Addiction is a serious health condition that can affect anyone. But the way it develops and the way it’s experienced can look different for men and women. Those differences don’t mean one group struggles more or less. They simply help explain why some people progress faster, face different health risks, or run into different barriers when trying to get help. A helpful way to think about this is through two lenses. Sex differences refer to biological factors (like hormones, metabolism, and body composition). Gender differences refer to social and cultural factors (like expectations, stigma, relationship dynamics, and access to care). Together, they shape how addiction can show up and what support can be most effective. Key differences at a glance In broad terms, research often finds that men have higher overall rates of use for many substances. At the same time, women may progress from first use to addiction more quickly in certain cases, and may face stronger stigma and more obstacles to treatment. Both men and women can experience severe health consequences, high relapse risk, and co-occurring mental health concerns. Understanding these patterns can help people recognize warning signs earlier and seek the kind of support that fits their needs. This is why there are men-only rehabilitation programs (such as Into Action Recovery Arizona) that focus on creating a stable and supportive environment designed to address the specific challenges many men face in addiction and recovery, like isolation, pressure to “tough it out,” and difficulty asking for help. Patterns of use and progression Men, overall, tend to have higher rates of substance use across many categories. That can mean addiction in men is more visible: more legal consequences, work issues, or external “red flags” that others notice. Women, however, may experience what some researchers call a faster progression from early use to a diagnosable substance use disorder for certain substances. That “faster ramp-up” matters because it can shorten the time between casual use and serious health risks, especially if someone is trying to manage it privately. These patterns aren’t rules. They’re trends. Individual risk depends on genetics, mental health, age of first use, trauma history, and the environment someone is living in. How biology matters Biology can change how strongly a substance affects someone and how quickly harm occurs. One of the most commonly discussed examples is alcohol. Because of differences in body composition and metabolism, women may reach higher blood alcohol concentrations with the same amount of alcohol compared to men. Over time, this can contribute to health complications at lower levels of drinking than some people expect. Hormones can also play a role. Hormonal changes across the menstrual cycle may influence how rewarding or reinforcing certain substances feel, and may affect craving intensity in some women. This doesn’t mean hormones “cause” addiction but they can influence vulnerability and relapse patterns for certain people. Another biological factor is pain and medical exposure. Women are more likely to live with chronic pain conditions and, historically, have been more likely to receive certain pain-related prescriptions. That increased exposure can raise the risk of dependence for some individuals, especially when stress, trauma, or untreated mental health symptoms are also present. Brain effects and health risks Substances affect the brain in complex ways for everyone, but research suggests there can be sex-related differences in certain risks. For example, studies have reported that women may be more vulnerable to specific negative effects related to cannabis use, including impacts on certain cognitive functions in some contexts. Adolescence is a particularly sensitive time for brain development, and early heavy substance use can increase long-term risk for both boys and girls. Some substances also carry sex-linked safety risks. For instance, research has raised concerns that young women may be at higher risk for dangerous water and sodium imbalances associated with MDMA use, which can lead to severe medical emergencies. The practical takeaway is simple: risk isn’t only about the substance. It’s also about the person using it, their body, and their health context. Withdrawal, cravings, and relapse When people think about addiction, they often think about the “high.” But withdrawal, cravings, and relapse risk are where many people get stuck, and this is another area where men and women may differ. Research suggests women may experience stronger links between stress and cravings in some cases, and may be more vulnerable to relapse during certain phases of recovery. This may be especially relevant in nicotine addiction, where studies have noted that women can have a harder time quitting and may experience more intense mood-related withdrawal symptoms, contributing to relapse. None of this means recovery is harder for women across the board. It means treatment and relapse-prevention planning can be more effective when it addresses stress, mood, sleep, and support systems, not just abstinence. Co-occurring mental health Addiction rarely exists in isolation. Co-occurring mental health conditions can influence why someone starts using, why they keep using, and what makes stopping so difficult. In research, women with substance use disorders are often more likely to have co-occurring anxiety or depression, and substances may be used to self-soothe, reduce tension, manage overwhelm, or temporarily escape emotional pain. Men can also face mental health struggles, but may be less likely to name it or seek help for depression or anxiety early due to social expectations around toughness and independence. Some studies also find differences in how certain personality disorders show up alongside substance use disorders, with higher rates of antisocial personality traits more commonly reported among men in some substance-using populations. The important point is this: effective treatment often needs to address both addiction and mental health together (also called dual-diagnosis care). Trauma, relationships, and environment Beyond biology, life experience and environment strongly influence addiction risk. Trauma is a major risk factor for substance use disorders in both men and women. But the way trauma is experienced, disclosed, and treated can differ. Women may be more likely to face stigma related to parenting, relationships, or sexual violence, which can delay treatment. Men may be more likely to keep trauma private and try to “push through,” which can also delay treatment. Relationships can matter too. In some cases, women report that substance use (or escalation into riskier use) is influenced by partners or social networks. Men may be more likely to use in social settings shaped by cultural norms around drinking or risk-taking. Again, these are trends, not definitions. Unique health considerations for women Women face certain health risks that deserve specific attention. These can include increased vulnerability to some alcohol-related health harms, a higher risk of dangerous outcomes linked to intoxication (such as violence or unsafe sex), and greater medical risk when smoking is combined with oral contraceptives, including increased clotting or cardiovascular risk. Research also points to important trends in opioid-related harm among women over time, especially related to prescription opioid exposure. Together, these patterns highlight why early screening, safer prescribing, and accessible treatment matter. Treatment barriers and what “gender-responsive” care can look like Many people want help but hit barriers that have nothing to do with motivation. Common barriers for women can include childcare needs, fear of stigma, concerns about losing custody, and limited access to programs designed around women’s realities. Women may also be more likely to seek help first through a primary care provider or mental health clinician rather than a specialty addiction program. Common barriers for men often include stigma around vulnerability, fear of being judged as “weak,” and discomfort talking about emotions. Men may delay treatment until consequences become severe. The best care is the care someone will actually engage in. That can include: Integrated mental health and addiction support Trauma-informed therapy Practical relapse-prevention and coping skills Peer support and accountability A treatment environment that respects the person’s identity and needs Different needs, same goal, lasting recovery Men and women can experience addiction differently for reasons that are both biological and social. Understanding those differences isn’t about labels but rather about better support, earlier intervention, and higher chances of long-term recovery. If you or someone you care about is struggling, consider reaching out for a confidential assessment or talking with a qualified provider about addiction treatment services in Baltimore. Getting help is not a sign of weakness. It’s a practical step toward a safer, healthier life.

