NYC Psychotherapist Blog

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Tuesday, March 31, 2020

Empowering Yourself During COVID-19: There Are Things You CAN Control

During the current COVID-19 crisis, many people are feeling powerless. This is understandable given the suddenness and the unprecedented nature of the crisis. Also, many of the social interactions, activities and diversions that would normally be available to people to support their well-being aren't available to them because people are physically isolated and might be lonely.  There are many unknowns about the future and it can feel like everything is out of your control.  But before you give into feelings of hopelessness and helplessness, let's take a look at the things that you can control (see my articles: Coping and Staying Calm During a CrisisCoping with Loneliness and Social Isolation, and Undoing Aloneness: Staying Socially Connected Even Though We're Physically Disconnected).

Empowering Yourself During COVID-19: There Are Things You CAN Control

There Are Things You Can Control During the COVID-19 Pandemic
The Serenity Prayer, which was written by Reinhold Niebuhr, contains much wisdom and many people, both in and out of the recovery community, find it calming:

"God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference."

Regardless of whether or not you believe in a God, a Higher Power, religion or prayer, these words remind you that, if you're worried about things you have no control over, you can redirect your attention to what you can control.

What You Can Control During the COVID-19 Pandemic
Rather than focusing on what you can't control, let's take a look at some things you can control:
  • Stay Informed But Don't Spend Too Much Time Watching the News
    • Getting reliable information is important to staying informed. 
    • It's also important to moderate how much time you spend watching or listening to the news.  
    • Much of the news is repetitive throughout the day, and the benefit spending time watching TV or online news is often outweighed by how anxious it can make you feel.
    •  So, you need to figure out what's best for you in terms of how much and when you watch the news.  
    • If you want to maintain your overall sense of well-being, it's especially important that you don't watch the news before you go to sleep.
  • Center and Ground Yourself: 
    • Practice doing breathing exercises to help to calm yourself (see my article: Square Breathing to Manage Stress). 
    • Practice online yoga at a pace that's right for you if yoga appeals to you. If you're not up to doing a vigorous form of yoga, there are online videos or chair yoga.
    • Practice meditation at a regular time. Some people prefer to meditate at night.  Others prefer to meditate when they wake up, and some people do it two or more times a day.  You don't need any special knowledge to quiet your mind to meditate.  You can start by taking a few deep breaths to activate your parasympathetic nervous system, which will calm you down.  There are also many online meditations that you can follow (see my articles: The Mind-Body Connection: Mindfulness Meditation and Calming the Body, Calming the Mind). 
    • Calm your thoughts by taking it one day, one hour or even one minute at a time.
    • Recognize that all things pass.
    • Feel gratitude and appreciation for what you do have right now. 
  • Establish a Routine For Yourself: Chances are good that your normal routine has been interrupted since the current crisis began.  A routine can give you comfort and a feeling of stability, so you can establish a new routine for yourself:
    • Wake up and go to sleep at the same time everyday.
    • Plan your meals.
    • Plan some quiet time for yourself, even if it's just a couple of minutes to breathe.
    • Make a To-Do list for yourself for the next day so you don't spend all day either in bed or watching news
    • A To-Do list can help to organize your day, your week, and your life.
    • Try not to be too ambitious with your To-Do list.
    • Be gentle with yourself. Recognize that you're probably not going to accomplish everything on the list--and that's okay.
    • Appreciate yourself for accomplishing whatever you accomplish on the list.
  • Stay Active: Even though you might be physically isolating, there are still ways to be physically active:
    • You can find many free workouts and yoga classes online.
    • You can also walk or bike outside as long as you take the precautions recommended to stay a healthy distance (at least 6 feet away) from others and follow The Center for Disease Control (CDC) recommendations.
  • Accept the Ups and Downs You Feel as a Common Response to a Crisis: You're living through an unprecedented time in modern history.  Chances are that your mood will go up and down at various times. This is a common experience during times of stress and crisis (see my article: Overcoming Your Fear of Your So-Called "Negative Emotions".
    • If you feel anxious, sad, fearful or whatever emotion you're experiencing at any given time, you're having a common response to a crisis.
    • Rather than judging yourself, accept all your emotions and do whatever you can to alleviate your stress and negative emotions.
    • Recognize that you're not alone.  Millions of other people, who are just like you, are experiencing the same thing. We're in this together.
  • Eat Nutritiously: Eating the right amount of protein, vegetables, grains and vegetables is important to stay physically and mentally healthy.  
  • Get Enough Sleep: Getting proper sleep is essential to your overall health and well-being (see my article: Tips on Improving Your Sleep).
  • Stay Connected Socially: Even though you might not be able to see loved ones now, you can still stay connected to them via: 
    • Phone calls
    • Video chats  
    • Games with friends online.  
    • Video night with a Netflix Party

Getting Help in Therapy
Times of crisis can trigger prior trauma and stressors, and it can be difficult to determine what you're reacting to emotionally.  The important thing to know is that you're not alone.

An experienced psychotherapist can help you to get through a stressful time when you feel overwhelmed.

Many psychotherapists, including me, are providing online therapy (also called telehealth, telemental health, and teletherapy) during the current crisis when therapists aren't in their office (see my article: The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person).

Rather than struggling on your own, you could get help from a licensed psychotherapist to overcome the obstacles that are hindering you.

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

I work with individual adults and couples.

I am providing online therapy during the COVID-19 crisis.

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.

Tips For Getting Better Sleep

Getting proper sleep is essential to maintaining good health and emotional well-being.  This is especially true when you're going through a stressful time.

Tips For Getting Better Sleep

The Effects of Poor Sleep
Poor sleep can affect you by:
  • Lowering your threshhold for pain
  • Increasing your blood pressure
  • Affecting your memory and ability to concentrate
  • Compromising your immune system, which can increase the likelihood of getting sick
  • Increasing the likelihood for impulsive behavior
  • Increasing the likelihood for weight gain
Improving Your Sleep Hygiene: Tips for Improving Your Sleep Hygiene
You might not realize that you're not getting enough sleep beausse you've become accustomed to being sleep deprived.  However, if you're not getting 7-8 hours (on average) of quality sleep, you're not getting enough sleep.  Here are some tips for improving your sleep hygiene:
  • Exercise at a level that's appropriate for you earlier in the day to relieve stress.  
  • Go to bed at the same time every night, including the weekends.
  • Avoid bright lights after the sun goes down.  Bright light will inhibit melatonin which prepares you for sleep.
  • Sleep about 7-8 hours straight (some people might require more sleep or a little less).
  • Don't do work in your bedroom. You want your brain to associate your bedroom with sleep.
  • Make your bedroom as comfortable as possible:
    • Regulate the temperature so it's comfortable
    • Decrease noise
  • Don't watch TV, including the news, in your bedroom.
  • Don't eat a large meal 3 hours or less before you go to sleep.  Indigestion can interfere with your ability to sleep.
  • Don't use alcohol as a sleep aid.  Alcohol might relax you at first because you'll get the sedative effect, but alcohol also disrupts your sleep routine because it will wake you up after a few hours.
  • Create a wind down routine to prepare you for sleep.  This might include bedtime rituals:
    • Brush your teeth
    • Wash your face
    • Take a relaxing bath or shower
    • Drink a relaxing cup of herbal tea 
  • Read for a few minutes before sleep can be relaxing and help you sleep.
  • Write in a journal earlier in the day to capture any thoughts that might be worrying you 
  • Don't judge yourself if you still can't fall asleep.  
    • Give yourself 20 minutes if you're unable to sleep.
    • If you still don't fall asleep after 20 minutes, go into another room and do something relaxing to see if you can go back to bed and get sleep.
Getting Help in Therapy
You're not alone.

