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Monday, January 25, 2016

Psychotherapy Blog: The Connection Between Perfectionism and Core Shame: A Clinical Example

In my last article,  I began a discussion about the relationship between perfectionism and core shame by defining core shame and discussing how it often begins in early childhood.

The Connection Between Perfectionism and Core Shame

In this article, which is Part 2, I've provided a fictionalized scenario to show how core shame develops and how it can be overcome in psychotherapy.

Alan
Alan grew up an only child in a household with his parents.  They lived in his maternal grandmother's house.

His grandmother was a domineering woman.  Even though his parents were in their 30s when they had Alan, his grandmother treated his parents as if they were children.

She had her own apartment in her house, but she spent most of her time in their apartment overseeing their daily routine, criticizing his parents, and overruling almost all of his parents' decisions.

Alan's father, who was frustrated with the grandmother's behavior, would urge his wife to stand up to her mother.  But even though Alan's mother was furious with her mother's behavior, she was too intimidated by the mother to stand up to her.  So, the grandmother continued to rule the roost with an iron hand.

The Connection Between Perfectionism and Core Shame

Alan tried to stay out of his grandmother's way because he was afraid of how critical she was of him.  By the time he went to school, his grandmother was overseeing his schoolwork and criticizing almost everything that he did.

He really tried to be perfect in everything that he did to ward off his grandmother's criticism.  But, no matter how perfect he tried to be, she was still critical.

Alan developed into a shy, withdrawn child.  He got good grades, but he was afraid of raising his hand in class because he feared being wrong.

His teachers called his parents up to school several times over the years to talk to them about Alan's shyness and lack of self confidence.

Although his parents understood why Alan had developed these problems, they both felt powerless to stand up to the grandmother.

When Alan moved away to college and got away from his home, he began to open up more.  He excelled academically and became more social.  But he still carried a sense of core shame within him that he tried to hide from others, and he was still a perfectionist.

By the time he entered into his first serious relationship after college, Alan's core shame became evident to his girlfriend as she got to know him better.  She also worried about all the pressure that Alan put on himself to be perfect and suggested that he seek help with a mental health professional.

When Alan came for his session of therapy, he thought he was supposed to already know why he was having problems.  He felt deeply ashamed that he had not already figured out the source of his problems.

The Connection Between Perfectionism and Core Shame

When his therapist told him that he wasn't expected to know the source of his problems and, in fact, it was her job to help him discover the source of his problems, he was somewhat relieved.

After the therapist heard Alan's family history, she suggested that they use EMDR (Eye Movement Desensitization and Reprocessing) to help him to overcome his shame and the need to be perfect (see my articles:  What is EMDR? and How Does EMDR Work?).

By processing his early childhood traumatic experiences with EMDR, Alan could feel something shifting in him emotionally.

Rather than blame himself for not being perfect and feeling ashamed about this, he had a deep sense that it was his critical and domineering grandmother and his passive parents who had problems when Alan was growing up.

Alan gradually worked on his anger and fear for his grandmother as well as his anger towards his parents with EMDR.

After processing his early childhood memories, Alan's core shame and need to be perfect were alleviated.

Eventually, Alan felt compassion for his grandmother, who was raised by very critical and abusive parents.  He also felt compassionate for his parents, who were too afraid to stand up to the grandmother.

The Connection Between Perfectionism and Core Shame

By the time Alan completed treatment, for the first time in his life he felt free of the core shame and the need to be perfect which had weighed him down since early childhood.

Conclusion
As I mentioned in my prior article, the need to be perfect often comes from a deep sense of core shame that develops in early childhood.

Most people who experience the need to be perfect often don't make the connection between core shame and perfectionism until they come to therapy.

Experiential therapy, like EMDR, is most effective in helping clients to overcome core shame which is at the root of perfectionism (see my article: Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

Getting Help in Therapy
Core shame is often at the root of many presenting problems in therapy.

Since core shame is usually unconscious, it's hard to overcome on your own.

Working with a licensed psychotherapist, who has expertise in helping clients to overcome core shame, you can free yourself from the childhood experiences that are at the root of core shame.

