Update on Therapy Hours

Since my recent departure from PRISM, I have been finishing the process of transition my direct service clients. I'm happy to announce that I've completed the transition process. 

I see clients at Neighborhood Involvement Program at 2431 Hennepin Ave S, Minneapolis MN 55403. Right now, I'm only available on Wednesday and Thursday. My hours will grow as I add clients. You can schedule any of the open times. For your convenience, all scheduling is now done online at

https://www.timetrade.com/book/VXLJ6

I currently see clients on a limited basis. I am not a provider for any insurance company (as of 9/4/12--Insurance companies are slow in updating their computer systems when it comes to customer service.).

Fees ($160/50 min hr) are due at the time of service. Courtesy billing to insurance companies is provided, but there is no guarantee of reimbursement of services.

Interpreting a Fantasy

I believe fantasies are amazingly powerful in helping an individual uncover/reveal parts of his/her deepest core. Jack Morin, in Erotic Mind highlights much of the academic material that is the source for this assignment. The following is a helpful tool in examining the core of a person’s fantasy(ies). By the way, some individuals suggest they don’t fantasize. If the word "fantasy" gets in the way, I will talk about daydreams, or hopes, or wants, or desires. (If you find the comparison helpful, fantasy analysis might be compared to dream analysis.)

The first step is to have a “solid” fantasy to work with. This occurs when an individual writes his/her fantasy. I ask clients to write the fantasy as if a reader could enact the fantasy based simply on what is written. For some people this might be the equivalent to a screenplay or script. I’m not expecting material that is “word for word,” but enough detail to have a pretty good sense of the actions/motivations of the individuals. The content of the fantasy can be anything, including relationship, dating, wants, joys, fears, the search, hunt, etc. I do encourage the individual to include sexual contact as well.

Second, I remind the individual this is a process of inquiry. The client is the one who makes the determination if something “fits.” I (or a group) may provide suggestions, but ultimately the client says, “This fits the bets.” There isn’t a right answer, simply today’s better answer. Future reflection might nuance what is uncovered. Within inquiry, it is important to brainstorm different thoughts about the underlying motivations. In another blog post, I ask, “Why does a person stop at a stop sign?” As I asked in the blog, “And why else, and why else, etc.” There are many reasons a person stops at a stop sign. So too there are many influences in the fantasy.

Third, remember that many conflicting answers can be applicable at the same time. This reflects the tension within the individual. The concept of layers within the individual is important.

Fourth, when possible, look for an expression of the primary thinking error. Often in the fantasy, the primary thinking error looses its power or is somehow addressed/resolved. You may also get a sense of the primary values. In philosophy, we talk about positive and negative arguments. The absence of something can affirm the presence of the same thing.

Fifth, I use a process that is helpful to me. Feel free to adapt. In my process, I have the client read through the entire fantasy without interruption. The goal for me is to understand the fantasy in context, length, and direction. Then, I have the client reread the fantasy. In the second time through, I will stop at places (usually a clause, or each sentence) and complete a literary analysis on that small piece. With some clients, I will revisit the fantasy 1-week, or 1-month later.

Sixth, use open-ended questions for each section. After you ask each question, engage in basic reflection of content/feeling, and ask, “What else?” Here are some basic questions that I start with. Feel free to adapt/add.

1) Tell me about the motivation that is going on in that moment.
2) Describe anything from your history reflected in that moment?
a. Describe how you felt or what you thought?
b. How is this important to you today?
3) What would happen if it were to come true?
4) Describe your fears if this was to happen?
5) Describe your hopes if this this was to happen?
6) How would you feel if this was to happen?
7) What would you think if this was to happen?

The academic material:

Finding a relationship therapist

A few weeks ago I highlighted a few strategies for finding a sex therapist. When looking for a relationship therapist, a few adjustments to the strategies are important.

1) What is your Goal?
Before you start, to the best of your ability clarify your goal. While it might be hard to acknowledge, if you know you don’t want to stay in the relationship, be honest and up front for the sanity of everyone.

2) Provide a time commitment.
Many times the individuals in the relationship will start therapy during a rocky period. If either one of the individuals is unsure about the future of the relationship, I ask for a time commitment from both of them to discern and work on the relationship.

3) Finding Referrals
Ask your friends and current therapist for referrals for individual therapy. Not everyone has training in relationship therapy. Questions such as "Who did you see?" or "Who do you recommend?" are helpful.

4) Who is the client?
Remember that the RELATIONSHIP is the client, not the individuals. Most individual therapists will NOT do relationship therapy when working with one person of the relationship. There are appropriate exceptions, so this is not an absolute rule. Check with the therapist.

5) Put everything on the table.
During the intake session, put everything on the table. Whether it is sexual issues, insecurity, jealousy, communication, respect, or whatever, put it on the table. In my work, my 2nd and 3rd session are individual meetings with each individual of the relationship to provide an opportunity to put additional issues on the table that may be too difficult in the first session.

6) Share the secrets.
This is a bit different than #5 simply because there might be things you don’t think are related. If you engage in alternative sexual behaviors, or had a sexual contact outside the relationship, say so. In some cases, external family pressure or fertility issues might be a secret.

7) Be realistic.
I use a juggling metaphor in relationship therapy. When starting relationships therapy, there are three balls to juggle: Person A, Person B, and the Relationship. This means it is more difficult than individual therapy to create change in the relationship.

Finding a sex therapist

Recent events reminded me how difficulty it is to find a clinician with skills in the area of sexuality. I thought it might be helpful to highlight a few strategies to find a clinician who specializes in sexuality. I forget the difficulty many clients have in talking about sexuality. I’ve been in the field for 16 years at this point; sometimes it feels like all I do is talk about sex. (Is it possible to talk about sex too much?) Client’s will often say, “I’ve never told a previous therapist about this…..” and then go into an story regarding their life, sexual history, acting out, or assault.

1) Advocate for yourself. Check out a number of websites, including SASH.NET and AASECT.ORG. (For example, between the two websites, about 15 clinicians are listed in the Minneapolis/St. Paul area.). Call your insurance company for referrals to see clinicians experience working in sexual matters.

2) Call. Most clinicians will take a 10-15 minute phone call to see if an initial interview should be set. Be direct and open in the phone call. This is not the time to beat around the bush. Use the time efficiently. Put your issue out there. I’m struggling with Internet porn. I’ve been sexually assaulted. Do you work with clients in this area? What is a summary of your treatment approach? Do you have any resources available on the web?

3) Ask for referrals. If the clinician responds no, ask him/her for referrals. Repeat the process until you have 1-3 clinicians who you might want to meet.

4) Set-up a meeting. Some clinicians will have free 1/2 hr sessions, others don’t. The intake interview is as much for you as it is for the clinician. Feel free to ask questions to the clinician as well. How busy are you? What is your training/experience in this area? How many clients have you worked with on this topic? The more forthright you will be, the more likely you will find a clinician who can help in your recovery.

Remember, the therapist is there for you, not you for the therapist.