Author: Alphaterapia

  • Responsive Sexual Desire: Why It Doesn’t Always Come First

    Responsive Sexual Desire: Why It Doesn’t Always Come First

    “I don’t feel the urge beforehand anymore.” It is one of the phrases I hear most often in the office — almost always said with a mix of guilt and confusion, as if it were proof that something broke. But for a huge portion of people, especially women in long-term relationships, responsive sexual desire never worked “beforehand.” It always came later. And no one ever told them that this is also normal.

    If you catch yourself comparing your sex life to an idea of spontaneous desire that never matched your experience, this text might lift a weight you perhaps didn’t even know you were carrying.

    Why the desire model you learned is not universal

    The most widespread idea about sexuality follows a linear logic: first comes desire, spontaneous and context-independent; then arousal; then orgasm. It is a simple model, easy to explain — and it is exactly what appears in movies, casual conversations, and even in a lot of sex education material. The problem is that it only accurately describes a part of the population, leaving out the experience of those who simply do not function that way.

    When someone measures their own sexuality by this standard and does not recognize themselves in it, the most common conclusion is not “maybe this model doesn’t suit me” — it is “there is something wrong with me.” And that is when the complaint arrives at the office cloaked in shame.

    What is responsive desire, after all?

    Canadian researcher Rosemary Basson proposed, in the early 2000s, an alternative model of sexual response in which desire is not always the starting point (Basson, 2000). In this model, the person starts from a state of sexual neutrality — neither craving it nor rejecting it — and approaches intimacy motivated by other reasons: affection for the partner, availability, curiosity, or simply the conscious decision to open up to the experience. It is only after the right context is established — touch, attention, emotional safety — that desire appears, as a response to what is already happening, rather than the trigger that started it all.

    In Brazil, this model is discussed by psychiatrist Carmita Helena Najjar Abdo, from the Sexuality Studies Program (ProSex) at USP, who highlights how this understanding changes the clinical evaluation of a “lack of desire” complaint (Abdo, 2010). Instead of asking “why don’t you feel desire?”, the more useful question is often “what needs to be present for desire to have the space to emerge?”.

    So “not having desire” is never a real problem?

    Not exactly — and it is important not to turn this concept into a ready-made answer for every complaint. Responsive desire explains many cases of “vanishing desire” that, in fact, are merely a different functional pattern. But there are also situations where desire genuinely diminishes or disappears for other reasons: hormonal issues, use of medications, unresolved conflicts in the relationship, extreme fatigue, or symptoms of anxiety and depression. These causes require their own investigation and would not be solved just by understanding Basson’s model.

    Therefore, individualized assessment remains irreplaceable: the role of sex therapy is not to fit every complaint into the same model, but to understand what each person’s pattern is — and from there, build together whatever is necessary.

    If, reading this, you recognized your own pattern — or are still in doubt about what yours is — that is exactly the conversation meant for a first session.


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    Frequently Asked Questions

    What is responsive sexual desire?

    It is a pattern of desire that does not arise spontaneously before any stimulus, but rather in response to physical or emotional closeness that is already underway. Instead of “feeling the urge and then seeking the partner,” the person approaches first — out of affection, curiosity, or availability — and desire appears along the way, motivated by the context and bodily sensations.

    Is having responsive desire a sign of a problem?

    No. It is a sexual response pattern described in scientific literature as common, especially among women and in long-term relationships. The problem usually lies not in the pattern itself, but in the expectation that desire should work differently — which creates the mistaken feeling that “something is wrong with me.”

    How do I know if it’s responsive desire or a real desire problem?

    An important clue is to observe what happens once intimacy has begun: if, given the right context — affection, safety, lack of pressure — desire and pleasure appear, it is likely a normal responsive pattern. When desire simply doesn’t come even in that context, or comes accompanied by discomfort, pain, or aversion, it is worth investigating what is behind it with a professional.

    Does therapy help in cases of misunderstood responsive desire?

    Yes. Much of the therapeutic work here is not to “create” desire, but to undo the belief that it should arrive spontaneously, and to help the couple or the individual create the conditions — time, context, communication — in which responsive desire has space to emerge.


    References

    ABDO, Carmita Helena Najjar. Considerações a respeito do ciclo de resposta sexual da mulher. Diagnóstico & Tratamento, São Paulo, v. 15, n. 2, p. 88-90, 2010.

    BASSON, Rosemary. The female sexual response: a different model. Journal of Sex & Marital Therapy, v. 26, n. 1, p. 51-65, 2000. DOI: 10.1080/009262300278641.

