Experiential Therapy: Learning to Sense Emotions in Your Body As Part of Trauma Therapy

One aspect of experiential psychotherapy that's different from regular talk therapy is sensing emotions in the body.  Sensing emotions in the body helps to deepen the work, get to unconscious emotions, and keeps the work in therapy from being just intellectual.  But some clients have difficulty sensing their emotions, especially if they have experienced significant trauma.  So, as part of the preparation phase of trauma therapy, the trauma therapist helps the client to learn to sense their emotions (see my article: The Body Offers a Window Into Unconscious Mind and What's the Difference Between "Top-Down" and "Bottom-Up" Approaches to Trauma Therapy?).

Experiential Therapy: Learning to Sense Emotions in Your Body as Part of Trauma Therapy 

Fictional Clinical Vignette: Learning to Sense Emotions the Body:
The following fictional clinical vignette shows how a client in experiential therapy can learn to sense emotions in the body:

Ellen
After numerous experiences of trying to work through unresolved childhood trauma in regular talk therapy, Ellen decided to try experiential therapy.

Ellen's psychotherapist provided her with psychoeducation about the different types of experiential therapy, including EMDR therapy, Somatic Experiencing and clinical hypnosis, and how each of them used the mind-body connection as part of the healing process.

As part of the preparation phase of trauma therapy, Ellen's therapist asked her to talk about 10 memories where she felt good about herself.  As she thought about it, Ellen had no problem coming up with the 10 memories from all different times in her life where she felt good about herself.  But as she and her psychotherapist went over each memory and her therapist asked her what emotions she felt in her body, Ellen was unable to identify the emotions or where she felt these emotions in her body.

Based on Ellen's traumatic history, as part of her defense mechanisms to protect herself when she was growing up, she learned to numb her emotions.  Unfortunately, as she discovered in her therapy, she not only numbed her anger, fear and sadness, she also numbed her positive emotions.  As a result, she wasn't sure what she felt.

Since experiential psychotherapy is based on being able to identify and experience emotions, Ellen's psychotherapist helped her to begin to sense her emotions in her body by starting with non-threatening situations.

For instance, Ellen had a puppy that she was very attached to from the day that she got him.  Whenever she held her puppy, she could feel how much she loved him and the puppy's unconditional love for her.

Using Ellen's experience with her puppy, Ellen's therapist asked her to close her eyes and imagine that she was holding her puppy.  Then, she asked Ellen to tell her what emotions came up for her and if she was aware of where she felt these emotions in her body.

Ellen had no problem imaging herself holding her puppy and sensing her emotions.  She told her therapist that she felt tremendous love for her puppy, and she felt protective of him.  She could also sense how affectionate her puppy was when he cuddled with her.  When she thought about where she felt her emotions for her puppy, she said she felt them radiating in her chest near her heart.

Over time, as Ellen and her therapist continued to work on other non-threatening experiences where she felt comfortable, she got better at identifying more emotions and sensing where she felt these emotions in her body.

After they had worked on a number of similar experiences, Ellen was ready to work on the 10 positive memories where she felt good about herself as part of the preparation phase of trauma therapy.

But Ellen was concerned that she might be unable to experience the negative emotions associated with her unresolved childhood trauma.  So, her psychotherapist recommended that they start by working on less threatening negative emotions.

She asked Ellen to come up with several memories that were mildly unpleasant.  She suggested that Ellen come up with memories that, on a scale of 0-10 (with 0 being no disturbance and 10 being the most disturbance Ellen could imagine) that were a 3 or 4 on that scale.

In response, Ellen came up with a memory of feeling mildly annoyed when she had to wait on line at the grocery store.  She was able to sense her annoyance and, on a scale of 0-10, she thought that memory was a 3.  Sensing where she felt the annoyance in her body was more difficult.

Her psychotherapist helped Ellen by suggesting that Ellen sense in her body to see where she was holding onto tension.  She also recommended that Ellen first focus on the area between her throat and her gut.  It took Ellen a while before she was able to detect that she felt mild tension in her upper stomach when she thought about that memory.

After they worked on a number of memories that were a 3 or 4, they gradually worked up to memories that were a 5 or a 6 in terms of how disturbing they were.

One such memory was when Ellen and her puppy ran into her neighbor in the elevator, and the neighbor complained that she didn't think the building management should allow dogs in the building because she was allergic to dogs.  Ellen told her therapist that she tried to be pleasant to her neighbor, who was being unpleasant to her, but she felt annoyed with her neighbor.

When Ellen re-experienced that memory and sensed into her body, she felt a constriction in her throat.  She told her therapist that she thought the constriction in her throat was probably related to wanting to argue with her neighbor but holding back.

Gradually, Ellen and her psychotherapist continued to work on increasingly difficult memories to help Ellen to identify and sense the emotions related to these memories in her body.  She was also expanding her window of tolerance for unpleasant emotions.

Experiential Therapy: Learning to Sense Emotions in Your Body As Part of Trauma Therapy

After a while, Ellen felt comfortable enough to be able to handle the difficult emotions that were associated with her unresolved childhood memories, and she and her psychotherapist used EMDR therapy to do trauma therapy (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Conclusion
Experiential psychotherapy involves identifying emotions and sensing where these emotions are in the body.  This deepens the work and keeps the therapy from being just an intellectual exercise.  It also helps to get to underlying emotions.

