My Letter to the Editor: The New York Times

Below is a Letter to the Editor I submitted to the New York Times, in response to their Feb. 2, 2024 opinion piece entitled The Complexities of Transgender Care for Kids. NYT published this Opinion piece online and in print on a two-page spread, presenting like an authentic news article. NYT is helping to promote anti-trans rhetoric and dangerous approaches to mental health care for trans people.

Since, USPATH (the United States branch of the World Professional Association for Transgender Health) sent an email to members with “point-by-point rebuttals to recent opinion pieces” aka Pamela Price’s opinion piece, “notably by Erin Reed (here) and Evan Urquhart (here) and jointly (here).” In addition, I am quoting a few critical points the USPATH highlighted from the latest findings of the 2022 US Trans Survey:

So-called Rapid Onset Gender Dysphoria is not a validated theory and social contagion is not supported by the evidence (more here)

The conflation of sex, sexuality, and gender deliberately ignores the historical and current experiences of trans people of all ages.

Gender identity change efforts (so-called conversion therapy) deliberately harm trans people.

Detransition does occur, is rare, and is unique for each person. Research by K. MacKinnon and team (here and here) highlight the need for us to include people who detransition in care and research.

Rates of satisfaction with transition are high, upwards of 94% overall and up to 98% for people currently receiving hormone therapy, according to the 2022 US Trans Survey.

—

Letter to the NYT:

Pamela Price's misleading opinion piece relies on scientifically debunked phenomena like "rapid onset gender dysphoria." She presents her personal opinions as facts, citing links that fail to support her claims. Her first source is a retracted article and her second is Lisa Littman who wrote the original paper on the topic that has since been repeatedly dismissed, including on the basis of illegitimate research.

Price also refers to Therapy First, the organization formerly known as The Gender Exploration Therapy Association (GETA), a relatively fringe group of therapists against the gender-affirming care model. Many prominent health professional organizations have published position statements supporting gender-affirming care, including the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Association, American Psychiatric Association, American Psychological Association, and World Professional Association of Transgender Health (WPATH) standards of care to name a few.

Therapy First, GETA, and writers like Price herself cleverly disguise themselves as being unbiased and reasonable, well-meaning even, but in actuality are doing dehumanizing mental health care for transgender people. Why anyone would trust pseudoscience against the numerous reputable scientific organizations' published research is beyond me.

Julia Simone Fogelson

The Dual-Control Model

I have been really enjoying Emily Nagoski’s podcast titled Come As You Are named after her bestselling book of the same name. I decided to create a graphic of what she calls her “most famous friend” aka the Dual-Control Model, inspired by the episode The Science of Horniness (click here to listen). Hint: it’s more about turning off the offs than activating more arousal!

Why Is Therapy So Expensive?

My brilliant colleague Lee Lynch, MFT of Queer Expressions made these handy graphics breaking down what goes into the cost of a therapy session. I think it’s important for therapy-consumers to understand why fees feel so high, and why many therapists, including myself, don’t take insurance. I wish our country had mental health parity and greater access to mental health care for all. Imagine if insurance companies actually valued and paid therapists, or even better, health care that did not depend on a person’s job. I hope this helps add some context!

The Deadly Rebrand of Conversion Therapy to "Gender Exploratory Therapy"

Beware of any therapy advertised as "Gender Exploratory Therapy." Gender Exploratory Therapy may attempt to present itself as a harmless exploration of one's gender identity, but in reality, it is nothing more than a repackaging of conversion therapy. Conversion therapy refers to any emotional or physical treatment that aims to "cure" or "repair" a person's same-sex attraction, gender identity, or expression. The harmful nature of conversion therapies has been widely recognized and condemned by reputable mental health organizations across the board.

By disguising itself as Gender Exploratory Therapy, this abusive practice seeks to deceive those who may be seeking support and understanding in their gender journey. Their goal is to withhold any gender-affirming treatment and instead find an explanation that is convincing enough to persuade a trans person to delay their transition. They especially pray on youth and their families.

