What Do You Need To Know About Asexuality?

I believe that every therapist, and certainly all sex therapists, should be prepared to work with asexual, or “ace” people. Some might assume that sex therapists don’t have anything to offer asexual clients. I can understand the misconception: what could a therapist who specializes in sex issues have to offer someone who has little or no interest in sex? However, NOT wanting sex is just as valid as WANTING sex, and both can create relational stress in certain circumstances—which you might be called upon to work with in therapy. 

Asexuality is one of the topics therapists ask me about frequently, so I’m going to provide a very brief primer on asexuality here, focusing specifically on challenges therapists have asked me about. There is much more to know; check out these online resources about asexuality:

The Asexuality Visibility and Education Network

Trevor Support Center: Asexual

50 Shades of Attraction: Understanding the Asexual Spectrum

If you’re going to work with asexual clients, there are a few basic things you must know. Asexual people and everyone in that ballpark (ace, demi-sexual, aromantic, grey-a, etc.) are marginalized populations. That means they get discriminated against as a result of people either having misconceptions and misinformation about them, no information about them, or believing they are in some way inherently bad, wrong, or broken. When you work with marginalized populations in therapy, it is extra important that you know enough about their identity (in this case, asexuality) to avoid causing harm. 

Happily, my blog post, a little online browse, and an open mind should be sufficient to get started. There is one important caveat: if you do a little reading, and find that you still believe asexual people are in some way flawed, you are not yet qualified to be their therapist. In that case, if you are still interested in working with the ace population, you will need extra training, consultation with an expert, and/or to refer those clients to someone who knows more about asexuality. 

Here are some basics:

  • An asexual person doesn’t need to have sex in order to be healthy and happy. 
  • It is possible to have a wonderful relationship without having sex. 
  • Asexuality isn’t a problem; it’s a perfectly normal way of being. 
  • Asexuality is an identity, meaning it is part of the way some people are, or how they see themselves. 
  • Asexuality is not the same as sexual aversion, or low desire, and is not a sexual dysfunction.
  • Asexuality is not caused by fear of intimacy, or attachment wounds. It is not connected to any psychopathology, any more than any other sexual orientation or identity is. That said, of course some people in any group may have attachment wounds or psychopathology. It is the lack of causation that is the important part. 
  • Asexuality is not the same as abstinence; some aces are abstinent, and some are not. Some experience self-pleasure, arousal, orgasm, and/or partner sex, and others do not.
  • Some aces enjoy romantic connections, some do not.
  • There is a huge range of self-expression in this, as in any other population. If you can imagine it, it exists.

You can put your asexual client at ease by making it clear that you understand and respect their identity, and that you’re not going to try to “fix” their asexuality. It’s ok to tell them you don’t have much experience in this area. For most people, the most important part is that your mind is open, your heart’s in the right place, and you’re willing to learn (and not just from your client). But if you happen to have a client who really wants a therapist with a lot of experience with asexuality, it would be doing them a disservice, and would also be unethical, to misrepresent yourself in this matter.

There are a number of sex- and relationship-specific challenges that might bring an asexual person to therapy, in addition to the vast array of challenges people experience that are not related to sex, sexuality, or asexuality.

For one thing, it can be very challenging as an asexual person to find an intimate partnership where they can be themselves comfortably, not feel pressured for sex, and experience intimacy in ways that they enjoy. As a therapist, your role might be to help your client navigate that challenge. You could support them through the emotional pitfalls of seeking and nurturing a relationship, and help them hold steady and speak their truth to potential partners. As always, you can do a great deal of good simply by normalizing asexuality and affirming your client’s identity. Sometimes there is also an opportunity to provide support, information, and resources to partners.

You might also see a client who needs help navigating an already existing relationship. Sometimes asexuality has always been part of the picture, and other times it emerges somewhere down the line. It is also not uncommon for a couple to come to therapy for a desire discrepancy, and in the course of therapy it begins to become clear that one partner is actually asexual. This may have always been the case for them, and they may or may not have been aware of it. Or their asexuality may have emerged more recently. Sometimes the client, and/or their partner, knows what asexuality is, and other times they are learning about asexuality from me in therapy. 

Here are some concepts that may help you as you begin to work with asexual clients:

  • Some asexual people experience willingness to have sex, even though they don’t experience desire. Being willing is sufficient for having a consensual and positive sexual experience. Identifying and accessing willingness to have sex, in the absence of sexual desire, can be a very successful solution for some couples. Of course you must ensure that the asexual partner’s choice to have sex is freely chosen and authentic, without any external or internal coercion or pressure. Otherwise, it doesn’t really check the box for “willingness”.
  • Sometimes consensual non-monogamy is a workable solution, because it makes it possible for the couple to preserve their relationship while also allowing the non-asexual partner to express and explore their sexuality. 
  • Lots of asexual people experience romantic love, so this can offer a point of intimate connection that works for all involved.
  • More people are somewhat ambivalent about sex than you might think, without being asexual. It is certainly possible for a sexual person to be in a relationship with an asexual person, and to make the decision that sex isn’t as important to them as other ways of connecting, experiencing intimacy, and being close. 
  • All relational therapy is about strengthening connection, so place your focus there. Some people connect through sex, some through outdoor activities, some by raising children together, some by playing video games, some by cooking together; the sky is the limit. Sex is far from the only way to experience closeness, intimacy, and vulnerability. 

What Happened To The Spark?

