Why Are So Many of Us Fearful of Change While Others Embrace It?

According to the latest research, while some people embrace change wholeheartedly, the vast majority of us don't like change--especially change we haven't chosen because it gets us out of our comfort zone.

Making Changes

As a New York City psychotherapist in private practice, I get to see how people respond to making changes--even changes they want--with a mixture of anxious anticipation, fear and ambivalence. 

On the surface, this might not seem to make sense. After all, you might say, if people are coming to therapy voluntarily because they want to make changes, why wouldn't they respond to change with open arms?

As we explore further, although it might not make sense objectively, it does make psychological sense.

Why Is Change so Hard For Most of Us?

When we look beyond the surface, we see that what most people really dislike is the lack of control and the uncertainty involved. 

Looking even further, we discover that, while we might like certain changes that we have chosen--like traveling on a much-anticipated vacation, falling in love or getting a raise at work, we tend to feel resistance to involuntary changes that are imposed on us.

Involuntary change might include:

• An unexpected life event like the death of a loved one, a new health concern or the end of a relationship where there is grief and loss

• A workplace restructuring that might involve reporting to someone new

• A financial loss

• Other similar unexpected changes

Under these involuntary circumstances, the pain and loss can feel confusing and threatening.

Why Do We Have Mixed Feelings About Change We Seek in Therapy?

The individual adults and couples I see in my private practice are all voluntary clients. None of them are mandated to come to therapy.

Making Changes in Therapy

They usually come to therapy, spending their time and hard-earned money in the effort, because some part of them wants to make changes. 

But, for most us, as we begin the change process, we also begin to have mixed feelings about it--even for changes that we really want.

Why is this?

Part of the answer is that the human brain naturally prioritizes predictability and comfort over the discomfort of growth. Even when a change is highly desired and voluntarily chosen, the status quo represents a survival strategy or behavioral pattern that has kept us safe, comfortable or, at least, it was familiar. 

With regard to safe and familiar, as the saying goes, "Better the devil you know than the devil you don't."

In psychotherapy this ambivalence is called the "approach-avoidance conflict" which means that we are simultaneously drawn to the benefits of change and a better life while also being repelled by the fear and effort to change.

In addition, maladaptive behaviors always serve a purpose--even if we don't know what that purpose might be. 

Making Changes in IFS Therapy

For instance, according to IFS Therapy (Internal Family Systems Therapy), we all have many different aspects of ourselves, including protector parts, also known as defense mechanisms in psychodynamic psychotherapy. 

It's common to have protector parts that resist change because these parts assumed these roles in order to "protect" a wounded traumatized part of us.

These protector parts have "good intentions" in terms of their protective roles. Most likely, they were useful at an earlier time in our life as a survival mechanism, but their impact becomes maladaptive as we become adults and these survival mechanisms hold us back. 

For instance, if we learned to become emotionally numb in a dysfunctional family when our parents were fighting, the emotional numbness might have protected us from feeling the overwhelming pain of being abused or neglected.

But, as an adult, becoming emotionally numb while our spouse is telling us how annoyed they are about something we did isn't adaptive anymore. As adults, we need to be attuned and attentive to what our partner is saying if we want our relationship to survive.

We might really want to be a good partner, but if we have a tendency to numb ourselves (also known as "zoning out") when our partner is complaining to us, being present would mean taking the emotional risk that we are now safe enough with our partner to let go of a long-standing defense mechanism, which isn't easy to do.

Another example: If we are working on unresolved trauma, we know logically that our life would be better once we no longer carry the burden of the psychological trauma, but dealing with painful unprocessed emotions might make us want to abandon the effort.

How Can the Change Process Be Easier to Manage?

As a trauma therapist, I can't eliminate the emotional pain with making changes, especially if the change involves processing unresolved trauma, but I can and do help clients to process trauma in manageable ways when possible (see my article: Coping With Emotional Distress in Experiential Therapy Using the Somatic Experiencing Technique of Pendulation).

Although change might not be easy, there are ways to make it more manageable with the help of an experienced therapist:

• Shift Out of An All-or-Nothing Mindset: All-or-nothing thinking sets us up for disappointment when we don't make difficult changes immediately. 