  • Couples Therapy and Sex Therapy: What Is the Difference?

    Couples Therapy and Sex Therapy: What Is the Difference?

    When a couple faces difficulties — whether recurrent fights, emotional distance, or problems in their sex life — the same question almost always arises: “should we seek couples therapy or sex therapy?”

    The short answer is: it depends on what is at the center of the suffering. But the complete answer is more interesting because these two approaches, although distinct, constantly intertwine. In this article, we will explain what science says about each of them, using the most studied and clinically validated models as references: the Gottman Method, Integrative Behavioral Couple Therapy (IBCT), and Emotionally Focused Therapy (EFT) in the field of couples therapy; and Cognitive-Behavioral Therapy (CBT) as the foundation of contemporary sex therapy.

    What is couples therapy, after all?

    Couples therapy is not a single technique, but a set of approaches that share a goal: to help two people relate in a healthier way, understanding the patterns that generate suffering and building new ways to connect. Among the most research-backed models, three stand out — and each reaches this goal through a different path.

    The Gottman Method, created by John and Julie Gottman after decades of observing couples in the laboratory, was born from a practical question: what differentiates relationships that last from those that end? It is an approach based on comprehensive assessment and research-oriented interventions, built on the observation of tens of thousands of couples. Therefore, it works very concretely: identifying destructive communication patterns, such as criticism and contempt, and teaching new ways to manage conflict and cultivate mutual admiration. The results are visible even in delicate situations — a study showed that the method was more effective than conventional treatment for couples recovering from infidelity, with gains in trust, conflict management, and also in sex life (Irvine et al., 2024).

    IBCT takes another path: it stems from classical behavioral therapy but adds an essential ingredient — acceptance. Created by Andrew Christensen and Neil Jacobson, it helps the couple understand the emotional origin of recurring conflicts and develop more tolerance toward differences that will likely continue to exist. It is one of the models with the most consistency in long-term research: in chronically dissatisfied couples, gains in marital satisfaction were maintained for five years after treatment, with an effect considered large (Christensen et al., 2010; Roddy et al., 2016).

    EFT, developed by Sue Johnson based on attachment theory, looks at what lies behind the fight: the fear of not being important to the other, of not being able to count on them, of being left aside. The work helps each person express these more vulnerable emotions — instead of the anger or silence that usually hide them — and respond to the partner in a closer way. Today, it is the only model of couples therapy built upon a systematic and empirically validated theory of adult emotional bonding, with results that hold up well over time, even in complaints of sexual dissatisfaction (Wiebe et al., 2022).

    These three models — Gottman, IBCT, and EFT — are the main references I use in my clinical work with couples. In practice, they do not compete with each other: each offers a different lens to understand what is happening in the relationship, and combining them allows for a more complete look at the couple in front of me, respecting the pace and specific needs of each history.

    And sex therapy?

    Sex therapy is its own specialization, with specific training in human sexuality. Unlike couples therapy, its focus is directly on sexual difficulties — low sexual desire, erectile dysfunction, vaginismus, anorgasmia, pain during intercourse — and can be done as a couple or individually.

    The most consolidated foundation today is CBT applied to sexuality: a work that moves on two fronts simultaneously, helping the person identify and reframe thoughts that hinder the sexual experience (rigid beliefs about performance, self-criticism, anticipatory anxiety) while proposing practical and gradual exercises — like classic sensate focus — to slowly rebuild a calmer and more pleasurable relationship with one’s own body. Science supports this combination: reviews show that CBT improves sexual function, satisfaction, lubrication, desire, and orgasm, although it has a more limited effect specifically on sexual pain — which reinforces the importance of an individualized assessment, often alongside a medical evaluation (International Journal of Sexual Health, 2024).

    When to seek each one

    There is no absolute rule, but some signs help guide the choice:

    Consider couples therapy when:

    • the sexual difficulty seems to reflect a greater emotional distance;
    • there are recurrent fights, accumulated resentment, or communication difficulties in various areas of the relationship (not just in bed);
    • there was a breach of trust (infidelity, lies) that needs to be processed before any other advancement.

    Consider sex therapy when:

    • there is a specific and persistent sexual dysfunction (pain, difficulty with erection, anorgasmia, very low desire);
    • the rest of the relationship works well, but the sex life has stagnated or is an isolated source of suffering;
    • there are sexual issues that predate the current relationship, linked to personal history, the body, or past experiences.

