Dear Young Therapist: Perspective is Everything

When I was in fourth grade I became somewhat obsessed with learning about the native people of the Americas. I poured through all the age-appropriate books in my school and public libraries, wrote age appropriate papers, and made a few age appropriate art projects. 

Somewhere tucked away in a box is a coffee stained crayon drawing that I made depicting the life of Seminole Indians. Mr. Sturgeon, my fourth grade teacher pictured on the left, wrote me an apology for the coffee stain. 

I was particularly fascinated with the people who lived in Central and South America: The Aztecs, Incas, and Mayans. The age appropriate books I read showed images of the savagery of the Aztecs. My young mind was particularly aghast over their sacrifice of humans to their sun god. I was horrified at the descriptions of beating human hearts being removed from people with flint knives. I worried about how that must have felt for both the sacrificed as well as the priest wielding the knife. 

It was such a strange juxtaposition--being attracted and repulsed at the same time. 

What I didn't know in fourth grade was that the history I was learning was from the perspective of the conquerors. We tell stories of native peoples as savages, in part, to reinforce a white Western European superiority. 

Myriad are the things that weren't included in suburban grade school lesson plans.

Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again

Meeting Humpty Dumpty/Joanna Pasek

Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall;
All the king's horses and all the king's men
Couldn't put Humpty together again.

--Mother Goose

We don't like to admit that things that are broken cannot always be repaired. We develop empirically supported interventions that demonstrate our facility for erasing symptoms of mental illness and curing the ills of the psyche. Chemists and biologists develop powerful substances that right the wrongs of the miniature chemical metaphors for mental illness inside the synaptic cleft.

We wrap ourselves in god-like metaphors of power, control, and authority. We heal the wounded. We restore the broken to a state of wellness. We right that which was wronged. 

We try to place all of the evils, pains, and terrors of our world back into Pandora's box with the hope of this cure called psychotherapy. Our way out of mental illness, a hope for a different future, has become interwoven with these notions of restoration and repair. Returning things to the way they were.

I've grown convinced this is not always possible. Even if it was, I'm not sure it is advisable. 

...and for those we can't repair? We call them treatment resistant. We tell them they don't want to get well. We tell them they are not ready to get well. We find any number of ways to subtly make them responsible for being broken, for not allowing us to repair them, or for having experienced a trauma from which there is no repair.

I don't think that's advisable at all. 

On any given day any number of survivor stories pass by my eyes on the internet about those who have experienced sexual abuse. As our seemingly endless "war on terrorism" slogs on, I see an increasing number of wounded soldiers displayed for pubic consumption. Stories like these make me angry and sad, hopeless and hopeful. Thousands of tales of lives broken by sexual and physical trauma. Thousands of tales of lives restored through the power of hope, courage, caring, and empowerment. 

As someone recently mentioned to me, some do come out of a traumatic experience stronger. Some find a certain kind of beauty in the growth that occurs after a trauma. Some isn't all. In fact, some is a far way away from all. 

Every 65 minutes a veteran of the US Military commits suicide.

Adults who have experiences sexual abuse are twice as likely to have a suicide attempt. 

What happens when that which was broken cannot be restored? Who speaks for those who are broken and either cannot or will not be repaired?

A huge industry of self-help groups have grown up around the books A Courage to Heal and Victims No Longer. While both books, in many ways, put childhood sexual abuse on the map, they both also perpetuate a disturbing trend toward a wish to repair that which remains unrepairable. An industry has grown up around us depicting survivors of sexual and physical traumas as strong, proud, and invincible warriors. I wince every time I see this meme replicated. I realize saying this may make me somewhat unpopular in some circles of the sexual abuse healing industrial complex.

I think we've lost our way, young therapist. In following our culturally prescribed roles to be powerful healers we've forgotten that not everything we touch can be restored. Sometimes, no matter how hard we try, we cannot put Humpty Dumpty back together again.

I'm not even sure it is important that we even try.

It is not that I am against strong, proud, and invincible warriors. I think those who find their journey takes them to these places are mighty fine. They've found their voices and found ways to make their lives a life worth living. 

What about the ones who find that no measure of gold or silver can hold the pieces together again in a fashion more beautiful than that which existed before? What of those who tried kintsukuroi and found they have nothing but a pile of pretty broken pieces?  What of those who, like Humpty Dumpty, have fallen and learned that all the kings horses and all the kings men cannot put them back together again?

Who speaks for them?

