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Friday, June 15, 2018

Experiential Therapy: Learning to Sense Emotions in Your Body As Part of Trauma Therapy

One aspect of experiential psychotherapy that's different from regular talk therapy is sensing emotions in the body.  Sensing emotions in the body helps to deepen the work, get to unconscious emotions, and keeps the work in therapy from being just intellectual.  But some clients have difficulty sensing their emotions, especially if they have experienced significant trauma.  So, as part of the preparation phase of trauma therapy, the trauma therapist helps the client to learn to sense their emotions (see my article: The Body Offers a Window Into Unconscious Mind and What's the Difference Between "Top-Down" and "Bottom-Up" Approaches to Trauma Therapy?).

Experiential Therapy: Learning to Sense Emotions in Your Body as Part of Trauma Therapy 

Fictional Clinical Vignette: Learning to Sense Emotions the Body:
The following fictional clinical vignette shows how a client in experiential therapy can learn to sense emotions in the body:

After numerous experiences of trying to work through unresolved childhood trauma in regular talk therapy, Ellen decided to try experiential therapy.

Ellen's psychotherapist provided her with psychoeducation about the different types of experiential therapy, including EMDR therapy, Somatic Experiencing and clinical hypnosis, and how each of them used the mind-body connection as part of the healing process.

As part of the preparation phase of trauma therapy, Ellen's therapist asked her to talk about 10 memories where she felt good about herself.  As she thought about it, Ellen had no problem coming up with the 10 memories from all different times in her life where she felt good about herself.  But as she and her psychotherapist went over each memory and her therapist asked her what emotions she felt in her body, Ellen was unable to identify the emotions or where she felt these emotions in her body.

Based on Ellen's traumatic history, as part of her defense mechanisms to protect herself when she was growing up, she learned to numb her emotions.  Unfortunately, as she discovered in her therapy, she not only numbed her anger, fear and sadness, she also numbed her positive emotions.  As a result, she wasn't sure what she felt.

Since experiential psychotherapy is based on being able to identify and experience emotions, Ellen's psychotherapist helped her to begin to sense her emotions in her body by starting with non-threatening situations.

For instance, Ellen had a puppy that she was very attached to from the day that she got him.  Whenever she held her puppy, she could feel how much she loved him and the puppy's unconditional love for her.

Using Ellen's experience with her puppy, Ellen's therapist asked her to close her eyes and imagine that she was holding her puppy.  Then, she asked Ellen to tell her what emotions came up for her and if she was aware of where she felt these emotions in her body.

Ellen had no problem imaging herself holding her puppy and sensing her emotions.  She told her therapist that she felt tremendous love for her puppy, and she felt protective of him.  She could also sense how affectionate her puppy was when he cuddled with her.  When she thought about where she felt her emotions for her puppy, she said she felt them radiating in her chest near her heart.

Over time, as Ellen and her therapist continued to work on other non-threatening experiences where she felt comfortable, she got better at identifying more emotions and sensing where she felt these emotions in her body.

After they had worked on a number of similar experiences, Ellen was ready to work on the 10 positive memories where she felt good about herself as part of the preparation phase of trauma therapy.

But Ellen was concerned that she might be unable to experience the negative emotions associated with her unresolved childhood trauma.  So, her psychotherapist recommended that they start by working on less threatening negative emotions.

She asked Ellen to come up with several memories that were mildly unpleasant.  She suggested that Ellen come up with memories that, on a scale of 0-10 (with 0 being no disturbance and 10 being the most disturbance Ellen could imagine) that were a 3 or 4 on that scale.

In response, Ellen came up with a memory of feeling mildly annoyed when she had to wait on line at the grocery store.  She was able to sense her annoyance and, on a scale of 0-10, she thought that memory was a 3.  Sensing where she felt the annoyance in her body was more difficult.

Her psychotherapist helped Ellen by suggesting that Ellen sense in her body to see where she was holding onto tension.  She also recommended that Ellen first focus on the area between her throat and her gut.  It took Ellen a while before she was able to detect that she felt mild tension in her upper stomach when she thought about that memory.

After they worked on a number of memories that were a 3 or 4, they gradually worked up to memories that were a 5 or a 6 in terms of how disturbing they were.

One such memory was when Ellen and her puppy ran into her neighbor in the elevator, and the neighbor complained that she didn't think the building management should allow dogs in the building because she was allergic to dogs.  Ellen told her therapist that she tried to be pleasant to her neighbor, who was being unpleasant to her, but she felt annoyed with her neighbor.

When Ellen re-experienced that memory and sensed into her body, she felt a constriction in her throat.  She told her therapist that she thought the constriction in her throat was probably related to wanting to argue with her neighbor but holding back.

Gradually, Ellen and her psychotherapist continued to work on increasingly difficult memories to help Ellen to identify and sense the emotions related to these memories in her body.  She was also expanding her window of tolerance for unpleasant emotions.

Experiential Therapy: Learning to Sense Emotions in Your Body As Part of Trauma Therapy

After a while, Ellen felt comfortable enough to be able to handle the difficult emotions that were associated with her unresolved childhood memories, and she and her psychotherapist used EMDR therapy to do trauma therapy (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Experiential psychotherapy involves identifying emotions and sensing where these emotions are in the body.  This deepens the work and keeps the therapy from being just an intellectual exercise.  It also helps to get to underlying emotions.

Many people, who have unresolved trauma, are unable to identify and sense emotions in the body related to traumatic memories.  This is due to the protective nature of the defense mechanisms they used as children, including emotional numbing, which was useful at the time to keep them from being overwhelmed, but isn't useful as an adult.

Usually, the more traumatic the memories are and the more defended these individuals had to be at the time, the more difficult it is to identify emotions and to be aware of the body.

As part of the preparation phase of trauma therapy, a trauma therapist can help clients to begin to identify non-threatening emotions, at first, as they gradually work their way to more challenging emotions.

By being aware of emotions in the body related to traumatic memories, clients in experiential psychotherapy are better equipped to gradually work through these difficult emotions to resolve the trauma.

Getting Help in Therapy
Unresolved traumatic experiences will remain a part of your experience to be triggered at any time.

Getting help from an experienced trauma therapist can free you from your traumatic experiences, so you can live a more fulfilling life (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than suffering on your own, you owe it to yourself to get the help that you need.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome their traumatic experiences.

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, June 11, 2018

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma - Part 2

In my prior article, I began a discussion about the importance of establishing safety for clients in trauma therapy before trauma is processed. One of the requirements that I discussed in the last article for establishing safety is that the client's life must be currently stable.  In other words, s/he is not currently in a crisis or creating new crises.  I'm discussing this topic further in this article.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma

As I discussed in the prior article, clients who are currently in a crisis need help to out of the crisis and keep from creating new crises before they can process traumatic memories.

