Why is the Psychotherapist's Empathic Attunement to a Client's Unconscious Communication So Important in Therapy?

When there is a strong sense of empathic attunement between the therapist and client, when feelings are unspoken and communicated without words.  Feelings can be communicated unconsciously (see my article: Why is Empathy So Important in Psychotherapy?).

A Therapist's Empathic Attunement

Sensing Unconscious Communication
A skilled therapist, who is trained in psychodynamic psychotherapy, can often pick up on a client's unconscious communication during a therapy session.  It often goes the other way too, where an intuitive client can pick up on what is unconsciously being communicated by the therapist.

In fact, at various times, we all pick up on what is unconscious and unspoken in our daily lives, especially with people who are close to us.  Sometimes we're more aware of it than others.

The Psychotherapy Session as a Unique Time and Place For Unconscious Communication
The psychotherapy session is a unique place where a special time is designated on a weekly basis for the therapist and the client to meet to focus on the client's emotional needs.  

There are no interruptions or distractions, so this creates an especially good environment for the therapist to pick up on unconscious communication if she works with unconscious process.

There are times when a therapist might ask about what she senses with the client on an unconscious level because she thinks it would help their work together.  Then, there are other times when she might not because it would be premature and would not serve their work.

As a therapist, I find that it's usually best to ask the client rather than to tell him or her what I might be sensing on the unconscious level for several reasons:

• First, I could be completely wrong in what I think I'm sensing.  
• Second, I might be correct, but the client might not be ready to talk about it.  
• Third, by being somewhat tentative in discussing possible unconscious communication, it allows clients the freedom to reflect on it in their own way rather than imposing my view.

Often, if the therapist is emotionally attuned and the timing is right, talking about what is being unconsciously communicated by the client can open up new areas to be explored in the therapy.

An Example of the Therapist's Empathic Attunement to Unconscious Communication in the Therapy Session
It's not unusual for clients to experience feelings of abandonment when their therapist plans to be away.  These are often unconscious feelings.

Clients, who had behave like adults when they were children, are very good at hiding fear of abandonment. They had a lot of practice as children pretending that they were okay when they really weren't (see my article: Unresolved Childhood Trauma).

Many clients even convinced themselves as children that they were really okay when they really weren't.  So, pretending to be okay to themselves as well as others when they're not comes naturally to them.  They don't even need to think about it.

If the therapist is attuned to a client and also knows the client's history, the therapist can often sense the client's unconscious feelings of abandonment before the therapist goes away.  

It's important for the therapist to be as tactful as possible, especially for clients with unresolved trauma.

If the therapist doesn't use tact and good timing, clients might feel ashamed of their feelings, as they might have when they were children when they were expected to be more mature for their age and psychological development at the time.

But if the therapist is tactful and helps clients to understand that many clients experience similar feelings, especially if they had childhood trauma where they were abandoned emotionally, then it can be a relief to clients. This usually makes discussing what has been communicated unconsciously more meaningful to them.

How Does a Therapist Sense the Client's Unconscious Communication?
Not all therapists work with the unconscious.  For instance, a therapist who is strictly a cognitive behavioral therapist often will not deal with the unconscious mind.  

But assuming that the therapist has training in psychodynamic psychotherapy and is skilled in  detecting unconscious communication, she has different ways she might sense unconscious communication from the client.

For instance, as a psychotherapist who was originally trained in psychodynamic psychotherapy, I often sense physically or emotionally what the client is feeling.  

It's often a visceral feeling for me.  Other times, it's a thought.  Or, I might have a particular song playing in my mind and the words or tune are relevant to what's happening with the client.  

A picture might also flash in my mind's eye that is relevant to my interaction with the client during his or her session.  Then, it 's a matter of whether or not to communicate it to the client and, if so, how.

The Therapist's Attunement Can Be Emotionally Reparative For the Client
The therapist's attunement is usually emotionally reparative experience for clients, especially if they grew up with adults who weren't emotionally attuned to them when they were children.

As previously mentioned, therapists make mistakes at times.  When a therapist makes a mistake with regard to emotional attunement, it's important for the therapist to acknowledge this to the client (see my article: Psychotherapy: Ruptures and Repairs Between You and Your Therapist).

My Next Article: The Healing Potential of the Therapist's Empathic Attunement

About Me

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

I work with individual adults and couples.

As an Experiential Psychotherapist, who is trained in psychodynamic psychotherapy,  I value clients' unconscious communication.

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 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.

Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works

No one knows how to "do therapy" before they've ever been in therapy.  Even clients who have been in therapy before need psychoeducation about the particular therapy modalities that the current therapist uses and how these modalities work.  

So it's important for the therapist to provide clients with this information during the initial stage of psychotherapy (see my articles at the end of this article).

Why It's Important For Therapists to Provide Clients With Psychoeducation About How Psychotherapy Works

It's common for clients to begin therapy with a certain degree of anxiety.  But when clients have an idea of what to expect in therapy, it helps to ease their anxiety.

