September 11th - World Trade Center: Never Forget - New York City

 

Common Nightmares During the COVID-19 Global Pandemic

Have you been having nightmares lately? If so, you're not alone. Pandemic nightmares have been common during this COVID-19 pandemic.  Regardless of age, sex, gender, sexual orientation, or nationality, many people have been having pandemic nightmares, which is the subject of this article (see my articles: How to Overcome Anxiety Dreams).

Common Nightmares During the COVID-19 Global Pandemic

These nightmares are so common that Robert Bosnak, a Jungian analyst in Santa Barbara California, has been offering a free online workshop on Friday nights at 6 PM (PST) during the pandemic called the Spooky Dreams Cafe where he uses Embodied Imagination, a method of dreamwork which he developed, to help some people on the Zoom call with these nightmares (see my article: Dream Incubation: Planting Seeds).

Many people, who lived through the crisis of the 9/11 World Trade Center attack, have reported in therapy that they're having similar nightmares during this time to the ones they had in 2001 and beyond (see my article: Tips For Getting Better Sleep).

Common Themes in Pandemic Nightmares
There are certain themes that are common in these COVID-related nightmares, including (but not limited to):

• Anxiety-related events or circumstances in the dream
• Places, which were once known and familiar, suddenly looking and feeling unfamiliar in the nightmare
• A need to escape or run
• Feeling trapped, helpless and/or lost
• A regression to an earlier age (e.g., an adult dreaming that they're a child again)
• Losing someone or something
• Phones and other gadgets malfunctioning
• Other sudden and inexplicable changes 

Typical Nightmares During the COVID-19 Global Pandemic
The following dreams are typical of the type of dreams people have been having during this COVID-19 crisis (as told to me by friends and used with permission):

Dream 1:
I'm in a classroom, which is taking place in my apartment. The instructor, whom I like, is taking things out of my dresser drawer to show the class. These items include a silk scarf I haven't seen in many years.  At one point, he breaks apart the wooden dresser drawer, and I'm fascinated by this (it seems like a deconstruction of some sort). Then, I notice that there's a similar dresser in the room that remains in tact.  I leave the room to go to the rest room, and when I come back, my laptop is gone. Somehow, I know that the instructor gave it away to one of my classmates, and I'm annoyed that he did this without my permission. I look around for it, but I can't find it. I see a male friend, who is sitting in a far off corner of the room. Then, suddenly, the scene changes: I'm walking around in an area of my neighborhood, not far from my home, where I've been many times before. I know that this place is familiar to me, but it looks and feels eerily unfamiliar.  I know I need to get back to class, but I don't know which way to go because I'm lost.  Then, I see a cab and get in it.  There's a couple, who are on their way home from the airport, who are already in the cab.  I don't know where to tell the cab driver to go because I'm lost, but I'm relieved to be in the cab.  The cab stops because the couple have arrived outside their home. I get out too because I realize it's useless to be in the cab if I don't know where I'm going.  The couple tell me that I have to pay thousands of dollars to them for the short distance that I went with them, and I get angry and tell them that I won't pay.  I know that my male friend is back in the class, he has his car and he would come get me if I call him, but I don't know where I am, so I can't tell him. The scene changes: I'm sitting at an outdoor bar with this same friend and our classmates.  We're all dressed up. I suddenly realize that I forgot that he's much taller than me.  I tell my friend about what just happened (that I was lost) and he's surprised and laughs. I'm feeling much better.  The outdoor bar is up on a bridge that overlooks people's homes down below. These people have shallow outdoor pools in front of their homes.  I tell my friend that we could do that too (we could each have outdoor pools).  Then, as I'm gazing out at the water from the bridge, I tell my friend, "Let's pretend that we're on the Arno Bridge in Florence" and he agrees.

