Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Clients often start psychotherapy with some degree of ambivalence--often a mixture of hope and fear.  The hope is that they will be able to work through their problems in therapy.  When clients come to therapy to deal with unresolved developmental trauma, the fear is that the psychotherapist might fail them, as they were failed in their earliest relationships with their parents, and they will be retraumatized (see my articles: Developmental Trauma: Living in the Present As If It Were the Past, Starting Psychotherapy: It's Not Unusual to Feel Anxious and Ambivalent,  Clients' Fears About Being Abandoned By Their Psychotherapist, Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About Psychotherapy, and Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations).

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

As I've mentioned in other articles, it's always important for the psychotherapist to establish a rapport with the client.  This is especially true when clients come to therapy to work through developmental trauma where they might have been neglected, abused or betrayed in some way. These clients often expect to be retraumatized in their personal relationships as well as in their client-therapist relationship.

Even when there seems to be a good therapeutic alliance between the client and the therapist, this rapport can be fragile and subject to sudden changes depending upon how vulnerable the client feels in a particular session, so the therapist needs to be aware that there can be these sudden changes.

If the client develops a positive transference to the psychotherapist and there is some misunderstanding, the client, who is ever vigilant for possible betrayal, can suddenly develop a negative transference when he thinks that the therapist is behaving in a similar way to his parents.

Many times this fear is unconscious on the client's part, and he might not know that he is reacting to the therapist as if the therapist was the parent who abused, neglected and betrayed him (this assumes that the therapist is really not being abusive, neglectful or betraying the client).

These ruptures are usually reparable if the therapist understands what's happening between her and the client and the client allows for the repair (see my article: Ruptures and Repairs in Psychotherapy).

Let's take a look at a fictional vignette that illustrates these dynamics:

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Agnes

Agnes was in her early-30s when she began psychotherapy. 

During the consultation, Agnes explained to the therapist that she felt like she was "just drifting" in her life without purpose.  She said she felt "dead" inside.  She had a history of several unhappy romantic relationships and many unsatisfying dead end jobs, including her current job.  

Coming to therapy was her first attempt to explore these issues.  In the past, she considered attending psychotherapy, but each time she would dismiss this idea because she feared being betrayed in therapy.

But lately she felt so miserable and her friends were tired of hearing her complain.  Even when they were willing to listen, she didn't find them to be helpful.  She thought they didn't understand what she was going through and their suggestions were simplistic.  So, she decided to try therapy, hoping that she would feel better, but dreading that it would be another bad experience.  

She described her family history as "a nightmare."  Her father was a severe alcoholic, and her mother was in denial about the severity of the father's drinking.  She described her mother as being in her own "fantasy world" where everything was "rosy."  Even when her father lost one job after the next because of his alcoholism, her mother blamed the bosses for firing the father.  

As the older of two children, Agnes felt she had to contain all her worries by herself because her mother was unable to talk to her about Agnes' concerns.  

Her mother would minimize Agnes' fears by telling Agnes that she was being "dramatic" or a "worry wort."  Agnes' brother, who was 10 years younger than her, didn't understand what was going on, so Agnes felt alone and she suffered from terrible anxiety.

From the time she was a child, she worried about things going wrong.  Even when things were going relatively well, she worried that there could be a sudden downturn and she would be devastated.

She was offered jobs that were commensurate with her education and skills, but she never felt confident enough to accept them.  Instead, she took low level, low paying because they didn't cause her to feel such fear and anxiety.

When she recently turned 31, she had a sudden awakening that she didn't want to just "drift" in life any more.  She wanted to get married and have a family, but she was afraid to date because her prior relationships were so awful.  

She also wanted to work in a more interesting job because she was bored at her current job.  Money wasn't an issue because her father left her a trust fund when he died, but she feared that one day when she was older that she would look back on her life and have many regrets because she was too afraid to take risks.

Recently, a family friend, who knew of Agnes' advanced education and skills, offered Agnes what she  considered to be her "dream job."  But she was highly ambivalent about taking it.  She feared that if she didn't do well, she wouldn't be able to face the family friend or her mother and brother.

