What Therapists Should Know About Sexual Health, Monkey Pox, and the Echoes of the AIDS Epidemic: An Interview with Mallory Garrett, LMFT

Curt and Katie interview Mallory Garrett about sexual health as well as the current concerns related to Monkey Pox. We discuss what therapists usually get wrong when working with sexual health, what therapists need to know about STIs, as well as Monkey Pox. We talk about the relevant history of the HIV/AIDs epidemic and the community responses to Monkey Pox. We also look at how therapists can be most helpful to clients within our scope of practice. Resources to stay up to date with Monkey Pox and sexual health are also included in the show notes.

Transcript

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An Interview with Mallory Garrett, LMFT

Mallory Garrett is a licensed Marriage and Family Therapist in California and New York. She graduated with a BA in Comparative Literature from UCLA and an MS in Counseling from CSU-Northridge. She began working in the social services sector as a Resident Services Intern with a low-income housing corporation for people living with HIV/AIDS and other chronic health conditions. She continued working in this field during her traineeship and internships as she worked towards licensure. She loves speaking to therapists about destigmatizing HIV/AIDS and STIs and has co-facilitated a workshop through Simple Practice Learning. When not working she enjoys going to the theater and traveling.

In this podcast episode, we talk about sexual health and sexually transmitted infections (STIs)

We talk about sexual health broadly as well as the recent concerns about Monkey Pox and the historical context of HIV/AIDs.

What do therapists get wrong when working with sexual health?

• Lack of education, or education that solely focuses on reproduction
• Fear about scope of practice when addressing folks who are being treated medically
• Lack of understanding and exploration of libido mismatches
• Downplaying the importance of sex in our clients’ lives
• The moralistic or puritanical nature of how many people approach sex

What do therapists need to know about sexual health, STIs, and Monkey Pox?

• Monkey Pox is not technically a STI, but is primarily transmitted sexually in the US
• The stigma and concerns of being ignored, especially from those who lived through the HIV/AIDS epidemic
• Gay Rights and Sexual Liberation has relevance to these diseases
• The extreme societal bias toward the gay community during that time, medical neglect
• The emergence of Monkey Pox brought back the fears, stigma, and neglect

How can therapists help therapists have discussions related to Monkey Pox or STIs?

• Approaching sexually transmitted infections with a harm reduction lens
• Empowering clients to make decisions
• Referring folks to their local public health department for information on vaccination

What is Monkey Pox?

• Monkey Pox does not seem to be spread asymptomatically
• The lesions are very painful and are the primary reason for hospitalization
• Primarily being spread through close intimate contact by men who have sex with men
• Monkey Pox is typically not fatal, but there are two different strains with different fatality rates

How do therapists support folks who have Monkey Pox?

• Push back against judgment and shame, checking own bias
• Meeting clients where they are
• Decreasing isolation through virtual sessions
• Understanding the pain related to the lesions, as well as the potential disfigurement

How can therapists stay up to date on sexual health issues, including Monkey Pox?

• Follow CDC and WHO online
• Follow AIDS activists who are following Monkey Pox
• Scroll down for links from Mallory

Why is it important for therapists to step into advocacy for our patients?

• Providing empathy and compassion regardless of our medical understanding
• Doctors and other medical providers are not perfect, so it is important for clients to have good questions and feel empowered
• Encouraging folks with lived experiences to sit at the table when policy decisions are being made

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client’s insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don’t need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code ‘moderntherapists’ for 1 month of no credit card fees or payment processing fees! That’s right – you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Mallory’s website:  https://www.mallorygarrett.com

Mallory’s twitter: https://twitter.com/nomad_therapist

Mallory’s course on SimplePractice: HIV & AIDS Awareness for Mental Health Providers

Mallory’s recommendations for staying up to date on sexual health issues:

https://twitter.com/dr_demetre

https://twitter.com/CDCgov

https://twitter.com/benryanwriter

https://twitter.com/WHO

https://twitter.com/peterstaley

https://youtube.com/c/MamaDoctorJones

Relevant Episodes of MTSG Podcast:

Understanding Polyamory: An interview with Dana McNeil, LMFT

Sex and Shame: An interview with Eliza Boquin, LMFT

Let’s Talk About Sex: An interview with Liz Dube, LMFT

Managing Chronic Pain and Illness: An interview with Daniela Paolone, LMFT

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm 0:00
This episode of the Modern Therapist’s Survival Guide is brought to you by Thrizer.

