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Friday, February 26, 2010

Psychotherapy: Overcoming Workaholism

What is Workaholsim?
Workaholism is a powerful obsession. It occurs when a people don't have a healthy balance between work and the other areas of their lives: their relationships, family, friends, leisure time, and social activities. 

Workaholics derive their sense of self and feel good about themselves primarily through work activities. They use work to derive a sense of approval, respect and success. They might spend 60-70 hours or more per week working. They have a hard time slowing down and relaxing. 

They often feel irritable and uncomfortable when they're not working. For some workaholics, even if they're not actually working, they're thinking about work most of the time. It's their main preoccupation. Often, relationships with their partners, children, and family suffer.


Workaholism is a Powerful Obsession
We Encourage Workaholism in Our Society
In our society, we often, unwittingly, encourage workaholism to the detriment of the individuals involved. Workaholics are often rewarded with praise, status, and money. Rather than encouraging people to have a healthy balance between work and personal life, many work settings take a narrow view only in terms of how their employees add to the bottom line.

But, over time, workaholism takes its toll on the individual's health and his or her relationships. Often, over time, when workaholics can't relax, workaholism will also take a toll on their work life because an extreme workaholic will eventually suffer from "burn out."

Martin (a composite of several cases with all identifying information changed):
When Martin came to see me for his first session, I found him pacing up and down in my reception area, on his cell phone and looking at his Blackberry at the same time. He sat at the edge of my couch and he had difficulty settling down. I encouraged Martin to take a few deep breaths before we began talking because he seemed so agitated. After a few minutes, he was able to calm down somewhat, but he kept glancing nervously at his Blackberry. I could tell that he was annoyed when I asked him to turn off his phone and put away the Blackberry.

Martin was referred to me by his coach, who had been trying to help him achieve more balance in his life. According to Martin's coach, Martin, who had been a successful salesman, was suffering from burn out. His burn out was evident in his insomnia, exhaustion, poor diet, problems at home with his wife, who felt neglected by him and, ultimately, in his sales performance.

Martin's personal life and ability to take care of himself (e.g., learn to relax, get to bed at a reasonable hour, eat nutritious meals, and so on) had been declining for some time. It wasn't until his boss spoke to Martin about his declining work performance that Martin sought out an executive coach. He found it intolerable that his work performance was slipping.

At first, he thought that he could just whip himself back into shape and his sales numbers would soar again, as they usually did. But Martin was running on empty, and if he couldn't whip himself back to where he had been before, he didn't know what to do. He thought that if he hired an executive coach, he could get back to his peak performance. But his coach recognized early on that Martin had more serious emotional problems that were beyond coaching. So, he referred Marin to me.

Initially, Martin had difficulty seeing that his life was completely out of balance. He had worked compulsively for so long that it seemed normal to him to work 80-100 hours a week. Even when he was not physically working, he was thinking obsessively about work. His wife was completely fed up with Martin's workaholism, and when she threatened to divorce him, Martin began to finally admit that he had a problem that could not be solved by beating himself up constantly.

Admitting that he had a serious problem was the first step in Martin's recovery from workaholism. But learning to actually let go of his obsessive need to work was a big challenge for him. As a result, work in therapy went slowly at first. But, gradually, over time, he began to understand that his obsessive need to work was just like any other addictive behavior.

Since he didn't know how to relax, at first, he had to learn to schedule in leisure time into his week. With some difficulty, he learned to meditate in our therapy sessions and he started meditating once a day in the mornings. He and his wife also scheduled a date night once a week. During their date night, Martin learned to turn off his phone and focus on his wife. Gradually, he learned to incorporate other leisure activities in his life.

As Martin learned to relax and take better care of himself, his work performance also improved substantially, even though he was spending a lot less time working. Because he was taking care of himself, he approached his work with much more vitality and creativity. His boss noticed and commended him for his improved performance. But Martin had to learn not to allow that praise to trigger him into starting to work obsessively again.

As we explored Martin's family background, it became evident that praise and admiration were strong triggers that drove Martin's workaholism. His father, who was usually emotionally distant, was a workaholic himself. He only praised Martin and showed any affection for him when Martin achieved perfect grades (all A's). His father could not tolerate anything less than perfection. So, as a child, Martin pushed himself harder and harder to gain his father's praise, which meant everything to him. Martin's relentless need to achieve as a child was the beginning of his workaholism.

Part of Martin's work in therapy was to grieve that he didn't have a father who could express affection to him for Martin just being himself. Martin grew up feeling that he was "not enough" and had to excel at whatever he did, especially schoolwork, in order for his father to love him. He only felt as good as his current grades. He was very competitive with his fellow students and felt that he always had to be the best.

The type of work that Martin chose was also conducive to his workaholic style. He was paid by commission and his salary structure fueled his obsession to earn more and more money. But no matter how much he earned, he only felt gratified for a while before he felt the need to earn more. Prior to coming to therapy, Martin was caught in a vicious cycle of greed. As an adult, instead of measuring himself by his grades, he now measured himself by the amount of money that he earned. In many ways, this was worse than performing for grades because his earning potential was nearly limitless if he brought in the business. The sales numbers for all the sales people were also always available for Martin and his colleagues to see, so that also fueled Martin's obsession to work compulsively.

Martin's therapy was not short term. After he was engaged in therapy and learned to be curious about his problems, he was able to delve deeper into the roots of his compulsively. It wasn't easy for him, but Martin came to his sessions regularly. Over time, he learned to have more balance in his life and he found his life much more fulfilling.

Workaholism Also Shows Up at Home
Workaholism is not just about what people do in their careers. It can also show up at home: The man or woman who cleans obsessively at home is also a workaholic. It's the same obsessive need that drives the person at work.

If you're a workaholic, learning to slow down is often a challenge. Learning not to treat yourself like you're a human being and not a production machine can also be challenging. But the benefits to your overall well being and your relationships cannot be overestimated.

People who are workaholics often cannot learn to stop working obsessively on their own.

If you think you're a workaholic, ask for support from your loved ones and get help from a licensed psychotherapist.

I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist. I have helped many clients overcome obsessive and addictive behaviors.

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.


photo credit: t3mujin via photopin cc


Thursday, February 25, 2010

Psychotherapy - Compulsive Gamblers: Beware of "March Madness"

The NCAA Division Basketball Tournament, also known as "March Madness," is just around the corner. March Madness is one of the most challenging times for compulsive gamblers. Sports gambling has become a very popular pass time, especially among college students. Online gambling is a big business. In 2003, online gambling brought in over $5 billion from gamblers, some as young as high school age. High school and college students, who are very savvy about using these online sites, are getting caught up in gambling, and many of them are becoming compulsive gamblers.

Compulsive Gamblers: Beware of "March Madness"

You might think that completing a tournament bracket for $5 or $10 is harmless, but for some people, it's the beginning of compulsive gambling. Just like some people can have a couple of drinks and not become an alcoholic, some people can gamble and not become a compulsive gambler. But for many people, it's just the beginning of a downward spiral on a slippery slope.

