NYC Psychotherapist Blog

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Sunday, January 31, 2010

Overcoming Adult Separation Anxiety Disorder

Up until about 15 years ago, separation anxiety disorder was mostly discussed in psychotherapy literature as it related to children, not as a problem that adults have. And, yet separation anxiety disorder is a phenomenon that has been experienced by adults for hundreds (if not thousands) of years. 

Now that it is more widely recognized and treated by psychotherapists, there is a greater recognition that adult separation anxiety disorder is a problem that exists in about 6-7% of the adult population, which is significant.

Overcoming Adult Separation Anxiety Disorder

Traditionally, separation anxiety has been viewed as a normal development in some infants starting at about the age of seven or eight months when babies begin to become aware that their caregivers are separate from them. 

As most children develop over time, they realize that even though their caregivers might leave the room, they still exist and will come back. For most children, this resolves separation anxiety, unless they have anxious caregivers, there are problems with bonding with their caregivers, or there is some other disorder or problem that causes them to feel anxious when their caregivers leave them.

Episodic Separation Anxiety vs. Separation Anxiety Disorder:
It's not unusual to have some degree of separation anxiety as an adult at certain points in your life (e.g., after the death of someone close to you or when experiencing other losses). This would be considered episodic separation anxiety. However, adult separation anxiety disorder is a recurrent and persistent problem that is not linked to anything objective that is going on in a person's life at the time.

Typical symptoms of adult separation anxiety disorder are:
  • Recurrent excessive worry about separating from a place or a person that you are close to (like a spouse)
  • Persistent and recurring fear about losing people close to you or that something bad will happen to them (when there is no objective reason for feeling this way)
  • Recurrent reluctance to go to school or work or go elsewhere due to fear of separating from someone close
  • Persistent and excessive fear of being alone
  • Persistent and excessive fear or reluctance of going to sleep without having someone who is close to you in the house or nearby
  • Repeated complaints about headaches and other physical symptoms when you are separated from the person or people that you are close to
  • Recurrent nightmares about separation
  • This anxiety causes significant impairment in one or more major areas of your life (e.g., your relationships, work life or in other significant areas).
  • These symptoms last a month or more, and they are not attributable to any other physical or emotional causes.
The following fictionalized scenario is an example of adult separation anxiety disorder:
Maureen was a married woman in her mid-30s when she started psychotherapy to deal with separation anxiety disorder. She had gone to her primary care doctor, at the insistence of her husband, because she would become extremely anxious and worried whenever her husband wanted to do anything on his own or when he was not around her for even a short period of time.

Overcoming Adult Separation Anxiety Disorder

It didn't matter if they had spent the entire day together and he wanted to go out for a short walk on his own to clear his mind. Maureen would become extremely anxious and worried at just the thought of her husband being away from her. She would become upset, tearful and angry if he told her that he preferred to go out on his own for his walk and not with her. She was convinced that something awful would happen to him (e.g., he would get hit by a car or someone would kill him or kidnap him) and she would never see him again.

At work, she would call him several times a day to "check in" and if she couldn't reach him, she would panic: What if something happened to him and no one knew how to contact her? When she finally reached him, she was a nervous wreck and this would anger him. He felt that she was too "clingy," "needy" and "insecure," and he told her that if she didn't get help, he didn't know how much longer he could deal with this.

Maureen's primary care doctor recognized the symptoms of adult separation anxiety disorder. He told her that he was not qualified to treat her, and he advised Maureen to see a licensed psychotherapist. Maureen's therapist took a detailed psychosocial history and provided Maureen with psychoeducational material about adult separation anxiety disorder.

They also began using clinical hypnosis to help Maureen to calm herself and to internalize a felt sense of a loving, caring figure in her life (in this case, it was her grandmother) that she could call on in her mind when she felt extremely anxious. After a while, she was able to mentally call on this loving person in her mind with ease and feel a secure attachment to her.

Overcoming Adult Separation Anxiety Disorder

Maureen worked hard in therapy and attended her sessions regularly. She learned that there would be no quick fix for her problem. However, over time, with the help of her therapist, Maureen's separation anxiety dissipated and her relationship with her husband improved.

Why Clinical Hypnosis?
There are many ways to treat adult separation anxiety. Clinical hypnosis is a safe and effective form of therapy. It allows you to relax enough to get to the unconscious causes of the problem. You maintain a dual awareness of the here-and-now as well as whatever comes up in the clinical hypnosis session. It also allows you to discover if you are being triggered by other prior events in your life.

Clinical hypnosis is usually faster than regular talk therapy--although, for adult separation anxiety disorder, it's important to understand that this is not a 3-5 session treatment. Separation anxiety disorder is a complex problem and requires a lengthier treatment, even with clinical hypnosis, than some of the other problems that lend themselves to short-term hypnosis treatment, like smoking cessation.

When seeking clinical hypnosis treatment, always make sure that the person you plan to see is a licensed mental health practitioner and not a lay "hypnotist." As I've mentioned in prior blog posts about clinical hypnosis (also known as hypnotherapy), there is a big difference with regard to the education, clinical expertise and skills between a hypnotherapist and a lay "hypnotist."

If You Suffer with Adult Separation Anxiety, Seek Help from a Licensed Psychotherapist:
If you suffer from adult separation anxiety, the people around you might not understand what is happening to you. They might tell you that you're being dramatic or immature. They might also tell you that you "just need to get over it." But for you, the symptoms are very real and painful. Rather than suffering alone, you could benefit from seeing a licensed psychotherapist who has experience working with clients who suffer with adult separation anxiety disorder.

There are many ways in psychotherapy to work with clients who have separation anxiety, including a combination of cognitive behavioral treatment, psychodynamic psychotherapy, EMDR and clinical hypnosis. You want to find a therapist who tailors treatment to the individual client's needs.

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

I have helped many clients overcome adult separation anxiety.

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.

Friday, January 29, 2010

Your Anxiety or Depression Could Be Having a Negative Effect on Your Relationships

As a psychotherapist in New York City, I often see clients who begin psychotherapy after spouses or partners have spoken to them about how their anxiety or depression are affecting their relationships at home. Often, people don't recognize that they might be experiencing depression or anxiety until someone close to them or someone at work tells them about the impact that it's having with people around them.

Anxiety and Depression Could Be Having a Negative Effect on Your  Relationships

The following vignette is a composite of a psychotherapy client who began psychotherapy after his wife spoke to him about his anxiety and depression and how it was affecting his relationshp with her and their children. All identifying information has been changed to protect confidentiality:

Jack was a man in his late 50s. He and his wife were married for over 20 years and they had two teenage children.

When Jack first came to see me in my psychotherapy private practice, he talked about how his wife had a difficult talk with him a few weeks before, telling him how his depressed and anxious mood affected their relationship as well as his relationship with their children.