Dream 2:
I'm a child of 7 or 8 years old. My mother tells me that we have to escape from where we're living to move back to the US.  Only a few close relatives know because it's a secret.  My mother doesn't want her husband, my stepfather, to know that we're running away because he's abusive and we're escaping from him.  I grab whatever I can quickly because we have to get to the airport fast, and I kiss my relatives goodbye.  I don't have time to say goodbye to a male friend, who has been good to me (I'm older in this part of the dream).  So, I try to text him to tell him that I had to leave due to an emergency, but my phone won't work. I know he's going to be hurt that I left suddenly without an explanation, and I feel terrible about this. Then, my mother, brother and I run to the airport to get on a rescue flight that's been arranged for us by the US government to bring us back to the states. Somehow, I get separated from my mother and brother (I'm a young child again in this part of the dream). I don't know which way to go. I'm scared and I call out to my mother, but I don't see her anywhere. Nothing looks or feels familiar, even though I know I've been to this area many times before. I see other people who are also running and I ask them the way to the airport because I'm lost.  They point the way and I run all the way to the airport. Once I get there, I realize I don't have a plane ticket. I call out to my mother again saying that I don't have a plane ticket.  Even though she's still nowhere to be found, a reassuring male voice tells me over the airport public address system that I don't need a plane ticket because this is a special government rescue flight for my family to escape. When I get to security, I realize that I'm not wearing a face mask so I'm not going to be allowed on the flight. I see everyone else around me wearing a face mask, and I look around to see if there's somewhere I can buy as mask (I'm older again in this part of the dream). Then, I realize that I do have a mask, but I've been wearing it on my chin, so I pull it over to cover my nose and mouth.  When I arrive at the gate, I still don't see my mother or brother, but I feel a little calmer because I know I'm going to make the flight and I'll escape from this place.  Somehow, I see the long document that my mother had to fill out to get approval from the government for this rescue flight. I feel badly that I didn't know before about the abuse that my mother endured at the hands of my stepfather.  While I'm waiting for the flight at the gate, I try to text my male friend again. I desperately want to reach him so he won't feel abandoned by me, but my phone still doesn't work. I feel sad that he's going to feel sad and abandoned.

A Word About These Nightmares
I'm going to deconstruct these nightmares and discuss how to work with nightmares in my next article but, for now, suffice it to say that both of these dreams have many typical features of anxiety dreams and, specifically, many elements typical of current pandemic nightmares (outlined above at the beginning of this article).

Getting Help in Therapy
Nightmares during times of crisis are often a way for the unconscious mind to work through difficult emotions and reconsolidate traumatic memories.

In addition, these nightmares sometimes reveal underlying unresolved trauma (see my article: Before and After Psychological Trauma).

If you've been having nightmares during this global pandemic, you're not alone.

An experienced psychotherapist, who helps clients during times of crisis and who works with dreams, can help you to understand and heal from nightmares.

Rather than suffering on your own, take the first step by calling a licensed psychotherapist for help.  Being able to work through your fears and nightmares can provide you with relief and allow you to feel more empowered.

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

I work with individual adults and couples.

One of my specialties is helping clients to overcome unresolved trauma.

During the global pandemic, like most psychotherapists, I'm providing online therapy, which is also known as teletherapy and telehealth (see my article: The Advantages of Online Therapy When You Can't See Your Therapist in Person).

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

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

Remembering Your Strengths as a Way to Cope With a Crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I'm currently providing confidential online therapy sessions.

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

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

Working on Developmental and Shock Trauma in Trauma Therapy

Shock trauma and developmental trauma are different types of traumatic experiences.  

In this article, I will define both shock and developmental trauma, discuss how clients often suffer with one or both, and provide a fictional clinical vignette to demonstrate how trauma therapy can help a client with both types of trauma to overcome his traumatic symptoms (see my articles: Understanding Shock Trauma and Overcoming Developmental Trauma).

Many People Experience Both Developmental and Shock Trauma

Shock Trauma vs. Developmental Trauma in Trauma Therapy
Whereas shock trauma usually involves a one-time traumatic event like a tornado, a car accident, being mugged, and so on, developmental trauma is chronic childhood trauma of neglect or abuse (or both) which occurs over time.

A one time experience of shock trauma with no other underlying issues and a high level of functioning  prior to the trauma is easier to resolve than chronic developmental trauma.  Under these circumstances, shock trauma without other layers of shock or developmental trauma can resolve relatively quickly with trauma-informed therapy.