Recently I was interviewed on the radio to discuss the question of how to prioritize your relationship with your spouse vs. your kids. You can listen to the 20-minute segment here. Here’s the spoiler: I come down firmly on the side of keeping your spouse #1 on your list. This of course doesn’t mean that you ignore your children’s needs or that you spend 100% of your time and energy on your spouse. It just means that your relationship with your spouse comes first. Many people think that “the children come first” and end up putting too little, or nothing at all, into the marital relationship. This often leads to trouble down the road, and the kids in fact lose out even more. Here are some reasons why everyone is better off when the marriage comes first: Happy parents are better parents. Marriage takes work. You’ve heard it before, but that doesn’t make it any less true. Any long-term relationship needs consistent emotional input to thrive. Just like you can’t expect to get in shape one time and then stop exercising, you can’t expect your relationship to remain in good shape if you’re not working on it. It will deteriorate over time as you drift apart. For most people, a happy relationship is key to overall life satisfaction. If there is distance in your marriage, or worse, discord, stress, and even violence, you will be less happy than if your marriage offers you connection, security, and peace. Unhappy and stressed-out spouses can’t be the best parents they can be either. They have less patience, less emotional energy, and less empathy to offer to children who very much needs these things. Trying to offer your best to your kids while being drained in your marital relationship – the very place you would be turning to for emotional support instead of emotional strain – is like trying to run a marathon after getting beat up. You’re unlikely to succeed and it hurts like heck. Marital conflict and divorce are bad for kids. Living in a home where there is tension and conflict takes a toll on children. They are living with the stress as well – often they are far more aware than you think of the strain in your marriage, and they worry about it too. Kids hate when parents yell at each other, and spousal abuse has been demonstrated to have a host of very negative effects on children living in its midst. Children of divorce also tend to fare worse than children from intact families. (This is not to put blame on anyone who is divorced – there are of course situations where divorce is the better option. But a family based around a healthy and happy marriage is still the best environment for kids.) If you pour your energy into childrearing and don’t save enough for your marriage, you can expect more arguments, more fights, more disconnection, and more unhappiness for everyone in the family. All couples have disagreements; only by putting in the effort to learn how to manage them effectively will you be able to keep the peace in your marriage, peace which is vital for your children’s well-being. Children need a model for good relationships. Speaking of disagreements, it is important to recognize how valuable these can be in educating your children positively. You know how the say “never argue in front of the kids?” I disagree. Argue in front of your kids! Of course, you have to know how to do it. Yelling, screaming, insulting, minimizing, criticizing, and a host of other unhealthy approaches are definitely harmful for kids to witness. But if you have developed tools for healthy communication, then showing your children how it’s done is phenomenally helpful to them. They will one day have their own long-term relationships, and few and far between are their opportunities to learn how to deal with conflict in them. If you are able to model that for your children, you are doing them a tremendous favor. In addition, by building a great marriage you will be demonstrating to your children what they have to look forward to. Research shows that intimate relationships are the greatest factor in a person’s long-term happiness. Children who grow up in homes with marital conflict are more likely to delay or avoid entirely getting married. Prioritizing your marriage leaves your children with a legacy of knowing that happiness is truly attainable instead of believing that it is a lost cause. Your children are not your friends. A common consequence of spouses not feeling connected to each other is that they end up looking to their children, consciously or unconsciously, to fill some of the void. If you aren’t feeling loved or needed by your husband, you might turn to young children to feel that way. If you don’t enjoy your wife’s company, you may opt for activities with your teenagers instead of with her. Of course it is important to spend time with your children and develop emotional connections with them, but those should not replace your spouse. Your children are not your friends and you cannot put demands on them to fill your social or emotional needs. Even worse, some parents turn their children into confidants, sharing with them problems at work, with money, and even in the marriage. This is called “the parentified child” and it exposes children to a level of responsibility and maturity they are not ready for. Prioritizing your marriage and making it a place where you can get these needs met is critical for the growth and success of your kids. Your children will eventually leave. Finally, there is a very practical reason for keeping your marriage at the top of the list: one day your children will all leave the home and you will be left there alone with your spouse. If you haven’t been keeping up a meaningful relationship, this moment can be awkward and disappointing, if not terrifying. Couples who find themselves face to face with the empty nest are sometimes devastated to discover that there is no relationship left with the person with whom they have been sharing the house and childrearing responsibilities for so many years. Such couples may end up living together in mutual loneliness, or may decide to split up now that there is nothing holding them together. Dating at 60 is not nearly as much fun as it was at 20, as many newly single people of that age will tell you. Even worse might be the prospect of living your last decades on your own. Family life is comprised of a complex set of relationships all interacting with each other. Maintaining them all is a juggling act – even more so when you add in the limitations of energy, money, and time (I know – there’s never enough time!). You can’t devote 100% of your resources to any one area, but you can make appropriate priorities among them. For all the reasons cited above and more, I strongly recommend putting your marriage at the top of your list. Learn more about our couples counseling services here.

The holidays this year will be different than ever before. COVID considerations will have to play into every decision we make about our plans. Are you willing to get into an airplane, or will you have to drive instead? Can you manage social distancing at grandma’s house? Can you visit family at all? There are no easy answers, and everyone has their own unique set of circumstances to think through. Here are some things you can do to make the process a little easier. Plan Ahead Don’t wait until you show up at mom’s door to have a conversation about what precautions you want to be taking. Think through what lines you need to draw for yourself and your family. Does everyone need to wear masks? What about when eating? Or maybe you want to skip the eating? Social distancing – 6 feet? Or is 3 feet enough? Does it make a difference if you’re indoors or outdoors? (Note that I certainly encourage following CDC guidelines; it’s just that they don’t cover every possible circumstance you might encounter.) Once you have a sense of what your comfort zone is, communicate that ahead of time. Let your folks and family know what your preferences are (in a gentle and nonaggressive way, of course). This will allow you to iron out any differences of opinion that come up before you find yourself in a family mess (and it is guaranteed that they will come up). Keep it Subjective People usually think that objective proofs are the best way to get someone else to go along with your requests. The truth is that this rarely works in relationships. If you are trying to get a significant other or family member to accept your position, you are far better off taking a subjective approach. This means that, rather than trying to convince your dad that masks really work and then sending him a litany of the latest studies, you drop the scientific line of reasoning and say something like, “you know, we seem to have different points of view about this issue, but it just makes me too uncomfortable to be there if you guys won’t be wearing masks. I’d really like to come. I’m not saying you’re right or wrong about the mask thing, I just wonder if you’d be willing to wear them so that we can feel comfortable being there and not anxious.” When you make it a discussion about which side is right, you make it into a battle. Who wants to accept being wrong? When you explicitly take out the right and wrong and just ask for consideration (while accepting the possibility that maybe you are wrong, even if you think you’re not), you have much better odds of success. (For those of you that are balking at the thought that I am suggesting putting feelings before facts, I can totally understand that, and I remind you that I am not speaking about creating public policy here. I am speaking about your family. So let me ask you this – have you ever resolved any of your arguments with your spouse by showing them the facts, and then they turned around, acknowledged you were right, and everything was hunky dory? I didn’t think so.) Expect the Expected If you already know that Uncle Leo isn’t going to respect your 6-foot rule, then don’t go in hoping it will be different and get upset when that happens. Decide in advance how you’re going to navigate the situation (which may simply be not going this year), and then put your plan into action when the moment comes. If you need to vent to your spouse later on, go for it. But don’t get bent out of shape when the inevitable happens. Uncle Leo is going to get too close. Mom is going to praise the wrong candidate. Dad will flip on that awful news network. Be prepared to hold your tongue as needed and know that you can’t change other people – you can only change how you’re going to react. This year will definitely have a different feel to it, whether it’s masks around the table or a family gathering via Zoom. Whatever your holidays look like, do your best to make the choices that will contribute to family peace and togetherness. Isn’t that what the holidays are about after all?.

If your child is experiencing negative feelings that persist to the point that they are not functioning properly, then they might be suffering from a depressive disorder. According to the Centers for Disease Control and Prevention, about 3.2% of children aged 3-17 years are diagnosed with depression. That percentage might look small, but this is equivalent to 1.9 million people as young as toddlers and, based on the ongoing trend, this figure will continue to increase over time. When left unchecked, depression can have consequences on your child’s emotional and physical development. So, here are a few things parents can do to help children navigate the difficulties that come with depressive disorders. Know the Warning Signs If you suspect that your child is depressed, you will need to know what the warning signs actually are. Symptoms of depression can differ from person to person, but SymptomFind can help you understand the different ways this mental health condition manifests. One telltale sign they outline is a loss of drive or motivation. Children with depression will lose interest in activities they found pleasurable in the past, including hobbies they may have been passionate about. They tend to withdraw from social situations and become reclusive. You also need to look for physical warning signs. Their weight might fluctuate drastically, while experiencing fatigue, insomnia, or, conversely, excess sleep. Provide Emotional Support Because depression can cause feelings of alienation, it’s important that you make your compassion felt. Be a steady source of emotional support but don’t force your child to open up. Focus on spending more quality time with your child, and engage in open and honest conversations. Above all, your child needs to know that you understand and acknowledge their struggles, so build a positive home environment that encourages empathy, not judgment. If you need a professional to help you facilitate better communication within the family, the Baltimore Therapy Center also provides resources for family therapy. Seek Treatment Just like any other sickness, depression is treatable. Consult with a psychiatrist to get an accurate diagnosis and determine the best strategy for helping your child recover. Provided below is a summary of common treatments for depression. Medication In moderate to severe cases where depression makes a notable impact on brain chemistry, taking medication is usually necessary. SSRIS and SNRIS can help regulate symptoms by regulating the levels of neurotransmitters within the brain. However, because depression can impair proper social functioning, it’s more important to have medication in conjunction with counselling. Combining the two will help provide your child with strategies on how to cope. Talk Therapy Psychotherapy, also known as talk therapy, aims to facilitate communication between a patient and a mental health professional in order to identify root causes of psychological distress. The common approaches to psychotherapy include psychodynamic therapy, and cognitive behavioral therapy (CBT). Psychodynamic therapy examines emotions, thoughts, and past experiences to help give patients a clearer picture of their situations. This can be beneficial for children who have experienced trauma. CBT, on the other hand, is all about identifying problematic thought patterns and replacing them with healthier coping strategies. Unlike psychodynamic therapy, CBT places little emphasis on past events and instead focuses on what a patient can control at present, which can be useful for children who have difficulty opening up. Encourage Healthy Activities Depression might make your child reluctant to engage in new activities, even ones that will help them improve. However, it is vital that you encourage your child to build habits that can help them maintain their physical and mental well-being. Exercise It is a well-known fact that exercise boosts happy hormones. According to a study by The Lancet Psychiatry, even light physical activity showed great results in the mental health of adolescents. The researchers outlined that it’s even more important in this day and age to incorporate exercise into kids’ daily routines, because they spend an average of nine hours a day doing sedentary activities. So to boost life satisfaction, positive self-image, and psychological well-being, encourage your child to get moving. Be sure to take it one step at a time and join them in being more active. Try not to overwhelm your child by making them start with physically demanding activities. Work light exercises into their routine, like taking a short walk around your block, going for a bike ride, or playing in the backyard. Meditation Using mindfulness techniques like meditation can help your child reach a heightened state of awareness. Meditation has many proven benefits on mental health, including reducing anxiety, stress levels, and better self-esteem. Fortunately, there are many available resources for learning meditation techniques. There are so many useful YouTube channels, videos, playlists, and apps that can help beginners get started with meditation. For starters, Headspace is a great resource to discover meditation. Having a child with depression can be a difficult and overwhelming experience. Fortunately, resources for prevention and treatment are becoming more accessible online. Take a proactive strategy to prevent your child from reaching a crisis point and reach out to us here at The Baltimore Therapy Center.

