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Monday, May 25, 2015

Psychotherapy Blog: Leaving Therapy: Confusing Starting to "Feel Better" With Emotional Healing

People often to come to therapy after their own efforts to heal emotionally haven't worked for them and they realize that they need help from a licensed mental health professional.  It's understandable that a big part of the reason why they come to therapy is because they want to feel better, and it's often the case that when they begin to talk about their problems, they start to feel better.  But the problem arises when clients stop attending therapy as soon as they start feeling better as opposed to when they have emotionally healed by working through the problem (see my article:  When Clients Leave Psychotherapy Prematurely).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Since starting to feel better often begins during the initial stage of therapy, a client who leaves therapy before s/he has worked through the problem is leaving prematurely and will usually experience a "relapse" of the emotional problem because starting to feel better isn't the same as resolving the problem.  It's just a temporary alleviation of symptoms until the symptoms come back to the surface again.

Let's take a look at an example of this in the following vignette which is a composite of many different cases to protect confidentiality:

Jack
Before coming to therapy, Jack tried to deal with his panic attacks around his difficult boss by working out at the gym, attending yoga classes, and talking to friends about it.  But none of these efforts helped him (see my articles:  Workplace: Coping with a Difficult Boss and How Your Workplace Can Feel Like a Dysfunctional Family).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

When he went to see his medical doctor, his doctor gave him a prescription for anti-anxiety medication for short term use and recommended that Jack see a psychotherapist to work out whatever underlying issues might be affecting him.

Jack discovered that the medication helped to relieve his panicky symptoms for short periods of time. But he realized that, after a while, he needed a higher dose to alleviate symptoms, and he didn't like becoming dependent upon medication.  So, although he preferred not to go to therapy, he followed his doctor's advice and contacted me for help.

After we talked about his family history, both Jack and I began to see parallels between his situation at work and his abusive father.  Both men were overbearing and verbally abusive.  Jack's father was also physically abusive with Jack when Jack was a child.

Just knowing this was a tremendous relief for Jack.  Until then, he felt that he was "going crazy" whenever he had a panic attack around his boss.

As Jack started to understand that he was reacting to his boss as if he were a child and his boss was his abusive father, he began to be able to separate his current experiences from his childhood experiences (see my articles:  Reacting to the Present Based on Your Traumatic Past).

At that point, Jack decided that he didn't need to continue in therapy anymore because he "understood" why he was having his panic attacks.  So, during a period of time when his boss was away on an extended business trip, Jack decided that he was "feeling better" and he would end therapy.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

I tried to explain to Jack that the alleviation of his symptoms was probably temporary since he had not worked through the underlying emotional problems (his childhood history of being abused) involved in his current problem.  Understanding logically was the first step, but it usually doesn't resolve these types of problems.  There was also the fact that his boss was away so Jack wasn't getting triggered at that point by the boss's abusive behavior.

But Jack had made up his mind about leaving therapy.  So, I told him that my door remained open and he could return in the future.

Within a couple of weeks, after his boss returned, I received a call from Jack, who said that he was having panic attacks again. In one instance, he thought he was having a heart attack and he went to the ER.  After the ER doctors ruled out a heart attack, they told Jack that he was having a panic attack with heart palpitations, shakiness and sweating and he should seek help from a licensed mental health professional.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Jack said that this was, by far, the worst panic attack that he had ever had and it frightened him to the point where he was now constantly worried that he would have another panic attack.

We resumed our work that week.

I began by helping Jack to develop internal resources, which are basically coping skills (see my article:  Developing Internal Resources in Therapy).

After helping Jack to develop the internal resources to do the therapeutic work, we started doing EMDR therapy (Eye Movement Desensitization and Reprocessing), a mind-body oriented type of therapy to work on the current situation as well as the underlying issues that were getting triggered by his unresolved childhood trauma (see my articles:  What is EMDR?How EMDR Works: Part 1: EMDR and the Brain, How EMDR Works - Part 2: Overcoming Trauma and EMDR: When the Past is in the Present).

As we worked together, Jack learned to manage his panic-related symptoms.  More importantly, over time, the EMDR therapy helped Jack to work through the unresolved childhood abuse he experienced with his father that was getting triggered with his boss (see my article:  Mind-Body Psychotherapy: The Body Offers a Window into the Conscious Mind).

He no longer had panic attacks because the underlying traumatic issues triggering the attacks got worked through so they were no longer there to be triggered (see my article:  Experiential Therapy. Like EMDR, Helps to Achieve Emotional Breakthroughs).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Not only did Jack "feel better," but his boss's abusive behavior no longer frightened him.  In fact, for the first time, Jack saw that his boss was really an insecure man who bullied employees to bolster his own low self esteem.

Rather than freezing in panic, Jack's attitude about the work situation was that, although it was unpleasant, he no longer felt threatened by it.

A few months later, Jack found a better job where he felt happier, respected and well compensated.

Summary
Just like "Jack," many clients think that their work in therapy is over once they understand their problem and they start to "feel better."  Unfortunately, this usually doesn't last, especially when emotional trauma is involved.

An intellectual understanding is a good start, but it's not the same as actually working through the problem, as "Jack" discovered.

The working through process necessitates working on a deeper level than just having a cognitive understanding.

EMDR and other mind-body oriented types of therapy, like Somatic Experiencing and clinical hypnosis tend to be more effective and efficient than regular talk therapy when the problem involves emotional trauma (EMDR: When Talk Therapy Isn't Enough).

Of course, everyone is different and these types of therapy aren't a quick fix but, as an experienced therapist, I have found that EMDR and other mind-body oriented types of therapy tend to work faster to resolve trauma.

Getting Help in Therapy
If you have tried unsuccessfully to work out your problems on your own, you owe it to yourself to get professional help from a licensed mental health professional (see my article:  How to Choose a Psychotherapist).

Rather than continuing to suffer on your own, you could work through your problems so that you can lead a more fulfilling life.

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

In addition to providing mind-body oriented psychotherapy, I also use talk therapy with clients who would benefit from it.

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.