If you're feeling overwhelmed, you can contact a licensed psychotherapist to help you develop the tools and skills that you need to achieve emotional well-being.

During the COVID-19 crisis, many psychotherapists are offering online therapy sessions during this period when in-office sessions aren't available.

Rather than struggling on your own, contacting a licensed therapist can make all the difference in your overall health and well-being.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Emotionally Focused Therapy for Couples and Somatic Experiencing therapist.

I work 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, March 30, 2020

Undoing Aloneness: The Client's and Therapist's Parallel Experience of a Crisis

In a prior article, I began a discussion about undoing aloneness and what that means (see my article: Undoing Aloneness: Staying Socially Connected Even Though We Are Physically Disconnected).

In the prior article, I suggested ways that individuals could remain socially connected to loved ones, even though they are physically apart. I also discussed how therapists could maintain meaningful connections with clients through online therapy or phone therapy while they are out of their offices.

In this article, I'm focusing on the fact that therapists and clients are having parallel experiences of the COVID-19 crisis and how these parallel experiences can enhance therapists' ability to provide a safe therapeutic environment, which includes helping the client to feel that he or she isn't alone with the experience.

Undoing Aloneness: The Client's and Therapist's Parallel Experience of a Crisis

The Therapist's Clinical Judgement About Self Disclosure to Clients in Therapy During Parallel Experiences: Undoing Aloneness
In a prior article, I wrote about times when both the client and therapist are going through a similar crisis at the same time (see my article: Parallel Losses For the Client and the Therapist).

In that article, I discussed that therapists often find that a client comes to their office with a similar problem that the therapist might be experiencing at the same time.  I provided a fictional clinical vignette where a client, Lois, came to therapy because her mother was rapidly decompensating from Alzheimer's.

In this fictional example, Lois' therapist was able to provide both practical resources as well as clinical interventions to help Lois cope with her grief and fear about her mother's deteriorating condition.

Lois felt the calming and soothing holding environment that her therapist provided in her therapy sessions (see my article: The Creation of a Holding Environment in Therapy).  Even though Lois felt grief, she also felt her grief was being held and contained by her therapist and this was healing for Lois.

What Lois didn't know was that her therapist was also going through a similar experience with her own mother.  The therapist assessed whether it would be beneficial for Lois to know this and she made a clinical judgement call (to herself) that Lois needed to feel that her therapist was outside the world of Alzheimer's and nursing homes, so she opted not to tell Lois about her own situation.  She assessed that it wouldn't be helpful, so she didn't self disclose.

In another situation with a different client, the same therapist might assess that it would be beneficial for the client to know that the therapist was having a similar experience.  Self disclosure of this nature is, of course, done with much forethought and might even involve consultations with other colleagues.

The other consideration that must be kept in mind when the therapist and client are having parallel experiences is that, even though there might be similarities, there are also differences in the client's and therapist's situations.  This isn't a situation where there is "twinship" between the therapist and client.  Although similar, each of their situations will be unique and they will experience differences based on each of their particular situations and who they are as individuals.

The therapist has to make sure that any self disclosure, especially on this level, is for the benefit of the client and not for the benefit of the therapist.  This doesn't mean that the therapist might not derive some benefit or healing from it as a byproduct of the self disclosure, but the focus must be on what's best for the client.

Parallel Experiences During the COVID-19 Crisis and Undoing Aloneness For the Client
In the situation where a therapist is going through a similar personal situation to the client, the decision to self disclose or not, although not easy or done lightly, is easier to make, as compared to self disclosure in the COVID-19 crisis, because in the personal situation the client usually isn't aware of what's going on in the therapist's personal life.

But in the current COVID-19 pandemic, everyone is affected in one way or another, and most clients know this.  The therapist can't pretend that she's not affected by this crisis because the client already knows that everyone is affected, possibly in different ways and to a greater or lesser degree.

Similar to other situations where self disclosure is a clinical judgment call, during the COVID-19 crisis, the therapist must decide if, when and how much to self disclose on a case by case basis depending upon the needs of the client.

For some clients, any form of self disclosure or reminder that the therapist is affected is contraindicated because this reminder would be too overwhelming for the clients.  Even though, of course, they know, on some level, the therapist is affected, beyond knowing that the therapist is in good health and available to them, they don't want to be reminded that the therapist is experiencing the same crisis.

For instance, for some clients, who grew up with parents who were overwhelmed by one crisis after the next, these clients felt emotionally unprotected by their parents and had to fend for themselves as best as they could while feeling alone in their traumatic experiences.  They might even have had to function as parentified children to their parents where they took on the role of adults to take care of their parents--even though they were just children (see my article: The Roles of Children in Dysfunctional Families).

These clients often need to feel that the therapist can overcome any situation in order for the clients to feel safe in the therapy sessions.  This usually involves an idealized transference that the client develops for the therapist, which is an idealized view of the therapist (see my article: What is Transference in Psychotherapy?).

This is what undoes aloneness in the therapy session--the idea that, unlike the client's parent, the therapist is a competent adult who can handle any situation that comes up.

The resolution of the idealized transference will be determined by the client, and the therapist will take her cues from the client.  Over time, as the client's trauma begins to resolve and the client feels more empowered, s/he no longer needs to see the therapist as an idealized, powerful figure.

Converesely, other clients have a need to know that the therapist is also affected by a crisis that they're both experiencing, like the 9/11 World Trade Center attack or the current COVID-19 crisis.

For instance, during 9/11, many clients in New York City wanted to know if their therapist lost anyone at the World Trade Center.  Or, they wanted to know if their therapist experienced fear when the therapist heard about the attack.

Since both the therapist and client lived through 9/11, the therapist's willingness to discuss this as an experience that they each went through was often necessary and helpful. Obviously, the therapist needed to know each client very well to know what would be beneficial to help the client to feel less alone.

Another example is during the COVID-19 crisis a client might say that time feels distorted to her since the crisis began. In response, the therapist makes a clinical judgment as to whether it would be beneficial for the client to know that the therapist is having the same experience--with the same recognition, as mentioned before, that, although similar, each individual will have his or her own unique experience.

