NYC Psychotherapist Blog

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Tuesday, June 30, 2020

Developing Self Compassion as an Essential Part of Trauma Recovery

Learning to develop self compassion is an essential part of overcoming emotional trauma.  At the same time, it can be challenging for most adults who experienced childhood trauma to feel self compassion because part of the trauma involved developing a harsh, critical attitude towards themselves (see my article: Self Compassion: Loving Yourself in the Places Where You Feel Broken).

Often, these are individuals who found themselves in impossible situations where they had to function as adults even though they were young children. These situations include children who were in a role reversal situation at home where they took on the role of being the "parent" in a dysfunctional family. The term for this role is a "parentified child" (see my article: Children's Roles in Dysfunctional Families).

Self Compassion as a Part of Trauma Recovery

Many of these individuals have childhood stories of making heroic efforts at home to take care of their parents and siblings despite formidable odds.  Anyone who heard these stories would feel an outpouring of compassion for these people, and yet, these individuals are often hypercritical of themselves for "not doing enough" for their families.

These feelings of either "not doing enough" or, worse, "not being enough" often develops early in childhood and continues through adulthood.  These feelings often permeate their relationships, including their romantic relationships, friendships and work relationships (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

These same individuals often feel a lot of compassion for others who had similar experiences as children, but they struggle to give themselves even one iota of compassion.  When they begin therapy, they might see the incongruity of this logically but, on an emotional level, they struggle when they attempt to feel compassion for themselves.

Clinical Vignette: A Traumatized Adult's Struggle to Feel Self Compassion
The following fictional vignette is a typical scenario of an individual's initial struggle in therapy to feel self compassion and how I use trauma therapy to help the client:

Initially, when Nina sought help in therapy she said the presenting problem was, "I have low self esteem." Although she was aware of her feelings of low self worth, she didn't see how harsh and critical she was of herself.

Since she wasn't aware of her inner critic, she was also unaware of the relationship between the inner critic and her feelings of low self worth and how this dynamic was connected to her traumatic experiences in childhood (see my article: Overcoming the Internal Critic).

Her self criticism extended to her inability to overcome her low self esteem. She felt that, as an adult, "I should be able to pull myself up by my bootstraps" (an expression her father often used when Nina was a child) to overcome her low self esteem. In fact, there was hardly an area in her life where she didn't experience herself as "weak."

As a trauma therapist, I'm aware that this inner critic can pose a significant challenge in trauma recovery and needs to be approached with care so traumatized clients don't leave therapy prematurely to protect this critical aspect of themselves (see my article: When Clients Leave Therapy Prematurely).  

You might wonder why someone would feel so protective of an internal part that is causing them so much emotional pain. Looking at this situation on the surface, logically, it might seem that they would want to overcome the internal critic.  

But, on an emotional level, it's important to understand that the internal critic was part of their survival strategy as children.  Even though the internal critic was harsh, it also pushed them to overcome obstacles as children.  Without the internal critic as a defensive strategy, these individuals would have fared much worse in their childhood homes (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

Getting back to Nina's story: When asked about her childhood, Nina recounted how, as a young child, she pushed herself (through her internal critic) to keep the household going. As the oldest of four children, she took on a parentified role with her parents and siblings. 

At the age of 10, not only did she get alcoholic father up and out in the morning so he could get to work on time, but she also made breakfast for the whole family (while her depressed mother stayed in bed) and got her younger siblings dressed and took them to school.

As she talked about this time in her life, Nina said she often said to herself, "You'd better get dad up because if you don't no one else will and then he'll lose his job and we'll all starve" or "You have to get your brothers and sisters to school everyday or the school might contact the authorities and then we'll all be taking away from mom and dad."

During the initial part of therapy, Nina believed it was her responsibility, as a child, to take on the role of her parents because neither of them could function as parents. And, even though she was correct that there was no one else to help and the family would have fallen apart if she didn't take on this role, she didn't see the high price she paid in doing it.

Initially, as Nina talked about her childhood best friend, Anna, who was in similar role as a child, Nina expressed enormous love and compassion for Anna for the challenges she faced in her childhood. She understood that Anna functioned above the capacity of most children and that Anna sacrificed their childhood to do so.  

During the initial stage of therapy, when I tactfully tried to point out her compassion for Anna as compared to her lack of compassion for herself, Nina would shut down emotionally.

Her protective feelings towards her inner critic were so strong that she couldn't see the similarity between her childhood experience and Anna's.  It was as if her internal critic was her savior, and she couldn't tolerate being open and curious about it.

