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Wednesday, July 29, 2020

How to Talk to Your Partner About Sex - Part 2

I began a discussion on how to talk to your partner about sex in my prior article with suggestions, including do's and don'ts to introduce the topic with your partner. In this article, I'm providing a clinical vignette to illustrate typical sexual problems in a relationship and how a couple is able to work through these problems in couples therapy.

How to Talk to Your Partner About Sex

A Common Problem: It Can Be Hard to Talk About Sexual Problems With a Partner
As an experienced therapist who works with individuals and couples, I have found that many people have difficulty talking to their partner about sex, especially when there are problems.  Even in relationships where people have been together for many years, they often feel shy or awkward to talk about sex with a partner.

Why Is It Hard to Talk About Sex With a Partner?
There are many reasons why people feel uncomfortable and avoid talking about sex, including:
  • Cultural or Religious Taboos: It's not unusual for people, who were raised in a particular religion or culture where talking about sex is taboo--even with a spouse of many years, to experience difficulty in expressing their sexual needs or talking about sexual problems.
  • Family History: For people raised in a family where sex was seen as "dirty" or secret, talking about sexual problems can be challenging. Also, in families where there were poor boundaries around sex (e.g., parents walking around naked in front of children or having sex in front of or within earshot of children), these children often grow up to be adults who experience problems with sex in their relationship.
  • Sexual Trauma: When there is unresolved sexual trauma (for either a man or woman regardless of sexual orientation), it's often difficult to separate out the traumatic experience from the current relationship.  The act of being sexual in the current relationship can trigger memories of being sexually abused, which makes it hard to talk about sex or to even engage in sexual activities with a partner.
  • Body Shame: Many people, especially women, feel ashamed of their body. There are many reasons for this, including a history of being shamed about their body, sexual abuse, popular and unrealistic images of men's and women's bodies, etc. So, talking about sex, which involves the body, feels too embarrassing.  
  • Fear of Being Rejected: For many people the idea of initiating a discussion about sex with their partner brings up fears of being rejected. Their fear might involve an outright rejection of them or a fear that their partner might also have things they don't like about them with regard to their sex life. This fear often inhibits people from bringing up the topic of sex.
There are also countless other reasons why people avoid talking about sex with their partner.  This avoidance ensures that the problem probably won't be resolved with the possible effect that the couple grows apart (see my article: Relationships: How to Get Closer When the Two of You Have Grown Apart).

Clinical Vignette: How to Talk to Your Partner About Sex
The following fictional vignette is a composite of many different cases so that there are no identifying features of any one person or couple. This case illustrates the sexual presenting problem, the effect of the problem on the relationship, and how it gets resolved in couples therapy.

Amy and Joe
By the time Amy and Joe came to couples therapy, they were already considering divorce.  In their mid-40s and married for 20 years with children, they decided to try couples therapy to see if they could salvage their relationship before they filed for divorce.

Just like many other couples who come to couples therapy, Joe and Amy told their couples therapist that they had "communication problems."  For many couples, presenting their problem to the couples therapist as a communication problem takes away some of the shame and awkwardness they feel about coming to couples therapy (see my article: Mental Health Awareness: Reducing the Stigma of Going to Therapy).

Their couples therapist recognized that, in a general way, they did have communication problems, but this description of their problem was too vague.

Knowing that many couples come to couples therapy because they're either having problems with sex or money (or both), the therapist normalized this by asking each of them specific questions, including questions about their sexual satisfaction in the relationship.  She had already informed them, when they called for the consultation, that a sexual assessment was part of the initial stage of therapy, so they were aware that they would be asked these questions.

Initially, both Amy and Joe hesitated before they responded.  They looked at each other awkwardly as if to get a response from the other as to what they should say.

In response, the therapist told them that problems with sex is a common reason for coming to couples therapy for many couples.  Once again, this was a way of normalizing the topic of sex by letting them know that it's a common problem for many couples.

In response, Amy laughed nervously, "Gee. I didn't know that. I always assumed that everyone else is having 'swinging off the chandeliers' sex every night."

With a reddened face and looking down at the floor (rather than at Amy or the therapist), Joe said, "So, you think everyone else is having more and better sex than we are?"

Amy just looked away rather than respond, so Joe, who was sitting right next to Amy on the therapist's couch, said, "You're not saying anything, so I'm guessing that you have a problem with our sex life that you haven't told me about. Is that right?"

Looking away from Joe, Amy winced, "Well..."  And then she stopped and looked at the therapist as if for guidance.

So, the therapist stepped in at that point and said, "It seems to me that you both still care about each other--otherwise, you wouldn't be here. When you contacted me for the consultation, I mentioned to you that I get a sexual history from each person in the relationship for every couple that I see.  Why don't we start with me getting a sexual history from each of you" (see my article: Why It's Important to Talk to Your Therapist About Sexual Problems).

