My colleague Rick Miller is an important thought leader in couples therapy. Rick is a social worker in private practice in Boston and on Cape Cod in Massachusetts. He is well-known for his pioneering work with gay male couples.
Rick has served nationally, (and internationally) on the faculty for The International Society of Hypnosis, the Milton Erickson Foundation of South Africa, the Brief Therapy Conference, the Society for Clinical and Experimental Hypnosis, the American Society of Clinical Hypnosis, the American Group Psychotherapy Association, and Harvard Medical School.
Rick developed a hypnotherapy curriculum for working with gay men that has been used at both the Milton Erickson Institute of Mexico City, in Mexico, and the National Autonomous University of Mexico, which is also in Mexico City.
Rick’s ego-strengthening hypnosis techniques, which he has designed specifically for use with gay men, focus on the unique challenges growing up and finding one’s place in the world as part of a gay male couple.
Rick not only drew on years of experience working therapeutically with gay men, but he also drew on his own as a gay man.
Rick’s approach unpacks the unique ways gay men experience pain. Gay men have long endured developmental challenges. Rick’s therapeutic imperatives are is to build comfort for gay male couples and better align their minds and bodies.
Here are some highlights from a conversation I recently had with Rick. Click this link to hear the complete interview. Rick’s words below are in italics.
There’s something about everyday stress being wiped away.
Even though this pandemic has its own stress, the stress of day-to-day life, the stress of commuting to work, getting out of the house, never seeing one’s partner, arguing about details of house and work, and being too busy to connect… are no longer part of my gay male couples’ lives.
And I’m seeing them for sessions, and they’re sitting next to each other on the couch with a level of connection that is very different from what I’ve seen, especially for some of these couples that have seen me for two or three years. It’s fascinating to me.
When a gay male couple is quarantined, whatever is going on in the relationship, good and bad, tends to be like a force multiplier. Being stuck together is a force multiplier.
What’s good gets noticed …and what’s difficult also gets noticed as well.
A “Power Couple” intent on acting on the world… may now realize that there’s not much of a world left to act upon, but if their underlying relationship is still pretty good, then they can return to that focus, and actually use that lockdown time to deepen their relationship. Rick Miller
Rick told me that Some gay male couples don’t necessarily know how good their relationship was before COVID. Like our team here at CTI, Rick often tends to work with “C” level executives, artists, and entrepreneurs.
I work with a lot of gay male couples who are in powerful positions in various industries. They’re traveling. They have meetings and getting them to my office at the same time sometimes is a huge challenge, so much so that I’ve actually changed some of my rules in working with these couples, which is that the time is sacred and they pay for their slot whether they come or not.
And as a result, they’ve become more committed to coming to couples therapy, because beforehand, my clients were canceling their sessions all the time because one of the partners had a business meeting or a work trip. So since I’ve been more firm with this, my gay male couples are showing up more regularly.
Rick told me that some gay male couples are doing so well during the lockdown, he openly wondered whether or not he could have persuaded his clients to do something like it pre-COVID…but we both agreed it would have probably been a hard intervention to sell.
I told him about a guy I knew in who went to federal prison for seven years. He was interviewed a few months after he was released. He was now selling cars. When asked about his experience of serving 7 years in federal prison he had this to say…
…in 7 years, I learned to speak fluent Spanish… and I became a competent jailhouse lawyer. I also became a pretty good watercolor painter. I thought long and hard about how I would repair my relationship with my wife and kids…Yeah, I served time… but I also made the time serve me.
It reminded me of something else I asked Rick to comment on…when natural disasters occur, like a weather event, there’s a beginning, there’s a middle, and there’s an end. We both agreed…there is no predictable end in sight to COVID-19.
So there’s an unknown dimension to what we’re going through. And it’s extraordinary and unpredictable.
I asked Rick, to what extent does that sense of the unknown impact his work with gay male couples. Here’s what he said:
I think it’s a theme that we’re all dealing with and interestingly enough, people talk about it but it’s not the focus of their work with me, especially with couples.
