Category Archives: De-Mystifying Therapy

Entherapalgia

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There is a particular emotional state, which through my years as both a therapist and a client of therapy I have come to recognize as a distinct state that we don’t seem to have a name for. It happens in the milliseconds following the experience of getting something we’ve needed for a significant length of time, almost in tandem with the needed relief. I’ve decided to begin calling it entherapalgia, meaning “the pain within healing.”

Somatically-speaking, it tends to show up as an opening sensation in the chest and/or stomach, often accompanied by a little gasp and a sigh that brings some muscle relaxation. Sometimes that relaxation is the softening feeling that precedes crying. Similarly, entherapalgia can feel like a sigh of relief and a punch in the stomach in tandem. As you might imagine if you can feel into those particular sensations, it can be difficult to tolerate.

Because it involves a lot of vulnerability, we will sometimes tense up when we predict that an experience will evoke the feeling of entherapalgia, or we try to clamp down on it once it’s begun. Both pleasure and pain share one entry point in vulnerability, so even though staying open is how we heal, it doesn’t always feel safe enough to do so.

Since I began using this word for myself and my clients, I’ve found that it’s quite helpful to expect healing to be a little painful. Why shouldn’t it be? Physical healing almost always is, especially when what we’re healing is something that we’ve been organizing ourselves around for a long time (my posture-correcting physical therapy comes to mind). When something pleasurable or relieving makes contact with something that hurts, of course we’d feel both. It’s an extra challenging one to be sure, as it seems that the experience of being vulnerable doesn’t really get easier, just more familiar. Though familiarity does bring some amount of comfort.

Part of the beauty of somatic work is in making space for healing by learning and practicing how to experience pain in a tolerable way. The aim is always for experiences to be embodied rather than solely intellectual, and the intellect and senses can be helpfully bridged with the right words. So I hope this term and its framing can be a support in our ever-progressing process of learning how to be vulnerable.

Shame Overload

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Shame fills the little hollow cavity that vulnerability creates.
-Kate Sheehan

Kate is my therapist. She said this to me in session when I was struggling to make sense of an emotional reaction I’d had. I think it’s a perfect articulation of the somatic experience of shame, and it was especially useful to me in that moment, because I hadn’t yet become aware that shame is what I was feeling. And that’s the thing about shame. It is so good at its job that you don’t even know it’s there. I think that’s exactly what’s happening in our country right now. It’s an ugly process the way it’s being held within our current political structure, but people are bringing it into the therapy room and it tends to go pretty damn well there. So let’s look at why and how, and get moving on resolving this on the cultural level.

Let’s begin by giving shame a face so that we can keep our eyes right on it, which is what shame both hates and needs. Shame is extreme discomfort caused by the feeling of not being ok with oneself. This discomfort stems from a chasm between how a person is seeing themselves or believing themselves to be seen, and how they believe they are supposed to be according to their own standards or societal ones. I often go to the words of Brené Brown for guidance here, and her distinction between guilt and shame is particularly handy: where guilt is “I did something bad,” shame is, “I am bad.” Somatically-speaking, it is the desire to hide when feeling more than a tolerable amount of discomfort with being seen. When we feel shame, we are often motivated to hide at any cost- sometimes literally, sometimes behind thoughts and words. Most painful and most insidious is that shame can be so good at getting us to hide that we will sometimes hide from ourselves. Typing #metoo into the town hall that is social media has been a way to bring ourselves back out into the light, and into the light we are bringing the shame that forced us into darkness. That affords us an incredible opportunity to face and dispel toxicity. But the gravity around shame is strong.

Allow me to disclaim right here that this article does not contain anything graphic, but I am going to discuss various aspects of sexual trauma and that alone can evoke difficult sensations and emotions. Please go slow in reading, and use your intuition to take care of yourself in what ever way you might need. What I’ll be focused on here is the role shame is playing within the #MeToo Movement and how to manage shame outside of the therapy setting, because we are struggling like crazy with resolving our collective experience of it. And thank goodness, because we are long, long overdue.

Brown writes that “shame gets it power from being unspeakable.” I would bet that that’s hugely why it’s taken us so long to begin to look at these topics that evoke so much shame, and why we’re having such a wretched time with it. Working with shame means regularly walking the line between tolerability and traumatization. That is exactly why trauma work requires a trained and practiced professional. And yet here we are having to work it out within our social-political structure.