Here’s a common relationship problem, and a frequent question I get from relationship therapists: What do you do when the “spark” fades from the relationship? 

This is an interesting question, because it is actually several questions disguised as one. Here is my rundown: 

  1. Why does the spark fade? Is inevitable?
  2. How can we navigate the transition (from super-hot to less-hot) gracefully, in ways that promote a deepening connection?
  3. Is it possible to get the spark back after it is gone?

This week, I’m tackling part 1. In the next two weeks, I’ll address numbers 2 and 3.

Let’s imagine a couple who has had a blissful first year or so of their relationship. They fell in love. Everything felt like a romantic movie. But now, they are starting to have some uncomfortable feelings, experience some disappointments, or notice things about their partner they don’t like so much. Maybe one notices their sweetie leaves socks in the middle of the hallway as a regular practice, not just once in a while. Or they don’t carry their dishes to the sink, or are obsessed with sparkling clean counters in a maddening way.  Or maybe one partner starts to miss their friends, who they haven’t seen much of lately during the flurry of new love. 

Or…maybe some issues are showing up in the bedroom. Often this starts with one partner realizing they are slightly (or not-so-slightly) dissatisfied sexually. They don’t know how to talk about it, they worry about hurting their partner’s feelings, they think there is something wrong with them, they think there is something wrong with their partner, or they don’t think it is ok to discuss sex for any number of reasons. Here are some common scenarios:

  • One partner realizes there is a sexual activity they used to really enjoy, that their new partner doesn’t seem to like, or doesn’t often engage in. 
  • One partner hasn’t been experiencing orgasm, and one or both are distressed about it.
  • One partner either takes hardly any time to reach orgasm, or “too long”, and it is distressing
  • One partner hasn’t been experiencing orgasm, but the other partner thinks they have; discussing it will reveal the deception.
  • One partner experiences painful sex and is afraid to bring it up 
  • One partner has anxiety about sex that results in various misunderstandings and difficulties
  • Erectile difficulties or other sexual function challenges create misunderstandings 
  • They don’t know how to talk about a perfectly normal difference in level of desire
  • Now that sex has settled into a routine, one or both partners are a little bit bored 
  • Something one partner is doing in bed is somewhat anti-erotic to the other, and the sexy-hot vibe has cooled enough for this to be a problem. 

I could go on, and on. There are many, many sex-related issues that crop up at this stage of relationship.

Now let’s go back in time, to the earlier stage of the relationship. Our couple has been dizzy with love for several months. They have eyes only for one another. They play together, look forward to seeing one another, talk about everything under the sun, revel in every discovery of commonalities. They are having so much fun together, they don’t want this stage ever to end. They are also becoming exhausted by staying up too late at night and they haven’t been able to find time for friends, or mundane tasks of daily living. 

This is the first stage of relationship, and is referred to as symbiosis. (I’m deeply indebted, by the way, to Ellyn Bader and Pete Pearson for this concept, and for creating the Developmental Model of Couple Therapy!) In the symbiotic stage, we look for, notice, and maximize all the ways we are similar to one another. We bond. We give and receive love, and feel cherished. We create as much same-ness as we can, in an effort to create emotional safety. We stretch ourselves to get curious, agree, try new things, explore. We want to share activities and interests with our new love, even if it is a bit of a stretch, and this can produce some pretty amazing personal growth outside of the previous restrictions of our comfort zone. All of this bonding is very important; it creates a foundation that is (hopefully) solid enough to hold us together as a team as we face life’s inevitable challenges. But symbiosis is only the first stage; there are other stages still to come, and each stage has some important aspects that lend support to subsequent stages.

The next stage is differentiation, and it usually starts when one or both partners start to notice some differences between them. Remember the dishes left out, hyper-clean counters, and sexual disappointment? If the couple succeeded in creating some significant amount of emotional safety in the symbiotic stage, it can feel like there is a lot to lose if the relationship doesn’t work out. That fear, the fear of losing the relationship, acts as an inhibitor to disclosing things we think our partner might have a hard time hearing as we start noticing differences and feeling uncomfortable feelings about it. (Refer back to the list of sex issues that often crop up, and consider the many other aspects of life in which such differences might emerge.)

So, now we have a couple who are disappointed, in love, fearful, hopeful, exhausted, probably somewhat out of touch with their friends, and sexually frustrated. They are trying to figure out how to stay connected while making sense of sudden realizations of differences between them. They might be questioning their judgment, making decisions about whether to stay or leave, or just trying to figure out how to have a conversation about sexual pleasure in a culture where we don’t generally do that. For most people, not much in life has prepared them to be able to do this easily, or in a way that fosters connection and increased intimacy. 

So you can see, sometimes the spark just gets lost in the shuffle. None of the above are sexy scenarios, and most people are terrified to talk about sex under even the best of circumstances. 

That’s why, even if it’s not entirely inevitable for the spark to fade from a relationship, it’s extremely common–and it’s pretty hard for people to know what to do about, especially since what will ultimately help (speaking up and saying the scary thing you’re afraid your partner won’t want to hear) feels like the worst possible thing to do, as it threatens the comfortable illusion of sameness that was created during the symbiotic phase. 

Things look tough for our couple now–but hope isn’t lost! Tune in next week, when I’ll discuss how couples can navigate the tricky transition from dizzy-in-love into a more mature stage of their relationship–and what you, as a therapist, can do to help. 

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.