The View From Here: Wrong Number Edition

The View from Here: Rest Edition

Ever wonder what psychologists do on breaks? Today I am sprawled out on a park bench looking at this.

The View From Here: Pollen Count Edition

Homosexuality 101 -- A Video Response

I remember a conversation I once had with a clinical mentor. She told me that once I put it out into the universe that I had concerns about the safety of a patient, I needed to diligently, vigorously, and continuously pursue all of my options to make sure that patient is safe. I could not rest until I did everything that I could do to protect my client.

I've taken Debora's words seriously. I've thought of them a lot these past couple of weeks since first encountering a video clip from the Family Research Council. I took what some have told me is an extraordinary act: I wrote a letter to a therapist from Florida who is engaging in so-called reparative therapy. I questioned her about her ethics. I don't find this act extraordinary. I find it a duty that is incumbent upon me to perform as a licensed psychologist. 

I take my ethical code seriously. When I watched the initial video and saw a licensed therapist using her position of authority and trust to spread pseudo-scientific propaganda. I saw a licensed therapist that furthers a damaging agenda that has caused untold pain on a vulnerable population. I felt violated as a person and as a psychologist. I  felt called to stand up for my profession--and most importantly--I felt called to stand up for vulnerable people who are damaged by this propaganda that Dr. Hamilton spews through her platform with NARTH.

For the record:

• Psychologists strive to benefit those with whom they work and take care to do no harm.
• Psychologists establish relationships of trust with those with whom they work.
• Psychologists seek to promote accuracy, honesty and truthfulness in the science, teaching and practice of psychology.
• Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures and services being conducted by psychologists... [and do not] condone unjust practices.
• Psychologists respect the dignity and worth of all people... and they do not knowingly participate in or condone activities of others based upon such prejudices.

For more information on what I'm doing to stand up for what I think is ethical, right, and just, please see my new blog The Truth About Homosexuality. For a discussion about what an ethical and competent psychologist might do, see my post Confessions from a Reparative Therapist.

Confessions from a Reparative Therapist

I admit it. I am a reparative therapist (also called conversation therapy)--just not the kind you think. As a psychologist I have worked with people who have sought to be relieved of unwanted same sex attractions since the dawn of my practice in 1997. Shocked? Expecting some sort of twist here? Of course there is a twist. Before we get to the twist, let's take a look at what the pseudo-scientific organisation called the National Association for Research and Therapy on Homosexuality, commonly called NARTH, has to say. This organization, by the way, has been called a hate group by the Southern Poverty Law Center.

NARTH writes:

Reorientation therapy is simply psychological care aimed at helping clients achieve their goals regarding their sexual attractions, sexual orientations and/or sexual identities. Reorientation is not decidedly different from other therapies. There are many psychological approaches to helping clients with unwanted homosexual attractions. All approaches supported by NARTH are mainstream approaches to psychotherapy. The term "Reparative Therapy" refers to one specific approach which is psychodynamic in nature, but not all who offer therapy aimed at orientation change practice Reparative Therapy.  

The Irreverent Psychologist (that's me!) wonders just what mainstream approaches to psychotherapy NARTH is speaking about. As you may have noted in another blog post of mine, not a single mainstream professional association endorses "reorientation" therapy.

Let's look at one more bit of what NARTH says before I get to my practice of reorientation therapy:

We respect the right of all individuals to choose their own destiny. NARTH is a professional, scientific organization that offers hope to those who struggle with unwanted homosexuality. As an organization, we disseminate educational information, conduct and collect scientific research, promote effective therapeutic treatment, and provide referrals to those who seek our assistance. NARTH upholds the rights of individuals with unwanted homosexual attraction to receive effective psychological care and the right of professionals to offer that care. We welcome the participation of all individuals who will join us in the pursuit of these goals.

It all sounds good, doesn't it? This business about achieving one's goals pertaining to their sexual orientation makes for a lovely thought, right? Remember the part about choosing their own destiny. This will be important.

Let's talk about the work I do, shall we?

