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NYC Psychotherapist Blog

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Showing posts with label breathing exercises. Show all posts
Showing posts with label breathing exercises. Show all posts

Friday, September 18, 2026

What is Dual Awareness in Psychotherapy?

Medical Review / Last Updated: September 18, 2026
The concept of dual awareness is foundational to modern psychotherapy, particularly when working through unresolved psychological trauma. You can read more about why a body-centered approach is vital in my guide on why experiential therapy is more effective than traditional talk therapy to overcome trauma.

A serene wooden dock extending into a calm blue lake under soft morning light, symbolizing dual awareness and staying grounded in present safety during trauma therapy
Dual awareness functions as a psychological anchor, allowing you to safely explore past memories while keeping your feet firmly planted in the safety of the present moment.
What is Dual Awareness in Trauma Therapy?
Dual awareness is the psychological ability to process traumatic memories while simultaneously remaining anchored in the physical safety of the present moment.
When a person experiences a trauma trigger, their autonomic nervous system often misinterprets the memory as an active, immediate threat. In specialized trauma care, maintaining dual awareness allows clients to balance two distinct realities:

  1. The Past Reality: The distressing thoughts, somatic sensations, and emotions tied to the traumatic memory being addressed.
  2. The Present Reality: The absolute safety of the here-and-now, grounded in the therapeutic environment.
By maintaining this balance, you remain fully aware that even though you are exploring a painful memory, you are physically safe with your therapist. For a deeper look at this prerequisite, see my article on why establishing safety is so important in trauma therapy.
The Importance of Embodiment and Sourcing Resources
Before initiating any deep trauma processing, a specialist must prepare your nervous system. This phase involves cultivating internal and external coping skills to ensure you can remain fully present and embodied.

To be embodied means maintaining a conscious, curious connection to your emotions and physical sensations as you navigate difficult emotional states. Building these foundational anchoring tools is covered in detail in my guides on developing coping strategies in trauma therapy and understanding the clinical benefits of somatic awareness.
Key Components of a Dual Awareness Practice
Prior to processing traumatic memories, a therapist works with you to cultivate two primary psychological pillars:
  • Balancing Two Realities: You learn to acknowledge and hold past traumatic sensations in your awareness at the exact same time that your logical mind recognizes you are safe in the room with your clinician.
  • Developing an Observing Self: You learn to step into an "observing self"—a compassionate, objective witness that observes your internal experiences (thoughts, body sensations, and emotions) without becoming consumed by them. Depending on the modality, this part of the psyche may be called the Core Self, Adult Self, or Higher Self. Actively unblending from the trauma texturally prevents you from feeling flooded, lowering the risk of retraumatization.
Advanced Therapeutic Techniques to Build Dual Awareness
Trauma specialists utilize several somatic and experiential techniques to help you balance historical processing with real-time grounding:
  • Pendulation (Somatic Experiencing): Developed by Dr. Peter Levine, pendulation is the practice of gently shifting your attention back and forth between a distressing trauma sensation and a calm, neutral resource (or your Core Self). This allows you to process memories in manageable, titrated segments so your nervous system does not become overwhelmed.
  • Imaginal Interweaves & Undoing Aloneness: Before accessing a trauma memory, you identify figures who represent absolute emotional safety—such as a loving relative, a supportive friend, a protective historical figure, or even a compassionate character from a book or movie. During processing, you imagine these figures accompanying you or intervening to protect your younger self. This creates a powerful somatic "felt sense" of being helped, actively undoing the aloneness inherent to trauma.
  • Somatic Containment Practices: Containment involves a mental visualization at the end of a session where you safely store the traumatic memory away in an imaginary secure container (like a locked box or safe). Some clients prefer to imagine leaving this container in the safe keeping of their therapist's office until their next session, allowing them to step back into daily life unburdened.
  • Regulated Breathing Exercises: Intentionally pausing the processing to practice slow, deep, cleansing breaths lowers autonomic arousal. This ensures the trauma work remains strictly within your tolerable window of tolerance, and serves as an excellent tool for managing and reducing day-to-day trauma triggers.
Leading Modalities for Effective Trauma Processing
If you are looking to process traumatic memories so they no longer disrupt your present life, traditional talk therapy can sometimes fall short. Highly effective, evidence-based experiential modalities include:
  • EMDR Therapy (Eye Movement Desensitization and Reprocessing)
  • Somatic Experiencing (SE)
  • Internal Family Systems (IFS) & Ego States Parts Work
  • AEDP (Accelerated Experiential Dynamic Psychotherapy)
Get Help in Trauma Therapy
Rather than struggling through chronic triggers or emotional blocks on your own, seek guidance from a licensed mental health professional explicitly trained in bottom-up trauma care. Reclaiming your dual awareness can free you from the weight of your history and allow you to live a more meaningful, connected life.
About Josephine Ferraro, LCSW
I am a licensed New York psychotherapist and advanced trauma specialist with over 25 years of experience helping individual adults and couples process complex trauma and reclaim their lives. 

