There are times in my psychotherapy practice with gay men (individuals and couples) when I’m working with an individual, and the subject of the client’s partner comes up, and how the partner feels about his partner (my client) being in therapy. The apparent reactions (well, at least according to my client’s reports of them) are varied. Some partners support that their partner is in therapy, and some don’t. The reasons for this can be varied.
I think sometimes partners find the role of the therapist as being somehow undermining to them, almost like a jealousy that the “professional intimacy” of the therapist-client relationship somehow threatens the “personal intimacy” of the client’s relationship with his partner. When everyone is a gay man in the situation, it’s not hard to imagine the social dynamics, even more so when we’re all near in age. Gay male dynamics (just like any group of men) can be instinctively competitive. It can feel like one giant three-way, especially when there are sex therapy topics that the work is about. But during the time you’re doing “the work”, the therapist joins, in a professional way, the dynamics of the couple long enough and close enough to support your household before he departs when the course of work is finished (which kind of sounds like Mary Poppins).
Another issue that comes up is that of boundaries and how couples handle them. Do you think that you, as a person in relationship, have the right to your own therapy where you don’t really talk about it much with your partner, or do you feel a need to “report” the content of your therapy sessions to your partner the minute you get home? Even if we just look at gay male couples, there will be variations on this.
I always say, when I do couples therapy, that a relationship has to work on four levels: 1) the emotional; 2) the physical (including your sex life); 3) the domestic (running a household together, including chores and finances, without killing each other); and 4) “managing The Other”, which means coping with forces and influences outside the relationship that somehow can be a strain on or within the relationship – a homophobic society, an intrusive ex, an intrusive in-law, a demanding job, an illness or health condition, an environmental issue (like noisy neighbors or an unsafe neighborhood, or living in a house with a leaky roof); or interlopers (flirts in your circle who are would-be homewreckers, given the chance). I have a whole article on this, here. So, then, is your seeing a therapist when your partner isn’t a part of #4, “Managing The Other”?
The role of a therapist in your relationship is obvious if you’re seeking couples therapy together, but what if only one of you is having individual therapy? This first starts with either you or your partner recognizing that you (or him, but let’s stick with “you” for now) have a problem for which having a course of psychotherapy is indicated. They say the first step toward solving a problem is recognizing it, so if you two have talked, or even if you have done some soul-searching and have decided you want therapy, this is a very personal and sensitive decision. You want your partner’s support, but even if you don’t get it, if you decide that having therapy is important to you, I think it’s important for you to get it. And you see, even my just saying that, I have become “The Other” in your relationship as your therapist, because when I work with a client, I affirming their rights as an individual, even if they are in a relationship. As I often joke with clients, especially being a therapist in Hollywood for many people in entertainment, “I am the agent for your mental health and well-being, and I negotiate top billing for you in your mind.” I encourage my clients to put themselves first, do what they need to do to take care of themselves and to be at their best, even if this means you’re having therapy even when your partner doesn’t approve.
CHOOSING A MODALITY OF TREATMENT
Often in couples therapy, we talk about cultural differences in the relationship. It’s not that cross-cultural gay couples have more problems; rather, I think that because this is Los Angeles, I see a lot of cross-cultural relationships in many older/younger, Black/White, White/Asian, Latino-White, etc. combinations (one would think I would see a lot of Top/Bottom combinations, too, which I do, but I also see a number of Top/Top and Bottom/Bottom couples, which can present their own challenges (by the way, I always say, Top and Bottom is something that you DO, not something that you ARE – these things are malleable, over time). But generally speaking, White guys tend to be culturally “prepared” to see therapy as valuable, whereas African-American guys and Latino guys sometimes were raised in families where you kept “family business” within the family, and the use of “outside” people like therapists was seen as “not done” (this is changing for younger generations, though). So, it can be difficult for you to take the time, money, and effort that undergoing therapy requires if your own partner doesn’t “believe in” or approve of therapy. This can take a lot of education about what therapy is (or, more likely, what therapy is NOT) from you to him, which can be a source of conflict in your relationship. Every couple has to discuss and determine where the boundaries are going to be about how much – or how little – you talk about your therapy at home.
Sometimes when I meet with a client for the first time, we have to have a discussion about what therapists call the “modality” of treatment. Will it be individual therapy for you, individual therapy for him, couples therapy for the both of you, or some combination of these? Often, I will see a couple and then refer out for individual work, but there are exceptions to this (such as if a couple is having a lot of arguments, and one partner in particular has an issue with anger getting out of hand, I might provide a brief course of psycho-educational Cognitive Behavioral Therapy for Anger Management techniques). But usually, the primary therapist is the “case manager” for the couple, and then makes referral recommendations to trusted colleagues (such as other therapists in the practice, or whose expertise he knows/trusts) for additional work for either partner. When discussing a problem in your household, consider your options for modalities, and if you get stuck, bring the issue to a couples therapy session. Too often, you might hear from your partner, “We have a problem in this house; it’s mostly you; so YOU go to therapy and change.” This is usually not the case. You have to look at the whole system, and how each of you contributes to the conflicts at home.
