Rik Isensee, LCSW

Helping Gay Men Thrive!

What is Gay Positive Therapy?


Gay Positive Therapy

(also referred to as “gay affirmative therapy”) is an approach to therapy that acknowledges and validates your gay orientation, building on your strengths, not just what’s troubling you.

Some of my influences have included cognitive/behavioral therapy (CBT); Gestalt; emotional intelligence and the positive psychology movement; extensive training in Hakomi, a mindfulness-based approach to therapy; and various mindfulness teachers, retreats, and practices.

(Click on About Rik for more info about these influences.)

I often use a focused approach to practical goals in gay positive therapy; however, some issues lend themselves to a more open-ended exploration, where you can reflect on your life and clarify what’s really important to you. There may not be an immediate problem to solve, but you’d like to get a clearer sense of how you’re feeling and what you want out of life. The rest of this section provides an overview of my approach to individual therapy.

(For more info on Rik's approach to gay couples counseling, click on Gay Couples.)


I’ve divided my approach to gay positive therapy into the following sections:

Practical Goals

Overcoming Blocks

Mindfulness and Shifting Your Mood

Dealing with Ambivalence

Repetition Compulsion

Recovery from Self-Defeating Behavior

Major Life Changes

Creative Expression as a Tool for Growth

* Practical Goals

I like to start out with what brings you to therapy: What would you like to see different in your life? This focus on practical goals can help us keep track of our work together.

We’ll come up with some strategies to address your issues, including tasks you can work on during the week. If you’re able to follow through, that’s great!

Of course, change is not always that easy! Your attempts to change may stimulate unresolved thoughts and feelings from the past. Rather than punishing yourself for not following through, we try to discover what’s getting in your way.

* Overcoming Blocks

Therapy often involves making a connection between the past and the present. If you’re feeling blocked, we question whether some of the assumptions and conclusions you made when you were younger still make sense as an adult.

It’s helpful to think of the block, whatever it is, not as some internal enemy, but as a part of you that kept you safe in some way. It may be that as an adult, the conclusions you reached when you were younger no longer serve you. We can counter these negative beliefs with a more realistic assessment of your true abilities.

Anxiety and depression can also make it difficult to follow through on plans for change. Both of these conditions often respond well to cognitive therapy, but if not, an evaluation by a psychiatrist can help determine whether medication might be a useful adjunct to therapy.

Finding a sense of purpose can also help overcome malaise by motivating a creative engagement with the world.


* Mindfulness and Shifting Your Mood

I like to use a form of focused attention, or mindfulness, to gain access to underlying issues. This awareness can help you make contact with images, sensations, emotions, or even core beliefs that continue to shape your present experience.

Mindfulness also enhances an awareness of our natural unfolding. At the same time, we develop a greater sense of choice about where we’d rather hang out: in our previous conditioning, or in the awareness of the present moment?

By challenging the usual stories we tell ourselves, mindfulness can be a valuable adjunct to cognitive therapy, as well as validating the assumptions behind gay positive therapy.

Bringing awareness to the present moment with a gentle, curious, and nonjudgmental attention often stimulates a natural shift toward resolution, growth, and healing.

* Dealing with Ambivalence

Maybe you’re ambivalent about whether you really want to change! Rather than getting down on yourself, we can recognize the block’s protective function and acknowledge its legitimate concerns (such as: What am I getting myself into by taking on a new career, going back to school, or getting involved in another relationship?). Addressing these concerns may allow you to move forward. Gestalt dialog is a great method for uncovering the positive aspects of both sides of your ambivalence. By leading your through this experience, you may discover a genuine sense of what you really want.

* Repetition Compulsion

Some people find themselves caught in the same pattern over and over again—like falling in love with someone who’s not emotionally available. We look at where this pattern comes from: with this example, it may be an attempt to master a previous abandonment. Understanding this pattern doesn’t necessarily mean you won’t be attracted to unavailable partners, but you’ll be able to make a more conscious choice about whether to pursue them.

* Recovery from Self-Defeating Behavior

Well-stabilized recovery provides an opportunity for examining deeper issues in gay positive therapy.

In early recovery, when you stop using alcohol, drugs, sex, food, or debt to escape from feelings, your emotional life becomes much more accessible. You may feel worse before you feel better, so it helps to get re-acquainted with yourself when you’re no longer “self-medicating” to push feelings away. Recovery programs can help you make these initial connections, and reinforce your recovery by encouraging you to reach out for support.

I enjoy working with men whose substance recovery is well-stablized, which generally requires a year of sobriety and ongoing contact with a recovery support program. When early recovery is not yet stable, exploring deeper issues in therapy can be re-activating and put their recovery in jeopardy. If you're still using -- especially meth -- you might want to try a Harm Reduction program. In San Francisco, contact the Stonewall Project.


Mindfulness can also assist recovery by helping you:

* Recognize the initial impulse

* Expand the moment between impulse and behavior

* Get in touch with underlying feelings; and

* Make healthier and more conscious choices.

(Click on Reclaiming Your Life, for a guide to recovery from early abuse, homophobia, addictions, and self-defeating behavior.)

* Major Life Changes

With life-changing events, there may not be a particular problem to solve; you’re simply experiencing a significant shift in your life, and you’d like support to figure out what you want to do next.

Major losses, such as a break-up of a relationship, a job loss, a serious accident or illness, or the death of a significant person in your life can lead to a normal period of mourning. Such losses can also stimulate a re-evaluation of your current situation.

Good news can also be stressful–starting a new job or a new relationship, although exciting, often requires a lot of adjustments. A new phase of life, such as moving in together, midlife, or retirement, can lead to reconsidering your priorities.

(Click on Are You Ready for an engaging discussion with ten gay men who are dealing with changes at midlife.)

* Creative Expression as a Tool for Growth

We often think of creativity in terms of fine art, music, or literature. However, creative expression can also help facilitate the exploration of new interests and goals. Instead of judging your artistic talent, you can experiment with a sense of freedom, curiosity, and discovery.

Using guided imagery, spontaneous drawing, movement, and writing, you can unleash your imagination, get in touch with your deepest yearnings, and re-envision your future.


Obviously, any style of therapy needs to be adapted to your own circumstances. Feel free to contact me through Contact if you’d like to explore how Gay Positive Therapy might work for you!