Columns Dec 19, 2012 at 4:00 am



Dear Gay Mississippi Penthouse,

I never thought it would happen to me, but [see letter 2].
Darn it.
Oh, Dan. So close! And yet so far.
To NOPE: I went through the same sort of thing when I was a teenager, thinking about and looking all sorts of "unconventional" porn. Today I'm a happily vanilla straight married guy.

This desire you have for extremeness isn't necessarily indicative of anything weird in you at all, just general teenaged messed-upness. Even if it does end up being a life-long kink, it doesn't mean you're bad, just that you're kinky. So chill out and forgive yourself for thinking bad thoughts.

And you don't have to date or have sex or want to have sex at this age, no matter what your peers are doing. Not being attracted to the teenage boys around you probably just means that you're a bit more mature than they are.
Finished the book, huh? Nothing to do but troll your own threads then...
The thing is, I can't tell if @2 was ironic. Time stamp says almost an hour after @1, but sometimes servers are very slow to post comments.

Either way, @2 and @3 are among the best comments I've ever seen on the Stranger. No way I or anyone else can top that. (Unless Krugman puts "first" someday in the comments on one of his own NYT op-eds. Now that would be fun.)
Oh Dan you were so close!!
NOPE- It's kind of weird for me to stumble upon this. I thought I was the only one in the world to have these thoughts. To read these stories of horrible people doing horrible things to children and getting turned on. I just a girl turning 20 who loves children dearly. And who was also horribly abused. I've been diagnosed with PTSD and other things. But I haven't heard anything relating it to unwanted thoughts. Anyways, you are not alone!
Respect to you for your advice to look into finding a treatment program that uses MDMA. The dark ages are slowly lifting and there is recently a resurgence in research approval for the use of various entheogens to assist with understanding and getting through PTSD, most notably spearheaded by Rick Doblin of MAPS ( Research MAPS has funded included use of MDMA for returning soldiers PTSD, which have produced very successful results.

The other biggie would be to look into another powerful medicine, Ayahuasca, as it has enormous potential for healing trauma (amongst other benefits) Just be advised to do your proper due diligence and if you conclude it is for you, seek out a reputable guide. With the explosion in popularity in recent years, there would likely be regular ceremonies in NOPE's region.
Young lady, my heart goes out to you. After being sexually molested, of COURSE you have more extreme fantasies. You had the curiosity aspect taken from you. In non-consent fantasies, the thinker, the "author", the narrator is the ultimate power holder. So even if the character under power is "abused", it's still for the enjoyment of the enduser: the masturbator. I think Dan is right on with his advice. I echo the sentiment about getting a sex-savvy therapist! Best wishes from an older lady who is still feeling good about her raunchy taste in erotica.
My heart goes out to you, NOPE.
@12, likewise...And also to @9, Taylor30313.

May you both find peace of mind.
Don't get me wrong. My heart also goes to all youngsters being taken advantage of, molested, abused, etc.

Now call me a cynical asshole, which I may very well may be for many different reasons, but I have a problem with a 17 Y.O. abused Australian/Argentinian/Syrian/German/Congolese girl who can write such an articulate, absolutely-heart-wrenching/ thoughtful/ sensitive/ etc. etc. detailed account to a trans-atlantic/pacific on-line sex/relationship advisor.
Same goes for a gay sibling who will actually send some self nude pictures to his "kinky brother".

Now make no mistakes, I voted for R-74 as well as 502, the Dan Savage home state measures for same sex marriage and legalizing marijuana, yet I see today's chosen letters as "sensational" for the sake of increased ratings and/or shock value. And I suspect they may be also fake to begin with.

Please correct me as I'd rather be much maligned than lose faith in Dan Savage and humanity.
@NOPE (and Taylor30313)
From an older survivor of incest : I experimented something like you're describing at your age, when I had also been out of harm's way for some years.

I had a hard time sleeping because of the vivid and totally disgusting things my mind was up too. It was very painful to live with, the more so because I couldn't talk about it, since what had happened to me was not out. I had only disturbing memories and even more disturbing dreams to turn to. That turned to self-hatred...

Some twenty years and a failed marriage later (I married a verbally abusive man who lavished attention and kindness on me, until I was pregnant and could not/would not escape the situation, for "my child came before myself"), and thankfully psychological help after that - I have eventually come to enjoy a pretty nice sexuality. With numerous orgasms during mostly vanilla partnered sex (I both love and dread having my toes licked).

So, there's hope, even without help right away. But to make that happen before you're well into your thirties, you're going to need to talk about it with a psychiatrist. So my advice for you would be three-fold :

- see a psychiatrist already, a sex-positive one, as Dan advised ;
- accept your brain's way of getting off as maybe not in the best taste ever, but as nothing earth-shattering either. It's not a window into whom you're going to grow up. It's a testimony on how confusing this whole sex matter is to you right now ;
- no partnered sex until you've resolved your issues and feel confident in being a great human, deserving of care and respect. You don't need to be revictimized in letting assholes into your life ; and you won't be able to recognize assholery until your inner self is damn sure you deserve respect.

It's most important : you have to cut yourself some slack and be good to yourself in order to heal faster. You may think from your imaginations (as I did) that you are broken or soiled or a risk to others, a future abuser, a future criminal - but you're not.

Having this kind of thoughts invade your mind only means that your brain has started to process what has happened to you, and is trying to make some sense out of it. Sure you need help for that, but this brain activity is a normal part of healing from childhood sexual abuse.

