Regaining Your Sense of Self After a Traumatic Event

It's not unusual for a change to occur in the way you see yourself after a traumatic event.  Assumptions that you made about yourself, whether these assumptions were conscious or unconscious, can seem off when you experience an event that was out of your control or beyond what you were able to handle.

Let's take a look at an example of this to demonstrate what I mean.

The fictionalized vignette shows how a traumatic event can change the way you feel about yourself and how I work with this kind of issue to help to integrate the experience and to help a client regain her sense of self:

Sandra
Sandra was a woman in her early 40s when she came to therapy to deal with the loss of her husband who had died a few years before in a car accident.

Regaining Your Sense of Self After a Traumatic Event

She attended cognitive behavioral therapy (CBT) a few months after her husband's death, and from that therapy she realized, on an intellectual level, that her husband's death wasn't her fault.  But on an emotional level she was still feeling deeply guilty, and she felt as if she didn't know herself anymore.

She described to me how, before her husband died, she felt like a competent person who was the one that others usually turned to for advice of help.   But after the car accident that killed her husband, Sandra was plagued by self doubt, self blame and a sense of foreboding about her future--even though she knew intellectually that she wasn't to blame.

On an emotional level, Sandra felt that she could have prevented the accident if only she had insisted that her husband get the brakes checked immediately when he said that he heard the brakes making a strange sound.

She did, in fact, tell her husband that until he got the brakes checked, he should use her car to drive to work.  But she felt that she didn't insist enough.  Her feeling was:  If only I had really insisted, he would be alive today.

As we went over the sequence of events, Sandra revealed that, even though her husband told her the night before that he would use her car because he didn't have time to go to the mechanic with his car, he left her a note the next morning while she was asleep that he decided to use his car because he didn't want her to be without her car for the day, and he said he would see the mechanic that night after work.  He told her not to worry--he was sure that everything would be okay.

That same morning, while Sandra, who worked from home on a business call, the police appeared at her door and told her that her husband was in a fatal car accident.  Even though she heard their words, she felt like she was in a surreal dream.

It was only after the police left that Sandra found the note that her husband left her on the kitchen table and she realized this was the last communication she would have with her husband and she felt the deepest sorrow she had ever felt in her life.

In our first session, Sandra spoke about feeling "crazy" that she could know one thing (she wasn't responsible for her husband's death) and, at the same time, she could feel the opposite (she was to blame).

Regaining Your Sense of Self After a Traumatic Event

I normalized Sandra's experience by letting her know that this is a common experience under these circumstances and she wasn't alone in thinking one thing but feeling another among people who had experienced this type of trauma.

Then I spoke to her about EMDR, Eye Movement Desensitization and Reprocess and how EMDR is used to process trauma (see my articles: What is EMDR? and How Does EMDR Work?).

During the next few sessions, Sandra and I worked on helping her to develop coping skills to work on the most traumatic event of her life, the death of her husband.

After she learned to do the Safe Place Meditation and she developed other emotional resources in our work together, we began to process the memory that she chose, which represented the worst part of her husband dying, which was the day the police came to her house and informed her that her husband was dead.

Part of the protocol in EMDR therapy is to ask the client what negative beliefs they have about themselves as a result of the traumatic memory that we're working on.

In Sandra's case, she said her negative beliefs about herself were, "I'm helpless" and "I'm a bad person."

As previously mentioned, before the traumatic event, Sandra felt like a good and confident person who could handle whatever came up in her life.  But after the accident that took her husband's life, Sandra felt just the opposite about herself.

As we processed the memory, Sandra experienced waves of sorrow that she didn't know were still there.  But she also experienced waves of deep relief between each wave.

This is what usually happens when people process loss during experiential therapy, like EMDR.  The emotional activation usually comes in waves with a build up, a peak and then a release of emotion which usually provides a sense of relief between waves.

Many people have the misconception that emotional activation will just peak in therapy and remain at that peak.  This misconception discourages some people from coming to therapy to work on their problems because they think it will be overwhelming, but for most people this isn't so.

Sandra went through feelings of guilt, self blame, and sorrow.  Then, as she continued processing the memory in our sessions with EMDR, to her surprise, she felt a sudden surge of anger towards her husband that she had never been aware of before:  "Why did he do this?" and "How could he do this to himself and to me?"

There was no question that it had been an accident, as opposed to a suicide, so this wasn't the issue.  The issue was that Sandra couldn't believe that her husband had been so irresponsible.

Even though these feelings were uncomfortable for her, this was a turning point in Sandra's therapy because, after her anger surfaced, she realized, on a deeply emotional level, that it actually wasn't her fault.  She realized that she had urged him to get the brakes checked and he was the one who chose to wait.

