Understanding Sexual Orientation

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People don’t need a sexual identity to justify their current sexual preferences.

We generally interpret, rather than gratify, patients' desires, and should also do so when the subject is sex.

We should aspire to help patients accept themselves without the comfort of believing they're "normal."

Even the asexual community cannot agree on a definition of "asexual".

“A client wonders if she’s bisexual. How do I help her decide?”

“A patient thinks he’s asexual. How do I evaluate this?”

I provide case consultations for many therapists each month, and questions like these are not unusual. Much to the surprise of my colleagues, I generally say that they—and their patients—are asking the wrong question.

Many therapists say that labels such as “bisexual,” “asexual,” and “demisexual” give people permission to (finally) be who they are. But I say they’re an inefficient route to self-acceptance—and are ultimately more limiting than freeing.

People don’t need an identity to justify their current preferences. And people don’t need an identity to accept that what they do or want is normal. I’d rather they decide that “normal” is irrelevant. That would be real growth.

How do I discuss this with patients? I ask a lot of questions. I often tell them what I just told you. Generally, my goal is to validate people without reassuring them.

Take Alyce, for example, wondering whether she’s bisexual. “She doesn’t need to decide this,” I told her therapist. “She only needs to decide if she wants sex with a particular person at a particular time. And she can give herself permission to fantasize about sex with absolutely anyone, without deciding who she is or what erotic team she belongs to.”

Indeed, if Alyce wants to sleep with individuals of many genders, that still doesn’t mean she’s bi (or pan, or whatever). Maybe she doesn’t want to sleep with “men” but rather with Juan. Maybe she doesn’t want to fantasize about “women,” but about Jacqui.

“But,” said her therapist in case consultation, “Alyce wants to know if she should be open to both men and women sexually. Knowing whether or not she’s bi would make that a lot easier." Plus, continued the therapist, “It would help explain—or challenge—her difficulty in her current marriage.”

Her therapist is right—with a defined sexual orientation, Alyce could lean on a category, and let that “fact” guide her decisions. It would definitely be more complicated for Alyce to decide what (or who) she wanted without such a crutch, to not give her desire a name, and just be (and accept) whoever she is.

And rather than confronting her discomfort about intimacy (a pattern that the therapist had observed), it would be far easier for Alyce to say “I’m bi, and therefore can’t be expected to be monogamous.”

This is a perfect example of how a category can make short-term life easier but limit long-term growth—even medium-term self-honesty.

Or take Sam, the possibly-asexual.

I could tell Sam’s therapist everything that’s wrong with the popular new category “asexual”: There’s no agreement on a definition; it organizes people based on what they say they don’t want; it assumes that some version of sexual attraction is “normal” (which "asexuals" then rebel against); there’s no differential diagnosis involving medication side effects, rage, fear of intimacy, or mental health issues like bipolar disorder; and it invites people to feel aggrieved when there’s absolutely no discrimination against them (a raised eyebrow isn’t quite the same as losing your job or being beaten up).

Understanding Sexual Orientation

Take our Do You Know Proven Psychology Facts?

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Or I could tell Sam’s therapist that “when people say they’re asexual we have no idea what they mean by that.”

Which is also true, although there's a deeper point.

In talking to Sam’s therapist, I referenced the same principle that I used with Alyce’s therapist: It’s not necessary to decide which erotic team someone is on. Sam could say, “I generally have a low sex drive.” He could say ,“I’m in a non-sexu al part of my life right now.” He could even say, “I’m not in the mood to have sex with you right now.” He also has the option to add, “Please don’t ask me again.”

And if Sam (or any other patient) tells their therapist, “But I want to know. I want to understand myself better. I want to make lifestyle decisions. You have to help me decide my orientation,” then what?

At least in principle, most therapists agree that encouraging patients to explore their emotional desires is better than simply gratifying the patient. When patients tell us, directly or (more often) indirectly, that they want to be admired, or pitied, or loved, or to feel special, it’s generally more helpful for people if we discuss their feelings rather than reassure them or give them what they say they seek.

So when Sam or any other patient says they want a category or formula to make life simpler, I sympathize—but I don’t provide one. Instead, I encourage patients to talk about this desire. And I invite them to talk about their frustration that life isn’t simpler (which is not the same as them whining, by the way).

This is how we can empower people—helping them talk about how they want to feel appreciated, how they struggle to make sense of an unfair world, and how they yearn for community. We accept people as they reveal what may feel like weaknesses to them. We connect with them even as they feel disconnected from others—or from us.

In response, people often find themselves rising to the occasion, as they realize the necessity (and therefore find the strength) to comfort themselves, grow beyond mean-spirited family members, and make more conscious decisions.

We do this all without telling patients “you’re great,” which they should have been told repeatedly when they were 8 years old. And we do this without predicting which sexual identity’s community will welcome them.

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