A quiet night in a two-bedroom apartment. Candles. Crickets.

What a life this is. Gratitude flows throughout me.

I moved to NC. I found a job. I have three weeks to play before I start. I'll be able to do full-time therapy in a very professional agency. Dear friends are getting together this week for a bachelorette party. Next month, more dear friends are throwing us a wedding shower. I am floored.

I like that word, floored. Like the floor is swept away and I'm levitating.

Lately I've enjoyed asking couples for their secrets and advice for a happy marriage. One lady really struck me with her answer. She and her husband were celebrating their 35th anniversary. As she struggled to come up with an answer to my question, she said, "I don't know. It was just...easy."

That really stayed with me. I'd never heard someone say that before, especially about a 35-year marriage. It sort of blew my mind a little bit, to think that such a thing is possible.

Living together has been...just...easy. And fun! There are so many little things we'll never take for granted. Like being able to cuddle as we fall asleep. Tiny little moments, glances, running into each other in the hallway. Coming home...and he's there. Seeing each other through all times of day and night, all moods, all the little daily minuscule nothings that make up intimacy. Going out together on a Tuesday night. Being able to serve each other in a million small ways, like doing the dishes, or taking out the trash, or finding a stolen laugh.

Before I met him, I lived with Emily. Emily had had many wonderful men in her life. She'd been in a long, healthy relationship for six years. She had nothing but great things to say about her boyfriend, and was bursting with good faith toward men and relationships. She blew my mind. She helped me see a whole new world. Her pure faith rubbed off on me. I consciously said to myself, "Yes, there are tons of fabulous men out there. They're everywhere." And then, boom.

I am ready, at any moment, for my mind to be blown wide open.

On Working with Men

I have a fabulous clinical supervisor who has been working as a therapist for almost 30 years. She has tons of experience with all sorts of people--adolescents, families, kids, women--but she's expressed surprise to hear how many men I see. My caseload has pretty steadily consisted of at least 25% men, and many couples.

Chances are that's because of limited resources. I can't think of a single Spanish-speaking male therapist who will work for free, so it's us or nothing. But that's given me a good opportunity.

An article called Need Therapy? A Good Man is Hard to Find was published in the New York Times on Saturday. It spells out what it calls the "feminization" of mental health care. The numbers of male counselors, social workers, and psychologists are dwindling rapidly. The article suggests that for that reason, many men who need counseling simply don't get the care they need, either because they don't want to see a woman or because a woman might not be able to understand and help as well as a man could.

Of course an important question is, Why aren't there more male counselors? Is the "talking cure" anti-masculine? After all, psychology was fathered by Freud. The article suggests the answer is the lower pay and prestige of fields like counseling and social work. (Psychiatry is still predominantly male-dominated.) So a "feminine" job is devalued, making only females attracted to it. Great. But, that speaks volumes to the importance of Pay and Prestige in Guy World.

In an article called "Why Men Fear Therapy," David Wexler, Ph.D. adds that the way therapy currently functions is a barrier for many men. "Too often therapists--both male and female--try to massage men into being more like women in the ways they express themselves and experience their emotions," he says.

"Think of what we typically ask a man to do in therapy sessions: recognize that something is wrong with him, admit that he needs help, openly discuss and express his emotions, get vulnerable, and depend on someone else for guidance and support--all extremely challenging tasks in Guy World. ...Many of us haven't figured out a way to do all these things and still really feel like men."

...And, I would add, many are simply not interested in doing them. Our goals are different. It is my job to adapt to my clients' realities.

I think many of us (us...women? feminists? therapists?) tend to dismiss or even belittle Guy World. Whatever that means exactly. I would like to better understand what it means, and these articles remind me how important it is to do so.

Call it socialization, but many men don't want to call it that. Consider how much they like talking about the animal kingdom. Steven Stosny, Ph.D. wrote an article called "Lions Without a Cause," entirely about male lions and how they can help us understand male humans. In a pride of lions, the females tend to congregate together and interact more than the males. The males hang out on the outskirts, guarding and protecting the group. They are defined by their proximity to the females and their ability to protect. He goes on to say that being a protector--or feeling like one--is the absolute most crucial priority for a man.

And the worst possible blow, he says, is humiliation. Shame-o-phobia, Dr. Wexler calls it. Underneath depression or anger or dysfunctional behavior often lies a feeling of failure, especially as a protector. Hence, a blow to the ego becomes a crisis of identity. Hence the importance of Pay and Prestige.

