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Monday, April 23, 2018

Understanding Internal and External Psychological Defense Mechanisms

I have discussed defense mechanisms in prior articles, including:
Understanding Internal and External Psychological Defense Mechanisms

In this article, I'm beginning a discussion about internal/intrapsychic and external/interpersonal defense mechanisms by identifying them.

In my next article, I'll discuss the consequences of using these defense mechanisms that alienate you from yourself and others.

Generally speaking, defense mechanisms are either directed inward against your own uncomfortable feelings or they are directed outward to avoid closeness or meaningful contact with others.

As I've mentioned in prior articles, defense mechanisms are often perceived as being negative.  But they can be life-saving for a child and living in a home where s/he is being abused or neglected (or both).  They serve as an important emotional survival strategy (also known as defense mechanisms) to keep the child from feeling overwhelmed in a situation where s/he can neither fight nor flee.

But, unfortunately, as that same child becomes an adult, these emotional survival strategies get in the way of having healthy relationships with oneself and others.  In order to maintain emotional distance, the adult ends up paying a high price by staying in a "bubble" (see my article: Emotional Survival Strategies That No Longer Work For You: "I Don't Need Anyone").

If you have been using defense mechanisms extensively in your life, they become so much a part of you that they are difficult for you to see without the help of a psychotherapist.  A skilled psychotherapist can help you to see how these defenses are "protecting" you and, at the same time, how they're also getting in the way of your relationship with yourself and others.

Of course, it's all a matter of degree.  No one would survive emotionally if s/he didn't use defense mechanisms at certain times to a degree.  But defense mechanisms become a problem when they alienate you from yourself and others.  I'll write more about this in my next article.

Common Intrapsychic/Internal Psychological Defense Mechanisms
Intrapsychic/internal defense mechanisms are used between you and your inner world to ward off what would be uncomfortable for you to experience.

These include both repressive and regressive defense mechanisms.

The repressive defense mechanisms serve to hold back uncomfortable feelings, thoughts, fantasies or impulses.

The regressive defense mechanisms are child-like mechanisms that were used at a younger stage in life that are used again as an adult.  These defense mechanisms are usually unconscious and, as previously mentioned, difficult for the individual who uses them to see.

  • Intellectualization
  • Rationalization
  • Worrying
  • Rumination
  • Minimization
  • Displacement
  • Reaction Formation
  • Ignoring
  • Avoidance
  • Procrastination
  • Externalization
  • Distraction
  • Self-attacking thoughts
  • Addictive Behavior

  • Projection
  • Denial 
  • Acting Out
  • Repetition Compulsion
  • Imitation
  • Identifying with the Aggressor
  • Passive-Aggressiveness
  • Isolation of Affect
  • Somatization

Common Tactical/External Defense Mechanisms
Tactical/external defense mechanisms are character defenses that are used between you and others.  If you habitually use tactical defense mechanisms, they're ingrained in your personality.

In effect, these defense mechanisms provide a wall between you and others to avoid closeness or to keep others at a distance.

Aside from personal relationships, these defense mechanisms are also used unconsciously by many clients in psychotherapy as a way to avoid developing a therapeutic relationship with their psychotherapist.  Since the behavior is unconscious, clients don't realize that they're doing it.  But, at the same time, using these defense mechanisms hampers the work in therapy because a positive outcome in psychotherapy is dependent upon a good working alliance between the client and the psychotherapist.

Like intrapsychic conflicts, these defense mechanisms are usually unconscious so they are difficult for you to detect on your own without help from a psychotherapist.

  • Vagueness
  • Speaking in generalities
  • Contradictory statements
  • Sarcasm
  • Changing the subject
  • Argumentativeness
  • Dismissiveness and blaming
  • Distancing
  • Passivity
  • 3rd person speech
  • Playing games
  • Body language
  • Physical presence
  • Eye contact/lack of eye contact
  • Fake smile and laughter
  • Weepiness and crying
  • Acting out
  • Posture
  • Voice and tonality
  • Speed of talk
  • Withdrawal
  • Detachment
  • Grooming and appearance
  • Weight and physical shape

Most people who tend to use defense mechanisms to ward off uncomfortable feelings internally and/or externally to keep others at a distance, don't seek help until they're experiencing significant consequences either within themselves or in their relationships or both.

See my next upcoming article for a continuation of this discussion.

Getting Help in Therapy
If you think your defensiveness causes problems in your life, you could benefit from seeking help in therapy (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to identify the defense mechanisms that you use either internally and/or externally.  Also, over time, a skilled mental health professional can help you to feel safe enough to relate to yourself and others in a healthier way (see my article: How to Choose a Psychotherapist).

As I mentioned before, defensive behavior is usually longstanding and ingrained by the time you become an adult, so the work in therapy isn't easy or fast.

A psychotherapist can assist you to expand your emotional window of tolerance so you can gradually tolerate emotions that were once too uncomfortable for you.  An expanded window of tolerance can allow you to come out of the "bubble" that you've kept yourself in (see my article: Expanding Your Emotional Window of Tolerance in Psychotherapy).

Once you're free of the kind of defensive behavior that is keeping you alienated from yourself and others, you can live a fuller, more meaningful life.

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

One of my specialties is helping clients to overcome developmental and shock trauma.  

I have also helped clients, who used defensive behavior for self alienation as well as alienation from others, to gradually feel safe enough to expand their emotional window of tolerance, so they could change.

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.

Friday, April 20, 2018

Relationships: The Ideal vs. the Real

When people fall in love, they often fall in love with their idealization of their lover rather than the reality.  At the beginning of the relationship before they know each others' habits, doubts and fears, each partner tends to see the best in the other and fills in the missing pieces with fantasies of who they want their partner to be.  But after they have been living together or married for a while, the ideal tends to fall away as reality sets in.  There is, inevitably, some disillusionment, but how each partner navigates his or her disappointment often predicts if the relationship will survive and thrive or end.

Relationships: The Ideal vs. the Real

Some people, who become disillusioned, leave the relationship and continue to look for their ideal mate.  Little do they realize that they will probably go through the same experience again with the next person.  For these people, searching for their "soul mate" can become a lifelong quest that is never fulfilled.

Fictional Clinical Vignette: Relationships: The Ideal vs. the Real
The following fictional vignette illustrates how the initial idealization can turn into disappointment and disillusionment and how psychotherapy can help to get to the underlying issues to resolve the problem:

After living together for six months, Cassie realized that her boyfriend, Steve, wasn't the person she thought he was when they first met at an outdoor photography class a few months before.

When she first met Steve, Cassie was struck by his good looks, his kindness, humor and intelligence.  From the moment they started talking, she was immediately drawn to him.  She had just gotten out of a one year relationship with another man, who turned out to be a different person from who she thought he was during the first few months together.

After the photography class, over dinner later, they spoke for three hours and continued the conversation the next day for several more hours.  Since their first day together, they spent time together everyday until Steve eventually moved in with Cassie.

She expected there would be things that annoyed her about Steve and that annoyed him about her.  But she didn't expect him to be so different from the person she originally fell in love with.

