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Monday, May 25, 2015

Psychotherapy Blog: Leaving Therapy: Confusing Starting to "Feel Better" With Emotional Healing

People often to come to therapy after their own efforts to heal emotionally haven't worked for them and they realize that they need help from a licensed mental health professional.  It's understandable that a big part of the reason why they come to therapy is because they want to feel better, and it's often the case that when they begin to talk about their problems, they start to feel better.  But the problem arises when clients stop attending therapy as soon as they start feeling better as opposed to when they have emotionally healed by working through the problem (see my article:  When Clients Leave Psychotherapy Prematurely).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Since starting to feel better often begins during the initial stage of therapy, a client who leaves therapy before s/he has worked through the problem is leaving prematurely and will usually experience a "relapse" of the emotional problem because starting to feel better isn't the same as resolving the problem.  It's just a temporary alleviation of symptoms until the symptoms come back to the surface again.

Let's take a look at an example of this in the following vignette which is a composite of many different cases to protect confidentiality:

Jack
Before coming to therapy, Jack tried to deal with his panic attacks around his difficult boss by working out at the gym, attending yoga classes, and talking to friends about it.  But none of these efforts helped him (see my articles:  Workplace: Coping with a Difficult Boss and How Your Workplace Can Feel Like a Dysfunctional Family).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

When he went to see his medical doctor, his doctor gave him a prescription for anti-anxiety medication for short term use and recommended that Jack see a psychotherapist to work out whatever underlying issues might be affecting him.

Jack discovered that the medication helped to relieve his panicky symptoms for short periods of time. But he realized that, after a while, he needed a higher dose to alleviate symptoms, and he didn't like becoming dependent upon medication.  So, although he preferred not to go to therapy, he followed his doctor's advice and contacted me for help.

After we talked about his family history, both Jack and I began to see parallels between his situation at work and his abusive father.  Both men were overbearing and verbally abusive.  Jack's father was also physically abusive with Jack when Jack was a child.

Just knowing this was a tremendous relief for Jack.  Until then, he felt that he was "going crazy" whenever he had a panic attack around his boss.

As Jack started to understand that he was reacting to his boss as if he were a child and his boss was his abusive father, he began to be able to separate his current experiences from his childhood experiences (see my articles:  Reacting to the Present Based on Your Traumatic Past).

At that point, Jack decided that he didn't need to continue in therapy anymore because he "understood" why he was having his panic attacks.  So, during a period of time when his boss was away on an extended business trip, Jack decided that he was "feeling better" and he would end therapy.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

I tried to explain to Jack that the alleviation of his symptoms was probably temporary since he had not worked through the underlying emotional problems (his childhood history of being abused) involved in his current problem.  Understanding logically was the first step, but it usually doesn't resolve these types of problems.  There was also the fact that his boss was away so Jack wasn't getting triggered at that point by the boss's abusive behavior.

But Jack had made up his mind about leaving therapy.  So, I told him that my door remained open and he could return in the future.

Within a couple of weeks, after his boss returned, I received a call from Jack, who said that he was having panic attacks again. In one instance, he thought he was having a heart attack and he went to the ER.  After the ER doctors ruled out a heart attack, they told Jack that he was having a panic attack with heart palpitations, shakiness and sweating and he should seek help from a licensed mental health professional.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Jack said that this was, by far, the worst panic attack that he had ever had and it frightened him to the point where he was now constantly worried that he would have another panic attack.

We resumed our work that week.

I began by helping Jack to develop internal resources, which are basically coping skills (see my article:  Developing Internal Resources in Therapy).

After helping Jack to develop the internal resources to do the therapeutic work, we started doing EMDR therapy (Eye Movement Desensitization and Reprocessing), a mind-body oriented type of therapy to work on the current situation as well as the underlying issues that were getting triggered by his unresolved childhood trauma (see my articles:  What is EMDR?How EMDR Works: Part 1: EMDR and the Brain, How EMDR Works - Part 2: Overcoming Trauma and EMDR: When the Past is in the Present).

As we worked together, Jack learned to manage his panic-related symptoms.  More importantly, over time, the EMDR therapy helped Jack to work through the unresolved childhood abuse he experienced with his father that was getting triggered with his boss (see my article:  Mind-Body Psychotherapy: The Body Offers a Window into the Conscious Mind).

He no longer had panic attacks because the underlying traumatic issues triggering the attacks got worked through so they were no longer there to be triggered (see my article:  Experiential Therapy. Like EMDR, Helps to Achieve Emotional Breakthroughs).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Not only did Jack "feel better," but his boss's abusive behavior no longer frightened him.  In fact, for the first time, Jack saw that his boss was really an insecure man who bullied employees to bolster his own low self esteem.

Rather than freezing in panic, Jack's attitude about the work situation was that, although it was unpleasant, he no longer felt threatened by it.

