How Far Do You Want to Go in Your Psychotherapy?

In a prior article, Psychotherapy is an Active Process: The More Engaged You Are In It, the More You Get Out of It, one of the issues that I discussed briefly was the decision as to how far you want to go in psychotherapy--everything from symptom relief to delving deeper into your unconscious process to get to the root of your problem.

How Far Do You Want to Go in Psychotherapy?

As I mentioned in that article, each client makes this decision in consultation with the psychotherapist.  But, ultimately, the decision is up to the client.

If you're new to psychotherapy, you might not understand what your choices are and the implications of these choices.  So, I will provide describe different types of therapy.

Choices in Psychotherapy
The following scenarios describe various choices in psychotherapy for the same client, Ted, at various points in his life:

Short Term Symptom Relief Therapy:  When you choose short term symptom relief, you're usually choosing brief therapy to get rid of a symptom and you're not delving deeper into the problem once you start to feel better.  Ted had his first experience of attending psychotherapy when he saw a psychotherapist to deal with his panic attacks.  Since Ted wasn't interested at that point in more than symptom relief, his psychotherapist taught him how to do breathing exercises and to meditate.  Within a few weeks, Ted was feeling better and he decided to end therapy (see my articles: Tips For Overcoming Panic Attacks, What is the Difference Between Fear and Anxiety? and Getting Help in Therapy For Anxiety Disorders).

Longer Term Symptom Relief Therapy: Longer term symptom relief is therapy that is longer than short term therapy but shorter than more intensive therapy.  Ted managed well with what he learned in his short term therapy for a few months.  Then, he began a stressful new job and became symptomatic again.  He returned to therapy with the same psychotherapist, and he told her that he still wanted only symptom relief, but he was willing to stay in therapy for a longer period of time to deal with his panic attacks.  Since he stopped doing the breathing exercises and the meditation, his psychotherapist reinforced the stress management techniques she taught him when he first came to her.  She also added more coping techniques so he could deal with the current stressors on his job.  When he felt better and he was no longer experiencing panic attacks, he told his therapist that he wanted to leave therapy.  He understood that he could return in the future.

EMDR Trauma Therapy: Ted returned to his psychotherapist a year later.  He rarely had panic attacks anymore and when he had them, he knew how to calm himself.  However, he was now experiencing persistent anxiety after he met his father again for the first time since he was a young child.  Their meeting was fraught with tension on both sides.  Ted's father wanted to reconcile their relationship, but Ted was leery because he had a lot of resentment towards his father for abandoning the family.  In addition, Ted realized that his boss had similar characteristics to his father, and Ted was getting emotionally triggered whenever he had to work closely with his boss.  His psychotherapist recommended that they do EMDR therapy to work on the unresolved trauma as well as the current situation with his boss.  She explained to Ted that EMDR therapy tends to be faster and more effective than regularly talk therapy.  Gradually, Ted was able to work through his traumatic reactions within a year of beginning EMDR therapy.  He realized that he could have stayed in therapy to develop deeper insights into himself, but he told his therapist that he would return if he felt the need for delving deeper (see my articles: What is EMDR Therapy?, How EMDR Works - Part 1: EMDR and the Brain, How EMDR Works - Part 2: Overcoming Trauma, and What is Adjunctive EMDR Therapy?).

Grief Work in Therapy:  Grief work is focused specifically on helping a client to grieve and mourn a loss.  It can be short term or long term.  With regard to Ted, a couple of years later, Ted found out that his father died.  At the time, they were not speaking because they were not able to reconcile their relationship.  When he received the call that his father died, Ted felt profoundly sad for the loss of his father as well as the loss of not ever having a father that met his emotional needs.  He also felt sad because any chance of reconciling their relationship was gone, and he felt very guilty about this as well.  He returned to his psychotherapist and they did grief work to help Ted get through this difficult time.  Between sessions, Ted kept a journal and wrote about his feelings about his father.  He also organized a photo album with pictures of his father and himself from when Ted was younger.  He was able to work through his grief, and he let his therapist know that he was feeling better and he wanted to discontinue therapy (see my articles: Grief: Coping With the Loss of a Loved One: Common Reactions, Complicated Grief, The Theme of Complicated Grief For a Mother in the Movie, Phantom Thread, Holding Onto Grief as a Way to Stay Connected to a Deceased Love One and Trying to Understand Your Father).

