EMDR Therapy Online is Just as Effective as in Person

Like many psychotherapists these days, I have a hybrid private practice in New York with in person and online sessions.

I know many people are apprehensive about doing online therapy because they believe it won't be as effective as in person therapy. 

I also believed this--until the pandemic made it necessary for therapists and clients to switch from in person to online therapy and I had to try working with clients online.

I was pleasantly surprised to discover that my experience with online therapy, including EMDR (Eye Movement Desensitization and Reprocessing) therapy, has been just as effective as in person sessions (see my article: How EMDR Therapy Works: EMDR and the Brain).

EMDR Online is Just as Effective as in Person

A lot of clients are also surprised to hear that EMDR can be done online, so when they ask me what the difference is between EMDR therapy in person and EMDR online, my response is that the EMDR protocol is exactly the same online as it is in person. 

In other words, the eight phases of EMDR therapy remain the same and the protocol for setting up EMDR sessions is the same.  

What might be different are some minor adjustments to the Bilateral Stimulation used during EMDR (see my article: What is Bilateral Stimulation (BLS) in EMDR Therapy?).

The reason I say might be different is that, depending upon the client's and therapist's preferences for doing BLS, BLS can often be done the same way online as it is in person.  

For instance, if there is a preference for bilateral tapping (the client tapping on their knees or upper arms) this can be done the same way online as it's done in person and this type of tapping is just as effective as eye movements or auditory tones.

Advantages of Online EMDR Therapy

EMDR therapy online has the same advantages as online talk therapy, including but not limited to:

• You Experience Therapy in the Comfort and Safety of Your Home: Some clients prefer to be in the comfort and safety of their own home when they're processing trauma. 

• You Save on Travel Time and Cost: Commuting can be expensive and time consuming, even if you live within New York City, Also, if you're late for a therapy session due to public transportation or traffic, you probably won't get the full hour because therapists often have clients scheduled back to back. Whereas if you're having an online session, you just need to go to where you have your phone, computer or iPad in your home.

EMDR Online is Just as Effective as in Person

• You Experience the Benefit of Greater Access to Therapy: For many clients traveling into New York City might not be feasible on a weekly basis. For instance, if you live in Long Island, Westchester, Upstate New York or anywhere within New York State that isn't Manhattan, you might not find it practical to travel to Manhattan every week, especially if you don't work in Manhattan. Also, there might not be an EMDR therapist in your area, but as long as you live within New York State, you can have online access to therapists anywhere in New York State, including New York City.

The Choice is Yours: In Person, Online EMDR Therapy or a Combination of Both

Whether you do in person or online EMDR therapy, if you are a candidate for EMDR therapy, the choice is yours.

Even if you choose in person therapy, you might have days when you can't commute to Manhattan for a particular reason, so you might need to do a combination of in person and online at times.

Conclusion

Many clients who haven't experienced online therapy are apprehensive about trying it. However, in my experience, most clients who try online therapy, whether it's EMDR or another type of therapy, are often pleasantly surprised to discover that they like it and some even prefer it.

EMDR therapy is just as effective online as it is in person.

In order to do online therapy, you need to have a reliable Internet connection for a cell phone, iPad or computer.  You also need to have privacy to make sure your sessions are confidential.

As of this writing, you must either live in the state where your therapist is licensed to do online therapy or you must be able to come to a therapist's office (even if you live in a different state). This law might change at some point, so check laws in your state.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and Sex Therapist.

I work with individual adults and couples in person in my Greenwich Village office and online on Zoom (see my article: What is a Trauma Therapist?)

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

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

The Mind-Body Connection: Developing a Felt Sense of Your Internal Experiences

In a prior article, Developing Your Inner Sense of Being Calm, Grounded and Centered, I began a discussion about developing the ability to be calmer and more grounded and centered in your body. I also provided techniques for how to do that.  But what if you don't have a sense of what's going on in your body and you're having a hard time connecting? That's the topic for this article (see my article: The Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

Mind-Body Connection: Developing a Felt Sense of Your Internal Experience

Developing a Felt Sense of Your Body
Since the mind and the body are connected, it makes sense that what goes on in the body affects the mind and what goes on in the mind affects the body.

Most people are so accustomed to focusing on their thoughts that they don't have experience paying attention to their bodies.  When asked to sense into their bodies, they have no idea how to do this, so this is something I teach many clients in my psychotherapy private practice in New York City and I'll address in this article.

What is a Felt Sense?
A felt sense is an internal bodily awareness that develops as you become more attuned to what's going on in your body.

The concept of a felt sense was developed by the American philosopher, Eugene Gendlin, and it refers to the connection between the mind and the body.  According to Gendlin, who developed Focusing therapy, the felt sense is a combination of emotion, awareness, intuitiveness, and embodiment.

When people begin to practice getting a felt sense, the experience is often unclear to them. Initially, people often describe it as a vague sense of their inner experience.

On the most basic level, they might experience it as various sensations in their body, aches, tension, soreness, tightness and so on.

As they practice and become more attuned to their body, they might begin to become aware of other physical sensations as well as emotions that are linked to those sensations.

How to Begin to Develop a Felt Sense of Your Body
When I work with clients, I often teach them how to develop a felt sense of their body so they can be aware of their emotions and where they feel these emotions in their body.  This is a valuable skill to have in therapy because it allows you to sense what you're feeling and the progress you're making in therapy.

Whether you realize it or not, you've had the experience of having a felt sense of your body many times.  You just might not be accustomed to thinking about your experience in that way.

For instance, when you wake up in the morning and you have a vague sense that you have a sore throat, in order to figure out if your throat is dry or if you really have a sore throat, you might sense into your throat when you wake up, then again after you have a drink of water and later on when you have your coffee or tea.

