CAMFT Annual Conference

This past weekend I attended the CAMFT Annual Conference in Garden Grove, California, two blocks away from Disneyland. I have attended this conference twice before, once in San Francisco and once in Los Angeles (it alternates between Norcal and Socal) and I have had mixed experiences. Of the three I have attended, this, by virtue of my selection of and/or the presenters of the sessions, was the best quality of the three.

The program was book-ended by two wonderful speakers talking about addiction. Dr. Gabor Mate framed addiction as one response to trauma and pain. The addiction is the coping or defense mechanism, not the primary problem. Dr. Adi Jaffe used his own experience with and journey to transcend addiction as a framework to talk about compassionate treatment that is accessible, affordable, and addresses the issue of abstinence. His data, his experience, and his approach present a form of treatment that addresses the barriers to treatment while taking into account that the addiction, as Dr. Mate describes, is the--dysfunctional--attempt at a solution rather than a primary problem.

Dr. Steven Sultanoff explored the use of humor in psychotherapy and how humor, when used appropriately, can be a powerful tool in the therapist's toolbox. He noted, though, that it must be intentional and directed toward the client to be useful. 

Dr. Johanna Olson-Kennedy and her husband Aydin Olson-Kennedy LCSW presented a two pronged exploration of health issues with trans youth. Johanna, the Medical Director at The Center for Transyouth Health and Development at Los Angeles Children's Hospital, dove deep into the medical issues of youth in transition while  Aydin, Executive Director of the Los Angeles Gender Center, presented on the mental health side of the issues. Together, they explored the impacts of the medical interventions such as hormone suppression and hormones augmentation as well as the psychosocial issues faced by trans youth. Of particular interest was  Aydin's--himself a transman--reframe of Gender Dysphoria from a disorder to Gender Dysphoria Noise as an experience than many transfolk have every day before, during, and after transition. He used a powerful exercise to help the audience understand some of the things that lead to transfolk not succeeding in school, being called out, and being hyper-vigilant for danger both real and perceived. 

All day Friday, David Jansen, JD, a staff attorney at CAMFT, did a great job of making the potentially dry 6 hours of required hours of Law and Ethics appealing. The framing of the topic was the Standard of Care and David used songs from three recording artist as samples for the audience to practice suicide assessments. He has a way of engaging audiences with the right amount of humor and meaningful metaphors that help me remember the material.

Saturday morning, Dr. Gary Small, Director of Geriatric Psychiatry at the UCLA Longevity Center, spoke about how habits and healthy living can help prevent and mitigate the issues of aging brains. Much of the talk was seen through the lens of dealing with patients suffering from Alzheimer's Dementia and what people can do for themselves and their clients to help prevent the onset and progression of AD. Again, the right amount of humor and engagement made this an entertaining and informative session.

In the afternoon, Dr. Yamonte Cooper LPCC spoke about Racial Battle Fatigue. This session was challenging not because of the content but because of the sheer volume of information. This could easily have been an all-day 6 hour presentation and it would have barely scratched the surface. I appreciated Dr. Cooper starting with a grounding exercise to help everyone be present in the room and with the material. As someone outside of the direct experience of People of Color and in particular African American men, I think it is important to do my best to understand their experience in order to be a better clinician. This session was a jumping off point to dig deeper into this topic. 

On Sunday morning, Suzanne Hughes, Executive Director of the One Life Counseling Center, spoke about tele-health including legal and ethical issues as well as her views on how to create a successful tele-health business. She highlight the pros and cons of both face to face and tele-health sessions. I appreciated her opening the discussion up to the audience to make sure we covered the topics that were most important. Copious amounts of audience input made this an informative and collaborative effort to help better understand tele-health. 

Throughout the weekend Heather Brewer LMFT and I, along with other attendees and members of the CAMFT staff, live-tweeted the event using the hashtag #CAMFTLIVE. Check it out to get a sense of an event that included not only great sessions and chances to network, but also a Petting Palace featuring dogs and a pony you could pet! I look forward to next year's conference in Burlingame and to connecting with new and old friends.  

