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Friday, December 31, 2010

Contemplating the New Year

Making Meaningful New Year's Resolutions:
Once again, it's that time of year, New Year's Eve, when people usually take stock of their lives and make New Year's resolutions. Often, those resolutions include losing weight, going to the gym more often, and other specific goals.

Contemplating the New Year
Making Meaningful New Year's Resolutions in the Context of a Healthy Life:
As I've mentioned in the past, at least half of people who make New Year's resolutions abandon their resolutions within a few months into the New Year. Often, this is because their resolutions are focused too narrowly on a particular goal rather than in the larger context of their lives.

With some reflection and forethought, New Year's resolutions can be broadened so that they are more meaningful and encompass overall positive changes in our lives instead of being so narrowly focused.

For instance, instead of making a New Year's resolution to lose 20 lbs., it would be more beneficial to make a resolution to eat healthier and engage in healthy forms of exercise. While there's nothing wrong with making a resolution to lose a certain amount of weight, the chances for success are much greater if this type of resolution is made in the context of overall improvements to our health.

Making New Year's Resolutions to Improve Our Relationships:
New Year's resolutions tend to be about the person making the resolution. But, aside from making New Year's resolutions for ourselves, with some reflection, we can also think about how we can improve our relationships.

For instance, we can make a resolution to be more self compassionate and also more compassionate to our loved ones and other people that we meet.

We can also make resolutions to make amends to people in our lives that we have hurt, if this is appropriate for you and them and would not cause more harm than good.

Nyepi - "Day of Silence:"
I'm very interested in learning about how various cultures celebrate different holidays, and I discovered that in Bali, they celebrate their New Year in a completely different way as compared to most of the Western world.

Nyepi is known as the "Day of Silence" in Bali during the Balinese celebration of Isakawarsa (the Baliense New Year). It is part of the Hindu tradition in Bali.

They celebrate their New Year in March (this year it will be on March 5, 2011). Nyepi is a day of silence, meditation, and fasting. Even though this is a Hindu tradition, even people who are not Hindu in Bali stay indoors, including tourists.

This is a day for self reflection. There are no distractions, so there is no TV, no computers, no radios, no unnecessary conversation, no traveling, no entertainment, no work, and no lighting fires. Even the airports and the beaches are closed that day.

The day after Nyepi, which is called Ngembak Geni, is also considered New Year's, and social activity resumes again. This is a day when friends, family and loved ones gather to ask forgiveness from one another and to perform various religious rituals.

Other religious, like Judaism and Christianity, also have times for atonement, which honor our relationships with the people in our lives.

We can learn a lot from other cultures without giving up the joy and revelry of the season. I especially like that the Balinese New Year is celebrated in silent contemplation followed by a day with loved ones where atonement is part of their social activities.

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

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.

photo credit: riptheskull via photopin cc

Psychotherapy for Shock Trauma

In my last blog post, Understanding Shock Trauma, I discussed shock trauma, including the types of traumatic events that can cause shock trauma and its symptoms. In this blog post, I will discuss psychotherapy and shock trauma and the treatment modalities that I find most effective in my psychotherapy private practice in NYC.

Psychotherapy For Shock Trauma

Psychotherapy for Shock Trauma - Initial Phase: Assessment and Developing Resources
When clients come to me to be treated for shock trauma, I assess each client with regard to the nature of the trauma and their internal and external resources. Before any processing of the trauma can begin, clients must have adequate internal and external resources or the trauma processing could be overwhelming for them.

What are Internal and External Resources?
When I refer to internal resources, I'm referring to a person's coping abilities. If the client doesn't have sufficient coping abilities, I assist them to develop them. Internal resources can be any of the following: an ability to meditate or calm oneself by taking calming breaths, visualizations of relaxing places, visualizations of supportive people in their lives, memories or associations of times in their lives when they felt good about themselves (confident, powerful, competent) and so on.

External resources can include friends, family, loved ones, mentors, coaches, or pets. If a client is in recovery for substance abuse or some other form of addiction, it could include 12 Step meetings, peers in 12 Step meetings, and sponsors.

Psychotherapy Treatment Modalities:
When dealing with trauma, I usually use mind-body oriented psychotherapy such as Somatic Experiencing, clinical hypnosis, or EMDR, depending upon the needs of the client. Sometimes, depending upon the needs of the client, I might use a combination of these treatment modalities. The treatment plan is a collaborative effort with the client.

Psychotherapy for Shock Trauma - Processing the Trauma:
Once the client has developed adequate resources, I titrate the trauma work so that it is performed in manageable pieces. (Titration means in manageable doses.) When dealing with the trauma, we're dealing with the reptilian brain (see prior blog post about the triune brain). The reptilian brain processes about 7x slower than the neo-cortex, so trauma work is, by necessity, slower than other types of work that is done in psychotherapy. If the therapist goes too quickly, the reptilian part of the client's brain will be overwhelmed and it will be to0 much for the client.

I help the client to move gently back and forth between manageable emotional activation related to the trauma and a calm emotional state so that the trauma work remains in a tolerable range.

The client is the best judge in terms of what he or she experiences in trauma work, so the client is in charge, and I am guided by his or her feedback during sessions.

Psychotherapy for Shock Trauma - The Goal of Treatment:
Using one of the mind-body oriented psychotherapy treatment modalities, the goal is for the client to process the trauma and to discharge the trauma-related "stuck" energy which is being held in the body so that the client can return to at least as good a level of his or her former level of overall functioning or better.

The discharge of "stuck" energy can come in many forms, including breathing out stressful energy, perspiring, yawning, experiencing tingling, and other forms of discharge. The client often senses when he or she has discharged the trauma-related energy that has been "stuck" in the body because there is a sense of calm or relief for the particular piece of trauma work that has been worked on.

Psychotherapy for Shock Trauma - Developing Self Compassion:
Many clients who begin trauma work blame themselves for what happened to them. They get caught up in negative cycles of self talk where they berate themselves, telling themselves that they should have known better or they shouldn't have gone to a particular place, etc. This only exacerbates their trauma symptoms.

