How Contemporary Psychotherapy Has Changed - Part 1

In the past, in classical Freudian psychoanalysis, as it was practiced in the United States, psychoanalysts in training were taught to be neutral towards their clients and avoid any outward display of their personal feelings about the client (referred to as countertransference).

How Contemporary Psychotherapy Has Changed

At that time, the psychoanalyst sat behind the client with the client lying down on the couch. The idea was that the client wouldn't be distraction by seeing the psychoanalyst, so the client could free associate, and the psychoanalyst could focus on listening to the client rather than looking at the client.

How Contemporary Psychoanalysis and Psychotherapy Have Changed
Of course, as most contemporary psychoanalysts and psychotherapists know these days, Freud may have espoused a neutral stance on paper but, by all accounts, he was warm and personal with his clients in person.  He would often walk with them in his garden or have them over in his home.  But American classical psychoanalysts followed Freud's written word rather than his actual practice.

I believe this is why traditional psychoanalysis came to view the psychoanalyst's reactions (or countertransference) to the client as being something to overcome rather rather than the reactions being useful clinical information about what the therapist was intuiting about the client and their therapeutic relationship.

Fortunately, this has changed significantly and most contemporary analysts and psychotherapists view their reactions to the client as being a useful part of the therapy which can be shared with the client when it is clinically appropriate to do so.

In many ways, this has freed up the psychotherapist to be more emotionally accessible to the client.  It opens up a new avenue for the therapist to use him or herself in a new way.  It also helps to create more of an egalitarian relationship with the client when the psychotherapist is more accessible and shares reactions when they are useful to the client.

In addition, for clients who grew up in an abusive or neglectful environment as children, interacting with a psychotherapist who is free to be more open and emotionally accessible is a welcome change from what traumatized them as children (see my article: The Psychotherapist's Empathic Attainment Can Be Emotionally Reparative For the Client).

But it also makes being a psychotherapist more complicated.  Without the strict practice of the psychotherapist taking a neutral stance with the client, the psychotherapist has to make many more clinical judgment calls about when and how to be more open with clients.  There is always the chance that if the psychotherapist shares his or her reaction to the client that the psychotherapist might make a clinical mistake and share something that the client isn't ready to hear.

Although there is room for error in this more contemporary and open way of working in psychotherapy, I believe it's a refreshing change from the old traditional way.

Under the traditional way, too many clients, who grew up in abusive or neglectful homes were retraumatized by psychotherapists who remained silent most of the time, and these therapists only made occasional comments or interpretations, which could take a long time--weeks, possibly months.

I believe that, generally, clients in psychotherapy need a more empathetic and emotionally accessible psychotherapist who is comfortable sharing his or her reactions to the client when it is clinically appropriate.

I say "generally" because, occasionally, there are clients who still want a traditional stance of neutrality and prefer that the psychotherapist not speak or speak very little.  

Although this is not what most clients usually seek, there are some clients who felt so impinged upon by one or both parents that a psychotherapist who is more interactive would feel like another impingement to them.  In those cases, it's up to the psychotherapist to respect the client's wishes or, if this way of working is so foreign to the psychotherapist, s/he would have to make a referral to another psychotherapist.

The Psychotherapist's Responsibility For Ruptures and Repairs in Psychotherapy
With regard to the possibility of the psychotherapist making mistakes, mistakes can usually be repaired between the psychotherapist and the client (see my article:  Ruptures and Repairs in Psychotherapy).

In fact, it's inevitable that, as a human being first and a psychotherapist second, a therapist will make some mistakes with some clients, especially since psychotherapy is as much an art as it is a science.

Hopefully, these "mistakes" are few and far between and don't involve ethical issues or boundary violations (see my article: Boundary Violations and Sexual Exploitation in Psychotherapy).

Aside from ethical mistakes, which are more serious than the usual mistakes, the mistakes that I'm referring to are clinical mistakes, possibly with the regard to the timing of a comment or a misunderstanding between the client and psychotherapist.