After their talk, Jack realized that he was having many of the typical symptoms of depression and anxiety that he had heard about on TV commercials about antidepressants and that he had read about: insomnia, irritability, a feeling of foreboding that something bad was going to happen to him, decreased appetite, feeling like he wanted to isolate himself, and feeling sad and anxious most of the time. He had been feeling this way for months, but he hated to go to the doctor and he thought it would eventually pass.

Anxiety and Depression Could Be Having a Negative Effect on Your Relationships: Jack and His Wife Had a Talk

After his wife spoke to him and told him that she was finding it difficult to be around him and his children were trying to avoid him when he came home from work, in hindsight, he recognized that his depressed and anxious mood was getting worse.

He realized that, in many ways, he had been in denial about his anxiety and depression. He also realized that his mood was affecting his relationships with his colleagues and subordinates at work. Since he did not want to alienate his family or his colleagues any further, he went to his primary care doctor.

Jack was almost hoping that his doctor would find a medical reason for his depressed and anxious mood. He also hoped that, even if his doctor couldn't attribute his mood to anything medically wrong with him, at least, maybe the doctor could give him a pill to help him feel better.

But, to Jack's surprise, his doctor ruled out any medical cause for his mood and counseled Jack that medication alone is not as effective for anxiety and depression as psychotherapy with medication or even psychotherapy alone. He provided Jack with psychoeducational material about depression and anxiety, advised him to try psychotherapy first before he tried medication, and gave him my telephone number to set up an appointment for psychotherapy.

Jack procrastinated calling my office for a couple of weeks, going back and forth in his mind whether he felt that he really "needed" psychotherapy. He called his doctor again and his doctor urged him not to wait--to call my office and begin psychotherapy. Jack had been going to his doctor for a long time, and he trusted doctor so, even though he had some misgivings about psychotherapy, he decided to follow his advice.

When Jack came for his initial psychotherapy consultation, I asked him if he had ever felt this way before. Jack thought about it and realized that he had felt depressed and anxious off and on since he was a child. He had never thought about it before, but my question made him realize that he had at least five or six prior episodes of depression and anxiety in the past.

Over time, we worked on helping Jack to overcome his depressed and anxious mood. Once he began to manage his current stress and work on the underlying issues that precipitated his depression and anxiety, Jack's relationships with his wife, children and colleagues improved. He felt better than he had in a long time.

The Impact of Anxiety and Depression on Your Relationships:  Jack's Relationship With His Wife Improved After He Began Therapy

This upward spiral, in turn, became an incentive to continue in psychotherapy and he became more internally motivated to make other improvements in his life.

Denial Can Be a Powerful Factor in People Avoiding Dealing with Depression and Anxiety:
Denial can be a powerful factor in people with depressed and anxious mood from seeking help. People often will deny to themselves that they are feeling what they are feeling.

Even if they admit to themselves that they don't feel like themselves, they also might tell themselves that their depressed and anxious feelings will go away or they attribute their mood to outside factors (e.g., the weather, their boss, their age, etc).

But it's usually harder to ignore that there's something wrong and that you need to do something about it when people close to you tell you that your mood is not just affecting you--it's having a negative affect on them as well.

Depression and Anxiety Often Go Together:
Depression and anxiety often go hand in hand. Sometimes, people start by feeling anxious and their anxiety triggers depression, and sometimes it's the other way around. Often, depression and anxiety don't go away by themselves without professional help.

Getting Help in Therapy
If you've been experiencing depression or anxiety for more than a few weeks, don't suffer alone. 

You owe it to yourself and your family to seek professional help with a licensed mental health professional.

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

I have helped many clients to overcome depression and anxiety.

To find 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.

Wednesday, January 27, 2010

Overcoming Low Self Esteem

As a New York City psychotherapist, I often see clients who come to psychotherapy because they want to overcome low self esteem. In my prior psychotherapy blog posts I've addressed issues of self esteem from different vantage points. In this post, I would like to discuss the link between self esteem, a sense of self mastery (also called self efficacy) and learning the life skill of self discipline.

Overcoming Low Self Esteem

The Importance of Learning Self Discipline, Self Mastery and Developing Healthy Personal Habits as Children:
Having a sense of self discipline, developing healthy personal habits, and a sense of self mastery are important to personal development and our sense of self esteem. These traits begin to develop, without our realizing it, when we're children.

When children learn to develop healthy habits like learning to put away their toys after they play, doing simple age-appropriate chores around the house, keeping their word about the commitments that they make, and so on, they're learning important life skills that are essential to their development beyond the particular chore or event that is involved. They're also learning to be responsible and deal with certain aspects of life that they might not want to do but that are essential to every day life as well as their personal growth and development.

Learning Healthy Habits as Children

When children don't learn to master certain chores or develop healthy personal habits like the importance of getting up on time, doing homework and turning it in when it's due, keeping their word about a commitment that they've made (and so on), they often have a much harder time as adults dealing with more mature issues in their work and personal lives than children who have gradually learned these life skills over time when they were growing up. Not learning these skills can also have a profound effect on a person's self esteem as well as how others view them as adults.

As a psychotherapist, I hear from many adult clients who talk about how frustrated they feel that their teenagers and young adult children have not developed healthy personal habits and self discipline and how this has affected the children's self esteem. These clients are often concerned that their children's lack of self discipline will not bode well for their chances out in the world with regard to personal relationships, school, and career.

 They fear that their children are just drifting without purpose and that they might have a hard time setting goals, holding onto a job or maintaining healthy relationships later in life. They talk about children who only want to do chores when they want to do them (or not at all), who spend most of the weekend loafing around or playing video games, who have no healthy routines, and they worry: "How is my child going to make his way in the world?"

When I hear clients who express these concerns about their teenagers or young adult children, I can understand why they're concerned. As any responsible adult knows, there are many things that we might not want to do, but we know that we must as essential parts of our lives. For instance, even if you think you have the most interesting job in the world, there are often parts of work that you don't like or you might find boring or unfulfilling.

 Imagine telling your boss that you just "didn't feel like" doing those aspects of your job, or you procrastinated doing them so that your boss had to come to you several times to ask about them, or if you pretended not to hear your boss because you were listening to your music (some of you who have teens might relate to this). After a while, you might not have that job for long. Aside from how your boss and colleagues might feel about you, you probably would not feel good about yourself and it would start to erode your self esteem.

Learning to develop healthy habits and self discipline should start gradually when you're young. Even young children can begin by learning to do simple tasks. Is it possible that they might grumble, pout or cry when you ask them to do simple things like learning to put away their toys when they're done playing? They might. They might question you as to "why" they need to do this or tell you that they don't want to do it.

They might test the boundaries with you in many ways. As a parent, you might even tell yourself that you would do it better and quicker and use that as an excuse to yourself to avoid having a confrontation with your child. But the importance of your child learning to do these simple chores is not only about the chores themselves--it's about their learning self discipline, responsibility and a sense of self mastery. They are probably too young to realize this but, as an adult, you know it.

