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Thursday, August 26, 2010

Changing Maladaptive Coping Strategies that No Longer Work for You: Controlling Behavior

In prior blog posts, I addressed avoidant and passive coping strategies as maladaptive strategies that usually do not work by the time we become adults. I mentioned that these maladaptive coping strategies usually develop from a combination of individual temperament and early home environment. In this blog post, I will focus on controlling behavior as a maladaptive coping strategy.

What Are the Signs of Controlling Behavior?


Controlling Coping Strategy
Just like any other type of behavior, controlling behavior is very individual and it will manifest in a variety of ways. Similarly, controlling behavior is on a continuum from moderate to severe.

People who are moderately controlling will try to control some aspects of their lives and the lives of those around them, but they realize that they can't control everything. Often they will respond to others' discomfort with their controlling behavior by backing off--at least for a while.

People who are severely controlling have a need to control or micromanage nearly everything. In most severe cases, when others around them express their discomfort, people who are severely controlling become angry. In some cases, they might become violent.

In both cases, controlling behavior often stems from underlying anxiety, fear, or insecurity.

The following fictionalized vignette, which is not about any one particular person, is an example of moderately controlling behavior:

Ruth:
Ruth grew up in a household that was almost always on the verge of chaos. She was the oldest of six children. Her mother, who stayed at home, tended to be very anxious and overwhelmed most of the time. Her father spent long hours at the office, leaving the mother to take care of the children and the household.

By the time she was 10, Ruth was helping her mother to prepare meals, do the wash, and take care of chores around the house. Since her mother tended to be in a state of high anxiety most of the time, this caused Ruth to feel anxious and insecure too.

By the time Ruth was married with children, she tried to make a lot of decisions for her husband and her teenage children, which caused friction in the household. Often, when she and her husband went out to dinner, she would order his meal for him, even before he had a chance to look at the menu. Whenever her husband pointed out to her that he would like to order his own meals, Ruth would realize that she overstepped her bounds and she would apologize. Similarly, when she continued to choose clothes for her 19 and 20 year old daughters, who still lived at home, and they told her that they wanted to make their own choices, she backed off. But even though Ruth backed off, in both instances, not being in control of these situations made Ruth feel anxious. It wasn't until she began psychotherapy to deal with these issues that she realized that she had underlying family of origin issues and her own temperament that caused her to develop this maladaptive coping style.

The following fictionalized scenario is an example of the other end of the spectrum of controlling behavior, severe controlling behavior:

Henry:
When Henry was 18, he moved out of his family's household to get away from his abusive father. For most of his life, he grew up witnessing his father hit his mother. He also witnessed his mother's passive response. He thought his father was a tyrant--always wanting to control every aspect of their lives.

Henry vowed to himself that he would never be like his father. He quit high school, got his GED, began working, and got his own apartment.

In his early 20s, Henry began dating a young woman, Linda, that he really liked. After a few months, they decided to date each other exclusively. At first, their relationship was going well. But after a while, as Henry got closer to Linda, he began asking her to let him know where she was going and with whom. At first, Linda was flattered because she thought this meant that Henry really cared about her. Whenever they went to a restaurant, Henry ordered for Linda. Initially, Linda felt he was being chivalrous, and she liked this.

After a while, Linda got tired of having to answer questions all of the time about where she was going and with whom, and she wanted to order her own food when they went out. Whenever Linda tried to talk to Henry about all of this, he refused to talk about it.

One day, when Linda brought this up again, Henry felt like he was going to explode. As Linda continued to insist that they talk about Henry's controlling behavior, Henry lost his temper and he slapped her. Linda was stunned and hurt. Henry was shocked by his own behavior. After that, despite his repeated attempts to apologize to her, Henry could not get through to Linda . She wanted nothing to do with him.

Shortly after that incident, Henry began psychotherapy to understand how and why, despite his vow to himself that he would never become like his father, he had become severely controlling and violent in his relationship--just like his father.

These two vignettes illustrate that, depending upon the person and the circumstances, controlling behavior is on a continuum. I provided examples of moderate and severe controlling behavior with the understanding that there is a wide variety of behavior between those two extremes.

What Can You Do If You Engage in Controlling Behavior?
If you engage in controlling behavior and it is affecting how you feel about yourself as well as how others feel about you, you're not alone. Many individuals and couples come to therapy to work on and resolve these issues. Often, you can work through the underlying issues in psychotherapy and learn new ways of coping so that you're no longer engaging in maladaptive coping strategies.

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

I work with individuals and couples, and I have helped many clients to overcome maladaptive coping strategies that no longer work for them.

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.

Also, see my articles:
Changing Coping Strategies that No Longer Work For You: Controlling Behavior

Coping Strategies that No Longer Work For You: Avoidance




Friday, August 20, 2010

Changing Maladaptive Coping Strategies that No Longer Work for You: Passive Behavior

In my last blog post, I addressed the maladaptive coping strategy of avoidance, and how it develops due to a combination of early childhood experiences and a person's particular temperament. Another maladaptive coping strategy is passivity, also referred to as lack of assertiveness or surrendering to the will of others.

As mentioned in my prior blog post, coping strategies that develop in early childhood often help a child to survive in a situation where he or she doesn't know what else to do and/or doesn't have the ability to do anything else. These coping strategies, which are usually unconscious, develop outside of the our awareness so we don't realize that we're continuing to use the same strategies that we used as children. And, whereas when we were children, these coping strategies might have helped to deal with an overwhelming situation, as adults, these strategies are no longer adaptive.

What is a Passive Coping Strategy?


A Passive Coping Strategy
A passive coping strategy is usually associated with a person being overly compliant and subjugating his or her needs to others. Often, this occurs because the overly compliant person fears being abandoned or punished or that they will incur the anger of others if they don't comply. There might also be a wish, often unconscious, that by complying, this person will gain the love or admiration of the other person. For an overly compliant child, this person is usually a parent or some authority figure. So, the passive coping strategy is an effort to ward off negative repercussions that the person fears as well as, at times, a wish to feel loved.

The following fictionalized scenario, which is not related to any particular person, is an example of a passive coping strategy and how this strategy can be overcome:

Ronald:
By the time Ronald started psychotherapy, his wife was threatening to leave him because she was fed up with Ronald's passivity. Ronald, who was in his 40s, was unable to assert himself with his domineering father, which was affecting Ronald's relationship with his wife. Ronald was also underpaid and overworked at his job as an engineer because he couldn't assert himself to ask his boss for a raise and a change in his workload. The demands of his job were also affecting his relationship with his wife.

Ronald grew up in a household where he was taught that his emotional needs weren't important. Neither his mother nor his father ever told Ronald this explicitly, but he was given this message implicitly nearly all of the time.

Ronald's father ruled the household with an iron fist. The father controlled almost every aspect of that household from how money was spent to what they ate to the clothes that they wore. The father had an explosive temper, and if he didn't get his way, he would yell, break furniture, and threaten to hit the mother, Ronald, and Ronald's siblings. The father never actually hit anyone, but he was a big man and his threats were enough to keep everyone in line. Ronald grew up not only acceding to his father's every wish, but he also learned to anticipate what his father wanted before his father even expressed it so that he could comply with his father's wishes and ward off any negative repercussions.