Get Curious About the Change Process

• Adopt Non-Judgemental Curiosity: Instead of viewing fear and ambivalence as a personal failure, get curious about your change process (see my article: How to Develop a Curious Mindset).

• Acknowledge Protective Habits: Recognize that old habits that are no longer adaptive once kept you feeling safe.

• Separate Fear From Action: Learn to carry the physical sensation of fear in therapy while you take steps to make changes.

Progress Isn't Linear

• Expect Non-Linear Progress: Expect that growth involves inevitable ups and downs. Progress isn't a straight line (see my article: Progress in Therapy Isn't Linear).

• Identify What is Controllable: Instead of focusing on what isn't controllable, focus on what you can control right now.

• Remember Prior Resilience: Write down the times when you were able to successfully make changes due to unexpected events and recognize that you probably still have the resilience to make changes now--especially if you approach change in a manageable way rather than all at once.

Challenge Catastrophic Thinking

• Challenge Catastrophic Thinking: Evaluate whether your fears are realistic or if your mind is focusing only on worst-case scenarios (see my article: Are You Catastrophizing?).

• Process Long-Term Regret: Forgive yourself for waiting until now to make changes so that guilt doesn't become an obstacle to making changes.

Conclusion

Change can be difficult.

Even when you seek help in therapy to make much-needed changes, you can experience an approach-avoidance conflict about the process.

Get Help in Therapy

There are steps you can take in the change process, with the help of a therapist, that can make the change more manageable.

In addition, choosing a therapist that allows you to feel safe enough to make changes is important--not only for making changes--but also to have a new experience of safety if you weren't safe when you were growing up (see my article: How to Choose a Psychotherapist).

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS/Parts Work Therapist, EFT Couples Therapist, Somatic Experiencing and Certified Sex Therapist.

As an experienced therapist, I have helped many individual adults and couples to make positive change over the years.

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

I provide a free 10-15 minute phone call before setting up a first appointment.

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

Also See My Articles:

Overcoming Your Fear of Making Changes

What is a Growth Mindset vs a Fixed Mindset?

Coping With the In-Between State of Change

Why It's Important For Therapists to Provide Clients With Information About How Therapy Works

What is Disenfranchised Grief?

Disenfranchised grief is a term used to describe grief that is not openly acknowledged, socially validated or publicly supported. This term was coined by Dr. Kenneth Doka, a grief researcher in 1989.

Disenfranchised Grief

Disenfranchised grief occurs when a person experiences a significant loss but society, culture or the people around them minimize or deny their right to mourn. 

This often leaves the individual grieving in isolation without traditional mourning rituals, support systems and validation that typically accompanies a recognized loss.

What Are Common Examples of Disenfranchised Loss?

The following examples are typical of disenfranchised loss:

• Unrecognized Relationships:  The connection to the deceased is either hidden or unrecognized. This includes mourning an ex-spouse or former partner, a casual partner, miscarriage or stillbirth, a secret lover, an LGBTQ+ when the relationship isn't publicly known.

Disenfranchised Grief

• Unrecognized Losses: The loss is viewed as minor or as not deserving of deep grief.  This includes: a miscarriage, the loss of a pet and non-death losses such as a breakup, loss of a job or a loved one with cognitive decline due to Alzheimer's (see my article: Coping With Ambiguous Loss).

Disenfranchised Grief

• Stigmatized Loss: The circumstances surrounding the death involve social judgment, which causes survivors to hide their emotional pain. Examples include deaths involving suicide, substance abuse overdose or criminal contexts.

• Disenfranchised Grievers: Many people often mistakenly assume that certain individuals lack either the capacity or need to grieve. This includes young children, the elderly or individuals with cognitive or developmental disabilities.

• Unconventional Grieving Styles: A person's outward expression of grief doesn't always match cultural expectations. This might include: Showing no visible emotion, using humor or grieving much longer than some people think is appropriate.

What is the Impact of Hidden Grief?

