EMDR is a Transformative Therapy for Trauma, But There Are a Few Exceptions

As a trauma therapist in private practice in New York City for over 20 years, I have been using EMDR therapy regularly since 2005 with excellent results.  I have found EMDR therapy to be a powerful and transformative therapy to help clients to overcome traumatic experiences.  I've also written several articles about EMDR therapy.  See my articles:

• What is EMDR Therapy?
• How EMDR Therapy Works: EMDR and the Brain
• Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs

Over the last 13 years, I have seen many clients for EMDR therapy for developmental and shock trauma.

EMDR is a Transformative Therapy For Trauma, But There Are a Few Exceptions

Clinically Assessing Clients For EMDR Therapy
As part of the initial consultation, I talk to clients about the types of trauma experiences where EMDR is effective which, fortunately, are most.  However, there are some exceptions when EMDR therapy would be contraindicated or where clients need more preparation to do EMDR, which is the focus of this article.

If a client comes to me for an initial consultation for EMDR therapy and reveals one of these contraindicated exceptions, I will discuss this with the client and will usually, if possible, provide him or her with another alternative recommendations.  If I don't do the particular alternative therapy that is needed, I usually offer to help this person to find another referral.

Although the exceptions to doing EMDR aren't many, when a client comes for a consultation and is told that EMDR therapy is contraindicated, this can be disappointing, especially since s/he may have heard about EMDR from a medical doctor, friends and the efficacy of EMDR to help resolve trauma.

But it's important for a psychotherapist who specializes in helping clients to resolve trauma to be a responsible and ethical therapist, even if the client will be disappointed and annoyed.

It's better to be honest with the client rather than go along with the client's wishes and place the client in harm's way or waste their time and money.

When is EMDR Therapy Contraindicated and When Is Additional Preparation Needed to Do EMDR?
For all EMDR therapy, after the initial consultation and a session or more to get family history, there is a preparation stage to help the client to develop the necessary internal resources and coping strategies to prepare to do EMDR.  However, there are times when EMDR is either contraindicated or additional preparation, beyond the usual, is needed.

The following is a list of the most common issues:

• Clients Who Are Psychiatrically Unstable:  Clients, who are psychiatrically unstable, need to be stabilized first before doing EMDR therapy or almost any other type of outpatient psychotherapy.  Clients who are actively suicidal, homicidal, too emotionally fragile, or who have some other serious psychiatric condition that is causing significant emotional impairment, need a period of stabilization, and after stabilization, they will need to develop the internal resources before EMDR can be considered.  Once clients are stabilized and they have the inner resources to do trauma work (of any kind), the psychotherapist can reevaluate clients to see if EMDR therapy would be the therapy of choice.

• Clients Who Are in An Unsafe or Unstable Home Environment:  Clients, who are in an unsafe or unstable home environment where they are being physically abused or they are the ones who are abusing a spouse or family member, are not ready to do trauma therapy.  They might need other types of help first, including but limited to:  supportive psychotherapy, domestic violence treatment, legal advocacy from an domestic violence agency, services from a child welfare agency, batterers' program and so on.  It would be irresponsible for a psychotherapist who does trauma therapy to ignore the fact that a client is in an unsafe home environment or is creating an unsafe environment.

• Clients Who Are Actively Abusing Alcohol, Drugs or Other Addictive or Self Destructive Behavior: Clients who are actively abusing alcohol, drugs or engaging in other addictive or self destructive behavior are often not candidates for EMDR therapy until they have had a period of sobriety.  When clients are engaging in self destructive behavior as a maladaptive way of coping, chances are good that, if they began to delve into traumatic memories, they might become more symptomatic and their addictive or self destructive behavior would become worse.  This is a situation where the EMDR psychotherapist would have to evaluate on a case-by-case basis.  There are some clients in this situation who could benefit from the EMDR protocol that is specifically designed for addictive behavior (if the psychotherapist is trained in this type of EMDR).  However, even in those circumstances, the client would have to already have the necessary inner resources and there might be a significant period of preparation work before traumatic memories can be processed with EMDR.

