Nuances of Consent: The Therapist’s Side

Recently, I wrote a blog post about consent, and discussed how the most common kinds of consent violations are much more subtle and insidious than those we see discussed in the media.

Today I want to discuss a related question: as a therapist, how might you see this showing up in your therapy room, and how can you help?

First, we have to acknowledge that subtle forms of internal and external pressure around sex are so common as to be completely expectable, and as such, nearly invisible in intimate relationships. Yet this seemingly benign dynamic can wreak havoc in a couple’s sex life.

One example is with the development of an aversion to sex, touch, or physical intimacy. This can range from quite mild to a full on “Ewww” response, complete with a visceral shudder. This is understandably distressing to all involved, and it may not be at all obvious how it developed. Whenever I encounter this in therapy, I look for a very subtle consent violation.

When one partner initiates sexual or intimate touch, are they both willing? And if one is not entirely willing, are they able to say that to their partner? What happens next for the partner, and the interaction between them?

Very often there are hurt feelings and painful meaning-making on one or both sides.  Maybe one hides their lack of willingness to avoid hurting the other. Maybe one partner broadcasts hurt feelings and frustration, thereby reinforcing the less-willing partner’s decision to “ just do it anyway”. Sex shifts from being a pleasurable, connecting experience to being an emotionally painful one. And very often, a slight aversion develops in one partner or the other.

Let me be clear; neither of these partners is an abuser, or a victim, except insofar as ALL of us are abusers and victims. This dynamic is so understandable from both perspectives; who would want to experience their spouse shuddering at their touch? Who would want to feel pressured to have sex or to feel like they are failing as a partner? This couple needs your help to become better able to look inside themselves and figure out what they think, feel, believe, and prefer and then to express that to their partner. They need to get good at holding steady when their partner is expressing something important but stressful.

Start by normalizing communication about sex. While you’re at it, normalize saying (and hearing!)  “yes”, “no”, and “maybe” without making a lot of problematic meaning about yourself, your partner, and your relationship.

Every lover wants to feel like a good lover. Getting and giving guidance sexually should be greeted as a roadmap to a positive, connecting interaction, rather than a threat to one’s self worth.

If you haven’t heard about “Will Lily”, my brief assessment tool, check it out! It is designed to help you identify subtle issues like this early on, so you can be an effective helper right from the start.  

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.

When Consent Isn’t Simple

A few years ago, a 3-minute video called Consent: It’s as Simple as Cup of Tea blew up online. You may have seen it. I like the video; it’s fun and engaging, and the message is important. Better yet, it got the whole world talking about consent. But my years of experience as a sex therapist have taught me that consent is much, much more complicated than a cup of tea.

Rape and assault are, horrifyingly enough, common in our society. Yet many people are suffering under a more subtle and more pervasive form of consent violation. This kind of violation arises, not when your partner ignores “no,” but when you, for whatever reason, can’t say it. This happens in abusive relationships, but not exclusively. In my experience, there are a host of reasons why someone might not be able to say “no,” even if they really want to:

  • They’ve been enjoying the sexual interaction up to now, and feel like it would be unfair to stop or change course
  • They want the experience of closeness and intimacy that comes with sex, without the actual sexual interaction, but don’t know how else to be intimate
  • Penis-in-vagina sex (or some other sex act) hurts and they don’t tell their partner because they’re ashamed or feel broken
  • They think that one thing has to lead to another, and then to “going all the way”, and for whatever reason, just aren’t up to it right then
  • They don’t want their partner to feel unattractive, rejected, or disappointed
  • They believe a “good woman” or a “real man” doesn’t say no or ask for course-corrections

However harmless these interactions may seem in the moment, they each represent a denial of self. Over time, a partner who continually chooses to have sex they don’t really want will begin to feel more and more trapped in the relationship, and sexual interactions will begin to feel like, at best, an obligation, and, at worst, a violation. Slowly, these small violations erode the connection between partners.

Sometimes I work with couples who haven’t touched–not even a kiss on the cheek, or a quick hug–for years. As we work together to unravel how this came about, we often discover that it started with a pattern of these non-communications, in which one or both partners were unable to express what they prefered in the moment. Might it have been simpler and more effective for each to speak up in the moment, even if it felt challenging?

Consider: are you holding back a portion of your whole truth from your partner? Are you too afraid of hurting their feelings to express your preferences, desires, and perceptions? Can you take a leap of faith and reveal your complete, flawed, unvarnished beautiful self–your self who sometimes is not in the mood, sometimes experiences pain in certain positions, or prefers some kinds of touch over others? What would happen if you shared these honest realities? More importantly, what would happen if you didn’t?