Many people, who have unresolved trauma, are unable to identify and sense emotions in the body related to traumatic memories.  This is due to the protective nature of the defense mechanisms they used as children, including emotional numbing, which was useful at the time to keep them from being overwhelmed, but isn't useful as an adult.

Usually, the more traumatic the memories are and the more defended these individuals had to be at the time, the more difficult it is to identify emotions and to be aware of the body.

As part of the preparation phase of trauma therapy, a trauma therapist can help clients to begin to identify non-threatening emotions, at first, as they gradually work their way to more challenging emotions.

By being aware of emotions in the body related to traumatic memories, clients in experiential psychotherapy are better equipped to gradually work through these difficult emotions to resolve the trauma.

Getting Help in Therapy
Unresolved traumatic experiences will remain a part of your experience to be triggered at any time.

Getting help from an experienced trauma therapist can free you from your traumatic experiences, so you can live a more fulfilling life (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than suffering on your own, you owe it to yourself to get the help that you need.

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, and I have helped many clients to overcome their traumatic experiences.

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.

When Idealized Heroes Falter

As a psychotherapist in New York City, who is a trauma specialist, I often hear from adult clients how disappointing it was for them as children, and even as adults, when their idealized heroes faltered.

When Idealized Heroes Falter

This topic often comes up when I'm preparing a client to do attachment-related EMDR therapy (see my article: How EMDR Therapy Works: EMDR and the Brain), and it's an opportunity to work through these issues.

As part of the preparation, I help clients to imagine a safe or relaxing place.  I also ask clients to come up with three people (real or imagined) who embody the qualities of being powerful, nurturing and wise.  I also offer the possibility, if they prefer, to name one person who embodies all of these qualities.

This is the resourcing part of the preparation phase of EMDR, and the three real or imagined people are used later on in EMDR processing, if necessary, as imaginal interweaves (as developed by EMDR expert, Laurel Parnell, Ph.D.).

Specifically, during the processing phase of EMDR, clients might run into difficulty and need to imagine one or more of the qualities embodied by these people to get through a difficult part of the trauma work.  Often these interweaves aren't needed if the processing of the trauma is going smoothly, but it's good to have them already set up before the processing of the trauma begins.

Depending upon their traumatic history, some clients struggle to come up with real or imagined people and I help them to come up with people who are meaningful in their lives either in the present or in the past.

It's often at that point that clients will talk about idealized heroes that disappointed them at some point in their lives, especially as children.

Sometimes, if these clients didn't process these disappointments with anyone before, their perspective about their disappointment can remain childlike, which is understandable because it's as if the disappointment is frozen in time.

At that point, it can helpful for a psychotherapist to help the client to develop an adult perspective about the former idealized hero who faltered, one that includes empathy and compassion if that's possible (see my article: Looking at Your Childhood Trauma From an Adult Perspective).

Fictional Clinical Vignette: When Idealized Heroes Falter
The following fictional vignette illustrates how an adult client in therapy can come to terms with his his disappointment about an idealized hero from his childhood:

Tom
Tom was in his early 40s when he began attending psychotherapy to deal with a traumatic history of emotional abuse.  He said he never thought he would come to therapy, but he realized that his history of emotional abuse was getting in the way of his having a relationship and he couldn't ignore it anymore.

After the initial consultation and sessions about his family history, the therapist explained EMDR therapy to Tom, including the various phases of EMDR.  They began the resourcing phase, which included coming up with a relaxing place and the three imaginal interweaves mentioned above (wise, nurturing and powerful people who are either real or imagined).

Since Tom experienced childhood emotional abuse by his father, it wasn't surprising that he had problems coming up with the imaginal interweaves because his whole world had been turned upside down by the emotional abuse.  The therapist told Tom that they could forgo this part of the preparation if he preferred, but Tom said he wanted to do this part and he would think about it between therapy sessions.

When he returned for his next psychotherapy session, Tom told his therapist that he remembered something that he hadn't thought of in a long time:  His disappointment in a neighbor, Jim, who was someone that Tom looked up to as a child and who was a friend and a hero to him.

Tom said that Jim lived with his wife in the same apartment building in Brooklyn where Tom and his family lived.  Jim was a mechanic and he had his own business a few blocks away from the apartment house.  He and his wife had no children of their own, but all the children in the neighborhood who knew Jim liked him.

On his days off, Jim would coach Little League games.  He was also active in the community, and he was instrumental in helping to set up the Police Athlete League (PAL) in Tom's neighborhood so the children had a place to play and learn.

The times that Tom liked best was when he and Jim would sit on the stoop to talk.  Tom felt he could talk to Jim about almost anything.  They would spend hours sitting on the stoop talking about sports, school, homework or whatever topic came up.

Tom never confided in Jim about how emotionally abusive his father was, but Tom sensed that Jim knew and that he was compassionate towards Tom and tried to be emotionally supportive.

Jim also talked about how when he was 18, he joined the Marines to get away from a difficult home life.  Afterwards, he said, he trained to be a car mechanic, met the woman who would eventually become his wife, and opened his own business with a partner.

Tom told his psychotherapist that from that day on Jim became his hero, and listening to Jim speak gave Tom hope that one day he would overcome his current circumstances at home.  It was at that point that Tom began talking to Jim about what he might want to do when he grew up.  It was the first time that Tom ever allowed himself to think he might be happy in the future.

