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Monday, September 26, 2016

Books: "Tea With Winnicott" at 87 Chester Square

In the book, Tea With Winnicott, Brett Kahr imagines what it might be like to bring back the British psychoanalyst and pediatrician, Donald W. Winnicott, who died in 1971, to interview him about his life and his work.

"Tea With Winnicott" at 87 Chester Square


The book is part of a series called Interviews with Icons, which are "posthumous interviews" with famous psychoanalysts.

In a poignant, imagined dialogue, Brett Kahr, who also wrote D.W. Winnicott: A Biographical Portrait, does an imaginary interview with Winnicott at Winnicott's consulting room at 87 Chester Square in London.

The book is wonderfully illustrated by Alison Bechtel.

Winnicott's former secretary makes them tea and sandwiches as they delve into the most important aspects of his life.

When I was in psychoanalytic training 20 years ago, I remember being drawn to Winnicott's books and papers more than any other theorist that we read. He has influenced my work more than any other psychoanalyst.

Through his writing, you could sense Winnicott's unique compassionate understanding about adults and infants (he was also a pediatrician), and he has been a valuable guide for new and experienced therapists all over the world.

"Tea With Winnicott" at 87 Chester Square

Kahr's book is organized in a way that helps clinicians and clients alike understand how Winnicott's early life influenced his theories about infants and adults.

Even experienced therapists, who have read Winnicott's papers and the various biographies about him, will find interesting stories about his personal life and his work.

Since it appears that Winnicott's mother, although loving and kind, was also depressed, there has been speculation that this might have influenced Winnicott's choice to become a psychoanalyst.

The section about Winnicott's early life shows how his own childhood influenced his psychoanalytic theories, especially the fact that he came from a loving home surrounded by his mother and other women in the household.

In his time, Winnicott had to navigate between the two predominant theorists of his time, Anna Freud and Melanie Klein.  Kahr provides interesting insights into what was going on in the psychoanalytic world at that time and how Winnicott was able to form the "Middle School."

Reading "Tea With Winnicott," you can easily imagine yourself sitting for a chat with this approachable psychotherapist and immersing yourself in his world.  The book is entertaining and accessible.

Much of what we now take for granted about raising a child and mother-child relationships originated with Winnicott.  His phrase "the good enough mother" conveyed that a mother didn't need to be "perfect," she just needed to be good enough.

His philosophy about the mother-child relationship was similar to his philosophy about the therapist-client relationship with regard to creating a safe, holding environment and repairing any ruptures in the relationship (see my articles:  The Creation of the Holding Environment in Psychotherapy and On Being Alone).

In the late 1930s, Winnicott did broadcasts on the BBC radio where he addressed mothers in a personal and reassuring way.  His talks weren't about giving advice to mother.  Instead, his talks provided mothers with basic information about an infant's needs and how to foster a loving, safe environment for the baby.

These BBC talks were very popular.  It was evident that Winnicott respected mothers and never talked down to them.  During his time, he reached millions of listeners.

"Tea With Winnicott" at 87 Chester Square

The "interview" also deals with some controversial issues, including Winnicott's relationship with Masud Khan, who was an analysand as well as a colleague of Winnicott's.  It also deals with his first marriage to his wife, Alice.

Although Winnicott died in 1971, leaving behind many volumes of books and letters that he wrote, he  still remains one of the most influential and popular psychoanalysts all these years later.

I highly recommend this book to anyone who is interested in Winnicott or the history of psychoanalysis and psychotherapy.

The format of the book is ideal for making a play, and I hope that someone will take on the project of producing the play in NYC.

About Me
I am a NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapists who works with individuals and adults.

I am also psychoanalytically trained and work in a contemporary, dynamic and collaborative way.

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, September 19, 2016

An Unconscious Identification with a Loved One Can Create an Obstacle to Change

People who start therapy often wonder why it's so hard to change, so I want to address one of the major reasons why people have problems changing, which is an unconscious identification with a loved one.

An Unconscious Identification With a Loved One Can Create an Obstacle to Change

From the time that we're infants, we learn to identify with our caregivers, usually our parents.  Even as adults, we can continue to identify with loved ones.

The identification can include values, opinions, thoughts, feelings, habits and lifestyle choices.

The following fictional vignette, which is a composite of many different cases, provides an example of someone who comes to therapy to make a change, but who encounters an obstacle within himself that makes it difficult for him to change.

Rick
Rick came to therapy after his doctor advised him to stop smoking or he would face increasingly debilitating health consequences in addition to the ones he was already experiencing, including severe headaches, problems breathing and a persistent cough that wouldn't go away (see my article:  Do You Want to Stop Smoking?).

Struggling with Health Consequences of Smoking 

Before coming to therapy, Rick tried to stop smoking on his own.  But even though he wasn't feeling well because he was smoking two packs of cigarettes a day for several years, he couldn't stop.

He tried the nicotine patch and nicotine gum.  He tried to go "cold turkey," but nothing worked for him.  His wife pleaded with him to stop, to no avail.

Rick came for clinical hypnosis as a last resort.  He didn't have much faith that hypnosis would help him, but he was feeling desperate and decided to give it a try.

I began, as I often do with people who want to stop smoking, by asking Rick about his motivation to stop smoking.  He told me that he knew that he "should" because of his doctor's warning and his wife was also unhappy about his smoking.

Based on Rick's tone and the shrug of his shoulders, I could tell that his internal motivation wasn't strong, and he admitted this.  His motivation was mostly external as opposed to a strong internal motivation that is often needed to help people to stop smoking or to make other difficult changes.

 I took a history of Rick's use of tobacco, including his many attempts to stop on his own (see my article:  Becoming a Successful Nonsmoker).

We also discussed his pattern of smoking (when he smokes, what time, how often, etc) with the idea of using "pattern interruption" as a way to help him to break his habit.