What Are Some of the Warning Signs of Compulsive Gambling?
The warning signs for compulsive gambling are very similar to the warning signs for other addictive behavior, but instead of being related to alcohol, drugs, sexual addiction, addiction to the Internet, or other addictive or compulsive behavior, these warning signs are related to compulsive gambling:
  • Preoccupation with gambling: thinking about it frequently, talking about it a lot, checking the stats often
  • Feeling a "high" or "rush" before placing a bet
  • A need to bet increasing amounts of money to get that same "high" or "rush"
  • Repeated attempts to stop that are unsuccessful
  • A need to continue gambling when you're winning
  • A need to return to gambling to chase losses
  • Feeling irritable and uncomfortable when you try to stop
  • Jeopardizing family relationships or your job due to gambling activities
  • Borrowing money from family and friends due to gambling activities
  • Using gambling activities as a maladaptive coping strategy to deal with stress or uncomfortable feelings or situations
If you have one or more of the above warning signs and symptoms, you have a compulsive gambling problem and you need help. Just like any other addictive or compulsive behavior, compulsive gambling is a progressive disorder that usually gets worse over time.

Don't wait to "hit bottom." Find a licensed psychotherapist in your area who has expertise in compulsive and addictive behaviors to overcome your problem with compulsive gambling.

For more information about compulsive gambling, go to: http://www.gamblinghelp.org

I am a licensed psychotherapist in NYC who has expertise in helping people with addictive and compulsive behavior, including alcoholism, drug addiction, sexual addiction, addiction to the Internet, compulsive gambling and other compulsive and addictive behaviors. I have helped many clients to overcome their addictive and compulsive behavior so they can lead 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.



Wednesday, February 24, 2010

Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent

Even the most motivated people who start psychotherapy often feel anxious and ambivalent about beginning to see a psychotherapist. As a psychotherapist, I understand that this is often a common reaction to beginning the psychotherapeutic process.

Why Do People Feel Often Anxious and Ambivalent About Starting Psychotherapy?
In general, making changes can be challenging for many people, even when they know they need to make these changes and they feel the time is right.

Starting Therapy:  It's Not Unusual to Feel Anxious or Ambivalent

Most people decide to begin psychotherapy because they want to make certain changes in their lives. But even when we know that we can benefit from making changes or that the people around us might also benefit, change can be scary.

We're familiar with our old habits and ways of being. Even when we've become uncomfortable with those ways or they're not working for us any more, often, when we think about what it might be like to be different, we're faced with the unknown:

"How can I make these changes?"
"Will I be able to do it?"
"I've tried before to change, and it didn't work. Will this be just another unsuccessful attempt?"
"What if I change and my family and friends don't like these changes in me?"

It's not unusual for doubts to start to creep in our minds when we begin thinking about making changes.

If you've never been in psychotherapy before, the psychotherapy process is very different from anything that you've done before.

Starting Psychotherapy:  It's Not Unusual to Feel Anxious or Ambivalent

To begin with, you need to find someone to see and that's not always easy. Many people like to try to see someone on their insurance plan, but many psychotherapists have dropped off managed care insurance panels because many managed care companies have been cutting their fees to therapists to the point where therapists can no longer sustain their private practices and meet overhead expenses.

Even if they don't cut fees, most managed care companies have not raised their fees in over 20 years, so the fees are not keeping pace with therapists' overhead expenses, like rents in Manhattan offices. So, there is that challenge, which can be frustrating.

I usually recommend going with recommendations from people that you trust, like friends or doctors. If you find a therapist that you like who is not on your managed care panel, you might have mixed feelings about paying for your therapy out of pocket.

But when you stop to think about how you spend money in other areas of your life (maybe you pay $10 a day for cigarettes or you think nothing of spending $100 for dinner and drinks with friends), ask yourself if it's worth it to spend the money to make the necessary changes that you want to make.

After you find a psychotherapist that is either recommended to you or you find on the Internet, you might feel awkward about making that first call: What will you say? How can you explain what you want in a way that is concise but still gets across what you're looking for? Often, you'll get the therapist's voicemail when the therapist is in session: What do you say? Where do you want to be contacted?

People often find that after they've managed to find a therapist, call and set up an appointment, they feel good about making a commitment to change. They feel that they've set an intention to make changes in their lives--they've started the process with that phone call.

 But it's not unusual to have mixed feelings about it at the same time. Some people worry prior to the appointment, anticipating what the therapist might be like: "Will the therapist be judgmental?" "Will the therapist think I'm crazy?" and so on.

For many people, coming to the first appointment can be anxiety provoking. Usually, even the most anxious people settle down after a while. They might find starting difficult, but a skilled therapist can help them to feel comfortable so they can use their session in a productive and satisfying way.

I usually like to provide a vignette that illustrates the points that I'm making in my blog posts because I think that it helps to clarify these points.

 My vignettes are always composites of actual cases, which means that they are made up of several different cases, with all identifying information changed to protect confidentiality.

The following vignette is an example of the affects of anxiety and ambivalence when a new client is starting psychotherapy:

Daniel:

Before Daniel called me to set up a psychotherapy consultation, he had been thinking about starting psychotherapy for several years. In the past, he had gone through the process of getting recommendations for psychotherapists from friends and his doctor, but he was too anxious to follow through with making the phone call to set an appointment.

When he called me the first time, he was so anxious about leaving a message that he forgot to leave his telephone number, so I couldn't call him back. Fortunately, he realized that he forgot to leave his number, so he called back, got my voicemail again and left a call back number so I was able to call him.

When I called Daniel back, I sensed that he was very anxious about making the appointment, so we spent a few minutes talking about what he was looking for in therapy.

As we continued to talk, I could hear that Daniel's anxiety was starting to decrease. He was able to say that he felt his low self esteem was getting in the way of his personal and work-related relationships and he wanted to overcome his poor sense of self. We set up an appointment and, as I usually do, I gave directions to Daniel about how to get to my office, explained the intercom system, and that when I buzz him in, he would wait for me in my reception area.

On the day of the appointment, I received a call from Daniel that he had misplaced my office address. I sensed that this was due, in part, to Daniel's anxiety about coming to our appointment, so I gave him the address again and tried to allay his anxiety. On his way to the appointment, Daniel got stuck on the subway, which increased his anxiety but, fortunately, he had left himself a lot of extra time, so he arrived early for his appointment.

When he arrived in my reception area, due to his anxiety, Daniel forgot that I told him that I would be with another client before him and that he could wait in the reception area for me to to get him after the prior client's session. So, he got to the reception area and he wasn't sure what to do. My office is set up so that the door between the reception area and my office is locked, for safety as well as confidentiality purposes (so clients don't accidentally walk in on another client's session).

 Soon after he arrived, which was about 20 minutes early, I began to hear him calling out in the reception area, "Hello? Is anyone here?" So, I came out of my session with the client who was in my office, introduced myself and told Daniel that I would be with him in 20 minutes. I pointed to the magazines in the reception area and told him that he could choose one of them to read while he was waiting, which he agreed to do.

When I came back out to meet Daniel again in 20 minutes, I noticed that he looked very anxious and he was sweating profusely. I invited him to sit wherever he was comfortable in my office, and we were about to begin the session when Daniel told me that he just remembered that he needed to make an important phone call, and he would be right back. I waited a few minutes, but Daniel never came back that day. He left in a state of panic. After I called him later that evening, he told me that he bolted out of the office because he panicked.

During our next session, Daniel was still anxious, but he was able to talk about his fears about beginning therapy. I encouraged him to ask questions and to express his concerns. Gradually, over time, Daniel began to settle into the therapeutic process. His doubts didn't disappear over night, but he was able to express them, look at them more objectively, and feel safer and more comfortable coming to his sessions.