After Ronald got married, he and his wife bought a two-family house so that his parents could live downstairs and he and his wife could live upstairs. Even though Ronald was now an adult, he continued to comply with his father's dictatorial style. His father continued to control everything from the heating system in the house to what plants were planted in the garden. Without consulting with Ronald or Ronald's wife, he took it upon himself to hire a crew to paint the house one day a color that Ronald's wife hated.

That was the last straw for Ronald's wife. She had been telling Ronald for years that she was fed up with his passivity and she wanted Ronald to stand up to his father. Now, she told him that, unless he took a stand with his father, she was leaving. At that point, Ronald felt caught between wanting to comply with his father's wishes and also wanting to comply with his wife's demands, and he didn't know what to do. At his wife's urging, he sought therapy.

During his psychotherapy treatment, Ronald's therapist helped him to understand the particular coping strategy that he developed as a young boy. Ronald was able to see that, when he was a child, he did the best that he could by complying with a domineering father. He was also able to see that he was still reacting to his father (as well as to his boss) as if he was still a young boy without choices and that his passivity was now detrimental to his marriage and his life in general.
Ronald's therapist worked with him by helping him to recognize where he was capitulating to his father's demands. Then, Ronald chose certain situations where he could begin asserting himself with his father. His therapist helped him by doing role plays where the therapist was the father and Ronald was his adult self.

Over time, Ronald recognized that he was continuing to operate from his old fears that his father would either hit, abandon or ridicule him. He also recognized that these old fears didn't apply any more. Not only wasn't he a small boy looking up to his big father but, at this point in his life, he was a strong man who was bigger than his father, and his father was no longer a physical threat to him. He also became aware that his deepest wish was that by complying with his father's demands, he would gain his father's love and praise. Since his father tended to be more critical than praising or demonstrative of affection, Ronald's deepest wish remained unfulfilled.

After practicing in a role play with his therapist, Ronald went home to talk to his father about his hiring a crew to paint the house. Before Ronald could get a word out of his mouth, his father began telling Ronald about the renovations he envisioned for the house. Ronald had planned what he wanted to say but, hearing his father's words, his stomach turned queasy and he began to perspire. Feeling defeated, he lapsed back into a state of passivity and abandoned his efforts to confront his father.

Ronald almost cancelled his next psychotherapy session because he feared that his therapist would be angry with him for not being assertive with his father. But instead of cancelling, he went and told his therapist that not only did he feel that he was not complying with his wife's wishes, but now that he was in therapy, he also felt that he was not complying with his therapist.

As he and his therapist talked about what was happening between them and how Ronald was applying the same passive strategies in their therapeutic relationship as he did in the rest of his life, that session was one of the best sessions that he had. He had a here-and-now experience of how he felt victimized even in his own therapy, and how this was the type of interpersonal template that he applied to most of his relationships. He also realized that, rather than owning the part of himself that wanted to assert himself with his father, he was projecting it onto his therapist--as if she was the one that was coercing him to be assertive rather than it coming from inside of him.

In addition, Ronald also began to become aware of a very important aspect of psychotherapy--that psychotherapy is a process, and progress in psychotherapy is usually not linear, but more like a spiral where clients make some progress and then they revert back to their old ways before they move forward again. This often happens many times in psychotherapy and it's all part of the process. In Ronald's case, his progress was his continuing to come to therapy, talking to his therapist about his hopes and fears, and being willing to put into practice what he learned in therapy. Even though he had a false start with his father, this is a common experience for most people and it's all part of the process.

Ronald and his therapist did other role plays where his therapist played the part of his father in a way that was similar to how his father had come across when Ronald tried talk to him about having the house painted. Ronald practiced how he could assert himself under these circumstances. With a few false starts, Ronald found his voice and he felt even more determined to assert himself with his father.

On the day that Ronald decided to talk to his father again about the house, Ronald's father interrupted him, and he began telling Ronald that his arthritis was bothering him. As if for the first time in a long time, Ronald looked at his father and saw a certain fragility in this strong man that he had not seen before. His father was no longer the towering, fierce figure that he had been when Ronald was a child. He was now a man in his late 60s who was starting to have the kind of health problems that many senior citizens have. This made Ronald feel sad and guilty about what he was about to do.

Ronald's first inclination was to back down. He felt that internal child part in him that wanted to please his father, hoping that his father would express some affection or praise. He began to think about how one day his father wouldn't be around any more, and this made him feel sad as well as guilty. But Ronald and his therapist had prepared for this, and he gathered his inner resolve and began to talk to his father.

Much to Ronald's surprise, his father listened to him that particular day. Ronald talked for a long time. He hadn't anticipated that he would say as much as he did, but after he told his father about how he felt about having the house painted, he poured his heart out about how he felt unloved by his father. His father began turning away at that point because he was a man who was uncomfortable with any talk about love or affection. But Ronald asked his father to hear him out, so his father stayed, looking uncomfortable.

When Ronald finished, there was silence for a couple of minutes, which seemed like an eternity to Ronald. Then, his father apologized to him about the house, and he told Ronald that he had always told other people how proud he felt of Ronald, but he never told Ronald directly because he was afraid that Ronald would develop a "swelled head." He apologized for that too.

This was the beginning of Ronald's learning to be more assertive in his relationship with his father. It continued to be a work in progress for a long time because his father would often revert back to his domineering ways and Ronald would feel the old pull to revert back to his old passive behavior. But Ronald was definitely making progress. He also began working in therapy on asserting himself with his boss so he could ask for a raise and some changes in his workload.

When Ronald's wife saw that Ronald was starting to make progress, she decided not to leave the marriage. Over time, their relationship improved.

This scenario demonstrates how maladaptive coping strategies develop and continue into adulthood, and the underlying issues that continue to influence an adult's behavior. It also demonstrates that people with maladaptive coping skills can learn to change and grow in psychotherapy if they're willing to work on these issues.

Getting Help
If you feel that you need to change coping strategies that are no longer working for you, you're not alone. This is a common problem for many people. Rather than struggling with this on your own, you can work with a psychotherapist who has expertise in this area and learn to develop healthy coping strategies.

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

I have helped many clients to improve their coping strategies so they can live more fulfilling lives.

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

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

Also, see my articles
Changing Coping Strategies that No Longer Work: Controlling Behavior

Coping Strategies that No Longer Work For You: Avoidance



photo credit: ToniFish via photopin cc




Thursday, August 19, 2010

Changing Maladaptive Coping Strategies That No Longer Work For You: Avoidance

Do you ever wonder how people develop maladaptive coping strategies?

Changing Coping Strategies That No Longer Work for You:  Avoidance

Well, to begin with, we all learn different coping strategies that start out being a combination of our own particular temperament and as well as the coping strategies that we learned growing up in our home environment as children. Two children who live in the same household under the same conditions can develop very different coping strategies.