Regaining Your Sense of Self After a Traumatic Event

This turning point was very important to our work together because it was the first time that Sandra felt on a visceral level, as opposed to an intellectual level, that she really wasn't to blame and she said she realized, "I did everything that I could, but I couldn't stop him from choosing to drive the car with the faulty brakes."

Our work continued and Sandra was able to work through her sadness, self blame and anger. Using EMDR, she was also able to regain a sense of herself as a good and competent person. She also realized that there would be things in life that she wouldn't be able to control and she would have to accept this.

Summary
The vignette above about "Sandra" reveals that a traumatic event can dramatically change how we feel about ourselves, but experiential therapy, like EMDR, can help to restore that sense of self.

Unlike other types of therapy, like CBT, which might only provide an intellectual understanding, like it did for "Sandra," experiential therapy helps clients to have a visceral felt sense of what's real, which is what leads to people getting better in therapy.

Getting Help in Therapy
Many people live their whole lives with a diminished sense of self after traumatic events because they don't get psychological help.

If the issues that I've discussed in this article resonate with you, you owe it to yourself to get help from a licensed mental health professional who has experience working with emotional trauma and who uses experiential therapy, like EMDR, Somatic Experiencing or clinical hypnosis.

Getting help in therapy could make the difference between continuing to suffer with a diminished sense of self and feeling good about yourself.

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

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

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

Experiential Therapy, Like EMDR, Helps Achieve Emotional Breakthroughs

In an earlier article, Self Blame and the Internal Critic, I began a discussion about how people often experience self blame.  In this article, I will discuss self blame, the need to feel in control and how experiential therapy, like EMDR, helps to achieve emotional breakthroughs.

Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs

Self blame can come in many forms, including a general feeling of "I'm wrong" or "I can't do anything right."

Self blame can also relate to a specific misfortune or trauma in one's life, including loss.

For people who are stuck and mired in self blame related to a traumatic incident, the feelings of self blame often give them the sense that they could have controlled some aspect of the traumatic event when it occurred and that this would have brought about a different outcome.

In most cases, this is an illusion and keeps people stuck emotionally at the point where the trauma incident occurred.

The following scenario is a composite of many different cases to protect confidentiality:

Rena
Rena came to therapy because she blamed herself for the death of her husband, who died on 9/11 at the World Trade Center.

Several years had passed since the tragic event and every day Rena thought about how she could have prevented her husband from dying that day if only she had insisted that he stay home from work because he wasn't feeling well.

She replayed the last moments in her mind over and over again--when she saw her husband as he was standing in their bedroom trying to decide whether to go to work or stay home.

He was sneezing and coughing, and she thought about telling him to stay home but, for some reason which she could never figure out, she didn't say it.  Instead, she told him to come home early if he felt worse and, with that, he kissed her, walked out the door, and she never saw him again.

Rena had attended cognitive behavioral therapy (CBT) a few months after her husband died and, because of that therapy, she realized that she wasn't really to blame.  But her realization was very much on an intellectual level and it didn't help to dispel the grief and guilt that she felt.

Deep down on an emotional level, she still felt that if only she had insisted that her husband stay home, he would be alive today.  Even though she knew logically that this made no sense, on an emotional level, she carried this heavy burden.

The weight of her grief and guilt was such that all she could do was go to work, come home and sleep.  She no longer saw her friends or engaged in activities that she used to enjoy.

Since Rena's prior therapy only helped her in a limited way, she wanted to try a different type of therapy.

So, when her friend told her that she was able to resolve a personal trauma with Eye Movement Desensitization and Reprocessing therapy (EMDR), Rena read up on EMDR and decided that she wanted to try this experiential form of mind-body oriented therapy (see my article:  What is EMDR?).

Rena wanted to work on the memory that she replayed in her mind over and over since 9/11.

After getting Rena's personal history and helping Rena to develop coping skills to work on the trauma, which took several sessions, we began to process the trauma.

When I asked Rena to think about an image that represented the worst part of that memory, she told me that in her mind's eye, she saw her husband standing in their bedroom as he was weighing whether or not to go to work and she was standing nearby, concerned, but silent.

Just saying these words caused Rena a great deal of pain and she sobbed.  After a few moments, she stopped crying and she was able to identify where in her body she felt the grief and guilt--in her chest and throat.

Identifying feelings in the body is an important difference between experiential therapies (like EMDR) and CBT, which tends to stay on the cognitive level.