For instance, if a client has a parent who is in hospice with only a short time to live, the client will need help to get through this crisis and the grief following the parent's death before s/he processes unresolved traumatic memories from childhood.

Likewise, if a client is continuing to create chaos in his or her life, this would need to be addressed and resolved before any processing of traumatic memories from the past can be done.

Fictional Clinical Vignette: Trauma Therapy: Establishing Safety Before Processing Trauma
The following fictional clinical vignette addresses the issue of establishing safety for a client who wants to process traumatic memories but who is still in crisis:

After a tumultuous breakup in what she described as an on-gain/off-again emotionally abusive relationship, Ann, who was in her late 30s, started therapy to deal with the emotional aftermath of the breakup.  She requested EMDR therapy to deal with the trauma of that relationship (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

During the initial consultation, Ann explained to her psychotherapist that she ended the relationship three months ago and, as far as she was concerned, the relationship was really over this time. She was fed up with the name calling and the way he tried to shame her in front of other people a lot of the time.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma
Ann talked about her history of emotionally abusive relationships that began when she was in high school and continued into adulthood.  She explained that, immediately after she ended her last relationship, she began dating someone new.  She said her new boyfriend seemed nice at first, but lately he was verbally abusive with her too.

When her psychotherapist asked Ann to tell her more about the abuse in this new relationship, Ann told her that he wasn't nearly as abusive as her former boyfriends.  She explained that, although she was aware that she was in another abusive relationship, she was worried about getting too old to have children. Since her new boyfriend also wanted to have children, she wanted to try to have a child with this man before she got any older.

She said she feared that if she broke up with him, she might not meet anyone else and she might miss her opportunity to have a baby.  As a result, she would rather put up with his verbal abuse than breakup with him to find someone new (see my articles: Do You Have a Pattern of Creating Chaos in Your Life?How to Stop Creating Chaos in Your Life, and Remaining in Therapy Beyond the Immediate Crisis).

The psychotherapist explained to Ann that they could not begin EMDR therapy to deal with prior trauma because Ann was in another emotionally abusive relationship where she was likely to be traumatized again.  She explained that it was important for Ann to be in a stable situation before they could do EMDR therapy.

Ann said she understood the rationale for not beginning to process a history of trauma while she was in another relationship where she would probably be traumatized again, but she was not ready to give up her current relationship.

She told the psychotherapist that the thought of ending the current relationship and facing the possibility that she might not meet anyone new was too frightening to her. She said she didn't want to wait much longer to have children, and she would rather have a child with her current boyfriend than risk getting too old to have children.

Even though they could not do EMDR therapy due to Ann's current circumstances, the psychotherapist offered to work with Ann with her current relationship and her difficulty with taking care of herself in terms of choosing men who were emotionally abusive (see my article: Are Your Fears of Being Alone Keeping You in an Unhealthy Relationship?).

Since Ann was not interested in this, she decided not to come for any other sessions.  The psychotherapist gave her information about domestic violence. She explained that domestic violence was emotional as well as physical.  She recommended that Ann contact the New York City domestic violence hotline to deal with this issue.

Two years later, Ann contacted the same psychotherapist.  She told the therapist that she never contacted the domestic violence hotline.  Instead, she had a baby with the boyfriend that she was with at the time when she came for the initial consultation, and the abuse escalated from emotional to physical abuse.  She said she ended that relationship several months ago, and she moved back in with her parents, who were helping her to raise the baby.

When Ann returned to see the psychotherapist, she told the therapist that she regretted remaining in the relationship with her baby's father.  She said that, once the stressors involved with raising a baby increased, the baby's father was unable to handle it.  As the stress increased, his abuse escalated from emotional abuse to physical abuse, and she feared for their child's safety.

Ann explained that, after she left the baby's father and filed for child support, the baby's father disappeared and she didn't know where he was.  As a result, she received no child support from him and she couldn't afford to support the baby on her own, which is why she moved back in with her parents, who took care of the baby while she worked.

When she returned to therapy, she was not in a relationship.  She said that, since she had the baby, she was more aware than ever that she made poor choices when it came to relationships, and she didn't want to jeopardize her baby's well-being by getting into another abusive relationship.  As a result, she wasn't dating at the time.

Although Ann was clearly unhappy, she was safe in her parents' home, and she wasn't in a current crisis.  Since she didn't seem likely to get into another abusive relationship at that point in time, her therapist agreed to do EMDR therapy with her, and they began the preparation work to begin processing her history of trauma.

Some clients, who seek help in trauma therapy, are still either in a current crisis or they are creating new crises in their lives--sometimes knowingly, like the example above in the fictional vignette, and sometimes without their awareness.

The fictional example that I gave is just one possible situation where safety and emotional stability must be present first before EMDR or any type of trauma therapy can be done.  In the prior article, I gave other examples.

A trauma therapist can assist a client who is in crisis to overcome the crisis, but she cannot begin to do trauma therapy until the client's life is stable.

Even after the client's life is stable, every client who does EMDR therapy must go through the history taking and preparation phases of EMDR before the client and therapist can begin processing the trauma.

Since EMDR therapy is more experiential than talk therapy, the preparation phase of EMDR therapy helps to ensure that the client has the necessary internal and external resources to deal with the strong emotions that can come up when working on traumatic memories.

Getting Help in Therapy
Too many people who need help in therapy don't come because of they feel ashamed or they're concerned about the possible stigma of being in therapy.  They mistakenly believe that going to therapy means they're "weak" (see my article: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak".

If you've been struggling on your own with an unresolved problem, you owe it to yourself to get the help in therapy that you need (see my article: The Benefits of Psychotherapy).

Once you have worked through your unresolved problems, you can be free from your traumatic history and live a more fulfilling life (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome traumatic experiences.

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.

Thursday, June 7, 2018

Trauma Therapy: Why Establishing Safety For the Client Is So Important Before Processing Trauma - Part 1

As a psychotherapist who specializes in helping clients to overcome traumatic experiences, I see many clients in my private practice in New York City who come for trauma therapy, including EMDR therapy, Somatic Experiencing, and clinical hypnosis.  Early on in the therapy process, I provide clients with psychoeducation about why establishing safety for the client is so important before traumatic memories are  processed in trauma, which is the topic of this article (see my article: Why is Experiential Psychotherapy More Effective Than Talk Therapy Alone to Overcome Trauma? and How EMDR Therapy Works: EMDR and the Brain).

Why Establishing Safety For the Client is So Important Before Processing Trauma

How is "Establishing Safety" Defined in Terms of Trauma Therapy?
Let's start by defining what safety means with regard to trauma therapy.