Often, there are coping strategies that might have worked for us as children to preserve our safety and emotional well-being that no longer work for us as adults. Avoidance is a particular maladaptive coping strategy.

Avoidant Coping Strategies


What are Avoidant Coping Strategies?
The following is a list of the most common avoidant coping strategies:

Social Withdrawal:
The person who uses social withdrawal or social isolation as a coping strategy disconnects from the people around him.

Social Withdrawal as Avoidance

He might disconnect by staying home alone and watching an excessive amount of TV or spend many hours on the Internet without having in-person social contact with others.

He might appear to be very "independent," but this is often a pseudo independence whose main purpose is to avoid dealing with others. People who engage in social isolation often prefer jobs where they work alone and only engage in minimal social contact.

Psychological Withdrawal:
The person who uses psychological withdrawal as a coping strategy copes by "numbing" herself emotionally.

The main goal is to keep herself from feeling overwhelmed. She might also spend a lot of time in her own fantasy world as a way to avoid dealing with the people and problems around her.

Another form of psychological withdrawal is dissociation, which can range from moderate to severe. An example of moderate dissociation is something that we all do from time to time--daydreaming. Daydreaming. in and of itself, is not necessarily avoidant.

Psychological Withdrawal as Avoidance

Many creative ideas come to us from daydreaming. However, if a person spends a lot of time daydreaming, rather than dealing with the world around her, this is considered a form of avoidant coping.

An example of severe dissociation is when a person has Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder. When someone has DID, most often, she has experienced severe trauma and her personality fragments as a way to compartmentalize the overwhelming experience.

Compulsive and Addictive Behavior:
Compulsive and Addictive Behavior as Avoidance

Compulsive and addictive behavior include many different types of behavior: abusing drugs, abusing alcohol, overeating, bingeing and purging food, compulsive exercise, compulsive overspending, compulsive gambling, workaholism sexually compulsive behavior, compulsive risk taking, and other tendencies that seek excitement and distraction to avoid dealing with whatever is too emotionally overwhelming.

The following fictionalized scenario, which is not based on any one person, illustrates how these avoidant coping strategies develop over time:

Jeff:
Jeff and his older brother, Tom, grew up in a household with an alcoholic father and a passive, emotionally overwhelmed mother. Their father, Dan, would come home from work everyday, eat his dinner alone in the den without interacting with the rest of the family, and then spend the rest of the night drinking beer and, eventually, falling asleep on the couch.

Sometimes, he would become angry and belligerent and pick an argument with his wife, Betty. Most of the time, she ignored him by retreating into the bedroom and closing the door. Sometimes, she would yell back at Dan and they would have an explosive argument. Even though he would wake up most mornings with a bad hangover, Dan almost never missed work as a train operator for the MTA subway system.

Even though Jeff and Tom were only a year apart and growing up in the same household, they each experienced their father's drunkenness in very different ways.

Jeff tended to be a very quiet child who would retreat into his room and watch TV quietly, losing himself in whatever program he was watching. If he was watching a program about an ideal family, he would fantasize that he was part of that family.

Tom would often leave the house, slamming the door behind him. By the time he was a teen, he had his own car and he would sometimes drive off in anger to get away from the home. He would meet his friends and they would go drag racing on the boulevard. He was brought home by the police a few times for speeding at 90-100 mph.

One day, Dan was sent home from work after he tested positive for alcohol on a random alcohol test at work. His supervisor told him that he would be brought up on disciplinary charges and he would either have to get into an alcohol treatment program or face losing his job.

They considered him to be too high a risk to allow him to drive the train. Before his disciplinary hearing, he would have to serve a 30-day suspension without pay.

Until then, even though he was an active alcoholic, Dan had been a good provider. Now, his job was in jeopardy, and this placed another burden on the family and created more tension in the household.

Neither his mother or his father talked to Jeff about this, but he overheard them talking quietly in the living room. He heard them say that they wouldn't tell Jeff and Tom about Dan's problems at work, so Jeff had to pretend that he didn't know and try to act "normal" around them.

When Tom got home, Jeff spoke to him quietly about what happened. Tom was furious. He told Jeff that he hated their father and he wished the father would die.

Fearing that his parents would hear Tom, Jeff tried to get Tom to be quiet, but Tom was so enraged that he ran out of the house, and sped away in his car. Jeff knew that Tom liked to speed and he worried that his brother would get into trouble. His parents were so preoccupied that they hardly noticed that Tom left in a rage.

Jeff spent the rest of the night in his room spacing out in front of the TV for hours. He had fallen asleep in front of the TV when he heard the doorbell ring late at night.

From inside his room, he heard a commotion at the front door. When he got up to see what was going on, he was not surprised to see a police officer at the door informing his parents that Jeff had gotten into an accident while speeding and he was in the local hospital. Fortunately, he survived the crash and he only had a broken leg and no one else was hurt, but the car was totalled. This was the beginning of Tom's long arrest record for reckless driving.

When Jeff got older, he moved out on his own. He had a few people that he socialized with occasionally, but he tended to keep to himself.

He was employed as a technical researcher, so he spent most of his working time alone as well. Although he tended to avoid socializing, he was often very lonely.

Part of him wanted to have close friends and a special woman in his life but, at that point, a bigger part of him was too afraid of getting hurt and disappointed.

Because he had spent most of his childhood isolating, he also lacked the social skills to go out to meet other people. And when he had opportunities to meet others in college or at work, he was too afraid to open up to these experiences.

By the time he was in his late 20s, he felt depressed and miserable. His father had long since retired on disability due to alcohol-related medical problems, and his mother was depressed and emotionally withdrawn. His brother had moved out of state and he was estranged from the family. No one knew where he was. So, Jeff felt like he had no family and no friends.

Jeff couldn't imagine spending the rest of his life in this state, so he knew he had to do something, but he felt too afraid to seek professional help.

For the next year, he went back and forth in his mind about whether he should see a psychotherapist. He realized that he was spending far too much time by himself watching TV and feeling lonely, but he couldn't get passed his fear of opening up to a stranger.

Finally, when he began having thoughts of killing himself, he called the Suicide Prevention Hot line and they gave him a referral to a therapist.

Because the pain of remaining isolated became greater than his fear of opening up in psychotherapy, Jeff decided to make an appointment to see the psychotherapist.

During the first session, he found it very hard to remain present in the session. He alternated between wanting to zone out and fall asleep.

Over time, Jeff learned how his avoidant coping strategies helped him when he was a child to avoid dealing with the situation at home, which would have been emotionally overwhelming for any child, but especially for a child who was as sensitive as Jeff.

Changing Coping Strategies That No Longer Work For You:  Avoidance

He also learned how this avoidant coping strategy was no longer working for him and that he needed to learn new coping strategies so he could live a full life and not spend the rest of his life hiding. He also needed to learn new social skills so he could meet other people and have a life outside of his work.

It wasn't easy, and there were many times when Jeff wanted to quit therapy because he felt too afraid to come out of his emotional shell. But when he thought of the alternatives, Jeff stuck with it.

Gradually, he learned to trust his therapist. Step by step, he developed better internal and external coping strategies.