Tom's friendship with Jim continued from the time Tom was in elementary school until he graduated high school.  It was Jim who encouraged Tom to participate in sports in high school and to apply to colleges.

Then, one day, when Tom came home on Spring break from college and he went to visit Jim, Jim's wife opened the door and told Tom that Jim wasn't there.  When Tom asked her where he was, she told Tom to come in and sit down.

After they sat in silence for what seemed like an eternity to Tom, Jim's wife lowered her eyes and told Tom that Jim was incarcerated for embezzling money from the business that he and his partner owned.  His partner pressed charges, and Jim admitted that he took the money.

When she raised her eyes, she could see that Tom was shocked and she said, "I know you idolized Jim.  I'm sorry to have to tell you this, but I thought it would be better for you to hear it from me."

He remembered that after she told him about Jim's incarceration, all he could say was, "But why?  Why did he do it?"

"There's no excuse for it, Tom," she said, "We were going through hard times financially.  After he was caught, he told me that he did it and planned to pay back every penny that he took, but he was caught before he could do that.  I can't believe it myself. It's so out of character for Jim."

Tom told his psychotherapist that prior to going home on Spring break, he had been out of touch with Jim for a few months, so he knew nothing about this until Jim's wife told him.  After he got over the shock, he felt deeply angry with Jim.

He thought about all the times that Jim talked to Tom about honesty and integrity.  After he heard what Jim did, all he could think was that Jim was a hypocrite and he was foolish for ever befriending Jim and believing in him.

He told his psychotherapist, "He was my hero.  He would have been the one that I would have chosen as a 'powerful' person, if he didn't end up going to prison.  After I found out what happened, I didn't make an attempt to ever reach out to him again."

Tom's psychotherapist could tell that, even though Tom was in his early 40s, he was stuck. His reaction to Jim was coming from his adolescent self and not his adult self.

They spent several sessions talking about how disappointed Tom was in Jim, and how he never saw Jim again, even after he got out of prison.  Eventually, Jim and his wife moved out of the neighborhood and Tom had no idea where they went.

Over the course of the next several sessions, Tom continued to talk about his feelings, and he mentioned that he was also having dreams about Jim.  His psychotherapist helped Tom to see that anger towards Jim covered over his deep sadness and disappointment (see my article: Discovering That Sadness is Often Hidden Underneath Anger).

Gradually, Tom began to see that, although what Jim did was wrong, Jim was human and he made a mistake.  He also realized that Jim never meant to hurt anyone and he must have been desperate to steal the money from his partner, even if he planned to pay it back, as his wife said.

Tom began looking at his relationship with Jim from an adult perspective.  His attitude towards Jim softened, and he was able to see that, even though Jim made a mistake that he paid for by going to prison, Jim helped him in many ways.  He realized that he probably wouldn't have studied as hard and gone to college if it hadn't been for Jim.  He also realized that Jim fulfilled an important role in his life at a crucial time, and he was grateful for that.

With that, Tom and his therapist were able to go on to complete the preparation phase of EMDR and process his childhood trauma of being emotionally abused by his father.

Eventually, Tom found out where Jim and his wife lived and sent Jim a letter expressing his gratitude for all that Jim had done for him when he was a child.  A few weeks after that, Jim invited Tom over to reconcile their friendship.

Tom could see that Jim had aged a lot since he last saw him more than 20 years ago, but he still had the same warm smile.

Jim acknowledged to Tom that he was wrong for stealing the money, regardless of his financial circumstances.  He also apologized to Tom for disappointing him.   Jim told him that when he was in prison, he often thought about Tom and some of the other children in the neighborhood, and he knew that he let them down.

Tom could tell that Jim was deeply affected by their reconciliation, and Tom felt the last vestiges of his anger slipping away.

Conclusion
People who are idealized heroes in our lives are human and have flaws, just like anyone else.

Even comic book superheroes have flaws: Clark Kent, who was Superman in the comics, comes to mind with regard to his powerlessness around kryptonite.  Despite his courage and superhuman  abilities, deep down he felt like an outsider because he was an orphan.  Those were feelings that he kept to himself.

Coming to terms with the faltering of an idealized hero can be difficult for a child, and it can even be difficult for an adult looking back on his experiences with a hero.

Parents can talk to a child about mistakes that the child made as a way to help the child to see the humanity in the child's hero.  But when there's no one for a child to process these feelings with, these feelings often remain frozen and somewhat childlike.

With the help of a psychotherapist, a client can look back on his disappointment that his hero faltered and learn to develop empathy and compassion.  He can also learn that it's not an all-or-nothing experience, and he can still appreciate and be grateful for all that was positive in their relationship (see my article: Overcoming All or Nothing Thinking).

Getting Help in Therapy
Psychotherapy can help you to work through traumatic experiences from your past so that you can free yourself from the trauma in your history (see my article: The Benefits of Psychotherapy).

Rather than suffering on your own, you can get help from a licensed mental health professional who can assist you to overcome a traumatic history so you can lead a more fulfilling life (see my article: How to Choose a Psychotherapist).

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

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.

Using Imagery as a Powerful Tool in Trauma Therapy

In prior articles, I discussed how developing internal and external resources are helpful in processing psychological trauma.

See my articles: 

Developing Internal Resources and Coping Skills, Coping Strategies in Mind-Body Psychotherapy

The Therapeutic Benefits of Integrative Psychotherapy

Understanding Your Shifting Self States).   

