Developing Insight in Therapy Isn't Enough to Make Lasting Change

There's a common misconception that if you develop insight in therapy, the insight alone will bring about lasting change.  But this isn't true (see my article: A Common Myth About Therapy: Therapy is All Talk and No Action).

Insight Isn't Enough to Make Lasting Change

Insight alone doesn't bring about change. Insight can help you to understand the problem, which is a good first step.  But you need a lot more than insight, especially when you want to make a major change.

Mind-Body Oriented Psychotherapy Combined With Action on Your Part Can Bring About Lasting Change

As I've written in a prior article, mind-body oriented therapy is also known as Experiential Therapy.

Experiential therapy, including EMDR, AEDP,  Somatic Experiencing and Parts Work, provides a window into the unconscious mind (see my article: Experiential Therapy and the Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

Experiential Therapy can facilitate change on an emotional level rather than just on an intellectual level.  This means an emotional shift, which can be transformational when it is combined with taking action.

The emotional shift can be in how you feel about yourself, your problems and the necessary steps needed to make lasting change (see my article: Experiential Therapy is More Effective Than Talk Therapy).

Are You Willing to Do the Work in Therapy to Make Lasting Change?

Over the years I've received many calls from people who have been in therapy with other therapists for years but who haven't changed. 

Often they'll say that they gained a lot of insight into their problems and their therapist was nice, but their problems remained the same.

In most cases these clients talked about their problems and the therapist helped them to make the connection between their personal history and their current problems. For most of these clients this was a good start, but that's where it ended.

Insight Isn't Enough to Make Lasting Change

How Contemporary Psychotherapy Has Changed

For the most part, contemporary psychotherapy no longer involves clients free associating to a neutral therapist who barely says a word the whole time. 

Contemporary psychotherapy is much more interactive these days with an active therapist and an active client.

Clients who want to make lasting change need to be willing to do the work. Beyond developing insight, this means taking steps--no matter how small--to make changes.  

I think many people don't realize that working on making changes in is a major commitment  in time and effort in weekly therapy.  

Unfortunately, there are some people who believe that the therapist is the one who does something to bring about the change they want.  But that's not how therapy works. 

In collaboration with your therapist, you have to be willing to make a plan so you can take steps to make changes (see my article: Making Changes Requires Taking Action).

Are You Feeling Stuck in Your Therapy?

If you're currently in therapy and you're feeling stuck, as a start, talk to your therapist so you can both assess how and why you're stuck (see my articles: How to Talk to Your Therapist When Something is Bothering You About Your Therapy and Overcoming Obstacles to Making Changes).

Sometimes there's a part of you that wants to change and another part that doesn't. This isn't unusual. Ambivalence is common for clients in therapy (see my article: Overcoming Your Fear of Change).

An effective way of working with these different aspects within you is to work with a therapist who does Parts Work Therapy, which is also referred to as Ego States Therapy or Internal Family Systems (see my article: How Parts Work Therapy Helps to Empower You).

Aside from talking to your current therapist, take time to assess your own willingness to take action.  If you're not ready to take any steps, you might not be ready to make changes at this point in your life.

If you continue to feel stuck after you have talked to your therapist and you have done your own personal assessment of your willingness to take steps to change, you can consult with another therapist who works in a different way to understand how another type of therapy might help you. 

Sometimes an adjunct therapy, like adjunctive EMDR therapy, can help to enhance the work in your current therapy (see my article: What is Adjunctive EMDR Therapy?).

When you attend an adjunct therapy, you remain with your current therapist and also work with an adjunctive therapist. 

Assuming your current therapist is willing, you provide consent to both therapists to share information about your therapy so they can collaborate on the work.

Being proactive in your own change process can be an empowering experience.

About Me

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

I work with individual adults and couples.

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

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

What is Empathic Failure in Psychotherapy?

Most licensed psychotherapists are individuals who are credentialed and skilled in their areas of expertise. I believe the vast majority of psychotherapists are ethical and empathetic individuals who have their clients' best interests at heart and help their clients to overcome their psychological problems. But there can be big differences in terms of skills and experience from one psychotherapist to the next, and I believe that clients should be informed consumers, which is why I'm focusing on this issue.  

Psychotherapists are also human and, like everyone else, they make mistakes in therapy.  In this article, I'm focusing on a particular mistake called "empathic failure" where this is not an occasional problem but a recurrent problem with some psychotherapists (see my article: Why is Empathy Important in Psychotherapy?).

What is Empathic Failure in Psychotherapy?

