When is a Relationship (Romance, Friendship, Whatever) Worth Saving?

A few weeks ago I was given a spreadsheet showing which of my online blogs and articles (on numerous websites) have gotten the most views. And no matter the website, the postings that topped the charts almost always dealt on some level with relationships and intimate emotional connections. And why not? After all, relationships help us to feel understood, loved, and part of – all of which are deeply important human needs. It’s only natural that people would be interested in this topic.

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Sex & Sexuality

The Viagra Conundrum

I’m of a certain age – if you don’t know what “certain age” means, then you’re not there yet – and I tend to watch television programs geared toward my demographic. With these shows I am inevitably treated to a barrage of commercials featuring impossibly attractive middle-aged and older couples looking unusually romantic in some wonderfully bucolic setting. Most often they’re either cuddling by a lake at sunset or sipping Chardonnay on the veranda of a remote mountain cabin. Whatever the locale, these doe-eyed twosomes are very clearly in the process of kindling and/or rekindling the flames of their relationship. Suddenly, before I can start to feel too badly about the fact that neither of these people has even an ounce of extra belly fat, they look into one another’s eyes and they experience “the moment” – the instantaneous realization that a bed is nearby and they both want to use it for a purpose other than sleeping. Then the ad’s voiceover screams: “Hey old guy! Yeah, you with the aching back! If you take one of these pills, you can become the sexual dude that you were 30 years ago!”

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Resolutions for Change: What are the Chances for Success?

Making Resolutions...

The season for overindulgence is finally past. Now is the winter of our discontent with all of that intemperance, and our desire to make commensurate life changes.

This year I will stop overeating and bingeing on junk food, and I will lose at least 20 pounds.
This year I will cut down on my drinking.
This year I will limit myself to $50 per week at the casino.
This year I will stop smoking pot and taking other drugs.

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How Trauma Work Best Occurs in Addiction Treatment (Part Two)

The Traumatized Addict

In my previous posting to this site I briefly discussed the undeniable link between chronic childhood trauma and adult-life psychiatric symptoms and disorders, most notably addictions, observing that this link is rarely addressed in treatment (potentially leading to addiction relapse). I then discussed the need for dual addiction/trauma assessment and treatment, with suggestions on how assessment best occurs, followed by a brief discussion on how to effectively move forward with initial...
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How Trauma Work Best Occurs in Addiction Treatment (Part One)

What Is Trauma?

My esteemed colleague, Dr. Christine Courtois, provides a brief definition of trauma in her new book, It’s Not You, It’s What Happened to You, writing: “Trauma is any event or experience (including witnessing) that is physically and/or psychologically overwhelming to the exposed individual.” She then notes that trauma is highly subjective; incidents that might be highly traumatizing to one person may be humdrum for another. (Some people are more resilient than others.) She also notes that there are many types of trauma:

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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 sexual addicts and co-occurring sex/drug addicts. For these clients, an integral (and somewhat advanced) part of the healing process is learning how to date in healthy ways. Oftentimes the creation of a “dating plan” is quite helpful.
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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.

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Sex Addiction Treatment

The Sex Addicted Client: General Advice for Clinicians

Do You Speak Sex?

Treating sexual addiction is not for the squeamish. Sex addicts, if and when they become honest in therapy, often relate harrowing tales of abuse and acting out. Many have engaged in sexual activities that even a seasoned prostir careers, their homes, their tute would blush to hear about, and they’ve often done so with more partners than they can count. They’ve put themselves, their spouses, their sexual hookup partners, theihealth, their children, and so much more at risk—all for a quick and ultimately meaningless sexual fix. Many were either covertly or overtly sexually abused in childhood and/or adolescence, sometimes repeatedly and horrifically. They may also have a concurrent addiction, usually some form of substance abuse but occasionally another behavioral addiction or even an eating disorder (especially among women), and this too can lead the client into episodes of traumatic experience and bad behavior.
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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:

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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.

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