Therapy For Gay Men

is there a kind of therapy for gay men? And I I had somehow come across Ken Howard on on my Instagram because I follow a lot of therapy things and then I get recommended this, and I get recommended that, and you know, we're on opposite coasts. So we've been trying to make this interview work for a while. But I've also noticed a try end that therapists have on

their websites. Now you know, oh, they're trained in this and that, and they see children and adults, and they're also lgbt Q affirming, which means they may not be gay themselves, but they will not um be completely oblivious to what the gay experience. Maybe you know, they may

be anywhere from just hey, I'm not a bigot too. Oh, I have some training in you know, the cultural things that may cause depression or anxiety in addition to you know what we just have inherently on our own because they are lgbt Q in America or in a certain state or in just the world during this time, or their you know, their family doesn't accept them or whatnot.

But I wanted to wait until I could talk to someone who is actually a specialist like kenn Is, so that I could give the most of this topic on an episode that I could since it's out of my depth. But um, I figured you don't want like, you know, me and in a straight therapist talking about you know, the gay experience. And so Ken exclusively has worked with gay men gay clients, whether as individuals or couples, for

over twenty nine years. He's based in Los Angeles and West Hollywood, and he does provide coaching for gay men and gay mail couples via phone or you know, a zoom session to clients all over the US and in many countries, especially places where people do not have access to a gay therapist. Now, what is interesting about this episode is although we don't really get into relationship anxieties.

We do just talk in general about anxieties that gay men might face, but we really kind of just end up talking about anxiety because there is obviously this universal thing that that if you have anxiety, have anxiety, We're all going to experience the same things. Of course, depending

on your circumstances in life. You know, if you're a black woman, if you're a gay man, you might have obviously different and more anxieties than someone in society who doesn't have to put up with extra pressures from society, bigotry from society. You know, there is more to quote worry about. But um, what's interesting about this episode is a lot of my episodes come from the place of the person with anxiety, in the sense that we talk about, you know, your normal, this is what it feels like,

this is what anxiety is. What I liked about my conversation with Ken Howard has really got into what he does in his practice, and he has so many different modalities of helping people, whether it is he takes more of a coaching attitude with some one in one moment or more of a you know, direct psychotherapy moment, whether

it's positive psychology or cognitive behavioral therapy. There is all of these different modalities that he is studied in and can kind of weave all of them through in one session, and you get to hear, you know, like a fly on the wall, Oh, he had a client yesterday with

this issue, a client yesterday who at that issue. And so I really think you'll get a lot out of this episode from that perspective, and it's a great episode if you've never been to therapy to kind of hear what can go on in a therapy session, as well as something Ken teld us at the end of the episode spoiler that anyone can go to therapy. You don't need to have a disorder of any kind. You don't have to have a mental health diagnosis or be on the lookout for one. You just can have a goal.

You don't even have to have a problem. You can just have a goal and you want some help achieving that goal. Okay, So before I get into my conversation with Ken Howard, I'll just let you know a little bit about him from his From his bio, he's devoted his professional career as a therapist exclusively to working with gay men or individuals um or gay mail couples. In the nineteen eighties, um Can enlisted in the War against AIDS as a training Can you hear the I live

next to a fire station. We've been so far, so good on this podcast, where you don't always hear it. I don't know if you could just hear that, but I'm not starting over. Listen. Sometimes there's fire trucks, okay. Um Ken began as a trainee in mental health, first in psychology and then in clinical social work. He volunteered at AIDS Project Los Angeles as a phone buddy, providing

phone counseling to people with eights. He noticed that the guys who had more mental health support survived longer and better than their peers with poor mental health. Later formal

research proved that observation. Ken's own diagnosis as HIV positive in November lad him to abandon the pursuit of his five year plus PhD psychology program because, as he says, at that time he was literally afraid that he would not live to see the completion of a doctoral program, and, as he says, he was far too obsessive compulsive to

die with a half finished degree. He chose to pursue the two year full time MSW Master of Social Work program in the Mental Health Concentration at the University of Southern California School of Social Work, where his internship training right from the very beginning, emphasized the population that he wanted to work with most, the LGBTQ community and to do his part in the fight against AIDS. At the LGBT Center, he co facilitated a group for gay and

bisexual male incest sexual abuse survivors. Later, he got very interested in helping people with more severe psychiatric disorders or chronic mental illness, and he completed a clinical internship at Pacific Clinics, Pasadena, specializing in assisting persons with schizophrenia and other severe persistent mental illness and developing a model of

care called psycho social Rehabilitation and assertive community Treatment. After years of formal supervised training, he earned his California State License to Practice Psychotherapy, which is the LCSW licensed clinical social worker, with a special additional training as a psychiatric social worker, which qualifies him to discuss medications and their use more in depth, but not as precisely as an

empty psychiatrist. So Ken Howard knows his ship. Okay, people, so enjoy my conversation with Ken Howard and maybe you'll learn about something new, like I did something called birthday anxiety, which I've got coming up the summer. But this isn't about me right now, Okay, enjoying my conversation with Ken Howard, and of course you can go to the links in the show notes and read more about Ken and find out about his podcast, in his book and all kinds

of things. So I'll see on the other side. You know, I always kind of kind of joke, you know, we gay men tend to pay the bills. You know. It's it's it's an affluent market niche in general. I mean, it's kind of a stereotype that all gay men, you know, have design and clothes all the time. That's not true, but um, you know, it's a desirable niche. It's just that I think niche as you have to be careful because you've got to have some kind of an entry

ticket in terms of credentials. You know. It's, uh, it's like any other field where specialized knowledge or specialized expertise really comes in handy. And you know, early in my career I made the very important decision that I was going to be a specialist. I was gonna put all

my eggs in one basket, you know. And at the time building my practice and building my career in the nonprofit world, people said to me, you know, if if gay men are or you know, if if gay people are approximately ten percent maybe a little less of the population, you're excluding of the world from ever being able to be your client if you really specialize in a exclusive practice.

