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Saturday, December 16, 2017

Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works

No one knows how to "do therapy" before they've ever been in therapy.  Even clients who have been in therapy before need psychoeducation about the particular therapy modalities that the current therapist uses and how these modalities work.  So it's important for the therapist to provide clients with this information during the initial stage of psychotherapy (see my articles: Psychotherapy is More Than Just VentingStarting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent, Common Myths About Psychotherapy: Therapy Takes a Long TimeCommon Myths About Psychotherapy: Going to Therapy Means You're "Weak" and Common Myths About Psychotherapy: Therapy is All Talk and No Action).

Why It's Important For Therapists to Provide Clients With Psychoeducation About How Psychotherapy Works
It's common for clients to begin therapy with a certain degree of anxiety.  But when clients have an idea of what to expect in therapy, it helps to ease their anxiety.

It's also important, if possible, for clients to say what they would like to get out of therapy.  I say "if possible," because there are times when clients start psychotherapy and they're not sure what they want from therapy or they might only have a vague idea or, during the initial stage of psychotherapy, they might not know how to articulate their needs and they might need help from the therapist to explore and define their needs (see my article: When You "Just Don't Feel Right" and It's Hard to Put Your Feelings Into Words).  

Psychoeducation About How Psychotherapy Works
The type of information that the therapist provides will depend on the type of therapy that she does.

It's helpful for clients to know how particular treatment modalities work and why it's more effective to work with a psychotherapist than it is to talk to a friend (see my article:  How Talking to a Psychotherapist is Different From Talking to a Friend).  

The following topics, which are listed by therapy modality, are some of the most important areas to discuss as part of the psychoeducation process.

Psychoanalysis and Psychodynamic Psychotherapy 
If the therapist does psychoanalysis or psychodynamic psychotherapy, she might talk to the client about transference/countertransference issues (see my article: Psychotherapy and the Positive Transference).

She will also probably discuss the importance of the unconscious mind, dreams, and the intersubjective process in therapy (see my article: Making the Unconscious ConsciousDiscovering the Unconscious Emotions at the Root of Your ProblemsThe Therapy Session: A Unique Intersubjective ExperienceEmbodied Imagination DreamworkTransforming Nightmares Through Creative Dreamwork and Working With Dreams to Develop Your Creative Imagination). 

Also, within psychoanalysis and psychodynamic psychotherapy, there are various ways of working.  For instance, I work as a Relational psychotherapist, which is a contemporary, interactive form of psychoanalytic/psychodynamic psychotherapy. Another psychotherapist who does psychoanalysis might use a Classical Freudian method or do Kleinian therapy, and so on.

EMDR Therapy 
If the therapist does EMDR therapy, she could talk about how EMDR can resolve trauma through memory reconsolidating and what are considered Big-T and Small-T trauma (see my articles: What is EMDR Therapy?, Overcoming Trauma With EMDR Therapy: When the Past is in the PresentBig T and Smaller T Trauma, and What is Adjunctive EMDR Therapy?). 

Somatic Experiencing/Somatic Psychotherapy
If the therapist uses Somatic Experiencing or Somatic Psychotherapy, she would probably talk about the mind-body connection, and how the body holds unconscious memories (see my article: Mind-Body Oriented Psychotherapy: Somatic ExperiencingThe Body Offers a Window Into the Unconscious Mind, and What is Somatic Psychotherapy?).

Clinical Hypnosis (also known as Hypnotherapy)
If the therapist uses clinical hypnosis, she would probably not only explain hypnosis, but she would also dispel some of the myths about hypnosis that have been perpetuated in movies and TV programs (i.e., the myth that hypnosis is a form of "mind control") and also about how clients maintain a dual awareness during hypnosis about being in the here-and-now as well as in the space of whatever comes up in the hypnosis (see my articles: What is Clinical Hypnosis?Clinical Hypnosis and the Mind-Body ConnectionHypnosis and Creative Visualization to Manage Stress and All Hypnosis is Self Hypnosis).

Cognitive Behavioral Therapy (CBT)
For the therapist who uses cognitive-behavioral therapy (also known as CBT), depending upon the problem, she might explain how desensitization works or why there's usually homework in CBT treatment.  She would probably explain when she uses CBT.  For instance, I use CBT for phobias and certain forms of anxiety.

Ego States Therapy (Parts work)
For the psychotherapist who does Ego States therapy (also known as Parts work), she could talk to the client about the different aspects of the self, dissociation, and shifting self states (see my articles: Parts Work in Therapy: Is a Split Off Part of Yourself Running Your Life? and How Shifting Self States Can Affect You For Better or Worse).

Integrative Psychotherapy
If the therapist uses Integrative Psychotherapy, as I do, she would explain how she integrates the various treatment modalities for the most effective treatment (see my article: The Therapeutic Benefits of Integrative Psychotherapy and Contemporary Psychoanalysis and EMDR Therapy: A Powerful Combination to Overcome Trauma).

Treatment Frame
There are other issues to be discussed during the initial stage of therapy, including the treatment frame (the fee, length of sessions, policies about missed sessions and payment of fees, and so on) so the expectations are clear at the beginning of therapy.

Feedback to and From the Psychotherapist
I believe psychotherapy should be a collaborative process between the client and the therapist.

One of the best predictors of a good outcome in therapy, regardless of the treatment modality, is a good rapport between the therapist and the client, which develops over time.

The Importance of Feedback to and From the Psychotherapist

Regardless of the therapist's experience and skills, if the client and therapist aren't a "good fit," chances are that the therapy won't go well.  That being said, as previously mentioned, most clients feel anxious at the start of therapy because it's uncomfortable for them to talk to a stranger--even the most empathetic stranger, so the client might need to give the process time before deciding if it's a "good fit" or not.

Most therapists are aware that not every therapist is for every client, so they're not offended if the client feels it's not a "good match."   

An open dialog between the client and the therapist is important, especially with regard to whether the therapy is working for the client.  It's important for the therapist to know what's working and what's not working.  

If the client was already informed about the treatment modalities that the therapist uses and how these modalities usually work for the client's presenting problem, he will not be as likely to expect a "quick fix" for a complicated problem.

But if there are areas that might need to be adjusted or if there are things that the therapist might not be aware of (e.g., the client becomes highly activated between sessions and has problems sleeping), this dialog provides the therapist with information to make adjustments to the therapy, if necessary (see my article: Asking For What You Need in Therapy).

If the client doesn't initiate this dialog, I believe it's important for the psychotherapist to "check in" with the client every so often.

Not only does an open dialog provide the client with the important message that the psychotherapist wants and welcomes feedback--even negative feedback--it also reduces the possibility that the client, who has problems expressing his feelings, will leave therapy prematurely (see my article: Ruptures and Repairs in Therapy and When Clients Leave Therapy Prematurely).

The client can also ask for feedback from the therapist about how the therapist thinks the therapy is going from the therapist's perspective.  This helps the client to understand the therapist's thinking about their work together (see my article: A Psychotherapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Getting Help in Therapy
As I've mentioned in prior articles, it takes courage to admit you have a problem, even admitting it to yourself, and to get help (see my article: Developing the Courage to Change).