As part of the pattern interruption, Rick agreed to change cigarette brands and to change where he smoked.  Interrupting the pattern in the rituals that Rick had for smoking was somewhat successful.  He was able to reduce his use from two packs to a pack a day and, a few sessions later, he reduced it to half a pack per day.

This was more than Rick had ever been able to do on his own.  He was also surprised that his cravings were reduced.  But, try as he might, he couldn't stop smoking altogether, and I realized that there was probably a strong unconscious underlying reason that was undermining our efforts.

In order to discover what Rick liked about smoking, he agreed to allow me to do a hypnotic induction.  While in a light hypnotic state, Rick expressed feeling very relaxed and, at the same time, he maintained a dual awareness of both his relaxed state and that he was sitting on a couch in my office.

I asked Rick to go back in his mind to the first time that he smoked and enjoyed it.  Rick remembered a pleasant summer day sitting on his grandfather's porch with his father and grandfather.  He remembered that it was after a great dinner that his grandmother had made and his grandfather was telling funny stories about his childhood.

He remembered how they all joked and laughed and how he realized that day how much he loved his father and grandfather.  He was particularly aware on that day of the strong bond he felt with them and how being allowed to sit with them, while the women in the family were in the house, made him feel proud, as if he was part of this exclusive "club"for the men in the family.

Many other similar happy memories of being with his grandfather and father came to his mind.  Just thinking of those memories brought tears to Rick's eyes.

Afterwards, as part of the debriefing in the session, Rick talked about how surprised he was to realize that when he smoked, he continued to feel a bond with his father and grandfather, both of whom he missed very much since they died.

No wonder it was so hard for Rick to give up smoking.  He had an unconscious identification with his father and grandfather through smoking cigarettes and it helped him feel connected to them even though they were both dead.

As he continued to talk about these two important men in his family, Rick said they were the two most important people in his life.  Then, he cried to think that he might give up this habit that kept him feeling connected to them.

During the next session, Rick and I talked about the strong bond that he felt with his teenage sons.  He often spent a lot of time with his sons and it was obvious that he was proud of them and loved them very much.

I asked Rick how he would feel if his sons began smoking.  Rick dismissed this idea.  He said that, even though he smoked, he had always told his sons not to smoke, and they promised him they never would start.  The idea of his sons smoking was so disturbing to him that he couldn't even consider the idea.

I told Rick, as tactfully as I could, that children learn more from what they see their parents do than what their parents tell them to do.  And, just like he started smoking as a way to bond with his father and grandfather, his children could do the same.

Rick acknowledged that this could happen, but he doubted that it would.  But if it did, he would never want to pick up a cigarette again because seeing his sons smoke would upset him too much.

By the end of that session, Rick began thinking about his place in the family--now that his father and grandfather were gone, he was the patriarch in the family and he wanted to set a good example for his sons.

When Rick came back the following week, he looked upset.  He told me that he was shocked to learn from his wife that his younger son, John was smoking and he had been keeping it a secret--until Rick's wife found a pack of cigarettes in John's pants pocket as she was sorting the laundry.

He said that after she told him about their son smoking, he sat by himself in the kitchen for a long feeling sad and upset.

How an Unconscious Identification with a Loved One Can Create an Obstacle to Change

He knew that if he confronted his son in an angry way, it would seem hypocritical to John.  So, he decided that, once and for all, he was going to give up smoking.  Hearing that his younger son had taken up smoking provided Rick with the motivation he needed to stop.  With the help of hypnotic suggestions, and his motivation to change Rick was able to stop smoking.

Several months later, when I followed up with Rick, he told me that he continued to be a successful nonsmoker and, shortly after he stopped, his son, John, also stopped.  Rick told me how proud he felt that he could "kick the habit" and he thought that his father and grandfather would also be very proud of him.  That feeling--that his father and grandfather would be proud of him--was another strong motivator for him to remain a successful nonsmoker.

Conclusion
Although the vignette above is a composite of many different cases, it has been my experience that, in many instances, an unconscious identification with a loved one can create an obstacle to change.

These identifications are usually not apparent at first.  A therapist, who is skilled at doing discovery work, can help clients to uncover the unconscious obstacle.

An Unconscious Identification with a Loved One Can Create an Obstacle to Change

As in the case with "Rick," a behavior or habit that represents a strong identification is often hard to change.

But, similar to the vignette above, if clients discover an even more compelling reason to change, as "Rick," that reason can help to transcend the original obstacle.

Getting Help in Therapy
Obstacles to change often include conscious and unconscious factors.

It is usually difficult to discover the unconscious factors on your own, which is one of the reasons why people come to therapy.

If you've having difficulty making changes, you could benefit from working with a skilled therapist who has experience helping clients to discover and overcome unconscious obstacles.

Discovering the unconscious obstacle is an initial step.  Developing the motivation to transcend the obstacle is what often leads to transformation.

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, September 12, 2016

Stress Management: Taking Time Out For Self Care

When life gets hectic and stressful, it's easy to forget about the importance of self care. At those times, many people try to get through the stressful time by plowing through rather than taking care of themselves (see my article: Staying Emotionally Grounded During Stressful Times).

Stress Management: Taking Time Out For Self Care

For other people, it's a matter of not feeling entitled to take care of themselves (see my article:  Self Care: Feeling Entitled to Take Care of Yourself).

Not feeling entitled to self care is often part of a larger problem that is usually longstanding.  This could involve a tendency to put others first, being unfamiliar with the concept of self care or a tendency to be a perfectionist to the point of exhaustion (see my article:The Connection Between Perfectionism and Core Shame).

Needless to say, a lack of self care often leads to burnout, whether it involves personal stressors or work-related stressors (see my article: Managing Your Stress: What Are the Telltale Signs of Burnout?).

