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Monday, February 23, 2015

Psychotherapy Blog: Emotional Trauma Often Creates Negative Expectations About the Future

People who suffer with a history of emotional trauma often have negative expectations for the future because of their trauma.  This is a common experience that many psychotherapists see in their clients, especially among adults with early childhood trauma.

 Emotional Trauma Often Creates Negative Expectations About the Future

Negative Expectations About the Future Are Often Unconscious
These negative expectations are often unconscious so people, who experience them, often don't question them because these thoughts are outside of their conscious awareness.

However a skilled therapist, who is attuned to clients, can recognize these negative expectations, especially when these clients talk about their future in an overly pessimistic way.

If a traumatized client is in therapy where only cognitive behavioral therapy (CBT) is used, the therapist usually will point out the distortions in the way that the client is thinking and the problematic behavior that s/he is engaging in.

This is a useful first step because it makes clients' unconscious feelings conscious and they can learn to become aware of these feelings in order to change them.

By becoming aware of their pessimism, they can begin to challenge their thoughts and feelings by asking themselves if these thoughts and feelings are objectively true.  This assumes that clients can take a step back for self reflection.

If they're able to challenge their thoughts and feelings, they might be able to entertain an alternate scenario where the possibility of the future could be more realistic.

If they're not at the point where they can actually imagine a positive future for themselves, they might, at least, be able to see that there is the potential for a future that is better than their past or present experiences.

Counteractive Therapy vs Experiential Therapy
As I mentioned in a prior article, Experiential Therapy, Like EMDR, Helps to Achieve Transformational Breakthroughs, CBT works as a counteractive therapy that provides clients in therapy with an alternate scenario to their usual way of thinking and feeling.

But, for many traumatized clients, this form of counteractive therapy isn't enough.  They can see the distortions in their thinking, but they're unable to feel it in an authentic way or to change it.

Emotional Trauma Often Creates Negative Expectations About the Future

This can be very frustrating and, for some clients, it makes them feel ashamed.  They feel like they're "not doing therapy right."  For some clients, the contradiction between how they feel and what they can  see can make them feel that there's something seriously wrong with them.

These clients often leave therapy because they continue to have negative expectations for their future.  At that point, they leave therapy with the idea that "I tried therapy--it doesn't work for me."

But the problem isn't with the client.  The problem is with the type of therapy, CBT.

Experiential Therapy and Brain Research
When it works, CBT affects the logical part of the brain, but it often has no impact on the emotional part of the brain, which is the part of the brain that needs to be changed when emotional trauma is involved.

We're fortunate now to have the brain research to prove this, as cited in Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation by Bruce Ecker, Robin Ticic, Laurel Hulley and Robert A. Neimeyer, and in other recent books and articles about brain research as it applies to emotional trauma.

Experiential Therapy and Brain Research

In their book, the authors discuss research that demonstrates that experiential therapies, like EMDR and other similar types of therapy, help these clients to have a transformational experience, as I mentioned in my prior article about experiential therapy.

Rather than just being a counteractive therapy that only provides an alternative on a logical level, experiential therapy affects the limbic system so that the client not only recognizes the distortion on a cognitive level--they also feel it.

With experiential therapies, like EMDR, Somatic Experiencing and clinical hypnosis, clients remember the narrative of their traumatic memories, but they experience the memories differently on an emotional level from how they did before they came to therapy.

Experiential Therapies Can Provide Transformative Experiences

Often, clients, who participate in experiential therapy, will make comments like:
  • "When I think about the memories, I remember everything that happened, but I no longer feel traumatized."
  • "I never thought I would be able to think about these memories without feeling upset about them."
  • "I used to feel so upset by these memories, but now when I think about them, my feelings about them are neutral."
Experiential therapies also help clients to overcome feelings of foreboding (based on their trauma past) about the future.

Getting Help in Therapy
If you have a history of trauma that causes you to feel pessimistic about your future, you could benefit from getting help in therapy with a licensed psychotherapist who provides experiential therapy.

Getting Help in Therapy

Rather than feeling trapped by your emotional history, you could be free to live a 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 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.

Saturday, February 21, 2015

Psychotherapy Blog: Developing Realistic Expectations About Your Family of Origin

In my prior articles, What is Childhood Emotional Neglect? and What is the Connection Between Childhood Emotional Neglect and Problems in Adult Relationships, I discuss "emotional neglect" and how unmet childhood needs often cause problems for adults.  In this article, I'll be focusing on how adults, who had unmet childhood emotional needs, often have unrealistic expectations about their family of origin, and how therapy can help them to develop more realistic expectations and heal emotionally.

Developing Realistic Expectations About Your Family of Origin:  Mother and Daughter

The Effect of Unmet Child Emotional Needs
As I mentioned in my earlier articles, without help in therapy, unmet emotional needs from childhood usually carry over into adulthood.