Starting Therapy: Daniel Was Anxious During the First Session

Like most clients who begin attending psychotherapy, Daniel began to learn how to use therapy by actively participating in treatment and with my assistance. Most skilled therapists know that new clients need psychoeducation about psychotherapy to help them begin the process.

As Daniel became accustomed to the process, his comfort level increased and his anxiety level decreased. He still often had mixed feelings about "what it meant" that he was in therapy, but those feelings also decreased over time.

Starting Therapy: As Daniel Became Accustomed to the Process, He Became More Comfortable


Helpful Tips About Starting Psychotherapy:
  • Realize that most people are anxious and ambivalent about starting psychotherapy and, if you're feeling this way, you're having the same experience that most people have.
  • Recognize that it might be hard these days to find a psychotherapist on your managed care panel.
  • Ask people that you trust, including friends and your doctor, for recommendations
  • Before you make that first call, recognize that it's normal to feel anxious, so think about what you want to say before you call.
  • Recognize that procrastination won't make you feel any less anxious. If anything, delaying making the call might make you feel more anxious as doubts and fears creep into your thoughts and might cause you to lose your resolve about starting psychotherapy.
  • Think about your financial priorities if you choose to call a therapist who is not on your managed care panel. While it's true that many people really can't afford to pay for therapy out of pocket, especially during these difficult financial times, often people can afford it, if they're willing to make some changes in how they spend their money and if they can find a therapist who works on a sliding scale.
  • Give yourself plenty of time to get to your appointment.
  • Recognize that most psychotherapists see clients back to back, so there is often a client in the therapist's office ahead of you.
  • Take a few deep breaths, read a magazine, do a crossword puzzle, or listen to music quietly on your Ipod while you're waiting for the therapist to come out to greet you.
  • Recognize that the initial consultation session is a time to talk about what brings you to therapy at this point in time. Many people have only a vague sense that their lives are not working for them or that they're not happy. But they might not know what the problem is or why they're not happy. This is completely fine and it's all part of the process. If you're not sure what's wrong, finding out will be part of your process in therapy. You don't have to come in with the answers. A skilled therapist can help you through this process.
  • Try to get a sense of whether you feel comfortable with the therapist. People often don't know this from one or two sessions because of their own anxiety. It's often hard to distinguish your own anxiety about being in therapy from a discomfort that you might feel with a particular psychotherapist. So, it might take you a few sessions to sense if you have a rapport with the therapist.
  • Assuming that you're able to separate out your own anxiety about the psychotherapeutic process from a lack of rapport with a particular therapist, don't hesitate to tell the therapist that you're feeling uncomfortable or that he/she might not be a good fit. Most therapists know that a good rapport is necessary for treatment to go well, and will not be offended by this.
  • Recognize that there are different types of psychotherapy (psychodynamic psychotherapy, cognitive behavioral therapy, EMDR, clinical hypnosis, and so on). Most therapists will explain during the consultation session the different types of therapy that they do and might refer you to websites or give you written information. If you're unclear, ask questions. You're not expected to be knowledgeable about this.
  • Know that, with few exceptions (smoking cessation being the most common example), most forms of psychotherapy, even EMDR and clinical hypnosis, which are often recognized to be faster and more effective, are not "quick fix" solutions. The therapy process is often an investment in time and money for you and you need to weigh this against where you are now in your life and where you want to be.
  • Ask questions. It's appropriate and often helpful to know about a therapist's professional background, education, and expertise. Make sure you see a therapist who is licensed in your state. Most therapists will not answer personal questions about themselves because you are the focus of the therapy and not them. But if you have a need to be with a particular kind of therapist (e.g., you're gay and you want to be with an "out" gay therapist), you can explore this with the therapist. Some therapists will divulge this information, if they think it's important to your therapeutic process, most will explore the meaning of your questions first and then divulge the information, and others will not. It's often a matter of style and professional training.
I hope this post was helpful to people who are thinking about beginning psychotherapy. I've confined my remarks to the beginning of the process because people often have difficulty starting.

I am a licensed psychotherapist, hypnotherapist and EMDR therapist in NYC. I work with both individuals and couples.

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

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














Thursday, February 18, 2010

Psychotherapy: Overcoming Internet and Porn Addiction

As a psychotherapist in NYC, one of my specialities is addictive and compulsive behavior.  Aside from assisting clients with alcohol and drug problems, I've been seeing many more clients who are struggling with Internet and porn addiction. Based on recent research, the number of people who are addicted to spending countless time and money on the Internet, whether it is on social networking sites or downloading pornography, has exploded. The Internet pornography industry is a multi-billion dollar industry.

Why Has There Been Such an Explosion in the Number of Internet Addiction Cases?
With the advent of the Internet and the profusion of pornography sites on the Net, it's easy to access pornography sites and chat sites from the privacy of your home. Whereas someone might be more cautious about going to a porn shop, this same person is assured of the anonymity that the Internet provides. So, it's fast, easy, immediately gratifying, anonymous, and often free. Many more people are now suffering with Internet addiction, and addiction to porn specifically, because of the easy access of the Internet.

What are the Consequences of Internet or Porn Addiction?
As a psychotherapist, I'm seeing many clients who are coming to treatment because there have been negative consequences in their relationships or at work. For example, if a client's wife has discovered that he has been spending an inordinate amount of time looking at Internet porn and less time with her, most likely, she will resent this and, often, insist that her husband get help. Or, if an employer finds out that one of their employees is less productive at work because he or she is spending work hours downloading porn or other Internet images, they would have reason to be very concerned about this, and employers have been known to mandate these employees to get psychological help or, in some cases, terminate the employee.

Aside from whether someone is caught or not by a spouse or an employer, often, people who are overly preoccupied with the Internet are compromising their relationships because they are spending less time paying attention to and nurturing their live, non-Internet relationships with their partners, spouses, children, friends and relatives. With severe cases, as people spend more and time on the Internet, their sex life with their partners wane, bills might not get paid, household chores might fall by the wayside, and other everyday responsibilities suffer because these people are in the grips of addictive and compulsive behavior.

The following composite account of several cases, where all identifying information has been changed, is an example of Internet addiction:

Edward:
When Edward contacted me to begin psychotherapy, he indicated that his employer had caught him downloading Internet pornography at work for the second time. He indicated that he had been given a warning by his Human Resources Department and his director when he was caught the first time downloading porn. Part of that warning was that they would be monitoring his computer activity very closely from that point on, and if they discovered that he continued to download porn, there would be consequences, including possible termination.

According to Edward, having that initial meeting with the head of Human Resources and his director was one of the most humiliating experiences of his life. Fortunately for Edward, he had a stellar reputation at work as being one of their best sales people, and there had been no prior problems at work. So, he got off with a warning the first time. After that, he made a commitment to them and to himself that he would never download pornography at work again. He said he never told his wife about what happened because he was ashamed and he also feared her reaction.

For the first few weeks, Edward said he was able to refrain from looking at porn at work. There were many times during the day when he felt bored at work when he was tempted to look at Internet porn, but he continued to refrain. Instead, he went home, waited until his wife was asleep and spent long hours at night downloading porn at home. Often, his wife, who thought he was doing work on the computer, would call to him from the bedroom to come to bed. But, eventually, she would go to sleep, and she didn't realize that Edward was staying up until 2 AM or 3 AM looking at porn and masturbating.

