NYC Psychotherapist Blog

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Tuesday, July 31, 2012

When "Family Loyalty" Gets in the Way of Your Psychotherapy Sessions

"What's said in this house stays in this house" is a phrase that many people heard as children when they were growing up, usually said by a parent, grandparent or another adult family member in a stern tone.  As children, many of us learned that family loyalty, with all that this implies about not talking about the family's personal business or family secrets, was a very important cultural value.  For someone who was raised with a strong sense of family loyalty, it can be difficult to start therapy and talk about family problems.  It can make a person feel guilty, ashamed, and ambivalent about therapy.  How can he or she reconcile the need to overcome unresolved family of origin issues with a strong sense of family loyalty?

"Family Loyalty" Can Get in the Way of Your Therapy Sessions

Feeling Like You're Betraying Your Family By Going to Therapy
For many people in therapy, who struggle with this dilemma, it can feel like they're betraying their family by even going to therapy, especially if their problems involve past or current family issues.  This becomes even more of a challenge if family members were not encouraged to be individuals while, at the same time, being a member of the family.  If there was an all-or-nothing attitude about this--you could either be your own person or a loyal family member (but not both), this dilemma becomes even more of a problem.

The following vignette, which is a composite of many different cases with all identifying information changed to protect confidentiality, is an example of this dilemma:

Betty, who was a first generation American, was raised in a very traditional family.  Family loyalty was paramount.  Her father often warned Betty and her siblings that the only people they could ever really trust was their family.  It was all well and fine to have friends, their father told them, but they should never put friends above their family.  They were raised to believe that they should never talk about family matters with "outsiders."  "Outsiders" were considered to be anyone who was not part of the immediate family.  

Most of Betty's siblings didn't leave the family home until they were married.  This is how it was for her parents, her grandparents, and prior generations.  But after Betty graduated from the local college, she began feeling stifled at home.  She longed to move out of the family home and away from their neighborhood in Brooklyn, which felt like a small town to Betty, so she could live in Manhattan with her friends.  As the youngest child and the only remaining child at home, she wanted to have a greater sense of autonomy.  

When Betty told her parents that she wanted to move out, they were very upset.  They couldn't understand why Betty would want to do this.  They had led such insular lives and it was so far from their own experiences that they didn't know how to respond.  They framed the issues in terms of family loyalty:  Wouldn't Betty rather stay with her family, who care about her, instead of living with "so called friends"?  Why would she want to spend money on rent when she could live at home for free?   Why not just wait until she met "a nice young man" to settle down with?

Betty tried to explain to her parents why she wanted to move out, but they couldn't understand her need  to spread her wings.  It was diametrically opposed to their core values.  She loved her parents and didn't want to upset them.  She felt torn between her parents' needs and her own.  But, ultimately, she knew she needed to be more independent, so she moved out.

Betty's world opened up to new and exciting experiences once she moved out.  She had a successful career, good friends, and a new boyfriend.  Things seemed to be going well for Betty and her boyfriend at first.  But a year later, Betty's boyfriend broke up with her to return to his former girlfriend.  Betty was heart broken.  Her friends suggested that she attend psychotherapy to deal with this loss.  

When Betty began therapy and it was time to talk about her family history, she felt very hesitant.  She felt like she was betraying her family.  She didn't want her family to be analyzed by her therapist.  On an intellectual level, she understood that talking about her family history is part of treatment, but she found it very hard, on an emotional level, to do this.  Her sense of family loyalty made it difficult to even talk about the most basic things about her family.  How could she balance her own needs with this sense that she shouldn't reveal personal aspects about her family?

It took a while for Betty to feel comfortable enough to talk about her family.  She almost felt as if her parents were standing behind her in the therapy room.  Over time, she built a rapport and a sense of trust with her therapist and she could talk more easily.  As she heard herself speak, she realized that, even though she loved her family very much, she also felt emotionally oppressed by them at times.  Gradually, she also learned that it was actually healthy for her to have her own sense of self, separate from her family, and she could love her family and still have some resentment towards them.  It wasn't an either-or thing.  She learned that she wasn't betraying her family by talking about them in her family sessions.  It wasn't a matter of complaining about them, but working through issues that involved them.  

Issues About Family Loyalty Can Come Up at Any Age
This vignette is about a woman in her 20s who, among other things, was struggling to differentiate herself from her family.  But issues about family loyalty often come up for psychotherapy clients in their 30s, 40s, 50s and beyond.  It can come up long after a person feels he or she worked out these issues.  People can be emotionally vulnerable to this at different stages in their lives.  

Struggling with the need to take care of oneself vs the need to be loyal to one's family can be even more challenging if there was physical, emotional or sexual abuse, alcoholism, or other family secrets.  

You Can Take Care of Yourself and Still Love Your Family
When you're engaged in your own therapy, you can learn to take care of yourself while, at the same time, you can still love your family.  It doesn't have to be an either-or choice.  And, unlike stereotypical ideas about psychotherapy, therapy is not about blaming your family.  There is a recognition that we are all, for better or worse, affected by our early childhood experiences.  But we're not slaves to those experiences.  As evolved adults, we learn that we can love ourselves as well as our families, if we choose to, and there's no contradiction in this.

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

I work with individual adults and couples, and I've helped many clients to overcome their struggles with family issues so they could 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.

For a related topic, you can read my article: 
How Do We Balance Our Own Needs with Being Responsive to the Needs of Our Loved Ones?

Saturday, July 28, 2012

Attention-Seeking Behavior in Therapy: Understanding Factitous Disorder

Factitious disorder (FD) is a complex psychological disorder in which patients either intentionally produce or pretend to have medical or psychological disorders.  The intent is to be in the patient role and to garner sympathy from the medical or psychological practitioner.  This is different from malingering where the patient pretends to have a problem in order to gain some form of external benefit  (e.g., disability payments, Workers Compensation, etc) or to get drugs, like pain killers.

