The Traumatic Impact of Verbal Abuse on Self Esteem

In a prior article I began a discussion about verbal abuse (see my article: The Connection Between "Tough Love" and Verbal Abuse).

The Traumatic Impact of Verbal Abuse on Self Esteem 

In the current article I'm focusing on how verbal abuse can affect self esteem.

How Does Verbal Abuse Affect Self Esteem?

When children experience verbal abuse, the abuse can have long lasting effects on their self esteem.

Clinical Vignettes

The following vignettes, which are composites of many cases, illustrates how verbal abuse can have long lasting effects and how trauma therapy can help:

John

As the youngest child, John grew up in a household where his father yelled and criticized him while his mother, who was intimidated by the father, stood by passively and did nothing. His older siblings would also join in the criticism by bullying John. He grew up feeling that he couldn't do anything right. His self esteem was so low that, even though he was intelligent, he was fearful of raising his hand in class to answer the teachers' questions. He only had one friend who also came from a household where he was verbally abused. 

The Traumatic Impact of Verbal Abuse on Self Esteem

By the time John got to college, he spent most of his time alone until he met Peggy in English class. She was friendly and outgoing and she asked John out on a date. They dated throughout college and both of them planned to move to New York City when they graduated. By then, John's confidence was so low that he was afraid to apply for jobs, so Peggy encouraged him to get help in therapy. 

After he began seeing a trauma therapist, John learned how his father's verbal abuse affected how he felt about himself. His therapist helped John by using EMDR Therapy (Eye Movement Desensitization and Reprocessing) to help him to overcome the traumatic effects of the childhood verbal abuse.

Nina

Nina was an only child with a single alcoholic mother. She learned to take care of herself at an unusually young age because she couldn't rely on her mother, who was often drunk and passed out. When her mother woke up with a hangover, she would be angry and hostile towards Nina. She would call her names and tell her she wished Nina had never been born. 

The Traumatic Impact of Verbal Abuse on Self Esteem

After one of her teachers suspected that Nina was being abused, she called the Administration For Children's Services Child Protective Services and Nina was eventually placed in kinship foster care with a maternal aunt who lived nearby. 

Although her aunt was much more nurturing, the impact of the mother's verbal abuse had already had a devastating effect on Nina. Even though she was no longer around her mother, Nina had internalized her mother's verbal abuse to such an extent that she was now criticizing herself silently by repeating in her mind, "I'm so stupid" or "I'm no good." 

By the time she was 18, her self esteem was so slow that she told aunt she didn't want to go to college. So, her aunt found Nina a trauma therapist who did AEDP (Accelerated Experiential Dynamic Psychotherapy) to help Nina overcome the impact of her mother's neglect and verbal abuse. After working in trauma therapy, Nina felt more confident and she applied to several colleges. 

Tom

By the time Tom was 35 years old, he had been living an lonely and isolated life for all his life. Growing up as the youngest child, he watched his parents argue constantly and his father frequently left the household for extended periods of time without saying when he would come back. Tom and his older brothers spent most of their time isolated in their own rooms. 

Eventually his older brothers moved out without a word, so Tom was left alone with his combative parents. He tried to stay out of their way, but they would often turn their anger on him by yelling at him and criticizing almost everything he did. As a result, Tom grew up with a lot of shame and low self esteem.  

The Traumatic Impact of Verbal Abuse on Self Esteem

In his mid-30s, he knew he needed to get help in therapy because he was suffering with anxiety and depression, and his self esteem was so low that he lacked the confidence to meet women. So, he sought help from a trauma therapist who did Parts Work Therapy and he began to recover from the impact of his childhood trauma.

Conclusion

The negative impact of verbal abuse experienced in childhood often endures throughout adulthood.

Even though verbal aggression tends to be minimized in our culture, verbal abuse can be just as traumatic as physical or sexual abuse.

The vignettes presented above are just some of the possible ways verbal abuse can be traumatizing. 

Often, adults don't connect their low self esteem, depression or anxiety to their childhood history.  Instead, they might blame themselves or believe they are "not good enough" or they are "unlovable" without ever making the connection to their history or realizing they can get help in trauma therapy.

Getting Help in Trauma Therapy

If you have been struggling with low self esteem as a result of unresolved trauma, you can get help in trauma therapy.

Getting Help in Trauma Therapy

A skilled trauma therapist can help you to overcome harmful effects of unresolved trauma so you can lead a more fulfilling life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Certified Sex Therapist.

I have over 20 years of experiencing helping 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.

Trauma and the Fawn Response: People Pleasing to Avoid or Diffuse Conflict

Fight, flight and freeze are the trauma responses that are usually discussed in trauma literature.  

In addition to these responses, Peter Walker, MA, a family therapist, coined the term "fawning" as another common trauma response to diffuse or avoid conflict (see my article: Unresolved Trauma: Living in the Present as if it Were the Past).

Trauma and the Fawn Response

Understanding Fight, Fight and Freeze as Trauma Responses

Before describing the fawn response, let's review the other three trauma responses: Fight, flight and freeze.

• Fight - Confront the Threat: The fight response involves anger and confrontation. This could be either verbal or physical and involves high energy.

• Flight - Run from the Threat: The flight response involves anxiety, avoidance and fleeing from the threat. It also includes high energy.

• Freeze - Shutdown to Block Out the Threat: The freeze response can include physical and/or emotional numbing and dissociation.  For animals in the wild, it's also called "playing possum" and it's often a powerful survival response to an imminent threat from a predator (the animal appears to be dead, which would make the predator lose interest).  This shutdown is a low energy response. For humans it often involves an involuntary response that includes feeling cold or numb, heaviness in the limbs, holding their breath and a sense of dread or foreboding.

Understanding Fawn as a Trauma Response

The fawn response usually develops due to unresolved childhood trauma, which is also known as developmental trauma (see my article: Looking at Your Childhood Trauma From an Adult Perspective).

The fawn response involves appeasing, which includes codependency, people-pleasing and lack of boundaries to avoid conflict or threat.  

The person who is fawning prioritizes the other person's needs over their own.  In some cases, the person is unaware of their own needs because they're so accustomed to putting the other people's needs first.

Fawning often develops as a psychological survival strategy for a child who is being abused or neglected. The child learns early on that appeasing the parent(s), even if it means sacrificing their own needs will diminish a threat--whether the threat is emotional or physical.