It's also important, if possible, for clients to say what they would like to get out of therapy.  I say "if possible," because there are times when clients start psychotherapy and they're not sure what they want from therapy or they might only have a vague idea or, during the initial stage of psychotherapy, they might not know how to articulate their needs and they might need help from the therapist to explore and define their needs (see my article: When You "Just Don't Feel Right" and It's Hard to Put Your Feelings Into Words).  

Psychoeducation About How Psychotherapy Works

The type of information that the therapist provides will depend on the type of therapy that she does.

It's helpful for clients to know how particular treatment modalities work and why it's more effective to work with a psychotherapist than it is to talk to a friend (see my article:  How Talking to a Psychotherapist is Different From Talking to a Friend).  

The following topics, which are listed by therapy modality, are some of the most important areas to discuss as part of the psychoeducation process.

Psychoanalysis and Psychodynamic Psychotherapy 

If the therapist does psychoanalysis or psychodynamic psychotherapy, she might talk to the client about transference/countertransference issues (see my article: Psychotherapy and the Positive Transference).

She will also probably discuss the importance of the unconscious mind, dreams, and the intersubjective process in therapy.

See my articles:

Making the Unconscious Conscious, Discovering the Unconscious Emotions at the Root of Your Problems

The Therapy Session: A Unique Intersubjective Experience, Embodied Imagination Dreamwork

Transforming Nightmares Through Creative Dreamwork

Working With Dreams to Develop Your Creative Imagination

Also, within psychoanalysis and psychodynamic psychotherapy, there are various ways of working.  For instance, I work as a Relational psychotherapist, which is a contemporary, interactive form of psychoanalytic/psychodynamic psychotherapy. Another psychotherapist who does psychoanalysis might use a Classical Freudian method or do Kleinian therapy, and so on.

EMDR Therapy 

If the therapist does EMDR therapy, she could talk about how EMDR can resolve trauma through memory reconsolidating and what are considered Big-T and Small-T trauma.

See my articles: 

What is EMDR Therapy?, 

Overcoming Trauma With EMDR Therapy

When the Past is in the Present

Big T and Smaller T Trauma 

What is Adjunctive EMDR Therapy

Somatic Experiencing/Somatic Psychotherapy

If the therapist uses Somatic Experiencing or Somatic Psychotherapy, she would probably talk about the mind-body connection, and how the body holds unconscious memories.

See my articles: 

Mind-Body Oriented Psychotherapy

Somatic Experiencing

The Body Offers a Window Into the Unconscious Mind

What is Somatic Psychotherapy?

Clinical Hypnosis (also known as Hypnotherapy)

If the therapist uses clinical hypnosis, she would probably not only explain hypnosis, but she would also dispel some of the myths about hypnosis that have been perpetuated in movies and TV programs (i.e., the myth that hypnosis is a form of "mind control") and also about how clients maintain a dual awareness during hypnosis about being in the here-and-now as well as in the space of whatever comes up in the hypnosis.

See my articles: 

What is Clinical Hypnosis?

Clinical Hypnosis and the Mind-Body Connection

Hypnosis and Creative Visualization to Manage Stress 

All Hypnosis is Self Hypnosis).

Cognitive Behavioral Therapy (CBT)

For the therapist who uses cognitive-behavioral therapy (also known as CBT), depending upon the problem, she might explain how desensitization works or why there's usually homework in CBT treatment.  She would probably explain when she uses CBT.  For instance, I use CBT for phobias and certain forms of anxiety.

Ego States Therapy (Parts work)

For the psychotherapist who does Ego States therapy (also known as Parts work), she could talk to the client about the different aspects of the self, dissociation, and shifting self states. 

See my articles: 

Parts Work in Therapy: Is a Split Off Part of Yourself Running Your Life?  

How Shifting Self States Can Affect You For Better or Worse).

Integrative Psychotherapy

If the therapist uses Integrative Psychotherapy, as I do, she would explain how she integrates the various treatment modalities for the most effective treatment.

See my articles: 

The Therapeutic Benefits of Integrative Psychotherapy 

Contemporary Psychoanalysis and EMDR Therapy: A Powerful Combination to Overcome Trauma).

Treatment Frame

There are other issues to be discussed during the initial stage of therapy, including the treatment frame (the fee, length of sessions, policies about missed sessions and payment of fees, and so on) so the expectations are clear at the beginning of therapy.

Feedback to and From the Psychotherapist

I believe psychotherapy should be a collaborative process between the client and the therapist.

One of the best predictors of a good outcome in therapy, regardless of the treatment modality, is a good rapport between the therapist and the client, which develops over time.

The Importance of Feedback to and From the Psychotherapist

Regardless of the therapist's experience and skills, if the client and therapist aren't a "good fit," chances are that the therapy won't go well.  That being said, as previously mentioned, most clients feel anxious at the start of therapy because it's uncomfortable for them to talk to a stranger--even the most empathetic stranger, so the client might need to give the process time before deciding if it's a "good fit" or not.

Most therapists are aware that not every therapist is for every client, so they're not offended if the client feels it's not a "good match."   