And I said, yeah, I know that, but you know, um, partially from a business standpoint, specialization and niche, you know, tends to create business. You know, if you're dry cleaners and you specialize in cleaning suede and you get a spot on a swaye jacket where you're gonna go, you know, or there's a specificity is just so important sometimes because

there isn't time to study everything equally, you know. I always make the joke if I get a call from a teenage girl with an eating disorder, I'm going to refer to a colleague who sees teenage girls with eating disorders all day long. But for gay men, it's kind of like, well it's and you know, and I was advised in grad school by this woman chev Romain names, but she said, well, I told her I wanted to specialize in gay men. You know, this is from day

one of grad school. And she said, well, and you're going to be a very narrow perison. And I thought, you know that that's one of those things I called subtle homophobia. Because if you had somebody saying just about any other specialization like ge that'd school counselor I want to specialize in teenage girls who suffered with eating disorders and support their recovery, they'd be like, oh, that's interest

good for what? Yeah, exactly, And and it's just and it's one of my things, you know, politically about subtle homophobia, because I think it's everywhere, and because I'm just old and curmudgeonly at this point. But you know, but but I'm very proud of that, and it was the reason why I made that kind of it sounds a little sappy,

but I am a little sappy. It's uh, you know, I I kind of came of age in my twenties during the AIDS crisis, and I saw a lot of beautiful souls, you know, gay men who died very prematurely. And I said, I can't stand back and watch this without giving to this community. Not on my watch. If I can do something about the decimation of gay men in America, I'm going to do something. It's like Superman. If I have these powers, I'm going to try and

save people with them. And so that's the commitment I made. First two people with HIV, especially gay living with HIV. Later I did work with women and kids in youth with HIV, so the whole HIV spectrum. But it's my I think it's my gift back and I think it's

my existential I can't speak French. They for my for my career, you know, kind of the the original kernel of inspiration, and so it really, I mean it sounds happy, but really what I'm doing every day and supporting gay men's mental health and well being is ultimately I'm fighting back against the AIDS crisis. You know, I did have that trauma, and every day, politically and clinically and socially, I fight back against what we lost in any way I can. And that to me, that's a career. Fine,

that's that's fine. If that's my life, I'm happy with that. My grandmother taught I'm sorry my grandmother taught first graders how to read for thirty years and that was her career. And it's like, okay that, you know, she didn't teach oul gebras, she didn't teach college chemistry. You know, she taught first graders how to read for thirty years. And to me, that's a noble life, you know. And I

don't really believe necessarily in St. Peter. But when I get to St. Peter and he says, who are you, dude, I'm gonna say I helped gay men's mental health and well being for over thirty years. Yeah, okay, come on in, welcome, Yeah, wipe your feet before you come in the door. Yeah. And uh. And that's kind of just the whole drive that drives my career. So when I do career coaching,

we sometimes talked about that. I say, what is the drive that will get you up in the morning, even on a rainy, cold Monday morning when you don't nobody wants to go to work, They want to stay in bed. But what is important enough to you that you might get up on a rainy Monday morning and go to work anyway? Because your work is that important? And you know, if people can answer that then I think they're on

their way to a good career. And I think what you said is so important to the people saying well, that's niche, that's narrow. You know, it's coming from this how much progress we've made, and I know there's so much more to go, but it comes from this really ignorant place. It's like you experienced this decimating plague that was being ignored by the government because most of the victims were gay and left a generation of who knows what kind of beauty we could have in the world.

This generation was left to die. The mental health impact on that is insane. And it's not like, um, gay people were able to get married or have protection at work. I mean it was like and these people still have

to be closeted while they're dying at this place. I mean I to me, that is broad in the sense that if you can help this community with mental health as they go out into the world and flourish, because this might be one of the first generations that really is allowed to um, you're taking your expertise and your

survival and your gift, you know. And to me, like you said, your grandmother taught people to read well once you learn to read, you can do anything, you know, and once you get your mental health in order, you can become anything. And then they will be inspired by you, and they'll inspire others that just I'm so happy to hear you say this and I and I'm just grossed out by those people that said those things, because it's it's you know, luckily you were not influenced by them.

That's one of the things about you know, the history of HIV and AIDS is that, um, so much of it is lost. And it taught me a lesson really about history, about what people in general know about the height of the AIDS crisis today. And I just think, wait a minute, wait a minute, that that's the tip of the iceberg. That's that's not even half of it.

You there's so much more than people know about. And I want to, you know, if you apply that to anything else, to World War two, or to the Civil War or the Civil rights movement, or just anything in history, and think, oh my god, anything in history we really only know the tip of the iceberg about, you know, if we could talk to people who live through some of that. Some there's still a lot very very old people.

But the Holocaust for example, something like that. You know, we realize it's humbling because it means that even what thirty years later, you know, so much as lost to history. And I think it's it's important because there were so many things about the AIDS crisis that nobody talks about, and yet you know they were there, just little everyday things, you know, things in the news. The level of hysteria

was much worse, I think than people realize. You know, there was a college director who wanted to put on a production of The Normal Heart, a gay and aids them to play, and somebody burned his house down for directing a gay themed play. I mean that stuff was lost to the news, but yet things like that happened.

Or Ryan White, a little boy with HIV trying to go to school and you know, I had to change schools, you know, just things like that, and people are like really, yeah, really, And there was a lot of you know, speaking of anxiety, you know, there's a there was a lot of the theme of anxiety that came out of the AIDS crisis, I think because there was anxiety about getting it, getting HIV positive, and then there was anxiety about what course

it would take which was my situation. You know, I always say I was diagnosed with HIV in n and I worried about whether I would outlive my ninety two year old grandfather. Yeah, and there was just all this. You know, people who were diagnosed, you know, practically within weeks of that. You know, we're dead in a year

and certainly in ten years. You know. Oh, you know this is you know, if your HIV negati if you take one pill once a day, you know, for prep pre exposure provolaxes, and if you're HIV positive you take one pill once a day for antivirus medications. So you know, gay men across America, you know, are getting up out of bed every morning and popping a pill. And and that's the end of the HIV store. I mean not really.