It is all too common for parents to cause real grief for their adult children. Many of those children find themselves asking, “Should I cut off my parents?” It’s not a small question and not a small step to take. As a family therapist, I tend to recommend taking this major step only in rare situations. How do you know if your situation is one of them? Here are the circumstances under which you might have to make the drastic decision of cutting off toxic parents: Your parents are abusive. Your parents refuse to respect the boundaries you have clearly set. There is a clear risk of harm to you or your children. Even minor interactions cause you major distress. Even in such situations, there are two more conditions I would suggest: You’ve tried maintaining a minimal, detached relationship. You’ve tried family therapy/coaching. Before we elaborate on these points, let’s understand first why this is such a big deal and why a person should not be so quick to cut ties with their parents. (Note that I am just referring to “parents” as a unit in this post, although you may be considering this for just one or the other of your parents.) Why is it a big deal to cut off your parents? Cutting off your parents is in some way similar to cutting off your legs. They are integral to who you are as a person, whether you like it or not. Sometimes they might cause you a lot of pain. But you’ve really got to have a pretty darn good reason for cutting them off. It’s not something you do without trying basically everything else in your arsenal! Why not? #1. People need parents I don’t mean this in the practical sense of helping with babysitting or finances (although sometimes that is true too). What I mean is that our biological and psychological wiring makes us want and need a connection with our parents. Why do most cultures consider it an offense to insult someone’s parents? Your parents are where you come from. If your origins are rotten, it says something about you as well. You see this very strongly in kids. No matter how awful, abusive, or dysfunctional the parents are, children will do all kinds of mental gymnastics to view them as good and okay, taking blame and guilt for terrible situations upon themselves instead. Even as an adult, coming to terms with the fact that one’s parents are irredeemable is a painful and difficult process. Cutting them out of your life forces you to contend with that reality or else bury it under the rug and try to ignore it. That takes a lot of mental energy and can be very draining. It’s also not usually all that successful. The most fundamental argument, then, against cutting off your parents is that it’s not good for you. It’s only when the costs of keeping even a cursory relationship with them are even greater that it becomes a preferable option. In many cases, keeping them at arm’s length to keep interactions at a safe emotional distance without cutting them off entirely is possible. #2. You never know what the future will bring Yes, things are bad now. Yes, your parents may never change. But – it’s also possible they might. Even hardened criminals have had epiphanies that turned their lives around! So while the relationship might be miserable right now, it’s not impossible for things to be different in the future, even if nothing seems to be able to shift at present. And even when parents don’t make a huge turnaround, they do tend to soften at the very end of their lives, if only out of physical or mental infirmity. After the funeral, many grieving sons and daughters have expressed regret over not having communicated with their parents for years or even decades It is easier to come back together if some minimal relationship has been maintained than if you have severed ties entirely. If it’s possible to maintain some connection, you keep more options open for the unknown future than if you draw a hard line in the sand. #3. Gratitude is key We are all here because our parents gave birth to us, and, except in the case of the most abusive or neglectful parents, because they cared for us and provided food and shelter when we were too young to survive on our own. For that alone, we owe them a debt of gratitude, and certainly all the more so when they did a half-decent job of raising us. But I am actually not arguing that you “owe it” to your parents to keep up a relationship with them even if they are causing you tremendous grief. That is a moral debate you may want to take up with your clergyperson of choice. The point I want to make is that, once again, it is not good for you to default on your debts. Gratitude is a fundamental driver of happiness. If someone has done something kind for you, then recognizing that and experiencing gratitude for it is critical for your own personal well-being. To close that out of your mind and convince yourself that you don’t owe gratitude to someone who has done you kindness is to build psychological walls that will hurt you more than anyone else. It is, of course, possible to feel thankful towards your parents and also determine that the right thing to do is nonetheless to cut them off, but the default position ought to be that our gratitude requires us to push ourselves to do for our parents, within reasonable limitations. Denying that gratitude out of anger for not treating you well is bad for your well-being. So when should I cut off my parents? Let’s now take a look at some indicators that this drastic step needs to be taken. This is not a comprehensive list – it’s impossible to conceive of every possibility a family could run into. But before you decide that your situation does call for a termination of the relationship, I urge you to think long and hard about it and talk to an individual or family therapist online or in person to ensure you’re thinking clearly. You may justifiably be angry, and you may be right that it’s time to cut the connection, but rarely is a decision made in anger the best one. #1. Your parents are abusive As an adult, you are probably not subject to physical or sexual abuse from your parents, although it’s unfortunately not unheard of. (Note: if you have been physically or sexually abused in the past by your parents or anyone else, please make sure you are getting help healing from that!) Certainly, if either of those is the case, severing ties with them (or the one who is abusing you) might be the safest option. More likely, though, we are talking about verbal and emotional abuse. If your parents intentionally try to tear you down and make you miserable, it might be necessary to get yourself away from that. This should be distinguished from parents who are obnoxious or genuinely believe their criticism is meant to help you “shape up” or improve yourself. Obviously, their approach might be lacking, but if they genuinely have good intentions, there is probably a way to keep some minimal relationship going without being miserable. It’s important to check this out with a neutral third party before deciding that your parents are intentionally being abusive or nasty. It’s easy to attribute negative intentions to someone who is hurting you, even when those intentions aren’t there. (There’s actually a name for it – hostile attribution bias. You commonly see this in kids who, for example, flip out when someone bumps into them, insisting it was done on purpose.) As you have already seen, I consider cutting ties a last resort, and it’s important to be sure it’s the only option before going ahead. #2. Your parents refuse to respect boundaries you have clearly set There are many ways that boundaries can be violated. It could be as literal as parents that won’t stop walking into your home uninvited (anyone remember the show Everybody Loves Raymond?). It could also be less obvious, like a refusal to stop asking questions about your love life or inserting themselves into your relationships with others (your spouse, siblings, etc.). Again, this should be distinguished from parents who are just pushy or nosy. In any relationship it’s on you to set boundaries. Maintaining those boundaries allows you to keep most people, including parents, at an appropriate distance. For example, you can change the locks and not give them the key, or change the subject any time your love life comes up. Likewise, you can make it clear that you won’t discuss with them your relationship with your brother. You should also verify that you have established and clearly communicated such boundaries. Wanting them to butt out and making a clear statement about what they should butt out of, and what the consequences will be if they do not, are two different things. Again, consulting with a coach or therapist can be helpful in determining if you’ve set clear boundaries or in learning how to do so. #3. There is a clear risk of harm to you or your children Here I am not referring to a situation of physical or sexual abuse – obviously, if a parent is physically attacking you or if you are concerned that a parent is sexually abusing your child, these are the kinds of situations where you may need to cut off contact for your or your family’s safety. There may also be situations where there is a risk of harm that your parents do not intentionally perpetrate. For example: A parent who has a problem with drug or alcohol addiction. A parent who has a mental illness that makes them unsafe. A parent who is providing your child with access to things that are unsafe, such as alcohol, cigarettes, guns, or pornography. (Showing a minor child pornography is in fact a form of sexual abuse.) Again, taking these as reasons to end the relationship with your parents assumes you’ve made it clear to them that their behavior is unacceptable to you. (You may think this should be obvious, but it’s nonetheless a step that should be taken.) #4. Even minor interactions cause you major distress If every interaction with your parents leaves you miserable, overwhelmed, and drained, it might be time to break away from that and cease contact. This is true whether your stress is due to how difficult they are or to your inability to cope. That is to say, it could be your parents aren’t toxic or abusive, just run-of-the-mill difficult, but you have your own mental health issues that make it impossible for you to manage. That is fair. If you don’t have the bandwidth to have them in your life and be able to function normally, then you need to make sure you can survive above all. But – it’s important in this case that you are attending to your mental health – learning coping skills, mindsets, and tools to manage better. The goal should be to strengthen yourself enough to be able to handle a relationship with run-of-the-mill difficulty and not fall apart (because, let’s be real, there are a lot of those people out there!). If you are in generally good mental health and are able to get along with other difficult people besides your parents, but your parents are so toxic that they manage to make every interaction into a disaster despite your best efforts at keeping the peace, then cutting the cord might be the best answer. Two Conditions I suggest two conditions that ought to be met before considering the last resort of ending contact with a parent. Obviously, these do not apply where there is physical/sexual abuse happening or where there is a clear and present danger at hand. To take an extreme example, if your parent is experiencing a psychotic mental illness and is literally threatening physical harm, you need to protect yourself and your family above all. However, in less severe situations, I think it is important to try all avenues before cutting off contact entirely for these reasons. Below are two options that should be considered first. 