NYC Psychotherapist Blog

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Friday, December 31, 2010

Psychotherapy for Shock Trauma

In my last blog post, Understanding Shock Trauma, I discussed shock trauma, including the types of traumatic events that can cause shock trauma and its symptoms. In this blog post, I will discuss psychotherapy and shock trauma and the treatment modalities that I find most effective in my psychotherapy private practice in New York City.

Psychotherapy for Shock Trauma

Psychotherapy for Shock Trauma - Initial Phase: Assessment and Developing Resources
When clients come to me to be treated for shock trauma, I assess each client with regard to the nature of the trauma and their internal and external resources. Before any processing of the trauma can begin, clients must have adequate internal and external resources or the trauma processing could be overwhelming for them.

What are Internal and External Resources?
When I refer to internal resources, I'm referring to a person's coping abilities. If the client doesn't have sufficient coping abilities, I assist them to develop them. Internal resources can be any of the following: an ability to meditate or calm oneself by taking calming breaths, visualizations of relaxing places, visualizations of supportive people in their lives, memories or associations of times in their lives when they felt good about themselves (confident, powerful, competent) and so on.

External resources can include friends, family, loved ones, mentors, coaches, or pets. If a client is in recovery for substance abuse or some other form of addiction, it could include 12 Step meetings, peers in 12 Step meetings, and sponsors.

Psychotherapy Treatment Modalities:
When dealing with trauma, I usually use mind-body oriented psychotherapy such as Somatic Experiencing, clinical hypnosis, or EMDR, depending upon the needs of the client. Sometimes, depending upon the needs of the client, I might use a combination of these treatment modalities. The treatment plan is a collaborative effort with the client.

Psychotherapy for Shock Trauma - Processing the Trauma:
Once the client has developed adequate resources, I titrate the trauma work so that it is performed in manageable pieces. (Titration means in manageable doses.) When dealing with the trauma, we're dealing with the reptilian brain (see prior blog post about the triune brain). The reptilian brain processes about 7x slower than the neo-cortex, so trauma work is, by necessity, slower than other types of work that is done in psychotherapy. If the therapist goes too quickly, the reptilian part of the client's brain will be overwhelmed and it will be to0 much for the client.

I help the client to move gently back and forth between manageable emotional activation related to the trauma and a calm emotional state so that the trauma work remains in a tolerable range.

The client is the best judge in terms of what he or she experiences in trauma work, so the client is in charge, and I am guided by his or her feedback during sessions.

Psychotherapy for Shock Trauma - The Goal of Treatment:
Using one of the mind-body oriented psychotherapy treatment modalities, the goal is for the client to process the trauma and to discharge the trauma-related "stuck" energy which is being held in the body so that the client can return to at least as good a level of his or her former level of overall functioning or better.

The discharge of "stuck" energy can come in many forms, including breathing out stressful energy, perspiring, yawning, experiencing tingling, and other forms of discharge. The client often senses when he or she has discharged the trauma-related energy that has been "stuck" in the body because there is a sense of calm or relief for the particular piece of trauma work that has been worked on.

Psychotherapy for Shock Trauma - Developing Self Compassion:
Many clients who begin trauma work blame themselves for what happened to them. They get caught up in negative cycles of self talk where they berate themselves, telling themselves that they should have known better or they shouldn't have gone to a particular place, etc. This only exacerbates their trauma symptoms.

During treatment, I help clients to realize that they're not to blame for what happened to them or for their trauma symptoms. Helping clients to develop self compassion is also part of the way I work with traumatized clients from the beginning so they don't get caught in negative cycles of self blame.

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

I work with individual adults and couples.

I have helped many clients to overcome traumatic events in their lives, including shock and developmental trauma, so that they can go on to lead productive and meaningful lives.

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.

Understanding Shock Trauma

What is Shock Trauma?
As opposed to developmental trauma, which develops over time when traumatic events overwhelm a child, shock trauma occurs usually from an overwhelming one-time event. Shock trauma can occur to an adult or a child. It can occur from experiencing the traumatic event or witnessing it. The traumatic event is usually sudden, unexpected and has a distinct beginning and end.

Understanding Shock Trauma

Many people describe their experience of shock trauma as if their whole world has been turned upside down. They describe it as if the rug has been pulled out from under their feet. Often, their perspective of their internal world and the world around them changes and they feel unsafe and that life is very unpredictable.

As with any overwhelming event, the trauma is not in the event itself, but in the way the person experiences the event. As a result, two people can experience the same event and one person might become traumatized while the other person does not.

What Type of Events Cause Shock Trauma?
There are many different types of events, which can cause shock trauma, including:
  • accidents
  • natural disasters
  • acts of war
  • assaults
  • falls
  • invasive medical procedures, and so on
Understanding Shock Trauma

What Are the Symptoms of Shock Trauma?
Each person has his or her own individual experience with regard to shock trauma. These symptoms can include:
  • anger
  • anxiety
  • panic attacks
  • depression
  • a sense of helplessness
  • a sense of hopelessness
  • a need to be vigilant all or most of the time
  • flashbacks
  • nightmares
  • isolation
  • loss of interest in activities that used to be pleasurable
  • exhaustion
In my next blog post, I will discuss psychotherapy for shock trauma and the treatment modalities that I find most effective in my psychotherapy private practice in NYC.

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

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.

See my article:  Psychotherapy For Shock Trauma

Tuesday, December 28, 2010

Trauma, the Triune Brain & Somatic Experiencing

What is the Triune Brain?
The triune brain is made up of three parts that developed in humans through evolution over time. Triune means "three in one."

Trauma, the Triune Brain and Somatic Experiencing

There is the reptilian brain, the mammalian brain, and the cognitive brain. All three parts of the brain inter-relate and communicate with each other. The reptilian brain developed first and it is the oldest part of the brain. The mammalian brain developed next, and the cognitive brain developed last in evolution.

I will discuss the reptilian brain last since this is the part of the brain that carries trauma when a person has been overwhelmed by a traumatic event.

