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Monday, March 30, 2015

Psychotherapy Blog: Dynamics of Adult Children of Dysfunctional Families

The Adult Children of Alcoholics World Service Organization outlines a laundry list of 14 traits of Adult Children of Alcoholics (ACOAs).  These traits often apply to adult children of dysfunctional families.

Dynamics of Adult  Children of Dysfunctional Families

As a psychotherapist who specializes in working with trauma, I work with individuals and couples who are challenged by these characteristics and who often don't come to therapy until they have been significantly impacted in their adults lives.

Dynamics of Adult Children of Dysfunctional Families

These traits, which are usually deeply ingrained, are often perpetuated from one generation to the next, and difficult to overcome on your own.

Dynamics of Adult Children of Dysfunctional Families

Adult Children of Alcoholics and people from dysfunctional families are often surprised when they read the laundry list to discover that they identify with many of these traits.  They're also usually relieved to discover that these problems are not unique to them and that there is an identifiable cause that is known.

Some of the traits include:
  • Approval seeking and loss of identity
  • Confusing love and pity
  • Confusing compassion and responsibility
  • Fear of angry people and personal criticism
  • Fear of authority figures
  • Difficulty completing things
Adult Children of Dysfunctional Families and Fear

I've discussed other traits that are often identified as characteristics of adults from alcoholic and/or dysfunctional families in prior articles, including:

Mind-Body Connection: Responding Instead of Reacting to Stress
Overcoming Fear of Abandonment
Overcoming Fear of Anger
Relationships: Overcoming Codependency
Avoiding Codependency With Your Children
Learning to Feel Comfortable With Yourself
Exploring Secondary Gains of Codependency in Therapy
Addicted to Stress
Al-Anon: Beyond Reciting Slogans
Overcoming Childhood Trauma That Affects You as an Adult
How to Stop Pretending That You're Happy When You're Not
Early Recovery: You've Stopped Drinking. Now What?
Overcoming the Temptation to Use "Liquid Courage" to Feel Comfortable in Social Situations
Toxic Family Secrets
Overcoming Dysfunctional Ways of Relating in Your Family
Overcoming Shame: Is Shame Keeping You From Starting Therapy?
Why Is It That It's Usually the Healthiest Person in a Dysfunctional Family Who Goes to Therapy?
Getting to Know the Only Person You Can Change: Yourself

I look forward to hearing your comments.

Getting Help in Therapy
Many people who come from dysfunctional families, whether there was alcoholism or not, feel that they were the only ones who experienced childhood trauma in this way in their families.

As a result, they tend to isolate or to pretend that they're doing well when they're not.

Free Yourself From the Psychological Effects of Trauma By Getting Help in Therapy

Rather than isolating and suffering with the psychological effects of trauma by yourself, you could get help from a licensed mental health professional who has experience working with psychological trauma so you can free yourself from the negative impact of your family history and live a 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 emotional 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.



















Tuesday, March 24, 2015

Psychotherapy Blog: When Self Help Isn't Enough, Consider Seeing a Psychotherapist

Self help books and self help meetings can be very useful for people struggling with emotional problems, especially people who tend to isolate.  But often self help strategies aren't enough to work through certain problems.  At that point, rather than continuing to do the same thing that doesn't work, it's often useful to consider attending therapy with a licensed mental health professional.

When Self Help Isn't Enough, Consider Seeing a Psychotherapist

Self Help as an Adjunct to Psychotherapy
I often recommend self help groups, especially to clients who are in early recovery when trying to change old habits tends to be the most challenging.

But for some people, self help groups are too overwhelming because hearing about other people's losses and trauma can be too much at this stage of recovery (see my article:  Early Stage of Recovery: What to Do If 12 Step Meetings Are Too Overwhelming For You).

When Self Help Isn't Enough, Consider Seeing a Psychotherapist
Aside from self help meetings, there are thousands of popular self help books available for just about any problem.

I often recommend Francine Shapiro's self help book which has suggestions from EMDR therapy that clients can use on their own (see my article:  Self Help Books: Getting Past Your Past) which clients can use to supplement our work in therapy.

Advice for the General Public vs Treatment Tailored to Your Needs
The problem for many people, who rely solely on self help books, is that these books are written in a broad way for the general public.  Since the author doesn't know you, she can't address your particular issues.

Even if they address general problem that you're struggling with, there's no way for the author to know how the problem manifests for you in particular.

Discovering Your Emotional Triggers in Therapy
Also, most problems have an unconscious component to them which is unique to each person.

