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Wednesday, December 16, 2009

Psychotherapy: Overcoming Binge Eating During the Holiday Season

Many people who have problems with binge eating really struggle during the holiday season. The holidays are an especially challenging time because they often involve many of the issues that trigger overeating in binge eaters: family stressors, excessive amounts of food, and stressful emotions. The combination of these three triggers can have a powerful impact on binge eaters.

For people who are separated from their families, feelings of loneliness and isolation can become overwhelming during the holidays. For others who have conflictual relationships or tension in their families, they might experience anger, frustration, anxiety and sadness. For many people, childhood memories, whether they are positive or negative, can trigger a binge as these people try to cope with their feelings by soothing themselves with food.

As a psychotherapist in private practice in NYC, I hear many clients talk about how food was the only form of comfort they felt when they were growing up. As an adult, food is still associated with comfort and feeling soothed for these people. So, it's understandable that during stressful times over the holidays these clients turn to food to feel better. But, just like any binge, which initially might feel comforting, for most people, there is a lot of discomfort after they have eaten an excessive amount of food. For many of these same people, the discomfort which comes from excessive food intake and fear of gaining weight leads them to purge their food, which is very dangerous to their health and overall well-being.

If you know that you tend to overeat or binge during the holidays, it's best to plan ahead and think about how you'll handle stress and the availability of a lot of food.

Here are a few tips that might work for you:

Eat Regular, Well-Balanced Meals:
Many people make the mistake of skipping meals with the idea that they can then eat more at holiday social events. But research has shown that when people skip meals, they're more likely to overeat when they attend social events because they're hungry. It's better to eat three regular, nutritious meals (or four or five smaller meals) than to skip meals.

Be Mindful of Your Food Choices and Stand Away from the Food Table:
If you're at a party where there is a buffet, take a small plate and fill it with nutritious choices, avoiding high calorie foods. If you exercise a certain amount of mindfulness about what you choose, rather than eating in a dissociated way, you're more likely to make better choices. Also, if you're standing in close proximity to the food, you're more likely to go back for seconds, thirds, and fourths. It's better to stand away from the table to avoid temptation.

Focus on the People at the Party Rather than the Food:
Ideally, getting together with friends and family is about talking to them, getting caught up with what's going on with them and telling them about yourself, and having a good time. It shouldn't be primarily about the food. Even if you're around difficult people, it's better to find one or two pleasant people that you can interact with than making the food your central focus.

Wait 20 Minutes to See if the Food Craving will Pass:
If you've eaten well-balanced meals before the social event so that you're not starving, most food cravings will pass after about 20 minutes. Often the food craving is not so much about being hungry as it is about relieving stress and other uncomfortable feelings. Usually, if you can wait 20 minutes, the food craving passes and you won't overindulge.

Engage in Stress Management Techniques:
During this time of year, it's especially important that you engage in stress management techniques that help you to stay calm. Whether it's meditating, going for walks, going to the gym, attending a yoga class, venting to a friend, listening to music, or whatever would help you to ease your tension, you'll be less likely to engage in binge eating if you have other ways to manage your stress.

Seek Support from Overeaters Anonymous:
http://www.oanyc.org
Attending support groups where other people are struggling with the same issues as you can be comforting and help you to get the support that you need.

Seek Professional Help from a Licensed Psychotherapist:
If you've tried the techniques that I've mentioned above and you're still struggling with binge eating, you could benefit from talking to a licensed psychotherapist with expertise in helping clients to overcome binge eating.

I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist. I have helped many clients in my private practice overcome binge eating so that they can lead more fulfilling lives.

I am conveniently located in Manhattan.

To find out more about me, visit my web site: http://www.josephine-ferraro.com.

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


Tuesday, December 15, 2009

Psychotherapy: Healing Old Emotional Childhood Wounds that are Affecting Current Relationships

As a psychotherapist in NYC, I see many clients in both individual psychotherapy and couples/marriage counseling who are struggling with old, unresolved childhood wounds that are affecting their current relationships. Most people know, at least on an intellectual level, that their unresolved family of origin issues have the potential to impact their current relationships. But when you've actually experienced how powerful these old emotional wounds are when they get triggered in current relationships, you have a deeper emotional understanding of their adverse impact in your intimate relationship.


Healing Old Emotional Childhood Wounds That Are Affecting Your Current Relationships
Often, these old emotional wounds remain buried for a long time and don't get triggered until you're in an intimate relationship. The closer you are to your spouse or partner, the more likely it is that issues like fear of emotional abandonment, fear of not being lovable, and other similar feelings will arise in your relationship. The reason for that is that you're most vulnerable emotionally when you're in an intimate relationship. When you're experiencing these issues in your relationship, it's often difficult to know if you're feeling these emotions due to problems in the current relationship, past family of origin issues, or they represent some combination of the two.

One clue that these feelings are connected to unresolved emotional issues from the past is that your emotional reactions in your current relationship are out of proportion to the situation. Obviously, to recognize this, you must have some degree of insight and objectivity or, at least, be willing to talk it over with a trust family member or friend who can offer an insightful perspective.

The following scenario, which is a composite of different clients with all identifying information changed, illustrates how unresolved childhood emotional issues can get triggered and cause problems in a current relationship:

Tom:
Tom was a man in his mid-30s. He and Jennifer had been in a relationship for two years. They were talking about getting married. But, at the point when Tom came to see me for individual psychotherapy, they were arguing and Jennifer expressed serious concerns about whether they should stay together.

 As Tom explained it, they were very happy together until Jennifer took a job where she had to travel to the West Coast every couple of months. Whenever Tom heard that Jennifer had a business trip coming up, he would become highly anxious, irritable and argumentative with Jennifer.

 Usually, Jennifer's business trips lasted no more than a week. But during the time when Jennifer was away, Tom became despondent and he had a terrible feeling of foreboding that he would never see Jennifer again. Neither Jennifer nor Tom understood why Tom was experiencing such strong emotional reactions. At first, she tried to be empathetic and console him. However, after a while, Jennifer felt frustrated and questioned whether she could be happy with Tom as a lifelong partner.

Healing Old Emotional Wounds That Are Affecting  Current Relationships
As Tom and I discussed his childhood history, I discovered that his father would often disappear for months at a time without warning, leaving the Tom, his mother, and his younger brother in a state of emotional and financial chaos. It became clear that whenever Jennifer left for a business trip, Tom's old, unresolved trauma was getting triggered and he was feeling the same fear and sadness that he experienced when he was a child. Realizing this on an intellectual level helped Tom to realize that he wasn't "crazy," but that knowledge alone did not prevent his fears.

Over time, Tom and I worked on his unresolved issues using EMDR (Eye Movement Desensitization and Reprocessing) and clinical hypnosis. Using these two powerful psychotherapeutic treatment modalities helped Tom to work through his trauma so that he was no longer triggered.

The real test came when Jennifer went on her next business trip. Tom was amazed that, despite fearing that he might have one of his usual traumatic reactions, he felt all right about Jennifer leaving. It was the first time, since she started traveling, that he wasn't in a panic, he didn't feel despondent, and he didn't feel abandoned by her. He felt completely free of his former traumatic symptoms. Jennifer was also greatly relieved. Within six months, they got married. When I followed up with Tom six months later, he reported that he continued to feel symptom free and they were happy together.

