Using the Affect Bridge to Heal Old Emotional Wounds

Old emotional wounds often get triggered in intimate relationships. Most of these unresolved feelings are core issues that originated in childhood and usually involve one or both of your parents or caregivers. These old wounds might involve feelings of abandonment, betrayal, feeling unloved, feeling abused or neglected, feeling like you're "not good enough" and other similar feelings.

Bridging Back to Heal Old Emotional Wounds

These feelings can come up unexpectedly, whether your partner behaves like one of your parents or not. So, for instance, to others, who might be more objective than you, your partner's behavior might seem like a minor slight or a minor empathic failure.

But if you have an early history of emotional neglect or abuse and you get triggered by a current dynamic between you and your partner, you would probably experience this slight or empathic failure as being much more intense.

This is because you're not only experiencing the current situation--you're also feeling the old emotional wound that is getting triggered, so you're experiencing both together. This adds an emotional charge to the current situation, and when you feel hurt, it's often hard to distinguish the old emotional wound from the current situation.

Unresolved wounds have a way of remaining just beneath the emotional surface where you might not be aware of them most of the time. But under certain circumstances, when you feel hurt by your partner, these old wounds come alive, as if they just happened yesterday, even though they might have occurred many years ago.

When you see a competent hypnotherapist, who is a licensed mental health professional, clinical hypnosis is often very effective in helping to heal these emotional wounds. In order to heal, it's important to be able to deal with the original emotional wound that is being triggered. There is a technique called the Affect Bridge and when it is performed by a competent hypnotherapist, it often helps to heal those old wounds.

Clinical Hypnosis and the Affect Bridge
As a hypnotherapist, when I use the Affect Bridge technique, I prepare clients beforehand by making sure that they have the internal resources that they need to feel safe, calm and emotionally protected. Internal resources is another term for coping skills.

Clinical Hypnosis and the Affect Bridge

The following vignette is a composite based on many clinical cases and demonstrates the use of the Affect Bridge in clinical hypnosis treatment:

Alan:
Alan and his wife were married for five years. They had a good and stable relationship most of the time. However, whenever Alan felt that his wife, Evelyn, was distracted, not listening to him, or not understanding him, he became very angry and upset. An hour or two later, Alan usually realized that he over reacted and he would feel very guilty and remorseful.

At first, Evelyn was understanding. She accepted his apology and forgave him. But, after a while, as this continued to happen, she got annoyed. Each time that it happened, Evelyn tried to remind Alan about how he over reacted in the past to similar situations between them and how this was another one of those times. But, when Alan was in this state, he was unreachable and he could not hear what Evelyn was saying.

When they came in as a couple, Alan admitted that he would over react for relatively minor incidents with his wife. He explained how, at the time, it felt like she was ignoring him or not hearing him, and this felt intolerable to him in that moment. He said he felt like he was "going crazy" because, when he was upset with his wife, he couldn't hold onto the fact that this was another situation where he was over reacting to her--no matter how many times it happened.

As I explored Alan's history, he talked about having an alcoholic mother who had a long history of drinking heavily and then passing out on the couch, leaving Alan and his younger brother to fend for themselves. His father had left the family when Alan was three, so there were no other adults in the household.

During the preparatory phase of our work together, I asked Alan to choose protective figures that he could visualize. I told him that they could either be real people that he knew or, if there was no one, he could visualize a fictional character from a book, movie, or TV program. Alan chose to visualize his first grade teacher and his Little League coach as his protectors for the clinical hypnosis work we were about to do. I suggested to Alan that he picture these protective figures as being with him as we began our hypnosis work together, which he was able to do.

Using the Affect Bridge technique, I asked Alan to focus on the feeling that he had when he felt that his wife was not paying attention to him or not hearing or understanding him. He said he felt it like a tense, heavy feeling in his stomach. Then, I asked him to go back in his mind and remember the first time that he felt this way. Alan remembered many incidents with his mother when she didn't hear him because she was in a drunken stupor.

His earliest memory of these feelings was when he was four years old. As usual, his mother was passed out on the couch as a result of a day of heavy drinking. Alan was trying to cook a meal for himself and his younger brother when his pajama sleeve caught on fire. He became very frightened and called out to his mother to help him, but she didn't hear him. Although he was very frightened, he was able to turn off the gas by himself, but not before he sustained a second degree burn on his arm. The neighbor who lived downstairs heard his cries and came running upstairs to help him. His mother never roused herself from her sleep.

Revisiting this memory during clinical hypnosis sessions and picturing his protective figures with him and helping him at that time had a healing effect on Alan. Although Alan knew what had actually happened when he was four and he got burned, after a while, being able to re-experience this memory with his protective figures allowed him to heal this old wound.

He felt safe, protected and nurtured by the protective figures that he visualized. As a result, after doing this hypnotherapy work for a while, he was no longer triggered when his wife either didn't hear him or misunderstood what he said. It was not just a matter that Alan realized this in a logical way, he actually felt healed and the old trauma was resolved.

Getting Help With Clinical Hypnosis
Clinical hypnosis is a safe and effective form of treatment when performed by a competent hypnotherapist with advanced training.

If you think you're becoming triggered by unresolved trauma, and regular talk therapy hasn't helped to resolve these issues, you might benefit from seeing a hypnotherapist for clinical hypnosis.

To find out more about clinical hypnosis, you can visit the web site of the professional organization, the American Society of Clinical Hypnosis also known as ASCH.

I am a licensed psychotherapist and hypnotherapist in NYC. I have helped many clients work through trauma.

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.

Relationships: Romantic Reconnections

Many people are reconnecting through social media with former high school and college sweethearts after 10, 15, 20 years or more of having no contact.

As a psychotherapist in New York City, I've been seeing more and more people who are reconnecting through these sites and falling in love all over again. The excitement of these reconnections is often very compelling. Often, these are long lost love connections from a happier time when both people were much younger and when there was much promise in their lives.