I'd like to introduce you to four patients. They are all representative of real people. I've changed biographical details to protect their identities and privacy. I've asked for their permission to include them in this way: they have all agreed. I am thankful for the people who are behind these stories for allowing me to share a small portion of their experience. 

• A sixteen year old male teenager coming to therapy because he's worried he might be gay.
• A Mexican-American woman with elderly parents, struggling between staying with her same-sex partner or caring for her aging parents who believe homosexuality is a sin.
• A businessman in his 50s who stayed closeted out of fear of his business would suffer. Facing the second half of his life, he struggles between satisfying his desire for companionship with men and maintaining strong business relationships in his conservative line of business.
• A hipster 20 something woman, raised by a father who was a Baptist minister who sexually abused her. "I'm not even sure I'm gay, I think it might just be something that happened because of my father."

In each of these clinical situations, a person grapples with important concerns. A teen grapples with schoolyard bullies, his Catholic upbringing, parental expectations, and the confusing desires of an adolescent.  A Mexican American woman struggles with a conflict between her heart and a cultural expectation to, as the youngest daughter, stay close to home and care for her parents. A businessman struggles with strong feelings that same-sex attraction is negative, a strong attraction to men, and making a choice to risk loosing life-long friends who might reject him for his sexual orientation. A hipster struggles with separating out desire, love, and attraction from trauma and abuse.

Four very different people, with very different life situations, clinical presentations, and developmental issues. Each of them, however, questioned their same-sex attraction at one point or another in their treatment with me. Among the things they wanted to explore and work on was furthering their understanding of their same-sex attraction.

Each of these four patients, at one point or another, had the goal to remove unwanted same sex attraction. Here's where it gets complicated. Who gets too decide what the goal is? Who is deciding whom's destiny?

I have a quiz for you. Don't worry, it's painless and will be over before you know it. Who decides whom's destiny in a psychotherapist-patient relationship? Circle one: (and grammar people, is it who, whom, whose, or whom's -- I'm sure someone will tell me.)

1. The patient
2. The psychologist
3. The intersubjective self

Many of you might circle number one. I like that choice. Almost without exception, I accept my patients exactly where they are at. It is not for me to decide what makes for a life worth living. Rather, it is for me to ask really good questions that help open and explore new ways of looking at their life and provide tools for my patients to be more effective agents in their life (thus making for a life that they make happen, rather than a life that happens to them). 

Choice number one, however, doesn't always make sense. Sometimes it is choice number two. For a large portion of my career, I've worked with patients who self-injure and are highly suicidal. Patients have starved themselves to near death, injected themselves with poisons, broken their own bones, and have tried to (or actually did) kill themselves. It would be disingenuous of me to say that I don't have a say in what the goals of therapy are.

There are, based on laws, ethics, and my own sense of decency, places where I need to exert power over a patient's decision making. I must intercede and protect children, senior citizens, and disabled people from abuse. I must intercede and protect my patients from killing themselves or killing another person (though from what I have gathered, if a patient kills someone and then tells me I cannot violate their confidentiality). Lastly, if I believe someone's decision making is impaired because of a mental illness I can have them involuntarily hospitalized. Those are the four ways in which the law and my ethical code dictate me to intercede and take over the life of my patient. I loathe to do this, and try to take every step I can so that my patients remain active agents in their life--not me.  

Members of SPLC Hate Groups Need Party Hats

Beyond ethics, there are myriad ways my personal beliefs directly and indirectly exert power over the the decisions I make in my consultation room. My job, as a seasoned and reflective psychologist, is to constantly work to become more and more aware of the ways in which I am using power to influence patients--and to use that power wisely, thoughtfully and transparently as possible.

Now what about therapy to rid oneself of unwanted same sex attraction? That's when we get to circle number three, the intersubjective self. What's that? That's where psychologist and patient get to have fun exploring an idea together. The patient and psychologist join together and explore many different ways of thinking. Our selves merge in a way, become one for a moment, and can see much further and deeper into any given issue. 

Choice number three isn't for the novice therapist or the weak at heart. It's painful, difficult, and challenging to be open enough to connect with another in this way. It's also dangerous if a psychologist isn't self aware enough to recognize their power and all the different ways they can use it to demand rather than guide.

