Translate

power by WikipediaMindmap

Saturday, June 30, 2018

EFT Couple Therapy: Overcoming the Negative Dynamic in Your Relationship That Keeps You Both Stuck

So many couples get stuck in a negative dynamic in their relationship that keep them stuck.  A big part of the problem is that many couples blame each other rather than seeing that the problem is the negative dynamic that they get caught up in.

Overcoming the Negative Dynamic in Your Relationship That Keeps You Both Stuck
In Emotionally Focused Couples Therapy (also known as EFT) couples learn to stop blaming each other and focus on their negative dynamic so they can change the dynamic.

Fictional Clinical Vignette: Overcoming the Negative Dynamic That Keeps Couples Stuck:
The following fictional clinical vignette illustrates how a couple can learn to stop blaming each other as they begin to see the negative dynamic and learn to change it with the help of an EFT couples therapist:

Alice and Sam
After five years of marriage, Alice and Sam were nearly ready to get a divorce when they started EFT couples therapy.

During the initial therapy consultation, Alice explained to their EFT couples therapist that she was at her wits end because whenever she tried to tell Sam what was bothering her, he withdrew from her emotionally and physically.  She said she felt alone and lonely in their relationship and she didn't know how to get through to him.

Sam sat in the therapist's office looking away from Alice with his arms folded.  When it was his turn to talk about his perspective of the problem, he shrugged his shoulders and said, "No matter what I do, it's never right."

When their EFT therapist prompted Sam to say more, he said that Alice tended to blame him for all the problems in their relationship and he gave up more than a year ago.  He said he didn't like to argue, so he preferred to go to his home office and shut the door when Alice yelled at him.  He said he was tired of being blamed and he dreaded coming home from work.

While Sam was speaking, Alice seemed as if she could barely contain herself, and she turned to the therapist and said, "You see? This is what I have to contend with. He just shuts down like he doesn't care, and I can't get through to him no matter what I do or say."

When the therapist asked Sam for an example of a typical argument, he brought up an argument that they had a few days earlier.  He said Alice got angry with him after he forgot their wedding anniversary.  He told the therapist that he understood that Alice was upset, but he felt that her reaction was "over the top."

From his perspective, Sam realized that he made a mistake, but when Alice kept criticizing him even after he apologized, he didn't see the point in discussing it, so he went to his office and shut the door.  But rather than allowing things to cool down, Sam said, Alice pursued him into his office and continued to berate him, which he couldn't stand, so he left the apartment.

When it was Alice's turn to speak, she said she didn't understand how Sam expected her not to be angry when he forgot their anniversary.  To her, this meant that he didn't care about her or their marriage.

As the couples therapist listened to Alice and Sam describe their arguments, she could see that they were stuck in a negative dynamic and this dynamic tended to get played out repeatedly with Alice being the pursuer and Sam being the withdrawer in their relationship.

Being stuck in a negative dynamic can be difficult for a couple to change on their own--especially if the couple has been in a particular negative cycle for a while.  But, over time, the EFT couples therapist helped Alice and Sam to see that there were "no bad guys" in their relationship--there was only a negative dynamic that they could learn to change.

Gradually, over time, the couples therapist helped Sam to become emotionally reengaged in the  relationship.  Then, she asked him to describe what he felt like when Alice blamed him for their problems.  In response, he thought about it and then said, "I feel like I'm worthless and that our relationship is hopeless, so why should I even try?"

As Sam said this, he choked back tears, and Alice, who seemed moved by Sam's sadness, reached over to touch his hand, "I didn't know that this was how you were feeling.  I thought you didn't care about me anymore.  I didn't mean to make you feel worthless."

Sam looked over at Alice, squeezed her hand and said, "Of course, I still care about you. I thought you were completely fed up with me, so I withdrew from you to protect myself emotionally."

The couples therapist asked Alice to talk about the emotions she experienced underneath her anger, and Alice responded, "I'm hurt and afraid that I'm losing Sam.  I don't want to lose him.  I don't mean to yell and blame him.  I just get so desperate that I don't know what to say or do.  I want our marriage to work out."

As Alice and Sam began to identify their underlying emotions, they began to see that they both still cared about each other, but the negative dynamic that they engaged in kept them stuck.

Overcoming the Negative Dynamic in Your Relationship That Keeps You Both Stuck
After Sam became more emotionally engaged in the couples sessions and talked about his emotional vulnerability, Alice's attitude toward Sam softened.  Rather than blaming him and yelling at him, she was able to say what she needed from him emotionally, which allowed Sam to open up to give Alice what she needed and express what he needed from Alice.

By rebuilding trust and being more emotionally vulnerable with each other, over time, Sam and Alice were able to change their dynamic so that they could express their underlying emotions rather than allowing anger and avoidance keep them stuck in a negative cycle.

Conclusion
The fictional clinical vignette is a common negative dynamic in relationships where one person is the avoidant withdrawer and the other person is the blamer/pursuer.

Each person in his or her role of withdrawer and blamer/pursuer makes the dynamic worse and reinforces continues to reinforce it.  The more the pursuer/blamer blames and pursues, the more the withdrawer avoids and withdraws.  Even though the couple might know that what each of them is doing isn't working, they don't know how to change this negative cycle.

In the fictional example above, which is brief and simplistic since this is a blog article, the EFT therapist assesses the couples' negative dynamic and the role that each person plays in it.  Over time, she helps each person to identify the underlying emotions that are often not apparent to the other person in the relationship.