The Cognitive Brain:
The cognitive brain is located in the pre-frontal or neo-cortex part of the brain. As mentioned earlier, this was the last part of the brain to develop through evolution. The cognitive brain is responsible for thoughts, planning, language, logic and awareness.

The Mammalian Brain:
The mammalian brain was the second part of the brain to develop through evolution. It is located in the middle brain. The mammalian brain mediates feelings, relationships, nurturing, images, and unconscious activity, including dreams and play. The mammalian brain fosters attachment between caregivers and infants when there is good enough caregiving. It also fosters empathy between individuals.

The Reptilian Brain:
The reptilian brain developed first during the evolutionary development of the brain, and it can be found in species from reptiles to humans. It is the oldest part of the brain in terms of the development of the triune brain. The reptilian brain sits at the base of the skull. It's responsible for instincts, including the sympathetic nervous system's survival instinct of fight-flight-freeze when there is perceived danger.

When a person perceives him or herself to be in danger, emotions and physiological energy are generated by the reptilian brain so that the person can take action. When this energy is not discharged (through flight or flight), it is stored in the person's muscle tissue. This emotion and energy are imprinted in the nervous system. This is what we mean when we refer to "trauma." Trauma is usually associated with feelings of powerlessness and helplessness.

Somatic Experiencing and the Trauma Vortex:
According to Peter Levine, Ph.D., who developed Somatic Experiencing, this trauma-related energy, which has not been discharged, can be conceptualized as being part of a trauma vortex.

Trauma, the Triune Brain and Somatic Experiencing 

The trauma vortex is a metaphor to describe what happens when trauma-related energy is "stuck" and has not been discharged. The trauma-related energy saps the person of vitality. This energy is trapped and unavailable for other life-affirming and life-enhancing activities.

Somatic Experiencing and the Healing Vortex:
Just as we can conceptualize the trauma vortex as the place where trauma-related energy is stuck, in Somatic Experiencing, we can also conceptualize the metaphor of a healing vortex.

The Somatic Experiencing therapist helps the client to develop this positive, healing energy to counteract the negative experience of the trauma vortex. The healing vortex can be any positive experiences, associations, memories, visualizations, and felt sense experiences that the traumatized person develops in Somatic Experiencing therapy.

The Somatic Experiencing therapist facilitates the healing process by "titrating" the processing of the trauma in therapy. "Titration" in this context means that the trauma is processed in manageable doses so it does not overwhelm the client or retraumatize him or her.

Trauma, the Triune Brain and Somatic Experiencing

Gradually, over time, the client, who is in Somatic Experiencing therapy, develops a greater capacity for self containment. By tracking the client's physiological and emotional experiences in treatment and with the use of titration, the Somatic Experiencing therapist helps the client to expand this capacity over time, so that as treatment unfolds, the client is better able to tolerate processing the trauma with increased coping abilities and a greater capacity for resilience.

When trauma is being processed, the therapist is dealing with the client's reptilian brain, where the trauma is stored. Compared to the cognitive brain (neo-cortex), the reptilian brain processes information 7x slower. This is why trauma work must be done in manageable pieces because if too much trauma work is done too soon, the reptilian brain becomes easily overwhelmed.

Somatic Experiencing is a mind-body oriented psychotherapy and it is one of the safest and most effective ways to process emotional trauma.

To find out more about Somatic Experiencing, visit the Somatic Experiencing website:

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

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 (917) 742-2624 during business hours or email me.

Saturday, December 11, 2010

Experiential Psychotherapy and the Mind-Body Connection

In recent years, increasingly, many psychotherapists have come to realize that mind-body oriented psychotherapy offers opportunities for healing that regular talk therapy alone often does not offer. 

There are different types of experiential psychotherapy, including clinical hypnosisEMDR (Eye Movement Desensitization and Reprocessing), Somatic Experiencing, all of which I have used in my psychotherapy private practice in New York City.

Many Experiences of Talk Therapy, But No Change:
Many clients come to see me feeling discouraged. Often, they have made many attempts on their own and attempts in regular talk therapy to make changes in their lives, but these attempts have not resulted in change.

Experiential Psychotherapy and the Mind-Body Connection

Often, clients in regular talk therapy develop intellectual insight into their problems, but there is no emotional insight. They can explain why they have the problems that they have, but no healing has taken place.

Why is this? Usually, it's because regular talk therapy alone often doesn't penetrate beyond our conscious minds. It involves our intellect which, of course, is important for any type of change that we might be contemplating. But for many problems, this isn't enough. The treatment needs to go beyond the surface to a more visceral level.

Why is Experiential Psychotherapy More Effective Than Regular Talk Therapy?
Mind-body oriented psychotherapy will often access deeper levels of consciousness because we can feel the treatment occurring on a visceral level. 

It's not just a matter of talking about the problem on an intellectual level. Mind-body oriented psychotherapy helps clients to change from the inside out. Clients are taught how to recognize where they feel their emotions in their body, and this helps them to access deeper levels of consciousness as well as enabling them to change at a deeper level.

I'm not saying that regular talk therapy doesn't ever work. My early training is as a psychoanalyst and I still practice psychodynamic psychotherapy. However, for many problems, this type of therapy is not enough, which is why so many psychoanalysts and psychodynamic psychotherapists have learned various types of mind-body oriented psychotherapy.

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

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 (917) 742-2624 during business hours or email me.

LGBTQ Relationships: Dealing with Homophobia in Families

As a psychotherapist in New York City, I've worked with many LGBTQ in couples counseling as well as in individual therapy where their families have not accepted that they're gay or that they're in a gay or lesbian relationship. The families' disapproval often causes individuals in gay and lesbian relationships to feel that they have to choose between spending time with their partners and spending time with their families.

LGBTQ Relationships: Dealing with Homophobia in Families

Of course, there are varying degrees of acceptance--everything from outright disapproval to half hearted acceptance to fully embracing the relationship and everything in between. It can be a very heart wrenching decision as to how to handle these situations.

