After Will Lily: How To Use What You Learn in the Brief Assessment

If you don’t know my Will Lily assessment tool yet, it’s a sequence of questions designed to open up a thorough, comfortable dialogue about sex with your client, and sort out multiple factors that tend to affect sexual pleasure and function. If you want to learn more, I share the whole assessment at no charge in my 2 part video workshop. You can sign up here.

Today, I want to share some context for Will Lily in order to help you make better use of it in your own therapy room. This blog post is the first in a two‐part series. The first post will give some larger context, describing how Will Lily can guide your treatment planning, and the second will dive into the specifics of how to follow up on the information you get from Will Lily.

I use Will Lily as a screening tool in the intake session. In addition to opening and normalizing the topic of sex, it efficiently narrows the field regarding which systems might be involved in any sex issue that might come up. If there are several sex issues involved, it helps distinguish between more and less pressing issues.

Once you’ve gone through Will Lily, you will know where the problem is and what you are actually treating. You will be able to focus your efforts, which will make you much more effective at helping. That’s why it’s important that you ask every question in Will Lily. If you skip one, you won’t get a complete picture of the issue.

For instance, if I spent the whole session discussing my client’s distress over low desire, I might not hear about arousal issues, like changes in erectile function. I might miss an important health issue that must be addressed immediately in order to prevent harm. (By the way, if you haven’t heard about the relationship between arousal signs and heart failure, you can read more about it here—it’s incredibly important, and more people should know about it.)

Will Lily helps clarify multiple aspects of any sex issue, but it really shines when a client has desire issues. Desire is so multifactorial! Just about everything affects desire. Will Lily is designed with that complexity in mind. The six questions cut through the tangle of overlapping factors to sort out what is affecting desire.

Here are some ways the different pieces of the brief assessment relate to desire:

  • A lack of willingness to engage in a sexual encounter is likely to affect desire. If a person feels any little bit of internal or external pressure, that can devastate desire. So can other factors that affect willingness, like fear of becoming pregnant, or contracting a sexually transmitted infection.
  • Pain can clearly affect desire, because nobody wants to have unintentionally painful sex, and nobody thinks it’s hot for their partner to experience that, either.
  • Erectile issues, which indicate problems with physiological arousal, are potentially early warning signs of life-threatening illness, and also wreak havoc with desire. The person with ED can develop low desire via performance anxiety, aversion to the drama that ensues with their partner, or any number of other reasons. The partner of  the person with ED can develop low desire too, for similar reasons.
  • Difficulty reaching orgasm can create internal or external pressure, performance anxiety for either partner, guilt, and deception. Sometimes it makes people think “I just don’t see what’s so great about sex,”  which, naturally, leads to a lack of desire for sex.
  • A sense of dissatisfaction after sex for any reason indicates a level of distress that is very likely to affect desire.

I hope this context helps you use Will Lily to illuminate underlying issues and develop a sound, strategic treatment plan. In part two of this series, I share examples of good follow up questions to build on what you learn from Will Lily. You can read it here

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.

3 Ways to Handle New Relationship Bliss That Support a Long-Term Healthy Relationship

This is the second post in a three-part series about sex and differentiation of self in relationships. If you missed the first post, about the phases relationships go through, and how that development can get stuck, check it out here.

Think about those exciting early days at the beginning of a relationship. All the hormones and novelty work together to ease much potential distress around sex. This is a stage where we don’t generally see our partner very clearly. We see all the things we agree about and love about them, based on quite limited experience from a few dates, or a few months together. Then we invent the other 98% to support the story that they are perfect for us. We see the best in one another, and see how much we can change ourselves to be as much alike as possible. This phase is called symbiosis. Over time, the new relationship energy starts to fade, time goes by, and at some point we look around and realize “they’re not who I thought they were”. We start to notice we have differences, and some of them are big. Some are huge. Who IS this person?? This is the beginning of a natural transition from symbiosis to differentiation.

You (or your client) can set yourself up for an easier transition from one stage to the next. If you know that in past relationships you’ve tended to lose yourself in your partner, setting aside your own interests or habits for theirs, and becoming dependent on their approval or attention, this is valuable information to take into future relationships. You can get better at holding on to what makes you a unique and separate person from your partner without losing the joy and intimacy of a loving partnership–in fact, that joy and intimacy will only be heightened, ultimately, by the vulnerability you can find in welcoming your partner into the truth of your innermost self. Here are a few important steps you can take to prevent getting stuck:  

  1. Don’t tell “kind untruths” like  “I always had an orgasm with you” or “I never use a vibrator” or “I only think of you when I fantasize”. Any kindly-meant bending or breaking of the truth will certainly come back to bite you later on, and when it does, it will seriously undermine or destroy your partner’s trust in you.  
  2. There is nothing wrong with seeking to grow as a person, but don’t give yourself up to your partner entirely. Grow to be more the person you want to be, not simply more the person you partner wants you to be.
  3. Don’t give up any parts of yourself that are a major part of the “juiciness” of your life, like independence, career aspirations, major life goals. The healthy business of the symbiotic stage of your relationship is to bond and stabilize, but if you take it too far and eliminate all of the things that are most important to you, you will find yourself without a sexual spark later on. Ask yourself (or your client):
    • When do I feel alive?
    • When do I experience joy?
    • If I stopped doing _____, would I miss it five years from now? Ten?

When you answer these questions you must go further than “when I’m with my partner”.  Get down to an answer that is just about you.

The things that make you feel alive are the things you must keep. In fact, they’re probably the things your partner was attracted to in the first place. Unless you want to feel flat in 5 years, prioritize those things. This creates a foundation for a relationship that has room for you to be happy!

In my next post, I’ll zero in on some reasons couples struggle when moving from symbiosis toward differentiation. I’ll talk about the Big Choice couples are faced with, between the path of differentiation (risk) and the path of assimilation (safety).