Disclaimer: real names of places, people and events may have been altered or abbreviated to protect the innocent. Namely, me.

XOXO, R.

 

Anonymous asked
Ryan, you know that chest pain that you experience when you're feeling sad? I've been experiencing that for the past few days lately... He and I, I don't what know we are... Sometimes I wondered if he sees me as friend, or perhaps less than that. I have to admit, all this while, it was just me having too much feeling for him... Every now and then, I'd revisit the past and recount the stupid things willingly I've done for him, and reaffirm that I'm just a sad fuck... But it's hard to turn away...

Hi Anon!

You sound like you are going through a really rough patch there, so here’s a huge hug for you! I hope that things have started looking up since you sent this to me? I can really relate to your feelings of being stuck in a position of unrequited love, the whole unfairness and anger towards it all.

Going over all the things you did and comparing that against what he did for you never works. It is all too easy to maximize our own suffering ("Can you believe I took that fucking one hour long bus ride to his school carrying his favorite sushi all just because he mentioned he was hungry when I could have been doing better things with my time like going for a manicure?!") and minimize that of his ("I never asked you to come over after work with that green tea latte anyway, so don’t you get all prissy and bitchy at me just because you’re sweating in your work clothes okay?!"), with the end result being that we will almost invariable end up with a conclusion skewed in our favor ("Oh my god poor me being taken advantaged of all the time!!!").

Expectations breed unhappiness and anxiety. What I found helpful for myself was recognizing that I have certain expectations towards some people and that these expectations are my own selfish ones alone. Which is pretty unfair to them, if I take a step back and think about it, because I am expecting them to be somebody they aren’t. And unfair to myself too, because all I am doing is setting myself up for, at best, okay-lor (since they just meet your expectations) and at worst, disappointment (when they fail to meet your expectations).

The expectations you have towards this person sound like they are causing you a lot of pain and pushing you towards making choices you normally wouldn’t do. Would ceasing contact with this person for a little while help in getting you back on stable ground, back into a calm state of mind and being able to make rational choices and see things as they are again? If so, that may be a choice worth considering and doing.

"I’m sorry!" I caught myself yelping as I wiped the bench down after my set while some impatient yahoo tapped his feet waiting for me to be done with my bench presses.
Which really got me thinking as I slurped at my smoothie after the workout (shoutout to the almond ones from Smoothie King: they rock!): what the heck am I feeling so apologetic for? For taking up space? For being a paying member of the gym just like you? Hashtag sorry not sorry.
It is interesting noting how "I’m sorry!" has replaced “Excuse me." in common vernacular. Which is unfortunate, because "I’m sorry!" carries the implication of you being in the wrong and your intention of trying to right that wrong, while "Excuse me." simply acknowledges that you are trying to be considerate of any possible inconvenience you may impose on another person.
Personal mission of the week: stop saying “I’m sorry!”, start saying “Excuse me.”

"I’m sorry!" I caught myself yelping as I wiped the bench down after my set while some impatient yahoo tapped his feet waiting for me to be done with my bench presses.

Which really got me thinking as I slurped at my smoothie after the workout (shoutout to the almond ones from Smoothie King: they rock!): what the heck am I feeling so apologetic for? For taking up space? For being a paying member of the gym just like you? Hashtag sorry not sorry.

It is interesting noting how "I’m sorry!" has replaced “Excuse me." in common vernacular. Which is unfortunate, because "I’m sorry!" carries the implication of you being in the wrong and your intention of trying to right that wrong, while "Excuse me." simply acknowledges that you are trying to be considerate of any possible inconvenience you may impose on another person.

Personal mission of the week: stop saying “I’m sorry!”, start saying “Excuse me.”

Anonymous asked
Hi Ryan. I'm a gay guy but not very open about my sexuality. I don't think of myself as straight acting. I'm just myself I guess. The thing is whenever I see a transsexual or very effeminate gays, I feel very disturb. I know we're all in the same LGBT community but I can't help how I feel. I find myself disgusting. 😓

Hi Anon!