Based on the sexual history assessment that the therapist did for Joe and Amy, she found out the following salient facts:
  • Neither Joe nor Amy had much sexual experience with each other or with others before they got married.
  • Despite their limited sexual experience prior to marriage, each of them assumed, before they got married, that their sex life would work out on its own without having to talk about sex and without having to put in any effort.
  • Both of them felt awkward talking about sex with each other and would prefer to avoid it if they could.
  • Amy's family was very religious and neither parent ever talked to her about sex. Sex was considered a taboo subject in her family. She found out about sex by reading books when she was a teenager, but she never discussed what she read with anyone.
  • Amy didn't get her period until she was almost 14 years old. She was self conscious at school because all the other girls had already developed breasts, but she was "flat chested" (her words). As a result, the boys in her junior high school often teased and body shamed her about this, which made her feel even more ashamed. She never told anyone about this until now.
  • Joe's family was the opposite of Amy's family: His parents had very loose boundaries. They often walked around naked in front of Joe and his siblings.  They would also have sex in the living room after they thought Joe and his siblings were asleep.  But, in fact, Joe and his brothers and sisters would hear them and feel uncomfortable and embarrassed.
  • Ever since he entered into puberty, Joe felt ashamed of his penis size.  When he was in high school, the other boys in the locker room would brag about having big penises and about their sexual conquests. This made Joe feel ashamed.  The few times that he was sexual with other women, before he met Amy, he never wanted women to see his penis, so he always insisted on having sex in the dark.  He secretly feared that, due to the size of his penis, he couldn't satisfy women sexually, which contributed to his shame about sex and his sexual awkwardness--even with Amy.
  • Both of them denied a history of sexual trauma or abuse.
  • Joe had a vague sense that he wasn't satisfying Amy sexually, but he felt too ashamed to talk to her about it.
  • Amy often "zoned out" during the rare occasions when she and Joe had sex. She rarely had an orgasm, and she usually couldn't wait until it was over.
  • Neither of them felt comfortable talking about sex initially, but answering the therapist's questions from her sexual assessment made each of them realize that they weren't the only couple who had these problems.
  • Both denied any extramarital affairs during the marriage.
  • Both of them eventually admitted that they were dissatisfied with their sex life together, but both felt too ashamed to discuss it before coming to couples therapy.
Gradually, Amy and Joe were able to open up more about their sex life in couples therapy.  Amy was the first one to broach the topic of their almost nonexistent sex life in the last several years.  After hearing Amy speak, Joe said, "I thought you didn't want to have sex, so I didn't want to bother you."  In response, Amy turned to Joe and said, "That's weird--because I thought you weren't interested and I didn't want to bother you about it."

Over time, they were able to talk about being somewhat satisfied with their sex life when they first got married.  Each of them acknowledged that this changed after they had their second child.  They often felt too exhausted to have sex and they also stopped prioritizing their sex life--until it dwindled to having sex, on average, once every few months.

The more they were able to talk about their sexual history, the freer each of them became to talk about the problems in their sex life.  Prior to this, they weren't sure what caused them to drift apart (leading to talk about a divorce).  Each of them just assumed that the other wasn't interested in the marriage anymore.

They each said that they still felt sexually attracted to the other.  They also agreed to go away on a relaxing vacation to rekindle their relationship.

When they returned, they seemed much closer. They also told their couples therapist that they made love several times while they were away on their weeklong vacation.

Amy talked about being bold enough to bring sex toys on their vacation, which they had fun using. She said she had more consistent orgasms while they were away.  In addition, she told their couples therapist that she had developed a new appreciation for her body, including her small breasts, and sh realized that Joe still found out attractive.

Joe talked about being more sexually adventurous about exploring different sexual positions.  He also discussed that they engaged in oral sex for the first time, both fellatio and cunnilingus, and they found it fun and enjoyable.

Using Emotionally Focused Therapy (EFT) For Couples, their therapist helped them to identify and change the patterns in their relationship that were causing problems for them.  They continued to make progress and they each made a commitment to save their relationship by continuing in their couples therapy.

Regardless of sexual orientation, age, race or other identifying factors, sexual problems are common in many relationships.

There can be many factors that contribute to the problems, which can be addressed and overcome in either individual or couples therapy.

The fictional vignette presented above gave a particular set of problems, but there are many other types of sexual problems.

Getting Help in Therapy
If you and your partner are having sexual problems, rather than avoiding the problems, you owe it to yourselves to get help.

Resolving the sexual problems in your relationship can rekindle and salvage your relationship.  So rather than waiting, get help from an experienced therapist who works on these issues so you can have a more satisfying relationship.

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.

I have helped many individuals and couples overcome problems related to sex, including sexual trauma.

I am currently providing teletherapy, also known as online therapy, telemental health and telehealth (see my article: The Advantages of Online 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, July 28, 2020

How to Talk to Your Partner About Sex - Part 1

Let's face it--talking to your partner about sex can be hard, especially when you're not satisfied with your sex life. But the basis of any good relationship is good communication, whether it's about sex, money, changes in your life or anything else that's significant (see my articles: Have You and Your Spouse Stopped Having Sex?,  What is Sexual Desire Discrepancy? and Overcoming Sexual Desire Discrepancy).

How to Talk to Your Partner About Sex

You know that not talking about the problem isn't going to make it go away. If anything, this problem usually gets worse because your needs aren't getting met, the dynamics aren't changing, and you're probably becoming increasingly resentful about the problem.  

Since the problem isn't going to go away by itself, it's better to address the problem instead of avoiding it, as many couples do. If anything, talking about improving your sex life can bring the two of you closer together.

