While I treat a variety of mental health issues, there are specific areas I tend to focus on most often, with details on each further below:
Dual-Diagnosis is the combination of substance abuse/self-medication with an ongoing, often undiagnosed, underlying mental health issue. While there are numerous combinations that create a dual diagnosis, here are some of the most common:
Typically, self-medicating behaviors are innocently developed to help manage the symptoms associated with the underlying, undiagnosed mental health issue. As time goes by, it becomes difficult to determine if the mental health issues are being made worse by the self-medicating or if the self-medicating is being made worse because of the mental health issue. As a result, steps need to be taken to focus on both issues simultaneously through a variety of approaches, depending on the severity of the self-medication.
SUBSTANCE ABUSE/MISUSE/ADDICTION/SELF MEDICATION
A common reason for seeking therapy is to further explore and understand self-destructive behaviors. Among the most common is drug and/or alcohol abuse. What may have started out as occasional recreational use begins increasing, both in frequency and volume, affecting key areas of life (e.g. work, relationships, health). As a therapist, it is less important for me to identify someone as an “addict” than it is to explore why they are self-medicating in the first place. Addiction is a serious illness, but even without the disease, occasional abuse of drugs, alcohol, food, sex, gambling, shopping, etc. can cause serious damage and, if left unaddressed, can certainly lead to addiction.
SELF-MEDICATING VS. SELF-SOOTHING BEHAVIORS
Self-medicating behaviors are typically “quick fixes”, but also self-destructive, leading the client to “check out”, “numb”, or “dissociate” from feelings that are overwhelming, resulting in a hangover effect. While the hangover effect may be most commonly associated with the physical symptoms of drinking too much, I include the emotional symptoms of regret, depression, shame, emptiness, guilt, fear, or sadness as additional components. A partial list of these behaviors is listed above.
Self-soothing behaviors are typically more positive and empowering, leading the client to feel present and engaged, followed by feelings of fulfillment and satisfaction upon completion of the activity. Unfortunately, they can be more difficult to stay attached to because, unlike self-medicating behaviors, they do not offer “instant gratification”. They require staying present and engaged, which is very hard to do when facing the onset of overwhelming feelings or anxiety.
Because everyone is different, what might be self-soothing and beneficial for one might be self-medicating and destructive for another. It is necessary to explore possible outcomes of engaging in certain behaviors to determine what might be the best fit.
There is a cruel irony that creativity often requires great sensitivity. The ability to feel and sublimate those feelings through artistic pursuits is a rare and valuable gift, but it can be difficult to hold our own value in the face of an industry where being judged is part of the process. Psychotherapy can serve as a place to identify how the “nature of the business” affects one’s sense of self so that being judged for a job or role is “just business” and not personal – even if it feels that way.
GAY MID-LIFE TRANSITION
The life of today’s middle-aged gay male is unique, as this is a generation that has come of age during a deadly epidemic, managed to survive, and has now witnessed the legalization of gay marriage and the emergence of families with same-sex parents. Despite the relief of surviving and the excitement of acceptance, there remains the residual trauma caused by years of trying to survive a war on their very existence (first emotional, then physical) and the effect this has had on intimacy and creating a map for aging and retirement. Who has time to think about the future when each day has been about surviving the present? This anxiety can be further compounded by the harsh reality of aging in a city and culture with a preoccupation on youth, beauty, and material success, leading to the same feelings of isolation and depression that haunted them before coming out.
MALE SEXUAL ABUSE
Despite the increasing awareness of sexual abuse against minors, the confusion around these early experiences often prevents people from ever discussing it – either when it is occurring or many years after. While the behavior of the perpetrator is shameful, the response of the victim to the abuse is not. Age of Consent laws exist in order to physically protect minors against behaviors they are not emotionally mature enough to fully understand, whether the experience feels pleasurable or not. When sexual abuse is perpetrated on a minor, it is natural for the minor to develop confusion about intimacy and trust, as well as confusion in relation to their own body. This confusion is often then carried over into adult relationships where it becomes difficult to stay both physically and emotionally present with partners. Recovering from such trauma requires redefining what intimacy is for each individual and how to connect in ways that feel safe and organic