What is the Difference Between Psychotherapy and Psychiatry?

Psychotherapy and psychiatry sound alike, so it can be confusing to know what the differences are and when to see a psychotherapist versus when to see a psychiatrist.

The Difference Between Psychotherapy and Psychiatry

What is the Difference Between a Psychotherapy and Psychiatry?

While the two terms might sound interchangeable, there are important key differences:

Psychotherapy

Psychotherapists tend to focus on thoughts, including unconscious thoughts, emotions and behavior.

The Difference Between Psychotherapy and Psychiatry

Psychotherapists have at least a two year Masters degree and many of them also have an additional four years postgraduate training from postgraduate institute (like the Institute for Contemporary Psychotherapy, National Institute of Psychotherapies and other institutes).

Aside from traditional talk therapy, psychotherapists who go on for advanced training also provide specialized therapy including (but not limited to):

• Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR)

• Internal Family Systems Parts Work (IFS)

• Accelerated Experiential Dynamic Psychotherapy (AEDP)

• Somatic Experiencing

• Hypnotherapy

• Emotionally Focused Couples Therapy

• Sex Therapy (for individuals and couples)

Depending upon their skills and training, many psychotherapists can help clients to:

• Manage Stress and Anxiety

• Overcome Depression

• Develop Resilience and Better Coping Skills

Couples Therapy

• Improve Relationships

• Process Unresolved Issues, including Unresolved Trauma

• Improve Communication Skills

• Cope with Workplace Issues

• Process Unresolved Grief

• Improve Self Esteem

And many other behavioral and interpersonal issues.

Most psychotherapy sessions occur at least once a week for 45-60 minutes.

Psychiatry

Psychiatry focuses on the medical side of mental health.

Psychiatrists are mental health professions who are medical doctors (MDs or DOs). They provide differential diagnoses, prescribe psychotropic medication such as antidepressants, anti-anxiety medication, antipsychotic medication and other similar medications.

In the past, psychiatrists provided traditional psychotherapy, like Cognitive Behavioral Therapy (CBT), psychoanalysis and psychodynamic psychotherapy. However, these days most psychiatrists provide medication management. 

Some specialized psychiatrists also provide Electroconvulsive therapy (ECT) for severe mental health conditions such as treatment-resistant major depression, ADHD, schizophrenia and  catatonia (a state where someone is awake but unresponsive to other people or the environment).

After the initial evaluation session, psychiatry sessions tend to be shorter in duration (15-20 minutes) to assess how a client is responding to medication management. After a client has been stabilized on medication, sessions might occur every 3-4 months unless the client needs help with medication.

Integrating Psychotherapy and Psychiatry

Clients, who need medication management, benefit from integrating both psychotherapy and psychiatric treatment and many psychotherapists and psychiatrists collaborate to integrate both treatments (see my article: Medication Alone Isn't As Effective As Including Psychotherapy).

For instance, a psychotherapist who is helping a client with anxiety will often be in touch with the client's psychiatrist to provide feedback on what she has observed in therapy sessions and to get information about medications prescribed. This is only done with a written consent from the client.

While some clients choose to only take medication, research has shown that combining psychotherapy and psychiatric treatments is most effective (when psychiatric treatment is needed) rather than just relying on medication because clients learn coping skills and strategies to deal with their mental health issues. 

Psychotherapy can get to the underlying issues that cause the mental health issues and if worked through in therapy, it's possible that medication won't be necessary for certain clients. 

In addition, when clients stop taking medication for certain mental health issues, they often go back to having the same problems they had before they took medication. For instance, if they never learned to manage anxiety symptoms or get to the root cause of their anxiety in therapy, once they stop taking the medication, they are back to where they were before they stopped taking the medication.

At the same time, there are certain mental health conditions that require medication such as schizophrenia, some forms of ADHD or bipolar disorder to mention just a few.

How to Choose Between Psychotherapy and Psychiatric Treatment

Making a decision about mental health treatment can be a big step, especially if you are new to it.

Consider what you need:

Are you looking for help with understanding yourself, improving your relationships, dealing with situational anxiety or working on unresolved trauma or are you dealing with more complex long-standing psychiatric problems?