When she first met him, Steve was living temporarily with a friend because he was new to New York City.  At the time, he was living out of boxes and suitcases, so when he moved into her apartment, Cassie made room for Steve's things in her closets and drawers.  She also made sure to buy things that she knew he would like to eat.  She wanted him to feel comfortable.

But after a few days, Cassie realized that, unlike her, Steve was sloppy.  He left his clothes and things all over the apartment--dirty socks on the floor, newspapers piled up in the living room, his toiletries taking up all the space on the bathroom counter they shared, and puddles of water on the floor after he took a shower.  And the worst thing for Cassie was that he didn't seem to mind living this way.

The first few times, she tried to be tactful when she spoke to him about his sloppiness, hoping that he would be neater.  She didn't want him to feel that her apartment wasn't his place too or that she wanted to boss him around.   But, even though he apologized and said he would try to be neater, he continued to be sloppy, which angered Cassie.

She also began noticing other things that bothered her: He tended to drink from the milk carton and leave it on the kitchen counter so it spoiled.  She also saw that if she left for work earlier than he did, Steve got up and left for work without making the bed or tiding up in the kitchen.  He also left his dishes and coffee cup in the sink.

Finally, Cassie suggested that they talk, and she mentioned the things that were bothering her.  Steve told her that he would try to be more considerate, but he also felt that Cassie was being picky about certain things.

Relationships: The Ideal vs. the Real

During their talk, Steve reminded her that the few times when he did make the bed, she wasn't happy about the way that he did it because she had a particular way that she preferred.  Cassie admitted that she tended to be somewhat of a perfectionist and she realized that she would have to let go of some of her perfectionism if the relationship was going to work.

Later that week, when Cassie spoke with her two close friends about Steve's sloppiness, both of her friends told her that their husbands were the same way. They said they used to argue about these things a lot in the beginning, but they gave up after a while.

With a long sigh, Cassie hesitated before she brought up what she was thinking.  Then, she told her friends that she felt disillusioned about Steve and their relationship.  She said he seemed so different when they first met.  She wondered if she had made a mistake in getting into a relationship with him. Her friends suggested that she talk to a psychotherapist first before she ended the relationship precipitously.

A few weeks later, Cassie felt so troubled about her relationship that she contacted a psychotherapist to be able to talk things out.  She didn't want to break up with Steve, but she wasn't sure she could stay in the relationship either.

As Cassie spoke with her psychotherapist about what was going on at home, she began to cry.  She said that, when she and Steve first met, they had sex all the time.  But, she said, shortly after they moved in together, they had sex once a week or less, and she didn't feel as attracted to him as she once did.  All she could think about was his sloppiness.  She also wondered if he felt less attracted to her because she criticized him for being sloppy.

When Cassie spoke with her psychotherapist about her family, she said that her mother also tended to be a perfectionist.  Her mother told Cassie that she had to "put her foot down" when she and Cassie's father got married because he tended to be sloppy.  After that, Cassie's mother controlled things in the relationship, and the father became much more passive.

Cassie told her psychotherapist that she didn't want to be controlling or have Steve become passive.  She said she just wanted the man she met when they first got together.  Then, she cried.

Her psychotherapist explained that almost every couple starts their relationship with an idealized image of each other.  Then, after they get to know each other, that idealization falls away and reality sets in and the couple has a chance to develop a more realistic relationship.

She asked Cassie questions about whether she and Steve had shared values and still enjoyed the same things together.  Cassie responded that their values were the same.  She also said that, lately, since things were strained between them, they weren't enjoying the same things together as much as they used to before.  She said she noticed that Steve was more apprehensive around her at home, and she realized that he probably expected her to be critical about the things he did or didn't do things at home.

As her psychotherapist normalized Cassie's experiences in her relationship, Cassie realized that she didn't know if she was ready to let go of the "idealized Steve" that she thought she was in a relationship with in order to accept the "real Steve."  She said that as she heard herself say these words, she felt immature.

Over the next few weeks, Cassie talked in therapy about being a perfectionist and how unhappy it made her--even before Steve was in her life.  She felt like "perfection is my norm."  They talked about how much shame there was underneath her perfectionism, and worked on helping her to overcome her shame (see my article:  The Connection Between Perfectionism and Core Shame).

Over time, Steve became more self aware and he was more conscientious about being neat and considerate.  He even told her that he realized that he preferred it when the apartment was neat and tidy.  Cassie could see that he was really trying, but she still felt like she missed the "idealized Steve," even though she realized that he never existed--except in her head.

In her psychotherapy sessions, Cassie talked about all the prior relationships that had a similar pattern where she thought each boyfriend was "wonderful," only to find out later that each of them had flaws that she couldn't stand, which led to her ending those relationships.

But now, at age 30, she was trying to focus on what was more important, and she realized, on an intellectual level, that the fact that she loved Steve and he loved her--although not in the head-over-heels way that they did at first.  She also realized that he was a good person, which was more important than some of his habits than annoyed her.

Casie told her psychotherapist that she just wished she could feel this on an emotional level and not just on an intellectual.  She kept thinking about what her mother might say if she knew how sloppy Steve was.  She knew her mother would disapprove and she would expect Cassie to control him, like her mother controlled her father (see my article: Ambivalence and Codependence in Mother-Daughter Relationships).

The more Cassie and her therapist talked about it, the more they both realized that Cassie was still seeing things from her mother's perspective and still trying to please her--rather than developing her own perspective.

Relationships: The Ideal vs. the Real

Over time, Cassie and her psychotherapist worked in therapy to help Cassie distinguish her own views from her mother's views.  As they did this, Cassie felt more like an adult.  Over time, she felt on an emotional level (and not just on an intellectual level) that she was satisfied in her relationship with Steve and, if anything, their love was growing in a more mature way.

It's normal to idealize the person that you're with when you're first in a relationship.  Over time, both of you get to know the "real" person you're in a relationship with and not the ideal.

Some people have problems accepting anything less than the ideal.  Often, this has to do with unconscious underlying issues, including still trying to live up to parents' expectations.

By letting go of your concept of the ideal and re-evaluating your relationship and what's most important to you, you have an opportunity to see your partner and your relationship in a more realistic light so that your love can mature and grow.

Getting Help in Therapy
Many people, who have problems with the disillusionment that reality is different from the ideal, are helped in psychotherapy (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to discover the underlying issues that are getting in your way and help you to make decisions about your relationship and your life (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, you owe it to yourself to get help in therapy.

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

I work with individual adults and couples.  One of my specialties is helping client to overcome traumatic experiences and deal with unresolved issues.

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.

Wednesday, April 18, 2018

Understanding How an Avoidant Attachment Style Affects You and Your Relationship

In my prior articles, How Your Attachment Style Affects Your Relationship and How Early Attachment Bonds Affect Adult Relationships, I discussed attachment styles in general and the affect they can have on relationships.  In this article, I'm focusing specifically on the avoidant attachment style, its origins, and how it can affect a relationship (see my article: An Emotional Dilemma: Wanting and Dreading Love).

Understanding How an Avoidant Attachment Style Affects You and Your Relationship

Relationships: From Passion and Excitement to Fear of Emotional Intimacy
While relationships often start with passion and excitement, each person's core vulnerabilities can emerge as the relationship becomes more serious, the couple becomes more attached, and the emotional intimacy increases.  If both people are emotionally secure because they grew up in loving and secure homes where their emotions needs were mostly met, when issues , they can usually be worked out more easily than one or both people have an insecure attachment style.

