Denis "Woodja" Flanigan, Psychotherapist

No Face Pic = No Chat

noreply@blogger.com (Woodja) — Thu, 31 May 2012 17:52:00 +0000

I cruise the hook-up apps just like most gay men that have smart phones. A comment I see in profiles a lot is something along the lines of “no face pic = no chat.” It is a sentiment that I can understand. In fact it is a sentiment I kind of share. I like to visualize what a guy that I am chatting with looks like. I think it makes it more like real time. It’s also nice to think the person I am chatting with is not dealing with shame. I am too out to try to be closeted when in public with someone.

However, I also recognize that despite the progress we have made in society there are still many proud people who do not feel comfortable being quite so public. In fact I have often thought about obscuring my identity on social media as well because of my professional position. It can be disturbing for clients to know too much about my personal life—it can be distracting from the work we are doing or they can find out something they don’t like but is irrelevant to the professional work we are doing. I know that some clients have seen me naked or seen pictures of me naked—just as I have stumbled onto naked pictures of my clients on occasion—and this is something that ideally I would not like to have as part of our relationship, but being open is a decision I personally have made.

One of the comments I have seen deriding the absence of a face pic referenced the age of Don’t Ask, Don’t Tell being over. I have a client who is an officer in the military reserves. We talked about what it might mean for him to add to his Facebook profile that he is in a relationship with another guy after Don’t Ask, Don’t Tell was overturned. He acknowledged that he thought it was great that he could not be kicked out for being found out anymore, but expressed sincere concern that he would not receive another promotion in his career if his superiors found out that he is gay. One’s career in the military is not secure just because of a change in policy, it will take a while before there is a change in attitude up the ranks.

There are also many conservative professions in which having that much exposure could be occupationally damaging. Here in Houston, the economy is dominated by oil & gas, the medical industry, and shipping. All three of these industries are notoriously conservative. Some of the energy companies have excellent non-discrimination policies. However, I think that by now we also know that not all of management abides by the spirit of non-discrimination policies. Similarly, we think of the medical field as well educated (and equate this with liberalism), but the medical industry (like the mental health industry) have a long history of keeping one’s private life private. The majority of the gay doctors I have talked to do not put their face on their profiles because they have to deal with both a broad political spectrum of patients and a politically conservative work environment. I don’t think there is any confusion about how liberal or conservative the shipping industry is.

The counter argument I hear a lot in my defending the faceless is that only other gay people are looking at the apps, so what would be the concern? This has been the argument about why it is safe to go to the gay bar for years—only other gay people will see you there. Today, neither of those arguments is quite true. I see straight people at my bar almost every time I go, and I go to one of the least straight-friendly bars in the city. But the apps are even more vulnerable to exposure outside of the community. How many gay guys are showing profiles to gal pals non-gay friends because the guy is particularly hot or the profile is particularly amusing? Okay, now what if the friend shown the app is a co-worker of the person whose profile was just shown? Sure, the friend is probably open-minded, but nonetheless the person on the app was just outed at work without control of that information—and without consideration of the possible consequences.

Everyone needs to decide what they want in a potential partner or trick on the apps, but I do wish that people would respect that not everyone is free of consequences of being out. The majority of states—including Texas—do not have non-discrimination clauses and many employers are still willing to punish, terminate, or limit gay employees. And besides, the next time you ignore the faceless guy on the apps, you just might be missing out on that doctor you mother wanted you to marry.

Excited and Angry

noreply@blogger.com (Woodja) — Fri, 25 May 2012 17:45:00 +0000

Two things of note happened in my life recently related my identity as a gay man, and as a mental health professional. President Obama publicly announced his support for same-sex marriage and in the same week a former client committed suicide because his family could not accept his sexual orientation. This is a rough juxtaposition for me.

Part of me wants to celebrate President Obama’s announcement. I want to share in the joy of this gesture. I see it as a symbolic action in that as President he has little official power to effect change in state marriage laws. I see that it has importance nonetheless, in that it will inevitably affect public opinion and has the potential to set same-sex marriage rights as an official party policy. I recognize that progress will only be made incrementally and often symbolic gestures can turn a real world, practical tide, which is what I hope happens in this case.

However, I am reminded on a weekly basis in my office, by the people that sit on my couch that as a people, GLBTs are far from being accepted. Many of us living our insulated lives—frequently among our liberal friends—are unaware of the daily oppression that has gone on or continues to go on. Most of us have not been directly affected by the oppression. I have been an out gay man for just over 25 years; in that time I have been threatened with physical harm or even death a half dozen times—sometimes anonymously, sometimes from a person standing right in front of me—and I have had my apartment door vandalized in grad school (see picture).

In those 25 years I have also seen sodomy legalized, DADT overturned, and same-sex marriage begin to be legalized. I have seen numerous openly gay or lesbian politicians be elected. I have seen numerous states pass non-discrimination laws. I have seen a President specifically address a GLBT audience, appoint openly gay and lesbians to sub-cabinet positions and ambassadorships, and invite GBLT individuals to state dinners. The amount of progress I have seen is sometimes enough to make my head spin.

We have made tremendous progress in the last 25 years. But there is a sentiment that (suddenly?) everyone can be out and open with reprisal. I see this sentiment on the online hook-up apps all of the time because the person himself feels safe without consideration for what consequences may result from another’s different consequences (demands that people have a face picture in their profiles without any consideration as to the workplace or family consequences involved in being exposed). There is a sense that since we live in a liberal city which elected an openly lesbian mayor we are safe. All of the threats and attacks that I experienced also occurred in exceptionally liberal cities.

The day that President Obama made his announcement there were protests all over the country planned in response to the vote the previous day in North Carolina to ban same-sex marriage. The majority of the protests were immediately converted into celebrations. I agree that having a sitting President express support for our equality is a momentous occasion as well. But I also was a little frustrated that it diffused our anger. It is our anger that fuels us toward continued progress, not celebration. Stopping to celebrate our progress is essential in maintaining hope and I fully support it. However, I also fear that we will become complacent with the crumbs of acceptance.

I am reminded of how far we still have to go about every week by my clients. I also am aware of the (indirect) effect of the barrage of stories of oppression—bullying and ministers, as of late—has on the psyche; it is not healthy to be continually reminded that people hate us. How many times a week are you exposed to homophobia by reading the news? I hope that we still get angry, but do not stay angry, but I also hope we do not stay joyous yet. I hope that we are able to appreciate the progress with one eye, while simultaneously recognizing the immense progress still to made with the other.

Therapy Does Not Equal Rent a Friend

noreply@blogger.com (Woodja) — Thu, 10 May 2012 19:44:00 +0000

“I don’t need therapy, I have friends”

This is a sentiment that is frequently expressed. However, this is not the reality that I generally see among my clients. While it is true that I often perceive that my clients could strengthen their social support networks, they do not come to therapy to share their mundane problems—that is what social support systems are for. Rather, they come to me with enduring or intense problems that they feel for which their support systems are inadequate.

A concern that I often hear from clients is that they do not want to overburden their support systems. I think most of do not like friends that are constantly complaining—most of us also do not like to be the friend that is constantly complaining. We do not want to be perceived as an embodiment of our problem, but to be seen for the multidimensionality that we are. As a consequence, we often withhold some of the pain we are experiencing from our friends in order to appear to be “bigger” or more than the pain. We want out friendships to be a balance of support and entertainment-companionship.

When a problem is enduring and personal it is difficult to constantly have ‘the problem” as the context in which one interacts with friends. Friends are often well meaning in asking about a problem, but rather unprepared to deal with the full brunt of the problem. They also do not understand that by asking about a problem, while they intend to be supportive and are genuinely interested and concerned, they actually help keep the problem in the forefront of the person’s mind. Sometimes we want our friends to offer us support as a “time out” from the problem.

Friends also lack the ability to be objective. Friends have insight that a therapist never will, however, they also have their own filters as well. Friends are also are rarely free of their own agenda. When a therapist develops an agenda for a client it is grounded in an understanding of the client’s best interest. While I genuinely care about the happiness of my clients, at the end of the day my life will largely be unaffected by the outcome of a client’s decisions. Friends are frequently affected by friend’s decisions, and are aware of this. Therapists are able to be outside, independent observer in a way that friends can never be. Friends also recognize that by being too challenging of their friends they can endanger the friendship. As a therapist I get more liberties to challenge people about their problems and call “bullshit” when I see it.

Sometimes clients come to me because they do not feel safe talking to their friends about their problems. If the problem is about a friend and one is not sure how to address it or is uncertain about the problem in some way, then talking to the friend about the problem is not likely to feel comfortable. There are also things that we would rather not have our friends know about us. While I am not a big fan of secrecy, it is a reality of many people’s lives—as is privacy. Sometimes there are things that we would like to better understand before we are ready to share with friends—or even know how to share with friends. One of the reasons people come to therapists is because we are trained to deal with the heavy shit—questioning the existence of god/good/evil, feeling life is meaningless, questioning one’s gender/sexual orientation, figuring out what roles one actually wants in society—these are not questions that most friends are prepared to deal with and can only give pat advice.

Friends also are not trained in theories of personality, human development, symptom identification and treatment, and processes of human change. Therapists are. Listening to problems and being supportive is an incredibly important role of friendship. But listening to problems and being supportive is not facilitating change or personal growth, actually it often facilitates the status quo. Therapy often provide and educational or normalizing role that friendship cannot—either the friends do not have the knowledge or they will be trusted as unbiased.

