NYC Psychotherapist Blog

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Wednesday, November 29, 2023

How to Set Boundaries Without Guilt

I began a discussion about setting boundaries in an earlier article.  In the current article I'm focusing on one of the hardest parts of setting boundaries for many people--dealing with guilty feelings.

Do You Feeling Guilty About Setting Boundaries?
A common problem for people who feel uncomfortable about setting boundaries is that they feel guilty and they fear conflict. So, if the thought of setting a boundary with someone fills you with fear and guilt, you're not alone.

Setting Boundaries Without Guilt

People who have problems setting boundaries often focus on how the other person might feel.  While this is an important aspect of boundary setting, it's only one part of the story.

Often people focus exclusively on the other person's feelings because they have problems focusing on their own discomfort.  

They might feel uncomfortable even acknowledging their own discomfort.  So, it's easier for them to focus on the other person (see my article: People Pleasing to Avoid Conflict).

This is especially common if you were raised to believe you should put other people's emotional needs above your own.  

It might not have been framed exactly that way. Instead, maybe you were told you have to be "strong" for other family members, which often results in you stifling your feelings so that others won't be uncomfortable or they can lean on your emotionally.  

If you grew up being accustomed to prioritize other people's feelings and suppressing your own, you might feel guilty about allowing yourself to even have feelings that are different from your loved ones. 

After a while, you might not even know what your feelings are because you have suppressed them for so long before they even came into your awareness (see my article: Being the Different One in Your Family).

Setting Boundaries Without Guilt

This usually happens in enmeshed and dysfunctional families where children grow up feeling they have to take care of their parent's needs (see my article: Children's Roles in Dysfunctional Families and Role Reversal in Families).

Another example of why you might have problems setting boundaries could be that your boundaries were violated when you were growing up.  This happens when children are abused either emotionally, physically or sexually or if they were neglected.

This is especially confusing when the person who was abusing you was someone you were supposed to be able to trust--your parent, a relative, a teacher, religious leader or someone else who was supposed to have your best interests at heart.  

Even if you weren't abused, you might have internalized a parent's guilt about setting boundaries with their own family of origin or with other loved ones.

For instance, if you saw your mother feeling putting aside her own emotional needs due to guilt, you probably internalized this as a powerful message, especially if you saw it over and over again--even though your mother might not have told you to do this directly.

Why Are Boundaries Important?
Knowing why boundaries are important can help motivate you to do the work involved with developing this skill.

Healthy boundaries:
  • Tell others how you want to be treated and, when the other person respects your boundaries, it can prevent you from being mistreated.
  • Help you to be your own person. You create a healthy emotional and physical separation between you and others so that you don't feel mistreated.
  • Allow you to have your own thoughts, feelings and needs that are separate from others.
  • Allow you to have the time and space you need for your own personal needs.

How to Set Boundaries Without Guilt
  • Get Clear on What You Want: This might be easier said than done, especially if you grew up overriding your own feelings. Thinking about it beforehand and writing in a journal can help to clarify your thoughts and feelings. If it helps you to feel more comfortable, you can write out a script, including any obstacles you anticipate.

Setting Boundaries Without Guilt

  • Be Aware That Healthy Boundary Setting is About Taking Care of Yourself--Not About Controlling Others: Appropriate boundaries is about taking care of yourself. It's not about controlling others--even though they might feel you're trying to control them. Just because they feel that way doesn't make it true. When you set healthy boundaries, you tell yourself and the other person that your thoughts and feelings matter and that you are worthy of being treated well (see my article: Feeling Entitled to Self Care).
  • Be Clear and Direct Without Apologizing: People who have problems setting boundaries are often unclear because they are so passive and indirect that the other person doesn't understand what they're trying to say. This is where it helps to have a clear and succinct message. Compare the following statements and notice the difference between the Examples A and B:
    • Example 1A"Mom, I know you have certain ways of doing things that are  important to you. I have my own way of doing things, so please respect that."

