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Thursday, December 18, 2014

Psychotherapy Blog: How to Recognize Passive Aggressive Behavior in Your Relationship

Learning to recognize passive aggressive behavior in your relationship is the start of not only becoming aware of this behavior but also the first stage in changing it before it ruins your relationship.

How to Recognize Passive Aggressive Behavior in Your Relationship

Whether you're the one who is being passive aggressive or it's your partner/spouse, engaging in this behavior usually compounds whatever problems there are in the relationship.

What is Passive Aggressive Behavior?
Passive aggressive behavior is a passive resistance to whatever is going on between you and your partner.  It can be expressed in a variety of habitual behavior including:
  • procrastination
  • forgetfulness
  • obstructive resistance
  • stubbornness
  • irritability
  • caustic comments
  • petty complaints
  • vacillation/ambivalence
  • grumbling
  • sabotaging behavior
  • hostile comments
  • veiled hostile comments
  • resentfulness
  • sarcasm
  • belittling comments
  • covert belittling
Anyone can have a bad day and engage in one or more of the behaviors above, so please note that I have italicized the word "habitual" with regard to the list of behaviors.

The following scenario, which is a fictionalized account of passive aggressive behavior in a relationship, illustrates how this behavior can play out in a relationship:

Sue and Mark:
Sue and Mark had been married for 10 years.  They tended to argue whenever Sue asked Mark to do something that he really didn't want to do but that he would not directly address.  Instead, he would engage in passive aggressive behavior.

How to Recognize Passive Aggressive Behavior in Your Relationship

They considered couples counseling for several years because they would argue about Mark's passive aggressive behavior.  But their last argument, when Mark's procrastination in taking care of a simple plumbing job at home worsened the problem and resulted in an expensive plumbing bill with a licensed plumber, was the last straw.  After talking it over, Sue made the appointment for them to get help in couples counseling.

Sue arrived first and she waited in the reception area for Mark to arrive.  About five minutes before the session was scheduled to start, Mark called her to let her know that he took a nap, forgot to set the alarm, and now there would be no way for him to get to the appointment before the appointment time was over.  They would have to reschedule.

Sue was fuming as she rescheduled the appointment and said, "This is just one example of many of Mark's passive aggressive behavior."

During the second scheduled appointment, Mark arrived on time, but he forgot his checkbook, so he was unable to write a check for the session.  Once again, Sue was fuming because they had agreed in advance that Mark would bring his checkbook and pay for this session.  Instead, they spent several minutes at the end of the session going through whatever cash they had so they could pay for the session.

A future blog post will continue will illustrate how this problem can be overcome in couples counseling.

Getting Help
People who engage in passive aggressive behavior are often unaware that they are doing this, especially if it is longstanding, ingrained behavior, but they can learn to recognize the signs of this behavior and they can also learn to change it.

A licensed mental health practitioner, who has expertise in this area, can help you to determine if individual or couples therapy is best.

If the scenario above is familiar to you, you owe it to yourself, your partner and your relationship to get help.

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

I have helped many individuals and couples to change negative ways of interacting so they could have happier relationships.

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:

Monday, December 15, 2014

Psychotherapy Blog: Choosing Healthier Romantic Relationships

One of the main reasons why people come to therapy is to learn to choose healthier romantic relationships.  This usually follows a long pattern of choosing emotionally unhealthy relationships where there has been hurt, anger, disappointment and, at times, abuse (see my article:  Are You Attracted to People Who Hurt You?).

Choosing Healthier Romantic Relationships

Confusing Sexual Attraction With Love 
There are many reasons why people develop a pattern of choosing unhealthy relationships.  Most of the time, these choices are unconscious so they are out of people's awareness.

One reason, as I mentioned in an earlier article, Relationships: Confusing Sexual Attraction With Love, is that people make decisions about relationships based on sexual attraction because they confuse this with love.

Falling In Love With Love
At the beginning of a relationship confusing sexual attraction with love often leads to confusing reality with fantasy as people fill in the gaps of what they don't know with what they think they know about a new romantic interest (see my articles:  Relationships: Falling In Love With Love and Are You In Love With Him or Your Fantasy of Him?)

What If You're Only Attracted to People Who Aren't Good For You?
This is a common problem.

What If You're Only Attracted to People Who Aren't Good for You?

Romantic attractions are complex phenomena that are based on unconscious patterns--whether they lead to healthy relationships or not.

All of us, to a greater or lesser degree, are attracted to people who remind us, on an unconscious level, of our earliest relationships with our parents.