I mean it's a lot of people would say, hey, buddy boy, you know, it's not over, and there's still a lot of suffering and challenges and and there are I have my own challenges medically. I'm at the doctors once or twice a week for some kind of HIV related something or something. And you know, so I understand that it's not over, but I think we also have to be very grateful for things like progress and change

and the heroes of our society, like scientists. I will never meet little little dweebs who were probably made fun of for being a chemistry geek, you know, instead of being a football player. But you know they're the ones with their little test tubes that found a way to keep me alive every day, you know, so just every day, I'm kind of grateful that some little dweeb or you know, white coat who studied chemistry while I studied theater, you know, is found a way to say my life because they

invented you know, I centrists or or whatever. And you know it's it's got bust the geeks, you know, because they're the ones that create the medicines that keep us in our loved ones alive, right, you know, they keep the theater department alive. Well, you know this brings me to this is what's so fun to talk to you about because you have, um, you have this episode of your podcast about birthday anxiety, which I never heard anyone

talk about, and you know we all have it. I mean, you know, I'm gonna be fifth you soon and I'm not not anxious, but you know, but I do like the specificity of it in the gay community too, because I don't know if you've seen this. I have a friend named Sam Pancake is very funny comedic actor and he lives in l a And there was a viral video going around of him on stage because he was talking to a younger gay man in his twenties and Sam's in his fifties, and the younger gay man said

to him, Oh, I can't believe. I can't imagine being in my fifties. I'm just gonna kill myself when I get to be that old. And Sam went on a rant on stage that was epic, and he was like just everything we've been saying, like, um, well, I'm glad you feel you have that luxury, but you know, I would you know in my generation, like we're all scared of AIDS and so many people I know would have loved to have lived till fifty and you know, blah

blah blah. And it reminded me of that when I listened to your episode about birthday anxiety, that you say there are men gay and who come to you with birthday anxiety and it's in and how would you I mean, I guess it could relate to anyone really, But what what is your advice for someone who is anxious about getting older? Well, I think, you know, I worked a

lot in my in my therapy practice. Um. You know, I mainly work in the school of therapy called cognitive behavioral therapy, which is awfully useful for a lot of things as opposed to the old school psychodynamic and psychoanalytic. Although there's a saying the older therapist gets the more here she uses psychodynamic and psychoanalytic elements because it gets

it more depth. I get that that's a developmental thing for therapists, and when I've done clinical supervision of coaching young therapists, we talk about different therapies and models of therapy that can be used. I actually taught models of therapy at USC. But I also draw a lot from developmental psychology and existential psychology, you know, existential stuff about what gives life meaning and purpose. So I was talking about, you know, what do you get up out of bed

rainy Monday morning to do? You know, that's kind of an existential motivation for what kind of mark do you want to make in this life? But then develop memorly, Um, I think there's a little bit of an underappreciation even among therapists for developmental issues across the lifespan, especially with what I call the zero birthdays. Birthdays that end into zero. Thirty and forty are the big ones. You know, in my practice, a guy turning thirty, there's a whole syndrome

of what happens. It's very predictable, and there's a whole syndrome at forty. It's less so at fifty and sixty. By fifty and sixty you kind of give your fuck. But it isn't that funny because I think it's different for women, because well, I mean everyone's different. But for me, you know, I'm like having physical symptoms I'm going through like menopause and is really the worst and uncomfortable, and so fifty for me, forty was like nothing. I was like,

who cares? And thirty I think it's a gen X thing. Um. I was a little anxious, but I feel old. But in my growing up, my generation, we knew that from twenty to thirty you were kind of supposed to be a funk up. It was fine. I think these days kids have more pressure than like want to have their life together by twenty five and I was just like, I don't need to do that. So at thirty I felt a little bummed out, like it was time to start growing up. But I didn't feel old. I didn't

feel old until I still don't feel old. But I feel like fifty is the first birthday I'm gonna go, oh ship. But it's what are people experiencing in your practice at thirty and forty? Like? What is it? Just? Um?

Well again, if you're looking at the gate mail niche you know, in in really a close up focus, you know, I think, um, you know, it's how people what there is called present you know, fancy word for the first thing a guy says on this first therapy session, really is you know, well, you know, I'm having some concerns about this and that and you know the turning thirty transition. Um. If we look at professional stuff, it's sometimes about coping

with their first managerial jobs, give or take. You know, you can be a CEO like twenty two, or you can be you know, the guy sweeps the floor at sixty. It just depends on the field and your individual career park.

But you know, in general, speaking broadly, you know it's coping with more responsibilities at work, you know, maybe less opportunities to go out in a weeknight because you've got a major presentation at work the next day, or because you're in a position where you give me major presentations at work then, or um, settling down. I think there's a homing instinct around thirty where you're like, yeah, then you know, just kind of horn around and um, you know,

at thirty you start to have a little bit of this. M. I wonder what it would be like if I met a guy and settled down and the issue maybe to have kids or not, And um, I think there's a whole financial responsibility. You know. One of the things I ask guys who are new who are thirty, I kind of saying, what's going on with you? Far one k? You know, and some of them are like million dollars in my four and because since I was twenty my grandfather's loaded and fine, you know, others will be like

what's that, and like where do you work? Oh? You know IBM, you know, someplace with full benefits where you

know they have afore own OK. And I'm like, Okay, tomorrow you're going to your HR office and saying, Hi, how do I enroll in the fore OUM okay, you know, because it's you know, there's professional things, there's financial things, there's certainly health things, um things about it's a it's a little bit of a wake up call about when you're not in your twenties anymore, you kind of transition.

It's like you've gotten a promotion in life. You know, you're going from twentysomething to thirty something, and you know that's a very characteristic change, you know, kind of a little bit of a buckle down, a little bit of a um, you know, completion thing. You know, it's like, well, I've had one more course to go before I finished my m b A and that's been going on for

four years. And it's like, okay, you're taking that course this year so that you have an NBA by your thirty one and then you're gonna be making twice as much by forty one and whatever. And you know, that's when I become kind of uncle ken about, you know, the mentor and then turning forty. Unfortunately, I try not

to tell guys who are thirty of it. It gets worse when you're turning forty because they're like, oh no, and uh but you know, turning forty, there's just a lot of neuroses that comes up about aging, body image. Did I make the right choices in life? Do I want to change my career? Did I choose the right person because I've been in a relationship for eighteen years since i was twenty two, and I'm not sure he's

the right one. You know, these are all things that whether or not you want kids, you know, by forty you've got to start really making that decision because I do the math. You know, if you have a baby, you're going to be fifty eight by the time it graduate. It's high school, so you know, it's uh, you can do. Plenty of people do that. It's not the end of