But people who developed an insecure attachment style, like avoidant attachment, as a coping strategy when they were children, can become increasingly uncomfortable as the relationship becomes more emotionally intimate.  With greater emotional intimacy, they become aware that they are more emotionally dependent upon their romantic partner, which can make them feel emotionally vulnerable.

People with an avoidant attachment style are often unable to put their fear into words.  Depending upon how threatened they feel by the emotional intimacy of the relationship, they will often dissociate and become estranged from their own feelings and from their partner because this is the emotional survival strategy that they developed in childhood.

They will often shut down emotionally.  Although they might appear from the outside as if nothing much is going on, internally they are in a state of turmoil and often unable to express their feelings.

They appear as if they are deliberately stonewalling their partner but, in most cases, they have really "checked out" or dissociated because they're overwhelmed, and the more the other partner insists that they talk about what's happening, the more dissociated they can become (see my article: Relationships: Are You a Stonewaller?).

How Do People Develop an Avoidant Attachment Style?
The avoidant attachment style usually begins in early childhood due to consistent neglect or abuse.  If the parents are unable to provide the baby with an emotionally safe home environment, the baby, who is unable to fight or flee, goes into "freeze" mode, which is another term for dissociation, as a last resort to cope with the abuse or neglect.

As adults, these individuals continue to be disconnected from their emotions.  Without the necessary help in early childhood about how to identify and tolerate uncomfortable emotions, these adults continue to engage in maladaptive coping strategies to avoid experiencing uncomfortable feelings.  So, a strategy that saved them as infants becomes an obstacle to their knowing themselves and connecting with others.

Fictional Clinical Vignette: Understanding the Avoidant Attachment Style
During the first three months of his relationship, Ken, who was in his mid-30s, was in a state of bliss whenever he was with Ann.  They met at a party and they were instantly attracted to one another.  Soon, they were dating a few times a week and enjoying each other's company.

By the fourth month, Ken realized how deeply he cared for Ann, and he began to feel anxious. He wasn't sure what made him feel anxious, but he knew that he was feeling different from before.  Whereas he felt loving and carefree whenever he was with Ann before, he now felt ambivalent about seeing her.

Rather than feeling carefree and in a state of bliss, he now experienced anxiety just before they got together.  He tried to think of what changed, but he couldn't think of anything.  Nothing had occurred that would account for his anxiety.

Sometimes, he wondered if he just didn't care for her anymore, but he knew this wasn't true.  If anything, he cared for her more now than during their few couple of months dating, so none of this made sense to Ken.

Ken had been in two other serious relationships before, and he experienced a similar pattern--feeling happy during the early stage of the relationship and then increasingly uncomfortable as time went on.  In each case, he assumed that his feelings had changed or they had "grown apart" and he ended the relationships.  But there was something different about how he felt this time because, even though he felt anxious, he knew he still cared for Ann.

When Ann brought up that he seemed to be more distant around her lately, she asked him if there was anything wrong.  Ken didn't know how to answer her, so he remained quiet for a while.  Then, he assured Ann that he cared for her a lot and wanted to continue to see her.  This response seemed to satisfy Ann, but Ken knew it was just a matter of time before this issue came up again.

As he became increasingly concerned about what was going on for him, he contacted a psychotherapist to try to understand himself. When his psychotherapist asked Ken to talk about his family history, Ken talked about being an only child in a household where his mother was emotionally distant and his father was emotionally and physically abusive.  He had few specific memories of his childhood, but he knew that he was happy to go away to college, and he never moved back in with his parents again.

Ken discussed how emotionally distant he was becoming when he was around Ann.  He also spoke about being concerned that if he didn't get help, he might be jeopardizing his relationship.

After his psychotherapist assessed Ken over the next several sessions, she provided him with psychoeducation about attachment styles.  She told him that due to his traumatic childhood, he developed an avoidant attachment style which surfaced when relationships became more emotionally intimate and threatening to him.

His psychotherapist explained that their work in therapy would be neither quick nor easy, but if he stuck with therapy, he had a chance of overcoming his fearful, avoidant attachment style.

She began by helping Ken to identify his emotions.  Initially, this was very hard for Ken when he thought about his relationship with Ann.  He knew that he was happy at first when they were first getting to know each other.  He also knew that he felt anxious around her lately, but he didn't know why.

His psychotherapist taught Ken how to sense his emotions in his body.  She told him that the body offers a window into the unconscious mind and that if he could sense into his body, over time, he might be able to identify more specifically what he was experiencing (see my article: The Body Offers a Window Into Unconscious Mind).

At first, Ken had difficulty sensing into his body.  It took a while for him to be able to sense tension in his neck and chest.  Then, gradually, he was able to identify other emotions, like fear, when he thought about getting together with Ann.

Over time, Ken also noticed in therapy that as he focused on an emotion in his body, like fear, that it eventually dissipated.  So, after a while, he realized that emotions often come and go and that he was not identified by his emotions.

Ken's psychotherapist paid particular attention to what Ken was able to tolerate with regard to uncomfortable emotions.  She knew that his window of tolerance for emotions that made him uncomfortable was narrow, so she was careful not to have Ken dwell on uncomfortable emotions longer than he could tolerate.

Over time, Ken's window of tolerance expanded so he could tolerate uncomfortable emotions for longer periods of time.  Using Somatic Experiencing, this allowed them to explore what thoughts, memories of physical sensations came up for him as he experienced these emotions.

Over time, Ken had expanded his window of tolerance significantly.  Then, his therapist recommended that they work on the root of his problem, which was the childhood abuse and neglect, using EMDR therapy (see my articles:  How EMDR Therapy Works: EMDR and the Brain).

In the meantime, Ann, who knew that Ken was in therapy working on his problems, was patient.  She mentioned to him that she noticed some progress.  Specifically, she sensed that his ability to remain emotionally connected to her had improved somewhat.  She noticed that he wasn't as emotionally distant with her as he had been before.  This was encouraging to both of Ken and Ann.

Understanding How an Avoidant Attachment Style Affects You and Your Relationship

Over the next year, Ken continued to work with his psychotherapist using EMDR therapy to resolve his traumatic past.  EMDR therapy helped Ken to make emotional connections between his current fear and the fear that he experienced when he was a child.

He also began to develop an ability to separate his fear from childhood from what was getting emotionally triggered in his relationship (see my article:  Overcoming Emotional Trauma: Separating "Then" From "Now").

He understood on an emotional level that, whether he was in a close relationship with Ann or with someone else, this fear would get triggered (see my article:  Coping With Trauma: Becoming Aware of Emotional Triggers).

Eventually, Ken worked through his early trauma, he became more connected to his internal world and more connected to Ann.

Attachment styles are developed early in childhood.  If a child grows up in a secure, loving home environment, all other things being equal, s/he will usually develop a secure attachment style.  If a child grows up in an abusive and/or neglectful home environment, s/he will probably develop an insecure attachment style.

The avoidant attachment style is one form of insecure attachment.  It becomes more obvious in a relationship as the relationship becomes more emotionally intimate.

