If you see women in your counseling practice, it will be hard to ignore the issue of female sexual desire in your work together, even if the focus of treatment is something that appears unrelated to sexuality. In fact, a woman’s relationship with her own experience of sexual desire is often inextricably linked to her sense of identity, self-esteem, personal agency, energy levels, self-care habits and interpersonal relationships. Her desire issues and how she feels about them will weave their way, often implicitly, into your sessions.
The more that counselors can increase their awareness of the nuanced issues related to female sexual desire, the easier it will be to create a space in which clients can explore these issues safely and productively. Working with women more explicitly on understanding, experiencing and sustaining sexual desire can empower them to proactively regulate their moods, reduce stress levels and decrease symptoms of anxiety and depression. Furthermore, reconnecting with the motivation to feel sexual desire has the potential to help transition trauma survivors from “survival to revival” (in the words of couples therapist Esther Perel) as they access the enlivening energy of their own erotic life force.
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), female sexual interest/arousal disorder is characterized by a lack of sexual interest or sexual arousal for at least six months. Whether a woman is upset or distressed by her lack of interest or arousal is a crucial criterion for the diagnosis. The disturbance can be moderate, mild or severe, lifelong or acquired, generalized or situational. Furthermore, according to the DSM-5, “Women in relationships of longer duration are more likely to report engaging in sex despite no obvious feelings of sexual desire at the outset of a sexual encounter compared with women in shorter-duration relationships.”
Rosemary Basson, director of the University of British Columbia’s sexual medicine program, has noted that other than in the early stages of a new relationship, women’s arousal doesn’t always follow the traditional model of spontaneous sexual desire. Rather, women’s desire tends to be more responsive, with a deliberate choice to experience sexual stimulation required before an actual experience of arousal.
Estimates on how many women suffer from female sexual interest/arousal disorder vary widely, in part because there is so much complexity, variability and subjectivity to how sexual desire issues and arousal problems are measured and experienced. According to an article by Sharon J. Parish and Steven R. Hahn in the April 2016 issue of Sexual Medicine Reviews, issues with sexual desire or arousal are present in 8.9 percent of women ages 18 to 44, 12.3 percent of women ages 45 to 64 and 7.4 percent of women 65 and older. These percentages translate into a significant portion of the female population. It is hard not to wonder what sociocultural circumstances are contributing to making problems with desire so pervasive and systemic for women.
In Standard E.5.c. of the 2014 ACA Code of Ethics, counselors are reminded to “recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others.” This ethical consideration comes into play when counselors treat women with desire issues.
With the work of Helen Singer Kaplan’s triphasic sexual response cycle and an ever-expanding body of nuanced research on women’s sexuality, studies have come a long way from the male-centric, Freudian view of women’s sexual and psychological functioning and even from Masters and Johnson’s linear model of spontaneous sexual response. Researchers today strive to be more objective and aware of the physiological and psychological reality of women.
Even so, systemic prejudices related to gender and gender identity continue to saturate every area of girls’ and women’s lives, creating unique challenges in female clients in the areas of desire and sex. Fostering the safety and trust necessary to explore your clients’ desire issues can move issues of female sexuality and desire from an implicit undercurrent in your work to an explicit focus of therapy. This can help clients separate the wheat of their erotic potential from the chaff of limiting, destructive or shame-based gender and sexual conditioning.
Take Louisa, a 30-year-old client who has been married for two years. (Note: Louisa isn’t an actual client; however, her situation illustrates common sexual desire issues experienced by clients who seek counseling.) Although Louisa initially seeks treatment for depression and anxiety, a few sessions into treatment she begins referring in passing to life stressors that are “TMI” (too much information). Following these TMI comments, Louisa deflects the conversation to other topics with a shrug and a laugh.
Counselors can be attuned to these “throwaway” comments and to dismissive humor, gently inviting clients to elaborate by expressing interest in the information the client is editing out. When the counselor gently points out Louisa’s “TMI” reference and explores what she thinks might be too much information for the therapist, the issue of Louisa’s sex life begins to surface. Counselors may need to reassure clients who experience shame around sexual desire and sexuality that it can be of great benefit to focus on and explore heretofore off-limit topics and the memories, beliefs, thoughts and feelings connected to those topics.
The following interventions may provide springboards for exploring desire issues in counseling sessions with female clients.
1) Provide psychoeducation on the connection between relaxation and sexual arousal, and work with your client to identify ways she can relax. Maureen Ryan, a sexual health coach in Amherst, New York, says, “The first step to a great sexual experience is to relax. Pleasurable touch helps facilitate this process. The body becomes aroused, and then the desire follows. For most women, sexual intimacy precedes desire.”
Explore the thoughts, fears and behavioral patterns that inhibit relaxation. Work on helping your client identify how she might create an external environment that would facilitate her transition into a sexually receptive or erotically engaged state. This might include activities that allow her to feel present or “in the flow” or connect more with pleasurable sensory input (tastes, sounds, smells, visual stimuli, touch).
