How Does Imagery and Imagination Enhance Psychotherapy?

I have been using imagery and imagination in therapy with my clients for many years (see my article: Using the Imagination as a Powerful Tool For Change).

Imagery and Imagination in Psychotherapy

The Imaginal Realm: Working With Visual Mental Imagery

I recently attended an advanced AEDP (Accelerated Experiential Dynamic Psychotherapy) seminar called "Imaginal Realm: Working With Visual Mental Imagery in AEDP" which was a deep dive into using imagery and imagination (see my article: What is AEDP?).

When I refer to "imagery", I'm not only referring to visual imagery. Aside from visual imagery, many people get non-visual imagery in sessions. 

For instance, some clients get mental representations through sound (hearing music in their mind), scents that can trigger old memories, kinesthetic experiences (feeling movement), tactile experiences, and an embodied or felt sense of conceptual/verbal imagery such as thinking of concepts or having an internal dialog.

During therapy sessions, I sometimes get visual images in my imagination or a song comes to mind. Over the years, I have learned to appreciate these experiences as messages from my unconscious mind because they often tell me what is going on for the client or what is going on between the client and me.

It's not unusual for me to have an image, song or a word in mind and then a few seconds later the client mentions the same image, song or word (see my articles: Synchronicities - Part 1 and Part 2).

Over time, I have learned that these experiences occur when I feel especially attuned to the client. Other therapists, especially therapists who are experiential therapists like me, have told me that they have similar experiences in therapy (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

The Use of Metaphors in Psychotherapy

Over the years, I have heard clients use many metaphors unprompted by me, including: 

• "It's like searching for the Holy Grail."
• "I'm no longer jumping into the vortex of other people's drama."
• "I feel like I'm trapped in a cage."
• "I'm no longer putting up walls."
• "I walked on eggshells with my ex."
• "I'm drowning in paperwork."
• "I keep hitting my head against a wall."
• "He swept me off my feet."
• "A weight has been lifted off my shoulders."

Metaphors are beneficial in therapy because they can:

• Enhance clients' communication by allowing them to express feelings they might otherwise have a hard time articulating

• Deepen insights that can lead to a reframing of a problem, a relationship or an idea

• Bypass rational defenses offering a way to talk about sensitive subjects and break rigid and unhealthy thought patterns

• Strengthen the therapeutic alliance between client and therapist

How Imagery and Imagination Enhance Psychotherapy

Imagery and imagination can enhance therapy by engaging the emotional brain. This allows clients to access and process unconscious emotions.

It also helps clients to make behavioral changes through mental rehearsal.

Imagery and Imagination in Psychotherapy

An example of how to use mental rehearsal is a client who wants to become more confident to give presentations at work. This client can vividly imagine their "Future Self", who can exist at any time in the future. They can imagine a self who has all the confidence, qualities and skills they would like to have (see my article: Experiencing Your Future Self).

Using imagination in this way can strengthen neural pathways and prepare the brain for success.

Clients can also see and feel themselves walking into the presentation room feeling prepared and confident, speaking with passion and receiving applause after the presentation. They might even imagine their boss coming over and praising the presentation. 

AEDP Portrayals

One of the main components in AEDP is doing "portrayals" in therapy sessions.

AEDP portrayals are active experiential and imaginative enactments in the therapy session.

To set up doing a portrayal an AEDP therapist prepares the client prior to doing the portrayal by:

• Establishing Safety and a Therapeutic Alliance: The therapist establishes an attuned connection with the client to ensure the client feels safe and to prevent them from feeling overwhelmed.

• Identifying the Core Material: In collaboration with the client, the therapist identifies a memory or a part of the client's self that still has an emotional charge.

• Inviting Immersion (The Setup): The therapist invites the client to slow down, close their eyes and visualize the scene using as many sensory details as possible (sight, sound, body sensations and so on).

• Role Playing (Doing the Portrayal): The therapist guides the client to talk to the imagined person or part of themself by expressing vulnerable or assertive feelings they couldn't express in the past. This might involve imagining talking to a frightened younger part of themself, talking to a parent in a memory from the past, confronting someone who abused them and so on.