Signs of Fawning Behavior:

The following behaviors are some of the most common signs of fawning behavior:

• Having problems being assertive and saying "no"
• Being overly compliant on a regular basis to avoid or diffuse conflict
• Having trouble setting boundaries
• Being overly apologetic
• Sacrificing your own needs to prioritize the needs of others
• Denying emotional and/or physical needs on a regular basis
• Compromising your values to align yourself with others
• Feeling guilty when you feel angry towards others because you don't feel entitled to your feelings
• Trying to "fix" or rescue others from their problems
• Attempting to control others or their choices so you can feel emotionally safe
• Gushing with praise or being overly complimentary toward someone--even when it's not how you actually feel--in order to appease someone
• Holding back feelings or opinions on a regular basis in order not to make others feel uncomfortable
• Changing your response or opinions to comply or be in synch with others
• Going out of your way to people-please to avoid or diffuse conflict
• Assuming responsibility for others' discomfort when it's not your fault
• Flying under the radar (making yourself small) to avoid getting attention
• Experiencing chronic pain or illness due to the stress of the trauma response
• Spacing out or dissociating when you feel uncomfortable in a social situation

Since the fawn response to trauma is a big topic, I'll continue this discussion in my next article (see my article: Trauma and the Fawn Response: A Clinical Vignette).

Getting Help in Therapy

Unresolved trauma can create anxiety, depression and lack of self confidence as well as other psychological problems.  

It can have a negative impact on your relationships.

Rather than struggling with unresolved trauma on your own, seek help from a licensed mental health professional (see my article: Why Experiential Therapy is More Effective For Unresolved Trauma Than Regular Talk Therapy).

Freeing yourself from your history of trauma can help you to have a more fulfilling life.

About Me

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

I work with individual adults and couples.

As a trauma therapist, I have helped many people to overcome trauma (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.

Now That You're An Adult, Your Parents Have Changed Into the Parents You Wanted As a Child

As a psychotherapist in New York City, I hear many adult clients tell me that they have problems reconciling who their parents were in the past to who their parents are now.

In these situations, psychotherapy clients often say something like, "My mother was so abusive when I was growing up, but now she's a sweet, kind lady. I can't believe she's the same person. I'm glad she's changed, but I'm having problems reconciling that the mother from the past is the same mother in the present.  Why wasn't she kind to me when I was a child?" (see my article: Looking at Your Childhood Trauma From An Adult Perspective).

Now That You're an Adult, Your Parents Have Changed Into the Parents You Wanted As a Child

This change often presents a dilemma for clients attending psychotherapy.  They are traumatized, they are affected in their current life by the childhood abuse.  But many of these clients also feel a sense of guilt for complaining about their parents' past behavior because their parents are no longer like that.  Not only do they experience guilt, but they also feel confused about the change.

On an intellectual level, most clients understand that people often change and who they were in the past is no longer who they are in the present.  But on an emotional level, especially if the past trauma is getting triggered in their current circumstances, it's hard to reconcile the change (see my article: Coping With Trauma: Becoming Aware of Emotional Triggers).

These clients often experience anger, sadness and resentment for the love and nurturing they didn't get as a child.  Many of them also express surprise to discover that their parents have changed because they never thought their parents would ever change.

In many cases, the change becomes evident when these adult clients have their own children and their parents, as grandparents, interact with their grandchildren in a much more nurturing way than they ever did with these clients when the clients were children.

This sometimes creates a dilemma for these clients because, on the one hand, they feel somewhat envious that their children are getting the love and nurturance from the clients' parents that these clients wanted for themselves as children.  But, on the other hand, even though these clients' feelings are understandable, no one wants to feel envious of their own children.

A Fictional Clinical Vignette: Your Parents Today Have Changed Into the Parents You Wanted As a Child:
The following fictional clinical vignette is typical of this issue and illustrates how psychotherapy can help:

Beth
Describing a horrific childhood with both physical abuse and neglect, Beth, who was in her 40s, told her psychotherapist that, she recently gave birth to a baby girl, Cindy.  She said that, after being estranged from her parents for many years, she and her husband were considering whether or not to contact her parents about Cindy's birth.

Beth described a traumatic childhood where she and her younger sister, Sandy, often cowered in their room when one or both parents lost their tempers and hit them with a belt.  Other times, her parents would leave them alone at home over the weekend with no food as the parents went to a resort in Upstate New York.

Beth said that neither she nor Sandy ever told anyone about the abuse or neglect because they were both too afraid of the repercussions.  As a result, they endured the abusive and neglectful behavior until they were old enough to leave the household.  Beth even delayed going to college for a year so that she and Sandy could leave the household at the same time.  She feared that if she left Sandy alone with their parents, they would unleash all their anger on her after Beth was gone.

Beth's husband, John, who had heard the horrific stories of Beth's childhood, would have preferred that Beth not contact them at all.  He feared that they might want to be involved with Cindy, and he definitely felt uncomfortable with that.  But he left the decision about contacting her parents up to Beth.

Ultimately, Beth decided to send her parents a note.  She would rather that they hear about Cindy directly from her rather than hearing it from other relatives who were still in Beth's life.

Based on their experiences with their parents, Beth and Sandy both doubted that their parents would want to be involved in Cindy's life.  So, Beth, Sandy and John were shocked when her parents wrote back that they were thrilled to hear that they were grandparents and they wanted to reconnect with Beth and Sandy and see the new baby.

At first, Beth wasn't sure what to do.  Before she contacted her parents, she knew there was a possibility that they might want to meet Cindy, but she thought of it as a very remote possibility.  She was shocked that her parents would even care enough to want to reconcile and meet Cindy.

When she talked it over with John, she understood his reluctance.  He had never met her parents and, after hearing about Beth's traumatic childhood, he hoped he would never meet them.  He was angry for the hurt that they caused Beth and Sandy.

After they talked it over and Beth discussed it in several therapy sessions with her psychotherapist, Beth and John decided to have a short visit with her parents in a nearby park rather than inviting them over to their apartment.  Sandy decided that she didn't want to see her parents, so she told Beth that she wouldn't go.

With much trepidation, Beth and John waited for Beth's parents at the area they designated in the park.  While they waited for Beth's parents to show up, they both wondered if they were making a big mistake.  But it was too late to back out at that point.

During her next psychotherapy session, Beth told her psychotherapist that she was amazed at how pleasant and nurturing her parents were with Cindy and with her and John.   Not only were they thrilled that they were now grandparents, they both said how much they missed Beth.

Afterwards, Beth was so surprised that she could hardly believe that they were the same parents who were abusive and neglectful with her and Sandy.

Her amazement was so great Beth told Sandy that when she was with their parents, for a second, she wondered if the abuse and neglect had ever happened.  She wondered: How could these be the same people?  But she was relieved that Sandy, who was also shocked to hear that their parents were pleasant, confirmed Beth's sense of reality about their childhood.

John was also surprised.  After hearing about Beth's childhood, he wasn't sure what to expect when they met for the first time.  But he wasn't expecting such a warm response from them.

Aside from needing help to reconcile her parents of today with her parents from the past, Beth also started therapy because she wanted to work on her unresolved childhood trauma.  But, after reconnecting with her parents, initially, Beth had difficulty processing the earlier trauma because she felt like her parents were such different people now, and she continued to have doubts regarding her perceptions of her childhood.

She felt a guilty complaining to her therapist about her parents when they were now behaving in such a loving and nurturing way with Cindy.  Even though Sandy confirmed her sense of what happened when they were children and she knew, on an intellectual level, what happened, there were still times, on an emotional level, when Beth felt like she might be "exaggerating" or "making a big thing out of nothing."