People who were lucky enough to have grown up in emotionally healthy families are usually less willing to put up with unhealthy relationships because these patterns are unfamiliar to them.

If they do get into an a relationship with someone who isn't good for them, they're less likely to stay in it because they're aware that it's not good for them and they don't want it.

For people who were not fortunate enough to grow up in a healthy family, they're more likely to be drawn to romantic partners who will repeat similar patterns to the ones that they experienced in their early family relationships.

Choosing Unhealthy Relationships Without Being Aware of It

As I mentioned, for most people this is an unconscious process.

Becoming aware that this is your pattern is the first step.

The next step is changing this pattern in therapy so you don't continue to choose unhealthy relationships.

But many people despair that they'll either continue choosing unhealthy relationships, based on their attractions, or they fear that they'll have to settle for someone that they're not attracted to at all.

Given this perspective, people who make unhealthy choices in relationships often feel pessimistic about changing this pattern.

From Unhealthy to Healthy Relationships:  Developing an Attraction Over Time
Very often, people who become instantly attracted to someone who isn't good for them do so based on an instant attraction and fantasy of who that person is.

I don't know how many times I've heard clients in my psychotherapy private practice, who have this problem, tell me that they always seem to choose the one person in a crowded room who will eventually make them unhappy.

On the face of it, this seems strange:  How can this keep happening?

As I mentioned, attraction is a complex phenomena but, on an unconscious level, we're constantly picking up information about other people without even realizing it.  Some people think of this as "picking up a vibe."  So, there can be 100 people at a party and the person who keeps repeating the same pattern of choosing someone who is unhealthy for them will unconsciously find that person in the crowd.

This is why I usually tell clients to question overpowering instant attractions where they don't really know the person that they're attracted to.  These kinds of instant attractions, where people often feel bowled over by a new person, usually has the seeds of dysfunction.

This is why it's so important, if you're interested in getting into a healthy relationship, that you take things slowly and take the time to get to know the person.

Contrary to what many people think, attractions can develop over time as you get to know someone.  These attractions, which aren't based on fantasy or unconscious unhealthy choices, are more likely to lead to a healthy relationship than the overwhelming instant attraction.

For people who grew up with a lot of "drama" in their family this can sound boring.  They're used to high highs and low lows, so that if things are going on an even keel, they feel something is wrong because they're "hooked" on drama (see my article:  Hooked on Drama: Getting Off the Emotional Roller Coaster).

Before they can get "unhooked" from dramatic and dysfunctional relationships, they usually need to work through a history of unresolved family trauma that is at the heart of these patterns of choosing romantic relationships.

From Unhealthy to Healthy Relationships:  Developing an Attraction Over Time

Attractions that develop over time are usually based on things that are more substantial than physical attraction.  Sexual chemistry can and does develop over time.

Becoming Emotionally Healthy Makes Dysfunctional Relationships Less Attractive
One of the problems for people who choose unhealthy, dysfunctional relationships is not only that they have an attraction for them, but they have a high tolerance for emotional (and sometimes physical) abuse.

As people become healthier in therapy, these unhealthy relationships become unappealing.

The challenge is often sticking with therapy long enough to work through the early family trauma.

Getting Help in Therapy
If you have a pattern of choosing unhealthy relationships, you could benefit from overcoming this problem in therapy with a licensed mental health professional who has experience helping clients with this issue.

This is a common problem for many people who grew up in dysfunctional families, and change can be challenging.  But many people, who seek help in therapy, do change.

Rather than going through your life continuing to choose unhealthy relationships, you can get the help you need to begin choosing healthy loving relationships.

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, December 13, 2014

Psychotherapy Blog: Self Reflection and Basic Mindfulness Techniques

In my previous article, Creating Time for Self Reflection: Mindfulness, I began a discussion about mindfulness as one way to engage in self reflection and included some of the benefits of mindfulness.

Self Reflection and Basic Mindfulness Techniques

In this article, I'll continue the discussion by providing some basic ways that you can begin to develop a mindfulness practice on your own, if you haven't done so already, so that you can reap many of these benefits.

The Roots of Mindfulness Practice
Although mindfulness has its roots in Buddhism, there are many other religions and spiritual practices that include some form of prayer or meditation technique that can be considered mindfulness techniques.

The Roots of Mindfulness:  Buddhism

But you don't have to be religious or even consider yourself to be a spiritual person to practice mindfulness in your everyday life.