Whatever is involved with the clinical mistake, it's up to the psychotherapist to acknowledge the mistake and make reparations by giving a heartfelt apology to the client and working together with the client to repair their therapeutic relationship.

Most clients are aware that psychotherapists make mistakes at times, and they are able to work through these issues.  If they came from homes where parents never acknowledged mistakes, let alone make attempts at reparations, the process of reparation in psychotherapy can be a healing experience for clients.

In my next article, I'll continue this discussion with regard to the types of reactions or countertransference that contemporary psychotherapists often share with clients (see my article: How Contemporary Psychotherapy Has Changed - Part 2).

Getting Help in Psychotherapy
Attending psychotherapy is a unique experience that provides an opportunity to get to know yourself better, overcome traumatic experiences, and work through current and past problems (see my article: The Benefits of Psychotherapy).

Choosing a psychotherapist often involves meeting with more than one psychotherapist to determine who you feel most comfortable with before you begin the therapeutic process (see my article: How to Choose a Psychotherapist).

If you have been struggling on your own with an unresolved problem, you could benefit from working with a skilled psychotherapist who can help you to work through your problem so you can live a more meaningful an fulfilling life.

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

I work in a contemporary way with individual adults and couples, and I provide a empathetic and supportive environment.

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

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

Using Imagery as a Powerful Tool in Trauma Therapy

In prior articles, I discussed how developing internal and external resources are helpful in processing psychological trauma.

See my articles: 

Developing Internal Resources and Coping Skills, Coping Strategies in Mind-Body Psychotherapy

The Therapeutic Benefits of Integrative Psychotherapy

Understanding Your Shifting Self States).   

One of the many resources that I use when doing trauma therapy is imagery, which is the subject of this article.

Using Imagery as a Powerful Tool in Trauma Therapy

As an integrative psychotherapist, I often combine various treatment modalities when it's beneficial to  the individual client.

The key to being able to combine treatment modalities in an integrative psychotherapy is to have a good foundation in a particular type of psychotherapy and professional training in the other modalities.

As I've mentioned in other articles, my original postgraduate training is in psychoanalysis and psychodynamic psychotherapy, and I work in a contemporary, dynamic and interactive way.

After using psychoanalysis and psychodynamic psychotherapy for several years, I could see that it had certain limitations--just as all therapy modalities do.

Although my personal experience in psychoanalysis was very effective in helping me to resolve traumatic experiences, that was nearly 20 years ago, times have changed and most clients don't want to come to therapy for multiple sessions per week for several years as I did.

Once a week psychoanalysis/psychodynamic psychotherapy, which is now the norm, lacks the same intensity as multiple sessions per week.  As a result, the transference/countertransference issues are not as intense, and generally it takes longer in once a week sessions to resolve trauma.

This is what prompted me to study EMDR Therapy, clinical hypnosis and Somatic Experiencing.

For many clients, who don't want to wait years for relief from their traumatic symptoms, these therapy modalities work faster than psychoanalysis/psychodynamic therapy in helping clients to overcome trauma.

This doesn't mean that I don't use my psychodynamic understanding while working with a client.  I still listen and pay attention for the client's unconscious process and transference/countertransference issues as I integrate other forms of therapy.

Before I go into how I use imagery, I want to clarify that the client doesn't need to be good at visualizing to use imagery.

Many clients, who say they can't visualize, are able to get a "felt sense" of images and this is just as useful in therapy.  Other clients who have difficulty visualizing have other senses that work, including an intuitive sense of the image, which can be very powerful.

Using Imagery as a Powerful Tool in Trauma Therapy
Imagery is a powerful resource in psychotherapy, especially when working with psychological trauma.

Imagery comes alive when the therapist helps the client to amplify and enhance the imagery.

The following fictional vignette demonstrates how imagery helps to process trauma:

Nick
Nick started therapy because he was having a difficult time asserting himself in his marriage and in his work-related relationships.

