What is Dual Awareness in Psychotherapy?

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

Dual Awareness in Trauma Therapy

What is Dual Awareness in Trauma Therapy?

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

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

Dual Awareness in Trauma Therapy

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

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

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

Key Concepts of Dual Awareness:

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

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

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

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

Some of these techniques include:

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

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

Dual Awareness in Trauma Therapy

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

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

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

What Are the Different Types of Trauma Therapy?

There are different types of trauma therapy including:

• EMDR Therapy (Eye Movement Desensitization and Reprocessing

• AEDP (Accelerated Experiential Dynamic Psychotherapy)

• Somatic Experiencing

• Parts Work Therapy (IFS and Ego States Therapy)

Getting Help in Trauma Therapy

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

Getting Help in Trauma Therapy

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

About Me

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

I have over 25 years of experiencing helping individual adults and couples.

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

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

Also See My Articles:

What is a Trauma Therapist? 

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

What is Complex Trauma? 

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:

• Pause and Slow Down: Whether you do this by using a breathing exercise, grounding exercise or a mindfulness meditation, pausing and slowing down helps you to calm down so you can think about what you need.

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.

 

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 Attacks, What 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 Brain, How 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 Reactions, Complicated Grief, The Theme of Complicated Grief For a Mother in the Movie, Phantom Thread, Holding 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.