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Monday, October 31, 2016

Co-Parenting After the Divorce

In a prior article, Talking to Your Young Child About Your Divorce, I discussed how to talk to young children about divorce.  In this article, I'm focusing on co-parenting after the divorce.

Co-Parenting After the Divorce

When a happy, romantic marriage disintegrates, it can be traumatic for the married couple as well as the children.

Most people don't get married with the idea that they'll be getting divorced one day.  There are usually expectations of a romantic, happy life together.

Unfortunately, about half of all marriages end in divorce.  Often, this is due to unrealistic expectations of marriage.

Whatever the reason for the divorce, if there aren't children involved, the two formerly married people need never see each other again.  This allows each person to grieve the end of the relationship and to, eventually, move on.

But when formerly married people have children, they need to find a way to co-parent their children in a mature, respectful way.

Despite their best efforts, many people struggle to find a way to co-parent without doing harm to their children.

Co-Parenting After the Divorce

The worst cases involve one or both parents who lack the necessary emotional maturity and interpersonal skills to co-parent and who end up doing emotional damage to their children.

Here are some basic concepts to co-parenting well:

  • Accept that the marriage is over and don't try to use your children to get your ex back.  Not only is this disrespectful to your ex, but it's emotionally damaging to your children to expect them to function in this way.  Be the adult.  Don't use your children as pawns and don't expect your children to be the adults.
  • Negotiate a plan with your ex, if possible, for how the two of you will speak to the children about the changes in their lives.
  • Speak with the children yourself, if it's not possible for your ex to be there, explain the changes and be prepared for questions.
  • Recognize that co-parenting is a challenge and prepare yourself to handle challenges as they arise.
  • Be prepared for your children to try to get you and your ex back together again, even after you have explained many times why you're not together.
  • Work with your ex, if possible, to get on the same page about basic rules so that your children will have a stable environment in your home as well as in your ex's home, including:  sleep time, when to do homework, curfews, etc.
  • Be respectful of your ex.  Although it might be gratifying on some level for you to hear your children criticize your ex, be sure to foster a respectful environment in your home.
  • Recognize that the situation will be continuously changing over time, including new romantic relationships for you and/or your partner, new marriages, new siblings or step siblings of your children, and so on.

Getting Help in Therapy
Many people who are in unhappy marriages think that they will feel completely better after the divorce.

While it's true that some of the relationship pressure between you and your ex will no longer be an issue, other issues related to co-parenting can be just as difficult if not more so.

Family and friends might be supportive, but they might not be the most objective.  In the worst of cases, they might unintentionally fan the flames of your anger and despair about the divorce and co-parenting issues.

If you're finding it difficult to handle the aftermath of your divorce, you could benefit from seeing a licensed mental health professional who is objective and has the experience and skills to help you overcome the challenges that you're facing.

If you're feeling unsure as to whether you want to go to therapy, it's usually best to think of the first session as a consultation where you're under no obligation to continue if you don't feel comfortable with the therapist.

The best predictor of a good outcome in therapy is for you to feel a rapport with the therapist.

Family therapy can also be helpful to assist you, your children and your ex with the transition.

So, if you're really struggling emotionally, don't wait until you're in an emotional crisis to seek help.  Take the first step today by setting up a therapy consultation.

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 through the aftermath of their divorce and the challenges of co-parenting.

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, October 24, 2016

Talking to Your Young Child About Your Divorce

Talking to young children about your divorce isn't easy.  Depending upon what your child has heard about from their  friends, she may or may not understand what the word "divorce" means or might have misconceptions (see my article:

Talking to Your Young Child About Your Divorce

This is why you and your spouse want to be on the same page about how to approach your child, choosing the right time and keeping it simple.

Here are some basic suggestions:

Get Together With Your spouse Beforehand and Present a United Front:  
  • Even though you and your spouse might not be getting along, you both need to put aside your differences for your child's sake.  You might be relieved that the marriage will soon be over, but expect that your child probably will be upset about it, even if she witnessed the marital conflicts.  
  • Decide in advance what you will say and keep it as simple as possible.  If your child asks why you're getting divorced, you can say something simple like, "We're not getting along," but don't say, "We don't love each other anymore" because this could lead to your child thinking that, at some point, you might not love her anymore.
Choose the Right Time and Place and Leave Plenty of Time For This Talk:
  • Choose a time when it's quiet and you'll have privacy to talk.  Also allot enough time for your child's questions or emotional reactions
  • This isn't the kind of talk you want to have with your child in a car, in a public place, before your child goes to school or just before you go to work. 
Remain Calm and Bring Forth Your "Best Self:"
  • You and your spouse need to summon your most mature and "best selves" to have this conversation.
  • This isn't the time to blame your spouse or for your spouse to blame you for things that haven't worked out or to express your grievances about the marriage.
  • It's also not the time to try to get your child to side with you.
Reassure Your Child That It Isn't Her Fault :
  • It's very important to assure your child that the breakup of your relationship isn't her fault.  Young children are naturally egocentric during the early stage of their development and it's normal for a child to blame herself for the divorce.
  • It's also very important to let her know that, even though the marriage will be over, you each will love her always and she'll be safe.