So, as Nina developed more of an awareness of her inner critic, I talked to Nina about the important function that her inner critic served when she was a child.  Nina agreed and told me, "That part of me pushed me to keep the family going, to do well at school and to do whatever was necessary to keep the household going. If I didn't have that part of me, I think I would have fallen apart and then my family would have fallen apart.  I couldn't allow that."

Over time, Nina felt safe enough in therapy to begin to go beyond appreciating the useful function that her internal critic served so that she was able to take small steps to explore the negative impact this internal part had on childhood, "I was often so exhausted. I could barely keep my eyes open in school. I see now how this part pushed me relentlessly and why it was so exhausting."

This realization didn't come like a lighting bolt. Instead, it evolved gradually over time as Nina saw that I appreciated the internal critic as the only survival strategy that she had as a child.  And, even as this initial realization developed, Nina was often quick to defend this part.  

Gradually, as Nina seemed ready for it, I helped her to tolerate seeing both the "good and the bad," as she put it, with regard to her internal critic.  This was a major breakthrough for Nina because, before this, she was only able to tolerate seeing the positive aspects of her internal critic rather than seeing the whole picture.

As we developed a positive therapeutic relationship, Nina felt safe enough with me to explore the more tender feelings that she had suppressed as a child so that she could take on an adult role.  She began to feel a sense of compassion for her younger self and, over time, she mourned for her lost childhood.

Parts work, which is also called Ego States therapy or Internal Family Systems (IFS), was helpful in allowing Nina to open up to those suppressed tender feelings.  By then, she had developed the emotional wherewithal to tolerate exploring the loneliness and emotional neglect she experienced as a child, and she allowed herself to grieve.

As Nina looked at her younger self, she began to feel a sense of love and compassion for that part of herself. During parts work in therapy, she was able to have a dialogue between her adult self and her child self where the child self was finally able to ask for what she needed and the adult self was protective of the younger self and helped to soothe her.  

This was an important turning point in therapy because as her adult self expressed compassion and love for her child self, the role of Nina's inner critic diminished.  Rather than pushing herself with harsh, critical messages, Nina nurtured her younger self in ways that she was never nurtured as a child.

At that point in therapy, I provided Nina with psychoeducation about EMDR (Eye Movement Desensitization and Reprocessing) therapy as a trauma therapy (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

After learning about EMDR therapy, Nina agreed to try it with me.  The work was neither quick nor easy, but EMDR therapy, along with parts work, helped Nina to work through her traumatic experiences.

By the time Nina completed trauma therapy, she was a much more psychologically integrated person.  Her traumatic experiences no longer had a negative impact on her life.  She experienced self compassion. And, in addition, she was able to form a healthy relationship with a man she began dating, and her friendships grew and deepened.

Self compassion is often sorely missing for individuals who grew up with childhood trauma. Although they might feel compassion for others in similar situations, they have difficulty feeling self compassion.  

A harsh inner critic is often part of a maladaptive survival strategy for people who experience trauma.

If the therapist doesn't appreciate role of the inner critic in terms of the client's survival, the therapist risks alienating the client and the client leaving therapy prematurely as a way to protect that part.

Before the negative impact of the inner critic can even be broached, the therapist needs to establish a strong therapeutic alliance with the client for the client to feel safe enough to explore the negative aspect of the inner critic (see article: The Creation of the Holding Environment in Therapy).

Parts work, also known as Ego States work or IFS, is helpful for clients to begin to see that their internal world is made up of many different aspects, including an internal critic.

When clients can begin to feel compassionate and nurturing feelings for the younger self, the internal critic often begins to soften and diminish.

EMDR therapy, which is a trauma therapy, helps traumatized clients to reprocess and reconsolidate their traumatic memories so that these memories no longer have a negative impact on them.  

Getting Help in Therapy
It's often difficult for traumatized individuals to seek help in therapy because many of them weren't able to form loving, trusting relationships in their family, so they're reluctant to reveal the more vulnerable parts of themselves to a therapist.

Finding a therapist that you feel comfortable with is essential. It might take a while before you feel comfortable enough to reveal the more tender parts of yourself, but most people get at least a sense of whether they feel a connection with a therapist during the first few sessions.

If you're feeling overwhelmed by unresolved trauma, you're not alone. Trauma therapy can help you to work through traumatic experiences so that these experiences no longer create obstacles for you, and you can live a more fulfilling life.

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

I work with individual adults and couples.

One of my specialties is helping clients to recover from trauma (see my article: What is a Trauma Therapist?).

During the COVID-19 pandemic, I am providing teletherapy, which is also known as online therapy, telehealth or telemental health.