Generally speaking, complex developmental trauma with layers of psychological trauma, will take longer to resolve because there is more than one traumatic experience.  There might be numerous traumatic experiences throughout childhood and also in adulthood.

Whereas it is easier to find a particular target memory in trauma therapy to work on for shock trauma because it is a one-time event, developmental trauma usually involves multiple memories over time.

In addition, if developmental trauma occurs early in childhood, the client might not have coherent memories of what happened due to the way traumatic memories are stored in the brain.

A person with preverbal (before the individual develops language) developmental trauma might only have access to conscious memories of one sense and no other senses.  For instance, he might only have a memory of a sound with no other sense of the memories (no visual, tactile, auditory, olfactory experiences are available).

This also occurs sometimes in shock trauma.  For instance, a client who was hit by a car and who never saw the car coming before he was hit, might only have a vague memory of hearing the siren of the ambulance.  Even so, in most cases, shock trauma is easier to resolve in trauma therapy than developmental trauma when it is a one-time event.

An experienced trauma-informed psychotherapist can work with whatever experiences a client brings to therapy, even if it is only a partial memory or a vague sense of what occurred.

There are also frequently cases where people come to trauma therapy to deal with shock trauma and they also have underlying developmental trauma.  So, it's not an either/or situation--it can be both shock and developmental trauma.

A Fictional Clinical Vignette:  Working on Developmental and Shock Trauma in Therapy
The following fictional clinical vignette is an example of a combination of shock and developmental trauma to illustrate how trauma therapy can help:

Ron
Ron began psychotherapy 17 years after the 9/11 World Trade Center attack.  He explained to his psychotherapist that he had been on the 10th Floor of the North Tower in the World Trade Center early in the morning on 9/11 when the terrorist attack occurred.

Working on Developmental and Shock Trauma in Therapy

He had vivid memories of feeling the impact of what he later learned was a plane as it crashed on the upper floors of the North Tower, his fear and confusion about what was happening, and how he and his colleagues ran down the stairs to safety shortly after the attack.

Afterwards, as he and his colleagues stood outside the North Tower, they were shocked to see a fire on the upper floors and the sound of fire trucks racing to the scene.  They were also shocked and upset to see people jumping from the Tower.

As he walked away from the building to safety, he tried to call his best friend, Joe, who worked on the 95th Floor of the North Tower, but there was no cellphone service.  So, he and several colleagues continued to walk north to the Brooklyn Bridge so they could get away from the scene and walk home to Brooklyn.

Less than 20 minutes later, Ron remembered hearing another crash.  The impact of the crash was so strong that the walkway shook and the bridge swayed.  When he turned around, he saw that the South Tower was also on fire.

Still not knowing what had happened, he stopped a police officer on the bridge, who told him that both towers were hit by planes and it appeared to be a terrorist attack.  Before Ron could ask any more questions, the police officer, who had been listening to his radio, began to run in the direction of the World Trade Center.

During his psychotherapy session, Ron told his psychotherapist that he and his colleagues, not knowing what else to do, continued to walk over the bridge with many other people who were trying to get away in a scene that felt surreal to him.

Less than an hour later while still on the Brooklyn Bridge, Ron and his colleagues heard and felt a tremendous crash, which they initially thought was an earthquake.  They looked in the direction of the Towers and saw that the South Tower was collapsing in on itself.

Ron and his friends felt momentarily paralyzed in place as they stood in shock, not quite believing what was happening.

Throughout it all, Ron kept trying to call his friend, Joe, but neither Ron's nor his companions' cellphones had a signal.

By the time Ron got home, he turned on his TV and heard that the North Tower had also collapsed.  He also discovered more details about the terrorist attack.

Since his office was closed for the rest of the week, Ron watched news coverage non-stop for rest of the week.  Every so often, he continued to try to reach Joe by phone, but his calls kept going to voicemail.

A few days later, he received a call from Joe's sister to let Ron know that Joe never came home.  The family was hoping that he would turn up, but they feared that he was trapped and killed at the World Trade Center site.

As Ron spoke to his psychotherapist about the events of that day and the following weeks, he was surprised at how emotional he still felt after almost 17 years.  He told his psychotherapist that he eventually learned from Joe's family that he was dead, which was a terrible loss.