At that point, what usually happens is that, on an unconscious level, the person with an avoidant attachment style uses the same emotional survival strategy that s/he used as an infant--s/he dissociates, which creates an internal emotional estrangement as well as creating distance from a romantic partner.

Although this is a maladaptive coping strategy as an adult, it keeps him or her from becoming overwhelmed.  However, it also creates the kinds of problems which I described in the vignette above.

Since the root of the problem is in childhood, this is where the therapeutic work needs to be.  However, the psychotherapist must make sure first that the client can tolerate feeling his or her uncomfortable emotions.  If the client can't tolerate uncomfortable emotions, which is usually the case, the therapist needs to help the client to expand his window of tolerance first so that, gradually, s/he can tolerate difficult emotions.

Once the client can tolerate difficult emotions, then the therapist can help the client to overcome the original traumatic experiences which are at the root of the problem using a form of trauma therapy, like EMDR (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Getting Help in Therapy
It can be very confusing to realize that your feelings have changed from bliss to anxiety during the course of a romantic relationship which has become more emotionally intimate.

A skilled psychotherapist, who uses experiential therapies, like Somatic Experiencing and EMDR therapy, can help you to expand your window of tolerance and, eventually, help you to work through the root of your traumatic experiences (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than suffering alone, you owe it to yourself to get help in trauma therapy.

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

I work with individual adults and couples, and I have helped many clients to overcome their traumatic experiences.

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, April 14, 2018

Overcoming Your Fear of Allowing Yourself to Feel Your Sadness

Many people have a fear of allowing themselves to feel their sadness.  Their fear is if they allow themselves to feel sadness or grief that they will drown in it, so they use various defense mechanisms to avoid feeling sadness or grief, which prolongs their discomfort (see my articles: Grief in WaitingCoping With GriefDiscovering that Sadness is Hidden Underneath Your Anger, and Allowing Yourself to Experience Your Emotions in a Healthy Way).

Overcoming Your Fear of Allowing Yourself to Feel Your Sadness

Usually people who fear feeling sadness or other feelings that cause them discomfort had experiences as young children where left alone with their emotions, so they were forced to soothe themselves with the limited capacities available to them as children (see my article: Overcoming Your Fear of So-Called "Negative Emotions").

Sometimes, this is related to experiences of childhood abuse and/or neglect where one or both parents were either emotionally unavailable to soothe them or where the parents were the perpetrators of the children's emotional distress (see my article: What is Childhood Emotional Neglect?).

In other cases, the parents weren't dealing with their own emotional discomfort and, as a result, they didn't know how to soothe themselves or their children.  Often, this becomes an intergenerational pattern unless people get help in therapy to cope with their fears of experiencing uncomfortable feelings (see my article: Intergenerational Family Dynamics).

People who fear dealing with sadness or other emotions that are uncomfortable for them usually don't seek out help in psychotherapy for the same reason why they don't allow themselves to feel their full range of their feelings--fear of being overwhelmed by their emotions.  Instead, they might keep themselves distracted and "busy" to ward off uncomfortable emotions (see my article: Are You Constantly "Keeping Busy" to Avoid Uncomfortable Feelings?).

The various forms of trauma therapy, including Somatic Experiencing and other experiential forms of psychotherapy, can be helpful to these clients because the work is titrated to the needs of the client after the psychotherapist assesses the client's ability to tolerate emotions that are uncomfortable to him or to her (see my article: Experiential Psychotherapy and the Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

Fictional Clinical Vignette: Overcoming the Fear of Allowing Yourself to Feel Your Sadness
The following fictional vignette illustrates how a trauma therapy, like Somatic Experiencing, can help a client to gradually develop the capacity to tolerate sadness so that the problem can be worked through and resolved:

Gene decided to begin psychotherapy after his medical doctor ruled out any medical cause for his headaches.  Since all tests were negative with regard to a physical cause to his problems, his doctor explained the mind-body connection and how psychological problems can create physical symptoms if these psychological problems are not dealt with and resolved.  The doctor recommended that Gene attend psychotherapy to deal with the underlying emotional reasons for the headaches.

Gene was reluctant to attend psychotherapy, but he also didn't want to continue to have headaches or develop other physical ailments, so he contacted a psychotherapist for a consultation.  During the consultation, Gene told the psychotherapist, "I don't believe in psychotherapy, but my doctor recommended that I begin therapy, so I'm willing to try it."

When his psychotherapist asked Gene about his family history, Gene, who was in his late 30s, said he didn't have clear memories of his childhood.  He provided basic information that he was the oldest of three children and grew up with both his parents in New York City.

He said he remembered that when he was a child, he spent most of his time alone because his parents were preoccupied with their own lives.  He also mentioned that he was not close to his parents or his young brother and sister.  They all lived in the same household, but they were each living a separate life (see my article: Disengaged Families).

With regard to his current relationship with his family, he only saw them a couple of times a year on holidays when Gene and his siblings visited his parents, who now lived in Florida.  He said that family relationships were strained, and he was always glad when he was on his way back to New York.

Gene told his therapist that he had been in one romantic relationship when he was in his late 20s.  He said it ended after a year because his then-girlfriend told him that she didn't feel he was emotionally available to her.  He said that, after the initial stage of passion and excitement in the relationship, he didn't want as much emotional intimacy as his girlfriend did.  He said, vaguely, that he thought they just "grew apart," but he didn't really understand what she meant when she said he was emotionally unavailable.

He also said that, although he dated "here and there," he didn't especially miss being in a relationship because he thought a relationship would demand more from him than he could handle.  He would see friends occasionally, but he spent most of his time alone, which is what he preferred.  Overall, he considered himself to be "a loner" (see my article: Seeing Yourself as a "Loner" vs. Experiencing the Shame of Feeling That You Don't Belong).

As his psychotherapist listened to Gene talk about himself, she could see how tense and uncomfortable he was feeling.  Towards the end of the consultation, she asked him how it was for him to talk about himself and history.  Gene thought about it for a moment, and then he said he wasn't sure how he felt about it but, in general, he never felt comfortable talking about himself.

She explained to Gene that she tended to work experientially and she developed treatment plans in collaboration with each client depending upon their needs.  She also told him that she worked in a way that respected each client's capacity to tolerate dealing the emotions that came up regarding his or her presenting problem.  Then, she provided Gene with basic psychoeducation about experiential psychotherapy (see my article: Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone).

His psychotherapist could tell that Gene was cutting off emotions that were uncomfortable for him and that he probably spent a lot of his childhood using the defense mechanism of dissociation in order to deal with his aloneness and lack of emotional support, which is why he had so few memories from childhood.

When Gene came to his next psychotherapy session, he asked his therapist what he needed to do to "fix things" so he didn't continue to get headaches.  His psychotherapist told him that she would need to get to know him better to assess the problem, and he would need to see if he felt comfortable enough with her to do the work.  She explained that the therapeutic alliance between the therapist and the client takes a while to build, and there would need to be a therapeutic alliance before they did any in depth psychological work.

In other words, there was no "quick fix" for his problems (see my article: Beyond the "Band Aid" Approach to Psychotherapy).

