Topics to Reflect Upon

In addition to adherence and alignment with the codes of ethics assigned to my profession I personally identify the following principles in my therapeutic style and public engagement:

1. Trust – Truth in language and transparency that invites feedback are integral components to being able to develop trust that serves self and others.
2. Autonomy – Freedom to be independent and able to protect one’s self from harm is a vital right that everyone deserves; all actions and engagement should support the autonomy of others.
3. Equality – Equitable distribution of resources and power are vital components to the development of honest and fair relationships.
4. Balance – At all times there should be changes and shifts to disrupt power imbalances to instill a sense of justice in all aspects of life.
5. Aesthetic – Creative beauty is subjective and a worthy thing to cultivate as it benefits one’s mental health, strengthens a person’s resolve and character in development, and guides an authentic future.
6. Love – Multiple forms of love exist and are often essential to having a well-rounded life. Love for humanity (Agape), self (Philautia), romance (Eros), play (Ludus), friends and family (Storge) are my focuses for a balanced life.
7. Courage – One’s relationship to risk and a willingness to face fear defines our experiences and the validity of any belief currently held.

Codes of Ethics

American Psychological Association

American Mental Health Counselors Association

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Counseling with a culturally aware lens involves a position of non-judgmental empathy; practiced in order to facilitate a space that grants clients discussions that validate their experiences and understanding of what culture means to them, what they were assigned, what they like, what felt harmful, what is desirable, and what is wanted/needed. Cultivating a multi-cultural mindset can affirm a person’s struggles with mental health stigma and obstacles to healing. Through such a lens feedback is offered regarding what changes would serve your goals, your surroundings, your networks, and your health.

Silence has historically benefited the oppressor, and open discussions in safe spaces for therapeutic ends can yield wonderful results for healing and developing authentic insight about self. For that reason I ask all couples and those seeking therapy to address relational problems to reflect on their cultural identities and systems of engagement in ethnic, regional, religious, educational, social, and institutional ways.

Concepts of shared and differing experiences in one’s upbringing are important discussions to have at the start of any relationship in order for us as humans and social beings to understand each other in connected and authentic ways. Many people struggle in their relationships due to elements of culture that are not talked about, some inherited, some learned.

People often find that making a genogram provides a visualization of the heritage factors that are present in their lives is a helpful tool to guide therapy or provide directions of focus.

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Trauma is a regular part of life, and one that is talked about very little for fear of expanding the space of impact and severity of affect. As a result people often have symptoms of Post Traumatic Stress Disorder (PTSD) even if they do not meet all expected symptoms of the diagnosis; this is due to a natural part of the physical body’s defense mechanism that works to protect you from pain, fear, and death. Common physiological responses are flight, fight, freeze, friend, and fawn and are important things to be aware of in regards to how your body protects itself and helps you live your life.

Coping with symptoms of trauma is often exhausting and may involve a lot of pattern and ritualistic behavior in order to establish a sense of control over variables, which helps to combat the severity of hypervigilance. This relationship between anxiety, worry, and fear regarding re-victimization is unique for people and requires developing a safe space to process first, then a slow process of identifying what makes sustainable sense for identity, lifestyle, schedule, socialization, and profession. It may involve working with internal parts of self to identify what part of you is struggling the most with the situation at hand. In those situations we work to organize the information and find a mental space to hold what can be held and granted healing.

Healing with trauma histories is difficult, and may require heavy doses of care and support. This can be due to the relationship people have with vulnerability and shame that limits ones ability to be strong enough to ask for support, help, or guidance. Belief structures are at times toxic to one’s mental health whenever they are allowed to convey ideas that indicate your authentic life is worth less than a lie. Such histories often result in a presentation of Complex PTSD for which relational and holistic therapy can aid a person in finding new ways to relate to their authentic life.

Working a holistic model often means taking the time to identify what different parts of self wants, needs, and/or desires and which options have been considered to decide how to care for these parts. Reviewing that process and determining a path forward can be a wonderful push forward into a healthy space working to heal the relationship with the past.

Trauma Narrative work is a specific kind of work for which journaling and narrative storytelling is part of externally processing your experiences and is helpful for working to de-sensitize one’s PTSD symptoms as well as work to increase insight on your perspective. This work is often essential in order for people to be able to work towards their future goals with regards to identity and lifestyle.

BreneBrown.com

Kezelman C, Stavropoulos P. The Last Frontier: Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. Kirribilli: Adults Surviving Child Abuse; 2012.