Jon Kabat-Zinn, the founder and former director of the Stress Reduction Clinic at the University of Massachusetts Medical Center, helped to bring attention to mindfulness practices to the general public.

The research that he conducted among patients showed that mindfulness practice can lead to physical and psychological improvements.

Basic Mindfulness Techniques
I think that many people, who aren't familiar with mindfulness techniques, believe that mindfulness techniques tend to be mysterious esoteric practices that would be difficult to learn and, as a result, they feel discouraged about learning to engage in mindfulness.

But, as I mentioned before, practicing mindfulness doesn't have to be connected to any form of religion or spirituality (although it can be), and it doesn't have to be complicated at all.

There are many ways to practice mindfulness, so I'm going to begin with very basic techniques that can help you to get started.

Mindfulness and the Mind-Body Connection
One of the reasons why I love using mind-body oriented approaches to therapy, like EMDR, clinical hypnosis and Somatic Experiencing in my psychotherapy practice in NYC, is because I believe that the mind-body connection is crucial for overall health and well being, and these types of therapy all have in common that they focus on the mind-body connection.

Mindfulness and the Mind-Body Connection

Since my focus in this article is how you can begin to develop basic mindfulness techniques on your own, I'll begin with the simplest techniques that don't involve attending psychotherapy.

A Basic Mindfulness Technique:  Noticing Body Sensations
One basic way to practice mindfulness is to just notice the sensations in your body.

To practice mindfulness in this way, you don't need to know how to meditate and you don't even need to know anything about the mind-body connection.  You just focus on your body.

A Basic Mindfulness Technique:  Noticing Sensations in Your Body

Here are some simple steps:
  • Focus on the physical sensations that you're experiencing right now.
  • Notice what you're sensing in your body without judgement, which means just noticing.  This can include noticing an itch, a tingling sensation, a pain, a sense of fullness or emptiness in your stomach, muscle tension, scratchiness in your throat, and so on
  • If you like this technique, you can start at the crown of your head and do a slow body scan from head to toe and just notice what you feel--again without judging it.
  • If you get distracted, it's okay.  Just bring your attention back to your body.
Another Basic Mindfulness Technique:  Noticing Your Emotions in Your Body:
After practicing noticing body sensations, if you find you enjoy this, you can add noticing your emotions in your body.

A Basic Mindfulness Technique:  Noticing Your Emotions in Your Body

This is a technique that I use with clients in my psychotherapy private practice with EMDR, Somatic Experiencing and clinical hypnosis, but you can also do it on your own (see my article:  Mind-Body Psychotherapy: The Body Offers a Connection to the Unconscious Mind).

Basic steps to noticing your emotions in your body:
  • Begin by noticing body sensations (as outlined above).
  • After you do a body scan from head to toe, begin to notice where you feel emotions in your body without judgment.
  • If you're new to this, it's easier to start by noticing certain sensations in your body and beginning to tentatively identify which emotions this might be related to.  So, for instance, if you sense tension in your jaw, tension in your shoulders or clenched stomach muscles, ask yourself what emotions might be connected to these sensations.
As you practice noticing emotions in your body, you will become better at identifying these emotions and using this information to develop a greater sense of self awareness.

One of the keys to practicing these mindfulness techniques is being nonjudgmental.  So, if you find yourself beginning to berate yourself for feeling certain sensations or emotions, just notice that you're doing this and, if you can, allow those judgmental thoughts to float away.

Another Basic Mindfulness Technique:  Notice Your Cravings
Noticing your cravings can help you to become more mindful of your cravings, whether it's a craving for food, alcohol, drugs, overspending or whatever it is.

A Basic Mindfulness Technique:  Notice Your Cravings

Whatever the craving is, if you just notice it first, rather than immediately giving in to your craving, you'll soon discover that cravings often come and go.

Basic steps to notice your cravings:
  • Begin by doing a body scan, as outlined earlier in this article.
  • Notice, without judgment, where you're experiencing these cravings in your body (mouth, stomach, etc).
  • Rather than denying or actively trying to get rid of the craving, just allow it to be.  If you don't indulge in the craving, it often just passes.
  • Notice what it feels like in your body and emotionally to have the craving come and go.
Another Basic Mindfulness Technique:  Mindfulness Meditation
There are many ways to practice mindfulness meditation, so I'm going to focus on a basic way to get started.  After you've practiced for a while, you can find your own way to practice.

