NYC Psychotherapist Blog

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Wednesday, November 30, 2022

How EMDR Therapy Works: EMDR and the Brain

As a psychotherapist who specializes in helping clients to overcome trauma, I learned to do EMDR (Eye Movement Desensitization and Reprocessing) in 2005 (see my article: What is EMDR?).  I decided to learn EMDR because the traditional therapy that I learned in postgraduate training didn't help some of the clients who came to me who had PTSD (posttraumatic stress disorder).  I've been using EMDR with many clients ever since with positive results.

EMDR Therapy For Trauma

EMDR and Advances in Brain Research
When I learned EMDR, which was developed by psychologist, Francine Shapiro, Ph.D., researchers still weren't sure exactly how it worked.  They just knew that compared to other forms of therapy and compared to medication, it was more effective.

Since that time, there has been a lot more research on EMDR and brain research, so how EMDR works is starting to become clearer.

EMDR is an integrative therapy.  It combines the best of psychodynamic, cognitive behavioral therapy (CBT), and other mind-body oriented therapies.

Many psychotherapists, myself included, now also integrate Somatic Experiencing and the use of imagination, which has powerfully enhanced EMDR.

How Emotional Trauma Affects the Brain
Before discussing EMDR any further, it's important to understand how emotional trauma affects the brain.

Emotional trauma has a powerful effect on the nervous system.

How EMDR Works: Traumatic Memories and the Brain

People often have problems processing traumatic memories in regular talk therapy because these memories are stored in the nonverbal, nonconscious, subcortical part of the brain, which includes the amygdala, thalamus, hippocampus, hypothalamus, and the brain stem.

Before traumatic memories are processed with EMDR, they're not accessible to the frontal lobes, part of the brain that is used for understanding, thinking and reasoning.

Very often, individuals who are traumatized are unable to give a coherent narrative about their traumatic past because, as previously mentioned, the traumatic memories are stored in the nonverbal part of the brain.

Advances in brain scanning have shown that often when people with a traumatic history remembered these traumatic memories, the left frontal cortex (speech and logic) actually shuts down.

At the same time, the right side of the brain, which is associated with, among things, emotional states, images, and autonomic arousal and includes the amygdala, lit up on these brain scans.

This would explain why traumatized individuals have problems providing a coherent narrative about their traumatic memories--the part of the brain that is associated with thinking and speaking is "off line" when they're asked to think about the trauma.

This is also why, for many people who have PTSD, there are flashes of images from the traumatic event, but no words.

These memories also have a sense of timelessness so that people who suffer with trauma often have a hard time distinguishing "then" from "now" (see my article:  Working Through Emotional Trauma: Learning to Separate "Then" From "Now").

These emotions and sensations are often felt with such immediacy that it feels like they're experiencing the traumatic event now, even though it might have happened many years ago.

For instance, this is a common experience for veterans traumatized in battle as well as for people with other types of emotional trauma.

The corpus callosum is a part of the brain that connects the right and left sides of the brain and it helps both sides to "communicate" with each other.   It helps to integrate the emotional and cognitive parts of the brain.

Trauma, by definition, is overwhelming.  It can cause dysregulation of the body and brain chemistry.

EMDR, the Adaptive Information Processing (AIP) Model, and Bilateral Stimulation (BLS)
Francine Shapiro, Ph.D., developed the Adaptive Information Processing (AIP) model to explain the effects of EMDR.

The AIP model says that all memory is associative, and that learning occurs through the creation of new associations.

EMDR Therapy and the Brain

For example, in order to recognize an object, your current perceptions have to link the object with your past experiences.

So, if your only experience of a stick is that sticks were used to beat you, you would have no past memories that could tell you that a stick could also be used for other things, like walking.

But if someone shows you that a stick can be used to help you walk, you can integrate this information with other similar information in your existing memory networks.

Our memory networks help us to survive in the world.  But emotional trauma causes impairment to these networks.

EMDR helps to restore the proper functioning and integration of these networks.

In order to heal from emotional trauma, to start, there needs to be an integration between the right and left hemispheres of the brain.  In EMDR this is done with "bilateral stimulation" (BLS).

Initially, when EMDR therapy was first developed, BLS only consisted of eye movements, hence the name Eye Movement, Desensitization and Reprocessing.

As advances were made in EMDR therapy, researchers and EMDR clinicians discovered that effective BLS in EMDR processing could take many forms, including alternating, rhythmic tapping, pulsing and music that alternates between the right and left ears.

Under normal non-traumatic circumstance, the brain has ways of integrating psychological disturbance.

For instance, if you have a minor disagreement with a stranger, you might feel annoyed, but it's usually not traumatic.

Part of emotional integration might involve talking to a friend or a therapist about the argument, writing about it in a journal or possibly having a dream about the incident.  These are all integrative processes for events that are non-traumatic.

But when there's a traumatic event, which overwhelms the body and the brain chemistry, talking, writing and dreaming often aren't enough to integrate the event, so it remains emotionally unintegrated.

After a while, these unintegrated memories can get triggered by other events.

The most common example that is usually given is when a veteran with PTSD returns from combat and  s/he hears a car backfiring, s/he experiences it as if s/he is back in combat.  This could include the sights, sounds, taste and other sensory experiences from the war.

There are many other types of triggers.  For instance, if you feel belittled by your boss, this could trigger what you experienced if you were belittled as a child.