Talking to Your Partner About Sex: Do's and Don'ts:
  • Be Sensitive to the Timing of Your Discussion: Don't talk to your partner about problems in your sex life during or after sex. Bringing up a discussion about the problems in your sex life either while you're having sex or just after you have sex is bound to make your partner feel defensive and hurt.  Instead, find a time when you're both getting along--possibly over dinner if you have privacy or some other neutral time.
  • Don't Start Out Angry, Criticizing or Blaming: One of the worst things you can do when you want to talk to your partner about sex is to start out by accusing your partner of not loving you, blaming your partner for sexual problems (after all, there are two people involved) or accusing your partner of having an affair (unless you have good reason to believe this and then this should be a separate conversation).  If you start out angry, blaming or criticizing, as many people do out of their own anxiety about the topic, you're not going to resolve the problem, and you will probably create even bigger problems. 
  • Don't Throw the "Kitchen Sink" Into the Discussion: Limit your conversation to your sex life. Now isn't the time to list all your grievances about the relationship. Not only is that counterproductive to getting the problem resolved, it also complicates the discussion with too many problems to tackle at once.
  • State the Problem in a Positive and Tactful Way: Instead of saying something like, "I think you don't love me anymore because we hardly have sex," state the problem in a positive way, "When we have sex, I feel closer to you. What can we do to have sex more often?" This doesn't mean that you demand sex when your partner is exhausted or has had a bad day. That will, rightfully, come across as selfish and uncaring. Instead, part of the discussion might be the best times for the two of you to have sex when you're both ready for it and have the privacy for it.
  • Take the Awkwardness Out of Talking About Sex: If you feel comfortable enough with your partner, instead of approaching your discussion in a stiff and constricted way, depending upon what the problems is, you can be seductive. For instance, if you want your spouse to kiss you in a certain way, you can suggest it in a playful, seductive way, "I just love it when you kiss my neck. It really turns me on.  Can we try that?"
  • Take Responsibility For Your Part in the Sexual Dynamic: There might be aspects of your sex life that your partner isn't pleased about.  So, when you open a dialogue about your sex life, be open to hearing things that your partner might want to change. Don't get defensive or angry. Just be open and curious to listen to what your partner tells you.  
  • Be Aware That There Can Be Physical or Trauma-Related Problems Involved: Sexual problems aren't always about a lack of desire. Sometimes there are physical problems that might need to be addressed.  For instance, some men have a low libido due to low testosterone levels, which might need to be addressed medically.  Similarly, some women experience sexual intercourse as painful for a variety of reasons, including: problems with lubrication or vulvodynia (painful intercourse due to yeast infections or pelvic inflammatory disease). A history of sexual abuse for either partner could also be a factor. If there are physical issues that either you or your partner haven't addressed until now, seek medical or psychological help.
  • Be Aware That Talking About Sex Isn't a "One and Done" Discussion: If you want to have a good sex life with your partner, having open and honest communication about sex is an ongoing dynamic.  Even if you resolve your current problems, things change. This doesn't mean that you have to talk to your partner about sex everyday.  But having a discussion about sex periodically can make it easier to talk about sex.  For instance, you or your partner might want to try something new in your sex life, like adding sex toys, different sexual positions, and so on. As mentioned earlier, the two of you might even find fun and sexy ways to talk about sex that will spice up your sex life.
  • Be Aware That Religion, Culture or Family History Might Be an Obstacle to Talking About Sex: In many religions, cultures and families, sex is a taboo issue.  If your partner was raised in an environment where it was considered wrong to talk about sex, you'll need to be aware of and sensitive to this.  You might even preface your discussion by acknowledging that you're aware that your partner was raised to believe that talking about sex is taboo.  Even if your partner no longer believes that sex is a taboo subject, s/he might still feel some guilt or shame about talking about it.  It's better to acknowledge this so you can get it out in the open. Then, you and your partner can try to find a way to talk about your sex life in the context of being in a loving relationship and wanting your relationship to succeed.  
In my next article, I'll provide a clinical vignette to illustrate some of the problems mentioned above and to show how these problems can be resolved (see my article: How to Talk to Your Partner About Sex - Part 2).

Getting Help in Therapy
Some couples are unable to resolve sexual problems in their relationship, and they need help to be able to talk about sex.

An experienced couples therapist can help you to improve your communication about your sex life.

Rather than avoiding the problem, seek help with a licensed mental health professional who works with couples.  

Resolving problems in your sex life can help you to have a more satisfying sex life and a happier relationship.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing therapist and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples (see my article: What is 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.



Monday, July 27, 2020

The Benefits of Laughter For Your Health and Mental Health

You've probably heard the saying, "Laughter is the best medicine" which hints at the physical and mental health benefits of laughter.  In the past, I wrote an article, Humor Can Be Helpful in Psychotherapy, which explored how humor can sometimes increase the effectiveness of therapy.  In this article, I'm focusing on how laughter benefits both your physical and mental health.

The Benefits of Laughter For Your Health and Mental Health

The Benefits of Laughter For Your Health and Mental Health
Laughter is beneficial for your mind and your body because it:
  • strengthens your immune system
  • elevates your mood
  • reduces pain
  • protects you against the harmful effects of stress
  • inspires hope
  • helps you to connect and bond with others
  • keeps you grounded
  • relaxes your body
  • eases stress and anxiety
  • strengthens resilience (see my article: Developing Resilience)
  • diffuses anger
  • reduces inhibitions
  • helps you to feel recharged and energized
  • increases your ability to use your imagination and increases creativity (see my article: Using Positive Imagination to Cope)
Adults Need to Seek More Opportunities For Laughter
Most children tend to laugh many times a day.  However, adults tend to be more serious, and they don't laugh as much as children. Therefore, adults, who want the health and mental health benefits of laughter, need to seek out more opportunities to laugh.

You can seek out these opportunities to include more laughter in your life by:
  • watching a funny movie or TV show
  • watching standup comedy
  • playing games with friends
  • spending time with people who are funny
  • playing with your pet
  • reading a funny story
  • sharing a funny cartoon with friends 
  • engaging in laughing yoga
  • being grateful for what you have
  • being "silly"
  • taking an improv class
  • sharing true stories about yourself with others (see my article: The Psychological Benefits of Storytelling)
Examples of How to Bring More Laughter Into Your Life

After realizing that she wasn't having as much fun as she used to, Sue decided to join an improv class, which was recommended by a friend. She had never taken an improv class before and, initially, she felt intimidated. But on her first day of class, she discovered that most other people in the class had never done improv or any type of comedy before, and they were feeling just as inhibited as she was feeling. By the second class, she realized she really liked her instructor, who made learning improv fun easy.  So, after a while, Sue opened up more and allowed herself to just have fun. She realized that she had not laughed so much in years, and she decided to take the next improv class when it was over.

