NYC Psychotherapist Blog

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Monday, September 26, 2016

Books: "Tea With Winnicott" at 87 Chester Square

In the book, Tea With Winnicott, Brett Kahr imagines what it might be like to bring back the British psychoanalyst and pediatrician, Donald W. Winnicott, who died in 1971, to interview him about his life and his work.

"Tea With Winnicott" at 87 Chester Square

The book is part of a series called Interviews with Icons, which are "posthumous interviews" with famous psychoanalysts.

In a poignant, imagined dialogue, Brett Kahr, who also wrote D.W. Winnicott: A Biographical Portrait, does an imaginary interview with Winnicott at Winnicott's consulting room at 87 Chester Square in London.

The book is wonderfully illustrated by Alison Bechtel.

Winnicott's former secretary makes them tea and sandwiches as they delve into the most important aspects of his life.

When I was in psychoanalytic training 20 years ago, I remember being drawn to Winnicott's books and papers more than any other theorist that we read. He has influenced my work more than any other psychoanalyst.

Through his writing, you could sense Winnicott's unique compassionate understanding about adults and infants (he was also a pediatrician), and he has been a valuable guide for new and experienced therapists all over the world.

"Tea With Winnicott" at 87 Chester Square

Kahr's book is organized in a way that helps clinicians and clients alike understand how Winnicott's early life influenced his theories about infants and adults.

Even experienced therapists, who have read Winnicott's papers and the various biographies about him, will find interesting stories about his personal life and his work.

Since it appears that Winnicott's mother, although loving and kind, was also depressed, there has been speculation that this might have influenced Winnicott's choice to become a psychoanalyst.

The section about Winnicott's early life shows how his own childhood influenced his psychoanalytic theories, especially the fact that he came from a loving home surrounded by his mother and other women in the household.

In his time, Winnicott had to navigate between the two predominant theorists of his time, Anna Freud and Melanie Klein.  Kahr provides interesting insights into what was going on in the psychoanalytic world at that time and how Winnicott was able to form the "Middle School."

Reading "Tea With Winnicott," you can easily imagine yourself sitting for a chat with this approachable psychotherapist and immersing yourself in his world.  The book is entertaining and accessible.

Much of what we now take for granted about raising a child and mother-child relationships originated with Winnicott.  His phrase "the good enough mother" conveyed that a mother didn't need to be "perfect," she just needed to be good enough.

His philosophy about the mother-child relationship was similar to his philosophy about the therapist-client relationship with regard to creating a safe, holding environment and repairing any ruptures in the relationship (see my articles:  The Creation of the Holding Environment in Psychotherapy and On Being Alone).

In the late 1930s, Winnicott did broadcasts on the BBC radio where he addressed mothers in a personal and reassuring way.  His talks weren't about giving advice to mother.  Instead, his talks provided mothers with basic information about an infant's needs and how to foster a loving, safe environment for the baby.

These BBC talks were very popular.  It was evident that Winnicott respected mothers and never talked down to them.  During his time, he reached millions of listeners.

"Tea With Winnicott" at 87 Chester Square

The "interview" also deals with some controversial issues, including Winnicott's relationship with Masud Khan, who was an analysand as well as a colleague of Winnicott's.  It also deals with his first marriage to his wife, Alice.

Although Winnicott died in 1971, leaving behind many volumes of books and letters that he wrote, he  still remains one of the most influential and popular psychoanalysts all these years later.

I highly recommend this book to anyone who is interested in Winnicott or the history of psychoanalysis and psychotherapy.

The format of the book is ideal for making a play, and I hope that someone will take on the project of producing the play in NYC.

About Me
I am a NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapists who works with individuals and adults.

I am also psychoanalytically trained and work in a contemporary, dynamic and collaborative way.

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, September 19, 2016

An Unconscious Identification with a Loved One Can Create an Obstacle to Change

People who start therapy often wonder why it's so hard to change, so I want to address one of the major reasons why people have problems changing, which is an unconscious identification with a loved one.

An Unconscious Identification With a Loved One Can Create an Obstacle to Change

From the time that we're infants, we learn to identify with our caregivers, usually our parents.  Even as adults, we can continue to identify with loved ones.