• Clients Who Are Unable to Engage in Dual Awareness in the Psychotherapy Session:  In order for trauma therapy to be safe and effective, clients must be able to maintain dual awareness in the therapy session.  In other words, they must be able to focus on the traumatic memory they are working on with their psychotherapist and also be aware of their here-and-now circumstances--that they are in a psychotherapist's office and not back in the traumatic situation.  So, for instance, if a client begins processing a traumatic memory with an EMDR therapist and the client plunges into the memory, she loses all consciousness of where she is, and she thinks she is actually back in that situation--rather than that she is with a psychotherapist, EMDR and other forms of trauma therapy are contraindicated.  There might be more preparatory work that needs to be done first to help the client to maintain dual awareness or, if that doesn't work, the client might not be ready for EMDR.  This might include clients who have DID (Dissociative Identity Disorder) where they become highly dissociative or switch into alters or clients who get thrown into flashbacks and have no awareness of where they are.

• Clients With Certain Eye Problems:  Clients who have certain eye problems might need clearance from their doctors in order to do EMDR.  As an alternative, the psychotherapist can use other forms of bilateral stimulation (BLS) like tappers, tapping, listening to music that alternates from one ear to the other.

• Clients With Certain Head Injuries:  Clients who have certain head injuries might need to get medical clearance from their doctors before doing EMDR.

• Clients Who Are Unable or Unwilling to Adhere to EMDR Therapy Recommendations and the Therapy Frame:  EMDR therapy is a weekly therapy.  There if often a lot that comes up in session and between sessions so if clients are unwilling or unable to come to weekly sessions, they should seek another type of therapy.  In general, consistency in therapy is necessary for any form of psychotherapy to be effective.

• Clients Who are Looking For a "Quick Fix":  Although EMDR therapy tends to be faster and more effective than regular talk therapy, it's not a "quick fix." Some clients come for an initial EMDR consultation with misconceptions about EMDR.  There are a few circumstances where EMDR therapy can be effective in 10-12 sessions.  These circumstances are rare.  They usually involve shock trauma where there were no other traumatic events prior to the shock trauma.  Even when clients come to EMDR therapy thinking that they have no other underlying trauma, in the course of doing EMDR therapy other underlying traumatic experiences might arise that are related to the current presenting problem.   In those cases, it is best to work on the underlying trauma or the client could get emotionally triggered again under similar circumstances (see my article: Beyond the Band Aid Approach to Overcoming Psychological Problems).

• Clients Who Are Engaged in Lawsuits Related to Their Trauma Should Consult With Their Lawyer First:  Clients who have a pending lawsuit are often advised by their attorneys not to do EMDR therapy before their case is settled.  There can be many reasons for this, but one of the main reasons is that if a client goes to trial after the trauma has been resolved, it might be difficult to convince a judge and/or jury that s/he was traumatized because they will not be exhibiting any traumatic symptoms.  This is more of a legal issue than a clinical issue.  However, many clients, who have lawsuits are unaware of this.  So, it's advisable to consult with your attorney first.

• Other Clients Who Need a Significant Preparatory Phase in Therapy Before Processing Traumatic Memories:  Aside from the other conditions already discussed above about clients who would need significant preparatory work, there are other conditions that might require preparatory work and reassessment.  One example of this might be clients who are unable to identify the emotions that they are experiencing.  This is important because in EMDR clients are asked to identify the emotions that they are experiencing now with regard to their traumatic memories.  If clients are so cut off from their emotions, as part of their preparation for doing EMDR, they will need help to identify their emotions (see my article: Experiential Psychotherapy Can Facilitate Emotional Development and Developing Internal Resources and Coping Strategies).  Another example might be clients who have personality disorder traits and who are emotionally unstable.  

Conclusion
EMDR is an evidence-based therapy that can help clients to overcome traumatic experiences.  This includes longstanding trauma that has not responded to other forms of psychotherapy.

There are a few circumstances where EMDR therapy is either contraindicated or where preparatory work, beyond the usual preparation, must be done first in order to determine if clients can do EMDR. This is part of the psychotherapist's clinical and ethical responsibility.

