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Sexual Development & Wholeness © Melvin W. Wong, Ph.D. All rights reserved, November, 2004 Melvin W. Wong, Ph.D. 黃偉康博士 Licensed Clinical Psychologist AsianPsy.com.

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Presentation on theme: "Sexual Development & Wholeness © Melvin W. Wong, Ph.D. All rights reserved, November, 2004 Melvin W. Wong, Ph.D. 黃偉康博士 Licensed Clinical Psychologist AsianPsy.com."— Presentation transcript:

1 Sexual Development & Wholeness © Melvin W. Wong, Ph.D. All rights reserved, November, 2004 Melvin W. Wong, Ph.D. 黃偉康博士 Licensed Clinical Psychologist AsianPsy.com Family, Forensic & Neuropsychology 220 Montgomery St., Suite 1098, San Francisco, CA

2 Day 1: Wednesday, November 17, :00-10:30 Overcoming Codependency 11:00-1:00 Psychosocial-Sexual Development 1:00 - 2:00 Lunch 2:00 - 4:00 Gender-Identity Formation Gender-Identity Disorder: Symptoms & Causes Gender-Identity Disorder: Prevention 4:15 - 5:00 Gender-Identity Disorder: Q/A

3 Day 2: Thursday, November 18, :00-10:30 Sexual Addiction: Causes & Treatment 11:00-1:00 Sexual Orientation: Gender Relationship 1:00 - 2:00 Lunch 2:00 - 4:00 Understanding Homosexuality Case examples and studies “Reparative” therapy: The controversies 4:15 - 5:00 Case Presentation: Leslie Lung: Q/A

4 Sexual Development & Wholeness © Melvin W. Wong, Ph.D. All rights reserved, November, 2004 Melvin W. Wong, Ph.D. 黃偉康博士 Licensed Clinical Psychologist AsianPsy.com Family, Forensic & Neuropsychology 220 Montgomery St., Suite 1098, San Francisco, CA

5 Codependent No More, by Melody Beattie, New York, Hazeldon Foundation, 1987 Defining the Codependent Person One who has let another person’s behavior affect him or her, and who is obsessed with controlling that person’s behavior.

6 Choice Making: For Codependents, Adult Children & Spiritual Seekers, Sharon Wegscheider-Cruse, 1985, Health Communications, FL A preoccupation & extreme dependence (emotionally, socially, & sometimes physically) on a person or object. Eventually, this dependence on another person becomes a pathological condition that affects the codependent in all other relationships. This may include - all person who (1) are in a love or marriage relationship with an alcoholic; (2) have one or more alcoholic parents or grandparents; or (3) grew up in an emotionally repressive family. It is a primary disease & a disease within every member of an alcoholic family.

7 Codependency A Psychological Definition © Melvin W. Wong, Ph.D. All rights reserved A person whose “Real-Self” is so underdeveloped that s/he becomes dependent on others for completion. And becomes addicted to the esteem & acceptance of others for survival to the point of desperation till it hurts. Gullibility- Deception: Manipulations, Self-Defeat, Tragic-outcomes, Win-Lose, Dehumanization, Death

8 Codependency: Serious outcome © Melvin W. Wong, Ph.D. All rights reserved Emotional Cannibalism The psychological “eating” and consumption of another’s ego so my starved ego can be emotionally “satisfied” be whole. 情感吞吃別人的自我

9 Family Tree Diagram Father Son-1 Son-1 Mother Daughter Son-2

10 Casts of the Dysfunctional Family Addict Enabler Adult-child: Man with problems; Gambling, affairs, rage & irresponsibility Mother who helps hide husband’s serious problems Survival for me

11 The “Addicted” Dependent Person (THE DEPENDENT) Thoughts Say: “ “ True Feelings Say: “I feel / I am “ Shame / Worthless Pain / Depression Fear / Despair Anger / Resentful Loneliness / Powerless Guilt / Remorseful Behavior Self-Righteousness, Aggression, Charm, Grandiosity, Rigidity, Isolation, Hostility, Perfectionism, Low Self- Worth, Control

12 Casts of the Dysfunctional Family Addict Enabler Mother who is trying to be the UN Peace- Keeper: Hoping things will not go out of her control Keep the peace: Survival for me

13 The Enabler (THE CHIEF CO-DEPENDENT) Thoughts Say: “I Don’t Know What More I Can Do???“ True Feelings Say: “I feel / I am “ Powerless / Depressed Pain / Fatigued Fear / Despair Anger / Resentful Loneliness / Powerless Guilt and Shame Behavior Isolation, Self-Pity, Seriousness, Fragility, Super- Responsible, Manipulator, Self-Blaming, Passive, Perfectionism, Control, The Family Martyr

14 Casts of the Dysfunctional Family Addict Enabler Be Perfect: Problems will go away Hero I want to be hero too! I am worthy Win-Lose Rivalry Detach

15 The Family Hero (THE RESPONSIBLE ONE) Thoughts Say: “If I Don’t fix It, Who Will??“ True Feelings Say: “I feel / I am “ Inadequate Fear / Despair Anger / Resentment Lonely / Remorse Guilt and Shame Behavior Super-Responsible, Perfectionism, Successful, Self-Reliant, All-Together, Unable To Relax, Special, life Away From Family

16 Casts of the Dysfunctional Family Addict Enabler Rebel: Believing I am the problem Scapegoat

17 The Scapegoat (THE ACTING OUT PERSON) Thoughts Say: “If Your Looking For Someone To Blame, Here I Am!!“ True Feelings Say: “I feel / I am “ Hurt Fear / Despair Anger / Resentment Loneliness / Remorse Guilt and Shame Behavior Strong Peer Value, Rationalizations, Delinquency, Anti- Social, Underachiever, Poor Self-Image, Withdrawn From Family, Rebellious