1. Family therapy/coaching Often people are locked into unhealthy relational patterns simply because that’s what they know and that’s what they’ve always done. But this can change. Families can learn new ways to interact and improve their relationships – and even if you don’t become a close-knit, picture-perfect family, you can certainly move the needle to where it’s actually enjoyable (or at least tolerable) to be around each other. If you try working together as a family with a family therapist in Baltimore (or online, from wherever you are), and there is no improvement (or not enough), or if you ask your parents to go to therapy with you and they refuse, at least then you can say you’ve tried everything you could. To walk away from the relationship without trying to get outside help is selling yourself short. Just as you wouldn’t cut off your legs, diseased as they may be, without talking to a doctor first, so too you shouldn’t run to cut off your parents without talking to a professional. 2. Maintaining an arm’s-length relationship Sometimes it’s sufficient to keep your parents at a distance without dropping them entirely. Maybe it’s a phone call once a week, once a month, or just seeing them on holidays (and keeping your head down to make it through). You share little about your personal life and nothing about topics that are very sensitive for you; you have a hey-how-are-you call from time to time, chat pleasantries, and move on. This is usually a healthier option where it’s possible. Of course, truly toxic parents can make even this level of relationship miserable (and if they are the boundary-violating type we discussed above, they may not accede to a relationship at this level anyway). It’s Up to You At the end of the day, only you know what you can and can’t handle in your life. That said, you are also not an objective participant in this process, and it’s critical to consult with folks who are before going through with cutting off your parents. I hope that is not your situation, but if it is, know that we’re here to help.

What is couples counseling? Couples counseling goes by various names: couples therapy, marriage counseling, marital therapy, relationship counseling, and more. These are all ways of framing the same process, namely, trying to help a couple (whether married or not) achieve a better level of functioning. What this means is that when one or both parties in a couple are not happy with the relationship because of the way they are interacting with each other, a couples counselor can help them change the way they relate to each other in order to help restore the happiness in the relationship. (In the vast majority of couples there was happiness in the relationship at some point; people who hate each other usually don’t get together romantically. Although sometimes in situations of an arranged marriage or a couple that gets married due to an unexpected pregnancy, there actually never was a happy point to return to.) It’s important to note that couples counseling is not about “fixing” anyone. If one person says they don’t like their partner because s/he is lacking some trait they are looking for – a sense of humor, intelligence, whatever – then couples counseling may not be the way to go here. Couples counseling is not going to make anyone funnier or smarter. Nonetheless, some couples work might still be relevant if both people are interested in staying together anyway, or at least in exploring that possibility. Couples counseling is also not a tool for one person to come in and expect a therapist to change their partner. Repairing a relationship is almost always a two-way street; even if one person has really wronged their partner, there is usually something that the partner can be doing differently in the relationship nonetheless. (An important exception to this is a situation of domestic violence, where often the victim cannot do anything differently to make the abuser stop doing what they are doing. Couples experiencing active domestic violence are usually not candidates for couples counseling.) How do I know if I need couples counseling or if I need individual counseling? The truth is, virtually anyone can benefit from both of these approaches at any time. Therapy is not something that’s just for people who are sick or crazy – it’s for anyone who wants to strive for a greater level of life satisfaction. I state this upfront because if you are looking to make something better in your life, both individual and couples counseling are likely to help. That said, there certainly are issues that might be better addressed in one format or another. For example, a person struggling with self-esteem issues might be a better fit for individual therapy. Someone experiencing stress due to marital conflict obviously would be more likely to gain from couples therapy. Fortunately, with a good therapist you can’t go wrong. If you come in by yourself and start describing relational issues that would be best dealt with along with your significant other, a competent therapist should notice this and recommend bringing them in (or refer you to someone who works with couples if they do not). Likewise, if you go to see a marriage therapist to deal with dissatisfaction in your marriage, but the problem is really rooted in some childhood trauma of yours, for example, the therapist might recommend you seek individual counseling in addition to or instead of couples counseling. The bottom line is, don’t wait until you are sure you know what the real issue and the best solution is – leave that to the therapist. Just starting the process of therapy, on your own or as a couple, is likely to improve your situation already. What do you do in couples counseling? Couples counseling is not just a place where we sit down together and negotiate a solution to a specific problem. For example, if you and your partner have an ongoing argument about how many times a week your mother should visit the house, it would be a real failure if all you got out of couples counseling was a number to answer that question. Having a third party help with a negotiation is called mediation, and while there is a time and place for that, couples counseling is not it. (Mediation is something generally used once a relationship has already fallen apart, not while it’s still alive and kicking.) What you should really be doing in couples counseling is learning how to resolve the argument yourself. It’s no good if the couples therapist solves the problem for you. Goodness knows there will be other problems down the pike. What you need to survive as a couple is tools to manage conflict in the future, not just this one in the present. Thus, a couples counselor might help you resolve the problem of your mother’s visits by guiding you to solve the problem together. Whether you come out with a specific number of hours is less important than whether you know how to have the discussion. This will involve learning about and practicing skills such as active listening, reflection, empathy, and validation. These are the tools you will need to have difficult discussions together in the future. If your couples counselor solves your problem but doesn’t leave you feeling like you could do it again on your own, you are not getting what you need out of the process. What if my partner doesn’t want to come to couples counseling with me? This is (unfortunately) a common situation. One partner is hoping for a change in the relationship, while the other one seems less concerned, or worse, says something along the lines of “it’s your problem – you go get therapy.” As we’ve outlined above, a relationship problem is often a problem of the way two people relate, as opposed to one person being broken or “messed up.” Fortunately, there is a lot to be gained from counseling even if your partner refuses to go. If you can change your own behaviors in the relationship, you can shift the dynamic so that your partner slowly begins to respond differently as well. In addition, when the reluctant party sees positive changes happening in their partner, often they are inspired to join in the counseling process as well and get in on whatever is changing their partner for the better. Or, failing any kind of success, you may come to realize that a relationship where your significant other is not willing to change and grow is not a relationship you really want to be in. What else should I know about couples counseling? You should be prepared to work hard. By this I (obviously) don’t mean that you will have to climb a lot of stairs to get to the therapist’s office (though I’m not saying you won’t). Rather, the work I’m talking about is the internal kind – the kind where you may have to admit that you have done some things wrong and can do better; the kind where you allow yourself to be vulnerable to another person; the kind where you consider changing the way you’ve done things for years and decades. That kind of work. It’s not easy, but if you really put some grit into it, you are likely to see tremendous results. Where can I find a couples counselor in the Baltimore area? Glad you asked! The Baltimore Therapy Center is a great place to start. We have availability during the daytimes, evenings, and weekends, and a great staff to help you out. I encourage you to check out some further FAQs on our couples counseling, read some of our posts, and look up our reviews. We’ve helped a lot of couples turn things around, and we’d love to help you as well. Be in touch! This entry was posted in Blog and Tags: couples counseling, marriage, marriage therapy Comment is closed now!