In addition, the therapist usually won't just end with self disclosure.  She would also talk about what the client can do to keep his or her perspective manageable.  So the therapist would provide the client with tools and techniques to accomplish this, so it's not just a shared experience but also an opportunity to learn how to manage emotions and maintain a perspective that's healthy for the client.

When the therapist self discloses, even if it's not a big self disclosure, it's always important for the therapist to metaprocess the experience with the client, which means asking the client what it was like to hear that the therapist was having a similar experience.  This helps to deepen the work and also helps the client to clarify the client's experience about the self disclosure.

In the event that the therapist made a clinical mistake in self disclosing, metaprocessing also provides an opportunity to repair that mistake (see my article: Ruptures and Repairs in Therapy).

Metaprocessing the experience of the therapist's self disclosure also helps the therapist to understand the client's experience.  This can lead to further explorations of the client's past, present and anticipated future.

The Therapist's Self Knowledge and Clinical Judgement About the Client
It's important for the therapist to know her own comfort level as well as knowing the client in order to make a clinical judgment call about self disclosure.

If the therapist knows that she tends to be reticent about self disclosure and that the client's question feels too personal for her, she needs to take this into consideration so that she's not uncomfortable with what she discloses.  At the same time, as mentioned earlier, she needs to know the individual client and what the client needs at any given time.  This is a balancing act.

At a particular point in time, a client might need to know something about the therapist's experience in order for the client not to feel alone in a situation.  However, over time, the client might have other thoughts and feelings about what s/he asked the therapist to self disclose.  All of this is grist for the mill and should be explored.

Undoing aloneness and self disclosure is an important and complicated topic, and one article isn't sufficient to address all the issues involved.  However, hopefully, this article gives you a sense of some important factors.

Getting Help in Therapy
As I've mentioned before, physical distancing doesn't mean that you can't connect in other ways to feel socially and emotionally connected.

If you're feeling overwhelmed, you could benefit from working with a licensed psychotherapist, who has the experience and skills to help you.

Rather than feeling alone and suffering on your own, you can get help from an experienced therapist.

Many therapists, like me, are offering online therapy while they're out of their office.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, Somatic Experiencing and AEDP therapist.  I also use EFT (Emotionally Focused Therapy) for couples.

I work 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 or email me.

Saturday, March 28, 2020

The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person

Due to the contagious nature of COVID-19 and the mandate to stay home in New York City, I recently began conducting therapy sessions online to assure my clients' safety as well as my own. Online therapy is also called telemental health, telehealth, and virtual therapy, and I'm grateful to have the ability to connect with my clients and continue to do therapy with them.  I'm also glad that my clients can do therapy from the comfort of their own homes during this crisis (see my articles: Coping and Staying Calm During the COVID-19 Crisis and The Importance of Getting Emotional Support During a Crisis).

The Advantages of Online Therapy When You Can't Meet With Your Therapist In Person

Using Online Therapy During COVID-19 Crisis
Like many therapists in New York City, I began using online therapy as of last week so I could remain in contact with my clients.  Some clients prefer to have regular phone sessions, but others like having the ability to see me and feel more connected with me online than on the phone.

The online therapy service that I use is free to clients and they don't need to have the service to use it. They also don't need to have any special equipment.  They have a choice of getting the link either via text if they want to use their cellphone or by email if they want to use their computer. I just let them know that, before the session, I will send them a link for the meeting.  Then, I get a notice from the service when they're in the virtual "waiting room" and I "let them in" so we can begin our online session.

Aside from the convenience of doing online sessions, one of the things that has been interesting for me is seeing myself in real time in the corner of my screen while I'm doing therapy with clients.

In my regular in-person sessions in my office, I'm not looking at myself.  But with the online service, I can see my facial expressions and gestures when I glance up at myself occasionally, which has the advantage of making me more aware of how I'm coming across with the client.

This reminds me of when I was in training to be a therapist more than 20 years ago and one of my supervisors asked me to do audio recordings of my sessions.  This was done with the clients' permission.

Most clients had no problem with audio recordings and, in fact, they liked the idea that I would listen to these recordings after the sessions as a way to improve my clinical skills while I was in training.  It made clients feel cared about.

Although most clients were receptive to it, as a therapist in training back then, initially, I was self conscious about the audio recordings. But, after I few sessions, I liked listening to the recordings.  Similar to seeing myself online, I learned a lot back then from hearing myself when I played back the audio recording.

So, as technology evolves, it often provides therapists and clients with new tools and strategies for conducting therapy sessions.

Advantages of Doing Online Therapy
So far, these are the advantages I see with doing online therapy:
  • Continuity of care for existing clients so that therapy sessions don't have to end because of the current crisis
  • Convenience
    • Fewer cancelled appointments due to work schedule or other appointments that would make it more difficult for the client to come in person to my office.
    • Acessibility to people who have mobility problems or cannot come in person for another reason
    • Accessibility for existing and new clients who can't meet in person due to the current Coronavirus outbreak
  • Free to the client 
  • Easy to use

Getting Help: Online Therapy
It could be a while before therapists and clients can return to in-person sessions in the therapist's office, so if you need help because you feel overwhelmed, rather than trying to cope on your own, you can contact a psychotherapist who is providing online therapy (see my article: Grieving Losses and Healing During a Crisis).

By working with a licensed psychotherapist online during this time, you can get the help that you need and overcome the obstacles that are keeping you from thriving in your life.

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

I work with individual adults and couples.  

I use Emotionally Focused Therapy for Couples in couples sessions.

I am currently providing online therapy sessions for existing and new clients.

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.

Helping the Helpers to Overcome Compassion Fatigue and Burnout

Compassion fatigue and burnout are real challenges in the helping professions, which include psychotherapists, counselors, pastoral counselors, doctors, nurses, physicians assistants, social workers, hospice workers, and other professionals that are part of the healthcare and helping professions (see my articles: Managing Your Stress: What Are the Telltale Signs of Workplace Burnout? and The Consequences of Workplace Burnout).

Helping the Helpers to Overcome Compassion Fatigue and Burnout

Many people in these professions are so devoted to their patients and clients that they put themselves last in terms of getting the emotional support that they need.  They often don't engage in the kinds of self care activities that would help to calm, soothe and help them to feel replenished (see my article:  Self Care: Is Self Care Selfish?).

Even before the current crisis, historically, helping professionals often neglected themselves to serve others.  While this might appear to be noble, these professionals often need more emotional support than most other professionals because they're often containing the anxiety and emotional needs of the people they're helping, and their burnout rate is high.

What is Compassion Fatigue?
Compassion fatigue is emotional and physical exhaustion for those in the helping professions who deal with their patients' problems.  When an individual experiences compassion fatigue, they often withdraw emotionally from their patients because they're too exhausted to continue.