Relationships: Romantic Reconnections

It's exciting to find out what the other person has been doing all these years later and to tell your story. It can also be a heady experience to find out that this person has been thinking about you all this time, wondering what you're doing, and thinking about your former relationship. It can also be uplifting to remember your youthful self at that time and cause you to remember a more passionate and optimistic part of yourself that you might not have been in touch with for a long time. There's a certain romantic nostalgia about these romantic reconnections.

Of the many stories that I've heard, many times, these reconnections seem to work out well. However, there are times when, after the initial reconnection, problems begin to emerge and these couples come into couples counseling to try to work out these problems.

Based on what I've seen, one of the main problems seem to be around expectations: When you remember how you and your old love were years ago, often, there are expectations that the two of you will be that same way again, and when this doesn't happen, it's disappointing.

Trying to recapture the love that you and your former partner had all those years ago in just the same way as you had it back then, when you were both young and the world seemed like it was going to be your oyster, can be tricky.

It can be fraught with disappointment if, as you're getting swept up in this romantic reconnection, you forget that time and circumstances have probably changed a lot of things for you and for your old love. Aside from the more superficial changes, like weight gain and wrinkles, along the way, each of you has had many experiences that have probably changed you and your outlook on life to a certain extent.

If you don't take these changes about yourself and your former love into account, you're probably setting yourself up for a fall. Also, you might be faced with whatever unresolved issues thee may have been from the past.

The following vignette, which is a composite of various cases, is an example of a romantic reconnection that started with a lot of excitement and then began to go wrong:

Sally and George:
Sally and George were in a relationship during their last two years of college. At the time, they were very in love and talked about getting married. All of their friends considered them to be "the perfect couple." However, towards the end of their last semester in college, they had a big argument about George joining his father's manufacturing business rather than pursuing his dream to be a teacher, which is all that he talked about while in college--making a difference for young students and helping to shape young minds.

Sally couldn't believe that George would give up his dream and give in to his father's pressure. She was furious. Unlike many teens and young people in their early 20s, George had never gone against his parent's wishes and he didn't know how to tell his father "no."

Sally also didn't want to move to Chicago where George's parents lived. All along, she and George had talked about either living in New York, where she was from, or Boston, a city that they both liked. By the end of the school year, both of them were heart broken about this argument, but neither of them saw a compromise, so they broke up.

Sally moved back to New York. She found a teaching job and an apartment with friends. And George moved back in with his parents and joined his father's firm as an assistant manager.

Neither Sally nor George had any contact again--until 20 years later when George found Sally's name on Facebook. Initially, when they reconnected by email and then by phone, they were both very excited. Both of them were now divorced and available.

Neither of them had children. Sally had been teaching for many years, and George inherited his father's business, sold it for a large profit, and eventually returned to his initial chosen profession, teaching. They both flew back and forth on weekends and holidays to see each other and they were caught up in a whirlwind romance.

After the first six months, George moved to NYC and they moved in together. He obtained a teaching job and things seemed to be going fine.

 However, as the initial excitement began to wear off, they each felt that "something was missing." Neither of them could put their finger on what it was, but they each began to feel vaguely disappointed. They began bickering about little things, and this was even more disappointing.

One day, in the middle of an argument, George said to Sally, "What happened to you? You're not the girl that I knew in college." This was a turning point in their relationship. George regretted saying these words as soon as they left his mouth, and Sally was very hurt. They both still loved each other, but they recognized that their relationship was spiraling down and they didn't know what to do. They decided that, to try to save their relationship, they needed to go to couples counseling.

After several sessions of couples counseling, they realized that they reentered their relationship hoping to find the same people that they were when they were in college but, in reality, both of them had changed somewhat.

They were no longer the idealistic young people that they were and time, their divorces, and other life experiences had changed them. Also, when they broke up in college and all the years since, they were left with the romantic fantasy of what it could have been like if they had stayed together all those years ago.

Now, 20 years later, they were actually living the reality of that experience. And while their experiences together now were generally good, the reality of their life together couldn't live up to the romantic fantasies that had built up in their minds over the years.

Through couples counseling, gradually, Sally and George learned to work out their differences and to let go of unrealistic expectations. They also had to work through the initial disappointment that lead to their break up in college. Sally realized that she had been immature about it all those years ago, and George realized that he wasn't assertive enough to be his own person back then. Within a few months, they became more realistic about their expectations of themselves and each other and their love for each other matured, deepened and reflected who they are now, as individuals as well as a couple.

It's wonderful that we now have ways of reconnecting with old friends and loved ones through the Web. It has provided us with opportunities that we didn't have before for reconnecting with people who were once important in our lives. When these reconnections are romantic, they present special opportunities and some challenges.

Getting Help in Therapy
If you and your partner have reconnected romantically after many years and you're facing certain challenges in your relationship, you could benefit from couples counseling with a licensed mental health professional.

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

I have helped many couples who have reconnected romantically to have more fulfilling relationships.

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

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

Clinical Hypnosis and the Mind-Body Connection

During the last 15-20 years mental health and medical experts have become increasingly aware of the strong connection between our emotions and our physical health and well-being. 

Clinical Hypnosis and the Mind-Body Connection

As medical experts become more knowledgeable about the mind-body connection, clients with certain physical problems that were once treated by doctors solely as medical disorders are now being referred to licensed mental health professionals with an expertise in clinical hypnosis (also known as hypnotherapy) due to a more sophisticated understanding of how our emotions affect us physically and the effectiveness of clinical hypnosis.

The following vignettes, which are composites of actual cases, with all identifying information changed to protect confidentiality, illustrate the connection between medical problems, the mind-body connection, and the effectiveness of clinical hypnosis:

Migraines and other Headaches:
When Lisa began having severe, debilitating headaches, she went to her medical doctor for help. She explained to her doctor how her headaches got so bad at times that she was unable to get out of bed. This resulted in significant time off from work as well as her husband having to take over most of the household responsibilities. These headaches were also starting to make her feel depressed and anxious. She tried most of the over-the-counter medications, to no avail.

When her medical doctor could not find any physical reason for her headaches, he referred her to a neurologist who conducted a battery of tests and tried various prescription medications to alleviate Lisa's headaches. But her neurologist ruled out any physical reason for her headaches and, not only did the medications not work, but they produced many annoying side effects.