    • Example 1B: "Mom, I'm sorry I don't do things the way you taught me. You're probably right, but I like my way. Is that okay?"
    • Example 2A"Jane, when you borrowed money from me two months ago, you agreed to pay me back within a month, but you haven't, so let's talk about this because I need the money."
    • Example 2B: "Jane, I feel badly about bringing this up because money is such an uncomfortable topic to talk about, but you haven't paid me back the money you borrowed from me. So, I apologize for even bringing it up. I'm sure you have a very good reason why you haven't repaid me, so maybe I shouldn't even be asking, but I really need the money now to pay the mortgage. Of course, if you don't have it, I would understand and maybe I could borrow money from my parents to pay the mortgage."
  • Expect and Plan for Obstacles: Whether the obstacles are your own difficulties with asserting yourself or you expect resistance from the other person, expect it and plan for these obstacles while you're preparing to set a boundary.  You can include how to deal with obstacles when you write about it beforehand.
  • Overcome Your Fear of Conflict: One of the major reasons why people have problems setting boundaries is that they anticipate conflict and they want to avoid it.  This expectation isn't unreasonable expectation when you take into account that other people might be benefitting from the lack of boundaries and they might want to maintain things the way they are. If your boundary setting is met with anger and/or resistance, this doesn't mean you should back off by sacrificing your own needs to placate someone else. Anger and resistance is often a confirmation that boundary setting is important in this situation. Instead of returning to a state of passivity, anticipate these reactions in advance and have a plan. In extreme cases where you expect aggression, make sure you're not alone.
  • Setting Boundaries is an Ongoing Process: If you have managed to set an appropriate boundary with someone, don't expect that this to be a one-and-done process, especially if there is a history of poor boundaries. You will probably need to reinforce the boundaries from time to time.  This doesn't necessarily mean that the other person is intentionally trying to harm you. Instead, it might mean that they also have problems with boundaries so they're trying to develop this skill at the same time that you're trying to develop it.  Also, be aware that your needs and your relationships can change over time so you might need to change the boundary agreements you already have with others.
Getting Help in Therapy
Learning to set boundaries without guilt isn't always easy, especially if the problem is rooted in your early history.

Getting Help in Therapy

A skilled psychotherapist can help you to overcome these obstacles. 

So rather than struggling on your own, seek help in therapy.

Once you have learned to set boundaries without guilt, you can have a greater sense of well-being and healthier relationships.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, 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.


Tuesday, November 28, 2023

5 Common Myths About Sex in Long Term Relationships

In this article I'll be challenging the most common myths about sex in long term relationships.

Pleasurable Sex in Long Term Relationships

Sex Education in the US is Inadequate
One of the leading reasons for so much misinformation, in general, about sex is that only 39 states and the District of Columbia mandate sex education and HIV education in high school.  

These programs vary widely in terms of the quality of the sex education they provide, and some states provide only abstinence-based sex education.  

In addition, all too often, sex education programs only focus on the health risks of having sex with no information about sexual pleasure.  This can leave young people with the misconception that sex is "bad" and always "dangerous."

A lack of quality sex education means people aren't getting the sex education they need. Furthermore, since many young people don't get sex education at home, they turn to porn, which is highly inaccurate.

Moreover, adults in healthcare settings are often too ashamed to ask their healthcare professionals about sex.  And, making matters even worse, many of these professionals, including medical doctors, get inadequate sex education as part of their medical training. So, all too often even if patients ask them questions about sex, they're unable to answer.

Taking all of this into consideration, is it any wonder there are so many myths about sex in long term relationships?

Ageism and Sex
In our youth obsessed culture, there is a stigma against aging and sex.

In addition, many people assume that older people don't want to have sex. While this might be true for some older people, many who aren't having sex, would enjoy sex, but they don't have a sexual partner.