When you know that continuing to do what you've been doing that hasn't worked for you is prolonging your suffering, you owe it to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

Rather than becoming overwhelmed by the process, it's important to take it one step at a time.  After you've acknowledged to yourself that you have a problem, the next step is to contact a psychotherapist for a consultation (see my article: How to Choose a Psychotherapist). 

During the consultation, you can give an overview of your problem and ask the therapists questions.

An experienced psychotherapist can help you to work through your problem so you can liberate yourself from your history and have a sense of well-being.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who provides integrative psychotherapy to individual adults and couples.

To find out more about me, visit my website:

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

Friday, December 15, 2017

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

Many people who are recovering from addiction don't understand the concept cross addiction, which is substituting one addiction for another (see my other articles about substance abuse:  Recovery: Maintaining a Balanced Life,  "Liquid Courage:" Overcoming the Temptation to Abuse Alcohol to Cope With Social SituationsThe Myth About Having to "Hit Bottom" to Change, and Coping With Addiction: Boredom as a Relapse Trigger).

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

The reason it's so important to understand cross addiction is that people who have a history of addiction often switch from one addiction to another, especially when they're under stress.

So, for instance, if someone who has been sober from alcohol for a few years suddenly finds himself under a lot of stress at work, instead of picking up a drink, he might start to abuse prescription drugs or gamble compulsively or engage in some other form of addiction.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

It's easy to fool yourself into thinking that you can dabble with another addiction because it's not your primary addiction.

But when you're under a lot of stress and you haven't developed adequate skills, if you have a history of addiction, you're more likely to either relapse with your primary addiction or engage in cross addiction.

Let's take a look at a fictional vignette to see how this plays out:

Fictional Vignette: Recovery: Understanding Cross Addiction: Substituting One Addiction For Another:

Connie was sober from alcohol for two years.  During that time, she struggled to maintain her sobriety, but with the help of her psychotherapist and her sponsor, she celebrated her second year as a sober person.

Soon after she celebrated her second anniversary of sobriety, she left Alcoholics Anonymous and told her psychotherapist that she wanted a break from therapy.

A few months later, her mother fell, broke her hip and had to go to an inpatient physical rehabilitation center.  When her mother got home, she needed Connie's help because she wasn't able to take care other daily needs.

Although Connie and her mother had a conflictual relationship, Connie agreed to move in with her mother temporarily to help her.  She knew that other siblings, who also had conflicts with their mother, wouldn't be willing to do it and her mother really needed help.

The stress of taking care of her mother and working a full time job took a toll on Connie after a few weeks (see my article: Are You Experiencing Chronic Stress and Unaware of It?).

There were times when she wanted to tell her mother to fend for herself, but she knew her mother couldn't be alone, so she tolerated her mother's emotional abuse.

Connie was often tempted to have a drink, but she knew that if she had one, she wouldn't be able to stop, so she refrained from drinking.  But she started using food to soothe her stress, and she gained 20 pounds within a few months.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

When she went to the doctor for her annual checkup, her doctor couldn't believe that Connie had put on so much weight since the last time he saw her.

Knowing that Connie had a history of alcohol abuse, her doctor asked her if she was overeating.  When Connie told him that she was "stress eating" at her mother's home, he talked to her about cross addiction and recommended that she get back into therapy.

Connie had never heard of cross addiction.  Before she saw her doctor, she thought that as long as she didn't touch alcohol, she was doing well.  But when her doctor explained cross addiction to her, it made sense to Connie, and she knew she needed to take care of herself (see my article: Self Care For Caregivers).

The next day, Connie called a family meeting with her siblings and explained to them that they needed to pitch in.  She could no longer take on the sole responsibility of being her mother's caregiver.

At first, her siblings balked, but Connie insisted that either they help her out or she would hire a home attendant for their mother.

None of Connie's siblings wanted a home attendant in their mother's home, so they agreed to work out a schedule so they could take turns taking care of their mother.  Since there were seven of them, they each took a day, and sharing the responsibility made it less stressful.

Once her siblings were involved, Connie went back to her former psychotherapist to deal with her stress eating and unresolved issues about her mother (see my article: Returning to Therapy).

She also resumed attending Alcoholics Anonymous meetings, and she contacted her old sponsor on a daily basis.

With emotional support and reduced stress, Connie was able to get back on track so she could eat in a healthy way again and lose the weight she gained.

She also had a new appreciation for how stress could put her at risk for cross addiction.

The term "cross addiction" refers to substituting one addiction for another.

The fictional vignette above highlights how important it is to recognize your particular vulnerability to cross addiction and also the importance of self care, self help meetings, and getting help in therapy.

Getting Help in Therapy
Setbacks are part of recovery and part of psychotherapy (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).

If you've had a setback in your recovery, it's important to get help before the problem progresses (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist, who is knowledgeable about addictions, can help you to get back on track again (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, contact a licensed mental health professional who has an expertise in addictions so you can remain healthy.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to establish and maintain their recovery.

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.

Understanding the Difference Between "I Can't" and "I Won't"

Understanding the difference between "I can't" and "I won't" is often the key to successfully making lasting changes in your life.  While "I can't" means you're not capable of doing it, "I won't" implies a choice--in other words, you're not willing to do it (see my article: Fear of Making Changes, Making Changes: Are You Creating Obstacles For Yourself Without Even Realizing It? and Making Changes: Overcoming Ambivalence).

Understanding the Difference Between "I Can't" and "I Won't"

Often, when people really mean "I won't," they say, "I can't."

For instance, when someone, who he wants to give up smoking, says, "I can't," he's saying that he thinks it will be too hard for him to do it so he chooses not to do.  Although he might not see it that way, if his psychotherapist explored the meaning of "I can't," it usually comes down to choosing not to do it (see my article: Becoming a Successful Nonsmoker).

While it's understandable that change can be scary, when you say, "I can't" it tends to foreclose any discussion about the obstacles that are getting in the way.  Whereas if you say, "I won't do it because I'm afraid that I'll fail" or "I won't do it because I'm too ashamed to admit that it's a problem," that leaves an opening for an exploration of the internal obstacles getting in the way.

The Clinical Implications of "I Can't" and "I Won't" in Psychotherapy
People often come to therapy because they want to make a change in their life.  Usually, they've tried on their own to make changes, but they run into obstacles.

Even though many people begin psychotherapy because they want to make changes, once there is a possibility for change, they often experience ambivalence because there are core issues that need to be addressed that are getting in the way.

If fear and shame are involved, and they often are, an inner conflict develops between the desire to change and the desire to remain the same and not work through the necessary obstacles to be able to change.  

The other possibility, when faced with fear and shame, is that the status quo begins to look good to the client for a while ("Maybe things aren't so bad in my life after all") until the client realizes, once again, that he really needs to change.

At that point, the client's psychotherapist can help the client, if the client is willing, to face the internal obstacles to making the change.  If the client isn't willing to explore his ambivalence, he might leave therapy prematurely (see my article: When Clients Leave Therapy Prematurely).

Let's take a look at a fictional vignette which illustrates these dynamics in therapy:

After Ed's father died, he became a compulsive gambler as a way to distract himself from his grief (see my article: Overcoming Grief Gambling).

His gambling began with March Madness and quickly progressed to other sports (see my article: Compulsive Gamblers: Beware of March Madness).

