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Wednesday, December 16, 2009

Psychotherapy: Overcoming Binge Eating During the Holiday Season

Many people who have problems with binge eating really struggle during the holiday season. The holidays are an especially challenging time because they often involve many of the issues that trigger overeating in binge eaters: family stressors, excessive amounts of food, and stressful emotions. The combination of these three triggers can have a powerful impact on binge eaters.

For people who are separated from their families, feelings of loneliness and isolation can become overwhelming during the holidays. For others who have conflictual relationships or tension in their families, they might experience anger, frustration, anxiety and sadness. For many people, childhood memories, whether they are positive or negative, can trigger a binge as these people try to cope with their feelings by soothing themselves with food.

As a psychotherapist in private practice in NYC, I hear many clients talk about how food was the only form of comfort they felt when they were growing up. As an adult, food is still associated with comfort and feeling soothed for these people. So, it's understandable that during stressful times over the holidays these clients turn to food to feel better. But, just like any binge, which initially might feel comforting, for most people, there is a lot of discomfort after they have eaten an excessive amount of food. For many of these same people, the discomfort which comes from excessive food intake and fear of gaining weight leads them to purge their food, which is very dangerous to their health and overall well-being.

If you know that you tend to overeat or binge during the holidays, it's best to plan ahead and think about how you'll handle stress and the availability of a lot of food.

Here are a few tips that might work for you:

Eat Regular, Well-Balanced Meals:
Many people make the mistake of skipping meals with the idea that they can then eat more at holiday social events. But research has shown that when people skip meals, they're more likely to overeat when they attend social events because they're hungry. It's better to eat three regular, nutritious meals (or four or five smaller meals) than to skip meals.

Be Mindful of Your Food Choices and Stand Away from the Food Table:
If you're at a party where there is a buffet, take a small plate and fill it with nutritious choices, avoiding high calorie foods. If you exercise a certain amount of mindfulness about what you choose, rather than eating in a dissociated way, you're more likely to make better choices. Also, if you're standing in close proximity to the food, you're more likely to go back for seconds, thirds, and fourths. It's better to stand away from the table to avoid temptation.

Focus on the People at the Party Rather than the Food:
Ideally, getting together with friends and family is about talking to them, getting caught up with what's going on with them and telling them about yourself, and having a good time. It shouldn't be primarily about the food. Even if you're around difficult people, it's better to find one or two pleasant people that you can interact with than making the food your central focus.

Wait 20 Minutes to See if the Food Craving will Pass:
If you've eaten well-balanced meals before the social event so that you're not starving, most food cravings will pass after about 20 minutes. Often the food craving is not so much about being hungry as it is about relieving stress and other uncomfortable feelings. Usually, if you can wait 20 minutes, the food craving passes and you won't overindulge.

Engage in Stress Management Techniques:
During this time of year, it's especially important that you engage in stress management techniques that help you to stay calm. Whether it's meditating, going for walks, going to the gym, attending a yoga class, venting to a friend, listening to music, or whatever would help you to ease your tension, you'll be less likely to engage in binge eating if you have other ways to manage your stress.

Seek Support from Overeaters Anonymous:
http://www.oanyc.org
Attending support groups where other people are struggling with the same issues as you can be comforting and help you to get the support that you need.

Seek Professional Help from a Licensed Psychotherapist:
If you've tried the techniques that I've mentioned above and you're still struggling with binge eating, you could benefit from talking to a licensed psychotherapist with expertise in helping clients to overcome binge eating.

I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist. I have helped many clients in my private practice overcome binge eating so that they can lead more fulfilling lives.

I am conveniently located in Manhattan.

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.


Tuesday, December 15, 2009

Psychotherapy: Healing Old Emotional Childhood Wounds that are Affecting Current Relationships

As a psychotherapist in NYC, I see many clients in both individual psychotherapy and couples/marriage counseling who are struggling with old, unresolved childhood wounds that are affecting their current relationships. Most people know, at least on an intellectual level, that their unresolved family of origin issues have the potential to impact their current relationships. But when you've actually experienced how powerful these old emotional wounds are when they get triggered in current relationships, you have a deeper emotional understanding of their adverse impact in your intimate relationship.