The following scenario is based on a composite of many cases, and it does not represent any particular couple:

Vickie and Susan:
Vickie and Susan had been living together in a committed relationship for over three years when they came to couples counseling. They were both in their early 30s and had successful professions. Susan's family lived in NYC, and Vickie's family lived out of state.

Susan tended to be "out" as a lesbian to her family, at work and in most social situations. Vickie tended to be more reserved and she only told certain people that she was a lesbian. She had never told her family directly that she was a lesbian, but she assumed that they knew and they just never discussed it.

They had many close lesbian and gay friends, both single people and couples, in NYC that they socialized with during the year. But the holiday season often presented a problem. If they were staying in NYC, there was no problem because Susan's family embraced Vickie as their daughter-in-law and made her feel at home. They would also spend time with their friends, both heterosexual and gay.

But there were certain years where Vickie missed her family and they wanted her to spend the holidays with them. In most ways, Vickie was close to her family and she loved them. She liked spending time with her parents, and her older sister. Her family had many holidays rituals that Vickie enjoyed from the time she was a young child. The problem was that, even though they knew that she lived with Susan, she had never told them explicitly that they were life partners.

Both Vickie and Susan wanted Vickie's family to recognize and honor their relationship, but Vickie was too afraid of losing her family if she actually "came out" to them and told them that Susan was her wife. For Vickie, it was one thing for it to be understood that Vickie was a lesbian without having to discuss it, and it was quite another for her to be direct about it.

At certain times, Susan and Vickie would argue about this during other times of the year. Susan wanted Vickie to be more direct and "come out" as a lesbian and introduce Susan as her wife. But their disagreements about this were never as bad as they were during the holiday season.

When Vickie and Susan started couples counseling, Vickie's family was urging her to come to see them for the holidays because they had not seen her the prior two holiday seasons. Vickie felt torn about what to do. On the one hand, she missed her family and she wanted very much to see them. On the other hand, she didn't want to hurt Susan's feelings by going without her or inviting her to come without defining their relationship to her family.

Aside from dealing with homophobia among friends and families, internalized homophobia can be just as challenging, if not more challenging for someone who is a gay man or a lesbian. And both Susan and Vickie had to be willing to look at their own internalized homophobia in couples counseling, especially Vickie, with regard to this situation.

In working through this problem in couples counseling, Susan and Vickie both made a commitment to put their relationship first. Vickie had to confront and overcome her fears about her family's reaction if she told them directly that she was a lesbian and she was in a lesbian relationship. Her worst fear was that her family would cut her off. She also had to look at how she was withholding an important part of herself from her family and the effect this was having for her own internal world, as well as the effect on Susan and their relationship.

As we worked through this issue, we came up with a plan that began by Vickie telling the person in her family who would be most receptive, her older sister. As Vickie expected, her older sister told her that she already knew that Vickie was a lesbian and she suspected that Susan was more than just a "roommate." She told Vickie that she would love to meet Susan. But she agreed with Vickie that their parents probably wouldn't be as receptive to Vickie being openly gay and bringing her partner for the holidays. She told Vickie that she was in her and Susan's corner, no matter how their parents reacted and she would be supportive.

Vickie was relieved that her sister was supportive, but she knew that talking to her parents would be more challenging. They tended to be conservative and not open to people and situations that didn't fit into their values.

Vickie decided to talk to her mother first because she felt that, even though both parents were conservative, her mother was a little more open than her father. When the day came for Vickie to have the conversation with her mother, as we discussed, she "bookended" her call by talking to her best friend first and planning to talk to her after she spoke to her mother. This helped her to feel supported.

Vickie had a plan for how she was going to broach the topic of being a lesbian in a lesbian relationship with her mother, but her mother threw her off by interrupting her and telling her about all she was doing to prepare for the holidays. Vickie listened for a while and she felt herself becoming increasingly anxious. At one point, she considered not telling her mother at all. But she didn't want to go back on her commitment to Susan and the commitment that she made in our couples counseling sessions.

After listening for more than 20 minutes to her mother go on about the holiday preparations, Vickie knew that she had to say something at that point or she might lose her nerve. So, when her mother took a breath, Vickie began by telling her mother that she was the most happy that she had ever been in her life. She was afraid that if she didn't tell her mother this from the outset, her mother might not hear it after she "came out" and talked to her about her lesbian relationship.

Vickie's mother reacted positively and told her that she was pleased that she was happy. Then, Vickie took a deep breath and told her mother, for the first time, that she was a lesbian and Susan is her wife. There was silence on the other end of the phone for a few long seconds. When she spoke, Vickie's mother's tone of voice had completely changed. Whereas she had been upbeat and chipper before, she spoke in a whisper and told Vickie that she must never tell her father this because he would be devastated. She also told Vickie that she never wanted to talk about this again. Then, she began to change the subject.

At that point, as planned, Vickie told her mother that she knew that it might be hard for her to understand, but it was important to her that the family accept that she is a lesbian and that she is in a committed relationship with Susan. 

Again, there was a long pause at the other end, and finally her mother told Vickie in a whisper, "We know you're a lesbian. We figured it out a long time ago. But we don't have to talk about it and you don't need to throw it in our faces. We love you very much, but you can't expect us to talk about this as if it were nothing. And you can't expect us to accept that you're in a gay relationship. If you want to invite Susan to come for the holidays, she can come, but you can't flaunt your relationship and you can't stay in the same room."

Vickie was deeply disappointed, but she was not surprised. As agreed, she told her mother that she couldn't and wouldn't come under these circumstances, and she hoped that they could talk about this in the future and try to work it out. But, for now, she was spending the holiday with Susan and her family. At that point, Vickie's mother hung up the phone, and Vickie didn't speak to her parents for over a year.

Vickie and Susan remained in couples counseling to work through the repercussions of this turn of events. It placed a strain on their relationship, but they were both committed to staying together and working things out. They also strengthened the bonds of their relationships in the lesbian and gay community so they felt supported among other gay people who had similar experiences.