Learning to do simple tasks, as a child, as well as learning to keep your word is also about learning to deal with your emotions when you feel annoyed and frustrated about something that you don't want to do--or just life, in general. Whether it's about learning to make your bed, practicing the piano or doing other things that you might not want to do at the moment because you're thinking about doing more interesting things, the skills that you learn by doing these tasks anyway (even when you don't want to do them) become part of your emotional development as well because you learn how to tolerate frustration.

We've all witnessed or experienced two year old children when they are having temper tantrums. The parent who is able to withstand the child's temper tantrum with love and patience, while the parent stands his or her ground, is helping that child to develop emotionally. For instance, when a child doesn't want to leave the park when it's time to go home or doesn't want to get in the carriage and a parent sets limits with the child (in a loving way), that child, without realizing it, is gradually developing a tolerance for acceptable amounts of frustration.

In these situations, the child has tested the boundaries with his mother, the mother demonstrates that she knows best, the child has a temper tantrum for a while (maybe a long while) but, in the end, the child learns that he must do something that he doesn't want to do.

 More importantly, he learns that he has survived in this ordeal, and that his mother has survived as well (although she might feel inwardly exasperated), and he learns that his mother still loves him and he still loves her. Can the two year old articulate these lessons? No. But, over time, we see the evidence of this in his personal development as he grows and continues to learn these important lessons in life skills. We can see it as the child learns to take on bigger, more complex age-appropriate responsibilities as they grow. We also see it in their sense of confidence.

Similarly, when a child learns life skills like keeping her word and following through with commitments , she will be better equipped as an adult to maintain her adult commitments. But when a child doesn't learn to develop these skills when they're younger, it's harder for them to keep their commitments when they're adults.

 If they haven't learned to develop a sense of the importance of keeping commitments and they only do certain things when they want to do them, they will probably struggle as adults. Lacking guidance from their parents as a child, they won't have internalized it as an adult. They will lack the internal emotional resources to deal with commitments and their only own internal "guide" might be whether they feel like it or not, which won't be acceptable in many circumstances in the outside world.

Lacking these internal resources as an adult will also affect how they feel about themselves. It's hard to feel confident, resourceful, and effective as an adult if your only guide to dealing with your responsibilities and commitments is whether you feel like it or not. You're definitely on shaky ground if this is your compass for functioning in the world. After a while, as friends, romantic partners and work supervisors refuse to put up with this, it reinforces an internal sense of incompetence and failure.

Conversely, when children learn to stick with their commitments and see the results of their efforts and diligence, it increases their self esteem and sense of self mastery.

 For instance, the child who learns to stick with practicing the piano on a regular basis (even though he would prefer to play video games at the moment) begins to make the link between practice, being diligent and responsible and a sense of self mastery. He sees that, over time, his time and effort has led to being able to play a certain piece of music with increasing skill. It becomes gratifying to him.

He also learns to translate this into other areas of his life: Studying and doing his homework, which might be boring in the short term, produces better academic results. Better academic results often leads to a more successful career. These life skills become an important part of his personal growth and development as well as his sense of self confidence.

It's certainly possible to learn to develop these life skills as an adult. I often work with clients in my psychotherapy practice helping them to learn these skills and this leads to a greater sense of self esteem. However, it's harder to learn when you're an adult and, often, by the time an adult comes to psychotherapy to deal with self esteem issues related to the lack of these related life skills, they have often struggled for a while in their relationships and career.

Getting Help in Therapy
If you're struggling with a sense of low esteem and you see that continuing on the same path has hindered your personal growth, you might benefit from working with a licensed psychotherapist.

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

I work with individual adults and couples.

I have helped many clients to overcome low self esteem to lead more fulfilling 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.

Tuesday, January 26, 2010

How to Reduce Emotional Reactivity in Your Relationship

In my prior psychotherapy blog posts I've discussed codependency in terms of the relationship between the person who has a substance abuse problem and the spouse or partner who does not. This is the classic example of codependency.

How to Reduce Emotional Reactivity in Your Relationship

As I've mentioned in those prior posts, the term codependency originated in the substance abuse field, however, the use of the term codependency has since expanded to include other relationships where there is no alcohol or drug addicted behavior. In this psychotherapy blog post, I would like to discuss the topic of overcoming excessive emotional reactivity to achieve emotional balance. Even if you're not in a codependent relationship, you might benefit from reading this post to learn how to be less emotionally reactive in your relationship.

Codependent Relationships:
Now that we recognize that codependency can exist in any relationship and there need not be alcohol, drugs, gambling or other addictive behavior involved, we have learned to expand our definition of codependency and recognize these dynamics in many different types of relationships. I will confine myself in this post to romantic relationships, but it is understood that codependency can exist in many different types of relationships.

As I've mentioned in my prior psychotherapy blog posts, when I discuss codependency, I'm not talking about relationships where there is normal dependency--like taking care of an elderly parent, a young child or someone who is disabled. I'm specifically addressing relationships where both people are mature and able-bodied, but one or both people are overly dependent on the other person in an unhealthy way.

In codependent relationships, one or both people usually over function for the other person in certain ways, often, in an effort not to deal with their own emotional issues. So that if one person is overly focused on the other person and overcompensating for that person, he has taken the focus off himself and his own issues. Often, what looks like purely altruistic behavior is also a defense to avoid dealing with his or her own problems ("I'm not the one with the problems--it's him"). In prior posts, I've given composite examples of codependent dynamics in relationships, so I won't repeat them here.

Why do People Become Overreactive in Codependent Relationships?
Often, people who are emotionally reactive haven't learned how to control their emotions. So that when things don't go their way or when old problems persist, they often become emotionally overreactive and have a great deal of difficulty maintaining their composure. 

They might lash out by losing their temper, act out by cheating on their partner, get even by overspending or running up a credit card, cry uncontrollably to make their partners feel guilty, make threats, or engage in other dramatic displays of behavior. Aside from the fact that they're having problems managing their emotions, often, this emotional reactivity is meant to control the other person's behavior. And, while it might work in the moment, it's usually ineffective in the long run.

Detaching with Love:
Al-Anon is a 12 Step program for loved ones who are in relationships with people who have alcohol problems or who suffer with other addictive behavior. There is a concept in the Al-Anon literature called "detaching with love." I think this is one of the most misunderstood Al-Anon concepts that often confuses people and it's worth spending a little time defining what this means and how it can be put to good practice in almost any relationship (whether there is addictive behavior involved or not).

The concept of "detaching with love" addresses the emotional reactivity that is often involved in many relationships. I think this idea is often misunderstood because people who are highly reactive often feel that it means that they have to be cold, cruel, hard or they don't care about their partners. They might also feel that if they "detach with love," it means that they're not allowed to feel their feelings. However, this is a big misconception.

When we talk about "detaching with love,"we're really talking about still caring and loving your partner, but maintaining your emotional equilibrium when there's a problem between the two of you. It means that when there's an argument or tension in the relationship, you're able to step back, take the time to calm down (and, possibly, take a break, if needed) before reacting emotionally. It doesn't mean that you don't feel your feelings or that you're not entitled to your feelings. Rather, it means that you stop, calm yourself and think before you react emotionally.

