Therapists, are you harming your autistic and ADHD clients? (Part One)

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Photo by Sid Verma on Unsplash

Part 1/2: Assumptions, Interventions, and When Good Intentions Go Bad

This post comes out of an online discussion involving a number of therapists who work with neurodivergent (ND) clients, many of whom are themselves ND or are parents of ND children. There was a lot of frustration expressed. I have summarised the discussion here and added some thoughts of my own.

I sense a wave building around this topic. Personally, it’s helping me crystallise some of the thoughts I’ve been having since long before I trained as a therapist but, until recent years, I was not able to name.

Why am I interested in this?

I am late-diagnosed ND. This has been highly impactful. As a previously undiagnosed ND client in therapy, I found myself on the receiving end of some of what you read here. And before I found greater understanding, as a therapist I may have also enacted some of these things myself, or at least believed in them. 

PLEASE NOTE 

• This article cannot be exhaustive, and cannot be a full-on explainer – it could easily be a long form essay or a book – but I hope it will be a conversation starter. In part two I will link to further resources.

• The main focus of this post is on working with adults rather than children.

• The online discussion focused mainly on autism, ADHD and AuDHD, so those identities are the priority here, but the neurodivergent umbrella (which covers both developmental and acquired neurodivergence) is way more expansive. However, many of the scenarios I describe here could apply across the board.

• If I have linked to an article on a particular website, it doesn’t mean I agree with everything else on that website.

• For brevity I will often be using the acronym ND in this article, short for ‘neurodivergent’ or ‘neurodivergence’. (NT = neurotypical).

‘Wait! You can’t be talking about MY modality, surely?!’

If you are a therapist reading this you may already be feeling on the defensive, so please give yourself some time. And, actually, there is no need to descend into modality wars – because there is literally no therapeutic modality that cannot be used harmfully with a neurodivergent client! 

Any therapeutic modality (as well as the therapy world itself) may become ossified without constant self-reflection and consideration of the shifting social context as well as increasing awareness of neuro difference. For example, out in therapy land you will find folks who believe that, for example, Unconditional Positive Regard and Attachment Theory, are immutable concepts like the sun rising again.

Also – and this is really important – a lot of therapy research has been carried out by, and with, white neurotypical people, which potentially limits their value to many. 

Much of what I’ve written below fits within the contemporary definition of gaslighting. The word has come a long way since the old movie, Gaslight. In essence, it’s about misusing power over another person by telling them that they don’t know their own mind. 

This list is long. I’ve laid it out as simply as possible.

ONE – RIGID ADHERENCE TO MODALITY

I go into further detail in the sections below, but here are some obvious ones:

(a) Being determinedly non-directive despite the client needing, and requesting, structure and clarity. 

(b) Not answering direct questions from the client without going into a whole ritual dance of ‘I wonder why you are asking that’ first is often unhelpful. [This is similarly unhelpful when a client is also GSRD (Gender, Sex and Relationship Diversity) identified and may welcome a therapist explaining or disclosing.] Psychoeducation is valid and may bolster a client’s sense of autonomy. For example, if someone is having issues at work, they may need help to understand the covert meanings of what is going on, and so start to protect themselves from power games played by colleagues. A client may feel abandoned if the therapist does not support them when they ask about something.

(c) Therapist silence can be highly detrimental. The inherent slipperiness of the blank screen technique can simply be torture to an autistic client who may be seeking rules to work by, or an ADHD client experiencing RSD (Rejection Sensitive Dysphoria).

(d) Relying on specific jargon, eg ‘splitting’, when the client shows strong emotion; or if they are talkative, being told this is ‘ego defence’ or ‘resistance’. (The irony of this rigid adherence may not be lost on an autistic client who may have previously been criticised for their ‘rigidity’.)

(e) CBT-style thinking: No one (ND or not) should be encouraged to see their thinking as defective, and be encouraged to change their behaviour as if they are the one at fault, when the issues are likely their environment and lack of accommodations.

TWO – THERAPIST ASSUMPTIONS

(a) ‘Of course it’s not autism or ADHD – it must be trauma!’

Being autistic or ADHD does not mean the person is automatically traumatised. But due to the way ND people are often treated from a young age, they are very likely to be traumatised because of this. Being either diagnosed and stigmatised, or living undiagnosed and spending life thinking they are defective or useless – that for sure is trauma.

(b) ‘Of course it’s not autism or ADHD – It must be attachment issues!’

There was particularly pronounced anger in the group about this, particularly from parents of ND children. I go into more detail on this in part two, on negative outcomes. There are many critiques of attachment theory and it is not an immutable law.

(c) ‘Isn’t this client just avoidant?’

The alleged avoidance may actually be alexithymia. Lack of ability to name feelings is one reason why an ND person may find life difficult, and be bullied and abused because they are simply unable to express what they are feeling or protest against it. Also, when you have been stigmatised because of who you are, you may well have learned to hold back as an aspect of masking, for safety.

If the client says they don’t know the answer to something, or cannot name how they are feeling, this is not an invitation for the therapist to start pushing them as if they are hiding the truth from themselves.

(d) Assuming deficits rather than differences

Using the medical model of cognitive or behavioural deficits, while not understanding, say, sensory processing differences or monotropism, is not helpful, and neither is assuming the client is broken or disordered and needs fixing. The therapist may rigidly adhere to the DSM, which assumes a deficit model. The therapist may try to get the client to change or deny their ND characteristics, and when this doesn’t work the ND client leaves feeling broken (see part two). This will not help a client work on undoing the internalised ableism they are likely experiencing.

(e) Not understanding the autistic sense of injustice and moral injury

‘I can’t understand why you’re still angry about that!’ It is infantilising and frustrating when a therapist regally waves away a client’s lingering sense of injustice. (Poorly held therapy may of course incite this feeling in the client also.) This may be compounded by the power dynamic between therapist and client, highlighted by, for example, gender, race or class differences.

(f) Assuming the client is ‘nervous’ or ‘anxious’ 

It’s important not to assume the client is nervous just because they are stimming in various ways, or they are talking a lot about special interests, which a therapist may dismiss as ‘obsessions’. Also many ND people may process what’s going on for them out loud and rapidly in a way that may seem over detailed, or a distraction, to a therapist who is not aware. If a client talks fast this may just be how they talk, rather than a sign that they are stressed and need to calm down.

(g) Infantilising the client for their ‘compliance’

A client who pays on time and turns up on time may be held to be ‘compliant’. This in autistic people may be viewed as something childlike or even negative rather than cooperative.

THREE – UNHELPFUL INTERVENTIONS

(a) ‘You’ve got to make them feel the feelings!’

Many ND clients are already feeling a lot of feelings and a therapist pushing them to feel more will not be therapeutic. Ditto the technique of goading the client into anxiety or anger in order to get them to have the feeling again in the ‘safe space’ of a transferential relationship in the therapy room. 

Also, a client may express feelings via all sorts of media, metaphor, simile, imagery, sounds, movements, creativity as a whole, and their special interests, rather than direct description. 

(b) ‘Let’s do some meditation!’

Speaking as someone who experienced the query ‘Have you tried meditation?’ many times in a therapeutic context, there are actually many people who cannot sit still and focus inwards, and for whom this may be actively detrimental. Focusing on the breath or doing body scans (see below) may be traumatic and bring up bad memories. In fact, meditation can be anything you want it to be, eg dancing or cleaning, but this is rarely pointed out. When I explained that traditional meditation methods did not work for me, there was often an implication that I just hadn’t tried hard enough, which is often directed at ND people.

Similarly with guided visualisations – someone who is aphantasic or hyperphantasic may struggle.

(c) ‘Let’s do a body scan!’ or ‘Let’s explore your bodily felt sense!‘

Many ND people struggle with interoception and may be unable to access what is apparently being asked for. Also, someone with sexual trauma (of which there is a higher than average incidence among autistic girls and women) may find themselves going into a fawn (compliant) response when asked to do things with their body, which will leave them feeling worse afterwards.

(d) ‘Why aren’t they looking me in the eye? I need to do something about this.’

The therapist may interpret a client not looking them in the eye as denial, avoidance or dishonesty. Actually, eye contact is not the universal positive this would seem to imply. In many cultures it is seen as disrespectful to look someone in the eye, particularly someone in authority. Some ND clients who struggle with eye contact will simply evolve a way of staring at a point on the therapist’s forehead and hope that it’ll do – thereby distracting them from the work.

(e) Pathologising a client being late for sessions

Again this is treated as if it must be avoidance, when it may be executive functioning or memory. Some people with ADHD really struggle with this.