I think with the gay male couples that have worked with me focusing on intimacy, focusing on sexuality, recognizing the good, talking about the routines of being at home together and how they’re doing it and why it’s working and what’s working is more of the focus rather than will this ever end.
And fortunately, knock on wood, many of the couples that I work with have not lost their jobs.
Now that may change and it probably will change, unfortunately. So everyone is working 9:00 to 5:00, 9:00 to 6:00, and the conversation is more about carving out a workspace at home, who works where, how do you navigate all of that, doing meals together, splitting up taking care of the dog (or dogs), which is the case for many people, making sure that they get exercise, recognizing that something is good between them and enjoying that.
That’s been more of the focus and in some ways, it’s been very gratifying for me. Sometimes I feel like I’m not doing intensive couples work. I feel like I’m just coaching them to enjoy what they have. And then a part of me wants to say, “See? I told you so. I told you your relationship was good.”
I remember when I began my own quarantine, my husband was here in the house. Fortunately, the house is set up and there are two offices that are bedrooms but they’re set up as offices and they are side by side, each separated by a bathroom, which acts as a sound barrier.
But I found myself feeling really self-conscious during the first few days.
It’s like, “Oh, my God. I work alone and suddenly he’s going to hear what I’m saying all day long to my clients and there’s no buffer between working and going to the kitchen or letting the dog out and running into him all day long, whereas normally, I’m completely alone.”
So it took some adjusting and I was so exhausted after day one and day two. I don’t know if you remember what it was like.. kind of like telecommuting… hour… after hour… after hour… after hour.
Eventually, I kind of got used to it and I was like, “This is a piece of cake… I’m doing it.” But there’s no accounting for which days I feel good and which days I don’t feel good. I don’t just do therapy… I also lead groups.
On the days when I lead groups, I think I’m anticipating needing extra energy and I’m using my energy before I need the energy and I’m more exhausted with that.
When it’s sunny and beautiful outside, sometimes I feel better and it’s just rejuvenating to have a bright day.
We had about 10 days of rain and clouds and horrible weather and on Cape Cod, there’s no escaping the gray. So that made it even harder.
So conducting therapy online it’s been an interesting transformation for me. I’m totally used to working next door to my husband now and of course, the kitchen is way too close!
Like a lot of people, I fear I’m eating everything in sight constantly… only because I can.
And when I’m sitting in a chair feeling my stomach, thinking I’ve never had a stomach before, but here we are. So that’s also a common conversation that I’ve had with my gay male couples, which is how much everyone is eating.
Whatever you’re feeling right now about this issue, check in with me in two weeks because it’s probably going to be different…and we’re all in this together. Rick Miller
Rick said that therapists are adjusting and adapting just as clients are adjusting and adapting. Normally, when people come to therapy or couples therapy, supposedly we’ve worked some of our own personal issues out enough to be able to be of service to the people that we’re working with.
But in this instance, it isn’t the case.
We’re all going through it together. I also felt this way around 9/11. People were so traumatized by what was going on in the world and of course, I was too. We all were.
And I also experienced this during the aids epidemic. I started working as a psychotherapist in the mid-’80s and the gay male community was being decimated, and I was going through it myself at the time as well.
What’s interesting about doing work with gay men in groups is that many gay boys growing up learn to conceal themselves and hide.
And so as an adult, what they unconsciously continue to do, is being overly protective of who they are. So in a group, they get to work on that and they get to support each other, and it’s very powerful and profound.
So I lead two groups in Boston, actually, and then in Truro on Cape Cod, I have a mixed group of men and women that I also do regularly. And so that’s exciting. And then now I’m leading a mindfulness group for healthcare providers on Cape Cod, which is kind of fun, was what I was going to say.
I work mostly with gay male couples. I also work with female couples as well but my specialty is more with men.
Frequently, people say to me why are you focusing on just gay men? My answer is pretty succinct and pretty easy. Gay male development is its own development. -Rick Miller
Male development, female development, they’re different experiences. So the issue of growing up gay as a boy is filled with struggles and some kinds of small traumas or in many instances, significant traumas, based on the culture in which people grew up.