Thank you for sending in this really frank confessional, it is really brave of you to air feelings that most of us find disagreeable and prefer to squash away on the inside and pretend don’t exist! Huge hugs to you; the first step to acceptance and love (not just to others, but to yourself as well) is recognizing and then embracing all aspects of yourself without judging whether they are good or bad.

I don’t want to speak for every person, but I daresay a significant majority of guys who identify as out and proud gays continue to carry about the culturally conditioned stigma against effeminate behavior and the belief that men should engage only in masculine behavior (or be emasculated and be all women-y and whatever). Gender studies is not my area of expertise and I am not sure about the current state of research and knowledge in the area; my very layperson’s understanding is that our current societal arrangement tends towards benefiting the male with negative attributes being assigned to the feminine.

top is the person performing penetration in sexual intercourse and a bottom is the person being penetrated by during intercourse. Notice how quickly we ascribe masculine characteristics to the former and feminine characteristics to the latter without even pausing to find out anything more about these hypothetical people!

I am really glad that you are aware of the internalized fem-phobia that seem to have been drilled into all of us. Look at people as people. Each and every one of us has a story of our own to tell, a story of how we got here, a story of what made us the person we are right now and a story of where we are going from here. It’s hard to hate what you empathize with. Behind every drag queen’s eyelashes is a living, breathing guy who is no different from you and me.

Played 42 times

Every little thing that you say or do
I’m hung up
I’m hung up on you.
Waiting for your call
Baby night and day
I’m fed up
I’m tired of waiting on you.

Hung Up
Madonna

Anonymous asked
Hi ryan! My bf and I had been together for 7 months now and we're not really chatting these days. Its been three weeks since I last saw him and our conversation is kinda on and off. It just doesn't feel the same anymore. I hate this feeling.

Hi Anon!

I am so sorry to hear you have to go through that… Here is a huge hug for you. It must feel terrible hanging on 24/7 waiting for some sort of response from him!

Requisite disclaimer: I am not a licensed psychologist/relationship or marriage therapist and I am answering questions on Tumblr to the best of my knowledge or ability. I would be more than happy to help you look for and hook you up with a lot more qualified source of help, just drop me a note in my inbox with your email address and I will get back to you as soon as I can.

I admit that given the lack of details I am not too sure what may be the circumstances behind the distance and strain which seems to be appearing in the relationship. I would suggest telling him that you are feeling neglected lately and setting an appointment to sit down together, have his full attention and have a talk, address all these feelings percolating on your inside and making you feel even more upset, and to figure out where to go from there on. Perhaps the boyfriend has his own concerns and feelings he needs to air too; do allow him to express them, listen to them and respect them just as much as you want him to do the same for you. I am sure that with honesty and mutual respect, you guys would be able to work out a mutually beneficial outcome as opposed to this upsetting status quo existing at the moment.

I hope this piece by Lerner (2013) may be of some help to you too!

"Oh god, I swear I am never doing that many shots ever again."
Funny how quickly these holy vows get forgotten until another hangover comes along reminding us that we once made them. Heh.

"Oh god, I swear I am never doing that many shots ever again."

Funny how quickly these holy vows get forgotten until another hangover comes along reminding us that we once made them. Heh.

Anonymous asked
Do you think it is sort of loserish for someone to be still a virgin at 27?

Oh my god of course not Anon!! I suppose it is kind of like the grass being greener on the other side kind of thing; I wish I have kept mine for someone important and who is my first, last and True Everlasting Love (yeah, you can blame Disney movies for that). On the other hand I can also identify with the opposite perspective of like, “Everyone has done it but me, am I a freak or something?”.

Take your time. Honest. Do it when you are ready, with someone who loves you, respects you. Too many friends and I agree that we wasted ours on a jerk who didn’t care that it actually meant something to us that it was like our, well, big V they’re taking. It’s purely symbolic. But it does matter in some way, when you look back at it in the future and go “Hmm maybe I shouldn’t have let him pop the bleep.”.