If they haven't worked this issue out in therapy, most people are unaware of the effect of these unmet needs.   They're also usually unaware of how they might still hold out hope that their parents or siblings might change and, finally, give them the love and nurturing they didn't give them when they were children.

From a psychotherapist's point of view, this makes psychological sense:  Just because someone is an adult doesn't mean that s/he doesn't still carry that strong wish to finally get what was their birth right as a child.

As most people would agree, every child deserves to be loved and nurtured.

Of course, there's no such thing as a "perfect family" and every parent makes mistakes.  Fortunately, parents don't have to be "perfect."

Due to most children's inherent resilience, parents just need to be "good enough" to provide their children with the a relatively stable, loving home.

But, as we know, for a variety of reasons, this doesn't always happen in every family, especially in families that are chaotic or dysfunctional.  Among the many reasons for this is that, often, the parents of these children weren't nurtured themselves, so they don't know how to nurture their own children.

Whatever the underlying cause might be, unless there are mitigating factors, children who have significant unmet emotional needs usually grow with these same needs.

Developing Realistic Expectations About Your Family of Origin: Mother and Daughter

This doesn't mean that someone who grew up under these circumstances is doomed for the rest of his or her life to be emotionally unfulfilled.  On the contrary, people often find nurturing friendships and romantic relationships if they're discerning and choose healthy relationships.  These relationships help to mitigate what they didn't get when they were children.

Also, there are times when parents and siblings, who were once unloving, can and do change so that familial relationships can be repaired.

But this isn't always the case:  Many people who lived in an unloving family environment continue to perpetuate this in their relationships by choosing unhealthy friendships and relationships, and parents and siblings often don't change, especially if they haven't worked out their personal issues in therapy (see my articles:  Falling In Love With "Mr. Wrong" Over and Over Again, The Connection Between Obsessive Love as an Adult and Unmet Childhood Emotional Needs, Letting Go of Unhealthy Relationships and Choosing Healthier Romantic Relationships).

What Happens When Family Members Don't Change to Become Who You Want Them to Be?
When dysfunctional family relationships don't change, the person who grew up feeling unloved can still yearn to gain the love s/he never got from the family.  In many cases, people in these circumstances still hope, against all odds, that they can change a parent or sibling(s).

Developing Realistic Expectations About Your Family of Origin: Sisters
Does this mean that they should stop trying to repair their family relationships?  No, not necessarily.  After all, people do repair family relationships later in life all the time.

Developing Realistic Expectations About Your Family of Origin:  Brothers

The problem arises when someone doesn't accept the reality of the current situation and continues to have unrealistic expectations of his or her family, even after repeated attempts to change the family dynamic.

Unrealistic Expectations Are Often Unconscious
The person in this situation often doesn't even realize that s/he has unrealistic expectations because this yearning can be unconscious.

Unrealistic Expectations of Family Members Are Often Unconscious:  Father and Son

So, how do these unconscious, unrealistic expectations come to light?

In many cases, these expectations come to light when someone airs his or her grievances about family members.

S/he might say something like, "Can you believe that my dad let me down again?" or "After all that I've done for my sister, she still won't do even this small favor for me?" or "Why is my mom still nasty to me on the phone?"

A close empathic friend might commiserate with this person about the unfairness of the situation.  Anyone would agree that it's disappointing to be hurt or let down by a family member, especially if there's a lifelong history of this.

But an attuned psychotherapist will hear something more.

An Empathically Attuned Psychotherapist Hears the Underlying Unconscious Wish
A psychotherapist also will hear something more, which is the underlying issue that the client, who has lived all of his or her life being disappointed by family members, seems to still expect different behavior from family members who have been consistently disappointing (see my article:  The Psychotherapist's Empathic Attunement to Unconscious Communication in the Therapy Session).

An Empathically Attuned Psychotherapist Hears the Underlying Unconscious Wish

Many therapists, who do ego states therapy, will also realize that there is an aspect of this client's personality, usually the child self with unmet emotional needs, who is still hurt and continues to have unrealistic expectations.

Ego States Therapy and the Inner Child (or Child Aspect of the Adult)
This type of therapy is called ego states therapy because it recognizes that we all have many different aspects of self, and certain situations elicit different aspects.

So, even though someone is an adult, s/he can still experience a situation, in part, as his or her child self (see my article:  Untreated Emotional Trauma is a Serious Issue: Overcoming an Impasse in Trauma Therapy for an explanation of ego states therapy).

Ego States Therapy and the Inner Child

As I've mentioned in other articles, ego states therapy (as called "parts work") has nothing to do with multiply personalities or dissociative identity disorder.

These different aspects of self are a part of everyone, but most people don't recognize this because these aspects often remain just under the surface.

Therapists who are trained in ego state therapy are attuned to the various states that come to the surface in therapy sessions.