Katie Vernoy 0:03
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don’t have to give up your rates they charge a standard 3% processing fee.

Curt Widhalm 0:23
Listen at the end of the episode for more information on a special offer from Thrizer.

Announcer 0:28
You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm, and Katie Vernoy.

Curt Widhalm 0:44
Welcome back modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists where we talk about the things that are going on in the world, the things that we talked about with our clients. And we are joined by one of our longtime listeners, I remember being at a conference several years ago, and…

Katie Vernoy 1:03
Oh my gosh! Me too!

Curt Widhalm 1:05
…possibly one of the first situations where somebody came up and was like, Oh, my God, it’s Curt and Katie.

Katie Vernoy 1:11
That was so cool.

Curt Widhalm 1:13
And somehow we didn’t scare her off. And she continues to listen and offer her expertise on the show. So we are very thankful to be joined today by Mallory Garrett LMFT, in both California and New York, talking today about sexual health. So thank you very much for joining us.

Mallory Garrett 1:33
Thank you for having me.

Katie Vernoy 1:35
We’re so excited to have you here. It’s always fun to have friends of the show on when, and able to share their expertise. So as you know, the first question we ask everyone is Who are you? And what are you putting out into the world?

Mallory Garrett 1:47
So I am a licensed Marriage and Family Therapist in New York and California. As a therapist, I definitely want to put out in the world that I always look for fairness and self empowerment. Something I strive for in my social life and my therapy world is to help people find their empowerment in themselves, achieve fairness, and equity. That’s what I hope I’m putting out in my work and my personal life.

Curt Widhalm 2:12
As an educator, one of the things that I talk with a lot of students about, talk with a lot of associates about, once people are out of school, as far as you know, what seemed to be most missing from your education criteria. And the top answer no matter what cohort, or what school I’m talking about, is how inadequate the sex and sexuality class is. And oftentimes, it’s described as we spent half the semester talking about body parts. And then we talk about half the semester about body parts gone wrong, and we don’t really get into any of the sexual health sort of stuff. And so what I imagined that that leaves many clinicians with is just kind of making it up on their own and passing on all sorts of either half truths or personal experiences. But you know, that we start a lot of our episodes with like, what do therapist usually get wrong about sexual health in the way that they work with clients? So that way, we’ve got a space to move towards the positive here.

Mallory Garrett 3:17
Yeah, no, absolutely. And I don’t I don’t think therapists are always wrong about sexual health. I mean, especially now, I think the dialogue has really shifted and more therapists realize that they may not have been informed as much about sex and sexuality, and sexual health in their graduate programs and throughout life. So a lot of sex education that we get throughout life is reproductive biology. It’s really just about how babies are created, and maybe some STIs are thrown in there as well. But a lot of it’s really centered around reproduction. A very small percentage of sexual activity involves reproduction, or even for reproductive purposes. So we’re one of the very few species that have sex for fun. And I think that’s what makes humans unique. And obvi, there are some species that have sex for fun, but for the most part, humans are the primary primates that have sex for fun. And a matter of fact, a lot of people’s sex lives are trying to not reproduce, and avoid reproduction. So it’s interesting that that’s where we focus in our education. But that’s not why people are having sex with for the most part. I think a lot of therapists what they get wrong about sexual health that they think it’s out of their scope of practice. I remember when I first started working in HIV care, and I would bring cases when I was in graduate school, and a lot of my cohort would say things like, Well, why are you even talking to clients about HIV? Or why are you even talking to them about their medication? That’s out of your scope of practice? And I’m like, Yes, it is out of my scope of practice to talk about the exact medications they’re on and side effects and et cetera. But it isn’t out of my scope of practice to explore with them about what they’re experiencing on their medication, how they feel taking their medication, how to talk to their doctor about that. So I think that’s where a lot of folks, we think that it’s out of our scope. And I also think that therapists sometimes don’t see, and of course, not all, but some, that sex isn’t important to someone’s life. That we see it is more of a symptom than it is. It can be a symptom of a problem more than it can actually be a problem or a benefit in someone’s life. So I think that often times we downplay sex.