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, June 26, 2020

Making and Receiving Loving Gestures to Repair an Argument

In his book, The Seven Principles For Making a Marriage Work, relationship expert John Gottman discusses what works in successful relationships and what ruins relationships (see my article: Are You a Stonewaller?). Being able to make and receive loving reparative gestures is an important part of successful relationships (see my article: The Challenge of Preventing Small Arguments From Becoming Major Conflicts in Your Relationship).

Making and Receiving Loving Reparative Gestures in Your Relationship

As John Gottman describes it, when both people in a relationship can make and receive sincere and genuine gestures as a way to repair an argument, it can make all the difference in the relationship.

What I'm referring to in this article is common arguments that spouses often have.  I'm not referring to ongoing abusive behavior.

Also, Gottman emphasizes that when there is a dynamic of contempt between spouses, this is one of the most destructive aspects of a relationship and often ends in divorce.

Clinical Vignettes: Responding to Your Spouse's Loving Reparative Gestures
The following vignettes illustrate the difference between spouses who are able to give and receive reparative gestures and spouses who are unable to do it.  These fictional vignettes aren't about any one particular couple. Instead, they are common dynamics seen in many relationships.

Vignette 1: Tom and Betty
Tom and Betty were married for two years. When Tom came home from work, he often needed time to himself. Not only did he have a stressful job, but his long commute made him feel tense and irritable.  By the time Tom came home, he wanted 15 minutes to himself before he was ready to interact with his wife. But when he got home, he experienced Betty as nagging him about household things that weren't pressing. Although he told her many times that he needed time to himself, he felt that she ignored his need by bombarding him with demands the minute he walked through the door.  

One day, when Tom came home from a particularly difficult day at work, he snapped at Betty when she berated him for making demands of him about household chores rather than allowing him to have time to himself. After he snapped at Betty, he went into the bedroom to compose himself and let go of the tension of the day.  Then, when he felt calmer, he approached Betty in the living room to apologize.  He sat next to her and, as he apologized for his behavior, he touched her shoulder in a loving gesture as a way to repair things between them.  But Betty pulled away from him and said, "I don't like the way you spoke to me, and apologizing doesn't change anything." 

Over the course of the next few days, Tom approached Betty several times to try to repair things between them, but Betty refused to accept his apology. Instead, she responded to him with contempt. These interactions between them were emblematic of the dynamics in their relationship. Betty was unable to let go of her hurt and anger and she refused to take in Tom's loving gestures to make amends with her. She also turned down Tom's pleas to go to couples therapy. After another year of this, Tom decided that he didn't want to be in a marriage where arguments couldn't be repaired and he felt Betty's contempt. So, he told Betty that he no longer wanted to be in the marriage and, within six months, they were divorced.

Vignette 2: Alice and John
Alice and John were married for two years.  This was the second marriage for both of them. Sometimes they had common arguments about household chores. Alice tended to like the household to be neat and John had more of a tolerance for messiness. They each learned to make compromises in this area. But one day when Alice felt particularly frustrated to find dirty dishes in the sink again, she confronted John in a harsh way, "Why are you such a slob!?!" 

When she saw the hurt look on John's face, Alice knew she had gone too far, but she wasn't ready to apologize yet. She went for a walk to try to calm down, and she realized that her reaction was out of proportion to the situation and that she had displaced some of her anger about her workday onto John. When she returned from her walk, Alice felt a lot calmer.  She approached John, who was sitting on the couch reading a book.  As she sat next to him, she took his hand in hers, looked into his eyes and said, "I'm sorry I overreacted about the dishes. I shouldn't have called you a slob. I realized while I was out walking that I allowed my frustration about work to affect my response to you. I'm sorry."  

John smiled at Alice and put his arm around her, "Yeah, it made me feel bad, but I also knew that you didn't really mean it. I know that I can do a better job of cleaning up after myself and I'll try to do better from now on." After that, they each let go of their annoyance. They watched a movie together holding each other and later that night they made love. Similarly, John was able to apologize for things he said that he regretted, and Alice was able to accept John's apologies.  They were each able to let go of their anger to work things out in their relationship. Over time, their love for each other grew and they felt closer to one another.

Discussion About the Two Vignettes
In Vignette 1, Tom made attempts to make amends with Betty, but Betty was unwilling to let go of her anger to accept Tom's gestures for repair. Not only did Betty ignore Tom's need for a short period of time for himself when he came home from a stressful day, but there was never a way to make repairs, as far as Betty was concerned, because she took a hard stance against accepting apologies and reparative gestures. Betty's unwillingness to accept Tom's reparative gestures resulted in the demise of their relationship because the relationship deteriorated over time, and Tom was unwilling to remain with someone who showed contempt and could never forgive.