So that if I hear a client, who came from a chaotic and unloving environment as a child tell me, as an adult, that "it's unfair" that a parent or sibling is continuing to behave in the same dysfunctional way he or she always has, I listen to see if there is a child state under the surface that needs psychological help.

Listening to a client in this way helps therapists to be more attuned and empathic to what's going on with the client.  Equally important, it alerts the ego state therapist that the client needs psychoeducation about ego states and the child state needs to be treated.

Due to the popularity and accessibility of John Bradshaw's books (Healing the Shame That Binds You and Healing the Child Within), many people know about their "inner child."  His books have provided much-needed psychoeducation for people who grew up in unloving dysfunctional homes.

So, whether we call this aspect of self the "inner child" or the child aspect of self, we're talking about the same phenomenon.

Over the years, I've had many clients who have told me that these books have helped them to understand their shame, emotional longing and family dynamics.  Knowing that this is a phenomenon that is experienced by many people helps to normalize how they feel and helps to decrease their shame.

Mind-Body Oriented Psychotherapy and the Unconscious Mind
As I've mentioned in other articles, often regular talk therapy isn't enough to heal certain emotional problems.  Clients might gain an intellectual understanding about the issue, but talk therapy might not be enough to actually change the problem on an emotional level (see my article:  When Talk Therapy Isn't Enough).

In my article, Mind-Body Psychotherapy: The Body is a Window Into the Unconscious Mind, I explain how certain experiential mind-body oriented types of therapy, like EMDR, Somatic Experiencing and clinical hypnosis help to resolve psychological problems when talk therapy might not be adequate.

Ego states therapy, which explores and heals the various states, including the child state, can be used in combination with any of the experiential types of therapy.

Mind-Body Psychotherapy:  The Body is a Window Into the Unconscious Mind

Although there are no quick fixes, experiential mind-body oriented therapy can often help with psychological healing much faster than regular talk therapy.

As I usually like to point out, I am psychoanalytically trained and I have seen the value of both psychodynamic and cognitive behavioral therapy (CBT).  But I also know that every therapy has certain limitations.

The limitation with CBT talk therapy is that CBT often stays on the surface without a transformative  effect for the client.  And psychoanalysis or psychodynamic psychotherapy can be transformative, but it can also take a long time (see my article:  Experiential Therapy Helps to Achieve Emotional Breakthroughs).

There are many ways that experiential mind-body oriented psychotherapy, like EMDR, Somatic Experiencing and clinical hypnosis and ego states therapy can help when an adult has a child aspect that, understandably, wants a parent or sibling to be different (see my articles:  What is EMDR?How Does EMDR Work - Part 1How Does EMDR Work - Part 2,  Overcoming Emotional Trauma With Somatic Experiencing,  Somatic Experiencing: Overcoming the Freeze Response and Clinical Hypnosis and Hypnoprojectives to Overcome Emotional Problems).

Getting Help in Therapy
It can be very hurtful and frustrating to hold to hope against all odds that a family member will change to be the attuned, loving person that you want him or her to be.

Letting go of these types of unrealistic expectations can be very difficult without doing work in therapy to heal the child self in you that still yearns to be loved and nurtured.

Getting Help in Therapy

In my experience as a psychotherapist, a mind-body oriented therapy is usually the best type of therapy to help with this healing process.

Rather than continuing to suffer with unrealistic expectations from family members who show no signs of changing, the best course of action is to focus on yourself and heal the emotional wounds that are keeping you stuck.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, ego states 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.

Sunday, February 15, 2015

Psychotherapy Blog: How EMDR Works - Part 2: Overcoming Trauma

In my prior article, How EMDR Works: EMDR and the Brain, I gave an overview of the basics of EMDR, including how emotional trauma affects the brain and how EMDR therapy helps to process trauma.

How EMDR Works:  Overcoming Trauma

In this article, which is a continuation of this topic, I'll give a composite scenario to demonstrate how EMDR therapy works.

I'll delve into some of the aspects of EMDR that are uniquely helpful to healing emotional trauma (for an overview of EMDR, see my article:  What is EMDR?)

As always, this composite is a combination of many different cases to protect confidentiality.

Alice came to therapy because she knew she was overreacting in her relationship with her boyfriend, Ed.

A day or so after she got angry with him, in hindsight, Alice could see that she had overacted, and she felt ashamed and guilty about it.  She would apologize and tell Ed that she would try not to be so reactive, but then a week or so later, she would find herself overreacting again, and this became an ongoing pattern in their relationship.

Alice loved Ed very much and she knew that Ed loved her.  When she was calm, she knew she could trust him, but when she was in the throes of an overreaction, she forgot all of this and she reacted as if he didn't love her and he wasn't trustworthy.

She would often feel rejected and abandoned by things that he said--only to realize afterwards that she overreacted once again.

