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Sunday, January 31, 2010

Overcoming Adult Separation Anxiety Disorder

Up until about 15 years ago, separation anxiety disorder was mostly discussed in psychotherapy literature as it related to children, not as a problem that adults have. And, yet separation anxiety disorder is a phenomenon that has been experienced by adults for hundreds (if not thousands) of years. Now that it is more widely recognized and treated by psychotherapists, there is a greater recognition that adult separation anxiety disorder is a problem that exists in about 6-7% of the adult population, which is significant.

Overcoming Adult Separation Anxiety Disorder

Traditionally, separation anxiety has been viewed as a normal development in some infants starting at about the age of seven or eight months when babies begin to become aware that their caregivers are separate from them. As most children develop over time, they realize that even though their caregivers might leave the room, they still exist and will come back. For most children, this resolves separation anxiety, unless they have anxious caregivers, there are problems with bonding with their caregivers, or there is some other disorder or problem that causes them to feel anxious when their caregivers leave them.

Episodic Separation Anxiety vs. Separation Anxiety Disorder:
It's not unusual to have some degree of separation anxiety as an adult at certain points in your life (e.g., after the death of someone close to you or when experiencing other losses). This would be considered episodic separation anxiety. However, adult separation anxiety disorder is a recurrent and persistent problem that is not linked to anything objective that is going on in a person's life at the time.

Typical symptoms of adult separation anxiety disorder are:
  • Recurrent excessive worry about separating from a place or a person that you are close to (like a spouse)
  • Persistent and recurring fear about losing people close to you or that something bad will happen to them (when there is no objective reason for feeling this way)
  • Recurrent reluctance to go to school or work or go elsewhere due to fear of separating from someone close
  • Persistent and excessive fear of being alone
  • Persistent and excessive fear or reluctance of going to sleep without having someone who is close to you in the house or nearby
  • Repeated complaints about headaches and other physical symptoms when you are separated from the person or people that you are close to
  • Recurrent nightmares about separation
  • This anxiety causes significant impairment in one or more major areas of your life (e.g., your relationships, work life or in other significant areas).
  • These symptoms last a month or more, and they are not attributable to any other physical or emotional causes.

The following fictionalized scenario is an example of adult separation anxiety disorder:
Maureen was a married woman in her mid-30s when she started psychotherapy to deal with separation anxiety disorder. She had gone to her primary care doctor, at the insistence of her husband, because she would become extremely anxious and worried whenever her husband wanted to do anything on his own or when he was not around her for even a short period of time.

Overcoming Adult Separation Anxiety Disorder

It didn't matter if they had spent the entire day together and he wanted to go out for a short walk on his own to clear his mind. Maureen would become extremely anxious and worried at just the thought of her husband being away from her. She would become upset, tearful and angry if he told her that he preferred to go out on his own for his walk and not with her. She was convinced that something awful would happen to him (e.g., he would get hit by a car or someone would kill him or kidnap him) and she would never see him again.

At work, she would call him several times a day to "check in" and if she couldn't reach him, she would panic: What if something happened to him and no one knew how to contact her? When she finally reached him, she was a nervous wreck and this would anger him. He felt that she was too "clingy," "needy" and "insecure," and he told her that if she didn't get help, he didn't know how much longer he could deal with this.

Maureen's primary care doctor recognized the symptoms of adult separation anxiety disorder. He told her that he was not qualified to treat her, and he advised Maureen to see a licensed psychotherapist. Maureen's therapist took a detailed psychosocial history and provided Maureen with psychoeducational material about adult separation anxiety disorder.

They also began using clinical hypnosis to help Maureen to calm herself and to internalize a felt sense of a loving, caring figure in her life (in this case, it was her grandmother) that she could call on in her mind when she felt extremely anxious. After a while, she was able to mentally call on this loving person in her mind with ease and feel a secure attachment to her.

Overcoming Adult Separation Anxiety Disorder


Maureen worked hard in therapy and attended her sessions regularly. She learned that there would be no quick fix for her problem. However, over time, with the help of her therapist, Maureen's separation anxiety dissipated and her relationship with her husband improved.

Why Clinical Hypnosis?
There are many ways to treat adult separation anxiety. Clinical hypnosis is a safe and effective form of therapy. It allows you to relax enough to get to the unconscious causes of the problem. You maintain a dual awareness of the here-and-now as well as whatever comes up in the clinical hypnosis session. It also allows you to discover if you are being triggered by other prior events in your life.

Clinical hypnosis is usually faster than regular talk therapy--although, for adult separation anxiety disorder, it's important to understand that this is not a 3-5 session treatment. Separation anxiety disorder is a complex problem and requires a lengthier treatment, even with clinical hypnosis, than some of the other problems that lend themselves to short-term hypnosis treatment, like smoking cessation.

When seeking clinical hypnosis treatment, always make sure that the person you plan to see is a licensed mental health practitioner and not a lay "hypnotist." As I've mentioned in prior blog posts about clinical hypnosis (also known as hypnotherapy), there is a big difference with regard to the education, clinical expertise and skills between a hypnotherapist and a lay "hypnotist."

If You Suffer with Adult Separation Anxiety, Seek Help from a Licensed Psychotherapist:
If you suffer from adult separation anxiety, the people around you might not understand what is happening to you. They might tell you that you're being dramatic or immature. They might also tell you that you "just need to get over it." But for you, the symptoms are very real and painful. Rather than suffering alone, you could benefit from seeing a licensed psychotherapist who has experience working with clients who suffer with adult separation anxiety disorder.

There are many ways in psychotherapy to work with clients who have separation anxiety, including a combination of cognitive behavioral treatment, psychodynamic psychotherapy, EMDR and clinical hypnosis. You want to find a therapist who tailors treatment to the individual client's needs.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist in NYC. 

I have helped many clients overcome adult separation anxiety.

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: josephineolivia@aol.com.

To find out more about clinical hypnosis, visit the American Society for Clinical Hypnosis (ASCH) website: http://asch.net.

Friday, January 29, 2010

Explorations in Psychotherapy and Clinical Hypnosis: Recapturing an Earlier, Happier Time

Clients Often Come to Psychotherapy When They Feel They have Lost a Vital Part of Themselves:
It's not unusual for people to come into psychotherapy because they feel that they have lost a certain zest for life and they want to try to recapture a vital part of themselves that they feel they have lost from an earlier time in their lives. While psychotherapy and clinical hypnosis can't provide the Fountain of Youth, it can help you to try to remember and revive a certain aliveness and authenticity that you might have felt at an earlier time.

More than just a feeling of nostalgia or the pain of a midlife crisis, when we look back to an earlier time, we might recognize parts of ourselves that we might want to have come alive again in our current lives. For instance, if we feel that we have become too complacent or we're stuck in a rut, we might want to recapture a part of ourselves from an earlier time that was more curious, daring, and adventurous. And, now, with the benefit of having had more life experience and, hopefully, better judgment, we can recapture those energized parts of ourselves to explore new ideas and expand our sense of ourselves.

It might be that those parts of yourself might have been dormant for a while. But, often, through clinical hypnosis, you can re-experience a particular phase of your life and see what you might want from that time and how you can benefit from recapturing and reviving that part of yourself. Of course, there are no guarantees in any treatment. But the following vignette, which is a composite of several cases, is an example of what I'm talking about:

Scott:
When Scott started psychotherapy, he was in his late 50s, divorced, and feeling like he was just living from one day to the next. He was successful in his career, but he had lost his enthusiasm for his field long ago. He was dating a couple of women casually, but he didn't have anyone that he felt strongly about. In fact, Scott didn't feel strongly or passionate about anything, and this was a big part of his problem. He felt like he was just existing. He didn't feel any highs or lows anymore. His emotional world felt flat. But, according to Scott, it wasn't always that way. There was a time when he was more actively involved in community affairs, he volunteered with several organizations, he was in love, and felt more involved and "alive" in his world.