What issues might one contemplate in regards to sexual orientation? Religion, morals, culture, spirituality, oppression desire, wishes, family, needs, homonegativity, heteronormativity, relevant scientific literature, scripture, and, well, it's endless really.

Do I have an opinion about people who are gay, lesbian, bisexual, queer, transgender, or questioning? Yes. I think they are people to be loved and people who are to be cared very deeply about. It's not really for me to decide whether people should or should not be LGBTQ--it is for them to decide. It's for me to help them explore, to separate fact from fiction, and to hold a picture bigger than they can hold on their own.

Some of the patients I've worked with over the years have decided (a) they are indeed an LGBTQ person. Other's have decided that (b) while they are likely an LGBTQ person, they would prefer to contain that part of their self because of a variety of reasons (family, culture, religion, etc.). Others have decided that (c) they aren't actually and LGBTQ person at all.

Options (a) and (c) are easy. I've yet to have a patient select option (b) as a way to lead their life. They have explored the notion for a long time, and in the end, opted for for either being LGBTQ and having loving fulfilling relationships with same sex partners, or choosing to LBGTQ and be celibate for religious reasons, family reasons, etc. A small handful have selected option (c)--they aren't gay, or not yet ready to decide if they are gay.

This is how therapy is done. Thoughtful. Reflective. Taking into account multiple perspectives, multiple ideas, and multiple positions. Let's return again to the so-called reorientation therapists. 

Julie Hamilton at NARTH--she had a lot to say in response to my questioning of her ethics. In reviewing her official statement on the NARTH website (this link will actually get you there, have fun with the others)

• Dr. Hamilton demonstrates both an unsophisticated understanding of ethics in her reliance of choosing option one (remember my little quiz!) 
• Dr. Hamilton appears to be falsely pretending that she isn't exerting any influence on her patients (a likely failure of even knowing there is a choice 3, and it's unclear if she is is able to admit to choice number two). 
• Dr. Hamilton demonstrates an egregious misuse of science and a total failure of scientific thought. Some day I'll have to review her failings--which in her capacity of president of NARTH become NARTH's failings--in a later blog post.

NARTH states on their website they believe in open scientific dialogue. Strangely they don't invite this dialogue. Note the comments on their blog are closed. Let's be serious here: they aren't interested in dialogue. NARTH is interested in foisting their agenda of propaganda and pseudo-science on a vulnerable population.

It seems likely that Julie really isn't in the market of helping patients. It seems that she is in the market of peddling her agenda of propaganda and personal beliefs under a thinly veiled guise of pseudo-science.

Julie writes:

Ethical therapists do not solicit clients or coerce clients into seeking change. The clients served by NARTH therapists are clients requesting change.  

Ultimately it is the client who must choose with proper informed consent and without therapist-coercion, the most satisfactory life for himself or herself.

Sounds good on paper, doesn't it? It's not good. It's dangerous. Julie's unsophisticated understanding of ethics and clinical practice is dangerous. What her words reveal is a situation in which a therapist, unaware of her own agenda, dangerously foists her world view on another. Therapists who do this are, in my opinion, are engaging in the worst kind of malpractice.

So I say this: I know you are out there--survivors of damaging reparative therapy--lost, forgotten, hurting, and silenced by alienation. Come find me and let's use this place to tell your stories, to find connection, and come back into community. Come take a critical look at ex-gay propaganda with me. Come tell your story (anonymously if you're scared).

I am standing up for you. Come find me.

The Human Costs of Reparative Therapy

Have you hear about the so-called reparative therapy, in which unethical therapists attempt to change the sexual orientation of a person? Check out here and here if you are outraged and want to stand up for love, compassion, and what is right.

Four Noble Truths: Let's Call the Whole Thing Off

The Treachery of Images

I'm not sure why I haven't thought of this before. I should have. Really. I know this. At least I did at one point.