Although he enjoyed painting in his free time, Jim found it to be too solitary an activity, especially since he already spent a lot of time on his own as an online editor.  He didn't look forward to spending even more time alone doing his artwork.  However, at the suggestion of a neighbor, he offered a free art class to the children in his apartment building, and while he was working with the children, he realized that not only were they having fun, but he was also having fun with them.  This group activity with children helped him to feel energized, and it allowed him to spend time alone doing his own artwork.

As mentioned above, there are many physical health and mental health benefits to laughter.

Sometimes, you need to experiment with different activities to find one that you enjoy.  If you approach this exploration with a sense of curiosity and playfulness, you'll discover an activity that's just right for you. In addition, you'll begin to experience the benefits of laughter.

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

I provide teletherapy, also known as online therapy, telemental health or telehealth for clients (see my article:  The Advantages of Online Therapy).

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

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

Sunday, July 26, 2020

Overcoming Shame With Experiential Therapy

In my prior article I began a discussion about shame being at the root of most psychological problems.  In this article I'll give a clinical vignette and discuss how experiential therapy helps clients to overcome shame (see my article: Healing Shame in Therapy).

Overcoming Shame With Experiential Therapy

Clinical Vignette: Shame is at the Root of Most Emotional Problems
The following clinical vignette about resolving shame in therapy with experiential therapy is a composite of numerous cases:

When he first came to therapy, Joe told his therapist that he felt he wasn't where he wanted to be in his life, "I'm not satisfied with any part of my life. I'm going to be 35 years old in a few months, and I'm not where I should be in my personal life or in my career. By the time my older brother, Sam, was my age, he was already married with two kids and he was one of the top salespeople at his company.  I feel like a loser."

Joe went on to say that whenever he got together with his family for Sunday dinners, his parents talked about being proud of Sam, but they never talked about about being proud of him.  He said, "Ever since I was boy, my mother and father talked about feeling proud of Sam, and I just had to sit and listen to them gloat about him.  They never said they felt proud of me."

From Joe's description, it appeared that Sam was the "golden child" in the family and Joe was the neglected child.  He said he felt he never measured up to his brother's accomplishments (see my article: Growing Up Feeling Invisible and Emotionally Invalidated and Children's Roles in Dysfunctional Families).

He felt his parents didn't love him as much as they loved Sam, and he could understand this because, compared to Sam, "I'm nothing" (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

It was clear that Joe felt deeply ashamed of himself and he was stuck in the negative perception that he was "a loser."  It was also evident that he felt he had to earn his parents' love by accomplishing things rather than just being loved for himself.

Based on his description of the family dynamics, his feelings of toxic shame were rooted in his childhood emotional neglect (see my article:  What is Childhood Emotional Neglect? and What's the Difference Between Healthy Shame and Toxic Shame?)

Joe had lots of "shoulds" that he used to beat himself up with, "I should've tried harder to make something of myself" and "I should've chosen a profession that would have made my parents proud of me" and so on.

Although he loved being self employed as an illustrator, Joe felt ashamed whenever his father described his work in a dismissive tone as "just drawing pictures" when the father talked to family friends.  Joe compared this to how his father described Sam as being "a go-getter who is the top salesperson at his firm."

Joe said even though he got illustration work from large accounts, like major newspapers and sports teams, he felt he wasn't doing enough to promote his business because of his lack of self confidence.

With regard to relationships, he said his last girlfriend, Sue, left him two years ago, and he felt unmotivated to start dating again. Even though he often felt lonely, he said he lacked the confidence to go out and meet women.  So, he spent a lot of time alone or seeing male friends to go to sports events.

His therapist realized that Joe's shame was longstanding, and it created a major obstacle in his life.  Since she was an experiential therapist, during the initial stage of therapy, she helped Joe to build a stronger sense of self by asking him to remember positive memories about himself (see my article: Developing Internal Resources in Therapy).

At first, Joe couldn't think of any but, gradually, he remembered winning art awards in high school and college, the first time he got a major contract for his illustrations from a top sports team, and other similar memories.

As Joe talked about these moments when he felt good about himself, his therapist used Somatic Experiencing to help him to slow down and feel the sense of pride he experienced with each memory.

By helping him to slow down and notice where he felt these good feelings about himself in his body, his therapist helped Joe to intensify and integrate these good feelings (see my article: Experiential Therapy and the Mind-Body Connection).

His therapist reflected back to Joe the change she saw in him--the pride she saw on his face and in his confident posture as he dwelled on these positive memories.  Joe said that he was surprised to remember so many memories that he usually didn't think about when he was feeling bad about himself.

In his subsequent sessions, Joe said he realized that, even though he felt like "a loser" with most women, he remembered meeting a few women in recent weeks who seemed interested in getting to know him, but he felt too shy to ask for their phone numbers.

Over time, Joe and his therapist explored his shame, and he realized that, along with shame, he felt hurt and sad that his parents neglected him.  At that point, his therapist explained how EMDR therapy helps clients to overcome psychological trauma, and they used EMDR in the next phase of therapy (see my article: Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

Gradually, Joe realized that, even though he was neglected, he deserved his parents' love--not for his accomplishments but for just being himself.  Rather than feeling ashamed, Joe felt angry that he didn't get what he needed from his parents.  This was a big psychological breakthrough for Joe because, instead of blaming himself for being "a loser" and not deserving his parents love, he felt he was a person who was worthy of love.

He also realized that his parents' dynamic of praising Sam and ignoring Joe was rooted in their own psychological problems and he wasn't to blame for that.  He knew that both of his parents experienced similar family dynamics as children where they were the ones who were neglected.  At that point, along with his sadness, anger, hurt and shame, he also felt compassion for them.

As his shame was lifting, Joe felt more confident and assertive in promoting his work.

In addition, when he attended family dinners with his parents and Sam, he felt freer to talk about himself.  To his surprise, his parents noticed and commented on this positive change in him.  Although he was at a point where he no longer felt he needed his parents' approval, his parents really  saw him for the first time in a new light and they praised him.