So, her dilemma was whether she should stay in her current, boring job where she was underemployed or if she should take the risk and accept the family friend's job offer.

Agnes also talked about coming to therapy as being a "risk."  She chose her psychotherapist based on a recommendation from her primary care doctor, but she feared that the therapist would be another disappointment in a long line of disappointments throughout her life.

Given all of Agnes' fears about therapy, she and her therapist decided that they would take it slow.  Agnes' preference was to deal with the career issue first since she had to give her family friend an answer soon.

During their sessions together, Agnes went back and forth as to what she wanted to do about the job offer.  In one session, she said she planned to take the job.  In another session, she changed her mind and said she was too afraid to take the risk.

As they talked about her need to make a decision and how difficult this was for her, Agnes' therapist helped Agnes to see the connection between her early history and her fear of taking what she perceived to be a big risk.

Agnes began to understand how overwhelmed and emotionally neglected she was as a child since neither parent was able to be emotionally supportive.

It was understandable that Agnes, who felt so insecure about most things since she was a child, would also be fearful of making a change in her career.  She had little confidence in her decision making process in part because she was so invalidated as a child (see my article: Growing Up Feeling Invisible and Emotionally Invalidated).

After a few weeks, Agnes expressed feeling comfortable in therapy.  She felt that her therapist understood her and was emotionally supportive.  

Soon after that, Agnes told the family friend that she would accept the job.  At first, she was relieved that she made a decision and she was no longer going back and forth in her mind.  

But shortly afterwards, she was overcome with anxiety and fear:  Was she taking on more than she could do?  Would she disappoint the family friend?  If she didn't succeed, would she feel like a failure in front of family and friends?

Whenever Agnes spoke with her therapist about her decision, she felt better.  She was almost defiant about "showing" her mother that she could do better.  She also knew that she could leave the job if it didn't work out and no one needed to know what happened.  

But she continued to ruminate about her decision, going back and forth in her mind even though she had already told the family friend that she accepted the position.  Her rumination caused her to lose sleep because she was so worried.

One day, Agnes showed up at her psychotherapist's office on the wrong day.  When her therapist saw her in the waiting room, she called Agnes into her office to talk to her for a moment and to let her know that her appointment was for the next day.  She explained that she couldn't see Agnes today because she already had other clients scheduled.

At that point, Agnes became furious.  She insisted that her appointment was for that day, and she blamed the therapist for being confused, "I knew I couldn't trust you.  You're just like my parents--so unreliable.  I knew you would betray me.  I don't think you're the right therapist for me" and with that she stormed out of the office.

Agnes' therapist called Agnes that evening after she saw her other clients.  When Agnes answered the phone, she sounded calmer.  She told her therapist that she realized afterwards that she was the one who was confused about the day, and she apologized.

During the course of Agnes' therapy, there were several more similar incidents.  Whenever an incident occurred, Agnes was sure that her therapist had betrayed her in some way.  

But when she calmed down and she and her therapist were able to talk calmly, Agnes realized that she had misjudged the situation and that her fear of being betrayed was always just under the surface waiting to erupt.

As Agnes and her therapist were able to repair their relationship after each incident, Agnes became more trusting of her therapist.  As time went on, these incidents decreased and there was more time between each incident.

In the meantime, Agnes was doing well at her new job.  This gave her more confidence, although she was still afraid sometimes that she would fail.  

When Agnes was ready and she felt more stable in her relationship with her therapist, she and her therapist began to work on her developmental trauma using EMDR therapy (see my articles: What is EMDR Therapy? and  How EMDR Therapy Works: EMDR Therapy and the Brain).

Developmental Trauma: The Client's Hopes and Fear in Psychotherapy

Over time, she was able to work through her traumatic childhood so that the trauma didn't continue to get played out in her adult life.

As she felt more comfortable and secure, she also started dating again, and she felt more hopeful about being in a long-term relationship.

Conclusion

People who have experienced developmental trauma often expect to be abused, neglected, disappointed or betrayed in some way in their adult relationships.

