When Labels Aren’t Helpful in Sex Therapy

Let me tell you about a former client of mine.

They were a couple married for almost 40 years, with grown children who had successfully launched. They were both in excellent physical health and were active in their various communities. They reported parenting their children cohesively with only rare episodes of differing parenting philosophies, were almost always financially stable, handled each’s aging parents with compassion and healthy boundaries, and enthusiastically supported each other’s careers and personal hobbies. They were excited about a new phase of their lives: they had young grandchildren, and he was close to retirement.

By almost all of society’s measures, they were an impressive couple. But there was one long-standing issue in their partnership that acted like a thorn stuck in their craw: their sex life.

See, she was the partner who always had the “higher libido” while he had the “lower libido." She was consistently the one "initiating sex,” to which he sometimes said yes and sometimes said no. However, over the last 10-15 years, he was saying no more often than yes. She felt demoralized, got tired of feeling rejected and not attractive to him, and so eventually, she stopped initiating. They stopped having sex entirely.

This is a common pathway to having a sexless relationship regardless of who is the initiator. But there was a twist with these two. At some point during the last 10-15 years, she “discovered he had a porn addiction.” It was a crisis: in her mind, why was he watching porn and having solo sex instead of consenting to partnered sex with her? She blamed porn for why he declined her initiations of sex. So she entered a support group and demanded he attend one as well. Because of his guilt, shame, and desire not to risk losing their marriage, he gave in to her demand. He attended with curiosity and in good faith but, over time, realized the group did not meet his psychological needs or speak to his dilemmas, so he quit the group. She interpreted this as him “relapsing.” They fought over these labels and whether they were accurate. He next agreed to do individual therapy. During all this, they also saw two other couples therapists, each for years of therapy at a time, but they said it didn’t help. Thankfully, they did not give up, though, and his individual therapist referred them to me. So that is where we began, with decades of all that history, hurt feelings, and wariness of couples’ therapists. I had my work cut out for me.

Their initial appointment is one I probably will not ever forget. Why? Because after getting the abridged version of their relationship history, I turned to him and asked, “Thinking back to when you two were having sex with some regularity, when she initiated sex with you, what would come up for you psychologically or emotionally?” There was silence in the room while he contemplated his answer. But before he could, though, she turned to me and said with softness and complete sincerity, “With all the couples therapy we have done, literally no one has ever asked that.” And then there was more silence in the room.

Clearly, my question was an emotionally complex lightbulb moment for them both. My heart broke for them.

This is just one example of the pain and prolonged stuckness that clients can experience when they see caring and well-intentioned therapists who are not adequately trained to work with their issues. What can end up happening is that the therapist can get bogged down in the labels either that the client or clinician uses. Those labels can sometimes be distractions to how the client is actually relating to themselves, others, and the world around them.

Are you curious to know how he answered my question about what came up for him when she tried to initiate sex? He said, “Fear.” She was shocked to hear this and could not, at least in that initial moment, understand how or why he could be afraid of sex or her.

So, this is where we started our work in that very first session. My question oriented them to the very purpose of psychotherapy: to gain awareness of one’s inner world of thoughts and feelings and how they impact one’s behavior and relationships. Not about labels like “higher libidos” and “lower libidos,” not about “porn addiction,” not about support groups, and not about “relapses.” I deliberately de-emphasized those labels and instead turned everyone’s focus to what each partner was actually thinking, feeling, and doing in their interactions about sex. And within a few months of working together, this couple started to have mutually satisfying partnered erotic experiences again.

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