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Wednesday, January 29, 2014

Enhancing Solutions to Your Problems With Clinical Hypnosis

When people come to therapy to work out emotional problems that they've been struggling with on their own, in many cases, they don't realize that they actually have the solutions to their problems within themselves.  Clinical hypnosis, also known as hypnotherapy, gives therapy clients an opportunity to access and enhance these solutions.

With the help of an experienced hypnotherapist, who knows how to help therapy clients to gain access to internal solutions to their problems, clients often gain access to internal resources that they have either forgotten about or never realized that they had.

While this might not work for every client and for every problem that clients bring to therapy, it works more often than most people realize.

As an example of how clinical hypnosis can be helpful in this way, the following composite vignette, which has all identifying information changed to protect confidentiality, illustrates this point:

Ed:
Ed, who is a writer, came to therapy because he had "writer's block."  He had already received an advance for his book and he was worried that he wouldn't meet the deadline that he and his publisher had originally agreed upon.

Accessing and Enhancing the Solutions With Clinical Hypnosis: Writer's Block 
The more Ed worried about meeting the deadline, the more "blocked" he felt in his writing.  He described spending hours staring at his computer trying to will himself to begin writing.  But he felt like he had nothing worthwhile to say, even though he was considered an expert in his field.

At those times, Ed described "feeling like a fraud" who had duped other people into believing that he knew what he was talking about.  During those times, he was in constant fear that people would find out that he really wasn't who they thought he was, and then his career would be over.

He described feeling an "old tape" play over and over again in his mind which sounded like his  father's voice saying, "Who do you think you are acting so important!?! No one wants to hear what you have to say."

Even though he had never experienced hypnosis before in his life, Ed agreed to give it a try.  Before we began, I explained, as I often do when a client has never experienced hypnosis, that Ed would be in control of his experience the entire time, so that he could stop at any time.  I also explained to him that he would be in a relaxed state where he would maintain a dual awareness of the here-and-now as well as whatever came up during the hypnosis session.

Since Ed was an experienced writer, this wasn't the first time that he was drawing a blank when he sat down to write.  It had happened to him many times before when he was trying to write magazine articles.  But Ed felt that this was different because his assignment involved writing a book and this seemed like a much more daunting process.

Prior to beginning hypnosis, I asked Ed what he had done in the past that helped him when he felt blocked while writing a magazine article, but Ed didn't think he had done anything special to overcome his other experiences with "writer's block."

But when he was in a relaxed hypnotic state, Ed remembered that during those other times, he was, in fact, active in overcoming his block and he remembered what he did:  Instead of conjuring up his critical father, like he was doing for his book assignment, he thought about his college professor from his writing class, who praised and encouraged Ed's writing.  He lifted Ed's spirit and helped him to believe that he had it in him to become a writer.

During hypnosis, Ed remembered how proud he felt when he could say, "I'm a writer" and feel good about it.  He attributed this new found self confidence at the start of his writing career to the encouragement from his professor, who became his writing coach and mentor.

Although his mentor wasn't around any more, Ed could still re-experience the joy he felt during the hypnosis session that someone as esteemed as his mentor had confidence in him.

Accessing and Enhancing the Solutions With Clinical Hypnosis

Using hypnosis, I helped Ed to amplify and deepen this experience with a post hypnotic suggestion so that he could access this empowering experience whenever he needed it.  After several sessions, Ed was writing again and his ideas were flowing.  He was able to look at the book as a series of chapters, similar to the magazine articles that he wrote, instead of becoming overwhelmed that it was a book.

At that point, Ed could have left therapy because his presenting problem was resolved, but he was fascinated by the hypnotherapy process and he decided to remain to work through the trauma of having a hypercritical father.

Accessing and Enhancing the Solution With Clinical Hypnosis
The reason why Ed and other therapy clients are able to access and enhance internal resources using clinical hypnosis is that hypnosis allows them to enter into a receptive state where they are more open to discovering internal solutions.

In the particular example that I gave about Ed, there was a direct relationship between what he did in the past to overcome "writer's block" to what he could do now to overcome the same problem.  But it's often the case that therapy clients discover in hypnosis that they can use internal resources that they used for completely different problems to overcome a current problem.

For example, a woman who showed courage in the past by confronting a bully at her high school was able to access the same courage, which was already a part of her, to ask her boss for a raise.

In a hypnosis session, she was able to access that same courageous self state that wasn't accessible to her during ordinary consciousness.  She could feel it on an emotional and physical level and, with hypnosis, we were able to deepen and amplify the connection that she felt to this self state so that she could use it in her current situation.

The Importance of the Client-Hypnotherapist Rapport
Just like any other type of therapy, clinical hypnosis works best when there is a good rapport between the client and the hypnotherapist.  This usually doesn't happen the first time that they meet in the therapist's office.  It takes time to build a rapport of trust and safety.

Getting Help
If you feel stuck with a problem that you've tried, without success, to work out on your own, you could benefit from seeing an experienced hypnotherapist.  During the initial sessions, the hypnotherapist would gather information about the presenting problem as well as your personal history and determine whether you can be helped by clinical hypnosis.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.  I have helped many clients to overcome the obstacles that  kept them from living a fulfilling life.

I also work adjunctively with clients who have primary therapists who are not hypnotherapists.

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

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



















Monday, January 27, 2014

Looking at Your Childhood Trauma History From an Adult Perspective

As a psychotherapist in NYC, one of my specialties is working with adults who are experiencing psychological trauma.  For many clients, their history of trauma stems from psychologically overwhelming events that occurred when they were children.  While working through childhood-related psychological trauma isn't easy, many therapy clients are grateful to discover that they often develop a more nuanced view of their childhood trauma that gives them a broader perspective.

Looking at Your Childhood Trauma History From an Adult Perspective

Becoming an adult provides an opportunity to develop a greater emotional capacity to deal with adversity, including a history of emotional trauma.

Life experience and the awareness that you have overcome challenges in your life in the past often increases your confidence that you can overcome current and future challenges.

You might also have a more mature and nuanced perspective about your childhood trauma now as compared to when you were going through it as a child.  For some people, this perspective is mostly an intellectual as opposed to a more integrated emotional understanding.

Sometimes, people don't develop this more nuanced perspective about their  childhood trauma history until they start processing their emotional trauma in trauma therapy.  When this happens, in some cases, certain aspects of their history can be quite surprising in a positive way.

Some clients discover that they're able to recapture positive aspects of their childhood that they had originally thought were "all negative."  When this happens, it's often an opportunity to have a more balanced view of a childhood history that, initially, seemed "all bad" to the client.

The following composite vignette, with all identifying information changed, illustrates this point:

Ann
Ann, who was in her late 20s, came to therapy because she had difficulty in her romantic relationships with men.

Ann had been in psychotherapy before, and she had some insight that her feelings about her father  had an negative impact on her ability to be in a relationship with a man, but knowing this was of little help to her when she started a new relationship.

Looking at Your Childhood Trauma History From an Adult Perspective

She felt a sense of despair that "men are no good" and she would never find anyone with whom she would have a lasting relationship.

On an intellectual level, Ann knew that there had to be men who were loving, kind and emotionally attentive.  But, deep down on an emotional level, she didn't feel it.

Initially, Ann told me that her father never loved her.  As we talked about her relationship with her father, Ann described him as "irresponsible" and "selfish" for leaving her and her mother when she was five.  From her perspective,  he only made "obligatory visits" and she didn't know why he even bothered since she was sure that he didn't love her.

At first, Ann said that she no longer felt hurt about her history with her father, but the painful look on her face told a different story.