This happened to Alice so frequently that she was beginning to feel like she was losing her mind.  After she calmed down, she couldn't understand how she could have felt so sure that he was rejecting and abandoning her when she was upset.

She asked herself:  Why couldn't she remember that he loved her?

Even though Ed was patient, Alice knew that her reactions would erode their relationship after a while. She knew she couldn't keep accusing him of being unloving and then apologize afterwards.  She knew she had to do something.

Having been in talk therapy in the past to deal with a traumatic childhood, Alice felt she needed to try a different type of psychotherapy, so when a friend told her how much EMDR helped her, Alice decided to give it a try.

How EMDR Works:  Overcoming Trauma

As we discussed Alice's family history, it became apparent that she was uprooted quite a bit from infancy to adolescence, due to her single mother's substance abuse problems.

During that time she was moved from her mother's home to her maternal grandmother's home and then to an aunt's house.

Finally, when she was a teenager, she moved back with her mother.  By then, her mother was sober, but her mother was still emotionally neglectful.

As an only child, Alice remembered feeling lonely and unloved.  Even though her grandmother and aunt took care of Alice's basic needs, they remained emotionally distant from her.  Alice would pray to have a loving adult come into her life, but she remained without emotional support.

Emotional Neglect:  The Past Affects the Present

As an adult, during her first therapy, which was talk therapy, Alice learned to make intellectual connections between the childhood emotional neglect and her feelings of being unlovable but, even though she had an intellectual understanding, talk therapy didn't help her to actually overcome these feelings.  So, she experienced herself as carrying around this heavy emotional burden throughout her life.

She usually managed to make only one or two close friends because she had a hard time trusting people.

While in college, even though she wanted to be in a loving romantic relationship, she had an even more difficult time trusting men because she felt too emotionally vulnerable to open up (see my article:  An Emotional Dilemma: Wanting But Dreading Love).

After college, having been in talk therapy, Alice knew that her feelings of being unlovable as an adult were connected to her early childhood neglect, but she didn't know how to change this.

She often wondered if she would ever feel emotionally safe enough to enter into a serious romantic relationship (see my article:  Adults Who Were Emotionally Neglected as Children Often Have a Hard Time Trusting).

When she met Ed, she knew he was one of the kindest, gentlest, loving men she ever met.

At first, they got along well.  But as they continued to see each other and got closer, after several months, Alice began to feel emotionally vulnerable and unsafe.

She knew these feelings weren't related to anything that Ed was doing or not doing, but she couldn't stop herself from seeing even the most innocuous remarks that he made as rejecting and abandoning.

During their last argument before Alice started therapy, Alice exploded when Ed said he had to work late and he couldn't see her.  She accused him of lying, not loving her, abandoning her and not caring about her feelings.

Overcoming Emotional Trauma With EMDR

Afterwards, Alice realized that she had overreacted, and she knew that Ed wasn't lying and that he genuinely cared for her.

As Alice recounted this argument and other similar arguments, she broke down in tears.  She said she was sick and tired of feeling this way, tired of accusing Ed of not loving her, and tired of the arguments that she started with him.  She also feared that she would bring about the very thing that she feared most--that Ed would get tired of her and leave her.

Developing Coping Skills as Part of Resourcing Before EMDR Processing
Since Alice came to do EMDR, I began by helping her to develop better coping skills so she could cope with her feelings both in our therapy sessions as we processed her traumatic background as well as in her everyday life.

We focused on helping her to respond instead of react (see my article:  Responding Instead of Reacting).

This phase of EMDR is called resourcing (for more details about resourcing, see  a prior article that I wrote).

As someone who was emotionally neglected as a child, Alice primarily knew only two maladaptive ways of attempting to cope:  overacting or emotionally shutting down.  She knew intellectually that neither way worked for her, but she didn't know what else to do.

After the resourcing phase of EMDR, we were ready to begin processing her traumatic childhood experiences which were triggering her emotional reactions in her current relationship.

Before we started, I reminded Alice that she was in complete control of the process in terms of stopping or pausing the EMDR processing if she felt too overwhelmed.

This is very important for people who have experienced early childhood trauma where they were overwhelmed, there was no one to soothe them, and they felt helpless to do anything about it.

Bridging Back in EMDR
Then, we used a recent memory of Alice being upset with Ed and used that to go back to her earliest memory of feeling this way as a child.

This concept in EMDR is derived from clinical hypnosis and it's known variously as the affect bridge, the float back technique or bridging (see my article:  Bridging Back to Heal).

How EMDR Works:  Bridging Back to Heal

Sensing her emotions and where she felt these emotions in her body, Alice was able to remember an early memory where she was being uprooted once again from her grandmother's house to her aunt's house and how scared and unloved she felt (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

This earlier memory turned out to be significant in terms of how she got triggered in her current relationship.