18 Casts of the Dysfunctional Family Addict Enabler Withdraws from Relationships: Numb Lost Child

19 The Lost Child (THE ADJUSTER) Thoughts Say: “I’d Rather Be Left Alone“ True Feelings Say: “I feel / I am “ Hurt Inadequate Anger / Resentful Loneliness / Remorse Guilt and Shame Behavior Withdrawal Into Self, Follower, Shy, Sometimes Overweight, Emotionally Closed, Passive, Invisible, Identity Confusion, Underachiever, Appears Selfish

20 Casts of the Dysfunctional Family Addict Enabler Makes laughter admist family tragedy Mascot

21 The Mascot (THE PLACATER) Thoughts Say: “I’m The Only Laugh This Family Has“ True Feelings Say: “I feel / I am “ Insecure Confused Fear / Despair Anger / Resentment Loneliness / Remorse Guilt and Shame Behavior Humor, Clown, Fragile, Hyperactive, Impulsive, Lacking Self-Worth, Emotionally Sensitive, Warm, Fixer, Distracter

22 The Addictive Family Roles The Sexually Dependent Person The Enabler / Co-Dependent The Hero / Responsible The Scapegoat / Acting Out The Lost Child / Adjuster The Mascot / Placater

23 The Codependent-Addicted Family Rules (Unspoken) DON’T FEEL DON’T TALK DON’T TRUST DON’T THINK DON’T CHANGE

24 Co-dependent Parent “I am a bad child” “Something is wrong with me” “I am ashamed” Perform for approval/love Abused child The Family Environment Of Codependence Hinder Development of God/true self Control others to protect & reconcile pain Robert Brennan, MA, MFT, 2004

25 The Dysfunctional Family Theme Song Paul Aldrich © 1991 Doulous Publishing 1) My parents got divorced before I was conceived, I blame myself of course, they blame it all on me My unwed pregnant half-step-sister is in therapy My family’s got more problems than the Simpson’s on TV > (Chorus) (Chorus) Dysfunctional, dysfunctional, we’re co-dependent, insecure dysfunctionals, dysfunctional, dysfunctional, dysfunctional as one family can be 2) My dad he drinks & gambles, my mom just talks and smiles, my sister has quit eating, we all live in denial My brother has low self-esteem, and thinks he just turned gay, they all take turns to beat me up, well what else can I say? > (Chorus) 3) I can’t wait to get married, to raise kids my own, I’ll buy them all a self-help book, a TV and a phone Then send them all to public school, for values they will need, I’ll keep the cycle going, so they’ll turn out just like me > (Chorus) We’re co-dependent can’t you see? We’re insecure, we’ll always be, We’re all receiving therapy, In just twelve steps we’ll be set free, Dysfunctional as one family can be

26 Contrasting Families Healthy vs. Unhealthy Functional Trusting is OK Feeling is OK Talking is OK Each Child is Special Love is unconditional (even after a mistake) Non-toxic Shame-Guilt developed No need to keep Secrets Communication is Clear & Direct Free & Open: Secure Growth-Optimism Producing Dysfunctional Trusting is not OK Feeling is not OK Talking is not OK Each Child is Worthless Love is Transactional (No acceptance approval/affirmation) Blame-Shame-Performance based Keeper of Family Secret Double-bind, mixed meanings Anxious-Restrictive: Fear Precipitate Self-Defeating Behaviors

27 Personal Boundaries A codependent person might say: An interdependent person might say: I am overwhelmed by and preoccupied with a person. I am able to keep my relationships in perspective and function in other areas of my life. I let others define me. I know who I am in Christ, and I am wary of people who want to remake me. Source: Counseling Adult Children of Alcoholics by Sandra D. Wilson, Ph. D

28 A codependent person might say: An interdependent person might say: I let others determine what I feel. I refuse to allow someone else to tell me, "You don't feel that way." I let others direct my life. I listen to opinions, but I make decisions for myself, based on God's leading of my choices. I violate personal values to please others. I am not willing to "do anything" to maintain a relationship. I have values that are not negotiable. Source: Counseling Adult Children of Alcoholics by Sandra D. Wilson, Ph. D

29 The Twelve Promises of Co-Dependents Anonymous 1. I know a new sense of belonging. The feeling of emptiness and loneliness will disappear. 2. I am no longer controlled by my fears. I overcome my fears and act with courage, integrity and dignity. 3. I know a new freedom. 4. I release myself from worry, guilt, and regret about my past and present. I am aware enough not to repeat it.

30 The Twelve Promises of Co-Dependents Anonymous 5. I know a new love and acceptance of myself and others. I feel genuinely lovable, loving and loved. 6. I learn to see myself as equal to others. My new and renewed relationships are all with equal partners. 7. I am capable of developing and maintaining healthy and loving relationships. The need to control and manipulate others will disappear as I learn to trust those who are trustworthy.

31 The Twelve Promises of Co-Dependents Anonymous 8. I learn that it is possible to mend - to become more loving, intimate and supportive. I have the choice of communicating with my family in a way which is safe for me and respectful of them. 9. I acknowledge that I am a unique and precious creation. 10.I no longer need to rely solely on others to provide my sense of worth.

32 The Twelve Promises of Co-Dependents Anonymous 11.I trust a guidance I receive from my Lord Jesus and come to believe in my own capabilities. 12.I gradually experience serenity, strength, and spiritual growth in my daily life.

33 Resources Against the Wall, men's reality in a codependent culture, by Marshal Hardy and John Hough Back from Betrayal, Recovering from His Affairs, by Jennifer Schneider, M.D. Beyond Codependency, and getting better all the time, by Melody Beattie Boundaries & Relationships, knowing protecting & enjoying the self, by Charles L. Whitfield, M.D.