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





























Monday, January 18, 2016

Psychotherapy Blog: The Connection Between Perfectionism and Core Shame

In two prior articles, Perfection vs. Good Enough and Overcoming Perfectionism, I address perfectionism and it's relationship to anxiety.  In this article, I will address the connection between perfectionism and core shame, which develops in early childhood.

The Connection Between Perfectionism and Core Shame

What is Core Shame?
Let's first start by defining core shame.

First, it's important to understand that core shame is different from an appropriate sense of shame, which is adaptive.  An adaptive sense of shame helps children as well as adults learn to behave in ways that are essential to emotional learning.

So, for instance, if a child hits a playmate in anger and he realizes that his action hurt his playmate, he will most likely feel an appropriate sense of shame and remorse about his behavior.  This is part of his emotional learning that his behavior has consequences and the shame is a signal to him that this is not the way to behave.

The shame that he feels is about his behavior and it will help him to learn how to interact with others when he feels angry.  If there are adults to help him, they will teach him that he can do other things that are healthier for himself and other ways to express his anger.

Core shame is a pervasive sense of worthlessness.  There is also usually a fear that others will see that you're worthless and a "fraud" (see my article:  Overcoming Impostor Syndrome).

As opposed to healthy shame, which is about behavior, core shame is feeling ashamed of who you are as a person.

Core shame often results in a strong need to be "perfect," which, of course, is impossible because we're all imperfect as human beings (see my article: Healing Shame in Psychotherapy).

People who feel core shame often feel like they're unlovable and they will be abandoned by others (see my articles: Overcoming the Emotional Pain of Feeling Unlovable and Overcoming Fear of Abandonment).

Feeling unlovable and having a fear of abandonment often result in self perpetuating life events.  So, for instance, people who feel unlovable and who fear abandonment, often shy away from relationships or behave in ways that alienate others.  Often, if they do chose to be in a relationship, they will unconsciously choose romantic partners who are unreliable and who will abandon them.

How Does Core Shame Develop and How Is It Connected to Perfectionism?
As I mentioned earlier, core shame develops at a very early age.

When attachment and bonding go well, babies develop a sense of secure attachment.  But when mothers are unable to provide a secure sense of attachment, usually because they didn't internalize a secure attachment with their mothers, infants will eventually develop insecure attachment which will have repercussions for them as young children and as adults.

The Connection Between Perfectionism and Core Shame

One of the repercussions of insecure attachment is core shame.

Since young children are naturally egocentric, they believe that if their mother is neglectful or abusive towards them, it must be their own fault.  They don't understand that their mother's misattunement is due to the mother's problems.  They're too young to understand that their basic emotional needs aren't being met.  Instead, they believe that, as children, they're unlovable and worthless.

These feelings of being unlovable and worthless develop into an unconscious need to be "perfect."  If this unconscious belief could speak, it would say something like, "I know that I'm unlovable and worthless, but maybe if I'm perfect, people will love me.  So, I must do everything that I can do to be perfect."

This is a very simple explanation to how core shame develops.  A more comprehensive explanation would include the how attachment develops and the various forms of insecure attachment (see my article:  The Impact of the Early Attachment Bond).

In my next article, I'll continue to discuss the relationship between core shame and perfectionism and how these problems can be overcome in psychotherapy:  The Connection Between Perfectionism and Core Shame: A Clinical Example.

Getting Help in Therapy
Core shame and perfectionism are common problems that many people struggle with throughout their lives.

If you're struggling with these issues, you can overcome them in therapy with an experienced psychotherapist who has an expertise in these areas.

Rather than struggling on your own, you can get help from a licensed mental health professional so that 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 people overcome core shame.

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.

Monday, January 11, 2016

Psychotherapy Blog: What is Adjunctive EMDR Therapy?

I've written prior articles about EMDR, including:
What is EMDR?
EMDR Therapy When Talk Therapy Isn't Enough
How Does EMDR Therapy Work?

In this article, I'm focusing on EMDR as an adjunctive therapy.

What is Adjunctive EMDR Therapy?

What is Adjunctive Therapy?
Many clients are seeing psychotherapists who might not do certain types of therapy, like EMDR, Somatic Experiencing or clinical hypnosis.