What is Empathy?
Empathy involves a psychological process where you're able to put yourself in other people's shoes and get a sense of what they're feeling.  For instance, if your friend is upset because her dog died, even if you never had a dog in your life, you can put yourself in your friend's shoes and understand why she's upset about the loss.  You can tap into your friend's feelings and sense what she's feeling and resonate with her sadness about the loss.

What is Empathic Failure in Everyday Relationships?
Empathic failures occur all the time between friends, spouses, family members, students and teachers and so on.  Except when dealing with highly insensitive people, I believe that most instances of empathic failure occur inadvertently.

For instance, a husband might forget that his wife told him that she would like a particular perfume for her birthday. Instead, he buys her a vacuum cleaner and he feels proud of himself because it's energy efficient.

He expects that his wife will be thrilled.  But his wife's reaction is the complete opposite of what he expected--she is upset and angry because she feels he didn't hear her when she told him what she wanted.  She also feels that he sees her only as a "housewife" who cleans the apartment rather than a sensual woman.

While this might be very disappointing for his wife and it's an empathic failure, this isn't a reason to get a divorce if he is usually empathetic and they have a good relationship most of the time.  They can work out this problem and the husband can be more aware next time.

What is Empathic Failure in Psychotherapy?
When clients begin psychotherapy, they usually have a certain degree of trust that the psychotherapist is a credentialed mental health professional who will be attuned to their needs in therapy and help them to overcome the emotional problems.

Aside from all the other clinical skills that psychotherapists learn, one of the most important is how to be empathetic towards clients in therapy.  This is a skill that is honed in graduate school and, if the psychotherapist goes to postgraduate training, this skill usually developed even more.

I believe that most psychotherapists are empathetic individuals and those who go to graduate school who lack this skill are weeded out by supervisors and instructors.  That's not to say that there aren't some people who somehow make it through the screening process at times.

Even the best psychotherapists make mistakes in therapy at times, including empathic failures.  But there's a difference between a therapist who makes occasional mistakes related to empathic failure and those who do it habitually. So, let's start by defining what an empathic failure is in therapy:

An empathic failure occurs in therapy when the psychotherapist isn't attuned to the client.  This can occur in many ways:

• Forgetting important details about the client's life
• Confusing the client's history with another client
• Forgetting what the client and the therapist discussed in the prior session
• Forgetting an appointment with the client
• Focusing on the psychotherapist's life instead of focusing on the client's problems
• Projecting the psychotherapist's needs, wants, and problems onto the client
• Being dismissive of the client's needs
• Failing to be attuned to the client's emotions and mislabeling these emotions
• Failing to take responsibility for the mistakes that the psychotherapist made in therapy

and so on.

As I mentioned, even the best psychotherapists commit empathic failures at times.  For instance, a therapist, who is usually punctual and organized, can confuse his appointment schedule if the therapist is going through a very stressful time in his life.  If things were going smoothly before that, assuming that the therapist takes responsibility for the mistake, most clients would accept an apology and the therapy would continue (see my article: Ruptures and Repairs in Psychotherapy).

The empathic failures that I'm most concerned about are the ones that occur on a regular basis with a client who might have grown up with parents who lacked empathy for him.

Since this client grew up in an environment with chronic empathic failure, he might not recognize that he is in an unhealthy situation with his therapist.  It might seem "normal" to him because this is all that he knows.

The following fictional vignette illustrates how empathic failure can occur between a client and a therapist and steps that the client can take to take care of him or herself.

Fictional Vignette:  Mistakes Psychotherapists Make in Psychotherapy: Empathic Failure

Mike
Mike began therapy after a recent breakup. He told his new therapist that he felt unlovable and not good enough for most of his life.  This began in early childhood when his mother let him know that neither she nor his father wanted to have children, and Mike was "an accident."

He grew up feeling like he was "an inconvenience" to his parents, who paid very little attention to him.  As soon as he was old enough, they sent him to boarding school, which was a lonely experience for Mike.

When Mike looked up, he saw that his therapist had fallen asleep.  He wasn't sure what to do, so he cleared his throat hoping to wake the therapist up.  The therapist was startled by the sound and woke up with a jolt, "Oh, ah...what were you saying?"

Mike wasn't sure how much his therapist missed, so he started again at the beginning to describe his breakup and his family history.

Over the next few weeks, there were several other incidents.   There were a couple of times when Mike's therapist double booked appointments and Mike had to go home instead of seeing the therapist.

There was an incident where the therapist seemed to completely forget what Mike had told him about his family history and about the breakup, so Mike had to tell the therapist about these issues again.  Then, there was one day when Mike showed up for his regularly scheduled appointment and the therapist wasn't there.  Mike checked his voicemail to see if the therapist had left a message, but there were no messages.