Why is it Important to Overcome Emotional Reactivity?
Often, when people feel angry with their partners, their first instinct is to lash out in anger, especially if it involves an ongoing problem, whether we're talking about addictive behavior, jealousy or other problems. However, even if you get a sense of immediate gratification from lashing out emotionally, it quickly dissipates because your behavior usually makes the situation worse.

When you react emotionally, without stopping to think and calm yourself first, you say or do the first thing that comes to your mind. This is an impulsive gesture, which often leads to regret. Often, as soon do you say or do whatever has come to your mind, you feel badly about it. But, by then, the words are out and they cannot be taken back. That often leads the argument or problem to be taken into other unintended directions. At the very least, it doesn't solve the problem. Worse still, being overly reactive usually becomes habitual, which means the more you do it, the more likely you are to continue to do it.

Recognizing the Physical and Emotional Cues as a First Step to Becoming Less Reactive and to Develop Emotional Equilibrium
If you've grown up in a family where there was a high degree of emotional reactivity, being highly reactive might seem normal to you. But you have only to look at the results that it produces in your relationship (and the history in your family) and how you feel afterwards to realize that being highly reactive is not serving you or your relationship well.

Learning to develop emotional equilibrium takes time, practice and a good deal of patience, but it's worth the effort. The first step is to become aware of the feelings and physical cues within yourself that proceed your emotional reactivity. For some people, this might include certain physical reactions like clenched fists, tension in your stomach or other parts of the body, a strong feeling of energy surging through your body, feeling flushed, hands trembling, feeling lightheaded, feeling like you're going to explode, and other similar reactions. You might also notice your thoughts going in a certain volatile direction ("I hate him," "She's so stupid," "Why is he doing this to me?" etc).

When I discuss this with clients in my psychotherapy practice in NYC during the early stage of therapy, many clients will often tell me that there are no prior warnings or cues for them that they're about to lose their temper or overreact emotionally. However, I usually respond to them by saying that that there are, in fact, warning signals--they just haven't learned to recognize them yet. We know this because we recognize that there is a connection between the mind and the body, meaning that your thoughts and physical sensations are connected. Learning to recognize the warning signals or cues to emotional reactivity requires that you slow down. You might be justified in feeling angry or upset, but your anger doesn't entitle you to lose your temper or say or do things that you'll regret later.

Stress Management:
In order to learn to slow down, you need to find other ways to reduce your stress. Everyone is different, so each person must find his or her own way to handle stress, whether that means learning to meditate, taking a yoga class, going for regular walks, remembering to breath deeply, counting to 10, playing with your pet, talking to close friends, praying, attending an Al-Anon meeting, or whatever other healthy activity you decide to do to reduce your stress and level of frustration. If you're managing your daily stress so that it doesn't build up and spill over, you're less likely to lose your temper or overreact emotionally.

Once you're engaging in healthy stress management activities, you can learn to slow yourself down so that you begin to see and feel the cues that precede an overreaction. Once you recognize those cues, then you can make a deliberate choice as to how you want to handle the situation instead of being at the mercy of your emotions.

Learning to Separate Your Feelings about Your Partner's Behavior from How You Feel About Your Partner:
Once you've calmed down enough to gain some perspective, you might recognize that you still love your spouse or partner, but you don't like his or her behavior. That's an important distinction. Not liking his or her behavior is different from not liking your partner.

Ultimately, you might decide that the relationship isn't working and you might leave. However, you will have gone through the decision making process in a more emotionally balanced way rather than reacting impulsively. Breakups that occur on an impulse often bring the people back to Square One. They often feel that there was something important missing when they broke up, that they made the decision without thinking, and then they reconcile. But, often, nothing changes in the relationship. So, they are left with the same problem that they started with, and the cycle continues: anger, breakup, reconciliation, anger, and so on.

When you "detach with love" from your partner, you are stepping back emotionally to take a breath, calm yourself, and get some perspective on the situation. You're also taking care of yourself during this time because you recognize that becoming emotionally overwrought on a regular basis has physical and emotional consequences for you, your partner and also your children, if there are children involved.

Learning to be Less Emotionally Reactive Can be Difficult:
Learning to be less reactive and develop emotional equilibrium can be very challenging. Even after you've begun to make progress in developing more emotional balance in your life, it's not unusual for there to be lapses into old behavior. 

If being emotionally reactive has been a lifelong pattern, it's understandable that you might have some lapses in the process. (Of course, when I talk about lapses that are understandable, I'm not referring to domestic violence. If your anger leads to physical violence, you need immediate help to deal with your problems with anger management and, in the meantime, that might mean that you and your partner separate so that you're both safe.)

If you recognize that you've reverted to old behavior, rather than giving up, be compassionate with yourself and recommit to maintaining emotional balance. When you think about it, you might realize that you've stopped doing the things that helped you to stay emotionally balanced in the first place. It's easy to become complacent, especially after you've had a certain amount of success. So, re-establish the routines or healthy behaviors that helped you and begin again.

What to Do if You're Unable to Reduce Your Emotional Reactivity
If you've tried the suggestions that I've outlined above (including attending Al-Anon if you are in a relationship with an person addicted to alcohol or drugs) and you find that you're still unable to achieve emotional equilibrium, you might benefit from seeing a licensed psychotherapist who has expertise with codependent relationships.

About Me
I am a psychotherapist in NYC who has helped many individuals and couples to become less emotionally reactive so that they can develop emotional balance in their relationships.

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.

Monday, January 18, 2010

Clinical Hypnosis and Perception of Time

There was an article in the New York Times' Science section called, "Where Did the Time Go? Do Not Ask The Brain" by Benedict Carey that discussed our perception of time (http://www/ 

Clinical Hypnosis and Perception of Time

The article reminded me that our perception of time is also different when we experience clinical hypnosis, also known as hypnotherapy.

As a psychotherapist and hypnotherapist in NYC, clients, who experience clinical hypnosis in my private practice, will often tell me that they experience time differently in hypnosis.

Even though clinical hypnosis clients maintain a dual awareness (meaning that they are in a relaxed state and they are aware of everything going on in the here-and-now around them as well as what they are experiencing in the hypnotic state), they often experience a certain timelessness in hypnosis.

This is essentially because clinical hypnosis helps to access the unconscious mind, and there is no time in the unconscious. The unconscious is timeless. Whether we're experiencing what happened 20 years ago or what happened yesterday, the unconscious doesn't make a distinction.

The other phenomenon that occurs in clinical hypnosis is that, whereas it might take weeks, months or even years to resolve certain problems (phobias, smoking cessation, anxiety, depression, and other problems) in regular talk therapy, including cognitive behavioral therapy (CBT), very often, issues are resolved in 1-3 sessions in clinical hypnosis, depending upon the complexity of the issue.