Attention-Seeking Behavior:  Understanding Factitious Disorder

In this blog post, I'll focus on factitious disorder in the psychotherapy office rather than the medical office with the following case example which, as always, is a composite of many different cases and does not identify any one person:

Mary, who was in her early 40s, had already been in therapy with many therapists in the past.  She rarely remained in therapy for more than a few sessions with most therapists.  She had many complaints about her prior therapists--they didn't understand her, they were shocked by her trauma history, they probably had not dealt with their own trauma history, they said inappropriate and unempathic things to her, and they questioned the authenticity of what she told them.

She told her new therapist in their first session together that she hoped the therapist would be able to handle hearing some horrific things about her early childhood.  She wanted to know, right from the start, if the therapist could deal with hearing about the gruesome details of her childhood sexual and physical abuse.  She was "tired" of having to seek out one therapist after the next in hopes of getting psychological help.

Mary's new therapist, who was an experienced mental health practitioner, listened intently and assured Mary that she had a lot of experience with trauma and she doubted there would be anything that Mary could say that she had not heard before.  The therapist thought to herself that she could form a rapport with Mary in treatment, but Mary's dramatic presentation and the fact that Mary went from one therapist to the next ("therapist hopping") concerned her.  She remained open to listening to Mary in a respectful and empathic way, and she continued to pay attention to her own internal promptings as to what might be going on.

Over the next three sessions, Mary presented her childhood history in a very dramatic way.  She presented everyone in her family (mother, father, siblings, aunts, uncles, grandparents on both sides, cousins, nieces and nephews) in a negative light.  Each one of them had harmed her in some way, either physically, sexually, or emotionally.  Everyone who was in a position to help had been either completely unhelpful, incompetent or somehow aided and abetted in the abuse.  This included teachers, principals, clergy, neighbors, family friends, the police, the court system, and the child welfare system.  Everyone was implicated in some way.

By the fourth session, Mary's therapist, who was following Mary's account very closely and taking notes, began to notice significant inconsistencies in Mary's story from one session to the next.  Mary watched the therapist in a wary sort of way, as if she expected the therapist to say or do something that would upset her.  She needed a lot of assurance that her therapist felt empathic towards her.  When the therapist tactfully asked for clarification about some of the more glaring inconsistencies, Mary exploded. She accused the therapist of being just like all her prior therapists--unempathic and unhelpful.    Then, she said she was ending therapy, she would find another therapist, and she left abruptly.  She was unresponsive to telephone calls from the therapist and, by the next week, she was having her first session with a different therapist.

Factitious disorder is a very difficult disorder to treat.  Aside from it being a complicated diagnosis, people often don't remain in treatment long enough with any one therapist.  They have a tendency to go "therapist hopping," just as people with this disorder tend to do in medical settings.  As soon as they sense that the therapist has doubts about the authenticity of their stories, they're gone.  Their intent is to get as much sympathy as possible and they don't want to be found out.

Attention-Seeking Behavior in Therapy: Understanding Factitous Disorder

Often, people with fictitious disorder do have histories of trauma, but usually not to the extent that they are portraying it.  They also often have a coexisting personality disorder, like borderline personality disorder.

Factitious Disorder:  The Importance of the Therapeutic Alliance
If the client with factitious disorder remains long enough and the therapist has built a therapeutic alliance with the client, broaching the topic of fictitious disorder can be a very delicate but necessary part of the process.  The therapist must have the ability to remain empathic, even while he or she knows the client is not being forthcoming and is trying to manipulate.

The therapist must remain focused on the client's intent--the need to feel cared about.   When the therapist and client have a good enough rapport, the therapist can then bring up the diagnosis of factitious disorder in a tactful, caring, and professional manner.

The goal would be to have the client admit that he or she has been attempting to manipulate and then getting to the underlying psychological issues.   If the client will allow this, there is hope that he or she can overcome this disorder and stop engaging in self sabotaging their treatment and their lives.

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 it, 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, July 27, 2012

Dating Again in Your 40s, 50s, 60s and Beyond

For many people who have ended long term relationships or marriages, entering the dating world for the first time in a long time when you're in your 40s and beyond can be challenging.  A lot has changed  in the dating scene, and it can be intimidating.

Dating Again in Your 40s, 50s, 60s and Beyond

When you're in your teens and 20s, it's easier to meet other single people because you're thrown together in high school or college. You don't have to make as much of an effort as you do when you're older and you have to seek people out.

After the end of a long term relationship, you might have a lot of mixed feelings about getting out into the dating world again.  

On the one hand, a lot of insecurities can come up for you about your age, your weight, your looks, and the fact that you're not familiar with this new world of dating.  It's tempting to stay home with the covers over your head and eat a pint of ice cream.  

Dating Again in Your 40s, 50s, 60s and Beyond

But, on the other hand, if you don't want to be alone, and there aren't a line of people standing outside your door dying to meet you, you need to make an effort to get over your fears and get out to meet people.

I won't go into all the ways there are to meet people these days, whether it's online dating services, speed dating, singles events or other activities.  This information is readily available.  I will add a note of caution that it's always best to meet people in a public place, especially before you get to know them well.  

I have worked with many clients who have found themselves single again after many years.  Their anxiety about entering this new phase of their lives is understandable, but many of them eventually felt an excitement about the possibility of meeting new people and having new experiences.

One woman, who loved to dance and who was married to a man for many years who hated dancing, was thrilled to meet a man who shared her enthusiasm for dancing.  They took ballroom dancing lessons together and had a great time together.  It opened up a whole new world for her.

I've know at least six or seven couples in their 50s and 60s who met online after being divorced or widowed for a long time.  They're having more fun now than when they were teenagers.  And they feel younger than they've felt in a long time.

Rather than engaging in a lot of negative self talk and indulging all your fears, have a positive attitude of openness and curiosity, and have fun.

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 people to overcome their fears about entering into new phases in 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 during business hours or email me.

