Navigating Asexuality: A Guide for Therapists and Counselors
Asexuality, the lack of sexual attraction, is often misunderstood and overlooked in therapeutic settings.
Asexuality, the lack of sexual attraction, is often misunderstood and overlooked in therapeutic settings. This lack of understanding can lead to misdiagnosis, invalidation, and harm for asexual clients. Therapists and counselors must recognize the importance of providing affirming and competent care to this population. This article aims to address the gap in training and resources by providing essential knowledge and practical tools to support asexual clients effectively.
The Basics of Asexuality
Asexuality is a sexual orientation characterized by the lack of sexual attraction. It's crucial to distinguish it from celibacy (a chosen behavior), low libido (a medical condition), and sexual dysfunction (a clinical diagnosis). Asexuality is an inherent identity, not a choice or a problem.
Romantic orientation, which describes who a person is romantically attracted to, is distinct from sexual orientation. Asexual individuals may also identify as aromantic (lacking romantic attraction), gray-romantic (rarely experiencing romantic attraction), or with other romantic orientations.
The asexual spectrum encompasses various identities, including:
Demisexuality: Experiencing sexual attraction only after forming a strong emotional bond.
Gray-asexuality: Experiencing sexual attraction rarely or under specific circumstances.
It's vital to acknowledge the fluidity of identity and respect the client's self-identification.
Asexuality and Mental Health
Asexuality is not a mental disorder. The DSM does not pathologize asexuality. However, asexual individuals may experience co-occurring mental health conditions, such as anxiety or depression, unrelated to their asexuality.
Minority stress, the chronic stress experienced by members of stigmatized groups, can significantly impact the mental health of asexual individuals. External acephobia, including invalidation, discrimination, and microaggressions, can lead to trauma and psychological distress. Therapists must differentiate between mental health conditions and the potential trauma caused by societal prejudice.
DSM Considerations and Criticisms
It is important to address the presence of diagnoses such as Male Hypoactive Sexual Desire Disorder (MHSDD) and Female Sexual Interest/Arousal Disorder (FSIAD) in the DSM-5. These diagnoses are intended to address clinically significant distress related to low or absent sexual desire or arousal. However, there is significant criticism regarding their application to asexual individuals.
The DSM-5 explicitly states that these diagnoses should not be applied to individuals who identify as asexual. This caveat, while intended to protect asexual individuals from pathologization, creates a problematic situation:
Self-Identification Requirement: It places the onus of protection on the individual's self-identification. This means that only those who are aware of the term "asexual" and feel comfortable using it are protected from misdiagnosis.
Vulnerability of Unaware Individuals: Individuals who are asexual but unaware of the term, or who are struggling with internalized acephobia and are hesitant to identify as such, remain vulnerable to being diagnosed with MHSDD or FSIAD. This can lead to inappropriate and harmful treatment.
Internalized Acephobia and Diagnosis: Individuals dealing with internalized acephobia may seek help for a perceived ‘lack of desire’ due to societal pressures, and be misdiagnosed, reinforcing their self hatred.
External Acephobia and Diagnosis: Individuals experiencing external acephobia may be pressured by partners or family to seek “treatment” for their lack of sexual attraction, and therapists who do not understand asexuality may misdiagnose them.
This creates a paradoxical situation where the very act of self-identification is what prevents pathologization. Therapists must be acutely aware of this issue and exercise extreme caution when assessing clients for MHSDD or FSIAD.
Thorough Exploration: A thorough exploration of the client's sexual history, identity, and feelings about sexuality is crucial.
Respect for Self-Identification: Therapists must respect the client's self-identification, even if it differs from societal norms.
Education and Awareness: Therapists must educate themselves about asexuality and challenge their own biases and assumptions.
Focus on Distress: The focus should be on the client's distress, not on the absence of sexual desire itself. If the client is not distressed by their lack of sexual attraction, a diagnosis of MHSDD or FSIAD is inappropriate.
Recognizing the potential for misdiagnosis and the harmful consequences it can have for asexual individuals is vital. Therapists must prioritize client autonomy, informed consent, and a deep understanding of the diverse spectrum of sexual orientations.
Internalized Acephobia: Identification and Treatment
Internalized acephobia refers to the negative beliefs and feelings asexual individuals hold about their own asexuality. Signs include self-doubt, shame, isolation, and questioning the validity of their identity.
Therapeutic approaches include:
Validation and Affirmation: Acknowledging and validating the client's experiences.
Cognitive Restructuring: Challenging negative thoughts and beliefs.
Exploring Identity and Self-Acceptance: Facilitating the client's journey towards self-acceptance.
Addressing Societal Messages: Helping clients deconstruct internalized stigma.
Building Self-Compassion: Encouraging self-kindness and acceptance.
External Acephobia: Navigating Societal Challenges
External acephobia is prevalent and can have a significant impact on asexual individuals. Therapists can support clients by:
Developing Coping Strategies: Helping clients navigate invalidation, discrimination, and microaggressions.
Advocating for Self: Supporting clients in advocating for their needs.
Building Support Networks: Connecting clients with supportive communities and resources.
Addressing Relationship Challenges: Helping clients navigate relationship dynamics related to differing sexual orientations.
Recognizing Trauma: Identifying and addressing potential trauma related to external acephobia.