I'm talking about words here. The words we use represent agreed upon symbols for phenomena that occur in this world. A soda, for example, isn't really a soda. We've just all socially agreed that the substance we experience as a bubbly liquid will be called a soda (unless you are from Ohio, in which case you'll call it pop).

The symbols (words) aren't representative of real things that we have direct knowledge of. Rather, our symbols are representative of perceptions of phenomena that we only have access to from our own senses--not some direct knowledge of a "real" thing.

Have I lost you yet? At best I have a 50/50 chance of getting lost myself.

I've been thinking about this sort of things for years. Sitting under a tree in college (I'm being serious here, and no, it wasn't a Bodhi tree) the class read Alfred Korzybski and learned that the map is not the territory. Words (maps) do not entirerly represent the territory of phenomena that the maps (words) are trying to describe. Later in college I studied Rene Magritte's The Treachery of Images (1928-1929), and learned that the image, like the word, does not represent the "real" thing. Still later I studied Michel Foucault and read his 1968 essay "This is Not a Pipe." I thought more about language being symbolic representations of phenomena that are never exactly "real." Lastly, in my doctoral program I spent an awful lot of time reading and writing about social constructionism. Identities aren't real things, I wrote. Identities are stories we communally create to describe our perceptions of the phenomena that are around us.

I better come back around toward my point. Things get lost in translation. I've known this for a long time. I just forget that I know this.

So here I am up late watching a documentary by David Grubin called The Buddha and was reminded that what we think to be true isn't exactly true. The first twenty times I've learned this lesson was not enough. Apparently I need a little more reinforcement.

The four noble truths of Buddhism, as they are popularly taught, are that (1) Life means suffering; (2) The origin of suffering is attachment; (3) The cessation of suffering is possible; and (4) There is a path of the cessation of suffering.

Suffering, of course, isn't actually suffering. The original meaning here has gotten lost in translation. I know this, or at least knew this, but forgot it at some point or another. The Grubin documentary reminded me once again that suffering is a translation of the word dukkha. Suffering is one understanding of the word--and an appealing one. It's short, simple, and speaks to all of us. Who doesn't want to have less suffering in their lives? Dukka, however, isn't exactly suffering. It means something more akin to dissatisfaction. The word speaks to our experience of never being quite happy--and if we do experience happiness it tends to disappear in an instant. Dukka speaks to our experience of dissatisfaction with the constantly changing experiences of our lives.



You say suffering, I say dissatisfaction. Let's call the whole thing off? Hold on a second more. If you stick with me I might convince you that we better call the calling off, off.

I wonder if the Gershwin brothers were trying to teach us the Four Noble Truths. They certainly captured some of the dissatisfaction that occurs when two people, with two different ways of understanding the world, come grinding together in a relationship (the first noble truth, suffering is inevitable). The brothers also got that we can let go of  this dissatisfaction about day-to-day gripes for a greater goal.

But oh if we call the whole thing off than we must part.
And oh, if we ever part than that might break my heart.
For we know we need each other,
we better call the calling off off,
let's call the whole thing off.

Back to the documentary--the Grubin documentary interviewed the Dali Lama. He said that many read the four noble truths and attempt to wipe out suffering and wipe out desire. "Where does enlightenment fit in without desire? Without desire, how how do we lead our life? Without desire, how can we achieve Buddhahood?" The Dali Lama goes on to talk about being cautious about choosing the right kind of desire. "Desire to be harmful, no that's bad."

I'm going to hazard the guess that the Dali Lama isn't suggesting that the right kind of desire to have here is for wanting the thing of romantic love, as the Gershwin brothers suggest. I'm going to guess that the Dali Lama considers the desire for compassion and joy to be the good desire. 

What's my take home message here? Look toward joy and compassion. Cultivate that if you want to have the good life. 

What's compassion and joy, you ask? I'll have to tackle that another time.

