How Does Imagery and Imagination Enhance Psychotherapy?

I have been using imagery and imagination in therapy with my clients for many years (see my article: Using the Imagination as a Powerful Tool For Change).

Imagery and Imagination in Psychotherapy

The Imaginal Realm: Working With Visual Mental Imagery

I recently attended an advanced AEDP (Accelerated Experiential Dynamic Psychotherapy) seminar called "Imaginal Realm: Working With Visual Mental Imagery in AEDP" which was a deep dive into using imagery and imagination (see my article: What is AEDP?).

When I refer to "imagery", I'm not only referring to visual imagery. Aside from visual imagery, many people get non-visual imagery in sessions. 

For instance, some clients get mental representations through sound (hearing music in their mind), scents that can trigger old memories, kinesthetic experiences (feeling movement), tactile experiences, and an embodied or felt sense of conceptual/verbal imagery such as thinking of concepts or having an internal dialog.

During therapy sessions, I sometimes get visual images in my imagination or a song comes to mind. Over the years, I have learned to appreciate these experiences as messages from my unconscious mind because they often tell me what is going on for the client or what is going on between the client and me.

It's not unusual for me to have an image, song or a word in mind and then a few seconds later the client mentions the same image, song or word (see my articles: Synchronicities - Part 1 and Part 2).

Over time, I have learned that these experiences occur when I feel especially attuned to the client. Other therapists, especially therapists who are experiential therapists like me, have told me that they have similar experiences in therapy (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

The Use of Metaphors in Psychotherapy

Over the years, I have heard clients use many metaphors unprompted by me, including: 

• "It's like searching for the Holy Grail."
• "I'm no longer jumping into the vortex of other people's drama."
• "I feel like I'm trapped in a cage."
• "I'm no longer putting up walls."
• "I walked on eggshells with my ex."
• "I'm drowning in paperwork."
• "I keep hitting my head against a wall."
• "He swept me off my feet."
• "A weight has been lifted off my shoulders."

Metaphors are beneficial in therapy because they can:

• Enhance clients' communication by allowing them to express feelings they might otherwise have a hard time articulating

• Deepen insights that can lead to a reframing of a problem, a relationship or an idea

• Bypass rational defenses offering a way to talk about sensitive subjects and break rigid and unhealthy thought patterns

• Strengthen the therapeutic alliance between client and therapist

How Imagery and Imagination Enhance Psychotherapy

Imagery and imagination can enhance therapy by engaging the emotional brain. This allows clients to access and process unconscious emotions.

It also helps clients to make behavioral changes through mental rehearsal.

Imagery and Imagination in Psychotherapy

An example of how to use mental rehearsal is a client who wants to become more confident to give presentations at work. This client can vividly imagine their "Future Self", who can exist at any time in the future. They can imagine a self who has all the confidence, qualities and skills they would like to have (see my article: Experiencing Your Future Self).

Using imagination in this way can strengthen neural pathways and prepare the brain for success.

Clients can also see and feel themselves walking into the presentation room feeling prepared and confident, speaking with passion and receiving applause after the presentation. They might even imagine their boss coming over and praising the presentation. 

AEDP Portrayals

One of the main components in AEDP is doing "portrayals" in therapy sessions.

AEDP portrayals are active experiential and imaginative enactments in the therapy session.

To set up doing a portrayal an AEDP therapist prepares the client prior to doing the portrayal by:

• Establishing Safety and a Therapeutic Alliance: The therapist establishes an attuned connection with the client to ensure the client feels safe and to prevent them from feeling overwhelmed.

• Identifying the Core Material: In collaboration with the client, the therapist identifies a memory or a part of the client's self that still has an emotional charge.

• Inviting Immersion (The Setup): The therapist invites the client to slow down, close their eyes and visualize the scene using as many sensory details as possible (sight, sound, body sensations and so on).

• Role Playing (Doing the Portrayal): The therapist guides the client to talk to the imagined person or part of themself by expressing vulnerable or assertive feelings they couldn't express in the past. This might involve imagining talking to a frightened younger part of themself, talking to a parent in a memory from the past, confronting someone who abused them and so on.

