Menopause and Therapy

Expressionist painting from Hokusai's Great Wave off Kanagawa in reds, yellows and black.

World Menopause Day 2021

Truthfully I don’t know how – or even whether – to celebrate World Menopause Day. What I do know is that if you are reading this, you may be seeking some clarity about your situation, whether for you or someone close to you.

Things are gradually changing for the better. Awareness-raising is increasing and more people are shouting about menopause, particularly those who are generally excluded from the mainstream narrative, for example: people who are LGBTQIA+, Black, neurodivergent, or who experience surgical or premature menopause. 

‘Why did nobody tell me?’ 

But there is so much more to do and, while society learns to adapt to the needs of this enormous population group, a lot of people are still floundering. Particularly those without the resources to have their voices heard via the media. But whoever you are, and whatever resources you have access to, you may still be wondering why no one ever said a word to you about peri/menopause.

Perimenopause is a Thing

I mean, you probably knew that – but if you’re in your 30s you need to be knowing about it now. If you’re in your mid-late 30s to early 40s and are experiencing changes in your mood or body, or exacerbations to existing conditions you may have, this may be peri and you need to know about it. You are not ‘too young’, no matter what anyone tells you. Looking back, mine started at 39 and possibly earlier.

Menopause is a Hormonal Transition

A hormonal transition means change. A change in outlook. A change in desire. A change in what you can tolerate. It may mean a shift in how you view your sexuality and your gender. I’ve spoken about this in a talk called ‘Menopause – Agent of Queerness?’

Menopause is Compounding and Multifactorial 

Whatever is already going on for you, whether connected to your identity or to your life experience, menopause is going to interact with it. If you are already affected by past or present trauma, mental and physical ill health, disability, financial concerns, domestic abuse, lack of resources, minority or minoritised identity, menopause will exacerbate it. (Eventually, it may help things too, but there is a lot to get through first.)

And the way menopause is promoted, and treated, in society mirrors systemic bias, whether ageism, racism, ableism, misogyny, or transphobia.

Menopause doesn’t only happen to Cis Women

Trans men and non-binary people also experience menopause. (I’ve written more here about the non-binary experience of menopause.) Seeing peri/menopause information, resources, discussions, social media posts, etc, addressed only to ‘women’ can actively hinder someone’s attempt to inform themselves and get support. There are negative health outcomes to this. Actually, lots of folks dislike the gendering of everything in healthcare particularly, especially being called ‘ladies’.

Menopause doesn’t only happen to White Women

As above, I could say the same about the whiteness of much menopause information and resources. People of colour’s experiences are barely being heard about or acknowledged. It’s not good enough.

‘I need help – but what kind of help?’

 In some corners of social media there is a certain pressure to be super positive about menopause. If you are seeking cheerleading, there are plenty of practitioners and they are easy to find.

But I’m thinking you came onto a therapist’s website because you need somewhere to talk about what’s going on for you on a number of levels. To name aloud what’s happening to you inside and outside. 

There may be anger, fear and shame. You may not feel able to talk about the things that are going on in your mind and body. Your working life and relationships may be in turmoil. You may be wondering who you ever were and realising that, looking back, it all felt like a costume. Parts of you may be opening up, and other parts may be shutting down.

You may be non-binary or trans or queer and have very few places to explore how menopause intersects with your life. You may be cis and straight but feel totally alienated by the mainstream menopause narrative. 

Whatever you need to bring, I can offer you a place to talk about it.

You can contact me here.

Conference: Black Trauma in the Therapy Room

BME Voices Talk Mental Health Trauma Conference 2020

This Saturday I attended Trauma Conference 2020 – Black Trauma: When it presents in the therapy room. This excellent online event was put on by BME Voices Talk Mental Health.

The speakers were Dr Dwight Turner (psychotherapist, academic, and forthcoming author), Dr Keren Yeboah (psychologist and author of the study ‘Power and the ‘hidden self’: reimagining the therapeutic use of power in work with Black people diagnosed with psychosis’), Ebinehita Iyere (youth practitioner working with young people affected by the youth justice system), Sharon Frazer-Carroll (occupational therapist, organisational expert and founder of Time To Talk Black), and Dr Isha Mckenzie-Mavinga (psychotherapist, academic, and author).

A note on trauma

Trauma is a spectrum, not a binary. Despite the best efforts of many, society as a whole is only just beginning to comprehend the multifarious nature of trauma, what trauma means for people individually and collectively, and the different ways it can manifest. Many now accept that you don’t have to be a combat veteran, refugee, or incest survivor to be traumatised and to experience PTSD or CPTSD, and that trauma in your ancestry is likely to manifest in the present.

It’s also more understood that ‘minor’ daily incidents, known as microaggressions, can cumulatively cause a high level of distress in a person. And that ongoing fear of threat can cause as much harm as an actual incident. But some, especially those with power, may find it harder to accept that certain populations experience this more than others. The challenge comes when these same people realise that it is they themselves who are causing the harm. Without deep reflection, it is hard to own our acts and do the work.

The multiple impacts of systemic inequality

At the conference every speaker, in different ways, outlined the systemic construct of whiteness and Blackness (the racial complex that binds us) and its impact, through racism, on Black lives. We heard about trauma responses to racism and the impact on mental and physical health, including internalised racism (or our ‘internalised supremacist’), and how quickly you lose touch with your humanity when you are forced to adapt to a culture that someone else has created.

Gaslighting and double standards

We heard about the harms done by the white-constructed mental health system to Black patients with psychosis, (for example being criminalised on entering the mental health system, and having anger mislabelled as a pathology) and the constant location of issues solely within the Black community, and the minimisation of the racism that creates this.

Ancestral trauma held in the unconscious

We had an interactive discussion about whether Black trauma exists, and whether therapists should undertake specific training about it. We were reminded that in 2020 the (white) world is waking up to a reality that many have already lived with for a long time, and that white therapists need to do more self-reflection and investigation. The silence of early lockdown ’emphasised the noise in peoples’ heads’ – the ancestral trauma, bursting to speak, that is so often buried in the unconscious.

Examining racism in supervision and training

We heard about the process of unmasking racism in clinical supervision, and the reminder that Black therapists are impacted by racial trauma while also hearing about it, and yet sometimes feel unable to name racism to a white supervisor. And when a Black student is expected to educate the rest of the students in the room, and do the labour of caretaking White fragility, (and keep their own feelings in check to protect others as well as themselves within a white system), they cannot give time to their own development.

The whiteness of the therapy world

Self-care

For the last hour of the conference, the primary theme in the panel discussion was self-care. When Black therapists speak about interaction with white colleagues, the word ‘exhaustion’ quickly comes up. There will be times when Black therapists cannot be with white friends and colleagues, because of this exhaustion, rage, and hurt. White people cannot expect to be rescued from this – ‘It’s not about you’. One speaker spoke of ‘trying not to be drawn into other peoples’ awakenings.’ Another quoted: ‘Just because we are in the same storm, does not mean that we are in the same boat.’ White therapists are advised to read, especially outside therapy subjects, and process shame and guilt by finding a place where it’s okay to talk.

Challenging course leaders

How do Black trainees stand up and challenge their course leaders? One speaker sent their comments to all their leaders and fellow students, and spoke out on social media, adding: ‘Get your message right and don’t endanger yourself.’ It is important to create Black spaces if there were none previously. But ‘realise you can’t do it all.’

Beyond eurocentric trainings

In the Q&A, someone asked: ‘Where are the Black and Asian modalities?’ The response came: ‘Here we are!’ The teachers, supervisors, and learnings are already here! They need to be listened to, and training organisations need their wisdom and experience in order to build equality-based and culturally competent trainings from the ground up. There are plenty of people and organisations out there who can help: Kaemotherapy, Race Reflections, Me & White Supremacy, Radical Therapist Network, Resmaa Menakem, and others can all contribute to new forms of training that prove the organisations truly value every student equally.

When I attended the inaugural BME Voices Talk Mental Health conference back in October 2018, I was surprised to see so few other white therapists there, perhaps 10% of the delegates. This was an indication of the work we have to do to make counselling and psychotherapy truly reflective of all populations, in respect of both therapists and clients. However, after the events of 2020, and the increasing profile of Black Lives Matter, I suspect this year the numbers were greater.

There is a long way to go

Every speaker had something positive to say about how we might go forward. But it was also clear that, in many ways, things have barely changed in 30 years. There are of course many individuals of all backgrounds desiring change in the mental health system and psychotherapy – but the process is slow. And, unfortunately, it is not clear that organisations are truly listening. One major piece of evidence of this is the ScopEd project, a proposed framework for a hierarchical classification of therapists, and promotion of particular member organisations. ScopEd was not mentioned at the conference (as I recall), but I feel it fits strongly with the theme.