An open dialog between the client and the therapist is important, especially with regard to whether the therapy is working for the client.  It's important for the therapist to know what's working and what's not working.  

If the client was already informed about the treatment modalities that the therapist uses and how these modalities usually work for the client's presenting problem, he will not be as likely to expect a "quick fix" for a complicated problem.

But if there are areas that might need to be adjusted or if there are things that the therapist might not be aware of (e.g., the client becomes highly activated between sessions and has problems sleeping), this dialog provides the therapist with information to make adjustments to the therapy, if necessary (see my article: Asking For What You Need in Therapy).

If the client doesn't initiate this dialog, I believe it's important for the psychotherapist to "check in" with the client every so often.

Not only does an open dialog provide the client with the important message that the psychotherapist wants and welcomes feedback--even negative feedback--it also reduces the possibility that the client, who has problems expressing his feelings, will leave therapy prematurely (see my article: Ruptures and Repairs in Therapy and When Clients Leave Therapy Prematurely).

The client can also ask for feedback from the therapist about how the therapist thinks the therapy is going from the therapist's perspective.  This helps the client to understand the therapist's thinking about their work together (see my article: A Psychotherapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Getting Help in Therapy

As I've mentioned in prior articles, it takes courage to admit you have a problem, even admitting it to yourself, and to get help (see my article: Developing the Courage to Change).

When you know that continuing to do what you've been doing that hasn't worked for you is prolonging your suffering, you owe it to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

Rather than becoming overwhelmed by the process, it's important to take it one step at a time.  After you've acknowledged to yourself that you have a problem, the next step is to contact a psychotherapist for a consultation (see my article: How to Choose a Psychotherapist). 

During the consultation, you can give an overview of your problem and ask the therapists questions.

An experienced psychotherapist can help you to work through your problem so you can liberate yourself from your history and have a sense of well-being.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who provides integrative psychotherapy to individual adults and couples.

To find out more about me, visit my website:

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

Also See My Articles:

Psychotherapy is More Than Just Venting

Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent

Common Myths About Psychotherapy: Therapy Takes a Long Time

Common Myths About Psychotherapy: Going to Therapy Means You're "Weak"

Common Myths About Psychotherapy: Therapy is All Talk and No Action).

The Therapeutic Benefits of Integrative Psychotherapy

Integrative psychotherapy is a client-centered approach to therapy that combines various forms of psychotherapy depending upon the needs of each client and the skills of the psychotherapist (see my article: The Benefits of Psychotherapy).

The Therapeutic Benefits of Integrative Psychotherapy

Psychotherapists, who use integrative psychotherapy, choose the types of therapy that they combine for each client.

As a psychotherapist, I combine a psychodynamic approach with various forms of mind-body oriented psychotherapy, including EMDR therapy, clinical hypnosis, Somatic Experiencing and Ego States work.

The benefit of using integrative psychotherapy is that the psychotherapist has many different ways that she works so that she can find the approach that is best suited for each client.

Integrated psychotherapy can be used together or separately at different points in therapy.

Let's take a look at a fictionalized vignette to see how integrative psychotherapy can be used:

Pat
Pat came to therapy to work on unresolved childhood trauma that was affecting her in her relationships.

She had heard from a friend, who was in EMDR therapy, that EMDR was effective in helping her friend to overcome emotional trauma, so Pat requested EMDR therapy.

Pat chose a psychotherapist who practices integrated psychotherapy, which included EMDR therapy, among other treatment modalities.

The Therapeutic Benefits of Integrative Psychotherapy

After the initial consultation and the history taking sessions, her therapist discussed the preparation phase of EMDR where the therapist assists the client to develop internal resources to deal with whatever might come up in EMDR therapy.  This is called the resourcing phase of EMDR therapy.

Since the therapist was also trained in clinical hypnosis, after discussing hypnosis with Pat, the therapist helped Pat to imagine a relaxing place (see my article: Safe Place Meditation).

While Pat was in a relaxed hypnotic state, she imagined herself on the beach and, using hypnosis, her therapist helped her to engage all her senses (sight, sound, smell, taste, physical sensation, hearing) to make the image as vivid as possible.

Afterwards, Pat said she felt very relaxed and she could use this image of the beach if anything came up in EMDR therapy that was disturbing to her.

Using clinical hypnosis, her therapist also helped Pat to imagine various friends and loved ones that had qualities that she liked (a nurturing person, a wise person, and a powerful person).  These are called imagine interweaves and they are also part of the resourcing phase of EMDR therapy.

Pat and her therapist talked about touchstone memories that related to the unresolved trauma, so Pat chose certain memories that reflected how emotionally neglected and invisible she felt as a child (see my article: What is Childhood Emotional Neglect? and Growing Up Feeling Invisible and Emotionally Invalidated).

Pat chose a memory that was emblematic of her parents neglecting her emotionally, and her therapist asked her, as part of the EMDR Therapy protocol, what negative belief she had about herself as it related to this memory.