You experimented the worst violence one can endure without dying - your brain got hurt bad (I hope not your body, although bodies do heal amazingly well). And, unfortunately, there's this link between all that trauma and sex ; and sex is something your brain is programmed to obsess about right now, as you're maturing into adulthood. So, it's a very confusing time for your brain.

Be kind to yourself and allow your brain its fantasies. Don't pass too harsh jugements on what your brain is currently needing to get off - it's only temporary, and what's in your mind can hurt no one but you. Right now your brain is not representing you, nor your core values, nor your future sexuality. But your brain needs help and understanding. And it also needs you to get off. So please, please yourself, and don't feel guilty about it, because it wants you to conjure up horrible ideas in order to do so.

You're not responsible of your thoughts. You're responsible of your acts. And survivors who distanciate themselves from their thoughts (as you both are already doing, calling them "vile" or "horrible") are a lot less at risk from ever becoming abusers than the never-abused population.

So do get help, but reassure yourself. Bad thoughts will calm down a lot in the next few years. And you'll learn to live well despite them. They'll end up being a minor encumbrance in your lives, resurfacing when your brain is confused about one thing or another - but knowing where they come from takes away most of the nuisance.

And be kind to male survivors, if you ever meet some. It's even harder for them to come forward and seek help.

My love to all of you out there...

17 is not too young to be fluent in one's native language.

Pointing out the obvious, but Australians are native English speakers. Unlike "Argentinian/Syrian/German/Congolese".

You took geography classes in the US, didn't ya ? I took some too. It's where I learned that the Baltic countries were on the shores of the Aral Sea. Coach was good at geography.
Fif, if I was experiencing those problems at 17 I would have been perfectly capable of writing a letter exactly like that. There are some very articulate 17 year olds out there. Given the volume of mail Dan receives and the fact that he is reasonably well known in Australia, I don't see any reason to think it's more likely that the letter is fake than genuine. In fact, if I were 17 and experiencing something like that (entirely within the realm of possibility), Dan Savage would be most likely the first person I would turn to.
@10 - FWIW, Ayahuasca is illegal in Australia, and it doesn't have the cultural/religious usage history here that would support decriminalisation any time soon. Likewise, Ayahuasca is not easily accessible to mainstream casual users here (at least, as I understand it). Obviously that's not a total impediment, but there may be other more legal ways to secure entheogenic therapy.

(I may just be a prude, but I'm uncomfortable advocating illegal acts to a minor, even one as mindful as NOPE seems to be.)
NOPE, take heart: my libido isn't very different from yours - I also have times when I need my fantasies to become more and more depraved, violent, and with awful things happening to people. I started out reading rape accounts in the newspaper, moved on to BDSM and humiliation and, indeed, some written pedo porn.

I'm also happily married, and have yet to harm anyone in my pursuit of pleasure - as a matter of fact, I've made a whole bunch of people happy.

See, what worked for me was finding porn with a more engaging narrative - when I'm emotionally invested in a character, reading a simple spanking session about them has the same effect on me as reading something far more extreme happening to a character who's just there for filler.

And I found that putting my own fantasies to paper not only helped me create sure-fire masturbation fodder, it also made a lot of other people with similar interests happy, and they made me realize I'm not alone.

So, yeah, I need to focus and fantasize hardcore to get off. So? My partner is happy to help me get off (essentially by holding and fingering me as I masturbate), and I do focus on him during other parts of sex. Needing extreme fantasies to get off has not made cuddling, making out, or even full out intercourse any less fun.

Seconding the recommendation to see a therapist - not because your kinks are wrong, but to help you feel more at peace about them.

Hang in there, kid. You're going to turn out fine.
Generally excellent advice for NOPE, Dan, thank you! The one important caveat is that, at least in the US, if you're under 18, your medical records are legally property of your parents, not you. A good adolescent shrink will make it clear to both teen and parents that the therapy will go better if parents never take advantage of that right-- but no therapist can promise you the same kind of absolute confidentiality they could promise an adult.

Also, this may not be useful for NOPE, as she's in Australia, but people in the US or Canada may have better luck looking for specifically kink-friendly therapists in the National Coalition for Sexual Freedom's Kink-Aware Professionals listing:…
please don't advice .if u can help me .recent i lost my dad .i have no shelter .i have no food .i can't give my semester fees ...$200.and my affordability is no more .so i am frustrated .i want to kill my self .by this no need money ,food or shelter...
Worth reading some of the unregistered posts (but not #19, which is a sales pitch). #20 is especially worth reading, NOPE, which I hope you are.
NOPE, I know from experience it can be frightening/uncomfortable to ask your parents to help you get psychological treatment. But there is no need to feel guilty about asking. You say you try not to worry them, but protecting your parents from worry is not a responsibility you have to take on. THEY are supposed to protect YOU. It's THEIR responsibility to worry about YOU. Really. Let them do it. They can handle it. Ask for help.