One of the many resources that I use when doing trauma therapy is imagery, which is the subject of this article.

Using Imagery as a Powerful Tool in Trauma Therapy

As an integrative psychotherapist, I often combine various treatment modalities when it's beneficial to  the individual client.

The key to being able to combine treatment modalities in an integrative psychotherapy is to have a good foundation in a particular type of psychotherapy and professional training in the other modalities.

As I've mentioned in other articles, my original postgraduate training is in psychoanalysis and psychodynamic psychotherapy, and I work in a contemporary, dynamic and interactive way.

After using psychoanalysis and psychodynamic psychotherapy for several years, I could see that it had certain limitations--just as all therapy modalities do.

Although my personal experience in psychoanalysis was very effective in helping me to resolve traumatic experiences, that was nearly 20 years ago, times have changed and most clients don't want to come to therapy for multiple sessions per week for several years as I did.

Once a week psychoanalysis/psychodynamic psychotherapy, which is now the norm, lacks the same intensity as multiple sessions per week.  As a result, the transference/countertransference issues are not as intense, and generally it takes longer in once a week sessions to resolve trauma.

This is what prompted me to study EMDR Therapy, clinical hypnosis and Somatic Experiencing.

For many clients, who don't want to wait years for relief from their traumatic symptoms, these therapy modalities work faster than psychoanalysis/psychodynamic therapy in helping clients to overcome trauma.

This doesn't mean that I don't use my psychodynamic understanding while working with a client.  I still listen and pay attention for the client's unconscious process and transference/countertransference issues as I integrate other forms of therapy.

Before I go into how I use imagery, I want to clarify that the client doesn't need to be good at visualizing to use imagery.

Many clients, who say they can't visualize, are able to get a "felt sense" of images and this is just as useful in therapy.  Other clients who have difficulty visualizing have other senses that work, including an intuitive sense of the image, which can be very powerful.

Using Imagery as a Powerful Tool in Trauma Therapy
Imagery is a powerful resource in psychotherapy, especially when working with psychological trauma.

Imagery comes alive when the therapist helps the client to amplify and enhance the imagery.

The following fictional vignette demonstrates how imagery helps to process trauma:

Nick
Nick started therapy because he was having a difficult time asserting himself in his marriage and in his work-related relationships.

Using Imagery as a Powerful Tool in Trauma Therapy

He told his therapist that ever since he was a child, he lacked confidence in himself and this lack of confidence had a profound effect on his life.

In his personal relationships, before he got married, Nick had a hard time asserting himself when he was attracted to a woman.  Throughout college, he had difficulty feeling confident enough to ask women out on a date.  Most of the time, he would go out with women who asked him out.

In his senior year, he met a woman, Jenna, that he really liked. He lacked the self confidence to ask her out, but he soon discovered that she was interested in him when Jenna asked him to go out for dinner.

Jenna was the one who initiated sex and, 10 years later in their marriage, she was still the one who initiated sex and all their activities, including social activities and vacations.  This was causing problems in their relationship because Jenna complained that she was tired of always being the one to take charge.  She wanted him to take charge sometimes.

Nick understood why Jenna was unhappy with his lack of assertiveness, but he didn't know how to change.

Nick was also having problems advancing in his career.  Other people that he trained and who knew less than Nick, were getting promoted into more senior positions because they knew how to advance their ideas and themselves with their superiors.

When Nick discussed his family history with his therapist, he described a neglectful and critical parents.  He was the younger of two sons, and his parents tended to dote on their older son and to ignore or criticize Nick.

They often compared Nick unfavorably to his older brother, John, and generally discouraged Nick.

Over time, Nick felt that he had nothing of value to offer, and he tended to remain quiet while his older brother got all the praise.

He often felt as a child that he was "a mistake" and that his parents didn't really want to have another child.  This was confirmed by his mother in a tactless admission on her part when Nick turned 21 and left home.

Until he began therapy, Nick never associated this critical, neglectful parent with his lack of confidence and assertiveness.  He also never realized that he had been traumatized by these early experiences.

As he discussed this with his therapist, he said this made sense to him, but he asked, "Now that I know this, how can I change it?"

Based on her experience as a trauma therapist, his therapist told Nick that, although his awareness was an important step, it was only the first step.  She recommended that they revisit his memories using imagery as a tool in trauma therapy.

One of Nick's touchstone memories was of his father telling Nick to "Be quiet" when he wanted to tell his family about an award he received at school for a science project.

Not only did his father tell Nick to "Be quiet," he also told him that "No one's interested in hearing about your award." Then his father turned to Nick's older brother, John, and asked him how his day went at school, and both his father and mother listened to John with admiration.

As a result of many similar experiences with his parents, Nick felt "I'm not important" and "I'm powerless."  These feelings remained with him as an adult.

Nick's therapist recommended that they use imagery to go back to that touchstone memory to see how Nick's experience of himself might change if he could imagine himself having a powerful ally in that situation.

At first, Nick couldn't think of anyone to be an ally to rework this memory.  Then, he remembered his science teacher, who recommended Nick for the award and who often complimented him on his work.

His therapist asked Nick to go back into the touchstone memory and to imagine what his science teacher might have said if he had been with Nick when his father told Nick to be quiet.  She asked Nick to describe the scene in the present tense.  She also helped Nick to amplify the imagery so he could experience it more vividly.

