Overcoming Anxiety About Starting Therapy: Why It’s Normal to Feel Ambivalent

This article was updated on October 10, 2026.

Many people seeking help in psychotherapy are surprised by how much anxiety and ambivalence they experience when beginning to see a psychotherapist. Even the most motivated individuals often feel a wave of hesitation before their first session. 

Minimalist single-line art illustration representing the transition from acute anticipatory anxiety to somatic calm—a therapeutic milestone utilized by Greenwich Village, NYC psychotherapist Josephine Ferraro, LCSW (10011)

to help clients navigate ambivalence about starting therapy.

As a licensed psychotherapist practicing in Greenwich Village, Manhattan, I want to assure you that this is a completely normal reaction to beginning the psychotherapeutic process.

Why Do People Feel Anxious About Starting Psychotherapy?

In general, making meaningful changes can be challenging. Even when you consciously know you need support and feel the time is right, stepping into the unknown is daunting.

Most people decide to begin psychotherapy because they want to break old patterns. However, we are familiar with our old habits and ways of being. Even when those ways become uncomfortable or stop working for us, imagining a different version of ourselves brings up deep uncertainties:

• "How can I actually make these changes?"
• "Will I be able to sustain it, or will this be another unsuccessful attempt?"
• "What if my family and friends don't like the changes they see in me?"

It is completely natural for these doubts to creep in. If you have never been in theray before, the psychotherapeutic environment is unlike any other professional relationship you have experienced.

The Pragmatic and Emotional Hurdles of Finding a Therapist

The logistical challenge of finding the right practitioner can amplify your initial anxiety. Navigating insurance panels in NYC is famously frustrating. Many specialized psychotherapists operate private practices outside of managed care panels because insurance constraints often restrict the depth and duration of clinical care.

When searching for a therapist, I highly recommend seeking trusted recommendations from friends or doctors. If you find a clinician who feels like the right fit but does not accept your specific insurance, you might feel conflicted about paying for therapy out of pocket.

When navigating this economic decision, it helps to look at therapy as a foundational investment in your future. Consider how resources are allocated elsewhere—such as dining out in Manhattan or daily impulse buys. Prioritizing your psychological well-being is an investment that yields lifelong dividends.

Once you identify a psychotherapist online or through a referral, making that initial phone call can feel awkward. You might worry about what to say or how to summarize your struggles concisely. If you reach a confidential voicemail, leaving a brief message with your contact details is all it takes to start the process.

Anticipatory Anxiety and the First Appointment

Taking that first step and scheduling an appointment often brings a temporary wave of relief. You have set a clear intention to heal. Yet, as the date approaches, anticipatory anxiety frequently spikes.

It is common to worry about the dynamics of the session:

• "Will the therapist judge me?"
• "Will they think my problems aren't real, or conversely, that I'm completely broken?"

Arriving at a Manhattan professional office for the first time can provoke significant vulnerability. However, a skilled clinician knows how to de-escalate this tension, helping you settle into the room so you can use your session in a productive, satisfying, and safe way.

Clinical Vignette: Understanding Ambivalence in Action

The following case study is an anonymized composite drawn from real-world clinical themes. All identifying details have been completely changed to protect client confidentiality.

Daniel's Story: From Panic to Progress

Before Daniel called my office, he had been actively thinking about starting psychotherapy for several years. He had collected names of recommended practitioners from his doctor, but his underlying anxiety continuously blocked him from making the phone call.

When he finally reached out to me, his anxiety was so intense that he forgot to leave his phone number on my voicemail. Recognizing the oversight, he called back and left his details. When I returned his call, I could sense his nervousness, so we spent a few minutes discussing what he hoped to achieve in therapy.

As we spoke, his voice settled. He shared that low self-esteem was severely impacting his personal and work relationships. 

We scheduled a consultation at my office in Greenwich Village, NYC (10011). I provided clear subway directions, explained the building's intercom system, and let him know he could wait in the reception area.

On the day of the appointment, Daniel's anxiety caused him to misplace the address, requiring a quick text to confirm. Due to subway delays, his stress escalated, though he still arrived 20 minutes early. For safety and confidentiality, the door between my waiting room and inner office remains locked so current sessions are never interrupted.

Forgetting that I would be with another client until our exact start time, Daniel began calling out anxiously in the reception room. I paused my session briefly to greet him warmly, assure him he was in the right place, and let him know I would be right with him.

When I opened the door at our scheduled time, Daniel was visibly sweating and shaking. He sat down, but within moments, he panicked. He stated he forgot an urgent phone call, bolted from the office, and left the building in a state of panic. I followed up with him later that evening with a message.

During our next scheduled session, Daniel was still anxious, but he was able to openly discuss his fears of being judged or exposed. 

