Providing Couples Therapy to Same-Sex Couples


Couples therapy can be a challenging event for both the couple…and the therapist. Often, when a couple has decided to engage in therapy, they have come to a place where they feel lost in the relationship, or have entered a space where they can no longer see, as I call it, “the light” in the relationship.


Clinical Depression and Psychotropic Drugs

Too many misinformed opinions about this topic out there leads to tragedy or poor quality of life for too many people.

Clinical depression is a mood disorder category. It is not a character or personal weakness. Within that category there are the Depressive Disorders. The Depressive Disorders include Major Depressive Disorder (MDD) and Dysthymic Disorder (DD). MDD includes single, recurrent, melancholic, atypical or seasonal subcategories. DD includes early or late onset categories.

Dysthymia is a less severe, chronic form of depression. It is often referred to as mild depression. It usually has an early onset before adulthood, however late onsets do occur. This form of depression does require treatment because if left untreated it can develop into a double depression which would include a major depressive episode. Psychotherapy and low dose antidepressant medication, along with lifestyle changes can help resolve the symptoms and bring on remission.

MDD, also known as major depression, is a much more severe form of clinical depression that also requires psychotherapy and usually antidepressant medications with higher doses. Diet, lifestyle and environmental changes can also provide relief of symptoms and remission along with clinical treatment.

Clinical depression can be caused by medical problems. It is always best to rule out this possibility by having a health examination performed to check for nutritional problems, thyroid problems, or other medical conditions. If there are no medical issues found, then the depression is likely caused by a combination of biological and environmental conditions (Preston & Johnson, 2012).

Symptoms of clinical depression include negative rumination, irritability, loss of feelings of pleasure, inappropriate feelings of guilt, extreme sadness and a profound sense of emptiness, among others.  Antidepressant medication and cognitive behavior therapy used together has shown to be an effective treatment for clinical depression. The medication helps relieve the symptoms so that the talk therapy can be effective.

There is still too much unfounded and learned stigma associated with antidepressants as well as with psychotherapy. As people become better educated about these medications and therapies, it becomes less of a stigma. The more that people understand that clinical depression is based on neuroscience, and therefore its treatment is more effective most of the times when approached from a combination of a psychological and medical perspective, the less stigma will play a role in diagnoses and treatment. It is important to note that physiological symptoms of clinical depression must be present in order to consider medication as part of the treatment. Some of these symptoms include unexplained weight loss or gain, fatigue, insomnia or oversleeping. Substance use and abuse must also be eliminated as a possible cause of the depression.

Although the medication typically takes between two to four weeks to take effect, it is important to remain on the medication for at least six months in order to ensure recovery and prevent relapse. Dysthymia does not always present with the acute symptoms that major depressive disorder does, but it can be just as debilitating in time. People who live with Dysthymia continue with their day to day life, unlike major depression which can be debilitating and cause individuals to isolate, shut down and withdraw completely from society. However, life can still feel difficult to someone with symptoms of Dysthymia.  


Preston, J. & Johnson, J. (2012). Clinical psychopharmacology made ridiculously simple (7th edition). Miami, FL: MedMaster, Inc.

Schatzberg, A.F., Cole, J.O., & DeBattista, C. (2010). Manual of clinical psychopharmacology (7th ed.). Washington, DC: American Psychiatric Publishing, Inc.

Medscape  References by WedMD (2012). Retrieved March 22, 2012 from

Follow Xiomara A. Sosa on Twitter @XiomaraASosa

Xiomara A. Sosa, NCC, LPC-I (application pending), is a National Certified Counselor, a Licensed Professional Counselor-Intern (application pending), a Clinical Mental Health – Forensic Counselor and a freelance writer based out of the Charleston, SC and Miami, FL metropolitan areas. Xiomara is passionate about integrative mental healthcare and holistic wellness and social change advocacy. Xiomara holds a Bachelor of Science in psychology from the University of Phoenix and a Master of Science in clinical mental health counseling with a specialization in forensic counseling from Walden University (CACREP accredited). She is currently a doctoral/PhD student for human services with a specialization in public health at Walden University. Xiomara is committed to helping people lead healthy lives. She is the founder and principal of her private practice, XAS Consulting, LLC, where she practices a progressive, innovative path to integrative mental healthcare and holistic wellness by combining psychological health, mental health, forensics, physical health, social services and public health. She is also the founder of The Get-Right! Organization, Inc., a social change advocacy nonprofit organization, whose mission is to educate families, teach children, and support communities about mental health and physical health. She is also the founder, president and CEO of You Are Strong! Center on Veterans Health and Human Services, Inc., a social change advocacy nonprofit organization, whose mission is to combat stigma and provide information about health and human services to veterans and their families.

