Monthly Archives: June 2016

The Trauma Currency, Part Two

(Continued from part one)

Cermak’s intent was to present codependency as a legitimate focus of clinical attention, applicable to a variety of contexts. And so we have the Co-Addict Model, which draws attention to problematic behavior as a function of an underlying, pervasive disorder. While RT adherents may agree with aspects the co-addict corollary, their clinical focus downplays the pathologizing accent. Coping strategies, such as keeping busy with tasks, are instead normalized, cast as affect regulating under exceptional circumstances. Certain behaviors such as indiscriminate sharing of a sex addict’s behavior with friends or family, including children, are discouraged; however, these behaviors are framed as products of social isolation and episodic trauma brought on by an addict’s behavior, not an underlying or even associated pathology. The notable literature that represents this position includes Your Sexually Addicted Spouse (Steffens, Means, 2009), and Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts (Carnes, et al., 2012): the latter, in keeping with recovery tradition, outlines a healing process in stages: a pre-discovery stage, followed by phases of crisis/decision, and repair. In the crisis/decision stage the partner asks, “how did I get here?”, and comes to realizations like, “nothing in this marriage has been real”. Note the emphasis upon present or recent past events, not family of origin, early developmental or even adult developmental material.

The framework of RT appears to contraindicate a neutral therapeutic stance, becoming partner-centric, especially upon discovery of sexual betrayals, because the proposed de-pathologizing shift only applies to partners. There’s nothing in the RT paradigm that contests the assessment of sexual addiction. Indeed, the scope of questions for the revised version of the Sex Addiction Screening Test (or SAST) has widened in recent years, to address not only changes in technology—the broader means of acting out available to sex addicts—but also the impact upon partners of sexual betrayals. Notice, for example, a question on the 1989 version of SAST, “Does your spouse ever worry or complain about your sexual behavior?” (Carnes, 1989), versus a question on the revised 2008 version: “Has your sexual behavior ever created problems for you and your family?” Notice the slant has shifted to query problems identified by the would-be addict, instead of that which is externally identified by a partner whose perspective might be denied by the would-be sex addict, or distorted by a co-addict disorder.

The RT model calls for sex addicts or acting out partners to be identified as perpetrators of trauma, and this term—“perpetrator”—seems close enough to the connotations of “offender” that observers may be surprised that APSATS hasn’t called for the inclusion of more sex addicts on public sex offender registries. In the RT model, partners are validated as victims of a relationship-specific betrayal, and thereafter supported to integrate this experience in a way facilitates a healthy re-emergence in life, comprised of self-care, fellowship with a strong support system, realistic observation of sex addict behavior, but also renewed trust in humankind. The approach suggests that observation of predisposing pathology and validation of traumatic experience are mutually exclusive goals, which may lead to facile, short-term interventions, tailor made for practitioners presenting brief, intensive programs of care. While this may be an appropriate shift in the paradigm with respect to many partners or with all partners of sex addicts in the immediate aftermath of discovery, I wonder about the pathology that will be overlooked in the service of trauma validation, especially amid follow-up treatment episodes wherein identified-patient premises collapse over time.

In cases of sexual betrayal, a therapist working with acting out and non-acting out partners functions as a container for memories and emotions that cry out for expression, or disavowal in the case of those struggling to cope with the past. This Winnicottian task dovetails with reparation efforts—a Kleinian concept before a sex addiction treatment strategy—which hinges upon individuals’ capacity for mourning. Klein (1975) wrote that grievances we harbor towards parents for the wrongs they have committed, and for having denied those wrongs, elicit feelings of hate and desire for revenge. Durham (2000) has argued that the capacity for making reparations in the internal world is the basis on which empathy for others is established. When individuals defensively split, they attach to a narrowly defined narrative: therefore (borrowing the RT Model identifiers) a victim’s anger and hatred is rigidified in the face of a perpetrator’s denial, which represents an evil system built upon a primitive intrapsychic structure. A working through of splitting, into mourning, requires the perpetrator to own his destructiveness so as to experience mourning; then, if the victim is sufficiently open to an awareness of “good enough” qualities in the perpetrator, a re-internalization of that individual as a good object might occur, which in turn enables the victim’s own work of mourning.

