Parallel Losses For the Psychotherapist and the Client

Loss and grief are an unfortunate part of life, and it's one of the reasons why many people come to therapy (see my articles: Who Are You After Your Parents Die?,  Grief: The Emotional Impact of Losing Both of Your Parents and Coping With Grief).  There are often times in psychotherapy when the psychotherapist and the client are going through parallel losses.  In fact, this phenomenon occurs more often than most people would think (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

Parallel Losses For the Psychotherapist and the Client

This parallel process between the psychotherapist and client often benefits the therapeutic work because, through her empathy, the therapist has more to give to the client because she is going through a similar process.

In order for this process to be healing for the client, the therapist must be trained and skilled at being able to experience the client's suffering while, at the same time, dipping into her own experience briefly without getting lost in her experience.  

The psychotherapist's focus must be mainly on the client and, while their experiences might be similar in some ways, the therapist can't assume that the client's experience is exactly the same as the therapist's experience.

From my own experience as a psychotherapist and from what colleagues have told me about their experiences, it's often the case that a client comes to therapy at the same time that a therapist is having a similar experience.

Depending upon the psychotherapist's theoretical orientation, the therapist probably won't share her loss with the client, especially if it will impinge on their work, because the therapy is focused on the client and not the therapist.

There might be times when it is therapeutic for the therapist to share a similar personal experience with the client, but only if it is in the service of furthering their work together.

Let's take a look at how this parallel process between therapist and client shows up in therapy in the following fictional vignette:

Fictional Vignette: Parallel Losses For the Psychotherapist and the Client

Lois

Lois began therapy because her mother, who had advanced Alzheimer's, was rapidly decompensating both physically and mentally.  

Parallel Losses For the Psychotherapist and the Client

Her mother began showing signs of dementia about 10 years before.

Until recently, the decline had been slow and her mother still knew Lois and Lois' siblings.  But a month prior to Lois starting therapy, her mother was becoming increasingly confused and no longer recognized Lois and other family members.

The doctor at the skilled nursing facility where Lois' mother lived told Lois and her siblings that her mother's condition was worsening, and they discussed the treatment plan, including advanced directives.

Lois and her mother were close, and it was excruciating for Lois to see her mother deteriorate over time.  Prior to the dementia, her mother had been very sharp and active, so it was especially difficult for Lois to watch the mother she knew slowly disappear.

She found support at an Alzheimer's support group, but she found her visits to see her mother increasingly difficult.

Knowing that her mother's life would soon be coming to an end, Lois knew that she would need more than her support group.  She needed the one-on-one support of a psychotherapist.

From the first therapy session, Lois felt understood and cared about by her therapist (see my article: The Creation of the "Holding Environment" in Therapy).

In addition to helping Lois cope with emotional pain of watching her mother decompensate due to Alzheimer's disease, the therapist also provided Lois with practical information. 

Lois felt fortunate that she found a psychotherapist who was so knowledgeable about loss, grief and the practical issues involved with having a family member who has dementia.

Little did Lois know that her psychotherapist also had a mother who was suffering with advanced Alzheimer's disease, and they were both going through a parallel process.

Lois' therapist wondered if it would be therapeutically beneficial for her to disclose to Lois that she was also going through a similar situation.  But she sensed, based on things that Lois told her, that Lois needed something different from her at this point in time--she needed to feel that her therapist was outside the world of Alzheimer's disease, nursing homes and hospitals.

As a result, her therapist decided that there would be no therapeutic benefit to disclosing her personal situation to Lois, so she kept it to herself.  She didn't want to impinge on Lois' experience.

Even though her therapist didn't disclose her personal situation to Lois, Lois felt that her therapist was present with her in a way that she had never felt before with her other therapists--as if her therapist really understood what Lois was going through--and this was healing for Lois.

Two months before Lois' mother died, her therapist called her to let her know that she would have to cancel their next two appointments because she had a loss in her family.  

When they resumed work together, Lois expressed her condolences to her therapist.  She didn't ask if the person who died was close to her therapist because she already felt overwhelmed by her own emotions.  Sensing that Lois didn't want to know, her therapist didn't divulge that her mother had just died from complications of Alzheimer's.

When Lois got the call from the nursing home that her mother died the night before, she was grief stricken.  All along she was grieving for the changes in her mother.  Somehow, she thought that, since she anticipated her mother's death.  She knew she would be upset, but she didn't think she would be so upset.

After their father died a few years earlier, Lois' siblings looked to her for advice because she was the oldest, and now it was no different with their mother's death.  They looked to her for guidance and emotional support, so Lois was glad to have her weekly therapy sessions so she could get her own emotional support from her therapist.