A few months later, Jack found a better job where he felt happier, respected and well compensated.

Summary
Just like "Jack," many clients think that their work in therapy is over once they understand their problem and they start to "feel better."  Unfortunately, this usually doesn't last, especially when emotional trauma is involved.

An intellectual understanding is a good start, but it's not the same as actually working through the problem, as "Jack" discovered.

The working through process necessitates working on a deeper level than just having a cognitive understanding.

EMDR and other mind-body oriented types of therapy, like Somatic Experiencing and clinical hypnosis tend to be more effective and efficient than regular talk therapy when the problem involves emotional trauma (EMDR: When Talk Therapy Isn't Enough).

Of course, everyone is different and these types of therapy aren't a quick fix but, as an experienced therapist, I have found that EMDR and other mind-body oriented types of therapy tend to work faster to resolve trauma.

Getting Help in Therapy
If you have tried unsuccessfully to work out your problems on your own, you owe it to yourself to get professional help from a licensed mental health professional (see my article:  How to Choose a Psychotherapist).

Rather than continuing to suffer on your own, you could work through your problems so that you can lead a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

In addition to providing mind-body oriented psychotherapy, I also use talk therapy with clients who would benefit from it.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.























Saturday, May 23, 2015

Psychotherapy Blog: Overcoming Your Denial About Family Problems

As I've written in previous articles, adult children from dysfunctional families usually survive their family chaos by being in denial about the problems in their family and how they were affected (see my article: Dynamics of Adult Children From Dysfunctional Families).

Overcoming Your Denial About Family Problems

What is Denial?
Denial is an unconscious defense mechanism. For people who grew up in a dysfunctional family, denial helped them to survive emotionally by preventing emotional trauma from overwhelming them as children.  But whereas denial helped them to survive as children, it gets in the way of healthy emotional development.

Coming to terms with the dysfunction in a family of origin is emotionally challenging, but not coming to terms with it is even more damaging.

Overcoming Your Denial About Family Problems

The unconscious process of denial keeps disturbing emotions out of awareness.  People who are in denial about the problems in their family of origin and how those problems affected them often use dissociation as a way to keep uncomfortable emotions split off from their conscious awareness.

While denial might ward off uncomfortable feelings, unfortunately, it also affects other areas--not just the emotions that are meant to be kept at bay.

There are degrees of dissociation--from mild to severe.  Even a moderate level of dissociation can dampen overall emotions, including happiness, so that people who use dissociation to remain in denial are often out of touch with their feelings.

It also takes a lot of energy to keep uncomfortable emotions out of awareness so that it can leave a person emotionally drained.

Adult who use denial as a maladaptive form of coping often have problems in their relationships.

Often, these adults are out of touch with issues in their marriage and with their children (see my article:  Unresolved Trauma Can Create Emotional Blind Spots That Affect You and Your Family). And if they're forced to deal with difficult situations, they might become emotionally overwhelmed.  At that point, psychotherapy can be helpful, especially experiential therapy.

Let's take a look at the following vignette, which is a fictional scenario that shows how denial creates problems and how experiential therapy can help (see my article: Experiential Therapy Can Help Achieve Emotional Breakthroughs):

Emily
Emily came to therapy because she felt overwhelmed by her problems with her husband and 17 year old son.

Overcoming Your Denial About Family Problems

Her husband, Mark, had been telling her for over a year that he suspected that their son, Tom, was drinking with his friends.

Although, like Mark, Emily smelled the alcohol on Tom's breath, she felt that her husband was making too big a deal out of it.  Her feeling was that Tom was rebelling and if they overreacted to it, Tom would want to act out even more by drinking more.  She felt that Tom would grow out of it.

Emily's attitude toward the situation infuriated Mark and when she wouldn't agree with him that they both should confront Tom about his drinking, he decided to do it on his own.

So, one evening when Tom came home from seeing his friends smelling of alcohol, Mark called him into the living room where he and Emily were sitting and told Mark and told him that he was concerned about his drinking.

As Emily talked about that evening in therapy, I asked her what she was feeling at the time.  I already knew, based on Emily's family history, that her father struggled with alcoholism and her mother and the rest of the family, including Emily, tiptoed around the father's problem.  Even after her father died from alcohol-related causes, no one in the family ever discussed it (see my article: Overcoming Childhood Trauma).

Emily response to my question about how she was feeling at the moment when her husband confronted their son about his drinking drew a blank look, and she told me that she wasn't aware of feeling anything in particular--except possibly being annoyed with her husband for creating the confrontation.

As we focused on what she might have been feeling at that moment, Emily thought back and she remembered her attention drifting out of the room and she felt like she was floating.  She described it as an oddly pleasant feeling that was familiar.