What Are the Symptoms of Compassion Fatigue?
Helping professionals often don't recognize the signs of their own compassion fatigue or burnout because they're so busy taking care of their patients.

The following is a list of symptoms for compassion fatigue:
  • Emotional exhaustion
  • Physical exhaustion
  • Insomnia 
  • Irritability
  • Anxiety
  • Depression
  • Apathy
  • Depersonalization: A state in which one's thoughts and emotions feel unreal
  • Feelings of shame and self contempt
  • Feelings that they're being treated unfairly
  • Poor job satisfaction
  • Chronic aches and pains, including headache, backache and muscle tension

Fictional Clincial Vignette: Helping the Helpers With Compassion Fatigue and Burnout
The following fictional vignette illustrates some of the typical problems experienced by helping professionals with compassion fatigue and burn.  It also addresses how psychotherapy, including online therapy, can help:

From the time Nan woke up in the morning until the time she went to bed, she was on the go.

When she woke up in the morning, she had about 10 minutes to herself before she got her children off to school, made her husband, Tom, breakfast, and sat down to a quick cup of black coffee before she headed off to the hospital where she was a nurse.

By lunchtime, she was starving, but there was so much to do that she often didn't take a lunch.  During the time that would have been her lunch hour, Nan spent time doing what she loved best--talking to the patients and their families. This was the part of her job that she derived the most satisfaction from, and she knew that the only way she could engage with patients and their families was to talk to them on her lunch hour because there was no time during the rest of the day.

Later on in the afternoon, she would grab an energy bar or a muffin rather than sitting down to lunch.  Some of her colleagues who had been there longer warned her that she was going to burnout if she tried to keep up this fast pace without taking a break, but she ignored them.  She thought of herself as being much more devoted to her profession than these other nurses who took lunch and their 15 minute breaks.

She often got home late.  Her husband would help the children with their homework because he got home first.  He also cooked their dinner and often sat down alone to eat his dinner because Nan often worked overtime.

By the time she got home, Nan was often too exhausted to eat.  She would take a few bites of her food, and then she was off to bed to wake up early in the morning and start the same routine over again.

On the weekends, Nan and her husband were too busy tending to the children and doing chores to pay much attention to each other.  Her husband often complained that their sex life was practically nonexistent, but Nan was usually too tired to think about sex.  She brushed off her husband's concerns and told him that she had no choice but to continue working the way she had been doing.

Nan had always wanted to be a nurse.  Both her mother and grandmother were nurses.  Nan was proud of them and she wanted to be like them.

Before she started her training, she imagined that she would sit with patients and talk with them as well as administering to their medical needs.  However, once she was in the profession, she quickly realized that her job was so fast paced and demanding that she had no time to chat with patients.  She was under so much stress that, even though she was a diligent nurse, she often feared that she would give the wrong medication to a patient because she was often frantically busy on the hospital floor.

When Nan was in her fifth year of nursing, her health began to break down.  She was having backaches, not only from lifting patients but from holding onto stress and not practicing any stress management techniques.

She was also getting debilitating headaches, and her husband urged her to take a day off to rest and recuperate from her busy schedule. But Nan knew her hospital was understaffed with nurses, and she didn't want to let down her patients or colleagues.

By her sixth year, Nan was showing physical and emotional signs of compassion fatigue and burnout.  Although she used to love her job, now she was often irritable and snappy with her patients and colleagues.  One day, she even snapped at her supervisor, who brought Nan into her office and recommended that Nan take time off because she feared that Nan was burning out.

Although Nan knew that she was physically and emotionally exhausted, she didn't want to take time off.  She felt there was just too much to do, so she apologized to her supervisor and went back to work.  But when she snapped at a patient's mother, the mother complained to the administration and Nan was given a verbal warning by her supervisor that if this or anything else like it occurred again, Nan would be written up, and if it continued to occur, she would be brought up on disciplinary charges.

Nan was upset with herself.  She knew better than to get into a verbal altercation with a patient's family member, but she was so tired that she didn't have the patience to speak calmly to this demanding relative.

When she got home that night, she was confronted by Tom, who told her that he wanted to talk to her after the children went to bed.  She told him that she was too exhausted to talk or to even eat, she had a very stressful day, and she was going to bed.  But Tom was adamant that they had to talk, so she took a nap for an hour and then got up after the children were in bed.

Since Nan had chronic insomnia by now, her hourlong nap did little to alleviate her exhaustion.  She felt resentful that her husband was insisting that they had to talk.  She wished he would just allow her to sleep and they could find time to talk in the morning.  But Nan also knew that there would be nothing different about the morning--she wouldn't have time to talk because she would be rushing around the house and, at the same time, trying to get ready to go to work.

So, wearily, she sat next to her husband on the couch and waited for him to begin talking. As she looked at him, she noticed his face looked strained.  Then, he looked like he was about to cry and  she got anxious, "Oh God.  What's wrong? Are you alright?"

"Nan," he began talking slowly, "I don't think I can take much more of this. We haven't been intimate in months.  We barely have time to talk. I don't want to leave you and the kids, but I'm so unhappy. Something needs to change."

Nan was shocked.  She felt her stomach lurch and the pain in her back intensified.  For a few seconds, she didn't know what to say, so Tom continued, "I want you to take time off.  You have so much sick and vacation time.  Let's plan a vacation just for the two of us.  We haven't gone away in years.  We'll leave the kids with my mother.  What do you say?"

Nan's first inclination was to say she didn't have time, but she knew now that Tom was seriously unhappy, and she didn't want him to leave.  After a few more seconds, she put her head back and closed her eyes.  Then, she could feel the tears coming and she couldn't hold back any more.

A few minutes later, Nan agreed that she couldn't keep up the pace and she knew she needed to take a break.  She knew her supervisor would be thrilled if she took time off from work, so she told Tom that he should pick out a destination and she would go.

Two weeks later, Nan and Tom were in Puerto Rico.  Although, initially, Nan felt uncomfortable and restless, by the third day, she was feeling more relaxed than she had felt in years and enoying her time off with Tom.  They rekindled their love life and enjoyed each other's company for the first time in a long time.  They also made a commitment to each other to go on vacation at least once a year.

By the time Nan got back, the first cases of COVID-19 began to pop up in New York City. Within a short period of time, she and her colleagues were inundated with Coronavirus cases, and Nan felt like she had never gone on vacation.

She felt herself becoming irritable and snappy again, and her supervisor saw the warning signs.  She recommended that Nan seek help through online therapy to deal with her emotional and physical exhaustion.  She also insisted, despite the shortages of nurses, that Nan stop working so many extra hours of overtime.

At first, Nan resisted the idea of online therapy because neither she nor anyone in her family had ever been to therapy before, and she resented being told to go.  But she also knew that both her marriage and her job were on the line, so she made an appointment for once a week online therapy, and after a couple of weeks, she was glad that she did.

