Follow

Translate

NYC Psychotherapist Blog

power by WikipediaMindmap
Showing posts with label ACE Study. Show all posts
Showing posts with label ACE Study. Show all posts

Monday, April 17, 2017

How One Person Can Make a Difference in a Traumatized Child's Life

One person can make a difference in an emotionally traumatized child's life (see my article: Overcoming Emotional Trauma and Developing Resilience).  More about this later in this article.

How Even One Person Can Make a Difference in a Traumatized Child's Life

First some background:

The ACE Study
A landmark study that was conducted in 1998, called the CDC-Kaiser Permanente Adverse Childhood Experience (ACE) Study found that the more types of emotional trauma a person experienced, the more likely it is that they  will develop social, behavioral, and emotional problems and the adult onset of chronic medical problems.

These adverse childhood experiences (ACEs) include:
  • direct emotional, physical and sexual abuse
  • a mother being treated violently
  • a family member with substance abuse or mental illness
  • parental separation and divorce
  • a house member incarcerated
  • emotional and physical neglect
Some specialists also include experiencing racism or witnessing violence, which I believe are also very important categories.

At around the same time that of the ACE study, Harvard researchers and pediatricians were conducting research on toxic stress.

They discovered that repeated and continuous exposure of toxic stress can have a negative impact on a child's brain development.  Their findings led them to question whether childhood trauma could be prevented or it's impact could be reduced.

How One Person Can Make a Difference in a Traumatized Child's Life

As a psychotherapist, who specializes in helping clients to overcome emotional trauma, I've worked with many clients who have experienced both shock trauma and developmental trauma.

I have found that it is often the case that, even where there was emotional, physical and sexual abuse or neglect, adults, who experienced trauma as children, can often name at least one person in their childhood who made a difference in their life.

How One Person Can Make a Difference in a Traumatized Child's Life

These often include relatives outside the immediate family, teachers, guidance counselors, coaches, family friends, therapists and others who provided emotional support that helped to mitigate the emotional trauma they were experiencing as children.

Even when clients come to therapy and they can't immediately think of someone in their life who made a difference, over time, while working in therapy, they often remember people that they haven't thought of in a long time and realize how important those people were to their emotional survival.

The following is a fictionalized vignette, which is a composite based on many different cases with no identifying information, illustrates these points:

Mike
Mike came to therapy after many years of experiencing very little joy in his life.

How One Person Can Make a Difference in a Traumatized Child's Life

He was married and gainfully employed, and he was able to function in his daily life.  But he always felt "there's something missing."  Mike felt an emptiness in his internal world.

When his therapist explored his family history, it became evident that, as an only child with emotionally distant parents, he was lonely and emotionally neglected (see my article: Looking at Your Childhood Trauma History From an Adult Perspective and Overcoming the Trauma of Parental Alienation).

How One Person Can Make a Difference in a Traumatized Child's Life

His parents, who were both focused on their professional careers, didn't plan to have children.

At a young age, Mike learned from his parents that he was "a mistake" (see my article: Growing Up Feeling Invisible and Emotionally Invalidated).  Even though his parents joked about this, Mike felt emotionally wounded by it and he sensed the truth behind their jokes:  They didn't want him.

Mike was often left in the care of a full time nanny, who was efficient, but cold and emotionally withholding (see my article: What is Childhood Emotional Neglect?)

As he explored his feelings about himself, he realized that he felt like an unlovable person (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

Mike's therapist prepared Mike to do EMDR Therapy to help Mike overcome the trauma he experienced as a child which resulted in his feeling unlovable (see my article: How Does EMDR Therapy Work?).

As part of EMDR therapy preparation, EMDR therapists often ask clients to remember people in their lives, either past or present, who were nurturing, protective or wise figures in their life (see my article: Developing Coping Strategies and Resources Before Beginning Trauma Processing in Therapy).

When his therapist asked Mike about people in his life who were emotionally supportive of him when he was growing up, Mike couldn't think of anyone from the past or present.  Not even his wife--they were together, but they were emotionally estranged.

How Even One Person Can Make a Difference in a Traumatized Person's Life

As mentioned earlier, his parents were cold and withholding, and Mike had no siblings.  He and his parents also had very little contact with extended family, so there were no relatives that Mike could think of from his childhood who were nurturing.

During the preparation phase of EMDR, clients can identify any emotionally supportive people--whether they are "real" (people that they've known) or people they don't know but whom they imagine are nurturing, including people from a movie or TV programs, historical figure, characters from a book, and so on.

