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…..


Sex & Relationships: Why Desire Is Fragile

Sexual Desire

Sexual desire, arousal and lust are powerful and alluring, so why is desire fragile? . Whether one believes one’s life to be erotically blessed and indulged, or deprived and wounded, it’s hard not to see that desire (and arousal) is still the most robust ways to feel ‘alive’ – or ‘dead.’ Also the most fragile, vulnerable, perilous… and easily thrown “off course.”


The Medical & Physical

What makes desire and arousal so difficult is often unrelated to physical or medical causes, While we should investigate the medical side, It sometimes means we are delaying a deeper, uncomfortable intimacy with ourselves and partner(s).

It isn’t that doctors shouldn’t touch this issue. But they should generally refer to a mental health professional trained in this area of human experience and mental health.  Only in isolated cases is desire or arousal, in all of its complexities, improved by medications.

Desire is Fragile

This simple idea – the fragility of desire – is not so novel. Some act as though this part of relationship can be deferred and subordinated to other ‘necessities’. Others will say it’s not that relevant to the outcome of a marriage.  Until you consider that many, many relationships – full of successful attachments of all kinds (marriage, careers, children, property,  in-laws, etc.) – struggle to maintain desire, arousal and real wanting, and fail for those reasons.

Desire Has It Tough

The day-to-day environment for desire is very adverse. Many of everyday life’s relentless, necessities, and the ways that our primary relationship(s) are run by them, have a negative effect on desire. It’s not only about conflict over priorities.  Desire and arousal are not great “competitors.” against the endless maintaining & developing of work/career, health, money, in-laws & extended family, property and parenting. Many relationships experience a meltdown when desire and work cross paths; the workplace affair is very destabilizing.

Desire Isn’t How The World Mostly Works

The world is not built on the same rules that desire plays by. Unlike the rest of human affairs, arousal and desire thrive in a tension of partners’ loving selfishness, separateness, aggression and willfulness. The rest of life’s relationships – which thrive on cooperation, compromise and predictability – would be havoc if they played by those rules. Yet this is why people so often want erotic and sexual lives; they can safely escape constraints and boundaries that relationships normally require, through consensual play and imagination.

Desire doesn't work this way

Desire doesn’t work this way

Teamwork vs. Differentiation

A relationship is often caught up in the accomodating teamwork that modern life can demand. Predictability, agreeability, accountability and equality are the standards that daily life is held to; as few surprises as possible. An ‘adequate’ sex life, employing an agreed-on (even silently) scripted sexual routine, functional, somewhat mutual & generous, may already exist. It’s a collaborative and serviceable arrangement, until it isn’t.

Desire-Arousal-Intimacy Can Be Threatening & Subversive

People so often develop relationships that are bound and obligated, but where they have little to no desire for one another. Desire, and increasing intimacy, actually threaten to subvert or re-organize the attachment they have built. The relationship may be quite rich, ‘successful’ and warm – but rarely if ever “hot.”

The ability to self-validate one’s own sexual character or nature requires both personal and relational differentiation. It takes the courage to be seen in ways that might be very vulnerable and anxiety-provoking (often due to fear of rejection), even in a long-term relationship. You cannot easily soothe a partner who thinks you are erotically threatening or sexually dangerous.

Unfortunate Beliefs

The non-erotic aspect of most of life’s maintenance tasks serves those who do not welcome ongoing development of their world of desire. It’s often seen as the part of the relationship that “naturally decreases.”  Yet their erotic imaginations – the safer, private erotic relationship with themselves – continue on however. We do not give up this sense of aliveness easily.

kick the desire can down the road

Kick the desire can down the road

Kicking The Can Down The Road

One common (anxiety-deferring) wisdom says, “desire is tricky,  you’ll feel it again someday – whenever” — or some similar post-mortem. Desire declines are therefore “not a big deal”.

Yet the loss of desire is a main reason for marriages and relationships to end (often faster than people can find the maturity they need to carry on.) There’s talk of “incompatibility”, “lack of chemistry” and “love, but not in love”.

Therapy may be used in a hurry-up effort to repair desire, but that kind of personal development doesn’t play well with deadlines or being rushed.

Warm Is ‘Helpful-Not-Sufficient’ for Hot

In some desperation or confusion of the loss of “hot”, increased applications of “warm”, well-attached behavior, do not, frustratingly, revive “it” in a durable way. I consider the idea of a “dishwashing husband rewarded with sex” to be folly, unless we’re talking about erotic life involving the kitchen setting, water, soap, etc.

“Hot” needs play and imagination, opposition, non-compliance, some comfort around risk and experimentation, self-validation, transgression (of something/anything), distance, self-interest, possible/likely generosity (“GGG“), etc., not chores. Even if sharing housework represents a good relational step, it’ll rarely induce the sought-after heat (other than hot water.)


Warm Not Hot

Warm attachment sets the table for “hot”, but that’s all. Then the partners must find the separateness to sit down, order what they want, and openly, consensually-selfishly enjoy it.

It takes at least one person in the relationship(s) who’s dedicated to having a sexual self – as a matter of life (and ‘death’).  And the decency to give one’s partner(s) room and flexibility to continuously develop an erotic/sexual self too. (I always liked Marty Klein‘s simple analogy of being a “good citizen in the relationship“.)

The Great Achievement

In my thinking, keeping desire alive and kicking in committed relationships is the greatest of all personal/relational achievements – one of the rare successes in life that no one else need know. Yet nearly everyone does know when they see a relationship that still has it long after the period of early infatuation ends. Maintaining desire is defined here as always developing it.

The Safety Of Desire & Arousal

Desire is fluid. Like water on the roof, it will go wherever it can. But it thrives on a certain kind of safety. Small wonder so much human desire exists in private mental life. That’s where the real safety lies, in the inner world privacy where this part of a person can emerge and find expression.

Michael Bader brings the idea of sexual expression as a milestone of personal development, setting the stage for helping a person cope with a core, and likely well-hidden worry. I think of it as undifferentiated anxiety from family and social relationships.

carve out time

Carve Out The Time

Time must be carved out by two (or more) adults to better figure out their erotic lives. All the other scheduled events must be set aside. Desire,needs to be openly supported, developed (hopefully with much humor), acted out and cared for. Desire is fragile and must be nurtured (because adults aren’t “really” allowed to play, and so they forget how.)

 ….an abrupt ending to be sure, but to be continued…

Relationship & Couples Therapy: BDSM Likely A Mainstream/Majority Practice

Is BDSM becoming a mainstream/majority practice? Thanks to Dr. Justin Lehmiller for his blog article, which supports the idea of a convergence or merger into a new hybrid of sexual behavior.


Monogamous, Monogamish, Poly

I’ve previously addressed the idea that there can be a dialogue and development of relational practices between monogamous, “monogamish” and polyamorous people. If we can digest and excrete “regressive-competitive” attitudes, people can develop their relationships and themselves more dynamically.


We may want the clarity of bright lines between “vanilla”, and “kink” like BDSM. I would argue that our digitally-driven social blender will evolve sexuality into an endless variety of practices and relational structures,

Jealousy Skills

The management of jealousy is one of the primary skill groups that people will need to handle the most typical tensions and problems. (UPDATE: if you are reading this post and are curious about jealousy, please check out this more recent blog post for a review of jealousy in its many forms, with helpful therapy tips!)