In Vignette 2, Alice and John would argue over common issues that couples often argue about, but they were both able to make and accept reparative gestures soon after the argument. They were able to move on from these arguments and let go of anger so that resentment didn't build up. This allowed their relationship to grow and deepen over time.

There are many people in relationships who are unable to make or take in repairs in their relationship. This is often the result of a childhood where mistakes weren't tolerated or where, as children, they didn't see their parents resolve their problems. Successful relationship skills weren't modeled for them.

The ability to make and receive reparative gestures in a relationship is crucial for the survival of a relationship. The alternative is a destructive dynamic that grows over time and often leads to the demise of the relationship.

Getting Help in Therapy
Being in a relationship often takes skills that people haven't developed.  Often these people haven't seen models of successful relationships when they were growing up.

Individual or couples therapy can help one or both people to develop the necessary relationship skills to salvage an otherwise good relationship (see my article: What is Emotionally Focused Therapy For Couples?).

Rather than continuing in a negative cycle that might be ruining your relationship, you owe it to yourself to get help from an experienced therapist.

Learning successful relationship skills will help you to feel better about yourself and improve your relationship.

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

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, June 9, 2020

10 Self Care Tips to Start Your Morning With a Sense of Well-Being

Starting your morning with healthy self care routines can improve your overall perspective and sense of well-being for the rest of the day (see my article: Overcoming the Morning Blues).

Self Care Tips to Start Your Morning With a Sense of Well-Being

10 Self Care Tips to Start Your Morning
Depending upon how much time you have in the morning, here are 10 ways to improve your overall mental health throughout the day:
  1. Prepare the Night Before: Rather than waking up and rushing around to figure out what you're wearing and what you need for the day, prepare everything the night before. This would include: laying out your clothes, gathering any work items that you'll need to take with you, having your MetroCard ready, making sure you have enough cash, having your keys handy, etc.
  2. Wake Up Feeling Rested: One of the keys to having a sense of well-being is having a good night's sleep (see my article:  Tips For Getting Better Sleep).
  3. Let the Sunshine In: Getting 5-10 minutes of sunlight in the morning can help to clear away grogginess and to wake you up feeling ready for the day. So, open your curtains and let the sunshine in. If you wake up before the sun comes up, turn on a lamp or consider getting a light therapy lamp (see my article: Coping With Seasonal Affective Disorder (SAD).
  4. Hydrate: Drinking water in the morning not only quenches your thirst, it can also help you to clear up cognitive confusion related to dehydration. If you don't especially like drinking water, you can add some lemon or lime to give it flavor.
  5. Avoid Technology: Reaching for your phone or computer as one of the first activities of the day can become compulsive. It's easy to get lost on social media or responding to texts and emails rather than taking care of yourself. So, unless it's absolutely necessary, refrain from using technology as part of your morning routine.
  6. Start the Day With an Intention: Starting your day with a healthy intention can help to improve your mood and overall perspective (see my article:  The Power of Starting Your Day With An Intention).
  7. Eat a Nutritious Meal: A healthy breakfast can help you to feel more energized during the rest of the day. You'll also be less likely to eat unhealthy foods, like donuts or junk food during the day because you'll already be full.
  8. Get Physical: Whether you go out for a morning walk, jog or do other cardio and/or core exercises in the morning, getting physical in the morning can help to boost your endorphins, which will give a boost to your mood. In addition, it can help to tone your body and reduce weight.
  9. Meditate: Spending 5-10 minutes meditating in the morning can help to calm your mind and body (see my article: The Safe Place Meditation).
  10. Be Grateful: Being mindful of the people and things in your life to feel grateful for is a great way to start the day. Rather than focusing on all the negative things in your life and in the world in general, practice gratitude (see my article: Keeping a Gratitude Journal).
Getting Help in Therapy
There might be times in your life when you engage in self care routines and yet you wake up feeling anxious, depressed or have a sense that your life lacks meaning or purpose.

Rather than struggling on your own, you could benefit from working with an experienced psychotherapist who can help you to overcome your problems.  

While therapists are out of their offices due to the COVID-19 pandemic, they are practicing therapy using teletherapy, which is a convenient and effective way to provide psychotherapy services (see my article: The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person).

Help is just a phone call away, so rather than struggling on your own, take the first step to getting help by calling a licensed mental health practitioner in your area.  

When you work through your problems with an experienced therapist, you can improve your mood and lead a more fulfilling life.

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

I work with individual adults and couples.

I am currently providing teletherapy services during the current pandemic.

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.