Not only did she feel less physical and emotional strain, but she felt she was coping much better than most of her colleagues. She could feel that her therapist understood her and cared about her.  Her online therapist scheduled an appointment that was convenient for her and she could talk to the therapist from the privacy of her bedroom while Tom kept the children entertained.

Nan noticed that she was no longer having backaches and headaches.  She also learned to switch her attention to her husband and children once she got home rather than ruminating about work like she usually did.

Her therapist helped Nan to develop a self care routine, which Nan never had before.  She also taught Nan meditation and breathing techniques that she could use on her own (see my articles: Breathwork to Cope With Stress: The Square Breathing Technique and Learning to Relax: Going on an Internal Retreat).

Even though Nan was going through a stressful time at the hospital, she no longer felt burnt out.  In the evenings and weekends, she took time for herself first before she spent time with her husband and children, and this made her time with her husband and children more enjoyable.

Throughout the crisis, Nan continued to attend her online therapy sessions, and both she and her therapist agreed that once the crisis was over, she would make time to come into her therapist's office to do in-person therapy.  Her only regret was that she hadn't started online therapy earlier.

Compassion fatigue and burnout are real problems among helping professionals.

Often other people, like a supervisor or spouse, notice the problems first because the helping professional is usually dedicated and immersed in work.

Online therapy sessions are an alternative for helping professionals who are working long shifts and doing stressful work.  They are both convenient and an effective way to provide mental health services to busy professionals.

Getting Help in Therapy
Anyone can experience stress, burnout or compassion fatigue, including caregivers to children and elderly relatives (see my article: Self Care For Caregivers).

If you feel emotionally overwhelmed, contact a licensed psychotherapist who is providing telementalhealth services, rather than getting physically and emotionally exhausted.

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

I work with individual adults and couples and provide online therapy sessions during the COVID-19 crisis.

I provide Emotionally Focused Therapy (EFT) for 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.

Remembering Your Strengths as a Way to Cope With a Crisis

In a prior article, Grieving Losses and Healing During a Crisis, I discussed the grief and loss that most people are feeling during this  COVID-19 crisis.  To an extent, one of the losses that some people feel is a certain erosion of a sense of self confidence (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).  Remembering your strengths during a time of crisis can help you to get through the current crisis (see my article: A Strengths-Based Perspective in Psychotherapy).

Online Therapy: Remembering Your Strengths as a Way to Cope With a Crisis

Remembering Your Strengths That Helped You During Prior Crises
Remembering your strengths is an inner way of knowing yourself and believing in your own self efficacy.  Sometimes, this sense of self comes to you with memories of your thoughts, feelings and behavior during a prior crisis.

As an example, during the last few days, I've been remembering the survivor instinct I felt during the 9/11 World Trade Center attack.  My daytime office was on Rector Street off of West Street in Downtown Manhattan, just two blocks from where the South Tower stood.

I remember that I was in early that morning and there were only a few colleagues there when we felt our building suddenly sway as the lights went off and back on. It felt like something big hit our building, and we were all confused at first about what had just happened.

I had a radio in my office and turned it onto the news as a colleague stood in my office and we both listened. We heard that a plane had hit the World Trade Center. My first thought wasn't that this was a terrorist attack.  I had no frame of reference for that.  I actually thought that the pilot of the plane must have been sick or impaired in some way and lost control of the plane.  We had no details at that point, so I was picturing a small plane--not a jumbo jet.

Then, I remember that we saw many pieces of paper that were torn and burnt floating in the air outside our windows, and it all felt very strange and surreal.  Soon after that, we heard the sirens of the fire engines and police cars.

Even though this was 19 years ago, the part of the memory that is most vivid for me is after we found out that the World Trade Center had been attacked and, after the second plane attacked the World rade Center, we were advised by our managers that the mayor said we should evacuate the building and walk north away from Downtown Manhattan.

I remember walking with two colleagues from our building and momentarily standing on the corner of Rector and West and looking at the South Tower. There was a jagged line of fire on the upper floors of the tower.  There were also many people around us who were standing there watching in disbelief.  But my immediate thought was, "We need to get out of here.  That building could fall."

I wasn't thinking the building would collapse in a pancake way, as it did.  I was actually thinking the top of building with the jagged line of fire could fall off and tumble down onto the street on top of us.
At the time, from our perspective, it looked like a real possibility.

Even though I was just as curious, if not more curious, as everyone else who was standing there looking at the South Tower, I had an overriding sense that we had to save ourselves in that moment and we should continue to walk north.

In times of crisis and during traumatic events, there can be a narrowing of the senses to deal with the immediate moment and one's own self preservation.  Many people have described this narrowing of the senses, especially a narrowing of vision, as if they had blinders on, that keeps them focused on what they need to do next.  And the usefulness of this survival strategy is obvious--it keeps you focused on what's most important: Staying alive.

It's difficult to describe what that narrowing of focus feels like if you haven't experienced it before.  The way that I experienced it was that any other extraneous thoughts and feelings fell far away, as if my colleagues and I were single-mindedly on a mission to walk north.

We eventually walked to the South Street Seaport. Fom there, after the collapse of the first tower, which shook the seaport, when it was safe to keep going, we headed to a colleague's husband's office, which was a media company.  It was there that we saw vivid images on giant screens on the wall of what had actually happened earlier that day.

Until then, we had little information.  We had heard that there might have been another plane with terrorists who were about to attack. So, we were confronted with this tragic news and had to figure out our next steps: Could we make it home safely? If there was another plane about to attack, was it safe enough to walk over the bridge or to take one the subway trains that were still running?

When I think about my own sense of self during that time, even though I was afraid and confused about what was happening, I had this inner sense that I had to stay focused and that I was going to survive.  That's the best way I could describe it.  I don't know where it came from, but it felt like a very deep and determined part of myself that emerged during this crisis. And, of course, my inner sense of knowing was right--I did survive.

Our work group was displaced for several weeks in a cramped conference room that belonged to another company.  Even though the conference room was cramped, we each worked at gathering information so that, as clinical social workers, we could provide important information to our clients, like: how to stay calm in a crisis, different ways to engage in self care or how to talk to children about the World Trade Center attack.  Soon after that, we were each conducting groups for employees all over New York City.

Even though I had my own concerns, I remember feeling like I was on a mission and staying focused on what needed to be done.  It felt good to be useful and provide some comfort to others.  While I was doing this, for the most part, I forgot about my own concerns and focused on our clients. Of course, there was plenty of time at night when things were quiet for my own concerns to emerge.  But while I was helping others and feeling useful, I was focused on what I needed to do.

When you think back to prior times when you went through a crisis, even if you were confused and frightened or you wish you had behaved differently, you can now look back and put your thoughts, emotions and behavior in perspective: The prior crisis had a beginning, a middle and an end, and you can now look back on it and realize that you survived.

Remembering that you survived and that the experience is in the past is an important part of the memory, especially during the current crisis where time can feel distorted. For instance, many people have said that the week or so that just passed feels more like a month or more.