My private practice integrates cutting-edge somatic and experiential modalities, including Somatic Experiencing, EMDR, AEDP, Internal Family Systems (IFS) Parts Work, Clinical Hypnotherapy, and Certified Sex Therapy.
Contact & Consultation Information
I see clients online throughout New York State and in person at my private office in Greenwich Village, New York, NY 10011.

I offer a free 15-minute introductory phone consultation before scheduling your initial appointment.
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Monday, February 9, 2026

Emotional Regulation: How Do You Know What You Need When You Feel Emotionally Dysregulated?

Many people who would like to be more emotionally regulated don't understand what they need when they feel upset (see my article: Developing Skills to Manage Your Emotions).

Emotional Regulation

This is understandable because when you are sufficiently upset, the part of your brain that allows you to reason (the prefrontal cortex) is often "off line". 

The more reactive part of your brain, the amygdala, gets into a fight or flight mode so that you  can't think your way into knowing what you need.

When you feel emotionally overwhelmed, here are some tips on what can be helpful:
Emotional Regulation
  • Try the 5-4-3-2-1 Technique: Name 5 things you see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste. This helps you to stop spiraling so you can get back to feeling like yourself again.
  • Pick a Color: If the 5-4-3-2-1 technique feels like too much in the moment, you can choose a color, like the color blue and look around the room and name all the things you see that are blue. This is an even simpler way to calm yourself. It also helps to orient you to your environment.
  • Try the Butterfly Tapping Technique: Another way to calm yourself is to use Butterfly Tapping:
    • Sit comfortably, cross your arms over your chest and rest your hands on your upper arms or shoulders. 
    • Give yourself alternating gentle taps on your upper arms or shoulder (right then left) in a slow rhythmic motion for 1-3 minutes or until you feel calmer.  This helps to reduce stress (see my article: Self Soothing with the Butterfly Hug).
  • Tune Into Your Body and Ask Yourself: "What do I need?"
    • What emotions are you feeling and where do you feel it in your body?
Emotional Regulation
    • Are you angry?  If so, what are you angry about? What do you need to feel safe?
    • Are you afraid? If so, what are you afraid about? What do you need to feel safe?
    • Are you lonely? If so, who can you contact to make a meaningful connection? This can also be a connection with a pet.
  • Practice Slowing Down With Low Stakes Situations: When you're learning to regulate yourself, practice slowing down with low stakes situations before you try to tackle more high stakes triggers.
Get Help in Therapy
Sometimes self help tips aren't enough and you might need professional help to learn to regulate yourself emotionally.

Get Help in Therapy

A licensed mental health professional can help you to get to the root of your problems so you can overcome the underlying problems that are triggering you.

Rather than struggling on your own, seek help from a licensed psychotherapist so you can live a more fulfilling 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 with over 25 years of experience, 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.










 

Saturday, February 10, 2018

How Far Do You Want to Go in Your Psychotherapy?

In a prior article, Psychotherapy is an Active Process: The More Engaged You Are In It, the More You Get Out of It, one of the issues that I discussed briefly was the decision as to how far you want to go in psychotherapy--everything from symptom relief to delving deeper into your unconscious process to get to the root of your problem.

How Far Do You Want to Go in Psychotherapy?

As I mentioned in that article, each client makes this decision in consultation with the psychotherapist.  But, ultimately, the decision is up to the client.

If you're new to psychotherapy, you might not understand what your choices are and the implications of these choices.  So, I will provide describe different types of therapy.

Choices in Psychotherapy
The following scenarios describe various choices in psychotherapy for the same client, Ted, at various points in his life:

Short Term Symptom Relief Therapy:  When you choose short term symptom relief, you're usually choosing brief therapy to get rid of a symptom and you're not delving deeper into the problem once you start to feel better.  Ted had his first experience of attending psychotherapy when he saw a psychotherapist to deal with his panic attacks.  Since Ted wasn't interested at that point in more than symptom relief, his psychotherapist taught him how to do breathing exercises and to meditate.  Within a few weeks, Ted was feeling better and he decided to end therapy (see my articles: Tips For Overcoming Panic AttacksWhat is the Difference Between Fear and Anxiety? and Getting Help in Therapy For Anxiety Disorders).

Longer Term Symptom Relief Therapy: Longer term symptom relief is therapy that is longer than short term therapy but shorter than more intensive therapy.  Ted managed well with what he learned in his short term therapy for a few months.  Then, he began a stressful new job and became symptomatic again.  He returned to therapy with the same psychotherapist, and he told her that he still wanted only symptom relief, but he was willing to stay in therapy for a longer period of time to deal with his panic attacks.  Since he stopped doing the breathing exercises and the meditation, his psychotherapist reinforced the stress management techniques she taught him when he first came to her.  She also added more coping techniques so he could deal with the current stressors on his job.  When he felt better and he was no longer experiencing panic attacks, he told his therapist that he wanted to leave therapy.  He understood that he could return in the future.

