Wednesday, February 14, 2007


Carrie: First they want you to come there two times a week, then three times a week, and eventually you're starting every sentence with 'my therapist says... '
Miranda: My therapist says that's a very common fear.
Sex In The City

It seems like a dodgy mental health time for many people I know. So I was thinking about how hard it is to find a decent therapist/ psychologist/ psychiatrist / counsellor. Particulalry if you are queer, or kinky, or a whore, or have some combination of these qualities. A lot of sex workers and a lot of BDSMers have identified having therapists see their sex work/ kink as either a symptom of poor mental health (you don't like yourself very much, hense this destructive behaviour) or creating the conditions for the poor mental health (you do these destructive behaviours, and screw yourself up in the process). Of course, having your choices and identity seen as pathology is incredibly patronising, and doesn't bode well for the therapy relationship. Ideally, a therapist should treat you with 'unconditional positive regard' or absolute respect for who and what you are - from that point, and continued respectful behaviour, such as not giving advice, or trying to get you to stop doing anything in particular - means that you can get the most out of the therapy (ei.e. greater self awareness and hopefully emerging from that a greater capacity for control over your own life and better self regard).

The really hard thing for most of us, even if we are used to and good at educating outsiders about our lives and communities, is to do sex work 101, kink 101 or queer 101 when we are in distress and just want to get our support needs met.

Bigotted therapists need to challenge their own judgements - and either proactively educate themselves about diversity, or acknowledge that their prejudices stand in the way of them being effective, and change careers. I wouldn't suggest sex work though, you need to be pretty comfortable with diversity. Maybe stocking supermarket shelves at midnight - not much in the way of people skills required.

Other things can get in the way of therapy feeling useful, can include fear of psychodynamic therapy - that whole lying on the couch, reliving every single painful episode in your life to date approach - which is sedom used these days, with CBT and other more in-the-moment approaches far more common. Also, fear of the often truly scary experience of dealing with your own issues - and the really hard work involved in changing unhelpful patterns, of having to examine your own stuff. I can also identify with a fear of lose of control, of letting a stranger into your internal landscape.

However, I've found taking charge of the therapy process - really taking a good hard look at my own issues within that context - and leading it, with much honesty, rigour and being able to articulate what changes I want for myself has been ultimately empowering. It has been helpful that I am really analytical to begin with, and like a dog with a bone when there is something I don't quite understand. And there is still enough middle class attachment to notions of dignity, which means I'd prefer to tackle all the demons of my psyche within the therapy space than metaphorically be bleeding all over the shop in other areas of my life. I have an absolute fear that I'm the only person in my life that isn't aware that I'm acting out my mental health issues all the time in public.

When first seeing a therapist, I've found it useful to articulate what I want to happen - that my decisions about sex work are off limits, and about what I wanted to get out of the process. I've found doing my homework in between sessions - going after extra information on particular issues, and examining my value system in relation to things that have emerged in sessions - increases my sense of control over the process, and generally makes me feel empowered. Also, most therapists would tell you that your independence is an important part of the process.

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