Talking to Your Young Child About Your Divorce

Explain What the Living and Visitation Arrangements Will Be:
  • Once again, due to the early stage of a young child's development, your child will naturally be concerned about where she will live.
  • You need to explain the living and visitation arrangements to your child in a simple way.
  • Anticipate other questions.
Don't Assume That Your Child is Okay Just Because She's Not Reacting:
  • Depending upon your child's personality and level of maturity, she may or may not react immediately.
  • Don't assume that everything is okay because she's quiet.
  • Although she is quiet, there can still be a lot going on in her mind that she's not expressing, so you might need to elicit questions or concerns during and after the initial talk.
Anticipate That Your Child Might Regress or Act Out After the Talk:
  • It's not unusual for a child to regress to an earlier stage of development after you and your spouse talk about the divorce.  Young children usually don't have the communication skills to express their feelings, so their upset is often expressed through a regression or through acting out.
  • A child of five or six might start wetting the bed or start using baby talk or feel the need to be treated like a baby again.
  • This usually passes, but if it doesn't speak with your pediatrician and explain what's going on.
  • Acting out could take the form of testing limits, like refusing to do homework or suddenly not want to go to school.
  • Speaking of school, your child's academic performance and behavior in school might become problematic, so you want to remain in contact with the school.  
  • Try to be as compassionate as you can be and recognize that your child might need further reassurance that she's going to be okay and that you and your spouse will each be okay.

Talking to Your Young Child About Your Divorce

Check In With Your Child From Time to Time After The Talk:
  • It often takes young children a while to absorb all the implications of how she will be affected by the divorce, so it's best to check in with your child from time to time.
  • Anticipate that she might try to bargain with the two of you to try to get you to stay together, so you might have to explain it to her again, keeping it simple.
Try Not to Worry Too Much--Most Children Are Resilient:
  • Although it's normal for your child to be sad, disappointed or angry about the divorce, over time, most children are resilient and eventually bounce back, especially if you and your spouse can be respectful of one another and have an amicable relationship when it comes to the welfare of your child.
  • Change can be challenging for anyone, especially children, who need structure and routine, but most children adjust to new routines, especially if they know what to expect.
  • If your child is having an especially difficult time, consider taking your child to a child therapist for help.
Seek Professional Help If You and Your Spouse Are Having a Hard Time Calm and Respectful Towards Each Other For the Sake of Your Child:
  • Although you and your spouse might be beyond fixing your problems, you will need to co-parent your child until she is at least 21.
  • If you're having a hard time coming together in a respectful, calm way, you could benefit from attending marriage counseling to develop the necessary skills to communicate effectively with your child.
  • It would be better to get help in advance than to have a talk with your child if you can't contain your hostility and anger.
  • Learning how to be mature and respectful when you talk to your child and in the co-parenting process will help your child to process the change in a healthy way.  You and your spouse will also feel better about yourselves in the long run.

Getting Help in Therapy to Co-Parent After the Divorce

Next ArticleCo-parenting After the Divorce

Getting Help in Therapy
Most people associate marriage counseling with trying to work out problems in a marriage so you can stay together.  That is certainly one aspect of marriage counseling.  But people also come to marriage counseling to learn how to part amicably, whether there are children are not.

If you have children, you and your spouse owe it to them and to yourselves to be your "best selves," which is often difficult to do when you're getting a divorce.

Being able to put your child first, regardless of your feelings towards your spouse, is important, and seeking help if you're unsure of yourselves can be the best step that you take during this challenging time.

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.

Also see my article: Coparenting After the Divorce.

Saturday, October 22, 2016

Overcoming the Trauma of Childhood Sexual Abuse

Childhood sexual abuse is more prevalent than most people think, and the psychological effects can be much more far reaching than had been recognized in years past. It's only been relatively recently that people have even begun to talk about childhood sexual abuse more openly, and people have sought psychological help to overcome its effects. Years ago, this topic was considered taboo and survivors of childhood sexual abuse often kept these traumatic secrets to themselves, often to their detriment.

Overcoming the Psychological Effects of Childhood Sexual Abuse

Childhood sexual abuse is a very broad topic and there have been many books, articles, and TV programs about the psychological effects. One blog article can hardly do justice to such an important topic.

What is Childhood Sexual Abuse?
Broadly speaking, childhood sexual abuse is any form of sexual touching, kissing, inappropriate undressing or any other form of sexual behavior with a child. Childhood sexual abuse is a boundary violation that often has severe detrimental effects on the child.

Who Engages in Childhood Sexual Abuse?
Anyone who is around a child is a potential sexual perpetrator. Often, the sexual perpetrator is someone who would, under normal circumstances, be trusted with the child, including one or both parents, another family member, a teacher, a religious leader, babysitter, or other people.

Often, people who engage in childhood sexual abuse have been sexually abused themselves and they are repeating this pattern.

Regardless of the circumstances of how or why this occurs, adults who engage in childhood sexual abuse are responsible for their behavior both morally and legally.

Can a Child Ever be Held Responsible for Sexual Abuse?
Many survivors of childhood sexual abuse often feel responsible for the abuse for a variety of reasons. First, let me answer my question with a resounding "No." Children are never responsible for their own sexual violation. However, as adults, as previously mentioned, they often feel that they brought it on themselves in some way which, of course, is not true because children don't have the developmental capacity and often don't have a way to stop the abuse.