It's the psychotherapist's responsibility to create a therapeutic environment that helps to establish safety in therapy (see my article about the therapeutic "holding environment" and a more detailed explanation below).  There can be many issues that get in the way of establishing a holding environment, including obstacles in the client's current life and traumatic experiences from the past (see more detailed discussion below).

Safety, which is a relative term that recognizes that there are degrees of feeling safe and the client needs to feel safe enough.  This is an important concept in any type of therapy, but it's especially important in trauma therapy because trauma therapy is experiential and without a sense of safety, the client can be retraumatized (see my article: Developing a Sense of Safety and Trust With Your Psychotherapist).

The following is a list of some of the most relevant issues with regard to establishing safety in trauma therapy with a recognition that, due to the fact this is a blog article and not a journal article or a book, this list might not include all issues:
  • The Client Needs to Feel Relatively Comfortable with the Psychotherapist:  In the most basic terms, the client needs to feel a rapport with the therapist and that there is a therapeutic alliance.  The therapeutic alliance between the client and psychotherapist usually develops over time as the client senses that s/he can trust the therapist.  Many clients get a sense of whether they feel safe with a therapist during an initial consultation, even though the therapeutic alliance hasn't developed yet.  The client often intuits whether s/he will get along with the psychotherapist and that the therapist is someone that s/he can work with on whatever the presenting problem might be.  In that case, there is enough of a sense of comfort to at least set up the next appointment.  Assuming that the therapist has an expertise in the area that the client wants to work on and that she feels she can be helpful to the client, they can proceed from there.  If not, it's important for the client and the psychotherapist to recognize that not every client-therapist dyad is a good match.  Every therapist is not for every client, so it's important to recognize that, regardless of the client's motivation and the therapist's skills, sometimes a particular client-therapist dyad doesn't work (see my article: How a Psychotherapist Creates a Holding Environment in PsychotherapyThe Therapist's Empathic Attunement Can Be Emotionally Reparative to the Client, and What is the Corrective Emotional Experience in Therapy?).
  • The Client is Not Involved in an Ongoing Crisis or Creating New Crises in His or Her Life:  It's not unusual for clients who have a history of unresolved trauma to be involved in an ongoing crisis or creating new crises in his or her life--often without even realizing.  This topic warrants its own article and it will be discussed further in my next article.  At this point, suffice it to say the processing aspect of prior trauma cannot be done when the client is still in crisis and needs help with crisis management .  The need for crisis management must take priority over processing trauma that is based in the past.  Likewise, if the client is creating new crises in his or her life, s/he needs to recognize this dynamic so s/he can change it before any processing of historical trauma can be done.  Once the client is no longer involved with a current crisis and s/he is no longer creating new crises or emotional drama, the psychotherapist can assist the client to prepare for the processing of trauma (see my articles: Do You Have a Pattern of Creating Chaos in Your Life?How to Stop Creating Chaos in Your Life and How a Crisis Can Bring About Positive Change in Your Life).
  • The Client is Not Involved in Excessive Drinking, Drug Abuse, Gambling or Other Compulsive Mood-Altering Behavior:  If a client is engaged in mood altering behavior, whether it involves alcohol, drugs, compulsive gambling, compulsive overspending, sexual addiction or compulsive viewing of pornography, including Internet pornography an eating disorder or other compulsive behavior, s/he isn't ready for processing traumatic memories from the past because s/he hasn't developed the necessary coping skills for trauma therapy.  The psychotherapist would need to assist the client to be stable enough without mood-altering behavior in order to delve into traumatic memories.  If not, the client's mood altering behavior will continue or increase because s/he won't be able to cope with delving into the trauma.  So, the mood-altering behavior must be addressed first, and there would need to be a period of "sobriety" before trauma processing can begin.  Without a period of six months or so of "sobriety," the client is likely to relapse into compulsive behavior.  So, as a first step, this might mean that, if the psychotherapist has a background in helping clients to overcome mood-altering behavior, the therapist will assess the client's true motivation.  Specifically, many clients say they want to stop engaging in mood-altering behavior, but they're not ready.  Since there is always some ambivalence, the therapist can help the client to recognize the ambivalence and, if the client is motivated enough, try to help the client to stop the compulsive behavior or refer the client to a higher level of care, like a detox, rehab or residential treatment.
  • The Trauma Therapist Helps the Client to Prepare For Trauma Processing in Therapy: Unlike regular talk therapy, trauma therapy is experiential, as mentioned above.  Whereas in talk therapy, the client and therapist talk about the trauma, in experiential therapy, they revisit traumatic memories and the experience is more immediate.  In order for the client not to be retraumatized by revisiting traumatic experiences from the past, the therapist needs to help the client to prepare for trauma processing.  The preparation phase, which is also called the resourcing phase, is crucial to trauma therapy and no responsible trauma therapist will proceed without first going through this phase of treatment.  To proceed without the preparation phase would be clinically irresponsible and unethical--no matter how much the client wants to jump right into processing the trauma.  Depending upon the individual client's coping skills, the preparation phase can be as little as a few sessions or, where the client has little in the way of coping skills, the preparation phase can be several months or more.  As a result, the therapist needs to assess the client's coping skills first.  At the very least, the therapist needs to assess if the client is able to maintain dual awareness when discussing the trauma.  In other words, when discussing the trauma, the client remains aware that s/he is in the here-and-now as well as remembering a memory from the past at the same time.  If the client gets so immersed in the memory that s/he forgets where s/he is in the here-and-now, the therapist cannot proceed with trauma processing before helping the client to develop the ability to maintain dual awareness--however long that takes.  An example of a client who cannot maintain dual awareness would be a client who loses all sense of the present moment.  S/he dissociates to such a degree that s/he completely forgets that s/he is in the therapist's office and actually relives the trauma as if it were happening now and not in the past.  This is an example of a retraumatizing experience, as opposed to a healing experience.  Assuming that the client is able to maintain dual awareness, the preparation, at a minimum, would include the client learning ways to de-escalate and cope with uncomfortable emotions during the session and between sessions (see my article: Developing Coping Strategies in Therapy Before Processing TraumaEmpowering Clients in TherapyTrauma Therapy: Using the Container Exercise Between Therapy SessionsTrauma Therapy: Using Grounding Techniques Between Therapy SessionsSafe or Relaxing Place Meditation
  • The Client Keeps Appointments and Comes to Regular Weekly Sessions: Due to the intensity of processing traumatic memories in therapy and the psychotherapist's need to continually assess the client's emotional state during trauma processing, clients must be able to come to weekly sessions.  This is an issue that often comes up during initial consultations when the client raises the issue of coming every other week or monthly or randomly.  Between therapy sessions, traumatic memories continue to be processed on an unconscious level, so the trauma processing continues even when the client is not in session. This often means that new material in the form of new memories or current emotionally triggering experiences can come up between sessions where the client needs the therapist's help.  Even the space of one week can be a long time for certain clients who have problems containing emotions that come up between sessions--even though they have gone through the preparation phase of therapy.  Progress in therapy, especially trauma therapy, isn't linear.  Sometimes, the client feels worse before s/he feels better, so weekly sessions are important for the client to maintain emotional stability.  If money is an issue, the client can inquire as to whether the therapist has a sliding scale or, if not, if the therapist can make a referral to a psychotherapy center where sliding scale therapy is available.
  • The Client is in Control During Trauma Processing:  Even the best psychological assessment cannot always predict when a client might need a break during trauma processing.  This is why it's important for the client to tell the therapist when s/he might need to take a break during the processing of a traumatic memory.  In many cases, a trauma therapist will be able recognize when a client is feeling overwhelmed and help the client to de-escalate before going back into processing the trauma or to debriefing.  But some clients have gotten so good at pretending that they are okay because they feel ashamed of needing help that they override their own internal signals that they need a break from the processing.  They need to learn in therapy how to honor internal signals that they need to de-escalate and feel comfortable enough to tell the therapist.  This doesn't mean that the client will necessarily need to stop when s/he is somewhat uncomfortable if s/he is within his or her window of tolerance.  It also doesn't mean that an inexperienced therapist, who has her own discomfort with seeing clients feeling tolerably uncomfortable, should stop the processing.  If the therapist senses that the client is overriding internal signals to stop, she can ask the client if it's okay to continue processing.  Similarly, clients, who are accustomed to people pleasing, need to learn to overcome their fantasy that they are pleasing the therapist by continuing to process a traumatic memory even though they feel overwhelmed.  Based on the issues that are being presented in this section, it's obvious that the client being in control of trauma processing can be complicated (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Therapy).
  • The Client Uses Coping Skills Between Trauma Therapy Sessions:  It's one thing to learn coping skills and it's another to actually use them between trauma therapy sessions.  Since, as mentioned above, clients continue to process traumatic memories on an unconscious level between sessions, it's not unusual for the client to have thoughts or dreams about traumatic memories between sessions.  Or, the client can get triggered by something in his or her current life between therapy sessions.  This is why the preparation phase of trauma therapy is so crucial.  If, for example, a highly traumatized client doesn't follow the therapist's recommendation to practice de-escalation techniques between sessions in order to stay calm, s/he might discover that s/he is unable to contain his or her experiences between sessions.  For clients who practice coping techniques between sessions, they are usually more likely to either avoid having experiences which are intolerable or mitigate such experiences (see my article: The Benefit of Journal Writing Between Therapy Sessions).
As I mentioned above, establishing safety in trauma therapy (or in any therapy) is a big topic, and a blog article cannot address every possible issue.

