Psychotherapy as a Co-Created Process Between the Psychotherapist and the Client - Part 2

In my prior article, I began a discussion about psychotherapy as a co-created process between the psychotherapist and the client.  I'm continuing this discussion to delve deeper into this topic, specifically about how the client and psychotherapist co-create the therapeutic relationship.

Psychotherapy as a Co-Created Process Between the Client and the Psychotherapist 

How the Client and Psychotherapist Co-Create the Their Therapeutic Relationship
As I mentioned in my prior article, the concept that psychotherapy is a co-created process is part of contemporary psychotherapy and it's different from how psychotherapy was practiced in the past.

There is now a recognition that each client-psychotherapist relationship is unique--just as any other type of relationship between two people is unique.

It's the psychotherapist's responsibility to provide the client with psychoeducation about psychotherapy and how she works in therapy.

If the psychotherapist uses Integrative Psychotherapy, as I do, she will explain the different therapy modalities that she uses, which can be used individually or in combination.

For instance, if the psychotherapist is trained as a contemporary psychoanalyst and she also does EMDR Therapy, she can explain how these two modalities can be used in combination (see my article: Contemporary Psychoanalysis and EMDR Therapy: A Powerful Combination to Overcome Trauma).

Most likely, she will also explain that if one modality doesn't work for this particular client, she can switch to another modality.

The relationship between the client and the therapist is also known as the therapeutic alliance.  At the most basic level, the therapeutic alliance is based on the therapist being able to provide a safe, trusting relationship, also called the "holding environment"  (see my article: The Creation of the Holding Environment in Psychotherapy).

Contemporary psychotherapy is a two-person therapy.  It's an intersubjective experience between the client and the therapist where the therapist is attuned to the client (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

Even though the psychotherapist is the one with the expertise in doing psychotherapy, most  psychotherapists also rely on feedback from the client about what's working and what's not working in therapy for the client (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Therapy).

Ideally, the therapist will ask at various points in therapy and encourage the client to give feedback at other times but, even if your therapist doesn't ask you for feedback, it's important to give feedback to her.

Why is it important?  It's important for the therapeutic process and also for maintaining a good relationship with your psychotherapist that you provide her with feedback as to how the therapy is going (see my article:  Why Being Honest With Your Psychotherapist is the Best Policy).

Many people have problems giving feedback to their therapists because they were discouraged or even punished for giving feedback to their parents when they were children, so even as adults, they still carry that fear.

Other people don't feel entitled to give feedback.  They think of it as "complaining" and they don't want to "offend" their psychotherapist.

So, instead of giving feedback, they might pretend that everything is going well in therapy, and the end result is that the client doesn't get what she needs in therapy, the therapy is an "as if" therapy and nothing changes.

Many psychotherapists recognize when clients are hold back from talking about misgivings in therapy or that a certain aspect of therapy isn't working for them, so they will try to elicit feedback.

But there are times when the therapist doesn't see it, and the therapy becomes ineffective or, rather than express himself, the client leaves therapy prematurely (see my article: When Clients Leave Psychotherapy Prematurely).

The client's trust and sense of safety develop over time.  For some clients, it happens relatively quickly and for others it can take a while, especially if they've had early experiences where they couldn't trust their parents or other close family members.

The therapeutic alliance is also based on there being a good match between the client and the therapist.

Initially, you might not know if a particular therapist is a good match for you.  You might need a few therapy sessions to be able to discern if the two of you are a good match.  This doesn't mean that the therapist isn't skilled or that you're being "resistant."  It might just mean that, like any two people, the two of you aren't a good fit.

Some psychotherapists are better trained, educated and more skilled than others as well as more empathetic than others.

An empathic failure can result from a psychotherapist's oversight, but in a good therapeutic relationship, once the client provides feedback about an empathic failure or other rupture in the therapy, there is an opportunity for a repair (see my article: (see my articles:  Why is Empathy Important in Psychotherapy?, What is Empathic Failure in Psychotherapy? and Ruptures and Repairs in Psychotherapy).

But if there are consistent empathic failures on the therapist's part, you would be wise to tell the therapist that you don't think the therapy is working for you and then seek out another therapist.

Even when you think the therapy isn't working for you, it's still important to provide the therapist with feedback rather than just leaving abruptly or disappearing from therapy.