"Much like how a crisis pregnancy center steers pregnant people away from abortion, GETA’s (Gender Exploratory Therapy Association) strategy is to sound cautious and helpful while promoting a very specific view of how people should live their lives, which is as the gender they were assigned at birth." –Slate article, 2023

Spread the word. Gender “Exploratory” Therapy sounds innocent enough, but is far from it. Dr. Jack Turban, a resident physician in psychiatry at Harvard Medical School, lead-authored the “first study to show that gender identity conversion efforts are associated with adverse mental health outcomes, including suicide attempts” published in 2019. Study co-author Dr. Alex Keuroghlian, director of the National LGBT Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program added, “What this new study shows is that transgender people who are exposed to conversion efforts anytime in their lives have more than double the odds of attempting suicide compared with those who have never experienced efforts by professionals to convert their gender identity.” See the whole article on NBC.

It is my hope that people who need the care of a real gender-affirming therapist will not fall into the trap of conversion therapy, branded by another name.

The Queer Ultimatum and NRE: Let's Talk about the Marriage Thing

I am hearing about the Netflix reality dating show the Queer Ultimatum everywhere: from clients, friends, and even mentioned at AASECT National Conference by a facilitator. While I found the show highly entertaining myself, as a couples therapist I couldn’t help but wonder - why is the goal here marriage?

In a country where gay marriage was not legalized in all 50 states until 2015, I am excited to see queer people on television vying to get married. However, my issue is with the timeline: many of the couples had been together for under two years, some even 1.5 years. I have the same question for the hetero ultimatum and other reality shows like Love Is Blind. The push from casually dating to the altar is lightning quick. The fact of the matter is, we don’t really know someone until well into a relationship. Much of the beginning of a relationship is full of NRE (new relationship energy) and projections on the other person of what we want them to be for us (regardless of if they are really that person). This is not the ideal time to become engaged or even to tie the knot.

There are many hormones that flood the body when we are falling in love. According to Harvard, different hormones contribute to the three categories of lust (testosterone and estrogen), attraction (dopamine, norepinephrine, serotonin) and attachment (oxytocin and vasopressin). With all these chemicals pumping, we might want to consider what life will be like with that person when these chemicals are not on full blast. And, perhaps more importantly, once we see if they have met our expectations of what we have projected upon them, or if we had simply sized them up to fit our fantasy partner.

So, sure it’s fun to watch people "fall in love,” but perhaps let’s slow the marriage pressure down. Once you get to know someone past the NRE stage, then you can take a more balanced, nuanced approach to your big decision.

A photo of lust, attraction and attachment and the hormones attributed to each characteristic. Source: https://sitn.hms.harvard.edu/flash/2017/love-actually-science-behind-lust-attraction-companionship/

How Goop Tried to Champion Women's Sexual Empowerment, but Ultimately Failed

Episode 3 titled “The Pleasure Is Ours” of The Goop Lab with Gwyneth Paltrow looked promising. As a sex therapist and sex educator, I was curious what sex-ed on Netflix would look like. Despite being allergic to pseudo-science hogwash, I figured I could stomach Gwyneth Paltrow as the price of admission to get to screen time featuring the late, esteemed sex educator Betty Dodson. I cringed as Gwyneth told Betty she didn’t know the difference between a vagina (the birth canal) and the vulva (the general name for the outer bits), but this is true for many vagina/vulva-owners. Her cohost admitted she had never even seen her vulva. I nodded along in approval, glad that cis-women were talking about their genitals and sex on a mainstream media source. Betty and her associate Carlin Ross continued to educate the Goop team and feature what appeared to be earnest and authentic moments of self-revelation.

It all seemed too good to be true, and then, it was. Towards the end of the episode, the following words were presented across the screen: “Research has shown that orgasm is linked to reducing stress, curbing appetite, boosting hormone levels, enhancing sleep and heightening one’s sense of smell.” WAIT, what? Let me repeat that. “Research has shown that orgasm is linked to reducing stress, curbing appetite….”

Betty Dodson’s associate Carlin Ross shows a model of the clitoris.

I jolted back into reality that this was indeed, Goop, a diet-culture brand proselytizing detoxes, cleanses, and basically everything else that could be in a starter pack for orthorexia. I felt foolish to think that they could present something better. Orgasm is linked to curbing appetite. And there, in that one line, is the Goopness of it all: a woman’s appetite is something to be curbed. Appetite is bad. A woman with an appetite, for food, sex, life, anything, scares people. Why is curbing one’s appetite listed nonchalantly in a list of other beneficial effects? One could even argue that a curbed appetite is indicative of poor health: “Has your appetite changed?” is often asked on health assessments. I was once taught that instead of assuming someone lost weight intentionally, to consider it may have been due to an illness, grief, a breakup, or another myriad of reasons. But according to Gwyneth and Goop, a woman should want a low appetite, and thus let’s just name it, thinness. Sure, an orgasm is great, but did you know it makes you eat less? Now that’s a reason to masturbate if there ever was one!

