Coping With Ambiguous Loss

The term ambiguous loss was coined by Dr. Pauline Boss in the 1970s. She is an internationally-recognized American educator, researcher and family therapist.

She has written a few books on the topic of ambiguous loss:

• Ambiguous Loss: Learning to Live With Unresolved Grief

• Loving Someone Who Has Dementia: How to Find Hope While Coping With Stress and Grief

• The Myth of Closure

What is Ambiguous Loss?

Ambiguous loss is defined as a loss that lacks closure or a clear understanding. 

Dr. Boss classified two types:

• Physically Absent But Psychologically Present: A loved one is gone physically but remains present in the minds and hearts of family and friends (e.g., a missing person, estrangement, giving up a baby for adoption, separation). The experience is: Gone but no certainty if they are alive or dead, which often leads to a search for answers.

Coping With Ambiguous Loss

• Physically Present But Psychologically Absent: In this type of loss a person is physically present but they are emotionally or cognitively absent (e.g., dementia/Alzheimers; traumatic brain injury; chronic depression; an intense preoccupation with work, technology, etc.) The experience: "Here but not here" which leads to grief for what is missing.

Ambiguous loss is considered the most stressful loss because it usually doesn't allow for typical grieving rituals and closure.

Coping With Ambiguous Loss

Coping with ambiguous loss involves accepting that complete closure may not be possible.

Strategies for coping include:

• Finding Meaning: Acknowledging the ambiguity and that the situation is not within your control but finding personal meaning for yourself

• Balancing Emotions: Managing the tension between hoping for a return/recovery and accepting the current reality

Coping With Ambiguous Loss

• Seeking Support: Utilizing therapy or a support group for emotional support and to validate your experience

Clinical Vignette

The following vignette, which is a composite of many different cases, illustrates how someone can cope with the ambiguous loss of a loved one being physically present but psychologically absent:

Gina

When Gina's mother, Ann, was diagnosed with Alzheimer's disease, Gina felt crushed. Her mother had always been an intelligent, active and loving person who held a responsible job as a hospital administrator for many years before she retired.

Coping With Ambiguous Loss

Several years after Ann retired, she complained to Gina that she was getting forgetful and confused. When Gina discussed this with her brother and sister, they decided to take their mother to a neurologist to get evaluated. That's when they were told that their mother was in the middle stage of Alzheimer's.

The neurologist provided them with resources for their mother and support groups for them, including the Alzheimer's Association. 

They talked about the diagnosis as a family and realized they had different views. Gina and her sister felt their mother should be told because they knew she would want to know what was happening to her and be part of the planning. However, their brother, who was the eldest, said their mother would only get upset if she knew so she shouldn't be told.

After going back and forth about this decision for several weeks, the brother relented and said he would go along with what Gina and her sister thought was best.

When they told Ann, they weren't surprised to hear that she already had a feeling that she might have Alzheimer's because her mother and maternal grandmother had it (although people don't always inherit Alzheimer's).

Knowing that she would decline over time, Ann was very sad, but she was also a practical person. She asked her children to arrange for visits with a geriatric social worker and an elder care attorney to advise them.

Gina and her siblings each had different reactions. Gina's brother tended to be stoic and he didn't want to discuss his feelings. Gina and her sister supported each other in their grief. They talked frequently. They also joined an online Alzheimer's support group and felt relieved to hear that other adult children were going through the same emotional ups and downs as they were experiencing.

Gina also sought help in individual therapy because she wanted the privacy to talk about things she didn't feel comfortable talking about in the support group.

She told her therapist that she had always relied on her mother for emotional support and advice whenever she had to make big decisions and the thought of not being able to do that made her feel tremendous grief.

As her mother declined, Gina's therapist recommended that she work on a family photo album with her mother. So, Gina gathered together the loose family photos her mother kept in a box, bought a photo album and went through the pictures with her mother as they placed the pictures in the album.

She and her mother laughed and reminisced about the events in the photos for hours. Her mother told her she hadn't thought about some of the people and events in the photos for a long time.

They also listened to some of her mother's favorite music which she enjoyed when she was younger. This also stimulated certain memories for her mother.

While her mother was still able to garden, Gina's sister and Ann spent time planting in the mother's garden, which they both found relaxing.

Gina's brother took Ann for walks around the neighborhood and pointed out places that Ann knew from years ago. 

Although the medication the neurologist prescribed helped to slow Ann's decline, eventually, Ann could no longer be maintained at home with a home health aide, and Gina and her siblings had to make tough decisions.

At that point, their mother had declined so much that she only remembered her children intermittently. She was also frequently agitated, which was so different from how Gina and her siblings had always known Ann to be prior to the onset of Alzheimer's.