OTHER RESOURCES
When you’re discussing problems in your home, therapy (individual or conjoint) is certainly an option, but there might be other community resources in addition to, or in place of, therapy. Does one of you need career coaching (I do this often, but not all therapists do)? Could the problem in your house be better solved by consulting a spiritual advisor about an existential dilemma (such as assisted suicide in a terminal illness)? Do you need a consultation with a lawyer (such as in preparing a pre-nuptial agreement, will, or trust)? Do you need a nutritionist (such as for a weight loss issue)? A physician for a health problem (such as urologist for erectile dysfunction)? A personal trainer for a body composition/esthetics issue? A gay-savvy financial planner (such as the wonderful David Rae, CFP, who has his own terrific blog)? Does one of you need to attend substance abuse rehab, or 12-Step meetings, or 12-Step alternatives like SMART or Moderation Management? There is a saying in clinical social work (which is my discipline, and also what I teach at USC) that for every challenge/problem we face, there is an antidotal resource that will help. Think about the problem in your house, and think about the resources (the professionals) who can help – a therapist, sure, or perhaps others in addition to (or in place of).
BUDGETING THERAPY
It’s important to discuss the household budget for therapy. Therapy isn’t cheap, nor should it be. Therapists in California have to have many years of higher education, which is high school, a college undergraduate degree, and 2-4 years (sometimes more) of graduate work in clinical social work, psychology, or counseling, as well as over 3,200 hours of supervised clinical work, additional course work, then two state licensing exams, then more educational courses every two-year license renewal period, in addition to significant overhead such as an office, furnishings, utilities, insurances, office supplies, self-employment taxes, insurances, advertising/marketing, and many other overhead expenses, in addition to making a living at home. So in order for private-practice therapists to even be available in the community, the fees are necessarily high. But you also have to consider the cost of “not” doing therapy, which means that a problem that one (or both) of you has either doesn’t get better, or, more likely, gets steadily worse. Most couples determine that the investment in therapy for the short term pays off in the long term with resolved (or at least mitigated) challenges. Discuss therapy in the context of other household expenses, including luxuries. Some couples will cut back on leisure travel or home furnishings in order to solve the problems at home, and I think that’s wise.
HOW MUCH TO ASK/TELL
How much you discuss your therapy with your partner is a matter of choice. Some couples are so estranged, they don’t talk about much together. This can be a problem. But other couples are so unhealthily enmeshed that you feel a compulsion to practically give a transcript of the session to your partner when you come home: “What did he say about this? What did he say about? Did he say you’re bipolar? I say you’re bipolar. Did he agree? Huh? Huh?” That kind of thing really isn’t necessary, from him or you. However, if the therapist’s intervention for you that day was that you need to have more time to yourself, ask your partner to respect this when you get home: “Ken said I need to identify one time in the week where I just relax by myself. I think I’m going to start doing yoga every Thursday night. I’d really like you to support me in that.” Sometimes, your own partner has a role in supporting your short-term cognitive or behavioral goals that you have identified in therapy, and support at home can be an adjunct to reinforce these goals.
If you’re working on bettering yourself, your partner needs to understand that therapy is a process, not an event. You don’t have to be in therapy forever, but you also have to have realistic expectations. If there is something you’re trying to change in yourself for the good of the relationship (such as remembering to do your share of household chores and not just leave everything to your partner to do), then you might have “good days and bad days” and you need reinforcement from your partner when things go well (“Hey, honey, you’ve done great at following through on promising to take the trash out half the time”) and you might need reminding for others for sustained behavioral change that you both want (Hey, honey, I thought your therapist said your goal this week was to do your share of taking the trash out. That hasn’t happened this week. Can we agree that we will split this chore evenly?”). While it’s not really necessarily your partner’s job to reinforce your goals in therapy, both your therapist and your partner are your allies for social support toward positive life changes.
If you’re an abuse survivor or a trauma survivor, and you’re working on this in your therapy, your partner might need to understand that you might get a little worse before you get better, because you are “working through” traumatic memories in session that might “carry over” to life at home. Your partner needs to understand that not everything about you is about him; some things are “your stuff” that come from your Family of Origin a long time ago, and you just have to work them out over time in your course of therapy.
When I work with clients on assertive communication skills, I’ve had a quite a few partners curse me in absentia because suddenly the partner they’re used to walking all over develops a real spine. Well, too bad. You have a right to have your needs met in a relationship 50/50 with your partner, and if you evolve from doormat to empowered individual, then he’ll just have to get used to it. Don’t abuse the assertive communication and run roughshod over your partner, but at the same time, if he has some discomfort just because you’ve learned to speak up for your own needs, that’s too bad. If he can’t handle that, it may be time to re-evaluate if that relationship is right for you. Good partners can tolerate their partner appropriately asserting their needs without getting defensive.
There is a philosophy of therapy that discusses systems, and how systems interact. When you have both a partner and a therapist, the business-as-usual dynamics at home might need to change, and perhaps the relationship that you have with your partner and with yourself. When necessary, you might bring your partner into your therapy for a one-time conjoint session, if you don’t need couples therapy on an ongoing basis, just so your therapist and your partner can support your treatment plan process. But if that would feel like an “invasion” of your private time, then leave him at home. Think about your goals in therapy, discuss them with your therapist, and discuss what role in your therapy, if any, that your partner might play. The goal in most therapy is to have positive outcomes, which really only you can define. Set yourself up for success from the beginning of your treatment.
For help with relationship issues, personal issues, or any life challenge, consider having counseling or coaching sessions. To do this with me, call/text 310-339-5778 or email Ken@GayTherapyLA.com. The resolution of problems requires rallying the resources to address them, and seeing it through to a better state of mental health and well-being.