Also, see my article:  Dating vs Being in a Relationship

Coping with a Close Friend's Betrayal

For many of us, our close friends are like a second family.  For some of us, who might have contentious relationships with our immediate family, we might rely even more on our close friendships for emotional sustenance and support.  We rely on and trust in our friendships, which makes it so painful when we find out that we've been betrayed by a close friend.

Coping With a Close Friend's Betrayal

When we think about coping with a betrayal, we usually associate it with the betrayal of a spouse or family member, not a betrayal by a close friend.  It's not a topic that is often written about in psychological literature, even though such betrayals often cause a great deal of emotional pain.  We expect close friends to be there for us emotionally, to be there for the good times as well as during rough patches in our lives.  Close friends are people we confide in and who confide in us.  We feel understood by our close friends, sometimes even more so than our spouses and immediate family.  We might even idealize our close friendships.  And we might have blind spots with certain friends.

There are many different types of betrayals that can occur in friendships.  The one that most often comes to mind and is portrayed in books and movies (as well as in "real life") is when a friend gets involved with one's spouse or romantic partner.  But there are other betrayals that can also hurt and be very difficult to come to terms with emotionally because of the trust that we usually place in close friendships.

Clinical Vignette:
The following fictionalized account, which is a composite of many different cases with all identifying information changed, is an example of a close friend's betrayal that is not discussed as often.

Mary and Alice:
Mary and Alice became best friends in high school and remained best friends in college.  They thought of themselves and described themselves to others as "sisters."  They were actually closer to each other emotionally than they were with their siblings.  They relied on each other for emotional support.  They confided in each other.  Over the years, after college, they helped each other through messy relationships and problems in their marriages.

When Mary found out that her husband, Tom, was cheating on her, the first person that she called was Alice.  Alice provided a shoulder for Mary to cry on, so to speak, and helped her to get through a difficult divorce.  Alice was Mary's emotional "rock," as Mary had been for Alice many times.

A year after her divorce, Mary ran into Tom and his girlfriend, Pat, the woman that he cheated with, in the grocery store.  If she had seen them first, Mary would have turned down a different aisle.  But she found herself in the awkward position of being almost face-to-face with them before she even realized it.  Mary knew Tom's girlfriend because they all went to high school together.  She also knew that Pat had always been interested in Tom and was jealous that Mary was with him.

Even though he cheated on her, Mary was still in love with Tom.  She never would have imagined in a million years that Tom would have an affair.  They were having problems communicating and their sex life had dwindled to almost nothing, but she couldn't believe, until he confessed to her about the affair, that he would ever cheat on her.  Tom wanted to try to work things out in their marriage, but Mary knew it was over.  She divorced him because she realized that she couldn't ever trust him again.

As she passed them in the food aisle and looked away, she felt herself close to tears.  Just as she was about to turn the corner to go in a different direction, she felt someone tapping her on her shoulder.  When she turned around, she was surprised to see Pat.  She was inclined to keep walking and ignore her, but Pat took her elbow and said, "I know you hate me because of what happened.  Everyone blames me for your divorce, but Alice needs to take some of the blame too.  If she hadn't told me about the problems that you and Tom were having, I never would have called him.  You know I was always in love with Tom, but the two of you were together and seemed so happy.  When Alice told me about the problems in your relationship with Tom, I saw a chance, and I thought he would be much happier with me, and I think he is." Without saying another word, Pat walked away.

Hearing these words, Mary felt numb with shock.  She managed to make it through the checkout and drive home in a stupor.  Later that night, when Alice came over, Mary told her about the incident in the grocery store.  She held her breath, hoping that Alice would say something, anything, to contradict what Pat had told her.  But, instead, Alice's face turned a bright red and she looked down at her feet without saying a word.  Then, Mary knew it was true--Alice had betrayed her by talking to Pat about things that Mary told Alice in the strictest of confidence.  Mary was stunned and all she could say was, "Why?  Why did you do this to me?"  Alice remained silent for a long time, and then she said, "I'm sorry I hurt you."  Then, she put her coat on and left.

Mary was left with no real explanation.  Over the next few days and weeks, she could barely think of anything else.  She felt betrayed by her ex-husband and now betrayed by her best friend.  She kept playing the situation over and over again in her mind trying to make sense of why Alice would have betrayed her in this way and with someone that Alice knew was interested in Tom.  How could she do this?

A month or so later, she received an email from Alice apologizing for the betrayal.  She said she never meant to hurt Mary, and she never thought it would contribute to the demise of Mary's marriage.  But she gave no explanation.  All she said was that she didn't know why she did it.  This was the first contact that they had for a while.  So, Mary was left to sort this out on her own.  She had other friends, but her sense of trust had taken a real blow, and she wondered if she could trust her other friends.

By the time Mary came to therapy, she was at a low point.  It took her a while to feel that she could trust her therapist.  Gradually, she established a rapport with her therapist and she began to sort out the double betrayal of her husband and her best friend.  She didn't completely blame Alice for Tom's affair because she realized that he was an adult and he made his own decisions about being unfaithful.  But she felt almost as violated by Alice's betrayal as by Tom's.

Over time in therapy, Mary began to realize that there had been signs all along that Alice could be indiscreet, but Mary chose to ignore them.  Alice would often tell Mary about very private things that other people had confided in Alice.  This made Mary feel uncomfortable, but she never thought Alice would betray her.  She realized that she didn't use good judgment in confiding in Alice.

It took a while for Mary to work through the double loss of her husband and her best friend, and to feel good about herself again.  She became closer with other friends over time.  She began dating a man that she really liked.  Eventually, she forgave Alice, but she didn't forget about the betrayal, and they were never really friends again.  Gradually, the pain of this double betrayal receded into the background and took its place as she moved on with her life.

Trust is Difficult After a Friend's Betrayal
The vignette above is just one example of many.  As this case illustrates, a close friend's betrayal can really knock our sense of trust in others as well as ourselves.  We question not just why we were betrayed by a close friend, but we question ourselves as to either we betrayed ourselves by trusting this friend in the first place.