At first, when basketball season ended and he began betting on baseball games, he told himself that he would stop gambling at the end of the baseball season.  Then baseball season came and went and he was gambling on football games, and he continued to bargain with himself about stopping.

When the bookmaker refused to take any more bets from Ed because Ed owed him money, Ed got panicky.

Without the highs and lows of gambling as a distraction from his grief, he felt overwhelmed with anxiety and sadness, and this was a "wake up call" for Ed.  He knew he needed help, so he contacted a therapist who specialized in addiction.

Understanding the Difference Between "I Can't" and "I Won't"

During the initial consultation, Ed told his psychotherapist that he knew he needed to stop gambling because he was in debt for thousands of dollars and he didn't want to get any further in debt.

At that point, Ed didn't make the connection between his gambling and his fear of facing his grief over his father's death.  He only knew that he couldn't go on gambling and getting more and more in debt.

When Ed and his psychotherapist talked about when the gambling started, Ed told her that he gambled a little when he was in high school, but nothing compared to his current level of gambling.

As they traced back the origin of his compulsive gambling, Ed was able to see that it began soon after his father died.  Reluctantly, he began to put the pieces together, and he understood that he used gambling as a way to distract himself from his grief.

His therapist recommended that, in addition to coming to therapy, he also attend Gamblers Anonymous groups (G.A.), but Ed didn't think this was necessary.  He told his therapist that he would "just stop."  He believed, "I can stop whenever I want to."

Understanding the Difference Between "I Can't" and "I Won't"

His therapist decided, at that point, not to challenge Ed or insist on G.A.  She told him that they could see how he did with coming to therapy and not attending G.A.

Ed managed not to gamble for the first week, but he felt overwhelmed by anxiety and sadness, so since his bookmaker refused to take his bets until Ed paid off his debt, he told himself that he would "just place one more bet" on an Internet poker site using his credit card.

After placing the first bet, Ed felt he still had his gambling compulsion "under control," so he placed another bet and another--until he was gambling online nearly every day.

Although he felt ashamed about it, he knew that if he wasn't honest with his therapist, he would be wasting his time in therapy, so he admitted that he was now gambling online nearly everyday.

His therapist explained the brain chemistry involved with gambling and other forms of addiction and why continuing to gamble would make it that much harder to stop.

His therapist recommended that they work on coping skills so that Ed could manage his urges.  She also recommended that he identify the triggers that made him want to gamble.

Ed knew that he had a problem tolerating his anxiety and sadness related to his father's death.  Until now, he didn't realize the magnitude of his gambling problem and what it would take to overcome his problem.

He agreed to practice mindfulness meditation at least once a day, but he didn't follow through with his commitment.  Instead, he gave into his urge to gamble, telling himself each time, "This will be the last time."

When he returned to see his psychotherapist, Ed acknowledged that he didn't listen to any of the mindfulness recordings that he downloaded on his phone.

He also admitted that he was still gambling, and he was beginning to feel hopeless about overcoming his gambling addiction.   He asked his therapist, "Isn't there any easier way?" (see my articles: Beyond the Band Aid Approach in Therapy).

His therapist recommended that Ed come twice a week to therapy, attend G.A. meetings and get a sponsor in G.A.  She also explained to Ed that, when he was ready, they could work on the underlying trigger, the grief that he was avoiding.

In addition, she discussed how, if he followed her recommendations, he would probably be able to build up his tolerance for his uncomfortable feelings so they would no longer feel intolerable to him (see my article:  Expanding Your Window of Tolerance in Therapy to Overcome Emotional Problems).

At that point, Ed threw up his hands and told his therapist, "I can't.  I can't do this."

When his therapist explained the difference between "I can't" and "I won't," at first, Ed continued to maintain that he couldn't do what needed to be done to overcome his gambling addiction.

But as they continued to explore whether he was really incapable of overcoming his gambling addition or he was unwilling to give it up, Ed reluctantly admitted that he was unwilling.

At that point, his therapist and Ed had a basis to discuss his unwillingness to give up gambling and unwillingness to deal with his grief.

Over time, the more Ed talked to his therapist about his emotional struggles, the more he was able to see that he was creating obstacles for himself.  So, he followed his therapist's recommendations to practice mindfulness meditation every day, he began attending G.A. meetings, and he obtained a sponsor.

After attending a G.A. meeting, Ed told his therapist that he was surprised to discover how many people were in a similar predicament specifically related to grief gambling.  When he heard other people in G.A. speak about their guilt, shame and overwhelming sadness, he understood what they were talking about.

Gradually, Ed began to talk to his therapist about his grief.  At first, he was afraid that he would be overwhelmed, but he was surprised to discover that he actually felt better after he talked about it.

Understanding the Difference Between "I Can't" and "I Won't"

As Ed dealt with his unresolved mourning in therapy, he felt no desire to gamble.  He paid off his debts and even began to save money.

Over time, Ed was also able to see that he used the idea of "I can't" as a way to avoid dealing with his uncomfortable feelings.  Now he could see the difference between "I can't" and "I won't" and it was an important lesson in other areas of his life.

Even when people really want to change and they come to therapy to get help with making a change, ambivalence often sets in as the process begins (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

At that point, they're likely to say, "I can't" when they really mean "I won't."

Although making a change can be scary, it's a conscious choice and, by the same token, so is not making a change.

Fear and shame are usually the underlying obstacles as to why people are unwilling to take the necessary steps to change.

This is especially common for people who grew up in a family where they didn't have the emotional support they needed when faced with difficulties as a child.

On an unconscious level, they fear that they will be as overwhelmed by emotion as they were as children, but this is rarely the case.  For one thing, as an adult, there is a greater capacity to tolerate emotions (as compared to when they were children).  And, for another thing, as an adult, they have the wherewithal to ask for help.

Making a change that's challenging is often a gradual process:  One step forward and two steps back.     Along the way, there are usually setbacks before you succeed (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).

Getting  Help in Therapy
It takes courage to make a major change (see my article: Developing the Courage to Change).

There are some changes that feel so daunting that you might need help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

If you've been struggling on your own to make a change in your life, you could benefit from seeing a licensed psychotherapist who has experience helping people to overcome obstacles to change (see my article: How to Choose a Psychotherapist)

Everyone needs help at some point in his or her life, and getting help from a skilled psychotherapist could make all the difference between making a successful change or not.

The choice is yours.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to overcome the obstacles that were getting in the way of making a major change in their life.

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

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

Thursday, December 14, 2017

How a Crisis Can Bring About Positive Change in Your Life

Sooner or later in life, everyone has to cope with a crisis.  It doesn't matter how much you try to avoid crises, they are an unfortunate part of life.  Sometimes, you can see a crisis coming in advance and prepare for it (see my article: Fear of Making ChangesStanding at the Crossroad: Fear of Making Major Life Decisions and Preparing Emotionally For Major Changes in Your Life).  Other times, a crisis occurs when you least expect it.  But in many cases crises can be opportunities to make changes that are, ultimately, for the better.

How a Crisis Can Bring About Positive Change in Your Life

People who are able to reframe crises into a possibility for an opportunity are better able to get through the chaos that crisis often brings (see my article: Developing a Positive Perspective About Reframing).