Psychotherapists who use social media outlets like Twitter might find themselves forced to navigate previously uncharted waters, and caught between contradictory personas. Common pitfalls and the questions they raise include: Is it ok for therapists to communicate casually? To opine or even joke about topics relevant to pop culture? And what about mental health? Does the discussion of serious topics on a public forum seem irresponsible or cavalier? When therapists decide to use social media channels like Twitter, how should they respond to followers who say negative things or complain about them?
For the first time in history a proliferation of social media outlets promises apparent instant access to mental health professionals. For those who don’t already know, Twitter works like this: anyone can open an account. Users write a brief factual paragraph and pair it with a photo or avatar. Tweets are similar to e-mail except they are limited to 140 characters. Plus, they are not private; anyone who follows an account is privy to the Tweeter’s communications. Tweets can also be sent to a particular environment by using a hashtag, the designated symbol “#,” and then spelling out the place they wish the tweet to appear, for example “#psychoanalysis.” Searching that environment will display recent tweets on related topics. Professional organizations, educational analytic institutes, and even therapists themselves use Twitter to post notices of talks, meetings and publications to their followers, as well as to anyone else who enters hashtags relevant to psychology or analysis. Of course they have other things to tweet about. And therein lies the problem. And the contradictory personas.
There are many possible difficulties that can occur when private topics are transmitted publicly. So why would professional organizations, institutes, and practitioners send public missives accompanied by personal photos?  Some see Twitter as offering a spontaneous and fun way to communicate.  Others find in it an online community and referral network. Many use it to promote books or blogs or boost a public image.
But what about the other side of the coin: psychologists, psychoanalysts, and other therapists must complete years of training, during which they learn to respect patients, value privacy, and protect personal boundaries. Licensed professionals are bound by a moral and ethical code, and if our goal is helping people, alleviating their pain or fostering insight on matters most intimate and private, then chatting publicly with strangers about private matters seems counterintuitive, if not a bit unreal.
Thinking along these lines it becomes obvious that the usual ways of professional comportment would not serve to govern the therapist’s interactions on Twitter. If we are trained to listen, and listen deeply for remnants of what had gone on in the past, to tune into how its artifacts remain alive in the present, and to pay attention to whatever might be going on in the room at any given moment with a patient, that’s certainly not the way we roll on Twitter. Helping others to develop insight into their psyches and come to a place of acceptance of all aspects of the self is often a jointly held goal in work with patients; our interactions reflect this mutual expectation and clinical arrangement. But on Twitter it is different. What must therapists do when approached for advice or counsel or when confronted with a stranger’s feelings? What is appropriate behavior for professionals who interact in the Twitterverse?
Top of the list: mental health professionals should never criticize or mock those with psychiatric problems. And while this sounds obvious, it is worth mentioning that social media and snark seem to go hand in hand. The zeitgeist is to take swings at others; cruelty and humiliation sell. Despite the public’s penchant for below-the-belt attacks, it seems most responsible to tweet about non-intimate matters in ways that are respectful in language and tone. Even so, this basic guideline falls short of addressing other possible inconsistencies between the therapist’s personal and professional personas.
Psychotherapists who blog are particularly susceptible to requests for advice and similar challenges to their clinical role. One recent exchange on Twitter illustrates the tension between personal and professional: I had posted a link to something I had written for a New York City newspaper; a post in which I argued that a character on Mad Men suffered from an internal fragility that caused him to flirt with sociopathic behaviors such as: stealing another person’s identity, frequenting call girls, lying to his long suffering wife, hiding money from her, and engaging in serial dalliances. I concluded that the TV couple seemed headed for divorce. In response I received the following tweet from a man with whom I had previously exchanged pleasantries. He wrote with a friend on cc: “I’ll bet Dr. Newman is divorced. I think Dr. Newman hates men.”
Though this man appeared to be communicating something important to me, it was clear I was not his analyst or therapist. I wasn’t there to make interpretations, and I definitely did not want to respond in any way that would seem rude or unempathic; this was supposed to be fun, after all. I joked, “Not divorced but will be if I continue to tweet at odd hours of the night.” The man responded that he was going through a divorce, and had been through a painful time. I wished him luck with this difficult situation.
Another man, tweeting anonymously as a famous fictional character, asked me several times to disclose my fee, and inquired about making an appointment with me. Knowing from his bio that he resided in another country, I asked whether he might be interested in a referral. “Would he like to meet Dr. Freud?” I certainly am not in the habit of referring people to the long deceased father of psychoanalysis. While money and fees are understood to have significant meaning and offer insight into an individual’s psychology, when it comes to the Twitterverse, such matters are all in good fun.
On another occasion a female tweeted to me in the middle of the night, asking for advice about how to handle a troubled relationship. Though I would have interpreted a late night call to my office, I did not respond in this manner to a request made on Twitter. I could see that she needed to talk to someone, so during the following day I tweeted that I could not give advice over the internet, and asked whether she had a therapist. Not surprisingly, she did; she told me she had already made an appointment.
People in my field have been criticized for offering gratuitous interpretations and for analyzing people in social situations. Sometimes we are accused of lacking in spontaneity and of overthinking everything and anything. So what to do when strangers communicate with you in ways that might be meaningful when they occur between analyst and patient, but are generally represent harmless interactions outside of the consulting room? The challenge of being a psychologist on Twitter is to figure out how to retain a professional demeanor but not act intrusively or callously; in other words how to engage in an authentic manner without making interpretations or hurting anyone’s feelings.
Psychotherapists using Twitter might find it helpful to follow certain basic rules of thumb: never tweet with patients. Instead of following patients or responding electronically, encourage them to bring all matters directly to the office. It is also a good idea to refrain from tweeting about personal things which can be difficult for others to hear (does someone struggling with infertility really want to see a picture of her therapist’s toddler? It is usually more helpful to be able to discuss the issue and work with it in the office a therapeutic way). When asked for advice on Twitter it is better to suggest making contact with a licensed professional in a treatment, not social media, situation. And, as previously mentioned, those in behavioral health fields should never be critical or mock patients or anyone struggling with emotional problems.
Many mental health professionals continue to shy away from social media avenues as they are unsure how to best use them. Twitter can be a useful tool for those wishing to build practices, expand referral networks, or promote academic and other kids of writing. The trick is to figure out how to best navigate its challenging waters.