Vickie's older sister was also supportive and she came to NYC to meet Susan and to spend time with them at their apartment. It meant a lot to Vickie to have her sister show support for her and her relationship, even if she wasn't talking to her parents.

Vickie's sister told her that their mother broke down and told their father, even though she had told Vickie not to say anything to him, and he was even more upset about it than their mother. When they weren't discussing it openly, prior to Vickie's call, they put the whole idea of Vickie being gay in the back of their minds. But when Vickie talked about it openly with her mother, it was too confronting for the mother. It also removed any shadow of a doubt that Vickie was a lesbian and that she was in a lesbian relationship.

The following year, Vickie's sister announced that she would host the holidays in her house and she was inviting Vickie and Susan. 

When her parents heard about this, they told her that they wouldn't come if Vickie was coming to "flaunt" her relationship with Susan--to which Vickie's sister responded, "That's up to you. But if you come, I expect you and dad to be pleasant and respectful of Vickie and Susan." She gave them a book to read that was written for parents of gay children. She also gave them information about PFLAG (Parents, Families and Friends of Lesbians and Gays).

After much chaos and commotion, the parents decided to come. Vickie and Susan were anxious, and it was obvious that when Vickie's parents came, they were also very anxious too. There were anxious and awkward moments when Vickie introduced them to Susan. But, eventually, things settled down, at least on the surface, and everyone was polite. But there was an under current of emotional strain in the air.

This was the first of many holidays where Vickie and Susan went home to see Vickie's family. Over time, Vickie's parents got to know and like Susan and Susan began to feel more comfortable with them. Vickie's parents even began to attend PFLAG meetings and talk to other parents of gay children. 

After a while, they were able to talk to Vickie more about her life with Susan. They told her that they didn't understand, but she was still their daughter, they loved her, and they wanted her to be happy. And if being happy meant that she was a lesbian and in a relationship with Susan, they accepted this.

Having gone through this ordeal together strengthened Susan's and Vickie's relationship. They both wished that Vickie's parents would more than just "accept" their relationship, but they came to terms with it, and it no longer interfered with their relationship.

For Vickie, as an individual, "coming out" as an open lesbian and telling them that her relationship with Susan came first was a huge step. It strengthened her self confidence and it was a great relief not to have this secret any more.

The above composite scenario is one of countless ways that lesbian and gay couples and individuals cope with homophobia in their families. 

LGBTQ Relationships: Dealing with Homophobia in Families

There is no one right way to deal with these situations. Each individual and each situation is unique.

Getting Help in Therapy
If you're a lesbian or gay man who is struggling with similar "coming out" issues, you could benefit from getting help from a psychotherapist who specializes in gay and lesbian issues. You could also benefit from seeking support from LGBT support groups.

In NYC, you can contact the LGBT Community Center:
They offer a host of services for the LGBT community, including support groups, 12 Step programs, and other special programs specifically for the LGBT community.

If you're outside of NYC, you can contact the Gay and Lesbian National Hotline for support:

If you're a parent of a gay, lesbian, bisexual or transgendered child, you can educate yourself and get support through Parents, Families and Friends of Lesbians and Gays. :

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

I work with individual adults and couples.

I have helped many gay and lesbian individuals and couples with their own "coming out" process, relationship issues, and other issues specifically related to the lesbian and gay community.

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.

Tuesday, November 16, 2010

Using Money to Get Revenge in a Relationship

In my prior blog post, I talked about money and arguments in relationships (at the end of this article). In this blog post, I will address a particular issue about money and problems in relationships, namely, when money is used to get revenge.

Using Money to Get Revenge in a Relationship

Using Money to Get Revenge:
It's not unusual for someone in a relationship to use money as a form of revenge. When money is used to get revenge, the person who is exacting the revenge will either overspend or use money to manipulate in some way to get back at his or her partner.

Using Money to Get Revenge in a Relationship

Often the person who "acts out" in this way doesn't know how to communicate his or her anger and uses money as a way to get back. Needless to say, when the other person in the relationship finds out about the overspending or financial manipulation, he or she often feels angry, betrayed, and sad. Most of the time, this leads to mistrust and, in some cases it results in the end of the relationship.

The following fictionalized scenario is an example of someone using money to get revenge in a relationship. As with other money and trust problems, this problem is found in heterosexual relationships as well as gay and lesbian relationships. And, although I'm presenting the person acting out as the man, it happens just as often with women.

Nick and Susan:
When Nick and Susan came to marriage counseling, Susan was close to ending their marriage. She had just found out, for the second time, that Nick had withdrawn a large sum of money from their joint account and used it to buy studio equipment for his music production business without talking to her first.

She found out about the large withdrawal when she made an ATM deposit into the account and she was shocked when she saw the balance. She almost went in to speak to the bank branch manager. But, having gone through this before with Nick, she called him first before she panicked and he admitted to withdrawing the money.

When this happened several months before, Nick and Susan had a big argument. At that time, Nick admitted that he was angry with Susan because he felt that she was too controling about their money. Susan felt that, since she was the major bread winner in the marriage, she should have more of a say about money decisions. She also felt that Nick tended to be irresponsible with money, and she cited many examples in their argument. Nick felt that Susan was emasculating him and he admitted that he took the money to get back at her.

That was several months ago. At the time, Nick promised that he would never do this again. He replaced the money in their account, and Susan forgave him. But when it happened again, Susan was angry and she felt betrayed. She felt that she could no longer trust Nick, and she wondered what else he was being dishonest about.

Nick asked Susan for another chance and suggested that they attend marriage counseling. Although Susan wanted to end the marriage, she agreed to make one last ditch effort to save their relationship. But she told Nick that if marriage counseling didn't work out, she wanted a divorce.