So, for instance, a self help book might be able to offer advice about how to calm yourself when you're feeling anxious, but it won't be able to help you to identify the particular unconscious triggers that bring on your anxious feelings.

When Self Help Isn't Enough, Consider Seeing a Psychotherapist

Over the years, as an experienced psychotherapist, I've discovered that the best way to uncover these triggers is to use mind-body oriented therapy that helps to connect to unconscious triggers and their related memories (see my article:  Mind-Body Psychotherapy: The Body Offers a Window Into the Unconscious Mind).

By making the unconscious conscious, you can discover the underlying issues that are creating your emotional problems (see my article:  Psychotherapy: Making the Unconscious Conscious) and you can work on transforming these problems (see my article:  The Unconscious Mind and Experiential Therapy: The "Symptom" Contains the Solution).

When you work with a licensed mental health professional, the process is specific to your particular problems and needs as opposed to general advice.

Getting Help in Therapy
Self help books and meetings can be useful, but they're often not enough for many people to overcome their problems.

If self help tools haven't helped you to overcome your problems, rather than struggling on your own, consider beginning psychotherapy with a licensed mental health professional (see my article:  How to Choose a Psychotherapist).

Working with a licensed therapist can help to free you so 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.

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, March 23, 2015

Psychotherapy Blog: The Psychological Benefits of Taking a Vacation

There are definite psychological benefits to taking a vacation.

Yet, taking a vacation is something that many people debate about, even when they have the time and money to go.  If you need convincing that going on vacation can be beneficial, here are some of the psychological benefits of going on vacation.

The Psychological Benefits of Taking a Vacation

Psychological Benefits of Taking a Vacation:

Vacations can provide you with an opportunity to:
  • Relax:  Even people who believe that they thrive on stress need down time every so often.  Taking a vacation gives you an opportunity to relax.  Getting away from your daily routines and worries, even for just a few days, helps to get some distance, not just physically but also psychologically, because you can leave your cares behind.
  • Learn New Things:  When you're at home, you're in familiar surroundings, but when you go on vacation, especially if you travel outside the country, chances are, you'll be learning new things, whether it's a few words in a new language or how to negotiate prices at a bazaar.   This can be fun and exciting.
  • Discover a New Perspective:  When you go to a new place, you're exposed to new cultures, different ideas, and ways of doing things.  Traveling gives you an opportunity to try new things--whether it's new foods, new customs or a different way of looking at life.  The contrast can also give you a different perspective about your own life (see my article:  Expanding Your Horizons While Traveling).
  • Help You to Realize How Resourceful You Can Be:  When you're at home going through your normal routine, there are times when you can almost do it with your eyes closed.  But when you travel, opportunities present themselves that might challenge you to be more resourceful in how you navigate change or deal with a challenging situation.  People often discover that they're a lot more resourceful than they realized (see my article:  The Joy and Challenges of Traveling).
  • Precipitate Change in Your Life:  A vacation to a place where you've never been can spark an idea that you'd like to make changes in your life, whether it's a geographical change or a psychological change.
  • Reconnect With Your Inner World and Your Partner/Spouse:  A vacation can give you an opportunity to reconnect with your inner emotional world in ways that staying at home often doesn't.  You have the time and space to focus on yourself.  And if you travel with your partner or spouse, you also have an opportunity to reconnect and rekindle things between you (see my article:  Learning About Yourself While Traveling).
The Psychological Benefits of Taking a Vacation:  Rekindling Your Relationship

Even just a few days away can provide you with many of these psychological benefits, so if you have the time and money to travel, treat yourself to some time away.

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, March 15, 2015

Psychotherapy Blog: How Your Unconscious Beliefs Affect Your Sense of Reality

As I discussed in my prior article, The Unconscious Mind and Experiential Therapy: The "Symptom" Contains the Solution, when individuals or couples seek help, the problems that they come into therapy with often have underlying unconscious beliefs and, prior to therapy, they have no awareness of how this affects their sense of reality.

How Your Unconscious Beliefs Affect Your Sense of Reality

Often, these unconscious beliefs were formed in early childhood and continue, without the client's awareness, through adulthood.

Let's talk a look at an example of this in the following vignette, which is a composite of many different cases with all identifying information changed:

Ted:
Ted came to therapy because he was having problems with his wife and his boss at work.

How Your Unconscious Beliefs Affect Your Sense of Reality

His wife, Mary, had been trying to persuade Ted for years to go to therapy to get help with his temper, but he was adamantly against coming to therapy--until he received an unsatisfactory performance evaluation at work and he feared he might lose his job.