Beth's psychotherapist provided her with psychoeducation about how adults, who were abused and neglected as children, often have doubts about their childhood history--especially if their parents had changed.  Knowing that this was a common experience for many clients, Beth felt somewhat relieved to know that other people had similar experiences.

In addition, Beth had many mixed feelings about her parents.  She told her therapist that, when she was a child, she longed to have parents who were as loving as her parents were now to her daughter.  Although she was glad that they were able to be loving towards her daughter, she also felt a lot of grief for what she didn't get emotionally from her parents when she was a child.  She told her therapist that she was felt guilty to admit that she sometimes envied Cindy because her parents could be so loving towards Cindy.

Her psychotherapist used EMDR therapy to help Beth to process her traumatic childhood (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

The work was neither quick nor easy.  As part of her trauma work, Beth grieved for the love she didn't get as a child.

In the meantime, as Beth was resolving her childhood trauma, she and her husband were making decisions about how much contact they wanted Cindy to have with Beth's parents.

Conclusion
People are often amazed when parents, who were abusive to them when they were children, can now be kind and loving as grandparents.

There can be many reasons for this, including:

• Abusive parents often mellow with age.  
• Grandparents are usually under less pressure with their grandchildren than they were as parents.  Often, they can have a good time with their grandchildren without the stress they felt when they were rearing their own children.
• People change, and abusive parents might have regrets about their behavior.  
• Grandparents, who have regrets about being abusive parents, often see grandparenting as a way to make up for the abusive way they treated their own children.

Of course, every situation is different, and each person needs to make his or her own decision about whether to allow a formerly abusive parents back in his or her life.

It's also true that, even when there aren't grandchildren involved, abusive parents can change over time, and their adult children have many of the same problems reconciling the parents of the past with the current parents.

Getting Help in Therapy
Coping with a history of unresolved childhood trauma is difficult, especially when, as an adult, unresolved trauma gets triggered in the present.

Psychotherapy with a skilled trauma therapist can help you to overcome unresolved trauma, so you can free yourself from your history and live a more fulfilling life (see my articles: The Benefits of Psychotherapy and 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 am a trauma therapist who works with individual adults and couples, and I have helped many clients to overcome unresolved 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.

Understanding How an Avoidant Attachment Style Affects You and Your Relationship

In my prior articles, How Your Attachment Style Affects Your Relationship and How Early Attachment Bonds Affect Adult Relationships, I discussed attachment styles in general and the affect they can have on relationships.  In this article, I'm focusing specifically on the avoidant attachment style, its origins, and how it can affect a relationship (see my article: An Emotional Dilemma: Wanting and Dreading Love).

Understanding How an Avoidant Attachment Style Affects You and Your Relationship

Relationships: From Passion and Excitement to Fear of Emotional Intimacy
While relationships often start with passion and excitement, each person's core vulnerabilities can emerge as the relationship becomes more serious, the couple becomes more attached, and the emotional intimacy increases.  If both people are emotionally secure because they grew up in loving and secure homes where their emotions needs were mostly met, when issues , they can usually be worked out more easily than one or both people have an insecure attachment style.

But people who developed an insecure attachment style, like avoidant attachment, as a coping strategy when they were children, can become increasingly uncomfortable as the relationship becomes more emotionally intimate.  With greater emotional intimacy, they become aware that they are more emotionally dependent upon their romantic partner, which can make them feel emotionally vulnerable.

People with an avoidant attachment style are often unable to put their fear into words.  Depending upon how threatened they feel by the emotional intimacy of the relationship, they will often dissociate and become estranged from their own feelings and from their partner because this is the emotional survival strategy that they developed in childhood.

They will often shut down emotionally.  Although they might appear from the outside as if nothing much is going on, internally they are in a state of turmoil and often unable to express their feelings.

They appear as if they are deliberately stonewalling their partner but, in most cases, they have really "checked out" or dissociated because they're overwhelmed, and the more the other partner insists that they talk about what's happening, the more dissociated they can become (see my article: Relationships: Are You a Stonewaller?).

How Do People Develop an Avoidant Attachment Style?
The avoidant attachment style usually begins in early childhood due to consistent neglect or abuse.  If the parents are unable to provide the baby with an emotionally safe home environment, the baby, who is unable to fight or flee, goes into "freeze" mode, which is another term for dissociation, as a last resort to cope with the abuse or neglect.

As adults, these individuals continue to be disconnected from their emotions.  Without the necessary help in early childhood about how to identify and tolerate uncomfortable emotions, these adults continue to engage in maladaptive coping strategies to avoid experiencing uncomfortable feelings.  So, a strategy that saved them as infants becomes an obstacle to their knowing themselves and connecting with others.

Fictional Clinical Vignette: Understanding the Avoidant Attachment Style
Ken
During the first three months of his relationship, Ken, who was in his mid-30s, was in a state of bliss whenever he was with Ann.  They met at a party and they were instantly attracted to one another.  Soon, they were dating a few times a week and enjoying each other's company.

By the fourth month, Ken realized how deeply he cared for Ann, and he began to feel anxious. He wasn't sure what made him feel anxious, but he knew that he was feeling different from before.  Whereas he felt loving and carefree whenever he was with Ann before, he now felt ambivalent about seeing her.

Rather than feeling carefree and in a state of bliss, he now experienced anxiety just before they got together.  He tried to think of what changed, but he couldn't think of anything.  Nothing had occurred that would account for his anxiety.

Sometimes, he wondered if he just didn't care for her anymore, but he knew this wasn't true.  If anything, he cared for her more now than during their few couple of months dating, so none of this made sense to Ken.

Ken had been in two other serious relationships before, and he experienced a similar pattern--feeling happy during the early stage of the relationship and then increasingly uncomfortable as time went on.  In each case, he assumed that his feelings had changed or they had "grown apart" and he ended the relationships.  But there was something different about how he felt this time because, even though he felt anxious, he knew he still cared for Ann.

When Ann brought up that he seemed to be more distant around her lately, she asked him if there was anything wrong.  Ken didn't know how to answer her, so he remained quiet for a while.  Then, he assured Ann that he cared for her a lot and wanted to continue to see her.  This response seemed to satisfy Ann, but Ken knew it was just a matter of time before this issue came up again.

As he became increasingly concerned about what was going on for him, he contacted a psychotherapist to try to understand himself. When his psychotherapist asked Ken to talk about his family history, Ken talked about being an only child in a household where his mother was emotionally distant and his father was emotionally and physically abusive.  He had few specific memories of his childhood, but he knew that he was happy to go away to college, and he never moved back in with his parents again.

Ken discussed how emotionally distant he was becoming when he was around Ann.  He also spoke about being concerned that if he didn't get help, he might be jeopardizing his relationship.