If you are dealing with a mental health issue that requires medication (e.g., ADHD, bipolar disorder), starting with a psychiatrist is a good first step. Then, once you are stabilized on medication, you can see a psychotherapist to help you to make the behavioral changes that medication alone won't do.

How to Discover What is Right For You

It's easy to get confused about the differences between psychotherapy and psychiatry.

The Difference Between Psychotherapy and Psychiatry

You're not a broken machine that needs to be "fixed". You're a human being which means that, like everyone else, you have messy, complicated and wonderful parts of yourself. We all do.

Rather than focusing on being "perfect", the goal is developing a better understanding of yourself, practicing self compassion, finding the right tools and strategies to deal with life's inevitable ups and downs and living a meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

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.

Also See My Articles:

Why is Experiential Therapy Better Than Traditional Talk Therapy to Deal With Trauma? 

With Experiential Therapy, There Are No Blank-Slate Therapists 

The Mind-Body Connection: Experiential Therapy Offers a Window Into the Unconscious Mind 

Coping With the Death of an Abusive Parent

One of the most complicated experiences of grief is coping with the death of a parent who abused you.

This is especially true if there were times when this parent was kind and caring and, at other times, abusive or just abusive most of the time, which can create confusion for the child being abused. And that confusion often continues into adulthood.

Coping With the Death of an Abusive Parent

In a prior article, Unresolved Trauma: Coping With a Passive Parent Who Didn't Protect You From Abuse, I wrote about an example of this issue in the vignette in that article.

Under these circumstances, it's common to feel a mixture of feelings including relief, sadness, grief, guilt and shame.

Since the parent who abused you is dead and if they didn't express remorse, this means that they can no longer express their remorse and ask for forgiveness. For many adult children, this is its own form of loss.

How to Process Your Emotions While Coping With the Death of An Abusive Parent

• Acknowledge All Your Feelings: It's important to acknowledge all of the mixed feelings you might have towards your dead parent--all the messy feelings like relief, grief, sadness, anger, resentment, guilt and shame.

Coping With the Death of an Abusive Parent

• Be Aware of Your Personal Survival Strategy: Whether your brain and body are numbing or your mind is overanalyzing, recognize that these are your coping strategies for the moment. Grounding techniques and breathing exercises can help you to stay relatively calm. Exercise, even walking, can help you to release some of this "stuck" energy.

• Grieve For the Lost Potential: You might find yourself grieving for the parent you wish you had and deserved to have in addition to any grief you might feel for your actual parent.

Why is Grieving Under These Circumstances So Complicated?

• Biological Paradox: Your brain's attachment system, which seeks connection, and your threat system, which detects danger, are both activated simultaneously. This can lead to internal chaos for you.

• If There Was No Reconciliation: Death removes any chance for the parent to understand, acknowledge and make amends for the abuse. You are left with many unresolved and complicated feelings that you need to work out on your own or, preferably, with the help of a licensed mental health professional who has an expertie in this area.

• Fragmented Memories: It's not unusual for a parent to be warm and loving at one point and threatening and abusive at other times. This can make it very difficult to understand who this parent was to you and how you feel about them. If the abuse occurred when you were young, you might even experience this parent almost as if they are two different people in your life.

• Lack of Validation: Other people might praise your deceased parent at a funeral or memorial service which can feel isolating because it doesn't match your reality. Even close relatives who might know your parent's abusive nature might tell you, "Don't speak ill of the dead" which can also make you feel alone and lonely in your experience.

What Can You Do to Heal?

• Validate All Your Feelings: Accept that it is normal and common to feel many contradictory feelings at the same time. 

• Prioritize Your Peace of Mind: You are not obligated to place your deceased parent who abused you on a pedestal, nor are you obligated to attend their funeral if it will compromise your peace of mind. Others might not understand or agree, but you have to do what is right for you.

• Externalize Your Emotional Pain: Writing a no-holds-barred letter, which you do not send, or writing in your journal can help you to express all your contradictory feelings and begin to process any unfinished business between you and your deceased parent.

• Get Help in Trauma Therapy: Grief counselors often don't have specialized training in how to deal with complex grief like this. Working with a trauma therapist, a licensed mental health professional who is trained in complex trauma, can help you to work through your mixed feelings and overcome the unresolved trauma. There are various modalities of trauma therapy including:

• EMDR (Eye Movement Desensitization and Reprocessing)

• AEDP (Accelerated Experiential Dynamic Psychotherapy)

• Somatic Experiencing 

• Parts Work Therapy (IFS and Ego States Therapy)

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

As a Trauma Therapist, I have helped many 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.