This type of betrayal can be very difficult to overcome on your own because it often challenges us to the core of our beings.  Seeking professional help can provide the support you need to get through a traumatic betrayal.  If, unfortunately, you find yourself in a situation where you've been betrayed by a friend and you're unable to overcome this problem on your own, you owe it to yourself to seek the help of a licensed mental health professional.

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

Thursday, July 26, 2012

Overcoming the Traumatic Effects of Childhood Trauma

Growing up as a child who was emotionally neglected or  abused is a very painful experience and has emotional consequences when that child becomes an adult.  Whether this is due to narcissistic parents who were so self involved that they were not attuned to the child or for other similar reasons, it is a lonely and hurtful experience.

Overcoming the Effects of Childhood Trauma

Many adults who grew up emotionally neglected or abused as children feel inadequate or like there's something wrong with them.  They often feel flawed and that they're not lovable.

One blog post cannot possibly do justice to such an enormous topic.  There are many forms of emotional abuse and neglect.  The following short vignettes, which are not about any one particular person, are representative of some forms of emotional abuse or neglect:

When Betty was a young child (between the ages of 7-10) her parents would often leave her alone at home so they could go bar hopping with friends.  She was very afraid of being home alone, which is normal for a young child, and she would beg them not to leave her.  But her parents would dismiss her concerns, telling her she was "being ridiculous" and calling her "a cry baby" as they slammed the front door behind them.  Betty grew up feeling insecure and doubting that her needs would ever be met in any relationship.

John's parents split up when he was only four years old, and he remained with his mother.  His mother was bitter and angry about the breakup, and whenever she would get angry with John, she would look at him with disgust and say, "You're just like your father."  Then, she would withdraw from him emotionally, and he felt lonely and sad.  As an adult, John felt that any woman that he liked wouldn't like him.  He felt he always had to prove himself and go above and beyond so the woman he was interested in would like him.  He felt that no woman would ever find him lovable.

Mary grew up primarily around her mother.  Her father traveled a lot for his job and when he was home, he was preoccupied with work and had little time for her.  Mary's mother was a very beautiful and self centered woman.   The only time that she paid attention to Mary was when Mary was admiring or complimenting her.  Mary learned, at a very young age, that she had to subordinate her own feelings and sense of self in order to get her mother's attention.  As an adult, she was attracted to highly narcissistic men who were unable to take her emotional needs into account.

In all of this fictionalized brief vignettes we can see the damaging effects of being a child who was not seen or heard by parents.  Under optimal circumstances, parents who are emotionally attuned to their children see their children as individuals with their own emotional needs.  Emotionally attuned parents can take in their children's feelings with empathy and understanding.  Of course, this doesn't mean that they should give their children everything that they want without regard for whether it's good for them.  It means that they can set aside their own concerns for a while to understand their children's concerns.

There are times when parents might want to be empathetic and understanding but, due to life circumstances beyond their control, they're unable to.  For instance, if a single mother has no choice but to work long hours to support her children, and she's not around to be nurturing, the children can feel emotionally neglected:

After Edward's father left the household (when Edward was 13 years old), his mother had to take on three jobs just to make ends meet.  Edward's grandmother lived downstairs, but she was preoccupied with raising three small grandchildren, and she had very little time for Edward, who was her oldest grandchild.  He had to learn to cook for himself, wash his clothes, and take care of many household chores after school.

Overcoming the Effects of Childhood Trauma:  Edward

When his mother was home, she was often exhausted.  Edward always knew that his mother loved him very much, but she no time for him.  She missed school plays that he was in and couldn't come to watch him at his basketball games.  One of his fondest memories was when his mother came to his high school graduation.  But, even then, he was painfully aware that his mother wouldn't get paid for that day at work.  In his first serious relationship, Edward had a hard time expressing his needs because he felt he wasn't entitled to have any of his emotional needs met, which frustrated his girlfriend.

As much as adults, who grew up under similar circumstances to the vignettes above, might understand intellectually that they were not to blame for what happened to them and that their feelings of low self worth are distorted, it's hard to overcome these feelings with just an intellectualized understanding.  

My experience, as a psychotherapist who specializes in working with trauma, has been that regular talk therapy, while it might be somewhat helpful, usually isn't enough to overcome these types of emotional trauma.

Many of my colleagues and I have discovered that a more integrated, mind-body oriented psychotherapy is much more effective to help clients overcome trauma.  This includes EMDR, clinical hypnosis, and Somatic Experiencing.

These mind-body approaches are usually more successful where talk therapy is not.  None of these approaches is "a magic bullet" and there is still work to be done, but I find that, generally, these mind-body approaches work faster and in a more effective way than regular talk therapy.

About Me
I am a licensed New York City psychotherapist.

I provide psychotherapy for individual adults and couples, including EMDR, Somatic Experiencing, clinical hypnosis, and dynamic talk therapy in an empathic treatment environment.

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.

Wednesday, July 25, 2012

Relationships: Are You Too Shy to Talk to Your Spouse About Sex?

As a psychotherapist and couples counselor in New York City, I see many clients, individually and in couples, who are too shy to talk to their spouse or their partner about sex.  Whether it's a heterosexual or gay couple, together for a short or long time, there are many couples where one or both people are too shy to talk about sex.  They have difficulty expressing, either explicitly or implicitly, what they like or their sexual fantasies.

Relationships: Are You Too Shy To Talk to Your Spouse About Sex?

Unfortunately, for many people, it's easier to go outside the relationship and have a sexual affair than to talk to a spouse or romantic partner about sex.  In many cases, people who find it easier to fulfill their sexual needs in sexual affairs find it easier because there is a lack of emotional intimacy.  No strings attached.  No emotional expectations.  If it's understood that the affair will never go beyond having sex, it's less threatening.  Whereas in a committed relationship there are all the everyday short term and long term obligations and responsibilities that can get in the way of enjoying sex for some people.

