BCACC Blog

by Geoff Plint, MA, RCC

LGBTQ. GLBTQIA? LGBTQQIP2SAA???!! Trying to get a handle on the range of sexual and gender identities for some parents, caregivers, and supports is no 5th Grade Spelling Bee. With progressive social action comes radical redefinition of what it means to be “Loud & Proud” in the 21st century. If you have ever felt lost, overwhelmed, or simply unsure of how to support a child, teen, or adult coming out, you are not alone.

Part 1: On Coming Out – A Personal, Parental Response

When I first came out, my mother feared for my safety; for her, growing up in the 1970s meant men who had sex with other men could be openly assaulted and harassed on the streets. My father? He emphasized the importance of my sexual health and wellbeing:

“Make sure you wear a condom…and don’t just sleep with anyone”.

I can only imagine how the visceral scars of the HIV/AIDS crisis, wounds that invariably impacted heterosexual men outside of the viral epicentre, informed his perspective.

Research on parent’s response to LGBTQ+ youth offers several clear and consistent messages:

• Defensive, reactive, or rejecting responses impair family connection and contact
• Culture* and upbringing, as opposed to a particular teen’s sexual and gender orientation, play a key role in predicting the direction of response.
• The more positive and warm the response, the greater impact on your teen’s sense of healthy self-esteem, perception of social support, and general wellbeing (including both physical and mental health).
• Positive responses help buffer teen’s from the all too common, and increasingly alarming, implications of rejection:  depression, risky substance use, and suicidal ideation.

*Culture in this particular instance includes all of the elements – status, country of origin, region, family practices, religion/spirituality, values – that make you, YOU. Understanding how the people around you spoke and speak about coming out can help you with the type of reaction that can best support your teen.

Strike a Chord: Common Themes for Coming Out

Since those early days of negotiating my sexuality, I have had the opportunity to nuance the conversation with my parents to a place of celebration and sharing, though it has been a journey. In my work with teens and families, similar fears and uncertainties show up in the room. Have you ever felt or wondered:

• I think my teen is gay – how do I even bring this up?
• Did I do something to cause this? Is this my fault?
• Who can I tell? What will everyone think?
• Will they be safe in the world?
• I feel afraid, unsure, and I just don’t know what to say

Know that these questions, feelings, and reactions apply beyond the caregiver-teen relationship. Anyone who has the honour – and I select that word intentionally – of receiving the courage and trust it takes to come out is placed in a vulnerable position. The “coming-out” process implicates more than just the person sharing. You will likely experience your own internal reactions as you begin thinking about who to tell, when, and how.  If these themes strike a chord somewhere inside, know you are part of a collective community that understands coming out never truly ends; though, it does start to feel easier.

Part 2: The Model Carer is You

Ask my mother and she will tell you I have a deep love for acronyms. They serve as powerful tools for memory retention and they offer an opportunity to play with language: empowerment at its finest. I offer you the CARER acronym as a starting point for offering support to a teen placing their trust in you at this vulnerable juncture of self-awareness.

Connect, Affect, Reflect and Express Respect (CARER)

• Connect: It is incredibly easy to get lost in the details of the unexpected and new. I encourage you to connect with the part of the sharing experience that is happening in moment, even if the content of what your teen is revealing triggers discomfort. While your first reaction may be shock or disbelief, your top priority is to consciously join with the being in front of you. Having trouble? Notice the rawness, the vulnerability, the courage, the trust, and the beauty in your safe relationship that allowed what was just said, to be said.
• Affect: Thanks to collective socialisation and your upbringing, you may experience an array of challenging feelings when your teen comes out to you. You may look for blame. You may feel afraid. You may feel a sense of anger, revulsion, or shame. The thought of losing the person who you thought you knew so well can be numbing and isolating. This collection of emotional responses is known as affect, and while they are not inherently negative, they are indicators for you to seek community care and support. Flag these feelings for later to debrief with someone you trust.
• Reflect: Asking questions and occupying a position of curiosity places you in the best position to learn and understand. You are looking to find ways to acknowledge and affirm the courage it took to come out. It is important to give space for your teen to speak their full experience and to know that you get it. Reflective questions involve repeating back information you gathered during your talk and using it to ask questions. They serve as an incredible tool to give power to your teen’s experience and to show you are listening. How do you do it? Here is a quick example:
  • Teen: “There’s this girl in class that I’ve been hanging out with…she makes me feel excited…but I still really like Tim too…I don’t know.”
  • You: “I hear you saying that you are excited by both Tim and this girl in your class, though, it feels uncertain right now. Did I capture it?”
• There are many ways to reflect back what you hear and it can feel clunky at first. Notice the use of “I” statements to express what you are hearing. Keep your tone similar to your teen; use the same words if you can. Lastly, feel welcome to check in for understanding.
  • “Thank you for sharing.”
  • “I appreciate you reaching out.”
  • “Know that I am always here if you need to talk further.”
  • “Is there anyone else you would like me to involve in this?”
  • “Here is how I would like to proceed…”
  • “I love you and I want to take the time to properly gather as much knowledge and resources as I can.”
  • “How would you like to proceed?”