After a couple of weeks of spending so many late nights looking at porn, Edward began to have problems waking up in the morning for work. He was just making to work on time, and he often felt drowsy at work. His concentration and focus also began to slip, which began affecting the quality of his work. After one of his customers complained to his director, Edward's director spoke to Edward about the complaint. According to Edward, in the 15 years that he had worked for his company, none of his customers had ever complained about him. When confronted about the complaint by his director, Edward brushed it off as a complaint from a difficult customer. At the time, his director seemed to believe him, and the matter was dropped.

Edward knew that he was beginning to slide down a slippery slope. He realized that he was spending way too much time on the Internet, but he told himself that he would stop tomorrow. He gave himself permission to look at Internet porn one more evening at home, and he told himself that he would stop after that. At that point, he believed that he could stop at any time.

But that night when Edward stayed up late to download porn at home, his wife came out to see what he was doing because she was concerned that he was staying up too late at night. Edward didn't hear her walking into his study while he was masturbating to the pornographic images on the computer. So, when his wife walked into the room and saw the images on the screen and realized that Edward was masturbating, she was shocked and angry.

Edward lied to his wife and told her that this was the first time that he had ever downloaded porn and masturbated to the images on the screen. His wife accused him of being more desirous of the women on the computer screen than of her. She also brought up that they were hardly having sex these days, and she wondered if it was because he was masturbating to these images. She told him that she felt that she could not compare with these screen images of women with "perfect" bodies. Edward denied everything but, inwardly, he feared that this was true. Once again, he vowed to himself to stop.

After that night, Edward's wife insisted that he go to bed early, so he was unable to download porn at home in the evenings. He was also still leery about downloading porn at work because he didn't want to lose his job. Over time, he became increasingly aware that, even though he wasn't downloading porn, his thoughts were more and more preoccupied with the numerous images that he had already seen. His preoccupation with these distracting thoughts caused him to start making small mistakes at work. At that point, he was still able to hide them, make excuses or blame others when his mistakes came to light.

Increasingly, Edward was becoming anxious and irritable. He felt that if he was only able to download some porn, he could "take the edge off" his nervousness. One day at work, after a few weeks of abstaining from Internet porn, Edward felt like he was going to explode. He felt that he was barely hiding his edginess at work and he was especially snappy with his wife at home. As a result, he convinced himself that he could go to a porn site at work one more time. He told himself that he worked for a big company and the tech people had a lot of people to monitor, not just him. He felt that, with all that was going on at work for the tech people, he wouldn't get caught if he downloaded porn just one more time.

After Edward closed his office door, he went to one of his favorite Internet porn sites. He felt the usual gratifying sexual arousal, which made him feel elated. With the sexual arousal came an urge to masturbate. Until then, Edward had never masturbated to porn at work because he felt this was just too risky. But after weeks of abstaining from Internet porn and now seeing the images that were so sexually arousing, he decided to go ahead and masturbate. (The word "decided" here is a bit misleading because, as Edward described it to me, it was more of an impulse, without any thought, than a decision.)

Suddenly, Edward's director walked into his office to bring Edward the latest sales report. He was in mid-sentence, telling Edward that his sales performance had slipped that month when he suddenly realized that Edward was half undressed, massaging his penis in his hand, and watching Internet porn. Needless to say, Edward was mortified. Several hours later, he had to tell his wife everything--that he was suspended from work for a month and he was mandated to treatment. He was given a final warning at work, and he had to sign documentation that he understood that if he didn't get psychological help or if there was a reoccurence of this behavior, he would be terminated.

This was the situation when Edward came to see me to get psychological help for his Internet porn addiction. He admitted, for the first time, that he had a serious problem that he couldn't solve on his own. He stopped deluding himself into thinking that he could stop at any time, and he stopped bargaining with himself that he would only do it "one more time." He and his wife were also seeing a marriage counselor to try to repair the damage that his addiction had done to their relationship. At that point, Edward's wife was seriously considering divorcing him because she didn't trust him any more.

With the help of weekly psychotherapy sessions and attendance at Sex Addicts Anonymous 12 Step meetings, including a 12 Step sponsor, Edward overcame his Internet addiction. There were still times when he felt the craving to look at Internet porn, but he was able to channel his cravings into healthier activities. With regard to his marriage, it took a while for Edward's wife to trust him again, but they began to pick up the pieces of their marriage. He also returned to work, feeling extremely humiliated at first, but he redoubled his efforts to improve his work performance and he had no more slips at work or at home.

You Can Become Addicted to Internet Porn and Chat Sites Before You Realize It:
Internet addiction, especially addiction to porn sites and chat rooms, can be very insidious. Without realizing it at first, it's easy to get caught up in this behavior and not realize it until there are serious consequences. People who never engaged in addictive behavior before are getting caught up by the compelling images on the screen and easy access to sexual partners in chat rooms.

Getting Help:
If you are struggling with Internet addiction or you are the partner of someone who is having this problem, you're not alone. Seek help from a qualified, licensed mental health professional who has expertise helping people to overcome Internet addiction so you can overcome this problem. Also, find out about local Sex Addicts Anonymous 12 Step meetings in your area and attend a beginners meeting.

I am a licensed NYC psychotherapist. One of my specialities is addictive behavior, and I have helped many clients to overcome Internet addiction.

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, February 16, 2010

When Your Relative's Financial Problems Affect Your Marriage

As a psychotherapist in NYC, who works with individuals and couples, I have been hearing more and more from individuals and couples about the adverse impact that the recession has had on their relationships. Even for couples who have been fortunate enough not to have lost their jobs, they are often dealing with relatives who are in dire financial straits. It's often difficult to turn down requests for financial help from your mother, father, brother, sister, son or daughter.


When Your Relative's Financial Problems Affect Your Marriage

You might want to help, but what if the situation is adversely affecting your relationship, either because you and your spouse don't agree about lending the money or because you've been lending your relative money and it's becoming too much of a hardship for you--and there seems to be no relief or end in sight?

How do you and your spouse decide what to do?

How do you keep this type of situation from ruining your relationship?

There are no easy one-size fits all answers to these questions that many couples are now facing. Maybe your brother lost his job and he can no longer pay his mortgage, or your mother can no longer afford to pay her rent, or your sister has asked you and your spouse for money because the court is about to issue a judgment against her and freeze her bank accounts due to unpaid credit card debt. There are so many other variations on these types of situations.

Not only do these situations often place an emotional strain on a couple's relationship, but it also puts a strain on the relationship between the relative who is lending the money and the one who is borrowing it. The person who is lending the money might feel anxiety as to whether he or she will ever see this money back again. And the relative who is receiving the money often feels ashamed for having to ask. Then, there is the question of whether the person who is lending the money has the right to tell the borrower how to spend the money.

The following is a vignette, which is a composite of several actual cases from the past with all identifying information changed to protect confidentiality, that will serve to illustrate some of the complications involved in these types of situations:

Jane and Alex:

When Jane and Alex, who were married for over 20 years, began marriage counseling, they were barely speaking to each other. They started marriage counseling because Alex's son, Bob, from Alex's first marriage, borrowed a sizable amount of money from them more than a year ago, and Bob was not making any attempt to pay them back, even though he started a new job.

When Your Relative's Financial Problems Affect Your Marriage

Initially, after Alex lost his job, he and his wife could no longer make ends meet on her part-time salary. The bills began to pile up and they were taking out cash advances on their credit cards. When that proved to be too costly, Bob approached Alex and asked for $20,000 to pay off his bills and meet basic expenses. Alex told Bob that he would need to talk this over with Jane. Jane thought the amount was too high and suggested that Alex lend Bob only $10,000. Initially, Alex agreed to this, but when he talked to Bob, Bob pleaded with him, telling him that he needed the full $20,000 because he feared that he would lose his house if he continued to miss mortgage payments.

