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Gay Men & Validation Dysphoria

As a psychotherapist in West Hollywood working primarily with gay men, there are certain themes that I see over and over in my practice. Probably the most common is the constant need, and never ending chase, for validation.

This has become such a common theme in my work that I’ve come up with my own term to describe it: validation dysphoria.

Symptoms of this experience include:

Constant craving for the approval of others
Dependence on external validation to maintain self-esteem
Chronic feelings inadequacy and low self-worth
Social anxiety
Lacking authenticity in personal relationships

Folks with validation dysphoria hold the belief that they are not worthy unless they receive constant praise from others. They simply confuse positive attention from others as proof of their self worth.

Most gay men understand where this comes from. We’ve grown up believing that who we are inherently is not enough. Then, as out gay men, we’ve been brainwashed to believe that our self worth is entirely dependent on how we look and how successful we are.

Trying to sustain self worth becomes a never ending chase for more and more validation. But with a hole at the bottom, your cup is only ever full for a fleeting moment before you are left feeling empty and depleted again. Validation gives you a momentary fix, a temporary high. But it quickly fades. The truth is any validation we receive is only very temporarily potent. You might receive lots of attention at your local gym on a Tuesday, only to be met with barely any notice at all on Wednesday. As the validation comes and goes, so does your self worth. If several handsome guys flirt with you, you are worthy. If they don’t, you’re not.

While this experience is most pronounced among other gay men, validation dysphoria can show up at work, with friends, with families, etc.

The best way to debunk validation dysphoria is to realize that the ultimate validation you need can only come from yourself. Once you are clear that you see and value all parts of yourself—both good and bad—you’re free. You no longer need validation from others to feel good about yourself. Will validation still feel nice? Of course. But it will just be icing on the cake. Not an essential ingredient you need to survive.

Convincing clients to give up long standing belief systems about their self worth is no easy feat. Although validation seeking is a very unsuccessful way of sustaining self esteem, it is a method. I’ve found that, although it's torturous, many people don’t want to let this strategy go.

I’ve found that the most confident, secure people I’ve come across simply don’t depend on others to feel worthy. They’re already found a sense of self-acceptance from within. That’s the task that all of us must do to finally be free of validation seeking.

What's Causing My Depression?

That's the question many people want answered when they come to therapy. Or rather, they want to know, what's causing my depression? IT will take some dedicated time with a mental health professional to determine your exact causes. For now, generally speaking, these are Several factors can play a role in depression:

Biochemistry: Neurotransmitters like dopamine, norepinephrine, and serotonin play crucial roles in regulating mood and emotions. Imbalances in these chemicals can be associated with depressive symptoms. Genetic factors can also make individuals more susceptible to depression.
Social Disconnection: Human beings are inherently social creatures, and strong social connections are essential for our emotional well-being. Isolation or a lack of meaningful social relationships can lead to feelings of loneliness and sadness, which are often linked to depression.
Environmental Factors: Exposure to adverse life events such as trauma, violence, neglect, abuse, or living in a stressful or impoverished environment can increase the risk of developing depression. These experiences can contribute to emotional distress and disrupt one's mental health.
Negative Schemas: Cognitive Behavioral Therapy (CBT) highlights the role of negative thought patterns and core beliefs in depression. Negative self-perceptions, such as feeling "worthless" or "hopeless," can influence behavior and further contribute to depressive symptoms. CBT aims to challenge and reframe these negative thought patterns.
Existentialism: Some therapeutic approaches emphasize the importance of finding meaning and purpose in life. A lack of a clear sense of purpose or existential crisis can lead to feelings of emptiness and despair, which may be associated with depression. Cultural and personal beliefs about the meaning of life can also influence this aspect.

It's important to note that these factors often interact and overlap. For example, a person with a genetic predisposition to depression may be more vulnerable to its development when exposed to adverse environmental factors. Therapy and treatment for depression often involve addressing these various factors to develop a holistic understanding of the individual's experience and to create an effective treatment plan. Additionally, the specific causes and experiences of depression can vary widely from person to person, making it essential to tailor treatment approaches to individual needs and circumstances.