I know I am late to the game, as the series debuted in 2020. I did not watch any other episodes, and I do not plan to. I bet Betty Dodson had a solid appetite and was not ashamed to admit it. A woman who is ravenous for life is the type of woman I want to be.

6 Tips for Coping With Travel Anxiety

I was recently asked by a media outlet to provide tips for overcoming travel anxiety. This is a hot button topic, as people are embarking on rescheduled trips that were postponed due to Covid-19.

Overcoming anxiety to travel is well worth it. In a cost/benefit analysis, the cost of experiencing the discomfort of anxiety is well worth the benefit of travel. Traveling outside of our routines can increase feelings of wellbeing, confidence, and connections to other places and people. In other words, the juice is worth the squeeze!

Pictured: the wing of an airplane on a background of clouds and sunlight.

• 6 actionable steps for coping with travel anxiety:

  • Before you travel, identify the exact thing that is causing your anxiety. Is it the airplane ride? Is it being away from your family? Perhaps it is a fear that something important will happen at work while you are gone. It is important to identify the cause so it can be addressed. Naming it will also take away the feeling of free-floating anxiety and make it feel more manageable and in your control. You can do this by writing out a list or speaking with trusted friends or a therapist. Once identified, you can work on it with a therapist. For example, interventions for flying anxiety are highly effective.

  • Pack with you items that grounds and relaxes you. For example, packing lavender essential oils or a favorite rock can be soothing to smell or touch if you find yourself feeling anxious on your travels.

  • Before your trip, load up your phone with favorite music and download favorite guided meditations. During your travels, you can play them should you feel especially anxious.

  • Don't forget your coping tools at home. If you deal with anxiety even when travel is not coming up, refer back to what has worked for you historically. Perhaps it is exercising daily or making sure you are eating balanced meals and getting enough sleep. Don't abandon these coping skills, but know you can continue taking care of yourself while on the road.

  • Prepare a list of 2 or 3 people you can call during your travels should you need to "phone a friend." These are people who remind you that you are not alone and can bring you words of comfort and encouragement if you are feeling anxious. Download Whatsapp for free international messaging and calls with wifi.

  • If you are on psychiatric medication, pack your prescription with you. You can also locate the nearest pharmacies to where you are traveling to should you run out of pills while you are away or misplace your medications. Remember, most everything you leave behind can be purchased away from home, even prescription medications.

Russian Doll: Nadia's Mother Wound

Russian Doll Season 2 Spoiler Alert!

Pictured: a photo of Natasha Lyonne playing Nadia in Netflix's Russian Doll.

In Season 2 of one of my favorite shows, Russian Doll on Netflix, main character Nadia time travels into her Jewish maternal family’s history via a New York City MTA train. We meet Nadia’s grandmother Vera in Nazi-occupied Budapest and later in her life in New York City, and her mother Nora in the 1980s on the verge of one of many breakdowns. Nadia has a complicated relationship with Nora, her mother, who is suggested in Season 1 to have schizophrenia. Through Nadia’s flashbacks, we see a traumatic childhood being raised by an unstable mother. In Season 2, we see Nora’s psychosis in the form of visual hallucinations. We also learn about the intergenerational trauma originating from her grandmother Vera surviving the Holocaust.

When Nadia gets the chance to travel back in time to the 80s and become her mother during her pregnancy with her, Nadia, she is caught literally giving birth to herself. Out from her own vagina comes her own baby self. Or, at least it seems to Nadia. Nadia steals the baby, herself, and time travels forward to 2022 New York City. The adult and child self are together, and now Nadia can parent herself the way she would have wanted to be parented. Her anger and grief at her mother can be resolved, as there would be no mother in the first place to ruin things. We see Nadia kissing baby Nadia’s head, holding her to her chest, leaving her in the watchful eyes of her best lesbian friends.

Shortly, Nadia realizes that changing the course of history is having dire consequences on 2022. Time is glitching and Nadia knows she must travel back in time and return her baby self to the rightful mother, her mother, Nora. Nadia walks out of a void and finds her mother on a subway car. Nadia sits opposite of Nora who asks her, “If you could choose your mother all over, would you choose me again?” Nadia begins to cry, sniffles, holding her baby self, and looks around the car at her child self in adolescence and her past maternal ancestors who are sitting at the other end of the car. She replies in her signature scratchy, New York accent, “Ma, Yeah I didn’t choose you the first time, but I guess that’s just how the story goes, huh mom?” Nora and Nadia smile at each other knowingly and Nadia returns her baby self to her mother.