34 Resources Boundaries: Where You End and I Begin, by Anne Katherine, M.A. Choice-Making, for codependents, adult children and spirituality seekers, by Sharon Wegscheider-Cruse Codependence: misunderstood-mistreated, by Anne Wilson Schaef Codependent No More, how to stop controlling others and start caring for yourself, by Melody Beattie

35 Resources Facing Codependence, by Pia Mellody Healing Together: a guide to intimacy and recovery for co-dependent couples, by Wayne Kritsberg I'm Dying To Take Care of You, nurses and codependence, breaking the cycles, by Candace Snow and David Willard

36 Resources In Sickness and In Health: The Codependent Marriage, by Mary S. Stuart Is It Love or Is It Sex?: Why Relationships Don't Work, by Carla Wills-Brandon Leaving the Enchanted Forest: The Path From Relationship Addiction to Intimacy, by Stephanie Covington and Liana Beckett Lost In the Shuffle, the codependent reality, by Robert Subby

37 Resources Reclaiming your self: the codependent's recovery plan, by Brian DesRoches Step-By-Step Guide To Recovery, for all adult survivors and codependents, by Mohan Nair Talk, Trust, And Feel, keeping codependency out of your life, by Melody Beattie The Truth Will Set You Free, by Fr. Jack McGinnis and Barbara Shlemon

38 Resource & References Handbook of Child and Adolescent Sexual Problems, George A. Rekers, Lexington Books, 1995 The Psychological Birth of the Human Infant, Margaret S. Mahler, et al, Basic Books, 1975 Comprehensive Textbook of Psychiatry/IV 4 th ed. Harold I. Kaplan & Benjamin J. Sadock, Williams & Wilkins. Homosexuality: A New Christian Ethic, Elizabeth R. Moberly. The Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) 4 th ed. American Psychiatric Association. 1994

39 What causes Homosexuality? The Question of Nature vs. Nurture What are the Root Causes of Homosexuality Homosexuality if not only about Sex Homosexuality & Same-Sex Attraction It is about Gender Security Male: Masculine Gender Identity Security Female: Feminine Gender Identity Security

40 The Hidden Secret of Psychiatry & Psychology in understanding the formation of Homosexuality… It is about Gender Identity Disorder

41 DSM-IV Sexual and Gender Identity Disorders, Quote (page 536) By late adolescence or adulthood, about three-quarters of boys who had a childhood history of Gender Identity Disorder report a homosexual or bisexual orientation,

42 T ypically, children are referred around the time of school entry because of parental concern that what they regarded as a "phase" does not appear to be passing.

43 Gender Identity Formation Stages Stage 1 (Birth to Four years old) –Parental Same-Gender Attachment Stage 2 (Kindergarten to Stage 1 School) –Social Same-Gender Attachment Stage 3 (Elementary to Middle School) –Social Opposite-Gender Attachment Stage 4 (Middle to High School) Stage 5 (High School to College) Stage 6 (Beyond First Stage College & Marriage)

44 Stage 1 (Birth to Four years old) Parental Same-Gender Attachment –Separation & Individuation –Same-Gender Attachment Failure –Opposite-Gender Attachment

45 Family Tree Diagram Father Son-1 Son-1 Mother Daughter Son-2

46 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son separates from mom for psychological individuation successfully

47 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son attaches with dad for Gender-Identity formation sucessfully

48 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son separates from mom for psychological individuation successfully

49 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son attempts to attach to father for Gender- Identity formation

50 Unhealthy Relationship Begins Father Son-1 Son-1 Mother Daughter Son-2 Son’s attempts to attach to father was rebuffed and he experiences rejection and hurt

51 Unhealthy Relationship Defensive Detachment Begins Father Son-1 Son-1 Mother Daughter Son-2 Son’s attempts to defend against more pain from rejection by defensively detaching from father’s relationship emotionally

52 Gender-Identity Development Separation-Individuation Successful Gender-Identity develops after an early dynamic relationship (Separation- Individuation) of child with Mother & Father Both Mother and Father are important for healthy gender development of their kids Dynamic psychological relationship begins when child walks & talks (Separation-Individuation) –Where Gender-Identity Imprinting begins

53 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D.1999 Object-Relations Separation-Individuation theory suggests there is a critical phase when a child will have to separate from mother to attain gender individuation For gender identity to be formed, child must successfully attach to the same-sex parent emotionally

54 Reference The Psychological Birth of the Human Infant Symbiosis and Individuation Margaret S. Mahler, Fred Pine & Anni Bergman ( pages) Published by Basic Books, Inc. Publishers, New York (Hardcover USD $45 Paperback $22)

55 The Psychological Birth of the Human Infant Symbiosis and Individuation Beginning of Gender Identity is 21 months –Boys turn to fathers to gender identify (p. 106) –Boys struggles with castration anxiety Task of becoming a separate individual for little girls are more difficult than boys –Girls turn to mother upon discovery of sexual difference –Girls blame, demand, ambivalent toward mom

56 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D.1999 Defensive Detachment theory –Dr. Elizabeth Moberly Defensive Attachment theory –Dr. Melvin Wong, Licensed Psychologist (Calif) Father-Son Separation: Emotional Detachment Mother-Son Enmeshment: Close emotional attachment, results in imprinting of mother’s gender-personality characteristics

57 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son separates from mom for psychological individuation successfully

58 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son attempts to attach to father for Gender- Identity formation

59 Unhealthy Relationship Begins Father Son-1 Son-1 Mother Daughter Son-2 Son’s attempts to attach to father was rebuffed and he experiences rejection and hurt

60 Unhealthy Relationship Defensive Detachment Begins Father Son-1 Son-1 Mother Daughter Son-2 Son ’ s attempts to defend against more pain from rejection by defensively detaching from father ’ s relationship emotionally

61 “Hand-me-down” Vows Sons I will not be like by my father! When I grow up, I will not be like my father! I hate my father, if being a man is to be like him, I rather not be a man! (what’s the alternative? My mother nags me too much! She’s a pain!

62 “Hand-me-down” Vows Daughters I will not be like my mother! When I grow up, I will not be like my mother! If being woman is weak like mother, I rather not be a woman! (What’s the alternative?) I hate my father! I hate man! I hate all men!