If your teen has come out to you, it is likely they have come to terms with their sexual and gender identity enough to feel comfortable having a conversation. Your responsibility is to contain your feelings and reactions in the most authentic way. While you may need time to adjust to the news, there is plenty you can do to maintain a strong connection with your teen AND look after yourself. Seek help: talk with friends and loved ones you trust. Consult with support workers and health professionals. Ultimately, remember to reassure your teen that their relationship with you is sacred and will continue to be important, no matter what.

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Geoff Plint, MA, is a Registered Clinical Counsellor practicing on unceded Coast Salish land in Victoria, BC. Geoff offers a holistic, and comprehensive alternative to the incomplete and unanswered questions of human sexuality and relationships for teens and families across the lifespan. www.geoffplint.com

Interested in being a guest blogger? Email your suggestions and feedback to: [email protected]

 

As a follow up to our Insights Fall 2017 article “Sex Therapy – It is More Than Just Being Comfortable Talking About Sex”, we would like to offer further resources, training and professional association information provided by the therapists interviewed.

 

Three Scenarios by Dr. Pega Ren

Dr. Pega Ren provides three scenarios that are common in her practice:

The Fifteen Minute Call

“All they need is to be able to call someone they can trust to be educated, knowledgeable, and non-judgmental, and say, ‘Can I ask you a question?’” and to hear, ‘Oh, I hear this question all the time. You know what? You don’t need to worry about that. That’s perfectly okay,’ or ‘That’s true for all men, women, adolescents, whoever.’

And that’s it. That’s the therapy. And somebody’s life is changed. You don’t get that from 10 hours of training in sex, because there’s too much to know.”

 

   The Triggered Counsellor

Pega Ren offers a hypothetical example of what might happen if a counsellor without adequate sex therapy training is triggered in a session.

“A client couple tells me that they have sex twice a year, and it’s not an issue for them, but I don’t think that’s enough. Do I encourage them to have sex more often? Do I ask them, ‘Why is that? How long has it been?’ Do I follow that branch of the tree or do I leave it alone because it’s not a problem for them? And how do I determine that? And whom do I ask?

“If the same couple says, ‘We have sex twice a year,’ and one of them says, ‘And we fight about it all the time.’ Who’s the problem in the relationship? And is it a problem of sex? Is it a problem of power? Is it a medical concern? Are they not having sex because it’s so painful for her? Are they not having sex because he can’t get it up, or he can’t come, or she can’t come? Or is it because they’re fighting so often? What if it is an enormous question to ask?

“The person who’s asking that question really has to be prepared to manage the answer. And if you don’t know, you have to be able to refer.”

      Client Shutdown

“Our medical doctors are the first line when anyone has [physical] sexual issues. They are most likely to ask their doctor, who gets some training,” she says, adding that sometimes that training is her four-hour workshop, though some doctors are getting a little bit more.

“The doctors, who are just flawed human beings like the rest of us, who are not sex therapists, come to an answer–whatever the answer is–with all their own misinformation, lack of education, biases, embarrassment, and lack of knowing how to talk about these things,” says Ren. “When that same person gets to a counsellor’s office and the counsellor reacts with the slightest shift in body language indicating an ‘uh oh,’ it’s over for that client.”

 

For those counsellors interested in pursuing training in sex therapy, our therapists recommend looking into the following associations, training opportunities and resources.

Associations:

American Association of Sexuality Educators, Counselors, and Therapists: Information, resources, and training and education programs.

Society for Sex Therapy and Research: Notable as a means of exchanging ideas and research, including annual meetings and conferences.

The Society for the Scientific Study of Sexuality:  A resource that includes a list of international educational opportunities.

International Society for the Study of Women’s Sexual Health:  A multidisciplinary, academic, and scientific organization that provides opportunities for communication and accurate information about women’s sexuality, sexual function and sexual health.

 

Training Opportunities:

Westland Academy of Clinical Sex Therapy:  Specialized sex therapy training for mental health and health care professionals, including online programs focusing on the PLISS aspects of Jack Annon’s PLISSIT model of sex therapy.

Options for Sexual Health (Vancouver): Sexual Attitude Reassessment (SAR) workshops (3.5 days) based on the program developed by the Institute for the Advanced Study of Human Sexuality.

