back to June 2024 newsletter
Interview with Alex MacKenzie, LMFT by Vidur Malik, LMFT, Director at Large

Vidur: Could you introduce yourself and the work you do?

Alex: I work primarily in private practice. I do a lot of couples work, which is really my favorite thing. I do work with a lot of LGBTQIA+ folks and I also have gotten really interested in working with what I like to call mid-adulthood or “third act” stage of life. I love working with people who are intentional about how they use this last part of adulthood – whether that's retiring, refocusing their career, whatever is meaningful and fulfilling for them. 

The intersection of those – that's kind of my favorite place– when I can work with LGBTQIA+ couples who are in that sweet spot of their life and identifying what that looks like for them as a couple. 

Vidur: How did you realize that was the sweet spot for you?

Alex: Well, honestly, it matches my personal experience. 
I had a sobering experience with getting a cancer diagnosis and so that brought things into sharper focus in terms of recognizing that I don't have the luxury of saying, “Well, maybe I'll do that later.” In mid-adulthood, you're at a time in your life where you don't really have that luxury. But it's an interesting paradox because limitations are really liberating in that they really clarify  this is the time – right now, and either you're going to do it or you're not. 

The third act is a sweet spot in that it’s the wisest, most fearless, most curious point in life. It can be a moment when you have less to prove, and the unneeded armor falls away, treating you to the joy of being the most authentic version of yourself.  

Vidur: What do you particularly enjoy about working with clients in that stage of life in a couples setting? 

Alex: My simple answer to that is I love “love.” I find it really inspiring to help people who may have become a little alienated from each other or who may not be communicating optimally to find that place where they can love each other and support each other in whatever their individual and collective pursuits are, and live the life they truly want. 

Vidur: What drew you to working with the LGBTQIA+ community in particular?

Alex: One thing is identification. Another is when I was going through my graduate program and doing my first internships, it was the community’s moment of reckoning with the AIDS crisis. 

I was in San Francisco at that time and I saw a lot of need and a lot of suffering and alienation. Sometimes crises bring people closer together, and sometimes they push people apart. I really wanted to be a part of the coming together and healing whatever ruptures could be could be healed. At that time, multiple traumas were playing out at the same time. We didn't know what caused AIDS, and gay men were dealing with this horrible question, ‘does my love kill me or kill somebody else?’ There was a lot of division and judgment about, ‘well if those people weren't doing those activities then we wouldn't be having this problem’ and kind of other-ing parts of the community. There was a lot of negative energy pointed at the gay community and even within the community there was a lot of, ‘I'm going to get my safety by differentiating myself from that part of the community, which is seen as objectionable.’

I really wanted to be part of working with people however I could, in groups, individually, and couples to heal some of those ruptures. 

Vidur: How have you found that therapy has helped heal some of those wounds? 

Alex: Therapy helps people who grew up with trauma - including the trauma of having to hide from your parents who you are, the trauma of feeling like society is hostile toward you and that you’re not safe - examine those thoughts and say, ‘well, there are places where I can be safe.’

Realizing that there are relationships where we can be safe and be okay. Accepting that our partners are not looking at us the way that some hostile parts of society does, or the way that a family may have,  if the family was rejecting. So reducing some of that defensiveness where it's not needed by re -examining –   reappraising those kinds of beliefs. 

And of course,  communication, helping people learn how to listen to each other with empathy, and teaching couples how to listen to each other and how to assert themselves heals ruptures and builds bonds. 

Vidur: What are some things that you would recommend for clinicians working with LGBTQIA+ clients to do to make sure that their clients feel safe with them? 

Alex: The first thing I think is that if you identify as LGBTQIA+ to come out to your patients, to let that be visible on your website or however you make yourself known. If you're LGBTQIA+ identified, then one of the first things I would say is to ask your clients if they feel you’re an appropriate clinician for them. It's legitimate to feel like you want to work with somebody who can understand you, and while you don’t have to come from the exact same experience to understand, it’s important to at least open up that conversation. 

I would say the next thing is to explore your own biases and work to expose yourself to information that contradicts those biases and acknowledge how and when they come up. It’s hard not to make assumptions that you understand things that you may not – our biases are insidious in that they just seem true. We all have them.

There’s a thin line between being open to learning from clients about their culture or their experience versus having them have to do the emotional labor of teaching you. I would advise just being aware of that line. It’s important to continue to check with yourself and your clients about how you're navigating that line. 

Vidur: As a gay man, I'm wondering whether you've noticed a parallel process in terms of the trauma that you might have had to deal with and whether that comes up when you support your clients with their trauma? 

Alex: Yeah– Isn’t it for all of us the lifelong unwinding of our own trauma?. There are some times when clients are talking about something that stimulates my own triggers in some way, and I have to use what I know about managing my own trauma response. I might feel tearful, for example, or even angry on their behalf.

Sometimes, something comes up that I'll just disclose, ‘I really relate to what you're saying, this is kind of triggering for me. Let me just acknowledge that and we'll work through it as best we can,’ and I try not to make that the client's job, of course. 

Vidur: How meaningful has it been to support the LGBTQIA+ community and the healing that you wanted to contribute to? Is that something you think about? 

Alex: Thanks for asking that because it's really something that's part of this life stage - looking back and asking, ‘how satisfied am I with what I've done?’

I feel rewarded, validated, and happy when I think of where the community has come and what we’ve achieved. Most of us of my age and many who are a bit younger never thought we'd have a serious conversation about marriage equality, and the fact that we today have marriage equality is quite amazing. 

I do like to think that our work as therapists has contributed to where the community has come to today. The fact that young people –  12, 13, 14 years old are self-identifying and there's growing understanding that gender is on a spectrum is amazing. We’ve created the safety to have some of those conversations. 

Part of satisfaction is acceptance of my own limitations. I sure wish I’d come pre-loaded with all the learning of these years, because I could have helped more, could have done better. 

Occasionally I'll run into a client or a couple (I worked with), and just seeing that they made it is just amazingly satisfying. 

As a community, we still have a long way to go. We are evolving, growing, encountering new challenges, and having to re-fight some old battles. I’m still here for it.  

Alex Mackenzie, MFT is a psychotherapist in private practice who has been licensed for more than 30 years.  He works with a diverse population, and has special interest in working with the LGBTQIA+ community of which he is a member, with age 50+ persons making the most of their "third acts", and with couples.  Alex volunteers as a board member for SCV CAMFT, and as a clinical consultant for Almaden Valley Counseling. He is an avid reader and writer, and rabid downhill skier and spends as much time as possible in the healing natural environment.   His website is alexmackenziemft.com

References:  

10 Principles for Doing Effective Couples Counseling -- Gottman Julie and John\
The Courage to Be Disliked -- Kishimi, Ichiro and Fumitake Koga
Learning to Love Midlife -- Conley, Chip
Stonewall Generation: LGBTQ Elders on Sex, Activism, and Aging -- Fleishman, Jane and Kate Bornstein