As Ted explained it, he couldn't understand why he was having problems in his marriage and at work.  He felt he was a good husband and a good worker.

Mary came with him for the first session because she was concerned that Ted's total lack of self awareness about his interpersonal problems would get in the way of his being able to change quickly enough to save his job.

As Mary explained it, Ted tended to become very angry and lose his temper with even the mildest, most tactful criticism.  This caused arguments at home between them, and it also created difficulties when Ted's boss tried to give him feedback at work.

She explained that Ted never lost his temper about anything else and, on the whole, he was "a calm, sweet guy."

Ted agreed that he would lose his temper whenever he felt criticized and he knew this was a problem.  He wanted to change, but he would get angry so quickly.  He described it as a "knee jerk response."

He felt highly ashamed about his "communication problem." He said he didn't want to ruin his marriage or lose his job, but he felt hopeless to change his automatic response to any criticism.

He recounted how he took an anger management course because he hoped that would help him not to react angrily, but it didn't do any good.  He continued to lose his temper whenever there was even the mere suggestion of criticism.

After getting his family history and preparing him to do EMDR (Eye Movement Desensitization and Reprocessing), we began to process the last incident where he lost his temper that was still emotionally vivid for him (see my articles: What is EMDR?How EMDR Works: EMDR and the Brain and Experiential Therapy, Like EMDR, Can Lead to Emotional Breakthroughs).

Ted recalled an incident a few weeks ago where his boss told him that a customer complained that Ted took too long to get back to him about a sales problem.  He told Ted that he also felt that Ted could have done better and he needed to be especially responsive to this customer because they hoped to increase their business with him.

Ted described how he felt his face turn red and he felt a surge of rage overtake him.  Before he knew what he was saying, he was yelling at his boss and telling his boss that he was disrespecting him.

How Your Unconscious Beliefs Affect Your Sense of Reality

His boss reacted by walking away.  But later on, he came back, when Ted was calmer, and told him that he needed to be able to accept constructive criticism without flying off the handle.

A few days later, Ted received his performance evaluation in his in box and, much to his dismay, it said, in part, that Ted needed to learn to take constructive criticism without losing his temper.  It also said that if Ted didn't improve in this area, he might be terminated.

Fortunately, Ted was by himself when he read this so no one observed him losing his temper again.  But he knew it would be only a matter of time before it would happen again.  This was why he was willing to accept help in therapy.

When I asked Ted about the negative belief he had about himself with regard to this memory of losing his temper with his boss, Ted said, "I feel helpless."  Asked how he would like to feel, he said, "I would like to feel confident and empowered in these situations and not lose my temper."

To determine if there were any underlying earlier memories that fed into the current situation, I helped Ted to do a "float back" (also called "bridging back") to see if there were any other similar experiences.

Ted was able to recount many similar experiences in his adolescence when he would get angry and fight when anyone criticized him.

Then, he remembered something that his father said to him when he was 12, which he hadn't thought of consciously for many years:  "If you allow people to put you down, you're not a man."

Ted was surprised to have this memory come back to mind.

As we continued to process this in EMDR, Ted realized that this was the unconscious belief that had been fueling his anger whenever he felt criticized.

Even though, as an adult, he didn't consciously believe this, the unconscious belief was very powerful and he recognized that there was still a part of him that felt this was true:  If he allowed others to criticize him, this meant he wasn't a man.

At first, Ted couldn't understand how he could have two contradictory feelings at the same time.  But as we continued to process this in EMDR, he also realized that he had another unconscious belief that was underneath the first one and that was that if he didn't defend himself when he was criticized, he would be a disappointment to his father.

This other unconscious belief was even more puzzling to Ted than the first one, especially since his father had been dead for several years.

As we continued to use EMDR therapy, Ted came to realize that the second belief about disappointing his father was even more powerful because it was a way of keeping him connected to his dad, and he felt that if he let go of that belief, he would be letting go of his father.

So, in the course of our doing EMDR, Ted came to see that he never completely grieved for his dad and a younger part of himself was still trying to please him.

We all have certain aspects of ourselves that are in conflict with other parts.  So, Ted needed to learn this in therapy so he could accept these contradictory parts of himself at that point in therapy.

EMDR helps clients to integrate unconscious contradictory parts and, with time, Ted was able to accept this about himself.  He was also able to grieve for his father and accept that he no longer needed to act on what was once an unconscious belief about defending himself against criticism.

EMDR helped Ted to see his unconscious belief in the "light of day" and to understand the function that it served with regard to his relationship with his father.