I cannot overemphasize the importance of a social support system. In fact it helps feel keep us stable and from sinking into poor mental health. But friends cannot offer the same professional guidance and exploration (not advice) that therapists provide.

Labels (Part 2)

noreply@blogger.com (Woodja) — Thu, 03 May 2012 16:30:00 +0000

I recently wrote about why I think labels can be useful, even though there is a mantra against labeling people. The double edged sword of labeling people is that they promote expectations, but this can be both problematic and beneficial. Names for relationship status is another area where I hear an avoidance of labels. I hear less encouragement of avoiding labels of relationships, but no less frequency of it; “it’s complicated” is one the ways that people frequently avoid labeling a relationship these days.

I have friends that are dating, and apparently in a monogamous relationship, only they are afraid to label their relationship as “dating” or refer to each other as “boyfriends.” They are sexually exclusive with each other and have romantic feelings for each other but do not dare label their relationship as “boyfriends.” I do not know what they think is the risk of labeling what is going on between them, but it feels risky to them.

It seems that they think that by not labeling it a relationship—they are roommates—they do not risk being emotionally hurt. However, I think they actually create greater risk by not labeling their relationship. Labeling a relationship does mark certain expectations, or can clarify expectations. But in this case, the absence of the label does not mean the absence of the expectations. If either of them were to have sex or go on a date with someone else they would very hurt—as much hurt as if they had labeled the relationship. Only without the label, the expectation is not made explicit.

Both of these guys are sexy guys and this is where the label would be useful for others. If they labeled themselves as being in a relationship it would give the rest of us a better sense of how to treat them—namely as a couple. Until I figured out that they were dating (unbeknownst to themselves) I would hit on each of them, now I know to back off. I still do not know when I am expected to invite them both to things or just one of them—with couples I default to inviting both, but with roommates I am more inclined to invite one or the other to something, based on what the event is.

Of course the flip side is that labels sometimes do not help in clarifying some things and can even cause more confusion because we have limited expectations for labels. Relationships come in many forms. But they can at least inform us as to what questions to ask. If someone is in a relationship I can inquire about the nature and boundaries of the relationship, but without a label we are more likely to step on toes without realizing it. Even when I encounter an open relationship I attempt to clarify the parameters of the openness of their relationship. So the label cannot tell one all of the nuances of the relationship, but it provides a framework in which to work.

There may be a shortage of terminology to describe the full range of relationship types—the term “monogamy” does not well apply to a triad relationship in which the three members are exclusive to each other, but neither does the term “open” apply well. Similarly, an open relationship in which the members of the relationship only play with outsiders separately is different than a couple that only plays with others together, but “open” is still the only term we have for either relationship style. However, “open” provides a framework for either style.

Expectations are essential to relationships—they are part of what defines them in fact. The label is not what defines the relationship—the expectations exist (perhaps unspoken) without the label—but the label helps others know how to best interact with the members of the relationship. Unfortunately, the feelings and expectations are there regardless of the label. The label also provides clearer guidance as to how to act for the members within the relationship—including what inquiries to make about how to act.

Labels (Part 1)

noreply@blogger.com (Woodja) — Thu, 26 Apr 2012 21:45:00 +0000

Many educated people often talk of the wisdom of avoiding labeling people and or interpersonal dynamics. To a certain degree I can agree. I agree that sometimes labels reduce us to objects within a category, rather than the individuals that we are. However the opposition to labels also misses the utility of labels. Labels allow us to form cognitive shortcuts and form expectations.

Many of the labels that we use in fact are problematic specifically in the ways in which they act as cognitive shortcuts and framing expectations. But the use of the label is not so much the problem as the rigidity to which we stick to the expectations or associations of that label. Take the labels “gay or “straight,” for example. Both of these labels are laden with expectations and associations, which often on whole are true for the majority (if not all) of the people that would fit the label. A liberal interpretation of the label would allow for a man labeled as “straight” to enjoy shopping or watching Glee more than watching sports and for a gay man to enjoy working on his car or hunting more than Project Runway or RuPaul’s Drag Race, as well for the more stereotypical reverse.

However, knowing that a man is “gay” or “straight” also informs me of the likelihood that he will know certain people or places that are frequented by other people labeled “gay.” Most “straight” people in Houston are not familiar with the Ripcord or BRB, but most “gay” people are. Perhaps most importantly, I know how safe or appropriate it is to hit on someone who has labeled himself “gay” or “straight.”

Of course, again there is the problem that while most people can in fact be neatly sorted into categories, others are poor fits for any of the existing categories that we have. I have a client who would less identify as “gay” or “straight,” as he does “submissive;” the striving force of his sexual arousal is grounded in the dominant nature of a partner, rather than the partner’s gender. This client shies away from identifying as “bisexual” because “bisexual’ tends to be interpreted as attracted to both males and females, but this terms side-steps the notion that a partner’s gender is irrelevant, but rather it is the nature of the person—regardless of gender—that attracts him. I know other people who are honestly attracted to males and females and for whom gender is actually part of the attraction—“bisexual’ applies aptly for these clients.

Labels also give us a sense of belonging. Race or ethnicity is another area in which there is resistance to labeling. Race and ethnicity are, like sexual orientation, false categories that are socially constructed and do not reflect the diversity of people. However, through such labeling one has a sense of belonging, of having a kin-group. According to Abraham Maslow, Belongingness is one of our basic needs and is foundational to our forming a positive sense of self. Acceptance, a form of belongingness, is essential to healthy self-esteem. Humans are naturally (it seems) suspicious of out-group members and more willing to support in-group members, and so labeling ourselves helps provide us with sources of support as well

So labels simultaneously allow us some expectations and associations (which we ought to confirm for each individual occurrence of a label in order to avoid too rigid of interpretation of the label), and fail to capture the full range and nuanced differences among people. They also help give us a sense of how to behave and toward and around others. Similarly, they help us can give us a sense of community and promote mental health. Rejecting labels altogether because they do not work perfectly seems equally unwise as interpreting labels too rigidly.

Choosing a 100% Chance of Being Miserable

noreply@blogger.com (Woodja) — Mon, 16 Apr 2012 21:16:00 +0000

There are a couple of things which clients have said to me over the years that really stuck. The first one is from my very first client in training as a graduate student; the other was in the early days of my private practice. Both statements continue to resonate for me because they symbolize a recurring issue that I see in counseling, namely a refusal to leave a bad relationship after recognizing it is a bad relationship.

My first client was a volunteer from a psychology class for trainees to practice on; many of them did not think that they had problems that warranted counseling. She described to me the discomfort and difficulties she was having in her relationship, how her boyfriend would say mean things and go out with friends and “force” her to stay home, and how he had broken the windshield of her car. When I asked why she was still in a relationship that was so distressing she responded “It doesn’t hurt enough yet.”

She was able to recognize that being in the relationship “hurt,” but did not see that as a good “enough” reason to leave the relationship ”yet.” As this was my very first session with my very first client, I did not feel that I had the rapport with her to ask “how much does it have to hurt before it is okay to leave?” or challenge her on the notion that there needs to be some sort of threshold for pain at all in order to leave an emotionally abusive relationship. Note that there was no hope or expectation that this relationship was going to get better. In fact there appeared to be an expectation that the relationship would get worse. I kind of presume that she was waiting for the abuse to become physical—because breaking her windshield was not violent enough yet.

This was the basic sentiment expressed by the second client that left such an impression on me. He came to me to better deal with a relationship in which he was very unhappy. He relayed that they had been together about three years and how the relationship was unsatisfying in a variety of ways and how his boyfriend showed no signs of (or interest in) changing his behavior. The client described his boyfriend as a nice guy, but who did not want to do anything except stay home and watch TV; they had also stopped having sex. The client was clearly frustrated and did not know what to do, and then he said the words that continue to echo for me: “I wish he would just hit me.”

He went on to explain to me that he did not want to look like “the bad guy” in a break-up. Apparently, being miserable in a relationship is preferable to being “the bad guy” in a break-up. Furthermore, being miserable enough to want one’s partner to him/her is not itself a good enough reason to leave a bad relationship.

I think these clients emphasize the idea that we consider what might happen more than what is happening. I think there is this fear that something bad (e.g., loneliness, rejection, or loss of reputation) might follow a break-up. This really speaks to the importance of our desiring acceptance and belongingness—a willingness to endure being miserable over risking not being accepted by another. However, I would argue that being miserable in a relationship is a sign that the “acceptance” within the relationship is false and unsatisfying in its own right. After all, one does not have to be alone to feel lonely or rejected.

I do not mean to suggest that everyone should quit their relationships when things get tough. However, examining one’s relationship with regard to the amount of satisfaction-dissatisfaction in the relationship and the realistic hope that things will change (what reason are there to expect that things will—not just can—change?) is important in actually getting one’s belongingness and acceptance needs met. Within a bad relationship one can be 100% certain those needs will not be satisfactorily met. After a break-up there is at least an opportunity that one can get them met—in fact ending a bad relationship increases, not decreases, one’s odds of getting the positive attention one is afraid of not getting.