Pat thought about it for a moment, and then she said, "It makes me feel unlovable, and I've felt this way my whole life" (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

As Pat and her therapist began working on the memory using EMDR, they came to an obstacle in the work.  Although Pat made clinical improvements until then, she was unable to get beyond a certain point in the therapy.

This is a common problem in trauma therapy, and her therapist helped Pat to explore if there was a particular belief (called a blocking belief in EMDR) that kept Pat from making further progress in their work.

Using Somatic Experiencing, her therapist helped Pat to explore what the blocking belief might be.

At first, Pat couldn't come up with anything.  But when her therapist asked Pat to sense into her body and see what she felt when she thought about the trauma being resolved, Pat said that she felt a tightening in her stomach (see my article: The Body Offers a Window Into the Unconscious Mind).

Her therapist helped Pat to describe this tight feeling in her stomach and to put words to this feeling.  Pat responded by saying, "I don't deserve to be loved."

As soon as she said this, Pat wanted to take it back.  She said, "I'm surprised that this is what came up because I don't feel this way completely."

Pat's therapist helped Pat to understand that we all have different aspects that make up who we are, and that there can be parts of ourselves that feel a certain way and other parts that don't (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

In Pat's case, there was a significant part of her that felt that she didn't deserve to be loved, and until her therapist could work with this part, their work together would remain blocked.

Using a combination of clinical hypnosis and Ego States work (also called Parts work), her therapist helped Pat to give a voice to this part who felt undeserving of love.  It turned out to be a very young part that had internalized her parents' emotional neglect and believed that Pat was unlovable.

By asking Pat to imagine this young aspect of herself sitting next to her, her therapist helped Pat to understand this part.

Using Ego States work, her therapist helped Pat to embody this young part so she could express what this young part needed.  Then, her therapist asked Pat to switch back to her adult self and to imagine her adult self holding and nurturing the younger part.  Then, she asked Pat to embody the child part and to feel the love that was coming from the adult part of her.

Since this was a very ingrained blocking belief, Pat and her therapist continued to do Ego States work  for several sessions until the younger part felt nurtured and deserving of love.

The Therapeutic Benefits of Integrative Psychotherapy

At that point, the blocking belief was resolved, and they were able to go back to doing EMDR therapy without any further problems.

Conclusion
Integrative psychotherapy combines various forms of therapy based on the client's needs and the psychotherapist's knowledge and skills.

The fictionalized vignette above demonstrates how various forms of therapy, including EMDR therapy, Somatic Experiencing, clinical hypnosis and Ego States work can be combined based on the needs of a particular client.

Not every therapist uses integrative psychotherapy.  So, in the case above, for a psychotherapist who only does EMDR therapy, she might have to use another approach to overcome the blocking belief.

In my experience, using integrative psychotherapy offers the therapist the best possible tools to help the client overcome problems that come up in the work, and it is more effective than just using one treatment modality, especially since there is no "one size fits all" form of therapy that works for every client.

Getting Help in Therapy
If you've decided that you could benefit from attending psychotherapy, it's good to be an informed consumer, which means educating yourself about the various forms of therapy (see my article: How to Choose a Psychotherapist).

When you see a psychotherapist for an initial consultation, you can ask the therapist how she works and what treatment modalities she uses.

In my professional opinion as a psychotherapist, an integrative approach that includes various mind-body oriented therapies is the most effective approach for most clients.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I use an integrative approach that combines mind-body oriented therapy with psychodynamic therapy.  

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 or email me.

An Emotional Dilemma in a Relationship: Wanting and Dreading Love

Many people, who have experienced childhood trauma, come to therapy because they feel stuck and confused when it comes to romantic relationships.  They often feel highly ambivalent about the possibility of having an intimate connection to another person.  

An Emotional Dilemma: Wanting and Dreading Love

On the one hand, they might be very lonely and long for someone who would love them and that they could love.  On the other hand, they might also feel extremely frightened of allowing themselves to be that emotionally vulnerable.  And therein lies the dilemma.

Early Attachment Problems Can Cause Problems in Relationships Later On
Usually, people who go back and forth between wanting and dreading a deep emotional connection experienced emotional attachment problems with one or both parents or caregivers.  Based on infant research, we now know how important early attachment is to having a healthy emotional life and being able to form intimate attachments with others.

When parents are either emotionally unreliable, neglectful, abusive, depressed, or emotionally unattuned to their young children, these children are more apt to grow up feeling emotionally insecure and vulnerable about forming relationships.  It's hard for them to trust.  They're very afraid of getting hurt or being emotionally abandoned again.  As a result, although they might feel very isolated and lonely, it's often difficult to allow themselves to open up emotionally to others.

An Emotional Dilemma: Wanting and Dreading Love

Fear of Opening Up in Therapy
Often, people who struggle between wanting and dreading an intimate connection find it difficult to come to therapy to get help for this issue.  Coming to therapy means opening up and taking a risk with a therapist, which means allowing themselves to be vulnerable.  How do they know they can trust the therapist when they couldn't trust their own parents?  It's a dilemma.