The problem is that, because these traumatic memories are stored in the nonconscious part of brain, the person who is triggered doesn't realize that much of what they're experiencing is from the past.

As I mentioned before, they often have problems distinguishing "then" from "now" when they're emotionally triggered.

Due to the lack of emotional integration, the traumatic memories are stored in isolated memory networks, which remain just below the surface and ready for reactivation.

EMDR Therapy For Trauma

EMDR was developed to help access and process these traumatic memories.

After accessing these memories, the goal of EMDR therapy is to make connections between the isolated memory networks and functional memory networks.   This is done, as previously mentioned, with BLS.

Next Article:  Part 2 of this article: How EMDR Works will give a composite example to demonstrate how EMDR therapy works.

Getting Help in Therapy
Emotional trauma that creates psychological, physical, and interpersonal problems is much more common than most people realize.

Getting Help to Overcome Trauma With EMDR Therapy

Research has shown that EMDR is one of the most effective forms of therapy to overcome emotional trauma.

If you are suffering with emotional trauma, rather than suffering alone, you could benefit from working with a licensed mental health professional who is trained as an EMDR therapist.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist who works with individual adults and couples.

I have helped many clients to overcome emotional trauma so they could lead a more fulfilling life (see my article: What is a Trauma Therapist?).

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. regular business hours or email me.

Tuesday, November 29, 2022

Overcoming Trauma With EMDR Therapy

In my prior article, How EMDR Works: EMDR and the Brain, I gave an overview of the basics of EMDR, including how emotional trauma affects the brain and how EMDR therapy helps to process trauma.

Overcoming Trauma With EMDR Therapy

In this article, which is a continuation of this topic, I'll give a composite scenario to demonstrate how EMDR therapy works.

I'll delve into some of the aspects of EMDR that are uniquely helpful to healing emotional trauma (for an overview of EMDR, see my article:  What is EMDR?)

As always, this composite is a combination of many different cases to protect confidentiality.

Alice came to therapy because she knew she was overreacting in her relationship with her boyfriend, Ed.

A day or so after she got angry with him, in hindsight, Alice could see that she had overacted, and she felt ashamed and guilty about it.  She would apologize and tell Ed that she would try not to be so reactive, but then a week or so later, she would find herself overreacting again, and this became an ongoing pattern in their relationship.

Alice loved Ed very much and she knew that Ed loved her.  When she was calm, she knew she could trust him, but when she was in the throes of an overreaction, she forgot all of this and she reacted as if he didn't love her and he wasn't trustworthy.

She would often feel rejected and abandoned by things that he said--only to realize afterwards that she overreacted once again.

This happened to Alice so frequently that she was beginning to feel like she was losing her mind.  After she calmed down, she couldn't understand how she could have felt so sure that he was rejecting and abandoning her when she was upset.

She asked herself:  Why couldn't she remember that he loved her?

Even though Ed was patient, Alice knew that her reactions would erode their relationship after a while. She knew she couldn't keep accusing him of being unloving and then apologize afterwards.  She knew she had to do something.

Having been in talk therapy in the past to deal with a traumatic childhood, Alice felt she needed to try a different type of psychotherapy, so when a friend told her how much EMDR helped her, Alice decided to give it a try.

Overcoming Trauma With EMDR Therapy

As we discussed Alice's family history, it became apparent that she was uprooted quite a bit from infancy to adolescence, due to her single mother's substance abuse problems.

During that time she was moved from her mother's home to her maternal grandmother's home and then to an aunt's house.

Finally, when she was a teenager, she moved back with her mother.  By then, her mother was sober, but her mother was still emotionally neglectful.

As an only child, Alice remembered feeling lonely and unloved.  Even though her grandmother and aunt took care of Alice's basic needs, they remained emotionally distant from her.  Alice would pray to have a loving adult come into her life, but she remained without emotional support.

Emotional Neglect:  The Past Affects the Present

As an adult, during her first therapy, which was talk therapy, Alice learned to make intellectual connections between the childhood emotional neglect and her feelings of being unlovable but, even though she had an intellectual understanding, talk therapy didn't help her to actually overcome these feelings.  So, she experienced herself as carrying around this heavy emotional burden throughout her life.

She usually managed to make only one or two close friends because she had a hard time trusting people.

While in college, even though she wanted to be in a loving romantic relationship, she had an even more difficult time trusting men because she felt too emotionally vulnerable to open up (see my article:  An Emotional Dilemma: Wanting But Dreading Love).

After college, having been in talk therapy, Alice knew that her feelings of being unlovable as an adult were connected to her early childhood neglect, but she didn't know how to change this.

She often wondered if she would ever feel emotionally safe enough to enter into a serious romantic relationship (see my article:  Adults Who Were Emotionally Neglected as Children Often Have a Hard Time Trusting).

When she met Ed, she knew he was one of the kindest, gentlest, loving men she ever met.

At first, they got along well.  But as they continued to see each other and got closer, after several months, Alice began to feel emotionally vulnerable and unsafe.

She knew these feelings weren't related to anything that Ed was doing or not doing, but she couldn't stop herself from seeing even the most innocuous remarks that he made as rejecting and abandoning.

During their last argument before Alice started therapy, Alice exploded when Ed said he had to work late and he couldn't see her.  She accused him of lying, not loving her, abandoning her and not caring about her feelings.

Overcoming Trauma With EMDR Therapy

Afterwards, Alice realized that she had overreacted, and she knew that Ed wasn't lying and that he genuinely cared for her.