I suspect that this distortion in time and space is occurring because the mind is still trying to rap itself around the magnitude of the worldwide effect of COVID-19.  Also, even though experts are making projections, we don't know when it will end.  We just know that it will end one day and we will look back on our experiences one day as a memory.

People With a History of Trauma Often Forget Their Inner Strengths
Many people who have a history of trauma, especially complex trauma where the trauma occurred early and on an ongoing basis, can lose their perspective even after the trauma is over (see my article: Reacting to the Present Based on Your Traumatic Experiences From the Past).

The trauma was so profound for them that when they have a new traumatic experience, the old trauma gets triggered and it becomes difficult to distinguish feelings from the past from feelings in the present.

As a trauma therapist, when I work with a client who has developmental trauma, which is trauma that occurred over time in childhood, aside from helping clients to process the past, present and their fears about the future, I help them to distinguish "then" from "now" (see my article: Working Through Psychological Trauma: Learning to Separate "Now" From "Then").

These individuals often lose their perspective of the present and have a hard time sorting out past and current feelings.  If it becomes overwhelming for them, I help them to distinguish "now" from "then."

So for instance, I might ask them how they're different now as compared to back in their childhood when they experienced the trauma.  Or, if they're stuck, I'll help them by reminding them that, as children they were powerless to stop the trauma, but I remind them that now, as adults, they now have inner resources and capabilities that they didn't have back then, and I'll list these skills and capabilities if they're unable to do so themselves.

I'll remind them that, as compared to back then when they were children, now, as adults, they can defend themselves or choose to walk away from situations that are hurtful and harmful to them.

Of course, on some level, these are things that they know logically when they're feeling less anxious, but they might not feel it on an emotional level when anxiety overtakes them.  When they're upset, people who are traumatized sometimes forget that they're not powerless any more like they were as children.

When they're reminded that what happened to them was in the past and that they're much more powerful and capable now, they get a sense of relief and feel more empowered.  Then, I work with them to strengthen these feelings of being empowered.

For some people, especially people who come to therapy for a trauma that involved a single incident, like an incident of getting robbed or attacked, trauma therapy, like EMDR therapy, can help resolve the trauma relatively quickly (approximately, 10-12 sessions or so).  These are cases where there are no underlying developmental trauma that gets triggered.

This type of single incident trauma is often referred to as shock trauma, and it's less complex than trauma that occurred over a period of time in childhood, known as developmental trauma (see my article: The Difference Between Shock Trauma and Developmental Trauma).

However, the majority of clients who come to therapy have developmental trauma or they have shock trauma with underlying developmental trauma as part of their history, which is more complicated.

The reason why most clients who come to therapy have developmental trauma, as opposed to single incident, might be because single-events of trauma (or shock trauma) can sometimes resolve itself without a clinical intervention.

For instance, if people who are in a car accident are often initially afraid to drive to the area where the accident occurred.  However, many people are eventually able to get back in their car and drive each day passed that spot, even though they're anxious.

If they can do that, they're learning to desensitize themselves to their traumatic experience.  So, even though their initial reaction is one of fear, over time, they overcome their fear through repeated experiences of going to that spot and and having the experience of "I'm okay now."

Developmental trauma rarely if ever resolves on its own.  To resolve this type of trauma, someone needs to work through these experiences with a trauma therapist who uses specific types of trauma therapy that have been proven to be effective.

Experiential therapy, like EMDR, helps to resolve developmental trauma.  Even though the length of time is longer than it would be for shock trauma, the good news is that, generally speaking, EMDR (or any experiential therapy) is shorter and more effective than regular talk therapy (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Getting Help in Therapy
Remembering your strengths to cope with a current crisis can be challenging when the crisis is as unprecendented as the current COVID-19 crisis.

Healing usually occurs on a dyadic level, which means on a one-on-one level with an experienced clinician, rather than by yourself.  So, if you're feeling overwhelmed, you're not alone.  Help is available to you.

Many psychotherapists, like me, are conducting therapy sessions online to make sessions accessible to clients.

Rather than suffering on your own, if you feel overwhelmed, get help from a licensed psychotherapist who can help you to get through this difficult time.

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

For couples work, I use Emotionally Focused Therapy, a well-researched and effective form of couples therapy.

I'm currently providing confidential online therapy sessions.

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.

Friday, March 27, 2020

Undoing Aloneness: Staying Socially Connected Even Though We're Physically Disconnected

Health experts have stressed the importance of remaining physically distant from each other by at least 6 feet during the COVID-19 crisis, but this doesn't mean that we can't find ways to be socially connected in other ways.  In fact, due to our need for meaningful connections with others, our overall health and psychological well-being depend on us being able to form these connections with our loved ones.  As part of my effort to undoing aloneness with my clients, I'm doing online therapy sessions (see my article: Emotional Support During the COVID-19 Crisis).

Online Therapy Sessions: Undoing Aloneness During the COVID-19 Crisis 

Expriential Therapy vs. Traditional Psychotherapy
AEDP, which was developed by Diana Fosha, Ph.D., stands for Accelerated Experiential Dynamic Psychotherapy, emphasizes the importance of "undoing aloneness" as part of healing trauma.

As a trauma therapist, I know that psychological trauma isn't just about a traumatic event or series of events that occurred.

What often makes traumatic events harmful is that the individual who experienced the trauma often went through it alone (see my article: Experiential Therapy and the Mind-Body Connection). 

In AEDP, the experience of going through a traumatic event feeling emotionally alone is often referred to as "unbearable aloneness." This doesn't mean that there weren't other people around at the time.

There might have been family members or other loved ones around during traumatic events, but the person who experienced the trauma often felt alone, misunderstood, emotionally invalidated or "invisible" to others (see my article: Growing Up Feeling Invisible and Emotionally Invalidated)

So, as an experiential therapist who uses AEDP, EMDR therapy, clinical hypnosis and Somatic Experiencing, I strive to be a supportive and an interactive presence with my clients so they feel that I'm resonating with them in their therapy sessions in a meaningful way (see my article: Experietial Therapy: Why Having Insight and an Understanding of Your Problems Isn't Enough).

The old tradtional way of working with clients where therapists were expected to be "abstinent and neutral" in their engagement with clients doesn't work.  This is especially true for clients who have experienced traumatic events.

Since they usually went through their traumatic experiences feeling alone, unheard and unseen, it's crucial that they don't experience a replication of these experiences in their therapy.

Experiential therapy tends to be a "bottom up" therapy vs. traditional talk therapy, which tends to be a "top down" therapy (see my article: Experiential Therapy: What's the Difference Between Top Down and Bottom Up Therapy?

Experiential therapists not only convey a positive regard for clients--they also try to resonate with clients and let the clients know that they're there for them in ways that clients have a "felt sense" of in their sessions.  In other words, clients, who have experiential therapists, usually feel their therapist's caring and positive feelings towards them.