How to Start Trauma Therapy
An exploration as to whether you want to begin trauma therapy (or any therapy) and work with a particular therapist begins with an initial consultation in person.  

As mentioned earlier, it's important to your emotional well-being to get a sense as to whether or not you feel comfortable with a particular therapist.  

When clients come to see me for an initial consultation, I tell them that the consultation is for them to provide me with an overview of the problem, ask questions about the process, my skills and experience, to see whether they feel comfortable enough to come back for another session and for me to assess if they appear to be ready to start therapy and if I have the particular expertise that they need.

Obviously, this is a very tall order for one session, and their comfort level and my assessment will continue, and it will be ongoing if they come back for therapy sessions.  As mentioned before, just like any relationship, it takes time for most clients and their therapists to develop a therapeutic alliance--assuming the therapist-client dyad works well enough for the client to want to return beyond the initial consultation.

It's also important to realize that although psychotherapists might approach the initial consultation in different ways, most therapists recognize that being in therapy involves participating in therapy while clients learn how to be clients in therapy at the same time.  In other words, you don't have to know all the answers before you start.  You learn as you go along with the therapist's help.

Choosing a psychotherapist that you feel comfortable with is important, and you might want to see more than one therapist before you make a decision (see my article: How to Choose a Psychotherapist).

Getting Help in Therapy
Unresolved trauma usually impacts issues in your current life, no matter how long ago the trauma occurred.  Whether the impact is in your personal life, where core issues are most likely to come up, or in your work life or both, unresolved trauma often creates current problems (see my article: Reacting to Your Current Life Based on Your Traumatic Past).

Rather than struggling on your own, you owe it to yourself to get help from an experienced trauma therapist.

If you're already in therapy and your therapist isn't trained in trauma therapy, like EMDR therapy, Somatic Experiencing or clinical hypnosis, you can explore the possibility of adjunctive trauma therapy with a therapist who is trained in trauma therapy.  

Adjunctive therapy means that you continue to see your existing psychotherapist and see a trauma therapist for adjunctive therapy.  It's important to discuss this with your primary therapist first before you begin adjunctive therapy with a trauma therapist.  Also, in most cases, the primary therapist and the adjunctive therapist will ask for your written consent to be able to confer with each other (see my article: What is Adjunctive EMDR Therapy?).

Taking the first step, which is contacting a trauma therapist by phone or email, is often the hardest step.  

Once you have worked through your unresolved trauma, you have an opportunity to let go of your traumatic history so you can lead a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who provides integrative psychotherapy (see my article: The Therapeutic Benefits of Integrative Psychotherapy)

As a trauma therapist, I work with individual adults and couples, and I have helped many clients to overcome their traumatic experiences.

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

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

Wednesday, June 6, 2018

Books: On Chesil Beach: How the Entire Course of a Relationship Can Be Changed By "Doing Nothing"

Usually, when you think of a relationship that doesn't work out, you think of something that one or both people actively did that resulted in the breakup.  But there are times, like in the book and movie, On Chesil Beach by Ian McEwan, when the entire course of a relationship can change by appearing to "doing nothing."

On Chesil Beach: How the Entire Course of a Relationship Can Be Changed By "Doing Nothing"

This occurs more often than most people think, and it's often only in hindsight, sometimes many years later, that the people in the relationship realize the impact of "doing nothing" when a response might have changed the course of the relationship.

On Chesil Beach is a good example of this dynamic but, in case you haven't read the book or seen the movie, I'll give another example so there are no spoilers in this article.

Fictional Clinical Vignette: How the Entire Course of a Relationship Can Change By Doing Nothing:
The following fictional clinical vignette illustrates how a relationship can change by seemingly "doing nothing":

A year after a breakup, Rick sought help from a psychotherapist to deal with the emotional aftermath of the breakup.