Often, when survivors of childhood sexual abuse begin psychotherapy to deal with the aftermath of the abuse, they talk about the sexual acts "feeling good" and they have a lot of guilt and shame about this. When a survivors of sexual abuse tells me this, I help them to distinguish between what might feel good in their body or on an emotional level from their feelings of being responsible.

Perpetrators of childhood sexual abuse have an uncanny way of selecting children that they sense are vulnerable.

These children are often lonely or neglected in some way and they're craving attention. To a child who craves attention, sexualized attention is better than no attention at all. Even if they feel uncomfortable, many children go along with the perpetrator because he or she might be nice to them in other ways: spending time with them, taking an interest in things that interest them, giving them gifts and so on.

If the perpetrator happens to be someone who would normally be considered a trusted family member, friend, or clergy, children who are being sexually abused can become very confused and doubt their own feelings of discomfort or that the abuse is even happening.

In some of the more egregious forms of childhood sexual abuse, perpetrators often threaten the children or threaten to harm a family member if the children reveal what's going on.

Psychological Effects of Childhood Sexual Abuse:
Each person's experience will be different and the psychological effects will be different. Experiences can vary depending upon age, temperament, the relationship with the perpetrator, whether there are explicit memories or only vague feelings or sensations, and so on.

The important point when considering the psychological effects of childhood sexual abuse is that no one goes unaffected because it is such a personal boundary violation.

Often, without realizing it, adults who were sexually abused as children have difficulty with sexual intimacy in their relationships.

Before I go on, I want to caution that not everyone who has difficulties with sexual intimacy has been sexually abused. There are many varied reasons why a person might have difficulty with sexual intimacy, including physical reasons, other types of violations or breaches, depression, anxiety, and so on. So, no one should automatically assume that because they're having problems being sexual with a partner that this means he or she was sexually abused.

The following scenario, which is a fictionalized account and does not represent any one person or persons, illustrates the possible psychological effects of childhood sexual abuse:

Alice was in her early 20s when she met Bob at a friend's party. They were instantly attracted to each other, they had similar interests, and they began dating soon after they met. It was important to Alice that she get to know Bob before they became sexually intimate, so she wanted to wait a while before they had sex. Bob was becoming increasingly fond of Alice, so he didn't mind waiting.

After they had dated for a couple of months, Alice felt like she was ready to be sexually intimate with Bob, and she let him know. After a romantic dinner, Alice and Bob went back to his apartment. His roommate was away, so they had the place to themselves.

Alice felt warm and close towards Bob, and she was excited about taking their dating relationship to the next level. Other than kissing, Alice had never had sex with any of the other young men that she had dated in the past, but she felt that there was something special about Bob.

As they were sitting on the couch, listening to music by candlelight, they began to kiss. Alice enjoyed kissing Bob and she was feeling increasingly passionate. But when Bob touched her breast, Alice froze both physically and emotionally, and she began to feel confused.

On the one hand, Bob's touch felt tender and exciting, but on the other hand, it also started to make Alice feel queasy. She tried not to pay attention to the queasy feeling in her stomach, but it continued to get stronger and her confusion increased.

At the point when Alice felt that she was going to vomit, she pushed Bob's hand away. He realized immediately that she was upset and asked her if she was all right. Alice didn't know what to say. She felt her whole body go rigid and cold, and she felt that she wanted to run out of the apartment. Aside from feeling confused, she also felt ashamed.

Without words to express what was going on with her, Alice told Bob that she had to go and she rushed out of his apartment and went back to the apartment that she shared with friends. Bob was stunned, and he tried to talk to Alice, but she left in a hurry and told him not to follow her.

Over the next few weeks, Bob tried to call Alice. She heard his voicemail messages, but she was too confused, ashamed and guilty to call him back. She didn't even feel comfortable talking to her close friends about what happened. She just knew that she never wanted to feel that disgusting, queasy feeling again. So, she continued to avoid Bob and, after a few weeks, he stopped calling.

This was the beginning of a long line of disappointments for Alice whenever she tried to be sexually intimate with men. Aside from getting an upset stomach and feeling ashamed, confused and guilty, Alice also felt a sudden emotional revulsion whenever she began to be sexually intimate with a man. Each time that she attempted to be sexually intimate, Alice hoped that the experience would be different, but it never was.

By the time Alice was in her 30s, she had experienced so many physical and emotional upsets with sexual intimacy that she no longer wanted to date. She tried to tell herself and her friends that she was "just fine" being alone. But the truth was that she was very lonely and she wanted to overcome whatever was causing her to feel so uncomfortable and mistrustful.

Struggling with this issue on her own brought no relief, so her best friend recommended that Alice see a psychotherapist. Alice had always thought that people who went to therapy were "crazy," but her friend explained to her that, quite to the contrary, many people went to psychotherapy for everyday, ordinary problems, and they weren't "crazy." So, Alice obtained a recommendation from her doctor and made an appointment with a psychotherapist.

During the first session, the psychotherapist took a family history as part of the initial session. This is standard practice. When the therapist asked Alice if she had experienced any sexual abuse or molestation, Alice's first inclination was to say "no," but she hesitated.