End of the Year Updates

As we move through the holiday season, I am reflecting on some of the activities I engaged in this year.

As a part of Bay Area Open Minds, I organized our participation in the SF Trans March, I worked our booth at Folsom Street Fair, and I organized a lunch for our clinicians at Dark Odyssey: Surrender. DO was a great conference and I was excited to be out and about in the community, meet new people, and reconnect with friends.

I taught didactics on Open Relationships, Gender, BDSM/Kink Relationships, and Using Culture in Psychotherapy at Haight Ashbury Psychological Services and I guest taught in the Couples Therapy class at Notre Dame de Namur. I am working on the Human Sexuality course I will teach this spring at Golden Gate University.

I continue to work as an EAP counselor for Concern EAP at Google in San Francisco and I gave a well-received presentation on Gender in Psychotherapy to the Concern EAP offsite clinicians. I also continue to see private practice clients in my San Francisco office.

In the coming year, I plan to do more teaching, to work on my book about attachment and open relationships, and to continue seeing clients at both locations. A new clinical interest has been working with gender as a spectrum. By this I mean working with people that find themselves somewhere between cisgender and transgender. This is something that grew out of my own experience with gender as well as out of who has been coming through my door and what I have been asked to speak about. I look forward to more exploration of this topic as well as nurturing myself as a therapist in general.

Last but not least, this year saw me make a change in my appearance by dying my hair first teal and then blue. This change has been interesting in terms of how and with whom I connect and it has given me food for thought in terms of working with clients that make significant, visible changes in their appearance and their lives.

Some updates

Last month, I began working once a week for Concern Employee Assistance Program as an onsite counselor located at Google in San Francisco. It has been exciting so far and I look forward helping the employees with their challenges. I continue to see clients in my private practice on Mon, Tue, and Thu.

Next month, I will be attending Dark Odyssey: Surrender. Fellow therapists, let's get together! Clients, know that I will keep your confidentiality and if we do run into each other, I won't reach out to you. If you want to reach out to me, that is fine, though I won't engage with you extensively.

Earlier this month, I did a training on Gender in Psychotherapy at Haight Ashbury Psychological Services and I will be doing a similar training for my fellow Concern EAP onsite counselors next month. Next year, I will be teaching Human Sexuality in the Golden Gate University graduate school program.

Finding a Therapist / Making Friends with Your Discomfort

There are a number of "Finding a Therapist" sites that I recommend for people seeking an affirming therapist. They are listed on my resources page and I want to highlight a few here:

I am on the Board of Bay Area Open Minds whose mission is best stated on our website:

"We are a group of San Francisco Bay Area psychotherapists and psychotherapy students who affirm that sexual and gender diversity are natural expressions of the human experience. We provide a safe haven for mental health clinicians to gather, network, support, and consult."

Here is our "Find a Therapist" page.

Also valuable in the Bay Area, I recommend Gaylesta, an educational resource and therapist directory that identifies as "the Psychotherapist Association for Gender & Sexual Diversity."

Farther afield, the National Coalition for Sexual Freedom has a national and international Kink Aware Professionals directory that I find valuable even for those not in the kink or BDSM communities.

An up and coming "Find a Therapist" site is Therapy Den which hopes to build off of a successful experience in Portland, Oregon, by providing a "progressive mental health directory and resource - made with love for the Bay Area.". From their site:

"Our mission is to make finding the right therapist or counselor as painless as possible, raise mental health awareness, support causes we believe in and challenge all systems of oppression."

My first post on Therapy Den is oriented toward therapists though I hope it is a beneficial read for all. Let me know what you think of making friends with your discomfort.

Fluid Bonding

People sometimes ask me, "What is the difference between working with open relationships and working with relationships in general?" The answer is often "Not all that much, but the small differences are quite significant." One area where this is the case involves types of commitments. 

In the myriad types of open relationships commitment can take many forms. This came to mind because of an essay about the concept of fluid bonding and what the term means to the writer and readers of the essay. One challenge is that here isn't a simple definition of fluid bonding. For some, it is Penis-In-Vagina (PIV) sex without a barrier. For others, it is no exchange of fluids including kissing except with a particular partner or partners. Another challenge is whether or not fluid bonding reflects a different type or level of commitment. Fluid bonding may also be both or neither of these.

