Asexual Clients
As evidenced in Kinsey’s “Category X,” a small minority of the population has consistently expressed a lack of sexual attraction to others and little distress about it (Kinsey, Pomeroy, & Martin, 1948). This increasingly visible minority self-identifies as asexual. Approximately 1% of the population can be classified as asexual, according to Bogaert (2004, 2006). Asexual identity can be complex and may challenge the therapist’s assumptions about “healthy” sexuality. Further, not all asexuals seek therapy for their lack of sexual interest in others. Some may be partnered and experiencing difficulty negotiating a sexual relationship.
Is asexuality an orientation? The asexual community, mainly coalescing online around the Asexual Visibility 8c Education Network (AVEN) (www.asexuality.org), largely supports the classification of asexuality as an orientation rather than a disorder (AVEN, 2014). See Parente and Albuquerque (2016) for further elaboration. Many have experienced a lifelong lack of sexual attraction towards others as a stable component of their sexuality (Brotto 8c Yule 2017). Further, asexual research subjects clarify that they do not experience aversion or anxiety regarding partnered sexual activity, but instead find it uninteresting or “boring” (Prause 8c Graham, 2007). Asexuals engage in solo sexual activity, reporting masturbation rates consistent with the general population (Brotto and Yule, 2011). The difference, rather, is that asexual interest is “not oriented toward another person” (Van Houdenhove, Gijs, T’Sjoen, 8c Enzlin, 2014, p. 180; Brotto 8c Yule, 2017). Masturbation provides a physical release rather than resulting from than a romantic attraction towards another.
Therapists need to be able to distinguish asexual individuals from those who experience low desire as outlined in DSM-5 (Steelman 8c Hertlein, 2016). Asexuality can be confused with sexual disorders such as Female Sexual Interest/Arousal Disorder (FSI/AD). Asexuality is sometimes associated with psychiatric conditions. Some of the emerging research has documented an association between Asexuality and Schizoid Personality Disorder, Asperger Syndrome, and Autism Spectrum conditions as cited by Brotto and Yule (2017).
Therapeutic Considerations
The initial therapeutic task is to make a thorough assessment of all aspects of the client system: individual, couple, intergenerational factors, and contextual stressors. Asexuals often feel marginalized and stigmatized by society, which is a major environmental stressor. Next, the therapist also needs to be educated on the variety of presentations of asexual individuals. For a review of types, see Steelman and Hertlein (2016). Specifically, the therapist should be clear on a subset known as Grey-A, in which asexual individuals do not experience strong, sexual attraction or desire towards others yet are open to the possibility of sexual attraction or desire in very limited situations; typically, they do not act on it. Additionally, it should not be assumed that all asexuals are single. Partnered asexuals may face sexual pressure or may have difficulty negotiating sexual activity with a spouse or companion. Gupta (2017) recommends that the therapist should expect to deal with the following issues in asexuals and their partners: the lack of communication around sexual activity, lack of agreement about sexual interactions and frequency, one partner feeling rejected or undesired, and issues of control (Gupta, 2017 p. 90). Once a comprehensive assessment is complete and the asexual partner is identified, important elements in the treatment process include joining, clarifying definitions, challenge beliefs and assumptions of socially sanctioned behavior, and developing a common or agreed-upon expression of affection (Steelman
Hertlein, 2016). This may include how the couple wishes to address and organize the sexual issues in their relationship. This discussion can begin with a description of each partner in terms of the inter-sectionalities of gender and sexuality, i.e., a kinky, black, genderqueer-identified female partnered with a white cisgender asexually identified female. Issues in sexually discordant couples may require negotiation of consensual agreements, often allowing for unilaterally desired sexual interaction (Brotto & Yule, 2011). A subset of these couples may resolve this discordancy with consensual non-monogamy (Scherrer, 2010). Treatment should be accepting of the sexual/gender identities of each partner with a goal towards helping them work together to understand how each other’s sexual/intimacy needs are expressed and met in the relationship.
In addition to feeling stigmatized in a heteronormative society, asexuals often feel invisible. Some uninformed therapists can add to the sense of alienation by failing to ask important questions about the sexual practices of the client. Worse, therapists sometimes pathologize asexual clients, adding to their anxiety and depression, which, reportedly, can be higher than other LGBT+ communities (Borgogna, McDermott, Aita, & Krindel, 2019). Furthermore, therapists must be aware that self-identified asexual individuals do not report feeling emotionally closer to their partner after sex (Prause & Graham, 2007); thus, suppositions about the inseparability of sexual and romantic attraction must also be explored and challenged, both in the clinician and the client.
Competency in working with asexual individuals includes education about the varied continua of sexual and romantic expression and potential barriers that might arise due to rigid beliefs about sexual normativity. Moreover, the clinician is required to be open and supportive of complex identities the asexual clients might affirm. Asexual people regularly experience microaggressions, as do other marginalized sexually diverse groups. The therapist must be aware and sensitive to the intersections between asexuality and other marginalized identities and the resulting negative mental health outcomes (Deutsch, 2018).
Client Resources
- • Asexual Visibility & Education Network (AVEN): http://www. asexuality.org
- • http://www.asexualityarchive.com
- • https://www.huffpost.com/entry/asexuality-the-x-in-a-sexual-world_ n_3444417
