Working with couples has become a sincere interest for me.  I have  completed Advanced Training from the Gottman Institute in Seattle, Washington, which has conducted therapeutic, assessment, and intervention research on couples and relationships since 1975.  In addition to straight married and non-married couples, Dr.  Gottman’s research and results have also been applied to gay and lesbian couples.   I have experience working with all types of relationships, including “mixed-orientation” marriages, with the understanding that each relationship is unique and that treatment is tailored accordingly.

If hearing the term “mixed-orientation” is unclear, a brief explanation might be helpful.  It isn't about marriages of different races or religions, but about a marriage in which one person is gay or lesbian, and the other person is straight.   We could also call it “gay/straight” marriages.  While gay couples have become more and more open in terms of accepting their sexual orientation and “coming out” to others, those who are in a mixed-orientation relationship are much more closeted.  When a gay spouse agonizes about disclosure, determining how to resolve the predicament can be petrifying.  Upon divulging one’s homosexual orientation, profoundly traumatic issues for both partners usually arise, including loss of trust, depression, betrayal, shame, how or if to inform the children (if any), whether to remain together or depart, etc.  Due to the delicacy and sense of vulnerability experienced by those suffering from this marital condition, I have become passionate about working with partners in this type of relationship, in order to help them address their dilemma and make the most comfortable decision about how to proceed.

Abandonment-related issues and their treatment have been researched for over 25 years by author and workshop facilitator Susan Anderson.  Abandonment is most easily described as our “primal fear” and “universal wound,” and includes an extensive array of symptoms, including unworthiness, insecurity, shame, emotional hunger, feelings of annihilation, self-sabotage, chronic emptiness, and repeated feelings of trauma.  These symptoms are just an inkling of the emotions that those with a history of abandonment encounter.  Some of the behaviors that emerge as a way to deal with these feelings include dependency and co dependency issues in relationships, setting ourselves up for re-abandonment, and even self-medication through food, drugs, or alcohol. 

I facilitate Abandonment Recovery Support Groups, which are highly beneficial because they not only put you in contact with others who understand your struggle, but will lead you through the process as outlined in Susan Anderson’s workbook entitled “The Journey from Heartbreak to Connection.”  As the author states, “Abandonment recovery offers a way to pick up the pieces, end your self-sabotage, and increase your life capacity.”

BDD is a psychological issue that has been described by professionals as a “disorder of imagined ugliness.”  It stands for Body Dysmorphic Disorder and is a disorder characterized by a perceived defect or a minor flaw in one’s physical appearance that is obsessively worried about and compulsively checked, to the extent that it causes clinically significant distress or impairment in one’s social life, work life, or other areas of daily functioning.  Although the official psychological diagnosis has been around for several years, it is often under-diagnosed or misdiagnosed by professionals due to lack of familiarity.  Not all people who suffer from BDD seek repetitive surgeries to fix their perceived defect, but many do.  If you have been pre-occupied with thoughts about some area of your physical appearance, have sought several treatments, assume that people notice it and make fun of it, and sometimes restrict yourself from being comfortable in public, these might be some signs that you may be suffering with BDD.

You might begin by asking yourself a few questions.  Are you pre-occupied with your appearance for at least an hour a day?  Are you feeling distressed about the fact that you are pre-occupied with your perceived defect?  Are you wanting to look beautiful, or do you just want to look normal so that you don’t feel you’re being highlighted and observed in public?  Did your surgeon imply hesitation about an additional procedure because the perceived defect is too minor, or that he or she is afraid you won’t be pleased with the results?   These are just some initial questions to ask yourself.

Often people with BDD are ashamed about their physical pre-occupation and therefore don’t want to seek help from mental health professionals.  They are more likely to seek help from dermatologists and cosmetic surgeons rather than psychologists and psychiatrists.  A mental health professional who is familiar with BDD symptoms can provide screening and testing to help determine whether or not this is a diagnosable problem.    

The good news is that there are some effective treatments for persons who have been diagnosed with BDD.  Anti-depressant medications such as serotonin-reuptake inhibitors, or SSRI's, are often very helpful for BDD.  They are not habit forming and are usually well tolerated.  A certain type of therapy called cognitive-behavioral treatment, or CBT, is also often helpful for BDD.  These two types of treatment have shown some significant improvement regarding symptoms and overall functioning.

Performance anxiety, or “stage fright", can create fear in many people and in many situations, such as public speaking, social communication, public appearance, athletics, intimacy, and artistic performance.  For example, symptoms such as shakiness, trembling, sweatiness, dry mouth and distraction can interfere with thinking and behavior, propelling musicians to lose focus on technical performance and begin to panic about their ability to continue.  While some performance anxiety puts us in a fight or flight mode, it can also put us in a “freeze” mode.

The source of performance anxiety can be in one’s performance history, whether it occurred during an audition, a live stage performance, or even a piano lesson.  Performance anxiety can also be influenced by one’s family or social history:  perhaps excellence was expected in several areas of childhood development from family members, teachers, religious authorities, or friends.  Or perhaps criticism was integrated into our self perceptions as being inept or inferior.  There are a variety of reasons for how performance anxiety might accumulate over time.  Unfortunately, it can affect people with outstanding talent, which adversely interferes with their ability to share their gift with others.

Performance anxiety can be eased if the therapist has an understanding of what the symptoms are and how they were “installed.”  This relates to family of origin issues, our social culture, knowledge of our “mind state” (which includes physiology, thoughts, attitudes, behaviors, and emotions), and helping  separate performance and identity.  A personal example may be helpful:  for many years I felt that my self-expression through music was the very best part of me.  Therefore, if I didn’t perform perfectly, then I wasn't a perfect person.  Combine that belief with a fear of being judged, and performance anxiety was strongly created!  Having struggled with this myself, I can now help others master their own performance anxiety.