An EMDR therapist continues to assess the client during the initial consultation and throughout EMDR processing for situations that might arise in the therapy where EMDR might need to be combined with other forms of therapy to be effective (e.g., Somatic Experiencing or clinical hypnosis) as part of an integrative psychotherapy.

Although I have included the most common examples of where EMDR therapy is either contraindicated or additional preparation is needed first, there might be a few other circumstances.

Getting Help in Therapy
If you have been struggling with unresolved problems on your own, you could benefit from seeking help from a licensed mental health professional (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Working through your traumatic problems could free you from history and allow you to live a more fulfilling 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.

Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 2

I began discussing this topic in my prior article, Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 1.  In Part 1, I outlined the problems of taking a "band aid" (also known as a "quick fix") approach to resolving psychological problems.  In that article, I discussed the problems involved in only taking psychotropic medication (instead of also attending psychotherapy) or only attending a few sessions of therapy to vent and feel better momentarily without resolving the underlying issues related to the problem.

Beyond the "Band Aid" Approach to Overcoming Problems

In this article, I'll expand on this topic by giving a composite scenario, which is made up of many different cases with all identifying information changed to protect confidentiality:

Ted
Ted had a long history of anxiety that began when he was a young child.

He was the oldest of five children in a family who lived from one crisis to the next.  Both parents worked two jobs and so Ted was usually in charge of taking care of his younger siblings.

Ted's anxiety began when he was a child

Ted, who was too young to take care of siblings, often felt overwhelmed.

He never allowed his parents or siblings to see how anxious he was, so he felt alone with his fears and sense of inadequacy.

Fortunately, by the time Ted went away to college, his family's financial situation had improved substantially so his parents no longer needed to each work two jobs, and Ted was free to go away to college.

But even with the improvement in their financial resources, the family was so accustomed to being in crisis that they would often react to common everyday family problems as if there was a crisis.

Both of the parents came from traumatic, crisis-oriented family backgrounds and neither had ever gone for psychological help, so this pattern was deeply ingrained and passed on from one generation to the next (see my article:  Psychotherapy and Transgenerational Trauma).

While Ted was in college, he often received calls from family members who were reacting to everyday problems as if they were crises.  This exacerbated Ted's anxiety to the point where he wasn't sleeping and he had some difficulty concentrating on his schoolwork.

He had problems concentrating on his work

After suffering several weeks with insomnia and poor concentration, Ted came home to see his family doctor, who placed him on an anti-anxiety medication called Xanax.

For a period of time after that, Ted took Xanax whenever he felt anxious and it helped him to calm down.  But it didn't help him to overcome the underlying issues that were creating problems for him.

One of those problems was that Ted continued to feel deeply inadequate.  What started as a sense of inadequacy about himself as a child trying to take care of his siblings continued into his adulthood in every area of his life.  And, although the medication helped to take the edge off of his anxiety, it didn't change the way he felt about himself.

Even worse, he began to realize that he needed more and more Xanax in order to function, and he knew that he couldn't go on this way.

Ted's doctor referred him to a psychotherapist

With the help of his doctor, he titrated off Xanax, he accepted the doctor's referral for psychotherapy to a licensed psychotherapist, and he attended a few therapy sessions.

During those sessions, he felt better after talking to the therapist and he also developed a basic understanding of why he felt anxious.

Once he felt some relief, he decided to leave therapy against the therapist's advice, believing that his problems were resolved.  But having a basic understanding about his problems wasn't the same as resolving his problems (see my article:  Healing From the Inside Out: Why Understanding Your Problems Isn't Enough).

In addition, his anxiety returned after the "feel good" feelings wore off.  So, he went to see another therapist, who advised that Ted remain in therapy to work through the underlying issues that were causing Ted's problems  But, once again, after he began feeling better, Ted left therapy (see my article:  When Clients Leave Therapy Prematurely).

After repeating this pattern several times with the same results, Ted felt frustrated and discouraged.  He wondered if, perhaps, therapy didn't work for him.  But he spoke with a close friend, who told Ted how sticking with therapy helped him and Ted realized that his pattern of leaving therapy after a few sessions was the real problem.