They will often have a very good therapeutic relationship with their therapist and not want to leave her or him to see a therapist who does another form of therapy.

Usually, they are happy to discover that there is a way for them to remain with their psychotherapist and to see another therapist adjunctively.

This means that their original therapist remains their primary therapist and the adjunctive therapist is the secondary therapist.

As long as the primary therapist is in agreement with this arrangement and, with the client's consent, both therapists can communicate with each other, adjunctive therapy usually works very well.

The adjunctive therapist usually works on a particular issue where she has particular expertise and skill, like psychological trauma, and the primary therapist remains the therapist who continues to see the client as before.

Aside from clients seeking out adjunctive therapy, primary therapists often refer their clients to adjunctive therapists, like EMDR therapists, because they know their clients can benefit from this other form of therapy.

How Does EMDR Work as an Adjunctive Therapy?
In my prior articles, I've written about how EMDR works when it is the primary therapy.

With EMDR as an adjunctive therapy, the client chooses a particular issue that s/he wants to work on with the EMDR therapist, usually involving trauma.

The psychological work can be about developmental trauma, which is psychological trauma that stems from unresolved childhood issues.  It can also be shock trauma (see my article:  ).

It is important that both therapists, the primary therapist and the adjunctive therapist, agree on the treatment plan so they aren't working at cross purposes to each other.

Another important element is that the adjunctive therapist must honor the relationship that the client has with the primary therapist, and it is understood in advance that the adjunctive therapist will not try to see the client exclusively without the primary therapist seeing the client.

The primary therapist must also be respectful of the adjunctive work and if s/he has any hesitation about it, s/he needs to express this to the client beforehand.

The following fictionalized scenario is an example of how adjunctive EMDR therapist can work:

Ted
Ted had been seeing his therapist for regular talk therapy for several years.  Although both he and his therapist felt that he had made some progress with unresolved family of origin issues, they both felt that their work had not helped Ted to resolve certain traumatic events in his childhood history, including a history of emotional abuse with his father.

Ted's therapist knew several colleagues who did the type of trauma work that she didn't do, including colleagues who did EMDR.

Since she wasn't trained in EMDR and she knew that EMDR is usually effective for the type of trauma that remained unresolved for Ted, she recommended that Ted have a consultation with one of her colleagues.

During the consultation, Ted signed a consent form so the EMDR therapist could speak with his primary therapist.

What is Adjunctive EMDR Therapy?

Ted was glad that he could do the trauma work with the adjunctive therapist without having to give up his primary therapist.

As the work progressed in EMDR, Ted felt that he was working through his childhood trauma in ways that he was unable to do with regular talk therapy.

During his sessions with his primary therapist, he talked about the things that came up for him during EMDR therapy.  He also talked about other areas in his life that were not part of his traumatic history.

During his sessions with his EMDR therapist, he and the therapist remained focused on the particular traumatic issues.  She remained available to him if things came up between sessions related to the work that they were doing.  However, he was also grateful to be able to speak with his primary therapist because they had a longstanding relationship with a very good rapport.

What is Adjunctive EMDR Therapy?

After Ted successfully completed EMDR, he remained with his primary therapist.  After several months, they talked about the possibility of ending their sessions since Ted was doing so well.

Conclusion
Clients that have an established relationship with their therapist don't need to choose between leaving their therapist to see an adjunctive therapist.

EMDR therapy, as well as other types of trauma therapy, can be done as a primary therapy or an adjunctive therapy.

Although it would involve an additional expense, clients often find that many different types of adjunctive trauma therapy works faster than regular talk therapy so, in the long run, it can help to shorten therapy and reduce expenses.

Getting Help Therapy
If you are interested in exploring EMDR as an adjunctive therapy, it's best to speak with your therapist (if she or he doesn't do EMDR therapy) to explore this option.

If you're both in agreement about the possibility of exploring EMDR therapy as an adjunctive therapy, the next step would be to find an EMDR therapist in your area and to set up a consultation.

As you would with any psychotherapy consultation, it's important to choose a therapist that you feel comfortable with (see my article:  How to Choose a Psychotherapist).

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

I work with individual adults and couples.

I work with EMDR as a primary therapist as well as an adjunctive 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.





