Let's take a look at some fictional scenarios, which represent common occurrences, that illustrates these points:

How a Crisis Can Bring About Positive Change in Your Life

Jim worked as a senior manager for his firm for over 25 years.  He had a good relationship with his boss and with his colleagues, who praised his work.  He thought he would ride out his last years at this company until retirement and then he planned to start his own consulting business.  But a few years before Jim planned to retire, he was laid off due to budget cuts.  His boss and his human resources director assured him that it had nothing to do with the quality of his work.

At first, Jim was paralyzed in fear.  He wasn't sure what he would do.  So much of his identity was tied up with his job (see my article: When Job Loss Means Loss of Identity).  When he told his wife about the layoff, she encouraged Jim to start his consulting company now and "Go for it!"  Although he was afraid, at first, within a year, he was making more money in his consulting business than he made at his former job, and he had more time to spend with his family.  So, what he initially experienced as a crisis turned out to be a blessing in disguise.

Betty was in a stagnant relationship that was going nowhere for a few years.  Although she wanted to get married and have children, she was afraid to leave her current relationship because she thought she would never meet anyone else.  Her rationale was, "The devil you know is better than the devil you don't know" and so she remained in this unhappy relationship (see my article: Are You Too Afraid to Leave an Unhappy Relationship?).  One evening, over dinner, her boyfriend, Ted, told her that he wanted to breakup.  He accepted a job out of state, and he didn't want to have a long distance relationship, so he thought it was better to end their relationship.  At first, Betty panicked.  Even though she was dissatisfied with the relationship, at least she had someone to have dinner with and to go to the theatre.  Now, she would have no one.  During the first few months after the breakup, Betty mourned the end of her relationship.

How a Crisis Can Bring About Positive  Change in Your Life

Shortly after that, a close friend introduced her to someone new, John.  After dating for a few months, Betty and her new boyfriend decided to be exclusive, and she realized that she was happier in this relationship than she had ever been.  Had she and Ted remained together, she would never started dating John.  What initially felt like a major crisis in her life turned out to be a positive change.

Donna had always enjoyed good health for most of her life.  But shortly after her 40th birthday, she had a mild heart attack and was hospitalized.  After she was discharged, her cardiologist spoke to her about her stressful lifestyle, including a stressful job that she hated and an unhealthy diet where she mostly ate on the run.  He told her that she would have to make changes to her lifestyle or she could have a massive heart attack, especially since there was a history of heart problems in her family (see my article: How Medical Problems Can Change How You Feel About Yourself).

Donna spoke with her husband about the changes she was thinking about--including leaving her stressful job.  Her husband encouraged her to do what she had always wanted to do--become a yoga teacher.  So, when she quit her job, and when her cardiologist gave his approval, Donna began a yoga training program.  Soon after she completed the yoga training, she began working for a local yoga studio, a job that she loved.  In retrospect, she realized that she probably would never have quit her stressful job to do what she really wanted if she had not had the heart attack.

Making changes in your life, even under the best of circumstances, can be challenging.  We often become comfortable with what's familiar, even if it's not what we want.

Making changes during a crisis is even more challenging because we're often not prepared for the crisis.  It can be like a tsunami that comes upon us suddenly.  

Being flexible, being able to reframe a crisis into an opportunity (if possible), and having emotional support can help you to make positive changes. 

But there are times when the crisis is so overwhelming that it is traumatic.

In other words, it's beyond what you can handle, and you might need help from a skilled mental health professional to help you to get through the crisis and come out of it more resilient than before.

Getting Help in Therapy
Everyone needs help at some point in his or her life.

Sometimes, friends and family, who are well-meaning, aren't helpful because they're part of the crisis or they're fearful of change so they can't see opportunities or alternatives.

When you're overwhelmed by a crisis, you could benefit from working with a skilled mental health professional who can help you to recognize your strengths and help you to regroup (see my article: The Benefits of Therapy).

Rather than struggling on your own, if you feel overwhelmed by a crisis in your life, seek help from an experienced psychotherapist who can help you to overcome the current obstacles so you can live a more fulfilling life (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 (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

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

I have helped many clients to overcome their problems so they could maximize their potential and live the life they want to live.

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

Clients' Fears of Being Abandoned By Their Psychotherapist

In prior articles, I've discussed fear of abandonment in relationships as well as psychotherapy clients' fear of being a disappointment to their therapist (see my articles:  Fear of Being a Disappointment to Your TherapistFear of Abandonment: Leaving Your Relationship Because You're Afraid of Being Abandoned, The Connection Between Fear of Abandonment and Codependency IssuesFear of Abandonment Can Occur Even in a Healthy, Stable Relationship, and How Psychotherapy Can Help You to Overcome Fear of Abandonment).  In this article, I'm focusing specifically on clients who have a general fear of abandonment because of their early traumatic history and the clinical implications of that fear in relation to their fear of being abandoned by their psychotherapist.

Clients' Fear of Being Abandoned By Their Psychotherapist 

There are many ways that clients, who have a fear of being abandoned, could perceive the therapist  as abandoning them.   Clients who have this fear are often hypervigilant for any possible signs that the therapist is not fully present in the therapy hour.

Most psychotherapists, who are trained in psychoanalysis or psychodynamic psychotherapy, have the ability to be emotionally engaged in the therapy session to the client's therapeutic process, including subtle shifts in the client's self states (see my article: Your Shifting Self States Can Affect You For Better or Worse).

Experienced contemporary psychoanalytic and psychodynamically trained psychotherapists are trained to intuitively pick up on what is going on in the intersubjective space between the client and the therapist even during times of silence.

But this doesn't mean that every psychodynamic psychotherapist is perfectly attuned during every moment of the therapy session.  There might be times when the therapist's mind momentarily wonders.  This is often related to the client's process even when it doesn't, at first, appear to be related.

For instance, if a psychotherapist is working with a highly dissociated client who is fairly disconnected from what he is talking about to the therapist, the therapist might find that her mind wonders momentarily as if both client and therapist are caught in the client's "cloud" of dissociation.

For an experienced psychotherapist, who is knowledgeable about dissociation, this momentary joining with the client in the dissociative "cloud" is important clinical information about what's going on with the client as well as what's going on between the client and the therapist.

For example, if, for a moment, the therapist "hears" a song in her mind, she asks herself inwardly whether this song has come into her thoughts unconsciously and how it may or may not be related to the client (see my article: The Psychotherapist's Empathic Attunement to Unconscious Process in the Therapy Session).

Psychotherapists who are comfortable disclosing their thoughts to the client might explore with the client if the client thinks it is related.

So, for instance, the therapist might say, "You know, you were just talking about your relationship and the song, "I Can't Make You Love Me" by Bonnie Raitt just popped into my head.  I'm wondering if I'm picking up something unconsciously about what's going on with you and your spouse."

More often than not, in this type of situation, even if the client wasn't talking about his feeling that his  wife no longer loves him, he might suddenly realize that the therapist picked up on a dissociated part of him that, until now, he was unaware of.  It's often a disavowed part of himself (or a disavowed self state) that he was unaware of but which was in the intersubjective "air" between the therapist and the client on an unconscious level.