She said she had talked about this in her prior therapy and she felt that "it is what it is" and there was nothing more she could do to change it.  She told me that she accepted her history, and she felt that she had "moved on" with her life.

And yet, she said, she just couldn't understand why it was still affecting her now in her relationships with men.

Ann agreed to explore her childhood history with her father with EMDR and, after preparing to do EMDR, Ann chose a childhood memory about her father that stood out in her mind.

The memory was of Ann, at age six, sobbing as her visit with her father was about to end because he had to leave.

Initially, she couldn't remember the context of this particular memory, but she had a sense that she often sobbed when her father was about to leave and she would beg him not to go.

At first, Ann said that, although she remembered this memory, which could have represented many similar memories, she didn't have any particular feelings about it now.

But when I asked her to sense into her body as she thought about this memory, she was surprised to realize that her face and stomach muscles were tight, her fists were clinched and her heart was pounding.

Since she had never had the experience of sensing into her body to become aware of emotions, she was surprised, so I normalized Ann's response and provided her with psychoeducation about the mind-body connection and how we often hold emotions, including emotions from past trauma, in our bodies.

Based on her physical reaction to remembering this memory, she realized that this memory was affecting her more than she would have thought.  But she still couldn't identify the emotions that she felt related to the memory.

So, we continued to process the memory with EMDR and, as we continued to work on the memory, she discovered, based on her physical reaction, that she was a lot more angry about the memory than she realized and she was holding a lot of this anger in her face, stomach muscles, her hands, and in her chest.

Over time, as we used EMDR in our therapy sessions and she focused on the emotions that she felt in her body, Ann was also surprised to discover that she still had a lot of sadness about this memory that she had not been in touch with before we started doing EMDR and before she became more attuned to what was going on in her body on an emotional level.

Ann had cut off her relationship with her father when she was 17.  And, during the first few months of EMDR therapy, Ann continued to berate her father as being "all bad" and praise her mother as being "all good."

She saw her mother as being the nurturing one who sacrificed her life to take care of Ann after the father abandoned them.

Although she wanted to be in a happy, loving relationship with a man, she just didn't see how this was going to happen since every man that she had ever dated turned out to be a disappointment.  She felt that if she had another disappointing romantic relationship, she just might not be willing to try again with someone new.

Over time, as often happens in EMDR, Ann's memory networks began to open up to other memories about her father.

One day, during an EMDR session, she was shocked to remember that she and her father used to spend time during some of his visits making brownies and how much she loved making brownies with her father.

Remembering these happy memories about baking brownies with her father brought up a mixture of happiness and sadness at the same time.  She was surprised and happy to feel how delighted she had been as a child to have these experiences with her father, but she was also sad to remember how disappointed she felt when those visits ended because her father had to leave.

As other happy memories emerged over time during our EMDR work together, Ann came to realize, much to her surprise, that all of her memories about her father weren't all bad.  And, in fact, she had many happy memories, and her sadness about feeling abandoned by him had overridden these memories in an "all or nothing" way.

Ann described her experience of remembering these happy memories as if she was going back to see herself and her father when she was a child.  And, as an adult, she could see and feel things that she didn't remember before.

Gradually, as Ann continued to process childhood memories related to her feeling abandoned by father, she developed a more nuanced perspective about her history that she didn't have before.

This motivated Ann, who felt no curiosity prior to this, to find out why her father left when she was a child.  She started by asking her mother, who never talked about the separation before.

As she expected, her mother was reluctant and uncomfortable at first, but Ann persuaded her mother that it had become important to her to know what happened back then.

So, reluctantly, her mother told her that she was the one who asked Ann's father to leave the household because she had fallen in love with another man.  She told Ann that her father didn't want to leave, but he acquiesced to her wishes.  She said that the relationship with the other man didn't work out, and she realized that she had made a mistake in ending her relationship with Ann's father but, by then, it was too late because Ann's father was too hurt and he didn't want to get back together again.

Ann's mother told Ann over and over again that her father's departure had nothing to do with Ann, he didn't want to leave, and that Ann's father had always loved Ann.

Then, her mother apologized to Ann because she knew that Ann was deeply hurt by this separation.  She apologized because she knew that Ann blamed her father and this led to Ann cutting off her relationship with her father.  She said she just couldn't bring herself to tell Ann before this.

Although she looked ashamed to admit these things to Ann, she also looked somewhat relieved that Ann knew the truth now.

Ann was so shocked by this turn of events that she needed time in therapy to absorb what her mother told her.  Ann had always assumed that her father left the household because he didn't care about her and her mother any more.  To hear her mother say that she was the one who asked her father to leave was totally unexpected.

Hearing her mother reveal the truth also made Ann realize that she had been going along all this time with a limited understanding about what happened--even as an adult.

Over time, she was able to forgive her mother.  And, with much fear of being rejected, she contacted her father.  Much to her surprise, he responded with delight and they reconnected for the first time in more than 10 years.

The first time that they met for coffee was awkward, but subsequent visits became easier.  During one of their visits, her father brought pictures of Ann as a child that he held onto and cherished, which was deeply moving to Ann.

Looking at Your Childhood Trauma History From an Adult Perspective: Ann Reconnected With Her Father

After a while, they were able to talk about what happened when Ann As a child.  And, as Ann let go of her resentment and anger, she developed a sense of compassion for each of her parents.

Ann also developed a broader perspective than she ever had before.   She came to recognize and accept that her parents were human and had certain flaws, like many other adults in similar situations.

As Ann worked through her childhood history, which had been getting emotionally triggered in her romantic relationships, she made better choices when she began dating men again.  Her perspective about men changed.  And, after she opened up more emotionally, she eventually met someone that she cared about deeply and who cared about her.

Developing an Adult Perspective About Childhood Trauma
Childhood psychological trauma often keeps people stuck on many levels. The most obvious level where people get stuck is on an emotional level.

When you try to work out childhood psychological trauma on your own, it's usually hard to see that your perspective could be stuck at a child-like level.

It's normal, on a developmental level, for young children to have an "all or nothing," "good or bad" or "black and white" view of things that happen to them.  They don't have the capacity to tolerate ambiguity and to see "grey."

Adults usually have a greater capacity to tolerate ambiguity and develop a more complex perspective.  This capacity is often enhanced in trauma therapy.

Adults, who experienced trauma as children, sometimes have an intellectual understanding that what happened to them was complex, but their intellectual understanding doesn't always develop into an emotional understanding that allows them to make changes.  In other words, they understand it with their head but not with their heart.

The vignette above is only one example of how an adult, who is processing trauma, is able to develop a more complex emotional understanding of childhood trauma.  There are many variations on this theme that I have seen working with clients on their trauma.

And, of course, for some people, depending upon the circumstances, it's not possible or even advisable to have a reconciliation.

Fear of Unmanageable Emotions Coming Up in Trauma Therapy
In order to overcome childhood trauma, a client has to be willing to be open to this exploration in therapy.

People, who have experienced trauma, often avoid going to therapy because they fear that something negative might come up unexpectedly that they're not prepared to handle.

Often, without realizing it, they fear what has already happened.  In other words, they fear that by working on the childhood trauma they will experience the same kind of fear they experienced as children.  They don't know or forget that, as adults, they have a greater capacity to deal with these memories than they did as children.

To help prepare clients in trauma therapy, I place a high degree of importance on the resourcing stage of EMDR which helps clients to develop the coping skills to deal with the emotions that come up when processing trauma.

Getting Help in Therapy From a Trauma Therapist
Getting help for unresolved psychological trauma takes courage.  Often people wait until the emotional pain of their trauma outweighs their fear of getting help.