Katie Vernoy 5:29
I’m so curious, I want to dig into that a little bit more about us downplaying sex. What do you mean?

Mallory Garrett 5:36
So I think that sometimes, you know, when a couple come in, for example, or when you’re working with someone who is in a mismatched libido relationship, oftentimes we look at it and say, well, the long term relationship is not about sex, it shouldn’t be about sex. It’s about other things. It’s about, you know, companionship, and friendship and mutual respect for your partner. And those are definitely important. And those are the cornerstones of a relationship. But sex is also a cornerstone of a relationship. I mean, what’s the difference really, between a friend and a romantic partner, it’s the sexual connection. So while some people can have a loving and wonderful companionate relationship where they don’t have sex and or an active sex life. That has to really be consensual, and for both parties, they both have to want that. Otherwise, sex is a problem. And I think therapists are sometimes scared to acknowledge that. And I think clients are also scared to acknowledge that in their own life, because sometimes they feel like if I come in and say, sex with my partner is not good. We’re not sexually compatible, but I love them. That they’re going to be shamed for that. Almost like, Well, you’re not a good partner, because you’re prioritizing sex. But sex is important. So I think that we often downplay its importance in someone’s life.

Katie Vernoy 6:50
When you’re describing this, it sounds like there is this kind of moralistic bias in our education. We’re only taught about reproduction. Sex is for making babies, which, as you said, largely is not true. And then there’s this other element of us feeling like it’s out of our scope. So we’re not even approaching the real depth of the conversation. And then further, we’re not actually looking at it as a primary issue for discussion. And so to me, it seems like when something comes up in sexual health, especially if we’re not up to date, or if we’re not, you know, actually confident in talking about it, we could completely blow over the importance of STIs, or other sexual health concerns. And so to me, it’s hard to think about how therapists could get this right, if they haven’t really been staying up to date on things.

Mallory Garrett 7:40
Absolutely. And I think that’s why it’s important to have tools in your toolbox as a therapist to stay up to date on those issues. And I know sex is very uncomfortable to talk about. I mean, I talk about it a lot with clients, and even I feel uncomfortable. And you know, especially if a client doesn’t bring it up. But if I’m noticing something or some pattern in their life is coming up, it’s hard to ask those questions about sex and sexuality. You know, I’m not shaming therapists for not asking or thinking of that, because I understand that especially in our society, we’re all living in a very puritanical culture, and sex of varying degrees. And sex and sexuality are often not talked about just in life, like I said, with reproduction is often the focus when that’s such a small part. I mean, I was very lucky to have a mom who was a nurse. And so when I asked her where babies came from, she told me and with my nieces now, you know, my nieces are five and seven. And they will ask us questions, my sister and I, you know, questions about like, Where do babies come from. Of course, I talked to my sister about how she wants to approach that because they’re her children. But she’s like, we use the name for body part. If they’re having an issue, we use the name for that body part. We don’t mince words with that. And we have the honest conversations that are age appropriate. So you know, we don’t go into too much detail, but we let them know the gist of how babies are born, starting with reproduction. And then obviously, as they get older, I hope that they can ask us questions about other issues as well, that we’ll have to put our own discomfort aside and have that conversation. But with our clients too, I think it’s important to put our own discomfort aside and also acknowledge, like I’m gonna ask you a question that might be very uncomfortable. You free to not answer that question if it’s uncomfortable. Like give them that option. Let them know that it’s awkward.

Curt Widhalm 9:31
So, we’ve done a couple of podcast episodes in the past with sex therapists and that kind of stuff, and I want to steer this podcast maybe a little bit more specific and even a little bit more of what’s going on in the world right now. And some of the ways that staying up with even just some of the sexual health topics and you know, this is been even, you know, just kind of, you know, alright, yay, sex sort of things. In particular, for you and your background, you have a good background at working with HIV, you had reached out to us about talking about monkey pox as well and kind of where this fits in some of these sexual health discussions and how those conversations get navigated. Because, you know, one thing when it’s like, alright, libidos aren’t matching up, it’s another thing when we have, you know, very prominent STIs that are existing out in the world and the effects that that has with clients.