Why?  It's not for the therapist (although it can be beneficial).  It's for your benefit to be able to assert yourself and speak up for what you need, especially if this is challenging for you (see my article: Ask For What You Need in Therapy).

So, if the therapy is going relatively well because you have a good therapeutic alliance with the therapist and you're starting to make changes in your life, does this mean that there will be all smooth sailing ahead?

Not necessarily.  There is the issue of transference, which is unconscious and which can change over time (see my articles:  What is Transference in Psychotherapy?,  Psychotherapy and the Positive Transference,  What is the Negative Transference? and Psychotherapy and the Erotic Transference: Falling "In Love" With Your Psychotherapist).

Having a negative transference at a certain point in therapy isn't necessarily a bad thing.  In fact, it can turn out to be beneficial.  Often, a negative transference is based on earlier relationships with parents where you weren't able to work out these issues with your parents.

But in a good therapy, you have a unique opportunity to work out these issues with a therapist who is receptive to working on issues in therapy that might have triggered earlier unresolved problems.  This can be healing to you and help you to resolve those earlier issues.

Getting Help in Therapy
It takes courage to admit that you have a problem and to ask for help (see my article: The Benefits of Psychotherapy).

Many people start therapy with a sense of ambivalence, especially if they've never been in therapy before (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Getting help in therapy starts with calling for a consultation.

The purpose of the consultation is to talk about your problem in a general way and to ask the therapist questions about her experience, training, history of helping clients with similar problems, and how she works (see my article: How to Choose a Psychotherapist).

Working through your problems in therapy can lead to your living a more fulfilling and meaningful life without the "baggage" from your history.

About Me
I am a licensed New York City 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.

How to Talk to Your Psychotherapist When Something is Bothering You About Your Therapy

In a prior article, I discussed the importance of psychotherapists providing clients with psychoeducation during the initial stage of therapy.  

I also stressed that it's up to the psychotherapist to check in with the client periodically to find out how the therapy is going from the client's perspective.  

This helps to avoid premature endings in therapy where the client leaves therapy abruptly out of frustration (see my article: When Clients Leave Therapy Prematurely).  

I also indicated that if the therapist doesn't check in, the client can initiate a conversation with the therapist.  But all too often the client has difficulty being assertive enough to initiate this conversation.  So, in this article, I'm focusing on how to talk to your therapist when something is bothering you about the therapy.

How to Talk to Your Psychotherapist

Why Might You Be Having Problems Initiating a Conversation With Your Psychotherapist?

Being Unable to Identify Feelings and Sensations Due to Early Developmental Trauma
Many clients who have difficulty initiating a conversation with their psychotherapist about the therapy also have the same difficulties in other relationships.  This is often a presenting problem for coming to therapy.

Many clients who have problems letting others know that something is wrong never developed this skill as a child because it was discouraged at home when they were growing up.

For instance, if a client grew up in a home where his parents communicated, either explicitly or implicitly, that everything that went wrong in the household was the child's fault, not theirs, this client will probably assume that problems in the therapy are his fault because he wasn't "good enough" or lovable enough for his parents and now he's not "good enough" for his therapist (see my article: Do You Feel Unlovable?).

Many adult clients, who experienced developmental trauma, including abuse or neglect (or both), have difficulty identifying their feelings.  They might know that "something isn't right," but they don't know what it is (see my articles: Developmental Trauma: Living in the Present As If It Were the Past and When You "Just Don't Feel Right" and It's Hard to Put Your Feelings Into Words).

In most cases, these clients' primary caregiver wasn't attuned to them as babies, which is crucial for physical and emotional development as well as being able to identify feelings and sensations, and so they didn't develop these skills.

Clients, who have difficulty identifying feelings and sensations, have difficulty putting words to their experiences.  They need a psychotherapist who is highly attuned to what is going on with them in therapy and who can help them to develop the ability to identify and express feelings and sensations, including unconscious feelings (see my articles: The Therapist's Empathic Attainment and The Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

If they don't have a highly attuned psychotherapist who can help them to become attuned to the mind-body connection, these clients often feel like they're "not doing therapy right" and this engenders guilt and shame in them.