63 Unhealthy Relationship Defensive Attachment Begins Father Son-1 Son-1 Mother Daughter Son-2 Son has no choice but to re-attach with mom for emotional security

64 Unhealthy Relationship Defensive Attachment Continues Father Son-1 Son-1 Mother Daughter Son-2 Son has no choice but to re-attach with mom for emotional security Forming Defensive Attachment

65 Unhealthy Relationship Defensive Attachment Intensifies Father Son-1 Son-1 Mother Daughter Son-2 Son generalizes defensive detachment to defensively attach to girls and women: Non- aggressive & softer

66 Unhealthy Relationship Defensive Attachment Intensifies Father Son-1 Son-1 Mother Daughter Son-2 Father becomes a stanger Generalization intensifies. Father becomes a stanger Girl 1 Girl 2

67 Unhealthy Relationship Defensive Attachment Intensifies Father Son-1 Son-1 Mother Daughter Son-2 Men are unfamiliar Generalization intensifies. Men are unfamiliar Girl 1 Girl 2 Girlfriend

68 Unhealthy Relationship Defensive Attachment Solidifies Father Son-1 Son-1 Mother Daughter Son-2 Men are objectified- curious-sexualized Girl 1 Girl 2 Girlfriend Grandma

69 Unhealthy Relationship Defensive Attachment Solidifies Father Son-1 Son-1 Mother Daughter Son-2 Men are objectified- curious-sexualized Girl 1 Girl 2 Girlfriend Grandma Aunt 1

70 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D Mother-Daughter Separation: Individuation Father-Daughter Attachment: Gender-Identity “Confirmation” process –“I am not mother, but I am myself as a wanted girl” Father-Daughter Detachment: Confusion Mother-Daughter Attachment-Enmeshment –Defensive Attachment: “I am wanted as a girl” –“I am not mother, so I must not be like her” Rejects Gender-Identity with mom for Individuation

71 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D Imprinting: An Opportune-Window of time for Gender Identity to take place –Successful attainment: Secure Gender Identity –Attainment failure: Incomplete Gender Identity When Imprinting period is passed, child becomes more vulnerable in Gender Identity Non-Gender-Imprinted child: Seeks attainment indiscriminately due to desperation: Mother Sexual Abuse: Genital-Arousal Pleasure-Imprinting

72 Stage 2 (Kindergarten to Elementary) Social Same-Gender Attachment Polarization-Strengthening Process –Gender Identity Opposite Gender seen as a threat –Clear Limits Boundaries across gender lines Gender Stereotyping: Hair-cut, clothes, toys, Same-Gender familiarity preferred

73 Therapeutic Approaches to Treatment of GID Stage 2 (Kindergarten to Primary School) Parents and teacher need to be in cooperation Prevent GID child from ridicule & bullying No cross-dressing for to please Mother’s desires Same-Gender Parent influence: Acceptance Dad: Spend more time with son: Gender specific Mom: Spend more time with daughter: Gender specific

74 Picture Credit: Janelle Ching, used by permission (Dr. & Mrs. Stephen & Lisa Ching, 2002)

75

76 Stage 3 (Elementary to Middle School) Social Same-Gender Attachment Physical Gender Identity Differentiation –Pre-Puberty Gender Ambiguity –Masculine Features: Security vs. Insecurity –Feminine Features: Security vs. Insecurity Acceptance vs. Rejection of Body –Body Discomfort of troubled children

77 Father’s Affair Hurts Daughter Men Cannot be Faithful 1.Men are Unfaithful, Don’t have anything to do with Men 2.I Don’t Want to be My Mother or like My Mother, because She Allowed him to do it 3.Mother = Weakness 4.Women are weak

78 Therapeutic Approaches to Treatment of GID Stage 3 (Elementary to Middle School) Boys: Dads aligns with son to protects them Girls: Dads able to relate to daughters, Mom is considered strong person, avoid being victims of sexual abuse by close family members

79 “Detachment” “Orphaning” Cannot Identify With Mother Detach from Mother The Self became “Orphaned” Detached Identity Detached Self Seeking Attachment Same-Gender Attachment

80 Stage 4 (Middle to High School) Social Same-Gender Attachment Self-affirmation & acceptance: –Girls: Make-up & clothes –Boys: Power & strength: Sports & work-out Interest & Curiosity over opposite gender –“Puppy Love”: Dating begins Affirmation through opposite sex peers –Comfort with opposite sex peers

81 “Not One of the Girls” Not Identify With Girls 1.Feel Different 2.Detached from Peers Members (same age) Unable to Gender Identify with Female 3.Seek Clear Identity Be Opposite of Peers

82 Therapeutic Approaches to Treatment of GID Stage 4 (Middle to High School) Focus is with the children, not only parents Same-gender peer acceptance is important Boys: Athletics potential, self-acceptance of body, reduce individual sports, team work Girls: Make-ups practices, dresses, girl-play

83 Stage 5 (High school to College) Social Opposite-Gender Attachment Security in self-affirmation & acceptance: –Girls: Less self-conscious & preoccupation –Boys: Power & strength: Sports & work-out More matured interest over opposite gender –Steady Dating begins Affirmation through opposite sex peers –Comfort with opposite sex peers

84 “I was raped when I was 14”! Being Woman is Weakness Rejecting Female Gender in order to Feel Safe Lesbianism: A Way to be Strong - In Control An Unhealthy Way to Cope With Abuse

85 “Opening Doors” 28-minute video Produced by Exodus Global Alliance Available online

86 Therapeutic Approaches to Treatment of GID Stage 5 (High school to College) Boys: Reduce Same-sex sexual fantasies, increase same-sex non-sexual relationships Girls: Reduce codependent same-sex emotional relationships, find a male mentor (teacher, coach), resolve conflicts with dad and mourn abuse issues with self or mom