For many people who somewhat overcome their fear to come to therapy, at least enough to come to a first session, their experience is often one of being hypervigilant--waiting to see if there are any signs that the therapist will betray or hurt them in some way.

A skilled clinician, who has worked with clients on developmental attachment problems, will know not to take it personally.  She would know that she must take her time to help the client to form a therapeutic alliance over time to build a rapport and trust.

Many clients, who suffer with developmental attachment issues, find it difficult to sustain treatment, and they leave after a few sessions.  Often, they give another "reason" for leaving therapy--money or time issues, never revealing that it's their dread of opening up that's making them want to flee from treatment.

For clients who can sustain treatment with therapists who have expertise in working with attachment issues, if they can allow themselves to build a rapport and trust with the an empathetic therapist, over time, they can also learn to form trusting and loving relationships outside of treatment.

This is the kind of therapeutic work that takes time.  A client, who has a fear of getting close to others, can't be rushed into overcoming his or her fear.  Each client is different and, if there is progress in treatment, it will probably be a process where it is two steps forward and one step backward due to the high level of ambivalence and fear.  There is also usually a lot of underlying shame of feeling "not good enough" or "not lovable."

Getting Help in Therapy

Wanting and Dreading Love:  Feeling Lost?  Get Help

My experience has been that using a combination of Somatic Experiencing, psychodynamic psychotherapy, resourcing (i.e., helping the client to develop better coping skills and an increased capacity to tolerate vulnerability) along with an expertise in developmental attachment issues, is often the most effective way to help clients to overcome the dilemma of longing for love and dreading it at the same time.

About Me:
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.

I work with individual adults and couples.

To find out more abut 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.

Psychotherapy and the Erotic Transference: Falling "In Love" With Your Psychotherapist

When Freud first encountered the erotic transference among his patients, he was very concerned and he didn't think it was a useful part of treatment. But, as he continued to work with these patients and to explore the transference, he discovered that it was, in fact, a very useful part of psychoanalysis, and the transference could be worked through so that the patient could gain insight and grow in treatment.

Psychotherapy and the Erotic Transference:  Falling "In Love With Your Therapist

Psychotherapists who are psychoanalysts have rigorous psychoanalytic training as well as years of their own psychoanalysis so that they are trained to work with the transferential aspects of therapy, including the erotic transference.

But, first let's understand what we mean by the word "transference" in the context of psychoanalysis or psychodynamic psychotherapy.

What is Transference?
There are many explanations for transference but, basically, transference entails, primarily, unconscious feelings that clients develop for their psychotherapists where they usually "transfer" feelings related to their childhood. Transference can be positive, negative, idealized, erotic and so on.

Usually, the clients develop these transferential feelings based on unmet needs from their childhood, so that if their parents were cold and neglectful, they have a strong desire for the psychotherapist to fulfill these needs that weren't met by their parents.

When you consider that psychoanalytic clients meet with their psychoanalysts any where from 2-5 times per week, you can see how transference, in whatever form, would build up quickly. Psychoanalysts also usually delve into the most intimate aspects of a client's interior world, including dreams, which can also fuel transferential feelings.

Psychotherapy and the Erotic Transference:  Falling "In Love" With Your  Therapist

Also, most psychoanalysts, especially at the beginning of treatment, don't reveal that much about themselves because transference is an important part of treatment. Since they want to work with the transference, they are unlikely to reveal a lot of personal information because the more a client knows about his or her therapist, the less room there is for transference to develop. So, the combination of the frequency of sessions, the intimate nature of what the client is sharing in the treatment, and the lack of information about the analyst (where there's lots of room for clients to project their fantasies) can create powerful transferential feelings.

Sometimes, clients' transferential feelings are not totally unconscious. They might be very aware of feelings that they're developing for the therapist, although they might not realize that the basis of these feelings is based on childhood experiences. This is all very common and part of what would be discussed in treatment.

Transference is not a phenomenon that is only found in treatment. In fact, it is a normal part of every day life in many areas of our lives. I'm sure that many of us can think of teachers that we had crushes on in school. This is also usually transference because it's a projection of the student's feelings for the teacher. Usually, students outgrow these crushes and, eventually, develop healthy relationships with their own peers.

What is Countertransference
I've chosen to focus on a particular type of transference in this blog article, namely, erotic transference, but I wanted to add a few words about countertransference. Countertransference is also a form of transference but, in the context of treatment, it's the transferential feelings that the therapist has for the client. Therapists who are psychoanalytically trained know that they will feel countertransference for some clients, and they often experience the same type of transferential feelings as clients do.

The big difference is that therapists who are psychoanalytically trained have the therapeutic skills to deal with these countertransferential feelings, and will usually recognize that it's not really about the client.

Rather, it can point to something that is lacking in their own lives, something from the past, or some unconscious feelings regarding their own unmet needs. Early on, in psychoanalytic training, psychoanalytic candidates in training use their own personal psychoanalysis and supervision to deal with these feelings and learn how to handle them without compromising the treatment. If countertransference becomes an issue for a therapist after his or her training, usually, he or she will seek professional guidance either in his or her personal therapy, in supervision, or among peers.