Clients who were raised in a family where they were placed in the role of caregiving their parents will often unconsciously try to take care of their psychotherapist.  They are often hypervigilant to the  therapist's every facial expression and body language for "clues" as to what might be going on with the therapist and what they think the therapist needs from them, similar to the role they were in as a child with their parents.

Just as they did as children with their parents, these clients try to anticipate the therapist's needs and try to find ways to accommodate the therapist instead of allowing the therapist to help them.  Even though this is a role reversal for the client, the client feels comfortable with in it because it's familiar.

That being said, a skilled therapist will recognize this and address it so the client can learn to allow the therapist to take care of the client's needs.  At first, this might not be easy for the client because he never developed that trust and comfort with his parents as a child, and it's hard to trust as an adult.

Psychotherapist and Client Mismatch
Another common reason for clients not being able to address issues about therapy with their psychotherapist is that the client and therapist are a mismatch.  They're not a "good fit" for each other.

What does it mean that the client and therapist aren't a good match?  It means that, for whatever reason, the client and therapist don't "click."

As I've mentioned in prior articles, every therapist is not for every client.  Even an award-winning psychotherapist, who has published books and articles and is recognized as an expert in her field, might not be the right therapist for a particular client.  This doesn't mean that there's something wrong with the therapist or the client.  It just means they're not a good combination to work together.

This mismatch can make it difficult for the client to communicate with the therapist because they're not on the same wavelength.

If there is a mismatch between the therapist and the client and the client knows he wants to leave, it's still important for the client to address this with the therapist, if the therapist doesn't address it first, rather than aborting therapy without saying anything.

Why is it important to address a mismatch rather than aborting therapy?  Well, the therapeutic relationship, although different from most relationships, is still a relationship, and just like it's important not to suddenly walk out on other relationships, it's also important not to leave therapy without a word.

The importance of talking to the therapist has more to do with learning to speak up for yourself than it does for sparing the therapist's feelings.  Although it's important to be considerate of the therapist, it's more important to be considerate of yourself.  And when you walk out of a relationship without a word, you don't feel good about it.  So, you speak up mostly out of consideration for yourself--not for the therapist.

Boundary Violations
There are also instances where there have been boundary violations between the client and the therapist, including sexual boundary violations.  Needless to say, when this occurs, the therapy is ruined and beyond repair (see my article: Boundary Violations and Sexual Exploitation in Psychotherapy).

No matter who initiated the boundary violation, the therapist or the client, the therapist is always responsible.  It's important to leave that therapy to get help from an seasoned, ethical psychotherapist who can help you deal with the traumatic aftermath of the violation.

Transference Issues
There might also be transference issues that get in the way of the client communicating with the psychotherapist. This means that the client might be experiencing the psychotherapist as a parental figure and this hasn't been addressed in the therapy.

For instance, if the client had highly authoritative, punitive parents as a child and he unconsciously experiences the therapist as another authority figure who will fail him like his parents did, the client might have the same difficulty addressing this in therapy as he did with his parents.  This, of course, assumes that the therapist isn't behaving in an punitive, authoritative manner.  If the therapist is behaving in an punitive and authoritative manner, this isn't a good match for this client or any other client for that matter.

There are many other reasons why a client might be having problems addressing issues about the therapy with his therapist, but the ones I've cited are among the main ones.

How to Talk to Your Psychotherapist If Something is Bothering You About the Therapy

Writing It Down First
If you're having problems articulating the issues you have about the therapy to your therapist, you could benefit from writing about it before you attempt to discuss it with your therapist.  This isn't a substitute for talking to your therapist.  It's just an initial step to take to clarify your thoughts.  You still need to have the discussion with your therapist in person.

If even writing about your problems in therapy feels too daunting to you, you can try writing a story about these issues as if they were happening to someone else.  When you externalize the problem as if it's about someone else in a story, it feels a little less personal and you might find ways to think about it that you don't when you're writing about yourself.

Talking About It: It Doesn't Have to Be "Perfect"
Finding your voice might be difficult, but don't assume that you have to communicate the problem "perfectly" in order to be understood.  Just starting the dialog is often a good beginning, even if all you say is, "I think I'm having problems with the therapy."  This lets the therapist know that there's an issue and she can help you to identify and express it.

Making a Decision About the Therapy - A Consultation With Another Therapist Might Help
In many cases, once the problems are out on the table, things can be cleared up, especially if there was a misunderstanding on the therapist's part or the client's part or both.