Challenging 5 Common Myths About Sex in Long Term Relationships
So, let's challenge 5 common myths about sex in long term relationships: 
  • Myth 1: Good Sex Means Frequent Sex: It's important to understand that quantity doesn't equal quality. Regardless of how often a couple has sex, sex is only "good" if both people enjoy it. So, for instance, if a couple's sex script is determined only by the demands of one partner and the other partner is only going along without enjoying it, this isn't good sex because it lacks mutuality.  It's "compliant sex" which often breeds dissatisfaction and resentment in the long run for both people (see my article: What is Good Sex?).
  • Myth 2: The Best Sex Always Occurs During the Initial Stage of a Relationship: Sex often gets better over time for couples, especially if the couple is able to communicate their needs to each other.  While it's true that many couples have more frequent sex during the initial limerence stage (the early stage of a relationship where two people are infatuated with each other), frequency doesn't automatically equal "good sex," as mentioned in Myth 1 (see my article: How to Talk to Your Partner About Sex).

Pleasurable Sex in Long Term Relationships

  • Myth 3: Couples in Long Term Relationships Eventually Stop Having Sex: This is one of the most common myths that our culture perpetuates. This myth is further complicated by Myth 1, which is that good sex means frequent sex. Many couples continue to have pleasurable sex into their 60s, 70s, 80s and beyond.  Although they might not have the physical agility they once had in their 20s, if they're willing to try new ways of having sex, their sex life can continue to be enjoyable. Note: If you and your partner have stopped having sex and one or both of you aren't happy about it you could benefit from working with a sex therapist.

Pleasurable Sex in Long Term Relationships

  • Myth 4: Once Couples Stop Having Sex, They Can't Resume Having Sex Again: Too many couples believe this myth, which deprives them of having a fulfilling sex life. Other couples are too ashamed to talk to each other about sex or they don't know how, so this problem never gets addressed.  If both people want to resume having sex, they can make a conscious effort on their own to resume having sex. And, if they're having a problem getting started again, they can consult with a sex therapist for help on how to address the underlying issues creating obstacles for them as well as learn behavioral interventions assigned by a sex therapist as part of the couple's homework to work on in the privacy of their home.

Pleasurable Sex in Long Term Relationships

  • Myth 5: Cheating Means Lack of Sexual Interest in the Relationship: There are a lot of misconceptions about cheating.  In many cases, there is no one particular reason why people cheat. Cheating often has nothing to do with a lack of interest in their partner or in the relationship. Many people, who love their partner and who still feel sexually attracted to them, engage in cheating.  In fact, many people who cheat say they still feel emotionally and sexually fulfilled in their relationship, but they want to feel sexually desirable to others (see my article: Why Do People in Happy Relationships Cheat?).

Getting Help in Sex Therapy
Sex therapy is a form of talk therapy (see my article: What is Sex Therapy?).

Individuals and couples attend sex therapy for a variety of reasons (see my article: What Are Common Reasons Why People Seek Help in Sex Therapy?).

There is no nudity, physical exam or sexual activity in sex therapy sessions. However, there are homework assignments to practice in the privacy of your own home to improve your sex life (see my article: What Are Common Misconceptions About Sex Therapy?).

If you have been unable to resolve sexual problems on your own, you could benefit from seeking help in sex therapy for a more fulfilling sex life.

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.

Sunday, November 26, 2023

To Improve Intimacy in Your Relationship, Get Off the Sexual Staircase

In their book, Desire - An Inclusive Guide to Navigating Libido Differences in Relationships, Lauren Fogel Mersey, PsyD and Jennifer A. Vencill, PhD., discuss the "Sexual Staircase" to describe the kind of routine, goal-oriented sex that people engage in when they're having sex with their partner (see my article: Understanding Your Sex Script).

Improve Intimacy in Your Relationship

What is the Sexual Staircase?
According to Mersey and Vencill, the Sexual Staircase, which is a metaphor, is how most people think sex is "supposed to be."

The Sexual Staircase is a list of hierarchical steps that usually start at the bottom of the staircase with foreplay and ends with sexual intercourse and orgasm.

Depending upon the couple, the sexual acts between foreplay and intercourse can include kissing, caressing, genital touch, oral sex, and so on.