There are different types of AEDP portrayals including:

• Reparative Portrayals: An example might be a client imagining a new outcome to a painful scene in their life. In this type of portrayal the client can offer themself what might have been needed and lacking in real life to repair emotional damage.

• Internal Parts Work (intra-relational portrayals): Having a dialog with different aspects of themself to resolve internal conflict (similar to Parts Work Therapy/IFS).

Imagery and Imagination: Internal Parts of Self

• Relational Attachment Portrayals: Reenacting relationships to process emotions to attachment figures (e.g., parents, siblings, a ex-lover, etc). 

• Feared Portrayals: Actively engaging with a threatening figure from real life or from a dream to process the emotional impact, reduce shame and anxiety, and to feel empowered.

• Longed-For Portrayals: The client imagines receiving the love, emotional support or validation they desired but never received from a significant person in their life.

• Moment-to-Moment Tracking: Moment-to-moment tracking is an essential part of AEDP whether the interaction involves a portrayal or a conversation between the client  and the therapist in session. This involves the therapist staying closely attuned to the client's facial expressions, movements, emotions and defenses. The therapist also monitors her own mental, emotional, imaginal and bodily sensations.

• Metaprocessing After a Portrayal: The client and therapist process the experience together afterward to help the client to integrate the experience by building a bridge between the client's right brain and left brain. Among other things, the therapist explores with the client what it was like to do the portrayal and, specifically, what it was like for the client to do the portrayal with the therapist. The focus is on what might have changed for the client or what was transformative about the experience. Processing helps the client to hold onto and integrate positive experiences (see my article: How Are Emotions Processed in AEDP?).

Using Imagery and Imagination on Your Own

Aside from the use of imagery and imagination in therapy, athletes  also use mental rehearsal, including visualization, to imagine a successful performance, including overcoming potential obstacles they might encounter. This can help them to build confidence, improve focus and enhance performance.

You can also use your imagination in creative ways on your own to have fun and, if you like, achieve goals.  There are endless ways to use your imagination on your own including:

• Using Creative Visualization For a Hoped-For Outcome: This can involve imagining a hoped-for outcome in your personal life, career or in any other part of your life.

Imagery and Imagination: Hoped-For Outcome

• Imagining "What If" Problem Solving: When you encounter an obstacle, including an internal obstacle, you can imagine "What if there were no limits?" and visualize different solutions, including solutions that might seem unattainable at first but might spark a new perspective.

• Using the "Lightstream" Technique: If you're dealing with stress, you can imagine a soothing, healing light flowing through your body to alleviate stress or physical discomfort.

Future Articles

Using imagery and imagination is one of my favorite topics, so I'll write more about it in future articles.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have over 25 years of experience helping 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 (917) 742-2624 during business hours or email me.

Also See My Articles:

The Mind-Body Connection as a Window Into the Unconscious Mind

Using the Mind-Body Connection to Create the World You Want 

Dreams and Embodied Imagination 

Working With Your Dreams to Develop Your Creative Imagination 

What Are Imaginal Interweaves?  

Books: Imagination and Medicine

Anxiety Can Be a Signal That You Are Suppressing Deeper Emotions

Anxiety is a common mental state that everyone experiences at one time or another. 

Anxiety can either be an adaptive emotion or it can be an inhibitory emotion, which I'll explain in this article (see my article: What is the Difference Between Fear and Anxiety?).

Anxiety Can Signal Suppressed Emotions

What is Anxiety?

Anxiety is characterized by physical and mental symptoms including (but are not limited to):

• Muscle tension
• Rapid heartbeat 
• Headaches
• Shortness of breath
• Digestive issues
• Lightheadedness
• Trouble sleeping
  
• Fatigue
• Nausea
• Trembling
• Twitching
• Excessive worry or a sense of impending danger
• Irritability
• Restlessness
• Avoidance of feared situations

When is Anxiety Adaptive?

Mild anxiety can be adaptive. 

For instance, mild anxiety can be adaptive before taking an exam, giving a presentation or preparing for a sporting event because it acts as a catalyst to help you to focus and prepare for these events to improve your performance.

When is Anxiety a Signal You Are Suppressing Deeper Emotions?