(f) Pathologising a client’s special interests

Someone might have an aspect of social justice or any kind of politics as a special interest. If this makes the therapist uncomfortable this is for them to work on.

(g) Expecting homework tasks to be completed

Many clients struggle with homework for all sorts of reasons. Making non-completion (non-compliance?) a thing may add to client stress. There may also be echoes from challenging schooldays here, as well as the impact of PDA (conventionally known as Pathological Demand Avoidance, but also known as Pervasive Drive for Autonomy).

(h) Suggesting the ND client has a personality disorder or other pathology

While this takes us closer to psychiatry, it’s still worth remembering that ‘personality disorder’ as an idea is often used harmfully, and the diagnosis of BPD/EUPD is often used stigmatisingly against young women, queer and trans clients, People of Colour and ND clients when, ironically, it is often trauma that is manifesting. Similar applies when suspecting the ND client is a ‘narcissist’.

FOUR – WHEN GOOD INTENTIONS GO BAD 

(a) Not raising the possibility that a client may be neurodivergent

Generally clients are open to hearing this. Yes, it has to be done with care as most therapists are not qualified to diagnose – but it can absolutely be explored. But withholding this possibility may cause harm to the client in the long run. 

(b) Not wanting to label the client

Following on from the above, some therapists cling to the idea of ‘Why do we need labels?’ [See also: working with GSRD clients] and it generally comes from a place of privilege (or structural social advantage). This may cause them not to suggest a client may have ND traits. Actually, labels help people find their peers and make adjustments to their lives where they can, and feel as if they aren’t going mad. This can also help prevent burnout from trying to survive in a neurotypical world and keeping up with neurotypical peers.

(c) Normalising the client as a therapeutic goal

A therapist’s goals may be to make the client fit better into society. This may come from a place of good intention, by wanting to rescue the client from their struggles. However, this is likely to result in the client masking even further, on top of what they are already doing. Therapists need to understand ND masking rather than pathologise it. 

(d) Assuming that the client always has the answer

This may appear to contradict some of what I am saying, but sometimes the client does not have the answer because they may not be aware they are autistic or ADHD and so may not have the answer that needs to be voiced. Open-ended questions may not always be helpful here.

(e) Assuming that all ND stereotypes apply to all ND people

Such as: Autistics have no empathy and are good with numbers; ADHD people are lazy and lose their keys all the time and can’t sit still. Assuming all ND people are the same does not help. For example, autistic people are often hyper-empathic and this contributes to many challenges of burnout and sensory processing. 

(f) Therapist has previous knowledge about autism but their knowledge is outdated

This is why many autistic and ADHD people refuse to engage with trainings, seminars or research where those teaching or writing are not autistic, ADHD or otherwise ND themselves. Also, some organisations/individuals are still promoting ABA (Applied Behaviour Analysis) therapy which is held in very low regard in the autism community.

(g) Lack of understanding of the Neurodiversity Paradigm

This may manifest as dismissing neurodivergence as a ‘young people with green hair on the internet thing’. [See also therapist’s attitude to gender variance; and there is a high correlation between gender variance and neurodivergence.] The therapist may infantilise a client who wants to explore themselves, or try to debate them either about the diagnosis they have received, or their self-diagnosis. Another issue is not understanding why a person might choose to self diagnose, or why they may have no option otherwise.

(h) Issues in the therapy room or when working online

A practitioner may think they have made their therapy room more inviting, but this is not necessarily the case. Bright fluorescent lights, ticking clocks, scented air fresheners, flickering lights or candles, insisting that the client remains sitting still in their seat and that the seat is directly facing the client, may all cause stress. Online, insisting the client is not lying in bed. [I’m also aware of challenges to this – that sometimes changing position can be helpful.] Insisting that the client leave their camera on.

CONCLUSION TO PART ONE

I can hear many theoretical objections to the above already! But remember this is real examples from real people we are talking about. Other ND folks may have had better experiences than the above, and there is no perfect therapy.

In part two [coming soon] I am looking at negative outcomes, suggestions of what you can do next, and a list of resources.

If you could choose to live without a physical body, would you?

When I ask people this question, whether my clients or my friends, the answer is nearly always yes.

To clarify, this post is not specifically about:

  • Spirituality, the spirit or the soul (although it could be, depending on your beliefs); 
  • Cryonics, or the fantasy of having your brain frozen and stored until technology has developed to the point where you can be reanimated (although it could be, depending on your beliefs); 
  • Physical disability (although it could be, depending on your situation and experience).

I am speaking about the sense of freedom you could have if your physical body wasn’t confining you emotionally, mentally, relationally, spiritually and politically.

Anyone may feel this – no matter how outwardly successful they may be, or how comfortably and conventionally their body functions.

If you are, for example, read as a woman or femme or female or feminine, (no matter what gender you were assigned at birth), you will know that you cannot move through the world without your physical body being scrutinised.

You will be informed constantly that your body (and therefore you) is either too much or not enough, sometimes simultaneously, and the goalposts move faster than you can adapt to their constant repositioning. You are relentlessly beholden to the opinions and assumptions of others. (Or perhaps you are read as not feminine enough. )

You are constantly aware of being on show, and of the consequent risk of mockery or violence, so your energy is drained and your nervous system taxed by being on constant alert.

It’s hard to challenge patriarchy (or any other embedded societal structure) when it has your face gripped in its hands and is unblinkingly staring you out.

Imagine this not happening to you.

Imagine no more comments about your weight or your face or your presumed sexual capacity. Imagine that you could go where you wanted without fear.

Actually, people of all genders have replied to this question with a yes.

And this is not just about gender. Much of society believes that others owe them their bodies – whether in terms of race, class, or disability. What if we, as individuals, could choose not to have these bodies? We could be free of so many demands. 

What if we could exist without a body, and in our chosen invisible shapes and dimensions?

What if you could shapeshift your bodyless self, and be infinitesimally small in one moment, all-encompassingly huge in another.

And what if it was up to you whether you experience sensation at all? If you struggle with the demands of sensory processing, what would it be like to be able to choose what, and how much, you experienced? What if we could choose where our imagined external boundary is – if we even wished for one at all?

As a late diagnosed neurodivergent person, I now have greater understanding of my own relationship with touch and movement, and why it was never as straightforward as it seemed to be for others. Interoception and proprioception are hard work at times – what if we didn’t have to navigate them?

In contrast to much social media output, to feel less can be a luxury.

Imagine you could feel just enough to get by and more easily navigate a world that constantly threatens to engulf us with its own needs and desires?

I spent a number of years in somatic and sexual experiential spaces where (consensual) touch was central, and participants were encouraged to be fully present. When we experimented with up-regulating and down-regulating breaths, it occurred to me that some people are already feeling more than is comfortable for them, and not all of the processes we entered into were helpful. Some of us, because of our previous experiences or simply because of who we are, already feel too present. The only way to tolerate this is through self-removal, or dissociation.

Remove the physical body and there could be so much more, so much more to do and be. And what could sex be?

I’m aware of the multitude of beliefs and philosophies that hang off this thought experiment, and how we could go down any number of roads when talking about it. (And I’m aware that my utopia becomes a little fuzzy, because who would choose to lose their corporeality and who would keep it? And what power structures might ensue?)

I’m aware that technology can partially take us there. As can meditation. As can drugs. Partially.

So let’s come back to the beginning. If you could live without a physical body, would you?

Negligent apathy – the pandemic gift that keeps on giving

Close up of a wet pavement with a small segment of orange dropped on it.
Out walking a few months ago, I noticed a baby navel orange that had been dropped on the ground.

What happened to our capacity for relating?

There is something that I have been noticing for a while now, in every part of my life.

Over the last three years, our capacity to honour working arrangements, connections, friendships, and even simple responses has often become severely impaired. Of course, I include myself in this.

So how have we come to this normalisation of burnout? Behaving as if those around us are disposable, and it is simply too much effort to put ourselves in others’ shoes and understand the consequences of our actions, because we are just too zoned out.

We were already overloaded

Looking back to long before the pandemic, many of us were already at the limits of our capacity to endure stress. This might be due to a minority or global majority identity, past trauma, juggling survival (perhaps with disabilities, housing issues, chronic health issues, and/or chronic financial stress), and the sheer exhaustion of living in a society that is, increasingly, trying to kill us. Then there was and is climate change and the rise of fascism.

Even if we had ‘enough’ resources for the day or week or month, or even the year, and were in good health, the spectre of that changing was ever present.