My parents and I are now in a position where - because I wasn't very communicative all those years ago about what kind of help I needed and wasn't very insistent about getting it, and my parents didn't pick up the slack - I continue to have some of the same issues I had as a kid. Meanwhile my parents seem to feel a bit guilty and defensive about the fact that they weren't more diligent in pursuing psychological treatment for me. Now I'm an adult with my own health insurance, and I can get treatment for myself - with emotional support from my parents, who know better now. Don't wait as long as I did to tell your parents what you need. There's no benefit in holding back, for them or for you.
NOPE, EMDR therapy helped my PTSD quite a bit. You might want to check that out at some point--it's a technique that helps your brain process traumatic memories, so that they are not continually accessed as active trauma. It doesn't work for everyone, but it might be worth a shot as you continue to work through things. I wish you the best!
@ #14 - I am sure that Dan has said more than once that he often takes the trouble to clean up spelling, grammar etc. And if I were writing such a column, I would probably completely rewrite half the letters I publish, based on the fact that so many people SUCK when it comes to writing composition.

Just sayin'
@16- I referred to the content rather than the language skills. And while I'm forever grateful for your Baltic lecture I suspect a 17 yo, wether living through such horrendous experiences or not, will have a hard time at this age articulating them (native English speaker or not), let alone asking for advice from some over seas online sex/relationship online columnist.

It is possible that Dan changed some of the personal details in order to protect the identity of a very vulnerable young person. If so then I think it would have helped all of us if he stated this in order to give himself more credibility.

And as I stated at the end of my original post, check out #14, "Please correct me as I'd rather be much maligned than lose faith in Dan Savage and humanity." So thanks for the maligning part, but my faith in humanity has yet to be restored and I honestly look forward for this "restoration"
@ fif

I found nothing out of step whatsoever with that letter.

It's not THAT unusual for a 17-year old to be able to speak in a detached, intellectual manner about their trauma, especially if they took an interest in psychology before they hit double digits and have been poring over university psych textbooks since 14. (It happens, trust me) There is such a thing as intelligent human beings.

Don't mistake the ability to talk insightfully about ones problems for the ability to maturely deal with those problems. They are VERY different skills.

Skipper Jo.

You know, some parents will say no.
That's what I was thinking. I know I was fairly well written as a teen (moreso than I am now as I wrote constantly back then)and knew a lot of other people my age who were as well.

I actually scrolled back up and reread the letter, because I didn't remember thinking anything in particular about how well written it was, and, while I don't think it was poorly written at all, I don't think there was anything that stood out to me to say, "Wow, she's so articulate." She used proper grammar and spelling, so there's that. The only thing I could say I found a little odd was her use of the word "vile", but I chalked that up to the supposition that there is a different vernacular in Australia, and maybe that word is used more there.
@#14 I would like to say, I, myself being an Australian teenager and having spent a lot of time on the internet, have known about Dan Savage since I was rather young. Although I have not been abused in the past I would think that if something is weighing on your mind you would probably research it a lot, not to mention she's probably spoken about it with actual psychologists given her experiences, and I've also read and seen a lot of kinky porn, VERY kinky....the internet is great for that nowaways. Now you may also notice grammar and spelling isn't much an issue (and if it was Dan would "tidy up" nor is the ability to be self aware, look up your issues/porn, have fantasies or speak about them. Nor is the capibility to discover an online sex column. Hopefully this factors into your belief in humanity and such. I think if I was having issues like this, a place like this with anonymity as well would be a good choice.
How is hope supposed to ask her parents to take her to a sex positive therapist, I think that's the advice she really needs
@32, you're right, it would be nice if Dan had asked the sex researcher to explain the process of getting a therapist who does sex therapy.

Maybe if NOPE just asks to see a psychiatrist, NOPE could then bring up the issue at the first session, and the psychiatrist could refer her to a particular therapist without necessarily explaining to the parents that that particular therapist is sex-positive and experienced with sex therapy.
Some parents might have an issue with that, but there are plenty that wouldn't. When I was 15 or 16 (though I'd had "the talk" long before that) my mother checked in with me and asked if I wanted to go on the pill or needed her to buy me condoms. If I ever have children, I plan to not even ask once they get to a certain age, I'll just leave condoms for them so they don't have to feel embarassed.
The parents who try to pretend their teenager isn't a sexual being have obviously forgotten what it was like to be a teenager themselves.
@25, EMDR is a placebo. I'm glad that you're doing better, that's awesome. But there is absolutely no evidence that EMDR itself is beneficial, and the theory behind it makes no sense at all. EMDR does not "help your brain process traumatic memories."
NOPE if you're reading one thing I want to point out is your fantasies do NOT mean you want these things in real life! I have fantasized about some jacked up stuff. Incest, creepy coercive gang bangs, sex in public places (I don't mean like in a secluded park, I mean like in a plane seat, making others around us uncomfortable). I used to be really grossed out by this and finally realized that um no I don't ACTUALLY want to bang various relatives. I just like the concept and the power dynamics and the ick factor *while fantasizing*. I mean I even fantasized about banging my sister. I DON'T HAVE A SISTER! And in real life I was grossed out by the idea of banging my dad, never found him remotely attractive in THAT way. Then I realized in my fantasies, it wasn't HIM. It was *A* dad. I'm not even sure the me was really me. I mean I've fantasized I was a guy before. It's like a running porno movie in my head and I'm the director! :-D

And even if you ARE imagining your actual parents, etc, the reason you're feeling ooked out is because you don't actually want to do this in real life. You see them in person and think OMG! NO! YUCK! So don't be too hard on yourself.

