Why are you more qualified to treat gay men (individuals and couples) than other therapists?
The gay male community is especially important to me because I was drawn to do therapy with gay men out of a sense of fraternity, community, esprit de corps, and cultural identification, and as a defense against the damage of societal challenges and systematic oppression gay men face unfairly and hatefully by others in the legal and social arena — locally, nationally, and globally.
I was moved to get involved with peers in my demographic (male, gay, Angeleno, etc.) as the AIDS Crisis intensified in the late 80s and early 90s. I do therapy with gay men, in part, to memorialize and honor friends and colleagues lost to AIDS years ago.
I work with people a lot like me, so that the theoretical effectiveness of therapy models is matched with a cultural affinity, identification, validation, and dignification of the gay male community. By providing a form of “professionalized peer social support”, the client’s identity is strengthened by seeing himself reflected in another in a collaborative and productive working relationship. My interpretation and application of Gay-Affirmative Therapy involves the therapist and the client knowing and sharing a language, slang, attitudes, beliefs, cultural literacy, influences, perspective, shared history, shared challenges, and shared values.
I am more qualified to treat this population than other therapists because I have made a deeper and stronger commitment to providing and specializing in gay-affirmative therapy with the Los Angeles community of gay men than other therapists have done to date, including other “gay-identified” therapists. I’ve been doing it longer. Unlike other gay-male-identified therapists, I’ve been doing gay-affirmative therapy more boldly, more specifically, almost to the exclusion of all other populations, in a focused way that is not diluted or distracted by trying to be all things to all people (clients), as evidenced by naming my website (GayTherapyLA), advertising in gay publications, and not merely (blithely) adding “LGBT” to a longer list of disorders and challenges treated in a general population. I even focus specifically on gay men’s mental health, not even the much broader implications of “the LGBT population”.
I have made gay men’s mental health not only a focus of the psychotherapy I provide, but also as focus of other professional activities, such as my academic and commercial writing. I have a public identity as an expert and specialist in gay men’s mental health that is promoted via media and social media, such as a podcast, Facebook page, Twitter account, Google+ account, paid advertising, e-newsletter, blog, radio appearances, television appearances, local and national advocacy groups, in the academic arena as a professor of clinical social work, as a local political/social activist, non-profit organization consultant, corporate consultant, local and national government consultant, expert witness, and conference speaker.
I have maintained and promoted my professional identity as a specialist in working with gay men’s mental health (as well as HIV Mental Health) as a niche that is currently unmatched by any other currently-practicing professional in Los Angeles County. I hold local recognition and “street cred” as an openly gay, openly HIV-positive clinician. I have more sheer volume of experience and exposure to different kinds of gay men’s problems, in terms of number of clients served and number of therapy service hours delivered in individual, conjoint, and group modality , in the private, public, hospital, and non-profit settings, than anyone else. I have more “observational data” that can only come with years of experience in observing how gay men solve common problems, because I’ve helped various gay male clients solve the same kinds of challenges over and over, to determine “best practices” and “most likely strategies for positive outcomes”.
What is your Theoretical Orientation that you use in psychotherapy?
Primarily, I use:
- Cognitive Behavioral Therapy (CBT)
- Existential Therapy
- Developmental Psychology
Can you please describe your personal theoretical orientation? How does this relate to your treatment of clients?
My theoretical orientation has developed over many years of practice, applying various interventions and seeing the real-life examples with clients of what has worked, and what hasn’t. I strongly identify with CBT because the explanation that our thoughts influence our emotions, which influence our behaviors, which result in our current life circumstances, is very compelling to me. In a sense, “we are what we think”. If we can identify the thoughts that ultimately are giving us bad (or at least challenging) outcomes, we can change those thoughts consciously, and a whole positive “domino effect” gets achieved. So, focusing on changing specific maladaptive thoughts and replacing them, or replacing certain behaviors, is key in the interventions that I suggest to clients.
I also work from an existential perspective, to help a client understand who he is, why is he here on Earth, and gives his life meaning, purpose, satisfaction, poignance, and lasting significance. If we can focus on what really makes us feel “alive”, then we are “squeezing the juice out of life”, and living every day to its fullest. When you live every moment, every day, to its fullest, you age and then look back on your life with a sense of joy, pride, and fulfillment of a Live Well-Lived.
I also work from a Developmental Psychology perspective, with the idea (borrowed from Erickson) that at each stage or phase of our lives, we as people in the current American culture tend to face very similar challenges (and rewards) at roughly the same periods of time in our life. Leaving college and getting our first jobs. Finding and experiencing our first relationships. Taking our careers past the first level, and gaining some experience, notoriety, and prestige in what we do. Contemplating the pros and cons of parenting. Evaluating the transition from the child we were, to the adult we are. Coming to terms with leaving the young person we were, with the middle-aged person we are becoming. Becoming aware of the very first thoughts of our own eventual mortality. Coping with turning 40, or 30, or 50. Seeing ourselves, our friends, and our world change as Time marches on. Getting clear about what is truly important in Life.
