Home September / October 2025 Volume 24, No. 5

SPECIAL TO THIS ISSUE

This Is What Happens When Therapists Don’t Understand Asexuality

Debbie Urbanski
 

The problem my husband and I had was, admittedly, a tricky one. I had always been disinterested in sex ever since my high school years—it didn’t make sense to me, I had no need for it, and I never enjoyed it—but, 9 years into our marriage, that disinterest had developed into a deep repulsion. After some sleuthing on the internet which led me to the Asexuality and Visibility Education Network (AVEN), I figured out I was asexual. My husband, at first, was fine with this, though he insisted that we continue to have penetrative intercourse, as he considered such sex to be the ultimate connection and a necessary form of love. But penetrative intercourse made me want to vomit.  

I never wanted to have it again and, instead, I needed us to find new ways of connecting. On our own we couldn’t figure out where our two realities might intersect so we decided to try couples counseling. I had done individual therapy on and off for decades and found it immensely helpful. I assumed couples counseling would be helpful as well. And so, between December 2014 and October 2017, my husband and I took part in a cumulative 26 months of therapy across three therapists (one LMFT and two psychologists who specialized in family and relationship issues).

This, looking back, was one of the worst decisions of my life.

I do not use the word trauma lightly when I say that my time in couples counseling was traumatic. Here is what I heard in those spaces over and over again from people that my husband and I had approached as experts: I was not okay as I am. My husband’s wants were normal while my wants were unimportant. It didn’t matter that intercourse made me feel like I was being raped. It didn’t matter that, to me, having sex with my husband was the same as having sex with a stranger or a relative or a child—that it felt just as wrong, just as nauseating. It didn’t matter that the only way I could get through sex was by imagining I was repeatedly cutting my throat or hacking at my wrists (I found those visualizations more comforting than inhabiting my body during sex). Sex between spouses was essential to any healthy and committed relationship, said our therapists, and we needed to fix what was wrong with me. The only alternative offered was divorce which was, for me, out of the question due to economic, family, and mental health reasons.

Many of us in the ace community have been told by family members, significant others, and popular culture that we’re broken, that something is wrong with us, that we’ll be fixed or cured if we just have sex with the right person (or, maybe we need our hormones adjusted, or maybe we need sex therapy and sensate focus exercises). But I had not imagined hearing this from therapists my husband and I had turned to for help, just as I did not expect the focus of couples therapy to become the erasure of my sexual orientation.

I’m guessing my husband’s needs were prioritized over mine because his were familiar to the therapists. They understood my lack of sexual desire as something that needed adjustment  (to be fair, the DSM had medicalized asexuality via “hypoactive sexual desire disorder“ up until the DSM-5 in 2013). One therapist told me I was making my asexuality up as a way to control my relationship. She said she was knowledgeable about LGBT issues and she had never heard of asexuality. How did I know it existed? She told me that in New York, intercourse is an expectation of marriage by law. It wasn’t just her: none of the therapists were familiar with asexuality as an orientation. And certainly, back in the mid 2010s, asexuality was not well known. Merriam Webster’s dictionary, after all, had only begun recognizing asexual as a term of sexual identity in 2017. Still, ignorance is no excuse for conversion therapy, which is how, in the end, I would frame my experience.

In the final months of couples counseling, I began drawing in a sketch book in an attempt to make the sessions bearable. As I scribbled darkly with a dark pen, my therapist talked with us about how I could move forward toward having penetrative sex a certain amount of times per month. Pressing my pen back and forth across the paper in whatever direction I wanted gave me a sense of control that I no longer had over my life or my body or my marriage. When I look at those pages now, I see someone, me, trapped and on the brink of hysteria and suicide, trying very hard to hold on to the only thing that was being offered to me, the edge of a knife.

Part of surviving that time of marriage counseling—and I use the term surviving literally, as with each therapy session I slid further down the steep slope of depression and suicidality—was writing in my journal after those sessions. Some entries drift into notes about ways to kill myself: should it be hanging, I wondered, the rope secured to a doorknob, or should I buy a charcoal grill and put it in the bathroom and tape the door shut. In other entries, I wondered at the disconnect between who I was and who people insisted I be.

Here are some excerpts:

You know, I just want to be myself. I just want someone to want me as I am, for being myself. To have that be enough for once.

I find it ridiculous that he still thinks something is love when it feels like rape to somebody else.

I don’t want to get in trouble in couples counseling for being sad and not wanting to spend time in bed.

I really believe who I am is normal too.

I want my body to be mine.

He doesn’t feel like we’re making progress.

Without us spending time in bed working toward intercourse, I’m worthless.

Eventually I knew I wouldn’t be okay—I would probably in fact be dead—if I continued these sessions. I told my husband I needed to stop going to couples sessions. I told him I would never attend again.