Since there is no one definition of fluid bonding (much like there is no one definition of making love) people use it in different ways. Some use it to indicate that they have stopped using barriers with one or more partners. Others use it to mean that their relationship has moved to a new level.

In some monogamous relationships, regardless of the composition of the relationship, the commitment can be somewhat simpler than in an open relationship. While each monogamous relationship is unique, most center on some kind of one to one partnership between two people. Many partnering ceremonies--a more inclusive term than marriage for my purposes--have language to this end. The concept of fluid bonding may even be built into the relationship structure and may reflect a deepening of the relationship.

In some open relationships, the discussion of fluid bonding can be the similar, though it can also involve pregnancy mitigation, sexually transmitted disease mitigation, and other concepts. Some people chose to have "closed open relationships" meaning that their relationship is more than two people, a triad or a quad for example, and there is exclusivity within that structure. This relationship is "open" in the sense that it does not look like a monogamous relationship but otherwise it may be more like a monogamous relationship than what people think of as an open relationship. In other open relationships, the discussion of fluid bonding may come up more often because there are usually more people to consider in the decision making.

There are many opinions for, against, and neutral regarding the use of the term fluid bonding and whether or not it reflects a type or level of commitment. I am curious about how people think and feel about the concept of fluid bonding. Do you use the term? If so, how do you use it? If you don't, do you have any judgments either way. Feel free to comment below.

TED talk relationship toolbox

When Esther Perel says (or in this case tweets) something, I pay attention. Recently, she pointed to these TED Talks that just might save your relationship featuring two of hers and one from Brené Brown that together comprise an excellent relationship toolbox. Topics covered include infidelity, vulnerability, daring to conflict, getting heard when you speak, and long term desire in relationships. They are all worth a watch.

Poly.Land and Mono / Poly as a Spectrum

I recently discovered the blog Poly Land written by Page Turner. Here is link to her Facebook page, too.

The post that caught my eye is about seeing monogamy and polyamory a spectrums rather than as a binary construct. In a time when more and more things are seen as spectrums, I think that this topic is an important addition to the conversation. The post was inspired by the reaction to two other posts titled 9 Things Monogamists Can Learn from Polyamory and 9 Things Polyamorists Can Learn from Monogamy. Both posts have great insights on different aspects of the different types of relationships and the 18 items taken together are great things to consider in any relationship.

Finding a Therapist

My friend and colleague Michel Fitos shared an informative article from last year about finding a therapist. Though focused on marginalized communities, it is good advice for all. 

Three quick takeaways regarding finding a therapist:

1. Shop! You can see more than one before you decide.
2. Advocate! You have no obligation to stay with any therapist let alone one who marginalizes you.
3. Refer! If you find a good therapist, tell other people so that they can benefit, too, and seek referrals from friends.


New York Times Magazine open relationship video

The New York Times Magazine seems to be the major news outlet talking about open relationships lately. In addition to the article published a few weeks ago, they posted a video with five people talking about their overlapping relationships. The participants talk about how they got to where they are and about some of the dynamics that they experience. I think it is a great video that speaks to the ups and downs of open relationships.

Some Thoughts on the Sexology Podcast

Having gotten feedback from therapists and non-therapists and from people in and out of the kink community about my episode on fetishes on Dr. Nazanin Moali's Sexology podcast, there are two themes that seem to resonate:

  • Normalizing fetishes with examples can help people put aside the biases and pre-conceived notions that they have about fetishes and better understand how they operate.
  • It is important to recognize that fetishes can be normalized and that many people can have them to varying degrees however it is equally important to realize that fetishes can become disordered.

These two themes are two of the most common themes in my work: normalizing and recognizing whether or not something is disordered.

The normalizing comes up in my work in alternative lifestyles communities because there can be a stigma about how people live their lives and how people practice their intimacy. This stigma can lead to shame and shame can lead to a number of things including not living a fulfilling life, to hiding wants and needs, and to acting on wants and needs without consent creating breaches of trust. I often use examples from outside of the alternative lifestyles communities that resonate with examples from within the communities to demonstrate that the various kinds of relationships are not all that different.