Whether or not labels of victim, perpetrator, addict, or codependent are necessary, harmful, or inhibitive of this process seems ambiguous. Assessment and diagnostic nomenclature informs psychiatric intervention; enables the placement of individuals in appropriate levels of care, including hospitals when necessary; generates short and long-term treatment planning goals. Informing patients of their diagnoses gives informed consent to treatment based upon an understanding of conditions that are the focus of clinical attention. At the same time therapists know the stigmatizing risk associated with assessment and diagnostic labels, particularly those whose prescriptive measures are not clearly defined, or subject to a range of treatment alternatives, despite the attempts of some who promote protocols in response to diagnoses. The advisability of informing a patient or client that he or she has a substance dependence, for example, seems predicated on particular factors well understood across professional disciplines, and by the general public: that the problem can be accurately assessed in a short time frame; that prescriptive measures can be readily understood by those potentially receiving services (such as recommendations of abstinence, or attendance at 12-step meetings); that a person may be at grave risk of illness, injury, or even death if immediate intervention does not occur.

Are these factors true with respect to sex addiction, or codependency, or personality disorders? Maybe in some cases, but of the forty five questions on the revised SAST, for example, only one pertains to behaviors that place afflicted individuals in dangerous situations. In my training I learned to refrain from using diagnostic or assessment labels when addressing clients about their problems, unless the applicable term or terms seem critical for intervention, or unless prescriptive measures based upon the nomenclature can be articulated succinctly and concretely. Otherwise, confusion and/or resistance typically follows, with clients left thinly understanding conditions, floundering to make sense of new identities imposed by expert opinion. I often experience this when clients meet with me for the first time, having been diagnosed by a previous practitioner with, say, Narcissist Personality Disorder. They’ve been given an article to read, or a DSM criteria sheet to examine. Afterwards, they exhibit disorientation, manifest with awkward attempts to describe their freshly assigned disorder. When devising a plan, they offer that they need to learn to empathize with others more. Woodenly, they report feeling instructed, and branded, but not understood.

This is often true with individuals who are told they have a sex addiction, or a codependency problem, and while many can wrap their minds around the concept of sex addiction, the assessment still bears much explanation and holding of emotion. As for codependency: from an object relations point of view, that umbrella term represents a whole multitude of dynamic relational configurations, replete with intersecting projections and introjections. So no wonder partners of sex addicts are flummoxed and invalidated by the term, regardless of what betrayals they have felt. Aren’t many or even most shocked to hear that they may have enabled another’s addiction? Won’t many be confused to hear they may have contributed to another’s disorder by an overly close, or conversely, a distant involvement? Doesn’t it jolt the senses, the unconscious, one’s entire being, to hear that one might have a sex addiction, and that an important aspect of that concept is its impact upon intimate partners? Ultimately, what seems important is to hold the idea of a complex problem, brought to light by acting out behaviors, but not reducible to those habits, necessarily. Might it not render the divide between rival models of treatment moot to consider that our clients deserve to not be hamstrung by labels, or denied what is useful in our nomenclature? Rather, they should feel held by our open minds and fuller understanding.

 

 REFERENCES

 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

 Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.

Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.

Carnes, P. (1989) Contrary to Love. Hazelden.

Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.

Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute

David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/

Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015

Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.

Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.

Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.

Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.

 

 

 

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The Trauma Currency, Part One

 

“You didn’t get here overnight,” writes Claudia Black in her 2009 book, Deceived. It’s a solemn lesson, aimed at co-addicts, partners of sex and porn addicts—women, mostly—who are raised in households impacted by addictions of various kinds. Their childhood histories are “training grounds” for adult dysfunctional relationships, wherein such individuals engage in so-called co-addict behaviors: tolerating hurtful behavior, avoiding conflict, taking care of others, accommodating. Black describes a woman named Katy, a “perfect candidate for partnering with an addict”, who becomes compulsive in busy behaviors, attending to her children, her job, avoiding seeing and feeling, the anticipated rejection and abandonment by her sex-addicted husband (Black, 2009, P.85-86).