“If people bring so much courage to this world the world has to kill them to break them, so of course it kills them. The world breaks every one and afterward many are strong at the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.” -- Ernest Hemingway

Somewhere along the way, young therapist, we've forgotten that our most powerful tools are not those which fix broken things. Our most powerful skill is our presence and our attention. 

Don't get lost in the illusion that therapy is about fixing the broken parts of people. It's nice when we can fix things. Don't get me wrong. It's just that fixing isn't our most important task. Somewhere in our training and acculturation as a therapist we learn to stop listening and get lost in our own theories of how to fix things. We move from being having a role of a midwife of dialogue to the role of a high-tech mechanic. 

The map is not the territory. -- Alfred Korzybski

The description is not the described. -- Jiddu Krishnamurti

The map is not the thing mapped -- Eric Temple Bell

Sometimes we therapists have a very helpful map to offer. Other times our maps are a hinderance and obscure the road ahead for our patients. In the end, the best maps are those which our patients create. The ones we have to offer are just temporary aids. 

Therapy is about helping people see the broken parts of themselves. Therapy is about being witness to that which was broken. Therapy is about co-creating a space where our clients have a place to feel fully broken, to feel helplessness and despair, and for clients to discover in their own ways the contours of the territory ahead. 

Don't forget to listen, young therapist. Create the space for people to be broken. Allow your patients the dignity of the agency to decide what lay ahead. 

Help them find their own maps and their own territories. 

Do not accept any of my words on faith,

Believing them just because I said them.

Be like an analyst buying gold, who cuts, burns, 

And critically examines his product for authenticity.

Only accept what passes the test 

By proving useful and beneficial in your life.

--The Buddha 

I can describe the mountain, but the description is not the mountain, and if you are caught up in the description, as most people are, then you will never see the mountain.

-- Jiddu Krishnamurti

Or as my mentor Joseph Shay used to say, "I'm just one guy talking."

For more letters to a young therapist see Dear Young Therapist: Don't Be Afraid of the Dark; Dear Young Therapist: That Time My House Burnt Down; Dear Young Therapist: Cultivate Patience and Listen to the Music; Dear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie Incident; Dear Young Therapist: Are You Ready to Jump; Dear Young Therapist: Perspective is Everything; Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again; Dear Young Therapist: Sometimes Race and Sex Matter; Dear Young Therapist: Don't Be Afraid to Love; and Dear Young Therapist: Allow for the Unexpected.

Dear Young Therapist: Don't Be Afraid to Love

"Graduation" by Caroll Lewis

Dear Young Therapist:

Love is a word you've probably not heard in your training. It's probably not appeared in your textbooks, been a topic in seminars, or come up in conversations with your clinical supervisors.

If you've talked about love at all, you've probably talked about avoiding it. You might have even been taught that love is a hinderance to therapy.

The messages about love that I've learned in the past twenty-one years of clinical practice are clear. Love is something that must not be discussed between patient and psychotherapist. It certainly is not something to be experienced--and if it is--it should be concealed and unspoken. Love is too dangerous. It is too confusing. The risks are too great. Patients get confused in therapeutic relationships and mistake care for love. Some patients, traumatized by violence, are too fragile to understand that love does not have to be sexual.

Perhaps you've been taught to be neutral, objective, relatively non-emotional, and essentially impersonal. Perhaps you've even been taught that it's useful to deprive your patients of the emotional connection they want in order to foster growth and achievement of therapeutic goals.

I was admonished by a supervisor once for gratifying a terminally ill patient's needs by expressing care for him. She was concerned that I wasn't giving him the opportunity to work through his infantile infintile (thanks CS for finding my parapraxis) dependency needs.

Later, as a postdoctoral fellow, I was taught to never tell a patient that I was proud of them. It was explained that it was too complex of a feeling and patients would get easily confused. I must not ever express love or pride. Patients need to learn to accept the limitations of the therapeutic relationship so they can learn to tolerate not getting their needs met in their other relationships.

I've also learned some other things along the way.

• I wasn't even 20 years old when I had an internship at a rape crisis center. I was left alone in a room to be supportive and helpful for people who endured unimaginable traumas. I had no skills, no words of advice, and certainly no therapeutic interventions. I did the only thing I knew how to do: I cared deeply for my patients and loved them. I never said a word of this, of course. I had already absorbed the notion that love is an unmentionable word in clinical contexts. Still, this was the first time I became aware that expressing care and concern (and genuinely caring and being concerned) for people--in and of itself--can be healing. 