Instead of losing himself in front of his TV, he incorporated new coping strategies: He began attending a yoga class and learned how to meditate in that class. He joined a local running club and met other young men and women who liked to jog and bike.

Jeff also began to date, and soon he met a woman that he really liked and they began dating exclusively.

As often happens in intimate relationships, some of Jeff's core emotional issues came up in this relationship, and he was often tempted to withdraw emotionally. However, he dealt with these issues with his psychotherapist as they came up, and he learned to cope with emotions that were difficult for him.

Even though this was a lot of hard work for Jeff, he felt like he was alive for the first time in his life. He realized that by withdrawing from difficult emotional experiences all of his life, he was also withdrawing from positive experiences as well.

Getting Help in Therapy to Change Coping Strategies That No Longer Work

He came to realize that, to survive as a child, he had blunted his emotions so that he felt almost nothing. So, taking the risk of feeling some pain came to outweigh feeling nothing.

In the above scenario, we can see several examples of avoidant behavior in Jeff's family, including alcoholism, social and psychological withdrawal, emotional numbing, and reckless risk taking behavior.

We can also see that engaging in avoidant behavior as children often allows us to survive overwhelming emotions. It comes at a cost in terms of the child's emotional development, but often the child has no choice if he or she wants to survive emotionally.

In addition, we see that the avoidant coping strategies that serve children in terms of emotional survival don't work for adults who must interact and make their way in the world.

Getting Help in Therapy
We also see that there is a lot of emotional pain for adults who recognize that they're stuck in maladaptive coping strategies, but there is also hope for those who seek the help of a licensed mental health professional.

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

I have helped many adults to overcome coping strategies that no longer work for them and learn to develop new coping skills.

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.

Also see my articles:  Coping Strategies that No Longer Work: Passive Behavior

Coping Strategies that No Long Work for You: Controlling Behavior

Tuesday, August 17, 2010

Stress Management: Creating Quiet Time for Yourself

Many people have such busy personal and work-related schedules that they consider finding quiet time for themselves to be a luxury. Most people are far too accessible by cell phone, Blackberry or other modern technology that, even when they make an attempt to create quiet time for themselves, they're often intruded upon when they're trying to relax.


Creating Quiet Time For Yourself
Far from being a luxury, creating quiet time for yourself is a necessity for your physical health and overall well-being. And, as such, creating quiet time is an important part of stress management. The medical benefits have been known to include lower blood pressure and heart rate. Even just taking a few minutes each day to close your eyes to relax can be helpful to your peace of mind.

In the US, we tend to be people who are always on the go. Pressuring ourselves and responding to outside pressure in our lives, we feel we have to work faster, harder and longer. Even when we play, so many of us feel that we must "play hard."

For many people, the idea of taking quiet time during the day seems like a waste of time that could be better used to do one more chore, to make one more phone call, or to do one more task.

When I talk to people about creating quiet time in their lives, they often respond that they don't have time. They tell me about all of the things that they must do and all of the things that they don't get to that they feel guilty about.

How I Create Quiet Time For Myself:
I understand how busy life can be. My workdays tend to be long and my schedule is often hectic. If I chose to, I could fill my every waking hour with work, phone calls and other tasks. In order for me to have quiet time in my day, I have to make a conscious effort to build it into my schedule, just like any other appointment or task.

Usually, during the week, I find at least 10-15 minutes around lunch time to either meditate or do some restorative yoga poses as part of my stress management routine. I turn off the phone, put my Blackberry away, and take off my watch in order to feel that this time is really mine. Those 10-15 minutes of relaxation make such a positive difference in how I feel the rest of the day.

Over the weekend, I usually attend two yoga classes that include several minutes of quiet relaxation at the end of the class. During the class, the yoga instructors give very detailed instructions about each pose so that I must focus my attention on what they're saying, what I'm doing, and how the pose feels in my body. I don't have time or space to focus on anything else, so that the hour and a half that I spend in class allows me to get away completely from my daily concerns. It feels like a moving meditation. Afterwards, not only do I feel relaxed, I also feel refreshed and leave the class with a sense of contentment.

For me, simple pleasures are best for creating quiet time. One of my favorite simple pleasures is going to the local community bookstore, which has been there for over 25 years (even though one of the major bookstore chains has been within walking distance for the last 10 years). The staff in this bookstore is knowledgeable, friendly, and involved with what's going on in the community. They encourage customers to come in and relax.

If I go early enough, this bookstore is usually quiet. I can choose a book from the shelf, sit on the couch and allow myself to enter into the author's world. My cell phone and Blackberry are usually off during this time.

There are two cats in this bookstore, and if I'm lucky, one of them comes to cuddle and sleep in my lap. Aside from enjoying the cats' company, as creatures who know how to relax, they remind me how to stretch and find a few peaceful moments to myself. On sunny days, the garden in the back is the perfect place to sit, read, sip tea, admire the plants and trees, listen to the birds, play with the cats, or get lost in a book.

From early on, my mother instilled in me a love of books. We would make trips to the local library at least twice a week to take out new books. Then, we would go to the park that was across the street from my school and my mother would read to me. The books that really stick in my mind are the Madeline series by Ludwig Bemelmans. Even today, when I'm in the local bookstore, which has a section for children, and I hear a parent reading  to her child, I get vicarious pleasure from eavesdropping and hearing the familiar stories.

I might stay in this bookstore 10 minutes or I might stay a couple of hours. How ever long it is, I usually feel like I've gotten away because it's a special time and a special place that's just for me that I allow myself to have.

So, those are some of the things that I do to create quiet time for myself. But what about you?

Suggestions for Creating Quiet Time For Yourself:

Get Up a Little Earlier Than You Usually Do to Have Some Quiet Time:
There is something so precious about having 10-30 minutes to yourself before the rest of the family gets up or you're expected to respond to other people's needs. Even if all you do is have a soothing cup of tea before your day begins, it's a good time to reconnect with yourself.

Rather than using that time to make to-do lists or take care of other chores, just sit, be quiet and breathe. I'm convinced that most of us are so busy talking and doing things that we don't take time to relax and be quiet. And many of us go through the day not realizing that we're often holding our breath much of the time due to excessive tension. So, remembering to be conscious to breathe fully is an important part of relaxation.

Take Time to Be Quiet at Lunch:
Even just a few minutes at lunch time to close your door to relax can be beneficial and, in the long run, make you more productive. Going out for a walk to a nearby park, river or peaceful place in nature can also be very relaxing. Can't find a nearby nature spot? How about watching dogs play at the local dog run?

Watching dogs play can be relaxing

Create a Peaceful Environment for Yourself:
I have two offices and both of them have pictures of nature. In one of them, I have a picture that's called "Proust's Garden." I have no idea if this is actually what Marcel Proust's garden looked like, but the name of the picture and the picture itself, full of plants and trees with dappled sun and shadows, has such a positive association to relaxation and beautiful prose that whenever I look at it, I feel peaceful. It's a very inviting picture that draws you in. Clients often comment about that picture and how soothing it is. In that same office, I have seashells on my bookshelf. Aside from the actual beauty of the shells, they're a reminder of the ocean and peaceful days spent by the water. In my other office, the picture that's behind me is of a garden and a gazebo. Clients often comment about that picture too and how restful it is when they're eyes land on it.