She knew that her Uncle John used to touch her breasts whenever no one else was around. She also knew that this began when she was about nine years old. But she wasn't sure what to say about it because whenever he touched her, she felt confused and she continued to feel confused about it.

Uncle John tended to be kind and generous with her, especially after Alice's father died when she was four years old. He took a special interest in her, taking her to the park, teaching her how to ride a bike, taking her to the movies, and listening to her in a way that her mother, who was depressed after Alice's father died, never did any more.

One day, soon after her 12th birthday, when she was alone with her Uncle John, he sat next to her on the couch, as he had many times in the past. However, this time, he offered her a sip of his beer. Alice never tasted beer before and she knew that her mother wouldn't like it, but she also thought that Uncle John would never ask her to do anything that was wrong. So, with some hesitation, she tasted his beer, and he encouraged her to drink more.

She didn't think much about it because it just felt like any other activity that she shared with Uncle John. But after a while, Alice's head began to spin. Uncle John had already drank quite a few beers and he asked Alice to sit on his lap. Alice had not sat on Uncle John's lap since she was about four or five years old, so she thought this was odd. When she hesitated, Uncle John said he felt hurt that she wouldn't do this. Not wanting to hurt his feelings, Alice sat on Uncle John's lap, even though she felt uncomfortable.

As Alice continued to drink more beer, she could hardly keep her eyes open, but she saw the expression on Uncle John's face change. She had never seen him look at her like this, and she wasn't sure what was happening or if she could even trust what she was seeing because she was pretty drunk by then.

But when Uncle John put his hand up her blouse and began fondling her breast, she felt confused. On a physical level, part of her felt good and excited, but and her stomach was also queasy. All the while, Uncle John was telling her how beautiful she was and that she was his favorite niece.

Soon after that, she passed out, and when she woke up, she was in her bed and her mother came home. Uncle John came up to her room to say goodbye. Alice remembered vaguely what happened, but Uncle John looked at her so kindly, the way he always looked, and she began to doubt her own recollection of what happened that day.

The next time that Uncle John babysat for Alice, she turned down his offer to drink his beer and she told him that she didn't feel comfortable sitting on his lap. Uncle John turned away from her and turned on the TV. He refused to talk to her, and this upset Alice greatly. He was the only one who took any interest in her in the family, and she loved him very much.

When she could not get him to pay attention to her, she went up to her room, feeling very lonely and sad, and she cried herself to sleep until her mother came home.

The following time, it was much the same, and Alice felt desperate for Uncle John's attention. So, she told herself that it wasn't so bad, after all, to drink beer with Uncle John and sit on his lap. When she told him this, Uncle John transformed into her Old Uncle John, kind, attentive and warm.

She didn't drink as much beer as she did the first time, but she acquiesced to Uncle John's wishes and allowed him to fondle her breasts. She fought off the queasy feeling in her stomach and told herself that this was a small price to pay to have Uncle John's attention.

So, this continued on without Alice revealing this to anyone. Uncle John told Alice that no one would understand the "special relationship" that they had together and he told her not to tell anyone so it would remain special between the two of them.

Around the time that Alice turned 15, Uncle John no longer wanted to spend as much time with Alice, which she didn't understand. He had many excuses as to why he wasn't available. But Alice found out from her mother that Uncle John was now spending more time with Alice's cousin, Lisa, who was a year younger than her.

One day, when Alice went over to Lisa's house to look for Uncle John, she found the door open so she walked in. She walked into Lisa's bedroom, where she heard Lisa and Uncle John laughing. At first, she could not see anything because the room was dark.

Then, when her eyes adjusted to the darkness, she saw Uncle John having sex with Lisa. She was stunned. It was obvious that they were both very drunk, and Uncle John shouted to Alice, "Get out of here! You're too old for me now! Lisa's my favorite niece now" and Uncle John and Lisa both laughed at Alice.

Lisa ran out of the house and never told anyone what she saw. After that, she never wanted to spend any time with Uncle John. Whenever she saw him at family functions, he acted like the Old Uncle John, as if nothing had happened. This confused Alice, and made her doubt what happened to her with Uncle John and what she saw when she went to Lisa's house. She thought to herself, "How could this be the same Uncle John who always took care of me?"

All of these thoughts were swimming around her head after the therapist asked her about childhood sexual abuse. Over time, Alice was able to talk about what happened and she realized that her uncle was a pedophile, and she was sexually abused as a child. She also began to connect the queasy, frozen feeling that she had as an adult when she was sexual with men to the feelings that she had as a child with Uncle John.

Alice had to work through a lot of anger, sadness, and bitterness. Just talking about the abuse and knowing that she got emotionally and physically triggered whenever she was sexual was not enough to resolve her trauma.

Talking about it was only the beginning. Alice's therapist used EMDR therapy, which is a mind-body oriented psychotherapy, to work through the trauma. It took time and effort, but Alice was able to overcome her trauma and, eventually, she had a healthy relationship with a man that she met soon after that.

The psychological effects of childhood sexual trauma can occur at any time. Many people don't realize that the sexual abuse is effecting them, and they often blame themselves for any sexual difficulties that they have as adults.

Very often, regular talk therapy is not enough to overcome the trauma. It might provide you with intellectual insight about what happened and how it is effecting you, but it's often not enough to help you heal.

