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Wednesday, November 25, 2009

Relationships: Oxytocin, Trust and Empathy

After I wrote my post yesterday about psychotherapy, gratitude and balance, which was in keeping with the Thanksgiving holiday, I read a fascinating article by Nancy Angier in the Science Times section of the NY Times that piqued my interest. The article is called 
The Biology Behind the Milk of Human Kindness.

Relationships: Oxytocin, Trust and Empathy

Research Links Oxytocin to Increased Levels of Trust and Empathy
Ms. Angier discusses new research linking the hormone, oxytocin, to increased levels of trust and empathy. (Oxycotin is a naturally-occurring neurotransmitter in mammals--not to be confused with the drug, Oxycodan).

Relationships: Oxytocin, Trust, Empathy

Prior to this research, researchers have long known that oxytocin has aided in child birth (many doctors inject women in labor with oxytocin to induce labor), breast feeding, and that it usually increases naturally during sexual arousal and orgasm.

Oxytocin Facilitates Bonding and Has Implications For Relationships
Researchers have also known that increased levels of oxytocin facilitates bonding between mothers and babies in humans and other mammals. It is also generally accepted that when there is sexual chemistry between two people, there are high levels of oxytocin and when there is a lack of sexual chemistry, there are lower levels of oxycotin.

Oxytocin Facilitates Bonding and Has Implications For Relationships

However, this new research, which links increased levels of oxytocin with a greater capacity for trust and empathy has important implications for our relationships.

If you haven't read Ms. Angier's article in Science Times, I recommend that you take a look at it to understand the connection between oxytocin and our ability to feel trust and empathy in our relationships (see link that I have provided at the top of this post).

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

One of my specialities is helping individuals and couples to enhance their personal and work-related relationships.

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

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



Tuesday, November 24, 2009

Psychotherapy, Balance and Gratitude

A common myth about psychotherapy, especially among people who have never been in in-depth psychotherapy before, is that clients primarily "complain" to their psychotherapists about their families and their lives or come in to "fix" a particular problem. 

This is a very narrow view of psychotherapy and does not take into account the full richness and experience of the in-depth psychotherapy process as a place where clients, in addition to resolving particular problems, often find balance and gratitude in their lives, their relationships and for themselves as well.

During this Thanksgiving season, when we tend to be more aware of the people and things in our lives that we are grateful for, I'd like to focus in this post on how in-depth psychotherapy often leads to a greater sense of balance and gratitude.

Often, when people first begin psychotherapy, they either come for a particular problem or they have a sense that "something is wrong" in their lives, but they don't know what it is. In our culture, our tendency is to approach problems in a logical, linear way: identify the problem, analyze the various options, chose an option, fix the problem, and the process is finished.

There's nothing wrong with this approach and, in many instances, it works very well. It also often works well for some specific problems in psychotherapy and hypnosis, like smoking cessation or overcoming a particular fear or phobia. However, in-depth psychotherapy can be so much more than this for people who are interested in finding a greater sense of balance and contentment in their lives.

How Contemporary Psychotherapy Has Evolved Over the Years:
As psychotherapy has evolved over the years, there has been more of an emphasis on cultivating and building a more balanced sense of self. As opposed to more classical ways of working in psychotherapy where the emphasis was primarily on uncovering and working through problems, contemporary psychotherapists also help clients to build a stronger sense of self.

This is done, in part, through the development of clients' internal resources. These internal resources can take many different forms. Sometimes, they're coping abilities that clients have had all along but have been overlooked and under utilized. Often, they're internal resources, or parts of ourselves, that are discovered and developed during the psychotherapy process.

When people are depressed or anxious, it's common to focus on what's wrong or missing in their lives. This is understandable. Often, under these circumstances, their view starts out being narrow until they begin to feel some relief from their anxiety-related or depressive symptoms in a supportive psychotherapy treatment environment.

In contemporary in-depth psychotherapy, clients can begin the process of building a stronger sense of equanimity: a greater capacity to soothe themselves, love and value themselves more, appreciate subtle and richer aspects of themselves, and develop a stronger sense of identity.

With a greater sense of balance for themselves often comes an increased capacity to value and have a greater sense of gratitude and compassion in their relationships, their work, and other important areas in their lives. So, what might have started as a narrow view at the start of psychotherapy begins to open up and broaden to include a more holistic and nuanced view of themselves and others: Not just what's wrong--but what's right too.

Keeping a Gratitude Journal:
I often recommend to clients that they keep a gratitude journal as a way to start developing a greater awareness and appreciation for the positive things that occur in their lives on a daily basis. The gratitude journal can be a simple list of two, three or more things that you feel grateful for each day. Over time, cultivating a sense of gratitude, even for the small things in life, can help to create a greater sense of balance, appreciation, and compassion in how we see our world as well as how we see ourselves.

I wish everyone a happy and healthy Thanksgiving.

I am a psychotherapist and hypnotherapist in NYC. I have helped many clients to develop a greater sense of self and an increased sense of balance and gratitude in their lives.

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

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

Friday, November 13, 2009

Relationships: How Your Stress Can Affect Your Spouse and Children

In a New York Times, there was a article called Job Woes Exacting a Heavy Tole on Family Life  by Michael Luo.

The article focused on a particular family and how the father's job loss lead to emotional strains in his marriage as well as stress-induced behavior in his children. According to Mr. Luo, the family was holding up financially, but the children were picking up on the father's stress and anxiety and the tension in the marriage, and this created a lot anxiety for the children. After the father obtained a job, he and his wife began marriage counseling to deal with the fall out of this crisis in their lives and to save their marriage.

As a psychotherapist in NYC, I see many clients who are under emotional strain for a variety of reasons. For many, even if they haven't lost their jobs, they're worried about the possibility of losing their jobs at some point in the near future.

Other clients are under enormous stress and anxiety for other reasons. What I especially liked about the New York Times article is that it highlighted how spouses and children are affected emotionally (and not just financially) by the problems of one or both parents.

Often, clients will tell me that, even though they're feeling anxious or depressed, they think that they're hiding it from their family and it's not affecting them.

What they often don't realize, and what I will discuss with them, is that their spouses and children usually do notice and feel their emotional strain. 

When one or both parents are going through an emotional crisis, the whole family is affected, as stated in the New York Times article. Fortunately, according to Mr. Luo, the family mentioned in the article was able to put their lives back together because the parents recognized that their marriage and children were adversely affected by the father's anxiety.

Over the years, I've observed that many people think that young children don't understand their parents' emotional strain and, as a result, the children are not affected emotionally.