Finding the right therapist can be a frustrating task, especially if your insurance isn’t top-of-the-line. Then again, some well-meaning friends will tell you to seek out a private pay therapist anyway because “all the good therapists don’t take insurance.” Is that true? What’s the difference between private pay vs. insurance when it comes to getting the right therapist? Let’s see if we can get a handle on this question and give you the info you need to make the right decision for yourself. Are Private Pay Therapists Really Better? First of all, it is definitely true that therapists who take insurance are less capable. There are many factors that go into therapists’ decisions to take insurance or not. Many very skilled therapists are committed to accepting as many insurances as they can in order to make therapy accessible to people of all income levels. The reason that many equally skilled therapists don’t take insurance is because insurance companies often don’t pay as well, but also because they are maddeningly difficult to deal with (as you may know from trying to work with them on the consumer side). So the insurance question alone doesn’t tell you whether a therapist is any good. (Unfortunately, there are all too many lousy therapists out there, both insurance-based and private pay.) To find the right therapist, you’ll want to look at other factors. So Then Why Go Private Pay vs. Insurance? If insurance-based and private-pay therapists aren’t qualitatively any different, why would you ever pay out of pocket for therapy? Well, there’s a few good reasons. Privacy Insurance companies not only know who you’re seeing for therapy and why; they get to look at your treatment plan and progress notes too. That may or may not bother you. (Maybe it bothers you more if you’re in therapy for erectile dysfunction or sex therapy or something like that…) Risk When a therapist bills insurance for their services, they are required to submit a mental health diagnosis to justify their work. Meaning, you are getting labeled with a mental illness, whether you are actively psychotic or just looking for some help with (normal) arguments in your marriage. This goes in your medical record, and that record might be called upon in various normal circumstances—for example, if you are applying for life insurance, they’ll want to see your medical history, including mental health diagnoses and treatment. Likewise, here in Maryland, it’s common for people who want to work in the federal government to seek security clearance. If you’ve been to therapy through your insurance, the government can see that, including the diagnosis you were given, and can require you to grant them access to the therapist and their records. (Private pay therapists do not necessarily assign you a diagnosis, and outside entities won’t even know you saw a therapist unless you reveal that.) Control Insurance companies get to decide whether you “really” need therapy, and how much of it. If they feel your condition doesn’t justify their paying for therapy, or if the procedures your therapist is using don’t meet their standards, they don’t have to pay. Even if they do pay, they can tell you they’ll only pay for X number of sessions. If you and your therapist feel there’s still work to be done—tough luck. Insurance says you’re all better! Likewise, if you’re in a crisis and need more than one session a week, that’s up to your insurance company, not you, and not your therapist. Are There Benefits to Going Through Insurance? Of course, the main benefit of using your insurance is that it saves you money—potentially quite a lot of it. Not everyone can afford paying hundreds of dollars a month for therapy. This is especially true when the situation just doesn’t seem that dire—you’re feeling down, but not terrible; your marriage isn’t great, but you’re doing okay. In those situations, it can feel hard to justify the extra expense if you’re not financially very comfortable. Having insurance to pay for it can make it easier and more palatable to seek help in the first place. And hey, if you’re not planning to get security clearance, already have life insurance, and don’t really care about some guy hundreds of miles away reading your file among the scores he’s already read that week—and I would consider myself in that category!—insurance really does make a lot of sense. In Sum The long and the short of it is, when it comes to private pay vs. insurance, it’s a personal decision. If finances are tight, going through insurance makes a lot of sense. On the other hand, if you have the means and are concerned about privacy and/or autonomy in your therapy, private pay could be the better fit. Either way, you still have to find the right therapist for you—and you can certainly find good ones both in your insurance network and outside of it. Need more help connecting with the right therapist? Feel free to reach out. We’re happy to help, even if you choose not to book a session here!

Completing an Intensive Outpatient Program (IOP) is a significant milestone. It reflects meaningful progress, the development of practical coping skills, and clear evidence that sustained change is achievable. Feeling uncertain, vulnerable, or somewhat anxious about what comes next is common. The transition following IOP is one of the most important phases of recovery, because it is when learned skills are applied in the environments that may present the greatest challenges. The next step does not need to be determined alone. There are well-established care options after IOP, including individual therapy for addiction recovery in Baltimore, and the most appropriate choice is the one that ensures continued support while building greater independence. Why the period after IOP can feel harder than you expected An intensive outpatient addiction program, or IOP, provides a framework for life after rehab. You know where you’re going, who you’ll see, and what you’ll work on each week. When that structure decreases, it can create a strange gap, especially if the rest of your life is still stressful, unpredictable, or emotionally demanding. That’s why life after IOP can feel shaky at first. There’s often less accountability, and fewer sessions can make it easier to rationalize skipping support altogether. At the same time, everyday triggers can show up quickly, such as work pressure, family conflict, social situations, and even isolation, which can feel more intense without the regular rhythm of treatment. You might also notice old patterns reappearing, not because you “failed,” but because your brain is used to reaching for familiar coping strategies when stress hits. And for many people, emotional healing is still in progress: anxiety, depression, trauma responses, and overwhelm don’t automatically disappear the moment IOP ends. This is exactly why step-down support exists: recovery doesn’t have to be all-or-nothing, and your plan can evolve with you. A quick check-in to guide your next step Before choosing what’s next, take an honest snapshot of where you are right now. Think of this as a practical self-assessment. Ask yourself the following: How strong are my cravings or urges lately? Am I dealing with anxiety, depression, trauma symptoms, or mood swings? Is my home environment stable and supportive? Do I have people I can call who understand recovery? Am I consistently using the tools I learned, or mostly “getting by”? If your answers raise concern, that doesn’t mean you’re doing something wrong. It simply means you may benefit from more direction for longer, which is a smart, protective choice. Common next steps after IOP There isn’t one universal path after IOP. Most people combine a few supports to create a strong recovery foundation. 1) Continuing care (step-down outpatient support) Continuing care is designed for the exact moment you’re in now: you’ve completed IOP (or another organized level of treatment), and you want to keep building without feeling like you’re starting over. In many programs, continuing care includes an outpatient program, with a mix of individual counseling to work through what’s coming up in real time, group support for accountability and connection, and relapse prevention work that focuses on triggers, patterns, and decision-making under pressure. It may also include support for co-occurring mental health concerns alongside substance use recovery, all within a system that can be scheduled around work, school, and family. This option is especially helpful if you want recovery support that fits into your actual life because that’s the kind of support that tends to last. 2) Weekly (or biweekly) outpatient therapy One-on-one therapy is a strong next step if you’re looking for consistency and a place to process deeper issues at your own pace. It can help you manage stress, anxiety, depression, and emotional regulation, while also supporting healthier relationships through stronger boundaries and communication. Individual therapy for recovery can be especially valuable for working through trauma, grief, shame, and self-esteem challenges, and for building routines that support long-term sobriety. Just as importantly, it helps catch small problems early, before they quietly turn into bigger ones. 3) Peer support groups Peer support is powerful because it gives you something many people lose in addiction: a connection that doesn’t require pretending. Groups can offer a space with people who truly understand what you’re navigating, along with practical support for cravings, triggers, and other high-risk moments. There are different approaches to peer support, including 12-step programs, SMART Recovery, and other options, so you can find one that aligns with your needs and preferences. They also provide accountability that's community-based, not clinical, and a steady reminder that you don’t have to do recovery alone. If you’re unsure which group fits, it can help to try a few. Remember, you’re building a network of support that can help you in the future. 4) Recovery housing or a more structured environment Sometimes the environment is the biggest challenge after IOP. If your living situation is unstable, high-conflict, or full of triggers, stepping into a more recovery-supportive setting can be a major turning point. An organized, post-rehab living environment may be worth considering if you feel unsafe or constantly triggered at home, if people around you are actively using substances, if you haven’t built reliable routines yet, or if you need daily accountability while you rebuild stability. 