That said, it can also be disturbing and gross and I totally get wanting to change your thought patterns there. It's really not too unlike Dan's thing where he tells guys to not wank off too much in one position or with the same kind of stroke lest they get too accomodated to it that way and can't others. It took me a bit to wean myself off the more extreme stuff, several months, years in some cases, but I got there eventually and I am REALLY happy I did it. Other fantasies I decided to just get over it and some of those eventually went away as I became bored with them. For the incest ones, it wasn't too hard... I substituted someone who was NOT a relative but a similar dynamic (say a family friend or something). I felt a lot better once I stopped thinking about stuff I found repulsive. Hugs to you, I completely get it. Make sure you find a sex positive therapist, and one who won't think you ACTUALLY want to fuck little kids/your parents or who won't shame you and although you might not consider it this way but one who won't go on and on and on about your family of origin and how you were clearly so horribly, terribly, brutally hurt and now you're so very, horribly, terribly broken. You're not a charity case, you lived through something awful, you're a damn fighter, you just need to learn new ways of thinking not to have some break down where you admit you're destroyed and incredibly messed up and unfixable. That kind of therapy doesn't help very many people and usually just makes them feel more miserable and depressed!

Of course some parents will say no to such requests. That's not a good reason not to ask. If someone feels unsafe asking, THAT's a good reason not to ask - just like when an LGBT kid is weighing whether to come out. But there's no indication in NOPE's letter that she has anything serious to fear from her parents. She says she's afraid to "freak them out." To me, that indicates loving and supportive parents who just want their kid to be okay.

I'm not saying everyone who asks their parents for medical or psychiatric help will get exactly what they need/want, but they might get at least something, so the potential benefits outweigh the discomfort of asking.
@32, good point. @33 makes a good suggestion, I think.

The advice blogger Captain Awkward likes to offer her LWs sample scripts to use on the people in their lives. Here's the basic gist of what I think NOPE could tell her parents:

"I've been having some thoughts and feelings about sex that confuse me. Considering my history with my birth family, and considering that I'm almost an adult, I want to talk through my feelings with a therapist. I think it would make me feel better. I know there are therapists who really know what they're doing with these issues, therapists with a positive attitude toward sex in general. Will you help me look for someone I can talk to?"

Edit for tone as needed, but this covers the basic points I think NOPE should bring up, and it leaves out the intimate or alarming details she doesn't want to share.
@35, from what I have read, EMDR can be a fairly effective form of cognitive behavioral therapy, better than plain some talk therapy/supportive listening. I don't think it's a magic technique. I do think it is one way to visualize and process. For me, it was much more effective than other therapy I have done. (Then again, this particular therapist in general has been a great match for me.)
As a teacher of 12- to 14-year-olds, I can tell you that a certain percentage of kids are able to write clearly and compellingly. Quite a lot of them are self-aware to boot. I'm tired of hearing people disparage kids by saying any well-written, thoughtful letter from a young person must be fake.

Regarding NOPE, I want to point out that a person's sexual orientation and romantic life can be utterly different from his or her fantasy life. I enjoy vanilla sex but my fantasies are all quite extreme, even vile at times. I have no interest in "realizing" my fantasies. They're fantasies. My reality is the one I like; a very nice, stable, Ozzie-and-Harriet kind of life. So I have to imagine some violent thing in order to have an orgasm. Big deal. To me, that's just the same as, say, having to rub my clitoris in some specific way in order to have an orgasm. It doesn't really mean anything about the whole rest of my life. It certainly has nothing to do with the people who have my affection, trust, and love. Nor does it have anything to do with the person who is always there when I orgasm.

I here by declare that thanks to:
@28 mydriasis
@30 KateRose
@31 Aussie Kid
as well as the “tired of hearing” teacher @40 Drusilla
my faith in Dan Savage and humanity in general has been fully restored, and I offer my sincere apologies to anyone who has been offended in any way.
I also wish the best for all the suffering people out there and wish us all happy, healthy, and fulfilling life.
A good place to start is the website of the Australian Psychological Society:…

Not all psychologists in Australia are listed - as you don't have to be a member of the APS to practice in Australia (although you do have to be registered with the national body, AHPRA). But this is a great resource to start with to find psychologists who deal in specific areas.

You may also wish to talk to your GP - who may know of an appropriate psychologist in your area they can refer you to - and in going through your GP you may be able to get the sessions covered under Medicare.

You don't have to disclose to either your parents or your GP the specifics about why you'd like to see a psychologist - you can be more basic and say that you'd like to work through some things/worries, with a psychologist, that have come up for you as a result of the childhood trauma.


I also suffered horrendous abuse as a child. At 17 I could have easily written that letter. I wouldn't have been able to speak the words, but I could have certainly written them. Without a doubt.

Chances are NOPE took their time writing that. Read and re read it to ensure they were sending Dan the very best letter they could have on the subject. I highly doubt it was a letter hastily tapped out in a few.minutes. Given the test they have in Dan, the internal struggle they are experiencing, I have a hard time believing that they didn't write the letter with all of theit intellectual prowess they could muster.

If it were me and I were writing at seventeen, I would have made dang sure I came across as mature, articulate, and concise.

Unlike this post im tapping out on my cell phone.

I also suffered horrendous abuse as a child. At 17 I could have easily written that letter. I wouldn't have been able to speak the words, but I could have certainly written them. Without a doubt.

Chances are NOPE took their time writing that. Read and re read it to ensure they were sending Dan the very best letter they could have on the subject. I highly doubt it was a letter hastily tapped out in a few.minutes. Given the test they have in Dan, the internal struggle they are experiencing, I have a hard time believing that they didn't write the letter with all of theit intellectual prowess they could muster.