After his psychotherapist assessed Ken over the next several sessions, she provided him with psychoeducation about attachment styles.  She told him that due to his traumatic childhood, he developed an avoidant attachment style which surfaced when relationships became more emotionally intimate and threatening to him.

His psychotherapist explained that their work in therapy would be neither quick nor easy, but if he stuck with therapy, he had a chance of overcoming his fearful, avoidant attachment style.

She began by helping Ken to identify his emotions.  Initially, this was very hard for Ken when he thought about his relationship with Ann.  He knew that he was happy at first when they were first getting to know each other.  He also knew that he felt anxious around her lately, but he didn't know why.

His psychotherapist taught Ken how to sense his emotions in his body.  She told him that the body offers a window into the unconscious mind and that if he could sense into his body, over time, he might be able to identify more specifically what he was experiencing (see my article: The Body Offers a Window Into Unconscious Mind).

At first, Ken had difficulty sensing into his body.  It took a while for him to be able to sense tension in his neck and chest.  Then, gradually, he was able to identify other emotions, like fear, when he thought about getting together with Ann.

Over time, Ken also noticed in therapy that as he focused on an emotion in his body, like fear, that it eventually dissipated.  So, after a while, he realized that emotions often come and go and that he was not identified by his emotions.

Ken's psychotherapist paid particular attention to what Ken was able to tolerate with regard to uncomfortable emotions.  She knew that his window of tolerance for emotions that made him uncomfortable was narrow, so she was careful not to have Ken dwell on uncomfortable emotions longer than he could tolerate.

Over time, Ken's window of tolerance expanded so he could tolerate uncomfortable emotions for longer periods of time.  Using Somatic Experiencing, this allowed them to explore what thoughts, memories of physical sensations came up for him as he experienced these emotions.

Over time, Ken had expanded his window of tolerance significantly.  Then, his therapist recommended that they work on the root of his problem, which was the childhood abuse and neglect, using EMDR therapy (see my articles:  How EMDR Therapy Works: EMDR and the Brain).

In the meantime, Ann, who knew that Ken was in therapy working on his problems, was patient.  She mentioned to him that she noticed some progress.  Specifically, she sensed that his ability to remain emotionally connected to her had improved somewhat.  She noticed that he wasn't as emotionally distant with her as he had been before.  This was encouraging to both of Ken and Ann.

Understanding How an Avoidant Attachment Style Affects You and Your Relationship

Over the next year, Ken continued to work with his psychotherapist using EMDR therapy to resolve his traumatic past.  EMDR therapy helped Ken to make emotional connections between his current fear and the fear that he experienced when he was a child.

He also began to develop an ability to separate his fear from childhood from what was getting emotionally triggered in his relationship (see my article:  Overcoming Emotional Trauma: Separating "Then" From "Now").

He understood on an emotional level that, whether he was in a close relationship with Ann or with someone else, this fear would get triggered (see my article:  Coping With Trauma: Becoming Aware of Emotional Triggers).

Eventually, Ken worked through his early trauma, he became more connected to his internal world and more connected to Ann.

Conclusion
Attachment styles are developed early in childhood.  If a child grows up in a secure, loving home environment, all other things being equal, s/he will usually develop a secure attachment style.  If a child grows up in an abusive and/or neglectful home environment, s/he will probably develop an insecure attachment style.

The avoidant attachment style is one form of insecure attachment.  It becomes more obvious in a relationship as the relationship becomes more emotionally intimate.

At that point, what usually happens is that, on an unconscious level, the person with an avoidant attachment style uses the same emotional survival strategy that s/he used as an infant--s/he dissociates, which creates an internal emotional estrangement as well as creating distance from a romantic partner.

Although this is a maladaptive coping strategy as an adult, it keeps him or her from becoming overwhelmed.  However, it also creates the kinds of problems which I described in the vignette above.

Since the root of the problem is in childhood, this is where the therapeutic work needs to be.  However, the psychotherapist must make sure first that the client can tolerate feeling his or her uncomfortable emotions.  If the client can't tolerate uncomfortable emotions, which is usually the case, the therapist needs to help the client to expand his window of tolerance first so that, gradually, s/he can tolerate difficult emotions.

Once the client can tolerate difficult emotions, then the therapist can help the client to overcome the original traumatic experiences which are at the root of the problem using a form of trauma therapy, like EMDR (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Getting Help in Therapy
It can be very confusing to realize that your feelings have changed from bliss to anxiety during the course of a romantic relationship which has become more emotionally intimate.

A skilled psychotherapist, who uses experiential therapies, like Somatic Experiencing and EMDR therapy, can help you to expand your window of tolerance and, eventually, help you to work through the root of your traumatic experiences (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than suffering alone, you owe it to yourself to get help in trauma therapy.

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 their 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 regular business hours or email me.

Seeing Yourself as Being "Rational" vs. Experiencing Shame For Not Being Able to Feel

As I discussed in my prior article, people often use defense mechanisms as emotional survival strategies when dealing with the underlying issues that would be too overwhelming for them.  These defense mechanisms usually develop early in life when they helped with emotional survival.  But, as adults, these defense mechanisms get in the way of personal development as well as developing healthy relationships.  Suppressing emotions to be "rational," as opposed to feeling ashamed of not being able to feel emotions, is the defense mechanism that I will focus on in this article (see my article: Overcoming Your Fear of So-Called "Negative" Emotions).

Seeing Yourself as Being "Rational" vs. Experiencing Shame For Not Being Able to Feel

People who tend to be rational most of the time, to the exclusion of feeling their emotions, usually pride themselves on their rationality.  They don't realize that they're being rational in order to avoid feeling uncomfortable feelings because this defense mechanism is unconscious.

Sooner or later, being rational in order to avoid feelings causes problems, especially in relationships.  The other partner, who has access to all or most of his or her emotions, gets frustrated with the partner who uses being rational as a defense--while the partner who uses being rational feels comfortable with this and can't understand what all the fuss is about.

A Fictional Clinical Vignette:  Seeing Yourself as "Rational" vs. Feeling Shame for Not Being Able to Feel
The following clinical vignette, although fictional, represents many different real cases and illustrates what often happens when someone uses being rational rather than feeling ashamed for not being able to feel a full range of emotions:

Ed began psychotherapy after his girlfriend, Meg, complained that she was frustrated with him because he tended to be rational and logical rather than allowing himself to feel his emotions.  She told him that if he didn't get help, she would end the relationship because she felt alone and lonely when emotional issues came up.

A recent incident lead to Meg giving Ed an ultimatum: Meg had a miscarriage and she couldn't understand Ed's lack of emotion.  Both Ed and Meg wanted to have a baby for the last few years.  When she got pregnant, they were both happy.  Then, several weeks into the pregnancy, Meg had a miscarriage while she was at home, and Ed took her to the hospital.

When they got home later that night, Meg felt devastated.  She couldn't stop crying, and when she turned to Ed, she felt angry and frustrated that he was so unemotional.  She knew that Ed loved her and really wanted to have the baby, so she couldn't understand how he could be so emotionally detached.

