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Saturday, December 6, 2014

Psychotherapy Blog: Learning to Feel Hopeful in Therapy: Developing a Stronger Sense of Self

In a prior article, Learning to Feel Hopeful in Therapy , I began a discussion about how difficult it can be for psychotherapy clients, who have a history of emotional trauma and who have not been healed by therapy in the past, to allow themselves to be vulnerable enough to feel hopeful in therapy again.

Learning to Feel Hopeful in Therapy:  Traumatized Clients Often Have a Hard Time Opening Up

In that article, I discussed that my experience (and the experiences of many other trauma therapists) has  been that a mind-body oriented approach in therapy tends to be more helpful in terms of healing trauma than regular talk therapy.

I also discussed the ongoing research about the neuroplasticity of the brain, how this research helps us to realize now, more than ever, that the brain can change itself and, as result, there can be a resolution to emotional trauma under the right circumstances in therapy.

For many clients, who have been devastated by emotional trauma and who were unable to trust their primary caregivers as children, the idea that they could expose their emotional hurt and pain to a therapist seems incomprehensible.

From the point of view of many of these individuals:  Why should they trust a therapist when they couldn't trust their primary caregivers who were supposed to love and protect them?

People Who Have Been Traumatized Often Have a Hard Time Trusting in Therapy

Even worse, if they've been to therapy before and they had bad experiences, they're now doubly afraid of opening up again.

As a psychotherapist, I hear this often and I can understand why it would be very frightening for these individuals to open themselves up to be emotionally vulnerable.

Often, these people come to therapy because they're in so much emotional pain and they really long for relief.

At the same time, many of them are so afraid that they're ready to bolt from therapy if, from their perspective, there's a chance of getting hurt again.

Developing Coping Strategies in Therapy:  Developing the Capacity for Emotional Regulation 
When I know that there has been significant trauma and the client is fearful of opening up in therapy, I usually start with helping them to develop the kinds of internal resources and coping skills that will empower them to open up.

Preparation for Trauma Therapy:  Developing Coping Strategies in Therapy

When I help clients through the resourcing phase of treatment, I develop an individualized plan for each client.

Resourcing includes ways that clients can learn emotional regulation, which is so important for people who have suffered trauma, especially early childhood trauma.

Early trauma can leave a child feeling helpless, abandoned and unable to contain the overwhelming emotions related to the trauma.  Often this is because his/her primary caregiver was either unavailable (physically and/or emotionally) or unable (due to her own trauma) or unwilling to help the child to contain overwhelming emotions.

Early Abuse or Neglect Can Result in an Inability Later on as an Adult to Regulate Emotions

As I mentioned in the prior article, early childhood abuse and/or neglect often results in deficits to the orbitofrontal cortex (in the right hemisphere of the brain) at around the time that this part of the brain is developing in an infant.

If there are no other mitigating factors (like another family member who helps the child), this deficit will result in the child's inability to self soothe or regulate difficult emotions.

When this inability to self soothe and self regulate continues into adulthood, which it usually does, the adult often feels bombarded and buffeted by life's many emotional challenges, even if these challenges aren't traumatic per se.

For these children and adults, instead of responding to problems, they automatically react in an impulsive way (see my article:  The Mind-Body Connection: Responding Instead of Reacting to Stress).  This causes many problems in both personal and work-related interpersonal relationships.

So, learning to self soothe and develop a greater capacity for stress is a key component to the initial stage of my work with clients, who never developed these skills, before we do any trauma work.

Although most clients find this very helpful in their lives as well as a preliminary step to doing trauma work, there are some clients who want to begin doing the processing of trauma immediately.

From their perspective, they've been suffering long enough and they want relief now from their emotional problems.

While I understand and empathize with these clients, I also know, based on my clinical experience, that if these clients have little to no tolerance for difficult emotions, they would become too overwhelmed if we began by processing the trauma immediately.