As Alice recounted this argument and other similar arguments, she broke down in tears.  She said she was sick and tired of feeling this way, tired of accusing Ed of not loving her, and tired of the arguments that she started with him.  She also feared that she would bring about the very thing that she feared most--that Ed would get tired of her and leave her.

Developing Coping Skills as Part of Resourcing Before EMDR Processing
Since Alice came to do EMDR, I began by helping her to develop better coping skills so she could cope with her feelings both in our therapy sessions as we processed her traumatic background as well as in her everyday life.

We focused on helping her to respond instead of react (see my article:  Responding Instead of Reacting).

This phase of EMDR is called resourcing (for more details about resourcing, see  a prior article that I wrote).

As someone who was emotionally neglected as a child, Alice primarily knew only two maladaptive ways of attempting to cope:  overacting or emotionally shutting down.  She knew intellectually that neither way worked for her, but she didn't know what else to do.

After the resourcing phase of EMDR, we were ready to begin processing her traumatic childhood experiences which were triggering her emotional reactions in her current relationship.

Before we started, I reminded Alice that she was in complete control of the process in terms of stopping or pausing the EMDR processing if she felt too overwhelmed.

This is very important for people who have experienced early childhood trauma where they were overwhelmed, there was no one to soothe them, and they felt helpless to do anything about it.

Bridging Back in EMDR
Then, we used a recent memory of Alice being upset with Ed and used that to go back to her earliest memory of feeling this way as a child.

This concept in EMDR is derived from clinical hypnosis and it's known variously as the affect bridge, the float back technique or bridging (see my article:  Bridging Back to Heal).

How EMDR Works:  Bridging Back to Heal

Sensing her emotions and where she felt these emotions in her body, Alice was able to remember an early memory where she was being uprooted once again from her grandmother's house to her aunt's house and how scared and unloved she felt (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

This earlier memory turned out to be significant in terms of how she got triggered in her current relationship.

EMDR and Imaginal Interweaves
EMDR uses a concept called "imaginal interweaves" to help clients to process emotional trauma.  These imaginal interweaves are used to help clients to feel emotionally supported during the EMDR processing of the trauma memory (see Laurel Parnell's book, Attachment-Focused EMDR).

The goal of EMDR is not to analyze the memories.  After all, many people who come for EMDR therapy have already analyzed their memories in talk therapy and they have intellectual insight.  After talk therapy, what they often don't experience is emotional healing.

This is not to say that talk therapy doesn't work because I continue to do talk therapy.  But there are certain people with early trauma that aren't healed by talk therapy.

So, rather than analyzing the trauma, the goal of EMDR is to process the traumatic memories with some form of bilateral stimulation, BLS (see my prior article for an explanation of BLS) so that the client is no longer affected by the trauma.

To use imaginal interweaves, clients are asked to imagine protective and nurturing people who might have helped them during the trauma.

These protective and nurturing people can be actual people in the client's life who are either from now or back then.   They can also be people from movies, TV programs, books or people from history.

Imaginal interweaves can include anyone and EMDR clients are only limited by their imagination.

They can include an imagined "ideal mother," who is different from their actual mother.

EMDR and Imaginal Interweaves:  Imagining the Ideal Mother

The idea of using imaginal interweaves is not for the client to believe that anything other than what actually occurred is what happened.  The logical part of the brain knows that, in actuality, there was no one who helped.

But the emotional part of the brain can take in these imaginal interweaves and this is emotionally healing.  This is why imaginal interweaves they're used.  Al Pesso, who developed Psychomotor Therapy, refers to this as new symbolic memories (see my article:  Mind-Body Psychotherapy: Healing With New Symbolic Memories).

The Therapist's Empathic Attunement 
An EMDR therapist needs to know more than how to do EMDR.  She also needs to be exquisitely attuned to what's going on with the client and be able to track the client's emotional experience.

A skilled EMDR therapist needs to be in sync with the client.  This is often referred to as a "right brain to right brain" connection, which means that the therapist's right brain, the area of the brain for empathic attunement, senses what's going on emotionally with the client.

This also presupposes that the client and the EMDR therapist have already developed a good enough working alliance so that the client will allow this (see my articles:  The Creation of the Holding Environment in Psychotherapy and The Therapist's Empathic Attunement Can Be Emotionally Reparative to the Client).

The EMDR therapist must also be able to repair whatever ruptures might occur in therapy (see my article: Ruptures and Repairs in Therapy).

Whenever Alice became stuck in the EMDR processing, we used an imaginal interweave to help her to get unstuck so that the processing could continue.

Gradually, over time, Alice's level of emotional disturbance about this memory was significantly reduced.

EMDR and Generalizable Effects
At the same time, she was much less reactive in her relationship with Ed, so we could tell that the EMDR processing was have a generalizing effect.

Generalizable effects in EMDR means that the healing effects of EMDR are also carrying over to other memories and current interpersonal interactions.

Overcoming Trauma With EMDR Therapy

Completing EMDR Therapy

By the time that Alice completed EMDR therapy, she was no longer overreacting.  She was also no longer feeling unlovable, rejected or abandoned in her relationship.  She was able to free herself emotionally from her traumatic history so that she could live her life unencumbered by these memories.  She was also able could to develop meaningful friendships.

Getting Help in Therapy:
Reacting negatively to the present based on the past is a common experience for people who have experienced emotional trauma, especially if they experienced early childhood trauma.