However, while it may be true that young children might not understand the nature of their parents' problems, they often do understand that "something is wrong" and "mommy and daddy aren't happy." Children are a lot more emotionally attuned to their parent's moods than most people think. When their parents are worried, depressed or not getting along, most children worry and often feel emotionally unsafe.

You might think that you're hiding your emotions under a facade that "Everything is all right" or by telling your children that "Nothing is wrong," but they usually know better. And, in fact, by trying to pretend to your children that everything is fine, when they sense that it's not, it becomes even more worrisome for them.

Of course, this doesn't mean that you're going to go to the other extreme and talk to your young children as if they were adults. But it does mean that you can talk to them, at a level that is appropriate for their age, and assure them that you love them and you're going to do everything you can to make sure that they're safe and secure.

It might also mean that, if your emotional strain is not likely to let up any time soon, you will need to find ways to cope with it to manage your stress and assure your own emotional well-being. This might mean that you begin a walking regimen, begin taking a yoga class, learn to meditate and do deep breathing, or any one of a variety of stress management techniques.

The main point is that, when it comes to your spouse's and children's well-being, what you say to them is much less important than what they observe in you. If they observe that you're depressed and anxious about a particular problem and you deny it or try to put up what you think is a good front, they're going to respond to and be affected by your overall emotional demeanor more than your words.

Young children usually don't have the cognitive or verbal capacity to explain to their parents that they feel anxious or depressed about the parents' problems. But parents can see it in other ways: a child's good grades suddenly plummet, a child who is normally well-behaved in school begins talking back to the teacher or fighting with other students, a child who usually sleeps well by himself suddenly becomes too afraid of the dark and wants to sleep with his parents, a child begins to pull out her hair because she is overcome with anxiety (as seen in the New York Times article), siblings who usually get along begin fighting, a 10 year old child might begin wetting the bed, and so on.

When parents are in denial about how their own problems affect their children, they might only consider external factors outside the family: the schoolteacher is not doing a good enough job, the boy next door is a bad influence, maybe someone in the neighborhood is bothering their child, etc.

Denial is a powerful emotional defense and we use it to ward off emotions that are difficult for us to handle. For many parents, it's too hard for them to believe that their own problems are the cause of their children's anxiety.

Often, individuals and couples come to psychotherapy after they come to terms with the fact that their problems are causing stress-induced problems in their children. As they learn to cope with their problems in a better way, often, this restores a sense of emotional equilibrium to the rest of the family.

As I think about this, I'm reminded of the safety advice that flight attendants give to passengers who have children with them on the flight: Put your oxygen mask on yourself first before you put the oxygen mask on your child. Although it might seem counter-intuitive at first, it makes perfect sense when you think about it: If you don't take care of yourself first, you won't be able to take care of your child.

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

To find out more about me, visit my web site: http://josephineferrarotherapy.com

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






Thursday, November 12, 2009

Psychotherapy: Getting the Most Out of Your Therapy Sessions

As a psychotherapist in NYC, I often see clients who are coming to psychotherapy for the first time or clients who have been in therapy before where they didn't have a positive outcome.

Psychotherapy:  Getting the Most Out of Your Therapy Sessions

Participating in psychotherapy involves a commitment of time, effort, and money. If you've never participated in psychotherapy or if your prior therapy experience was not a positive one, you might not know what to expect from your therapist or what your therapist expects of you. So, I usually like to talk to new clients about this so they can understand the treatment frame and they can get the most out of their sessions with me.

Choosing a psychotherapist:

A Good Therapeutic Relationship:
If you're trying to find a psychotherapist in a large city like NYC, you usually have many therapists available to you, especially if you have the ability to go outside of your managed care network.

Generally, the most important factor in choosing a psychotherapist is whether or not you feel a rapport with him or her. This might not be evident immediately. It takes time to build a professional rapport with your therapist. Having a good therapeutic working relationship is usually the best predictor of whether or not your therapy will be successful.

It's important to feel that your therapist has empathy and cares about you within the bounds of the professional treatment relationship.

Not every therapist is for every client. Someone else might really like a particular therapist and establish a good rapport with that therapist, whereas you might feel that you're not connecting with that same therapist. It doesn't mean that there's anything wrong with you or necessarily wrong with the therapist. It means that we're all unique and what works for one person might not work for someone else. Usually, after a few sessions, you can tell intuitively if you're connecting with a particular therapist.

Establishing a good therapeutic relationship doesn't mean that you're always going to "feel good" in your psychotherapy sessions. After all, the change process can be challenging and you might be discussing topics that bring up uncomfortable emotions. So, it's important to distinguish between those feelings and the overall rapport you feel with your therapist.

Different Types of Psychotherapy:
Aside from feeling a rapport with your therapist, there are also many different types of psychotherapy.

As a psychotherapist, I work in many different ways, depending upon the needs of the client: psychodynamic psychotherapy, cognitive behavioral treatment (CBT), EMDR (eye movement, desensitization and reprocessing), clinical hypnosis (also known as hypnotherapy), and Somatic Experiencing are among the different treatment modalities that I use.

You might find that you like and respond best to certain forms of psychotherapy and not others. Obviously, you're not responsible and cannot be expected to know about these different forms of psychotherapy before you start therapy, but you can ask any prospective therapist about them, and he or she should be able to explain in plain English any treatment modality that he or she uses.

Choosing A Licensed Psychotherapist:
It's important that whoever you choose is a licensed mental health professional.

There are people who call themselves counselors or therapists who have no professional training, expertise or psychotherapy background. They might be very nice people but, in most states, including New York State, if they're not licensed, they're not psychotherapists.

Knowing that your therapist is licensed lets you know that he or she mets the basic professional requirements in his or her profession.

It doesn't guarantee that he or she will be a good therapist or the right therapist for you, but it demonstrates that the minimum requirements stipulated by your State have been met. It also means that the therapist is governed by a State professional licensing bureau and is ethically bound and accountable to that bureau.

If you're not sure, you can ask your therapist. You can also check with the State professional licensing board. In New York State, you can go to the Office of the Professionals - NYS Education Department: http://www.op.nysed.gov/ and go to the section for verifications.

Choosing a Psychotherapist Who Stays Up-to-Date With Current Practices:
Aside from meeting the minimum requirements for licensing, you should ask any prospective psychotherapist that you're considering about his or her background and training. Generally, you want someone who has stayed up-to-date with current practices.

Psychotherapy:  Choosing a Therapist

Often, clients who would be concerned about these issues when choosing a doctor, don't think about it when they're considering a psychotherapist.

