Inkwell: Authors and Artists

    
hello all, and thank you for this opportunity to read and discuss michael's
wonderful book.

i'm about halfway through, and as i read, i keep thinking...this is a great
book for those who are considering psychotherapy. i was thinking it would be
addressing therapy aficionados or practitioners, but it really is the 101
for those overwhelmed by, or uninformed about, the art of psychotherapy. i
am guessing as the book progresses it will talk more about psychotherapy
that's tweaked with gay consciousness and compassion.

it's nicely written, especially the more challenging expository sections and
the stories are pointed without being too obvious or gratuitous.

michael, since i haven't read the entire thing, i won't ask if you plan to
travel around teaching therapists to open their hearts and minds to queer
clientele in a deeper way.

do you think training -- from the outside -- can impact a therapist who is
not doing the inside, soul-transforming work that creates the field of
compassion necessary to be truly queer-affirming (assuming said therapist is
not him/herself queer)?
  

    
To respond the the question just asked by (jillmaxi), I began my
career as a high school teacher and soon moved to the counseling
department.  Deep in my heart, I am a teacher and believe people can
and do learn.  I have taught on and off for most of my career.  I
believe people can and do learn.  There is a teaching component in all
therapy.  And, therapists, too, can learn.  All is takes in a
willingness and spending time doing the learning.

I do not have any plans at this point to travel to teach, but I am
always open to teaching opportunities in the Bay Area.  One of the
"problems" with being a therapist is that we get to listen a lot more
then we get to talk. I like to talk, so teaching is a good forum for
me.  

The kind of learning you speak of is difficult.  It is
"soul-transforming", and that requires a lot of motivation.  If the
person doesn't have that motivation in the first place, the learning
goes a lot slower.
  

    
indeed, michael.
i am about to begin the formal training...of some sort. to begin doing
therapy after x many years in therapy and on the spiritual path. so this
book is helpful to me as well. i feel like sending it to people i know who
resist therapy but are always first on line to ask questions.
  

    
Thanks, Jill for the kind words about the book.  While the book is
primarily aimed toward the consumer of mental health services, more
than a few clinicians have given me feedback that the way I organized
and approached the topics has helped them to understand more of what
they are about as therapists, and as a result, they can tell potential
clients more precisely what they offer and how they go about that.
  

    
Michael, in your book, you go into some of the differences among different
types of therapists in terms of style and the things they actually do in the
room with clients.  For example, you discuss the directive vs. non-directive
style, etc.

These distinctions are important, since many people will respond to one
approach to therapy much better than they will another
Can you talk a bit about the different "types" of therapy a potential client
might consider?
  

    
good question.
standing by.
  

    
The “style” of any therapist is based on his or her theoretical
orientation and personality.  I believe the personality is actually the
more important determinant, and therapists with various kinds of
personalities find theoretical orientations that suit their
personalities.

I would roughly divide therapists into two classes, those that do a
considerable amount of talking during the hour, and those that don’t.
All therapists listen, but some will respond in a more active way,
while others will take in what the client is saying and respond much
less frequently.

Innumerable times I have had clients come to see me and when I ask
them about any former therapy they have had, they often comment that
they were in therapy at one point, “but the therapist didn’t say much”.
 To me this almost always means that the therapist is doing therapy
form a psychodynamic/psychoanalytic perspective, and not making that
clear to the client.  These therapists believe that the most important
thing they can do for the client is to remain a blank slate, and let
the client transfer onto the therapist any number of ideas.  Since the
therapist has not shared much with the client, the therapist believes
these ideas are mostly about the client and not the therapist, and the
client most likely does roughly the same with other people in their
lives.  By working on the “transference”, the client gets to understand
how he or she gets him or herself into trouble with others, and can
use that information to help him or herself with whatever issues they
are bringing into therapy.

The problem, as I alluded to, is that psychoanalytic therapists rarely
if ever make this well understood to their clients.  The clients are
often confused as to why the therapist says little.  Psychoanalytic
psychotherapists would do themselves a great service by making this
clear to clients near the beginning of the therapy process.  That would
enable the clients to decide whether they want to continue with this
type of therapy, and if they do, they will understand why the therapist
says little.

The other half of my equation is therapists who talk a lot more.  This
comprises many different kinds of therapy.  In this case, (as in the
former case) it is not just how much the therapist talks, but what he
or she is responding to.  In any conversation, a person says a lot. 
The other person can respond to any number of different parts of the
content of what someone said, or something in how they say it (their
process).  Humanistic psychotherapists respond to the existential
question in a person life, the meaning of life, death, etc.  Behavioral
psychotherapist respond to symptoms and how they can be relieved
through actions.  Cognitive therapist respond to a person’s thinking
process.  Transpersonal psychotherapist respond to spiritual questions.
 Family systems psychotherapist respond to interactive patterns in
families (this is not to be construed narrowly, many family systems
therapist are aware of queer alternative family arrangements.