This is is because, through clinical hypnosis, our unconscious minds can access the answers to our problems. We often don't know exactly how it happens, but it's not unusual, after a clinical hypnosis session, for the answers to our problem to come to us, seemingly, out of the blue. Of course, it's not really out of the blue or magical at all. It's the power of our own unconscious mind to access the solution through clinical hypnosis.

Getting Help in Therapy
Remember, when considering clinical hypnosis, there is a big difference between a lay "hypnotist" and a hypnotherapist with regard to training, skills, clinical expertise, and licensure. 

Always choose a licensed mental health professional who has advanced training in clinical hypnosis.

About Me
I am a psychotherapist and hypnotherapist in NYC. I have helped many clients overcome problems through clinical hypnosis.

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

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

Thursday, January 14, 2010

Explorations in Psychotherapy of the Road Not Taken in Life

As a psychotherapist in NYC, I see many clients who come to psychotherapy to explore decisions that they are currently faced with or decisions that they've already made and how those decisions are affecting their lives. These decisions often involve whether to take one path or another in their personal lives or in their careers, whether to stay or leave their relationships, or how to handle a particular crisis in their lives.

Explorations of the Road Not Taken

One of my favorite poems is "The Road Not Taken" by Robert Frost. I remember first reading this poem in high school. It had meaning for me then, and it still has meaning for me now in my own life as well as in my work as a psychotherapist when it often comes to mind.

The Road Not Taken - By Robert Frost
Two roads converged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down as far as I could
To where it bent in the undergrowth.

Then took the other just as fair
And having perhaps the better claim
Because it was grassy and wanted wear,
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black,
Oh, I marked the first one for another day!
Yet knowing how way leads on to way
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I,
I took the one less traveled by
And that made all the difference.

We all come to forks in the road at different points in our lives where we have to make decisions. At the time, we might not know where our decisions might ultimately lead later on in our lives. We make these decisions with whatever information we have, based on whatever is going on in our lives at the time, as well as our own psychological make up at that point.

The following vignette is an example of a client who comes to psychotherapy to deal with "the road not taken" in his life and the particular dilemma that he faced when he came to therapy. As always, this example is a composite of various clients with all identifying information changed to protect confidentiality:

When Bill first came to see me in my psychotherapy private practice, he was a successful oncologist and surgeon in his late 40s. He was recognized as one of the top oncologists in NYC who specialized in a particular form of cancer. He was well respected by colleagues, sought after by patients, very successful financially, and he loved his wife and children. Yet, he was deeply unhappy.

According to Bill, he originally wanted to be an engineer. He knew he wanted to be an engineer since he was a teenager. But, from an early age, Bill's father let him know that he wanted Bill to become a doctor. Bill's father and mother escaped their country of origin to come to the US when they were first married. Neither of them spoke English when they arrived. But they were both very intelligent and ambitious so they learned quickly, and both of them attended a top Ivy League college. Bill's mother became a scientist and his father became a professor. Both of them were successful, but Bill's father had always wanted to be a doctor. He didn't pursue a medical career due to pressures from his family for him to become a professor.

So when it came time for Bill to make a decision about choosing a major, he felt a lot of pressure from his father to choose pre-med. Bill didn't want to give up his dream to become an engineer, but he wanted very much to please his father. He described his father as a cold, reserved man who only showed any feelings towards Bill when Bill excelled in school. Bill knew that his father would be very disappointed if he didn't pursue a medical career.

So, when faced with the decision about choosing a major, Bill told himself that he would pursue a medical career but, at some point, like the narrator in "The Road Not Taken," he told himself that he would go back to college and pursue an engineering degree after he graduated from medical school. But as in the poem, "way leads to way," and life didn't turn out the way Bill had planned. He never went back to college for engineering. After he graduated from medical school with honors, he was faced with high student loan bills and a new marriage with young children. so Bill had to work hard to establish himself in his medical career and make money. He had no time, energy or money after medical school to go back to college for an engineering degree.

Bill enjoyed performing surgery and getting involved in cancer research projects. Those two aspects of his work were what he enjoyed the most. However, he really disliked the patient contact which, of course, was a big part of his work. He felt ill at ease dealing with patients' and families' emotions. He would usually leave that to the oncology social workers. And in those instances where it was apparent that nothing more could be done for a patient and the patient was facing end-of-life decisions, Bill would begin limiting his contact with the patient and the patient's family He couldn't tolerate what he perceived as a failure on his part to save the patient, and he could not deal with the patient's and family's emotions. So, he relegated that to the oncology social workers as well.

At first, Bill enjoyed the success and recognition that he received in his profession. He also knew that his father was very proud of him and boasted to his friends about "my son, the doctor." This made Bill feel happy at the time. And although Bill's father was never really affectionate with him, Bill felt that they became a little closer after Bill established himself as one of the top doctors in his field. But after Bill's father died, Bill began to feel lost, depressed and irritable. He was snapping at his wife and children, which he had never done before. He was even snapping at his staff.

But the incident that brought him into my psychotherapy office involved a particular interaction with patient and her husband after it became apparent that treatment was not going to save the patient. At first, as usual, Bill instructed one of the oncology social workers to discuss palliative care and hospice with this patient and her husband, as Bill withdrew from the case. However, the patient insisted on speaking to Bill, and she left several messages on Bill's voicemail. At that point, Bill felt it was his "ethical duty" to speak to the patient and her husband, but he felt backed into a corner.

His secretary arranged for a meeting and during that meeting the patient and her husband took Bill to task for his withdrawal at a time when the patient was facing her death. Bill listened to their complaints with increasing anxiety. He felt trapped and wanted to leave the room, but he couldn't. He kept thinking to himself: "What do they want from me? I've done the best I can. I can't do anything else for them!" When he felt he couldn't tolerate listening to them any more, he apologized to them for disappointing them and then cut them short in a curt manner, telling them that he had another patient waiting and they had to leave his office. When he looked up and saw the hurt and shock looks on their faces, he felt deeply ashamed, but he felt too emotionally paralyzed to do anything else so he let them leave.

Afterwards, when Bill got home, he began talking to his wife about what happened. He was in mid-sentence when he felt a profound sadness come over him and he began to cry. He was surprised at the depth of his feelings because he considered himself to be a logical, rational person and he was usually quite unemotional. At that point, his wife told him that she had been fearing for some time that Bill was in crisis, but she didn't think he would be open to talking about it with her. She suggested that he call the patient and her husband, apologize, and seek professional mental health, which he did.

Over the course of the next several months, Bill came to therapy on a weekly basis. The emotional crisis that he faced forced him to be more open than he ever would have been in the past. He admitted that, before coming to psychotherapy, he "didn't believe in" psychotherapy, and he thought that psychotherapy was for people who were "weak."

Over time, Bill realized that when he chose to be a doctor rather than an engineer, he sacrificed his dream, hoping desperately that his father would show him that he loved him. He dealt with his anger, sadness and resentment towards himself as well as his father. He mourned his father in a way that he had not done before. He also mourned the loss of an engineering career because he had no desire to return to college. And by the time he left treatment, he decided to focus on what he liked best, his research projects, and to stop seeing patients because he knew that he was not well suited for this. He also had a new found respect for psychotherapy.