A Basic Mindfulness Technique:  Mindfulness Meditation

Basic steps to practice mindfulness meditation:
  • Find a quiet place and time where you won't be interrupted for at least 15 minutes (you can increase the time, if you like, as you develop your mindfulness meditation practice).
  • Sit quietly and notice your breathing.
  • Notice what it feels in your body to breathe in and what it feels like to breathe out.
  • Allow your thoughts to come and go without judging them or trying to hold onto them (this includes both "negative" thoughts as well as positive thoughts).
  • If you get distracted, bring your attention back to your breathe again.
Later on, if you like mindfulness meditation, as I mentioned, you can develop your own unique way of practicing.  But, in the beginning, this is all you need to do to start.

Practicing Acceptance, Self Compassion and Being Nonjudgmental
Allowing judgmental thoughts to come and go can take practice.

Self Reflecting and Basic Mindfulness Techniques:  Acceptance and Self Compassion

When you start practicing mindfulness techniques, you might need to allow these thoughts to come and go many times.  That's okay.  It usually gets easier over time with practice.

Getting Help in Therapy
Many people have problems getting started with basic mindfulness techniques on their own because they feel overwhelmed with emotional problems.

If you're feeling emotionally overwhelmed, you're not alone.

Seeing a licensed mental health practitioner can help you to overcome your problems so that you can live a more fulfilling life.

Seeing a psychotherapist who has a mind-body oriented approach to therapy can help you to work through your problems in a more holistic way.

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.

Psychotherapy Blog: Creating Time for Self Reflection: Mindfulness

In a recent conversation that I had with a therapist, who is a friend and colleague, we talked about how, generally speaking, many people seem to value "staying busy" much more these days than spending even a small amount of time on self reflection.

Creating Time for Self Reflection:  Mindfulness 

I believe that this overall decrease in self reflection, in turn, has lead to detrimental health effects, lack of satisfaction with life, a deterioration in important relationships for many people as well as a disregard for the environment and the health of our planet.

In a prior article, Psychotherapy and the Mindful Self: The Benefits of Mindfulness in Therapy, I focused on why I'm a proponent of mindfulness in therapy.

In this article, I'll discuss why I think mindfulness, as one form among many, of self reflection, has overall health and mental health benefits whether you're in therapy or not.

Why Is Self Reflection Important?
I know a lot of people pooh-pooh the idea of taking time for self reflection and refer to it derisively as "navel gazing."

At the same time, people who actually do spend some time each week either practicing mindfulness, meditating, doing yoga, journal writing or coming to therapy to reflect on their lives, tend to express much more satisfaction with their lives than people who focus on just "keeping busy."

There can be many reasons why people keep themselves distracted by "keeping busy" (see my article:  Are You "Keeping Busy" to Avoid Painful Emotions?).

Creating Time for Self Reflection:  Mindfulness

By "keeping busy" most of the time, it's easy to live in a "mindless" way without self reflection or empathy for yourself and others.

Life can feel meaningless, shallow and overly routine as you become more disconnected from yourself, significant people in your life and your environment (both personal environment as well as the environment of our planet).

Becoming Mindful of the Environment of Our Planet

More than ever, I'm hearing from clients in my psychotherapy private practice in NYC that they're feeling an increased sense of loneliness and alienation.

I think there are many reasons for this, including an emphasis on "staying busy," less time for self reflection as well as less meaningful in-person contact with significant others--just to name a few causes of this complex phenomena.

As with anything, there needs to be a balance between spending time on self reflection and taking care of your responsibilities, working, having fun and everything else that is part of a full life.

By "Keeping Busy" Most of the Time, It's Easy to Live in a "Mindless" Way

We can always find something else "to do" that can eliminate time for self reflection, so it's usually a matter of making it a priority and creating the time to do it, much as you would for anything else that you feel is important.

Once you create the time for self reflection and develop this as a healthy habit, it often doesn't take a lot of time to reap the benefits.

Mindfulness and Self Reflection
Mindfulness is one way to engage in self reflection.

Creating Time for Self Reflection:  Mindfulness

Even just 15 minutes a day of mindfulness can help improve your overall health and sense of well being, and these benefits include:
  • focusing on the here-and-now rather than focusing on regrets about the past or worrying about the future
  • developing a greater capacity to form meaningful connections with others
  • developing better coping skills
  • cultivating a healthier perspective about life
  • improving sleep
  • alleviating gastrointestinal problems
  • alleviating depressive symptoms
  • alleviating symptoms of anxiety
  • helping with obsessive compulsive disorder
  • lowering blood pressure
  • reducing chronic pain
  • helping to improve communication in relationships
  • developing a healthier appreciation of the environment
These are just some of the many benefits.