This sensing in is an initial experience of having a felt sense, and it could include any part of your body.

You can practice doing this when you wake up in the morning by sensing into different parts of your body to develop an increased awareness of your body.

Becoming More Attuned to the Mind-Body Connection Through a Felt Sense
As you become more aware of what's going on in your body, you can begin to connect bodily awareness with your emotions.

I often teach my psychotherapy clients, who are disconnected from what's going on for them physically and emotionally, to develop this skill.

Since emotions are held in the body, you can begin to become more attuned by paying attention to muscle tension in your body.

For instance, you might become aware that whenever you feel angry, you feel tension in your stomach.  Or when you're anxious, you feel tension in your shoulders or lower back, and so on.

How Trauma Affects the Mind-Body Connection
By definition, trauma is a psychological response to an experience that's overwhelming for the individual. What matters is the individual's subjective experience of the event(s).  What might be overwhelming for one person might not be overwhelming for another.

When someone experiences trauma, s/he can lose an ability to experience the felt sense and the mind-body connection.  This is called "dissociation"  or "emotional numbing" which is a self-protecting mechanism to keep the traumatized person from being completely overwhelmed.

There are various degrees of dissociation on a spectrum from mild to severe.  Usually, the greater the impact of the trauma on the individual, the more dissociated s/he becomes.

Although this emotional and physical numbing is self protective, it also creates problems for the individual because s/he has a decreased awareness of emotions and bodily sensations (see my article: What is Emotional Numbing?).

Emotional numbing can decrease awareness of emotional pain but, unfortunately, it also decreases awareness of positive emotions too like joy and happiness.  It can create a feeling of emotional flatness and rob the individual of a rich emotional life.

Emotional numbing can make it difficult for the individual to know what s/he feels at any given time.  Aside from making it difficult for the individual, emotional numbing can create problems in a relationship (see my article: How Trauma Affects Relationships).

Getting Help in Therapy
Many people have a difficult time sensing the mind-body connection, especially if they have suppressed their emotional and bodily awareness because of traumatic experiences.

Experiential therapists, who use mind-body oriented therapy, like EMDR, Somatic Experiencing and AEDP, work with clients to overcome the clients' blocked sense of emotions and bodily sensations so they can be aware of their felt sense and live a richer, more fulfilling life (see my articles:  Why Experiential Therapy is More Effective Than Talk Therapy and Experiential Therapy Helps to Create Emotional Breakthroughs).

If you're struggling with unresolved problems that create obstacles for you emotionally and physically, you could benefit from working with an experiential therapist.

Many therapists, including me, are providing online therapy (also known as teletherapy or telehealth) while they're out of the office due to the COVID-19 crisis.

Overcoming your problems in therapy will allow to live your life to the fullest.

About Me
I am an experiential therapist who is licensed to provide psychotherapy services, which include psychodynamic psychotherapy, EMDR trauma therapy, AEDP, Somatic Experiencing, sex therapy, clinical hypnosis and EFT for couples.

I work 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.

Overcoming Shame With Experiential Therapy

In my prior article I began a discussion about shame being at the root of most psychological problems.  In this article I'll give a clinical vignette and discuss how experiential therapy helps clients to overcome shame (see my article: Healing Shame in Therapy).

Overcoming Shame With Experiential Therapy

Clinical Vignette: Shame is at the Root of Most Emotional Problems
The following clinical vignette about resolving shame in therapy with experiential therapy is a composite of numerous cases:

Joe
When he first came to therapy, Joe told his therapist that he felt he wasn't where he wanted to be in his life, "I'm not satisfied with any part of my life. I'm going to be 35 years old in a few months, and I'm not where I should be in my personal life or in my career. By the time my older brother, Sam, was my age, he was already married with two kids and he was one of the top salespeople at his company.  I feel like a loser."

Joe went on to say that whenever he got together with his family for Sunday dinners, his parents talked about being proud of Sam, but they never talked about about being proud of him.  He said, "Ever since I was boy, my mother and father talked about feeling proud of Sam, and I just had to sit and listen to them gloat about him.  They never said they felt proud of me."

From Joe's description, it appeared that Sam was the "golden child" in the family and Joe was the neglected child.  He said he felt he never measured up to his brother's accomplishments (see my article: Growing Up Feeling Invisible and Emotionally Invalidated and Children's Roles in Dysfunctional Families).

He felt his parents didn't love him as much as they loved Sam, and he could understand this because, compared to Sam, "I'm nothing" (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

It was clear that Joe felt deeply ashamed of himself and he was stuck in the negative perception that he was "a loser."  It was also evident that he felt he had to earn his parents' love by accomplishing things rather than just being loved for himself.

Based on his description of the family dynamics, his feelings of toxic shame were rooted in his childhood emotional neglect (see my article:  What is Childhood Emotional Neglect? and What's the Difference Between Healthy Shame and Toxic Shame?)

Joe had lots of "shoulds" that he used to beat himself up with, "I should've tried harder to make something of myself" and "I should've chosen a profession that would have made my parents proud of me" and so on.

Although he loved being self employed as an illustrator, Joe felt ashamed whenever his father described his work in a dismissive tone as "just drawing pictures" when the father talked to family friends.  Joe compared this to how his father described Sam as being "a go-getter who is the top salesperson at his firm."

Joe said even though he got illustration work from large accounts, like major newspapers and sports teams, he felt he wasn't doing enough to promote his business because of his lack of self confidence.

With regard to relationships, he said his last girlfriend, Sue, left him two years ago, and he felt unmotivated to start dating again. Even though he often felt lonely, he said he lacked the confidence to go out and meet women.  So, he spent a lot of time alone or seeing male friends to go to sports events.