During treatment, I help clients to realize that they're not to blame for what happened to them or for their trauma symptoms. Helping clients to develop self compassion is also part of the way I work with traumatized clients from the beginning so they don't get caught in negative cycles of self blame.

To find out more about the mind-body oriented psychotherapy treatment modalities that I have discussed in this blog post, please see the resource list below:

Resources:
Somatic Experiencing therapy (SE): http://www.traumahealing.com
Clinical hypnosis: http://www.ASCH.net
EMDR: http://EMDRIA.org

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

I have helped many clients to overcome traumatic events in their lives, including shock and developmental trauma, so that they can go on to lead productive and meaningful lives.

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

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



Understanding Shock Trauma

What is Shock Trauma?
As opposed to developmental trauma, which develops over time when traumatic events overwhelm a child, shock trauma occurs usually from an overwhelming one-time event. Shock trauma can occur to an adult or a child. It can occur from experiencing the traumatic event or witnessing it. The traumatic event is usually sudden, unexpected and has a distinct beginning and end.

Understanding Shock Trauma

Many people describe their experience of shock trauma as if their whole world has been turned upside down. They describe it as if the rug has been pulled out from under their feet. Often, their perspective of their internal world and the world around them changes and they feel unsafe and that life is very unpredictable.

As with any overwhelming event, the trauma is not in the event itself, but in the way the person experiences the event. As a result, two people can experience the same event and one person might become traumatized while the other person does not.

What Type of Events Cause Shock Trauma?
There are many different types of events, which can cause shock trauma, including:
  • accidents
  • natural disasters
  • acts of war
  • assaults
  • falls
  • invasive medical procedures, and so on
Understanding Shock Trauma

What Are the Symptoms of Shock Trauma?
Each person has his or her own individual experience with regard to shock trauma. These symptoms can include:
  • anger
  • anxiety
  • panic attacks
  • depression
  • a sense of helplessness
  • a sense of hopelessness
  • a need to be vigilant all or most of the time
  • flashbacks
  • nightmares
  • isolation
  • loss of interest in activities that used to be pleasurable
  • exhaustion
In my next blog post, I will discuss psychotherapy for shock trauma and the treatment modalities that I find most effective in my psychotherapy private practice in NYC.

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

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

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

See my article:  Psychotherapy For Shock Trauma







Tuesday, December 28, 2010

Trauma, the Triune Brain & Somatic Experiencing

What is the Triune Brain?
The triune brain is made up of three parts that developed in humans through evolution over time. Triune means "three in one."

Trauma, the Triune Brain and Somatic Experiencing

There is the reptilian brain, the mammalian brain, and the cognitive brain. All three parts of the brain inter-relate and communicate with each other. The reptilian brain developed first and it is the oldest part of the brain. The mammalian brain developed next, and the cognitive brain developed last in evolution.

I will discuss the reptilian brain last since this is the part of the brain that carries trauma when a person has been overwhelmed by a traumatic event.

The Cognitive Brain:
The cognitive brain is located in the pre-frontal or neo-cortex part of the brain. As mentioned earlier, this was the last part of the brain to develop through evolution. The cognitive brain is responsible for thoughts, planning, language, logic and awareness.

The Mammalian Brain:
The mammalian brain was the second part of the brain to develop through evolution. It is located in the middle brain. The mammalian brain mediates feelings, relationships, nurturing, images, and unconscious activity, including dreams and play. The mammalian brain fosters attachment between caregivers and infants when there is good enough caregiving. It also fosters empathy between individuals.

The Reptilian Brain:
The reptilian brain developed first during the evolutionary development of the brain, and it can be found in species from reptiles to humans. It is the oldest part of the brain in terms of the development of the triune brain. The reptilian brain sits at the base of the skull. It's responsible for instincts, including the sympathetic nervous system's survival instinct of fight-flight-freeze when there is perceived danger.

When a person perceives him or herself to be in danger, emotions and physiological energy are generated by the reptilian brain so that the person can take action. When this energy is not discharged (through flight or flight), it is stored in the person's muscle tissue. This emotion and energy are imprinted in the nervous system. This is what we mean when we refer to "trauma." Trauma is usually associated with feelings of powerlessness and helplessness.

Somatic Experiencing and the Trauma Vortex:
According to Peter Levine, Ph.D., who developed Somatic Experiencing, this trauma-related energy, which has not been discharged, can be conceptualized as being part of a trauma vortex.

Trauma, the Triune Brain and Somatic Experiencing 

The trauma vortex is a metaphor to describe what happens when trauma-related energy is "stuck" and has not been discharged. The trauma-related energy saps the person of vitality. This energy is trapped and unavailable for other life-affirming and life-enhancing activities.

Somatic Experiencing and the Healing Vortex:
Just as we can conceptualize the trauma vortex as the place where trauma-related energy is stuck, in Somatic Experiencing, we can also conceptualize the metaphor of a healing vortex.

The Somatic Experiencing therapist helps the client to develop this positive, healing energy to counteract the negative experience of the trauma vortex. The healing vortex can be any positive experiences, associations, memories, visualizations, and felt sense experiences that the traumatized person develops in Somatic Experiencing therapy.

The Somatic Experiencing therapist facilitates the healing process by "titrating" the processing of the trauma in therapy. "Titration" in this context means that the trauma is processed in manageable doses so it does not overwhelm the client or retraumatize him or her.

Trauma, the Triune Brain and Somatic Experiencing

Gradually, over time, the client, who is in Somatic Experiencing therapy, develops a greater capacity for self containment. By tracking the client's physiological and emotional experiences in treatment and with the use of titration, the Somatic Experiencing therapist helps the client to expand this capacity over time, so that as treatment unfolds, the client is better able to tolerate processing the trauma with increased coping abilities and a greater capacity for resilience.

