During my 22 years of clinical practice providing psychotherapy, mostly to both gay (www.GayTherapyLA.com) and straight (www.MensLifeSkillsCenter.com) men, I have helped clients with the well-known challenges that people seek therapy for: depression, anxiety, relationship concerns, career concerns, and loss. The general public knows all of these. But there are more subtle situations and reasons for seeking out therapy or coaching (depending on the situation), that the general public tends to overlook. The reality is, therapists help with more situations than you might think.
Below, I discuss some of these. See if you recognize yourself, or someone close to you. If so, we should talk about doing some work together.
1. When you find yourself often late for appointments or events – This can be a sign that yo have more adult Attention Deficit Disorder (ADD) than you might think. Even if you’ve never been diagnosed with ADD/ADHD as a kid, this disorder (which is a natural phenomenon of the brain) might be having an impact you’re not fully aware of. Other subtle symptoms can be getting bored with reading or book, or avoiding reading. Or, not liking your job because it requires sustained periods of reading, focusing, and concentration, particularly on material you find tedious. Having financial troubles, forgetting/avoiding filing taxes, having very little savings or retirement funds, having a messy place where you live or office desk, being “clumsy”, having frequent small injuries, experiencing more than your fair share of car accidents or parking tickets, or impatience with other people (roommates, boyfriends, people in public, store clerks) can be very subtle signs of ADD. Working with a therapist to learn skills in Cognitive-Behavioral Therapy, and discussing perhaps a referral to an MD for a prescription medication that might help your symptoms, are some of the tools to liberate yourself and eliminate these small (or not-so-small) frustrations in your life.
2. When you get frustrated by not affording the things you want, you get late fees on bills, or trouble paying all your bills, due to a lack of money – Money frustrations are actually more of an indicator of a need for therapy and coaching than you might think. Not having health insurance, putting off necessary medical treatment, not fulfilling social obligations (“host gifts”, birthday presents), feeling embarrassed about not wearing good clothes, fearing your future due to lack of savings, impatient with car repairs, or fear of being seen as miserly (cheap) can be signs that you’re not earning enough money for your age, education, and skill-set. These signs might indicate that you could benefit from counseling or coaching to advance your career and to improve your personal finance management skills. Our office (comprised mostly of clinical social workers from USC) can help you with developing strategies for job-hunting, refining a resume, building a professional networking plan, role-playing to practice job interviews, improving your appearance, or learning money-management skills across your lifespan, including referral to a certified financial planner or related books and websites.
3. When you feel controlled or scared in your relationship – Up to 40 percent of relationships, straight and gay, can include Interpersonal (Domestic) Violence. If you feel like your partner controls you, threatens you, isolates you, discourages you from having friends/work, makes you have sex in a way you don’t like, yells, threatens your pets, threatens to “out” you (as gay or HIV-positive, for example), calls you humiliating names, stalks you, or “mooches” off you financially in a manipulative way, you could be experiencing more types of abuse than you think – even if that person doesn’t live with you. It’s easy to feel like you have no place to discuss these issues privately, or to plan on how to deal with them. But therapy is the perfect place to discuss these, because it’s confidential and because therapists are trained very specifically on how to help people in your situation. The first priority is your safety, and the second is helping you make a plan to feel liberated from the oppression you can feel “trapped” in.
4. When you have to get treated for frequent STDs – This can be a sign of sexual compulsivity that needs counseling. At our office, we challenge the current “popular but controversial” fad called “sex addiction treatment.” We feel that this notion is over-diagnosed, manipulates the patient into expensive and prolonged “pseudo-treatment”, is not an official diagnosis recognized by the mental health professional organizations, and is not rooted in treatment techniques that are proven to work in research (evidence-based practice). Instead, at our offices, we offer our unique Sexual Self-Empowerment model, which helps you identify the underlying issues that lead you to behaviors that might put you at risk for sexual assault, lewd conduct arrest, exposure to HIV, or breaking relationship agreements. This is done using Cognitive-Behavioral Therapy or other legitimate therapy models, not “addictionology” and certainly not the moralism inherent in being labeled a “sex addict” by others. At our office, we practice only secular (non-religious-based), clinical, evidence-based, nationally-accepted therapies.