The identification can include values, opinions, thoughts, feelings, habits and lifestyle choices.

The following fictional vignette, which is a composite of many different cases, provides an example of someone who comes to therapy to make a change, but who encounters an obstacle within himself that makes it difficult for him to change.

Rick came to therapy after his doctor advised him to stop smoking or he would face increasingly debilitating health consequences in addition to the ones he was already experiencing, including severe headaches, problems breathing and a persistent cough that wouldn't go away (see my article:  Do You Want to Stop Smoking?).

Struggling with Health Consequences of Smoking 

Before coming to therapy, Rick tried to stop smoking on his own.  But even though he wasn't feeling well because he was smoking two packs of cigarettes a day for several years, he couldn't stop.

He tried the nicotine patch and nicotine gum.  He tried to go "cold turkey," but nothing worked for him.  His wife pleaded with him to stop, to no avail.

Rick came for clinical hypnosis as a last resort.  He didn't have much faith that hypnosis would help him, but he was feeling desperate and decided to give it a try.

I began, as I often do with people who want to stop smoking, by asking Rick about his motivation to stop smoking.  He told me that he knew that he "should" because of his doctor's warning and his wife was also unhappy about his smoking.

Based on Rick's tone and the shrug of his shoulders, I could tell that his internal motivation wasn't strong, and he admitted this.  His motivation was mostly external as opposed to a strong internal motivation that is often needed to help people to stop smoking or to make other difficult changes.

 I took a history of Rick's use of tobacco, including his many attempts to stop on his own (see my article:  Becoming a Successful Nonsmoker).

We also discussed his pattern of smoking (when he smokes, what time, how often, etc) with the idea of using "pattern interruption" as a way to help him to break his habit.

As part of the pattern interruption, Rick agreed to change cigarette brands and to change where he smoked.  Interrupting the pattern in the rituals that Rick had for smoking was somewhat successful.  He was able to reduce his use from two packs to a pack a day and, a few sessions later, he reduced it to half a pack per day.

This was more than Rick had ever been able to do on his own.  He was also surprised that his cravings were reduced.  But, try as he might, he couldn't stop smoking altogether, and I realized that there was probably a strong unconscious underlying reason that was undermining our efforts.

In order to discover what Rick liked about smoking, he agreed to allow me to do a hypnotic induction.  While in a light hypnotic state, Rick expressed feeling very relaxed and, at the same time, he maintained a dual awareness of both his relaxed state and that he was sitting on a couch in my office.

I asked Rick to go back in his mind to the first time that he smoked and enjoyed it.  Rick remembered a pleasant summer day sitting on his grandfather's porch with his father and grandfather.  He remembered that it was after a great dinner that his grandmother had made and his grandfather was telling funny stories about his childhood.

He remembered how they all joked and laughed and how he realized that day how much he loved his father and grandfather.  He was particularly aware on that day of the strong bond he felt with them and how being allowed to sit with them, while the women in the family were in the house, made him feel proud, as if he was part of this exclusive "club"for the men in the family.

Many other similar happy memories of being with his grandfather and father came to his mind.  Just thinking of those memories brought tears to Rick's eyes.

Afterwards, as part of the debriefing in the session, Rick talked about how surprised he was to realize that when he smoked, he continued to feel a bond with his father and grandfather, both of whom he missed very much since they died.

No wonder it was so hard for Rick to give up smoking.  He had an unconscious identification with his father and grandfather through smoking cigarettes and it helped him feel connected to them even though they were both dead.

As he continued to talk about these two important men in his family, Rick said they were the two most important people in his life.  Then, he cried to think that he might give up this habit that kept him feeling connected to them.

During the next session, Rick and I talked about the strong bond that he felt with his teenage sons.  He often spent a lot of time with his sons and it was obvious that he was proud of them and loved them very much.

I asked Rick how he would feel if his sons began smoking.  Rick dismissed this idea.  He said that, even though he smoked, he had always told his sons not to smoke, and they promised him they never would start.  The idea of his sons smoking was so disturbing to him that he couldn't even consider the idea.

I told Rick, as tactfully as I could, that children learn more from what they see their parents do than what their parents tell them to do.  And, just like he started smoking as a way to bond with his father and grandfather, his children could do the same.