He explained to his therapist that he "powered through" during the next several months without the help of therapy.  He thought he was managing, but he was surprised that he recently began having nightmares about the events on 9/11.

His psychotherapist provided Ron with psychoeducation about how people can develop traumatic symptoms many years after a traumatic event.

In subsequent psychotherapy sessions, Ron's psychotherapist asked him about his family history, and Ron revealed that his father was emotionally abusive throughout Ron's childhood, which left Ron feeling that he was powerless and unlovable.  He said that he continued to feel that way as an adult.

Ron also told his psychotherapist that he also felt powerless on 9/11 because initially he didn't know what was happening and he couldn't reach his friend, Joe.

Ron's psychotherapist provided Ron with additional psychoeducation to inform him that he was suffering with both shock and developmental trauma.  She explained to Ron that his earlier childhood trauma might have made him more vulnerable to the shock trauma that occurred as a result of 9/11, especially since he felt powerless as it related to both the shock and developmental trauma.

She recommended that they use EMDR therapy to work on the shock trauma first and then they would work on the chronic developmental trauma (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

After the preparation phase of EMDR therapy, Ron and his psychotherapist talked about which 9/11 memories were the most disturbing and agreed to work on those memories first.  After a few months, they completed the EMDR processing of the 9/11 memories, including the loss of his friend, Joe.

Then, they proceeded to use EMDR therapy for the developmental trauma, which was more complex since it was ongoing throughout Ron's childhood and he continued to feel the emotional impact of his father's abuse as an adult.

Ron came to his psychotherapy sessions every week and worked hard in therapy and between sessions for the next several months.  The work was neither quick nor easy, but by the time Ron completed therapy, he was no longer was having nightmares, he no longer felt powerless or unlovable, he grieved the loss of his friend, and he no longer was affected by his childhood trauma.

Conclusion
Whereas shock trauma is usually related a one-time event, developmental trauma is childhood trauma that occurs over time, like physical abuse or emotional neglect.

People who experience developmental trauma are often more susceptible to developing shock trauma if they are exposed to a shocking or traumatic event.

It's not unusual for trauma-related symptoms to show up many years after the trauma, which can be confusing for anyone who experiences this.

Getting Help in Therapy
EMDR therapy is an effective type of trauma therapy to assist clients to overcome traumatic symptoms in both shock and developmental trauma (see my article: The Benefits of Psychotherapy).

Although EMDR therapy tends to be faster and more effective than regular talk therapy to overcome trauma, when there is complex developmental trauma, it can take time to overcome the traumatic symptoms.

If you have been suffering on your own with traumatic symptoms related to shock trauma, developmental trauma or both, you owe it to yourself to get help from a licensed mental health professional who is a trauma-informed psychotherapist (see my article: How to Choose a Psychotherapist).

Once you have worked through your traumatic symptoms, you have a chance to live a fuller, more meaningful life.

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

I am a trauma-informed psychotherapist who works with individual adults and couples.

I have helped many clients to overcome the both shock and developmental trauma.

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.

Experiential Therapy, Like EMDR, Helps Achieve Emotional Breakthroughs

In an earlier article, Self Blame and the Internal Critic, I began a discussion about how people often experience self blame.  In this article, I will discuss self blame, the need to feel in control and how experiential therapy, like EMDR, helps to achieve emotional breakthroughs.

Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs

Self blame can come in many forms, including a general feeling of "I'm wrong" or "I can't do anything right."

Self blame can also relate to a specific misfortune or trauma in one's life, including loss.

For people who are stuck and mired in self blame related to a traumatic incident, the feelings of self blame often give them the sense that they could have controlled some aspect of the traumatic event when it occurred and that this would have brought about a different outcome.

In most cases, this is an illusion and keeps people stuck emotionally at the point where the trauma incident occurred.

The following scenario is a composite of many different cases to protect confidentiality:

Rena
Rena came to therapy because she blamed herself for the death of her husband, who died on 9/11 at the World Trade Center.

Several years had passed since the tragic event and every day Rena thought about how she could have prevented her husband from dying that day if only she had insisted that he stay home from work because he wasn't feeling well.