According to Rick, he and his girlfriend, Diane, had been seeing each other for two years when they got into an argument about an insensitive remark that Diane made to Rick.  Specifically, he got angry with Diane after she called him "stupid" for forgetting her birthday.

Rick told his psychotherapist that he became so livid after she called him "stupid" that even after she apologized several times, he refused to talk to her.  After a few weeks, Diane stopped reaching out to him, and he made no effort to reach her.

How the Entire Course of a Relationship Can Be Changed By "Doing Nothing"

By the time Rick came to therapy, more than a year had gone by since he and Diane had any contact with each other.

It was only in hindsight, Rick said, that he realized that he shutdown emotionally and he was unresponsive to Diane because his father used to call him "stupid," and when she called him "stupid," he got emotionally triggered.  As a result, he didn't accept her apology (see my article: Coping With Trauma: Becoming Aware of Your Emotional Triggers).

Since that time, Rick realized that his relationship with Diane had been the best thing that he had ever experienced, and he made a mistake by not being willing to talk to her.  In hindsight, he realized that she had never done anything like this before, and she lashed out at him that one time in hurt and anger.  He also realized that when she apologized to him, she was sincere.

But when he contacted her a year after the breakup, she told him that she was in another relationship, which was serious, and she couldn't see him.  She said she felt no resentment or anger towards him, and she wished him well, but she couldn't have any more contact with him.

As he sat in his psychotherapist's office, he told her that he felt tremendous regret for shutting down and not accepting Diane's apology when the incident occurred.  He realized that he overreacted at the time, and it was now too late to get back with her.

He told his therapist that, looking back over his life, he realized that he had done this before in other relationships, but he never felt such regret as he did with Diane.  He came to therapy to overcome the emotional triggers that caused him to shutdown emotionally so he wouldn't keep ruining his relationships.

As Rick and his psychotherapist discussed his family history, he talked about his critical father, who belittled Rick from the time he was a young child.  He also talked about his passive mother, who did nothing to protect Rick or intervene on his behalf.

His psychotherapist recommended that they use EMDR therapy to work on the more recent issue involving Diane as well as the history of being criticized by his father (see my article: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

His therapist helped Rick to understand that his defense mechanism of shutting down emotionally was useful to him when he was a child to keep him from getting overwhelmed, but it was no longer useful to him as an adult.  Not only was it not useful, it was actually doing him harm (see my article: What Happens When You Numb Yourself to Emotions From Your Traumatic Past).

The work in therapy was neither quick nor easy.  During their EMDR sessions, Rick felt such grief and compassion for the sad child that he was when he was younger.  He also grieved for his relationship with Diane and dealt with his fear that he might never meet anyone that he loved as much as he loved her.

By the time Rick completed therapy, he was no longer getting triggered by criticism or when someone called him a name because he worked this out with EMDR therapy.  He also understood that shutting down emotionally can be just as harmful to a relationship as being outwardly reactive in a negative way.

Romantic relationships often involve getting triggered by core unresolved issues, including trauma experiences from the past, as in the fictional vignette above.

When someone shuts down emotionally, also known as emotional numbing, s/he can be unreachable and unable and/or unwilling to try to reconcile the relationship because of the emotional trigger.

When this occurs, the person who experiences emotional numbing isn't thinking clearly.  The defense mechanism of emotional numbing "works" so effectively that it might take a while (if ever) before this person can look back in hindsight and realize the damage of being outwardly unresponsive.

Although from the outside, it might appear that "nothing is happening," there is actually quite a lot that's happening internally for the person who shuts down emotionally.  S/he is very overwhelmed, even though s/he might not be aware of it.

To the other person, it appears that s/he is being "stubborn" or "rigid," but, in actuality, the emotional numbing keeps the person emotionally inaccessible even to him or herself.

Getting Help in Therapy
Experiential psychotherapy, like EMDR therapy, helps you to overcome unresolved trauma so you no longer get triggered in your current life (see my article:  Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone)

If you realize that you keep getting triggered by unresolved trauma, you owe it to yourself to get help so you can free yourself from your traumatic history and live a fulfilling life (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many 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.

Tuesday, May 29, 2018

How Unresolved Trauma Affects How You Feel About Yourself

Psychological trauma often has a negative impact on how you feel about yourself.  In trauma therapy, like EMDR, the psychotherapist explores the negative beliefs that developed for the client as a result of trauma (see my articles: How EMDR Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

How Unresolved Trauma Affects How You Feel About Yourself

These beliefs often remain unconscious before the client seeks help in psychotherapy.  But these negative beliefs often get enacted in other areas of the client's life without his or her realizing it before therapy.

Depending upon the kind of trauma and the lasting impact, these negative beliefs might include feeling unlovable, unworthy, powerless, weak and so on.  This is especially true if there weren't people who intervened at the time of the trauma on the traumatized person's behalf.

Fictional Clinical Vignette: How Trauma Affects How You feel About Yourself
The following fictional vignette, which is similar to many actual therapy cases, illustrates how trauma can have a negative lasting impact on self perception:

After she experienced herself as being helpless in a situation at work where she was being sexually harassed, Nina sought help in psychotherapy.

Nina explained to her psychotherapist that she had always done well in college and in her prior jobs.  She was able to negotiate whatever challenges presented themselves in all her prior educational and career endeavors.

However, in her new position as a director, she felt undermined by a manager, Alan, who felt that he should have been the one promoted into the new position--not Nina.  Not only did Alan voice his anger about her getting the promotion when he felt he was better qualified, but he also tried to belittle her by making comments with sexual innuendos when no one else was around.

Nina told her therapist that she ignored him at first but, over time, Alan's sexual comments were more brazen and hostile.  She knew he was trying to intimidate her, and she thought about reporting him to her executive director and the human resources department, but she was afraid that no one would believe her because it would be her word against his, and Alan was generally well liked.

At the same time, Nina knew that she needed to do something because Alan's remarks were becoming more outrageous, and it was getting to the point where she dreaded going to work and encountering him alone in the pantry or on the elevator.  She was losing sleep over it, and over time, this problem was taking up more and more of her thoughts.  It was also interfering with her work.

The psychotherapist explored Nina's background and discovered that Nina was sexually abused from the time she was five until she was 18 by a paternal uncle, who was much loved by the family.  The sexual abuse included making sexual comments to her, kissing her on the mouth and fondling her breasts (see my article: Overcoming the Psychological Effects of Sexual Abuse).

With much trepidation, when Nina was seven, told her mother about the uncle's inappropriate behavior. But her mother refused to believe her.  Not only didn't she believe Nina, but she punished her because the mother believed that Nina was lying.

As a result, the sexual abuse continued whenever the uncle found an opportunity to be alone with Nina (similar to her situation at work with Alan), and Nina felt that, somehow, she was at fault for what her uncle was doing.