The important aspect of this part of the work is for clients to be able to have internal access to an emotionally supportive figure that they can imagine while they're doing the trauma work.  This helps them to sense emotional support, especially during the therapy work.  This, of course, would be in addition to the emotional support from the therapist.

When there has been emotional neglect or abuse, clients often have a hard time coming up with anyone from their life or someone imagined.

There can be such a pervasive feeling of being "unlovable" that, even when there actually were people who were supportive, these clients often don't have immediate access to those memories because they feel so unlovable and undeserving of love and nurturance.

After thinking about it for a while, Mike couldn't think of anyone from his life, so he chose a person from a program that he used to watch as a child, Mister Rogers of Mister Rogers' Neighborhood.

Initially, Mike said he felt "silly" imagining Mister Rogers being there with him, but he understood the importance of re-experiencing his traumatic memories while sensing the presence of a nurturing figure, so he imagined Mister Rogers sitting next to him.

At first, it felt contrived to Mike, but as he continued to do it, he was surprised that he could actually feel the love and support of this kind person that he used to watch on TV.

As an emblematic memory of his feeling unlovable, the memory that Mike chose to work on was being told by his mother that he was "a mistake."

Even as he recalled his mother's words and how she laughed, as if she were making a joke, Mike felt profound waves of sadness and shame.

But, when the sadness and shame felt overwhelming, he was able to temporarily shift his attention away from the memory to imagining the emotional comfort of Mister Rogers.   At that point, he really understood the importance of the EMDR preparation work and using nurturing figures.

Several weeks into processing this memory, Mike suddenly remembered Mr. Blake, who had been like a Mister Rogers to him when he was a child.

Remembering Mr. Blake was part of the memory reconsolidating aspect of EMDR therapy. It helped Mike to access these positive memories about Mr. Blake.

How One Person, Like Mr. Blake, Can Make a Difference in a Traumatized Child's Life

Once he remembered Mr. Blake, Mike was surprised that he didn't think of Mr. Blake before when he and his therapist were working on the EMDR preparation phase.

Then, Mike remembered many of his talks with Mr. Blake and, for the first time in his life, Mike became fully aware of the positive effect that Mr. Blake had on his life.  It was like an epiphany to Mike.

Mike remembered that he did well in school, but he was very quiet and kept to himself.

He also remembered that the school bullies would pick on him, taunting and harassing him all the way home from school because they sensed his vulnerability.

One day, as Mike was leaving school, the same bullies followed him and began calling him names.

Just as one of the bullies started tugging on Mike's jacket, their teacher, Mr. Blake, who was nearby, confronted the bullies, reprimanded them and threatened them with disciplinary action if they ever bothered Mike again.  This frightened the bullies and they ran off.

Mr. Blake took Mike aside and told him that he could come to him at any time if the bullies bothered him again or if he needed to talk about anything else.  Mike was grateful, but he was too shy to say anything except "Thank you" in a near whisper.

During the next few years, Mr. Blake would often talk to Mike after school to find out how Mike was doing, even after Mike was no longer in his class.

Unlike his parents, Mr. Blake was kind and empathetic and took an interest in what Mike had to say, and  Mike began opening up more to him to tell him about his interests.  Mr. Blake listened and praised Mike and encouraged him to pursue his interests.

When Mike was in high school, he would sometimes drop by his old school to talk to Mr. Blake.  During those visits, Mr. Blake encouraged Mike to go to college, even though Mike was filled with self doubt about applying to college.

Based on Mike's hard work in high school and Mr. Blake's encouragement, Mike got into the college of his choice.  Mike maintained contact with Mr. Blake for a while, but the demands of college soon overtook Mike's time and they lost contact.

By the time Mike came to therapy many years later, he had initially forgotten about Mr. Blake but, as previously mentioned, EMDR therapy helped him to access these memories, even though he wasn't consciously aware of them.

When he was younger, he didn't really understand the difference Mr. Blake made for him.  But now that he was accessing these memories about Mr. Blake, Mike was able to look back at those times and realize how pivotal his interactions with Mr. Blake were in his life.

Mike talked to his therapist about how, without Mr. Blake, he probably wouldn't have developed some of his interests and he wouldn't have gone to college.  He knew his life would have been very different without this mentoring and guidance.

As Mike talked about this, he realized that Mr. Blake really cared about him, and Mike was emotionally moved by this.  He couldn't believe that he went through his life feeling that no one really cared about him when Mr. Blake took the time to talk to him and obviously cared.