I've seen that it works out fine. But you know in that in the the the blog article about gay men and birthdays, there's also another part of it, you know, like the guy at at sam Pancakes show that you know a lot of aging anxiety. And Eric Erickson, who was a great theorist psychologist author, kind of said every phase of life and he outlined certain phases has a challenge and a reward. It's not done any one age

is better than or worse than others. It's just that you get some kind of an advantage of being whatever, forty something, but you also have a challenge with it. And he said, if you the trick, the trick to life. Eric Erickson was basically saying, if you can emphasize the joys of each phase and minimize the pitfalls with a risk of each phase, it gives you a more confident,

less anxious that word, way of approaching your life. And it's also an opportunity to the existential, you know, to celebrate your existence, you know, to celebrate that you have a life. You didn't you know that car did not hit you when you crossed the street running for the ice cream truck at age ten. It missed you. So now you're fortyes, so be glad. You know, you could

have been on the pavement, you know, or um. You know that infection that you had, you know, when you were twenty two, Okay, they were antibiotics for that and

you survived. So welcome to forty. You know, all of these existential things about your here and all the other people who love you in this life are here, and so your birthday is always a time to celebrate it because think about the guy who wanted to have a forty six birthday and he didn't because the junk driver hit him, you know, when he was thirty one, and

that's it. No more forty six. So if we cognitively reframe what a birthday means to emphasize the reward and kind of the challenges, Yeah, they take care of themselves, then then you got it and you get you get to do that every year. You know, you kind of get a new lace on life every year on your birthday, and I'll take it. You know. It's better than tached

time every year. So it is a reframing because I think a lot of people spend their birthday jumping into the future, Oh my god, I'm closer to older, and then looking back, Oh did I do everything I should have done? But you're saying no, look back and celebrate the fact that you're you're here, Like anything could have happened that would have taken off this planet and it didn't, so here you are. Yeah. I have a friend who's ninety two who runs two miles a day, and it's like, okay,

I'll have what he's having. Yeah, exactly. God, I mean, I'm sure he enjoys the running, but I'm like, like running now. He also has a very strict raw foods diet, and I'm not I'm not sure I could handle that because I like I like my junk food. Well, plenty of people have lived to a hundred on junk food. That's true. We'll be right back. I know you've talked

about that. You I love this. In terms of dealing with anxiety, you say that people are not really experiencing like an anticipatory anxiety about anything in their life, because there um there. It's because they're experiencing a fear of a possible loss. I've never heard it framed that way. I love that. If you can tell us about that, well, I was. There were two guys yesterday in my practice.

They were almost backed back. And that happens sometimes where you know, I'll see two clients in a day, or maybe sometimes in a row, that are remarkably similar. It's like some kind of alignment of the planets that's making them think about anxiety. And sometimes something in the news. I noticed that I've had days where guys will come in and every one of them will be somewhat agitated, and then I'll say I'll get a break and I'll say, Okay,

what's going on. I'll turn on my my phone with the Apple something in the news, and there'll be something like a mass shooting or something, and I'm like, something is making everybody anxious today? What is it? And then lo and behold there's there's always some kind of news story that you know, just it's kind of like the full moon. You know, a lot of people psych hospitals sometimes say, you know, oh boy, full moon. You know, people act up. But in cognitive therapy work, I frame

anxiety management in certain ways. You know, it's others probably do it better. But what I've come to use over a long time about we have a relationship to anxiety. And I think anxiety draws on the human psychological defense mechanisms, you know, because we're programmed as people to assess and respond to threats, kind of like the animal Kingdom, you know, the animal Kingdom, these these national geographic specials or something. You know, how does a muskrat deal with threats? You know?

And I think sometimes anxiety means that are warning systems are out of whack, you know. So sometimes I make the analogy of anxiety like a smoke detector in your home. You know. Sometimes it's three in the morning and your building has bad wiring and a fire is starting in your living room and you're gonna die if you don't wake up and get out, you know, So the thing goes off, Beppe, you know, get out now so that you live. Other times, you know, the smoke along goes off.

It just because you burned the toast, you know, and you can't wave the thing and open the windows and stuff, and you have to say, smoke destector, stop, I'm fine, really, you know, and the smoke detector says, yeah, but I smell smoke. Are you sure you're okay? Yes, I just it's burnt toast, don't worry about it. And you know, our anxiety system is like that, you know, anxiety system goes off and say, are you sure this isn't a day injuriest thing? Because should should we not be running?

Should we not be hiding right now? And we have to say no, it's okay. It's just I'm asking my boss for a raise. I am a little unpins and needles. It's not a problem, you know. We have to talk back to our anxiety mechanism. I love this. I will now put this in my tool kit of talking to it that way, that like something's checking in on me and I have the control to say thank you for checking in. This isn't a fire. I love it anyway, Sorry interrupt going. And I think also it's about a

fear of loss, you know, anxiety. I think it just means that we value something. You know, I'm anxious to drive my brand new car home from the dealership and get it home because it's my new baby. And you know, if you're anxious, you know, the first time driving at home, well,

it's because you like your new car, you know. Or if you're anxious before you give a talk at work of sales, presentation and on you know, the fourth quarter of sales, of course you're anxious because you want to do a good job and you want the company to succeed and you want the audience to appreciate your efforts. Or or an actor going on stage, gosh, and anxious before going on stage, Well, of course you are because you you want to do right by the play and

do right by the audience and the director. And um, it's not a guarantee that you will, because maybe Seen three is a little under rehearsed, you know, but you do it anyway because you know, one of my favorite self help books by Susan Jeffers, I think she's gone now, but it's all in the title, feel the fear and do it anyway. You know, just just because you're anxious about something doesn't mean that you don't do it. It means that you know, okay, too bad. You're gonna have

to just be uncomfortable. But that's not a reason not to go on stage or give the sales presentation or ask for a raise. You know, you have to work through that, and you don't wait until you're comfortable to do something, because you might wait forever and it's too important. You know, you kind of have to say not today, satan, you know, to your anxiety, which is a cognitive intervention. You know, um, that's thoughts stopping in cognitive behavioral therapy,

or it's really it's reframing. Especially oh gosh, I have to give a sales presentation, and I'm so nervous. It's I get to make a sales presentation because I've got this great job. You know. They ethel Merman, the Great Broadway star. They asked her do you ever get anxious before performance? And then I don't get anxious. I know what I'm gonna do. The audience ought to be anxious. They don't know what they're gonna get. Oh that's great,

you know, And I think that's what it's. I don't know if she was always that confident, but yeah, it's probably a thing she had to tell herself, you know, before she and out there. You know, I like the idea of the laws. So let's say someone is anxious because they're about to make a presentation or they're going to propose to someone, or they're gonna asked him on on a date or whatever. Is like, okay, like you said,

of course you're angios. You want to do right by the company and you want to do a good job. But is underneath that the loss, like the deep anxiety is and if I don't do a good job, like it gets that's where it gets disproportionate. Where it's like, if I don't do a good job, like the proportionate thing might be like, oh my boss would be a little disappointed, but they still value me. But the deep

like anxiety, that's not proportionate. That's the loss is like and then they'll fire me and then I'll be homeless. Or I asked this person on a date and they say no, and I'm rejected and no one loves me. Ever I'm alone, you know, is it? Is it that?