87 Stage 6 (Beyond College & Marriage) Navigate a mutually nurturing committed relationship through Marriage & Parenting Marital Relationship Can merge without threat of over-crowding Can be autonomous without fear of abandonment Parenting Relationship Can affirm gender of same-sex children Can affirm gender of opposite-sex children

88 Therapeutic Approaches to Treatment of GID Stage 6 (Beyond College & Marriage) Refer to mental health professional Specific personal addiction issues Men: Sexual addiction (Internet, gay sex) Women: Emotional-Relational addiction

89 Therapeutic Approaches to Treatment of GID Gender Identity Disorder is an Identity problem and not a sexual disorder per se While sexual issues are symptoms, the key to treatment is not only sexual in focus The focus is in the area of Gender security development Boys: Masculine Identity Security Girls: Feminine Identity Security

90 Therapeutic Approaches to Treatment of GID Intervention strategy is different for each age group Younger the child The easier & more effective is the treatment It is most important to diagnose early Average referral is three and a half year-old Remember: Most are victims of sexual abuse

91 Therapeutic Approaches to Treatment of GID Specific Local Issues Absentee Fathers & Depressed Mothers –Detachment-Rejection of Father & significant males –Detachment-Rejection of Mother & significant females –Increased of Gender Confused male & female children –Increased of GID boys and girls (Filipina) Nannies & Maids: At-risk-boys –Women’s emotional dominance: Detachment –Ambivalence toward male gender: Teasing & touching –Intentional or “casual” sexual exploitation & abuses

92 Day 2: Thursday, November 18, :00-10:30 Sexual Addiction: Causes & Treatment 11:00-1:00 Sexual Orientation: Gender Relationship 1:00 - 2:00 Lunch 2:00 - 4:00 Understanding Homosexuality Case examples and studies “Reparative” therapy: The controversies 4:15 - 5:00 Case Presentation: Leslie Lung: Q/A

93 Root Causes of General Addictions Dysfunctional-Abusive family – –Rigidity & perfectionism: Can’t fail – –Enmeshment between family members Can’t talk about emotions – –Denial of feelings – –Re-labeling-Minimizing your feelings by adults Ineffective, non-satisfying social relationships

94 Circumplex Family Map High Low Low Cohesion High Chaotically Enmeshed Rigidly Enmeshed Chaotically Disengaged Rigidly Disengaged Adaptability

95 Circumplex Family Map Low Cohesion High HighLow AdaptabilityAdaptabilityAdaptabilityAdaptability Flexibly Connected Structurally Connected Flexibly Separated Structurally Separated Connected Flexibly Enmeshed Rigidly Connected Structurally Enmeshed Separated Flexibly Disengaged Rigidly Separated Chaotically Enmeshed Rigidly Enmeshed Chaotically Disengaged Rigidly Disengaged

96 Low Cohesion High High Low AdaptabilityAdaptabilityAdaptabilityAdaptability Flexibly Connected Structurally Connected Flexibly Separated Structurally Separated Chaotically Connected Flexibly Enmeshed Rigidly Connected Structurally Enmeshed Chaotically Separated Flexibly Disengaged Rigidly Separated Chaotically Enmeshed 0% 0% Rigidly Enmeshed Chaotically Disengaged 2.5% 68% Rigidly Disengaged Addicts Family of Origin

97 Abuse & Addictions Chemical Dependency42% Eating Disorder36% Compulsive Work27% Compulsive Spending26% Gambling 5% Sexual Addiction ?

98 Proximal Causes of Sexual Addiction Premature Sexual-Genital Familiarization Over-exposure to adult pornographic materials “My dad’s Playboy magazine” “My uncle’s books under his bed or mattress” “One day I found a stash of magazine in my neighbor’s trash” “I watched HBO after my parents went to sleep” “I watched my mom having sex with her boyfriend”

99 Immediate Causes of Sexual Addiction Child was a victim of sexual violation Molestation-Fondling: Culture specific (Sexual curiosity of adults in Asian ethnic groups) Men’s sexual curiosity over self: Projected on children Men exposed self to children: To satisfy “something” about themselves Servant-Maid: “Bathing a toddler” Sexual arousal as a way to soothe a child

100 Direct Causes: Biology & Psychology Behavioral: Stimulus-Response Cycle – –Boredom: Social-Interpersonal Isolation – –Excitation: Immediate Gratification – –Stimulus-Response : Emotional Reminders Habit-Forming Behaviors – –Cigarettes smoking – –Rage: Temper Tantrums Relaxation Cycles – –Physiological Arousal & Rest States

101 Why Sexual Addiction? Needs for Arousal Life is Boring Gambling Sex Stimulant Drugs High-Risk Behaviors

102 Why Sexual Addiction? Needs for Satiation Life is Not Satisfying-Unhappy Sex Over-Eating (Bulimia-Binging) Depressant Drugs (Marijuana) Narcotic Drugs (Anesthetic effect) Alcohol

103 Why Sexual Addiction? Needs for Fantasy Reality is too Hard: Need a Quick Escape Voyeuristic Sex : Intelligent fantasy & Routine Psychedelic Drugs: LSD Marijuana Mystic/Artistic Preoccupation

104 10 Types of Sex Addicts (After Patrick Carnes, Ph.D.) Fantasy Sex Seductive Role Sex (dress) Voyeuristic Sex Intrusive Sex (obscene calls) Exhibitionism 6. Sex Trading 7. Anonymous Sex 8. Paying For Sex (Prostitution) 9. Pain Exchange 10. Exploitive Sex

105 Some Theories Explaining Addiction Dynamic To Follow

106 The Physical Intimacy-Orgasmic Cycle Copyright © Melvin W. Wong, Ph.D All Rights Reserved “Intimacy Always Feels Good!” “Emotional Intimacy Leads to Physical Intimacy!” “Physical Intimacy Can Lead to Orgasm!” “Orgasm Always Feels Good!” “Orgasmic Feeling is Intimacy?” Physical Intimacy is an Antidote for Loneliness, Low-Self Worth, Boredom, Aggression, Anger, Despair, Abandonment “H.A.L.T. Defeated”

