Thanks to Bisexuality-Aware Professionals Directory

Professional Directory For Bisexual People

Thanks to the Bisexuality-Aware Professionals Directory for including me recently. You can click on any state for their listings, including mine in Washington State. Integrating human sexuality into individual and relational therapy should include a good understanding of bisexuals. This directory is one of the few that require evidence of direct experience and training with bisexual clients. If you have questions about my practice, please feel free to contact me here.

Bisexuality –> Fluid

Bisexuality, or the more expansive term fluid sexuality (no assumption of only two genders ) is a common form of human sexual behavior. While no clear genetic markers have yet to be found, they are likely linked or identical to those already identified with homosexuality.

Social System

Although bisexuals are more fluid sexually, there are anxieties projected onto them by  straight hetero, Queer, gay or lesbian populations. There is also much more understanding today than in the past. But community development remains difficult due to panoramic stigma.

These and other issues are involved in working with bisexuals. Future blog posts to come


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…..


Affordable Mental Health Care: The ACA In My Office

I start with an overview about the Affordable Care Act (ACA), and then shift to seeing it at the level of an solo private mental health practitioner in Seattle.

Change Happened

Over the last six years, the Affordable Care Act has restructured the regulation of health insurance at the Federal level.  It has also expanded the range and depth of most mental & behavioral health benefits. There are new minimum benefit levels that all insurance plans must now include by law.

Permanent Structural Change

The law adjusted elements of Medicare (including its mental health benefits), Medicaid, employer-sponsored and individual insurance plans. Plus, the EDI (electronic data interchange) infrastructure of American healthcare is permanently altered. Changes were made partly so that universal & affordable access to health care, including mental health, could become a feasible national policy goal. It appears to be working.

ACA Here In Seattle

Here in Seattle, the State of Washington developed its own health insurance exchange website, and was among the first to accept the Medicaid expansion allowed by law. It’s easy to see on the site how many more private companies are now competing to manage the benefit. Yes, private sector profit motive still drives the system, but healthcare jobs are growing sustainably to meet the new demand. Competition has clearly increased, and the rates of medical and insurance cost increases are slowing.

Apple Health

Clients With ACA ‘Expanded Medicaid’

This is just a modest attempt to anecdotally note my experience working with the people I’ve seen through the ACA “expanded Medicaid” benefit. The total number of these clients I’ve worked with would not support a full-on demographic analysis.

The clients have been under 40, and either self or part-time employed. These include entrepreneurs, musicians (artists need health care too!), psychotherapists, graduate students, and the recently unemployed.

The ACA Benefit

The clients I’ve seen have benefits which allow for outpatient psychotherapy with no out of pocket cost – neither copayment/coinsurance nor deductible. Typically, that benefit structure is seen by therapists as promoting a decreasing a client’s ‘stake’ in the therapy (client’s commitment to therapy is partially expressed financially).

Yet despite paying nothing out of pocket, I saw them for the same average number of appointments as all other clients. Being freed from any cash costs did not increase client dependence; in effect, people do not act like freeloaders

One Complaint Is Gone

I don’t see the anxiety and occasional terror that was once attached to becoming unemployed. No longer does the personal liberty to change jobs, nor the disappointment of losing one, come tied as strongly to the threat of a personal/family medical cost disaster. Some of the more grievous flaws of the 2010 health insurance industry, which insured health-for-some at ‘off-the-charts’ per capita cost, are beginning to heal.