EMDR and Imaginal Interweaves
EMDR uses a concept called "imaginal interweaves" to help clients to process emotional trauma.  These imaginal interweaves are used to help clients to feel emotionally supported during the EMDR processing of the trauma memory (see Laurel Parnell's book, Attachment-Focused EMDR).

The goal of EMDR is not to analyze the memories.  After all, many people who come for EMDR therapy have already analyzed their memories in talk therapy and they have intellectual insight.  After talk therapy, what they often don't experience is emotional healing.

This is not to say that talk therapy doesn't work because I continue to do talk therapy.  But there are certain people with early trauma that aren't healed by talk therapy.

So, rather than analyzing the trauma, the goal of EMDR is to process the traumatic memories with some form of bilateral stimulation, BLS (see my prior article for an explanation of BLS) so that the client is no longer affected by the trauma.

To use imaginal interweaves, clients are asked to imagine protective and nurturing people who might have helped them during the trauma.

These protective and nurturing people can be actual people in the client's life who are either from now or back then.   They can also be people from movies, TV programs, books or people from history.

Imaginal interweaves can include anyone and EMDR clients are only limited by their imagination.

They can include an imagined "ideal mother," who is different from their actual mother.

EMDR and Imaginal Interweaves:  Imagining the Ideal Mother

The idea of using imaginal interweaves is not for the client to believe that anything other than what actually occurred is what happened.  The logical part of the brain knows that, in actuality, there was no one who helped.

But the emotional part of the brain can take in these imaginal interweaves and this is emotionally healing.  This is why imaginal interweaves they're used.  Al Pesso, who developed Psychomotor Therapy, refers to this as new symbolic memories (see my article:  Mind-Body Psychotherapy: Healing With New Symbolic Memories).

The Therapist's Empathic Attunement 
An EMDR therapist needs to know more than how to do EMDR.  She also needs to be exquisitely attuned to what's going on with the client and be able to track the client's emotional experience.

A skilled EMDR therapist needs to be in sync with the client.  This is often referred to as a "right brain to right brain" connection, which means that the therapist's right brain, the area of the brain for empathic attunement, senses what's going on emotionally with the client.

This also presupposes that the client and the EMDR therapist have already developed a good enough working alliance so that the client will allow this (see my articles:  The Creation of the Holding Environment in Psychotherapy and The Therapist's Empathic Attunement Can Be Emotionally Reparative to the Client).

The EMDR therapist must also be able to repair whatever ruptures might occur in therapy (see my article: Ruptures and Repairs in Therapy).

Whenever Alice became stuck in the EMDR processing, we used an imaginal interweave to help her to get unstuck so that the processing could continue.

Gradually, over time, Alice's level of emotional disturbance about this memory was significantly reduced.

EMDR and Generalizable Effects
At the same time, she was much less reactive in her relationship with Ed, so we could tell that the EMDR processing was have a generalizing effect.

Generalizable effects in EMDR means that the healing effects of EMDR are also carrying over to other memories and current interpersonal interactions.

How EMDR Works:  Overcoming Trauma 

Completing EMDR Therapy
By the time that Alice completed EMDR therapy, she was no longer overreacting.  She was also no longer feeling unlovable, rejected or abandoned in her relationship.  She was able to free herself emotionally from her traumatic history so that she could live her life unencumbered by these memories.  She was also able could to develop meaningful friendships.

Getting Help in Therapy:
Reacting negatively to the present based on the past is a common experience for people who have experienced emotional trauma, especially if they experienced early childhood trauma.

If you feel that unresolved trauma is keeping you stuck, rather than spending your life reacting based on your past, you owe it to yourself to seek help from a licensed mental health professional who is trained in a mind-body oriented experiential therapy, like EMDR (see my articles:  Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs) and Reacting to the Present Based on Your Traumatic Past).

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

One of my specialities 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.

Saturday, February 7, 2015

Psychotherapy Blog: How EMDR Works: Part 1 - EMDR and the Brain

As a psychotherapist who specializes in helping clients to overcome trauma, I learned to do EMDR (Eye Movement Desensitization and Reprocessing) about 10 years ago (see my article:  What is EMDR?).  I decided to learn EMDR because the traditional therapy that I learned in postgraduate training didn't help some of the clients who came to me who had PTSD (posttraumatic stress disorder).  I've been using EMDR with many clients ever since with positive results.

How EMDR Works

EMDR and Advances in Brain Research
When I learned EMDR, which was developed by psychologist, Francine Shapiro, Ph.D., researchers still weren't sure exactly how it worked.  They just knew that compared to other forms of therapy and compared to medication, it was more effective.

Since that time, there has been a lot more research on EMDR and brain research, so how EMDR works is starting to become clearer.

EMDR is an integrative therapy.  It combines the best of psychodynamic, cognitive behavioral therapy (CBT), and other mind-body oriented therapies.