Later that evening, when Mike met his close friend, Larry, and told him what had happened when Mike went to his therapist's office and the therapist wasn't there, Larry asked him questions about the therapy and if there were other problems in the therapy before this.

Mike thought about it for a minute and then told Larry about the other incidents.  While Mike spoke, Larry, who had good experiences in therapy before, listened carefully.  After Mike told him about the incidents, Larry told Mike that he needed to find another therapist because his current therapist seemed irresponsible and not attuned to Mike.

Since Larry knew Mike a long time, he also knew about Mike's childhood history and knew that Mike's experiences with his therapist were harmful.  He told Mike that he thought Mike's therapist wasn't treating him well and gave him all the reason why he thought this.  Mike listened, realized that what Larry was telling him resonated with him and that he probably had a blind spot about this.

When he went to his next session, Mike explained to his therapist why he thought the therapy wasn't working out for him and specifically why he felt he wasn't being treated well by the therapist.  His therapist looked uncomfortable, but he acknowledged that he had made mistakes with Mike.

Mike thought about it and decided that he ought to have consultations with other psychotherapists.  After two other consultations, Mike chose to work with another psychotherapist who seemed much more attuned to him.

He had one more session with his current therapist for closure and then began to meet regularly with the new therapist.  During that therapy, Mike began to understand why he had a blind spot in his former therapy.

He was also able to make connections between his history of emotional neglect with his family and the empathic failure that he experienced with his previous therapist.  This work helped Mike to feel that he deserved to be treated better in all areas of his life.

Conclusion
As I mentioned earlier, I believe that most psychotherapists are empathetic individuals who got into the mental health field to help people.

There can be empathic failures in any relationship.  Ideally, they are few and far between and when they occur, the person who made the mistake is able to admit it so there can be emotional repair.

An occasional mistake can occur in therapy, and the therapist should acknowledge the rupture and make an effort to repair the therapeutic relationship.  But when there are consistent empathic failures in psychotherapy with a particular psychotherapist, the client would do well to address these issues in therapy and to make a decision as to whether s/he wants to stay or find a different therapist.

Unfortunately, clients who grew up being emotionally neglected or abuse often have a blind spot for empathic failures because it seems "normal" to them.

Although this is a blog article and of necessity it's short, I hope it will be helpful to clients who might be experiencing consistent empathic failures in their therapy to become more aware of it and to take care of themselves by finding a therapist who can meet their needs.

Getting Help in Therapy
If you are struggling with an emotional problem that you have been unable to resolve, you could benefit from seeing a licensed mental health professional.

A consultation or two with a therapist (or more than one therapist) can help you to decide if you and the therapist are a good match (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who provides integrative psychotherapy to individual adults and couples (see my article: Integrative Psychotherapy).

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.

Using Somatic Psychotherapy When Clients Doesn't Know How to Express Emotions

In prior articles, I've discussed the mind-body connection and psychotherapy.

See my articles:  

Mind-Body Psychotherapy: The Body Offers a Window Into the Unconscious Mind

Clinical Hypnosis and the Mind-Body Connection

Overcoming Childhood Trauma That Affects You as an Adult

Experiential Therapy, Like EMDR, Helps to Achieve Clinical Breakthroughs).  

In this article, I'm focusing on how Somatic Psychotherapy can be used when the client has no words to describe a psychological problem.

Using Somatic Psychotherapy When the Client Has No Words

There are times when, due to the nature of the problem or for a variety of reasons, the client might not have words to describe the problem.

So, when might this happen?  

One possibility is that the traumatic event might have occurred when the client was very young so there aren't clear memories or it might have even occurred preverbially (a birth trauma would be an example of preverbal trauma).

With regard to preverbal issues, before a child can speak, she cannot symbolize her problems for herself or others because she doesn't have language, so there are no words.  

However, as I've discussed in a prior article, the body holds onto unconscious memories, and it's possible to use mind-body oriented psychotherapy (also known as Somatic Psychotherapy) to work on the problem.  More about this below.

Most forms of psychotherapy rely exclusively on words to resolve psychological problems. That's the nature of talk therapy.  The client comes to see the psychotherapist, describes the problem as best as she can and they work on the problem by exploring the current situation, getting history, and helping the client to make psychological connections and work through the problem.

But when the problem is outside of the client's conscious awareness, she might only have a vague awareness, if at all, of what the problem is.