So, for instance, if you needed surgery, you would want to make sure that your surgeon continued to get training beyond his or her medical school training and stayed current with state of the art medical and surgical practices, especially for your particular medical problem. You wouldn't dream of seeing a surgeon who said, "I've never done this type of surgery before, but I'm happy to try it out on you" or "It's been a long time since I've performed this surgery. I might be rusty, but I think I can muddle through."

It's no different with psychotherapy. If a prospective therapist has not continued to train beyond graduate school, in my professional opinion, this isn't a good sign.

Ethical Considerations in Psychotherapy:
Ethical considerations in psychotherapy is a vast topic. There have been many books and articles written about it. I cannot possibly do justice to this topic in one posting. I think the vast majority of psychotherapists are ethical and caring people who want to help their clients. However, unfortunately, there are instances where there are boundary violations which are detrimental to the client. I will touch on some important factors:

"Dual Relationships" in Psychotherapy Are Unethical:
The psychotherapeutic relationship is unlike most relationships. It's different from a friendship or a familial relationship, even though you're talking about very personal things about yourself. Your therapist is not going to be your friend, not even after you stop therapy with him or her.

Psychotherapists' code of ethics considers it a boundary violation for therapists and clients to be in "dual relationships." That means that your relationship with your therapist will be strictly professional and limited to your therapy

Even though your therapist might have a warm and friendly manner, as a mental health professional, he or she is responsibile for maintaining clear and consistent boundaries.

Getting romantically or sexually involved with clients or taking advantage of clients in other ways is strictly forbidden. If a therapist seduces you into a romantic or sexual relationship, he (or she) can lose his license. You have the right to report the therapist to his or her professional board of ethics sessions (see my article:  Boundary Violations and Sexual Exploitation in Psychotherapy).

The therapy should be focused on you. An ethical therapist will not be discussing his or her own personal problems or focusing on him or herself.

This is another way that the psychotherapeutic relationship is different from most other relationships. Depending upon the psychotherapist, most therapists do not disclose a lot of personal information, especially if the therapist works in a psychodynamic way. The primary reason for this is, once again, to keep the focus on you.

That doesn't mean that the therapist might not selectively disclose certain things about him or herself if it's in the service of furthering the treatment.

Therapists' self disclosure is also another vast topic. Generally, even the most conservative psychoanalysts today no longer believe that they are "blank screens" for clients to project their thoughts and fantasies on. However, it's important to understand that if a therapist is not disclosing personal things about himself or herself, it's usually in the service of providing the best possible treatment for you.

Ethical Issues Regarding Managed Care Fees:
If your therapist is an in network provider on your managed care insurance panel, he or she should not be asking you to pay additional money, beyond your copayment, to bring your fee in line with his or her non-managed care fee structure.

When your therapist is on a managed care panel, he or she signed a contract with the managed care company to accept their fee. The contract also stipulates how to handle missed or broken appointments. If your therapist asks for additional money beyond what is allowed in the insurance contract, this is insurance fraud and is reportable to your insurance company and your therapist's professional board of ethics.

Also, most managed care companies don't allow your psychotherapist to charge the insurance for your missed or broken appointments. This is a contractual issue between your therapist and your managed care company.

That means that, in most cases, you are often responsible for the entire fee (not just the copayment) when you have a broken appointment with your therapist. This is a topic that should be discussed at the first sssion so that you're clear about your responsibility with regard to missed appointments. If you're not clear, you can call your insurance company and ask.

Some therapists bill the managed care company for broken appointments, even though it's against their contract with the insurance company. Possibly, they feel that they're being nice to clients by not charging them or they're trying to preserve the therapeutic relationship. However well intentioned this might be, you should know that, unless an insurance contract allows for this (and I don't know of any that do) this is insurance fraud and your therapist can lose his or her license for this.

Doing Your Part in Psychotherapy:
Usually, the therapeutic hour is somewhere between 45-60 minutes per week for individual therapy, depending upon your therapist and the type of therapy. An hour out of a week is not very much time. So, if you want to get the most out of your therapy, it's important that you know what is expected of you in therapy.

Doing Your Part in Therapy

Showing up for your appointments:
This might seem obvious, and most clients don't start therapy with the intention of not showing up for their appointments. However, it's not unusual to feel ambivalent about going to therapy. Clients will often start therapy saying that they want change, but the process of change is sometimes diffiicult, and when a client and therapist begin to discuss topics that are uncomfortable, some clients begin missing appointments.

They might not even realize that they're missing appointments because of their discomfort. Emotional discomfort and ambivalence can show up in many different guises: "forgotten" appointments, missing therapy because you feel "tired," and other reasons that might mask an unconscious wish to avoid change. Clients might also begin arriving late for their appointments as an unconscious way to avoid dealing with the process of change.

Thinking About What You Discussed in Therapy Between Sessions:
As I've mentioned, the therapeutic hour is brief compared to the rest of the time in your week. If you want to get the most out of therapy, it's important to think about what you and your therapist have discussed. That means taking time during the week to think or journal about the issues and feelings that come during and after your session.

It's also important to apply whatever you've learned in your every day life. Your therapy will be of little value to you if you have insights in your therapy session, but you forget them once you've left the therapist's office. Also, pay attention to whatever emotions come up between sessions and let your therapist know, even if you might feel uncomfortable. Chances are, if you're seeing an experienced, licensed mental health professional, he or she has already dealt with these issues before.

Doing Homework:
As a psychotherapist, I usually don't give a lot of homework to most clients between sessions. However, at times, I might recommend reading an article or a book, practicing something that has been learned in the session (like meditation or self hypnosis) or I might ask a client to journal or reflect on a particular issue or emotion. I might recommend attending a 12 Step meeting, getting a sponsor, etc.

I might also come to an agreement with a client to take a particular step or action to further the process.

For instance, if a client has problems with procrastination, it's important to talk about it and try to understand it but, ultimately, the client needs to take certain steps in order to overcome this problem. So, we might come to an agreement about what the next step might be to further the process along. Among other things, doing homework between sessions helps to bridge one session with another. A week might not seem like a long time, but in psychotherapy, it can be very long--enough time to forget or put out of your mind what you and your therapist have discussed. So, finding ways to bridge that time can be very valuable.

One posting about how to get the most out of your psychotherapy sessions is not enough to cover all the relevant topics. However, if you're thinking about starting therapy or if you're already in therapy, I hope this posting will be a good start for you and get you thinking about it.

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 lead more fulfilling lives.