Getting Help in Therapy From a Trauma Therapist

Rather than waiting for your emotional experiences to get worse, you owe it to yourself to get help from a licensed mental health professional who has expertise in working with trauma so that you can free yourself from a history that has become an obstacle to leading a more fulfilling life.

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

I also work adjunctively with clients who have primary therapists who aren't trauma therapists.  

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.














































Saturday, January 25, 2014

Why Is It That It's Often the Healthiest Person in a Dysfunctional Family Who Goes to Therapy?

It's not unusual for the one person who comes to therapy from a dysfunctional family to get scapegoated by the family into feeling like she or he is the unhealthy one in the family.

Why Is It That It's Often the Healthiest Person in a Dysfunctional Family Who Goes to Therapy?

Often, other family members point to this person as the one who has the most problems because s/he is attending therapy.  But, in fact, the person who goes to therapy from a dysfunctional family is often the healthiest person in the family.

Why Is It That It's Often the Healthiest Person in the Family Who Goes to Therapy?
Let's understand, first, that by saying that it's often the healthiest person in a dysfunctional family that goes to therapy, it's understood that this is a generalization and it's not always true.

But, having said that, it is often the case because the person who recognizes that s/he needs help is, at least, aware that there is a problem that s/he can't overcome alone, and s/he wants help from a licensed mental health professional to make changes.

In an earlier article, I discussed The Role of the Family Scapegoat in Dysfunctional Families, which is an important concept in order to understand why family members often turn on the healthiest person in the family who seeks help in therapy.

When someone, who is part of a dysfunctional family, seeks help from a psychotherapist, the other family members often feel that this person is being disloyal by airing the family's "dirty laundry," and they often feel worry that the therapy will upset the tenuous "equilibrium" that has been established in the family and upset the status quo (see my article:  When Family Loyalty Gets in the Way of Your Psychotherapy Treatment).

I usually find that a composite vignette, helps to clarify the subjects that I discuss in my articles.   As always, this is a composite of many different cases with all identifying information changed to protect confidentiality:

Jane
When Jane was growing up, no one in the family talked about uncomfortable feelings.  They also didn't talk about Jane's older brothers, Bob and John, who were drinking, getting into trouble at school, and getting arrested for disturbing the peace.

Jane's parents blamed their sons' schoolteachers, the principal, their neighbors, and the police, and they refused to acknowledge that their sons had problems.

Despite the trouble that their sons were getting into, they refused to acknowledge that there was anything wrong at home or that they could or should do anything about the problems.

Whenever other family members, like Jane's uncles and aunts, would try to point out to her parents their sons' problems were escalating, the parents made excuses and refused to believe it.

As a result, Jane learned to keep her feelings to herself and she also tended to ignore her brothers' problems, even if one or both of them came to the dinner table drunk.

After Jane's oldest brother, Bob, died in a car accident, her parents and John focused on suing the other driver, who was not hurt, and the police for "not doing their job."

But a toxicology report revealed that Bob, who was not wearing a seat belt, had twice the legal limit of alcohol in his system and he was the one who rammed into the other driver.

Jane's parents' denial was so strong that they refused to believe the toxicology report.  They wanted "someone to pay" for the loss of their son, but they couldn't find an attorney who was willing to take the case, so they gave up in frustration.

At that point, Jane was living on her own.  When she heard about the toxicology report, she had enough physical and psychological distance from her family to begin to realize just how much her parents and brother were in denial.

She also realized that she had been in denial all of her life about the dysfunctional nature of her family.

After Bob died, Jane tried to talk to John about his drinking, but he didn't want to hear it.  He dismissed her concerns and told her he could control his drinking at any time.

Jane's parents also became upset with her when they found out that she was trying to talk to John about his drinking.  They also refused to talk about Bob's death.

This resulted in a big argument between Jane and her parents and, even though she loved them, Jane decided to take a break from her family.

Jane knew she needed this time away from her family to grieve the loss of Bob and to think about what had been going on for her all of these years while she was living at home.

After Jane's best friend recommended that Jane get help, Jane started therapy.

Working in therapy, Jane soon discovered that, even though she was more willing than her parents and brother to deal with her feelings of loss and confusion, she was also fairly shutdown emotionally.
She realized that she had been numbing herself emotionally for years and there were times when she didn't know how she felt.

Working with Jane, I helped her to develop the necessary coping skills to deal with the feelings that she had been blocking for so long.

After we worked on coping strategies, I helped Jane to connect with her dissociated emotions by helping her to pay attention to what was going on in her body.

Gradually, she was able to identify her emotions based on what she was feeling physically in her body.

When Jane decided to reconnect with her family, against her better judgment, she told them over dinner that she was in therapy.  She hoped that they might consider going to therapy too.

John left the table abruptly knocking down his chair as he walked out of the house.  Jane's parents remained silent.

But later on, while Jane was washing the dishes, her father told her that he had always felt that, out of all of his three children, she was the one who was "too sensitive," and she needed to learn to "toughen up."  He also told her that he didn't "believe" in therapy.

When Jane tried to tell him that she thought he was in denial about Bob's and John's problems, her father was outraged and said he couldn't believe she was saying this to him.

Why Is It That It's Often the Healthiest Person in a Dysfunctional Family Who Goes to Therapy?

Jane's mother remained silent for a while.  Then, she told Jane that she knew something was wrong with Jane when Jane tried to tell them that Bob and John had problems.  She told Jane she couldn't understand why Jane would say this, and it indicated to her that Jane was the one who had the most problems in the family.

As she spoke, her mother's voice escalated until she was shouting.  She told Jane that she couldn't believe that Jane was giving money to "some quack" and saying negative things about the family in therapy.

At that point, Jane was angry and humiliated.  Once again, she took a break from her family because she realized how unhealthy it was for her to be around them at this point.

Even though she was in therapy, she was just at the beginning stage of therapy and she didn't feel that she had consolidated the gains she had made so far.  She needed time to work on herself without her family's criticism and distorted views.

During Jane's next session in therapy, she was able to process her emotions about her family's reactions to her being in therapy.  Even though it was painful to feel these feelings, she was still relieved to be able to feel them instead of pushing them down.

Over time, Jane felt more confident in herself and the gains she made in therapy.  Since she still loved her family and she didn't want to remain estranged from them, she worked in therapy on how she could have them in her life while taking care of herself at the same time.

Jane realized that she couldn't change her family and it was useless to try.  All she could really do was to change herself and try to accept them as they were.

At the same time, she didn't want to feel emotionally abused when she went to visit her parents, so when she called them, she set some boundaries with them:  She wouldn't try to convince them to change how they felt, and they would agree not to tell her that she was the one who had the most problems in the family.

Jane's parents and John missed her so they agreed to keep their feelings about Jane's therapy to themselves.  Jane knew there was no perfect solution and she was resigned that this was the best that they could do.  So, when she went for visits to see her parents and her brother, everyone, including Jane, kept to the agreement.

A few years later, Jane got a call from her mother and, in a somewhat awkward tone, her mother revealed that she had recently found out from a friend that she really admired that this friend had been helped in therapy.  She talked about how shocked and dismayed she had been at first to hear that her friend was in therapy.  But, over time, her friend was persuasive in convincing her that she had been helped in therapy.  And, her mother said, she had to admit that she saw positive changes in her friend.

Jane knew that this was her mother's way of apologizing to her, and she felt relieved that her mother was starting to become more open minded.

In the meantime, Jane felt that she benefited from grieving the loss of her brother and regaining a part of herself that she had lost during all of those years that she was pushing down her emotions.

It's Often the Healthiest Person in a Dysfunctional Family Who Goes t Therapy

She realized now that by numbing the uncomfortable feelings, she was also numbing all of her feelings, including any positive feelings.