As a result, the neurologist consulted with the medical doctor and they both agreed that whatever was causing Lisa's headaches had its origins in some emotional issue. They both concluded that Lisa could benefit from seeing a hypnotherapist to get rid of her headaches. Since Lisa knew nothing about hypnotherapy, at first, she was stunned and somewhat leery of their recommendation.

Clinical Hypnosis and the Mind-Body Connection

But her primary care doctor explained that many physical symptoms are derived from emotional issues, and he took the time to explain the mind-body connection of many different medical issues. He also explained the difference between stage hypnosis and clinical hypnosis (also known as hypnotherapy). He told her that when hypnotherapy is performed by a licensed mental health professional who is a trained hypnotherapist, it is an effective and well-respected form of treatment. He explained how Lisa would be in a relaxed state during hypnosis and in control at all times, maintain a dual awareness of the here-and-now as well as whatever she and the hypnotherapist were working on.

Lisa trusted her primary care physician, and she accepted his referral to a local hypnotherapist. She was a little anxious at first, but the hypnotherapist helped to set her mind at ease by patiently answering all of her questions during the initial consultation. Lisa was amazed that, within three sessions, her headaches were gone. Even more amazing to her, the hypnotherapist taught her how to do self hypnosis so that she could proactively manage her stress levels and prevent further occurrences of her debilitating headaches. Her hypnotherapist followed up with her in a month and then again in three months, but there was no recurrence of Lisa's headaches. At this point, it has been over three years since Lisa has had a headache. She continues to use self hypnosis to manage her stress. She no longer feels depressed or anxious, and she is grateful to be fully engaged in her life again.

Back Pain:
Robert woke up every morning with severe back pain in his lower back. When his primary care physician, his chiropractor, and a physical therapist could not find any medical reason for his back pain and medication only provided temporary relief, they all agreed that the origin of Robert's back pain probably had an emotional connection. They also all agreed that Robert could benefit from seeing a hypnotherapist.

Robert didn't know anything about clinical hypnosis and, even with their detailed explanations and the literature that they provided to him, Robert didn't feel comfortable seeing a hypnotherapist. He began taking painkillers, which helped for a while. But he soon found that he had to take higher and higher doses to get temporary relief from his back pain.

Clinical Hypnosis and the Mind-Body Connection

His primary care doctor warned him that the painkillers were addictive and Robert needed to be careful not to become addicted to the drugs. So, Robert stopped taking the medication and he decided to tough it out for a while. But after a week, he could barely get out of bed, he could no longer have sex with his wife, and he was falling behind in his work because he could hardly sit still at his computer, due to his excruciating back pain.

Reluctantly, he asked his doctor for a referral to a hypnotherapist. Robert approached his initial consultation with the hypnotherapist with a lot of skepticism, but he was desperate for a solution to his back pain so he listened attentively and tried to keep an open mind as the hypnotherapist explained the mind-body connection. The hypnotherapist answered all of his questions and concerns. Robert was especially fearful that he would lose control during the hypnotic state, and being in control at all times was very important to him.

To help ease Robert's mind, with Robert's permission, the hypnotherapist helped Robert to get into a relaxing, hypnotic state. Robert was amazed--this was the most relaxed that he had ever felt in his life. He was aware of the ticking clock in the office, the sounds coming from the street outside the office, and he felt that, if he wanted to, he could get up and leave at any time. It was just as the hypnotherapist had said--he was able to maintain a dual awareness of everything around him at the same time that he was enjoying this relaxed state. He was even more amazed when he returned to his usual state that he was only in this hypnotic state for five minutes. His experience of the hypnotic state was that it felt timeless.

Having had this relaxing, positive experience of clinical hypnosis, Robert was now ready to have the hypnotherapist use hypnosis to treat him for his back pain. Within five session, Robert was pain free. The hypnotherapist also taught Robert how to control his stress levels on his own through self hypnosis. A follow up session after one month revealed that Robert had no new occurrence of back pain. And after two years, Robert continued to report to his primary care physician that he continued to have no back pain.

These vignettes are just two examples of many that demonstrate the mind-body connection and the effectiveness of clinical hypnosis for pain management. Clinical hypnosis is also an effective tool for smoking cessation (usually within 3-5 sessions).

If you are suffering with a physical problem and your doctor cannot find a medical cause for your problem or if you have decided that you want to stop smoking, you could benefit from clinical hypnosis.

Getting Help - How To Choose A Hypnotherapist:
If you're considering clinical hypnosis, it's important to make sure that you see a licensed mental health professional who is a trained hypnotherapist and not a "hypnotist." There are important distinctions between a hypnotherapist and a hypnotist.

A hypnotist might have learned various hypnotic techniques, but he or she is not a therapist, not licensed, and will not have any mental health training. A hypnotherapist is a licensed mental health professional who understands the mind-body connection and who has been trained under the guidelines of a professional organization like the American Society of Clinical Hypnosis (ASCH). For more details, you can visit the ASCH web site: http://www.asch.net/.

About Me:
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.

To find our more about me, visit my web site: Josephine Ferraro, LCSW - NYC Psychotherapist

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

Developing a Different Perspective Through Reframing

Often, the way that we respond to a situation has a lot to do with our particular perspective and attitude about it. One way to help yourself to look at certain situations or problems is to "reframe" them for yourself. By reframing, I mean looking at the same situation from a different angle to come up with other creative points of view.

Developing a Different Perspective Through Reframing

Here are a few vignettes that are examples of reframing:

Peg:
Whenever Peg met Susan for lunch, she would feel so annoyed because Susan was habitually 15 minutes late. Peg would sit and fume, thinking about how busy she was and all the things that she needed to do, and here she was sitting and waiting for Susan.

One the one hand, she felt like she was wasting her time waiting for Susan when she could be taking care of some of these other things. On the other hand, she also liked Susan very much and she didn't want to give up their lunches together because of Susan's problem with lateness.

One day, as she hesitated to pick up the phone to invite Susan to a lunch that she was sure Susan would be late for by 15 minutes, she decided that she needed to find another way to deal with this problem. She knew that she didn't have the power to change Susan, nor did she want to.