Contemporary Psychodynamic Psychotherapy: Psychodynamic psychotherapy is a form of psychoanalysis.  Generally, it focuses on the unconscious mind and might include dreams and daydreams.  It usually also includes exploring transference issues.  When Ted returned to therapy, he felt lost.  He had just ended an enmeshed two year relationship with a woman that he loved very much when they first started seeing each other.  Gradually, they grew apart, and Ted sensed that he contributed significantly to the demise of the relationship because he had problems committing to his then-girlfriend.  He believed that he had issues with trust and this is what made it difficult for him to make a long term commitment.  He felt he was now ready to delve deeper into his unconscious mind to get to know himself better.  He agreed to attend open ended contemporary psychodynamic psychotherapy with the understanding that he could leave therapy whenever he wished; however, his therapist recommended that it would be better to work together towards termination in therapy when the time came.  Sometimes, Ted brought in dreams to discuss with his therapist.  He was also interested in exploring the unconscious underpinnings of his problems.  Gradually, his therapist helped Ted to make connections between his original panic attacks, his history of childhood emotional neglect, the loss of his father, and his problems with making a commitment in a relationship.  Ted also felt more emotionally integrated in contemporary psychodynamic psychotherapy (see my article: Discovering the Unconscious Emotions at the Root of Your Problems and What Unconscious Decisions Have You Made That Are Impacting Your Life?).

Conclusion:
The scenarios above show how one person can choose various forms of psychotherapy over a period of time depending upon the problem and what the client is ready to deal with at the time.

Each form of therapy mentioned above serves a particular purpose and could be appropriate at various times in a client's life.

Getting Help in Psychotherapy
When you decide that you would like to attend psychotherapy, the first step is to contact a psychotherapist for a consultation (see my article: The Benefits of Psychotherapy).

During the consultation, you give an overview of your problem and asks the psychotherapist questions about how she works, what type of therapy she does, her expertise and so on.

The psychotherapist will usually make a recommendation within a few sessions as to what form of therapy she thinks would be best for the client given his or her particular problems.  There are usually a few different ways to work, as outlined above, and depending upon the therapist's expertise.

The choice as to which type of psychotherapy is generally up to the client, unless the therapist thinks that the client needs a higher level of care or a different type of therapy.

Over time, as shown in the examples above, a client can return for different types of therapy (assuming that the therapist does these different forms of therapy) or the client can go to a different therapist (see my article: Returning to Therapy).

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

Freeing yourself from problems that are hindering you from maximizing your potential can lead to living a more fulfilling and meaningful life.

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.

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: Is Your Partner's Behavior Kindness or Controlling Behavior?

I've written about relationship issues in prior articles (see my articles: How Your Attachment Style Affects Your Relationship and Fear of Being Emotionally Vulnerable).  In this article, I'm focusing on the difference between kindness vs. controlling behavior (see my article: Changing Maladaptive Behavior That No Longer Works For You: Controlling Behavior).

Relationships: Kindness or Controlling Behavior?

Over the years, I've met many individual adults and couples where the issue of kindness vs. controlling behavior has come up.  Usually, one or both partners in a relationship weren't sure if what they were experiencing from their partner was kindness, controlling behavior or some combination of the two.

Fictionalized Vignette:  Relationships - Kindness or Controlling Behavior
The following fictionalized vignette is an example of this problem and how psychotherapy can help:

Sara and John
Sara and John, who were together for a year, came to couples therapy because they were having disagreements about what Sara saw as John's controlling behavior and what John saw as his being kind to Sara.

Six months into their relationship, Sara took a job where she had to travel internationally a few times a month.

When Sara began traveling, John asked her to provide him with all the information regarding her flights, arrival time, and hotel.  He also asked her to call call or text him when her plane landed.