Scott said he had not felt "alive" and passionate about his life in at least 20 years. He yearned to feel energized again the way he used to feel. When we discussed when was the last time that he felt passionate about his life, he talked about a time when he was involved in a local community project that was very important to him, he was in a relationship with a woman that he really loved, and he felt invigorated by his world, curious, and open to new experiences. "What ever happened to that person?" he asked.

Although clinical hypnosis tends to be faster and go deeper than regular talk therapy, there was nothing magical or very quick about Scott's hypnotherapy treatment. There were many underlining issues that had to be dealt with before Scott started to feel better. However, through clinical hypnosis, Scott was able re-experience that earlier phase in his life and remember--not just in a factual way--but to actually have a felt sense of what it was like for him when he was happier and more fulfilled in his life. Over time, he was also able to recapture and revive that part of himself in his current life.

Although his hypnotherapy treatment was not a "quick fix," he began opening up and allowing himself to experience life more fully again. He left his current field and went into the field that he wanted to be in 20 years ago. It was a dream that he had let go of because he felt like he was being more "practical." What he didn't realize is that, over time, he had become closed off and his life had narrowed. This had a deadening effect on him mentally, emotionally, and physically. Soon after he entered into his new field, he felt that his life was now more aligned with his personal values. He also met a woman that he really cared about.

As the years go by, it's easy to overlook how some of the compromises that we make, often out of necessity, can affect our lives. After a while, if we're not careful, we might find that our world has become a lot smaller and we are less and less satisfied with our lives. Sometimes, it's only after we have been in a rut for a while that we realize that life isn't as meaningful as it used to be. We might look back at a happier time and yearn for those earlier years. Often, through clinical hypnosis, you can recapture the felt sense of the more energized parts of yourself that are dormant now and reintegrate them to lead a more fulfilling life.

I am a psychotherapist and hypnotherapist in NYC.

To find out more about clinical hypnosis, visit the ASCH website: http://www.asch.net.

To more about me, visit my website: http://www.josephine-ferraro.com.

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

Your Anxiety and Depression Could Be Having a Negative Effect on Your Relationships

As a psychotherapist in NYC, I often see clients who begin psychotherapy after spouses or partners have spoken to them about how their anxiety or depression are affecting their relationships at home. Often, people don't recognize that they might be experiencing depression or anxiety until someone close to them or someone at work tells them about the impact that it's having with people around them.


Anxiety and Depression Could Be Having a Negative Effect on Your  Relationships

The following vignette is a composite of a psychotherapy client who began psychotherapy after his wife spoke to him about his anxiety and depression and how it was affecting his relationshp with her and their children. All identifying information has been changed to protect confidentiality:

Jack:
Jack was a man in his late 50s. He and his wife were married for over 20 years and they had two teenage children.

When Jack first came to see me in my psychotherapy private practice, he talked about how his wife had a difficult talk with him a few weeks before, telling him how his depressed and anxious mood affected their relationship as well as his relationship with their children.

After their talk, Jack realized that he was having many of the typical symptoms of depression and anxiety that he had heard about on TV commercials about antidepressants and that he had read about: insomnia, irritability, a feeling of foreboding that something bad was going to happen to him, decreased appetite, feeling like he wanted to isolate himself, and feeling sad and anxious most of the time. He had been feeling this way for months, but he hated to go to the doctor and he thought it would eventually pass.

Anxiety and Depression Could Be Having a Negative Effect on Your Relationships: Jack and His Wife Had a Talk

After his wife spoke to him and told him that she was finding it difficult to be around him and his children were trying to avoid him when he came home from work, in hindsight, he recognized that his depressed and anxious mood was getting worse.

He realized that, in many ways, he had been in denial about his anxiety and depression. He also realized that his mood was affecting his relationships with his colleagues and subordinates at work. Since he did not want to alienate his family or his colleagues any further, he went to his primary care doctor.

Jack was almost hoping that his doctor would find a medical reason for his depressed and anxious mood. He also hoped that, even if his doctor couldn't attribute his mood to anything medically wrong with him, at least, maybe the doctor could give him a pill to help him feel better.

But, to Jack's surprise, his doctor ruled out any medical cause for his mood and counseled Jack that medication alone is not as effective for anxiety and depression as psychotherapy with medication or even psychotherapy alone. He provided Jack with psychoeducational material about depression and anxiety, advised him to try psychotherapy first before he tried medication, and gave him my telephone number to set up an appointment for psychotherapy.

Jack procrastinated calling my office for a couple of weeks, going back and forth in his mind whether he felt that he really "needed" psychotherapy. He called his doctor again and his doctor urged him not to wait--to call my office and begin psychotherapy. Jack had been going to his doctor for a long time, and he trusted doctor so, even though he had some misgivings about psychotherapy, he decided to follow his advice.

When Jack came for his initial psychotherapy consultation, I asked him if he had ever felt this way before. Jack thought about it and realized that he had felt depressed and anxious off and on since he was a child. He had never thought about it before, but my question made him realize that he had at least five or six prior episodes of depression and anxiety in the past.

Over time, we worked on helping Jack to overcome his depressed and anxious mood. Once he began to manage his current stress and work on the underlying issues that precipitated his depression and anxiety, Jack's relationships with his wife, children and colleagues improved. He felt better than he had in a long time.

The Impact of Anxiety and Depression on Your Relationships:  Jack's Relationship With His Wife Improved After He Began Therapy

This upward spiral, in turn, became an incentive to continue in psychotherapy and he became more internally motivated to make other improvements in his life.

Denial Can Be a Powerful Factor in People Avoiding Dealing with Depression and Anxiety:
Denial can be a powerful factor in people with depressed and anxious mood from seeking help. People often will deny to themselves that they are feeling what they are feeling.

Even if they admit to themselves that they don't feel like themselves, they also might tell themselves that their depressed and anxious feelings will go away or they attribute their mood to outside factors (e.g., the weather, their boss, their age, etc).

But it's usually harder to ignore that there's something wrong and that you need to do something about it when people close to you tell you that your mood is not just affecting you--it's having a negative affect on them as well.

Depression and Anxiety Often Go Together:
Depression and anxiety often go hand in hand. Sometimes, people start by feeling anxious and their anxiety triggers depression, and sometimes it's the other way around. Often, depression and anxiety don't go away by themselves without professional help.

Getting Help:  If You're Feeling Depressed or Anxious, Seek Professional Mental Help with a Licensed Psychotherapist:
If you've been experiencing depression or anxiety for more than a few weeks, don't suffer alone. You owe it to yourself and your family to seek professional help with a licensed mental health professional.

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

I have helped many clients to overcome depression and anxiety.

To find 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: josephineolivia@aol.com

Wednesday, January 27, 2010

Overcoming Low Self Esteem

As a psychotherapist, I often see clients who come to psychotherapy because they want to overcome low self esteem. In my prior psychotherapy blog posts I've addressed issues of self esteem from different vantage points. In this post, I would like to discuss the link between self esteem, a sense of self mastery (also called self efficacy) and learning the life skill of self discipline.

Overcoming Low Self Esteem

The Importance of Learning Self Discipline, Self Mastery and Developing Healthy Personal Habits as Children:
Having a sense of self discipline, developing healthy personal habits, and a sense of self mastery are important to personal development and our sense of self esteem. These traits begin to develop, without our realizing it, when we're children.

When children learn to develop healthy habits like learning to put away their toys after they play, doing simple age-appropriate chores around the house, keeping their word about the commitments that they make, and so on, they're learning important life skills that are essential to their development beyond the particular chore or event that is involved. They're also learning to be responsible and deal with certain aspects of life that they might not want to do but that are essential to every day life as well as their personal growth and development.