Creating a Peaceful Environment For Yourself
Even if you have one picture or one object that you like that your eye can land on from time to time, your association to that object can bring about a state of well-being when you can't get away.

If you think about it, I'm sure that you would discover other ways that are meaningful to you to create quiet time for yourself. And when you do, you'll experience the benefits of having that special time that you deserve.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR 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.



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Thursday, August 12, 2010

Psychotherapy to Overcome Your Past Childhood Trauma

Many people avoid seeking psychological help for past childhood trauma because they fear that it will be too emotionally overwhelming for them. While it is understandable that someone with childhood trauma would feel this way, the emotional consequences of not dealing with past childhood trauma often far outweigh whatever emotional upset involved with seeking psychological help and overcoming the trauma.


You Can Overcome Your Fear of Dealing with Childhood Trauma
Emotional trauma, by definition, is overwhelming when it occurs, whether it is a single incident of trauma or complex trauma where there was an array of traumatic events.

Dealing with Trauma as an Adult vs. Dealing with Trauma as a Child:
When we're children and we experience emotional trauma, we don't have the emotional or cognitive abilities to cope. A child's emotional system can be easily overwhelmed by emotional trauma, especially if there isn't a competent and caring adult to help the child. Children often react to emotional trauma by dissociating the event (numbing themselves emotionally). They might become very quiet, and what's going on for them in their internal emotional world might not be apparent to adults. Other children who dissociate traumatic events might appear to be functioning at their normal level because they compartmentalize the event, and the effects might not surface until they are adults. Other children act out at home or at school, and this is a signal to parents and teachers that something is wrong, and the child needs help.

While it's true that a child usually lacks the ability to deal with emotional trauma, that same person as an adult usually have coping abilities that he or she didn't have to deal with the same trauma as a child. Often, adults who fear dealing with their childhood emotional trauma fear that they will feel as overwhelmed now as they felt as children.

The fear that dealing with their trauma will be too much for them is often an unconscious fear that they will feel the same feelings in the same exact way as they did when they were children. But, because it's an unconscious fear, what is usually overlooked is that the thing that they fear has already happened. In other words, there is no distinction for them in their internal emotional world that what happened was then and this is now. They might know on an intellectual level that "that was then and this is now," but they don't feel it emotionally.

In addition, adults who fear dealing with their prior childhood trauma often don't know that most psychotherapists who have an expertise in dealing with trauma have careful ways of working to help clients so they usually don't feel as emotionally overwhelmed as when these adults were children.

As a Psychotherapist, How I Work with Trauma:


Developing Internal Resources to Deal with Trauma
When I work with a client who has unresolved childhood emotional trauma, I usually start by making sure that this client has the emotional ability to deal with working through the trauma. As part of the early work, I assess for these capabilities.

If I find that a client lacks the internal emotional resources to deal with the trauma, the early work will be helping the client to develop these internal resources. Internal resources that allow clients to cope with whatever comes up are very important in trauma work.

An example of an internal resource would be the ability to calm yourself by going to a safe or calm place in your mind where you can relax and let go of overwhelming emotions. It's also important for clients to have external resources to help them cope, such as being able to talk to close friends and caring family members, meditating, going to yoga class or the gym or other helpful external ways to manage stress.

Working Gently and Effectively with Childhood Trauma
Also, when I am working with clients who have unresolved trauma, I usually work in a way where the traumatic experiences are titrated so clients are less likely to feel overwhelmed. This titration usually involves dealing with the trauma by working through manageable pieces of the trauma.

After clients have developed internal resources, if they begin to feel overwhelmed in session as we're working on the trauma, I help them to switch from the beginnings of that overwhelming emotion back to their internal resources until they feel safe enough to go back to dealing with the trauma. So, in other words, I help clients to "pendulate" between their overwhelming feelings to a calmer state.

The Negative Consequences of Not Dealing with Unresolved Trauma:
Whether we realize it or not, past unresolved trauma often has negative consequences in our lives. Depending upon the trauma, the following is a list of the negative consequences that people often experience when they do not work through their trauma in therapy:

People with unresolved trauma often suffer from higher rates of anxiety and depression as compared to the general population. Their anxiety or depression make it difficult for them to perform their daily activities of living and compromise their close relationships. This often results in loss of relationships or loss of jobs.

You Can Overcome the Depression and Anxiety Related to Unresolved Childhood Trauma
Untreated emotional trauma can result in fear of getting close to other people. This might mean that the people with unresolved trauma fear getting involved in intimate relationships or they are unable to form close friendships. They might keep people at a distance from them because of their fear of getting hurt again, which could cause them to feel lonely and sad.

Even when people with unresolved trauma do get involved in intimate relationships, they often, unconsciously, choose people who will be emotionally and or physically abusive to them in similar ways to how they were abused as children. This often happens repeatedly, even though these people might tell themselves that they don't want to choose abusive partners again.

People who have unresolved trauma often have higher rates of substance abuse problems, as compared to the general population. They often use alcohol or drugs to numb their overwhelming emotions.

Unresolved trauma often results in physical problems, including high blood pressure, headaches, asthma attacks and other medical problems. Even though people with unresolved trauma might not be consciously thinking about or remembering their trauma, their bodies "remember" the trauma in ways that make them sick physically.

Many medical doctors who are savvy about the mind-body connection and how trauma affects people on both emotional and physical levels will refer their patients for psychotherapy with psychotherapists who have an expertise in trauma. But many doctors are not knowledgeable about the mind-body connection, and they continue to treat their patients only on a physical level with medication. The medication, while important, is only treating the physical symptoms of trauma--it's not helping the patients to resolve the trauma.

People with unresolved trauma often feel less resilient so they have a hard time "bouncing back" from current problems. They're so overwhelmed with the old trauma that they haven't dealt with that new problems are often too much for them. So, other people, who might not know that a person has prior unresolved trauma, might think that this person is overreacting to current problems. They might not see that this person is reacting not only to current problems but that the unresolved trauma is getting triggered too. To outsiders, these people often appear to be behaving in emotionally irrational ways. The person with the unresolved trauma might not understand himself or herself what's happening and it can be frightening.

You Can Become More Resilient with Mind-Body Oriented Psychotherapy
Unresolved trauma is often passed on from one generation to the next. Of course, this isn't intentional. It happens unconsciously as children often absorb their parents' fears. This can happen even if a parent never talks to his or her child about what happened to the parent when he or she was younger. It happens because children are often exquisitely attuned to what's happening emotionally to their parents and they "pick up" on trauma more easily than most people realize. For instance, this is often seen among children of Holocaust survivors or survivors of other man-made or natural disasters. The parents might never talk about their experiences, but children can often intuit that their parents have overwhelming fears. When they sense this, they often grow up to feel that the world is not a safe place for them, and something bad and overwhelming could happen at any time.

The above list will begin to give you an idea of how unresolved trauma can affect you and those that you love.