107 Sexualized “Love” (Compensational) Admiration Love Obsession Obsessive Love Sexualization of Love Emotional Cannibalism

108 Internet/Porn Addiction Criteria Frequent viewing for longer periods than intended Repeated, unsuccessful attempts to stop,cut back or control behavior Irritability off-line during period of attempted abstinence

109 Internet/Porn Addiction Criteria Escalating sexual behavior-more intense and higher risk Deceive family and friends to protect internet activity Committing Illegal Acts online Jeopardizing or losing relationships, job, education or career

110 Myths / Denial about Pornography Justifies Masturbation Doesn’t hurt anyone, even me Helps stimulate marital sex It’s not real Can stop whenever I want No consequences Just a game – virtual reality

111 Role of Pornography Safe Relationships I have power over image No rejection Replaces real relationships-too difficult/complex Stimulation because real life is stressful, difficult, boring, or unhappy

112 Addiction Cycle Addictive Cycle Fulfillment Orgasm Visual Triggers Action Masturbation Let Down Connection Porn Image Arousal Hunt Image Search Fantasy Mental Plan Pain Repression Craving-Tension The Vow

113 The Inner Conflict of Addiction The addicted person is ambivalent because: – –Addiction is both pleasurable and destructive – –Addiction is accepted by the non-Christian world but not by God – – Addiction is pleasurable and yet over time takes over the minds neurotransmitters – –The addict can justify their use of pornography and yet know in their heart it is wrong for them

114 Impact of Pornography Damaging To Marriages – –Creates unrealistic demands on wife – –Compare images to wife body – –Anger with wife – –Pornographic image relationship takes place of intimacy with wife – –Decreases interest in sex with wife

115 Impact of Pornography Destructive to Users 4 Step progression – –Addiction--Stimulant – –Escalation-Increased Arousal Potential – –Desensitization-Dulled Senses – –Acting out sexually-Increased Activity

116 The Role of Masturbation Self Soothing Release of Tension Release of Stress Means to alter a bad mood A way to punish someone An escape from difficult relationships An escape from boredom

117 Breaking the Pornography- Masturbation Cycle Come to your own assistance-You are responsible to get help. You cannot do it on your own! Get help – –Confess and trust an accountability partner to keep you accountable – –Enter a treatment program /12 step, live in program, etc. Therapy and accountability programs simultaneously produce higher success rates

118 Breaking the Pornography-Masturbation Cycle Necessary Changes – –Beliefs about sex, intimacy and family – –Beliefs about addiction – –Core beliefs about self and relationships – –Coming to terms with pain in your past – –Learning to grieve losses in life – –Determination to change – –A new love and respect for self

119 200 Subjects Who Claim to Have Changed Their Sexual Orientation from Homosexual to Heterosexual Robert L. Spitzer, M.D. Chief, Biometrics Research and Professor of Psychiatry, Columbia University 1051 Riverside Drive, Unit 60, NYS Psychiatric Institute New York, NY (Presented at the APA: American Psychiatric Association Meeting: May 9, 2001, New Orleans, U.S.A.)

120 Changing Sexual Orientation: a Consumers’ Report Professional Psychology: Research and Practice 33(3), Ariel Shidlo, Michael Schroeder. New York City “The data presented in this paper do not provide information on the incidence and the prevalence of failure, success, harm, help and ethical violations in conversion therapy.” “84 participants, one intervention; 87 participants, two interventions; and 31 participants, three interventions.” “interventions that took place 12 years ago”

121 Is Homosexuality Treatable? Treatments for homosexuality are known as 1.Conversion Therapy 2.Re-Orientation Therapy 3.Re-Conversion Therapy 4.Reparative Therapy

122 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, In 1973, I opposed the prevailing orthodoxy in my profession by leading the effort to remove homosexuality from the official list of psychiatric disorders. For this, liberals and the gay community respected me, even as it angered many psychiatric colleagues. I said then -- as I say now -- that homosexuals can live happy, fulfilled lives. If they claim to be comfortable as they are, they should not be accused of lying or of being in denial.

123 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, Now, in 2001, I find myself challenging a new orthodoxy. This challenge has caused me to be perceived as an enemy of the gay community, and of many in the psychiatric and academic communities. The assumption I am now challenging is this: that every desire for change in sexual orientation is always the result of societal pressure and never the product of a rational, self-directed goal. This new orthodoxy claims that it is impossible for an individual who was predominantly homosexual for many years to change his sexual orientation -- not only in his sexual behavior, but also in his attraction and fantasies -- and to enjoy heterosexuality. Many professionals go so far as to hold that it is unethical for a mental-health professional, if requested, to attempt such psychotherapy.

124 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, This controversy erupted recently, when I reported the results of a study that asked an important scientific question: Is it really true that no one who was predominantly homosexual for many years could strongly diminish his homosexual feelings and substantially develop heterosexual potential? Is it really true that no one who was predominantly homosexual for many years could strongly diminish his homosexual feelings and substantially develop heterosexual potential?

125 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, What I found was that, in the unique sample I studied, many made substantial changes in sexual arousal and fantasy -- and not merely behavior. Even subjects who made a less substantial change believed it to be extremely beneficial.

126 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, Complete change was uncommon. My study concluded with an important caveat: that it should not be used to justify a denial of civil rights to homosexuals, or as support for coercive treatment. I did not conclude that all gays should try to change, or even that they would be better off if they did. However, to my horror, some of the media reported the study as an attempt to show that homosexuality is a choice, and that substantial change is possible for any homosexual who decides to make the effort.