• Two years later I was living in Ithaca, New York. It was my last day working at a supervised apartment program for adults who had developmental disabilities and mental illness. The residents threw a surprise party for me. I walked into one of the apartments to do my last check and I was surprised with a song. After a rousing chorus of "For He's a Jolly Good Fellow" each one of the residents and staff gave me a hug. Most of the residents whispered in my ear that they loved me. I whispered quietly into each of their ears "I love you too." I worried what people would think but said it anyway. It was true.

• Two years after that I sat on the back stoop of a shelter for runaway and throwaway teens. A male resident had ran away from the runaway shelter. As he was thinking of returning, I sat with him while he raged against the world and how poorly he had been treated. I looked at him with all the love in my heart. I remained silent fearing what would happen if he heard those words. 

• Three years later I sat with an gentleman in his late 50s. He'd been diagnosed with HIV before the virus even had a name. He was having a bad day--filled with pain from the side effects of his medications. He was afraid of dying alone. I sat next to him on the couch and held his hand. I loved him and wished I had the courage to tell him that.

• Three years later, I met two women that forever changed the course of my career. My supervisors and teachers, Robin Cook-Nobles and Judy Jordan, regularly--and fearlessly--talked, taught, and told me that it was okay (and powerful) to love my patients in appropriate ways. I vividly remember the rainy afternoon Robin said that it was okay to love patients, and okay to talk about it. I've never heard a psychologist say that aloud before. I've never heard a psychologist say it again since leaving the Stone Center.

• Later that year I drove to do the oral section of the second part of my comprehensive examinations. My intervention, though concealed with flashy prose and the relational cultural model of the Stone Center, rested in my love of my patient and this song. I almost failed. My intervention was not seen as a strong one. I was not doing things like I was supposed to--I failed to conform to accepted protocols. My stubbornness and belief in the inherent worth of my patient carried the day. I passed.

• A few years after that, as a post-doctoral fellow, I worked with a rather ornery teenager. Rather than talk with me and tell me how much he disliked me and the rest of the world, he sprawled himself out on the couch and pretended to sleep. Every so often one eye would peep open to see if I was still paying attention. I sat for the entire hour focused on him, loving him, and imaging how his parents might have (or might not have) just sat gazing at him with love when he was a tiny baby. My supervisor, Louise Ryder, seemed moved to tears when I told her this story. I was too. 

I've developed a good deal of technical brilliance in the last twenty-one years of working with people. I can create masterful interventions in a variety of modalities and nimbly conceptualize people and problems from a variety of theoretical orientations. You'll need to learn how to do this too, young therapist. It's a necessary part of learning to be a good at what we do.

Technique and skill, however, are not enough. Don't let yourself dwell too much thinking you are something special. Most trained monkeys can develop technical brilliance with the number of hours we spend in supervision and class.

There are more important things that cannot be taught. They must be discovered.

You'll need to learn to love. Loving patients is a dangerous method. Yet in the end, I think you'll learn that it is the only method that you'll keep by your side--day in and day out--for your entire career.

Love is the only method and theory that I have. It is the place from which every action I take as a psychologist originates from--at least on days in which I am not cranky. I suspect many other therapists, of all training and orientations, would discover the same after wading through years of injunctions against and fear about love.

When I graduated from high school my mother gave me the book her mother gave to her when she graduated from high school. In some ways, this passage started my development as a psychologist. Vicktor Frankl writes in his book Man's Search for Meaning:

Love is the only way to grasp another human being in the innermost core of his personality. No one can become fully aware of the very essence of another human being unless he loves him. By his love he is enabled to see the essential traits and features in the beloved person; and even more, he sees that which is potential in him, which is not yet actualized but yet ought to be actualized. Furthermore, by his love, the loving person enables the beloved person to actualize these potentialities. By making him aware of what he can be and of what he should become, he makes these potentialities come true.

More recently, reading Gail Hornstein's book To Redeem on Person is to Redeem the World: The Life of Frieda Fromm-Reichmann,  I came across this passage from Erich Fromm's book The Anatomy of Human Destructiveness:

To have faith means to dare, to think the unthinkable, yet to act within the limits of the realistically possible; it is the paradoxical hope to expect the Messiah every day, yet not to lose heart when he has not come at the appointed hour. This hope is not passive and it is not patient; on the contrary, it is impatient and active, looking for every possibility of action within the realm of the real possibilities. 

So there you have it. Love and Faith. The two bookends of my professional practice as a psychologist. Deceptively simple. Incredibly powerful. Often scorned by the professional community.

