Let's Talk About Sex

When I first started working as a therapist, I expected to hear about people's proudest moments, their deepest shame, promises that had been broken, dreams and relationships that had turned sour or died an agonizing death. I was (semi-)prepared to hear about profound pain and loss. What I didn't expect was to talk so much about SEX.

NOT Just the Birds and the Bees

My clients have educated me as much as I have them. Over the past 20 years, I've helped couples create ethically open relationships, learned about the searing pain caused by sex addiction, and been schooled about the difference between consenting BD/SM behavior and fetishistic activity. I've aided clients in discovering their long-buried sexual identities, and helped clients rediscover their sexual energy after years of it laying dormant. Clients share fantasies, desires, and fears that either fuel them or create great fear. I have developed an appreciation and respect for the range of human sexual feelings, behaviors, and energies. Many believe the human sex drive is a manifestation of the life force; I've certainly witnessed the courage and power within many clients as they have striven to develop their sexual selves in healthy and dynamic ways. As happens so often, I am humbled and privileged to be a witness to the strength and creativity my clients demonstrate. I can only hope I provide them with a safe and respectful space for them to discover their best and fullest sexual selves. 

Investing In Resentment

Resentment can be defined as holding onto pain, anger or the wrongdoing of another. In the recovery movement, letting go of resentment is part of the foundation of sobriety. Most of us can't imagine WANTING to sit with resentment; it's discomfort is the emotional equivalent of rubbing sandpaper on sunburned skin. I can easily identify the behaviors of others that create my resentment, but when it's my own choices that fuel my internal wrath, my awareness is sometimes less than crystal-clear.

IT'S NOT YOU, IT'S ME

On Mother's Day, we got invited to my mother-in-law's for brunch to celebrate the day, and to my brother's for dinner to fete my mom. Both houses are an hour apart, and nearly as far from our own home. That meant I would be spending my Mother's Day largely in transit between two points, and while I love both the moms in my life, I had also been looking forward to wiling away the afternoon on my couch, reading a trashy novel and eating junk food provided by my loving family. To be clear, neither my mom or mother-in-law "required" my appearance. In fact, they would've signed off on my hedonistic plans with complete support. But my sense of propriety or guilt, habit or belief about what was the "right" choice to make, led me to decide to spend the day meeting what I believed was everyone else's needs over my own. Which, not surprisingly, led me to a state of exhaustion and resentment that I didn't do what I wanted to do. I couldn't blame my wife, my mom or mother-in-law for my emotional state. I couldn't hold society's expectations that we spoil our mothers on Mother's Day to task for MY decision. Ultimately, how I spent my day was my choice. By not being conscious and present to my decision, I denied my moms my full participation in their celebrations as much as I denied myself some R&R. I need to accept the mantra I tell my clients: to value our selves equal to others is not selfish, it's self-ist. I won't wait until the next holiday to listen to my feelings and respect my own needs alongside others'. I've felt the burn, and I'm ready to drop that rock. 

Peeling Back the Label

Labels help us understand what's before us. Without labels, grocery shopping would be impossible. How would we know which can contained the green beans, and which housed the creamed corn? How would we  know which pair of jeans would offer the right fit, if a little white tag wasn't nestled in the waistband? Imagine searching for the latest best-seller at the bookstore without the headers of "Biography", "Cookbooks" and "New Fiction" pointing the way? Labels make life run more efficiently, save time and reduce confusion. And they can be hurtful and reductive.

WHAT'S IN A NAME?

Labels can be limiting. They can reduce a person or an experience to a bite-sized morsel of information, when, in reality, a platter wouldn't hold the whole truth. For example, for centuries society has labelled humans with two genders: male and female. Yet I work daily with folks who are transitioning from one gender to another, or even discarding the notion of gender altogether. In our binary, either/or world, how do we acknowledge or understand someone who is rejecting labels that have categorized our "reality" for as long as we can remember? Similarly, clients diagnosed with conditions like bipolar disorder or depression can often be regarded as their "label" rather than their personhood. Certainly, certain characteristic are shared by all people with schizophrenia; otherwise, the diagnosis couldn't be consistently applied. But each person's experience, wisdom and consequences with an illness is unique and particular to him. Some labels conjur up positive feelings or associations, while others engender fear or rage. Labels provide a starting point for conversation, an entry into someone's internal world. When it comes to people, labels don't guarantee what's inside. We enrich ourselves, and respect others, when we are willing to go beyond a label to truly understand and empathize with another's human experience.