A missed opportunity

This is not the post to go into detail about this, but I will describe it in brief. There was an opportunity for some real systemic thinking to address the huge missing pieces currently within mainstream therapy trainings, (race, racism and white supremacy being one of the most significant, but not the only one). Instead a top-down medical and analytic model is being proposed, and many counsellors may be put out of business by being deemed incapable of taking paid work. This hierarchical structure does nothing to address racism, misogyny, homophobia, biphobia, transphobia, classism or ableism, and does not seem to address systemic factors at all, even though they affect all of us every single day, therapist or client. It also doesn’t address the access issues that prevent so many people (particularly Black, and working class) from training as therapists in the first place. While I would agree that training standards do need to be addressed, it is the counsellors who are bearing the brunt of this project, rather than the training organisations who trained them.

In his book How to be an antiracist, Ibram X Kendi states, over and over again, that it is racist policies that need to change, and that only working towards anti-racist policy will have meaningful impact. Sadly it feels as if this is being played out, however unintentionally, in the counselling world. Of course, good intentions mean nothing without deep reflection on the impacts of our actions.

I am very grateful to all the conference speakers for sharing so much, and to Helen George, founder of BME Voices Talk Mental Health, and co-host Leoni Cachia. I’m looking foward to the next one already.

Doing Therapy Online – Advantages and Challenges

Illustration of a flu virus

Taking my private practice online

The world is experiencing a pandemic of Coronavirus, or Covid-19 flu. Due to the way it’s transmitted, people are being advised to severely limit in-person contact with others, and to take great care around hygiene. As everywhere, the situation in London is very much ongoing – and changing rapidly.

This post is to announce that, due to the current situation with Coronavirus, I am now seeing my clients entirely online. This will remain in place until things change again. This means I will be working either by video/audio link using Zoom (or another similar service as backup), or by phone. My colleagues are doing the same, or working towards it. 

The benefits of online therapy

I would like to say more about this as not everyone feels comfortable with the idea of working with a counsellor or psychotherapist remotely. I have been working online and by phone for a number of years, and I would like to reassure anyone who is looking for therapy at the moment but has never done it online before. 

There are significant advantages to working online:

  • We do not need to be in the same location to work together. Online access has created a revolution in therapeutic communication and relationships.
  • We have greater choice of working times, as I am not tied to the in-person hours I have at my office.
  • It provides access if you are unable to leave your home for any reason, or if you find in-person work very difficult.
  • Very importantly, we can continue to work during unusual periods like this when meeting in person is not possible.

There are also challenges:

  • Finding a private space to have therapy. This is important to reflect on, if your home or workplace are not right for this.
  • Feeling comfortable using a medium that you may not have used before, or which you have previously mainly used for social or sexual contact.
  • The reliability and safety of the technology.

If you’ve never had counselling online before, I have tried to answer some of the queries you may have:

Doesn’t it feel weird doing therapy while looking at each other on a screen?
I think we all felt weird the first time we did any kind of video call, even with someone we know well in real life. The first time you have a session on video as a client, it’s okay to take some time to feel into it, make sure you are sitting in a comfortable position and, if you need to, feed back to your therapist about what’s going on for you. 

I’m worried it might feel distancing.
It may do at first, and it’s important to honour whatever you’re feeling at the time. However, humans are highly adaptive, and it’s likely that, it will gradually start to normalise.

Don’t you lose something by not being in the same room?
You lose some body language for sure. But your senses recalibrate.

Isn’t it strange to do therapy by phone?
My experience is that you can do very effective therapy by phone. With only hearing to guide us, our senses recalibrate further and our focus increases.

Do I have to install anything on my computer/phone?
You may well need to download an app and/or sign into a website. I am happy to guide you through this.

What if something goes wrong and the tech doesn’t work on the day?
This happens occasionally. Wi-fi can go down. Services may be busier as more people take their lives online. However, I have several apps on my laptop as backup, andwe can use our phones. Depending on the access issues, we can look at each other on video while speaking on the phone, or even typing on messenger. (For the latter, a discussion on confidentiality is necessary.) If everything goes down completely, we can reschedule.

What about confidentiality?
In terms of what we say to each other, my approach to confidentiality is the same as when we are working in a room together. As for protection when working online, as soon as electronic media are being used for communication, there is a slightly greater risk. This is unavoidable. It’s about balancing the possible risks with your needs at the time. Some VOIP apps are seen to be more secure than others, and it is my responsibility as the therapist to check up on this. 

When reflecting on whether I and a new client are a good fit, I take a number of things into account – and working online is not going to be the right thing for everyone. I’m also aware that for some people, the act of leaving your home, travelling to your therapist’s consulting room, and coming back again, is part of the process, and it feels odd not to have this.

While these tools – computers, phones, and the internet – are not perfect (because humans made them) they are enormously useful, especially at times like this when there are very few other options.

While we all try to adapt to this rapidly changing situation, therapy may not be uppermost on your mind. However, if you would like to start therapy and are interested in working with me online, on video or by phone, please get in touch.

Pink Therapy’s Sex Work and Psychotherapy Conference – history in the making

3 Comments

I have just spent an extraordinary two days at the Pink Therapy ‘Sex Works!’ conference, about the intersection of mental health and sexuality professionals.

Every year the Pink Therapy conference covers a different GSRD (Gender, Sexual and Relationship Diversity) topic. Created by Pink Therapy founder Dominic Davies, in recent years they have featured gay men, trans, bisexuality, and kink, non-monogamies and other sexualities/orientations beyond LGBTQ. 

The purpose of the Sex Works! conference was multiple: to look at sex worker mental health and how the system could better support sex workers; to look at the experience of psychotherapists/counsellors (and trainees) who are also sex workers; and to look at the various forms of somatic sexology that may include genital touch, and how a dual trained counsellor/somatic sexologist may be protected within the psychotherapy system; and the ethical issues relating to all the above.  

For clarity: somatic sexology can include sex coaching, sexological bodywork, somatic sex education, some tantric practice, and sex surrogacy.

We heard about: busting some of the myths around sex work, sexual services for people with disabilities in Australia, somatic sexology, and a large scale research study of sex worker mental health. Sex surrogacy, conscious kink, Urban Tantra and Somatic Sex Education 101. We heard about ethical frameworks from a British Association for Counselling and Psychotherapy (BACP) perspective and from a highly experienced long-term member of the UK Council for Psychotherapy (UKCP), and about the Association of Somatic and Integrative Sexologists (ASIS). Also sex coaching for sex therapists. To round off the second day, there was a panel discussion about ethics (that included a representative from the Psychotherapy and Counselling Union (PCU) and the College of Sex and Relationship Therapists (COSRT)), which was supposed to be about how to protect dual-trained therapists, but turned out rather differently. 

The conference was a potent reminder of the enormous variety of what might be called sexuality work. As well as an opportunity to speak to dual-trained practitioners, there was a lot of vital, and courageous, testimony from speakers who are both psychotherapists and sex workers.

What became rapidly clear was just how badly people who do sex work can be treated as trainees of psychotherapy – and this mirrors the experience that many sex workers have as clients trying to access counselling.

Many sex workers are not out to their therapists, because it is just not worth it, due to the judgements and pathologisation they are likely to experience. Importantly, very often the reason someone might want to go for therapy has nothing to do with their life in sex work, but they need to know they won’t have to endure projections, rescue or confused hostility.

The bottom line is that therapy clients who do sex work are often being harmed – by therapy.

What was especially disappointing was the way the therapy registration bodies represented, BACP and COSRT – (sadly we lost the official UKCP representative at the last minute) – seemed to have provided those speaking with very little relevant research and opinions for the conference, even though they were invited to participate six months ago. Contrast this with how, after the presenter of the session that preceded the final panel discussion was absent at the last minute, two psychotherapist sex workers created an excellent workshop at two minutes’ notice.

It was particularly saddening to see how the psychotherapy establishment continues to conflate sex work with abuse.

It seemed impossible to discuss the ethics of being a dual trained practitioner, or a sex worker being a psychotherapist, without the discussion leaning further and further into complaints, abuse, and the nebulous and highly politicised concept of ‘disrepute’. It was pointed out that sex work is actually legal in the UK – and yet there is a persistent lack of clarity on this in the psychotherapy world.  This is part of a bigger picture, of a generalised lack of understanding of GSRD clients and identities that is consistently displayed in mainstream psychotherapy and, as a consequence, in training organisations. I find this issue especially disturbing.

