What We Might Talk About: Therapeutic Dialogues

 Therapeutic Dialogues

(A bit of a break since the last post. I’ve been relying far too much on feeding @SeattleShrink! While Twitter allows me to draw on many sources, the blog is where some of those inputs can synthesize into information that is helpful to you – the ultimate test.)

The blog is also meant to give an ongoing picture about my practice, and the person leading it. Blogging about therapeutic dialogue(s) seems to fit that well.

I Talk To Clients About…

….Wanting and Choosing

Wanting is the verb of desire. Choosing is the act of commitment.

Wanting v. Choosing, a tension to manage. We get better at it as we age. This tension can create remarkable, resilient, self-aware decent people.


The Commitment Anchor

Choosing is how the world gets built – it’s fundamental, essential, powerful.  So, most people lean toward mastering the relative certainty of commitment over the more fluid, variable, playful desire.

The Tide Of Desire

Wanting must be constantly nurtured (by the imagination) and generally defended, as a priority in relational life. It’s highly perishable, needy. Yet desire problems drive so much breakup and divorce, mono and poly.

Who Wants to Be Seen & Known?

That’s understandable since most adults know that wanting powerfully reveals the self. Our sexual development is influenced by the fear of being seen and known, by intimacy we have to tolerate.



The term immunity comes from the study of biological life and health, of which psychology is but a subset. Immunity presumes exposure – to everything. To learn how to protect, it must fail often enough. But it copes well with each loss – it’s rarely fooled again by identical bacteria or virals. Think of how that might hold equally true for your emotional life, and your relationship(s). As long as you are vulnerable enough to connect with your feelings, yet with a solid sense of self, you will learn much about who you are. (Attachment-centered therapists may see this model as an invite to an “auto-immune disorder”. I don’t.)

… Differentiation

together and separate

The pursuit of a self, guided by thoughtfulness about intimacy and privacy (self-intimacy). Intimacy that’s understood to be both indulged (wanted) and tolerated (frustrated.) Right in that crease lives the kind of personal development that understands emotional pain (and joy) as part of ongoing personal development. That means balancing awareness with careful, accurate thought about your big picture.



Mastery speaks realistically to that core development process that we want in our work, and in life. This is a “modest and durable” module, grounded in the practical life of spirituality, gender and sex-role netural. It owes nearly everything to George Leonard.  It can fit into just about any therapy approach – it’s like ‘behavioral support service.’ And all about practicing self-control.

A ‘practice’ can be built to reconstruct a life and a self. It orients and organizes, but understands full well — that there can be ‘practice without progress.’ The model is usually helped by a meditation or greater body conditioning.



is not an emotion

The vast majority of my clients refer to anger as an emotion. I don’t. Anger is affect, emotion’s visible/audible ‘wrapper’. It’s driven by many different emotions. I ask clients to identify the emotions that fuel their angers, and there are often surprises on that ‘list.’ This starts a process of exploration, where before there was only a fear of losing self-control. The heat of anger leads to the light of clearer thinking about



A missing element in many adults. Why? How you’ve been loved, or not (and just how so), truly surfaces in adulthood. Self-love (masturbation) migrates to & from the imagination, then expressed in adult relational play. Our erotic/sexual ‘template’ is a way to relieve worries (per Bader), to relinquish anxiety — to feel fully alive.

The erotic connection lovingly turns the world on its head. Relieved of of typical daily importance, familiars can safely be strangers. An endless paradox: taking for oneself — as a primary form of giving, of showing up, of wanting intimacy of all kinds.


grief counseling

Grief is the seam between life and death, where they “meet”. Through my critical incident practice, I’ve learned more deeply how to help those who have endured painful loss. While I think of grief as a system equally ‘elegant’ to gestation & birth, I also know that going through most of it is lousy. Sometimes with the feeling there’s little to no light at the end of the tunnel. When someone can make durable meaning from a significant death, the process ripens.

…..Kink Aware; Sex Positive

kink aware

To credibly present these two credentials begins to heal the long history of professional mental health abuse towards the sexually, erotically and relationally diverse. That abuse has evolved into a fear of psychotherapists who either moralize, or refer clients they know they can’t relate to – after the therapy relationship has begun. Ouch.

I’ve worked with many clients advanced in the imaginative & playful living (or educating) known as kink. Their sex positive beliefs are openly practiced, even as they face nearly universal problems of intimacy and integrity.

You’ll be safe in this office with your erotic and sexual selves, exactly as they are.

To be continued…..


Social Work Perspective: How Will This Therapist “Do Better”?

Not only as a sentient adult, but also as the parent of a middle schooler, my emotional life since last Friday morning’s holocaust at Sandy Hook Elementary School in Newtown, CT. has been rocked with pain and grief.

Response From Social Work Profession

So I’ve only begun to think about how my profession might participate in the discussion of change to mental health practice. We are certainly more connected than most professions, as we are mental health professionals. Do we need to look at new national policy regarding assessment, evaluation and mandated reporting of mentally ill individuals? It looks like there will be a revived national discussion and policy-making process related to gun regulation?

Public Policy Development

Clinical social workers like myself are of course first and foremost social workers. As such, we define ourselves in our professional canon as participants in policy development and community organization. Educationally, public policy and community organization are a part of all accredited Masters programs in Social Work (see Educational Policy 2.1.8.) Members of my professional association, the Washington State Society For Clinical Social Work, know this well from our legislative activity as an professional association. I was personally involved in legislative activity in Olympia, as President of the Board of Directors from 2008-2010.

Yet I wonder how we as a profession would “do better”, as the President admonished yesterday.  I hear some dialogue about outpatient therapists gaining the authority to identify individuals who may be at risk for violent acts. Politically and policy-wise, I think it will be difficult to move beyond the use of a criminal record database for background checks that qualify individuals for gun purchasing. The question remains whether that will become universal to all gun transactions.

Mental Health Database

The current mental health criteria for inclusion in the background check system is:

  • A person adjudicated mental defective or involuntarily committed to a mental institution or incompetent to handle own affairs, including dispositions to criminal charges of found not guilty by reason of insanity or found incompetent to stand trial.

By that standard, the Newtown shooter and many others have evaded restrictions on their ability to purchase or simply get guns. The database itself has become a leaky sieve. Current Federal law allows various ways to circumvent it, to the point of near uselessness when it comes to effective prevention. It makes little sense for health care professionals and administrators to report to a database that is itself badly compromised in terms of its comprehensiveness and effectiveness.

Social Work Profession

It’s easy for the general public to view the everyday office therapist as disconnected from public policy. I can assure any reader of this post that the social work profession as a whole is quite well connected to the policy process, concerned and capable of acting in the national discussion.

Those are just my thoughts for now. More to come…