Within several months, Joe shed his old identity of feeling like "a loser" and he was no longer feeling awkward and shy around women.  He began dating a woman he really liked.  Over time, he saw the potential for the relationship to develop into a lasting, meaningful relationship.

Toxic shame is rooted in early childhood neglect and trauma (see my article about Developmental Trauma).

Shame is emotionally debilitating, especially when it's as pervasive in a person's life as it was in the vignette above.  It often shows up with the person experiencing many "shoulds" about him or herself.  These "shoulds" are a clue to deep-rooted shame.

During the initial stage of experiential therapy, it's important that the therapist ensure that the client has the necessary internal resources to cope with whatever comes up in experiential therapy, like EMDR.

There are many different ways to develop internal resources depending on the needs of the client.  With strong internal resources, the client is better able to cope with whatever comes up as s/he works through feelings of shame.

Anger, hurt and sadness often accompany feelings of shame below the surface. When clients begin therapy, they're often unaware of these other emotions so, when the time is right, an experiential therapist helps the client to work through those emotions as well.

As shame and other debilitating emotions lift, clients often feel lighter and more confident. Rather than being burdened by childhood trauma, they're free from their traumatic history so they can live more authentically.

Getting Help in Therapy
Many people, who have been traumatized at a young age, are unaware of the negative impact of shame in their life.  They might be aware of feeling anxious or depressed, but shame is often suppressed because it's too difficult to face alone.

If you've been struggling with emotional problems you have been unable to resolve on your own, you could benefit from working with an experiential therapist (see my article: What's the Difference Between Top Down vs Bottom Up Therapy?).

Once you're free from the emotional burden of a traumatic childhood history, 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 articles: The Therapeutic Benefits of Integrative Therapy and What is a Trauma Therapist?).

I work with with individual adults and couples.

I am currently providing teletherapy, also known as telemental health, online therapy and telehealth (see my article: The Advantages of Online 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.

Wednesday, July 22, 2020

Shame is at the Root of Most Emotional Problems

Shame is at the root of most psychological problems (see my articles: What's the Difference Between Healthy Shame and Toxic Shame? and Healing Shame).  I will begin an exploration of how shame develops and how psychologically debilitating it is in this article, and I will discuss how psychotherapy can help in a future article.

Shame is at the Root of Most Emotional Problems

So, when we're discussing deep-rooted shame, which is also called core shame, we're talking about toxic shame, the type of shame that erodes a sense of self and makes people feel that they are not "good enough," they are unlovable and undeserving of love (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

No one is born with shame.  Shame is rooted in childhood psychological trauma, which is also known as developmental trauma (see my article: How Developmental Trauma Affects How You Feel About Yourself). 

The Connection Between Developmental Trauma and Shame
The Connection Between Childhood Trauma and Shame
Infant research has shown that toxic shame develops in childhood and it can affect infant brain development  (see the article: Early Shame Experiences and Brain Development by Allan N. Schore, Ph.D).

An example of this is when a baby reaches out to his mother and the mother's habitual response is to turn away or ignore the baby due to the mother's emotional problems, including postpartum depression, major depression or her own unresolved trauma (see my articles: What is Childhood Emotional Neglect? and Psychotherapy and Intergenerational Trauma).

When this happens often enough, the baby learns that it is shameful to have emotional needs and, after a while, he learns to suppress these needs and to stop reaching out.

This type of developmental trauma can occur at any time in childhood. When this dynamic occurs in infancy, the trauma is preverbal, so that baby can't express the shame he feels in words.  Initially, he might cry out for the mother and even scream.

But after a while, if the mother does not respond, the baby learns to stop seeking nurturance.  If there are no mitigating factors like a nurturing father or grandparent, that baby grows up to be an adult who suppresses his emotional needs out of deep-rooted shame.

This is adaptive in childhood because the emotional pain of seeking love and nurturance when it's not forthcoming is too emotionally devastating for a child.  So, this need is suppressed in order to avoid feeling devastated.  But while this suppression is adaptive to keep the child from being overwhelmed, it's not adaptive in adulthood.

As an adult, this individual often continues to feel that he is unlovable and that even wanting love is emotionally dangerous because he believes he cannot have it, and it is too shameful to even want it. So, unconsciously, this individual not only hides his emotional needs from others.  He also hides his emotional needs from himself.

He might tell himself that he is "strong" or emotionally "independent" and he doesn't need anyone (see my article: Emotional Strategies That No Longer Work: "I Don't Need Anybody" and Seeing Yourself as "Independent" vs Allowing Yourself to Feel Your Shame).

But this is a pseudo-independence.  It's a defense mechanism to hide the emotional pain of feeling unlovable as well as to hide the shame and ambivalence that is attached to wanting to be loved at the same time that he believes he doesn't deserve it (see my articles: Reacting to the Present Based on Your Traumatic Past and An Emotional Dilemma: Wanting and Dreading Love).

This often results in an avoidant attachment style or he gets into relationships that are retraumatizing with people who hurt him.

Recreating the early trauma is an unconscious process, so it is out of the individual's awareness.  Each time this occurs it will reinforce the existing trauma that he is unlovable and undeserving of love, which intensifies the shame.

Most skilled psychotherapists know that shame is at the root of many emotional problems.  The problem might be labeled as depression, anxiety or any one of a number of other diagnoses, but at the core lies shame.

It's understandable that many clients will resist the painful process of looking at their shame in therapy because by the time they come to therapy, they have spent many years suppressing it.  But if the shame is not worked through in therapy, it will remain an unresolved emotional block (see my article: Working on Emotional Blocks in Therapy).