But if the problem you're having in therapy can't be cleared up and you're not sure what to do, you can have a consultation with another therapist to try to clarify what's going on in your therapy.  The consultation can be done with or without your current therapist.

I usually recommend that clients let their therapist know if they're going for a consultation with another therapist.  But there might be reasons why you don't let your therapist know, especially if there have been serious boundary violations in your therapy.

Whether you go for a consultation with another therapist or not, at some point, you'll need to make a decision as to whether this therapy is working for you or not.

This can be a difficult decision, and there's no magic answer as what to do and when to do it.  Depending upon your particular situation, it can be complicated.

For instance, if you have a history of going from one therapist to the next in a relatively short period of time, there might be other issues going on.  You might get skittish in therapy at the point when you and the therapist are getting to core issues.  If you recognize this pattern, you would do well to think about what's really going on and if you're constantly avoiding dealing with core issues.

Another reason why it's difficult to make a decision of whether you should stay or leave a particular therapy is that, if you're new to therapy, you might not have a basis for comparison to know if the therapy isn't going well or if you had different expectations of therapy.

This gets back to what I discussed in my prior article about having psychoeducation during the early stage of therapy.  But even with psychoeducation, it can be a tough decision to make.

But once you've made the decision of whether to stick with your current therapist or see a different therapist, as I mentioned before, it's important to communicate your decision with your therapist if you've decided to end the therapy rather than just leaving without talking about it.

Getting Help in Therapy
If you've been struggling with a problem on your own and you haven't been able to resolve it, you could benefit form working with a skilled mental health professional who can help you to work through the problem (see my article:  The Benefits of Psychotherapy).

The first step is to make an appointment for a consultation with a therapist, and it's often the hardest step for most people.

At the consultation, you'll have an opportunity to talk about your presenting problem in a broad way and ask the therapist questions.

You might even ask for another consultation to have more time to find out how the therapist works and, more importantly, to get a better sense of the therapist to see if you think the two of you are a good match (see my article: How to Choose a Psychotherapist).

Being able to free yourself in therapy from the problematic parts of your personal history will allow you to live in a more meaningful way with a greater sense of well-being.

About Me
I am a New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrated 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.

Asking For What You Need in Therapy

Many clients who are in therapy have difficulty asking for what they need from their therapists.  This is especially true for clients who have a history of being physically or emotionally abused.  Often, because of the abuse, they're out of tune with their needs and, as a result, they might not know what they need.

Asking For What You Need in Therapy

Even the most empathically-attuned psychotherapist might miss the fact that s/he isn't working in a way that meets the client's needs, which is why it's so important that, every so often, the therapist and client reevaluate their work together.

Usually, this discussion is initiated by the therapist, but a client, who feels s/he isn't getting what s/he needs, can also initiate this conversation.

Here are some tips that may be helpful in getting what you need in therapy:

Tips on How to Get What You Need in Your Therapy:

• If your therapist doesn't take time periodically to review the work you're doing together, you can take time to reflect on your own how you're feeling about your therapist and your work and then tell your therapist that you would like to talk about this.  Most therapists will be open to this.

• Don't assume that if your needs aren't being met that it's your fault.  This is an assumption that many clients, who have been abused, make in their therapy.

• If you're unclear about the way your therapist is working, ask about it.  Your therapist should be able to give you an explanation in simple terms that you can understand.

• If you feel the work is going too fast and you're having difficulty coping between sessions, talk to your therapist about this so the two of you can come up with ways that you can cope better between sessions.  It might also mean that you spend more time processing what's going on between you.

• If you feel the work is going too slow, tell your therapist about this.  S/he will can explain the way the two of you are working together and, if needed, might make changes in the work.  Also, this can help to clarify whatever beliefs or misconceptions that either of you might have about the work.

• If you feel you and your therapist haven't developed a rapport after working together for a while, it might be that the two of you aren't a good fit.  It might also mean that, due to your history, you might have problems trusting and it might take you a while to develop a therapeutic alliance with any therapist.