If it were me and I were writing at seventeen, I would have made dang sure I came across as mature, articulate, and concise.

Unlike this post im tapping out on my cell phone.
@43 and @44 (identical for some reason)
Please check my admission and apology @41
The saddest part about about @fif is the EXPECTATION that a 17-year-old can't know how to write well in their native language.

How low the bar has fallen.
I am not sure why Dan says to stay away from pedo material that is stories only.

Text is text, and no more harmful than any other form of pure fantasy, whether the stories are about consenting adults, children, animals, unicorns/elves, or anything else. Seems like the most harmless way to indulge a kink that can not or should not ever be played out in real life.
I was also abused as a child and have had fantasies I'd characterize as "disturbing", but I don't get off on the content so much as the intent. "OMG, that's dirty."

As I've become more confident in my sexuality and less adversarial towards it, the fantasies have subsided. Having a healthy relationship and sex life has helped immensely with that.

My suggestion echoes the others: Work through your trauma in a way that acknowledges what you've been through, and move on.

This is an example where I'd use Dan's phrase, "it gets better".
I've got my quirks, but overall I seem like a pretty healthy kid, and I try not to worry them.

That's a great attitude, but you're probably not going to worry your parents by asking them to see a counselor to work through some of your experiences with your birth family. Many adults would interpret that as a sign of maturity and self-awareness.

Judging from many of the comments, what you are going through doesn't seem all that uncommon. I would think if you looked for therapists who are experienced in dealing with sexual abuse, you could find one who is validating and who has worked with others on similar issues.
@9 Taylor30313: I'm so sorry----I didn't see your post!
My heart goes out to you, too!

@13 EricaP: Thanks for catching that!

I think the whole world needs a Band-Aid, hug, and kiss!
@46 Biggie- Please follow my responses to #16 and others, #27 and up, before becoming so "sad". As I did state it's not necessarily the language skills that triggered my initial response.

In any case, I did have my doubts and expressed them. Other people corrected me in a civilized manner and I did come around as stated @41.

I assume your "bar lowering" statement meant mostly to make yourself feel so superior to others, but so be it.

This is going to be my last comment this week and I still wish all of us, even you "Biggie", happy, healthy, and fulfilling life.
Let's assume that NOPE has no trouble finding a good therapist and no trouble from her family for wanting to see one. My question is: What does a good therapist do?

It would seem that there are 2 tacks to take.

1. Helping NOPE to dial back the fantasies to a level where they're not that disturbing and she gets off anyway.

2. Convincing NOPE that there's nothing wrong with violent fantasies because there doesn't have to be a connection between a fantasy and the rest of one's life.

There's also dealing with the sexual abuse. Dan's correct that there isn't a necessary cause and effect between abuse and violent fantasies. (In my case, humiliation fantasies, no sexual abuse-- if a survey of one helps any.) But what does a therapist say? How does it work? I'm having trouble imagining what would go on in that therapist's office.
@53: What does a good therapist do?

I don't have any special insight into therapeutic approaches to sexual abuse (and I'm sure there are many specific, well-established techniques) but there are general benefits to therapy that I think would apply:

1) The simple act of talking about an issue can help the patient take a more "objective" perspective on it and thereby make them less emotionally beholden to it (there's a term for this I'm forgetting).

2) Validation and normalization. "Well of course you felt X in response to Y, lots of people do." Same benefits as above, with added benefit of releasing shame/humiliation, which often plays a role in maintaining problematic cycles.

3) Giving the patient a realistic sense of the possibilities by sharing with them how others with similar issues and circumstances have progressed.
@35 Plenty of evidence that EMDR is an effective treatment for trauma.…

seandr @50 is quite right.

NOPE, if your parents have a healthy enough attitude towards sex - as it seems, since they've brought you up and you know enough to write to Dan Savage - they'll be relieved that you're now taking this into your own hands. A sexually abused child asking, on his/her own, to see a psychiatrist about some sex stuff is very good news to a mindful parent. It shows that healing is actively sought after. It's good.

I'd suggest a psychologist specialized in childhood sexual abuse. Many psychologists are completely clueless about what past childhood sexual abuse does to a person. You don't have to endure their cluelessness. And yes, obviously a sex positive one.

@38 Good idea, but my 17-yo self would have found it's already giving Too Much Information to admit sexual thoughts are creeping around.

Alternative script : "Mom and dad, you know what happened to me before I lived with you. I feel like now, it's a good time for me to talk about it with a psychologist who specializes in this field, one who has a positive attitude towards sexuality. It would help me a lot. Could you help me find one ?"

And if they start asking what's wrong exactly (though I highly doubt they would ever - family usually treads lightly around known survivors) : "Really Mom and Dad, I can't talk about that with you, it's gross, it has nothing to do with us as a family, I never want to broach this subject with you, nor do I want you to go and ask anything about it to the psychologist. It's my story and I'll walk this walk alone. Please trust me on this."

It was meant as a general comment on the state of education in the US, specifically its inability to turn out 17-year-olds who can write, to the point that the expectation has become that 17-year-olds can't write.

Not directed at you personally.

All the survivors I know or I've read have suffered from similar fantasies that gross them out. It's violent, it's sexual, it's abusive, and it can be way worse than the abuse actually suffered - it's not reliving past trauma. The most disturbing part about it, is that the body becomes really aroused. It's really hard to stand.