Erotic Transference:  Falling "In Love" With Your Therapist

When psychoanalysts act on transferential and/or countertransferential feelings, rather than seeing them as a signal for work to be done with the client and/or with themselves, there can be boundary violations, especially sexual boundary violations, which I discussed in an earlier blog post. This type of boundary violation, whether it occurs during the treatment or after the treatment, is usually most harmful to the client. It can leave a client feeling devastated since these types of "relationships," which continue to be unequal even if the treatment is over, almost never work out.

There are some psychotherapists, who are not psychoanalytically trained, who are uncomfortable with clients' transference or their own countertransference, and they avoid dealing with it and don't know how to deal with it. This is usually detrimental to the treatment and has been the cause of many treatment failures.

What is the Erotic Transference?
The erotic transference is a particular form of transference that occurs when the client thinks that he or she has fallen in love with the therapist. Once again, as mentioned previously, feelings can develop quickly in psychoanalysis or psychodynamic psychotherapy due to the intensity of the treatment.

Initially, this can be emotionally painful for clients because, an ethical psychotherapist who maintains the treatment frame, won't gratify these erotic transferential feelings and fantasies, so that clients feel a yearning for their therapists that cannot be satisfied. These feelings are explored in treatment and, usually, as previously mentioned, they have their origins in unmet childhood needs.


It's easy to see how someone who grew up in a home where their emotional needs were not met or not sufficiently met, for whatever reason, would feel like he or she is falling in love with the therapist who is spending so much time listening to his or her most innermost feelings. The early yearning to have these needs met can come roaring to the surface very quickly. Many times, clients have repressed (pushed down) these needs for so long that. before starting treatment, they might not even be aware that they still have these needs. Then, lo and behold, these needs are tapped into and they often erupt with full force.

Note that I emphasized that this can be part of the initial part of treatment. The reason for this is that a skilled psychoanalytically trained therapist will use these transferential feelings not only to explore those unmet needs but also to help the client to develop healthy relationships outside of treatment where those needs can be met. So, although it can be initially painful to feel unrequited love as part of the erotic transference, the client is helped to develop into an adult who can have his or her needs met.

The erotic transference can occur regardless of the client's and therapist's gender or sexual orientation. That means that a heterosexual woman can develop an erotic transference for a heterosexual female therapist, even if this client never had erotic or romantic feelings for women in the past.

It can also occur with a heterosexual man and a gay therapist, even if the client never had sexual or romantic feelings for gay men before. A gay male client can develop an erotic transference for a heterosexual female therapist. And so on. This can be very confusing for clients and, at times, causes them to question their sexual orientation. But, most often, especially if they're not having these romantic and sexual feelings outside of treatment, it's not about a change in their sexual orientation. It's usually about unmet childhood needs and, as an adult, these needs can be transformed into romantic and/or sexual feelings for the therapist.

In a successful psychoanalytic or psychodynamic treatment, the client matures into a person who can work through these early unmet needs and find mature love among his or her own peers rather than continuing to fantasize about the therapist.

But it would be misleading to say that this happens quickly in every psychoanalytic of psychodynamic treatment or that, for some people, it happens at all. Some clients can spend years feeling that they're in love with their therapists and not understanding why the therapist is not willing to satisfy their needs by seeing them outside of the therapy sessions or going out with them or telling them about personal aspects of the therapist's life.

If a therapist is not able to help a client work through the transference so that the client can transfer his or her feelings from the therapist to a healthy, mature relationship with a peer, the therapist might have to refer the client to a different therapist to work out these issues. This can feel very rejecting to the client, who might not understand why this is necessary, but it is sometimes necessary and preferable to allowing a client to spend year after year feeling deprived because his or her therapist won't gratify his erotic or romantic needs.

The fictionalized vignette below demonstrates how the erotic transference can develop in a psychoanalytic treatment. As an aside, I also want to reiterate that, although I'm focusing on psychoanalytic and psychodynamic treatment, transference can develop in any type of therapy and, overall, transference out in the world (outside of the treatment setting) is ubiquitous.

Terry:
When Terry began treatment, she had just ended her third long-term relationship with a man who turned out to be cold and distant. She felt depressed and "a failure" because she continued to choose men who didn't meet her emotional needs.

Terry chose a woman psychotherapist who was recommended to her by her doctor. During the initial few visits, the therapist asked Terry about her childhood history, and Terry recounted a childhood where her parents provided her with everything that she needed and wanted materially, but they were emotionally distant. Whenever she wanted to talk to her parents, they were too preoccupied with other things to listen to her. As an only child, Terry grew up feeling lonely. She loved to go visit her best friend's home because her friend's mother was very warm and affectionate. Terry used to secretly wish that her friend's mother would become her mother.

Since Terry was significantly depressed (although not suicidal), Terry and her therapist agreed to meet three times a week. As the treatment went on, Terry described how she had never felt that anyone close to her ever really listened to her. She was tired of going out with men who turned out to be so much like her parents, and she couldn't understand the unconscious process that compelled her to continue to choose the same type of man over and over again.