They both use these ideas to present tons of helpful tips for working with men, among them:

• Normalizing their experience ("I know this probably isn't much fun for you"),
• Educating ("Did you know men experience more physiological stress when they talk about feelings than women do?"),
• Assuming they have the best of intentions ("You're a good man, you're just doing some unhelpful things"),
• Using power language ("I want to help you be in charge, not the stuff outside of you"),
• Framing your goals as his own ("Compassion/listening is a great way to protect/provide for your family"),
• Seeing their aggression/withdrawal/substance abuse/etc. as their way of expressing pain,
• And good old-fashioned praise.

I have to say in my work, the men have been almost as diverse as the women. There have been some who fit the prototype of the machista Hispanic man (though most of those wouldn't be caught dead in the office of female, white, young hot-shot therapist. Self-selection, yes). But I've also seen a sweet, shy man with social phobia; a gay man struggling to be accepted at church; an adolescent who came to me crying after he committed a sex crime; a young man struggling with low sex drive; and a ton of other things. They have almost always been very respectful, cried with abandon, and happily accepted suggestions. We (women, feminists, therapists) might forget that they need just as much validation as anyone else. We talk about radical acceptance--we also need radical validation.

I don't think I gave men enough credit before, back when I only worked with women. It's been helpful to hear their side of the story. Frequently, I find them particularly fun to work with. We spend a lot less time talking in circles; they're often ready to get stuff done. They appreciate frankness and want me to be transparent, which I like to do. Many anticipate antagonism, so a little understanding softens them quickly. We tend to smile less but use more humor. Most really do have the best of intentions.

The best thing I can do for them is to work from within their world.

Celina

I am posting this with permission from my client. My program, N*COMMON, is being featured in our company newsletter this month. As a part of our article, we're featuring Celina's success story. She was one of my very first clients; we worked together for over two years. This is a picture of her in our therapy room. She wore a leather jacket and lipstick just for the occasion. Here's the excerpt from the newsletter. (It's meant to sell the program so forgive the slightly cheesy tone.)

"Through her interaction with N*COMMON, Celina has steadily healed and found new hope in her life. Her husband left El Salvador and came to the United States to support the family, including their four children. When he stopped sending money, Celina was desperate to care for her family. She left El Salvador, where she grew up, and moved without her children to the U.S. to try to find work herself. She moved back in with her husband even though he'd been abusive from early on in their marriage. He continued the abuse, to the point that she feared for her life, and she found the courage to leave him.

"Feeling very alone and having become depressed, Celina started treatment with N*COMMON. Work with her therapist (that's me! :) ) began with helping her become stable, both emotionally and in her daily life. Emotional support helped lift her from the worst of her depression. She and her therapist focused on helping her cope with her feelings and manage the stress in her life. They then moved to processing the pain and grief she endured with her husband and in separating from her children. Celina began to understand her feelings and to work through them. As she discussed domestic violence in depth with her counselor, Celina stopped blaming herself and gained confidence. She began to leave the house more often and to engage in positive activities like English classes and exercise. Assertiveness and communication skills helped Celina manage the daily stressors of work and relationships. Now, Celina says, life’s ups and downs affect her less. When she meets a challenge, she problem-solves and bounces back quickly. She finds hope in her life, in telling her story and in sharing with others – Celina is now an inspiration to many!"

Hehe! She totally is. She was really excited to share her story.

Psychiatrists

Whew. Where do I start on this one. My thesis: (many) psychiatrists are (medically speaking) Loony.

My interactions with psychiatrists have been...unexpected. As far as I know, they are held to the standard of being the experts in my field. They are highest on the hierarchy of authority. The more serious or complicated a client is, the more likely the first line of defense will be Send Her to a Psychiatrist. Therapists look to them for the most accurate diagnosis and treatment recommendations.

Thus, I always expect a psychiatrist to say something like: "Here's her history, and her symptom profile, so here's my diagnosis and what I recommend." Ha! Wouldn't that be great. So far, it hasn't gone that way.

They always have their own ideas:

"Eh, she's just a little histrionic and needs someone to talk to."

Doc: "You know, it's okay to be gay." My client: "I know, but I'm not gay." Doc: "No but really, it's okay to be gay." My client: "I know, but I'm not gay. I'm here because I can't sleep."

They are often lacking in the gender and sexuality department.

"Your (gay, male, Hispanic) client reminds me of this Korean girl I used to see. She lived with this guy for a while who put her through school in exchange for sex. In the end, it really wasn't that bad of a setup." <--phjiodaweamkdopugwWTF??

Doc: "Did you know this drug helps with PMS?"

Client: "Yes. You've told me this many times."

2 months later
Doc: "Hey, did you know this drug helps with PMS?"
Client: "And no, I didn't have PMS in the first place."

With my clients, no matter what the problem: PTSD, anxiety, depression, impulsiveness, insomnia, being a human being--80% of the time they are prescribed celexa and trazodone. You don't like it? Meh, give it four weeks. You still hate it? Meh, give it four more weeks.