At first, Sara wasn't completely comfortable with John's request, but she didn't want John to worry, so she provided him with the information beforehand and would usually call him or send a text message to him when her plane landed.

But there were a few times when she was with colleagues and they were in a hurry to get to a meeting with a customer, so she didn't have time to text John immediately.

She felt she always tried to be considerate of him, so she didn't delay more than 10-15 minutes.  But, when she couldn't reach him immediately, by the time she turned on her phone, she already had a few panicky text messages from John wondering if she was okay.

During those times, John would also call her at the same time that she was texting him, and she didn't have privacy to talk because she was with her colleagues.

After this happened a few times, Sara tried to explain to John that she would always try to text or call as soon as she could, but when he panicked and she had to try to calm him down, he was adding to the stress she was already experiencing on the trip.

John told Sara that he felt hurt that she was experiencing him as adding to her stress when, from his perspective, he was being kind and caring.  He said he didn't want to be controlling.  He cared about her and he just wanted to make sure that she was safe.

Since they were getting nowhere on their own with these arguments, they decided to go to couples therapy.

During their couples therapy sessions, Sara told John and their therapist that she appreciated that John cared about her, but she couldn't understand why he needed to be contacted immediately.  She explained that she was often with senior managers on these business trips, and she didn't always have privacy to try to calm John down when he panicked.

She also expressed feeling confused and annoyed that John felt the need to be contacted immediately when nothing bad had ever happened on her business trips.  She couldn't understand his behavior, and she felt it was a boundary issue between them.

As John listened to Sara during their couples therapy sessions, over time he was able to acknowledge that he worried excessively when Sara traveled, and he wasn't sure why.

Sara told their therapist that, other than these business trips, John didn't try to keep tabs on her at any other time.  He never questioned when she went out with friends or went to business meetings locally.

John said that he tried to stay calm, but 10 minutes or so before he knew Sara's plane was about to land, he would become highly anxious.

By arrival time, he was on the verge of a panic attack imaging all the things that could have gone wrong.  So, he felt he needed to hear from Sara immediately when the plane landed to help him to calm down.

Relationships: Kindness or Controlling Behavior?

When he looked back on those times when he was calm, he acknowledged that, even though he still felt that he was being kind, his behavior was excessive, but he didn't know how to calm himself once he began to panic (see my article: Tips For Coping With Panic Attacks).

During one of their couples therapy sessions, John revealed to Sara for the first time that he had a history of panic disorder, and even as a child, he worried excessively whenever his father traveled on business.  He feared that something catastrophic would occur and he would never see his father again.

Since his father was self employed, he was usually on his own, and it wasn't a problem for to call John from his hotel to let him know he landed safely.  All the while, until John got his father's call, he imagined the worst.  But once he received the call, he calmed down.

John said that his parents never took him to see a psychotherapist when he was a child because they thought he was "outgrow" his anxiety.  But he never did and it was a problem in his prior relationships before he met Sara.

John said he felt deeply ashamed of his panic attacks and, as an adult, his shame got in the way of his getting help in therapy.  Even when he was talking about this with Sara and their therapist, his face was red and he didn't make eye contact (see my article: Healing Shame in Psychotherapy).

Since John eventually acknowledged that he had a problem, the couples therapist recommended that John see an individual psychotherapist to work on his anxiety and panic attacks while he and Sara worked in couples therapy to try to resolve these issues in their relationship.

The couples therapist also taught John a few techniques to calm himself when he felt a panic attack coming on (see my articles: Developing Coping Strategies and Internal Resources).

But she said that there were probably deeper issues involved that he would need to work on with an individual psychotherapist.

After John had a few individual sessions to give his family history, his individual psychotherapist recommended that they use a clinical hypnosis technique called the "Affect Bridge" to try to get to the root of his problem.

When they used the Affect Bridge, John remembered overhearing his grandfather talk about a plane accident where the grandfather lost his best friend.

When the grandfather was telling the story to John's parents, none of them knew that John was nearby listening to the conversation, so they talked about the accident in a detailed way that they would not have if they knew that four-year old John was listening to them.