After a few weeks, Terry really began to look forward to her therapy sessions. Her therapist provided a safe and nonjudgmental environment for Terry to express her innermost feelings. Terry told her therapist about thoughts and feelings that she had never revealed to anyone else in her life, and she was amazed at how easily she was able to do this with her therapist. Most of all, she felt that her therapist was caring, attentive and really listened to her in a way that she had never been listened to before.

Erotic Transference:  Falling "In Love" With Your Therapist

Soon after that, Terry began having erotic dreams about her therapist. These dreams made her feel very frightened, confused, and embarrassed because she considered herself to be heterosexual, and she had never had romantic or erotic feelings for a woman before. She had gay and lesbian friends, and she didn't think she was prejudice against gays. She was just bewildered by these dreams and wished that she would stop having them.

Terry also began to notice that she was ruminating about her therapist between sessions, wondering what she was doing and with whom. She fantasized about meeting her therapist outside of their sessions for dinner and getting to know her therapist personally. When her fantasies turned erotic, she began to worry because now she was having erotic feelings for her therapist in her dreams as well as her waking hours. In fact, she worried because she was feeling obsessed.

Erotic Transference:  Falling "In Love" With Your Therapist

At that point, whenever she went to therapy, she wished that the session wouldn't end. She looked at her therapist's ring finger to see if she was wearing a wedding ring, but she saw no signs of whether her therapist was married or had a significant other. She felt that, at least, if she knew that her therapist was married, maybe she could stop ruminating about her day and night.

When her therapy session ended and Terry walked out into the waiting room and saw the next client about to go in to see the therapist, she felt jealous. On an emotional level, she wanted the therapist to only spend time with her and it was painful to think that she had to share her with other clients. On a rational level, Terry could step back and look at her feelings and know that they were irrational, but she couldn't stop them.

She had fantasies about standing across the street from her therapist's office, somewhere where the therapist couldn't see her, and waiting to see where she went or if she met up with a husband or lover. She felt that her curiosity and yearning to know more about her therapist's life was overwhelming. And, although she often had this fantasy, she never gave into it because she didn't want to feel like a stalker.

Finally, one day when Terry couldn't tolerate having these erotic feelings for her therapist any more, with much hesitation and embarrassment, she told her therapist about her erotic feelings. Part of her hoped that her therapist would tell her that she felt the same way about her, which she also knew would be terrifying for her. Another part of her was afraid that her therapist would think this was highly inappropriate and she would need treatment with Terry.

Terry's therapist listened intently to what Terry had to say. Terry became tearful because she was confused about what this meant about their therapeutic relationship and also what it meant in terms of Terry's sexual orientation. Terry poured out all the feelings that she had been holding back and allowed her tears to flow.

After she finished, Terry raised her eyes for the first time during that session to meet her therapist's eyes. What she saw was the same empathetic and compassionate look that her therapist usually had. She breathed a sigh of relief that, at least, her therapist wasn't throwing her out of the office. Then, her therapist talked to Terry about transference and, in particular, the erotic transference. Terry was surprised to hear that this is a very common experience in psychoanalytic and psychodynamic psychotherapy. At least, she knew that she was not some odd ball and that many other clients in therapy experienced the same feelings. Most importantly. she learned that most clients work through these feelings as they learn to develop healthy, romantic relationships outside of treatment.

Terry and her therapist continued to explore these feelings as they related to her unmet childhood needs. Terry did a lot of grieving for what she didn't get when she was growing up. Over time, she also learned to accept that her parents, who would never even think of getting into their own therapy, probably would not change. This is often a very hard part of treatment for many clients who still hold onto the wish, no matter how impossible it might seem, that one day their parents would change.

In the meantime, Terry began to date again. Whenever she started to see a man who turned out to be cold and distant as all the other men she dated, she wished that she could be in a romantic relationship with her therapist. Sometimes, these feelings were so strong that she felt they were unbearable. Although she still really didn't know if her therapist was heterosexual or a lesbian and she didn't know if her therapist was in a relationship, she fantasized about her therapist being a single lesbian.

Although she understood that she and her therapist couldn't be romantically or sexually involved while she was still in treatment, she now had fantasies that they could be together after the treatment ended. She even had thoughts about terminating the treatment with her therapist and seeing a different therapist so that she and her current therapist could be together.

This thought made her feel happy and excited her sexually as well. She no longer cared if she considered herself to be heterosexual or a lesbian. It didn't matter. All she could think about at that point was that she and her therapist could be so happy together if she was no longer in treatment with her. She thought to herself, "Why didn't I think about this before? Surely, my therapist must recognize that there's a special feeling between us. She's too ethical to pursue this feeling while I'm in treatment with her, but she'd have no reason not to be with me if I was in treatment with someone else."