Learning Healthy Habits as Children

When children don't learn to master certain chores or develop healthy personal habits like the importance of getting up on time, doing homework and turning it in when it's due, keeping their word about a commitment that they've made (and so on), they often have a much harder time as adults dealing with more mature issues in their work and personal lives than children who have gradually learned these life skills over time when they were growing up. Not learning these skills can also have a profound effect on a person's self esteem as well as how others view them as adults.

As a psychotherapist, I hear from many adult clients who talk about how frustrated they feel that their teenagers and young adult children have not developed healthy personal habits and self discipline and how this has affected the children's self esteem. These clients are often concerned that their children's lack of self discipline will not bode well for their chances out in the world with regard to personal relationships, school, and career.

 They fear that their children are just drifting without purpose and that they might have a hard time setting goals, holding onto a job or maintaining healthy relationships later in life. They talk about children who only want to do chores when they want to do them (or not at all), who spend most of the weekend loafing around or playing video games, who have no healthy routines, and they worry: "How is my child going to make his way in the world?"

When I hear clients who express these concerns about their teenagers or young adult children, I can understand why they're concerned. As any responsible adult knows, there are many things that we might not want to do, but we know that we must as essential parts of our lives. For instance, even if you think you have the most interesting job in the world, there are often parts of work that you don't like or you might find boring or unfulfilling.

 Imagine telling your boss that you just "didn't feel like" doing those aspects of your job, or you procrastinated doing them so that your boss had to come to you several times to ask about them, or if you pretended not to hear your boss because you were listening to your music (some of you who have teens might relate to this). After a while, you might not have that job for long. Aside from how your boss and colleagues might feel about you, you probably would not feel good about yourself and it would start to erode your self esteem.

Learning to develop healthy habits and self discipline should start gradually when you're young. Even young children can begin by learning to do simple tasks. Is it possible that they might grumble, pout or cry when you ask them to do simple things like learning to put away their toys when they're done playing? They might. They might question you as to "why" they need to do this or tell you that they don't want to do it.

They might test the boundaries with you in many ways. As a parent, you might even tell yourself that you would do it better and quicker and use that as an excuse to yourself to avoid having a confrontation with your child. But the importance of your child learning to do these simple chores is not only about the chores themselves--it's about their learning self discipline, responsibility and a sense of self mastery. They are probably too young to realize this but, as an adult, you know it.

Learning to do simple tasks, as a child, as well as learning to keep your word is also about learning to deal with your emotions when you feel annoyed and frustrated about something that you don't want to do--or just life, in general. Whether it's about learning to make your bed, practicing the piano or doing other things that you might not want to do at the moment because you're thinking about doing more interesting things, the skills that you learn by doing these tasks anyway (even when you don't want to do them) become part of your emotional development as well because you learn how to tolerate frustration.

We've all witnessed or experienced two year old children when they are having temper tantrums. The parent who is able to withstand the child's temper tantrum with love and patience, while the parent stands his or her ground, is helping that child to develop emotionally. For instance, when a child doesn't want to leave the park when it's time to go home or doesn't want to get in the carriage and a parent sets limits with the child (in a loving way), that child, without realizing it, is gradually developing a tolerance for acceptable amounts of frustration.

In these situations, the child has tested the boundaries with his mother, the mother demonstrates that she knows best, the child has a temper tantrum for a while (maybe a long while) but, in the end, the child learns that he must do something that he doesn't want to do.

 More importantly, he learns that he has survived in this ordeal, and that his mother has survived as well (although she might feel inwardly exasperated), and he learns that his mother still loves him and he still loves her. Can the two year old articulate these lessons? No. But, over time, we see the evidence of this in his personal development as he grows and continues to learn these important lessons in life skills. We can see it as the child learns to take on bigger, more complex age-appropriate responsibilities as they grow. We also see it in their sense of confidence.

Similarly, when a child learns life skills like keeping her word and following through with commitments , she will be better equipped as an adult to maintain her adult commitments. But when a child doesn't learn to develop these skills when they're younger, it's harder for them to keep their commitments when they're adults.

 If they haven't learned to develop a sense of the importance of keeping commitments and they only do certain things when they want to do them, they will probably struggle as adults. Lacking guidance from their parents as a child, they won't have internalized it as an adult. They will lack the internal emotional resources to deal with commitments and their only own internal "guide" might be whether they feel like it or not, which won't be acceptable in many circumstances in the outside world.

Lacking these internal resources as an adult will also affect how they feel about themselves. It's hard to feel confident, resourceful, and effective as an adult if your only guide to dealing with your responsibilities and commitments is whether you feel like it or not. You're definitely on shaky ground if this is your compass for functioning in the world. After a while, as friends, romantic partners and work supervisors refuse to put up with this, it reinforces an internal sense of incompetence and failure.

Conversely, when children learn to stick with their commitments and see the results of their efforts and diligence, it increases their self esteem and sense of self mastery.

 For instance, the child who learns to stick with practicing the piano on a regular basis (even though he would prefer to play video games at the moment) begins to make the link between practice, being diligent and responsible and a sense of self mastery. He sees that, over time, his time and effort has led to being able to play a certain piece of music with increasing skill. It becomes gratifying to him.

 He also learns to translate this into other areas of his life: Studying and doing his homework, which might be boring in the short term, produces better academic results. Better academic results often leads to a more successful career. These life skills become an important part of his personal growth and development as well as his sense of self confidence.

It's certainly possible to learn to develop these life skills as an adult. I often work with clients in my psychotherapy practice helping them to learn these skills and this leads to a greater sense of self esteem. However, it's harder to learn when you're an adult and, often, by the time an adult comes to psychotherapy to deal with self esteem issues related to the lack of these related life skills, they have often struggled for a while in their relationships and career.

Getting Help
If you're struggling with a sense of low esteem and you see that continuing on the same path has hindered your personal growth, you might benefit from working with a licensed psychotherapist.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. I have helped many clients to overcome low self esteem to lead more fulfilling lives.

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

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

Tuesday, January 26, 2010

Overcoming Codependent Behavior in Therapy: Learning to Reduce Reactivity to Achieve Emotional Balance

In my prior psychotherapy blog posts I've discussed codependency in terms of the relationship between the person who has a substance abuse problem and the spouse or partner who does not. This is the classic example of codependency.

Overcoming Codependent Behavior in Therapy: Learning to Reduce Reactivity

As I've mentioned in those prior posts, the term codependency originated in the substance abuse field, however, the use of the term codependency has since expanded to include other relationships where there is no alcohol or drug addicted behavior. In this psychotherapy blog post, I would like to discuss the topic of overcoming excessive emotional reactivity to achieve emotional balance. Even if you're not in a codependent relationship, you might benefit from reading this post to learn how to be less emotionally reactive in your relationship.

Codependent Relationships:
Now that we recognize that codependency can exist in any relationship and there need not be alcohol, drugs, gambling or other addictive behavior involved, we have learned to expand our definition of codependency and recognize these dynamics in many different types of relationships. I will confine myself in this post to romantic relationships, but it is understood that codependency can exist in many different types of relationships.

As I've mentioned in my prior psychotherapy blog posts, when I discuss codependency, I'm not talking about relationships where there is normal dependency--like taking care of an elderly parent, a young child or someone who is disabled. I'm specifically addressing relationships where both people are mature and able-bodied, but one or both people are overly dependent on the other person in an unhealthy way.

In codependent relationships, one or both people usually over function for the other person in certain ways, often, in an effort not to deal with their own emotional issues. So that if one person is overly focused on the other person and overcompensating for that person, he has taken the focus off himself and his own issues. Often, what looks like purely altruistic behavior is also a defense to avoid dealing with his or her own problems ("I'm not the one with the problems--it's him"). In prior posts, I've given composite examples of codependent dynamics in relationships, so I won't repeat them here.