So this was the state of their relationship when they began marriage counseling. Susan was very angry and hurt, and Nick was contrite, but underneath it all, he was angry too and unaware of it

Part of the initial stage of marriage counseling was to explore if there was a viable marriage to save and how invested each of them was in salvaging the marriage. Initially, Nick seemed more invested in saving the marriage than Susan. 

But after she was able to express her anger and also look at how she might have contributed to their problems by never allowing Nick to forget about financial mistakes that he made in the past, Susan realized that she didn't want to end the marriage. She wanted to feel that she could trust Nick and that he wouldn't try to get revenge against her, using their money, when he felt angry.

The marriage counselor helped Susan and Nick to improve their communication skills. She also helped Nick to see just how angry he was and how out of touch he was with his anger for Susan, which contributed to his seeking revenge by taking money from the joint account.

There were a lot of issues to work out, including family of origin issues for both Nick and Susan, Nick learning to be more responsible about money, reestablishing trust in the relationship, and both of them learning to communicate better with each other and not to use money to try to gain power and control in the relationship.

It was hard work but, gradually, over time, Susan and Nick worked towards salvaging their marriage.

Money problems are common in relationships. As previously mentioned, money problems are often one of the major reasons that couples seek out marriage counseling. It's not unusual for one or both people to "act out" and try to get revenge by either running up credit cards or manipulating money in some way.

Although it is usually a serious breach of trust when partners use money to get revenge, many relationships can be worked out with professional help from a marriage or couples counselor.

If you or your partner are using money to get revenge, you can work out this issue with an experienced marriage or couples counselor.

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 website: Josephine Ferraro, LCSW - NYC Psychotherapist

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

Relationships: Arguing About Money

In my prior blog post, I discussed sexual incompatibility as being one of the major reasons why couples come to marriage or couples counseling (see link below). In this blog post, I'll focus on one of the other major reasons why couples seek help--arguments about money.

Money is often symbolic of power. Whoever has or makes more money in a relationship is often seen as the more powerful person in the relationship, and this can lead to arguments.

Relationships: Arguing About Money

Similarly, differing values about money between a couple in a relationship can also lead to arguments and, at times, irreconcilable differences.

What Are the Different Problems that a Couple Can Have About Money?

The Saver vs the Spender:
It's not unusual in a relationship for there to be one person who prefers to save money and another person who would rather save money. When this is the particular dynamic in a relationship, there are bound to be differences of opinion and, often heated arguments, about what to purchase, when to make purchases, when to save, and, in general, how to manage the money.

Combining Each Person's Money vs Having a Separate Pot of Money:
Couples often differ as to whether they should pool the money that they had before they got together or if they should each keep what they had and create a separate pot of money to pay bills, make major purchases, etc.

For the person who prefers to combine their individual financial accounts, he or she might feel that the other person doesn't trust him/her enough to combine assets or lacks faith in the relationship.

The person who wants to keep their individual accounts separate and create a separate pot for expenses might have gotten burnt in prior relationships by pooling all the money together. With combined finances, it's not unusual for there to be problems if the couple separates. Of course, no one wants to enter into a relationship thinking that things might not work out, although this is a reality for many couples.

What to Do About Prior Debt:
Related to the above, if one person in the relationship enters the relationship with excessive debt, the couple needs to make decisions about how to handle that debt. Are they going to work on reducing the debt together or is the person with the debt going to take care of it on his or her own? If the couple can't negotiate their differences around this issue, it can become a major issue between them leading to frequent arguments.

Secrecy About Money:
I've seen many couples where one or both people keep secrets about money. For some people, it's a matter of withholding information about debt or how much money or assets they have or other related issues. Often, when there's secrecy about money, there are often other issues related to secrecy. If one of the people in the relationship finds out that his/her partner has been keeping secrets about money, it often engenders feelings of anger, betrayal and lack of trust.

Money as Power and Control:
As previously mentioned, when there is a difference in assets or earning power within a relationship, this can create arguments around power and control. The person who earns more money might feel that this gives him/her the right to greater control over their money and other major decisions. If the other person in the relationship doesn't agree and they can't negotiate this, this issue can lead to big arguments.

Money as a Cover Up for Other Problems in the Relationship:
Sometmes, it's really not about the money per se. The couple might be arguing about money because it's a concrete and tangible issue, but the real issue might be about other feelings. For instance, if one of the people in the relationship feels that there is a power differential in the relationship (let's say that one person makes most of the decisions that effect the relationship), the person who feels less powerful can use money as a handy issue to argue about when it might not be about the money (although it could be).

Using Money as a Way to Get Revenge:
When there are problems in a relationship, sometimes one of the people "acts out" by running up credit cards or overspending in some way to get back at his or her partner. This is an issue that I'll address in a separate post. However, it's easy to see how this could create arguments and, in some cases, end a relationship.

In most of these cases, there is often poor communication in the relationship and/or fundamental value differences about money and other important issues.

As I mentioned in a prior blog post, it's always better to talk about money before getting married or entering into a committed relationship. It often saves a lot of heartache if a couple can either negotiate these issues beforehand or, prior to making a major commitment, find out that they're just not compatible with regard to money and they're unable to negotiate these issues. But many people neglect talking about money until they're already in a relationship and it becomes a major problem.

If you and your partner or spouse are arguing about money, before this problem sabotages your relationship, get help. This is a common problem that can often be worked out with professional help.

Aside from the possibility of consulting with a financial planner who can help you with the "technical" nuts and bolts regarding money issues, consulting with a marriage or couples counselor can help you to navigate the emotional rough waters related to money problems.

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 couples to work out the emotional issues around money so that they can stop arguing about money and enjoy their relationship.

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.

Thursday, November 11, 2010

Psychotherapy: Ruptures and Repairs Between You and Your Therapist

In the last two blog articles, I discussed transference in psychotherapy in the context of the erotic and the idealized transference( Psychotherapy and the Erotic Transference and Psychotherapy and the Positive Transference). I also mentioned "ruptures" in treatment and discussed this briefly. 

