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.

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

Q: I was taught, and have frequently heard, the truism that if you clear up a couple’s emotional connection in therapy, their sexual connection will heal all by itself. In light of all that I have been learning in your course, I am beginning to think this might be wrong. What do you think?

A: This very common belief is a grave disservice to both therapists and clients! It is certainly true that for most people, satisfying sex both fosters connection and requires connection. However, in most cases, strengthening communication and emotional connection is not nearly enough to improve sexual intimacy.

Here are three important reasons why:

  1. Accurate information is not readily available, and misinformation is plentiful. There is nothing more satisfying than offering up a few pieces of carefully timed psychoeducation and watching entrenched gridlock between partners dissolve, leading to a dramatically faster and more effective therapy.
  2. Limiting yet culturally normative views about what sex is, what constitutes healthy sexuality, and what a “good” sexual interaction looks like are usually a huge part of the problem. Discussing this directly is crucial; we don’t know we’re trapped by a myth until someone shows us another way.
  3. Sex is a taboo topic. Many couples who become able to skillfully communicate about other topics are much less effective when it comes to this vulnerable material. These are the clients who come into my office complaining that they have seen many therapists, yet their primary issue remains unchanged because I am the first one who has talked directly about sex with them.

Until every therapist has accurate information about sex, the ability to conceptualize cases beyond culturally limiting constructs, and effective strategies for doing so with skill, many clients will not get the help they need.

I would love to hear about your thoughts and experiences. Did you learn that focusing on connection cures everything? Do you find that a frank, direct discussion makes a difference in your effectiveness? How do your clients respond? Please head over to my Facebook page and tell me about it!

Life After STIs: The Therapist’s Role

For most of my clients, the first few weeks after diagnosis are the hardest time.

As a midwife, I diagnosed people in a busy gynecology clinic. I’ve been up close and personal with the fear, shame, and trauma that people experience when they learn they have an STI.

As a therapist, I work with clients who are struggling with their diagnosis. I’ve seen people overcome the trauma, find the courage to disclose, and come to terms with having an STI.

The biggest hurdle is overcoming the fear that having an STI means the end of a relationship, or of intimacy, the end of love. Over time, and particularly with skillful help, the client will discover that being diagnosed with an STI is not the end of their ability to experience intimate connection and pleasure. Here’s how you can get that process started.

  1. Give them the facts. Getting accurate information about the particular STIs in question is a crucial first step.
    • How is it transmitted, how likely is transmission, what activities are particularly risky, and why?
    • Are there treatments that are effective?
    • What are the consequences to having the infection?
    • What preventative measures are there, and how effective are they?

    There is a lot of misinformation out there. Some of it even comes from the offices of physicians. Most physicians aren’t specialists in sexual health or STIs, and staying up to date is difficult. Also, there is a lot of variability in skill of support staff who do client counseling and provide information.

    Primarily, though, people are traumatized when they learn they have an STI. That makes it incredibly hard to take in information and retain it with accuracy, no matter how skilled the counselor or educator. Fact-checking at a later date just makes sense. The most trustworthy resources I am aware of are the Centers for Disease Control and Prevention and the American Sexual Health Association.

  2. Be realistic about risk. Normalizing risk is one of the most powerful things you can do for your client. Make sure they know that there is no safe sex except self-pleasure. Being sexual with others is a risk management project, and people have very different risk tolerance, relational skills for disclosing difficult things, self-esteem, resilience, values systems that contribute to meaning-making, trust in their partners, and so on. All of this is such important fodder for therapy.
  3. Work on differentiation and flexibility. Disclosing STI status to a potential partner is a highly differentiated communication. It depends on a perspective that holding to one’s values (in this case, perhaps, honesty and integrity) is more important than being with any particular partner. It requires sufficient resilience to bounce back from a hard rejection, potentially many rejections. It also requires adopting a flexible and improvisational style of intimacy if certain activities are not feasible.It is easy to look down on someone who is unable or unwilling to disclose STI status, and the ethics around that are certainly complicated. However, it’s no surprise that this is a significant hurdle for most people. As a therapist, you are uniquely placed to help with the big underlying problems: differentiation of self, identifying and strengthening values, and building resilience. The therapeutic challenge is to attend to the medical and ethical content while also attending to the underlying process.
  4. Understand your responsibilities. What are your responsibilities when it comes to STIs and ‘duty to warn’? Is there a limit to client confidentiality? Where is the line?The short answer: it’s complicated.Here, law, ethics, and professional practice guidelines all intersect; the requirements vary from state to state and profession to profession. You will have to do some legwork to find out what the laws and guidelines are in your state and profession. Keep in mind:
    • Some states have a legal requirement that a person who has been diagnosed with an STI disclose it to their partners, with risks of civil and criminal charges.
    • Some states have specific legislation regarding HIV reporting.

Other issues that may become relevant when considering whether a threat falls under ‘duty to warn’:

  • has the threat already occurred? Is there future threat?
  • is it lethal?
  • is there an identified victim?

To jumpstart your thinking on this issue, check out this excellent article about HIV and ‘duty to warn’: Is there a Duty to Warn When Working with HIV-Positive Clients?

If you missed part 1, check it out here!