Lois resumed her therapy sessions a week after her mother died, and she was relieved to feel enveloped in the caring and empathetic environment that her therapist created for her (see my articles: Why is Empathy Important in Psychotherapy? and The Psychotherapist's Empathic Attunement to Unconscious Communication in the Therapy Session).  

Parallel Losses For the Psychotherapist and the Client

She could feel her therapist's attunement to her, and there were times in her sessions when she felt she didn't even need to talk.  It was enough to be there and feel her therapist's empathy.  

Aside from her advanced clinical training and experience, her therapist also had her own therapy that she relied on for her support through the grief process.  

Her therapist had many years of experience helping clients to cope with grief.  As she listened to Lois talk about her feelings, she recognized the parallel experiences between them.  She sensed the similarities as well as the differences in their relationships with their mothers and their experiences of grief.

Just as Lois found these therapy sessions to be healing, her therapist also had an internal experience of how healing these sessions were for herself.

Conclusion

It's not unusual for a psychotherapist and client who are working together in therapy to be having a parallel experience--whether it's about loss, happy experiences, personal relationships or any other experiences.

Most of the time, if the psychotherapist is skilled, experienced and can contain her own experiences with appropriate boundaries, the client can benefit from going through this parallel experience with the therapist--whether the client knows about the parallel experience or not.

There are times when even the most skilled psychotherapists must be aware of their own limitations and not take on certain clients because they are aware that they have a particular emotional vulnerability to whatever the client is going through and the therapy wouldn't be beneficial for the client.  Usually these instances are more the exception than the rule.

The therapist usually makes a decision on a case-by-case basis, depending upon the client's needs and the therapist's comfort level with disclosure, whether or not to disclose her own experience.  For instance, in substance abuse treatment, therapists often reveal their own history with substance abuse because this is an accepted practice in substance abuse treatment.

Psychotherapists' disclosure is a topic where there are many different views.  While the therapist is expected to be genuine and no longer expected to be a "blank screen" with her client, the decision to disclose personal information or not must be viewed in light of whether it would be of therapeutic benefit to the client and not solely for the therapist's benefit.

Getting Help in Therapy

Whether or not to start therapy can be a challenging decision (see my articles: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent and Psychotherapy and Beginner's Mind).

Finding a licensed mental health professional who is right for you is a process (see my articles: How to Choose a Psychotherapist).

When you and your psychotherapist are a good match, you can benefit from your work together in ways that might exceed your expectations (see my article: The Benefits of Psychotherapy).

The healing process in therapy can lead to emotional breakthroughs and a more fulfilling life.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

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 Psychotherapy: My Articles About Psychotherapy.

The Holding Environment in Therapy: Maintaining a Safe Environment for the Client

In a prior article, I began a discussion about the holding environment in therapy (see my article: The Creation of the Holding Environment in Therapy).  As I mentioned in that article, the idea that the psychotherapist creates a safe therapeutic holding environment for the client was developed by British psychoanalyst, Donald Winnicott (for more on Winnicott, see my article: Books: "Tea With Winnicott" at 87 Chester Square).  In this article, I'm focusing on a particular aspect of the holding environment, which is the therapist's ability to keep the work emotionally manageable for the client.

The Holding Environment in Therapy

As an example, it's often the case that clients come to therapy because they're not feeling good about themselves.  This can be a lifelong problem or a new development for a client.  Either way, the client might focus on the aspects of himself that he is unhappy about and miss the fact that he has many strengths.

A skilled psychotherapist will usually see the client's strengths, even when the client is unaware of these strengths.  

The challenge for the psychotherapist is when to talk to the client about his strengths.

Timing is everything.  If the therapist brings up the client's strengths too early in therapy, the client, who has a particularly negative view of himself, will often minimize or dismiss the idea that he has these strengths (see my article: Overcoming the Internal Critic).

Some clients, who are focused on what they perceive as emotional deficits in themselves, might even think the therapist is being disingenuous when she tries to talk to them about their strengths (see my article: A Strengths-Based Perspective in Psychotherapy).  

In many cases, on an unconscious level, these clients are too afraid to consider the possibility that they have strengths.  Rather being overwhelmed by their fear, they protect themselves emotionally by remaining stuck in their denial.

It's important that the psychotherapist not interpret the client's reluctance as "resistance."  This comes across as judgmental.  It would only make the client feel uncomfortable and it's not helpful to the work.

If the therapist doesn't know how to handle the client's fear,  this could lead to the client leaving therapy prematurely to avoid dealing with uncomfortable feelings (see my article:  When Clients Leave Therapy Prematurely).