Healing Old Emotional Childhood Wounds That Are Affecting Your Current Relationships
Often, these old emotional wounds remain buried for a long time and don't get triggered until you're in an intimate relationship. The closer you are to your spouse or partner, the more likely it is that issues like fear of emotional abandonment, fear of not being lovable, and other similar feelings will arise in your relationship. The reason for that is that you're most vulnerable emotionally when you're in an intimate relationship. When you're experiencing these issues in your relationship, it's often difficult to know if you're feeling these emotions due to problems in the current relationship, past family of origin issues, or they represent some combination of the two.

One clue that these feelings are connected to unresolved emotional issues from the past is that your emotional reactions in your current relationship are out of proportion to the situation. Obviously, to recognize this, you must have some degree of insight and objectivity or, at least, be willing to talk it over with a trust family member or friend who can offer an insightful perspective.

The following scenario, which is a composite of different clients with all identifying information changed, illustrates how unresolved childhood emotional issues can get triggered and cause problems in a current relationship:

Tom:
Tom was a man in his mid-30s. He and Jennifer had been in a relationship for two years. They were talking about getting married. But, at the point when Tom came to see me for individual psychotherapy, they were arguing and Jennifer expressed serious concerns about whether they should stay together.

 As Tom explained it, they were very happy together until Jennifer took a job where she had to travel to the West Coast every couple of months. Whenever Tom heard that Jennifer had a business trip coming up, he would become highly anxious, irritable and argumentative with Jennifer.

 Usually, Jennifer's business trips lasted no more than a week. But during the time when Jennifer was away, Tom became despondent and he had a terrible feeling of foreboding that he would never see Jennifer again. Neither Jennifer nor Tom understood why Tom was experiencing such strong emotional reactions. At first, she tried to be empathetic and console him. However, after a while, Jennifer felt frustrated and questioned whether she could be happy with Tom as a lifelong partner.

Healing Old Emotional Wounds That Are Affecting  Current Relationships
As Tom and I discussed his childhood history, I discovered that his father would often disappear for months at a time without warning, leaving the Tom, his mother, and his younger brother in a state of emotional and financial chaos. It became clear that whenever Jennifer left for a business trip, Tom's old, unresolved trauma was getting triggered and he was feeling the same fear and sadness that he experienced when he was a child. Realizing this on an intellectual level helped Tom to realize that he wasn't "crazy," but that knowledge alone did not prevent his fears.

Over time, Tom and I worked on his unresolved issues using EMDR (Eye Movement Desensitization and Reprocessing) and clinical hypnosis. Using these two powerful psychotherapeutic treatment modalities helped Tom to work through his trauma so that he was no longer triggered.

The real test came when Jennifer went on her next business trip. Tom was amazed that, despite fearing that he might have one of his usual traumatic reactions, he felt all right about Jennifer leaving. It was the first time, since she started traveling, that he wasn't in a panic, he didn't feel despondent, and he didn't feel abandoned by her. He felt completely free of his former traumatic symptoms. Jennifer was also greatly relieved. Within six months, they got married. When I followed up with Tom six months later, he reported that he continued to feel symptom free and they were happy together.

Often, when dealing with unresolved childhood trauma, regular talk therapy is not enough to overcome these problems. Talk therapy might provide intellectual insight into the trauma and what triggers the traumatic symptoms. But, often, it is not enough to heal old emotional wounds. Within the last 10-15 years, research has shown that, when it comes to healing trauma, mind-body oriented psychotherapy is usually more effective than regular talk therapy. Both EMDR and clinical hypnosis are considered forms of mind-body psychotherapy.

Many clients who are already in regular talk therapy will often come to an EMDR therapist or hypnotherapist for adjunctive therapy, where their current psychotherapist is the primary therapist and the EMDR therapist or hypnotherapist provides treatment in collaboration with the primary psychotherapist.

Healing Old Emotional Wounds with EMDR and Clinical Hypnosis

To find out more about EMDR, visit the EMDRIA web site: http://www.EMDRIA.org.

To find out more about clinical hypnosis, also known as hypnotherapy, visit the professional web site for hypnotherapy: http://www.ASCH.net.

When choosing a psychotherapist, EMDR therapist or a hypnotherapist, always choose a licensed mental health professional. 

 Also, there is a big difference with regard to training and professional background between a "hypnotist" and a hypnotherapist. As the name implies, a hypnotherapist is a licensed therapist and a hypnotist is usually someone who has learned hypnosis techniques but who does not have the therapeutic background and expertise to deal with emotional issues.