Since this type of grief goes unrecognized by others, it can create certain mental health challenges for the individual experiencing the grief including:

• Intense Isolation: Without the usual emotional support and rituals of grief, the individual who is experiencing the grief carries the weight of the grief on their own.

Disenfranchised Grief

• Self Doubt and Shame: Grievers often internalize the lack of validation. This often causes grievers to question whether their feelings are "wrong", "dramatic" or inappropriate.

• Prolonged or Complicated Grief: When grievers can't process loss openly, the pain frequently persists longer and evolve into clinical complications (see my article: Coping With Complicated Grief.

What Are Strategies For Healing?

Coping with disenfranchised grief requires alternative ways to validate your experience:

• Name Your Grief: Recognizing that your grief is a legitimate response to a real loss is an essential part of healing.

• Give Yourself Permission to Feel All Your Feelings: Grief often comes in waves so it's not a linear process. Disenfranchised grief can be particularly intense due to your isolated state and the lack of empathy from others. You might feel emotionally numb, sad, hopeless, hopeful, angry, alone, relieved, overwhelmed, anxious, curious and many other emotions.

Disenfranchised Grief

• Create Personal Rituals: If you're unable to have a formal ceremony, create your own. This can involve planting a tree, writing letters, creating a private memorial space in your home or whatever feels meaningful to you. You can also write in a journal to express all your feelings about the loss (see my article: The Power of Creating Personal Rituals).

Get Help in Therapy

Getting help in therapy for disenfranchised grief counteracts the isolation of an unacknowledged loss and it can prevent the development of more complex mental health problems and emotional stagnation.

Get Help in Therapy

Rather than struggling on your own, get help from a licensed mental health professional who can witness your pain and help you to work through grief.

About Me

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

I have helped many individual adults and couples over the years.

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

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

Also See My Articles:

Coping With the Loss of a Loved One - Common Reactions 

The Many Layers of Grief 

The Emotional Impact of Losing Both of Your Parents 

You Continue to Have An Internal Relationship With Your Parents After They Die 

Looking at Depression From an IFS Parts Work Therapy Perspective

As I have discussed in prior articles, IFS (Internal Family Systems) Parts Work Therapy is a form of Experiential Therapy (see links at the end of this article for more articles about IFS).

Looking at Depression From an IFS Perspective

From an IFS perspective, depression is viewed as a "part" or a collection of "parts" rather than a permanent identity or a sign of a problem in the brain.

Depression From an IFS Therapy Perspective

In IFS, the mind is naturally subdivided into parts (or subpersonalities). 

As I discussed in my prior article, What is the Connection Between IFS Parts Work Therapy and Neural Networks?, the word "parts" is a metaphor for these naturally occurring subdivisions that everyone has. This makes the language of IFS understandable and accessible to clients.

In IFS, depression is typically viewed as either a proactive part, a reactive part or a wounded part depending upon the function of the part:

• Depression as a Proactive Part ("The Shield"): Depression can act as a protective proactive part where the objective is for the part to act as a preemptive "shutdown" mechanism.  The goal is to keep you safe from taking risks that could lead to failure, rejection or overwhelming disappointment. In IFS language, this part is called a "Manager" due to its proactive role.

Depression From an IFS Therapy Perspective

• Depression as a Reactive Part ("The Circuit Breaker): When emotional pain from the outside world is sudden or overwhelming, this reactive part can step in as a way to numb you emotionally. The goal is to instantly extinguish anxiety, shame or grief. This part is called a "Firefighter" due to its sudden reactive function.

• Depression as a Wounded Part ("The Wound"): This is often a young wounded part of you that is stuck in unresolved trauma. This part isn't trying to protect you. Instead, it carries the burden of the early emotional wounds ("I'm unlovable" or "I'm no good" or "I'm powerless"). This part is called an "Exile". The Exile is frozen in the past at whatever age the trauma occurred. The feelings it carries are raw and unprocessed. When someone is triggered, it is the Exile that experiences the trigger. However, the Exile, as the name implies, usually remains below the surface (unless triggered) and what is usually more apparent is either a the proactive Manager or reactive Firefighter.

How is IFS Therapy Different From Traditional Therapy For Depression?