Understanding 'Radical Acceptance'

"Radical acceptance" is indeed a concept rooted in various forms of therapy and mindfulness practices, particularly dialectical behavior therapy (DBT). It involves embracing reality as it is, without judgment or resistance. Here's a breakdown of the key points:

Complete Acceptance: Radical acceptance involves accepting something from the core of your being, acknowledging it as a real part of your life. It's about letting go of the struggle to change or deny what has already happened or what is happening.
End of Resistance: By accepting reality as it is, you stop fighting against it. This cessation of resistance can lead to a reduction in emotional suffering because much of our suffering arises from our resistance to what is.
Non-Agreement: Radical acceptance doesn't mean you agree with or condone a situation or action. It's not about saying that something is right or wrong. It's merely recognizing the objective reality of the situation without passing moral judgment.
Suffering Reduction: The idea is that while pain is an inevitable part of life (physical, emotional, or psychological), much of our suffering is a product of our mental resistance to that pain. Acceptance allows us to experience pain without adding unnecessary suffering.
Problem Solving: Paradoxically, once you fully accept a situation, you are in a better position to decide how to handle it. It opens the door to constructive problem-solving because you're not clouded by emotional turmoil.
Serenity Prayer: The Serenity Prayer is often cited in discussions of acceptance. It encourages individuals to discern between what they can change and what they cannot, emphasizing the need for acceptance when change is not possible.
Existentialism: Existentialist philosophy acknowledges the inherent suffering in human existence but suggests that individuals can find meaning and purpose in their suffering. It's about recognizing that life's challenges can be opportunities for personal growth and self-discovery.

In summary, radical acceptance is a therapeutic and mindfulness practice aimed at reducing emotional suffering by embracing reality as it is. It doesn't imply agreement with or resignation to difficult situations but rather a way to clear the path for effective problem-solving and personal growth. Existentialism, on the other hand, invites individuals to contemplate the meaning and purpose they can derive from the inevitable pain and challenges of life.

What are Sexual Templates?

Sexual templates, also known as erotic templates or sexual preferences, refer to the unique set of characteristics, scenarios, and stimuli that individuals find sexually attractive or arousing. These templates encompass a wide range of factors, including physical, emotional, and intellectual attributes that influence an individual's sexual desire. Here's a breakdown of key points related to sexual templates:

1. Physical Attributes: These can include features such as height, body type, age, facial features, hair, and more. People often have specific preferences for certain physical characteristics in their sexual partners.

2. Scenarios and Activities: Sexual templates can also involve specific scenarios or activities that individuals find arousing. This can range from exhibitionism and voyeurism to BDSM, role-playing, or other sexual practices.

3. Fluidity of Sexuality: Contemporary views of sexuality acknowledge that it exists on a fluid spectrum rather than rigid categories like gay or straight. Concepts like the Kinsey Scale highlight the diversity of human sexuality and attraction.

4. Flexibility of Preferences: People vary in the flexibility of their sexual preferences. Some individuals have rigid and unchanging sexual templates, while others are more open to exploring a wider range of desires and partners.

5. Development and Change: Sexual templates typically develop during childhood and adolescence and become relatively fixed by the time of puberty. However, they can change or evolve over time due to various factors, including personal experiences and exploration.

6. Illogical Nature: Sexual templates don't always align with logic, and individuals can develop desires and interests that may seem unconventional or counterintuitive, such as eroticizing punishment, which can lead to an interest in BDSM.

7. Origins: The origins of sexual templates are not fully understood. They can be influenced by a combination of genetic, environmental, cultural, and personal factors, making them unique to each individual.

8. Sex Positivity: One goal of sex-positive approaches is to reduce shame and stigma associated with sexuality. This includes acknowledging and accepting diverse sexual preferences and desires as long as they are consensual and safe.

9. Substance Use: Substance use can impact sexual desire and behavior. Some substances may lower inhibitions, leading individuals to act on desires they might have been hesitant to explore otherwise. However, this can also lead to later feelings of shame or regret.

10. LGBTQ+ Experiences: Many LGBTQ+ individuals may face unique challenges in developing their sexual templates due to societal stigma, discrimination, and the need to navigate their own identities and desires in a heteronormative world.

11. Emotional Needs: Beyond physical pleasure, sex can also fulfill emotional needs such as connection, intimacy, a sense of importance, and a feeling of joining or belonging.

