Learning to Communicate Effectively With Your Therapist

In a prior article, I discussed how there are often ruptures and repairs in therapy between clients and their therapist (see my article: Ruptures and Repairs in Therapy).  As I mentioned in that article, what is most important is that the client and the therapist take time in person to clear up any misunderstandings, miscommunication or an empathic failure on the therapist's part.  In this article, I'm addressing a related topic:  Learning to Communicate Effectively With Your Therapist.

Learning to Communicate Effectively With Your Therapist

Learning to communicate effectively in therapy can be challenging for clients who have problems communicating in their daily lives.

Although it's wonderful to have the ease and comfort of email in daily life, sending email when you're upset or angry can also create problems because there's a lot of room for misunderstandings with email.

I've heard so many stories from clients where they're communicating about important issues with their significant other via text and email, including long drawn out arguments and even breakups.  In many cases, they found out that there were misunderstandings that could have been avoided if they had communicated in person or, at least, over the phone.

This is one of the reasons why I encourage clients to talk about anything that is concerning them about our sessions in person or, if it can't wait until the next session, to call, rather than communicate via email or text.  It's easier to sort out problems in person than going back and forth by email.  Also, email is not necessarily confidential.

Learning to Communicate Effectively With Your Therapist

Clients who are uncomfortable talking about their concerns in person with their therapist often had similar problems in their family of origin.  Often, direct communication was either discouraged or even punished, so they never learned how to communicate their feelings effectively because they feared that there would be negative repercussions.

Although it might feel "safer" in a sense to communicate indirectly with email or text, you're missing an opportunity, even though you might be afraid, to express your feelings, to be heard and to work through whatever issue you might have.  If you weren't able to do this when you were growing up, it can be tremendously healing experience.

If you're concerned about something that came up in therapy, it's best to talk to your therapist when it happens rather than allowing your feelings to fester.  It also gives you and your therapist a chance to not only clear up whatever is bothering you but to also see how it might relate to your earlier history in your family.

Tips For Communicating Effectively With Your Therapist:

• Take responsibility for your therapy.  Although your therapist has clinical expertise, training and skills, only you know for sure what's going on in your mind.  Don't assume that she knows that there's something bothering you because she might not know.  It's up to you to bring it up--even though it might feel uncomfortable.
• Plan what you want to say by thinking about it first.  It's often helpful to write down for yourself (as opposed to being reactive and sending out an email or text) what you want to say and, if you have time, sleep on it to see if you feel the same way the next day.   This helps you to clarify for yourself what's bothering you rather than being reactive and sending out an email in anger or upset.  It also helps to prepare you to communicate in a clear way if you're anxious about bringing up your concerns.
• Bring up your concerns at the beginning of the next session so that you and your therapist will have time to talk about it.  This is a lot more effective than waiting for the end of the session or making a "door knob comment," which is a comment that clients make as they're on their way out of the therapist's office.
• Try to stay calm while you're telling your therapist what concerns you.  You might feel angry or upset, but if you can remain calm, you're more likely to express yourself clearly so that your therapist can understand what's bothering you.
• Be open to hearing feedback.  You might feel sure that you're "right" about whatever the problem is, but if you're open and flexible, you might realize that there was a misunderstanding or miscommunication.
• Recognize that therapists are human and they make mistakes.  Most therapists will acknowledge their mistakes and try to repair the situation.  If your therapy has been going well until now, give your therapist a chance to repair things between you in person--rather than leaving therapy prematurely (see my article: When Clients Leave Therapy Prematurely).

Very often, once misunderstandings are cleared up, the therapeutic relationship improves because you and your therapist got through a difficult patch where you felt uncomfortable.  Not only will you feel better for having expressed yourself in an effective way, but your therapist will understand you better.

Learning to Communicate Effectively With Your Therapist

Even if you do end up leaving because you and your therapist turn out not to be a good fit, you'll feel better about yourself for having expressed yourself directly, calmly and maturely.

Getting Help in Therapy
If you've been unable to resolve your problems on your own, you could benefit from working with a licensed psychotherapist who can help you to work through your problems.

It takes time to build a rapport with a psychotherapist and, along the way, there might be times when there are ruptures and a need for repair.  Even though this might feel scary and hard, it's worth the effort to communicate your feelings to your therapist and to do it calmly in person.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individuals and adults.

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.