When you consider the substantial benefits of mindfulness, isn't it worth spending 15 minutes to help improve your health and overall sense of well being?

In my Self Reflection and Basic Mindfulness Techniques, I'll discuss some simple ways that you can practice mindfulness to get started.

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.

Sunday, December 7, 2014

Psychotherapy Blog: Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 2

I began discussing this topic in my prior article, Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 1.  In Part 1, I outlined the problems of taking a "band aid" (also known as a "quick fix") approach to resolving psychological problems.  In that article, I discussed the problems involved in only taking psychotropic medication (instead of also attending psychotherapy) or only attending a few sessions of therapy to vent and feel better momentarily without resolving the underlying issues related to the problem.

Beyond the "Band Aid" Approach to Overcoming Psychological Problems

In this article, I'll expand on this topic by giving a composite scenario, which is made up of many different cases with all identifying information changed to protect confidentiality:

Ted had a long history of anxiety that began when he was a young child.

He was the oldest of five children in a family who lived from one crisis to the next.  Both parents worked two jobs and so Ted was usually in charge of taking care of his younger siblings.

Ted's anxiety began when he was a child
Ted, who was too young to take care of siblings, often felt overwhelmed.

He never allowed his parents or siblings to see how anxious he was, so he felt alone with his fears and sense of inadequacy.

Fortunately, by the time Ted went away to college, his family's financial situation had improved substantially so his parents no longer needed to each work two jobs, and Ted was free to go away to college.

But even with the improvement in their financial resources, the family was so accustomed to being in crisis that they would often react to common everyday family problems as if there was a crisis.

Both of the parents came from traumatic, crisis-oriented family backgrounds and neither had ever gone for psychological help, so this pattern was deeply ingrained and passed on from one generation to the next (see my article:  Psychotherapy and Transgenerational Trauma).

While Ted was in college, he often received calls from family members who were reacting to everyday problems as if they were crises.  This exacerbated Ted's anxiety to the point where he wasn't sleeping and he had some difficulty concentrating on his schoolwork.

When Ted was in college, he had problems concentrating on his work
After suffering several weeks with insomnia and poor concentration, Ted came home to see his family doctor, who placed him on an anti-anxiety medication called Xanax.

For a period of time after that, Ted took Xanax whenever he felt anxious and it helped him to calm down.  But it didn't help him to overcome the underlying issues that were creating problems for him.

One of those problems was that Ted continued to feel deeply inadequate.  What started as a sense of inadequacy about himself as a child trying to take care of his siblings continued into his adulthood in every area of his life.  And, although the medication helped to take the edge off of his anxiety, it didn't change the way he felt about himself.

Even worse, he began to realize that he needed more and more Xanax in order to function, and he knew that he couldn't go on this way.

Ted's doctor referred him to a psychotherapist

With the help of his doctor, he titrated off Xanax, he accepted the doctor's referral for psychotherapy to a licensed psychotherapist, and he attended a few therapy sessions.

During those sessions, he felt better after talking to the therapist and he also developed a basic understanding of why he felt anxious.

Once he felt some relief, he decided to leave therapy against the therapist's advice, believing that his problems were resolved.  But having a basic understanding about his problems wasn't the same as resolving his problems (see my article:  Healing From the Inside Out: Why Understanding Your Problems Isn't Enough).

In addition, his anxiety returned after the "feel good" feelings wore off.  So, he went to see another therapist, who advised that Ted remain in therapy to work through the underlying issues that were causing Ted's problems  But, once again, after he began feeling better, Ted left therapy (see my article:  When Clients Leave Therapy Prematurely).

After repeating this pattern several times with the same results, Ted felt frustrated and discouraged.  He wondered if, perhaps, therapy didn't work for him.  But he spoke with a close friend, who told Ted how sticking with therapy helped him and Ted realized that his pattern of leaving therapy after a few sessions was the real problem.

Beyond the "Band Aid" Approach:  Getting Help in Therapy

Once Ted accepted this and made a commitment in his next therapy to remain until he worked through the underlying causes of his psychological problems, he was able to work through his problems in therapy with a skilled therapist who was empathetic and supportive.

Getting Help in Therapy
"Band aid" or "quick fix" approaches to overcoming psychological problems rarely work.

Overcoming psychological problems requires a commitment to complete the process beyond "feeling good" temporarily.