From the many personal stories I have heard, a trainee therapist with a minority identity may well be expected to educate their peers about this identity, and may also endure endless questioning, assumptions, microaggressions and invalidating ‘debate’, even from tutors. The lack of understanding of minority stress, in organisations supposedly training people in how to support others, and how it can contribute to trauma, is mind boggling.

Of course, the excuse might be that by marginalising sex workers and sexuality practitioners, they are simply mirroring public life and the media.

Sexual pleasure in all but its most regimented, prescribed forms is othered and kept in darkness in a society where attention is not paid to sexual competence, and we are educated neither in negotiation nor consent, let alone in giving attention to our true desires. Apparently there is a perfect way to be a human, and that is to be monogamous, vanilla, cisgender and heterosexual, and the further away you go from that, the more deviant and in need of fixing you are. If you sell sex and do therapeutic or educational sexual touch, you are seen as almost beyond repair.

Counselling students who do sex work may be told that there are grey areas that may cause them to fail their course. This despite that, as was pointed out repeatedly, one of the skillsets necessary to survive as a sex worker – (intuition and trusting your gut, negotiation, establishing consent and boundaries, working with the client’s needs) – goes far beyond anything taught on counselling courses.

There was a lot of anger in the room towards the end, particularly when one panel member suggested the audience give them more information. It was pointed out that marginalised groups get very tired of doing the labour of explaining. 

I and a couple of my colleagues have a list of queries that have been left hanging:

  • Can you be a sex worker while training as a psychotherapist? (Still unclear)
  • How are the registration bodies going to look out for dual-trained practitioners? (Still unclear)
  • What is the legal reason for COSRT’s two ethical issues, that a COSRT member therapist cannot refer a client to a sex surrogate because it constitutes a form of ‘pimping’ (scare quotes mine), and that a member cannot signpost a client towards doing sex surrogacy work as this apparently constitutes coercion?
  • COSRT’s journal, Sex and Relationship Therapy, is currently planning a special issue about sex work, written entirely by sex workers. (Deadline for submissions March 31st.) We are wondering why this was not mentioned at the conference?

And here are some thoughts about how we can all move forward:

  1. There needs to be a basic CPD training for therapists around competency in working with sex workers.
  2. There needs to be a directory of sex work friendly therapists, a bit like the kink and poly ones that already exist, with a badge to go on the practitioner’s website.
  3. The main counselling and psychotherapy bodies would do well to reflect on why there is increasing frustration among therapists who work with GSRD clients, and who may well be GSRD identified themselves. There is a great opportunity here for these organisations to offer better support to all these client groups. Currently, too many minority clients are being harmed by a lack of understanding of their needs, judgement and pathologisation, and unhelpful use of therapeutic techniques and theories.
  4. Led by the registration bodies, training organisations need to focus on diversity as the baseline, not an extra – and actual identity-based diversity rather than just ‘theories of diversity’ or relying on the students to provide the topics. The same goes for sex – this also needs to be a baseline subject. I have encountered many clients who are not sure whether they are allowed to mention sex at all in sessions. 
  5. Training organisations need to find ways to make trainings accessible to less well off students. Important minority voices are being lost due to this. Actually, many people do sex work because it is the only way to make a reasonable living (often on top of parenting and working around health issues) – for many people it would be the only way to make the kind of money needed to pay for counselling training.
  6. Dual-trained practitioners are crying out for a membership organisation that can respect them and cater for all their needs. When one becomes visible, I suspect many will leave their existing registration bodies.

Several participants were reminded of the American Psychiatric Association conference in 1972, when being gay was still designated a mental illness. John Fryer, a gay psychiatrist, spoke on the stand while heavily disguised in a mask. This was an act of great courage, and we saw similar courage over the last two days. 

This was a groundbreaking event that I was incredibly privileged to attend. Huge thanks to everyone who organised, presented and participated.

The next Pink Therapy conference, where I may be speaking, is ‘Contemporary Issues in BDSM and Therapy’ on 6 October 2018.

 

Gender and Sexuality CPD trainings

Need some CPD?  Would you like to to update your skills and knowledge?

In 2017, as part of London Sex and Relationships Therapy, I am offering trainings on Gender and Sexuality in the therapy room, and other related subjects.

In January I will be in Cambridge and Edinburgh, facilitating:

Gender and Sexual Diversity in the Therapy Room

Drawing on the book Sexuality and gender for mental health professionals: A practical guide (Richards & Barker, 2013), this training provides a basic outline of good practice when working with issues of gender and sexuality. Attendees will be encouraged to reflect upon their own ideas and assumptions about gender and sexuality, and those implicit in their therapeutic approaches. We will consider various ways of understanding sexuality and gender, and their implications for therapy across client groups. Specifically we will focus on the issues which can be faced by those who fit into normative genders, sexualities and relationship structures, as well as for those who are positioned outside the norm.

If you would like to attend, please follow the links below for bookings:

Relate Cambridge – Saturday 14th January 2017 (10-4pm)

Information about this training and about Relate

Relationships Scotland – Saturday 28th January 2017 (10-4pm)

Information about this training and about Relationships Scotland

If you would like further training

If you are looking for training on this subject or something related, please contact me and either I or one of my colleagues will come back to you.

Am I kinky? And is this a problem?

screen-shot-2016-11-16-at-10-07-38Due to media stereotyping, unhelpful labelling with words like ‘paraphilia’ and ‘perversion’, and the assumption of mental illness or pathology – if you identify as kinky (or feel you may be) you sometimes wonder if there is something wrong with you.

You may have felt unable to share your feelings with anyone else. And you may also have avoided going to therapy, even for something entirely unrelated to your identity or lifestyle, because you fear either being treated as ‘sick’, or having to spend many hours justifying yourself.

For a start, kinky does not equal bad or weird

For some people, being drawn to BDSM (Bondage and Discipline, Domination and Submission, Sadism and Masochism) dates from their oldest waking thought or memory. Others discover it later in life. We live in a time when what you might call identity essentialism (‘If you weren’t born this way it’s fake’) is being questioned. Identities and orientations can evolve over time:

  • For example, from a young age you might have found yourself wishing to be restrained, or were aroused by certain scenes on television or in books, or took a specific dominant or submissive role during play with others. You may have put these thoughts and feelings away for years.
  • Or perhaps, as you grew up, you never felt right doing what everyone else seemed to be doing sexually, but weren’t sure how to articulate it, and just carried on doing things that didn’t really do much for you. Or stepped away from intimacy altogether. 
  • Or later in life you felt exciting changes coming on and, like Alice down the rabbit hole, you tumbled into a whole new world that you never wanted to come back from.

Secondly, it’s far more common than you think

And, even more importantly, studies (see the links at the end of the article) suggest that the kink identity correlates with a number of positive attributes.

A spectrum rather than a binary

I find it preferable to open up the definition rather than narrow it. Do you find greater release in giving or receiving extreme sensation? Do you experience something deeper when you give yourself over to another person, or take power over them? Do these experiences make you feel more fully you?

There are an almost infinite number of ways to express your kink

You do not have to join a particular community, or love leather or rubber, or spend your evenings in underground play spaces. For some it may be about handcuffs and a blindfold, for others total enclosure, for others extreme sensation. For others it could have nothing to do with physical sensations and everything to do with psychology. It could be about taking control, or giving up control, with no pain or restraint at all. 

For one person, it may be spending thousands on rubber clothing and dungeon furniture. For another, a simple phrase sent in a text message and a 24/7 household setup that others would have to guess at. It might involve going out to events, like clubs or munches, with others who share the same interests. For some people, no act, however apparently extreme, counts as kinky unless there is an exchange of power. 

It could be mild and playful, or it could be extreme and unusual, or combinations of all the above.

Does it have to be ‘all about sex’?

For some kink is inextricably linked with genital sex. Other people very clearly separate the two, and others are fluid in their approach. So however you feel, however you see yourself, there is no ‘one true way’.

Our society has a very poor record on acceptance of sexual diversity and many remain closeted just to feel safe

Perhaps you feel shame when reflecting on your fantasies or activities, and have never told anyone about them. You may also be struggling because:

  • What you like may have a more extreme taboo edge or safety element to it.
  • You may fear that you might hurt someone non-consensually.
  • You are happy for it to remain in fantasy, but want to be sure you are okay.
  • You have been paying for kink services and are wondering if this is okay.
  • You fear you are doing it too much, or thinking about it too much, and need reassurance that you are sane and not an ‘addict’.

If any of this troubles you, it may be helpful to talk to a therapist

Psychotherapy can help you look at the emotions underlying your current situation, and help you with any difficult feelings you may be experiencing.