Psychotherapy vs. Psychopharmacology

noreply@blogger.com (Woodja) — Tue, 10 Apr 2012 13:38:00 +0000

Many patients seek medication for emotional discomfort, difficulty concentration, sleep disturbance, and somatic or physical manifestations of emotional discomfort. There is a tendency in our culture to treat illness with a pill—which drives this inclination, along with the continued stigma of being labeled with a mental illness—despite that so many people are on anti-depressants and anti-anxiety medications that their use is now “normal” to most people. Somehow being medicated for an emotional disturbance is not as stigmatizing as being in therapy for one. Additionally, there is a perspective that taking pills is easier (and cheaper) than seeking psychotherapy treatment. However, research on the effectiveness of psychotropic medication and psychotherapy show that many of these patients are doing themselves a disservice in this approach.

Overall, in early research the effectiveness of treatment of emotional disturbance (such as anxiety or depression) was shown to be roughly equal between psychotropic medication alone and psychotherapy alone for most common mental disorders. While there is a fair amount of research that has shown that combined therapy (medicine and talk therapy) is the most effective, more recent research has been suggesting that psychotherapy alone is as effective as combined therapy in the long run. Similarly, more recent research (focusing on long-term effectiveness, rather than immediate effectiveness) has shown that psychotherapy is more effective than medication with regard to long-term benefits. It turns out psychotherapy is advantageous compared to medicine in a number of ways.

Cumulatively, the research suggests that psychotherapy offers more long lasting benefits than medicine. Psychotherapy is actually shorter term. Even if one is in therapy for a number of years, people who begin antidepressants and anti-anxiety medication (without the additional benefit of psychotherapy) frequently end up on those medications for life—on account of the high relapse rates for medication alone. Ironically, studies have shown that across a lifetime, the cost of medication tends to exceed the cost of psychotherapy. Psychotherapy tends to be higher initial cost, but typically clients achieve a level of functioning that makes treatment unnecessary and the cost stops.

Psychotherapy additionally is safer. There are many dangerous drug interactions between psychotropic medicines and other medicines, while psychotherapy does not interact chemically with any medicines. Psychotherapy has few side effects—some initial increased emotional discomfort is common, but loss of sexual performance due to psychotherapy is extremely rare, for example. Likewise, sleeping disruption seems to be temporary and psychotherapy is not associated with unwanted weight gain—psychopharmacology cannot make those claims.

Ideal treatment for many emotional disturbances appears to be co-joint treatment with medication and therapy initially, with patients gradually reducing and terminating their medication as progress in psychotherapy provides symptom relief such that symptoms become tolerable in the absence of medication. However, there are some disorders, such as schizophrenia, ADHD, bipolar disorder, and dysthymia (chronic depression), for which psychotherapy is not as effective medicine. But even in these cases, there is also strong evidence that psychotherapy administered along with psychopharmacology is more effective than medication alone in treating these more severe mental disorders.
Of course, the downside is that psychotherapy is more work and requires actually looking at one’s pain (and sometimes the source of it), rather than covering it over. Psychotherapy functions with a goal of symptom removal, whereas medication frequently has the effect of symptom mediation. Of course, harder work also equals more meaningful reward though.

Mental Hygiene and Mental Health

noreply@blogger.com (Woodja) — Tue, 03 Apr 2012 14:10:00 +0000

In this country “mental health” typically refers only to the negative end of the spectrum, in other words, neutral mental health to mental illness—we too often think of “mental health” in terms of either having mental illness or not. We tend to ignore the role of mental health in terms of strength or resilience—the positive end of the spectrum. Psychologists are thought of in terms of fixing things that have gotten broken, but not thought of in terms of preventing things from getting broken in the first place. We do preventative maintenance our cars, but do not often (enough) think about preventative maintenance on our psyches.

The opposite of negative is not zero, but rather positive. Yet the role we have relegated psychologists to is to deal with the negative to zero range. We have come to equate “happiness” with the absence of being unhappy, and they really are not equivalent. Happiness is a positive, while the absence of unhappiness is actually zero. The greater happiness (in terms of contentment, rather than momentary joy) we have in our lives, the less susceptible to mental illness we are. As long as we ignore half of the spectrum, we will find ourselves more and more in the side of the spectrum to which we do attend.

We fail to recognize that many of the skills and techniques that psychologists have developed for mental remediation and repair can also be used for mental enhancement and strengthening (e.g., communication and social skills, openness to experience, stress management). Pre-marital counseling used to be valued, but now we only go to a counselor after the relationship has become problematic (and even then usually not until the resentment has gotten out of control).

When I was deciding on a graduate program I choose a Counseling Psychology program (rather than the more popular and better known Clinical Psychology) because as a sub-field it was known to emphasize mental wellness, instead of mental illness. Counseling Psychology was (and is) known for the emphasis on optimal function, not simply adequate functioning. Counseling Psychology tends to be more focused on hope, optimism, self-efficacy, emotional intelligence, wisdom, courage, and personal strengths. We are less excited about helping a client get better than we are about helping the client become a better version of himself or herself—even if that is from a position of mental illness.

I think of Counseling Psychology as aspirational, let’s not just make you better, let’s make you the best. When Counseling Psychology was first forming as a discipline within psychology, it focused on what was called “mental hygiene.” It was focused on keeping people’s minds functioning well, not on returning people’s minds to a functional state. There is a wealth of research on the benefits of psychological enrichment, above and beyond psychological remediation. However, we continue to value psychological remediation over psychological enrichment.

I have a friend who is a psychologist who claims that the reparative work he does with clients is more valuable or meaningful than the work that I strive to do with (typically higher functioning) clients to bring them to optimal functioning. In our culture we focus on deficiency rather than enhancement; we focus on what is missing in our lives rather than how to better develop and utilize what we already have. But the research shows that nation-wide, the impact of improving the lives of people who are already functional can have more of a positive impact than bringing (the minority of) people back to base functioning. People’s productivity and pro-social helping behaviors are more affected by life improvement than remediation of a disorder. Improve the lives of many slightly and there is more of a positive impact on society than remediating the problems of the few. However, even in the presence of many studies that have shown that happier people who better manage their stress—including the cost savings of mental preventative maintenance, mental hygiene is dismissed as unimportant.

I often run into people socially who tell me about how their lives are unsatisfying, even though they are adequately functional. They will even tell me they are not unhappy, but also unfulfilled (not happy). Most of these people would never consider going to a counselor, psychotherapist, or psychologist to help them improve their lives because they do not see their lives as “broken.” Instead they spend their time acquiring objects or sex to feel more fulfilled, which will never be as effective as counseling, and more expensive in the long run.

Partial Presentation and the Hook

noreply@blogger.com (Woodja) — Mon, 26 Mar 2012 21:44:00 +0000

Have you ever met someone who seemed a little too together? I acknowledge that some people really do have their shit together—they have both a sense of accomplishment and a sense of purpose and direction. But there is perhaps no one that does not simultaneously harbor some self-doubt as well. In fact, I have found that people’s uncertainty is a big part of what makes them relatable to me.

I recently met a guy online and had some rather enjoyable chats with him. However, when we met in person for lunch he presented himself as having solved all of his problems and as being very certain about himself and his life. He relayed a situation with his boyfriend in which he had recently addressed and successfully resolved a problem. There was no regret or doubt in his telling of the story—no un-sureness that the resolution would be successful. He presented his life as on track and betrayed no fear of challenges or obstacles or dissatisfaction.

Online he had been quirky and we had shared our respective senses of not fully understanding ourselves. It was as if online he was able to be more vulnerable, but face to face he needed to present well. The self-doubt, the willingness to be not quite “normal” which appeared in the online conversations disappeared in person. Unfortunately, this persona was very distancing for me. I do not know to what degree he presented this composure because he realized I was a psychologist, but it caused me to experience him as false or at best “partial,” as if I were only getting the shiny part of the whole picture.

In counseling and psychotherapy we talk about clients’ “hooks.” The hook is the aspect of the client from which our empathy for the client grows. Typically it has to do with the internal struggle. People who appear to be trying to do life right are appealing. People who are not struggling are difficult for anyone to relate to—few (if any) of us have a sense of what it is like to not have an internal struggle of some kind. Some people’s struggles do not make sense to us personally as struggles. That they are struggling internally is what makes them relatable—not necessarily the struggle itself. Sure, the person has to be likable or someone we can care about in the first place in order for their struggle to matter, but someone who is simply likable usually feels incomplete, or false. This guy seemed likable—not offensive in any way—just not fully present (or fully presenting).

I enjoy confident people. I have frequently said that confidence is the most attractive cologne. I like people who have a sense of accomplishment and a sense of purpose and direction. However, someone who is accomplished and simultaneously is uncertain is someone I experience as a real person. I don’t think anyone wants to be friends with just a façade of a person. We may even admire a person without apparent problems, but their friendship would not actually be rewarding.

Ideally, one would present as confident, but perhaps not certain. We like to know that others are also vulnerable. Similarly, I think it is comforting to present as recognizing that you are flawed—accepting of the flawed state, but also maybe wishing not to be. Though I would caution that (especially upon initial and early contact) it is also important to exhibit that you are grounded and not just a mass of uncertainty—that can be just as partial, absent a center. In the absence of substance there is also no personality in which to hook into. Someone who seems to have it all figured out does not seem like someone who is going to grow much.