For example, when Sam withdrew from Alice, Alice assumed that this meant he didn't care about her anymore.  All she could see was that Sam was withdrawing emotionally and physically.  Not knowing what else to do, Alice continued to pursue and blame Sam and he withdrew even more.

In EFT couples therapy, the EFT couples therapist creates a safe therapeutic environment which helps the withdrawer to feel safe enough to reengage emotionally so s/he can identify the underlying emotions and tell the other person in the relationship what s/he is experiencing.

When the person, who is in the role of the pursuer, hears that the withdrawer feels sad, helpless and hopeless (or whatever emotions s/he might be experiencing), this often comes as a surprise and a relief that the withdrawer still actually cares.

Once the withdrawer becomes emotionally engaged again and can communicate what s/he actually feels, the pursuer often softens his or her stance so that s/he can communicate what s/he is really feeling underneath all the blaming.

The example above is a simply illustration of how EFT couples therapy works.  Each relationship is, of course, different, and there can be other complications in the relationship, especially if the negative dynamic has been going on for a long time.

Sometimes, the withdrawer needs more time to feel emotionally safe enough to say what s/he feels.  Similarly, the person who is in the role of the pursuer/blamer might not trust that that the withdrawer will remain open enough to hear how hurtful things have been for him or her.  So, it can take time.

One important difference between regular couples therapy and EFT couples therapy is that there are "no bad guys" in the relationship.  The focus is on changing the dynamics that aren't working in the relationship rather than assigning blame.

More Information About EFT Couples Therapy
To find out more about EFT couples therapy, you can read Hold Me Tight by Sue Johnson, a clinician and researcher, who developed EFT couples therapy.

See my article: How EFT Couples Therapy Can Help to Improve Your Relationship.

Getting Help in EFT Couples Therapy
When couples are stuck in a negative dynamic, it can be hard to see a way out.

Research has shown that EFT couples therapy is an effective form of couples therapy that gets lasting results.

Rather than feeling helpless and hopeless, you owe it to yourself and your spouse or partner to get help to overcome the negative cycle that keeps you both stuck.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist, who is trained in EFT couples therapy.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me
















Thursday, June 28, 2018

Feeling the Need to "Be Strong" to Avoid Feeling Your Unmet Emotional Needs

People who grew up in families where their emotional needs weren't met often feel they must "be strong" in order to deny their emotional needs to themselves and to others.  This denial of their emotional needs was part of their emotional survival strategy as children and they continue to use this strategy in their adult relationships--even though it's no longer helping them (see my articles: Understanding Your Emotional NeedsWhat is the Connection Between Unmet Childhood Emotional Needs and Problems Later on in Adult Relationships?, What is Childhood Emotional Neglect? and Emotional Survival Strategies That No Longer Work: "I Don't Need Anyone").

Feeling the Need to "Be Strong" to Avoid Feeling Your Unmet Emotional Needs
Whether they received an explicit message when they were children to "be strong" or whether it was an unspoken understanding in the family, as adults, these individuals often feel ashamed of their emotional needs--shame that developed when they were children.

Denying their unmet emotional needs as children was a way of compartmentalizing those needs so that they didn't feel overwhelmed that there wasn't someone to comfort them.  In that way, the defense mechanisms of denial and compartmentalization helped them.  But, as an adult in a relationship, denying emotional needs gets in the way of having a healthy relationship.

Fictional Clinical Vignette: "Being Strong" to Avoid Feeling Unmet Emotional Needs
Jan
Growing up in a home where her parents were usually preoccupied with their own relationship and careers, Jan learned at a young age to deny her emotional needs.

Instead of her parents accommodating Jan's emotional needs, Jan learned to accommodate her parents by never asking them to comfort her or listen to her when she was scared or feeling doubtful.  She learned that she had to "be strong" on her own, and she became a pseudo "independent" child who appeared, externally, to be emotionally self reliant.

Her parents expressed their pride in having a child like Jan who never asked for anything from them and who was seemingly able to take care of her own emotional needs.

But behind this exterior of pseudo independence, Jan was a frightened, sad child who felt ashamed of having emotional needs.  At a very young age, whenever she felt the need for love or comfort, she told herself that she was  "being a baby."  In effect, she internalized her parents' attitude towards her and she shamed herself.

Years later, when she entered into her first serious relationship, she continued to deny to herself and to her boyfriend that she had any emotional needs that he needed to attend to, but she was willing to pay attention to his emotional needs.

Her boyfriend, who was an warming, affectionate, caring person, knew that Jan had lived her entire life denying her emotional needs because of her relationship with her parents, and he found it difficult to be the nurturing person that he really was in his relationship with Jan.  So, he talked to her about getting help in therapy.

Initially, Jan was offended by her boyfriend's suggestion that she get help in therapy.  She thought he was implying that she was a "weak" person (see my article: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak").

As far as she was concerned, there was nothing wrong with her, and she couldn't understand why he would recommend therapy.  But she wanted to be open minded, so she made an appointment to see a psychotherapist.

During the initial psychotherapy consultation, Jan apologized for taking up the therapist's time when there was really "nothing wrong" with her.  She told the therapist that her boyfriend thought it would be a good idea for her to come to therapy, and she wanted to keep an open mind about it.

As Jan talked about her family history, she was so emotionally detached from the details about her relationship with her parents.  It was as if she was giving a news report.  It was only when the psychotherapist asked Jan to slow down that Jan heard herself and she began to feel sad and anxious about what she was saying.