NOT Child's Play: When Adults Were Ill as Children

Most of us have weathered childhood health issues like chicken pox, broken bones, stitches and tonsillectomies. And other than some faded scars, we probably have few continuing reminders of those early afflictions. But for some adults, especially those who have experienced severe or chronic childhood illnesses, like cancer, juvenile diabetes, or cystic fibrosis, the impact of those experiences continues to play out in their grown-up lives and bodies.

THE COST OF CHILDHOOD ILLNESS 
Experiencing a severe or chronic illness as a child can have long-term, adverse effects.  Some adults missed out on significant developmental milestones as their peers, not being able to attend prom or get a driver's license due to hospitalizations or limited mobility. Depression, anxiety and strained family relationships can continue for years after a childhood health condition has resolved. Occasionally, clients will report unresolved trauma symptoms related to medical procedures or conditions they experienced decades before.  Others become aware that their coping or relationship skills have been stunted by extensive time away from the childhood millieau of school, sports and play dates. Counseling can be instrumental in helping adults address and move past these obstacles. Therapy can be a safe place to access stored grief, resolve trauma, obtain psychoeducational training to develop delayed life skills and recognize resiliencies that enhanced survival. If you struggled with health concerns as a child and experience any of these challenges, consider contacting a therapist to bring  healing to  your mind and spirit as well as your body.

Understanding Binge-Eating Disorder

Many of us have had the experience of over-eating to the point of abdominal pain. Just think about your last Thanksgiving feast: how many people pushed away from the table, groaning with discomfort, loosening their belts, unsnapping the waistband of their jeans? Occasional over-eating is not a clinical diagnosis, but more usually a sign of distracted eating, intense enjoyment of a particular meal, or a result of indulging in a special treat. Binge-Eating Disorder, however, is a serious eating disorder that can have life-threatening consequences.

DIAGNOSING BINGE-EATING DISORDER 

Specific behavioral and emotional characteristics are present for clients with Binge-Eating Disorder(BED), including: 

1. Recurrent episodes of binge eating, characterized by eating much more food in a specific amount of time than most people would, and feeling a lack of control over the eating episode.

2. Binge eating episodes include three or more of the following components:

      A. Much more rapid eating than normal

      B. Eating until uncomfortably full

      C. Eating large amounts of food when not hungry

      D. Eating alone out of embarrassment about the amount one is eating

      E. Feeling disgusted with oneself,  depressed or very guilty afterward

3. The person feels marked distress about his/her binge eating.

4. Binge eating occurs at least once a week for three months.

5. The binge eating is not associated with the recurrent use of compensatory behavior (i.e., over-exercising, abuse of laxatives) like in bulimia nervosa, and doesn't occur only during the course of a person suffering with bulimia or anorexia nervosa.

PUTTING BED TO REST

Various treatment options exist for BED. Inpatient, partial hospitalization, intensive outpatient and outpatient therapy modalities provide the appropriate level of care and oversight for clients' differing needs. Besides counseling, the treatment team also includes a nutritionist, medical doctor and psychiatrist to help manage the client's physical health. Obtaining a comprehensive evaluation from a certified physician or therapist specializing in eating disorders is essential to ensure the correct level of care is initiated, and to screen for other co-morbid diagnoses, including substance abuse, personality disorders, depression and anxiety. Like all eating disorders, recovery from BED can be a lifelong process. But early intervention and a commitment to the therapy process can provide BED sufferers with the skills and resilience to triumph over this complicated disease. 