Alex felt caught in the middle between Bob and Jane. He wanted to help his son and his daughter-in-law, but he didn't want to upset his wife. Alex and Jane talked about this and went back and forth about it for a while.

When they came to speak to me, they both agreed on the story until that point. After that, they each had a different recollection of what happened. According to Alex, he and Jane came to a decision that they would lend the money to Bob and tell him that he could pay them back when Bob and his wife were in a better financial situation. According to Jane, she and Alex agreed to lend the money to Bob, but they wanted Bob to sign an agreement that he would start to pay back the money once he began working. Each of them insisted on his or her version of the story.

They both agreed that the problem between them developed after Bob started working again. Instead of starting to pay Alex and Jane back, Bob chose to invest what was left of the money. Not only did Bob not make an effort to pay back the money to Alex and Jane, he never mentioned it again.

At that point, Alex felt hurt and Jane was enraged. Even though part of the $20,000 was her money too, she felt awkward talking to Bob about it and insisted that Alex talk to Bob. She was also angry because she thought that she and Alex had agreed on specific terms for Bob repaying the money. She felt that Alex was being too passive with Bob and that Bob was taking advantage of their generosity. She and Alex began arguing about this situation and it was causing a rift in their marriage.

After several marriage counseling sessions, Alex agreed that it would be best if he was the one who approached Bob. Although he felt very uncomfortable bringing up the loan with Bob, Alex didn't want this situation to continue to come between him and Jane any more than it already had.

The following week when Alex and Jane came for their next session, Alex reported that when he approached Bob about the money, Bob told him that he thought the money was a gift--he never realized that Alex wanted him to pay him back. Alex said that he was stunned. Jane was extremely angry about this. Alex admitted that, when he lent the money to Bob, he was very unclear about it and, although it seemed surprising to him that Bob would assume that it was a gift, he could see where his lack of clarity might have caused Bob to think this.

Based on our working on this issue in the marriage counseling sessions, Alex was careful not to make it seem that Jane was the only one who wanted the money back. It would have been easy for Alex to try to make Jane seem like the "heavy" to try to preserve his relationship with Bob. Although Bob wasn't happy about it, he agreed to various terms of repayment and began to repay back the loan. For a while, this placed a strain on the father-son relationship between Alex and Bob, but they eventually worked it out.

In the meantime, once Bob began paying back the money, the tension between Jane and Alex began to ease. They learned to improve their communication with each other and agreed that if ever they found themselves in this type of situation again with either of their relatives, they would approach it with much more clarity and mutual understanding.

Jane and Alex Worked Out Their Issues in Couples Counseling

Often, what begins as a gesture of kindness and good will to help a family member can turn into a tension-filled situation for everyone involved.

Here are some tips if you and your spouse decide to lend money to a friend or relative:
  • Make sure that you both agree on the situation beforehand.
  • Never go behind your spouse's back to lend money to a relative because this can cause serious problems in a relationship.
  • Make sure that you and your spouse understand what the money is for before you make the loan.
  • Make sure the relative who is the borrower is clear that this is a loan and not a gift.
  • Be clear about what your expectations are with regard to repayment and, even though it might sound cold, it's often best to put terms in writing, if only for the sake of clarity.

Getting Help in Therapy
If you and your spouse are having difficulties about money that you've lent to a friend or relative, you might benefit from sorting out this issue in marriage counseling.

When choosing a couples counselor, make sure you see a licensed mental health professional.

I am licensed NYC psychotherapist who works with individuals and couples.

I have helped many couples to work out emotional issues.

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 an email: josephineolivia@aol.com.











Monday, February 15, 2010

When Job Loss Means Loss of Identity

The recession in the US has meant the loss of jobs for tens of thousands of people. We read everyday in the newspapers and hear on the news the statistics of high unemployment, but these statistics don't even begin to relate the emotional loss for former employees and their families. Aside from the financial loss, job loss can also mean the loss of an important identity for the person who has lost his or her job: One day, you're the head of accounting in a prestigious firm, and the next day you're an unemployed person sitting at home wondering what happened, who you are, and what you will do next.

When Job Loss Means Loss of Identity

As I've mentioned in other posts, prior to being a psychotherapist, many years ago, I was involved in other fields, including banking and finance. Being in the banking and financial field as a human resource manager, I had many occasions to see people laid off from their jobs due to mergers, cutbacks, and "downsizing" (a euphemism that I have never learned to like).

Even though I had seen many employees lose their jobs (through no fault of their own), nothing prepared me for when it actually happened to me.

A few months prior, I had received an excellent performance evaluation and there was no reason to think at the time that I would be laid off. But I can still remember how my mouth went dry and my brain was slowly trying to catch up to my boss's words when she told me that she was truly sorry to be letting me go.

She had tears in her eyes, assuring me that it was nothing that I had done (or not done), she offered to give me an excellent letter of recommendation, and help me in any way that she could.

But, based on company protocol, which I knew well, I had to pack my personal belongings and leave by the end of the day. That protocol, which is generally observed for security reasons (the idea being that an employee might get angry and engage in sabotage) is one of the most dehumanizing experiences you can go through.

I think some part of me went on automatic and I gathered my things in boxes. There was no time to say goodbye to colleagues (and I don't even know what I would've said to most of them at the time). But, before I left, I called one colleague that I had a close collegial relationship with to tell her that I had just been "let go." She knew and admired my work, and she was shocked. Months later, she told me that she was so surprised when I called her that she didn't know what to do or say, so she just put her head down on her desk.

Afterwards, as I was taking the train home, I was so distracted that I got on the wrong train and only realized it when I had traveled a distance from my home.

I felt like I was in a fog. I was fortunate to have a good emotional support system, and that night, I made up my mind to do what I had been thinking about doing for a long time--completing my undergraduate degree, going to graduate school, and changing careers. So, I was able to channel my emotions into advancing my new plan with determination.

But it wasn't easy at all. Even though I had this new determination, I still went through most of the feelings that people go through when they lose their job: shock, denial, sadness, and anger.

I also come from a family with a very strong work ethic, which has generally been beneficial to me. My grandparents lived through the dark days of the Great Depression and their attitude was: "If you have a job, no matter what kind of job you do, do it with pride to the best of your ability, and be happy that you have a job."

My father, grandfather, uncles, and cousins were all hard workers. Although my cousins and I knew that our grandparents suffered during the Depression, we never dared to ask them about it directly. We heard oblique references to it at times and how hard it was, but that was it.

And, as children, we knew that there were two things that you did not ask my grandfather about because it was too upsetting for him: 1) Did he miss his family in Italy, a family that he was very close to, and that he never saw again after he came to the US by himself when he was 17 years old, and 2) What happened after he lost his job during the Depression?

Of course, by the time my cousins and I arrived on the scene, they were okay: My grandfather had a job as a janitor for the post office that he was very proud of. He talked about the post office a lot when the whole family got together every Sunday for dinner.

Having gone through the Depression, we sensed that it was like a badge of honor for him that he had this secure Federal civil service job. And, through a lot of hard work, before my cousins and I were born, my grandparents also eventually achieved the American Dream of buying their own home: Be it ever so humble in a part of Brooklyn where goats still roamed the streets at the time when they bought their two-family house.