Anxiety can also act as a secondary emotion that let's you know you're suppressing core emotions, which are also known as deeper emotions or primary emotions (I'll use these terms interchangeably).

Core emotions include:

• Sadness
• Fear
• Joy
• Anger
• Surprise
• Disgust

When is Anxiety an Inhibitory Emotion?

When you experience anxiety as a secondary emotion, the anxiety is a signal that you are suppressing (or inhibiting) core emotions. 

Learning to suppress emotions often occurs early in life. 

As a child, you might have learned that emotions are "dangerous". 

This usually occurs when a  parent, who is uncomfortable with certain emotions, either ignores, punishes or lets you know in some other way that these emotions are unsafe.

Learning to Suppress Emotions as a Child

For instance, let's say you cried as a child because you were afraid of going to school. If your  parent was uncomfortable with your crying and didn't know how to handle your emotions, your parent might have said, "Stop being a drama queen" or "Big girls don't cry" or "You look ugly when you cry" (see my article: What is Childhood Emotional Neglect?).

If you had enough of these experiences as a child, you learn that it's unsafe to experience certain emotions because your parent isn't going to comfort you or, worse still, your parent will ignore, punish or criticize you. So, rather than experiencing the unbearable vulnerability of being alone with uncomfortable emotions, you learn to suppress these emotions.

When emotions are suppressed, the suppression creates trapped emotional energy which forces the body to keep the nervous system in a chronic state of fight-or-flight. This results in sustained spikes of cortisol or adrenaline which can create the anxiety-related symptoms mentioned above (racing heart, muscle tension and so on).

How Can You Address Suppressed Core Emotions?

If you notice you're feeling anxious and it's not a mild anxiety that is adaptive, you can pause, get curious, tune into your body and ask yourself, "What am I feeling underneath this anxiety?"

Using Somatic Awareness to Tune Into Your Body

For instance, if you tune into your body and notice that underneath your anxiety you're feeling sadness, you can reduce the anxiety in your body by allowing yourself to feel the sadness (see my article: The Mind-Body Connection and Somatic Awareness).

At that point, maybe you allow yourself to cry to release some of the sadness or maybe you write in a journal to express your sadness. 

You might also talk to a trusted friend so you don't feel alone with your sadness and you can  receive validation that your experience is normal and your friend has had similar experiences.

Other emotions that suppress core emotions are shame and guilt.

Getting Help in Therapy

If you find it difficult to tune into your body and detect the emotions you are suppressing, you could benefit from working with a licensed mental health professional who practices Experiential Therapy.

A psychotherapist who practices Experiential Therapy can help you to develop the necessary somatic awareness to deal with suppressed emotions and the underlying issues.

Experiential therapies are especially helpful in overcoming anxiety and trauma (see my article: Why is Experiential Therapy More Effective Than Traditional Talk Therapy?).

Experiential therapies include:

• Eye Movement Desensitization and Reprocessing (EMDR)

• Accelerated Experiential Dynamic Psychotherapy (AEDP)

• Somatic Experiencing (SE)

• Parts Work Therapy (IFS or Ego State Therapy)

Getting Help in Therapy

Rather than struggling on your own, seek help in therapy so you can calm your nervous system, deal with the underlying issues you have been suppressing and live a more fulfilling life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

As an Experiential Therapist, I have over 25 years of experience helping individual adults and couples.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles:

Self Help Tips For Coping With Anxiety

Getting Help For Anxiety in Therapy 

What Does Processing Your Emotions Mean?

How to Cope With News Anxiety 

Overcoming Adult Separation Anxiety

What is the Connection Between Anxiety and Depression? 

Grieving For a Parent Who Wasn't There For You

Grief for a deceased parent isn't always related to how close you were.

Grieving For a Parent Who Wasn't There For You

In fact, grief related to the loss of a parent you weren't close to can be even more intense than grief for a nurturing parent because it often involves grieving for what  you hoped for and never got (see links for my articles about grief below).

For adults who have lost a parent under these circumstances, part of the grief is knowing that the warm loving relationship you might have wished for can never be experienced after your parent died. The death can bring a painful finality to your wish and wash away any hopes you might have had to improve the relationship.