So, she thought about what change she could make, without giving up their friendship, where she could feel that her needs were being met. That's when an idea popped into her head: Instead of sitting and fuming about all the things that she needed to do, she could bring some of those things along with her and take care of them while she waited for Susan.

Developing a Different Perspective Through Reframing

It seemed so simple that Peg couldn't believe she had not thought of this before. So, the next time that she met Susan, Peg brought her checkbook and some of her bills with her as well as her Blackberry to respond to email. When Susan arrived 15 minutes late, as usual, Peg felt that she had taken care of what she needed to do for herself and she could now relax and enjoy Susan's company instead of being distracted with her own annoyance and impatience. What Peg did was take a situation that was normally annoying to her and reframed it for herself into a time when she could do some things for herself.

Linda:
Linda was a receptionist in a small firm. She had worked there for many years. One of her duties was to keep the daily appointment calendar listing clients who were coming to visit managers. She had never become accustomed to using the computer to keep track of these appointments, relying on a basic appointment book instead.

Linda was extremely meticulous about this appointment book. Her supervisor thought she was meticulous to a fault. In fact, Linda was a perfectionist. She hated it whenever anyone crossed out names in the book or when there was any kind of messiness.

She would sometimes scold the managers if they crossed out anything in the book, but she refused to write in pencil. She had very set ideas about what was appropriate and what was not. Her supervisor spoke to her a few times about trying to be more flexible in her approach and warned her that if she continued to berate the managers, she would be written up.

Linda decided that she needed to change her attitude about this, but she wasn't sure how to do this. Then, one day, one of the managers approached her desk and told her that one of the clients cancelled his appointment. Linda noticed that her supervisor was standing nearby watching her reaction as this manager crossed out the client's name in the appointment book. Linda held her tongue.

After the manager walked away, Linda's supervisor approached her and suggested to her that this could be a chance for Linda to reframe this situation for herself: It could be an opportunity to practice letting go of her perfectionism. Linda thought about it for a few minutes and the more she thought about it, the more she liked her supervisor's suggestion: Instead of getting angry and frustrated, she could use this situation to practice. After a while, Linda was able to reframe for herself what was once an annoyance as a challenge to change her attitude and, over time and with practice, her attitude did change.

Reframing: An Opportunity For a Positive, Creative Response
The vignettes above are simple examples of reframing. I'm sure you can think of many others where you can challenge yourself to reframe what is usually an annoyance into an opportunity to have a more positive, creative response:

• Getting stuck in traffic
• Dealing with a rude sales clerk
• Waiting for a train that is late
• Being placed on "hold" for a long time
• Missing a flight

With practice, reframing becomes easier to do. When we reframe our experiences, we use our creativity to look at the same situation in a different way. Reframing helps us to deal with stressful situations in a more effective way. Often, we can find a lesson that can be learned from a particular problem. The facts of the situation remain the same, but we reframe the issue for ourselves so that we develop a new perspective about it.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.

I have helped many clients learn to develop new perspectives to old problems through reframing.

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

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

Stress Management: Finding Moments of Peace and Relaxation

It seems that, for many of us, finding a moment of peace and relaxation is becoming more and more of a challenge.

Stress Management: Finding Moments of Peace and Relaxation

With so many people multi-tasking, answering their cell phones while they're also sending out email, watching their computer screens at the same time that they're watching the news on TV, rushing from one place to another, finding a moment of peace and relaxation often takes a backseat to just about everything else and the typical response is, "I just don't have the time."

Taking A Few Minutes to Relax and Unwind
What we sometimes forget is that it often only takes a few minutes to unwind and relax. We can take an internal mini-retreat from our hectic day by finding a quiet place, taking a few deep breaths, closing our eyes for a minute or two and picture ourselves in a calm, relaxing place.

Stress Management: Finding Moments of Peace and Relaxation

In our mind's eye, we can go on a mini-vacation to any peaceful place that we choose to get away from the stress and strain of the day. As you breathe and picture this calm, relaxing place, allow your muscles to soften and relax. This short meditation can help refresh you for the rest of the day.

Taking just those few minutes to relax can make such a difference. When we return from our internal mini-retreat, we often feel refreshed and better able to tackle whatever stressors life throws our way.

It's important to have your own personal strategies for stress management that work for you. It can make such a big difference in your physical as well as emotional health and well-being.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

I have helped many clients to learn to relax, create and develop their own stress management strategies that work for them.

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.

Creating a Positive Rippling Effect

In my last post I wrote about The Positive Ripple Effect based on a chapter in Dr. Yalom's latest book, Staring at the Sun. I also gave case examples that I'm personally aware of about the positive rippling effect.

Creating a Positive Ripple Effect

 
Irving Yalom, Ph.D.
Dr. Yalom is an Existential psychotherapist and, while I'm not an Existentialist and I don't agree with all of his views, especially his views about religion and spirituality (basically, he says that he doesn't believe in any type of spirituality), I like his ideas about rippling and the positive effect it can have in an individual's social network and beyond.

The Positive Rippling Effect
When we hear about the positive rippling effect, we often hear about situations where someone has taken a big step towards affecting a change in his or her life as well as the lives of others: the person who engages in an act of courage who inspires others to act, the teacher or mentor who encourages others, the person who starts a movement that inspires others to join in, and so on.

But creating a positive rippling effect doesn't have to involve grand feats of courage or inspiring movements. More often, it's the every day small things that we do that can create a positive rippling effect.

It's a matter of being mindful of how we think and behave with others. It starts with our thoughts because our behavior is usually the result of our thoughts, attitudes, and beliefs. In my prior post, if the social services director believed that the situation was hopeless and she could not affect any change in her staff or the clients, she would not have implemented the changes that she did, which had a positive rippling effect in the environment and beyond (see prior post).