Terry was very excited on the day when she decided to bring this up in her psychotherapy session. She had fantasies about having romantic candlelight dinners with her therapist, being sexually intimate, and, in time, even living together. So, when she brought up her feelings about this in therapy, as always, her therapist listened to her intently. Terry was so happy to have someone finally listen to her as if she was the only person in the world, and she imagined how wonderful this would be to experience all the time, and not for 45 minutes several times a week.

Once again, Terry's therapist acknowledged that it is not at all unusual for a client to have these feelings and, in fact, many clients had these feelings. Then, she proceeded to explain to Terry how, even after their treatment ended, whenever it ended, they could never be together or have anything but a therapeutic relationship because it would ruin the treatment that they had together. Also, she explained that these romantic and sexual feelings that Terry had, while very strong, were still based on her unmet childhood needs. And a relationship between a former therapist and a former client would be disastrous for the client.

Even though her therapist normalized her feelings, Terry was extremely disappointed. She thought she had found a way to be with her therapist, only to be rejected. This was the subject of many sessions after that session. Terry's therapist was also able to help her connect her current feelings to her earlier feelings connected to the childhood emotional neglect.

As treatment continued, Terry began to feel deep down that she deserved to be with someone who was emotionally available to her. Since she didn't have attractions for women outside of her therapy sessions, she continued to date men and talk about these experiences in her therapy. She still held onto a wish that her therapist would eventually change her mind and get romantically involved with Terry after the treatment was over. But she also began to choose men who were more emotionally attuned to her.

Several months later, Terry met a man that she really liked and who was very kind and generous with her. Unlike her other relationships, he was attentive and also reciprocated her feelings. Initially, she was almost too afraid to get excited about this man because she feared that she would get disappointed and hurt like she had in the past. But, as she continued to see him, their relationship developed and became more intimate.

At first, Terry felt like she was "cheating" on her therapist, although, rationally, she knew this wasn't true. But, until then, most of her erotic dreams and fantasies had been about her therapist, and it had been the most intense relationship (albeit it a therapeutic relationship) that she had ever had.

Unlike her mother, who had almost never shown much concern for Terry's emotional well being, Terry sensed that her therapist was happy for her that she had met someone that she really cared about and who really cared about her.

As Terry continued to see this man and continued to talk about it in her therapy, gradually, over time, she realized that her feelings for her therapist were changing. Although she felt a deep caring for her therapist, she no longer had romantic or sexual feelings for her therapist.

This surprised Terry greatly because, when she was obsessing about her therapist, she thought these feelings would never change and she worried about what it might be like to terminate treatment and never see her therapist again. Whenever she had those feelings, she worried that she had become "too dependent" on her therapist. But much to her surprise, over time, she was beginning to feel that she could foresee a time when she could end treatment and be all right about it.

Erotic Transference:  Falling "In Love" With Your Therapist

When she discussed this with her therapist, her therapist assured her that, even after she ended this treatment, if she felt that she wanted to work out other issues that had come up after this treatment was over, she could return to see her. She also told Terry that it wasn't unusual for people to return to their therapists after years of being away from treatment. She also told her that Terry had the option in the future of seeing a different therapist, possible someone who worked differently, to get a different perspective.

Soon after that, Terry and her therapist went through the termination process, which lasted a few months. During that time, they saw each other less frequently. They processed the therapy in a way that gave closure to their therapeutic relationship. During that time, Terry realized that her feelings for her therapist had changed to no longer feeling at all erotic, romantic or idealized in any way. Rather, she saw her therapist as being an ordinary person who happened to be very skilled at her work. And, when she looked back at her erotic transferential feelings, she was glad that her therapist was ethical, and maintained the therapeutic frame in a safe and empathic environment.

Terry and her boyfriend eventually got married and, overall, she was happy. After a few years, she returned to see her former therapist for brief treatment to work through particular issues. She was grateful to be able to return for treatment whenever she needed it. And rather than feeling caught up in transferential feelings that were based on unmet childhood needs, she felt that she was with a capable mental health professional who could help her to overcome these problems.

About the Fictionalized Scenario 
The fictionalized scenario that I presented above is one example, among many different types of situations, of the erotic transference and how it might appear in treatment and get worked through. There are times when clients, who feel too uncomfortable with their erotic and romantic feelings for their therapist, leave treatment and never work through these issues or the unmet childhood needs that tend to fuel these feelings.

While there are certainly times, especially if a psychotherapist is crossing professional boundaries, where clients should leave treatment before transferential feelings are worked through (and work them through with another more professional and ethical therapist), most of the time, it is beneficial to stay in treatment and get to the early core issues that are at the heart of the matter.

Getting Help in Therapy
If you're overwhelmed with problems that you've been unable to resolve on your own, you could benefit from seeing a licensed mental health professional who can help you to work through these issues so you can lead a more fulfilling life.

About Me
I am a licensed psychotherapist in New York City, who is psychoanalytically trained.

Since my psychoanalytic training, I have also developed expertise in other treatment modalities, including EMDR, clinical hypnosis, Somatic Experiencing, AEDP, EFT and Sex Therapy.  

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 or email me.