Desire Discrepancy Lesson #2: Look for the Blocks

I’m continuing my series on desire discrepancy this week. If you missed last week’s post on normalizing variation, you can find it here.

What do you do if you’re seeing a couple with a big desire discrepancy, their marriage is on the rocks, and you recognize that you can’t wave a magic wand and make one partner want just as much sex as the other one? Sometimes there are things you can do that will increase desire for the lower desire partner, and other times there are not. The good news is, even if you can’t directly affect desire, you can certainly help your clients remove obstacles that prevent desire from blooming.

There are lots of factors that can impede or inhibit desire, and often they fall right into your wheelhouse as a therapist. Whether or not you’ve had training in sex therapy, I’m certain you have the skills to work with issues like anxiety and depression, both of which strongly inhibit desire.

My Will Lily assessment will help you identify some very common blocks–for instance, sex pain, which is, quite understandably, a major inhibitor of desire. If your client is experiencing sex pain, they absolutely must resolve it if they are going to have any kind of positive experience of desire.

Similarly, internal or external pressure is a common inhibitor of desire. Even without full-blown coercion, it’s very common for people to feel subtly pressured into having sex they don’t really want to have, for a variety of reasons–fear of disappointing their partner, for instance, or a belief that once a sexual interaction starts, they don’t have a right to stop or redirect the activity. Over time, subtle pressure can really put a damper on desire and do lasting damage to a relationship. Will Lily can help you identify cases like this in the very first session.

As I continue this series, I’m going to be talking in more detail about some of the factors that can inhibit desire. In the meantime, keep looking for the blocks. They can take all kinds of forms. Are your clients dealing with intensely demanding, stressful work schedules? Are they listening with one ear for the baby crying in the next room? Are they dealing with grief, or working through past trauma?

Identifying and working with factors that inhibit desire is absolutely necessary to increasing desire. No matter how much desire there is, these factors will stop the action.  Helping your clients remove obstacles is what creates space for desire to blossom.

Working With Undisclosed Sex Pain: Vivian’s Story

In my last post, I told you about one of my experiences working with sex pain and desire discrepancy in therapy. Today’s story from the therapy room comes from Vivian, who lives and practices in Sydney, Australia. Vivian recently took my 16-week online course “Assessing and Treating Sex Issues in Psychotherapy.”  Vivian writes:

I would describe my skill level with sex issues before I took your class as intermediate. I was comfortable asking about sex issues and I could help couples use those discussions to support more intimacy and healing of wounds. And I still got so much out of your course!

Since taking your course, I use your script to open the topic of sex with every new client, both couples and individuals. What an easy way to introduce this topic right in the first session! In the majority of cases, clients tell me there is something about sex they want to discuss, and then I use your brief assessment tool as a non-threatening, normalizing way to delve into the issues. This usually opens up a conversation between us, which in itself is diagnostic in that I get a good sense of their comfort with the topic and their interactional patterns.

It’s been surprising to me to see how often sex pain is an issue, and has so often never been revealed let alone discussed. For example, a young woman I saw last week said that pain happens “sometimes” during penetration and that she’d never told her partner. After unpacking this a bit, I was able to give them some psychoeducation, make a recommendation about how to proceed, and ask them to stop any activities that resulted in pain until it could be resolved; I was able to let them know that continuing to have painful sex can cause other problems both physically and emotionally.

With the same couple, I used several other tools and techniques I learned in your course and was able to help her be able to tell him that there were things she’d like him to do which she hadn’t been able to say. Although those were difficult conversations, and they both had to stretch to have them, I had the tools, knowledge, and the confidence to help them get there.

I am still exploring the wealth of information included in your course, and reveling in all the resources too. Thank you so much!

Kind regards,


One question you can’t fail to ask your clients

I know from experience as a therapist how difficult working with desire discrepancy can be. Some of the most distressed, frustrated, angry, hurt couples I’ve worked with have been struggling with all the difficult feelings that come with mismatched desire.

There is just so much to be upset about. We invent a lot of stories about why one partner might want sex more often than the other, usually judgmental or dire things about ourselves, our partner, or our relationship. We feel trapped, frightened, depressed, and things start to feel complicated and tangled very quickly. The clients feel hopeless. After a few months of therapy, the therapist often begins to feel hopeless too. But I’ve worked hard to figure out how to be more effective with these couples, and I’ve developed some tools that make dealing with desire discrepancy much, much easier.

I want to show you how well these tools can work by walking you through a story from my therapy room. This is the true story of a couple that had almost given up hope of fixing their desire discrepancy, and how I was able to restore their hope within just the first ten minutes of my time with them.

When the couple walked into my office, they didn’t believe I would be able to help them.

I couldn’t blame them for that. Their relationship had been floundering for years as they bounced from one therapist to another. Their therapists, they told me, always wanted to talk about improving communication. This wasn’t unhelpful, exactly—they had learned to communicate better—but it failed to address the root of their distress. Even a sex therapist hadn’t been able to shift the problem. Over time, they had come to fear that their relationship was unfixable.

The wife was weeping in my office, blaming herself for not wanting sex. Why dont I want sex? What is wrong with me?  she wondered. Her husband wanted to be supportive, but he was afraid that his wife wasn’t attracted to him anymore, or that he was bad lover. I could feel their despair, and I wondered how painful it must be for them to live with these feelings, day‐in and day‐out.

But after I heard their story, I was able to determine within five minutes a very likely root cause of the desire discrepancy, a root cause which no other practitioner had brought up with the couple. With a few more minutes of discussion, I had explained my theory and made an appropriate referral. I was able to see hope begin to bloom between them, and they left my office so much happier than they had arrived.

How was I able to do this? By asking the right questions. Using the assessment tool I run through with all my clients, and which I share in my free video workshop, I was able to identify the root of the problem as unresolved sex pain.

Imagine what it must be like to have pain be a regular feature of the most intimate moments between two partners. Imagine the harm that can do to a relationship and an intimate connection. Imagine the strength of the love between partners butting up against the body’s wise and very adaptive drive to protect itself. How could desire possibly bloom?

The really sad aspect of this to me is that none of the therapists they had seen before had known to ask about sex pain! In my further questioning, the couple told me they had even consulted an ob/gyn and STILL they experienced unresolved sex pain. Of course, it is helpful to know how to work with sex pain, but that’s not rocket science. There are a handful of very common causes and there are specialists who work very effectively with most of those. There are also specialists whose job is to identify and treat unusual or difficult-to-treat causes.

But in this couple’s case, I was the first to ask about sex pain, form a theory based on the description of symptoms, and inquire whether they had consulted a pelvic floor physical therapist. When they did, the pain began to improve. Over the course of several months of steady improvement, their relationship recovered, buoyed by hope and positive results. Therapy with me simply supported this progress. The couple and the physical therapist did all the work.

Are you thinking “Sure, but she’s a specialist, I know nothing about sex pain and could never do that?” Not true!! I have explained to thousands of therapists, including generalists, specialists, and students, how to use my brief assessment tool and what to do with the findings. I am 100% confident that each and every one of them would have come to the same conclusion I did, and made the same referral.

You can too. If you haven’t already, sign up for my video workshop. It will help you get a strong head start dealing with any sex issue. And if you’re ready to go deeper, to begin helping clients ease distress in this extremely vulnerable area, consider giving my online course a try. It’s a full toolkit for assessing and treating sex issues, packed with robust, flexible interventions that you can put into practice right away. No matter your level of experience, it will help you stretch your limits, increase your potential, and grow as a therapist.