So by the time they make it to our offices for couples therapy, they’ve kind of grown up in a world of feeling disenfranchised, being made fun of, being ridiculed, being tortured, the whole bit.
I asked Rick about gay male couples and attachment…
A lot of what I do in couples therapy with men is eliciting vulnerability, tenderness, and truth. Before COVID, people were too busy in life.
I work with a certain kind of gay male couple who live in big cities. They traveled frequently, and are able to distance themselves from their spouses by sheer busyness.
Often by the time they get into couples therapy, who knows? Any number of things may be going on… but they’ve learned how to claim space and distance from each other.
So as I do couples work, this is the very thing that I work on with my clients. And when I conduct training seminars for couples therapists who want to learn how to work with gay male couples… this is what I address.
Working with gay male couples is challenging. It’s almost like two dismissive people, (from an attachment perspective), come together and have a hard time being warm, being expressive, and nurturing with one other.
So they come to my office, and frequently they’re sitting next to each other on the couch and looking straight at me.
And it’s really interesting about body language and body contact. I think that a good couples therapist would do amazing with a gay male couple if they simply focused on the issues of how feelings of vulnerability and tenderness are expressed…or not.
Interestingly enough, what’s happening these days compared to 20 years ago is the emergence of a gay diaspora. Gay men used to flock together and live in the same neighborhood, and there were coffee shops and bars and usually in a city, a real community.
But as life and the world is becoming more and more accepting, gay men don’t just have to live in the hood anymore and gay male couples are spread out throughout cities, throughout neighborhoods.
And so there isn’t a gay neighborhood the way that there used to be.
And now we have the Internet so people are online getting their sense of community. And we all know that that’s wonderful in some ways, challenging in other ways, but a very long-winded way for me to say that gay couples can now live wherever they want because there’s a much greater sense of acceptance. With that comes a sense of isolation when they may not necessarily have other gay male couples as neighbors.
Then there’s gay sexuality and the norms of the gay subculture, which is a subculture that has very liberal sexual norms. And what that means is that sometimes people feel as though they need to be a certain kind of gay man or they don’t fit in.
I’m coaching my clients to take baby steps, learning that it’s okay to be expressive, to have conversations about your needs and wants.
And I spend a lot of time kind of backing up to what has just been said to exploring what each person was feeling and wanting from the other at that moment and what they were anticipating their reactions would be. I do the same thing when they come in and they talk about different things that have gone on over the course of the week.
We’ll spend a lot of time with each person discussing their own kind of private reaction to these moments, even before anything was said. And it’s so profound and so important to be able to share their inner lives with each other, something that men were taught not to do.
Rick told me that the guy code is alive and well… and fully applicable whether you’re straight or gay.
Our culture needs men to go on the battlefield. We need men to run into burning buildings.
We require both gay and straight men to chase the bad guy.
These men will override their nervous systems, ignoring what it’s telling them, and do their duty. And out of this sense of socialized responsibility comes this guy code… where we feel obliged to stuff feelings down. We don’t talk about our feelings.
It’s almost like part of your work with gay men is to invite them to have a safer inner world…where they can notice what they’re feeling and what they’re thinking and actually give voice to it.
Yes, that’s it. I mean again, we’re talking about dismissive traits as opposed to a dismissive attachment disorder. Someone with dismissive traits learns to be protective and so when men come into therapy, they’re watchful, they’re suspicious.
Gay men coming to my office will be very watchful about who’s this guy…meaning me.
Is he good? Does he know what he’s talking about? There’s a little bit of a competition about who’s the more successful one. Can I hold my own with authority? There’s a lot of dynamics at play and sometimes in couples, it takes a while – meaning two or three times – for people to trust me and to let me in and to let me do my job in a way that I want to.
And once we cross that threshold, then the magic happens.
And the magic is slow and steady. I work with some couples for two or three years… and now we’re dealing with the coronavirus there’s still plenty to do so it’s not a quick fix.
So usually what happens is that there has been a recurrent struggle that’s unending and cyclical, going around and around and around and around.
In many instances, the more avoidant partner is put to task and he’s been sequestered to make the appointment.