There is no one best form of psychotherapy.  All have about the same
success and failure rate (depending on how you measure such things).

When someone asks me what kind of therapy I do, I tell them I am an
active therapist and will share my thoughts, feelings, ideas,
experiences and intuition when appropriate.  I happen to work from a
humanistic and family systems perspective, so I will respond in a way
consistent with that orientation.
  

    
a very useful explanation. i now have names for those things.
  

    
I want to comment on "directive" versus "nondirective," using bare
definitions of those terms.

I decided the style of my first ever therapist was sort of
neo-Freudian, even though I didn't ask him. I wondered if he hated me
but, again, didn't ask. Um hmm um hmm um hmm, he said. I saw him for 12
years and never found out anything about him. Yet somehow I became
more self-aware. Maybe that guy was subtle.

He was certainly very nondirective. In simple terms, as a
psychotherapist myself now, I'm more directive with some clients and
much less or not at all with others, depending on the approach that
seems to fit where they are.
 
Sometimes clients ask for specific guidance and I offer it. Others
want to figure things out more on their own with me there for support.
In both styles a goal is to help the client develop insight.

One new client told me he was having some difficulties at work and
stated that he needed a "strong directive" therapist. I wondered. When
he complained about how rigid his work environment was, I backed off
from telling him what to do, opting to explore with him instead.

Figuring out how much to say and how to say it are part of the
therapist's art, and we take both direct and indirect cues from the
client.
  

    
Your post makes me also want to make the distinction between being
"directive" as a therapist and being "engaged".

I believe there are certain types of therapy and certain conditions that
call for "directiveness" -- e.g., suggestions, "homework", coaching, etc.
Many models of family therapy are very directive.  Cognitive and behavioral
therapies also have a strong directive element.  These types of therapies
seem to be useful for things like depression, anxiety and obsessive-
compulsive-type disorders (for example).

Of course -- as Michael points out in his book -- you will get differences
of opinion (depending on a therapist's own theoretical orientation -- which
I agree says volumes about their worldview) as to whether certain conditions
(e.g., depression) are best treated in short-term vs. long-term therapy and
with insight-oriented vs. behavior-oriented therapy and so forth.

But a more generic word for a therapist's "style" might be "engaged" vs.
"not-so-engaged" (very few therapists are truly "disengaged" -- although
some may appear to be!).  I was definitely an interactive therapist.  I also
prided myself on knowing when to shut up -- although I made my share of
errors in that dept.  Also some therapists rely more heavily on "reflection"
(mirroring back what the client has expressed without loading much/any
interpretation into it), whereas others are more "probative" (questioning,
exploring) whereas still others are more "analytical" (interpretting,
reframing).
  

    
I would describe my style as conversational.  At times I find myself
being directive, at other times I find myself being non directive. 
Much of this is related to whatever the client is seeking.  For those
who most want me to be a witness to their lives, I tend to be quite non
directive.  I often ask questions to clarify or to help me to
understand what is being said, but I refrain from giving directions. 
That is not why the client is seeing me.

Other people come to me for both my opinions and advice.  Sometimes I
give it, sometimes not.  It depends again on why a client is seeing me.
 However, short of telling a suicidal client not to kill him or
herself, I rarely tell a client directly what to do.    I do make
suggestions and ask clients to consider those as suggestions.

An example of how I might be directive is that I often ask clients to
investigate the Enneagram.   This is a method of typing personalities
that uses non psychological jargon and is easy for most people to
understand.  I find that if a person understands their Enneagram type,
they can often accept and normalize parts of their personality that
they don’t like but are also parts of the personality that tend to be
enduring.  If a client resists my suggestion, I generally don’t press
it. 

Being directive can be tricky. More than a few clients ask for
directions so they can resist those directions.  Under it all, I
believe they are attempting to regain their sense of themselves that
was taken away by highly directive parents insisting the child do as
the parent wants.  They come to the therapy asking for the same kind of
directions they had and hated, but unconsciously they are attempting
to set up a similar situation to what they grew up with in order to
gain mastery over that situation and regain self worth, self esteem and
a sense of being able to be themselves that wasn’t possible as
children.  
  

    
what a great conversation this is. i hope you don't mind if i do a lot of
listening...trying to get a grip on which way to go in terms of training.
my therapist of many years never told me what to do. i really came away with
knowing i am my own healer. i'm trying to remember if she asked a lot of
questions.
  