So, the skilled psychotherapist, who is aware that it would be premature to talk to the client about his strengths, must keep these observations to herself until the time is right.  This requires the therapist to be emotionally attuned to the client (see my article: The Psychotherapist's Empathic Attunement).

Even with self critical clients who are willing to explore the possibility that they have strengths, they might perceive their strengths on an intellectual level but not on a deeper emotional level.

For these clients, the therapist might broach the topic of the client's strengths, let the client know that she (the therapist) sees these qualities and will hold a space for them until the client can accept this on an emotional level.

This is a way for the therapist to create a safe holding environment for the client because the client knows that the therapist holds onto these observations until the client is ready.

Let's take a look at a fictional vignette that illustrates these points:

John

John had been in and out of therapy for many years.

He usually attended a few sessions with a therapist, and then he aborted therapy because he felt the therapist didn't understand him.

John struggled with depression, including low self esteem, since he was a child.  He grew up in a household where both parents were mostly preoccupied and paid little attention to John, who was an only child.

John's father often criticized him and told John that he would never amount to anything.  His father's critical comments were so frequent that John internalized them and, over time, believed them.  John's mother was depressed and withdrawn, and she was emotionally unavailable to him.

When he was in school, his teachers often told John that he had a lot of potential, but he was not trying.  From John's depressed perspective, he didn't see a reason to try since he believed his father that he wouldn't ever amount to anything.

As an adult, John drifted from one job to another.  Since he never expected to do well, he put little effort into his work, which resulted in disappointment for him.

John also had very low expectations about relationships.  He had a few close friends, but his romantic relationships didn't last beyond a few months.

He would go through long periods when he didn't even try to meet anyone, but then his loneliness caused him to try again with the same low expectations.  It was an ongoing cycle.

By the time John came to therapy again, he felt he was at a low point.  He was already in his mid-30s and he felt he had nothing to look forward to in his life.

The Holding Environment in Therapy

He told his current therapist at the start of therapy that he left his prior therapists because they were unable to see him as he was.  He felt that each of them saw him as they wanted him to be, which frustrated him.

He appreciated that his former therapists were "nice people" and they tried to speak to him about his personal strengths, but he didn't believe what they were saying.  He wasn't sure if they were mistaken or if they were intentionally trying to boost his confidence in a false way.  

Either way, whether the therapist was well-meaning but wrong or whether the therapist was only trying to boost his confidence and didn't really believe he had strengths, John found these discussions intolerable and he would abort therapy.

John's current therapist could see how self critical he was.  She also saw that he had many strengths.  But she also heard John loud and clear that he was unable to even consider that he had strengths, and she knew, based on what he was telling her, that if she tried to broach this with him, he would leave therapy, as he did in the past.  So she waited until he was ready.

Until then, his therapist remained attuned to John's experience and reflected back to him what he told her.  In doing this, she showed John that she understood how he felt about himself, and for the first time in his life, John felt that he was finally seeing a therapist who understood him.

In the meantime, his therapist held onto her perception of the many strengths she saw in John over time.  She waited until she saw a possible opening to explore this with him.

Gradually, as John felt more comfortable with his therapist, he opened up more with her, and she continued to let him know that she understood how he felt by mirroring back to him.

One day, John came to therapy in an agitated state.  He told his therapist that his new supervisor complimented John on a project.

John's first reaction was to get angry because he thought his supervisor was lying to him or he was trying to manipulate John in some way.

But as he thought about it, John said that he knew his supervisor wasn't a manipulative person, so he doubted that this was the reason for his compliment.  He said that maybe his supervisor was just trying to make him feel good--like some of John's prior therapists.  

Whatever the supervisor's intentions, John found it difficult to sit there and listen to his supervisor's compliments.  He said nothing to his supervisor but, for some reason, John realized, it brought up a lot of shame and sadness for him.

During the next several sessions, John continued to talk about this because his supervisor came to him again and told him that he really liked his work.  This continued to baffle John.

Over time, John became more open to exploring this issue and his own sadness and shame.  He was able to connect his negative feelings about himself to his critical father.

During that time, his therapist continued to maintain an open and empathetic stance with John, allowing John to draw his own conclusions (see my article: Why is Empathy Important in Therapy).

She knew that if she intervened prematurely, John would shut down emotionally and he might leave therapy.  She had to wait until he was ready.

Then, one day John came in and told his therapist that his supervisor took him to lunch.  John was surprised that he enjoyed talking to his supervisor over lunch.  He was also surprised to realize that his supervisor liked him and that his praise really was genuine.

As John opened up more emotionally in therapy, he allowed himself to feel his sadness about being a disappointment to his father.  He wished he could have had a father who was more like his supervisor--a kind and generous man.