By encouraging him to voice his doubts, Daniel gradually began to settle into the therapeutic alliance. His anxiety did not vanish overnight, but by staying in the chair, he learned that the therapy room was a space built to hold his ambivalence safely.

About Josephine Ferraro, LCSW

👤 Josephine Ferraro, LCSW - NYC Psychotherapist & Trauma Specialist
I am a licensed NYC psychotherapist with 25+ years of experience. 

I have helped many individual adults and couples over the years.

I see clients in person in my office in Greenwich Village, Manhattan, NYC (10011). 

Online therapy are available throughout New York State.

I offer a free 15-minute phone call before setting up an initial appointment.

I am an advanced practitioner in EMDR, AEDP, IFS, Somatic Experiencing, Emotionally Focused Therapy for Couples and I am a Certified Sex Therapist.

Contact Information

🌐 Website: Josephine Ferraro, LCSW - NYC Psychotherapist

✉️ Email: josephineferraro@iCloud.com

📞 Call: (917) 742-2624 (during business hours)

Trauma Therapy: Why Establishing Safety is Crucial Before Processing Trauma (Part 1)

This article was updated on October 9, 2026.

As a licensed psychotherapist specializing in trauma recovery in New York City, many clients come to my private practice seeking advanced, mind-body oriented modalities like EMDR therapy, IFS Parts Work Therapy, AEDP, Somatic Experiencing (SE), and clinical hypnosis.

Developing a balanced therapeutic holding environment is essential before historical trauma processing can safely begin. Josephine Ferraro, LCSW - Greenwich Village, NYC 

Early in the therapeutic process, a critical phase must occur before diving into traumatic memories: establishing a foundational state of safety. This step is non-negotiable. Proceeding straight to processing without proper psychological and physiological stabilization can destabilize the nervous system and lead to severe retraumatization.

What Does "Establishing Safety" Mean in Trauma Therapy?

In trauma therapy, establishing safety means building a structured, collaborative therapeutic environment where a client feels secure enough to experience intense, historic emotional distress without becoming overwhelmed or dissociating.

Safety is not an absolute, all-or-nothing state; it exists on a spectrum. In experiential modalities, the goal is to help the client feel safe enough to handle the immediate somatic and emotional charges of their history. This clinical foundation requires a secure therapeutic "holding environment" developed entirely on trust, rapport, and boundary management.

4 Core Criteria Required Before Processing Trauma

Before an ethical trauma therapist begins processing historical events, the client must meet specific stabilization checkpoints.

1. A Strong Therapeutic Alliance

The client must feel a relative sense of comfort, trust, and rapport with their psychotherapist. While an initial consultation can give you an intuitive sense of whether a therapist is a good fit, a true therapeutic alliance develops over time. Not every therapist-client dynamic is a perfect match, and a skilled practitioner will ensure a mutual clinical fit before moving forward.

2. Stabilization from Active Life Crises

Unresolved trauma often causes individuals to experience ongoing crises or inadvertently cultivate emotional drama in their daily lives. However, active crisis management must always take priority over historical processing. If you are currently navigating an emergency, your immediate coping needs require your therapist’s full focus. Once life stabilizes, processing can safely begin.

3. Freedom from Active Substance Misuse or Compulsive Behavior

If a client is actively engaging in mood-altering behaviors—such as drug or alcohol abuse, compulsive gambling or other addictive and impulsive behavior—they are not yet structurally ready to process trauma. Without alternative coping skills, digging into heavy trauma will frequently trigger a severe relapse. Generally, a period of stabilization or "sobriety" (often up to six months or more) is required or a referral to a higher level of care if active dependency is present.

4. Adequate Somatic Resourcing and Dual Awareness

Unlike traditional talk therapy where you merely discuss a past event, experiential trauma therapies ask you to safely revisit the physical memory. To do this ethically, a therapist guides you through a resourcing phase to build your internal coping skills.

At a minimum, you must be able to maintain dual awareness. This means that while your mind remembers a distressing memory from the past, your physical body remains firmly anchored in the safety of the present moment. If a memory completely floods your awareness and causes you to lose touch with the here-and-now, processing must stop until you and your trauma therapist can help you to ground and center yourself.

Seeking Ethical, Specialized Trauma Therapy

Working collaboratively with a trauma specialist ensures that your path toward healing is paced safely, predictably, and effectively.

See Part 2 of this topic: Trauma Therapy: Can You Process Historical Trauma During an Active Crisis? (Part 2)

👤 Josephine Ferraro, LCSW - NYC Psychotherapist and Trauma Specialist

I am a licensed New York City psychotherapist and Trauma Specialist with over 25 years of clinical experience. 

My private practice is located in Greenwich Village, Manhattan, NYC (10011).