When you’re already on the edge, small setbacks feel like big ones, and big ones feel like catastrophes. If you haven’t had time to recover from one thing, and another one happens, you are dealing with more than one layer of response, and these layers can quickly pile up. This over time is likely to reduce your capacity for empathy and your energy to receive others’ bids for attention or help, let alone your capacity to respond to them.

The impact of sudden change

We have all had different responses to the pandemic. But one thing is true, that we all had to adapt to Covid-19 very quickly. Over time, we realised our resources were shrinking : social, personal, and financial. While time seemed to stretch, and some felt persistently hopeful that we were almost out of the woods (we aren’t, still), many people found themselves with less energy. Many people stepped away from relating because it just took too much personal resource.

Remember the frenetic activity of those suddenly finding themselves at home all days? Creating mockups of famous paintings using saucepans and pet cats, learning Italian, and baking sourdough. Those whose labour keeps society propped up were neglected, while being expected to keep turning up for work, or they would lose everything.

The pandemic itself

If you have Long Covid, (or greatly fear getting it for all sorts of valid reasons) you will have been navigating that on top of the huge society wide denial by many governments that the pandemic is still happening. A very redundant form of individualism has been normalised and encouraged, as if to check whether others are okay – family wide, community wide, or country wide – is seen as laughable. An infantile notion of ‘freedom’ has been invoked, freedom from ‘lockdown’ which sounds carceral and something to be rebelled against, instead of a way to keep us all safe.

People as a whole have been encouraged since the start not to take the pandemic seriously. So many aren’t wearing masks now, or acknowledging the decreased capacities, and increased access needs, of a significant minority of people. I am sad to see this even in queer/left community. I wrote more about this here.

This is a trauma response

Before you think I am condemning all humans, it is very clear that this negligent apathy is also a trauma response. Many people have been struggling to connect the way they did before. They may have felt abandoned by close people, friends, partners, and the social system they exist in. They may have experienced multple bereavements, both due to Covid-19, waiting lists, or inadequate medical care due to a deliberately depleted NHS. They may have hated working from home, or been laid off work, or lost their business. They may have been evicted by a rogue landlord.

Life has changed, and this is the new normal, but many people still feel that we can get ‘back to normal’ with no consequence. I find this somewhat delusional – but I am well aware sometimes our delusions and denials are all we have in order to remain upright.

Traumatic dissociation is a major driver of what I am talking about in this post. Dissociation is a very valid survival response and most of us fall into it at some time or another. It may for example be masking a flight response, or a freeze, or any other response to overwhelm.

And what is hard to talk about here is that trauma can make us self-absorbed, selfish and worse. Trauma isn’t pretty. The fight response often isn’t, and the fawn safety response (tend and befriend, caretaking, or appeasing) tries to be pretty, but often can only be sustained on the surface. I’ve even noticed a hierarchy of trauma responses – basically fawn is the most acceptable, and fight the least – which deserves unpacking in another post.

How do we reframe our existence, heal, and reconnect?

I wish I had an immediate answer to this.

I admit that I have been shocked to the core by the behaviours and attitudes of people that I thought I knew. And I know I’m not alone in this. I’ve been baffled at being ignored, over and over, when attempting to maintain a collaboration. Again, I know I’m not alone. Endless one-sided initiation feels like a mug’s game, and trust seems in short supply now.

One thing this society does is divide and rule. The more we fight each other, the more we remain divided. I also know that it is not that simple, and in many cases of discrimination there definitely aren’t two equal sides.

I hear people in certain circles criticising individualism and insist on community all the way, especially in terms of transforming society from the extractive to the supportive. Which is fine, but many of us have not been trained in how to be in community, and we have no experience of how to do it at all, let alone well. And when we do try, very often abusers (emotional, financial, or sexual) find their way into positions of power. It happens over and over again.

There is a lot of work to do here, and a lot of healing and reconfiguring. And we have to start somewhere. As in therapy, sometimes all we can do to begin is make the unconscious concious, by naming what is going on and keep it from falling below the surface again.

Do you struggle with cooking? You’re not alone!

Image plates and bowls on shelves - by Brooke Lark https://unsplash.com/@brookelark
I chose this image (by Brooke Lark) because it reflects the struggle of decision-making in the kitchen, whatever the reason for it.

You wouldn’t think that cooking was a challenging topic, especially at this time of year! *sardonic laughter*

As you read this, you might be recovering from holiday cooking. If this is a huge pleasure for you, (and someone else did the clearing up), I’m glad. But I know this is not the case for everyone.

Actually, the more I’ve reflected on our personal relationship to food and cooking, the more I feel an edge of shame and stigma – and a sense of authoritarianism – around the subject. I have known people who would be horrified by the idea of eating, and offering, anything but fresh ingredients cooked from scratch. If you are one of them, you may find something to think about here.

There’s a gigantic post to be written about food, who has enough of it, who doesn’t, food quality, economic power, the carbon cost of moving it around, labour (everything from who harvests and processes food to who prepares it and who consumes it), and what is called privilege but is also known as relative (or actual) structural advantage. This is not that post.

Here I’m looking at the personal experience of getting and preparing food, and why many more people than you think find it a giant chore and actively stressful on an ongoing basis.

Anything on this list may be further impacted by holiday periods (like right now), when eating/hospitality rituals are at their most significant.

This list is not exhaustive or exclusive

This post was greatly helped by a long discussion thread which ran to over 100 posts and was clearly bringing a lot up for people.

Please note: None of these headings are exclusive – what I have written in some of them of course can apply to others. It’s a rough and ready roundup and for sure I will have missed something.

Not everyone loves to cook

There, I said it.

Not everyone is able to cook

… for themselves or others, for all sorts of reasons.

(TL;DR: Shame features a lot here.)

(1) General food shaming and snobbery

The media is full of images of perfect looking food and recipes. Not all are super posh and expensive and presented by thin white people, and many writers go out of their way to present cheap and easy recipes. But it can seem like we’re never doing enough to make this somewhat mythical-looking proper healthy food. Many of us are too busy or too tired, whether from work or from life, or too skint to think about it.

If this topic is making you uncomfortable – (think of all those politicians saying that they could make Christmas dinner out of three chickpeas and an apple, and why didn’t all these feckless people on low incomes just learn to cook properly?) – it’s worth wondering why. Many people regularly order takeaway or eat microwave or freezer meals or eat food from tins, for many of the reasons you will read in the list below. Yes, you can critique the nutrition in some of it, and the relative expense of takeaways, for sure.

But this is far from being a lazy option, because remember the systemically abusive productivity ethic that sits behind the word lazy.

(2) You never learned to cook and you’re ashamed about it

There are many possible reasons you never learned to cook much. Only a tiny proportion of people never learned because their family was well off enough to employ a full time chef. It’s more likely that your caregiver/s weren’t into it or had no time for it. Perhaps they were out working and/or socialising all the time and you had to make do with what was in the cupboard. Or there was no money for fresh foods that needed to be prepared. If your family was hungry and skint it is unlikely that they were making elaborate things that take ages. Quick, tasty and filling are the most important factors, via takeaway or microwave.

If your childhood was like this you may have mixed feelings about it. If there was trauma attached to it (see below), the kitchen may just seem like a no-go area.

(3) Preparing and sharing food was a fundamental expectation from your earliest days

You may have grown up in a family/culture where cooking for others was an axiomatic part of existence. It is what you did, and to not do this would have been a source of great shame. Being a poor host would be unthinkable. If you were assigned female at birth (see below), you may have been drafted in to help your mother and other relatives prepare large meals. You learned a lot and quickly because there was no choice. Of course that didn’t mean you automatically enjoyed it, and if this is the case, your lack of enthusiasm may cause you to feel as if you are betraying your roots and culture. You may then force yourself to perform ‘Good host and amazing cook’ when you are not feeling it.

Your childhood may have left you with great cooking skills, and the capacity to please others with them – but if food was used as a substitute for love in your family, and not acknowledged as such, control and emotional blackmail may have been in the frame.

(4) Lack of money

It is getting harder and harder to survive in this country if you are on a low income or benefits. We have been at ‘heating or eating’ for a long time now. And heating bills are going up and up. Making sure you have enough for both you and your children or dependants is becoming a normal aspect of daily life for an increasing number of people. Having to be creative, not about flavours or colours or sheer fun, but about whatever you can find that will keep you going for a few hours, is not a joyous experience. If you are struggling to feed yourself or others, you are eventually liable to be traumatised (see below), also from chronic shame, which no one should ever underestimate. You may enjoy dumpster diving, but equally you may not be able to do it or have the energy or time for it.