Why do People Become Overreactive in Codependent Relationships?
Often, people who are emotionally reactive haven't learned how to control their emotions. So that when things don't go their way or when old problems persist, they often become emotionally overreactive and have a great deal of difficulty maintaining their composure. They might lash out by losing their temper, act out by cheating on their partner, get even by overspending or running up a credit card, cry uncontrollably to make their partners feel guilty, make threats, or engage in other dramatic displays of behavior. Aside from the fact that they're having problems managing their emotions, often, this emotional reactivity is meant to control the other person's behavior. And, while it might work in the moment, it's usually ineffective in the long run.

Detaching with Love:
Al-Anon is a 12 Step program for loved ones who are in relationships with people who have alcohol problems or who suffer with other addictive behavior. There is a concept in the Al-Anon literature called "detaching with love." I think this is one of the most misunderstood Al-Anon concepts that often confuses people and it's worth spending a little time defining what this means and how it can be put to good practice in almost any relationship (whether there is addictive behavior involved or not).

The concept of "detaching with love" addresses the emotional reactivity that is often involved in many relationships. I think this idea is often misunderstood because people who are highly reactive often feel that it means that they have to be cold, cruel, hard or they don't care about their partners. They might also feel that if they "detach with love," it means that they're not allowed to feel their feelings. However, this is a big misconception.

When we talk about "detaching with love,"we're really talking about still caring and loving your partner, but maintaining your emotional equilibrium when there's a problem between the two of you. It means that when there's an argument or tension in the relationship, you're able to step back, take the time to calm down (and, possibly, take a break, if needed) before reacting emotionally. It doesn't mean that you don't feel your feelings or that you're not entitled to your feelings. Rather, it means that you stop, calm yourself and think before you react emotionally.

Why is it Important to Overcome Emotional Reactivity?
Often, when people feel angry with their partners, their first instinct is to lash out in anger, especially if it involves an ongoing problem, whether we're talking about addictive behavior, jealousy or other problems. However, even if you get a sense of immediate gratification from lashing out emotionally, it quickly dissipates because your behavior usually makes the situation worse.

When you react emotionally, without stopping to think and calm yourself first, you say or do the first thing that comes to your mind. This is an impulsive gesture, which often leads to regret. Often, as soon do you say or do whatever has come to your mind, you feel badly about it. But, by then, the words are out and they cannot be taken back. That often leads the argument or problem to be taken into other unintended directions. At the very least, it doesn't solve the problem. Worse still, being overly reactive usually becomes habitual, which means the more you do it, the more likely you are to continue to do it.

Recognizing the Physical and Emotional Cues as a First Step to Becoming Less Reactive and to Develop Emotional Equilibrium
If you've grown up in a family where there was a high degree of emotional reactivity, being highly reactive might seem normal to you. But you have only to look at the results that it produces in your relationship (and the history in your family) and how you feel afterwards to realize that being highly reactive is not serving you or your relationship well.

Learning to develop emotional equilibrium takes time, practice and a good deal of patience, but it's worth the effort. The first step is to become aware of the feelings and physical cues within yourself that proceed your emotional reactivity. For some people, this might include certain physical reactions like clenched fists, tension in your stomach or other parts of the body, a strong feeling of energy surging through your body, feeling flushed, hands trembling, feeling lightheaded, feeling like you're going to explode, and other similar reactions. You might also notice your thoughts going in a certain volatile direction ("I hate him," "She's so stupid," "Why is he doing this to me?" etc).

When I discuss this with clients in my psychotherapy practice in NYC during the early stage of therapy, many clients will often tell me that there are no prior warnings or cues for them that they're about to lose their temper or overreact emotionally. However, I usually respond to them by saying that that there are, in fact, warning signals--they just haven't learned to recognize them yet. We know this because we recognize that there is a connection between the mind and the body, meaning that your thoughts and physical sensations are connected. Learning to recognize the warning signals or cues to emotional reactivity requires that you slow down. You might be justified in feeling angry or upset, but your anger doesn't entitle you to lose your temper or say or do things that you'll regret later.

Stress Management:
In order to learn to slow down, you need to find other ways to reduce your stress. Everyone is different, so each person must find his or her own way to handle stress, whether that means learning to meditate, taking a yoga class, going for regular walks, remembering to breath deeply, countng to 10, playing with your pet, talking to close friends, praying, attending an Al-Anon meeting, or whatever other healthy activity you decide to do to reduce your stress and level of frustration. If you're managing your daily stress so that it doesn't build up and spill over, you're less likely to lose your temper or overreact emotionally.

Once you're engaging in healthy stress management activities, you can learn to slow yourself down so that you begin to see and feel the cues that precede an overreaction. Once you recognize those cues, then you can make a deliberate choice as to how you want to handle the situation instead of being at the mercy of your emotions.

Learning to Separate Your Feelings about Your Partner's Behavior from How You Feel About Your Partner:
Once you've calmed down enough to gain some perspective, you might recognize that you still love your spouse or partner, but you don't like his or her behavior. That's an important distinction. Not liking his or her behavior is different from not liking your partner.

Ultimately, you might decide that the relationship isn't working and you might leave. However, you will have gone through the decision making process in a more emotionally balanced way rather than reacting impulsively. Breakups that occur on an impulse often bring the people back to Square One. They often feel that there was something important missing when they broke up, that they made the decision without thinking, and then they reconcile. But, often, nothing changes in the relationship. So, they are left with the same problem that they started with, and the cycle continues: anger, breakup, reconciliation, anger, and so on.

When you "detach with love" from your partner, you are stepping back emotionally to take a breath, calm yourself, and get some perspective on the situation. You're also taking care of yourself during this time because you recognize that becoming emotionally overwrought on a regular basis has physical and emotional consequences for you, your partner and also your children, if there are children involved.

Learning to be Less Emotionally Reactive Can be Difficult:
Learning to be less reactive and develop emotional equilibrium can be very challenging. Even after you've begun to make progress in developing more emotional balance in your life, it's not unusual for there to be lapses into old behavior. If being emotionally reactive has been a lifelong pattern, it's understandable that you might have some lapses in the process. (Of course, when I talk about lapses that are understandable, I'm not referring to domestic violence. If your anger leads to physical violence, you need immediate help to deal with your problems with anger management and, in the meantime, that might mean that you and your partner separate so that you're both safe.)

If you recognize that you've reverted to old behavior, rather than giving up, be compassionate with yourself and recommit to maintaining emotional balance. When you think about it, you might realize that you've stopped doing the things that helped you to stay emotionally balanced in the first place. It's easy to become complacent, especially after you've had a certain amount of success. So, re-establish the routines or healthy behaviors that helped you and begin again.

What to Do if You're Unable to Reduce Your Emotional Reactivity
If you've tried the suggestions that I've outlined above (including attending Al-Anon if you are in a relationship with an person addicted to alcohol or drugs) and you find that you're still unable to achieve emotional equilibrium, you might benefit from seeing a licensed psychotherapist who has expertise with codependent relationships.

I am a psychotherapist in NYC who has helped many individuals and couples to become less emotionally reactive so that they can develop emotional balance in their relationships.

To find out more about Al-Anon, visit their website: http://www.alanon.org

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: josephineolivia@aol.com.

Thursday, January 21, 2010

Managing Your Stress and Overcoming Trauma: The Psychological Effects of Overexposure to News About Disaster

What Many Psychotherapists Saw After the 9/11 World Trade Center Attack:
After the 9/11 World Trade Center attack, many psychotherapists in NYC began to see the damaging psychological effects of overexposure to broadcast news stories about 9/11. This included seeing people who were not directly affected by the attack (people who were not anywhere near the World Trade Center that day and who were fortunate not to have lost anyone). These people were coming into psychotherapists' offices feeling emotionally overwhelmed by the tragedy. For many people, it was triggering their own personal history of psychological trauma. Even people who grew up in relatively healthy homes as children, felt overwhelmed. Although most psychotherapists were already aware that overexposure to broadcast news about tragic events can cause damaging psychological stress, NYC psychotherapists (and I include myself) were reminded that it's healthier to limit your exposure to the graphic images on broadcast news about disaster.