12. Therapeutic Exploration: In therapy, individuals may explore their sexual templates to better understand their sexual desires and histories. This can include examining when and how different aspects of their template developed and how substances may have influenced their sexual experiences.

It's important to note that sexual preferences are diverse and can vary widely from person to person. What matters most is that sexual activities and relationships are consensual, respectful, and safe for all parties involved. Therapy can be a helpful space for individuals to explore and understand their own sexual templates in a supportive and nonjudgmental environment.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a widely practiced and evidence-based therapeutic approach that focuses on helping individuals identify and change dysfunctional thought patterns and behaviors. Your description provides a comprehensive overview of CBT principles and techniques, but I'll break it down further:

1. Perception and Thought Patterns: CBT recognizes that our thoughts and perceptions significantly influence our emotions and behaviors. It emphasizes that our thoughts are not entirely our own and are often shaped by various factors like family, trauma, culture, and life experiences, especially during early childhood (ages 0-7).

2. Modifying Thought Patterns: CBT aims to facilitate change by modifying dysfunctional thought patterns. It helps individuals become aware of negative or irrational thoughts and beliefs and replace them with more accurate and realistic ones.

3. Structured Approach: CBT is known for its structured and methodical approach to therapy. It involves setting clear goals, identifying specific thought patterns and behaviors to target, and using various techniques to address them.

4. Thought-Emotion-Behavior Connection: CBT recognizes the strong connection between thoughts, emotions, and behaviors. It teaches individuals that their thoughts can lead to immediate emotional responses and that changing thoughts can subsequently change emotions.

5. Re-framing: One of the key techniques in CBT is re-framing, which involves looking at a situation from an alternative and more balanced perspective. This can help individuals challenge their negative or distorted thoughts.

6. Behavioral Change: CBT also emphasizes the importance of changing behaviors to influence feelings and thoughts positively. The concept of "acting your way into new thinking" suggests that taking positive actions can lead to changes in thought patterns.

7. Health and Wellness: CBT recognizes the impact of health and wellness factors like sleep, hygiene, diet, and exercise on mood and mental well-being. It often incorporates behavioral interventions in these areas to improve overall mental health.

8. Exposure Techniques: CBT utilizes exposure therapy and systematic desensitization to help individuals confront and manage anxiety and phobias. Exposure therapy involves gradually and repeatedly exposing individuals to feared or triggering situations to reduce fear responses.

9. Breaking Negative Cycles: CBT addresses the tendency to reinforce negative thought patterns through behaviors such as avoidance. By encouraging individuals to face challenging situations and develop coping skills, it aims to break these negative cycles.

CBT is known for its effectiveness in treating a wide range of psychological issues, including anxiety disorders, depression, obsessive-compulsive disorder, and more. It provides individuals with practical tools and strategies to better understand and manage their thoughts and emotions, ultimately leading to improved mental well-being and behavior. CBT is typically delivered in a structured, time-limited format by trained therapists.

I'M SOBER... DO I NEED THERAPY TOO? FOUR WAYS PSYCHOTHERAPY CAN STRENGTHEN YOUR RECOVERY

A sober friend of mine recently asked me, “I already spend so much time working on myself . . . do I really need more help?” A lot of people come into our clinic who have already gotten sober through a 12-step program. AA and other forms of community-based recovery can be extremely helpful. However, many sober people often struggle with issues that require specialized treatment. This is where psychotherapy can come in. But there is often confusion about what exactly therapy is and how it can help. If you are already in a 12-step program here are four ways therapy differs and can enhance your recovery:

1. Getting Professional Help

According to recent research, about 42% of people with an addiction also struggle with a mood disorder, such as depression. In fact, substances are often used to self-medicate the symptoms of these disorders. Psychotherapists undergo years of rigorous training to treat these conditions, so therapy can reduce your need to self-medicate.

2. Getting an Objective Point of View

Unlike a sponsor, a therapist can offer a more objective perspective because they are not personally involved in your daily life. Of course, your therapist cares about helping you feel better, but your relationship with them will not extend beyond the therapy room. You will meet with a therapist typically once or twice a week, usually for 50 minutes sessions. You will see them in the same place, at the same time to help create a sense of structure and routine. Therapy is confidential. More than that, you will interact with your therapist in a contained, controlled place—outside of your everyday life.