Traditional therapy usually treats depression as a single entity. This can leave clients feeling consumed by it. 

Depression From an IFS Therapy Perspective

IFS therapy teaches clients how to "unblend" from the part of them that is depressed so instead of a client saying "I'm depressed", an IFS client would say, "A part of me is depressed."

This shift allows an IFS client to access their Core Self with the guidance from the IFS therapist so they can approach their depression from a curious and compassionate stance rather than be consumed by it.  

How Does the IFS Therapist Verify the Role of the Depressed Part?

An IFS therapist tracks the depressed part by facilitating communication between the client's Core Self and the depressed part. This is a skill the therapist helps the client to develop.

The depressed part might respond that they are protecting the client from failing, which would indicate a proactive protector part (a Manager).  Alternatively, they might say they are tryng to numb the client, which would indicate a reactive part (a Firefighter).  The other possibility is that the part is a young wounded part that is feeling alone and stuck in unresolved early trauma (an Exile).

How is Depression Healed in IFS?

An IFS therapist will lead the client through a process of helping them to lift the depression which would include recognizing depression as a part, helping the client to access their Core Self and from the Core Self's perspective the client observes the depressed part, befriends the part, and encourages the part to release their psychological burden.

Depression From an IFS Therapy Perspective

This allows the parts to take on a new and healthier role .

Although this might sound simple, it's often not so simple for a variety of possible reasons. Most of the time the proactive and reactive pars will step aside when asked, so that the client and therapist can work with the wounded part that holds the trauma. 

But there are times when these parts haven't developed trust yet with the client and the therapist, so it can take longer for them to agree to step aside.  

In the long run, IFS, which is a gentle, evidence-based trauma therapy, tends to be more effective at helping clients with depression. This is due to IFS's non-pathologizing stance and its step-by-step process of working with depression and unresolved trauma.

Get Help in IFS Therapy

If you have been struggling on your own or you haven't had success in traditional talk therapy, you could benefit from working with a licensed mental health professional who is an IFS therapist.

Get Help in IFS Therapy

When you free yourself from the burden of depression and trauma, you can lead a more fulfilling life.

About Me

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

I have helped many individual adults and couples over the years.

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

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

Also See My Articles

IFS is a Gentle, Evidence-Based Therapy 

IFS Therapy Can Help With Anxiety 

How Are Emotions Processed in IFS Therapy? 

Healing Trauma With IFS Therapy

How Does Experiential Therapy Achieve Psychological Breakthroughs?

In my prior article, How is Experiential Therapy Different Than Traditional Talk Therapy?, I began a discussion about why Experiential Therapy is more effective than traditional talk therapy.

Experiential Therapy Achieves Breakthroughs

In the current article, I'm focusing on how Experiential Therapy achieves psychological breakthroughs.

First, it's important to understand what types of therapies come under the umbrella of Experiential Therapy.

Experiential Therapies includes many mind-body oriented therapies such as:

• EMDR - Eye Movement Desensitization and Reprocessing

• Somatic Experiencing - also known as SE

• AEDP - Accelerated Experiential Dynamic Psychotherapy

• IFS - Internal Family Systems Parts Work Therapy

• EFT - Emotionally Focused Therapy For Couples

How Does Experiential Therapy Achieve Psychological Breakthroughs?

Experiential Therapy achieves psychological breakthroughs by:

• Bypassing the Analytic Mind: Many clients are very good at "talking about" their problems without being in touch with how they feel. This is especially true for clients who have had prior therapy. Experiential therapy uses the mind-body connection so that therapy isn't just an intellectualized experience. Instead, clients can get to the root of their problems in a more effective way by getting to unconscious issues rather than remaining on an intellectual level.

Experiential Therapy Achieves Breakthroughs

• Engaging Somatic Memories: Trauma and chronic stress are stored in the nervous system rather than just in the logical mind. Rather than focusing only on what the client thinks, an Experiential therapist emphasizes body awareness. Instead of only asking, "What do you think?", the Experiential therapist will ask, "What do you feel and where do you feel it in your body?" This helps the client to have a felt sense of their problems. This felt sense can release trapped physical tension and stress. 