Nick closed his eyes and imagined himself back at home with his family.  He also imagined that he invited his science teacher, Mr. Ross, to dinner that night and Mr. Ross was sitting next to Nick when Nick brought up his science award, "Mr. Ross is there sitting next to me.  When he hears my father tell me to be quiet, he interrupts my father and says, 'Now wait a minute--this is a very important award at the school and Nick's science project was by far the best project the school has seen in years.  I can't sit here and allow you to be dismissive of Nick and this wonderful honor.  Nick deserves much better than this.  I don't have children but, boy, if I had a son like Nick, I would never tell him to be quiet.'"

Nick's therapist could see that Nick's demeanor changed as he imagined Mr. Ross standing up for him.  His chin was raised, his posture was more erect and he had a smile on his face.

Then he explains to his therapist, "Both of my parents have always had a lot of respect for teachers, and they liked Mr. Ross so they would listen to him.

Then Nick goes back into his memory, "So, when they hear Mr. Ross say this, both of my parents look embarrassed and they look at me in a different way.  Then, my father says, 'I'm sorry for interrupting you, son.  Tell us more about your award."

Nick's therapist helped Nick to amplify the shift he was experiencing and to anchor that new feeling in his body.

Nick and his psychotherapist did many similar exercises in therapy using imagery for other traumatic touchstone memories.

Using Imagery as a Powerful Tool in Trauma Therapy

Gradually, Nick was able to internalize the feeling that he is a worthwhile and lovable person.  Over time, as he gained more confidence in himself.

To his wife's delight, he took more of an initiative in terms of their sex life and social activities together.

With regard to his career, Nick and his therapist used imagery to rehearse scenes with his manager where Nick would be more assertive in advancing his ideas.  This allowed Nick to present himself and his ideas with increased confidence, which resulted in praise and promotion with a substantial pay increase.

Conclusion
Every client is unique and their needs in therapy are different, which is why it's helpful for therapists to have a number of different modalities to use to help clients to overcome their problems.

Imagery can be a powerful tool in trauma therapy.  It is one of many tools that trauma therapists can use to help clients to transform traumatic experiences.

When clients use imagery in therapy to imagine the help of powerful figures, such as mentors, wise people, nurturing people or whatever type of figure would be helpful, this can help to create new neural networks in the brain that facilitate change.

Using imagery can help clients to see themselves in a different way and allows them to transform their unresolved trauma.

Getting Help in Therapy
If you have unresolved traumatic experiences, rather than continuing to suffer on your own, you could benefit from working with a trauma therapist (see my article: The Benefits of Psychotherapy).

Once you're free of your trauma, you will have a greater sense of well-being and lead a more fulfilling life (see my article: How to Choose a Psychotherapist).

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

I work in an integrative way depending upon the needs of each client.

One of my specialties is helping clients to overcome trauma, and I use many creative therapeutic tools, including imagery.

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.

See My Other Articles About Psychological Trauma.

Developing Coping Strategies in Therapy Before Working on Trauma

Many people, who have a traumatic history, avoid coming to therapy because they fear being overwhelmed (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious and Ambivalent).

That's why it's so important for psychotherapists to help clients develop coping strategies while working on emotional trauma so that they can overcome their fears and do the therapeutic work without becoming overwhelmed.

Developing Coping Strategies in Therapy Before Working on Trauma 

Before any trauma work begins in therapy, a skilled therapist will help clients to develop the internal resources needed to do the work.

Some clients, who engage in meditation, yoga or other mind-body oriented practices, might already have some internal resources.

Other clients, who might not know how to soothe themselves, will need help from a psychotherapist on how to develop these internal resources.

Internal resources are an important part of preparing to do trauma work.  They allow the client to switch, if necessary, from disturbing memories of trauma to relaxing places within themselves to take a break before resuming the processing of the trauma.

Knowing that they have a way to soothe themselves helps most clients to feel that the trauma work in therapy is manageable so they don't approach the work with overwhelming fear.

Unfortunately, many people who need help to overcome traumatic experiences don't know that skilled trauma therapists facilitate the internal resourcing process, so they avoid coming to therapy because they're too afraid of being overwhelmed.

If they do eventually come to therapy, it's often at the urging of a spouse, their doctor or their employer because the unresolved trauma is causing problems in other areas of their life.

Let's take a look at a fictionalized scenario that addresses these issues, which is representative of many similar cases, and I'll discuss how I work:

Tom
Tom sought therapy for the first time at the age of 35 at the urging of his wife and his medical doctor.

Despite growing up in a highly dysfunctional family where his mother gambled and his father was physically abusive with everyone in the family, including Tom, Tom did very well in college.

Developing Coping Strategies in Therapy Before Working on Trauma 

He established himself in a successful career, he got married and had two children.

Judging from outer appearances, anyone would think that Tom was leading a happy and successful life.  Having a loving wife and children and everything that he needed on a material level, he seemed to be living the American dream.

But, despite external appearances, Tom's inner life was in a state of chaos.  He was good at hiding his anxiety and deep sense of low self worth so that no one would have guessed at his deep unhappiness--except his wife and his doctor, who knew about Tom's panic attacks, anxiety-related stomach problems and his frequent nightmares about the childhood physical abuse he experienced at the hands of his father.

As time went on, Tom experienced an increasing disconnect between the happy facade that he managed to put on for friends and colleagues and his deep unhappiness.