So let’s get into what shame needs. In the therapeutic setting, shame surfaces the most often around intimacy and sexuality, and especially around sexual or physical trauma. This is because the body and its contact with others is the most potent medium through which we experience ourselves and the world. When these experiences go poorly, especially if they go poorly many times and/or are traumatic enough, shame begins to take up space within them. If we are quite young when these difficult or traumatic experiences happen, shame is particularly likely to rush in as a way to protect us. It is, in fact, a penultimate resort- the last stop before dissociating entirely. Sometimes it simply becomes a launching pad into exactly that. We can’t avoid feeling, but we can avoid feeling what we’re feeling. It’s a brilliant mechanism when we have nothing else at our disposal, and the protective part is something to keep. The work is in replacing shame with other forms of protection, so that feeling can become safe again.

In somatic work, we work directly with the experience of being seen in the literal sense. When in the therapy space a client and I are onto shame and its sneaky little game, we begin to look at the nature of our eye contact, at how much space is between us in the room, whether I’m facing them directly or I’m at an angle, what sort of physical contact might be helpful, if any- all these ways in which we can contact each other in the room. What we’re doing is finding out together what’s needed in order to have safe, comfortable, authentic connection, which is the antidote to shame. From there we continue to practice listening and responding to the body as we work to stay in contact with ourselves and each other.

Let’s deepen this a bit further with an example of how shame typically shows up around sexuality, since it’s sexual content we’re dealing with in our cultural struggle right now. In the therapy room, the experience usually goes something like this: a person realizes that naming something sexual is necessary within what we’re exploring (that is in itself a feat to be celebrated since shame will keep us quiet for a long time). This might be a fantasy or desire, a masturbatory habit, a frightening encounter, or even just a casual remark with sexual content. Even if there’s conscious awareness of how it could help, the disclosure might be followed by sensations of shame. Shame needs no invitation from us. So a person might begin to feel things like: a sinking sensation, pressure in the chest, closing one’s eyes, covering the face, feeling cold, feeling numb, feeling floaty or fuzzy, feeling confused. These sensations overlap heavily with the symptoms of dissociation, and that makes sense, right? Shame is about hiding, and dissociating is a very effective way to hide by hiding from what you’re feeling. For that same reason, anger has a high chance of surfacing in this space. It will sometimes surface when shame is being evoked, and sometimes it will rush in to replace the experience of shame after it’s begun to be felt. Feeling angry is especially common for people who were raised not to show any vulnerability. They don’t know what to do the feeling when it surfaces, so they feel angry at whoever or whatever made them aware of feeling it. I find it really helpful to know how common this is, because it helps me to respond appropriately. Let’s spend another moment on that.

One of the aspects of shame that seems to me to be the least understood is that it will surface entirely on its own. It doesn’t need to be drawn out or added to. Because it’s a protective mechanism of the autonomic nervous system, it pops up automatically. So what’s needed most for the experience of shame to become useful is for it to be safe to become vulnerable. I like to think of shame, and guilt too, like an alarm bell; it lets us know that there’s something to pay attention to. The struggle almost always comes in the response. We have to know how to pay the right sort of attention to shame to create a proper holding environment for resolving what ever is being highlighted by the shame. This is exactly what makes it so incredible when a person who has been a victim of sexual violence is able to speak up for themselves despite a high likelihood of being shamed. They are doing for themselves in that moment something that very few of us can do: create the space to be vulnerable, open up our chests, and keep them open by shrouding them with respect, kindness, and acceptance as we are pummeled with anything but.

I wanted to get this piece of writing out and into your inboxes and feeds, so I’m publishing it in its current form. I keep starting into other components of this dynamic we have around shame, but it’s getting too big for one article. I know what that drive is in me, which also motivates me to stop here for now: I want to help you create a safe holding space for yourself right this very moment, so that you can get on with the beautiful experience of being free to feel. But shame can’t be rushed out the door too quickly, or it comes back louder. The work is only done well at a steady pace. So I’ll keep at it and give you more pieces as soon as I am able to paint them, but I’ll leave you with the name of one particular portrait.

It is incredibly important to this process that we end the stigma around mental health, which contributes to the perpetuation of a hierarchical structure. Right now we’re working with an especially ugly version of patriarchy, but any hierarchical structure is problematic unless (or probably even if) we know how to be truly fair with anyone who we encounter. And this is not to diminish the agonizingly harmful effects of Patriarchy in itself; the problem is cyclical. Patriarchy perpetuates mental illness and the failure to address mental illness serves to maintain Patriarchal structures. If you want to dive further into understanding this in its complexity, I highly recommend the writing of James Baldwin, Audre Lorde, and Laurie Penny. They will show you how necessary it is to understand not just basic but complex principles of psychology and sociology. Low emotional intelligence is a severe hindrance to critical thinking. I happen to believe that emotional intelligence should be a core curriculum subject beginning in the first grade. Naturally there are many people out there teaching children how to notice and make use of their sensations and emotions. Yet what we’re seeing right now is in part an effect of a collectively low ability to address our intrapsychic worlds, so we know that we have to keep working at this. It’s a skill that needs to be more widespread and practiced far earlier in life, so as you move back out into the world after reading this, know that you can have an immediate, steady impact on all of this by being a proponent of mental health literacy.