I am an advanced practitioner of mind-body oriented trauma therapies including:

• EMDR
• AEDP
• IFS Parts Work Therapy
• Somatic Experiencing
• Clinical Hypnosis (Hypnotherapy)

I am also an Emotionally Focused Therapist For Couples and a Certified Sex Therapist.

I provide a free 15-minute phone call before setting the initial appointment.

To learn more about my therapy services or to schedule an initial consultation:

🌐 Visit My Website: Josephine Ferraro, LCSW - Manhattan Psychotherapist - NYC

✉️ Email: josephineferraro@iCloud.com

📞 Call: (917) 742-2624 during standard business hours.

How is Therapy With a Psychotherapist Different From Using Artificial Intelligence?

In the last several years some people have been relying on Artificial Intelligence (AI) for their mental health issues instead of seeing a licensed mental health professional.  

Psychotherapy With a Live Therapist vs Using A.I.

Although AI can be useful in terms of understanding certain mental health issues, it's not a substitute for working with a psychotherapist. 

How is Therapy With a Psychotherapist Different From Using AI?

Psychotherapy and AI are fundamentally different:

The primary distinctions between AI and psychotherapy include:

The Therapeutic Relationship: 

• Psychotherapy: The therapeutic relationship between a client and therapist is central to psychotherapy. Healing occurs through a felt, trusted human relationship. In addition to what is said, therapists are attuned to non-verbal cues like voice tone, micro-expressions, posture and silences. Many psychotherapists who are trained to work in a psychodynamic way also tune into the client's conscious and unconscious gestures.  When psychotherapists and clients work together, whether it is online or in person, there is a right-brain-to-right brain attunement between therapist and client which enhances the client's healing.

Psychotherapy With a Live Therapist vs Using A.I.

• AI: AI operates on textual inputs. It cannot form a relational bond or therapeutic alliance with a client. Although it can mimic validation, it generates language statistically rather than experiencing an emotional connection with the client. 

Therapeutic Empathy:

• Psychotherapy: Therapeutic empathy is an essential part of healing in psychotherapy. Therapists are trained to develop empathy for clients and help clients to develop empathy and self compassion  (see my article: Why Is Empathy Important in Psychotherapy?).

Psychotherapy With a Live Therapist vs Using A.I.

• AI: An AI chatbot can adjust its responses based on sentiment analysis and learning algorithms, but lack the emotional bandwidth which is found with human psychotherapists. It can mimic empathy, but it cannot feel it. It could possibly guide, but it can't witness. 

Clinical Judgment vs Pattern Recognition

• Psychotherapy: Psychotherapists spend years training to diagnose conditions, assess complex safety risks and change treatment based on clients' responses.

Psychotherapy With a Licensed Therapist vs Using A.I.

• AI: AI evaluates texts based on probability and patterns from their training data. It struggles with deeply complex content and cannot make nuanced clinical choices.

Crisis Management and Safety

• Psychotherapy: Psychotherapists are legally bound to intervene during a crisis. Therapists actively build therapeutic plans for conditions such panic attacks or psychological trauma.

Psychotherapy With a Licensed Therapist vs A.I.

• AI: Chatbots cannot manage a crisis and often default to crisis-line referrals. If they fail to read the situation appropriately, they can provide inappropriate and stigmatizing advice.

Accountability and Ethics

• Psychotherapy: Mental health practitioners operate under strict state boards, ethical codes and HIPAA privacy laws.

Psychotherapy With a Licensed Therapist vs Using A.I.

• AI.: Chatbot platforms are corporate products not medical entities. Data privacy rules can vary widely which raises the risk regarding how sensitive personal information is stored and shared.

Intended Outcomes

• Psychotherapy: Psychotherapy is designed to foster psychological breakthroughs, process deep-seated trauma and build long term, structural psychological changes.

Psychotherapy With a Licensed Therapist vs Using A.I.

• AI: AI cannot foster psychological breakthroughs. It is best suited as an adjunct to therapy for accessing certain behavioral tools like reflection prompts, mood tracking or breathing exercises between psychotherapy sessions. 

Conclusion

The future of mental health will not be a choice between working with a human psychotherapist versus texting a chatbot.

In moments of crisis where psychotherapy is unavailable, like in a war-torn country, AI can provide information, but it has limitations.  

In terms of psychological healing, the human-to-human contact that available in psychotherapy is essential and irreplaceable for psychological healing.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

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.

Also See My Articles:

Why is Empathy Important For Healing in Psychotherapy?

The Psychotherapy Session: A Unique Intersubjective Experience 

The Creation of the Holding Environment in Psychotherapy 

Psychotherapy as a Co-created Process Between Client and Therapist 

 

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.