Since both of these topics were so taboo and shrouded in a dark mystery, as children, we grew up feeling that losing your job would be one of the worst calamities that could ever happen to you. Even though I was living in a very different time than when my grandfather lost his job and I was not a child when it happened to me, I still had a sense (as distorted as it might have been) that this terrible thing happened to me, and I was somehow at fault. This is a common initial reaction for many people who are laid off as they try to sort through in their minds what happened to them.

At this point, I'm fortunate to be able to say that losing that job was one of the best things that ever happened to me. I went on to complete my undergraduate and graduate degrees, and obtained postgraduate training. I can honestly say that I've never had any regrets about it. But that's jumping ahead in the story quite a bit and, at the time, I didn't have a crystal ball that would predict a good outcome, so I was worried.

Aside from losing a daily routine that gives so much structure to people's lives and losing the day-to-day affiliations with coworkers, when people lose their jobs, they often lose their sense of identity. No matter how much you might like to say, "I'm not my job" or "I'm not my title," it's the rare person who doesn't go through this kind of loss of identity.

In my case, I went from being a full time assistant manager to being a full-time student. I'm a naturally curious person and love learning.

But, aside from losing a regular income and knowing that there was no cushion of a second income, it was a hard adjustment to being a returning college student as a middle-aged person among people in their late teens and early 20s.

So, to cope with this adjustment and the accompanying doubts and fears, I had to learn to keep very focused on my goal, which was years away for me at that point. I took whatever part-time work that I could find (we were going through another recession at the time, so work was not plentiful), took out student loans, and reigned in my spending immediately.

Even though this occurred to me many years ago, I still remember how it felt for me, and I have a lot of empathy for people who are going through it now. Of course, everyone's situation is different, but in general, to sustain yourself emotionally, I would recommend:

  • Stay connected with your emotional support system: Allow your spouse or partner, close friends, and other family members to be supportive of you. As tempting as it might be to not pick up the phone when a friend calls, this is not the time to isolate.
  • Stay in contact with former colleagues and supervisors. They are often a valuable resource for references, tips about job openings, and what's going on in the field.
  • Join business networks like LinkedIn (http://www.linkedin.com/) to pursue career opportunities.
  • Find meaning and value in the other aspects of your life: You're still the same person that you were before you lost your job--father, mother, son, husband, wife, Little League coach or whatever other roles you might have.
  • Don't blame yourself if you were laid off due to cutbacks. Chances are the decision to lay you off, which is, of course, very personal to you and your family, was made based on financial decisions. And if you were terminated for cause (for something that you did or did not do), learn from whatever mistakes that you might have made.
  • After you go through the initial shock, denial, grief, and anger, work towards accepting what has happened and mobilize yourself to take action. Avail yourself of whatever resources there might be in your local library or State Department of Labor. Take advantage of whatever funds there might be through Unemployment insurance for additional educational training.
  • Recognize that you're going through a crisis and take good care of yourself. This is not the time to skimp on medical and dental visits, especially if you are eligible under the new current Federal COBRA law, to extend your health benefits at a reduced rate, if you qualify. Engage in stress management techniques that work for you (like meditation or going for regular walks).
  • Remember other times when you went through other crises and you came out of it okay--maybe even better than okay. Maybe you'll be able to make changes in your life, as I did, that you might not have made if you didn't lose your job. Also, remember, that we're often more resilient than we realize.
Stay Connected With Your Emotional Support System


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

Sunday, February 14, 2010

Valentine's Day: Unrealisic Expectations Can Lead to Great Disappointments in Your Relationship

Feeling Disappointed on Valentine's Day due to Unmet Expectations:
Valentine's Day, like so many other celebrated occasions, is one of those times when people often feel disappointed because their expectations have not been met by their romantic partners. It's often a time when people in relationships expect certain big gifts, which might mean a diamond engagement ring or some other large gift. When those big expectations are not met, it can lead to big disappointments and a lot of pressure and anxiety for the other partner.

The Origin of Valentine's Day:
The origin of Valentine's Day seems to be somewhat in dispute. As far as I can tell, it's based on at least two (some say three) martyred saints, Valentine of Rome and Valentine of Terni. There isn't much known about these two saints, except that there was nothing romantic about their stories and they lived some time in the Third Century AD. Others think that Valentine's Day is connected to an old Roman pagan holiday called Lupercalia, which was related to fertility rites, and was celebrated between February 13th-February 15th.

The Commercialization of Valentine's Day: What's Important in Your Relationship?
The idea of a romantic Valentine's Day came much later with the making of home made greeting cards with hearts and cupids around the 18th century. Since that time, Valentine's Day has been commercialized and there seems to be increasing pressure and expectation for big gifts. With all the emphasis on gifts, what often gets lost is the expression of genuine love and kindness between two people, as if that's not enough.

But is this reasonable and should we stop and think about what's really important in our relationships?

As far as I know, there hasn't been any research to show that big, showy gifts on Valentine's Day are correlated with successful relationships. However, there has been substantial research over the years to show relationships that are based on unrealistic expectations and an emphasis on grand gestures or big gifts, and less emphasis on love, compassion, kindness and being there for each other, are less likely to succeed.

I'm not saying that it's wrong to want a special gift on Valentine's Day. We all like to be treated special at times. But you need to be honest with yourself and your partner as to whether your expectations are realistic and reasonable, given where you and your partner are in the relationship. You need to take into account the level of commitment, timing, what you and your partner can afford, and the context of your relationship.

A gift that is sincerely given by your partner, whether it was what you wanted or expected, is to be appreciated for the intention that it represents. If your partner gives you something other than what you hoped for, you shouldn't take it as a sign that your partner doesn't love you.

Equating gifts with love is a slippery slope. Not only is it overly materialistic, but when you think about it: What material object would be big enough to show your partner's love?

Inability to Make a Commitment is Another Matter:
On the other hand, if you and your partner have been together for a while and you want more of a commitment from him or her and your partner has been unable to give that commitment, all other things being equal, that's a different story. Valentine's Day might represent to you another occasion that has come and gone, possibly like Christmas and your birthday, when your partner is unable to commit. At some point, only you can decide how much longer you want to remain in a relationship where your emotional needs are not getting met. That's different from material wants. And what constitutes a reasonable time frame is different for each couple. But that's a subject for another post and it's not what I'm talking about here.

I'm referring to unrealistic expectations in committed romantic relationships where people get carried away with how "it's supposed to be" on Valentine's Day without regard for their circumstances in the relationship.

What are Unrealistic Expectations in a Relationship?
To a certain extent, this is subjective. There are many ways that we can have unrealistic expectations in our committed relationships, especially when we're focused on getting what we want and not taking into consideration other factors in the relationship.

The following vignette, which (as always) is a composite with no identifying information about any particular client, is one example of how unrealistic expectations can lead to big disappointments:

Linda:

Linda, who was in her mid-30s, had been coming to see me for individual psychotherapy for several months when she came to her session, just after Valentine's Day, to talk about how disappointed she was that her boyfriend didn't give her an engagement ring. When she came to therapy initially, she came to work on her anxiety about wanting to get married and have children before her late 30s.

According to Linda, she loved Tom very much, and he was loving and caring towards her. After a couple of months of dating, they made a commitment to each other not to see other people, and they were both faithful to that commitment. The relationship seemed to be going well at first, but not fast enough for Linda, who was very focused on getting married and who had legitimate concerns about having children at her age.