What It’s Actually Like To Be A Therapist

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Spoiler: It’s awesome.

From time to time I’ll get little peeks into what people who’ve never been in therapy, or who went briefly, think it’s like. It’s usually off-base in some way, sometimes minor and sometimes pretty unsettling. A bunch of this is surely due to the many misconceptions and goofy portrayals of therapists in our entertainment media.  So I try very hard to be quite vocal about the reality of it, with the hopes that more people will allow themselves to find out. The work is incredibly beautiful and fulfilling. But its authenticity, and how that extends far beyond session time, comes up too infrequently. Even those who are clients of therapy probably don’t know a bunch of this stuff, which I realized when I began to have conversations about it with friend of mine. So I thought I’d share a few things that the general public might find fun, funny, helpful, relieving or maybe even a little scary.

I want to answer very thoroughly the question, “Is it hard not to ‘take your work’ home with you?” The short of it is that no, it’s not, because I know my role, and I’m pretty awesome at boundaries and self-care. I’m not a fixer. I’m a witness and a supporter. The work is entirely about healing and experiencing and growing. It results in the ability to enjoy way more pleasure, because you get to learn how to manage pain and complexity. And for any of that to happen it means I get to have deeply intimate connections with a bunch of people. It’s pretty awesome.

Now, keep in mind that this is about only me as a therapist. While much of what I will share is universal, that won’t be the case for all of it. Let’s start with a big, fun one…

I dream about my clients.

All.the.time. And how could I not? I spend hours with them engaged in deeply intimate, difficult and moving explorations. My dreams are part of those explorations, because they can inform me about what’s happening in my unconscious and subconscious in relationship to my client. They tell me things I may have missed, they inform me about what I’m thinking or feeling about someone, what I’m feeling about myself as their therapist, where their material overlaps with my own, etc. Sometimes I’ll dream that a client has met someone from my personal life, which opens up a whole other bag of possibilities: Is that about something they need in their life? Is it someone I would or wouldn’t want them to meet? Why? All of those things further inform me and our work together. It’s like free case consultation with my subconscious. Our subconscious is very smart, you know. It’s like the Oracle in “The Matrix.”

I think about my clients outside of session all the time.

It’s not just during my sleep that a client will pop into my mind. A song will remind me of them. I’ll see their favorite food and think of them. I’ll hear a joke that I want to share with them. I’ll see a store I think they’d like. I’ll remember a story they told and I’ll giggle or worry or feel proud. I’ll suddenly have a question or insight about them. The same goes for my old clients. I wonder how they are, what they’re doing, how our work together is or isn’t serving them now. And I often miss them like crazy.

I bring things from my clients lives into my own.

As with any interaction we have with others, I learn more about the world through my clients. I read books they read, watch movies they have mentioned, try restaurants they like. Sometimes I do it primarily for their sake as a means to deepen an exploration by having more information about it. Sometimes it’s just because it’s of interest to me personally. But even then, I enjoy thinking about my client, imagining their experience and thereby learning more about them in that way, too. And I get to learn more about myself, because I have my own, different reactions. In exploring those differences, I learn things about both of us.

I learn things from my clients’ processes.

I’m inspired by and learn from my clients all the damn time. If someone paid all my bills and supported my knitting and vintage clothing habits, I’d do this work with only that as payment because it’s a huge source of nourishment and reward. Because this work is about what’s best for the individual in front of me, I have to constantly look at my own stuff to keep it out of their way. And sometimes I’ll encounter a place where I have a blind spot or an unconscious agenda. Sometimes just recognizing that is enough, other times I have to take it to my own therapist to get her support in processing the material. Sometimes (and this is a fun and challenging one) a client will come in with something that I was just exploring in my own life. If the material is too painful or I can’t keep my agenda out of it, I refer out. But because therapy isn’t about advice-giving, and especially because I work somatically, the work stays clear. It very often doesn’t matter if I’m still working on the same explorations. So many of them are life-long, anyway. I think that’s beautiful. We are masterpieces that get to be attended to over an entire lifetime.

A client once asked me what the difference is between therapy and the outside world. As you can see, not a whole damn lot. That’s why you can and should trust it. It’s the safest possible version of the outside world, because we therapists are trained to be awesome at making it that way for you. It’s incredible what people are capable of when the environment and the relationship is right.

We affect each other. That is the point of therapy: to find healing in a relationship, and to master being oneself (in all its complexity) while in a room with another person so that you can move through the world in the same way.