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

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

Tuesday, November 10, 2009

Overcoming Sexual Addiction in Therapy

As a psychotherapist in NYC who specializes in sexual addiction, I've helped many clients overcome problems with sexual addiction. Both men and women, heterosexual, gay or bisexual can suffer with sex addiction. Like most addictions, sexual addiction can occur regardless of a person's age, race, ethnic background, sexual orientation, profession, income, religion, and educational background.
Overcoming Sexual Addiction in Therapy


What is Sexual Addiction?
Let's start out with what sexual addiction is not: Just because someone has affairs or looks at porn doesn't necessarily mean that he or she is a sex addict. If someone is cheating on his or her spouse or partner, this is obviously a problem, but it doesn't necessarily mean that he or she is a sex addict.

According to Patrick Carnes, Ph.D., a psychologist who is an expert in the sexual addiction field and who has written several books about it (see Resources below), someone who has a sexual addiction usually has some of the following characteristics:
  • A pattern of uncontrolled sexual behavior
  • Consequences (sometimes severe) to this uncontrolled sexual behavior. These consequences might include problems in his/her relationships due to sexual acting out behavior; legal problems, including arrest; work-related consequences as more and more time is spent preoccupied with sex rather than work or, among other things, getting caught downloading Internet porn or chatting online; and other similar consequences.
  • Ongoing efforts to try to stop sexual acting out, but an inability to stop engaging in sexual acting out despite consequences.
  • Pursuing self-destructive and high-risk sexual behavior. This might include getting drunk or high on drugs that leads to acting out sexually; meeting strangers for sex; going to known "cruising" areas to have sex with strangers in areas where he or she might get caught, beaten up or killed; engaging in sex without using contraception which could lead to a sexually-transmited disease, and other similar self-destructive and high-risk behavior.
  • Using sexual acting out to deal with untreated anxiety and depression, and the need to engage in more frequent or more dangerous sexual acting out as the current level no longer excites as much or wards off feelings of low self esteem or feelings of inadequacies
  • Large mood swings around sexual activity
  • Spending a significant amount of time either preoccupied with sex, sexual acting out or recovering from sexual activities
  • Neglecting important social, occupational or recreational activities due to compulsive sexual behavior
How Does Sexual Addiction Start?
The current American Psychiatric Association's Diagnostic and Statistical Manual for psychiatric disorders does not include sexual addiction as a separate diagnosis. This might change in future editions.

However, current research has found that there can be a genetic predisposition for sexual addiction. Current research has shown that there is often a family history of addiction, whether it is drug addiction, alcoholism or sexual addiction. In addition to the genetic component, when there is a history of addiction, the person who grows up in such a family also learns to self-medicate as a way of coping with painful emotions.



Sexual Addiction (both online and off) Affects Both Men and Women

Sexual Addiction Can Affect Anyone Regardless of Sexual Orientation

The Cycle of Sexual Addiction:
According to Patrick Carnes, the cycle of sexual addiction usually begins when the person has bad feelings about him or herself ("I'm unlovable," "No one cares about me," "I'm a bad person," "My needs will never be met in an ordinary relationship," and other similar negative feelings. When something negative happens to this person, it seems to confirm his or her feelings of low self worth. Since he or she has not learned good coping skills or healthy ways to deal with emotional pain, this person resorts to sexual acting out.

Prior to the sexual acting out behavior, the person who struggles with sexual addiction usually dissociates (i.e., unconsciously distances himself from his feelings) and enters into somewhat of an altered state where there is an emotional split between who he is in his every day life and who he is when he is acting out sexually. He becomes preoccupied with sexual fantasies that enable him to distance himself from his emotional pain. Once he enters into this dissociated state, he is more likely to act out sexually. There is often a ritualization to the sexual acting out. For example, part of the ritual might be to go to a strip club, get sexually aroused and then go see a prostitute to pay for sex or go home and participate in online sexual chat rooms or engage in some other form of infidelity.


Getting Help For Sexual Addiction in Therapy

Sexual acting out often relieves tension or regulates a depressed or anxious mood momentarily. However, this relief or elevation in mood doesn't last long. After acting out sexually, the person often feels an inordinate amount of shame, humiliation, guilt, and, often a higher level of depression or anxiety. At that point, the person who suffers with sexual addiction might promise himself and/or his spouse (if he is caught) that he will never do it again. However, this is part of the cycle of addiction, and the increase in painful emotions is often what fuels the next episode of sexual acting out. As a result, he is caught in the vicious cycle of sexual addiction, often needing more frequent, more intense or more dangerous forms of sexual acting out. The sexual addiction becomes a way to self-medicate painful emotions, similar to how alcoholics and drug addicts use alcohol and drugs to self-medicate.

When I work with people who have problems with sexual addiction, I start with a consultation to see if the client and I are a good therapeutic match. A good therapeutic match means that there is a good rapport between the client and the therapist. This might not be evident in the first session because most people feel very uncomfortable and ashamed of having a problem with sexual addiction. However, the client should feel at least comfortable enough to want to return for another session. When treatment is going well, the therapeutic alliance builds over time as the client gradually learns to trust the therapist.

I also assess clients for their motivation for change. It's not at all unusual for people to feel ambivalent about coming for treatment. Often, people come into treatment primarily because a spouse or an employer has urged them to come. This might be what gets someone into treatment and, initially, motivation might be low. The client might not even be sure if he or she has a problem with sexual addiction. However, if there is a problem, it's possible to develop your own internal motivation to overcome sexual addiction. Internal motivation is essential for a good treatment outcome. If your primary focus remains that you're doing it for someone else rather than yourself, you might need to do some soul searching in order to get to a place where you feel that you're doing it for yourself and you deserve to overcome this problem and lead a happier life.

Getting Help For Sexual Addiction


It's also important to know whether there is an underlying depression, anxiety disorder, attention deficit disorder or some other underlying emotional issue or trauma that needs to be addressed.

During treatment, I help a client to understand what triggers his sexual acting out. I also help him or her to learn new ways of coping, which is also essential to having a positive treatment outcome.

When you can anticipate what triggers your sexual addiction and you have other healthy ways of dealing with these triggers, you're more likely to stop the cycle of sexually acting out.

Depending upon the client and the underlying emotional issues, I might use cognitive behavioral treatment, psychodynamic psychotherapy, clinical hypnosis (also known as hypnotherapy) or EMDR (Eye Movement, Desensitization and Reprocessing) or a combination of these forms of psychotherapy to treat sexual addiction.

Going to self help meetings like Sex Addicts Anonymous or Sexual Compulsives Anonymous and getting a sponsor is also usually very helpful. It is also important to educate yourself with current literature about sexual addiction (see Resources below for information about 12 Step meetings and books).