Often, when dealing with unresolved childhood trauma, regular talk therapy is not enough to overcome these problems. Talk therapy might provide intellectual insight into the trauma and what triggers the traumatic symptoms. But, often, it is not enough to heal old emotional wounds. Within the last 10-15 years, research has shown that, when it comes to healing trauma, mind-body oriented psychotherapy is usually more effective than regular talk therapy. Both EMDR and clinical hypnosis are considered forms of mind-body psychotherapy.

Many clients who are already in regular talk therapy will often come to an EMDR therapist or hypnotherapist for adjunctive therapy, where their current psychotherapist is the primary therapist and the EMDR therapist or hypnotherapist provides treatment in collaboration with the primary psychotherapist.

Healing Old Emotional Wounds with EMDR and Clinical Hypnosis

To find out more about EMDR, visit the EMDRIA web site: http://www.EMDRIA.org.

To find out more about clinical hypnosis, also known as hypnotherapy, visit the professional web site for hypnotherapy: http://www.ASCH.net.

When choosing a psychotherapist, EMDR therapist or a hypnotherapist, always choose a licensed mental health professional. 

 Also, there is a big difference with regard to training and professional background between a "hypnotist" and a hypnotherapist. As the name implies, a hypnotherapist is a licensed therapist and a hypnotist is usually someone who has learned hypnosis techniques but who does not have the therapeutic background and expertise to deal with emotional issues.

I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist.

I have helped many clients in individual therapy as well as in couples therapy to overcome unresolved emotional trauma that is adversely affecting their current relationships.

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

To set up a consultation, please call me at (212) 726-1006 or email me: josephineolivia@aol.com


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Tuesday, December 8, 2009

Is it Depression or the Holiday Blues?

The holiday season is upon us once again. For many people, this is a time of joy and celebration with loved ones that they look forward to eagerly. But for many others this is a sad and stressful time where they suffer with the Holiday Blues. Sometimes, it's hard to distinguish between the Holiday Blues and depression. However, whereas the Holiday Blues usually pass when the holidays are over, depression is longer lasting and has certain symptoms that are unique compared to the Holiday Blues.


Is it Depression or the Holiday Blues?
Symptoms of Depression
According to the National Institute of Mental Health (NIMH), if you suffer from five or more of the following symptoms for two or more weeks, you should seek the help of a licensed mental health professional:
  • Persistent sad or anxious mood
  • Overall feelngs of pessimism and hopelessness
  • Feelings of guilt, worthlessness and helplessness
  • Loss of interest in activities that you once enjoyed, including sex
  • Difficulty with memory, concentration or decisionmaking
  • Insomnia (either falling or staying asleep)
  • Change in appetite (either overeating or undereating)
  • Restlessness, irritability
  • Persistent physical symptoms that do not go away when medical reasons have been ruled out (headaches, digestive problems, or other aches and pains)
Coping with the Holiday Blues
Is it Depression or the Holiday Blues?
As previously mentioned, whereas depression is a serious mental health problem, the Holiday Blues are usually transient and people are often able to cope if they follow a few of the following recommendations:

Maintain Your Perspective
The holiday season can be a time when you feel exhausted, sad and anxious from too much shopping, overspending, overeating. socializing, not getting enough rest, and the pressure to meet your own as well as others' expectations.

If you're feeling overwhelmed, try to maintain your perspective about what is meaningful about the holidays. Is it really about the gifts or is there a deeper meaning for you and your family?

It's often valuable to look at how various cultures address issues of overindulgence. In Patanjali's Yoga Sutra, the Yamas are the first of the eight limbs of yoga that represent ethical guidelines for living one's life, similar to the Golden Rule ("Do unto others as you would have them do unto you"). One of the Yamas is called Aparigrapha, which is usually translated to mean: non-possessiveness, non-holding through the senses, non-grasping, non-indulgence, non-acquisitiveness, and non-covetousness (see Yoga Journal: http://www.yogajournal.com/basics/158 for more information about the Yoga Sutra).

The Wisdom of the Yoga Sutra
You don't have to be a yogi to benefit from this philosophy. During this time to year, it's a good time to take stock, even if you're not religious or particularly spiritual, with regard to what the holidays mean to you, rather than getting caught up in the commercialism, greed and overindulgence that, unfortunately, have become a part of the holiday season.

Stay Focused on the Present
Comparing your current experience of the holidays to your experiences from years gone by can be a recipe for disaster, whether you had pleasant or unpleasant experiences in the past.

If you had wonderful holidays as a child and your current holidays don't quite measure up, you might find yourself pining for those former times. If you become so focused on the past, you might miss precious moments of joy that are occurring now. A moment of joy can be as simple as watching the sense of wonder on a child's face as she experiences the joy of the holidays. Similarly, if your holidays as a child were a disaster, you might close yourself off to what could be meaningful times with family and friends now because you have negative expectations.

Keeping a mindful awareness of the here-and-now can be a good antedote to ruminating about the past of fantasizing about the future.

Avoid Controversial Topics at Family Gatherings
This is not the time to debate contentious political issues or rehash old resentments just because you and your family are all together in the same place. Stay focused on the deeper meaning of the holidays. If family members attempt to discuss controversial topics, suggest keeping this time as pleasant as possible. You can get together at another time to talk about these topics.

You might also need to gauge how much time you spend with family members as part of your own self care. A reasonably pleasant couple of hours is better than a day of bickering.

Also, you want to ensure that your expectations about your family are reasonable. If you know there are certain ongoing family issues or dysfunctional dynamics in your family, don't expect that they will suddenly become the ideal famly portrayed in the movies or TV. Just because it's the holidays doesn't mean that you and your family will overcome whatever ongoing problems that may exist.

Take Care of Yourself

Practice Self Care
When you're tired and run down, you are more likely to get sick. During the holidays, you need to take even better care of yourself than you would normally. This means getting a good night's sleep, eating nutrious meals, and getting emotional support if you need it.

Volunteer


Volunteering Can Be a Good Way to Create the Holiday Spirit For Yourself and Others
If you're not spending time with family and friends during the holidays, volunteering can be a good way to create the holiday spirit for yourself and others who might be less fortunate than you. There are so many volunteer organizations that would be grateful for your help. If you're not sure which volunteer organizations are in your area, you can consult with the local churches, synagogues, mosques, charitable organizations in your area as well as your municipality for a list of volunteer organizations.

If you're not sure if what you're feeling is the Holiday Blues or depression, you might benefit from consulting with a licensed psychotherapist.

I am a NYC licensed psychotherapist, hypnotherapist and EMDR therapist.

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

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

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Tuesday, December 1, 2009

Psychotherapy and Compassionate Self Acceptance

As a psychotherapist in NYC, I have found that one of the major challenges for people who begin psychotherapy is overcoming their own critical and judgmental beliefs and assumptions about themselves. When I work with clients who have developed a harsh sense of self, I often begin by talking to them about how psychotherapy can help them to become more mindful, attuned and compassionate towards themselves.


Psychotherapy and Compassionate Self Acceptance

Low Self Esteem, Lack of Self Compassion and Self Acceptance, and the Development of the "False Self":
Many clients who begin psychotherapy to overcome low self esteem want to find a way to feel better about themselves. As their psychotherapy unfolds, often, what comes to light is that they have rejected parts of themselves that they have come to hate. Hate is a strong word, but it is usually apt for the type of self loathing that these clients have come to feel for parts of themselves over time.