For many people in long term relationships these steps don't deviate. They engage in the same steps in the same way most or all of the time.  

After a while, people in long term relationships often skip some of the steps as they prioritize a goal-oriented approach that always ends with penetrative sex and strives for orgasm.  

Having sex the same way all the time becomes boring after a while (see my article: What is Sexual Boredom in Long Term Relationships?).

What's the Problem With the Sexual Staircase?
If you and your partner enjoy doing the same thing, the same way all of the time and neither of you have a problem with it, then there's nothing wrong with the Sexual Staircase for you.

But many people find this approach to be too routine and unfulfilling.  The problem is that they think this is the way they're supposed to do it, so they just keep doing it the same way.

People who find the Sexual Staircase boring, sexually unfulfilling or not applicable to them often have the following problems with it:
  • It's a heteronormative sex script that focuses on cisgender heterosexual men. For heterosexual men, sexual intercourse is one of the most reliable ways to have an orgasm, but this isn't the case for most women (see below).
  • It assumes that most people want penis-in-vagina sex even though there are many people who don't want it or it doesn't work for them because of problems with dyspareunia (persistent or recurrent genital pain that occurs during penetrative sex) or erectile unpredictability (a persistent or recurrent problem with getting and maintaining an erect penis) or because they're not heterosexual (see below).
  • Sexual intercourse is the least reliable way for most women to have orgasms because they need direct clitoral stimulation, which they often don't get from sexual intercourse or clitoral stimulation is skipped altogether (see my articles: Closing the Orgasm Gap - Part 1 and Part 2).
  • In many long term relationships, the Sexual Staircase gets shorter and shorter over time so that there is little or no foreplay, which has a negative impact of women's sexual pleasure. The focus becomes getting sex over and done with it as quickly as possible because it's unsatisfying.
  • In addition to problems with painful sex and erectile unpredictability, penetrative sex isn't always possible for a variety of reasons, including childbirth, certain disabilities, age-related physical limitations, surgery or other types of problems.
  • When penetrative sex isn't possible (for whatever reason), many couples skip having sex altogether because penetrative sex is the only way they know how to have sex.  Over time, one or both of them become frustrated and dissatisfied.
  • The heteronormativity of this model isn't useful for LGBTQ people, as previously mentioned. Many LGBTQ people assume that since they're not having penis-in-vagina sex, they're not having "real sex," which, of course, is false.  This often leads to feelings of shame, guilt and self consciousness about their sexual orientation.
The Wheel Model
The authors of Desire cite the Wheel Model, which was inspired by Robert T. Francoeur in his book, Becoming a Sexual Person (1991).

Picture a wheel that's divided into different sections with sexual activities represented in a non-hierarchical way.  

Rather than the linear, hierarchical model represented in the Sexual Staircase, in the Wheel Model none of the sexual activities has a higher priority over any of the others.  Other than sexual pleasure, there are no goals, which usually means less pressure for both people and more enjoyment.

In addition, with the Wheel Model, people can engage flexibly pick and chooe what they like, in whatever order they like without being constrained to the rigid model of the Sexual Staircase.

The authors provide an example of what sexual activities might be included in the Wheel Model:
  • Kissing
  • Caressing
  • Touching
  • Massaging
  • Using a sex toy
  • Showering together
  • Cuddling
  • Oral sex
  • Orgasm
  • Penetrative sex
  • Manual stimulation
And more.

The sexual activities included with the Wheel Model are only limited by your imagination.

But this is not to say that you and your partner should engage in the activities they write about or that you should stop having sexual intercourse if it's enjoyable to both of you.  You can do whatever you both enjoy.

The Wheel Model helps to dispel the myth that there's one right way to have sex or that everyone should have the same predetermined sex script.  

Making Changes to Your Sex Script
Once again, I want to reiterate that if you and your partner are happy with your sex script, you can continue using it without a problem.