It's like your own body and mind join in and behave as a torturer, of yourself or of others. Not fun. Most survivors don't ever share the actual contents of their "nightmares", even anonymously, since the guilt is tremendous.

This does fade over time, but the "nightmares" never totally go away. One must learn to live with them, and not let oneself get affected by them too much. There's no other choice, really. The thousandth occurence is nowhere near as frightening as the tenth one.
@14 - Even if fake, they are scenarios that some people in similar situations might be able to draw some comfort and advice from.
@ Crinoline

What does a therapist do?

And by that you mean, how does a therapist do what they do?

I find something curious about the fact that therapy is often scrutinized in such a way. Do you understand how architects do their job? Do you understand how songwriters do what they do? What about chemical engineers?

Anyway there are many different kinds of therapy and they work on different principles. Typically a therapist may help a patient with:

- better understanding their own emotions
- better understanding their own motivations for behaviours that trouble them
- coming to realize and/or accept things they have been denying or fighting
- learning to hold themselves in higher regard
- challenging unrealistic or harmful thoughts
- remodelling their behaviour
- learning coping skills
- having a source of supportive structure from a trusted adult (often for the first time in life)

In addition, if the therapist is a psychiatrist they can also prescribe medication that may help the patient.

They often do these things by talking: asking questions, offering suggestions and ideas, etc.
@61: I find something curious about the fact that therapy is often scrutinized in such a way.

It may be in part due to ignorance or inaccurate preconceptions, but I think it's also because:

a) It's a very hard job to do well, which means there are a lot of practitioners out there who are ineffective or worse.
b) Sometimes, effectiveness depends on whether the therapist's personality, personal history, and theoretical approach are a good fit with the patient.
c) Psychodynamic/Psychoanalytic (i.e., contemporary Freudian) psychotherapy. It's a bunch of endless, useless masturbatory blathering to a therapist who feels his/her primary job is to be cool, detached, say as little as possible, and appear to be earnestly scribbling notes. Embodies pretty much every negative stereotype of psychotherapy. Bizarrely, it's still popular, especially on the east coast.

@62 seandr

I agree.

I'd only like to add to point a that I've noticed something (just personal observation) that especially among people who are new to therapy, rapport matters more than nearly anything else. So even a perfectly competent and even very skilled therapist can be rendered 'ineffective' in that case.

P.S. this comes down to nomenclature but I'm pretty sure not all psychodynamic therapy is like that. In my experience (unless I'm remembering incorrectly) pscyhodynamic therapy is essentially just nondenominational talk therapy which can borrow from any form (CBT, DBT, etc).

Long story short, when it comes to styles of therapy I've seen different things work for different people.

I'm sure I've incorrectly linked "psychodynamic" with psychoanalysis.

Having seen a number of talented, well-known, insider-referred therapists over the years, no question rapport is a critical ingredient, both for newbies who aren't entirely sold on the enterprise as well as people with more experience "on the couch."

I think the field also suffers from a shortage of masculine therapists, which makes it a difficult sell and/or ineffective for a lot of men. It's partly a matter of rapport, but also, therapeutic processes as commonly practiced tend to have a decidedly feminine style (i.e., a focus on introspection, emotional processing, empathy, compassion, reflection, etc.). I think a lot of men would benefit from a process that looks more like mentoring and problem solving.

I saw a number of really smart and insightful women and (to be frank) wimpy/dorky men, but never really got anywhere and had written off therapy as not for me. Finally, I was referred to a guy who is hip and unabashedly male (and good!), and he has profoundly changed my life for the better.
There seems also to be a lack of evidence which kinds of psychotherapy work and to what degree and for which population groups.

With new drugs it's comparatively easy to design a randomised, double-blind placebo-controlled study.

Double-blind and placebo-controlled do not work well for talk therapy. How do you define a success? What is a reasonable time frame until you should see the positive outcome?
@63 "I'd only like to add to point a that I've noticed something (just personal observation) that especially among people who are new to therapy, rapport matters more than nearly anything else. So even a perfectly competent and even very skilled therapist can be rendered 'ineffective' in that case."

This. Very much. I attempted several therapists that were awful... for me. I'm sure there were people who worked very well with them, but I didn't.
If a person is completely unwilling to open up, it doesn't matter how good a therapist is, they won't be able to accomplish anything. I know that, for me, talking about things that are NOT hot button topics and letting them evolve into other things works much better, because, even if I know I should talk about it, I won't. Inside I envision myself as that little kid with their arms crossed over their chest screaming, "I don't wanna!"
So, for someone like me, it takes almost the whole hour to get anywhere, which makes for slow going, lol. I'm sure other people want to let things out so much that their therapist may not have to talk at all.
I really wish that seeing a therapist was a part of normal healthcare, because I think building a rapport with someone before there's a need for them would be much easier than trying to build one while you're in crisis and not really wanting to talk about it.
@ migrationist

Comparing drugs and therapy is, in some ways, like comparing apples and oranges.

I'll start off by saying that I'm not anti-medication (lest we forget my lengthy and heavily contested defense of psychiatric medications a few weeks back or whenever that was).

But therapy holds the benefit of not increasing suicidal ideation. Therapy also doesn't cause such intense nausea that the patient has to take a week off work or out of school. Therapy doesn't increase your risk of diabetes. Therapy is pretty unlikely to cause erectile dysfunction. You can't take all your therapy sessions at once in an attempt to kill yourself. In fact, therapy poses virtually no risk to your health at all.