If you feel that unresolved trauma is keeping you stuck, rather than spending your life reacting based on your past, you owe it to yourself to seek help from a licensed mental health professional who is trained in a mind-body oriented experiential therapy, like EMDR (see my articles:  Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs) and Reacting to the Present Based on Your Traumatic Past).

About Me:
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

One of my specialities is helping clients to overcome emotional trauma (see my article: What is a Trauma Therapist?

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.

Post-Traumatic Growth: Finding Personal Meaning in Your Life After Trauma

In my prior article, Coping With Psychological Trauma and Asking "Why Me?"," I discussed how people who are experiencing trauma can go through a stage where they feel that it's unfair that they're experiencing trauma.  In the scenario that I gave, I also discussed how psychotherapy can help people find personal meaning in their emotional pain--even while they're going through it (see my article: A Search For a Meaningful Life).

Finding Personal Meaning in Your Life After Trauma

Finding personal meaning in trauma often comes when time has passed and people have developed some level of acceptance, if not complete acceptance, about the trauma.  This doesn't mean that they're not sad or angry or that they're still not traumatized.

Clinical Vignette
In the fictionalized scenario that I gave in the prior article, Jane began trauma therapy to deal with the loss of her husband, who died in a fatal car accident.

Like many people who start therapy after a traumatic loss, Jane wasn't sure that she would benefit at all from therapy and she couldn't imagine that she could ever feel any better about her husband's death (see my article: The Benefits of Therapy).

However, her trauma therapist introduced her to EMDR therapy, a therapy that is usually effective in helping people to overcome trauma and, gradually, Jane realized that her emotional pain was starting to diminish.

As her pain began to diminish, she began thinking that she would like "something good" to come out of her loss, but she wasn't sure what it could be at that point.

This is a stage that many people go through as they attempt to find meaning in their psychological pain.

Let's continue to look at Jane's story, which is common to many people trying to find personal meaning in their pain and loss.

As Jane felt a strong urge to find personal meaning in her experience of having lost her husband, she and her therapist began to explore what might be meaningful for Jane (see my article: Coping With Grief).

There were still days when Jane felt discouraged, and there was an inner negative voice that told her she wasn't going to find anything meaningful about her loss so it was useless to try (see my article: Making Changes: Overcoming the Inner Voice of Negative Prediction).

But over the weeks and months that followed, she was having more days when she felt she wanted to channel her energy into something positive and life affirming.

When she thought about how she spent most of her days at work, she realized that she no longer liked her work as a corporate executive.  She was well compensated and she liked her colleagues, but she didn't find the work meaningful.

Initially, even thinking about making a change was scary for her.  Her current career was all that she knew.  She had worked her way up from an entry level to an executive position.  She didn't feel qualified to do anything else.

As part of her grief work, Jane was part of a bereavement group.  She liked the group members and she derived a tremendous amount of support.

Several months later, it occurred to Jane that she would like to "give back" by helping others who were going through experiences that were similar to her own.

As Jane and her therapist explored various possibilities, Jane looked into getting a Master's degree in social work.

She looked into the various schools and their requirements and became excited about the possibility of making a career change.

At the same time that she was excited, she was also scared about making such a big change.  A career in social work would be completely different from what she had done for most of her adult life.

She was aware that she would earn a fraction of what she was currently earning, but she was fortunate to be in a financial position to take such a cut.

She was also aware that it would be a complete change in the way that she saw herself.  At the same time, as she took stock of her life, she knew her current career was no longer satisfying to her.

In addition, Jane knew that her parents and siblings wouldn't understand why she was making such a drastic change in her life.

She knew that her mother, especially, often bragged to her friends that Jane was a successful executive and that she would think that Jane was making a terrible mistake by becoming a social worker.  In her mother's mind, there was no prestige in being a social worker.  So, Jane decided to keep her thoughts about changing careers to herself for the time being.

She took one step at a time by talking to her therapist, who was a clinical social worker and psychotherapist, about it.  She also spoke to other social workers to find out more about the field and the possibilities.

When she was ready, she sent several applications to graduate social work programs in NYC, hoping to get into one of them.  In the meantime, she continued working at her current job.

To her disappointment, she wasn't accepted into any of the graduate programs.  But several of them suggested that she could improve her chances of getting in by doing volunteer work at a social services organization.

Asking around, she discovered that there were volunteer positions open at a different nonprofit organization that held bereavement groups that were lead by trained facilitators.  After training for a few weeks, she observed a seasoned volunteer facilitator lead a group.  Eventually, she was given her own group to facilitate.

Jane enjoyed leading the group and found the experience to be personally meaningful to her.  She also discovered that many of the issues that people raised in the group, not surprisingly, were issues that she was struggling with at the same time.

Fortunately, she was able to talk to her therapist about this in her own individual therapy, so she could listen to group members and not feel flooded by her own feelings.

The following year, when she reapplied to social work graduate programs and wrote about her experiences as a bereavement group facilitator, she was thrilled to be accepted into two programs.

Jane decided to go to the program where she could attend classes part time on Saturday so she could continue to work at her current job.

She loved most of the classes, her professors and her fellow students.  She discovered that many of the students in this part time graduate program were also undergoing a career change.

She and several other students got together after class to talk about the challenges involved with changing careers.  Some of them were in similar careers to Jane's.  After a while, they became a support network for each other.

