Sexual Desire: Therapy’s Dirty Little Secret

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Sexual desire.

Therapists don’t understand enough about it. We know a little about what diminishes desire, even less about what enhances it.

Oh, we know one thing about how desire works in relationships: for many people, you treat them poorly and they want sex less. But with a lot of people, you treat them well and they don’t want sex more.

And someone whose sexual desire is simply turned off? We don’t know much about how to turn it on.

Good therapists know how to fix certain aspects of desire:

* Someone who hates their body? Get them to like it.
* Someone who feels guilty about their fantasies? Get them to accept them.
* Someone whose partner is an alcoholic? Get the partner to stop drinking.
* Someone who’s angry that their partner cheated? Get them into couples counseling and resolve the betrayal.
* Someone who’s afraid of getting pregnant? Get them onboard with birth control and alternatives to intercourse.
* Someone who’s anxious that sex is a bedroom performance? Get them to understand that the goal of sex is closeness and pleasure.
* Someone who can’t seem to say no to certain activities they dislike? Get them to be more assertive.
* Someone who feels bad that they can’t do what they used to do 25 years ago? Get them to focus on what they can do now.

The solution to inhibited desire is to uncover the psychological, emotional, or practical dynamics repressing the desire and address them. What is the person angry about? What trauma are they wrestling with? Whose judgements (God’s? Their partner’s? Their own?) are they afraid of?

This all implies that a level of desire exists in the person, but it’s just being squashed by circumstances (external or internal)—like a loaf of bread sagging under the weight of a pile of dirty dishes. We hope that when we reduce or remove the emotional rubble, the loaf of sexual desire will spring back.

But low desire? A lifetime that lacks sexual curiosity, interest, pursuit, experimentation, fantasy, maybe masturbation? Even the best therapist is quickly thwarted by such a life. That doesn’t make the person wrong or bad. In fact, since their mate (and perhaps a series of prior mates) often spends years telling them they’re cold, unfeeling, unfair, selfish, neurotic or worse, it’s critical that the therapist doesn’t duplicate that.

But gee, these low-desire people have a genius for coupling up with people who want a lot of sex. And people who want a lot of sex seem to be experts at finding and coupling up with these low-desire people.

After years of frustration—and, often, unfortunately, several children—they come to therapy. The typical result: they communicate better, they may have more physical affection, but the higher desire partner is rarely satisfied, and the lower desire partner rarely feels content with their partner’s frustration.

Distinguishing between inhibited desire and low desire is our job. I always hope it’s the first; I know how to do psychotherapy, and I’m good at fixing miscommunication and power struggles.

But too often, it’s the second. I do my best. There’s rarely a happy ending.


In the last few years some people with little or no sexual desire have started to call themselves “asexual,” claiming that this is a sexual orientation like homosexuality. This isn’t helpful, especially since various self-described asexuals say they experience romantic feelings, fall in love, experience sexual arousal, and masturbate. I’m quite sympathetic toward people who don’t want to be pathologized just because they don’t want sex. But I don’t think establishing that condition as an orientation is the best way to find safety or peace of mind in our world.

“Asexual” makes far more sense as an identity, in much the same way that people interested in BDSM, swinging, and hairy partners tend to seek each other and form communities. Everyone is entitled to find their compatriots, of course. But not- wanting-sex is an interesting source of commonality. And what if a self-described asexual actually meets someone with whom they experience sexual desire? Does that make them formerly asexual? If not, what distinguishes an asexual person who feels and acts on sexual desire from a non-asexual?

One thing adults do need to understand is that as we go through the lifecycle, the experience of sexual desire typically changes. It tends to be less urgent, less a hunger demanding to be satisfied. It becomes more like an interest in a familiar form of enjoyment.

Exceptions to that typically involve a new partner, such as in an extramarital affair.

Desire rarely feels the way it’s portrayed in porn or Hollywood. Showing people so excited that they can’t even wait to get into a comfortable place, or to take off all their clothes, or to pee, or to lock the door gives the rest of us the wrong idea. Desire may be like that at 19, but it’s rarely like that at age 39, 59 or 79.

This brings us to the question of desire versus receptivity. The world is full of people who desire sex as an ongoing fact of daily life. They think about sex, anticipate it, and initiate it. Other people don’t think about, don’t anticipate, and don’t initiate sex—but they do respond when invited, especially if they’re not tired, angry, anxious, or had sex yesterday.

When these two people get together it could be fine, but conflict often ensues. The higher-desire person gets tired of initiating all the time, and feels unloved or undesired. The receptive-but-lower-desire person often says “Hey, I generally say yes when you initiate, so what’s the problem? We end up having sex, so why can’t we just enjoy that?”

A person who’s “only” receptive might benefit from realizing what desire really feels like in adulthood. A person who’s tired of initiating might ask their partner how they express their affection or attraction (say, by physical affection or by making coffee every morning), and decide to get more emotional mileage out of it.

And both will be better off if they can agree on how to create the circumstances under which both people want sex.


So one of therapy’s dirty little secrets is that we are often successful with inhibited desire; sometimes successful moving receptivity into enthusiasm or even desire; and rarely successful enhancing true low desire. It’s important that a professional figure out which they’re facing as quickly as possible. To make things more complicated, sometimes we’re facing more than one of these.

How do we break it to people when we realize we’re not going to succeed with their goals for therapy? It’s one of the more painful conversations therapists ever have. But I believe it’s better to be honest with patients than to drag them through a year of therapy that doesn’t deliver much besides well-meaning encouragement.
If you liked this piece, you’ll enjoy my article at
If you prefer my quick video on the subject Desire–For What?, see

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