5. When you have concerns about your heart or stomach, or when you put off recommended medical treatment – Feelings that you may be having a heart attack or frequent indigestion can sometimes be signs of Generalized Anxiety Disorder, Panic Disorder, Social Anxiety, Specific Phobia, or Agoraphobia. Research shows that these disorders often are a part of discussions with your doctor first, and therapist only later. Similarly, a specific phobia related to blood, needles, fear of having an MRI, or other medical interventions could lead to you avoiding or refusing medically-necessary treatment. This avoidance could threaten your health, functioning, appearance, or comfort. Often, it’s important to receive therapy for the phobia before your medical treatment plan with your doctor can be carried out. At our office, we use Systematic De-Sensitization for such phobias, and Mindfulness-Based CBT for other anxiety disorders.
6. When you focus a little “too much” on weight gain, weight loss, eating, “imperfections” to your body, or how muscular you are – These reported symptoms can be a sign of Anorexia Nervosa, Bulimia, or Body Dysmorphic Disorder, or a Major Depressive Disorder. For men, anabolics have been shown in research to be effective treatment for HIV-related wasting, fatigue, lipoatrophy or lipodystrophy, but in HIV-negative men, cultural influences (such as American culture’s general demands for lean-ness or muscularity) can pressure men into abuse of these medications as a defense against being judged as socially inferior. I have seen many clients approach the use of steroids, nutrition, and exercise healthfully in their relationship with their doctor, but this is a topic best addressed by a combination of the doctor’s and the therapist’s advice and guidance, helping you to know and evaluate all the different risks and benefits. We use a technique called Motivational Interviewing, which can help you clarify your questions and empower your plan of action, and CBT that can raise your self-esteem and self-confidence.
7. When you feel like using anxiety meds, sleep meds, or pain meds a little too much – While a lot of these medications can work wonders to help you, too much of a good thing can be a bad thing. If you’re using Xanax, Klonopin, Ativan, Adderall, Ritalin, Ambien, or Vicodin, to name a few, you might want to think about how much and how often you’re using them, and whether you feel comfortable with their use. Therapy can help you uncover any underlying feelings or sources of stress that might be driving you to use these meds more often than prescribed, or more often than you’re really comfortable with. Therapy can also help teach you how to replace any habits with more “adaptive” behavioral coping strategies for certain emotions and situations that trigger your use. Having frequent contact with your therapist (such as inter-session, supportive text messaging) and other principles from Dialectical Behavioral Therapy has been seen to be effective with many clients at our office.
8. When you’re living with HIV and experience viral breakthrough and have to change meds – In HIV treatment, frequent or repeated viral breakthrough, requiring a change in your HIV medications, can be a sign that you’re having trouble taking your medication consistently, and you might be missing doses. This can be a sign of job over-work, depression, relationship troubles, getting tired of taking pills, or even ADD. People living with HIV can often benefit from counseling that focuses on behavioral coaching to achieve sticking to your medication schedule that is needed effective, sustained suppression of HIV. We use techniques from my article and speech on “The Mental Health Aspects of HIV Medication Adherence” (available for local and national presentation to groups, offices, and organizations; click here for more information).
Recognizing these subtle signs and getting help early can help you improve your mental health and well-being in many areas of your life. While we do not accept HMO insurance plans, our office offers a sliding-scale of fees (based on income), weekday and weekend appointments, and appointments in the office, via phone, or via Skype, to maximize your access to all the services we offer, through Ken Howard, LCSW (weekdays/weeknights), and three associate staff clinicians (weekends). You can email Ken at Ken@GayTherapyLA.com, or visit www.GayTherapyLA.com or www.MensLifeSkillsCenter.com, or call 310-726-4357, for more information on these or any other issues that are on your mind. We appreciate the opportunity to support you in your goals.