    And when the two things are intertwined — which is very common — many couples benefit from doing both therapies, either in parallel or in sequence. It is not uncommon for a couples therapist, upon identifying that the sexual issue needs a more technical look, to refer them to a colleague specialized in sexuality — and vice versa.

    In summary

    Couples therapy, supported by models like Gottman, EFT, and IBCT, acts on the emotional and communicational fabric of the relationship. Sex therapy, with CBT as its main technical foundation, acts directly on the sexual experience and function. Both have decades of research showing consistent results — and, in clinical practice, they often complement rather than compete.

    If you and your partner are unsure which path to take, a good first conversation with a professional (from either of the two fields) can already help clarify what the most appropriate gateway is for the moment you are experiencing.


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    Frequently Asked Questions

    Does couples therapy solve sexual problems?

    It can help significantly, especially when the sexual difficulty is linked to emotional issues in the relationship — hurt, lack of communication, distance. But when there is a specific and persistent sexual dysfunction, it is usually ideal to combine the counseling with a professional specialized in sex therapy.

    Do I need to go with my partner, or can I do sex therapy alone?

    Couples therapy, by definition, is done with both people. Sex therapy, on the other hand, can be done either as a couple or individually — many sexual issues originate from personal history and can be worked on even without the partner present.

    How long does the process of couples therapy or sex therapy take?

    It varies according to the complaint and the approach, but evidence-based protocols usually have a structured format, with constant evaluation of progress and readjustment of goals along the way.

    Do you need a serious problem to seek couples or sex therapy?

    No. Many couples seek this type of counseling preventively, to strengthen communication and intimacy before small difficulties accumulate.

    Is it normal to feel ashamed to talk about sex in therapy?

    Yes, it is a very common reaction. It is part of the professional’s job to create a safe and non-judgmental space so that this subject can be approached naturally, at each person’s pace.


    References

    CHRISTENSEN, Andrew et al. Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, [s. l.], v. 78, n. 2, p. 225-235, 2010.

    GOTTMAN INSTITUTE. The effectiveness of the Gottman Method. Seattle: The Gottman Institute, 2025. Available at: https://www.gottman.com/about/research/effectiveness-of-gottman-method/. Accessed: 08 Sep 2026.

    IMPACT of Cognitive Behavior Therapy on Sexual Dysfunction of Women in Reproductive Age: a systematic review. International Journal of Sexual Health, [s. l.], v. 36, n. 3, p. 287-301, 2024. DOI: 10.1080/19317611.2024.2360731.

    IRVINE, Taylor J. et al. A pilot study examining the effectiveness of Gottman Method couples therapy over treatment-as-usual approaches for treating couples dealing with infidelity. Journal of Couple & Relationship Therapy, [s. l.], 2024. DOI: 10.1177/10664807231210123.

    RODDY, McKenzie K. et al. Integrative behavioral couple therapy: theoretical background, empirical research, and dissemination. Family Process, [s. l.], v. 55, n. 3, p. 408-422, 2016.

    WIEBE, Stephanie A. et al. A comprehensive meta-analysis on the efficacy of emotionally focused couple therapy. Couple and Family Psychology: Research and Practice, [s. l.], 2022.

  • Sex Therapy: What It Is For and When to Seek It

    Sex Therapy: What It Is For and When to Seek It

    Few topics carry as much silence as sex life. It is common for someone to live for years with a complaint — lack of desire, pain, difficulty reaching orgasm, physical distance from a partner — without ever saying it out loud to a professional. Not because the problem is small, but because naming it seems bigger than it is. The shame, in this case, usually weighs more than the difficulty itself. In sex therapy, this is discussed without judgment.

    If you’ve ever thought “is this something for therapy?” and gave up on the question before reaching an answer, this text is for you.

    What is sex therapy, in practice?

    Sex therapy is a space to treat difficulties related to desire, arousal, pleasure, or pain during your sex life — individually or as a couple. It differs from couples therapy because the focus specifically enters the sexual dimension, although, in clinical practice, it is common for the two to intertwine: sexual difficulties affect the relationship, and difficulties in the relationship affect the sex life.

    An important and rarely discussed point: sexuality is not an isolated compartment of mental health. A Brazilian study conducted at the Sexuality Studies Program (ProSex) of the Institute of Psychiatry at USP, with men seeking treatment for sexual issues in São Paulo, found a consistent association between symptoms of anxiety, depression, and sexual difficulties (Scanavino et al., 2018). In other words: in many cases, the sexual complaint is also a symptom of something broader — and treating it in isolation, without looking at this emotional context, tends not to solve the root of the problem.