    
One of my primary rules in life is that there is no one way for almost
anything.  So many ways we do things are merely just one was that is
effective.  I believe we choose to do things in a certain way because
deep inside of us that makes sense.  That includes therapy.  There is
no one way to do psychotherapy.  Many avenues to lead to the same
destination.  My choices, based on Humanism and systems theory suits my
personality.  And, I find I need to attract clients who my approach
suites them well. Others need to find other therapists.  

Unfortunately, many people choose the first therapist to whom they are
referred (I believe people do the same with lawyers, accountants,
plumbers, etc).  But therapy is such a great committment that it would
be worth a person's while to get the kind of therapy that suits them
best. I hope the book helps people to do that.
  

    
Michael, you just reminded me of one of my mental post-it notes from earlier
in the conversation!  BECAUSE of the point you just raised (it's worth it
for a person to really investigate the different types of therapy available,
etc.), your book has particular relevance for queer clients.  Because -- as
you say -- queer is different.

Not only is being queer different than being straight/not-queer -- it is
also different than being an ethnic or other kind of minority we typically
think of.  Some of these differences involve what we are likely to
experience in our families and the world around us.  Some of these
differences are in the dynamics of our relationships.  Some are in our
internal phenomenological experiences of ourselves.  And some just seem to
be in our wiring.  Can you talk more, Michael, about your thoughts on this?
  

    
i also appreciate how together the author is about therapy in general and
about doing it. this isn't an angry "they don't get us" rant. one of the
great strengths of this book is that i think it serves anyone wanting to
understand therapy - not just queer folks.
  

    
I believe queer people are different in many ways from non queer
people.  Our differentness is not merely about our sexual orientation,
but encompasses much more than that.  Proving that statistically is a
different thing.

For a long time the emphasis was on proving that queers were “no
different’ than any other folks.  Most of that had to do with
depathologizing queer people.  Initial studies in this area showed that
queer people could not be identified as such by scores on standardized
tests of mental or emotional functioning.  The “we are all the same”
mentality was assumed to cross over into other areas, such as cultural
areas.  

We are now beginning to understand that queer people not only form a
unique culture, as does every other group, but that in some ways we are
different going into all this.  One small way we have been able to
identify is that queer people are more likely to be androgynous than
non queer people.  Androgyny means having the personality
characteristics that are usually associated with both genders.  It is
more likely that a queer man will have some personality characteristics
associated with women, and the opposite is true for queer women when
compared with non queer people.   (Being transgender is a whole other
topic).

This does not mean that queer men are really women or visa versa. 
Queer women are still mostly female in their characteristics, just as
queer men are more like men than women.  But as a group we tend to have
more of the characteristics of the other gender than do non queer
people.

This has an impact on a lot of queer life; our relationships, our
friendships, the work we choose, and the culture we create.  More
research is needed here.  But the experience of being queer is not only
shaped by the society, but also by how queer people are different, in
all the ways we can or can’t identify.   
  

    
There have been some interesting ideas to come out of research done in the
past 10 - 15 years or so that busts open a lot of myths and stereotypes
people have about queers.  For example, you might remember the old notion
(based on some study) that gay men are more likely to come from families
with a distant father and an overprotective mother.  Some researchers, I
believe they were out of Minnesota, have since speculated that this is not a
"cause" or a "precursor" to male homosexuality, but rather AN EFFECT OF IT
within a family.  Which is to say the parents behavior didn't cause the
boy's homosexuality -- it's more the other way around!

Another interesting area of research involves couple and relationship
dynamics.  Of course we good old lesbians still lead the pack on most
enmeshed (or intimate -- depending on how you frame it!) relationships.  But
there's long been an assumption that gay men's relationships are the more
disengaged than lesbians or straight couples.  Michael, I believe you've
found something that challenges this assumption as well, yes?

What have you found, in your studies and clinical experience, about the
uniqueness of queer relationships?  And -- alongside that question -- here's
a sub-question: are there any interesting, noteworthy patterns that have
emerged among bisexual persons in relationships with persons of the opposite
gender?
  

    
Cindy - You raise some interesting points that I have given much
thought to.   One of them is the overly protective mother/distant
father syndrome that Freud and others believed caused homosexuality. 
While research dismissed that a long time ago, it couldn’t be validated
in controlled studies, it may have some validity, and your notion that
it is a result is probably right on. And the reason is simple. 
Straight men do not like being the sex objects of other males,
including their own sons.  I believe that some of these men realize
their very young sons look at them with sexual eyes; they are their
son’s first love object and they react with panic.  When humans are
afraid, they either get aggressive, or run away.   From the stories we
hear from many adult gay men, that is how their father’s reacted to
them, and this was quite different from the reaction these fathers had
to their heterosexual sons.