If you're struggling with problems that haven't responded to your own efforts or to "quick fix" attempts, you could benefit from the help of a licensed mental health professional who can help you work through your problems beyond just "feeling good."

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.

Psychotherapy Blog: Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 1

In most cases getting psychological help should be more than just a "band aid" or "quick fix" approach, especially for people who have a history of trauma or who have complex psychological problems.  

Beyond the "Band Aid" Approach to Overcoming Psychological Problems

Unfortunately, the "band aid" approach has been a trend in mental health for the last decade or so and there's no sign that this will change any time soon.

What Are "Band Aid" or "Quick Fix" Approaches to Psychological Problems?
For a variety of reasons, including the heavy promotion of psychotropic drugs by pharmaceutical companies who are making huge profits, many more people, who really need more in-depth psychological treatment, are being encouraged to seek "quick fix" solutions to their problems.

Beyond the "Band Aid" Approach to Overcoming Psychological Problems

The "band aid" or "quick fix" solution often involves just taking medication or a "triage" approach to therapy.

The "band aid" approach is usually inadequate for most people because without psychotherapy, clients don't develop an understanding about their problems, nor do they develop skills to overcome these problems.

Psychotropic Medication Alone Isn't as Effective as Psychotherapy For Many Psychological Problems
While it's true that in many cases psychotropic medication might be necessary to help with stabilization, there are also many more cases where clients are encouraged to rely solely on medication when they could benefit more from attending psychotherapy.

In addition, there are often side effects to psychotropic medication that clients are unaware of before they start taking them.  Some of the side effects are mild, but some are more significant.

Also, what happens when clients want to stop medication (hopefully, in collaboration with their doctor)?

Very often, when people stop taking medication and they haven't attended therapy, they return to their former level of psychological functioning without the medication because they haven't learned, beyond taking a pill, what changes they can make themselves to overcome their problems.

So, in many cases, they resume the medication, and it becomes an endless cycle.

Medication Alone Usually Isn't as Effective as Therapy For Many Psychological Problem
This isn't to say that people should stop taking psychotropic medication without consulting with their doctor.  As I've said, there are particular problems (like schizophrenia or bipolar disorder, to name just two) where medication is necessary.  There are also times when medication can be helpful as an adjunct to therapy.

The problem arises when clients only take medication without attending therapy.

Many people, who rely solely on medication, would benefit more from seeing a licensed psychotherapist.

What is the Triage Approach to Therapy?
Aside from just taking medication, triage therapy is where the client comes to therapy in crisis and the therapist helps the client to feel better momentarily in a few sessions without getting to the root of the problem.

Beyond the "Band Aid" Approach to Overcoming Psychological Problems

For some people, like people who are in war-torn countries or who experience natural disaster, who have limited access to therapy, and who are in crisis, triage therapy might be all that is possible.  In those cases, triage therapy is better than no therapy at all.

But aside from these unique circumstances, the problem with this approach is that, while the client might "feel better" momentarily because she or he vented about the problem for a few sessions, the client has no meaningful understanding of the problem.  In other words, aside from "feeling good" for the moment, nothing substantial has really changed.

When this occurs, these clients feel some relief from their psychological problems which, of course is important, but this relief is usually short lived.  And since nothing of substance has changed for them psychologically, they will often return again and again (either to the same therapist or to a different therapist) when the temporary feelings of relief have subsided.

Temporary Feelings of Relief in Therapy Can Lead Eventually to a "Revolving Door" Cycle 

This can set up a "revolving door" cycle for many clients.  After many of these attempts, they often get discouraged and feel that therapy "doesn't work" for them.  They don't understand, and no one has ever educated them, that there's no shortcut to making significant changes and that while there might be different forms of therapy that tend to be shorter and more effective than others, the "quick fix" approach of only attending a few sessions usually doesn't work for long.

How Can Psychotherapy Help?
When a skilled mental health professional provides psychotherapy services, it can help clients by:
  • providing an empathic and supportive environment where clients feel cared about and understood (for many people, this might be their first meaningful experience of feeling really heard and cared about in their lives)
  • empowering clients to understand their problems, including dysfunctional patterns that they keep repeating in their lives
  • helping clients to develop the necessary internal resources and skills they will need to make and sustain important changes 
  • helping clients to work through and overcome psychological problems 
The "band aid" approach, whether it involves just taking medication or a triage approach in therapy, doesn't do this.

In the next article, I'll give an example to clarify why the "band aid" approach usually doesn't work and how psychotherapy can be beneficial (see my article:  Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 2).