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

I have helped many clients in individual therapy as well as in couples therapy to overcome unresolved emotional trauma that is adversely affecting their current relationships.

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

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


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Tuesday, December 8, 2009

Is it Depression or the Holiday Blues?

The holiday season is upon us once again. For many people, this is a time of joy and celebration with loved ones that they look forward to eagerly. But for many others this is a sad and stressful time where they suffer with the Holiday Blues. Sometimes, it's hard to distinguish between the Holiday Blues and depression. However, whereas the Holiday Blues usually pass when the holidays are over, depression is longer lasting and has certain symptoms that are unique compared to the Holiday Blues.


Is it Depression or the Holiday Blues?
Symptoms of Depression
According to the National Institute of Mental Health (NIMH), if you suffer from five or more of the following symptoms for two or more weeks, you should seek the help of a licensed mental health professional:
  • Persistent sad or anxious mood
  • Overall feelngs of pessimism and hopelessness
  • Feelings of guilt, worthlessness and helplessness
  • Loss of interest in activities that you once enjoyed, including sex
  • Difficulty with memory, concentration or decisionmaking
  • Insomnia (either falling or staying asleep)
  • Change in appetite (either overeating or undereating)
  • Restlessness, irritability
  • Persistent physical symptoms that do not go away when medical reasons have been ruled out (headaches, digestive problems, or other aches and pains)
Coping with the Holiday Blues
Is it Depression or the Holiday Blues?
As previously mentioned, whereas depression is a serious mental health problem, the Holiday Blues are usually transient and people are often able to cope if they follow a few of the following recommendations:

Maintain Your Perspective
The holiday season can be a time when you feel exhausted, sad and anxious from too much shopping, overspending, overeating. socializing, not getting enough rest, and the pressure to meet your own as well as others' expectations.

If you're feeling overwhelmed, try to maintain your perspective about what is meaningful about the holidays. Is it really about the gifts or is there a deeper meaning for you and your family?

It's often valuable to look at how various cultures address issues of overindulgence. In Patanjali's Yoga Sutra, the Yamas are the first of the eight limbs of yoga that represent ethical guidelines for living one's life, similar to the Golden Rule ("Do unto others as you would have them do unto you"). One of the Yamas is called Aparigrapha, which is usually translated to mean: non-possessiveness, non-holding through the senses, non-grasping, non-indulgence, non-acquisitiveness, and non-covetousness (see Yoga Journal: http://www.yogajournal.com/basics/158 for more information about the Yoga Sutra).

The Wisdom of the Yoga Sutra
You don't have to be a yogi to benefit from this philosophy. During this time to year, it's a good time to take stock, even if you're not religious or particularly spiritual, with regard to what the holidays mean to you, rather than getting caught up in the commercialism, greed and overindulgence that, unfortunately, have become a part of the holiday season.

Stay Focused on the Present
Comparing your current experience of the holidays to your experiences from years gone by can be a recipe for disaster, whether you had pleasant or unpleasant experiences in the past.

If you had wonderful holidays as a child and your current holidays don't quite measure up, you might find yourself pining for those former times. If you become so focused on the past, you might miss precious moments of joy that are occurring now. A moment of joy can be as simple as watching the sense of wonder on a child's face as she experiences the joy of the holidays. Similarly, if your holidays as a child were a disaster, you might close yourself off to what could be meaningful times with family and friends now because you have negative expectations.

Keeping a mindful awareness of the here-and-now can be a good antedote to ruminating about the past of fantasizing about the future.

Avoid Controversial Topics at Family Gatherings
This is not the time to debate contentious political issues or rehash old resentments just because you and your family are all together in the same place. Stay focused on the deeper meaning of the holidays. If family members attempt to discuss controversial topics, suggest keeping this time as pleasant as possible. You can get together at another time to talk about these topics.

You might also need to gauge how much time you spend with family members as part of your own self care. A reasonably pleasant couple of hours is better than a day of bickering.

Also, you want to ensure that your expectations about your family are reasonable. If you know there are certain ongoing family issues or dysfunctional dynamics in your family, don't expect that they will suddenly become the ideal famly portrayed in the movies or TV. Just because it's the holidays doesn't mean that you and your family will overcome whatever ongoing problems that may exist.