But if you're stuck in a routine and you're getting tired of doing the same thing over and over again, consider how you can work towards making changes  in your sex script (see my article: Changing Your Sex Script).

As Emily Nagoski, PhD., sex educator and author of the book, Come As You Are, says, "Pleasure is the measure."

This means "good sex" is what's pleasurable for both of you.

Getting Help in Sex Therapy
A skilled sex therapist can help you to overcome sexual problems.

Sex therapy is a form of talk therapy where the focus is on sex and relational problems getting in the way of sexual enjoyment (see my article: What is Sex Therapy?).

Individuals and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

There is no nudity, physical exam or sex during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?)

Rather than struggling on your own, seek help in sex therapy so 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.

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.


Saturday, November 25, 2023

Can You Learn to Trust Your Therapist When You Weren't Able to Trust Your Family?

A common dilemma that comes up for people who have been traumatized is how they can trust their therapist when they weren't able to trust their family as they were growing up (see my article: Dynamics of Adult Children of Dysfunctional Families).

Developing a Sense of Trust in Therapy

Traumatized Clients Have Good Reasons Not to Trust
Most trauma therapists know that it often takes a while before a client can feel comfortable enough to open up.  And this makes sense when people grew up in homes where they couldn't trust family members. They have good reason not to trust a stranger right away--even if the stranger is a licensed psychotherapist.  

As a trauma therapist, who has been working with traumatized clients for over 20 years, I recommend that clients who contact me for help start by talking to me for 10-15 minutes on the phone before they set up a 60 minute consultation.

The 60 minute consultation is for them to talk about what they want to work on in a general way without delving too deep into their problem. I also suggest that they use the session to ask questions about how I work, my education and training, and get a sense of whether they feel comfortable enough with me to book another session.

The reason why I emphasize talking in broad terms during the consultation is that I want the client to feel as safe as they can without making themselves so emotionally vulnerable that they feel overly exposed emotionally after the session.

My Own Experience During My Training to Become a Therapist
When I was in training to be a psychotherapist 20+ years ago, I was required to be in my own three-time-a-week psychoanalysis as part of the training process.  This involved having consultations with potential senior therapists who were part of the institute where I trained.  

Since I was aware that these therapists were part of my institute where they taught and supervised students in the program, I wanted to make a good impression and appear to be a worthy therapist-in-training who had enough life experience to empathize with potential clients but also the potential skills to merit passing the training.

But these consultations turned out to be a lot more stressful than I anticipated because these first session involved delving deep into my history and my deepest emotional vulnerability.  

So, never having experienced this before, I walked out of the first consultation feeling like I was in an altered state.  Walking out into the street I felt all my senses felt heightened.  Everything I saw was brighter and noises were louder than usual.  Even though I knew I was having this experience because I had opened up too much, I still felt unsettled.  It was only after I could take a few deep breaths that I calmed down.

I knew that part of this altered experience was a psychological "fishbowl effect" of feeling exposed as a therapist-in-training where I knew I would run into this therapist at the institute and now she knew so much about my early personal history.

Soon after a few initial consultations, I returned to the first therapist I met and told her about the experience I had in the consultation with her.  Just being able to talk to her about it helped tremendously.  She was sincerely apologetic and I felt a lot more comfortable with her.  

During the next two consultations with the same therapist, my experience was completely different.  I felt safe and comfortable with her, and I eventually chose her because we clicked so well in the second and third consultations.

My Consultations With Psychotherapy Clients
I never forgot that experience and I remember it each time a client calls me for help. I usually spend 10-15 minutes talking to them on the phone and then, if they're interested, we set up an initial 60 minute consultation either in person or online (see my article: How to Choose a Psychotherapist).

I want them to feel as safe, comfortable and in control of what they divulge in that initial consultation.  I also encourage them to ask me questions about the modalities I use and how I might work with their particular issue.  Since I have many different modalities that I use, I usually tell them what it might be like with each modality.

If clients choose to return, I check in with them to find out how they experienced the initial consultation.  If there is anything to process, we talk about it and I listen to what the client needs to feel safe.