When Meg confronted Ed about it, he told her that, while he understood that she was upset, he thought it didn't make sense for him to get emotional about it, "It won't change anything." He thought it would be best for him to stay calm and recognize that they could try again to have a baby.

Meg knew that Ed loved her.  But she also knew that when it came to dealing with emotions that he felt were unpleasant, he would ward off these feelings by being rational in a way that made her feel like she was alone.  She was so upset by his lack of emotional support about the miscarriage that she left for a few of weeks to stay with a friend.  She said she found it too upsetting to be around him.

Seeing Yourself as Being "Rational" vs. Experiencing Shame For Not Being Able to Feel

Before she left, Ed pleaded with Meg to stay.  He tried to tell her that he loved her and he wanted to have a child.  He just couldn't understand how it would help to get upset about it.  But Meg left anyway and told him to get help in therapy.

As Ed sat in the psychotherapist's office, he told her that he didn't understand why Meg was so upset with him.  He didn't know why she didn't understand how much better it was in this situation to remain rational and not "lose my head" with emotion.  He felt badly that Meg thought he didn't care when, in fact, he really did care a lot.  He said that it was because he cared that he thought it was better to be rational than to be emotional.

As Ed and his psychotherapist explored his family history, he revealed that both of his parents prided themselves on being rational people.  They had each gone through traumatic experiences as children and they believed that they got through those difficult times by being rational and unemotional, which is what they taught Ed and his younger brother, Jack (see my article: Psychotherapy and Intergenerational Trauma).

As he described his family history, his psychotherapist could see that Ed used being rational to ward off feelings that were difficult for him--like sadness and anger.  She understood that this was a long-standing problem for him, and he wouldn't respond well if she proceeded too quickly to explore the feelings that he was warding off.

His psychotherapist asked Ed to give her examples from his childhood when he remained rational under difficult circumstances.  He told her that one of his earliest memories was when he was five losing his beloved dog, who had been part of the family from before Ed was born.

He remembered crying when his parents told him that the dog died.  Then, both of his parents told him to dry his eyes and stop crying because crying wouldn't change anything.  His father told him that it was always better to remain rational and unemotional under these types of circumstances.  So, Ed stopped crying and dried his eyes.

As he reflected on this experience in his psychotherapist's office, he said he agreed with his parents and he thought they taught him a valuable lesson about remaining rational during difficult times.  He knew that when each of them escaped their country of origin as children with their parents, it helped them to remain rational and unemotional, and he was glad he learned this lesson at an early age.

He thought the same idea applied to Meg's miscarriage.  Rather than being upset about it, he thought, they should focus on the positive things in their lives and try to have a baby again (see my article: Are You Using Your Idea of "Positive Thinking" As a Form of Denial).

A few weeks later, Meg called Ed and told him that she decided to take a break from the relationship. She wanted time to think about what she really wanted, and she would get back to him.

Seeing Yourself as Being "Rational" vs. Experiencing Shame For Not Being Able to Feel

By the time Ed came to his next psychotherapy session, he said he felt like he was "going crazy."  Ever since he received the call from Meg, he felt completely overwhelmed.  He couldn't sleep, eat or concentrate at work.

He kept trying to tell him that being upset wouldn't help him, but it made no difference--he continued to feel upset.  This made no sense to him at all, which is why he felt like he was "going crazy." He said he felt like he desperately needed help or "I'll lose my mind."

Ed's psychotherapist understood that Ed's usual defense mechanism of being rational wasn't working for him now.  In the past, he was able to suppress his feelings by being rational, but his feelings for Meg were so strong that his defense mechanism wasn't working.  Since Ed wasn't accustomed to dealing with strong unpleasant emotions, he felt like he was losing his mind.

His psychotherapist assured Ed that he wasn't losing his mind--he was having a normal reaction to the possible loss of his relationship.  Then, sensing that he was now open because he was in an emotional crisis, she provided him with psychoeducation about defense mechanisms (see my article: How a Crisis Open You Up to Positive Changes).

His psychotherapist normalized Ed's reaction to Meg wanting to take time away and helped him to deal with his emotions.  Over time, Ed discovered in therapy how he learned to suppress uncomfortable emotions by using the defense mechanism of being rational.

He also learned that deep down he felt ashamed for not being able to feel all of his emotions, and being rational suppressed his shame.  In addition, he learned that it was healthier for him to be able to experience the full range of all his emotions rather than suppressing them.

His psychotherapist helped Ed to strengthen his tolerance for experiencing the emotions that he had been avoiding (see my article: Expanding Your Window of Tolerance in Psychotherapy).

Over time, he became more comfortable with unpleasant emotions like sadness, grief, and anger, and he also dealt with the losses that he never dealt with as a child.  Although he had to get accustomed to  feeling the full range of his emotions, he told his psychotherapist that he felt relieved to experience these emotions rather than suppress them.

After several months, Meg came back and they dealt with the loss related to the miscarriage together.  Although he was relieved to feel all his emotions, there were still times when Ed thought it was easier, in some ways, not to deal with the unpleasant emotions.  But he also knew that it was healthier for him to experience all of his feelings.

Conclusion
Just like any other defense mechanism, being rational without dealing with uncomfortable emotions, serves to ward off uncomfortable emotions. People who are adamant about being rational and logical, rather than experiencing their emotions, usually don't realize that they're defending against their emotions.

Most of the time, it's a defense mechanism that they learned at an early age, and they really believe that it's a healthy coping strategy.  But being rational and suppressing feelings doesn't work, as in the vignette above.

When a defense mechanism doesn't work, this can create an emotional crisis, which might enable the person in crisis to be more open to looking at his or her emotional survival strategy and to consider change.

With tact and sensitivity for a client's vulnerable state, a skilled psychotherapist can help a client to explore this emotional survival strategy and how s/he can change.

The psychotherapist can also help the client to gradually strengthen his or her window of tolerance to be able to experience emotions that are being defended against.

Getting Help in Therapy
Longstanding emotional survival strategies can be very difficult for you to change on your own (see my article: The Benefits of Psychotherapy).

If your emotional survival strategies aren't working for you, you owe it to yourself to get help in therapy.

Learning healthier coping strategies can help you to experience your full range of emotions so you can feel more alive.

Rather than struggling on your own, get help from a licensed mental health professional (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.

I have helped many clients to overcome trauma and develop healthy coping strategies so they could go on to live more fulfilling lives.

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.

Masking Vulnerability and Shame By Pretending You Don't Need Anyone

As I have mentioned in prior articles, defense mechanisms are important in terms of keeping you from feeling overwhelmed, especially when you're a child and you're in a physically or emotionally abusive family situation.  

But when you become an adult, these same defense mechanisms get in the way of having access to a full range of emotions.  Aside from having negative consequences for your emotional development, your relationships suffer as well.  