So, in order to help a client to uncover the shame at the root of trauma, the therapist must first develop a trusting relationship with a client.  The client must have confidence in the therapist and know that the therapist has the client's interests at heart before the therapist asks the client to begin the painful process of working through the underlying shame (see my article: The Creation of the "Holding Environment" in Therapy).

In future articles, I will continue this discussion about shame.  I will also discuss how shame is worked through in experiential therapy (see my article: What's the Difference Between "Top Down" vs "Bottom Up" Therapy?).

To read the next part of this discussion, see my article: Overcoming Shame With Experiential Therapy.

Toxic shame develops at an early age and it's usually at the root of most psychological problems.  Most people, who have experienced early shame, have learned to protect themselves from feeling the emotional pain of shame using defense mechanisms, like denial, for instance.

Although an individual can protect himself from becoming aware of deep-rooted shame, the effect of that shame can be pervasive in all his relationships, especially in romantic relationships where an individual can feel the most emotionally vulnerable.

Whether the individual is aware of his or her shame or not, shame doesn't usually resolve itself.  So, in order to work through shame, s/he needs the help of an experienced psychotherapist who can assist the in uncovering and working through shame.

Getting Help in Therapy
If you have been unable to resolve your problems on your own, you could benefit from working with an experienced psychotherapist.

Once you have established a trusting relationship, a skilled therapist can help you to identify and work through shame which keeps you from living fully.

Rather than suffering on your own, seek help from a licensed mental health professional who has experience helping clients to overcome shame.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: The Therapeutic Benefits of Integrative Therapy and What is a Trauma 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.

Sunday, July 19, 2020

Understanding Serial Monogamists - Part 2

In Part 1 of this topic, Understanding Serial Monogamists , I provided basic information describing the characteristics of most serial monogamists.  Of course, each person is an individual, whether they're a serial monogamist or not, so although that article discussed the most common characteristics, there will always be individual differences.

Understanding Serial Monogamists

In this article, I'm providing two typical vignettes.  Clinical Vignette 1 is about the relationship dynamics of a person who is a serial monogamist and the other who is not. Clinical Vignette 2 is about what it's often like when two serial monogamists get together.

Needless to say, as previously mentioned, no example can encapsulate all the nuances of individual relationships, so think of these vignettes as examples of typical characteristics of these relationships.

Clinical Vignette 1: A Serial Monogamist With Someone Who Wants to Take Time to Get to Know the Other Person

June and Ed
After meeting on a dating app, texting and talking on the phone a few times, June and Ed decided to meet for a drink for their first date.  They were both in their early 40s.  June was widowed three months before, and Ed was out of his prior relationship and dating other people for almost a year.

During their first date, they both felt physical chemistry.  At the same time, although Ed enjoyed his date with June, he noticed that June spent a lot of time talking about her deceased spouse.  While he was sympathetic to June's loss, he wanted to know more about June as an individual rather than hearing about June's deceased husband, John.

He attempted to steer the conversation to other topics several times, but June kept relating these topics to her prior relationship with John.  He noticed that whenever she mentioned John's name, she would light up.  Not only did she spend a lot of time talking about her former marriage, but she had high praise for John.  She said that her spiritual belief was that he was still hovering above her, watching over and protecting her.

On the one hand, Ed thought to himself that June might not have given herself enough time to mourn the loss of John and she might not be ready to date.  But, on the other hand, he really liked her and he wanted to get to know her better.

When Ed asked June what she was looking for in a relationship, she told him that she didn't want to spend a lot of time dating.  In fact, she said, she wanted to get into a new relationship as soon as possible.  She said she liked the comfort and security of being in a monogamous relationship and she hoped to be in new relationship very soon.

When June asked Ed what he wanted, he told her that he liked being in a relationship, but he also wanted to give himself some time to be one his own, date casually and get to know someone well before getting into a new relationship.  He said that, after his last relationship, which lasted three years, he got into therapy because he noticed that he was repeating certain patterns in that relationship, and he wanted to get to know himself better before he got into another relationship and repeated the same patterns.

In response, June said that she "didn't believe in therapy." She told him that her 10 year marriage to John was "perfect," and she already knew she wanted a similar relationship with someone else.  She said that the thought of spending time dating different people was very unappealing to her because she wanted the comfort and security of being in a relationship.  She said she needed someone who was going to be as loyal and true as John, and she wouldn't settle for anything less.

Although both of them saw "red flags" from the beginning in terms of wanting different things, they decided to continue to see each other to see where things would go.

June told Ed from the beginning that she couldn't tolerate the thought that he might be dating other women, so she asked him to date her exclusively.  Initially, Ed was reluctant to make this agreement, but he felt so attracted to June and liked her that he agreed.

Within the next few months, June and Ed were struggling with their differences. Whenever Ed wanted to spend time with his friends or engage in hobbies that didn't interest June, she complained, and he felt stifled by what he perceived as her "neediness."

She told him that she expected him to spend most, if not all, his free time with her and when he spent time with friends or doing things that she wasn't interested in, she felt her needs weren't being met and he was neglecting her.

Over time, Ed also got tired of hearing how "wonderful" John was and how "great" June's marriage to John had been.  Although June never said it directly, Ed felt that she was hinting that, compared to John, he didn't measure up in her eyes.

Although he knew that June was probably idealizing her marriage to John in an unrealistic way because no relationship is "perfect," he couldn't help feeling annoyed and frustrated.  He felt that, in effect, John's "ghost" was always hanging over them in a way that made him feel that he was in a love triangle with June and John where she thought he was inadequate compared to John.

After a while, Ed felt that June was constantly nagging him to spend time with her, and he wished that she had more friends and other interests to occupy her time so that he didn't have to be everything to her.  And June felt that if Ed really cared about her, he would want to spend all his free time with her and try to please her in every way he could.  She had already told him that she hated being alone, so she couldn't understand why he didn't listen to her.