When this happens, this phenomenon allows this disavowed self state to come "online" for the client. It might have been a part of himself that was just below the surface, so to speak, and was being unconsciously communicated to the therapist.

Although the client might not be happy to realize that he's really worried about his wife not loving him any more, he and his therapist now have a deeper understanding of a part of himself that was dissociated, and this part can now be worked with in therapy.

So, this is an example of what seems like a lapse in the psychotherapist's attention, but it's actually the client's unconscious material becoming conscious and furthering the work.

But a client, who is not ready to deal with his fear of not being loved by his spouse--even if he expressed this fear in prior therapy sessions--and who generally fears being abandoned, including by his therapist, will deny that the song that popped into the therapist's head is relevant.

Not only will the client deny it, he will also perceive the therapist's momentary thought about the song as being intrusive and a form of abandonment, "Why are you thinking about songs when you should be paying attention to me?"

The client sees this as "evidence" that the therapist really isn't interested in him because the therapist's mind wandered for a second.

Months later, when the client becomes ready to own his fear about his wife, he might tell the therapist that it was prescient of her to pick up on this dissociated fear a few months back in the form of the song.

But before the client is ready to allow that disavowed part of himself (the part that has this fear about his wife) to fully emerge, he will only see this phenomenon as a disruption to the therapy session and proof that the therapist abandoned him--even if it was just for a second.

What the client is unaware of is that the abandonment which he fears will happen already happened with his primary caregivers and this is now the template through which he sees his relationships, including his relationship with his therapist (see my article: Developmental Trauma: Living in the Present As If It Were the Past and Overcoming Trauma: When the Past is in the Present).

Let's take a look at a fictional clinical vignette which illustrates these dynamics:

Sandy started therapy because she wanted to be in a relationship, but whenever she got close to anyone in a romantic relationship, she would become too afraid to remain in the relationship and she would find a way to consciously sabotage it (see my article: An Emotional Dilemma: Wanting and Dreading Love).

In hindsight, Sandy would see how she sabotaged the relationship but, no matter how many times this happened, she was unable to see it while it was happening.

Clients' Fears of Being Abandoned By Their Psychotherapist

This part of her that unconsciously destroyed her relationships was so dissociated that it operated as if it were not a part of her at all.  She would tell her therapist, "It's as if it's 'not me' acting in the relationship--as if I'm in a dream and I only wake up after I've damaged the relationship beyond repair."

Sandy talked to her therapist about her fear that if her friends or a potential boyfriend ever really got to know the "real me," they wouldn't like her and they wouldn't want to be around her (see my article: Overcoming the Fear That People Won't Like You If They Knew the "Real You").

Her therapist was aware that, most likely, if Sandy had this fear with others, she probably had this fear with the therapist as well because this is a common experience with clients who have this fear.

When her therapist attempted to explore whether Sandy had this same fear with her, Sandy denied it.  But her therapist sensed that this fear was out of Sandy's current awareness and Sandy wasn't ready to recognize it.

A few weeks later, when her therapist told Sandy that she would be going on vacation in a couple of months for three weeks, Sandy became highly anxious.  She struggled with her internal conflict of  wanting to suppress this fear and wanting to talk about it.

A week later, when Sandy came for her next session, she told her therapist that she was having nightmares about being a young child who was being accompanied by a woman in a subway station.  Sandy didn't recognize this woman, but in the dream this woman seemed to be a nanny or some sort of caregiver.  Suddenly, in the dream, the woman, who was accompanying her, disappeared and Sandy was lost and confused in the crowded subway station.  She didn't know where to go or what to do and she began to panic.

Each time that she had this dream, Sandy told her therapist, she woke up startled and couldn't go back to sleep.  Her heart was pounding and her thoughts were racing.  Even hours after she woke up, she still felt a sense of dread that was residue from her dream.

Sandy and her therapist explored the meaning of the dream, especially as these dreams began right after her therapist told Sandy that she would be going on vacation in a couple of months for three weeks.

Sandy's first reaction was that she felt ashamed.  On the one hand, she knew, logically, that her therapist deserved to go on vacation, as everyone does.  But, on the other hand, a part of her feared that her therapist wouldn't come back or that if she came back, she would decide that Sandy was "just too much" for her and end the therapy.  Then, Sandy would be left on her own, feeling abandoned and not knowing what to do.

Given Sandy's childhood history of her father disappearing one night (never to return) and her mother's major depression where she was barely able to function, it was understandable that Sandy would have a fear of abandonment because she had been traumatized by each of her parent's abandonment--the physical abandonment by her father and the emotional abandonment by her mother.

This fear of abandonment was what was getting in the way of Sandy having a lasting relationship.  She unconsciously sabotaged the relationship to end it because she wanted a sense of control of the end rather than waiting for her boyfriend at the time to abandon her.

Sandy's fear of being abandoned by her therapist was now out in the open for her and her therapist to work on.  Sandy knew that she didn't completely believe that her therapist would abandon her--it was only a part of her that felt this way, but it was a powerful part (see my article: Reclaiming a Lost Part of Yourself).

As Sandy and her therapist talked more about her fear, she felt the fear somewhat subside.  She was aware that her fear was based on her childhood trauma of real abandonment (not just fear of abandonment).  So, over time, Sandy and her therapist were able to process her early trauma, which was the origin of her fear (see my article: Psychotherapy to Overcome Your Unresolved Childhood Trauma) and, gradually, the fear of being abandoned as an adult began to subside.

People who have a childhood history of emotional or physical abandonment often have a fear that important people in their life, including their psychotherapist, will abandon them.

At first, the fear might not be explicit.  It might be just under the surface and come to light through dreams or other unconscious material.

Before clients realize that they have this fear, the fear can get played out in other ways, like missed appointments, or in some cases by the client aborting therapy altogether rather than, from their point of view, risk being abandoned by the therapist (see my article: When Clients Leave Therapy Prematurely).

Once the fear is out in the open, clients often recognize that there is a part of them that has this fear.  In other words, they're not completely convinced that the therapist will abandon them--it's more like a disavowed part (or self state) contains this fear.

Becoming aware that what they fear has already happened in their childhood and that this has created a relational lens through which their fear is projected onto current relationships is helpful.

Even more helpful is the processing of the original trauma so that the fear of being abandoned doesn't get triggered in current close relationships.

Getting Help in Therapy
Fear of being abandoned is one of the major reasons why clients come to therapy, especially if this fear is being enacted in important adult relationships.

Clients often don't recognize that they have this fear about their therapists until there is an upcoming separation, like the therapist's vacation.

When the fear comes to light in therapy, there is an opportunity to work on this issue because it's alive in the therapy.

Just knowing logically that the fear of abandonment is from a prior trauma, although helpful, isn't enough to overcome this fear.  The client and therapist need to do trauma-informed therapy to process the original trauma so that the fear no longer gets enacted in current relationships.

If you're struggling with fear of abandonment in your close relationships, you could benefit from working with a licensed trauma-informed mental health professional who can help you to overcome this fear (see my articles: The Benefits of Therapy and How to Choose a Psychotherapist).

Once you no longer fear being abandoned, you can live your life with a greater sense of ease and well-being.  You can also 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 (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients overcome a history of trauma, including a fear of being abandoned.

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.