Gene was displeased with this answer.  He wasn't accustomed to the idea of an emotional process and that there would be a process in therapy where he and his psychotherapist would need to develop a relationship.  He thought it would be similar to going to the doctor where he would receive either medication or a shot to deal with his problems.

So, his psychotherapist provided him with more information about the psychotherapy process and how, if there was a good fit between the client and the psychotherapist, the client would learn to trust the therapist over time.  In the meantime, they could continue to explore the timing of his headaches and if these headaches coincided with something that was going on in his life.

At first, Gene said that he didn't see the connection between his headaches and anything that was going on his life.  So, his therapist asked him if he remembered what was going on when his headaches started.

Initially, Gene said he didn't remember anything in particular.  But then, he remembered that his headaches started after his maternal uncle died last year, but he didn't see the connection between his uncle's death and his headaches.  When his therapist asked Gene how he felt about the loss of his maternal uncle, Gene was confused by this question.  So, she asked him specifically how he grieved for the loss.

Gene still didn't understand what his therapist meant by "grieved."  He said he wasn't aware that he did anything in particular other than going to the funeral and paying his respects to his aunt and cousins, which was something that was "expected" of him.  He said he wasn't aware that there was anything more to do about his uncle's death.

His psychotherapist provided Gene with psychoeducation about the rituals that many people perform in order to grieve this kind of loss, but Gene still didn't understand.  He said that, although he cared for his uncle and they were close at times when he was a child, he went to the funeral out of sense of obligation to his aunt and cousins.

As they explored Gene's reaction to his uncle's death, it became apparent to his psychotherapist that Gene was defending himself against his uncomfortable feelings about the loss.  As she watched Gene fold his arms across his chest and look away with barely any eye contact, she could see that he was defending against feeling his sadness.

At one point, as he was talking about the loss of his uncle, Gene became irritated and told the psychotherapist that he didn't see how talking about his uncle's death was going to help him to get over his headaches.  He thought this was a waste of time.

His psychotherapist asked Gene what he was experiencing in that moment, and he said he was feeling annoyed.  Then, she asked him if it would be tolerable for him to stay with that feeling for a moment to see what happened next.  Gene didn't see how this would be helpful, but he agreed to try it.

After a minute, Gene said he was surprised that, as he focused on his feeling, he felt his annoyance starting to dissipate.  His therapist explained to Gene that, often when a person focuses on an emotion, it changes because emotions tend to come and go.

She also explained that each person has a particular capacity to deal with uncomfortable emotions.  She called it their "window of tolerance" (see my article: Expanding Your Window of Tolerance in Psychotherapy So You Can Overcome Emotional Problems).

As they continued to work together, Gene was beginning to discover that he had a narrow window of tolerance, which was why it was so difficult for him to relate to emotions that made him feel uncomfortable, especially sadness.

Over time, Gene also discovered that he was warding off much of his sadness for his uncle's death because he was afraid that he would drown in his sadness if he allowed himself to feel it.  Using Somatic Experiencing, his psychotherapist helped Gene to experience his sadness in a manageable way, rather than dwelling on it for a long period of time in therapy.

Gradually, Gene began to develop a greater capacity to tolerate sadness and he allowed himself to grieve in his psychotherapy sessions.  Having his psychotherapist there to help him with his sadness and grief was an experience that he had never known before because he grew up in an environment where he was alone with his feelings almost all of the time.

As Gene mourned the loss of his uncle, his headaches dissipated.  He realized that when he was warding off his sadness in the past, he was placing himself and his body under a lot of stress, which is what was causing the headaches.

He also realized that, prior to allowing himself to feel his sadness and grief, he feared that his emotions would be overwhelming and he would drown in his emotions.  But, with the help of his psychotherapist and the titration of his emotional experiences so that they were manageable, he was able to cope with whatever came up for him emotionally.

As he opened up to experiencing his emotions more, Gene also realized that he was feeling lonely, but he had not allowed himself to experience that feeling until this point in his therapy.  The loneliness and his increased openness to other people allowed Gene to open up to connecting emotionally with women and the possibility of finding a relationship.

When people shut down emotions that are uncomfortable for them (whether it's sadness, anger or any other emotion), they usually don't realize that this is what they're doing because they're often out of touch with their emotions in general.

Fear of experiencing uncomfortable emotions usually begins at a young age when the child is overwhelmed by emotions that aren't mediated by his parents.  Since children need their parents to help them to cope with uncomfortable emotions, they don't develop the emotional capacity to deal with these emotions, and this continues into adulthood where they have a fear of uncomfortable emotions.

Getting Help in Therapy
Experiential therapy, like Somatic Experiencing, is usually much more helpful to overcome fear of allowing yourself to feel uncomfortable emotions.  The problem with not allowing yourself to experience uncomfortable emotions is that these emotions remain and continue to come up from time to time and get in the way of connecting emotionally with yourself and others.

It usually takes more and more effort to  avoid these feelings, which can develop into physical symptoms, like headaches, irritable bowel syndrome (IBS), stomach problems, and other medical issues.

A skilled experiential psychotherapist will help the client to begin experiencing uncomfortable emotions in a manageable way a little at a time.  During that process, the therapist helps the client to develop and expand their window of tolerance so s/he has a greater capacity over time to experience and eventually let go of these emotions (see my article: How to Choose a Psychotherapist).

If you think you might be avoiding emotions that are uncomfortable for you, you owe it to yourself to get help from a skilled psychotherapist who uses experiential psychotherapy.

Once you have expanded your window of tolerance for experiencing uncomfortable emotions, you might be surprised that you can experience and let go of these emotions over time.

With a greater capacity to feel a range of emotions, you can live a more fulfilling life.

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

I work with individual adults and couples, and I have helped many clients to expand their window of tolerance so they can overcome their fear of their emotions and live a fuller 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.

Friday, April 13, 2018

How Do You Know If You're in an Unhealthy Relationship?

How do you know if you're in an unhealthy relationship?  Being objective about whether or not your relationship is healthy for you can be complicated when you're in love and sexually attracted to someone.  You might overlook certain red flags in your relationship.  This is especially true if you were raised in a family where there was a high level of dysfunction and conflict (see my articles: Relationships: Are You Attracted to People Who Hurt You?Are You in a Toxic Relationship? and Choosing Healthier Relationships).

How Do You Know If You're in an Unhealthy Relationship?
To avoid getting into an unhealthy relationship, it's important to date someone long enough to get to know him or her before you both decide that you're in a committed relationship (see my article: Dating vs. Being in a Relationship: Taking the Time to Get to Know Each Other).