“Alcoholic”

noreply@blogger.com (Woodja) — Thu, 08 Mar 2012 21:08:00 +0000

As a therapist the word “alcoholic” is bothersome. It is not that I have a problem with alcoholics particularly, but rather I have a problem with how the term—and its associations—interfere with treating alcohol-related problems. The common use of the term, and especially the commonly held definitions or expectations of the label, create an either/or designation for alcohol problems—either one is an alcoholic or one is not, there is no in-between ground . If someone is using alcohol to his or her detriment, but does not drink to messy intoxication regularly (or always), we tend not to label that person an alcoholic and consequently there is (frequently) no attempt to address the problems that are associated with the alcohol use.

“Alcoholic” and “Alcoholism” are not clinical terms and therefore they sometimes have poor operational definitions. If someone drinks every day, but not to the point of apparent (or clinically significant—in psychologist speak) dysfunction, we do not classify that person as an alcoholic—even if his or her drinking is negatively affecting the overall quality of his/her personal life (e.g., relationships, sex life, hobbies). If the drinking causes problems, but does not appear to be an "addiction" (another term that is not clinically defined), then we tend not to label it as something to be treated. We may even talk to the person about how his/her drinking is affecting him, but we do not typically address it in terms of maybe the person should seek help—that would mean he/she was an alcoholic after all, and we do not want to give that stigmatized label to anyone inaccurately.

Furthermore, someone who is experiencing alcohol-related problems but does not experience the symptoms associated with “addiction” is not likely to benefit from Alcoholics Anonymous meetings. Maybe he/she is drinking more frequently, but not substantially more at any one time, or has cravings, but not actually withdrawal. These could, however, qualify someone for a diagnosis of Alcohol Dependence or Alcohol Abuse. But a person is not likely to see himself/herself as an “alcoholic.” “Alcoholism” and “addiction” are the common terms used to describe someone who we perceive as having as having a drinking problem, not “dependence” or “abuse,” which allow for more flexibility in identifying problematic drinking.

Another aspect that is missed with traditional thinking on alcoholism is that someone over 50 may not be drinking more, but is most likely getting more drunk on the same amount of alcohol. Around the age of 50 our bodies become less able to detoxify alcohol, so smaller amounts can actually have more major impacts. But we see a person having two to three drinks a night still—without needing a greater quantity of alcohol, yet his/her body is processing the same amount as if it was in fact more. This can disguise the tolerance a person might be developing.

If we were willing to think of drinking problems in terms other than “alcoholism” or “not alcoholism” we could better address the negative impacts that some people’s alcohol use causes.

Mimicking Depression

noreply@blogger.com (Woodja) — Tue, 28 Feb 2012 23:23:00 +0000

There are two medical conditions that frequently show up in psychologists’ office as depression. These medical disorders outwardly mimic depression (and may even cause depression), but have distinctly different causes, and, untreated, can endanger a person’s health. If you are experiencing depression symptoms, you may want to consider seeing a physician, not for antidepressant medications, but rather to be checked for other problems that may mimic depression.

When I was in graduate school we were frequently reminded to consider hypothyroidism (insufficient release of thyroid hormone) in women who presented with depression. Both cause lethargy/fatigue and hypersomnia (sleepiness), are associated with physical pain in the joints and muscles, and involve lack of motivation, anhedonia (loss of enjoyment in things which use to be enjoyable), negative mood states (e.g., sadness, regret, or anger), mood swings, and weight gain. Many of the symptoms of hypothyroidism mimic depression and it is consequently frequently under-diagnosed, or misdiagnosed as depression.

No amount of anti-depressant medication will make the symptoms of hypothyroidism go away. Thyroid hormone affects many other bodily functions and low levels can negatively affect multiple organ systems. Untreated hypothyroidism can lead to goiter and heart problems and can even cause birth defects if a pregnant woman has hypothyroidism, so proper diagnosis is very important. More women than men present with depression symptoms, so awareness of this mimicking phenomenon is drilled into psychologists in grad school. However, it is also important that women be aware of the similarity so that they know to consult a physician (perhaps in addition to a psychologist) if they experience symptoms of depression.

Perhaps because men present for depression less frequently than women, being able to distinguish medical disorders from mental disorders is less emphasized in grad school. If a man presents with difficulty attaining or maintaining an erection, lack of sex drive, irritability, mood swings, negative mood states (e.g., sadness, regret, or anger), difficulty concentrating, lethargy/fatigue, a lack of motivation, and weight gain the psychologist is likely to diagnose depression, whereas the medical doctor will probably evaluate testosterone levels. These symptoms are common to both disorders and both would be reasonable diagnoses given the respective experts’ fields.

Many of the symptoms that might allow for differential diagnosis are not likely to be mentioned by men over 35 to either a psychologist or a physician. Hair loss is normal as a man ages, but is also accelerated by low testosterone. The development of fatty tissue in the breast/chest area probably also isn’t going to have attention called to it when presenting to a health professional—either because it is embarrassing or because it won’t even be noticed with the rest of the weight gain. But these are some of the things that can be used to assess if a man is suffering depression or low testosterone. Sometimes, though increasingly less so, male clients will not tell their psychotherapist or counselor about sexual dysfunction either. Even in the absence of these symptoms I have encouraged some of my male clients to have their testosterone levels checked.

Decreased testosterone is normal for a man over 40, but sometimes there is a precipitous drop in testosterone levels and that will lead to depression-type symptoms, along with health risks. Low testosterone is associated with heart problems and even susceptibility to broken bones. And, like hypothyroidism, anti-depressant medication will not address the symptoms, not even the mood symptoms, effectively.

Along with the normal drop in testosterone, there is a natural drop in sexual function and energy, which may be perceived as the normal part of aging—and for many it is—but even many physicians are not trained to ask about the effects of lessened testosterone in a way which would indicate lower-than-normal-for-age testosterone levels. It is important that men be aware of the symptoms and question the severity of the drop (and the mood features associated with low testosterone) in order to take care of themselves.

There is some controversy whether hypothyroidism and low testosterone mimic or actually cause depression. To me the distinction might be irrelevant. If after taking the medication the depressive symptoms do not go away after a few weeks, you might want to see a therapist to address whatever depression may have followed the body chemistry problems from the physical disorder. If the depressive symptoms go away from treating the primary physical problem, then the depression has gone anyway. But the main point is that, like with so many physical disorders, it is important to know to consider with the medical or mental health professionals all of the possibilities.

Doling Out Your Crazy

noreply@blogger.com (Woodja) — Sat, 18 Feb 2012 23:33:00 +0000

When we meet someone for the first time, especially someone with whom we want to get intimate, we want to make a good impression. Part of making a good impression is being yourself with someone. People are pretty good at detecting insincerity; people do not respond well to partial presentations. But people also don’t tend to want to associate with people who present as a “mess.”

I encourage my clients to dole out their crazy a little at a time when developing a relationship. There is a pace at which it feels healthy and appropriate to share one’s uncertainties and idiosyncrasies. It is sort of like testing the waters. Trying to see how much of our own craziness the person is ready to handle. This is partially determined by how much quality is perceived in the person—in other words: “Does the person have enough good stuff to put up with the crazy?” By the way, we all have a little craziness.

The craziness may be some odd superstitious ritual or fear that is not grounded in any rationality, but is grounded in the perception of our own experiences. We all have some strange ideas about the world and frequently our own un-founded insecurities (e.g., I have a faux paranoia about ebola). No one is really quite “normal,” while they might be mentally quite healthy. These are the quirks that make us who we are—often the parts that people find endearing after they get to know us.

However, emphasis on “after they get to know us” is worth highlighting. Too much intimacy—crazy or not—too soon is usually off-putting. We enjoy the process of getting to know someone; the process of discovery is engaging. Knowing everything at once can feel overwhelming—there is no context for the details, no sense of nuance or flavor. It can feel too raw. Additionally, I think there is something to feeling special because an intimate aspect of someone was shared with us. Aspects of oneself shared too easily do not feel like intimacy.

We also take as a cue how much we will share (or are expected to) based on how much another shares, and therefore someone sharing too much too quickly may feel threatening. Most of us want to control the rate at which someone knows our quirks and insecurities—there is vulnerability in it. When someone blurts out all of his or her idiosyncrasies, we don’t feel safe sharing with him or her our personal thoughts. Furthermore, the expectation to match the pace of sharing can make us want to back away (and protect our privacy).

I do not mean to discourage sharing, of course. Exposing our true selves actually tends to open us up to greater connection and happiness. However, when trying to decide to share one’s quirkiness think about the purpose of the sharing—what are you trying to achieve by it? Are you trying to provide insight? Are you trying to explain a particular behavior or tendency? Are you trying to be funny? Or is it just coming out of you uncontrollably? That last one is the one to watch out for—it will drive people away (or to stare).

The Five Love Languages

noreply@blogger.com (Woodja) — Mon, 13 Feb 2012 21:34:00 +0000

Gary Chapman came up with the theory of the five love languages. It is an idea I use with clients frequently. It addresses the idea that demonstrations of love often go unnoticed (or unappreciated) by a partner. Chapman discovered that people engage in and recognize demonstrations of love differently. He categorized these disparate actions into the categories, or languages: words of affirmation, quality time, receiving gifts, acts of service, and physical touch.