Many people come to therapy when they get to the point where they feel they just can't cope any more.

The following fictional vignette illustrates how a lack of self care can lead to bigger problems, and how therapy can help:

Nina
Nina came to therapy after she developed stress-related health problems, including debilitating headaches, chest pains related to anxiety as well as insomnia.

Self Care: Taking Time Out to Take Care of Yourself

At her doctor's recommendation, she took off a month from work, which she had resisted doing for a long time.  But when her doctor warned her that her symptoms would get worse unless she took time off to relax and regroup, she knew she had to do it.

During that time, she stopped having headaches and panic attacks, but she began to feel depressed at home without her usual demanding work schedule.

When she consulted with her doctor again, she told her to get help in therapy, so she started therapy a week after she began her break from work.

Nina was a perfectionist since she was a child.  If she didn't do things perfectly at school and at home, she felt she was a failure.  There was no in between.   She was a straight A student, but she derived no joy or satisfaction from her accomplishments because she felt this was what was expected of her--she had to be perfect.

Both of her parents were perfectionists as well.  Before they retired,  both of them were rewarded in their fields for their perfectionism.  Her mother was a well-respected lawyer and her father was a top surgeon in his field.  So, Nina grew up in a household where there was a lot of pressure to be "the best."

Nina did very well in college and in graduate school.  She found it relatively easy to be at the top of her class.

Then, she came to NYC and entered into a highly competitive field that attracted the top people in her  field from all over the world.  Even though she came from a highly competitive family, she never experienced this type of competition.  She felt like she had to always be on her toes to stay on top.

She was rewarded with the respect of her superiors as well as monetarily for her long hours at work but, as previously mentioned, the pace was taking its toll on her health.

Self Care: Taking Time Out to Take Care of Yourself

When her therapist mentioned self care, Nina wasn't even sure what her therapist meant.  She wasn't even sure where to begin.

Her therapist taught Nina breathing exercises and how to meditate, and she recommended that Nina practice for a short time everyday to get into the habit of taking care of herself.

Initially, this felt so unfamiliar to Nina that she felt guilty taking the time to de-stress instead of working or "doing something productive."

When she felt her mind wandering, her sense of perfectionism got in her way because she was sure that she "wasn't doing it right," which almost felt unbearable to her.

It took a lot of practice and a lot of encouragement from her therapist for her to stay on track with her self care practices.

Once she was able to practice meditation and breathing with less difficulty, her therapist helped Nina to work on her perfectionism.

Nina learned that underneath the perfectionism there was core shame.

Working on her shame was more challenging because it was uncomfortable for her.  But her therapist helped Nina to see that this is a common problem and shame is often at the core of emotional problems for many people.

Self Care: Taking Time Out to Take Care of Yourself

When Nina went back to work, she got into the habit of taking time each morning to do her breathing exercises and meditation, even if she only did it for 10 minutes.

Nina also made a conscious decision that her health was more important to her than her next promotion and that if getting that promotion meant compromising her health, it wasn't worth it.  So, she reduced the hours that she put in at work.

Nina and her therapist continued to work on Nina's longstanding sense of shame that fueled her perfectionism.  Her therapist used a combination of EMDR (Eye Movement Desensitization and Reprocessing) and Somatic Experiencing.

Over time, Nina was able to work through her feelings of shame.

Eventually, she decided that her current profession no longer suited her and she began to train for a less stressful profession.

She continued to engage in the self care techniques that were helping her to cope, and she learned that she didn't have to be "perfect" at it.

Along the way, Nina developed a greater sense of self worth and an appreciation for life that she never felt before.

Getting Help in Therapy
If you're struggling with stress, anxiety or depression, you're not alone.

Many stress-related health problems can develop if you learn how to take care of yourself on a physical and emotional level.

If you've never developed strategies for self care or you don't feel entitled to take care of yourself, you could benefit from working with a therapist who specializes in helping clients to overcome these problems (see my article:  The Benefits of Therapy).

Rather than waiting until you are experiencing burnout or health problems, get help from a licensed mental health professional so you can begin to live a more satisfying life.

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.

















Tuesday, September 6, 2016

Why It's Important For Psychotherapists NOT to Have "All the Answers" in Therapy

There was a time in the history of psychotherapy when traditional psychotherapists believed they had  "the answers" for their clients (see my article: A Therapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

Back then, it was assumed a client would come in, free associate to whatever was on his or her mind, and when the time was right, the therapist would make an interpretation as to what was going on for the client.

If the client didn't accept the therapist's interpretation, the client would usually be thought of as being "resistant" (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

Fortunately, times have changed and most contemporary therapists work in a more collaborative way with clients.  And yet, there are still many clients who come to therapy who expect the therapist to have "all the answers" to their problems.

Not only is it a distortion of what goes on in therapy to think that a therapist is all-knowing, it's also counterproductive.

And, it's likely that any therapist who presents him or herself as knowing all the answers won't be listening to the client or helping the client to develop his or her own ability to develop insight and inner knowledge.

Self exploration and personal discovery is part of the psychotherapeutic process.  And while it's understandable that some clients want "the answer" to their problems from the therapist, it's not realistic or helpful.

Although psychotherapists, who have advanced training in psychoanalytic or psychodynamic therapy, are trained to do in-depth therapy, they are neither mind readers nor fortunate tellers, so they don't have "all the answers" to your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy


Knowledgeable, skilled therapists can facilitate clients' self exploration and help them to develop the psychological skills to overcome problems and lead a healthier life.

If they're trained as trauma therapists, which not all therapists are, they can also help clients to overcome psychological trauma.

But psychotherapists also need to get to know clients over time, and it would be presumptuous and foolhardy for any therapist to assume that she knows from the start what would be best for the client.

If the therapist assumes that she already knows the answers to the client's problems before there is any psychological exploration, this usually means that the therapist isn't taking the time to listen empathically and to get to know the client.

