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Monday, December 1, 2014

Psychotherapy Blog: Learning to Feel Hopeful in Therapy

For many clients who start psychotherapy to deal with trauma, especially longstanding trauma stemming from significant unmet emotional needs from childhood, it can be difficult to feel hopeful that therapy will make a difference and help them to change their lives.

Learning to Feel Hopeful in Therapy:  Clients with Trauma Can Find It Difficult to Feel Hopeful

As a psychotherapist in NYC, I've found this to be especially true of clients who have been in many different types of psychotherapy before and who have experienced no resolution to their trauma.

Psychotherapy Clients with a Fear of Being Vulnerable and Only a Glimmer of Hope
Often, clients come to see me because they know that, in addition to using talk therapy, I'm also an EMDR therapist as well as a hypnotherapist and Somatic Experiencing therapist.

These clients usually come to see me because they've haven't experienced relief from their emotional trauma in traditional talk therapy.  And although there might only be a small part of them that brings them back to therapy, often they feel too emotionally vulnerable to really allow themselves to feel a sense of hope that things could change for them.
Clients with Longstanding Unresolved Trauma Can Feel Too Afraid to be Hopeful in Therapy

This is, of course, understandable when you consider that they've been disappointed too many times in their life, including disappointments in therapy.  It becomes hard for them to trust others and, often, hard for them to trust themselves.

It's also not unusual for people to come to therapy and not even know that they've been emotionally traumatized.  This is especially common if they've experienced complex trauma or they've lived their lives since childhood experiencing one crisis after another.  They might be too emotionally numb to feel a lot more than fear, anger and apprehension.

They might only know in some vague way that they feel "stuck" in their lives, but they don't make the connection between their current problems and their personal history (see my article:  When You Just Don't Feel Right and It's Hard to Put Your Feelings Into Words).

Psychoeducation in Therapy
Knowing this, I usually provide clients with psychoeducation at the start of therapy about the different types of treatment modalities that I use and any research about the efficacy of these modalities.

I also tell them about my own evolution as a psychotherapist who originally trained in psychoanalysis and psychodynamic psychotherapy and who went on to train in different types of trauma therapy, like EMDR, clinical hypnosis and Somatic Experiencing.

I can also tell new clients what I have observed in my psychotherapy private practice with regard to the different types of therapy and how it has been my experience over the years that a mind-body orientation in therapy tends to work better and faster for most people as compared to regular talk therapy.

Intellectual Insight in Therapy Usually Isn't Enough to Heal Trauma
This isn't to say that psychoanalysis, psychodynamic therapy and cognitive behavioral therapy don't work.  However, most of the time, these forms of therapy don't resolve trauma.

Clients in talk therapy often develop intellectual insight into their problems, which is important, but their trauma often remains unresolved.

Intellectual Insight in Therapy Usually Isn't Enough to Heal Emotional Trauma

Clients, who have developed only intellectual insight, often feel that there must be something really wrong with them because their insight doesn't bring about change.

Clients, who have a history of trauma, often carry within themselves the burden of guilt and shame to begin with because of their trauma.  They blame themselves for what happened to them.

So, when therapy only brings insight and not healing, they often blame themselves for that too which, in many ways, is a retraumatization.

But the problem usually isn't with them--it's a problem with the therapy that doesn't get to the core of their problems.

Overcoming Emotional Trauma:  Interpersonal Neurobiology Points the Way
Due to the relatively new field of interpersonal neurobiology and the work of professionals like Allan Schore, Ph.D. and Daniel Siegel, MD, we now know that early childhood emotional trauma and attachment problems with the primary caregiver can cause deficits in the right hemisphere of the brain, specifically the right orbitofrontal cortex and that regular talk therapy often doesn't help to heal these deficits (see:  Affect Dysregulation and Disorder of the Self by Allan Schore, Ph.D. and Healing Trauma: Attachment, Mind, Body and Brain by Dan Siegel, MD, which are both part of the Norton series on interpersonal neurobiology, as well as The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma by Bessel van der Kolk, MD).

Healing Trauma with the Mind-Body Connection

The Neuroplasticity of the Brain
Not long ago neuroscientists believed that, over time, brain cells died and the brain just continued to lose cells without being able to regenerate cells or to make changes (hence the old saying, "You can't teach an old dog new tricks").

Fortunately, we also now know about the neuroplasticity of the brain.  Neuroplasticity refers to the brain's ability, under the right circumstances, to reorganize itself throughout the life cycle.

The Neuroplasticity of the Brain

So, even in circumstances where there have been deficits in the right orbitofrontal cortex (right hemisphere of the brain) due to childhood trauma of early abuse or neglect, the adult brain can still change later in life to make up for these emotional deficits.

The discovery that the brain can change itself was a very hopeful discovery (see:  The Brain that Changes Itself: Stories of Personal Trauma from the Frontier of Brain Science by Norman Doidge, MD).

The Mind-Body Connection in Therapy
To heal these trauma-related deficits, a treatment modality that takes into account the mind-body connection is required, like Somatic Experiencing, EMDR or clinical hypnosis, among others (see my article:  Mind-Body Psychotherapy: The Body Offers a Window into the Unconscious Mind).

The Mind-Body Connection in Therapy

Of course, there are no guarantees that therapy is going to resolve a particular person's problems.  So, while I'm enthusiastic about the different types of therapy that I use, I'm also honest that there's no way to predict in advance if therapy is going to work.

Over the course of a therapy, I often use a combination of mind-body oriented treatment modalities because no one form of therapy works for every single client.

Also, even when a particular treatment modality is working for a while, there can be a treatment impasse and, in order to overcome an impasse, I'll switch to a different modality that is better with that particular obstacle in treatment.

Sometimes, the switch to another modality might only be temporary to overcome the impasse, and other times the client might prefer it so we continue with it (see my article:  Overcoming an Impasse in Trauma Therapy).

Emotional Trauma and Hopelessness
Getting back to clients' problems with feeling hopeful:  There are different types of challenges that clients face with regard to feeling too afraid to feel hopeful, including:
and so on.

In an upcoming article, I'll discuss how clients, who come to therapy feeling too afraid to be hopeful, can overcome this challenge.

Getting Help in Therapy
If you're feeling overwhelmed by your emotions, whether your problems are related to longstanding unresolved trauma or more recent emotional problems, you're not alone.

Getting Help in Therapy

Although you might find it difficult to ask for help in therapy, you can attend a consultation with a licensed mental health professional to see if you and the therapist are suited for each other (see my article:  How to Choose a Psychotherapist).

Rather than continuing to suffer on your own, you could benefit from working with a licensed mental health professional who is knowledgeable about mind-body oriented therapy.

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 emotional 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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