Making the Shift from Handling Everyday Responsibilities to Becoming Sexual 
For people who are too shy or uncomfortable talking to their partner about sex, it's often hard for them to go from handling daily responsibilities with their partner to becoming sexual in the bedroom.  Making the transition is awkward for them.  They feel embarrassed and nervous.

Relationships:  Are You Too Shy to Talk to Your Spouse About Sex?

This often leads to a decrease in sexual activity in the relationship as one or both people find reasons to avoid having sex:  They 're too tired, too busy, not feeling well, etc.  After a while, it can feel like they're roommates or siblings rather than a couple.  Resentment and misunderstands can arise, especially if one of the partners has a bigger sex drive than the other.

The Importance of Being Able to Talk About Sex
There are also couples who have difficulty talking about sex, but once they're in bed, the sparks fly.  They don't need to talk.  They communicate with their eyes and the rest of their body.  They fall into a natural sexual rhythm with each other.  So, who needs to talk if your sex life is going well?

The Importance of Meeting Each Other's Sexual Needs
But if you and or your partner can't communicate sexually either verbally or non-verbally and one or both of you feel like your sexual needs aren't being met in the relationship, you have a problem.  If you find yourself in this predicament with your spouse or partner, you're not alone.

The Importance of Meeting Each Other's Sexual Needs

There are many couples with this problem.  But, rather than doing nothing, you should seek professional help rather than allow this situation to develop into a long-term problem.  Trying to shove this problem under the rug won't make it go away.

Getting Help in Therapy
There are numerous reasons for the underlying possibilities that can cause this type of problem--too numerous to discuss in this blog post.  An experienced couples counselor or a sex therapist can often help you to overcome a shyness about sex.  You owe it to yourself and your relationship to get help.

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.

Tuesday, July 24, 2012

Learning to Forgive Yourself

Learning to forgive yourself is often more difficult than forgiving others.  Many people come to therapy because they're unable to forgive themselves and they're plagued by guilt and shame.  Even when they know objectively that there's nothing to be gained by continuing in self blame, they're unable to let go of these feelings--even when the other person (or people) involved have long since forgiven them.

Learning to Forgive Yourself

Is There a Part of You that Needs to Hold Onto Self Blame?
When a psychotherapy client is stuck in this kind of dilemma, usually, there's a part of him or herself that won't let go--that continues in this self defeating dynamic of self blame.  Regular talk therapy, although useful, often doesn't get to the core of the issue.  A person can get stuck in a loop of knowing that he or she needs to let go, but not being able to engage in self forgiveness.  

Clinical hypnosis in combination with "parts work" (also known as ego states therapy) can be very helpful to overcome this problem.   The combination of hypnosis and "parts work" allows the hypnotherapist and client to explore if there is an internal part of the client that feels the need to hold onto this self blaming stance and the reason why it feels this need.

In a relaxed hypnotic state, clients can sense into themselves and access unconscious information that is usually not available in their ordinary state of consciousness.

For instance, a client, who lied to a friend, could feel very ambivalent about forgiving herself for lying.  Even if her friend has forgiven her and she knows logically that it would be best to let it go, a part of herself might feel the need to hold onto the guilt and shame in order to make sure this doesn't happen again.  Once this is revealed in the relaxed hypnotic state, the therapist can work with this part to explore if there are other ways to handle this (other than continuing to feel guilty and engage in self recrimination) that will satisfy this part.

This is just one example, but there can be many reasons why an aspect of oneself can't or won't let go of self blame  Most of the time, these reasons are not in a person's ordinary awareness.   It's often a relief to discover, first of all, that there's an actual a reason why part of the self is having difficulty with self forgiveness.  And, more importantly, that there can be other options that don't involve continuing to blame oneself.

An Inability to Forgive Yourself Can Lead to Anxiety and Depression
All of this is not to say that if someone has engaged in a transgression that he or she shouldn't feel remorse.  It's a sign of health to feel remorse when we've hurt others (or ourselves).  But the kind of problem that I'm discussing is beyond that--it's when a reasonable length of time has passed and a person continues to blame him or herself.

In some cases, people can continue to blame themselves for over 20 years.  This is usually debilitating to one's sense of self and can get in the way of maintaining important relationships.  For some people, their inability of forgive themselves causes them to isolate themselves from loved ones.  It can lead to anxiety or depression.  For some people, it can lead to abusing alcohol or drugs as a maladaptive way to soothe their emotional pain.

Getting Help in Therapy
If an inability to forgive yourself has you feeling stuck, you owe it to yourself to seek professional help from a licensed mental health practitioner, preferably a hypnotherapist who can help you to overcome this problem.  Many people find it so freeing to let go of the self blame that had been weighing them down so they can move on with their lives.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR therapist, and Somatic Experiencing therapist.  I also provide dynamic talk therapy in a supportive and empathic environment.

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.


Monday, July 23, 2012

Arguments with Your Spouse Can Trigger Old Emotional Wounds from Childhood

It's not at all unusual for arguments with a spouse or romantic partner to trigger old emotional wounds from childhood.  Without even realizing it, we can become so emotionally triggered that we can surprise even ourselves with our out of proportion responses.  Old, unresolved wounds are often just under the surface and when we're triggered, we often don't even know it.  Later on, when we're calmer, we might reflect that our responses were emotionally over the top, and wonder how and why we could have become so upset over something that we realize, once we can be more objective, didn't warrant this kind of upset.

Arguments With Your Spouse Can Trigger Old Emotional Wounds

I'm not referring to the occasional loss of temper that we experience when we're too tired, hungry or overwhelmed by stress.  What I'm referring is a consistent pattern of emotional upset that we wonder about when we've had a chance to calm down and we ask ourselves, "Why did I get so upset over that, when it wasn't really that important?" It can leave us feeling embarrassed, perplexed and confused about ourselves.