5) Medication management when needed For some people, medications can help support recovery, especially when cravings, sleep issues, anxiety, depression, or other mental health symptoms are making it hard to stay steady. This isn’t a “shortcut.” It’s one tool among many. If you’re curious, talk with a qualified provider about what might be appropriate for your situation. What effective continuing care looks like in real life Not all step-down support is created equal. The best continuing care programs tend to share a few qualities that make them sustainable: Flexible structure. Support should work around your responsibilities and not require you to abandon them. Trauma-informed care. Many people in recovery carry trauma, and support should respect that reality. Evidence-based skills. The focus stays practical: coping strategies that work under pressure. Relapse prevention at the center. Not fear-based, but empowering, learning your patterns and responding early. Whole-person support. Some programs also include helpful practices like mindfulness, movement, or yoga as additional tools for stress and emotional regulation. Community and accountability. Connection is not a “bonus.” It’s a protective factor. A simple 30–90 day plan after IOP It helps to treat life after IOP like a transition period with its own plan because waiting to “see how it goes” can quietly lead to isolation. Studies have shown it’s ideal to have an aftercare program after IOP for sustained recovery. Here’s a realistic framework: Weeks 1–2: Stabilize Confirm your next level of care (continuing care, therapy, groups, or a mix) Set a weekly schedule you can stick to Reduce extra stress where possible (sleep, routines, basic structure) Weeks 3–6: Build strength in real situations Identify your top triggers and create a response plan Practice coping tools when stress is low, not just in emergencies Strengthen your support network (don’t wait until you “need” it) Weeks 7–12: Grow independence without losing connection Review what’s working and adjust your schedule Expand healthy routines (exercise, hobbies, community, purpose) Create a relapse prevention plan you can actually follow in the moment If you want one simple guiding principle: consistency beats intensity after IOP. Signs you may need more support Sometimes the best move is to increase the support, not because you’re failing but because you’re paying attention. Consider reaching out for more support if you notice: More cravings, more irritability, more “checking out” Skipping therapy, groups, or appointments Isolation, secrecy, or minimizing what you’re feeling Returning to high-risk situations without a plan Worsening anxiety, depression, panic, or trauma symptoms If any of this is happening, act early. Talk to your provider, increase support, and don’t wait for a crisis to “prove” you need help. How loved ones can support life after IOP If you’re a family member or friend reading this, your role matters, but it works best when it’s grounded in support, not control. Helpful support often looks like encouraging consistency and follow-through, respecting boundaries (yours and theirs), staying steady instead of reactive, learning about addiction and recovery, and considering family support or counseling when it makes sense. What usually doesn’t help is monitoring or interrogating, using threats or shame, minimizing how much work recovery takes, or expecting someone to “be fine now” simply because treatment ended. Conclusion Attending an IOP helps establish a strong foundation for recovery. The next phase focuses on maintaining and strengthening that progress. Whether you continue with ongoing care, individual therapy, peer support, or a combination of approaches, the objective remains the same: to stay connected to support while applying recovery skills in everyday life. Perfection is not required. What matters most is having a clear plan, appropriate support, and consistent follow-through.

No. Okay, that was a little harsh. But hear me out. This is not a moral discourse on the propriety of pornography in general but rather a consideration of what it does to your marriage (or other committed relationship). While some writers have commented enthusiastically about the benefits of porn for married couples, some deeper thinking – to say nothing of my clinical experience – leads me to suggest that the drawbacks far outweigh the benefits. Meaning, although there are arguably some pros to pornography viewing as a part of your sex life, there are a number of cons that must be considered as well. And those cons are likely to tank a marriage. This is true of both the folks watching it solo and those watching as a couple (“married porn”). Let’s take it one at a time. (Warning: this post doesn’t pull any punches – be prepared for frank language.) Individual Porn Consumption Let us assume that your partner says she doesn’t mind your viewing porn. (Yes, I am addressing men primarily here – despite advances in male-female equality in many areas, research still shows that men watch porn more than women. This is meant to be an empirical statement, not a political one.) If she does mind then this really oughtn’t be a question to begin with – watching porn against the wishes of your partner is nothing but destructive to the relationship. But let’s say she’s okay with it, which some people are. I contend that it’s still a bad idea. Here’s why: You can’t help but compare You don’t see many porn stars with cellulite or even slightly protruding stomachs. They have perfectly toned and often surgically altered bodies specifically designed to meet the current cultural definition of attractiveness. Your wife most likely does not – and even if she does, it ain’t going to be the same body ten years from now. How are you going to remain attracted to your wife if you are continually turning to these picture-perfect bodies to turn you on? What about your own self-image? How are you going to feel about yourself in the long run (obviously in the moment you feel fine and dandy) when you see the male porn star with his body parts, his perfect ability to please women, his seemingly endless stamina? Even when people know that the scenes they witness are unrealistic, they often can’t help but start to believe that their own performance is lacking. (This is actually even more pronounced with women, who in our culture are barraged with messages about how they should look and act – comparing one’s own body to the lead porn actress’s is a recipe for body image problems.) Porn Gives You Unrealistic Expectations Here are some of the messages you will absorb from watching pornography, none of which translate to real sex in real life: Women don’t need foreplay to become aroused or achieve orgasm. A sexual relationship that is satisfying for both partners takes work. Porn movies usually skip the dinner by candlelight, the sensual snuggling, along with all the other components that precede good sex – not the least of which is also who took out the trash this morning and whether you spent more time talking to your spouse or your iPhone today. Women will always achieve orgasm. Quickly. Sure, some women may be like that. But for many women, orgasms are not a guarantee every time you have intercourse. Again, a sexual relationship takes work. Orgasms are loud and frenzied. Many men are surprised to learn in their first sexual experiences that real-life women look, sound, and act nothing like unreal porn stars do when climaxing. Those who are waiting for the Big Bang tend not to notice when, or whether, their wife is satisfied or not. Men can get an erection whenever they want. If you’re old enough to be married, you are old enough that it is normal to not be able to achieve or maintain an erection 100% of the time. Yes, really. That is the experience of many otherwise healthy men – but it sure isn’t what you see in the dirty movies. Men can get two erections whenever they want. Again, the older you get, the longer the refractory period between erections. It’s normal. If you think you are supposed to be able to have sex multiple times a night and you can’t, you are likely to feel bad about yourself – but you shouldn’t. Bodies just don’t work the way they do in the movies. (Again, it’s worth noting that even if you know this in your head, repeated exposure to such messages can absolutely affect the way you feel.) Most women enjoy violent sex. No. Most women enjoy anal sex. Although research indicates that this practice is on the rise, it also seems to show that most women are doing it because they or their partners saw it in a porn video and not because it particularly enjoy it. Watching porn inculcates you with these ideas, even if you consciously know them to be untrue. Bringing these expectations to your marriage is virtually guaranteed to lead to disappointment, sexual frustration, and conflict over time. Porn teaches you poor sexual habits Men who masturbate with (or without) the visual stimulus of pornography are generally not engaged in a long, romantic process with themselves. Instead, they’re aiming for a quick fix of sexual gratification. This is not a habit that trains one well for a satisfying sexual experience with a woman. As suggested above, and can be attested to by many, women tend to seek sexual experiences that are slower, longer, and more involved than men. (I know we are generalizing here again, and it is not true for everyone, but the generalization is backed up by research. I am also not making a case here for whether this is biological or cultural or both.) Habituating oneself to start and finish your sexual encounter in minutes (or less?) is unlikely to result in a satisfied partner. Watching porn together Okay, so watching porn as a side deal to your marital sex life is problematic. But what about when you watch together as a way of spicing things up, inspiring new ideas, or just sharing a pleasurable experience? Is that so bad? Yes. Again, I’m not denying that shared viewing time can be fun and pleasurable. But in the long run, I strongly believe that it does more harm than good, for the reasons I’ll describe below – and all this not to the exclusion of what I’ve already said above necessarily. Even when watching with one’s spouse for fun, it is not uncommon for folks to wish their partner had a body like the one they are seeing, or to wonder why their bodies and their partner’s bodies don’t seem to work like the ones on the screen. But even if a couple could realistically separate what they see from what they experience in real life, there are consequences to consider. It’s Hard to Erase a Mental Image Most people don’t like the idea of their partner imagining someone else while they are in the marital act. But getting those images of pristine, nude physiques out of your head is easier said than done. If sex is meant to be about deep emotional connection in addition to (or more than?) simple physical gratification, that goal will be seriously stymied by fantasies of other people in your mind and your spouse’s. The Harsh Reality There will forever be new porn stars gracing the screen, and they will always be young and attractive – whereas you and your partner are, without a shadow of a doubt, going to get older, fatter, and uglier. That’s just the way nature works, folks. How long can a person realistically be attracted to an aging partner’s body when they gorge their eyes on eternally youthful flesh? If you are using young, pert actors to stimulate your sexual desires, will you really be able to achieve the same effect by seeing a body that is 40 years old? Or 60? Or 80? Most people are hoping their marital sex life extends past twenty-something, after all. Indeed, a sexual relationship can last well into one’s senior years – but if partners are using porn to get turned on, that is a rather improbable outcome. The Danger of Novelty Likewise, if you are aiming to cultivate a lifelong sexual relationship with your spouse, you will need to put in the work to develop a sexual relationship that goes beyond “getting turned on” and grows into an interplay of physical, mental, and emotional factors. Seeking new images, new videos, new stimuli to keep a sexual spark alive is precisely the opposite direction of the path towards this lifelong endeavor. Sure, you will hopefully try new things in the bedroom from time to time, but if you need novelty to keep it up you will almost certainly find yourself looking for a novel person to get excited about as well. In Conclusion… Look, I know that pornography can be a lot of fun and even has its benefits. It’s exciting, it’s arousing, it feels good to watch. But I nonetheless contend that overall it is not a good thing for your marriage, especially if we are looking at the long-term picture (which, let’s face it, is ideally what we ought to be doing when it comes to the success of a marriage). I am not trying to throw cold water on anyone’s sex life here – I am trying to help make it happier, deeper, more satisfying, and longer lasting. And I maintain that porn will hamper all of that. Do you think otherwise? I’d be happy to hear from you in the comments below. And if you are struggling with pornography in your marriage (or on your own) consider reaching out to a couples counselor in Baltimore to find out how we can help! . Check out the followup post, Porn in Committed Relationships Revisited! See also the Gottmans’ take on this question, which largely agrees with what I’ve written here. . .