This lack of self acceptance and self loathing is not always obvious to see at first. Sometimes, it manifests itself in a critical and judgmental attitude towards others. Other times, it shows itself through a need to be "perfect" themselves and to have others be "perfect." Very often, this self loathing and lack of compassion for oneself can be seen when people develop a "false self" when they are interacting with others.

Donald Winnicott and the "False Self"
Donald Winnicott, a British Object Relations psychoanalyst and pediatrician, was one of the first psychotherapists who developed a theory about the "false self."

In his developmental model of the "false self," Winnicott posits that, early on, when parenting is "good enough" a baby learns to relate to his or her primary caregiver in an authentic and loving way.

"Good enough" is the operative term here, since parenting can never be perfect and parents cannot always be perfectly attuned to their children.

However, according to Winnicott, when the primary caregiver (usually the mother) is sufficiently and lovingly attuned to the baby, the baby is usually able to thrive emotionally and, over time, learns to relate well to others as well as to him or herself. However, when the primary caregiver is unable to connect emotionally with the baby, either because he or she is depressed or for some other reason, the infant feels rejected and develops a "false self" to try to elicit the caregiver's love and attention.

People who have developed a "false self" often describe themselves as feeling "empty" or "hollow" and have difficulty relating to themselves as people who are worthy of love and compassion. They also often have difficulty relating to others because their own critical judgments and self loathing gets projected onto others: What they unconsciously cannot accept in themselves becomes intolerable when they sense these qualities in others.

So, over time, in psychotherapy, it becomes apparent that low esteem, depression, anxiety and other emotional problems are often connected to a lack of compassionate self acceptance for oneself and the development of a "false self." It may seem somewhat contradictory, but until you can accept the parts of yourself that you don't like, they're difficult to change.

The following is a vignette which represents a composite of several psychotherapy cases where a client has a "false self":

Carol:
Carol began psychotherapy because she felt that her life was "meaningless." She was in her mid-30s and she had never had a romantic relationship that lasted for more than a year. She described herself as feeling that she "existed" but she was "not really living." She could only express this feeling in the vaguest of terms, but the feeling was strong in her. Her emotional world felt flat--no passion, no real highs or lows.

Psychotherapy and Compassionate Self Acceptance

She worked as an attorney for a nonprofit social service agency, and her employer valued her work because she worked very hard advocating for the clients and often won her cases. However, even though she knew that she was highly esteemed in her organization, she could not feel good about herself at work or in any other part of her life.

In describing her childhood history, she emphasized that she felt she had good parents and she denied any abuse or big traumatic events. As such, she had a hard time understanding why she felt the way she did, "If my parents beat me, I could understand why I feel this way about myself, but they didn't, so there must be something very wrong with me."

It soon became apparent in psychotherapy that underneath that flat sense of meaninglessness, Carol had a strong sense of self loathing. Most of the time, she was able to push down those feelings of self hatred by working long hours and keeping herself distracted. However, as she talked about herself in a judgmental and critical way, it became evident that she lacked a sense of acceptance and compassion for herself.

She ran roughshod over herself with a sense of perfectionism and judgement that was truly soul crushing. No matter how much external praise she received from others, she never felt that anything she did was good enough. She spent a lot of time ruminating about what she perceived as her personal flaws or how she "could have done it better." She was her own worst taskmaster with standards that were unattainable.

In discussing her family history in more depth, it turned out that her parents, who were highly-regarded Ivy League college professors, were rather critical and emotionally distant with Carol. They provided her with everything that she needed on a material level, but they gave Carol the overarching message again and again that what they truly valued in her was her accomplishments in school. There was little sense that they valued her just as she was as a person.

Carol learned as a child that if she got very good grades and tried to be as "perfect" as she could, her parents would praise her efforts. But if she fell short in any way, as all of us do at some point or another because we're human, they found this intolerable.

Carol was also very aware that her mother, who stayed home with Carol until she was five years old and started school, had a lot of resentment about this. Her mother would have preferred to be teaching her classes and continuing her research than staying home with a helpless, dependent baby.

Carol had heard her mother lament many times about how the time she spent away from her field was detrimental to her career and that she was never able to regain the stature that she had prior to staying home with Carol.

Carol's father concurred with her mother about this. One can only surmise that Carol's mother's anger about her role as a mother probably did not allow her to be as emotionally attuned to Carol as an infant. And throughout Carol's childhood, neither parent demonstrated much emotional attunement for Carol as a child who deserved love for herself, without having to perform to their impossibly high standards.

Prior to starting psychotherapy, Carol had never questioned her parents' attitude towards her. The feeling that she was somehow to blame for her mother's lost professional opportunities and that she needed to perform to gain her parent's love and attention was so deeply ingrained at such a young age that it had become a strong part of Carol.

And even though her parents had somewhat mellowed as they aged and they no longer had such a punitive attitude towards Carol, it didn't matter because Carol had internalized their critical and judgmental attitude on such a deep and unconscious level that she was now doing it to herself.

Over time, Carol was able to see how she had developed a "false self" to please her parents. And even though this "false self" might have developed due to her parents lack of emotional attunement, she realized that it was now her responsibility, as an adult, to overcome the emotional obstacles that kept her from accepting herself just as she is.

It was a real challenge for her, but Carol began to question her harsh, punitive attitude towards herself. She mourned for the inner child part of herself who didn't get the unconditional love that she deserved.

She also began to learn to love that part of herself that she had learned to hate--the part that needed to be loved for herself and not for her "accomplishments." As she did this, she began to feel more authentic.

She no longer felt that she was performing a role or just going through the motions in her life. Life became richer and more meaningful as she became more emotionally attuned to herself. She also learned to forgive her parents and she developed better relationships with them as she recognized that they were no longer the punitive, emotionally withholding parents that she grew up with.

As they aged, they went through their own emotional transformation and she learned to relate to them as they are now and not how they were when she was a child.

As Carol became more compassionate and accepting towards herself, she felt better about herself.


Psychotherapy and Compassionate Self Acceptance

Accepting that she was human, she could make mistakes, she no longer needed to be "perfect," her self worth did not have to be based on her accomplishments, and that she deserved love, enabled her to open up others in an authentic way that she had never experienced before.

Eventually, she was able to open up to a relationship with a man who loved for her for herself, and they developed a healthy, loving and stable marriage.

Getting Help in Therapy


Compassionate Self Acceptance
If you are struggling with your own critical and judgmental beliefs and assumptions about yourself, you could benefit from participating in psychotherapy with a licensed mental health professional. Although it can be a challenge, you can learn to develop a more self accepting and compassionate sense of self so you can improve your relationship with yourself and others.

I am a licensed NYC psychotherapist, hypnotherapist and Somatic Experiencing therapist. I have helped many clients to develop a more self accepting and compassionate sense of self.

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

To set up a consultation, please call me at (212) 726-1006 or email me: josephineolivia@aol.com





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Wednesday, November 25, 2009

Relationships: Oxytocin, Trust and Empathy

After I wrote my post yesterday about psychotherapy, gratitude and balance, which was in keeping with the Thanksgiving holiday, I read a fascinating article by Nancy Angier in the Science Times section of the NY Times that piqued my interest. The article is called 
The Biology Behind the Milk of Human Kindness.

Relationships: Oxytocin, Trust and Empathy

Research Links Oxytocin to Increased Levels of Trust and Empathy
Ms. Angier discusses new research linking the hormone, oxytocin, to increased levels of trust and empathy. (Oxycotin is a naturally-occurring neurotransmitter in mammals--not to be confused with the drug, Oxycodan).

