NYC Psychotherapist Blog

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Monday, February 24, 2014

Psychotherapy: How Early Attachment Problems Can Affect Your Relationship With Your Therapist

In an earlier series of articles about early attachment bonds between infants and their primary caregivers, including How the Early Attachment Bond Affects Adult Relationships, I discussed how problems with early attachment can affect adult romantic relationships.  In this article, I'll focus on how early childhood attachment problems can affect adults in their relationship with their psychotherapist.

How Early Attachment Problems Can Affect Adults' Relationships With Their Therapist

The attachment style that people develop early in life with their primary caregiver usually continues on in adult relationships.

When the emotional bond between the baby and the primary caregiver goes well, it's a secure attachment and if there's no major trauma in childhood, as an adult, this person will probably be able to form healthy, secure attachments in adult relationships.

But if the attachment bond that the baby develops with the primary caregiver is an insecure attachment, which is traumatic for the baby, problems often develop later on in adult relationships (see my article: How the Early Attachment Bond Affects Relationships: Insecure Attachments for an explanation of insecure attachment).

How Attachment Problems Can Affect Adults in Therapy
When someone has an attachment problem that developed in early childhood, the insecure attachment doesn't just carry over only into romantic relationships.  Depending upon the severity of the insecure attachment, it can also carry over into other adult relationships, including work relationships, friendships, and the therapeutic relationship with a therapist.

Generally speaking, people are complex, and people with insecure attachment styles don't fall into neat categories of avoidant, ambivalent, disorganized or reactive attachment.

But to illustrate the point that therapy clients often develop therapeutic relationships with their therapist based on their attachment style, I'll simplify the example I'm about to give in the vignette below to deal specifically with the avoidant attachment style.  The same principles would apply for the other forms of insecure attachment, but they would probably show up in a different way.

As always, this vignette is a composite of many cases with all identifying information changed to protect confidentiality:

Ella, who was in her late 20s, came to therapy because she had a history of problems in her romantic relationships.

Ella's Avoidant Attachment Style Caused Problems in Her Romantic Relationships 

Although she was focused primarily on her problems in romantic relationships, Ella also had problems with her relationships at work.  However, since she made a lot of money for the company, her superiors overlooked her interpersonal problems.

Ella said she wanted to meet someone that she could settle down with, get married and have children, but her relationships never lasted more than a year.  She was also keenly aware that she would be entering into her 30s soon, and she was concerned about her "biological clock."

Her problem was that whenever a romantic relationship became serious, she became fearful that her partner would leave her.

In each relationship, Ella's fear became a self fulfilling prophecy because, even though she loved the man she was in a relationship with, her fear would become so overwhelming that she would become avoidant and start to distance herself from him.

She did this by finding all kinds of reasons for canceling plans, making excuses, including that she didn't feel well or that she had too much work to do.

Sooner or later, the man she was seeing at the time would get fed up and leave the relationship, and Ella would feel sad and frustrated.

After this happened in three relationships, Ella also began to feel angry with herself because she couldn't understand why she was sabotaging each relationship.  It also left her feeling very lonely.

Each time this happened, Ella would promise herself that she wouldn't give in to her fears in the next relationship. But each time her fear overwhelmed her in the next relationship, and she found ways to distance herself again.

Knowing that clients' attachment styles can affect their therapeutic relationship with their therapists, I usually address this issue early on in therapy to educate clients so they won't be surprised to see that they're engaging in the same dynamic in therapy.

When a client with this problem knows in advance that it can affect how they engage (or disengage) in therapy, it can help clients to anticipate this before it happens.  It gives the therapist and client an opportunity to talk about it before client acts on it.

Although talking about it beforehand can help to mitigate an insecure attachment style, simply having this information doesn't necessarily stop it.

Attachment dynamics are usually unconscious, so that when a client engages in an insecure attachment style in therapy, s/he isn't necessarily aware of it at the point when it's happening.

It can take a while for a client to develop enough awareness in therapy to anticipate the behavior and, even more time to change it.

Ella was psychologically minded, so she was surprised and curious about how this avoidant dynamic might play out in therapy.

In the initial stage of therapy, as I was learning about Ella's family history and how it contributed to her insecure attachment style, Ella seemed fine.  She had been in therapy several times before, and she had talked about her family history many times before.  She was almost somewhat detached and unemotional as she gave her history.

When Ella told me about the many false starts she had in her prior therapies, I pointed out to Ella that, just like she found ways to be avoidant in her romantic relationships, she also became avoidant in her therapeutic relationships with prior therapists.

Ella's Avoidance in Prior Treatment Was Unconscious

Ella had never thought of this before but, as we discussed it, she realized that she usually left therapy just when she and the therapist were at the point where they were delving deeply into her problems.  Whenever she left therapy, she thought she was doing it because "it wasn't helping."

But, as we discussed this, Ella was able to see, in hindsight, that she didn't really give any of her prior treatments a chance because she would leave before she made progress.

We spent time talking about the internal cues that Ella might have missed before she aborted therapy in the past, and we also talked about whether she could pick up on these cues this time if she felt like aborting therapy again.