Rick acknowledged that this could happen, but he doubted that it would.  But if it did, he would never want to pick up a cigarette again because seeing his sons smoke would upset him too much.

By the end of that session, Rick began thinking about his place in the family--now that his father and grandfather were gone, he was the patriarch in the family and he wanted to set a good example for his sons.

When Rick came back the following week, he looked upset.  He told me that he was shocked to learn from his wife that his younger son, John was smoking and he had been keeping it a secret--until Rick's wife found a pack of cigarettes in John's pants pocket as she was sorting the laundry.

He said that after she told him about their son smoking, he sat by himself in the kitchen for a long feeling sad and upset.

How an Unconscious Identification with a Loved One Can Create an Obstacle to Change

He knew that if he confronted his son in an angry way, it would seem hypocritical to John.  So, he decided that, once and for all, he was going to give up smoking.  Hearing that his younger son had taken up smoking provided Rick with the motivation he needed to stop.  With the help of hypnotic suggestions, and his motivation to change Rick was able to stop smoking.

Several months later, when I followed up with Rick, he told me that he continued to be a successful nonsmoker and, shortly after he stopped, his son, John, also stopped.  Rick told me how proud he felt that he could "kick the habit" and he thought that his father and grandfather would also be very proud of him.  That feeling--that his father and grandfather would be proud of him--was another strong motivator for him to remain a successful nonsmoker.

Although the vignette above is a composite of many different cases, it has been my experience that, in many instances, an unconscious identification with a loved one can create an obstacle to change.

These identifications are usually not apparent at first.  A therapist, who is skilled at doing discovery work, can help clients to uncover the unconscious obstacle.

An Unconscious Identification with a Loved One Can Create an Obstacle to Change

As in the case with "Rick," a behavior or habit that represents a strong identification is often hard to change.

But, similar to the vignette above, if clients discover an even more compelling reason to change, as "Rick," that reason can help to transcend the original obstacle.

Getting Help in Therapy
Obstacles to change often include conscious and unconscious factors.

It is usually difficult to discover the unconscious factors on your own, which is one of the reasons why people come to therapy.

If you've having difficulty making changes, you could benefit from working with a skilled therapist who has experience helping clients to discover and overcome unconscious obstacles.

Discovering the unconscious obstacle is an initial step.  Developing the motivation to transcend the obstacle is what often leads to transformation.

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, September 12, 2016

Stress Management: Taking Time Out For Self Care

When life gets hectic and stressful, it's easy to forget about the importance of self care. At those times, many people try to get through the stressful time by plowing through rather than taking care of themselves (see my article: Staying Emotionally Grounded During Stressful Times).

Stress Management: Taking Time Out For Self Care

For other people, it's a matter of not feeling entitled to take care of themselves (see my article:  Self Care: Feeling Entitled to Take Care of Yourself).

Not feeling entitled to self care is often part of a larger problem that is usually longstanding.  This could involve a tendency to put others first, being unfamiliar with the concept of self care or a tendency to be a perfectionist to the point of exhaustion (see my article:The Connection Between Perfectionism and Core Shame).

Needless to say, a lack of self care often leads to burnout, whether it involves personal stressors or work-related stressors (see my article: Managing Your Stress: What Are the Telltale Signs of Burnout?).

Many people come to therapy when they get to the point where they feel they just can't cope any more.

The following fictional vignette illustrates how a lack of self care can lead to bigger problems, and how therapy can help:

Nina came to therapy after she developed stress-related health problems, including debilitating headaches, chest pains related to anxiety as well as insomnia.

Self Care: Taking Time Out to Take Care of Yourself

At her doctor's recommendation, she took off a month from work, which she had resisted doing for a long time.  But when her doctor warned her that her symptoms would get worse unless she took time off to relax and regroup, she knew she had to do it.

During that time, she stopped having headaches and panic attacks, but she began to feel depressed at home without her usual demanding work schedule.

When she consulted with her doctor again, she told her to get help in therapy, so she started therapy a week after she began her break from work.

Nina was a perfectionist since she was a child.  If she didn't do things perfectly at school and at home, she felt she was a failure.  There was no in between.   She was a straight A student, but she derived no joy or satisfaction from her accomplishments because she felt this was what was expected of her--she had to be perfect.