Many people, who have unresolved developmental trauma, tend to be vigilant so they won't be caught off guard when the disappointment comes.  Even when things are going relatively well in their life, their fears can dominate their emotions.

Clients with developmental trauma usually come to therapy hoping that they will find relief from their problems, but many of them also dread that their therapist will betray them in some way.  

Even if the client with developmental trauma develops a positive transference with the therapist, even a minor misunderstanding can cause the client to regress to feeling suspicious and fearful again.

Under these circumstances, there can be many incidents of ruptures and repairs between the therapist and the client--if the client will allow the repair.  Some clients just leave therapy precipitously and never allow for the repair (see my article: When Clients Leave Psychotherapy Prematurely).

But if the client and therapist can work on repairing the relationship, this is healing for the client because her childhood experience was usually that there were no repairs, only ruptures, so seeing that ruptures in therapy can be repaired is healing for the client.

Over time, if the client stays in therapy, a consistently positive relationship can develop between the client and the psychotherapist and can create an opening to develop other positive relationships.

Getting Help in Therapy

One of the most difficult things for many clients with developmental trauma to do is to come to therapy (see my article:  The Benefits of Psychotherapy).

For these clients, balancing hope and fear can be challenging.

Clients with developmental trauma often come to therapy when the emotional pain they're experiencing is greater than their fear.

Over time, if the client and the therapist are a good match, these issues can be worked through in therapy and the unresolved developmental trauma can be gradually resolved (see my article: How to Choose a Psychotherapist).

If the issues that I've described in this article resonate with you, you owe it to yourself to find a skilled psychotherapist who has experience working with developmental trauma.

Once you are free from your traumatic history, a huge emotional burden will be lifted from you.  It can improve how you feel about yourself, your outlook for the future, and your relationships.  

About Me

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

I work with individual adults and couples.

I have helped many clients to work through their traumatic experiences so they can live more fulfilling lives.

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

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

Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations

In prior articles about developmental trauma, I discussed that it's not unusual for adults, who have  developmental trauma from childhood, to have problems putting words to their feelings and sensations (see my article:  Developmental Trauma: Living in the Present As If It Were the Past and Developmental Trauma: "This is Who I Am" vs "This is What I Do").  In this article, I'm focusing more on this clinical issue.

Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations 

For infants to develop neurologically and emotionally, their primary caregiver (usually the mother) must be emotionally attuned to the infant.  Beyond providing basic physical care, the mother must enter into an intersubjective dynamic with the infant where she interacts in an emotionally nurturing way.

Over time, this emotional attunement facilitates the infant's brain development, especially the right side of the brain which is the dominant side of the brain up until the third year of life.

Since the right side of the brain is already activated for infants, they learn quickly using the right side until the age of about 3 when dominance shifts from the right side to the left side of the brain.

The right side of the brain is involved in the processing of social-emotional information, the facilitation of attachment functions, and regulating bodily and emotional states.

If the primary caregiver's provides "good enough" emotional responses to the baby's movements, gestures and sounds, the baby will develop a secure attachment bond to the primary caregiver and, as an adult, will have the capacity to form healthy relationships with other adults.

But if the primary caregiver does not provide these emotional responses to the baby or provides them in an inconsistent or disorganized manner, the baby develops an insecure attachment to the caregiver, which has negative implications later on for adult relationships.

In addition, if the infant is neglected in this way or abused by the caregiver, there are also negative implications for emotional regulation as well as the ability to identify feelings and sensations.

Needless to say, these deficits in the ability to identify feelings and sensations have serious consequences for the adult's inner world as well as the ability to form healthy relationships.

Clients, who start psychotherapy because they're having problems understanding themselves and forming relationships and who often blame themselves for their problems, usually don't make the connection between early neglect or abuse and their current problems, which is why it's so important for psychotherapist's to provide this psychoeducation to them (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

Providing these clients with psychoeducation isn't a matter of blaming the mother or the primary caregiver, who often had an early history of abuse or neglect.  It's a first step in helping the clients to understand the origin of their problems.