Within four months, Ed felt like he had enough. He was bored with June, he felt frustrated by her clinginess and tired of hearing about her deceased husband. So, he told June he thought things weren't working out between them and they should end their relationship.  June said she was very disappointed because she had hoped Ed would eventually be as committed to being in a relationship with her as she was with him.

After the breakup, Ed continued to talk to his therapist about aftermath of his relationship with June and his patterns in relationships.  He realized that he didn't pay attention to his initial gut feeling when he first met June that they weren't compatible.

He also felt badly about hurting June's feelings, even though he knew that ending the relationship was for the best. However, he found out from mutual friends that within a week of their breakup, June was already seeing someone new and talking about wanting a committed relationship with the new person.

Clinical Vignette 2: Two Serial Monogamists Get Together

Agnes and Bill
After they met at a friend's party, Agnes and Bill, who were both in their late 30s, began seeing each other almost every day.  They had each gone through a breakup only a few weeks before, and they both agreed that they wanted and needed to be in a relationship.  They also agreed that they didn't want to date casually or see other people, so their relationship was intense from the beginning.

Within two months, Bill's lease ended, and he moved into Agnes' apartment.  Since Agnes was the main lessor on her lease, she gave her roommate a few weeks notice to find another apartment. She told Bill that she used to like having her roommate around because she didn't like to be alone, but now that she was in a relationship with Bill, she wanted to spend all of her free time with him.

Bill agreed that he didn't like being alone, which is why he remained at home with his parents until he moved in with Agnes.  Even though his parents kept urging Bill to move out to be on his own, he remained with his parents because of his aversion to being alone.

Bill's and Agnes' friends were surprised that their relationship became so intense so quickly.  These friends urged them to slow down to get to know each other.  But neither Bill nor Agnes were interested in slowing down.  They knew they wanted to be together every moment they could.

Within a few months of living together, Agnes and Bill began to feel bored with each other--even though neither of them said it.  Rather than addressing it directly, their boredom came out in frequent irritability and petty arguments that seemed to go nowhere.

In their own way, each of them felt disappointed in the relationship.  They both thought they knew each other from the time they first met, but they were discovering that there were things they didn't know or like.

Although it was never discussed between them, each of them began feeling nostalgic about their previous relationships.  John decided to get together for coffee with his prior girlfriend, Jane. While he was with Jane, he realized he still had romantic and sexual feelings for her.  He knew that Jane would be open to having a sexual affair with him even though he was supposed to be in a monogamous relationship with Agnes.  But he considered himself to be a loyal person, so he put that thought out of his head.

Agnes often daydreamed about her former boyfriend, Greg.  She wondered if she made a mistake when she broke up with him a few months before. She felt sad when she thought about Greg and even sadder because she felt her needs weren't being met in her current relationship with Bill.  She realized that she also felt that her needs weren't being met when she was with Greg, but she couldn't help thinking about him.

A month later, Agnes and Bill mutually decided to end their relationship because things weren't working out between them.  Within a few weeks, each of them was with someone new in another intense relationship, and they were repeating the same patterns.

The vignettes provided above are just two examples of these type of relationships.  In reality, there are many variations for both types.

Two people, one of whom is a serial monogamist and the other who wants to take time to get to know the other person, can work things out in the long run if they're each willing to compromise and try to negotiate their differences.

But in this dynamic, the reality is that these two people often don't get to the point where they get into a relationship because the serial monogamist is put off by the person who wants to take things slowly.  And the person who wants to take thing slower feels too pressured by the serial monogamist.

Similarly, two serial monogamists can work out their relationship and they might even be willing to stay together, despite boredom and stagnation, because they want to be in the relationship.

Most of the time, for a relationship between adults to work out, each person needs to come to the relationship as a mature individual who can handle the give-and-take involved in a long term relationship.  This means that they have developed independently, and they have taken the time to grieve the loss of a prior relationship so that they come to the new relationship without the emotional baggage.

It also means that, as individuals, they each bring something to the relationship and they're not solely dependent on the relationship to meet all their emotional needs.

Getting Help in Therapy
If you're currently having problems in your relationship that you've been unable to resolve on your own, you owe it to yourself to get help in therapy.

A therapist, who has experience helping individuals and couples to work on relationship issues, can help you to understand your dynamics in a relationship and the relationship dynamics so you can decide if you want to salvage your relationship or if it's best to end it.

Taking the first step, which is contacting a licensed psychotherapist for help, is often the hardest, but it can also be part of a transformative experience.

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.

I am currently providing teletherapy, which is also known as online therapy, telemental health and telehealth (see my article: The Advantages of Online 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.

Understanding Serial Monogamists - Part 1

There are many different types of relationships: traditional monogamous relationships, polyamorous relationships, relationships that are mostly monogamous but allow for occasional sexual encounters with other people, and so on.  I'm focusing on a particular type of relationship dynamic in this article, which is serial monogamy (see my article:  Dating vs Being in a Relationship).

Understanding Serial Monogamists
What is a Serial Monogamist?
Serial monogamists often have many of the following characteristics:
  • They want and need the comfort of being in a committed relationship--often from the start of dating someone.
  • They're usually emotionally intense about being in a relationship right from the beginning.  They're not into casual dating or dating different people at the same time.
  • They need and expect a new romantic partner to bring the same level of intensity and commitment to the relationship as they do. 
  • They expect a high degree of loyalty from their new romantic partner because they're usually loyal people.
  • Due to their need to feel comfortable and secure in a relationship, they often want to jump ahead 6-12 months when the relationship is more established and settled.
  • They usually don't like to be alone. They like having someone around all the time--whether it's a relative, a roommate or a romantic partner. They crave company. This often means they haven't matured or developed psychologically as adults because they can't tolerate being alone.
  • They usually go from one relationship to the next rather than mourning the loss of the previous relationship, understanding what went wrong or looking at their patterns of being in a relationship.  This means they often bring their emotional baggage from the last relationship into the new relationship. Often, they're looking to get into a new relationship as soon as the last one ends without being on their own.
  • They have a tendency to spend a lot of time talking about their ex with their new partner, often without even realizing it, because they haven't taken the time to deal with the end of the last relationship.
Knowing What You Want From a New Romantic Partner
There's nothing right or wrong about serial monogamy.