Mallory Garrett 10:33
Yeah, no, absolutely. And I mean, monkeypox isn’t technically being classified as an STI, because it can be transmitted through other modes of contact. But right now, especially in the US, and that’s obviously what I would focus on is the United States. Because internationally, there are other issues to take into account. But in the United States, specifically, it is being sexually transmitted as its primary mode of transmission. So monkey pox has brought up a lot of issues in the culture about stigma and STI stigma. I really think it’s reignited that conversation that has been laying a little dormant since the beginnings of the HIV epidemic. But yeah, so I was noticing it in my colleagues and in my work setting, and even amongst my clients how they were talking about monkey pox as it was emerging in the news. And it’s hard to because we just came out of this. Well, we’re still in it. This other pandemic…

Katie Vernoy 11:26
Yeah.

Mallory Garrett 11:26
…of COVID. And it’s like, I was hearing a lot of pandemic fatigue from, especially my younger clients about like, Another thing to be worried about, you know, I’m just starting to get out there, just starting to date, just starting to have sex. And I have to worry about monkeypox. And then from my older clients, especially clients who’ve been living with HIV, maybe for a long time, I was starting to hear a lot of like, here we go again. We’re being ignored again. We’re being dismissed again. We’re being stigmatized again. So there, there was a different outlook generationally. And so I thought that there was definitely something there to talk about to educate, help educate some therapists, you know, as I’m also being educated right now, I’m not I’m not a monkey pox expert. But I’ve definitely been trying to stay in the loop about monkey pox and have those conversations with clients.

Katie Vernoy 12:14
So before we jump into monkey pox, I know you and I talked about this because I worked in HIV, AIDS, and mental health and substance abuse actually 20 years ago. So my, my knowledge is a little bit out of date, but a little bit more relevant than potentially folks who’ve never been connected to the communities of folks with HIV and AIDS. And so can you talk a little bit about how this stigma and the community trauma is being reignited. Give a little bit, maybe some history about, especially kind of that horrible time long ago for HIV and AIDS?

Mallory Garrett 12:50
Absolutely, I think, so, it’s hard to know when to go back because there’s so much systemic issues. And I think, you know, so starting around, you know, the 60s and 70s, I think is important actually, because to know the history of AIDS in America and how it’s impacted our culture, you have to know about like the gay rights movements and sexual liberation. Because that’s really important that’s really intertwines. We always like pinpoint the gay rights movement is starting in 1969 on Stonewall, but there was a whole movements going on, decades before that, but that’s definitely pinnacle. So not getting too much into that. But you know, when AIDS was identified in the communities, primarily in the gay community. In 1981, was when the first few cases were starting to be reported, with the you know, New York Times headline, I think it was on page, it was pretty much buried, they buried the lead of for, you know, 41 cases of cancer found in gay men. And this was a really rare cancer. So obviously, the New York Times was reluctant to put it on the front page, which, given that it was spreading so deep in clusters in the city of primarily among gay men, that’s kind of the beginning of the stigma. And I mean, for years, obviously, Gay Men’s Health was neglected. There have been other, you know, STI outbreaks before that were smaller and more contained, and neglected. But AIDS was absolutely devastating. Killed large percentages of the gay population gay community and led to a lot of fear and stigma, fear and stigma that we still see today. I mean, I remember growing up in the 90s hearing stories about folks and immediately assuming that if someone was gay, then that means they had AIDS. And I remember my mom I had a conversation with her about someone I was like, Oh, do they have AIDS? And that was my first question. I was probably like five or so at that time and she looked at me she said, Just because someone’s gay doesn’t mean they have AIDS. And first that’s always stuck with me is like a very calm, collected way to answer that question. And I always say, that’s when I became an activist. Because it made me think about the world differently. But getting back on track with like, the history, so yeah, there was a lot of stigma with like housing, people could be evicted fired from their jobs. I actually have just started looking at apartments in New York and I was doing some research on real estate. And there was a clause that real estate agents are not allowed to disclose if someone died in the apartment from AIDS.