The only reason the abuse stopped was that Nina went away to college.  Determined to put the sexual abuse out of her mind, she focused on her college work and excelled in her studies.  After college, she shared an apartment with friends, and she never attended family events where she knew her paternal uncle would be there.

Until Alan began sexually harassing her, Nina thought that she had overcome her history of sexual abuse.  But she realized that she was feeling just as powerless in her current situation as she felt when she was a child.

Her psychotherapist recommended that Nina could take the situation at work one step at a time, so if Nina was too afraid to file a formal complaint with her human resources department, she could speak with her human resource manager informally to find out her rights.

Her therapist also told Nina that it appeared that her earlier trauma of feeling powerless was triggering feelings of powerlessness in her current situation.  She explained to Nina that she had an unresolved trauma that was complicating her current situation, and she recommended that they use EMDR therapy to help Nina to resolve the original trauma involving the sexual abuse with her uncle as well as the fact that her mother didn't believe or support her when she told her mother about the abuse (see my article: EMDR Therapy - When Talk Therapy Isn't Enough).

Nina took practical steps to speak with the human resource (HR) manager about what would happen if she filed a sexual harassment complaint.  To her surprise and relief, the HR manager told Nina that she was already conducting an investigation and, based on a complaint from a few other women in Nina's department, she was about to contact Nina to ask her if she was being harassed.

Since Nina had come to her on her own, the HR manager asked her specifically about her experiences with Alan, and Nina was able to tell her about the sexual comments that he made to her.  A few weeks later, based on several women coming forward to complain about Alan's behavior, he was terminated.

At the same time, Nina and her psychotherapist did EMDR therapy to work on the many years of sexual abuse that she experienced by her uncle.  They also worked on how betrayed Nina felt that her mother thought she was lying.

Nina was somewhat surprised that, after all the years that had gone by, she could still be triggered into feeling powerless in her situation at work.

Their work with EMDR therapy was neither quick nor easy but, her therapist explained, EMDR therapy tends to be faster and more effective than regular talk therapy with unresolved trauma.

Over time, Nina was able to work through the unresolved trauma so that it was no longer affecting her.  She no longer felt powerless in relation to her memory of the abuse or in her current life.

In fact, when another male colleague tried to sexually harass her, Nina put him in his place and told him in no uncertain terms that if he did not stop, she would report him.  Startled by her assertiveness, the colleague seemed intimidated by Nina.  He apologized for his behavior, and he stopped making inappropriate comments.

Feeling Empowered After Resolving Prior Trauma

Afterward, Nina felt she had handled the situation well, and she told her psychotherapist that she felt good about herself.

Shortly after that, Nina had a long talk with her mother about the sexual abuse that occurred when Nina was child.  Her mother believed her this time.  She apologized and they began to work on improving their relationship.  Her mother also forbid the uncle from coming to any more family events.  With Nina's permission, her mother also told other family members so that they would be aware of his behavior and prevent any other children from being abused.

This brief fictional vignette illustrates that, even when a client thinks that s/he had suppressed the negative emotions associated with an early trauma, these feelings can get triggered in a current situation.

The unresolved trauma remains unmetabolized just under the surface, and it can remain there for many years until it gets triggered again.

Trauma therapy, like EMDR therapy, can help clients to overcome traumatic experiences in a more effective way than regular talk therapy.

Getting Help in Therapy
If you are struggling with unresolved trauma, you owe it to yourself to get help in trauma therapy (see my article: The Benefits of Psychotherapy).

A skilled trauma therapist can help you to overcome unresolved trauma so you can free yourself from your history and lead a more fulfilling life (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  How to Choose a Psychotherapist).

As a trauma therapist, I work with individual adults and couples, and I have helped many clients to overcome unresolved 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.

Wednesday, May 23, 2018

Emotionally Intimate Relationships Provide An Opportunity to Know Yourself in New Ways

People who are in new relationships are understandably focused on getting to know their partner, but being in a relationship also provides you with an opportunity to get to know yourself better--sometimes in unexpected ways.

Emotionally Intimate Relationships Provide An Opportunity to Get to Know Yourself in a New Way

Although there is always the potential to get to know yourself in all relationships, including friendships and work-related relationships, being in an emotionally intimate relationship brings up core emotional issues that you often don't discover in other relationships.  This is because you're at your most emotionally vulnerable when you're in a relationship that is emotionally intimate.

Often, these core issues involve aspects of yourself that you haven't encountered before--even if you're been in other relationships--because every relationship is different.  Each dyad is unique and combines the personal histories of each person in a unique way.

Getting to know yourself in a relationship gives you a chance to see yourself in a new light in both ways you like and in ways you might want to change.

Fictional Clinical Vignette:  Emotionally Intimate Relationships Provide You With An Opportunity to Get to Know Yourself in New Ways
The following fictional clinical vignette illustrates how being in a relationship provides an opportunity to get to know new aspects of yourself and how psychotherapy can help:

After his divorce, Tod waited a year before he started dating.  He had been married for 15 years and, initially, he found the dating world to be daunting.  It was all new to him.  He lacked confidence in himself and he felt discouraged by online dating.  He often felt like he was "doing it wrong" when he met women online or he felt inadequate in some way.  But when he met Nicki through mutual friends, he felt he met someone who was special, and he stopped his online dating activity.

They were both divorced, in their mid-40s, and without children.  Not only did they have similar values and interests, but they both had demanding careers and were both looking to get into a serious relationship.  After dating for several months, they decided to take the next step and move in together.

After living together for a couple of months, Nicki began to express her frustration with Tod's unspoken expectation that she do all of the cooking and housework.

Hearing her complaints, Tod was surprised--mostly at himself--because he always saw himself as believing that men and women were equal in his personal relationships as well as in his work-related relationships.  As a managing director at work, he tended to mentor and promote qualified women, and he encouraged his managers to do so as well.  So hearing Nicki say she thought his behavior at home was sexist was something he hadn't thought about before.  But when he did think about it, he realized that she was right.

As Tod thought about it more, he realized that when he was married, his wife, who didn't work, did the housework, and she didn't mind.  This is what he was accustomed to for 15 years and it was never an issue for them.  He also grew up in a household where his mother stayed home and took care of all the household chores while his father was at work.

The problems that led to Tod's divorce had nothing to do with disagreements about household chores and more to do with their growing apart.  His wife at the time was a perfectionist about housework, and she preferred to do things herself, which suited both of them.