I don’t know if this is the norm with heterosexual couples or if it’s stereotypically the wife that calls.
Am I hearing what you are saying, that with a gay male couple, the most reluctant partner is often tasked with reaching out to find a therapist?
Yes…Frequently because they’ve waited so long.
I can assure you…THAT is not a heterosexual dynamic!
This is interesting. We may have just figured out something really significant in the couples therapy world to talk about and research.
Among heterosexual couples, the pursuer (typically the wife) is the one who tends to reach out, with one exception..the walk-away wife. In those particular situations, we hear invariably from their husbands.
You’re describing a situation where, like a heterosexual couple, a gay male couple has been kicking around the problems between the two of them for years…and it reaches a critical mass.
But what I’m hearing you saying is that with many gay male couples, one partner says to the other, “Hey, you’re dragging your feet here. You’re going to have to find a couples therapist.” I can assure you…that is not what typically happens with heterosexual couples.
I would say at least in my practice with gay male couples, at least 60 percent of the time, the foot-dragger makes the call.
So I’m always thrilled to spend a little time with people to develop a comfort level so that they can work with me, and interestingly enough, this is a good case because of the coronavirus.
This is exactly what happened to me recently. Two members of a gay male couple called me on the same day.
This was before the quarantine, not knowing that the other one was going to call.
Or maybe the pursuer didn’t trust that the distancer was going to call me.
And they each gave me their last names that were different from each other, so I didn’t know they were the same couple.
So I called both of them back and I thought the second time I’m hearing from the second person with the same story. It’s like this sounds familiar… but I can’t violate confidentiality.
So I asked him what his partner’s or husband’s first name was and it was an unusual name so I realized that I was speaking to the husband of the person that I’d just spoken to.
I spent a long time with them on the phone, kind of educating them about what I can do and what couples therapy will be. And I went above and beyond what I normally do, simply because I had some time that day to speak with them.
What’s interesting is what you said about how being caught up in the home quarantine kind of takes over the initial conversation. It’s almost as if that becomes top of mind because it’s something that everybody…it’s almost like what we used to say is, well, how’s the weather, which is a nothing thing to say but everybody has an observation about it.
Yeah, so let me just back up for one second because what you just said reminded me of a different issue.
I practice on Cape Cod. And I’m in Truro so it’s a very small town and it’s packed and loaded with tourists in the summer and it’s desolate in the wintertime.
So frequently when people come for therapy, they may want to talk about those things and only that. But when couples come in for other things, touching base on these themes – what it’s like living here, how busy it is in town, how irritating it is, how desolate it is – that becomes a touchpoint for the work at the beginning of sessions.
And that’s exactly what’s happening these days with the coronavirus. It’s like we kind of start there. It becomes the touchpoint, the check-in point.
And for some people, it ends up being the gist of what we’re going to talk about the entire session, whereas for other people, it becomes the backdrop and everything gets arranged nicely by defining that and then we go in a little bit deeper. I can’t even think of a session where it isn’t mentioned. It wouldn’t be right not talking about it because it’s so intense.
The notions of certainty vs. uncertainty now have new mystery and meaning. I can see where that could be top of mind. I want to shift gears a little bit and talk about your clinical perspective in terms of, from a theoretical lens of how you look at things because therapists will be watching this.
Did you identify at any particular school of therapy or are there key influences or thinkers that have been particularly important to you in terms of your development as a couples therapist?
Not a really clinical answer, but what happened for me is that I was trained in Boston in the ‘80s, which is very psychoanalytic, psychodynamic, and as a gay therapist, I was out and I was known as an out gay therapist in the ‘80s. So I got all kinds of referrals simply because I was gay.
So my training as a couples therapist didn’t consist of any specific theoretical training. It consisted of me being gay and getting male gay couples to work with me.
What I learned about my success as a couples therapist prior to getting training was that I could sit with a lot of conflict in the room and hold my own without falling apart and without panicking too much.
I also discovered that my interactive style was working well with gay male couples, and my ability to help partners make peace was where my success was coming from.
So even before I got training in couples therapy, I just had an affinity that I didn’t even know about that was part of my strength.