The Earthquake Disaster in Haiti:
All of this comes to mind again following the earthquate disaster in Haiti. Even among people who don't have friends or relatives in Haiti, there are many people who are glued to their TV sets watching broadcast news stories and feeling emotionally overwhelmed. What's going on in Haiti is certainly horrific beyond most of our imaginations. It's easy to see, especially if you have friends or relatives in Haiti, why the news stories would be so compelling. However, watching these recurring images of disaster can cause traumatic stress and psychological impairment without your even realizing it. At the end of this post, I'll give some tips for how to cope with feelings that you might be experiencing and how to manage your stress.

At this point, it's too soon for me to present examples of the current situation from my psychotherapy private practice in NYC of recent events without violating confidentiality, so I will present a composite of a case from after the 9/11 World Trade Center attack. While I realize that the disaster in Haiti is on a more massive scale with more far reaching and longer lasting effects, my objective is to demonstrate how, even when someone is not directly affected by a disaster, overexposure to broadcast news about the disaster can have adverse psychological effects. As always in my composite vignettes, there is no identifying information about any one particular client.

Susan - After the 9/11 World Trade Center Attack:
Susan was a woman in her mid-30s. She moved to NYC from the Midwest in 2002, a few months after 9/11. She was not in NY on 9/11 and she did not know anyone who was directly affected by the tragedy. However, after the 9/11 attack, like many people, she felt compelled to watch hour after hour of broadcast news about the tragedy. Much of the news and many of the images that she watched were repetitive, but she was glued to her TV set.

Susan moved to NYC for a career opportunity. By the time she came to see me, she was expressing common symptoms of acute stress: anxiety, insomnia, nightmares, irritability from lack of sleep, an overwhelming feeling of fear and foreboding, as well as depression. At that point, there wasn't anything else going on in her life that would account for how she felt. She was happy in her relationship, she had a good emotional support system, she really liked her new job, and she was doing well financially. Yet, she felt like she was falling apart.

Susan's nightmares were anxiety dreams that combined the recurring images that she watched on TV with scenes from her childhood in a very chaotic and emotionally abusive household. Susan was the oldest of four children. She and siblings grew up with alcoholic parents who gambled and were often violent with each other (although not with the Susan or the other children). Life was not only chaotic but unpredictable. Susan grew up watching violence between her parents and feeling helpless to do anything about it. As the oldest, she felt that she should be able to do something to help her family but, of course, this wasn't realistic because she was only a child. Even though both parents earned good incomes, the family was often on the brink of financial disaster due to the parents' excessive drinking and gambling. At various times, her parents couldn't pay the mortgage because of their gambling debts and they often feared they would lose their home. Susan talked about always feeling that the rug could be pulled out from under her at any time.

Susan was surprised that her dreams about 9/11 included violent scenes from her childhood because she had attended psychotherapy (talk therapy) back home for several years in her early to mid-20s to address her childhood trauma. She felt that she had developed insight into her family history and how it affected her--until she began having nightmares about it again. As she and I continued to talk about her current emotional reactions, she began to realize that the graphic news stories that she had been watching triggered traumatic emotions about her childhood. What had appeared to be resolved in her prior talk therapy was not resolved. She had learned to manage her life in her prior psychotherapy, which was important, but the underlying emotions were still there under the surface and were being triggered. After 9/11, she began to feel those same helpless feelings that she felt as a child--that something bad could happen at any time and she would be powerless to do anything about it. The relentless TV images from 9/11 triggered and reinforced these feelings in her.

Gradually, we worked together using EMDR and clinical hypnosis, which is often more effective than regular talk therapy for overcoming trauma, to help Susan overcome her current fears and process the unresolved childhood trauma that was being triggered. She learned coping strategies in psychotherapy to calm herself and deal with her stress. In addition to learning to meditate and learning other stress management techniques, Susan took a break from the daily stories and images of disaster on broadcast news. She kept abreast of what was going on by reading the newspaper and she was more selective about which stories she delved into.

Susan learned that the compelling desire that she had to watch hours of "bad" news on TV was linked to the unresolved trauma from her childhood. If her mind could "talk" to her, it would have said, "Here's a story about chaos, fear and confusion that's familiar to me. I feel helpless, but I have to watch it so I'll know how it turns out." By the end of treatment, Susan learned to manage her stress, she overcame the underlying childhood trauma so that it was no longer there to be triggered, and she returned to the high level of emotional functioning that she was experiencing prior to 9/11.

The Mind-Body Connection as it Relates to Trauma:
During the last 15-20 years, psychotherapists and mental health researchers have been learning more about the mind-body connection as it relates to trauma. One of the things that they have learned is that violent and disturbing images can trigger underlying feelings about earlier trauma, even for people who are not directly affected by the current stories and even for people who have had a fair amount of regular talk therapy to deal with the effects of childhood trauma. For most people, it doesn't matter how long ago the trauma occurred because the unconscious mind doesn't make distinctions about time. And, as time goes on, we are continuing to learn more about how the mind works and the mind-body connection.

Here are some tips to deal with the stress of the news about the disaster in Haiti and other traumatic news stories:

Limit your exposure to TV news stories:
Watching recurrent images of disaster can have adverse emotional effects on you. These stories and images have a way of sticking in your mind and causing you a lot of stress. For a while, depending upon how you're feeling, you might need to take a break from the news. If you have friends or family members in Haiti, it's understandable that you want to keep informed. However, watching endless replays of the same stories will only increase your stress and anxiety.

Maintain your normal routines and manage your stress:
Even if you're waiting to hear about loved ones in Haiti, as much as possible, it's best to maintain your normal routines, especially if you have children. Eating nutritious meals, going on with your regular daily routines, maintaining a healthy sleep regime, getting support from your emotional support system, and going for walks are all good ways to help reduce the effects of stress.

Keep things in perspective:
Try not to let your thoughts run away from you. I understand this is easier said than done, especially if you're waiting to hear about loved ones. But excessive worry and rumination about what's happening, what could happen and what might happen will only exhaust you. If you find yourself doing this, once again, talk to people in your support system who have a calming influence on you. If you consider yourself to be a spiritual or religious person, try to find solace in your spirituality.

Rather than feeling helpless, learn what you can do and find constructive ways to channel your energy:
Whether you're directly affected by the disaster or not, rather than feeling helpless, find constructive things that you can do. One of the most debilitating aspects of any disaster, even for those of us watching it from afar, is the feeling of helplessness in the face of overwhelming events. If you feel that you want to do something constructive about what's going on in Haiti, you can find out about the many reputable organizations involved in the disaster relief effort and make a contribution, if possible. If you're not sure which charitable organization to contribute to and you want to avoid getting caught in a scam, you can go to Charity Navigator's web site (http://www.charitynavigator.org/) and read about the various reputable charitable organizations.

Once again, I want to stress how important it is, even if you volunteer your time and money to some aspect of the disaster relief effort in Haiti, to stay involved in your own life and with the people who are close to you.

Maintain a positive attitude:
As much as possible, strive to maintain a positive attitude. Remember, as tragic as events are, there have also been stories about compassion, hope and survival. During other disasters, there have been many examples of people who have been emotionally resilient. This is not to minimize the tragedy in Haiti. However, it's important to remember that, in the long run, many people who experience tragedy talk about how it has given them a new appreciation for life, their loved ones, and the importance of living every day to its fullest. For those not directly affected by the disaster in Haiti, it can increase their gratitude about what they do have in their lives.

