Therapy News

I’ve been a therapist for almost 15 years now. I’ve seen hundreds of different clients. My niche is working with people who feel anxious in relationships. But I tend to work with mostly people in their 30’s who are just trying to figure out what life is going to be about. They are trying to answer the big questions in life. Should I get married? Should I have kids? Should I switch careers? Should I move to another city and start all over? Should I start binge watching LOST? Is that a good TV series? Is the journey worth the payoff? Will I regret starting that show? 

While I have no problem answering the last question as a therapist (no, you should not watch LOST. It seems like a good series but trust me it’s dumb and convoluted. The journey is not worth it because the last episode is garbage. And yes you will regret it and you’ll never get back the hours you invested), I have more of a problem answering the other questions about what clients should do with their lives and what big decisions they should make. In fact I don’t really want to weigh in at all. As a therapist, I have no desire to give life advice. I may very well want my clients to move in a certain direction because I think they’ll benefit or it would be the healthy decision. But I try my very best to never show my cards. I keep my opinions close to the chest. Or at least, I try my best to. 

But this article is about the times where I did show my cards. Whether it was obvious or subtle. At the time I thought it was the right thing to do. But in the end, I was wrong. If you’re a therapist, or planning to be one, you’re going to get it wrong sometimes. It’s important to notice those times and learn from them. Every time I turned out to be wrong, I felt pretty horrible. So if you feel compelled to send me a message that I should have known better please don’t. I have already processed the appropriate amount of guilt and shame. 

Disclaimer: All the names and identifying details have been changed to protect confidentially. 

Jim really wants to be with Marisa

Jim came to me to process his recent divorce. The relationship was exciting at first. He experienced lightening bolts when he met his wife Heather. They got married quickly. Moved to a new city. Bought a house. And then things fell apart. Heather was emotionally avoidant and unavailable. It drove Jim crazy. The relationship crashed and burned. 

Jim became a long-term client and we talked weekly for years. He processed and grieved his divorce. He got back into the dating scene. And he fell in love with his new city. While dating there was one young woman, Marisa, who kept stealing Jim’s attention. She was a lot like Heather in many ways. He would date women that seemed pretty emotionally stable but he would find himself magnetized to Marisa every time she decided to give him some attention. Inevitably she would disappear and Jim would have to spend longer than he wanted grieving her and re-living the feelings he experienced in his marriage. 

On the 6th go around with Marisa, Jim asked me if I thought he should give her another chance. I dodged the straightforward questions like every annoyingly good therapist does. But after a few sessions and his persistent asking, I finally answered. I said no. I explained to him why I felt he was attracted to her, how she is continuing to re-traumatize him, how it never works out and there is no reason the pattern won’t continue. 

He defied my advice. Which was predictable. They are now married and have a beautiful child together. The relationship is healthy. Marisa doesn’t pull away emotionally anymore. Jim is very happy and he enjoys reminding me how wrong I was. I had no idea that the 6th time would be the charm. I was totally convinced it wouldn’t work out. It seemed clear to me that Marisa wouldn’t change and that Jim was enabling and helping to create her behavior. But Marisa was doing work on her end to stop pulling away. It worked and Jim was able to feel more stable and not act as anxious. I’m happy I was wrong. 

Barry wants to wear a diaper and be treated like a baby

Stay with me here, because some therapists might read this and get triggered. So I guess this is a trigger warning for therapists. And a growing opportunity! 

Barry, an adult male in his 30’s has always had a secret kink. He wants to dress up like a baby and wear a diaper while a female takes care of him. Nothing wrong with that. We all have sexual fantasies. Some more out of the “norm” than others. The issue isn’t the kink itself. The issue is that he doesn’t want to tell his partners about it or experience the kink within a primary romantic relationship. Barry pays a sex worker to treat him like a baby. This sex worker happens to specialize in diaper fetishism so it works out perfectly. 

Barry has always kept the kink secret and hasn’t told anyone he’s ever dated about it. As his therapist, I routinely challenged him to bring it up with partners he has gotten close with. I didn’t push hard. But I did let him know that I thought he would be accepted if he spoke up. Especially with the current woman, Stephanie, he had been seeing for quite a while. While dating Stephanie, he stopped seeing the sex worker. This made his kink even stronger and harder to avoid fantasizing about. 