His therapist realized that Joe's shame was longstanding, and it created a major obstacle in his life.  Since she was an experiential therapist, during the initial stage of therapy, she helped Joe to build a stronger sense of self by asking him to remember positive memories about himself (see my article: Developing Internal Resources in Therapy).

At first, Joe couldn't think of any but, gradually, he remembered winning art awards in high school and college, the first time he got a major contract for his illustrations from a top sports team, and other similar memories.

As Joe talked about these moments when he felt good about himself, his therapist used Somatic Experiencing to help him to slow down and feel the sense of pride he experienced with each memory.

By helping him to slow down and notice where he felt these good feelings about himself in his body, his therapist helped Joe to intensify and integrate these good feelings (see my article: Experiential Therapy and the Mind-Body Connection).

His therapist reflected back to Joe the change she saw in him--the pride she saw on his face and in his confident posture as he dwelled on these positive memories.  Joe said that he was surprised to remember so many memories that he usually didn't think about when he was feeling bad about himself.

In his subsequent sessions, Joe said he realized that, even though he felt like "a loser" with most women, he remembered meeting a few women in recent weeks who seemed interested in getting to know him, but he felt too shy to ask for their phone numbers.

Over time, Joe and his therapist explored his shame, and he realized that, along with shame, he felt hurt and sad that his parents neglected him.  At that point, his therapist explained how EMDR therapy helps clients to overcome psychological trauma, and they used EMDR in the next phase of therapy (see my article: Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

Gradually, Joe realized that, even though he was neglected, he deserved his parents' love--not for his accomplishments but for just being himself.  Rather than feeling ashamed, Joe felt angry that he didn't get what he needed from his parents.  This was a big psychological breakthrough for Joe because, instead of blaming himself for being "a loser" and not deserving his parents love, he felt he was a person who was worthy of love.

He also realized that his parents' dynamic of praising Sam and ignoring Joe was rooted in their own psychological problems and he wasn't to blame for that.  He knew that both of his parents experienced similar family dynamics as children where they were the ones who were neglected.  At that point, along with his sadness, anger, hurt and shame, he also felt compassion for them.

As his shame was lifting, Joe felt more confident and assertive in promoting his work.

In addition, when he attended family dinners with his parents and Sam, he felt freer to talk about himself.  To his surprise, his parents noticed and commented on this positive change in him.  Although he was at a point where he no longer felt he needed his parents' approval, his parents really  saw him for the first time in a new light and they praised him.

Within several months, Joe shed his old identity of feeling like "a loser" and he was no longer feeling awkward and shy around women.  He began dating a woman he really liked.  Over time, he saw the potential for the relationship to develop into a lasting, meaningful relationship.

Conclusion
Toxic shame is rooted in early childhood neglect and trauma (see my article about Developmental Trauma).

Shame is emotionally debilitating, especially when it's as pervasive in a person's life as it was in the vignette above.  It often shows up with the person experiencing many "shoulds" about him or herself.  These "shoulds" are a clue to deep-rooted shame.

During the initial stage of experiential therapy, it's important that the therapist ensure that the client has the necessary internal resources to cope with whatever comes up in experiential therapy, like EMDR.

There are many different ways to develop internal resources depending on the needs of the client.  With strong internal resources, the client is better able to cope with whatever comes up as s/he works through feelings of shame.

Anger, hurt and sadness often accompany feelings of shame below the surface. When clients begin therapy, they're often unaware of these other emotions so, when the time is right, an experiential therapist helps the client to work through those emotions as well.

As shame and other debilitating emotions lift, clients often feel lighter and more confident. Rather than being burdened by childhood trauma, they're free from their traumatic history so they can live more authentically.

Getting Help in Therapy
Many people, who have been traumatized at a young age, are unaware of the negative impact of shame in their life.  They might be aware of feeling anxious or depressed, but shame is often suppressed because it's too difficult to face alone.

If you've been struggling with emotional problems you have been unable to resolve on your own, you could benefit from working with an experiential therapist (see my article: What's the Difference Between Top Down vs Bottom Up Therapy?).

Once you're free from the emotional burden of a traumatic childhood history, you can live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist (see my articles: The Therapeutic Benefits of Integrative Therapy and What is a Trauma Therapist?).

I work with with individual adults and couples.

I am currently providing teletherapy, also known as telemental health, online therapy and telehealth (see my article: The Advantages of Online Therapy).

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.

Shame is at the Root of Most Emotional Problems

Shame is at the root of most psychological problems (see my articles: What's the Difference Between Healthy Shame and Toxic Shame? and Healing Shame).  I will begin an exploration of how shame develops and how psychologically debilitating it is in this article, and I will discuss how psychotherapy can help in a future article.

Shame is at the Root of Most Emotional Problems

So, when we're discussing deep-rooted shame, which is also called core shame, we're talking about toxic shame, the type of shame that erodes a sense of self and makes people feel that they are not "good enough," they are unlovable and undeserving of love (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

No one is born with shame.  Shame is rooted in childhood psychological trauma, which is also known as developmental trauma (see my article: How Developmental Trauma Affects How You Feel About Yourself). 

The Connection Between Developmental Trauma and Shame

The Connection Between Childhood Trauma and Shame
Infant research has shown that toxic shame develops in childhood and it can affect infant brain development  (see the article: Early Shame Experiences and Brain Development by Allan N. Schore, Ph.D).

An example of this is when a baby reaches out to his mother and the mother's habitual response is to turn away or ignore the baby due to the mother's emotional problems, including postpartum depression, major depression or her own unresolved trauma (see my articles: What is Childhood Emotional Neglect? and Psychotherapy and Intergenerational Trauma).