She replayed the last moments in her mind over and over again--when she saw her husband as he was standing in their bedroom trying to decide whether to go to work or stay home.

He was sneezing and coughing, and she thought about telling him to stay home but, for some reason which she could never figure out, she didn't say it.  Instead, she told him to come home early if he felt worse and, with that, he kissed her, walked out the door, and she never saw him again.

Rena had attended cognitive behavioral therapy (CBT) a few months after her husband died and, because of that therapy, she realized that she wasn't really to blame.  But her realization was very much on an intellectual level and it didn't help to dispel the grief and guilt that she felt.

Deep down on an emotional level, she still felt that if only she had insisted that her husband stay home, he would be alive today.  Even though she knew logically that this made no sense, on an emotional level, she carried this heavy burden.

The weight of her grief and guilt was such that all she could do was go to work, come home and sleep.  She no longer saw her friends or engaged in activities that she used to enjoy.

Since Rena's prior therapy only helped her in a limited way, she wanted to try a different type of therapy.

So, when her friend told her that she was able to resolve a personal trauma with Eye Movement Desensitization and Reprocessing therapy (EMDR), Rena read up on EMDR and decided that she wanted to try this experiential form of mind-body oriented therapy (see my article:  What is EMDR?).

Rena wanted to work on the memory that she replayed in her mind over and over since 9/11.

After getting Rena's personal history and helping Rena to develop coping skills to work on the trauma, which took several sessions, we began to process the trauma.

When I asked Rena to think about an image that represented the worst part of that memory, she told me that in her mind's eye, she saw her husband standing in their bedroom as he was weighing whether or not to go to work and she was standing nearby, concerned, but silent.

Just saying these words caused Rena a great deal of pain and she sobbed.  After a few moments, she stopped crying and she was able to identify where in her body she felt the grief and guilt--in her chest and throat.

Identifying feelings in the body is an important difference between experiential therapies (like EMDR) and CBT, which tends to stay on the cognitive level.

Then, in keeping with the EMDR process, I asked her what words would best describe how she feels about herself now with regard to that memory, and she said, "I should have made him stay home so he would be alive now."

In terms of how disturbing this memory was for her on a scale of 0-10 (where 0 equals no disturbance and 10 equals the most painful disturbance imaginable), Rena said it felt like a 10.

Then, I asked Rena what words best describe how she would like to feel about herself in relation to that memory, and she said she wanted to feel, "I did the best that I could."

At that point in EMDR therapy, Rena didn't feel this way about herself at all.

Before we started processing this traumatic memory, I reminded Rena that if at any time she felt she was too upset to continue, she could signal me and we could stop for a few minutes or stop altogether for the rest of the session.  It was important for her to know that she was in charge.

Although Rena experienced waves of sorrow during the EMDR processing, she did not want to stop because she felt that something was shifting inside of her, but she wasn't sure what it was yet.

This sense of internal shifting is a common experience for clients who are in EMDR therapy.

We continued to work on this memory for several more weeks.

At the end of each session, we talked about the session, and Rena continued to say that she felt something, which was unidentifiable to her, that was shifting internally.  At that point, it was still hard for her to imagine that she could ever let go of her guilt and sadness for not stopping her husband from going to work on 9/11.

Then, a few weeks later, Rena had an emotional breakthrough.

Until then, as I mentioned earlier, her understanding that her husband's death was not her fault was only a logical construct in her mind--she didn't feel it emotionally, and she continued to carry this contradiction within herself.

But on that day, as she sensed into her body to feel what emotions came up for her about the memory, she realized that she wasn't feeling self blame.  She was sad that her husband died, but she didn't feel responsible for his death.

At first, she could hardly believe that there had been this internal shift within her.

Instead of feeling self blame, she felt a deep sense of knowing that she couldn't have altered the chain of events.  She felt deeply that she wasn't to blame.  She knew deep down that no matter what she would have said, based on how her husband reacted in similar situations prior to that day, he still would have gone to work.  So, she couldn't have controlled the situation--and now she knew this on a an emotional level.