Clinical Vignette:

The following clinical vignette is a composite of many different cases with all identifying information removed:

Alex

Alex was in his mid-30s when he received a phone call from his stepmother, a woman he had never met, telling Alex that his father had terminal cancer. She told him that his father was in hospice and he wasn't expected to live more than a few days.

Before Alex could respond, his stepmother put his father on the phone to say a few words. It was clear to Alex that his father was heavily medicated and Alex didn't know what to say. His father asked for Alex's forgiveness for walking out on Alex and Alex's mother more than 30 years ago. He said he regretted not ever contacting Alex after he walked out on them.

Alex was shocked and confused. He didn't want to reject his father's dying wish, so he told his father that he forgave him. Then, his stepmother got back on the phone and told Alex that his father was too weak to talk any more. Before she hung up,she told Alex she would keep him apprised.

Not knowing what else to do, Alex sat for several minutes to take in what had just happened. When he was a child, he would ask his mother where his father had gone and his mother would tell him that his father was away on a business trip. But as weeks turned into months and years, Alex realized his father wasn't returning and he never asked his mother about it again because he didn't want to upset her.

Alex buried his feelings about his father and tried not to think about him. But there were times in his life when Alex felt sad that his father wasn't there for him, like when he graduated high school, when he graduated college, when he got married and when he had his first child. But during those times he didn't allow himself to dwell on those thoughts.

By the next day, Alex thought he might want to go visit his father before his father passed away, but then he received another call from his stepmother that his father died that night. She said she planned to have a memorial service in a few months and invited Alex to attend and meet his half brother, Jack.

A wave of profound sadness came over Alex. His wife attempted to soothe him, but Alex was too confused, anxious and angry to talk about it. He never even knew he had a half brother.

His wife said to him, "But you haven't seen your father in so many years and you don't even remember him. So, why do you feel sad?"

Alex couldn't explain why he felt so many mixed emotions, but after weeks passed and he didn't feel any better, he got help in therapy.

Grieving For a Parent Who Wasn't There For You

His therapist helped Alex explore his feelings and he realized that, even though he didn't allow himself to dwell on being abandoned by his father, he always had a wish that he and his father would reunite and they would develop a strong father-son relationship. But now that his father was dead, the reconciliation was impossible and this made him feel deeply sad.

His therapist helped Alex to grieve the abandonment and the loss of a relationship he wished for but now would never have. He also worked on his anger about his father asking him as he was dying to forgive him because, even though Alex said he forgave him, he wasn't sure how he felt.

As Alex continued to work on these issues in therapy, he realized how much he had stuffed his feelings from the time he was young because there was no one to help him with his complicated feelings about being abandoned and never seeing his father again. He believed his mother did the best she could, but she wasn't emotionally equipped to help him when he was a child.

After his father's death, when he spoke to his mother, he realized her memories of that time were different from his. She believed she had sat him down, talked to him and comforted him after his father left. When he told her what he remembered, she denied it, so Alex dropped the subject.

The memorial service was several months away and Alex had mixed feelings about going. Part of him wanted to go to meet his half brother and to find out more about his father, but another part of him didn't want to go. Even though he knew logically that none of this was his half brother's fault, he felt hurt and angry that his half brother had the relationship with his father that Alex wanted.

Then one day Alex received a call from his half brother, Jack, and they talked for over an hour. Jack said he could only imagine how difficult it must have been for Alex to get the call from Jack's mother after so many years. He also hoped they could meet and get to know each other.

Over time, they developed a relationship and Alex decided to go to the memorial service.

It took Alex a while to sort out his feelings about his father and his anger about the way his mother lied to him when his father left. But he also felt relieved to release the emotions in therapy--emotions he had suppressed for so many years.

Over time, Alex worked out his grief in therapy and maintained a relationship with Jack.

Getting Help in Therapy

Grieving for a deceased parent is difficult and it can be that much more difficult when a parent hasn't been there for you.

Getting Help in Therapy

Rather than trying to deal with these complicated emotions on your own, seek help from a licensed mental health professional who has experience helping clients with grief and loss.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I am an experienced psychotherapist who has helped many 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 (917) 742-2624 during business hours or email me.