Linda had no doubts about Tom. They shared similar values, and she felt that Tom would make a wonderful husband and father. They were in the second year of their relationship, and the big obstacle between them was Tom's young children from his first marriage. Tom had two young sons (7 and 9) from his first marriage. The arrangement that he and his ex-wife worked out was that he saw his children every other weekend. In general, Linda liked most children very much, but she admitted that she couldn't help feeling jealous and resentful towards Tom's children whenever she was around Tom and them. According to Linda, they were well behaved, kind children, and they accepted her as Tom's girlfriend. She couldn't attribute her resentment and jealousy towards anything that the children did or that Tom did when the children were around.

As we continued to explore this problem in Linda's psychotherapy sessions, Linda realized that, even though there was no objective reason for her to feel neglected or mistreated by Tom when the children were around, she still felt irritated and annoyed with the children. She tried to conceal her feelings from Tom and his children, but Tom picked up on her resentment and jealousy, and he had concerns about her feelings with regard to their taking the next step in their relationship.

Linda often felt moody a day or so before Tom's children came to visit him. Without realizing it, she would sometimes pick a fight with him a day or so before to avoid seeing him with the children. Even after she gained some insight into what she was doing, she found it hard to stop feeling resentful and jealous. After a few arguments about this, Tom told Linda, in no uncertain terms, that he was not about to give up seeing his children--not now or ever--and Linda would need to work out whatever negative feelings she had before he would consider getting engaged. They continued to see each other, but there was some tension in the relationship.

All of this occurred several weeks prior to Valentine's Day. On Valentine's Day, when Tom came to Linda's apartment, he gave her a small black velvet jewelry box. Linda was thrilled, anticipating that there was an engagement ring inside. But when she opened the box and she saw a small pair of gold earrings, she was extremely disappointed and let Tom know. Aside from her own expectations of where their relationship should be, she was also very aware that all of her friends were either married or engaged, and she was the only one who was still single. Tom was hurt and angry at Linda's reaction. He felt that she was ungrateful and he left her apartment in anger.

In our next session, Linda and I talked about what happened on Valentine's Day in light of the issue between her and Tom about his children. We also talked about what Tom had told her several weeks before about his concerns. In light of all of this, was it a realistic expectation for Linda to think that Tom would give her an engagement ring when there was still this big issue between them about Linda's jealousy and resentment towards his children?

Most people would say "No, it wasn't realistic" but, like many people, Linda was very focused on what she wanted and felt she needed. She was very much in denial. At first, she was unable to see that her expectations were not reasonable, given the circumstances. She knew what she wanted, she wanted it, and she wouldn't let go of it.

After that Valentine's Day incident, Tom told Linda that he thought they needed to take a break for a while so they could both think about what they wanted. He hoped that, during that time, Linda would change her feelings towards his children so they could resume their relationship and Tom wouldn't feel like he was caught in a triangle between Linda and his children.

After a lot of work in therapy on family of origin issues, Linda realized that her feelings had nothing to do with Tom's children. But they had everything to do with her feelings of being neglected in her own family when she was a child. Over time, she realized that when she saw how loving Tom was with his children, it triggered feelings in her of loss and emotional deprivation for what she didn't get as a child. Also, to a certain extent, Linda felt her own need to have children more acutely whenever Tom's children were around. It made her feel jealous that he had this experience with his first wife before he met Linda. Eventually, Linda was able to work through these issues in her psychotherapy sessions. And, after attending couples counseling, Linda and Tom were able to get back together. Linda was also able to appreciate Tom's children for themselves, without feelings of resentment or jealousy. And a year or so later, they got married.

Unrealistic expectations in relationships can occur at any time, not just on Valentine's Day or other special occasions. However, the build up and the pressure of certain occasions, like Valentine's Day, often exacerbate these expectations. It's also easy to compare ourselves to others, especially if we imagine that they're getting what we want for ourselves, even if these thoughts are really our own fantasies about what other people have in their relationships and might not be accurate.

More than big gifts or grand gestures, the important elements in a successful relationship, whether it's Valentine's Day or not, are:
  • being loving and kind to each other
  • being friends
  • making a commitment to the relationship
  • being dependable and trustworthy
  • being responsible to each other
  • being respectful and treating each other well
  • having similar values
  • being willing to compromise
  • having realistic expectations of your partner and your relationship

If you feel that you're struggling with relationship issues, you might benefit from seeing a licensed psychotherapist for individual therapy or a couples counselor or marriage counselor for couples counseling.

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

I work with individuals and couples to help them 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.












Friday, February 12, 2010

Psychotherapy: Developing Self Awareness and Making Personal Changes

At certain points in our lives, we might become aware that we're either not satisfied with our lives and that we want to make changes. At those points, we might not even be able to identify what's wrong or what changes we want to make, but we may have a vague sense that we're either not happy or we feel out of sinc with our environment. 

Developing Self Awareness and Making Personal Changes
This may be the start of a rudimentary sense of self awareness or it might be longstanding feelings that "something isn't right." Even if we're not aware of what is going on with us, other people who are close to us might see it better than we can. One of the benefits of psychotherapy is that it can help us to develop self awareness so that we can start to identify what's not working in our lives and we can begin the process of change.

What Do We Mean By "Awareness" and "Self Awareness"?
A few weeks ago, as I was walking home from yoga class, I walked along a block of beautiful, turn- of-the-century limestone buildings. Now, the reality is that I've walked by these same limestone residential buildings countless times before. On this particular day, instead of rushing by as I usually do, I had a little extra time so I was strolling more leisurely. It was also a lovely, sunny day and I was very relaxed from yoga class and feeling more connected to my environment.

So, as I passed these buildings, I suddenly noticed something that I've never noticed before: Each of these two-story residential buildings has a large beautiful image of a young, serene-looking woman just above the entrance way. I was so surprised to notice this, after all these years, that I stopped to admire the artistry and the detail of these images. The images were very pleasing to the eye and, combined with the serenity I felt from my yoga class, I felt a sense of attunement with my environment and more connected to my own internal response to such beauty.

Developing Self Awareness and Making Personal Changes

Then I thought to myself: How odd that I've passed these buildings so many times before and I've never noticed these images which have been around since the late 1800s. This experience made me think about issues of awareness and self awareness in general. Since that day, I now notice these beautiful images all the time, and I have the same sense of appreciation and well-being whenever I see them.

Developing self awareness is an ongoing process. Self awareness is not a state where we feel that we have "arrived." My example above is a simple illustration. But awareness and self awareness, like many things, are on a spectrum. At the other end of the spectrum, where there is more of a lack of awareness and self awareness, there can be delusion.

What Do We Mean By Ordinary "Delusions" and "Self Delusion"?
For most people, when they hear the word "delusion," they usually think about a form of psychotic delusion: the person who thinks they're Jesus Christ or the person who thinks that the FBI has installed cameras in their house to watch them. But ordinary, every day delusion is not psychotic. It's much more subtle than that. For each person, it starts in a different way but, often, self delusion becomes a habitual form of denial. Over time, self delusion can become a serious emotional problem as we go through life not realizing that we've placed blinders on ourselves--about ourselves, the people in our lives and, possibly, the world around us.

