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

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: http://www.traumahealing.com.

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.

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 hypnosis, EMDR (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.

Conclusion
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: http://www.gaycenter.org.
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: http://www.glnh.org.

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. : http://www.pflag.org.

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.

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

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.

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:
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.

Triangulation in Families and Love Triangles

This article was updated on September 15, 2026.

When we think of "triangles" in relationships, we often associate them with "love triangles" where a person is romantically involved with two people at the same time. 

Triangulation in Families and Love Triangles

Typically, we think of two people who are married or in a primary relationship who are having an affair with someone else. These relationships are often complex. 

Less talked about are triangles in family relationships and how this can lead to "love triangles" when children from these families become adults.

What is Triangulation in Family Relationships?

In certain families, members form unhealthy alliances against others in the family. This could be a mother and daughter against the father or a father and son against the mother or mother and son against the father or father and daughter against the mother, as well as other permutations of these triangular relationships.

In triangular relationships, there are usually two people against at least one other person. The two people who have aligned with each other usually have an unhealthy, enmeshed relationship with each other and the other person that they are aligned against is the odd one out.

Needless to say, these triangular relationships are emotionally unhealthy and detrimental to all members of the family, regardless of whether they are part of the enmeshed alliance or the odd one out. These triangular relationships form for a variety of reasons. 

Generally, there is a power struggle going on in the family and the two that are aligned are trying to have power over the other family member.

Often, when children, who are in families with triangular relationships, grow up, they tend to triangulate in their adult relationships, often leading to illicit affairs or to triangles in their own families with their spouses and children.

Clinical Vignette

The following vignette is a composite of many different cases:

Tom:
Tom grew up as an only child. As far back as he could remember, his parents were always arguing.

When he was seven years old, Tom's father, Scott, started confiding in Tom about how unhappy he was being married to Tom's mother, Nancy (see my article: What is Parentification and Why Is It Traumatic?).

Tom would listen to his father, happy to spend time with him. Sometimes, he worried that his father would leave the household so, he made sure to pay extra special attention to his father's complaints, even though he didn't understand them.

Even though he didn't understand, Tom still felt it was important to be on his father's side. When he saw how unhappy his father was and he feared that his father would leave the household and abandon him, he felt very angry with his mother. 

Often when he was alone with his mother, he would tell her, "Stop fighting with dad." Usually, his mother would respond by saying, "Your father is an idiot," which made Tom feel even more angry (see my article: What is Parental Alienation?).

Tom's parents sometimes argued at night and this kept Tom up most of the night. When it was time to go to school, Tom was too groggy to get up. 

 Often, this caused arguments between Nancy and Scott, with Nancy telling Tom that he needed to go to school, and Scott telling Nancy to leave Tom alone. 

Nancy usually left for work before Scott, and she would tell Tom to get dressed, eat his breakfast and go to school. But when they were alone, Scott would tell Tom that he didn't have to go to school and he could stay home with his paternal grandmother who lived downstairs.

Tom felt that his father was on his side since Scott allowed Tom to stay home. He especially felt this way when his mother got home and scolded him for not going to school and his father defended him.

Even after his grades began to slip, Scott allowed Tom to stay home from school when he didn't want to go. During that time, Tom's school engaged in "social promotion" so that even though he was not doing well, they kept allowing him to go to the next grade.

This pattern continued into Tom's adolescence. It seemed that Nancy and Scott had completely different ideas about child rearing. When Tom was 14 and Nancy found out that Tom was smoking, she hit the roof and forbade Tom to smoke. 

 But when they were alone, Scott would provide Tom with cigarettes, and Tom thought this was "cool" of his father. When Nancy got home, she detected the cigarette smell on Tom and she and Scott would get into a screaming match.

By this time, Tom saw his father as "the cool one" and his mother as "the witch." Around that time, one day when Nancy and Scott were fighting about Tom failing his classes in junior high school, Tom lost his temper with his mother and told her to "shut up." He was filled with such rage against her that he felt like hitting her, but he punched the wall instead and broke his knuckles.

Nancy and Scott argued all the way to the ER. Seeing the dysfunctional family dynamic, after attending to Tom, the ER doctor recommended that the three of them attend family counseling. Nancy agreed, but Scott and Tom refused to go.

By the time Scott was 16, he was smoking marijuana with his friends. One of those friends' mother called Nancy and told her that her son was smoking marijuana with her son and she wanted to put a stop to it. When Nancy told Scott about it, he brushed it off and told her that she was making too big a deal about it. When Tom got home, he found his parents arguing about it and he aligned with his father against his mother.

After Tom moved out on his own, his parents decided to get a divorce. Tom still had a lot of anger towards his mother. He felt that she was always trying to stop him from doing things that he wanted to do, but he thought that his dad understood him. He also thought his father was better off without her.