Barry came to me and said he wanted my professional opinion. His idea was that he was going to tell Stephanie that he wanted to see a sex worker to explore a kink that he did not want to introduce into his relationship. He would be honest about seeing a sex worker in the past but he wanted to keep the specific kink to himself. He wanted to keep this part of his life private and contained. While I appreciated his direct and honest request, instead of secretly seeing the sex worker on his own without telling Stephanie, I felt like it would be better to ask Stephanie to integrate the kink into their sex life. Or at least to try. Stephanie seemed so open and sex positive. We explored all the reasons why he didn’t want to tell her. We spent many sessions exploring and analyzing this issue.

In the end, Barry decided to talk to Stephanie about his original idea to every once in a while experience his secret kink outside of the relationship with a professional. Steph was cool with it. They’ve now had this arrangement for over five years and it seems to be working out great for the both of them. Barry is able to keep it private and indulge when he needs to. And Stephanie is willing and able to accept this unique request. While there are some issues that can spark up regarding the arrangement, they are both able to communicate honestly around it and it seems like they are closer because of it! I was wrong when I thought it would be a better idea to introduce the kink to their sex life. I think it’s working out just fine like this. 

(Are you a sex worker positive therapist like me and hundreds of other counselors on TherapyDen? We believe that sex workers should not be shamed or judged. Sex workers are under attack by our current government forcing them to be on the streets instead of safely posting their services online. Sex workers can be scared to reach out for mental health services for a host of reasons. Please consider joining TherapyDen’s therapist directory if you too are sex worker positive so that more people feel comfortable about reaching out for care. TherapyDen allows sex workers, and clients who visit with them to search for a therapist who is sex worker positive.)

Mark can’t stop fantasizing about Stacey

I was seeing Mark for years. He is a pragmatic guy with a professional job and a yearning for predictability. But not unlike Jim from above, he was attracted to a dramatic and chaotic relationship with Stacey. Stacey is an energy healer and a hippy at heart. She can’t be tamed and lives life on the wild side. Mark and Stacey are opposites. And they believed that’s what made them attract. I’m more of a “birds of a feather flock together” than an “opposites attract” kinda therapist, but I can be open to being challenged. Not this time though. Mark and Stacey’s fights were epic. Their fights would make for fantastic stories but would 100% of the time lead to a crash and burn with horrible things said to one another. 

Mark tried his best to stay away from her and date people that were better matches or had similar values. He finally met Lisa who was a lot like him. She was logical, deliberate, supportive and, once in awhile, a little spontaneous. I figured she’d be a perfect match for Mark. Mark planned to ask her to marry him. He went ring shopping. Came up with a cute little engagement idea and was all set to start his life with her. 

A week before he was planning to get on one knee he told me he wanted instead to take that engagement ring and ask Stacey to marry him. I was blindsided. I mean I knew that he still had fantasies of being with Stacey, but I figured they were just that. Fantasies. We explored all the reasons he wanted to do this. I figured it had to do with fear of commitment or normal cold feet or his typical sabotage behavior that would pop up every now and then. The session was running out of time. Mark kept pressing me and asking me what he should do. I felt cornered. So I said he shouldn’t do it. I gave him what I thought were some pretty solid clinical reasons. He left my office. He made a b-line for Stacey. Told her he was going to use the ring to ask for Lisa’s hand but instead wanted to give it to her. Stacey said yes. 

Stacey and Mark are still married four years later. From all accounts, they seem like a perfectly good match. They can still get into some fiery arguments. But it seems like it works for them. I was wrong when I figured the relationship would crash and burn. Mark tried many times to convince me, and himself, that all the relationship needed with Stacey was firm boundaries of commitment and that would keep them from breaking up. It seems to have worked. Good for them. 

April wants to be honest with her mom

April is in her late 20’s and both of her parents are Vietnamese. They moved to the US when April was a baby. Her parents worked hard to give April and her siblings a good life. They have high expectations for each one of their children. One very strictly held expectation is that their kids will never get a tattoo. 

April has about 10 tattoos. Her parents have no idea. The tattoos are small and all easily hidden with a sweater or long sleeve top. April has always kept them hidden out of respect for her parents and their culture. And also because she is afraid of what they’ll think and do. There is a real possibility that if she showed her parents her tattoos the relationship would change forever and she may be disowned.

