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Saturday, April 25, 2015

Psychotherapy Blog: Remaining in Therapy Beyond the Immediate Crisis

Many people, who might not otherwise have started psychotherapy, come to therapy when they're in an emotional crisis.  They recognize that they're in serious trouble and they seek help from a licensed mental health professional, which is a positive step.  But some people, who have deeper psychological issues that go beyond the current crisis, often leave therapy once the current crisis is resolved--only to find themselves in crisis again because they haven't dealt with the underlying emotional issues (see my articles:  Overcoming Trauma: When the Past is in the Present and Leaving Therapy Prematurely).

Remaining in Therapy Beyond the Immediate Crisis

When people don't deal with the underlying issues that create one emotional crisis after the next, they're bound to continue to have the same problems until these issues are worked through (see my article:  Overcoming Childhood Trauma That Affects Your Adult Relationships).

People who leave therapy prematurely often don't see the pattern to their emotional problems, but an experienced psychotherapist, who explores the history of the problems, can often see that there is an underlying theme that continues to get repeated.  It might be different people involved or a different situation, but the underlying theme is often the same.

Having one emotional crisis after the next can be debilitating, anxiety-producing, and discouraging.  For someone who does not have psychological insight into him or herself, it might seem that the cause of these crises are external and s/he might look for external solutions as a quick fix (see my article:  Beyond the Band Aid Approach to Resolving Psychological Problems).

Experiential therapy, like EMDR, Somatic Experiencing or clinical hypnosis, are especially effective in helping therapy clients to become more aware of possible underlying issues that are getting repeated in their lives, whether it involves relationship issues or other problems in their lives (see my article:  Experiential Therapy, Like EMDR, Can Create Emotional Breakthroughs).

To illustrate how this dynamic plays out, let's look at a composite scenario, which is made up of many different cases to protect confidentiality:

Lisa
Lisa began therapy after the breakup of her most recent relationship.

Lisa talked about how she and John were very happy during the initial six months of their relationship.

The relationship was going well during the initial six months

But after that initial happy period, as the relationship became more serious, Lisa began to have fears that John wanted to end the relationship--even though he assured her that he didn't want to end it.

Lisa began to have fears that John wanted to end the relationship, despite his assurance

Lisa talked to her friends about this, and they asked her why she thought he wanted to end it.  But she couldn't come up with anything specific, other than her own feelings about it.  She didn't know why she was feeling this way.

Despite John's assertions that he wanted to remain in the relationship, Lisa became increasingly anxious that John was going to break up with her.  She was preoccupied with her fears both day and night.

Remaining in Therapy Beyond the Immediate Crisis

Over time, Lisa struggled with her anxiety.  And when it became unbearable for her, she felt she could no longer endure waiting for what she felt was inevitable, so she ended the relationship with John, preferring for it to be finally over rather than feeling like the breakup was hanging over her head.

Initially, Lisa felt a tremendous sense of relief that she wasn't worried about John breaking up with her.  The pressure was off and she felt like she could breathe again.

But after a few weeks, she felt like she had made a terrible mistake:  She loved John and she realized that he loved her too.  She missed him and she wanted him back, but when she called him to tell him, he told her that he was hurt and angry that she didn't trust him when he told her that he didn't want to break up, and he didn't want to take her back.

This is what brought Lisa into therapy.  She was upset with herself for allowing her fears to overtake her to the point where they clouded her perspective.  She was even more upset that John wouldn't take her back.

Remaining in Therapy Beyond the Immediate Crisis

As we explored her background, she revealed that both of her parents were in and out of her life from the time she was a young child.  Both of them had problems with alcohol and they were in and out of rehabs, but Lisa didn't know this when she was a young child.

She just knew that, at various times, each of her parents would leave suddenly and she would be sent to live with her aunt, who resented taking care of her.  Lisa never knew when one or both parents would leave and she grew up feeling insecure and constantly abandoned.

Exploring Lisa's history of relationships prior to John, it became evident that she experienced the same fears in those relationships and she also ended them in a similar way.

Lisa was able to understand her fears of being abandoned and see how her fears of being abandoned carried over into her relationship with John.  But, at that point, it was only a preliminary intellectual understanding.  Lisa didn't have an emotional understanding of it.

I explained to Lisa how EMDR works and recommended that we process her earlier trauma, which was getting triggered in her as an adult (see my article:  How EMDR Works: EMDR and the Brain).

Lisa agreed, but a few days before we were going to begin using EMDR, she heard from John.  He was missing her a lot and he wanted to get back together again.

When Lisa came in for her next therapy session, she was very happy.  She told me that she and John were going to "start over" and put the past behind them, so she didn't feel the need to continue in therapy.

Even though I attempted to explain to Lisa that starting over with John wouldn't change the emotional issues that continually got triggered whenever she was in an intimate relationship, Lisa left therapy.

Several months later, I heard from Lisa again:  She had broken up with John again when her fears that he would leave her became too overwhelming.  Once again, after the initial relief, she regretted it.  But this time John said he wouldn't take her back, and she felt devastated.

When Lisa came to therapy this time, she made a commitment to complete therapy.  Using EMDR, over time, we were able to work through Lisa's fears of being abandoned (see my article:  Overcoming Fear of Abandonment).

Remaining in Therapy Beyond the Immediate Crisis

She and John didn't get back together.  But when she entered into her next serious relationship a year later with a man named Ted, she was no longer afraid of being abandoned.  She was able to allow herself to be open and caring without her old fears, and the relationship flourished.

Conclusion
As many people do, Lisa left therapy as soon as the immediate crisis passed.

Having only an intellectual understanding of her problems, as opposed to a deeper emotional understanding, Lisa thought that all she and John needed to do to overcome their problems was to have a fresh start.

But Lisa's underlying issues (and whatever issues John might have been dealing with at the time) were still there to get triggered again and to undermine the relationship as soon they got close again.

These underlying emotional issues are often unconscious and respond best to experiential therapy where the client can develop an emotional understanding of the problems as well as a way to resolve them.

Getting Help in Therapy
Attending psychotherapy is a commitment of time, money and effort.

It's tempting to leave therapy once the immediate crisis has passed and you begin to feel a little better.   But when there are recurring underlying issues that are having a major impact on your life, taking the time to work these issues out in therapy can help you to stop engaging in the same dynamics that are creating problems for you.

Although you might not see the underlying issues, an experienced therapist who uses an experiential type of therapy can help you to overcome these issues so they no longer have a negative impact on your life.

Rather than continuing to repeat the same unhealthy patterns, with help in therapy, you could be leading a more fulfilling life (see my article:  How to Choose a Psychotherapist).

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 josephineolivia@aol.com.





















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