Change Begins with Our Thoughts, Attitudes and Beliefs
So, change often begins with our thoughts, attitudes and beliefs, and if you find that your thoughts tend to be pessimistic most of the time, it's worth questioning yourself as to what these thoughts, attitudes and beliefs are based on. Often, pessimistic thoughts are based on a history of disappointments and, in some cases, trauma. Other times, it's a learned pessimistic way of thinking that often is not questioned by the thinker. And, while you might be right that, in certain cases, there is reason to be pessimistic, if you find that this is your overall attitude towards life, you would probably benefit from stepping outside of yourself, taking an objective look, and questioning your overall beliefs and attitudes about life and other people.

So, as I mentioned, creating a positive rippling effect starts with our thoughts and manifests in our mindful actions with others. The positive rippling effect can start with simple acts: smiling at a stranger, giving your seat to an older or disabled person on the train, expressing gratitude to a spouse, friend, colleague or family member, and so on. These are small acts of kindness that, based on the phenomenon of emotional contagion, can ripple from you to that person and from that person to others.

Of course, if you're in a position to create a positive rippling effect by creating bigger changes in your environment, that's wonderful. But the point is that no one should feel discouraged about this because they're only focused on big changes. Small changes often have a way of snowballing into big changes, even if you're not always aware of it.

You can experiment with creating positive rippling effects by becoming aware of how you interact with others: Do you offer encouragement or discouragement? Do you tend to focus on the negative and the "glass being half empty" rather than seeing the positive? What is the quality of your engagement with others? Do you take the time to notice people in your environment and how you affect them? Are you conscious of being ethical with others? Are you empathetic towards others? Are you compassionate?

We all know how good it feels when someone offers us encouragement, compassion, inspiration, or engages in an act of kindness with us. It tends to open us up and allow us to feel that we can do the same for others.

Once you've developed an awareness of how you interact with others, if you don't like what you see in yourself, you can make a conscious effort to change. As with any change, it doesn't have to be perfect. The important step is to make a start. After you practice this for a while, the quality of your interactions with others often changes automatically so that you don't have to make such a conscious effort--you're doing it without even thinking much about it, and your affecting a positive rippling effect in your environment and beyond.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.

I work with individual adults and couples.

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

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

The Positive Ripple Effect

I've been reading Dr. Irvin D. Yalom's latest book, Staring at the Sun, which I recommend. Dr. Yalom is a highly-regarded psychiatrist and author who has written several books, including Love's Executioner and When Nietzsche Wept, among others. He has a psychotherapy private practice in California and he specializes in Existential Psychotherapy. While I'm not an Existentialist, I like Yalom's latest book.  

The Positive Ripple Effect

In Chapter 4, Yalom discusses "the ripple effect," the effect that we have on others and how that effect ripples out throughout individuals' social network, often from one generation to the next. He indicates that, when people are struggling with the transience of life, it often helps them to think about the positive effects that they have had on others and how that effect continues to ripple out beyond their immediate social circle in ways that they often don't even realize. Knowing that something you did or said can have a positive rippling effect, sometimes going from one generation to the next, often helps mitigate fears about the transient nature of life.

In addition, the Framingham Heart Study, conducted by Nicholas Christakis of Harvard University, looked at 5,000 people who were followed over a 20 year period. One of the findings was that there was a ripple effect of happiness that spreads within social circles due to the phenomenon known as emotional contagion, where the happy emotions felt by those at the center of the social circle are spread out to the rest of the social network, similar to the concentric circles that you see if you toss a pebble in a pond. Of course, emotional contagion works the other way too--unhappiness can also spread within the social network.

The following vignettes, which are composites of various cases, are examples of the positive ripple effect and emotional contagion factor that I have witnessed in my psychotherapy private practice (all identifying information has been changed to protect confidentiality):

Alice:
Alice, who was a clinical social worker, was hired as a director for a social service agency that provided services to the homeless. When she was hired, her predecessor, who was retiring, warned her that morale in the agency was low and many of the caseworkers were unmotivated. By nature, Alice was a positive, upbeat person. No Pollyanna, she had worked in the social service field for many years and she was well aware of the challenges that social workers and caseworkers faced. She had no illusions that her job would be easy.

On her first day, she noticed immediately how unhappy and unmotivated the employees were. Their unhappiness was palatable and hung in the air with a dull heaviness. During the first week, she met with each employee to find out how they felt about their job and any recommendations they had for improvements. What she found was that most employees, especially those who had been there for several years, felt very pessimistic about the impact that they could have with the homeless population. They gave many examples of homeless clients returning again and again after they were domiciled, high alcohol and drug relapse rates, and the frustration of dealing with a cumbersome bureaucracy.

Alice was very concerned about the emotional contagion factor among employees as well as the effect it would have on clients. Within the first few months, she set about making changes to streamline bureaucracy and unnecessary paperwork and implement other important changes. Unlike her predecessor, who spent the last several years waiting for her retirement and who remained distant from employees and clients, Alice was very hands-on. She made sure that she was at the center of things and accessible to everyone.

Initially, her employees found her pleasant, but they were wary of her optimistic nature. However, over time, she started to gradually win them over, especially after she implemented a program where formerly homeless clients, who had gone on to further their education, get good jobs, and felt happy with their lives now, came back to talk to the staff and current homeless clients at the agency. 

These presentations helped to inspire both the caseworkers and the homeless clients. The staff got to see the positive impact that they had on former clients. Many of the current homeless clients at the agency felt hopeful that they too could make positive changes in their lives. 

All of them witnessed the ripple of effect of the staff's efforts and how it continued to have an effect on the former clients' children, the children's friends, and beyond. After a while, morale improved substantially and staff and clients alike began volunteering to work on projects to help improve the physical environment at the center (e.g., painting, putting up artwork, and making repairs). All of this served to have an upward spiraling effect.

Ralph:
Ralph was going through a particularly difficult time in his life. He and his wife had just separated and now he only saw his children on the weekends. He felt sad and pessimistic about his life. As the holidays approached, he dreaded having to attend an upcoming family reunion. He didn't know how he would respond if family members, who knew of his marital separation, asked him about it. He wanted to avoid the whole thing, but he knew this would be upsetting to his parents and other relatives and he didn't want to be alone, so he made the trip back home, expecting the worst.