I also put my client in a biological, cultural, geographic, and historic context, using the social work “Person-In-Environment” theory.
I apply all of this with sensitivity, humor, analogies, cultural references, jokes, sayings, timely examples and selective self-disclosure to illustrate the concepts as applied to each client.
I take all of these, and match them up with a thorough Psychosocial Assessment of my client. I collaboratively, with the client, take all this into perspective to develop a Treatment Plan, a strategic plan for making and sustaining positive life changes, with the client, and working that plan very specifically with every topic discussed in every session.
What are the most common challenges your clients request help with?
There are many different ones, but I would say:
- Anxiety or Fears
- Need for Life Coaching
- Substance Abuse
- Thriving as Gay Men
- Thriving as People Living with HIV
Based on your above examples, what is different, unique, and worth knowing about your treatment, approach, and methods?
What is different, unique, or worth knowing about my treatment, approach, and methods is that all of these professional interventions are, by now, infused with my unique personality that tends to combine a pretty serious “academic” perspective of evidence-based psychotherapy techniques, with my own philosophies, perspectives, and sense of humor. Academic clinical social work would call this “professional use of self”. It’s the meeting point of my own personal mind, heart, and soul with my work as a clinician. We all know Julia Child was a cook, and that her technique was mainly mid-Century French cooking for the common domestic kitchen. We also know her personality: a high-voice with a certain devil-may-care attitude, the joy of experimentation, the sense of forgiveness for any mistakes made, the relief of self-deprecating humor, the joy of discovery, the necessity of critical thinking to decide what’s important and what’s not, when to follow the rules precisely and when to take liberties just because we can. My approach to doing therapy is a lot like Julia Child’s approach to cooking – sure, there is an important and time-honored formal technique to the art, but it also becomes real, present, and fun when you make it your own. And my personal style of therapy includes what I just did: I used a commonly-known cultural reference to illustrate an inspiring person, a description, a point of view – an analogy – to help someone else understand a feeling, a philosophy, a perspective that might otherwise be hard to describe. That’s what I do with my clients – and they end up understanding some relatively complex stuff pretty accessibly.
Would you please describe at least 2 differentiators per issue you selected?
Anxiety or Fears: I think what differentiates me as a therapist in my treatment of Anxiety or Fears is that I invoke and use materials from many different authors and sources that I have become aware of over the years, and recommended to my clients. I will use, for example, Susan Jeffers, Ph.D.’s book “Feel the Fear and Do It Anyway” as almost a text book on fear and anxiety. I will also explore what kinds of “fear of loss” (the definition of anxiety I invoke) the client has, their cognitive underpinings, and explore some alternative replacement thoughts. I will also use examples from my own life as a gay, HIV-positive, cancer survivor man to illustrate how I’ve had my own fears and losses, but in each case, developed some kind of coping strategy to get me through it – in ways that the client could “borrow” as “behavioral modeling” from me for their own situation.
Depression: What differentiates me regarding Depression is that I am trained as a psychiatric social worker, so I can educate a client on the unique roles of medication (in collaboration with a local psychiatrist, which I can refer them to), and therapy, and how both medication and therapy each has their pros and cons in alleviating Depression. I educate on how Depression can be either “just out of nowhere” or “situational”. I educate on the genetic or family history influences, and assess them. I also explore Depression from a cognitive, existential (especially!) and developmental psychology perspective. I help the client create an entire system of internal (intrapsychic) resources, and external resources to support the client’s adaptive coping, or even alleviation, of Depression symptoms.
Life Coaching: What differentiates me from other practitioners who call themselves “life coaches” is that I actually have very formal training in the form of 8 years of higher education past high school on “interpersonal” or “talk” therapy, unlike modern-day charlatans who might take a weekend course from some “self-validating” entity within the “coaching” profession that someone might take casually. I actually have real-life experience working with people, in person, for many years under supervised practice, continuing education, evaluation, and a competitive admissions before graduate school and a rigorous licensing procedure afterwards. Accept no substitutes; insist that a licensed psychotherapist provide goal-oriented coaching services.
Self Esteem: What differentiates me in terms of self-esteem training is that I do it in a context and perspective of being from a traditionally marginalized and stigmatized group, or groups, as both a gay man and as a person living with HIV/AIDS. I apply CBT, existential, and developmental concepts to help a person re-frame their own perspective on themselves, to emerge through a self-reflective/self-evaluative process, into a deeper, more compassionate, more sophisticated understanding of their inherent value and worth as a person in society, at every phase of life.