It’s worth choosing carefully, however. There has been a tendency in traditional therapeutic schools of thought that any activity that is not 100% heterosexual, monogamous or vanilla (ie non-kinky) must stem from a pathology, or possible early-years damage. I have gone further into the problems with this viewpoint in a piece for Lancet Psychiatry: BDSM, Psychotherapy’s Grey Area.

I never discount the idea that this could for some people be the case, that a response to a past difficulty has evolved into a kink or fetish. And people do sometimes eroticise past experiences. But past experience may have meaning here or it may not. Be very wary if someone wishes to turn detective and start ‘uprooting’ your kink or trying to convert you.

You are not sick – you may just need to be heard. Rest assured you are not alone.

Where to find a kink friendly therapist

Further reading and research

On the subject of orientation and identity, there is an interesting discussion around this post by Clarisse Thorn: BDSM As A Sexual Orientation, and Complications of the Orientation Model

These two studies may also be of interest:

Sex work and the transactional nature of human relationships

Sonnenschirm_rot_redNew essay in Lancet Psychiatry

My latest piece is called Sex work – society’s transactional blind spot.

In the article I explore the transactional nature of human relationships and how we are encouraged to bargain with others, from a very young age, for social and emotional survival. I have focused on sex work because it is a significant cultural issue that polarises opinion and inspires much clichéd and harmful representation in art and media.

Sex workers also report poor experiences in therapy and within the mental health system as a whole.

The opinions and experience of those who actually do it are often ignored or marginalised

Even if you cannot imagine doing sex work yourself, or think you don’t know anyone who does it, it’s worth reflecting on it as an issue of labour rights, self-determination and consent.

Political support for change

Just after the piece was published, the UK Home Affairs Select Committee declared in a report that there was a very strong case for decriminalisation. Amnesty International reached a similar conclusion in 2015 which has now become policy. This move has also been supported by the Lancet.

If you are affected by any of the issues here and would like to explore them further in therapy, please get in touch.

[The image above is by Usien and can be found at commons.wikimedia.org]

Infidelity – deception is even more exciting than sex

beach 3Cheating – why do people do it?

Actually, perhaps the word ‘cheating’ sounds a little bit old fashioned, so let me put it another way: Why do people go behind the back of a negotiated relationship? Even if the relationship involves multiple partners and freedom to explore sexually?

And why do people do this even when the secret sex isn’t that good – and even when there may be no sex going on at all?

As a relationship therapist, I reflect often about what makes people seek something beyond the current boundary of their romantic partnership(s).

A popular subject for study

There are many theories about nonconsensual non-monogamy. This 2010 paper, Infidelity – When, Where Why? is a thorough roundup of a number of studies on the subject, covering everything from improving the gene pool; poaching a ‘better’ partner; unhappiness in the current pairing, whether due to insufficient sex, care or support; attachment style; boredom; dissatisfaction; and entitlement. There are also a large number of self-help books that attempt to address the issue.

This piece covers one aspect that has been on my mind for a while.

I suspect that, for many people, the urge to secrecy is even stronger than the sexual drive

This may not sound very logical on the surface. We are all supposed to be obsessed with sex, worrying about it all the time, chewing over about who is ‘getting’ more than we are. We spend loads of money on our appearances and fall easily into what I call ‘sex toy capitalism’, the endlessly evolving supply of slightly variant and increasingly expensive tools, of somewhat varying efficacy, which are sold as ways to enhance sexual pleasure. (This mirrors the encyclopaedic numbers of barely distinguishable (or pointlessly athletic) positions used to fluff out magazine articles, eg ‘The Wheelbarrow.’)

Sex is supposed to be the most important thing ever. Only money has more significance in terms of taking our attention and symbolising our social success to others.

So who would care about secrecy?

Ok, think about all the times you have been lied to. Well, there will have been so many of them that you won’t be able to. And then think about all the times you have lied to someone else. Much of the time people claim to hate the idea of lying, (and children are frequently warned against it) but when someone comes along and states the truth to you very brutally, you may well wish the untruths had continued.

So most of us have a shifting wall of defence available to us at the drop of a hat, when social needs arise. How many times have you told a person you were fine when you were not? Secrecy, of which this relatively innocuous exchange is an aspect, protects us from others and protects others from our real selves.

The excitement of a double life

It is very easy to fall into ways of living that do not feel fulfilling or exciting. We can easily forget the importance of excitement and fulfilment when we only have one life to live and we have been told over and over that we must live it in a certain way – through getting a job and a mortgage, and being married to one person, and having children. We may have had very good reasons for doing these things, and they can be very fulfilling in themselves. But perhaps we gradually stop testing ourselves, stretching our capabilities, until we have no idea what we are capable of. In that light, secret sex is a very quick way to reassert a lost, and intoxicating, sense of risk. And our suddenly dull-seeming partner, still stuck in their pyjamas, is unaware of our adventures, and momentarily we become more alive.

Secrecy is power

Secrecy is also control. Doing a thing that another person doesn’t know you’re doing gives you space. It gives you a chance at another identity, even for a few brief hours. It gives you space where you are less known and fewer assumptions can be made about you.

Secrecy is a form of individuation

If we are in any way unsure about who we are, no amount of sex will give us a solid sense of ourselves as individuals. If we find the presence of others encroaching despite our urge to bond with another; if being very close to another person risks us being truly known by them, we may seek to find outlets where we feel we can breathe, away from the main figure in our lives. Lies are like oxygen when the space you occupy with another person is overwhelming.

Response to a parent?

I could take this further and say it is an intrusive parent that we escape from when we do something secretively behind a partner’s back. An intimate partner can become an all-seeing eye – our instinctive response is to rebel.

Secrecy – not all bad

A person may have good reasons to have secret sex – perhaps they are caring for a partner who is incapacitated. They are not going to abandon them, but would like a sexual outlet.

I float this idea as a way of interpreting something I see very often. It is, of course, open to discussion. If anything in this post is relevant to what’s going on in your life and you would like to explore it, please contact me.

Trying to fix your relationship ? Change does not have to equal loss

Flames

As a therapist working with couples, one of the most persistent issues I see is fear of change.

However challenging things have become for both partners, and however untenable the relationship in its current form, people have an incredibly strong urge to cling to what they know, because the alternative terrifies them.

The will to hold on sometimes feels even stronger than the will to actually fix the relationship and make both partners happy.

I’m repeatedly astounded by people’s drive to remain connected in the way they always have, as if any form of adaptation will destroy everything that came before and erase all the happy memories.

People will stay together even when there is ongoing anxiety, constant sparking off each other, endless transferences and overreactions, and frequently calling the other out over tones of voice, events from the past and other points of conflict, and when sex has been adversely affected or become non-existent.

In other words, constant stress. And yet when I suggest a gentle reframe, and paint a picture of what the relationship might look like if they pushed the structure around a bit, there is panic. Because for so many of us, change automatically equals loss. Even just the thought of adapting to new conditions can put someone into a grief process.

Pre-mourning

You could call this sadness ‘pre-mourning.’ And I well know myself that it’s very hard to accept that change might actually make things better – enabling both parties to preserve the connection and eventually re-create happiness.

Fear of failure

It’s the same mindset that calls the ending of a relationship a ‘failure’. By this standard, all relationships that end have by definition automatically failed. (I wonder what kind of ending would not count as a failure – both partners actually dying?)

I have written before about the cultural primacy of a very particular kind of coupling, and the idea that to be a fully actualised person you must have been publicly chosen by another, and this must be seen to be the case in your family and community. To tell others that your coupling is in fact not working the way the world expects it to is a source of shame. You feel that you will be pitied or laughed at, and are left wondering if people said ‘How long do you give this one then?’ when you first got together.

There are more options than you think

The normative view of relationships that they are both binary and linear. If they are not one thing they must be another, and that they must follow a certain direction and ascent or they are not valid, or just weird. If you are in a heterosexual monogamous relationship, for example, you will find little public support for alternative ways of being together, except what creates lurid headlines: ‘We tried swinging and have never looked back!’

In fact, there are many ways that a relationship can be reframed or rebuilt, but these options are rarely spoken about as viable options. Like so much in society, if you aren’t doing it in a very specific way, there is something wrong, something lesser, about your choices. Needless to say, this is rubbish, but can be very hard to get past without support, whether therapeutic or from your community.

Some ways to reframe a relationship that is struggling

In the early days of relationship conflict, you may well have worked on behaviour and communication skills. Here I am talking about further down the line.

(1) Decide to live apart, if you cohabit. (Needless to say, the more financially you are tied together, the more this will affect your decision-making. But the decision to live together in the first place should not be undertaken lightly, and ideally never for purely financial reasons. If you have children, the issues are multiplied.)