A Call for Ethics

This morning I came across a  YouTube clip that I live tweeted and also made available on my blog.  It's a sad clip, filled with an enormous amount of misinformation. I was aghast to discover a credentialed mental health professional spewing some of the misinformation. Her actions, to me, violate the ethics and responsibilities of someone in our field. In that it is incumbent upon me as a licensed psychologist to seek a resolution of ethical dilemmas directly with the offending individual, when possible, I have sent out this letter today:

May 11, 2012

Julie Harren Hamilton, Ph.D., LMFT

P.O. Box 1382

West Palm Beach, FL 33402

Dear Dr. Hamilton:

It is my obligation as an ethical psychologist to directly address other psychotherapists who are engaged in behaviors that I believe are unethical. In watching the video published on YouTube by the Family Research Council, I became concerned about your work as a representative of NARTH as well as within your private counseling practice.

Specifically, you state:

“While the general public seems to believe that people are born gay and can’t change, that has not been the conclusion of researchers.”

Let me not mince words here Julie, you are simply wrong. There is no credible evidence in any peer reviewed journal that provides substantive empirical evidence to suggest that so-called reparative therapy is effective or ethical. Further, the American Academy of Pediatrics, American Association of School Administrators, American Counseling Association, American Federation of Teachers, American School Counselor Association, American School Health Association, Interfaith Alliance Foundation, National Association of School Psychologists, National Association of Secondary School principals, National Association of Social Workers, National Educational Association, and School Social Work Association of America have all taken  the position that “homosexuality is not a mental disorder and thus is not something that needs to or can be cured” (APA, Sexual Orientation and Youth, 2008, pg. 6). Your own professional association, the American Association of Marriage and Family Therapists, also states that “same sex orientation is not a mental disorder. Therefore, we do not believe that sexual orientation in and of itself requires treatment or intervention.” (AAMFT Board of Directors, July 31, 2005)

In the YouTube clip, you continue:

“There are many people who claim that it’s harmful for a therapist to try to help someone change in their sexual orientation and so when clients come in saying I have these attractions—these homosexual attractions and I don’t want to be gay there are many people who say that therapists should not assist those clients in achieving the goals for their lives because it is harmful yet the research reveals it is not harmful. There have never been research studies that have concluded that therapeutic attempts to change sexual orientation are harmful. In fact, it’s unethical not to assist a client in seeking to accomplish their goals for their lives, including their goals of living a life beyond their homosexual attraction.”

Again Julie, the evidence here is that reparative therapist is harmful, doesn’t work, and shouldn’t be done. Your public statements are not consistent with the professional literature. You are misrepresenting science and your field. Your apparent failure to understand the literature is putting those you serve at great potential risk for harm.

I’m deeply concerned that the patients you see become trapped in therapy and are not given ample opportunity to both consider the effects of discrimination, oppression, and misinformation about sexual orientation as well as what their faith teaches about sexual orientation. Further, I am concerned that you misrepresent the professional knowledge about sexual orientation to your patients causing them additional potential harm.

I am writing to ask that you practice within the established professional guidelines and that you meet your ethical responsibilities. Be truthful about the data, do not misrepresent the science, and assure that each of your patients are afforded the opportunity to explore their experience both within the context of their own faith as well as within the context of an understanding of oppression.

I further ask that you respond to these ethical concerns, in writing, so I can be assured your patients are receiving the best possible treatment and care. If I do not hear from you in a timely manner I will assume you are not interested in clearing up these ethical concerns and I will issue a complaint with your professional association and/or licensing body to seek assurances that you are practicing in an ethical manner.

                                                                                                                                   

                                                                                                                         

Sincerely,

Jason Evan Mihalko, Psy.D.,

Massachusetts Licensed Psychologist

and Health Service Provider

A Call to Action/Shine Brightly

This  morning I came across a video produced by the Family Research Counsel. I found it to be a particularly repugnant piece of propaganda and live tweeted my responses to the video. I felt that in good conscious, I couldn't let out-right falsehoods go unchallenged. I strongly encourage you to watch the video for yourself.

Interested in encouraging these folks to move from hate toward compassion? Consider an e-mail, tweet, phone call, or letter. Share with them the importance of love, compassion, and acceptance of all of our humanity. Tony Perkins, near the 26:50 mark, says that it is important to be "letting your light shine before men in such a way that they can see your good works." Show them all your good lights. Shine bright. Our futures--your futures--depend on it.