When it was time for Jane to do her first internship, she knew she would have to talk to her boss about rearranging her work schedule.  Until then, she hadn't told anyone at work or in her family that she was attending social work graduate school.

Initially, her boss was stunned and he laughed.  He thought she was joking, but when he saw that Jane was serious, he told her that there was no way that they could spare her during the day.

He said it was "all well and good" if she wanted to spend her own time on Saturdays to take classes, but they would need her to be present for meetings and conference calls during the day.  He told her that she was a highly valued executive at the firm, but he also hinted that if she wasn't continuing to bring in revenue as she had been until now, it would be reflected in her next bonus.

Jane was disappointed as she walked back to her office.  She knew that her company had made generous contributions to many nonprofit organizations, and she thought her boss might be somewhat open to her rearranging her schedule as long as she continued to meet her goals.  But his response left her feeling cynical about him and the company.

With only a few months to go before she had to start her first internship, Jane talked about it with her therapist.

Money wasn't an issue.  The real issue was:  Could she leave her job after so many years to pursue a career in social work?  She knew that this would have been a decision she would have had to make eventually, but she didn't think she would be facing it so soon.  She had hoped that she would have more time to deal with this.

As she continued to discuss this possible change, she realized how identified she had been for so many years with her career.  It had been fulfilling to her--until now.  At this point, it was increasingly meaningless to her.  At the same time, although it was no longer fulfilling, she felt secure in it.  It was the only career that she knew.

Then, she thought about all the changes that she had made since her husband died, how difficult it had been--and yet, she was doing better.  Her desire to change careers from the corporate world to the social work world was part of those changes.

At one point, she wondered aloud in her therapy, "What would my husband advise me to do?"  Then, she knew instantly that he would tell her to "Go for it!"

Moved to tears by how much she missed him and the memory of his unwavering encouragement, Jane decided that if she had to quit her job in order to do an internship, she would do it.

The following week when she met with her boss again, Jane told him about her decision.  This time her boss, knowing that Jane was completely serious, didn't laugh.  Instead, he tried to persuade her to change her mind, "Think about what you're giving up?  You've worked so hard to get to where you are now.  Why would you throw it all away?  We don't want to lose you.  You're one of the best producers in the company. What can I say to make you stay?"

By the end of their discussion, they compromised.  At her boss's suggestion, she agreed to take a personal leave of absence instead of quitting.  Jane's projects were transferred to a colleague and she was ready to begin her first internship.

After she met the senior clinician who would be supervising her internship at a nonprofit counseling center, Jane knew that she found her niche.

Throughout this time, Jane continued to attend her therapy sessions to help her manage all the changes that she was going through.

The next change, talking to her family about her career change, would be one of the more difficult ones, which I'll discuss in my next article.

Many people who experience trauma have a desire to find personal meaning in their life.

This can begin an exploration, often in therapy, about what would be personally meaningful.

Often, this exploration can lead to personal changes, including changes in how people see themselves, their worldview and what they find meaningful in their lives.

Although it can be challenging, finding personal meaning after trauma can also lead to living life in a deeper, more fulfilling way.

Getting Help in Therapy
Self-exploration is part of psychotherapy.

Finding personal meaning after trauma is a journey, and a skilled psychotherapist can help to facilitate that process.

If you're currently reexamining your life, you could benefit from working with a licensed mental health professional who can help you through this process so that you can lead a more fulfilling life.

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

I have helped many clients to discover what is personally meaningful to them and to make the necessary changes to lead a more fulfilling life.

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, November 28, 2022

The Healing Potential of the Therapist's Empathic Attunement

In my prior article, I began discussing the therapist's emotional attunement in the therapy session.  In this blog article, I would like to continue to discuss emotional attunement by focusing on how the therapist's attunement to the client can be emotionally reparative.

The Therapist's Empathic Attunement Can Be Emotionally Reparative for the Client

The following vignette, which is a composite of many cases, will help to illustrate this point:

Jane grew up in a household where she was the youngest of 10 children.  Her mother worked cleaning people's apartments, and her father worked in a factory during the day and as a taxi driver at night.  Both of them were exhausted when they came home, and they relied on Jane's older sister, Ruth, to help them with the children and the household chores.

Jane was very different from her siblings.  While they liked to go out and play in the yard, she preferred to stay in and read books.  She loved using her imagination to make up stories and do artwork.  But Ruth, who was 12 years older than Jane, had little patience for Jane.  Ruth was often irritated and resentful that so much was expected of her and she became very impatient with Jane at times, especially when she thought Jane was "wasting time" playing, reading or drawing.

All of Jane's basic needs were taken care of in terms of having a roof over her head, food to eat, and clothing to wear.  But she often felt lonely in her home.

Jane had lots of fantasies about what she wanted to do when she grew up, but she had no one to talk to about it.  Her parents' attitude was that when she graduated high school, she should be happy to find a job, any job.  It didn't matter if she liked it or not.  Liking your work seemed like too big a luxury to Jane's parents.

So, when Jane decided to go to college, her parents and older siblings were flustered and confused.  None of them had gone to college and they couldn't see why she wanted to go.  Her parents warned her that they didn't have the money to send her, so she had to rely on scholarships and part time jobs throughout college.

When Jane graduated college, she was surprised that she didn't feel good about it.  She felt like something was missing, but she didn't know what it was.  