From then on, Mike used his memory of Mr. Blake as a nurturing figure to continue to do the trauma work.

As he continued to do the work, Mike suddenly remembered other people, who were kind and nurturing to him in small ways but, until then, Mike had forgotten all about them.

Mike also realized that, despite the emotional neglect that he experienced as a child, he was also a resilient person and he overcame many obstacles in his life from childhood through adulthood.  This really helped Mike to feel good about himself.

Working Through Early Childhood Trauma as an Adult 

Over time, Mike was able to overcome his feelings of being unlovable and, as he did, he opened up more to his wife.  He discovered that, until then, his wife experienced him as emotionally detached and didn't know how to approach him.  She assumed that he didn't love her anymore.

She didn't realize what an emotional rut he had been in for such a long time until he processed his childhood trauma and began coming out of his rut. As Mike felt more alive, he was able to rekindle his relationship with her.

Conclusion
Even in situations where children are abused or neglected, one person's can make a positive difference in a child's life by being emotionally attuned and caring.

At the time, children might have little to no understanding of the impact that this person is making in their life.  But later on in life, when they look back, especially if they're in therapy, they often become aware of how important this person was to them for their emotional survival and well-being.

As time goes by, it's not unusual for some people to forget about these pivotal people in their lives, especially if there is significant emotional trauma.

EMDR therapy and other forms of experiential therapy, like Somatic Experiencing and clinical hypnosis often help clients to have access to these memories, which can have a profound healing effect (see my article: Experiential Therapy, Like EMDR, Can Achieve Emotional Breakthroughs).

Getting Help in Therapy
As discovered in the ACE study and many years before that, going back to the time of Freud and the early days of psychoanalysis, childhood emotional neglect and abuse can have an adverse impact on adults' emotional and physical well-being with the adult often developing chronic physical ailments.

These detrimental effects usually carry over into adulthood.  But many adults, who feel anxious, depressed, emotionally numb or who have chronic ailments don't realize that what they're feeling is the result of their earlier childhood experiences.

They also don't realize that they can be helped in therapy to overcome these problems.

If you're feeling unhappy with yourself and your life, you're not alone.

You can be helped to overcome your problems with the help of a skilled mental health professional (see my article: How to Choose a Psychotherapist).

The first step is making a phone call to set up a consultation.

While it might be the hardest step in the process, it can lead to positive changes in your life (see my article: The Benefits of Psychotherapy).

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

One of my specialties is helping clients to overcome psychological trauma, and I have helped many clients to overcome trauma to live fulfilling lives.

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, December 19, 2016

Are You Experiencing Chronic Stress and Not Aware of It?

In my prior article, How Do You Know When You're Under Too Much Stress?, I began a discussion about enduring overwhelming stress.  As I mentioned in that article, there are many people, who have lived with chronic stress all their lives, who don't recognize when they're overwhelmed by stress.  It just feels "normal" to them.

Are You Experiencing Chronic Stress and Not Aware of It?

But there are definitely psychological and health-related consequences to longstanding chronic stress.

In this article, I'm exploring this dynamic by giving a fictionalized clinical vignette to illustrate how people who experience chronic stress can be unaware of it and what can be done to overcome this problem:

Ina
Ina started therapy after she saw her doctor for debilitating headaches and chest pains and medical tests ruled out any underlying medical problems.  Her doctor told Ina that the cause of her headaches and chest pain was stress and recommended that she start therapy (see my article: Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

Are You Experiencing Chronic Stress and Not Aware of It?

Ina had never been to therapy before, so she wasn't sure what to expect, but her therapist provided Ina with psychoeducation about therapy and helped her to understand how therapy could help.

During the next two sessions, Ina talked about her family history.  Although her family history was filled with many losses and significant emotional trauma, Ina talked about it in a matter-of-fact way without much emotion.  She was very emotionally detached from her own childhood history.

When her therapist reflected back to Ina, Ina seemed surprised.  She had never thought of her childhood history as being particularly traumatic.  In fact, she had not thought much about it at all.  In response to her therapist, she shrugged her shoulders and said, "That's just the way it was."

Part of her early history was that Ina had to over-function for both of her parents because they both had serious problems with alcohol.

As the oldest, Ina took it upon herself to cook, clean and take care of her younger siblings--starting at the age of 10.  She told her therapist, "If I didn't do it, no one would have done it.  I couldn't just let my brothers and sisters starve or not go to school."

Ina was so detached from that younger part of herself that was emotionally and physically neglected and who had to mature beyond her years that she didn't realize that she had paid a psychological and physical price for taking on this role.