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Most of my clients have had a relationship with suicide in one fashion or another. I recommend that people readily have coping skills available that grant them positive distractions when the thoughts are strong, but media consumption alone will not eliminate them. Coping with suicidal thoughts is difficult, but sometimes the context of certain statistics can be helpful in conceptualizing how common it is to struggle with suicide. 

Several populations struggle with suicide at much higher rates due to how society and certain shared historical factors of heritage affect the individuals. Trauma is a unifying theme for nearly all suicide attempts, though sometimes the trauma experienced is emotional, unable to be observed directly, and part of systemic factors. Such systemic trauma is something that exists in specific populations.

Veterans are 50% more likely than non-veterans to die by suicide, making up 60% of all suicide deaths each year. Death by suicide is more common among middle aged men, with a firearm and when not receiving mental health care/treatment (54%). Several factors block access to care for those who need it most including: underfunding, lack of community support, and cultural beliefs/views.

Those who identify as queer youth are four times more likely to attempt suicide than their straight peers; 45% of all queer youth seriously consider suicide every year. Research has indicated that the most important intervention and factor that reduces suicidal ideation for a gender expansive child is having affirming adults in their life for whom their identity, expression, and boundaries are respected. 

Shared elements in the two groups are that of trauma and being perceived as less by others. Veterans who struggle with suicide often identify a loss of who they once were, a struggle with acclimating back into civilian life, having difficulty with secrecy and memory and storytelling, and/or coping with change while managing moderate to severe symptoms of PTSD. Queer youth who struggle with suicide often identify fear of not being able to satisfy the expectations of others, rejection, disownment, loss of support, loss of friends, shame, and guilt for being different. 

Much of what is thematically associated with suicide is societal shame and/or abandonment that is re-inforced in the persons support network, family, and/or peer network through any number of things including silence, lack of patience, use of derogatory terms, disregard of sensory triggers, political and religious beliefs of exclusion with a disregard for an opposing viewpoint as potentially being valid, and lacking empathy and a space to be vulnerable.

To support those in your life that are struggling with suicide it is advisable to provide space to listen to their needs and work to engage with them without judgment or language that indicates obligation. People in active states of suicidal thinking are often struggling with agency and helping them identify what direction they would prefer the moment to take can help you coach self-determined coping skills that serve them.

If you are feeling vulnerable, pain, unsafe, and at risk to attempt suicide or think you may harm yourself please call 988 or utilize the Resource Directory to talk to someone on a hotline that is right for you.

For more information on navigating a mental health crisis, please consult NAMI’s resource guide.

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Concepts outside established physical science or metaphysical thought can be a wonderful source of comfort and structure important things in a person’s life such as their moral code, relationship to death, and understanding of values. A healing space provides for a person’s relationship to spirituality and religion to be openly discussed and reviewed at the comfort and insight of the client. 

My personal view of spirituality and religion is that all belief structures have the potential to hold merit that serve a greater good. I believe that individuals benefit from personal exploration of what life means to them from an existential view and that it is a struggle to define what we experience as mortal beings. To that end I believe that organized religion can serve the needs of many by forming a community that one can call upon and engage with as a way in which to be socially conscious and supported. I also believe that non-traditional forms of religious and spiritual engagement can serve an individual and group when driven by the needs and insight of said individual/group.

Concerns arise when exclusivity, superiority, single path access to salvation, and shame are utilized as forms of required engagement with any understanding of divinity. I have experience with the following themes: old world traditions/values of moral piety in the US, Christian Fundamentalism, shunning, religious trauma, and working with mixed faith families.

I have enjoyed personal research and exploration of dozens of faith structures and practices and welcome my clients to share what personal beliefs and practices serve them. Support is granted to any practice that serves a client’s need and grants a net positive yield to those engaged. I find that many people who focus on spiritual health succeed with a little more ease in utilizing coping skills and finding ways to ground themselves, though some are unable to reap this benefit.

At all times equal respect is shown to people who identify as members of any denomination and to those who practice individually a monotheistic or polytheistic discipline either traditionally or mystically.

If you do not wish for your religious views and rules to be questioned in the process of your therapy please inform me of which views are paramount to your belief structure so that I am able to respect and support them while providing what space I feel is important to the reflective process of therapy.

If you do not wish spirituality to be a component of therapy please provide such feedback at any time for which my engagement begins to touch such a boundary.

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In discussing topics related to race and ethnicity it is important to understand what systemic/institutional racism is, what historical truths exist relating to the struggle for civil rights for all, and what an anti-racist stance really means. I work to understand the unique heritage factors each of my client’s have associated with their race and ethnicity. I invite all persons to reflect on what identity they hold, what privilege and burden has been assigned to them, and what degree of shame and guilt may be unique to their experience as a person of minority status.