Relationships: Oxytocin, Trust, Empathy

Prior to this research, researchers have long known that oxytocin has aided in child birth (many doctors inject women in labor with oxytocin to induce labor), breast feeding, and that it usually increases naturally during sexual arousal and orgasm.

Oxytocin Facilitates Bonding and Has Implications For Relationships
Researchers have also known that increased levels of oxytocin facilitates bonding between mothers and babies in humans and other mammals. It is also generally accepted that when there is sexual chemistry between two people, there are high levels of oxytocin and when there is a lack of sexual chemistry, there are lower levels of oxycotin.

Oxytocin Facilitates Bonding and Has Implications For Relationships

However, this new research, which links increased levels of oxytocin with a greater capacity for trust and empathy has important implications for our relationships.

If you haven't read Ms. Angier's article in Science Times, I recommend that you take a look at it to understand the connection between oxytocin and our ability to feel trust and empathy in our relationships (see link that I have provided at the top of this post).

I am a NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

One of my specialities is helping individuals and couples to enhance their personal and work-related relationships.

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

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



Tuesday, November 24, 2009

Psychotherapy, Balance and Gratitude

A common myth about psychotherapy, especially among people who have never been in in-depth psychotherapy before, is that clients primarily "complain" to their psychotherapists about their families and their lives or come in to "fix" a particular problem. 

This is a very narrow view of psychotherapy and does not take into account the full richness and experience of the in-depth psychotherapy process as a place where clients, in addition to resolving particular problems, often find balance and gratitude in their lives, their relationships and for themselves as well.

During this Thanksgiving season, when we tend to be more aware of the people and things in our lives that we are grateful for, I'd like to focus in this post on how in-depth psychotherapy often leads to a greater sense of balance and gratitude.

Often, when people first begin psychotherapy, they either come for a particular problem or they have a sense that "something is wrong" in their lives, but they don't know what it is. In our culture, our tendency is to approach problems in a logical, linear way: identify the problem, analyze the various options, chose an option, fix the problem, and the process is finished.

There's nothing wrong with this approach and, in many instances, it works very well. It also often works well for some specific problems in psychotherapy and hypnosis, like smoking cessation or overcoming a particular fear or phobia. However, in-depth psychotherapy can be so much more than this for people who are interested in finding a greater sense of balance and contentment in their lives.

How Contemporary Psychotherapy Has Evolved Over the Years:
As psychotherapy has evolved over the years, there has been more of an emphasis on cultivating and building a more balanced sense of self. As opposed to more classical ways of working in psychotherapy where the emphasis was primarily on uncovering and working through problems, contemporary psychotherapists also help clients to build a stronger sense of self.

This is done, in part, through the development of clients' internal resources. These internal resources can take many different forms. Sometimes, they're coping abilities that clients have had all along but have been overlooked and under utilized. Often, they're internal resources, or parts of ourselves, that are discovered and developed during the psychotherapy process.

When people are depressed or anxious, it's common to focus on what's wrong or missing in their lives. This is understandable. Often, under these circumstances, their view starts out being narrow until they begin to feel some relief from their anxiety-related or depressive symptoms in a supportive psychotherapy treatment environment.

In contemporary in-depth psychotherapy, clients can begin the process of building a stronger sense of equanimity: a greater capacity to soothe themselves, love and value themselves more, appreciate subtle and richer aspects of themselves, and develop a stronger sense of identity.

With a greater sense of balance for themselves often comes an increased capacity to value and have a greater sense of gratitude and compassion in their relationships, their work, and other important areas in their lives. So, what might have started as a narrow view at the start of psychotherapy begins to open up and broaden to include a more holistic and nuanced view of themselves and others: Not just what's wrong--but what's right too.

Keeping a Gratitude Journal:
I often recommend to clients that they keep a gratitude journal as a way to start developing a greater awareness and appreciation for the positive things that occur in their lives on a daily basis. The gratitude journal can be a simple list of two, three or more things that you feel grateful for each day. Over time, cultivating a sense of gratitude, even for the small things in life, can help to create a greater sense of balance, appreciation, and compassion in how we see our world as well as how we see ourselves.

I wish everyone a happy and healthy Thanksgiving.

I am a psychotherapist and hypnotherapist in NYC. I have helped many clients to develop a greater sense of self and an increased sense of balance and gratitude in their lives.

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

To set up a consultation, please call me at (212) 726-1006 or email me: josephineolivia@aol.com

Friday, November 13, 2009

Relationships: How Your Stress Can Affect Your Spouse and Children

In a New York Times, there was a article called Job Woes Exacting a Heavy Tole on Family Life  by Michael Luo.

The article focused on a particular family and how the father's job loss lead to emotional strains in his marriage as well as stress-induced behavior in his children. According to Mr. Luo, the family was holding up financially, but the children were picking up on the father's stress and anxiety and the tension in the marriage, and this created a lot anxiety for the children. After the father obtained a job, he and his wife began marriage counseling to deal with the fall out of this crisis in their lives and to save their marriage.

As a psychotherapist in NYC, I see many clients who are under emotional strain for a variety of reasons. For many, even if they haven't lost their jobs, they're worried about the possibility of losing their jobs at some point in the near future.

Other clients are under enormous stress and anxiety for other reasons. What I especially liked about the New York Times article is that it highlighted how spouses and children are affected emotionally (and not just financially) by the problems of one or both parents.

Often, clients will tell me that, even though they're feeling anxious or depressed, they think that they're hiding it from their family and it's not affecting them.

What they often don't realize, and what I will discuss with them, is that their spouses and children usually do notice and feel their emotional strain. 

When one or both parents are going through an emotional crisis, the whole family is affected, as stated in the New York Times article. Fortunately, according to Mr. Luo, the family mentioned in the article was able to put their lives back together because the parents recognized that their marriage and children were adversely affected by the father's anxiety.

Over the years, I've observed that many people think that young children don't understand their parents' emotional strain and, as a result, the children are not affected emotionally.

However, while it may be true that young children might not understand the nature of their parents' problems, they often do understand that "something is wrong" and "mommy and daddy aren't happy." Children are a lot more emotionally attuned to their parent's moods than most people think. When their parents are worried, depressed or not getting along, most children worry and often feel emotionally unsafe.

You might think that you're hiding your emotions under a facade that "Everything is all right" or by telling your children that "Nothing is wrong," but they usually know better. And, in fact, by trying to pretend to your children that everything is fine, when they sense that it's not, it becomes even more worrisome for them.

Of course, this doesn't mean that you're going to go to the other extreme and talk to your young children as if they were adults. But it does mean that you can talk to them, at a level that is appropriate for their age, and assure them that you love them and you're going to do everything you can to make sure that they're safe and secure.

It might also mean that, if your emotional strain is not likely to let up any time soon, you will need to find ways to cope with it to manage your stress and assure your own emotional well-being. This might mean that you begin a walking regimen, begin taking a yoga class, learn to meditate and do deep breathing, or any one of a variety of stress management techniques.

The main point is that, when it comes to your spouse's and children's well-being, what you say to them is much less important than what they observe in you. If they observe that you're depressed and anxious about a particular problem and you deny it or try to put up what you think is a good front, they're going to respond to and be affected by your overall emotional demeanor more than your words.