You might be visiting food banks, unless shame has prevented you and you are waiting for true rock bottom before you go there. Often we think we are waiting for rock bottom when in fact we are already there.

(5) Gender essentialism

If you were assigned female at birth it is more likely, the world over, that you will be expected to cook for others as a matter of course. And to put others’ needs before yours. I don’t need to put an essay here about the implications of this for human relations everywhere, and the assumptions that ride on it. You may have grown up in a family where everyone sat around doing their thing while your mother cooked meals for everyone. Snacks and cups of tea may have mystically appeared by your side at random times and this was Just The Order of Things. If this was modelled to you when you were young, whatever gender you are, if may be harder to shake off than you think. ‘Bad homemaker!’ ‘Bad woman!’ ‘Bad human!’

Tradition can create self-induced pressures: ‘My mother always did it this way!’ You may find yourself experiencing resentment, whether you act on it or not.

(6) Cooking for family

I’ve heard plenty of folks say they loved cooking until they had to cook for their children, however much they love them, and as the years passed their love for preparing food eventually just evaporated. Bring on the freezer meals! Sometimes the mainstream media gets on a high horse about this, even today.

If being a really good cook was part of your identity before having family, you may need some time to adjust.

(7) Eating disorders

You may have had, or currently have, an eating disorder. So preparing food is going to affect you in a number of possible ways. You may have been keeping this a secret from most or all of the people you know. You can just about deal with putting something together for yourself (if you live alone), but when others are around it’s a whole different matter. Even thinking about food may bring a lot of difficult feelings that you would rather keep away from others.

(8) Allergies and intolerances

There is increasing awareness of food allergies and intolerances, which themselves may be increasing. They may cause minor/temporary but life impacting discomfort; cause illness and periods of incapacity; or be actively life threatening. There are many risks in not preparing your own food. If you can get hold of foods that are safe you should be okay to cook. But you will likely need to cook from scratch if you have, for example, a nut allergy or if you are coeliac. (See also having the spare time and money to obtain these foods). If you have Mast Cell Activation Syndrome, you may become increasingly vigilant about new reactions to foods.

Other autoimmune conditions may make cooking complex, so someone might use meal replacement shakes so they know exactly what they are consuming.

(9) Weight shaming

If you live in a larger body, you may have experienced fat shaming from childhood, (and certainly as a adult), as everyone around you pathologised you. Every bite you eat may bring feelings of trauma and stigma. Plus, experiencing other peoples’ judgemental hypervigilance in the guise of caring, as well as medical gaslighting, will also cause harm.

Also, if you wish to lose weight whatever your size, cooking for others may become incredibly stressful. You may feel shame at what your body looks like and what you perceive it to look like; shame at having succumbed to diet culture or having dieted unsuccessfully; and feeling as if you have let everyone down by wanting to lose weight, particularly if you have friends in larger bodies than you. It’s a minefield of shame, whose layers are numerous. None of this will make cooking enjoyable.

(10) Disabilities, physical and mental

Cooking from scratch may be physically tiring for you, or impossible to carry out without help. You may have ME/CFS or Long Covid and have experienced gaslighting around those conditions, and therefore not tell anyone about them. Preparing food may exhaust you for many reasons, but you may not have your access needs fully met. Medication, including pain meds, may also make cooking into a challenging and even unsafe task.

Pre-chopped and peeled foods are a godsend to many. There is a lot of ableism around critiques of these accessible forms of food, and this includes ready made meals.

Depression and anxiety can make cooking much harder too. Take care when suggesting that someone ‘Just batch cook!’ – it may not go down well.

(11) Childhood or past trauma

As you can see above, childhood trauma around food may leave its mark on you – screaming fights in the kitchen, or meals thrown across the room, particularly at Christmas and other holiday times, perhaps fuelled by alcohol or drugs. Caregiver/s may have forgotten to feed you, or have simply ignored you, and you had to find what you could find in the cupboard. Kitchens themselves, and the sounds they make, may become a trigger. As holiday times are seen as ‘family time’, therefore group eating time, if you have experienced abuse in your family you may experience difficult feelings.

(12) Current trauma

If you are recovering from more recent traumatic experiences or grief, you may be in a dissociated state and find it very hard to coordinate in the kitchen. Food may taste different, or have no taste, and everything may feel pointless. You may have lost your appetite, or may be eating whatever comfort foods are easiest to find. These may not be the healthiest but will need minimum preparation. You may be forgetting to eat at all.

And decision making can be a huge struggle for some people at the best of times, even over the simplest things.

(13) Executive dysfunction

This may be defined as struggling with time management and planning; following detailed instructions; adapting to new input; trying not to lose things, and general difficulty with self organisation. It can impact someone due to ADHD, trauma, or brain injury, etc. This may affect someone’s capacity to list and choose food, follow instructions and focus on what needs to be done in what order. For many people this may be a lifelong struggle. Cooking here needs to be the most efficient journey from A-Z with the minimum in between.

There is a Facebook Group, Executive Dysfunction Meals, which is very helpful. Also Day to Day Tasks Explained Step by Step.

(14) Neurodivergence in general

I am using a broad definition here, encompassing both differences you are born with and acquired ones.

If you are, for example, autistic you may (and everyone is different) have a range of foods that you simply cannot eat. You may have safe foods that may seem repetitive or bland to others, but you know you need to have a supply of them. Eating outside those foods may cause distress. You may experience sensory processing issues when shopping for food because supermarkets can be exhausting. (24 hour ones may be a blessing here, with peaceful 4am expeditions possible.) The lights, the noises, the random people, are all stressors.

Tastes and smells when cooking may make it enormously challenging. Plus there is the mess of cleaning up afterwards, the issue of food waste, and stress over who does the labour if there is more than one of you.

There is also the performance aspect of cooking for others that may cause huge anxiety. Being looked at while making something and possibly having your labour judged and commented on, may feel like just too much. Similarly experiencing the pressure to be creative, the pressure to make something pretty, or the dread of cooking on a group rota in a shared home.

You may become hyperfocused and forget to eat for hours and hours at a time. If you have issues with interoception, you may not know when you are hungry, or mistake it for another sensation in the body. (Or you may take all sensations to be hunger and eat more than you need.)

Sometimes, if the resources are there, people get meals delivered because it is absolutely an access issue. Having entire grocery shopping delivered however may not work if the company won’t deliver inside your home.

(15) You just hate cooking!

If none of the above apply to you, you are totally allowed to hate cooking for no reason other than you would rather do just about anything else!

As you will hear in neurodivergent and other circles: fed is better than not fed.

If there is someone in your life who might benefit from reading this list, please forward it to them.

I wish you the best possible festive break, if you are having one.

Chosen Family – 10 pitfalls to be aware of when creating one of your own

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Autumn leaves arranged on a windowsill

An increasing number of people refer to their  ‘Chosen Family’. These are the close people we’ve gathered around us who we are not related to by blood or by law.

While anyone might create such a group while having a perfectly OK relationship with their Family of Origin, Chosen Family is often about putting distance between yourself and your Family of Origin as the only way to stay sane or safe. For this reason, it is often used in a queer context. 

Whether you are escaping violence, prejudice, sexual abuse, bullying or neglect, you may put a lot of time and energy into gathering specific people around you.

Essentially, Chosen Family is a group of people who you believe will treat you as an equal, who you might rely on in a crisis, and who you hope will stay close to you, even when one of you has a major life change.

This applies on a societal level as well as a personal one – if you are queer, gender variant, kinky, consensually non-monogamous or a sex worker, for example, mainstream society likely sees your relationships – and your life – as less valid than those enjoyed by the majority. So it makes sense to band together and create something that works for you.

Created over years

I’m aware that my talking about ‘creating a family’ might imply that this is something done quite rapidly, like picking sports teams at school. ‘I’ll take this one and that one… oh and they look nice, but not that one…’ To be clear, we make these choices over years, during which time the desire to bond and create connection with others may override the quieter messages we may be getting that something is, despite our best hopes and intentions, not quite working.

Added to this is the fact that we may replicate behaviours that were modelled to us from a very young age. Remember, your family is the first group you know. That is where you first learned to navigate other people and

We may, in our eagerness to create the perfect safe zone, forget that it takes two people to form a friendship, and more than two to form a group. We may forget that consent and boundaries here need to be negotiated, as much as in any sexual scenario, and assume agreements that have not in fact been made.