I am a white guy that has a family who did not move from outside the country to give me a better life. My family has pretty progressive values and even though they have certain expectations of me, they highly value honesty and acceptance. So if I revealed to my parents something they did not like about my body or who I am, they would probably love me and embrace me even if at first they didn’t approve of what I did. I have to keep this in mind when talking to April because I don’t want to just project my own cultural experience on to her situation. Just because it would be a good idea to reveal something secret about myself to my family it doesn’t mean it’s a good idea for April. And just because I am a therapist who values being honest about who you really are, especially with your parents, that might not be clinically appropriate for people that are from a different culture than mine. 

April wanted to reveal her tattoos to her parents. The way April was talking about the real consequences that she might face if she revealed her tattoos, the more I felt like it would damage her relationship with her parents to a possibly irreparable degree. We talked about it for over a year. She felt compelled to show them to her parents. While I never directly told her that I thought it was too risky, I did usually end up exploring the ways it could negatively effect her life. In my heart, I hoped she wouldn’t show her parents and I am sure that came through in my words even though I did my best not to reveal my beliefs. 

One weekend her mom and dad came to visit her from back home. On a whim she decided to wear a short sleeve shirt. Her parent saw her arms and were shocked. They shortened their trip and took the first flight back home. I was right about her parents being shocked and upset. But that wasn’t hard to predict. I was wrong about how her parents came around later that year when they missed their daughter after not speaking for months. Since then April has revealed even more cultural taboos she has railed against and her parents have grown to accept them and in some cases celebrate them. I couldn’t have imagined this would happen and I couldn’t be happier for them. 

Kyle wants to stop cold turkey

Have you heard of Kratom? Kratom is an herb that is used as medicine and for recreational purposes. Some people use Kratom for opiate withdrawals. Living in Portland, I see Kratom advertised at every herb shop. I don’t know too much about it. Or at least I didn’t when Kyle, a client in his mid twenties, was telling me about it. 

Kyle was introduced to Kratom through work buddies. His work friends were mixing it in a smoothie and having a serving or two at the start or end of their days. It created a subtle feeling of relaxation. Kyle said it had a slight mood enhancement and would help him concentrate when he was doing homework for college. He had been using it for over a year and never mentioned it to me because he didn’t think it was a problem. I asked him about drug use but he didn’t think to report Kratom because he didn’t see it as a drug. He saw it more like a vitamin or a supplement. 

One session he started to casually talk about the herb. He mentioned that he felt like stopping cold turkey because he did’t like how it started to feel like he needed it to do his homework or wind down at night. He asked if I thought it was okay to stop cold turkey. Without thinking too much about it I said he might as well give it a try. Kyle was successful at quitting cigarettes and caffeine cold turkey so I figured Kratom would be the same. It wasn’t. 

Kyle stopped taking Kratom the day of our therapy session. Two days later he was severely depressed, could not fall asleep, couldn’t stop the tremor in his legs, felt like his heart was pounding out of his chest and was throwing up all day. He was only able to make it three days with no Kratom. He started taking his typical dose after that and he was back to his previous self. 

I was wrong when I nonchalantly encouraged him to quit cold turkey. I should have done more research on the herb. Not everyone reacts the way Kyle did, but it’s not uncommon for someone to mimic heroin withdrawals when abruptly stopping. I felt horrible. I felt like I was the worst healthcare provider. I felt like I didn’t properly educate my client because I didn’t properly educate myself. I felt like I caused harm. 

I’m not trying to make this a PSA about Kratom. There is a whole debate around the herb and I’m not going to get into it here. I just wanted to use this experience as an example of when I was a negligent therapist and hopefully inspire other therapists to do their research when a client asks a question about what seems to be as innocent and as innocuous as a health supplement. Because it might not be that at all. 

I’ll never be wrong again!

Just kidding. I’ll be wrong plenty more times. When I was a baby therapist I thought it was the end of the world when I was wrong. But now as a more seasoned therapist, I don’t judge myself as much. Each time I get it wrong, I use it as a learning opportunity. It doesn’t mean I enjoy being wrong. The only thing I do know for sure is that LOST is a trash show that got my hopes up and then shattered them in the end and the whole premise was dumb in the first place and I should have known better. If anything I hope you learn from this mistake. And maybe from the other ones as well ;)