Then, she remembered that her feeling of floating was interrupted abruptly by an argument that broke out between her husband and their son.  They were shouting at each other and then Tom stormed off to his room slamming the door behind him.

Mark was angry that Emily remained passive when he confronted Tom.  He expressed his anger and frustration that she refused to see that Tom was in trouble.  He accused her of colluding with Tom.  Then, he told her that he was sick of trying to get her to see that Tom had a drinking problem, and he was moving out of the house for a while.

Emily remembered feeling emotionally paralyzed as Mark packed his things and drove to a hotel.  Other than shock, she wasn't sure what she felt.

During our second session, Emily was upset and crying because a week after Mark moved out, the police called her to tell her that her son and his friends were arrested for underage drinking during a routine traffic stop.  The driver was also charged with DWI.

This was a shocking wake up call for Emily.  When she called Mark to tell him, he came home immediately so they could face this problem together.

Our work together began with helping Emily to develop basic coping skills and, gradually, to help her to connect with her emotions.

Since Emily was so disconnected from her feelings, we began with basic Somatic Experiencing exercises to help her to connect what she was sensing in her body with her emotions.

Over time, she realized that, for her, tightness in her stomach muscles was anxiety, a sinking feeling in her chest was sadness, and so on.

When Emily was at the point that she could tolerate it emotionally, we used EMDR to help her to process her current family problems and, eventually, her unresolved family of origin problems.  By then, she could see the connection between her family of origin problems that were getting triggered by her current problems.

The work was neither quick nor easy, and Emily had setbacks along the way (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).  But by the end of therapy, Emily no longer used denial as her attempt to cope, and her family life improved.

Conclusion
Denial, which is an unconscious defense, can take many forms, including dissociation and emotional numbing.  It often develops in childhood to prevent the child from being emotionally overwhelmed, and continues in adulthood where it creates its own problems.

Experiential therapy, like Somatic Experiencing and EMDR, can be effective in helping clients to develop better coping skills and to overcome current and earlier trauma.

Getting Help in Therapy
Since denial is an unconscious defense mechanism, you might not be aware that you use it as a maladaptive attempt to cope with your problems, but you might have some awareness that you're out of touch with how you feel and how this is affecting you and your relationships.

Rather than struggling on your own, you could benefit form seeking help from a licensed mental health professional who uses experiential therapy.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.











































Saturday, May 16, 2015

Psychotherapy Blog: Developing a Sense of Safety and Trust With Your Therapist

Being able to trust your therapist and feel safe in therapy is an essential part of psychotherapy that develops over time.

Developing a Sense of Safety and Trust With a Therapist is a Process
Developing trust can take a while, especially if you have a traumatic history where your trust was violated by family members or other people in your life who were supposed to be trustworthy.

Developing a Sense of Safety and Trust With Your Therapist

Skilled psychotherapists know that the initial stage of therapy is about building a rapport and a sense of trust, and it's up to the therapist to create a therapeutic environment that fosters trust and safety (see my article:  The Creation of the Holding Environment in Therapy).

Feeling like you can trust (or not) isn't an all-or-nothing process.  Trust develops gradually by degrees over time.

From the moment a client walks into a psychotherapist's office for the initial consultation s/he is trying to assess whether or not the therapist can be trusted.  Often, this is more of an unconscious process that occurs not only in a therapy setting but also in most situations where people are meeting someone new or coming into a new environment.

But, unlike many other settings, since you're coming to work on personal problems, you're more emotionally vulnerable in therapy than you are in more casual circumstances.  So, it's understandable that most people feel a degree of apprehension and ambivalence when they begin therapy (see my article:  The Psychotherapist's Empathic Attunement).

How to Use Your Therapy Consultation Session
When potential clients contact me about therapy, I usually tell them to think of the first session as a consultation.  It's an appointment to talk about their problems in a broad way, to ask questions about how I work in therapy and my experience, and to get a basic sense of whether they feel enough of a rapport to come back for another session.  It's also a time for me to assess whether or not I feel I can help the client.

Most clients don't take the time to ask questions on their own about the therapist's background, skills and whether she has worked with other clients on this same issue (see my article:  How to Choose a Psychotherapist).

These are important questions that can save you time and money as well as help to ensure that this is the right therapist for you (see my article:  Getting the Most Out of Therapy).

Assuming that you set subsequent appointments, the process of assessing whether you can trust a therapist and if you feel safe in therapy continues over time.

Some tips to consider as to whether a therapist is right for you:
  • Do you feel heard by the therapist?
  • Does the therapist seem to be empathetic?
  • Is she reliable and professional?
  • Does she seem to have your best interests at heart?
  • Is she clear about her policies with regard to fee, cancellations and appointment times?
  • Has she collaborated with you about the treatment?
  • Does she have the therapeutic skills necessary to help you with your problems?
  • Does she adhere to the fee structure and other policies?
If, after a few sessions, you feel that you and the therapist aren't a good match, it's best to talk about this in your next therapy session.  Don't just abort treatment abruptly.