When trauma is being processed, the therapist is dealing with the client's reptilian brain, where the trauma is stored. Compared to the cognitive brain (neo-cortex), the reptilian brain processes information 7x slower. This is why trauma work must be done in manageable pieces because if too much trauma work is done too soon, the reptilian brain becomes easily overwhelmed.

Somatic Experiencing is a mind-body oriented psychotherapy and it is one of the safest and most effective ways to process emotional trauma.

To find out more about Somatic Experiencing, visit the Somatic Experiencing website: http://www.traumahealing.com.

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

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

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




Saturday, December 11, 2010

Mind-Body Oriented Psychotherapy: Somatic Experiencing

Somatic Experiencing is a mind-body oriented psychotherapy that was developed by psychologist, Peter Levine, Ph.D. One of the basic premises of Somatic Experiencing is that people have a natural ability to heal emotionally if they are provided with the tools. Somatic Experiencing recognizes that there is a mind-body connection, and traumatic memories are not just stored in the mind--they're also stored in our bodies as well.


Mind-Body Oriented Psychotherapy: Somatic Experiencing

Experiences of Being Retraumatized in Regular Talk Therapy:
When traumatic memories are triggered, they're often overwhelming for people. Regular talk therapy is often inadequate for dealing with trauma.

Years ago, therapists used to think that all clients needed to do was to "vent" about their traumas and they would experience an emotional release that would be curative. However, now that we know more about the mind-body connection, trauma experts know that not only is it not helpful to just have someone venting about their trauma--it can actually be a retraumatizing experience.

Why is this? When a someone recounts their traumatic experience, if he has not developed coping mechanisms (called "resources" in Somatic Experiencing) to deal with the trauma, he's just reexperiencing the same emotions and physical body sensations that he experienced at the time of the trauma. (This assumes that the client is not completely cut off from his feelings, which is another type of traumatic reaction called dissociation.) In effect, he is reliving the trauma and going around and around in the same trauma "vortex," so to speak. There is usually no healing going on in this situation.

Titrating Trauma Experiences in Somatic Experiencing:
Somatic Experiencing (SE) techniques allow the SE therapist to help the client titrate the traumatic experience into manageable pieces. The Somatic Experiencing therapist doesn't go directly for the most traumatic aspect of the experience immediately. As previously mentioned, the SE therapist makes sure that the client has adequate internal and external resources to call on before doing the trauma work.

Mind-Body Oriented Psychotherapy: Somatic Experiencing

Once the SE therapist and client begin processing the trauma, the experience is dealt with in manageable parts, often starting with what might have been happening that was positive just before the trauma. So for instance, to give a simple example, if someone was in a car accident, she might have been enjoying her favorite song on the radio just before impact.

Why is this significant?

The SE therapist helps the client to recognize where she is holding onto emotions in the body. Often, these traumatic emotions are "frozen," so to speak, in the body, without the client even realizing it.

So, to help clients to deal with the difficult emotions that are stored in the body, it helps to access internal resources.

So, in the above example, this client has also stored in her body the pleasant experience of listening to her favorite song. In effect, this is a positive resource that the client can use. Connecting to these pleasant feelings is one part, of many, that would help to fortify the client to deal with the trauma.

As part of processing traumatic experiences, in addition to helping clients to use both internal and external sources, the Somatic Experiencing therapist also helps clients to develop a greater emotional capacity to deal with the trauma before the worst part of the trauma is processed. In SE, this is called, metaphorically, developing a larger "container" for the experience.

What does this mean?

Well, if we think of pouring a lot of water into a small container, we know what will happen--the container will be flooded and the water will spill all over the place.

Similarly, Somatic Experiencing therapists recognize that people have "emotional containers" of various sizes.

Some people have larger "emotional containers" than others and they can absorb more emotional content. However, people who have been traumatized, by definition, have been "flooded" by emotional experiences that are too overwhelming for them and their "emotional containers" were not large enough. This is not a negative comment about the client. It is a recognition that we all have our limits.

It's the Somatic Experiencing therapist's job to help clients develop a larger "emotional container" in order for the client not to be flooded while processing the trauma in therapy. In doing so, Somatic Experiencing therapists help clients to become more resilient and better able to process the trauma without becoming retraumatized.

In Somatic Experiencing, after a client has been prepared by developing resources and a larger "emotional container," the therapist helps the client to titrate the experience through a process called "pendulation."

Somatic Experiencing and the Process of Pendulation
An example of this might be that the client has already learned to visualize a "relaxing place" in his mind's eye prior to processing the trauma.

Not only has the client learned to visualize this place, but he has also learned how to shift his emotional and physical state from one of high emotional activation, which would be too uncomfortable, to a relative state of calm.

Usually, after clients have experienced some degree of calm, they're willing to go back to processing the trauma, knowing that if they experience a degree of emotional activation that is too high again, they can go back to accessing the relaxing place.

The Somatic Experiencing pendulation process allows clients to be in control. Somatic Experiencing assumes that clients know innately what's best under these circumstances. The Somatic Experiencing therapist is there to teach and facilitate the process.

Does this mean that Somatic Experiencing is effortless and there is no discomfort? No, it doesn't. But it does mean that, as opposed to regular talk therapy, the Somatic Experiencing therapist works to ensure that the client is not overwhelmed and not retraumatized.

One blog post is not sufficient to cover Somatic Experiencing. To learn more about Somatic Experiencing, I suggest that you read Peter Levine's books, each of which are written in an accessible way for the general public. His first book is called Waking the Tiger, and his latest book is called In An Unspoken Voice.

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

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

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






Mind-Body Oriented Psychotherapy

In recent years, increasingly, many psychotherapists have come to realize that mind-body oriented psychotherapy offers opportunities for healing that regular talk therapy alone often does not offer. There are different types of mind-body oriented psychotherapy, including clinical hypnosis, EMDR (Eye Movement Desensitization and Reprocessing), Somatic Experiencing, Psychomotor Psychotherapy, Focusing, all of which I have used in my psychotherapy private practice in NYC.