Afterwards, John and his individual psychotherapist talked about what came up during the Affect Bridge.  He said he had completely forgotten about that memory and he was amazed that it was at the root of his panic attacks when Sara traveled.

His individual therapist explained that John was getting emotionally triggered whenever Sara traveled abroad and his fears stemmed from that earlier memory.

She explained that, even though John didn't witness the plane accident that his grandfather talked about, the story was told in such vivid detail that it was almost as if John had witnessed it and he became traumatized by it (see my article: Overcoming Trauma: When the Past is in the Present).

His individual psychotherapist recommended that they use EMDR Therapy to help John to overcome the trauma that was getting triggered whenever Sara traveled.

Gradually, as John processed the memory of hearing his grandfather's tragic story, he began to be able to separate out that memory from the times when Sara traveled (see my article: Working Through Emotional Trauma: Separating "Then" From "Now").

In the meantime, Sara felt much more compassionate towards John after she realized he was getting triggered.  She told John in their couples therapy that she now understood why he would become so upset.

Until John could work through the original trauma that was getting triggered, Sara continued to call or text John so he wouldn't worry.  But when she couldn't contact him immediately, John used the techniques he learned in his therapy to stay calm.

Relationships: Kindness or Controlling Behavior?

Over time, when John worked through the original trauma with EMDR therapy, he no longer kept tabs on when Sara's plane landed and he no longer panicked.

After a while, when he was no longer symptomatic, John told Sara that it was no longer necessary for her to contact him--he could wait to hear from her whenever it was convenient for her.

Conclusion
Sometimes, it's difficult to distinguish between kindness and controlling behavior.

There are times when what is meant to be kind also has elements of controlling behavior.  Sometimes, there are more than just elements--it's mostly controlling behavior and the person who is engaging in it has little to no insight into it.

The vignette above is one example of this kindness vs. controlling behavior.

There are many other examples:

• The parents who tend to show up at their adult child and spouse's home without calling ahead to see if it's convenient for them because they want to see them--even though this feels intrusive to their adult child or the spouse.  If couple tries to set a boundary with the parents, the parents feel offended because, from their perspective, they're just trying to be "nice." Then, the adult child and the spouse feel guilty for hurting the parents (see my article: Setting Boundaries With Family Members Who Want to Interfere in Your Relationship and Learn to Stop Interfering in Your Adult Child's Relationship).

• The friend, who tends to want to help by giving unsolicited advice, and then gets angry when the friend with the problem tries to set a boundary with her (see my article: Friendships: Losing a Friend After Giving Advice).

• The overprotective boss who gets involved in her employees' personal problems and tries to resolve these problems.  When an employee, who feels the boss is being intrusive, tells the boss tactfully that she doesn't want to talk to her about it, the boss becomes offended.  From her perspective, she only wants to help.

And so on.

Getting Help in Therapy
Although you have a right to set boundaries with the other people, setting boundaries can be difficult, and these situations aren't always easy to work through on your own, especially if the person who thinks s/he is being kind takes offense to boundary setting.

If you find yourself in this type of situation and you've been unable to resolve it on your own, a skilled psychotherapist can help you to discern what's going on and how to deal with it (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than struggling on your own, you could get help from a licensed mental health professional, who has experience assisting clients to overcome these problems.

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.

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 Are Phobias and How Do They Develop?

In my prior two articles, I discussed the difference between fear and anxiety and panic attacks (see my articles:  What is the Difference Between Fear and Anxiety? and Tips For Coping With Panic Attacks).  In this article, I'm focusing on phobias.

What Are Phobias and How Do They Develop?

What is a Phobia?
A phobia is an excessive, irrational and persistent fear of an object or a situation. Most of the time, people who have phobias know consciously that their fear is irrational, but since the fear is in their unconscious minds, it can make little or no difference in terms of the way they feel.

There are many different types of phobias: fear of closed in places, fear of heights, fear of dogs, fear of injections, fear of flying, social phobia, and so on.

How Do Phobias Develop?
Phobias usually develop by some triggering event, which might not be obvious at the time when it occurs.