Also See My Articles:

Grieving For a Parent Who Wasn't There For You

Coping With the Loss of a Loved One: Common Reactions 

Coping With Complicated Grief 

Mourning the Loss of a Father You Have Never Known 

Letting Go of Resentment

Unresolved Trauma: Coping With Resentment For a Passive Parent Who Didn't Protect You From Abuse

Coping with resentment towards a passive parent for their role in childhood abuse or neglect is usually a difficult process (see my article: Letting Go of Resentment).

Coping With Resentment For a Passive Parent

When you were younger, you might have seen this parent as the "safer parent" or the "nice parent" as compared to the parent who was mistreating you.  However, as an adult, you might come to the realization that the parent you thought was safer or nicer didn't protect you from the parent who mistreated you.

Coping With Resentment For the Parent Who Didn't Protect You

Resentment is often a signal that your boundaries were violated and your need for safety was ignored.

Shifting from a child's view to an adult view often includes:

• Allowing the Pedestal to Fall: Shifting from idealizing the passive parent to a realistic understanding of their complex role is a first step in recognizing and coping with your anger and resentment. While it's understandable that, as a child, you might have seen the passive parent as the "good one" compared to the abusive parent, now that you're an adult, you can develop a more mature understanding of why they prioritized the abusive parent's comfort over your well-being. There can be many complex reasons for their passivity, but being aware of this parent's role in your mistreatment is essential to your healing.

• Understanding Responsibility vs Blame: There is a difference between blaming versus responsibility. The passive parent had a responsibility for your safety and well-being when you were a child. This is often a trap that many traumatized individuals get stuck in because they want to be empathetic towards the passive parent and yet they feel resentment towards them.

• Considering the Passive Parent's Humanity: At some point, as an adult, when you have worked through some of your resentment, as part of your healing, you can consider that your passive parent wasn't infallible. Acknowledging your passive parent's flaws, including their own fear, conditioning and their possible unresolved trauma, can help you to see them as a flawed peer.

What Steps Can You Take As An Adult to Deal With Your Resentment?

• Validate Your Reality: Your feelings of resentment and betrayal are real and valid. In many instances, the passive parent tends to minimize your experience in order to keep the peace with the mistreating parent. This might involve the passive parent telling you as an adult, "This happened a long time ago. Why don't you let it go?" or "You turned out alright so why are you still resentful about this?" Rather than allowing the passive parent to minimize your experience, you don't have to participate in the gaslighting as you reclaim your power (see my article: Self Validation).

• Set Firm Boundaries: Boundaries are for your own well-being. They are not meant to hurt your parents. Start by affirming your right to be treated with respect and prioritize your healing and personal growth (see my article: How to Set Boundaries Without Guilt).

• Learn to Stop Self Abandoning: In situations like these, many adult children learn to abandon their own needs to placate the passive parent, so it's important not to self abandon (see my article: What is Self Abandonment?).

• Expect the Possibility of Resistance: If you have changed your role with the passive parent, you might encounter resistance in terms of being described as someone who has been "brainwashed" or, from their point of view, they might say you are unnecessarily resentful. Try to remain calm and firm in your stance.

• Consider Their Limitations: You cannot force the passive parent to change or leave their situation. Each of you must make your own decisions. You also need to prioritize your well-being.

• Get Help in Trauma Therapy: Untangling these complex situations can be difficult to do on your own. You could benefit from working with a trauma therapist who can help you to heal and grow (see my article: How Trauma Therapy Can Help You to Overcome Unresolved Trauma).

Clinical Vignette

The following clinical vignette illustrates the complexities involved in terms of coping with resentment towards a passive parent and how trauma therapy can help with unresolved trauma:

Ann

As an adult, Ann revealed to her mother that had her father touched her inappropriately multiple times when Ann was 10 years old. In response, her mother remained silent for a long time. Then she said, "You're 25 years old. These things happened a long time ago. Why can't you just let it go?" 

Coping With Resentment For a Passive Parent

Ann was stunned. When she could find her voice, she told her mother that the of sexual abuse by her father was traumatic and, as an adult, it impacted her sexual relationship with her boyfriend as well as her prior relationships with other men.