127 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, In reality, change should be seen as complex and on a continuum. Some homosexuals appear able to change self-identity and behavior, but not arousal and fantasies; others can change only self-identity; and only a very few, I suspect, can substantially change all four. Change in all four is probably less frequent than claimed by therapists who do this kind of work; in fact, I suspect the vast majority of gay people would be unable to alter by much a firmly established homosexual orientation.

128 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, parents should not use my study to coerce them into unwanted therapy. I certainly believe that parents with homosexually oriented sons and daughters should love their children -- no matter how their children decide to live their lives -- and should not use my study to coerce them into unwanted therapy.

129 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, However, I continue to hold that desire for change cannot always be reduced to succumbing to society's pressure. Sometimes, such a choice can be a rational, self-directed goal. Imagine the following conversation between a new client and a mental- health professional.

130 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, Client: "I love my wife and children, but I usually am only able to have sex with my wife when I fantasize about having sex with a man. I have considered finding a gay partner, but I prefer to keep my commitment to my family. The homosexual feelings never felt like who I really am. Can you help me diminish those feelings and increase my sexual feelings for my wife?"

131 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, Professional: "You are asking me to change your sexual orientation, which is considered by my profession as impossible and unethical. All I am permitted to do is help you become more comfortable with your homosexual feelings."

132 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, can make a rational choice to work toward developing their heterosexual potential and minimizing their unwanted homosexual attractions. In fact, such a choice should be considered fundamental to client autonomy and self- determination. The mental health professions should stop moving in the direction of banning such therapy. Many patients, informed of the possibility that they may be disappointed if the therapy does not succeed, can make a rational choice to work toward developing their heterosexual potential and minimizing their unwanted homosexual attractions. In fact, such a choice should be considered fundamental to client autonomy and self- determination.

133 Commentary: Psychiatry and Homosexuality By Robert L. Spitzer, a professor of psychiatry at Columbia University Wall Street Journal, May 23, Liberty Street, New York, NY, Science progresses by asking interesting questions, not by avoiding questions whose answers might not be helpful in achieving a political agenda. Gay rights are a completely separate issue, and defensible for ethical reasons. At the end of the day, the full inclusion of gays in society does not, I submit, require a commitment to the false notion that sexual orientation is invariably fixed for all people.

134 DSM-IV “Homosexuality is not a disease” 1973 APA Committee Action Political action Not a Clinical Decision Many Psychiatrists and Psychologists are in disagreement NARTH.com: National Association of Research and Therapy for Homosexuality

135 Dr. Robert Spitzer’s Research APA: New Orleans, May 9, 2001 New York Times But he said he decided that a study was needed after talking with protesters objecting to the association's policy discouraging such therapies.

136 Dr. Spitzer said. "It occurred to me that maybe the general consensus, which was that the behavior can be resisted but sexual orientation couldn't be changed, was wrong,"

137 200 Subjects Who Claim to Have Changed Their Sexual Orientation from Homosexual to Heterosexual Robert L. Spitzer, M.D. Chief, Biometrics Research and Professor of Psychiatry, Columbia University 1051 Riverside Drive, Unit 60, NYS Psychiatric Institute New York, NY (Presented at the APA: American Psychiatric Association Meeting: May 9, 2001, New Orleans, U.S.A.)

138 274 Subjects interviewed Excluded 74 (e.g., no change in attraction, change less than 5 years, not predominantly homosexual before change effort) 200 Study Subjects 143 Men, 57 Women

139 Referral Source Ex-Gay Ministries* 43% NARTH23% Former therapist 9% Other25% Exodus International, religious ministries programs * Exodus International, religious ministries programs

140 Mental health professional 47% Ex-Gay/ religious support group 34% Other (mentoring, books, spiritual work) 19% Most Helpful or Only Type of Help

141 Age (mean)43 Currently marriedM=76%F=47% Married before change20% Caucasian95% Completed college76% Sample Description

142 Religion Protestant Protestant81% Catholic8% Mormon7% Jewish3% Religion “ extremely ” or “ very important ” 93% Had publicly spoken in favor of efforts to change 78%

143 Gay life-style not emotionally satisfying 81% Religious conflict 79% Desire to get or stay married Male 67% Female 35% Reasons for Wanting to Change

144 Time Line Age Onset of same sex arousal12 Begin change effort30 Begin to feel different sexually32 End of change effort (for 78% of subjects)35

145 “Markedly” or “Extremely” Bothered by Depression 43% 47% 1% 4% 1% 4%

146 Sexual Attraction Scale Mean (100 = same sex, 0 = opposite sex)

147 Change effort was “Very Helpful” in… …feeling more [masculine, feminine]87% …developing nonsexual relations with same sex93%

148 Dr. Robert Spitzer’s Research APA: New Orleans, May 9, 2001 New York Times For Dr. Spitzer's May 9, 2001 APA presentation "200 subjects who claimed to have changed their sexual orientation from homosexual to heterosexual“ Full Research Presentation in its original form Full Research Presentation in Chinese 二百個自稱已將他們的性取向從同性戀者改變成為異性戀者

149 Caring for Homosexuals Basic Principles 1.Double-Edged Sword: They need to be accepted in the process to get well 2.Individual acceptance and group acceptance 3.Walking this thin line: Excuse v. limits 4.Non-sexual same-sex friendships: Intimacy 5.Secure with opposite-sex peers & friends

150 The Ethics of Treatment Is Ego-Dystonic Homosexuality a Disease? – –What is unwanted Same-Sex-Attraction? – –Homosexuality vs. Gay? – –Genetics versus Environmental influences – –Hamer “Gay Gene” – –LaVey “Brain Dissection” – –Pillard & Bailey “Twin Studies” Review of Treatment literature

151 Failure in (Father) Male-Attachment “Defensive Detachment” Object-Relations: Separation-Individuation – –Self-Identity Development: Who-What am I? – –Mom-Son: Physical-Emotional Detachment & Attachment – –Son-Dad: Bonding (Attachment failure: rejection) – –“Rejection = Pain; Detachment = No Pain” Son-Dad relationship Disturbance – –‘Sour Grape’ Syndrome as a defense against more hurts – –Avoids father: No “Aggressiveness-Toughness, etc.”

