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NYC Psychotherapist Blog

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Showing posts with label inner world. Show all posts
Showing posts with label inner world. Show all posts

Thursday, March 8, 2018

Focusing on Your Inner World to Understand How Your Unconscious Mind Affects Your Behavior: A Clinical Vignette

In my prior article, Focusing on Your Inner World to Understand How Your Unconscious Affects Your Behavior, I discussed the importance of focusing on your inner world and how to tap into your unconscious mind in psychotherapy using experiential therapy such as EMDR therapy, clinical hypnosis, and Somatic Experiencing.  In this article, I'll be providing a fictional clinical vignette to provide an example.

Fictional Clinical Vignette: Focusing on Your Inner World to Understand How Your Unconscious Affects Your Behavior

Sam
Sam began psychotherapy because he was having problems in his romantic relationships with women.

Focusing on Your Inner World to Understand How Your Unconscious Affects Your Behavior 

His last relationship ended in much the same way as his prior two relationships ended with his girlfriend, Jane, telling him that he was too jealous and possessive.  She was also hurt that he tended to be suspicious that she might be cheating on him when she never gave him a reason not to trust her.  After getting fed up with Sam questioning her about her whereabouts, she ended the relationship (see my article: Relationships: Overcoming Jealousy).

Sam told his psychotherapist that neither Jane nor his other girlfriends ever gave him a reason to doubt they were faithful to him, but he still had a hard time trusting women.  He had a very hard time controlling his suspicions, jealousy and possessiveness while he was in the relationship.

In hindsight, he would see that he was being irrational, but that insight never came until after the relationships ended.  Although he knew that there was no chance of repairing his relationship with Jane, he wanted to avoid behaving in this way in a future relationship.

When his psychotherapist asked Sam about his family history, Sam, who was in his mid-30s, revealed that he had only sketchy memories of his childhood.  His psychotherapist knew that this is often a sign that there was developmental trauma in childhood, but she wanted to wait until she knew more about Sam before she speculated about this.

He revealed that was the youngest of three children who grew up in New York City.  When he was in his 20s, his oldest sister, Anna, told him that their mother left the family household for several months when Sam was five and that he had a very hard time while she was away, but he had no memory of this.

Sam said that, according to Anna, their mother just disappeared one day while they were in school.  Anna told Sam that their mother had not left a note or phoned to say where she was or when she would be coming back, which worried everyone.

Anna told Sam that he was inconsolable after their mother left and he refused to go to school, but Sam had no memory of this.  He was aware that his mother eventually returned and his parents were still together, but this is all that he knew.

Sam talked about having chronic insomnia for as long as he could remember. He had problems both falling and staying asleep.  He also described problems with irritable bowel syndrome (IBS), tension headaches and backaches.  He said his doctor gave him medication for IBS, which sometimes worked and sometimes did not.  His doctor also told him that his medical problems were probably psychologically related and recommended that Sam attend psychotherapy.

His psychotherapist, who was a trauma-informed therapist, also knew about the connection between various medical issues and developmental trauma, so she noted this information in Sam's therapy file and kept it in her mind.

She provided Sam with psychoeducation about psychological trauma and how unresolved childhood trauma, even trauma that people cannot remember from their childhood, can affect them later physically and psychologically as adults (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

Then, his psychotherapist prepared Sam to work on his issues by explaining that there would be a preparation phase to their work where she would teach him to how to de-escalate his anxiety and to use self care exercises at bedtime to deal with his insomnia and to anything anxiety-producing at the end or between psychotherapy sessions (see my article: Trauma Therapy: Using Grounding Exercises Between Psychotherapy Sessions and Trauma Therapy: Using the Container Exercise Between Therapy Sessions).

After Sam began meditating, doing breathing exercises and practicing grounding and the container exercises, which helped him to calm himself and to sleep better, his psychotherapist talked to him about the Affect Bridge in clinical hypnosis and how it could help them to understand the root of his problems.  She explained that Sam would be in a safe and relaxed state while they were doing the affect bridge, and she asked him to go back to one of his memories where he was suspicious of Jane.

Sam remembered that there was an evening when Jane was late coming home from work and he was worried about her.  He tried to reach her on her cellphone, but the call went directly to her voicemail.  He said that's when he began to get anxious and suspicious that she might be with another man.

At first while he was waiting for Jane to come home, he tried to rationalize that he had no reason to believe that she was cheating on him, but his anxiety got the best of him and it just continued to escalate.

By the time Jane came home to the apartment that they were sharing, he was in a terrible state.  He went into a rant and accused her of being with another man.

Jane had been through his rants before, so she waited for him to calm down.  Then, she told him that she was stuck between stations on the subway and she had no way to make or receive calls or texts.  She got on the computer and showed him the MTA website that indicated that there were significant delays on the train line that she used.

Then, Jane had a serious talk with Sam and told him that she couldn't deal with his suspicious nature anymore and she wanted to leave the relationship. Within a week, Jane was gone.  Sam felt devastated.

