Types of Psychotherapy Offered In My Practice
I am a practicing psychotherapist based in New York City. Please email me any and all inquiries about my practice
The first psychoanalytic patient was named "Anna O" in Freud's first book (written with Joseph Breuer) called Studies in Hysteria." She started her therapy in 1880 and terminated two years later. Her name was actually Bertha Pappenheim and she later went on to become the first social worker in Germany and a prominent feminist in the early 20th-century where she fought for the equal rights of women and the welfare of children.
Pappenheim is interesting because she originated an excellent metaphor for psychoanalysis. She called it " chimney sweeping." By that term she analogized that the flow of the chimney was like a person's unconscious, hidden from sight by the surrounding brickwork. One couldn't see inside the flu; only the chimney sweeper could clean out the residue of creosote that lined the flu after years of burning coal and wood. As anyone who now burns wood in his chimney knows, creosote-lined chimneys are dangerous; a fire or explosion may result.
In Pappenheim's metaphor, the chimney represents a person's life, his presence in a family, his relationship to his parents and siblings, and in the case of the gay men, his feelings and experiences coming out and living (or not living) a gay life. That also includes his feelings about his body, his sexuality, and the kind of lovers he chooses.
The flu of the chimney represents the darker side of our personalities. The creosote lining its walls represent the psychological pains of childhood and adolescence, one or both parents who are ill prepared to show unconditional love to their children, and the pains of living a satisfying gay life in a traditionally homophobic society.
If you are considering entering psychotherapy, think of it as coming in to have your chimney swept of all the behaviors, mostly originating in the past, that prevent you from living the good life. Perhaps you come from an alcoholic family in which your father, in an alcoholic rage, beat your mother, and you were forced to intervene. These memories, and their effects may linger in you, affecting the future choices you make in life including sex partners and lovers.
Perhaps you were a sissy as a child. Many gay men were. Most sissies are taunted and abused both physically and psychologically. Some men were even terrorized by their own parents who looked upon the child's rejection of sports and interest in "feminine" things as a stain upon the family. The memory of these early experiences have a life of their own, the boy burning with rage toward other boys who were admired and popular, and an equivalent attraction toward them; a perfect definition of internal conflict.
But not all people who enter psychotherapy were damaged in childhood. Sometimes a person merely wants to get more out of life by learning how to be a better lover, or relate to his parents more maturely, or work more efficiently on the job. These are legitimate goals in psychotherapy.
Without question the single most important factor in therapy is the relationship between the therapist and his patient. With trust, something that takes time to develop, individual therapy will be hastened considerably. It's important to report warm feelings towards your therapist, such as, moments of affection or anger, feelings of being ignored or unwanted, even dreams in which the therapist appears. They may be pieces of "creosote" whose meaning has been hidden but can now be "cleaned" so that they no longer control your life.
It's a good idea to get recommendations from friends when seeking a therapist. It's also acceptable to visit a potential therapist to see how you feel in his presence. You can also learn if he is a licensed professional by using my link to the State Licensing Board. Don't see anyone not licensed.
Common reasons people go into individual psychotherapy include:
- Coming out problems
- Relationship problems
- Sexual dysfunction
- HIV and AIDS
- Low self-esteem
- Alcohol and drug use
Through the first half of this century there was only individual psychotherapy. There was a reason for this. Psychoanalytic theory stated that all problems in life were motivated by unconscious conflicts within the individual psyche. Any problems in marriage, therefore, were seen as a result of internal conflicts within two people, not between them. Problems in communication, sexual incompatibility, and in the case of homosexuality, living in a homophobic society, were considered "mere" external factors that were irrelevant to psychotherapy. If a marriage was in trouble, both husband and wife sought therapy individually because their troubles were defined as only "symptoms" of an underlying and unconscious disorder. Of course in those days no therapist would have treated a gay couple with the aim of helping them to establish a good relationship. Instead they would have been advised to go into individual therapy in order to be "cured" of their sexual affliction.
Things changed after the Second World War. Psychologists began studying styles of communication and conflict resolution between married couples. The first Kinsey report on sexual behavior in men was another factor that help change the times. Published in 1948 to a howl of protests from the religious right and the established (and conservative) psychoanalysts of the day, it made public information about people's actual sexual behavior. It was important for gay people because it demonstrated that one third of men have had homosexual sex to orgasm after puberty. It had the effect of normalizing sex between men.
There was also a new brand of therapist on the scene. They called themselves "Behaviorists," and they denied the claim that problems in people, and in relationships, were mere symptoms. The behavior was the problem, not a symptom of it, they claimed. Some behaviorists invented “Aversion Therapy” (electric shock) as a technique for “curing” gay men. Fortunately, it’s a thing of the past.
Marriage counseling became an acceptable form of treatment. Its intention was, and still is, to illuminate the communication patterns and conflict resolution between partners that lead to disunity instead of attachment and intimacy. Therefore, couple counseling has as its focus how two men communicate with one another.
Therapists often find that over time gay couples in trouble (like their straight counterparts) develop a sadomasochistic relationship. That means discussions between them about their problems spiral to the point where they continually hurt each other by their words and actions. They know they're going about it the wrong way, but can't find a way out of the mutual recriminations and accusations.