On the one hand, if two people get together and they're both serial monogamists, this might feel comfortable to both people because they know they both want to be in a committed relationship right from the beginning.

But even when both people feel the same way, as previously mentioned, they might get into a new relationship without really knowing the other person.  This often means they're not taking the time to get to know the person they're with because they don't go through a dating phase--they just jump right into being in a relationship.

They skip ahead in their mind to a time that's usually further along in a relationship because they need the comfort and security of an established relationship. This often means that they see what they need in the other person, which can be very different from the reality.  This can lead to disappointments when the reality becomes apparent (see my article: Falling In Love With the Fantasy Rather Than the Reality).

As previously mentioned, they also unknowingly bring emotional baggage from the prior relationship into the current relationship because they haven't mourned the end of that relationship or learned from it.  They have just gone on to the next person without dealing with the loss.

Since people who go directly from one relationship to the next haven't mourned the loss of the last relationship, they're often mentally preoccupied with the last person--without even realizing it.  It can be annoying and frustrating for the new person to keep hearing about an ex.

In addition, since serial monogamists often haven't grown psychologically because they're uncomfortable with being alone and they're so emotionally dependent on others, two people who are serial monogamists bring a level of immaturity into the relationship.  Not only do they not grow as individuals, but the relationship often doesn't grow, so it can feel stagnant and boring after a while.

On the other hand, if you're someone who likes to take their time to date and get to know someone, you're probably going to feel pressured by a serial monogamist who wants a commitment immediately--often during what's usually considered the dating phase.  In fact, there might not be a dating phase in the mind of a serial monogamist.

Also, since someone who tends to be a serial monogamist doesn't like to be alone, you might find this person to be emotionally and physically clingy, especially if you're someone who likes their alone or down time.  It might be possible for the two of you to negotiate this time together versus time apart, but this is usually a challenge for both people (see my article: Relationships: Time Together vs Time Apart).

If you're someone who needs to have other important relationships or time to indulge in other interests or hobbies, you might feel pressured by a serial monogamist who wants most, if not all, of your time.  Often, these relationships don't work out in the long run because one person feels s/he isn't getting enough of the partner's time and the other person feels stifled (see my article: Relationships: Your Spouse Can't Meet All Your Needs).

There is no right or wrong here.  It really depends on what you want from a relationship.

I'll continue discussing the issue of serial monogamy in my next article with an example of this type of relationship (see my article: Understanding Serial Monogamists - Part 2).

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.

I am currently providing teletherapy, which is also known as online therapy, telemental health or telehealth (see my article: The Advantages of Online 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.

Saturday, July 18, 2020

How Teletherapy Can Help You Overcome Anxiety

In a prior article, I discussed the advantages of doing teletherapy, which is also called telemental health, online therapy or telehealth.  In this article, I'm focusing specifically on how teletherapy can help you to overcome anxiety (see my articles: Common Reactions to the COVID-19 Pandemic: Fear and Anxiety and Coping and Staying Calm During the COVID-19 Crisis).

How Teletherapy Can Help You to Overcome Anxiety

Fortunately, in recent years, the stigma about attending psychotherapy has decreased significantly so that now many people feel more comfortable seeking help from a psychotherapist (see my articles: Mental Health Awareness: Reducing the Stigma of Getting Help in Therapy and Why Is It That It's Usually the Healthiest Family Member in a Dysfunctional Family Who Seeks Help in Therapy?).

Whether you're experiencing persistent anxiety or situational anxiety related to things going on in your life, anxiety can be a debilitating condition.

Not only can anxiety keep you up at night due to insomnia and nightmares, it can also erode your sense of self and interfere with your normal self care routines.  Lack of sleep and interference with your self care routines exacerbates your anxiety and it can precipitate a downward spiral in terms of how you feel.

Different Forms of Anxiety
There are many different types of anxiety, including:
  • generalized anxiety
  • separation anxiety
  • anxiety with depressive symptoms
  • adjustment disorder with anxiety
  • posttraumatic stress disorder
  • obsessive compulsive disorder
  • panic disorder (see my article: Tips For Coping With Panic Attacks).
  • agoraphobia
  • social anxiety (see my article: Overcoming Social Anxiety).
And so on.

Pandemic-related Anxiety
It's not surprising that the COVID-19 crisis has precipitated an increase in anxiety due to many factors, including (but not limited to):
Mental health experts expect a record number of people will seek help for the psychological stress related to the pandemic (see my article: The Emotional and Physical Impact of Loneliness During the COVID-19 Pandemic).

Although it's important to follow the health experts' guidelines for remaining virus free, the emotional toll of being in prolonged isolation without the usual social supports systems that people normally depend on is expected to be significant.

How Teletherapy Can Help You Overcome Anxiety
Most psychotherapists are currently doing teletherapy due to the COVID-19 pandemic.

As I mentioned in a prior article, teletherapy offers many advantages when you're unable to see a therapist in person, including:
Getting Help in Therapy
If you're feeling overwhelmed with anxiety or other forms of emotional distress, you owe it to yourself to get help from a licensed mental health professional.

Teletherapy offers a convenient and effective way to get help.

Rather than struggling on your own, take the first step of contacting an experienced psychotherapist.  

An experienced psychotherapist can help you to overcome anxiety and develop a sense well-being so you can move on with your 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.

With over 20 years of experience as a psychotherapist, I have helped many clients to overcome anxiety-related issues.

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.