As he continued to discuss this in therapy, John became aware that his father was a disappointed, bitter man, and his father didn't feel good about himself.

As he looked at his childhood from an adult perspective, he realized that his father was projecting his own negative feelings about himself onto John (see my article: Looking at Your Childhood Trauma From an Adult Perspective).

This led to John questioning whether his father's perceptions about him were accurate, "Maybe I'm not such a loser after all.  What do you think?"

At that point, his therapist realized that John created a small opening for them to be able to discuss the possibility that he wasn't "a loser" and he might have positive qualities.  She also knew that this was a tentative opening that could shut down if she rushed in because John might get overwhelmed, so she had to be cautious.

His therapist said she observed positive qualities in him, and she explored with him whether he would be open to discussing this.  John responded by shifting in his seat and telling her that it felt uncomfortable but, at the same time, there was a part of him that wanted to talk about it.

Gradually, John was able to explore his feelings.  He trusted his therapist enough to know that she wasn't going to lie, hurt him or try to manipulate him.

His therapist relied on John to tell her whether their discussions about his strengths felt too uncomfortable, and he told his therapist when he felt uncomfortable.  In this way, his therapist was able to maintain an emotionally safe environment for John in their sessions.

The Holding Environment in Therapy

Over time, John developed the emotional tolerance to discuss seeing himself in a positive light.  This was new and scary for him at first, but he was starting to feel better about himself.

By being attuned to John, his therapist was able to provide him with feedback about his positive qualities in "manageable doses" for him.  She respected his feedback when he told her that he was beginning to feel overwhelmed, and she would not push him beyond where he could go emotionally.

Working with John in this way, over time, his therapist was able to help John to mourn what he didn't get as a child and to develop more self confidence (see my article: Psychotherapy and Compassionate Self Acceptance).

Conclusion

There are many ways for a psychotherapist to create a therapeutic holding environment for a client.

One way, as I have discussed in this article, is to keep the therapeutic work manageable for the client.

To create a holding environment, the therapist must be emotionally attuned to the client and intuitively sense when the client is ready to explore uncomfortable issues.  She must also ask the client for feedback.

When the client provides a tentative opening, a skilled therapist doesn't rush in.  She helps to facilitate an exploration that is manageable for the client.

In this way, by being attuned and titrating the work, the therapist helps the client to make progress in therapy.  In other words, going slowly in these particular cases, is more effective than trying to get under the client's defenses and overwhelming the client.

From the outside, it might appear that the work is going too slowly, but with regard to the client's internal world the client is developing the internal resources for more in-depth work.  

Not every client has these particular problems, and in many cases the therapist senses that she can make observations early in therapy without jeopardizing the work.  But for clients who aren't ready, premature explorations often lead to premature endings in therapy because the client aborts therapy.

Getting Help in Therapy

Many people, who could be helped in therapy, never come to therapy and struggle on their own without success.

Finding the "right fit" with a particular therapist might be a matter of trial and error as you interview various therapists (see my article: How to Choose a Psychotherapist).  

I usually tell prospective clients to follow their own instincts when choosing a therapist and not to remain with a therapist if their gut feeling is telling them that it's not working out.  However, if you have a long history of aborting therapy prematurely, it might be worth considering that you're avoiding dealing with certain issues in therapy.

Rather than struggling on your own, you could benefit from seeing an experienced therapist who can help you to work through the problems that are keeping you stuck.

By working through problems that are keeping you stuck, you can lead a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, Somatic Experiencing and Sex Therapist who works with individual adults and couples.

I work in an empathetic, attuned and respectful manner with clients to help them to overcome their problems and maximize their potential.

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.

Why It's Important For Psychotherapists NOT to Have "All the Answers" in Therapy

There was a time in the history of psychotherapy when traditional psychotherapists believed they had  "the answers" for their clients (see my article: A Therapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

Back then, it was assumed a client would come in, free associate to whatever was on his or her mind, and when the time was right, the therapist would make an interpretation as to what was going on for the client.

If the client didn't accept the therapist's interpretation, the client would usually be thought of as being "resistant" (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

Fortunately, times have changed and most contemporary therapists work in a more collaborative way with clients.  And yet, there are still many clients who come to therapy who expect the therapist to have "all the answers" to their problems.

Not only is it a distortion of what goes on in therapy to think that a therapist is all-knowing, it's also counterproductive.

And, it's likely that any therapist who presents him or herself as knowing all the answers won't be listening to the client or helping the client to develop his or her own ability to develop insight and inner knowledge.

Self exploration and personal discovery is part of the psychotherapeutic process.  And while it's understandable that some clients want "the answer" to their problems from the therapist, it's not realistic or helpful.