Many Experiences of Talk Therapy, But No Change:
Many clients come to see me feeling discouraged. Often, they have made many attempts on their own and attempts in regular talk therapy to make changes in their lives, but these attempts have not resulted in change.

Mind-Body Oriented Psychotherapy

Often, clients in regular talk therapy develop intellectual insight into their problems, but there is no emotional insight. They can explain why they have the problems that they have, but no healing has taken place.

Why is this? Usually, it's because regular talk therapy alone often doesn't penetrate beyond our conscious minds. It involves our intellect which, of course, is important for any type of change that we might be contemplating. But for many problems, this isn't enough. The treatment needs to go beyond the surface to a more visceral level.

Why is Mind-Body Oriented Psychotherapy More Effective Than Regular Talk Therapy?
Mind-body oriented psychotherapy will often access deeper levels of consciousness because we can feel the treatment occurring on a visceral level. It's not just a matter of talking about the problem on an intellectual level. Mind-body oriented psychotherapy helps clients to change from the inside out. Clients are taught how to recognize where they feel their emotions in their body, and this helps them to access deeper levels of consciousness as well as enabling them to change at a deeper level.

I'm certainly not saying that regular talk therapy doesn't ever work. My early training is as a psychoanalyst and I still practice psychodynamic psychotherapy. However, for many problems, this type of therapy is not enough, which is why so many psychoanalysts and psychodynamic psychotherapists have learned various types of mind-body oriented psychotherapy.

In my next blog post, I will discuss a particular type of mind-body oriented psychotherapy called Somatic Experiencing, which was developed by Peter Levine, Ph.D.: http://www.traumahealing.com

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

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

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

Lesbian and Gay Couples: Dealing with Homophobia in Families

Holiday season can be a stressful time for most people, but it's often even more stressful for couples in lesbian or gay relationships. As a psychotherapist in NYC, over the years, I've worked with many gay and lesbian couples in couples counseling as well as in individual therapy where their families have not accepted that they're gay or that they're in a gay or lesbian relationship. The families' disapproval often causes individuals in gay and lesbian relationships to feel that they have to choose between spending time with their partners and spending time with their families.


Gay Couples Coping with Homophobia in Their Families
Of course, there are degrees of acceptance--everything from outright disapproval to half hearted acceptance to fully embracing the relationship and everything in between. It can be a very heart wrenching decision as to how to handle these situations.

Lesbian Couples Coping with Homophobia in Their Families
The following scenario is based on a composite of many cases, and it does not represent any particular couple:

Vickie and Susan:
Vickie and Susan had been living together in a committed relationship for over three years when they came to couples counseling. They were both in their early 30s and had successful professions. Susan's family lived in NYC, and Vickie's family lived out of state.

Susan tended to be "out" as a lesbian to her family, at work and in most social situations. Vickie tended to be more reserved and she only told certain people that she was a lesbian. She had never told her family directly that she was a lesbian, but she assumed that they knew and they just never discussed it.

They had many close lesbian and gay friends, both single people and couples, in NYC that they socialized with during the year. But the holiday season often presented a problem. If they were staying in NYC, there was no problem because Susan's family embraced Vickie as their daughter-in-law and made her feel at home. They would also spend time with their friends, both heterosexual and gay.

But there were certain years where Vickie missed her family and they wanted her to spend the holidays with them. In most ways, Vickie was close to her family and she loved them. She liked spending time with her parents, and her older sister. Her family had many holidays rituals that Vickie enjoyed from the time she was a young child. The problem was that, even though they knew that she lived with Susan, she had never told them explicitly that they were life partners.

Both Vickie and Susan wanted Vickie's family to recognize and honor their relationship, but Vickie was too afraid of losing her family if she actually "came out" to them and told them that Susan was her wife. For Vickie, it was one thing for it to be understood that Vickie was a lesbian without having to discuss it, and it was quite another for her to be direct about it.

At certain times, Susan and Vickie would argue about this during other times of the year. Susan wanted Vickie to be more direct and "come out" as a lesbian and introduce Susan as her wife. But their disagreements about this were never as bad as they were during the holiday season.

When Vickie and Susan started couples counseling, Vickie's family was urging her to come to see them for the holidays because they had not seen her the prior two holiday seasons. Vickie felt torn about what to do. On the one hand, she missed her family and she wanted very much to see them. On the other hand, she didn't want to hurt Susan's feelings by going without her or inviting her to come without defining their relationship to her family.

Aside from dealing with homophobia among friends and families, internalized homophobia can be just as challenging, if not more challenging for someone who is a gay man or a lesbian. And both Susan and Vickie had to be willing to look at their own internalized homophobia in couples counseling, especially Vickie, with regard to this situation.

In working through this problem in couples counseling, Susan and Vickie both made a commitment to put their relationship first. Vickie had to confront and overcome her fears about her family's reaction if she told them directly that she was a lesbian and she was in a lesbian relationship. Her worst fear was that her family would cut her off. She also had to look at how she was withholding an important part of herself from her family and the effect this was having for her own internal world, as well as the effect on Susan and their relationship.

As we worked through this issue, we came up with a plan that began by Vickie telling the person in her family who would be most receptive, her older sister. As Vickie expected, her older sister told her that she already knew that Vickie was a lesbian and she suspected that Susan was more than just a "roommate." She told Vickie that she would love to meet Susan. But she agreed with Vickie that their parents probably wouldn't be as receptive to Vickie being openly gay and bringing her partner for the holidays. She told Vickie that she was in her and Susan's corner, no matter how their parents reacted and she would be supportive.

Vickie was relieved that her sister was supportive, but she knew that talking to her parents would be more challenging. They tended to be conservative and not open to people and situations that didn't fit into their values.

Vickie decided to talk to her mother first because she felt that, even though both parents were conservative, her mother was a little more open than her father. When the day came for Vickie to have the conversation with her mother, as we discussed, she "bookended" her call by talking to her best friend first and planning to talk to her after she spoke to her mother. This helped her to feel supported.