Most experienced therapists know that every therapist isn't right for every client, and this often has nothing to do with the therapist's skills.  Often, it's an intuitive sense that the client has.

To evaluate this for yourself, it's important to be honest with yourself and to be able to distinguish your possible discomfort with dealing with your problems in therapy vs. your comfort level with the  therapist.

It's easy to fool yourself and tell yourself that you're not comfortable with the therapist when maybe there's an unconscious part of you that would rather not deal with your problems at all, no matter who the therapist is.

Once again, if you come from a traumatic background, the idea of "safety" is a relative issue.  It might be challenging for you to trust anyone, so the initial stage of treatment might be about how you can know if you feel safe and trusting enough.

Getting Help in Therapy
Allowing yourself to be vulnerable enough to start therapy can be challenging.

Many people avoid therapy, even though they feel they need it, because they're too afraid to take that emotional risk of finding out if they can trust a therapist.  But, even for people who feel most vulnerable, when the thought of continuing to be affected by their problems feel worse than taking the risk of being vulnerable, they will consider coming for a consultation.

Most people can use their instincts as to whether they feel they can trust a particular therapist, especially if they remember that it's a gradual process and not an all-or-nothing event.

Getting help in therapy can make the difference between continuing to suffer with your problems or working through your problem and living a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.


















Thursday, May 14, 2015

Psychotherapy Blog: Setting Boundaries With Family Members Who Want to Interfere With Your Relationship

In a prior article, Learn to Stop Interfering in Your Adult Child's Relationship, I focused on well-meaning parents who get overly involved in their adult child's relationship and the problems that this causes.  In this article, I'll be discussing this issue from the perspective of the adult child who needs to learn to set healthy boundaries with relatives who might be attempting to interfere with their relationship.

Setting Boundaries With Family Members Who Want to Interfere in Your Relationship

The earlier article about parents learning not to interfere in their adult child's relationship, is one of the most popular articles on my blog.  Not only have people emailed me (from both perspectives), but I've received phone calls from parents and adult children who feel frustrated.

Let's start out by saying that I'm not talking about relationships where something dangerous is going on, like domestic violence where children are involved.  In those cases, the safety of everyone involved is of paramount importance and parents, the children's school and others might have to contact the child welfare bureau.

I'm focusing on everyday problems that most couples have where one or both parents insert themselves in the situation between their child and the spouse.

Let's also start out, as I did in my earlier article, by assuming that, with some exceptions, most of the time, parents who interfere in their adult children's relationship are usually concerned and they mean well. They're usually not trying to create the havoc which often results when parents interfere in their children's adult relationships.

Setting Boundaries With Family Members Who Want to Interfere in Your Relationship

But, as the old saying goes, "The road to hell is paved with good intentions," so good intentions aren't enough.

So, is there a way for an adult child to set boundaries with a parent without alienating that parent or causing resentment?

The answer is:  Most of the time, yes.  But there are situations where the parent might not "get it" and might feel hurt or angry.

A lot will depend upon your relationship with your parents and how you handle boundary setting.

As a psychotherapist, over the years I've heard many accounts from both the both parent's and adult child's perspective.

Let's take a look at a fictional vignette which is based on many different cases where no confidential information is revealed, but the essence of the problem is discussed.

Mary
Mary and her husband, Tom, were married for a year and, generally, things were going well between them.

One issue that they were trying to work out was how to handle their money jointly.  Tom felt that they should pool all their money, and Mary felt that they should each keep whatever money they had before they got married and just set up a joint account, where both of them contributed, for bills and long term saving.

Setting Boundaries With Family Members Who Want to Interfere With Your Relationship

As far as Mary was concerned, it was not a big problem.  She and Tom had married friends who were dealing with the same issue.  Her sense was that she and Tom would work it out.

But Mary happened to mention her frustration to her sister, Carla who, in turn, discussed it with their mother, Pam.  Soon after that, Pam, who tended be a worrier, called Mary and wanted to talk to her about this issue.

Mary's initial reaction was to be annoyed with Carla for getting their mother involved.  Then, when she calmed down, she told her mother that everything was fine and she didn't feel the need to talk about it with her.  Afterwards, she made a mental note not to confide in Carla about similar issues.

A couple of weeks later, Pam called Mary again sounding worried and tried to talk to her about this issue again, asking Mary if she and Tom were having financial problems.

Once again, Mary tried to calm her mother down, and assured her that she and Tom were doing fine financially and they would figure this out on their own.

Sounding somewhat hurt, Pam persisted by telling her daughter that if they needed financial help, Mary  could tell her and she would help her.  Exasperated, Mary told her mother that this issue had nothing to do with financial problems and she asked her not to ask about it again.

