Welcome back to my series on acephobia and therapy. Last time, I shared my personal experiences with confronting acephobia from my therapist. This time, I’ve interviewed a good friend of mine, who is a LMSW (Licensed Master Social Worker) in New York, and has been practicing since 2007. She currently does intake evaluations for an outpatient mental health clinic, in addition to doing per diem work in ER crisis services. We spoke about all manner of concerns many asexuals have before or during therapy, including what happens if flibanserin becomes an issue. For the purposes of this interview, I will be referring to her as Pocky.
Smrf: I’m assuming this kind of work gives you access to a multitude of different kinds of patients and patient stories, which would naturally include those who are asexual and/or have problems with sexual desire. Have you heard about flibanserin?
Pocky: I have, yes, but not in any context related to my work. Sadly, discussion of sexual orientation and gender identity issues in the community of mental health professionals tends to lag a bit behind when compared to discussion in online queer communities and online communities of mental health service consumers. I’m often getting my information from social media, and then being the one to pass it on to my colleagues weeks or even months after the fact.
Smrf: What tends to be the reaction when you pass the information on? Overall, does there seem to be interest in learning more about these discussions, or does it seem to be more in one ear and out the other?
Pocky: I’d say the vast majority of professionals I’ve had conversations like this with have a genuine desire to provide their clients with the best and most effective service possible. But when you have clinicians who have literally never been exposed to or educated about a particular issue, it can be like trying to teach them Greek. The desire to learn and do better is there, but there’s going to be a lot of stumbles and missteps along the way.
Smrf: So for someone who is going to see a clinician who may not be as tied into social media and intracommunity discussions as you are, what would your advice be on the best way to approach them about their sexual, gender, and/or romantic orientations?
Pocky: That would depend a lot on your individual reason for seeking therapy and what role your orientation(s) do or don’t have to play in that reason. If you’re in a position where you have a lot of different options for therapy, I’m a big believer in interviewing/vetting therapists before you even get started, so you have your best chance of working with someone whose therapeutic methods, style, and personality are a good match for yours.
Unfortunately, due to insurance, access limitations, and a whole bunch of other reasons, you may not have a say in who your therapist is, and then that may put you in the position of having to do some educating. Open up the lines of communication by asking, in a straightforward way, “What do you know about (blank)?” Ideally, the clinician will know something about it. A lot of times, they won’t, or will have limited or inaccurate information. It helps to come armed in a situation like that. Be able to offer up a couple of links or resources that you feel reflect your experience.
Smrf: Let’s assume that someone who is asexual has mentioned this to their clinician, and has received or perceived hostility from them. If they don’t have a choice in their clinician (or even if they do), what are some steps they can take to rectify the situation?
Pocky: A lot of people feel frightened or insecure about confronting their therapist or telling them that their needs aren’t being met. Please, don’t be! Barring a handful of yahoos who really shouldn’t be working in this field to begin with, any hostility or push-back you sense from your therapist is more likely to come from a place of ignorance than a place of malice, especially if they’re inexperienced in working with asexual clients. They want to provide good therapy as much as you want to get good therapy, and may not even be aware they’re doing anything wrong. So while it can feel very intimidating, bring it up, and talk with your clinician about it.
For people who are asexual in particular, you may need to stress the fact that you do not see your orientation as a problem. For clients who are not asexual, a loss or absence of sexual desire can be a symptom of Major Depressive Disorder, or a hallmark of past sexual trauma. And a therapist is going to reflexively go to the most likely reason for any piece of information they receive. As they say in diagnostic medicine, “When you hear hoofbeats, look for horses, not zebras.” You are a zebra. Your therapist is looking for horses. Your therapist may have never seen a zebra before. Unfortunately, it falls to you, then, to inform your therapist of what they’re looking at, and how their inaccurate response is making you feel.
Ideally, this should open up a good conversation with your therapist about how they can do better. But if they’re still resistant, or if you feel dismissed or invalidated, this may just not be the healthiest therapeutic relationship for you to be in. If you have the option of doing so, find another provider. If you’re working with, say, a public mental health clinic and your therapist was assigned to you, contact a supervisor or director to express your concerns. They may be able to reassign you or refer you elsewhere.