If you have a therapist and this is bringing up a few questions for them, don’t be afraid to ask. Be ready to process what you learn, or even the question itself, but you can always ask. While we’re on it, the same goes for hugs. Little known fact: hugs are a-ok by a whole lot of us. Ask for them. See how cool this work is?

The Inherent Feminism of Psychotherapy

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One of my very favorite descriptions of therapy is that it’s about being with a person in such a way that they can be exactly who they are. This is also a fundamental part of the feminist movement, and all equal rights movements- differences are to be honored through equal rights and equal treatment. It’s a very simple concept, but it’s difficult to put into practice when you’re dealing with unconscious beliefs and motivations. These things guide as like a trance. And it is the realm of the unconscious where change must be exacted if we are to see it on a global scale. The practice of knowing yourself well enough to understand when you’re being guided by these unconscious forces is tremendously helping for staying mindful and present. Through the observation of present behavior, we are able to understand what the past meant to us.

When it comes to feminism, understanding the past occurs on a very grand scale. We must look at the thousands of years of cultural perspectives on gender to understand history and what led us to this point. This is why good education is paramount. It’s why it drives us feminists crazy that history lessons have such a heavily heteronormative, cisnormative and masculine bent. Worse, we too often fail to educate our children about how beliefs systems shape behavior and social constructions. Because it’s not just having information that exacts change.

This shows up in the therapeutic process all the time, and it’s why one can fairly quickly exhaust the benefits of the talk therapy modality. Insight does not always exact change. It gives us the why, but not the how. It is in the mastering of mindfulness and presence through much practice that we are able to really get our needs met. Only with this skill can we effect larger scale changes.

Institutional sexism (or any -ism) is a macro scale version of this unconscious process. The continue inequality of pay, for instance. is less of a malicious phenomenon than an unconscious one. For many historical cultural reasons, women are still often seen as inferior. So when it comes time to decide where a woman ought to fall on a pay scale range compared to a male counterpart. it’s the underlying beliefs that play the role that ends in bias. Tina Fey and Robert Carlock capture this beautifully with their comedic genius in The Unbreakable Kimmy Schmidt when Carol Kane’s character Lillian says, “Ah change the channel; I can’t get the news from a woman.” This strikes us as absurd, because it is! As a viewer, you can feel that this isn’t something she’s though through. It’s unintentional. It’s unconscious. It’s a spot on example of internalized sexism.

Internalized oppression is when a person has negative beliefs about oneself which result from the experience of oppression. This can pop up all over the place, because it’s inadvertent. And this is where we must explore ourselves and encourage others to do the same. Because activism, as with therapy, is impossible if we focus on patching up all the symptoms of the problem. If Lillian is to change this belief about a woman’s ability to provide the news, it will be necessary for her to explore her beliefs about the female gender. If we over-focus on the news issue, her beliefs will pop up somewhere else, perhaps even somewhere very similar. But through a therapeutic process she would be able to look at her own personal history to understand the influences leading to this belief, to process when she’s been a victim of it herself, and to be mindful of when and how she’s unnecessarily limited herself and others through the behavior resulting from this belief.

Institutional -isms are macrocosms of internalized -isms.

The skills one learns through psychotherapy can then be extended to others. Fostering the process of therapy as a society would cause a whole lotta healing on both the personal and, eventually, the societal level. I’m lucky enough to live in a city where most people welcome a reference to therapy. I can say, “I’ve been exploring that with my therapist,” and get an, “Oh, that’s great,” instead of a, “What do you need therapy for?” I love when people say to me, “I don’t need therapy, but…” because no matter how they finish their sentence, I get to say, “Actually, it sounds like you’d really like therapy!” Those sorts of negative reactions are indicative of underlying negative beliefs about therapy. And lemme tell ya, negative beliefs about therapy are misunderstandings of what it actually is. Negative experiences as a client certainly happen, but that doesn’t mean that all of therapy is painful or unhelpful. We can change these misconceptions by inspiring others through self-disclosure, normalizing, and through demonstrating what we’ve learned. The more people who are skillful at understanding, accepting, and expressing themselves will mean way less baloney interactions, personal and macro scale.

Mental health is a social contagion. Just look at powerhouse of openness and insight Amy Poehler. Her message “good for her, not for me,” encourages people to disengage from comparing and making assumptions, and it is a fabulous example of this. This one simple sentence demonstrates self-knowledge as well as openness to and acceptance of others’ differences. This is what comes from the therapy process. You learn how to reach understanding, so you can practice with yourself as well as with others. Engaging in the work of psychotherapy is a revolutionary act.

Big ol’ shout outs to the likes of HeForShe, Jade Rivera, Jenipher Lyn, and SmartGirls for engaging in this kind of micro-level activism. I triple dog dare you to watch one of Poehler’s Ask Amy videos and not feel better about yourself, others, and the future of our world.