Although psychotherapists, who have advanced training in psychoanalytic or psychodynamic therapy, are trained to do in-depth therapy, they are neither mind readers nor fortunate tellers, so they don't have "all the answers" to your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

Knowledgeable, skilled therapists can facilitate clients' self exploration and help them to develop the psychological skills to overcome problems and lead a healthier life.

If they're trained as trauma therapists, which not all therapists are, they can also help clients to overcome psychological trauma.

But psychotherapists also need to get to know clients over time, and it would be presumptuous and foolhardy for any therapist to assume that she knows from the start what would be best for the client.

If the therapist assumes that she already knows the answers to the client's problems before there is any psychological exploration, this usually means that the therapist isn't taking the time to listen empathically and to get to know the client.

In my professional opinion, as a psychodynamically trained therapist who has gone on to do advanced trauma training, psychotherapy is an intersubjective experience (see my article:The Therapy Session: A Unique Intersubjective Experience).

It takes time for the client and therapist to develop a therapeutic rapport and this doesn't always happen.  Not every therapist is for every client, and most therapists recognize that it's not always a "good fit" with every client.

Most therapists know that each client is unique and, even when it appears that a particular client might have a similar problem to other clients, there's never a one-size-fits-all approach that will work for every client.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

A skilled therapist also knows that part of creating a therapeutic rapport is creating a "holding environment," as initially explained by British psychoanalyst, Donald Winnicott, where the client feels safe (see my article: The Creation of the Holding Environment in Therapy).

A skilled therapist also knows that she must listen empathically to what the client is saying on both a  conscious and unconscious level in order to begin to understand what's happening with the client (see my articles: Psychotherapy: Therapists Should Listen and Learn From Their Clients and The Therapist's Empathic Attunement to the Client)

By listening empathically, the therapist is actually learning from the client about the client rather than the other way around where the therapist makes premature interpretations as to what's going on.

It's also the therapist's job to help the client to develop the skills to tolerate the ambiguity of what's going on in therapy, especially during the initial stage of therapy when it might not be so clear.

In other words, some clients come in with a specific problem and while the resolution might not be clear, the problem is clearer than when clients come in a state of general malaise and they're not sure what's going on (see my article:  When You Just Don't Feel Right, It's Hard to Put Your Feelings Into Words).

For the client, developing skills to tolerate ambiguity might include self soothing techniques or other forms of coping skills (see my article:  Developing Coping Skills in Therapy).

There are no quick fixes in psychotherapy, even with some of the more advanced forms of trauma therapy, which tend to be shorter than some forms of talk therapy when there is psychological trauma (see my article: Beyond the "Band Aid" Approach to Overcoming Psychological Problems).

If you're new to psychotherapy, it helps to have realistic expectations of your therapist and of the psychotherapy process.

Generally speaking, the more complex the problem, the longer it takes to work it through in therapy, although therapy shouldn't be an interminable process where you feel you're not making any progress.

Rather than giving you the answers, a skilled therapist helps you to get to know yourself, grow psychologically, and learn how to work through your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

I recommend that you take your time when you're choosing a psychotherapist (see my article:How to Choose a Psychotherapist).

As part of the process of finding a therapist, you might want to see several therapists to determine which one you feel the most comfortable with before you delve into therapy.

And, as I mentioned before, even highly respected, reputable therapists are not always a "good fit" for everyone, so trust your intuition when making a choice.

Getting Help in Therapy
Many people avoid seeking help in therapy because they believe in common myths and distortions about therapy (see my articles: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak" and Common Myths About Psychotherapy: Therapy Takes a Very Long Time).

It's takes time to develop a sense of trust and safety in therapy, especially if you've had early childhood experiences where you were abused or neglected.

Getting Help in Therapy

Psychotherapy can be a  transformative and dynamic process if you approach it with a sense of openness and curiosity about yourself, choose a therapist who is right for you, and approach therapy with realistic expectations (see my articles: Psychotherapy and Beginners Mind, Starting Therapy With a Sense of Curiosity and Openness and Experiential Therapy Can Be a Transformative Experience That Helps to Achieve Emotional Breakthroughs).

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

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

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

How is Talking to a Psychotherapist Different From Talking to a Friend?

As a psychotherapist, I often hear people, who have never been in therapy, ask the question, "How is talking to a therapist different from talking to a friend?"  This comes up often enough for people considering going to therapy that I think it's worth discussing in this article.

Talking to a Psychotherapist is Different From Talking to a Friend

Many people, who have never been to therapy, think that there's no difference between speaking with a  licensed mental health practitioner and speaking with a friend.  They feel that the only difference is that they have to pay a therapist and they don't have to pay a friend, but working on your issues with a licensed psychotherapist is very different from talking to a friend.