Vickie had a plan for how she was going to broach the topic of being a lesbian in a lesbian relationship with her mother, but her mother threw her off by interrupting her and telling her about all she was doing to prepare for the holidays. Vickie listened for a while and she felt herself becoming increasingly anxious. At one point, she considered not telling her mother at all. But she didn't want to go back on her commitment to Susan and the commitment that she made in our couples counseling sessions.

After listening for more than 20 minutes to her mother go on about the holiday preparations, Vickie knew that she had to say something at that point or she might lose her nerve. So, when her mother took a breath, Vickie began by telling her mother that she was the most happy that she had ever been in her life. She was afraid that if she didn't tell her mother this from the outset, her mother might not hear it after she "came out" and talked to her about her lesbian relationship.

Vickie's mother reacted positively and told her that she was pleased that she was happy. Then, Vickie took a deep breath and told her mother, for the first time, that she was a lesbian and Susan is her wife. There was silence on the other end of the phone for a few long seconds. When she spoke, Vickie's mother's tone of voice had completely changed. Whereas she had been upbeat and chipper before, she spoke in a whisper and told Vickie that she must never tell her father this because he would be devastated. She also told Vickie that she never wanted to talk about this again. Then, she began to change the subject.

At that point, as planned, Vickie told her mother that she knew that it might be hard for her to understand, but it was important to her that the family accept that she is a lesbian and that she is in a committed relationship with Susan. Again, there was a long pause at the other end, and finally her mother told Vickie in a whisper, "We know you're a lesbian. We figured it out a long time ago. But we don't have to talk about it and you don't need to throw it in our faces. We love you very much, but you can't expect us to talk about this as if it were nothing. And you can't expect us to accept that you're in a gay relationship. If you want to invite Susan to come for the holidays, she can come, but you can't flaunt your relationship and you can't stay in the same room."

Vickie was deeply disappointed, but she was not surprised. As agreed, she told her mother that she couldn't and wouldn't come under these circumstances, and she hoped that they could talk about this in the future and try to work it out. But, for now, she was spending the holiday with Susan and her family. At that point, Vickie's mother hung up the phone, and Vickie didn't speak to her parents for over a year.

Vickie and Susan remained in couples counseling to work through the repercussions of this turn of events. It placed a strain on their relationship, but they were both committed to staying together and working things out. They also strengthened the bonds of their relationships in the lesbian and gay community so they felt supported among other gay people who had similar experiences.

Vickie's older sister was also supportive and she came to NYC to meet Susan and to spend time with them at their apartment. It meant a lot to Vickie to have her sister show support for her and her relationship, even if she wasn't talking to her parents.

Vickie's sister told her that their mother broke down and told their father, even though she had told Vickie not to say anything to him, and he was even more upset about it than their mother. When they weren't discussing it openly, prior to Vickie's call, they put the whole idea of Vickie being gay in the back of their minds. But when Vickie talked about it openly with her mother, it was too confronting for the mother. It also removed any shadow of a doubt that Vickie was a lesbian and that she was in a lesbian relationship.

The following year, Vickie's sister announced that she would host the holidays in her house and she was inviting Vickie and Susan. When her parents heard about this, they told her that they wouldn't come if Vickie was coming to "flaunt" her relationship with Susan--to which Vickie's sister responded, "That's up to you. But if you come, I expect you and dad to be pleasant and respectful of Vickie and Susan." She gave them a book to read that was written for parents of gay children. She also gave them information about PFLAG (Parents, Families and Friends of Lesbians and Gays).

After much chaos and commotion, the parents decided to come. Vickie and Susan were anxious, and it was obvious that when Vickie's parents came, they were also very anxious too. There were anxious and awkward moments when Vickie introduced them to Susan. But, eventually, things settled down, at least on the surface, and everyone was polite. But there was an under current of emotional strain in the air.

This was the first of many holidays where Vickie and Susan went home to see Vickie's family. Over time, Vickie's parents got to know and like Susan and Susan began to feel more comfortable with them. Vickie's parents even began to attend PFLAG meetings and talk to other parents of gay children. After a while, they were able to talk to Vickie more about her life with Susan. They told her that they didn't understand, but she was still their daughter, they loved her, and they wanted her to be happy. And if being happy meant that she was a lesbian and in a relationship with Susan, they accepted this.

Having gone through this ordeal together strengthened Susan's and Vickie's relationship. They both wished that Vickie's parents would more than just "accept" their relationship, but they came to terms with it, and it no longer interfered with their relationship.

For Vickie, as an individual, "coming out" as an open lesbian and telling them that her relationship with Susan came first was a huge step. It strengthened her self confidence and it was a great relief not to have this secret any more.

The above composite scenario is one of countless ways that lesbian and gay couples and individuals cope with homophobia in their families. There is no one right way to deal with these situations. Each individual and each situation is unique.

Don't Let Your Family's Homophobia Interfere with Your Relationship
If you're a lesbian or gay man who is struggling with similar "coming out" issues, you could benefit from getting help from a psychotherapist who specializes in gay and lesbian issues. You could also benefit from seeking support from LGBT support groups.

In NYC, you can contact the LGBT Community Center: http://www.gaycenter.org.
They offer a host of services for the LGBT community, including support groups, 12 Step programs, and other special programs specifically for the LGBT community.

If you're outside of NYC, you can contact the Gay and Lesbian National Hotline for support: http://www.glnh.org.

If you're a parent of a gay, lesbian, bisexual or transgendered child, you can educate yourself and get support through Parents, Families and Friends of Lesbians and Gays. : http://www.pflag.org.

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

I have helped many gay and lesbian individuals and couples with their own "coming out" process, relationship issues, and other issues specifically related to the lesbian and gay community.

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.