Mary heard nothing more about this until she and Tom went to visit her parents for the holidays.  She happened to walk into the room where Tom and her mother were talking and she overheard her mother offering to lend money if things were tight financially.

Tom had a bewildered look on his face as he looked over at Mary to try to figure out what was going on.  Mary changed the subject.  But on the drive home, Tom asked her about it again.

Knowing that her mother's behavior seemed odd to Tom, Mary explained that she happened to mention to her sister, Carla, that she and he were trying to work out a way to deal with their money and Carla told her mother.

She explained that she had already told her mother that they weren't having financial problems and it wasn't a big deal, but her mother is a worrier and it has all been blown out of proportion.

Hearing this, Tom got annoyed and asked Mary why she talked about this to Carla.

From there, it escalated into an argument where Mary said that she just happened to mention it without thinking and Tom feeling that Mary was talking about him behind his back and her mother had problems with boundaries.

By the time they got home, they weren't speaking to each other.  Mary was tempted to call her mother and Carla to confront them with what they started, but she thought better of it.

Instead, she decided to wait a couple of days until she went to her therapy session to discuss it with her therapist.

After she spoke to her therapist, she had a plan for what to do.  Things were still tense at home with Tom, but they were starting to talk again.

Based on her discussion with her therapist, who knew Mary for a few years, she explained to him that she should have stopped to think before she spoke to Carla, who had problems keeping confidences to herself.

Mary acknowledged that she didn't use good judgment and she apologized.  This helped to ease the tension between them.

She told Tom that she realized, in hindsight, that all of this could have been avoided if she spoke to her therapist, who is bound by confidentiality not to divulge anything that she says.

She also told him that she planned to have a talk with her mother face-to-face to address this issue and to try to set healthy boundaries with her.

Tom seemed satisfied, and he came up with a compromise about how to handle their money that both of them could live with.  This eased tension between them.

Setting Boundaries With Family Members Who Want to Interfere With Your Relationship

So, Mary invited her mother to lunch and talked to her tactfully.  Mary told her that she knew that she was concerned, but there was no need--she and Tom were doing well financially and they were only trying to work out an issue that many couples do.

She also told her mother that, no matter how well meaning she felt, she didn't want her to go behind her back to talk to Tom.  She explained how this caused an argument between her and Tom, and she didn't want to see this happen again.  She also told her that she and Tom worked everything out so there was no need to be concerned.

Pam apologized for causing problems between her daughter and Tom, and she agreed not to interfere again.

Conclusion
The situation that I described in the fictionalized vignette is not unusual.

Setting boundaries with family members might feel awkward and uncomfortable at first.

Rather than assuming that your family members just want to be busybodies, if you realize that, for most families, these situations come up due to their concern, you will probably approach the boundary setting with more tact and compassion.

Before you speak with a family member about a boundary issue involving your relationship, it's better to talk to your spouse first so that you're both on the same page.

Getting Help in Therapy
If you feel that the situation that you're dealing with is beyond what you can handle or your efforts to try to handle it haven't worked, you could benefit from consulting with a licensed mental health professional who works with these issues.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have helped many clients to deal with setting boundaries in all areas of their lives.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.









































Tuesday, May 12, 2015

Psychotherapy Blog: The Therapy Session: A Unique Intersubjective Experience

Over time, people who are in therapy come to appreciate the uniquely private space of the therapy room.

The Therapy Session: A Unique Intersubjective Experience

Considering how busy most people are these days, other than their therapy sessions, many people don't take the time to reflect on what's going on in their lives and to get objective feedback.

For many people, the psychological insights that they have about themselves occurs in their therapy sessions.

The Privacy of the Therapy Session
In recent times, privacy has been eroded to such an extent that there are few (if any) other places where someone can come in and say whatever is on his or her mind in an accepting, objective, nonjudgmental private place.

Making Connections Between the Present and the Past in Therapy 
It's also a unique environment where an experienced therapist is trained to help clients to make possible connections between what is going on now and the past, and to begin to understand the many different aspects of themselves.

Most people don't feel immediately comfortable divulging a lot of private information about themselves at first.  It takes time to build a relationship with a therapist and to establish a rapport.

The Therapeutic "Holding Environment"
The attuned therapist creates a comfortable, secure environment for the client where the client feels heard and cared about (see my article:  The Attuned Therapist Creates a Therapeutic Holding Environment).

During the initial therapy sessions, it's important for the client and the therapist to each assess if they are a good "match" to continue to work together.  There aren't any specific steps for the client to determine this.  Mostly, I recommend that clients trust their intuition.

The Therapy Session: A Unique Intersubjective Experience

For the therapist, it's important that she work within the scope of her knowledge and skills.  So, if a client is looking for a therapist with a particular specialty, it's important for the therapist to reveal whether or not this is one of her specialties.