On Sex Therapy

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I had the pleasure of being interviewed by one of my favorite sexual wellness companies, Peekay Inc., whose line of female-centric boutique shops are all about sex-positivity, education, and fun. Together we’d like to share with you about the beautiful world of sex therapy.

Originally published as “The Life of a Sex Therapist: Heather Brewer” by LoversPackage.com on 3 April 2015.

“We met Heather Brewer at the Sexual Health Expo in L.A. this January. She stopped by our A Touch of Romance booth, where we talked briefly about her work. With a focus on listening to our bodies, she is a great resource for sex and gender exploration.

Heather Brewer is a registered Marriage and Family Therapist Intern; Therapist internships can be likened to a doctor’s residency status. After seven years of face-to-face client work, Heather is close to completing her required 3,000 internship hours. She works under the supervision of Mindy Fox, a Marriage and Family Therapist in Santa Monica, California. As for her education and training, she attended the somatic psychotherapy program at the California Institute of Integral Studies in San Francisco.

Without further ado, here’s our in-depth interview with Heather Brewer.

 

What do sex therapists do, exactly?

“Sex therapist” is a bit of an umbrella term for slightly different types of healers who make sexuality a central focus of their psychotherapy practice. While sex is the topic of exploration, the modalities differ amongst us. I work somatically, which means that I have extensive knowledge of the body, and that I use it as a diagnostic tool as well as a vehicle for healing. Because the body speaks very clearly, what goes on for a person in their sexual life is both an excellent source of information about how they move through the world, as well as a wonderful place for growth and healing to occur. What I do in session depends on the wants and needs of my clients, but it always includes tracking of sensations and gestures.

“Heart rate, muscle tension, and the nature of one’s breath are major indicators of what’s happening in a person’s emotional landscape… Somatic work takes you beyond the ‘why’ into the ‘how.’” – Heather Brewer

 

What makes you, and your practice different from other therapists and sex therapists?

My specialization in sex and gender definitely sets me apart from many other therapists. Sometimes this is simply due to my knowledge base, but clients often seek me out for my willingness to explore these realms without judgment. Sex can be so evocative that people sometimes won’t engage in a process with it, or fail to see it as symbolic of a larger dynamic.

Most sex therapists are very familiar with the inner workings of the body, especially the nervous system, but not all of us work somatically. For instance, let’s say a couple comes to me because neither one of the partners is adept at initiating sex. This dynamic will inevitably play out in our sessions (they might both experience discomfort with starting to talk when the session begins, etc.), and they will be gently and safely guided through becoming conscious of it, and practicing better ways of relating. Somatic work is really effective and long-lasting, because it’s systemic. You can’t hide from sensation.

Also, I often quote Seinfeld or refer to Star Wars for analogies. And actually, that brings an important point to mind. I’m very big on being myself in the room. It’s the relationship between therapist and client that is the most important in therapy, so it matters that my clients and I like each other. Therefore, I have to show some of myself and my emotions. So our particular ways of being will inherently differ from each other.

 

Can you pick three words that describe the world of sex therapy? Can you share how these words are important?

Beautiful, intense, and complex. These are the things that come up for me the most often both in my own explorations, and in my work with my clients. I think they kind of speak for themselves, and they’re necessarily subjective anyway. It’s such a vast landscape.

 

Who can benefit from seeing a sex therapist? Who might it not help?

I truly cannot imagine anyone not being able to benefit from exploring their sexuality, because everyone has one. It is simply part of our being. And it is my belief that all therapists ought to be comfortable making this a part of their practice, and I hope that “sex therapist” will eventually be a redundant term. But perhaps this is a good time to clarify that sex therapists don’t always or only focus on sexuality. There are many realms I explore with my clients. Letting people know that I’m a sex therapist is more of way of saying, “We can talk about that, too,” because it’s not yet a given. That said, sometimes a person isn’t yet ready to talk about sex directly, or they desire to focus on it too narrowly. But as long as a person is willing to invest themselves, there is always a way to do therapy that’s right for them.

 

Can you describe your journey towards this type of work?

I find that I have slightly different answers for this each time I’m asked, so there are probably a great many reasons. But what often comes to mind is this conversation I had in high school with some of my friends. I can never remember how it started, but the topic of masturbation was being skirted around, and I decided to just disclose that I did indeed masturbate. Each of our reactions was this fascinating mix of astonishment, relief, and excitement. I also had a really potent desire to discuss it more. And to get other people to discuss it. The desire to do so had obviously been getting squelched for all of us, and it was so easy to just name it and get things rolling. I guess that sums up a lot: it’s really important to most people, yet most people don’t talk about it. I really wanted that to change, and it’s been an honor be on that crusade since.

 

Is there anything else you’d like to share?