There are different types of AEDP portrayals including:

• Reparative Portrayals: An example might be a client imagining a new outcome to a painful scene in their life. In this type of portrayal the client can offer themself what might have been needed and lacking in real life to repair emotional damage.

• Internal Parts Work (intra-relational portrayals): Having a dialog with different aspects of themself to resolve internal conflict (similar to Parts Work Therapy/IFS).

Imagery and Imagination: Internal Parts of Self

• Relational Attachment Portrayals: Reenacting relationships to process emotions to attachment figures (e.g., parents, siblings, a ex-lover, etc). 

• Feared Portrayals: Actively engaging with a threatening figure from real life or from a dream to process the emotional impact, reduce shame and anxiety, and to feel empowered.

• Longed-For Portrayals: The client imagines receiving the love, emotional support or validation they desired but never received from a significant person in their life.

• Moment-to-Moment Tracking: Moment-to-moment tracking is an essential part of AEDP whether the interaction involves a portrayal or a conversation between the client  and the therapist in session. This involves the therapist staying closely attuned to the client's facial expressions, movements, emotions and defenses. The therapist also monitors her own mental, emotional, imaginal and bodily sensations.

• Metaprocessing After a Portrayal: The client and therapist process the experience together afterward to help the client to integrate the experience by building a bridge between the client's right brain and left brain. Among other things, the therapist explores with the client what it was like to do the portrayal and, specifically, what it was like for the client to do the portrayal with the therapist. The focus is on what might have changed for the client or what was transformative about the experience. Processing helps the client to hold onto and integrate positive experiences (see my article: How Are Emotions Processed in AEDP?).

Using Imagery and Imagination on Your Own

Aside from the use of imagery and imagination in therapy, athletes  also use mental rehearsal, including visualization, to imagine a successful performance, including overcoming potential obstacles they might encounter. This can help them to build confidence, improve focus and enhance performance.

You can also use your imagination in creative ways on your own to have fun and, if you like, achieve goals.  There are endless ways to use your imagination on your own including:

• Using Creative Visualization For a Hoped-For Outcome: This can involve imagining a hoped-for outcome in your personal life, career or in any other part of your life.

Imagery and Imagination: Hoped-For Outcome

• Imagining "What If" Problem Solving: When you encounter an obstacle, including an internal obstacle, you can imagine "What if there were no limits?" and visualize different solutions, including solutions that might seem unattainable at first but might spark a new perspective.

• Using the "Lightstream" Technique: If you're dealing with stress, you can imagine a soothing, healing light flowing through your body to alleviate stress or physical discomfort.

Future Articles

Using imagery and imagination is one of my favorite topics, so I'll write more about it in future articles.

About Me

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

I have over 25 years of experience helping 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.

Also See My Articles:

The Mind-Body Connection as a Window Into the Unconscious Mind

Using the Mind-Body Connection to Create the World You Want 

Dreams and Embodied Imagination 

Working With Your Dreams to Develop Your Creative Imagination 

What Are Imaginal Interweaves?  

Books: Imagination and Medicine

Emotional Numbing: The "Wall" That Once Protected You Now Imprisons You

 I've written about emotional numbing in prior articles (see my article: How Therapy Can Help You to Take Down the "Wall" You Built Around Yourself).

In the current article, I want to dive deeper into the subject of emotional numbing that started as a survival strategy and ended up imprisoning you with social isolation, an inability to feel emotions deeply, including joy, and creating stagnation in your life.

What is Emotional Numbing?

Emotional numbing is an unconscious psychological state where an individual feels detached or indifferent. They are often unable to experience, process or express emotions.

Overcoming Emotional Numbing

What Are Some of the Symptoms of Emotional Numbing?

Someone who is experiencing emotional numbing can have some or all of the following symptoms:

• Flat Affect: A lack of emotional response, often described as "robotic" or indifferent

• Reduced Emotional Range: An inability to feel high excitement or deep sadness

• Detachment: Feeling emotionally and psychologically disconnected from others and, possibly, from surroundings

• Indiscriminate Blocking: Emotional numbing blocks all emotions including sadness, joy, excitement and gratitude

• Loss of a Sense of Self: Chronic detachment can lead to loss of identity, which can make you feel like a passive observer in your life 

• Avoidance and Isolation: Withdrawing from people and social activities

• Energy Depletion: Maintaining internal "walls" takes a lot of psychological energy which can lead to chronic fatigue or burnout

What Causes Emotional Numbing?