Mind-body oriented psychotherapy, like EMDR, is often more effective in overcome sexual trauma and trauma in general.

The fictionalized case that I presented is about a girl, but sexual abuse also occurs to boys. It can be just as confusing and depressing for a man to deal with these feelings when they are triggered as it is for a woman.

Getting Help in Therapy
If you're a survivor of childhood sexual abuse, you're not alone and you can overcome your trauma with help from a licensed mental health professional who specializes in this area.

To find out more about EMDR therapy, see my article:  EMDR Therapy - When Talk Therapy Isn't Enough.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR, and Somatic Experiencing therapist.

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, October 17, 2016

Leaving Therapy Prematurely: Overcoming the Urge for a "Flight Into Health"

In a prior article, When Clients Leave Therapy Prematurely,  I wrote about clients leaving therapy before they've completed the work.  In this article, I'm focusing on a particular dynamic called a "flight into health" where a client avoids any further exploration of his or her problems out of fear with a temporary cessation of symptoms that brought the client into therapy in the first place.

Psychotherapy: Overcoming the Urge for a "Flight to Health"

Often, this "flight into health" is unconscious.  It is based on a fear of further in-depth work on the presenting problem.  At the time, the client is convinced that s/he is feeling better and no longer needs to come to therapy.

S/he is usually unaware that what's really happening is that s/he has convinced him or herself that everything is fine now.  But, usually, s/he is suppressing the symptoms, and the suppression of these symptoms can only be maintained for so long before they come to the surface again.

There are some clients who go through this time after time with different therapists and they are unaware of what they're doing, so they can be in and out of therapy many times.

In many cases, these clients haven't developed the necessary internal resources and coping skills to do the work (see my article:  Developing Internal Resources and Coping Skills).

Let's take a look at a fictional vignette, based on many different cases, to understand how this plays out:

Lynn had been in therapy several times as an adult.  Each time she started therapy, she came for the same reason:  to deal with a history of physical abuse by her mother when she was a child.

Psychotherapy: Overcoming the Urge For a "Flight Into Health"

Her pattern was that she would remain in therapy for several sessions, and when she and her therapist began to speak about how angry and sad she felt about the physical abuse, she would suddenly "feel better" and decide that she no longer needed to be in therapy.

Against her therapist's advice, she would leave, feeling somewhat relieved to have talked about the abuse.  But within a few months, she would begin feeling depressed and anxious about her childhood abuse and decide to try a different therapist.

From her perspective, the prior therapies "didn't work" because she began feeling anxious and depressed again.  She didn't realize that she had fooled herself each time into thinking her problem was resolved when, in fact, it wasn't.

Instead, on an unconscious level, she suppressed her anxiety and depression, and covered it over with a lot of activity to mask her feelings.  She would plan many trips, outings, and social events to keep herself distracted and exhausted.

But after a while, this defensive behavior no longer worked for her and she felt disappointed that her old feelings were back.

When she talked about her prior attempts to get help in therapy with her latest therapist, she expressed her sadness and disappointment that prior therapists were unable to help her.

When the therapist discerned what was happening, she explained the concept of "flight into health" to Lynn as a way to help Lynn to understand her history in therapy.  Somewhat skeptical, Lynn listened, but she didn't feel it applied to her.

She wanted to begin immediately by delving into her traumatic history.

But suspecting that Lynn might be having problems with containing difficult emotions, her therapist told her that it was important to start with building the internal resources to do the work.

Her therapist explained that, without the internal resources and the necessary coping skills, Lynn could become easily overwhelmed and want to leave therapy by convincing herself that she was "feeling better" when, in fact, not much had changed.

Her therapist spent several sessions teaching Lynn how to calm herself with a breathing exercise, the Safe Place exercise, and certain mindfulness exercises.

She also helped Lynn with various containment exercises, including a visualization exercise where Lynn imagined that, before she left each session, she could place her uncomfortable feelings and reactions into an imaginary box with a lid on it that was kept in the therapist's office ready and waiting for the next time that Lynn came to therapy.

Initially, Lynn felt impatient with this preparation phase of therapy.  But when they began working on a memory about the early childhood physical abuse, using EMDR (Eye Movement Desensitization and Reprocessing) and Lynn began to feel overwhelmed, her therapist reminded her to use her internal resources, including the breathing, internal resources and visualizations.

By using her internal resources, Lynn was able to calm herself and contain difficult emotions.  She also made good use of the imaginary box with the lid that allowed her to imagine that she was leaving this traumatic memory and the difficult emotions associate with it with her therapist.  In other words, she didn't have to take it with her.

By the Lynn completed therapy, she felt the difference between her usual "flight into health," which was a defense against completing the work and actually overcoming the trauma.  In hindsight, she realized that whenever she thought she was "feeling better" before, it was only temporary.

Psychotherapy: Overcoming the Urge For a "Flight Into Health"

Lynn and her therapist went back to the traumatic early childhood memories again and Lynn no longer felt upset by them.  She felt compassion for herself as a child, but she no longer felt anxious or depressed.

Her therapist followed up with Lynn several months later, and Lynn told her that their work was holding.

While it's understandable that no one wants to dwell on traumatic memories, the reason why people come to therapy is that these memories are getting in the way of their leading the life that they want.

