NYC Psychotherapist Blog

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Thursday, March 8, 2018

Focusing on Your Inner World to Understand How Your Unconscious Mind Affects Your Behavior: A Clinical Vignette

In my prior article, Focusing on Your Inner World to Understand How Your Unconscious Affects Your Behavior, I discussed the importance of focusing on your inner world and how to tap into your unconscious mind in psychotherapy using experiential therapy such as EMDR therapy, clinical hypnosis, and Somatic Experiencing.  In this article, I'll be providing a fictional clinical vignette to provide an example.

Fictional Clinical Vignette: Focusing on Your Inner World to Understand How Your Unconscious Affects Your Behavior

Sam began psychotherapy because he was having problems in his romantic relationships with women.

Focusing on Your Inner World to Understand How Your Unconscious Affects Your Behavior 

His last relationship ended in much the same way as his prior two relationships ended with his girlfriend, Jane, telling him that he was too jealous and possessive.  She was also hurt that he tended to be suspicious that she might be cheating on him when she never gave him a reason not to trust her.  After getting fed up with Sam questioning her about her whereabouts, she ended the relationship (see my article: Relationships: Overcoming Jealousy).

Sam told his psychotherapist that neither Jane nor his other girlfriends ever gave him a reason to doubt they were faithful to him, but he still had a hard time trusting women.  He had a very hard time controlling his suspicions, jealousy and possessiveness while he was in the relationship.

In hindsight, he would see that he was being irrational, but that insight never came until after the relationships ended.  Although he knew that there was no chance of repairing his relationship with Jane, he wanted to avoid behaving in this way in a future relationship.

When his psychotherapist asked Sam about his family history, Sam, who was in his mid-30s, revealed that he had only sketchy memories of his childhood.  His psychotherapist knew that this is often a sign that there was developmental trauma in childhood, but she wanted to wait until she knew more about Sam before she speculated about this.

He revealed that was the youngest of three children who grew up in New York City.  When he was in his 20s, his oldest sister, Anna, told him that their mother left the family household for several months when Sam was five and that he had a very hard time while she was away, but he had no memory of this.

Sam said that, according to Anna, their mother just disappeared one day while they were in school.  Anna told Sam that their mother had not left a note or phoned to say where she was or when she would be coming back, which worried everyone.

Anna told Sam that he was inconsolable after their mother left and he refused to go to school, but Sam had no memory of this.  He was aware that his mother eventually returned and his parents were still together, but this is all that he knew.

Sam talked about having chronic insomnia for as long as he could remember. He had problems both falling and staying asleep.  He also described problems with irritable bowel syndrome (IBS), tension headaches and backaches.  He said his doctor gave him medication for IBS, which sometimes worked and sometimes did not.  His doctor also told him that his medical problems were probably psychologically related and recommended that Sam attend psychotherapy.

His psychotherapist, who was a trauma-informed therapist, also knew about the connection between various medical issues and developmental trauma, so she noted this information in Sam's therapy file and kept it in her mind.

She provided Sam with psychoeducation about psychological trauma and how unresolved childhood trauma, even trauma that people cannot remember from their childhood, can affect them later physically and psychologically as adults (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

Then, his psychotherapist prepared Sam to work on his issues by explaining that there would be a preparation phase to their work where she would teach him to how to de-escalate his anxiety and to use self care exercises at bedtime to deal with his insomnia and to anything anxiety-producing at the end or between psychotherapy sessions (see my article: Trauma Therapy: Using Grounding Exercises Between Psychotherapy Sessions and Trauma Therapy: Using the Container Exercise Between Therapy Sessions).

After Sam began meditating, doing breathing exercises and practicing grounding and the container exercises, which helped him to calm himself and to sleep better, his psychotherapist talked to him about the Affect Bridge in clinical hypnosis and how it could help them to understand the root of his problems.  She explained that Sam would be in a safe and relaxed state while they were doing the affect bridge, and she asked him to go back to one of his memories where he was suspicious of Jane.

Sam remembered that there was an evening when Jane was late coming home from work and he was worried about her.  He tried to reach her on her cellphone, but the call went directly to her voicemail.  He said that's when he began to get anxious and suspicious that she might be with another man.

At first while he was waiting for Jane to come home, he tried to rationalize that he had no reason to believe that she was cheating on him, but his anxiety got the best of him and it just continued to escalate.