When stress management techniques and mutual support are not enough:
If you find that, after using these tips you're still feeling emotionally overwhelmed, you could benefit from seeing a licensed mental health professional in your area who knows how to work with trauma. Licensed psychotherapists are professionals who have completed their undergraduate and graduate education in the mental health field and who have demonstrated expertise so that they are licensed by the State.

Finding someone who also has advanced postgraduate mental health training is most beneficial.

To find someone, you can contact your insurance carrier or, even better, you can seek recommendations from people that you trust who have seen or who are seeing a licensed mental health professional.

To find out more about clinical hypnosis and hypnotherapists in your area, you can visit the ASCH website: http://www.asch.net/

To find out more about EMDR and EMDR psychotherapists in your area, you can visit the EMDRIA website: http://www.emdria.org/.

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

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

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

Monday, January 18, 2010

Clinical Hypnosis and Perceptions of Time

There was an article in the New York Times' Science section called, "Where Did the Time Go? Do Not Ask The Brain" by Benedict Carey that discussed our perception of time (http://www/nytimes.com/2010/01/05/health/05mind.html). 


Perceptions of Time

The article reminded me that our perception of time is also different when we experience clinical hypnosis, also known as hypnotherapy.

As a psychotherapist and hypnotherapist in NYC, clients, who experience clinical hypnosis in my private practice, will often tell me that they experience time differently in hypnosis.

Even though clinical hypnosis clients maintain a dual awareness (meaning that they are in a relaxed state and they are aware of everything going on in the here-and-now around them as well as what they are experiencing in the hypnotic state), they often experience a certain timelessness in hypnosis.

Clinical Hypnosis and Perceptions of Time

This is essentially because clinical hypnosis helps to access the unconscious mind, and there is no time in the unconscious. The unconscious is timeless. Whether we're experiencing what happened 20 years ago or what happened yesterday, the unconscious doesn't make a distinction.

The other phenomenon that occurs in clinical hypnosis is that, whereas it might take weeks, months or even years to resolve certain problems (phobias, smoking cessation, anxiety, depression, and other problems) in regular talk therapy, including cognitive behavioral therapy (CBT), very often, issues are resolved in 1-3 sessions in clinical hypnosis, depending upon the complexity of the issue.

This is is because, through clinical hypnosis, our unconscious minds can access the answers to our problems. We often don't know exactly how it happens, but it's not unusual, after a clinical hypnosis session, for the answers to our problem to come to us, seemingly, out of the blue. Of course, it's not really out of the blue or magical at all. It's the power of our own unconscious mind to access the solution through clinical hypnosis.

Remember, when considering clinical hypnosis, there is a big difference between a lay "hypnotist" and a hypnotherapist with regard to training, skills, clinical expertise, and licensure. Always choose a licensed mental health professional who has advanced training in clinical hypnosis.

I am a psychotherapist and hypnotherapist in NYC. I have helped many clients overcome problems through clinical hypnosis.

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


To find out more about clinical hypnosis, visit ASCH: American Society of Clinical Hypnosis



photo credit: ♥KatB Photography♥ via photopin cc

photo credit: crocus08 via photopin cc




Relief Efforts in Haiti: How You Can Help

The news reports coming from Haiti have been truly heart wrenching. The Haitian people are in need of just about everything but, at the moment, rather than sending canned food and goods, what's most needed is money.

If you're in a position to donate even a small amount of money, you want to make sure that you donate to a well-established, reputable charitable organization because, unfortunately, as there with any disaster, there are unscrupulous people who are perpetrating scams to take advantage of the situation.

I recommend that you make your donations to organizations that have experience with the type of disaster that has occurred in Haiti. If you're not sure about a particular charitable organization, you can check on them on through:

Charity Navigator: ( http://www.charitynavigator.org).

The following charitable organizations are generally considered to be reputable. They are involved with the relief effort in Haiti and they have received 4-star ratings on Charity Navigator:

Doctors Without Borders,-USA: http://www.doctorswithoutborders.org

Action Against Hunger-USA: http://www.actionagainsthunger.org

Americares: http://www.americares.org

CARE: http://www.care.org

Medical Teams Intl: http://www.medicalteams.org

You can also find other reputable charitable organizations on Charity Navigator.

If you have relatives or friends in Haiti and you are seeking information about them, the US State Department Operations Center has set up a toll free number that you can call:
1-888-407-4747.

The difficult work that is being done by doctors, nurses, firefighters, and other volunteers, under impossible circumstances, is to be truly commended. Even though we might not be on the ground in Haiti, we can all do our part. If you'd like to help, but you're not sure what you can do, contact your local church, synagogue, mosque, temple, local government or civic organizations to find out how you can make a difference.

I am a psychotherapist in NYC. To find out more about me, visit my web site: http://www.josephine-ferraro.com/.

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

Thursday, January 14, 2010

Exploring the Road Not Taken in Psychotherapy

As a psychotherapist in NYC, I see many clients who come to psychotherapy to explore decisions that they are currently faced with or decisions that they've already made and how those decisions are affecting their lives. These decisions often involve whether to take one path or another in their personal lives or in their careers, whether to stay or leave their relationships, or how to handle a particular crisis in their lives.


Exploring the Road Not Taken in Psychotherapy
One of my favorite poems is "The Road Not Taken" by Robert Frost. I remember first reading this poem in high school. It had meaning for me then, and it still has meaning for me now in my own life as well as in my work as a psychotherapist when it often comes to mind.

The Road Not Taken - By Robert Frost
Two roads converged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down as far as I could
To where it bent in the undergrowth.

Then took the other just as fair
And having perhaps the better claim
Because it was grassy and wanted wear,
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black,
Oh, I marked the first one for another day!
Yet knowing how way leads on to way
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I,
I took the one less traveled by
And that made all the difference.

We all come to forks in the road at different points in our lives where we have to make decisions. At the time, we might not know where our decisions might ultimately lead later on in our lives. We make these decisions with whatever information we have, based on whatever is going on in our lives at the time, as well as our own psychological make up at that point.

The Road Not Taken
The following vignette is an example of a client who comes to psychotherapy to deal with "the road not taken" in his life and the particular dilemma that he faced when he came to therapy. As always, this example is a composite of various clients with all identifying information changed to protect confidentiality:

When Bill first came to see me in my psychotherapy private practice, he was a successful oncologist and surgeon in his late 40s. He was recognized as one of the top oncologists in NYC who specialized in a particular form of cancer. He was well respected by colleagues, sought after by patients, very successful financially, and he loved his wife and children. Yet, he was deeply unhappy.

According to Bill, he originally wanted to be an engineer. He knew he wanted to be an engineer since he was a teenager. But, from an early age, Bill's father let him know that he wanted Bill to become a doctor. Bill's father and mother escaped their country of origin to come to the US when they were first married. Neither of them spoke English when they arrived. But they were both very intelligent and ambitious so they learned quickly, and both of them attended a top Ivy League college. Bill's mother became a scientist and his father became a professor. Both of them were successful, but Bill's father had always wanted to be a doctor. He didn't pursue a medical career due to pressures from his family for him to become a professor.

So when it came time for Bill to make a decision about choosing a major, he felt a lot of pressure from his father to choose pre-med. Bill didn't want to give up his dream to become an engineer, but he wanted very much to please his father. He described his father as a cold, reserved man who only showed any feelings towards Bill when Bill excelled in school. Bill knew that his father would be very disappointed if he didn't pursue a medical career.

So, when faced with the decision about choosing a major, Bill told himself that he would pursue a medical career but, at some point, like the narrator in "The Road Not Taken," he told himself that he would go back to college and pursue an engineering degree after he graduated from medical school. But as in the poem, "way leads to way," and life didn't turn out the way Bill had planned. He never went back to college for engineering. After he graduated from medical school with honors, he was faced with high student loan bills and a new marriage with young children. so Bill had to work hard to establish himself in his medical career and make money. He had no time, energy or money after medical school to go back to college for an engineering degree.