(2) See each other less often but perhaps for longer each time, or varying contact.

(3) See each other less often full stop.

(4) Figure out the sex, if it was part of your relationship previously. (If it’s gone, can it be rekindled? Do you want/need it to be? You need to be realistic about the consequences when you both assert your needs around it.)

(5) Have some time apart with a timescale on it. (This one scares people a lot as there is a lot of conventional wisdom that says ‘break=ending’. Sometimes it does – but you can only find out by trying.)

(6) Open up the relationship up to other people. (This one scares people even more, often with good reason, and it should not be undertaken without a lot of negotiation and research. There has to be mutual consent.)

Love – or helpless attachment?

The tie that binds here is a thread of what is called love, but may be more akin to helpless attachment. I cannot say for sure what is love or what is not, but if the pain and fear are outweighing the good times, you may be closer to the other.

What if it’s really broken?

It hurts when it’s broken. So the feeling of acceptance is often welcome. I am divided over whether true acceptance can really be worked on, or whether you can only invite it in, to appear when you are ready.

If you’re experiencing difficulties in a relationship and would like to explore things with a therapist, you can contact me here.

Are you stuck on the Sex Escalator?

3 Comments

tg-1-27Today I’m talking about the repetitive sexual conveyer belt that we can find ourselves on if we pay too much attention to cultural influences and not enough to our own needs.

I’m calling it the Sex Escalator because you can sit on it and it will take you somewhere that feels vaguely elevated over and over again – and you need not think about it, ever.

Remember the ‘Relationship Escalator’?

You may well have heard of the ‘relationship escalator’, an idea that originated in non-monogamy research circles and promoted in excellent article about polyamory that I have linked to before. It’s about how relationships are culturally encouraged to follow a tried and tested formula – essentially meeting, dating, becoming a (preferably heterosexual) couple, becoming exclusive and monogamous, moving in together, getting married, buying property and having children.

This model suits many people for many reasons – but it also has a purpose, namely to uphold social cohesion and provide a foundation for a very specific way of having a family. It does not deserve to be rejected outright, but it does deserve examination because many people fall into it before realising it is not what they want or need at all. And this is when relationships can become damaging.

As with relationships, so with sex

Discussing this with friends and colleagues (and working in communities where we talk about these issues a lot), even highly creative sexual adventurers will admit to having sat on the escalator at some point in life. The process goes something like this:

  1. Kissing
  2. Manual stimulation
  3. Oral sex 
  4. Penetration (preferably PIV)
  5. Peak genital orgasm
  6. The End (someone falls asleep)

People base entire marriages around this paradigm. Any deviations from this become treats, exceptions or outliers, or simply never thought of.

And of course, parts of this sequence may be missing altogether because they were never there in the first place.

This is not to judge anyone or criticise this as a way of having a good time together. Over time you may have discovered the most efficient way to orgasm with one person – and after all it’s pleasure and connection you’re after. You may be frequently tired and you may be busy and you may have family to take care of.

The problems start when you’re increasingly unhappy – but you’re not doing anything about it.

Communication as taboo

The problems start when communication ends. For many people, unaccustomed to stating even the simplest needs, useful communication will stop as soon as mutual liking is discovered. For many people this may even come as a relief. In the UK we have a popular trope of two people getting drunk together on a date, waking up in a relationship, and then being delighted that it need never be mentioned again, perhaps for several years.

As with emotions, so with sex.

A package deal of conditioned behaviours and expectations

On the Sex Escalator:

  • Anything else doesn’t really count as sex, or is weird.
  • It’s vital to have a goal, and that goal is ‘full sex’ because the rest is just ‘foreplay’.
  • If you miss out the genital penetration, the sex is incomplete and has failed.
  • If the escalator doesn’t arouse you that much, you should keep quiet about it so as not to create disruption.
  • If the escalator doesn’t arouse you that much, you may need to seek outside help, because the problem is your fault.
  • If the escalator doesn’t arouse your partner that much, you should tell them to seek help, because the problem is their fault.
  • Obviously the penis owner will have an orgasm, because they definitely enjoy penetration. (Go here for a longer discussion on why a number of people actually aren’t into penis-in-vagina sex. Go here for a rather more brutal takedown of this sexual trope from a feminist perspective.)
  • The vagina owner really ought to have an orgasm because otherwise they must be dysfunctional and the penis owner won’t like them any more due to their imperfect functioning. 
  • You dare not discuss any of this with your partner in case they are offended or think you are about to criticise them.
  • Deviating from this pattern in any way is terribly adventurous and needs masses of preparation and expense.

I would like to think that the generations that have grown up with the internet will have found a better way, but looking at what young people seem to be learning, I am not so sure. And although this feels like a strictly heterosexual/cis model, any pairing of genders and sexualities could technically enact this. 

I also have a suspicion that this conveniently boxed scenario keeps people more heterosexually confined than they would ideally wish to be.

If the Sex Escalator isn’t working for you

If you keep on ending up having sex like this, and you’re not enjoying it, or you feel that there’s something missing – ask yourself some questions. If you have a partner, ask each other some questions.

  • Am I or my partner truly consenting to any of this?
  • Have we actually ever discussed it?
  • Do either of us really want it?

And if you’ve said to yourself and/or each other: ‘Well, this is okay enough, and if we don’t do these things it doesn’t feel like we’ve actually had sex – ‘

STOP!

If you want something different, here are some things to remind yourself about:

  • Sex does not need either a goal or a destination.

  • Genital sensation does not need to have primacy.

  • Specific activities do not have to have primacy over others.

  • There are no rules about which parts of the body should be included or left out.

  • Orgasms are nice but they are not obligatory.

  • Communicating your needs is vital. 

  • Focusing on breathing can add a whole layer of experience.

  • There is a whole world of sensation waiting for you in many areas of your body that you may not have considered.

  • Have you talked about your fantasies? Have you even thought about them?

What if you went right back to the start and asked yourself – or asked each other – what do I/we really want?

Am I overstating this? Judging by the responses I encounter when someone (or two people in a relationship) realises there is another world of sexual connection out there I am, if anything, understating it.

In a future post I’ll go into more detail about ways to expand your sexual experience.

If you’re concerned about anything I’ve raised in this post and would like to explore this aspect of your life in more detail, you can contact me here.

Bisexual life – hiding in plain sight?

2000px-Bi_flag.svg

Pink Therapy conference 2016

Last Saturday I spent the day with colleagues at Pink Therapy‘s annual conference for therapists. This year’s theme was Beyond Gay and Straight. 

‘There are gay bars and straight bars, but where are the bi bars?’

Someone made this point during the plenary session. Erasure is something bi people experience on a regular basis. I’ve been told more than once that the word ‘bisexual’ is a bit of an audience killer and best left off publicity materials. This is sadly unsurprising.

Bisexuality and mental health

Dr Meg John Barker reminded us that not enough studies have been done specifically around bisexuality, but what there is – sometimes the B element has to be squeezed out of the side of a larger piece of research – is unequivocal. A bisexual person is likely have worse mental health than someone who is either gay or straight. An aside from another discussion, a good proportion of people diagnosed with Borderline Personality Disorder (who are, incidentally, mostly likely to be women) also identify as bisexual. (For more research and information, see BiUK.)

Prejudice from all sides

Bisexual people experience discrimination from both straight and gay communities. Bi people are seen as fence sitters, greedy, manipulative, unstable, sex-obsessed, and indecisive, perpetually on the way from one place to another but never getting there. Women only ‘do it’ to tease or please men. It is seen as marginally more acceptable to be a bi woman than a bi man, however – bi men are either ‘gay, straight or lying.’ A bi person must experience an exactly balanced 50/50 attraction to men and women (never mind other genders), or they are fakes and must be straight. Sometimes therapists (and partners) offer to convert them, or tell them that their issues will be resolved when they ‘pick a side’.

Charles Neal, author of The Marrying Kind, talked about the lives of gay and bi men married to women, the ‘mixed-orientation marriage,’ and the misery experienced by people stifling their identities in order to remain in a socially acceptable unit. ‘Experience before identity’ was his message – but even nowadays, if you don’t identify sufficiently with one tribe over another, you may feel left out in the cold. (See also How To Support Your Bisexual Husband, Wife, Partner)

Born this way?

Current activism tends to promote sexual and gender identities as self-defined, but it wasn’t so long ago that you had to be ‘born this way’ in certain queer scenes, (and adopt one of a specific set of appearances) or you were seen as a ‘tourist’. You were ‘bi-try’ (for bi or bi-curious women entering lesbian environments) or a ‘stray’ (for bi or bi-curious men entering gay ones). And, on arriving at an event, there was that look from the door person that said ‘Your hair goes past your shoulders – are you here to write an article about us?’