When this happens often enough, the baby learns that it is shameful to have emotional needs and, after a while, he learns to suppress these needs and to stop reaching out.

This type of developmental trauma can occur at any time in childhood. When this dynamic occurs in infancy, the trauma is preverbal, so that baby can't express the shame he feels in words.  Initially, he might cry out for the mother and even scream.

But after a while, if the mother does not respond, the baby learns to stop seeking nurturance.  If there are no mitigating factors like a nurturing father or grandparent, that baby grows up to be an adult who suppresses his emotional needs out of deep-rooted shame.

This is adaptive in childhood because the emotional pain of seeking love and nurturance when it's not forthcoming is too emotionally devastating for a child.  So, this need is suppressed in order to avoid feeling devastated.  But while this suppression is adaptive to keep the child from being overwhelmed, it's not adaptive in adulthood.

As an adult, this individual often continues to feel that he is unlovable and that even wanting love is emotionally dangerous because he believes he cannot have it, and it is too shameful to even want it. So, unconsciously, this individual not only hides his emotional needs from others.  He also hides his emotional needs from himself.

He might tell himself that he is "strong" or emotionally "independent" and he doesn't need anyone (see my article: Emotional Strategies That No Longer Work: "I Don't Need Anybody" and Seeing Yourself as "Independent" vs Allowing Yourself to Feel Your Shame).

But this is a pseudo-independence.  It's a defense mechanism to hide the emotional pain of feeling unlovable as well as to hide the shame and ambivalence that is attached to wanting to be loved at the same time that he believes he doesn't deserve it (see my articles: Reacting to the Present Based on Your Traumatic Past and An Emotional Dilemma: Wanting and Dreading Love).

This often results in an avoidant attachment style or he gets into relationships that are retraumatizing with people who hurt him.

Recreating the early trauma is an unconscious process, so it is out of the individual's awareness.  Each time this occurs it will reinforce the existing trauma that he is unlovable and undeserving of love, which intensifies the shame.

Most skilled psychotherapists know that shame is at the root of many emotional problems.  The problem might be labeled as depression, anxiety or any one of a number of other diagnoses, but at the core lies shame.

It's understandable that many clients will resist the painful process of looking at their shame in therapy because by the time they come to therapy, they have spent many years suppressing it.  But if the shame is not worked through in therapy, it will remain an unresolved emotional block (see my article: Working on Emotional Blocks in Therapy).

So, in order to help a client to uncover the shame at the root of trauma, the therapist must first develop a trusting relationship with a client.  The client must have confidence in the therapist and know that the therapist has the client's interests at heart before the therapist asks the client to begin the painful process of working through the underlying shame (see my article: The Creation of the "Holding Environment" in Therapy).

In future articles, I will continue this discussion about shame.  I will also discuss how shame is worked through in experiential therapy (see my article: What's the Difference Between "Top Down" vs "Bottom Up" Therapy?).

To read the next part of this discussion, see my article: Overcoming Shame With Experiential Therapy.

Conclusion
Toxic shame develops at an early age and it's usually at the root of most psychological problems.  Most people, who have experienced early shame, have learned to protect themselves from feeling the emotional pain of shame using defense mechanisms, like denial, for instance.

Although an individual can protect himself from becoming aware of deep-rooted shame, the effect of that shame can be pervasive in all his relationships, especially in romantic relationships where an individual can feel the most emotionally vulnerable.

Whether the individual is aware of his or her shame or not, shame doesn't usually resolve itself.  So, in order to work through shame, s/he needs the help of an experienced psychotherapist who can assist the in uncovering and working through shame.

Getting Help in Therapy
If you have been unable to resolve your problems on your own, you could benefit from working with an experienced psychotherapist.

Once you have established a trusting relationship, a skilled therapist can help you to identify and work through shame which keeps you from living fully.

Rather than suffering on your own, seek help from a licensed mental health professional who has experience helping clients to overcome shame.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: The Therapeutic Benefits of Integrative Therapy and What is a Trauma Therapist?).

I work 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.

How Teletherapy Can Help You Overcome Anxiety

In a prior article, I discussed the advantages of doing teletherapy, which is also called telemental health, online therapy or telehealth.  In this article, I'm focusing specifically on how teletherapy can help you to overcome anxiety (see my articles: Common Reactions to the COVID-19 Pandemic: Fear and Anxiety and Coping and Staying Calm During the COVID-19 Crisis).

How Teletherapy Can Help You to Overcome Anxiety

Fortunately, in recent years, the stigma about attending psychotherapy has decreased significantly so that now many people feel more comfortable seeking help from a psychotherapist (see my articles: Mental Health Awareness: Reducing the Stigma of Getting Help in Therapy and Why Is It That It's Usually the Healthiest Family Member in a Dysfunctional Family Who Seeks Help in Therapy?).

Whether you're experiencing persistent anxiety or situational anxiety related to things going on in your life, anxiety can be a debilitating condition.

Not only can anxiety keep you up at night due to insomnia and nightmares, it can also erode your sense of self and interfere with your normal self care routines.  Lack of sleep and interference with your self care routines exacerbates your anxiety and it can precipitate a downward spiral in terms of how you feel.

Different Forms of Anxiety
There are many different types of anxiety, including:

• generalized anxiety
• separation anxiety
• anxiety with depressive symptoms
• adjustment disorder with anxiety
• posttraumatic stress disorder
• obsessive compulsive disorder
• panic disorder (see my article: Tips For Coping With Panic Attacks).
• agoraphobia
• social anxiety (see my article: Overcoming Social Anxiety).