For many clients, this is hard work, especially for clients who really believe that, each time they leave therapy, it isn't because they're avoiding dealing with their problems.  They want to believe that they have a legitimate reason each time because "therapy isn't working."

This isn't to say that clients don't leave therapy for legitimate reasons or that their therapist really isn't helping them.  But for clients who have an avoidant attachment style, they often have a pattern of leaving therapy prematurely (see my article:  When Clients Leave Psychotherapy Prematurely).

In addition to discussing Ella's avoidant behavior in therapy, as part of our preparation for our work, we also worked on helping her to develop coping strategies to deal with her anxiety and fears.

We also talked her commitment to therapy and the treatment frame, including my cancellation policy, which is 48 hours unless there's an emergency.

Although this preparation helped Ella to deal with her urges to leave therapy during the early stage of treatment, as we delved deeper into Ella's early childhood history with an unstable mother, Ella began to cancel appointments more frequently.

For many people, a cancellation policy where they had to pay the full fee for broken appointments can be a deterrent to their canceling appointments when they want to cancel because they're uncomfortable with the material that we were discussing in the prior session.

But Ella earned a very good salary and it wasn't a hardship for her to pay for broken appointments.  So, the cancellation policy didn't keep her from missing sessions.  She also became adept at canceling the appointments 48 hours in advance so, technically, she complied with the cancellation policy but, in effect, she was sabotaging her treatment because of her fears of dealing with emotional material that came up.

At the point when she cancelled the appointments, she had no insight as to what was happening with her because her fears were unconscious at the time.  It was only after she returned to her therapy sessions and we discussed what happened that she was able to see, after the fact, that she was being avoidant.

Fortunately, even though there was a part of Ella that was ambivalent about dealing with her problems in therapy, there was a bigger part that was motivated.  So, we worked with the motivated aspect of her in therapy to strengthen it so she wouldn't allow the fearful part of herself to sabotage her sessions.

We also had to develop some new ground rules that we would mutually agree to about cancelled appointments.  So, we agreed that she could only have so many cancellations per six months, and she was able to abide by that.

Since regular talk therapy often isn't as effective for insecure attachment problems, we used a combination of Somatic Experiencing and clinical hypnosis, which are both mind-body oriented therapies that are considered a "bottom up" approach as compared to regular talk therapy, which is more of a "top down" approach.

Ella's therapy was long-term treatment because, even though she was making progress over time, she would sometimes revert to avoidant behavior.  So, our work together required patience on both of our parts.  But as we continued to work together, Ella began to trust me more over time and this allowed her to open up more.

And, as is usually the case, the interesting thing was that as she was developed the skills to form a stronger, stable therapeutic alliance with me, she used these same skills to form a more stable relationship with the new man that she was dating as well as her colleagues at work.

Over Time, Ella Worked Through Her Avoidance in Therapy and in Relationships

Over time, Ella worked through her avoidant behavior, and when she felt the urge to withdraw out of fear, she was able to see the signs before she acted on it, which was a major breakthrough for Ella.

The Challenge of Working on Insecure Attachment in Therapy
Working on any one of the insecure attachment styles in therapy can be challenging for the client and the therapist.

In the vignette that I presented above, even though Ella was fearful, she also had strengths and she had access to a part of herself that was motivated to overcome her avoidant behavior.  She was able to use the therapy well and, over time, she was able to work through her early childhood trauma and overcome her fears.

Many people who have an avoidant attachment style never come to therapy at all.  Their fear of developing a therapeutic relationship with a therapist is so great that, unfortunately, it keeps them out of therapy and, as a result, they never work out their problems in relationships.

For other people who start therapy and who might not be as motivated or as psychologically mind,  they often have a hard time sustaining it.  They might go from one therapist to the next in an effort to get help, but they don't remain in therapy long enough to work through their problems.  Sometimes, in hindsight, some of these clients see that their fear overwhelmed them.

But other people with this problem, no matter how many different therapists they see, they tend to externalize their problems and believe that they left because of the therapist as opposed to what usually happens:  They leave because of their insecure attachment style and the fear and dread that are associated with this problem.

When you consider that overcoming an insecure attachment style is not short term work, this presents another challenge for these clients.

Getting Help
The good news is that many clients who come to therapy to overcome the consequences of problems with early attachment are able to work through these problems.

Just like in any other therapy, it's important for the therapist and client to be a good match.

It's also important that the therapist, who should be a licensed mental health professional, is knowledgeable about insecure attachment issues.

Also, in many cases, as I mentioned earlier, straight talk therapy, which is usually a "top down" approach, isn't as effective as a more "bottom up" approach in therapy, like Somatic Experiencing, EMDR or clinical hypnosis.

If the composite vignette above resonates with you, you could benefit from working with a licensed therapist who has expertise in working with clients who have attachment problems.

It's common for most people to feel some discomfort about starting therapy.  But it's preferable to deal with the fear than to look back late in life and have regrets that life has passed you as you continue to suffer with attachment problems.

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

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

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

Saturday, February 22, 2014

Staying Positive and Focused on Your Goals

Staying positive and focused on your goals, especially long-term goals, can be challenging.