I guess I’d just like to add that the point of this work is to uncover who you already are, and to maintain an environment that nourishes you. That can look so many different ways, and I really want people to understand that. Find the people, places, art, books, music, and explorations that feed you. In some ways it’s a very simple path.”

 

Interview conducted by Aleesha Alston. Aleesha and I share a passion for sexual education and healing, and Peekay is lucky to have her! Check out the company’s own killer mission and browse their website for all kinds of sexy time resources.

Read This Book: In Quest of the Mythical Mate

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This should be required reading in high school. I mean it. I decided this when I was reading it for the first time in one of my couples therapy courses in grad school, because I suddenly found myself overflowing with insight into a bunch of my old friendships and relationships. Every single person who walks into my office does so because of something that is relational at the root. I strongly believe that studying relationships in our formative years would go incredibly far in creating more ease and fulfillment throughout adulthood.

Psychologists Ellyn Bader and Peter Pearson walk you through the stages that every relationship goes through. They are a direct parallel to the work of Mahler, and Erikson, both of which many of you will already been familiar. Because the book is written for professionals on how to use a developmental model in couples therapy, it’s packed with case examples, which I believe is why it’s readable by anyone. Each point is driven home with a felt sense of learning about real people.

One of the major gems is in realizing that a lot of people don’t effectively make it property through separation and differentiation. Differentiation is the process of determining, on a very deep level, yourself from another. It results in a healthy expectation of differences, and the belief that the connection will sustain through working them out. Holy shit is that hard! But it’s really important. The muscle needs to grow properly, so that it can be used properly when it’s needed later.

But because a bunch of us still have differentiation work left to do, it’s extra difficult when it comes up in our relationships. And it comes right after symbiosis, which is that amazing cocooning time of “we are one.” It just isn’t fair that after months of that you find out something about the other person that devastates you. This is why it’s the stage where a lot of couples break up.  Differences are hard enough to negotiate without lingering beliefs about how they’re inherently dangerous, and will result in complete disconnection. That’s why we gotta process that shit! A couple may still break up, but instead of doing it over distress at the process and past triggers (which we are rarely conscious about without some good therapy), it can be about the reality of now.

Many of the other learnings are similar in that they are as near to cause and effect as you can get with psychology. The model grounds you in understanding what is trying to be worked out, and encourages progress by laying out the sorts of practices that will get you what you need.

How to Read It-

Because this book is written as a guide for therapists working with couples, it’s heavy on case examples, and therapeutic interventions. Many of my clients have enjoyed getting this kind of psychoeducation about the process. But you may also find that hearing about other people and techniques isn’t for you, as it’s a whole lot of clinical stuff. If that’s the case, I recommend reading the first two chapters, the chapter(s) covering the stages you suspect you’re in, and the frequently asked questions in the back.

What To Do With What You Learn-

As you read, remember that you needn’t be in relationship now, nor do you need to have ever been in a romantic relationship in order to benefit from this learning. We are invited into these stages with everyone we encounter- our friends, therapist, co-workers, teachers, everyone. Consider which parts you’re adept at navigating, and where you tend to get stuck, and then put your new knowledge into practice. This book is full of wisdom, but it’s not enough to simply understand concepts. If you aren’t already in therapy, find someone to work with so that you can move through those stuck places. It is one of the very best places for exploring relationships, because the therapist-client relationship is a real one. But better yet, it’s one in which you get to do direct exploration. It is real-time exploration of how you are, and practice for how you want to be with others. We are hurt in relationships, and relationships are exactly where we heal.

The Importance of Talking About Sexuality with Your Clients

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Making sexuality a part of your clinical work is absolutely essential. Let’s start by looking at why this is so.

Sexuality is where the body and psychology come together without trying. Our sexual dynamics in partner sex, as well as in masturbation, are a stripped-down version of our m.o. The body speaks in clear and simple terms. What happens when someone is using her body so directly for experience and communication is the clearest possible message about what it’s like for her to relate to herself and to others. It is for this very reason that the sexual self is a primary interest in a client’s self-exploration in therapy. But do not expect your clients to be the one to broach the subject. More importantly, do not confuse a client’s reticence with a lack of desire, or even a lack of willingness, to explore their sexual life.

When I was 17, I was at a pool party with my friends and I brought up the topic of masturbation. I was aware that it was taboo, but when it came up organically in a discussion, it suddenly seemed silly to me to hold back from commenting. So I didn’t. And the response was pretty intense! Everyone there exclaimed some version of surprise, relief and excitement about the unfolding conversation. “You do that, too? Oh my god! I thought I was the only one!” I was happy and relieved that bringing it up went well, and amused at how little it took to get the discussing going. I was also a little angry. Why had we been so secretive? Something needed to change. For me this moment solidified my understanding of the need for an invitation.