For many clients, who experienced more traditional forms of therapy, this might be a new experience.  However, most of them find it a welcome experience where they no longer feel isolated in their emotional pain.

As I mentioned earlier, since in-person therapy sessions aren't possible during the COVID-19 crisis, I am now providing online therapy sessions on Zoom on a confidential platform.  Athough we cannot be in the same room together, we can still feel connected with each other online, and many clients have expressed that they're surprised at just how connected they feel in their online sessions.

What Can You Do to Achieve Physical Isolation and Social Connection?
Being physically distant from your loved ones can be very challenging, especially if you live alone.

I prefer the term "physical isolation" rather than "social isolation."  I find the term "social isolation" to be somewhat of a misnomer in terms of what's possible during this time.

Whether you connect via online services like Zoom, Skype, Facetime or other online platforms, being able to see and connect with your friends and loved ones can make all the difference in undoing your feelings of aloneness.

Some people are organizing book club meetings, comedy groups, improv groups, storytelling events or other social events online to create a feeling of community and a feelng of connectedness, which is so important now.

If you don't have access to online services, phone calls are the next best thing.  Last night I received a call from a relative that I haven't spoken with in a while.  As soon as I heard her voice, I felt myself transported back to our times together when we were children.  And, despite the current crisis, we were able to talk and laugh about some our memories together.

Just knowing that she was thinking about me and cared enough to call really made me feel loved and cared about in a special way, especially since we share a family history that goes back to when we were children.  This is a special relationship, and I was glad to hear that she and the rest of the family there are all doing well.

I've also maintained contact by phone and online services with friends and colleagues and this has made a difference in undoing the aloneness of this time.

Getting Help in Therapy
During this crisis, as I mentioned, I'm providing online sessions through Zoom.

If you're feeling overwhelmed, rather than trying to get through it by yourself, you can contact a licensed psychotherapist who is providing online services.

Your overall health and psychological well-being can be negatively affected during this time, so reach out for help from a licensed mental health practitioner sooner rather than later.  You'll be glad that you did.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing therapist (see my article: 

I work with individual adults and couples (EFT couple therapy).

I'm currently providing online sessions during the current COVID-19 crisis.

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.

Wednesday, March 25, 2020

Grieving Losses and Healing During a Crisis

Much has been written about coping, staying calm, lifting one's spirits, performing acts of kindness, and getting emotional support during the current crisis, including articles that I've written for this blog (see my articles: Coping and Staying Calm During the COVID-19 CrisisCoping With Loneliness and IsolationResilience: Accepting Your Negative Emotions During a CrisisThe Powerful Impact of Kindness and The Importance of Getting Emotional Support During Difficult Times).  However, when you're ready, there's also a need to grieve the losses involved with the current pandemic in order to heal.

Grieving Losses and Healing During a Crisis

There is no one way, right way, or right time to grieve.  Each person's grieving process is different, so don't judge yourself or anyone else if you're not ready to grieve yet.  It's still early days in the current crisis.

Many people need to focus on lifting their spirits at this point in time because if they allow themselves to grieve, it's too overwhelming for them.  So, you need to know yourself and your particular needs at any given and act accordingly.

Grieving the Losses Related to the Current Crisis
People normally think of grieving as feeling a deep sorrow for the death of a loved one, including pets.  But, aside from death, we can also feel grief for other losses.

Grief For Losses
The following is a list of losses that many people experience at one time or another, which are unrelated to the death of a loved one:
  • Loss of one's usual sense of self
  • Loss of a sense of security
  • Loss of social contact due to physical isolation
  • Loss of a job 
  • Breakup of a relationship
  • Loss of a friendship
  • Rupture or problems in a relationship with a loved one that threaten the relationship
  • Empty nest syndrome (see my article: Coping With the Empty Nest Syndrome)
  • Loss of income
  • Change in a daily or weekly routine 
  • End of college and loss of place and the relationships formed in college
  • Termination process in therapy/end of therapy sessions
  • Loss of freedom
  • Loss of autonomy
  • Health problem that changes your life
  • Loss of a body part
  • Loss of activities or events that bring pleasure (e.g., sports and other forms of entertainment)
And so on.

When you look at the items on the list, many of them might apply to your situation during this current health crisis.

A Loss of a Sense of Self
The loss of your sense of self often involves the way you see yourself. You might see yourself as having multiple identities (e.g., a mother, a sister, an executive, etc) and some identities might be stronger for you than others.

For instance, if your sense of self is tied to your job and you can no longer work, this is a loss of a sense of self.  Or, if you identify yourself as someone who is always "productive," but now you have little or nothing to do that brings you satisfaction, this is also a loss of your sense of self (more about this in a future article).

A Loss of a Sense of Security
The loss of a sense of security is similar to how many people in the US, especially New York City, felt after 9/11 terrorist attack on the World Trade Center.  Due to the unprecedented nature of the current crisis, most people wouldn't have expected this type of crisis, which threatens our health and sense of security.

A Loss of Income
Many people are having either a temporary or permanent loss in income if their place of business is closed.  Many people's daily or weekly routines have been upended, and activities or events that would normally bring pleasure, like live sports events, movies or concerts, are no longer available to them.

Loss of Social Contact Due to Physical Isolation
People who stay home and cannot see loved ones or colleagues are experiencing a social loss.  These are relationships that people often depend on for pleasure and support.  Adult children are also worried about their older parents or grandparents whom they cannot see in person.  This can result in loneliness for everyone involved.

Loss of Freedom
Other people organize their schedule around going to the gym, which brings enjoyment and stress management as well as social relationships with other staff or gym members.  In addition, in most states, people are being told to stay inside, except to go to the food store, pharmacy or bank, so there has been, of necessity, a loss of freedom.

The Damage Related to Ignoring Emotions Related to Your Losses
Eventually, these losses need to be acknowledged and grieved in order for people to move on and heal.  When losses aren't grieved, the losses can develop into complicated losses or lingering losses that are ignored on a conscious level but continue to affect people on an unconscious level.

If you ignore your emotions related to your losses indefinitely, you might experience your losses on a physical level.

You might get headaches, backaches, insomnia, and so on because, even though you're able to keep the thoughts and feelings from bothering you on a conscous level, on an unconscious level, due to the connection between the mind and the body, your body might register these losses in a painful way.

You might not even make the connection between what you're experiencing physically and your unresolved grief.

The Five Stages of Grief
As you might already know, there are five stages of grief.  To discuss them as stages can be somewhat misleading because these stages don't usually occur as a linear process.  You don't necessarily go through the stages in a particular order and you'll probably revisit certain stages more than once or the stages might overlap.

The five stages of grief include:
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance 
Current Losses Can Trigger Emotions About Prior Losses
It's not unusual for current losses to trigger emotions about earlier losses, especially if those losses haven't been worked through and remain unresolved.