Having worked through this issue in therapy for herself, she now had access to a range of emotions that she had been denying before, and she felt more alive than she had ever felt.

Focusing on Yourself Rather Than Trying to Change Your Family
It's a common experience that when someone from a dysfunctional family gets help in therapy, s/he wishes that the rest of her family would get help too.

Even though this longing often comes with the best of intentions, it often backfires in families that aren't ready to hear this.

Maintaining the status quo in the family often becomes paramount, even if it means pathologizing the healthiest member of the family.

Their rationale is often:  "If you're going for help, there must be something wrong with you" or that the family member who is going to therapy is being duped in some way by the therapist.

Another accusation that families make is that people who seek help in therapy are "weak" (see my article:  Common Myths About Psychotherapy: You're Weak If You Go to Therapy).

Although some families come around after a while, especially if they discover that someone that they admire outside of the family is attending therapy (as in the vignette above), many family members never change their minds in terms of identifying the person who is getting help as being the emotional "weak link" in the family.

Under those circumstances, usually, the best thing that you can for yourself is to focus on your own psychological development in therapy and not try to change your family.

As an adult, you might also want to consider whether you want to reveal that you're in therapy and, if you do, if you can deal with the potential criticism and hostility that might come from your family.

Only you can decide what's best for you, but many therapy clients learn a sense of self preservation under these circumstances and, in many circumstances, they learn to have a sense of compassion for their family members.

Getting Help
If the vignette about Jane resonates with you, you could benefit from getting help from a licensed mental health professional who has experience dealing with this issue.  Although getting help might bring certain challenges with your family, the benefits, including leading a more fulfilling life, usually outweigh the challenges.

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

I have helped many clients who come from dysfunctional families to lead happier, 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 21, 2014

Untreated Emotional Trauma is a Serious Issue: Part 5: Overcoming an Impasse in Trauma Therapy

Prior to writing this article about overcoming an obstacle in trauma therapy, I wrote Parts 1-4 about untreated emotional trauma, including The Negative Consequences of Untreated Emotional TraumaUnderstanding the Impact of Untreated Emotional TraumaStarting Therapy to Deal With Untreated Emotional Trauma and Starting to Process the Trauma in Therapy.






Untreated Emotional Trauma is a Serious Issue: Overcoming an Obstacle in Treatment

In this article, I'll focus on what happens when there is an impasse in trauma therapy because of a client's blocking belief that becomes obstacle that develops in treatment.

Joe:
Continuing with the same composite vignette about Joe from the prior articles on this topic, at this point in his treatment, Joe reached an impasse where he was unable to go any further with EMDR because he was blocked by a belief left over from childhood that caused him to feel ambivalent about overcoming the traumatic effects of the memory we were working on.

Overcoming Blocking Beliefs Which Become Therapeutic Impasses
Therapeutic impasses are frequent occurrences in therapy--no matter what type of therapy a therapist is using with a client.  When faced with a therapeutic impasse in therapy, the challenge is to find a way to overcome this impasse so the work can continue.

In the composite case that I've been writing about, as I mentioned in my last article, Joe had a blocking belief that, as a child, he had spared his mother a beating at the hands of his father by taking the beating himself.

So, the beating and the emotional impact of that trauma became almost like "a badge of courage" that Joe carried with him and that a part of him felt needed to remain as it was without changing.

As I mentioned in the last article, now that Joe was an adult, he realized that this childhood belief was a distortion, but knowing this on a rational level didn't help him to overcome the effect of this blocking belief.  He remained stuck.

Cognitive interweaves, which are often successful for many EMDR clients in helping them overcome this type of blocking belief didn't help Joe.  So, even though Joe had made a lot of progress in reducing his discomfort with the memory, we couldn't proceed any further with EMDR at that point.  In order to continue with EMDR eventually, we first had to deal with the blocking belief.

Working With a Self State That Carries a Blocking Belief
In order to overcome the blocking belief, I knew that we had to deal with the part of Joe that was still holding onto this belief.  So, I provided Joe with psychoeducation about the concept that we have many different aspects of self that all of us carry inside of us.

This type of work in therapy is often called parts work, ego states work or self state work, and there are many different ways to approach working with the multiplicity of selves that is in each of us.

Just a word to avoid confusion:  When I talk about parts or states of self in this context, I'm not referring to multiple personality disorder.  Rather, I'm referring to what we all experience at various points, which is the different aspects of ourselves that express themselves at different times.

In Joe's case, there were at least two self states that were in conflict:  There was the part of him that came to therapy and wanted to work through his trauma.  And there was also the other part of him, which originated when he was a child, that felt that overcoming this particular traumatic memory would be disloyal to his mother because he would feel that he was letting go of something very important that he did for her--namely, taking the beating from his father and enduring the emotional aftermath of that beating, which he saw as part of protecting his mother.

Overcoming an Obstacle in Trauma Therapy: Helping a Client to Understand About Self States

As human beings, we're complex creatures and, as most of us know, it's often possible to hold onto two opposing feelings at the same time.  And knowing, rationally, that one feeling is distorted often doesn't help to overcome it.  And, unless a person understands that this is a normal part of being human, s/he could feel like it doesn't make sense and s/he is "going crazy."

So, it was important to provide Joe with psychoeducation that having conflicting self states is a common experience, and rather than thinking of the younger self state as being something to be gotten rid of, we needed to do the opposite:  We needed to find out what that self state needed.  Only after we could determine what that self state needed could that self state begin to be integrated and stop creating obstacles.

As I've mentioned another article about self states, it's usually best to think of uncomfortable self states as having a purpose whose intention is benign.  Usually, the purpose is to preserve the self in some way, but this state, despite its good intentions, ends up having a negative impact.

In Joe's case, as he and I continued to work together, we discovered that this earlier self state's purpose was to feel that the beating he endured from his father was not in vain.  Even though he was powerless to stop his father from beating him, the feeling that he was protecting his mother helped to compensate for his feelings of powerlessness for himself.  And, this is what made letting go of this feeling so hard.

Fortunately, Joe was very motivated in therapy and he stuck with the process.

Using clinical hypnosis, I helped Joe to become more in touch with this earlier self state.  As we worked together on this, like most hypnosis clients, Joe maintained a dual awareness of the here-and-now (in the therapy room with me) as well as an awareness of his earlier self state, and he was completely in control of the process, which is very important to clients who have been traumatized.

Very often, by paying attention to an earlier self state and having a "dialogue" with it in terms of its well intended motives and what it needs, the self state ceases to be an obstacle.  And this is what happened with Joe.

After we did the parts work, this self state became a more integrated part of Joe's personality stopped being an obstacle in the work.

Then, over the next few months, we were able to process the traumatic memory we were working on by using EMDR once again, and Joe was able to work through the trauma.

As an aside, it's important to understand that self states are, by no means, always problematic.  There are times when we want to access certain self states that are positive, empowering and help to advance the therapeutic work (see my article: Reclaiming a Lost Part of Yourself).

Getting back to Joe:  After we worked through the traumatic memory, we went back to the other nine traumatic memories that Joe had brought in as part of the EMDR work.  There were a couple of other memories to work through, but most of the memories were cleared by working on the earliest memory that had the most emotional charge to it.

Then, as part of the EMDR work, we worked on the phase of treatment that deals with the Future Self, the way that Joe wanted to be now that he processed the trauma.  Not only did Joe want to feel more empowered in his life in general, but he wanted, specifically, to be more socially adept.  So, we began to work on this.

