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…..


@SeattleShrink: The Small Pleasures of Twitter

Twitter @SeattleShrink

@SeattleShrink on Twitter

I have to admit enjoying my @SeattleShrink Twitter feed, which is located in the right sidebar on every page here . The feed is a mixture of professional interests – sexuality, relationships, mental health, (psychotherapy and psychiatry) medical health and wellness, and an array of related tweets. Fear not, the occasional tweet on social justice, or lifestyle won’t turn it into a Twitter clone of Salon.comHuffington Post, Slate.com, or Alternet.com

I read those who seek creative eroticism, and pass along what I think are the most usable (and sometimes entertaining) bits. Occasionally I’ll throw in a tweet about Seattle, the latest in relationship therapy, mental health research, gay life & politics, polyamory & monogamy, or humor. I like that a feed can reflect so many things.

So I’d love it if you followed @SeattleShrink, and hope you find it fun and interesting!


Relationship & Couples Therapy: How Long Will It Take?

Couples seeking relationship and couples therapy in Seattle sometimes ask a particular question when we set up a first appointment on the phone: “How long will couples therapy take?” I’d like to discuss some common reasons for that question, and then offer a different take on it.

The Common Reasons

The usual curiosity behind that question has to do with the duration and financial cost of treatment. Those issues are also about the effectiveness and efficiency of the therapist. As the sayings go, “money does not grow on trees.” And, “time is our most valuable resource.” Yet on that first call, it’s nearly impossible to give an informed or comprehensive response to these questions. There are too many unknown factors.

Prior Therapy

A background for these questions is often the clients’ prior experience in therapy (in Seattle or elsewhere.) Prior therapies may have lost their forward drive, meandered into advice sessions, vague questions about feelings, forgettable homework, excessive therapist self-disclosure, ‘small talk’ or passive listening (the so-called therapist “blank screen.”)1 Difficulties in developing the therapeutic relationship can manifest in many ways:

Communication problems©The New Yorker, January 27, 2014. Cartoonist: Harry Bliss

No Stigma

Couples often feel badly or anxious about being in treatment. The idea of getting as little help as possible seems sensible, avoiding stigma.  I’ll often hear that:

  • the problems are “about communication”
  • the goal is to “fix” the relationship
  • the solution is receiving “tools” from the therapist.

It can sound like a car needing repair due to a constant noise. The actual relationship situation is usually a bit more dire than how it’s originally described. But beginning treatment can soon reveal the depth of the problem and what hope exists for improvement. Even the more superficial start to therapy can soon lead to greater depth and meaning.

Intense Worry, Then Relief

At the other end of the scale, I get calls from partners who are emotionally injured, alienated from each other – and actively making it worse. They wonder if help is even possible, or years might pass before they find a happier, more secure place. Sometimes, “enough” improvement arrives faster than any of us expected at first. 2 The clients sometimes terminate treatment at that point out of a sense of immediate relief, though the amount of personal & relational growth is fairly minimal.

Different Strokes For…

So, I take a different approach to the question of “how long will therapy take?”

My practice experience reveals that the shape of the relationship I build with relationship clients differs according to several factors. Each committed relationship has its own set of stories of personal development. It’s also a story of relational development. Where and how I fit into an improvement in each partner’s functioning is different, even when the presenting issues are familiar to me.

Putting Out “Fires”

Some clients want me to “put out fires.”  They begin treatment, leave when they feel better and achieve some new sense of security. They might return when the next “fire” is burning.  That fire might look different to them, even when I can link the nature of the crises fairly closely.

Long Term Role

Some clients seek a longer term relationship. I occupy a position where I provide a range of interventions. We work together to find linkages between different “issues.” Time is spent with each partner’s personal development, as well as keeping pace with whether, or how, they can raise their level of differentiation.3 The longer term presence of the professional can bring about a gradual but durable change in the interaction between partners. I believe this observation to be mostly true, and, one of the less well understood phenomena in this work.

How Often?

The question “How long will it take?” doesn’t take into consideration “how often?” Typically, I work more frequently with clients early on in the relationship, and less frequently as the relationship develops. But there’s no single pattern: I’ve worked monthly with some couples, or every two weeks, for anywhere between three months and ten years.


The duration or frequency of therapy is not the only criterion. Sometimes it’s about the (flexible) structure of how the therapist will influence the client.

Some relationship clients want a therapist that they can work with individually as well as relationally. To my thinking, this requires the most skill and experience that a therapist can bring to the office. Most couples therapists have been taught that they should never give partners confidentiality from one another, or only see them together.4 The fear is that keeping a secret will over-identify the therapist with that client, as well as risk a mistaken disclosure of the secret.

Your ‘Private Space’

The approach that has developed allows for each individual to have their private ‘space’ in therapy. This privacy links to the individuality that partners rightfully retain in a relationship. This way of working is often useful with couples who have lost sexual desire for one another. It can heighten their differentiation, which allows for two secure adults to actually become far closer while being more self-disclosing.

A Helpful Preview?

I hope this provides a helpful preview to people seeking relationship therapy. I mean to address all types of relationships, from 30 year long monogamies to 6 month-old polyamories.  It’s not easy to know ahead of time how our relationship(s) should be structured, much less how long they might last. Yet if you can settle into a form that makes sense to you, it should deepen our common purpose, provide a useful orientation and a clearer contract for seeking and receiving help.



  1. Clients usually tell me that they did not disclose to another therapist the reasons they suddenly stopped seeing him/her.
  2. Never underestimate the value of a really strong complaint.
  3. an idiosyncratic weblink that fairly deftly positions classic Bowen theory with the advances brought about by Schnarch.
  4. the primary exception is using individual interviews to assess domestic violence