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Monday, February 26, 2018

Why Experiential Psychotherapy is More Effective Than Talk Therapy Alone to Overcome Trauma: A Clinical Vignette

In my prior article, Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone, I began a discussion about experiential therapies like EMDR therapy, Somatic Experiencing and clinical hypnosis and why experiential therapy is more effective than talk therapy (psychodynamic or cognitive behavioral therapy) alone.  As I mentioned in my last article, I'm providing a clinical vignette to illustrate these points in this article.


Why Experiential Psychotherapy is More Effective Than Talk Therapy Alone to Overcome Trauma

Fictional Clinical Vignette: Why Experiential Psychotherapy is More Effective Than Talk Therapy Alone to Overcome Trauma:

Tia
Tia began psychotherapy with an experiential psychotherapist after having been with prior psychotherapists who practiced psychodynamic psychotherapy and cognitive behavioral therapy (CBT).

Although she felt she gained valuable insights in her therapy with a psychodynamic psychotherapist and she learned some helpful tools with her CBT therapist, she felt that her core problem, which was a fear of being sexual with her current boyfriend as well as, in the past, with her previous boyfriends.

In her prior psychodynamic psychotherapy, she learned that her fears stemmed from early sexual molestation by her maternal uncle.  Prior to attending this therapy, she had always known about the sexual molestation, but she never connected it to her fear of being sexual.

Although this insight was valuable to her, Tia still got emotionally triggered in her relationship with her boyfriend, John, especially when they made love.  She loved John and she had no doubt that he loved her.  She felt close to him most of the time, but when they had sex, she felt numb and there were times when she had to ask John to stop making love to her because she felt overwhelmed with fear.

Even though she understood the origin of her fear of making love with John, it didn't help her to overcome the emotional and physical numbing that she experienced when he touched her sexually.

After being with her psychodynamic psychotherapist for several years, she went to a therapist who practiced CBT.  Her CBT therapist provided her with tools for anxiety and tried to use desensitization  techniques to help Tia overcome her fear of being sexual with John.

But when Tia was with John and they attempted to be sexual, she continued to feel fearful and then numb, even though she tried using the tools that she developed in CBT.  The CBT desensitization also didn't help her outside the therapy room.

Since Tia wanted to overcome her fear of being sexual, she decided to try experiential psychotherapy after hearing from a friend that it was helpful to her.

After several sessions of providing the history of her problem, family history, and preparation to do trauma work, Tia's experiential psychotherapist recommended that they use EMDR therapy (see my articles: EMDR Therapy - When Talk Therapy Isn't EnoughHow EMDR Therapy Works: EMDR and the Brain, and EMDR Therapy For Big T and Smaller T Trauma).

As they worked on Tia's problem using EMDR therapy, Tia's therapist did a "float back" (similar to the affect bridge in clinical hypnosis) to see if there were any earlier memories (also called "feeder memories") that were affecting Tia.  

As Tia focused on whether there were any earlier memories where she had the same emotions and negative beliefs about herself that she had related to her memory of her uncle sexually molesting her, she remembered that when she was a few years younger, an older cousin sexually molested her and threatened to hurt her if she told anyone about the sexual abuse.

Tia's psychotherapist explained to her that, based on feedback from Tia, her earlier psychodynamic therapy provided Tia with insight and helped her to understand the unconscious emotions that were affecting her.  And CBT provided her with some tools, but that therapy remained superficial.

As a result of both therapies, Tia could talk about her problem, but her understanding remained intellectual.  Neither therapy helped her when she froze in fear physically and emotionally when she and her boyfriend tried to have sex.

In addition, and this was important--neither therapy got to the earlier memory of the sexual molestation and threats by her cousin.

After they discovered that there was an earlier memory of sexual molestation when she was younger, Tia's psychotherapist focused on that memory first and when they completed the work on that memory, they focused on the later sexual molestation involving the uncle.  This took several months.

Since EMDR therapy focuses on the past, present and future, after they worked through both memories, they focused on Tia's fear and numbing in the present with her boyfriend.

Why Experiential Psychotherapy is More Effective Than Talk Therapy Alone to Overcome Trauma 

Having worked though the earlier memories of abuse, the present and future/anticipated situations were easier.  And Tia reported to her therapist that she was no longer feeling fearful and numb when she had sex with her boyfriend, and they were enjoying an active sex life.

Conclusion
In this particular scenario, I used an example of EMDR therapy, but the same could apply to clinical hypnosis, Somatic Experiencing, Coherence therapy, and Ego States therapy (also known as Parts Work).

Some people respond better to one type of experiential therapy than another.  For the sake of brevity, I used a scenario where the client responded well to EMDR, but I could have also given a scenario where the therapist either switched to one of the other types of experiential therapies or used these experiential therapies in combination as many integrative psychotherapists do.

As I mentioned in my prior article, there are many reasons why experiential psychotherapy is more effective than talk therapy alone, including the fact that talk therapy tends to remain on a cognitive level whereas experiential therapy gets to the root of the problem on a deeper (limbic brain) level where the problem exists.

Also, both EMDR therapy and clinical hypnosis have particular methods to discover whether there are "feeder memories," which are earlier memories that are affecting the trauma.  In clinical hypnosis, the method is called the affect bridge and in EMDR the method is called the float back technique.

Unless the earlier feeder memories are worked on, the problem will only be partially solved and the client is still likely to get triggered.

In the scenario above, if the psychotherapist had not looked for feeder memories, Tia and her therapist would only have worked on memory that Tia came in with, but that earlier feeder memory would have continued to affect her when she was sexual with her boyfriend.

Although experiential psychotherapy tends to be more effective and work faster in helping clients to overcome trauma as compared to talk therapy alone, experiential therapy isn't a quick fix, and everyone processes their problems differently with experiential psychotherapy.

Getting Help in Therapy
If you have been suffering with unresolved trauma, you could benefit from getting help from a licensed mental health professional who practices experiential psychotherapy.

To overcome trauma, you need more than just insight.  You need psychotherapy that will get to the root of the trauma in the limbic brain, which is what experiential therapy does (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

After you have overcome your traumatic experiences, you can be free from the emotional burdens of your history and live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I am a trauma-informed experiential psychotherapist who works with individual adults and couples.

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

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


















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