BEYOND RAINBOWS: Affirming Mental Health Care with Gender and Sexuality Diverse Clients

Santa Clara County Behavioral Health Tuesday, October 23, 2018

1 PART 3: RELATIONAL STRUCTURE DIVERSITY

2 WORKING WITH POLYAMOROUS CLIENTS

3 Kel Walters TED Talk on

4 A Definition Polyamory is a lifestyle in which a person may have more than one romantic relationship with and support expressed for this choice by each of the people concerned. –Weitzman, Davidson, and Phillips, NCSF 2009

5 Polyamory Basics ■ Poly = many/multiple; Amory = ■ Nonmonogamy or multiple (romantic and/or sexual) relationships ■ Consensual nonmonogamy (CNM) is term often used ■ Different from /polygany (typically one man with many ) ■ Consensual (different from cheating) ■ Boundaries are usually negotiated ■ Sometimes differentiated from open or open relationship in that romantic bonds may be formed with more than one (primary) partner 6 Who is polyamorous? ■ Single people ■ Married people or people in long-term relationships ■ ■ Heterosexual people ■ LGBTQQI people ■ People who engage in BDSM, people who have no interest in BDSM ■ People of all cultural backgrounds: people of color, people with disabilities, religious, non-religious, gender-conforming, gender-non- conforming…

7 Examples of Polyamorous Relational Structures ■ Hierarchical: One primary relationship / one or more secondary relationship(s) ■ More than one relationship; not hierarchically ordered ■ One primary partner with emotional relationship / Sex with others allowed but no emotional relationships allowed (Nonmonogamy/Open relationship or marriage) ■ Poly (similar to ): A relationship between 3+ people that may or may not include sex. ■ No primary relationship; multiple partners ■ Mono/poly: Polyamorous partner(s) with monogamous partner(s)

8 9 Demographic data

■ While openly polyamorous relationships are relatively rare (Rubin, 1982), there are indications that private polyamorous arrangements within relationships are actually quite common. ■ Blumstein and Schwartz (1983) noted that of 3,574 married couples in their sample, 15-28% had "an understanding that allows nonmonogamy under some circumstances. ■ The percentages are higher among cohabitating couples (28%), couples (29%) and male couples (65%)" (p. 312).

From What Psychology Professionals Should Know About Polyamory by Geri D. Weitzman, Ph.D. 10 Common Misconceptions and Therapist Errors ■ People who are polyamorous are afraid of commitment or intimacy. ■ All polyamorous people are sex and love addicts. ■ Poly relationships cannot be healthy ones. ■ Poly people are somehow “deviant” in terms of sexuality (sound familiar?). ■ People who open their relationships only do so as a last ditch effort to save their relationship. ■ Exposure to polyamory is damaging to children. ■ Poly relationships are more difficult or fraught with problems than monogamous ones. ■ The focus of therapy is always polyamory. ■ Polyamorous people don’t get jealous.

11 Why do poly people come to therapy?

■ Anxiety ■ Depression ■ Life transition ■ Grief ■ Help communicating relationship boundaries and agreements ■ Dealing with emotion regulation in the context of a relationship (e.g. strong emotions related to ) ■ Relationship conflict ■ Someone has not kept to a commitment or boundary

Many of these issues are very similar to reasons why people who are not poly seek therapy. 12 Jealousy? Compersion? ■ Jealousy often seen as either a human emotion that can signal something unresolved in oneself. ■ Jealousy is an emotion that partners seek to work through (rather than use as rationale for changing another’s choices/behavior). ■ Compersion: genuine happiness for another person’s pleasure.

13 Ways that Therapists Can Help Polyamorous Clients ■ Deciding if polyamory is right for them ■ Deciding what form of polyamory is best for them ■ Negotiating agreements and boundaries; communication ■ Building community with other polyamorous people ■ Providing psychoeducation and resources ■ Managing issues of disclosure (i.e., to others about being polyamorous) ■ Coping with and combatting ■ Changing language on forms (i.e. "name of partner/s," not "name of spouse") ■ Learning more about polyamory issues

Adapted from What Psychology Professionals Should Know About Polyamory by Geri D. Weitzman, Ph.D. 14 The Role of Privilege

15 Suggestions for Therapists

■ When seen in psychotherapy, the client may present as a polyamorous couple OR as multiple partners (e.g. 3 partners seek out therapy) ■ If you are open to working with multiple partners, you may want to consider changing the language you use in marketing your services – “relationship therapy” versus “couples therapy” – “couples and multiple partners” versus “couples therapy” ■ Check your assumptions and biases that may interfere with your clinical competence or objectivity ■ Listen to clients’ presenting problems and be careful to not make the “poly” issue the problem if it isn’t