Gina and her sister wanted to explore nursing homes, but their brother refused to even consider the idea. The thought of putting their mother in a facility was beyond what he could bear. So, he decided to take time off from work and, with the help of an aide, took care of Ann full time.

He soon discovered how exhausting this was--even with Gina and her sister relieving him for a few days out of the week and the help of a home health aide.

When Gina's brother needed to return to work, they spoke with the geriatric social worker who helped them to find facilities that were suitable for their mother. They visited several places, which were good but left each of them feeling very sad.  These facilities had memory units to help patients with dementia and Alzheimer's, patients were well taken care of, but the sight of many elderly impaired patients was upsetting.

At that point, Ann was no longer able to make decisions for herself. Gina and her siblings had already consulted with an elder care attorney to establish a durable power of attorney with Gina in charge. Then, they chose a facility close to where they all lived so they could visit Ann frequently.

At each stage of her mother's decline, Gina felt, at times, that her sadness and grief were unbearable. But she continued to discuss her feelings with her therapist and in the Alzheimer's support group because this was unlike any loss she had ever experienced before.

Over time, even though she felt tremendous sadness and grief, she accepted she couldn't control what was happening to her mother. 

There were some days when her mother seemed content to be participating in activities at the facility and other days when Ann glared at Gina and her other children and said, "Why did you put me here?"

Every time Gina felt she had come to accept her mother's condition, she had to contend with the next stage of her mother's decline. 

Gina's friends, who had older parents who were still functioning well, seemed to want to avoid talking to Gina about how she felt. Gina felt frustrated about this, but she understood that they had their own fears for what might eventually happen to their parents.

In addition to therapy and the Alzheimer's support group, Gina also felt some comfort in journaling. 

After her mother died, Gina felt a mixture of sadness, grief and relief that her mother was no longer suffering. 

She told her therapist she felt guilty that she felt relief and her therapist normalized what Gina was experiencing. She told Gina that it's common for adult children to experience a mixture of emotions including relief.

Gina learned to accept that her grief and sadness would come in waves so that she could feel better for a period of time but, seemingly out of nowhere, she felt tremendous sadness.

Over time, Gina learned to live with her grief. There were even days when she felt hopeful and grateful for what she had in her life. 

She also volunteered to be a peer group leader with the Alzheimer's support group so she could help others to deal with their loss and provide them with a sense of hope.

Conclusion

There are two types of ambiguous loss. I focused on the physically present but psychologically absent because this type of loss isn't addressed as often as the physically absent but psychologically present.

The vignette presented a daughter with a mother who had Alzheimer's. This type of loss could also involve someone coping with a sick or cognitively impaired spouse.

Coping With Ambiguous Loss

Both types of ambiguous loss are difficult, but with help there is hope.

Getting Help in Therapy

Loved ones can be well-meaning but often say and do things that are unsupportive.

A licensed mental health professional, who has an expertise with helping clients to cope with ambiguous loss, can help you to navigate the stages of loss.

Rather than struggling on your own, seek help from a qualified mental health professional so you can learn to cope with ambiguous loss.

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 with grief, loss, trauma and many other issues.

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

The Challenges of the "Sandwich Generation": Raising Children and Taking Care of Elderly Parents

Coping With the Loss of Loved Ones - Common Reactions 

The Many Layers of Grief 

You Continue to Have an Internal Relationship With Your Parents After They Have Died

Coping With the Loss of a Pet

What Does It Mean to Be "On a Break" From Your Relationship?

Anyone who watched the "Friends" episode, "The One Where Ross and Rachel Take a Break" remembers the problems that resulted from Rachel telling Ross during a heated argument that they should take a break.

Taking a Break From Your Relationship

During their argument, after Rachel suggests they take a break, Ross walks out feeling devastated. Then, he goes out to a club, gets drunk and he gets sexually involved with Chole, the "copy girl."

Soon afterwards, Rachel finds out that Ross slept with Chloe, which leads to another argument about what it means to be "on a break" and whether it meant that Ross and Rachel were broken up or they were temporarily not seeing each other but also not seeing anyone else.

This misunderstanding leads to a breakup because Rachel is hurt, angry and mistrustful of Ross.

What Does It Mean to Be "On a Break" From Your Relationship?

To avoid potential misunderstandings, it's important to be clear on what it means when you say you want a break in the relationship.

Here are some factors to consider:

• Define the Terms: Be clear with each other as to whether you're each taking a "pause" from the relationship in order to fix problems or if the break is actually the beginning stage of a permanent breakup.