After a while during the initial psychotherapy consultation, Jan told the therapist that when she slowed down and reflected on her relationship with her parents, she felt uncomfortable.  She thought about the children that she knew now that were the same age as Jan was when she was a child, and she realized that her family life "wasn't normal" (her words) because, of course, it's normal for children have emotional needs.

Over time, Jan's psychotherapist helped Jan to put words to her emotions by using Somatic Experiencing.  When Jan had difficulty identifying her emotions, her therapist asked her to sense what she felt in her body in order to put words to her emotions (see my article: Using Somatic Psychotherapy When the Client Has No Words to Express the Problem).

Initially, this was difficult and frightening for Jan because she spent her life, until now, denying her emotions.  But her therapist titrated the work so that it wasn't overwhelming for Jan.

Once Jan was able to express her emotions and accept that her emotional needs were "normal," she and her therapist used EMDR therapy to help her to resolve the trauma related to her early emotional neglect (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

This work was neither quick nor easy but, over time, Jan grieved for what she needed and didn't get as a child.

As she worked on resolving her childhood trauma, she became more emotionally engaged in her relationship with her boyfriend.  She was able to accept love and nurturance from her boyfriend, who was happy that Jan was growing emotionally and more present in their relationship.

Conclusion
Emotional survival strategies that were helpful during childhood often get in the way of adult relationships.

Someone who spent their childhood denying his or her emotional needs often doesn't recognize, as an adult, that this is what they are doing.  Often, their spouse or romantic partner is the one to point out that there is a problem.

Trauma therapy, like Somatic Experiencing and EMDR therapy, helps to overcome unresolved trauma.

Getting Help in Therapy
Trying to overcome these type of traumatic problems on your own is very difficult (see my article: The Benefits of Psychotherapy).

A skilled trauma therapist can help you to overcome emotional survival strategies that are no longer working for you so you can replace them with healthy ways of relating and coping (see my article: How to Choose a Psychotherapist).

Admitting to yourself that you have a problem and contacting a trauma therapist is often the hardest part of trying to overcome trauma.

The first step is having a consultation to explore these issues further and to see if you feel comfortable enough with the therapist to continue to work with her.

Once you're free of your traumatic history, you can lead a more meaningful and fulfilling life.

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

One of my specialties is helping clients to overcome traumatic experiences.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.


















Friday, June 15, 2018

Experiential Therapy: Learning to Sense Emotions in Your Body As Part of Trauma Therapy

One aspect of experiential psychotherapy that's different from regular talk therapy is sensing emotions in the body.  Sensing emotions in the body helps to deepen the work, get to unconscious emotions, and keeps the work in therapy from being just intellectual.  But some clients have difficulty sensing their emotions, especially if they have experienced significant trauma.  So, as part of the preparation phase of trauma therapy, the trauma therapist helps the client to learn to sense their emotions (see my article: The Body Offers a Window Into Unconscious Mind and What's the Difference Between "Top-Down" and "Bottom-Up" Approaches to Trauma Therapy?).

Experiential Therapy: Learning to Sense Emotions in Your Body as Part of Trauma Therapy 

Fictional Clinical Vignette: Learning to Sense Emotions the Body:
The following fictional clinical vignette shows how a client in experiential therapy can learn to sense emotions in the body:

Ellen
After numerous experiences of trying to work through unresolved childhood trauma in regular talk therapy, Ellen decided to try experiential therapy.

Ellen's psychotherapist provided her with psychoeducation about the different types of experiential therapy, including EMDR therapy, Somatic Experiencing and clinical hypnosis, and how each of them used the mind-body connection as part of the healing process.

As part of the preparation phase of trauma therapy, Ellen's therapist asked her to talk about 10 memories where she felt good about herself.  As she thought about it, Ellen had no problem coming up with the 10 memories from all different times in her life where she felt good about herself.  But as she and her psychotherapist went over each memory and her therapist asked her what emotions she felt in her body, Ellen was unable to identify the emotions or where she felt these emotions in her body.

Based on Ellen's traumatic history, as part of her defense mechanisms to protect herself when she was growing up, she learned to numb her emotions.  Unfortunately, as she discovered in her therapy, she not only numbed her anger, fear and sadness, she also numbed her positive emotions.  As a result, she wasn't sure what she felt.

Since experiential psychotherapy is based on being able to identify and experience emotions, Ellen's psychotherapist helped her to begin to sense her emotions in her body by starting with non-threatening situations.

For instance, Ellen had a puppy that she was very attached to from the day that she got him.  Whenever she held her puppy, she could feel how much she loved him and the puppy's unconditional love for her.

Using Ellen's experience with her puppy, Ellen's therapist asked her to close her eyes and imagine that she was holding her puppy.  Then, she asked Ellen to tell her what emotions came up for her and if she was aware of where she felt these emotions in her body.

Ellen had no problem imaging herself holding her puppy and sensing her emotions.  She told her therapist that she felt tremendous love for her puppy, and she felt protective of him.  She could also sense how affectionate her puppy was when he cuddled with her.  When she thought about where she felt her emotions for her puppy, she said she felt them radiating in her chest near her heart.

Over time, as Ellen and her therapist continued to work on other non-threatening experiences where she felt comfortable, she got better at identifying more emotions and sensing where she felt these emotions in her body.

After they had worked on a number of similar experiences, Ellen was ready to work on the 10 positive memories where she felt good about herself as part of the preparation phase of trauma therapy.

But Ellen was concerned that she might be unable to experience the negative emotions associated with her unresolved childhood trauma.  So, her psychotherapist recommended that they start by working on less threatening negative emotions.

