sex Doesn’t Go as Planned” for more information and some specific examples.