 

Human Sexuality Resources:

For counsellors…

Behavioral Treatment of Sexual Problems. Jack Annon, Harper and Row, 1976. (The PLISSIT model)

Principals and Practice of Sex Therapy by Sandra Leiblum. Guildford Press, 4th edition, 2007. Leiblum.  – The nuts and bolts of sex therapy for someone who wants to become a sex therapist.

Single Session Therapy: ‪Maximizing the Effect of the First (and Often Only) Therapeutic Encounter. Moshe Talmon. Wiley, 1990.  – Very helpful for counsellors who don’t want to be sex therapists and don’t want to cause harm.

The Handbook of Clinical Sexuality for Mental Health Professionals. Eds. Stephen B. Levine, Candace B. Risen, Stanley E. Althof. Routledge, 2016.  – Each chapter is written for health professionals by a different sex therapist or sex researcher who is at the pinnacle of their career in a particular issue.

New View of Women’s Sexual Problems. Eds. Ellyn Kaschak and Leonore Tiefer. 2002. Routledge, 2002. – Resources also available at www.newviewcampaign.org

 

For clients and counsellors…

Guide to Getting it On. Paul Joaniddes and Daerick Gross Sr. Goofy Foot Press, 8th edition, 2015  – “It’s massive but covers almost every “how to” topic on sexuality. Good for clients and those wanting to become more confident in bed.” – Dr. Teesha Morgan

Heads Up: Increase your sexual confidence, expand your sexual repertoire, and get the real low down on oral sex. Teesha Morgan and Constance Lynn Hummel. CreateSpace Independent Publishing, 2016.

Mating in Captivity: Unlocking Erotic Intelligence. Esther Perel. Harper Paperbacks, reprint edition, 2007.

Come As You Are: The Surprising New Science that Will Transform Your Sex Life. Emily Nagoski. Simon & Schuster. 2015.  – Understanding women’s sexuality, low libido/sex drive, body image, context, etc

OMGYES by the Kinsey Institute.  – Helps women achieve orgasm through an educational format

Playing Well With Others: Your Field Guide to Discovering, Exploring and Navigating the Kink, Leather and BDSM Communities. Lee Harrington and Mollena Williams. Greenery Press, 2012.

Sex At Dawn: The Prehistoric Origins of Modern Sexuality. Christopher Ryan and Cacilda Jetha. Harper, 2010.

Ethical Slut: The Practical Guide to Polyamory, Open Relationships, and Other Adventures. Janet W. Hardy. Celestial Arts, 2nd revised edition, 2009.

Opening Up: A Guide to Creating and Sustaining Open Relationships. Tristan Taormino. Cleis Press, 2008.

More Than Two: A Practical Guide to Ethical Polyamory. Franklin Veaux and Eve Rickert. Thorntree Press, 2014.

Petals. Nick Karras. Crystal River Publishing, 2003.  – Artistic focus on female body image and education

10 Steps: Completely Overcome Vaginismus. Mark Carter. M&L Carter, 2004.

Love the Body You Have: Freedom from Negative Body Image

By: Joelle Lazar, MA, RCC

 

Many people are tormented by toxic beliefs about the unworthiness of their body. Negative body image can perpetuate an unhealthy relationship with food, or in more extreme cases lead to an eating, or mental health disorder. To transform a negative body image, and heal from disordered eating, we need to learn to accept and love the body we have, as well as understand the causes of negative body image that hurt us all.

My client, “Rebecca” (a composite of many women I have seen in my practice) has struggled with a negative body image since the onset of puberty.

“My body is disgusting”, she says looking down.

“I avoid looking in mirrors, and I dread social situations because I feel that people are thinking that I am fat and ugly.”

For 30 million people in US, and 1.5% of women in Canada a relentless preoccupation with food, weight, and body image causes significant anguish. Every 62 minutes at least one person dies as a direct result from an eating disorder.

Our body image is what we believe about our appearance, and how we judge our body, including our height, shape, and weight. Beliefs such as only other people are attractive, and one’s own body is a sign of personal failure cause feelings of anxiety, sadness, and shame. Beliefs about one’s body that cause severe emotional distress, the inability to function, and compulsion to undergo unnecessary plastic surgeries, is called body dysmorphia disorder (BDD).

There was a time in my life when I hated my body. Between the ages of 12 and 23 years, I went through periods when I deprived myself of the necessary calories that I needed to be nourished, or gorged myself rather than slow down to enjoy my food. For a brief period, I made myself vomit after overeating which only caused more damage.

When I look back on it, several forces shaped my negative body image, and my unhealthy relationship with food. The first one is lineage. Both my mother and maternal grandfather had an eating disorder. How people looked, whether they’d gained or lost weight, were readily discussed in judgemental tones.

I knew if I was slim, I’d get acceptance and acknowledgment. I also knew that I didn’t want to be in the category of those who gained weight and were silently mocked for it.