Saying “I love you” is important and can be powerful in its own right. However, in our culture the word “love” has lost some of its strength because of how loosely it is used (“Oh, I love those shoes”). “I love you” can also feel obligatory and insincere sometimes. I encourage clients to share what about their partner(s) they love. Those are true words of affirmation. I do caution people not to use them as blackmail though, don’t turn them into “I love it when you...” in order to get someone to do something, but rather only as sincere appreciation for their having done it.

One of the most valuable and overlooked things that we can offer a partner is our time. Companionship is essential for a relationship (of any kind). Doing things together can function as a bonding experience. It is important to find shared interests and it is important to be curious about your partner(s) interests, even when it is not a shared interest. Work on enjoying your partner’s company when you do things with them that you don’t necessarily enjoy doing yourself—make enjoying their company what you get out of it rather than the joy of the activity itself. Another aspect of quality time that is frequently overlooked is that just sitting with someone who is suffering, enduring what they are going through—without an agenda of your own—is one of the greatest gifts you can give someone.

Meaningful trinkets can in fact be very meaningful. A few years ago my BF was putting in some glass doors, to open the house up to the backyard. I appreciated what he was doing (and his concern that it was temporarily inconveniencing us) so I purchased and wrapped a DVD of a movie I knew liked and stuck in conspicuous place in the jobsite one night so that he found it the next day when he went back to the project. Flowers are the gold standard of trinket gifts, but occasionally spontaneously providing something that your partner has casually mentioned wanting is a great way of saying “I care about and attend to you.”

Doing non-chore household tasks, especially without being asked can be a powerful statement of “we are in this together.” Noticing things that your partner does not like or is incapable of doing and doing those things for him or her is another way of showing you are attending and care. If you can notice something you can do to improve a process of your partner’s or can create something to facilitate the ease of his or her process, you are likely to be appreciated. Even helping out in mundane ways tends to be felt as cared for. My boyfriend cooks most of the dinners in our home and I recognize his doing so is at least partially an act of appreciation for having me in his life.

Touch can be incredibly powerful. There is research that chemicals are released in our brains by just watching another person be tenderly touched. Research has even shown that a comforting touch can be desirable than sustenance. A simple caress or reaching for a partner’s hand while watching TV says “I value you.” While sexual groping can be a great way of saying “I find you sexy,” a non-sexual touch can say “I appreciate you beyond the great sex” (and might even lead to great sex!). Even people who are not touchy-feely can appreciate an occasional touch.

But the important thing to remember is that you may be saying “I love you” all of the time, but if you are speaking a different love language than you partner, the message may not be getting through. It is important to learn the language that your partner comprehends and speak that language. It may even be a good idea to let your partner know what language you hear. An issue that I have not seen Chapman address is that some people speak and hear different love languages themselves. So you cannot always count on getting your love message heard simply by speaking the same language your partner speaks. It is also worth learning what love language your partner speaks, so that you can become better aware of when he or she is saying “I love you” in a language that you don’t hear. Ideally you won’t send messages that are not received, but nor will you miss the messages that are sent in a foreign love tongue.

Misdirected (Dis)Respect

noreply@blogger.com (Woodja) — Sat, 08 Oct 2011 20:16:00 +0000

I recently had a client tell me about a guy with whom he was maybe, sort of, kind of, possibly beginning to start a relationship. And the client shared with me that one of his hesitations about starting the relationship was that “the guy deserved better.” The statement stopped me.

The idea that someone deserves better than oneself is a notion that has never made sense to me. Unless you know that you are going to do harm to someone or are being duplicitous, then I don’t know from where anyone gets the idea that he or she has the authority to decide whether one is good enough for another. I asked my client on what basis was he making the decision for his potential love interest and my client was unable to produce a coherent, rational argument. It seemed to be more of a feeling. In this case, it was a feeling of personal inadequacy of my client’s.

It strikes me as very presumptive that someone would feel he or she was in a better position to decide what would be rewarding to a (potential) partner than the partner himself or herself. On what basis does one make such a claim? Are you thinking of dating someone with poor judgment?—if that is the case, then the person probably does not deserve better than you. The assertion strikes me as rather self-centered actually.

I think the statement is made out of respect for the (potential) partner, but is actually an act of disrespect. It is grounded on the person either not being able to make good decisions or not knowing what would be good for himself or herself or that the person cannot adequately assess others. Those aren’t very respectful claims to make about another. In fact, they pretty well disregard the other person’s ability to decide or determine what he or she would most enjoy or benefit from in a partner. It pretty much is the same as saying “I know what would be good for you better than you do.”

But the aspect that I think makes it the most self-centered is that it is really about the person making the statement’s self-image than the person about whom the statement is being made. As with my client, it is more often a statement of one’s own sense of inadequacy. It seems it would a healthier and more productive approach to acknowledge and explore how the qualities you see in yours love interest make you feel, rather than write off the compatibility. Heck, you may even want to be honest with your partner. But I would strongly encourage you to be open to what your partner might see in you of value that you do not recognize in yourself.

I really don’t think we are in a position to decide if we are worthy of or good enough for another. I think we are not the best judges of that. I think that we grant a (potential) partner more autonomy and more respect by being honest about who we are (with our concerns about compatibility and being open to his or her perspective). Respect for your (potential) partner’s ability to make a good decision as much as you respect the qualities that make you feel unworthy.

Put Your Oxygen mask on First before Assisting Others

noreply@blogger.com (Woodja) — Sat, 01 Oct 2011 19:43:00 +0000

This piece of advice from flight attendants is a useful metaphor for the rest of one’s life. Many people end up putting others before themselves, end up assisting others before taking care of themselves. And, in a sense, the same consequence occurs as might if you waited to put your oxygen mask on until all those around you had been taken care of—they spiritually or emotionally pass out. Perhaps more accurately, they end up being less functional because they have averted too many of their resources towards others. This is perhaps a particular concern for the submissive members of the BDSM community.

When I was in graduate school the faculty emphasized the importance of taking care of oneself in order to be available to give one’s best in taking care of another. Being in a profession that is highly susceptible to “compassion fatigue,” this was frequently repeated in all of my training experiences. However, for people for whom compassion and service toward others is their nature but are not in a “compassion profession” they are rarely taught the importance of self-care.

One of the barriers to awareness about self-care is the blurring of self-preservation or even self-interest and selfishness. I addressed this previously on this blog, but it is common enough of a phenomenon that it is worth repeating. Self-care is more akin to being responsible, than being selfish. Self-care (or equally self-preservation or self-interest) can as reasonably be seen as maintenance. The best service is offered by the best maintained machines. This is also true of people; we operate best when we take care of ourselves (first).

When we haven’t taken care of ourselves first, then we are prone to the effects of stress. We are more likely to get distracted, more likely to forget things, more likely to make bad decisions, and more likely to become irritable, rather than act in a loving manner. Taking care of others can actually increase one’s happiness. However, this is much less likely if the care feels like a burden rather than an act of kindness. If one is worn out or unfulfilled in his or her own life, then the care that is given—to a child, parent, partner, or friend—is more likely to generate feelings of resentment. This will in turn undermine both the relationship and the reward of the relationship. Subsequently, the quality of the care provided will suffer.

I do not want to promote selfishness under the guise of self-care, but I too often see people neglect themselves under the guise of caring for others. This actually seems more insidious than selfishness to me. I suppose what I would truly advocate is greater awareness in taking care of oneself, rather than putting others first. I would even suggest that to my sub (slave/boy) friends and clients—a good Dom/Master/Daddy needs to be aware of when his/her sub needs to care for himself/herself as well. So, if you find yourself providing a lot of service or care to another or others, check with yourself to make sure that your needs are being met too. You will be able to provide better care and service if you do.

Friendship is Not an a la Carte Option

noreply@blogger.com (Woodja) — Sat, 24 Sep 2011 19:48:00 +0000

I recently received an email from a client that asked “why should I continue to try to be friends with people, when people will invariably disappoint me?”

Generally, from what I see with my clients, isolation and loneliness are more damaging and more painful than disappointment. One of our core needs is the need to be accepted, to belong. When we isolate ourselves from others because we find it difficult to tolerate disappointment, then we deny ourselves getting this need met. Without this need we are not whole. Belongingness and acceptance are not things we can provide for ourselves, and are only truly available from others. In fact, former head of the American Psychological Association Abraham Maslow argued that our self-acceptance is grounded on feeling a sense of acceptance by others.

If we refuse to allow others to occasionally disappoint us (because of earlier experiences in which disappointment was associated with real needs—like food, shelter, affection), then we insure that some of our needs will go unmet. We may become so starved for belongingness and acceptance that we perceive the disappointment as rejection—being valued is seen in rather all-or-nothing terms. Sometimes our friends really do care about us but do not know how to show it in a way that we can perceive. Sometimes we have to lovingly invite a conversation about it how feels when we are disappointed.

Sometimes our friends seem unable to change the behavior that disappoints us. Then we have a choice. We have to decide if the behavior that offends weighs more than the value that the friendship offers. Often times a big part of what makes the behavior offensive is that we cannot understand it. Developing compassion for why our friends are unable to change their behavior (right now)—or at least what motivates the behavior—may make the offending behavior easier to tolerate. It may also be worth recognizing that the behavior does not mean the same thing to the friend as it does to you. Sometimes the behavior is just a quirk. It might also be worth remembering that we disappoint our friends too—hey, nobody’s perfect.

