Thank you for joining me for “Tough Cases.” As you probably know, I specialize in training therapists to be highly effective working with desire discrepancy, and to that end I’ve created a series that focuses on some specific and very challenging presentations. In this series, you’ll gain serious practical skills working with issues like sex pain, pressure for sex, porn use, and more. It will culminate with a free webinar on working effectively with higher-desire partners, so don’t forget to mark your calendar for Friday, March 3rd, at 1 pm CST.

In the first article in this series, I talked about how sex pain reliably inhibits desire, worsening over time if it’s left untreated. In this article, I’m addressing what happens to desire when there is a perception of being pressured for sex. There’s a lot of similarity here: Just like sex pain, feeling pressured for sex invariably decreases desire, and if it goes unaddressed, it also compounds over time and creates larger problems, including relational issues.

Before I dive in, a disclaimer: pressure for sex exists on a continuum from super subtle innuendos all the way to domestic violence. For the purposes of this series, I’m only discussing how I conceptualize and work with the more subtle forms of pressure. This is because I think most therapists are already prepared to work with domestic violence, but we often miss or ignore “normal” presentations of pressure for sex.

By this, I mean all of the following:

• An internal sense of pressure within the lower desire partner:
• “I owe it to my partner.”
• “This is what partners have to do for one another.”
• “I just have to suck it up.”
• “I just can't tell my partner no one more time, it’s not fair to them.”
• Pressure from the higher desire partner:
• “It’s been 2 months, 1 week, and 3 days since we had sex!”
• “My birthday is next week… I’m really hoping for a special gift.”
• “I did the dishes… now you owe me.”

These dynamics are tough to work with, and I’ve spent years trying different strategies to help both partners in this kind of impasse shift how they think about themselves, their partner, and their relationship.

The first step is to remove all pressure. This is because desire doesn’t bloom under pressure. Desire comes from a place of freedom, exploration, adventure, and play. Arousal resides in the “rest-relax-recover” part of the autonomic nervous system, also known as the parasympathetic nervous system. It’s very difficult to access the parasympathetic nervous system when the sympathetic nervous system is activated by stress, pressure, or anxiety. Whether pressure is overt or subtle, internal or external, it diminishes and eventually kills whatever desire might otherwise have emerged.

As you work with a couple experiencing desire discrepancy where there is a subtle (or not so subtle) sense of coercion or pressure for sex, the first thing to consider is where that pressure is coming from. Keep in mind that internal pressure and external pressure can coexist, and they often do. Imagine, for instance, a client whose internal narrative is “I need to provide my partner with sex.” That is someone who is likely to have trouble expressing their own preferences when faced with even very subtle manifestations of external pressure from their partner.

Once I identify which partner is exerting pressure, my goal is to work with them to release that pressure. This is generally a combination of challenge, warm support, validation, normalizing, psychoeducation, and sometimes deep intrapsychic work.

So how do you tease all this out and start making progress? Here’s my approach:

Dispel misinformation. I might start by busting some common myths that may be contributing to the feeling of pressure. I’m talking about ideas like:

• You must have sex with your partner if it’s a special occasion (for instance, on a birthday, Valentine’s Day, or after an expensive date)
• Sex is a ‘wifely duty’ and not about pleasure for women
• If you don’t have sex with your partner on a frequent enough basis, they’ll definitely end up cheating or leaving you
• There is a “normal” frequency of sex
• Self-pleasure is wrong, gross, or a form of infidelity
• It’s not ok to openly discuss sex, differences between partners, or differences between partners about sex; we just have to fix it or close our eyes and hope for the best
• Erotic supports, like written, audio, or visual erotica, are by their very nature bad for the connection between partners

Because of these messages, pressure for sex can exist even in relationships between very loving partners who would never want to coerce or be coerced into anything. Widespread cultural messages like these create pressure around all aspects of sex—not just how often you “should” have sex, but also what that sex “should” involve, how you “should” and “shouldn’t” express yourself erotically. I want my clients to be free to explore whatever consensual activities bring them pleasure and connection, so I try to dispel all these “shoulds” as quickly as I can.

