Category: Mental Health

Inwardness, Marital Discord, and Porn

A positive, nurturing, etc. upbringing psychologically prepares a person to successfully meet the challenges that inevitably arise in an intimate relationship. I say inevitable because there will always be some friction at times between two people, no matter how well suited they are for each other. The other person in a relationship is another person, with his/her own needs, values, perspective, trigger points, moods, idiosyncrasies, foibles, quirks, blind spots, and so on. No one’s needs, wants, etc. are fulfilled 100% of the time by one’s partner or spouse. Thus all relationships are challenging in certain ways and degree. Read more

Why Do People Who Drink Excessively Need Personal Therapy?

Why do people have to be in therapy in order to stop drinking? You’d think that bad outcomes themselves would be reason enough to stop or at least lead to being careful and moderate. Why would a person need therapy in order to stop harming himself and getting himself in trouble? The simple answer is that people are doing the best they can in living’”doing the best they can to cope with the stress and challenges of life as they experience them. Read more

To What Extent is the Addict Responsible?

Freud once commented that we are responsible for our dreams because well, who else could be responsible? This is Jewish humor, as I well know. Are we really responsible for our dreams? What actually are we responsible for and why? This is a pressing question for both husband and wife after (typically) the husband’s infidelity of one or more sorts has emerged (I must say many of the men I see have been strikingly lax in trying to cover their tracks). Is the husband bad or sick or both or something else or what?
Read more

man thinking about when to seek therapy

The Identified Patient

I typically meet men who describe problematic sexual behavior following an ultimatum given by their wife to get into treatment or else. They have been discovered. Their wife wants their sexual addiction treated. The men are sitting in my office because they want the marriage to continue. Why they want the marriage to continue, is frequently not that clear. There are often children, money, and property involved. Reputation is involved. The prospect of losing their familiar way of life is not attractive. Read more

Sex Addiction Treatment

The goal of diagnosis is to formulate a realistic and adequate statement of what is the matter. Treatment has no direction without a grasp of what is ailing an individual. I have discussed my view of what is going on in sex addiction in a companion piece. As with all addictions, what is the matter in the case of sex addiction treatment must refer to what is actually driving the person’s insatiable need for the addictive activity and all the fantasizing, planning, arranging, plotting, and scheming that goes along with it. Read more

Whose Interests Really Matter?

One cannot be precise about the figures, but it is all too apparent that many people grow up having to endure very serious adversity within their own family. In 1962, in a landmark article appearing in Journal of the American Medical Association, a group of emergency room physicians implored medical colleagues across the country to stop covering up parental battering of infants and young children.Maltreatment of children within the family is not a pleasant topic, but it will not do to make believe it does not happen or that it is rare. Read more

Sex Addiction Treatment

The goal of diagnosis is to formulate a realistic and adequate statement of what is the matter. Treatment has no direction without a grasp of what is ailing an individual. I have discussed my view of what is going on in sex addiction in a companion piece. As with all addictions, what is the matter in the case of sex addiction treatment must refer to what is actually driving the person’s insatiable need for the addictive activity and all the fantasizing, planning, arranging, plotting, and scheming that goes along with it. Read more

Your Adult Relationship With Your Parents Could Be Your Most Consequential Adult Challenge

Time passes; you get older and become an adult. You have gone to college or not, you have a job, you make money, perhaps you are very successful, you get married and have children. You still have parents. They are, if this is the case, the toxic parents you grew up with. They have changed little if at all as you grew from childhood to adulthood. You have a life of your own as an adult, but your parents are still part of your life, still in your life. Read more

What’s the matter? (Diagnosis)

Based on persistent distress and so on, people ask about themselves or others ‘What’s the matter?’

Over the past 31 years (that is, since the 1980 publication of the American Psychiatric Association’s third edition of its Diagnostic and Statistical Manual, the DSM for short), American psychiatry has trained not only the mental health industry but also the public at large to think and speak in the language of DSM disorder categories. Read more

How Does Change Occur in Psychotherapy?

I think it will be helpful to me and to prospective and beginning clients to try to provide an overview of how I think about …

Make-Believe in the Addiction Treatment Industry

Therapists shouldn’t be in the business of make-believe. There is a great deal of make-believe in the addiction treatment …