Binary versus fluidity

These attitudes remind us how the desire for a binary universe is so pervasive. If you are not one thing you must be another, because of course there are only two things to be. The idea that a person’s desires may shift and evolve over time seems entirely absent. To be fair, if you have fought for years for your singular identity, you may well feel threatened by any kind of flexibility around this, but this feels increasingly out of step with younger people, for whom fluidity of identity feels as if it’s becoming the norm.

It all sounds very like the dismissive way some old-school kinksters speak of switches, ie people who are comfortable occupying both sub/bottom and dom/top roles, or have a different role depending on the gender of their play partner. And, for that matter, people who cannot accept non-binary gender identities. There is, perhaps unsurprisingly, a high proportion of bisexuality in trans communities. DK Green spoke in detail about both topics. Validation from partners is essential: ‘Does your partner see you as you see yourself?’ (Trans Media Watch has a good resources page.)

Caution around labels

A therapist simply being affirmative may in fact be damaging when a client holds multiple identities, and this can apply particularly if they are intersex. And in a flurry of anti-religionism (for sure understandable given the damage that religion has done to people with minority identities), you may trample over the fact that a queer person is religious and gains comfort from it.

Multiple intersections – multiplied difficulties

Ronete Cohen spoke about the intersection of bisexuality and race, where a bisexual person of colour can be marginalised and objectified in a number of communities simultaneously. Microaggressions are multiplied, and there is far less social support and consequently worse mental health outcomes. She gave the example of a bi person of colour asking for help dealing with stress, and being told to go to yoga. There are a number of reasons why this was inappropriate – western yoga is generally white, middle class, often expensive, promotes a particular body type, and contains potential inherent cultural appropriation.

Elsewhere during the day, someone gave another example of a therapist trying, unsuccessfully, to take mindfulness into communities of colour, having not thought through the missionary implications of this. A therapist may have training around gender, sexual and relationship diversities, but they may not have any cultural competence training around race. (See Bis of Colour for more information and support.)

Queering relationships

From the other sessions I attended:

Niki D talked about biphobia in relationships, and the difficulties of being a bisexual person in a relationship with someone who is monosexual.

Meg John Barker, using their excellent zine ‘What Does A Queer Relationship Look Like?‘ talked about queer relationships, and the fact that a high proportion of bisexuals are also non-monogamous. (The ‘Normativity Castle’ is especially pertinent here.)

Amanda Middleton presented on queer identities and offered a breakdown of Queer Theory. She outlined the slippery and paradoxical implications of queer – (for example, if a queer person experiences microaggressions, it can mean they are doing queerness well) – and the fact that identity will inevitably change over space and time.

It’s an exciting time for Gender, Sexual and Relationship Diversities therapy

Thanks to Dominic Davies and the Pink Therapy team once more for a great day and an excellent learning and networking opportunity. There’s a lot of work to do – especially around training – but this community is growing.

For videos of the main talks, go here.

Contact

If any of the issues in this post are affecting you and you would like to talk further to someone, you can contact me here.

Am I A Sex Addict?

1 Comment

Silhouette of person watching stripper in club

Sex Addiction – what it isn’t

A lot of people worry about whether they are sex addicts or not, and you may be reading this because the headline rang a bell for you. You may be doing things, looking at things – or even just thinking things – that you feel you cannot share with anyone else because you’re not sure of their reaction. Such is our society’s shame-based confusion around sexual behaviour that many people fear that they may be somehow abnormal. One of the quickest ways to contain your sense of perceived abnormality is by calling yourself an addict.

The Addiction Industry

‘Sex And Love Addiction’ has become a global concept. The media loves it because it feels on-trend, has an air of danger, and pushes buttons deep in us all. And the idea of attending 12-step meetings as the only way to fix ourselves has become a powerful meme. To be ‘needy’ is to be stigmatised out there in the world, the story goes – but in the safety of a meeting you will find a community where you can express your true self. There is nothing wrong with reaching out to a group of people that share a common issue. But by accepting a label you are also paying a price, and in saying ‘it’s not me, it’s my illness’ there is always a risk of remaining in a state of helplessness that is increasingly hard to come back from.

The Addict as Anti-Hero

It is also tempting to identify with the addict as a kind of maverick or renaissance person. There is a strong subconscious (and cultural) narrative in which the addicted person (whether to drugs or anything else) is a prodigal child who is too creative for this earth, fundamentally different from others, and even a shaman. This kind of identification is an effective way of feeling in control of needs that may be making you feel guilty, whether they are in fact doing harm in your life or not.

20 Things that are not Sex Addiction

Such is the push-pull between obsession and denial that almost any behaviour connected to sex whatsoever can be enlisted in support of the sex addiction model. I’ve seen a concerning number of activities and behaviours named as possible symptoms all over the internet and in other media. Here is a roundup:

(1) Thinking about sex a lot

(2) Having sexual fantasies

(3) Having a lot of partner sex

Societal codes dictate all sorts of highly unrealistic attitudes about numbers of previous partners. Numbers do not make you an addict.

(4) Having group sex

Ditto.

(5) Frequent masturbation

How frequent is frequent? This would be my first question.

(6) Being a particular gender and liking sex a lot

A woman is expected to have very few sex partners before her character is called into question and she may be labelled a ‘nymphomaniac.’ She is liable to be labelled an addict by others before a man is, or encouraged to label herself as one. A man may be more likely to self-diagnose as an addict as this self-label may help with fears of helplessness which are seen as insufficiently masculine.

(7) Infidelity

You entered into a relationship without first reflecting on your or your partner’s needs, and you find you cannot stay within the agreed terms of it (if there even were any). It does not make you an addict. The social primacy of the closed couple may simply not be for you.

(8) Being LGBTQ+

Othering of people who are not heterosexual or cisgender often involves a critique of presumed sexual behaviours. This particularly applies to bisexual people, for being ‘greedy’. Trans people are sometimes accused of something similar.

(9) Being polyamorous or in an open relationship

Non-monogamists are sometimes thought to be sex addicts because there must be only one reason for having more than one partner, and that is to have more sex.

(10) Having a fetish

Having an erotic focus on a particular object, form of dress, or experience is fairly common and does not make you a sex addict.

(11) Cross-dressing

Wearing clothes commonly associated with a gender other than the one you were assigned at birth does not make you a sex addict.

(12) Being into kink/BDSM

Negotiating boundaries and consent before having intimate contact is not addiction, and neither is giving or receiving extreme sensation or enjoying power exchange. People into kink may be labelled addicts because they actually talk about the sex and intimate contact they are about to have before doing it. One of the rules of normative sex is that you do not talk about it, thereby denying all responsibility for your feelings about it.

(13) Using porn

Porn use can become problematic, but one of the main reasons is our abysmal record on sex and relationships education for children and young people. It is shame based rather than pleasure based. Hand in hand with this is the denial that puts the porn industry in the shadows. There is nothing wrong with wanting to watch people having sex. At best, porn can also be educational and an aid to solo or partner sex.

Plus, don’t forget how many people skip work and partner/family time to watch or listen to sport. No one calls them a ‘sport addict’ and packs them off to a meeting (although I suspect there will be a clinic for it somewhere).

(14) Voyeurism

Enjoyment of looking at people being sexual is not sex addiction.

(15) Exhibitionism

Enjoyment of being looked at while being sexual is not sex addiction.

(16) Visiting sex shops and websites

Where else do you obtain sex toys and other sex-related material?

(17) Visiting (or working in) lapdance/strip clubs

Being involved in, or enjoying, sex-based entertainment does not make you an addict.

(18) Attending (or running) swinging/kink/fetish parties

Hosting, or attending, sex or kink-focused gatherings does not make you an addict.

(19) Paying for sex or kink

Paying for sex does not make you an addict.

(20) Receiving money for sex or kink

And neither does receiving money for it.

Lest I labour the point even further, none of these things in themselves are indicators that someone has a problem that needs fixing.

‘But my sexual behaviour is causing me a lot of problems, so I must be an addict. Are you saying my feelings are wrong?’

Your feelings are not wrong. As a therapist I would be failing at my job if I did not acknowledge someone’s own account of their situation. There is an increasing movement towards self-definition, of sexuality and of gender – so why not this too? My issue here is that sexual behaviour is too individualised to be labelled an addiction. In this model, we are very few steps from labelling some sexual behaviours an illness and even a pathology. Overall, too often (as my list above illustrates) this is no more than ill-founded moral judgement. In fact, sexual self-expression can go to all sorts of extremes and still be completely healthy and non-damaging.