Both of her parents were perfectionists as well.  Before they retired,  both of them were rewarded in their fields for their perfectionism.  Her mother was a well-respected lawyer and her father was a top surgeon in his field.  So, Nina grew up in a household where there was a lot of pressure to be "the best."

Nina did very well in college and in graduate school.  She found it relatively easy to be at the top of her class.

Then, she came to NYC and entered into a highly competitive field that attracted the top people in her  field from all over the world.  Even though she came from a highly competitive family, she never experienced this type of competition.  She felt like she had to always be on her toes to stay on top.

She was rewarded with the respect of her superiors as well as monetarily for her long hours at work but, as previously mentioned, the pace was taking its toll on her health.

Self Care: Taking Time Out to Take Care of Yourself

When her therapist mentioned self care, Nina wasn't even sure what her therapist meant.  She wasn't even sure where to begin.

Her therapist taught Nina breathing exercises and how to meditate, and she recommended that Nina practice for a short time everyday to get into the habit of taking care of herself.

Initially, this felt so unfamiliar to Nina that she felt guilty taking the time to de-stress instead of working or "doing something productive."

When she felt her mind wandering, her sense of perfectionism got in her way because she was sure that she "wasn't doing it right," which almost felt unbearable to her.

It took a lot of practice and a lot of encouragement from her therapist for her to stay on track with her self care practices.

Once she was able to practice meditation and breathing with less difficulty, her therapist helped Nina to work on her perfectionism.

Nina learned that underneath the perfectionism there was core shame.

Working on her shame was more challenging because it was uncomfortable for her.  But her therapist helped Nina to see that this is a common problem and shame is often at the core of emotional problems for many people.

Self Care: Taking Time Out to Take Care of Yourself

When Nina went back to work, she got into the habit of taking time each morning to do her breathing exercises and meditation, even if she only did it for 10 minutes.

Nina also made a conscious decision that her health was more important to her than her next promotion and that if getting that promotion meant compromising her health, it wasn't worth it.  So, she reduced the hours that she put in at work.

Nina and her therapist continued to work on Nina's longstanding sense of shame that fueled her perfectionism.  Her therapist used a combination of EMDR (Eye Movement Desensitization and Reprocessing) and Somatic Experiencing.

Over time, Nina was able to work through her feelings of shame.

Eventually, she decided that her current profession no longer suited her and she began to train for a less stressful profession.

She continued to engage in the self care techniques that were helping her to cope, and she learned that she didn't have to be "perfect" at it.

Along the way, Nina developed a greater sense of self worth and an appreciation for life that she never felt before.

Getting Help in Therapy
If you're struggling with stress, anxiety or depression, you're not alone.

Many stress-related health problems can develop if you learn how to take care of yourself on a physical and emotional level.

If you've never developed strategies for self care or you don't feel entitled to take care of yourself, you could benefit from working with a therapist who specializes in helping clients to overcome these problems (see my article:  The Benefits of Therapy).

Rather than waiting until you are experiencing burnout or health problems, get help from a licensed mental health professional so you can begin to live a more satisfying life.

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.

Tuesday, September 6, 2016

Why It's Important For Psychotherapists NOT to Have "All the Answers" in Therapy

There was a time in the history of psychotherapy when traditional psychotherapists believed they had  "the answers" for their clients (see my article: A Therapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

Back then, it was assumed a client would come in, free associate to whatever was on his or her mind, and when the time was right, the therapist would make an interpretation as to what was going on for the client.

If the client didn't accept the therapist's interpretation, the client would usually be thought of as being "resistant" (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

Fortunately, times have changed and most contemporary therapists work in a more collaborative way with clients.  And yet, there are still many clients who come to therapy who expect the therapist to have "all the answers" to their problems.

Not only is it a distortion of what goes on in therapy to think that a therapist is all-knowing, it's also counterproductive.

And, it's likely that any therapist who presents him or herself as knowing all the answers won't be listening to the client or helping the client to develop his or her own ability to develop insight and inner knowledge.

Self exploration and personal discovery is part of the psychotherapeutic process.  And while it's understandable that some clients want "the answer" to their problems from the therapist, it's not realistic or helpful.