• Establish Ground Rules: Be specific: Does it mean a one week break or a one month break or some other time period? Also, be clear as to whether you can each date other people or if other people are off limits.  Does it mean you're going to go no-contact? If not, what type of contact will you have (text? phone calls? etc) and how often. Whatever you both decide, respect the boundaries you have both agree to.  If you don't define the terms together, you're going to have misunderstandings similar to Ross and Rachel on "Friends".

Taking a Break From Your Relationship

• Focus on Self Care and Reflection: Use your time apart to think about your needs, your partner's needs, the relationship issues and whether or not you want to be in this relationship.

• Avoid Manipulation: Do not use the break to gain leverage or make your partner jealous.

• Manage Your Expectations: Be prepared for an outcome that could go either way including the possibility that the break can lead to a permanent separation.

• Don't Use a Temporary Break to Avoid Saying You Want a Permanent End to the Relationship: Many people who don't feel comfortable saying they want to end the relationship tell their partner that they want a temporary break knowing beforehand that they don't plan to reunite with their partner. They're too uncomfortable to talk about their real feelings, so they use the excuse of a temporary break as a way to exit the relationship. Then, they ghost their partners and don't respond when their partners contact them which leaves their partners feeling hurt, angry and betrayed. If you know. you want to end the relationship, say so. It will be a lot less painful for both of you in the long run if you're upfront and honest with yourself and your partner.

Get Help in Couples Therapy

If you're not sure how to handle being on a break or you're not sure if you even want a break, seek help in couples therapy.

Get Help in Couples Therapy

A skilled couples therapist can help you to define what you each want from your relationship and, if you choose to stay together, provide you with the tools and strategies to get there. 

If you decide not to stay together, a couples therapist can help you to break up in a way that is caring and respectful.

So, rather than struggling on your own, seek help from a licensed mental health professional who is a couples therapist.

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 experience working 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.

What Are the Pros and Cons of Rebound S£x After a Breakup?

According to Justin Lehmiller, Ph.D., social psychologist and sex researcher, there are pros and cons to having rebound sex after a breakup (see my article:  The Problem With Rebound Relationships).

What is Rebound Sex?

Rebound sex is sexual activity with someone new to get over a breakup.  The objective is to get over an ex by having sex with someone else.

Rebound Sex

This can involve hooking up for a one-night stand with someone you have no intention of seeing again. It can be with someone you start dating after you go through a relationship breakup. It might also involve having casual sex with one of your ex-partners.

According to Dr. Lehmiller, rebound sex is more likely to occur, on average, about a month after the breakup.  He describes rebound sex as being a short term coping strategy.  

He also indicates that rebound sex is much more likely to occur if you were the one who was left behind (i.e., your partner broke up with you).

What Are the Pros and Cons of Rebound Sex?

According to Dr. Lehmiller's article in Psychology Today, while there is nothing inherently right or wrong about rebound sex, there are pros and cons depending upon the circumstances and context which can make a big difference about whether it's a positive or negative experience for you.

Pros

• Under the right circumstances and in the right context, rebound sex can be a confidence booster.

• Similarly, rebound sex can, potentially, help you to move on from a breakup (if context and circumstances are right).

Cons

• If the context and circumstances aren't right for you, you might regret having rebound sex. For instance, if you were drunk or impaired by drugs, you might have regrets afterward.  This can lower your sense of self confidence.

• If you regret having rebound sex, you might find yourself missing your ex even more intensely than before (this isn't mentioned in the Psychology Today article, but it has been my clinical experience that when clients have regrets about rebound sex, they often long for their ex, who is known and familiar).

• If rebound sex involves feelings of revenge against an ex, you might be left with regrets and unresolved feelings.

Clinical Vignettes

The following brief clinical vignettes, which are composites of many different cases with all identifying information changed, are examples of the pros and cons of rebound sex:

Pros

    Alice

After Alice's boyfriend of three months broke up with her, she wanted to start dating again, but she wasn't emotionally available enough to even consider getting into a serious relationship.  So, when she met Bill at a bar about a month after her breakup, she could feel they were both sexually attracted to each other and she explained her situation to him. She was honest about only wanting to have casual sex with him. Bill responded by telling her that he was just out of a long term relationship and he wasn't looking for anything serious.  

Rebound Sex: Alice and Bill

Both of them were sober and in the right state of mind to make responsible sexual decisions. So, they went back to Alice's place and had a passionate night of sex.  By the next morning, Alice felt sexually desirable again in a way she had not felt in a long time. She also felt a boost to her self confidence. Bill told her that he felt great the next morning.  After that, they met a few more times to have casual sex, but they mutually decided not to continue seeing each other because, other than sex, they had very little in common.  They both dated other people and remained friendly whenever they ran into each other. They both felt the rebound sex they had with each other helped them to move on from their breakups.