Smrf: Getting back to the discussion of flibanserin, this is a drug that is supposed to be targeted towards women who have HSDD. While it doesn’t seem to be a necessarily effective drug in general, Sprout Pharmaceuticals has come out and said that this drug specifically isn’t meant to target asexuals, either, and claims that they’re going to be providing information for therapists on the differences between asexuality and HSDD. In theory, a woman who has come out as asexual and explained it to their therapist shouldn’t be having it suggested to them, but there’s always a chance that it will be. What can be done if flibanserin seems to be becoming an issue between the therapist and the patient?
Pocky: This is where the difference between psychotherapy and psychiatry comes into play. A therapist is not in a position to recommend or prescribe medication of any type. That is outside our scope of practice, as we are not MD’s or nurse practitioners, and treatment with psychotropic medication is left to psychiatrists, who do have the necessary medical credentials.
You do sometimes see psychiatrists who also do therapy, but more often a therapist and a psychiatrist form a partnership in working with the same client. Oftentimes if a therapist thinks medication may aid a client’s progress in treatment, they may suggest or recommend consulting with a psychiatrist and make a referral. It is well within your rights as a client to say no to this. If you are already seeing a psychiatrist for medication and they recommend flibanserin, it is, once again, your right to say no and to explain to your provider why. For a lot of people who are not asexual, mental health professionals included, sexual desire is such an integral part of their lives that they can’t imagine being without it as ‘normal’, or even good. It’s horses and zebras again – they’re trying to help you with a problem that you don’t have, and what might be a welcome suggestion to someone who actually has HSDD, it can be offensive or demeaning to a person who is asexual.
If your provider starts treating you like you’re ‘uncooperative’ or a problem client because you’re not comfortable saying yes to a med you don’t need, once again, it’s time to go shopping for another provider, or to take your concerns further up the ladder. Good therapy is about the client. Good therapy is about meeting the client where they are, and addressing the problems that they identify as their priorities for treatment. If your therapist or your psychiatrist is trying to treat a problem that doesn’t exist, that’s not good therapy. I can’t stress that enough.
Smrf: One of the big reasons that someone might go to a therapist is that they have been sexually abused, in one of many different ways. I personally know a few asexual survivors who are apprehensive about going to therapy because they’re afraid that a doctor will try to persuade them that their asexuality is based just in this assault, or else make some sort of connection that may not be there, and claim that their asexuality can therefore be healed if they deal with their trauma from the sexual assault. Or, if not that specific fear, some nervousness about what their therapist will say about the association between sexual trauma and their asexuality that may or may not be true. What would you suggest for those patients?
Pocky: This is where it gets a little hairier, because there are a lot of sexual assault survivors in treatment who are troubled by lack of sexual desire or anxiety about sex. Once again, stress that you do not consider your orientation to be a problem. Make a comparison to other forms of sexual orientation if you have to – would the therapist suggest that a lesbian who was raped by a man be “cured” and become heterosexual once her trauma has been successfully treated? I think not, and just typing it out that way makes me feel gross.
Do not let anyone talk you into doubting your identity and your sense of self. It’s easy to think “This person is a professional, what if they know best? What if I really am just broken?” But the truth is that no one knows you better than yourself. Even if there is a relationship between your asexuality and your history of trauma – and for some people that is the case – you should still be making it clear to your therapist that this is not something that you feel needs to be fixed or cured.
Smrf: I think that’s all the questions I have for now. Thank you for your time, and your amazing answers. This was really insightful, and will help a lot of people.
Pocky: Glad to be of help!
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I was lucky. I raised my asexuality in my session in relation to trauma, and it slipped by without a word of comment. I think the context is vital. I think after talking about sexual triggers, all the mention of asexuality did was indicate to her that the triggers were not stopping me from doing something I wanted.
Similarly bringing it up in context of bad coming out experiences and things like that can be easier to start off with because it doesn’t necessitate a total understanding of asexuality. You have to be prepared to do a fair bit of explaining if you want to talk about it in detail anyway just because of how people vary around the spectrum.
Would a good therapist not undertake their own research if they were faced with something unfamiliar? It seems surprising that they would depend totally on what their client can explain.
Well, a really good therapist might, but sadly, an average therapist might not.
That said, one of the things that I suspect can be helpful in ace-therapist interactions is having an outside third party the therapist can go to for the “I’m not sure if asking this is going to be offensive but I really don’t get asexuality” types of questions – most people need some time to work through a lot of misconceptions when they first learn about asexuality, but a therapist shouldn’t be relying on their client to have to shepherd them through that.