Also, if they have children, having this psychoeducation helps them to understand the importance of forming a secure attachment bond with their own children so the problems don't continue into the next generation (see my article:  Psychotherapy and Intergenerational Trauma).

Unfortunately, many adults who have problems identifying their feelings and sensations never make it to therapy.  For some people, it's a matter of shame.  They think that, somehow, their problems are their own fault, and their parents might have communicated this to them when they were children.

Other people with developmental trauma don't come to therapy because they're confused about their problems and they think they have to be able to articulate their problems or they can't be helped.  They don't know that most psychotherapists will start at whatever point they find themselves when they begin therapy, and therapists will help clients to  understand these problems as they work towards resolution.

Then again, there are other practical issues involving health insurance and other financial concerns that keep so many people out of therapy in general.

Let's take a look at a fictional vignette, which illustrates the issues that are so common to this problem.

Fictional Vignette: Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations

Amy
Amy started psychotherapy when she was in her early 30s because she had problems sustaining romantic relationships (see my article: The Psychotherapy Session: A Unique Intersubjective Experience and The Psychotherapist's Empathic Attunement Can Be Emotionally Reparative For the Client).

Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations

Attractive and intelligent, Amy had no problems meeting and dating men that she was interested in.  Typically, her problems began a few months into the relationship when the relationship became more emotionally intimate.

At that point, Amy became unsure of herself.  She usually knew when she was sexually attracted to a man and she enjoyed the sex during the first few weeks of the relationship.  But as the relationship intensified, she felt confused about what she felt for her boyfriend and she no longer enjoyed sex.

This left Amy and whoever she was dating at the time confused and frustrated.  And when these issues didn't clear up, the relationship would fall apart.

After a recent breakup where Amy found herself in this predicament again, she decided that she needed help in therapy.

At first, she was unsure how to describe her family background.  However, over time, it emerged that she was the only child of a single teenage mother, who sent Amy to live with an elderly great aunt shortly after Amy was born.

As an adult, Amy learned from relatives that this great aunt, who suffered with a multitude of medical problems, was barely able to care for Amy.

After the first year, the great aunt sent Amy to live with Amy's mother's sister, a woman who struggled with major depression her whole life and who resented taking care of Amy.

Throughout her childhood Amy was shifted from one relative to the next in different states around the country until she was 10 and her mother was in a better position financially to take care of her.

Since Amy's mother made no effort to maintain a relationship with Amy, Amy described how awkward it was for both of them.

Although her mother provided her with food and shelter, her mother didn't know how to develop a mother-child relationship with Amy because she never had that experience with her own mother.  She treated Amy was if Amy was a small adult with no understanding of what Amy needed from her.

If Amy was upset, her mother, who didn't know how to soothe Amy, would tell her, "If you're upset, it's your own fault."

When Amy was 18, she got a scholarship to an out of state college and jumped at the chance to get away from her mother.  After college, she got a job and moved in with women she knew from college, and she hardly saw her mother after that.

Amy's last relationship ended in much the same way that her other relationships ended.  She and Tom met through friends.  There was a strong attraction between them from the start.  But after a few months, Amy felt confused about whether she still liked Tom or not.

Tom was confused and couldn't understand the change in Amy, and Amy couldn't explain what happened. Soon after that, Tom ended the relationship and Amy felt she was to blame, once again, for a relationship not working out.

Amy's therapist provided Amy with psychoeducation during the initial stage of psychotherapy.  She also explained to Amy that core emotional issues tend to come up as a romantic relationship becomes more emotionally intimate, which would explain why Amy began having problems when her relationships became more intimate.

In addition, Amy's therapist explained how psychotherapy could help Amy.

With regard to Amy's developmental trauma, her therapist explained that, as a result of Amy's childhood history where her caregivers were unable to form an emotional attachment with Amy, Amy experienced emotional neglect (see my article: What is Childhood Emotional Neglect? and How Your Attachment Style Affects Your Relationship).