Below is a range of issues you may come across when navigating chosen family:

(1) Letting shiny new people in much too quickly

As a young person you may have been told you had to ‘take what you’re given and be grateful’. So it can feel very exciting, even intoxicating, to realise that you have choices – particularly if this realisation has come to you later in life. 

At the same time, it can also feel quite isolating and frightening to reflect on your own situation when ‘everyone’ around you appears to have so much support from blood relatives, partners and an array of incredible people they seem to have known for years. (Social media really doesn’t help here.) 

So when you meet a new person and things seem to click, the temptation can be to grab them and not let go. ‘This person is fun and we have lots in common and we’ve talked so much already – this must mean we’re destined to be really close!’ And there may be a sense of relief that counteracts the feelings of isolation, and you may stop monitoring the situation because at last you’re home safe.

But having some things in common does not mean everything will match up. NRE  (New Relationship Energy) is a phrase usually used to describe the intense feelings at the start of a romantic relationship, but it also serves to describe feelings at the start of any new association. It’s okay to enjoy this feeling – but it’s also good to wait until it dies down and re-evaluate whether this exciting new friend is right for you as a long-term close person. And it’s worth reflecting before jumping in and sharing your deepest darkest self.

(2) Ignoring warning signs

I have long found it to be the case that when you look back after any kind of breakup or rupture, you realise you actually saw the seeds of it very early on. It was likely a tiny thing the person said or did, which you ignored because it seemed too minor to be worth mentioning. And who wants to look mean-spirited or critical with the shiny new person?

It’s those little moments when the Lovely New (or not so new) Friend suddenly looks at you and says something that is – apparently – totally out of character. Or sends a message that makes you inwardly go ‘WTF?!’ Something a little bit tactless, jarring or controlling that is out of your comfort zone but you don’t have a rudder to navigate it – and you don’t want to scare them away by questioning them on it. It’s that that feeling where your stomach drops into your shoes and you can’t quite believe what you just heard – so you discount it. Such is the fear of abandonment. 

Don’t ignore these little messages. They are tiny tells and they are important. For an exploration of the more extreme aspects of this, read Gavin de Becker’s excellent The Gift Of Fear.

(3) Getting sucked into other people’s stuff

When other people are friendly to you and invite you into their group, you may quickly lose a sense of yourself, particularly if you were excluded or othered as a child. If you aren’t used to it, it can feel amazing to be included in a ready made group whose members appear to be welcoming you and inviting you to things. It’s intoxicating when you are the Shiny New Person. Be aware of your feelings around this. You may feel excess gratitude for this inclusion that may eclipse other more realistic – and accurate – feelings.

Reflect on who is really in control in this new group – the person/couple at the centre may not have your best interests at heart once the fun dies down. Are you there to prop up their glory? Are they really trying to recruit you to go to their workshops or parties (monetised or not)? Or for sex? Are there lifestyle issues, like drugs or alcohol, where you are not on the same page? Are you being increasingly weighed down by a lot of gossip and expected to take sides?

You might want to ask yourself why you want to come in at the edges of someone else’s group rather than starting with yourself and people you yourself have chosen.

(4) Trying so hard to be acceptable that you hide the real you

If your Family of Origin message was that you are unacceptable in some way, you may attempt to hide aspects of yourself from new people, in case they find you similarly unacceptable. The trouble is, the Real You is going to leak out somewhere. If you sense that your outrageous true self is disapproved of in your chosen group, wonder about it. What exactly is it that you are needing to conceal from your chosen people? Are you actually avoiding the fact that, while they may be lovely, they may just not quite be the right people for you?  

(5) Doing the opposite of whatever people did at home

Remember – your Family of Origin is the first group you know. This may be hard to hear, but it will inevitably influence how you respond to your role in the groups you create or join as you go through life. 

This feels unfair, but until we have sufficiently understood our own dynamics and patterns, we may continue to replicate the harmful structures we are trying to get away from. Simply doing the opposite of whatever a parent did is reactive and may cause harm. If, for example, you vow never to shout at anyone the way you were shouted at, you may go too far the other way and become a quiet doormat who never gets their needs met.

(6) Sacrificing yourself for the sake of the friendship or group

Something’s not working but you’re not going to say anything in case the whole thing falls apart. It’s cold when the fire goes out and you know how that feels. It’s horrible and you’ll do anything not to feel that again. Similarly, when you feel that if you don’t do it, it won’t get done – such as organising meetups, for example. If you couldn’t rely on your childhood family for the reinforcement and validation you needed, you may understandably find yourself seeking this in others, and this is where problems can arise.

One good way to check the temperature of things is to stop initiating. If you are always the one who suggests meeting up, just stop doing it and see how long it takes for others to realise. It can provide a harsh but fruitful lesson. It doesn’t mean the friendship is over – but it means you likely need to state your needs and decide how much more to invest in this person or group. 

(7) Your priorities clashing with the priorities of others

This is where you need to decide how aligned you need to be with your chosen family. About having or not having kids. And about politics. Being of a different political persuasion can be exhausting, no matter how much you feel you can put these things to the side. Endlessly explaining things, or being hooked into debate, is not sustainable.

You may find that some people prioritise romantic partners over friendships, putting you further down a hierarchy than you realised you were. (You may not have realised you were in one.) You may also be sad when you have a child and so few of your Chosen Family are still around a year later. 

(8) Feeling as if you matter less than others

This is hard because there may be so many echoes from childhood here – some of them are your mind playing tricks on you, and some are real. 

Example: when your Friend X mentions their other Friend Y a lot, who perhaps lives abroad and you have never met, and keeps on going on about how amazing this person is. Months or years pass, and you are finally introduced to Friend Y.  You greet them with enthusiasm – ‘I’ve heard so much about you!’ – and they look a bit embarrassed and say ‘Oh, um, what did you say your name was? Oh, I don’t think they’ve ever mentioned you.’ This hurts, but is worth knowing.

And sometimes people really love you but cannot prioritise you for a huge and complex number of reasons.

(9)  Guilting yourself into not acting on your feelings

You may have found yourself staying in friendships that are not working any more out of fear. One sure way of telling this is if you find yourself wondering what on earth your life would be like if this person wasn’t in it. If it seems unimaginable, it’s worth wondering why you have come to rely on this person (or group) for so much, even when they are making you unhappy.

You may have been told as a child that you were not allowed to have feelings, or you were ‘mean’ or even ‘selfish’ when you said you didn’t like someone or didn’t want to do something. Perhaps you were told you were inherently defective or just ‘bad’. As a result, you may have found yourself letting others take advantage of you because you just don’t think you have the right to refuse, and you must continually atone for your ‘badness’ by letting people push you around. Needless to say, you are doing all the work here, and this is not healthy.

If it’s not working – it’s not working.

You cannot make something work if it isn’t. You can try, but at some point you will need to find a way to go your separate ways. The relief you feel when this association is broken will be tremendous and tangible.

(10) Not being able to discuss the difficulties in a friendship – or end it

So much public advice is about romantic relationships: getting together and breaking up. We are not encouraged to have much emotional literacy about that, and with friendships even less. Are you able to sit one of your Chosen Family down and explain how things are not working out between you? Do you fear their anger? (Perhaps like that of a parent?) Can you find a way to hold a course with them, or is it time to move on? 

Dealing with ending friendships is a whole post in itself. And while not everyone is into Relationship Anarchy, disrupting the presumed hierarchies among friends, romantic partners, (and bio family too), by treating them all with more equality is something many could benefit from.

If any of what you have read feels familiar and challenging and you would like to talk about it in therapy, please contact me here.

Further reading:

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.

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?

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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?

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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.

So you don’t enjoy penis-in-vagina sex? You’re not alone

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Penis-in-vagina (PIV) sex – not everyone loves it

In my personal and professional life I’m hearing an increasing number of people saying that PIV sex is ‘fine but not their main thing’, or that they don’t bother to seek it out, or that they actively dislike it. (This isn’t just about orgasms, but the whole experience of penetration.) For sure, many people absolutely love it – but many, it seems, do not. While you don’t have to be heterosexual to practise it, PIV is a mainstay of heterosexual culture.

In this article I’m exploring the cultural aspects of PIV sex, and offer a number of reasons why some people don’t enjoy it or wish to have it.

A note on terminology

Penis-in-vagina sex is often referred to as ‘penetrative sex’. This is confusing because there are actually a large number of ways one body can penetrate another that do not involve a penis or a vagina. (I will cover these in a future article.) However, where I use the word ‘penetration’ in this post, it refers solely to PIV.

