This is a draft/work-in-progress, to be reposted at a later time. If you’ve read or written any of the comments that helped me draft this post, it should be easy to see the fingerprints of that input all over this, but I’ve tried to develop a consistent, authoritative voice throughout.
Note: This guide presumes familiarity with the asexual identity. For some basic 101, you can view Asexuality: Basics for Health Professionals.
There are many issues to bear in mind when conducting therapy with a client who identifies under the asexual umbrella. Aces may have unique needs and experiences that challenge traditional practice and conventional wisdom within the mental health field. However, in order for you to even be aware that your client is ace, they’ll need to decide to disclose their sexuality to you in the first place, which can be a fraught decision to make, especially in dealings with mental health professionals. To signal to clients that you can be trusted with this information (and to attract clients who may be looking specifically for an ace-friendly therapist), here are some preliminary steps you can take.
Presenting Yourself as an Ace-Friendly Therapist
In some ways, you can think of this goal as similar to presenting yourself as LGBT-friendly, although it’s worth noting that because not all LGBT-friendly therapists are ace-friendly (and because the LGBT and asexual communities have a complicated relationship), people who identify with asexuality may need additional, specific assurance. If you have an online or written bio that notes you’re “LGBT-friendly” or some similar variation, aces might look for signals such as an ambiguous acronym (LGBTQ+) or one of the variations of the acronym that includes an “A” (LGBTQIA), but the clearest cue would be an explicit “asexual-friendly” statement or a mention of the asexual spectrum. If you have a rainbow symbol or safe space icon somewhere in your office space, you might print out a similar image for aces, such as the inclusivity poster you can find here. If you require clients to fill out any standardized forms on the subjects of libido or “intimacy,” at least see about providing a N/A option for each question, even the questions you would assume are always applicable.
Presenting yourself as ace-friendly extends into the therapy session, as well. Don’t assume there is any “normal” when it comes to sex and sexuality, and make this a general practice for all your clients. Many things are common; few things are universal. Puberty, sensuality, and desire can all be experienced (or not experienced!) in a myriad of ways. Conventional dating scripts, “levels of intimacy,” and “progressions” in a relationship may not apply.
Be careful not to steer clients toward a certain “default” way you would expect their sexuality to unfold over their lives. Asexuality is something you should preemptively take into account even with clients who do not identify themselves to you as ace, especially since many people haven’t heard of it as a sexual orientation in people. When you’ve done the research to become knowledgeable of common ace experiences, you can be prepared to notice similarities in the experiences of your clients and recognize when a client might benefit from being introduced to the concept of asexuality.
When A Client Comes Out As Asexual, Gray-Asexual, or Demisexual
An ace who’s doing therapy might come out to their therapist for a multitude of reasons. Although you should be prepared for the possibility, don’t assume that just because they’re informing you of their sexuality that it’s something they’ve come to therapy to “work on” or that their orientation itself is a source of distress. Sometimes, the client’s ace identity may be necessary prerequisite knowledge they need to impart before they can explain something else going on in their lives (they could be an asexual education activist, for example!). An ethical therapist would not want clients to keep secrets out of shame or fear that revealing certain information about themselves might alter the course or the quality of their therapy.
When a client comes out to you as ace, they’ll likely be gauging your reaction and looking for clues as to whether you accept their identity or you don’t. Be prepared to offer them reassurance and make clear that the imparted information will not interfere with your willingness to help them work on their stated goals.
Remember: coming out can be scary! Especially coming out to a mental health professional as a sexual identity that is popularly pathologized. Your client may have received judgmental, dismissive, or hostile responses to their sexuality in the past, or they may have read about these responses being received by others who share their identity, and they may be bracing themselves for the worst. Do not assume that your client acting tense or nervous around the subject means that their identity itself is the problem. It could be that they’re just unsure whether it’s safe to be talking about it with you.
To address these fears, you may want to think of something to say in advance. For example, a nod, a smile, and a comment about “I’ve heard of that before” can go a long way. Affirming acknowledgements such as “That’s normal” or “Sexuality is a spectrum” can be helpful as well. This applies no matter the age of the client. Never tell anyone they’re “too young to know” or that they “might not be asexual forever.”
As always, let your client’s concerns guide the session. How relevant asexuality is to their reasons for seeing you is up to them, and how much they want to share is up to them, too. Some aces are comfortable answering questions on the subject, but pay attention to your client’s body language and how they seem to handle curiosity; you don’t want them to feel like they’re being interrogated or like their identity’s legitimacy is on trial. Most basic questions can be answered with a google search outside of the therapy session. Don’t rely on your client to educate you. Bear in mind, also, that you only need to know what’s relevant to helping your client reach their therapy goals (i.e. you may be proud of the research you’ve done, but it’s not appropriate to spring a question like “So what’s your romantic orientation?” on someone if that has nothing to do with why they’re seeing you).