When Ted recognized the underlying purpose of his unconscious belief, he no longer felt ashamed because working in this way in therapy is non-pathologizing.

How Your Unconscious Beliefs Affect Your Sense of Reality

Once Ted grieved for his father, he no longer had negative reactions at home or at work whenever he felt criticized.

If I had used only a cognitive-behavioral approach and not an experiential therapy like EMDR in this case, Ted never would have gotten below the surface of his symptom of losing his temper when he was criticized.

Experiential Therapy, Like EMDR, Helps to Achieve Therapeutic Breakthroughs

He never would have traced it back in his memory to his relationship with his father or see the underlying symptom below the first layer that acting on this belief kept him attached to his father whom he had never really let go.

Getting Help in Therapy
Ordinary consciousness often masks unconscious beliefs that affect your sense of reality.

In "Ted's" case, his unconscious belief told him that if he didn't defend himself, he wasn't a man.  This was his unconscious sense of reality that was driving his interactions with his wife and his boss.

This unconscious belief was completely outside of his ordinary conscious awareness and regular talk therapy often doesn't get to this.

Experiential therapy, especially therapy that uses the mind-body connection, provides an opportunity to get to these unconscious beliefs so that they can be seen for what they are.

If you're struggling with problems that you don't understand and regular talk therapy hasn't helped you, rather than continuing to suffer, you could benefit from working with a psychotherapist who uses experiential types of therapy like, among others, EMDR, Somatic Experiencing, and clinical hypnosis (see my article:  EMDR: When Talk Therapy Isn't Enough).

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, March 14, 2015

Psychotherapy Blog: The Unconscious Mind and Experiential Therapy: The "Symptom" Contains the Solution

Unconscious emotions and beliefs often contain meaningful emotional truths.  Experiential therapy provides an opportunity to access these unconscious emotions and beliefs, which often leads to a transformative shift and an emotional breakthrough for the client (see my articles:  How Your Unconscious Beliefs Affect Your Sense of Reality and Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

The Unconscious Mind and Experiential Therapy: The "Symptom" Contains the Solution

Accessing the Unconscious Through Experiential Therapy:  The "Symptom Contains the Solution:"
People who start psychotherapy with a desire to change an unwanted behavior are often unaware that unconscious emotions have important meanings for them in terms of the very behavior that they say they want to change (see my article:  Mind-Body Psychotherapy: The Body Offers a Window Into the Unconscious Mind).

There is a saying in clinical hypnosis, which encapsulates this idea:  "The symptom contains the solution."

Bruce Ecker, LMFT addresses "symptoms" as containing solutions within the framework of another experiential therapy that he and Laurel Hulley, Ph.D. developed, Coherence Therapy and in his two books, Depth Oriented Brief Therapy: How to Be Brief When You Were Trained to Be Deep and Vice Versa and Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation.

The Unconscious Mind and Experiential Therapy:  The "Symptom" Contains the Solution

In his books about Coherence Therapy, which I see as a meta-explanation for many different types of experiential therapy (EMDR, Somatic Experiencing, clinical hypnosis, and other forms of experiential therapy), he describes how the client's presenting problem (referred to as the "symptom") often contains the solution to the issue.

Vignettes From Experiential Therapy Where the "Symptom" Contains the Solution
For instance, he gave an example of how a client came to therapy to overcome procrastination which kept him from completing his graduate studies.  Ecker calls the presenting problem the "anti- symptom," the problem that the client wants to change.

Knowing that the presenting problem also has an unconscious "pro-symptom" component, the therapist asked the client to imagine how things would be if he didn't procrastinate about doing the work.

There are many different ways to help clients in therapy to access the unconscious, and these techniques are only limited by the therapist's imagination and ingenuity.

Ecker uses one of those techniques in his work with this client,"symptom deprivation."

Through the use of "symptom deprivation," the therapist asked the client to imagine himself without this problem, and the client realized that procrastinating kept him from realizing an even more challenging issue for the client, which was that he was procrastinating because he really wasn't interested in his graduate studies and he was only in the graduate program to please his father.

The Unconscious Mind and Experiential Therapy:  The "Symptom" Contains the Solution

Prior to attending therapy and using his imagination to sense himself without the problem, this client had no conscious awareness of this important underlying emotional truth.

By tapping into his imagination and experiencing himself without the problem, he was able to access the unconscious reasons for his procrastination and, more importantly, recognize that his symptom of procrastination was actually keeping him for making a major life change that he didn't want.

What initially appeared as a "problem" turned out to be a solution to a worse problem, namely, completing a degree and entering into a field that the client didn't want.