His psychotherapist explained that the anxiety that he had was related to separation anxiety, and she explained this form of anxiety to him (see my article: Overcoming Separation Anxiety).

Sam's psychotherapist asked him to go back to when he felt anxious when he couldn't reach Jane and describe what he felt and where he felt it in his body now as he recalled the memory, assuming this was tolerable for him.  Sam said it was tolerable.  He described the rising state of his anxiety and the related pain in his stomach.  He also felt angry and sad.

His psychotherapist asked Sam to stay with the emotions that he was feeling and to go back to his earliest memory of feeling this same way.

In response, Sam took a couple of minutes to focus on the emotions and the pain in his stomach.  His  mind took him back to a memory of coming home from school when he was five and looking for his mother in their  family apartment.  He looked all over the apartment and couldn't find her.  After a few minutes, he felt terrified that something happened to his mother.

Alone and afraid, he called his father at work in tears.  His father came home immediately and looked around the apartment to see if he could find a note from Sam's mother.  Finding no note, he called his in-laws to find out if she was there, but they said they had not heard from her.  Sam remembered that he was inconsolable all that night, and his father stayed with him until Sam fell asleep.

When Sam opened his eyes in his psychotherapist's office, he said that he was surprised because, until they did the Affect Bridge, he had no memory of that day.

Over the next several weeks, Sam and his psychotherapist continued to work on the early childhood memory of his mother leaving the family.  He recalled that a week or so after his mother left, he overheard his father telling his oldest sister that he heard from Sam's mother and she told the father  that she left the family to be with another man.

Over time, Sam began to remember many more memories related to his childhood.  He was also able to connect his irrational feelings of jealousy and suspicion in his relationships to his childhood memory of his mother leaving the family for another man.  Once he understood the connection, his jealousy and anxiety in his relationships made sense to him.  He realized that the unresolved trauma was still getting played out in his adult life (see my article: Developmental Trauma: Living in the Present As If It Were the Past and Understanding Why You're Affected By Trauma That Happened a Long Time Ago).

His psychotherapist explained to Sam that understanding the root of his problem was the first step, but understanding it alone would not be enough to overcome his problem when he got emotionally triggered in a future relationship (see my article: Coping With Trauma: Becoming Aware of Emotional Triggers).

She recommended that they use EMDR therapy to help Sam overcome the original trauma triggered his separation and abandonment anxiety(see my article: EMDR Therapy: Overcoming Childhood Trauma So You Can Have Healthier Adult Relationships and How Psychotherapy Can Help to Overcome Fear of Abandonment).

Gradually, over time, Sam and his psychotherapist used EMDR therapy and discovered that there were other similar memories of feeling abandoned that contributed to his current psychological and physical problems (see my article: Psychotherapy to Overcome Childhood Trauma).

Eventually, Sam was able to work through his traumatic memories in EMDR therapy.  By the time he got into a new relationship, he no longer got emotionally triggered.

Conclusion
Many clients come to therapy because they don't understand why they are having problems.  Often, they are not aware of how unresolved childhood trauma affects them psychologically and physically as an adult.

Experiential therapy, like clinical hypnosis, Somatic Experiencing and EMDR therapy, can help clients to focus on their inner world to understand how the past, even the past that is not conscious to them, affects them now.  Experiential therapy can also help clients to overcome traumatic experiences.

Getting Help in Therapy
Working with a skilled mental health professional in therapy provides an opportunity to get to the root of your problems and work through unresolved trauma (see my article: The Benefits of Psychotherapy).

Once you have worked through unresolved trauma, you can live a more fulfilling life free of your traumatic history.

Rather than suffering on your own, you owe it to yourself to get the help you need in therapy from an experienced psychotherapist (see my article: How to Choose a Psychotherapist).

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

I work with individual adults and couples, and one of my specialties is helping clients to overcome trauma.

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

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













Tuesday, March 6, 2018

Focusing on Your Inner World to Understand How Your Unconscious Mind Affects Your Behavior

As I've mentioned in prior articles, people's behavior is often based on unconscious thoughts and feelings, so that if you want to understand yourself, a good place to start is with your unconscious mind.   Psychotherapy provides an opportunity to understand your unconscious mind and how it affects your behavior (see my articles:  Psychotherapy: Making the Unconscious ConsciousYour Unconscious Beliefs Affect Your Sense of RealityHow Psychotherapy Helps You to Expand Your Inner Awareness, and Focusing on Your Inner Self is More Effective to Overcome Shame Than Focusing on Your Outer Self).

Focusing on Your Inner World to Understand How Your Unconscious Mind Affects Your Behavior

Some people are naturally more introspective than others.  They take the time to try to understand their unconscious mind in psychotherapy by working with their psychotherapist to become aware of their underlying thoughts, feelings and dreams and how it affects their behavior.