Emotional numbing can be caused by unresolved psychological trauma, PTSD (posttraumatic stress disorder), severe stress, grief, burnout or a side effect of medication (see my article: What is the Difference Between Trauma and PTSD?).

Overcoming Emotional Numbing

Emotional numbing often starts during childhood as a survival strategy or defense mechanism which is adaptive at the time because the child is in a psychologically overwhelming environment at home.

In that sense, emotional numbing helps to mitigate overwhelming stress and trauma which would be detrimental to the child.

However, when the child becomes an adult, emotional numbing is no longer adaptive because it prevents the individual from being fully present in personal relationships, friendships, social activities and at work.

As an adult, chronic emotional numbness puts a strain on relationships and daily life.

Clinical Vignette

The following clinical vignette,which is a composite of many cases, illustrates how emotional numbing which once protected a young child in a dysfunctional family from being overwhelmed but created problems later on as an adult. The vignette also illustrates how trauma therapy can help.

Nick

When Nick was growing up, he learned to cope with his parents' constant arguments by going into his room and "spacing out" with video games.

After a while, he got so good at numbing himself that he felt like he was in his own world apart from everyone and everything else.

As an adult in his first relationship, Nick had problems connecting emotionally with his girlfriend. She complained that she experienced him as emotionally detached and indifferent about her and their relationship.

At the time, Nick had no awareness about how he was numbing himself because it had become so automatic for him. At the point when he thought his girlfriend might end their relationship, Nick sought help in therapy.

Nick's therapist helped Nick to realize that the "wall" he created around himself as a child protected him from the chaos between his parents, but that same "wall" now came with a cost because he had problems connecting emotionally with his girlfriend and others.

His therapist, who was a trauma therapist, helped Nick to gradually take down his protective "wall" by working on the unresolved trauma from his childhood.

Using a combination of EMDR therapy and Parts Work therapy, over time, Nick worked through his childhood trauma so that he no longer felt the need to numb himself emotionally (see my article: Why is Experiential Therapy More Effective Than Traditional Talk Therapy to Overcome Trauma?).

The work in therapy was neither quick nor easy, but Nick was able to connect emotionally with his girlfriend as he worked through his unresolved trauma.

Conclusion

Like all defense mechanisms, emotional numbing occurs on an unconscious level and it's usually related to trauma.

Trauma therapy can help to work through the original trauma so there is no longer a need for emotional numbing.

Getting Help in Trauma Therapy

Working with a licensed mental health professional who is a trauma therapist can help you to work through unresolved trauma and emotional numbing (see my article: What is a Trauma Therapist?).

Getting Help in Trauma Therapy

Rather than struggling on your own, seek help from a trauma therapist so you can live a more fulfilling life.

About Me

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

As a trauma therapist, I have over 25 years of experience helping 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.

Also See My Articles:

Allowing Yourself to Feel Your Feelings So You Can Heal 

What Happens When You Numb Yourself to Your Traumatic Past 

How Are Emotions Processed in Internal Family Systems (IFS) Parts Work Therapy?

I have been focusing on how emotions are processed in different types of therapies (see links below for prior articles).

What is Parts Work Therapy

IFS, which stands for Internal Family Systems, was developed by Richard Schwartz as a form of trauma therapy in the 1980s.

Processing Emotions in Parts Work

Prior to IFS, Ego States Therapy, which is another form of parts work therapy, was developed by psychiatrists John and Helen Watkins in the 1970s, so IFS wasn't the first type of parts work. 

Ego States Therapy is a psychodynamic approach which is used to resolve inner conflicts, trauma and improve emotional regulation by fostering communication and harmony between the different parts of a person's personality.

I learned Ego States Therapy while I was learning how to do hypnotherapy in 2011 and when I learned IFS a few years later, I saw the similarities between Ego States Therapy and IFS immediately.