His doctor, who knew Tom and his family for many years, provided Tom with psychoeducation about the Adverse Childhood Experiences Study (ACE) and talked to Tom about how his unresolved trauma from childhood was affecting him now (see my article:  Overcoming Childhood Trauma).

After Tom learned about the ACE study from his doctor, he was amazed that his experiences from so many years ago were still affecting him.

Before he learned about the ACE study, he felt like there was wrong with him since he have everything that he ever wanted, but he still felt anxious and insecure.

His doctor also told him that he could resolve his childhood trauma by getting help in therapy with a psychotherapist who specializes in working on trauma.

Tom was hesitant about seeking help in therapy.  He was afraid that he would be overwhelmed in therapy if he had to delve back into his painful childhood memories.  At the same time, he knew that he needed help.

If Tom came to see me for a consultation, I would explain how I work with clients who have unresolved trauma.

Before processing any traumatic memories, I would get a thorough history of the trauma and family of origin dynamics.  I would also develop an understanding of how the trauma affected him in the past and the present as well as his fears about how it could affect him in the future.

I would help Tom to develop coping skills which, in experiential therapy, is called "resources."

Most clients who come to therapy to work on trauma are usually relieved to hear that I help clients to develop coping tools before any processing of trauma begins.

Resourcing for Tom could include, among other things, helping him to learn how to meditate, learning to discover a "safe or relaxing place"within himself, working to help him integrate and reinforce positive memories about himself as well as helping him to develop imaginal interweaves, which involve imagining nurturing, protective and powerful figures in his life  (see my articles:  Why is EMDR? and Empowering Clients in Therapy).

Developing Coping Strategies in Therapy Before Working on Trauma

Usually, as I help clients to process their trauma using experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis, clients begin to experience and understand the connections between their current problems and their unresolved problems from childhood.

Experiential therapy is usually successful with helping clients to overcome trauma more effectively than regular talk therapy.

Getting Help in Therapy
People with unresolved trauma often don't realize that their fears of working on their trauma in therapy are usually based on events that already occurred in their life.

As adults, we all have a much greater emotional capacity to deal with trauma than we had as children.

When you look for a therapist, ask her how she works (see my article: How to Choose a Psychotherapist

In addition to finding a therapist who is a trauma expert, you also want to sense that the therapist is empathically attuned to you (see my article: A Therapist's Empathic Attunement Can Be Healing For Clients).  This could take a few sessions to determine.

In my professional opinion, experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis are the most effective forms of therapy for most people who have unresolved trauma (see my article: Experiential Therapy Helps to Achieve Emotional Breakthroughs).

Rather than continuing to suffer on your own, get help from a licensed mental health professional who is a trauma expert and who uses experiential therapy.

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

One of my specialities is helping clients to overcome emotional trauma.

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.

Untreated Emotional Trauma is a Serious Issue: Part 4: Starting to Process the Trauma in Therapy

I've written three prior articles on the topic of untreated emotional trauma, including: 

Part 1:  The Negative Consequences of Untreated Emotional Trauma

Part 2: Understanding the Impact of Untreated Emotional Trauma

Part 3: Starting Therapy to Deal With Untreated Emotional Trauma.

Untreated Emotional Trauma: Starting to Process the Trauma in Therapy

To understand how, as a trauma therapist, I help clients with psychological trauma, in my last article I discussed the resourcing phase of treatment during the initial stage of therapy.  As I mentioned, the purpose of the resourcing phase is to help clients to develop internal resources, also known as coping skills, to deal with the processing phase of psychological trauma.

In this article, I'll continue with the vignette about Joe, who represents a composite of many different clients who have come for trauma therapy, and I'll look more specifically at the initial stage of processing the trauma in treatment.

Joe
Joe made progress during the resourcing phase of trauma therapy to the point where, instead of automatically lapsing into dissociation (i.e., "zoning out" or numbing himself emotionally) whenever he felt emotionally uncomfortable, he was able to tolerate remaining present more often.  There were still times when he dissociated somewhat, but he was somewhat more resilient now as compared to when he first started treatment.

He practiced the Safe Place Meditation that he learned in our prior therapy to help calm and soothe himself.  He also practiced the Square Breathing exercise I taught him to help him relax.  In addition, he mentally rehearsed positive memories from his life and noticed how focusing on these memories often shifted him from a state of anxiety to a more relaxed state.

Beyond Developing Coping Strategies:  Why Process the Trauma?
At this point, many clients often ask why, if they've learned better coping skills, they need to process the trauma.  They want to know:  Isn't it enough to be able to know how to cope when they feel upset?

Usually, what I tell clients is that, even though they've gotten better at dealing with uncomfortable feelings by developing better coping skills, the traumatic memories are still there to be triggered in their current life.

In other words, it's great to be able to calm yourself, learn to relax and shift your emotional state from one of anxiety to a more relaxed state, but you're still vulnerable to getting emotionally triggered whenever what would normal trigger you emotionally in the present.

Getting back to Joe:
Now that Joe had developed better internal resources, we were ready to process his psychological trauma which stemmed from an early childhood history with his father, who was often rageful and drunk.

As part of the earlier psychoeducational phase of our work together, Joe had already begun to develop intellectual insight into the affect that his family history had on him.  Now, it was time to help Joe to understand his trauma in a more integrated way where his understanding wouldn't be just intellectual.