When it's a good match, over time, clients develop a comfort level where they feel they can talk about anything with their therapist.

Of course, there will be times when clients will feel ashamed to talk about certain topics, but it's important to remember that most experienced therapist have heard just about everything and, most likely, won't be shocked by what clients say.

Having a compassionate, skilled therapist and the time and place to talk about whatever is on a person's mind is a very freeing experience that is rare.

Many people, who are in therapy, look forward to attending their therapy sessions because it's such a unique experience where they have their therapists undivided attention and the time is dedicated to them.

Unconscious Communication:  The Intersubjective Space Between Therapist and Client
Clients and therapists often talk about getting into a particular intersubjective space that is unique to their particular therapeutic relationship (see my article:  The Psychotherapist's Empathic Attunement).

Within this intersubjective space, there is a form of unconscious communication between client and therapist that is particular to that client-therapist dyad.

As a result, there is more being communicated than the words that are being spoken.

There is also a latent communication that therapists, who are trained to work with unconscious communication, experience on a felt sense level.

Many clients will often talk about how they also sense this unconscious communication that is part of the intersubjective space between client and therapist.

Although there is always unconscious communication between people who are together, the unconscious communication between therapist and client is more focused than it would be between two other people and it usually develops over time.

When there is a good match between a therapist and client, it's not unusual for a therapist to intuitively sense what a client is about to say or for a client to sense what a therapist is about to say.  

This is because this unconscious communication is "in the air" between them.

Choosing a Therapist
Thinking of the first session as a consultation is a good way to approach that first session.

Not only are you talking about your problems in a broad way, you're also getting a sense for whether you feel comfortable with the therapist.

You might not be able to tell in the first session, but after the a few sessions, you usually get a sense as to whether it's a good match.

For more information about how to choose a therapist, see my article:  How to Choose a Psychotherapist.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, see my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.





















Monday, May 11, 2015

Psychotherapy Blog: Regaining Your Sense of Self After a Traumatic Event

It's not unusual for a change to occur in the way you see yourself after a traumatic event.  Assumptions that you made about yourself, whether these assumptions were conscious or unconscious, can seem off when you experience an event that was out of your control or beyond what you were able to handle.

Let's take a look at an example of this to demonstrate what I mean.

The fictionalized vignette shows how a traumatic event can change the way you feel about yourself and how I work with this kind of issue to help to integrate the experience and to help a client regain her sense of self:

Sandra
Sandra was a woman in her early 40s when she came to therapy to deal with the loss of her husband who had died a few years before in a car accident.

Regaining Your Sense of Self After a Traumatic Event

She attended cognitive behavioral therapy (CBT) a few months after her husband's death, and from that therapy she realized, on an intellectual level, that her husband's death wasn't her fault.  But on an emotional level she was still feeling deeply guilty, and she felt as if she didn't know herself anymore.

She described to me how, before her husband died, she felt like a competent person who was the one that others usually turned to for advice of help.   But after the car accident that killed her husband, Sandra was plagued by self doubt, self blame and a sense of foreboding about her future--even though she knew intellectually that she wasn't to blame.

On an emotional level, Sandra felt that she could have prevented the accident if only she had insisted that her husband get the brakes checked immediately when he said that he heard the brakes making a strange sound.

She did, in fact, tell her husband that until he got the brakes checked, he should use her car to drive to work.  But she felt that she didn't insist enough.  Her feeling was:  If only I had really insisted, he would be alive today.

As we went over the sequence of events, Sandra revealed that, even though her husband told her the night before that he would use her car because he didn't have time to go to the mechanic with his car, he left her a note the next morning while she was asleep that he decided to use his car because he didn't want her to be without her car for the day, and he said he would see the mechanic that night after work.  He told her not to worry--he was sure that everything would be okay.

That same morning, while Sandra, who worked from home on a business call, the police appeared at her door and told her that her husband was in a fatal car accident.  Even though she heard their words, she felt like she was in a surreal dream.

It was only after the police left that Sandra found the note that her husband left her on the kitchen table and she realized this was the last communication she would have with her husband and she felt the deepest sorrow she had ever felt in her life.

In our first session, Sandra spoke about feeling "crazy" that she could know one thing (she wasn't responsible for her husband's death) and, at the same time, she could feel the opposite (she was to blame).

Regaining Your Sense of Self After a Traumatic Event

I normalized Sandra's experience by letting her know that this is a common experience under these circumstances and she wasn't alone in thinking one thing but feeling another among people who had experienced this type of trauma.

Then I spoke to her about EMDR, Eye Movement Desensitization and Reprocess and how EMDR is used to process trauma (see my articles: What is EMDR? and How Does EMDR Work?).