Emotional trauma doesn't resolve itself on its own (see my article:  ).

Without working through the trauma in therapy, it continues to have a strong impact on your current life.

A "flight into health" is an unconscious defense mechanism that clients use when their fear becomes  too much for them.  They convince themselves that they're "better" when, in fact, "feeling better" is a self generated feeling and only temporary.  Sooner or later, the problem makes itself felt again.

Preparation to do trauma work is essential to help the client to deal with the difficult emotions that can come up.  When clients have developed the necessary internal resources and tools beforehand, the trauma work is usually tolerable.

Rather than going from one therapy to the next, clients can complete the work and go on to lead more fulfilling lives without the affect of the earlier trauma.

Getting Help in Therapy
If you recognize yourself in this article, you owe it to yourself and your loved ones to get help with a therapist who can assist you with the necessary initial preparation.   The time spent doing on preparation before trauma work is well spent in the long run (see my article: The Benefits of Therapy).

Rather than spending the rest of your life carry the burden of your emotional trauma and having it get in the way of leading a happy life, you can learn to contain and tolerate the emotions that arise so that you can resolve the trauma (see my article: How to Choose a Therapist).

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, October 10, 2016

Growing Up Feeling Invisible and Emotionally Invalidated

Healthy emotional development is based on parental attunement and secure attachment (see my articles: How the Early Attachment Bond Affects Adult Relationships and What is Childhood Emotional Neglect?).  When children grow up in a family where a chronic lack of attunement and their feelings are invalidated, they often grow up feeling invisible as children as well as feeling invisible later on as adults.

Growing Up Feeling Invisible and Emotionally Invalidated

By "invisible" I mean feeling left out, unlovable, excluded, unimportant, ignored, and passed over.

Many of these same children, who grew up feeling invisible and emotionally invalidated in their families continue to feel that way as adults.  They grow up with negative core beliefs about themselves, including:  "I'm not important," "I'm unlovable,""I'm powerless" and so on (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

Without realizing it, many people with these core beliefs perpetuate the problem by withdrawing emotionally if they are in a social situation.  

People around them will often think they are picking up social cues that they're not approachable, so they hesitate to connect with them.

Growing Up Feeling Invisible and Emotionally Invalidated

This often becomes a cycle where people with negative core beliefs eventually avoid social situations because they don't realize that people around them are reading into their facial expressions and overall demeanor that they want to be left alone.

To make matters even more complicated, people with negative core beliefs about themselves are often ambivalent about whether they want to be approached or not.

There is usually a part of them that craves social connection and another part that is fearful of it based on their experiences of feeling rejected from an early age (see my articles:  Untreated Emotional Trauma Can Have Serious Emotional Consequences and An Emotional Dilemma: Wanting and Dreading Love).

This can leave these individuals feeling lonely, on the one hand, but afraid of making social connections on the other hand (see my article:  Overcoming Loneliness and Social Isolation).

When the loneliness is greater than the fear, people with negative core beliefs about themselves often seek help in therapy.  

It's a brave step for these individuals, who expect to be rejected and abandoned, to seek help in therapy.  If their own parents couldn't provide them with the emotional attunement and validation that they needed, it's hard to believe that a psychotherapist, who starts out as a stranger, would do it.

For many people in this situation, it's a last ditch effort to turn around a lonely, unhappy life, and if they've never been in therapy before, they're taking a leap of faith that they can make themselves emotionally vulnerable in therapy (see my article: Fear of Being Emotionally Vulnerable).

Let's take a look at a fictionalized scenario to illustrate some of these issues and to see how these problems can be overcome in therapy:

Pam came to therapy when she was in her early 30s.

She thought about seeking help in therapy since she was in her early 20s, but her fear of being disappointed and emotionally abandoned by a therapist kept her from seeking help.  

What precipitated her coming to therapy was that her last close friend, who wasn't married, had gotten engaged and she was preoccupied with her fiancĂ© and her wedding plans to the extent that she spent less time with Pam.  This made Pam feel very lonely, and she realized that if she didn't overcome her fear of being rejected and abandoned that she would ensure that she would be alone for the rest of her life.  

The fear of being alone for the rest of her adult life was greater than her fear of being disappointed and emotionally abandoned in therapy, so she obtained a referral from her doctor and set an appointment.

Pam was intelligent and she had a lot of insight into her negative beliefs about herself and how these beliefs developed from a young age.

Even though she could see where her problems began and how they were affecting her as an adult, she had little faith that anything, including therapy, could make a difference for her.  But she didn't know what else to do so, at the recommendation of her doctor and her close friends, she kept the appointment.

She was very apprehensive while she sat in the therapist's reception area waiting for the initial consultation. She was tempted to get up and leave, but before she knew it, the therapist came in to the reception area to get her (see my article:  Starting Therapy: It's Not Unusual to Feel Anxious and Ambivalent).

The therapist started the session by asking Pam what brought her to this consultation and what she hoped to get out of therapy.  Pam knew the therapist was going to ask her this, but when she attempted to speak, she felt overcome with sadness and shame and choked back tears in order to speak.

Seeing that Pam was having a hard time, the therapist told Pam to take her time. She helped Pam to feel more comfortable by normalizing her experience and telling her that many people feel uncomfortable during the initial consultation, so Pam's reaction wasn't unusual.