Let's take a closer look at the differences:

Licensed Psychotherapists are Trained Mental Health Professionals
To be a licensed psychotherapist in New York, you have to get special training.  Aside from getting a graduate degree, a therapist must have of several years of experience in the field before she can call herself a licensed therapist.

Aside from taking mental health courses in graduate school, this also includes two internships as well as a fair amount of clinical supervision.

Talking to a Psychotherapist is Different From Talking to a Friend

Psychotherapists who want more in-depth clinical training attend four more years of advanced training beyond graduate school as I did when I attended postgraduate mental health training.

Psychotherapists in New York also have to continue to develop professionally by attending continuing education courses to continue developing their clinical skills.

By the time a therapist is licensed in New York, she has already worked in the field for a while and has seen many clients.

An experienced therapist knows how to be attuned to clients (see my article:  A Psychotherapist's Attunement Can Be Emotionally Reparative to Clients).

Licensed Psychotherapists Are Objective
Whereas your friends are caring and compassionate, they're usually not objective.  They might automatically take your side without being objective enough to see your situation in all of its complexity.  They might tell you what you want to hear or they might have some stake in the situation that you're dealing with at the time.

In addition, they might allow their personal feelings to get in the way of hearing what you have to say, especially if they're dealing with similar problems.

Talking to a Psychotherapist is Different From Talking to a Friend

Psychotherapists are trained to be objective.  They're also trained to help you look at your problems from many different angles, possibly angles that you haven't considered before.  They can help you to develop new insights into yourself so that you can grow as a person.

In addition, they can help you to understand how your current problem might be related to your history.  This is often difficult for most people to do if they're not trained as a psychotherapist.

Licensed Psychotherapists Must Keep Your Sessions Confidential
Except under a few circumstances that involve either suicide, homicide or child or elder abuse, your psychotherapy sessions are confidential.

While your friend might inadvertently reveal your personal problems to someone else, your therapist is bound by confidentiality.

Also, therapists are trained to create a safe and emotionally supportive environment for clients without judging them (see my article: The Creation of a "Holding Environment" in Therapy).

In addition, many people, who are concerned about a friend or a family member being judgmental, prefer to talk to a therapist about their problems.

Licensed Psychotherapists Are Trained to Maintain Appropriate Boundaries in Therapy Sessions
Along with maintaining confidentiality, psychotherapists get training to maintain professional ethics.

An experienced therapist knows how to develop a rapport with clients while maintaining appropriate boundaries.

Talking to a Psychotherapist is Different From Talking to a Friend

Licensed Psychotherapists Keep the Focus on You
Whereas your friend might want to also talk about her problems when you already feel overwhelmed by your own, a therapist focuses on you.

The therapy session is a time and place that is dedicated to only you.  The therapist isn't going to be talking about her problems.

The Importance of Having an Emotional Support System Outside of Therapy
As I've written in a prior article, it's important to have an emotional support system outside of therapy (see my article: Emotional Support From Your Family of Choice).

It's not a matter of choosing friends or choosing to be in therapy.  Both are important and have different roles in your life.

Getting Help in Therapy
If you've never attended therapy before, you might find it helpful to read my article, How to Choose a Psychotherapist).

There are times when we all need help.  If you haven't been able work out your problems on your own, you could benefit from seeing a licensed mental health professional who can help you work through your problems so you can lead a more fulfilling life.

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

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

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

The Psychotherapy Session: A Unique Intersubjective Experience

Over time, people who are in therapy come to appreciate the uniquely private space of the therapy room.

The Therapy Session: A Unique Intersubjective Experience

Considering how busy most people are these days, other than their therapy sessions, many people don't take the time to reflect on what's going on in their lives and to get objective feedback.

For many people, the psychological insights that they have about themselves occurs in their therapy sessions.

The Privacy of the Therapy Session
In recent times, privacy has been eroded to such an extent that there are few (if any) other places where someone can come in and say whatever is on his or her mind in an accepting, objective, nonjudgmental private place.

Making Connections Between the Present and the Past in Therapy 
It's also a unique environment where an experienced therapist is trained to help clients to make possible connections between what is going on now and the past, and to begin to understand the many different aspects of themselves.

Most people don't feel immediately comfortable divulging a lot of private information about themselves at first.  It takes time to build a relationship with a therapist and to establish a rapport.

The Therapeutic "Holding Environment"
The attuned therapist creates a comfortable, secure environment for the client where the client feels heard and cared about (see my article:  The Attuned Therapist Creates a Therapeutic Holding Environment).