Ego States Therapy and IFS have the following similarities:

• The personality is perceived as consisting of separate subparts rather than perceiving the personality as a single, unified whole. Subparts are a part of everyone's personality. This is different from multiple personality disorder.

• Both Ego States Therapy and IFS strive to help the various parts of the personality to work together. The goal is not to get rid of any parts because there are no bad parts. All parts have good intentions even if the intentions aren't apparent at first.

• Both types of parts work are effective for trauma, PTSD and resolving inner conflict.

• Ego States Therapy uses guided imagery and sometimes hypnotherapy to identify and communicate with specific parts, also known as Ego States. IFS uses somatic awareness to identify and communicate with parts.

How Does IFS Parts Work Process Emotions?

Similar to Ego States Therapy, IFS identifies specific parts using compassionate curiosity through the Core Self, which is also known as the Self, Adult Self or Higher Self (see my article: Discovering Your Core Self in IFS Parts Work Therapy).

Here are the key stages of emotional processing in IFS:

• Identifying "Trailheads": Emotional triggers or intense feelings (anger, fear, sadness and so on) are recognized as "trailheads". In other words, they are recognized as gateways to understanding a part.

• Unblending and Self Compassion: Instead of being overtaken by an emotion, you learn to separate from it. This separation or externalization allows for your calm and compassionate Core Self to observe and connect with the emotion without judgment. This is similar to mindfulness where you learn to observe your experiences.

Processing Emotions in Parts Work: Befriending Parts

• Befriending Protective Parts: Before accessing deeply painful emotions, IFS focuses on understanding "managers" (proactive protector parts) and "firefighter" parts (reactive, numbing parts). You learn that these protective parts, which would be identified as defense mechanisms in psychodynamic or psychoanalytic therapy, have positive intentions of protecting you, such as preventing future harm.

• Witnessing the Unburdened Exiles: Once you have developed a trusting relationship with the protective parts, they can allow the Core Self to access the wounded, vulnerable "exile" parts which hold the trauma. The Core Self listens to and observes the exile's story and helps them to release the painful emotions or limiting beliefs they carry. This is called unburdening the exiles.

The 6 Fs of IFS

To process emotions, IFS often uses a structured process to engage with the parts:

• Find: Locate/sense the emotion/part in the body.

• Focus: Bring your attention to it.

• Flesh Out: Get to know the parts (images, sensations, memories).

• Befriend the Part: Listen to and understand the part's intention.

• Fears: Listen to and understand what the part fears if it stops doing what it's doing. For example, a protector part might be afraid when you ask the part to step aside because it fears letting go of control. This is similar to how defense mechanisms work. For instance, you might unconsciously protect yourself with denial about a problem and letting go of that denial can make you afraid. So, whether you conceive of it as a part or a defense mechanism, you have to gain its trust so it feels safe enough to let go.

Through the IFS or Ego States Therapy process, emotions are no longer suppressed or acted out impulsively. Instead, emotions are validated and released. This leads to healing and internal integration which is an essential part of mental health.

Emotional Blocks in Parts Work

After reading the summary above, it would be easy to think that processing emotions in Parts Work, either IFS or Ego States Therapy, is simple, but this isn't always the case (see my article: Working With Emotional Blocks).

Just like in any other therapy, you can experience emotional blocks that get in the way of processing emotions. For instance, in attempting to feel compassion, you might access a critical part instead that gets in the way and needs to be worked with before you can access self compassion. This critical part is often a protector part and it also functions as an emotional block.

In addition, the mind can resist what's unfamiliar. So, if your familiar experience is to berate yourself because you internalized that experience at a young age, you have accessed a protector part that is difficult to let go of because it has become a longstanding part of you.

Although it might not sound like it's protective, all parts have good intentions so it's important to find out what the intention is when a part blocks progress. Then, you can form a trusting relationship with the part so it will eventually let go of criticizing and judging you.

Conclusion

IFS and Ego States Therapy are two of several types of trauma therapies.

The trauma therapist assesses each client to determine which type of trauma therapy--whether it's EMDR, AEDP, Somatic Experiencing, Parts Work or a combination of these modalities is for a particular client. 

