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.

How Asking About Satisfaction Can Guide Your Treatment Plan

Very often therapists ask me how much to focus on the sex issues in therapy, and how much to focus on the relational issues. This is a very important question, because of course the sexual and relational aspects of sex issues are intertwined. Therapists who don’t feel comfortable discussing sex in therapy will focus on the relational issues, thereby missing multiple rich opportunities to help, but focusing on the sex issues to the exclusion of relational dynamics would almost always be totally unproductive.

If you’ve watched my Will Lily workshop, you’ll know that the final question I ask on my introductory sex issues assessment is “When a sexual encounter is over, do you feel satisfied? Would you do it again?”

This question is a little broader than the others I ask in the assessment. Instead of pinpointing a specific issue, or pointing to an immediate and urgent intervention, it invites the client to take a broader view, to step back and assess the sexual encounter as a whole. Often by the time you ask this question you have a pretty good idea of the answer, but this question points to exactly where the distress is, so you know where to focus once the urgent matters are addressed.

It can also be very interesting when you get an answer that surprises you. It’s a cue to ask more questions and rethink some of your assumptions.

Your clients’ answers to the satisfaction question are also important because they open the door to looking at the relational distress. Satisfaction resides at the intersection between sex issues and relational issues. When you ask this question you have already gathered quite a bit of specific information about sex, and now you will learn how all together affects the clients and their relationship. The answer to the question about satisfaction will shape your long-term treatment plan as you help the clients understand the sex issues in the context of the relationship, and vice-versa.

After Will Lily: How to Use What You Learn in the Brief Assessment (Pt 2)

In my last post, I discussed how Will Lily fits into a treatment plan. I explained how the pieces of Will Lily work together to disentangle the factors underlying a complicated issue, like low desire. Now, I’m going to dive into the specifics of how to follow up on Will Lily. This guide will help you explore the issues that were revealed in the assessment in more depth and detail.

When I follow up on Will Lily, I prioritize the most pressing issues. If there is a problem with willingness, arousal, or pain, it is particularly concerning, because it indicates a serious risk for your client’s health and safety. However, I will follow up on anything that seems concerning.

There’s nothing particularly surprising about what I do to follow up. I’ll bet the kinds of questions I ask would come naturally to you. Your instincts as a therapist can guide you here.

Here are a few example of good follow‐up questions to inspire you:

    • When did it start?
    • How has it changed over time?
    • What is your theory about what is going on?
    • Specifically, where/when do you experience the problem?
      • If the symptoms are specifically sexual, you will be having a detailed conversation about body parts and sexual interactions. That’s ok. You can do it. You won’t be able to tell what’s going on (or ask me!) unless you know a fair amount about specifics.
    • Are there ever any exceptions?
    • How do you and your partner handle it when this issues arises?
      • This is the intersection between relational interactions and sex issues; you might want to refer to my blog post “When Sex Doesn’t Go As Planned.”
    • Are you taking any medications?
      • Many medications have sexual side effects. You should be able to google this quite easily; I encourage you to do so with every medication your client takes, because you might be surprised by how common these side effects are.

Once you have more of an idea about what is going on, particularly regarding the 3 categories that are potentially pressing (willingness, pain, & arousal), you can refer back to the assessment video for next steps. If you don’t find the answer there, err on the side of caution and consult.

I hope you get a ton of use out of my assessment tool, and I hope these ideas for how to follow up help you further uncover the tool’s potential as you grow more and more practiced and confident using it.