Young children usually don't have the cognitive or verbal capacity to explain to their parents that they feel anxious or depressed about the parents' problems. But parents can see it in other ways: a child's good grades suddenly plummet, a child who is normally well-behaved in school begins talking back to the teacher or fighting with other students, a child who usually sleeps well by himself suddenly becomes too afraid of the dark and wants to sleep with his parents, a child begins to pull out her hair because she is overcome with anxiety (as seen in the New York Times article), siblings who usually get along begin fighting, a 10 year old child might begin wetting the bed, and so on.

When parents are in denial about how their own problems affect their children, they might only consider external factors outside the family: the schoolteacher is not doing a good enough job, the boy next door is a bad influence, maybe someone in the neighborhood is bothering their child, etc.

Denial is a powerful emotional defense and we use it to ward off emotions that are difficult for us to handle. For many parents, it's too hard for them to believe that their own problems are the cause of their children's anxiety.

Often, individuals and couples come to psychotherapy after they come to terms with the fact that their problems are causing stress-induced problems in their children. As they learn to cope with their problems in a better way, often, this restores a sense of emotional equilibrium to the rest of the family.

As I think about this, I'm reminded of the safety advice that flight attendants give to passengers who have children with them on the flight: Put your oxygen mask on yourself first before you put the oxygen mask on your child. Although it might seem counter-intuitive at first, it makes perfect sense when you think about it: If you don't take care of yourself first, you won't be able to take care of your child.

I am a psychotherapist and hypnotherapist in NYC who works with individuals and couples.

To find out more about me, visit my web site: http://josephineferrarotherapy.com

To set up a consultation, call me at (212) 726-1006 or email me:  josephineolivia@aol.com.






Thursday, November 12, 2009

Psychotherapy: Getting the Most Out of Your Therapy Sessions

As a psychotherapist in NYC, I often see clients who are coming to psychotherapy for the first time or clients who have been in therapy before where they didn't have a positive outcome.

Psychotherapy:  Getting the Most Out of Your Therapy Sessions

Participating in psychotherapy involves a commitment of time, effort, and money. If you've never participated in psychotherapy or if your prior therapy experience was not a positive one, you might not know what to expect from your therapist or what your therapist expects of you. So, I usually like to talk to new clients about this so they can understand the treatment frame and they can get the most out of their sessions with me.

Choosing a psychotherapist:

A Good Therapeutic Relationship:
If you're trying to find a psychotherapist in a large city like NYC, you usually have many therapists available to you, especially if you have the ability to go outside of your managed care network.

Generally, the most important factor in choosing a psychotherapist is whether or not you feel a rapport with him or her. This might not be evident immediately. It takes time to build a professional rapport with your therapist. Having a good therapeutic working relationship is usually the best predictor of whether or not your therapy will be successful.

It's important to feel that your therapist has empathy and cares about you within the bounds of the professional treatment relationship.

Not every therapist is for every client. Someone else might really like a particular therapist and establish a good rapport with that therapist, whereas you might feel that you're not connecting with that same therapist. It doesn't mean that there's anything wrong with you or necessarily wrong with the therapist. It means that we're all unique and what works for one person might not work for someone else. Usually, after a few sessions, you can tell intuitively if you're connecting with a particular therapist.

Establishing a good therapeutic relationship doesn't mean that you're always going to "feel good" in your psychotherapy sessions. After all, the change process can be challenging and you might be discussing topics that bring up uncomfortable emotions. So, it's important to distinguish between those feelings and the overall rapport you feel with your therapist.

Different Types of Psychotherapy:
Aside from feeling a rapport with your therapist, there are also many different types of psychotherapy.

As a psychotherapist, I work in many different ways, depending upon the needs of the client: psychodynamic psychotherapy, cognitive behavioral treatment (CBT), EMDR (eye movement, desensitization and reprocessing), clinical hypnosis (also known as hypnotherapy), and Somatic Experiencing are among the different treatment modalities that I use.

You might find that you like and respond best to certain forms of psychotherapy and not others. Obviously, you're not responsible and cannot be expected to know about these different forms of psychotherapy before you start therapy, but you can ask any prospective therapist about them, and he or she should be able to explain in plain English any treatment modality that he or she uses.

Choosing A Licensed Psychotherapist:
It's important that whoever you choose is a licensed mental health professional.

There are people who call themselves counselors or therapists who have no professional training, expertise or psychotherapy background. They might be very nice people but, in most states, including New York State, if they're not licensed, they're not psychotherapists.

Knowing that your therapist is licensed lets you know that he or she mets the basic professional requirements in his or her profession.

It doesn't guarantee that he or she will be a good therapist or the right therapist for you, but it demonstrates that the minimum requirements stipulated by your State have been met. It also means that the therapist is governed by a State professional licensing bureau and is ethically bound and accountable to that bureau.

If you're not sure, you can ask your therapist. You can also check with the State professional licensing board. In New York State, you can go to the Office of the Professionals - NYS Education Department: http://www.op.nysed.gov/ and go to the section for verifications.

Choosing a Psychotherapist Who Stays Up-to-Date With Current Practices:
Aside from meeting the minimum requirements for licensing, you should ask any prospective psychotherapist that you're considering about his or her background and training. Generally, you want someone who has stayed up-to-date with current practices.

Psychotherapy:  Choosing a Therapist

Often, clients who would be concerned about these issues when choosing a doctor, don't think about it when they're considering a psychotherapist.

So, for instance, if you needed surgery, you would want to make sure that your surgeon continued to get training beyond his or her medical school training and stayed current with state of the art medical and surgical practices, especially for your particular medical problem. You wouldn't dream of seeing a surgeon who said, "I've never done this type of surgery before, but I'm happy to try it out on you" or "It's been a long time since I've performed this surgery. I might be rusty, but I think I can muddle through."

It's no different with psychotherapy. If a prospective therapist has not continued to train beyond graduate school, in my professional opinion, this isn't a good sign.

Ethical Considerations in Psychotherapy:
Ethical considerations in psychotherapy is a vast topic. There have been many books and articles written about it. I cannot possibly do justice to this topic in one posting. I think the vast majority of psychotherapists are ethical and caring people who want to help their clients. However, unfortunately, there are instances where there are boundary violations which are detrimental to the client. I will touch on some important factors:

"Dual Relationships" in Psychotherapy Are Unethical:
The psychotherapeutic relationship is unlike most relationships. It's different from a friendship or a familial relationship, even though you're talking about very personal things about yourself. Your therapist is not going to be your friend, not even after you stop therapy with him or her.

Psychotherapists' code of ethics considers it a boundary violation for therapists and clients to be in "dual relationships." That means that your relationship with your therapist will be strictly professional and limited to your therapy

Even though your therapist might have a warm and friendly manner, as a mental health professional, he or she is responsibile for maintaining clear and consistent boundaries.

Getting romantically or sexually involved with clients or taking advantage of clients in other ways is strictly forbidden. If a therapist seduces you into a romantic or sexual relationship, he (or she) can lose his license. You have the right to report the therapist to his or her professional board of ethics sessions (see my article:  Boundary Violations and Sexual Exploitation in Psychotherapy).

The therapy should be focused on you. An ethical therapist will not be discussing his or her own personal problems or focusing on him or herself.

This is another way that the psychotherapeutic relationship is different from most other relationships. Depending upon the psychotherapist, most therapists do not disclose a lot of personal information, especially if the therapist works in a psychodynamic way. The primary reason for this is, once again, to keep the focus on you.

That doesn't mean that the therapist might not selectively disclose certain things about him or herself if it's in the service of furthering the treatment.