An extremely thought provoking piece by Newman (2014) which tackles the thorny issue about mental health workers and social media. Given the potential pitfalls inherent in social media (discovering your therapist’s social media account outside the treatment context and going HAY WAIT A MINUTE YOU AREN’T AS WELL ADJUSTED AS I THOUGHT!!! for example), too many organizations (and therapists themselves) place onerous restrictions on the usage of them, often to the point of a blanket ban. Which I (matter of personal opinion of course) think might be just a tad too extreme. On the other hand, the care and best possible outcome for clients come in number one too, and if declining to participate in social media contributes to that, that may be a worthy enough trade off.
Ryan’s contribution to the debate:-Practicing psychotherapy over the internet has its own pros and cons, and I do not think Twitter is an effective medium for doing so given space constraints and huge potential for misunderstanding inherent.-Answer questions to best of knowledge.-Acknowledge own lack of knowledge.-Don’t pull a Dr Oz and go all pseudoscience.-Refer people who need help to places where they can obtain it from.-Practice ethically. Which begins with: familiarizing self with APA ethics code.

Psychotherapists who use social media outlets like Twitter might find themselves forced to navigate previously uncharted waters, and caught between contradictory personas. Common pitfalls and the questions they raise include: Is it ok for therapists to communicate casually? To opine or even joke about topics relevant to pop culture? And what about mental health? Does the discussion of serious topics on a public forum seem irresponsible or cavalier? When therapists decide to use social media channels like Twitter, how should they respond to followers who say negative things or complain about them?

For the first time in history a proliferation of social media outlets promises apparent instant access to mental health professionals. For those who don’t already know, Twitter works like this: anyone can open an account. Users write a brief factual paragraph and pair it with a photo or avatar. Tweets are similar to e-mail except they are limited to 140 characters. Plus, they are not private; anyone who follows an account is privy to the Tweeter’s communications. Tweets can also be sent to a particular environment by using a hashtag, the designated symbol “#,” and then spelling out the place they wish the tweet to appear, for example “#psychoanalysis.” Searching that environment will display recent tweets on related topics. Professional organizations, educational analytic institutes, and even therapists themselves use Twitter to post notices of talks, meetings and publications to their followers, as well as to anyone else who enters hashtags relevant to psychology or analysis. Of course they have other things to tweet about. And therein lies the problem. And the contradictory personas.