The following vignette, which is a composite of several people with all identifying information changed to protect confidentiality, may help to illustrate the detrimental impact of ordinary delusion and self delusion:

Helen:

When Helen came for a psychotherapy consultation, she came at the urging of her best friend who was worried about her. Helen did not seem concerned about her friend's worry and brushed it off as well-meaning but misguided. She wasn't sure what her friend was concerned about--maybe her friend noticed that she was under more stress than usual at work. Helen also lacked any real curiosity about her friend's concerns. Helen had never been in therapy before, she was curious about psychotherapy on an intellectual level, and she decided to give it a try.

From Helen's perspective, she felt she was under a lot of stress at work--all she really needed was a vacation so she could relax and she was sure that she'd be fine after that. She described a wonderful, "perfect" childhood. She also talked about her husband and her marriage in glowing terms. Other than some recent stress at work, she felt her life was "perfect" and, it seemed, her attendance at the consultation with me was perfunctory. She felt that, at worse, she would be wasting her time and money and, at best, she might learn some stress management techniques to deal with recent work stressors.

Although she expressed her overall happiness and contentment with her life, Helen seemed somewhat disconnected from her feelings, and she had a somewhat rigid and stiff demeanor. Of course, it's not unusual for people to feel anxious during an initial psychotherapy consultation with a therapist that they don't know. So, we agreed to meet for several psychotherapy sessions to continue the dialogue and see what might develop. I was open to Helen's assertion that she was basically fine and, at the same time, I was also curious to see how the therapy would unfold.

Over the next few weeks, Helen continued to come to her sessions saying that her personal life was "perfect." We talked about stress management techniques, which she began to use. And she continued to tell me that she didn't think she needed to be in therapy. However, increasingly, I noticed that Helen's words, her tone, her emotions, and her body language didn't match. While she was saying that her personal life was "perfect" and that she was really very happy, she came across as being unhappy and anxious. When I gently pointed this out to her, she brushed it off, once again, attributing it to her need for a vacation.

When Helen came to her sessions, it was obvious that she was very meticulous about how she dressed. Her outfits were always appeared expensive, of good quality, and always completely coordinated. It was obvious that she spent time and effort wanting to look put together and, from outward appearances, she did look very well put together.

About a month later, which was a week before what was supposed to be our last session, she and her husband went on vacation. Prior to going on vacation, Helen was anticipating coming back feeling relaxed and refreshed. During our last session prior to her vacation, Helen told me that she was using the stress management techniques that we had discussed. She said she felt sure that she was just fine and after the next session, she would not continue in therapy.

The following week, when Helen arrived for her post-vacation therapy session on what was supposed to be her last session with me, I hardly recognized her. Not only was she not meticulously dressed or relaxed and refreshed--she looked almost disheveled. It was also obvious that she had been crying. It took a while before she could gather herself to begin to talk, but when she did, the words pored out of her.

Apparently, during their vacation together, Helen's husband told her that he wanted a divorce. He revealed that he had been having an affair for several years and he realized that he wanted to be with the other woman. He told her that he would leave her well provided for and she would have nothing to worry about financially, but he wanted to move out as soon as they returned from vacation. He was very apologetic, but he had made up his mind, and he saw no reason to delay what he saw as the inevitable.

Helen talked about feeling like she had been beaten up by her husband's words. His words and the reality of their situation crashed through her sense of reality like a ton of bricks. As soon as they returned, he moved out to be with his girlfriend, and Helen felt more alone than she had ever felt in her life. She was unable to eat, she couldn't sleep, she cried most of the day, and she was unable to return to work. She talked about pacing around her large apartment, where she and her husband had lived together for 10 years, and feeling estranged from everything around her.

Developing Self Awareness and Making Personal Changes: Trying to Piece Together What's Happening
To make matters worse, when Helen confided in her best friend (the one who recommended that Helen come to therapy), she found out that her friend had seen Helen's husband with the other woman and suspected that he was having an affair. It seems that Helen's husband had been to local restaurants and he was openly affectionate with this other woman and not at all discreet about the affair. So, on top of her feelings of betrayal about the infidelity, she also felt betrayed by her best friend for not telling her about the affair. Helen also realized that many of her other friends and neighbors probably knew about the affair long before Helen knew what was going on. Her sense of humiliation was profound.

Over time, as Helen continued to come to her therapy sessions and piece together what had happened, she began to see that there had been telltale signs of the infidelity all along that she refused to see. She also realized, when she thought about it, that her friend had tried to tell Helen about it several times, but Helen was so emotionally invested in believing that her life was happy, well ordered, and "perfect" that she refused to hear her friend. She kept her emotional blinders on. The Helen that came to these therapy sessions was angry, sad, hurt, and resentful, a far cry from the person who had been coming to therapy prior to this but, at the same time, she was much more emotionally authentic.

After her initial shock about her husband's affair, Helen realized that she had been deluding herself in many areas of her life, including her childhood and her history with her family. It took this emotional crisis in her marriage to open her to the many lies that she had been telling herself, aided and abetted by her parents, who wanted to preserve an image of the "perfect" family. Helen realized, for the first time in her life, that her father was an alcoholic and her mother was depressed and withdrawn when Helen was growing up. When she finally allowed herself to see the truth about her childhood, she wondered how she had not seen these things before.

As Helen continued to come for her therapy sessions, she realized that, as a child, she had entered into this fantasy world where everything was "perfect" as a way to protect herself from an emotional reality that would have been too overwhelming at the time. Rather than blame herself from these fantasies, she learned to develop compassion for herself. In her childhood fantasy world, she and her family were happy and loving, and no one had any problems. This fantasy was reinforced by her family who presented a happy front to the world around them. And, without realizing it, Helen continued to engage in this fantasy of perfection as an adult in her marriage. So, what started out as an emotional defense to ward off overwhelming feelings as a child became a habitual form of delusion that she continued to live by.

Although it was painful to come to terms with her self delusion, Helen talked about feeling emotionally authentic for the first time in her life. Her words, emotions and overall demeanor were more congruent. Gradually, as she learned in therapy to use her new, fledgling sense of self awareness to change her way of being, she realized the countless times during the day when she was tempted to lie to herself and to close friends about how she felt or about her life.

Rather than deluding herself when she felt uncomfortable about some aspect of herself or in her environment, she learned to stay emotionally attuned and true to her reality. Gradually, she learned to feel more comfortable in her own skin, even when she felt sad, and that she preferred to feel her feelings rather than mask them with self deception. After a while, Helen also realized that her delusions kept her from hearing her best friend's warnings. As a result, Helen took responsibility for the breach in her relationship with her best friend and reconciled that relationship.

Developing Self Awareness, Making Personal Changes and Feeling More Authentic

Helen realized that, even after she left therapy, there would be many times when she might be tempted to revert back to deluding herself because this emotional pattern was so strong and ingrained in her. She knew she would have to continue to work on her own with the skills that she developed in psychotherapy to continue to be authentic with herself and with those who were close to her. And even though it was challenging, she preferred to have a genuine sense of emotional authenticity, regardless of whether she felt happy or sad, than to remain in denial and in fantasies about life being "perfect."

Self Delusion is Common:
Self delusion often starts as a way to protect ourselves from unconscious feelings that we fear will be too hurtful and overwhelming. There are many ways to develop a better sense of self awareness and emotional authenticity. Meditation and yoga practices are often helpful tools to develop increased self awareness.

Psychotherapy with a licensed therapist can also help you to see where you might be holding onto delusions about yourself or your relationships. Psychotherapy can also help you to work towards changing your life to be more emotionally authentic.

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

To find our 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