    Why “desire” is not as simple as it seems

    For a long time, sexuality was described through a linear model: desire leads to arousal, which leads to orgasm, which leads to resolution — a single sequence, the same for everyone. However, clinical practice (and research) shows that this is not quite the experience for most people, especially women.

    Psychiatrist Carmita Helena Najjar Abdo, also from ProSex/USP, discusses in her work an alternative model — developed by Canadian researcher Rosemary Basson — in which desire does not always come first. It often arises after intimacy has already begun, motivated by emotional closeness, context, and the body’s response, not as a spontaneous “initial trigger” (Abdo, 2010). Understanding this completely changes how a complaint of “lack of desire” is evaluated: sometimes the problem is not a true absence of desire, but the expectation that it should appear in a way that, for that person, has never worked like that.

    Want to understand this model in depth? I wrote an article dedicated solely to it — see “Read also” at the end of this page.

    How I work

    In my practice, my work is guided by Cognitive-Behavioral Therapy and the resources of third-generation contextual therapies, which broaden the perspective on how thoughts, emotions, and behavior also connect in the field of sexuality.

    I arrived at this field in a way that might be similar to many colleagues: gradually, I noticed how much sexuality appeared — often indirectly — in the issues people brought up. This perception turned into curiosity, and curiosity turned into study: specializations, training, congresses, constant reading. I continue in this movement today, because sexuality is a living field, and the demands that arrive at the clinic change all the time, intertwined with other aspects of life — the relationship, the body, personal history, emotional health.

    In the office, my commitment is to a welcoming and non-judgmental listening, treating every complaint — however small it may seem — as legitimate, and seeking to understand the person (or the couple) in the real complexity of life, not just the symptom that brought them here.

    Read also: Why can’t you stop? The science behind dopamine addiction

    You don’t need a “severe dysfunction” to seek help

    A common misunderstanding is thinking that sex therapy is only for those with a formal diagnosis of sexual dysfunction. In practice, a large part of those seeking this type of support are dealing with something more subtle: a sex life that “works” but does not satisfy, difficulty communicating what they like or dislike, an unnamed discomfort, or simply curiosity about their own sexuality.

    There is no complaint too small to deserve a space for conversation. If something in your sex life bothers you — or makes you curious — that is already reason enough to seek help.


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    Frequently Asked Questions

    Is sex therapy only for those with a diagnosed sexual dysfunction?

    No. A significant portion of those who seek this type of counseling are dealing with something more subtle: a sex life that works but doesn’t satisfy, difficulty communicating what they like or don’t like, an unnamed discomfort, or simply curiosity about their own sexuality. There is no complaint too small to deserve a space for conversation.

    Does sex therapy replace couples therapy?

    Not exactly — they have different focuses, although they usually intertwine in practice. Sex therapy specifically addresses the dimension of desire, arousal, pleasure, or pain during sex life, while couples therapy treats the relationship more broadly. Sexual difficulties affect the relationship, and relationship difficulties affect the sex life — which is why the two processes often go hand in hand.

    Is a lack of sexual desire always a problem to be treated?

    It is not always a true absence of desire — often it is the expectation that desire should arise spontaneously before intimacy, when in practice it usually appears after emotional closeness and the context have already begun. Understanding this difference completely changes how a complaint of “lack of desire” should be evaluated.

    Can sexual complaints be linked to anxiety or depression?

    Yes. Brazilian research has found a consistent association between symptoms of anxiety, depression, and sexual difficulties in people seeking treatment. This means that, in many cases, treating the sexual complaint in isolation, without looking at this broader emotional context, tends not to solve the root of the problem.


    References

    ABDO, Carmita Helena Najjar. Considerações a respeito do ciclo de resposta sexual da mulher. Diagnóstico & Tratamento, São Paulo, v. 15, n. 2, p. 88-90, 2010.

    SCANAVINO, Marco de Tubino et al. Sexual compulsivity, anxiety, depression, and sexual risk behavior among treatment-seeking men in São Paulo, Brazil. Brazilian Journal of Psychiatry, [s. l.], v. 40, n. 4, p. 424-431, 2018. DOI: 10.1590/1516-4446-2017-2476. Disponível em: https://doi.org/10.1590/1516-4446-2017-2476. Acesso em: 26 ago. 2026.