Some Clients Need a Dating Plan…

Not Everyone Knows How to Date

For many psychotherapy clients, issues with relationships and intimacy are paramount. Typically, individuals seeking help with these issues display insecure attachment styles, usually the result of inconsistent, neglectful and/or abusive parenting – though many other forms of early-life (and even adult-life) trauma may also be in play. Sometimes these clients have turned to an addiction, either substance or behavioral, as a way to cope with the discomfort caused by adult-life relationships. In my practice I have dealt with many such people, primarily
Continue Reading


Breaking Up Is Hard To Do, Especially in the Digital Age

Relationship Drama: Digitally Enhanced

Relationship breakups and the angst surrounding them have always been solid psychotherapeutic fodder. As we’re all aware, these issues are challenging in and of themselves, and they also tend to evoke deeper emotional and psychological issues that can be worked through over time in therapy. On the one hand, this can be quite productive, as a well-managed clinical crisis often leads to useful therapeutic insights and breakthroughs. On the other hand, the emotional pain of a disintegrating relationship is nearly always incredibly distressing for the client, particularly if that client is emotionally fragile to begin with.

Continue Reading

Hypersexual Disorders

Recognizing the Consequences of Sexual Addiction

Assessment Questions

It’s not exactly a clinical secret that most of the sex addicts who enter therapy do so in response to their addiction’s related symptoms—disintegrating relationships, depression, severe anxiety, inability to focus at work or in school, social isolation, and the like. Rarely do these individuals walk in the door say, “You know, I think maybe I’m a sex addict, and that’s probably the first thing I need to deal with.” Instead, sex addicts will tell you that they’re unhappy, and that they’re having a variety of life and relationship problems. In my previous blog I discussed the fact that therapists should always ask at least a few specific but non-graphic questions about sexual activity during assessment in an effort to unearth sex-related issues. These questions may include the following:

Continue Reading

Sex & Technology

Does Your Client Have a Cybersex Problem?

Levels of Cybersex Use

In today’s digitally driven world it can be difficult to distinguish between those whose involvement with online sexual behavior is recreational, those whose involvement is “at-risk,” and those who are cybersex addicted (those whose lives and functionality are negatively affected by repetitive online sexual activity). This is compounded by the fact that most of the people who are struggling with cybersexual activity who enter psychotherapy choose to talk about their symptoms (depression, anxiety, issues with sleep, inability to form lasting relationships, and the like) rather than their problematic patterns of cybersexual activity. Making matters worse, current therapeutic evaluation tools (standard bio-psycho-social assessments) typically do not ask clients much about their sexual lives or sexual histories, meaning these issues can easily go undiscovered and unaddressed (to the client’s detriment). This non-discovery is aided and abetted by the very nature of the Internet, which, in addition to being highly affordable and continually accessible, allows for relatively anonymous use, making it easy for cybersex abusers to keep their behaviors private and to psychologically compartmentalize what they are doing.

Continue Reading

Sex & Sexuality

Out of Control Sexual Behavior: Addiction or Offending?

When It Comes to Sex, Confusion Reigns

After more than two decades spent treating both sexual addicts and the occasional offender, I’ve watched the field of sexual disorders assessment and treatment come very far in its understanding of both sexual addiction and sexual offending. Nevertheless, the general public is often wildly misinformed on both topics, as are at least a few clinicians. One of the most common misperceptions is that sex addicts and sex offenders are one and the same. This is most definitely not the case.

In reality, there are significant differences between
Continue Reading


Addicts Just Want to Have Fun (in Recovery)

All Work and No Play...

Jack a 52-year-old divorced high school guidance counselor, after a stint of inpatient substance abuse rehab, had nine months sober from both alcoholism and marijuana addiction. In addition to working 8 to 5 every weekday, Jack kept a journal, meditated daily, and attended at least one twelve step meeting each evening. He also met with his therapist once per week and his twelve step sponsor twice weekly. Until the eight month mark of sobriety, he was riding the “pink cloud” of early recovery - that blissful time when many recovering addicts feel so relieved to finally be addressing their longstanding problem that, no matter what comes their way, they feel generally positive and cheerful about themselves and the world.
Continue Reading

Sex & Sexuality

The Truth about Gay Conversion Therapy

Therapists are Trained, Governors are Not

A few weeks ago Texas Governor Rick Perry, speaking in San Francisco, defended his state’s Republican Party Platform endorsing gay conversion therapy (also called reparative therapy), essentially stating that homosexuality is a choice. So once again this topic is in the news and in need of intelligent discussion. Somewhat amazingly, the basic questions being asked about homosexuality and conversion therapy haven’t changed much in the last 50-plus years, despite the almost incalculable progress we’ve made in our scientific understanding of human sexuality and romantic attraction. The two primary questions seem to be:

Is homosexuality a psychological disorder (or the result of a psychological disorder)?
Can homosexuals be repaired (i.e., converted into heterosexuals) via psychoanalytic treatment or any other methodology?

The answer to both of these questions is a resounding NO. Yet here we are again, fighting off painfully misguided, highly moralistic efforts to judge healthy forms of sexuality.
Continue Reading


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.
Continue Reading