Getting Help in Trauma Therapy

If you have unresolved trauma that you have been unable to work through on your own, you could benefit from working with a licensed mental health professional who is a trauma therapist (see my article: What is a Trauma Therapist?).

Getting Help in Trauma Therapy

Freeing yourself from unresolved trauma can help you to live a more fulfilling life.

About Me

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

As a trauma therapist, I have over 25 years of experience helping 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.

Also See My Articles:

Trauma Therapy: The Mind Has a Powerful Innate Ability to Heal Itself

What Does Processing Your Emotions Mean? 

How Are Emotions Processed in EMDR Therapy?

How Are Emotions Processed in AEDP?

What is the Life Cycle of an Emotion?

 

How Are Emotions Processed in EMDR Therapy?

EMDR stands for Eye Movement Desensitization and Reprocessing (see my article: How EMDR Therapy Works: EMDR and the Brain).

How Are Emotions Processed in EMDR Therapy?

EMDR was developed by Dr. Francine Shapiro in the 1980s as an alternative to traditional talk therapy to heal psychological trauma. 

EMDR is one of several types experiential therapies, including AEDP (Accelerated Experiential Dynamic Psychotherapy) IFS (Internal Family Systems) Parts Work and Somatic Experiencing, that were developed by trauma therapists help clients to overcome trauma (see my article: Why is Experiential Therapy More Effective Than Traditional Talk Therapy to Overcome Trauma).

The cornerstone of EMDR is the Adaptive Information Processing (AIP) system which is a theory about how the brain stores memories and that the brain stores regular memories and traumatic memories in a different way.

While normal memories are stored by strengthening connections between neurons, traumatic memories aren't stored in a cohesive way. Instead, traumatic memories are stored with fragmented, sensory and emotional imprints due to the hyperactivation of the amygdala and inhibition in the hippocampus in the brain.

The unprocessed nature of traumatic memories can cause flashbacks and triggers.

Prolonged trauma can lead to structural changes in the brain with a reduction in neuroplasticity, but the reduction can be repaired by EMDR therapy and other trauma therapies.

How Are Emotions Processed in EMDR Therapy?

Emotions related to traumatic memories are processed in EMDR therapy using bilateral stimulation (BLS) which can be either eye movements, bilateral tones or tapping, to stimulate the brain while the client focuses on the traumatic memory (see my article: What is Bilateral Stimulation?).

EMDR Therapy Using Tappers For BLS

This technique is similar to REM (Rapid Eye Movement), which is a crucial stage of sleep associated with dreaming and increased brain activity.

Bilateral stimulation helps the brain to "metabolize" the unprocessed traumatic memories by  reducing their emotional charge and replacing negative self beliefs with positive, adaptive beliefs.

Prior to processing traumatic memories with EMDR, an EMDR therapist assesses whether EMDR is the appropriate therapy for a particular client. 

If so, she obtains a client's history, helps the client to develop the necessary internal resources and coping skills to do the trauma work and evaluates whether the client is ready to process the trauma. 

Some clients, who have a significant history of ongoing trauma might need an extended period of resource development before they can process traumatic memories (see my article: Developing Internal Resources and Coping Skills).

What Are the Key Aspects of EMDR Therapy?

Here is a breakdown of the eight phases of EMDR therapy.

If the therapist assesses that EMDR therapy is appropriate for a client, there are eight phases to EMDR which vary in length depending upon each client's needs:

• Phase 1: History Taking and Treatment Planning: The therapist obtains the client's history, as mentioned above. She identifies the traumatic memories and creates a treatment plan in collaboration with the client. During this stage, the therapist helps the client to identify the "touchstone" memory, which is the earliest memory related to the trigger the client is experiencing. For instance, if the client seeks EMDR therapy to deal with a difficult boss who humiliates the client in staff meetings, the touchstone memory might be memories of being humiliated by a critical father. The earlier memories would each have their own eight stages for processing. The therapist tries to find a touchstone memory which will have generalizable effects meaning that working with a one or a few of these memories is healing to the other similar memories. If these earlier touchstone memories aren't processed, the client is likely to get triggered again with another current situation that has similar elements to the touchstone memory. The mechanism for identifying the touchstone memory is the Float Back technique which is also known as the Affect Bridge in hypnotherapy (also known as clinical hypnosis).