In my professional opinion, as a psychodynamically trained therapist who has gone on to do advanced trauma training, psychotherapy is an intersubjective experience (see my article:The Therapy Session: A Unique Intersubjective Experience).

It takes time for the client and therapist to develop a therapeutic rapport and this doesn't always happen.  Not every therapist is for every client, and most therapists recognize that it's not always a "good fit" with every client.

Most therapists know that each client is unique and, even when it appears that a particular client might have a similar problem to other clients, there's never a one-size-fits-all approach that will work for every client.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

A skilled therapist also knows that part of creating a therapeutic rapport is creating a "holding environment," as initially explained by British psychoanalyst, Donald Winnicott, where the client feels safe (see my article: The Creation of the Holding Environment in Therapy).

A skilled therapist also knows that she must listen empathically to what the client is saying on both a  conscious and unconscious level in order to begin to understand what's happening with the client (see my articles: Psychotherapy: Therapists Should Listen and Learn From Their Clients and The Therapist's Empathic Attunement to the Client)

By listening empathically, the therapist is actually learning from the client about the client rather than the other way around where the therapist makes premature interpretations as to what's going on.

It's also the therapist's job to help the client to develop the skills to tolerate the ambiguity of what's going on in therapy, especially during the initial stage of therapy when it might not be so clear.

In other words, some clients come in with a specific problem and while the resolution might not be clear, the problem is clearer than when clients come in a state of general malaise and they're not sure what's going on (see my article:  When You Just Don't Feel Right, It's Hard to Put Your Feelings Into Words).

For the client, developing skills to tolerate ambiguity might include self soothing techniques or other forms of coping skills (see my article:  Developing Coping Skills in Therapy).

There are no quick fixes in psychotherapy, even with some of the more advanced forms of trauma therapy, which tend to be shorter than some forms of talk therapy when there is psychological trauma (see my article: Beyond the "Band Aid" Approach to Overcoming Psychological Problems).

If you're new to psychotherapy, it helps to have realistic expectations of your therapist and of the psychotherapy process.

Generally speaking, the more complex the problem, the longer it takes to work it through in therapy, although therapy shouldn't be an interminable process where you feel you're not making any progress.

Rather than giving you the answers, a skilled therapist helps you to get to know yourself, grow psychologically, and learn how to work through your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

I recommend that you take your time when you're choosing a psychotherapist (see my article:How to Choose a Psychotherapist).

As part of the process of finding a therapist, you might want to see several therapists to determine which one you feel the most comfortable with before you delve into therapy.

And, as I mentioned before, even highly respected, reputable therapists are not always a "good fit" for everyone, so trust your intuition when making a choice.

Getting Help in Therapy
Many people avoid seeking help in therapy because they believe in common myths and distortions about therapy (see my articles: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak" and Common Myths About Psychotherapy: Therapy Takes a Very Long Time).

It's takes time to develop a sense of trust and safety in therapy, especially if you've had early childhood experiences where you were abused or neglected.

Getting Help in Therapy

Psychotherapy can be a  transformative and dynamic process if you approach it with a sense of openness and curiosity about yourself, choose a therapist who is right for you, and approach therapy with realistic expectations (see my articles: Psychotherapy and Beginners MindStarting Therapy With a Sense of Curiosity and Openness and Experiential Therapy Can Be a Transformative Experience That Helps to Achieve Emotional Breakthroughs).

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, see my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

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




































Monday, August 29, 2016

Fear of Abandonment Can Occur Even in a Healthy, Stable Relationship

In prior articles, I've discussed fear of abandonment in various contexts, including fear of being abandoned in therapy (see my articles:  Old Abandonment Issues Can Get Triggered During Your Therapist's Time Away From the Office and Overcoming Fear of Abandonment).  In this article, I'm focusing on the fear of being abandoned, which can occur even in a healthy, stable relationship.

Fear of Abandonment Can Occur Even in a Healthy, Stable Relationship

Fear of being abandoned in a relationship is usually associated with on-again, off-again chaotic relationships (see my article: The Heartbreak of the On-Again, Off-Again Relationship).

But many people, who are in healthy, stable relationships, also have fears of being abandoned--even when there are no signs that a spouse of partner has any intention of abandoning them in any way.

This fear often stems from early childhood experiences of feeling abandoned, whether it was a physical or an emotional abandonment (see my article: Overcoming Unresolved Childhood Trauma).

People who fear being abandoned when they're in a healthy, stable relationship often feel ashamed, guilty or confused about their fear because they're aware, on some level, that their partner isn't doing anything to cause this fear.

They might think of themselves as being "weak" because they don't understand that they have unresolved psychological trauma from the past (see my article: Reacting to the Present Based on the Past).

Since the early trauma is unresolved, it gets played out, usually unconsciously, in the present.  It has nothing to do with "weakness."

It's easy to see how childhood psychological trauma occurs with parents who are predominantly abusive and/or negligent.

What is often not understood is that the past unresolved psychological trauma can occur in an otherwise loving childhood.

The memory of that trauma, whether it is explicit (conscious and remembered) or implicit (unconscious), can continue to have an impact into adulthood.

The following fictionalized vignette illustrates how fear of abandonment, which developed early in childhood, can occur in a stable relationship.

Fictionalized Vignette

Nina
Nina came to therapy because she was afraid that her fear of being abandoned would ruin her marriage.

Fear of Abandonment Can Occur Even in a Healthy, Stable Relationship

Deep down, she knew that Ed loved her and wanted to be with her but, at the same time, she felt overwhelmed by her fears that he would leave her--even though they were married for five years and there were no signs that he wanted to end the relationship.

She felt deeply ashamed of her constant need for reassurance that he loved her and didn't want to leave her.   She also worried about herself, "I feel like I'm losing my mind.  How can I know that he loves me and wants to be with and, at the same time, be afraid that he'll leave me?"