She asked Ellen to come up with several memories that were mildly unpleasant.  She suggested that Ellen come up with memories that, on a scale of 0-10 (with 0 being no disturbance and 10 being the most disturbance Ellen could imagine) that were a 3 or 4 on that scale.

In response, Ellen came up with a memory of feeling mildly annoyed when she had to wait on line at the grocery store.  She was able to sense her annoyance and, on a scale of 0-10, she thought that memory was a 3.  Sensing where she felt the annoyance in her body was more difficult.

Her psychotherapist helped Ellen by suggesting that Ellen sense in her body to see where she was holding onto tension.  She also recommended that Ellen first focus on the area between her throat and her gut.  It took Ellen a while before she was able to detect that she felt mild tension in her upper stomach when she thought about that memory.

After they worked on a number of memories that were a 3 or 4, they gradually worked up to memories that were a 5 or a 6 in terms of how disturbing they were.

One such memory was when Ellen and her puppy ran into her neighbor in the elevator, and the neighbor complained that she didn't think the building management should allow dogs in the building because she was allergic to dogs.  Ellen told her therapist that she tried to be pleasant to her neighbor, who was being unpleasant to her, but she felt annoyed with her neighbor.

When Ellen re-experienced that memory and sensed into her body, she felt a constriction in her throat.  She told her therapist that she thought the constriction in her throat was probably related to wanting to argue with her neighbor but holding back.

Gradually, Ellen and her psychotherapist continued to work on increasingly difficult memories to help Ellen to identify and sense the emotions related to these memories in her body.  She was also expanding her window of tolerance for unpleasant emotions.

Experiential Therapy: Learning to Sense Emotions in Your Body As Part of Trauma Therapy

After a while, Ellen felt comfortable enough to be able to handle the difficult emotions that were associated with her unresolved childhood memories, and she and her psychotherapist used EMDR therapy to do trauma therapy (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Conclusion
Experiential psychotherapy involves identifying emotions and sensing where these emotions are in the body.  This deepens the work and keeps the therapy from being just an intellectual exercise.  It also helps to get to underlying emotions.

Many people, who have unresolved trauma, are unable to identify and sense emotions in the body related to traumatic memories.  This is due to the protective nature of the defense mechanisms they used as children, including emotional numbing, which was useful at the time to keep them from being overwhelmed, but isn't useful as an adult.

Usually, the more traumatic the memories are and the more defended these individuals had to be at the time, the more difficult it is to identify emotions and to be aware of the body.

As part of the preparation phase of trauma therapy, a trauma therapist can help clients to begin to identify non-threatening emotions, at first, as they gradually work their way to more challenging emotions.

By being aware of emotions in the body related to traumatic memories, clients in experiential psychotherapy are better equipped to gradually work through these difficult emotions to resolve the trauma.

Getting Help in Therapy
Unresolved traumatic experiences will remain a part of your experience to be triggered at any time.

Getting help from an experienced trauma therapist can free you from your traumatic experiences, so you can live a more fulfilling life (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than suffering on your own, you owe it to yourself to get the help that you need.

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 I have helped many clients to overcome their traumatic experiences.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.

















Monday, June 11, 2018

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma - Part 2

In my prior article, I began a discussion about the importance of establishing safety for clients in trauma therapy before trauma is processed. One of the requirements that I discussed in the last article for establishing safety is that the client's life must be currently stable.  In other words, s/he is not currently in a crisis or creating new crises.  I'm discussing this topic further in this article.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma

As I discussed in the prior article, clients who are currently in a crisis need help to out of the crisis and keep from creating new crises before they can process traumatic memories.

For instance, if a client has a parent who is in hospice with only a short time to live, the client will need help to get through this crisis and the grief following the parent's death before s/he processes unresolved traumatic memories from childhood.

Likewise, if a client is continuing to create chaos in his or her life, this would need to be addressed and resolved before any processing of traumatic memories from the past can be done.

Fictional Clinical Vignette: Trauma Therapy: Establishing Safety Before Processing Trauma
The following fictional clinical vignette addresses the issue of establishing safety for a client who wants to process traumatic memories but who is still in crisis:

Ann
After a tumultuous breakup in what she described as an on-gain/off-again emotionally abusive relationship, Ann, who was in her late 30s, started therapy to deal with the emotional aftermath of the breakup.  She requested EMDR therapy to deal with the trauma of that relationship (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

During the initial consultation, Ann explained to her psychotherapist that she ended the relationship three months ago and, as far as she was concerned, the relationship was really over this time. She was fed up with the name calling and the way he tried to shame her in front of other people a lot of the time.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma
Ann talked about her history of emotionally abusive relationships that began when she was in high school and continued into adulthood.  She explained that, immediately after she ended her last relationship, she began dating someone new.  She said her new boyfriend seemed nice at first, but lately he was verbally abusive with her too.

When her psychotherapist asked Ann to tell her more about the abuse in this new relationship, Ann told her that he wasn't nearly as abusive as her former boyfriends.  She explained that, although she was aware that she was in another abusive relationship, she was worried about getting too old to have children. Since her new boyfriend also wanted to have children, she wanted to try to have a child with this man before she got any older.

She said she feared that if she broke up with him, she might not meet anyone else and she might miss her opportunity to have a baby.  As a result, she would rather put up with his verbal abuse than breakup with him to find someone new (see my articles: Do You Have a Pattern of Creating Chaos in Your Life?How to Stop Creating Chaos in Your Life, and Remaining in Therapy Beyond the Immediate Crisis).