Anyway, to my knowledge there is a fair bit of evidence for which kinds of psychotherapy work in which population groups (by disorder, not gender, though) - I just personally think that there's enough individual variation within those groups to muddy the waters somewhat.

How do you define a success?

Um. I'd imagine the exact same way you would for medication? The symptoms improve?

What is a reasonable time until you should see the positive outcome?

Who's "you"? In this equation? The patient? In my experience, people often make progress and improve in ways that are perceptible to others (the therapist, friends) but that they don't realize yet. Depressed people especially are not especially sensitive to positive trends in their lives so it might take a while for the message to sink in. Different kinds of therapy suggest different time lines. CBT often gives a 6 month timeline from what I've seen.

But improvement isn't binary. The longer a person dedicates, the more they will improve, in different amounts, at different times, in different ways. Maybe a little jump in functioning at six months. Maybe a jump in mood at 11 months, etc.
@ seandr

You ever watch Scrubs? I'm picturing Dr. Cox's therapist as the quintessential "male" therapist. :p


I'm a big believer that people should have mental health 'checkups' just like healthy people have physicals once a year. I also think that sometime in junior high (hey we could get rid of all the anti-drug stuff and then we'd have the space) they should have someone come into schools and talk to each of the students. Obviously it wouldn't be perfect but just to identify if anyone is in need of psych help. Pretty much every mental disorder shows up by 13 (except schizophrenia, off the top of my head) so I think it'd be the ideal time to screen.

Of course it would never happen but it's my dream. I'd also love it if they could spend some time breaking down misconceptions about mental health, teaching kids to not stigmatize eachother.

I could go on, but I'll spare you.
Mydriasis- 61- In my world, people often scrutinize how people do their jobs. The subject certainly comes up for artists. A lot of attention is paid to where ideas come from and how those ideas are realized into concrete forms. Off the top of my head, the same goes for contractors. The client wants to know what the contractor has in mind, how the estimate was figured, how this whole thing is going to work. Or take the example of the time I had the chance to talk a dealer in a gambling casino. I was interested to know everything from how he was hired to what the training consisted of to what they're told to do about drunk betters.

That said, I believe there is more mystery to what psychotherapists do. You kind of wonder if the information couldn't be gotten more cheaply from a book, or you wonder if sympathy is for sale.

69- Pretty much every psych disorder besides schizophrenia shows up before age 13? What about depression or substance abuse or PTSD? I'm thinking of a friend who had his first major psychotic episode with bi-polar when he was in his late 30s.

But more than that, the problem with psychiatric screenings is that I'm afraid people would learn the right things to say to get the results they want. You find that in drug treatment programs. They work wonders for some number of people who want help getting sober, but for others, they learn the party line, the script, and then go on to give a great performance on following the 12 steps when they're still getting drunk on non-meeting time. If someone knows that there's a likelihood that they'll be committed to a mental institution if they don't straighten up, they're probably not going to think that there's this nice place where they're going to get the help the need. They'll more likely think that they better show all the signs of conforming.

So while I certainly agree that it makes sense to remove the stigma on mental illness and make it easy for people to get treatment, I see practical barriers until the treatments get better. Right now, even with the best efforts, we don't really have something that works for bi-polar or schizophrenia or for psychopaths. It's a puzzle.
Having known far too many people who have considered/attempted/succeeded at suicide, I definitely agree that getting rid of the stigma is a great place to start. More people would be willing to get help if they weren't afraid others would consider them "crazy" or "screwed up".
Some mental health problems are so severe that no amount of help is going to keep a person from doing something to harm themselves or others, but most people have a chance to, maybe not get better, but maintain a normal life.
@ Crin

There were a few things about your post that threw me, but I'll start with the age thing since I'm pressed for time.

What about depression

The average age of onset is getting lower. As it currently stands, age 15-24 has the highest rate of depression and I would not be the least bit surprised to see subclinical/mild depression in those 13 year olds who will have depression later in life.

"Depressive symptoms that don't quite meet the diagnostic criteria for major depression are even more common in adolescents. A study of 9863 students in grades 6, 8, and 10 in the United States found that 25% of the girls vs. 10% of teh boys reported elevated depressive symptoms."

or substance abuse

Substance abuse is certainly not unheard of in middle school, and most hardcore drug addicts start early. But in any case, substance abuse is virtually always a comorbid condition with another disorder and I think it's disingenious to treat it in a vacuum.

or PTSD?

Um, look above - there's lots of PTSD in children. Childhood abuse is a massive cause of PTSD. And PTSD in adults who have experienced massive trauma is a miraculously low-stigma disorder, so it's low on my concern list in this context.

I'm thinking of a friend who had his first major psychotic episode with bi-polar when he was in his late 30s.

That's an argument for early screening, not against it. There's a big difference between the onset of a disease and the first major psychotic (manic?) episode of the disease. So in other words, with screening they get offered help at the former, without screening they don't look for help until the latter.

We're currently more likely to recognize bipolar in teenagers and young adults (typical onset) but again, there are people trying to pioneer ways to catch it earlier.
@migrationist: There seems also to be a lack of evidence which kinds of psychotherapy work and to what degree and for which population groups.

