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General

Wake Up California Therapists! Protecting Client Confidentiality per Proposed California Law AB 1775

The Current Situation vs. AB 1775

For a very long time, California psychotherapists have been required to break client confidentiality only when we believe a minor or dependent adult is in imminent danger of serious abuse or neglect or a life is imminently at risk (homicide and/or suicide with a clear plan). Over the years this has enabled us to privately counsel countless men and women seeking help with discontinuing illegal or potentially harmful behaviors, or with diminishing shame and self-hatred over past misconduct. Many of us have helped these individuals develop and maintain healthier, happier, and safer lives - without needing to break our vow of confidentiality.
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General

Therapists and Clients: Common Problems and How to Avoid Them

Therapists Are Not Perfect

As therapists, each of us would like to do exactly the right thing in each and every session. However, given the stressful nature of our work, the lengthy and sometimes sporadic hours, the occasional inability to feel secure in our continued income, and even our own not-yet-totally-resolved issues, we sometimes fall a bit short of this lofty goal. Simply put, despite our good training, supervision, and continuing education, we occasionally make errors. A few of the more common therapeutic missteps are discussed below, along with suggestions on how to avoid them. That said, professional organizations have guidelines that are (and always should be) a therapist’s first line of defense in this regard. Plus, without doubt I’ve missed a few things. If so, please add your thoughts on those issues in the comments section. That way, anything I’ve overlooked will still be discussed.
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General

Do You Want to be Happy?

What is Happiness?

As a therapist, I often encounter clients who say things like: “I don’t know what’s wrong with me. I have everything I want and yet I never feel satisfied. There’s no joy in my life. Maybe I’m just not a happy kind of person. Maybe I’m just a glass-half-empty person.” When I get hit with that sort of proclamation, I typically respond with a few probing questions: “What would happiness look like and feel like for you? How would you know if you had achieved it?” Sadly, much of the time these “unhappy” clients simply don’t have an answer. For them, happiness seems so elusive that they can’t even picture it.
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General

Understanding LGBTQ-Affirmative Psychotherapy

I don’t understand the concept of having a “gay agenda.” In my belief system caring people closely hold to a “human agenda” of loving, accepting, and helping all people.
What are L, G, B, T, and Q?

We live in a heteronormative society. In other words, heterosexual relationships are the cultural norm, and anything different is, well, different. Yes it is true that things are changing rapidly in parts of the Western world and elsewhere - evolving societal attitudes about cultural diversity, softening religious dogma, the repeal of DOMA and the military’s “don’t ask, don’t tell” policy, growing intolerance of pejorative terms like “faggot,” “homo,” and “dyke,” legalized gay marriage, and more - but this doesn’t mean that people whose sexual orientation and/or gender identity falls outside the norm suddenly have an easy time of it. In fact, these individuals typically experience, at best, confusion (not just from others but within themselves) about who/what they are why/how they are different. In fact, sometimes even psychotherapists are unsure about
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General

Men and Depression: Not Just the Same Sad Face

Feeling Down?

Scenario 1: Joan, a 32-year-old working mother of two young children

Joan arrives in therapy complaining that over the past six to eight months she has experienced growing feelings of both sadness and fatigue. She admits to frequent crying jags over what she accurately describes as relatively minor incidents. She also reports difficulty falling asleep, usually because she’s worrying that her children need more from her than time allows. As a result she is fatigued, easily prompted to tears, spaced out, and increasingly forgetful. The final straw for Joan was when she inadvertently locked her toddler son in the family car with the keys inside (requiring a visit from the local AAA truck to free both her son and her SUV). The following day, after a long talk with her husband, who encouraged her to seek help for her general unhappiness, she reached out to a local psychotherapist. After reviewing Joan’s history and stated symptoms over the course of several sessions, Joan’s therapist diagnosed her as being in the middle of a moderate depressive episode. The therapist gave her a referral for medication evaluation, and continued to work with her in therapy - focusing on helping her to better manage stress and to feel more confident as a mother.
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General

Crystal Methamphetamine: The Other Sexual Addiction

Cross and Co-Occurring Addictions

Individuals who are cross-addicted are people who switch from one addiction to another—for instance, Suzanne stops drinking alcohol, then gains 40 pounds in three months, replacing booze with compulsive eating. People with co-occurring addictions struggle with multiple addictions at the same time—for instance, Eric smokes pot morning, noon, and night, and also plays video games for eight to ten hours each day.

Cross and co-occurring disorders are especially common with sex addicts. In one survey of male sex addicts, 87 percent of respondents reported that they regularly abused either addictive substances or other addictive behaviors. Considerable anecdotal evidence suggests that for a majority of sex addicts with a co-occurring addiction the secondary drug of choice is crystal methamphetamine. Sex addicts also use cocaine, crack cocaine, and almost any other stimulant—but crystal meth is usually cheaper and more readily available.

Consider Brad, a married, 38-year-old lawyer:
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Fantasy

The 12 Steps as Therapeutic Tasks for Sexual Addiction Recovery (Continued): Steps 4 through 9

Stepping It Up in Treatment

Sex addicts, like many in early addiction recovery, are often highly resistant to the idea of attending 12-step recovery meetings. Their reasons are myriad and usually without merit, though they sure can sound convincing on first listen.

Basically, it boils down to this: individuals who hang out in adult bookstores, cruise local red light districts looking for prostitutes, download hard-core pornography on work computers and masturbate in their office during business hours, post hi-definition photographs of their exposed genitalia on dating websites, and openly announce their extramarital availability on Ashley Madison (with a face photo but without a second thought) are the same folks who become very concerned about being “spotted” at one of “those” meetings.

“What if someone sees me there and thinks I’m a pervert?” they fret. Never mind the fact that these meetings usually take place in churches, school classrooms and local businesses after hours with no neon signs announcing what’s going on. Resistance to change is what it is, and even though sex addicts invite risk when acting out, they are risk averse in terms of being seen in 12-step sexual recovery meetings like SAA, SLAA, SCA, SA, and SRA. It is therefore up to the addiction therapist, when working with a 12-step-averse client, to bring the themes, neurobiological rewiring, and experience of 12-step recovery into the treatment arena—especially in a group therapy setting. Once the sexual behavior problem has been clearly assessed and client/treatment goals and expectations aligned, sex addiction treatment is well served by the therapist initiating discussions on themes like surrender, feeling out-of-control/powerlessness, developing personal integrity, asking for help, accepting responsibility, turning it over, establishing accountability, etc., all within the framework of cognitive behavioral treatment.
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