In this post, I would like to focus on the effect of ruptures in treatment and how they can be repaired so that the therapeutic relationship between therapist and client can be preserved and, in many cases, even thrive after a rupture.

Psychotherapy: Ruptures and Repairs in Therapy

What are Ruptures in Psychotherapy?
In any long-term psychotherapy, there are bound to be treatment ruptures. Usually, these ruptures occur when the therapist unwittingly commits an empathic failure with the client. Even the most empathic psychotherapist will, at times, either misunderstand what a client is saying or give a response that is less than empathic. This is usually not intentional. It's a mistake.

When a client, especially a client who might be emotionally fragile, feels that his or her therapist has been either insensitive or doesn't hear or understand what the client is saying, the client often experiences this as a rupture in treatment. 

Sometimes these ruptures are small, as when a therapist forgets a particular small detail of a client's history and this becomes obvious to the client. And sometimes, these ruptures can be big, and I'll give an example of this later on.

Whether the rupture is perceived by the client as big or small is determined by many factors, including the strength of the therapeutic relationship at the time of the rupture, how fragile the client is feeling what the therapist actually did or said and so on

If the therapeutic alliance is strong and there haven't been many ruptures in the past, clients can overlook a therapist's mistake, especially if the client knows that this was a mistake. 

However, if the client and therapist have just begun to work together or if there have been frequent ruptures or if the client has a personal family history where he or she was neglected or abused, any kind of empathic failure can lead to a big rupture between client and therapist.

If there are egregious offenses by the therapist, like sexual boundary crossings or other serious offenses, this not just a rupture. This is a serious ethical and legal breach, and that's not what I'm referring to in this article.

How Can Ruptures Be Repaired?
If we consider that in most long-term psychotherapy treatments there will be inevitable and unintentional empathic failures or mistakes on the part of the therapist, how can these empathic failures be addressed and repaired so that the rupture doesn't lead to the failure of the treatment?

The most important part of repairing a rupture in treatment is for the therapist to be able to acknowledge that he or she made a mistake. Except for the most narcissistic psychotherapists, most therapists can and will do this. Even if it wasn't originally perceived as a "mistake" by the therapist, once the client feels misunderstood or not heard, the therapist needs to acknowledge and take responsibility for it.

Almost any rupture, if it's not egregious, can be repaired in treatment if the therapist acknowledges that he or she either made a mistake or failed the client in some way. For most clients, the acknowledgement on the part of the therapist that there was a mistake or the client was hurt in some way is often enough to repair the treatment.

Ruptures in Therapy Can Be Repaired

Many clients have grown up in homes where their parents never owned up to mistakes they made, so the experience of having the therapist take responsibility for an empathic failure can be reparative in itself, especially if the client feels that the therapist's acknowledgement is heartfelt.

Even Experienced and Skilled Therapists Can Commit Unintentional Empathic Failures:
I remember early on when I was training to be a psychotherapist at a psychoanalytic institute, my peers and I were very concerned about making mistakes in treatment. As therapists in training, most of us feared that our inexperience could lead to irreparable damage to clients.

In the context of a discussion about empathic failures, one of our instructors, who was much admired, told us a story about a rupture in treatment due to an empathic failure that he had committed with a client. 

Before I discuss what the empathic failure was, I should mention that not only was this instructor much-admired by the psychoanalytic trainees and faculty, but most of the trainees had a strong idealizing transference for him, which relates to my prior blog post.

Most of us, at the time, were very surprised that someone of his talent and skill could make such a mistake. This is another example of the effects of the idealizing transference between students and instructors.

Our instructor was well aware of this and he used the story he told us not only to show that ruptures can be repaired in treatment but in his humility, to show that even seasoned and skilled therapists can make mistakes in treatment. He didn't want us, as therapists in training, to be so afraid of making a mistake that we would be too self conscious with clients, which would have, in and of itself, interfered with treatment.

His main point in telling us about a mistake that he made was: While it's not great to make mistakes with clients, in most cases, it's not so much about the mistake that leads to the rupture-- it's more about how the therapist handles the mistake and repairs the rupture.

To that end, he told us about a time when he forgot about a client's appointment and he left the office. The client had been coming to treatment for a few years, and he had a great deal of difficulty trusting people, including his therapist.

During these sessions, the client often talked about wanting more from the therapist in terms of being more like friends rather than client and therapist. Since this would be an ethical breach of the treatment frame, the therapist explained, as gently and tactfully as possible, that this wasn't possible and explained the reasons why.

Most clients would understand that the client-therapist relationship, albeit caring and, at times, intense, is still a professional relationship. However, some clients, for a variety of reasons (sometimes, due to a history of neglect or abuse), want more from the therapist and it's up to the therapist to preserve the safety of the therapeutic relationship and the treatment to maintain the treatment frame.

All of this is to say that, even after a few years of treatment where the client came multiple times per week and kept his appointments, the therapy sessions were often rocky because the client wanted a more personal relationship with the therapist and, in some ways, he felt deprived that the therapist would not give in to his wishes.

So, in a nutshell, that's the background of the case, and you can picture many sessions where the client attempted to get the therapist to break the treatment frame and the therapist was holding the line for the sake of the client's emotional safety, although the client didn't realize it at the time.

One day, the therapist received a call from his young daughter's school that his daughter was sick and he needed to pick her up from school. At the time, the therapist had a very busy schedule that included a full-time private practice; being an instructor and supervisor at the psychoanalytic institute; involvement in various professional committees, and so on.

Tired, distracted and focused on his concerns about his daughter, he left the office completely forgetting about the client's appointment. He picked up his daughter, brought her home, and called the pediatrician. Fortunately, it turned out to be only a cold, and his daughter went right to sleep.

Relieved that his daughter didn't have a major illness, the therapist began to relax after a busy, stressful day. It was only then that he realized that he had forgotten about his client, something that had never happened to him before in his many years of practice.