Clients Struggling With Shame Can Leave Therapy Abruptly

In an earlier article, Healing Shame in Therapy, I addressed how feelings of shame often bring clients into therapy.  Shame is often at the core of many psychological problems, even when clients in therapy don't realize it.  The unconscious roots of shame usually go deep and can make clients feel uncomfortable in therapy.

Clients Struggling With Shame Can Leave Therapy Abruptly

In this article, I'm focusing on a particular dynamic that occurs when clients feel their shame is so unbearable that they leave therapy abruptly.

Being able to communicate about feeling uncomfortable in therapy is an important skill.  Unfortunately, it's a skill that people starting therapy don't have because they weren't encouraged to express their feelings in their families, so they never developed that skill.

Also, for many clients, feeling ashamed can feel so intolerable that they would rather leave therapy than deal with their uncomfortable feelings.  Unfortunately, it's a skill that many people starting therapy don't have because they weren't encouraged to express their feelings in their families when they were growing up, so they never developed that skill.

For many clients in therapy feeling ashamed can feel so intolerable that they would rather leave therapy abruptly  than deal with their uncomfortable feelings.

Their discomfort might be intense but, at the same time, they might not be able to identify their feelings or they might think their feelings are different emotions, so they might not identify these feelings as shame.  Rather than accepting their feelings, they might think that their therapist is causing them to feel this way rather than seeing that the feelings of shame are coming from within them rather than outside.

The following is a fictionalized example of how this can play out in therapy:

Bill
Bill came to therapy because he was feeling depressed, anxious and angry about a breakup that occurred several months before.  Even though he was the one who ended the relationship, he felt victimized, once again, by a woman who mistreated him.

Clients Struggling With Shame Can Leave Therapy Abruptly

As he talked about the relationship, he gave many examples of how the woman he was dating, Ina, was inconsiderate and hurtful from the start.  There were many "red flags" that were evident from the beginning, but Bill wanted so much to be in a relationship that he overlooked them--until he couldn't overlook them anymore.

The final straw was when he found out from his best friend, Joe, that Ina called Joe and asked him out on a date.  Bill felt deeply humiliated and told Ina that he didn't want to see her anymore.

As we talked about his history of prior relationships, the pattern was similar:  Bill chose women who mistreated him, but rather than ending these relationships when he first experienced the mistreatment, he held on until he was so hurt that he couldn't stand it anymore.

After each breakup, Bill's sense of self worth was so low that he felt that no woman was ever going to live him.  At that point, he felt hopeless about ever finding anyone that he could be happy with in a long term relationship.  He said he felt like he was unlovable (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

After discussing his family history, which included a fair amount of emotional abuse from both parents, Bill recognized that he was unconsciously repeating this pattern with the women that he was dating--he was choosing women that would be emotionally abusive (see my article: Unhealthy Relationships: Bad Luck or Poor Choices?).

When he came in for his next session, he seemed very uncomfortable.  His therapist asked him how he experienced their last session.  Looking very ill at ease, he said he wasn't happy about the last session.  Then, with increasing agitation, he said that he was offended that the therapist told him that he felt unlovable.

His therapist tried to tell him that she wasn't the one who said this--he was the one who identified feeling unlovable.  But, with increasing agitation, he interrupted her, denied that he ever said this.  At that point, the therapist attempted to help Bill to calm down, but he walked out of the therapy room abruptly.

His therapist contacted him afterwards and asked him to come to another session so that they could talk about what happened.  At first, he rejected this idea, but by the next day, he was calm enough to come in to talk.

As they talked about the last session, Bill remembered that he was the one, not his therapist, who said he felt unlovable.  As his discomfort increased around these feelings, his therapist slowed down the session so that Bill was able to stay calm, even though he was uncomfortable.

Over the course of the next few weeks, Bill realized how deeply ashamed he felt about himself and that his feelings of shame were longstanding, going back to his childhood.  From the time that he was a child, he believed that if his parents didn't care about him, there must be something very wrong with him.  He must be defective in some way.

His therapist pointed out that this is a common response that many children have when they are emotionally and/or physically abused by their parents.  Rather than thinking that their parents are abusive, they believe that there's something wrong with them because it would be too painful to believe that their parents had problems taking care of them.

Feeling unlovable feels shameful for children and this feeling often continues into adulthood, even when adult children recognize that their parents were the ones who had problems.