Phobias are debilitating and, depending on what the phobia is, it often has an adverse effect on a person's personal and work life.

For example, if a person has a fear of flying, and travel is a big part of his job, he will experience a lot of anxiety and possibly panic attacks when he has to travel for business. The same would be true if he had to fly for a family vacation.

There is often a genetic component with phobias.

Conclusion

Overcoming a phobia can be challenging.  That is why it's important for you to get help from a licensed psychotherapist.

Getting Help in Therapy to Overcome a Phobia
Clinical hypnosis is one of the best ways of treating phobias, because hypnotherapy works with the unconscious mind (see my article: What is Clinical Hypnosis?).

Once you're no longer struggling with a phobia, you will live your life with a greater sense of well-being.

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

I have helped many clients to overcome phobias.

To find out more about me, please 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.

Tips For Coping With Panic Attacks

In a prior article, What's the Difference Between Fear and Anxiety?,  I discussed the difference between fear and anxiety.  In this article, I'm providing tips for coping with panic attacks.

Tips For Coping With Panic Attacks

What Are Panic Attacks?
A panic attack is usually caused by anxiety. Symptoms usually come on suddenly.  The most common symptoms can include:

• shortness of breath
• muscle spasms
• choking sensation
• nausea
• irregular heartbeat
• dizziness or lightheadedness
• shaking
• sweating
• fatigue
• tingling sensations in hands or feet 
• feelings of foreboding
• fear that you're losing your mind
• fear that you're going to die

Not everyone gets every symptom.

If you're experiencing these symptoms, its important to see your medical doctor to rule out a medical cause.

Panic attacks can be debilitating.  Some people get occasional panic attacks, and others have chronic panic attacks.  I

Tips For Coping With Panic Attacks
If you have occasional panic attacks, relaxation, grounding and breathing exercises can be helpful.  See my articles for tips on how to cope with panic attacks:

Journal Writing to Relieve Stress and Anxiety
Learning to Stay Calm During Stressful Times
Finding Inner Peace During Uncertain Times
Self Care: Feeling Entitled to Take Care of Yourself
The Mind-Body Connection: Mindfulness Meditation
Self Reflection and Basic Mindfulness
Research Shows That Meditation Can Change Your Brain
Learning to Relax: Square Breathing
Staying Calm When You're in the Middle of Chaos
Finding Moments of Peace During Stressful Times
Self Soothing Techniques to Use When You're Feeling Distressed
Learning to Relax: Going on an Internal Retreat
Discovering the Quiet Place Within Yourself

Panic Attacks Can Get Worse If Untreated
People who have panic attacks often become afraid of when they will have the next panic attack.  For many people, this causes them to avoid certain activities, including going outside.

This avoidance causes its own problems.  For instance, panic attacks can include agoraphobia, a fear and avoidance of being out in public.  If someone develops panic attacks with agoraphobia, this is an obvious hindrance to maintaining a job and a social life.

If you have panic attacks, you could benefit from seeing a licensed mental health professional who has experience helping clients with panic attacks and other related problems with anxiety.

Getting Help in Therapy to Overcome Panic Attacks
For many people panic attacks get worse over time without treatment, so it's important to get help sooner rather than later (see my article: How to Choose a Psychotherapist).

A skilled psychotherapist can help you to overcome the debilitating effects of panic attacks, so you can live your life with a sense of well-being.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works collaboratively with clients and uses Integrative Psychotherapy to develop the best treatment plan for each client (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to overcome panic attacks.

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 Anticipatory Anxiety

In a prior article, How to Stop Worrying, I addressed a concern that many chronic worriers have.  In this article, I'm addressing a specific type of worrying, which is called anticipatory anxiety.

Overcoming Anticipatory Anxiety

Many people struggle with anticipatory anxiety, which is worrying about something in advance of it occurring.

The thing that you're worried about is something that may or may not occur at some point in the future.

Anticipatory anxiety isn't an anxiety disorder.  It's part of different types of anxiety disorders, including generalized anxiety, panic attacks, posttraumatic stress disorder (PTSD) and other forms of anxiety.