Traditions and beliefs about PIV sex

Here are some ingrained ideas about PIV (and sex in general) that are foisted on us from an early age:

  • It’s ‘the one true way’.
  • PIV is ‘full sex’ – other kinds are merely ‘foreplay’.
  • It’s about being a heterosexual man and woman together.
  • PIV is the only way for two people to be fully intimate and anything else is not sufficient.
  • It’s about couples and being in a couple is something to aspire to.
  • It makes babies so it is special. (To be fair, before science intervened several decades ago, PIV was the primary way to conceive.)
  • ‘Taking’ a woman’s virginity involves putting a penis inside her. No other form of sex counts as loss of virginity. (This is a powerful tradition, as if having a penis inside her creates the woman as an adult, and nothing else can do this.)
  • There must and will be orgasms from penetration alone or something is wrong.
  • Penetration must occur via the genitals or sex didn’t happen.
  • In fact, if there isn’t a penis in the room, it isn’t possible for sex to happen.

Unfortunately, the increased awareness that we are all supposed to have gained via the internet does not seem to have affected the Sex and Relationships Education agenda very much. It still tends to be focused around fear rather than pleasure.

And people often confuse PIV sex not working well with sex as a whole not working well. This causes some people to sideline sex altogether. However, showing people the almost limitless amount of sexual choice available to them beyond PIV can be very challenging. It becomes easier to just hide in the ‘sex isn’t working’ bubble and do nothing about it, rather than really talk about what you want. (See also BISH UK on Why Penis in Vagina Sex can be Meh.)

I have heard BDSM practitioners refer to PIV as ‘just another kink among many’, and this seems far healthier. There can be huge personal cost to going along with what everyone else seems to be doing, in other words trying to be normal. There are as many different body types as there are sexual responses, and that includes inside the body as well as outside. The reality is that some people’s bodies work in some ways and some in others.

There are of course a large number of gendered aspects to this

As I said above, PIV is a cultural mainstay of heterosexual life. There is still pressure on a vagina-owner to ‘submit’ to being penetrated (showing that they like it but not too much and not having opinions about what the sex should be), and that they must be entered only after protracted negotiation (if they give it up too easily they are a slut).  Actually, the majority of people with vaginas don’t orgasm through penetration, but this myth continues to be perpetrated everywhere and it damages everyone, as it encourages false expectations. This creates not only an entitlement culture but a blame culture about who has an orgasm and who doesn’t, and whose fault it was. For more on this, please see my post ‘Some Myths and Half Truths about Orgasm.’ See also this piece on vibrators, which outlines the issues very well.

There is still pressure on someone with a penis to be manly and thrusty and penetrate things because that is what they are obliged to do in order to fulfil some sort of masculinity contract, and this after all is what genitals were designed for. Effectively, penises must chase vaginas for sex, as many as possible, (and possibly impregnate the owner too where possible) and if they don’t, then the very concept of masculinity is in question.

Eight reasons some people don’t like or want penis-in-vagina sex

As you can see, this list ranges from the preferential to the situational to the medical. All have the potential to be pathologised in a culture that values PIV above all else. This list does not pretend to be exhaustive (particularly the health-related content) and I welcome additional suggestions.

(1) You just don’t like it very much.

Or you don’t orgasm from it and prefer sexual activities that are more reliable. Or you prefer other forms of sexual connection anyway.

(2) Sexual orientation

The cultural primacy of PIV sex sidelines and erases non-heterosexual identities. While queer sexuality embraces a multitude of ways of connecting sexually, those who do not do PIV because of their orientation or lifestyle are seen in heterosexual culture as ‘not doing it properly’ and may be quizzed in detail about what it is they actually do.

(3) Varying intimacy tolerance

Intimacy is often stated as something desirable above all else, and if you don’t have ‘enough’ of it, there is something wrong with you. For sure, having your body penetrated by another, (in whatever way), is a very intimate act, both for giver and receiver. But if someone doesn’t want this, it means therefore that they have a problem that needs fixing, medically or therapeutically.

I reject this traditional framing of intimacy because it does not take into account individual experience. For example, one person’s attempt to remove the emotional boundaries between them and another person might be another’s profoundly destabilising intrusion. And in fact many childhood experiences create a bedrock of feeling where physical intimacy is profoundly unsafe, (and this does not need to have come from sexual abuse). People commence their emotional and sexual lives at different levels. It is not an equal playing field. Culturally, individual experience is persistently and ongoingly sacrificed to the benefit of an outdated agenda.

 (4) Performance anxiety

PIV sex demands a certain level of performance from the bodies of both parties. Both sets of genitals have to do certain things to make it happen. Of course there are tools that can help the process – lube, pumps, pills, porn – but there can often be a psychological disconnect between how a person is feeling and what their genitals appear to be experiencing. This is heightened by Sex Olympics Confusion about who has the biggest penis and who is the longest lasting, or who has either the tightest pussy or can take the biggest size, whether of penis or object, or who can ejaculate the most prolifically. Lack of lubrication is also an issue, because everyone’s body and expression of desire is different, and this is not always due to a health/medical issue. ‘Long lasting’ penetrative sex can cause discomfort, but it’s still A Thing that some feel they must aspire to.

In our highly visual culture of competition, it is possible to feel very inadequate. In cases of ‘dysfunction’ (and the whole concept of dysfunction is problematic) the body may be speaking where the mind cannot.

(5) Partner incompatibility 

Genital mismatch, sex drive mismatch, or intimacy tolerance mismatch. Sometimes people put up with these things for years in order to remain in a relationship. Such is the power of couple culture. Some suffer in silence and some end up avoiding sex altogether, simply because it is easier to do this than ask for what you want and negotiate.

(6) Fear/shame

Fear of getting a Sexually Transmitted Infection – HIV, syphilis, chlamydia, herpes, gonorrhoea, etc. Many fear herpes because, while not life threatening and asymptomatic for many, it seems to have more shame attached to it than some other more serious conditions. Also, the shame around having an STI can also make sex a less desirable activity.

Fear of pregnancy or getting someone pregnant. (Also, if you have recently given birth, you may want to be sexual without being penetrated.)

Fear of engulfment inside another person. (Sometimes expressed by the myth of the vagina dentata.)

(7) Pain/discomfort

‘Honeymoon cystitis’ – In the early days of a relationship, PIV sex can put the body into an illness cycle – vigorous penetration can cause cystitis, which is then treated with antibiotics, which then cause thrush, which is treated with messy insertables. This cycle can persist, and needs to be caught and treated to avoid the condition travelling to the kidneys.

Vaginismus – the vaginal muscles clench so that penetration becomes difficult and painful, or impossible. Given the pressures on us all to conform to specific appearances and body types, I am amazed that more people don’t experience this – plus the number of people who have their physical boundaries crossed when they are too young to protest and for whom penetration has deeper and more stressful significance. One of the advised ‘cures’ for vaginismus is dilation with increasingly sized ‘vaginal trainers’, as if the lack of desire for penetration must be fixed at all costs.

Muscle tension – there is often confusion about vaginal musculature. Often there is a rush to do kegels (PC squeezes) because ‘loose’ vaginal muscles are seen as the worst thing in the world. In fact, although the exercises can be helpful, the underlying problem can be excessive muscular contraction rather than ‘looseness’. Biofeedback (which is also used to help urinary incontinence) can help show what is going on in the vagina. Sexological bodywork or intimate massage can help. A person if they are lucky could be sent to a woman’s physio at a hospital. Pelvic tension is an issue for both sexes, but is rarely mentioned by doctors.

Phimosis – the foreskin won’t retract properly and makes sex painful. This is a source of shame and embarrassment and many people even in middle age don’t feel comfortable seeing a doctor about it and continue to put up with painful sex, or none. There is an opposite disorder (paraphimosis) where it becomes stuck in the retracted position.

Pain syndromes such as dyspareunia and vestibulodynia. Also Medically Unexplained Symptoms (MUS) relating to shame.

Internal conditions such as endometriosis, ovarian cysts, Polycystic Ovary Syndrome (PCOS), Pelvic Inflammatory Disease (PID). Tilted or retroverted uterus, which can make deeper penetration painful. Internal scarring/adhesions (either sex). Prostate issues.

External skin conditions which can make genital touch or friction painful – eczema/psoriasis, lichen planus/sclerosus, and thrush (in fact thrush has traditionally been used as a catch-all diagnosis where something else is the problem) – and/or whose appearance may cause the person to feel self conscious.

You might have read the list of health conditions above and thought to yourself, ‘Why not go to the doctor and get it sorted out?’ Unfortunately, many of these conditions are not so easily fixed. Sometimes a person has to learn to live with them and negotiate their sex life around them.