During the initial therapy sessions, it's important for the client and the therapist to each assess if they are a good "match" to continue to work together.  There aren't any specific steps for the client to determine this.  Mostly, I recommend that clients trust their intuition.

The Therapy Session: A Unique Intersubjective Experience

For the therapist, it's important that she work within the scope of her knowledge and skills.  So, if a client is looking for a therapist with a particular specialty, it's important for the therapist to reveal whether or not this is one of her specialties.

When it's a good match, over time, clients develop a comfort level where they feel they can talk about anything with their therapist.

Of course, there will be times when clients will feel ashamed to talk about certain topics, but it's important to remember that most experienced therapist have heard just about everything and, most likely, won't be shocked by what clients say.

Having a compassionate, skilled therapist and the time and place to talk about whatever is on a person's mind is a very freeing experience that is rare.

Many people, who are in therapy, look forward to attending their therapy sessions because it's such a unique experience where they have their therapists undivided attention and the time is dedicated to them.

Unconscious Communication:  The Intersubjective Space Between Therapist and Client
Clients and therapists often talk about getting into a particular intersubjective space that is unique to their particular therapeutic relationship (see my article:  The Psychotherapist's Empathic Attunement).

Within this intersubjective space, there is a form of unconscious communication between client and therapist that is particular to that client-therapist dyad.

As a result, there is more being communicated than the words that are being spoken.

There is also a latent communication that therapists, who are trained to work with unconscious communication, experience on a felt sense level.

Many clients will often talk about how they also sense this unconscious communication that is part of the intersubjective space between client and therapist.

Although there is always unconscious communication between people who are together, the unconscious communication between therapist and client is more focused than it would be between two other people and it usually develops over time.

When there is a good match between a therapist and client, it's not unusual for a therapist to intuitively sense what a client is about to say or for a client to sense what a therapist is about to say.

This is because this unconscious communication is "in the air" between them.

Choosing a Therapist
Thinking of the first session as a consultation is a good way to approach that first session.

Not only are you talking about your problems in a broad way, you're also getting a sense for whether you feel comfortable with the therapist.

You might not be able to tell in the first session, but after the a few sessions, you usually get a sense as to whether it's a good match.

For more information about how to choose a therapist, 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.

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

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

Empowering Clients in Therapy - Part 1

Many people, who are depressed, anxious or traumatized, avoid coming to therapy because they feel ashamed of their problems, they fear they'll be overwhelmed by opening up emotionally in therapy or they feel a sense of helplessness related to a history of trauma (see my article: Overcoming Feelings of Helplessness Related to Childhood Trauma).

Empowering Clients in Therapy

As compared to the number of people who need mental health treatment, only a small percentage actually come to a therapist's office.

This is all the more reason why it's so important for psychotherapists to find way to empower the clients who, although apprehensive, come to therapy.

Empowering Clients in Therapy
There are many ways to empower clients in therapy, including:

Helping Clients to Feel Safe
As I've mentioned before, for many people coming to therapy is an act of courage.  It's not easy coming for a consultation with a stranger, not knowing what to expect.

The therapist sets the tone, especially at the start of therapy, and it's important that s/he create a safe, comfortable, respectful environment (see my article:  The Creation of a Holding Environment in Therapy).

An emotionally attuned therapist can make all the difference to clients who feel apprehensive.  Empathy and respect are the hallmarks of good therapy and help clients to feel comfortable (see my article:  The Therapist's Empathic Attunement Can Be Emotionally Reparative to Clients in Therapy).

Providing clients with information
Many clients who have never been in therapy before don't know what to expect.  They might not understand about the treatment frame regarding regular appointment times, lengths of sessions, fee arrangements, therapist's education and skills, and so on.

Empowering Clients in Therapy

Even if clients have been in therapy before, each new experience will be different.

After therapists get to know clients, clients need help to understand their problems.  If they've never spoken to anyone about their problems, they might feel that they're the only ones who feel this way or who have had these experiences.

As much as possible, it's important for therapists to normalize clients' experiences so they know that they're not the only ones who have ever gone through these problems before and that other people have been able to work through these issues in therapy.

This empowers clients so they don't feel ashamed and guilty about their problems.  It might also help them to feel hopeful that they can also work through their problems.

Talking to Clients About Their Expectations and Goals
Clients who are new to therapy (or new with a particular therapist) might not know what to expect in treatment or they might come with misconceptions.  For instance, they might think that the therapist will provide them with "answers" to their problems rather than being someone who facilitates their development and growth in treatment.

Even if they've been in therapy before, they might have had bad experiences and they are, once again, summoning their courage to give it another try.