Being very concerned, he called the client to apologize, but the client was too upset to accept the apology. He didn't tell the client that he had to pick up his daughter. It would have been too hurt for a client, who wanted more of a personal relationship from his therapist, to feel that the therapist's daughter took precedence over him. He simply apologized and told the client that he was called away from the office, he forgot about his appointment, and he was deeply sorry.

As an aside, one could speculate as to whether there was an unconscious wish on the part of the therapist to avoid dealing with this client on this particular day. While this might have been a factor, if and when that occurs, it's up to the therapist in this situation to do some self-analysis to explore this question.

In any case, the client was unable to accept the therapist's apology immediately. In fact, he focused on this empathic failure and the rupture in the treatment for about two months in every session. They were unable to move beyond this problem and it consumed the client's thoughts. Not only was the client very angry, but he was very deeply hurt that the therapist forgot about him.

This empathic failure fed right into his worst fear that the therapist really didn't care about him and he wasn't important to the therapist which, of course, was not the case at all. However, for a client who grew up with emotional neglect, he was very sensitive to any kind of empathic breach. In many ways, he was always vigilant and suspecting that this would happen because he found it difficult to trust people. So, in terms of empathic failures, this couldn't have happened to a more emotionally fragile client.

The therapist knew the client was unconsciously"testing" him. The therapist needed to withstand the client's anger and hurt to show the client he cared about him. 

After a few months of the client venting his anger and hurt and, together with the therapist, making connections to how this empathic failure triggered his history of emotional neglect, over time, the client and therapist were able to repair their relationship.

What's more, the relationship was more than just repaired to its former state, it was actually enhanced

Over time, the client was able to see that his therapist actually did care about him a great deal and that the empathic failure was an unintentional mistake. He realized that his therapist was human and he let go of some of his idealization (much as I and the other psychoanalytic trainees did on the day when our instructor told us this story).

Feeling cared about, over time, the client stopped demanding that the therapist be his friend. He realized that it was enough that the therapist was compassionate and cared about him.

As psychotherapists in training back then, we were much relieved to hear that, even a therapist who was known to be highly skilled, could make such a mistake. It served to take a lot of pressure off us, and I've always remembered this story.

For most clients, a sincere and caring apology can go a long way to repairing a rupture in treatment. And, in many cases, the reparative experience is more important than the rupture.

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

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 (917) 742-2624 or email me.

Wednesday, November 10, 2010

Psychotherapy and the Idealized Transference

In my last blog article, I discussed the erotic transference in psychotherapy. I also discussed the the overall meaning of transference in psychotherapy as well as transference in our daily lives outside of therapy sessions. In this blog post I will focus on the idealized transference in psychotherapy and how it can enhance treatment in many cases.

Psychotherapy and the Idealized Transference

What is the Idealized Transference in Everyday Life?
As with the erotic transference, most of us have experienced the idealized transference at some point in our lives. Examples of the idealized transference would include the idealization that a student might feel for a favorite teacher, a church member's idealization of a minister, or a young person's idealization of a political candidate (e.g., John F. Kennedy in the 1960s or Barack Obama in the last presidential election).

As with any idealization, there is usually some distortion with the idealized transference because no one can be perfect, ideal or even very good 100% of the time. There are bound to be times when the person who is being idealized will be off the mark. Depending upon the strength of the idealization and how much the person feels the need to put the idealized person on a pedestal, he or she will often rationalize the idealized person's mistakes in order to maintain this person on the pedestal.

What is the Idealized Transference in Psychotherapy?
Similar to any idealization, the idealized transference is usually more about the client's need to see the therapist as being all good or all powerful or always right, especially if the client is coming to treatment with a history of abuse or neglect or feelings of low self worth about him or herself.

How Does the Idealized Transference Form in Psychotherapy?
Every experience of the idealized transference will be different. Very often, if the psychotherapist maintains good boundaries, the client often doesn't know very much about the therapist, especially at the beginning of treatment. If the therapist is empathic and caring, he or she will provide a safe emotional "holding environment" for the client. All of this increases the likelihood that the client will develop a positive transference (he or she has good feelings about the therapist and the work they are doing together) and, in many cases, will idealize the therapist.

No matter how non-hierarchical or egalitarian the therapist is in treatment, there is still a power differential between therapist and client with the therapist being in the more powerful position. This occurs, in part, because the therapist sets and maintains the treatment frame with regard to time and fees. It also occurs because the therapist is considered "the expert" that the client comes to see. All of this feeds into the transference, whether the transference is positive, negative, eroticized or idealized.

This is not a matter of therapists creating the idealized transference and pretending that they're something that they're not. In fact, if therapists did this, in most cases, it would be counterproductive because most clients would see through any deliberate efforts to create an idealized transference. And in the particular case of a narcissistic therapist, who might actually believe in his or her perfection or an idealized self, most clients would sense the inauthenticity of this as well.

Rather, when the idealized transference occurs, it's usually a naturally-occurring phenomenon that stems from the client's need to idealize the therapist, often without even realizing it.

As discussed in my previous blog article, transference can form quickly, especially if a client is coming for multiple sessions per week, and the client is emotionally vulnerable and has the need to be with a therapist who is "perfect." For many clients, having someone that listens intently to them and is empathic might be a new and much-needed experience.

There are many issues that can affect transference, including treatment ruptures, where the therapist unintentionally makes a mistake that might be hurtful. These ruptures can usually be repaired if the therapist is willing to admit that he or she made a mistake. Often, it the rupture is handled well by the therapist, this can strengthen the therapeutic alliance between client and therapist, especially if the client grew up in an environment where the parents were unable to acknowledge mistakes. However, treatment ruptures is a topic for a future blog post.

What Are the Advantages of the Idealized Transference in Psychotherapy?If we think of psychotherapy as being a treatment with a beginning, middle and end phases, the idealized transference usually forms at the beginning and/or middle stages of treatment.