Getting Help in Therapy

Once Ted accepted this and made a commitment in his next therapy to remain until he worked through the underlying causes of his psychological problems, he was able to work through his problems in therapy with a skilled therapist who was empathetic and supportive.

Getting Help in Therapy
"Band aid" or "quick fix" approaches to overcoming psychological problems rarely work.

Overcoming psychological problems requires a commitment to complete the process beyond "feeling good" temporarily.

If you're struggling with problems that haven't responded to your own efforts or to "quick fix" attempts, you could benefit from the help of a licensed mental health professional who can help you work through your problems beyond just "feeling good."

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

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

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

Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 1

In most cases getting psychological help should be more than just a "band aid" or "quick fix" approach, especially for people who have a history of trauma or who have complex psychological problems.  

Beyond the "Band Aid" Approach to Overcoming Psychological Problems

Unfortunately, the "band aid" approach has been a trend in mental health for the last decade or so and there's no sign that this will change any time soon.

What Are "Band Aid" or "Quick Fix" Approaches to Psychological Problems?

For a variety of reasons, including the heavy promotion of psychotropic drugs by pharmaceutical companies who are making huge profits, many more people, who really need more in-depth psychological treatment, are being encouraged to seek "quick fix" solutions to their problems.

Beyond the "Band Aid" Approach to Overcoming Psychological Problems

The "band aid" or "quick fix" solution often involves just taking medication or a "triage" approach to therapy.

The "band aid" approach is usually inadequate for most people because without psychotherapy, clients don't develop an understanding about their problems, nor do they develop skills to overcome these problems.

Psychotropic Medication Alone Isn't as Effective as Psychotherapy For Many Psychological Problems
While it's true that in many cases psychotropic medication might be necessary to help with stabilization, there are also many more cases where clients are encouraged to rely solely on medication when they could benefit more from attending psychotherapy.

In addition, there are often side effects to psychotropic medication that clients are unaware of before they start taking them.  Some of the side effects are mild, but some are more significant.

Also, what happens when clients want to stop medication (hopefully, in collaboration with their doctor)?

Very often, when people stop taking medication and they haven't attended therapy, they return to their former level of psychological functioning without the medication because they haven't learned, beyond taking a pill, what changes they can make themselves to overcome their problems.

So, in many cases, they resume the medication, and it becomes an endless cycle.

Medication Alone Usually Isn't as Effective as Therapy For Many Psychological Problem

This isn't to say that people should stop taking psychotropic medication without consulting with their doctor.  As I've said, there are particular problems (like schizophrenia or bipolar disorder, to name just two) where medication is necessary.  There are also times when medication can be helpful as an adjunct to therapy.

The problem arises when clients only take medication without attending therapy.

Many people, who rely solely on medication, would benefit more from seeing a licensed psychotherapist.

What is the Triage Approach to Therapy?
Aside from just taking medication, triage therapy is where the client comes to therapy in crisis and the therapist helps the client to feel better momentarily in a few sessions without getting to the root of the problem.

Beyond the "Band Aid" Approach to Overcoming Psychological Problems

For some people, like people who are in war-torn countries or who experience natural disaster, who have limited access to therapy, and who are in crisis, triage therapy might be all that is possible.  In those cases, triage therapy is better than no therapy at all.

But aside from these unique circumstances, the problem with this approach is that, while the client might "feel better" momentarily because she or he vented about the problem for a few sessions, the client has no meaningful understanding of the problem.  In other words, aside from "feeling good" for the moment, nothing substantial has really changed.

When this occurs, these clients feel some relief from their psychological problems which, of course is important, but this relief is usually short lived.  And since nothing of substance has changed for them psychologically, they will often return again and again (either to the same therapist or to a different therapist) when the temporary feelings of relief have subsided.