Recognize that if you're having an unusually intense reaction to your current losses, you might be experiencing the stirring up and triggering of these other unresolved losses.

Most therapists who practice experiential therapy usually check for memories of earlier losses that might be feeding into your current emotions.

In clinical hypnosis, this type of checking back is called an Affect Bridge.

In EMDR therapy, much of which was derived from clinical hypnosis, the checking back is called a Float Back.

Future Articles About Grieving Losses to Heal During the Current Crisis
In future articles, I'll elaborate on the issues raised in this article and discuss how these stages might relate to the losses involved in the current health crisis and how to grieve for these losses when you're ready.

In the meantime, even if you're not ready to grieve, recognize that part of what you're feeling with regard to these losses is grief, and what you're feeling is a common response to loss.

Getting Help in Therapy
Grieving for your losses can be difficult to do on your own.

Rather than ignoring your grief, you can work with a licensed psychotherapist who has experience helping clients to work through these issues so you can heal in a shorter period of time.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP , Somatic Experiencing therapist and Emotionally Focused Therapy (EFT) for Couples  (see my article: The Therapeutic Benefits of Integrative).

I work with individual adults and couples.

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

During the current crisis, I'm providing phone and online video sessions.

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

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

Tuesday, March 24, 2020

The Importance of Getting Emotional Support During a Crisis

We all need emotional support at some point in our lives.  This is especially true during a crisis when fear and anxiety can be overwhelming. So, it's important to seek emotional support to help you get through a crisis (see my articles: Coping and Staying Calm During the COVID-19 CrisisCoping with Loneliness and Isolation, The Powerful Impact of Kindness and Self Compassion: Loving Yourself--Even in the Places Where You Feel Broken).

The Importance of Getting Emotional Support During a Crisis

Feelings of Shame and Embarrassment Can Create an Obstacle to Asking for Emotional Support
Too often people think that they're "supposed to" manage their own fear and anxiety on their own, and they feel ashamed to ask for help (see my article: Fear and Shame Can Be an Obstacle to Asking For Help and Overcoming Your Fear of Asking For Help).

This is especially true for individuals who lived through traumatic chilhood events where they had no emotional support.  Miraculously, most of them learned as children how to fend for themselves as best as they could--but at a serious cost to their psychological well-being.

In many cases, not only were these individuals unable to get the nurturance that they needed, but they were often involved in a role reversal where they were expected to be the emotional support for their parents (see my articles: Children's Roles in Dysfunctional Families).

Being able to overcome your shame and discomfort of asking for emotional support can be challenging.  People who are afraid to ask for support anticipate being criticized and rejected for their emotional needs because they were often shamed by the adults in their life for needing love and support when they were younger. (see my article: Overcoming Your Discomfort With Asking For Help).

These children often grow up to be adults who feel that they're a burden if they ask for help.  So, they try to go it alone, which only exacerbates their fear, anxiety and loneliness (see my article: Adults Who Experienced Trauma in Childhood: Living in the Present As If It Was the Past).

We Are Hardwired For Attachment and Emotional Connection 
The truth is that we are all hardwired for attachment and emotional connection from birth.  It is one of the most basic needs mammals have.

In fact, infants who are only fed and changed without nurturing and touch either don't survive or, even if they survive physically, their brain development is compromised. They need nurturing and mirroring from their primary caregiver for brain development, especially the right side of the brain, which develops first and is primarily where emotional development occurs (see my article: How Early Attachment Bonds Affect Adults Later On).

So, in addition to understanding that feeling loved and cared about is a basic need to survive and thrive, we also know that this need doesn't end when you become an adult.  We continue to need nurturance and emotional support our whole life.

Psychotherapists Develop Their Own Emotional Support Groups
People who provide emotional support to others, like psychotherapists, also need their own emotional support system because we are the "containers" for other people's fear, anxiety and grief, so it's important for us to have emotional support.

I'm fortunate to be in a group of peer clinicians who have been meeting for about 16 years.

Originally, the purpose of the group was to share information, including methods and tools learned in conferences and workshops, about mind-body oriented psychotherapy, which is also known as experiential psychotherapy (see my articles: Experiential Therapy and the Mind-Body Connection).

Over time, as we got to know each other better, we also became a source of support for each other in doing clinical work with clients and in times of crisis.  And, eventually, in addition to being a peer support group, we became good friends.

Since the latest crisis developed, we are in regular contact with one another, even though some of the group members have moved out of New York City.  We have been meeting on online video platforms and talking over the phone about once or twice a week to sustain ourselves through this difficult time.  I can tell you that it has made a tremendous difference for me.

When I was in graduate school and even in my four year fellowship/postgraduate training, I don't remember any of my instructors talking about the importance of having a support system outside the clinical setting. That was more than 20 years ago, and I hope that graduate and postgraduate programs are now encouraging therapists-in-training to develop emotional support systems.

Of course, we had supervisors, advisors, mentors and our own required three-time-a week psychoanalysis as part of postgraduate training.  They were tremendously helpful, but I quickly realized back then that I would need a peer group as well, especially during the first couple of years of the fellowship.  That period of time was particularly stressful because most of us felt we were having a "fish bowl" experience in our training where we were being observed as therapist- in-training.

I was fortunate that there were three other clinicians who felt the same way, and we had a lot in common other than our training.  So, we would often meet for coffee or brunch for mutual support and also just to have fun.

Any therapist who tries to go it alone, especially a therapist in a solo practice, usually burns out pretty quickly doing this work.  So, I always recommend to new therapists in the field to develop a support network.

Resources For Emotional Support
I realized that not everyone is fortunate enough to have close friends or nurturing family members to call upon in a crisis, so I'm providing the following resources for anyone who might need them:
  • National Suicide Hotline: 1-800-273-8255
  • Disaster Stress Hotline:  1-800-985-5990
  • National Domestic Violence Hotline: 1-800-799-7233
  • NAMI HelpLine: 1-800-NAMI (6264): Available Monday-Friday between 10 AM-6 PM EST
If you're feeling suicidal and you are in imminent danger of hurting yourself, call 911 immediately.

Getting Help in Therapy
You're not alone.  If you feel overwhelmed, you can seek help in individual therapy.

During this time when we are urged to stay home, many psychotherapists are doing phone and online video sessions.

Working with a licensed psychotherapist can make all the difference in getting through times of crisis and beyond.

Rather than trying to go it alone, you could benefit from working with an experienced psychotherapist who can help you develop the skills and tools that you need to stay calm and cope.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP , Somatic Experiencing therapist and Emotionally Focused Therapy (EFT) for Couples  (see my articles: The Therapeutic Benefits of Integrative Psychotherapy and What's the Difference Between "Top Down" and "Bottom Up" Approaches to Therapy?).

I works with individual adults and couples.

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

I am trained and experienced in trauma therapy.

During the current crisis, I'm providing phone and online video sessions.

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.