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Mismatched desires in a relationship problem between both people--not just a problem for the individual with lower desire (see my article: What is Desire Discrepancy?).
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| Desire Discrepancy is a Relationship Problem |
So, why do many individuals "send" their partner to sex therapy instead of joining them to resolve the relationship problem?
The "Identified Patient" Dynamic
There can be many reasons why a partner might not want to join their partner in sex therapy, including sexual shame. But one of the main reasons is because Partner A, the one with the higher desire, tries to convince Partner B, the one with the lower desire, that something is wrong with Partner B and B should go so the therapist can "fix" them.
As a certified sex therapist, I see this so often in my New York private practice and I know that most of the time there is a misunderstanding about why they're having sexual problems.
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| Desire Discrepancy is a Relationship Problem |
Partner A, the one with the stronger sexual desire, pathologizes Partner B's normal desire so that Partner B feels like they're "broken" and needs to be "fixed".
Often this pathologizing is unintentional. More often, it's a misunderstanding about how sexual desire works and that there can be either spontaneous or responsive sexual desire which are both normal.
Clinical Vignette
The following clinical vignette is a composite of many different cases:
Janet and Mark
When Janet contacted a sex therapist, she said her husband, Mark, told her she should make an appointment for herself because she didn't want to have sex as often as he did.
The sex therapist told Janet that desire discrepancy (also known as mismatched libido), is a common problem in relationships and it's a relationship problem--not an individual problem---because it's a dynamic between two people.
Janet thought her husband would probably join her after the first appointment, so she saw the therapist on her own the first time.
During the first appointment, the sex therapist told Janet that it's normal and common for two people to have different levels of desire--just like they would have different levels of desire for certain foods and other activities. She told Janet there is no such thing as a "normal level of desire."
After the first appointment, Janet went home and told Mark about what the sex therapist said. He scoffed and told her to see another therapist. So, Janet began therapy with a therapist who had no knowledge or training in sex therapy, but she agreed to see Janet individually.
Janet wanted to please her husband so she was happy to be able to tell him that she would go for therapy and he could stay home. Over time, Janet went to therapy and talked about the problem, but nothing changed. The therapist listened quietly and provided no feedback.
After a few weeks, Janet realized that this therapist was working outside her area of expertise and stopped seeing her.
When she approached her husband again about seeing the sex therapist, he refused. He told her to go see someone else, but whenever Janet called a certified sex therapist, she was told that this is a relationship problem and both people need to be in the therapy.
This went on for a while and Mark was complaining more than ever because Janet didn't want to have sex as often as he did. So, Janet decided to do her own research and she discovered that the first therapist was correct--both she and her husband needed to be in sex therapy together.
After several years passed with Mark being increasingly dissatisfied, he decided to join Janet in seeing the original sex therapist and they began to make progress.
Why Do Some People Refuse to Participate in Couples Therapy For Relationship Problems?
It's always been interesting to me that most people wouldn't tell a medical doctor how to treat their medical issues, but many people insist they know how a therapist should treat relational and sexual problems.
Since a lot of people think that therapy is "just talking", they think they know how it should work. They don't understand that therapy, especially couples sexual therapy, is a specialized treatment that is performed by licensed mental health professionals who have gone for advanced postgraduate training. Also, there are specific interventions that are not about "just talking."
Couples sex therapy is not the only therapy where people tend to designate an "identified patient" as the one who is to "blame" for having a problem.
Families often scapegoat a certain family member as the one who has all the problems when, in reality, the one who is designated as the scapegoat might be the healthiest one--and the problems in the family are systemic family problems--not the problem of one individual.
Let's look at some of the problems involved in the vignette with Janet and Mark:
The "Identified Patient" Dynamic in More Detail
- Pathologizing Lower Desire: If the issue is desire discrepancy, the partner with lower desire is often incorrectly labeled as the one with the medical or psychological problem. In the vignette above, Mark incorrectly labeled Janet as the problem.
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| Desire Discrepancy is a Relationship Problem |
- Ignoring the Loop: Mark saw Janet's lower desire as being an isolated malfunction. So, he completely overlooked how his behavior, communication style and refusal to split chores acted as a sexual brake for Janet.
- Outsourcing the Problem: Mark hoped a professional would "fix" Janet's behavior so their sexual relationship would change to his preferred baseline of sexual activity so he didn't have to make any personal changes.
Couples therapy, including couples sex therapy, acts as a mirror and many individuals are very uncomfortable looking at what the mirror reveals about them:
- Fear of Judgment: Mark worried that a sex therapist would criticize his sexual performance, technique or emotional maturity. This kept him out of therapy.
- Shame Around Rejection: For Mark, admitting that his wife doesn't want him sexually as much as he wants her was deeply painful. By pushing Janet into individual therapy, he pretended the issue was an abstract medical problem.
- Emotional Exposure: Mark was conditioned to hide emotional vulnerability. Attending therapy involves discussing deep fears, inadequacies and failures, which can feel incredibly threatening.
Misunderstanding Sex Therapy
There is an incorrect common assumption that sex therapy is only about the physical mechanics of sex rather than about emotional connection:
- The "Instruction Manual" Myth: Mark believed that the sex therapist would provide Janet with tools, exercises or psychological "tricks" to boost her physical arousal, but this isn't how sex therapy works.
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| Desire Discrepancy is a Relationship Problem |
- Missing the Emotional Link: Mark failed to recognize that for many women (and many men too), sexual desire is linked to emotional intimacy, safety and mutual respect outside the bedroom.
For many people, including Mark, refusing to attend couples sex therapy is a way to maintain control over the narrative of the relationship:
- Protecting an Ego: By remaining outside the therapy sessions, Mark ensured that his habits and contributions to the sexual problems weren't analyzed. He never had to look at that his ways of initiating sex and that what he did sexually with Janet wasn't satisfying to her. No one wants sex that isn't satisfying to them.
- Dictating Terms: By sending Janet to therapy, Mark positioned himself as the "healthy" partner and Janet as the "deficient" partner--the one who had sole responsibility for their sexual happiness.
Moving Forward
Once Mark came to couples sex therapy with Janet, they both benefited from learning how to talk about sex, finding out what they each liked and disliked and understanding how each of their personal histories contributed to their problems.
Conclusion
Sex therapy is for adult individuals and couples.
There are times when individual sex therapy can be beneficial in helping an individual to overcome problems like sexual shame or other personal issues. But when the problem involves a dynamic in the relationship, both people need to attend.
Get Help in Couples Sex Therapy
Although it might feel challenging to join your partner in couples sex therapy, the consequences of remaining outside the sessions and sending your partner for relational issues, like desire discrepancy, is a much more challenging issue to face when the problem continues for months and maybe even years.
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| Desire Discrepancy is a Relationship Problem |
Like most problems, the sooner you address them, the less complicated they tend to be to resolve.
Rather than waiting until the problem becomes worse, get help from a licensed mental health professional who is a certified sex therapist.
Working on your problem together can bring you closer emotionally and sexually so you can have a more fulfilling life.
About Me
I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS, EFT Couples Therapist, Somatic Experiencing and Certified Sex Therapist.
I have helped many individual adults and couples over the years.
To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.
I provide a 10-15 minute phone call prior to setting up an appointment.
You can reach me at (917) 742-2624 or by email for an in person or online appointment.
Also See My Articles:
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