Temporary Feelings of Relief Can Lead Eventually to a "Revolving Door" Cycle 

This can set up a "revolving door" cycle for many clients.  After many of these attempts, they often get discouraged and feel that therapy "doesn't work" for them.  They don't understand, and no one has ever educated them, that there's no shortcut to making significant changes and that while there might be different forms of therapy that tend to be shorter and more effective than others, the "quick fix" approach of only attending a few sessions usually doesn't work for long.

How Can Psychotherapy Help?

When a skilled mental health professional provides psychotherapy services, it can help clients by:

• providing an empathic and supportive environment where clients feel cared about and understood (for many people, this might be their first meaningful experience of feeling really heard and cared about in their lives)
• empowering clients to understand their problems, including dysfunctional patterns that they keep repeating in their lives
• helping clients to develop the necessary internal resources and skills they will need to make and sustain important changes 
• helping clients to work through and overcome psychological problems 

The "band aid" approach, whether it involves just taking medication or a triage approach in therapy, doesn't do this.

In the next article, I'll give an example to clarify why the "band aid" approach usually doesn't work and how psychotherapy can be beneficial (see my article:  Beyond the "Band Aid" Approach to Overcoming Psychological Problems - Part 2).

Getting Help in Therapy
In the meantime, if you've either tried on your own or you've only ever sought a "quick fix" approach to your problems, you could benefit from attending therapy with a licensed mental health professional who will work with you to empower you in a meaningful way to resolve your problems.

Getting Help in Therapy in a Meaningful Way

Rather than looking for shortcuts that don't work, you could have a more meaningful experience in therapy so you can overcome your problems and live a more fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

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

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

Staying Positive and Focused on Your Goals

Staying positive and focused on your goals, especially long-term goals, can be challenging.

Many people who made New Year's resolutions in January have already given up on keeping their resolutions (see my article: Making and Keeping New Year's Resolutions).

There are many reasons why people, who start out motivated at the beginning of the year, lose their motivation after just a few months or even a few weeks.

Here are some of the primary reasons why people give up on their goals:

Having Unrealistic Goals
Many people have unrealistic ideas about what they can achieve.

New Year's resolutions tend to be about things like losing weight, exercising more or eating healthier.

These are all worthy goals, but the problem arises when people set unrealistic goals, like wanting to lose 50 lbs in a month.  This is an unrealistic and unattainable goal for most people and it sets them up for failure.

In addition to being realistic and attainable, you're more likely to succeed at accomplishing your goals if they're specific, measurable, relevant and time bound.

Engaging in All or Nothing Thinking
When goals are unrealistic and unattainable, people usually become discouraged and give up rather than recognizing that the goal was unrealistic and modifying it.

It becomes an all-or-nothing proposition for them (see my article:  Overcoming All or Nothing Thinking).

Having False Expectations that Accomplishing Your Goals Will Create a "New You"
The idea of people "reinventing" themselves is a part of the American culture.

We read in self help books and hear ads all the time that say that you can create a "new you" if you only lose weight, have whiter teeth or ____________________ (fill in the blank).

This cultural stereotype appeals to people who want a "quick fix" as opposed to people who recognize that change is a process that usually occurs over time.

Avoid False Expectations That Accomplishing Your Goals Will Create a "New You"

When people focus exclusively on external change without focusing on internal change, even when they succeed at their external goal, it's harder to persevere in that goal if they haven't done the psychological work that's necessary to maintain the process.

For instance, I've known people who had lap band surgery to lose weight.

After the surgery, they lost a lot of weight.  But if they didn't work on the psychological issues that triggered overeating, they often either reverted to overeating and got sick or they developed another addictive behavior, like gambling.

Allowing People in Your Life to Discourage You
When you have an important goal, it's important to share your intention with people who are going to be supportive of you (see my article: Beware of Emotional Saboteurs).

Emotional support to accomplish a goal can make the difference between accomplishing your goal or giving up.

Don't Allow Emotional Saboteurs to Discourage You From Accomplishing Your Goals

In an ideal world, everyone in your life would be supportive and encouraging.  But, as most of us know, this just isn't the case.

When you share your intention to accomplish a goal with people who tend to be discouraging, you're exposing yourself to their negative thinking and, possibly, allowing their negativity to derail you.