One common defense mechanism is developing a pride-based identification to cover up shame.  For instance, a child who was neglected or abused grows into an adult who sees himself as being "independent" (not needing anyone) as opposed to dealing his underlying emotions--experiencing shame and hurt for feeling like a burden to his family (see my article:  Emotional Survival Strategies That No Longer Work For You: "I Don't Need Anyone").

Masking Vulnerability and Shame

It's understandable why a child, who has to fend for himself at a young age, would rather see himself as being independent and not needing anyone else.

But this is really a pseudo-independence because children can never really be independent in terms of their emotional and physical needs. Children who are neglected or abused might have no other choice, if they want to survive, than to try to take care of their own needs as best as they can at a great cost to their psychological development and, possibly, their physical development.

It would be too overwhelming for a young child, who has to take care of his own needs, to also try to come to terms with why his parents aren't taking care of him.  So, instead of dealing with the emotional pain involved with that, they develop defense mechanisms that prevent them from feeling overwhelmed, including pride-based identifications ("I'm independent so I don't need anyone") and emotional numbing (see my article: What Happens When You Numb Yourself to Your Traumatic Past?).

The defense mechanism of believing yourself to be independent, which excludes others, masks a deeper sense that the parents didn't take care of the child.  Emotional numbing can numb or mute most feelings.  By shutting off the hurt and anger, you also shut off emotions of joy and happiness.

In addition, you could grow up to feel that you can't trust anyone, so you have to take care of all your needs on your own.  This has negative repercussions for developing healthy relationships.  Some people, who grow up feeling pseudo-independent, unconsciously choose relationships where they have to take care of the other person.  Other people decide to remain alone.

Whether you choose people who you have to take care of and who will never meet your needs or you choose to remain alone, sadly, you can live your entire life trying to maintain the myth that you don't need others in order to avoid dealing with your traumatic history.

When people who believe themselves to be independent, without needing others, come to therapy, they often say they come for other reasons.  Their defense mechanism of feeling pseudo-independent is so firmly established that they don't see it or how it affects their lives.

A skilled psychotherapist usually won't address this dynamic directly at the start of therapy because, in most cases, it would be too emotionally threatening to a client who uses this defense mechanism if the therapist addresses it prematurely.  The therapist needs to assess when the client would be ready to deal with these issues.

A Fictional Clinical Vignette: Seeing Yourself as Independent vs. Feeling Shame For Feeling Like a Burden
The following fictional clinical vignette is based on many different cases and illustrates the issues outlined above and how psychotherapy can help:

Tom, who was in his early 30s, began psychotherapy reluctantly because he was having problems at work.  His director praised Tom's work, but he also told Tom that he needed to learn to be a team player.

Specifically, his director referred to a recent project where the tasks for the project were divided among Tom and four other employees, but Tom took on the whole project and completed it himself by working late nights and weekends.  The director reiterated what a great job Tom did, but he told him that Tom's coworkers felt they missed an opportunity to shine on this project.  In addition, they complained that Tom was aloof and avoided interacting with them.  As a result, the director told Tom that he wanted him to develop better relationships with his team and learn to be a part of the team rather than taking on the whole project.

Tom told his psychotherapist that there would be a big new project coming up in a few months where everyone on Tom's team, including Tom, would be assigned a role, and his director expected Tom to interact well with his teammates while he sticks to his assigned role.

Tom told his psychotherapist that he preferred to work alone, even if it meant that he worked many hours.  But his director made himself clear, and Tom didn't want to appear uncooperative or lose his job.  He needed to learn how to, at least, appear like a team player, but he knew this would be stressful for him, which is what brought him to therapy.

He said that he never thought he would seek help in therapy because, from the time he was a young child, he prided himself on being "independent" and "never needed anyone."  Similar to when he was a child, as an adult, he spent most of his time alone, and he preferred it that way.

When his psychotherapist asked Tom to describe his childhood, Tom wasn't sure where to start.  He folded his arms defensively, and asked his therapist what she wanted to know.  Then, he added that he couldn't see how his childhood was relevant to his current problem.

Not wanting to alienate Tom, his psychotherapist asked Tom a few brief questions about his childhood and assumed that, over time, she would find out more when he was ready.  Tom responded to his therapist's questions by saying, "I had a great childhood.  There were no problems in my childhood.  My parents did the best they could."

Over time, Tom divulged more details about his childhood.  He mentioned that he was an only child.  He said his parents were often out of the house much of the time.  His father was a musician who was frequently at gigs at night.  After the gigs, his father and band mates would go out to drink ("My father had a little bit of a drinking problem.  It wasn't really that bad"). He said his mother worked three jobs to make ends meet because his father's gigs didn't bring in much money.   As a result, Tom was mostly alone, so he learned to fend for himself at a young age, which he said gave him a great sense of pride.

His psychotherapist could see that Tom was a neglected child, who developed the defense mechanism of seeing himself as "independent" rather than neglected and he had an avoidant attachment style.  She could also tell that Tom was nowhere near being ready to deal with this, so she didn't want to address it prematurely.

After Tom talked about his parents, he looked uncomfortable and, even though she said nothing, he accused the psychotherapist of trying to say that he had "bad parents."  He told her that he had "the best parents in the world" and wouldn't allow anyone to say that they weren't (see my article: How Your Attachment Style Can Affect Your Relationship With Your Psychotherapist).

In response, his psychotherapist recognized that Tom was using projection as a defense mechanism--projecting his own unconscious and disowned feelings about his parents onto her. She tactfully pointed out to Tom that she had not said a word about his parents and wondered what was going on.

Tom seemed to recover himself and apologized.  He said one of the reasons why he avoided coming to therapy in the past was that he assumed that "all psychotherapists" blamed clients' parents, and he had strong feelings about anyone blaming his parents, "I won't allow anyone to say anything negative about my parents."

In the meantime, Tom was dealing with his situation at work by "pretending" to like his coworkers and to feel like he was part of the team.  He said he only did it to save his job, but he felt like "a phony,"which he hated.   At the same time, he admitted that, as he got to know his teammates better, he was starting to like them a little.

As previously mentioned, in his personal life, Tom spent most of his time alone.  Occasionally, he visited his parents to help them with chores and also to help them financially.  His parents were both retired now and dealing with medical problems.

His mother had arthritis so bad that there were days when she was in severe pain.  His father developed liver problems several years before, and his doctor convinced the father that he had to stop drinking.  Although they continued to live together, his parents lived parallel lives with their own friends.  Tom also suspected that his father was having an extramarital affair, but Tom used the defense mechanism of minimization by saying, "Well, he's unhappy, so I don't blame him."

Tom told his psychotherapist that he dated casually from time to time, but he had no real interest in being in a relationship.  When he wasn't helping his parents, he spent most of his time watching TV or playing video games alone.

It took several months for Tom to begin to trust his psychotherapist and to develop a therapeutic alliance with her.  He focused mostly on his work and avoided talking about his personal life.