In that moment, we see Nadia’s grief at never having the mother she had wanted. The truth is she got the mother she got, and in the end and we see something that feels like acceptance.

Spotting Green Flags in a Relationship

Pictured: a rainbow walkway.

Green flags in a relationship are signs that the person you are dating is treating you with respect. The relationship feels safe and consensual. As another definition, green flags are also signs that the person is meeting your expectations for a relationship and you can see a future together. Red flags are generally looked at as signs of abuse or future abuse, or that this is just not a good match. They are to be taken *very* seriously.

While red flags should give us a pause and a chance to reevaluate if a safe person to be around, or if this person is the right match, green flags propel us forward. While a red flag could be a partner never asks you about yourself, is controlling, makes you doubt yourself, or you find yourself not wanting to see them, a green flag is a blinking sign that says, keep going, you're on the right track!

The green flags, or signs, that a relationship has potential to last a long time are:

• The relationship is adding to your life, not making it more stressful. For example, feeling excited and looking forward to seeing the person you are dating is a great sign you are interested and enjoy their company.

• The person you are dating takes the time to ask you how you are doing, feeling, thinking etc. They do not spend the entirety of your time together speaking about themself, but are genuinely interested in knowing you as a person. They are a good listener.

• The person you are dating has good friend potential. When we are dating someone, not only do we hope there will be romance or intimacy, but being caring, good friends to each other will pull the relationship through the hard times.

• The person you are dating has other relationships in their life they care about. This demonstrates they know how to tend to a relationship. How do they talk about their exes? Are they vindicate and cruel, or do they express insight?

• They tell you how they feel. There is no guessing game, drama, wondering, fretting, texting a million friends to analyze text messages... this is an adult relationship where two people earnestly want to know each other.

How to Seek Connection When You are Depressed

Pictured: a pink flower with rain droplets, surrounded by green foliage.

It is important to seek out connection as a human being, but especially during the times when we feel down and depressed. Depression has a quality of feeling very inward, and people suffering from depression will often isolate themselves from others. By connecting with other people, isolation can be mitigated. However, it is often very difficult for people with depression to reach out and connect, because depression is also a huge energy drain.

Something as easy as texting a friend might feel like an insurmountable task if you are feeling very depressed. It is important to set up achievable social tasks: if leaving the house and attending a social event is totally inconceivable, then I recommend connecting with an easy friend, someone you feel comfortable with and do not need to exert too much energy to interact with. This can also be a parent or a relative. Sometimes people are worried about being a burden on their social supports. Since feelings of worthlessness can be a symptom of depression, it is important to remember that these are the people that love, support, and want to help you.

For people more oriented toward IRL connections and have the energy, an adult sports league can provide social support to feel connected with the world around you. Feeling alikeness with other human beings can be deeply beneficial to our wellbeing and feelings of connectedness with the world. Another platform is Meetup.com. You can browse groups based on your interests and identities, which means it will be more likely you will meet new people you can connect with.

Lastly, don’t be afraid to ask for help with practical support. A symptom of depression is fatigue or loss of energy, often daily, which makes daily tasks difficult. If you are feeling chronic low energy, a loved one can help tasks, like grocery shopping, refilling prescriptions, and scheduling your first therapy session.

The "Let's Be Friends" Breakup Pitfall

During a breakup, there is not a one size fits all approach to continued friendship. One mistake many exes make is trying to make a friendship work right after a breakup. Often there needs to be space to heal and decompress from the relationship, and if the breakup ended on amicable terms, then a friendship can be pursued in the future. However, a friendship with an ex should not be the default. Be sure to temper expectations and not promise friendship when that is not what you can provide. Sometimes people will make an offer of continued friendship to soothe and caretake the partner they just broke up with. Avoid this pitfall by spending time contemplating what it is you truly want, not what you may feel you owe the person. Not pursuing a friendship is completely okay.

During a breakup, it is helpful to use mindful communication. Hurt feelings drive people to say malicious things, like accusing a partner that the breakup is their fault. Although this very well might be the case, especially if one partner caused damage to the relationship by breaching their trust, give space between your thoughts and your words. What do you really want to say? If you are angry, what other feelings are below the anger? Do you feel rejected, hurt, or disrespected?