She knew, at least on an rational level, that graduating college was a significant accomplishment. But she didn't feel it.  Her family came to her graduation, but they seemed self conscious, guarded and out of place.  Jane watched her friends' parents swell with pride about their children's graduation, and she wished her family could do the same.

Throughout her 20s, Jane continued to feel that something was missing inside of her, but she couldn't put her finger on what it was.  So, when she was 24, she began therapy.

No one in Jane's family had ever been to therapy, and she didn't dare tell her family.  She knew they wouldn't approve of it and they would think she was wasting money.  They would never understand if she told them that she felt something was missing in her.  They would probably laugh and tell her she had too much time on her hands to think about herself.

Initially, Jane felt self conscious and anxious in therapy.  On some level, she felt she didn't deserve to be there:  Maybe her family was right--maybe therapy was an indulgence that was for other people, not someone like her.  Whenever she had these thoughts, she burned with shame.  And yet...she knew there was something of value for her in therapy.

The Therapist's Empathic Attunement Can Be Emotionally Reparative for  the Client

Over time, Jane began to sense that her therapist cared about her and wanted to hear about what she felt.  At first, this was uncomfortable because Jane wasn't accustomed to this.  When she was growing up, she would normally keep her thoughts and feelings to herself.  Or, she would write stories about young girls like herself, never quite realizing at the time that she was writing about herself.

During the first few months of therapy, Jane felt ambivalent about the therapy process.  On the one hand, she was grateful to have a place where she could speak uninterrupted and have the therapist's undivided attention.  It was a new experience for Jane to be heard in this way.

On the other hand, Jane felt a deep hurt because she realized what she was missing when she was growing up.  As a child, she never allowed herself to feel the pain of the emotional deprivation.  But she felt it now and it made her feel very sad.

One day, when she was feeling particularly undeserving, Jane decided to make up an excuse about not being able to afford therapy.  This wasn't true because Jane had very good out of network benefits that paid for 70% of her therapy.  

But Jane couldn't bring herself to tell her therapist that she felt she didn't deserve all this attention.  So, at the next therapy session, she went in looking outwardly cheerful and confident and told her therapist that she had to end therapy because she could no longer afford to come.

Jane was especially good, even with her close friends, at convincing people that she was happy even when she felt very sad.  She had a lot of experience pretending that she was okay when she really wasn't.  

She was sure that she would convince her therapist.  But to Jane's surprise, her therapist, who was empathically attuned to Jane, mentioned that she sensed there was something else going on, and she wondered if Jane would be willing to discuss it.

What followed in that session was an emotional breakthrough for Jane and a breakthrough for her therapy.  Jane took an emotional risk and opened up.  She cried a lot during that session for everything she didn't get as a child and for how undeserving she felt now.  She spent many sessions after that one focusing on these issues while her therapist remained empathically attuned to her.

If Jane's therapist had not been empathically attuned, she might have accepted Jane's excuse on face value.  And Jane would have continued to feel emotionally deprived and undeserving. 

More than likely, this would have had consequences for both her personal life and her career.  But, being empathically attuned, Jane's therapist sensed the underlying issues going on with Jane and let Jane know.

Overall, Jane's therapist's empathic attunement was an emotionally reparative experience for Jane.  It was the first time Jane felt genuinely cared about and understood in this way.

Empathic Attunement and Therapeutic Rapport
In order for there to be empathic attunement in psychotherapy, there needs to be a good fit between therapist and client.

A good fit means there is a rapport between the client and the therapist.  Often, this develops over time.  But when it doesn't  happen, when clients don't feel a rapport with the therapist, I recommend that they discuss it with their therapist.  And if it continues to be a problem, they can find a therapist where they can feel this rapport.

A good therapeutic relationship between client and therapist is one of the best predictors of a good outcome in therapy.  And, just like anything else, some therapists are more empathically attuned than others.

Getting Help in Therapy
No therapist is going to be 100% attuned all of the time.  Therapists are human.  But, overall, as the client, you deserve to have a therapist that you feel is empathically attuned to you most of the time.  As a client, the most important thing is to trust your instincts when choosing a therapist.

And if you're with a therapist, who is usually attuned to you, but who may have lapsed into an empathic failure by not hearing you or misunderstanding you in some way, your therapist might be unaware of it.  Tell her or him.  Often these kinds of situations in therapy can be repaired and it can lead to a breakthrough in therapy and an emotionally reparative experience for the client.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex 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, November 27, 2022

Why is the Psychotherapist's Empathic Attunement to a Client's Unconscious Communication So Important in Therapy?

When there is a strong sense of empathic attunement between the therapist and client, when feelings are unspoken and communicated without words.  Feelings can be communicated unconsciously (see my article: Why is Empathy So Important in Psychotherapy?).

A Psychotherapist's Empathic Attunement to Unconscious Communication

Sensing Unconscious Communication
A skilled therapist, who is trained in psychodynamic psychotherapy, can often pick up on a client's unconscious communication during a therapy session.  It often goes the other way too, where an intuitive client can pick up on what is unconsciously being communicated by the therapist.

In fact, at various times, we all pick up on what is unconscious and unspoken in our daily lives, especially with people who are close to us.  Sometimes we're more aware of it than others.

The Psychotherapy Session as a Unique Time and Place For Unconscious Communication
The psychotherapy session is a unique place where a special time is designated on a weekly basis for the therapist and the client to meet to focus on the client's emotional needs.  

There are no interruptions or distractions, so this creates an especially good environment for the therapist to pick up on unconscious communication if she works with unconscious process.