Bill enjoyed performing surgery and getting involved in cancer research projects. Those two aspects of his work were what he enjoyed the most. However, he really disliked the patient contact which, of course, was a big part of his work. He felt ill at ease dealing with patients' and families' emotions. He would usually leave that to the oncology social workers. And in those instances where it was apparent that nothing more could be done for a patient and the patient was facing end-of-life decisions, Bill would begin limiting his contact with the patient and the patient's family He couldn't tolerate what he perceived as a failure on his part to save the patient, and he could not deal with the patient's and family's emotions. So, he relegated that to the oncology social workers as well.

At first, Bill enjoyed the success and recognition that he received in his profession. He also knew that his father was very proud of him and boasted to his friends about "my son, the doctor." This made Bill feel happy at the time. And although Bill's father was never really affectionate with him, Bill felt that they became a little closer after Bill established himself as one of the top doctors in his field. But after Bill's father died, Bill began to feel lost, depressed and irritable. He was snapping at his wife and children, which he had never done before. He was even snapping at his staff.

But the incident that brought him into my psychotherapy office involved a particular interaction with patient and her husband after it became apparent that treatment was not going to save the patient. At first, as usual, Bill instructed one of the oncology social workers to discuss palliative care and hospice with this patient and her husband, as Bill withdrew from the case. However, the patient insisted on speaking to Bill, and she left several messages on Bill's voicemail. At that point, Bill felt it was his "ethical duty" to speak to the patient and her husband, but he felt backed into a corner.

His secretary arranged for a meeting and during that meeting the patient and her husband took Bill to task for his withdrawal at a time when the patient was facing her death. Bill listened to their complaints with increasing anxiety. He felt trapped and wanted to leave the room, but he couldn't. He kept thinking to himself: "What do they want from me? I've done the best I can. I can't do anything else for them!" When he felt he couldn't tolerate listening to them any more, he apologized to them for disappointing them and then cut them short in a curt manner, telling them that he had another patient waiting and they had to leave his office. When he looked up and saw the hurt and shock looks on their faces, he felt deeply ashamed, but he felt too emotionally paralyzed to do anything else so he let them leave.

Afterwards, when Bill got home, he began talking to his wife about what happened. He was in mid-sentence when he felt a profound sadness come over him and he began to cry. He was surprised at the depth of his feelings because he considered himself to be a logical, rational person and he was usually quite unemotional. At that point, his wife told him that she had been fearing for some time that Bill was in crisis, but she didn't think he would be open to talking about it with her. She suggested that he call the patient and her husband, apologize, and seek professional mental health, which he did.

Over the course of the next several months, Bill came to therapy on a weekly basis. The emotional crisis that he faced forced him to be more open than he ever would have been in the past. He admitted that, before coming to psychotherapy, he "didn't believe in" psychotherapy, and he thought that psychotherapy was for people who were "weak."

Over time, Bill realized that when he chose to be a doctor rather than an engineer, he sacrificed his dream, hoping desperately that his father would show him that he loved him. He dealt with his anger, sadness and resentment towards himself as well as his father. He mourned his father in a way that he had not done before. He also mourned the loss of an engineering career because he had no desire to return to college. And by the time he left treatment, he decided to focus on what he liked best, his research projects, and to stop seeing patients because he knew that he was not well suited for this. He also had a new found respect for psychotherapy.

A year after he left psychotherapy, Bill contacted me to let me know that he was doing well. He had transitioned into full time research work and he was much happier in his work life as well as at home.


Exploring the Road Not Taken
Attending psychotherapy with a licensed psychotherapist provides an opportunity to work through personal and career decisions, past and present, in a way that most people cannot do on their own or with loved ones.

If you're faced with decisions in your life and you're standing at a crossroads, not sure which path to take, or if you're not dealing well with the aftermath of decisions that you've already made, you could benefit from seeking the help of a licensed psychotherapist.

I am a licensed psychotherapist and hypnotherapist in NYC. I have helped many clients who are facing tough decisions or who are looking back on past decisions and how they have affected their lives.

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

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









Tuesday, January 12, 2010

Psychotherapy and End of Life Talks

In today's New York Times Science section, there's an article entitled "Facing End-of-Life Talks, Doctors Choose to Wait" by Denise Grady (http://www.nytimes.com/2010/01/12/health/12seco.html).

The first sentence of the article is, "It's a conversation that most people dread, doctors and patients alike." The article focuses on how and when doctors handle end-of-life talks with their patients as well as, from the patients' and their families' perspectives, when they might be ready to have these talks about accepting or rejecting further medical treatment, and where the patients want to die.

It's an interesting topic, not only from a medical point of view, but also from a psychological point of view. This particular article focused primarily on medical issues but, at least in my mind, as a psychotherapist, it made me think about psychological aspects about a person accepting (or not) that he is going to die and, aside from being comforted medically and physically, what this person would need to attain a measure of psychological comfort about a death that is imminent.

Most people don't like to think about the fact that we're all going to die one day. It's something that we know but, for most of us, we keep these thoughts in the back of our minds and we remain somewhat in denial about it--unless either we or someone close to us is facing an imminent death. Many people might find this topic to be too morbid for a blog post but, upon reflection, most of us would want our loved ones (and ourselves) to have as peaceful a passing as possible when the time comes. In my opinion, that means not just physical comfort and making sure that health care proxies and wills are "in order," but also a coming to terms with death on a psychological level.

Reading the New York Times article reminded me of a training film that I saw several years ago at a psychotherapy conference. The client in the film, who gave her therapist permission to show the film as part of advanced level training for licensed psychotherapists, was an elderly woman in her mid-70s who was diagnosed with end stage cancer. Unlike most of the doctors that are mentioned in the New York Times article, her doctors told her early on that her cancer was terminal and the best that they could do for her was to provide her with palliative care at the end. When this patient told her husband of over 50 years that she had end-stage cancer and she was probably going to die in 12-18 months, he packed up his things and he left her without even a goodbye. So, not only did she feel betrayed by her own body because of the cancer, she also felt alone and abandoned by the person who was closest to her in her life, her husband.

This was this client's predicament when she began psychotherapy. As I watched this film, I thought to myself that I could hardly imagine there being a more traumatic scenario than being abandoned by your partner of 50 years after you were told that you would die in less than two years. By the time this client came to therapy, she had accepted that her death was imminent. So, the treatment focused on her husband's abandonment. It was truly inspiring to watch this client work through such a tragic loss at this time in her life. Step by step, she made good use of the EMDR treatment to process the loss, which started with the image of her seeing her husband's back as he walked out of the house with his suitcases.

It was a testament to this client's spirit, the skill and empathy of her therapist, and the power of EMDR treatment that she was able to process this terrible loss so that she no longer felt crushed by it. In fact, towards the end of her life, she was helping and providing emotional comfort to other patients in the hospital with terminal cancer. She was an extraordinary woman. And her husband did return a few months later, full of remorse for having abandoned his wife at such a critical time. She forgave him, and they reconciled before she died.

This teaching film was one of the most powerful and compelling examples of the need for people to deal with end- of-life issues before they die. And although it's not a topic that most people like to face, death and dying are a natural part of life. How we reconcile our relationships with our loved ones, and how we come to terms with our own lives is a critical factor in the final days of our lives. If we are fortunate to be well enough and have enough time to avail ourselves of psychotherapy to deal with end-of-life issues, I believe it can make such a difference to our psychological comfort at the end of our lives.

If you're curious about EMDR, you can visit the EMDRIA website: http://www.EMDRIA.org.