Katie Vernoy 12:54
Wow.

Mallory Garrett 12:58
And I saw that written and I was like, they were doing that? That was happening. And it was very interesting to see. But um, yeah, so I mean, the stigma in that community and just being neglected. Medical providers didn’t fully understand they thought, Well, like, none of my patients are gay, so I don’t need to know. So in the mid 80s, it was AIDS was primarily impacting people with hemophilia, homosexuals, and Haitian immigrants. So from the get go, you had racial disparity and minority stress as a part of that public health fight.

Katie Vernoy 16:05
And my understanding of it, and definitely correct me if I’m wrong, but it seems like there was poor knowledge in the medical community, but also really reluctance and very poor communication on what it was, how it was spread, how people could prevent it. To me, it was something where there was just huge amounts of loss that was so unnecessary. Had we actually been on top of it and understood it better. But it was it was like, well, it’s just a small group of people. And honestly, the bias was like, and we don’t care about them. Right, which is horrible. And so it’s, it’s that element of this community was going through huge amounts of trauma, and nobody cared.

Mallory Garrett 16:45
Yeah, absolutely. And that that I think, is at the center of the trauma is absolute neglect, when people are literally dying. Dying in hospital hallways, alone, orderlies wouldn’t bring food to some folks, because they were afraid to go into their room because they were worried they could catch AIDS from casual contact. So people were dying alone. And then you had on top of that family rejection, shame. You know, in my family, we lost a family friend to AIDS in the early 90s. And, you know, I remember hearing people say, Oh, he died of cancer, he died of cancer.

Katie Vernoy 17:24
So erasure.

Mallory Garrett 17:25
It wasn’t until I became older that my mom was like, oh, no, he had AIDS. And it was like, almost like, we can’t talk about it now. Because we talk about it, then we have to explain what homosexuality is. And so it goes back into that, like, how do we talk about sex? And those are really hard conversations to have. But yeah, the community stress of being ignored. I mean, Ronald Reagan didn’t even say AIDS until 1000s of people had died.

Katie Vernoy 17:51
Wow.

Mallory Garrett 17:51
And he didn’t even acknowledge it publicly. And there’s some pretty good evidence that the reason why is just purely political, didn’t want to be associated. And those are those are scars that definitely stay in communities. With monkey pox one thing I heard again, a lot was like, Oh, here we go, again, like being blamed or being blamed for an outbreak…

Katie Vernoy 18:11
Yeah.

Mallory Garrett 18:12
…is a big thing that I was hearing. And then another thing is like, we’re being ignored again. So it’s like, there were two sides of the coin. People were like, We need to sound the alarm to gay and bisexual men, men who have sex with men, that they need to be careful about this. Like monkey pox, you have to be careful. Then there was the other side that was like, don’t bring this on our community. Like we don’t want to be stigmatized again. So there’s definitely this dichotomy of voices. And both voices make really good points.

Katie Vernoy 18:39
Yeah.

Mallory Garrett 18:40
So it’s like, I yeah, I agree with both both sides. But I’m always on the side of like, academia, I hope. I try to be and it’s like, okay, well, this is just like part of STIs and are just a part of life. They’re just a part of life. They’re they don’t mean you did anything wrong. They don’t mean that you’re behaving immorally or any way. They just mean that you are a human being who was looking for human contact.

Katie Vernoy 19:08
Yeah.

Mallory Garrett 19:08
And STI is our price. We all pay in our society to have the human connection that we all need as human beings. And I say a price we pay in quotation marks, of course, it’s the cost of human connection, that we take on those risks. And we can decrease the risks. But that’s really all we can do. We’re all taking them. So that’s why I think it’s important to destigmatize STIs.

Curt Widhalm 19:32
How can therapists help empower their clients in these discussions? And it sounds a little bit like where you’re going with this is just kind of leading by example, in some of the conversations that you’re having with your clients. Is there other things that you’re particularly aware of?