Not at all. Pick any common mental affliction, and you'll find scores of treatment outcome studies along with meta-analyses that rank the effectiveness of various approaches. The best approach usually depends on the affliction (DBT for borderlines, Maudsley for anorexia, cognitive behavioral for phobias, etc.)

No, they aren't double-blind, but when you're dealing with a program that operates through the recipient's conscious mental processes, they can't be, nor should they be - the point of blindness in drug studies is to filter out the influence of psychological processes, whereas with therapy, those processes are largely the point. This is the same for outcome studies of, say, educational programs (e.g., math curricula, charter schools vs public).

As for lack of a placebo control group, if a study compares 2 or more different therapeutic methods, it can still isolate some of a given method's contribution beyond the simple act of showing up and having a chat. FWIW, my disdain for psychoanalysis is based in part on my familiarity with some of these types of studies.

That said, a lot of people seek help for problems that manifest as depression or dissatisfaction but are caused by some combination of that patient's personality, history, and the particular set of circumstances they find themselves in (e.g., relationship, career). In those cases, anti-depressants can provide symptom relief, usually at the cost of some unfortunate side effects, but they don't necessarily target the dynamics responsible for the problem. In my experience, they simply can't compete with an effective therapist who is able to figure the particular puzzle you present to them.

There is nothing I disagree with in your post. But I think you missed my point.

All I wanted to point out was that it seems more difficult to design a good rigorous study to compare different approaches to psychotherapy than for different kinds of drugs. And funny that you should mention lack of side-effects as the advantage of psychotherapy. There's just been an article about the outcomes of psychotherapy and its side-effects, and that negative side-effects are more common than expected. In Austria university researchers apparently have developed a list of risks and side-effects of psychotherapy for patients.
@ Crinoline (70)

There is absolutely a chance that some people will work the system to get what they wanted out of it. I have been guilty of that myself when it comes to mental health treatment in the past. However, I think if the stigma were removed, it would happen less often. Mental health treatment (in America anyway) can be expensive, besides being looked down on. Making it not only more accessible, but a requirement, would mean that you wouldn't be singled out for seeing a therapist, it would be normal. Some people would still work the system, but overall, people would be less inclined too, IMO.
Hey, maybe someone already said this, but actually, in the US, confidentiality is not guaranteed in therapy for individuals under 18. A therapist is obligated to inform parents of session content *if they request this information.* A way around that is for the therapist, at the start, to ask for the parents' word that they will not ask for information on session content (explaining that doing so will undermine treatment); in return, the therapist can agree to inform parents when it is necessary for maintaining the safety of the under-age client.

Could you link up that study please?

I think that seandr answered your question better then?

Seandr - I agree. I typically see medication as a push for people who can't manage therapy yet.

Wow, that's awful. Therapy should always be confidential, I can't imagine the use of an age limit.


I agree. I also think that faking/manipulating is more common for people in court-ordered, school-orderered or otherwise punitive therapy. I don't believe in forcing people (even children) into therapy. The point is identifying the problem, and offering the opportunity to work on it. People who are willingly in therapy are unlikely to intentionally manipulate their therapists.
Did anyone else log on earlier and get "An After-Christmas Miracle" instead of "Help!"? Just curious.
@77 Sometimes I just love you Hunter.

Bipolar, schizoid disorders and psychosis tend to show up (diagnosed anyway) in your early-mid twenties, so late 30's is pretty late.

And those problems actually are some of the ones we have the most effective treatments for. You can medicate for this stuff, and it makes a huge difference. Therapy too, of course, you need help to navigate the disease, but man, on meds off meds is like night and day. You can look at someone and know if they've been taking them correctly. It's like a miracle when they get them (more or less) right.

And the earlier you treat, the less severe they tend to get. So best figure out how to identify it faster, including in kids, if it can be.

Anyway, that's kind of off topic to the original letters. I think therapy does have some use for this girl if she chooses it, because here's what therapists do - they offer you perspective, are neutral, don't judge, you don't have to spare their emotions like you would a friend, they are completely confidential and you can talk to them knowing that they will never tell a soul and you don't have to see them in your everyday life, they offer a sounding board for your problems and help alleviate self-hatred by helping you work toward some sort of clarity. Therapy is a tool, and it can be useful if you want it to be. Can be lifesaving too, and certainly helps drive through pain faster than working on things alone. It's good to talk to someone with some experience with these things, right?
#72 Creepy Spam Alert
Very good and interesting site with very good look and perfect information ... I like it.
@88 Santa and his elves. His two fully grown-up elves.

One the color of caramel, his touch nervous and light in turns, his body as smooth as satin. And one as big as a bear and wholy covered in luscious fur, soft spoken and gentle.

Oooh Mommy loves Christmas...
Note to self... never be on SL comments at Christmas...
@mydriasis @80:

It was a German newspaper article (pop science, not original research) so there is no point in linking it directly.

But among others, they cited this study:…

This might be connected:…

And they referred to a, as-yet unpublished, study by Nestoriuc from Vienna university about the factors leading to side-effects of psychotherapy.
It only makes sense that psychotherapy could cause problems, just as any mistreatment could -- either by neglecting things that should be treated, or by actively doing or saying the wrong thing. I don't know that "side effects" is the right technical term, any more than one says that bad or wrongheaded parenting has "side effects," but certainly there may be unintended bad effects.
Broken link alert! "An After-Christmas Miracle" keeps redirecting here and I can't read the new column.

Please wait...

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