Tracking Teen Development: When to Intervene

Seemingly out of nowhere, my previously sweet, considerate and affectionate 15-year-old son is sometimes replaced by a surly, disrespectful and eye-rolling teenager who doesn't hesitate to point out my every shortcoming and flaw. In the past, my son would join me in our "Car Dancing"--maniacally rocking out to our favorite songs on the radio. Now, he FORBIDS me not only from dancing in the car, but even singing along (which, of course, necessitates my immediate need to belt out song lyrics as loudly as I can WITH THE WINDOWS DOWN). His behavior irritates and frustrates me, but I am  familiar  enough with adolescent development to understand my son is a typical teenager. But how do we tell the difference between normal adolescence and behavior that indicates a need for intervention?

TYPICAL TEEN -- OR TYRANNICAL TERROR? 

According to experts Dinkmeyer and McKay's seminal books on parenting, teens can generally be grouped into three categories. Review these attributes and behaviors and consider where your teen falls:

Typical Teenager--This teen exhibits a greater interest in friends than in family. He may try out different values as a way of separating and creating a sense of self distinct from his family. She may experiment with smoking cigarettes, trying alcohol, swearing, and minor rule-breaking at home or school. Lying, pushing againt established boundaries and occasional disrespectful behavior fall into this category.

At-Risk Teenager--This teen may isolate from family, demonstrate a more consistent use of  alcohol or marijuana, and express less interest in school or other achievements. She may experience conflict with authority figures, disregard house rules, engage in sexual experimentation at an earlier age or deliberately express disregard for family values and activities.

Out-of-Control Teenager--This adolescent regularly uses substances, may he skipping classes or even dropping out of school. He may be sexually active indiscriminately or engage in risky behaviors. He may be involved in the juvenile justice system, and have difficulty in sustaining healthy relationships.  A high level of disengagement from prosocial activities and an investment in dangerous or unhealthy behaviors is a consistent theme.

Clearly, at-risk and out-of-control adolescents are in need of immediate interventions, including a referral to counseling. Typical teens, however, can also benefit from individual, family or group counseling. This challenging and vulnerable stage of development is a time ripe for growth and insight. Counseling can provide teens -- and exasperated parents -- with support, education and skills to navigate these years with limited eye-rolling and exaggerated sighs. Just don't expect car dancing lessons. Some talents are simply inborn.

Parental Guiding Suggested

Wiping runny noses. Driving carpool. Answering the same question 12 times. Scheduling doctors' appointments. As parents, we expect and accept that these tasks are everyday obligations in our roles as caretakers. As the American population ages, however, many adults find themselves in the role of caretaker for their parents as well, with sometimes ambivalent feelings  about the tasks involved in this balancing challenge.

PARENTING OUR PARENTS

Different cultures approach aging, and caring for the aged, with varied perspectives. While some families believe that caring for aging parents is always the responsibility of family members (usually the adult children), others feel that older folks receive the best, most informed care from trained providers, whether in-home care or professionally-staffed facility. No single approach works for all families, nor for the needs of each aging member.  If you are exploring the best care options for your aging parent, consider the following points:

1. Call your township. Most areas have a senior services department, which can help schedule Meals  on Wheels and volunteer visits, offer financial or transportation assistance and suggest area resources to help you and your parent.

2. Establish a "treatment team." With your parent's doctor as the center point,  develop

a circle of providers to help manage your parent's needs. Consider a counselor, home health staff, nutritionist, physical therapist, attorney and accountant who specialize in older clients--whoever can best advise you and your parent and sustain his independent functioning for as long as possible.

3. Research options sooner, rather than later. Aging people's health status can change quickly. Start looking into different levels of care, including assisted living, independent living and nursing home facilities, so you and your parent are not caught off guard if the need arises.

4. Join a support group. Just as your parent can benefit from time with his peers at the senior center, caregivers can get replenished, educated and understood by peers experiencing the same developmental milestones. Check with local hospitals, senior centers, and your parent's physician for referrals to area support groups for adults caring for aging parents. 

5. Keep communicating. The changes and limitations that come with aging can be challenging to accept--for both parent and adult child. Talk regularly about your feelings about your parent's functioning, your fears and concerns for them and your opinions about their care options. Encourage your parent to share her feelings with you. When we love someone, we sometimes "hide" truths from them that we fear may be upsetting. In reality, the "known" is much easier to cope with than the "unknown." Whereas we are unable to craft a response to the unknown, with the known, we are empowered to act and choose.