Wednesday, December 13, 2017

Developmental Trauma: Living in the Present As If It Were the Past

My prior articles about psychological trauma discussed how unresolved childhood trauma, also known as developmental trauma, affects traumatized individuals as adults (see my article: Overcoming Trauma: When the Past is in the Present).  In this article, I'm focusing specifically on how developmental trauma often affects clients' relationship with their psychotherapist, especially during the early stage of psychotherapy.

Developmental Trauma: Living in the Present As If It Were the Past
In his paper, Developmental Trauma Disorder, trauma expert Bessel van der Kolk, MD indicated that developmental trauma, which includes abuse and neglect, is probably this country's biggest public health challenge.

He estimated that approximately 3,000,000 children are reported as being abused or neglected per year--and these are only the cases that are reported.  Many cases go unreported, so that number is probably much higher.

According to Dr. van der Kolk, approximately 80% of these cases are the result of abuse and neglect by the children's own parents.  As a result, developmental trauma is a significant problem in this country, and much remains to be done.

Since untreated trauma does not simply go away when children become adults, it's important to understand the impact of trauma (see my article: Untreated Trauma is a Serious Issue With Negative Consequences).

What is Developmental Trauma?
Before going into more clinical material, let's define "developmental trauma."

Developmental trauma occurs in childhood. It causes overwhelming stress for the child, especially when the stress is not alleviated by the parents.  This includes:
  • physical abuse
  • emotional abuse
  • sexual abuse
  • physical neglect
  • emotional neglect

The dysfunction in the home can include, among other things:
  • mental illness
  • substance abuse
  • domestic violence
  • an incarcerated relative
  • divorce
Developmental trauma is also called Adverse Childhood Experiences (ACE) and has serious long term health and mental health implications (see ACE Childhood Study).

Since adults, who experienced Adverse Childhood Experiences, were unable to trust their parents, who were supposed to love and protect them as children, it makes sense that they often have problems trusting people in their adult relationships, including their psychotherapist (see my article: Adults Who Were Neglected or Abused as Children Often Have Problems With Trust).

What Are the Clinical Implications in Therapy For Adults With Developmental Trauma?
For adults, who experienced developmental trauma as children, it takes a lot of courage to come to therapy to be emotionally vulnerable enough to work through their trauma (see my article: Starting Therapy to Overcome Untreated Trauma and Developing the Courage to Change).

It's not surprising that these adults often come to therapy with a great deal of ambivalence and mistrust (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Since most trauma-informed psychotherapists recognize these dynamics, they are aware of the importance of trying to establish a trusting relationship with these clients.

It's not unusual for these individuals to go from one psychotherapist to the next as soon as they feel emotionally vulnerable in therapy--especially since they often come to therapy unconsciously anticipating that the therapist will fail them in the same way that their parents failed them.

Their unconscious anticipatory fear that the psychotherapist will fail them in much the same way that their parents failed them usually indicates that they are living in the present as if it were the past.

The following fictional clinical vignette, which represents a common scenario for adults with developmental trauma, illustrates these points:

Fictional Clinical Vignette: Living in the Present As If It Were the Past

Nina, who was in her mid-30s, began therapy after her relationship with John ended six months after they started dating.

John ended the relationship because of Nina's jealous accusations.  John vehemently denied that he was cheating, but Nina didn't believe him.

Developmental Trauma: Living in the Present As If It Were the Past

Although they got along well during their first three months together, Nina began to suspect that John was cheating after their relationship became more emotionally intimate in their fourth month together.

Even though she saw no direct signs of John's infidelity, her suspicions alone were enough for her to assume that he was cheating, and she was relentless in her accusations.

When she came for her first session with her therapist, Nina expressed regret that she had destroyed her relationship with John with no objective evidence that he was cheating.  In hindsight, she understood her mistake and why John got fed up.

She also explained to her therapist that this was her pattern in relationships--she always assumed that her boyfriend at the time was cheating, even when there were no objective signs of infidelity.

When she came to therapy the following week for her second session, Nina had a completely different take on why her relationship with John ended.

She told her therapist, "All men cheat and since all men cheat, I know that John was cheating on me.  He ended the relationship because I called him on it and he didn't like it."

When her therapist attempted to explore Nina's feelings about the relationship in the current therapy session versus what Nina said in the first session, Nina acknowledged that she had initially said that  she had made a mistake with John.  But she maintained that she was wrong in her first session and what she felt today was the truth, "Men can't be trusted."

Her therapist realized that, although Nina did a 180 degree turnaround from her first therapy session to her second session a week later, she knew that Nina did not meet the clinical criteria for multiple personality disorder or, as it is now called, Dissociative Identity Disorder (DID).

She recognized Nina's turnaround as a matter of shifting self states, which is a dissociative process, but not as dissociative as DID (see my article: How Shifting Self States Can Affect You For Better or Worse).

And, while everyone has shifting self states to some degree, people who are not traumatized usually have barely perceptible shifts as compared to people with unresolved trauma.

So the fact that Nina had a completely different view about the demise of her relationship when she returned to therapy on the second week was understandable considering her history of childhood trauma.

When Nina talked about her childhood, she vacillated between idealizing and denigrating her mother.

When she idealized her mother, Nina thought that her mother could do no wrong.  But when she denigrated her mother, she blamed her mother for not leaving the father, who had a long history of cheating on the mother.  Once again, her therapist understood these shifts as being part of Nina's shifting self states which were emotionally unintegrated.

Nina also had a long history of aborting therapy.  She explained to her current therapist that she had seen 10 therapists in the last two years, and she left each one when she felt that she couldn't trust the therapist (see my article: When Clients Leave Psychotherapy Prematurely).

Based on what Nina told her, her current therapist could see that Nina's pattern was that she left therapy as soon as the therapeutic work intensified and she felt too vulnerable.  Before that, Nina tended to idealize her therapists.  But once the work progressed and came close to her core traumatic issues, Nina became fearful, she developed a mistrust for the therapist and left therapy abruptly.

Forewarned of Nina's pattern in therapy, her therapist knew that there was a real possibility that Nina might abort the current therapy--even if it seemed like she developed a trusting relationship with the therapist before they processed Nina's traumatic experiences.

During most of her therapy sessions, Nina made it clear to her therapist that she understood that her traumatic childhood, including her father's infidelity, impacted her ability to have lasting relationships with men.

Most of the time, she expressed regret for her mistrust and wanted to "...hurry up and get over my trauma, since I'm not getting any younger and I'd like to get married and have children."

Nina sought therapy with her current therapist because the therapist specialized in working with trauma using EMDR Therapy.  Nina wanted to try EMDR therapy because she heard that it tends to work faster than regular talk therapy.

On the days when Nina acknowledged how her childhood history affected her adult relationships, she was in a hurry to get relief from her traumatic symptoms.

But on the days when she came to therapy blaming "all men for being dogs," she disavowed any connection between her childhood history and the demise of her relationships.  Once again, her shifting perspective was due to her shifting self states.

As part of the therapeutic process, Nina's therapist was the "container" for these different self states (see my article: The Holding Environment in Psychotherapy).

She knew that, even when Nina was in a hurry to process her childhood trauma, Nina wasn't ready.  Nina needed to develop internal resources and a greater sense of emotional integration before she would be ready to process her childhood trauma--otherwise, she would be flooded with anxiety and completely overwhelmed by the trauma therapy.