Many psychotherapists, myself included, now also integrate Somatic Experiencing and the use of imagination, which has powerfully enhanced EMDR.

How Emotional Trauma Affects the Brain
Before discussing EMDR any further, it's important to understand how emotional trauma affects the brain.

Emotional trauma has a powerful effect on the nervous system.

How EMDR Works: Traumatic Memories and the Brain

People often have problems processing traumatic memories in regular talk therapy because these memories are stored in the nonverbal, nonconscious, subcortical part of the brain, which includes the amygdala, thalamus, hippocampus, hypothalamus, and the brain stem.

Before traumatic memories are processed with EMDR, they're not accessible to the frontal lobes, part of the brain that is used for understanding, thinking and reasoning.

Very often, individuals who are traumatized are unable to give a coherent narrative about their traumatic past because, as previously mentioned, the traumatic memories are stored in the nonverbal part of the brain.

Advances in brain scanning have shown that often when people with a traumatic history remembered these traumatic memories, the left frontal cortex (speech and logic) actually shuts down.

At the same time, the right side of the brain, which is associated with, among things, emotional states, images, and autonomic arousal and includes the amygdala, lit up on these brain scans.

This would explain why traumatized individuals have problems providing a coherent narrative about their traumatic memories--the part of the brain that is associated with thinking and speaking is "off line" when they're asked to think about the trauma.

This is also why, for many people who have PTSD, there are flashes of images from the traumatic event, but no words.

These memories also have a sense of timelessness so that people who suffer with trauma often have a hard time distinguishing "then" from "now" (see my article:  Working Through Emotional Trauma: Learning to Separate "Then" From "Now").

These emotions and sensations are often felt with such immediacy that it feels like they're experiencing the traumatic event now, even though it might have happened many years ago.

For instance, this is a common experience for veterans traumatized in battle as well as for people with other types of emotional trauma.

The corpus callosum is a part of the brain that connects the right and left sides of the brain and it helps both sides to "communicate" with each other.   It helps to integrate the emotional and cognitive parts of the brain.

Trauma, by definition, is overwhelming.  It can cause dysregulation of the body and brain chemistry.

EMDR, the Adaptive Information Processing (AIP) Model, and Bilateral Stimulation (BLS)
Francine Shapiro, Ph.D., developed the Adaptive Information Processing (AIP) model to explain the effects of EMDR.

The AIP model says that all memory is associative, and that learning occurs through the creation of new associations.

How EMDR Works:  EMDR and the Brain

For example, in order to recognize an object, your current perceptions have to link the object with your past experiences.

So, if your only experience of a stick is that sticks were used to beat you, you would have no past memories that could tell you that a stick could also be used for other things, like walking.

But if someone shows you that a stick can be used to help you walk, you can integrate this information with other similar information in your existing memory networks.

Our memory networks help us to survive in the world.  But emotional trauma causes impairment to these networks.

EMDR helps to restore the proper functioning and integration of these networks.

In order to heal from emotional trauma, to start, there needs to be an integration between the right and left hemispheres of the brain.  In EMDR this is done with "bilateral stimulation" (BLS).

Initially, when EMDR therapy was first developed, BLS only consisted of eye movements, hence the name Eye Movement, Desensitization and Reprocessing.

As advances were made in EMDR therapy, researchers and EMDR clinicians discovered that effective BLS in EMDR processing could take many forms, including alternating, rhythmic tapping, pulsing and music that alternates between the right and left ears.

Under normal non-traumatic circumstance, the brain has ways of integrating psychological disturbance.

For instance, if you have an minor disagreement with a stranger, you might feel annoyed, but it's usually not traumatic.

Part of emotional integration might involve talking to a friend or a therapist about the argument, writing about it in a journal or possibly having a dream about the incident.  These are all integrative processes for events that are non-traumatic.

But when there's a traumatic event, which overwhelms the body and the brain chemistry, talking, writing and dreaming often aren't enough to integrate the event, so it remains emotionally unintegrated.

After a while, these unintegrated memories can get triggered by other events.

The most common example that is usually given is when a veteran with PTSD returns from combat and  s/he hears a car backfiring, s/he experiences it as if s/he is back in combat.  This could include the sights, sounds, taste and other sensory experiences from the war.

There are many other types of triggers.  For instance, if you feel belittled by your boss, this could trigger what you experienced if you were belittled as a child.

The problem is that, because these traumatic memories are stored in the nonconscious part of brain, the person who is triggered doesn't realize that much of what they're experiencing is from the past.

As I mentioned before, they often have problems distinguishing "then" from "now" when they're emotionally triggered.

Due to the lack of emotional integration, the traumatic memories are stored in isolated memory networks, which remain just below the surface and ready for reactivation.

EMDR Therapy Was Developed to Help Clients Overcome Traumatic Memories

EMDR was developed to help access and process these memories.