A year after he left psychotherapy, Bill contacted me to let me know that he was doing well. He had transitioned into full time research work and he was much happier in his work life as well as at home.

Getting Help in Therapy
Attending psychotherapy with a licensed psychotherapist provides an opportunity to work through personal and career decisions, past and present, in a way that most people cannot do on their own or with loved ones.

If you're faced with decisions in your life and you're standing at a crossroads, not sure which path to take, or if you're not dealing well with the aftermath of decisions that you've already made, you could benefit from seeking the help of a licensed psychotherapist.

About Me
I am a licensed psychotherapist and hypnotherapist in NYC. I have helped many clients who are facing tough decisions or who are looking back on past decisions and how they have affected their 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 or email me.

Saturday, January 9, 2010

Leading a Double Life as the Other Woman or Other Man in an Affair

In prior posts, I've discussed affairs from the point of view of the people in the primary relationship, where one of the people in the relationship was having an affair, and how psychotherapy and couples/marriage counseling could help in these situations. In this post, I'd like to focus on the person who is the "other woman" or "other man" in the affair, some of the possible emotional effects of leading a double life in an affair, and how individual psychotherapy can help in these situations.

Leading a Double Life as the Other Woman or Other Man

Most People Begin Psychotherapy When the Affair and Leading a Double Life Becomes Too Painful:
As a psychotherapist in NYC, over the years, I've worked with many individuals who were leading double lives, having affairs with people who were in primary relationships with someone else.

Being the "Other Man" in an Affair

Usually, clients who are the "other woman" or the "other man" begin psychotherapy with me when they've come to a point where they're either trying to decide whether or not to end the affair or being in the love triangle and leading a double life has become too painful for them to endure, but they feel "stuck."

The Emotional Effects of Being the "Other Woman" or "Other Man" and Leading a Double Life in an Affair:
Being involved in a love triangle, from the perspective of the "other woman" or the "other man," can be very lonely. Often, the person who is in this situation feels too ashamed to talk to friends or family members about it because he or she fears their judgment or condemnation. So, very often, the affair is kept a secret and this person endures the emotional pain, including self condemnation, by him or herself. This is a difficult and lonely place to be.

Whereas the beginning of the affair might have started out as being mostly sexual and fun, if romantic feelings develop and you begin to feel attached to someone who is in a primary relationship with someone else, the feelings often turn to ones of hurt, longing, fear, anger, resentment and shame.

Expectations Change:
At the beginning of the affair, from the point of view of the "other woman" or "other man," there might not have been any expectations, but once a more serious attachment forms, this often changes. The longing and loneliness for the other person, especially on certain days, like weekends, holidays and birthdays, when the person in the primary relationship is not around, can be intense. It can feel overwhelming to deal with this by yourself.

The following vignette is a composite of various clients who were involved in affairs with someone who was in a primary relationship with someone else. All identifying information has been changed to protect confidentiality:

When Mary came to see me for individual psychotherapy, she had been involved in an affair with her graduate school professor, Dan, for almost two years. She was leading a double life, and she was feeling very lonely, sad, ashamed, angry with herself, angry with him, and resentful.

She knew he was married when she first got involved with him but, at the time, she felt swept away by his good looks, charismatic personality, intelligence, and all the attention that he was giving her. He made her feel "special." She had no prior history of getting involved in affairs, and she felt confused about the situation, confused about herself, and confused about Dan.

The affair began while she was helping Dan with a research project and they were spending many hours alone together after class. At first, Mary was satisfied just to spend time with him working on the research project, often going back to her place for hours of passionate sex, and allowing him to go back to his wife and children in the evenings. During that stage of the affair, she felt special, beautiful and sexy, and she was flattered by his attention.

But, as time went by, they both developed strong romantic feelings for each other, and then things changed. Mary began to resent that he left her for his wife after they made love. She wanted him to stay, but he didn't want his wife to suspect that he was having an affair, and he definitely didn't want to leave his wife and children.

At that point, what was once a fun affair for Mary turned lonely and sad. She began to resent being "the other woman" in his life and she wanted him to leave his wife to be with her. But time after time when Mary demanded more of his time and attention, although he said he loved her very much, he told Mary that he had no intention of leaving his wife.

Mary couldn't understand why, if he loved her (and she felt sure that he did), he wouldn't leave his wife to be with her. Before she began psychotherapy, she had a big "blind spot" about the fact that this man also really loved his wife and the life that he had with her, even though he was cheating on her.

Prior to therapy, Mary ruminated about this constantly and couldn't come up with any answers for herself, and Dan seemed just as confused. At that point, she was leading this secret double life, and she had no one to talk to about it because she felt too ashamed about it. So she continued to live a double life, kept the secret of the affair and her feelings about it to herself, which made it even more emotionally painful.

At the point when Mary began psychotherapy, she was considering giving Dan an ultimatum: "Either leave your wife and be with me or let's end this affair." But she had a lot of mixed feelings about this, and she couldn't make up her mind about it.

On the one hand, she felt she couldn't endure the feelings of sadness, loneliness, anger, fear and shame any more. It was beginning to feel too overwhelming for her, and it was taking up a lot of her time and emotional energy. Leading this double life, she was starting to isolate from friends and family because of the affair and her feelings about being involved in a love triangle. And it was also hard for her to concentrate on her studies.

Worst of all, Mary was feeling very bad about herself. She was plagued by self doubt, anger and humiliation. And, whereas initially, she felt special, attractive and sexy when she was with Dan, now she felt that she wasn't "good enough" because he wouldn't leave his wife.

This also triggered many old emotional wounds of not feeling "good enough" with her parents when she was a child. Her constant thought was, "If I were good enough, Dan would leave his wife for me, but I'm not. There must be something wrong with me. "

On the other hand, Mary felt that life without Dan at all would be unbearable. She thought, "Maybe I should just try harder to enjoy the time we have together and make him see that he really loves me more." But, at this stage, their times together were not so enjoyable. Mary and Dan were spending a lot of time arguing and crying together. He told her that he didn't want to hurt, he didn't want to hurt his wife, and he didn't want to lose either one of them--he wanted them both. He also didn't know what to do.

Initially, our work focused on helping Mary to develop better coping skills and to increase her support network. Her sleep and appetite were poor and she often felt angry, sad and irritable. As therapy progressed, she began to spend more time engaging in self care, taking yoga classes, learning to meditate, and going to the gym. Her sleep and appetite improved. Also, she began talking to her friends about what was going on.

Although, at first, she feared that her friends might judge her harshly, when we talked about it in our psychotherapy sessions together and she thought about it more realistically, she realized that her friends cared about her a lot and wouldn't judge her. And this turned out to be true.