Notice that in this case the therapist didn't try to use cognitive-behavioral techniques (or other similar techniques that only remain on the surface) to try to change the symptom so that the client would stop procrastinating.  The therapist also didn't try to give advice or tools to stop procrastinating, which would have been ineffective in light of the powerful underlying issues.

Instead, the therapist correctly assumed in a non-pathologizing manner that there was an unconscious emotional truth that was significant for the client and that accessing this unconscious truth in an experiential way (as opposed to just thinking or talking about it) would help the client feel and understand a very meaningful emotional truth.

Another example that Ecker gives is of a woman who comes to therapy because she's developed agoraphobia after she starts to imagine that her former therapist, who moved out of state, is still in the neighborhood and watches the client when she goes outside.

This symptom became so problematic to the client that she dreaded going outside because, even though she knew, in reality, that the therapist wasn't around, she felt like the therapist was in the area and watching her.

By the time she came to therapy, she thought she was delusional because she knew one thing (the therapist moved out of state) but she felt another (the therapist was still around watching her).

By helping the client to access the unconscious meaning of her symptom, the therapist helped the client to experience, once again through the "symptom deprivation" technique, what it would be like not to feel that the therapist was around and watching her when the client went outside.

Once again, the therapist isn't trying to persuade the client that she is just thinking about the therapist. The purpose of the "symptom deprivation" technique isn't to try to make the client stop feeling that the therapist is around.  Instead, the purpose is to access, experience and understand the unconscious meaning of imagining that the therapist was watching her.

When the client imagined that she no longer felt the therapist watching her when she went out, the client experienced the unconscious meaning of the presenting problem, which was that she missed the therapist and she was lonely.

The client also realized that she had an underlying core belief that she was unlovable, which stemmed from her early childhood.

In this case, she chose not to work on this underlying issue of feeling unlovable, which the therapist honored.   But another client might decide to work on this underlying issue, and experiential therapy can be very effective with this type of underlying problem.

Also, once she understood on a deep level that imagining her former therapist outside served a meaningful purpose for her, she relaxed about it and no longer pathologized this issue.  Instead, she felt that she had a choice, depending upon how she felt on any given day, to either imagine the therapist around or not.

Having a choice was empowering for her.

Transformative Shifts Through Experiential Therapy
Ecker stresses (and I totally agree) that these unconscious meanings often don't come to the surface for the client if s/he doesn't experience the meaning of the symptom (the symptom is also known as the presenting problem).

In other words, talking about it only in an intellectual way often doesn't get to the unconscious meaning.  It keeps the therapeutic work flat and on the surface.

In both cases, these clients would have missed important information about what was actually positive and meaningful about what each of them originally considered to be problems.

By experiencing the unconscious emotional truth, the client has an opportunity for a transformative shift, which often leads to emotional breakthroughs.

Experiential Therapy Can Provide Access to the Client's Unconscious Emotional Truth
As I mentioned earlier, experiential therapy includes any therapy that allows the client to have an experience of the problem and the solution.

Experiencing can include emotional and, possibly, physical experiencing.

How the client experiences the unconscious is different for each client.

Some clients have an intuitive "sense."  Other clients experience the unconscious on a somatic (physical) level.  Others experience it on an emotional level.  Some clients experience a combination of intuitive, emotional and physical.

There's no one right way to experience the unconscious emotional truth.

EMDR therapy, clinical hypnosis, Somatic Experiencing and ego states therapy (parts work), among others, are all experiential mind-body oriented therapies that provide an opportunity for clients to access the unconscious beliefs and emotions that are not readily apparent in talk therapy alone.

Rather than dealing with the problem in a very limited, surface kind of way, these experiential therapies can help to transform a client's experience of him or herself as well as what, until then, was experienced as his or her reality.

The Unconscious Mind and Experiential Therapy:  The "Symptom" Contains the Solution

In the first example, where the client wanted to stop procrastinating and he considered this to be a "problem" that he needed to change, his perception of his personal reality was transformed when he experienced the underlying emotional truth that he really didn't want to continue to pursue a graduate degree in a subject that he wasn't interested in.

In the second example, the client recognized that what she considered her "problem" was actually meaningful and helping her to feel less lonely.  Her perception of her personal realty shifted and she stopped judging herself and feeling like she was delusional.  Not only did she stop feeling agoraphobic, but she was able to use and have a sense of control over whether she wanted to imagine her former therapist around or not.

The important emotional meaning in both of these cases would have been missed if the clients didn't have an opportunity to experience their unconscious reality.