In the last few years of his marriage, Tod started psychotherapy to deal with the loss of his mother to a sudden illness.  While in therapy, Tod learned things about himself that he never realized before.  Getting to know aspects of himself that he never knew before helped Tod to grow and become more psychologically minded, but his wife didn't understand why he attended psychotherapy.  Even when it was obvious to both of them that they were drifting apart, his wife wouldn't even consider going to couples therapy, so the relationship eventually ended with each of them acknowledging the unhappiness in the marriage and opting for an amicable divorce.

Tod began discussing with his psychotherapist how surprised he was to realize that he was behaving in a traditional sexist way at home and even more surprised that he didn't realize it himself before Nicki mentioned it.  Although he agreed with Nicki once she pointed it out, he felt completely inept about doing housework because he had never done it before.  When he lived with his former college roommates after he graduated college, they hired a cleaning person to do the housework and, as previously mentioned, when he was married, his wife preferred to do the housework.

His psychotherapist sensed that there was something more going on for Tod beyond that he didn't like or feel good at doing housework, so she explored this issue with him further.

What eventually came up was that, beyond housework, Tod often felt "not good enough" when he tried anything new, including online dating before he and Nicki moved in together.  This included going away to college, which resulted in him attending counseling through the college counseling center when he was tempted to drop out of college during his freshman year.  It also included when he was new at work after college.

Fortunately, his college counselor helped him to get through that difficult first year so he stayed at college.  And he was assigned to a caring mentor at his company, who helped him make the transition from college to work when he was a new employee, and it also helped Tod to build up his self confidence in his career.

As Tod discussed this problem with his psychotherapist, he realized that new situations still triggered the feelings of not being good enough in many areas of his life, and he wanted to work through this issue since it was bound to come up again and again in his life.

To discover the underlying issues involved with Tod not feeling good enough, his psychotherapist used the current situation with Nicki and the clinical hypnosis technique called the Affect Bridge (see my article: What is Clinical Hypnosis?).

With the Affect Bridge, Tod was able to sense his emotions and where he felt them in his body with regard to his current problem and go back to the earliest time that he felt this way about himself to get to the root of the problem.

Once Tod and his psychotherapist were able to pinpoint the earliest experience where he felt inadequate, which was in his childhood, they used EMDR therapy to help him to resolve the past, present and anticipated future events that could trigger these feelings of inadequacy (see my articles: What is EMDR Therapy?How Does EMDR Therapy Work: EMDR and the Brain, and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Along the way, Tod began taking over half of the household responsibilities that Nicki had been doing, which Nicki appreciated, and after doing EMDR therapy, he no longer felt inadequate with this  issue or other new situations.

Emotionally intimate relationships provide an opportunity for you to get to know yourself in new ways, including both positive and negative aspects of yourself.

When there are issues that are getting triggered in your relationship, these issues often have their roots in earlier experiences.

Experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis are effective forms of therapy that help you to overcome unresolved trauma.

Getting Help in Therapy
If you have been struggling with unresolved issues, you can get help in psychotherapy (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to overcome the problems that are keeping you stuck so you can lead a more fulfilling life, so rather than struggling on your own, get help from a licensed mental health professional (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many people to overcome unresolved problems.

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, May 21, 2018

Why Ghosting Your Psychotherapist is Harmful to You

Ending a relationship can be difficult, and many people try to avoid dealing with endings--whether those endings involve a romantic relationship, family members, coworkers and even psychotherapists.  "Ghosting" is a relatively new term to describe when someone disappears from a relationship, regardless of the type of relationship, in order to avoid a conflict or the fear of ending that relationship (see my article: When Clients Leave Therapy Prematurely).

Why Ghosting Your Psychotherapist is Harmful to You

Ghosting in Psychotherapy 
Clients in psychotherapy often talk about how emotionally painful it is when someone that they were dating ghosts them.

They talk about feeling abandoned, rejected and confused about why the other person disappeared from their life without telling them why.  And yet, some of these same clients will ghost their psychotherapist even when they have had a good therapeutic relationship with them before they disappeared.

Although ghosting a psychotherapist isn't the norm, it happens often enough for psychotherapists to begin talking about it.  Often, clients who ghost their therapist have a long history of passive-aggressive and avoidant behavior in other personal and work-related relationships.

Why Do Clients Ghost Their Psychotherapists?
With the advent of dating apps where people can swipe right or left for their dating preferences, some people haven't developed the necessary tact and interpersonal skills for interacting with others.

I hear from many clients, who are unhappy with online dating, that for many of the people they are meeting online, there is a feeling that there might be "someone better" one swipe away ("better" is often defined as better looking, sexier, richer, smarter, and so on).  So, these people tend to enter into the dating world lacking the interpersonal skills and motivation to get to know people before ghosting them.

Why Ghosting Your Psychotherapist is Harmful to You
Unfortunately, this phenomenon has carried over into the realm of psychotherapy with some clients opting to disappear from therapy rather than talking to their psychotherapist about whatever is bothering them (see my article: How to Talk to Your Psychotherapist About What's Bothering You About Your Therapy).

For people who ghost their psychotherapist, there is often little to no recognition that they have a  relationship with their psychotherapist--a therapeutic relationship, which is, of course, different from a personal relationship, but a relationship nonetheless, and that relationship deserves the respect of any other type of relationship.