Her friends were surprised, but they were compassionate and empathetic towards Mary. They told Mary that they wished she had come to them before.  They also helped Mary to remember "who she was" before Mary felt sad and ashamed about the affair. Mary's friends saw what I also saw: An intelligent, vibrant, outgoing, attractive woman who had a lot going for her.

Talking about the affair in our psychotherapy sessions, letting her friends know about the affair and getting so much emotional support took some of the pressure off of Mary. She still felt all of her difficult feelings, but she wasn't alone with these feelings any more, and she didn't feel she was leading such a double life any more.

After several psychotherapy sessions, Mary decided that the pain of being the "other woman" was more than she could stand and worse than being without Dan.

She began to understand that it's possible for someone (like Dan) to love two people at the same time, and this was probably what Dan was feeling. Increasingly, she also allowed herself to feel what it might be like to be Dan's wife under these circumstances. She wondered, even if he left his wife and married her, if he would be unfaithful to her as well. Whereas before she would push down any feelings of compassion for Dan's wife, she now felt more than just guilty--she felt remorse. She felt that the situation was unfair to everyone involved, including Dan's wife and his children.

Mary was also at a point where she was feeling better able to cope with the loss of the relationship with Dan. She knew it would be very painful, but she also knew that she had the support of our psychotherapy sessions as well as the love and support of her best friend. So, when they saw each other again, instead of slipping into their usual routine of going back to her apartment to make love, she told Dan that, as much as she loved him and she knew that he loved her, she thought it was best for them to end their affair. They both cried about ending their relationship, but Dan agreed that it would be for the best.

Even though she felt resolved to end their relationship, Mary was surprised that, when she did it, there was still a part of her that hoped Dan would tell her that he loved her too much to leave her. But he didn't. He said he also felt that it was too hard for him to go on hurting Mary and too hard to continue to cheat on his wife and risk hurting her. So, since the research project was over and Mary was about to graduate, they decided to end all contact.

The following weeks and months were difficult. Mary was tempted to call Dan many times and tell him that she missed him and wanted to see him, but she didn't. She continued to come to her psychotherapy sessions with me, talk to her best friend and, even though many times she didn't feel like, she began seeing old friends again and making new ones. The thought of never seeing Dan again was very hard for her so, through our work together, she learned to take it "one day at a time." Thinking about not seeing Dan for a day was a lot easier than thinking about never seeing him again. It was a process.

But, as it turned out, Mary did see Dan again--but not in the way that she would have ever liked to see him: She was leaving the university one day when she saw Dan waving to a woman who was in a car with two small children. Dan didn't see Mary, but Mary watched from the sidelines, feeling sad and bitter, as Dan kissed and hugged his wife and greeted his children. Dan looked so happy. Before seeing Dan on that day, Mary knew that he loved his wife and children, but seeing it made Mary realize it on a much deeper level: This was Dan's life, and Mary would never be a part of it. It hit home in a way that it never had before.

Mary went home and cried but, afterwards, she felt that something had lifted. The last vestiges of any hope that she might have had that, somehow or some way, maybe she and Dan would get back together again in the future were gone. She was sad, but she also felt free. Mary and I continued to work on the emotional aftermath of the affair. Rather than condemning herself, she began to understand, on a deep emotional level, the dynamics involved and the feelings that had been triggered in this affair from her family history.

Several months later, Mary began dating another man, and she fell in love. She realized then that having someone who was available and who cared about her exclusively was so much more satisfying than leading a double life in an affair. A couple of years later, they got married. They shared a life together with friends and both of their families, and Mary was happy.

Not all affairs for the "other woman" or "other man" end this well. Some people are involved in love triangles, leading double lives, for years, and they find it too difficult to extricate themselves from these relationships. After years have gone by and they regret the time that they have lost and possible missed opportunities to be happy with other romantic partners who are actually available, they have many regrets and often wish they had chosen more emotionally fulfilling lives for themselves.

Getting Help in Therapy
If you find yourself involved in a love triangle where you are the "other woman" or "other man," leading a double life, you could benefit from seeking the help and support of psychotherapy with a licensed mental health professional.

Get Help in Therapy

Most psychotherapists won't give you advice about what to do--that's not their job. But a licensed mental health professional can help you to figure out what you want to do if you are in this type of untenable situation. You might feel that you can never leave your current situation and, at the same time, it feels too hard to stay. But many other people, who were faced with your situation, have been able to resolve their problems in psychotherapy with a qualified therapist.

About Me
I am a licensed psychotherapist in NYC who works with individuals and couples.

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

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

Friday, January 8, 2010

Relationships: Is Your Partner Stuck in a Codependent Relationship with An Ex?

Codependency and Problems with Letting Go of the Ex Are Not Unusual:

Is Your Partner Stuck in a Codependent Relationship with His Ex?

As a psychotherapist in New York City who sees individuals and couples with relationship problems, this is a problem that I hear about often: The client is in a relationship with a person who is wonderful in every other way, except that they still maintain regular contact with a former romantic partner, who is dependent upon them, and this creates problems in the current relationship. 

The dependence is often an emotional dependence or it can be a dependence related to basic every day things. But the point is that the ex still relies heavily on the partner, who is reluctant to set boundaries with their ex.

This can be a thorny issue to contend with and often leads to hurt feelings and, in some cases, the breakup of the current relationship.

When there are Children Involved:
Of course, there are times when this problem is unavoidable--specifically, when there are children involved. 

If you begin a relationship with someone who has children from a former relationship, you know (although you might not like it) that your partner must talk to his ex about matters relating to the children.

This is what a responsible parent does, and it requires a good dose of understanding, compassion and patience on your part to deal with this situation. 

It helps a lot if you feel secure in your relationship and you know that you can trust your partner to maintain appropriate boundaries with their ex, basing their contact solely on the children's welfare without blurring the lines.

This is a dynamic that I help individuals and couples with in individual psychotherapy and couples counseling. These are issues that people deal with in blended families, but that's not the focus of this particular posting.

How the Former Relationship Affects the Current Relationship:
The particular dynamic that I'm addressing has more to do with someone who leaves his relationship (where there are no children), enters into a new romantic relationship but, for whatever reason, he finds it extremely difficult to sever his ties with his former girlfriend or wife.

If you're in a new relationship with someone (whether it's with a boyfriend or a girlfriend) who can't or won't let go of his former partner and it's affecting your relationship, I don't need to tell you that you're in a challenging situation.

I'm not even talking about situations where there is actual infidelity going on with the former partner. I'm focusing on the situation where your partner still makes and receives calls to his ex, still gets together with her (without you), and where this interferes with your relationship.

I know that there are situations where maintaining contact with ex partners doesn't interfere with the current relationships. I've had clients who divorce, both people remarry and maintain friendships with their ex-husbands and ex-wives.

Not only is it not a problem, but the couples enjoy going out together, they vacation together, and they value the friendship. The boundaries are clear, and it isn't a problem for anyone.

I'm mostly referring to situations where, for all intents and purposes, the prior romantic relationship has ended, but the two people who were involved decide to try to maintain a friendship. So, for example, in this type of situation, you begin a new relationship and you find that your boyfriend is still very focused on his ex.