Rev. John Rankin
Theological Educational Institute
P.O. Box 297
West Simsbury, CT 06092
tei@teii.org
860-408-1599

Jeff Buchanan (or here)
Executive Vice President
Exodus International
1-888-264-0877

Joe Dallas
email here
17632 Irvine Blvd.
Suite #220
Tustin, California 92780
714-508-6953

Tony Perkins
Peter Sprigg
Chris Gacek
(email here)
Family Research Counsel
801 G Street, NW
Washington, D.C., 20001
203-393-2100 (p)
202-393-2134 (f)

Redeemed Lives
Rev. Mario Bergner
(email here)
P.O Box 451
Ipswich, MA 01938
978-356-0404

Massachusetts Family Institute
(email)
(web)
781-569-0400

Liberty Legal Foundation
Kelly Shackelford
9040 Executive Park Drive
Suite 200
Knoxville, TN 37923
324-208-9953
(web)
(email)

Carol M. Swain
Vanderbilt University Law School
131-21St Avenue South
Nashville, TN 37203
615-322-1001 (o)
615-310-8617 (c)
615-322-6631 (f)
(web)
(email)

Rep Vicky Hartzler
(web)
(email)
1023 Longworth HOB
Washington, DC 20515
202-225-2876 (o)
202-225-0148 (f)

Alliance Defense Fund
Austin R. Nimocks
15100 N. 90th Street
Scottsdale, AZ 85260
1-800-835-5233
(web)

Mass Resistance
P.O. Box 1612
Waltham, MA 02454
781-890-6001
(web)

Julie Harren Hamilton, Ph.D., LMFT
P.O. Box 1382
West Palm Beach, FL 33402
561-312-7041
(email)
(web)

(read my letter to Dr. Hamilton here)

The County Masturbation Trainer

Carnegie Hall, Baldwin-Wallace College

Who knew my career would lead me to having discussions about whether someone had the attention span to masturbate? These were not topics of conversation in the old sandstone building, pictured on the left, were I did my undergraduate study of psychology.

Nevertheless, I did indeed find myself having just this conversation a few short years after graduating. Since May has been named the National Month of Masturbation, I thought I might revisit this discussion. First a little background.

One of the nondescript homes nestled along a tree lined street in suburban Cleveland held a group home that I worked in over eighteen years ago. I was the QMRP of a home for people with developmental disabilities. Our residents were some of the most challenging individuals who were living outside of institutions. A few years prior to getting the job, one of the last developmental centers in Ohio was closed down. Of the 3,000 individuals that the institution once cared for, a handful remained. Twelve of that handful of hard-to-place residents were placed in my group home.

The residents had cognitive abilities that were below the threshold of what tests could measure. They had little to no verbal language skills. Our one resident who could speak had echolalia, which means his language capacity consisted solely of being able to echo back exactly what was spoken to him (at least simple words). The remainder of the residents of my group home had no formal language skills.

The residents had spent their entire lives living in an institution. Care was something provided on a production line. Compassion was something that came infrequently at best. The people who had been put in my care did not know how to dress, bathe, cook, or eat. Behavior plans were created to help residents (those who had the motor skills) learn to dry themselves after showers, dress themselves as independently as possible, and use forks and spoons to eat food. Every day that I went to work I felt like I was entering into a secret world of broken people that the world had forgotten.

While not many words were spoken, sounds would fill the air. For those who took the time to listen closely, human desires and wishes could be heard. The residents would desperately try to communicate with their caregivers. Sometimes we got it right, sometimes we didn't.

Sexuality, and desires for the sensual, were some of the most obvious of all communications. A few examples come to mind (all modified, disguised, and a hybrid of many different experiences).