• Be aware that, due to ethical boundaries, your therapist can't be your friend or have a personal relationship with you outside of your sessions, even after you complete therapy.  So, if part of what you think you need or would like is for your therapist to be your friend, this won't be possible.  At the same time, it's common for clients to develop these feelings, including sexual attractions, for their therapist (see my article:  Psychotherapy and the Erotic Transference).  Even though you might be disappointed at first that you can't have a personal relationship with your therapist, a discussion about your feelings can be helpful in highlighting what you need in your life and how you can go about creating it outside of the therapy room.

Too often clients abort therapy prematurely because they feel too vulnerable or ashamed to have these kinds of discussions with their therapist (see my article:  When Clients Leave Psychotherapy Prematurely).

But, usually, even though you might not be accustomed to talking about your needs and it might take courage on your part, being able to talk about what you need helps you to develop self confidence and often helps to improve the therapy.

Also, if part of the problem is that there has been a misunderstanding or rupture between you and your therapist, there is a chance for repairing this rupture, which can create a stronger therapeutic alliance between the two of you (see my article:  Psychotherapy: Ruptures and Repairs in Therapy).

Getting Help in Therapy
Asking for help isn't easy, especially if you've spent most of your life denying your needs or being unaware of your needs.

Asking For What You Need in Therapy

Rather than continuing to ignore your emotional needs, if you're concerned about your therapy, speak to your therapist.  Even if you're feelings are vague, a skilled, empathic therapist can help you to clarify and express your feelings.

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.

How Early Attachment Problems Can Affect Your Relationship With Your Therapist

In an earlier series of articles about early attachment bonds between infants and their primary caregivers, including How the Early Attachment Bond Affects Adult Relationships, I discussed how problems with early attachment can affect adult romantic relationships.  In this article, I'll focus on how early childhood attachment problems can affect adults in their relationship with their psychotherapist.

How Early Attachment Problems Can Affect Adults' Relationships With Their Therapist

The attachment style that people develop early in life with their primary caregiver usually continues on in adult relationships.

When the emotional bond between the baby and the primary caregiver goes well, it's a secure attachment and if there's no major trauma in childhood, as an adult, this person will probably be able to form healthy, secure attachments in adult relationships.

But if the attachment bond that the baby develops with the primary caregiver is an insecure attachment, which is traumatic for the baby, problems often develop later on in adult relationships (see my article: How the Early Attachment Bond Affects Relationships: Insecure Attachments for an explanation of insecure attachment).

How Attachment Problems Can Affect Adults in Therapy
When someone has an attachment problem that developed in early childhood, the insecure attachment doesn't just carry over only into romantic relationships.  Depending upon the severity of the insecure attachment, it can also carry over into other adult relationships, including work relationships, friendships, and the therapeutic relationship with a therapist.

Generally speaking, people are complex, and people with insecure attachment styles don't fall into neat categories of avoidant, ambivalent, disorganized or reactive attachment.

But to illustrate the point that therapy clients often develop therapeutic relationships with their therapist based on their attachment style, I'll simplify the example I'm about to give in the vignette below to deal specifically with the avoidant attachment style.  The same principles would apply for the other forms of insecure attachment, but they would probably show up in a different way.

As always, this vignette is a composite of many cases with all identifying information changed to protect confidentiality:

Ella
Ella, who was in her late 20s, came to therapy because she had a history of problems in her romantic relationships.

Ella's Avoidant Attachment Style Caused Problems in Her Romantic Relationships 

Although she was focused primarily on her problems in romantic relationships, Ella also had problems with her relationships at work.  However, since she made a lot of money for the company, her superiors overlooked her interpersonal problems.

Ella said she wanted to meet someone that she could settle down with, get married and have children, but her relationships never lasted more than a year.  She was also keenly aware that she would be entering into her 30s soon, and she was concerned about her "biological clock."

Her problem was that whenever a romantic relationship became serious, she became fearful that her partner would leave her.

In each relationship, Ella's fear became a self fulfilling prophecy because, even though she loved the man she was in a relationship with, her fear would become so overwhelming that she would become avoidant and start to distance herself from him.

She did this by finding all kinds of reasons for canceling plans, making excuses, including that she didn't feel well or that she had too much work to do.

Sooner or later, the man she was seeing at the time would get fed up and leave the relationship, and Ella would feel sad and frustrated.

After this happened in three relationships, Ella also began to feel angry with herself because she couldn't understand why she was sabotaging each relationship.  It also left her feeling very lonely.