Other people, who are naturally more outer directed, but who also want to understand the underlying issues that affect their behavior, learn in therapy how to discover the unconscious motivation for their behavior.

A skilled psychotherapist, who works with unconscious thoughts, feelings and dreams, can help clients to develop the ability to pay attention to their inner, unconscious world to understand themselves.

When you're aware of what's going on in your unconscious mind, your behavior begins to make sense.  Whereas you might not understand your behavior before you understand the underlying issues, when you've developed the ability to understand your inner world, you begin to understand that there are coherent reasons for your behavior that you weren't able to detect before.

How to Tap Into Your Unconscious Mind

Working With Dreams:
There are many ways to tap into the unconscious mind, depending upon the experience and skills of the psychotherapist.

The most traditional way is to pay attention to your dreams (see my article: Are You Fascinated By Your Dreams?).

By keeping a pad and pen near your bed before you go to sleep, you give your unconscious mind the message that you want to remember your dreams.  

In any given night, most people have 5-6 dreams.  The ones that are easiest to remember are the ones that are closest to your waking up.  

If you want to remember your dreams, upon waking up, rather than jumping out of bed or even shifting your position, remain still for a couple of minutes (shifting your position in bed makes it more likely that the dream will elude you).  

You might start by having a sense that you have had a dream.  For instance, you might still be immersed in the mood of the dream.  Or, you might remember an image or phrase from your dream.  By being patient and waiting a minute or two, the rest of the dream might unfold, usually in reverse order.

Remembering your dreams is a skill, and much like any skill, it can take time to develop.  People who are patient and take the time often remember a few dreams each morning, especially when they are in the process of writing down the dream that was closest to their waking state.  

Just like you might remember the last part of your last dream first, you will usually remember the last dream and then the one before that and the one before that in reverse order.

There are many ways to work with dreams in psychotherapy depending upon how your psychotherapist works.  

Some psychotherapists look for images or symbols in dreams that are prominent to discover the underlying meaning of the dream.

Other psychotherapists believe that every image in the dream represents a part of the client and helps clients to understand their dreams by assisting them to discover what parts of themselves are represented in the dream.

Many psychotherapists focus on the emotion on the dream:  Was the client feeling sad, happy, scared, angry, and so on, to help the client to understand the unconscious material in the dream?

Other psychotherapists work with Embodied Imagination, developed by Neo-Jungian psychoanalyst, Robert Bosnak, to work with dreams (see my article: Dreams and Embodied Imagination and Dream Incubation: Planting Seeds).

When clients are interested in working on their dreams to understand their underlying issues related to their problems, I use all of these ways of working with dreams depending upon what works best for the particular client.  Some clients have more of an affinity for working one way than another.

Working With the Mind-Body Connection
Since the body offers a window into the unconscious mind, I also use mind-body oriented psychotherapy, like clinical hypnosis, EMDR therapy, and Somatic Experiencing, to help clients to discover underlying issues (see my article: The Body Offers a Window Into the Unconscious Mind).

In clinical hypnosis, there is a technique called the Affect Bridge, which helps clients to get to unconscious issues by asking clients to use their emotions and where they feel these emotions in the body to allow unconscious material to come to the surface.

I have found the Affect Bridge to be a very good technique that often gets to unconscious thoughts, feelings and memories related to clients' problems.

Somatic Experiencing works in a similar way.  Clients learn to pay attention to their thoughts, feelings, body sensations, images or anything else that comes up for them as we are working on a problem.  

Part of EMDR Therapy, which was originally developed to help clients to overcome psychological trauma, is also now used for many other issues. For instance, EMDR therapy is also used for performance enhancement for executive, artists, performers, writers, athletes and anyone that needs help with performance enhancement.  There is a component of the EMDR therapy protocol that involves a free associative process where clients can access associative memories and unconscious thoughts and feelings.

EMDR therapy is also used adjunctively when your primary psychotherapist does not do EMDR and you see an adjunctive EMDR therapist (see my article: What is Adjunctive EMDR Therapy?).

Conclusion
Your inner world is a rich source of information that can help you to understand your behavior.

There are many ways to tap into your unconscious mind, including dreams and mind-body oriented types of therapy, such as clinical hypnosis, Somatic Experiencing and EMDR therapy.

In my next article, I'll provide a clinical vignette to demonstrate how focusing on your inner world can help you to understand how your unconscious mind affects your behavior (see my article: Focusing on Your Inner World to Understand How Your Unconscious Mind Affects Your Behavior: A Clinical Vignette).

Getting Help in Therapy
Without understanding your internal world, you're bound to continue to have the same problems because the root of your problem lies in the unconscious mind.

A skilled psychotherapist can help you to delve beneath the surface to understand the underlying issues involved so that you can get to the root of your problems and take action to change your behavior (see my article: The Benefits of Psychotherapy).

If you have been struggling unsuccessfully on your own to resolve your problems, you could benefit from working with a licensed mental health professional (see my article: How to Choose a Psychotherapist).

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

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.