What you mean by that? There's another thing about kind of the train or the ladder of you know, it's it's filling in all these and therefores you know, it's like, I'm anxious about my presentation and therefore I'm going to do badly, and therefore my boss is gonna fire me, and therefore I'm going to be homeless, and therefore I'm going to be whatever from there. And you know, it's it's kind of the fear fantasy or the the spiral,

you know, that whole downward spiral thing. And you know I said, you know, be careful of the crystal ball. You know, you just can't predict the few. The odds are that you're going to do a good job, because first of all, you want to, and then if you don't, you know, um, then you have to kind of adapt

in the moment. You know, if you go to make your sales presentation, your zip drive you know, got wet and it doesn't work and you're without your power point or something and you have to wing It's like, well then you you wing it, you know, and you're just

gonna do the best you can. You know, I was coached one time by a business coach that kind of Most people professionals could probably stand up and give a talk on what they do for an hour without any notes, in any preparation, but if they've been doing it for a while, you know, people freak out about speaking, but most people have it, especially in the Q and A. We'll continue the interview on the flip side of a

quick message from our sponsors. Worked yesterday with a guy who has a particularly strong case that session after session about anticipatory anxiety. You know, if you're an adult child who has caretaking responsibility for elderly parents, you know there might be an anticipatory anxiety about your parents getting worse and passing away. Or if you've had a dog for fifteen years, you might start to get real concerned that

she might not live much longer as your pet. And you know, it's it's you can really kind of make yourself crazy by living in the future where you're living with that loss, but you're you're feeling it today, and you know that's when kind of way I think we have to kind of orient ourselves to the present. You know, I think we're ring about the future is kind of

an anxiety that we're borrowing from the future. And then, you know, feeling bad about a lot of stuff in the past is a little bit living in the past when you're right here today. And so you know, there's a big argument for kind of living in the present. You know, it's lots of horrible things could happen in our future, because horrible things have happened in our past, but there's also great things that have happened in our past that we felt just great about, and probably things

in our future that will feel great about. And there's a there's a Shakespeare line but kind of butchering it, but it roughly says, our lives are as a fabric, a weave of good and ill. And now that's kind of what what that is. I mean, Okay, you have to leve with the fact that, yeah, you if you're anxious that there is going to be some real ship that's gonna happen, it's gonna hurt, It's absolutely gonna hurt. But there's also going to be some stuff. Hopefully the

majority that that's good stuff too. And you know, I think cognitively a tool that you always have is what social workers are taught with. What is the adaptive coping for this? No matter what happens, even if it's something really bad, like you lose your job and you totally your car on the way home. Okay, that is one

fucking bad day. But if you say, okay, what's the adaptive coping for this, It's like, well, I call the insurance company and I'm gonna get a new car soon and I'm gonna my insurance with the house and get some new stuff. And you know, look at yourself, you know, are you in little pieces? We'll know I'm I'm fine. All right, Well let's start with that. Let's start with the fact that you got shoes on your feet. You can walk and see and here and I'll be in poop and eat and drink and all that. So so

you've got something to work with. You know, you have no house and no car, but you got shoes. Let's start with that. You know. Or Louise Hayes little adage, Um Louise Hey, was this inspiration? You know her? Yeah? You know, and she uses the phrase, you know, how

can I take a positive approach to this? Yeah? You know, you bank the presentation and it sucks because you had bad numbers and the power point broke, and you know your college is like dude, um, that's a great job and that board, you know, and then you say, how do I take a positive approach to this? You know, you might email your boss and say, I don't think today went well. I want to revise this. How about

the next staff meeting? I do an update with the missing slides and should probably go yeah, that's probably a good idea because that one sucked, you know, And then the next week, you know, you do it over again, say sorry, guys, that didn't work out so well last week. Anyway, follow up fourth quarter is going to be there. You know. That's adaptive coping. And I love that you say positive approach and that Louise said that because you're not saying

positive thinking. You're not saying, oh, it's great that I am only of my shoes, it's great. I sucked up. You're saying, Okay, let me take a like like you said, a coping, let me take, let me cope, let me you know, be honest, get in touch, try to think of something better for next time. I it's very realistic. Is something people can do right, It's not just think

positively about it. I love it, And I think the other thing it's really important to talk about, which we're not getting to it we should, is which a lot of people I think would say, is say, you know, that's easy for you to say, buddy boy. You know you didn't get fired from a six figure job because you gave a shitty sales presentation. Now you have to do another one and your asses on the line. You know.

It's that idea that sometimes anxiety comes from trauma. You know, it's like, oh, I'm going to walk down the street at through in the morning because you know, I forgot something and I'm going to go look for it and in the dark alley. You know, that's a lot easier to do if you weren't beaten and mugged in a dark alley three years ago or thirty three years ago,

you know. And so some of that is validating the trauma and the loss that we've been through, because when we've been through a very painful loss, you know, there's a part of our psyche that's kind of say, okay, note to self. There are dangers out there. There are muggers out there, there are drunk drivers out there, there are bad critical bosses out there. But again, that's where you have to bring it to the present and say, I realized, you know, I was really upset by being

mugged in the dark alley. However, that was another city. It was years ago. I'm with somebody, you know, I'm with my boyfriend, and my boyfriend's a cop. You know, I'm now accompanied by a cop on a dark alley, and you know, I'm going to look and see where