(8) None of the above – you just don’t like it.

 

Conclusion

Our culture currently privileges one way of being at a cost to the rest. We would save a lot of money public health if we improved sex education around this and people felt able to express their true sexual selves without feeling inadequate.

The more people speak out about this, and promote other ways of being sexual, the happier many people will be.

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

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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.

Surviving the Festive Season Part Two: Strategies for getting through it

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tg-1-12In part one of this series I looked at all the things that make Christmas and other festival times so stressful. Here in part two I’m offering suggestions on how to make the experience easier to manage.

I’ve been discussing this a lot recently, and several big stressors have emerged: finances, competition with others, and the sense of obligation. Some people prepare for this time of year as if it wasn’t Christmas day coming on 25th December, but a large asteroid. So this piece is my personal take on how you might manage a potentially difficult Christmas.

Further down there are links to various advice and charity sites. (If you’re expecting to have a happy and relaxed time and none of this applies, maybe you know someone who might benefit from something I’ve written here.)

Some of my thoughts here come in the form of questions. They may not have a specific answer, but I hope that reflecting on them will make things feel less overwhelming.

MENTALLY PREPARE

• Can you identify what it is you do and don’t like about this time of year? You might feel more in control if you can identify which aspects you can just about tolerate, and which ones you would avoid/abandon if you could. Are you in a position to act on this?

• If you do feel able to act, put your foot down early. One way to think about it is to imagine opening the doors and windows in your life and finally letting a breeze through – ie, saying a great big ‘no’. Practise this.

• If you’re feeling a sense of reluctant obligation, reflect on what you really owe to anyone? Also, do you feel that anyone owes anything to you?

• If your mental state means careful rationing of what you do, honour this if you can by planning in advance. If you find yourself without the energy to do this, can someone else organise things for you?

• Can you arrange something to look forward to after Christmas as a reward? Seeing a person you don’t see often, or a trip somewhere?

• If you know things are going to be difficult, can you ask available friends if they are okay with you texting them during the day if it all gets too much?

• If you cannot drum up any positive feelings at all, can you visualise Christmas as the monstrous birthday party of someone you loathe but must appease? Or perhaps imagine you are in some hideous panto or whodunnit?

SHARE YOUR FEELINGS

• Asking for help, or just sharing how you feel, can seem like a radical and terrifying act. But the chances are you are not alone.

• Can you talk to the others around you about your feelings about this time of year? Do the people closest to you agree with you? You may find that no one else has had the courage to say what they have been feeling all along, and through your words you have potentially rescued them too.

WAYS TO ESCAPE

Travel – Can you leave the country? Flights, especially long haul ones, go up hugely in price over this period, so the cost may well be prohibitive. If a holiday is out of reach, is some kind of physical escape possible? A working holiday, a retreat of some kind, or a house or cat-sit?

Work – Can you hide behind work? Selflessly offer to take others’ shifts? Suddenly take on a big pile of freelance? (If, of course, it’s out there).

Charity work – There are lots of ways to volunteer at Christmas, such as Crisis.  If you’re in London, Londonist has a good list of places where you could offer to help out over the holiday period.

Invented scenarios (ok, lying) – Normally, I would not suggest you engage in dishonesty. However, in this case, if you have to lie to get out of a situation that you absolutely do not want and which may be actively harmful to you, (and you absolutely cannot tell the truth because that would be even more harmful to you), you are in a way being more authentic, so I would not condemn it. Your safety comes first. If you are going to do this, I should remind you that the backstories may take work, as well as getting any collaborators on board, so this is not for the faint hearted.

• Illness – a new one or a flareup of an existing one – or an accident or disaster. (But then you may be fending off offers of help which could take you back to square one. This one is best used when you were going to have to take a long journey.)

• The sudden illness/disaster of someone close to you, who needs your help. Is this ‘wrong’? I return to my points about authenticity and safety.

• Pretending you are away when you are not, and you are in fact staying quietly in your home with the telly. A woman wrote somewhere that if anyone asked her what she was doing for Christmas, she would say, ‘Oh, it’s just going to be the three of us on the sofa,’ neglecting to mention that the other two were in fact her cats.

IF YOU CANNOT GET AWAY

MONEY 

This is the tough bit. Christmas is supposed to be about giving, yes? Perhaps, but not to your own detriment.

• How early can you start preparing? (Some people buy things in the sales for the next Christmas). So a huge January to-do list might make you feel more in control. Can you pay for anything in instalments? (Bearing in mind the increased cost over time and the cost of borrowing in general.)

• Ask people to bring food over instead of providing it all yourself. I’ve noticed that potluck dinners have got a lot more common since the recession. For low-cost recipes, try Jack Monroe, Netmums budget recipes, Gluten Free on a Shoestring. Also, the Gluten free vegan.

• Have a secret santa with strict budget attached. (Depending on the configuration of the people you will be with, you don’t even have to assign a person to give a present to – you could distribute them lucky dip style.)

Here’s a piece from Netmums about benefit dates over Christmas, with lots of advice on budgeting. Money Saving Expert has a Christmas forum where people ask for and give advice. Crafting isn’t for everyone, but (time and everything else allowing) could you make, or cook, something instead? 60 great alternatives to toys has some useful discussion points about presents for children.

• Beware vouchers, sales, and ‘bargains’. Money Saving Expert again has some tips on end of year savings. All sorts of shenanigans goes on with pricing during sale times, and some shops buy things in for sales that they don’t normally sell. Once upon a time I read that this was all illegal, but the goalposts seem to have moved considerably.

• Be proud of what you do make or bring. If there is a financial disparity between you and others, can you talk about it? it’s essential to lay down boundaries early so there are no misunderstandings. This is even more important if you have children. Ditto if you are the one with more money than the rest. If you are in this fortunate position, try to remember the stress people go through when they don’t have enough but are expected to put on a show. If you suggest a restaurant or other activity that costs money, and there is an awkward silence, frozen faces, or ripple of embarrassment, there is your answer. Again, if you are in a fortunate position but don’t want to show off or make others feel awkward, is there anything you could do for anyone in private?

DIFFICULT OR ABUSIVE PEOPLE

• We joke about ‘drunk uncle and racist auntie’ but you may be stuck with them for the day, or the entire week. You could try to imagine bedtime, or going home, as a beautiful forest or beach that you are slowly walking towards. If this sounds too hippy, can you plan something for afterwards that you can look forward to and think about?

• Can you find others in the same boat as you so you feel less alone? When you look online, you might not find someone with your exact problem immediately, but this tends to be the nature of problems. We think our issues are unique and this keeps us isolated.

• There may be people who don’t recognise your gender/sexuality/relationship/lifestyle/work and are either rude to you about it or actively threatening. The Albert Kennedy Trust works to help young (16-25) LGBT people who are homeless or living in a hostile environment. London Friend and Switchboard LGBT (also UK-wide) provide telephone support.

• You may be experiencing, or fearing, domestic violence. Refuge and Women’s Aid charities support women and children experiencing domestic abuse.  ManKind supports male survivors, and Respect supports both men and women, and has a helpline for anyone who is carrying out abuse too. Galop is an LGBT domestic violence charity. You can contact them by phone, email or live chat.

ANNIVERSARIES AND LOSSES

• If you have experienced a major loss this year, or are having the anniversary of one, your first duty is to yourself, and then to anyone vulnerable you care for. There is a lot of advice online about dealing with loss, which can be amplified by experiencing the enforced joyfulness around you. Cancer Research UK has some information on coping with grief. Cruse is the main UK bereavement charity. They offer help by phone, email, or in person.

• Distractions can be good – if this feels right, you could fill your home with a manageable number of hand-picked people, (or arrange a number of visits or meet ups) – but let your feelings guide you, and let others take the strain.

• Can a friend or family member take you in? Would you allow them to?

• The loss may not be a person, but a negative change in circumstances (loss of job, home or relationship), or a beloved animal companion. These can all have powerful fallout that needs a grieving process – again, put yourself first.

FAMILY ESTRANGEMENT

• You may be estranged from family. There is a charity, Standalone, that supports people in this situation. They have a detailed festive survival guide.

• Even if you are totally happy about your choice, this time of year may bring on all sorts of concerned and potentially exposing questioning. While ‘none of your business’ may be the appropriate response, this may only inflame the questioner and cause all eyes to be on you if you are in a group. Saying someone is are ‘away’ may be enough. (Again remembering to craft your story – Australia? But where in Australia?) Total honesty may torpedo the conversation, or it may induce a further flood of questioning.