By the time Jane came home to the apartment that they were sharing, he was in a terrible state.  He went into a rant and accused her of being with another man.

Jane had been through his rants before, so she waited for him to calm down.  Then, she told him that she was stuck between stations on the subway and she had no way to make or receive calls or texts.  She got on the computer and showed him the MTA website that indicated that there were significant delays on the train line that she used.

Then, Jane had a serious talk with Sam and told him that she couldn't deal with his suspicious nature anymore and she wanted to leave the relationship. Within a week, Jane was gone.  Sam felt devastated.

His psychotherapist explained that the anxiety that he had was related to separation anxiety, and she explained this form of anxiety to him (see my article: Overcoming Separation Anxiety).

Sam's psychotherapist asked him to go back to when he felt anxious when he couldn't reach Jane and describe what he felt and where he felt it in his body now as he recalled the memory, assuming this was tolerable for him.  Sam said it was tolerable.  He described the rising state of his anxiety and the related pain in his stomach.  He also felt angry and sad.

His psychotherapist asked Sam to stay with the emotions that he was feeling and to go back to his earliest memory of feeling this same way.

In response, Sam took a couple of minutes to focus on the emotions and the pain in his stomach.  His  mind took him back to a memory of coming home from school when he was five and looking for his mother in their  family apartment.  He looked all over the apartment and couldn't find her.  After a few minutes, he felt terrified that something happened to his mother.

Alone and afraid, he called his father at work in tears.  His father came home immediately and looked around the apartment to see if he could find a note from Sam's mother.  Finding no note, he called his in-laws to find out if she was there, but they said they had not heard from her.  Sam remembered that he was inconsolable all that night, and his father stayed with him until Sam fell asleep.

When Sam opened his eyes in his psychotherapist's office, he said that he was surprised because, until they did the Affect Bridge, he had no memory of that day.

Over the next several weeks, Sam and his psychotherapist continued to work on the early childhood memory of his mother leaving the family.  He recalled that a week or so after his mother left, he overheard his father telling his oldest sister that he heard from Sam's mother and she told the father  that she left the family to be with another man.

Over time, Sam began to remember many more memories related to his childhood.  He was also able to connect his irrational feelings of jealousy and suspicion in his relationships to his childhood memory of his mother leaving the family for another man.  Once he understood the connection, his jealousy and anxiety in his relationships made sense to him.  He realized that the unresolved trauma was still getting played out in his adult life (see my article: Developmental Trauma: Living in the Present As If It Were the Past and Understanding Why You're Affected By Trauma That Happened a Long Time Ago).

His psychotherapist explained to Sam that understanding the root of his problem was the first step, but understanding it alone would not be enough to overcome his problem when he got emotionally triggered in a future relationship (see my article: Coping With Trauma: Becoming Aware of Emotional Triggers).

She recommended that they use EMDR therapy to help Sam overcome the original trauma triggered his separation and abandonment anxiety(see my article: EMDR Therapy: Overcoming Childhood Trauma So You Can Have Healthier Adult Relationships and How Psychotherapy Can Help to Overcome Fear of Abandonment).

Gradually, over time, Sam and his psychotherapist used EMDR therapy and discovered that there were other similar memories of feeling abandoned that contributed to his current psychological and physical problems (see my article: Psychotherapy to Overcome Childhood Trauma).

Eventually, Sam was able to work through his traumatic memories in EMDR therapy.  By the time he got into a new relationship, he no longer got emotionally triggered.

Many clients come to therapy because they don't understand why they are having problems.  Often, they are not aware of how unresolved childhood trauma affects them psychologically and physically as an adult.

Experiential therapy, like clinical hypnosis, Somatic Experiencing and EMDR therapy, can help clients to focus on their inner world to understand how the past, even the past that is not conscious to them, affects them now.  Experiential therapy can also help clients to overcome traumatic experiences.

Getting Help in Therapy
Working with a skilled mental health professional in therapy provides an opportunity to get to the root of your problems and work through unresolved trauma (see my article: The Benefits of Psychotherapy).

Once you have worked through unresolved trauma, you can live a more fulfilling life free of your traumatic history.

Rather than suffering on your own, you owe it to yourself to get the help you need in therapy from an experienced psychotherapist (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and one of my specialties is helping clients to overcome trauma.

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.