One day, Tom came in and told his therapist that he watched a TV program where a sad young boy was left at home alone most of the time, and this boy would cry a lot when he was alone.  Tom said that while he was watching the program, he realized that he was crying too, but he didn't know why, "It was only a TV program.  I don't know why it would make me sad.  I know it's not real."

He said, even as he sat in his therapist's office now, he felt like crying about the TV program, and he felt silly about this.  In response, his therapist asked Tom if he would be willing to explore this further.  Tom said that, on the one hand, he felt silly wasting his time in therapy talking about a TV program.  But, he said, on the other hand, he realized that he was deeply affected by this program.

As they explored Tom's reaction to the TV program, Tom told his therapist that he felt sorry for the young boy because his parents left him alone and he was lonely and scared.  As he continued to talk about his emotional reaction to the young boy, suddenly he stopped, "Oh my God!  That boy was me!"

With this realization, Tom burst into tears.  He sobbed for a few minutes, and afterwards, when he recovered, he said he now understood why he felt so sad for the boy in the TV program.  He said this boy's story was also his story.

This sudden realization helped Tom to open up in his therapy.  Over the next few months, Tom opened up more about how sad and lonely he felt as a young boy.  Although he was careful not to blame his parents, he now understood how sad and scary it was for him to be alone so much when he was a child.

A big part of his therapy was mourning what he needed but didn't get as a child.  Waves of grief washed over Tom each time.  Afterwards, he said he felt relieved to allow himself to feel his sadness and, eventually, his anger too, at being left alone.

Another part of his therapy was coming to terms with having seen himself for so many years as being "independent," which masked his sadness and loneliness for feeling like he was a burden to his parents when he was younger.

Tom also realized that, on some level, he still felt like people would see him as a burden, and this was why he tended to remain alone.  He assumed that he was an unlovable person that no one would want.  But instead of allowing himself to feel these feelings, before he got to this point in his therapy, he defended against these feelings by having a general disdain for others (see my article: Overcoming the Pain of Feeling Unlovable).

Masking Vulnerability and Shame 

Over time, as Tom continued to work on these issues in therapy, he allowed himself to form better working relationships at work.  He also took risks in his personal life to develop friendships and a romantic relationship.

Conclusion
Children who are physically abused or neglected often develop defense mechanisms to ward off the overwhelming sadness and anger they feel.  As a child, these defense mechanisms work to ward off overwhelming feelings at a time when children don't have anyone to help them to deal with the feelings.

A common defense mechanism is for these children is a pride-based defense of seeing themselves as "independent" rather than face the fact that they are in over their heads trying to take care of themselves.  This defense, which is unconscious, is much easier for them than the underlying shame they really feel for feeling like a burden to their parents.

When these children become adults, they continue to use this defense mechanism to avoid their underlying feelings.  They often have an avoidant attachment style that makes it difficult for them to form relationships with others.  But, in reality, what they perceive as "independence" is really a pseudo-independence that masks shame, hurt and anger.

Sadly, many people live their whole lives warding off their shame, anger and sadness to preserve their false sense of independence and a much-needed false image of "a great childhood."

Often, adults with a false sense of independence, due to childhood neglect or abuse, come to therapy for other reasons.  They might be having problems with relationships at work or in their personal lives.  They might think they have "communication problems."  But the reality is that the problems are much deeper, and it often takes time in therapy for clients to feel safe enough to explore these issues.

Getting Help in Therapy
If you think you might have developed defense mechanisms in childhood that are causing you problems as an adult, you could benefit from attending psychotherapy (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you in a way that feels safe for you to deal with these issues (see my article: How to Choose a Psychotherapist).

Many psychotherapy clients say that, once they have dealt with these underlying issues, they feel so much more alive and energized because they're no longer using so much energy to ward off emotions that are difficult for them.

Rather than suffering on your own, you owe it to yourself to get help so you can live a more authentic 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, 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.

A "Flight Into Health" as an Escape From Therapy

In a prior article, Overcoming the Urge for "a Flight Into Health," I discussed a particular dynamic that comes up with many clients as they talk about childhood abuse.  In this current article, I'm focusing on childhood neglect, which is often more difficult to detect than abuse, and how it can affect relationship choices as an adult.

See my articles: 

What is Childhood Emotional Neglect?

What is the Connection Between Childhood Emotional Neglect and Problems Later on in Adult Relationships? 

As an Adult, Overcoming the Effects of Childhood Trauma).

"A Flight Into Health" as an Escape From Therapy

In psychotherapy, the term "a flight into health" implies that the client leaves therapy abruptly out of fear, telling herself that she no longer needs therapy.  This often happens when something comes up in therapy that the person is frightened by and not ready to deal with at that point.

This doesn't mean that the client is lying or trying to fool the therapist.  Usually, the client really believes that s/he is ready to leave therapy but, based on whatever came up just before the client decides to leave, the therapist usually knows that this is a defensive gesture on the client's part that comes from fear.

An astute psychotherapist will try to reengage the client to discuss what came up and what might have frightened the client.

If the therapist and client have a good rapport, the client might be willing to come back for another session to explore whatever might have come up to cause him or her to leave.

If the therapist and client haven't established a rapport, the client might not be open to exploring this further because s/he really believes everything is okay or, even if s/he knows things aren't okay, s/he might feel too emotionally vulnerable to explore it further.

A Fictionalized Scenario
Let's take a look at a fictionalized scenario, based on many cases, which deals with a "flight into health" involving a history of childhood emotional neglect:

Mary
Mary started therapy because she wanted to make healthier relationship choices (see my articles: Choosing Unhealthy Relationships: Bad Luck or Poor Choices?, Falling In love With "Mr. Wrong" Over and Over Again and Choosing Healthier Romantic Relationships.

She attended a few sessions with a psychotherapist who was recommended to her, and told the therapist about her tendency to get involved with men who were in and out of life.

The relationships usually started out well.  With each relationship, Mary thought there was a possibility for a long term relationship.  But whenever she and the current man in her life would became more serious, the man disappeared.

Mary was very confused and hurt about these dynamics and wanted to stop choosing men who turned out to be so unreliable.

By the second session, the therapist asked Mary to share her family history, and Mary said she thought she had "a very good childhood."  But when she talked about her parents, she was very vague, and the therapist had to ask questions in order to understand the family dynamic.

A "Flight Into Health" as an Escape From Therapy 

As a result of the therapist's questions, Mary alluded to her father being around sometimes and not around other times.  But as soon as she said this, Mary looked uncomfortable and guarded.

She folded her arms in front of her chest, and said, "He was a very good father, even if he wasn't around all the time.  He had a rough childhood himself and I don't hold it against him that he would sometimes have to disappear for months at a time."

Having said this, Mary appeared upset.  She told the therapist that, until now, she never thought about how similar the dynamics were between her and her boyfriends and her and her father.

Since Mary was the one who made this connection, the therapist asked Mary what it was like to realize this.  But Mary was at a loss for words.