Many people who made New Year's resolutions in January have already given up on keeping their resolutions (see my article: Making and Keeping New Year's Resolutions).

There are many reasons why people, who start out motivated at the beginning of the year, lose their motivation after just a few months or even a few weeks.

Here are some of the primary reasons why people give up on their goals:

Having Unrealistic Goals
Many people have unrealistic ideas about what they can achieve.

New Year's resolutions tend to be about things like losing weight, exercising more or eating healthier.

These are all worthy goals, but the problem arises when people set unrealistic goals, like wanting to lose 50 lbs in a month.  This is an unrealistic and unattainable goal for most people and it sets them up for failure.

In addition to being realistic and attainable, you're more likely to succeed at accomplishing your goals if they're specific, measurable, relevant and time bound.

Engaging in All or Nothing Thinking
When goals are unrealistic and unattainable, people usually become discouraged and give up rather than recognizing that the goal was unrealistic and modifying it.

It becomes an all-or-nothing proposition for them (see my article:  Overcoming All or Nothing Thinking).

Having False Expectations that Accomplishing Your Goals Will Create a "New You"
The idea of people "reinventing" themselves is a part of the American culture.

We read in self help books and hear ads all the time that say that you can create a "new you" if you only lose weight, have whiter teeth or ____________________ (fill in the blank).

This cultural stereotype appeals to people who want a "quick fix" as opposed to people who recognize that change is a process that usually occurs over time.

Avoid False Expectations That Accomplishing Your Goals Will Create a "New You"

When people focus exclusively on external change without focusing on internal change, even when they succeed at their external goal, it's harder to persevere in that goal if they haven't done the psychological work that's necessary to maintain the process.

For instance, I've known people who had lap band surgery to lose weight.

After the surgery, they lost a lot of weight.  But if they didn't work on the psychological issues that triggered overeating, they often either reverted to overeating and got sick or they developed another addictive behavior, like gambling.

Allowing People in Your Life to Discourage You
When you have an important goal, it's important to share your intention with people who are going to be supportive of you (see my article: Beware of Emotional Saboteurs).

Emotional support to accomplish a goal can make the difference between accomplishing your goal or giving up.

Don't Allow Emotional Saboteurs to Discourage You From Accomplishing Your Goals

In an ideal world, everyone in your life would be supportive and encouraging.  But, as most of us know, this just isn't the case.

When you share your intention to accomplish a goal with people who tend to be discouraging, you're exposing yourself to their negative thinking and, possibly, allowing their negativity to derail you.

People who tend to be negative and discouraging aren't always doing it to sabotage you.  Sometimes, without even realizing it, they project their own discouragement about themselves onto you.

If you know you have a healthy, realistic and worthy goal, you have to become more self protective and talk about your goal with other motivated people who are doing positive things in their lives and want the same for you.

Allowing Self Sabotage and Negative Thoughts to Keep You From Accomplishing Your Goals
Even more detrimental than other people's negativity are your own negative thoughts that can creep in so easily, before you realize it, to discourage you from accomplishing your goals (see my article:  Are You Sabotaging Yourself With Negative Self Talk?)

Negative thoughts (also known as negative self talk) can be so insidious and so automatic that, before you know it, you've talked yourself out of pursuing your goals.

Staying Positive and Focused on Your Goals
Remember that change is a process.

Staying Positive and Focused on Your Goals: Change is a Process

Keeping a journal where you write down your progress along the way to accomplishing your goals can help you to stay positive and focused on your goals (see my article:  Are You Able to Celebrate Your Progress or Are You Only Focused on How Much More You Have to Go?).

Along the way, keeping a gratitude journal can also help you to appreciate all that you have to be grateful for throughout the process of working on your goals.

Getting Help in Therapy
It can be challenging to stay positive and focused on your goals even under the best of circumstances, but if you have a history of emotional trauma or there are other psychological issues that are creating obstacles for you, it's even harder.

If you realize that psychological issues are preventing you from fulfilling your dreams, you owe it to yourself to get help.

Working with a licensed mental health professional who has expertise in helping people to overcome psychological issues that create obstacles to realizing your goals can make the difference for you of being successful or falling short of your goals.

Getting help can lead to a more meaningful, fulfilled life.

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

I have worked with many clients to help them to overcome emotional obstacles 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.

Tuesday, February 18, 2014

Overcoming the Temptation to Use "Liquid Courage" to Cope With Social Situations

As a psychotherapist in NYC, I've been seeing more clients these days, as compared to the past, who are experiencing crippling fears in social situations, and many of them are relying on alcohol to give them "liquid courage," which provides a false sense of confidence in these situations (see my article: Overcoming Social Anxiety).

Fear and Shame in Social Situations

Fear and Shame in Social Situations
There have been tons of article written about why people are having such difficulty overcoming their feelings of vulnerability and shame when it comes to socializing and dating (see my articles: Overcoming Loneliness and Social Isolation and Overcoming Shame).

                   Fear and Shame in Social Situations

These articles give many reasons why this phenomenon is especially prevalent these days, including the fact that people are communicating more online than in person, and many people haven't learned the basic skills necessary to interact socially in person without experiencing dread.