Then, in keeping with the EMDR process, I asked her what words would best describe how she feels about herself now with regard to that memory, and she said, "I should have made him stay home so he would be alive now."

In terms of how disturbing this memory was for her on a scale of 0-10 (where 0 equals no disturbance and 10 equals the most painful disturbance imaginable), Rena said it felt like a 10.

Then, I asked Rena what words best describe how she would like to feel about herself in relation to that memory, and she said she wanted to feel, "I did the best that I could."

At that point in EMDR therapy, Rena didn't feel this way about herself at all.

Before we started processing this traumatic memory, I reminded Rena that if at any time she felt she was too upset to continue, she could signal me and we could stop for a few minutes or stop altogether for the rest of the session.  It was important for her to know that she was in charge.

Although Rena experienced waves of sorrow during the EMDR processing, she did not want to stop because she felt that something was shifting inside of her, but she wasn't sure what it was yet.

This sense of internal shifting is a common experience for clients who are in EMDR therapy.

We continued to work on this memory for several more weeks.

At the end of each session, we talked about the session, and Rena continued to say that she felt something, which was unidentifiable to her, that was shifting internally.  At that point, it was still hard for her to imagine that she could ever let go of her guilt and sadness for not stopping her husband from going to work on 9/11.

Then, a few weeks later, Rena had an emotional breakthrough.

Until then, as I mentioned earlier, her understanding that her husband's death was not her fault was only a logical construct in her mind--she didn't feel it emotionally, and she continued to carry this contradiction within herself.

But on that day, as she sensed into her body to feel what emotions came up for her about the memory, she realized that she wasn't feeling self blame.  She was sad that her husband died, but she didn't feel responsible for his death.

At first, she could hardly believe that there had been this internal shift within her.

Instead of feeling self blame, she felt a deep sense of knowing that she couldn't have altered the chain of events.  She felt deeply that she wasn't to blame.  She knew deep down that no matter what she would have said, based on how her husband reacted in similar situations prior to that day, he still would have gone to work.  So, she couldn't have controlled the situation--and now she knew this on a an emotional level.

Afterwards, when we talked about this, Rena said that her sense of knowing that she wasn't to blame was different this time from how she had felt before.  She said that this time she felt it in her gut and in her heart.

She knew on a deep level that the idea that she could have changed the course of events was an illusion that she had been hanging onto.

As we continued to work together, what surfaced was that Rena's illusion that she could have changed the course of events at that pivotal point (when he was standing in the bedroom trying to decide what to do) served to keep her feeling emotionally attached to her husband--to that last time that she saw him.

This is why, prior to her emotional breakthrough, thinking about that moment over and over again was so powerful for her.

This emotional breakthrough for Rena helped her to release her grief, which had been pent up in her for several years.  It also allowed her to deal with other emotions that had been covered over by her feelings of self blame.

Over time, we continued to work on other emotional issues that arose about her husband's death, including her feelings of abandonment.  Even though she knew logically that her husband didn't choose to leave her, she experienced this common reaction that people often have when loved ones die.

Along the way, Rena learned other ways to have an internal experience of closeness for her husband without having to remain stuck in the traumatic memory.

Being able to feel the release of grief helped her to start putting her life back together again.  Gradually, she began to see friends again and she took up hobbies that she had neglected since her husband's death.

CBT as a Counteractive Therapy vs EMDR as Experiential Therapy
Each client is different and there's usually no way to know in advance what will be emotionally transformative for a particular client.

I do use CBT for some clients under some circumstances, but my experience as a psychotherapist who specializes in working with trauma, has been that, although CBT can be useful to a certain extent, it often offers limited help, particularly in situations described in the scenario about "Rena."

Of course, it's important for clients to understand on a cognitive level that they're not to blame for traumatic incidents that they could not have controlled.  But, as in the case with Rena, this kind of cognitive understanding is limited and clients will often say, "I know logically that I wasn't to blame, but I still feel on an emotional level that it was my fault."

It's important that clients understand that feeling this contradiction isn't at all unusual when it comes to trauma.

The problem with CBT in these instances is that it is a top-down approach that acts only as a counteractive force to the negative feelings that clients feel about themselves, which often keeps the internal conflict of what they know vs. what they feel in place for clients.

It provides the client with an alternative to how they're thinking, which is good, but it often doesn't change the feelings where they reside, which is deep in the limbic part of the brain.

EMDR Therapy Helps Achieve Breakthroughs

Experiential therapies, which use a bottom-up approach that involves the mind-body connection, like EMDR, Somatic Experiencing, clinical hypnosis and other types of experiential therapies, go to that deeper level and help to make the emotional shift that leads to emotional breakthroughs.