This is a period of time, if treatment is going well, when clients often internalize their therapists to the point where, even outside treatment sessions, when faced with problems or decisions, clients can ask themselves, "What would my therapist say about this?" At that point, the therapist becomes a sort of auxiliary mind that the client can call upon internally for support and wisdom. This is a normal, natural part of treatment when it's going well.

Being able to internalize the idealized therapist usually allows clients to make positive changes in their lives.

The following fictionalized scenario, which is a composite and not about any one client, will illustrate these points:

Ted was in his early 30s when he began attending psychotherapy for longstanding depression. His feelings of low self worth kept Ted from excelling in a career, and he was unable to form intimate, romantic relationships with women.

For years, Ted tried reading self-help books and going to workshops to overcome his depression, but nothing helped, and he knew now that he couldn't change his depression on his own.

Ted had never attended psychotherapy before, so he didn't know what to expect, and he felt anxious and ambivalent on the day of his first appointment. He almost cancelled the appointment, but he knew that he couldn't manage his feelings of low self worth on his own any more. In the past, he rationalized to himself that he didn't need therapy because he never felt suicidal so, in his mind, his depression wasn't so bad. But as time passed and he continued to feel stuck in his life, he knew he needed professional help.

During his first session, he was surprised that he actually felt comfortable and he was able to talk relatively easily to the therapist. He liked the therapist and also felt very comfortable in the office. He discussed his family history, including how depressed and anxious his parents were when he was growing up. He also talked about how critical his father was and how his father made him feel that he couldn't do anything right. He knew that his parents did the best that they could but, as an only child, he felt alone and lonely. He excelled at school, hoping to get his parents' love and approval, but they were too preoccupied with their own lives to pay attention to Ted.

By the time Ted went away to college, he went from being a "straight A" student in high school to being an average student in college. He had given up trying to please his parents, and he had such a poor sense of self that he didn't care about how he performed in college. He also felt socially inept, so he hardly attended any social activities. And when he did, he felt awkward and shy. He dated a few women, who took the initiative of asking him out, but nothing ever came of these dating relationships.

After Ted graduated college with a major in psychology, he took the first job that he could find as a sales clerk in a clothing store. He was bored and, on some level, he knew that he was underemployed, but he lacked the self confidence to get a job that was commensurate with his education.

Ted had a few close friends, but he had not dated anyone in over a year, and he felt lonely.

After he was in therapy for a couple of months, Ted began to admire his therapist. He really liked that his therapist listened to him attentively and that he was also so empathic with Ted and seemed to understand him. Ted had never experienced this before. He felt that his therapist cared about him, and he looked forward to his sessions.

Ted imagined that his therapist was everything that Ted was not. He didn't know anything about his therapist's personal life because they focused on Ted in their sessions, but he imagined that his therapist was happy in a relationship and successful in his private practice. He imagined that his therapist was everything that Ted wanted to be in his own life.

Without realizing it, Ted began to change the way that he dressed so that it was similar to his therapist's appearance.

He also liked looking at his therapist's book shelves, and he was fascinated by all the psychology books. Ted used to enjoy reading psychology but, other than self-help books, he stopped reading scholarly psychology books. But when he noticed his therapist's books, he felt more curious and open again, and he started taking out these same books from the library, and this re-ignited his interest in psychology.

Whenever he encountered problems outside of treatment, Ted asked himself what his therapist might say. And, when he spoke to friends, he often spoke highly of his therapist to them.

Step by step, Ted began making changes in his life. After about six months, Ted began to feel a sense of optimism again. He was beginning to see a glimmer of a possible future for himself. He began having thoughts about going to graduate school for psychology or clinical social work. Just having these thoughts was surprising to him. This was the beginning of an upward spiral for Ted.

As he talked to his therapist about his thoughts about going to graduate school, his therapist encouraged him to explore various possibilities. Ted began to fantasize that he might have his own psychotherapy private practice one day.

About a year later, Ted began attending social work graduate school. He continued in therapy and he often spoke to his therapist about his internship. It was during this internship that Ted realized that he didn't like seeing clients one-on-one as much as he had anticipated.

This was a surprising disappointment to him. He discovered that he really liked his community organizing classes. There seemed to be two primary groups at his university, those who wanted to go into psychotherapy private practice and those who were passionate about community organizing.

Ted began forming friendships with the students who wanted to be community organizers. He liked their ideas and their passion. He also felt that he could help many more people if he became a community organizer than if he became a psychotherapist and worked with people one-on-one.

This made him wonder why his therapist became a psychotherapist and not a community organizer. It was the first time that Ted began to have some doubts as to whether he wanted to be just like his therapist (or as he imagined his therapist to be). This made him feel a little sad because, until then, he thought of his therapist as being "perfect."

Ted was able to discuss this with his therapist, including the sadness that he felt about it. At first, he was hesitant to tell his therapist that he had some doubts about him for his career choice. But what came out of these discussions was very important: Ted was beginning to see his therapist as a person and not as an idealized figure. He was also beginning to see himself as a separate person from his therapist who could have his own feelings and ideas.

Over time, Ted was able to achieve some balance in his feelings and perceptions about his therapist. He still liked his therapist and found their sessions to be very valuable to him, but he no longer idealized his therapist and he felt comfortable with that. Along the way, he also developed more confidence in himself, and he began a relationship with a woman that he met in his social work program.

A year after Ted became a community organizer and he and his girlfriend moved in together, he successfully completed treatment. During the final stage of treatment, Ted and his therapist reviewed their work together and Ted had a sense of how far he had progressed. He also knew that he could return to see his therapist in the future.

As demonstrated above, the idealized transference is often useful in helping clients to make positive changes in their lives during the initial and middle stages of treatment. The client uses his or her own idealized fantasies and projections about the therapist to make personal changes.

There are times when the idealized transference is not resolved because the client has a need to maintain that view of the therapist. Not only is this true about clients coming into therapy, but it is often true of psychoanalytic students at institutes, some of whom never lose their idealized view of their psychoanalysts. But, once again, this is another topic.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR therapist who works with individual adults and couples.

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

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