At that point, psychotherapists who are trained to use mind-body oriented therapy, like EMDR therapy, clinical hypnosis or Somatic Experiencing, can help the client to explore the problem by using the mind-body connection.

The following fictionalized vignette illustrates how the mind-body connection can help when the client is unable to express the problem in words:

Nina
Prior to starting therapy again, Nina had been to several therapists in the past.

Although she liked her prior therapists, she didn't feel she got much out of therapy because she didn't know how to describe her problem.  She only knew that she felt extreme anxiety whenever she went home to visit her grandmother.  Other than going to her grandmother's home, she usually didn't feel anxious.

Talking about her anxiety with her prior therapists didn't help her.  They were only able to get so far, but she continued to have this extreme anxiety whenever she went on these visits.  Even talking about going on one of these visits was somewhat anxiety producing.

Nina chose her current therapist because she read articles that certain types of mind-body oriented therapy are helpful with clients where regular talk therapy hasn't been helpful.

Using Somatic Psychotherapy When the Client Has No Words to Describe the Problem

Nina's current therapist worked with Nina to help her to explore the sensations and emotions that she felt in her body using a technique called the Affect Bridge in clinical hypnosis (also known as hypnotherapy).

Nina was able to tell her therapist that, aside from the anxiety she felt, she also felt a tightening in her stomach when she thought about those visits.

Over time, as Nina and her therapist continued to explore these emotions and sensations, Nina realized that her anxiety about going to her grandmother's house was longstanding--ever since she was a young child.

Further exploration in her therapy sessions revealed that Nina felt most anxious about her grandmother's basement.

Then, gradually, over the course of months, as Nina became more attuned to what she was experiencing, she remembered that she saw a man molesting her cousin, Betty, one day in the basement.  At the time, Nina became so frightened that she ran upstairs and she was too afraid to tell anyone what she saw.

Since memories tend to be unreliable, even memories that are associated with the mind-body connection, Nina called Betty and she began speaking to her about her anxiety when she visited their grandmother's home.

She didn't know how to ask Betty about whether she was sexually molested or not, but she didn't have to because Betty told her that she also felt very uncomfortable going there and then she told Nina what happened:  A handyman who came to do repairs was in the basement when Betty went down there.

He seemed nice at first, but after talking to her for a few minutes, he grabbed her and touched her breasts.  As soon as she was able to pull away, Betty ran upstairs, but she never told anyone what happened--until she had this conversation with Nina.

Then, Nina told her that she recently remembered in therapy that she was on the basement steps when she saw this man molesting Betty, but she was also too afraid to tell anyone, so she ran.

Nina and Betty talked for a long time and Betty was able to confirm the details that Nina remembered in her therapy.  They were also able to be emotionally supportive of each other.

When Nina had her next therapy session, she told her therapist that Betty confirmed the memory.

Her therapist told her that, even though Nina wasn't the one who was molested, that it was emotionally traumatizing to see her cousin being molested.

From that point on, now that they knew they had a valid memory, her therapist used EMDR therapy to help Nina to work through the trauma.

Conclusion
There can be times when, for a variety of reasons, psychotherapy clients are unable to express their problem in words.  In some cases, there are no words and in other cases the issues might be unclear.

Using a mind-body oriented therapy can get to unconscious issues that regular talk therapy often cannot.  The reason for this is that the body offers a window into the unconscious mind.

Mind-Body Connection: Using Somatic Psychotherapy When the Client Has No Words to Describe the Problem

It can take a while before a client becomes accustomed to accessing emotions and sensations through the body, but many clients become adept at this over time.

Clients who are already in talk therapy and who want to remain with their current therapist can have adjunctive therapy sessions with a therapist who uses mind-body oriented psychotherapy (see my article: What is Adjunctive Therapy?).

In that case, the talk therapist is the primary therapist and the mind-body oriented therapist is the secondary therapist.

For clients considering adjunctive therapy, it's best to start by talking to your primary therapist about it.

Getting Help in Therapy
If you're finding that regular talk therapy hasn't been helpful to you, you might consider a form of somatic psychotherapy (How to Choose a Psychotherapist).

We know so much more now about the connection between the mind and the body than we ever knew before, and psychotherapists who use various forms of somatic psychotherapy usually know how to help clients to access unconscious issues.

Rather than suffering on your own, you could benefit from getting help from a psychotherapist who uses somatic psychotherapy.

The first step is to set up a consultation.

About Me
I am a licensed New York 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 or email me.

What is Adjunctive EMDR Therapy?

I've written prior articles about EMDR, including:
What is EMDR?