The normalizing also comes up with my work in general. It is reasonable to be anxious when you are going on a job interview or meeting someone new. It is reasonable to be depressed if your pet dies or you don't get that job you wanted. For whatever reason, mental health states and moods can be stigmatized. It may be socially acceptable for me to have high cholesterol or high blood pressure though please don't let anyone know that I can be anxious or depressed! It is this stigma that can lead to people not seeking the help they want or need. Sometimes citing an example outside of the client's experience can help demonstrate the things in common that their situation has with others.

The recognizing whether something is disordered is an important part of my work. Whether it is depression, anxiety, or stress; whether it is relationship choices; whether it is communication or lack thereof, I believe it is important to understand whether what is happening is a reasonable reaction to a situation or if it is a disordered reaction.

Though I use normalizing above, I use reasonable in my elaboration on reactions because I don't know that there is an objective standard of normal. I use disordered because I believe that something can be out of sorts without being a diagnosable disorder. Having disordered eating is different that having an eating disorder. 

As I spoke about with fetishes in the podcast, one of the key things when examining an issue that a client presents is the impact that the issue is having on their lives. I have had a couple come in because they were concerned about some disagreements and arguing that they were having, and we determined that these things were reasonable and, in fact, were a part of adjusting to the new situation of living together. I have had individual clients bring up the shame they felt for having the sexual desires they had. When we looked into the desires and the shame, we determined that the desires were objectively fine. The initial impact can seem serious though when examined more closely, the reaction is reasonable. Disordered versions of these include some kinds of acting out with the couple that makes it difficult for them to function or the individual acting out their desire without consent.

I am happy with my Sexology episode because it spoke not only to a specific topic--sexual fetishes--but also spoke to some important concepts in therapy in general.

On Being and the Lack of a Cure

[This post appeared on my previous web site and this is an updated version.]

Recently, I again picked up Psychotherapy Grounded in the Feminine Principle by Barbara Stevens Sullivan. As I have said previously, this was one of the more influential books that I read while at Pacifica Graduate Institute about doing therapy, though in light of Sullivan’s message of embracing the practice of being noted below, saying so (“doing therapy”) is perhaps ironic. In addition to a wealth of other ideas, Stevens explores using the feminine-oriented (more receptive) practice of being with clients rather than the more masculine-oriented (more active) practice doing things with or to clients.

Along with being with clients, using a responsive and inviting approach, comes the idea that the role of the therapist is not to cure the client. The medical model that is the basis of a lot of therapy eduction is often focused on curing the patient. 

For more thoughts on this topic click here.

From the New York Times Magazine article

In re-reading the recent New York Times Magazine article, I am struck by this passage:

Open marriages, I started to think, are not just for people who were more interested in sex, but also for people who were more interested in people, more willing to tolerate the inevitable unpacking conversations, the gentle making of amends, the late-night breakdowns and emotional work of recommitting to and delighting each other.
Few claimed there was no pain in nonmonogamy; but they were not afraid of that pain, whereas the notion of any extra pain in my life seemed an impossible burden, a commitment along the lines of taking on a second part-time job or caring for an ailing parent.

I appreciate the author's observations and her candor about her feelings. My overall takeaway from the article is that it portrays some of the challenges that come up in open relationships--other partners not knowing, jealousy, insecurity--as well as the possibility for success.

I don't believe that every relationship type is ideal for every person--I tend not to speak in all or nothing anyway--though the reality is that a variety of relationship types exist. Some people may know up front that one type or the other may or may not work for them. Others may need to try things out, with better or worse results, to get a better idea. 

A quick note on fetishes

Recently, I was interviewed by Dr. Nazanin Moali for an upcoming episode of her podcast Sexology. We talked about fetishes, both from a clinical point of view and a practical point of view. Clinically, fetishistic disorder falls under paraphilia, things like exhibitionism, voyeurism, and other sexual practices that are often taken to extremes. Specifically, fetishistic disorder involves arousal by non-living objects or non-genital parts of the body. The important factor is that for a fetish to be disordered, there must be some significant impairment of functioning or negative impact on the person's life. I think that many people may have fetishes though fewer people have fetishistic disorder.