Gradually, Joe became less fearful of allowing other to get close to him.  Unlike how he interacted with colleagues before he came to therapy, he was able to relax more, interact more comfortably, and accept invitations from colleagues to go out socially when they got together after work, which improved his interpersonal relationships on the job.

Working Through His Emotional Trauma, Joe Was No Longer Affected By His History

Eventually, Joe began dating a woman that he really liked and, after a year, they started living together and talking about getting married.

By working through his childhood trauma in therapy, Joe was no longer at the mercy of his traumatic history.  He was no longer affected by traumatic memories that held him back in his life.

The Mind-Body Connection in Trauma Therapy
The vignette about Joe that I've presented in these articles is an example of just one way of working with psychological trauma, and not all cases work in the same way.

As I've mentioned before in other articles, my experience as a trauma therapist has been that therapies that help clients to make the mind-body connection, whether they are EMDR, Somatic Experiencing, clinical hypnosis or other forms of mind-body oriented therapy, are the most effective in helping clients to overcome therapy.

Getting Help
EMDR, Somatic Experiencing and clinical hypnosis are all mind-body oriented types of therapy that help therapy clients to overcome psychological trauma.

If psychological trauma has become an obstacle in your desire to lead to fulfilling life, you could benefit from getting help from a licensed mental health trauma therapist who can help you to work through the trauma so you can go on to live a happier and more satisfying life.

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

I also work adjunctively with clients who have primary therapists who are not trauma therapists.

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.







Monday, January 20, 2014

Untreated Emotional Trauma is a Serious Issue: Part 4: Starting to Process the Trauma in Therapy

I've written three prior articles on the topic of untreated emotional trauma, including: Part 1:  The Negative Consequences of Untreated Emotional Trauma, Part 2: Understanding the Impact of Untreated Emotional Trauma  and Part 3: Starting Therapy to Deal With Untreated Emotional Trauma.

Untreated Emotional Trauma is a Serious Issue: Starting to Process the Trauma in Therapy

To understand how, as a trauma therapist, I help clients with psychological trauma, in my last article I discussed the resourcing phase of treatment during the initial stage of therapy.  As I mentioned, the purpose of the resourcing phase is to help clients to develop internal resources, also known as coping skills, to deal with the processing phase of psychological trauma.

In this article, I'll continue with the vignette about Joe, who represents a composite of many different clients who have come for trauma therapy, and I'll look more specifically at the initial stage of processing the trauma in treatment.

Joe
Joe made progress during the resourcing phase of trauma therapy to the point where, instead of automatically lapsing into dissociation (i.e., "zoning out" or numbing himself emotionally) whenever he felt emotionally uncomfortable, he was able to tolerate remaining present more often.  There were still times when he dissociated somewhat, but he was somewhat more resilient now as compared to when he first started treatment.

He practiced the Safe Place Meditation that he learned in our prior therapy to help calm and soothe himself.  He also practiced the Square Breathing exercise I taught him to help him relax.  In addition, he mentally rehearsed positive memories from his life and noticed how focusing on these memories often shifted him from a state of anxiety to a more relaxed state.

Beyond Developing Coping Strategies:  Why Process the Trauma?
At this point, many clients often ask why, if they've learned better coping skills, they need to process the trauma.  They want to know:  Isn't it enough to be able to know how to cope when they feel upset?

Usually, what I tell clients is that, even though they've gotten better at dealing with uncomfortable feelings by developing better coping skills, the traumatic memories are still there to be triggered in their current life.

In other words, it's great to be able to calm yourself, learn to relax and shift your emotional state from one of anxiety to a more relaxed state, but you're still vulnerable to getting emotionally triggered whenever what would normal trigger you emotionally in the present.

Getting back to Joe:
Now that Joe had developed better internal resources, we were ready to process his psychological trauma which stemmed from an early childhood history with his father, who was often rageful and drunk.

As part of the earlier psychoeducational phase of our work together, Joe had already begun to develop intellectual insight into the affect that his family history had on him.  Now, it was time to help Joe to understand his trauma in a more integrated way where his understanding wouldn't be just intellectual.

In this phase of treatment, he would develop more of an integrated felt sense for the impact of the trauma and work through the trauma so it would no longer affect him.

Starting to Process Psychological Trauma
I have different ways of treating psychological trauma that are part are considered mind-body oriented psychotherapy, including EMDR, Somatic Experiencing, and clinical hypnosis.

My clinical expertise told me that it would be best in Joe's case to start with EMDR, Eye Movement Desensitization and Reprocessing, which has a structured protocol, developed by Francine Shapiro, Ph.D., in the late 1970s as a treatment specifically for trauma.

EMDR has eight phases of treatment, which you can read about in more detail on the EMDR website. Joe and I had already completed the history taking and resourcing phases of treatment, and we were ready to start the processing.

I asked Joe to bring in 10 memories that related to his traumatic experiences with his father, and after we went over these memories, I asked him which one still had the most emotional charge for him.  Joe responded immediately by choosing a memory from the time he was five years old.

He told me about the memory:  His father became enraged with him after Joe accidentally dropped a crystal vase that had been in his father's family for many years.  Joe's mother had given Joe permission to look at the vase, which his mother had placed on the dinning room table as they waited for guests to arrive for dinner.  She told Joe that he could look at it, but she also told him not to touch it.

Being a curious boy, Joe waited until his parents left the room and then he picked up the vase so he could look at it more closely.  But when his father came into the room and yelled at Joe for touching the vase, Joe got so startled that he dropped it and it shattered beyond repair.

When Joe's mother saw the father running towards Joe to hit him with his belt, she stepped between them and told the father not to hit Joe.

Then, a big argument ensued between between his parents where his father came close to hitting his mother.  But, instead, the father grabbed Joe, dragged him into another room, locked the door so his mother couldn't intervene, and he spanked Joe hard with his belt.

This was Joe's earliest traumatic memory and it also had the most emotional charge for him of the 10 traumatic memories that he brought in.

The importance of choosing an early memory with the most emotional charge is that, by working on this memory with EMDR, the work can have generalizable effects so that, ideally, a trauma therapist doesn't have to work on every traumatic memory.

As we worked on developing the EMDR protocol, which included identifying an image that represented this memory, the emotions that go with this memory, where Joe felt these emotions in his body (an important mind-body aspect of EMDR that helps to make it a more integrative experience), Joe came up with another part of the protocol, which was the negative feeling that he had about himself in relation to this memory (called the Negative Cognition in EMDR) and that was:  "I feel powerless."

Joe realized that feeling powerless was a feeling he carried around with him much of the time without even realizing it.  He also realized that this was how he felt whenever he was in social situations or when he even thought about allowing others to get close to him.  He sensed this not just in an intellectual way--he had a felt sense of it.  In other words, he felt it on a visceral level.

This is an important part of EMDR and other mind-body oriented types of therapy as compared to talk therapy.  Clients often say they have a more visceral sense of their problem when they're being treated with a mind-body oriented therapy, and this gives them a more holistic sense of their problem.

So, when we talked about how he would like to feel about himself when he completed therapy, he said, "I would like feel more empowered in my life."  So, this gave us a goal to work towards in our work together.

As part of the EMDR protocol, the trauma therapist asks the client about their current subjective experience of the memory.  So, I asked Joe how disturbing this memory was for him now on a scale of 0-10, and he said it was a "9," which is very disturbing.

When I'm doing EMDR, I often use a small device called a Tac/Audio Scan that clients hold in their hands.  It provides the bilateral stimulation in EMDR that helps to process the trauma (click this link for more information about the importance of bilateral stimulation in EMDR).

So, Joe held the Tac/Audio Scan tappers in his hands and began by focusing on the image that he had chosen that represented this memory for him, which was the locked door in the room where his father dragged Joe.