I've dropped my wallet or something. And it's well lit, and you know, the chances of being mugged they're there, but they're not so great that I can't go look for my wallet in the dark alley and kind of revisit the same circumstances that you know, I worked with somebody who had a phobia about driving because he had two bad car accidents. And you know, to rehabilitate from the anxiety of driving when you've had two accidents, that

that's a real process. You know, you have to kind of validate that it was painful to go through that. But at the same time, that does not mean we don't say and therefore never drive again. We say, and therefore you've been through a lot that was hard to get through. Let's rehabilitate so that you can live your

life as a driver again. Yeah. So, I you know, when I have a client in therapy for anxiety, I look for trauma, and you know, sometimes we have to validate and have them process the trauma before we can get to day to day anxiety management. You know, it's like a prerequisite course for the anxiety management is trauma recovery. And what would you say could be categorized as trauma? I mean, are you looking for like big T trauma or can you say maybe trauma for them was losing

a pet or you know whatever. Does it matter? Well, I think you know, it's it's very subjective because it's

also cultural. You know, UM, the definition and the the d s M, you know, the Diagnostic and Statistical Manual NONM disort is by the American Psychiatric Association, you know, has altered the definition of post traumatic stress disorder over the years because they took out something that was in a previous edition of you know, Outside Normal Functioning or outside normal circumstances, and it's like, well, but if you live in a war zone, you know, in Syria or something,

you know, bombs are in everyday occurrence. So it's not like, you know, if if you were living in l A and there were bombs going off everywhere, that would be unusual, but not in the war zone. So it's so it's it's somewhat culture bound because I think a trauma can be anything that's a trauma to that person that kind of rips the fabric of their adaptive coping skills, that overwhelms their ability to cope. And you know, sometimes we say, well, that's not a bad stress, get over it. But who's

to say what's a bad stressor or not. You know, it's like that line in Antimame with the Society Girls. As I stepped on the ping pong ball, it was gashly and in the ping pong tournament, you know, and it's like okay to her, it was Josh gosh like, but you know, to us, it's like, honey, get over yourself. And you know, it's we don't we don't want to minimize other people's trauma because it has the most meaning

to them. Yeah, you know it's I've dealt with guys who have had breakups after you know, five weeks of dating, and I kind of feel like something, dude, it was five weeks. Come on, But you know, if it was a five weeks that meant a lot of things to them.

You have to work with it as if it were five years or whatever, because we're kind of the definers of what our trauma is, of what it what it means to us and why and if you if you deal with it that way, you're giving them to tools, whereas if it's like, hey, just learn how to be like, hey, it was just five weeks. I don't know what how

much of a tool that is. If you do treat it like it was five years, now they're going to learn, you know, grief skills, survival skills, whatever right that they need for the next time, because they might the next time they fall in love and through that type of person, it might have another five week relationship that devastates them.

Now they have that life experience under their belt that you've helped them through, especially when we understand trauma is a social experience, it's a cultural experience, it's a neurobiological experience. That's the other thing I think if if those neurobiological defenses get activated, that gets activated regardless of whether we think the stimulus warrants that or not. You know, it's if we get goose bumps watching a horror movie, you know,

because we're scared. The person next to us might be like, this is boring, Why do you have goose bumps? You know, but the other persons like, yeah, this is really scared. Whatever. You know, It's it's a little bit subjective. But but once that system gets activated, all the stuff around trauma is right there, reporting for duty and and that's part of that's kind of as a psychological process, but it's also a neurobiological process. Yeah, that's why trauma recovery involves

so much neurobiology. I used to teach about that. It's about how the left brain is talking to the right brain and you know, things like that. You know, but trauma has to be processed like we're digesting a meal in our g I system, anxiety bites will be right back. After a quick little message from one of our sponsors, Well, I like what you said to about like back in the anticipatory anxiety of you know, my parents are getting older,

they could die my pet. It's like you can't say, unlike someone who's saying the sky is falling, you can't say, that'sn't gonna happen, right, it's like going to validate that is going to happen. But I love what you said

about don't borrow, you know, borrowing from the future. And I love that example because literally, if you think about it, um, if you keep borrowing, if we're talking about money, if you kept borrowing from your savings to buy a car, buy something fun by the time you really need it, and maybe you're too tired to really work a full time job and you need your retirement savings and you get there and it's empty. You know you're on empty

when you get there. So if you're borrowing like from your future and trying to grieve now, I don't know how because you're not really doing it right now. By you're not like actually grieving now, you're doing some weird anxiety things. So like by the time it's time to grieve right, I imagine they have no practice in doing so correctly. And so same with trauma, Like if you don't validate it, they're not going to get better, like you have to validate yes, this happened, and you have

to validate yes, these things will happen. Now what you know, here's our room. Yeah, and it's existentially you know, accepting that. You know, I call it the ocean moment. It's like, you know, it's um when you realize what's going on with you where you have these symptoms and it's like, I don't know why I'm doing this, what's going on with me? And then you talk to a therapist and it's like, I think you have PTSD and there's that,

or I think you have generalized anxiety. Just sort of there's this moment of oh shit, really I'm one of those I've got a diagnosis now. But you know, you can transcend it and say, because the next question should be okay, how do I adaptively cope with that? And you say, well, you know, let's do this, this and this. And it's not only I think we're preventing against you know, calamity in the future, but I think it's also about building.

You know, you might be oh, I'm already even gonna get old and I'm gonna be penaltist and I'm gonna be like that old homeless guy saw in the street last week, and it's like, well, you know, there are ways to do your very best to avoid that. And you know, I don't want to blame the poor homeless guy, but something went wrong along the way that he ended up like that. You know, um, bad fortune, which is part of it, and possibly bad choices which are a

part of it. You know, it's some kind of a combination of what happens to us and what we do. And so a lot of what I do, from a very positive psychology standpoint and even a coaching standpoint, is to say, at every phase in life, I think every day in life, you say, how do I put my best foot forward? You know, it's like if I don't want to end up home? Was like the guy I saw last week, really, what's in your retirement fund? Well? Two cents? Okay? Uh? Could you you know, do you

have twenty bucks? And well, sure, I got three dollars in savings. Okay, take thirty of that or that and go on Amazon and buy a used copy of a Susie Ormon book on money management. You got six san bucks with chipping to get Yeah, all right, you get that copy and maybe it's a Little Dog here because it's used. But you you read every word of that book, can do everything Susie Orman says, and you just reduce your chances. It didn't eliminate them, but it reduces your

chances of being old and homeless. You know, if you do everything that Susie Orman says in her books, or Jane Bryant Quinn says in her books, you just reduce the probability of calamity financially quite a bit. And you could say that about anything if you, um, you know, I had a kidney stone last year, so of course I was like, what is the adaptive coping for kidney stone? And I found a YouTube channel, um Jill Harris, and you know she said, how do you eat better to