Fear and Shame in Social Situations

Fear of Socializing Without "Liquid Courage"
So, I'm not going to focus so much on the reasons for this problem, which have have already been discussed in many other articles.  Instead, I'm going to focus on a social phenomenon that I've seen with people of all ages, which is that they feel they can't socialize without "liquid courage" to get them through.

Overcoming the Temptation to Use "Liquid Courage" to Cope With Social Situations

As I usually do in my articles, I'll give a scenario to highlight the problems and some of the ways these problems can be overcome in therapy.

Although the example that I give is about a man, this issue affects both men and women regardless of age, race or sexual orientation.

As always, this scenario is a composite of many cases with all identifying information changed to protect confidentiality:

Mike, who was in his early 30s, never attended any social event without having at least one drink before he went.

Although, at this point in his life, he very much wanted to be in a relationship, he felt almost paralyzed with fear when he thought about talking to an attractive woman at a party.

Before, he went, he imagined all the things that could go wrong and how embarrassed he would be:  What if there were uncomfortable pauses in the conversation because he couldn't think of anything to say?  What if he looked "stupid" because he didn't understand what she was talking about?  What if she thought he was a bore?  What if he spilled his drink all over himself?  And he ruminated on and on, which escalated his fear.

At times, he felt so emotionally vulnerable when he thought about an upcoming party that he would agonize for days beforehand.

Sometimes, his fear and shame were so great that he would cancel at the last minute rather than deal with facing a situation where he felt sure he would make a fool of himself.

But the immediate relief that Mike felt from avoiding the social situation was often short lived.  Within hours, he regretted not going because his avoidance kept him feeling stuck and lonely for female companionship.

He had plenty of male friends that he hung out with, but socializing with women that he had never met before felt like an insurmountable challenge for him.

Although he felt confident in his career (where he worked mostly with men) and hanging out in a sports bar with his buddies, he lost all confidence in himself when he was in a situation where there were women he didn't know.

On those occasions when he did go to parties, he fortified himself with "liquid courage" (one or two drinks) before he left the house.  Then, he had a few more drinks when he arrived at the party and he was able to loosen up enough to chat with women he didn't know.

Overcoming the Temptation to Use "Liquid Courage"  to Cope With Social Situations

With a few drinks in him, Mike felt less inhibited and he was able to forget about being self conscious.  He was often funny after a few drinks, and women would tell him that he had a great sense of humor.  He also felt more confident about asking women to go out.

The problem was that, by the next day, without alcohol, he still felt the same crippling fear as before, and he was sure that when he called the woman that he met, he would be so socially inept that she wouldn't want to go out with him.

Fear and Shame in Social Situations Without Alcohol

After struggling this way for a couple of years, Mike realized that he had a real problem and he came to therapy.

In therapy, Mike and I worked on the underlying issues, including a childhood with overly critical parents, that were at the core of his problems.  Even though he was an adult, he continued to struggle with these old messages that made him feel worthless in social situations with women he didn't know.

Aside from working through these underlying emotional issues, Mike also needed to practice getting more comfortable approaching these social situations without fortifying himself with alcohol.

On a rational level, Mike knew that he couldn't keep relying on alcohol to get him through because it was only a temporary fix.  And, since his father had problems with alcoholism, Mike also knew that a possible genetic predisposition to alcoholism could create a bigger problem for him if he continued to rely on alcohol.

But, on an emotional level, Mike felt that alcohol had become his reliable "friend" in helping him to get through these situations.  Even though Mike wasn't an alcoholic, he knew that his maladaptive ways of coping with social situations wasn't going to be easy to change.

We worked on Mike's childhood history of emotional abuse using EMDR therapy.  We also used the cognitive behavioral technique of desensitization for his fears related to socializing.

Using a desensitization technique, we set up a hierarchy of Mike's fears and worked on them, step by step, one by one (from low to high) so that he could overcome his fears.

In addition, we used clinical hypnosis (also known as hypnotherapy) to help boost Mike's confidence.

In the meantime, Mike cut back on his drinking.  He practiced going to social events without having a drink beforehand.  He also cut back on the alcohol that he drank while at social events.

Needless to say, it wasn't easy for him.  Initially, he was so afraid that he just hung out with mostly friends that he knew and steered clear of talking to women that he really would have liked to meet.

But as we continued to work together, over time, Mike became more comfortable taking small steps to allow himself to be more emotionally vulnerable in these situations.

As you would expect, some days were better than others.  But what was most important was that Mike was willing to work on these issues in therapy and, even more important, he was willing to put himself out there in ways that were, initially, uncomfortable.

Overcoming the Temptation to Use "Liquid Courage" to Cope With Social Situations

It wasn't easy but, gradually, he overcame the near paralyzing fear and shame that had kept him feeling too vulnerable, and he was able to do it without relying on alcohol as a social lubricant.

At the same time, Mike developed more confidence in himself socially, and he eventually met a woman  he really liked and, a couple of years later, they got married.

Getting Help in Therapy
If you're often tempted to use "liquid courage" as a maladaptive way to cope with social situations, you're not alone.