Each time this happened, Ella would promise herself that she wouldn't give in to her fears in the next relationship. But each time her fear overwhelmed her in the next relationship, and she found ways to distance herself again.

Knowing that clients' attachment styles can affect their therapeutic relationship with their therapists, I usually address this issue early on in therapy to educate clients so they won't be surprised to see that they're engaging in the same dynamic in therapy.

When a client with this problem knows in advance that it can affect how they engage (or disengage) in therapy, it can help clients to anticipate this before it happens.  It gives the therapist and client an opportunity to talk about it before client acts on it.

Although talking about it beforehand can help to mitigate an insecure attachment style, simply having this information doesn't necessarily stop it.

Attachment dynamics are usually unconscious, so that when a client engages in an insecure attachment style in therapy, s/he isn't necessarily aware of it at the point when it's happening.

It can take a while for a client to develop enough awareness in therapy to anticipate the behavior and, even more time to change it.

Ella was psychologically minded, so she was surprised and curious about how this avoidant dynamic might play out in therapy.

In the initial stage of therapy, as I was learning about Ella's family history and how it contributed to her insecure attachment style, Ella seemed fine.  She had been in therapy several times before, and she had talked about her family history many times before.  She was almost somewhat detached and unemotional as she gave her history.

When Ella told me about the many false starts she had in her prior therapies, I pointed out to Ella that, just like she found ways to be avoidant in her romantic relationships, she also became avoidant in her therapeutic relationships with prior therapists.

Ella's Avoidance in Prior Treatment Was Unconscious

Ella had never thought of this before but, as we discussed it, she realized that she usually left therapy just when she and the therapist were at the point where they were delving deeply into her problems.  Whenever she left therapy, she thought she was doing it because "it wasn't helping."

But, as we discussed this, Ella was able to see, in hindsight, that she didn't really give any of her prior treatments a chance because she would leave before she made progress.

We spent time talking about the internal cues that Ella might have missed before she aborted therapy in the past, and we also talked about whether she could pick up on these cues this time if she felt like aborting therapy again.

For many clients, this is hard work, especially for clients who really believe that, each time they leave therapy, it isn't because they're avoiding dealing with their problems.  They want to believe that they have a legitimate reason each time because "therapy isn't working."

This isn't to say that clients don't leave therapy for legitimate reasons or that their therapist really isn't helping them.  But for clients who have an avoidant attachment style, they often have a pattern of leaving therapy prematurely (see my article:  When Clients Leave Psychotherapy Prematurely).

In addition to discussing Ella's avoidant behavior in therapy, as part of our preparation for our work, we also worked on helping her to develop coping strategies to deal with her anxiety and fears.

We also talked her commitment to therapy and the treatment frame, including my cancellation policy, which is 48 hours unless there's an emergency.

Although this preparation helped Ella to deal with her urges to leave therapy during the early stage of treatment, as we delved deeper into Ella's early childhood history with an unstable mother, Ella began to cancel appointments more frequently.

For many people, a cancellation policy where they had to pay the full fee for broken appointments can be a deterrent to their canceling appointments when they want to cancel because they're uncomfortable with the material that we were discussing in the prior session.

But Ella earned a very good salary and it wasn't a hardship for her to pay for broken appointments.  So, the cancellation policy didn't keep her from missing sessions.  She also became adept at canceling the appointments 48 hours in advance so, technically, she complied with the cancellation policy but, in effect, she was sabotaging her treatment because of her fears of dealing with emotional material that came up.

At the point when she cancelled the appointments, she had no insight as to what was happening with her because her fears were unconscious at the time.  It was only after she returned to her therapy sessions and we discussed what happened that she was able to see, after the fact, that she was being avoidant.

Fortunately, even though there was a part of Ella that was ambivalent about dealing with her problems in therapy, there was a bigger part that was motivated.  So, we worked with the motivated aspect of her in therapy to strengthen it so she wouldn't allow the fearful part of herself to sabotage her sessions.

We also had to develop some new ground rules that we would mutually agree to about cancelled appointments.  So, we agreed that she could only have so many cancellations per six months, and she was able to abide by that.

Since regular talk therapy often isn't as effective for insecure attachment problems, we used a combination of Somatic Experiencing and clinical hypnosis, which are both mind-body oriented therapies that are considered a "bottom up" approach as compared to regular talk therapy, which is more of a "top down" approach.