An Obstacle in Processing the Trauma
Over the next few months, Joe made progress in processing this traumatic memory.  There were times when he felt the need to imagine an "ally," in addition to having me there with him helping to process the memory.  So, he imagined that his former coach and mentor was sitting next to him and he felt empowered with this imagined presence.

But, after a while, Joe began "looping" in his processing of the memory.  Even though his subjective experience of his disturbance about the memory was now a "5" instead of a "9," he couldn't seem to go beyond this.

Part of the goal of EMDR is to process the memory so it's no longer disturbing to the client, ideally getting to a subjective disturbance that the client feels as being either a 0 or 1 (on a scale of 0-10).

As we talked about what was happening for Joe at this stage of the therapy, he said that he had just realized that part of the memory was that, even though he was terrified of his father and the beating hurt, he was willing to take the beating because he felt that, by enduring the beating, he had spared his mother from getting beaten up by his father.

As an adult, Joe knew objectively that this was probably a distortion in his thinking as a child because there were plenty of times when his father hit his mother.  His father could have hit his mother on that day too if he wanted to but, on that day as a child, Joe felt he made this sacrifice for his mother.  And, now that we were processing the memory, there was a part of him that was ambivalent about letting it go.

He recognized that a part of himself felt this way even though this was probably a rationalization that he created in his own mind as a child to console himself about the beating.

This obstacle in the treatment was another example of how Joe (or anyone of us) can know something on a objective, logical level and yet, what we feel on an emotional level can be very different, and it can become an obstacle in the treatment.

I tried a common method in EMDR called a "Cognitive Interweave" where Joe tried to think of the incident as having occurred to another small boy, instead of to him:  Wouldn't he feel that this person, who is now an adult, deserves to be free of the effect of this traumatic memory?

Joe responded that he would, if it was someone else.  He felt that clearly.  But when he thought of it for himself, he couldn't overcome that part of himself that felt he had taken this beating to spare his mother from being hit by the father.

And if we processed the memory so that it was no longer disturbing, he felt that, on some level, it would take away from what he did for his mother.

Bumps in the road in trauma therapy are very common, and it helps if the trauma therapist has different ways of working to overcome these obstacles.

In a future article, I'll continue this discussion and discuss a particular intervention which is often helpful for overcoming obstacles in trauma therapy.

Getting Help
If a traumatic past is having a negative impact on you now as an adult, help is available to you if you work with a licensed mental health professional who is a trauma therapist.

Processing the trauma will help to free you from history that is creating obstacles in your life now.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.  I have helped many clients to overcome psychological trauma.

I also work adjunctively with clients who are already in therapy with a therapist that they want to remain in therapy with but who might not be trauma therapists.  

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, January 19, 2014

Untreated Emotional Trauma is a Serious Issue: Part 3: Starting Therapy

In two prior articles, I began a discussion about the effects of untreated emotional trauma:  Part 1, Untreated Emotional Trauma is a Serious Issue With Negative Consequences  and Part 2 of this topic, Understanding the Impact of Untreated Emotional Trauma.

In the current article, I'm continuing the discussion about the case I began discussing the last time about Joe, which, as always, is a composite of many different therapy clients to protect confidentiality.

Joe
Joe was considering attending psychotherapy because he was having a hard time allowing people to get close to him.  At that point, he knew that something was wrong because he wanted very much to have close friends and to be in a relationship, but his fear of allowing people to get close to him was the major obstacle for him.

His emotional dilemma was that he felt trapped--his longing for emotional connection and his fear of getting close to others kept him in an internal state of conflict, and he saw no way to overcome this on his own.

Untreated Emotional Trauma is a Serious Issue: Starting Therapy

For years, he had been ambivalent about starting therapy, but when he thought about whether he wanted to be stuck in this emotional dilemma of wanting but fearing closeness, he knew, no matter how fearful he felt about going to therapy, he needed to get help because he didn't want to look back on his life when he was older and regret that he remained fearful, alone and lonely.

His doctor, who had been encouraging Joe to go to therapy for several years, referred Joe to me because he knew that I'm a trauma therapist.

The Initial Stage of the Therapy Consultation
I encouraged Joe to come in for a therapy consultation to see if he felt comfortable enough with me so we could work together.  I also use this first session to get an overview of a client's problems and for the client to ask whatever questions he or she might have about the therapy process, how I work  or about my professional background as a psychotherapist.

Although Joe was anxious, he was comfortable enough to come to weekly sessions.  During the initial sessions, we discussed his his family background, which included a father who had alcohol problems and who was physically abusive.

Psychoeducation About Psychological Trauma
I knew that Joe wasn't making the connection to how his early childhood trauma was affecting him now in his adult life.  Like many people, Joe assumed that, because these problems occurred years before, they weren't connected to his current problems.

So, I started, as I usually do, with providing Joe with psychoeducation about how early trauma can affect people in their adult lives, including the connection to fears about emotional intimacy.

Understanding Psychological Trauma Intellectually vs Overcoming the Trauma
I could tell that Joe understood this intellectually, but it didn't resonate with him emotionally.

I also knew that just talking about his early emotional trauma in therapy wouldn't be enough for Joe to overcome his problems.

In other words, if we only used talk therapy, Joe would make intellectual connections and he would develop insight into his problems, which is important, but his problems probably wouldn't change.

This is the frustrating position that many therapy clients find themselves in when they're in a therapy that uses talk therapy exclusively:  They learn to understand their trauma, but little or nothing changes.

Mind-Body Oriented Psychotherapy
In my professional opinion, Joe needed the type of therapy that would help him to connect his intellectual understanding to a felt sense of his problems.

As a psychotherapist, my experience has been that mind-body oriented therapy works best for most clients who are dealing with psychological trauma.  These types of therapy include EMDR, Somatic Experiencing and clinical hypnosis (also known as hypnotherapy).

Developing Internal Resources
We started, as I usually do, by helping Joe to develop his internal resources, also known as coping strategies or coping skills, to prepare him to start processing the trauma (see my article about Coping Strategies in Mind-Body Oriented Psychotherapy to get an idea of how I help clients develop coping strategies).

Like many people who have been traumatized, Joe relied on dissociation, which is a defense mechanism to "zone out" and numb himself emotionally, whenever he felt uncomfortable.  So, we worked on helping Joe to learn to use positive coping strategies instead of dissociation.

This isn't an all-or-nothing process, but by using the internal resources that he learned in our work together, Joe began to develop enough resilience to begin to tolerate some of his discomfort and enough tolerance to begin working on his emotional trauma.

In my next article, I'll discuss the next phase of therapy, which is processing the trauma.

Getting Help
If you think emotional trauma has been in obstacle to your leading a fulfilling life, you owe it to yourself to get help from a licensed mental health professional who has expertise in working with trauma.

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

One of my specialties is helping clients to overcome psychological trauma.  

In addition to working with clients as a primary therapist, I also do adjunctive trauma therapy for clients who want to remain with their primary therapist, who might not be a trauma therapist.

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.









Friday, January 17, 2014

Untreated Emotional Trauma is a Serious Issue - Part 2: Understanding the Impact of Trauma

In Part 1 of my article,  Untreated Emotional Trauma is a Serious Issue With Negative Consequences, I defined emotional trauma and gave examples of some of  the possible consequences of untreated trauma.  In Part 2 of this article, I discuss the problem of making a connection between the impact of childhood trauma in adult lives.

Untreated Emotional Trauma is a Serious Issue: Understanding the Impact of Trauma

Problems With Understanding the Impact of Untreated Early Emotional Trauma
As I mentioned in my last article, people who have early emotional trauma from childhood, often minimize the impact of the trauma in their adult lives because they feel it happened a long time ago or they don't understand the consequences of the trauma.