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

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

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

Monday, January 11, 2010

NYC Psychotherapist at the Movies: "It's Complicated" When a Divorced Couple Try to Decide Whether to Reconcile

Recently, I went to see the movie, "It's Complicated" starring Meryl Streep, Alec Baldwin, and Steve Martin (http://www.itscomplicatedmovie.com). My post today is not intended to be a film review so much as an exploration, as a psychotherapist in NYC who works with individuals and couples, of some of the emotional issues faced by many formerly married couples who, sometimes, consider getting back together again.

The Basic Plot of "It's Complicated:"
Without giving too much away, the basic plot of this romantic comedy is that Jane (Meryl Streep) and Jake (Alec Baldwin) have been divorced for about 10 years. We learn early on that Jake cheated on Jane while they were married, and he left her to be with a much younger woman, who is now his second wife. Both Jane and Jake are successful in their respective careers in Southern California. However, whereas Jake seems to have moved on with his life with his new wife, Jane has not entered into a new relationship since the divorce. She's a woman in her late 50s, and her last child is about to move out of the house, leaving her alone and feeling a little lonely.

Through a series of comical mishaps, which I'll leave for you to discover, Jane and Jake find themselves at the same hotel in Manhattan a day before their son is about to graduate from a NYC college. Each of them is about to dine alone at the hotel restaurant when they see each other and decide to dine together. Many drinks and reminiscences later, they begin to have an affair. This time Jane is the "other woman" and, although she has some misgivings, she's having a great time. They discover that there's still a lot of sexual chemistry between them, and they still care deeply for one another. And I think I'll leave it at that, so I don't spoil it for anyone who wants to see the movie.

It's Not Unusual for Divorced Couples to Still Love Each Other and Consider Getting Back Together Again:
What interested me most about "It's Complicated" is that it raises important psychological issues experienced by many couples who divorce and then later consider getting back together again. I think that most people would assume that once couples divorce, the feelings that they once had for each other just go. But just because two people get a divorce doesn't mean that, deep down, they might not still love each other. It might be buried under a lot of anger, sadness and resentment, but for many couples, the feelings are still there.

If you've never experienced this yourself or you've never heard of this happening before, I can tell you that, over the years, I've worked with a number of formerly married couples who have come to couples counseling to explore whether they should get married again.

As the movie title, "It's Complicated" implies, the emotional dynamics in these types of situations are complex and often confusing. Relationships end for all sorts of reasons. Once the dust has settled and the divorce papers have been signed, it's not unusual for one or both people to have second thoughts about the divorce.

The following vignette is an example of two people who were married for many years, divorced, and came to see me in my psychotherapy private practice for couples counseling to decide whether they should get back together or not. As always, this vignette is a composite of several different cases with all identifying information changed to protect confidentiality:

Sally and George were in their mid-50s when they came to see me for couples counseling. After being married for 25 years and raising two children, they had divorced two years prior to their first visit with me. The divorce was precipitated by Sally's discovery that George was having an affair with a woman he met online.

Both of them agreed during the initial consultation with me that the marriage had been strained for more than 10 years. They were arguing a lot--mostly about money, and their sex life had been dead for the last five years of their marriage. After Sally discovered the affair, she threw George out of the house and consulted with a divorce attorney a week or so later. George wanted to try to save the marriage. He stopped seeing the other woman and tried to persuade Sally to go to marriage counseling with him, but Sally was too hurt and angry. Their divorce was bitter, and they were both unhappy immediately afterwards. The children, who were in their early 20s, sided with their mother and barely spoke to George.

Several months after the divorce was finalized, George began dating a couple of different women. Even though he missed his life with Sally and he felt sad that he was estranged from his children, he started to enjoy his new freedom. Sally had a much more difficult time adjusting to being single again and the thought of dating was very unappealing to her.

One day, Sally saw George shopping in the local grocery store. She said she was surprised that, rather than feeling angry and bitter when she saw him, she felt a mixture of love and pity for him as she watched him try to shop for himself. When George looked up and noticed her, he waved and soon they were chatting. They decided to go for coffee afterwards, and this was the start of their "dating" again. Their children were surprised, but they accepted the situation and they reconciled with George.

All of this sounded fine, except that Sally still had a lot of mixed feelings for George. On the one hand, she realized that she still loved him and enjoyed his company. Part of her wanted to get back together again. But, on the other hand, she still had a lot of pent up anger and resentment for George because of the affair. They were also still arguing and getting into power struggles about money, even though they were both doing very well financially in their careers.

George seemed genuinely remorseful for his infidelity. He was glad to be spending time with Sally again, and he was relieved to have reconciled with the children. However, at this point, he wasn't so sure he wanted to give up being a bachelor so quickly. Even though he was not dating anyone else, mostly not to hurt Sally, he wasn't sure that he wanted to be married any more. He was also concerned that, even though their sex life together was better than ever, they were still having many of the same arguments that they had before. So, from his point of view, he would've been happy to continue to date Sally but to maintain separate households and separate bank accounts.

George and Sally came to weekly couples counseling sessions, but after a few sessions, it became apparent that these sessions were not going anywhere because they were too contentious. Even though, as their couples counselor, I set certain basic guidelines and boundaries for the emotional safety of each of them, as I would with any couple (e.g., speak from your own experience, don't interrupt the other person, don't speak for the other person, and so on), they both constantly violated these boundaries so that nothing was accomplished in the couples sessions.

As a result, I met with each of them separately in individual sessions for a few weeks to work through each person's concerns. When it seemed that each of them was sufficiently calm to come together again for couples counseling, I suggested that we try it again with the understanding that they must adhere to the therapy guidelines in order to continue the couples counseling sessions. With some difficulty, gradually, they learned how to communicate with one another without shouting, finger pointing, accusations, or one of them walking out of the session.

Over time, as they came to their couples sessions, Sally forgave George for the infidelity. They also learned to compromise about the financial issues that had been so contentious. After Sally forgave George and they stopped arguing so much, George decided that he wanted to get remarried to Sally. Sally's friend tried to discourage her from doing it. They told her things like "Move on with your life and find someone else" and "Once a cheater, always a cheater." But Sally felt her friends didn't understand the strong bond between them, even though they were divorced. She regretted that she had not gone to marriage counseling with George when their problems first began when they were married.

A year after they came to couples counseling, Sally and George were planning their wedding. They left couples counseling with the understanding that my door was always open to them, and they could come back again if they started having problems again.

Not All Divorced Couples Who Still Love Each Other Can Reconcile:
No two couples are alike. Each couple is unique, with their own dynamic, their own set of issues, and their own history.

The composite vignette of Sally and George represents cases where both people still loved each other, worked hard in couples counseling, came regularly, and were, eventually, willing and able to make changes in themselves for the relationship to work.

However, over the years, I've worked with divorced couples who came to couples counseling to explore whether they should or shouldn't get back together where there was still too much resentment, an unwillingness on the part of one or both people to compromise and, in some cases, the realization that they were just not compatible, even though they still loved each other. In some cases, one or both people were still hoping, somewhat unrealistically, that the other person would change but, for a variety of reasons, that didn't happen.

What to Do if You and Your Former Spouse Are Considering a Reconciliation:
If you and your former spouse are considering reconciling, you might benefit from couples counseling. You can speak with close friends and family members, but often they don't know what to say or, if they do, they can't be objective and might give advice that is based on their own bias or based on being loyal to you as a friend and not seeing your former spouse's point of view.

Attending couples counseling is no guarantee that your relationship will work out. But if you attend couples counseling sessions with a licensed psychotherapist who has experience working with these types of issues and with whom you both feel a rapport, you will probably stand a better chance of finding out if you should get back together than if you both try to work it out on your own and continue to come up against the same obstacles.

I am a licensed psychotherapist in NYC. I have helped many couples in couples and marriage counseling.

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

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