• One thing I’ve noticed in the last few years is that whenever an online problem page deals with family estrangement, very few people are judgemental (bucking a trend, it must be said), and many will share similar stories. The Guardian has a good range of articles on family estrangement and going no contact. From all my reading, a fair number of people choose to go no contact, and many more wish they had made that decision long ago.

• 13 things no estranged child needs to hear on Mother’s Day – this is actually very good advice on what not to say to someone who is estranged from any family member, and could equally apply to Christmas or any other festival. [NB: the link is currently broken – the piece is still somewhere out there though.]

INTOXICATION

• Alcohol and drugs (over the counter, prescribed or illegal) give and take at the same time. They may be all you have to get you through a challenging day. I would not necessarily recommend someone sober up for its own sake for a difficult Christmas unless you or those around you would be in immediate danger, or unless you need to remain alert and/or are driving. If you want to make a fresh start in the new year, a charity like Addaction can help.

• Bear in mind you say and do things when intoxicated that you would not when sober. Some of it can never be taken back.

• Some people change personality when intoxicated and become incredibly unpleasant, angry or violent. This doubles during festive periods. If this is you, you need to stop. If this feels too hard, you may want to try cutting down or stopping. I have expressed many reservations about the 12 step/anonymous movement as a whole, but I know it has helped some people. You could try Alcoholics Anonymous, Narcotics Anonymous or another 12 step meeting. You will find community there and a great variety of human experience.

• If you have given up drinking previously, this is a challenging time and you may wish to refer further back in this article for ways to escape Christmas. If anyone comes at you with ‘Oh, can’t you just have one?’ or rudely interrogates you about why you stopped, keep remembering why you did it.

• If you are presented with the prospect of a Christmas with a relative who has a drink problem that threatens your safety, or the safety of someone else, you are under no obligation to participate. Your duty, again, is to yourself.

SOCIAL MEDIA

• In part one I described the various irritations on social media – other peoples’ photos of festive bounty, and their urge to tell you how blessed they are. Do not feel guilty about muting/unfollowing them for a few days. If it’s a friend who you basically like, you can always just send them a nice message so you don’t feel guilty. These networks are valuable, particularly if you are alone, so a few tweaks will make them bearable until it all blows over.

• You could start a secret group on Facebook, or create a locked Twitter account, so you can share with a few people who feel the same way as you, and let off steam.

SPENDING THE DAY ALONE

• If you’re going to be happily, consensually on your own on December 25th, Christmas day alone can be great. Your time, your choice.

• If you’re reluctantly, non-consensually alone, (and don’t have anywhere to go) it can feel terrible. Perhaps you just want to sleep? That’s okay. Or go on a huge walk. Write. Work. Is there anyone at all you can contact? Ignore the day and do your usual routine and make it a day like any other?

THINGS NOT TO SAY TO SOMEONE WHO IS STRUGGLING

• ‘It’s only one day.’

• ‘X is just insecure.’

• ‘What did you get?’

• ‘Where’s Y?’ or ‘Why aren’t you with Z?’

• ‘Can’t you just deal with it?’

• ‘You’ll be fine.’

If you’re still reading, I hope this was helpful.

  • If you’d like to find out more about how I work, and what I specialise in, please go here.
  • If you’d like to read more of my published work, please go here.

Low-cost counselling and psychotherapy services in London

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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)

CBT ‘a scam’, the joy of polyamory, parental estrangement, terrible sex ed…

keyboard close-up‘Are you a pervert?’, invisible disability, trans* history and politics, sex work and the modern slavery bill…

A regular roundup of links to things I’ve found interesting, either because they’re very recent, or because I think they deserve another outing.

Please note: me linking to something doesn’t mean I endorse every word in the the article or anything else carried on that particular website. Some of these articles carry an obvious content warning, and some, depending on their subject matter, may be very slightly unsafe for work.

 

MENTAL HEALTH

The Debt – When terrible, abusive parents come crawling back, what do their grown children owe them? (Slate)
Long, excellent article about people debating whether to resume contact with the parents who harmed them.

‘Loved ones and friends—sometimes even therapists—who urge reconnecting with a parent often speak as if forgiveness will be a psychic aloe vera, a balm that will heal the wounds of the past. They warn of the guilt that will dog the victim if the perpetrator dies estranged. What these people fail to take into account is the potential psychological cost of reconnecting, of dredging up painful memories and reviving destructive patterns.’

Lauren Laverne – It’s Time to Make Emotional Abuse a Crime (Guardian)
I think it’s important to keep saying this, whether individuals or charities. But I’m curious about the way language is used when applied to children. Children are ‘bullied’ at school, but this word is often not used when this occurs in families at home. Similarly, the word ‘abuse’ is rarely used in a school context. Sometimes is not quite joining up for me here.

‘What I remember most about emotional abuse is that it’s like being put in a box. […] So you try to make yourself fit. You curl up, become smaller, quieter, remove the excessive, offensive parts of your personality – you begin to notice lots of these. You eliminate people and interests, change your behaviour. But still the box gets smaller. You think it’s your fault. The terrible, unforgivable too-muchness of you is to blame. You don’t realise that the box is shrinking, or who is making it smaller. You don’t yet understand that you will never, ever be tiny enough to fit…’

Am I obligated to disclose my invisible disability? (xojane)
Invisible illness/disability comes up a lot in conversation, particularly around mental health as well as physical.

‘Frequently, when people who know about my accident ask me if it hurts still, I deflect or spew platitudes and just say, “Oh, you know.” I don’t say that physical discomfort has been a near constant companion.’

Oliver James declared Cognitive Behavioural Therapy to be a ‘scam and a waste of money.’ (Daily Mail)
This started a long discussion online, with most having the view that CBT is very useful for specific things, but less effective where there are deeper problems that need longer work and a fuller therapeutic relationship. There’s a general sense of too much money being funnelled for far too long into this very specific way of working. One size doesn’t fit all. I’m curious that this story has not been carried anywhere else. I’ve put it here as a discussion point, and I’m interested as to whether there will be more on this.

 

RELATIONSHIPS / GENDER AND SEXUAL DIVERSITY

The Joy of Polyamory (Archer)
Long and fulsome article by Anne Hunter. One of the big contrasts I notice between monogamy and polyamory is the issue of terminology. It feels to me as if many people in monogamous situations that are not working for them are caught in structures that they would change if only there were a name for what they are looking for.

‘Many of my relationships don’t have a simple label available to them. For example, I have some beloved intimates with whom I will jump into bed, naked, and talk about absolutely anything. The relationship is way past what most people think of as a friend – there’s no sex, so it’s not a lover; we don’t make life decisions together, so it’s not a partner. There is no term that accurately describes our connection.’ 

‘Are you a pervert?’  (Vice)
This is actually a serious and quite important piece by Martin Robbins outlining the double standards around what are still, in some quarters, known as ‘paraphilias.’

‘The thing is, pretty much every type of sexual desire can cause distress or harm to others, regardless of the kinkiness involved. Why fixate on kink? How can you even determine what is normal or paraphilic in the first place? […] Are the people who are trying to express their sexuality really mentally ill, or is the real sickness in the repressed culture that’s so terrified of them?’

The ‘dispute’ between radical feminism and trans people (New Statesman)
Long and important piece by Juliet Jacques in the New Statesman. It’s also an excellent history, both public and personal.

‘In a world where left-wing politics have often derided LGBT identities as ‘bourgeois’ and then accused us of splitting the movement, it infuriates me that I’ve had to take a break from writing a piece on the Tories’ ‘liberation’ of the NHS to write 8,500 words to debunk a sexological concept that was shown to be untenable before the start of the First World War.’

Yesterday (Nov 20) was also International Transgender Day of Remembrance.

Listen to sex workers – we can explain what decriminalisation would mean (Guardian)
After intense campaigning, an amendment to the modern slavery bill was dropped, which would have brought in the Swedish model of criminalising clients.

‘Mactaggart’s justification for attacking “demand” (clients) is that “prostitution is an extreme form of exploitation”. But exploitation is rife in many industries, including the agricultural, domestic and service industries, particularly at a time of increasing poverty, decreasing wages and insecure employment, and no one suggests that domestic work or fruit-picking should be banned.’ 

Sex education in schools: it’s just bananas (Guardian)
Eye popping Guardian piece about the state of Sex Ed in schools. I’m putting this here because this lamentable situation affects us all, whoever we are. The way we are introduced to sex can reverberate throughout our whole lives.