The Therapeutic Work of Desire

For most of my life, I thought I knew what I wanted. I’d inherited a map that spelled it out, with predetermined stops and destinations—the right career, the right choices, and the right way of moving through the world. For years, I followed that map closely, not realizing that doing so wasn’t the same as knowing myself.

As a therapist, I’ve asked the same question to hundreds of clients hundreds of times: What do you want? Not, what do you think you should want, but what do you actually want?

Their responses vary. Some look away. Others laugh nervously, as if I’ve made a joke they don’t quite understand. Some look frustrated—at me, at themselves, at the question. Some come up with an answer so quickly that I wonder whether it’s true. But three responses stayed with me longer than others.

The first is the pause that ends in “I don’t know.” What I’ve learned to hear underneath those words isn’t ignorance or avoidance. It’s not knowing how to want. Reaching inward and finding a yes that belongs entirely to yourself is a skill they were never taught.

The second response is subtler, but revealing: “I think I want…”

Notice what’s happening here. Something is emerging, making it as far as the mouth, and then immediately running itself through a filter. We’ve been taught to trust thinking more than feeling, reason more than intuition, so desire often gets routed first through the mind and inspected for acceptability before it’s allowed to fully arrive. The result is a wanting wrapped in an apology.

Then there’s the response I didn’t expect the first time I heard it: relief. A visible, physical release, like something held for a long time that was finally being let go. The not-knowing had been sitting there, taking up space for a very long time.

What all three responses share is this: an inner self that has been made very, very quiet. I recognize this, because I lived it.

***

Long before I became a therapist, a friend called me one evening because he was struggling. I did what I usually did—I listened, reflected, and helped him find solid ground. I don’t remember exactly what I said, but I remember what he said next: “I think you should become a therapist.”

At first, I resisted the idea. Not because it was wrong, but because it pointed toward something I’d been circling for years without naming—a wanting that had been present in the books I read and in my late-night thoughts. My friend saw my wanting, my yes, before I could—which made sense. After all, I’d been living a life that required me not to see it.

My parents had immigrated from Hong Kong to Taiwan long before I was born, building lives and careers as doctors in an unfamiliar country. Medicine wasn’t just their profession, but their proof of worth—a logic I unwittingly inherited. Long before I could question any of it, I was holding a map that had been already drawn.

When I turned 14, I moved to the U.S. while my parents stayed behind in Taiwan. I carried my map across an ocean, holding it tighter than ever. It was how I stayed close to them, and questioning it would’ve felt like leaving them a second time.

Years later, when I chose pre-med, I wasn’t simply following an approved path. I was attempting to replicate theirs. To say, with my life, Mom, Dad—what you sacrificed was worth it.

But the classes were hard. I didn’t enjoy them, and I failed several. What I felt wasn’t just academic disappointment, but a specific kind of shame that belongs to the children of immigrants who couldn’t become what their parents idealized. The gap between me and that path didn’t register as misalignment, but as deficiency. The problem, I concluded, was me.

What I didn’t have—and what nobody offered—was a question: What’s actually life-giving for you?

Instead of asking myself this question, I tried harder, following career paths that seemed to promise stability and honor. Something I could point to and say, This is what it was all for.

Over the next several years, I carried the weight of this inheritance without knowing what to do with it. I mistook exhaustion for weakness. I pushed down the quiet but persistent voice inside me that wanted something different, something life-giving. It felt like a distraction I couldn’t afford. But even though I didn’t know it yet, that voice would turn out to be the most authentic thing about me.

For most of her career, my mother was an OBGYN, who spent her days in intimate service to women’s bodies, delivering life into the world with her own hands. But she raised me inside a framework that asked her to leave that intimacy at the clinic door. In our Christian, Chinese-Taiwanese household, desire was something to be contained until marriage. Pleasure was a language I’d never learned to speak, and wanting was considered a disruption to harmony, something to be managed and contained.

My parents taught me that curiosity about sexuality was acceptable only through an intellectual or clinical lens. When I decided to become a sex therapist in graduate school, it was a choice that arrived slowly, the way most true things do—from the accumulation of many smaller decisions, rather than a single, grand revelation: choosing to study sexual perfectionism for my capstone. Deciding that healing shouldn’t stop at the absence of symptoms. That joy and pleasure belong in the work, too. Each of these felt like its own small move, until I looked back and saw the direction they’d been pointing all along.

One afternoon, while thinking about my clinical focus, I searched for @asiansextherapist on Instagram and found that the handle was unclaimed. I sat with what that meant. A community that needed mental health care around sexual issues, precisely because sexuality had been so thoroughly silenced, had so few practitioners that nobody had even thought to take the name. This absence confirmed what I’d long suspected: that the silence I’d grown up with wasn’t just felt by me, but by an entire community.