People who were traumatized as children often don't make the connection between what's going on in their lives now and what happened to them when they were children.

The following vignette, which, as always, is a composite of many cases with all identifying information changed, illustrates the impact of childhood trauma on an adult:

Joe:
Joe, who was in his early 30s, had no close friends.  There were people that he knew from college and kept up with on Facebook, but he spent most of his free time alone and feeling lonely.

Even though he was lonely and, in many ways, he wanted to have a girlfriend and close friends, Joe had a hard time trusting people enough to allow them to get close to him.  He talked to people at work, mostly because they approached him, but he never accepted their invitations to go out afterwards to socialize because he felt shy and socially awkward.

He spent most weekends either zoning out in front of the TV or playing video games.  Sometimes, he went to visit his mother, who lived a few miles away, but he often regretted these visits because his father was frequently drunk and verbally abusive with Joe and his mother.  His father's behavior reminded Joe of  how terrified he used to be of his father when his father got into one of his frequent drunken rages and would hit him and his mother when Joe was a child.

Even though he knew that, as an adult, he could now physically restrain his father if he had to, Joe still flinched whenever his father went into a drunken tirade and came close to Joe in a menacing way.  When they were alone, his mother would tell him that his father no longer hit her and, in fact, his father wasn't in good health because of his alcoholism.

During those visits, Joe could look at his father and see that he was frail, especially compared to what an imposing and intimidating figure he used to be when Joe was a child and he felt terrified of his father.   But even though he could see this with his own eyes, deep down, he still feared his father, and Joe had a hard time understanding why he continued to feel this way when he knew, logically, that his father was no longer a real threat to him.

Joe also knew that he had a fear of most people, even people that he liked from a distance.  Even though he was lonely and part of him really yearned for an emotional connection with others, a bigger part of him was too afraid to allow anyone to get close to him, and he just couldn't understand why he felt this way.

Over time, Joe's fears got worse.  He tried to understand why he felt this way, even with people that he thought he might like to get to know better.  He didn't understand what stopped him from initiating conversations with people that he liked at work.  He knew that most people in the office seemed to like him.

He knew, logically, that they weren't people who were actually dangerous in any way.  And, yet, whenever he imagined himself taking the initiative to start a conversation with one of them or accepting an invitation to go out with the group after work, he felt frightened.  It just didn't make sense to him and it continued to be an emotional dilemma for Joe.

Joe didn't make the connection between his early childhood trauma of living in a household with a raging and abusive father and his fear of connecting with people as an adult.  But he knew something was wrong, and he began to consider whether he should see a psychotherapist.

In a future blog article, I'll continue this discussion and discuss how getting help from a licensed psychotherapist can make a difference in overcoming emotional trauma.

Getting Help
The impact of untreated trauma can take its toll in many ways, including psychologically, physically and socially.  If you have experienced emotional trauma, you owe it to yourself to get help from a licensed mental health professional to work through the trauma so it no longer affects you and you can lead a more fulfilling life.

About Me:
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.  I have helped many clients to overcome the impact of trauma.

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

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




Saturday, January 11, 2014

Untreated Emotional Trauma is a Serious Issue With Negative Consequences - Part 1

Untreated emotional trauma is a serious issue with negative consequences.  But many people try to minimize the effect of their trauma by trying to "forget it" or "ignore it."  They're often in denial about how their untreated trauma is affecting them now because they don't understand it and they don't recognize the consequences.

Often, their attitude is, "It happened a long time ago, so why should I be concerned about it now?"  In this article, I'll define emotional trauma and some of its symptoms.  In future articles, I'll address why it's important to get help for emotional trauma in psychotherapy with a licensed mental health professional.

Many People Who Were Traumatized Are in Denial About the Impact of the Trauma on Their Lives

What is Emotional Trauma?
There are many experiences that can lead to emotional trauma, including:

  • physical abuse, emotional or sexual abuse
  • witnessing domestic violence as a child
  • living in a family where one or both parents have an alcohol or substance abuse problem or other compulsive or addictive problem, including gambling
  • being removed from a childhood home
  • having a parent or close relative who is incarcerated
  • living in a family with serious financial problems
  • loss of close family members or friends, especially at an early age in childhood
  • medical problems
  • disabilities
  • being bullied
  • experiencing a natural disaster
  • living through a war

Even when many years have passed since the original trauma, untreated trauma can result in people developing the following symptoms:

  • insomnia
  • anxiety
  • depression
  • fear and a sense of foreboding
  • alcohol or drug problems
  • sexual addiction
  • workaholism
  • eating disorders
  • problems with anger management
  • irritability
  • impatience
  • avoiding other people/social isolation
  • feeling unlovable
  • a sense of hopelessness 
  • a sense of helplessness
  • low self esteem
  • being emotionally numb or "shutdown"
  • problems with dissociation or feeling disconnected from other people and the environment
  • medical problems, including autoimmune disorders
  • problems trusting others
  • fear of getting involved in relationships and friendships
  • getting involved in emotionally or physically abuse relationships
  • being too passive
  • being too rigid
  • problems concentrating
  • problems in school
  • problems holding onto a job
  • problems with authority figures
  • legal problems
  • engaging in risky behavior
  • phobias
  • obsessive behavior
  • being overly protective with their children
  • having emotional blind spots for abuse or other problems that might be occurring to their children


The list above is just some of the many problems that can result from untreated emotional trauma.



Untreated Trauma Can Result in Alcoholism or Drug Abuse


Untreated Trauma Can Result in Insomnia



Untreated Trauma Can Result in Workaholism

Very often, the people who experienced trauma at a young age don't make the connection between the early trauma and the problems they're having now.

They don't understand that there's a connection between their current problems and their early trauma.

Many people who have been traumatized just feel resigned to their history, and their attitude is, "That's just the way it was."

Untreated Trauma Often Result in Choosing an Abusive Spouse

Dissociation: Compartmentalization of the Traumatic Experience
Often, when they were growing up, there was no one available to let them know that what they were going through was traumatic.  There was no one to help them, so they did the best they could as children under the circumstances.

Coping with their trauma as children often meant compartmentalizing or dissociating their traumatic experiences.  Their dissociation probably helped them to cope with what was going on at the time because it numbed their emotional pain.  But, even though dissociation might have helped them, to a certain extent, from feeling the full impact of the emotional pain, inevitably, it has consequences for them as adults.

In future articles, I'll continue discussing why it's so important to work through emotional trauma in therapy.

Getting Help
If you experienced emotional trauma, you could benefit from getting help from a licensed mental health professional who has expertise in helping therapy clients to overcome trauma.  Working through trauma in psychotherapy can help you to free yourself from your traumatic history.

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

One of my specialties in my psychotherapy private practice is helping clients to overcome trauma.

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

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
























Workplace: Coping with a Difficult Boss

At some point in your career, unless you're very lucky, you will probably have to deal with a difficult boss. Knowing how to deal with a difficult boss is essential to your well being and the future of your career.

Workplace: Coping With a Difficult Boss

In this post, I'll consider certain types of bosses that most people would describe as "difficult" and provide some suggestions that you might find helpful. Since there are so many different kinds of difficult bosses, I'm sure I won't cover everything, and your comments are valuable so that I can include more information in the future.

Workplace: Coping With a Difficult Boss

It's also important that, since no one can truly understand a situation with a difficult boss unless you're in it, just like anything else, you need to use your judgement about your particular situation as to whether my recommendations would work for you.