Whether he went on a business trip or went out for the evening with friends, Nina felt a growing sense of panic that she wouldn't ever see him again.  She tried to hide her fears, but they were so overwhelming that she couldn't help asking Ed for reassurance over and over again.

Nina was afraid that she was going to bring about the very thing that she was to bring about the very thing that she feared if Ed got fed up with her and left her.

Ed came for one session to give his perspective.  It was evident that he really loved Nina and had no intention of leaving her.  But after several years of enduring her insecurities, Ed admitted that it was taking a toll on each of them and their relationship.  He reassured Nina that he didn't want to leave her, but he hated seeing her so unhappy and he wanted her to get help.

In the following sessions, Nina talked about her family history.  There was nothing obvious that stood out to indicate that her parents were abusive or negligent.  On the contrary, they sounded like very loving and attentive parents.

Most skilled trauma therapists understand that there are often unconscious roots to fear of abandonment when someone is in a healthy, stable relationship.

One way to discovery the unconscious is to use a technique from clinical hypnosis called the Affect Bridge (the same technique is used in EMDR (Eye Movement Desensitization and Reprocessing), and it is called the Float Back technique.)

Before using the Affect Bridge, the therapist must assess the client's ability to tolerate whatever difficult emotions that might come up.  This is a clinical judgment call on the therapist's part.

If she has doubts about the client's ability to tolerate strong emotions, the therapist will usually help the client to develop the ability to contain strong emotions as an initial step before doing the Affect Bridge or any other form of discovery work (see my article:  Developing Internal Resources and Coping Skills).

Using the Affect Bridge, the therapist asks the client to remember a recent memory (or a memory that still has an emotional charge) to bring up the emotions related to the fear.  Then, the therapist asks the client to identify those emotions and where s/he feels them in the body.

After the client has identified the emotions and where s/he feels these emotions in the body, the therapist asks the client to go back in time to the earliest memory of feeling this way--even if that memory seems to be unrelated to what's going on in the present.

When Nina went back in her memory, she remembered being a four year old child lost at the beach after she wandered away from her family's blanket.

She was standing alone, terrified and crying.  She remembered looking around and seeing hundreds of people, but there was no sign of her family.  She felt completely abandoned.

Fear of Abandonment Can Occur Even in a Healthy, Stable Relationship

A woman, who noticed Nina crying, offered to take her hand and help her to look for her family. But Nina wasn't sure what to do.  She remembered her mother telling her never to go with strangers.  At the same time, she was afraid that, on her own, she would never find her family and she would be alone forever.  This terrified her even more.

So, crying and shaking in fear, she walked with the woman to try to find her family.  After what seemed like a very long time, her mother, who was also worried and upset, noticed Nina and called her over.

By the time Nina reunited with her family, she was so upset that they decided to go home.

After that experience, as a young child, she never wandered far from her parents.  She also developed a fear whenever her parents went out and left her with a babysitter that they wouldn't come back.  She worried that they might die in a car accident or that there would be some misfortune where she would never see them again.

Her parents thought Nina would "grow out of it."  Also, as she got older, Nina learned to hide her fear of being abandoned, so it didn't seem to be as much of a problem.

After doing the Affect Bridge, Nina and her therapist talked about her earlier experience of feeling abandoned at the beach.  Nina was surprised at how similar these old feelings were to what she felt now in her relationship.  She was also surprised at the long lasting effect of this incident in an otherwise stable, loving family.

When she first started dating Ed, she didn't feel fearful that he would leave her.  But as the relationship progressed and she developed stronger feelings for Ed, she felt there was more to lose because of how much she loved him.

Many people who have fears of being abandoned unconsciously choose relationships where their partners will recreate their fears.  In other words, they choose people who will, more than likely, abandon them or betray them in some way.

In those cases, the therapy will focus on both the past and the present.  It will also focus on helping the client to make better relationship choices in the future.

But, as previously mentioned, this clearly wasn't the case with Nina.  Other than Nina's fear, which was based on the past, they had a good relationship, so the work was focused on the original fear that occurred when Nina was a child.

Using EMDR therapy, over time, her therapist helped her to gradually work through the original fear.

Since there were no other memories related to Nina's fear of abandonment, they only had to work through the one memory.

In cases where there were many instances of abuse and neglect, it's often necessary to work through many more complex memories.

Overcoming Fear of Abandonment


Once Nina worked through the original fear, she no longer worried about Ed abandoning her.  She described it as having a huge burden lifted from her, and she and Ed were happier than they had ever been.

Conclusion
Fear of being abandoned is a common problem that many clients come to therapy to resolve.

When there is no evidence of anything going on in the present to cause this fear, the work usually focuses on memories, which might be unconscious, from the past.

Before trauma therapy begins, trauma therapists must assess if clients are ready to do the work and, if not, help clients to prepare to do the work.

When the memories are unconscious, various discovery techniques, like the Affect Bridge, are used to help uncover the underlying issues from the past that are affecting the present.

Talk therapy alone is often not as effective as trauma therapy, like EMDR therapy, to help clients overcome this fear.

Getting Help in Therapy
It's unfortunate that many people suffer through their whole lives with a fear of abandonment, and they never get help.

As a result, either they continue to feel insecure in their relationships or they choose not to be in a relationship at all because their fear is so great.

If you feel stuck in your fear of abandonment, you're not alone.  You can seek help from a licensed mental health professional who has experiencing helping clients to overcome this fear.

Once you've overcome you're fear of being abandoned, you can live a more fulfilling life.

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

I have helped many clients to overcome their fear of abandonment so they could lead happier, more fulfilling lives.