Therapists' self disclosure is also another vast topic. Generally, even the most conservative psychoanalysts today no longer believe that they are "blank screens" for clients to project their thoughts and fantasies on. However, it's important to understand that if a therapist is not disclosing personal things about himself or herself, it's usually in the service of providing the best possible treatment for you.

Ethical Issues Regarding Managed Care Fees:
If your therapist is an in network provider on your managed care insurance panel, he or she should not be asking you to pay additional money, beyond your copayment, to bring your fee in line with his or her non-managed care fee structure.

When your therapist is on a managed care panel, he or she signed a contract with the managed care company to accept their fee. The contract also stipulates how to handle missed or broken appointments. If your therapist asks for additional money beyond what is allowed in the insurance contract, this is insurance fraud and is reportable to your insurance company and your therapist's professional board of ethics.

Also, most managed care companies don't allow your psychotherapist to charge the insurance for your missed or broken appointments. This is a contractual issue between your therapist and your managed care company.

That means that, in most cases, you are often responsible for the entire fee (not just the copayment) when you have a broken appointment with your therapist. This is a topic that should be discussed at the first sssion so that you're clear about your responsibility with regard to missed appointments. If you're not clear, you can call your insurance company and ask.

Some therapists bill the managed care company for broken appointments, even though it's against their contract with the insurance company. Possibly, they feel that they're being nice to clients by not charging them or they're trying to preserve the therapeutic relationship. However well intentioned this might be, you should know that, unless an insurance contract allows for this (and I don't know of any that do) this is insurance fraud and your therapist can lose his or her license for this.

Doing Your Part in Psychotherapy:
Usually, the therapeutic hour is somewhere between 45-60 minutes per week for individual therapy, depending upon your therapist and the type of therapy. An hour out of a week is not very much time. So, if you want to get the most out of your therapy, it's important that you know what is expected of you in therapy.

Doing Your Part in Therapy

Showing up for your appointments:
This might seem obvious, and most clients don't start therapy with the intention of not showing up for their appointments. However, it's not unusual to feel ambivalent about going to therapy. Clients will often start therapy saying that they want change, but the process of change is sometimes diffiicult, and when a client and therapist begin to discuss topics that are uncomfortable, some clients begin missing appointments.

They might not even realize that they're missing appointments because of their discomfort. Emotional discomfort and ambivalence can show up in many different guises: "forgotten" appointments, missing therapy because you feel "tired," and other reasons that might mask an unconscious wish to avoid change. Clients might also begin arriving late for their appointments as an unconscious way to avoid dealing with the process of change.

Thinking About What You Discussed in Therapy Between Sessions:
As I've mentioned, the therapeutic hour is brief compared to the rest of the time in your week. If you want to get the most out of therapy, it's important to think about what you and your therapist have discussed. That means taking time during the week to think or journal about the issues and feelings that come during and after your session.

It's also important to apply whatever you've learned in your every day life. Your therapy will be of little value to you if you have insights in your therapy session, but you forget them once you've left the therapist's office. Also, pay attention to whatever emotions come up between sessions and let your therapist know, even if you might feel uncomfortable. Chances are, if you're seeing an experienced, licensed mental health professional, he or she has already dealt with these issues before.

Doing Homework:
As a psychotherapist, I usually don't give a lot of homework to most clients between sessions. However, at times, I might recommend reading an article or a book, practicing something that has been learned in the session (like meditation or self hypnosis) or I might ask a client to journal or reflect on a particular issue or emotion. I might recommend attending a 12 Step meeting, getting a sponsor, etc.

I might also come to an agreement with a client to take a particular step or action to further the process.

For instance, if a client has problems with procrastination, it's important to talk about it and try to understand it but, ultimately, the client needs to take certain steps in order to overcome this problem. So, we might come to an agreement about what the next step might be to further the process along. Among other things, doing homework between sessions helps to bridge one session with another. A week might not seem like a long time, but in psychotherapy, it can be very long--enough time to forget or put out of your mind what you and your therapist have discussed. So, finding ways to bridge that time can be very valuable.

One posting about how to get the most out of your psychotherapy sessions is not enough to cover all the relevant topics. However, if you're thinking about starting therapy or if you're already in therapy, I hope this posting will be a good start for you and get you thinking about it.

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

I have helped many clients to lead more fulfilling lives.

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

To set up a consultation, call me at (212) 726-1006 or email me: josephineolivia@aol.com

Tuesday, November 10, 2009

Overcoming Sexual Addiction in Therapy

As a psychotherapist in NYC who specializes in sexual addiction, I've helped many clients overcome problems with sexual addiction. Both men and women, heterosexual, gay or bisexual can suffer with sex addiction. Like most addictions, sexual addiction can occur regardless of a person's age, race, ethnic background, sexual orientation, profession, income, religion, and educational background.
Overcoming Sexual Addiction in Therapy


What is Sexual Addiction?
Let's start out with what sexual addiction is not: Just because someone has affairs or looks at porn doesn't necessarily mean that he or she is a sex addict. If someone is cheating on his or her spouse or partner, this is obviously a problem, but it doesn't necessarily mean that he or she is a sex addict.

According to Patrick Carnes, Ph.D., a psychologist who is an expert in the sexual addiction field and who has written several books about it (see Resources below), someone who has a sexual addiction usually has some of the following characteristics:
  • A pattern of uncontrolled sexual behavior
  • Consequences (sometimes severe) to this uncontrolled sexual behavior. These consequences might include problems in his/her relationships due to sexual acting out behavior; legal problems, including arrest; work-related consequences as more and more time is spent preoccupied with sex rather than work or, among other things, getting caught downloading Internet porn or chatting online; and other similar consequences.
  • Ongoing efforts to try to stop sexual acting out, but an inability to stop engaging in sexual acting out despite consequences.
  • Pursuing self-destructive and high-risk sexual behavior. This might include getting drunk or high on drugs that leads to acting out sexually; meeting strangers for sex; going to known "cruising" areas to have sex with strangers in areas where he or she might get caught, beaten up or killed; engaging in sex without using contraception which could lead to a sexually-transmited disease, and other similar self-destructive and high-risk behavior.
  • Using sexual acting out to deal with untreated anxiety and depression, and the need to engage in more frequent or more dangerous sexual acting out as the current level no longer excites as much or wards off feelings of low self esteem or feelings of inadequacies
  • Large mood swings around sexual activity
  • Spending a significant amount of time either preoccupied with sex, sexual acting out or recovering from sexual activities
  • Neglecting important social, occupational or recreational activities due to compulsive sexual behavior
How Does Sexual Addiction Start?
The current American Psychiatric Association's Diagnostic and Statistical Manual for psychiatric disorders does not include sexual addiction as a separate diagnosis. This might change in future editions.

However, current research has found that there can be a genetic predisposition for sexual addiction. Current research has shown that there is often a family history of addiction, whether it is drug addiction, alcoholism or sexual addiction. In addition to the genetic component, when there is a history of addiction, the person who grows up in such a family also learns to self-medicate as a way of coping with painful emotions.



Sexual Addiction (both online and off) Affects Both Men and Women

Sexual Addiction Can Affect Anyone Regardless of Sexual Orientation

The Cycle of Sexual Addiction:
According to Patrick Carnes, the cycle of sexual addiction usually begins when the person has bad feelings about him or herself ("I'm unlovable," "No one cares about me," "I'm a bad person," "My needs will never be met in an ordinary relationship," and other similar negative feelings. When something negative happens to this person, it seems to confirm his or her feelings of low self worth. Since he or she has not learned good coping skills or healthy ways to deal with emotional pain, this person resorts to sexual acting out.