In this phase of treatment, he would develop more of an integrated felt sense for the impact of the trauma and work through the trauma so it would no longer affect him.

Starting to Process Psychological Trauma
I have different ways of treating psychological trauma that are part are considered mind-body oriented psychotherapy, including EMDR, Somatic Experiencing, and clinical hypnosis.

My clinical expertise told me that it would be best in Joe's case to start with EMDR, Eye Movement Desensitization and Reprocessing, which has a structured protocol, developed by Francine Shapiro, Ph.D., in the late 1970s as a treatment specifically for trauma.

EMDR has eight phases of treatment, which you can read about in more detail on the EMDR website. Joe and I had already completed the history taking and resourcing phases of treatment, and we were ready to start the processing.

I asked Joe to bring in 10 memories that related to his traumatic experiences with his father, and after we went over these memories, I asked him which one still had the most emotional charge for him.  Joe responded immediately by choosing a memory from the time he was five years old.

He told me about the memory:  His father became enraged with him after Joe accidentally dropped a crystal vase that had been in his father's family for many years.  Joe's mother had given Joe permission to look at the vase, which his mother had placed on the dinning room table as they waited for guests to arrive for dinner.  She told Joe that he could look at it, but she also told him not to touch it.

Being a curious boy, Joe waited until his parents left the room and then he picked up the vase so he could look at it more closely.  But when his father came into the room and yelled at Joe for touching the vase, Joe got so startled that he dropped it and it shattered beyond repair.

When Joe's mother saw the father running towards Joe to hit him with his belt, she stepped between them and told the father not to hit Joe.

Then, a big argument ensued between between his parents where his father came close to hitting his mother.  But, instead, the father grabbed Joe, dragged him into another room, locked the door so his mother couldn't intervene, and he spanked Joe hard with his belt.

This was Joe's earliest traumatic memory and it also had the most emotional charge for him of the 10 traumatic memories that he brought in.

The importance of choosing an early memory with the most emotional charge is that, by working on this memory with EMDR, the work can have generalizable effects so that, ideally, a trauma therapist doesn't have to work on every traumatic memory.

As we worked on developing the EMDR protocol, which included identifying an image that represented this memory, the emotions that go with this memory, where Joe felt these emotions in his body (an important mind-body aspect of EMDR that helps to make it a more integrative experience), Joe came up with another part of the protocol, which was the negative feeling that he had about himself in relation to this memory (called the Negative Cognition in EMDR) and that was:  "I feel powerless."

Joe realized that feeling powerless was a feeling he carried around with him much of the time without even realizing it.  He also realized that this was how he felt whenever he was in social situations or when he even thought about allowing others to get close to him.  He sensed this not just in an intellectual way--he had a felt sense of it.  In other words, he felt it on a visceral level.

This is an important part of EMDR and other mind-body oriented types of therapy as compared to talk therapy.  Clients often say they have a more visceral sense of their problem when they're being treated with a mind-body oriented therapy, and this gives them a more holistic sense of their problem.

So, when we talked about how he would like to feel about himself when he completed therapy, he said, "I would like feel more empowered in my life."  So, this gave us a goal to work towards in our work together.

As part of the EMDR protocol, the trauma therapist asks the client about their current subjective experience of the memory.  So, I asked Joe how disturbing this memory was for him now on a scale of 0-10, and he said it was a "9," which is very disturbing.

When I'm doing EMDR, I often use a small device called a Tac/Audio Scan that clients hold in their hands.  It provides the bilateral stimulation in EMDR that helps to process the trauma.

So, Joe held the Tac/Audio Scan tappers in his hands and began by focusing on the image that he had chosen that represented this memory for him, which was the locked door in the room where his father dragged Joe.

An Obstacle in Processing the Trauma
Over the next few months, Joe made progress in processing this traumatic memory.  There were times when he felt the need to imagine an "ally," in addition to having me there with him helping to process the memory.  So, he imagined that his former coach and mentor was sitting next to him and he felt empowered with this imagined presence.

But, after a while, Joe began "looping" in his processing of the memory.  Even though his subjective experience of his disturbance about the memory was now a "5" instead of a "9," he couldn't seem to go beyond this.

Part of the goal of EMDR is to process the memory so it's no longer disturbing to the client, ideally getting to a subjective disturbance that the client feels as being either a 0 or 1 (on a scale of 0-10).

As we talked about what was happening for Joe at this stage of the therapy, he said that he had just realized that part of the memory was that, even though he was terrified of his father and the beating hurt, he was willing to take the beating because he felt that, by enduring the beating, he had spared his mother from getting beaten up by his father.

As an adult, Joe knew objectively that this was probably a distortion in his thinking as a child because there were plenty of times when his father hit his mother.  His father could have hit his mother on that day too if he wanted to but, on that day as a child, Joe felt he made this sacrifice for his mother.  And, now that we were processing the memory, there was a part of him that was ambivalent about letting it go.

He recognized that a part of himself felt this way even though this was probably a rationalization that he created in his own mind as a child to console himself about the beating.

This obstacle in the treatment was another example of how Joe (or anyone of us) can know something on a objective, logical level and yet, what we feel on an emotional level can be very different, and it can become an obstacle in the treatment.

I tried a common method in EMDR called a "Cognitive Interweave" where Joe tried to think of the incident as having occurred to another small boy, instead of to him:  Wouldn't he feel that this person, who is now an adult, deserves to be free of the effect of this traumatic memory?