Using Imagery as a Powerful Tool in Trauma Therapy

He told his therapist that ever since he was a child, he lacked confidence in himself and this lack of confidence had a profound effect on his life.

In his personal relationships, before he got married, Nick had a hard time asserting himself when he was attracted to a woman.  Throughout college, he had difficulty feeling confident enough to ask women out on a date.  Most of the time, he would go out with women who asked him out.

In his senior year, he met a woman, Jenna, that he really liked. He lacked the self confidence to ask her out, but he soon discovered that she was interested in him when Jenna asked him to go out for dinner.

Jenna was the one who initiated sex and, 10 years later in their marriage, she was still the one who initiated sex and all their activities, including social activities and vacations.  This was causing problems in their relationship because Jenna complained that she was tired of always being the one to take charge.  She wanted him to take charge sometimes.

Nick understood why Jenna was unhappy with his lack of assertiveness, but he didn't know how to change.

Nick was also having problems advancing in his career.  Other people that he trained and who knew less than Nick, were getting promoted into more senior positions because they knew how to advance their ideas and themselves with their superiors.

When Nick discussed his family history with his therapist, he described a neglectful and critical parents.  He was the younger of two sons, and his parents tended to dote on their older son and to ignore or criticize Nick.

They often compared Nick unfavorably to his older brother, John, and generally discouraged Nick.

Over time, Nick felt that he had nothing of value to offer, and he tended to remain quiet while his older brother got all the praise.

He often felt as a child that he was "a mistake" and that his parents didn't really want to have another child.  This was confirmed by his mother in a tactless admission on her part when Nick turned 21 and left home.

Until he began therapy, Nick never associated this critical, neglectful parent with his lack of confidence and assertiveness.  He also never realized that he had been traumatized by these early experiences.

As he discussed this with his therapist, he said this made sense to him, but he asked, "Now that I know this, how can I change it?"

Based on her experience as a trauma therapist, his therapist told Nick that, although his awareness was an important step, it was only the first step.  She recommended that they revisit his memories using imagery as a tool in trauma therapy.

One of Nick's touchstone memories was of his father telling Nick to "Be quiet" when he wanted to tell his family about an award he received at school for a science project.

Not only did his father tell Nick to "Be quiet," he also told him that "No one's interested in hearing about your award." Then his father turned to Nick's older brother, John, and asked him how his day went at school, and both his father and mother listened to John with admiration.

As a result of many similar experiences with his parents, Nick felt "I'm not important" and "I'm powerless."  These feelings remained with him as an adult.

Nick's therapist recommended that they use imagery to go back to that touchstone memory to see how Nick's experience of himself might change if he could imagine himself having a powerful ally in that situation.

At first, Nick couldn't think of anyone to be an ally to rework this memory.  Then, he remembered his science teacher, who recommended Nick for the award and who often complimented him on his work.

His therapist asked Nick to go back into the touchstone memory and to imagine what his science teacher might have said if he had been with Nick when his father told Nick to be quiet.  She asked Nick to describe the scene in the present tense.  She also helped Nick to amplify the imagery so he could experience it more vividly.

Nick closed his eyes and imagined himself back at home with his family.  He also imagined that he invited his science teacher, Mr. Ross, to dinner that night and Mr. Ross was sitting next to Nick when Nick brought up his science award, "Mr. Ross is there sitting next to me.  When he hears my father tell me to be quiet, he interrupts my father and says, 'Now wait a minute--this is a very important award at the school and Nick's science project was by far the best project the school has seen in years.  I can't sit here and allow you to be dismissive of Nick and this wonderful honor.  Nick deserves much better than this.  I don't have children but, boy, if I had a son like Nick, I would never tell him to be quiet.'"

Nick's therapist could see that Nick's demeanor changed as he imagined Mr. Ross standing up for him.  His chin was raised, his posture was more erect and he had a smile on his face.

Then he explains to his therapist, "Both of my parents have always had a lot of respect for teachers, and they liked Mr. Ross so they would listen to him.