After accessing these memories, the goal of EMDR therapy is to make connections between the isolated memory networks and functional memory networks.   This is done, as previously mentioned, with BLS.

Next Article:  Part 2 of this article: How EMDR Works will give a composite example to demonstrate how EMDR therapy works.

Getting Help in Therapy
Emotional trauma that creates psychological, physical, and interpersonal problems is much more common than most people realize.

Getting Help in Therapy

Research has shown that EMDR is one of the most effective forms of therapy to overcome emotional trauma.

If you are suffering with emotional trauma, rather than suffering alone, you could benefit from working with a licensed mental health professional who is trained as an EMDR therapist.

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

I have helped many clients to overcome emotional trauma so they could lead a more fulfilling life.

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.

Monday, February 2, 2015

Psychotherapy Blog: Reconciling Your Relationship With a Sibling Now That You're Both Adults

In a prior article, Overcoming Unresolved Guilt Towards a Sibling, I discussed how guilt that interferes with a sibling relationship can be resolved.  In this article, I'm focusing on a related topic, reconciling a longstanding conflictual relationship between adult siblings that began in childhood.

Reconciling Your Relationship With a Sibling Now That You're Both Adults

Sibling dynamics are usually developed early in childhood with the possibility of many different influences, including overall family dynamics, age, gender, emotional trauma and other factors.

Many siblings, who grew up with conflictual sibling relationships often feel that they want to overcome the pattern of conflict and reconcile these sibling relationships when they become adults, but this can be challenging, especially if these patterns are longstanding.

The following composite scenario, with all identifying information changed to protect confidentiality, is an example of these issues between siblings and how they were able to overcome them:

Bob and Joe
Bob and his younger brother, Joe, spent most of their time as young children with their mother, who was diagnosed by her psychiatrist with major depression and borderline personality disorder.

Their mother spent much of her time in bed, too depressed to rouse to get up to cook or take care of her sons.  Their father, who was a salesman, spent most of his time away on business.  As a result, Bob took on the responsibility of taking care of himself and his younger brother.

Bob and Joe as Children

On those occasions when the mother felt well enough to get out of bed, she favored her younger son, Joe, lavishing him with praise for his looks, his personality, his school work and just about everything about him.

In contrast, she criticized almost everything about Bob, and she told him that no one would ever love him when he grew up.

Not only did she criticize and denigrate Bob, but she instigated Joe against Bob.  At a young age, Joe learned that if he wanted to keep his mother's love, he had to side with her against his brother and so, being too young to understand his mother's emotional problems, he sided with her against Bob.

As a result, this set the dynamic between these two brothers from an early age.  It was deeply hurtful to Bob, who was also too young to understand that his mother's borderline traits were the underlying cause of the problem (see my article:  The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder).

Bob tried to please is mother by trying to help her, making things for her in art class, and trying to be as good as he could be.  He did very well in school.  He won academic and sports awards, always with the hope that he could gain his mother's love.

But his mother didn't changed how she treated her two sons--Joe was the "good one" and Bob was "the bad one," and Joe remained close to his mother by disparaging Bob.

Bob grew up feeling that he was flawed and unlovable in some basic way that he couldn't understand.  Even though he had friends, he was lonely.

On the rare occasions when the father was at home, he distanced himself from Bob, Joe and their mother.  She was disparaging of him too.  Eventually, he left the family to be with a new girlfriend who lived out of state, and he had little contact with Bob and Joe.

Bob went away to college, and he moved to New York City for his first job.  Joe went to a community college near home and continued to live with their mother.  He became a sort of emotional surrogate husband to their mother even in his late teens.

As time went on, Bob saw less and less of his mother and Joe because these visits were very hard emotionally.  He was successful in his career, but he was deeply affected by his mother telling him for many years that he was unlovable and would end up alone.  And, each time that he saw his mother and brother for an occasional family visit, he felt the sting of his mother's disdain which, for him, confirmed that he was unlovable.

Reconciling Your Relationship With a Siblings Now That You're Both Adults

Joe never moved away.  He remained with his mother, taking a local job so he could continue to be live with her rather than moving away for better job opportunities.  None of Joe's attempts to have a  romantic relationship worked out because his mother would come between him and his girlfriend and Joe felt compelled to side with his mother.  Since none of the women wanted to put up with this, these relationships ended quickly.

Bob's sense that he was a deeply flawed individual affected his ability to get into a relationship with a woman.  He was afraid that after a woman got to know him, she would discover how unworthy he was and she would leave him (see my article:  Overcoming the Fear That People Won't Like You If They Discover the "Real You").

But when he was in his mid-20s, he met a woman, Sandy, that he really liked.  Sandy took the initiative to ask Bob out for a date.  As they continued to see each other, even though he liked her, Bob became increasingly afraid of allowing himself to be emotionally vulnerable with her (see my article:  Relationships: Fear of Being Emotionally Vulnerable).