I'm sure there are perfectly logical reasons behind why they do these things. But all too often, my clients end up dropping out of treatment and deciding quite reasonably that their psychiatrists are the "los locos."

The Making of a Therapist

I am slowly preparing to leave my job, and I've begun telling a few of my longer-term clients that I'll be leaving in June. In preparation for my departure, I've decided to start a new series about my first years as a therapist. My heart is brimming with things I've learned, special moments with clients, questions and musings.

I told one of my longest-running clients yesterday. She's been coming for over a year and a half. She came in because of marital problems: her husband was psychologically abusive, mean, ornery, and generally a brute. She worked herself to the bone cleaning houses because he wouldn't help with any of their household costs. She was miserable. We tried a million things with her husband, to no avail, so we focused on helping her emotionally cope. A survivor of loss and abuse, she felt what helped her most was learning to maintain her emotional independence--not to let him "dominate my mind," not to react. We had all but given up on him, and we were working on helping her leave. As an undocumented immigrant, that turned out to be way more difficult than we anticipated.

Then, almost overnight, he changed. He was diagnosed with diabetes, and started turning his life around. He began helping with costs, childcare, and household tasks. He stopped yelling. His mood improved. He even went to work with her to help her clean houses. He started bringing the family to church. We were both shocked. "I ask him, 'Where did this new husband come from? Has he been hiding in the basement?'" She says. He blew our expectations wide open.

When I told her I was leaving, she teared up. "You have no idea how much you helped me," she said. "You really listened to me. I mean, I know that's your job, but I could feel that you really listened as a person, as a human being. No one ever does that. Family doesn't do that. Everyone always has their opinions and judgments. I can't tell you how much you helped me."

I was fighting back tears myself. Once in a while, life drops me into a moment like that--real. Frozen in time.

I think that's the #1 thing I've learned: that I should never underestimate the power of pure, unadulturated, supportive listening. When asked what they're looking for, and what has helped the most, that's what most clients say.

How to Appear Racist 101

A Korean-American client reports that she suffers from aches and pains and occasional insomnia. She doesn't describe any other symptoms or disclose information about her personal life or family. She says she has come in to see the social worker only because her doctor told her to. What should the social worker do?

A. Refer the client to a pastor at a local Korean church.
B. Refer the client to a neuropsychologist for testing.
C. Focus on the specific problem brought in by the client and help her develop her own goals for therapy.
D. Ask the client if she has been feeling depressed.

Dear social worker: limit your scope of practice and inflate your ability to generalize by choosing one. What would you choose? Cause did you know the answer is "A"? Forgive my language, but WTF?

A friend and I are studying for the social work licensing exam, and we send each other ridiculous questions we come across in the practice exams.

At the beginning of therapy with a Caucasian social worker, an African-American client is MOST likely to experience which of the following?

A) High self-expression.
B) Significant anxiety.
C) Transference.
D) Lack of motivation.

We're actually supposed to answer this question. My answer: Dear Social Work Licensing Board: Let's critically examine the presentation of this question. And the answer is "C." What kind of transference, you ask? Transferring of what exactly? Excellent question. The rationale makes sense to me: "It is recommended that therapists consider the influence of historical hostility as a necessary part of effective therapy with African-Americans." That's very helpful. Thanks. Apparently we missed the importance of EFFECTIVE WORDING in helping us appear less racist!

Lyrics of life

I won't reveal this band because it may cause judgments. But I was drawn to them powerfully because of their beautiful, beautiful lyrics. They exemplify so much of life to me. :)

A personal philosophy that resonates with me:

Feed my will to feel this moment urging me to cross the line.
Reaching out to embrace the random.
I embrace my desire to feel the rhythm, to feel connected...
to swing on the spiral of our divinity and still be a human.
Reaching out to embrace whatever may come.
I'm reaching for the random or what ever will bewilder me. Whatever will bewilder me.

On love, continual rebirth:

My blood before me begs me open up my heart again.
And I feel this coming over like a storm again. Considerately.
As the walls come down and as I look in your eyes,
my fear begins to fade, recalling all of the times
I have died and will die. It's all right. I don't mind.

On communication, and also reminds me of politics:

I know the pieces fit cause I watched them fall away
Mildewed and smoldering. Fundamental differing.
We cannot see to reach an end, crippling our communication.
I know the pieces fit cause I watched them tumble down.
No fault, none to blame. It doesn't mean I don't desire
to point the finger, blame the other, watch the temple topple over.
To bring the pieces back together, rediscover communication.

The poetry that comes from the squaring off between.
And the circling is worth it.
Finding beauty in the dissonance.