As he anticipated, some of his relatives asked about the marital separation and it reinforced Ralph's feeling of being a failure in his marriage. This feeling of being a failure clouded his view of himself in just about every other area, even though, in reality, he was successful in his work and he had many friends and family members who cared about him.

At one point, his cousin, Mark approached him. Ralph had not seen Mark in many years, and he groaned inwardly, anticipating that Mark would ask him about Ralph's separation. Mark asked Ralph to take a walk with him around the garden so they could talk. Ralph thought, "Here it comes. He's going to ask me about my marriage." But to Ralph's amazement, Mark told him that he's been wanting to thank him for a long time, and it was way past time to express his gratitude on the positive effect that he had on his life.

At first, Ralph could not imagine what Mark was talking about. Then, Mark proceeded to talk about his incarceration in a federal prison for stealing checks from the mail while he was a postal employee. 

Initially, this made Ralph feel uncomfortable. However, Mark persisted, "I want to thank you for a letter you sent me while I was in prison that really turned my life around." Ralph had a vague recollection of sending Mark a letter, but he could not remember the details. Mark went on, "When you encouraged me to not give up, to use my experience to learn and grow, I really took that to heart. I saved that letter and read it over and over again. It got me through some difficult times in prison and motivated me to get my degree while I was in prison and to find a sense of peace and spirituality. Thank you so much. I've always remembered your words, and I tell my children the same thing when they go through difficult times."

Ralph was stunned and didn't know what to say. Just then, Mark's 13 year old son, Bobby, came out into the garden. Ralph had never met Bobby because he had not seen Mark or his family in many years. When Mark said, "Bobby, this is your cousin, Ralph," Bobby flashed a big smile and looked visibly excited. He said, "Oh, wow! Hi Ralph. It's great to meet you. Dad and I have talked about you a lot. He always tells me, whenever I feel like giving up, what you wrote to him and how much it helped him. Thanks so much."

Ralph felt very moved and held back tears. He had no idea that he had such a positive effect on his cousin and his cousin's family. Before going back into the house, he called his wife, Laura, and asked her if she wanted to try to work things out. To his surprise, she said she was going to call him and ask him the same thing. After three months of couples counseling, they worked out their differences, they got back together again and were happier than ever.

Whether we realize it or not, we often have a positive rippling effect on others around us who then pass on this effect to others. When we become anxious about the impermanence of life, the transient nature of all things, or other stressors in our lives, it helps to think about the positive effect that we can have in our social circles that often lives on from one generation to the next.

Next Article: Creating the Positive Ripple Effect

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  

I work with individuals and couples.  

I have helped many clients to overcome obstacles so they can lead more fulfilling lives.

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

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

Coping with Secrets and Lies in Your Relationship

Couples often come to couples counseling after one of them discovers secrets, lies or betrayal by his or her partner. Once trust is breached, it's difficult to restore it without the help of a licensed mental health professional who works with couples.

Secrets and Lies in a Relationship

Clinical Vignettes
The following stories are examples of couples who struggled with betrayal in their relationship and came to couples counseling to work on these issues. All examples in this post, as well as all other posts, are composites of actual cases with all identifying information changed to protect confidentiality.

Larry and Barbara:
Soon after they got married, Barbara discovered that Larry had significant credit card debt that he had not revealed to her. Barbara felt betrayed because they had talked about their personal finances, and she thought they had each shared all the important information that each needed to know. It wasn't until they wanted to buy a house that Larry, who felt very ashamed of his debt, revealed that he had poor credit. After that, Barbara wondered what else Larry might not have told her. When they began couples counseling, they were barely talking to one another and their marriage was spiraling down. However, over time, with Larry working hard in couples counseling to regain Barbara's trust, they re-established communication, and they were able to salvage their marriage.

Maureen and Cathy:
Maureen and Cathy moved in together after dating for two years. Soon after they were living together, Maureen sensed that Cathy was not being honest with her about Cathy's relationship with her ex. Maureen knew that Cathy maintained a cordial relationship with her ex, Mary, but she soon discovered (by looking at Cathy's cell phone bills) that Cathy was in contact with her ex a lot more than Maureen realized. When she confronted Cathy about it, Cathy became angry that Maureen was snooping on her. Maureen became furious that Cathy led her to believe that she and Mary only had limited contact, when, in fact, Cathy was talking to Mary several times a week.

Cathy denied that anything romantic was going on any more between her and Mary, and Maureen believed her. But Maureen felt betrayed that Cathy lied to her. Cathy countered that she felt Maureen wouldn't understand that Mary was going through a difficult time and she wanted to be supportive of her. When they came to couples counseling, each of them was polarized in their position. Maureen was ready to walk out on their relationship, but she decided to give it a last-ditch effort in couples counseling.

 Shortly after they started couples counseling, Cathy came to understand that lying to her partner was a betrayal, regardless of how much she thought Mary needed her. She realized that she had to put her relationship first and she was genuinely remorseful. Maureen, in turn, realized that she shouldn't snoop on Cathy. A few months later, Cathy set appropriate boundaries with Mary. When she saw Mary, she either saw her with Maureen or she let Maureen know that she was spending time with Mary. Both Maureen and Cathy learned to regain trust in each other.

John and Bill:
John and Bill were together for 15 years when John discovered that Bill had recently begun having secret chats in online sexual chat rooms. When John confronted Bill about his activities online, Bill was very contrite. He insisted that he only engaged in sexual fantasy online, and he never met any of these men in person. John was so stunned and angry by Bill's behavior that he didn't know what to believe. 

He felt betrayed by Bill's secrecy, and he thought about ending the relationship. But Bill convinced him to go to couples counseling to deal with their problems. While in couples counseling, Bill told John that he felt neglected by him sometimes, and he liked the attention he got online in the chat rooms. Rather than acting out, Bill learned how to express his feelings to John. He came to see that secretly participating in online chats was a form of infidelity. Over time, John forgave Bill and they were able to strengthen their relationship in couples counseling and re-establish trust.

Getting Help in Therapy
Dealing with secrets, lies and betrayal in your relationship and regaining trust can be very challenging.