Then Nick goes back into his memory, "So, when they hear Mr. Ross say this, both of my parents look embarrassed and they look at me in a different way.  Then, my father says, 'I'm sorry for interrupting you, son.  Tell us more about your award."

Nick's therapist helped Nick to amplify the shift he was experiencing and to anchor that new feeling in his body.

Nick and his psychotherapist did many similar exercises in therapy using imagery for other traumatic touchstone memories.

Using Imagery as a Powerful Tool in Trauma Therapy

Gradually, Nick was able to internalize the feeling that he is a worthwhile and lovable person.  Over time, as he gained more confidence in himself.

To his wife's delight, he took more of an initiative in terms of their sex life and social activities together.

With regard to his career, Nick and his therapist used imagery to rehearse scenes with his manager where Nick would be more assertive in advancing his ideas.  This allowed Nick to present himself and his ideas with increased confidence, which resulted in praise and promotion with a substantial pay increase.

Conclusion
Every client is unique and their needs in therapy are different, which is why it's helpful for therapists to have a number of different modalities to use to help clients to overcome their problems.

Imagery can be a powerful tool in trauma therapy.  It is one of many tools that trauma therapists can use to help clients to transform traumatic experiences.

When clients use imagery in therapy to imagine the help of powerful figures, such as mentors, wise people, nurturing people or whatever type of figure would be helpful, this can help to create new neural networks in the brain that facilitate change.

Using imagery can help clients to see themselves in a different way and allows them to transform their unresolved trauma.

Getting Help in Therapy
If you have unresolved traumatic experiences, rather than continuing to suffer on your own, you could benefit from working with a trauma therapist (see my article: The Benefits of Psychotherapy).

Once you're free of your trauma, you will have a greater sense of well-being and lead a more fulfilling life (see my article: How to Choose a Psychotherapist).

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

I work in an integrative way depending upon the needs of each client.

One of my specialties is helping clients to overcome trauma, and I use many creative therapeutic tools, including imagery.

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.

See My Other Articles About Psychological Trauma.

Contemporary Psychoanalysis and EMDR Therapy: A Powerful Combination to Overcome Trauma

In prior articles, I've discussed aspects of psychoanalysis as well as the benefits of using integrative therapy.

What is EMDR Therapy?

See my articles: 

What is EMDR Therapy?

How EMDR Therapy Works: EMDR and the Brain 

EMDR Therapy for Big T and Smaller T Trauma.  

In this article, I'm focusing on the powerful combination of contemporary psychoanalysis and EMDR therapy.

A Powerful Combination: Contemporary Psychoanalysis and EMDR Therapy

What is Contemporary Psychoanalysis?
This is a brief explanation of contemporary psychoanalysis, and I provide links below for books, specifically on a type of contemporary psychoanalysis called Relational psychoanalysis, for anyone who wants a more in-depth understanding of contemporary psychoanalysis.

Many people have the old stereotypical image of psychoanalysis as being the type of therapy where the client does all the talking while lying down on a couch and the psychoanalyst remains seated behind the client, quiet for long stretches at a time until she makes an interpretation to the client for the purpose of helping the client develop insight into his problems.

In the old stereotypical image of psychoanalysis, clients would come for multiple sessions per week, and this could go on for many years.  Also, the analyst tended to remain "abstinent" and "neutral" and did not self disclose anything personal.

Fortunately, very few psychoanalysts work this way any more.

Contemporary psychoanalysis is different from older forms of psychoanalysis.

For instance, I consider myself to be a Relational psychoanalyst, which is a form of contemporary psychoanalysis.

I work in an interactive, dynamic, empathetic and collaborative way with clients.

The number of times the client comes to therapy, whether the client sits up facing me or lays down on the couch or how long the client chooses to remain in therapy doesn't take away from the fact that I'm using contemporary psychoanalysis--even if I don't make interpretations.