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

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











































Monday, August 22, 2016

Psychotherapy Blog: Fear of Abandonment: Leaving Your Relationship Because You're Afraid of Being Abandoned

Fear of being abandoned is one of the most common reasons why people come to therapy (see my article: Overcoming Fear of Abandonment).  For adults who have experienced early traumatic abandonment, the fear can be so great that, without realizing it, they abandon others first because they fear being abandoned (see my article: Overcoming Childhood Trauma).

Fear of Abandonment: Leaving Your Relationship Because You're Afraid of  Being Abandoned

A person who has experienced traumatic abandonment as a child can get easily triggered.  To someone who is looking at the situation from the outside, it might be hard to understand what precipitated this trigger.  But to the person who fears being abandoned, the fear is very real at the time.

Often, the emotional trigger is unconscious so that the person who fears being abandoned might not even know what caused him or her to react.

People who fear being abandoned will often say that they felt panicky at the time and would do anything to avoid feeling abandoned.  They will often describe the feeling as a sudden rush of emotion that comes over them which they feel they can't control.

Sometimes, in hindsight, when they no longer feel triggered, they say they realize that they overreacted to a particular situation.  But realizing this often isn't enough to prevent it from happening again because it's not a conscious response--it's an unconscious response.

The fear is usually related to an unresolved childhood trauma.  In other words, it already happened, but the emotions are so strong that it feels like it's happening now.

Even though a romantic partner can try to be understanding when this occurs, over time, s/he might give up on the relationship because it becomes too painful to keep going through one breakup after another, especially if the partner also has abandonment issues, which isn't so unusual.

So, unfortunately, this becomes a self fulfilling prophecy for the person who feels abandoned.  This becomes "proof" that his or her fears were real in the here and now and not just related to early traumatic experiences.

In order to understand this dynamic better, let's take a look a fictional vignette, which represents many different cases where these dynamics are common:

Cindy:
Cindy came to therapy because she was deeply afraid that her boyfriend, John, would leave her.  She told the therapist that whenever she felt this way, she would panic and want to leave the relationship before her boyfriend left her.

There were times when she could calm herself enough so that she could tell herself that there was no rational reason for her to feel this way.  At those times, she would realize that her boyfriend, who was loving and kind, gave her no indication that he wanted to leave her.

But there were other times when she tried to use the same type of self talk to calm herself, but it didn't work.

Contrary to everything that she knew about her boyfriend, she felt sure that he was going to leave her, and she knew she couldn't tolerate that.  So, she would end the relationship abruptly, telling her boyfriend that she knew he wanted to end it with her and she would rather end it herself rather than wait for him to end it.

Fear of Abandonment: Leaving Your Relationship Because You're Afraid of Being Abandoned

When Cindy was feeling most fearful, no matter how much her boyfriend told her that he had no intention of breaking up with her, she just "knew" that he would, so he couldn't convince her not to breakup with him.

When she talked to her therapist about it, in hindsight, she was able to describe how she felt "in control" of the situation during those times when she ended it.  She felt like she had averted a "catastrophe" in her life.  But shortly afterwards, she felt miserable because she missed her boyfriend and she regretted breaking up with him.

Cindy asked her therapist, "Why am I doing this?  Am I losing my mind?  How can I feel like I'm in control when, in reality, I'm completely out of control?"

As they talked about Cindy's family background, it soon became apparent what was getting triggered for Cindy.

Cindy was raised by a single mother and her mother's parents.  When Cindy was four, her mother moved away from their home town to take a job in another state where there were better employment opportunities.

Many years later, Cindy found out that her mother and grandparents were very ashamed of the fact that Cindy's mother, who never graduated high school, couldn't find a job in their town and she had to move away to take a job as a domestic worker in another town.  They were so ashamed of it that it became the "family secret" (see my article: Toxic Family Secrets).

Since it was the "family secret," no one talked to Cindy about this before her mother left.  Cindy's mother and maternal grandparents mistakenly thought it would be best not to mention anything to Cindy beforehand.  So, one day when Cindy came home from playing with a friend and she asked her grandmother where her mother was, her grandmother told her that the mother would be back "in a little while."

As day turned to night, Cindy became worried when her mother didn't come home.  Her grandparents responded by trying to distract her, but all Cindy could think about was that something awful must have happened to her mother.

Her mother and grandparents loved Cindy and they had no intention of hurting her.  They just didn't understand how damaging this would be for Cindy.  They thought "she's young, she'll get over it."

Fear of Abandonment

As days turned into weeks, Cindy became sad and angry.  She also felt guilty and ashamed because she thought she did something to make her mother leave her.

Until then, she had always been well behaved, but as she felt more and more frustrated by her grandparents' excuses about her mother, she would have temper tantrums, refuse to eat and refuse to go to bed.

After a while, when her grandparents saw that Cindy was inconsolable, they told her that her mother had to go away for a while and she would be back.

When she asked why, they wouldn't talk to her anymore about it.  So, Cindy assumed that they were lying and that, for sure, something awful happened to her mother and they just didn't want to talk about it.

Cindy became a very anxious child.  She remembered having nightmares where she would see her mother and ask her why she left and her mother would just smile and then fade away.

Several months after her mother left, the mother returned to the household, which was shocking to Cindy.  She remembered wondering if she was dreaming.  The mother and the grandparents didn't understand why Cindy seemed so shocked when she saw her mother.

After that, even though she normally slept by herself, Cindy insisted on cuddling with her mother and holding onto her mother's pajama top throughout the night.  She was so afraid that her mother would leave again that she felt she had to hold on to her.

Even though her mother remained in their town, Cindy never got over the feeling of being abandoned by her mother and always feared that her mother would leave again without telling her.

Years later, when she got into a relationship with John, she had a hard time whenever he had to go on a business trip. She feared that there would be some calamity that would take him away from her, like a plane crash, or that he would decide not to return.