Having a third party to talk to gives the therapist a place to deal with their “learning about asexuality and voicing their doubts about it’s legitimacy” that isn’t on client time.
So, to that end, that’s something that is probably good to provide in any recommendations to therapists; and for someone seeing a therapist for the first tie, one idea would be to give them contact information (with permission) for a place like RFAS, or the local ace activist group, or even an ace blogger you trust (if they are up for it).
Exactly. As mentioned in my last post, after we had that big blow out, my therapist spent at least a day googling asexuality and had browsed through all the AVEN forums and the AVEN wiki, so the next time we saw each other she had a clearer understanding of what I was trying to say. I probably should have given her that link before it ever became a problem like that, and then we could have worked out misconceptions together.
For the record, I am always willing to help a therapist who may be struggling and needs a third party, if you want to send them either to my WP or my Tumblr. Just make sure to tell them to mention that they are a therapist so that I know a bit better where they might be coming from.
I would really like advice for graces specifically, and for aces for whom saying “my orientation is not a problem or source of distress”…isn’t true!
Specifically, navigating that tricky space of, sex being distressing, maybe wanting to work on it to be less distressing… Especially survivors, and sex-repulsed (or arcflux!) folks…
And for folks who are questioning! How to tell if your therapist is trying to talk you out of an identity, or if their saying “I don’t think that’s right for you” is a good/bad thing. (I mean, I think that’s always a bad thing — but for awhile I listened, like my ex-therapist knew me better than myself, because I didn’t trust my self-analysis. Whoo therapeutic gaslighting.)
And navigating relationships as a grace, or as a sex-favorable ace — especially the whole topic of “my not being attracted to this person has hurt them” — I feel like you might need a therapist with a specific stance/knowledge/competence, to handle that shame and guilt and what-now.
I am so lucky to have found an amazing therapist, now, who has been careful to ask “Okay, so what are your goals around sex, asexuality, greyness, identity, behavior? What do you want help with? What would be hurtful for me to say?” But it’s still really hard! Trying to separate out, I want to integrate my repulsed mindset with my “favorable” mindset, I want to improve my consent, I want to feel safe, I want to have OPTIONS, but I don’t want to feel like this project is important except when I SAY it is. I want my life to be easier but that doesn’t mean more normal. Etc.
sooooo much stuff that intertwines (sexual intrusive thoughts and compulsions! trauma hypersexuality! body dysphoria!) that I’d like to address while not…having to aver, Yes, I Am Happily Asexual in order to have a therapist be careful about their assumptions about my goals.
This comment really resonated with me. What stands out to me is how knowledgeable the asexual person would have to be about themselves to even try and balance being distressed by being asexual and yet still wanting to identify as asexual. For example, it’s taken a lot of soul searching for me to say I’m completely fine with not experiencing sexual attraction, but, as you mentioned, to simultaneously say I’m not okay with my lack of sexual attraction hurting my partners. I want to work on the latter. I also want to work on figuring out under what conditions I shift from sexually repulsed to other people to just being bored by them. Because I’m sex-favorable, I’d like to maximize the latter, while completely recognizing it’s perfectly okay for me to never actually be attracted. Some parts of my repulsion seem natural to my asexuality, but some are tied to being a survivor, and I don’t want to be held back by those experiences. These goals are so personal to me and the very unique ways in which my asexuality is distressing.
I’m trying to imagine a framework a therapist could construct to give ace people a safe space to figure out their own goals that work on what actually is distressing them and not what society thinks should be distressing them. I think I have built that framework together with therapists in the past, but I’m not sure we could have built it if I hadn’t been so knowledgeable about my own asexuality.
I have had someone tell me they didn’t think I was asexual, to which I just firmly said no, and then blabbered on about all of the research I had done that verified my account of asexuality. Not only did I need to be secure in my asexual identity, but I also have to be very secure in what distresses me. The fact that I might “need” that level of introspection, especially in therapy, really bothers me.
I think the best thing, insofar as talking to a therapist about it, would be saying you have a problem with it and then asking them if they can be your sounding board while you try to figure out why. You would hope that a good therapist would help you get to the root of your issues, and then figure out the best course of action from there, instead of just automatically going “WELP they don’t wanna be asexual, time to make them straight!”
As far as the dealing with things like talking about asexuality as a survivor, the next portion of my series is actually going to be a set of interviews with some people from RFAS, so keep an eye out for that one and hopefully it will help to answer some of your other questions.
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