I'm a psychotherapist at a dual diagnosis residential alcohol and drug treatment center in West Hollywood (WeHo).

We typically have a large population of gay male clients. Generally speaking, the gay men we see in our clinic are often severely traumatized and frequently use methamphetamine paired with habitual anonymous sex via hook up apps.

This trifecta of trauma, meth and sex addiction is really difficult.

It's chilling how fast these clients become activated and leave treatment, or relapse despite high motivation, even after doing really good work.

I consider myself a life long LGBTQ ally. I have spent a lot of time around gay men. I have worked for and with gay men for decades, and I have close friendships with gay men.

But I (and my colleagues) have struggled tremendously to help our clients with this particular profile e.g. trauma, meth and sex addiction (chem-sex).

First off.

Methamphetamine.

It's an awful drug.

Overdriving dopaminergic systems up-regulates craving/wanting systems in the brain (ventral regimental area), down regulates areas responsible for 'liking' (nucleus accumbans), up regulates the memory encoding processes (hypocampus) and disables executive function (pre frontal cortex).

So. In a nut shell, you want the drugs more, you like them (and everything else) less, everything associated with the drugs are a trigger and you can't say no.

And when you add unlimited, anonymous, internet delivered sexual encounters to the mix. It's a perfect storm.

All that aside, I have struggled to help my gay male clients in general. I frequently find it difficult to conceptualize their cases and I often get the sense that I am missing something important from my experience and training.

I'm not alone.

I have witnessed colleges doing what seemed to be real damage to some of our gay male clients by inadvertently invalidating them and abandoning them when they protest.

Its like everyone in the therapeutic system, the clients and the clinicians, all get caught in this awful recapitulation of some other, larger, very wounding dynamic, despite our best intentions to help, and despite their best intentions to seek help and recover.

This book is an answer to my prayers (I don't actually pray but you get what I mean).

It's been so helpful to have author Joe Kort systematically explain the biological, psychological, social and epistemic factors that contribute to gay male and lesbian trauma, depression and relational difficulties.

Additionally he maps out how therapy can be either affirming or invalidating and wounding for gay men and women, and posits a model for gay affirmative therapy (GAT).

All I can say is that this is an important book for all therapists to read.

My only criticism is that the title may be off putting to many gay and lesbian readers.

I think many of my gay male and lesbian colleagues, and clients could benefit from reading this material.

It's incredibly eye opening and normalizing.

Thank you Joe Kort.