When someone does feel out of control, it’s important to look at the reasons that may be underlying this rather than stick a label on them.

If you have stopped taking responsibility for yourself, and are harming others, this may be a warning sign, along with:

  • Regularly missing work or appointments
  • Neglecting those closest to you
  • Behaving non-consensually
  • Draining your or someone else’s finances
  • Putting your or someone else’s health in danger

However, the problem is as much to do with any other aspect of you as it is about sex. It may be to do with numerous other aspects of your life, or past events that you have not fully integrated. [Of course there is a red flag in here – it does not automatically follow that a person who has a lot of sex, or participates in non-normative practices, has been abused.]

If we compulsively return to a behaviour that is not serving us (whether sexual or not), it may be because nothing else in our lives is satisfying us or making us feel held.

Repeatedly doing something that takes pain away, even when the positive feelings are very short lived, may well be a sign of underlying unease. Examining harmful patterns with deep roots that we feel helpless to change is one of the main reasons people come for therapy. It does not make anyone an addict – or otherwise we are all emotion addicts.

Am I saying sex addiction can’t exist at all, ever? No, but I find that the term is being misused to the point where it is unhelpful.

Self-Help

Seeing a therapist can help you gain some clarity about what’s going on for you. You may, for example, have grown up with the message that you were ‘too much’ as a child. That you took up too much of everyone’s space and time, and that everything you do is wrong. It may also have left you with the sense that you are doing ‘too much’ of something – therapy may help clarify whose version of ‘too much’ that is.

Also, there is nothing wrong with questioning an aspect of your sexual life, identity or practice, that is starting to feel intrusive or ‘not you’ any more, and taking it to therapy. Please bear in mind, however, that conversion therapies are increasingly outlawed and no reputable therapist will suggest them.

  • To find out how I work, and what areas I specialise in, go here.
  • You can find more of my published writing, in the Lancet and elsewhere, here.

Seasonal Affective Disorder – in summer?

Cornish beach in black and white

Added 24th April 2021

I’m writing this as we semi-emerge from Covid-19 lockdown in UK. The sun is bringing happiness and excitement for many people. It is also highlighting the ambivalence that others feel about exiting lockdown, particularly given that Covid is likely to be here for a while, and that many do not feel fully safe, vaccines or not. 

What is summer depression?

I will start with my own experience. I remember the feeling vividly. It came on at the start of the school holidays when I was about 14. After the elaborate goodbye rituals, the end of term (and every end of summer term after that) felt like falling off a high building, but slowly, into a state of emptiness and loss. This feeling was made all the worse by the fact that when the sun’s out and the temperature goes above a certain level, you are supposed to be out there having fun. It is practically the law. ‘But you’ve got to go outside! It’s sunny!’ 

Gradually the feeling bedded in through university and into my twenties. Summer meant other peoples’ lives, not mine. Staying in sometimes helped, sometimes not. Sometimes seeing blue sky through a window made it even worse, because the barrier between me and the world was tangible, something I could touch.

‘Summer SAD’?? But everyone loves summer, don’t they?

‘April is the cruelest month…’ This endlessly quoted line from TS Eliot’s The Waste Land evokes the sense of alienation brought on by this phase of nature. Green shoots, flowers, colours, warmth, baby animals – all these things symbolise the world turning and everything changing and moving on.  It’s Hollywood tropes like Yay! Beach! Shorts! Convertibles! Drink! Sex! And it is precisely those aspects of the spring and summer seasons that fall on some of us like hailstones. The suicide rate is highest in late spring and into the summer.

Summer also makes itself known to us through sound. Windows open. Music, laughter, glasses clinking, beer cans crushed in hand, barbecues – heard from just across the way, just out of reach. And so the sounds and smells of someone else’s new season hang over you. Fresh cut grass and the sound of lawnmowers. The obsession with light is perhaps unsurprising in the UK’s northern European climate. But this is not always healthy. Light is very exposing. There is a sense that once the bright light has been on you, you cannot go back. And social media can make all this feel so much worse. As with other holiday periods, you may feel surround by people telling you that you can choose how you feel about this.

What does summer SAD feel like?

In a way it’s like any kind of depression, but it has a particular flavour. Symptoms could include:

  • A desire to withdraw from the world
  • A strong feeling of alienation from culturally defined and enforced notions of happiness due to the temperature going up and there being more light
  • Loneliness
  • Anxiety
  • A sense of exclusion
  • A fear of exposure
  • A sense of being trapped
  • A desire to cover up the body
  • FOMO – Fear Of Missing Out

So what causes it?

I think it’s from the same family of responses brought on by Christmas and other annual festivals. The difference is that summer is more drawn out. (For some more detailed thoughts on why holiday times are so stressful, please go to my blog post here. Although what I’ve written there applies to end of year festivities, I think many issues there apply to summer as well.)

Here I’ve listed some aspects of what may contribute to it:

  • The weather may push you into remembering difficult times and traumatic experiences you had when you were younger.
  • You may be trans or gender non-conforming and may dread the exposure that summer brings. 
  • You may have children and be dreading trying to fill up the long weeks until the autumn term starts.
  • The obligation to look as if you’re having fun, and being singled out and exposed if not.
  • A sense of a vast natural cycle that is leaving you behind. You may be ‘still’ single, ‘still’ unemployed, ‘still’ without a child, or ‘still’ married to the wrong person or living somewhere you have outgrown.
  • As with Christmas and other festival times, you may feel obliged to see relatives or go to places that you dislike. If you are a young person you may have no choice in the matter.
  • Summer can be expensive and you may have fears around money. If you had holidays when you were young, perhaps they were stressful and you could not escape. If you didn’t have them, another summer reminds you of what you didn’t have. 

The feelings can also be anticipatory. Many people dread summer for reasons which occur at different places on the continuum between practical and emotional.

The fear of being exposed physically

  • You would rather cover up your body because your size or shape attracts attention and this causes you anxiety.
  • You wish to avoid comments in the street/on the beach because of the above.
  • You wish to avoid sexual harassment.
  • There are aspects of your body that others may be more likely to notice and comment on when you are wearing fewer clothes, or doing sporting activities (for example if you are transitioning, or have tattoos, extensive scarring, or an ostomy.)
  • You dread fending off the expectation that you will participate in sports.

Summer-related physical health issues

  • Hay fever (many suffer miserably with this for months)
  • Sunburn
  • Rashes (including heat-related, ‘chub rub’ and running/cycling rashes etc)
  • Insect bites (many people have a terrible response to mosquito bites, and there is Blandford Fly, ticks etc)
  • If you cover up in jeans/layers in order to hide your body, excessive sweating can cause problems
  • Sleeping problems due to light and heat, which can contribute to depression
  • Light sensitivity (some people find the bright light makes them physically ill and need to wear sunglasses frequently)

So how did I deal with it?

I was astonishingly lucky. Having spent many years doing self-care (see below) fairly badly, my summer SAD was lifted overnight in 2003 by a kind American hippy I met online. We were members of a support group email list and we chatted quite often. When I explained my feelings to him, he suggested I do a ritual of thanks to the sun for giving me life. I was to write a message to the sun on a piece of paper and throw it in the nearest river and watch it float away on the tide. At the time I was living not far from Westminster Bridge, so the river bit was easy. However, the Iraq war had just begun and there were police everywhere. So he suggested I burn the piece of paper instead.

I did it – and it worked. I woke up the next day and the feelings had gone, never to return.

What was going on there, you might be wondering? I cannot tell you. The message seemed to be about personifying my relationship with the sun, and reframing it so that the summer did not feel like enemy territory, or a malign superego, or that something was being taken from me. Also, the previous year had been momentous and life changing in terms of my own survival, and perhaps subconsciously I was ready to let go of my fears.

Strategies for self care

So what to do, short of upping sticks to the antipodes, or very far north, for four months of the year?

  • Choose your clothes and research the best medications well in advance so you feel prepared. Get a good hat and sunglasses.
  • Are there work projects that you can just spend the summer getting on with?
  • Get a good fan or air-con unit for hot days when you don’t want to be outside, so that your home feels like a refuge.
  • If it is not safe for you to be open and honest about how you feel, you are going to need a cover story about why you’re not going swimming, playing ball games or going to the beach. Prepare it carefully. Burn easily? Knee injury? Allergy to XX? Get it straight and stick to it.
  • Suggest activities to family/friends which have an indoor and outdoor aspect, so you can take cover without hiding.
  • Hiding away and saying nothing may feel safer, but may not be a good long-term strategy overall. Can you share your feelings with some friends and others who are close to you? You may find they feel the same.
  • Relish the cloudy days, those grey and green veiled and comforting days when other people are complaining. Even better when there’s a rainstorm!
  • Some people give a lot of significance to solstices and equinoxes and the various festivals that go with them. Even if the language and pageantry around neopaganism doesn’t appeal, observing these time markers give a sense of the world turning and impermanence which you may find helpful.
  • Make plans for the autumn and winter so you have something to look forward to.
  • If you don’t feel you can share what’s going on with people close to you, a therapist can help.