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Financial Problems During the Holiday Season

As a psychotherapist in NYC, during the holiday season, I hear from many clients that they don't know how to tell their children, friends and relatives that they're too broke financially this year to spend money on holiday gifts.

In some cases, either one or both spouses may be out of work, they're worried about losing a job, or experiencing other financial challenges. Whereas they might have been very generous in the past, this year they don't have the financial wherewithal to spend money on gifts and they feel too ashamed to tell their loved ones.

Financial Problems During the Holiday Season

Financial Problems Often Make People Feel Ashamed
Objectively, many of these same people know that their financial challenges should not be a cause for shame. But they feel ashamed nonetheless. And their shame prevents them from addressing this issue directly with loved ones.

Rather than opening up the lines of communication for an honest dialogue, some people try to avoid the issue. Other people end up spending money that they don't have by racking up debt on their credit cards.

Having a discussion with a young child about financial hardships in the family during the holiday season can be especially challenging. But rather than avoiding it, parents can address the issue with their children in an age-appropriate way, depending on the child's maturity level.

Of course, most parents would like to give their child whatever new and exciting toy or computer game that is the latest craze. But for many people, especially in these financial tough times, this just isn't possible. There are other financial priorities that need to come first--like meeting the family's basic needs.

When faced with this situation, one way to address this issue is to get back to basics with your family by remembering what the holiday season is all about.

Rather Than Focusing on Gift Giving, Find Other Meaningful Ways to Celebrate the Holidays
Rather than focusing on gift giving, you can find other ways to celebrate the holidays in a meaningful way. If you and your family are spiritual, you can talk to them about the spiritual rituals for this time of year, which usually don't cost money.

Rather Than Focusing on Gift Giving, Find Other Meaningful Ways to Celebrate the Holidays

Rather than focusing on what they're going to get, it can be so much more meaningful to teach children what they can give to others who might be less fortunate than themselves. Spending time serving food to homeless people, singing Carols at a nursing home or hospital where people might be without family is so much more about the holiday spirit than focusing on material gifts.

For adults, rather than giving a material gift, your "gift" could be your time and effort on their behalf.

Giving a "gift" of babysitting for a single mother who might be overwhelmed and might need a respite can mean a lot more to that mother than a material gift. Going grocery shopping or cooking a meal for an elderly or home bound person means more to that person than getting a wrapped gift.

It's a matter of getting letting to of the shame about financial problems, getting creative and looking beyond the holiday hype. You might discover a whole new way of celebrating the holidays that brings you and your loved ones together in a more uplifting and meaningful way.

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

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

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

A New Year: Letting Go of Unhealthy Habits

As the New Year approaches, this is the time of year when people take stock of their lives and make decisions about what they'd like to change, including letting go of bad habits. Breaking negative habits can be challenging, especially for habits that are longstanding, like smoking cigarettes, overeating, eating in unhealthy foods, overspending, and other negative habits.

A New Year: Letting Go of Unhealthy Habits

It's one thing to make a commitment at the New Year to make a change. It's quite another thing to stick with it, especially when we're under stress. Most New Year's resolutions fall by the wayside within the first few months of the year.

Most people underestimate the type of resolve, external support, and the inner resources that they'll need to let go of bad habits. Engaging in a bad habit, especially one that is longstanding, is like driving down the same dirt road hundreds of times. After a while, ruts start to form in the road that the tires have rode over again and again.

This reminds me of when I went to Ercolano (on the other side of the volcano from Pompeii in Italy) several years ago. I could see where the chariots had gone over the cobblestones hundreds of times from the deep ruts in the stones. Similarly, engaging in negative habits over and over again creates deep pathways in our brains so that when we're emotionally triggered, our inclination is to go down that same pathway. This is one of the reasons why it's so hard to break bad habits.

Fortunately, clinical hypnosis can be very effective in helping most people to break bad habits, whatever the bad habit might be. When used by a hypnotherapist, clinical hypnosis can access the unconscious mind, bypassing the conscious mind. If the client is motivated, very often, clinical hypnosis will not only help to break bad habits, but it can also help to sow the seeds of new, healthy behavior.

As I've mentioned in prior posts, there is a difference between a "hypnotist" and a "hypnotherapist." People who call themselves "hypnotists" might know various hypnotic techniques, but they're not trained and skilled as psychotherapists who are hypnotherapists. As a result, their work is often not as effective.

If you're thinking about bad habits that you'd like to let go of and healthy behaviors you'd like to replace them with in 2011, you could benefit from seeing a hypnotherapist who can help you to make the changes that you want in your life.

censed psychotherapist, hypnotherapist, EMDR therapist, and Somatic Experiencing therapist in NYC.

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

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

Tuesday, November 16, 2010

Relationships: Using Money to Get Revenge

In my prior blog post, I talked about money and arguments in relationships (see link below). In this blog post, I will address a particular issue about money and problems in relationships, namely, when money is used to get revenge.

Using Money to Get Revenge


Using Money to Get Revenge:
It's not unusual for someone in a relationship to use money as a form of revenge. When money is used to get revenge, the person who is exacting the revenge will either overspend or use money to manipulate in some way to get back at his or her partner.

Often the person who "acts out" in this way doesn't know how to communicate his or her anger and uses money as a way to get back. Needless to say, when the other person in the relationship finds out about the overspending or financial manipulation, he or she often feels angry, betrayed, and sad. Most of the time, this leads to mistrust and, in some cases it results in the end of the relationship.

Relationships: Using Money to Get Revenge


The following fictionalized scenario is an example of someone using money to get revenge in a relationship. As with other money and trust problems, this problem is found in heterosexual relationships as well as gay and lesbian relationships. And, although I'm presenting the person acting out as the man, it happens just as often with women.

Nick and Susan:
When Nick and Susan came to marriage counseling, Susan was close to ending their marriage. She had just found out, for the second time, that Nick had withdrawn a large sum of money from their joint account and used it to buy studio equipment for his music production business without talking to her first.