16 CASE EXAMPLES

17 Case: Sasha

■ Sasha is a 42-year-old Latinx genderqueer/ individual (they/them/their) ■ Has been in relationship with Joan for 7 years, has been in relationship with Mario for 2 years; non-hierarchical ■ Sasha and Mario are considering becoming parents; Joan will also help co-parent but to a lesser degree ■ Wants help with decision-making about how manage relationships and parenting responsibilities; also feels a great deal of stress related to medical process and wanting systems to recognize both partners

1. What questions would you have for Sasha? 2. How might you proceed?

18 Case: Jonathan and Madeline ■ Jonathan (White, cis straight man, 33yo) and Madeline (mixed race, API, cis queer woman) have been married for 10 years; happy and securely attached relationship ■ Madeline is interested in being polyamorous (she was before the marriage) ■ Jonathan is not interested in polyamory but wants Madeline to be happy; he experiences some jealousy but “believes he can work through this” ■ They come to your for couples therapy to negotiate nonmonogamy agreements

1. What else would you want to know? 2. How might you proceed?

19 Polyamory Resources: Books & Magazines

Anapol, D. M. (1997). Polyamory: The new love without limits: Secrets of sustainable intimate relationships. Intinet Resource Center. Easton, D., & Hardy, J. W. (2009). The ethical slut: A practical guide to polyamory, open relationships and other adventures. Labriola, K. (2010). Love in Abundance: A Counselor’s Advice On Open Relationships. Greenery Press, 2010. Taormino, T. (2013). Opening up: A guide to creating and sustaining open relationships. Cleis Press. Xero Magazine on Polyamory: http://xeromag.com/fvpoly.html Veaux, F., & Rickert, E. (2014). More Than Two: A practical guide to ethical polyamory. Thorntree Press, LLC.

20 Polyamory Resources: Articles

For Lovers and Fighters by Dean Spade: http://makezine.enoughenough.org/newpoly2.html Privilege Checklist: by Cory Davis http://www.eastportlandblog.com/?p=9176 What Psychology Professionals Should Know About Polyamory by Geri D. Weitzman: http://www.polyamory.org/~joe/polypaper.htm#Demographic Therapy With Clients Who Are Bisexual and Polyamorous by Geri D. Weitzman, Ph.D.: http://www.numenor.org/~gdw/psychologist/bipolycounseling.html Working With Polyamorous Clients In The Clinical Setting by Joy Davidson: http://www.ejhs.org/volume5/polyoutline.html 21 Polyamory Resources: Groups Bay Area Open Minds (therapist network): http://bayareaopenminds.com More Than Two: Franklin Veauxs Polyamory Site: https://www.morethantwo.com National Coalition For Sexual Freedom: http://www.ncsfreedom.org The Polyamory Society: http://www.polyamorysociety.org Poly-Friendly Professionals: http://www.polychromatic.com/pfp/main.php Loving More: http://www.lovemore.com

22 PART 4: BDSM COMMUNITIES

23 RECENT MEDIA ATTENTION

24 DEFINITION “The knowing use of psychological dominance and submission, and/or physical bondage, and/or pain, and/or related practices in a safe, legal, consensual manner in order for the participants to experience erotic arousal and/or personal growth.” -Jay Wiseman, SM101

25 Who is kinky? ■ Straight people, gay people, queer people, ■ Monogamous, nonmonogamous people ■ People who play publicly ■ People who only play in private ■ People of all cultural backgrounds: people of color, people with disabilities, religious, non-religious, gender-conforming, gender- non-conforming… ■ People who wear leather, people who dont ■ People with an history, people with no abuse history whatsoever. You can’t always tell whether someone is kinky by looking at them.

26 Terms and Roles

Terms

Roles (not static; may change depending on context or partner) Top or dominant Bottom or submissive Switch

27 Safe, Sane, and Consensual (SSC)

■ "Safe" = being knowledgeable about what you are doing and the physical and emotional risks. ■ "Sane" = knowing the difference between fantasy and reality. Knowledgeable consent cannot be given by a child or under the influence of drugs or alcohol. ■ "Consensual" = respecting the limits imposed by each participant. One of the most easily recognized ways to maintain limits is through a "safeword" - in which the bottom/submissive can withdraw consent at any time with a single word or gesture. Critique: “Safe” is relative, denies that there is risk involved, “sane” is a forensics term and can be ableist/pathologizing

28 Risk Aware Consensual Kink (RACK)

■ Risk-aware: Both or all partners are well-informed of the risks involved in the proposed activity. ■ Consensual: In light of those risks, both or all partners have, of sound mind, offered preliminary consent to engage in said activity. ■ Kink: Said activity can be classified as alternative sex.