Cons

    John

After John's wife, Beth, left him in their sixth year of marriage, John was in a state of despair.  He had no awareness that Beth was so unhappy that she would end their marriage, so it came as a shock to him. Two weeks after the breakup, John felt inconsolable.  Even before the breakup, he didn't know how to handle uncomfortable emotions, so he didn't feel equipped to handle the sadness and pain that came up for him. 

Rebound Sex: John and Nina

Not knowing what to do with his emotions, he turned to alcohol and got drunk every night for two weeks.  During that time, while he was in a drunken stupor, he called Nina, a woman he dated briefly before he got married and they spent the weekend together having sex. Nina was also Beth's former college roommate.  John wanted revenge against Beth so he secretly hoped that Nina, who had unresolved issues with Beth, would tell Beth about their weekend together as a way to get back at Beth. He wanted Beth to feel as much pain as he did when she left him.  But by the time he sobered up and he realized that Nina had feelings for him and she hoped they would get back together, he knew he had made a mistake because he didn't tell Nina that this was just rebound sex and he had no intention of getting back with her. He felt even worse when Beth called him and told him that Nina told her that she and John had sex. Beth told him she couldn't believe he would act out this way to hurt her. Then, he felt even worse and regretted having rebound sex.

Communicate Openly and Honestly With Rebound Sex Partners

As these two vignettes illustrate, it's important to be open and honest with your partner about what you want when you want rebound sex as illustrated in the vignette about Alice.

You want to make sure you and the other person are in agreement that you both only want casual sex and neither of you is looking for anything more, which was also illustrated in the vignette about Alice.

If you don't communicate honestly, there's the potential for misunderstandings and hurt feelings as illustrated in the vignette about John.

Don't have rebound sex to get revenge on your ex because everyone involved might get hurt, which was also illustrated in the vignette about John.

Getting Help in Therapy

There are times, especially after a breakup, when you might not know what you want.

A skilled psychotherapist can help you to explore your feelings and make choices that are right for you.

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

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and sex therapist.

I work with individual adults and couples.

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

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

What is Revenge Porn and How Can You Prevent It?

Revenge porn has become a serious problem over the last several years.  In this article I'll define revenge porn and what you can do to take care of yourself if this happens to you.

Revenge Porn

What is Revenge Porn?

Revenge porn is usually defined as sharing sexually explicit photos of someone to shame or humiliate them.

The usual scenario is that when someone in a relationship wants to end it, the other person either threatens to share sexually explicit photos with others or on social media as a way to get back at the individual who wants to end the relationship.

These threats are also made as form of coercion where the partner who is making the threats hopes to prevent the breakup.

The person who threatens or who actually shares sexually explicit photos wants to frighten, control, and embarrass the other person and cause emotional pain.

Why Do People Engage in Revenge Porn?

Generally speaking, the person who is angry about being left wants to hurt the partner because s/he feels hurt, abandoned and angry about being left.  It's a way to get back at their ex.  This is not an excuse to condone this behavior.  It's an explanation for the behavior.

Some people who make these threats might hope that the threats will keep their partner from leaving or, if they have already broken up, they might hope that it will force the ex to get back in the relationship.  This is obviously a very serious form of manipulation.  

Note:  In New York City, revenge porn is a crime (more about this later).

Not surprisingly, research into this behavior has revealed that people who engage in revenge porn often lack empathy and are not concerned about hurting others.

Feeling Betrayed and Violated by Revenge Porn

Anyone who has ever had the experience of having sexually explicit pictures shared with others or placed on social media without permission feels betrayed and violated.

Going through a breakup can be painful enough without having to deal with an ex--someone you once loved and trusted--violating your trust by exposing your nude photos.  It can make you feel like you never knew this person, and it can make it hard for you to trust again in future relationships.

Revenge Porn: Prevention First

To avoid having potential problems in the future, your best option is not to allow anyone to take nude or sexually explicit pictures of you that you wouldn't want to be revealed.

It might feel sexy and fun to share nude pictures, but once these pictures are out of your possession, it's hard to control what someone might do with them.

If someone has taken pictures of you that you're unaware of, that's a different story.  But, to the extent that you can avoid this problem, prevention is your best choice.

Revenge Porn is Illegal in New York
I want to emphasize that I am a psychotherapist and not a lawyer.  But I'm aware that in New York City revenge porn is a crime.

The New York City Council passed a law that makes it illegal to leak nude images with the intent to harm someone.  In New York City, the person who leaks such photos risks going to jail or being fined $1,000.

In order to break the law, the individual who is sharing the photos must be trying to cause harm on an economic, physical or on an emotional level.  It is also illegal to threaten to show nude photos, and the perpetrator can be sued (click on this link for more information from the NYC Council website about the law).