In both cases, the client experienced emotional breakthroughs.

Experiential Therapies:  Clinical Hypnosis, Somatic Experiencing and EMDR
Experiential therapies usually allow clients access to a dual awareness, which is the here-in-now reality as well as the unconscious reality.

With regard to hypnosis (also known as hypnotherapy) when the client is in the hypnotic state, clients can often make an experiential shift that can lead to an emotional breakthrough (see my article:  What is Clinical Hypnosis?)

Similarly, Somatic Experiencing provides the client in therapy with a somatic awareness of unconscious thoughts and emotions which are stored in the body (see my article:  Somatic Experiencing: Overcoming the Freeze Response Related to Trauma).

I often combine clinical hypnosis, Somatic Experiencing and Ego States therapy to help clients to access the unconscious and achieve emotional breakthroughs (see my article:  Ego States Therapy)

EMDR (Eye Movement, Desensitization and Reprocessing), which is another form of experiential therapy, also helps the client to experience the unconscious beliefs that s/he has about him or herself.  One of the questions that the EMDR therapist asks is "What negative belief do you have about yourself?" related to the presenting problem.

As the client continues to process the presenting problem with EMDR, s/he comes to have access to his or her unconscious beliefs (see my articles:  What is EMDR?How Does EMDR Work: Part 1: EMDR and the Brain, and How EMDR Works - Part 2: Overcoming Trauma).

Rather than focusing on "fixing" the presenting problem, all experiential types of therapy provide an opportunity for transformation on a deep level.

Getting Help in Therapy
In my experience as a psychotherapist, an experiential type of therapy, which provides the client with access to the mind-body connection as well as unconscious meaningful truths to the client's problems, is the most effective therapy to help clients who want to experience transformation.


The Unconscious Mind and Experiential Therapy: Getting Help in Therapy

If you've been struggling on your own to try to overcome your problems, you owe it to yourself to seek professional help from a licensed mental health professional.

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.
























Monday, March 9, 2015

Psychotherapy Blog: Empowering Clients in Therapy - Part 2: Clinical Issues

In Empowering Clients in Therapy - Part 1, I began discussing some of the basic ways that psychotherapists can empower clients in therapy.  In this article, I'll discuss clinical issues involved with empowering clients.

Empowering Clients in Therapy - Clinical Issues

Empowering Clients Clinically 
Empowering clients clinically is often one of the goals of therapy.

There are many ways to do this in therapy--too many to write about in one article.  So, I'll focus on how I do this using EMDR therapy, which stands for Eye Movement Desensitization and Reprocessing (see my articles:  What is EMDR?How Does EMDR Work? Part 1: EMDR and the Brain and How Does EMDR Work? Part 2: Overcoming Trauma).

Many of the clinical strategies that I'm about to describe are used in other times of therapy.  The ones that I've chosen are the ones that I've often found to be most effective.

Helping Clients to Develop Internal Resources
What are internal resources? See my article:  Psychotherapy: Developing Internal Resources).

On the most basic level, internal resources are coping strategies.

Most people have developed some coping strategies just to survive, but it's useful to develop new internal resources that help clients to go beyond just surviving.  This is especially true when clients are about to begin processing traumatic emotional experiences in therapy.

Before processing traumatic experiences, I help clients to develop internal resources that they can use to calm and soothe themselves in session as well as between sessions.

A Safe or Relaxing Place:
Being able to close your eyes and to see in your mind's eye a relaxing place provides a respite from difficult material in therapy or at any time when you're feeling anxious or uncomfortable (see my article: Wellness: Safe or Relaxing Place Meditation).

Empowering Clients in Therapy:  A Safe or Relaxing Place

It helps you to breathe more easily and decide if you want to resume processing a traumatic memory or if you want to take a break in the therapy session.

Butterfly Taps:
This is a resource that I learned in training with Laurel Parnell, Ph.D., who is a world-renown expert, based in California, in EMDR therapy.  It's another resource that clients can use either in session or between sessions.

To do butterfly taps, you place your right hand on your left upper arm and your left hand on your right upper arm (so arms are crossed) and you alternate taps rhythmically at a speed that feels comfortable for you.  The tapping is soothing and helps you to calm down.

Interweaves
Using interweaves is another resource that I learned from Laurel Parnell, Ph.D.

Most of the time, interweaves are used in EMDR when clients feel stuck in the processing of traumatic material.