As to why clients ghost their psychotherapist, there can be many reasons, including:
  • A History of Avoidant Behavior: Some people just haven't learned how to end a relationship in a way that is respectful to the other person and respectful to themselves.  They might have an avoidant attachment style or aspects of that attachment style.  In most cases, they want to avoid any kind of unpleasantness or conflict--even when they know, logically, that their psychotherapist is trained to deal with endings.  
  • A Problem With Interpersonal Skills: As mentioned before, some clients haven't developed the necessary social skills for interacting with others.  Either due to inexperience with relationships or a lack of recognition of the importance of relationships, they don't know how to talk about what's bothering them in a relationship and how to end a relationship that's not working for them, including a therapeutic relationship (see my article: How Psychotherapy Can Facilitate Emotional Development in Adult Clients).
  • A Fear of Emotional Intimacy: A client-therapist relationship is one of the most emotionally intimate relationships that many people have.  For some people, it's the only emotionally intimate relationship they have in their lives, especially if they're not connected to family member, friends or in a romantic relationship.  For clients who have never been in therapy before or who have skipped around to many different therapists without developing a therapeutic relationship, the emotional intensity of the therapeutic relationship can be uncomfortable.  If they have never developed a good therapeutic relationship with a psychotherapist, they might not have anticipated what opening up to a therapist would be like.  For some clients, when the therapy sessions become deeper than they anticipated, they bolt (see my article: Fear of Emotional Intimacy).
  • An Early History of Traumatic Endings:  Often ghosting is related to unresolved trauma where there were one or more early traumatic endings.  This might include: being abandoned by a parents early in life, experiencing marital separation or divorce where the parents didn't take the time to talk to the children about the change, sudden evictions from a home, etc.  Someone who has experienced traumatic endings has inadvertently learned that endings are dangerous and should be avoided, so rather than letting their therapist know that they are thinking about leaving therapy, they become too anxious about the ending and just leave (see my article: Fear of Abandonment and Adults Who Were Traumatized As Children Are Often Afraid to Express Their Feelings).
Why is Ghosting Your Psychotherapist Harmful to You?
While it's true that no psychotherapist likes to be ghosted by a client, when clients ghost their psychotherapist, they are mostly harming themselves for the following reasons:
  • Your Therapy Often Doesn't Go Beyond the Surface: When you disappear from your therapy, you often cheat yourself from having the experience of going beyond the surface in therapy.  Clients who leave therapy prematurely will often say to their next therapist that they didn't know what else to talk about once they talked briefly about the presenting problem.  A skilled psychotherapist will usually recognize that the client might have been defensively warding off delving deeper into their problems (see my article: Beyond the "Band-aid" Approach to Resolving Your Problems in Therapy).
  • You Might Be Avoiding Dealing With Your Problems:  Most, if not all, people begin psychotherapy with a degree of ambivalence.  Even the most motivated clients, who are serious about working on their problems, have some mixed feelings about being in therapy.  So, when you have an urge to disappear from your therapy sessions, you would be wise to ask yourself what you might be avoiding.   You might feel a temporary sense of relief by leaving therapy prematurely, but sooner or later your problems will resurface (usually, it's sooner), and you might be returning to your therapist or looking for another therapist.  If this is a pattern for you, you could reenact this ghosting pattern many times with different therapists and not resolve your problems (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).
  • You Don't Feel Good About Yourself After Ghosting Your Psychotherapist:  Except in rare cases of the most callous or narcissistic people, most people who have a pattern of ghosting their psychotherapists will often say that they feel shame and guilt afterwards for leaving in such a passive-aggressive way.  If this occurs with one therapist after another, they develop a sense of failure or the misconception that "therapy doesn't work for me."  Before disappearing from therapy, take some time to first reflect upon what you will feel like after the initial sense of relief, especially if you have skipped around a lot from one therapist to another.  
  • You Don't Learn to Assert Yourself in a Healthy Way:  Even when it's clear that you and your psychotherapist aren't a good match, rather than disappearing from therapy, you owe it to yourself to assert yourself so you can have a good ending in therapy.  If you have never learned to end a relationship in a healthy way, discussing termination with your psychotherapist is an opportunity to learn how to have a healthy ending.  This means having at least one session to end the therapy--not texting, emailing or leaving a voicemail message telling your therapist that you're ending therapy.  
What Can Psychotherapists Do to Help Clients With a Pattern of Ghosting?
Psychotherapists who recognize that a client has a pattern of ghosting people in relationships can help by doing the following:
  • Bring Up the Topic of Ghosting Early On in Therapy For Clients Who Have a Pattern of Ghosting:  Very often, whatever problem a client is having in his or her personal or work life also becomes a problem in therapy.  That's why it's important for a therapist to address the ghosting issue early on in therapy when she hears that a client has a pattern of doing this in relationships.  By bringing up this topic, the therapist lets the client know that she is receptive to hearing any complaints about the therapy or what the client thinks isn't working, so the client knows it's safe to talk about these issues and s/he doesn't have to disappear from therapy at the first sign of a problem.  This provides an opportunity for the client and therapist to talk about other ways of handling uncomfortable feelings, conflict or whatever might be causing the client to want to disappear.  For some clients, this might not be enough to keep them from bolting from therapy when they're uncomfortable, but at least it has been addressed.  It increases the chance that these clients might remember the discussion even after they leave, and they might consider returning (see my article: Starting Where the Client is in Psychotherapy and Why It's Important For Psychotherapist to Provide Clients With Psychoeducation).
  • Don't Take It Personally:  Most experienced psychotherapists are trained not to take abrupt endings in therapy personally.  This doesn't mean that the therapist might not have contributed to the abrupt ending in therapy.  It could mean that, even when the therapist made mistakes and had no opportunity for repairing the rupture, this isn't a personal abandonment (although it never feels good to be ghosted).  But if, as a psychotherapist, you experience it as a personal abandonment or if it triggers abandonment issues in you, you would do well to seek help in your own personal therapy to work out these unresolved issues.  Self care is important. You would also probably benefit from working with an experienced supervisor or colleagues who can help you to deal with this issue (see my article: Psychotherapists' Reactions to Their Clients).
  • Contact a Client Who Has Disappeared From Therapy: It can be very helpful to a client, who is fearful and avoidant, to hear from his or her therapist that the door remains open to returning.  This is especially true for clients who have been traumatized by unhealthy endings in their family where there was no opportunity to return to repair relationships.  The client might not come back soon or ever, but knowing that the therapist is open to discussing the reasons for leaving, even if the client still wants to end therapy after the discussion, can be a healing experience.  Some clients, who disappear from therapy, return months or years afterwards based on the therapist letting them know that her door remains open to them.  Also, let them know your policy regarding inactive cases (e.g., a client's case would be considered inactive after a month or whatever your policy is).
  • Help Clients to Work Through the Issue of Abrupt Endings If They Return: As previously mentioned, some clients return after they have heard from their psychotherapist that they can come back.  For those clients, who might still feel uncomfortable, guilty or ashamed, it's important to address their disappearance from therapy.  This can be a healing experience for the client and the therapeutic relationship (see my article: Ruptures and Repairs in Psychotherapy).
Ghosting is phenomenon which occurs for a variety of reasons, in personal relationships, work relationships and therapeutic relationships in psychotherapy.

When ghosting occurs in psychotherapy, it's harmful to the client, who might be perpetuating a pattern of disappearing from relationships or unconsciously recreating trauma from the past.

Psychotherapists, who recognize a pattern of ghosting with particular clients, can help these clients by providing psychoeducation about why ghosting is harmful to them and how to deal with problems directly rather than avoiding them.

When clients, who tend to bolt from relationships, learn to confront their fears in psychotherapy (rather than disappearing from therapy), they can take pride in achieving an important goal.  Learning to deal with problems related to psychotherapy can help clients to develop the necessary skills to deal with problems in their personal relationships and in their career.

Getting Help in Therapy
Rather than struggling alone, you could benefit from seeking help in psychotherapy (see my article:  The Benefits of Psychotherapy).

Finding the psychotherapist that's right for you might take time and effort (see my article: How to Choose a Psychotherapist).

Freeing yourself in therapy from a traumatic history can allow you to lead a more meaningful and fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome unresolved 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.