You can also consult with an attorney to find out your other legal options.

Getting Help in Therapy
Trying to cope with revenge porn can be traumatic on many levels.

Many people who have experienced revenge porn feel too ashamed to talk to friends and family about it or, if they do, they often find that their loved ones don't understand.

A skilled psychotherapist can help you to overcome the feelings of betrayal, sadness and anger that people often experience after revenge porn (see my article: The Benefits of Psychotherapy).

Rather than suffering on your own, you could get help from a licensed mental health professional who can help you to work through these feelings (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I am a sex positive trauma-informed psychotherapist, and I have helped many clients to overcome 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.

Improve Communication in Your Relationship By Eliminating the "4 Horsemen of the Apocalypse"

Relationship expert, John Gottman, Ph.D., came up with a metaphor to describe destructive communication in relationships which he calls the 4 Horsemen of the Apocalypse, a term which was originally used in the Bible to describe the four elements of the end times: conquest, war, hunger and death (see my article: Improving Communication).

Eliminate the 4 Horsemen of the Apocalypse

What Are the 4 Horsemen of the Apocalypse?

According to the Dr. Gottman, the 4 Horsemen of the Apocalypse in a relationship are:

• Criticism
• Contempt 
• Defensiveness
• Stonewalling

Let's take a look at each one to understand why these actions represent destructive communication styles that can lead to the demise of a relationship:

• Criticism:  When you express a complaint to your partner, it's different from attacking him or her personally.  When you criticize your partner, s/he feels rejected and hurt.  Here's the difference:

Complaint: "I feel sad that you forgot my birthday."

Criticism: "You never remember my birthday because it's not important to you. You're selfish!"

Note that in the first example, with the complaint, you're speaking from your own experience ("I felt") whereas in the second example, the criticism, you're making a personal attack on your partner's character.  

Criticism is especially damaging when it happens frequently.  Furthermore, you're not likely to resolve the problem if you use criticism (see my article: Learn How to Stop Criticizing Each Other).

• Contempt: Contempt is worse than criticism.  When you address your partner with contempt, you're being mean.  Contempt includes sarcasm, ridicule, name calling, and cursing your partner, among other things.  You're showing disrespect for your partner, and you're speaking to your partner from a position of moral superiority:

Contempt: "You forgot to bring home the milk! I give you one thing to do and you're too stupid to even do that."

Note that contempt is often fueled by longstanding resentment towards a partner that comes out in a toxic way.

• Defensiveness: Defensiveness is a common problem.  When you feel criticized by your partner, you find excuses for your behavior. Unfortunately, this doesn't resolve the problem because your partner is likely to feel that his or her concerns aren't important to you.

Defensiveness: "So what! I forgot to bring the milk. You know I've had a lot of things on my mind. Why didn't you have one of the kids get it?"

Note that, aside from not resolving the problem, you're also not taking responsibility for your part, and you're pointing an accusatory finger at your partner.  

By being defensive, you're also just escalating the conflict (see my article: Habitual Defensiveness Can Ruin Your Relationship).

• Stonewalling: Stonewalling usually occurs when the listener becomes overwhelmed. The listener either tunes out, walks away, distracts him or herself and, generally, shuts down emotionally (see my article: Are You a Stonewaller?).

People who stonewall are often shutting down to regroup emotionally.  The problem is that they often don't tell their partner that they need to take a break from the conflict to calm down.  

The other problem is that people who make a habit of stonewalling appear to be calm on the outside, but they're flooded with stress on the inside.  

Since people who stonewall appear to be calm externally, the other partner will often double down on their criticism in an effort to provoke the partner to speak.  

This starts a destructive cycle where the person who is stonewalling shuts down more and more and the other partner escalates their argument.  Soon they're caught in a destructive cycle.

Getting Help in Therapy

If you're like most people, you learned how to communicate from what you observed in your family of origin.  

If you weren't lucky enough to come from a family where you experienced healthy communication, you might have developed destructive communication habits.

A skilled psychotherapist can help you to enhance your communication skills to maintain a healthy relationship.

Rather than continuing in destructive communication patterns that could lead to the demise of your relationship, seek help from a licensed mental health professional.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing Therapist and Sex Therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

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

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

Tips on Getting Along as a Couple During the COVID-19 Crisis

Although being alone and feeling lonely during the COVID-19 crisis is challenging, being in a relationship where you're both staying in your home for long periods of time together can also be challenging (see my article: The Challenge of Keeping Small Arguments From Becoming Big Arguments and Telltale Signs That You and Your Spouse Are Growing Apart).