People who tend to be negative and discouraging aren't always doing it to sabotage you.  Sometimes, without even realizing it, they project their own discouragement about themselves onto you.

If you know you have a healthy, realistic and worthy goal, you have to become more self protective and talk about your goal with other motivated people who are doing positive things in their lives and want the same for you.

Allowing Self Sabotage and Negative Thoughts to Keep You From Accomplishing Your Goals
Even more detrimental than other people's negativity are your own negative thoughts that can creep in so easily, before you realize it, to discourage you from accomplishing your goals (see my article:  Are You Sabotaging Yourself With Negative Self Talk?)

Negative thoughts (also known as negative self talk) can be so insidious and so automatic that, before you know it, you've talked yourself out of pursuing your goals.

Staying Positive and Focused on Your Goals
Remember that change is a process.

Staying Positive and Focused on Your Goals: Change is a Process

Keeping a journal where you write down your progress along the way to accomplishing your goals can help you to stay positive and focused on your goals (see my article:  Are You Able to Celebrate Your Progress or Are You Only Focused on How Much More You Have to Go?).

Along the way, keeping a gratitude journal can also help you to appreciate all that you have to be grateful for throughout the process of working on your goals.

Getting Help in Therapy
It can be challenging to stay positive and focused on your goals even under the best of circumstances, but if you have a history of emotional trauma or there are other psychological issues that are creating obstacles for you, it's even harder.

If you realize that psychological issues are preventing you from fulfilling your dreams, you owe it to yourself to get help.

Working with a licensed mental health professional who has expertise in helping people to overcome psychological issues that create obstacles to realizing your goals can make the difference for you of being successful or falling short of your goals.

Getting help can lead to a more meaningful, fulfilled life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have worked with many clients to help them to overcome emotional obstacles in their lives.

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.

Starting Psychotherapy: Developing a Sense of Psychological Mindedness

What is Psychological Mindedness?
Often, for people who are starting psychotherapy for the first time, there is a misconception that the client comes to see the psychotherapist, explains the problem, and the therapist gives the client "the answer" about what to do. This is what's meant by the client who seeks the "quick fix."

Starting Psychotherapy: Developing a Sense of Psychological Mindedness

Aside from certain specific problems. like coming for clinical hypnosis for smoking cessation, generally, there are no "quick fixes" in psychotherapy. There are certain types of psychotherapy that tend to be faster and more effective than regular talk therapy, like EMDR and clinical hypnosis, for certain problems.

But, generally, psychotherapists don't tell their clients what to do. Unlike counseling, where counselors often give advice, in most cases, psychotherapy involves a self exploration of your internal emotional world. And in order to engage in this self exploration of your internal emotional world, you need to begin with a sense of curiosity that allows you to develop psychological mindedness.

When you develop a sense of psychological mindedness, you're more open and curious about your emotional world. Rather than passively waiting for the therapist to tell you what to do, you become actively involved in your own internal process. I emphasize the word "process" because this is not a one-time event. It's a process that usually unfolds over time.

Developing psychological mindedness involves more than just coming to vent about your problems or "report" on what happened in the last week. When you develop a sense of psychological mindedness, you develop an awareness of your thoughts, feelings and behavior.

If you're working with a psychotherapist who emphasizes the mind-body connection, as I do, you also become more aware of where you feel your feelings in your body. Learning to recognize where you feel your feelings in your body can be very powerful. It helps you to develop emotional insight and not just intellectual insight.

The difference between emotional insight and intellectual insight is that when you have emotional insight, you feel it in your "gut." You have a deeper sense of knowing than you would when you only have intellectual insight and it's just ideas in your head.

When you're psychologically minded, your emotional world as well as your external world around you, opens up for you in a new way. You begin to become more aware and make psychological connections in your life that you wouldn't have made if you remained passively waiting for a therapist (or anyone else) to tell you what to do. Generally, you begin to see more readily what you're doing that's not working for you. You also often see what triggers your behavior, whether it's unresolved issues from the past or something that is going on in the here-and-now.