Sexuality is sacred, but that does not mean it has to be secretive. We tend to like to keep it private, but secretive can breed misunderstanding and shame. Sexuality is a thing to be explored and understood and wondered at. And we could all use a little help with exploration of such a powerful force. Many clients simply don’t realize that it’s ok to talk about sex. Follow their pace, but let them know that it’s a welcome and important topic.

If you’d like to make this part of your practice, here’s how to successfully navigate this territory, especially if you feel hesitant:

1. Know your own sexual self. This is no different than the ongoing work of being a therapist: You must know yourself well, and know how to continue to do so, before you can assist others.

  • Bring up your sexuality with your own therapist (a move which will itself propel forward the ability of our field to be awesome at this).
  • Revisit your psychodynamics. What did you learn about sex and the body? From who? What were the gender rules or expectations in your family? What wasn’t ok? What’s hot to you? Why? What isn’t? Why? When one of your clients tells you that they want to urinate on their partner’s face, because it’s always been a fantasy of theirs, you’ll need to have already practiced telling your internalized parental voice that judges such things to stfu, and let you explore this with your client.
  • Find books you’re pulled to and read them (see my resources for some curated options).

2. Know your facts and/or where to find them. Learn all of the basic facts you can, and develop go-to resources for yourself as well as your clients. As with any topic that arises in the room, be mindful of your blindspots, and be sure that your self-education includes the following:

  • Basic anatomy and physiology. A few things that come up regularly with my clients are the facts about the orgastic cycle and related hormones, the complicated nature of expecting vaginal orgasms, and the fact that men still ejaculate after a vasectomy.
  • Cultural awareness and sensitivity. For some cultures, the mere existence of this blog is blasphemous. I know that. For that reason, I don’t recommend it to everyone, and sometimes I give warnings about the content. Know your client’s cultural and religious background as you begin to guide them into exploration. This includes generational considerations. Find out what the general teachings are about sexuality within their culture(s), so that you can remain sensitive and empathetic. And enjoy the gift of an expanded body of knowledge. There are so many ways to get sex “right.”
  • Trauma considerations. If you do not already work somatically, get very familiar with the nervous system. It will be crucial for you to be able to track any traumas responses during your discussions with your client. This can be especially important when it comes to BDSM play, which toys with the line between healing and catharsis.

While being informed is important, do not be held back by the feeling of not knowing enough facts. Your training and experience as a therapist will guide you here, as it would with any other topic that arises in the room. As always, it is ideal for you to be a little ahead of the game, but your willingness to engage in the exploration is often enough for you to be of service to the client. This does not apply to trauma awareness.

3. Cultivate a matter-of-fact tone. One of the main qualities shared by my favorite sexologists is that they all speak matter-of-factly. Sex is a big deal, but it also just isn’t that big of a deal. You will help to normalize the discussion by speaking about it with confidence and directness. I strongly encourage you to practice speaking aloud about sex. You will encounter any stuck places very quickly! Penis! Cunt! Fucking! Dildos! This leads me to my next point.

4. Have a sense of humor. Be willing to laugh. This also helps with normalization, and it can bring a little relief into the room. As is often the case with laughter in therapy, there may be a need for you to clarify what you’re laughing at and why. It is very important not to perpetuate any shame for your client, which is rampant when it comes to sex. But laughter can be healing when it comes to shame. And sex is just funny sometimes! Sometimes your cat watches you, sometimes you run out of lube at an inopportune time, sometimes the body makes funny noises, and sometimes things just get a little awkward. Your client will benefit enormously from being able to laugh about sex. Show them how.

When you feel ready, make sure that clients and prospective clients know that sexual exploration is part of your skill set. Check that box for “sexual issues” on those therapist search engines. And make use of me! I offer one on one coaching for psychotherapists, as well as case consultation.

You can find my curated list of resources here. I also highly recommend that you check out The Unlaced Librarian’s book reviews, and Sexologist Vixenne’s own resource page. Enjoy your sex ed!

Why Therapy Rocks

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Let’s clear up some major misconceptions about psychotherapy, because it kinda kicks ass and everyone should understand why.

I’d like to start with something very basic. A few years back, I was in a conversation with a fellow patron at a local diner. When the gentleman asked what I do for a living and I said, “I’m a psychotherapist,” he gasped, furrowed his brow, and said, “Therapy for… psychos?” Now, this is the most extreme of the misunderstandings that I have ever encountered, but it points to a belief that comes up a bit too often. “Psycho” is a pretty commonly used word, and it doesn’t mean anything good. But “psyche” means soul. In fact, even that is a derivation. And it’s root is the Greek word for life. Life! Psychotherapy is the healing of the soul.