Therapeutic Approaches and Considerations
Creating a safe and affirming therapeutic environment is crucial. Therapists should:
Use Inclusive Language: Avoid heteronormative assumptions and use inclusive language.
Practice Active Listening: Validate the client's experiences.
Avoid Pathologizing Asexuality: Recognize asexuality as a valid sexual orientation.
Respect Client Autonomy: Honor the client's pace and autonomy in exploring their identity.
Educate Partners/Family: When applicable, provide education to the client's partners and family to increase understanding.
Ethical Considerations
Maintain Confidentiality: Respect client privacy and autonomy.
Avoid Imposing Personal Beliefs: Refrain from imposing personal values or beliefs.
Seek Consultation: Recognize limitations and seek consultation when necessary.
Stay Updated: Continuously update knowledge and skills.
Example Case Studies
To illustrate the therapeutic approaches discussed, here are some case studies and examples. (Note: These are made up for educational purposes and do not reflect actual medical studies of patients.)
Case Study 1: Internalized Acephobia and Self-Doubt
Client: Alex, a 22-year-old college student, identifies as asexual and aromantic. They present with symptoms of anxiety and depression and express significant self-doubt about their identity. They describe feeling "broken" and "abnormal" because they don't experience sexual or romantic attraction.
Therapeutic Approach: (Validation, Cognitive Restructuring, Exploring Identity, Building Self-Compassion)
Example Dialogue: (Alex & Therapist dialogue provided in previous response)
Case Study 2: External Acephobia and Relationship Challenges
Client: Sarah, a 35-year-old woman, identifies as demisexual. She is in a long-term relationship with a partner who is allosexual. They are experiencing relationship difficulties due to differing sexual needs and expectations. Sarah reports feeling pressured to engage in sexual activity.
Therapeutic Approach: (Relationship Counseling, Education, Boundary Setting, Advocacy)
Example Dialogue: (Sarah & Therapist dialogue provided in previous response)
Case Study 3: Trauma Related to Acephobia
Client: Jordan, a 17-year-old high school student, identifies as gray-asexual. They have experienced bullying and harassment at school. They present with symptoms of PTSD.
Therapeutic Approach: (Trauma-Informed Care, Safety, Trauma Processing, Advocacy)
Example Dialogue: (Jordan & Therapist dialogue provided in previous response)
Example of Therapist Self-Reflection:
A therapist notices they have a tendency to ask all clients about their sexual activity. They reflect that this could be harmful to asexual clients. They then decide to change their intake form, and to add a section about sexual orientation, and variations of sexual orientation. They also decide to educate themselves further on asexuality.
Resources for Therapists
To further enhance understanding and promote ongoing education, therapists can utilize these resources:
The Asexual Visibility and Education Network (AVEN):
Website: www.asexuality.org
Description: Offers extensive information, forums, and research on asexuality.
Academic Databases:
JSTOR, PubMed, Google Scholar: Search for peer-reviewed articles on asexuality and related topics.
LGBTQ+ Professional Organizations:
Organizations like the American Psychological Association (APA) Division 44 (Society for the Psychology of Sexual Orientation and Gender Diversity) often have resources and training materials.
Continuing Education Workshops:
Seek out workshops and training sessions on LGBTQ+ competency, specifically addressing asexuality.
Books:
"Ace: What Asexuality Reveals About Desire, Society, and the Meaning of Sex" by Angela Chen.
"The Invisible Orientation: An Introduction to Asexuality" by Julie Sondra Decker.
Online Forums:
Reddit subreddits like r/asexuality provide insight to ace experiences.
Resources for Clients
Therapists can provide these resources to asexual clients:
The Asexual Visibility and Education Network (AVEN):
Website: www.asexuality.org
Description: A supportive online community and information hub.
Online Forums and Communities:
Reddit: r/asexuality, r/aromantic, r/demisexuality, and other related subreddits.
AVEN forums: Offers a safe space for discussion and support.
Books:
"The Invisible Orientation: An Introduction to Asexuality" by Julie Sondra Decker.
"Loveless" by Alice Oseman (Fiction, but very relatable to many Aces)
Local LGBTQ+ Centers:
Provide information on local support groups and resources.
Mental Health Professionals:
Referrals to therapists with experience in LGBTQ+ issues and asexuality.
Crisis Hotlines:
The Trevor Project, Crisis Text Line, and other mental health crisis resources.
Asexual Awareness Week:
Website: asexualawarenessweek.com
An international campaign that seeks to educate about asexual, aromantic, demisexual, and grey-asexual experiences.
Conclusion
Providing affirming and competent care to asexual clients is essential. Therapists and counselors must prioritize ongoing education, self-reflection, and advocacy to create a more inclusive and supportive therapeutic environment. By recognizing the validity of asexuality and addressing the unique challenges faced by asexual individuals, therapists can empower their clients to live fulfilling and authentic lives.
Sources
Is Asexuality Really a Thing? Isn’t it Actually a Disorder? - Elevatus Training
Asexuality, Attraction, and Romantic Orientation - LGBTQ Center
REFUSING COMPULSORY SEXUALITY by Sherronda J. Brown ★★★★★ | Kara.Reviews
Understanding Asexuality and Its Impact on Mental Health | Sage Therapy
Asexuality and Mental Health: Challenges and Support Strategies