Getting Help in Therapy
In the meantime, if you've either tried on your own or you've only ever sought a "quick fix" approach to your problems, you could benefit from attending therapy with a licensed mental health professional who will work with you to empower you in a meaningful way to resolve your problems.

Getting Help in Therapy in a Meaningful Way

Rather than looking for shortcuts that don't work, you could have a more meaningful experience in therapy so you can overcome your problems and live 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, you can call me at (212) 726-1006 or email me.

Saturday, December 6, 2014

Psychotherapy Blog: Learning to Feel Hopeful in Therapy: Developing a Stronger Sense of Self

In a prior article, Learning to Feel Hopeful in Therapy , I began a discussion about how difficult it can be for psychotherapy clients, who have a history of emotional trauma and who have not been healed by therapy in the past, to allow themselves to be vulnerable enough to feel hopeful in therapy again.

Learning to Feel Hopeful in Therapy:  Traumatized Clients Often Have a Hard Time Opening Up

In that article, I discussed that my experience (and the experiences of many other trauma therapists) has  been that a mind-body oriented approach in therapy tends to be more helpful in terms of healing trauma than regular talk therapy.

I also discussed the ongoing research about the neuroplasticity of the brain, how this research helps us to realize now, more than ever, that the brain can change itself and, as result, there can be a resolution to emotional trauma under the right circumstances in therapy.

For many clients, who have been devastated by emotional trauma and who were unable to trust their primary caregivers as children, the idea that they could expose their emotional hurt and pain to a therapist seems incomprehensible.

From the point of view of many of these individuals:  Why should they trust a therapist when they couldn't trust their primary caregivers who were supposed to love and protect them?

People Who Have Been Traumatized Often Have a Hard Time Trusting in Therapy

Even worse, if they've been to therapy before and they had bad experiences, they're now doubly afraid of opening up again.

As a psychotherapist, I hear this often and I can understand why it would be very frightening for these individuals to open themselves up to be emotionally vulnerable.

Often, these people come to therapy because they're in so much emotional pain and they really long for relief.

At the same time, many of them are so afraid that they're ready to bolt from therapy if, from their perspective, there's a chance of getting hurt again.

Developing Coping Strategies in Therapy:  Developing the Capacity for Emotional Regulation 
When I know that there has been significant trauma and the client is fearful of opening up in therapy, I usually start with helping them to develop the kinds of internal resources and coping skills that will empower them to open up.

Preparation for Trauma Therapy:  Developing Coping Strategies in Therapy

When I help clients through the resourcing phase of treatment, I develop an individualized plan for each client.

Resourcing includes ways that clients can learn emotional regulation, which is so important for people who have suffered trauma, especially early childhood trauma.

Early trauma can leave a child feeling helpless, abandoned and unable to contain the overwhelming emotions related to the trauma.  Often this is because his/her primary caregiver was either unavailable (physically and/or emotionally) or unable (due to her own trauma) or unwilling to help the child to contain overwhelming emotions.

Early Abuse or Neglect Can Result in an Inability Later on as an Adult to Regulate Emotions

As I mentioned in the prior article, early childhood abuse and/or neglect often results in deficits to the orbitofrontal cortex (in the right hemisphere of the brain) at around the time that this part of the brain is developing in an infant.

If there are no other mitigating factors (like another family member who helps the child), this deficit will result in the child's inability to self soothe or regulate difficult emotions.

When this inability to self soothe and self regulate continues into adulthood, which it usually does, the adult often feels bombarded and buffeted by life's many emotional challenges, even if these challenges aren't traumatic per se.

For these children and adults, instead of responding to problems, they automatically react in an impulsive way (see my article:  The Mind-Body Connection: Responding Instead of Reacting to Stress).  This causes many problems in both personal and work-related interpersonal relationships.

So, learning to self soothe and develop a greater capacity for stress is a key component to the initial stage of my work with clients, who never developed these skills, before we do any trauma work.

Although most clients find this very helpful in their lives as well as a preliminary step to doing trauma work, there are some clients who want to begin doing the processing of trauma immediately.

From their perspective, they've been suffering long enough and they want relief now from their emotional problems.

While I understand and empathize with these clients, I also know, based on my clinical experience, that if these clients have little to no tolerance for difficult emotions, they would become too overwhelmed if we began by processing the trauma immediately.