EMDR Therapy When Talk Therapy Isn't Enough

How Does EMDR Therapy Work?

In this article, I'm focusing on EMDR as an adjunctive therapy.

What is Adjunctive EMDR Therapy?

What is Adjunctive Therapy?
Many clients are seeing psychotherapists who might not do certain types of therapy, like EMDR, Somatic Experiencing or clinical hypnosis.

They will often have a very good therapeutic relationship with their therapist and not want to leave her or him to see a therapist who does another form of therapy.

Usually, they are happy to discover that there is a way for them to remain with their psychotherapist and to see another therapist adjunctively.

This means that their original therapist remains their primary therapist and the adjunctive therapist is the secondary therapist.

As long as the primary therapist is in agreement with this arrangement and, with the client's consent, both therapists can communicate with each other, adjunctive therapy usually works very well.

The adjunctive therapist usually works on a particular issue where she has particular expertise and skill, like psychological trauma, and the primary therapist remains the therapist who continues to see the client as before.

Aside from clients seeking out adjunctive therapy, primary therapists often refer their clients to adjunctive therapists, like EMDR therapists, because they know their clients can benefit from this other form of therapy.

How Does EMDR Work as an Adjunctive Therapy?
In my prior articles, I've written about how EMDR works when it is the primary therapy.

With EMDR as an adjunctive therapy, the client chooses a particular issue that s/he wants to work on with the EMDR therapist, usually involving trauma.

The psychological work can be about developmental trauma, which is psychological trauma that stems from unresolved childhood issues.  It can also be shock trauma (see my article:  ).

It is important that both therapists, the primary therapist and the adjunctive therapist, agree on the treatment plan so they aren't working at cross purposes to each other.

Another important element is that the adjunctive therapist must honor the relationship that the client has with the primary therapist, and it is understood in advance that the adjunctive therapist will not try to see the client exclusively without the primary therapist seeing the client.

The primary therapist must also be respectful of the adjunctive work and if s/he has any hesitation about it, s/he needs to express this to the client beforehand.

The following fictionalized scenario is an example of how adjunctive EMDR therapist can work:

Ted
Ted had been seeing his therapist for regular talk therapy for several years.  Although both he and his therapist felt that he had made some progress with unresolved family of origin issues, they both felt that their work had not helped Ted to resolve certain traumatic events in his childhood history, including a history of emotional abuse with his father.

Ted's therapist knew several colleagues who did the type of trauma work that she didn't do, including colleagues who did EMDR.

Since she wasn't trained in EMDR and she knew that EMDR is usually effective for the type of trauma that remained unresolved for Ted, she recommended that Ted have a consultation with one of her colleagues.

During the consultation, Ted signed a consent form so the EMDR therapist could speak with his primary therapist.

What is Adjunctive EMDR Therapy?

Ted was glad that he could do the trauma work with the adjunctive therapist without having to give up his primary therapist.

As the work progressed in EMDR, Ted felt that he was working through his childhood trauma in ways that he was unable to do with regular talk therapy.

During his sessions with his primary therapist, he talked about the things that came up for him during EMDR therapy.  He also talked about other areas in his life that were not part of his traumatic history.

During his sessions with his EMDR therapist, he and the therapist remained focused on the particular traumatic issues.  She remained available to him if things came up between sessions related to the work that they were doing.  However, he was also grateful to be able to speak with his primary therapist because they had a longstanding relationship with a very good rapport.

What is Adjunctive EMDR Therapy?

After Ted successfully completed EMDR, he remained with his primary therapist.  After several months, they talked about the possibility of ending their sessions since Ted was doing so well.

Conclusion
Clients that have an established relationship with their therapist don't need to choose between leaving their therapist to see an adjunctive therapist.

EMDR therapy, as well as other types of trauma therapy, can be done as a primary therapy or an adjunctive therapy.

Although it would involve an additional expense, clients often find that many different types of adjunctive trauma therapy works faster than regular talk therapy so, in the long run, it can help to shorten therapy and reduce expenses.

Getting Help Therapy

If you are interested in exploring EMDR as an adjunctive therapy, it's best to speak with your therapist (if she or he doesn't do EMDR therapy) to explore this option.

If you're both in agreement about the possibility of exploring EMDR therapy as an adjunctive therapy, the next step would be to find an EMDR therapist in your area and to set up a consultation.

As you would with any psychotherapy consultation, it's important to choose a therapist that you feel comfortable with (see my article:  How to Choose a Psychotherapist).

About Me

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

I work with individual adults and couples.

I work with EMDR as a primary therapist as well as an adjunctive 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.