Empowering Clients in Therapy

Discussing their expectations and what they would like to accomplish in therapy encourages them to be active participants in their own treatment.  This is something which might be new and unfamiliar at first but, ultimately, it can empower them.

Some clients might need help formulating goals and strategizing how to accomplish their goals.  They might need help to understand that, for some people, setting goals are a work in progress, and that's okay.

Other clients might not even feel that they are entitled to want anything or to set goals because of their early history of being subjugated in their families.  Just the idea that they have choices might be a new experience.

Offering Clients Choices in Therapy
There is no one-size-fits all treatment, especially when it comes to mental health issues.

It's important for therapists to be skilled in different treatment modalities so that clients have choices.

This can be empowering for clients in therapy, especially since many clients didn't have choices when they were growing up.

Listening to the Client
Many people have never had the experience of really being listened to by another person before they came to therapy.

It's important that therapists be willing to listen to what is being said and also to what is not being said, which could be just as important.

It's also important for a therapist to learn from clients (see my article:  Psychotherapy: Listening and Learning From the Client).

For instance, the client might have a different perspective about a situation because s/he is from a different culture.  No therapist can know about every culture, so listening and learning from the client can help the therapist to see things from the client's point of view.

Repairing Ruptures Quickly When They Occur
Even the best therapist will make mistakes at times.  No one is perfect.  It's important for therapists to repair ruptures in treatment as soon as possible.

Empowering Clients in Therapy:  Ruptures and Repairs in Therapy

This can be empowering to clients, especially clients who grew up in households where they were hurt, emotionally or physically, by parents who never made amends.

Often, after a rupture is repaired between a client and a therapist, the therapeutic relationship is strengthened and it is better than before the rupture (see my article: Psychotherapy: Ruptures and Repairs in Therapy).

Aside from these basic ways of empowering clients in therapy, there are also clinical ways to empower clients, which I'll discuss in my next article:  Empowering Clients in Therapy - Part 2: Clinical Issues

Getting Help in Therapy
Asking for help is never easy.

Considering therapy might be a new idea that you've never considered before or you might be returning to therapy after having been away for a while.

There are many different types of therapies and many psychotherapists with different orientations to therapy and different levels of skill and experience, so I recommend that, if you're considering therapy, ask for a consultation first to find out about the therapist, to see if you're comfortable with him or her, to give an overview of the issues that you would like to work on, and to ask questions.

You might need to see a few therapists before you find someone that you're comfortable with, and most therapists will understand this.

For more information, 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.

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.

Working Through Emotional Trauma in Psychotherapy: Learning to Separate "Then" From "Now"

One of the most challenging aspects for people considering through emotional trauma in therapy is their fear that they'll be as emotionally overwhelmed in therapy as they were originally when they experienced the trauma.  Many clients have this fear even when the trauma occurred a long time ago.  So, when a therapist does trauma work, it's important to help the client to distinguish between what happened "then" from what's happening "now."

Working Through Trauma in Psychotherapy: Learning to Separate "Then" From "Now"

The Dual Experience in Trauma Work

To help clients work through trauma, as a trauma therapist, I help clients to keep "one foot" (so to speak) in the here-and-now of the therapy room with me and "one foot" in the memory of the trauma.

Having this dual experience is crucial for the client to feel safe enough emotionally to do the trauma work and not fearful that s/he will be emotionally overwhelmed.

Clients Need to Have the Emotional Capacity to Do the Trauma Work
As a trauma therapist, I assess if the client has the emotional capacity to do the work.  If I assess that the client lacks the capacity at the beginning of therapy, I help the client to develop this emotional capacity before the actual work on the trauma begins.

Creating a Therapeutic "Holding Environment" for Doing Trauma Work
A therapeutic "holding environment" is important in any kind of therapy work, but especially when the client comes to do work on trauma.

It's not enough for the client and therapist to have a rapport.  The client must feel emotionally "contained" in order to feel safe enough to do the work.

See my article:  The Creation of the "Holding Environment" in Psychotherapy for more details about this.

Somatic Experiencing and Trauma Work
I have found that Somatic Experiencing is a gentle and effective form of therapy that helps clients work through trauma.

Somatic Experiencing also helps clients to differentiate "then" from "now" so they are less likely to feel emotionally overwhelmed.

When clients come to see me and they're considering Somatic Experiencing, I usually recommend that they read Peter Levine's book, Waking the Tiger, which explains Somatic Experiencing.  I also recommend his more recent book, In an Unspoken Voice.

Getting Help in Therapy
If you have emotional trauma that has not been worked through, you owe it to yourself to get help from a licensed psychotherapist who specializes in trauma work so you can lead a more fulfilling and meaningful life.

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

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

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