Ann's mother looked uncomfortable, "You know your father was drinking at the time. He probably didn't even know what he was doing. Now that he's dead, let him rest in peace."

Suddenly it dawned on Ann that her mother might have known about the sexual abuse when Ann was a child and her mother didn't stop it, "Did you know what he was doing to me?"

Her mother left the room quickly and Ann realized that her mother did know and she didn't protect her.  Ann felt enraged and followed her mother into the living room, "You knew, didn't you?"

Her mother looked upset, "You don't understand what it was like. When your father got drunk, he would threaten me. I was terrified that if I confronted him, he would hit me. And I wasn't working so I had no money. What was I supposed to do? Where was I supposed to go?"

"So you didn't do anything!" Ann shouted at her, "You just let him do it!"

"You were so young. I thought you wouldn't remember what happened when you got older" her mother responded.

Ann was speechless and she froze in the moment. But when she reconnected with her body, she left her mother's home and drove back to her apartment (see my article: Understanding the Freeze Response Related to Trauma).

On the way home, Ann was in tears. She recalled, as a child, hearing her parents arguing when he was drunk. At the time, she thought of her mother as an angel and her father as a devil.

Now she realized that, as a child, she had idealized her mother. But, as an adult, she now realized that her mother didn't protect her or try to get help to make the abuse stop--even though she knew about the abuse.

After several months of trauma therapy, Ann became aware that of just how angry she was that  her mother didn't take responsibility to protect her from her father.

She told her therapist that, when she was 15, a few months prior to her father's death, she confronted her father about the abuse. Her father told her he couldn't remember what he did when he got drunk and said, "Let's just put this behind us."

Her therapist used a combination of EMDR Therapy and Parts Work Therapy (IFS) to help Ann work through the unresolved trauma including Ann's feelings of resentment and betrayal towards each of her parents.

She and her boyfriend, Mike, also attended sex therapy to work on their relationship. Initially, when they first met, their sex life was good, but as their relationship became more emotionally intimate and Ann felt more emotionally vulnerable, Ann would freeze whenever Mike touched her.

During her treatment, Ann's trauma therapist and her sex therapist collaborated for the benefit of Ann and Mike's therapy.

Eventually, Ann's mother began her own individual therapy to deal with her role as the passive parent.

After a year in her own therapy, Ann's mother told her that she was ashamed that she didn't try to protect Ann and she apologized. She realized she needed to take responsibility for not doing her part to stop the abuse. She had profound regret and shame and she wanted to work towards reconciling her relationship with Ann (see my article: Understanding the Barriers to Reconciliation in Families).

Her mother also revealed to Ann that she had also been sexually abused as a child by her father and, in hindsight, she realized that her own experience complicated her feelings about her husband abusing Ann. She said she didn't want to make excuses. She just wanted Ann to understand.

Ann had a lot of mixed feelings towards her mother, but she wanted to forgive her. She also had mixed feelings about father because there were times when he was sober when Ann was a child that he was mostly a kind and loving father. 

She continued to work in trauma therapy to reconcile her feelings towards each of her parents. Since her father died, Ann had no way to reconcile with him directly, but she realized that adult children continue to have an internal relationship with their parents even after they are gone.

In the meantime, Ann and Mike continued to work on their relationship in sex therapy so that Ann could separate her traumatic experiences with her father from her sexual experiences with Mike.

Conclusion

The first step in these situations is to look at your childhood history with adult eyes.

Get Help in Trauma Therapy

Each person has to decide whether they are willing to reconcile with their parents or not. 

Some people decide that what happened when they were a child was unforgivable and others try to reconcile with one or both parents. 

Others decide to maintain a superficial relationship as opposed to being completely estranged (see my article: Family Estrangements: Understanding the Barriers to Reconcilation).

There is no right or wrong decision. There is only the decision that is right for you as an individual.

Trauma therapy can help you to free yourself from your traumatic history so you can live a meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

As a trauma therapist, I have helped many individual adults and couples over the years.

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.

 

Intergenerational Trauma: What is the Link Between Perfectionism and Unresolved Trauma?

In my prior article, How a Parent's Unresolved Trauma Can Affect Their Child, I started a discussion about the potential impact for children of parents with unsolved trauma (see my article: What is Intergenerational Trauma?).