This is what was happening to Bill, but the emotional pain involved with feeling this shame felt unbearable to him, so his therapist slowed down the work and helped Bill to develop the emotional resources and coping skills to tolerate doing the work.  She also helped Bill to learn to express his feelings about the shame.

As Bill progressed, there were still times when he wanted to leave therapy, but he began to trust his therapist more and their sessions felt like a safe place where he could deal with his emotions.

The work wasn't easy or fast, but Bill felt, for the first time in his life, that he deserved to with a woman who loved him and treated him well.

Overcoming Shame in Therapy

As he began to date again, he no longer felt so desperate to be loved that he would tolerate being mistreated.  And, when he saw the early warning signs that he used to ignore in the past, he wouldn't continue seeing that person.

Gradually, Bill realized that shame is a common response for many people who were abused or neglected as children.  He wasn't alone.

Over time, his confidence grew.  He realized that he was a genuinely lovable person and there were people in his life who also found him to be a lovable person.  They were there all along but, in the past, Bill was focused on the people who were mistreating him.

Eventually, he entered into a healthy romantic relationship where he was able to both give and receive love.

Conclusion
Shame is a powerful emotion.  Shame is at the core of many psychological problems.

For many people, without help in therapy to develop the wherewithal to deal with shame, shame often feels too uncomfortable to tolerate.

Many of people unconsciously project their feelings about themselves onto their therapists and, in a state of anger, they leave therapy abruptly.

For clients who are able to allow themselves to recover emotionally enough to come back and talk to their therapist, there is a good chance that this dynamic will change over time.

Learning to recognize feelings of shame and low self worth can be challenging.  Clients need the time and space to develop an emotional tolerance to recognize that they feel ashamed of themselves and it is their own feelings about themselves.  Then, there is a possibility for healing from the shame.

Getting Help in Therapy
Shame is often poses a barrier to people either starting therapy of staying in therapy.

It's not unusual for people to leave therapy because they feel ashamed of themselves and their problems.

If you feel burdened by shame, you could benefit from seeing a licensed mental health professional who helps clients with this issue (see my article: Overcoming Shame in Therapy).

Once this burden is lifted, you can develop self confidence and live 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.

I have helped many clients overcome their feelings of shame.

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.

Coping with the Sudden Realization That You Don't Really Know Your Spouse

In an earlier article, Movies: "45 Years:" An Old Secret Haunts a Loving Long Term Marriage, I discussed how events from the distant past upend a long-term marriage causing the wife to feel suddenly that she really didn't know her husband or understand their marriage.  Until then, they had been, seemingly, going along happily.

Betrayal

As I mentioned in my prior article one of the things that makes this movie so powerful is that this is the sort of thing that happens in many relationships.  If it's happening to you, you can feel that you're the only couple going through it because, similar to the couple in "45 Years," couples often don't talk about these issues aside of their relationship or their couples therapy.

If you're experiencing a betrayal in your relationship, aside from the shock, you can feel very alone in your experience.

The betrayal can make you ask yourself: Who is this person that I'm married to?  You can also question your marriage.

This can be extremely disturbing and leave you reeling, especially in a long-term relationship where, prior to the betrayal, you  thought you understood your spouse well and you felt confident in your marriage.

In prior articles, I've written about infidelity (see my articles: Your Relationship: Your Spouse Cheated on You--Should You Stay or Should You Go?  and Coping with Infidelity in Your Relationship).

But infidelity is not the only form of betrayal that couples often go through.

The following vignette, which is a fictionalized example of many different cases with all identifying information changed, I discuss another form of betrayal in a long-term relationship:

Donna and Jim:
Donna and Jim came to couples counseling because they were struggling to overcome Donna's sudden realization that Jim had gambled away their life savings (see my article: Compulsive Gambling: Beware of March Madness).

They were married for 15 years, until Jim's secret gambling problem emerged, Donna felt content and secure in their relationship.

Jim worked as a stockbroker and Donna worked as an executive assistant.

Until recent events unfolded, Donna was unaware of any serious problems in their relationship.

Jim took care of their finances, so Donna was unaware that there was any problem--until she came across a bank statement that Jim had accidentally left out and she saw that their savings was a fraction of what she had always known it to be.

Alarmed, Donna approached Jim with the statement to show him what she thought was a bank error.  But when he hung his head down and averted her gaze, she felt queasy and knew something was terribly wrong.