When this dynamic occurs fairly consistently, it's often a sign that old emotional wounds from childhood are being triggered.  In other words, we're not just responding to the situation at hand.  The magnitude of our emotions are often being fueled by unresolved childhood issues from our families of origin.

The following scenario, which is a composite of many different cases with all identifying information changed, illustrates this phenomenon:

Alice, who was in her late 30s, was normally a calm and rational person most of the time.  But whenever she and her husband, Ed, got into an argument where he had problems seeing her point of view, she became enraged.  It didn't matter if they were talking about money, politics, or where to vacation.  If Alice felt that Ed was unable to understand her perspective, she became livid.  She would lose her temper and feel out of control.  Sometimes, she felt so agitated that she could barely breathe.

Usually, after he had a chance to think about it later on, Ed would often come around to see Alice's point of view.  He still might not agree, but he could empathize with Alice's feelings.  He just needed a little time to reflect on it.  But this didn't make a difference for Alice.  Once she became enraged, she might take a few hours or even a whole day to calm down.  Before that, she couldn't even hear what Ed had to say.

Needless to say, this dynamic had a big impact on their marriage.  After the first year of enduring Alice's strong emotional reactions, Ed told Alice that he didn't want to live this way and if she didn't get help, he might leave the marriage.

Even without the possibility of Ed leaving, Alice would often realize after she calmed down that her emotional reaction to their argument was over the top.  But she didn't know what to make of it or what to do.  After she sought help in therapy, it soon came apparent that these disagreements with her husband were triggering old, unresolved emotional wounds from her family.

As we explored Alice's emotional build up during a recent argument with her husband, we slowed everything down so Alice could experience how her emotions escalated to such a point.  I asked her to identify the feelings she was experiencing in her body.  As she sensed into her body to feel what was going on for her, she realized that whenever Ed didn't understand what she was trying to tell him, she erupted in anger, but the anger masked a lot of fear.

Using clinical hypnosis, we were able to trace that fear back to a time when she was four years old.  Her father, who was a severe alcoholic and often in a drunken stupor, was too drunk to understand what Alice would try to tell him.  At the time, her mother was in denial about the severity of the father's alcoholism, so she would leave Alice alone with him whenever she visited her mother across town.

On one of those occasions, Alice's father left a pot of water boiling on the stove, and then he fell asleep in a drunken stupor.  Alice smelled something burning, ran into the kitchen, and saw the pot burning.  But when she tried to wake up her father, she couldn't get him up.  He was so groggy that he couldn't understand what she was saying and pushed her away.  She was terrified.  But fortunately, she ran to the neighbor next door, who called the fire department.  Soon after that, the Bureau of Child Welfare got involved and provided services to Alice and her family.

The hypnosis allowed Alice to connect her current emotional reactions to the earlier ones.  She was able to see that the emotions connected to this memory, which she had never forgotten and was accessible to her even before we did hypnosis, got triggered whenever she had an argument with her husband were she felt he didn't understand her.

We were able to work on this memory, which was representative of many similar memories, so that Alice could overcome her unresolved trauma and no longer get triggered in her marriage.  It took a lot of work, but she was relieved to have some explanation as to why she was overreacting with her husband.

I want to be clear that, in this example, I'm not referring to "recovered memories," which can be inaccurate and misleading.  I often get calls from people who sense they might have been sexually or physically abused and they hope that hypnosis will give them the answer.  What I usually tell them is that memory can be very tricky.  It's not like hypnosis enables you to be able to recover information like  picking out a file from a file drawer.

The memory that I'm referring to in this example is a memory that Alice had been well aware of before we began using hypnosis.  The difference is that she never connected her childhood trauma with her current dynamic with her husband.  Once we were able to work through the childhood trauma, Alice was no longer triggered in her current life, which was a tremendous relief.

Getting Help

Often, in our ordinary consciousness, we're not able to make these connections.   When you work with an experienced hypnotherapist, you enter into a state of deep relaxation which allows you access to your unconscious.  In that state, you can make connections that are usually not available to you in ordinary consciousness.

As I've said many times before in other blog posts, you're in complete control at all times with clinical hypnosis.  People who have been traumatized are often afraid of not being in control, and their notions about hypnosis are derived from stage hypnosis, which is nothing like clinical hypnosis (also known as hypnotherapy).

I recommend that, if you're considering clinical hypnosis that you only see a licensed mental health professional who is a hypnotherapist rather than seeing a non-clinician who might have some training in   hypnosis but who has no clinical skills.

It's possible to free yourself of trauma or old emotional wounds that can get triggered in your current life.  Transcending old emotional wounds can make a big difference in the quality of your life and the lives of your loved ones.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR therapist and Somatic Experiencing therapist.  I am certified in mind-body oriented psychotherapy.

I work with individual adults and couples.

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

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

Saturday, July 21, 2012

Overcoming Feelings of Inadequacy

Overcoming feelings of inadequacy can be very challenging, especially if you've been feeling this way for many years.  There can be many causes for feeling inadequate, including early childhood trauma, an abusive spouse, a boss who is a bully, and so on.

Often, people who are feeling inadequate know in their rational minds that there is no objective reason for feeling this way.  I've had clients, who are quite accomplished and who are looked up to by many others, who still feel inadequate.  They might hide it well when they're around other people, but deep down inside, they still feel worthless.

Overcoming Feelings of Inadequacy

Talking about it in therapy often goes nowhere.

People who feel inadequate can often identify what triggers their feelings of inadequacy and even pinpoint early trauma that precipitated their feelings of worthlessness.

But this is often not enough to help them overcome their negative feelings about themselves.  If anything, it's usually very frustrating because then they wonder, if they can see objectively that there is no rational reason for their feelings, why they still persist in feeling this way.

I was originally trained as a psychoanalyst.  I still love psychoanalysis and, when clients come to me requesting psychoanalysis, I work in a contemporary, dynamic way (as opposed to classical psychoanalysis).