Profiles like the one above seem conducive to interventions that draw attention to patterns of dysfunctional behavior; patterns that implicitly predate the discovery of addictive behaviors by sexually addicted partners—this is according to adherents of the co-addict model, which is based upon the Al-anon 12-step recovery program. Treatment based upon this model prescribes self-examination for partners of sex addicts: examination of and responsibility-taking for repetitively destructive or self-defeating behaviors; examination of trauma repetitions, reenactments of familial scripts with the unconscious hope of creating new drafts in later life. The idea recalls certain 12-step slogans, such as the supposedly Einsteinian definition of insanity: doing the same thing over and over again, expecting a different result. This too is a derivative notion, echoing Freud’s concept of repetition compulsion, first published in 1914 at the outset of the First World War. The concept of trauma has gradually merged into the lexicon of psychology since then, reaching into or underlying our understanding of several mental health disorders, including addictions.

However, some practitioners and researchers might disagree upon the premises of partners of sex addiction treatment, and therefore differ significantly in therapeutic approach. In “From Victimhood to Victorhood” (published in the March/April issue of The Therapist), Alex Katehakis writes that a “major shift has occurred in treating partners of sex addicts”. The shift she describes is towards the Relational Trauma (RT) Model, in which practitioners emphasize that partners’ relational bonds are destroyed by betrayal, as precipitated by the discovery of sexual acting out—not a historical and ongoing pattern of destructive or self-defeating behavior by non-acting out partners. In the RT approach, practitioners eschew the implication that partners contribute significantly to an addiction by an elaborate, conscious or unconscious pattern of enabling. Such suggestions are misplaced and hurtful, if sometimes accurate, assert the proponents of the RT Model, while their interventions are by contrast comforting and affirming, emphasizing the depth of betrayal by a perpetrating partner. The champions of this position are The Association for Partners of Sex Addicts Trauma Specialists (or APSATS). Their members, as well as those of the hegemonic Certified Sex Addiction Therapist (CSAT) network refer to “sex addiction induced trauma” as a specified subset of a PTSD-like condition.

PTSD-like because while discovery of sex addiction has been deemed a life altering event and has even been demonstrated to be a traumatic event for partners, according to numerous researchers (Bergner & Bridges, 2002; Glass, 2003; Steffens, 2006), each stops short of applying the PTSD diagnosis, suggesting that many or most partners of sex addicts do not meet full criteria for the condition. A resulting controversy seems partly attributable to conflicting language in the DSM-V. Psychologist David J Ley argues that typical partners of sex addicts do not meet criteria of section C of PTSD code F43.10, “persistent avoidance of stimuli associated with the traumatic event(s)”, by pointing out that these partners often demonstrate “obsessive, ruminating fixation on the details of their partners’ betrayals and actions”. He states that the essential features of sex addiction—sexual betrayal, infidelity, lying—do not constitute trauma for partners, however repetitive these behaviors may be, and that describing them as such does disservice to those who need services relating to life threatening events. With respect to the diagnostic question, I observe that language in section E of code F43.10 indicates that “marked alterations in arousal and reactivity associated with the traumatic event(s)” do meet criteria for the diagnosis of PTSD. This includes hypervigilance, which would likely describe the partners Ley discusses in his writing. Perhaps at odds with the criteria of section C, this language of section E suggests that a more concrete understanding of “avoidance of distressing memories”, versus hypervigilance, is called for; or that alternating or interwoven patterns of avoidance and hypervigilance merit further discussion as features of partners’ clinical presentations.

Ley’s position is interesting in so far as it challenges the premise of the RT model, the sex addiction-induced trauma assertion. While the assignment of trauma to sex addiction may be debatable, it might lead us to consider what life altering events are brought on for partners by other addictions. Alcoholics and gambling addicts also engage in patterns of deception and blaming alongside their destructive behaviors, yet we do not hear of “alcoholism induced trauma” or “gambling addiction induced trauma” as it might pertain to partners or families of drinkers and gamblers. With respect to sex addiction, I’d suggest that it is not so much the presentation of PTSD-like symptoms that warrants a specialized assessment label, or the pervasiveness of deception, or even the ongoing denial of partners’ assertions that sex addicts often exhibit. Rather, I think it’s the nature of the behavior, the context of the lies and deflections—sex—that hurts so deeply. After all, what is harder for our clients to talk about than problems relating to sex? What elicits shame, triggers vulnerability, rage, more than this traditionally-cited root of psychoneurosis?