Also See My Articles

Mourning the Death of a Father You Never Knew

Common Reactions to the Death of a Loved One 

The Many Layers of Grief 

The Emotional Impact of Losing Both Parents

Who Are You After Both of Your Parents Die?

Writing to Cope With Grief

What is Dual Awareness in Psychotherapy?

The concept of dual awareness is essential in psychotherapy, especially when working on unresolved trauma (see my article: Why is Experiential Therapy More Effective Than Traditional Talk Therapy to Overcome Trauma?).

Dual Awareness in Trauma Therapy

What is Dual Awareness in Trauma Therapy?

The ability to maintain dual awareness is especially important when processing traumatic memories in trauma therapy (see my article: Healing in Trauma Therapy).

Dual awareness is the ability to process traumatic memories while remaining grounded in the safety of the here-and-now.

Dual Awareness in Trauma Therapy

In other words, clients need to balance two realities: the here-and-now as well as the traumatic memory that is being worked in therapy. That means they are aware that, even though they are discussing a traumatic memory, they are safe with their therapist (see my article: Why Establishing Safety is So Important in Trauma Therapy).

Before doing any processing in trauma therapy, it's important for the trauma therapist to prepare clients for the work by ensuring clients have internal and external resources or coping skills, including the ability to remain present and embodied (see my article: Developing Coping Strategies in Trauma Therapy).

To remain embodied means maintaining a conscious connection to their emotions and bodily experiences while processing traumatic emotions (see my article: What is Somatic Awareness?).

Key Concepts of Dual Awareness:

Prior to processing traumatic memories, their therapist helps prepare clients to:

• Balance Two Realities: Clients acknowledge feeling certain emotions related to past traumatic memories at the same time that they know they are safe in the moment with their therapist. 

• Develop an Observing Self: Clients learn to develop an observing self who witnesses their internal experiences (thoughts, emotions, bodily sensations) while processing memories from the past. This observing self can go by many names including Core Self, Adult Self, Higher Self or whatever name is meaningful to clients. Because they have developed a part of themselves that can witness their experiences, they don't feel overwhelmed. This also helps to prevent retraumatization.

Therapeutic Techniques: Trauma therapists often use various techniques to help clients to balance processing past memories with remaining grounded in the present moment. 

Some of these techniques include:

• Pendulation which was developed in Somatic Experiencing Therapy, where the therapist helps clients to shift their awareness from a traumatic memory or experience to a calm or neutral experience or to their Core Self/Adult Self as a way to work on these memories in manageable segments so clients don't become overwhelmed.

• Imaginal Interweaves: Prior to choosing a traumatic memory to work on, clients choose people from their past or present life who would be emotionally supportive. While working on the memory, clients imagine these individuals are accompanying them on their healing journey to undo feelings of aloneness. These people might include a favorite relative, a best friend from the past or the present, a loving teacher and so on. If clients can't imagine anyone they know, they can also choose a person they don't know personally, like a character from a movie or a book, that they can imagine being with them in an emotionally supportive role. In some circumstances, clients might choose someone who they imagine could have intervened directly, like a protective or powerful person who would have protected them when they were younger.  In reality, clients know there might not have been anyone in the original traumatic memory that helped them, but dual awareness allows them to imagine and have a felt sense of being helped or protected.

Dual Awareness in Trauma Therapy

• Breathing Exercises: Being able to pause the work and take a cleansing breath can help the trauma work to remain manageable and tolerable. Clients can also use breathing exercises between sessions.

• Containment: Containment can include clients imagining they can put the traumatic memory away in a box of their choosing at the end of the session. Some clients like to imagine that their therapist keeps the box for them or that they keep the box themselves in a safe place until the next time they work on the memory.

• Learning How to Manage and Reduce Triggers : A trigger is a person, place or thing that causes an unexpected intense reaction related to an experience from the past (see my article: 8 Tips For Coping With Triggers).

What Are the Different Types of Trauma Therapy?

There are different types of trauma therapy including:

• EMDR Therapy (Eye Movement Desensitization and Reprocessing

• AEDP (Accelerated Experiential Dynamic Psychotherapy)

• Somatic Experiencing

• Parts Work Therapy (IFS and Ego States Therapy)

Getting Help in Trauma Therapy

Trauma therapy can help you to process traumatic memories so they no longer affect you in your current life.