Interweaves help to:
  • integrate memory networks
  • differentiate memory networks
  • create a coherent narrative
  • create a broader perspective
To determine which interweave would be best to use, the therapist asks the client what s/he needs at that moment.   The client is usually the best judge of what s/he needs.

Sometimes, when clients are stuck, they're not sure what they need at that moment, so the therapist, being attuned to the client, can different suggestions to see if any of them resonate with the client.

There are many different types of interweaves, including imagining:
  • nurturing figures
  • protector figures
  • inner wisdom figures
  • other types of figures that the client feels would be helpful
The reason why resource interweaves are developed before the actual processing of the trauma memory is that the therapist wants the client to have these interweaves in mind if the processing becomes difficult.
Empowering Clients in Therapy:  Resource Interweaves:  A Protector Figure

In case the client gets stuck, s/he can use the resource interweave to get the therapeutic work back on track.

So, for instance, if a client is processing a memory using EMDR therapy about childhood physical abuse and she feels stuck because she is in touch with her "child self" and she feels frightened by the person who abused her, she can call on a protector figure in her mind to imagine that person protecting her in the situation.

This protector figure can be someone real (someone from the past or the present) or imagined (from a movie, TV program, book, and so on).  The protector figure could also be the client's "adult self" who helps his or her "child self" in the client's mind's eye.

The "Ideal Mother" Interweave
Another example of an imaginal interweave is imagining an ideal mother who is loving, attuned, soothing and protective as well as powerful (or whatever qualities a client would need in an ideal mother).

An ideal mother is usually the type of mother that the client wishes s/he had.  If the client feels stuck in processing a traumatic memory, s/he can imagine an ideal mother with all the attributes that s/he wished she had.

Like all of these resources, they can be used even if the client isn't in EMDR therapy.


Empowering Clients in Therapy:  Imaginal Interweave:  Ideal Mother 
If you haven't experienced using imaginal interweaves, they might sound silly, fantastic or unrealistic.  But most clients feel soothed by the ideal mother and it "makes sense" to the emotional part of the brain.   In effect, it creates a new symbolic memory in the emotional part of the brain (see my article:  Healing Trauma With New Symbolic Memories).

It doesn't effect narrative/biographical memory which, of course, knows who the actual mother was when the client was a child.

Sometimes, clients feel guilty imagining an ideal mother because they feel that they're being disloyal to their actual mother.  In that case, a client can imagine that the ideal mother is a co-mother, as Laurel Parnell suggests.

There are times when clients feel enmeshed with their parents and the idea of imagining an ideal mother feels like they're abandoning their actual mother, so they can imagine giving their actual mothers an ideal mother as well.

This can also be used for earlier generations so that the client can imagine that the grandmother had an ideal mother so that the grandmother could have been nurturing to the mother and mother could have been nurturing to the client.

Most clients respond very well to imaginal resources, but there are some clients who say, "But I know that I didn't have an ideal mother," to which I respond, "Try suspending disbelief and see how it feels." Almost always, if the client can suspend disbelief, s/he feels relieved by the imaginal resource and the work gets back on track.

What Does the Client Need?
Everyone is different.  The particular client's needs determine the type of clinical intervention used to empower him or her.

Sometimes, clients come up with their own resources.

They might use art work, prose, poetry, dance or some other creative endeavor to empower themselves.

Empowering Clients in Therapy:  Keeping a Journal Between Sessions

Many clients find journal writing to be empowering and an important bridge between sessions, and this is something that I recommend.

The possibilities are endless.

Empowering Clients in Therapy
People often come to therapy because they're feeling disempowered in one way or another in their lives--either due to their history, their current situations or some combination of both.

Empowering Clients in Therapy

When the client is assisted in therapy to be more empowered, the client usually feels better able to tackle problems, overcome traumatic memories and have a sense of a hopeful future.

Discovering that they had the power within themselves all along is one of the best discoveries that a client can make in therapy.

Getting Help in Therapy
If you've been on the fence about starting therapy, you're not alone.

If your own efforts to overcome your problems haven't worked out for you, you could benefit from working with a licensed mental health professional whose priority is helping to empower clients.

When you find a skilled and empathic therapist who is a good match for you, you might be surprised to discover the progress that you can make in 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.






















































Monday, March 2, 2015

Psychotherapy Blog: Empowering Clients in Therapy - Part 1

Many people, who are depressed, anxious or traumatized, avoid coming to therapy because they feel ashamed of their problems, they fear they'll be overwhelmed by opening up emotionally in therapy or they feel a sense of helplessness related to a history of trauma (see my article: Overcoming Feelings of Helplessness Related to Childhood Trauma).