• Memory Consolidation: A breakthrough requires updating old neural scripts. In Experiential therapy the brain updates the old memory with new adaptive information with the help of the therapist.

• Emotional Catharsis: Psychological shifts often require an emotional release. Examples of this include: Expressing long suppressed anger, grief and shame. 

Psychological Breakthroughs With Experiential Therapy

Rather than just gaining only an intellectual insight into their problems, clients experience a felt shift.  They can rewrite their emotional scripts through action (see my article: Healing From the Inside Out: Why Insight Isn't Enough to Heal).

Experiential Therapy Achieves Breakthroughs

For example, instead of just understanding their childhood trauma, they experience a felt sense of what has held them back and what has shifted for them in Experiential Therapy in an embodied way. This somatic and emotional alignment changes their internal representation of their world which leads to psychological and behavioral change.

Get Help in Experiential Therapy

If you have been struggling with unresolved problems and traditional therapy has been unhelpful, consider working with a licensed mental health professional who is an Experiential therapist.

The psychological breakthroughs can lead to a more fulfilling life.

About Me

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

I have helped many individual adults and couples over the years.

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

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

Also See My Article:

Why is Experiential Therapy More Effective Than Traditional Talk Therapy? 

Cinema Therapy: How Can Watching Movies Improve Your Mental Health?

Watching movies with complex characters can be beneficial to your mental health. The practice known as cinema therapy (also known as movie therapy) is a growing therapeutic technique which uses the narrative arc and depth of films to foster psychological growth.

Cinematherapy Can Improve Your Mental Health

When you engage in multi-layered, three-dimensional characters, rather than flat, predictable archetypes, it stimulates specific cognitive and emotional processes that can directly support well being.

Watching complex characters can benefit your mental health through several key mechanisms:

Safe Emotional Distance and Projection

Discussing or processing your own personal pain can sometimes make you feel vulnerable  under certain circumstances. In cinema therapy complex characters in a movie provide an emotional buffer that includes:

• Safe Exploration: You can project your own fears, unvoiced struggles or internal conflicts onto a character.

Cinematherapy Can Improve Your Mental Health

• Objective Detachment: This allows you to process intense themes, including grief, trauma or confusion, with enough distance to evaluate them objectively without flooding your nervous system.

Catharsis and Emotional Regulation
Bottled up feelings can lead to anxiety and pent up stress.  Complex stories act as an emotional pressure valve:

• Controlled Release: Watching a character face existential dilemmas or deep emotional pain provides a structured container that invites you to laugh, cry or feel anger in a safe way.

• Neurochemical Reset: This cathartic release can trigger a drop in cortisol and an increase in dopamine which can lower physical and emotional tension.

Cognitive Flexibility and Shattering Binary Thinking

Flat characters teach us to view the world in black-and-white terms (good vs evil). Complex, morally ambiguous characters force your brain to stretch:

• Brain Activation: Neuroimaging studies show that watching complex characters activates the parts of the brain that handle perspective-taking and the management of cognitive conflict.

• Nuanced Realism: Seeing a character who is deeply flawed yet capable of profound kindness helps you to reject harsh, binary judgments about yourself and others, which builds tolerance for life's natural ambiguities.

Building Inner Resources and Resilience
When characters navigate complicated psychological terrain, they model coping mechanisms and self discovery:

• Inner Resources: Watching a character struggle to find their authentic self amidst social pressure or personal crisis can awaken forgotten internal resources and coping skills as well as help to build resilience.

Cinematherapy Can Improve Your Mental Health

• Active Reflection: It inspires post-viewing reflection, which is the mental integration that happens after watching the movie. It can help you to apply the character's breakthroughs and gained wisdom to your own life.

Universal Experiences and Reduced Isolation

A core part of many mental health problems is that you feel alone with your experience and that no one else has ever experienced what is happening to you, so watching movies with complex characters helps you to realize you're not alone:

• Validating the "Hidden Self": Complex cinematic portrayals capture the messy realities of the human condition. An example of this is putting on a happy public persona while struggling on the inside (see my article: Looking Happy on the Outside But Feeling Broken on the Inside).