There are times when a therapist might ask about what she senses with the client on an unconscious level because she thinks it would help their work together.  Then, there are other times when she might not because it would be premature and would not serve their work.

As a therapist, I find that it's usually best to ask the client rather than to tell him or her what I might be sensing on the unconscious level for several reasons:
  • First, I could be completely wrong in what I think I'm sensing.  
  • Second, I might be correct, but the client might not be ready to talk about it.  
  • Third, by being somewhat tentative in discussing possible unconscious communication, it allows clients the freedom to reflect on it in their own way rather than imposing my view.
Often, if the therapist is emotionally attuned and the timing is right, talking about what is being unconsciously communicated by the client can open up new areas to be explored in the therapy.

An Example of the Therapist's Empathic Attunement to Unconscious Communication in the Therapy Session
It's not unusual for clients to experience feelings of abandonment when their therapist plans to be away.  These are often unconscious feelings.

Clients, who had behave like adults when they were children, are very good at hiding fear of abandonment. They had a lot of practice as children pretending that they were okay when they really weren't (see my article: Unresolved Childhood Trauma).

Many clients even convinced themselves as children that they were really okay when they really weren't.  So, pretending to be okay to themselves as well as others when they're not comes naturally to them.  They don't even need to think about it.

If the therapist is attuned to a client and also knows the client's history, the therapist can often sense the client's unconscious feelings of abandonment before the therapist goes away.  

It's important for the therapist to be as tactful as possible, especially for clients with unresolved trauma.

If the therapist doesn't use tact and good timing, clients might feel ashamed of their feelings, as they might have when they were children when they were expected to be more mature for their age and psychological development at the time.

But if the therapist is tactful and helps clients to understand that many clients experience similar feelings, especially if they had childhood trauma where they were abandoned emotionally, then it can be a relief to clients. This usually makes discussing what has been communicated unconsciously more meaningful to them.

How Does a Therapist Sense the Client's Unconscious Communication?
Not all therapists work with the unconscious.  For instance, a therapist who is strictly a cognitive behavioral therapist often will not deal with the unconscious mind.  

But assuming that the therapist has training in psychodynamic psychotherapy and is skilled in  detecting unconscious communication, she has different ways she might sense unconscious communication from the client.

For instance, as a psychotherapist who was originally trained in psychodynamic psychotherapy, I often sense physically or emotionally what the client is feeling.  

It's often a visceral feeling for me.  Other times, it's a thought.  Or, I might have a particular song playing in my mind and the words or tune are relevant to what's happening with the client.  

A picture might also flash in my mind's eye that is relevant to my interaction with the client during his or her session.  Then, it 's a matter of whether or not to communicate it to the client and, if so, how.

The Therapist's Attunement Can Be Emotionally Reparative For the Client
The therapist's attunement is usually emotionally reparative experience for clients, especially if they grew up with adults who weren't emotionally attuned to them when they were children.

As previously mentioned, therapists make mistakes at times.  When a therapist makes a mistake with regard to emotional attunement, it's important for the therapist to acknowledge this to the client (see my article: Psychotherapy: Ruptures and Repairs Between You and Your Therapist).

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT,  Somatic Experiencing and Sex Therapist. 

I work with individual adults and couples.

As an Experiential Psychotherapist, who is trained in psychodynamic psychotherapy,  I value clients' unconscious communication.

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, November 25, 2022

Trauma Therapy: The Therapeutic Benefits of Somatic Experiencing Therapy

As a trauma therapist, I have been using Somatic Experiencing (SE) to help clients overcome traumatic experiences for the last 12 years in my private practice in New York City (see my articles: Somatic Experiencing: A Mind-Body Oriented Therapy and Overcoming Emotional Trauma With Somatic Experiencing Therapy).

The Therapeutic Benefits of Somatic Experiencing Therapy

The Somatic Experiencing Framework: SIBAM
Whereas most types of talk therapy use a top down approach, which focuses only on developing insight, SE and other types of Experiential Therapy, use a bottom up approach that incorporates the mind-body connection to work through trauma (see my article: What is the Difference Between Top-Down and Bottom-Up Approaches to Trauma Therapy?).

The basic SE framework consists of the following:
  • Sensation: This includes learning to experience sensations in your body in an emotionally safe way. In other words, if you're not accustomed to feeling bodily sensations as a result of your traumatic experiences, an SE therapist will help you to feel these sensations in a way that feels manageable to you. You will learn how to track internal sensations in your body as you work on issues in SE, including:
    • Kinesthetic: Muscle tension patterns
    • Proprioceptive: Awareness of your position in space
    • Vestibular: Movement, gravity and sense of balance
    • Visceral: Sensations from the gut, lungs, heart
  • Imagery: The use of imagery is an important part of SE healing. This includes using your five senses:
    • Sight
    • Sound
    • Taste
    • Smell
    • Hearing
  • Behavior: The behavioral aspects of SE include:
    • Voluntary gestures
    • Facial expressions
    • Posture
    • Autonomic signals, including
      • heart rate
      • breathing
  • Affect: Affect is how you show categorical emotions, including anger, sadness, happiness, fear and disgust. It also includes sensation-based feelings of attraction and avoidance, which is referred to as the felt sense (see my article: What is the Felt Sense in Experiential Therapy?).
  • Meaning: Meaning refers to the words you use to describe your experiences in therapy related to all of the above (sensation, imagery, behavior and affect).  It includes whatever trauma-based negative beliefs about yourself and the world around you that you might have formed as a result of traumatic experiences. It also includes how open you are to positive emotions.