My second holiday season post also has a number of thoughts on how to prepare for a difficult holiday period.

I hope my article gives you something to work with as the summer approaches.

You can contact me here.

Alternative sexualities conference – keynote videos

pink_therapy_people

Pink Therapy conference 2015

Here are the keynote videos from Pink Therapy’s Beyond The Rainbow Conference in March.  The conference was a great success and was very well attended, showing the great interest in – and need for – more teaching about sexual identities that are beyond the mainstream.

If you’re a therapist yourself, you may wish to use these videos for CPD.

(1) Non-monogamies

Author, psychologist and activist Dr Meg John Barker outlines the extensive range of relationship styles and structures beyond monogamy. (Video 26.16.)

(2) The kink paradox

Counsellor/psychotherapist DK Green unpacks the issues for practitioners when working with a client who has both a history of traumatic abuse and an interest in BDSM. (Video 26.35.)

(3) Living and working in the kink communities: professional boundaries and ethics

Pink Therapy founder Dominic Davies examines dual relationships when working in small communities, and how to maintain ethical boundaries. (Video 24.25.) (Needs login due to adult content.)

(4) Asexualities – doing without?

Counsellor, supervisor and trainer Olivier Cormier-Otano talks about his survey of asexuals, their diversity of experience, and their pathologisation in a culture that expects people to be sexual in very specific ways. (Video 20.21.)

(5) The place of kink in psychotherapy and counselling training

Psychotherapist Henry Strick van Linschoten discusses the reasons why kink should be included in psychotherapy and counselling training. (Video 29.44.)

(6) Further sexualities

Psychologist and senior research fellow Christina Richards describes sexualities considered to be less common than others – such as adult babies, furries and puppy play – and considers how clinicians can best support clients who are looking for help. (Video 36.42.) (Needs login due to adult content.)

You can find out more about the conference and other seminars here.

Low-cost counselling and psychotherapy services in London

1 Comment

London skylineSeeing a therapist in private practice isn’t financially accessible to everyone.

Here’s a list of reduced-fee talking therapy services in the London area. I hope you find it useful.

PLEASE READ THIS FIRST:

• This list is not definitive or exhaustive – it is a work in progress, and I will be adding to it as time goes on. [Most recent changes 17/12/17]

• Being listed here doesn’t necessarily mean I know the service and/or can personally endorse it. It may have been recommended to me, or I may have heard of it a number of times. I am going on what is stated on the organisations’ websites so cannot personally guarantee the content.

• There will be a number of different fee scales and a variety of numbers of sessions offered, from a few to open-ended. The trend is generally towards time-limited work of up to 12 sessions, but some places offer longer. And there will also be a variety of therapy offered. Don’t be embarrassed to ask questions.

• The counsellor you see at some of these services may be in the later stages of their training. Please don’t let this put you off. In order to practise, their trainers, if they are from a reputable college, will have spent time reflecting on whether they are ready or not. Psychotherapy students generally work very hard and have to give very detailed accounts of themselves on a regular basis.

• Some therapists in private practice do offer reduced fee places. Pink Therapy, The Counselling Directory, and the BACP’s It’s Good To Talk are all good places to start looking.

GENERAL – Clients accepted from all round London

Awareness Centre (Clapham SW4)

The Blues Project at the Bowlby Centre (Highbury N5 – waiting list currently closed at 11/17, but they say they may have spaces again in 2018 – also worth contacting the main therapy team as there may be some therapists there offering lower cost)

British Psychotherapy Foundation (Scroll down for their list of reduced fee schemes. Longer-term work.)

Centre for Better Health (Hackney E9)

Centre for Counselling and Psychotherapy Education (CCPE) (Training organisation in Maida Vale W2. Also runs The Caravan drop-in counselling service at St James’s Church, Piccadilly W1)

Community Counselling (East Ham E6)

Free Psychotherapy Network (Collective of therapists offering free and low-cost therapy, mostly in the London area but also elsewhere)

IAPT (Improving Access to Psychological Therapies) (A long list of London-wide local counselling services, many of which take self-referrals. Otherwise through your GP.)

Metanoia Institute (Training organisation in Ealing W5)

Mind in Camden – Phoenix Wellbeing Service (Mental health charity in Camden Nw1)

Mind in Haringey (Mental health charity in Haringey N4)

Minster Centre (Training organisation in Queens Park NW6)

Psychosynthesis Trust (Training organisation near London Bridge SE)

Spiral (Holloway N7)

WPF (London Bridge SE1)(Fees not really low, but they have a range of types of therapy.)

BOROUGH SPECIFIC

Help Counselling (Kensington & Chelsea W11 – mainly for residents of K&C but not entirely)

Kentish Town Bereavement Service (Kentish Town NW5 – for residents of Camden, Islington, Westminster and the City of London only)

Mind in Islington (Several sites – short term therapy for Islington residents only. Longer-term work also available.)

Mind in Tower Hamlets and Newham (Tower Hamlets E3 – for residents of Tower Hamlets and Newham only)

Time to Talk (Hammersmith & Fulham; part of Mind – likely for Hammersmith & Fulham residents only)

West London Centre for Counselling (Hammersmith W6 – for residents of Hammersmith and Fulham only)

Wimbledon Guild (Wimbledon SW19 – for residents of Merton only)

BME/INTERCULTURAL

BAATN (Black, African and Asian Therapy Network) (Extensive list of free counselling services for BME clients – UK-wide with a good number in London)

Nafsiyat (Finsbury Park N4 – for residents of Islington, Enfield, Camden and Haringey only)

Waterloo Community Counselling (Waterloo SE1 – for residents of Lambeth and Southwark, and London-wide)

CANCER SUPPORT

Maggie’s (Hammersmith W6 – clients from all round London. Also other centres UK-wide.)

Dimbleby Cancer Care (Based at Guy’s and St Thomas’s Hospitals SE1 – patients from South East London and West Kent.)

HIV SUPPORT

Living Well (North Kensington W10 – clients from all round London)

River House (Hammersmith W6 – clients from Hammersmith & Fulham, Ealing, and Kensington & Chelsea only)

Terrence Higgins Trust (Online counselling; Also London and UK-wide in person services)

Metro (HIV prevention and support services in English, Spanish, Romanian, Polish and Portuguese – centres in Greenwich, Vauxhall, Gillingham and Essex)

LGBT

Spectrum Trans Counselling Service (Ladbroke Grove W10 –  free service for people who identify as trans, non-binary or are questioning their gender identity)

ELOP (Walthamstow E17 – clients from all round London)

Metro (Greenwich SE10, Vauxhall SE11, Rochester Kent ME1 – clients from all round London)

London Friend (Kings Cross N1 – clients from all round London)

Albany Trust (Balham SW17 – LGBT+ and anyone with sexual issues/difficulties)

OLDER PEOPLE

Age UK Camden (Camden WC1 – for those registered with a GP in Camden)

WOMEN

Women and health (Camden NW1 – residents of Camden only)

DRUGS & ALCOHOL

REST at Mind in Camden (Camden NW1 – support for people experiencing difficulties due to benzodiazepine dependency)

Welcome to London Central Counselling

Welcome to my new counselling and psychotherapy blog.

If you’ve suddenly found yourself on this page and are wondering what it’s all about, I’m Tania Glyde, author turned counsellor/psychotherapist in private practice in Central London.

There are so many interesting things going on in the world and it all moves so fast. I’m going to share articles I’ve written, thoughts on therapy, and other material that might be useful or interesting. I’ll also be putting up links relating to mental health and gender/sexual diversity. I’ll be focusing partly on articles that have come out in the last week, and partly on older stuff that I think deserves another outing because I found it so helpful. (Needless to say, me linking to something doesn’t mean I endorse or agree with every word of it, but I and my colleagues might have found it a fruitful talking point.)

If you’re brand new to therapy, here’s my guide to having counselling and what to expect. If you’d like to read more, Sense About Sex has a detailed section about getting help. I’ll also be addressing some issues that come up a lot, and making suggestions about how to make the festive season go as well as it can, whether you’re participating or trying to avoid it.

Thanks for reading.