There are many possible difficulties that can occur when private topics are transmitted publicly. So why would professional organizations, institutes, and practitioners send public missives accompanied by personal photos?  Some see Twitter as offering a spontaneous and fun way to communicate.  Others find in it an online community and referral network. Many use it to promote books or blogs or boost a public image.

But what about the other side of the coin: psychologists, psychoanalysts, and other therapists must complete years of training, during which they learn to respect patients, value privacy, and protect personal boundaries. Licensed professionals are bound by a moral and ethical code, and if our goal is helping people, alleviating their pain or fostering insight on matters most intimate and private, then chatting publicly with strangers about private matters seems counterintuitive, if not a bit unreal.

Thinking along these lines it becomes obvious that the usual ways of professional comportment would not serve to govern the therapist’s interactions on Twitter. If we are trained to listen, and listen deeply for remnants of what had gone on in the past, to tune into how its artifacts remain alive in the present, and to pay attention to whatever might be going on in the room at any given moment with a patient, that’s certainly not the way we roll on Twitter. Helping others to develop insight into their psyches and come to a place of acceptance of all aspects of the self is often a jointly held goal in work with patients; our interactions reflect this mutual expectation and clinical arrangement. But on Twitter it is different. What must therapists do when approached for advice or counsel or when confronted with a stranger’s feelings? What is appropriate behavior for professionals who interact in the Twitterverse?

Top of the list: mental health professionals should never criticize or mock those with psychiatric problems. And while this sounds obvious, it is worth mentioning that social media and snark seem to go hand in hand. The zeitgeist is to take swings at others; cruelty and humiliation sell. Despite the public’s penchant for below-the-belt attacks, it seems most responsible to tweet about non-intimate matters in ways that are respectful in language and tone. Even so, this basic guideline falls short of addressing other possible inconsistencies between the therapist’s personal and professional personas.

Psychotherapists who blog are particularly susceptible to requests for advice and similar challenges to their clinical role. One recent exchange on Twitter illustrates the tension between personal and professional: I had posted a link to something I had written for a New York City newspaper; a post in which I argued that a character on Mad Men suffered from an internal fragility that caused him to flirt with sociopathic behaviors such as: stealing another person’s identity, frequenting call girls, lying to his long suffering wife, hiding money from her, and engaging in serial dalliances. I concluded that the TV couple seemed headed for divorce. In response I received the following tweet from a man with whom I had previously exchanged pleasantries. He wrote with a friend on cc: “I’ll bet Dr. Newman is divorced. I think Dr. Newman hates men.”

Though this man appeared to be communicating something important to me, it was clear I was not his analyst or therapist. I wasn’t there to make interpretations, and I definitely did not want to respond in any way that would seem rude or unempathic; this was supposed to be fun, after all. I joked, “Not divorced but will be if I continue to tweet at odd hours of the night.” The man responded that he was going through a divorce, and had been through a painful time. I wished him luck with this difficult situation.

Another man, tweeting anonymously as a famous fictional character, asked me several times to disclose my fee, and inquired about making an appointment with me. Knowing from his bio that he resided in another country, I asked whether he might be interested in a referral. “Would he like to meet Dr. Freud?” I certainly am not in the habit of referring people to the long deceased father of psychoanalysis. While money and fees are understood to have significant meaning and offer insight into an individual’s psychology, when it comes to the Twitterverse, such matters are all in good fun.

On another occasion a female tweeted to me in the middle of the night, asking for advice about how to handle a troubled relationship. Though I would have interpreted a late night call to my office, I did not respond in this manner to a request made on Twitter. I could see that she needed to talk to someone, so during the following day I tweeted that I could not give advice over the internet, and asked whether she had a therapist. Not surprisingly, she did; she told me she had already made an appointment.

People in my field have been criticized for offering gratuitous interpretations and for analyzing people in social situations. Sometimes we are accused of lacking in spontaneity and of overthinking everything and anything. So what to do when strangers communicate with you in ways that might be meaningful when they occur between analyst and patient, but are generally represent harmless interactions outside of the consulting room? The challenge of being a psychologist on Twitter is to figure out how to retain a professional demeanor but not act intrusively or callously; in other words how to engage in an authentic manner without making interpretations or hurting anyone’s feelings.