Ella's therapy was long-term treatment because, even though she was making progress over time, she would sometimes revert to avoidant behavior.  So, our work together required patience on both of our parts.  But as we continued to work together, Ella began to trust me more over time and this allowed her to open up more.

And, as is usually the case, the interesting thing was that as she was developed the skills to form a stronger, stable therapeutic alliance with me, she used these same skills to form a more stable relationship with the new man that she was dating as well as her colleagues at work.

Over Time, Ella Worked Through Her Avoidance in Therapy and in Relationships

Over time, Ella worked through her avoidant behavior, and when she felt the urge to withdraw out of fear, she was able to see the signs before she acted on it, which was a major breakthrough for Ella.

The Challenge of Working on Insecure Attachment in Therapy
Working on any one of the insecure attachment styles in therapy can be challenging for the client and the therapist.

In the vignette that I presented above, even though Ella was fearful, she also had strengths and she had access to a part of herself that was motivated to overcome her avoidant behavior.  She was able to use the therapy well and, over time, she was able to work through her early childhood trauma and overcome her fears.

Many people who have an avoidant attachment style never come to therapy at all.  Their fear of developing a therapeutic relationship with a therapist is so great that, unfortunately, it keeps them out of therapy and, as a result, they never work out their problems in relationships.

For other people who start therapy and who might not be as motivated or as psychologically mind,  they often have a hard time sustaining it.  They might go from one therapist to the next in an effort to get help, but they don't remain in therapy long enough to work through their problems.  Sometimes, in hindsight, some of these clients see that their fear overwhelmed them.

But other people with this problem, no matter how many different therapists they see, they tend to externalize their problems and believe that they left because of the therapist as opposed to what usually happens:  They leave because of their insecure attachment style and the fear and dread that are associated with this problem.

When you consider that overcoming an insecure attachment style is not short term work, this presents another challenge for these clients.

Getting Help
The good news is that many clients who come to therapy to overcome the consequences of problems with early attachment are able to work through these problems.

Just like in any other therapy, it's important for the therapist and client to be a good match.

It's also important that the therapist, who should be a licensed mental health professional, is knowledgeable about insecure attachment issues.

Also, in many cases, as I mentioned earlier, straight talk therapy, which is usually a "top down" approach, isn't as effective as a more "bottom up" approach in therapy, like Somatic Experiencing, EMDR or clinical hypnosis.

If the composite vignette above resonates with you, you could benefit from working with a licensed therapist who has expertise in working with clients who have attachment problems.

It's common for most people to feel some discomfort about starting therapy.  But it's preferable to deal with the fear than to look back late in life and have regrets that life has passed you as you continue to suffer with attachment problems.

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

Humor Can Be Effective in Psychotherapy

Humor can be effective in psychotherapy when the timing is right and when it's used in a tactful way. The therapist needs to know the client well enough to know how the client will respond to humor.  Sometimes, humor helps clients to develop a different perspective about their problem.

Humor as a Sign of Resilience
Over the years, many of my clients, as they have started to feel better, have come in with humorous stories about themselves.  Whereas in the past, the same event might have been overwhelming for them,  at that point in the therapy, they can poke fun at themselves and gain a different perspective on their situation.  It's often a sign of emotional resilience when clients can laugh at themselves in a good natured way.

Humor Can Be Effective  in Psychotherapy

Seeing a Funny Movie or Reading a Funny Book Can Be an Emotional Uplift

Clients who are anxious and depressed will often report that they feel uplifted by going to see a funny movie or reading a comical passage in a book.  Sometimes, that emotional uplift that they feel is enough to open them up to the possibility of overcoming certain obstacles that seemed too daunting before.

Sometimes, people are able to see the humorous side of an otherwise difficult situation.  Good examples of this can be found in books by David Sedaris, who is a master at poking fun at himself and finding humor in even the most dismal circumstances.

Charlie Chaplin's movies often combine pathos and humor.  An example of this would be his movie,  "Modern Times."

Humor Can Be a Bonding Experience Between a Client and a Therapist
Humor can be a bonding experience between a client and a therapist.  When used appropriately, it can open up a dialog between the client and therapist that might not have been possible before.

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 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.

photo credit: gwilmore via photopin cc