I wouldn’t say that I’ve had any particular training that I identify with… but interestingly, in the last 10 to 15 years, I’ve pursued extensive training in clinical hypnosis.
Now I’m not doing clinical hypnosis in couples necessarily but what I’m doing is I’m having people pay attention to what’s happening inside of them.
Not just what they think but what they feel.
Any sensory awareness issues in their bodies that they can draw upon are very, very influential in couples work.
Something shifted in my own work as I got hypnosis training, which is that my clients stayed much longer in therapy, individual and group, whether I was doing hypnosis with them or not.
So I think something was happening in my own lens of concentration, appreciation, going to a deep level that was touching them in a particular way and they were staying in therapy, and I think that that is the success of my couples work as well, that there is an appreciation and a certain depth of understanding what’s happening for each partner in the context of the gay male couple. That’s one piece.
The other thing that’s happened for me is that I started doing more reading about sexuality and sex therapy with couples and I began to talk about sex a little bit differently with couples and with individuals, a little more explicitly, a little bit more comfortably.
And that’s been an important part of my couples therapy, and I’m realizing that a lot of couples therapists may convince themselves that they’re comfortable with sexuality when in fact they may not be comfortable with the gist of talking about sex.
And I’m still not 100 percent comfortable with that, but I am a little bit more.
Some advice for therapists. If you’re a heterosexual therapist and you’re working with gay male couples and you don’t feel comfortable talking about sex, it doesn’t mean that you shouldn’t see them.
See them, but refer them out for consults regarding sexuality to a gay male therapist who’s comfortable talking about sex, and then consult with that person as part of the couples therapy instead of throwing the baby out with the bathwater.
In fact, there’s something very healing for gay men working with heterosexual therapists, women, and particularly men, who are accepted by their therapist for who they are. -Rick Miller
That may not be the reason why they’re coming in for couples therapy but there’s a deep, deep layer of healing that takes place as a result of that acceptance. So in many instances, there are advantages for gay male couples working with a heterosexual therapist because of that kind of healing.
That’s an interesting observation. So what I’m hearing you say is that in many cases, the context of a heterosexual male therapist working with a gay male couple,…that context itself is healing from the get-go before anything else even happens.
I remember when was getting training in Emotionally Focused Couples Therapy. The trainer was an out gay male. He was from San Francisco. We had some interesting discussions.
He wanted us to understand some of the cultural and subcultural issues with gay men. He says, “Look, there’s about 25 percent of committed gay couples who engage in sex with other men and it’s part of the lifestyle that they have.”
He described discussing this lifestyle with Sue Johnson, to see if she was comfortable saying, “We have to look at attachment in a different way and not through a heterosexual lens to work with certain types of gay men.”
And that struck me. I felt humbled thinking about how much of what passes for a theoretical understanding of couples therapy might be marinated in a lot of unspoken heterosexual underpinnings, so to speak.
Thank you for bringing that up. That is a danger.
Gay male couples are very busy assessing whether they are going to be understood or misunderstood. And when they walk into your office as a couples therapist, they’re going to size you up and down and assess whether you’re good for them or not.
And they may be accurate or they may be inaccurate in their assessment. And that heterosexual kind of norms around sexuality and monogamy is not necessarily going to work for every gay couple.
I think the couples therapists unconsciously put that message out to their clients and it scares certain clients away.
That being said, again, the relational match of a couples therapist with a couple is so important, but that piece is not the only defining success of couples therapy at all.
I think the more important piece is how you as a couples therapist are understanding what’s happening communication-wise, interpersonally in this relationship and whether you kind of have the strength to get in there with them and help them sort that out.
For some gay male couples that are only focused on sexuality, the heterosexual normative might scare them away.
Fine. But that isn’t the bulk of why gay male couples are pursuing therapy. And even if gay clients are coming in for sexual functioning issues… there’s so much more going on.
So an EFT therapist, a therapist who’s committed and attuned to the people that they’re sitting with, will do amazing work with their clients.