If they become too overwhelmed, they could have one of several adverse reactions.  They could:
  • leave treatment prematurely because they can't tolerate what comes up in trauma therapy
  • dissociate (become emotionally numb) so that they're no longer aware of what's happening in the therapy and no longer present in the room emotionally for processing their problems
  • become rageful, overwhelmingly sad and/or avoidant
  • feel powerless 
  • feel ashamed
  • feel guilty because they think they "should" be able to handle their emotions
  • become distrustful of the therapist and the therapy so that there is a treatment impasse
  • have physical reactions where their overwhelming emotions become somatized due to the mind-body connection (migraine headaches, irritable bowel syndrome, asthma attacks, and so on)

This list represents only a few of the possible adverse reactions that people could have when the therapist allows them to start processing emotional trauma before these clients have developed the internal skills and resources to handle it.

I don't want to make trauma therapy sound like it's dangerous in and of itself.  I just want to emphasize that it's important for clients to be prepared by the therapist before they start processing trauma.  The preparation phase of treatment shouldn't be skipped over no matter how much a client insists.

Often, by developing a greater emotional capacity and tolerance, clients who start out being impatient to begin learn to be more patient.

On the other hand, there are some clients who come to therapy to work on emotional trauma who have done a lot of work either in a prior therapy or on their own so that they come to trauma therapy with a capacity to begin doing work.  But this is something that the therapist must assess clinically before doing the trauma work.

Empowering Clients to do Trauma Therapy
The preparation (or resourcing) phase of trauma therapy, whether the therapy is EMDR, Somatic Experiencing or clinical hypnosis, helps to empower the client to do trauma therapy.

Empowering Clients in Therapy

It's very gratifying and heart warming for me when I see a client develop in this way.

The client might have come in with very little in the way of the capacity for emotional regulation or frustration tolerance.  But as we work on helping him or her to develop these skills, s/he becomes more confident and open to doing the trauma work.

Strengthening the Rapport and Trust Between Client and Therapist
The preparation phase also helps to strengthen the rapport between the client and therapist, which is necessary for any therapy to be successful.

When the therapist helps the client to develop better coping skills, including emotional regulation and self soothing skills, the client usually feels cared for by the therapist.

For some clients, this might be the first time that they've had the experience of being cared about, so this  is an important step.

Strengthening the Rapport and Trust Between Client and Therapist

Knowing that the therapist cares about them and empathizes with their feelings helps clients to develop trust which, in turn, helps them to feel more hopeful and motivated about the therapy.

This is a very individual process and it will be different for each client.

This doesn't mean that the therapy will go forward without any problems between the therapist and the client.

After all, therapists are human and they make mistakes.  What's more important is how these mistakes get resolved.  In other words, there can be ruptures in therapy, due to misunderstandings or mistakes, but the most important thing is how these ruptures get repaired (see my article:  Psychotherapy: Ruptures and Repairs in Therapy).

Even though going through the repair process, after a therapeutic rupture, can be challenging for both client and therapist, it can also be a healing experience.

It keeps the therapist humble.  It also gives clients, who might only have ever grown up with ruptures and no repairs, an experience that interpersonal difficulties can be repaired so that the therapeutic relationship can continue to develop and flourish.

Aside from what I've discussed above, there are many other ways to develop a stronger sense of self in therapy with the help of an experienced trauma therapist.

Mind-Body Oriented Psychotherapy
After the client has developed the necessary skills and a stronger sense of self during the preparation phase, the processing of the trauma can begin.

The Mind-Body Connection

As I mentioned in my prior article, there are various types of mind-body oriented therapy for trauma therapy, including EMDR, Somatic Experiencing and clinical hypnosis.

Some treatment modalities work better for some clients than others.  This is why it's important for trauma therapists to have a repertoire of ways to work to help as many clients as possible rather than relying on only one way.

This topic merits a book rather than a couple of articles.   I hope I've given people, who might be interested, a sense of what works in trauma therapy and how clients (whether they're reluctant to feel hopeful initially or they're prone to jump in too quickly) can be helped by a therapist who is a trauma specialist.

Getting Help in Therapy
If you've been unable to work through your problems on your own, you could benefit from working with a licensed mental health professional who has experience helping clients to overcome difficult emotional problems.

Getting Help in Therapy

Clients, who have worked through their emotional trauma, often describe a sense of freedom with more energy to focus on what they want in their lives.  They often go on to have more fulfilling lives once they're no longer struggling with emotional difficulties.

Rather than struggling on your own, you owe it to yourself to get professional help from a licensed therapist so you too can live 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.

One of my specialties is helping clients to overcome trauma.

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.