Although psychotherapists, who have advanced training in psychoanalytic or psychodynamic therapy, are trained to do in-depth therapy, they are neither mind readers nor fortunate tellers, so they don't have "all the answers" to your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

Knowledgeable, skilled therapists can facilitate clients' self exploration and help them to develop the psychological skills to overcome problems and lead a healthier life.

If they're trained as trauma therapists, which not all therapists are, they can also help clients to overcome psychological trauma.

But psychotherapists also need to get to know clients over time, and it would be presumptuous and foolhardy for any therapist to assume that she knows from the start what would be best for the client.

If the therapist assumes that she already knows the answers to the client's problems before there is any psychological exploration, this usually means that the therapist isn't taking the time to listen empathically and to get to know the client.

In my professional opinion, as a psychodynamically trained therapist who has gone on to do advanced trauma training, psychotherapy is an intersubjective experience (see my article:The Therapy Session: A Unique Intersubjective Experience).

It takes time for the client and therapist to develop a therapeutic rapport and this doesn't always happen.  Not every therapist is for every client, and most therapists recognize that it's not always a "good fit" with every client.

Most therapists know that each client is unique and, even when it appears that a particular client might have a similar problem to other clients, there's never a one-size-fits-all approach that will work for every client.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

A skilled therapist also knows that part of creating a therapeutic rapport is creating a "holding environment," as initially explained by British psychoanalyst, Donald Winnicott, where the client feels safe (see my article: The Creation of the Holding Environment in Therapy).

A skilled therapist also knows that she must listen empathically to what the client is saying on both a  conscious and unconscious level in order to begin to understand what's happening with the client (see my articles: Psychotherapy: Therapists Should Listen and Learn From Their Clients and The Therapist's Empathic Attunement to the Client)

By listening empathically, the therapist is actually learning from the client about the client rather than the other way around where the therapist makes premature interpretations as to what's going on.

It's also the therapist's job to help the client to develop the skills to tolerate the ambiguity of what's going on in therapy, especially during the initial stage of therapy when it might not be so clear.

In other words, some clients come in with a specific problem and while the resolution might not be clear, the problem is clearer than when clients come in a state of general malaise and they're not sure what's going on (see my article:  When You Just Don't Feel Right, It's Hard to Put Your Feelings Into Words).

For the client, developing skills to tolerate ambiguity might include self soothing techniques or other forms of coping skills (see my article:  Developing Coping Skills in Therapy).

There are no quick fixes in psychotherapy, even with some of the more advanced forms of trauma therapy, which tend to be shorter than some forms of talk therapy when there is psychological trauma (see my article: Beyond the "Band Aid" Approach to Overcoming Psychological Problems).

If you're new to psychotherapy, it helps to have realistic expectations of your therapist and of the psychotherapy process.

Generally speaking, the more complex the problem, the longer it takes to work it through in therapy, although therapy shouldn't be an interminable process where you feel you're not making any progress.

Rather than giving you the answers, a skilled therapist helps you to get to know yourself, grow psychologically, and learn how to work through your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

I recommend that you take your time when you're choosing a psychotherapist (see my article:How to Choose a Psychotherapist).

As part of the process of finding a therapist, you might want to see several therapists to determine which one you feel the most comfortable with before you delve into therapy.

And, as I mentioned before, even highly respected, reputable therapists are not always a "good fit" for everyone, so trust your intuition when making a choice.

Getting Help in Therapy
Many people avoid seeking help in therapy because they believe in common myths and distortions about therapy (see my articles: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak" and Common Myths About Psychotherapy: Therapy Takes a Very Long Time).

It's takes time to develop a sense of trust and safety in therapy, especially if you've had early childhood experiences where you were abused or neglected.

Getting Help in Therapy

Psychotherapy can be a  transformative and dynamic process if you approach it with a sense of openness and curiosity about yourself, choose a therapist who is right for you, and approach therapy with realistic expectations (see my articles: Psychotherapy and Beginners MindStarting Therapy With a Sense of Curiosity and Openness and Experiential Therapy Can Be a Transformative Experience That Helps to Achieve Emotional Breakthroughs).

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, see my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

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