Her therapist also helped Nina to recognize her different self states by doing Ego States therapy (also known as Parts Work therapy) with Nina.  In this type of therapy, the therapist helps the client to get to know each of her shifting self states in order to foster greater emotional integration.

Nina understood most of the time that the internal resourcing and the Ego States therapy was preparation to eventually process her traumatic memories.  But there were times when she came to therapy feeling angry with her therapist for "dragging out the process and not helping me to get over my trauma."

During those times, Nina was ambivalent about her therapist and about the therapy.  Nina feared that she was being "duped" by the therapist and that she shouldn't trust the therapist.  She threatened to leave therapy and accused her therapist of being "no better than all the other therapists that I've had before."

But Nina and her therapist weathered these storms and, most of the time, Nina was able to see that her doubts and mistrust were the result of a particular self state that got triggered when she became anxious about the therapy (see my article: Coping With Trauma: Becoming Aware of Your Emotional Triggers and Expanding Your Window of Tolerance in Therapy).

She could see that what she was experiencing was the result of her traumatic past which she was living out in the present with her therapist.

Along the way, there was enactments in therapy, as there often are with clients who have been traumatized:  There were several sessions in a row where Nina "forgot" to bring a check to pay her therapist, she "forgot" to come to her sessions, and she was annoyed when her therapist held her accountable for her broken appointments.

All of these enactments were unconscious on Nina's part and were part of her dissociative shifting self states.

Most of the time, her therapist did not get caught up in these enactments but, being human, there was one time when she found herself right in the middle of an enactment with Nina: Nina's therapist had to take a couple of weeks off for a medical procedure.  She made a conscious decision not to disclose her medical problem, which was not serious, to Nina because she assessed that Nina was not ready emotionally to handle this disclosure.  She also wanted to preserve her right to privacy by not disclosing her medical problem.

When her therapist told Nina that she had to take a couple of weeks off, Nina exploded.  She was angry because she felt she was being abandoned by her therapist and with only a couple of weeks notice (see my article: Abandonment Issues Can Get Triggered While Your Therapist is Away).

Nina's therapist had little notice from her doctor that she needed this medical procedure, which could not wait, so she couldn't provide Nina with more notice.  But her therapist didn't want to reveal this to Nina because, as previously mentioned, she thought Nina was too emotionally fragile at that point.

Her therapist did the best she could under the circumstances to contain Nina's upset as well as her own feelings of being misunderstood.  But, after two sessions where Nina ranted about the two week break, her therapist told Nina in an angry tone that she would have a backup therapist that could consult during that two week break.

Even though her therapist got caught up in a mutual enactment by talking to Nina in an angry tone, something shifted for Nina where she stopped ranting and realized that she was being unreasonable (see my article: Mutual Enactments in Psychotherapy Between Client and Psychotherapist).

They were able to talk about what had just happened between them, and Nina expressed that, while she didn't like that her therapist spoke to her in an angry tone, she could feel the genuine nature of her therapist's upset and this caused her to "wake up" and see her therapist as a "normal human being" with her own experiences and feelings.  This was a major breakthrough for Nina.

As I mentioned in an earlier article about enactments, there are times when mutual enactments can have a positive effect on the therapy if the therapist is able to repair the rupture between the therapist and client and they come to a new understanding of their therapeutic relationship (see my article: Ruptures and Repairs in Psychotherapy).

Of course, although these enactments can be repaired and advance the therapeutic work, a therapist should never plan an enactment.

Gradually, over time, Nina became much more perceptive of when she was going through a self state shift.  She had developed a much more observing sense of self so that she could step back, even when she was in a mistrustful state, and see, "It's happening again," which made it easier for her to be more objective and shift into a more emotionally balanced state.

Developmental Trauma: Living in the Present As If It Were the Past

As Nina became more emotionally integrated with fewer dramatic self state shifts, she was now ready to process her earlier traumatic experiences using EMDR therapy.

By processing her childhood trauma in therapy, eventually, Nina freed herself from her traumatic history so that she was no longer living in the present as if she were in the past.

Reenacting unresolved childhood trauma is an unconscious process.

These reenactments occur in personal relationships, work relationships, and in the client's relationship with his or her psychotherapist.

There are times when traumatized clients are able to get a glimpse into these reenactments in therapy but, due to the nature of their shifting self states, this new understanding can be tenuous and change back and forth over time until the client becomes more emotionally integrated as a result of the work in therapy.

A skilled trauma-informed psychotherapist understands that clients often go back and forth in their understanding of their problems because the shifting self states are unconscious.

Developing a trusting relationship with a traumatized client is of the utmost importance before any processing of trauma occurs.

The therapist must also help the client to develop the necessary internal resources and coping skills before processing trauma.

Each client is unique as to when he or she feels safe enough in therapy and prepared to do the therapeutic work.

When a client has worked through developmental trauma, s/he is free to live life without constantly reenacting the past.

Getting Help in Therapy
Making the decision to start therapy is an important step which most people don't take lightly, especially people with a history of trauma (see my article: The Benefits of Psychotherapy).

People with developmental trauma often come to therapy after they have had a series of major disappointments or setbacks in their life.

It takes courage to face a painful history of trauma, and most trauma-informed psychotherapists are aware of this and the clinical implications for the client (see my article: How to Choose a Psychotherapist).

If you think you might be living in the present as if it were the past, you owe it to yourself to get help from a licensed trauma-informed mental health professional.

Although the therapeutic work isn't quick or easy, once you have worked through the trauma, you can live a more fulfilling life without the burden of your past.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients to overcome trauma so they could go on to live a more fulfilling life.

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, December 12, 2017

How Your Attachment Style Affects Your Relationship

In her book, Hold Me Tight: Seven Conversations For a Lifetime of Love, marriage and family therapist, Sue Johnson, discusses, among other things, how attachment styles impact relationships and how to overcome relational dynamics that might be ruining your relationship (see my article: Telltale Signs That You and Your Spouse Are Growing Apart).

How Your Attachment Style Affects Your Relationship

Before going much further, I think it would be useful to define the term "attachment styles."

What Are Attachment Styles?
Your attachment style is how you relate to people.

Your attachment style is developed during infancy and it is formed based on your relationship with your primary caregivers (usually your parents).

The four attachment styles for adults are:
  • secure
  • insecure - anxious-preoccupied
  • insecure - dismissive-avoidant
  • insecure - fearful-avoidant
Based on the names of the categories above, it's obvious that the healthiest attachment style is the secure attachment style.

Although much has been written about attachment theory, I'm focusing more on the practical aspects of understanding attachment styles in relationships rather than the theory, so this is a basic explanation of attachment styles.

Even though people develop their attachment style early in life, it is possible to change how you relate.

How Do Attachment Styles Affect Relationships?
When two people come together in a relationship, they interact with each other based on their attachment style.

Although this might not be evident at first, once the relationship becomes more emotionally intimate, each person will interact with the other based on the attachment style they developed at an early age (this assumes that neither person has been to therapy and has not made any changes).

Most people have little to no aware of their particular attachment style.  They behave in a relationship in a way that feels right to them or their behavior might be unconscious.