During the next few sessions, I gather information about their history as it is relevant to their problem.  This usually includes family and relationship histories and, if they're coming to work on a sexual problem, their sexual history.

When I work with couples, after the initial consultation, I meet with each one individually for one or two sessions to talk about their individual histories.  I also emphasize that it's important for each of them to feel comfortable with me.

Preparation to Do Therapy
If clients come to work on unresolved trauma, after gathering information about their history, I help them to develop coping strategies to deal with whatever might come up in trauma therapy.  Depending upon the client, this could take anywhere from a few sessions to a few months of sessions (see my article: Developing Internal Resources and Coping Skills).

For instance, if a client already has good coping skills and they have a regular meditation practice or they practice yoga, that they might not need as much preparation as someone who is having panic attacks.  Specifically, the person who is having panic attacks needs help to overcome them before working on trauma.  So, each client will have different needs.

In addition, clients need to feel enough of a sense of trust and safety before they can begin processing trauma (see my article: Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma).

Empowering Clients in Therapy
I also let each client know that they are in control of the trauma processing no matter what type of therapy we're doing--whether it's EMDR Therapy, Somatic Experiencing, AEDPEgo States Therapy or any of the other modalities which I use (see my article: What is a Trauma Therapist?).

Developing a Sense of Trust in Therapy 

This is important because people who were traumatized weren't in control of their experiences, and new experiences in therapy can make them feel vulnerable.  So, it's important for them to feel empowered during the therapeutic process (see my article: Empowering Clients in Therapy).

I try to work with each client within their window of tolerance, and I'm usually good at tracking how clients are doing in session. But some people are so good at hiding their discomfort (they had a lot of practice since childhood) that they might hide it from me in order to appear to be a compliant client.  So, I encourage clients to tell me, to the extent that they know, before they get to the point of overwhelm, and I teach them how to detect these feelings.

Helping to get clients back to their window of tolerance could mean that the trauma processing stops temporarily in a session so we can do some grounding or containment  exercises and then return to processing the trauma in that session.  Or, it could mean that we stop and debrief for the rest of the session about what might have come up that was so disturbing.  It's up to the client how we proceed (see my article: Riding the Waves From Trauma to Transformation).

When You're Looking For a Therapist, Take It One Step at a Time
The following steps can be helpful when you're looking for a psychotherapist:
  • Referrals: Get a referral from a trusted source--like your doctor or personal friend or you can read therapists profiles online on a professional therapist directory.
  • Verify License: Make sure whoever you're considering is a licensed mental health professional. You can do this by looking up and verifying their name online in your particular state's professional licensing website (therapists are licensed by state).
  • Look Beyond Location: I know a lot of people choose therapists based on geographic location these days and, while I understand the importance of convenience, I would encourage you to look beyond location.  As long as the therapist is licensed in your state, you can choose anyone, but looking up therapists based on whether they are walking distance from your home or office shouldn't be the sole criteria for choosing a therapist.
  • Talk to Them: Take the time to speak with the therapist on the phone for a few minutes to find out if s/he has the expertise for your presenting problem.  You also might want to know how long they're practicing and what professional training they have.
  • Do a Full Session Consultation: Do at least one initial consultation with the therapist and get a sense of whether you feel comfortable. This doesn't mean you're necessarily going to feel completely comfortable since, after all, you're speaking to a stranger.  It might take a few sessions to know if you feel a connection with a therapist.
Once You Begin Therapy: Tell Your Therapist If There's Anything That's Bothering You About the Therapy
Once if you've begun therapy, let your therapist know if anything has come up that's bothering. you (see my article: How to Talk to Your Therapist About Something That's Bothering You About Your Therapy).

Many people feel too intimidated to talk to their therapist about things that make them feel uncomfortable in the session or they don't know how to do it.  They're afraid the therapist will take it personally or that it might damage the therapeutic relationship.