When Tom was in his mid-20s, he entered into a relationship with Ann. At first, he enjoyed being with her and he had fun. But as the relationship got more serious, Tom became fearful of the intimacy. He knew that he loved Ann, but he often found the relationship to be "too intense."

One day, he met Susan at a local bookstore, and he started dating her without telling Ann and without telling Susan that he was supposed to be in a monogamous relationship. Once he began the affair with Susan, even though she was unaware of it, Tom entered into a classic "love triangle".

After he began dating Susan, he felt more comfortable in his relationship with Ann. Whenever he felt that things were getting "too intense" with Ann, he would go out with Susan. After a while, he got good at juggling these two relationships. But one day, Susan confronted him by telling him that her friend saw him with Ann and that it was obvious that he was in a relationship with her.

Tom tried to lie, but he knew that Susan knew the truth, so he admitted that he was in a primary relationship with Ann. He expected that Susan would leave him, but she told him that she didn't want to end their relationship and she begged Tom to leave Ann for her.

Tom wasn't sure what to do. He liked seeing both women and he wasn't sure if he would be happy with just one of them. He considered Ann to be his primary relationship and, after he thought about it for a while, he told Susan that he wasn't leaving Ann. To his amazement, Susan continued to see him, knowing that she was "the other woman."

Then, one day, Susan found Ann's telephone number on Tom's cell phone and called her. She told Ann all about her affair with Tom and that she would wait for Tom to leave Ann. When Ann angrily confronted Tom about this, he felt that Ann was overreacting. He left Ann to go be with Susan that night, and the two of them aligned with each other and agreed that Ann was blowing things out of proportion.

Susan told Tom that she would never leave him and she would wait for him as long as it took. Tom was very flattered by this. In the meantime, Ann threatened to leave Tom if he didn't end things with Susan. When Tom told Susan this, she told Tom that Ann couldn't really love him that much if she was threatening to leave and she was the one who really loved Tom, not Ann.

Two weeks later, Ann ended the relationship with Tom. He was surprised that he missed her as much as he did, even when he was with Susan. He tried to get Ann back, but she refused to see him or take his calls.

Susan was thrilled that Ann was out of the picture because she thought that now she would have Tom all to herself. But once Tom was no longer in a "love triangle" with Ann and Susan, he began to feel very uneasy. He didn't want to spend all of his time with Susan. It frightened him and he felt it was "too intense." So, when he met Linda, he began dating her without telling Susan--until Susan found out and she left him.

Tom's relationships continued in this way until he was in his 30s and he began to feel that his life was empty. He continued to create "love triangles" without fully understanding why. By the time his next relationship with a woman named Amy ended, he felt despondent and exhausted. He loved Amy more than any other woman that he had ever loved and his feelings frightened him more than ever, which lead him to engage in his usual pattern--to cheat on her as a way to distract himself from his scary feelings.

After Amy left him, Tom realized that he couldn't continue to live his life this way, and he began psychotherapy. His psychotherapist helped Tom to understand the connection between the triangular relationship he had with his father and mother and the "love triangles" that he formed in his romantic relationships. He realized that he had a lot of hard work to do in therapy to overcome his fear of intimacy so he could have a healthy relationship.

Over time, Tom was able to confront his fear of intimacy. He entered into a relationship with Betty and, whenever he felt tempted to act out by going outside their relationship, rather than act out impulsively, he talked about it with his therapist and avoided the impulse to act out. He also worked through the effects of his dysfunctional relationship with his parents.

As the above fictionalized account illustrates, people who create "love triangles" in their relationships often (although not always) grew up in families were there was triangulation. When they become adults, triangulating seems normal and natural to them and, not only will they do this in their romantic relationships, but they often create these triangles in their friendships, pitting one friend against another.

Triangles in families and in romantic relationships usually give the person at the head of the triangle (like Tom) the sense of power. Triangulation also serves as a defense against feeling alone and vulnerable. It usually creates havoc in families and romantic relationships and is detrimental to all involved.

Getting Help in Therapy
If you are aware that you tend to create triangles in your family or your romantic relationships, you owe it to yourself and your loved ones to get help. 

Rather than continuing in destructive patterns that are damaging to yourself and to those you care about, with professional help from a licensed psychotherapist who has expertise in this area, you can learn how to function in healthy and loving ways in your relationships.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, IFS, Somatic Experiencing and Certified Sex Therapist.

I have helped many individuals and couples overcome the detrimental effects of triangulation so that they can have more satisfying relationships.

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

I offer a free 15 minute phone call before setting up an appointment.

I see clients in person in my office in Greenwich Village in New York City and online.

You can reach me at (917) 742-2624 during regular business hours or email me.