During the next few sessions, Sandra and I worked on helping her to develop coping skills to work on the most traumatic event of her life, the death of her husband.

After she learned to do the Safe Place Meditation and she developed other emotional resources in our work together, we began to process the memory that she chose, which represented the worst part of her husband dying, which was the day the police came to her house and informed her that her husband was dead.

Part of the protocol in EMDR therapy is to ask the client what negative beliefs they have about themselves as a result of the traumatic memory that we're working on.

In Sandra's case, she said her negative beliefs about herself were, "I'm helpless" and "I'm a bad person."

As previously mentioned, before the traumatic event, Sandra felt like a good and confident person who could handle whatever came up in her life.  But after the accident that took her husband's life, Sandra felt just the opposite about herself.

As we processed the memory, Sandra experienced waves of sorrow that she didn't know were still there.  But she also experienced waves of deep relief between each wave.

This is what usually happens when people process loss during experiential therapy, like EMDR.  The emotional activation usually comes in waves with a build up, a peak and then a release of emotion which usually provides a sense of relief between waves.

Many people have the misconception that emotional activation will just peak in therapy and remain at that peak.  This misconception discourages some people from coming to therapy to work on their problems because they think it will be overwhelming, but for most people this isn't so.

Sandra went through feelings of guilt, self blame, and sorrow.  Then, as she continued processing the memory in our sessions with EMDR, to her surprise, she felt a sudden surge of anger towards her husband that she had never been aware of before:  "Why did he do this?" and "How could he do this to himself and to me?"

There was no question that it had been an accident, as opposed to a suicide, so this wasn't the issue.  The issue was that Sandra couldn't believe that her husband had been so irresponsible.

Even though these feelings were uncomfortable for her, this was a turning point in Sandra's therapy because, after her anger surfaced, she realized, on a deeply emotional level, that it actually wasn't her fault.  She realized that she had urged him to get the brakes checked and he was the one who chose to wait.

Regaining Your Sense of Self After a Traumatic Event

This turning point was very important to our work together because it was the first time that Sandra felt on a visceral level, as opposed to an intellectual level, that she really wasn't to blame and she said she realized, "I did everything that I could, but I couldn't stop him from choosing to drive the car with the faulty brakes."

Our work continued and Sandra was able to work through her sadness, self blame and anger. Using EMDR, she was also able to regain a sense of herself as a good and competent person. She also realized that there would be things in life that she wouldn't be able to control and she would have to accept this.

Summary
The vignette above about "Sandra" reveals that a traumatic event can dramatically change how we feel about ourselves, but experiential therapy, like EMDR, can help to restore that sense of self.

Unlike other types of therapy, like CBT, which might only provide an intellectual understanding, like it did for "Sandra," experiential therapy helps clients to have a visceral felt sense of what's real, which is what leads to people getting better in therapy.

Getting Help in Therapy
Many people live their whole lives with a diminished sense of self after traumatic events because they don't get psychological help.

If the issues that I've discussed in this article resonate with you, you owe it to yourself to get help from a licensed mental health professional who has experience working with emotional trauma and who uses experiential therapy, like EMDR, Somatic Experiencing or clinical hypnosis.

Getting help in therapy could make the difference between continuing to suffer with a diminished sense of self and feeling good about yourself.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.
















Saturday, May 9, 2015

Psychotherapy Blog: Relationships: The Problem With Trying to Change and "Improve" Your Partner

Are you someone who has the tendency to choose romantic partners that you try to change and "improve"to try to mold them into who you want them to be (see my article: I'll Change Him/Her After We Get Married) ?

Relationships: The Problem With Trying to Change and "Improve" Your Partner?

This is usually more of an unconscious process than a conscious one which often leads to disappointment and frustration for both people involved.

In healthy relationships people develop and grow together.  There is a mutuality.  There is reciprocity.  Each person contributes to the growth and development of the other in different ways.

The dynamic that I'm referring to in this article is where there's a pattern of choosing one romantic partner after the next as a "project" to be worked on, changed and "improved."

Often people who tend to engage in this dynamic focus on their fantasy of what they want their partner to be rather than who he or she is at the moment.  It's as if they get caught up in the fantasy and lose sight of the actual person in front of them (see my article:  Relationships: Are You In Love With Him or Your Fantasy of Him?)

Assuming that their partner goes along with this dynamic (for his or her own unconscious reasons), this becomes a codependent relationship where each person in this relationship usually ends up being frustrated, disappointed and resentful.

To explore this dynamic further, let's take a look at a fictionalized vignette:

Jane and Ed
When Jane met Ed, she was attracted to his gregariousness and easygoing nature.  Unlike the men that she usually met, he was kind and unpretentious.

Although she liked him and she was attracted to him, she felt that he needed to lose weight and, since she was so health conscious and physically fit, she knew that, with her help, he could lose the weight.