What Are the Symptoms of Anticipatory Anxiety?
Symptoms can include:

• excessive worrying
• insomnia
• muscle aches
• nausea
• headaches
• hyperventilation
• feelings of dread
• overeating
• gastrointestinal problems
• panic attacks

When, Why and How Does Anticipatory Anxiety Occur?
Anticipatory anxiety can occur at any time and for many people it's a chronic condition.

Anticipatory anxiety can include worrying in advance of anything being wrong about money, job loss, problems in a relationship or any other event or situation that hasn't occurred yet.

The fact that it hasn't occurred yet is key--it is the anticipation that something bad will happen.  It's not necessarily based on anything objective that is going on now.

Anticipatory anxiety can occur based on your past, including early childhood experiences.

For instance, if you grew up in a home that was chaotic where your parents were constantly worried about real and imagined problems, you can grow up feeling that the world isn't a safe place and, generally, anything that can go wrong will go wrong in your life as an adult.  This can develop into generalized anxiety disorder.

Many people who suffer with anticipatory anxiety are unaware that they have become accustomed to this habitual way of worrying.  Their habit of worrying has become automatic.

If you had significant trauma that has resulted in your developing posttraumatic stress disorder (PTSD), you might respond to many events or situations in your life as if they will result in catastrophe (see my article:  Are You Catastrophizing?)

There is no differentiation between traumatic events and normal non-traumatic life events.

How to Overcome Anticipatory Anxiety?
Here are some tips that might be helpful to you:

• Rather than allowing your thoughts to run away with you, make a conscious effort to step back from worrying and question whether the things you're worrying about are likely to happen.
• Ask yourself if you're okay now (as opposed to your worries about the future).
• Think about all the other times when you worried about something and things turned out well.
• Distract yourself from your worries by focusing on something else.
• Talk to a friend or loved one to get a better perspective.

Getting Help in Therapy
The tips outlined above work for some people.

Many other people, who try to deal with their anticipatory anxiety on their own find that they need the help of a professional mental health professional, especially if their problems are longstanding and ingrained.

A licensed psychotherapist can help you to get to the root of the problem that causes you to have anticipatory anxiety.

Rather than suffering on your own, with the help of a licensed therapist, you can overcome this problem 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.

Confusing Starting to "Feel Better" With Emotional Healing

People often to come to therapy after their own efforts to heal emotionally haven't worked for them and they realize that they need help from a licensed mental health professional.  

It's understandable that a big part of the reason why they come to therapy is because they want to feel better, and it's often the case that when they begin to talk about their problems, they start to feel better.  

But the problem arises when clients stop attending therapy as soon as they start feeling better as opposed to when they have emotionally healed by working through the problem (see my article:  When Clients Leave Psychotherapy Prematurely).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Since starting to feel better often begins during the initial stage of therapy, a client who leaves therapy before s/he has worked through the problem is leaving prematurely and will usually experience a "relapse" of the emotional problem because starting to feel better isn't the same as resolving the problem.  It's just a temporary alleviation of symptoms until the symptoms come back to the surface again.

Let's take a look at an example of this in the following vignette which is a composite of many different cases to protect confidentiality:

Jack
Before coming to therapy, Jack tried to deal with his panic attacks around his difficult boss by working out at the gym, attending yoga classes, and talking to friends about it.  But none of these efforts helped him (see my articles:  Workplace: Coping with a Difficult Boss and How Your Workplace Can Feel Like a Dysfunctional Family).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

When he went to see his medical doctor, his doctor gave him a prescription for anti-anxiety medication for short term use and recommended that Jack see a psychotherapist to work out whatever underlying issues might be affecting him.

Jack discovered that the medication helped to relieve his panicky symptoms for short periods of time. But he realized that, after a while, he needed a higher dose to alleviate symptoms, and he didn't like becoming dependent upon medication.  So, although he preferred not to go to therapy, he followed his doctor's advice and contacted me for help.

After we talked about his family history, both Jack and I began to see parallels between his situation at work and his abusive father.  Both men were overbearing and verbally abusive.  Jack's father was also physically abusive with Jack when Jack was a child.