Chances are that you also know a lot of people, possibly even your close friends, who are doing the same thing.  But, whether they admit it to themselves or not, most people who are struggling with this problem realize deep down that relying on alcohol isn't the solution.

Rather than trying to go it alone, you owe it to yourself to get help from a licensed mental health professional who has the expertise to help you overcome this problem.

Although there's no quick fix for this issue, by getting help you can give yourself an opportunity to approach social situations with more pose and confidence.

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

In addition to being a licensed therapist, I am also a certified Substance Abuse Professional.

I also work adjunctively with clients who want to remain with their primary therapists who might not have expertise in this area.

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.

If you think you have an alcohol or drug problem, see my article:
Early Recovery: You've Stopped Drinking. Now What?

You can also find an Alcoholics Anonymous meeting in your area by clicking on this link:
Alcoholics Anonymous.

Sunday, February 16, 2014

Dating: Is It Time to Have "The Talk"?

During recent years, dating has become a lot more complicated than it used to be.  From my perspective, as psychotherapist, people seemed a lot more open to being emotionally vulnerable in the past when they were dating as compared to how self protective many people are now (see my article:  Dating vs Being in a Relationship: Take Time to Get to Know Each Other).

Dating:  Is It Time to Have "The Talk"

To be sure, there have always been people who have been too afraid to allow themselves to be open and vulnerable to communicating their feelings in a dating relationship.

But it seems this is even more the case now, especially since people are relying on more indirect means of meeting each other, like dating websites and social media, and in the current environment, this makes it harder for people to be direct about their feelings or to say whether they want to continue to date or if they want a more committed relationship.

Stages of Dating
Another phenomenon that I've noticed is that many people are unaware that there are certain stages of dating or they just don't know how to date.

When I refer to "stages of dating," I'm not referring to specific, concrete stages.  I'm referring to the progression that might start with the first date and go on to the first kiss and might move onto a sexual encounter.

I realize that many people bypass these stages and refuse to even call what they're doing "dating."  They might see themselves as just "hooking up" or "hanging out."  Of course, this can lead to even more confusion because there's no process involved.

But, assuming that you're dating someone and you both agree that this is what you're doing, there are choice points along the way.

So, for instance, if you decide to go out on the first date, depending upon your experience during that date, you might decide that you don't want to continue to see this person or vice versa. Hopefully, this is handled with tact and compassion.

But if you continue to see each other, at some point during the first several months, it's a good idea to check in with the other person about how he or she feels.

What Is "The Talk"?
"The talk" is the conversation that you and the person you're dating have to reveal, openly and honestly, how you feel about each other.  Among other things, you talk about whether the two of you want to be exclusive with each other or whether you want to continue dating other people.

Why Is It Necessary to Have "The Talk"?
Lots of people who are dating try to avoid having "the talk" for as long as possible.  Others make their feelings known early on.

There can be many misunderstandings between people who are dating.  One person might think they're dating each other exclusively while the other person might still be "playing the field."

Dating:  Why Is It Necessary to Have "The Talk"?

When this mismatch comes to light, it can be emotionally painful, especially for the person who was under the assumption that they were exclusive.

To avoid these types of misunderstandings and also avoid trying to "read between the lines," it's better to have an open and honest conversation about how each one of you feels about the other and what each of you wants.

Why Is It So Hard to Have "The Talk"
Nowadays, many people fear having the dreaded "talk" with the person they're dating because they're afraid of looking foolish, needy, and being embarrassed.

If they're interested in having an exclusive relationship, they fear putting their feelings on the line because the other person might not want this.

For other people, who want the freedom to see other people, they fear hurting the person they're dating because s/he might not feel the same way.

So, many people feel they're stuck in an emotional quandary about how to even approach "the talk."

Generally speaking, women often fear that the man they're dating will see them as "clingy" and men fear that women will feel they're begin "pushy" and, sometimes, vice versa.

When to Have "The Talk"
There are no hard and fast rules about when to communicate your feelings to the person that you're dating.

If several months have gone by, and you're really not sure where things stand between you, it's probably a good idea to broach the topic with the person you're dating.

Dating:  When to Have "The Talk"

Although you might fear looking foolish if you want more from this person than he or she might want from you, isn't it better to know rather to wonder or, worse still, to assume that you know when you really don't?

Who Should Initiate the Conversation?
Once again, there are no rules about who should bring up the topic.

Generally speaking, among heterosexual couples, women tend to be the ones to raise this topic because, typically, they're more comfortable talking about relationships.

This certainly doesn't mean that heterosexual men don't initiate conversations about where things stand in a dating relationship.  It's just that, often, they're not as comfortable doing it.

So, if there are no rules about this in heterosexual relationships, there certainly are no rules in gay relationships.

Often, when one or both people feel that they're unsure about where things are heading, the discomfort and lack of certainty is often more uncomfortable than the vulnerability involved with having "the talk."

This probably isn't the best way to approach "the talk,"but often this is the way it goes.

I'll continue this topic in future articles.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR 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 during business hours or email me.