Although I practice many different types of therapy, including EMDR Therapy, Somatic Experiencing, clinical hypnosis, contemporary psychoanalysis informs my work in terms of the way I conceptualize the client's current problems, the importance of the unconscious mind and the transference aspects of therapy.

What is Relational Psychoanalysis?
Relational psychoanalysis is an integration of British Objects Relations, Self psychology and Interpersonal psychology.

In my professional opinion, this combination offers the best of contemporary psychoanalysis.

Stephen A. Mitchell, Ph.D. is recognized as the psychoanalyst who developed Relational psychoanalysis in the 1980s.

Stephen A. Mitchell and Jay Greenberg's book, Object Relations in Psychoanalytic Theory (1982) emphasized the importance of relationships.

Dr. Mitchell also wrote about Relational psychoanalysis in his book Relational Concepts in Psychoanalysis.

Combining Contemporary Psychoanalysis and EMDR Therapy
As I've mentioned in a prior article, I integrate different types of therapy depending upon the client's needs.  This includes integrating contemporary psychoanalysis and EMDR therapy, as needed.

When clients come to therapy to overcome traumatic events in their life, it's important for them to understand how their history contributed to their problems and contemporary psychoanalysis provides this perspective.

It's also important that they understand how their unconscious mind affects their history, their relationships, their decision-making process and, possibly, how their unconscious creates obstacles to overcoming their problems (see my article: Making the Unconscious Conscious).

Contemporary psychoanalysis, especially Relational psychoanalysis, allows clients to make these connections.

EMDR therapy, which was originally developed specifically to work on trauma, helps to process traumatic events so that they are no longer disturbing to clients.

Why is the Combination of Contemporary Psychoanalysis and EMDR Therapy So Effective?
Contemporary psychoanalysis and EMDR therapy offer powerful therapeutic benefits separately.  But when they're combined for trauma therapy, they offer the client the in-depth insight of contemporary psychoanalysis and EMDR's relatively faster way of processing trauma.

Among other aspects of EMDR therapy, EMDR helps clients to identify the negative beliefs that they have about themselves related to their trauma.  This negative belief is often rooted in family history and can often be found in many aspects of the client's life.

For example, the negative belief related to the traumatic memory might be "I'm unlovable," which is often part of other problems--not just the one that they're coming in to work on (see my article: Overcoming the Emotional Pain of Feeling Unlovable for more details).

EMDR therapy often has generalizable effects, which means that the therapist and client don't have to work on every traumatic event related to the negative belief.

Contemporary psychoanalysis offers the client an opportunity to appreciate the depth of the negative belief as well as other aspects of the trauma.

EMDR therapy offers clients an opportunity to unlock information related to the trauma that is stored in a maladaptive way in the brain.  It allows for memory reconsolidation, which is one of the reasons why it works relatively quickly compared to other forms of trauma therapy.

Combining EMDR therapy and contemporary psychoanalysis provides the most powerful and effective aspects of in-depth therapy with relatively brief therapy.

Getting Help in Therapy
If you have been suffering with unresolved psychological trauma, you owe it to yourself to get help from a trauma therapist (see my article: How to Choose a Psychotherapist).

Resolving your trauma will free you from a history that has been keeping you stuck in your life.

Rather than suffering on your own, you owe it to yourself to get help from a trauma therapist.

A skilled trauma therapist can help you to overcome the problems that are keeping you from maximizing your potential.

See my articles: 

The Therapeutic Benefits of Integrative Psychotherap

The Creation of the Holding Environment in Psychotherapy

Psychotherapy and the Positive Transference

Psychotherapy and the Erotic Transference  

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist with over 20 years of experience.

I work with individuals and couples.

For clients who are already in therapy with therapists who do not do EMDR therapy and who want to remain with their therapists, I also provide adjunctive EMDR therapy so that clients can remain with their therapists (see my article: What is Adjunctive EMDR Therapy?).

I have helped many clients to overcome their traumatic history to lead a more fulfilling life.

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.