At least trauma has been codified into psychiatric nomenclature. The same can not be said of sex addiction and codependency, neither of which is delineated within the DSM-V, still. While proponents of RT and co-addict models appear to accept the existence and clinical relevance of sex addiction, or Hypersexual Disorder (as it was proposed to DSM-V committees), they differ with respect to codependency. Proposal for inclusion of a Codependent Personality Disorder was originally made by Timmen L. Cermak in 1986. The diagnostic criteria for the condition then included such statements as “continued investment of self-esteem in the ability to control oneself and others”, “assumption of responsibility for meeting others’ needs to the exclusion of one’s own”, “enmeshment in relationships with personality disordered, chemically dependent, or impulsive individuals”. Cermak’s proposal also included a category which outlined other symptoms, including “excessive reliance on denial’, and “hypervigilance”, which should sound familiar, as the language of the DSM-V criteria for PTSD appears to echo this juxtaposition of ideas/symptoms.

REFERENCES

 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.

Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.

Carnes, P. (1989) Contrary to Love. Hazelden.

Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.

Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute

David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/

Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015

Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.

Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.

Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.

Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.

 

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The Opportunity

 

Eric and Daniel had been working together for years, although technically it wasn’t a partnership. Daniel worked for Eric. It was largely agreeable: Eric gave Daniel status, a decent if underwhelming salary; modest benefits, an annual retirement contribution, plus regular flattery in collegial circles, patronizing the younger man’s erudition and clinical skills. Their arrangement was quite satisfactory, despite Eric’s reservations about Daniel’s lack of ambition; Daniel’s suspicion that his long-time employer took him for granted.

Matters changed when trouble emerged over some psychoeducational workshops, the scheduling of which was thrown into disarray because the junior staff Eric had originally slated for the six-month job had just quit, complaining of being underpaid and overworked. Poised to leave for a vacation in Cabo, Eric was scrambling, knowing the workshops were not Daniel’s thing but desperate to avoid a financial hit should he scrap his plans.

“Why don’t you do them?” Daniel asked, treading a line of impertinence as Eric floated the opportunity. Eric stared upwards at the ceiling of his office—a habit Daniel interpreted as a sign of annoyance, perhaps impending panic.

“I could do that,” Eric replied, tugging at his straggly beard, which Daniel interpreted as meaning, fuck that. “I’m going away next week of course, so I couldn’t do the first two weeks.” Daniel frowned. He thought Eric’s trip to Cabo was one week, not two. They always seemed to miscommunicate on such things.

“I guess I could take the first class,” Daniel said, swallowing hard upon this reluctant compromise. Eric brightened, sensing a swift end to this noisome dilemma. “That’ll help out, I think,” Daniel added, insinuating something else.

“You could have the whole job if you wanted. It’s right there. I could just leave it to you, and I think you’d be great for it.”

Daniel noted the way in which Eric spun the workshops as a gift, a job right up his alley, as if Eric had planned them with him in mind all along. He shuffled uneasily, half-plotting a methodical counter.

“Yeah, I don’t know. You say it’s on a Saturday, which is an off day for me, plus a Monday, when I already have other responsibilities.”

“You could change the workshop times if you want. Not the first week or two, but maybe in September—”

“That’s a lot of re-scheduling, Eric. Plus the students for the course wouldn’t appreciate the changes, I’m sure.”

“Well, you could just say that these things happen. Changes occur in life. I’d support you if anyone made a complaint, say it’s on me.”

Daniel paused. “Except that wouldn’t be true, would it? They’d know that changes were the accommodation of my schedule, since I’d be doing the teaching.”

Eric gazed upwards again, his arms fluttering then settling upon his head, pulling back hair. “Hmm, I don’t think so,” he tried to dismiss. He didn’t care for derailing, logical arguments, details. They intrude upon airy principles, the good things that can and should happen if only people had energy, guts, and desire.

“Plus, what about the cost?” Daniel persisted. “At what I assume is my current rate, I’d make a few extra hundred dollars a week, but that would be offset by my losses, because I’d have to cancel my Monday activities.”

“You’d maybe have to re-schedule, I guess. You could use this office if you want, for those other appointments. I’d waive the sublet cost.” At this point Daniel was biting his lip, wanting to say something biting; something about sales tactics. His thoughts turned to late-night cramming: a soldierly effort to rescue Eric’s initiative, his investment, while he sunned himself on a Cabo beach. Daniel pulled out his phone, clicked on its calculator feature.