Over the next hour, Jim broke down in tears and confessed to Donna that he had been secretly gambling in the last several years and he had depleted their savings.  He apologized to her over and over again, but Donna was in a state of shock trying to come to terms with what she was hearing.

Donna described how she suddenly felt like the floor under her feet had dropped away and she was falling into an abyss.  She was so upset that she could barely understand what Jim was telling her.  She felt like she was in a bad dream and any moment she was going to wake up and feel relieved.

But, as the hours passed, she realized that this was no dream and her shocked turned to rage.  She told Jim to stay at his parents' home for the time being so she could wrap her mind around what was happening.

During the days that Jim was away, Donna felt lonelier that she had ever felt.  She couldn't bear to tell her family or close friends what had just happened.  At that point, she couldn't even bear to tell her daughters.

All the while, Donna felt like she was going through the motions in her life. It was as if everything looked the same, but nothing felt the same.  She felt like her every day life had been replaced by replicas of people and things that she ordinarily knew.  Nothing seemed real.

All of this time, she could never have imagined that Jim had a gambling problem or that he was gambling away their savings.  The thoughts that kept going around in her mind were:

Who is this man that I thought I knew for all of these years?
Does he really love me?
How could he do this?
What is our marriage about if he could be so dishonest and ruin us in this way?
How can I ever trust him again?

Initially, Donna considered divorce and told Jim that she didn't think they could ever overcome this betrayal.  But Jim begged Donna for forgiveness and pleaded with her to reconsider and not give up on their marriage.

After several weeks of trying to talk it out between them to no avail, Jim sought out couples counseling as a last resort, and Donna agreed reluctantly to give it a try.

After a couple of sessions, Donna agreed to stick it out in couples counseling to see if they could work out their problems.  She was still deeply hurt and upset but, after the initial shock wore off, she realized that she still loved Jim and she didn't want to give up their marriage.  She also realized that he had a serious problem and he needed help.  She was still very angry, but less so than she had initially been.

Betrayal

Clearly, finding out about Jim's gambling problem was traumatic for Donna, especially since she grew up in a household where her father was a gambler with devastating consequences for her family.  She had always vowed to herself that she would never marry a gambler and to find out about Jim's secret reopened old emotional wounds related to her father's gambling.

Jim agreed to attend his own individual therapy with a therapist who specialized in addiction.  He also began to attend Gambler's Anonymous regularly and obtained a sponsor.

On a practical level, Jim had to borrow money from his family, which meant that he had to reveal his gambling problem to them.  Donna took over the finances because, at that point, she didn't trust Jim with their money.

Betrayal

On an emotional level, they had a steep road to climb to repair their relationship.  Jim acknowledged that he had been deceitful and seemed genuinely remorseful.  Over time, Donna realized, in hindsight, that there had been signs of Jim's secrecy that she chose to ignore.  Eventually, she attended Gam-Anon, which are self help meetings for spouses or family members of gamblers.

Over the next two years, with much difficulty, Donna and Jim reconciled their relationship.

Jim discovered in his own individual therapy that, on an unconscious level, he wanted to be found out.  Although it appeared that he had accidentally left the statement out, he realized that he felt so guilty and worried about his secret that he wanted Donna to know, but he didn't know how to tell her.

Jim also discovered what triggered his craving to gamble, and he learned to develop better coping skills.  He also changed careers because his job as a stockbroker was not conducive to overcoming his gambling problem.

After they completed couples counseling, Donna entered into her own individual therapy to deal with the aftermath of Jim's betrayal as well as her own unresolved issues regarding her father.

As time went on and Jim abstained from gambling, the family became closer again.

Having gone through this traumatic event in their lives, Donna and Jim seemed to grow as a couple and as individuals.

Conclusion:
There can be many forms of betrayal in a relationship.

The fictionalized scenario presented in this article illustrates many of the stages that a couple can go through when a betrayal comes to light.

In the scenario presented above, the couple got help in couples counseling and decided to remain together.  Of course, this is not always the case.  But after the initial shock of a betrayal, many couples decide to try to reconcile their relationship in couples counseling.

Often, couples who come to couples counseling learn new things about themselves as individuals and as a couple.  They often learn that they are more resilient than they thought they were.

A couples counselor won't tell you whether or not to stay together (see my article: Your Relationship: Should You Stay or Should You Go?).  However, she will facilitate the process so that each person in the relationship can decide if he or she wants to try to salvage the relationship.