The psychotherapist explained to Ann that they could not begin EMDR therapy to deal with prior trauma because Ann was in another emotionally abusive relationship where she was likely to be traumatized again.  She explained that it was important for Ann to be in a stable situation before they could do EMDR therapy.

Ann said she understood the rationale for not beginning to process a history of trauma while she was in another relationship where she would probably be traumatized again, but she was not ready to give up her current relationship.

She told the psychotherapist that the thought of ending the current relationship and facing the possibility that she might not meet anyone new was too frightening to her. She said she didn't want to wait much longer to have children, and she would rather have a child with her current boyfriend than risk getting too old to have children.

Even though they could not do EMDR therapy due to Ann's current circumstances, the psychotherapist offered to work with Ann with her current relationship and her difficulty with taking care of herself in terms of choosing men who were emotionally abusive (see my article: Are Your Fears of Being Alone Keeping You in an Unhealthy Relationship?).

Since Ann was not interested in this, she decided not to come for any other sessions.  The psychotherapist gave her information about domestic violence. She explained that domestic violence was emotional as well as physical.  She recommended that Ann contact the New York City domestic violence hotline to deal with this issue.

Two years later, Ann contacted the same psychotherapist.  She told the therapist that she never contacted the domestic violence hotline.  Instead, she had a baby with the boyfriend that she was with at the time when she came for the initial consultation, and the abuse escalated from emotional to physical abuse.  She said she ended that relationship several months ago, and she moved back in with her parents, who were helping her to raise the baby.

When Ann returned to see the psychotherapist, she told the therapist that she regretted remaining in the relationship with her baby's father.  She said that, once the stressors involved with raising a baby increased, the baby's father was unable to handle it.  As the stress increased, his abuse escalated from emotional abuse to physical abuse, and she feared for their child's safety.

Ann explained that, after she left the baby's father and filed for child support, the baby's father disappeared and she didn't know where he was.  As a result, she received no child support from him and she couldn't afford to support the baby on her own, which is why she moved back in with her parents, who took care of the baby while she worked.

When she returned to therapy, she was not in a relationship.  She said that, since she had the baby, she was more aware than ever that she made poor choices when it came to relationships, and she didn't want to jeopardize her baby's well-being by getting into another abusive relationship.  As a result, she wasn't dating at the time.

Although Ann was clearly unhappy, she was safe in her parents' home, and she wasn't in a current crisis.  Since she didn't seem likely to get into another abusive relationship at that point in time, her therapist agreed to do EMDR therapy with her, and they began the preparation work to begin processing her history of trauma.

Conclusion
Some clients, who seek help in trauma therapy, are still either in a current crisis or they are creating new crises in their lives--sometimes knowingly, like the example above in the fictional vignette, and sometimes without their awareness.

The fictional example that I gave is just one possible situation where safety and emotional stability must be present first before EMDR or any type of trauma therapy can be done.  In the prior article, I gave other examples.

A trauma therapist can assist a client who is in crisis to overcome the crisis, but she cannot begin to do trauma therapy until the client's life is stable.

Even after the client's life is stable, every client who does EMDR therapy must go through the history taking and preparation phases of EMDR before the client and therapist can begin processing the trauma.

Since EMDR therapy is more experiential than talk therapy, the preparation phase of EMDR therapy helps to ensure that the client has the necessary internal and external resources to deal with the strong emotions that can come up when working on traumatic memories.

Getting Help in Therapy
Too many people who need help in therapy don't come because of they feel ashamed or they're concerned about the possible stigma of being in therapy.  They mistakenly believe that going to therapy means they're "weak" (see my article: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak".

If you've been struggling on your own with an unresolved problem, you owe it to yourself to get the help in therapy that you need (see my article: The Benefits of Psychotherapy).

Once you have worked through your unresolved problems, you can be free from your traumatic history and live a more fulfilling life (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 I have helped many clients to overcome traumatic experiences.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.






















Thursday, June 7, 2018

Trauma Therapy: Why Establishing Safety For the Client Is So Important Before Processing Trauma - Part 1

As a psychotherapist who specializes in helping clients to overcome traumatic experiences, I see many clients in my private practice in New York City who come for trauma therapy, including EMDR therapy, Somatic Experiencing, and clinical hypnosis.  Early on in the therapy process, I provide clients with psychoeducation about why establishing safety for the client is so important before traumatic memories are  processed in trauma, which is the topic of this article (see my article: Why is Experiential Psychotherapy More Effective Than Talk Therapy Alone to Overcome Trauma? and How EMDR Therapy Works: EMDR and the Brain).

Why Establishing Safety For the Client is So Important Before Processing Trauma

How is "Establishing Safety" Defined in Terms of Trauma Therapy?
Let's start by defining what safety means with regard to trauma therapy.

It's the psychotherapist's responsibility to create a therapeutic environment that helps to establish safety in therapy (see my article about the therapeutic "holding environment" and a more detailed explanation below).  There can be many issues that get in the way of establishing a holding environment, including obstacles in the client's current life and traumatic experiences from the past (see more detailed discussion below).

Safety, which is a relative term that recognizes that there are degrees of feeling safe and the client needs to feel safe enough.  This is an important concept in any type of therapy, but it's especially important in trauma therapy because trauma therapy is experiential and without a sense of safety, the client can be retraumatized (see my article: Developing a Sense of Safety and Trust With Your Psychotherapist).