It reminds me of something you said and I was thinking to myself what you were saying was true but also the opposite also has some truth to it as well, is it’s one thing to understand but as Andre Gide said so famously, “please don’t understand me too quickly.” It’s also important to not know and be able to say, “Tell me what this is like for you,” or, “Tell me how you do your relationship and tell me what your rules are.”
And don’t we all make assumptions and try to sell ourselves a little too quickly in session one or session two? Which frequently can be misunderstood by our new clients.
So Rick, what I’m learning from you in this conversation, which is really interesting, is that you’re describing a very particular common mindset of gay male couples, which is they tend to be a bit dismissive.
They’re going to be sort of very evaluative, sizing you up about whether this is good for me. So there’s almost like an inherent implicit skepticism is taking place.
That may be less true of heterosexual couples because heterosexual couples live in a world that accepts them in all their beliefs and their ideas and their norms as implicitly the truth, so to speak.
Gay men are almost sort of go through life developmentally in secret. And so that they’re careful. They may be leery. And they’re starting therapy because their relationship is breaking down for whatever reason…which is going to be even more difficult and scary for them. It’s hard enough going into individual therapy. It’s even harder going into couples therapy. I mean we all know when couples come to our offices the first time, they’re frightened. They’re vulnerable. It’s just, it’s painful.
Are there any particular issues relative to home quarantine for gay male couples that perhaps might not be true for other couples?
I think again from what I’ve seen, it’s mostly been a joy.
That cooking together, figuring out the shopping list, doing more kind of “female-oriented” activities are things that people are enjoying and it’s been very, very beneficial for these gay male couples.
I don’t know if I have a skewed sample of couples that I work with, but I’ve been really, really admiring their adaptability and the way that they’ve assimilated to being homebound and enjoying the aspects of cooking, and being together, and cleaning the house and like all the things that they used to hire people to do. They’re now doing themselves and it’s working out.
One of the things that we’re seeing about heterosexual couples, is that some of them are going stir crazy and feeling antsy.
But what you’re describing here is something that’s more fluid. It’s more appreciative of the ordinary and mundane, of finding joy in simple tasks and simple things. And yet we’re not seeing that being discussed very often with straight couples, which I think is…and I’m wondering to what extent gender norms might be more oppressive for heterosexual couples in that regard.
Well, maybe I’m lucky that the couples that I’m referring to don’t have kids. So being at home isn’t as hard.
Children are a source of frustration because straight couples are dealing with so much…working from home, carving out space, homeschooling, oh, forget about it, cooking – who does what, literally, there’s too much that’s actually going on for them.
There seems to be, at least what you’re describing with gay male couples, there’s a more defined couple space.
There’s nobody else to manage within that space who’s suddenly there.
I think that for some of these male couples, just enjoying home and having the time to do so is something that they haven’t done before. And that is strengthening. They can’t go out to dinner. They can’t go to business meetings. They can’t travel. They’re home… and home can be a peaceful place, much more than they realized. And that’s pretty amazing. Rick Miller
So we’re back to novelty again, it seems.
This is something new. What’s going on outside our home is new and different and perhaps scary and threatening, but what’s going on inside our home is also new but comforting and reassuring.
And, Rick, isn’t that the goal of good couples therapy?
Yes, that certainly is the goal of good couples therapy.
And now it is the threshold of Autumn. Our vacations, barbecues, and travel plans have been either deferred or discarded to meet the challenge of an ever-evolving public health crisis.
We are living in history. It is a strange, unsettling time. Dealing with COVID requires both gay male couples and straight couples to bob and weave between adapting and finding some kind of functional “new normal.” My thanks to Rick Miller for sharing his thoughts.
Rick has written several important books about working with gay men and gay male couples:
Rick is also a contributing author to For Couples: Ten Commandments For Every Aspect Of Your Relationship Journey (Zeig, Tucker & Theisen publishers, 2012).
Daniel is a Marriage and Family Therapist and the blog editor. He currently works with couples online and in person. He uses EFT, Gottman Method, Solution-focused and Developmental Models in his approaches. Daniel specializes in working with neurodiverse couples, couples that are recovering from an affair, and passive aggressive behavior patterns.
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