Pam took a deep breath and spoke about how afraid she was that she would be alone in life.  She had three close friends, all of whom were either married or engaged and this precipitated an emotional crisis for Pam.  

Even though she was happy for her friends, she couldn't help comparing herself to them and feeling like she was coming up short because she had never been in a serious relationship before.  Worse still, her friends weren't as available to her as when they were all single.  All of this combined to make Pam feel anxious that she would be alone and lonely for the rest of her life.

Even though she was lonely and wanted very much to be in a relationship, she was also afraid of getting hurt and disappointed.  This made it difficult for her to put herself in social situations or to sign on to social dating sites to meet men.

She told the therapist that she was seeking help because she knew she couldn't overcome her ambivalence on her own and, even though it was difficult to believe that therapy could help, there was a part of her that wanted to give it a chance.

Pam sensed that the therapist was listening to her attentively and compassionately, which helped her to express her feelings, even though it was still difficult.

Towards the end of the session, the therapist explained how she worked in a contemporary way and that it was important to her that her clients feel emotionally safe before they began processing their innermost feelings.

She explained that, for some people, it takes time to build a strong therapeutic alliance with the therapist and that this was crucial to doing the work.

She also explained how the mind-body connection was important to the way that she worked (see my article:  (see my article: Mind-Body Oriented Psychotherapy: The Body Offers a Window Into the Unconscious Mind).

After the first session, Pam realized that she felt a little better.  She felt relieved to finally put her feelings into words and speak with someone who was compassionate and seemed to understand her (see my articles:  The Creation of the Holding Environment in Therapy and The Therapist's Empathic Attunement Can Be Emotionally Reparative For Clients).

During the next session, Pam spoke about her family history, including growing up with parents who were preoccupied with their own lives and who often dismissed Pam's early childhood emotional needs as being "childish." 

There was no recognition that what Pam wanted and needed was what any child needed--to feel their loving attention and emotional attunement.  Instead, they invalidated her feelings to the point where Pam grew up questioning whether her feelings were valid or even real. She often felt invisible to her parents and to others and that her feelings weren't important.

As an only child, Pam spent much of her time at home alone while her parents were focused on work projects.  To cope with her loneliness, she often lost herself in imaginary games and stories where she had many brothers and sisters to play with and a fairy godmother who anticipated all of her needs.

This was a creative attempt for a small child, but it was no substitute for having nurturing parents.

Being shy and feeling badly about herself made it difficult for her to make friends.  Fortunately, there were outgoing students in her classes who saw Pam's kindness and intelligence and who went out of their way to befriend her.

When she was in college, she dated a few men, but these relationships never lasted more than a few months.  Most of the young men that she dated had similar traits to her parents, self involved and lacking in empathy, so these relationships were unsatisfying to Pam.

Three young women in college befriended Pam, and Pam remained friends with them after they graduated.  Over time, Pam realized how much these friends cared about her and how much she cared about them.  She valued these friendships and they were like the sisters that she never had.

But, over time, as each woman got into a serious relationship, they had less time for Pam.  She still saw them and spoke to them by phone, but it wasn't the same.  As mentioned earlier, after the last remaining single friend got engaged, Pam feared that she would be alone.

Pam's therapist validated her feelings, which was a relief to Pam.  But there was also a part of her that felt she was being "childish" and making too big a deal out of these things.

When she told the therapist that this is how part of her felt, her therapist recognized that this part of Pam was speaking to Pam in Pam's mother's voice, the voice that Pam had internalized from childhood (see my articles: Understanding the Different Aspects of Yourself That Make You Who You Are and Overcoming the Internal Critic).
The therapist spoke to Pam about how traumatic it was for a young child to have to fend for herself emotionally and the impact that this had on Pam's adult life.

She spoke to Pam about doing EMDR therapy to process the trauma and helping Pam to develop the necessary coping skills before processing began (see my articles:  How EMDR Therapy Works: EMDR and the Brain.

Pam was feeling increasingly more comfortable with her therapist and she felt ready to work on coping skills, which is called resourcing in EMDR (see my article:  Coping Strategies in Mind-Body Oriented Psychotherapy).

But there was still a part of her that was ambivalent and fearful about trusting the therapist and allowing herself to be emotionally vulnerable.

When she spoke to her therapist about this, her therapist helped Pam to understand that even though this part might seem "negative" to Pam, this part was actually attempting to be protective.

They mutually decided that it was important to work with this part first to address the fears and help this part to feel comfortable.  

Pam's therapist explained that the preparation work would be gradual to help Pam to develop the skills she needed to work on the trauma.  Her therapist wanted Pam to have these necessary skills so that she would have the wherewithal to deal with whatever came up when they processed the trauma of growing up with parents who were unable to give Pam what she needed emotionally.

Pam didn't mind that the preparation work was gradual because, along the way, she was seeing progress in her ability to talk about feelings that she had buried as a child.

By the time Pam was ready to do EMDR, she focused on an early memory of feeling alone and lonely as a young child (see my articles: Looking at Your Childhood Trauma History From an Adult Perspective).

As Pam processed this memory with EMDR, initially, she couldn't believe that she could ever feel better about it.  Pam and her therapist focused on same memory for a few months because there were so many related experiences.  