The following is a list of some of the most relevant issues with regard to establishing safety in trauma therapy with a recognition that, due to the fact this is a blog article and not a journal article or a book, this list might not include all issues:
  • The Client Needs to Feel Relatively Comfortable with the Psychotherapist:  In the most basic terms, the client needs to feel a rapport with the therapist and that there is a therapeutic alliance.  The therapeutic alliance between the client and psychotherapist usually develops over time as the client senses that s/he can trust the therapist.  Many clients get a sense of whether they feel safe with a therapist during an initial consultation, even though the therapeutic alliance hasn't developed yet.  The client often intuits whether s/he will get along with the psychotherapist and that the therapist is someone that s/he can work with on whatever the presenting problem might be.  In that case, there is enough of a sense of comfort to at least set up the next appointment.  Assuming that the therapist has an expertise in the area that the client wants to work on and that she feels she can be helpful to the client, they can proceed from there.  If not, it's important for the client and the psychotherapist to recognize that not every client-therapist dyad is a good match.  Every therapist is not for every client, so it's important to recognize that, regardless of the client's motivation and the therapist's skills, sometimes a particular client-therapist dyad doesn't work (see my article: How a Psychotherapist Creates a Holding Environment in PsychotherapyThe Therapist's Empathic Attunement Can Be Emotionally Reparative to the Client, and What is the Corrective Emotional Experience in Therapy?).
  • The Client is Not Involved in an Ongoing Crisis or Creating New Crises in His or Her Life:  It's not unusual for clients who have a history of unresolved trauma to be involved in an ongoing crisis or creating new crises in his or her life--often without even realizing.  This topic warrants its own article and it will be discussed further in my next article.  At this point, suffice it to say the processing aspect of prior trauma cannot be done when the client is still in crisis and needs help with crisis management .  The need for crisis management must take priority over processing trauma that is based in the past.  Likewise, if the client is creating new crises in his or her life, s/he needs to recognize this dynamic so s/he can change it before any processing of historical trauma can be done.  Once the client is no longer involved with a current crisis and s/he is no longer creating new crises or emotional drama, the psychotherapist can assist the client to prepare for the processing of trauma (see my articles: Do You Have a Pattern of Creating Chaos in Your Life?How to Stop Creating Chaos in Your Life and How a Crisis Can Bring About Positive Change in Your Life).
  • The Client is Not Involved in Excessive Drinking, Drug Abuse, Gambling or Other Compulsive Mood-Altering Behavior:  If a client is engaged in mood altering behavior, whether it involves alcohol, drugs, compulsive gambling, compulsive overspending, sexual addiction or compulsive viewing of pornography, including Internet pornography an eating disorder or other compulsive behavior, s/he isn't ready for processing traumatic memories from the past because s/he hasn't developed the necessary coping skills for trauma therapy.  The psychotherapist would need to assist the client to be stable enough without mood-altering behavior in order to delve into traumatic memories.  If not, the client's mood altering behavior will continue or increase because s/he won't be able to cope with delving into the trauma.  So, the mood-altering behavior must be addressed first, and there would need to be a period of "sobriety" before trauma processing can begin.  Without a period of six months or so of "sobriety," the client is likely to relapse into compulsive behavior.  So, as a first step, this might mean that, if the psychotherapist has a background in helping clients to overcome mood-altering behavior, the therapist will assess the client's true motivation.  Specifically, many clients say they want to stop engaging in mood-altering behavior, but they're not ready.  Since there is always some ambivalence, the therapist can help the client to recognize the ambivalence and, if the client is motivated enough, try to help the client to stop the compulsive behavior or refer the client to a higher level of care, like a detox, rehab or residential treatment.
  • The Trauma Therapist Helps the Client to Prepare For Trauma Processing in Therapy: Unlike regular talk therapy, trauma therapy is experiential, as mentioned above.  Whereas in talk therapy, the client and therapist talk about the trauma, in experiential therapy, they revisit traumatic memories and the experience is more immediate.  In order for the client not to be retraumatized by revisiting traumatic experiences from the past, the therapist needs to help the client to prepare for trauma processing.  The preparation phase, which is also called the resourcing phase, is crucial to trauma therapy and no responsible trauma therapist will proceed without first going through this phase of treatment.  To proceed without the preparation phase would be clinically irresponsible and unethical--no matter how much the client wants to jump right into processing the trauma.  Depending upon the individual client's coping skills, the preparation phase can be as little as a few sessions or, where the client has little in the way of coping skills, the preparation phase can be several months or more.  As a result, the therapist needs to assess the client's coping skills first.  At the very least, the therapist needs to assess if the client is able to maintain dual awareness when discussing the trauma.  In other words, when discussing the trauma, the client remains aware that s/he is in the here-and-now as well as remembering a memory from the past at the same time.  If the client gets so immersed in the memory that s/he forgets where s/he is in the here-and-now, the therapist cannot proceed with trauma processing before helping the client to develop the ability to maintain dual awareness--however long that takes.  An example of a client who cannot maintain dual awareness would be a client who loses all sense of the present moment.  S/he dissociates to such a degree that s/he completely forgets that s/he is in the therapist's office and actually relives the trauma as if it were happening now and not in the past.  This is an example of a retraumatizing experience, as opposed to a healing experience.  Assuming that the client is able to maintain dual awareness, the preparation, at a minimum, would include the client learning ways to de-escalate and cope with uncomfortable emotions during the session and between sessions (see my article: Developing Coping Strategies in Therapy Before Processing TraumaEmpowering Clients in TherapyTrauma Therapy: Using the Container Exercise Between Therapy SessionsTrauma Therapy: Using Grounding Techniques Between Therapy SessionsSafe or Relaxing Place Meditation
  • The Client Keeps Appointments and Comes to Regular Weekly Sessions: Due to the intensity of processing traumatic memories in therapy and the psychotherapist's need to continually assess the client's emotional state during trauma processing, clients must be able to come to weekly sessions.  This is an issue that often comes up during initial consultations when the client raises the issue of coming every other week or monthly or randomly.  Between therapy sessions, traumatic memories continue to be processed on an unconscious level, so the trauma processing continues even when the client is not in session. This often means that new material in the form of new memories or current emotionally triggering experiences can come up between sessions where the client needs the therapist's help.  Even the space of one week can be a long time for certain clients who have problems containing emotions that come up between sessions--even though they have gone through the preparation phase of therapy.  Progress in therapy, especially trauma therapy, isn't linear.  Sometimes, the client feels worse before s/he feels better, so weekly sessions are important for the client to maintain emotional stability.  If money is an issue, the client can inquire as to whether the therapist has a sliding scale or, if not, if the therapist can make a referral to a psychotherapy center where sliding scale therapy is available.
  • The Client is in Control During Trauma Processing:  Even the best psychological assessment cannot always predict when a client might need a break during trauma processing.  This is why it's important for the client to tell the therapist when s/he might need to take a break during the processing of a traumatic memory.  In many cases, a trauma therapist will be able recognize when a client is feeling overwhelmed and help the client to de-escalate before going back into processing the trauma or to debriefing.  But some clients have gotten so good at pretending that they are okay because they feel ashamed of needing help that they override their own internal signals that they need a break from the processing.  They need to learn in therapy how to honor internal signals that they need to de-escalate and feel comfortable enough to tell the therapist.  This doesn't mean that the client will necessarily need to stop when s/he is somewhat uncomfortable if s/he is within his or her window of tolerance.  It also doesn't mean that an inexperienced therapist, who has her own discomfort with seeing clients feeling tolerably uncomfortable, should stop the processing.  If the therapist senses that the client is overriding internal signals to stop, she can ask the client if it's okay to continue processing.  Similarly, clients, who are accustomed to people pleasing, need to learn to overcome their fantasy that they are pleasing the therapist by continuing to process a traumatic memory even though they feel overwhelmed.  Based on the issues that are being presented in this section, it's obvious that the client being in control of trauma processing can be complicated (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Therapy).
  • The Client Uses Coping Skills Between Trauma Therapy Sessions:  It's one thing to learn coping skills and it's another to actually use them between trauma therapy sessions.  Since, as mentioned above, clients continue to process traumatic memories on an unconscious level between sessions, it's not unusual for the client to have thoughts or dreams about traumatic memories between sessions.  Or, the client can get triggered by something in his or her current life between therapy sessions.  This is why the preparation phase of trauma therapy is so crucial.  If, for example, a highly traumatized client doesn't follow the therapist's recommendation to practice de-escalation techniques between sessions in order to stay calm, s/he might discover that s/he is unable to contain his or her experiences between sessions.  For clients who practice coping techniques between sessions, they are usually more likely to either avoid having experiences which are intolerable or mitigate such experiences (see my article: The Benefit of Journal Writing Between Therapy Sessions).
As I mentioned above, establishing safety in trauma therapy (or in any therapy) is a big topic, and a blog article cannot address every possible issue (see my article: Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma - Part 2).