Cinematherapy Can Improve Your Mental Health

• The Power of Shared Humanity: Seeing those hidden, complicated parts of yourself reflected on the screen helps you to realize that many problems are universal. This can help you to realize that your struggles are a normal part of being a human being.

How Does a Psychotherapist Use Cinema Therapy in Therapy Sessions?

A psychotherapist uses cinema therapy (or movie therapy) as an emotional bridge to help clients to discuss personal issues. 

The therapist uses a structured framework where clients watch the movie, discuss the movie and process their own real-life experiences which are similar to what the characters dealt with in the film.

How Therapists Use Cinematherapy With Clients

Talking about fictional characters can feel less threatening than if clients talk directly about their problems. 

The therapist will often ask questions like, "Why do you think the main character made that choice?" or "What would you have done in this character's place if you had the same dilemma?"

The therapist can also explore with clients what it was like to watch the movie and to realize they aren't the only ones who have these types of problems. 

They also ask questions like "Would you have handled this problem in the same way or in a different way?"

After clients have processed their thoughts and feelings about the movie with the therapist, the therapist can also ask what it was like to discuss the movie with her. This is called metaprocessing.

This can help clients to open up to discuss their own problems and reflect on their therapeutic relationship with the therapist.

What Kind of Movies Can Help to Improve Your Mental Health

There are so many movies that can be beneficial.

Here is one example that can be beneficial for individuals and couples to watch:

The Before Trilogy: The Before Trilogy is a highly acclaimed series of three romantic dramas by Richard Linklater and starring Ethan Hawke and Julie Delpy. The three films in the trilogy are:

• Before Sunrise (1995)
• Before Sunset (2004)
• Before Midnight (2013)

The trilogy follows the evolving relationship between an American man named Jesse and a French woman named Celine. This series, which was filmed in real time over several years, is famous for its naturalistic conversation-driven format.

What Can You Learn From Watching the Before Trilogy? (No spoilers)

The Before Trilogy teaches that long term relationships require active continuous choices rather than relying only on romantic fate:

• Love changes over time
• Communication predicts survival of the relationship
• Love requires constant effort
• Time can alter your perspective

When I assign this trilogy to watch over a period of a few weeks, I use the films to help the client reflect on their personal struggles and how the characters in the movie dealt with similar struggles.

If I assign it to a couple, I ask them to watch the movies and discuss it afterward in terms of the characters and the dilemmas the characters faced in an effort to stimulate deeper communication between them and a deeper understanding of their relationship.

Conclusion

Cinema therapy is an expressive therapeutic modality where a mental health professional assigns a certain movies to help clients process emotions, gain new perspectives and heal. Therapists can also use TV programs or other types of videos.

Cinema therapy works by using carefully selected movies as a "third person" tool to mirror real-life struggles, encourage empathy and prompt breakthroughs.

It can be beneficial for individual adult clients or couples.

About Me

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

I have helped many individual adults and couples over the years.

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

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

What is the Difference Between Psychotherapy and Psychiatry?

Psychotherapy and psychiatry sound alike, so it can be confusing to know what the differences are and when to see a psychotherapist versus when to see a psychiatrist.

The Difference Between Psychotherapy and Psychiatry

What is the Difference Between a Psychotherapy and Psychiatry?

While the two terms might sound interchangeable, there are important key differences:

Psychotherapy

Psychotherapists tend to focus on thoughts, including unconscious thoughts, emotions and behavior.

The Difference Between Psychotherapy and Psychiatry

Psychotherapists have at least a two year Masters degree and many of them also have an additional four years postgraduate training from postgraduate institute (like the Institute for Contemporary Psychotherapy, National Institute of Psychotherapies and other institutes).