Take Care of Yourself

Practice Self Care
When you're tired and run down, you are more likely to get sick. During the holidays, you need to take even better care of yourself than you would normally. This means getting a good night's sleep, eating nutrious meals, and getting emotional support if you need it.

Volunteer


Volunteering Can Be a Good Way to Create the Holiday Spirit For Yourself and Others
If you're not spending time with family and friends during the holidays, volunteering can be a good way to create the holiday spirit for yourself and others who might be less fortunate than you. There are so many volunteer organizations that would be grateful for your help. If you're not sure which volunteer organizations are in your area, you can consult with the local churches, synagogues, mosques, charitable organizations in your area as well as your municipality for a list of volunteer organizations.

If you're not sure if what you're feeling is the Holiday Blues or depression, you might benefit from consulting with a licensed psychotherapist.

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

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.

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Tuesday, December 1, 2009

Psychotherapy and Compassionate Self Acceptance

As a psychotherapist in NYC, I have found that one of the major challenges for people who begin psychotherapy is overcoming their own critical and judgmental beliefs and assumptions about themselves. When I work with clients who have developed a harsh sense of self, I often begin by talking to them about how psychotherapy can help them to become more mindful, attuned and compassionate towards themselves.


Psychotherapy and Compassionate Self Acceptance

Low Self Esteem, Lack of Self Compassion and Self Acceptance, and the Development of the "False Self":
Many clients who begin psychotherapy to overcome low self esteem want to find a way to feel better about themselves. As their psychotherapy unfolds, often, what comes to light is that they have rejected parts of themselves that they have come to hate. Hate is a strong word, but it is usually apt for the type of self loathing that these clients have come to feel for parts of themselves over time.

This lack of self acceptance and self loathing is not always obvious to see at first. Sometimes, it manifests itself in a critical and judgmental attitude towards others. Other times, it shows itself through a need to be "perfect" themselves and to have others be "perfect." Very often, this self loathing and lack of compassion for oneself can be seen when people develop a "false self" when they are interacting with others.

Donald Winnicott and the "False Self"
Donald Winnicott, a British Object Relations psychoanalyst and pediatrician, was one of the first psychotherapists who developed a theory about the "false self."

In his developmental model of the "false self," Winnicott posits that, early on, when parenting is "good enough" a baby learns to relate to his or her primary caregiver in an authentic and loving way.

"Good enough" is the operative term here, since parenting can never be perfect and parents cannot always be perfectly attuned to their children.

However, according to Winnicott, when the primary caregiver (usually the mother) is sufficiently and lovingly attuned to the baby, the baby is usually able to thrive emotionally and, over time, learns to relate well to others as well as to him or herself. However, when the primary caregiver is unable to connect emotionally with the baby, either because he or she is depressed or for some other reason, the infant feels rejected and develops a "false self" to try to elicit the caregiver's love and attention.

People who have developed a "false self" often describe themselves as feeling "empty" or "hollow" and have difficulty relating to themselves as people who are worthy of love and compassion. They also often have difficulty relating to others because their own critical judgments and self loathing gets projected onto others: What they unconsciously cannot accept in themselves becomes intolerable when they sense these qualities in others.

So, over time, in psychotherapy, it becomes apparent that low esteem, depression, anxiety and other emotional problems are often connected to a lack of compassionate self acceptance for oneself and the development of a "false self." It may seem somewhat contradictory, but until you can accept the parts of yourself that you don't like, they're difficult to change.

The following is a vignette which represents a composite of several psychotherapy cases where a client has a "false self":

Carol:
Carol began psychotherapy because she felt that her life was "meaningless." She was in her mid-30s and she had never had a romantic relationship that lasted for more than a year. She described herself as feeling that she "existed" but she was "not really living." She could only express this feeling in the vaguest of terms, but the feeling was strong in her. Her emotional world felt flat--no passion, no real highs or lows.

Psychotherapy and Compassionate Self Acceptance

She worked as an attorney for a nonprofit social service agency, and her employer valued her work because she worked very hard advocating for the clients and often won her cases. However, even though she knew that she was highly esteemed in her organization, she could not feel good about herself at work or in any other part of her life.