Being psychologically minded and making psychological connections about your internal world and how you interact with others allows you to start making changes, if you're ready and willing to make those changes.

You might wonder why I would say "if you're ready and willing." After all, if you're coming to see a psychotherapist, doesn't that imply that you're having problems and you want to change? Well, not necessarily.

Often, people begin psychotherapy because the discomfort of having certain emotional problems has become overwhelming. They know that they're emotionally overwhelmed and they don't want to feel that way. They want the emotional pain to stop or the problems to end. But actually going through the psychological process of developing curiosity and awareness so they can make changes in their life is not always what they bargained for.

Once again, the desire for the "quick fix" can be strong, and it might be hard to understand why coming to psychotherapy is different than going for a one-time visit to your medical doctor where your doctor diagnoses the problem, tells you what it is, and gives you a pill or an injection to solve it.

Psychological problems are more complex than most regular medical problems. There are often multiple layers of meaning to your thoughts, feelings and behaviors. So, when your therapist listens to the problems that you bring into your session, he or she is not just listening for a list of symptoms and connecting it to a particular illness that can be readily resolved with a prescription.

Developing Psychological Mindedness as a First Step in Psychotherapy:
So, becoming curious and open to your thoughts and feelings as well as your behavior, and learning to make psychological connections between them is the beginning of developing psychological mindedness. It's a much richer and more rewarding process than if someone just tells you what to do (even if there were someone who actually knew what was best for you). It's the beginning of your psychological process in psychotherapy.

Developing a Sense of Psychological Mindedness in Therapy

Why do I say developing psychological mindedness is just the beginning? The answer is that, in order to make changes, in most cases, you need to take action. Most of the time, it's not enough to just be psychologically minded, understand the problems and stop there. Depending upon the problem, you often need to actually do something to make a change.

Getting Stuck After Developing Psychological Understanding and Before Taking Action:
Many clients in psychotherapy get stuck at the point where they need to take action. Developing a psychological understanding of the problem, while being essential, is not the be-all and end-all of the process. Getting stuck before taking action is common obstacle, but it doesn't need to be a permanent state. It can be a stage in the process that needs to be overcome and clients often do overcome these obstacles if they're willing to stick with the process.

Once again, psychological mindedness can help clients to understand why they get stuck before they take action to change their problems. It can be that they're really not ready yet to make the changes they need to make. It can also be a fear of what it might be like to change and have things be different. There can be so many other factors involved.

A skilled psychotherapist can often help clients to translate emotional insight and psychological understanding into action, but the therapist can't do it for them. When a client gets stuck, patience on the part of the client and the therapist is usually helpful. There might be other underlying issues, possibly trauma, that might not be immediately apparent at first to the client or even to the therapist.

If you're seeing a thearpist who is trained in different forms of psychotherapy, it might be necessary to switch from one form of psychotherapy, like regular talk therapy, to EMDR or clinical hypnosis to overcome the particular obstacles or trauma that have arisen which prevent the client from making the change. But that's a different blog post (see my earlier posts that describe EMDR and clinical hypnosis and how they're different from regular talk therapy).

Learning to be a Psychotherapy Client:
Most clients who begin psychotherapy learn how to be psychotherapy clients as they go along with the help of their therapist. Learning to be a psychotherapy client is a learning process in itself because participating in psychotherapy is different from most anything else that you've ever done before. You might have seen movies or TV programs of people in psychotherapy and, even if it's an accurate portrayal of psychotherapy (and it's often not), when it's your personal psychotherapy, you experience it on a very different level.

When you begin psychotherapy, developing a sense of psychological mindedness can be a challenge. But it's often an experience that allows you to know yourself in a deeper and more fulfilling way. Developing a psychological understanding of yourself involves more than just brief treatment. It involves dedication and patience that develops over time.

As I mentioned earlier, there are certain problems (like smoking cessation) that can be overcome in 3-5 sessions. But for most complex problems, even problems are amenable to EMDR and clinical hypnosis, developing psychological understanding is a process that takes time.

About Me

I am a licensed psychotherapist, hypnotherapist and EMDR therapist in NYC.

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

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