reduce your chances of recurring kidney stone? It's just whatever it is, I think you research it and say how can I put my best foot for my mom survived cancer three times. You're in colon and breast and she's eighty seven now, and you know, well, how do you do that? It's like all you you know what early symptoms are. If you have them, you get checked. If you have that, you get good treatment. You follow a treatment plan. Thousands of more and more hundreds of thousands,

millions die of cancer. But you reduce the odds that that something bad is going to happen by saying, what is the absolute best set of choices that I can make that gets me ahead in some way? Health, dating, sex, I certified sex there because you know, there are all these things that we can do about. I think sometimes when we were dealing with anxiety and focusing on laws with the threat of loss, what's the other side to that? How are we focusing on gain and growth? Yeah? Is

this what? Because I was going to ask you about positive psychology, the positive psychology method, because I saw that on your website and I actually had never heard of it before, and so it sounds like that's what part of it is. It almost has that like coaching element to it in a way. It's not positive like like um, hippie dippy, like just manifest the money, but you're just saying like you're taking a positive step, like we'll start saving. I mean, you know, there's the things we can control,

things we can't. One thing you can control, start saving, you know, Yeah, you can't control the stock market crashes after that, but just start saving and it does step to the brain about a positive mindset, you know, the acting about to go on stage, that I can't go out there and look like an amateur. Okay, that's that's great.

But see that's very different from I'm gonna go out there and I'm going to give a good performance because I'm going to do justice to the script and the directing, and I'm going to tell this story the best I can. To see the difference there, it's it's there's a real difference between I don't want to lose and I will win. I also hear in that example of the actor a little bit like with all the things they want from it and that they plan to do, none of them

really are about the actor. Like I hear a little bit like getting out of self, you know. With that, it's like I want to honor the work. I want to do a good job. You know, I'm just the vessel. Like there's something about that that I feel like must be part of it too. Like if you're sitting there anxious about your future, someone's offering you some practical steps. If you're like, no, I think I'll just sit here

and worry. It's like they want to cling to their self and their ideas and if you just say we'll start saving. It's kind of like, I don't know if there's like a lack of not narcissism, but there's like a lack of thinking about all the time a little bit. Yeah, A good way to you know, help a lot of things is to kind of get out of yourself, you know. And yeah, there's that cliche, best way to help yourself

is to help others. I think there's a lot to that because it takes the you know, the belly button gazing and the ruminating. You know, ruminating is really an anxiety symptom or perseverating on something, so you know, it's you also have to look at the secondary game we call it. You know, some people have a secondary gain to being sick because they never have to take responsibility

for anything. Or what secondary gain and anxiety might be, you know, kind of unconsciously wanting people to take care of you because they never really have. Ye that that can be something about that you know about um, is there a downside to being relaxed and confident? Well, maybe there's a responsibility there. If you're relaxed and confident, you're expected to do great things. Whereas you an, I don't know about this. I don't know about this. I'm just

gonna I'm just gonna stay inside and hide. It's like, well, how convenient you know that doesn't take much effort, that that can be confused with introversion and social anxiety, which is its own Well, you know, I was going to bring that up, but I love you are the only person to say secondary gain. And I think I've heard that somewhere in my life. But I love it because you know, again, I'm just a pot I'm not a

THERAPISTMS podcast or about anxiety. And the people will write to me and you know, like I'll do an episode where the guest clearly lays out this is how you da da um, you know, get over your fear of drawing driving okay, And someone will write me, I just heard your episode about fear of driving. Nothing was left on the table in that episode, like you will if you do these things and work with people, get over

your fearture. And they go, um, it didn't help me, um, because I have the worst fear of driving more than anybody. And they'll say that and I can just like intuitively feel that they didn't listen to they didn't put anything to practice, but they need to be the most anxious driver who ever lived. Because if that's true and no solutions work, then they're just they can't drive. There's no solutions,

and so that's simple, you know. And then once people here, you're not a lot of people don't want to hear you're not alone. This is normal, there's a solution. They're like, oh no, it's like you've just given them homework, not hope. You know, it just depends on the personality, I assume, right, and you have to be willing to change. Louise Hey was real big on that, you know, she said it was someone's down there and they're reaching up. I will

reach down my hand and pull them up. But I will not take their hand and have them pull me down, you know, because you know that that's you got to be careful with that stuff, because you know it's about identity shift. You know, if you're you know, big, were big ap on your shirt, anxious person. You know, if you weren't the anxious person, and what would you be, Well, maybe you would be the neighborhood's greatest dog trainer, or

the city's greatest architect, or the city's greatest attorney. You know, there has to be that identity shift from what's familiar and even comfortable, comfortable in the uncomfortable, you know, like the hypochondriac um and have an identity? Shall I do a lot in substance vieuse recovery When I worked with so many gay men who have gotten in over their head with Crystal Matthews, A big part of it is identity.

I say, what are you? Who would you be if you were not a Crystal methodict, because that's their primary identity. You know. It's like, well, you know, to start, you know, I used to be this great architect. It's like, what have you done lately? Well? Nothing, I've been too messed up. It's like, well, how about being the great architect again? What would that take? No, I'll going to a a

every morning before work. Okay, go to every every morning before work, and then focus on you know, the new building on Third Street, the big blue and you like it. Will know because it did did it's not environmental and they should have fixed it. All right, Well, then you do you do it, you know, go build a building that is environmentally friendly and you know, long story short, you know, that's that's what he did. You know, he got back into work. He he not everybody needs twelve star.

I've worked with guys who've had success with and without twelve stuff. I would, but you know, he recovered and got married, and you know, he posted it on Facebook. I'm normally not Facebook friends with clients, but somehow we ended up, and you know, and he posted a picture from his wedding and I commented, you know, congratulations, and he wrote back, well, a lot of that's due to you.