Since she couldn't see it for herself, her therapist asked Ina how she would feel if one of her own young children had to take on these adult responsibilities at such a young age and without help from any other adults.

At that point, Ina began to cry because even though she was detached from her own early childhood trauma, she cared very much for her children and she never would want them to have to go through the same thing as she did.

It was only when Ina was able to see her situation from the point of view of her own children that she realized that what happened to her was traumatic.

In the following therapy sessions, her therapist talked to Ina about the ACE study, which was an extensive study which showed how experiencing early childhood trauma could lead to stress-related psychological and physical problems.

After that, Ina began to open up more and she was able to talk about how hard it was for her and how anxious she was all the time because she didn't know how to do half the things she was doing for her siblings.  She worried all the time that she might get it wrong and they would suffer in some way.

In many ways, Ina still worried excessively about her siblings--even though they were all doing well as adults.  So, her therapist realized that Ida was emotionally stuck in the past.  Even though she knew that her siblings were all doing well now, she still had the same worries as when she was a child.

When her therapist pointed this out to her, Ina was surprised because she never thought of this before.  She realized that her therapist was right--there really was no need to worry about her siblings anymore.  Then, she became curious about why she was continuing to worry.

Her therapist explained to Ina that she had learned to habitually worry about her siblings and her emotions had not caught up with the present.  She was still worrying as if she was living in the past.

Are You Experiencing Chronic Stress and Not Aware of It?

Over time, Ina learned had to take better care of herself.  Her therapist taught her how to meditate.  She also began exercising at the gym.

Her therapist also talked to Ina about how EMDR therapy could help Ina to work through her unresolved childhood trauma so that she wouldn't have to continue to live in the past (see my articles:

As Ina and her therapist did EMDR therapy, Ina noticed that her chest pain had disappeared and her headaches were infrequent.

Gradually, Ina worked through a childhood of trauma and loss and, as she did, she was under much less stress.  It was as if a big weight had been lifted from her shoulders.

It was only after she experienced much less stress that she realized how much stress she had been carrying around inside of her.  She was able to relax more, sleep better and enjoy life more.

Conclusion
A lifetime of chronic stress can take a heavy toll on you both physically and emotionally.

Chronic stress can become increasingly debilitating over time.

Many people who have experienced childhood trauma and loss become "shutdown" to just how much stress they're experiencing.

This makes sense when you realize that, as children, they didn't have many options if they wanted to survive.  Like "Ina," they did what they had to do without much awareness of the toll that it was taking on them.

Medical doctors who are savvy about the mind-body connection know that many (if not most) medical complaints that their patients have are stress related.  After they have eliminated any underlying medical cause, they know that their patients need psychological help--not medical help--and they refer them to a psychotherapist.

Getting Help in Therapy
If you recognize yourself in the vignette above, you're not alone.  Millions of people have had similar experiences.  The unfortunate thing is that most of them never realize that their symptoms have psychological roots.  They often go from one medical doctor to another for "the answer."

As a child, you might have survived your circumstances by not allowing yourself to be conscious of how bad the situation was and how it was affecting you.

Often, it's not until you're an adult that you begin to experience the stress-related symptoms.

Although it's helpful to go to the gym and use other self care techniques, if you have the kind of childhood history that "Ida" had, those self care techniques aren't enough to overcome the trauma.  They can help temporarily to overcome the stress, but the psychological trauma will still be there just under the surface waiting to be triggered by a current situation.

If you can identify with the vignette above, you can take the first step to overcome these stress related  problems by setting up a consultation with a psychotherapist.

By working through your unresolved childhood trauma in therapy, you can live a more fulfilling life free from your history.

About Me
I am a licensed NYC 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 business hours or email me.

























Saturday, September 26, 2015

Developing Coping Strategies in Therapy Before Working on Trauma

Many people, who have a traumatic history, avoid coming to therapy because they fear being overwhelmed (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious and Ambivalent).

That's why it's so important for psychotherapists to help clients develop coping strategies while working on emotional trauma so that they can overcome their fears and do the therapeutic work without becoming overwhelmed.

Developing Coping Strategies in Therapy Before Working on Trauma 

Before any trauma work begins in therapy, a skilled therapist will help clients to develop the internal resources needed to do the work.

Some clients, who engage in meditation, yoga or other mind-body oriented practices, might already have some internal resources.

Other clients, who might not know how to soothe themselves, will need help from a psychotherapist on how to develop these internal resources.