Getting Help in Trauma Therapy

Rather than struggling on your own, seek help from a licensed mental health professional who is trained as a trauma therapist so you can live a more meaningful life free from your traumatic history.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy, Somatic Experiencing and Certified Sex Therapist.

I have over 25 years of experiencing helping 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 (917) 742-2624 during business hours or email me.

Also See My Articles:

What is a Trauma Therapist? 

Overcoming Trauma: You're Not Defined By What Happened to You 

What is Complex Trauma? 

The Unspoken Rift: Resentment, Emotional Disconnection and Loneliness in Relationships

Resentment, emotional disconnection and loneliness tend to form a negative cycle in relationships where unspoken pain gradually creates"walls" that replace emotional and physical intimacy with distance.

Resentment, Disconnection and Loneliness in a Relationship

Resentment is a complicated emotional response to perceived mistreatment or unmet needs. Resentment is a mix of anger, bitterness and disappointment.

What is the Life Cycle of Resentment and Disconnection?

• A Slow Build Up: Resentment rarely develops overnight.  It builds up over time due to repeated experiences of feeling unseen, unheard or unsupported. Resentment often starts when one or both people in the relationship have unexpressed feelings as a result of wanting to avoid conflict.

• Emotional Numbing: As a way to avoid feeling emotional pain in the relationship, individuals "numb out" or detach emotionally. This withdrawal creates an unspoken rift (see my article: What Happens When You Numb Yourself Emotionally?).

• Loneliness When Together: Unspoken resentment can lead to a sense of loneliness even when a couple is physically together in the same space. Their interactions can become transactional or as if on "autopilot' lacking warmth or genuine connection (see my article: Feeling Lonely in a Relationship).

• The Negative Cycle Feeds on Itself: The negative cycle of resentment, disconnection and loneliness feeds on itself. 

What Are the Signs of Resentment, Disconnection and Loneliness in a Relationship?

The following are some of the signs:

• Silence and Avoidance: One partner staying up late to avoid their partner. One or both partners retreating to another room or avoiding topics that might create conflict.

Loss of Emotional and Physical Intimacy

• Loss of Intimacy: A decrease or cessation of affection, physical intimacy, meaningful conversation or interest in the other partner's inner emotional world.

• Passive Aggressive Behavior: Using sarcasm, subtle jabs or eye rolling as a form of contempt instead of direct communication (see my article: Improving Communication By Eliminating the Four Horsemen of the Apocalypse).

• Keeping Score: Constantly comparing efforts or bringing up old mistakes during unrelated arguments (see my article: How to Stop "Kitchen Sinking" Your Partner).

Strategies For Dealing With Resentment, Disconnection and Loneliness in a Relationship

• Acknowledge the Resentment: Address the resentment using "I" statements rather than being accusatory. Shift away from blame to vulnerability: "I miss you when we don't talk" instead of "You never talk to me!"

Disconnection and Distractions in Relationships

• Avoid Distractions: Instead of distracting yourself with your phone or being on the Internet, avoid distractions so you can connect with your partner. 

• Find Ways to Reconnect Emotionally: Find meaningful ways to reconnect by engaging in activities you both enjoy. This could involve planning a date night--even if that means staying at home and playing a game together or watching and talking about a favorite movie. In addition, make plans to take a trip together at least once a year, if that's possible. Instead of one person doing all the planning, plan it together as a way to connect and anticipate the pleasure of the upcoming trip.

• Find Ways to Reconnect Physically: Start slowly with physical touch and other gestures of affection. Talk about what you used to enjoy together sexually and what you each miss about not being physically intimate (see my article: Have You and Your Partner Stopped Having Sex?)

• Get Help in Couples Therapy: When there has been a build up of resentment, emotional disconnection and loneliness over a period of time, self help techniques are often not enough. If you have stopped having sex, a skilled couples therapist who is also a sex therapist can help you to develop the tools and strategies to improve your relationship over time. This usually begins with a focus on emotional and relational issues before sexual issues are addressed.