While couple counseling generally doesn't analyze ids, egos and superegos like traditional Freudian psychoanalysis, there may be an examination of the couple's developmental history. This may be crucial in the treatment. For instance, how your parents behaved toward one another may become the model of how you behave toward your lover. Fine if their marriage was a great success, but few of us, come from such model families. Identifying with parental marriage styles is one of the most common causes of conflict in gay couples. If your mother, for instance, was a nag toward your father, you may (quite unconsciously) take on the nagging role toward your lover. "You're just like your mother," is an accusation that illustrates identifying with parental marriage styles, and a sadomasochistic attack all at once. Its purpose is to hurt one's lover -- which it will do -- especially if it's true. But it's effect is to put another nail into the relationship. Therapists trained in family systems are particularly knowledgeable in understanding these interactions.
Patients in individual therapy sometimes ask if it's OK to see their private therapist for couple therapy as well. Most therapists will advise against it. One's lover might reasonably object as well. Your individual therapist should suggest another couple therapist for treatment.
Common reasons patients seek couple counseling include:
- Problems in communication
- Sexual incompatibility
- Monogamy problems
- Financial conflicts
- “In-law” problems
Group therapy also made its appearance after World War II. While some gay men prefer a group to individual therapy because of its lower-cost, that isn't the professional justification for joining a group. The rationale of a group is that, in many ways, it replicates the family including siblings and parents. There are many different types of groups based mainly on how directive or non-directive the therapist role is.
What is the difference between a support group run by a facilitator and a therapy group run by a psychologist? Support groups focus on a particular issue or problem. Alcoholics Anonymous, for instance, is concerned about alcohol abuse. PFLAG is a support group for parents who have a gay child. Men with prostate cancer may meet in order to share their feelings about the diagnosis and information about new treatments or doctors. It is problem-centered and operates in the “here in now.” There may even be a rule against bringing up events or problems from the past.
Therapy groups focus on the people and their problems, wherever it may take them. While one's emotional problems are experienced in the here and now, they usually originate in the past and the process of uncovering old (but still painful) abandonments and family disorder are grist for the mill in a therapy group.
Members of a group are encouraged to discuss all the things they would say in individual therapy, including sexual fantasies, reactions to each other and to the therapist. In contrast to a 12-step program where members are discouraged from "cross-talk," members of a therapy group are encouraged to interact with one another in the group.
A group is not for everyone. It's quite frightening to most people at the beginning. That's because old fears of not being accepted or worthy or the pains of rejection create defensiveness, mainly silence. Most people get over it, but some don't. For those who adjust to a group, it usually provides a feeling of intimacy that encourages a person to examine his goals in life and his means of achieving them. Therapy groups are generally very supportive toward its members.
Patients often choose to see a therapist both privately and in a group. That's an acceptable form of treatment.
Common reasons patients seek group therapy include:
- Conflicts with lovers
- Sexual problems
- Coming out
- Family conflicts
The treatment of sexual dysfunctions is the newest form of therapy for gay men. It originated in the 1970s. There was a time when all sexual problems were thought to be psychological. That's no longer true. Sex therapy can be divided into two sub-groups: physiological dysfunction and sexual interactions.
Physiological dysfunctions: these are the three traditional problems of impotence, premature ejaculation (coming too soon) and retarded ejaculation (not coming). Impotence is usually caused by blocked arteries, pathological veins or disturbances in nerve conduction from the brain (as in diabetes). There is also "situational" impotence caused by emotional conflict regarding the person you're having sex with, or recreational drugs or alcohol. Premature ejaculation is thought to be caused by lack of control, and retarded ejaculation by over-control in men.
Sexual interactions include how your attitude about being gay, about being a man, about other men, about having sex with another man affect you sexually. Especially important is whether you can integrate emotional attachment and intimacy toward another man with your sexual desire toward him. Many men, for instance, don't share their "dirtiest" sexual fantasies with a lover under the belief (I'm tempted to say illusion) that the sexual relationship should be pure -- i.e. vanilla. The really exciting fantasies are reserved for masturbation or tricking if they have a non-monogamous relationship. Sex therapy is designed to integrate those sexual fantasies into the relationship. Sex therapy is problem-focused and in the here and now, however, how we function sexually is often a reflection of the lessons learned at home. It is generally short-term but may sometimes shift to individual or couple therapy in order to work on other problems. It was designed as a treatment for couples, not individuals, but under certain circumstances an individual can also be treated.
Sex therapy may be the appropriate form of treatment for you, but that decision must be made by a certified sex therapist. After examination, it may turn out that individual or couple therapy is more appropriate because one or both of you are using sex in the relationship as a weapon.
Common reasons patients seek sex therapy include:
- Retarded ejaculation
- Premature ejaculation
- Fear of sex
- Communication with a partner regarding sexual desires
Since I am a psychologist, I am not licensed to prescribe medication. I have a working relationship with three specialists in psychopharmacology the psychiatric specialty concerned with the effects of psychotropic medications. A medical evaluation is particularly important for patients who are taking medications for HIV. Patients in need of medication are treated by these psychopharacologists, while I continue the work of psychotherapy, and we coordinate the care. In almost all cases, medication is taken for a limited period of time. Some patients refuse medication because of their potential side effects (such as the sexual side effects of some anti-depressants), or for other reasons. If I believe medication is called for, I discuss it with the patient who makes the final decision.
In some cases (and with the patient’s consent) I will coordinate my care with the patient’s internist when medical conditions may be influencing his emotional state.