The sudden shift to all day/all night togetherness can put even the best relationship under a strain (see my articles: Coping and Staying Calm During the Pandemic, Common Reactions to the Crisis: Fear and Anxiety and Grieving Losses During the Crisis).

Tips on Getting Alone as a Couple During the COVID-19 Crisis

Depending upon the relationship, couples are responding differently, but most couples are finding it difficult to deal with the shift to being around each other all the time.

Some couples that were already experiencing a strain in their relationship before the pandemic are finding it even more stressful to be around each other.  Other couples have put aside their differences for now to focus on what they need to do to get through the current crisis.

Many couples will go through different experiences at different times.  Couples that are getting along now might not get along well over time due to the ongoing strain of the crisis and vice versa.

It's not unusual for individuals in a relationship to want different things with regard to time together vs time apart, and this is especially true now (see my article: Learning to Compromise About Time Together vs Time Apart).

In addition, when you live together, there are always other issues that need negotiating.

Whether you're currently having problems in your relationship or not, it's a good idea to anticipate and be prepared for possible problems before they occur.

Potential Problems For Couples During the Pandemic:
With the pandemic, there can be unique issues to deal with that affect the health and well-being of both people, including:

• What to Do If One Person Gets the Coronavirus:
• In the event that one person becomes infected, both people will need to decide how to handle this.  
• The dilemma is that the person who is sick would probably need help to get through the illness. But the uninfected person would be fearful of getting the virus.
• A consultation with your doctor is best.  

• Whether to Stay in NYC or Leave Temporarily to Go to a Second Home (if possible)
• Each person might have different feelings about whether to stay or leave, if they're fortunate enough to have a second home that they can go to temporarily. 
• One person might prefer to stay in New York City and the other person might prefer to leave. They will have to negotiate and might need to compromise about this. 

• How Much Space and Privacy to Give Your Partner
• Different people need varying degrees of alone time. Some people like to be with their partner most if not all the time.  
• If their partner doesn't feel that way, the person who wants to be together most or all the time can feel rejected.  
• Other people need their own space and privacy to have a sense of well-being.  
• If you're living in an apartment that's large enough, this can often be negotiated.  But most New York City apartments aren't large so both people might feel too confined in a small space.

• How to Negotiate Childcare Responsibilities 
• If a couple is accustomed to normally having childcare either in a daycare or with an nanny whose services are no longer available, they need to figure out how to negotiate childcare responsibilities. 
• Older children will, obviously, still need parental care and guidance, but they can be more independent.
• Younger children will need more time and attention, including help with online schoolwork.
• Will each parent can take turns and give the other parent a break? Will they divide up the tasks or come up with some other way?
• If a couple already has differences in terms of childrearing, going through this health crisis can highlight those differences and make things worse.

• Differences in Cleaning Standards Around the Home 
• Many couples already have differences to negotiate around cleaning standards.  One peron might be neater and want to clean more often, and the other person might be a lot more relaxed about it.  
• With the current health crisis, there can also be issues around what and how much to disinfect.

• Whether to Go to the Grocery Store or Order Grocery Online (if possible)
• Most people are trying to minimize their time outdoors, so one person might prefer to order grocery online and the other might prefer to go to the store.  
• The person who wants to order online might have concerns about his/her coming into contact with other people in the grocery store as well as having concerns about the partner's exposure to others.

• Whether to Order Takeout
• This issue is similar to whether or not to go to the grocery store.  
• Some people prefer not to cook.  Others feel safer cooking their own food.

• Whether to Wear Masks Outside or Not (the latest recommendations from the CDC as of the writing of this article)
• There has been some recent confusion about this.  Originally, people in the US were told that there was no need to wear a mask.  Now CDC is recommending the wearing of masks, but they're not mandating it.
• One person might feel strongly that wearing a mask is important, while the other person might not want to wear a mask.  This creates a potential problem because the person who feels strongly about a mask might worry that the partner who doesn't want to wear a mask is putting each of them at risk.

• How to Have Quality Time, Fun and Socialize While Practicing Social Distancing
• Couples who are accustomed to socializing in person with friends and loved ones might feel at a loss about how to socialize with the new requirement for social distancing.  
• One partner might enjoy socializing online and the other partner might not.

And so on.

Tips on Getting Along as a Couple During the Pandemic
There are no right answers to the dilemmas that couples face during the pandemic, but here are some tips that might help, which will require some flexibility, compromise and negotiation:

• Create a Routine and Structure Your Day
• Since both of your routines have been upended, it's important for a couple to come up with a rough schedule for how they will spend their days.  
• Each person might have different needs, so that will need to be taken into account.