Therapy is not something you seek out because you are weak. Therapy engages you more deeply in both everyday occurrences, as well as more acute incidents. By “deeply” I mean that it assists you in understanding your underlying beliefs and needs, which affect most everything you do. When we know ourselves intimately, we are better able to get what we need in order to thrive. It’s for everyone. That said, sometimes we really need it. And that’s ok, too. A big part of therapy is learning when to lean, and when to use internal resources that you already have, as well as the ones gathered from your work with your therapist.

The work done in therapy cannot be done alone. Oodles of it depends on your involvement in the process, of course. But almost every last thing that hurts us is the result of an injury in a relationship with another person. Because of this, it takes another person to provide the external portions of what is needed to heal those wounds. We are hurt in relationships and we heal in relationships. This is a primary reason that beginning therapy can be scary. It means being vulnerable enough to open up to someone. But unlike many other places, therapy is a safe place to do so. We therapists are trained to find out what it takes for you to be exactly who you are. This is what makes the therapeutic relationship different from friends, family, or co-workers. This brings me to the next vital point.

It matters that you like your therapist. While you must expect there to be occasions of discomfort or disagreement, you should have a general sense of your therapist being your kind of person. This doesn’t have to mean that they are your same gender, race, age, etc. In fact, much healing can happen when you have diversity in the room. However, you must have some basic comfort and connection in order to get anything done. You could hate your G.P., and still benefit from the medicine she prescribes you. But the “medicine” of therapy is relational. You must be willing to take it in to benefit from it. If you’re seeing someone for the first time, give yourself two or three sessions to make a decision about the fit.

Therapy is not a place to go to feel crappy about yourself. You will not be shamed or judged for who you are, what you believe, or what you do. You will be assisted in identifying what works for you and what doesn’t. One of my favorite articulations about therapy is the metaphor of the thorn. We must find the thorn, and then we must pull it out. In that process, there is some pain and difficulty, but then it’s out! And then you will then be able to practice new or better ways of being in the world. Remember, the goal of therapy is for you to realize and actualize who you have in you to become.

If you’re a Los Angeleno, contact me. If not, check out the search engines at GoodTherapy.org or PsychologyToday.com. And enjoy!

Therapeutic Technique: The Empty Chair

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The “empty chair” is a therapeutic exercise made popular by the genius Fritz Perls. In short, you imagine someone (or something) sitting in the chair and you express to them whatever it is you need. The intention is to complete a cycle, which results in feelings of relief, closure, and completeness.

Gestalt therapy, as it’s called, is based upon the belief that we have the ability to self-regulate and heal. I believe this 100%. Given the perfect environment, we’d be happy as clams, because nothing would lie between us and what we need. It’s the obstacles that create tension resulting in anxiety, depression, etc. As the poet Rumi said (and I’m pretty sure he knew everything about everything), “Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it.” That is what therapy is about. It’s my job as a therapist to create an environment in which you can be exactly who you are.

So what does that actually look like? Let’s look at a really common theme. Imagine that you feel a lot of anger towards your father, because he rarely let you do what you wanted. He pushed you to dress a certain way or play a certain sport or chose a specific career, etc. If you brought up something different, he’d criticize you or shoot down the idea. If you showed anger about this, you were grounded or sent to your room. Whatever your current level of happiness with your life, you’ve got leftover tension from these experiences. That leftover tension wants out. You have shit to say. So let’s create a space for you to say it.

Let’s put Dad in the chair. You know you’ve succeeded in imagining him there when you begin to feel sensations and emotions. The super cool part? He’s not really there! You’re safe. And your therapist is right there with you. You get to speak your piece. You won’t be met with criticism or judgment or punishment or anything icky! Just like you always deserved. What’s even cooler is that it doesn’t matter that Dad isn’t really there. He could completely unavailable for this or even have already passed away. What’s important is that your body learns how to release that kind of tension. You find the barrier and, because you have support, you discover how to get it the hell out of your way.

Sound scary? It should! It’s not easy. And that’s why us therapists spend years learning and practicing these things! It’s not scary for us. Let us teach you. Because really: “Shit happens, somebody’s gotta deal with it, and who you gonna call?”

 

Oscar Wilde on the Therapeutic Process

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From Oscar Wilde, and shared with me by a beautiful human being that I know:

“I won’t tell you that the world matters nothing, or the world’s voice, or the voice of society. They matter a good deal. They matter far too much. But there are moments when one has to choose between living one’s own life, fully, entirely, completely—or dragging out some false, shallow, degrading existence that the world in its hypocrisy demands. You have that moment now. Choose!”

Wilde’s writings are a rich source of inspiration for how to shed shame and embarrassment, and to instead just live. I love the way he demands unhindered self-expression, and holds society to a higher standard of supporting it. He is a great cheerleader for the work of therapy.