There are also times when we experience a friend’s behavior as genuinely intolerable. Sometimes our friends’ behavior is damaging or exploitive to us. Even if their friendship offers us something good, we may need to sever the friendship. It is important to balance self-preservation and growing to be more compassionate of others. There is no simple answer here.

The psychological reward from friendships is in the sense of companionship and having a confidant. Friendships should make us feel better about ourselves. Friendships have been shown to improve one’s mental health, physical health, and longevity. If what you have a is a real friendship, then the disappointing parts are probably worth finding a way to not be bothered by them, but if the “friendship” does not build you up and make you feel more sure of yourself, then it might be time to move on. Either way, we cannot get the good without the bad.

Self–Esteem vs. self-esteem

noreply@blogger.com (Woodja) — Sun, 18 Sep 2011 16:01:00 +0000

"I'm good enough. I'm smart enough. And doggone it,
people like me."

Stuart Smalley

In the last few decades there has been a movement toward an “everyone is great” attitude. This idea was (not so?) subtly addressed in the move The Incredibles. Syndrome points out the problem with this position when he says that “when everyone is super, no one will be.” This idea is repeated when Dash is graduating from the 4th to 5th grade and Mr. Incredible says “It's psychotic! They keep creating new ways to celebrate mediocrity.” After a while Self-Esteem becomes grounded in nothing, and consequently also becomes meaningless.

The claim that one is special becomes as empty as Stuart Smalley’s affirmations. Affirmations have been shown to be an effective tool to change one’s thinking—BUT ONLY when the person can actually believe the affirmation. Otherwise, affirmations are as likely to reinforce the idea that one falls short of the very thing he or she is trying to believe or achieve. This is what happens when we build up Self-Esteem in the absence of any foundation for it. In fact, telling people that they great in the absence of a basis (e.g., actual achievement) has been shown to be detrimental to both performance and emotional wellbeing. Martin Seligman, one of the leading researchers on happiness, has claimed that the increased interest on Self-Esteem has actually led to increased occurrence of depression. However, high Self-Esteem has been correlated with better performance, initiative, and happiness. People with high Self-Esteem tend to be more comfortable in social interactions. Consequently, Self-Esteem as a psychological phenomenon has become rather controversial.

When I talk about self-esteem with clients I talk about it terms of what do they actually value about themselves, or what do they feel that they have that they can contribute or that will draw people toward them. Self-esteem gives one a sense that he or she will be accepted (or is acceptable); this is essential to one of our fundamental needs—belongingness. It allows us to take risks, both a good and bad thing, because we less fear rejection. In my experience, valuing something specific about oneself makes a difference. Few of us believe claims (especially about ourselves) in the absence of evidence.

I see many clients who are anxious or depressed because they lack initiative or confidence and socially isolate themselves specifically because they do not recognize what they have to offer. I try to get them to list the traits they perceive in themselves and then help them recognize how some of those traits may be valuable to others. I ask them what they like about themselves. Sometimes I have them ask important others in their lives what those people like about them. This sometimes helps the client see that a trait he or she did not recognize as valuable is in fact valuable to others—and will consequently promote acceptance and belongingness.

This is a technique that many of us could benefit from. Make a list of what about you is valuable and keep it around for those times when you become less certain about how likable you might be. Just make sure these are traits that you believe (a) are valuable to others, and (b) that you actually have. It can be good to proud of oneself, as long as one is proud of something about oneself. That makes for healthy, beneficial self-esteem.

Lessons on Love from Country Music

noreply@blogger.com (Woodja) — Sat, 10 Sep 2011 19:06:00 +0000

And now I'm glad I didn't know
The way it all would end the way it all would go
Our lives are better left to chance I could have missed the pain
But I'd of had to miss the dance
“The Dance” by Garth Brooks

Had I known my heart would break
I would've loved you anyway
“I Would’ve Loved You Anyway” by Trisha Yearwood

Many of my clients laugh at me because I tend to quote country music songs to help them see the ways in which they are getting in their own way. A kinky, well-educated, gay man from the Northeast looking to redneck music for wisdom? Regardless of what one thinks about country music, there is wisdom in those lyrics. Both of these songs are about the pain of having lost love and embracing the idea that to have avoided the pain, they also would have had to avoid the joy. I fully believe that in order to be available for love, we must also be available for pain.

Around the time that I went back to college I met a really wonderful man, Frederick. We tricked and I fell for him, hard. He had a T-cell count of 17. This was before protease inhibitors, and I realized that most likely if we started dating I might fall in love with a man and then watch him die. I thought as seriously about on what I might miss out by not being in a relationship with him. We ended up dating for about 5 years, really wonderful years. We grew in different directions and we are now both with different boyfriends. I am so glad that I took the risk of loving a “dying man” and had the wisdom to see that the potential joy outweighed the potential pain.

A few years later I was faced with a similar situation. I met a wonderful man, Dwayne, who was HIV+ and had a T-cell count of 4—and this was after protease inhibitors were released. I again thought as much about what I might miss out on by passing up on this “dying man.” I made the same decision and we began dating. He died about 8 months later from opportunistic infections. It was excruciating for me. It was the right choice nonetheless. I sure wish we had gotten more time together, but I am grateful for the time we did get.

I like to explain to my clients that the “hole” in our walls through which love passes is the same “hole” through which pain passes. We don’t get to choose the level of intensity of our individual emotional experiences. We either experienced life with muted emotions—usually longing for greater joy, or we experience life with full-contact emotions—good and bad. I always recommend to treat life as full contact. From what I have seen with clients and friends, the stunted emotional life is usually more damaging than the fully experienced pain of life—though I recognize this can be rough too. Love is risky business; potentially wonderfully rewarding risky business.

To quote another country song: “when you get the choice to sit it out or dance, I hope you dance.”

Dual and Dueling identities

noreply@blogger.com (Woodja) — Tue, 05 Jul 2011 18:31:00 +0000

I have recently experienced my 15 minutes of fame with a New York Times Magazine article. The issue that this exposure has concerned is my recognition that someone may experience his or her religious identity as strongly as his or her sexual orientation identity and that it might be necessary to help a client embrace his or her religious identity, and bracket (set aside) his or her sexual orientation identity. As you can imagine, this is a controversial idea.

Many GLB people undergo an extremely difficult struggle to accept their sexual orientation. Often this struggle involves dismissing a set of religious beliefs, and frequently accepting an alternative set of religious beliefs (and occasionally an outright rejection of religious beliefs). The people that make a successful acceptance of their sexuality and modify their religious beliefs experience their sexuality as unchangeable and their religious beliefs as changeable. They are able to establish dual identities for their sexuality and their religion. For most of us this seems logical.

I identify as a gay white man. This is at the core of who I understand myself to be. It feels unchangeable. It is at the essence of who I am. It is upon which much of the rest of my identity (e.g., socialist, activist, and atheist) is hung. I experience the parts of my identity that hang upon the core as changeable —I don’t expect them to change, but I can at least imagine them doing so. I suspect that many GLB people that have accepted their sexuality (and particularly those that have adopted a new religious belief system) relate to this understanding of myself.

However, what if the core of my identity was as a Christian white man? What if I felt that my particular version of my Christianity felt like my core? What if I felt that this was unchangeable, that it was at the essence of who I am, and upon which all the rest of my identity was hung? Most GLB people have had to teach others that their sexuality was at their core and unchangeable—this is an experience that I bring in dealing with clients for whom their religious belief feels as unchangeable and essential to one’s personhood as my sexuality does for me.

Though I identify as an atheist, I sincerely respect people’s right to their religious beliefs. I am aware of the empirical research that shows that having certain religious aspects in one’s life improves both quality of life and longevity. It seems that for me to encourage someone to reject, rather than embrace, one’s religion would be inappropriate and perhaps even irresponsible as a mental health professional.

When I work with a client who experiences religious-sexuality conflict, I first try to identify the importance of the client’s specific religious beliefs or how flexible he or she might be about his or her religious beliefs. If I can help a client find balance in his or her religion and sexuality—and there are many religious traditions today that are compatible with a GLB identification—that is the direction in which I will try to point the client. But when a client has an inflexible belief in the fundamental nature of his or her religious convictions my pushing an alternative understanding of scripture is only going to further alienate the client or add to the internal conflict. Neither of these are healthy pursuits in counseling.

I do not believe that in assisting a client bracket his or her sexuality I am helping a client on a path toward genuine happiness, satisfaction, or fulfillment. But I do hope to help the client reduce the active tension and conflict in his or her life. I hope to help the client achieve more (if not absolute) peace. I value personal authenticity as a mental health goal, but I would rather have a client in inauthentic resolution and alive and functioning, than forced between a choice of suicide or what feels like an impossible authenticity, stuck in a state of dueling identities.

Gay Pride

noreply@blogger.com (Woodja) — Mon, 27 Jun 2011 13:34:00 +0000

This weekend was Gay Pride in Houston. I did not participate. Not because I am not proud of myself for standing up to homophobia and living as an out gay man. Not because I am not proud of the accomplishments of GLBT people. Not because I am not proud of my GLBT culture. In fact, I very much am proud of all that. But in Houston—I have found—Gay Pride is grounded in how mainstream we are. This actually feels more like shame to me than pride.