Prior to the sexual acting out behavior, the person who struggles with sexual addiction usually dissociates (i.e., unconsciously distances himself from his feelings) and enters into somewhat of an altered state where there is an emotional split between who he is in his every day life and who he is when he is acting out sexually. He becomes preoccupied with sexual fantasies that enable him to distance himself from his emotional pain. Once he enters into this dissociated state, he is more likely to act out sexually. There is often a ritualization to the sexual acting out. For example, part of the ritual might be to go to a strip club, get sexually aroused and then go see a prostitute to pay for sex or go home and participate in online sexual chat rooms or engage in some other form of infidelity.


Getting Help For Sexual Addiction in Therapy

Sexual acting out often relieves tension or regulates a depressed or anxious mood momentarily. However, this relief or elevation in mood doesn't last long. After acting out sexually, the person often feels an inordinate amount of shame, humiliation, guilt, and, often a higher level of depression or anxiety. At that point, the person who suffers with sexual addiction might promise himself and/or his spouse (if he is caught) that he will never do it again. However, this is part of the cycle of addiction, and the increase in painful emotions is often what fuels the next episode of sexual acting out. As a result, he is caught in the vicious cycle of sexual addiction, often needing more frequent, more intense or more dangerous forms of sexual acting out. The sexual addiction becomes a way to self-medicate painful emotions, similar to how alcoholics and drug addicts use alcohol and drugs to self-medicate.

When I work with people who have problems with sexual addiction, I start with a consultation to see if the client and I are a good therapeutic match. A good therapeutic match means that there is a good rapport between the client and the therapist. This might not be evident in the first session because most people feel very uncomfortable and ashamed of having a problem with sexual addiction. However, the client should feel at least comfortable enough to want to return for another session. When treatment is going well, the therapeutic alliance builds over time as the client gradually learns to trust the therapist.

I also assess clients for their motivation for change. It's not at all unusual for people to feel ambivalent about coming for treatment. Often, people come into treatment primarily because a spouse or an employer has urged them to come. This might be what gets someone into treatment and, initially, motivation might be low. The client might not even be sure if he or she has a problem with sexual addiction. However, if there is a problem, it's possible to develop your own internal motivation to overcome sexual addiction. Internal motivation is essential for a good treatment outcome. If your primary focus remains that you're doing it for someone else rather than yourself, you might need to do some soul searching in order to get to a place where you feel that you're doing it for yourself and you deserve to overcome this problem and lead a happier life.

Getting Help For Sexual Addiction


It's also important to know whether there is an underlying depression, anxiety disorder, attention deficit disorder or some other underlying emotional issue or trauma that needs to be addressed.

During treatment, I help a client to understand what triggers his sexual acting out. I also help him or her to learn new ways of coping, which is also essential to having a positive treatment outcome.

When you can anticipate what triggers your sexual addiction and you have other healthy ways of dealing with these triggers, you're more likely to stop the cycle of sexually acting out.

Depending upon the client and the underlying emotional issues, I might use cognitive behavioral treatment, psychodynamic psychotherapy, clinical hypnosis (also known as hypnotherapy) or EMDR (Eye Movement, Desensitization and Reprocessing) or a combination of these forms of psychotherapy to treat sexual addiction.

Going to self help meetings like Sex Addicts Anonymous or Sexual Compulsives Anonymous and getting a sponsor is also usually very helpful. It is also important to educate yourself with current literature about sexual addiction (see Resources below for information about 12 Step meetings and books).

If you're suffering with sexual addiction, you're not alone. Many people who are sexually addicted have been helped with psychotherapy and 12 Step meetings.

I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist.  I work with individual adults and couples, and I have helped many clients to overcome sexual addiction.

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

If you're thinking about treatment, you can call me at (212) 726-1006 to set up a consultation.

Resources:
12 Step meetings:
Sex Addicts Anonymous: http://www.saa-recovery.org/
Sexual Compulsives Anonymous: http://www.sca-recovery.org/

Inpatient Treatment:
The Meadows: http://www.themeadows.org/

Books:
Out of the Shadows: Understanding Sexual Addiction - By Patrick Carnes
Don't Call It Love: Recovery From Sexual Addiction - By Patrick Carnes
In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior - By Patrick Carnes
Lust, Anger, Love: Understanding Sexual Addiction and the Road to Healthy Intimacy - By Maureen Canning



photo credit: Daniel Conway via photopin cc

photo credit: nataliej via photopin cc

photo credit: NeezyGFX Photography via photopin cc

photo credit: Ronan_tlv via photopin cc

photo credit: DerrickT via photopin cc

Friday, November 6, 2009

EMDR for "Big T" and "Smaller t" Trauma

As a NYC psychotherapist who is an EMDR practitioner, I see clients for EMDR treatment for both "Big T" and "Smaller t" trauma. I will clarify what I mean by "Big T" and "Smaller t" trauma below.


EMDR For "Big T" and "Small T" Trauma

What is EMDR?
First, as I have written about in earlier posts, I want to reiterate that EMDR (Eye Movement Desensitization and Reprocessing) is a form of psychotherapy which has been found to be effective for healing trauma. Francine Shapiro, Ph.D., who is a psychologist, developed EMDR in the late 1980s.

Since that time, EMDR has been one of the most well-researched forms of psychotherapy for posttraumatic stress disorder (PTSD) and other types of trauma. It has been recognized as a safe and effective form of treatment by the Veteran's Administration, the American Psychiatric Association, the International Society for Traumatic Stress Studies, the Israeli National Council for Mental Health and the United Kingdom Department of Health, among other mental health organizations.

EMDR uses bilateral stimulation of the right and left brain hemispheres (through eye movements, alternate taping, bilateral music, and other similar methods) to activate the brain's "information processing system" to heal trauma.

When we are overcome by experiences that produce overwhelming emotional and physical reactions, often, our minds are unable to process these experiences.

Under certain circumstances, which are unique to each person, these overwhelming experiences can produce adverse reactions, like debilitating depression, anxiety and other psychological difficulties. EMDR allows clients to reprocess these experiences, allowing us to get to the root of these emotional processes, and usually produces a long-term cure.

EMDR therapists, who have advanced training, know how to work with clients in a way so that they are not overwhelmed with the EMDR reprocessing. Each client's experience is unique.

Generally speaking, high levels of emotional reaction tend to dissipate with EMDR treatment. Also, an experienced EMDR therapist makes sure that clients are well prepared for EMDR processing before the actual processing begins by working with clients to develop internal resources (coping skills) to deal with any uncomfortable reactions that might take place during the reprocessing of emotional trauma.

What is the Difference Between "Big T" and "Smaller t" Trauma?
EMDR is usually associated with what is referred to in psychological literature as "Big T" trauma. However, it seems that it is less well known that EMDR is usually very effective for "Smaller t" trauma as well.

"Big T" Trauma
When we refer to "Big T" trauma, we are usually referring to trauma that occurs during war or natural disaster, rape, kidnapping, physical attack, and other similar types of trauma. These types of trauma are usually so overwhelming for most people that they are unable to cope.

An example, of this is the Vietnam or Iraqi veteran who has witnessed atrocities during war and who comes home, relives these atrocities through flashbacks, where it adversely affects his or her ability to function in every day life.