If you're suffering with sexual addiction, you're not alone. Many people who are sexually addicted have been helped with psychotherapy and 12 Step meetings.

I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist.  I work with individual adults and couples, and I have helped many clients to overcome sexual addiction.

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

If you're thinking about treatment, you can call me at (212) 726-1006 to set up a consultation.

Resources:
12 Step meetings:
Sex Addicts Anonymous: http://www.saa-recovery.org/
Sexual Compulsives Anonymous: http://www.sca-recovery.org/

Inpatient Treatment:
The Meadows: http://www.themeadows.org/

Books:
Out of the Shadows: Understanding Sexual Addiction - By Patrick Carnes
Don't Call It Love: Recovery From Sexual Addiction - By Patrick Carnes
In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior - By Patrick Carnes
Lust, Anger, Love: Understanding Sexual Addiction and the Road to Healthy Intimacy - By Maureen Canning



photo credit: Daniel Conway via photopin cc

photo credit: nataliej via photopin cc

photo credit: NeezyGFX Photography via photopin cc

photo credit: Ronan_tlv via photopin cc

photo credit: DerrickT via photopin cc

Friday, November 6, 2009

EMDR for "Big T" and "Smaller t" Trauma

As a NYC psychotherapist who is an EMDR practitioner, I see clients for EMDR treatment for both "Big T" and "Smaller t" trauma. I will clarify what I mean by "Big T" and "Smaller t" trauma below.


EMDR For "Big T" and "Small T" Trauma

What is EMDR?
First, as I have written about in earlier posts, I want to reiterate that EMDR (Eye Movement Desensitization and Reprocessing) is a form of psychotherapy which has been found to be effective for healing trauma. Francine Shapiro, Ph.D., who is a psychologist, developed EMDR in the late 1980s.

Since that time, EMDR has been one of the most well-researched forms of psychotherapy for posttraumatic stress disorder (PTSD) and other types of trauma. It has been recognized as a safe and effective form of treatment by the Veteran's Administration, the American Psychiatric Association, the International Society for Traumatic Stress Studies, the Israeli National Council for Mental Health and the United Kingdom Department of Health, among other mental health organizations.

EMDR uses bilateral stimulation of the right and left brain hemispheres (through eye movements, alternate taping, bilateral music, and other similar methods) to activate the brain's "information processing system" to heal trauma.

When we are overcome by experiences that produce overwhelming emotional and physical reactions, often, our minds are unable to process these experiences.

Under certain circumstances, which are unique to each person, these overwhelming experiences can produce adverse reactions, like debilitating depression, anxiety and other psychological difficulties. EMDR allows clients to reprocess these experiences, allowing us to get to the root of these emotional processes, and usually produces a long-term cure.

EMDR therapists, who have advanced training, know how to work with clients in a way so that they are not overwhelmed with the EMDR reprocessing. Each client's experience is unique.

Generally speaking, high levels of emotional reaction tend to dissipate with EMDR treatment. Also, an experienced EMDR therapist makes sure that clients are well prepared for EMDR processing before the actual processing begins by working with clients to develop internal resources (coping skills) to deal with any uncomfortable reactions that might take place during the reprocessing of emotional trauma.

What is the Difference Between "Big T" and "Smaller t" Trauma?
EMDR is usually associated with what is referred to in psychological literature as "Big T" trauma. However, it seems that it is less well known that EMDR is usually very effective for "Smaller t" trauma as well.

"Big T" Trauma
When we refer to "Big T" trauma, we are usually referring to trauma that occurs during war or natural disaster, rape, kidnapping, physical attack, and other similar types of trauma. These types of trauma are usually so overwhelming for most people that they are unable to cope.

An example, of this is the Vietnam or Iraqi veteran who has witnessed atrocities during war and who comes home, relives these atrocities through flashbacks, where it adversely affects his or her ability to function in every day life.

Another example of "Big T" trauma is when a woman who has been raped continues to have nightmares about the rape; she ruminates about what happened, reliving the event over and over again in her mind.

An Example of a "Big T" Trauma Reaction: A Woman Who Was Raped Has Nightmares


 She might be too afraid to start new relationships or to even go outside.

Generally, "Smaller t" trauma is trauma that is more subtle than "Big T" trauma.

An example of "Smaller t" trauma can occur when we're children and we witness events that are upsetting and overwhelming to us because our child-like minds are unable to understand or process these events.

An example of a "Smaller t" trauma could be when a child witnesses loud arguments between his parents and he fears that they are going to get a divorce. As a child under these circumstances, it's normal to be concerned about his safety and well-being. After all, he worries about what will become of him and who's going to take care of him if his parents are not together.

These kinds of experiences can leave a mark on a child's psyche, leaving him vulnerable to feeling anxious, depressed, or insecure later on in life.

There are many other everyday examples of "Smaller t" trauma that people often don't recognize at the time when they're occurring. The emotional damage that has been done often does not show up until later on in life. Sometimes the events that led up to these problems later on are apparent and, other times, they're not. Either way, EMDR is usually an effective form of therapy to overcome the effects of "Smaller t" trauma.

Since most literature focuses on "Big T" trauma like PTSD, I would like to focus on "Smaller t" trauma in this post to illustrate its effects and how EMDR can help. The following vignette is a composite of many cases with all identifying information changed to protect confidentiality:

John:
When John first came to treatment, he was in his late 30s. He worked as an attorney in a large corporate law firm. Like most attorneys in his law firm, John hoped to become a partner one day in his firm.

Generally, he liked corporate law and enjoyed working with his clients. However, he felt very anxious around his boss because his boss was a bully. Whenever his boss felt that John fell below what was considered an acceptable rate of "billable hours," he berated him in the most demeaning way.

John understood the importance of "billable hours" and knew what was expected of him. He felt that, overall, he was a knowledgeable and capable attorney. However, whenever his boss berated him, John felt emotionally paralyzed.

John felt his confidence plummet and he would ruminate for days about whatever his boss told him. His colleagues experienced the same bullying from the boss and, although they were concerned about it, they were not as affected by it as John.

John Felt His Confidence Plummet

John recognized this and he knew that he needed to get help or his boss's tirades were going to continue to be detrimental to him. He realized that his reaction to his boss's comments were out of proportion to the current situation.

The First Phase of EMDR Treatment: During the first phase of EMDR treament with John, I obtained a detailed history from John about his background. From his family history, I learned that John's father was very much like his boss. He was hypercritical of John and often berated him, leaving him feeling like he could never please his father. If John came home with a report card with all A's and one B, John's father focused on the "B" and berated him for not getting an "A" in that subject, leaving John to feel badly about himself.