If they become too overwhelmed, they could have one of several adverse reactions.  They could:
  • leave treatment prematurely because they can't tolerate what comes up in trauma therapy
  • dissociate (become emotionally numb) so that they're no longer aware of what's happening in the therapy and no longer present in the room emotionally for processing their problems
  • become rageful, overwhelmingly sad and/or avoidant
  • feel powerless 
  • feel ashamed
  • feel guilty because they think they "should" be able to handle their emotions
  • become distrustful of the therapist and the therapy so that there is a treatment impasse
  • have physical reactions where their overwhelming emotions become somatized due to the mind-body connection (migraine headaches, irritable bowel syndrome, asthma attacks, and so on)

This list represents only a few of the possible adverse reactions that people could have when the therapist allows them to start processing emotional trauma before these clients have developed the internal skills and resources to handle it.

I don't want to make trauma therapy sound like it's dangerous in and of itself.  I just want to emphasize that it's important for clients to be prepared by the therapist before they start processing trauma.  The preparation phase of treatment shouldn't be skipped over no matter how much a client insists.

Often, by developing a greater emotional capacity and tolerance, clients who start out being impatient to begin learn to be more patient.

On the other hand, there are some clients who come to therapy to work on emotional trauma who have done a lot of work either in a prior therapy or on their own so that they come to trauma therapy with a capacity to begin doing work.  But this is something that the therapist must assess clinically before doing the trauma work.

Empowering Clients to do Trauma Therapy
The preparation (or resourcing) phase of trauma therapy, whether the therapy is EMDR, Somatic Experiencing or clinical hypnosis, helps to empower the client to do trauma therapy.

Empowering Clients in Therapy

It's very gratifying and heart warming for me when I see a client develop in this way.

The client might have come in with very little in the way of the capacity for emotional regulation or frustration tolerance.  But as we work on helping him or her to develop these skills, s/he becomes more confident and open to doing the trauma work.

Strengthening the Rapport and Trust Between Client and Therapist
The preparation phase also helps to strengthen the rapport between the client and therapist, which is necessary for any therapy to be successful.

When the therapist helps the client to develop better coping skills, including emotional regulation and self soothing skills, the client usually feels cared for by the therapist.

For some clients, this might be the first time that they've had the experience of being cared about, so this  is an important step.

Strengthening the Rapport and Trust Between Client and Therapist

Knowing that the therapist cares about them and empathizes with their feelings helps clients to develop trust which, in turn, helps them to feel more hopeful and motivated about the therapy.

This is a very individual process and it will be different for each client.

This doesn't mean that the therapy will go forward without any problems between the therapist and the client.

After all, therapists are human and they make mistakes.  What's more important is how these mistakes get resolved.  In other words, there can be ruptures in therapy, due to misunderstandings or mistakes, but the most important thing is how these ruptures get repaired (see my article:  Psychotherapy: Ruptures and Repairs in Therapy).

Even though going through the repair process, after a therapeutic rupture, can be challenging for both client and therapist, it can also be a healing experience.

It keeps the therapist humble.  It also gives clients, who might only have ever grown up with ruptures and no repairs, an experience that interpersonal difficulties can be repaired so that the therapeutic relationship can continue to develop and flourish.

Aside from what I've discussed above, there are many other ways to develop a stronger sense of self in therapy with the help of an experienced trauma therapist.

Mind-Body Oriented Psychotherapy
After the client has developed the necessary skills and a stronger sense of self during the preparation phase, the processing of the trauma can begin.

The Mind-Body Connection

As I mentioned in my prior article, there are various types of mind-body oriented therapy for trauma therapy, including EMDR, Somatic Experiencing and clinical hypnosis.

Some treatment modalities work better for some clients than others.  This is why it's important for trauma therapists to have a repertoire of ways to work to help as many clients as possible rather than relying on only one way.

This topic merits a book rather than a couple of articles.   I hope I've given people, who might be interested, a sense of what works in trauma therapy and how clients (whether they're reluctant to feel hopeful initially or they're prone to jump in too quickly) can be helped by a therapist who is a trauma specialist.

Getting Help in Therapy
If you've been unable to work through your problems on your own, you could benefit from working with a licensed mental health professional who has experience helping clients to overcome difficult emotional problems.

Getting Help in Therapy

Clients, who have worked through their emotional trauma, often describe a sense of freedom with more energy to focus on what they want in their lives.  They often go on to have more fulfilling lives once they're no longer struggling with emotional difficulties.

Rather than struggling on your own, you owe it to yourself to get professional help from a licensed therapist so you too can live a more fulfilling life.

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

One of my specialties is helping clients to overcome trauma.

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

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













































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