Monday, February 10, 2014

Overcoming Unresolved Guilt Towards a Sibling

Your unresolved guilty feelings can have a negative impact on your relationship with a sibling, and it can also erode how you feel about yourself, especially when your guilt is longstanding.

Too often, unresolved guilt between siblings can lead to misunderstandings or, in some cases, the demise of the siblings' relationship.

Let's look at an example in the following composite vignette, which represents many cases with all identifying information changed to protect confidentiality:

Tom and Ed:
When Ed was born, his older brother, Tom, was a caring and protective older brother.  When he was older, Tom would babysit for his parents.

Overcome Unresolved Guilt Towards a Sibling

As a child, Ed looked up to Tom as his older brother, and they had a loving relationship.

But Tom had a difficult relationship with their father that got worse when he became a teenager.  By the time he was 18, Tom knew that if he didn't leave the family home, he and his father might come to blows.

Tom thought about leaving for a long time before he moved out.  He worried about not being around for Ed, who was still in elementary school.  He went back and forth in his mind debating what he should do.

Ultimately, although he was reluctant to leave Ed behind, he decided to move in with friends, and he moved out of his parents' home while his parents and Ed were out one afternoon.  His friends helped him to swiftly move out of the house while the rest of the family was out, and Tom left a note for his parents.

After that, Tom didn't see his family for several months.  His parents were angry with him for moving out without telling them in advance, and Ed missed him.

Tom maintained contact with Ed by phone.  He felt guilty for leaving Ed, and he tried to explain why he couldn't come home, but Ed didn't understand.

Eventually, Tom's parents asked Tom to come home for a family visit to talk things over.  Tom and his parents went into the dining room to talk about what happened.

The talk went a lot better than Tom had anticipated.  Although they were angry and disappointed, his parents acknowledged that Tom and his father weren't getting along and it was probably for the best that Tom moved out.  As the adult, his father took responsibility for not doing more to try to repair the relationship.

Afterwards, Tom went to see Ed in his room.  Ed barely made eye contact with Tom.  He kept playing a computer video game as Tom tried to talk to him.

Over time, as Tom came around more, their relationship seemed to improve.  But Tom continued to feel guilty and he had a nagging feeling that Ed still feel abandoned by Tom.  He also worried that Ed might have resentment for him that Ed couldn't or wouldn't express, even though Tom encouraged him talk.

As Ed got older, he developed more friends and he had less time to see Tom.  Although, Tom also had many friends and a girlfriend, he kept looking for signs that Ed might still feel resentful towards him.  And when Ed wasn't as available, Tom wondered if this was a sign of resentment.

Over time, Tom and his father's relationship became less contentious.  They were even starting to get close.  But Tom continued to feel guilty about leaving his brother.

So, when Tom came to therapy, he brought up his unresolved guilt.  He said he knew, on a rational level, that he did the right thing for himself by leaving his parents' house and, back then, there wouldn't have been any way to talk to Ed about this because Ed was too young to understand.

Tom also knew, on a rational level, that back when he was 18, if he had remained at home, his contentious relationship with his father and the tense atmosphere it created in the household would have been damaging to Ed.  But, on an emotional level, Tom continued to blame himself and feel guilty.

So, I suggested that Tom could invite Ed to a therapy session to talk over his feelings and I could act as a facilitator of their communication, if both Tom and Ed were open to this idea.

After we talked about it, Tom decided that it was a good idea.  He was a little reluctant to tell Ed that he was in therapy, but he summoned his courage and spoke to him.

To his surprise, Ed agreed to come to the session.

By the time Ed came, Tom already had in mind what he wanted to tell Ed.  Somewhat nervous at first, he told Ed that he felt guilty about leaving him behind years before, and he was afraid that Ed might be harboring resentment towards him.

Ed seemed genuinely surprised that Tom still felt this way.  He told Tom that he remembered feeling surprised and disappointed when Tom moved out, but his childhood memories of Tom were mostly positive.  He remembered Tom taking care of him as a young child and how loving Tom was with him, and he expressed his love and gratitude to his older brother.

Ed also said that, when he got older, he understood that Tom had to leave because of the contentious relationship between Tom and their father.  Ed even said that he sometimes felt guilty that their father treated him so much better as compared to how he treated Tom when they were younger.

There was no sign that Ed harbored resentment towards Tom.  To the contrary, he seemed to still look up to his big brother.

Overcoming Unresolved Guilt Towards a Siblings

Hearing Ed tell him that he cared so much for him and he wasn't holding onto resentment was a great relief for Tom.  He felt like a big weight had been lifted off his shoulders.

A Disconnect Between What You Might Know Rationally vs What You Feel Emotionally
In the particular example that I gave above, there was a disconnect between what Tom felt on an rational level vs. what he felt on a emotional level.  Given the circumstances, Tom knew that he did the best thing for himself at that time.

A disconnect between what someone knows rationally versus what s/he feels emotionally is a common experience in these types of situations.  Sometimes, knowing that the experience might be irrational can be helpful, but it often doesn't make the guilty feelings go away.

In the scenario above, it turned out that Ed wasn't resentful, so Tom's guilty feelings were unwarranted.  But there are many complicated situations where a sibling does harbor resentment and this needs to be worked out.