These cultural messages tend to become belief systems. It’s not my business to decide what my clients believe or argue about belief systems, but it is my job to ask where they want to get to with our work together, and to inquire whether their beliefs and thoughts are supporting their goals or undermining them. I often point out that thoughts and beliefs are optional and can be changed.

Strengthen your join with both partners. Everyone will need to feel validated, heard, understood, and supported in this type of dynamic. Often therapists err on the side of supporting one partner or the other, but I think it is very important that you find a way to genuinely appreciate the challenges both are facing. Your work together is going to ask a lot of both partners in terms of relaxing both internal and external pressure for sex. This is vulnerable material, and likely extremely anxiety-producing for both partners.

The lower-desire partner is probably worrying that you’ll tell them to “just do it,” while the higher-desire partner is worried you’re going to tell them that their desires aren’t important and that they have to give up on ever having sex again. They’re worried they’re either bad, or broken, when in fact neither is true at all.

Make sure your clients understand that you care about their needs and desires, and that one of the goals of your work is to try and create the conditions for them to have amazing sex, if at all possible, assuming they both want that. (Stay tuned for an article on how to tell the difference between low desire and asexuality coming soon in this same series, and a webinar deep dive into working with higher-desire partners.)

Help both partners identify what they want to be experiencing. This is a critical early step in any treatment, especially one that involves such a sensitive and anxiety-producing impasse between partners as a big desire discrepancy.

I will ask my clients, “What do you want to be experiencing that is different from what you are experiencing now?” For the lower-desire partner, this question is the key to knowing if they want to experience more desire, or if they actually do not want that for themselves (again, stay tuned for that asexuality article).

For the higher-desire partner, this question points us toward their strengths, while helping them orient toward where they can experience more personal power. In other words, you’re encouraging them to look at themselves, rather than obsessing about what they want from their partner and marinating in how powerless they feel trying to make their partner do what they want them to do. Most higher-desire partners do not want to be pressuring their partner for sex. They want to be responsive to their partner’s needs and desires. They just feel powerless, disillusioned, and even panicky about what this means for their future.

Explain the relationship between pressure and desire. I do a little psychoeducation about the parasympathetic and sympathetic nervous system, because it so clearly explains how anxiety, fear, and stress undermine desire and arousal. Both partners need to know that any pressure, no matter how subtle, from internal messages or external, will dry up desire.  Nobody can easily access a wholehearted “yes” when they don’t feel completely empowered to say “no” without any negative consequences resulting. And in the absence of asexuality, what both partners are shooting for is a rapturous “yes.”

Encourage growth towards differentiation. Differentiation of self is the relational skill that underlies true consent, and increasing differentiation protects against both external and internal pressure for sex. Mustering up the courage to honestly tell your partner “no,” “not right now,” or “I’d rather try something else” is a differentiation skill, and so is receiving that information with grace and curiosity, and responding sensitively.

The higher-desire partner will have to pull back from anything that creates pressure. This might mean:

• Building the skill of hearing ‘no’ without getting upset
• Sensitizing themselves to subtle ways their partner may express a ‘no’
• Getting comfortable with downshifting or sideways-shifting an intimate interaction, rather than always escalating 

At the same time, the lower-desire partner will likely have to strengthen their defenses against internal pressure. This is also a differentiation project, and one that may involve:

• Attuning more deeply to what they actually desire and feel
• Clearly and honestly expressing “no,” “not right now,” or “let’s try something else,” regardless of what they think their partner may feel about it 
• Holding steady if their partner is upset or disappointed, without collapsing and trying to fix it right away by giving them what they want

Explain the concept of differentiation to your clients and its relevance to this issue. Notice when your clients take steps toward increased differentiation, and give them tons of positive strokes for it. This is a long-term project and, in my opinion, one of the key overarching goals of most therapeutic projects. It won’t happen overnight, but every step your clients take towards differentiation will support increased vulnerability, connection, and ultimately, desire.