Joe responded that he would, if it was someone else.  He felt that clearly.  But when he thought of it for himself, he couldn't overcome that part of himself that felt he had taken this beating to spare his mother from being hit by the father.

And if we processed the memory so that it was no longer disturbing, he felt that, on some level, it would take away from what he did for his mother.

Bumps in the road in trauma therapy are very common, and it helps if the trauma therapist has different ways of working to overcome these obstacles.

In a future article, I'll continue this discussion and discuss a particular intervention which is often helpful for overcoming obstacles in trauma therapy.

Getting Help
If a traumatic past is having a negative impact on you now as an adult, help is available to you if you work with a licensed mental health professional who is a trauma therapist.

Processing the trauma will help to free you from history that is creating obstacles in your life now.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.  I have helped many clients to overcome psychological trauma.

I also work adjunctively with clients who are already in therapy with a therapist that they want to remain in therapy with but who might not be trauma therapists.  

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.

Untreated Emotional Trauma is a Serious Issue: Part 3: Starting Therapy

In two prior articles, I began a discussion about the effects of untreated emotional trauma:  Part 1, Untreated Emotional Trauma is a Serious Issue With Negative Consequences  and Part 2 of this topic, Understanding the Impact of Untreated Emotional Trauma.

In the current article, I'm continuing the discussion about the case I began discussing the last time about Joe, which, as always, is a composite of many different therapy clients to protect confidentiality.

Joe
Joe was considering attending psychotherapy because he was having a hard time allowing people to get close to him.  At that point, he knew that something was wrong because he wanted very much to have close friends and to be in a relationship, but his fear of allowing people to get close to him was the major obstacle for him.

His emotional dilemma was that he felt trapped--his longing for emotional connection and his fear of getting close to others kept him in an internal state of conflict, and he saw no way to overcome this on his own.

Untreated Emotional Trauma is a Serious Issue: Starting Therapy

For years, he had been ambivalent about starting therapy, but when he thought about whether he wanted to be stuck in this emotional dilemma of wanting but fearing closeness, he knew, no matter how fearful he felt about going to therapy, he needed to get help because he didn't want to look back on his life when he was older and regret that he remained fearful, alone and lonely.

His doctor, who had been encouraging Joe to go to therapy for several years, referred Joe to me because he knew that I'm a trauma therapist.

The Initial Stage of the Therapy Consultation
I encouraged Joe to come in for a therapy consultation to see if he felt comfortable enough with me so we could work together.  I also use this first session to get an overview of a client's problems and for the client to ask whatever questions he or she might have about the therapy process, how I work  or about my professional background as a psychotherapist.

Although Joe was anxious, he was comfortable enough to come to weekly sessions.  During the initial sessions, we discussed his his family background, which included a father who had alcohol problems and who was physically abusive.

Psychoeducation About Psychological Trauma
I knew that Joe wasn't making the connection to how his early childhood trauma was affecting him now in his adult life.  Like many people, Joe assumed that, because these problems occurred years before, they weren't connected to his current problems.

So, I started, as I usually do, with providing Joe with psychoeducation about how early trauma can affect people in their adult lives, including the connection to fears about emotional intimacy.

Understanding Psychological Trauma Intellectually vs Overcoming the Trauma
I could tell that Joe understood this intellectually, but it didn't resonate with him emotionally.

I also knew that just talking about his early emotional trauma in therapy wouldn't be enough for Joe to overcome his problems.

In other words, if we only used talk therapy, Joe would make intellectual connections and he would develop insight into his problems, which is important, but his problems probably wouldn't change.

This is the frustrating position that many therapy clients find themselves in when they're in a therapy that uses talk therapy exclusively:  They learn to understand their trauma, but little or nothing changes.

Mind-Body Oriented Psychotherapy
In my professional opinion, Joe needed the type of therapy that would help him to connect his intellectual understanding to a felt sense of his problems.

As a psychotherapist, my experience has been that mind-body oriented therapy works best for most clients who are dealing with psychological trauma.  These types of therapy include EMDR, Somatic Experiencing and clinical hypnosis (also known as hypnotherapy).

Developing Internal Resources
We started, as I usually do, by helping Joe to develop his internal resources, also known as coping strategies or coping skills, to prepare him to start processing the trauma (see my article about Coping Strategies in Mind-Body Oriented Psychotherapy to get an idea of how I help clients develop coping strategies).

Like many people who have been traumatized, Joe relied on dissociation, which is a defense mechanism to "zone out" and numb himself emotionally, whenever he felt uncomfortable.  So, we worked on helping Joe to learn to use positive coping strategies instead of dissociation.

This isn't an all-or-nothing process, but by using the internal resources that he learned in our work together, Joe began to develop enough resilience to begin to tolerate some of his discomfort and enough tolerance to begin working on his emotional trauma.

In my next article, I'll discuss the next phase of therapy, which is processing the trauma.

Getting Help
If you think emotional trauma has been in obstacle to your leading a fulfilling life, you owe it to yourself to get help from a licensed mental health professional who has expertise in working with trauma.

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

One of my specialties is helping clients to overcome psychological trauma.  

In addition to working with clients as a primary therapist, I also do adjunctive trauma therapy for clients who want to remain with their primary therapist, who might not be a trauma therapist.

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

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

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.