 Maybe they've ended the romantic and sexual aspects of their relationship, but (even though they might not admit it) they're still very emotionally dependent upon each other: He still feels that he must have her advice before he makes any major decisions, she still calls him frequently to help her with her problems, and so on. And if it happens frequently enough and it starts to impact your relationship, there you are, feeling left out and, possibly, feeling like you're having an affair with your own boyfriend.

Feelings Don't Always End When the Former Relationship Ends:
Just because two people have broken up doesn't mean that there might not still be strong emotional feelings between them. It's usually better to know about this before you enter a new relationship with someone. Then, you have the option of deciding whether you can handle a relationship with someone who still has strong emotional ties with his or her ex.

As I mentioned earlier, for some people, it's not a problem because there is a recognition that the girlfriend or wife in the new relationship is primary and, usually, when this type of situation works out well, the new girlfriend is included in any plans and it's clear that the former romantic relationship has developed into a real friendship and it's not a threat to the new relationship.

 Anyway, the point is that the end of a relationship doesn't necessarily mean the end of feelings. And if your boyfriend (or girlfriend) is unwilling and/or unable to be clear about whether you or the ex is primary, that's when problems develop.

The following vignette, which is a composite of many clients' stories over the years with all identifying information changed, is an example of the type of problem that I'm addressing:

Susan and John
When Susan met John, he had broken off his relationship with Jane about six months before. Susan and John began dating and they hit it off right away. They both felt a strong romantic connection that was different from anything either of them had experienced before. Their relationship seemed ideal--with the exception of one thing: He still maintained frequent contact with Jane.

Relationships: When Your Boyfriend is Stuck in a Codependent Relationship with His Ex

John was very upfront from the start that he and Jane wanted to remain friends. They had been together for five years, and they still cared about each other, even though they weren't romantic or sexual any more. At first, since everything else seemed to be going so well, Susan told herself that it was admirable that John and Jane were able to maintain a friendship. But, over time, she began to resent John's frequent contact with Jane, especially as it began to interfere with her relationship with John. It seemed that things were not quite what they appeared to be at first. Susan never felt that John was cheating on her, per se. But she sensed that now that Jane knew that John was seeing someone new, Jane called John more frequently and seemed to depend on him more.

Whether it involved household repairs, late night talks about how lonely she felt or about her personal problems or wanting to get together with John (without Susan), more and more, Susan began to feel that Jane was taking up a lot more time than Susan felt comfortable with, and she was resenting it. Susan sensed that Jane still wanted to maintain an emotional hold on John, even though he was in a new relationship, and she sensed something manipulative in the way that Jane played on John's feelings of guilt for having ended the relationship with Jane. She also sensed that, for whatever reason, John was caught up in this dynamic.

When Susan talked to John about this, he responded by trying to reassure Susan that nothing romantic was going on between him and Jane and Susan had nothing to worry about. He seemed unable to see how much time Jane was taking up and how this affected his new relationship with Susan.

For a while, Susan tried to be understanding. She loved John, she trusted him, but she also had a bad feeling about the dynamic between John and Jane. Then, one night, John was staying over with Susan and they were starting to be intimate. It was close to 11 PM when John received a call on his cell phone from Jane. Susan asked John not to take the call, but he gave her a pained look and said that if Jane was calling at this time, it must be important. He asked Susan to be understanding, and he took the call. From her side of the bed, Susan could hear Jane sobbing on the other end. Susan felt the now-familiar anger and resentment welling up in her. John could see that Susan was getting annoyed, but he gave her a helpless shrug, as if to say, "I can't abandon Jane. She needs me" and took the call in the other room.

A half hour later, when John came back into the bedroom, Susan pretended to be sleeping. She felt too hurt and angry to talk to John, and she didn't want to have a late night argument with him. So, they each slept on either side of the bed and feelings were tense the next morning before they each left for work.

This was the situation when Susan and John began coming for couples counseling. Susan felt that she was in a terrible dilemma--she loved John and she knew that he loved her, but she couldn't tolerate how his friendship with Jane was affecting their relationship. For his own reasons, having to do with his history with a dependent mother and his complicated relationship with Jane, John was unwilling to give up his friendship with Jane.

 He loved Susan, he didn't want to hurt her, and he didn't want to ruin the relationship, but he felt tangled in a strong emotional web with Jane, and he said he couldn't let go of his friendship with her or even set limits with her constant emotional demands. He had an intellectual understanding that he was in a dysfunctional and codependent relationship with Jane, but he didn't know what to do.

It was a very sad and painful situation for both Susan and John. John began his own individual psychotherapy to deal with his family history which was a big part of the problem. Over time, he began to see that each time that Jane called in crisis, he felt emotionally triggered in the same way that he felt with his mother who had been overly dependent on him when he was a child. In many ways, John was "primed" for the codependent situation with Jane due to his family history, and this was primarily why he had such a hard time letting go of Jane or even setting limits with her.

As John began to work through those earlier issues, he developed greater awareness and insight into the current situation and realized, on a deep emotional level, that he was caught up in a codependent situation with Jane and it was ruining his relationship with Susan.

Although it was difficult for him, he began setting limits with Jane, letting her know that his relationship with Susan was primary--no more late night crisis calls, no more getting together without Susan, and so on. Jane did not respond well to this type of limit setting and, eventually, she decided to sever her ties with John. Over time, John dealt with the loss of this friendship in his own individual psychotherapy, how it related to his family history and, over time, his relationship with Susan began to thrive again.

It Takes a Commitment from Both People in the Relationship:
This vignette illustrates that couples can work out problems when one or both of them can't let go for a former partner.

 It takes a big commitment from both people, a willingness to work on this issue in couples counseling, an understanding of the underlying psychological dynamics that are often involved in this type of situation beyond the current people involved, a recognition and acknowledgement that the friendship with the ex is having an impact on the current relationship and, ultimately, a commitment to the current relationship as being primary and a recognition that, if the friendship with the ex cannot be modified so that it's not adversely impacting the current relationship, that relationship needs to end.

Unfortunately, not all relationships that have this problem end well. Sometimes, there's just too much unfinished business with the former partner or spouse. Other times, the partner who is maintaining an enmeshed or codependent relationship with the ex refuses to see it for what it is and thinks the current partner is being unreasonable. Sometimes, it just gets too complicated. But it's more likely to work out if you don't wait too long to try to get help.

Getting Help in Therapy: 
If you find yourself in the type of situation that I've described in this posting, whether you're the person with the partner who is stuck in a codependent relationship with your ex or you're in a relationship with someone who can't let go, recognize that you're not alone.

Getting Help in Therapy

This is a phenomenon that often occurs in relationships, and you and your partner could benefit from attending couples counseling. If your partner or spouse is unwilling to attend couples counseling, you could benefit from seeking help in individual psychotherapy.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with many individuals and couples who have successfully worked through relationship problems.

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 regular business hours or email me.