Regarding the relationships that lesbians and gay men create, we are
unique in some ways.  Years ago, as part of my doctoral dissertation I
investigated the dynamics of closeness and flexibility among gay man
while a fellow student, Ellie Zacks of Sacramento did a similar study
of lesbians.  We found some seminal information about queer couples. 
Lesbians, as expected, were the most enmeshed couples.  Less enmeshed
than lesbians, but still considerably enmeshed were the gay male
couples.  And, the least enmeshed couples, the ones who did the least
together, had the least friends in common, were the married
heterosexual couples.  The reason for this is not clear but this
research has been duplicated and the results were the same.  Queer
couples are the closest couples that there are in America.

We are different as couples in other ways.  We are the most flexible
of all couples.  There are no rules going into queer couples as to who
will do the dishes, who will take out the garbage, who will fix the
car.  All these things have to be determined by the couple. Sometimes a
member of the couple will gravitate toward an activity; sometimes it
is negotiated.  But queer couples change these roles considerably more
often than do non queer couples.

I am not aware of the present research into couples where one or both
are bisexual, but I am sure we will find some interesting results.  
  

    
do you think this can be said across the board, or does class have anything
to do with it?

in my recent experience, i have found self-described "edgy" lesbians who
come from privileged backgrounds to be suprisingly rigid about boy/girl
roles in lesbian dating rituals and coupleships. but this is the silly world
of the gender police. i wonder about that stuff. this is why i think of
myself as just plain queer.
  

    
Just changed health insurance plans and had to arrange for a new
therapist. When I called to make the appointment I requested someone
who worked with gay men. (Under different insurance plans, I've even
had people ask me if wanted a gay therapist.) The person I spoke to
seemed to think this was the oddest question in the world. 

I'm not at all happy with the person they've assigned me to, and I
suppose I will try to find someone else and pay out of pocket. Any
suggestions on finding queer-positive therapists in San Francisco? I
know this should be incredibly easy, but my web searches so far have
not turned up very much. Thanks. 
  

    
Finding a queer-affirmative psychotherapist in San Francisco is really
easy.  You can go one of two routes.

1. BUY MY BOOK!  Shameless self promotion here.  The book will not on
ly help you to find a therapist, but it will give you a lot more
information than just how to find a therapist.

2. Take the easy route - Call the GAYLESTA (Gay/lesbian therapist
association) referral line at  888.869.4993.  Depending on what
insurance you have, they may have a list of therapists who are part of
that insurance panel.

Better yet, do both.

Now a comment on the person at the insurance company with whom you
spoke.  She was completely out of line by saying your request was “the
oddest question in the world”.  She has something important to learn. 
This will only happen if someone like yourself reports this to the
insurance companies.  Insurance companies are in business to make
money, and most of them have figured out by now that they will make
more money by being queer sensitive. It is likely that you will get a
good reception if you report the incident.

Back to Jill’s comments on some lesbians being extremely rigid.  Gee,
I hadn’t noticed that. :-^) Seriously, there are rigid people, and a
lot of them within every group.  Lesbians tend to be the most flexible
of all couples by far.  This is an average so individuals may appear
quite different.  And I do now know how much of this is class
sensitive.  Most of the research was done on middle class people or
people with middle class values.  I would suspect however, that in the
upper and lower income scales, lesbian couples will still come out the
most flexible when compared with other couples in that socio-economic
group.
  

    
Thanks for the information!

>Now a comment on the person at the insurance company with whom you
>spoke.  She was completely out of line by saying your request >was
“the oddest question in the world”.  

Well, I only said that she "seemed to think that." She didn't make any
overt comments. Her reaction was just "huh, what? What do you mean?" 
  

    
Still, I think Michael's comment is on the money.  Insurance companies rely
on these folks to make a successful interface with their customers.  Someone
in her position who is not prepared to respond to a statement like yours is
not performing up to par.
  

    
Thanks for a wonderful book Michael. I appreciated the teaching nature of
your discussion of various forms of therapy. It had never occurred to me,
for instance, that a support group was for folks dealing with a common
condition and was not about changing as opposed to group therapy where
members are working on changing themselves.  Did I state that correctly?
It seems obvious now that you describe it. I'm amazed at the way you say
such simple things without speaking down to the reader. I'll bet you are a
fine teacher.

I wondered if you have any comment on drug and alcohol abuse and addiction
in the queer community. It seems to be a common thought that the rate of
such problems is disproportionatly high.

I also have the same question about queerfolk and depression. Is depression
a larger problem here than in the rest of the population?

If so, do you credit anti-queer sentiment from the majority for any of these
problems?
  

    
thanks for your reply michael. lesbian flexibility is news to me;)