And so on.

Pandemic-related Anxiety
It's not surprising that the COVID-19 crisis has precipitated an increase in anxiety due to many factors, including (but not limited to):

• uncertainty related to the pandemic (see my article: How to Stay Calm During a Crisis)
• fear of contagion
• fear of an unknown future
• fear of going outside
• anxiety related to being isolated
• anxiety related to being lonely (see my article: Coping With Loneliness and Isolation During the Pandemic)

Mental health experts expect a record number of people will seek help for the psychological stress related to the pandemic (see my article: The Emotional and Physical Impact of Loneliness During the COVID-19 Pandemic).

Although it's important to follow the health experts' guidelines for remaining virus free, the emotional toll of being in prolonged isolation without the usual social supports systems that people normally depend on is expected to be significant.

How Teletherapy Can Help You Overcome Anxiety

Most psychotherapists are currently doing teletherapy due to the COVID-19 pandemic.

As I mentioned in a prior article, teletherapy offers many advantages when you're unable to see a therapist in person, including:

• providing a safe environment for you to talk about your distress (see my article: The Holding Environment: Maintaining a Safe Environment For the Client)
• offering guidance on how you can manage your anxiety (see my article: Reducing Stress With the Body Scan Meditation)
• helping you to develop better coping strategies (see my article: Developing Coping Strategies)
• teaching you various anxiety reduction techniques, including meditation (see my articles: Self Care During the Pandemic: Mindfulness Meditation)
• offering you guidance for self care (see my article: Stress Management: Taking Time For Self Care)
• providing you with tips on overcoming insomnia (see my article: Tips For Better Sleep)
• helping you to gain insight into possible distortions in your thinking (see my article: Changing Distorted Thinking)
• helping you to make healthy changes in your lifestyle
• offering emotional support (see my articles: The Importance of Getting Emotional Support During a Crisis)
• providing you with techniques to overcome emotional triggers (see my article: Coping With Emotional Triggers)

Getting Help in Therapy

If you're feeling overwhelmed with anxiety or other forms of emotional distress, you owe it to yourself to get help from a licensed mental health professional.

Teletherapy offers a convenient and effective way to get help.

Rather than struggling on your own, take the first step of contacting an experienced psychotherapist.  

An experienced psychotherapist can help you to overcome anxiety and develop a sense well-being so you can move on with your life.

About Me

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

I work with individual adults and couples.

With over 20 years of experience as a psychotherapist, I have helped many clients to overcome anxiety-related issues.

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 Emotional and Physical Impact of Loneliness During the COVID-19 Crisis

Everyone experiences some degree of loneliness at some point in their lives. Even prior to the COVID-19 pandemic, loneliness was already an epidemic throughout the world, especially among the elderly.  However, the need to physically isolate from others to stop the spread of the virus has made the problem of loneliness much worse for many people (see my article: Coping With Loneliness During the COVID-19 Crisis and The 5 Stages of Grief During the COVID-19 Crisis).

The Emotional and Physical Impact of Loneliness During the COVID-19 Crisis

In this article, I'm focusing on the emotional and physical impact of loneliness on people who are isolated.  In my next article, I'll address the issue of loneliness during this pandemic if you live alone.

What is Loneliness?
First, let's define what we mean by loneliness.

Loneliness is a subjective negative emotion that occurs when our social needs aren't met. It's the discrepancy between our desire for connection and our actual experiences of connection.

Our need for social connection is hardwired in us from infancy. We are born with the need for attachment.  As infants, we need more than being fed, clothed and sheltered. We need to feel an emotional attachment to our primary caregiver in order to survive and thrive.

The need for emotional attachment doesn't end in infancy.  It continues throughout the lifespan. Although some people like spending a lot of time alone because it gives them a feeling of solitude, most people need to feel connected with others in a meaningful way (see my article:  How the Early Attachment Bond Affects Adult Relationships and Loneliness vs Solitude).

To form meaningful connections with others, our social needs must be met in terms of both quantity and quality.  So, while superficial relationships can distract us momentarily from our loneliness, they don't fulfill the deeper need to feel connected meaningfully in safe and secure surroundings.

What is the Emotional and Physical Impact of Loneliness?
Experiencing loneliness heightens our feelings of vulnerability and often takes a toll on our mind and body.

     The Connection Between Loneliness and Depression
Loneliness can put us at risk for depression.  The reason for this is that we often turn our attention inward in a critical way when we're isolated and lonely.  We become self critical and engage in negative self talk (see my articles: Are You Sabotaging Yourself With Negative Self Talk? and 5 Tips For Overcoming Chronic Negative Thoughts).

Negative self talk and the feelings connected to it can create a downward spiral that reinforces itself.  So, the more lonely and disconnected we feel, the more likely we are to criticize ourselves, and the more we criticize ourselves, the more likely we are to experience a downward spiral.  This makes it harder for us to connect with others because we feel unworthy (see my article: Overcoming the Internal Critic and Overcoming the Emotional Pain of Feeling Unlovable).

To stop this downward spiral, first, it's important to become aware of this cycle of negativity.  Second, we need to step back from our negative thoughts to be objective and question these thoughts to recognize that thoughts and feelings aren't facts (see my article: Your Thoughts and Feelings Aren't Facts).

If you're unable to stop the downward spiral into depression, you could benefit from seeking help from a licensed mental health professional (see the section below: Getting Help in Therapy).

Depression can lead to suicidal thoughts. So, if you're feeling suicidal, call 911 immediately to get help.

     The Connection Between Loneliness and Physical Problems
Aside from the emotional impact, loneliness can put you at risk for physical problems.