How to Start Trauma Therapy
An exploration as to whether you want to begin trauma therapy (or any therapy) and work with a particular therapist begins with an initial consultation in person.  

As mentioned earlier, it's important to your emotional well-being to get a sense as to whether or not you feel comfortable with a particular therapist.  

When clients come to see me for an initial consultation, I tell them that the consultation is for them to provide me with an overview of the problem, ask questions about the process, my skills and experience, to see whether they feel comfortable enough to come back for another session and for me to assess if they appear to be ready to start therapy and if I have the particular expertise that they need.

Obviously, this is a very tall order for one session, and their comfort level and my assessment will continue, and it will be ongoing if they come back for therapy sessions.  As mentioned before, just like any relationship, it takes time for most clients and their therapists to develop a therapeutic alliance--assuming the therapist-client dyad works well enough for the client to want to return beyond the initial consultation.

It's also important to realize that although psychotherapists might approach the initial consultation in different ways, most therapists recognize that being in therapy involves participating in therapy while clients learn how to be clients in therapy at the same time.  In other words, you don't have to know all the answers before you start.  You learn as you go along with the therapist's help.

Choosing a psychotherapist that you feel comfortable with is important, and you might want to see more than one therapist before you make a decision (see my article: How to Choose a Psychotherapist).

Getting Help in Therapy
Unresolved trauma usually impacts issues in your current life, no matter how long ago the trauma occurred.  Whether the impact is in your personal life, where core issues are most likely to come up, or in your work life or both, unresolved trauma often creates current problems (see my article: Reacting to Your Current Life Based on Your Traumatic Past).

Rather than struggling on your own, you owe it to yourself to get help from an experienced trauma therapist.

If you're already in therapy and your therapist isn't trained in trauma therapy, like EMDR therapy, Somatic Experiencing or clinical hypnosis, you can explore the possibility of adjunctive trauma therapy with a therapist who is trained in trauma therapy.  

Adjunctive therapy means that you continue to see your existing psychotherapist and see a trauma therapist for adjunctive therapy.  It's important to discuss this with your primary therapist first before you begin adjunctive therapy with a trauma therapist.  Also, in most cases, the primary therapist and the adjunctive therapist will ask for your written consent to be able to confer with each other (see my article: What is Adjunctive EMDR Therapy?).