An EMDR Therapist Writing Down the Client's History

• Phase 2: Preparation: The therapist explains the process, establishes safety for the client, and teaches the client coping skills (also known as internal resources) to manage emotional stress during trauma sessions and between sessions (see my article: Why is Establishing Safety So Important in Trauma Therapy?).

• Phase 3: Assessment: The therapist activates the traumatic memory that she and the client have chosen to work on by identifying specific images, the client's negative self beliefs, emotions and physical sensations related to the trauma. This is also known as setting up the EMDR protocol.

• Phase 4: Desensitization: Bilateral stimulation (eye movements, taps or tones) is used to reduce the distress associated with the memory. When clients have experienced ongoing trauma, such as developmental trauma during childhood, there can be many memories to process using the eight stages for each memory. For instance, if a client experienced extensive physical abuse as a child as well as bullying in elementary school and date rape in adolescence, each one of those experiences would need to be processed.

• Phase 5: Installation: A positive belief, which is identified by the client, is strengthened to replace the negative belief associated with a particular traumatic memory.

• Phase 6: Body Scan: The client checks for any remaining tension in the body linked to the traumatic memory. If there is tension in the body associated to the memory, the therapist uses bilateral stimulation until the tension dissipates.

• Phase 7: Closure: After each EMDR session, the therapist uses stabilization techniques, which might include debriefing/talking about the experience or a meditation, to ensure the client feels secure at the end of a session.

• Phase 8: Reevaluation: The therapist assesses the client's progress, determines the success of the treatment and plans the next step of the therapy in collaboration with the client.

What Are Emotional Blocks?

Emotional blocks are unconscious barriers to processing traumatic memories.

Overcoming Emotional Blocks in EMDR Therapy

An emotional block can occur at any phase of the EMDR processing.

I have been doing EMDR therapy regularly since 2006 and, unless a client comes with an uncomplicated one-time traumatic event, there will be emotional blocks during processing.

The emotional block can take many forms. One common example is the belief, "I don't deserve to feel better". 

When a therapist and client encounter an emotional block, to use a metaphor, it's like encountering a tree that has fallen across a train track. The train can't go any further until the tree, which is blocking the train track, is removed.

Similarly, EMDR processing won't go any further until the emotional block is removed. 

When a client and I encounter an emotional block in EMDR processing of a memory, I find it's useful and efficient to conceptualize the block as a part of a client. It might be a very young part (or inner child) or another part the client has internalized. 

Whatever the block might be, I have found that working with the part using Parts Work can help to soften or remove the block so that the part allows the processing to continue (see my article: Trauma Therapy: Combining EMDR Therapy and Parts Work to Overcome Emotional Blocks).

Another way to think about an emotional block is to think of it as a defense mechanism that was a survival strategy at one point (usually when the client was younger) but no longer is adaptive.

It's not unusual for there to be several emotional blocks along the way during EMDR processing and each one needs to be addressed before EMDR processing can continue.

Conclusion

EMDR therapy is one of several types of trauma therapies.

The trauma therapist assesses each client to determine which type of trauma therapy--whether it's EMDR, AEDP, Somatic Experiencing, Parts Work or a combination of these modalities is for a particular client. 

Getting Help in Trauma Therapy

If you feel stuck with unresolved trauma, you could benefit from working with a licensed mental health professional who is a trauma therapist.

Getting Help in Trauma Therapy

Freeing yourself from your trauma history can help you to live a more fulfilling life.

About Me

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

As a trauma therapist, I have over 25 years of experience helping 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.

Also See My Articles:

Trauma Therapy: The Mind Has a Powerful Innate Ability to Heal Itself

What Does Processing Your Emotions Mean? 

How Are Emotions Processed in AEDP?

What is the Life Cycle of an Emotion?

Healing From Childhood Trauma: What is the Difference Between Abuse and Emotional Neglect?

I've written about childhood trauma in prior articles, including articles about childhood abuse and neglect.

Childhood Abuse vs Neglect

A common question that clients ask when they are in trauma therapy involves understanding the difference between abuse and neglect, which is the subject of this article (see my article: How Trauma Therapy Can Help You to Overcome Unresolved Trauma).