Let's start out with certain premises. First, it's important to understand that one person's opinion about a boss might be very different than another's, so that what you might consider to be "difficult" others might find appealing. Second, it's possible, as hard as this might sound, that your difficult boss might actually think that he or she is doing a very good job. Your boss might lack any kind of self awareness about his or her behavior. Also, it's possible that this behavior might actually be encouraged by his superiors. The other factor to consider is whether or not you're contributing to the situation by your own behavior. This is an especially difficult thing to acknowledge. So, you need to look at your own behavior in the situation and be honest with yourself about your role in the situation and how you might need to change yourself in order to change the situation.

What is a Difficult Boss?
As previously stated, one person's idea of a difficult boss might be the ideal for someone else. It can be very subjective. However, here's a few of the most common "difficult boss" categories that I usually hear about in my office. Recognize that, for simplicity's sake, these are stereotypes. People are more complex than stereotypes and, to a certain extent, what you're dealing with might be different or a combination of several "types."

The Micromanager


Dealing with a Difficult Boss:  The Micromanager
The micromanager usually likes to feel in control of the most mundane aspects of a project. Often, he or she is insecure and cannot allow competent staff to carry out their duties without having staff constantly coming back to him or her at every step of the way to get approval. He or she can bog down projects with unnecessary meetings, sign offs, telephone calls, and other time wasters and, generally, annoy the staff with his or her need to oversee every little detail.

The Hands Off manager
The hands off manager is just the opposite of the micromanager. He or she is usually disengaged from the work and the staff. He gives little direction and leaves the staff wondering what he wants with regard to goals and objectives. Sometimes, he might not know or he might think that he is allowing his staff to take charge. However, the effect is often inefficient and ineffective if the staff "guesses" wrong and must waste time and effort redoing a project.

The Fault Finder


Dealing with a Difficult Boss:  The Fault Finder
The fault finder is similar to the micromanager and some people consider this type of manager to be a subset of that category. The fault finding boss is usually very critical and looks for what's wrong most of the time and gives little or no credit for what's right. This type of boss can demoralize the staff quickly. He or she might look for the smallest mistake to point out, possibly overlooking a generally excellent job. This might be because his own level of competency is limited and he cannot judge the project on anything more than the smallest details or it might be his character. Whatever the reason, after a while, the staff will often lose their motivation to do a good job because it is almost never recognized. This, in turn, can make the fault finder even more negative.

The Indecisive Manager
The indecisive manager cannot make up his mind what he wants. As a result, he either gives little or no direction (similar to the hands off manager) or he keeps changing his mind. The indecisive manager is often insecure or he might be inexperienced. Possibly, he was thrown into his position with little or no training and he is not really competent for his job. The result is that he will often frustrate the staff with changes in direction or goals for a project, wasting time and effort.

The Boss who Takes All the Credit


Dealing with a Difficult Boss:  The Boss Who Takes All the Credit
The boss who takes all the credit for your ideas and your work, giving you little or no credit, is often a manipulative and insecure person. If he was not insecure about his own position, he would be generous enough to give you credit. He is often the boss who that will go to his superiors, without your knowledge, and claim responsibiliity for your ideas.

The Bully


Dealing with a Difficult Boss:  The Bully
Bullies are one of the most difficult types of bosses to deal with on the job. Often, they know that they're bullying the staff and either they don't care or they think that this is an effective way to get people to do their jobs or they just don't know any other way. These types of bosses are usually insecure and angry in general. They might not act this way at home with their spouses because their spouses might not put up with it and they might be very accommodating with their own superiors, but when they come to the office, they enjoy having power over their staff. They might yell or scream, demean people in staff meetings or be hyper critical. The bully gets off on power and control. Just like any other bully, like the schoolyard bully, there's often a scared person underneath it all who is hiding his fear by bullying his subordinates around.

Also see article: HR, It's Time to Show Bullies the Exit

The Sexual Harasser
Sexual harassment is a big topic. It can take many forms. It can range from inappropriate comments to be a "quid pro quo" situation where your manager offers you a raise or a promotion if you have sex with him. If you are being sexually harassed by your manager and if you work for a large company, you can speak with your Equal Employment Opportunity Officer to get help. Sexual harassment is against the law and it often does not stop unless you take steps--whatever steps you decide to take. If you're in a small company, you can go to your local, State or Federal EEOC agency to get help. Only you can decide the best course of action for your particular situation, but you should educate yourself as to your options. Go to your local, State or Federal EEOC website to get information. You might decide to leave, if that's an option for you.

I'm sure you can think of other types of difficult bosses.

How to Handle the Difficult Boss
Once again, you know your situation best. Other than the "sexual harasser" and "the bully" who might require you to go above his head or outside your company for help, if you think that your manager doesn't realize the effect he or she is having on you, consider whether this is someone that you can talk to privately to discuss the situation. If you think your manager would be open to it, ask him or her for a convenient time when you can talk privately. I'm stressing "privately" because a public confrontation is usually a bad idea. It might make you feel good at the time, but the repercussions are usually bad. First, your manager will be humiliated and won't hear what you have to say. Second, you'll be seen as someone who doesn't know how to handle difficult situations. Third, you might get fired.

Assuming that your manager is open to it and schedules a time for you, organize your thoughts before the meeting by writing down what you want to discuss. You don't have to discuss every time and every situation. This would probably not be effective. However, a few examples would suffice. Also, rather than just focusing on what's wrong (like the critical boss), try to find some things you think are positive, if you can. In addition, if you have some suggestions as to how the situation might improve, talk about them, once again, if you think your manager would be receptive to it.

If you think that speaking to your manager might make things worse because he or she cannot tolerate hearing any complaints, then you need to decide how to proceed. Is there a Human Resources Department? Do you have confidence in them? Do they have any authority or power to change the situation? Are there other colleagues who are experiencing the same problems with this manager? In certain situations, it might be better to go as a group rather than your going alone. However, in other situations, you might be perceived as "a troublemaker" if it gets out that you're the one who organized people. So, once again, you must use your judgement.

There are some situations with difficult bosses that are not likely to be improved for a variety of reasons. One might be that this is the culture of the particular workplace where you are and these problems go to the top. Another might be that your boss is the head or the owner of the company and he feels that he can do whatever he wants. Another reason might be that talking it out with an insecure or angry boss or with his boss or the Human Resources Dept. could make things worse. Your boss might never trust you again and might try to take steps to get you fired.

It's important for you to be able to "read" the particular situation that you're in and decide if it's worth it to stay or if you should leave. There might be particular reasons why you're staying for a while--maybe you're close to retirement or the job market is not good or you know you'll need to take Family Medical Leave soon and you won't get it immediately at a new company. There can be so many different reasons. That's why it's a very personal and individual decision.

One important factor to consider is how this boss or this job is affecting your self esteem and overall well being. If you feel that working under your particular circumstance is having a detrimental effect on your self worth or affecting your relationships at home because you come home stressed out and upset on most days, then it might be worthwhile to start looking for another job.

Hopefully, your encounters with difficult bosses will be few and far between in a long, successful career. However, if you feel that you are stuck and need support on how to deal with a difficult boss, you might consider going to a licensed mental health professional who is experienced in this area and who can help you to sort out your feelings and options and strategize on what to do.

And if, by chance, you recognize yourself as being a manager in one of the categories discussed in this post and you want to change your behavior for yourself as well as your staff, you can benefit from seeing a licensed mental health professional. More and more, companies are less willing to tolerate managers who have poor interpersonal skills, so you, your company, and your staff could benefit from your getting help.

I am a licensed NYC psychotherapist, hypnotherapist, and EMDR therapist. One of my specialities is helping clients to deal with career and workplace issues.

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.




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