29 The 4 C’s Model (Williams et al., 2014) ■ Caring ■ Communication ■ Consent ■ Caution

30 The Literature ■ Estimated 10% of population has engaged in BDSM activities, with a higher percentage being interested. ■ 2009 study suggests that kink increases oxytocin and decreases cortisol. ■ Kolmes (2006) found that some mental health professionals considered kink to be unhealthy and required clients to give up on kinky activities in order to continue treatment. ■ DSM-5 (2013) clarified that people with “atypical sexual interests” are not mentally ill. It is considered pathological only if: – the person experiences distress beyond what’s expected from the social stigma surrounding kink – it does not respect the wishes of others, especially those who are unwilling or unable to consent ■ This clarification led to a 57.5% drop in requests for child custody legal assistance to the National Coalition for Sexual Freedom from 2012 to 2014. 31 Therapeutic Recommendations

If someone brings up BDSM or kink as part of their life: ■ Do ask them to clarify what it means to them, what it looks like in their life in the way that you might ask for detail about other interests or cultural markers. ■ Do respect boundaries about how much a client might want to share with you. ■ Do not assume BDSM is connected to trauma. ■ Do be honest about your knowledge in this realm. – I don’t know much about this culture, so I may ask you to explain some of the things I dont understand. This is so that I can better understand the meaning of your experience. ■ Do not assume anything about this persons based on their involvement with BDSM. ■ Do examine your countertransference, especially if it is very hard for you to imagine why people have the fantasies they do.

32 Myths and Misconceptions ■Myth 1: BDSM is a reenactment of abuse ■Myth 2: BDSM always reinforces patriarchal power dynamics ■Myth 3: People are either kinky or vanilla, and theres nothing in between ■Myth 4: BDSM is dangerous

33 BDSM or Abuse?

34 Kink/BDSM Resources National Coalition For Sexual Freedom: http://www.ncsfreedom.org Leather and Roses: http://www.leathernroses.com/lnrhome.htm Xero Magazine on BDSM: http://xeromag.com/fvbdlinks.html From “SSC” and “RACK” to the “4Cs”: Introducing a new Framework for Negotiating BDSM Participation: http://mail.ejhs.org/volume17/BDSM.html Why Doctors Need to Pay More Care to their Kinky Patients https://qz.com/342268/why-doctors-need-to-pay-more-attention-to- their-kinky-patients/ Sexual Minorities are Fearful of Coming Out to Health Providers https://www.forbes.com/sites/zhanavrangalova/2017/11/06/sex ual-minorities-fearful-coming-out-to-health-providers/#3e1e0e3a316c

35 PART 5: WORKING ACROSS SIMILARITY & DIFFERENCE

36 Working across difference ■ Be aware of your identities and how these inhabit privileged and marginalized spaces. ■ Refrain from trying to “prove” allyship (e.g., savior complex). ■ Take time to challenge your own assumptions about what is normal or typical. ■ Take time to learn from others who may be more similar to the client. ■ Maintain cultural humility – strengths and areas of growth. ■ Careful to not get too caught up in the story or the novelty/fascination.

37 Working across similarity ■ Be aware of your identities and how these inhabit privileged and marginalized spaces, especially ways that you may differ. ■ Be aware of overidentification. ■ Refrain from making assumptions based on your own experience. ■ Maintain cultural humility – strengths and areas of growth. ■ Be cautious with self-disclosure. ■ Be mindful about dual/multiple role/relationships and small communities.

38 Ways to invite conversations about the client-therapist dyad

“You are telling me that your ______identity is very important to you. I want to invite you to feel safe and comfortable talking about all aspects of your identity here.”

“There are ways in which we may be similar and ways in which we may be different. I want to welcome you to talk about what comes up between us regarding our similarities and differences.”

“What is it like for you to talk about this part of your identity with me given what you know about who I am in the world?”

39 Help! No one ever taught me how to deal with this! ■ Your clients start dating each other ■ Your clients talk about each other ■ You run into your client at a birthday or dinner party ■ You have professional overlap with clients ■ Your roommate calls to tell you his new friend (your client) is coming over today

40 Four Potential Therapeutic Dyads (Helms) 1. Parallel – Client and therapist are at same level of racial identity 2. Crossed – Therapist and client at opposing levels of development – Lack of empathy with respect to racial issues – Each tries to educate the other about their point of view – Usually terminates prematurely 3. Progressive relationship – Therapist’s racial identity at least 1 stage higher than the client’s – Therapist able to facilitate exploration of racial issues with the client 4. Regressive relationship – Client’s racial identity at least 1 stage higher than the therapist’s – May be conflictual – Commonly characterized by power struggles – Therapist downplays the importance of race in client’s worldview and experiences – Therapist views client’s attempts to take about racial differences as resistance; client feels the need to justify their position A Note About Regressive Relationships ■ Clients are intuitive and can pick up on discomfort we may have based on our biases or lack of experience working with certain groups. ■ It is important that we do our own self-reflection and growth work if we are to help someone else in that area.

42 When to refer? ■ When we know there is someone who may be more experienced or a better fit ■ When we do not know very much and do not have anyone to professional consult with (or do not have the time/resources to consult) ■ When we know our biases may end up hurting the client

Clients usually appreciate when therapists are honest about their level of expertise/competence.

43 QUESTIONS?

44 CONTACT

Sand Chang, Ph.D. 510-545-2321 [email protected]

45