The parade here consists more of church and employee groups than independent gay organizations. The so-called “fringe” of the gay community does not seem to be particularly welcome as part of Gay Pride in Houston. In the 6 years I have been in Houston there has only once been a leather organization in the parade. The organization that was invited is primarily heterosexual. In order for leather to be in our parade, it too had to be mainstreamed by being largely straight-identified.

I am a gay leatherman. A large part of my gay identity is tied into the fact that I embrace an alternative sexuality, that I am specifically not mainstream. I intentionally sexualize my gay identity. I am proud to push the boundaries of what is acceptable sexuality—not just for GLBT people, but for all people.

In the 1970s when Gay Pride began, we were proud to be sexual outlaws. We were proud to be challenging the gender and sexual norms. I am still proud to be challenging social norms to be more flexible and more inclusive. In 1990 Marshall Kirk and Hunter Madsen published After the Ball, a book about how the GLBT community could gain acceptance through presenting a mainstream persona. In this After the Ball era, Gay Pride has taken on a role of trying to make our community look like it fits gender and sexual norms, rather than make a statement that an alternative to this was equally valid.

The GLF (Gay Liberation Front), the organization that formed the first Gay Pride celebrations, was adamantly opposed to gay marriage. They viewed gay marriage as the GLB community forsaking what made our culture great—our alternative views of sexuality and gender. As gays gain the right to marry today, I do not expect us to conform to the traditionally-defined monogamous version of marriage. I expect us to redefine what marriage means. Marriage is about commitment, but commitment as defined as an intention to be there for another—nothing about sexual exclusivity or sexual normalcy.

We are a community that has been oppressed based on our sexuality—an adult theme. The celebration of our community, culture, and accomplishments should not have to be “family-friendly.” The celebration of our sexuality should be radical to honor the radical nature of our sexuality and gender. Our community is unified by being sexual and gender outlaws, regardless of how mainstream we might individually live our lives. I have taken as my daily mission to teach the world that my radical sexuality—as non-family friendly as it might be—is as right (morally, psychologically, biologically, etc.) as mainstream or traditional sexuality. I hope more members of the GLBT community remember our roots and that if we are going to truly celebrate Gay Pride, then we need to celebrate the breadth of the community, not just the so-called “acceptable” parts of it.

Honor Thy Father

noreply@blogger.com (Woodja) — Mon, 20 Jun 2011 18:00:00 +0000

Being the day after Father’s Day I figured this might be a timely topic. A phenomenon that I see over and over again with my clients, primarily—but not exclusively—male clients, is living one’s life or making decisions based on what would make one’s father happy or proud. There is nobility in this quest, but I more often see the damage from the pursuit.

Whether we are Christian or not, the Commandment of “honor thy father” is pervasive (and unavoidable?) in American culture. It is incorporated into the cultural norm and ethos of American life and the definition of family. Frequently “honor” is translated in terms of “obey,” or even please, one’s father. Biblical scholars differ on the true interpretation of the commandment. Some have argued honor is simply to express gratitude.

I can see where all of these approaches to honoring one’s father are valid and worthy, though I am most inclined toward a gratitude approach. But I think there is an inherent assumption in the directive (whether Christian or American cultural) that gets tragically ignored, which is: if your father warrants honor. It is utterly nonsensical to honor a father that does not warrant honor (or even respect). Yet, these are frequently the very fathers that I see clients damaging themselves by trying to honor by trying to make them proud or happy. Sometimes the clients no longer even have contact with their fathers and still have an orientation toward trying to please them.

I have great dad. He is flawed, but he is actually a truly loving, caring and respectful man. We have had our differences—I severed all contact with my parents for three years over conflict I had with my parents, but having resolved those conflicts now I sincerely enjoy his company and admire him. My dad has a voracious appetite for historical non-fiction that I downright envy. He has a great sense of humor that I do not have to envy because I he passed that down to me. I feel that he genuinely wants to see me succeed, not just so that he can look at me as his success, but for my own happiness.

That last aspect is noteworthy. It was something that I had to learn about my father. My misunderstanding of this was also at the core of the conflict that drove me away many years ago. Either the misunderstanding of this for many of my clients, or the reality that my clients’ fathers want them to be a success for his vicarious sense of accomplishment is what I see as setting up many of my clients for failure in this pursuit. We cannot accomplish success for our fathers if it means that we are inauthentic—it will never be real and it will never be enough.

If you feel that you are astray, ask yourself to what degree are you making choices that don’t feel right because you are either trying to “honor” your father, or deliberately rejecting the demand to honor him. So much of the substance abuse that I have seen has been due to rejection of the path to a father’s honor that the person felt as impossible or inappropriate for the person himself or herself. The healthiest way to honor one’s father is to succeed at being authentic—living the life YOU can be proud of and experiencing your own happiness. This is a great gratitude-based way to honor your father for what he actually gave you (even if sometimes fathers don’t themselves recognize it).

I am fortunate that my father is proud of MY experience of success and that I have come to recognize that. I wish this for everyone—and if it is not real, live as if it is. Thanks dad!

The Miss Fizzy Phenomenon

noreply@blogger.com (Woodja) — Sat, 04 Jun 2011 20:06:00 +0000

My boyfriend used to have a cat named Miss Fizzy. As I understand the story, Miss Fizzy was a rescue cat and was very thin and starved when she came into the care of my boyfriend. In his household she had ready access to food. This, it seems, was a huge change for Miss Fizzy. In response to the presence of food, following a lifetime of scarcity of food, Miss Fizzy gorged herself on every occasion and became an obese cat.

My boyfriend and I moved to Houston about 6 years ago and struggled to gain an economic foothold. He does small project construction and has spent years slowly developing a steady stream of clients, scraping for work along the way; he was in a constant state of anxiety about from where his next job would come. Similarly, I opened my practice and spent the next 3 months sitting my office waiting for the phone to ring. My practice picked up and after about 3 years I was finally bringing in enough money to pay my bills most months. We spent the first 5½ years in Houston in our own version of starving.

Within the last 4 months my boyfriend has had steady work and is now scheduling clients about a month out. During February and March I started to have record weeks with regard to number of clients I was seeing each week. Suddenly after a Houston lifetime of scarcity of income, we find ourselves with ample opportunity for income. He has been engaging in 50 to 60-hour physical labor weeks and I have been scheduling more clients than was my goal to see in a week. So like Miss Fizzy, we appear to be gorging on income opportunities. In fact, it seems we could work ourselves into our own version of poor health if we are not careful.

The temptation for what has been absent is great. Part of the motivation comes from the fear that the opportunities will not last: How do I know that there will still be some later, so I had better grab all that I can now. A gluttonous period following famine is natural, but it can also be unhealthy—the body needs to gradually adjust to the change. Consequently, I have imposed limits on myself with regard to how many hours a week I will see clients. I know that I may need to even adjust that down once the sense of scarcity has faded in order to protect my health.

The Miss Fizzy Phenomenon can affect people in a number of ways. One of the ways to which my boyfriend and I are particularly sensitive is spending—suddenly having disposable income after 5 years is REALLY tempting. But another common version of this which I see with clients is sexually. When someone leaves a relationship or when someone changes their body (e.g. weight loss or body building) and can screw around, he or she can binge on sex or sexual novelty, which may have felt scarce during the relationship or when one did not find himself or herself attractive. Unfortunately, this type of sexual gorging often leaves someone feeling empty—and frequently increases his or her pursuit of sex. There are, of course, too many other ways in which one can gorge following deprivation to enumerate here.

I think many of us experience sudden access to something that previously felt scarce at some point in our lives. When this happens keep Miss Fizzy in mind. Be mindful of the gorging in which you engage. Attend to the effect on both your body and your mind and pace yourself.

Satisfaction and Dissatisfaction

noreply@blogger.com (Woodja) — Fri, 18 Mar 2011 02:52:00 +0000

Frederick Herzberg proposed that job satisfaction and job dissatisfaction are two different things, rather than just two ends of the same continuum. Roughly, he suggested that job satisfaction is related to the inspirational (one’s sense of mission) and internally rewarding (sense of achievement) aspects of a job and that job dissatisfaction is related to the burden (policies) and externally rewarding (benefits) aspects of a job. In talking with clients about their feelings toward their job, I use his theory in at least an exploratory way to facilitate discussion and thinking. Ideally one wants to experience high job satisfaction and low job dissatisfaction. While evidence suggests that the two ideas are not as independent as Herzberg claimed, there is some support for the differential effects of the factors.

In exploring with a client if his or her job is satisfying, I look at what Herzberg called motivation factors: challenging work, opportunity for growth, recognition, responsibility, and personal sense of achievement. A lot of this is task based—“do you enjoy what you are doing in your job?” or “how do you feel about the work (not the job) specifically?” This can include how one feels about the overall importance of one’s work: doing research on the impact of mining on the environment may be very rewarding in itself, but not feel as good if it is for a mining company that is using the information to skirt or exploit environmental protection laws. Job satisfaction appears to be grounded in life-job values. Job satisfaction appears to be associated with how much one aspires in his or her work.