The past couple of posts have been addressing parents of adult children and discussing the family conflicts that are not uncommon in such relationships. Continuing on the theme, I’d like to touch on the issue of strained relationships between adult siblings. This is often a cause of great pain for older parents who feel their family is not as close or unified as they’d like. Of course, this pain is understandable. Nobody sets out to build a family its members don’t want to be part of. All parents expect and hope for some degree of cohesiveness, of unity for the families that they are creating. The sibling rivalry that starts when kids are little and sometimes continues through adulthood is seen as a threat to the integrity of the family unit, and parents often try to manage and contain it as quickly and definitively as possible. There are many reasons adults may decide to stop talking to their siblings. Old wounds from their childhood interactions are a major culprit, as are ongoing personality differences that cause friction. Often a major life event will lead to a break, such as a Thanksgiving dinner gone awry, or, regrettably, the death of a parent and the inheritance squabbles that can ensue. A discussion of dealing with sibling rivalry among younger children can and has taken up many volumes. But what about when they’re all grown up? You can’t separate them and send them to their rooms anymore (not that that was particularly effective for reducing the rivalry between siblings back then, either). How do you bring your kids closer together? The answer is, you don’t. Controlling, Meddling, Helping The sibling relationships among your children are simply not something you have control over. They are independent people – they were as children too, but now even more so – and deciding what relationships they should have and how they should look is well outside your purview. It may be deeply painful to watch your kids drift apart, or, worse, engaged in persistent conflict. But it is neither in your job description nor in your power to make things better. In fact, as you may have discovered, your inserting yourself in the middle of these relationships is prone to be met with rejection and anger. The relationship of brothers and sisters is between them, and, as saddening as it might be, not you. That is not to say that you can’t have any role here. One of the most helpful things you can do is to gently offer up the idea of family therapy for siblings (with or without you involved, depending on the situation) – and, in many cases, to offer to pay for it. Note that I said “gently offer up” – this does not mean that you should push them to do it, remind them multiple times, ask if they’ve thought about it since last you spoke, etc. Any meddling (or perceived meddling) in their relationship with each other is likely to be taken poorly. A large part of this is about letting go – again, it’s their relationship, not yours. The Reality of Family Conflict I once met with a family (details changed for confidentiality purposes) where the parents, in their sixties, were desperate for some peace in the family, in which their two daughters, in their thirties, simply could not get along, to the point of physical violence. The parents were able to convince them to come to family therapy, where I met with the four of them, and helped the parents understand how important it was for them to back off the pressure on their kids to make things work. Once that pressure was off, the two women were free to work out their relationship on their own terms. They didn’t. After our third session, there was an incident in which one of them made a snotty comment to the other, who took the bait, ignited a major argument, and they refused to come back to counseling. This was a major loss for all involved. Fortunately, the parents, recognizing that they could not fix this from the outside, were able to maintain their good relationships with each daughter independently, even though the family unit as a whole was terribly fractured. Had they tried to pressure their daughters on this issue further, they could have put the parent-child relationships at risk as well. The Hardest Part of Parenting Probably the most difficult aspect of parenting is the letting go. After putting in a couple of decades raising them as children, which include a long list of challenges that could easily contend for the Hardest Part of Parenting Award, many parents are surprised to find that nothing turns out to be quite as difficult as bowing out to let their children become adults. Keeping out of their business and out of their choices – even the ones that directly impact your family – can be excruciating. Dealing with that reality may be something a family therapist can help you sort through as well. But at the end of the day, trying to coerce others – even your own children – to love each other is a losing strategy. .

If you are in a relationship where your spouse or partner has cheated on you, you no doubt have a lot you are dealing with. Infidelity in a relationship can cause tremendous pain and conflict between partners. You are probably feeling sad, angry, confused, shocked, and more. One area of significant confusion for betrayed partners is whether to tell their parents or siblings about what’s happened. On the one hand, if you’re close with your family members, it seems crazy to withhold from them such a major event in your life. On the other hand, how will they look at your partner if you do tell them? How will they look at you? These are real questions, and there is no clear answer that is right for everyone. At the end of the day, the decision whether to tell your family is up to you. It is wise to consider the pros and cons before making such a choice. Pros include family support and helpful outside perspectives. Cons include the ramifications for the future of your relationship, and the possibility of getting “help” you don’t want, including pressure and judgment, from your loved on. Let’s take a deeper look at these considerations. Why are you telling your family about the infidelity? This is an important question to get clear for yourself before you disclose anything. Some people believe that their partner has done wrong and thus deserves to be exposed for what they are. If you are hoping to save and restore this relationship, then this approach will certainly take you in the opposite direction. You of course have every right to feel angry about what’s happened. However, trying to even the score, take revenge, or establish justice does not follow from that. This kind of reaction will deepen the wounds in the relationship and make it harder to heal for both of you. Being hurt by your partner does not give you the right to hurt them back, nor does it leave you feeling good in the long term. Note that even if you are not hoping to reconcile with your partner, seeking revenge is generally not a good way to get over things and move on. It may be sensible to tell your family why the relationship has ended rather then try to cover it up, but vengefulness generally does not lead to happiness. There are, however, other more compelling reasons to share with your family what’s happened – for example, if you are looking for support or advice. If you need help getting through this difficult time, it certainly makes sense to want to reach out to the people closest to you. It’s kind of like I tell my kids about telling on others: if you’re telling to get someone else in trouble, don’t do it. If you’re telling to get someone out of trouble, then you should do it. And what if you’ll get one person in trouble and one person out of trouble? You still tell. You need to protect the one who’s been hurt – and in this case, it’s you. Considerations on whether and whom to tell about the infidelity There are a number of pitfalls to be aware of when thinking about whether you can share this information and with whom. First, will this person have your best interests at heart? If your mother has always been the controlling type who tries to get you to follow her wishes, you may be on the receiving end of a lot of pressure if you choose to tell her. Consider whether the person you want to tell is really on your side. Likewise, ask yourself, is this person is objective? Or might they have some agenda? If your relative believes that divorce is a sin, you are probably not going to get objective advice from that relative. (However, if you also believe divorce is a sin and want counsel from that perspective, that may a fine person to discuss the issue with.) If they have a past history of infidelity themselves (whether as betrayer or betrayed), that could also impact how objective they can be with your situation. Is this person trustworthy? If you decide to open up to your sister about it, will your mom, cousin, and hairdresser also hear about it? Make sure you can trust your confidant before you talk about the affair with them. Does this person trust you? Will they respect whatever decisions you make in the end? You may ultimately choose to stay with your partner or to leave them. You need someone who will support you the way you need, not the way they need. If you want to work things out, you need a listening ear from someone who won’t pressure you to leave or put you down for wanting to stay. Likewise, if you decide to leave, you don’t want to feel pushback from someone who thinks divorce is out of the question or that it means failure. Finally, consider the long-term effect of sharing this information with a loved one. Will your parents ever be able to look at your spouse the same way in the future? You may succeed in going through a reconciliation process with your partner, but your relative may not. It takes a person with a lot of maturity and emotional awareness to be able to support you through this and then love and treat your partner the same as before when it’s all through. You don’t want your relative looking down on your partner for the rest of your lives once you’ve moved past this if they cannot. What do you need from your family? If you do have someone in your life you believe you can turn to with this problem, I encourage you to be clear with them about what you need. If you are looking for moral support but not advice, state this clearly. Everyone will have their own opinion about what you should do. You may or may not want to hear those opinions. If you don’t say what you need, you will probably have those opinions foisted upon you. It is okay to want emotional support without advice. You are not obligated to listen to someone’s ideas about how to solve this problem just because you share the problem with them. It is best to be clear about that up front if that feels right for you. For example, here’s a way you can present this: “Mom, I have something important to share with you. I am looking for some support here, and I am really not looking for advice right now. Would you be able to hear me out for a bit without giving me your opinion?” It can be incredibly frustrating and deflating to get unsolicited advice from someone who thinks they have the answer to what is inevitably a more complex situation than they can possibly understand from the outside. Being clear about what you’re looking for can help lower the possibility that that’s what you’ll hear. At the end of the day, whether to talk about your partner’s infidelity with your family is not a simple decision to make. Talking to an objective, confidential third party can be helpful when family is not an option for you. Or, if you’d like some help thinking through whether to share with your family, that’s a question a counselor can help you work out as well. Contact us if we can be of any help to you or your loved ones during what is certainly a difficult time. Read more about infidelity counseling in Baltimore.