Mallory Garrett 19:50
Yeah, I think you know, I really am a huge supporter, as I think most therapists are of harm reduction. I think we’ve all definitely seen the benefits. I mean, with COVID we’re doing the same thing. For ourselves of, you know, I love to go to the theater, I love to travel, those are two things that for me make life complete and rewarding. And so I do those things, even though COVID is still very present in our lives, I mitigate for those risks. So wearing my mask, getting vaccinated, trying to avoid all the things that could potentially increase my risk further. So I think empowering our clients to make those decisions for themselves. What’s worth taking a risk for? And how are you going to mitigate for that? I’ve been talking to all my clients about getting vaccinated if they’re eligible for monkey pox. Obviously, I don’t tell anyone go get vaccinated, but I always refer to them to their local public health department. So for California, I refer that and then for New York, I’ve been referring them to their health department to stay in the loop about getting vaccinated and decreasing any kind of risk.

Katie Vernoy 20:51
Moving into kind of monkey pox basics, I mean, how is it spread? Who’s getting it? Is it fatal? You know, like, what do we need to know so that we can educate our clients and potentially move towards that harm reduction or prevention.

Mallory Garrett 21:07
So monkey pox in the United States is primarily being spread through men who have sex of men. So those aren’t necessarily men who identify as gay or bisexual, but their behavior is that they are having sex with men. I don’t actually have data on the trans communities and how they’re being impacted, which is definitely a flaw in the data system. But I would just have the same conversation with, like I said, all my clients. But that’s primarily how it’s being spread. And it’s spread right now through close, intimate contact. So on the CDC website, it does say that you can get it through sharing utensils and bed sheets with someone who may have monkey pox lesions and have an active infection. But the data so far has shown that those are very few cases that are being spread that way. So that’s not the primary mode of transmission, even though it can be spread that way. Like I said, primarily who’s getting in are men who have sex with men. And is it fatal? That’s definitely one of the biggest differences between monkey pox and HIV is that it HIV untreated over the long term is fatal, can lead to aids and other opportunistic infections. But monkey pox is not fatal for the most part. In the United States. I looked at the CDC data yesterday. We’ve had about 26,000 cases so far, and we’ve had two deaths. So the death rate is very low. There are two strains of monkey pox. So the ones spreading in the US and West Africa has a fatality rate of about 1%. So I wouldn’t be surprised if that number went up a little bit. But for the most part, so far, it has not been fatal. There is another strain of monkey pox, primarily located in the Congo Basin. And that strain has a fatality rate of 10%.

Katie Vernoy 22:47
Wow. Okay.

Mallory Garrett 22:47
So that’s significantly more deadly. Luckily, that strain seems to be contained. But that’s why it’s important to be vigilant so far. So that way, we don’t have a repeat of what we’re experiencing with COVID.

Katie Vernoy 23:03
So prevention, it sounds like follows along the same types of things as HIV AIDS, right? Or any kind of STI really…

Mallory Garrett 23:14
Yeah.

Katie Vernoy 23:14
Is kind of being aware. Potentially getting tested, although my understanding with monkey pox as a lesions would be pretty obvious and are super painful. So I don’t think it would be a surprise. It’s not something that’s hidden like HIV is.

Mallory Garrett 23:26
Exactly.

Katie Vernoy 23:27
Okay.

Mallory Garrett 23:28
Yeah, because HIV can be spread asymptomatically. Whereas monkey pox, for the most part, person will be experiencing symptoms. And most of the hospitalizations have come from the pain caused by the lesions, especially when they’re located in the genitalia or anal areas. Yeah, hearing stories of folks who’ve been going through that has been just horrifying. Because it’s extremely painful. So it’s not something to be taken lightly. But it’s also not something to fear too much.

Curt Widhalm 23:59
So maybe beyond reacting to clients as they’re describing this with like…Ooof

Mallory Garrett 24:03
…is my instinct.

Curt Widhalm 24:10
How are we supposed to be providing affirming care, whatever clients are expressing these fears in that community reaction?

Mallory Garrett 24:19
Yeah.

Curt Widhalm 24:19
Not that Ooof is uncalled for. But what else can we do?