The Importance of Communication to Deal With Unresolved Guilt Between Siblings
Unfortunately, this dynamic between siblings often goes unspoken, and people can spend years tiptoeing around each other because neither sibling wants to bring it up.

Decades can go by with these underlying emotions that never get discussed or resolved.  Over time, siblings can grow apart because these underlying emotions have a negative impact on their relationship.

In some cases, one or both siblings don't know how to discuss what happened between them or one or both of them is unable or unwilling to talk about it.

Shame is often a major factor for one or both siblings that gets in the way of clearing up whatever happened.

This is when it can be helpful to seek the assistance of a licensed mental health professional to facilitate a dialogue between siblings.

Getting Help in Therapy
If you and a sibling are struggling with a similar issue, rather than continuing to allow guilt to have a negative impact on how you feel about yourself and get in the way of your relationship with a sibling, you could get help in therapy with a licensed mental health professional who can help to mediate between you and your sibling.

Getting Help in Therapy

Even in cases where your sibling is unwilling to participate in therapy, you could benefit from working through your guilt in individual therapy sessions.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR 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 during business hours or email me.

Monday, February 3, 2014

Developing a New Psychological Perspective About Your Parents After They're Gone

As a psychotherapist, I see many clients who come to therapy because they have unresolved feelings about deceased parents.  In an earlier article, Looking at Your Childhood Trauma From an Adult Perspective, I discussed how clients often develop a different perspective, as adults, about their childhood trauma.  In this article, I'll focus on how it's possible to develop a new psychological perspective in therapy about deceased parents.

Strange as it might sound, many clients do develop a new relationship, within their own internal world, with one or both parents even after their parents are deceased.

Is It Possible to Develop a New Psychological Perspective About Your Parents After They're Gone?

Working Out Parental Relationships Can Be a Longstanding Endeavor
For many people, working out their parental relationships can be a longstanding endeavor.  It's not unusual for people to struggle with their feelings on their own from early childhood to old age without finding a peaceful resolution.

Working Out Parental Relationships Can Be a Longstanding Endeavor Starting From Childhood

From Childhood to Adulthood:  An Increased Psychological Capacity to Understand Parents
Children often have a narrow perspective about their parents.  This is understandable because, generally speaking, children's capacity for psychological understanding isn't as developed as adults.

It's natural that children often idealize one or both parents.  For instance, a child might see a mother as being very glamorous and all knowing or feel that a mother can protect the child against whatever danger there might be in the environment.  Or, a child might see the father as being strong and powerful, the family protector.

Then, as children get older, especially in their teens, they tend to place more importance on their friends' opinions and values.  And, at that stage, they might even denigrate their parents' opinions or values, much to the chagrin of their parents.

The change, from idealization as young children to separation and need for autonomy as teenagers, is a natural stage of development.  Of course, it's all a matter of degree.

When people come to therapy to deal with unresolved issues about their parents, it's usually because there are negative feelings that are lingering about their parents.   They want to experience a resolution to these feelings so they don't continue to experience the resentment, which is eating away at them, for the rest of their lives.

There are many reasons why people have longstanding resentment towards one or both parents.  Sometimes, children grow up feeling disappointed in their parents without really understanding what's going on for the parent at that time.

In cases where there are more serious issues, like parental abuse, which I won't be discussing in this article, clients need trauma therapy.  See my articles on this topic:

Overcoming the Psychological Effects of Childhood Sexual Abuse
Resolving Childhood Trauma to Lead a More Fulfilling Life as an Adult
Adults Who Were Emotionally Neglected as Children Often Have Problems Trusting Others

From a Negative Psychological Perspective to a New More Integrated Perspective
In this article, rather than dealing with abuse, I'm focusing on a particular issue that involves disappointment and resentment towards a parent when the child sees the parent as inept.

The focus will be on a psychotherapy client who began therapy with a negative perspective about his father and who was able to develop a new, more integrated  psychological perspective.

In the example that I give in the vignette below, the client is able to work through these issues in therapy. As always, this vignette is a composite of many psychotherapy cases and has no identifying information about  any particular clients:

Roger was an engineer in his early 30s.  When he came to my psychotherapy private practice in NYC, he was filled with anger and resentment towards his boss.  He feared that his resentment might eventually cost him his job if it became apparent to his boss.

Developing a New Psychological Perspective About Your Parents After They're Gone

In general, Roger had problems with male authority figures throughout the course of his life.  Now that he was in his 30s, he recognized that his anger towards his current and prior supervisors was out of proportion to the situations involved, and he didn't understand it.

As we discussed his family history, it became apparent that Roger also had lifelong anger and resentment towards his father, Dan, who had died suddenly of a heart attack several years before.

Roger's main complaint about his father was that he was disappointed in his father and he saw his father as inept.

As a young boy, Roger longed for his father to be his hero.  He wanted to be able to look up to his father like other boys did but, instead, he felt consistently disappointed in his father.

Most of Roger's memories about his father were about his father being inept in some way.  He thought of his father as being a kind, well-meaning man, who "just couldn't get it right."