The following scenario is a composite of many different cases and should serve to illustrate the consequences of unresolved trauma as well as how trauma therapy can help:

Ann:
When Ann was 21, she was relieved to be able to move out of her parents' home. She had lived all of her life with an alcoholic father who was emotionally and physically abusive to her as a child and a mother who was extremely passive and emotionally beaten down herself from her husband's abuse. After saving up enough money to get her own apartment, Ann vowed that she would look upon her childhood as a chapter in her life that she was closing, never to be looked at again. Moving out for Ann was a new beginning and she never wanted to look back at the abuse that she experienced growing up.

Ann took a lot of satisfaction in being able to set up her apartment the way that she wanted and the freedom of coming and going as she pleased without anyone, like her abusive father, being able to tell her what to do or to put her down.

Ann had a couple of friends that she talked to and socialized with now and then. But, usually, she felt too afraid to form close or intimate relationships. When she was growing up, she could never bring friends over because she never knew when her father was going to be in an alcoholic rage and she felt too ashamed to allow other people outside of the family to see this. So, she might go to other children's houses to play, but she never invited them to her house.

Often, this became uncomfortable because children would ask her about her parents and her home, and she didn't know what to say. She felt too embarrassed to tell them that her father drank a lot and he was abusive, so she would make up excuses, even though she knew that the other children didn't always believe her. At times, she would overhear some of the children talking and laughing about her and her parents, and this hurt her feelings and made her want to keep to herself.

As an adult, Ann's two friends would often tell her that they felt that she was emotionally distant from them. They liked her and wanted to get closer to her, but they felt that she managed to keep her distance. Whenever this topic came up, Ann felt very uncomfortable. She had a sense that what her friends were saying was true, but she found it was too emotionally overwhelming to deal with it, so she denied it to herself and to them. At the same time, she felt very lonely and wanted and needed to feel close to someone, but she was too afraid to allow herself to get close to anyone.

Then, one day, when Ann was out with her two friends at a bar, she met Bill. Bill was so friendly and charming that Ann found him hard to resist, in spite of her usual very cautious nature. From the moment that she met Bill, Ann felt that there was something so familiar about him, as if she had known him for years. She had never felt this way before, and she was amazed and taken off guard.

Ann and Bill began dating, and she found herself falling in love with him quickly. Her friends, who thought that Ann would never allow anyone to get that close to her, were thrilled that she met someone who was so loving and attentive towards her. Ann felt like a whole new world had opened up for her both internally and externally, and she realized that she had never felt this way before.

A year or so later, Ann and Bill decided to get married. Ann dreaded having Bill meet her parents, but she had visited Bill's parents numerous times, and she knew she couldn't avoid having Bill meet her parents indefinitely. On the day that Ann brought Bill to meet her parents, Ann's mother greeted them at the door looking anxious. She told them that Ann's father wasn't feeling well and he was upstairs in the bedroom sleeping.

Ann knew instantly that this meant that her father was sleeping off an alcoholic binge. She felt very angry that her father couldn't stay sober long enough to meet Bill, but she kept these feelings to herself and tried to make the best of it. Her mother made an effort to appear chipper and carefree, but she looked like a nervous wreck. When Ann saw how her mother was acting, she felt very ashamed. All of her old childhood fears of allowing other people to meet her parents came rushing to the surface. She felt that bringing Bill to her parents' home was a big mistake. For his part, Bill was his usual charming self and he handled the situation well.

Throughout dinner, Ann felt like she was part of some surreal play in which all of the characters were playing their parts and doing their best to ignore the emotional environment around them. After they finished dinner, Ann couldn't wait to leave, so she turned down her mother's dessert and made up an excuse to leave early. Ann felt that her mother said all the right things to encourage them to stay, but Ann felt that, underneath it all, her mother was just as relieved to have them leave. Once she was out the door, Ann breathed a sigh of relief and she and Bill went back to her apartment.

After they got married, things seemed to be going well, at first. But, over time, Ann began to suspect that Bill had a drinking problem that he had managed to keep hidden from her while they were dating. At first, she didn't want to see how much Bill was drinking when he got home from work. She made excuses to herself about his behavior because it was too much for her to see.

But one night it all came to a head at a dinner in their home with Ann's two friends and their boyfriends. Bill started out the evening being charming, gracious host, but as he continued to drink, he became loud and argumentative. Ann felt close to tears, and she put her head down and hoped the evening would pass quickly. But before the night was over, Bill nearly punched one of the friend's boyfriends, and Ann's guests left abruptly with her friends telling her that they would call her tomorrow.

At first, Ann told herself that this was only one night and Bill had never behaved in this way before. Bill was very apologetic and promised her that it would never happen again. She forgave him, called her friends to apologize, and she decided to put the whole incident behind her as if it had never happened. But these incidents began to happen more regularly whenever they had his or her friends over, as Bill began to drink more and more. And Ann was beginning to run out of excuses that she made to herself and to her guests for Bill's behavior. Finally, after an incident where Bill got so drunk that he was abusive to her in front of their guests, shouting at her and attempting to take a swing at her, Ann couldn't remain in denial any longer. One of Bill's friends grabbed hold of Bill and told him to calm down or he would call the police. Then, he helped Bill to stagger up to the bedroom where he fell into a drunken stupor.

After that night, Ann had the painful realization that she had married a man who was a lot like her father. She could hardly believe that Bill had this other side to him that she had never seen before when they were dating. She also couldn't believe that she was behaving just like her mother with the same resignation, passivity, and denial. Even though she had told herself when she was growing up that she would never be like her mother and never marry anyone like her father, here she was in the same situation that she vowed she would never be in.

Ann realized that she needed help, and she found a psychotherapist who specialized in working with trauma
Subsequently, Ann made what were some painful decisions for her: She decided to find a psychotherapist who could help her. She also told Bill that he needed to go to an alcohol program and go to A.A. if he wanted to save their marriage. Bill was not at all open to getting help and told her that he felt he could control his drinking on his own. A part of Ann felt that if Bill wasn't going to get help, why should she? After all, in her eyes, he was the one with the problem. But Ann was in an emotional crisis, and she didn't want to confide in her friends so, with some resentment towards Bill, she found a psychotherapist who specialized in the problems that she felt overwhelmed by and started therapy.

Her psychotherapist, who was a trauma expert, helped Ann to develop coping skills that she never had. Her therapist knew that Ann was not ready to leave her marriage, even though she was in an emotionally abusive relationship. So, she helped Ann to deal with the day-to-day crises in her marriage, and she told Ann about Al-Anon and encouraged her to attend. As Ann developed better coping skills, she began to feel stronger emotionally and more able to deal with the problems in her marriage. When Bill continued to refuse to get help, Ann proposed a trial separation, which Bill did not want. He realized that Ann was serious and he could lose her, so he began attending an outpatient substance abuse program and going to A.A.