Loneliness and isolation creates stress and can also create increased inflammation in the body.  This is a genetic reaction that goes back centuries, and it occurs because the body still perceives loneliness and isolation as a threat to survival--like a physical attack or an infection.

Inflammation is the body's way of defending itself against the danger of an attack, and the body reacts the same way whether it's a real danger or only a perceived danger.  So, although inflammation is a way for the body to protect itself, too much inflammation can create serious medical problems. 

Chronic inflammation puts the body at risk for heart problems, stroke, cancer, autoimmune disorders and other medical problems.

Physical Distancing and Social Connection
Physical distancing is necessary to prevent the spread of COVID-19, but you can still maintain social connections with loved ones (see my article: Reframing Social Connections).

Connecting with loved ones online isn't the same as connecting with them in person, but it's the next best thing (see my article: Undoing Aloneness: Staying Socially Connected While Being Physically Distant and Developing a Felt Sense of Connection While Physically Distant).

Getting Help in Therapy
If you're feeling overwhelmed, you could benefit from seeing a licensed mental health professional.

Many therapists are providing online therapy during this pandemic (see my article: The Advantages of Online Therapy When You Can't See Your Therapist in Person).

Rather than struggling on your own, you could benefit from working with a licensed psychotherapist to combat the emotional and physical impact of loneliness and social isolation.

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

I work with individual adults and couples.

During the COVID-19 pandemic, I am providing online therapy.

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 a Trauma Therapist?

My previous article focused on the importance of making sure that anyone you're considering seeing for psychotherapy is a licensed therapist (see my article: Tips on How to Check If a Therapist is Licensed). The subject of this article, "What is a Trauma Therapist?," will focus on the difference between therapists who are trauma therapists vs. therapists who are generalists.

What is a Trauma Therapist?

Psychotherapists: Generalists vs Specialists

In the medical field there are generalists, like your general practitioner, and the specialists that your general practitioner refers you to when your problem is beyond the scope of the general practitioner's  skills and knowledge.

So, for instance, if the general practitioner thinks you have potential heart problems, s/he would refer you to a cardiologist who has the necessary knowledge and skills you need.  To do otherwise would be irresponsible and unethical of the general practitioner.

Similarly, in the psychotherapy field there are also generalists and specialists.  Generalists are therapists who work with a variety of common problems.  For instance, if a client is having problems adjusting to a new job or a new situation in life, a therapist who is a generalist can help a client to overcome common obstacles that are creating problems for a client.  

But if the generalist discovers that there is significant underlying trauma that is affecting the client's ability to adjust to a new situation and the client isn't making progress in therapy, the generalist will often refer the client to a trauma therapist because the problem is beyond the scope of the generalist's skills and training.

Similar to the medical field, it would be irresponsible and unethical for the generalist to continue working with this client because it would be beyond the scope of his or her skills and training.

After the generalist refers the client to a trauma specialist, the client has a choice of either continuing to work with the generalist and going to the trauma therapist for adjunctive therapy or the client can stop seeing the generalist temporarily (or permanently) to work with the trauma specialist.

What is a Trauma Therapist?

A trauma therapist, like a generalist, is a mental health practitioner who completed all the requirements for state licensure and, in addition, has the training and skills to work with trauma and posttraumatic stress disorder (PTSD).

What does this mean? It means that the trauma therapist has gone beyond the training of the generalist with specialized training in trauma therapy, like EMDR therapy (see my articles: EMDR and Emotional Breakthroughs).

Is this enough? No. Many psychotherapists train to do trauma therapy, like EMDR, but they rarely use it.  This means they haven't honed their skills.

In order to develop trauma therapy skills, a psychotherapist needs to see many clients with traumatic experiences and used trauma therapy over a period of time. 

Just like developing any other skill, it's not enough to learn a type of therapy once in a workshop and get little or no practice using it with clients.  Trauma therapy skills need to be practiced over time for a therapist to become skilled at it.  

The importance of skill level was really brought home to me a few years ago when I needed to refer a friend for trauma therapy.  Since she was my friend, I couldn't see her myself, so I needed to refer her to a specialist in trauma.

Although I know many therapists who are trauma therapists, none of them took my friend's health benefits, so I made a request on my professional listserve to try to find someone who did.  In response to my inquiry, a therapist, who was unknown to me, responded that she used EMDR therapy with clients.  She also said she took my friend's health benefits, and she would be glad to meet my friend.  So, I provided this therapist's information to my friend.

It turned out that even though this therapist said she was a trauma therapist, in fact, she was a generalized with a substance abuse background.  She admitted after several weeks of treating my friend that she attended an EMDR workshop, but she never used it.  In effect, she misrepresented herself because she wanted the referral.  Not only was this clinically irresponsible, it was also unethical, and I never made any more referrals to her.  

Fortunately, I was able to find someone else who was a qualified trauma therapist and my friend did well in that therapy.  But I never forgot that experience and, since that time, I ask more detailed questions when I'm making a referral rather than relying on a therapist describing him or herself as a trauma therapist when they're not.

So, while it's important to ask specific questions about the therapist's licensure and training, it's also important to ask how much experience a therapist has with regard to actually doing trauma therapy.  This doesn't mean that you shouldn't work with a beginner who is in training. You might choose a trauma therapist in training if that therapist works for a clinic that offers low fee therapy where the trainee is getting supervision if cost is an issue for you.

Choosing Among Trauma Therapists

Not all trauma is alike.  There are different types of trauma (see my article: What is the Difference Between Shock Trauma and Developmental Trauma?).