Signs That You're in an Unhealthy Relationship
Here are some red flags to be aware of:
  • Excessive Jealousy:  If you know that you've been faithful to your partner, but your partner exhibits excessive jealousy or s/he is accusing you of cheating, this is a significant red flag that your partner is insecure and possessive and that you're in an unhealthy relationship.  This type of problem rarely, if ever, gets better on its own (see my article: Overcoming the Jealousy and Insecurity That's Ruining Your Relationship).
  • Controlling Behavior: Related to excessive jealousy, your partner might not exhibit controlling behavior at first, but this can develop later on in the relationship.  Controlling behavior includes your partner telling you where you can go, who to socialize with, when to come home, what to wear, and so on.  This type of behavior tends to get worse over time, so if your partner is trying to control you, you know you're in an unhealthy relationship (see my articles: Relationships: Is It Kindness or Controlling Behavior?).
  • Problems With Anger Management: If your partner has problems controlling his or her temper, this is a sign that you're in an unhealthy relationship, especially if your partner refuses to get help.  Problems with anger management include problems with verbal and/or physical aspects of anger management (shouting, making demeaning remarks, breaking things, threatening you, threatening people who are close to you, and so on).
  • Emotional Blackmail:  If your partner uses emotional blackmail to control you, this is a sign that you're in a dysfunctional relationship.  For instance, if you and your partner get into an argument and, to get back at you, s/he stops speaking to you, this is emotional blackmail.  This is not the same as when a partner needs a temporary time out to regroup and then comes back to discuss whatever you were disagreeing about.  This is a deliberate form of manipulation to punish you or to get his or her way (see my article: Breaking the Cycle of Emotional Blackmail).
  • Gaslighting/Manipulation: When someone uses gaslighting, s/he is attempting to deliberately manipulate you to make you think that you're the problem.  When someone engages in gaslighting, s/he knows that s/he is attempting to manipulate.  It's not just a matter that s/he has a different opinion from the partner.  People who engage in gaslighting are often narcissistic and some of them are sociopathic.  This is a sure sign that you're in an unhealthy relationship (see my article: Are You Being Gaslighted?).
  • Addiction: If your partner is abusing substances or engaging in other addictive behavior and s/he refuses to get help, you're in an unhealthy relationship.  Addictive behavior includes excessive drinking, abusing drugs, compulsive gambling, compulsive overspending, sexual compulsivity, compulsive overeating, and so on (see my article: Recovery: Understanding Cross Addiction - Substituting One Addiction For Another).
  • Codependent Behavior: Codependent behavior occurs when one or both partners enable the other's unhealthy behavior.  A typical example of this would be if a partner makes excuses for his or her partner's addictive behavior.  This is a sign of an unhealthy relationship and both people need to be willing to work on their issues in therapy to develop healthier ways of relating to each other (see my article: Overcoming Codependency: Taking Care of Yourself First).
  • Infidelity: If your partner is cheating on you and s/he refuses to get help in therapy, you're in an unhealthy relationship.  Aside from the emotional pain that infidelity causes, it also creates mistrust and it's often hard to get trust back.  This is not to say that everyone should leave a partner who cheated.  Some couples are able to work through infidelity in individual therapy or in couples therapy.  But if your partner refuses to get help, there is little to no chance that your trust can be restored (see my article: Gaslighting and Infidelity).
  • Physical, Emotional and Sexual Abuse: Any form of physical, emotional or sexual abuse is unacceptable and a definite sign that you're in an unhealthy relationship.  Abuse often escalates and gets worse over time.  Your primary concern should be your own safety and well-being.
The items on the above list are some of the most significant signs that you're in an unhealthy relationship, but there might be other signs as well.

I believe that most people know deep down when they're in an unhealthy relationship, but they choose to overlook red flags for any number of reasons.  Denial can also be a strong defense mechanism with regard to not wanting to see the red flags.

Sometimes, people who overlook red flags don't feel good about themselves and they believe that if they let go of the relationship that they're in, they won't find another relationship.  Other people engage in wishful thinking that things will get better on their own, but that rarely happens without help (see my article: Wishful Thinking Often Leads to Poor Relationship Choices).

Getting Help in Therapy
If you think you're in an unhealthy relationship and you're having problems recognizing it or taking steps to preserve your own well-being, you could benefit from working with a licensed mental health professional (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Getting help in therapy from an objective clinical professional is an important first step to taking care of yourself and making important decisions for yourself.

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

I work 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.

Thursday, April 12, 2018

How Psychotherapy Can Help You to Overcome Trauma and Develop a More Accurate Sense of Self

Does it seem like your perception of yourself is off?  Does it seem that logically, you know your sense of self should be higher but, on an emotional level, you're not feeling it?  This is a problem that many people experience.  In this article, I'm focusing on how psychotherapy can help you to overcome the disconnect between what you know and how you feel about yourself (see my article: How Developmental Trauma Affects How You Feel About Yourself).

How Psychotherapy Can Help You to Overcome Trauma and Develop a More Accurate Sense of Self

How Self Perception Develops
Your self perception develops in early infancy and it's based on interactions between you and your primary caregiver (a mother, in most cases).

An infant looks at his mother's face to discover who he is.  If the mother is attuned to the baby most of the time, the baby forms a positive perception of himself.  But if the mother is distracted, depressed or angry most of the time, the baby will often form a negative perception of himself, unless there are other adults who interact positively with the baby enough to offset the negative effects from the mother.

How Early Experiences Affect Self Perception As An Adult
Throughout life people continue to scan other people's faces to discover how these people are reacting towards them.  As children develop into adults, they have a greater ability to develop their own sense of self that is separate from how others perceive them.

But if there was significant early childhood neglect or abuse, it can be challenging to have a positive self perception.  Even when a person might know, on an intellectual level, that she is a "good person" who is kind, honest, intelligent and empathetic towards others, she might not feel it.  The disconnect between what a person knows objectively and what she feels can be disturbing.

The problem is that, as an infant, this person internalized a negative sense of self from the primary caregiver.  Adults have defense mechanisms that can serve to protect them against these negative reactions, but infants don't have strong defense mechanisms.  If something in their environment is bothering them, they can't fight or flee.  If protesting by crying doesn't work, their only recourse is to dissociate.

Later on, as an adult, it can be confusing when someone can't understand the difference in what he thinks vs. what he feels.  He might not know that, when he was an infant, his mother was too depressed, anxious, neglectful or abusive to reflect back love and nurturance to him.

Under these circumstances, it usually doesn't matter how many people might praise him as an adult.  He will probably still feel like he is "not good enough" or "unlovable" (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

Fictional Clinical Vignette
The following fictional clinical vignette illustrates how psychotherapy can help a client to overcome traumatic early experiences so he can develop a more accurate self perception:

From the time Ed was a young child, he had a poor sense of self.  No matter how many "A's" he got in school, no matter how much his teachers and others praised him, Ed felt unworthy.

Ed's poor sense of self interfered with his making friends and socializing with others.  Fortunately, throughout his life other people saw positive qualities in Ed, liked him, and gravitated towards him.  But Ed had difficulty feeling like a worthwhile individual--no matter how many people befriended him or what he accomplished in his life.

When Ed was in his mid-30s, he won a prestigious award in his field and he attended an awards ceremony where he was honored.  As he listened to the speakers praise him, he was grateful for their kind words, but he felt empty inside because, despite the award and the recognition, he had a poor sense of self.

During the award ceremony, Ed felt an urge to flee.  He knew objectively that he worked hard and his achievements merited the award, but he still felt like a fraud and an impostor, which confused him.

He also felt ashamed because he felt that if the people who were honoring him knew him deep down, they wouldn't think he was a worthy person (see my article: Overcoming the Feeling That People Wouldn't Like You if They Really Knew You and Overcoming Impostor Syndrome).