I'm old enough to no longer care how my fellow psychologists evaluate me. I'm skilled enough to know how to wield these twin tools of relational growth and change within the safe boundaries of a therapeutic relationship.

I'm thankful that I've never met a patient that I couldn't love or couldn't learn to love. It's from that space that I begin to see the seeds of where a person might be able to go, grow, and let go. It's from that space that I can find the confidence to let go of wanting a patient to be something I need them to be (or society needs them to be) and let them go about finding what they need themselves to be.

Still, young therapist, I don't frequently tell my patients that I love them. It is often dangerous and disruptive to use the word. Patients can become incredibly confused and conflicted. Too many therapists also become confused and conflicted.

Just because love is dangerous, doesn't mean it shouldn't be thought about.

I am not afraid to love and to say that I do when a moment of genuine honesty is the best intervention. Don't forget this, young therapist. Don't forget that our work is built on a foundation of faith in humanity and love of the person who sits across from you.

The flashy (or boring) masterful interventions and protocols you learn are necessary. Caring and loving and believing in humanity is necessary. Neither, on their own, is enough to accomplish much of anything. Joined together you have the possibility for movement and growth.

You need to both become a master at your craft and a master at loving a fellow human being--being with a patient, loving them, caring for them, and having faith in them--in combination with masterful interventions--that allows another person to find themselves.

We wither and die alone.

We grow in connection with others. We grow in being loved by another. We grow in finding that after all we've experienced, you've got the love inside--it's been there all along.

I had a dream that our hearts are like flowers

opening up every time that we love

and I'm wondering if we just try and risk everything for love

how can we ever go wrong

Nobody said it would be easy

nobody said it would be fair

all we can do is try to keep our fears from running us

just let our innocence be our cure

#radiowisdom

For more letters to a young therapist see Dear Young Therapist: Don't Be Afraid of the Dark; Dear Young Therapist: That Time My House Burnt Down; Dear Young Therapist: Cultivate Patience and Listen to the Music; Dear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie Incident; Dear Young Therapist: Are You Ready to Jump; Dear Young Therapist: Perspective is Everything; Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again; Dear Young Therapist: Sometimes Race and Sex Matter; Dear Young Therapist: Don't Be Afraid to Love; and Dear Young Therapist: Allow for the Unexpected.

Empirically Supported Protocol Based Psychotherapy

Necessary, but not sufficient.

Pretty in Pink: Two Vintage Chinese Men

Two Chinese Men in Matching Traditional Dress, c, 1870s 

While this image of two Asian men does not portray the men as having a particularly intimate relationship, it does show men who usually don't find their way onto websites chronicling intimacy between men. The vast majority of vintage images that bloggers post depicting intimate relationships between men are of white men. It's rare to find images of men from other races.  

This image is also also an excellent example of how our unconscious associations with certain symbols shape the meaning of what we see. This picture on the left of two Asian men with pink robes--they must be gay, right? 


The pink robes worn by the two men in this picture read to many bloggers as something that constitutes gayness. It's not necessarily a signifier of sexual orientation or attraction. Beyond the pinkness, I can't fathom why people listing this image on blogs and Tumbler would see this picture as one that depicts a vintage gay relationship.

The thousands of observations we make about people in our silent and mostly unconscious process of categorizing and stereotyping people into easily understood categories aren't any more accurate that are assumptions about the color pink in this photograph. Our categories and stereotypes are useful heuristics--but they need to be constantly evaluated and checked with actual data.

In all probability, these men are not gay. It's unclear whether or not they even have any sort of relationship (intimate or not). 

Perhaps a reader with knowledge about 19th century Chinese history might come upon this blog and share some thoughts (anyone read Mandarin? The text in the background might say something interesting). 

The men in the image, the story about why they were captured on film, and who the photographer was are currently unknown. It's fairly easy, however, to find out a lot about some basic identifying information about the image. 

This albumen silver print from a glass negative, produced sometime in the 1870s, is owned by the Metropolitan Museum of Art. The image, not currently on display in the museum, is one of 8,500 photographs from the Gilman Paper Company Collection. If you want to do some very deep research on the people who collected this photographs, check out these two articles about the rise and fall of the Gilman family fortune: here and here. 

Beware of what you think you see when you look at photographs. We easily see what we want to see in vintage photographs. It's much more difficult to stand back and let the image tell us the story it has to tell.

