When Willpower Isn’t the Problem: How Therapy Helps With Substance Use

When it comes to problematic substance use, most people sit in my office and say some version of, “I know I should just stop.” If only it were that simple. Substance use isn’t a moral failure or a motivation problem—it’s a coping strategy that’s become unhealthy. For a time it was doing a job, often quite efficiently, until it wasn’t. Talk therapy helps you identify that job, meet the need more safely, and rebuild real choice—whether your goal is cutting back or pursuing abstinence.

Substances Have a Job. Find It Before You Fire It.

Alcohol, weed, pills, cocaine—each tends to “work” for something: numbing grief, quieting anxiety, easing social pressure, turning down intrusive thoughts, or interrupting loneliness. When we treat use like pure bad behavior, we miss the function. In therapy, we map patterns: What’s happening right before the urge? What relief does the substance deliver? What’s the cost—now and later? Naming the job gives us leverage to meet the same need with fewer consequences.

Don’t start with “stop.” Start with “what is this doing for me?”

Harm Reduction Isn’t Giving Up—It’s Getting Safe Enough to Change

Harm reduction is a compassionate and practical approach to managing substance use or risky behaviors. Instead of insisting on complete abstinence, harm reduction focuses on making these behaviors safer and reducing potential harm, supporting you in progressing at your own pace. It recognizes that for many people, an all-or-nothing mindset can feel overwhelming or unattainable, so it provides a middle ground where safety takes precedence.

This approach includes strategies such as planning for safer use by choosing cleaner substances or using measuring tools, reducing dosing by spacing out consumption or lowering amounts, and changing the environment to safer settings or using with trusted people. Adding food and water helps your body process substances better and can lessen negative effects. Tracking triggers and patterns can help you identify situations or feelings that lead to risky behaviors, so you can develop ways to manage or avoid those triggers. Preparing exit strategies, such as having a safe place to go or someone to contact during cravings or emergencies, adds another layer of safety. Engaging support from medical professionals, counselors, or support groups is also essential, especially when managing withdrawal symptoms or overdose risks.

Harm reduction is rooted in the belief that safety is non-negotiable, but recovery is a gradual process built on compassionate care and trust. It provides a stable foundation, allowing you to make responsible, incremental changes when you're ready, rather than cycling through an all-or-nothing mindset.

Many people find themselves trapped in this pattern of “nothing-then-all,” but harm reduction offers a middle path. This includes planning for safer use, delaying or lowering doses, changing environments, staying hydrated and nourished, tracking triggers, and preparing exit strategies for when cravings hit. It also involves coordinating with medical providers to manage withdrawal risks and ensure safety. 

My background in addiction work is firmly rooted in harm reduction principles, and I bring this perspective into my work as a therapist. I am experienced in supporting individuals at all stages of their recovery, emphasizing steady progress at your own pace while always prioritizing your safety, well-being, and personal growth.

For Loved Ones: Boundaries Are a Form of Care

Partners and family often carry frustration, fear, grief, and guilt. Supporting someone doesn’t mean shrinking your life or doing the work for them. In therapy, we clarify boundaries (“I’m willing to drive you to appointments; I’m not willing to fund your use”), replace lectures with requests, and learn how to step out of power struggles with the substance. You can protect your well-being while staying connected; those aren’t opposites.

Try This Week (Small, Doable Experiments)

• The 10-Minute Delay: When an urge hits, set a timer for 10 minutes and do one neutral action (shower, short walk, text a friend). Re-evaluate after.

• Trigger Map: Write down the top three “when/where/with whom” patterns. Pick one to tweak this week (change time, place, or people).

• If-Then Plan: “If I feel the 4–7 pm slump, then I’ll eat, drink water, and text __ before deciding.”

• Use Log (No Judgment): Track what, when, how much, and how you felt before/after for seven days. Patterns beat hunches.

• Boundary Script (for loved ones): “I care about you. I’m willing to __. I’m not willing to __. If __ happens, I’ll __. I’m here when you want support.”

Substance use thrives in secrecy and shame. Therapy offers a steady, non-judgmental place to tell the truth, reduce harm, and build the skills and structures that make change durable—whether that means drinking/using less, stopping altogether, or learning new ways to cope with pain, stress, or mental health challenges. If this perspective resonates, I work with individuals and with partners/families navigating a loved one’s use.

This article is for general information and isn’t a substitute for medical or mental-health care. Alcohol, benzodiazepine, and opioid withdrawal can be dangerous—consult a clinician. If you’re in crisis, call 988 in the U.S. or your local emergency number

You’re Not Doing Grief “Wrong”: What Talk Therapy Can Do in Times of Mourning

In the first session after a loss, people often apologize—for crying, for not crying, for forgetting words, for remembering too much. Grief isn’t a problem to fix; it’s a bond to carry. Talk therapy doesn’t erase grief. It helps you survive it, honestly – and still make room for love and meaning alongside pain.

Grief Is Not Linear—It’s Layered

You’re not only grieving a person or a diagnosis; you’re grieving secondary losses: routines, roles, future plans, a version of yourself. When we name those layers, your pain becomes more understandable and manageable. In sessions, we slow down the “shoulds” (I should be over it / I should be crying more/less) and replace them with permissions (I’m allowed to feel anger, relief, numbness, longing—sometimes all in an hour).