He described many situations where his father tried to work on a household project, but he fumbled around instead.  Inevitably, Roger's mother would have to take over in order to complete the project.  Roger knew that his mother felt disappointed and resentful, and he sympathized with her.

Dan also had difficulty concentrating and would often "space out" when he was trying to help Roger with his homework.   Then, his mother, who became exasperated, would have to take over.

Roger was also aware that his father would often shout in his sleep during his frequent nightmares.  Then, his father was up for the rest of the night pacing around the house before he could go back to sleep again.  But Dan never wanted to talk about his nightmares or what was bothering him.

There were days when Dan couldn't go to work at the retail business, which was owned by Dan and his brothers, because he was too tired and shaken up by his poor sleep.  Fortunately, his brothers, although somewhat impatient, made allowances for Dan and they shared the profits of the business with him equally so that he never suffered financial consequences from his inability to work.

But Roger knew, even as a young child, that his father felt humiliated and upset by what Roger and other family members saw as Dan's ineptitude.

Roger also sensed that his father had no understanding of why he was having these problems.  Throughout his educational history, Dan was always at the top of his class, so it was clear that he was an intelligent man.  It made no sense to Dan and to anyone else that he would be having these difficulties.

When he was a young child, Roger's feelings for his father vacillated between sadness filled with longing and intense anger.  Each time Dan embarked on a new endeavor, Roger hoped that his father would be successful but, more times than not, Roger was deeply disappointed.

As he got older, Roger struggled with his resentment for his father.  He could hardly look at his father without feeling angry.  He tried to hide these feelings from his father because he didn't want to hurt his feelings, but he knew that his father was aware it.

Roger described his father as "a broken man" who sank deeper and deeper into depression just before he died.  And, after Dan died, Roger was left with many conflicting feelings about his father.

As we continued to talk about his father and his current boss, it became apparent to both of us that there were many parallels in his feelings about them.  He described his boss as a bumbling, incompetent man, which is also how he described his father.

But he also felt guilty for feeling this way about his father and wished he could let go of his resentments, especially now that his father was dead.  He regretted that he didn't come to some resolution before his father died.

It occurred to me, as I heard more about his father from Roger, that there was an important part of Dan's history that Roger didn't understand.

Roger knew from his mother, Betty, that his parents were "going steady" before Dan was drafted into the Army and sent to Vietnam.  They got married soon after Dan returned from Vietnam.  However, his mother told Roger that she realized soon after they got married that Dan wasn't the same man after he got back from the war.

As we continued to talk about his Dan's history, it seemed to me that Dan might have been suffering with untreated post-traumatic stress disorder (PTSD) from the horrific experiences he endured during the war.

After I mentioned this to Roger, he asked his mother about it and, reluctantly, she told Roger that Dan was, in fact, diagnosed with post-traumatic stress disorder when he came back from Vietnam, but he never wanted to go for psychological help.  She also didn't understand this diagnosis and how it affected Dan.

She said that all she knew was that before Dan left, he was an intelligent, capable individual, and after he came back, he was struggling to deal with basic things in their lives.

With this new understanding, Roger was able to look back on his father's life and his relationship with his father and see them in a new way.
Roger Developed a New Psychological Perspective 

Roger was able to develop a different perspective about his father.  It all made sense to him now.  He felt a sense of love and compassion for his father that he had never felt before.  He regretted that he didn't know this while his father was alive.

Over time, as we continued to work on this issue, he felt at peace with his feelings for his father for the first time.

He also realized that, even though his boss was somewhat incompetent, the depth of his anger for his boss was out of proportion to the situation and it was triggered by his unresolved feelings for his father.

Developing a New Psychological Perspective About Parents After They're Gone
One of the myths about psychotherapy is that clients spend years blaming their parents instead of taking responsibility for their own feelings.  The myth is that therapy clients keep going over the same material and getting nowhere in their own psychological development or in working through their feelings for their parents.

And, yet, in my experience this isn't the case:  Therapy clients can work out their unresolved feelings for their parents with the help of an experienced psychotherapist.

Developing a New Psychological Perspective About Parents After They're Gone
The ideal would be for someone to work through his or her issues about parents before parents die.   But, for a variety of reasons, regrettably, this isn't always possible.

But even though your parents might be deceased and you don't have a relationship with them in your everyday life, you still continue to have a relationship with them in your internal emotional world.

And just because they're not around any more, all is not lost in terms of developing a sense of peace about your relationship with your parents.  As in the vignette about Roger above, it's possible to see and understand things in therapy that you didn't see before.

And, in many cases, it is possible to develop a new internal relationship with a parent even after he or she is gone.

Getting Help in Therapy
Struggling with unresolved feelings for parents can be complicated, especially after they're deceased.

Without your being aware of it, your unresolved feelings can have a negative impact on you and the other relationships in your life.

Getting Help in Therapy: It's Possible to Grow and Develop  a New Psychological Perspective

Rather than continuing to struggle with these feelings, you owe it to yourself to get help from a licensed mental health professional who can help you to work through these issues and develop a new psychological perspective that gives you a greater sense of well being.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR 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 during business hours or email me.