Internal resources are an important part of preparing to do trauma work.  They allow the client to switch, if necessary, from disturbing memories of trauma to relaxing places within themselves to take a break before resuming the processing of the trauma.

Knowing that they have a way to soothe themselves helps most clients to feel that the trauma work in therapy is manageable so they don't approach the work with overwhelming fear.

Unfortunately, many people who need help to overcome traumatic experiences don't know that skilled trauma therapists facilitate the internal resourcing process, so they avoid coming to therapy because they're too afraid of being overwhelmed.

If they do eventually come to therapy, it's often at the urging of a spouse, their doctor or their employer because the unresolved trauma is causing problems in other areas of their life.

Let's take a look at a fictionalized scenario that addresses these issues, which is representative of many similar cases, and I'll discuss how I work:

Tom
Tom sought therapy for the first time at the age of 35 at the urging of his wife and his medical doctor.

Despite growing up in a highly dysfunctional family where his mother gambled and his father was physically abusive with everyone in the family, including Tom, Tom did very well in college.

Developing Coping Strategies in Therapy Before Working on Trauma 

He established himself in a successful career, he got married and had two children.

Judging from outer appearances, anyone would think that Tom was leading a happy and successful life.  Having a loving wife and children and everything that he needed on a material level, he seemed to be living the American dream.

But, despite external appearances, Tom's inner life was in a state of chaos.  He was good at hiding his anxiety and deep sense of low self worth so that no one would have guessed at his deep unhappiness--except his wife and his doctor, who knew about Tom's panic attacks, anxiety-related stomach problems and his frequent nightmares about the childhood physical abuse he experienced at the hands of his father.

As time went on, Tom experienced an increasing disconnect between the happy facade that he managed to put on for friends and colleagues and his deep unhappiness.

His doctor, who knew Tom and his family for many years, provided Tom with psychoeducation about the Adverse Childhood Experiences Study (ACE) and talked to Tom about how his unresolved trauma from childhood was affecting him now (see my article:  Overcoming Childhood Trauma).

After Tom learned about the ACE study from his doctor, he was amazed that his experiences from so many years ago were still affecting him.

Before he learned about the ACE study, he felt like there was wrong with him since he have everything that he ever wanted, but he still felt anxious and insecure.

His doctor also told him that he could resolve his childhood trauma by getting help in therapy with a psychotherapist who specializes in working on trauma.

Tom was hesitant about seeking help in therapy.  He was afraid that he would be overwhelmed in therapy if he had to delve back into his painful childhood memories.  At the same time, he knew that he needed help.

If Tom came to see me for a consultation, I would explain how I work with clients who have unresolved trauma.

Before processing any traumatic memories, I would get a thorough history of the trauma and family of origin dynamics.  I would also develop an understanding of how the trauma affected him in the past and the present as well as his fears about how it could affect him in the future.

I would help Tom to develop coping skills which, in experiential therapy, is called "resources."

Most clients who come to therapy to work on trauma are usually relieved to hear that I help clients to develop coping tools before any processing of trauma begins.

Resourcing for Tom could include, among other things, helping him to learn how to meditate, learning to discover a "safe or relaxing place"within himself, working to help him integrate and reinforce positive memories about himself as well as helping him to develop imaginal interweaves, which involve imagining nurturing, protective and powerful figures in his life  (see my articles:  Why is EMDR? and Empowering Clients in Therapy).

Developing Coping Strategies in Therapy Before Working on Trauma

Usually, as I help clients to process their trauma using experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis, clients begin to experience and understand the connections between their current problems and their unresolved problems from childhood.

Experiential therapy is usually successful with helping clients to overcome trauma more effectively than regular talk therapy.

Getting Help in Therapy
People with unresolved trauma often don't realize that their fears of working on their trauma in therapy are usually based on events that already occurred in their life.

As adults, we all have a much greater emotional capacity to deal with trauma than we had as children.

When you look for a therapist, ask her how she works (see my article: How to Choose a Psychotherapist

In addition to finding a therapist who is a trauma expert, you also want to sense that the therapist is empathically attuned to you (see my article: A Therapist's Empathic Attunement Can Be Healing For Clients).  This could take a few sessions to determine.

In my professional opinion, experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis are the most effective forms of therapy for most people who have unresolved trauma (see my article: Experiential Therapy Helps to Achieve Emotional Breakthroughs).

Rather than continuing to suffer on your own, get help from a licensed mental health professional who is a trauma expert and who uses experiential therapy.

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.

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.