There were so many things that would trigger her fear of being abandoned that John would avoid telling Cindy certain things too far in advance because he didn't want her to suffer the whole time.  Cindy came to realize that John would try to avoid telling her about his business trips too far in advance and this only made her more anxious.

Although he was normally patient, John was starting to feel exasperated because he didn't know what to do.  Cindy could see how frustrated John was and this was another trigger for her to worry about him leaving her.

At that point, John suggested that Cindy see a therapist to work on her fear of being left.

Cindy's therapist used EMDR Therapy to work on the current fear related to John and they eventually went back to her earliest memory related to her mother leaving (see my article:  How EMDR Therapy Works).

The work wasn't easy or fast, but Cindy had a felt sense of the connection between her current fears of being abandoned and the earlier, deeper fears.

Overcoming Your Fear of Abandonment

With EMDR therapy, she was able to work through her fears, both the current fear and the early fears of being abandoned so that it was no longer a problem for her.

Conclusion
Fear of abandonment is one of the most common reasons why people come to therapy.

This fear is usually related to earlier memories that get triggered in a person's current life.

Often, the fear can be so intense that the person would rather leave his or her partner or spouse first than anticipate being left.

This dynamic can repeat itself over and over again in different relationships until the trauma is worked through in therapy.

Experiential types of therapy, like EMDR, are especially effective in helping clients to overcome traumatic memories (see my article: Experiential Therapy, Like EMDR, Can Help to Achieve Emotional Breakthroughs).

Getting Help in Therapy
If you have fears of being abandoned, you're not alone.

Experiential therapy is usually effective in helping clients to overcome this fear.

Rather than continuing to enact your fears, you could work with a licensed mental health therapist who has experience helping clients to overcome trauma.

Once you're free from the effects of your history of trauma, you'll be free to live 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.

Over the years, I have worked with many clients to help them overcome their fear of abandonment.

To find out more about me, visit my website:

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











































Monday, August 15, 2016

How Compartmentalization Can Be Used As a Healthy Short Term Coping Strategy in Therapy

Compartmentalization is a defense mechanism that is usually discussed in negative terms.  Used as a unhealthy coping strategy, compartmentalization is usually used to avoid feeling the discomfort of conflicting thoughts or behaviors that are contrary to one's values or beliefs (see my article: Living Authentically Aligned With Your Values).

How Compartmentalization Can Be Used as a Healthy Short Term Coping Strategy in Therapy

There are many examples of how compartmentalization can be used to avoid feeling uncomfortable.

So, for instance, an otherwise ethical person might use compartmentalization to deal with conflicting feelings about cheating on her taxes.

Another person, who is usually loyal, might compartmentalize his guilty feelings about an extramarital affair.

But a healthy form of compartmentalization can also be used as a short term coping strategy to help you get through a difficult time.  The emphasis is on short term because as a long term coping strategy compartmentalization usually backfires, which I will discuss in the first fictional vignette in this article.

To a certain extent, most of us compartmentalize as a temporary coping strategy whether we realize it or not.  Just like many defense mechanisms, compartmentalization on a short term basis, can help you get through certain experiences in life temporarily so you don't feel emotionally overwhelmed.

Most of us have had the experience of having to put certain disturbing issues on the back burner temporarily to focus on what's pressing at the moment.

The alternative to putting certain issues on the back burner would be to try to cope with all your problems at once, the most pressing and the least pressing, all at once.

Not only would this be psychologically exhausting, but it doesn't work.  Trying to focus on everything at once means that you're not really focusing on anything with any degree of attention or clarity.

Fictional Vignettes
Let's look at two fictional vignettes.  The first one is an example of an emotionally unhealthy way of using compartmentalization and the second one is an example of a healthy way of using compartmentalization as a short term coping strategy.


Vignette 1:  Compartmentalization As An Unhealthy Coping Strategy
Bob was happily married, successful in his career and he had many friends.

Most people who knew Bob, including his wife, children, other family members, friends and colleagues, thought of Bob as being a loving, smart, friendly, responsible and practical person.

Their view of Bob was based on the wholesome way he lived in most areas of his life--except for one that they didn't know about:  His secret compulsion to gamble.

Not only did Bob keep his compulsive gambling a secret from those who were close to him, but he kept his own emotions of guilt and shame compartmentalized within himself to avoid feeling uncomfortable that he was engaging in behavior that went against his values and his beliefs.

Compartmentalization as an Unhealthy Coping Strategy

His compulsive gambling was a split off part of himself, like a modern day "Dr. Jekyll and Mr. Hide."

This compartmentalization was not like having a split personality where the different aspects of a personality aren't known to the core personality.

The compartmentalization was more like a form of dissociation:  When he was gambling, he was fully immersed in that activity and he didn't allow himself to think of the negative consequences for himself and his family.  And when he was with his family, he didn't allow himself to think about the compulsive gambling.

This strategy helped him to avoid feeling the emotional conflict of behaving in a way that was shameful to him.

But after a particularly bad losing streak where Bob lost most of the family's savings and he was unable to meet his next mortgage payment, his worlds collided in a devastating way.

He felt the full negative impact of the guilt and shame that he was trying to avoid when he was faced with talking to his wife and children about his devastating loss.

Aside from dealing with his family's shock, anger and disappointment, Bob felt so emotionally overwhelmed that he considered suicide.  But when his wife's anger and sense of betrayal cooled off to the point where she could speak with him, she gave him an ultimatum:  Either get help or she would divorce him and take the children.

Shortly after that, Bob came to individual therapy to start picking up the broken pieces of his life and he and his family also participated in family therapy.


Vignette 2:  Compartmentalization as a Healthy Short Term Coping Strategy
Alice was going through an emotionally challenging time in her life.

She was trying to cope with the care of her elderly mother, who was partially disabled as a result of a recent stroke; her husband's recent job loss, and helping her son through the college application process at the same time that she was starting up a new business.