In describing her childhood history, she emphasized that she felt she had good parents and she denied any abuse or big traumatic events. As such, she had a hard time understanding why she felt the way she did, "If my parents beat me, I could understand why I feel this way about myself, but they didn't, so there must be something very wrong with me."

It soon became apparent in psychotherapy that underneath that flat sense of meaninglessness, Carol had a strong sense of self loathing. Most of the time, she was able to push down those feelings of self hatred by working long hours and keeping herself distracted. However, as she talked about herself in a judgmental and critical way, it became evident that she lacked a sense of acceptance and compassion for herself.

She ran roughshod over herself with a sense of perfectionism and judgement that was truly soul crushing. No matter how much external praise she received from others, she never felt that anything she did was good enough. She spent a lot of time ruminating about what she perceived as her personal flaws or how she "could have done it better." She was her own worst taskmaster with standards that were unattainable.

In discussing her family history in more depth, it turned out that her parents, who were highly-regarded Ivy League college professors, were rather critical and emotionally distant with Carol. They provided her with everything that she needed on a material level, but they gave Carol the overarching message again and again that what they truly valued in her was her accomplishments in school. There was little sense that they valued her just as she was as a person.

Carol learned as a child that if she got very good grades and tried to be as "perfect" as she could, her parents would praise her efforts. But if she fell short in any way, as all of us do at some point or another because we're human, they found this intolerable.

Carol was also very aware that her mother, who stayed home with Carol until she was five years old and started school, had a lot of resentment about this. Her mother would have preferred to be teaching her classes and continuing her research than staying home with a helpless, dependent baby.

Carol had heard her mother lament many times about how the time she spent away from her field was detrimental to her career and that she was never able to regain the stature that she had prior to staying home with Carol.

Carol's father concurred with her mother about this. One can only surmise that Carol's mother's anger about her role as a mother probably did not allow her to be as emotionally attuned to Carol as an infant. And throughout Carol's childhood, neither parent demonstrated much emotional attunement for Carol as a child who deserved love for herself, without having to perform to their impossibly high standards.

Prior to starting psychotherapy, Carol had never questioned her parents' attitude towards her. The feeling that she was somehow to blame for her mother's lost professional opportunities and that she needed to perform to gain her parent's love and attention was so deeply ingrained at such a young age that it had become a strong part of Carol.

And even though her parents had somewhat mellowed as they aged and they no longer had such a punitive attitude towards Carol, it didn't matter because Carol had internalized their critical and judgmental attitude on such a deep and unconscious level that she was now doing it to herself.

Over time, Carol was able to see how she had developed a "false self" to please her parents. And even though this "false self" might have developed due to her parents lack of emotional attunement, she realized that it was now her responsibility, as an adult, to overcome the emotional obstacles that kept her from accepting herself just as she is.

It was a real challenge for her, but Carol began to question her harsh, punitive attitude towards herself. She mourned for the inner child part of herself who didn't get the unconditional love that she deserved.

She also began to learn to love that part of herself that she had learned to hate--the part that needed to be loved for herself and not for her "accomplishments." As she did this, she began to feel more authentic.

She no longer felt that she was performing a role or just going through the motions in her life. Life became richer and more meaningful as she became more emotionally attuned to herself. She also learned to forgive her parents and she developed better relationships with them as she recognized that they were no longer the punitive, emotionally withholding parents that she grew up with.

As they aged, they went through their own emotional transformation and she learned to relate to them as they are now and not how they were when she was a child.

As Carol became more compassionate and accepting towards herself, she felt better about herself.


Psychotherapy and Compassionate Self Acceptance

Accepting that she was human, she could make mistakes, she no longer needed to be "perfect," her self worth did not have to be based on her accomplishments, and that she deserved love, enabled her to open up others in an authentic way that she had never experienced before.

Eventually, she was able to open up to a relationship with a man who loved for her for herself, and they developed a healthy, loving and stable marriage.

Getting Help in Therapy


Compassionate Self Acceptance
If you are struggling with your own critical and judgmental beliefs and assumptions about yourself, you could benefit from participating in psychotherapy with a licensed mental health professional. Although it can be a challenge, you can learn to develop a more self accepting and compassionate sense of self so you can improve your relationship with yourself and others.

I am a licensed NYC psychotherapist, hypnotherapist and Somatic Experiencing therapist. I have helped many clients to develop a more self accepting and compassionate sense of self.

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





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