Afterwards, when we talked about this, Rena said that her sense of knowing that she wasn't to blame was different this time from how she had felt before.  She said that this time she felt it in her gut and in her heart.

She knew on a deep level that the idea that she could have changed the course of events was an illusion that she had been hanging onto.

As we continued to work together, what surfaced was that Rena's illusion that she could have changed the course of events at that pivotal point (when he was standing in the bedroom trying to decide what to do) served to keep her feeling emotionally attached to her husband--to that last time that she saw him.

This is why, prior to her emotional breakthrough, thinking about that moment over and over again was so powerful for her.

This emotional breakthrough for Rena helped her to release her grief, which had been pent up in her for several years.  It also allowed her to deal with other emotions that had been covered over by her feelings of self blame.

Over time, we continued to work on other emotional issues that arose about her husband's death, including her feelings of abandonment.  Even though she knew logically that her husband didn't choose to leave her, she experienced this common reaction that people often have when loved ones die.

Along the way, Rena learned other ways to have an internal experience of closeness for her husband without having to remain stuck in the traumatic memory.

Being able to feel the release of grief helped her to start putting her life back together again.  Gradually, she began to see friends again and she took up hobbies that she had neglected since her husband's death.

CBT as a Counteractive Therapy vs EMDR as Experiential Therapy
Each client is different and there's usually no way to know in advance what will be emotionally transformative for a particular client.

I do use CBT for some clients under some circumstances, but my experience as a psychotherapist who specializes in working with trauma, has been that, although CBT can be useful to a certain extent, it often offers limited help, particularly in situations described in the scenario about "Rena."

Of course, it's important for clients to understand on a cognitive level that they're not to blame for traumatic incidents that they could not have controlled.  But, as in the case with Rena, this kind of cognitive understanding is limited and clients will often say, "I know logically that I wasn't to blame, but I still feel on an emotional level that it was my fault."

It's important that clients understand that feeling this contradiction isn't at all unusual when it comes to trauma.

The problem with CBT in these instances is that it is a top-down approach that acts only as a counteractive force to the negative feelings that clients feel about themselves, which often keeps the internal conflict of what they know vs. what they feel in place for clients.

It provides the client with an alternative to how they're thinking, which is good, but it often doesn't change the feelings where they reside, which is deep in the limbic part of the brain.

EMDR Therapy Helps Achieve Breakthroughs

Experiential therapies, which use a bottom-up approach that involves the mind-body connection, like EMDR, Somatic Experiencing, clinical hypnosis and other types of experiential therapies, go to that deeper level and help to make the emotional shift that leads to emotional breakthroughs.

Skilled EMDR therapists also know how to work in a way where clients feel emotionally safe, which is important for clients who have experienced trauma.

I'll discuss this topic further in a future article.

Getting Help in Therapy
Many people live their whole lives blaming themselves for traumatic events that they could not have changed.  They live with the illusion that they could have controlled events, and this serves to keep them stuck in the memory.

For people who are stuck in this way, on an emotional level, it's as if there is no difference between "then," when the event occurred vs "now," their current life (see my article:  Overcoming Trauma With EMDR: When the Past is in the Present).

If this resonates with you, you owe it to yourself to get help from a licensed mental health professional who has expertise in one of the experiential types of therapy, like EMDR, Somatic Experiencing and clinical hypnosis, among others.

Once you're no longer living as if you're still in that traumatic memory, you will be free to live a fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing 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 regular business hours or email me.

September 11th: We Will Never Forget

To all the families and friends who lost loved ones on September 11th, a heartfelt wish that you are with loving friends and family on this anniversary to ease the pain of your loss.  

Let us all remember the lives that were lost in that senseless attack and honor those lives.

After the September 11th World Trade Center attack, I met with many spouses and family members who lost loved ones on that shocking day.

Anniversaries such as September 11th can stir up a lot of emotions.  If you're experiencing a flood of emotions for your loss, be especially kind to yourself on this anniversary.

If you know someone who lost a loved one on September 11th, find out how they're doing and be compassionate.

Life goes on, but we will never forget.

I am a licensed psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist in NYC.

To find out more about me, visit my website:  http://josephineferrarotherapy.com.

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