If you and your partner are having a difficult time regaining trust in your relationship as a result secrecy, lies or some form of betrayal, you could benefit from couples counseling with a licensed mental health professional who works with couples.

About Me

I am a licensed psychotherapist and couples counselor in NYC. I have helped many couples to work through problems in their relationship.

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

To set up a consultation, you can call me at (917) 742-2624 or email me.

Coping with Blended Family Issues

Blended families, where children from different relationships, come together as a result of a second marriage or relationship, are becoming more and more common.

Coping With Blended Family Issues

Blended families have certain challenges that other families don't have. When you bring together children from two different relationships, certain conflicts can emerge as everyone gets adjusted to the new relationship and the combination of two different families. With a certain amount of forethought and planning, many of these issues can be resolved.

The following examples, which are composites of actual cases with all identifying information changed to protect confidentiality, illustrate some of the challenges that blended families might face:

Sam and Martha:
Sam and Martha were both in their mid-50s when they got married. It was the second marriage for both of them. Each of them had adult children from their previous marriages. A year after they got married, they bought a home together. They were both very happy in their marriage and in their new home. Six months after they moved in, Sam's daughter, Nina, a single mother of three children, lost her job and couldn't afford to stay in their apartment.

When she approached her father, Sam, about staying with him and Martha temporarily until she could get another job, Martha and Sam agreed to allow her to move in with them. However, nine months later, Nina was still living in their house with her children, and she was not making any effort to find another job. Martha was getting irritated and talked to Sam. He agreed that Nina was not living up to their agreement, and he agreed to talk to her. But Sam found himself unable to talk to Nina because he felt guilty about not being around when she was growing up.

So, he kept putting off having the talk with her, and Martha was getting increasingly annoyed. She felt taken advantage of by Nina, and she resented Sam's passivity. By the time they came for couples counseling, Martha was talking about divorce and Sam was despondent, caught between his daughter and his wife. After a few sessions, they realized that they allowed Nina to move in without a well-thought out plan. Although they couldn't go back to undo that mistake, they talked how to resolve this situation in a way that would preserve their marriage and try not to alienate Nina.

Sam also entered into his own individual therapy to deal with his guilty feelings about not being around for Nina when she was a child. Soon, they came up with a reasonable plan that they both agreed to, and Sam presented it to Nina. Nina felt hurt initially, but she eventually came to understand that Martha and Sam wanted their home back. So, within two months, she found another job and moved into her own apartment with her children. The tension between Martha and Sam was resolved, and they were closer than before, and Sam was able to make amends with Nina for neglecting her as a child.

Betty and John:
Betty and John met each other in a bereavement group that they were attending to grieve the loss of their spouses. What started out as a supportive friendship turned into a romantic relationship within a few months. Betty had two teenager daughters and John had a seven year old son and a five year old daughter. After they got married, they all moved into Betty's house because it was larger than John's house.

Problems between the children from this blended family began almost immediately. Betty's daughters resented John's younger children and felt annoyed when they wanted to hang around when their friends from high school came over. John's younger children felt left out and would cry and act out. Betty was home all day and so she had to deal with these conflicts. She found herself caught in the middle between her children on one side and John and his children on the other side.

When she told her daughters to be patient with the younger children, they got angry with her and they felt that she cared more about John's children than them. When she told the younger children to play on their own and not to barge in on her daughters and their friends, John's children sulked and complained to John when he got home from work.

Then, John would get irritated with Betty. She felt she was in a no-win situation. When they came to couples counseling, John and Betty were both exhausted and frustrated with the situation and wondering if they had made a mistake by getting married. However, after a few couples counseling sessions, they learned that they needed to come up with a united front to deal with these blended family issues.

They also came to appreciate just how difficult it is for children to deal with the loss of a parent at the same time that they are adjusting to a new blended family. They soon came up with a compromise that allowed the teenagers to have their privacy at certain times as well as family outings where everyone came together for a good time.

Getting Help in Therapy
Blending family issues can be problematic but, with the assistance of a licensed mental health professional, they can often be resolved.

If you and your partner are struggling with blended family issues that you cannot resolve on your own, it might be beneficial to attend couples counseling to work out these issues and save your relationship.

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

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

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

Developing Internal Resources and Coping Skills

Whether you realize it or not, you have internal resources and coping abilities that you can tap into when you're facing a challenging situation or life event. Very often, the question is how to access these internal resources and coping abilities when you need them the most.

Developing Internal Resources and Coping Skills

As a psychotherapist in New York City, I see many clients who are overwhelmed after trying to deal with problems on their own. Often, by the time they come to therapy, they're feeling emotionally depleted and defeated by their problems. 

As a psychotherapist, I treat each client as an individual and I don't have a standard way of working with all clients. However, often, as a start, I find it useful to help clients to access their own confidence, internal resources and coping abilities to deal with whatever obstacles they're facing.

What Are Internal Resources?
Our internal resources are made up of the various internal aspects of ourselves that have the emotional strength, compassion, confidence and overall wherewithal to deal with the issues that we're facing. When we're able to remember and re-experience these internal aspects in a deep way, we can use them as part of our coping strategies to face our problems. This might not be enough to actually resolve our problems, but it's a good way to start.

Examples of Internal Resources:

Remembering a time when you felt the inner emotional fortitude to deal with a particular problem or fear with courage and confidence. This might have been a time when, initially, you didn't think you could find it within yourself to deal with this problem but, ultimately, you did, and you felt good about that. How can you take that experience of yourself and use it to deal with whatever problem you're facing now?

Remembering someone special in your life (e.g., a teacher, mentor, friend, family member, psychotherapist, coach) who helped you when you faced a particular obstacle.
This might involve recalling some advice this person gave you or how supported you felt when this person helped you. What might this person say to you now in your current situation?

If you can't think of anyone in particular that helped you in the past, you can also think about other people that you admire, possibly people in your every day life, a character from a movie or a historical figure, and ask yourself what that person might do.
You could close your eyes and imagine what that person might tell you or what it might feel like to be that person in the particular situation that you're dealing with now.