Systemic racial trauma has damaged the relationship communities of color have with the institutions of medicine, justice, education, and society influenced by Colonial heritage and standards of “White professionalism.” Evidence of this systemic trauma is demonstrated in disparities experienced by the individuals of these communities and reported in several statistics. Rates of PTSD and the severity of those symptoms are higher for Black Americans than Latinx Americans which are higher than for White Americans. For that reason, discussion about systemic racism is often essential to establish a safe space for healing.

There are several key components of historical and continued items that I keep in mind when acknowledging racism, perspectives, harms and a lack of reparation in the United States. The Tuskegee Syphilis Study, Henrietta Lacks, residential segregation practices, lending practices affecting the accumulation of wealth in families, disproportionate removal of men and father figures in communities of color through racial profiling and other policing practices, treatment and conscripted labor practices of prisoners in Georgia and other states resulting in mimicry of former slavery practices, and White-centric employment practices (e.g. coding natural hair and grooming as “unprofessional” affecting promotion and compensation rates), are starting points to conceptualize the degree of racism that has and does exist at all levels of society.

The history of racism in the United States must include a discussion about the degree of propaganda and alternative facts used for hundreds of years to instill values entrenched in White supremacy and ethno-centricism. Therapy can evaluate what degree of belief one holds that one’s viewpoint about race, ethnicity, and culture is right and justified to the extent that it is inappropriately used for all measures of judgment on self and others. The inherent bias often created from unchecked world-views can leave well meaning people to act indifferent to the plight of others, diminish the capacity for empathy, and limit one’s ability to critically think about their life and the degree of authenticity in the values they profess.

I strongly believe that an anti-racist stance includes empathy to those who have been victim to institutional/systemic racism and working to find language that appropriately and truthfully conveys the work still needed for justice to exist. As a therapist I continue to learn and appreciate any information my clients wish to share about their experiences and understanding of what racism looks like today, in their upbringing, and what language was passed down to them. 

All lives cannot matter until Black lives matter.

Articles to Consider

American Psychological Association Guidelines on Race and Ethnicity in Psychology

Braveman PA, Arkin, Proctor D, Kuah T, Holm N. Systemic And Structural Racism: Definitions, Examples, Health Damages, And Approaches To Dismantling. Health Affairs 2022;41(2).

Evans AM, Hemmings C, Burkhalter C, Lacy V. Responding to race-related trauma: counseling and research recommendations to promote post-traumatic growth when counseling African American males. Journal of Counselor Preparation and Supervision. 2016;8(1).

Spoont M, McClendon J. Racial and ethnic disparities in PTSD. PTSD Research Quarterly. 2020;4:1-12.

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A large focus in my undergraduate studies was on gender and what defines masculinity, androgyny, and femininity in modern culture. Consideration of varying cultural traditions regarding gender, roles in relationships, and diversity in identity and expression are important for any person who is navigating what gender authenticity means to them.

Gender constructs and beliefs in American society are typically expressed in simple binary terms that were largely affirmed as scientific truths in the 1950s and ’60s. The idea that there are only two sexes and that those two sexes (male/female) must respectively correlate to two gender identities (man/woman) is a hallmark of a cultural mythos designed to protect the idea that all persons need to fit in one of two categories and these categories are mutually exclusive. But, concepts and presentations of gender expansiveness have existed and been recorded since ancient times and are not indicative of anything other than normal diversity in life. 

Through formal study, personal research, individual and group discussions, and clinical experience I strive to provide a space to learn, explore, and wrestle with concepts of what gender means to my clients and what gender norms have been projected in society that affect them both individually and relationally. Through analysis of the micro-, mezzo-, and macro-systems that a client has been exposed to and has access/membership to, I strive to provide language that allows the client to answer questions relating to their identified struggle with gender identity and expression.

Psycho-education about third genders in other cultures, variances in coding historically, and conceptual understanding of Colonialism (which includes beliefs and behaviors that dictate White-Cis-Hetero identities as the default) as superior are important topics for which any person would benefit from their own research to better understand how gender is defined in their mind and in the spaces for which they function. Dress codes, gender assigned roles in society, gender coded assumptions about personality, and binary classification of persons based on genitalia are concepts openly discussed and considered to be potentially helpful and harmful depending on the degree of rigidity assigned to any specific detail.