Developing Coping Skills: During that initial phase of treatment, I also helped him to develop basic coping skills. Since he didn't do anything to manage his stress, John began working out and going to yoga class. I also taught John to meditate.

In addition, we developed internal resources that he could use during EMDR processing. For instance, John learned to think about and visualize certain "protective" figures from his life (his grandfather, a kind uncle, his nurturing older sister, as well as a lifelong friend and confidant). Through EMDR processing, we worked to help John to internalize these protective figures in such a way that he could "call on them" (essentially, remember, visualize and sense them) when he felt emotional distress either in the psychotherapy session or outside. Just using these internal resources whenever he had to deal with his difficult boss helped John tremendously.

EMDR Processing: During the next phase of treatment, John chose a particular incident that occurred at work with his boss and we began to process that incident using EMDR eye movements. Initially, before the procesing, John rated this incident as a "9" out of a possible 10 in terms of how emotionally disturbing it was to him (with 0 being no disturbance and10 being the highest level of disturbance). So, overall, it started out as being very disturbing to him. However, as we continued to do EMDR processing, the incident became less and less disturbing. It gradually went down to a 5 for John. He felt relieved, compared to how he felt originally, but it was still disturbing. Further processing of that incident did not decrease John's level of disturbance.

When Processing of Trauma Gets Blocked: When the level of processing gets "blocked" (meaning that it stays at a certain level of disturbance and it won't go down to 0 or 1), it generally means there is underlying trauma that is feeding into the current situation and is making it more emotionally charged than it might normally be. Having already obtained John's family background, I was aware that John's relationship as a boy with his father was probably feeding into his current problems and activating his emotional response.

The Difference Between EMDR and Regular Talk Therapy for Trauma: If we were doing regular talk therapy, we might have discussed John's relationship with his father and how if affected him now.

It probably would have been enlightening to John but, usually, this would only remain as an intellectual insight. In other words, it's interesting and informative to know, but it doesn't produce any change. And therein lies the problem with regular talk therapy and trauma.

In addition to my EMDR training, I'm also trained as a psychoanalyst, so I understand and value psychodynamic treatment for most problems. However, when it comes to trauma, regular talk therapy is often limited in terms of resolving and healing trauma.

Processing the Earlier Trauma that Triggers the Current Trauma: So, knowing that there were probably earlier memories that were feeding into and triggering John's emotional reaction to his current situation, we did what is known in EMDR as a "float back."

During a "float back," the client thinks back to an earlier time when he might have experienced these same feelings. An experienced EMDR therapist might have a sense of what those memories might be, but he or she doesn't make any suggestions about them. The EMDR therapist allows the client to come up with whatever he or she remembers or senses.

In John's case, his earliest memory of feeling the same way as he did in his current situation was when his father berated him during Little League practice. According to John, he struck out each time that he was up at the plate during a big game with a rival team.

Afterwards, he was feeling bad enough, but when his father yelled at him in front of his team mates and the other parents, John was mortified. John rated his level of disturbance as being a "10" for this memory. Gradually, as we continued to process the memory with EMDR, his level of disturbance went down to a "0." When it went down to 0, he, of course, remembered the memory with all of the details, but he no longer felt disturbed by it.

Resolution of the Trauma: After we processed this earlier memory, which was emblematic of his experiences with his father, we went back to the current situation with his boss. As is usually the case, having reprocessed the earlier "Smaller t" trauma produced a "0" in terms of John's level of emotional experience in the current situation.

John was really surprised and greatly relieved. He was able to go back to work, deal with his boss, and when his boss saw that he could no longer intimidate John the way he used to, he stopped ranting at him and chose to bully another more vulnerable attorney instead.

EMDR For the Resolution of Trauma

EMDR Follow Up: When John checked in with me several months later, he told me that the results of our work continued to hold. He also said that his self esteem was now higher than it ever had been and his boss told him that he was on track to become a partner, which made John feel very happy.

The above vignette is one brief example that demonstrates how EMDR can work. Everyone's experience of EMDR is unique.

EMDR is an effective treatment for dealing with trauma, and it is usually faster than regular talk therapy.

Getting Help
If you have unresolved trauma, you could benefit from working with an experienced EMDR therapist who is a licensed psychotherapist.

To find out more about EMDR, visit the official EMDR website, EMDRIA, to get more information: http://www.emdria.org/.

To find out how EMDR is being used all over the US and around the world to help millions of people heal from trauma, visit the EMDR Humanitarian Association Program's (EMDR HAP) web site: http://www.emdrhap.org/.

I am a NYC licensed psychotherapist and EMDR clinician who has helped many clients resolve both "Big T" and "Smaller t" 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 send me an email: josephineolivia@aol.com



photo credit: shari anna heck via photopin cc

photo credit: CharlesFred via photopin cc

































Wednesday, November 4, 2009

EMDR Humanitarian Assistance Program

As an EMDR therapist, I receive many calls from clients who are seeking EMDR treatment for a variety of traumatic issues. EMDR (Eye Movement Desensitization and Reprocessing) is an effective treatment for trauma, including posttraumatic stress disorder (PTSD) and other emotional problems. It is often much faster than regular talk therapy in resolving trauma. It is one of the most researched forms of psychotherapy, and it is currently being used by the Veterans Administration and other organizations, like local Bureaus of Child Welfare, to deal with trauma.

Although many people know about EMDR, they are often not familiar with EMDR HAP (Humanitarian Assistance Program). The EMDR HAP is a 501(3)c nonprofit organization. On their web site (http://www.emdrhap.org), they describe themselves as "the equivalent of Doctors Without Borders: a global network of clinicians who travel anywhere there is a need to stop suffering and prevent the after-effects of trauma and violence." EMDR HAP was on the scene in the Gulf Coast after hurricane Katrina. EMDR HAP volunteer clinicians are also in the Middle East and many other parts of the world where there are wars and natural disasters.

If you would like to find out more about the EMDR Humanitarian Assistance Program, visit their web site: http://www.emdrhap.org.

If you would like to find out more about EMDR treatment, you can visit the EMDRIA web site: http://www.EMDRIA.org.

I am a licensed psychotherapist, hypnotherapist, and EMDR therapist in NYC.

To find out more about me, visit my web site: http://www.josephine-ferraro.com.

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

Workplace Issues: Strategies for Dealing with Office Politics and Malicious Gossip

I came across an interesting article in the New York Times by John Tierney called Can You Believe How Mean Office Gossip Can Be.  It was based on a journal article in the Journal of Contemporary Ethnography. 