She found out about the large withdrawal when she made an ATM deposit into the account and she was shocked when she saw the balance. She almost went in to speak to the bank branch manager. But, having gone through this before with Nick, she called him first before she panicked and he admitted to withdrawing the money.

When this happened several months before, Nick and Susan had a big argument. At that time, Nick admitted that he was angry with Susan because he felt that she was too controling about their money. Susan felt that, since she was the major bread winner in the marriage, she should have more of a say about money decisions. She also felt that Nick tended to be irresponsible with money, and she cited many examples in their argument. Nick felt that Susan was emasculating him and he admitted that he took the money to get back at her.

That was several months ago. At the time, Nick promised that he would never do this again. He replaced the money in their account, and Susan forgave him. But when it happened again, Susan was angry and she felt betrayed. She felt that she could no longer trust Nick, and she wondered what else he was being dishonest about.

Nick asked Susan for another chance and suggested that they attend marriage counseling. Although Susan wanted to end the marriage, she agreed to make one last ditch effort to save their relationship. But she told Nick that if marriage counseling didn't work out, she wanted a divorce.

So this was the state of their relationship when they began marriage counseling. Susan was very angry and hurt, and Nick was contrite, but underneath it all, he was angry too and unaware of it

Part of the initial stage of marriage counseling was to explore if there was a viable marriage to save and how invested each of them was in salvaging the marriage. Initially, Nick seemed more invested in saving the marriage than Susan. But after she was able to express her anger and also look at how she might have contributed to their problems by never allowing Nick to forget about financial mistakes that he made in the past, Susan realized that she didn't want to end the marriage. She wanted to feel that she could trust Nick and that he wouldn't try to get revenge against her, using their money, when he felt angry.

The marriage counselor helped Susan and Nick to improve their communication skills. She also helped Nick to see just how angry he was and how out of touch he was with his anger for Susan, which contributed to his seeking revenge by taking money from the joint account.

There were a lot of issues to work out, including family of origin issues for both Nick and Susan, Nick learning to be more responsible about money, reestablishing trust in the relationship, and both of them learning to communicate better with each other and not to use money to try to gain power and control in the relationship.

It was hard work but, gradually, over time, Susan and Nick worked towards salvaging their marriage.

Money problems are common in relationships. As previously mentioned, money problems are often one of the major reasons that couples seek out marriage counseling. It's not unusual for one or both people to "act out" and try to get revenge by either running up credit cards or manipulating money in some way.

Although it is usually a serious breach of trust when partners use money to get revenge, many relationships can be worked out with professional help from a marriage or couples counselor.

If you or your partner are using money to get revenge, you can work out this issue with an experienced marriage or couples counselor.

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

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

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


Relationships: Arguing About Money


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Relationships: Arguing About Money

In my prior blog post, I discussed sexual incompatibility as being one of the major reasons why couples come to marriage or couples counseling (see link below). In this blog post, I'll focus on one of the other major reasons why couples seek help--arguments about money.

Money is often symbolic of power. Whoever has or makes more money in a relationship is often seen as the more powerful person in the relationship, and this can lead to arguments.

Relationships: Arguing About Money

Similarly, differing values about money between a couple in a relationship can also lead to arguments and, at times, irreconcilable differences.

What Are the Different Problems that a Couple Can Have About Money?

The Saver vs the Spender:
It's not unusual in a relationship for there to be one person who prefers to save money and another person who would rather save money. When this is the particular dynamic in a relationship, there are bound to be differences of opinion and, often heated arguments, about what to purchase, when to make purchases, when to save, and, in general, how to manage the money.

Combining Each Person's Money vs Having a Separate Pot of Money:
Couples often differ as to whether they should pool the money that they had before they got together or if they should each keep what they had and create a separate pot of money to pay bills, make major purchases, etc.

For the person who prefers to combine their individual financial accounts, he or she might feel that the other person doesn't trust him/her enough to combine assets or lacks faith in the relationship.

The person who wants to keep their individual accounts separate and create a separate pot for expenses might have gotten burnt in prior relationships by pooling all the money together. With combined finances, it's not unusual for there to be problems if the couple separates. Of course, no one wants to enter into a relationship thinking that things might not work out, although this is a reality for many couples.

What to Do About Prior Debt:
Related to the above, if one person in the relationship enters the relationship with excessive debt, the couple needs to make decisions about how to handle that debt. Are they going to work on reducing the debt together or is the person with the debt going to take care of it on his or her own? If the couple can't negotiate their differences around this issue, it can become a major issue between them leading to frequent arguments.

Secrecy About Money:
I've seen many couples where one or both people keep secrets about money. For some people, it's a matter of withholding information about debt or how much money or assets they have or other related issues. Often, when there's secrecy about money, there are often other issues related to secrecy. If one of the people in the relationship finds out that his/her partner has been keeping secrets about money, it often engenders feelings of anger, betrayal and lack of trust.

Money as Power and Control:
As previously mentioned, when there is a difference in assets or earning power within a relationship, this can create arguments around power and control. The person who earns more money might feel that this gives him/her the right to greater control over their money and other major decisions. If the other person in the relationship doesn't agree and they can't negotiate this, this issue can lead to big arguments.

Money as a Cover Up for Other Problems in the Relationship:
Sometmes, it's really not about the money per se. The couple might be arguing about money because it's a concrete and tangible issue, but the real issue might be about other feelings. For instance, if one of the people in the relationship feels that there is a power differential in the relationship (let's say that one person makes most of the decisions that effect the relationship), the person who feels less powerful can use money as a handy issue to argue about when it might not be about the money (although it could be).

Using Money as a Way to Get Revenge:
When there are problems in a relationship, sometimes one of the people "acts out" by running up credit cards or overspending in some way to get back at his or her partner. This is an issue that I'll address in a separate post. However, it's easy to see how this could create arguments and, in some cases, end a relationship.

In most of these cases, there is often poor communication in the relationship and/or fundamental value differences about money and other important issues.