Within trauma therapy, some therapists have more experience with some trauma versus other types of trauma.  For instance, one trauma therapist might have more experience with the trauma of parental alienation and less with sexual abuse.  So, it's important to ask about this when considering various trauma therapists.

When you're looking for a trauma therapist, you might decide to have consultations with a few therapists to determine which therapist is right for you (see my article: How to Choose a Psychotherapist).

On the other hand, if you have a consultation with a trauma therapist and you feel she's the right therapist for you, you might choose that therapist without having other consultations because having several consultations can be time consuming and expensive.  This is a personal decision and each individual chooses what feels right.

Getting Help in Therapy

While the process of finding a trauma therapist might seem daunting, in the long run you can save a lot of time and money by making sure that you're with a specialist who has the necessary qualifications to help you.

Many trauma therapists, including me, are doing effective trauma therapy online during the pandemic crisis. Online therapy is also known as teletherapy, telemental health and telehealth (see my article: The Advantages of Online Therapy When You Can't See Your Therapist in Person).

Choosing a trauma therapist, instead of a generalist, can make all the difference between effective therapy versus ineffective therapy.  

Rather than struggling on your own with unresolved trauma, get the help you need from a trauma therapist so you can work through your trauma and lead a more fulfilling life.

About Me

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

One of my specialties is working with trauma (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work 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 regular business hours or email me.

Tips on How to Check If a Therapist is Licensed

More and more people are seeking help in therapy.  Unfortunately, it can be a confusing process to try to determine if someone claiming to be a therapist is actually a qualified mental health professional (see my article: How to Choose a Psychotherapist).

How to Check if a Therapist is Licensed

Tips on How to Check if a Therapist is Licensed:

It's important to check if a prospective therapist you're considering working with has a state license because working with someone who doesn't have a license means that you're working with someone who is unqualified.  

Not only is this a waste of your time and money, it can also be harmful to you. 

Just like you would want to make sure that a medical doctor is licensed, you also want to make sure that anyone who calls him or herself a therapist has a state license.

Here are some tips to check on state licensure:

• Real Psychotherapists Have a State License
• There are many people who claim they're therapists when they're really not, including life coaches, personal coaches and other people who work outside the scope of their expertise.  
• Anyone can call themselves a therapist, but real psychotherapists have a state license.  

• Why State Licensing Matters For Real Psychotherapists
• Licensing is important because you want to make sure that the person you have chosen to help you with your problems is qualified.  
• A licensed therapist has a verified skillset to help people with various mental health issues.  
• A therapist obtains a license by satisfying various state and clinical requirements and have the necessary qualifications to treat you.
• A licensed therapist have fulfilled the necessary supervised clinical hours and have demonstrated that they have the necessary skills to obtain a license.  
• A licensed therapist has the proper training and experience to be a mental health professional.

• In New York State: Check with the Office of Professions - NYSED Website
• It's important to check that anyone who calls themselves a therapist is licensed.
• When you put yourself in someone's hands to help you with your problems, you want to know that they have the minimum requirements to work with you and that minimum requirement is state licensure.
• When you take it upon yourself to check a therapist's license, you're being a smart consumer of psychotherapy services.
• You can look up if a particular therapist you're considering by name by visiting the website of the licensing organization in the state where the therapist works.  In New York State, you can click on this link, NYSED - Office of Professions, and look up the therapist you're considering by name. 
• 
  
• Why is it Harm to Work With Someone Who Doesn't Have a License?
• Anyone who claims to be a therapist who doesn't have a license isn't a psychotherapist.
• If someone says s/he is a therapist and isn't licensed, they don't have the necessary skills, training and experience to help you.
• From a legal perspective, an unlicensed individual who attempts to practice therapy is committing fraud.
• More importantly, from a clinical perspective, anyone who isn't licensed will be harmful to your mental health and overall well-being.
• An unlicensed person who calls himself as therapist can leave you in a worse state than when you first started because s/he doesn't know what he's doing.
• An unlicensed person who fraudulently says he is a therapist is someone who hasn't demonstrated the basic skills required to be a psychotherapist.
• 
  
• Is a State License Enough to Qualify a Therapist to Treat You?
• Licensure is the minimum requirement for being a psychotherapist.  
• After a psychotherapist obtains a license, s/he must go on to do continuing education to stay current with regard to best practices in the psychotherapy field.
• For instance, if a therapist claims to have a particular expertise, like trauma therapy, s/he must have the necessary education and training beyond graduate school to develop the expertise to do trauma therapy.

Getting Help in Therapy
Beyond making sure that a therapist is licensed, finding a psychotherapist who is right for you is usually a process that begins with a consultation to see if the two of you are a good therapeutic match.

You might meet with a particular therapist a few times before you know if you're comfortable with him or her.  Ask questions about how the therapist works with the particular issue you want to work on.

There are many qualified psychotherapists in New York, but you're not going to feel comfortable with all of them, so trust your gut feeling.

During the COVID-19 pandemic, many therapist are providing online therapy, which is also called teletherapy, telemental health or telehealth (see my article: The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person).

If you're struggling with problems and feel overwhelmed, get help from a licensed psychotherapist who is right for you.  Getting the right help from a licensed mental health professional can help you to overcome your problems so you can lead a more fulfilling life.

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

I work with individual adults and couples.

I am currently providing online therapy while I'm out of my office due to the COVID-19 pandemic.  

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.

Relationships: 10 Reasons Why Trying to Change Your Spouse Doesn't Work

So many people enter into a relationship where they see the "potential" in their partner, but they won't accept how their partner is in the present.  Although men do it too, it's usually women who try to change, "fix" or rescue their partner.  They believe they can get their partner to change to be the way they want him to be.  Many of them become so focused on fixing their partner that they neglect themselves (see my articles: Overcoming Your Need to Rescue Your Loved Ones as Part of a Codependency Pattern and You Want to Change Your Spouse, But You Can't, So What Can You Do?).