The Body Grieves, Too

Grief is physical: it manifests as brain fog, chest tightness, fatigue, and appetite swings. We stabilize the basics—sleep cues, sunlight, hydration, gentle movement—so your nervous system isn’t fighting on every front. My background in oncology social work also means I’m attuned to medical grief: scans, side effects, waiting rooms, and ambiguous outcomes. We create routines and language for appointments and family updates so the process feels less dehumanizing.

Meaning Emerges; It’s Not Assigned

Rituals (a weekly walk, a candle, a song), objects, and stories keep the connection alive without pretending the loss didn’t happen. In individual or group work, we practice “continuing bonds”—ways to stay in relationship with what was lost—while also reclaiming pieces of life that still want your attention. We move gently around guilt, anger, or relief; all are common travelers in grief.

Let meaning arrive on its own timeline. Your job is to make space, not manufacture answers.

You don’t have to carry this alone. Therapy offers a steady witness, practical scaffolding, and a place where nothing about your grief is “too much.” If this approach resonates, I offer confidential, affirming support (individual and groups)—in NYC and virtually for New Yorkers.

This article is for general information and isn’t a substitute for medical or mental-health care. If you’re in crisis, call 988 in the U.S. or your local emergency number.

Curiosity Over Performance: What Sex-Positive Therapy Really Means

Last week, three different people apologized to me before they even sat down. One worried they were “behind” in their sex life, another felt broken because desire had gone missing, and a third whispered a question they’d never said out loud. The common thread wasn’t their specific story—it was the shame they carried for having one.

Here’s my stance: sex-positive therapy isn’t about saying yes to everything; it’s about removing shame so you can choose what you actually want. Skills matter, education matters, and sometimes treatment matters—but none of it sticks if judgment is running the show.

Shame Is Louder Than Desire

We’re taught to treat sex like a performance review. Are you having enough? With the “right” person? In the “right” way? That scorekeeping turns curiosity into anxiety and intimacy into self-monitoring.

In the room, I see this all the time: people try to “fix” a symptom (low desire, difficulty with arousal or orgasm, pain) without addressing the climate around it—fear of conflict, people-pleasing, cultural or religious scripts, trauma, or simply a nervous system that’s learned to brace. When we slow down and put shame on the table, pressure drops and information rises. Desire is quieter than shame; you have to make enough quiet to hear it.

Takeaway: If sex feels like a test, you’re grading, not relating. Trade evaluation for observation.

Labels Help—Until They Trap Us

I work with folks across the LGBTQIA+ spectrum and with many who are questioning or expanding identity. Labels can be liberating; they offer language, community, and relief. But a label that was once a doorway can become a rule book if we forget it’s descriptive, not prescriptive.

The same goes for diagnosis. “Dysfunction” can sound like a verdict when it’s really a cluster of solvable problems—some medical, some relational, some nervous-system-based. Sex-positive work doesn’t erase labels; it right-sizes them. You’re allowed to evolve. You’re allowed to be fluid. You’re allowed to be consistent.

 Safety First, Then Techniques

People often ask for “tools.” Tools are useful—breathwork, scheduling intimacy,, communication frameworks, pelvic floor referrals, values mapping. But tools without safety become another way to “do it right.”

Safety isn’t a vibe; it’s a set of agreements: we move at the speed of consent, we honor boundaries without pouting, we welcome no’s, we repair when we miss each other, and we keep private things private. In that container, techniques create learning instead of pressure. Outside of it, techniques can feel like homework you’re failing. Techniques work when your body believes you’re safe. Build the container before the curriculum.

Allyship Is a Practice, Not a Badge

I have a long history of allyship with LGBTQIA+ clients and communities, and I keep learning—because allyship is ongoing work, not an identity. It means I expect to be corrected, I update my language, and I don’t assume your experiences from my perspective. A truly sex-positive space is inclusive by design, not by exception.

When people tell me they’ve felt judged, pathologized, or fetishized in previous care, I take that seriously. Affirming care isn’t “I won’t judge you.” It’s “I will advocate for your agency, dignity, and joy—and we will name the systems that made this harder than it needed to be.”

Embracing Sex-Positivity…final thoughts

Sex-positive therapy, at its core, is an invitation to tell the truth without punishing yourself for it. It makes room for the full range of sexual experiences—curiosity, ambivalence, exuberance, tenderness, grief—and treats them as data, not defects. If you’ve only ever known sex as a place to perform or prove, there’s another way to relate: slower, kinder, more honest, and ultimately more satisfying.

Quick Experiments to Try This Week

• Swap goals: Replace “I should want more” with “I want to learn how my desire actually works.”

• De-performance a moment: Choose one encounter to be exploratory, not evaluative. No goals; just notice.

• Practice a boundary: Write (and say) one sentence you’ve been avoiding: “I’m not into that,” or “I want to go slower.”

• Upgrade consent: Ask, “What would make this feel safer or freer for you?” Then listen like the answer is gold.

• De-shame your questions: Write them down as if you were asking a doctor who’s unshockable. Bring them to therapy—or answer one for yourself with compassion.
  

  This article is for general information and is not a substitute for medical or mental-health care.