Couples therapists are not only for couples who are trying to improve their relationship. Exes or soon to be exes can attend therapy together to consciously uncouple. A skilled relationship therapist can help with this painful process and provide both member's support.

Pictured: a pink, ripped paper heart on a string.

Dating 101: How to Break Unhelpful Thought Patterns

Pictured: stones creating the image of a heart.

Single people often get in their own way by going through a list of all the reasons they do not think they are datable. The common anxieties I hear amount to "Why would anyone want to date me?" When we dig into where the lack of confidence is coming from, it is often wounding from a previous partner who wreaked havoc on their self-esteem or from messaging received from society of unrealistic standards: not thin enough, fit enough, smart enough, etc.

If this sounds like you, try the following tips:

• Notice your thought patterns. For example, do you keep noticing the same phrase repeated over and over again in your mind? Time to examine these thoughts and challenge them. How were they formed, and are there other voices contributing to them? (ie. This thought sounds like something my mom used to say!)

• Don't assume. Often my clients assume no one would want to date them because they think a prospective partner would not like any of their hobbies or quirks. Love anime? Go to an anime convention or a specific anime meet up group. You’d be surprised how many people out there are interested in what you are interested in–you might just need to widen your net.

• Do a mini experiment. Ask your friends in relationships you admire: how did you get here? Did you have any doubts about dating? How did you get through it? Let others help you get out of your own way!

Working with a therapist can help clarify what barriers are coming up as you set out to meet someone special. Without knowing what is causing self-sabotage, you cannot address and improve it. By talking through your anxieties and issues in a safe, confident space, a new perspective is offered. Amazing things happen when you get out of your head and consequently, out of your own way.

How to Seek Group Exercise as a Trauma Survivor

Pictured: hand weights and an orange resistance band with handles.

If we know anything about trauma, we know that the body quite literally "keeps the score" and remembers trauma. Trauma imprints on the body.  A yoga pose or a weight training pose that seems as simple as opening the hips might not be so neutral for a sexual assault survivor. We also know that trauma can cause chronic body pain.

Attending a group exercise class, or even 1:1 personal training, can be incredibly healing when done in the right environment and with the right facilitator. There are so many easy ways working with a trauma-informed exercise teacher can alleviate unnecessary triggers for trauma survivors.

A trauma-informed exercise facilitator would be vigilant on their own body’s positioning. For example, if someone was assaulted from behind them (grabbed, pushed, etc.), a trainer would not want to stand behind their client where the client could not see them. They would offer touch adjustments only with explicit consent. For example, “Can I place one gentle hand on your lower back to deepen your downward dog?” Notice the teacher outlines exactly what they will be doing. Their language is not vague. I am encouraged to see some yoga studios using consent cards to be placed on their mat. This is a vital way studios can create a culture of touch consent.

In order to ensure your provider is trauma-informed, you can ask them questions. If they are not open to taking the time to answer them, they are not a compassionate teacher. Some questions you might want to ask are:

• Have you received any training in working with clients with trauma or PTSD?

• Have you worked with trauma or PTSD before?

• You can also disclose a small amount of information if you trust your provider and what you need to feel safe around them. Advocate for yourself!

Some people might feel triggered by the body’s reaction to exercise, like heavy breathing, accelerated heart rate, and sweating. These feelings can mirror anxiety or panic, which some people who have experienced trauma may experience. It is important to know difference: anxiety, or just the body’s response to exercise? As your internal smoke alarm may be falsely going off, you can use positive self talk like, “This is just my body’s response to exercise. I am safe.” A therapist can help you work on these reactions and thought processes.

Exercise can be especially fraught territory for people with a history of eating disorders or those in recovery. The exercise industry as a whole is generally not weight-neutral, but rather encourages weight loss and "working on that bikini body". This type of language may be triggering. As advised before, advocate for yourself and ask if your teacher uses a weight-neutral approach to their exercise instruction, if they have worked with people with eating disorders, or anything else you’d like to know. Usually you can glean some information from an exercise institution’s marketing. For example, are they promoting losing that stubborn 10 pounds, or joyful connection to the body and mind? Do they use pictures in their marketing of different bodies?

By being a conscious consumer of public exercise, you can garner another tool to heal from trauma and reestablish safety in your body.