This goes for viewing people in your day-to-day life, too. It's always more challenging--and rewarding--to stand back and let a person tell their own story rather than to hear the story we think they should tell.

For more images of vintage men and their relationships (some gay, some straight) visit: Two Men and Their Dog; Adam and Steve in the Garden of Eden: On Intimacy Between Men; A Man and His Dog; The Beasts of West Point; Vintage Men: Innocence Lost | The Photography of William Gedney; It's Only a Paper Moon;Vintage Gay America: Crawford Barton; These Men Are Not Gay | This Is Not A Farmer | Disfarmer; Desire and Difference: Hidden in Plain Sight, Come Make Eyes With Me Under the Anheuser Bush, Hugh Mangum: Itinerant Photographer, Two men, Two Poses; Photos are Not Always What They Seem,Vintage Sailors: An Awkward Realization, Three Men on a Horse, Welkom Bar: Vintage Same Sex Marriage, Pretty in Pink: Two Vintage Chinese Men, Memorial Day Surprise: Vintage Sailor Love, Memorial Day: Vintage Dancing Sailors, The Curious Case of Two Men Embracing, They'll Never Know How Close We Were, Vintage Love: Roger Miller Pegram,Manly Affections: Robert Gant, Homo Bride and Groom Restored to Dignity, The Men in the Trees, The Girl in the Outhouse, Tommy and Buzz: All My Love,Men in Photo Booths, and Invisible: Philadelphia Gay Wedding c. 1957. You can also follow me on Tumblr.

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 Heart of the Story Part I: Yoda Meets Cognitive Behavioral Therapy

My mother recently sent me a rather long e-mail. That's not a particularly uncommon experience. Answering it here on my blog, however, is very unusual.

You talk a lot about life as the stories we tell ourselves.  I've been thinking about that a lot lately. Do you have a good resource for me to read about this?  Have you written anything about it on your blog that you could perhaps share with me?

Actually, I don't think I have written much here on my blog about stories--and how those stories are the way in which I've come to see as the way we create our own humanity. Since she asked, and since I've been looking for a good topic to write about, why not have you all join in on my response to my mother?

I just finished a book entitled, You Don't Look Like Anyone I Know.  It's a true story about a woman who came from a chaotic, dysfunctional family, as in her mother was a paranoid schizophrenic & her father, a cross dressing alcoholic who was also crazy.  She had been face blind all of her life, but didn't really realize it until she was in her early 40's...  I took some rather extensive notes citing the more interesting parts. 

For those of you who wonder how the Irreverent Psychologist got to be the Irreverent Psychologist: you might find some clues in the above paragraph. The Mother of the Irreverent Psychologist (MIP) notes that she has taken "extensive notes citing the more interesting parts" of the book. As regular followers on Twitter may have noticed, a small portion of the voluminous notes I take while reading appear on my Tumblr page. 

The nut doesn't fall far from the tree. 

...but I digress. The MIP started her email with a question about stories but manage to ask two questions. The first question--about stories--will come a little later. First I'll tackle the MIP's question about cognitive behavioral therapy.

The Safe Emergency of Therapeutic Situations: Fritz Perls and Gloria (and me)

Recently I wrote about Carl Rogers. While putting together that blog post, I rediscovered the "Gloria" tapes that every psychotherapist-in-training has likely had some exposure. The tapes were therapy demonstrations filmed in 1965. "Gloria," a young recently divorced women, volunteered to meet with Carl Rogers, Fritz Perls, and Albert Ellis.

I haven't watched this tapes in years--the last time was perhaps sometime in the late 1990s. They are fun for me to watch. It is also interesting to see a lot of myself--both my history and my current practice--embedded within the words of these three men.

Let's start off with Fritz Perls. Along with his wife Lara, he founded the school of Gestalt psychotherapy. It's not a theory I think a lot about anymore--that's probably because the theory itself sits deep in my bones and works behind everything I have learned. In the early 90s I started hanging out at the Gestalt Institute of Cleveland, took several workshops, worked individually with a gestalt therapist for several years, and later participated in a gestalt therapy group for several additional years.

I'm indebted to this early teachers--Jody Telfair, Barbara Fields, Karen Fleming, Mary Ward, and Jackie Lowe Stevenson. There have been many teachers since then but none so central as these.

On to the show. Here is part one of the the full Gloria tape with Fritz Perls.

A friendly sort, eh? Before judgement sets it, put Perls in his time. This was 1965. It was a time of great social change and liberatory movements. Confrontation was in, as was, apparently, smoking.