What is the Difference Between Abuse and Neglect?

The main difference between childhood abuse and neglect is action versus inaction of the caregiver as well as the intent of their behavior. 

• Abuse: Abuse is often an active, intentional, effort to harm, threaten or injure a child. It is an act of commission. Examples include (but are not limited to) physical harm, emotional abuse and sexual abuse. Abuse usually involves intentional, reckless and premeditated behavior.

• Emotional Neglect: Emotional neglect is often passive. It is an act of omission. The caregiver does not provide the necessary basic care (food, shelter, medical care) and emotional nurturance which includes the emotional support, validation, empathy and secure emotional connection for healthy childhood development.

Clinical Vignettes

The following clinical vignettes illustrate the difference between childhood abuse and neglect.  All identifying information has been removed to protect confidentiality.

An Example of Abuse: Sara

When Sara was a young child, her father would often come home drunk and beat Sara and her siblings. He would also hit their mother who felt powerless to stop him from hitting her and the children. By the next day, when the father was sober, he didn't remember hitting his wife and children. But after Sara's maternal uncle moved into the home, he put a stop to the abuse by restraining the father and calling the police. After several incidents where the police were called, the father was court mandated to get into alcohol treatment and the family received mental health services from a local community mental health service.

An Example of Neglect: Tom

When Tom was a young boy, he was emotionally neglected by both of his parents. His mother focused on her design business so that she rarely went to any school activities that Tom participated in. She would frequently place Tom in front of the television while she entertained clients in the house. His father was usually away on business trips and, when he was at home, he spent most of his time in his den watching sports while Tom was alone in his room. When a young family moved next door, the mother would invite Tom to come over to play with her children. She was also kind and compassionate with Tom because she realized he was a lonely boy.

The Trauma of Childhood Abuse and Neglect

Both abuse and emotional neglect are traumatic.

There are times when emotional neglect can be more damaging than abuse because:

• Emotional Neglect is Often Invisible: Emotional neglect can be hard to identify because it's often invisible. Neglect is characterized by what didn't happen (lack of love, attention or validation) as opposed to certain forms of abuse that can be detected based on marks or scars on a child's body that are noticeable.

Childhood Abuse vs Neglect

• Children Internalize Neglect: Whereas children who are abused might blame the abuser, children  who are emotionally neglected often blame themselves. These children believe they are flawed in some way and, as a result, they were unlovable (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

• Brain Development: Many children who are severely and chronically neglected can experience cognitive and language deficits.

What Are the Long Term Effects of Childhood Abuse and Neglect?

Both abuse and neglect can have a long lasting potential psychological effects including:

• Mental Health: Anxiety, depression and post-traumatic stress disorder (PTSD)

• Relationship Problems: Problems with trust, fear of intimacy or self abandonment in relationships (see my article: What is Self Abandonment?)

• Problems with Emotions: Difficulty identifying, managing and expressing emotions 

Conclusion

Although both abuse and neglect can have long lasting effects, studies have shown that neglect is often particularly damaging especially when the neglect is unseen, ignored or overlooked.

Although I have discussed abuse and neglect separately to distinguish one from the other, there can also be a combination of abuse and neglect.

Many adults believe their experience wasn't bad enough to get help.  However, the trauma of abuse and neglect usually require the therapeutic interventions of trauma therapy.

Getting Help in Trauma Therapy

Trauma therapy includes a group of therapies that were specifically developed to help clients to overcome the traumatic effects of their history (see my article: Why is Experiential Therapy More Effective at Resolving Trauma Than Talk Therapy?).

Getting Help in Trauma Therapy

Trauma therapy includes:

• EMDR Therapy (Eye Movement Desensitization and Reprocessing)

• Somatic Experiencing

• AEDP (Accelerated Experiential Dynamic Psychotherapy)

• Parts Work (IFS and Ego States Therapy)

Rather than struggling on your own, seek help from a licensed mental health professional who is trained as a trauma therapist.

Working through unresolved trauma can help you to free yourself from your history so you can live a more fulfilling life.

About Me

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

As a trauma therapist, I have over 25 years of experience helping 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.