Taking the first step, which is contacting a trauma therapist by phone or email, is often the hardest step.  

Once you have worked through your unresolved trauma, you have an opportunity to let go of your traumatic history so you can lead a more fulfilling life.

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

As a trauma therapist, I work with individual adults and couples, and I have helped many clients to overcome their traumatic experiences.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.



































Wednesday, June 6, 2018

Books: On Chesil Beach: How the Entire Course of a Relationship Can Be Changed By "Doing Nothing"

Usually, when you think of a relationship that doesn't work out, you think of something that one or both people actively did that resulted in the breakup.  But there are times, like in the book and movie, On Chesil Beach by Ian McEwan, when the entire course of a relationship can change by appearing to "doing nothing."

On Chesil Beach: How the Entire Course of a Relationship Can Be Changed By "Doing Nothing"

This occurs more often than most people think, and it's often only in hindsight, sometimes many years later, that the people in the relationship realize the impact of "doing nothing" when a response might have changed the course of the relationship.

On Chesil Beach is a good example of this dynamic but, in case you haven't read the book or seen the movie, I'll give another example so there are no spoilers in this article.

Fictional Clinical Vignette: How the Entire Course of a Relationship Can Change By Doing Nothing:
The following fictional clinical vignette illustrates how a relationship can change by seemingly "doing nothing":

Rick:
A year after a breakup, Rick sought help from a psychotherapist to deal with the emotional aftermath of the breakup.

According to Rick, he and his girlfriend, Diane, had been seeing each other for two years when they got into an argument about an insensitive remark that Diane made to Rick.  Specifically, he got angry with Diane after she called him "stupid" for forgetting her birthday.

Rick told his psychotherapist that he became so livid after she called him "stupid" that even after she apologized several times, he refused to talk to her.  After a few weeks, Diane stopped reaching out to him, and he made no effort to reach her.

How the Entire Course of a Relationship Can Be Changed By "Doing Nothing"

By the time Rick came to therapy, more than a year had gone by since he and Diane had any contact with each other.

It was only in hindsight, Rick said, that he realized that he shutdown emotionally and he was unresponsive to Diane because his father used to call him "stupid," and when she called him "stupid," he got emotionally triggered.  As a result, he didn't accept her apology (see my article: Coping With Trauma: Becoming Aware of Your Emotional Triggers).

Since that time, Rick realized that his relationship with Diane had been the best thing that he had ever experienced, and he made a mistake by not being willing to talk to her.  In hindsight, he realized that she had never done anything like this before, and she lashed out at him that one time in hurt and anger.  He also realized that when she apologized to him, she was sincere.

But when he contacted her a year after the breakup, she told him that she was in another relationship, which was serious, and she couldn't see him.  She said she felt no resentment or anger towards him, and she wished him well, but she couldn't have any more contact with him.

As he sat in his psychotherapist's office, he told her that he felt tremendous regret for shutting down and not accepting Diane's apology when the incident occurred.  He realized that he overreacted at the time, and it was now too late to get back with her.

He told his therapist that, looking back over his life, he realized that he had done this before in other relationships, but he never felt such regret as he did with Diane.  He came to therapy to overcome the emotional triggers that caused him to shutdown emotionally so he wouldn't keep ruining his relationships.

As Rick and his psychotherapist discussed his family history, he talked about his critical father, who belittled Rick from the time he was a young child.  He also talked about his passive mother, who did nothing to protect Rick or intervene on his behalf.

His psychotherapist recommended that they use EMDR therapy to work on the more recent issue involving Diane as well as the history of being criticized by his father (see my article: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

His therapist helped Rick to understand that his defense mechanism of shutting down emotionally was useful to him when he was a child to keep him from getting overwhelmed, but it was no longer useful to him as an adult.  Not only was it not useful, it was actually doing him harm (see my article: What Happens When You Numb Yourself to Emotions From Your Traumatic Past).

The work in therapy was neither quick nor easy.  During their EMDR sessions, Rick felt such grief and compassion for the sad child that he was when he was younger.  He also grieved for his relationship with Diane and dealt with his fear that he might never meet anyone that he loved as much as he loved her.

By the time Rick completed therapy, he was no longer getting triggered by criticism or when someone called him a name because he worked this out with EMDR therapy.  He also understood that shutting down emotionally can be just as harmful to a relationship as being outwardly reactive in a negative way.

Conclusion
Romantic relationships often involve getting triggered by core unresolved issues, including trauma experiences from the past, as in the fictional vignette above.

When someone shuts down emotionally, also known as emotional numbing, s/he can be unreachable and unable and/or unwilling to try to reconcile the relationship because of the emotional trigger.

When this occurs, the person who experiences emotional numbing isn't thinking clearly.  The defense mechanism of emotional numbing "works" so effectively that it might take a while (if ever) before this person can look back in hindsight and realize the damage of being outwardly unresponsive.

Although from the outside, it might appear that "nothing is happening," there is actually quite a lot that's happening internally for the person who shuts down emotionally.  S/he is very overwhelmed, even though s/he might not be aware of it.

To the other person, it appears that s/he is being "stubborn" or "rigid," but, in actuality, the emotional numbing keeps the person emotionally inaccessible even to him or herself.

Getting Help in Therapy
Experiential psychotherapy, like EMDR therapy, helps you to overcome unresolved trauma so you no longer get triggered in your current life (see my article:  Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone)

If you realize that you keep getting triggered by unresolved trauma, you owe it to yourself to get help so you can free yourself from your traumatic history and live a fulfilling life (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 I have helped many 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 (212) 726-1006 or email me.