What Are the Benefits of Somatic Experiencing?
Unresolved traumatic experiences, which are held in the body, often cause problems with managing emotions.

The Therapeutic Benefits of Somatic Experiencing Therapy

Traumatic responses include fight, flightfreeze and fawn (fawn refers to people pleasing).  

Somatic Experiencing can help you:

Develop Bodily Awareness: Unlike regular talk therapy, which focuses on developing intellectual insight, Somatic Experiencing and other Experiential Therapy, helps you to develop a mind-body awareness including an awareness of the unconscious mind (see my article: Experiential Therapy and the Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind and Why Intellectual Insight Isn't Enough to Overcome Trauma).

The benefits of bodily awareness include:
  • Learning to Do a Body Scan: You learn how to sense into your body and assess where you're holding onto tension or pain and what you're feeling emotionally in your body (see my article: Doing the Body Scan Meditation).
Transform Emotional Dysregulation into Emotional Regulation
When you become aware of your emotions and how they are stored in your body, including emotional triggers related to trauma, you can learn how to use your bodily awareness, including grounding and containment techniques, internal resources, visualization and body scans, to bring your mind and body into a calm state.

Use SE Techniques on Your Own: The resources you learn in SE can be used at home, including the grounding and containment exercises, internal resources, visualization and the body scan, so that you can calm yourself between sessions and learn to deal with emotional triggers before trauma is processed to completion.

Release Trauma: Over time, as you become aware of the physical and emotional sensations in your body, you can learn to release trauma and reset your nervous system with the help of your SE therapist so you no longer feel affected by trauma from the past.

Somatic Experiencing (SE) is a mind-body oriented Experiential Trauma Therapy.  

SE is a gentle form of trauma therapy because SE therapists work in a titrated way to help clients to process trauma in a manageable way (see my article: Trauma Therapy: Why Establishing Safety For the Client is Important Before Processing Trauma).

SE also uses a technique called Pendulation which helps clients to manage and cope with distressing emotions. Pendulation is another resource you can use on your own (see my article: Coping With Emotional Distress by Using the SE Techniques of Pendulation).

Many people experience posttraumatic growth after they work through psychological trauma (see my article: Posttraumatic Growth: A Greater Sense of Hope and Meaning After Working Through Trauma).

When to Get Help in Trauma Therapy
If you have been unable to overcome psychological trauma on your own or in other types of therapy, you could benefit from working with a Somatic Experiencing therapist.

Working through psychological trauma allows you to live free of your traumatic history so you can live a more fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to overcome psychological trauma (see my article: What is a Trauma Therapist?).

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.

Pets Can Improve Your Mental Health

Millions of people around the world consider their pets to be part of their family.  Not only are pets a source of unconditional love, they can also improve your mental health.

How Can Pets Improve Your Mental Health?
Pets can provide the following mental health benefits:
  • Providing Comfort and Social Support: The mutual love between pets and their humans is a source of comfort for most people.  Pets and humans form a bond that helps each of them to feel less alone. 
Pets Can Improve Your Mental Health

  • Providing Companionship: The comfort of having a pet can reduce loneliness and social isolation. In addition, taking care of a pet can help you to feel needed and loved.
  • Helping to Relieve Stress and Anxiety: Many people who struggle with anxiety experience relief with their pet. Many pets are attuned to their human's stress and anxiety and they provide emotional support.
  • Helping to Relieve Depression: The companionship of a pet can help to relieve depression.
  • Reducing Work Stress: Pets have a way of building bridges in groups. In most work environments employees come together more easily when there is a pet in the office. Pets also help people to be more productive and reduce stress at work.
Pets Can Reduce Work Stress

  • Improving Physical Health: People who have dogs get exercise when they walk them. Daily walks can help with cardiovascular health.
  • Providing Structure and Routine: Pets need daily structure to thrive and so do humans. When you have a pet, you benefit from the daily structure as well.
Pets Can Improve Your Mental Health

  • Helping to Meet New People: People who have pets, especially dogs, often meet new people in dog parks or on daily walks, so pets can be help to increase your social circle.
  • Providing Sensory Stress Relief: Stroking a dog or a cat can help reduce your stress and help to reduce blood pressure. 
  • Providing Help With Managing Emotions: Unconditional love from a pet can help people to manage their emotions when they come home from a stressful day and they are met by their loving pet at the door. This interaction can help people to transition from a difficult day to a loving home environment.
  • Providing Meaning and Joy: Having a pet can provide meaning and joy, especially as you age and lose connection with loved ones who aren't around any more. A pet can increase your pleasure, give you a sense of meaning and purpose, and increase your sense of confidence and optimism.
Pets Are a Major Commitment
Before getting a pet, make sure you understand that it's a major commitment in terms of time and money.

You also have to be around most of the time to take care of a pet. For instance, if you travel a lot and you're not around, this can be lonely for a pet who doesn't understand where you are or if you're coming back.

You also need to make sure you're not allergic to certain pets.

Before you get a pet, make sure you have the right home environment. For instance, big dogs might not get the exercise they need in a small apartment.  In that case, having a cat might be better since they can thrive in cozy spaces.

Under the right circumstances, pets can help improve your overall health and mental health as well as bring you joy and comfort in many ways.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex 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.