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Culturally Competent Psychotherapy for the Asexual Community

What is Asexuality?

So that clinicians do not “other” their clients, it is important to know the term that defines the majority of people. That term is allosexuality; this term describes people who experience average sexual attraction and are not asexual (Drincic, 2017). Asexuality is a sexual orientation generally described as those who experience little or no sexual attraction or those who self-identify as asexual (DeLuzio Chasin, 2011). Like other sexual orientations, asexuality can be fluid or fixed and exists on a spectrum. Standard terms that describe variations that exist on the spectrum of asexuality include demisexuality and greysexuality.

  • Demisexuality is a term that describes people who experience sexual attraction after developing an emotional bond with someone (Decker, 2015).
  • Greysexuality is a term that describes people who do not readily identify as asexual or allosexual. These people may feel sexual attraction, but it is weak, or they may cycle through phases of feeling sexual attraction and phases of not feeling sexual attraction (Decker, 2015).

There are many myths perpetuated by popular culture regarding asexuality. Some have derided asexuality as something fabricated, a complex, form of immaturity, a pathology, or inherent loneliness (Cerankowski & Milks, 2010). Thankfully, most contemporary clinicians recognize the fallacy of myths perpetuated in the past about sexual orientation, namely, homosexuality. Clinicians should do the same regarding myths perpetuated about asexuality.

Demographics of Asexuality

There is limited demographic research on the asexual community. However, the estimated percentage of asexual-identified individuals has remained relatively constant at 1% since the work of Alfred Kinsey was published (Bogaert, 2004; Kinsey, 1948). Many clinicians are unaware Kinsey’s scale included an X outside of the 0-6 to identify individuals with little or no sexual attraction.

Miller (2011) found that:

  • 56% of asexual individuals identified most with the term asexual
  • 18% of asexual individuals identified most with the term demisexual
  • 22% of asexual individuals identified most with the term greysexuality
  • The remaining 5% of asexual identified individuals identified most with another term to describe their asexuality

Diversity Within the Asexual Community

People who identify as asexual may partner with other asexual-identified individuals or be in mixed-orientation relationships (Decker, 2015). Asexual-identified individuals may derive emotional pleasure from their allosexual romantic partner’s sexual satisfaction, or consensual non-monogamy could be part of the relationship agreement (Decker, 2015). All relationships involve a degree of compromise; clinicians need to remember this, despite being less aware of compromise in mixed-orientation asexual relationships.

Why Learn More About Asexual Clients?

Borgogna, McDermott, Aita, and Kridel (2019) found that asexual-identified individuals had higher PHQ-9 and GAD-7 scores than the overall scores for the LGBTQ community. Meyer (2003) proposed Minority Stress Theory; positing LGB individuals had elevated levels of mental health dysfunction due to experiencing more stigma and prejudice. It is possible that as LGB identities become more normalized in areas of the country, emerging identities such as asexuality experience increased stigma and prejudice. This heightened social stress may lead to elevated anxiety and depression.

If clinicians are working with asexual-identified clients and not practicing culturally competent care, they may be reinforcing the social stressors experienced by clients outside of the therapy room.

Can it be “Treated”?

  • Regarding homosexuality, the first DSM stated that “atypical gender behavior or feelings are symptoms of the disease or disorder to which mental health professionals need to attend. These theories hold that some internal defect or external pathogenic agent causes homosexuality” (Drescher, 2015).
    • Well-intentioned clinicians may immediately point to something like a history of trauma as a cause of asexuality. However, this pathologizing approach was not healthy for gay individuals, and it likely is not right for asexual individuals (Turchik, & Edwards, 2012).
  • Similarly, the DSM II defined Sexual Orientation Disturbance (SOD) as an illness if an individual found same-sex attractions distressing and wanted to change. This diagnosis legitimized conversion therapies (Drescher, 2015).
    • While it is understandable to want to help a client feel less othered in hypersexualized Western society, attempts to convert someone’s sexual orientation are damaging (Jenkins, & Johnson, 2004).

Asexuality vs. Sexual Aversion Disorder

Clients who are content with little or no sexual desire toward others, i.e., they experience distress from social stigma and prejudice rather than distress because of their lack of sexual attraction to others would likely be asexual (Bogaert, 2006).

Psychosexual dysfunctions like Sexual Aversion Disorder (SAD) have additional criteria that need to be present like marked distress and interpersonal difficulty (Brotto, 2010). This distress is different from the stress experienced by those who identify as asexual. People with SAD experience stress due to a phobia-like inhibition to engage in desired sexual activity (Brotto, 2010).

What Guidelines or Parameters are there for Practice?

While there are no formal APA guidelines for practice with asexual-identified clients, the APA Guidelines for Multicultural Practice (2017), as well as humanistic and feminist theories of psychotherapy, provide insight for practicing psychotherapy with asexual-identified clients.