But I've found, over the years, that psychoanalysis and regular talk therapy is often not sufficient, by itself, to help clients overcome feelings of inadequacy.

I have found over the years that mind-body oriented psychotherapy, like clinical hypnosis, EMDR, and Somatic Experiencing are much more helpful to overcome feelings of worthlessness and low self esteem.

Overcoming Feelings of Inadequacy

These mind-body oriented psychotherapies help clients to access their strengths and power to heal in a much more profound and effective way.

Getting Help in Therapy
To find out more about EMDR, Somatic Experiencing and clinical hypnosis, you can go to the following professional websites:

Clinical Hypnosis:
Somatic Experiencing:

I am a licensed NYC psychotherapist, who is certified in mind-body oriented psychotherapy.  I work with individual adults and couples.

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

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

Clinical Hypnosis and Hypnoprojectives to Overcome Problems

Clients often come to me with longstanding problems that they have been unable to overcome. Often, these clients have had many years of talk therapy.  They might have gained some intellectual insight into their problems, but the problems still persist.  They usually feel frustrated and discouraged by the time I see them.

Clinical Hypnosis and Hypnoprojective

As a therapist who uses mind-body oriented psychotherapy, I have discovered that using hypnoprojectives during clinical hypnosis often alleviates problems that have resisted change for many years.  A hypnoprojectives is a technique that is used in clinical hypnosis where a client, who is in a relaxed hypnotic state, can "watch" a movie or TV program in his or her imagination about a person who is very much like him or her with a very similar problem.  In this relaxed state, clients will often come up with creative solutions to their problems that they would never have come up with in their normal state of consciousness.

There is something about seeing a problem from someone else's perspective while in this relaxed state that allows a person to see the situation in a new way.  Also, being in a relaxed hypnotic state allows a person access to his or her unconscious where creative solutions often reside.

As I've mentioned in prior blog posts, clinical hypnosis is not magic.  It's not something that it "done" to you.  When you're in a hypnotic state, you are completely conscious of everything around you and in complete control the entire time.

If you're considering clinical hypnosis, always see a licensed mental health professional. There are many people who call themselves hypnotists who might be trained in certain hypnotic techniques, but they're not licensed clinicians.  If something should come up in the hypnosis that is disturbing, they will not know how to handle it, whereas a licensed mental health professional will be trained for these types of situations.

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

I work with individual adults and couples.

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

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

Book: "Almost a Psychopath"

I recently read Almost a Psychopath by Ronald Schouten, MD, JD and James Silver, JD.  Both authors have extensive experience working with psychopaths and "almost psychopaths."

According to Schouten and Silver, people who are "almost psychopaths" are individuals who don't quite meet the full criteria for being a psychopath.

In their book, they discuss in details how we can distinguish between the two, and they give many examples of people who are "almost psychopaths."

As a therapist who meets many different clients, it was fascinating to read about how common "almost psychopaths" are.

According to Schouten and Silver, they are all around us.  More importantly, they discuss what you can do if you are with someone who is almost a psychopath or if you recognize yourself to be in this category.

One important difference between a psychopath and someone who is almost a psychopath has to do with empathy.

Someone who meets the full diagnostic criteria for being a psychopath lacks empathy for the people that he or she hurts.

If this is a topic that interests you, either because you're with someone who displays psychopathic tendencies or you think you might be psychopathic yourself, I recommend that you read "Almost a Psychopath," which is an informative and interesting read.

About Me
I am a licensed NYC psychotherapist who works with individual adults and couples.

My specialities include dynamic talk therapy, clinical hypnosis, EMDR, Somatic Experiencing and Emotionally Focused Therapy (EFT) for 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.

Belittling Behavior in Relationships

Several years ago, I was at a dinner party with friends and I met a couple who were friends of the hostess. The husband was talking about his position as a senior partner in a law firm and telling us about the impressive cases that he had worked on.  We listened politely and then I asked his wife about her work. As she began telling us about her interior design business, her husband chuckled and said, "Oh yeah, Mary has her 'little business' that she runs from home.  It keeps her busy and out of trouble." Mary looked mortified and she cut short her conversation, and soon afterwards she made an excuse to leave the party early.

Belittling Behavior in Relationships

I'm almost sure that Mary's husband didn't see that what he said was belittling and humiliating for Mary.   His comment was probably motivated by an unconscious need to put her down in order to boost himself up.  But, in reality, although none of us said anything to him about his comment, we commented to each other afterwards about this type of covert belittling that, unfortunately, goes on all too often in relationships.

A Pattern of Belittling Behavior
As a psychotherapist in NYC who works with individuals and couples, I hear about covert belittling from clients often.  Often, the person who is doing the belittling behavior has a pattern of doing this with his or her partner.

When confronted about it, s/he often denies that s/he meant any harm.  It can take a while before the person who engages in this type of belittling can see that it's offensive and hurtful to the other person.  This is assuming, of course, that the partner who is being belittled is able to speak up about it.  Unfortunately, too often, the partner who is being belittled has endured these put downs for a long time, and it can take a toll on his or her self esteem.

At another social event that I attended, I heard a wife making negative comments about her husband's inability to fix things around the house.  She made her comments in a teasing tone, and when her husband got embarrassed and asked her to stop, she said, "Oh, don't be so sensitive.  I was only teasing."  Apparently, she was either unable or unwilling to see that her comments were hostile and showed contempt for her husband.  Instead, she accused him of being overly sensitive, which only humiliated him even more.

Underlying Issues in Relationships that Cause Belittling Behavior
There is no one-size-fits-all answer as to why couples do this to one another.  In my experience, it's often due to underlying issues in the relationship that the couple is not dealing with.

Belittling Behavior in Relationships

When I see a couple where one or both of them engage in belittling, I help each of them to see the dynamic and work towards changing it.  Most of the time, if the person who engages in this type of belittling has some degree of empathy, s/he will come around and recognize that these comments are hostile and abusive.

