One of the most common complaints that I work with is loss of sexual desire. I would say that at least fifty per cent of my caseload, at any given time, involves some aspect of absent or low sexual desire. Although more common among women, men can also experience a lack of libido, and it can be one of the most complex and challenging problems to treat.
In my experience of working with desire, the problem is rarely down to a single physiological or medical issue and more likely to be caused by a mix of historical, psychological, relationship, lifestyle, and contextual factors. This is why absent or low sexual desire can be more tricky to work with than other psychosexual difficulties – and why it is necessary to do a thorough assessment first before treating it.
I find that a good starting point is to ask clients what works, outside of sex. How do they connect in the day-to-day? How do they have fun? How do they spend their spare time together? What makes them laugh and get silly? Often, couples will get caught up on what they think ought to be happening in the bedroom (or what seems to be glaringly missing in their relationship) and they fail to notice the more subtle non-sexual behaviours already taking place which make them feel loved and cared for and connected. Sometimes, I may ask couples to keep a record of these thoughts, feelings, and behaviours over the course of a week (in a notebook or diary) and to share their observations with each other at their next therapy session. I may suggest they pick one small behaviour, which they have fallen out of the habit of doing, and to commit to doing it for their partner, daily, over a fortnight.
Sometimes, helping couples remember what it was like when they first met can be a simple yet powerful tool for re-creating the feeling of an intimate connection. What did they notice when they first laid eyes on each other? What caught their attention? What were they most drawn to? How did they feel? What colours and sounds do they remember from that moment? Can they see, taste, or feel some of those sensations now as they start to reminisce? To help amplify the mood, I may enter that space with them as they provide more details, and get excited with them. I watch for feedback and nonverbal signals. There might be a smile; a stifled giggle; a softening of the body; a special spark. Together we create a small, new experience – a brief connection – in the therapy room. And sometimes this is enough to instill hope that change is possible.
Many couples who experience problems with desire have forgotten how to touch each other. Touching has become a source of anxiety, as it has time and time again led to feelings of rejection and disappointment. I am interested in Process-oriented Psychology; a discipline which involves working with movement and bodily experiences. If they are open to it, I may ask a couple to spend a moment in the room focussing on touch. For example, I may invite a couple to hug or touch with meaning and intention. I will slow them right down and ask one of them to close their eyes and to touch their partner’s forearm in a number of different ways. I’ll encourage them to notice what happens to their heart rate, their thoughts, their bodies, as we do this.
There are many small interventions that can be carried out, right here in the therapy room. These are not only opportunities for the therapist to measure the current health of a relationship; they are also means for ‘waking up’ the intimacy in subtle, gentle ways and under controlled circumstances. These experiential techniques can also be useful in helping us break down and explore the notions of desire and attraction – concepts which can feel rather abstract at the best of times!
Of course, there is no ‘one size fits all’ with these things and some couples may not be receptive to this kind of approach; it may feel too unfamiliar and exposing; or there is already too much conflict and hostility. I will always pay attention to what feels most comfortable for my clients, whilst at the same time pushing them a little beyond their safety zone.
Building on successes, no matter how small, is of utmost importance in sex and relationship therapy, particularly when couples arrive feeling despondent and pessimistic. I love that moment when clients acknowledge to each other the relief they feel for finally seeking help, and how good it is know that they are both working together at resolving a problem. Often this is the very first step towards rebuilding an intimate connection.