The best way for me to demonstrate attachment styles in a relationship is through a fictionalized vignette:

Fictional Vignette:  How Your Attachment Style Affects Your Relationship:

Mary and Joe
Mary and Joe, who were both in their early 30s, were dating exclusively for a year.

During the early part of their relationship, they got along well and decided to be monogamous to see if their relationship would develop.

After six months, Mary suggested that they talk about where their relationship was going (see my article:  Dating: Is It Time to Have the Talk?).

Although she didn't want to rush things between them, she knew that she wanted to get married eventually and have children, and she was increasingly conscious of her age and that her "biological clock was ticking." All of this made her feel anxious.

Joe was open to having this talk.  He had also been thinking about talking about their relationship, but he probably would have waited a few more months.

At first, it was awkward for each of them to begin this discussion.  So, Mary began by saying that she loved Joe, she was happy in their relationship and she could see them getting married and having children together.  Then, she waited anxiously for Joe to respond.

Joe listened to Mary, and he responded that he loved her very much and he could also see them getting married and having a family "eventually," but he wasn't ready to make that commitment at this point.

When Mary asked him when he thought he would be able to make this commitment, Joe thought about it and then told Mary that he didn't know.  Even though he felt their relationship was heading in the direction of getting married and having a family, it just didn't feel right to him at the moment to make that commitment.

Mary was disappointed to hear Joe say this.  She had hoped that he would, at least, tell her that he wanted to set a date for them to get engaged.

When she told Joe this, he said he would be open to their living together and seeing how things worked out.  And, then, if things worked out for them, he would feel comfortable talking about getting engaged.

On one level, this made sense to Mary but, on another level, she also had a nagging doubt that if she and Joe moved in together that he would never ask her to get married.  She was aware that she felt this way based on how her mother talked about couples who lived together (her mother would say, "Why buy the cow when the milk is free?").

Over the next few weeks, they talked about this impasse several times, and Mary tried as best as she could to put aside her doubts.  They decided that even though they both had their own apartments, it would be better to find another place together that was neither hers nor his.

Two months later, they found an apartment that they both liked, and they moved in together.

Mary had hoped that when they moved in together, they would spend most of their free time together.    But Joe wanted to continue to go out with his friends a few nights a week and even sometimes on weekends, which left little time for Joe and Mary to spend together.  Mary realized that they were seeing each other less than before they lived together.

When Mary complained that they weren't spending as much time together as she would like, Joe dismissed her feelings as out of hand.  He told her that he felt they spent plenty of time together and he wasn't willing to give out his nights out with the guys (see my article: New Relationships: Time Together vs Time Apart).

As time went on, Mary felt increasingly upset and anxious about Joe's time away from her.  She felt that it meant he didn't care about her.  Her reasoning was: If Joe cared about me, he would want to spend as much time as possible with me (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

At the same time, Joe felt increasingly annoyed with what he perceived as Mary's demands on his time.  He couldn't understand why she was "making such a big deal" out of the time he spent with his friends.  He assured her that he wasn't seeing other women. What more could she want?

How Your Attachment Style Affects Your Relationship

The more Joe dismissed Mary's feelings, the more insecure and unlovable she felt.  She also blamed herself for going against her feelings that she shouldn't move in with Joe unless he made more of a commitment.  She saw Joe's dismissive comments about her feelings as proof that she made a mistake.

One Friday night when Joe came home from playing pool with his friends, he was shocked to discover that Mary had packed her bags and she was ready to go home to her family.

Mary was sitting on the couch in tears, "I'm not happy.  It must be my fault that you don't care about me, but I don't know how to fix it.  I think it's better if I leave."

When Joe got over the initial shock of seeing Mary with her bags packed, he sat next to her on the couch and told her not to be so hasty.  He suggested that they talk before she moved out, which she agreed to do.

Then, Joe explained that he likes his independence.  He said he didn't want to feel hemmed in by their relationship.  He still wanted to have friends and spend time with them.  He thought part of the problem was that Mary didn't spend more time with her friends and because of this, she was too emotionally dependent upon him.

Mary disagreed with Joe.  She told him that, as far as she was concerned, he was her primary relationship and more important than her friends, but it was clear to her that he didn't feel this way.

Joe thought that Mary was being too "clingy," but he didn't want to tell her this because he knew that she was feeling bad enough already.  He wondered to himself if he even wanted to be in relationship.  He never felt a real need for a relationship.  He preferred to be independent and on his own, but he also didn't want to be lonely, and when he met Mary, he fell in love with her.

Joe and Mary didn't resolve anything that night, but they agreed to continue to talk about it, so Mary unpacked and she stayed.

After a few days, when Mary felt her anxiety escalating again, she told Joe that she thought they could benefit from going to couples counseling.  Joe groaned inwardly when he heard Mary say this.  He didn't think they needed couples counseling, but he could see that she was very anxious and he didn't want to lose her, so he agreed to go.

After a few sessions of couples counseling, their couples counselor talk to them about attachment styles.  She said her impression was that Mary had an anxious-preoccupied attachment style and Joe had a dismissive-avoidant style.  She also told them that it was not unusual for people with these attachment styles to be attracted to each other.

Their therapist helped them to recognize their attachment styles and how it was impacting their relationship.  She also helped them to begin to make changes.

Since attachment styles are ingrained, it was not easy or quick work in couples counseling, but Joe and Mary made progress.

Mary learned to deal with her insecurities in the relationship, and Joe learned that his dismissive manner was a defense mechanism that kept him from getting closer to Mary.  He also learned that what he saw as "independence" was part of the defense mechanism.  Each of them learned to communicate about what they needed from the other.

How Your Attachment Style Affects Your Relationship
Joe recognized that he was spending much of his free time with his friends to avoid getting too close to Mary.  He saw that, even though he loved her, he was also afraid of getting hurt.  So, he agreed to spend only one night with his friends and spend the rest of his free time with Mary.  This increased their emotional intimacy and made him feel more vulnerable, but he was able to talk about this in the couples counseling.

Mary recognized that part of her unconscious attraction to Joe was that he was avoidant.  His avoidance seemed to confirm how she felt about herself--that she was unlovable.  So, Mary dealt with her longstanding feelings of being an unlovable person and with their new level of emotional intimacy.

As they continued to work on these issues in couples counseling, which was challenging, they were both happier in their relationship.

Most people have little to no knowledge of their attachment styles or that they are relating in a particular way with other people.

As mentioned earlier, attachment styles develop at an early age based on the relationship that infants have with their primary caregivers.

While no relationship is perfect, when both people have a secure attachment style, generally, they tend not to have the kind of problems that people with insecure attachment have.

Although attachment styles are ingrained from an early age, people can change how they relate if they attend individual therapy or couples counseling with a knowledgeable psychotherapist.

Getting Help in Therapy
If you're having problems in a romantic relationship or in your relationships with other people, it could be related attachment styles.

A skilled psychotherapist can help you to understand your attachment style, how it developed and how you can change how you relate to others (see my article: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Although changing how you relate to others can be challenging, you will be happier with yourself and others if you learn to relate in a healthier way.

Rather than continuing to do what doesn't work for you, you could benefit from getting help from a licensed mental health professional who is knowledgeable about attachment styles.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

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