Why Trying to Change Your Spouse Doesn't Work

Many people push, prod and try to do everything in their power to get their spouse to change, and no matter how good their intentions are, it usually doesn't work.

Exploring why it doesn't work and how to change this dynamic is the subject of this article.

A Short Fictional Vignette
The following fictional vignette, which is representative of hundreds of clinical cases, illustrates why trying to change your spouse doesn't work:

Helen and Tim
Helen and Tim, who were both in their 40s, were married for 10 years.

After Tim's father died, Tim started gambling compulsively (see my article: Overcoming Grief Gambling).

Prior to his father's death, Tim and his friends would get together every few months to play Poker.  But after his father's death, Tim felt a strong urge to play Poker more often, so he found other games, including online gambling.

At first, Helen wasn't concerned, but when she saw that Tim was spending almost all his free time in Poker games and he was losing money they didn't have, she became very concerned and told Tim to stop.  Tim would respond by promising Helen that he would stop, but he continued to gamble and lose large sums of money.

By then, Helen and Tim were spending a lot of their time arguing about his gambling and no time enjoying themselves the way they used to do before.  Helen was angry most of the time with Tim, and Tim felt resentful.  He felt that Helen was nagging him and acting like his mother.

The situation deteriorated until they were barely talking to one another, and they were no longer sexual (see my article: Have You and Your Spouse Stopped Having Sex?).

A few months later, they were sitting in a couples therapist office trying to salvage their relationship. Over time, they learned that Tim hadn't grieved for his father and the gambling was not only a distraction, it was also an addictive behavior that gave Tim a dopamine high in much the same way that taking drugs gives a dopamine high.

Gradually, as Helen learned not to nag and to focus on herself, Tim agreed to go to Gamblers Anonymous (GA) and work with a sponsor.  He also entered into his own individual therapy to deal with the loss of his father.  Over time, as he dealt with his emotions, he stopped gambling.

10 Reasons Why Trying to Change Your Spouse Won't Work:

• Trying to Get a Spouse Who is Unwilling and/or Unable to Change is Futile
• Before you try to change your spouse, consider whether he actually wants to change.
• Is he capable of changing?

• Focusing on Your Spouse's Behavior Takes Your Focus Away From Your Own Behavior
• It takes two people to be in a relationship.
• If you're focusing mostly on your spouse's behavior, you might not see how your own behavior affects the situation between the two of you. 

• Focusing on Your Spouse's Behavior Takes Your Focus Away From the Dynamic Between the Two of You
• There's a particular dynamic between you and your spouse.
• When you focus on your spouse's behavior, you might miss that dynamic. 

• Trying to Get Your Spouse to Change Might Be Unrealistic
• Ask yourself how realistic you're being.
• Ask yourself if you can live with the current situation when you consider everything.

• Reframing Your Expectations Might Be More Realistic
• Reframing your expectation is not about accepting abuse or accepting a situation that you find completely unacceptable.
• If your spouse is unwilling or unable to change, is it possible to look at the situation from a different perspective that might make it acceptable to you?

• Pushing Your Spouse to Change Can Erode the Relationship
• No one likes to feel pushed or nagged.
• People rarely change when they feel pushed and, if they do, they do it with resentment which causes other problems in the relationship.

• Trying to Change Your Spouse Puts You in a Parental Role
• When you take on a parental role, you're damaging your relationship--even though you might have the best of intentions (see my article: Behaving Like a Parent to Your Spouse Can Ruin Your Relationship).
• Your spouse will probably resent you.
• You will eventually resent being in this role.

• Focusing on Changing Your Spouse Might Make You Lose Sight of What's Good in Your Relationship
• Are you only focusing on your spouse's problems and not seeing what's good in your relationship?
• Has your focus on your spouse's problems overshadowed what's positive?

• Criticizing Your Spouse Can Lead to Divorce
• Being overly critical is a relationship killer (see my article: Learn to Stop Criticizing Each Other).
• Being critical can become habitual.

• Focusing on Yourself and Making Your Own Positive Changes Can Help the Dynamic Between You and Your Spouse
• Rather than focusing exclusively on your spouse's problems, you can focus on yourself.  
• People often focus on their significant other as a way to avoid looking at themselves.
• Practice self care and try to find ways to improve things for yourself (see my article: Is Self Care Selfish?).

Conclusion
People often don't change when they feel pressured or pushed.  Not only is this not an effective strategy, it often does more harm than good.

In order to make significant lasting change, a person has to be internally motivated to change as opposed to complying with someone else's wishes. 

Even though no one should accept abusive behavior or put up with things that they know are unacceptable to them, focusing on yourself is usually more effective than focusing on what you perceive as another person's faults.

Getting Help in Therapy
It's hard to live with problems that you feel are unacceptable, especially when you love someone and also want the best for him or her.

Focusing on yourself might be challenging.  It can also be hard to break old habits of focusing on someone else instead of focusing on yourself.

Even if you're not pressuring your spouse to change, you might find it hard to decide whether to stay or to leave the relationship.

If you're struggling with one or more of these issues, rather than struggling on your own, you could benefit from working with a licensed psychotherapist who has experience helping clients with these issues.

Many therapists, including me, are providing online therapy, which is also called teletherapy and telehealth, while they are out of their office during the COVID-19 pandemic (see my article: The Advantages of Online Therapy When You Can't See Your Therapist in Person).

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

I work with individual adults and couples.

I am providing teletherapy sessions during the COVID-19 crisis.

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.