The Link Between Perfectionism and Unresolved Trauma

I'm continuing this discussion in the current article by focusing on one aspect this issue,  which is perfectionism (see my article: Overcoming Perfectionism).

Estimates vary as to what percentage of children of traumatized parents develop perfectionism, but the current estimate as of the date of this article is 25-30%.

What is the Link Between Perfectionism and Intergenerational Trauma?

Trauma-related perfectionism is passed down through biological and environmental pathways:

• Parental Modeling: Children often internalize the harsh, self critical inner voices of parents who use perfectionism to cope with unresolved trauma.

• Epigenetic Predisposition: Chronic stress and trauma in parents can influence gene expressions related to anxiety and chronic stress, potentially exposing children to perfectionistic tendencies.  

• Parentified Roles: Children who are forced to take on adult responsibilities or care for a parent's emotional needs may use perfectionism to fulfill these overwhelming obligations (see my article: What is Parentification and Why Is It Traumatic?).

Signs of Trauma-Based Perfectionism

Unlike healthy striving for excellence, trauma-based perfectionism is driven by fear and shame. 

This includes:

• All-or-Nothing Thinking: Viewing any minor mistake as a total failure or proof of inherent unworthiness (see my article: Overcoming All-or-Nothing Thinking).

The Procrastination Paradox

• Procrastination Paradox: Avoiding tasks entirely because the fear of doing them imperfectly is paralyzing

• Chronic Self Criticism: A persistent internal dialog that equates mistakes with being "bad" or at risk for abandonment

Support the Healing Process

If your child is experiencing perfectionistic tendencies related to intergenerational trauma, healing begins with you:

• Create a Nonjudgmental Space: Create an environment in your home where mistakes are welcomed and met with curiosity instead of judgment.

Create a Nonjudgmental Environment

• Practice Compassion: Help your child to distinguish their worth from their achievements.

• Get Support For Yourself in Trauma Therapy: Healing begins with you. If you have unresolved trauma, get help in trauma therapy so you can become a parental model of mental health. Trauma therapy modalities include:

• Parts Work Therapy (IFS and Ego States Therapy)
  

• Accelerated Experiential Dynamic Psychotherapy (AEDP)
  

• Eye Movement Desensitization and Reprocessing (EMDR)

• Somatic Experiencing (SE)
  

• Get Help For Your Child: Seek help from a licensed mental health professional who does trauma-informed therapy for children. Therapist directories like Psychology Today can provide you with referrals to psychotherapists who work with children in your area.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

As a trauma therapist, I have helped many 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.

Also See My Articles:

How Trauma Therapy Can Help You to Overcome Unresolved Trauma

The Potential Long Lasting Impact of Trauma 

How a Parent's Unresolved Trauma Can Affect a Child 

You Are Not Defined By What Happened to You 

 

The Potential Long Lasting Impact of Trauma

While it's important for everyone to be able to speak up when they are being touched inappropriately, it's mostly a problem for women which I'm addressing in this article.

Why Do Some Women Have Problems Speaking Up When They Are Touched Inappropriately?

There can be many individual reasons why women don't speak up, but the main reasons are fear retaliation, fear of escalation and social conditioning that prioritizes being polite over taking care of oneself.

Speaking Up

In addition, internalized shame and guilt and the societal stigma that often blames the victim instead of holding the perpetrator accountable (e.g., "Look what she was wearing. What did she expect?").

Many women also fear that they will not be believed or they will be seen as overreacting. 

All of these issues create barriers to women speaking up when someone is touching them inappropriately.

In addition, many women experience an internal freeze response where they feel immobilized by the shock of what is happening to them.

Clinical Vignette

The following clinical vignette illustrates these issues and how therapy can help:

Ina

When Ina was 20, she came home from college to visit her family during a holiday break.

Her parents invited family friends, Jack and Betty, over for dinner. This was a couple that Ina had known since she was a young child.

After dinner, while everyone else was in the kitchen, Ina was alone with Jack. She noticed Jack starring at her breasts. At first, she thought she imagining it--until he walked over to her and grabbed her breast.

Shocked and speechless, Ina stood frozen there after Jack walked away not knowing what to say or do.  She never would have imagined that Jack would ever touch her inappropriately.