“Let me just see here. So we’re talking about an extra three classes, over two nights. That’s…let’s see…about four hundred dollars, before taxes. Then defray the cost of losing at least three, maybe four client hours on a Monday.”

“Well, the class is only an hour and a half, so that’s only two hours, right?”

“Yes, but there’s the commute. The class is downtown, isn’t it? A half hour in the opposite direction of my office. So traveling there and back precludes at least two other hours.”

“Okay, I can see that,” Eric replied levelly. He scratched his chin thoughtfully, thinking of his next move, and noting, as ever, that Daniel was not a dull-witted prey. “I’d be willing to increase your fee, depending on the enrollment.”

“Meaning, I’d be responsible for how many students enroll?”

“Well no, the information is on the website. However, if you wanted to do a talk somewhere, or promote the class, that might bring in more students, make you more visible in the community.”

“Would you subsidize that?”

Eric chuckled. “You’d have to be responsible for your own self promotion, of course.”

Daniel gazed into his own head, not wanting to meet Eric’s eyes while he felt a rising ire. “But it’s not self-promotion, is it? It’s a job that someone else doesn’t want to do that you’re offering to me at the eleventh hour.”

Instantly, Daniel felt the stillness of the room, the silence except for the hollow pop of his stomach. Eric’s face clouded over. He stretched as if purging a demon and his gaze circled about Daniel’s frame, as if its center would burn him. Finally, he shrugged and said, “Hmm. I think it’s an opportunity. Anyway, I’m still covering your benefits, even though the premiums are going up.” His voice lowered, as it tended to upon muttered non sequiturs, “…there’s an extra couple of hundred there…for me, but if you don’t want it then…”

“It? Meaning, the opportunity you’re offering?”

“Yes. The opportunity,” Eric stated flatly, his voice suddenly clear, even loud.

“Doesn’t sound like a good deal for me, to be honest.” Daniel shook his ahead, now affecting a forlorn rather than affronted stance; his ire at once subsided into something unclear. For reasons further unclear, he found it hard mustering or rather sustaining anger towards his senior colleague, a man whose intangible gifts and intentions were due a thorough, scrutinizing inventory.

Eric nodded softly while maintaining his steely gaze aimed into Daniel’s head. His look was at once genial and menacing, containing a search for weakness, a patient wait for surrender. Expectation. After another silent gap he stretched his body again and yawned, releasing droplets of a permanently-managed tension. When he sat forward he looked aged, self-pitying. A previously concealed layer of flab now hung off his face as he glanced sideways, looking about his office, the floor: stray items, of books, files, documents–things he wanted others to deal with. He looked up, gave Daniel a bitter-looking smile, and spoke languidly, with near whimsy.

“Well, I may have to hire someone else, I guess. There’s a guy who I met at a meeting who may be interested, says he’s looking for some hours.”

A guy at a meeting? Daniel thought fleetingly. That sounds feeble, he judged, only to then parlay his disdain into a challenge.

“Is that a threat?”

Eric returned a surprised look, his eyes widened yet tired. Finally, he started to flail. “It’s not a threat, but I don’t know what you want me to say. I have an investment, a commitment I’ve made. I need to follow through or else we’ll take a significant loss, which affects everyone here. I need help on this thing. If you don’t want this opportunity, or others I may have in mind, I have to look elsewhere. As for the future, I don’t know. If I find someone who appears energetic and willing, then I may need to make a decision.”

Daniel gritted his teeth, and stifled a gulp. “On my future employment, you mean?” The two men stared at each other. It—what Daniel did—had never been called employment before.

“It’s not my intention to go there. Is this…I don’t know. Are you saying you want to leave?” Eric asked, turning it around.

Daniel didn’t answer at first. He got up, collected his jacket, his notebook, his thoughts, which now swirled upon peripheral and then center stage ideas. History. He tends not leave like this, he realized. That’s what others do, or did. He tends not to notice change until it’s upon him. Relationships: they don’t end.

“I don’t know,” he replied, matching Eric’s nonplussed air. “I’ll talk to you later. Maybe it’ll be different then.” He turned his back, stepped out onto a hallway leading to a waiting area, there to see one of Eric’s regular clients, a man who nods amiably at Daniel but otherwise says nothing whenever they pass each other. The man was the only point of normalcy as Daniel walked past. The room looked darker like it was closing in on him, while the light from outside shone through a doorway carelessly left open.