Our North American culture’s judgment and intolerance of bodies that don’t conform with a specific, increasingly skinny vision of beauty played a part in my unhealthy body image. Like the thirty-seven percent of girls in grade nine and 40% in grade ten who perceive themselves as too fat, I too grew up believing that to be accepted I needed to be beautiful, and to be beautiful I needed to be skinny.

As Naomi Wolf writes in the Beauty Myth,

“…inside the majority of the West’s controlled, attractive, successful working women, there is a secret “underlife” poisoning our freedom; infused with notions of beauty, it is a dark vein of self-hatred, physical obsessions, terror of aging, and dread of lost control”.

Rigid notions of beauty don’t only affect women and girls. Men who have a lot of body hair, or whose body doesn’t match the dominant stereotype of manliness are just as prone to take steroids, engage in disordered eating, and undergo invasive cosmetic surgeries to conform with manufactured ideals of beauty.

Since 2000, overall plastic surgery procedures have risen by 115 percent.  According to the American Society of Plastic Surgeons, nearly 64,000 cosmetic surgery patients in 2014 were aged 13-19, and experts believe this number is bound to rise.

In her blog on how to have a positive body image, clinical psychologist Elizabeth Halsted discusses how hetero-centric, and racial stereotypes negatively impact queer and non-white individuals ability to feel comfortable in their bodies.

We need to step back and examine to what degree how we see our body is influenced by a socially constructed and normative vision of beauty.

When our starting point is the belief that “my body is faulty and unacceptable because of how I look”, we become a slave to achieve a version of ourselves that is externalized and out of reach.

How can we cultivate a positive body image?

1. Step back and examine the thoughts and beliefs that you have about your body. Reflect on where these beliefs came from, such as negative messages from family, peers, and media.
2. Step back and notice when you are being critical of yourself and others, such as comparing yourself to others, or judging yourself or other people’s appearance.
3. Actively appreciate the body you have by noticing all that it does for you, such as breathes, digests, helps you to accomplish tasks, and allows you to just be here to hear a bird sing, see the sun shine, and receive the love in your life.
4. Accept and value human beings, including yourself, regardless of your/their weight and shapes. Remember that a person’s physical appearance says very little about their character and value as a person.
5. Accept and live comfortably with the notion that there are normal variations in human size, shape, and weight, and that the shape we might wish to have might not be the size or shape we are biologically designed to have.
6. See food and exercise as instruments for self-care rather than a means to become more skinny, and “beautiful”.
7. Seek help from kind and compassionate friends, family, and professionals to help you nurture a healthy body image.
8. Become a political activist for people of all body sizes.

To transform negative into positive body image we need to acknowledge the sources of negative body image, and stop punishing ourselves for not having  “the perfect” body. We don’t have to conform with an image of beauty that is artificial, and beyond our reach. When we are compassionate with ourselves, we can appreciate what our body can do, and benefit from its inner wisdom. Learning to eat and exercise in a way that is appropriate and helpful is important, as well as celebrating our natural body shape.

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Joelle Lazar, MA, RCC  is a A Registered Clinical Counsellor and Yoga Therapist who works with individuals, couples, and families in Vancouver, BC.  With additional studies in Sensorimotor psychotherapy, Joelle’s approach is trauma-informed and mindfulness-based. Her skills and genuine warmth provide safety and clarity. Joelle works with you to cultivate strength, and her caring and encouragement help you move through challenges.

If you or one of your clients is interested in a Loving Your Body support group, please contact [email protected], 604-788-2804. www.centrepointpsychotherapy.com

 

References

The Beauty Myth by Naomi Klein

The Compassionate-Mind Guide to Ending Overeating: Using Compassion-Focused Therapy to Overcome Bingeing and Disordered Eating by: Ken Goss

NEDA, https://www.nationaleatingdisorders.org/

ANAD, http://www.anad.org/

http://nedic.ca/know-facts/statistics

https://www.plasticsurgery.org/news/press-releases/new-statistics-reflect-the-changing-face-of-plastic-surgery

https://www.psychologytoday.com/blog/contemporary-psychoanalysis-in-action/201602/how-have-positive-body-image

Comorbidity of Anxiety Disorders With Anorexia and Bulimia Nervosa Walter H. Kaye, M.D. Cynthia M. Bulik, Ph.D. Laura Thornton, Ph.D. Nicole Barbarich, B.S. Kim Masters, B.S. (Am J Psychiatry 2004; 161:2215–2221)

The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication, James I. Hudson, Eva Hiripi, Harrison G. Pope, Jr., and Ronald C. Kessler, Biol Psychiatry. 2007 Feb 1; 61(3): 348–358.

http://www.biologicalpsychiatryjournal.com/article/S0006-3223(06)00474-4/fulltext