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Monday, March 9, 2015

Psychotherapy Blog: Empowering Clients in Therapy - Part 2: Clinical Issues

In Empowering Clients in Therapy - Part 1, I began discussing some of the basic ways that psychotherapists can empower clients in therapy.  In this article, I'll discuss clinical issues involved with empowering clients.

Empowering Clients in Therapy - Clinical Issues

Empowering Clients Clinically 
Empowering clients clinically is often one of the goals of therapy.

There are many ways to do this in therapy--too many to write about in one article.  So, I'll focus on how I do this using EMDR therapy, which stands for Eye Movement Desensitization and Reprocessing (see my articles:  What is EMDR?How Does EMDR Work? Part 1: EMDR and the Brain and How Does EMDR Work? Part 2: Overcoming Trauma).

Many of the clinical strategies that I'm about to describe are used in other times of therapy.  The ones that I've chosen are the ones that I've often found to be most effective.

Helping Clients to Develop Internal Resources
What are internal resources? See my article:  Psychotherapy: Developing Internal Resources).

On the most basic level, internal resources are coping strategies.

Most people have developed some coping strategies just to survive, but it's useful to develop new internal resources that help clients to go beyond just surviving.  This is especially true when clients are about to begin processing traumatic emotional experiences in therapy.

Before processing traumatic experiences, I help clients to develop internal resources that they can use to calm and soothe themselves in session as well as between sessions.

A Safe or Relaxing Place:
Being able to close your eyes and to see in your mind's eye a relaxing place provides a respite from difficult material in therapy or at any time when you're feeling anxious or uncomfortable (see my article: Wellness: Safe or Relaxing Place Meditation).

Empowering Clients in Therapy:  A Safe or Relaxing Place

It helps you to breathe more easily and decide if you want to resume processing a traumatic memory or if you want to take a break in the therapy session.

Butterfly Taps:
This is a resource that I learned in training with Laurel Parnell, Ph.D., who is a world-renown expert, based in California, in EMDR therapy.  It's another resource that clients can use either in session or between sessions.

To do butterfly taps, you place your right hand on your left upper arm and your left hand on your right upper arm (so arms are crossed) and you alternate taps rhythmically at a speed that feels comfortable for you.  The tapping is soothing and helps you to calm down.

Interweaves
Using interweaves is another resource that I learned from Laurel Parnell, Ph.D.

Most of the time, interweaves are used in EMDR when clients feel stuck in the processing of traumatic material.

Interweaves help to:
  • integrate memory networks
  • differentiate memory networks
  • create a coherent narrative
  • create a broader perspective
To determine which interweave would be best to use, the therapist asks the client what s/he needs at that moment.   The client is usually the best judge of what s/he needs.

Sometimes, when clients are stuck, they're not sure what they need at that moment, so the therapist, being attuned to the client, can different suggestions to see if any of them resonate with the client.

There are many different types of interweaves, including imagining:
  • nurturing figures
  • protector figures
  • inner wisdom figures
  • other types of figures that the client feels would be helpful
The reason why resource interweaves are developed before the actual processing of the trauma memory is that the therapist wants the client to have these interweaves in mind if the processing becomes difficult.
Empowering Clients in Therapy:  Resource Interweaves:  A Protector Figure

In case the client gets stuck, s/he can use the resource interweave to get the therapeutic work back on track.

So, for instance, if a client is processing a memory using EMDR therapy about childhood physical abuse and she feels stuck because she is in touch with her "child self" and she feels frightened by the person who abused her, she can call on a protector figure in her mind to imagine that person protecting her in the situation.

This protector figure can be someone real (someone from the past or the present) or imagined (from a movie, TV program, book, and so on).  The protector figure could also be the client's "adult self" who helps his or her "child self" in the client's mind's eye.

The "Ideal Mother" Interweave
Another example of an imaginal interweave is imagining an ideal mother who is loving, attuned, soothing and protective as well as powerful (or whatever qualities a client would need in an ideal mother).

An ideal mother is usually the type of mother that the client wishes s/he had.  If the client feels stuck in processing a traumatic memory, s/he can imagine an ideal mother with all the attributes that s/he wished she had.

Like all of these resources, they can be used even if the client isn't in EMDR therapy.


Empowering Clients in Therapy:  Imaginal Interweave:  Ideal Mother 
If you haven't experienced using imaginal interweaves, they might sound silly, fantastic or unrealistic.  But most clients feel soothed by the ideal mother and it "makes sense" to the emotional part of the brain.   In effect, it creates a new symbolic memory in the emotional part of the brain (see my article:  Healing Trauma With New Symbolic Memories).

It doesn't effect narrative/biographical memory which, of course, knows who the actual mother was when the client was a child.

Sometimes, clients feel guilty imagining an ideal mother because they feel that they're being disloyal to their actual mother.  In that case, a client can imagine that the ideal mother is a co-mother, as Laurel Parnell suggests.

There are times when clients feel enmeshed with their parents and the idea of imagining an ideal mother feels like they're abandoning their actual mother, so they can imagine giving their actual mothers an ideal mother as well.

This can also be used for earlier generations so that the client can imagine that the grandmother had an ideal mother so that the grandmother could have been nurturing to the mother and mother could have been nurturing to the client.

Most clients respond very well to imaginal resources, but there are some clients who say, "But I know that I didn't have an ideal mother," to which I respond, "Try suspending disbelief and see how it feels." Almost always, if the client can suspend disbelief, s/he feels relieved by the imaginal resource and the work gets back on track.

What Does the Client Need?
Everyone is different.  The particular client's needs determine the type of clinical intervention used to empower him or her.

Sometimes, clients come up with their own resources.

They might use art work, prose, poetry, dance or some other creative endeavor to empower themselves.

Empowering Clients in Therapy:  Keeping a Journal Between Sessions

Many clients find journal writing to be empowering and an important bridge between sessions, and this is something that I recommend.

The possibilities are endless.

Empowering Clients in Therapy
People often come to therapy because they're feeling disempowered in one way or another in their lives--either due to their history, their current situations or some combination of both.

Empowering Clients in Therapy

When the client is assisted in therapy to be more empowered, the client usually feels better able to tackle problems, overcome traumatic memories and have a sense of a hopeful future.

Discovering that they had the power within themselves all along is one of the best discoveries that a client can make in therapy.

Getting Help in Therapy
If you've been on the fence about starting therapy, you're not alone.

If your own efforts to overcome your problems haven't worked out for you, you could benefit from working with a licensed mental health professional whose priority is helping to empower clients.

When you find a skilled and empathic therapist who is a good match for you, you might be surprised to discover the progress that you can make in therapy.

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 (212) 726-1006 or email me.






















































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