If you’ve discovered that your partner has been having an affair, you may feel like your whole world has been rocked; your illusions have been shattered; your emotional life has been devastated. It is a heavy blow to bear, and for many people it spells the end of the relationship or marriage. (I want to jump to the end for a moment and just assure you that it doesn’t have to mean the end of the relationship. Recovery is possible. You may not see the path to that right now, but that’s okay. You don’t have to. I just wanted to put it out there that there are still choices.) One of the hardest questions a person asks themselves when they find out about their partner’s infidelity is, “can he cheat and still love me?” It is natural to assume and to feel that your partner must not love you if they could have done this to you. And yet, the real answer to this significant question is this: It is absolutely possible that your partner does love you, did love you before, and will continue to love you in the future. Infidelity does not mean that the love is gone or never existed. The reality is that you can love someone and still cheat on them. In fact, many affairs happen in relationships that are otherwise very happy. There does not need to be some kind of emotional lack or sexual dysfunction for someone to cheat on their partner (although certainly those factors can sometimes lead to affairs). I have worked with many couples where one of the partners cheated and yet it was clear that, apart from intense remorse, they still felt a great deal of love and care for their spouse. Get help now – whether or not your partner is on board How is it possible to cheat when you love your partner? First, let’s understand that the human mind is masterful at rationalizing just about anything. (In How To Win Friends and Influence People, Dale Carnegie quotes mobster Al Capone as saying, “I have spent the best years of my life giving people the lighter pleasures, helping them have a good time, and all I get is abuse, the existence of a hunted man.” Even his extensive involvement in organized crime is nothing that could not be justified to himself!) Perhaps you and I have never been part of the mafia. But certainly we’ve done things we know are wrong and rationalized it along the way. (“That scratch was probably on that car already. I barely touched it with my door…”) It is a natural part of the human experience. And when powerful feelings like love or lust are the motivator, it’s not hard to imagine that someone could rationalize away the pain they may at the same time be causing someone else. (I am not by any means condoning such behavior; I am just laying out that since this is something many normal people do, it is possible for cheating partners to do so as well.) Let’s also recognize that temptation is powerful. Even if your relationship is a happy one, nobody is immune to it. It is normal human functioning to be attracted to other humans, to want to connect to others emotionally and sexually. Marriage doesn’t mean that you suddenly stop feeling those things for the rest of your life; it just means that you take it upon yourself not to pursue them for the rest of your life. People in committed relationships don’t suddenly find everyone else unattractive. It takes work and discipline to continually refocus yourself towards your partner. When temptation comes around, the natural reaction is to feel the attraction. It is a conscious act that makes us turn away out of commitment to our partner. One who fails to do that may have transgressed the boundaries of the relationship, but it does not mean that the relationship wasn’t real to begin with. Love is not enough to stop the natural pull towards someone else – it takes forethought, grit, commitment, intellectual honesty – all kinds of qualities that can fail without it saying anything about the love that person feels towards you. And, just as it is possible to feel sexually attracted to more than one person, it is possible to feel loving feelings towards more than one person. Anyone who has more than one child can attest to this! You don’t stop loving your firstborn when child number 2 comes along; you just add to the love you feel. It’s no different when the other person is an adult – you don’t necessarily stop loving one adult just because another came along. Human experience has room for adding love without diminishing from what was already there. Relationship problems do sometimes lead to infidelity. All this is in a relationship with no major problems! Every relationship encounters bumps in the road. There’s no such thing as a relationship where the partners never disagree, never fight, never mess up and say the wrong thing. Even people in good, loving marriages can have big fights and low periods. Relational breaches like these can open up space for a third party to squeeze in between beloved partners. And certainly it is easy to grow apart as the years (or decades) go on, leading to feeling of emotional distance (which doesn't have to me you are “falling out of love"). That feeling of distance breeds vulnerability to the attention of and connection with someone else. We can be very much in love, but if you’re busy with your projects and I’m busy with mine, and I’m not getting much attention from you, then the advances of someone at work can be a lot more alluring. Sex & Cheating Then there is the obvious question of sexual issues in the relationship. I want to reemphasize that not every person who engages in extramarital sex is sexually unsatisfied in their marriage! People can be very happy with their sex life and still make the choice to cheat on their partner. This can happen for any number of reasons. It could be that the affair was primarily emotional and simply progressed to a physical relationship without real intent (“one thing led to another”). It could be that the straying partner got pulled in by the excitement of something new. (Esther Perel and others have written at length about the challenge of maintaining newness in a long-term relationship; an affair provides feelings and experiences that are difficult, if not impossible, to recreate in a secure and stable long-term relationship.) It could be that they simply felt attracted to both their spouse and the affair partner at the same time. It could be that the person has a sexual addiction and cannot be satisfied with any quantity of sex! Again, there are many explanations that do not involve the absence or disappearance of love for their partner. (And again, none of this is to excuse the choice a person makes to violate the commitment of monogamy to their partner.) All this said, yes, it is possible for someone to look elsewhere when sex is lacking or unsatisfying in their relationship. But this too is different from saying they couldn’t possibly love their partner. Two people can be very much in love but not be on the same page sexually and not know how to address that. (Couples counseling in Baltimore is a great way to gain the tools to deal with this kind of problem; sexual differences do not necessarily mean that two people are incompatible.) And a sexually frustrated partner who interacts daily with an attractive and interested coworker is at great risk for an affair. Now what? None of this takes away from the fact that a huge breach has occurred in your relationship. None of this means you shouldn’t be hurt, or that your partner isn’t responsible for the choices they made. Betrayal trauma is real. What it does mean is that it’s very possible that your partner does truly love you. It’s possible that they made a colossal mistake not out of a lack of feelings for you but for any of the abovementioned reasons and many others. And it’s possible to repair your relationship and reclaim a loving, meaningful connection, if you want to. I am sorry for the pain you are in right now. It can be overwhelming. But you don’t need to do this alone. Why risk letting things get worse? Get in touch with us to connect with an experienced infidelity counselor in Baltimore who can guide you through this mess, whether it’s on your own or as a couple. Love can still win out.