• Make Time For Alone Time
• Make time for time apart to work, nap, talk to friends on the phone or online, read, meditate, watch a program the other person doesn't like or engage in other solo activities.  
• Try to be respectful of your partner's need for time apart so that when you come together again you'll feel ready to be in each other's company.

• Learn to Communicate With Each Other Effectively 
• Over time, nerves can get frayed.  One or both of you is bound to either get inpatient or lose your temper.  Expect it (see my article: Learn How to Communicate More Effectively in Your Relationship). 
• Learn how to take responsibility for your words and behavior and make amends with your partner as soon as you can.  
• Pick your battles.  
• Don't argue over small issues.  It's better to let some things go sometimes rather than arguing about them.
• Tell your partner if you need time to regroup after an argument. 
• It's not unusual for one person to want to work things out immediately and for the other person to need time to cool off first.  
• If you're the person who wants to work things out immediately, recognize that if your partner isn't ready to do it and you push to do it, you'll probably continue to argue, and your partner will resent you.  
• If you're the person who needs time to cool down before you talk, let your partner know about how long you'll need so it doesn't feel endless to them, and don't stonewall (see my article: Are You a Stonewaller?).
• Remember to express your love and gratitude to your partner (see my article: The Importance of Expressing Gratitude To Your Spouse).

• Find Meaningful Ways to Connect
• One of the biggest complaints that couples often have under normal circumstances is that they barely see each other during the week because of their busy work schedules and then on weekends they feel too exhausted.
• If you have more time now, talk to your partner about how you would like to spend your time together in a way that's meaningful and enjoyable.
• This could include:
• Spending more time having sex and discovering new things that you both want to do sexually, possibly including a willingness to explore new ways of being together and enjoying each other sexually.
• Redecorating your home
• Learning a new game
• Learning a new language together
• Talking about future plans, including travel plans when it's safe to travel again 
• Reading aloud to each other
• Listening to a podcast together
• Watching a movie you've always wanted to see

And so on.

Getting Help in Couples Therapy
Despite your best efforts, you and your partner might find that getting along during the pandemic
highlights problems that you've had all along that you've never dealt with before.

Even if you got along well before, the stresses and strains involved with too much time together at home, a change in your routine, the loss of things you used to do outside, and the unknowns involved with the pandemic and economy are threatening your relationship.

If you can't work things out on your own, rather than watching the demise of your relationship, you could benefit from atending couples therapy.

Many therapists, including me, are providing individual and couples therapy online (also known as teletherapy, telemental health and telehealth) while they're out of their offices (see my article: The Advantages of Online Therapy When You Can't See Your Therapist in Person).

Rather than allowing your problems to destroy your relationship, seek help from a licensed mental health professional who works with couples.  It could save your relationship.

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

I have worked with individual adults and couples for over 20 years.

I'm providing online therapy (also known as teletherapy, telemental health and telehealth) during the pandemic.

Emotionally Focused Therapy For Couples (EFT) is the therapy I use to work with couples. EFT is one of the best effective and well-researched therapy to help 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.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma - Part 2

In my prior article, I began a discussion about the importance of establishing safety for clients in trauma therapy before trauma is processed. One of the requirements that I discussed in the last article for establishing safety is that the client's life must be currently stable.  In other words, s/he is not currently in a crisis or creating new crises.  I'm discussing this topic further in this article.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma

As I discussed in the prior article, clients who are currently in a crisis need help to out of the crisis and keep from creating new crises before they can process traumatic memories.

For instance, if a client has a parent who is in hospice with only a short time to live, the client will need help to get through this crisis and the grief following the parent's death before s/he processes unresolved traumatic memories from childhood.

Likewise, if a client is continuing to create chaos in his or her life, this would need to be addressed and resolved before any processing of traumatic memories from the past can be done.

Fictional Clinical Vignette: Trauma Therapy: Establishing Safety Before Processing Trauma
The following fictional clinical vignette addresses the issue of establishing safety for a client who wants to process traumatic memories but who is still in crisis:

Ann
After a tumultuous breakup in what she described as an on-gain/off-again emotionally abusive relationship, Ann, who was in her late 30s, started therapy to deal with the emotional aftermath of the breakup.  She requested EMDR therapy to deal with the trauma of that relationship (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

During the initial consultation, Ann explained to her psychotherapist that she ended the relationship three months ago and, as far as she was concerned, the relationship was really over this time. She was fed up with the name calling and the way he tried to shame her in front of other people a lot of the time.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma

Ann talked about her history of emotionally abusive relationships that began when she was in high school and continued into adulthood.  She explained that, immediately after she ended her last relationship, she began dating someone new.  She said her new boyfriend seemed nice at first, but lately he was verbally abusive with her too.