As she continued to do EMDR therapy, Pam noticed that she felt less upset about the memory and, in general, she was feeling better about herself.

Working Through Emotional Trauma With EMDR Therapy

The work was not easy or quick because the feeling of being invisible and unlovable as a child was so pervasive throughout her childhood.  But, gradually, the trauma was processed and worked through (see my article:   Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

Gradually, Pam felt more confident in herself and she began socializing more.  Unlike how she felt for most of her life, she now felt that she not only wanted to be in a relationship but she deserved to be with someone who loved her and treated her well.

Eventually, Pam met someone whom she loved and who loved her very much.

Healthy emotional development is predicated on developing a secure attachment with emotionally attuned parents.

When a child grows up with parents who are dismissive of their feelings and when there are no other mitigating factors (e.g., a loving grandparent, aunt or uncle), the child's emotional needs often become unbearable for her to contain.  

This often results in a child burying their feelings because it becomes too hurtful to continue to have unmet emotional needs.

Children who have unmet emotional needs usually grow up to be adults who feel unworthy of love.  This makes it difficult for them to form relationships with others.

Under these circumstances, adults often feel lonely and want social connections, but they are also very afraid of being rejected.  This ambivalence gets played out in an internal tug of war within the adult of wanting and yet dreading love.

As in the fictionalized scenario about Pam, these individuals are often afraid to come to therapy because they fear making themselves emotionally vulnerable in therapy.  This is understandable because if your own parents couldn't be attuned to your needs, why would you think that a stranger (the therapist) would be?

Often, when the fear of being alone for the rest of their lives is greater than the fear of trusting a therapist, these individuals come to therapy, albeit with much trepidation.

A skilled therapist can help these clients to develop the necessary therapeutic alliance so they can begin preparing to process the early trauma.

The preparation stage in any trauma therapy is crucial.  To jump into processing the trauma before the client has developed the necessary skills to do the work can be retraumatizing.

Talk therapy is often of limited help when it comes to processing these types of early trauma.  Clients will become knowledgeable about the source of their trauma, but often nothing changes.

Experiential therapy, like EMDR therapy, is more effective in helping clients to overcome psychological trauma, whether it is a one-time trauma or pervasive developmental trauma.

Getting Help in Therapy
People with pervasive childhood trauma take a leap of faith when they come to therapy.

Often, they don't know what to expect or if they will feel better or worse by coming to therapy.

It's a good idea to consider the first session to be a consultation to talk about your problem in a broad way and to ask the therapist questions.

You might feel that you want to rush into processing your traumatic experiences, but a skilled therapist will first help you to develop the necessary skills to do the work so that the work isn't retraumatizing.

Rather than suffering on your own, seek help from an experienced trauma therapist who can help you to work through your unresolved problems so you can live a happier, more fulfilling life (see my articles:  The Benefits of Therapy and How to Choose a Psychotherapist).

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

One of my specialties is helping adult clients to overcome traumatic experiences that are having a negative impact on 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.

Monday, October 3, 2016

Coping with Seasonal Affective Disorder (SAD)

Seasonal affective disorder, also known as SAD, affects many people during the fall and winter months when there is a decrease in sunlight.

Coping With Seasonal Affective Disorder (SAD)

What Are Some of the Symptoms of Seasonal Affective Disorder?
  • Experiencing depressive symptoms during the fall and winter, and no depressive symptoms during the other seasons
  • Sleeping more than usual
  • Increased appetite
  • Experiencing a decrease in energy
  • Losing interest in activities that you usually enjoy
  • Experiencing problems focusing

What Can You Do to Cope With Seasonal Affective Disorder?
  • Try to get as much sunlight as you can, including going out for a walk during the day, keeping shades or blinds open to get maximum exposure to light, spending time near a window at work and going away, if you can to sunnier vacation spots.
  • Exercise at a level that is right for you to raise your endorphin levels.
  • Try doing gentle yoga to elevate your mood.
  • Spend time with close friends and family doing activities that you enjoy.
  • Eat nutritious meals and limit caffeine.
  • Consider light therapy.
  • Manage your stress

Coping with Seasonable Affective Disorder: Get As Much Light As You Can

Coping with Seasonal Affective Disorder (SAD):  Consider Light Therapy

If none of the above suggestions work, it's a good idea to see your medical doctor to rule out medical issues that cause depressive symptoms.

For instance, many people who have an undiagnosed thyroid condition, can have depressive symptoms, but once their thyroid is stabilized, they are no longer depressed.  So, it's a good idea to rule out medical problems first.

If you have ruled out medical problems and the suggestions above for dealing with SAD aren't working for you, consider seeing a psychotherapist to determine if you have Seasonal Affective Disorder or if you have a different form of depression, such a major depressive disorder or dysthymia (see my article: How to Choose a Psychotherapist and What is the Difference Between Sadness and Depression?)

Getting Help in Therapy
An experienced psychotherapist can help you to develop resources for dealing with seasonal affective disorder so that you are better able to cope with the decrease in light during the fall and winter.

Seeing a psychotherapist, who knows how to work with SAD can make such a difference in the quality of your life.

If you're suffering with SAD, get help today.

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 who suffer with SAD to overcome SAD symptoms.

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.