Relationships: The Problem With Trying to Change and "Improve" Your Partner

As they began to date, she wanted to be tactful about how she broached the topic of his weight.  So when he mentioned that he admired her for being so health conscious and fit, she saw an opening to talk to him about changes that he could make to be healthier.

Ed was open to hearing her suggestions and expressed a desire to lose weight and get fit, which thrilled Jane.  By the following week, he accompanied her to the gym and she invited him to her aerobic classes.

Within a few weeks, Ed was starting to lose weight and feel healthier.  He was grateful to Jane for her help, and Jane felt a great deal of satisfaction in helping Ed to make these changes.

A few weeks later, while she and Ed were at a party where her friends were talking about a book on the best seller list that , Jane realized that, compared to her, Ed wasn't as well read.  She felt embarrassed that Ed had nothing to contribute to the conversation about that book or any other books.

Not wanting to offend him, Jane talked to a close friend about this and asked her if she thought it would be offensive for her to give Ed a list of recommended books to read.

Her friend warned Jane against doing what Jane had done so many times before--working so hard to change the man that she was seeing and feeling frustrated and angry when it ended badly.

Jane understood what her friend was telling her, but she felt that this time it would be different.  She really cared for Ed and she felt that he could benefit from her guidance.  She didn't detect any of the resentment that she experienced from prior boyfriends.

Relationships: The Problem With Trying to Change and "Improve" Your Partner

But when she gave Ed a reading list, she was surprised at his reaction.  He took the list and looked at it with an absent stare.  Then, he handed it back to Jane and told her that he appreciated her intention, but he felt that she was saying he wasn't smart enough for her and this hurt his feelings.

Jane felt anger welling up in her and she took a moment to compose herself outwardly.  But inwardly her thoughts were racing:  How could he be so ungrateful?

They tried to talk about it, but their discussion devolved into an argument, so they agreed to take a couple of days apart to cool down and then talk again.

When Ed called her a few days later, he told her that, even though, he appreciated how much she helped him to be more fit and healthy, he felt hurt and annoyed that she was now trying to get him to change his reading habits--as if she was saying that he wasn't good enough.  He asked her if she could accept him as he is without trying to change him.

At that point, Jane realized how much she hurt and offended him and she felt badly about this.  But she also realized that she didn't want to accept him without trying to change him and this was a problem for each of them as well as for their relationship.

She thought about what her friend told her and she realized that, once again, she was on the brink of ruining another relationship by trying to change and "improve" Ed.

Although she felt confused and conflicted, Jane apologized to Ed for hurting his feelings and she told him that she needed more time to think about why she was doing this.  So, they both agreed to take a break from each other for a few weeks until they could both sort out their feelings.

At the suggestion of her best friend, Jane got into therapy to try to understand why she was always trying to change and "improve" the men that she went out with and why she kept doing it even though things ended badly each time.

Exploring her family history revealed that Jane's mother did the same thing with Jane's father, pushing him into one self improvement endeavor after another.  And even though Jane's father, who was passive, went along with it, her mother would still express to Jane, from the time Jane was a young child, how dissatisfied she felt with her marriage.

Jane became aware that, without even realizing it, she came to believe that all men needed improving and it was the woman's role to change them.

When these unconscious beliefs came conscious for Jane, she was surprised and dismayed.

Awareness is the first step in making a change and, with this new awareness Jane realized why she tried to "make over" her boyfriends.  She also realized that she wanted to stop.

Using EMDR, over time, we processed her childhood experiences that were triggering her current behavior (see my article:  Overcoming Childhood Trauma That Affects Your Relationship).  She was able to process her anger and disappointment towards both parents as well as the distorted beliefs that arose from her childhood experiences.

Relationships: Learn to Stop Trying to Change and "Improve" Your Partner

Once the triggering experiences were gradually processed using EMDR, Jane no longer had the urge to try to change Ed, and her relationship improved over time as she accepted him as he was and she stopped trying to change him.

Conclusion
People who get into one relationship after the next where they're trying to change their romantic partners tend to have underlying issues that trigger this behavior.

Often, these underlying issues are unconscious and once they are made conscious, this awareness is the first step in changing this dynamic.

But awareness isn't enough.  The underlying issues need to be processed and experiential therapy, like EMDR, is usually the best type of therapy for processing.

Usually, after the underlying issues that are triggering the behavior are processed, the current behavior tends to change.

In the fictionalized vignette in this article I gave a particular family dynamic that triggered these issues for "Jane," but there can be many other underlying issues.

Getting Help in Therapy
If you have a tendency to try to change and "improve" your romantic partners, you could benefit from seeing a licensed mental health professional who uses experiential therapy so you can work through the underlying issues that are triggering this behavior.

Overcoming the urge to change your romantic partner is beneficial for you, your partner and your relationship.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.