152 Failure in (Father) Male-Attachment “Defensive Attachment” to Mother (Copyright © Melvin Wong, Ph.D. 2000) Homosexuality primarily an Identity Disturbance A Disturbance of a person’s Gender Identity A Disturbance of the Masculine Identity Development Upon failure to Attach (Separation-Individuation task) – –Defensive Detachment from Father » »Son’s resultant yearning for Male attention and affirmation » »Curiosity for the unfamiliar: “Male aspects” of Masculinity ID – –Causing a Defensive Attachement to Mother » »Son’s Masculinity Development became frustrated & stops » »Over familiarity-socialization with females: No “Intrigue”

153 Masculinity Identity Disturbances Victim of sexual abuse: Molestation-rape Pre-mature same sex sensitivity & curiosity Mixed emotions: Attention-Getting, Pain-Pleasure reversal Over-Identification with Mother-Sisters-Aunts – –Over-familiarity: “Know them (women) too well!” – –Suffocation: Enmeshment-Limits & Boundary – –Dislike-Anger-Rage: “family’s emotional barometer” – –Role Reversals: “My mother’s keeper!” Misogynist Labeling that turns to a “Self-fulfilling prophesy” – –“I am gay” “I behave gay” “Once gay, always gay”

154 Masculinity Identity Deficits “Body Discomfort” Dissatisfaction-rejection: own body – –Self insecurity: Emotional over-sensitivity “cave-ins” Rejection of the “Real Self” (Peer dependence) Yearning (craving) for the “perfect man body” Attraction (obsessing-preoccupation) of Men Neurotic need for “Symbolic Union” with “Man”, “Manhood”, “Symbols of Men” – –Military, Police, Uniform, Power-Predation, Bondage

155 Treatment Issues Factors affecting prognosis Therapist/Client match Transference/Counter-transference issues Object Relations Nonsexual male relationships Group therapy The role of father and religious support groups

156 Specific Treatment Areas (Copyright © Melvin Wong, Ph.D ) Ideational (Mindset) –R–R–R–Reduction of Intrusive Thoughts Behavioral –R–R–R–Reduce Masturbation & Acting-Outs Relational –I–I–I–Increase Male Non-Sexual Friendships Spiritual –I–I–I–Increase Pursuit of Holiness-Maturity

157 Specific Male Treatment Issues (Copyright © Melvin Wong, Ph.D All Rights Reserved) Ideations: Reduction of Intrusive Thoughts Explain thought origin, validation not encouragement Explain thought origin, validation not encouragement –Desperate crave for intimacy and acceptance Develop insight into precursors of thoughts: HALT Develop insight into precursors of thoughts: HALT Re-interpret to reframe the meaning of the thoughts Re-interpret to reframe the meaning of the thoughts –Neediness and affirmation needs Re-direct thoughts with more competitive thoughts Re-direct thoughts with more competitive thoughts –Accountability partner-tell a friend Medication: SSRI’s (Selective-Serotonin-Reuptake Inhibitors) Medication: SSRI’s (Selective-Serotonin-Reuptake Inhibitors) –Fluoxetine:Prozac, Sertraline:Zoloft, Paroxetine:Paxil

158 Specific Male Treatment Issues (Copyright © Melvin Wong, Ph.D All Rights Reserved) Behaviors: Reduce Masturbation & Acting-Outs Goal is to reduce frequency and intensity Goal is to reduce frequency and intensity Check-in with client weekly: Accountability Check-in with client weekly: Accountability –How did it feel afterwards? “Good but bad!” Reduce stimuli: No Cyperporn, chats, media Reduce stimuli: No Cyperporn, chats, media Positive-Negative reinforcements Positive-Negative reinforcements –Commendations, Loss of spouse, rubber-bands Medication: Prozac, Zoloft, Paxil help Medication: Prozac, Zoloft, Paxil help

159 Specific Male Treatment Issues (Copyright © Melvin Wong, Ph.D All Rights Reserved) Relational: Increase Male non-sexual friendships Reduce same-sex pedestal effect of males Reduce same-sex pedestal effect of males –Develop insight of over-adulation and devaluation Develop courage to befriend attractive males Develop courage to befriend attractive males –Sexual-attraction desensitization, ego-stability –“I’m one of the guys!” “I can’t believe I belong!” –Learn to keep relationships: reduce jealousy Group meetings-activities with guys Group meetings-activities with guys –Attend regular self-help groups: EA, SA’s, Exodus

160 Specific Male Treatment Issues (Copyright © Melvin Wong, Ph.D All Rights Reserved) Spiritual: Increase Pursuit of Holiness-Maturity Increase involvement in local place of worship Increase involvement in local place of worship –Accountability within the family of God –Acceptance: To accept and be accepted & affirmed “Will overcoming desires” “Will overcoming desires” –Spiritual Discipline: Process of sanctification –Daily renewal of spiritual relationship »Personal relationship with the Lord-Jesus-Brotherhood Place to “give-back” “re-invest” as messengers Place to “give-back” “re-invest” as messengers –Provide hope for other struggling on the journey

161 Religious Support Groups Exodus International (North-America) ExodusNorthAmerica.org ChristianMentalHealth.com National Association for Research & Therapy for Homosexuality narth.com Regeneration Books (Exodus Member) Courage (Catholic) Parents and Friends of Ex-Gays Pfox.org Evergreen International (Mormoms) Evergreen-intl.org

162 Exodus Global Alliance 出埃及全球聯盟會 ExodusGlobalAlliance.org ExodusInternational.org Exodus.to ********* ChristianMentalHealth.com 网上閱讀同性戀康复書籍 愛 的 尋 覓 思 仁 著 和多种類中文的資源

163 Case Presentation: Leslie Lung


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