Workplace Issues:  Strategies for Dealing With Office Politics and Malicious Gossip

Considering the fact the many of us spend at least eight or more hours in an office and gossip is part of most organizations, this is an important issue to explore.

Years prior to my becoming a psychotherapist, I was a human resource manager. In my prior career. I saw, first hand, the negative effects of gossip, which included undermining and, in some cases, ruining people's career.

Workplace Issues: Strategies for Dealing With Office Politics and Malicious Gossip

People engage in office gossip for all sorts of reasons. Some people, who work in organizations where there are reorganizations or layoffs looming, gossip to deal with the stress of the situation, the lack of information, and to try to give and get information. The problem is that the information is often wrong.

Other people gossip to vent about the boss or top management when they feel disempowered in their work environment. The obvious danger with this is that you could lose your job if the boss finds out that you're talking about him/her. The other problem is that this kind of gossip can undermine your entire office, which could have repercussions in how others, including future prospective employers, see you. They could easily say, "If the boss is a incompetent, everyone under him is probably incompetent too.
Workplace Issues: Strategies for Dealing with Office Politics and Malicious Gossip

Even if you don't lose your job because you're gossiping about the boss, frequent malicious gossip can produce a toxic office environment where the group's dissatisfaction grows, festers, and feeds on itself, reducing morale and making it a very unpleasant place to work.

Some people gossip because they're bored or dissatisfied with their jobs. Others hope to form certain alliances among a particular group of employees while alienating other employees.

Gossiping might seem like a harmless diversion and it might bring about a certain temporary cohesiveness within the group where the gossiping is taking place. But there is usually a certain amount of suspicion within the group, "If he's gossiping about her, he's probably gossiping about me too." And, of course, this is often the case.

Workplace Issues: Strategies for Dealing With Office Politics and Malicious Gossip

One situation that was not explored in the article is when employees purposely start a cycle of gossip as a way to intentionally sabotage an employee. If you happen to be that employee, it can be extremely difficult to combat this form of sabotage because you might not be able to find out who started it and you might not be able to control it due to the covert nature of the gossip.

When you're in a work setting where there's a lot of office gossip, it's hard to avoid. John Tierney's article suggests certain strategies if you happen to be part of a gossipy group and you feel uncomfortable.

One suggestion is to say something positive about the person being maligned. According to the article, this makes it difficult for others to continue to talk negatively about that person. Another strategy is to change the subject, a subtle suggestion that you're not interested in engaging in this gossip. A third recommendation is that you suggest, in a tactful manner, that you and others get back to work.

Workplace Issues:  Strategies for Dealing with Office Politics and Malicious Gossip

In my opinion, one of the most effective strategies for discouraging office gossip is for top management to encourage employees to come forward with their dissatisfaction.

Now we all know that many managers talk a good game about having an "open door policy," but not all of them mean it. Employees quickly pick up on the disingenuousness of this, and it creates more bad feelings. But if employees see that top management is genuinely concerned and problems are addressed and resolved, this can go a long way towards decreasing office gossip.

But what can you do if the boss is the one who is gossiping to you about his/her colleagues, superiors or your coworkers? This situation is not addressed in the article. This is obviously a very ticklish situation where you may be damned if you do and damned if you don't join in the conversation with your boss.

Tact and diplomacy are essential, and you might suddenly "remember" that important call that you need to make to a client or the report that's due today, making it necessary to excuse yourself. If possible, you might also consider looking for another job before it's your turn to be the object of your boss's disaffection.

Whether we like it or not, gossip is a fact of life in most offices. Men and women both engage in it.

It can be annoying, uncomfortable, and make you feel like you're back in junior high school again. Learning to deal with office gossip requires tact and maturity as you balance your need not to participate in malicious gossip with the reality that, for as long as you're in this work environment, you still need to work with the worst offenders of office gossip.

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

I have helped many clients deal with workplace and career issues.

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

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


Tuesday, November 3, 2009

Relapse Prevention During the Holidays

With Thanksgiving, Christmas and New Year's Eve around the corner, if you're in recovery for an addiction, it's not too early to start thinking about and planning for relapse prevention.

For many people, the holidays can be a joyous time of getting together with family, friends, and colleagues to celebrate. However, if you're in recovery, it can also be a time when you are at risk for relapse.

Relapse Prevention During the Holidays

As a psychotherapist, hypnotherapist and certified Substance Abuse Professional, I see many clients who struggle with relapse during the holiday season. Even people with many years in recovery can give in to the temptation to relapse into the addiction of their choice during this time of year.

Family get-togethers, office parties, and social events with friends where there might be alcohol or drugs can lead to relapse very quickly. Feelings of loneliness, depression, anxiety or low self-esteem can be intensified during the holidays because we often feel that we're "supposed to feel happy," and if we don't, we feel disappointed, ashamed, and that there is "something wrong" with us.

Relapse Prevention  During the Holidays

For people who grew up in dysfunctional families, holidays were often a time of chaos, anger, sadness, disappointment and, possibly, even violence. During the holidays, these childhood memories often come flooding back and add to overall feelings of loss and sadness.

Even though the holidays can be a challenging time if you're in recovery for an addiction, often, some forethought and advanced planning can help you to avoid relapse.

Seek Out Self Help Groups and Sponsorship:
This is the time to re-intensify your participation in self help or 12 Step meetings (see list of resources at the end of this post).

If you've never been to a self help or 12 Step meeting, they can be a wonderful resource to get support and build a sober support network.

If you don't have a sponsor, get one. Listen to people in recovery speak and if you feel inspired by what someone has to say and he or she has a solid background in recovery, talk to that person about sponsorship.

Relapse Prevention During the Holidays: Seek Out Self Help Meetings

Many beginners meetings also offer interim sponsors who volunteer to be your sponsor until you find someone that you really like. Some people stick with their interim sponsors and others continue to look.

If you already have a sponsor and you know the holidays will be a challenge for you, talk to your sponsor about talking more often. Get a list of telephone numbers from your meeting of people who volunteer to make themselves available for telephone contact or meeting for coffee to talk.

Plan Ahead for Holiday Social Events:
Many holiday social events include alcohol and, unfortunately, some of them include drugs. There might be some parties that you know you can and should avoid.

For instance, if your old drinking buddy is having a party and you know that there will be a lot of drinking or drugging at the party that will tempt you, don't go. However, there might be other healthier social events that you either want to attend or you are obligated to attend. Being in recovery doesn't mean that you avoid all social occasions.

If you know that you have a social obligation, whether it's a family event, a friend's party or an office party, where there will be temptation for you to relapse, plan ahead.