This problem often originates in clients' history where, as children, they couldn't tell their family about things that made them feel uncomfortable. Back then, it might have been emotionally and/or physically dangerous to do this.  So, being able to talk to your therapist about misattunements or an empathic failure is an important part of your personal growth.

Once clients and their therapist work through any misattunement or other rupture, they often discover that the therapeutic relationship is enhanced when these ruptures get repaired in session (see my article:  Ruptures and Repairs Between You and Your Therapist).

If a therapist is unwilling to talk about a misattunement or rupture, this is often an indication that this isn't the right therapist for you.

Also, remember that not every therapist works well with every client, so even though the therapist might come highly recommended to you by someone you trust, you have to trust your own sense as to whether the therapist is the right for you.

Getting Help in Therapy
Getting help in therapy can feel like a daunting process, but it's less daunting than continuing to suffer with unresolved problems that are having a negative impact on you now.

Rather than struggling on your own, seek help from a licensed mental health professional so you can lead a more fulfilling life.

About Me
I am a licensed New York 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.

Wednesday, November 22, 2023

Relationships: How You Feel About Yourself Can Affect Whether of Not You're Attracted to Your Partner

In my prior article, Relationships: What is Attraction?, I discussed the conscious and unconscious aspects of attraction as it relates to relationships.

In the current article, I'm focusing on how a partner's intolerable feelings of inadequacy can result in the unconscious projection of negative feelings onto the other partner (see my article: Are You Projecting Your Negative Feelings About Yourself Onto Your Partner?).

Projections often don't occur until after the early stage of a relationship when the relationship becomes more emotionally intimate and the partner, who uses projection, feels more emotionally vulnerable (see my article: Romantic Attractions: What Are the 3 Stages of Limerence?).

Clinical Vignette
The following clinical vignette, which is a composite of many cases with all identifying information removed, illustrates how an inability to tolerate negative feelings about oneself can lead to the use of projection:

Jack and Carla:
When Jack and Carla first met in college, they were immediately drawn to one another physically, romantically, emotionally and sexually, and they each felt they had never experienced so much love for anyone else.

Projection and Loss of Sexual Attraction in Relationships

They got married a year later with both of them still feeling so in love and lucky to have found each other.  But their problems began a few months after they got married and moved in together.

Although they had a great sex life before they got married, after they got married Jack gradually lost interest in sex and Carla yearned for their former passionate sex life (see my article: What is Sexual Desire Discrepancy in Relationships?).

After six months of no sex, Jack blamed Carla for his lack of sexual desire.  He told her that he no longer felt attracted to her because she wore sweatpants in their apartment, and he thought this made her look unattractive.

At first, Carla thought Jack was joking, but she quickly realized he was serious and she was in a state of disbelief.

She knew she didn't look different from how she looked before they got married, but she acquiesced to his wishes and stopped wearing sweatpants. Instead, she made sure she was dressed in a nice top and slacks when she was at home and she wore sexy lingerie at night to be more attractive to him.  

But Jack told her that he still didn't feel attracted to her and he blamed the cellulite on the back of her legs for making her look unattractive.  

Carla felt deeply hurt. She told him that he had never complained about the cellulite before, but Jack brushed off her comment by saying, "I can't help it. That's how I feel."

After a year of no sex, Carla suggested they see a sex therapist to work out their problems.  Initially Jack didn't want to attend sex therapy, but he eventually agreed to go.  He hoped the sex therapist would see things his way. 

After the initial consultation where she met with Carla and Jack together, the sex therapist met with each of them separately to get their individual family, relationship and sexual histories.

Carla's family history revealed that she came from an intact stable family. She was the middle child of three children.  Her parents had a loving relationship, and Carla felt loved by her parents and siblings. The only notable trauma in the family was when Carla's father's business failed and the family suffered from a financial downturn for several months until the father took a job as a chief financial officer in a large corporation.  

Prior to her relationship with Jack, Carla had one other serious relationship while she was in college with her classmate, Bill.  They were together for two years and they mutually agreed to end their relationship in an amicable manner.