Substance Abuse: What differentiates me in terms of treating substance abuse is that while many therapists “claim” to practice from a non-judgmental stance, too often, they are anything but. They make their disdain for experimentation, relapse, recreational use, or cultural significance of any drug use known, and their negative counter-transference toward the client is palpable, obliterating all objectivity. Therapists in AA recovery themselves are among the worst at this. I take a rational approach with clients with substance addictions, and explore the pros and cons of their use from a Motivational Interviewing technique perspective. I challenge the government’s adage that “ALL drugs are ALL equally bad for ALL people in ALL circumstances, always.” I help the client self-evaluate what the harm actually is of the use for him, not for others, but perhaps exploring the feedback others have given him. I apply critical thinking to the pressures the client might feel to undergo expensive, elitist, luxurious, and even self-indulgent “rehab” programs in exotic locales, only to return to his normal life and milieu. I help the client evaluate the pros and cons of the Twelve Step programs, and hold them to the same critical thinking as we do most other clinical resources, challenging the idea that the Twelve Steps are infallible and above all reproach. I will also help a client interpret the Twelve Steps, each one at a time, from a psychological perspective that includes CBT, Developmental, and Existential concepts. I will work with (gay) atheist or agnostic clients to re-interpret the “Higher Power” concept in a gay-affirmative, Secular Humanist way that is unique to that client. I will help a client differentiate between the function of a Sponsor in AA versus a therapist, and how both can be complementary external resources and social support that assists the client in recovery. As an independent practitioner without any ties to any “treatment facility”, I can be objective and avoid the common trap of manipulating the client into expensive ancillary treatments at affiliated facilities. I help the client form a new “relationship” to substances, including “breaking up” from a “demanding affair”. I help clients move toward a new identity that dominates their life, from “addict” to something else that means more to them existentially in the long term. I have a long “track record” of success with this, especially with gay men in recovery from crystal meth, but I’ve also had success with people who have abused everything from marijuana to Adderall to heroin. I am particularly experienced in helping clients who are “triply-diagnosed” with substance addiction, psychiatric illness, and personal trauma (often abuse or neglect).
Gay Men: What differentiates me from most other therapists treating gay men is my personal biography, and my well-cultivated professional identity as a specialist and expert in gay men’s mental health, beyond just a, “Oh, I do that, too” add-on in a biography. Some would call that “narrow”; I call that “expert”.
People Living with HIV: There are VERY few licensed therapists who openly identify as HIV-positive, which I do. Of the others who do, none advertise and promote themselves as gay men’s mental health specialists or experts EXCLUSIVELY. Others include Alan Downs, Rick Coons, Tony Zimbardi, and Matt Silverstein, but none of these also identifies in their professional (promoted) persona as a gay men’s specialist; they are generalists or specialize in something else (DBT in Recovery, Sex Addiction, Gay Parenting, and Mindfulness, respectively).
How would you specifically define your “personal style” as a therapist?
I am informal, collaborative, active, conversational, action-oriented, self-disclosive, cerebral, philosophical, opinionated, “hip”, artistic, creative, supportive, (gently) confrontive, logical, assertive, “affectionate”, educational, optimistic, generous, affable, curious, humorous
What about your personal style makes you an effective therapist?
I find other people inherently fascinating. I read biographies. I like interaction. I’m open-minded. I’m liberal. I’m non-judgmental (on most things, except violence, conservatism, and oppression). I’m curious. I’m intellectual. I like to challenge or even defy convention. I’m creative. I’m appreciative. I’m interested. I’m aware.
What are some specific personal life experiences that have influenced you the most as a therapist?
See Biography; mostly my HIV diagnosis in1990 at age 26, my cancer bout at 37, and my status as a childhood abuse survivor, as well as socio-cultural-political battles for gay rights. My marriage at 42. My training at The Suzanne Dworak-Peck School of Social Work at USC. My clinical supervision. My mentoring from a gay specialist therapist, the late Michael Shernoff, LCSW.
What was the “take-away message” of those experiences for you?
The takeaways are/where:
HIV diagnosis: Live life one day at a time. Shit happens. Cope with challenges as they come. Roll with the punches. Accept help from myriad sources.
Cancer: Appreciate your health every day. Face your fears. Get help as you need it. Don’t complain. Live your life with purpose. Know who your friends are. Laugh. Confront those who dismiss or ignore you. Persevere.
Childhood Abuse: Don’t let your past ruin your future. Be kind. Set limits with those who mistreat you. Indulge your rage if you have to defend yourself. Decide your character. Challenge the Sadist. Be energized by victimization, not defeated by it. Practice compassion. Don’t act out if others don’t do as you demand them to. Practice Tolerance. Confront Intolerance. Decide with whom you spend time.
Gay Rights Advocacy: Everyone deserves equal dignity; everyone is created equal. The march of Time is toward Justice.
Marriage: Dreams come true. Relationships take work, but it’s a noble challenge with countless rewards.
USC Training: Knowledge, Understanding, and Wisdom are virtues.
Clinical Supervision: Sharing with others in the pursuit of excellence is a noble quest.
Mentoring by Peer: Make the most of life. Never stop growing. Travel. Read. Write. Fuck. Love. Speak Up.
What was the effect of those experiences on a personal level in your life?
They all made me wiser, more compassionate, more insightful, and more resilient.
What was the effect of those experiences on your work as a therapist?
They all made me wiser, more compassionate, more insightful, and overall, more effective.