• The woman who would spend significant amounts of time attempting to masturbate. She never could quite orgasm (perhaps due to side effects of psychotropic medications or lack of skill). She would try so long and hard she would injure her genitalia. 
• There was a male resident who suffered a similar problem. Every time I turned around he was trying a new way to stimulate his penis. He would try rubbing and banging his penis on any surface he could find. Like the female resident, he never seemed to manage to have an orgasm, and frequently damaged himself. 
• A third resident could frequently be found wearing a female resident's clothes and masturbating with them. The female resident would discover him wearing her clothes and chase him around the house pinching him.
• Another resident, who was able to have an orgasm, would frequently chase staff and residents around and throw his ejaculate on them. On one very unfortunate day, I was on the receiving end of this.

Why do I share these experiences? We don't often think of our most vulnerable and disabled community members as sexual beings. We should, because they are. We also take advantage of these people's vulnerabilities and push our own moral agendas on their sexuality. Too often our modes of treatment control rather than liberate the human experience.

How are their vulnerabilities taken advantage of? These residents, with no verbal skills, were heavily medicated to manage symptoms that they were not able to verbally express. I'm not even sure if we always knew what their symptoms actually were. Sometimes medication was used to manage dangerous behaviors such as self injury that could be life threatening. Other times medication was used to control symptoms that were considered a nuisance, like medication to dampen the sex drive of the man who threw his ejaculate at people. Resident staff, who were untrained, would roll their eyes at masturbating residents and yell at them to stop. One parent told me she knew her son didn't really want to masturbate because he was Catholic and knew he would go to hell. She insisted that his treatment plan included making him stop masturbating. 

Being young, idealistic, and a product of the Dr. Ruth school of parenting, I had a much different idea of what should be happening. Prior to working at this particular group home I used to drive a resident to an adult store so he could buy gay erotica. Now I was being told to develop behavior plans so a person could be trained to stop masturbating with women's clothes. I wasn't very happy about this but had not yet developed (or been granted) the authority to make an impact. This was one of the first experiences that pushed me toward getting a graduate degree.

Back to the group home. I discovered there was a county masturbation trainer (not their real job title, I think it was something like sexuality trainer, or something like that). They came out to the group home and evaluated the residents. The evaluation revealed that many of them did not possess neither the physical ability (i.e., dexterity) to masturbate or  have the attention span to learn.

Those that did, assuming that their guardian gave consent, could have access to a variety of training materials (videos, instruction with anatomically correct dolls, etc.). As you might guess, the only resident that was deemed capable of learning to masturbate was the resident who had the guardian who believed that masturbation was a sin. 

Can you imagine that--not having the attention span to masturbate or the physical ability to manipulate your body parts with your hands (or other tools) to get the job done? Just think about that for a minute. I'll wait.

Here is an interesting factlet: from the time period of 1942-1989, it was reported that 652 men in a single institution were castrated to control (aka prevent) masturbation. Some current treatment protocols involve squirting lemon juice into the mouths of people who are masturbating in inappropriate places. Click here for a very interesting article about interventions for socially inappropriate masturbation.

Imagine that. Castration to control masturbation. Squirting lemon juice in the mouths of those who are being offensive and wacking off in public. Is one expected to believe that someone with no verbal skills can distinguish between the pleasure of masturbating in private and the punishment that comes from masturbating in public? I think not.

There are of course better ways to help out those who are most vulnerable. Are you the caregiver for a person with a developmental disability, or know someone who is? An educator? Do you have a disability yourself? I've put together a few resources.

• "Sexuality and disability is still a taboo subject: Therefore, it is important to be informed about sex and erotic desires and the possibilities to fulfill these desires." Check out the website www.myhandicap.com for more information. Of particular interest, and for provocative thought, read their article about sexual assistants. 
• For more information about disability and sexuality, check out the Center for Research and Education on Gender and Sexuality.
• Disabled World offers a helpful page on disability sexuality and sex and sexual issues with disabilities.
• Two helpful lists of books and training materials for sexuality education with persons with developmental disabilities can be found here and here.

The View From Here: Super Moon Edition

The View From Here: Worried For Snow White Edition

May is for Masturbation

In 1995, Surgeon General Joycelyn Elders dared to utter the word masturbation. Among the many things she said, Dr. Elders said "in regard to masturbation, I think that is something that is part of human sexuality and it is a part of something that should be perhaps be taught." John Boehner, who was apparently still orange at the time, said "her war on tradition values, her crusade to legalize drugs, her efforts to put condoms in the pocket of every five year old is over."