Mallory Garrett 24:24
I’m Jewish, and my family’s from New Jersey. So a lot of like, Oy vey is a very common reaction that I’ve had. Yeah, that’s definitely been a common reaction that I’ve been having. Um, so I think you know, if a client comes to you with monkey pox, like really sitting and allowing them to process their emotions around that I think is really important and listening and trying not to judge. I think that this is kind of the same with COVID. Like, I think toward, you know, with COVID. A lot of us were like, Oh, of course, they got COVID they, you know, went to a party. It’s like, okay, well you can get COVID going to the grocery store too. So it’s, you know, it’s one of those things, I think of listening and let giving the client space, and encouraging them to reach out to their social networks digitally, because they can’t in person. So I really think like, helping them channel those alternative social mechanisms is really important, because the isolation can be pretty intense for folks who are experiencing monkey pox. And when you’re isolated, and you’re in pain, those are not pleasant things to be experiencing.

Katie Vernoy 25:34
Well, I was also reading somewhere that there’s also the disfigurement that at least is present a portion of the time that can also be really impactful to someone’s self esteem and their outlook, their hopefulness, that kind of stuff.

Mallory Garrett 25:48
Absolutely. And that’s one thing too about monkey pox, once again, where there is an overlap, I think, with HIV in the early days, especially, is that there were physical markers. So with in, you know, with HIV, and I’m talking primarily 80s, and 90s, because we don’t see that as much now although I have had folks come in with Kaposi sarcoma on their faces or with wasting. There are these physical markers that people can experience that lead to a lot of shame and stigma. And with the monkeypox lesions as well, those can be visible on the face and in other parts of the body that are visible. And that can lead to feeling self conscious. And you know, folks even who are experiencing bumps or rashes who don’t have monkeypox are experiencing that as well. So that can be very subconscious. I think, you know, like not to draw too much with COVID. But I think, you know, if you’re in a rush, if you’re in a grocery store, and you cough a lot, or have a coughing fit with COVID, you’re like, I don’t have COVID. Just to calm a bit, because we’re now like super hyper sensitive. And I think in certain communities, the hypersensitivity towards lesions can definitely be present, even if it’s not monkeypox.

Katie Vernoy 26:59
Yeah.

Mallory Garrett 26:59
So being aware of that checking your own biases as well.

Katie Vernoy 27:04
A lot of empathy and compassion. I missed what I’m hearing.

Mallory Garrett 27:06
Yeah, a lot of empathy and compassion. I think just giving clients space to process it is really important. And in trying to not be as judgmental as humanly possible for yourself, because we’re all human. So we all judge. So that’s natural. But I think also checking your judgment, too. I always tell my clients to if you ever feel uncomfortable, or you feel like you can’t tell me something that you want to share, please let me know. Because I might be giving off a vibe that I don’t intend to.

Curt Widhalm 27:33
How are you staying up to date with these kinds of emerging things going on in the fields.

Mallory Garrett 27:39
So I follow the CDC a lot. And also, I’ve been following a lot of AIDS activists online, as well on Twitter and Facebook, staying up to date with the information that they’re providing. There’s a health columnist, his name is Ben Ryan, I’ve been following him on Twitter, and then also Peter Staley is someone I stay up to date with. So they’re AIDS activists who have been keeping up with the monkey pox pandemic, and CDC and World Health Organization, are my big go tos as well.

Katie Vernoy 28:12
We’ll put links to that in the show notes. And definitely we’ll stay in touch to make sure we have the right links on that page at mtsgpodcast.com. But it seems like there’s basic knowledge we should have. And then there’s also this advocacy piece, which I think is where you sit a little bit more firmly. Why do you think advocacy and empowering our clients around this stuff is so important? I think that I know your answer, but I just would love to kind of talk through that a little bit. Because I think, the skates on that scope of competence, scope of practice, it skates on the, you know, kind of being very present as a whole person in session. And so I’m just curious in your thoughts about how/why we step into advocacy versus just knowledge?