As I mentioned in a prior blog post, it's always better to talk about money before getting married or entering into a committed relationship. It often saves a lot of heartache if a couple can either negotiate these issues beforehand or, prior to making a major commitment, find out that they're just not compatible with regard to money and they're unable to negotiate these issues. But many people neglect talking about money until they're already in a relationship and it becomes a major problem.

If you and your partner or spouse are arguing about money, before this problem sabotages your relationship, get help. This is a common problem that can often be worked out with professional help.

Aside from the possibility of consulting with a financial planner who can help you with the "technical" nuts and bolts regarding money issues, consulting with a marriage or couples counselor can help you to navigate the emotional rough waters related to money problems.

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

I have helped many couples to work out the emotional issues around money so that they can stop arguing about money and enjoy their relationship.

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

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


Also see:
Overcoming Sexual Incompatibility








Relationships: Overcoming Sexual Incompatibility

As a marriage counselor in NYC, I see many couples who are struggling with sexual incompatibility. This is one of the main reasons why couples come to marriage or couples counseling. Aside from the many factors that we already know about that affect sex in a relationship, like work and personal stressors, busy schedules, health issues, and so on, there are many couples who are unhappy in their sexual relationships because they're just not sexually compatible with each other and, in many cases, they never were. 


Relationships: Overcoming Sexual Incompatibility
Their problems are not about occasional periods when they're not having sex, as is often the case with many long-term relationships. Rather, the problem is about a fundamental sexual incompatibility between them.

Sexual incompatibility can take many forms.  It can be as basic as one person really doesn't like sex and the other person does.  Or, one person wants to have sex more often than the other person.  Or,  a couple might not be compatible with regard to what they like sexually.  Or, on person might be comfortable being on the "giving" end of sex, but not comfortable "receiving" or vice versa.  All of these problems can occur with both heterosexual couples as well as gay and lesbian couples.

Why Do Couples Often Struggle with Sexual Incompatibility?
Underestimating the Importance of Sexual Compatibility:
Very often, in cases where there is sexual incompatibility, one or both people in the relationship will underestimate the importance of being sexually compatible. During the early stages of a relationship, one or both people might be more focused on compatibility of values and minimize the importance of good sex. This is not to say that compatible values are not important because they are. But in placing all of the emphasis on values, this couple might short change themselves with regard having a satisfying sex life.

Relationships: Overcoming Sexual Incompatibility

After a while, when a couple has downplayed importance of sex in their relationship, one or both people might might begin to feel that they are more like roommates or like siblings. At that point, dissatisfaction with the relationship can set in, and if the couple is not comfortable talking about sex, one of the partners might begin casting around to find someone else who is more sexually exciting to him or her, often leading to infidelity.

Feeling Too Ashamed to Talk About Sex:
Often, couples who are dealing with issues of sexual incompatibility have a great deal of difficulty talking about their sexual relationship and what's working and what's not (assuming that they're still having sex). They might feel too ashamed to talk about sex or they worry that talking about it will only make it worse. Often, this shame might be related to childhood experiences where children are taught that sex is shameful, or there were sexual boundary violations (sexual abuse or incest), or other related childhood issues.

A Lack of Emotional Attunement in the Relationship:
This often goes hand-in-hand with poor communication. When you're not emotionally attuned to what your partner needs, it's hard to be sexually attuned to him or her. When there's emotional resonance between two people in a relationship, they are more likely to sense what they each need.

A Lack of Sexual Experience:
If one or both people enter into the relationship with little or no sexual experience, they just might not know what to do to please each other sexually or what might please themselves. Of course, this doesn't have to be a long-term problem if both people are open and willing to explore. But the sexual incompatibility comes about when one or both people are not just inexperienced but also closed off to the possibility of sexual exploration within the couple and they don't want to seek help or educate themselves.

A Rush to Get Married or Enter into a Long-term Relationship:
I've seen many couples where one or both people were anxious to get married or enter into a long-term relationship and this strong desire to be with someone often blinds them to certain basic incompatibilities, including sexual incompatibility. Some people end up "settling" for someone who is not suitable for them because they fear that they'll never find anyone and they'll be alone. Often, it's only after they're in a committed relationship that they realize that they're not compatible.

Fear of Intimacy:
There are couples where one or both people are only able to have "good sex" when there is no emotional intimacy. They might only find sex as exciting when they're with other people that they don't feel close to, but as soon there is emotional intimacy, they're unable to get excited, which is obviously a problem in a committed relationship.

Hoping that the Sexual Incompatibility will Resolve Itself Without Effort:
The hope is that, somehow, the problem will fix itself without any effort. Then, when it doesn't, usually, both people feel dissatisfied and this dissatisfaction effects the emotional intimacy in the relationship. After that, it's not unusual for the relationship to feel "flat" and boring. And, once again, if the couple is unable to communicate with each other about this, it can lead to infidelity.

Rationalizing Away the Problem of Sexual Incompatibility:
I've heard many rationalizations in couples counseling as to why there is sexual incompatibility in a relationship. For instance, some people assume that when people get to a "certain age," they no longer desire sex. However, often, when I get the sexual history of the couple in a long-term relationship, I discover that they were never sexually compatible, even when they were young and they first got together.

If you and your partner are sexually incompatible and it's causing problems in your relationship, get help from a marriage or couples counselor who has expertise in this area, especially if you're not making any progress in resolving this problem on your own. Don't wait until anger and resentment have built up to such a point that the relationship cannot be salvaged. While there's never a guarantee that a relationship can be saved in marriage or couples counseling, doing nothing is not the answer.

Many couples have overcome sexual incompatibility with help in couples counseling.





Couples Can Overcome Their Sexual Incompatibility
I am a licensed NYC licensed psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.

I have helped many couples overcome problems with sexual incompatibility.

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.


You can also check out my article entitled 
Relationships: Have You and Your Spouse Stopped Having Sex?


Also, visit my Psychotherapy Daily News for updates on mental health issues, health education, and science news.