"I told someone, 'I went to Washington feeling like prime steak, and I left feeling like low-grade hamburger,' " Joycelyn Elders, MD

The resulting controversy resulted in her being forced to step down at the leading medical voice of our country. She was clearly a woman before her time--and a woman we very much needed to show us the way. Take a listen:



To help keep our country talking about the importance, the San Francisco store Good Vibrations named May as National Masturbation Month to keep our focus on open, honest, and frank talk about masturbation and sexuality--just as our Surgeon General had hoped.

I'm not sure we really have gotten all that much further toward a responsible, open, and non-sexually repressed society in the 18 years since Dr. Elders was fired. I remained shocked at how many psychologists are unable to talk about sex and sexuality with their patients, and remain amazed that so many come to my office having felt prevented by other therapists about talking about sex and sexuality.

This of course does not surprise me. In my eight years of post-baccalaureate training, sex was not mentioned a single time in a class, lecture, workshop, or small group meeting. Not a single time.

Okay, that is a bit of hyperbole. It was mentioned once, as a post-doc. Our list of "pleasant" activities for teens to engage in to help improve their feels included masturbation. No one ever mentioned it and the list was eventually changed. Already being irreverent, and iconoclastic, I  made it a point to continue talking about masturbation.

I have a few key experiences and people to thank. My parents, of course, who I believe came from the Dr. Ruth school of parenting (is there such a school?). Sex and sexuality was something that was private but could be discussed in appropriate ways (and my mother was filled with all sorts of wonderfully inappropriate jokes). I also was a trained safer-sex educator in New York City in the early 90s. I carted around a bag of dildos and condoms in the subway back and forth to classes that I taught teens so they had the skills to protect themselves from HIV. I also have to thank my first very first patients at the Free Medical Clinic of Cleveland. I had no choice but to figure out how to talk openly about sex in the context of therapy because it was part of what every one of my clients wanted to talk about.

My biggest thanks, however, goes to one clinical supervisor in my doctoral program, Glenda Russell. She was my only supervisor who spoke about this part of the human experience. She taught me that if I'm not talking about sex and sexuality in therapy with my clients I am doing something wrong. She taught me how to talk about it. Additionally, she taught me that it's my responsibility to bring it up if it wasn't being talked about.

If your clients aren't talking about sex, age, religious, race, disability, or any other difficult topic in the first three or four sessions they will never be able to talk about it. If they don't bring it up, it is your responsibility to bring it up so it becomes something okay to talk about. 

I haven't forgotten these words--and have seen hundreds of patients blush at first mention of sex, masturbation, sex toys, or any other "sensitive" topics. I've also watched those same patients look relieved and relaxed as they are able to become more whole people, capable of openly talking and thinking about "unmentionable" issues.

In honor of masturbation month I have a few things to say: shame on you, therapists who are unable to have frank conversations about sex and sexuality. This is important, and by not creating space for your patients to think about these issues you are failing in your responsibilities to your patients. The biggest shaming goes toward clinical training programs who are so uptight that they swoon at a single mention of sex or masturbation. It's not as if we are going to grow blind. In fact, there are myriad health benefits associated with masturbation for both men and women. Try it out. You'll see.

Lastly--all of you--go out and have some safe and consensual fun. Talk about masturbation. Talk with your friends about sex. Go to a sex shop. For those of you who are repressed New England types, try holding hands in public. You have to start somewhere. 

Happy Birthday Keith

Happy birthday to Keith Haring, who would have been 54 today. He felt his swift hand was not controlled by himself, but by some mysterious artistic force. "If you are being honest to yourself, and honest to whatever this thing is coming through you, that the work makes itself and you just become a vehicle for it."

The imagery that came through him gave us all ways to think about birth, death, sex, and war. Take some time today to look at the world through his eyes. What do you see?

The View From Here: Community Wine in Community Gardens Edition

Apparently here in Cambridge the community gardens feature community wine. A nice touch.