These days, articles on asexuality can be found in mainstream outlets like Men’s Health, Elle, Scientific American, and Ms. Magazine. There are ace characters on television shows such as BoJack Horseman, Sirens, and Heartstopper (though TV and movies could use more diverse asexual rep, including older asexuals and married asexuals).  Even JK Rowling is talking about asexuality in her toxic way. The number of young people who are identifying as asexual is striking and worth noting. Ten percent of LGBTQIA+ youth identified as asexual or ace spectrum in a 2020 Trevor Project survey. What this means, in my mind, is that therapists will soon be encountering asexuals in greater numbers—and this concerns me. Are marriage and family therapists ready to help asexual clients, particularly those who may be in mixed-orientation relationships? I am overjoyed that the AAMFT offers an excellent online continuing education course about asexuality (“Facilitating an Affirming Approach that Embraces Asexuality”), but as of September 4, 2025, only 23 members have taken the course out of AAMFT’s 25,000 membership.

I don’t think the harm I experienced during couples therapy is inherent to such therapy itself. Rather, it was caused by the preferences of my therapists who held up the idea of a traditional allosexual marriage as the only possibility; a relationship where they insisted sex of a particular type must be at the center. One of the things I love about the asexual community is its assertion that there is not one right way of loving someone in a marriage or long-term relationship or in a friendship—and anyone who tells you otherwise, including both therapists and partners, is buying into a made-up story we’ve been forcing on each other for way too long.

Here are the questions I wished our marriage counselors had asked:  What if sex were no longer considered a given right of marriage? What if sex were no longer held up as the ultimate way of connection, but more like one of many physical activities one might or might not do with a spouse? What if there were an infinite number of ways for us to love and be loved?

My husband and I did, eventually, figure things out on our own. Our marriage has been able to heal in the years since, though my idea of marital stability, or stability in any type of relationship based on love, was permanently shattered from my time in couples therapy. Still, I’m proud that my husband and I managed to find our own compromises and middle ground. We managed to do this despite the mess that therapy had made of my identity and our lives. Our marriage doesn’t look like the marriages I see on TV, in the movies, or on Instagram. Nor does our relationship look like what our couples therapists held up as the ideal. It is still a marriage.

The therapists my husband and I met with presented themselves as liberal and progressive. They positioned themselves as LGBT supportive, a safe space, because they allowed that men can want to have sex with men, and women can want to have sex with women—but they could not imagine other queer possibilities, such as a committed and deep love without intercourse.

The letters of queerness no longer end at T, you know. They haven’t since 2015. The only proper way to write that acronym now is LGBTQIA+, where the A stands for asexual (as well as agender and aromantic). Couples therapy has a responsibility to reflect this.

So how could things have gone better? And more specifically, how can you, as a marriage and family therapist, help asexual clients?

Educate yourself on asexuality, ideally before an ace client walks into your office. Realize that asexuality exists on a spectrum and that there are many different types of aces (I’m describing here being a sex-repulsed asexual. Other asexuals are demisexual or graysexual. Some asexuals have fetishes or like to masturbate. Some asexuals don’t mind having sex). Remember that people who are asexual still experience love. Make sure you understand the split attraction model, where romantic attraction and sexual attraction are independent of each other. This concept is central to understanding asexuality. See the list of recommended resources below for starters.

Use the full acronym LGBTQIA+ when speaking of the queer community to acknowledge and recognize that asexuality (and aromanticism and agenderism) exists.

Realize that the traditional set-up of marriage/relationships that puts sex at the center doesn’t work for most asexuals. Be ready to suggest other narratives and other forms that marriage and other committed relationships can take. Don’t present these as alternatives; put them on equal footing with traditional marriage/relationships. David Jay’s conversation with the podcast Sex in Space has some great thinking around this.

Read up on alternative arrangements for physical intimacy in mixed-orientation relationships. Check out the “asexual relationships” section of AVEN’s forum or the “for sexual partners, friends and allies” part of AVEN. Often, concrete ideas come up if you search for the term compromises (like here at Reddit on r/asexuality). Remember, though, that “compromise” is not shorthand for the asexual person in a relationship having sex. Asexuals are not the only people in relationships who can compromise.

Challenge compulsory sexuality and do your part to decenter the myth that sex is the ultimate connector and necessary for relationships, marriage, connection, happiness, and/or love.

If you aren’t familiar with asexuality and you have an asexual client, refer them to someone who is more knowledgeable. It is very clear to me, looking back, that the therapists my husband and I met with had no idea what to do with us. They treated me like I wasn’t asexual and they treated our marriage like it wasn’t a mixed-orientation relationship. If you don’t have the skills yet to help asexual clients, please refer asexual clients to someone who does.

Lastly, I would encourage AAMFT to come out with a position statement that recognizes asexuality as an orientation and not as a condition that needs to be fixed (see the American Association of Sexuality Educators, Counselors, and Therapists’ Position on the Dignity and Rights of Asexual Individuals for a great example).

Further resources

I’d also like to recommend some of my own writing on asexuality:

  • “9 Books That Center Asexuality”: A round-up of asexual books I pulled together for Electric Lit along with recommendations from leaders and thinkers in the ace community.
  • Portalmania: My recent collection of stories that circle around collisions between asexuality and an allosexual world.
  • “The Dirty Golden Yellow House”: The original version of my short story that includes therapists as a chorus of characters badgering the narrator to have sex. This story delves deeply and specifically into how it feels to be asexual in a traditional relationship.
  • “Hysteria”: Another short story of mine comprised of a conversation between an asexual woman and her therapist.

Thank you to Kimberlee Bryce, director of publications at AAMFT, for allowing me this space to share my thoughts and experiences.

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