After she got over the initial shock, she couldn't decide what to do when the everyone else came back into the dinning room. So, not knowing what to do, she did nothing, but she didn't feel good about it.

When she was a young child, her parents would leave her with a neighbor, Don, next door who was also a family friend.  Most of the time, Don played with her and told her stories, but sometimes he undressed her and touched her all over her body. 

During those times when Don touched her, Ina froze. When she got the courage to tell her mother about it, her mother didn't believe her. She told Ina that she must be imagining things (see my article: Overcoming Childhood Sexual Abuse).

It wasn't until her parents heard from another neighbor that Don molested another child  their that they realized he was a child molester. So, they stopped allowing Don to babysit for them, but they never confronted Don or reported the incident to the police.

After the incident with Jack, when Ina went back to college, she felt so confused and angry about the incident that she sought counseling at the college counseling office. 

The counselor validated Ina's experience and recommended a trauma therapist off campus who had experience helping clients to work through trauma.

Using a combination of trauma therapies, EMDR and IFS, the trauma therapist helped Ina to work through the recent incident and the childhood incidents (see my article: Combining EMDR Therapy and IFS Parts Work Therapy).

The work was neither quick nor easy, but Ina felt empowered by it and she felt she could assert herself if it ever happened again (see my article: How Can Trauma Therapy Help You With Unresolved Trauma?).

Ina also had a talk with her parents about what happened with Jack as well as the childhood incidents with Don. Her parents expressed shock about Jack and remorse, regret for not believing her when she was a child as well as regret for not realizing that Jack was capable of sexual assault.

Over time, Ina and her parents gradually worked to repair their relationship.

Tips That Might Be Helpful:

Every situation will be different but, in general, the following tips might be helpful depending upon your particular situation:

• Establish Distance: If someone is touching you inappropriately, move away from the person immediately. If you are in a crowded place, like a subway, try to create a physical barrier with the other person by using a bag or another person. 

Speaking Up

• Speak Up in a Loud Tone: Silence often encourages harassers. Use a firm, loud voice to say things like, "Stop touching me!" or "Don't touch me!" This draws attention to the incident and can shame the person into stopping.

• Be Direct and Firm: Avoid being polite if you feel unsafe. Use clear commands like, "Remove your hand immediately!" or "I don't know you. Get away from me!"

• Seek Help From Others: If you are in a public place, alert others by saying, "This man is touching me without my permission." You can also ask for help from a specific person, like a subway conductor, police officer or, if you are outside, from a shopkeeper.

• Report the Incident: If the incident occurs at work, report the incident to the HR department. Document the time, date and details of what happened. There are also laws from the NYC Human Rights Department and City, State or Federal EEOC that are designed to protect you.

• Reconsider a Relationship If Your Partner Doesn't Respect Your Boundaries: Healthy relationships require respect for personal boundaries. If your partner doesn't respect your "no", it's a troubling sign and a reason to seek support or to end the relationship.

• Recognize That Prior Trauma Might Cause You to Freeze, So Get Help in Trauma Therapy: As in the example above, prior unresolved trauma can create a freeze response so don't be hard on yourself. Get help in trauma therapy so you can process unresolved trauma. 

Conclusion

Problems with speaking up when someone is touching them is mostly a problem for women due to the reasons mentioned above.

Worldwide approximately 30% of women are subjected to sexual assault and this number might under estimate the problem.

Men Are Also Subject to Inappropriate Touch

According to the latest statistics, approximately 3% of men are subjected to sexual assaulted, so this is not exclusively a problem for women.

If you have been sexually assaulted, you are not alone. 

You can contact the National Sexual Assault Hotline: 1-800-656-HOPE (4673).

Get Help in Therapy

Being touched inappropriately in any situation is a violation of your personal boundary.

Getting Help in Therapy

If you are struggling with issues related to being inappropriately touched in the past or in your current life, you can benefit from working with a licensed mental health professional.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), AEDP, Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

As a trauma therapist, I have helped many individual adults and couples (see my article: What is a Trauma Therapist?).

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

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

What is Dual Awareness in Psychotherapy?

The concept of dual awareness is essential in psychotherapy, especially when working on unresolved trauma (see my article: Why is Experiential Therapy More Effective Than Traditional Talk Therapy to Overcome Trauma?).