Clinical Vignette

The following clinical vignette is a composite of many cases:

Lisa and Ed

Married for 25 years, Lisa and Ed co-existed together in their home.

Both of them grew up in families where conflict was never discussed so neither of them knew how to talk about uncomfortable feelings. 

Rather than talking about the increasing emotional and physical gulf between them, they tried to avoid one another.

Over time, their sex life dwindled to a couple of times a year. During their sexual encounters, they both experienced sex as "robotic" and disconnected, but neither of them knew how to talk about it (see my article: How to Talk to Your Partner About Sex?).

After they had sex, Ed would usually roll over and go to sleep and Lisa would get up to do chores around the house. There were no expressions of affection either verbally or physically (see my article: Why is Sexual Aftercare Important?).

Ed spent most of his free time in the basement tinkering in his workshop and Lisa spent most of her time driving their teenage sons to sports and other extracurricular activities.

Both of them were unaware of how their sons acted as a buffer between them until both sons left for college. At that point, Lisa and Ed felt increasingly lonely, but neither of them had the communication or relationship skills to talk about it.

Unhappy and desperate to change their situation, Lisa listened to a podcast with Emotionally Focused Couples Therapist (EFT) Julie Menanno, LMFT who talked about the negative cycle in relationships. 

As Lisa listened to the podcast, she realized that she and Ed were stuck in a negative cycle and it was possible to learn strategies for how they could break out of that cycle.

When she summoned the courage, Lisa broached the topic of attending couples therapy with Ed over dinner. She could see this made Ed very uncomfortable, but she persisted by telling him she realized they were both unhappy in their relationship and, as she was approaching her 50th birthday, she knew she wanted more out of a relationship.

Ed was reluctant to attend couples therapy at first, but he also sensed that Lisa might end their relationship and he wasn't ready to end their marriage. So, after considerable thought, Ed agreed to go to couples therapy.

Emotionally Focused Couples Therapy (EFT)

Their couples therapist was an Emotionally Focused Couples Therapist (EFT) who helped Ed and Lisa to develop the communication and relationship skills they were lacking.  This was challenging for both of them because it meant confronting their discomfort about difficult issues between them. But, over time, they improved their communication skills and let go of their fear of dealing with conflict and resentment.

Both of them were surprised to feel relieved to finally be able to address years of resentment in a way that was respectful and empathetic.  This helped them to open up emotionally in a way they had never experienced before. Gradually, they also let go of their resentments.

After several months, they were both ready to improve their sex life and their therapist provided them with psychoeducation about sex therapy homework to do at home. 

Initially, it was awkward for Lisa and Ed to be sexually intimate, but they developed patience and a sense of humor to overcome the awkwardness until, eventually, they were able to have a more satisfying sex life again.

The work was neither quick nor easy and, just like any other type of therapy, there were setbacks (see my article: Setbacks Are a Normal Part of Therapy on the Road to Healing).

However, step by step, Lisa and Ed saw gradual improvements that built on each other until, over time, they had the fulfilling relationship they wanted.

Conclusion

Resentment and emotional disconnection in a long term relationship usually builds up over time. 

When conflicts go unaddressed and unrepaired in a relationship and resentment increases, emotional disconnection and loneliness also increase until the couple is trapped in a negative cycle.

Acknowledging the problem is the first step to improving the relationship. 

Although many couples end their current relationship and start a new one, they usually discover they develop the same problems in the new relationship because they don't have the communication and relationship skills necessary to sustain a healthy relationship (see my article: How to Avoid Making the Same Mistakes in One Relationship After the Next).

Getting Help in Couples Therapy

If you want to improve your relationship, seek help from a licensed mental health professional who is a couples therapist and certified sex therapist (see my article: What is Couples Sex Therapy?).

Individuals and couples seek help in sex therapy for a variety of reasons (see my article: Why Do People Seek Help in Couples Sex Therapy?).

A skilled sex therapist can help to dispel many of the misconceptions about sex therapy. For instance, there is no nudity, physical exams or sex during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?).

Rather than struggling on your own, seek help so you can develop a more fulfilling relationship.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have over 25 years of experience helping individual clients and couples.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Article

How to Let Go of Resentments in Your Relationship