2) Invite your client to create a body map. Sex therapist Aline Zoldbrod suggests using this technique with couples to facilitate a dialogue about current preferences. However, it can also be used one-on-one with female clients who may struggle with shame issues related to their bodies and their experiences of sexual desire.
Your client draws a body shape, back and front, and then uses red, yellow and green crayons to color the shapes in. Green means “I like to be touched here always,” yellow means “I like to be touched here sometimes,” and red means “I never like to be touched here.” This map can serve as one starting point for a deeper exploration of a client’s relationship to her body and her history with touch.
3) Introduce the “prop” of a velvet vulva into your arsenal of psychoeducational tools and use it to help clients understand the anatomy of the vulva, the clitoris and what movements and sensations typically stimulate arousal. This prop can also be used to instruct women on arousal as counselors model a clear, sex-positive language for expressing needs and preferences to a partner.
4) Introduce your client to the concept of “sexual blueprints.” You may want to provide a client with a handout summarizing sexologist Jaiya’s five erotic blueprints: energetic, sensual, sexual, kinky and shapeshifter. Reading about and discussing these blueprints can reduce shame, normalize a client’s experience of her own sexual predilections and help her consider new possibilities. Jaiya’s website (missjaiya.com) has a quiz to help women and men identify their blueprints.
5) Explore the meaning of pleasure for your client. What turns her on? What charges her up and connects her to her own sense of flow or aliveness? A counselor can coach a client to say, “I feed my own desire when …” and then complete the sentence with different activities, thoughts and behaviors that enliven her. Encourage your client to begin developing a running list of whatever it is she can proactively do to power herself up, delight herself and revitalize herself.
Also be sure to have an extensive list of your own desire-feeding activities. This will help you menu ideas for your clients.
6) Help clients develop awareness about the sex-negative and body-negative influences that have shaped how they see and experience themselves and their bodies. Encourage them to limit the sex- and body-negative influences in their lives. This may mean avoiding certain magazines, being mindful about television shows and choosing not to watch certain movies or videos. It may mean setting clearer boundaries with select people in their lives.
Also help clients explore ways that they can take in more sex- and body-positive messages, either through reading different magazines, limiting their exposure to narrow standards of beauty, increasing their vigilance of the kinds of advertising or body imagery they expose themselves to, or regularly and intentionally appreciating their own bodies through pleasurable body rituals and experiences.
A shift in attitude
Over time, Louisa begins to understand that the lack of sex in her marriage underlies her anxiety and depressive symptoms. She fears it means that she and her husband are on their way to divorce and that it’s “all her fault.” Here, the counselor helps Louisa increase her awareness of this critical inner voice and develop greater self-compassion.
Louisa’s husband has become more vocal about their sexual problems and grown increasingly more irritable and withdrawn in their day-to-day life. As a result, Louisa is no longer able to continue pretending the problem is just situational, temporary or unimportant.
In therapy, she examines her sexual misconceptions and beliefs and the influence of her family’s cultural and gender-based expectations of her. To her surprise, she realizes she has limited awareness of her actual bodily sensations. She often “lives in her head” and ignores the signals her body sends her. As a result, she has never really tuned in to what she feels leading up a to sexual encounter. Her low sexual desire is just the tip of an iceberg of denial related to sensations and emotions.
Part of Louisa’s work in therapy becomes learning how to “listen” to her body. She practices doing this in session and also sets aside time outside of sessions to sit quietly and observe her own sensory experience.
In the past, when Louisa lost her motivation to have sex with one of her boyfriends and couldn’t recreate the feeling of strong, active arousal with him, she would interpret it as “falling out of love” or the boyfriend “not being right for her.” It wasn’t until Louisa married her husband that she was faced with the stark truth of her own sexual experience: She had a hard time experiencing spontaneous, robust arousal once the novelty of a relationship wore off. Mostly, later in a relationship, she simply responded to her partner’s desire for her.
This insight signaled a shift in Louisa’s attitude toward sex and herself. She started to mourn her lack of erotic engagement with her past partners and current husband and to commit to cultivating a relationship with her own erotic experience. She began recognizing her own inhibitions, her lack of erotic accountability and the expectation she had always carried that her partner should know what pleased her without her assistance, guidance or willingness to explore the ways that their needs and desires met or diverged.
Because Louisa loved her partner and wanted to make their marriage work, she committed to learning how to experience her own desire and arousal more regularly. Her motivation to feel desire for her own pleasure and sense of wholeness shifted her approach to the sexual disconnection in her marriage from that of a burdensome problem to an adventure.
When it comes to working effectively with female sexuality and desire, remaining neutral about larger cultural biases can stall your work as a counselor. In a culture saturated with narrow and distorted models and templates of beauty, it is nearly impossible for human beings who emerge from their mothers as female babies to grow up free of misconceptions about their core selves, their bodies, their sensuality and their eroticism.
Some women may manage to stay intuitively connected to their erotic core throughout childhood and adolescence despite the social, relational and societal risks involved, perhaps even making it into adulthood relishing the full range of their sexual experiences on their own terms. A great number of women, however, wouldn’t have survived physically, much less psychically, without shutting off their sexual circuit boards.