EMDR Trauma Therapy: Ted returned to his psychotherapist a year later.  He rarely had panic attacks anymore and when he had them, he knew how to calm himself.  However, he was now experiencing persistent anxiety after he met his father again for the first time since he was a young child.  Their meeting was fraught with tension on both sides.  Ted's father wanted to reconcile their relationship, but Ted was leery because he had a lot of resentment towards his father for abandoning the family.  In addition, Ted realized that his boss had similar characteristics to his father, and Ted was getting emotionally triggered whenever he had to work closely with his boss.  His psychotherapist recommended that they do EMDR therapy to work on the unresolved trauma as well as the current situation with his boss.  She explained to Ted that EMDR therapy tends to be faster and more effective than regularly talk therapy.  Gradually, Ted was able to work through his traumatic reactions within a year of beginning EMDR therapy.  He realized that he could have stayed in therapy to develop deeper insights into himself, but he told his therapist that he would return if he felt the need for delving deeper (see my articles: What is EMDR Therapy?How EMDR Works - Part 1: EMDR and the BrainHow EMDR Works - Part 2: Overcoming Trauma, and What is Adjunctive EMDR Therapy?).

Grief Work in Therapy:  Grief work is focused specifically on helping a client to grieve and mourn a loss.  It can be short term or long term.  With regard to Ted, a couple of years later, Ted found out that his father died.  At the time, they were not speaking because they were not able to reconcile their relationship.  When he received the call that his father died, Ted felt profoundly sad for the loss of his father as well as the loss of not ever having a father that met his emotional needs.  He also felt sad because any chance of reconciling their relationship was gone, and he felt very guilty about this as well.  He returned to his psychotherapist and they did grief work to help Ted get through this difficult time.  Between sessions, Ted kept a journal and wrote about his feelings about his father.  He also organized a photo album with pictures of his father and himself from when Ted was younger.  He was able to work through his grief, and he let his therapist know that he was feeling better and he wanted to discontinue therapy (see my articles: Grief: Coping With the Loss of a Loved One: Common ReactionsComplicated GriefThe Theme of Complicated Grief For a Mother in the Movie, Phantom ThreadHolding Onto Grief as a Way to Stay Connected to a Deceased Love One and Trying to Understand Your Father).

Contemporary Psychodynamic Psychotherapy: Psychodynamic psychotherapy is a form of psychoanalysis.  Generally, it focuses on the unconscious mind and might include dreams and daydreams.  It usually also includes exploring transference issues.  When Ted returned to therapy, he felt lost.  He had just ended an enmeshed two year relationship with a woman that he loved very much when they first started seeing each other.  Gradually, they grew apart, and Ted sensed that he contributed significantly to the demise of the relationship because he had problems committing to his then-girlfriend.  He believed that he had issues with trust and this is what made it difficult for him to make a long term commitment.  He felt he was now ready to delve deeper into his unconscious mind to get to know himself better.  He agreed to attend open ended contemporary psychodynamic psychotherapy with the understanding that he could leave therapy whenever he wished; however, his therapist recommended that it would be better to work together towards termination in therapy when the time came.  Sometimes, Ted brought in dreams to discuss with his therapist.  He was also interested in exploring the unconscious underpinnings of his problems.  Gradually, his therapist helped Ted to make connections between his original panic attacks, his history of childhood emotional neglect, the loss of his father, and his problems with making a commitment in a relationship.  Ted also felt more emotionally integrated in contemporary psychodynamic psychotherapy (see my article: Discovering the Unconscious Emotions at the Root of Your Problems and What Unconscious Decisions Have You Made That Are Impacting Your Life?).

Conclusion:
The scenarios above show how one person can choose various forms of psychotherapy over a period of time depending upon the problem and what the client is ready to deal with at the time.

Each form of therapy mentioned above serves a particular purpose and could be appropriate at various times in a client's life.

Getting Help in Psychotherapy
When you decide that you would like to attend psychotherapy, the first step is to contact a psychotherapist for a consultation (see my article: The Benefits of Psychotherapy).

During the consultation, you give an overview of your problem and asks the psychotherapist questions about how she works, what type of therapy she does, her expertise and so on.

The psychotherapist will usually make a recommendation within a few sessions as to what form of therapy she thinks would be best for the client given his or her particular problems.  There are usually a few different ways to work, as outlined above, and depending upon the therapist's expertise.

The choice as to which type of psychotherapy is generally up to the client, unless the therapist thinks that the client needs a higher level of care or a different type of therapy.

Over time, as shown in the examples above, a client can return for different types of therapy (assuming that the therapist does these different forms of therapy) or the client can go to a different therapist (see my article: Returning to Therapy).

If you have been unable to resolve problems on your own, you could benefit from seeing a licensed mental health professional to help you to resolve your problems (see my article:  How to Choose a Psychotherapist).

Freeing yourself from problems that are hindering you from maximizing your potential can lead to living a more fulfilling and meaningful life.

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

I 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.