As the situation at home calmed down, Ann's therapist helped her to explore her childhood issues which had lead Ann, unconsciously, to repeat her childhood trauma in her adult life. Whenever Ann began to feel overwhelmed by emotions that felt like they were going to overtake her, she was able to tell her therapist and her therapist helped her to manage those feelings by temporarily entering into a meditative state to calm down until she felt calm enough to continue dealing with the childhood trauma.

As Ann's therapist helped her to "pendulate" back and forth from discomfort to comfort, Ann began to realize that she could manage and, eventually, overcome these emotions that she had avoided dealing with for years. Ann's therapist also helped Ann to deal with her childhood trauma in "manageable bites" so that Ann didn't feel like she was on a runawsay train of emotional trauma.

As Ann continued in her therapy, she learned about the mind-body connection in trauma. She learned that the body holds the memories of the trauma, even when she wasn't consciously thinking about it. She began to realize that her headaches and body aches were often the result of her tremendous efforts to hold back these traumatic memories from consciousness, and when she allowed herself to deal with the trauma in a manageable way, she often felt calmer and her body felt less tense than when she braced herself against feeling her feelings.

As she continued in her therapy work and her marriage improved, Ann realized that she had kept her world very small because of her trauma and shame. Gradually, she began to allow others to get to know her better. Her friends began to comment that she seemed more relaxed and open with them. While her trauma work in therapy wasn't easy, she began to discover that it was easier for her to deal with it than to continue to avoid it, so she felt encouraged to continue.

Overcoming Childhood Trauma
The above composite account of a psychotherapy case illustrates how unresolved childhood trauma can continue to affect an adult even when that person is no longer in their old environment. It also demonstrates that there is hope and the possibility of living a more meaningful life when people make a choice to get psychological help to overcome their trauma rather than continuing to avoid it out of fear.

Overcoming Childhood Trauma:  You're Not Alone
Getting Help
If you have unresolved trauma, you owe it to yourself and the people that you love to get psychological help from a licensed mental health professional who has an expertise in trauma. The renewed energy and peace of mind that people regain after they have overcome unresolved trauma usually outweighs the discomfort of working out these problems in therapy.

I am a licensed NYC psychotherapist, hypnotherapist, and EMDR therapist who works with trauma using mind-body psychotherapy.

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

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


Also, see my article:  Overcoming Childhood Trauma that Affects Your Adult Relationships


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Thursday, August 5, 2010

Coping with a Spouse Who Has Borderline Personality Disorder

Generally, as a psychotherapist, I tend not to think of people in terms of diagnoses. People are more complicated than that, and looking at people only in terms of diagnoses tends to be reductionistic and pathologizing.

While a mental health diagnosis will not capture the complexity of a particular human being, there are times when it is helpful to understand and cope with people who are close to you who are suffering with emotional problems. It's also important to understand yourself in relation to this person, what's happening to you in this relationship and steps that you might need to take to protect yourself emotionally, physically, and financially.

As I mentioned in my previous post, borderline personality disorder (BPD) is a serious mental health problem. It's often hard to understand for the person who has borderline personality traits as well as his or her loved ones. As with any mental health diagnosis, borderline personality disorder is on a continuum. There are certain people who have various traits and not others, and there are also people who meet the full criteria for the disorder.

Living with a spouse who has borderline personality traits can be extremely challenging. Usually, it means that you're living in a very chaotic emotional environment where you've not sure if you're losing your mind or your spouse is "going crazy."

How Do You Know If Your Spouse Has Borderline Personality Traits?
Listed below are some questions that you can ask yourself. While it's understandable that, if you're not a licensed mental health professional, you're not qualified to diagnosis anyone, but the questions below will help you to begin to understand what you might be dealing with in your relationship:

Does your spouse or partner become irrationally angry or enraged at the drop of a hat over relatively minor issues?

Do you feel like your spouse goes back and forth at various times between idealizing you and devaluing you?

When your spouse becomes angry with you, does he or she "forget" everything that is good about you and your relationship so that you feel that he or she has done a complete "180"?

Does your spouse engage in emotional "cut offs" with you or his or her family members or friends with little provocation?

Do you often feel that you're "walking on egg shells" with your spouse because you fear that things you might say or do will cause him or her to become extremely angry and possibly violent?

Do you often find yourself avoiding certain topics because you're afraid that your spouse will have an angry or violent reaction?

Do you often feel misunderstood by your spouse and your efforts to try to clarify things that you've said or done are not heard or understood by your spouse?

Do you often feel manipulated and controlled by your spouse?

Are you fearful of asking your spouse for what you need emotionally because you're afraid that your spouse will accuse you of being "too demanding"?

Do you often feel that your spouse changes his or her mind a lot so that you're not sure what he or she wants from you?

Does your spouse accuse you of doing or saying things that you never did or said?

Does your spouse seem to go from trusting you to being highly suspicious and distrustful of you for no apparent reason?

Do you often find it difficult to plan social activities because of your spouse's changing moods, impulsivity, and unpredictability?

Over time, do you often feel like you're living with "Dr. Jekyll and Mr. Hyde"?

Does your spouse often seem very charming and engaging to other people, but when you're alone with your spouse, you see a completely different side of him or her that most people don't see?

Does your spouse abuse alcohol or drugs or engage in gambling or sexual addiction as a way to cope?

Does your spouse often accuse you of not caring for him or her so that you feel that no love or caring is ever enough?

Does your spouse vacillate between wanting to be emotionally or financially rescued to cutting you off emotionally?

Do you find that you and your spouse often go through frequent breakups and reconciliations?

Do you find that your spouse engages in a lot of "all or nothing" or "black and white" thinking and there often doesn't seem to be any middle ground in his or her thinking, especially when he or she is angry?

If you've tried to leave the relationship, has your spouse tried to use charm, manipulation or even physical violence to keep you from leaving?

Does he or she threaten to commit suicide or threaten to hurt you if you leave?

It's important to understand that the above characteristics are often common to many different types of emotional problems, not just borderline personality disorder. So that, as a non-mental health practitioner, you're not going to be able to analyze or diagnosis your spouse. Also, while your spouse does not need to have all of these traits, having one or two of these traits does not mean that your spouse has borderline personality disorder. The above list is meant to give you an idea of what you might be dealing with in your relationship.

The following fictionalized scenario, which is not about any particular person, is an example of some of the problems involved in a relationship with someone who has borderline personality disorder traits:

Mary and John:
When Mary met John in their senior year of college, she thought he was one of the most charming and thoughtful people that she had ever met. She felt completely swept off her feet by him. She had also never felt so close to anyone before. No one had ever made her feel so terrific before. He thought that almost everything that she did was wonderful. When her friends met him, they also really liked him and found him to be very charming and engaging. He was funny and very generous. Often, when people met him for the first time, they would say that they felt he was so familiar to them, as if they had known him for a long time.

Before introducing Mary to his family, he warned her that his family tended to be very chaotic. He told her, "In my family, you need a score card to keep track of who's angry with whom and who's not talking to whom, but I'm sure they'll love you just as I do."