Usually, this shutdown isn’t a conscious choice. It is something that girls learn to do within the context of their relationships as a way of maintaining caregivers’ and others’ love and approval. Even for girls growing up in progressive, supportive families, fitting in with peer groups or feeling socially rooted can sometimes cost them some important piece of connection to their core sexual selves. Girls may grow up lacking erotically vibrant, powerful female role models. Sometimes their families and circumstances don’t allow them the luxury of maintaining a strong, healthy, intact relationship with their bodies.
When girls suppress aspects of their deepest erotic impulses and experiences, layers of judgment and shame encase not only what and how they feel, but also who they are. Like a seed trapped in amber, a woman’s erotic potential can remain untapped even as she develops and grows in other areas. It waits for the right conditions to emerge.
Counselors can provide those conditions in therapy. Here are some key ways that counselors can help women reclaim their erotic selves.
1) Take continuing education courses on sexuality.
2) Read progressive, inclusive books on women’s sexuality and women’s sexual empowerment, such as Getting the Sex You Want by Tammy Nelson, She Comes First by Ian Kerner, Mating in Captivity by Esther Perel, Woman on Fire by Amy Jo Goddard, Pussy: A Reclamation by Regena Thomashauer, Come as You Are by Emily Nagoski and Women’s Anatomy of Arousal by Sheri Winston.
3) Familiarize yourself with the facts regarding the unique challenges that women continue to face today locally, nationally and globally, particularly as they relate to physical safety, fiscal equality, political representation and reproductive issues and rights.
4) Learn to talk about all of the parts of women’s bodies with ease. Practice with your children, spouses, colleagues and friends. Learn the exact locations of women’s body parts, study how they interact and learn to identify a woman’s body parts by their correct names (e.g., distinguishing between a woman’s visible genitals — her vulva — and the internal, muscular tube that leads from her vaginal opening to her cervix — her vagina). Learn to discuss sex, sexuality and sexual acts correctly and comfortably.
5) When you pick up on a client’s reactivity, defensiveness, shame or self-consciousness related to a sexual topic, bring warmth and compassion to the moment through attuned interventions. For example: “I noticed that you covered your eyes just now as you mentioned having sex with your boyfriend. Can we be curious about what just came up for you?”
It is important to keep in mind that low desire and lack of sexual interest are issues that many women won’t openly admit to, even when these experiences are their daily reality. There is a lot at stake. Just as a man’s sexual identity and sense of competence can get tied up with his ability to pleasure his partner to orgasm or to maintain an erection, a woman’s sense of sexual self-worth can be intricately connected with her ability to both stimulate and quench her partner’s sexual desire.
When the impetus or the drive to engage in sex with her partner or spouse wanes, a woman’s sense of sexual self-confidence can waver. It can feel as if she is failing at an essential aspect of her being: loving and being loved sexually. It can also inspire terror. Will she lose connection to this person she depends on and loves? How will this affect her family relationships? Is this a prelude to something worse? What changes lie around the corner as a result of her inability to match her partner’s sexual needs with her own authentic responses and initiatives?
Counselors are in a privileged and important position with their female clients at this particular historical juncture. Women are feeling pulled to take up leadership positions and exert influence in spheres of power previously dominated by men, from political offices to corporate headquarters to influencing the ecological trajectory of the planet. To experience the fullness of their emotional range, the force of their uniquely feminine values, priorities and principles, and the vitality of their full aliveness, many women need help developing a healthier relationship with their erotic selves. Because many women have adapted and suppressed aspects of themselves to function in a world that prioritizes the more traditionally masculine values of strength, dominance, competition and self-protection, they need to find ways to access the more traditionally feminine priorities of sustainability, vulnerability, connection and empathy to feel truly like themselves again.
Counselors can safely, warmly and sincerely support the exploration of women’s low sexual desire or inhibited arousal by first prioritizing a woman’s desire as an essential energy source in her life. They can help their female clients navigate the unique, nuanced challenges of low desire and the ways it manifests in a woman’s relationship to her own self, her body and those she loves. Once this issue is prioritized in treatment, it can be made explicit and explored. From there, it becomes easier to disentangle the negative beliefs that women harbor about their bodies and themselves from their inalienable, noncontingent worth as women.
Because many women have come to experience their own desire as beyond their control, they may fear that they are the problem — outliers on the graph of normative human sexual desire doomed to disappoint and frustrate the people they love and need most. Helping women take control of their own experience of sexual desire through explicit counseling interventions has the potential to shift clients’ views of what’s possible for them erotically and, in so doing, what’s possible for them as vibrant, entitled human beings with desires that matter. This shift is seismic and can transform all aspects of women’s lives.
Alicia Muñoz is a licensed marriage counselor and desire expert in private practice in Falls Church, Virginia. She is also a speaker, author, blogger and frequent contributor to various print and online publications. Visit marriedtodesire.com for more of her writing on desire, or sign up for her weekly Relational Growth Challenge at aliciamunoz.com.
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Very good article. Sorry to say that in many countries not even one per cent of counselors will be able to raise and deal with issues of sexuality with their clients.
Thank you for sharing!