VIDEO: Veterana Apoya la Salud Mental de la Comunidad Hispana

Veterana Apoya la Salud Mental de la Comunidad Hispana

Xiomara A. Sosa, Psicóloga, Consejera Forense y veterana militar es entrevistada por Lorena Mora-Mowry desde Charleston, Carolina del Sur via Skype para conocer sobre cómo apoya con sus dos organizaciones sin fines de lucro a la comunidad hispana en especial a los veteranos y a la comunidad LGBTQQIA.

Xiomara A. Sosa es Clinical Mental Health – Forensic Counselor, tiene un B.S en Psicología, un M.S., Clinical Mental Health – Forensic Counseling y actualmente está haciendo su Ph.D., en Human Services – Public Health.

Para Xiomara A. Sosa: “Hay mucha necesidad para los veteranos y a los que no han ido a la guerra porque tienen experiencias que los cambian. Estar en la armada es muy diferente a los que tienen una vida normal. Cuando se entra a la vida civil se tiene que adaptar y esa adaptación necesita soporte y ahí es donde viene el problema especialmente con los veteranos que han ido a sitios y han visto cosas que normalmente no se ven en los Estados Unidos. Ellos vienen cambiados, no necesariamente traumatizados, pero han visto cosas que pueden en un futuro causar trauma porque han visto cosas que los han cambiado y tienen que PROCESARLO, tienen que HABLARLO y tienen que tener una COMUNIDAD que los apoye, una FAMILIA que los entienda porque de ahí vienen divorcios y muchos problemas. Ese soporte, esa conexión es la que yo trato de educar, informar, enseñar a la comunidad que deben estar preparados para cuando ellos regresen…” –

Effecting Positive Social Change: Ferguson

Personal disclosure: I come from a family of law enforcement officers and black and white members of society.

I am a social change advocate. Yesterday was a dark day for the social change community. It is a dark day for law enforcement officers who want to do the right thing and are now living under the dark shadow of yesterday. It is also a dark day for the majority of the black community who is also now living under the darkness of yesterday yet is trying to do the right thing. But there is hope that enough people on both sides will make the positive social change necessary as a result.

The only way to truly effect positive social change is to change the system itself. We must pursue positions of power within the system where we are not proportionally represented so that institutional discrimination and culturally based bias is put into proper perspective with the reality that exists. We must balance our systems to accurately and fairly represent who they serve.  Just because something is lawful does not mean there is justice.

What we see happening on a local level is a mimicking of what is going on at the highest level of power. When we have so many grown-up white men publicly, viciously and purposely spewing their biased vitriol at the black leader of the free world, what are we to expect white men with lesser power to do to black men with no power on a street level? What do we expect those systems to operate like when we have our highest systems, the House of Representatives, state governments, the media, etc., acting as they do?

Law enforcement officers are not the ones with the real power. They are tasked to enforce laws made and implemented by systems out of their control. Changing the system and replacing those in the position of power within law enforcement is what will effect social change.

Just as rape culture within our higher education and military systems will not change until the individuals with the power to change that culture are replaced. The students, soldiers, marines, etc., are not the ones with the power to change those cultures.

The institutional discrimination and religious and culture based bias that lead to creating hostile and dangerous encounters for the gay community will not change until we change the system and replace the hostile leaders with leaders who promote equality and justice for that community.

Those of us, who are educated, trained and experienced in human behavior and reaction, have our own evidence-based perspective on why the protests, looting, burning, and violent responses to injustice is foreseeable. It is not justifiable, however it is foreseeable. It is human nature. Those who are educated trained and experienced in enforcing the law have their perspective. Both perspectives are equally valid and should be honored and respected.

The Ferguson Police Department is in dire need of an Industrial Psychologist to make the changes it must make at its most fundamental level. Most police departments are. Most institutions are.

It is also predictable that the people who are too uncomfortable with the disturbing precipitating event that caused the looting and burning will focus only on the looting and burning. They will not put the equal amount of attention, judgment and disgust into the precipitating event to the looting and burning. They will instead focus on the looting and the burning now, because it is too uncomfortable for them to focus on the events that lead up to and directly caused the effect they are now unhappy about. Those people will continue to focus on the burning and the looting rather than the precipitating event, rather than trying to understand it without judgment. That is human nature. That is the epitome of bias.

Xiomara A.  Sosa, NCC, LPC-I

BS, MS, PhD student