If a couple decides that they can't salvage their relationship, they can benefit from going to couples counseling to try to end the relationship as amicable as possible, especially if there are children involved.

Getting Help in Therapy
When you feel betrayed in your relationship, you can feel confused and bewildered about what to do.  It's often not the best time to make any lasting decisions.

You might not feel comfortable talking to family or friends because you might know that could make any decision that you're trying to make that much more difficult.  Family and friends usually want the best for you and they might try to sway your decision one way or the other before you're ready to make a decision.

Many people seek help in individual therapy first to be able to sort out their feelings about the betrayal and how they feel about the relationship.  Over time, like Donna in the fictionalized scenario in this article, people often discover that the betrayal opens up old wounds from their childhood.

Other people enter into couples counseling and then one or both people might attend their own individual counseling.

If you're struggling with a betrayal in your relationship, you're not alone.

Rather than trying to deal with it on your own, you could benefit from seeking help in therapy to help you to work through the issues involved (see my articles: The Benefits of Therapy and How to Choose a Psychotherapist).

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

I have helped many clients struggling with a betrayal in their relationship to overcome the emotional trauma and make important decisions about 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.

Movies: "45 Years": An Old Secret Haunts a Loving Long-Term Marriage

In the movie, 45 Years, an old secret, which is suddenly thrust upon them, haunts an older married couple, who were, seemingly, happily married for many years (for 45 years, hence, the name of the movie).  They face the emotional challenge, both alone and together, that could ruin their relationship.

An Old Secret Haunts a Loving Long-Term Marriage*

Until this old secret surfaces, the couple, Kate and Geoff Mercer (portrayed beautifully by Charlotte Rampling and Tom Courtnay) seem to have an ordinary, serene life in their retirement in the beautiful English countryside.

Suddenly, their world is upended by a letter that Geoff receives about a deceased girlfriend, Katya, who died during a mountaineering accident when Katya and Geoff were very young, and whose body was just found intact in a glacier after all of these years.

Geoff's short-lived romantic relationship with Katya preceded his relationship with Kate, and he told Kate about it many years before.

But as he starts to ruminate about Katya and he sinks into a depressed state about this old loss, Kate begins to realize that he never revealed to her how important that past relationship was to him.  They never talked much about it, and the news about finding Katya's body is now threatening their marriage.

It haunts both Geoff and Kate in different ways.

For Geoff, the power of memory has overtaken him.  He can't sleep.  He starts smoking again.  He is preoccupied and lost in thought about his short, youthful romance with Katya.  He wants to immerse himself in pictures and mementos of her.  When he speaks about his old romance to Kate, he calls Katya "my Katya."

Initially, Kate comforts herself by telling herself that Geoff's youthful romance with Katya was very brief and a long time ago, especially compared to the many years that he and Kate have been married.  After all, Kate and Geoff have had a whole lifetime together, and it's been a good life.

She reasons to herself:  A brief romance from many years ago with a woman who is long dead can't compete with their 45 year marriage.

And, yet, it does in ways that gradually unfold in this movie.

Kate makes her own secret discoveries into Geoff's past romantic attachment to Katya.

As Kate becomes more aware of the effect of this old romance, she wonders how she can compete with the memory of an attractive, young lover who is deceased, but who is still very much alive in Geoff's memory.

Over the course of only one week, with the backdrop of Kate planning a big party for their 45th wedding anniversary, it gradually dawns on Kate that all of her assumptions about her husband and their marriage might be wrong:

• How does Geoff really feel about Kate and their marriage?
• How well does she understand Geoff's romantic history with Katya? 
• Has Geoff been secretly harboring unspoken feelings for Katya all along throughout their long marriage? 
• How can she be jealous of a ghost from the past?
• Would Geoff still have married her if Katya was still alive?
• Now that these secrets have come to light, what does all of this mean for their marriage?
• What is the truth about about their marriage?

Far from being melodramatic, 45 Years, is a the story of a very ordinary couple and the devastating effects of time and memory, which can change everything.  This is what makes it so haunting:  It could happen to anyone.

Without giving too much away, the expression on Kate's face, which is so dissonant from the all the revelry around her at the anniversary party, says it all.

Time seems to stand still for Kate and her expression tells us everything there is to know about how she feels and her dawning emotional awareness.

But there are no easy answers for this couple--just as there are no easy answers for any couple faced with this emotional dilemma.

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 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.



*The couple in this picture are not from the movie.  The picture is from Shutterstock.