When Mary met John's family, which consisted of his parents and five brothers and sisters, Mary realized that what John had told her about them was accurate. Although they welcomed her with open arms, there was a lot of tension in the air between family members. She noticed that certain siblings were barely talking to each other and there seemed to be various alliances between certain siblings against other siblings. At various points in her visit, arguments suddenly erupted for no apparent reason, making Mary feel very uncomfortable. But, just as quickly as these arguments erupted, they also subsided just as quickly. John's mother said to Mary, "Don't mind us. This is just how we are. We fight, we stop talking to each other for months at a time, but we love each other and we always make up--until we begin fighting again"

Within a few months of having met each other, Mary and John got married. Mary was sure that she had never been happier and she had never felt so loved and appreciated in her life as she felt with John. During the first month or so, Mary felt like she was living with a prince and John treated her like his queen. He brought her flowers. He told her that he thought she was the best wife and lover that a man could ever have. He praised everything that she did.

Then, one day, without warning, all of this seemed to change. John was under a lot of stress at work and he felt that his boss was harassing him. Mary had never seen John in such an anxious and angry state. When she got home from work, she found John pacing the room back and forth. He told her that his boss was on his back and he was thinking of quitting his job. Mary was very surprised to hear John say this because during the first few months that John worked with this particular boss, John had nothing but praise for him. John often talked about what a great future he felt he had with the company and how much he loved his job.

Since John would often tell Mary how much he valued her advice, she began to tell John that maybe his boss was in a bad mood that day and things would probably go back to being as good as they usually are tomorrow. She was putting away grocery when she saw John whirl around with a look of rage on his face that she had never seen before. Then, John yelled at her, "Who's side are you on!?! Are you taking my boss's side!?!"

Mary was so shocked and dumbfounded by John's reaction that she dropped the eggs on the floor, which only made John more angry, "Oh God, Mary! What the hell are you doing? Look at this mess! You always make a mess of things! Can't you do anything right!?! And what do you know about my job. You're always putting me down! Why aren't you ever on my side!?!" Then, John suddenly walked out of the apartment, leaving Mary feeling like she was in the middle of a nightmare.

While John was gone, Mary tried to calm herself. She had never seen John like this before. She thought about what he had said. She could not ever remember putting John down or not being on his side. She couldn't understand how or why he would say these things.

About a half hour later, Mary received a call from John's mother. She told Mary that John had come to her house and he was talking to her and the rest of the family about the argument. She told Mary, "You know, Mary, John is very sensitive and you should try not to get him angry because he explodes. You're his wife. You should try to be supportive of him and not put him down. I thought you were different." Mary worked hard to contain her own anger about this intrusive call. She didn't want to explain herself to John's mother, so she decided to wait until he got home to talk to him.

When John came home a few hours later, he seemed like his old self again. He brought her flowers and told her that he was sorry that he lost his temper. He told her that he didn't mean all the things that he said, and he wanted to make up with her. Mary was confused, but she was glad that John was "himself" again and she thought that his overreaction earlier that evening might have been due to his being under a lot of stress at work. She decided to leave well enough alone and not bring up anything about John's boss or his work or the phone call from his mother that evening. That night, John and Mary made passionate love and, once again, Mary felt that no one had ever loved her as much as John.

Over the next few weeks, everything seemed back to normal again--until John had an argument with his mother. Once again, John was pacing back and forth and he was very angry and upset. There were numerous calls back and forth between John and his mother where they were yelling at each other, crying, and hanging up the phone. As Mary watched things unfold, she told John, "Try not to let your mother affect you so much. Why don't you just let things simmer down before you call your mother again." John responded by losing his temper with Mary, "What are you talking about!?! My mother is the best mother a son could have. She's not bothering me! You're the one who's bothering me. You're never on my side. You're the worst wife a man could have! Why don't you leave me alone!?! I don't know why I ever married you!" Then, John stormed out of the apartment.

As these scenes became more frequent, Mary began to realize that John had serious emotional problems, and that his family was very dysfunctional. She became very vigilant when she got home to try to "read" John' s mood because she never knew when he was going to be his charming, loving self or when he would be angry and demeaning of her. She also began avoiding certain topics that she knew would make John angry to avoid dealing with his temper. But as careful as she tried to be, she was still subject to John's impulsive and destructive rage which often came for no apparent reason. She also often felt misunderstood by him, and when she tried to explain herself, John dismissed whatever she said when he was in an angry or anxious mood.

Over time, Mary began to realize that John stopped being as attentive to her needs. When she tried, very tactfully, to bring this up with John, he lashed out at her because he felt criticized, "Oh, like I don't have enough going on at work and dealing with my family! Now, you're going to make demands of me too! You're too demanding! I can't deal with it, Mary! You have to stop!" Mary began to explain that she often felt lonely and she couldn't understand what happened to their relationship. Hearing that, John's anger escalated and he began breaking things around the apartment.

Mary became so frightened that she started to run out, but John caught her by the arm and began begging her not to leave. He dissolved into tears and promised her that he would change, "You have to help me, Mary. I need your help. Don't leave me." At that point, Mary had already seen enough of this behavior to know that John was unable to keep his promises to change. She told him that she thought they both needed to get help and if he didn't get help, she would leave.

Since John had a very strong fear of being abandoned, he complied with her wishes. He asked his family doctor for a referral, and his doctor referred him to a DBT therapist who specializes in working with people who have borderline personality traits. Mary also began her own individual psychotherapy to deal with her issues in their relationship.

It took a long time and it wasn't easy, but John learned how to cope with his overwhelming feelings of anger and fear of abandonment. There were many times when John wanted to leave therapy because he felt the therapist didn't understand him. Then, there were times when he thought his therapist was the best therapist in the world. Mary also learned to take care of herself in their relationship. Over time, their relationship began to improve. The family dynamics in John's family never changed, but John and Mary learned not to get so caught up in them.

The above scenario represents a somewhat optimistic outcome of living with a spouse who has borderline personality disorder. Not every relationship turns out that well. For instance, people with borderline personality disorder often refuse to get help. It's hard for them to see that they have a problem, and they often blame everyone else. In other cases, they might go back and froth between blaming others and blaming themselves.

If you're the spouse who is on the receiving end of this behavior, it can be very hard, if not impossible, to deal with on an ongoing basis. One of the most challenging aspects of this type of relationship is that you often can't see when your spouse is going to shift from being loving and thinking that you're wonderful to being angry and blaming and accusing you of being the worst spouse ever.

When you go through these sudden ups and downs with your spouse, you might feel like you're on an emotional roller coaster. You might also feel that you hardly recognize this person, who is supposed to be your spouse, when he or she makes these sudden emotional shifts.

While there is a place for compassion and understanding, you should never allow someone to emotionally abuse you or your children. Remember that the person with borderline personality disorder traits is responsible for his or her behavior. If there is abuse, especially physical abuse, you need to make a safety plan for yourself and your children to be able to leave the household quickly, if needed, and go somewhere where you feel safe.

Even if your spouse refuses to get help, you probably need help yourself to deal with a spouse who has borderline personality traits. Only you can decide how much is too much and if you want to stay or leave, but by seeing a licensed mental health professional, you can sort this out and learn what your role is in participating in this relationship.

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

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.