Her therapist also explained that when she went to live with her mother, Amy experienced emotional abuse because her mother blamed Amy whenever Amy had problems and, due to her own lack of maternal nurturing, her mother didn't know how to nurture Amy.

As a result of these issues, Amy never developed the skills she needed to form intimate adult attachments.  Amy's developmental trauma also had negative implications for Amy being able to identify her feelings and sensations.

Since Amy's psychotherapist used mind-body oriented psychotherapy, like Somatic Experiencing, she was able to help Amy to begin to identify her feelings using her body (see my article: Somatic Experiencing: Tuning Into the Mind-Body Connection).

For instance, Amy learned to recognize that when she felt fearful, which was often, her stomach would clinch.  She also learned that when she felt angry, she felt a tightness in her throat.

Using this mind-body oriented "bottom up" approach, rather than a "top down" approach which is used in cognitive behavioral therapy (CBT), Amy's therapist helped Amy to recognize her feelings and to be able to put words to those feelings.

This work in therapy was neither quick nor easy since Amy was working to overcome early developmental trauma and to develop skills that she never developed early on.

As time went on and Amy got better at connecting to her body to identify feelings and sensations, she and her therapist were able to process her early developmental trauma using EMDR therapy (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR and the Brain).

Over time, as Amy became more adept at connecting with her emotions, she also developed better relationship skills.  When she entered into a new relationship, she was able to remain connected to herself emotionally and physically as well as being attuned to her boyfriend.

Rather than shutting down emotionally and physically, as she did in the past, Amy was able to remain open in herself and her boyfriend as the relationship became more serious.  Eventually, she and her boyfriend moved in together and they began talking about getting married.

Conclusion
When an infant's needs aren't met because the primary caregiver is unable or unwilling to meet those needs or because there has been multiple and inconsistent caregiving over time, the infant's brain development, in particular the right brain, suffers.

These developmental deficits have negative implications for adult relationships and often result in the individual being unable to identify feelings and sensations.

There is now a greater understanding of developmental trauma due to infant research and the development of trauma-informed therapy.  Within the last 20 years or so, there has also been many advances in psychotherapy to help clients to overcome developmental trauma.

Getting Help in Therapy
A skilled trauma-informed psychotherapist can help clients to overcome developmental trauma.

Trauma treatment modalities, such as Somatic Experiencing and EMDR therapy, help clients to overcome developmental trauma.

Somatic Experiencing and other Somatic psychotherapies help clients to begin to identify their feelings and sensations.

EMDR therapy helps to process traumatic experiences.

If the problems described in this article resonate with you, you owe it to yourself to get help from a trauma-informed psychotherapist (see my article: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than continuing to suffer internally and in your interpersonal relationships, you could work with a trauma-informed psychotherapist to overcome your problems.

By resolving your trauma, you free yourself from a history that has been an obstacle to your happiness.

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

I have helped many clients to overcome developmental trauma so they could go on to lead happier lives.

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

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

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.

Clients' Fears of Being Abandoned By Their Psychotherapist

In prior articles, I've discussed fear of abandonment in relationships as well as psychotherapy clients' fear of being a disappointment to their therapist (see my articles:  Fear of Being a Disappointment to Your Therapist, Fear of Abandonment: Leaving Your Relationship Because You're Afraid of Being Abandoned, The Connection Between Fear of Abandonment and Codependency Issues, Fear of Abandonment Can Occur Even in a Healthy, Stable Relationship, and How Psychotherapy Can Help You to Overcome Fear of Abandonment).  In this article, I'm focusing specifically on clients who have a general fear of abandonment because of their early traumatic history and the clinical implications of that fear in relation to their fear of being abandoned by their psychotherapist.

Clients' Fear of Being Abandoned By Their Psychotherapist 

There are many ways that clients, who have a fear of being abandoned, could perceive the therapist  as abandoning them.   Clients who have this fear are often hypervigilant for any possible signs that the therapist is not fully present in the therapy hour.