Aside from traditional talk therapy, psychotherapists who go on for advanced training also provide specialized therapy including (but not limited to):

• Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR)

• Internal Family Systems Parts Work (IFS)

• Accelerated Experiential Dynamic Psychotherapy (AEDP)

• Somatic Experiencing

• Hypnotherapy

• Emotionally Focused Couples Therapy

• Sex Therapy (for individuals and couples)

Depending upon their skills and training, many psychotherapists can help clients to:

• Manage Stress and Anxiety

• Overcome Depression

• Develop Resilience and Better Coping Skills

Couples Therapy

• Improve Relationships

• Process Unresolved Issues, including Unresolved Trauma

• Improve Communication Skills

• Cope with Workplace Issues

• Process Unresolved Grief

• Improve Self Esteem

And many other behavioral and interpersonal issues.

Most psychotherapy sessions occur at least once a week for 45-60 minutes.

Psychiatry

Psychiatry focuses on the medical side of mental health.

Psychiatrists are mental health professions who are medical doctors (MDs or DOs). They provide differential diagnoses, prescribe psychotropic medication such as antidepressants, anti-anxiety medication, antipsychotic medication and other similar medications.

In the past, psychiatrists provided traditional psychotherapy, like Cognitive Behavioral Therapy (CBT), psychoanalysis and psychodynamic psychotherapy. However, these days most psychiatrists provide medication management. 

Some specialized psychiatrists also provide Electroconvulsive therapy (ECT) for severe mental health conditions such as treatment-resistant major depression, ADHD, schizophrenia and  catatonia (a state where someone is awake but unresponsive to other people or the environment).

After the initial evaluation session, psychiatry sessions tend to be shorter in duration (15-20 minutes) to assess how a client is responding to medication management. After a client has been stabilized on medication, sessions might occur every 3-4 months unless the client needs help with medication.

Integrating Psychotherapy and Psychiatry

Clients, who need medication management, benefit from integrating both psychotherapy and psychiatric treatment and many psychotherapists and psychiatrists collaborate to integrate both treatments (see my article: Medication Alone Isn't As Effective As Including Psychotherapy).

For instance, a psychotherapist who is helping a client with anxiety will often be in touch with the client's psychiatrist to provide feedback on what she has observed in therapy sessions and to get information about medications prescribed. This is only done with a written consent from the client.

While some clients choose to only take medication, research has shown that combining psychotherapy and psychiatric treatments is most effective (when psychiatric treatment is needed) rather than just relying on medication because clients learn coping skills and strategies to deal with their mental health issues. 

Psychotherapy can get to the underlying issues that cause the mental health issues and if worked through in therapy, it's possible that medication won't be necessary for certain clients. 

In addition, when clients stop taking medication for certain mental health issues, they often go back to having the same problems they had before they took medication. For instance, if they never learned to manage anxiety symptoms or get to the root cause of their anxiety in therapy, once they stop taking the medication, they are back to where they were before they stopped taking the medication.

At the same time, there are certain mental health conditions that require medication such as schizophrenia, some forms of ADHD or bipolar disorder to mention just a few.

How to Choose Between Psychotherapy and Psychiatric Treatment

Making a decision about mental health treatment can be a big step, especially if you are new to it.

Consider what you need:

Are you looking for help with understanding yourself, improving your relationships, dealing with situational anxiety or working on unresolved trauma or are you dealing with more complex long-standing psychiatric problems?

If you are dealing with a mental health issue that requires medication (e.g., ADHD, bipolar disorder), starting with a psychiatrist is a good first step. Then, once you are stabilized on medication, you can see a psychotherapist to help you to make the behavioral changes that medication alone won't do.

How to Discover What is Right For You

It's easy to get confused about the differences between psychotherapy and psychiatry.

The Difference Between Psychotherapy and Psychiatry

You're not a broken machine that needs to be "fixed". You're a human being which means that, like everyone else, you have messy, complicated and wonderful parts of yourself. We all do.

Rather than focusing on being "perfect", the goal is developing a better understanding of yourself, practicing self compassion, finding the right tools and strategies to deal with life's inevitable ups and downs and living a meaningful life.

About Me

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

I have helped many individual adults and couples over the years.

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

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

Also See My Articles:

Why is Experiential Therapy Better Than Traditional Talk Therapy to Deal With Trauma? 

With Experiential Therapy, There Are No Blank-Slate Therapists 

The Mind-Body Connection: Experiential Therapy Offers a Window Into the Unconscious Mind