At that point, we can explore a more tactful and respectful way of communicating.  We can also get to any underlying issues that might be causing these types of comments.  Usually, the person who engages is covert belittling recognizes that s/he is really angry about something else about the partner.  Or, s/he is feeling insecure about him or herself.

Belittling Behavior Disguised as "Teasing"
Belittling behavior, whether it's disguised as "teasing" or innocent remarks, has the potential to destroy a relationship.

If you or your partner recognize this pattern in your relationship, you and your partner could benefit from seeing an experienced couples counselor to help you both to learn to communicate in a healthier way.

About Me
I am a licensed NYC psychotherapist who works with individuals and couples.  I have helped many couples to improve the way they communicate so they could have a happier relationship.

I specialize in working with clinical hypnosis, EMDR, Somatic Experiencing, and dynamic talk therapy.

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.

Wednesday, July 4, 2012

Do Your Friends See Red Flags About Your Partner that You Don't See?

One of the most challenging situations between friends is when your friends don't like your lover or vice versa.  At times, your friends might not like your lover because they see things about him or her that you don't see.  It can be a very disappointing and frustrating situation.  It can put a strain on your friendships and on your relationship.

Do Your Friends See Red Flags About Your Partner That You Don't See? 

The following example, which I'm providing with permission from a friend, with names changed and all identifying information changed, illustrates how friendships can be challenged in this type of situation:

John and I have been close friends for more than 20 years. Several years ago, he began dating Ali.  Prior to dating Ali, John had been in a two year divorce battle with the woman who was his wife at the time, which left him emotionally depleted and disillusioned about relationships.

So when those of us who were close to him heard how enthusiastic he was about this new person he was dating, we were thrilled for him and looked forward to meeting Ali.  But all of that changed when we met Ali one night over dinner at John's apartment.   Within a few minutes of meeting us, she told me she "didn't believe in psychotherapy," she told our journalist friend that she didn't like his newspaper, and she kept calling another friend by the wrong name (even though our friend kept telling her the right name). Ali looked bored throughout the meal as if her participation was part of a court mandated community service penalty.

About an hour in, she told John she felt a headache coming on and she asked him to drive her home. Throughout the dinner, John sat there gushing over Ali, looking at us and saying, "Isn't she wonderful!"  We all nodded our heads politely, not knowing what to say.  He was so smitten with her that he didn't even notice how she behaved towards his friends.

It was an awkward situation, but I thought, "He's really crazy about her, and I guess if she treats him well and he's happy, that's what really matters." But no sooner did I have this thought when I heard Ali criticizing John, while he was telling us he'd be back shortly, for not being quick enough to get his car to drive her home. She barely said good night to us as she sailed out the door.

After they were gone, we were silent for a long minute.  Finally, Amy broke the silence, "This is a nightmare! What are we going to do? Should we say something to John?"  We decided to wait to see if he asked us for our opinions about Ali.  But when John returned, he was gushing about her. Knowing how unhappy he had been in his marriage and how enthusiastic he was about Ali, none of us had the heart, at that point in time, to say anything negative.

A few days later, I met John for lunch. It was just the two of us.  When he brought up Ali, he told me that he hadn't been this happy in a long time.  Prior to that, I considered talking to John, hoping to spare him the heartache that seemed like it would come inevitably.  But he didn't seem to want to hear it, so I hesitated.  Sensing my hesitation, he said, somewhat defensively, "I know she's rough around the edges, but I really care about her.  All I ask is that you get to know her and give her a chance."  His look made it clear that he didn't want to hear anything negative, so I kept quiet.

Over the next couple of months, I socialized with John and Ali a few more times with similar results.  Each time she showed very little interest in getting to know John's friends and she found some reason to end the night early, insisting that John leave too.  It was painful to see John being bossed around like this and his being so unaware of Ali's behavior.  But he had already made it clear to all of us that he didn't want to hear anything negative.  I reasoned that he is an adult who could make his own decisions. His other friends and I were all dismayed, but we respected the boundary he set.

Then, one day I got a late night call from John, who sounded very upset.  He asked if he could come over to talk.  When he arrived, he threw himself on my couch and began to cry.  He looked awful, as if he had already been doing a lot of crying. I waited for him to compose himself, and then he told me that Ali informed him via text message that she no longer wanted to see him. He couldn't believe she would end things this way. He never saw it coming.  Then, with a touch of resentment, he said, "You knew all along that she wasn't right for me, but I didn't want to hear it."

In the weeks that followed, John and I were able to talk about what happened. He told me that he knew I had his best interests at heart, and he wished he had been more open to hearing my feedback, as well as the feedback of his other friends.  He was hoping so much that this relationship would work out that he put blinders on.

John did eventually meet another woman and they're happy together.  But every once in a while, he talks about how he ignored all the obvious negative signs with Ai, and how he discouraged his friends from saying anything negative about her.

This is a common experience for many people. Fortunately, this situation didn't destroy longstanding friendships.  But many similar situations end badly for friendships.

Of course, friends aren't always right when they disapprove of your lover, but if if you have close friends that you know have your best interests at heart, isn't it worth it to take a moment to consider if they might be seeing things about your lover that you don't want to see? Especially at the beginning of a relationship, love be truly blind. It's easy to say, "They don't know him the way I do."  But very often, like John, you do know when something is amiss in your relationship, but you don't want to see it.

What is Your Responsibility to Your Friend if He or She is in an Emotionally Abusive Relationship?
If you're the friend of someone who is with a lover who doesn't seem right for him or her, what is your responsibility towards your friend?  This can be a tough dilemma, and there's no one-size-fits-all answer. If your friend is in a physically abusive relationship, you should talk to him or her about it.  But in other situations, where your friend doesn't want to hear any criticism, sometimes all you can do is let him or her know you're there as a friend.  As in the case of John, your friend will probably come to you for support when the relationship falls apart.

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

I have helped many clients with relationship issues.

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.