Skilled EMDR therapists also know how to work in a way where clients feel emotionally safe, which is important for clients who have experienced trauma.

I'll discuss this topic further in a future article.

Getting Help in Therapy
Many people live their whole lives blaming themselves for traumatic events that they could not have changed.  They live with the illusion that they could have controlled events, and this serves to keep them stuck in the memory.

For people who are stuck in this way, on an emotional level, it's as if there is no difference between "then," when the event occurred vs "now," their current life (see my article:  Overcoming Trauma With EMDR: When the Past is in the Present).

If this resonates with you, you owe it to yourself to get help from a licensed mental health professional who has expertise in one of the experiential types of therapy, like EMDR, Somatic Experiencing and clinical hypnosis, among others.

Once you're no longer living as if you're still in that traumatic memory, you will be free to live a 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, call me at (917) 742-2624 during regular business hours or email me.

Self Blame and the Internal Critic: Overcoming the Tyranny of "Shoulds" You Impose on Yourself

Many people have such a strong internal critic that they feel overwhelmed by that self blaming part of themselves.  The internal critic imposes so many "shoulds" that it becomes emotionally and physically exhausting.

Self Blame and the Internal Critic

For many people, this internal critic is so strong that it stops them from even starting a new endeavor because they know in advance that they'll be overwhelmed by self criticism.  It feels safer to just stick with what's familiar than risk the tyranny of "shoulds" they impose on themselves.

The Internal Critic Can Show Up in Any Area of Your Life
For some people, the internal critic comes up in specific areas, like their physical appearance.

For those people, just looking in the mirror can be emotionally painful as the internal critic criticizes their physical appearance, often in very distorting ways.

For other people, the internal critic comes up, not just in specific areas, but in most areas of their life, no matter what they're doing.

Parts Work Combined with the Mind-Body Connection in Therapy to Overcome the Internal Critic
Parts work in therapy has many different names, including ego state therapy, internal family systems, and so on.

Parts work combined with the mind-body connection can be a very effective way to overcome the internal critic.

Self Blame and the Internal Critic

Using parts work and mind-body therapy, like Somatic Experiencing, the therapist can help facilitate the identification of the different internal aspects of self (or parts) that are affecting the client, including the internal critic.

Parts work is non-pathologizing, so that all the parts are recognized as having a good intention of wanting to preserve the self, but the parts might be going about it in a skewed way.

Here's an example of a client struggling with a strong internal critic and how a combination of parts work and mind-body therapy helped.  As always, this is a composite of many cases with all identifying information changed:

Nina
When Nina came to therapy, she was nearly paralyzed by self blame.  In almost every situation in her life, she had self blaming thoughts like, "You should have done it this way instead of that way" or "You shouldn't try that--you're just going to fail."

Before she could embark on any new endeavor, like a new job or a new project, she had to do battle with all her negative thoughts.  It was mentally, emotionally and physically exhausting.

Nina was aware that she grew up in a home where both of her parents were highly critical of her and of themselves. So, she knew she internalized this critical part of herself from an early age.  But just knowing this wasn't enough to change it, which is often the case with problems like this.

Helping Nina to get into a relaxed state, I asked her to recall a memory when she felt the internal critic as being especially strong.

Nina remembered how she felt when she moved to NYC from her small hometown in the Midwest to attend college in NY.

She remembered being plagued with negative thoughts about how she would never make it in NY, including the thought, "You should stay home and go to the local college.  You'll never measure up to the other students in NYC."

We continued to work with this self blaming part to try to understand what its intention was.

Before I go on, I should explain that looking at the internal critic this way is a symbolic way of making it come alive in an accessible way.

Rather than just thinking about the thoughts, we explored the internal critic almost as if it was a person.  After a while, Nina was also able to identify where she sensed the internal critic in her body, including a tightening in her throat and in her stomach.

Using parts work and the mind-body connection (i.e., identifying where the feeling is sensed in the body) helped Nina to continue to explore the feeling more deeply.

After a while, what she discovered was that the internal critic really did have a good intention, which was to keep her from getting hurt.  So, for instance, when it told her that she should stay home instead of moving to NYC to attend college, this part held a lot of fear and its intention was to keep Nina safe.

The problem was that, even though the internal critic's intention was good, the way it expressed itself was critical and damaging.  So, we worked towards helping that part to be more balanced in its expression.

With practice, instead of being critical, Nina learned to soften this part's expression so that it could evaluate in a more balanced way instead of being critical.

Of course, this takes a lot of work because the internal critic doesn't develop overnight and it takes a while to change.