Just knowing this was a tremendous relief for Jack.  Until then, he felt that he was "going crazy" whenever he had a panic attack around his boss.

As Jack started to understand that he was reacting to his boss as if he were a child and his boss was his abusive father, he began to be able to separate his current experiences from his childhood experiences (see my articles:  Reacting to the Present Based on Your Traumatic Past).

At that point, Jack decided that he didn't need to continue in therapy anymore because he "understood" why he was having his panic attacks.  So, during a period of time when his boss was away on an extended business trip, Jack decided that he was "feeling better" and he would end therapy.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

I tried to explain to Jack that the alleviation of his symptoms was probably temporary since he had not worked through the underlying emotional problems (his childhood history of being abused) involved in his current problem.  Understanding logically was the first step, but it usually doesn't resolve these types of problems.  There was also the fact that his boss was away so Jack wasn't getting triggered at that point by the boss's abusive behavior.

But Jack had made up his mind about leaving therapy.  So, I told him that my door remained open and he could return in the future.

Within a couple of weeks, after his boss returned, I received a call from Jack, who said that he was having panic attacks again. In one instance, he thought he was having a heart attack and he went to the ER.  After the ER doctors ruled out a heart attack, they told Jack that he was having a panic attack with heart palpitations, shakiness and sweating and he should seek help from a licensed mental health professional.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Jack said that this was, by far, the worst panic attack that he had ever had and it frightened him to the point where he was now constantly worried that he would have another panic attack.

We resumed our work that week.

I began by helping Jack to develop internal resources, which are basically coping skills (see my article:  Developing Internal Resources in Therapy).

After helping Jack to develop the internal resources to do the therapeutic work, we started doing EMDR therapy (Eye Movement Desensitization and Reprocessing), a mind-body oriented type of therapy to work on the current situation as well as the underlying issues that were getting triggered by his unresolved childhood trauma (see my articles:  What is EMDR?, How EMDR Works: Part 1: EMDR and the Brain, How EMDR Works - Part 2: Overcoming Trauma and EMDR: When the Past is in the Present).

As we worked together, Jack learned to manage his panic-related symptoms.  More importantly, over time, the EMDR therapy helped Jack to work through the unresolved childhood abuse he experienced with his father that was getting triggered with his boss (see my article:  Mind-Body Psychotherapy: The Body Offers a Window into the Conscious Mind).

He no longer had panic attacks because the underlying traumatic issues triggering the attacks got worked through so they were no longer there to be triggered (see my article:  Experiential Therapy. Like EMDR, Helps to Achieve Emotional Breakthroughs).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Not only did Jack "feel better," but his boss's abusive behavior no longer frightened him.  In fact, for the first time, Jack saw that his boss was really an insecure man who bullied employees to bolster his own low self esteem.

Rather than freezing in panic, Jack's attitude about the work situation was that, although it was unpleasant, he no longer felt threatened by it.

A few months later, Jack found a better job where he felt happier, respected and well compensated.

Summary
Just like "Jack," many clients think that their work in therapy is over once they understand their problem and they start to "feel better."  Unfortunately, this usually doesn't last, especially when emotional trauma is involved.

An intellectual understanding is a good start, but it's not the same as actually working through the problem, as "Jack" discovered.

The working through process necessitates working on a deeper level than just having a cognitive understanding.

EMDR and other mind-body oriented types of therapy, like Somatic Experiencing and clinical hypnosis tend to be more effective and efficient than regular talk therapy when the problem involves emotional trauma (EMDR: When Talk Therapy Isn't Enough).

Of course, everyone is different and these types of therapy aren't a quick fix but, as an experienced therapist, I have found that EMDR and other mind-body oriented types of therapy tend to work faster to resolve trauma.

Getting Help in Therapy
If you have tried unsuccessfully to work out your problems on your own, you owe it to yourself to get professional help from a licensed mental health professional (see my article:  How to Choose a Psychotherapist).

Rather than continuing to suffer on your own, you could work through your problems so that 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.

In addition to providing mind-body oriented psychotherapy, I also use talk therapy with clients who would benefit from it.

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.