When her psychotherapist asked Ann to tell her more about the abuse in this new relationship, Ann told her that he wasn't nearly as abusive as her former boyfriends.  She explained that, although she was aware that she was in another abusive relationship, she was worried about getting too old to have children. Since her new boyfriend also wanted to have children, she wanted to try to have a child with this man before she got any older.

She said she feared that if she broke up with him, she might not meet anyone else and she might miss her opportunity to have a baby.  As a result, she would rather put up with his verbal abuse than breakup with him to find someone new (see my articles: Do You Have a Pattern of Creating Chaos in Your Life?, How to Stop Creating Chaos in Your Life, and Remaining in Therapy Beyond the Immediate Crisis).

The psychotherapist explained to Ann that they could not begin EMDR therapy to deal with prior trauma because Ann was in another emotionally abusive relationship where she was likely to be traumatized again.  She explained that it was important for Ann to be in a stable situation before they could do EMDR therapy.

Ann said she understood the rationale for not beginning to process a history of trauma while she was in another relationship where she would probably be traumatized again, but she was not ready to give up her current relationship.

She told the psychotherapist that the thought of ending the current relationship and facing the possibility that she might not meet anyone new was too frightening to her. She said she didn't want to wait much longer to have children, and she would rather have a child with her current boyfriend than risk getting too old to have children.

Even though they could not do EMDR therapy due to Ann's current circumstances, the psychotherapist offered to work with Ann with her current relationship and her difficulty with taking care of herself in terms of choosing men who were emotionally abusive (see my article: Are Your Fears of Being Alone Keeping You in an Unhealthy Relationship?).

Since Ann was not interested in this, she decided not to come for any other sessions.  The psychotherapist gave her information about domestic violence. She explained that domestic violence was emotional as well as physical.  She recommended that Ann contact the New York City domestic violence hotline to deal with this issue.

Two years later, Ann contacted the same psychotherapist.  She told the therapist that she never contacted the domestic violence hotline.  Instead, she had a baby with the boyfriend that she was with at the time when she came for the initial consultation, and the abuse escalated from emotional to physical abuse.  She said she ended that relationship several months ago, and she moved back in with her parents, who were helping her to raise the baby.

When Ann returned to see the psychotherapist, she told the therapist that she regretted remaining in the relationship with her baby's father.  She said that, once the stressors involved with raising a baby increased, the baby's father was unable to handle it.  As the stress increased, his abuse escalated from emotional abuse to physical abuse, and she feared for their child's safety.

Ann explained that, after she left the baby's father and filed for child support, the baby's father disappeared and she didn't know where he was.  As a result, she received no child support from him and she couldn't afford to support the baby on her own, which is why she moved back in with her parents, who took care of the baby while she worked.

When she returned to therapy, she was not in a relationship.  She said that, since she had the baby, she was more aware than ever that she made poor choices when it came to relationships, and she didn't want to jeopardize her baby's well-being by getting into another abusive relationship.  As a result, she wasn't dating at the time.

Although Ann was clearly unhappy, she was safe in her parents' home, and she wasn't in a current crisis.  Since she didn't seem likely to get into another abusive relationship at that point in time, her therapist agreed to do EMDR therapy with her, and they began the preparation work to begin processing her history of trauma.

Conclusion
Some clients, who seek help in trauma therapy, are still either in a current crisis or they are creating new crises in their lives--sometimes knowingly, like the example above in the fictional vignette, and sometimes without their awareness.

The fictional example that I gave is just one possible situation where safety and emotional stability must be present first before EMDR or any type of trauma therapy can be done.  In the prior article, I gave other examples.

A trauma therapist can assist a client who is in crisis to overcome the crisis, but she cannot begin to do trauma therapy until the client's life is stable.

Even after the client's life is stable, every client who does EMDR therapy must go through the history taking and preparation phases of EMDR before the client and therapist can begin processing the trauma.

Since EMDR therapy is more experiential than talk therapy, the preparation phase of EMDR therapy helps to ensure that the client has the necessary internal and external resources to deal with the strong emotions that can come up when working on traumatic memories.

Getting Help in Therapy
Too many people who need help in therapy don't come because of they feel ashamed or they're concerned about the possible stigma of being in therapy.  They mistakenly believe that going to therapy means they're "weak" (see my article: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak".

If you've been struggling on your own with an unresolved problem, you owe it to yourself to get the help in therapy that you need (see my article: The Benefits of Psychotherapy).

Once you have worked through your unresolved problems, you can be free from your traumatic history and live a more fulfilling life (see my article: How to Choose a Psychotherapist).

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

I work with individual adults and couples, and I have helped many clients to overcome traumatic experiences.

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.