Empowering Clients in Therapy
As compared to the number of people who need mental health treatment, only a small percentage actually come to a therapist's office.

This is all the more reason why it's so important for psychotherapists to find way to empower the clients who, although apprehensive, come to therapy.

Empowering Clients in Therapy
There are many ways to empower clients in therapy, including:

Helping Clients to Feel Safe
As I've mentioned before, for many people coming to therapy is an act of courage.  It's not easy coming for a consultation with a stranger, not knowing what to expect.

The therapist sets the tone, especially at the start of therapy, and it's important that s/he create a safe, comfortable, respectful environment (see my article:  The Creation of a Holding Environment in Therapy).

An emotionally attuned therapist can make all the difference to clients who feel apprehensive.  Empathy and respect are the hallmarks of good therapy and help clients to feel comfortable (see my article:  The Therapist's Empathic Attunement Can Be Emotionally Reparative to Clients in Therapy).

Providing clients with information
Many clients who have never been in therapy before don't know what to expect.  They might not understand about the treatment frame regarding regular appointment times, lengths of sessions, fee arrangements, therapist's education and skills, and so on.

Empowering Clients in Therapy
Even if clients have been in therapy before, each new experience will be different.

After therapists get to know clients, clients need help to understand their problems.  If they've never spoken to anyone about their problems, they might feel that they're the only ones who feel this way or who have had these experiences.

As much as possible, it's important for therapists to normalize clients' experiences so they know that they're not the only ones who have ever gone through these problems before and that other people have been able to work through these issues in therapy.

This empowers clients so they don't feel ashamed and guilty about their problems.  It might also help them to feel hopeful that they can also work through their problems.

Talking to Clients About Their Expectations and Goals
Clients who are new to therapy (or new with a particular therapist) might not know what to expect in treatment or they might come with misconceptions.  For instance, they might think that the therapist will provide them with "answers" to their problems rather than being someone who facilitates their development and growth in treatment.

Even if they've been in therapy before, they might have had bad experiences and they are, once again, summoning their courage to give it another try.

Empowering Clients in Therapy
Discussing their expectations and what they would like to accomplish in therapy encourages them to be active participants in their own treatment.  This is something which might be new and unfamiliar at first but, ultimately, it can empower them.

Some clients might need help formulating goals and strategizing how to accomplish their goals.  They might need help to understand that, for some people, setting goals are a work in progress, and that's okay.

Other clients might not even feel that they are entitled to want anything or to set goals because of their early history of being subjugated in their families.  Just the idea that they have choices might be a new experience.

Offering Clients Choices in Therapy
There is no one-size-fits all treatment, especially when it comes to mental health issues.

It's important for therapists to be skilled in different treatment modalities so that clients have choices.

This can be empowering for clients in therapy, especially since many clients didn't have choices when they were growing up.

Listening to the Client
Many people have never had the experience of really being listened to by another person before they came to therapy.

It's important that therapists be willing to listen to what is being said and also to what is not being said, which could be just as important.

It's also important for a therapist to learn from clients (see my article:  Psychotherapy: Listening and Learning From the Client).

For instance, the client might have a different perspective about a situation because s/he is from a different culture.  No therapist can know about every culture, so listening and learning from the client can help the therapist to see things from the client's point of view.

Repairing Ruptures Quickly When They Occur
Even the best therapist will make mistakes at times.  No one is perfect.  It's important for therapists to repair ruptures in treatment as soon as possible.

Empowering Clients in Therapy:  Ruptures and Repairs in Therapy
This can be empowering to clients, especially clients who grew up in households where they were hurt, emotionally or physically, by parents who never made amends.

Often, after a rupture is repaired between a client and a therapist, the therapeutic relationship is strengthened and it is better than before the rupture (see my article: Psychotherapy: Ruptures and Repairs in Therapy).

Aside from these basic ways of empowering clients in therapy, there are also clinical ways to empower clients, which I'll discuss in my next article:  Empowering Clients in Therapy - Part 2: Clinical Issues

Getting Help in Therapy
Asking for help is never easy.

Considering therapy might be a new idea that you've never considered before or you might be returning to therapy after having been away for a while.

There are many different types of therapies and many psychotherapists with different orientations to therapy and different levels of skill and experience, so I recommend that, if you're considering therapy, ask for a consultation first to find out about the therapist, to see if you're comfortable with him or her, to give an overview of the issues that you would like to work on, and to ask questions.

You might need to see a few therapists before you find someone that you're comfortable with, and most therapists will understand this.

For more information, 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, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

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