When helping a client explore what feels bothersome about a job, I try to look at what Herzberg refers to as hygiene factors: work environment/corporate culture, hours, working condition, job security, salary (compensation), and fringe benefits. A lot of this is workplace based—“how do you feel treated by your employer?” or “how much do you enjoy your coworkers?” This relates more to job stress: enjoying a task and feeling that it will make a real difference may be very rewarding in itself, but not feel as good if you are constantly behind schedule or working long hours every day. Job dissatisfaction appears to be grounded in how fairly one feels treated. Job dissatisfaction appears to be associated with much one engages in sabotage, theft, or loafing at work.

In working with clients I have also extrapolated the idea onto overall quality of life, as life satisfaction and life dissatisfaction and have found this useful as well (if not actually scientifically founded). Life satisfaction analogously relates to how inspired one is in his her life, while life dissatisfaction is analogous to how burdened or stressed out one feels.

I help clients explore if they are feeling challenged, experiencing personal growth, feel connected, or feel that they are making a difference in their personal lives. In other words, is one socially and intellectually stimulated and rewarded. Similarly, I inquire if clients feel that their lives are monotonous or they feel that they are laboring at what they do outside of work. Ideally, our interpersonal relationships feel fulfilling and that we have some purpose.

In exploring relative levels of life satisfaction I often ask the question as “are you living or simply waiting to die?” A “simply waiting to die” stance suggests low life satisfaction, but also low life dissatisfaction—it is more like numbness. I then try to work with a client to find a sense of purpose or meaning—something to live for or work toward. If a client expresses enthusiasm for life, but also feeling bogged down, that usually suggests that they have high life satisfaction, but also high life dissatisfaction. With a client like this is often a matter of removing what feels like obstacles—often obstacles with which he or she has become comfortable or has come to depend on. Clients both low in life satisfaction and high in life dissatisfaction frequently experience a sense of helplessness/hopelessness—they feel burdened by being alive and without any reason to be alive. These are, of course, the clients that scare me the most and are most challenging. With them I need to work with them to both develop a sense of purpose and simultaneously develop a sense that improvement in life is possible.

How satisfied and dissatisfied are you in your job and in your life? Looking at these ideas as separate things rather than ends of a singular continuum may help you recognize areas of your job or life that you want to improve or change.

My Personal Lent

noreply@blogger.com (Woodja) — Thu, 10 Mar 2011 00:17:00 +0000

Today is the beginning of Lent and I have been thinking about Lent a lot recently. I did not grow up in a religious tradition that celebrated Lent, but the town in which I grew up was about 75% Catholic, so I was exposed to the idea as a child. Many of my classmates gave up chocolate for Lent. I am not sure how many of my elementary school classmates knew what the purpose of the “fasting” was. I was raised in a Baptist tradition in which the idea of making a sacrifice for the Lord for only 40 days (depending on how you count) was offensive and that true repentance meant making the sacrifice year round. I think this indoctrination is part of what led me to reject the concept of Lent for so many years.

In the last few years I have come to have a great appreciation for the idea of Lent, within in my own conceptualization of it. In looking at the meaning/purpose of Lent, I see a lot of good that can be applicable to people who do not engage in this religious practice, but perhaps do see themselves as spiritual. In recently discussing with a client a behavior that she feels she needs to give up, we have been talking about the possibility of her giving up the behavior for Lent and taking this period to reflect upon what role she wants this behavior to play in her life. The idea is that the abstinence/fasting will allow her to see more clearly the role that this behavior does play in her life and see what it might be like without it or, at least, with it in much more moderate or appropriate ways.

In talking about this refraining from behavior, we have talked about it in terms of not just being a fresh start, but in terms of repentance and cleansing her spirit, or at least giving her spirit a rest. We have talked about the fasting in terms of something she can do for her soul—to stop dumping toxicity into her body/self through this behavior. We dump toxicity into our bodies/selves when we invite drama into our lives, not just when we put into our bodies substances that hurt our bodies. We have talked about repentance, not in terms of repenting of sins done unto God, but rather sins done unto oneself.

Another common part of the Lent celebration is prayer. The purpose of prayer is to get one closer to the spirit, traditionally God. If prayer is not the way you connect to your spirit, you can engage in a variety of behaviors that helps you get closer in touch with your own spirit as well. Meditation, for example, is often a quieting of the mind in which extraneous or damaging thoughts are chased away and one focuses on one’s self—it is a communing with oneself, as it were—promoting mindfulness. Recitation or affirmation of the goal can also be prayer-substitute behaviors that can be other ways of connecting the mind and body. Within a non-religious approach “prayer” can be an act of deliberate self-reflection.

I have twice decided to give up deserts/sweet baked goods for an extended period (3 months), not so much in repentance for the sin of cake-eating, but to get back into a better relationship with my body. I have engaged in my Lent-like behavior when I discovered that I was eating deserts at a rate that threatened my health (I am diabetic) and experienced this habit as out of synch with my spirit. In other words, I was not living in accordance with how I see myself and was experiencing internal discomfort with this. I have taken the opportunity during my “Lent” to evaluate my relationship with deserts and my body and consider patterns that are more in accordance with how I want to live following my “Lent” period. I am in the midst of such a Lent-based evaluation of my behavior right now as I reconsider with what frequency and under what conditions do I want to allow myself sweets. My “Lent” followed a period of indulgence (my Mardi Gras, of sorts) of desert consumption during the holiday season. While in this fasting, the temptation of desert seems to be ever present, but each opportunity for desert allows me to look at what role desert plays in my life and what role I would like it to play.

Just as I did not begin my “Lent” on Ash Wednesday, you do not have to begin your period of self-reflective fasting at any particular time—the date is rather arbitrary. But if you are feeling that a persistent behavior of yours in causing you distress, then you may want to consider engaging in an extended fast of that behavior in which you observe and reflect upon what role and impact that behavior is having in your life. I do not imagine that I will give up desert forever after my “Lent,” but I expect to establish a behavior that better suits my intentions and relationship with my body. If I lose the path again, as I did after my last “Lent,” you can again engage in a reflective fast, in your own personal “Lent” at anytime.

Our Dirty Little Secret, So What?

noreply@blogger.com (Woodja) — Wed, 02 Mar 2011 23:19:00 +0000

Part 3: Undermining Commitment

I recently wrote about non-monogamy being gay men’s dirty little secret. This is the third and final part of my response to why it matters that it is a dirty little secret. My intent is not to cast a negative light non-monogamy, but rather to encourage that we talk, individually and collectively, about what this means for us. We have forged a working model of the gay male relationship without very good prototypes grounded in the open-mindedness for which the GLBT community is known and which incorporates male sexuality. As we close in on having our relationships recognized on par with heterosexual marriage I would like us to again come out of the shadows about relationships and have open dialogue promoting the development of ways to cope with the particular challenges of these relationships.

Many of us were taught that committing to someone means not having sex with anybody but your single primary love partner. Yet many people in non-monogamous relationships consider themselves in committed relationships. So how do you know if your partner is committed to you in this situation? This question can be especially important during the beginning stages of a relationship or during times of turmoil. This is something that many non-monogamous couples need to figure out that monogamous couples generally do not.

Non-monogamous relationships need to deal with many of the threats that monogamous couples grapple with, but with a twist. Bed-death (the decline or disappearance of sex within a relationship) can happen in both monogamous and non-monogamous relationships. I know of a number of couples in which both partners are having plenty of sex, just not with each other. When sex is so readily available outside the relationship, sex within the relationship sometimes becomes “boring” and may even cease to be a part of the relationship. Few relationships remain strong when the solitary (or even primary) source of sex is from outside the relationship. The emotional bond may remain strong, but is the relationship still a romantic relationship, or is it more like best friends? How do we deal with the draw of sexual variety available in open relationships such that we do not lose the sexual connection with our partners? The sexual element in monogamous relationships is fostered by the availability of sex only within the relationship, non-monogamous relationships are not buoyed by this.

The loss of sex as a bond can also undermine the sense of commitment. This can become especially threatening if one of the partners finds someone with whom he does enjoy having sex with and enjoys spending non-sexual time with. Even non-monogamous relationships can be subject to affairs, and with the open boundaries perhaps even more at risk.

It is not uncommon for someone to act out sexually when there is conflict in the relationship. Conflict is a common driving force in failures of fidelity in monogamous relationships. It also is a rather unhealthy way to deal with relationship conflict. Non-monogamous relationships make this option even easier and more subtle. How can you differentiate between horny play outside the relationship and sex that is venting unresolved relationship conflict—which is likely to foster the conflict, rather than act as a catharsis for the tension?

I have a friend who is a dad and was in a committed relationship of 8 years. He also likes to trick a lot. His relationship with his partner was explained to his son as being equivalent to his mom’s relationship with his step-father. Only his mother and step-father did not have a train of guys coming through for casual sex. So how do we explain or manage our extra-relationship sexual exploits when our children stay with us or our elderly parents move in? The special form and dynamics of non-monogamous relationships can be hard to explain to people outside of the community, whether they be family or colleague. One of the benefits of having our relationships validated in society is that we can look for support from our friends and families. We likely will not be able to fully utilize our support systems if what we seek support about is something that we feel we cannot share.

I firmly believe that non-monogamy is not in itself a threat to gay male relationships, but rather the ways in which we deal with (or ignore) the unique challenges of these relationships is a threat. Unless we open up a dialogue about these issues we will not know how to deal with them or each couple will have to invent their own way to address the concern. Unless we develop healthy ways to deal with the unique challenges of our relationships our dirty little secret will matter.