Since Bob felt Sandy was very special and she seemed to like him a lot too, he decided to come to therapy to deal with his fear and confusion.  As we explored his family history, the origins of Bob's fear and feelings of being unlovable became clear.

Although Bob was able to understand intellectually why he felt unlovable, on an emotional level, it didn't change how he felt about himself, so we began to use EMDR (Eye Movement Desensitization and Reprocessing) to help him overcome his traumatic family history and his feelings of being unlovable (see my articles:  What is EMDR? and EMDR: When Talk Therapy Isn't Enough).

Bob Came to Therapy

Gradually, over time, as Bob processed the emotional trauma of having a unloving, critical mother who played his brother against him, he began to feel better about himself for the first time in his life.  He was able to open up to Sandy in a way that he never believed possible.

He also began to feel that he wanted to try to reconcile his relationship with Joe, if Joe was willing.  Even though he wanted this reconciliation, Bob knew that he couldn't force the issue and that he might have to accept Joe's refusal, especially since Joe remained very close to their mother.

Bob and Joe hadn't been in touch with each other for more than a year when Bob called Joe.  Bob could hear his mother in the background telling Joe to get off the phone after she found out that Bob was calling.  After that, Joe's voice sounded shaky and he ended the conversation abruptly.

We had prepared for this possibility in therapy and although Bob was deeply disappointed, he took Joe's rebuff in stride.  A few months later, feeling that he was doing well and his relationship with Sandy was going smoothly, he left therapy knowing that he could return at any time.

About a year later, Bob contacted me because his mother was diagnosed with advanced cancer and she was already in hospice.  Bob was preparing himself emotionally to see her, possibly for the last time and to see Joe.  So, Bob returned to therapy (see my article:  Returning to Therapy).

We met for a couple of therapy sessions that week before he went home to see his mother and Joe.  His mother, who was heavily sedated, spent time with Bob alone while Joe waited outside.  To Bob's amazement, with tears in her eyes, his mother apologized to him for how cruel she had been over the years.  She asked Bob for his forgiveness and, to Bob's relief, they were able to reconcile just a couple of days before she died.

Although he was relieved to have made amends with his mother, Bob also felt sad for all the time that he and his mother allowed to pass before they reconciled.

After the death of their mother, Joe was so bereft that he asked Bob if he could come stay with him.  Bob realized that, without their mother, Joe felt desperately sad and confused. Joe also expressed shame for the way he treated Bob and said he would understand if Bob refused to have anything to do with him.

Bob hoped this could be the beginning of a reconciliation between them and he took Joe in without hesitation.  It was awkward at first for both of them.  So many years of being at odds with each other couldn't be erased immediately.

After a few weeks, Joe agreed to come to a few sessions of therapy with Bob to try to reconcile their relationship.  He was able to see, for the first time, how their mother influenced the dynamic between them and he felt deeply sorry.  They each expressed sadness, anger, and resentment.  They also felt hopeful, for the first time, that they could have a better relationship now.

Reconciling Your Relationship With a Sibling Now That You're Both Adults

When Joe went home, he also began his own individual therapy to deal with the effect of his enmeshed relationship with his mother now that she was gone.  He struggled but, over time, he began to put his life together and he maintained contact with Bob in the context of their new relationship.

Reconciling Sibling Relationships as Adults
The composite scenario above isn't unusual.  Children are often influenced by their need to remain close to a parent who might engage in splitting between siblings.

This is usually an unconscious process for the sibling who sides with a parent against another sibling.  The child's need to have his or her emotional needs met by the parent can overshadow everything else.  And this doesn't automatically change when a person becomes an adult, especially when the sibling remains overly attached to the parent, as in the case with Joe.

Even though the siblings in this scenario weren't able to reconcile until after the mother died, many siblings do work out their relationships as adults before the parent who is engaging in splitting dies.

Reconciling Your Relationship With a Sibling Now That You're Both Adults

This type of reconciliation requires that each sibling has matured enough to be his or her own person; s/he sees the splitting dynamic for the destructive pattern that it is; and s/he is willing to risk the anger of the parent in order to have a better relationship with the sibling as well as to be his or her own person.

Getting Help in Therapy
The scenario that I presented above is one example, among many, of how siblings can grow up to be estranged from each other and how they can reconcile.  There are many variations on this theme.

As adults, many siblings have been helped by seeking the assistance of a licensed mental health professional to help them navigate the emotional difficulties involved with a reconciliation where there has been longstanding animosity or estrangement.

Getting Help in Therapy

If you and a sibling want to explore the possibility of an emotional reconciliation, you could be helped by a psychotherapist who has experience with this issue.

About Me
I am a licensed NYC psychotherapy, 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.