Talking about fetishes from a practical point of view, I drew a connection between the idea of a fetish in culture and a sexual fetish. Culturally, a fetish is an ordinary object that has been made extraordinary by a person or a community often for some ritual or religious purpose. The key here is that the magical, mystical, or religious quality--what makes it extraordinary--of the fetish object comes from the person or community and it is not imposed from outside the community.

As an example, I talked about the idea of a shoe fetish. Someone may be aroused by the idea of shoe worship--often as a ritual--and for them, shoes in general or certain types of shoes specifically may be a turn-on. They may like all high heels or only leather ones. They may like sneakers, though only sweaty ones. If this is an activity that they can engage in with the consent of the other people involved, it is not the only way they can become aroused or achieve orgasm, and it is not having a significant negative impact on their life, then it has the quality of a fetish though it is not a fetishistic disorder. 

For more of my discussion with Dr. Moali, look for the June 6, 2017, episode of her Sexology podcast. I'll post more about our discussion when the podcast goes live.

New York Times Magazine article on Open Marriages

The New York Times Magazine featured an article recently titled "Is an Open Marriage a Happier Marriage?." I find the article an interesting read and I believe that it reflects a number of different experiences that people can have in open relationships, though somewhat limited to open marriages as a subset of open relationships.

My fascination is in the intensity of the comments after the article, many wholly against the idea of open relationships and critical if not scornful of people who engage in them. I often say that the judgements that people make say more about them than they do about what they are judging. I wonder if some of these critical comments--and this can apply to positive comments as well--come from people who came in with preconceived notions and who may not have read the article at all.

When I teach other therapists about working with clients in open relationships, one of the points that I make is that it is not a matter of wondering if open relationships should exist in the first place. Rather, it is a matter of accepting that they do exist, and if and when an open relationship client enters your office, you need to know how to handle it.

Diving in Love

A topic that comes up with some frequency with my clients goes more or less like this: "We wanted to open our relationship and we agreed that we wouldn't fall in love."  You can likely guess what happened. What may come into my office is: "We promised not to fall in love and s/he broke that promise! How can I have trust now?"

While I understand the logic and intention behind this statement, I also think that falling in love is something that is difficult to control since the process seems to be at best irrational and unconscious. I doubt that there is an intention or a conscious breach of trust behind someone falling in love. I think we can choose who we love and I am less sure we can choose when and with whom we fall in love. Or can we?

For more thoughts on this topic click here.

Porn versus BDSM

"BDSM isn't what you see in porn flicks. The image of BDSM that is portrayed in many materials of this sort has about as much to do with BDSM as the child's tale "Jack and the Magic Beanstalk" has to do with agriculture."

--Franklin Veaux

I love this quote from Franklin Veaux's valuable (and potentially Not Safe For Work) overview of BDSM. Veaux, the author of More than Two, has a lot of good things to say about alternative sexuality in general and he has a sense of humor that I enjoy.

"I don't know" and "I don't care"

"I don't know" and "I don't care"

"I don't know" and "I don't care" are two phrases that I have heard a lot in the therapy office. I don't say *my* therapy office because I have heard these come out of my mouth in my own analysis. What I have tried to do for myself and what I encourage my clients to do is to pause when they think or say either of things and ask: "Do I *really* not know?" or "Do I *really* not care?" More often than not, the answer to either or both of these questions is "No, I do know or I do care."

Click here for more thoughts on this topic.

From Mating in Captivity

"Sex is not a metaphor for a relationship, it's a parallel narrative. It speaks its own language. Love and desire are two different languages. We would like to think that they flow from each other. While love and desire relate, they also conflict. Love thrives in an atmosphere of reciprocity, protection , and congruence. Desire is more selfish. In fact, at times, the very elements that nurture love: comfort, stability, safety, for example, can extinguish desire.
Love seeks closeness, but desire needs space to thrive."

--Esther Perel