Consideration of a non-binary or gender fluid identity is supported for any person who does not have a strong identity at either end of the masculine/feminine spectrum of identity/expression and/or for which gender neutral pronouns are more comfortable in conceptualizing one’s identity. Non-binary individuals are not excluded from receiving support and advocacy for any treatment or modification to their body that they desire; non-binary identities are affirmed as equal to any other expression of gender or identity.

Determining if a person should transition their body medically through the use of hormone therapy and/or surgery of the chest and/or genitals is a slow and thorough process. Starting with what changes regarding one’s own social, emotional, and physiologically expression is needed to develop authentic relationships that align with their authentic gender identity. Each client seeking formal support to transition their body should understand their reasoning and articulate awareness of potential consequences as well as clear identification of what are the benefits. Each case is unique and I do not take the modification of a person’s body lightly as not all desired changes to decrease symptoms of distress require medical intervention; but each client will be met with respect and support that considers the value of medical intervention to help them alleviate symptoms of Gender Dysphoria.

In my experience, client’s seeking gender counseling appreciate having a space for which they can openly discuss all points I have highlighted here and roughly half seek out and follow through with some degree of medical transitioning. For further information of what steps are involved to transition medically, change one’s name, and other resources specific to the transgender population please go to the Transgender Starting Points page.

Lastly, if you have not engaged with Judith Butler’s work, I strongly recommend you do, they are one of the foundational philosophers of Queer Theory.

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The goal of sex therapy is different for each client and my process encourages each person to reflect on how they came to understand sex in their development, what relationship models were available, and what kind of feedback a person has received from their peers and authority figures that shaped their understanding of sex. 

All therapy engagement strives to provide formal/professional language and space to explore a client’s sexuality and lower distress about elements for which a person has confusion, anxiety, sadness, low self-esteem, shame, and/or other negative emotions and rumination/thoughts in regards to themselves and their relationship to sex. At all times boundaries, agency, and access to resources will be identified factors to utilize in defining each person’s needs for sexual health.

My competencies in providing talk therapy to individuals regarding their sexuality include the following elements: anatomy, puberty, pregnancy, abortion, STIs (including HIV/AIDS and PrEP), dysfunction, pain, orientation, pornography, masturbation, behavior patterns, expression, changes in identity, communication, boundaries and consent, infidelity, ethical structures of relationships both monogamous and not, polyamory, BDSM, kink/fetish, role-playing, CNC, and unwanted attraction. No specific lifestyle will be advocated or encouraged as correct for a client, but all may or may not be identified for consideration in the course of therapy.

For people struggling with sexual identity I will often engage with them with language and spaces that are represented in the Zine Mapping Your Sexuality, for which spectrums of definitions and consideration for intersectionality are prioritized in helping a person define who they are and what they want.

Sex as a performance is an important component of coming to terms with any difficulty a person is having in understanding what is holistic and healthy for them to have authentic sexual expression. Measures of performance, both internal and external, are typically reviewed and examination of the accuracy and validity of a person’s judgment of their own sexuality is utilized as a basic model that guides a client to self-determine what steps they do or do not need to take to improve the quality of their life as it relates to sexuality. All sexualities have the potential to be full, satisfying, beautiful, and more.

No sex therapy with a licensed psycho-therapist (LMHC, LMFT, LICSW, etc) requires touch or visual display. In situations for which a visual aid is required a vulva puppet or other examples curated for educational purposes will be used. I do not provide therapy or space that supports sexual activity that violates consent.

Intoxicated/unconscious people, children, and animals cannot provide consent and no support or guidance will be granted to anyone seeking to have sex without consent; a history of any such experiences will be met with neutral compassion, but a code of conduct and agreement that future activity is not wanted, planned, or condoned is required as part of any engagement with me for sex therapy.

Consent is like a cup of tea:

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Represented by the “I” in “LGBTQIA+”

People who are intersex are those that were born with genitalia ambiguous to simple classification of penis or vulva, or for which their external genitalia do not match internal organs, and/or chromosomes do not present as expected.

The prevalence of persons born intersex is not well determined, but available statistics indicate that surgery for intersex babies occurs once for every 2,000 births and that as many as 1.7% of all births are intersex. Millions of people currently living were born intersex and may or may not disclose such an identity, may or may not continue to have ambiguous genitalia, and may or may not even know they are. 

Intersex is a term that encapsulates over 60 medical conditions, most of which do not require medical interventions or surgery for the child to be able to grow and function normally. Surgery and treatments to place an intersex baby more clearly in a binary box of “male” or “female” is common and current advocacy in the intersex community calls for a delay in any changes to the body until the intersex person has decided it would benefit them.

FAQ

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