Another example of "Big T" trauma is when a woman who has been raped continues to have nightmares about the rape; she ruminates about what happened, reliving the event over and over again in her mind.

An Example of a "Big T" Trauma Reaction: A Woman Who Was Raped Has Nightmares


 She might be too afraid to start new relationships or to even go outside.

Generally, "Smaller t" trauma is trauma that is more subtle than "Big T" trauma.

An example of "Smaller t" trauma can occur when we're children and we witness events that are upsetting and overwhelming to us because our child-like minds are unable to understand or process these events.

An example of a "Smaller t" trauma could be when a child witnesses loud arguments between his parents and he fears that they are going to get a divorce. As a child under these circumstances, it's normal to be concerned about his safety and well-being. After all, he worries about what will become of him and who's going to take care of him if his parents are not together.

These kinds of experiences can leave a mark on a child's psyche, leaving him vulnerable to feeling anxious, depressed, or insecure later on in life.

There are many other everyday examples of "Smaller t" trauma that people often don't recognize at the time when they're occurring. The emotional damage that has been done often does not show up until later on in life. Sometimes the events that led up to these problems later on are apparent and, other times, they're not. Either way, EMDR is usually an effective form of therapy to overcome the effects of "Smaller t" trauma.

Since most literature focuses on "Big T" trauma like PTSD, I would like to focus on "Smaller t" trauma in this post to illustrate its effects and how EMDR can help. The following vignette is a composite of many cases with all identifying information changed to protect confidentiality:

John:
When John first came to treatment, he was in his late 30s. He worked as an attorney in a large corporate law firm. Like most attorneys in his law firm, John hoped to become a partner one day in his firm.

Generally, he liked corporate law and enjoyed working with his clients. However, he felt very anxious around his boss because his boss was a bully. Whenever his boss felt that John fell below what was considered an acceptable rate of "billable hours," he berated him in the most demeaning way.

John understood the importance of "billable hours" and knew what was expected of him. He felt that, overall, he was a knowledgeable and capable attorney. However, whenever his boss berated him, John felt emotionally paralyzed.

John felt his confidence plummet and he would ruminate for days about whatever his boss told him. His colleagues experienced the same bullying from the boss and, although they were concerned about it, they were not as affected by it as John.

John Felt His Confidence Plummet

John recognized this and he knew that he needed to get help or his boss's tirades were going to continue to be detrimental to him. He realized that his reaction to his boss's comments were out of proportion to the current situation.

The First Phase of EMDR Treatment: During the first phase of EMDR treament with John, I obtained a detailed history from John about his background. From his family history, I learned that John's father was very much like his boss. He was hypercritical of John and often berated him, leaving him feeling like he could never please his father. If John came home with a report card with all A's and one B, John's father focused on the "B" and berated him for not getting an "A" in that subject, leaving John to feel badly about himself.

Developing Coping Skills: During that initial phase of treatment, I also helped him to develop basic coping skills. Since he didn't do anything to manage his stress, John began working out and going to yoga class. I also taught John to meditate.

In addition, we developed internal resources that he could use during EMDR processing. For instance, John learned to think about and visualize certain "protective" figures from his life (his grandfather, a kind uncle, his nurturing older sister, as well as a lifelong friend and confidant). Through EMDR processing, we worked to help John to internalize these protective figures in such a way that he could "call on them" (essentially, remember, visualize and sense them) when he felt emotional distress either in the psychotherapy session or outside. Just using these internal resources whenever he had to deal with his difficult boss helped John tremendously.

EMDR Processing: During the next phase of treatment, John chose a particular incident that occurred at work with his boss and we began to process that incident using EMDR eye movements. Initially, before the procesing, John rated this incident as a "9" out of a possible 10 in terms of how emotionally disturbing it was to him (with 0 being no disturbance and10 being the highest level of disturbance). So, overall, it started out as being very disturbing to him. However, as we continued to do EMDR processing, the incident became less and less disturbing. It gradually went down to a 5 for John. He felt relieved, compared to how he felt originally, but it was still disturbing. Further processing of that incident did not decrease John's level of disturbance.

When Processing of Trauma Gets Blocked: When the level of processing gets "blocked" (meaning that it stays at a certain level of disturbance and it won't go down to 0 or 1), it generally means there is underlying trauma that is feeding into the current situation and is making it more emotionally charged than it might normally be. Having already obtained John's family background, I was aware that John's relationship as a boy with his father was probably feeding into his current problems and activating his emotional response.

The Difference Between EMDR and Regular Talk Therapy for Trauma: If we were doing regular talk therapy, we might have discussed John's relationship with his father and how if affected him now.

It probably would have been enlightening to John but, usually, this would only remain as an intellectual insight. In other words, it's interesting and informative to know, but it doesn't produce any change. And therein lies the problem with regular talk therapy and trauma.

In addition to my EMDR training, I'm also trained as a psychoanalyst, so I understand and value psychodynamic treatment for most problems. However, when it comes to trauma, regular talk therapy is often limited in terms of resolving and healing trauma.

Processing the Earlier Trauma that Triggers the Current Trauma: So, knowing that there were probably earlier memories that were feeding into and triggering John's emotional reaction to his current situation, we did what is known in EMDR as a "float back."

During a "float back," the client thinks back to an earlier time when he might have experienced these same feelings. An experienced EMDR therapist might have a sense of what those memories might be, but he or she doesn't make any suggestions about them. The EMDR therapist allows the client to come up with whatever he or she remembers or senses.

In John's case, his earliest memory of feeling the same way as he did in his current situation was when his father berated him during Little League practice. According to John, he struck out each time that he was up at the plate during a big game with a rival team.

Afterwards, he was feeling bad enough, but when his father yelled at him in front of his team mates and the other parents, John was mortified. John rated his level of disturbance as being a "10" for this memory. Gradually, as we continued to process the memory with EMDR, his level of disturbance went down to a "0." When it went down to 0, he, of course, remembered the memory with all of the details, but he no longer felt disturbed by it.

Resolution of the Trauma: After we processed this earlier memory, which was emblematic of his experiences with his father, we went back to the current situation with his boss. As is usually the case, having reprocessed the earlier "Smaller t" trauma produced a "0" in terms of John's level of emotional experience in the current situation.

John was really surprised and greatly relieved. He was able to go back to work, deal with his boss, and when his boss saw that he could no longer intimidate John the way he used to, he stopped ranting at him and chose to bully another more vulnerable attorney instead.

EMDR For the Resolution of Trauma

EMDR Follow Up: When John checked in with me several months later, he told me that the results of our work continued to hold. He also said that his self esteem was now higher than it ever had been and his boss told him that he was on track to become a partner, which made John feel very happy.

The above vignette is one brief example that demonstrates how EMDR can work. Everyone's experience of EMDR is unique.

EMDR is an effective treatment for dealing with trauma, and it is usually faster than regular talk therapy.

Getting Help
If you have unresolved trauma, you could benefit from working with an experienced EMDR therapist who is a licensed psychotherapist.

To find out more about EMDR, visit the official EMDR website, EMDRIA, to get more information: http://www.emdria.org/.

To find out how EMDR is being used all over the US and around the world to help millions of people heal from trauma, visit the EMDR Humanitarian Association Program's (EMDR HAP) web site: http://www.emdrhap.org/.

I am a NYC licensed psychotherapist and EMDR clinician who has helped many clients resolve both "Big T" and "Smaller t" 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 send me an email: josephineolivia@aol.com



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