And that's you know, that's the greatest compliment because he went from you know, shooting up a needle in his arm three times a day or whatever it was, to not doing that at all, and you know, and that's a success. You know, It's a shift and identity. And I think a lot of people could say if they're dealing with an identity that's that doesn't feel right to them. You know, I'm the unemployed person or I'm the person who's underemployed, Say to yourself, what is the identity I'm

trying to cultivate. Do that with actors all the time. You know, I'm a and server, but what I want to be is a sitcom star. It's like, well, okay, that's one of the hardest things you can ever ever do in Hollywood. But you know it's it's possible. You know, they right checks every day to sitcom stars on umpteen different shows. You know, work for somebody entertainment payroll. It's like, you know, there's a lot of checks that go out. Yeah, and you know, but but it is kind of a

shift in identity and and processing. The therapists use something go motivational interviewing about change about and we say what are the pros and cons of that? You know, if you said to somebody, what are the pros and cons of your anxiety being resolved? They what do you mean cons? It's great, It's like, no, look closer. There would be some cons to you changing the life that you've known for years now. Yeah, and you know you get out

of the sick role. It's interesting, like some people in your life might want you to stay that small some some don't you know, who knows. You might have to give up the friends you have that are uh, you know, as they say in twelve Supercovery lower companions, you know, you might have to meet people that um give you

a run for your money. You might have to meet other successful architects, and that's kind of scary and I almost wish there was an intervention process for people with anxiety, not to bully them, but in the sense that your family and friends sit around and they tell you, like who you could be if you didn't wear the identity of anxious person, like if you got help, Like I

see you differently, the news of yourself. You know, you used to be whatever, you know, whatever, Because I think a lot of people don't know how to deal with the anxious person in their life, and they kind of just ignore it. Everyone pretends everything's okay. And I don't know how anyone would move out of that identity if they didn't feel um, I don't they weren't encouraged or um if they didn't know that others saw them as

having that potential, you know. I think it's it's both the support and the challenge, which of course therapists do all the time. If you only challenge people, they'd be like, fuck you, buddy, I can get beat up somewhere else. If you only part them, then they never change. It's like, oh yeah, he was very nice as a therapist. He'd be a very pleasant guy. Why did you leave him? Well, I didn't make any progress, you know, And so I

joke with clients. Sorry too, I'm gonna beat up on you today because I think you're making a wrong choice or something like that, you know. And it's both. It's it's the dichotomy of I hear you because I think anxious people need to be heard. I have this fear. Why well, because of this? Why because of this? You know,

you want to hear them out. But at the same time, there's just a little bit of Okay, I hear you, But suck it up, you know, feel the fear and do it anyway, because at some point you have to think what you're trying to do with your life is too important for your anxiety to hold you back. That's

too much power. Oh I love that. Yeah, And you focus on what you want to do or what what do I want to do that my anxiety is keeping me from And you've got to walk through it like you're walking for a burning building, in order to get the other side and say, Okay, now I can drive, Now I can fly. I'm gonna fly. I'm gonna go to my niece's wedding in Poughkeepsie. I'm gonna fly tomorrow, you know. And it's because you want to be there at the wedding and say congratulations, honey, this is your

dream wedding. Congratulations, you know, and you want to be there. You focus on what's on the other side of the challenge. Is there anything any words of wisdom that like, just someone is listening, they want to take the first step to going to therapy. They're like, I do and know if I have this bad note and whatever, you want to say to anyone out there that is thinking about taking that step and starting therapy, starting therapy, just well, I think people say, you know, they think that there's

some kind of a high threshold for therapy. It's like, oh, well, you know, I mean, I'm a mess every day, but I don't need therapy. I'm not I'm not crazy. I just you know, drink myself into oblivion every day or whatever. And it's they think it's some high bar to you know, you that you need therapy. You know, the bar for

going into therapy is just having any kind of goal. Well, I don't really have a goal except well, you know, I want to raise because I've been in my job for four years and I wanted to tell my cheap boss to give me a raise. Okay, that's a goal, because you could go into therapy and say, I need to build my skills in a sort of communication because I want to ask my boss for a raise, you know, or or anything. There's really nothing too mild to bring

to therapy if it's important to you. You know, you you don't have to be have you know, associate identity disorder in order to therapy, and you know, and you're because it usually means that it's part of a broader growth, you know. So anytime you go to therapy, it's like putting a little seedling and sticking it on the window sill in bright sunlight, because you know it's going to grow in the light of that support. Hey, hope you enjoyed my conversation with Ken Howard. So here are someon

takeaways from this episode. Again, everything you need to know about Ken is in the show notes. If you want to follow me on social media, I'm at Jen Kirkman on Twitter and on Instagram as well. Send an email to the show Anxiety Bites Weekly at gmail dot com. We might read it on the air. And don always say we it's me. Do you hear any other people hosting? Here we Go? Here are some takeaways from this episode and you Get You can also find them on Jen

Kirkman dot com click Anxiety Bites. Links are in the show notes. Okay Can saw during the AIDS crisis that there was also an epidemic of anxiety, anxiety about getting HIV and anxiety about having it and not knowing what course it would take. Developmental psychology and existential psychology look at things like what gives life meaning and purpose For anyone with birthday anxiety, Instead of worrying about the future or regretting the past, try to stay in the present

moment and celebrate that you're alive, here and now. If you can emphasize the joys of each phase of life and minimize the risks of each phase of life, that can help with confidence, which can alleviate anxiety. You can think of anxiety like a smoke detector that's going off in your home, which is great when there's a fire, but the anxiety smoke detector only goes off when there is no fire. You're just cooking some toast and the toaster and you don't have to respond to the anxiety

as if there is a real fire. Sometimes the underlying reason that someone feels anxious in a situation is that they're worried about experiencing a loss. And anything that we care about deeply can cause us anxiety for that very reason, we are afraid of losing it. When we feel anticipatory anxiety, we are borrowing from the future, and we need to orient ourselves to the present instead of trying to feel

a future loss today. There is always an adaptive coping mechanism for any bad thing that can happen to us, which involves taking the next best step to solve a problem. Sometimes a client in therapy for anxiety is really actually experiencing trauma, and they have to be helped to work on and process that before getting to work cognitively on the anxiety. In that case, the prerequisite course for anxiety management is trauma recovery. Trauma is a social experience, a

cultural experience, and a neurobiological experience. Trauma recovery involves a lot of neurobiology. It has to be processed like digesting food in the GI system has to be processed. When people are working through addiction, recovery or anxiety recovery. They are going to have a new life on the other side, which means in a way, they're shedding their previous identity as that always anxious or addicted person. A therapist job is to support but also challenge a patient. Anyone can

go to therapy. You do not need to have any kind of mental health disorder. You could see a therapist just to get some tools in order to achieve a life goal. There you go, Thanks for joining me on another episode, and just remember anxiety bites, but you're in control. For more podcasts for my heart Radio, visit the I Heart Radio app, Apple podcast, or wherever you listen to your favorite shows.