Developing Internal Resources and Coping Skills

What If You Can't Access Your Internal Resources?
Sometimes, just remembering that you've faced similar or worse problems in the past or remembering how an important person in your life might have helped you, is enough to help you access your internal resources and coping skills.

However, there are other times when you might feel so "stuck" in your particular problem that just the act of remembering these experiences on your own is not enough to help you. At those times, it's often helpful to work with a licensed mental health professional who can help you to rediscover your internal resources and coping abilities so that you can overcome the problems that you're facing.

How I Work to Help Clients to Access Their Internal Resources and Coping Abilities:
As I mentioned before, as a psychotherapist, I see each client as a unique person, and I don't have a particular approach that I use with all clients. However, I often find it very helpful to use Richard Schwartz's Internal Family Systems model to help clients to overcome internal conflicts and rediscover their coping abilities.

The name "Internal Family Systems" can be misleading, and you might think that it involves bringing your family into treatment. However, this is not the case.

The main idea in Richard Schwartz's theory is that we all have internal parts (or aspects of ourselves) that we can access and use to help us. When I use the term "internal parts," I'm referring to our inner emotional world.

We often see these internal parts when we're having a debate with ourselves about a particular problem or question: "A part of me wants to sleep later in the morning, but another part of me knows I feel better when I get up early and go to the gym."

One of the reasons why I like the Internal Family Systems model is that it's a gentle, positive, optimistic, strengths-based theory. As opposed to many other psychological theories that look at what's wrong with a person, Internal Family Systems looks at what's right. It also puts us in touch with our internal core selves.

When I'm helping clients to access these internal parts, I will often help them to get into a relaxed meditative state or I use clinical hypnosis.

I've discussed clinical hypnosis in detail in prior posts (see post dated May 31, 2009). As a reminder, I'll reiterate that when you're seeing a licensed mental health professional who is trained in hypnotherapy, clinical hypnosis is a safe and very effective tool in therapy.

You maintain dual awareness of the here-and-now as well as whatever you're working on in hypnosis, and you're in complete control at all times. Clinical hypnosis can help you to access your internal resources because it allows you to experience your unconscious mind where your internal resources are located.

For more information about Richard Schwartz's Internal Family System, you can visit his web site: http://www.selfleadership.org/.

Getting Help in Therapy
If you feel like you're stuck emotionally and you're unable to overcome the emotional challenges that you're currently facing, you could benefit from seeing a licensed psychotherapist.

Getting Help in Therapy

I'm a licensed psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing in New York City who works with individuals and couples. 

I have helped many clients to access their own internal resources and coping abilities to overcome their problems.

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

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

Relationships: When Love Doesn't Conquer All

When most people enter into a new relationship, they experience that heady, passionate time when they feel invincible and that nothing could get in their way because they're so deeply in love with each other. So, it can be very disappointing, after these heady feelings subside, to discover that, contrary to popular myths, love doesn't always conquer all, and it's often not enough for a relationship to survive and withstand the many challenges couples face today.

Relationships: When Love Doesn't Conquer All

The following scenarios, which are composites of actual cases with all identifying information changed to protect confidentiality, are typical examples of couples who enter into couples counseling:

Bill and Sandra met in college. They fell deeply in love after dating for a few months. While they were dating, they became aware that they had significant differences in terms of their values and goals in life: Sandra wanted children and Bill was not sure; Bill was a spender and Sandra was a saver; Sandra had a few close friends and preferred to stay home most of the time, and Bill was very outgoing, enjoyed going out and liked meeting new people, and so on. Even though they were aware of these differences, they believed that, since they were so deeply in love, their love would carry them through and they would work out these differences.

However, four years after they got married, even though they still loved each other very much, they were arguing a lot about these differences. They were each disappointed, hurt and confused as to why, if they cared about each other so much, their relationship was not working out.

Greg and Denise met while they were each going through a divorce. They were both in their mid-40s. Initially, the relationship began as a friendship, where they consoled and supported each other. But it quickly turned romantic, and when each of them was free, they got married. Denise considered herself to be a spiritual person. She went to church on a regular basis and she was involved in various church committees. She was aware that Greg considered himself to be an atheist, but she overlooked this and thought she could change it after they got married.

Relationships: When Love Doesn't Conquer All

Two years into their marriage, they began arguing about religion. Denise was disappointed that Greg refused to participate in her church services and that he was not even willing to reconsider his views on religion. Greg was angry and felt badgered by Denise because he was upfront about his atheism and he thought she accepted it, only to find out that she held a secret hope that he would change.

Lisa and Robert seemed like the "ideal couple" to their friends. They were both very in love and devoted to one another. They had similar values, and they shared of vision and a plan for what they wanted their life to be like together. But after Lisa and Robert had their first child, they began to drift apart. They had both looked forward to having children, but the reality of having a baby turned out to be very different from what each of them had anticipated. Both of them were sleep deprived from the baby waking up crying several times a night, which caused them to be irritable with each other. Robert also felt that Lisa spent so much time doting on the baby that she hardly paid attention to him. He felt neglected. They hardly went out any more, and he felt they were in a rut. Each of them thought, "How could this have happened to us?"

Margaret and Karen met at a mutual friend's birthday party. They fell in love almost immediately. After dating for six months, they moved into Margaret's apartment, since it was much larger than Karen's and more convenient to each of their jobs. Soon after moving in, they began arguing and getting into power struggles about the apartment.

Karen wanted to make a few changes so she could feel comfortable and make the apartment feel that it was as much hers as it was Margaret's. But Margaret liked things just as they were and saw no need to change anything. They both felt disappointed that they were arguing about what seemed like petty things when they knew that they cared about each other very much. But they didn't know how to get passed this problem.

Getting Help in Therapy
If you and your partner are having ongoing arguments, if the two of you can't seem to overcome the obstacles in your relationship, you could benefit from couples counseling. 

An experienced couples counselor can help you to overcome these obstacles to either decide to stay together or to split up in an amicable way without the usual anger and bitterness that is associated with breakups and divorce.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. I help individuals and couples to overcome obstacles that are keeping them from leading fulfilling lives.

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

To set up an appointment, call me at (917) 742-2624 during regular business hours or email me.