Mallory Garrett 28:56
I think that’s a really great question. Because more than an expert, I would describe myself as an advocate, because it is one of those things where it’s so hard sometimes to stay up to date with all the science and the details. And ultimately, like as therapists especially, we don’t need to know the science and the details we need to know like the gist, but not the specifics. I don’t need to know what viral strain, etc, to have empathy and understanding for my clients. So I think also as people we tend to defer to medical professionals as if they’re the experts on everything. And we need to realize too, that they’re humans, and they have biases, and they have limits to their own knowledge. If they’re a doctor or PhD or a public health director, they still have biases and limits. So I think being an advocate is a good way to question authority, help clients get what they need from their providers, because and that’s one thing that about, especially early aids advocacy, and continuing on now, is that AIDS activism impacts everyone’s health, not just people living with HIV. But it impacts everyone’s health, because they very much brought the patient to the forefront. Oftentimes people do what the doctor says, because the doctor said it, and the doctor is always right. And there was definitely a deferral to medical authority, which they’re experts. So there should be more of a deferral to their authority. But patient advocacy is so important because you know, the expression, nothing about us without us. So having these closed door meetings and talking about, you know, STI transmission or disease transmission, and not having people who are being impacted in the community in the room is a huge problem, because they are the experts. They’re the experts of their bodies, they’re the experts of their community. And so, you know, with Dr. Fauci that was one of the wonderful things he did when he took over the NIH was that he collaborated with activists. So really brought in that, like, let’s hear from the people who are being impacted the most by the community. So I always encourage my clients, if they you know, on a micro level, if they have a doctor that they don’t feel comfortable talking to any kind of medical provider, and they don’t want to talk about sex, or sexuality, or their own sexual health or things are experiencing. Go find a new doctor, find someone who’s affirming. That’s the number one question I was asked by clients, especially clients who’ve been diagnosed with a chronic health condition. Do you have a doctor you feel comfortable talking to? Because in order to defer to that authority, you have to feel comfortable talking to them.

Katie Vernoy 31:29
Well, they need to know all the information.

Mallory Garrett 31:30
Exactly.

Katie Vernoy 31:31
And they need to make sure you’ve had the appropriate tests, and they need to make sure that you’re actually being treated for what’s wrong, versus assuming. And we have so many episodes on kind of the bias that can happen in the medical system, I guess, maybe not so many. But I’ll I’ll add some in the show notes. But it’s, it’s really interesting, because I think, recognizing how important our medical system is, but where the limitations are, and how we as individual clinicians can help our clients access it better, which then improves it, I think, is so important.

Mallory Garrett 32:06
Absolutely. And like finding affirmative clinicians to like, I know so many people who are so happy that they have a gay male doctor, because they know that their doctor is a part of their community and has a medical knowledge of what their needs are. So has both the personal knowledge and also the medical knowledge. Like I never get offended when a client says, Hey, I’d rather talk to a gay male therapist or, or a male therapist, because I understand my limits as a cisgender female who is on the younger side, too. So it’s like, I understand that and I never get offended when a client asks.

Curt Widhalm 32:46
Where can people find out more about you and your practice?

Mallory Garrett 32:49
So my website is mallorygarrett.com. I haven’t updated in a while, but I’m getting to it. And I offer consultation as well. So if folks have clients that they’re working with who they’re not entirely sure about how to address their presenting issue, especially around HIV, AIDS, sexuality, things like that, I offer that. And also, I’m on Twitter. So my Twitter is a mishmash of politics, Broadway show tune references, and some mental health thrown in there for good measure, but my Twitter is nomad_therapist.

Curt Widhalm 33:24
And we’ll also include links to those in our show notes over at mtsgpodcast.com. And follow us on our social media, join our Facebook groups, the modern therapists group, and if you want to support us in other ways you can become a patreon member or support us on Buy Me a Coffee, and until next time, I’m Curt Widhalm, with Katie Vernoy and Mallory Garrett.

Katie Vernoy 33:46
Thanks again to our sponsor, Thrizer.

Curt Widhalm 33:49
Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinicians should earn what they are worth. Every time you bill a client through Thrizer an insurance claim is automatically generated and sent directly to the clients insurance. From there Thrizer provides concierge support to ensure clients get their reimbursement quickly and directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick and easy to get set up and it works great with EHR systems.

Katie Vernoy 34:29
Their team is super helpful and responsive and the founder is actually a longtime therapy client who grew frustrated with his reimbursement times. Thrizer lets you become more accessible while remaining in complete control of your practice. Better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Signup using bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free. You will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.

Curt Widhalm 35:03
Once again sign up at bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free.

Announcer 35:12
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