Beyond the Label: An Existential Sex Therapist’s View on Diagnosis, Trauma and Responsibility
In modern clinical settings, a diagnosis is often seen as the necessary first step—a way to name suffering, assign treatment protocols and navigate insurance reimbursement. Many clinicians practice the “diagnose everyone with something” perspective in order to get paid by insurance companies. But in existential sex therapy, we take a more critical and cautious approach. As an existential sex therapist, I’ve learned that labels can often tell us very little about a person’s meaning, history or truth—and can sometimes obscure those very things.
Diagnosis as Distraction
A diagnosis like "low desire" or "sexual addiction" can quickly become a shortcut—a way to name a problem without actually understanding it. From an existential perspective, the danger is that diagnosis can prematurely close inquiry. It can bypass the deeper, often more uncomfortable questions:
What is this person’s sexual story?
What relational, cultural or existential forces shaped their experience?
What is being expressed through this symptom—shame? grief? fear of freedom?
In existential sex therapy, we’re less interested in whether someone meets diagnostic criteria and more interested in how they’ve come to live in a particular way—and what that way of living means to them.
Diagnosis Can Be a Way to Bypass Trauma & Natural Responses to Life’s Challenges
Many clients come to therapy with a diagnosis in hand. But too often, the label they carry has become a shield against looking at underlying trauma, neglect, or unmet emotional needs. A client may say, “I have hypoactive sexual desire disorder,” when the real story is a long history of touch being unsafe. Or someone may carry the diagnosis of "sex addiction," while no one has asked about the isolation, abandonment, or disconnection at its root.
From the existential perspective, symptoms are not problems to be “fixed”—they are messages. They are invitations to deeper reflection. When we reduce those messages to diagnostic labels, we risk silencing the very stories that need to be heard.
Yalom’s View: The Limits of Diagnosis
Irvin Yalom, one of the most influential figures in existential psychotherapy, has long critiqued the diagnostic model for its reductionism. He wrote:
“I have never placed much emphasis on diagnosis. The more I work with patients, the more I believe that diagnosis is often irrelevant and can even be misleading. Every person is too unique, too complex, too mysterious to fit into neat diagnostic boxes.”
As an existential sex therapist, I deeply resonate with this. The nuance of desire, the mystery of pleasure, the fear of intimacy—these do not fit easily into DSM codes. Yalom reminds us that therapy is not about classification; it is about connection.
Why Existential Sex Therapists Rarely Provide Diagnoses
Unlike other therapeutic models that rely on diagnosing disorders in order to apply specific interventions, existential psychotherapy does not pathologize human struggle. Diagnoses are used sparingly—typically only when required for referrals, insurance purposes or for psychiatric conditions with a strong biological influence (ie, schizophrenia, personality disorders) —most of which are not directly treated in sex therapy (Watter, 2017).
As Emmy van Deurzen writes:
“Existential therapists are not concerned with diagnosing mental illness, but with understanding the way in which people confront the challenges of existence. The focus is not on pathology, but on possibility.”
— van Deurzen (2002, p. 50)
Existential therapists understand that labeling someone often reduces them to their “symptom” and can discourage personal agency. In existential sex therapy, we explore how suffering reflects someone’s way of living, relating, and navigating meaning—not just how it manifests in behaviors or biology.
Diagnosis as Crutch or Excuse
It’s also worth naming that diagnosis, while validating, can become a crutch. I’ve had clients say, “I’m just not a sexual person, I have a dysfunction,” or “I can’t change—I have trauma.”
From an existential perspective, these statements may reflect genuine suffering, but they also risk becoming identity traps. They relieve the client of having to ask more difficult, more active questions:
What would change require of me?
What do I fear losing if I heal?
What might it mean to take responsibility for how I live now?
The existential approach gently but firmly calls us toward freedom—not freedom as license, but freedom as the capacity to choose, even in the face of limitation.
We Don’t Reach for the "Bag of Tricks"
As Emmy van Deurzen also notes, existential therapy resists technique-driven approaches:
“Existential therapy is not about technique. It is about truth.”
Unlike some models that lean heavily on interventions and behavior management strategies, existential therapists resist pulling from a "bag of tricks" to “fix” symptoms. We stay with the discomfort. We explore it. We trust that real transformation comes from encountering ourselves—honestly, courageously, and without quick fixes.
As an existential sex therapist, I don’t offer formulas. I offer presence, inquiry and a space where you can explore your relationship to desire, connection, shame and possibility.
Over-Identification and Narrative Entrapment
When diagnoses are repeated—by doctors, partners, or even therapists—they can begin to calcify into identity:
“I am a low-desire person.”
“I am a sex addict.”
“I am disordered.”
But who are you without that narrative?
Maybe the low desire is a boundary finally asserting itself. Maybe the compulsive behavior once protected you from unbearable aloneness. Maybe what’s being labeled as a “problem” is actually a profound inner wisdom asking to be understood.
In existential sex therapy, we help you loosen the grip of old narratives and ask, What else might be true?
From Diagnosis to Meaning
Ultimately, existential sex therapy is not about treating disorders—it’s about understanding the person behind them. We ask:
What is your sexual story?
Where did your desire go—and what does its absence mean?
How do fear, freedom, and mortality shape your intimacy?
How do you want to live, now, in light of everything you’ve been through?
Final Thoughts
Diagnosis can be helpful. It can offer language, validation, and sometimes access to care. But it is not the whole story—and it is rarely the most important one.
As an existential sex therapist, I’m not here to label you. I’m here to walk with you through the deeper questions—about meaning, embodiment, connection, responsibility, and choice.
If you're ready to explore what lies beneath the label, beneath the coping, beneath the symptoms—existential sex therapymay be the path forward.
Interested in working with an existential sex therapist?
Reach out for a consultation. Let's explore your sexuality not as a diagnosis, but as a lived and meaningful part of your human experience.
Existential Sex Therapist
References
van Deurzen, E. (2002). Existential Counselling and Psychotherapy in Practice (2nd ed.). London: Sage Publications.
Watter D. N. (2018). Existential Issues in Sexual Medicine: The Relation Between Death Anxiety and Hypersexuality. Sexual medicine reviews, 6(1), 3–10. https://doi.org/10.1016/j.sxmr.2017.10.004
Yalom, I. D. (2002). The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients.New York: Harper Perennial.