As previously mentioned, the LGBT community and the asexual community have a complicated relationship (as well as considerable overlap). When you are responding to a client’s disclosure of asexuality, it’s not a good idea to say something like, “I’ve heard Dan Savage talk about that.” You may think that citing a popular gay rights activist should earn you credibility, but in fact, the well-publicized dismissive and demonizing things that Dan Savage has said about asexual people in the past, even if he carries different beliefs in the present, means that if you bring him up, an ace client is more likely to cringe and become more wary of you rather than less. In general, it’s best to avoid specific namedrops. On the other hand, you shouldn’t assume that an ace identity and a gay, bi, and/or transgender identity are mutually exclusive.
Ethical, Informed Therapy With An Ace Client
So now you know that one of your clients identifies, to whatever degree, with asexuality. Here are some tips on how to proceed.
Firstly, no matter if your client is questioning or uncertain, no matter how much it challenges what you’ve been taught, do not tell your client what they “really” are or try to steer them away from an ace identity. In fact, you shouldn’t be steering at all. Your job is to facilitate their journey, not take over for them.
Your prior education might tell you that a low sex drive can be a symptom of other illnesses, and that may be true, but it’s not always appropriate to broach the subject — you don’t need to bring it up unless you recognize other symptoms. Asexuality and pathologization is a touchy subject, and a low or absent sex drive alone is not cause for concern. If they’re concerned about their sex drive and ask you about it, mentioning related illnesses would be appropriate, but so would introducing them to the concept of asexuality.
Despite what the current DSM may lead you to believe, identifying as asexual does not necessarily preclude someone from being “distressed” about low sexual desire. When considering a sexual disorder diagnosis, do not operate off a dichotomy that sorts people as either disordered or asexual based off of whether or not they “experience distress.” Remember, also, that people who might benefit from the asexual label often haven’t heard of asexuality as a legitimate orientation before. It’s fairly common for aces to go through complex periods of questioning, self-doubt, and even self-hatred before and while identifying as ace. A lack of proud proclamation and confidence in the identity, or even mentioning it at all, doesn’t mean someone is not ace.
During the therapy session, you may feel called upon to encourage your client to question their assumptions and thought processes. This can be helpful and healing in many situations. It is not necessarily helpful, and may even be damaging, to take that approach to identification under the asexual umbrella. Undermining your client’s confidence in calling themselves ace is unethical and unproductive. If anything, the most helpful thing may be to encourage them not question themselves so much, when it comes to this matter, especially if their doubt spirals are consistently inconclusive.
An asexual identity can coincide with a wide variety of experiences, traits, diagnoses, preferences, and other identities. It is also not necessarily indicative of anything else. This is a key point to remember. Don’t assume, for example, that someone can’t be both asexual and gay, or that that’s a sign of a problem. Additionally, make space for greyness, ambiguity, and “contradictory” experiences, and don’t assume that knowing your client is ace can tell you anything about their relationship preferences or how they feel about romance (aces are diverse when it comes to this subject and many others).
Direct your client toward ace-specific resources, if they need them. For example, if they mention they wish they knew other aces in person, you can suggest they find a local meetup. There are also ace-specfic resources for survivors of sexual violence and eating disorders.
Understand that aces can be abused. Coercing someone into sex, for example, doesn’t become morally acceptable just because the relationship would be sexless otherwise. As a therapist, you should be familiar with signs of abuse in general, but you can also educate yourself on abuse tactics that are commonly used on asexual-spectrum people in particular.
If a client is coming to therapy for the purpose of working through harmful beliefs about sex or recovering from damaging experiences related to the topic, do not anticipate that successful progress on this goal will correlate with reducing personal sex aversion or increasing sexual desire. In your sessions, be careful to separate the harmful ideology from their personal preferences, which themselves do no harm. Do not focus on these as the only valid measuring stick of real progress.
If a client is a survivor of sexual violence, “liking sex” or “renewed interest in sexual activity” shouldn’t be your yardstick, either. Disinterest in and aversion to sex are valid experiences unto themselves, and you shouldn’t invalidate those by arguing they can only be products of the client’s trauma and that they’re a problem to be resolved. Please consult this link compilation for additional guidance on giving survivor-competent & ace-competent advice. Although that piece is geared toward an audience of non-professionals, much of it should still be applicable.