Shortly after that, Ed realized that, in reality, he had a very good life and he had everything to look forward to but, despite this, he was miserable because of his low sense of self.  He knew he needed to get help in therapy.  So, he contacted a psychotherapist who specialized in his presenting problem and began attending therapy sessions.

After Ed talked about his presenting problem of having a low sense of self, he discussed his family history with his psychotherapist.  He told her that his brother, Jack, who was older by 12 years, told Ed that their mother was significant depressed after Ed was born.

As a result, Ed was raised primarily by a nanny who was known to be efficient but not warm or loving.  Jack also told Ed that their father was often away on business trips and that Ed was usually left alone in his crib for hours at a time.

As his psychotherapist listened to Ed's account of his early childhood history, she realized that it appeared that he was emotionally neglected a child.  As a result, as an infant, Ed didn't get the necessary mirroring and nurturing necessary for an infant's healthy emotional and psychological development.

His psychotherapist provided Ed with psychoeducation, based on mother-infant research, about the importance of early mirroring and nurturing and the negative consequences to emotional and psychological development when they are missing.

Ed had never made these connections before.  While he was glad to know the possible origin of his low sense of self, he also felt discouraged.  He told his therapist that, while it was helpful to have this information, he didn't know what to do with it to change how he felt about himself.

His psychotherapist explained that before experiential therapy, including trauma therapy, was developed, all that psychotherapists could offer clients was insight into their problems.  But since trauma therapy was developed, these problems could now be worked through.

She also provided Ed with information about EMDR therapy, a trauma therapy, which was well researched. She explained that EMDR therapy was developed more than 30 years ago by a psychologist named Francine Shapiro, Ph.D. (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

His psychotherapist recommended that they use EMDR therapy to help Ed to overcome his low sense of self, and Ed agreed.

Over the next several sessions, after the initial period of preparation to do EMDR, Ed provided his psychotherapist with 10 memories that he had about himself from all different times in his life where he felt he was unworthy.

After Ed and his therapist went over the memories, Ed chose a memory to work on using EMDR therapy that still had an emotional charge for him.  Over time, as they processed this memory with EMDR, his psychotherapist asked Ed to think back to the earliest memory that he had where he had the same emotional/physical experiences as he did with the memory that they were working on.

Ed was surprised that he remembered an early memory of being about three years old when he tried to get his mother's attention.  He remembered calling his mother, who was in the room with him, but she didn't respond.  Then, he remembered crying and getting louder and louder, but his mother still didn't respond.  She just sat there.  Eventually, the nanny came, but when she discovered that Ed wasn't hungry and he wasn't in need of anything else that was physical, she put him back in his crib and left.

How Psychotherapy Can Help You to Overcome Trauma and Develop a More Accurate Sense of Self

After several months of processing similar memories, Ed began to actually feel like he was a worthy individual.  His self perception became a lot more positive and objectively accurate.  He was able to take in others' praise because he felt deserving.  He was also able to interact more easily with others and form closer bonds with friends.

Individuals, who experience early trauma of either neglect or abuse, often develop a negative sense of self because they have internalized these experiences at a young age.

This usually results in a disconnect between what these individuals think and what they feel.  Regardless of what someone might think on an objective level, and all evidence to the contrary, s/he will most likely feel a low sense of self, which can be confusing.

The fictional vignette which was provided above is a simplified version of how trauma therapy can help clients in therapy to overcome early trauma that creates a negative sense of self.

Each client is unique in terms of how s/he responds to trauma therapy, like EMDR, and how long it takes to overcome early trauma.

Getting Help in Therapy
Early trauma often has a negative impact on an individual's sense of self, and this affect can be very difficult to overcome alone.

Trauma therapy, like EMDR, was developed to help individuals in therapy to overcome the impact of traumatic experiences (see my article: The Benefits of Psychotherapy and Why Experiential Therapy is More Effective to Overcome Trauma Than Talk Therapy Alone).

If you're struggling on your own, you can get help from a licensed mental health professional who is trained as a trauma therapist (see my article: How to Choose a Psychotherapist).

Once you have overcome your traumatic experiences, you can live a more fulfilling life free of your traumatic history.

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

I work with individual adults and couples, and I have helped many clients to overcome trauma experiences.

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.

Wednesday, April 11, 2018

Books: Imperfect Love in "My Name is Lucy Barton"

The novel, My Name is Lucy Barton, by Elizabeth Strout, is primarily about a mother-daughter relationship that is an "imperfect love" where so many emotions, including love, are unspoken.  Although her mother is unable to express her love directly in words, when Lucy most needs her as an adult, the mother demonstrates her love by her actions (see my articles: Mother-Daughter Relationships Over the Course of a LifetimeMother-Daughter Relationships: Letting Go of Resentments, and Getting Help in Mother-Daughter Therapy).

Imperfect Love in "My Name is Lucy Barton"

Lucy's Traumatic Childhood History
As young children, Lucy and her two siblings are raised in dire poverty in the rural town of Amgash, IL where the five of them live in her granduncle's garage with no heat or hot water, no TV and no other modern conveniences.

One of Lucy's earliest memories is of being cold in bed and her mother bringing her a hot water bottle so she can try to get warm.  She also remembers going hungry, and having only bread and molasses to eat as a child.

Aside from the financial poverty, there's also an emotional estrangement between members of this dysfunctional family--despite their close proximity living together in a small space in the garage (or maybe because of their physical proximity).  Even among Lucy and her siblings, there's no affection or closeness, as if they are suspicious of one another (see my article: Dynamics of Adult Children of Dysfunctional Families).

There is so much that is unspoken.  For instance, her father, who served in the military during World War II, suffers from what we now know is post-traumatic stress disorder (PTSD). But neither the father nor the mother name it--possibly they didn't know what it was.  They also don't talk about his traumatic experiences.  Lucy thinks of her father's odd behavior as "the thing" because it remains unnamed and undefined.

It is only later, when Lucy brings her soon-to-be husband of German descent to meet that family that Lucy learns that her father is uncomfortable around Germans.  Her father is awkward and unable to look Lucy's fiance in the eye, but he never explains his discomfort.  During that same visit, when Lucy and her mother are alone, her mother scolds her for bringing a young man of German descent to their home because this upsets the father. But, of course, Lucy had no way of knowing that this would upset her father because her parents never discussed his discomfort with Germans.

Later in life, Lucy finds out that her father murdered two young, innocent, unarmed German civilians because they startled him.  She learns that not one day went by in her father's life when he wasn't haunted by this memory. So, in retrospect, Lucy realizes that when she brought her soon-to-be-husband to meet her parents, her father experienced it as if one of those young dead German men came back to haunt him.

As a child, Lucy also experiences her own trauma, including both parents' sudden impulses to hit Lucy and her siblings for no apparent reason.

One of the other ongoing traumas in her life is that, as a desperate form of "childcare," her parents regularly locked Lucy up in her father's truck while they were both out working, and she is trapped in the truck with a snake.  This results in a lifelong phobia of snakes or even hearing the word "snake."  The reader gets a visceral sense of how desperate and frightened Lucy felt trapped in the truck with no one within earshot to rescue her.

