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Thinking about therapy?


Most of us have been there… a difficult moment in our lives, or perhaps just a curious moment, where we wonder to ourselves what therapy would be like, or how exactly it can help us.  “What is therapy, anyway?”  “Why should I subject myself to the awkwardness of deciding how much of my inner world I should share with a complete stranger?”  “Is it worth the price?”  “What if I don’t like my therapist… or worse… he/she tells me horrific things about myself that I really don’t want to hear?”  These are big questions, and I’ll admit, difficult for me to answer.  However, there are a few honest truths I can tell you about therapy: 

There are many different theoretical orientations out there.  How to choose?  Some exciting news is that according to several studies, the ISTC’s included, at least 60% of therapy’s effectiveness is due to the strength of the “therapeutic relationship,” or in other words, how much you like your therapist.  Feeling aligned with your therapist and feeling heard and respected will have a lot to do with how helpful therapy will be for you.  We therapists aren’t “off the hook” completely.  The other 40% is estimated to be a result of actual technique/skillfulness of the therapist.  The take home point is: put your time into finding a therapist who “speaks” to you in some way.  Do you see yourself liking him/her?  Do you see yourself feeling comfortable with the person, and respecting them?  They should encourage you to make sure you feel good about the relationship, and not coerce you in any way to continue with therapy if it’s not a good fit.     

How is talking with a therapist different from talking with a friend or close loved one?  The truth is, there is no other relationship like the one you might have with your therapist.  Here, you are greeted by him or her, asked to sit down and for about 50 minutes the entire conversation is about you, your process in the present moment and your needs as a unique human being.  Your therapist offers an objective, trained perspective on what is happening in the moment and in your life.  Sometimes they offer advice.  Other times they help to guide you into arriving at your own conclusions or truths, a process by which you learn a great deal that stays with you for the rest of your life.  Many times, simply being encouraged to be completely honest with oneself, and the act of verbalizing it in the presence of another, can be life-changing in itself. 

Now, is therapy worth the price?  In many cases, that depends on what price you would put on your happiness.  In other cases, it depends on the price you might put on increased self-awareness, better relationships, a better sense of self or more confidence.  Keep in mind that there are many good therapists available (especially around Los Angeles) at low-fee counseling centers or who see patients on a sliding scale.

I will close with this:  Therapy is meant to be an experience in itself.  Some people need it at certain times in their life, and some of us treat it as we would a college education—it is a profound experience that will likely benefit us for life, and at any given point we might be ready for it.  As we go about our busy lives, therapy is a time in the week to dedicate to the self, and to the growth of the self.  The best part is, no one can ever take away what is experienced and learned in your therapy, (and no one ever has to know if you don’t want them to!)  











Eating Disorders in Gay Men:  Factors that increase vulnerability (2011)


We know there is an overrepresentation of eating disorders in gay men, as gay men are more than twice as likely to suffer from eating disorders as straight men.  This article highlights much of Miles Cohen, M.D.’s article on the topic, which examines factors that make this sexual minority vulnerable to taking unhealthy measures to achieve the ideal physical appearance. 

The message to men in the media is loud and clear:  ‘you must have a defined chest, washboard abdominals, and practically no body hair in order to be successful, accepted and loved.’  The preoccupation with this stereotypic masculine image is no different from the preoccupation with the almost-too-slender look idealized by most women. 

Whereas an estimated 1 in 4 women will engage in disordered eating to try and lose weight or body mass, the focus of gay men tends to be overexercising and cutting caloric intake to a dangerously low level in order to burn fat and maintain sculpted muscle.  So, why do gay men strive for an exaggerated “masculine” appearance? 

Dr. Cohen poses that low self-esteem, in addition to lacking a sense of control over one’s life are the major factors contributing to eating disorders.  Although it is 2011 and “times are changing,” gay men have always been and still are marginalized, feeling less-than for living in a “straight world.”  Therefore, low self-acceptance seen in the form of internalized homophobia can be nearly impossible to overcome.  In a “straight” world, gays are often viewed as bad, unusual, shameful, or sinful, and these feelings are therefore directed at the self.  In order to raise one’s feelings of self-worth, especially in the gay community, physical appearance is the first personal quality to be manipulated. 

In gay communities, it is quickly learned that “appearance-oriented criteria determine the amount of acceptance, understanding and positive regard one receives.”  Thus, a better appearance leads to more attention, recognition and sexual feedback, which the gay man with low self-worth so needs or desires. 

I thought the notion interesting that perhaps subconsciously, in an effort to distance themselves from a “weak,” or classical “sissy-boy” stereotype, gay men strive for a masculine physique to suggest masculinity and hence, competence and ability.  This physique might also be strived for in order to distance themselves from illness associated with the HIV era, since muscularity is thought to automatically connote good health. 

What can be done to help?

Education is most likely the best strategy for prevention and early detection of eating and body image problems.  Because “working out,” even to excess, is culturally lauded, most gay men do not seek treatment for their difficulties.  Specific education focusing on gay men’s struggles would be especially helpful, given a chronic sense of sub-par acceptance from society. 

If the gay media were to portray a variety of body types as being culturally acceptable, then perhaps gay men and gay youth would be deterred from developing negative eating and exercise habits.  Ultimately, with greater self-acceptance, gay men are more likely to lead healthier, more balanced lives.       



Cohen, M.  2011.  National Eating Disorder Information Center:

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