With regard to Carla's sexual history, she had a few casual sexual encounters while she was in college and she had no history of sexual trauma.

Jack's family history was tumultuous. He was an only child, and his parents had separated and gotten back together several times during Jack's childhood due to the father's infidelity.  Both parents were highly critical of Jack and he grew up with a lot of shame. In addition, their financial situation tended to be precarious.  

With regard to his relationships prior to Carla, Jack had been in two short term relationships which started out sexually passionate and fizzled out after a few months.  He told the therapist that he tended to get bored with his girlfriends and lose interest.

During his last year of high school and until he began seeing Carla in college, Jack had many brief casual sexual encounters.  He denied any sexual trauma.

During their sex therapy sessions, Jack spoke about how his attraction for Carla waned soon after they got married.  He believed that if it was possible for her to have a medical procedure to remove the cellulite, he would feel attracted to her again.

Objectively, the sex therapist could see that both Jack and Carla were attractive people and she didn't believe cellulite had anything to do with Jack's lack of sexual interest in Carla.  

The sex therapist suspected that Jack was unconsciously projecting his own feelings of low self worth, which originated in childhood, onto Carla. She was also aware that Jack had no awareness of this because he was doing it unconsciously.

As they discussed sexual attraction, the therapist provided Jack and Carla with psychoeducation about the different types of attraction.

She also had individual sessions with Jack and Carla.  During the individual sessions with Jack, she broached the topic of projection as a defense mechanism.  But Jack was adamant that projection had nothing to do with how he felt toward Carla.

During the next several months Jack threatened to stop attending sex therapy whenever the therapist tried to help him to make a connection between how he was treated as a child and how he was treating Carla.  He refused to see the connection.

Gradually, after a couple of years, Jack developed a more trusting therapeutic relationship with the sex therapist so he could open up more to explore his inner world of longstanding disavowed shame.  

Over time, he was able to look at Carla more objectively and see that she was actually a very attractive and desirable woman and that he was, in fact, projecting his own feelings of inadequacy onto Carla.  

That's when Jack sought help in individual therapy to work on his unresolved trauma and shame. Over time, he learned to contain and work through his feelings without projecting them onto Carla. 

Carla remained patient, and she also sought help in her own individual therapy to deal with Jack's hurtful criticism about her body.  At one point, she talked to her individual therapist about the possibility of ending the marriage, but when she saw Jack making progress, she decided to stay.

Once Jack acknowledged he was projecting his own feelings of inadequacy onto Carla, this allowed the sex therapist to focus on helping the couple to revive their sex life.

Sex Therapy Can Help Couples to Revive Their Sex Life Together

Their sex therapist gave them homework assignments to help them develop greater emotional land sexual intimacy.  

Projection is an unconscious defense mechanism that people who have unresolved childhood trauma often use with their partners.  

The fact that it is unconscious makes it difficult for people to see and acknowledge what they're doing. 

In addition, they often have difficulty trusting the therapist when she points out how they use projection with their partner.

Projection is used as a way of pushing unwanted and disavowed trauma-related feelings onto a partner.

When projections are used, they are often used after the initial limerence phase of the relationship when the couple's emotional and sexual intimacy increases and the partner, who uses projection, feels too emotionally vulnerable in the relationship.

Since vulnerability is essential to developing greater emotional and sexual intimacy in a relationship, the partner who uses projection needs to be willing to develop self awareness, stop using projection, and find other ways to cope and overcome disavowed feelings in order for the relationship to improve (see my article: Emotional Vulnerability as a Pathway to Emotional and Sexual Intimacy).

Getting Help in Sex Therapy
Couples stop having sex for varied and complex reasons.

Sex therapy, which is a form of talk therapy, can help (see my article: What is Sex Therapy?).

Getting Help in Sex Therapy

Individual adults and couples attend sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

There is no nudity, physical exams or sex during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?).

If you have unresolved sexual problems, you could benefit from getting help in sex therapy to have a more fulfilling sex life.

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

I am a sex-positive therapist who works 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.