Psychotherapists using Twitter might find it helpful to follow certain basic rules of thumb: never tweet with patients. Instead of following patients or responding electronically, encourage them to bring all matters directly to the office. It is also a good idea to refrain from tweeting about personal things which can be difficult for others to hear (does someone struggling with infertility really want to see a picture of her therapist’s toddler? It is usually more helpful to be able to discuss the issue and work with it in the office a therapeutic way). When asked for advice on Twitter it is better to suggest making contact with a licensed professional in a treatment, not social media, situation. And, as previously mentioned, those in behavioral health fields should never be critical or mock patients or anyone struggling with emotional problems.

Many mental health professionals continue to shy away from social media avenues as they are unsure how to best use them. Twitter can be a useful tool for those wishing to build practices, expand referral networks, or promote academic and other kids of writing. The trick is to figure out how to best navigate its challenging waters.

An extremely thought provoking piece by Newman (2014) which tackles the thorny issue about mental health workers and social media. Given the potential pitfalls inherent in social media (discovering your therapist’s social media account outside the treatment context and going HAY WAIT A MINUTE YOU AREN’T AS WELL ADJUSTED AS I THOUGHT!!! for example), too many organizations (and therapists themselves) place onerous restrictions on the usage of them, often to the point of a blanket ban. Which I (matter of personal opinion of course) think might be just a tad too extreme. On the other hand, the care and best possible outcome for clients come in number one too, and if declining to participate in social media contributes to that, that may be a worthy enough trade off.

Ryan’s contribution to the debate:
-Practicing psychotherapy over the internet has its own pros and cons, and I do not think Twitter is an effective medium for doing so given space constraints and huge potential for misunderstanding inherent.
-Answer questions to best of knowledge.
-Acknowledge own lack of knowledge.
-Don’t pull a Dr Oz and go all pseudoscience.
-Refer people who need help to places where they can obtain it from.
-Practice ethically. Which begins with: familiarizing self with APA ethics code.

Anonymous asked
Hi Ryan, How do you decide what questions to answer? Have you ever thought of publishing all the questions you don't plan to answer? I'm curious on what arrives into your question box...

Hey Anon! I admit that I do not have specific criteria for answering questions that appear in my inbox. If there is a question you asked but didn’t get answered, it never hurts to try again, because I might have missed it the first time I looked it over in the pile of questions in my inbox.

Some questions that I would not answer:
-Are you dating ___?
-Are you top or bottom?
-Are you gay?
-You are going to hell.
-Would you have sex with me/would you fuck me/would you get fucked by me?
-Show us your cock.

Some questions that I would try my best to answer:
-Those in need of help.
-Those I am confident I can offer some form of help to.
-If you wish to share anything, don’t hesitate in popping them into the ask box; it doesn’t have to be a question, recommendations for movies, books, random thoughts and stuff would rock too!

PS: if you would prefer I reply to your question privately, please indicate a way for me to get back to you whether by email, private messaging by Line or such!

"I will be leaving soon too!"
I wanted, tried to smile. But I have a feeling that what came through was a rictused, tortured grin. Which made no sense at all. I should be happy that you’re moving on to better things, happier prospects. But the little kid in me wanted to throw a tantrum, cry and flail about on the floor.
“Why are you leaving? I promise I will be good. Please don’t go." he cried.
The older me collected myself and made the congratulatory noises I am supposed to do.
I wish I am not such a little kid when it comes to things changing, people leaving.

"I will be leaving soon too!"

I wanted, tried to smile. But I have a feeling that what came through was a rictused, tortured grin. Which made no sense at all. I should be happy that you’re moving on to better things, happier prospects. But the little kid in me wanted to throw a tantrum, cry and flail about on the floor.

Why are you leaving? I promise I will be good. Please don’t go." he cried.

The older me collected myself and made the congratulatory noises I am supposed to do.

I wish I am not such a little kid when it comes to things changing, people leaving.