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Venus and AB1775

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In August 2014, the California legislature passed bill AB1775, a law that redefines sexual exploitation for the purpose of mandated reporting guidelines. For the first time since the codification of child abuse reporting law in the early 1980s, the consuming of a product (such as the accessing or downloading of illegal pornography) must be reported by mental health professionals and other mandated reporters to authorities. For many in the field of mental health, this bill constitutes a threat to therapist-patient confidentiality, a bedrock principle in the treatment of mental health disorders. The bill was written by child advocacy groups in coordination with California police departments, and was promoted as “cracking down on child porn and child abuse” by assembly woman Melissa Melendez, though it was written by lawyers for the California Association of Marriage and Family Therapists, whose 30,000 deep membership mostly learned of the bill just weeks prior to its passing.

This controversial law serves as a real life backdrop to my novel, Venus Looks Down On A Prairie Vole, a first person narrative about an alcoholic, widowed psychologist named Daniel Pierce who takes an impromptu hiatus from his practice, only to be stalked by a former prostitute and lawyer who wants information about and his intervention with a recent patient of his whom she says has perpetrated a child molestation. Pierce resists intervening or giving information, citing patient-therapist privilege, though he is intrigued by the woman’s ardent appeal, for professional and personal reasons: attracted to her, he is nonetheless unmoved by her insistence that he break the confidentiality of his patient as he finds her pretexts grounded more in prejudice than in substance. Aware of his patient’s substance abuse, predilection for prostitutes, and compulsive use of pornography, he doesn’t dismiss the possibility that a crime against a child has occurred, but he resists reporting information that will likely prejudice police, a criminal or family court, or a jury. Unknowingly dodging subpoenas, Pierce retreats to a sober living house to examine his grief, his conscience; even his role in society. However, in the small world of 12-step recovery, he meets the patient who is the object of so much fear and suspicion. The impromptu hiatus becomes an impromptu therapy between two men, neither of whom is a shining example of mental health.

The novel is a dramatic expression of social concern: about the role of the psychotherapist in society, which is a subset of society’s broader desire for heroes, sometimes at the expense of reason; about the need for privacy such that effective mental health treatment can transpire; about the relationship between pornography and sexual abuse; about the influence of feminism upon sexual mores, the process of family courts. As a psychotherapist who works with self-proclaimed sex addicts, state-identified sex offenders, I observe a degree of cynicism on all sides: within the minds of the offenders, or addicts, but also within the schemes of their critics and persecutors. In one sense, it’s no surprise that Daniel Pierce is a burn-out case. His personal drama illustrates what has previously fascinated readers of Irvin Yalom’s novels, or viewers of the HBO drama, In Treatment: that mental health professionals are also flawed, and vulnerable to addictions, if not anti-social behaviors. I think this unknown facet of the mental health professional intrigues members the public. As my protagonist states, they want “in the room” of psychotherapy, to find out what’s being said and done.

Sprinkled within this heavy drama is an equally heavy dose of satire. While excoriating the state’s intrusion upon mine and others’ professional space, I also poke fun at a few segments of society: at the subcultures of pornography and 12-step recovery in particular. Meanwhile, my text lampoons the social engineering that occurs in advertising, via the themes of TV commercials; the products that line the shelves of retail. I write with mischief about contemporary issues that subtly divide men and women, teasing feminists and paternalists alike. This commentary is intended as comic provocation, but is not comic relief or gratuitous soapboxing. These themes are the subtext of my protagonist’s alienation.

The result is a melancholic, if sometimes flippant (some say arrogant) story that is typical of my style. I’ve written four novels prior to this one, but despite better reviews for previous efforts, I think this novel my best. I like repeated themes, inside jokes, and metaphor that stirs the imagination of the reader. I like anti-heroes, difficult people who are not easy to understand, because real people are not easy to understand. Venus Looks Down On A Prairie is an obscure title, no doubt—but no more so than Catcher In The Rye or even Fifty Shades Of Grey—and its meaning should not elude an attentive, curious reader, whom I intend to engage in the deepest possible way.

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