Due to their poverty and what others perceived as their oddness, Lucy and her siblings are ostracized and made fun of by the children at school.  Her classmates make fun of her for her clothing.  They also despise Lucy and her cousin for being hungry and dumpster diving for food.  And, since they have no TV and have never gone to the movies as children, they are also culturally ostracized from their classmates (see my article: Feeling Like an Outsider).

When Lucy and her siblings are children, the father humiliates Lucy's brother after the father discovers that the brother is secretly cross dressing in the mother's clothing.  The father forces his son to wear his mother's clothing and high heels in public to shame him while the father drives alongside him loudly demeaning him.

Later on in life, Lucy finds out from her mother that her brother, as an adult who remains home with the parents, sleeps with a neighbor's pigs the night before they are about to be slaughtered, and he reads children's books about a family who lives on the prairie.  No one knows why and no one asks the brother about his unspoken suffering (see my articles: The Role of the Family Scapegoat and Being the "Different One" in Your Family).

In her childhood, there are a couple of people in Lucy's life who are sympathetic.  One of them is the school janitor, Tommy, who allows Lucy to stay in an empty classroom to do her homework and to sleep in the warmth of the classroom.

Although Lucy is too shy to speak with Tommy, she recognizes that he is being kind to her by allowing her to stay in the classroom.  She remains there everyday, until she has to go home, because there is heat in the classroom, unlike where she lives in the garage.

Tommy's own poignant story is told in Ms. Strout's next book, Anything is Possible, and the reader develops a better understanding from that books about why he is as empathetic as he is towards Lucy.  He has his own tragic history, but he is also a resilient survivor.

Lucy and Her Mother Reconnect: An Imperfect Love
After she moves to New York City and she is married with two young daughters, Lucy is hospitalized for nine weeks with a mysterious infection.  While she is hospitalized, Lucy's husband arranges for her mother to come stay with her in the hospital.

After not seeing each other for years, there is an awkwardness and tension between Lucy and her mother, especially since the mother is unable to express her love for Lucy in words.  Also, from the mother's standpoint, there is no possibility of discussing all that is unresolved between them.  But, for Lucy, having her mother there--even just hearing her voice--is soothing.  Lucy knows that, in her own way, her mother loves her, and she becomes aware of how important her mother is to her.

Even though the mother is unable to tell Lucy in words that she loves her, just the fact that she got on a plane for the first time in her life, as frightened as she was by the experience, and stayed by Lucy's side for five days with little to no sleep, demonstrates how much she loves Lucy.

They spend most of their time talking about the people they know from their small town.  Her mother gossips about their neighbors, focusing on their unhappy marriages.  But she doesn't talk about Lucy's father and what must have been a difficult marriage for mother given the father's PTSD symptoms and their crushing poverty.

The reader gets the sense that, even though the mother is talking about other people's unhappy marriages, on an unconscious level, she is actually talking indirectly about her own unhappy marriage.

The mother also alludes cryptically to her own experience of feeling unsafe as a reason why she doesn't sleep well and prefers catnaps.  She alludes to a history of having to be vigilant.  But when Lucy asks her mother why she didn't feel safe, her mother doesn't respond, so it remains another unspoken mystery.

When Lucy is taken for a CT scan, her mother searches for Lucy in the hospital basement so that Lucy won't be alone.  Lucy knows that this was a big challenge for her mother.  Once again, there is an unspoken understanding between them that even if they're not telling each other "I love you," there is a lot of love between them.

Despite Lucy's mother's emotional support, she leaves very abruptly when Lucy's doctor tells them that Lucy might need an operation.  The mother never communicates why she feels the need to leave so quickly, but the reader senses that she is running from some unnamed fear that even she might not understand.  This saddens Lucy because she wants her mother to stay, especially if she will need surgery, but she understands that her mother is too frightened to stay.

Despite the unspoken love conveyed while Lucy is in the hospital, after her mother leaves, they go back to their usual emotional estrangement and speak only on holidays and birthdays.  The reader senses that Lucy's mother cannot sustain the level of closeness they had when Lucy was in the hospital.

Throughout her stay in the hospital, Lucy likes to look out her window at the Chrysler building lit up at night as if she sees it is as a strong and sturdy beacon of hope that assures her.

Lucy and the Kindness of Strangers
As a result of her traumatic childhood experiences, Lucy develops a strong sense of empathy for other people's loneliness and trauma.  She intuits that she and they are kindred spirits.

Throughout her life, Lucy is drawn to lonely, traumatized people that she barely knows who are kind to her.  Most of these people are just passing through her life, but she recognizes and appreciates their kindness.  She relates to the quote by Blanche Dubois from A Streetcar Named Desire by Tennessee Williams, "I have always depended on the kindness of strangers" and all that this implies about isolation and loneliness (see my article: Overcoming Loneliness and Social Isolation).

Of the people who are kind to her, there's the attending physician in the hospital who visits her every day including weekends.  Lucy finds out indirectly that the doctor lost his family during the Holocaust and that he carries this sadness with him.  Without words, he seems to intuitively understand Lucy.  And Lucy senses his sadness and loneliness.  She senses how much he cares about her.

There's also the kind neighbor in her building, who is a psychoanalyst, originally from France, who sees Lucy's artistic side.  When he learns that Lucy is writing, he tells her to be "ruthless" in her writing, which she doesn't understand at first.  They have an unspoken affection for each other, but Lucy doesn't know much about him.  After he dies from complications related to AIDS (this is the height of the AIDS epidemic in the 1980s), she finds out that he was gay.  At that point, she understands the cause of his loneliness and isolation.

Lucy Discovers Her Voice in Her Writing
Lucy finds her voice in her writing.  Although she lacks confidence and tends to minimize her accomplishments, other people see the value of her work.  There's a writing teacher, who is a well-known New York City writer, who, just like Lucy, also suffers from PTSD.  She praises Lucy's writing and encourages her to continue writing.

Lucy seems to sense that she and these lonely, traumatized people are kindred souls.

Lucy's Sense of Hope and Resiliency
One of the amazing things about this character is that, despite her traumatic experiences, Lucy remains hopeful and resilient, in spite of her trauma.  She finds strength where she can, and she doesn't seem to feel victimized by her experiences.  She is also able to see the positive qualities in others, and she remains open to making connections with them (see my articles: Resilience: Bouncing Back From Life's ChallengesOvercoming Trauma and Developing Resilience, and Posttraumatic Growth: Developing a Greater Sense of Hope and Meaning in the Aftermath of Trauma).

I highly recommend this book.  Elizabeth Strout's characters are people you can relate to, and she is able to convey their mysterious inner worlds in a poetic way without sentimentality.

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

I work with individual adults and couples, and I specialize in working with psychological 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.

See My Other Articles About Books:
Love and Longing in "Enigma Variations" by Andre Aciman
"Call Me By Your Name" - by Andre Aciman: Part 1: "Is It Better to Speak or to Die?"
"Call Me By Your Name" by Andre Aciman: The Concept of Living Parallel Lives
Denial and Illusions in "The Iceman Cometh" - by Eugene O'Neill
"Three Tall Women" - by Edward Albee
Reading Literature and the Positive Effect on the Brain
Books: "Tea With Winnicott" by Brett Khar