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Monday, November 24, 2014

Psychotherapy Blog: The Counterphobic Defense: Getting Psychological Help

In my prior articles, What is the Counterphobic Defense? and The Counterphobic Defense and Hypersexuality, I discussed a particular type of counterphobic response, hypersexuality, which I defined and gave a fictionalized scenario to describe how childhood sexual abuse could lead to hypersexuality.  As I mentioned in my prior article, this fictionalized account is not about any one client--it is a composite of many different cases with all identifying information changed.

Fictionalized Scenario About Hypersexuality as a Counterphobic Response:
When we last left off in the prior article, Marie, who had been sexually abused as a child by her stepfather and who, subsequently, acted out sexually in a hypersexual manner, met a man, Tom, whom she really liked.

The Counterphobic Response:  Getting Psychological Help

But, unlike her other encounters with men, which were sexual but non-intimate and where she felt "in charge" and empowered due to her counterphobic response, Marie felt emotionally vulnerable and ambivalent about this relationship.

Her fear of being emotionally vulnerable troubled her so much that, at times, she was tempted to break off her relationship with Tom.  At the same time, she knew that this was the only healthy relationship that she had ever had and she knew she needed psychological help to overcome her fears.

Marie went to several different psychotherapists.  Each time they would get close to the core of her problems, including the early childhood loss of her father, the guilt she felt for her father leaving, the emotional abandonment by her mother, and her feelings of helplessness when her stepfather sexually abused her as a child, Marie would find a way to sabotage the treatment.

Either she would stop going to her therapy sessions or she would find faults with whichever therapist that she was seeing and then she would leave.

In her treatment with a male therapist, she attempted to seduce him, and when he set limits with her, she left treatment (see my article:  Boundary Violations and Sexual Exploitation in Therapy).

All the while, her boyfriend, Tom, tried to be patient with her ambivalence and moodiness towards him.  He knew that they loved each other, but he couldn't understand why Marie would be kind and loving to him one day and then annoyed and dismissive with him on another day.  And whenever he asked her what was wrong, she had no answer for him.  She only knew that she was terrified of being in this relationship, but she was too afraid to tell him this, so she gave him no answer.

Finally, he gave her an ultimatum:  Either she get psychological help for whatever was affecting her or it was over between them.

Faced with the possibility of the end of their relationship, Marie would have thought she would be relieved.  It would have put an end to her fears.  But, instead, she realized that she was more afraid of losing him and the relationship that they had than she was of being in the relationship, so she knew she had to get psychological help and stick with it.

When Marie came to see me for her first therapy session, it was obvious that she was very frightened.  She seemed like she was going to bolt out the door.

During the consultation, I explained how I worked and told her that I usually start with psychological resourcing (e.g., developing coping skills and mechanisms) before I deal directly with the trauma, and we would go at whatever pace she felt comfortable with because I could titrate the work so she would not become overwhelmed.  Marie seemed relieved about this.

I also explained that, given her significant childhood trauma, this would not be short-term therapy, so she would need to know that it required a commitment to do the work involved with trauma therapy.

Once she was in therapy and Tom realized that she was committed to getting psychological help this time, he agreed to remain in the relationship as long as she remained in treatment.

Marie and I worked on resourcing to help her develop coping mechanisms that she never developed before.  There were many times that Marie wanted to leave therapy, but she remained.

After a few months of her developing internal resources to do the trauma work, she and I agreed that she was ready to deal her counterphobic response and the underlying trauma.

We used EMDR (Eye Movement Desensitization and Reprocessing) therapy to deal with her early childhood losses and sexual abuse as well as her feelings of sadness, anger and helplessness.

Despite her trauma, Marie had a lot of strengths  She also came to her weekly sessions regularly.  The coping tools that she developed during the initial stage of therapy helped her to deal with her fear and ambivalence about her relationship with Tom.

The Counterphobic Response:  Getting Psychological Help

As she continued to work through the trauma and used her coping skills to deal with her fears, she was able to allow Tom to get closer to her.  She was no longer tempted to act out sexually with other men when she felt afraid.  Instead, she was able to communicate her fears to Tom, and they were able to talk it out.

Marie became increasingly aware that there was no "quick fix" for her problems, but she remained motivated in treatment, even though it was difficult at times.

When Marie divulged her history to Tom, including her hypersexuality, he was understanding and willing to be supportive in any way that she needed.

As she became psychologically healthier, Marie began to understand what it felt like to feel genuinely empowered as opposed to the pseudo empowerment she felt, which was related to her former counterphobic response.

The Counterphobic Response:  Getting Psychological Help

By the time Marie completed her treatment, she was more emotionally open and vulnerable with Tom than she had ever been with anyone.  They made plans to move in together and talked about getting married.

Getting Help in Therapy
Overcoming the counterphobic response, whether it involves hypersexuality or other counterphobic responses, is challenging but it is possible.

If you think you're affected by a counterphobic defense in your life, you could benefit from getting help from a licensed mental health professional.

Getting psychological help could make the difference between you living a life where you are constantly trying to quell your fears through compulsive or dangerous behavior and living a fulfilling and meaningful life with a genuine sense of empowerment.

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

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

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

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