Monday, January 4, 2016

Psychotherapy Blog: Getting Help in Mother-Daughter Therapy

I've written previous articles about mother-daughter relationships, including: Mother-Daughter Relationships Over the Course of a LifetimeAmbivalence and Codependence in Mother-Daughter Relationships and Mother-Daughter Relationships: Letting Go of Resentment.

Getting Help in Mother-Daughter Therapy

There are times when mothers and adult daughters, who love each other and want to get along, find it too difficult to reconcile their relationship so they come to mother-daughter therapy in an effort to repair their relationship in sessions facilitated by an experienced psychotherapist.

If resentment has been building over time, it can be especially difficult for mothers and daughters to reconcile on their own.

Often, when they try to improve their relationship, they don't get anywhere because each person is entrenched in her own position.  This can lead to even more misunderstandings and hard feelings.

Let's take a look at a fictionalized scenario, which is a composite of many different cases and which illustrates how therapy can be helpful:

Betty and Jane
When Jane was a young child, she and her mother, Betty, were close, especially since Jane was an only child and her father was often away on business.

Their problems started around the time when Jane turned 15.  As a teenager, Jane wanted more autonomy to go out with friends, but Betty preferred that Jane invite her friends over the house rather than going out.  This caused friction between them, and Jane began to rebel by staying out past her curfew.

By the time Jane was in college, she rarely came home to visit her parents.  Jane's father, Bob, accepted that Jane was older now and she wanted her freedom, but Betty felt hurt and angry that Jane only called once every few weeks and only came home on holidays.  This increased the friction between them.

Jane moved back home briefly after she graduated college, but she felt that her mother was trying to control her even though she was now 21 and had already experienced the freedom of being away.  Betty's attitude was, "You're in my house so you need to obey my rules."

There were frequent arguments between Jane and Betty, and as soon as Jane earned enough money to share an apartment with friends, she moved out.

Their relationship continued to be strained throughout Jane's 20s.  Bob tried to be a mediator between them, but nothing he did worked.

After Betty had a health scare, which turned out to be a false alarm, both Betty and Jane regretted the rift between them.  They both wanted to improve their relationship, but they didn't know how to do it.

At that point, Betty's close friend, Pat, told Betty that she and her daughter attended mother-daughter therapy after a rough patch in their relationship and it helped them to reconcile longstanding issues. So, Betty spoke with Jane, who was willing to give it a try, and Betty set up a consultation.

During their therapy sessions together, Betty and Jane learned to listen and empathize with each other.  Betty realized that she was too strict when Jane was growing up and that she could have allowed her more independence as a teenager.  Jane realized that she had been impatient with her mother and, now that she was older, she could appreciate why her mother was so concerned about what could happen if Jane was out with friends.

The therapist gave Jane and Betty exercises to do between sessions where they each took turns expressing their feelings without interruption and then the "listener" had to repeat what she heard.  This involved developing active listening skills where the "listener" focused on what the "speaker" was saying without getting caught up with what she wanted to say to respond.

The "speaker" focused on using "I messages" where she took responsibility for her own feelings and didn't blame the "listener."

Aside from coming to sessions regularly and doing the between session assignments, one of the most important factors was that Jane and Betty were really motivated and, underneath the tension and conflict, they really loved each other and wanted to have a good relationship.

Getting Help in Mother-Daughter Therapy

By the time they completed therapy, they were getting along much better.  Even though they still had occasional arguments, which is common between any two people who are close, they were able to reconcile these arguments quickly without the resentment that they had before.

Conclusion
It's not unusual for mothers and daughters to have problems in their relationship.

Even when mothers and daughters want to reconcile their relationship, it's often hard to do on their own without help.

A licensed psychotherapist, who has experience helping mothers and daughters to overcome their problems, can facilitate this process.

Getting Help in Therapy
If some of the issues in this article resonate with you, you and your mother (or daughter) could benefit from getting help in mother-daughter therapy.

Rather than allowing resentment and bitterness to continue to grow, you can address your problems with a licensed mental health professional who can assist you to have a more fulfilling relationship.

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

I have helped mothers and daughters to work through their problems so that they could develop a healthy relationship.

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.