Compartmentalization as a Healthy Short Term Coping Strategy

Several months ago, when she began taking steps to start her own business to provide coaching to people who wanted to improve their public speaking skills, her life had been going fairly smoothly.

But within weeks, her husband was laid off from work, her mother had a disabling stroke and her son needed a lot of her attention choosing a college.

Initially, Alice felt so overwhelmed and emotionally paralyzed that she considered abandoning the development of her new business and going back to her old job just to have stability in one area of her life.

At the same time that Alice considered going back to her old job, she felt the full weight of how disappointing it would be for her to give up a long held dream that she was on the verge of accomplishing.

She talked to her husband and sons as well as close friends to get help with her decision.  But she got conflicting messages.  Her husband and sons encouraged her to persevere with her goals, but her close friends told her to play it safe and go back to her former job.

Not sure which way to go, Alice started therapy to get help.

After learning basic coping strategies, including breathing exercises, meditation and other self care strategies, Alice felt that she had a lot more clarity about her situation and she was able to mobilize herself.

She looked into her mother's insurance and discovered that they would pay for several hours of a home attendant's services. After talking to her siblings, they agreed to pitch in to help with the mother's needs.

Alice and her husband talked about their financial situation, which was good.  Her husband also felt confident that he would get another job with a former boss or, if not, he would use his extensive network of colleagues to find another job.

He encouraged her to go for her dream and not delay any further.  He also told her that he thought she could go back at any time to her former employer, who would love to have her back, if her business didn't work out.  In addition, he agreed to take a more active role in helping their son with the college application process.

As a result, Alice began the process of developing her new coaching business.  She designed a website and she began making contacts to market her business.

But every so often, even with her newly developed coping strategies, Alice felt overwhelmed, especially about not being more active in terms of her mother's care.

She talked about her feelings in her therapy, and her therapist helped Alice to see that her feelings that she "should" be doing more to help her mother were part of older issues in her family where family members were overly dependent upon her, even when she was a young child (see my article:  Working Through Emotional Trauma: Learning to Separate "Then" From "Now" in Therapy).

Alice and her therapist both agreed that, since she already had so much going on now, the current time wasn't right for her to work on her earlier unresolved trauma.  They agreed that they would put this issue on the back burner for now and her therapist would help her to temporarily compartmentalize her feelings so that she wouldn't be overwhelmed by them.

Whenever Alice began to feel guilty and ashamed about not doing more for her mother, she reminded herself that these feelings were based on her past (then) and had nothing to do with the present (now).

Whenever she did this, and sometimes she did it several times a day, Alice was able to put aside her worries and focus on developing her new business.

Alice used this short term coping strategy of compartmentalization until her life calmed down:  Her husband got a new job, her mother made progress in out patient rehabilitation to be more independent, and her son completed the application process.

After her life calmed down and after she began to get referrals for her business, Alice's therapist told her that she thought Alice was ready to deal with the early unresolved emotional trauma.

At that point, Alice asked her therapist why she needed to deal with it at all.  She felt she could continue to remind herself whenever she felt guilty or ashamed that this was related to her history and not to her life now.

But her therapist reminded Alice that using compartmentalization in this way was only a temporary strategy so she wouldn't become emotionally paralyzed.  It wasn't going to resolve her problem.  Sooner or later, there would be another life event that would trigger these feelings and it would be best to work on resolving the old trauma.

Her therapist talked about how soldiers who are in battle learn to compartmentalize their emotions so that they can be effective at the time.

But if these soldiers continued to compartmentalize their emotions once they got back from battle, they could develop serious emotional problems, including posttraumatic stress disorder (PTSD).  This is why they need to get help in therapy to deal with the trauma of war--so that it doesn't have a lasting negative impact on their lives, including getting emotionally triggered, anxious and depressed.

Similarly, Alice needed to work through the unresolved childhood trauma so that she wouldn't continue to get triggered in her life.

By that point, Alice trusted her therapist and they began to use effective trauma treatment modalities, including EMDR Therapy (Eye Movement Desensitization and Reprocessing) and Somatic Experiencing to help Alice to overcome the unresolved trauma (see my articles:  Somatic Experiencing: Tuning Into the Mind-Body Connection and Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

By the time she completed, Alice worked through her unresolved trauma and she was no longer triggered by difficult life events (see my article: Psychotherapy to Overcome Unresolved Childhood Trauma).

Compartmentalization as Healthy Short Term Coping Strategy

She was glad that she was able to put aside the emotions that were paralyzing her so that she could eventually work through her childhood trauma when she was ready.

Conclusion
Compartmentalization, like most defense mechanisms, is a form of denial.

If it is used as a long-term strategy to avoid uncomfortable emotions associated with thoughts and behavior that contradict important beliefs and values, it will eventually backfire, as it did for Bob in the first fictional vignette.

When compartmentalization is used as a short term coping strategy with the understanding that the dissonant emotions are temporarily being placed on the back burner until there's a better time to delve into them, it can be an effective strategy under the guidance of an experienced mental health professional who can provide support and teach other coping strategies.

Depending upon a client's emotional state and what's going on at the time, an experienced psychotherapist can assess when it's the right time to work on resolving the problem so that a client doesn't get stuck avoiding it (see my article: Changing Maladaptive Strategies That No Longer Work For You: Avoidance).

Getting Help in Therapy
If you're feeling overwhelmed and you're having difficulty coping with your emotions, you could benefit from working with a licensed psychotherapist who help you in therapy to develop the necessary coping strategies and, eventually, when you're ready, to work through the problem (see my article:  How to Choose a Psychotherapist).

Rather than using denial as a permanent strategy to deal with uncomfortable emotions, get psychological help so you can eventually work through your problems.

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

I have helped many clients in my private psychotherapy practice to work through their problems to lead a more fulfilling life.

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.