As Nina became more aware when the internal critic was operating, she asked herself, "What's the intention of this part?  What is it trying to do?"

By looking at the internal critic in this way, Nina learned that there were times when the internal critic had something of value to express but, as mentioned before, it was expressing it in a skewed way.  Nina could stand back and look at her negative thoughts (the internal critic) and use her judgment to assess when to pay attention and when to gently put the thought aside.

Doing Parts Work and Mind-Body Psychotherapy
Parts work combined with mind-body psychotherapy is a gentle process.  We're never trying to squelch or get rid of a part.  Instead, we're recognizing that the part usually has a good intention, but there's a distortion involved and the part needs to be modified in a way so that it's more balanced.

Parts work helps with many different aspects of yourself.  It can be an angry part, a sad part, a fearful part, and so on.

Parts work combined with mind-body psychotherapy helps you to recognize how many different aspects of yourself are involved in you, and how the different parts can manifest at various times and in different ways.

It also helps to explain why you might feel many different feelings at the same time.  Before you recognize that you have many different aspects of self, this can be confusing.

Mind-body psychotherapy and parts work work well together in combination in dealing with difficult parts.

Getting Help in Therapy
If you feel overwhelmed by self blame that comes from a harsh internal critic, you could benefit from working with a therapist who does parts work and mind-body psychotherapy, like Somatic Experiencing.

If you work through the issues involved with your internal critic, it's possible to feel a heavy burden being lifted from you and you'll feel freer to live your 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, call me at (917) 742-2624 during business hours or email me.

Learning to Forgive Yourself

Learning to forgive yourself is often more difficult than forgiving others.  Many people come to therapy because they're unable to forgive themselves and they're plagued by guilt and shame.  Even when they know objectively that there's nothing to be gained by continuing in self blame, they're unable to let go of these feelings--even when the other person (or people) involved have long since forgiven them.

Learning to Forgive Yourself

Is There a Part of You that Needs to Hold Onto Self Blame?

When a psychotherapy client is stuck in this kind of dilemma, usually, there's a part of him or herself that won't let go--that continues in this self defeating dynamic of self blame.  Regular talk therapy, although useful, often doesn't get to the core of the issue.  A person can get stuck in a loop of knowing that he or she needs to let go, but not being able to engage in self forgiveness.  

Clinical hypnosis in combination with "parts work" (also known as ego states therapy) can be very helpful to overcome this problem.   The combination of hypnosis and "parts work" allows the hypnotherapist and client to explore if there is an internal part of the client that feels the need to hold onto this self blaming stance and the reason why it feels this need.

In a relaxed hypnotic state, clients can sense into themselves and access unconscious information that is usually not available in their ordinary state of consciousness.

For instance, a client, who lied to a friend, could feel very ambivalent about forgiving herself for lying.  Even if her friend has forgiven her and she knows logically that it would be best to let it go, a part of herself might feel the need to hold onto the guilt and shame in order to make sure this doesn't happen again.  Once this is revealed in the relaxed hypnotic state, the therapist can work with this part to explore if there are other ways to handle this (other than continuing to feel guilty and engage in self recrimination) that will satisfy this part.

This is just one example, but there can be many reasons why an aspect of oneself can't or won't let go of self blame  Most of the time, these reasons are not in a person's ordinary awareness.   It's often a relief to discover, first of all, that there's an actual a reason why part of the self is having difficulty with self forgiveness.  And, more importantly, that there can be other options that don't involve continuing to blame oneself.

An Inability to Forgive Yourself Can Lead to Anxiety and Depression

All of this is not to say that if someone has engaged in a transgression that he or she shouldn't feel remorse.  It's a sign of health to feel remorse when we've hurt others (or ourselves).  But the kind of problem that I'm discussing is beyond that--it's when a reasonable length of time has passed and a person continues to blame him or herself.

In some cases, people can continue to blame themselves for over 20 years.  This is usually debilitating to one's sense of self and can get in the way of maintaining important relationships.  For some people, their inability of forgive themselves causes them to isolate themselves from loved ones.  It can lead to anxiety or depression.  For some people, it can lead to abusing alcohol or drugs as a maladaptive way to soothe their emotional pain.

Getting Help in Therapy

If an inability to forgive yourself has you feeling stuck, you owe it to yourself to seek professional help from a licensed mental health practitioner, preferably a hypnotherapist who can help you to overcome this problem.  Many people find it so freeing to let go of the self blame that had been weighing them down so they can move on with their lives.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR therapist, and Somatic Experiencing therapist.  I also provide dynamic talk therapy in a supportive and empathic environment.

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.