Dual Awareness in Trauma Therapy

What is Dual Awareness in Trauma Therapy?

The ability to maintain dual awareness is especially important when processing traumatic memories in trauma therapy (see my article: Healing in Trauma Therapy).

Dual awareness is the ability to process traumatic memories while remaining grounded in the safety of the here-and-now.

Dual Awareness in Trauma Therapy

In other words, clients need to balance two realities: the here-and-now as well as the traumatic memory that is being worked in therapy. That means they are aware that, even though they are discussing a traumatic memory, they are safe with their therapist (see my article: Why Establishing Safety is So Important in Trauma Therapy).

Before doing any processing in trauma therapy, it's important for the trauma therapist to prepare clients for the work by ensuring clients have internal and external resources or coping skills, including the ability to remain present and embodied (see my article: Developing Coping Strategies in Trauma Therapy).

To remain embodied means maintaining a conscious connection to their emotions and bodily experiences while processing traumatic emotions (see my article: What is Somatic Awareness?).

Key Concepts of Dual Awareness:

Prior to processing traumatic memories, their therapist helps prepare clients to:

• Balance Two Realities: Clients acknowledge feeling certain emotions related to past traumatic memories at the same time that they know they are safe in the moment with their therapist. 

• Develop an Observing Self: Clients learn to develop an observing self who witnesses their internal experiences (thoughts, emotions, bodily sensations) while processing memories from the past. This observing self can go by many names including Core Self, Adult Self, Higher Self or whatever name is meaningful to clients. Because they have developed a part of themselves that can witness their experiences, they don't feel overwhelmed. This also helps to prevent retraumatization.

Therapeutic Techniques: Trauma therapists often use various techniques to help clients to balance processing past memories with remaining grounded in the present moment. 

Some of these techniques include:

• Pendulation which was developed in Somatic Experiencing Therapy, where the therapist helps clients to shift their awareness from a traumatic memory or experience to a calm or neutral experience or to their Core Self/Adult Self as a way to work on these memories in manageable segments so clients don't become overwhelmed.

• Imaginal Interweaves: Prior to choosing a traumatic memory to work on, clients choose people from their past or present life who would be emotionally supportive. While working on the memory, clients imagine these individuals are accompanying them on their healing journey to undo feelings of aloneness. These people might include a favorite relative, a best friend from the past or the present, a loving teacher and so on. If clients can't imagine anyone they know, they can also choose a person they don't know personally, like a character from a movie or a book, that they can imagine being with them in an emotionally supportive role. In some circumstances, clients might choose someone who they imagine could have intervened directly, like a protective or powerful person who would have protected them when they were younger.  In reality, clients know there might not have been anyone in the original traumatic memory that helped them, but dual awareness allows them to imagine and have a felt sense of being helped or protected.

Dual Awareness in Trauma Therapy

• Breathing Exercises: Being able to pause the work and take a cleansing breath can help the trauma work to remain manageable and tolerable. Clients can also use breathing exercises between sessions.

• Containment: Containment can include clients imagining they can put the traumatic memory away in a box of their choosing at the end of the session. Some clients like to imagine that their therapist keeps the box for them or that they keep the box themselves in a safe place until the next time they work on the memory.

• Learning How to Manage and Reduce Triggers : A trigger is a person, place or thing that causes an unexpected intense reaction related to an experience from the past (see my article: 8 Tips For Coping With Triggers).

What Are the Different Types of Trauma Therapy?

There are different types of trauma therapy including:

• EMDR Therapy (Eye Movement Desensitization and Reprocessing

• AEDP (Accelerated Experiential Dynamic Psychotherapy)

• Somatic Experiencing

• Parts Work Therapy (IFS and Ego States Therapy)

Getting Help in Trauma Therapy

Trauma therapy can help you to process traumatic memories so they no longer affect you in your current life.

Getting Help in Trauma Therapy

Rather than struggling on your own, seek help from a licensed mental health professional who is trained as a trauma therapist so you can live a more meaningful life free from your traumatic history.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy, Somatic Experiencing and Certified Sex Therapist.

I have over 25 years of experiencing helping 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.

Also See My Articles:

What is a Trauma Therapist? 

Overcoming Trauma: You're Not Defined By What Happened to You 

What is Complex Trauma?