This could take the form of "bookending" the event by talking to your sponsor before and after the event to bolster your support. It might also involve your thinking in advance about what you'll say or do if someone offers you a drink, marijuana, cocaine or some other addictive substance.

Relapse Prevention During the Holidays: Talk to a Friend or Sponsor

If you plan ahead to say "no thanks" and walk away, you're more likely to avoid relapse than if you leave it to chance and impulse.

If you know that you're a compulsive overeater and there will be lots of food at the event and, as a result, lots of temptation for you to overeat, plan ahead how you'll either have a light, healthy meal before you go to the party to avoid overeating, take only a small plate of healthy food while you're at the event, or develop some other healthy strategy to avoid relapsing into negative eating habits.

Don't Engage in All-or-Nothing Thinking:
It's best to plan ahead during times when you know you'll be challenged by a possible relapse, but if you do relapse, all is not lost.

Don't engage in all-or-nothing thinking where you think that because you relapsed, you should just continue abusing your substance of choice.

Remember that occasional relapses are often part of recovery. The important thing is to stop after you've realized that you've relapsed and get back on track with the healthy habits that you've used before in your recovery.

Seek the Help of a Licensed Psychotherapist with an Expertise in Addictions:
At times, self help meetings and sponsorship are not enough. This is nothing to be ashamed of. It doesn't mean that you're "needy," "weak" or "crazy." We all need extra help sometimes.

When choosing a mental health professional, make sure that this person is a licensed mental health professional in your state and has an expertise in addictions.

I am a licensed psychotherapist, hypnotherapist and certified Substance Abuse Professional. I have helped many clients over the years to achieve and maintain their recovery.

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

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

Resources:
Alcoholics Anonymous of NY:
http://www.nyintergroup.org
Al-Anon in NYC: http://www.nycalanon.org
Cocaine Anonymous in NYC: http://www.canewyork.org
Debtors Anonymous of NYC: http://www.danyc.org
Gamblers Anonymous of NYC: http://www.gamblersanonymous.org
Narcotics Anonymous of NYC: http://www.newyorkna.org
Nicotine Anonymous: http://www.nicotine-anonymous.org
Overeaters Anonymous of NYC: http://www.oanyc.org
Sexual Compulsives Anonymous: http://www.sca-recovery.org

Coping With Addiction: Boredom as a Relapse Trigger

As a psychotherapist, hypnotherapist and certified Substance Abuse Professional in NYC, one of my specialities is working with people who have problems with addictions and codependency. Over the years, I've found that one of the most challenging aspects of overcoming addictive and codependent behavior is overcoming boredom as a relapse trigger.

Overcoming Addiction: Boredom as a Relapse Trigger

What is Boredom?
For most people, feeling bored means that they're doing the same things over and over again and not feeling fulfilled. Life feels dull and monotonous. They feel like they're in a rut and can't get out. Life and relationships might not feel as meaningful when someone is bored.

Why Does Boredom Often Lead to Relapse?
For someone who is accustomed to feeling "high" from drinking, drugging, overspending, overeating, bingeing and purging food, gambling, engaging in sexual addiction, cutting, or getting overly involved in someone else's life drama, trying to live a clean, sober and healthy life might feel unexciting and dull.

When you're used to dealing with your problems by looking for stimulation in unhealthy habits, you might feel a void in your life as you let go of these habits, people you used to engage in these habits with, and former places where you used to go.

At that point, if you haven't developed other healthy habits to take the place of addictive behavior, you are at risk for relapse as you begin to think about stimulative and thrill seeking behavior. It's very tempting to revert back to old habits as you bargain with yourself: "I'll just do this one more time, and then I'll stop" or "I can have one drink. I can control it" or other self deceptive thoughts.

How to Overcome Boredom to Avoid Relapse:
First: Realize that you're not alone. Many people who are struggling with addictions and codependence have faced the same challenge as you have and they have successfully overcome having boredom lead to relapse.

Second: It's important to get out, talk to people who have overcome these problems, and get support. Self help groups like A.A., N.A., Debtors Anon, Al-Anon, Sexual Compulsives Anon, Gamblers Anon, Overeaters Anon and other self help groups are often an excellent source of support (see resource list below at the end of this post).

When you listen to other people talk about how they struggled and overcame boredom as a relapse trigger, you'll often hear aspects of their stories that will resonate with you and help you develop your own ideas about overcoming boredom. Get a sponsor to help you work the Steps and navigate through your difficulties with relapse.

Third: Think about activities and hobbies that you used to enjoy that you might have given up after you began engaging in the addiction of your choice. Maybe you used to like to listen to music before. Or, maybe you liked a particular sport, hobby, or other healthy recreational activity. Often, when people get immersed in addictive behavior, they let go of and forget about activities that they used to enjoy. You can recapture the enjoyment that you used to get from these activities.

Overcoming Boredom to Avoid Relapse

Fourth: Be willing to try new and healthy activities to get out of the rut that you're in. If you're out of shape, consult with your doctor and find out if you're up to exercising at the gym, or taking a yoga or dance class. For most people, walking, at a pace that is healthy and right for you, is often a safe form of exercise. Join a book club where you can clear out the cobwebs from your mind, meet new people, and find other ways to stimulate your mind through new ideas.

Fifth: Get involved by volunteering. There are so many organizations that desperately need help: from soup kitchens for the hungry and homeless to reading and mentoring programs in schools. When you help someone else or make a positive contribution to a worthwhile organization, you feel good about yourself and it helps to build your self-esteem. Even if you have a tendency towards codependence, you can learn to help others in a healthy way.

If you find that you're still struggling with boredom as a relapse trigger, you could benefit from working with a licensed mental health professional who has an expertise in helping people overcome addictive and codependent behavior.

I am a licensed psychotherapist, hypnotherapist and certified Substance Abuse Professional in NYC. I have helped many clients overcome addictive and codependent behavior.

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

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


Resources:
Alcoholics Anonymous of NY: http://www.nyintergroup.org
Al-Anon in NYC: http://www.nycalanon.org
Cocaine Anonymous in NYC: http://www.canewyork.org
Debtors Anonymous of NYC: http://www.danyc.org
Gamblers Anonymous of NYC: http://www.gamblersanonymous.org
Narcotics Anonymous of NYC: http://www.newyorkna.org
Nicotine Anonymous: http://www.nicotine-anonymous.org
Overeaters Anonymous of NYC: http://www.oanyc.org
Sexual Compulsives Anonymous: http://www.sca-recovery.org
Smart Recovery: http://www.smartrecovery.org/