Mary remained quiet for a while, and then she said that she needed to leave the session early.  The therapist tried to help Mary to calm down, but Mary told the therapist that she was "alright"--she just needed to leave.  She said she would come in for her session next week.

But a few days before her next session, Mary left a message on the therapist's voicemail, at a time when she knew the therapist wasn't there, saying she was "feeling better" and no longer needed to come in.

Her therapist knew that Mary was bothered by what came up in the prior session, and she tried to reach Mary a few times, but Mary didn't return her phone calls.

Several months later, after being hurt and disappointed again by another man, Mary resumed therapy with the same therapist.

Initially, she was defensive, saying that she didn't want to talk about her family, "After all, my parents both did the best that they could."

When her therapist asked Mary why she left the last time, Mary didn't respond to the question.  She said she only wanted to focus on her current life and what she could do to find a man who would treat her well.

As soon as she said that, she began to sob and told her therapist, "I don't even know why I'm crying."

Her therapist realized that Mary wasn't ready to make any further connections between her father and the unconscious choices she was making about the men in her life.

She knew she had to develop more of a rapport with Mary.

The therapist also knew that  they would need to go slowly, and she would need to help Mary with the anxiety about these issues--otherwise, Mary would become too anxious again and she might take another "flight into health." And next time, she might not come back.

Her therapist suggested that they begin by working on coping skills and helping Mary to develop internal resources.

Based on their work together, Mary began to meditate for 10 minutes in the morning and at night.  She also started a beginners yoga class.  In addition, her therapist helped Mary to visualize a relaxing place so that whenever she felt anxious, she could imagine herself going there.

As the holidays approached, Mary talked about trying to decide if she wanted to go home to see her family or not.  She still maintained that she had "a very good childhood," but she also expressed her strong ambivalence about going home.

When her therapist asked Mary about this, Mary started getting agitated, so her therapist suggested that Mary visualize the relaxing place, do the breathing exercises she taught her, and then they could resume talking about her family--if Mary wanted to do it.  Her therapist made it clear that it was up to Mary if they talked about the upcoming holiday and her family or not.

After Mary relaxed a little, she said she didn't want to make it sound like there were problems in her family home.  She said, "Far from it..."  But she was unable to articulate why she had mixed feelings about going home to her parents.

By the next session, Mary brought in a dream:  She was five years old and she was waiting for her father by the window that faced the street.

In the dream, every time she saw a man walking towards the house, she got excited because she thought it was her father.  But each time the man got closer, she could see that it wasn't her father and she was disappointed each time. The dream ended with Mary waiting and waiting and her father never showed up.

After she told the dream, Mary burst into tears.  She remembered being that little girl by the window many times, hoping to see her father, but he didn't come.

Her therapist was listening and sensing what was going on for Mary and if she would be able to explore this further.  Rather than push her to go somewhere where she wasn't ready to go, she would take her cues from Mary (see my article: The Therapist's Empathic Attunement and The Creation of the Holding Environment in Therapy).

Mary seemed to be in her own world, as if she was back in the dream, "I don't understand why my father came and went like that.  I know he loved us, but he would just suddenly leave without saying a word and we never knew when he was coming back."

Her therapist remained attuned to Mary and stayed close to Mary's experience, reflecting back to her how difficult that must have been for such a young girl.  Mary nodded her head.

By the end of the session, Mary told her therapist that she felt supported by her and she was grateful for that.  She had never felt so supported in her life before.

During the next few sessions, Mary continued to talk about the dream and how it reflected her childhood experience with her father.  She went back and forth between feeling sad and defending her father vs. telling her therapist what a good man he was.

When Mary felt comfortable, they did "parts work" where Mary imagined her younger self sitting next to her and she spoke to her younger self to soothe and reassure her.

Then, her therapist asked her to switch roles and be her younger self and ask Mary for what she needed.  Mary said she felt soothed by these exercises.

When she came in the next time, she talked about a recent dream where she was sitting on the couch next to her five year old self, holding and rocking her.  She said she felt the sadness from her younger self, but her younger self also felt comforted, and Mary was happy that she could do this for her.

Several months later, Mary came in and told her therapist that she thought she felt a little more comfortable now exploring the connection between her relationship with her father and her relationships with the various men that she dated.

Her therapist said they could do this, but she wanted Mary to tell her if she began to feel like she wanted to leave therapy.  She asked Mary to talk about it, if she could, rather than acting on it.

Mary said she would try to do this, and she said she might feel like leaving, but she really wanted to stay and talk about it, especially now that she felt a stronger bond with the therapist.

A "Flight Into Health" as an Escape From Therapy

Gradually, over time, Mary was less defensive and she was able to express her sadness and anger about her father's erratic behavior when she was a child.

She also began to understand how she was unconsciously repeating these experiences in her current life by choosing men who would behave in a similar way as her father.  Unconsciously, she was repeating this behavior in the hope that there would be a different outcome.  This is called repetition compulsion in psychotherapy.

This was a big step for Mary, and it was the beginning of her healing process.

She admitted that talking about this felt a little anxiety provoking, but her anxiety was no where near what it had been.  She also felt good that she could say this, and it didn't feel nearly as frightening as it did when she first made the connection on her own when she began therapy.

Conclusion
A "flight into health" is a reaction that many people in therapy have when something comes up in therapy that causes them to feel anxious and they're not ready to deal with it.

This is usually an unconscious response.  At that point, the client is often convinced that whatever symptoms or problems brought them into therapy are now gone--they're "better" now.

If clients in this situation remain long enough for the therapist to help them to develop the skills to cope with their fear, they can eventually go back, when the client is ready, to explore together what was too frightening before.

When clients leave therapy, as in the fictionalized vignette above about "Mary," they often return at some point because they become aware that their problems aren't really gone.  It just seemed that way because they convinced themselves of it out of fear.

At that point, the client and therapist can strengthen the therapeutic alliance between them by allowing the client to set the pace.

Most skilled psychotherapists know that it's counterproductive to push clients beyond where they can go emotionally, especially if they're not feeling safe.

It's better to take a step back and help the client to develop the necessary internal resources so that if and when the client becomes ready, s/he can feel more confident to deal with whatever comes up, knowing that the therapist is there for them.

Getting Help in Therapy
It's often comforting for clients to know that if they've taken "a flight into health" that they're not the only ones who have ever experienced this.

If you recognize this dynamic in yourself, you can be assured that an experienced psychotherapist understands this dynamic.

Whether you return to your former therapist or decide to see someone else, you're not alone.  You can think of the"flight into health" as a temporary obstacle that a skilled therapist can help you to overcome.

Being afraid and ambivalent about exploring uncomfortable personal problems is normal.

It's also alright to tell a therapist that you're uncomfortable, and the two of you can work together to help you get to the point where you feel more comfortable.

The first step is making the phone call to get help.

Freedom from a traumatic history allows you to live a more fulfilling life.

About Me
I am a NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

One of my specialties is helping clients to overcome emotional trauma.

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

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