3. Therapy is Designed to Help You Understand Yourself

People often say “AA is a program of action” because twelve-step programs focus on helping you change your behaviors. Well, therapy is a bit more complicated. In therapy the focus is typically on understanding why you behave in a certain way. At its best, therapy also helps you understand your unconscious mind, and why you to avoid certain feelings or issues. Through therapy you gain insight into how you perceive yourself, how you relate to others, and how your emotions work.

4. Therapy + 12 Step: A Great Collaboration

More than anything, psychotherapy does not replace the need for your 12-step program. In fact, I would never suggest anyone quit AA in favor of therapy. 12-step programs offer valuable tools that can strengthen the usefulness of therapy. Similarly, psychotherapy can complement and enhance the important work you have already done, and continue to do, to better yourself.

Treating Chem-Sex in the LGBTQIA+ Community

With chem-sex, we see a unique presentation of symptoms, behaviors and triggers that clinicians must understand in order to provide proper treatment. Chem-sex is particularly pervasive in the LGBTQIA+ community. Over the past couple of decades, there is a growing problem of chem-sex with gay cis men who use crystal meth in particular. While many therapists are well-versed in addiction, very few providers are educated on the nuances of this specific presentation. Clients who engage in chem-sex have often developed a bind, where sex and substances rarely exist separately. Therefore, teaching clients to develop a new relationship with their sexuality—one that is absent from any exogenous substance—is a complex task. Clients will need help identifying their sexual ideals, and differentiating healthy from unhealthy sexual behaviors. They will need to address underlying shame that drives the need to engage in chem-sex in the first place. And finally they will need community support to remain accountable and committed to their recovery. Lastly, therapists will need to manage their own biases and reactions as they navigate this work.

Here are my top tips for treating chem-sex:

1. Avoid triggers, such as hook-up apps.

2. Find a therapist who specializes in chem-sex.

3. Identify healthy & unhealthy sexual behaviors.

4. Create a safety plan, with bottom-line behaviors.

5. De-catastrophize cravings (they will happen).

6. Stay accountable with your support system.

Trauma Therapy in the LGBTQIA+ Community

What is Trauma?

Generally speaking, trauma is an experience that overwhelms one’s ability to cope, leading to severe dysregulation, anxiety, panic, shame, depression, helplessness and dissociation. One often feels as though they are coming apart, fragmented or disembodied. Trauma can be acute (one discrete event, such as an assault) or complex (multiple events that occur and compound over time). There are a lot of other life experiences that can trigger unsettling emotions. While these are important to process in therapy as well, I wouldn’t necessarily consider these instances traumatic unless they meet the criteria above.

Understanding Different Treatments

There are a variety of therapeutic modalities. Traditionally, therapy involves meeting with a therapist once a week and engaging in talk therapy. There are a number of modalities that fall under that category itself (another entire blog can be written about those). Over the last couple of decades, psychologists have developed a number of techniques to treat trauma that are somatically based. Meaning, they focus on working with the body, rather than engaging in a verbal dialog. The most popular modality here is EMDR, which utilizes bilateral stimulation (such as alternate tapping on each side of the body) to process traumatic memories.

Queer Trauma

Queer trauma refers to any discrimination, harassment, or even violence you encountered as a result of being LGBTQ+ identified. From my perspective, all queer people experience some of minority stress. For some it’s relatively mild, and for others it can be quite severe. Regardless of your background, I would argue that we all receive messaging from culture, family, friends, etc. that being LGBTQ+ is somehow less acceptable than being heterosexual and cisgendered. This chronic negative messaging can become internalized, leading to what we call internalized homophobia (or biphobia, transphobia, etc.)

LGBTQ Affirmative Treatment

Having a therapist who identifies as queer, or a highly educated ally, is essential. It is imperative that therapy addresses all parts of you—especially the parts that have already been wounded. It is not enough for therapists to simple passively accept you, your sexual identity and your gender identity. They must actively affirm and celebrate you. I always offer to my clients: if you have to leave a part of yourself at the door, you are in the wrong room.