  • The Second of the APA Guidelines for Multicultural Practice states “psychologists aspire to recognize and understand that as cultural beings, they hold attitudes and beliefs that can influence their perceptions of and interactions with others as well as their clinical and empirical conceptualizations” (American Psychological Association, 2017).
  • The fifth of the APA Guidelines for Multicultural Practice states, “psychologists aspire to recognize and understand historical and contemporary experiences with power, privilege, and oppression. As such, they seek to address institutional barriers and related inequities, disproportionalities, and disparities…” (American, Psychological Association, 2017).
    • Considering guidelines two and five, competent clinicians should be aware of the biases they hold regarding allosexuality and its normative value and the power dynamics at play between asexual and allosexual individuals.
  • Clinicians should also reflect upon the humanistic model of psychotherapy; Rogers (1959) believed in an empathic stance that required entering the client’s internal frame of reference. Through a humanistic model, psychotherapy can “help clients learn to self-reference and learn to develop their own solutions to problems, they tend to work within the clients’ frame of reference” (Levitt, Whelton, & Iwakabe, 2019, p. 430).
  • Finally, to practice competent psychotherapy with asexual-identified clients, clinicians should reflect upon the feminist model of psychotherapy. The feminist model “emphasizes the role of context and intersecting social identities such that therapists help clients understand their roles acting within in a larger system of environmental resources and strains” and emphasizes social change and the empowerment of oppressed people (Enns & Byars-Winston 2010; Enns & Williams 2013)

Summary

By utilizing the APA Guidelines for Multicultural Practice and reflecting upon humanistic and feminist theories of psychotherapy clinicians can avoid pathologizing their clients. Furthermore, they can appreciate the rich diversity of the asexual community from a client’s perspective and help heal some of the social stress-induced psychological dysfunction in the asexual community.

Where can I find more resources?

  • The Asexual Visibility and Education Network (AVEN) at http://asexuality.org/ has more information, resources, articles, and support forums available.
  • Asexual Awareness Week happens annually in mid-October and resources can be found at http://asexualawarenessweek.com/
  • Finally, http://meetup.com/ can be searched for local asexuality Meetup groups in most metro areas.
Cite This Article

Boot, J. (2019, November). Culturally competent psychotherapy for the asexual community. [Web Article]. Retrieved from https://societyforpsychotherapy.org/culturally-competent-psychotherapy-for-the-asexual-community

References

American Psychological Association. (2017). Multicultural guidelines: An ecological approach to context, identity, and intersectionality. Retrieved from https://www.apa.org/about/policy/multicultural-guidelines.pdf

Bogaert, A. F. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279-287.

Bogaert, A. F. (2006). Toward a conceptual understanding of asexuality. Review of General Psychology, 10(3), 241-250.

Borgogna, N. C., McDermott, R. C., Aita, S. L., & Kridel, M. M. (2019). Anxiety and depression across gender and sexual minorities: Implications for transgender, gender nonconforming, pansexual, demisexual, asexual, queer, and questioning individuals. Psychology of Sexual Orientation and Gender Diversity, 6(1), 54-63.

Brotto, L. A. (2010). The DSM diagnostic criteria for sexual aversion disorder. Archives of Sexual Behavior, 39(2), 271-277.

Cerankowski, K. J., & Milks, M. (2010). New orientations: Asexuality and its implications for theory and practice. Feminist Studies, 36(3), 650-664.

Decker, J. S. (2015). The invisible orientation: An introduction to asexuality. New York, NY: Simon & Schuster.

DeLuzio Chasin, C. J. (2011). Theoretical issues in the study of asexuality. Archives of Sexual Behavior, 40(4), 713-723.

Drescher, J. (2015). Out of DSM: Depathologizing homosexuality. Behavioral Sciences, 5(4), 565-575.

Drincic, R. (2017, November 15). Acephobia, allosexuality, and what it means to be queer. Retrieved from https://medium.com/@herbixarre/acephobia-allosexuality-and-what-it-means-to-be-queer-cc5b5329bfdd

Enns, C. Z., & Byars-Winston, A. M. (2010). Multicultural feminist therapy. In H. Landrine & N. F. Russo (Eds.), Handbook of Diversity in Feminist Psychology (pp. 367-388). New York, NY: Springer.

Enns, C. Z., & Williams, E. N. (2013). The Oxford handbook of feminist counseling psychology. New York, NY: Oxford.

Jenkins, D., & Johnston, L. B. (2004). Unethical treatment of gay and lesbian people with conversion therapy. Families in Society, 85(4), 557-561.

Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1998). Sexual behavior in the human Male. Philadelphia, PA: W.B. Saunders and Company.

Levitt, H. M., Whelton, W. J., & Iwakabe, S. (2019). Integrating feminist-multicultural perspectives into emotion-focused therapy. Clinical handbook of emotion-focused therapy, 425-444.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.

Miller, T. (2011). Analysis of the 2011 Asexual Awareness Week community census. Retrieved from http://www.asexualawarenessweek.com/census/SiggyAnalysis-AAWCensus.pd

Turchik, J. A., & Edwards, K. M. (2012). Myths about male rape: A literature review. Psychology of Men & Masculinity, 13(2), 211-226.

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