When I decided to become a sex therapist, I recognized that the choice was different from every choice that had come before. It wasn’t “approved,” and it didn’t abide by the rules I’d inherited. I wasn’t honoring someone else’s sacrifice, either. It was a choice I made because it was life-giving. Because it was mine.

But even afterwards, I continued to feel a lingering shame—the residue of my upbringing. I knew that before I could ever invite any client into the territory of wanting and choosing, I needed to first inhabit it myself.

That meant practicing what I’d spent my life avoiding, asking myself, in small ways and large, what I actually wanted. Saying it out loud, even when I worried that the wanting would inconvenience someone. And listening, when fear or guilt arose, for what those inner voices were trying to protect me from. I now understand that they weren’t betraying me—they’d been keeping me safe under conditions that no longer applied. What I learned through that personal work is something I now see reflected in my clients, from the other side of the therapy room.

***

In our training, disconnection is often framed as stemming from a personal problem, like a confidence issue or childhood wound. But this is a limited perspective. To genuinely want something is politically inconvenient.

Someone who knows what they want is significantly harder to manage, redirect, and trap inside the containers of systems like patriarchy, capitalism, and religion—systems that put collective harmony above individual desire and regard it with suspicion. They tell us that desire needs to be filtered or approved before it’s allowed to be ours.

Eventually, this becomes an inheritance. Ordinary people—parents, teachers, communities—pass on what was passed to them, usually with love, and almost always without examining the costs.

The result, perpetuated across generations, is a silencing of the inner self. The wanting is still there, but it’s been routed through so many filters that by the time it reaches the surface, it arrives as I think I want—as hesitation.

Here’s why this matters for therapists. Saying “no” is reactive. But saying “yes” is generative. It requires you to reach inside and access something held with conviction. When that inner self has been silenced for long enough, saying yes feels like reaching into a dark room. You’re not sure what’s in there—or if anything’s in there at all. Over time, you become extraordinarily skilled at elimination, at naming everything you don’t want, which can feel like self-knowledge. But what’s missing is what you do want.

The choices people make when their wanting is unfamiliar to them aren’t the wrong ones, they’re simply the choices they were able to make with the knowledge they had at the time. They’re something more complicated than “self-betrayal,” the kind of language I often hear from clients. The work of therapy isn’t to invalidate these choices, but to honor them as something that made the present moment possible, and to create a space where the client feels permission to choose, where they can finally, confidently ask themselves, What do I really want? The capacity to want grows with the capacity to be permitted to want.

Naming the systems matters, too. Highlighting the conditions that shaped the client’s silence eliminates the common feeling that they’re somehow broken. But even after knowing how these systems have forced them to abandon their wanting, the client can still not know how to want. Insight isn’t the same as access, and diagnosis isn’t the same as recovery. It’s practicing the unfamiliar back into familiarity—in the therapeutic relationship, with a guide who’s willing to ask the question What do you really want? and listen for the answer—that makes a difference.

So how do we help our clients grow into wanting and choosing? Most therapy is oriented toward what isn’t working—toward ambivalence, dysfunction, or dissatisfaction. Exploring these things is useful. But this exploration is oriented toward the no, toward what clients are moving away from. Instead of asking, “What isn’t working?” we need to instead ask, “What would feel true for you? What would you move toward?”

This sounds simple, but these questions can be disorienting for clients who’ve spent decades seeking validation outside themselves. I’ve watched successful, thoughtful, and self-aware clients struggle to answer them. Not because they lack insight, but because wanting is genuinely unfamiliar.

So first, we must normalize. We must name that the unfamiliarity itself is information—not a deficiency, but evidence of a very human inheritance. And then we must sit with the client in the discomfort of not-knowing, without rushing toward resolution, until something begins to emerge organically from inside.

Of course, we can only do this if we’ve been willing to sit in that same discomfort ourselves. We carry many of the same inherited views about what desire should look like and what kind of wanting is appropriate. And if we haven’t examined our own disconnection from wanting—our own inherited frameworks around sexuality, collective obligation, and what bodies are permitted to know and claim—we will inevitably reinforce those frameworks in the therapy room. Doing our own work begins with the willingness to ask ourselves the same question we ask our clients: What do you want?

***

It was only a few years ago that I had a revelation: my mother was also trapped by an inheritance she’d never asked for. The framework she’d lived in and passed on was not her own creation, but something that had been handed to her by systems much older and larger than both of us.

Against the odds, my mother outgrew that framework quietly. As I found my own way, she took notice. She read what I wrote, and tried—sometimes with great difficulty—to talk with me about it. She asked questions she was never given the language for. The framework that had passed from her to me is now being passed back, only now it’s different.

I’m still learning to say these things out loud, with my family, with my clients, and with myself. After all, we don’t outgrow our inheritance once. We outgrow it slowly, in pieces, often in relationship with someone who’s willing to ask what we want and listen patiently for the answer. This is what we’re offering in therapy: the slow, patient labor of becoming legible to oneself in conditions that finally allow it.