Most psychotherapists, who are trained in psychoanalysis or psychodynamic psychotherapy, have the ability to be emotionally engaged in the therapy session to the client's therapeutic process, including subtle shifts in the client's self states (see my article: Your Shifting Self States Can Affect You For Better or Worse).

Experienced contemporary psychoanalytic and psychodynamically trained psychotherapists are trained to intuitively pick up on what is going on in the intersubjective space between the client and the therapist even during times of silence.

But this doesn't mean that every psychodynamic psychotherapist is perfectly attuned during every moment of the therapy session.  There might be times when the therapist's mind momentarily wonders.  This is often related to the client's process even when it doesn't, at first, appear to be related.

For instance, if a psychotherapist is working with a highly dissociated client who is fairly disconnected from what he is talking about to the therapist, the therapist might find that her mind wonders momentarily as if both client and therapist are caught in the client's "cloud" of dissociation.

For an experienced psychotherapist, who is knowledgeable about dissociation, this momentary joining with the client in the dissociative "cloud" is important clinical information about what's going on with the client as well as what's going on between the client and the therapist.

For example, if, for a moment, the therapist "hears" a song in her mind, she asks herself inwardly whether this song has come into her thoughts unconsciously and how it may or may not be related to the client (see my article: The Psychotherapist's Empathic Attunement to Unconscious Process in the Therapy Session).

Psychotherapists who are comfortable disclosing their thoughts to the client might explore with the client if the client thinks it is related.

So, for instance, the therapist might say, "You know, you were just talking about your relationship and the song, "I Can't Make You Love Me" by Bonnie Raitt just popped into my head.  I'm wondering if I'm picking up something unconsciously about what's going on with you and your spouse."

More often than not, in this type of situation, even if the client wasn't talking about his feeling that his  wife no longer loves him, he might suddenly realize that the therapist picked up on a dissociated part of him that, until now, he was unaware of.  It's often a disavowed part of himself (or a disavowed self state) that he was unaware of but which was in the intersubjective "air" between the therapist and the client on an unconscious level.

When this happens, this phenomenon allows this disavowed self state to come "online" for the client. It might have been a part of himself that was just below the surface, so to speak, and was being unconsciously communicated to the therapist.

Although the client might not be happy to realize that he's really worried about his wife not loving him any more, he and his therapist now have a deeper understanding of a part of himself that was dissociated, and this part can now be worked with in therapy.

So, this is an example of what seems like a lapse in the psychotherapist's attention, but it's actually the client's unconscious material becoming conscious and furthering the work.

But a client, who is not ready to deal with his fear of not being loved by his spouse--even if he expressed this fear in prior therapy sessions--and who generally fears being abandoned, including by his therapist, will deny that the song that popped into the therapist's head is relevant.

Not only will the client deny it, he will also perceive the therapist's momentary thought about the song as being intrusive and a form of abandonment, "Why are you thinking about songs when you should be paying attention to me?"

The client sees this as "evidence" that the therapist really isn't interested in him because the therapist's mind wandered for a second.

Months later, when the client becomes ready to own his fear about his wife, he might tell the therapist that it was prescient of her to pick up on this dissociated fear a few months back in the form of the song.

But before the client is ready to allow that disavowed part of himself (the part that has this fear about his wife) to fully emerge, he will only see this phenomenon as a disruption to the therapy session and proof that the therapist abandoned him--even if it was just for a second.

What the client is unaware of is that the abandonment which he fears will happen already happened with his primary caregivers and this is now the template through which he sees his relationships, including his relationship with his therapist (see my article: Developmental Trauma: Living in the Present As If It Were the Past and Overcoming Trauma: When the Past is in the Present).

Let's take a look at a fictional clinical vignette which illustrates these dynamics:

Sandy
Sandy started therapy because she wanted to be in a relationship, but whenever she got close to anyone in a romantic relationship, she would become too afraid to remain in the relationship and she would find a way to consciously sabotage it (see my article: An Emotional Dilemma: Wanting and Dreading Love).

In hindsight, Sandy would see how she sabotaged the relationship but, no matter how many times this happened, she was unable to see it while it was happening.

Clients' Fears of Being Abandoned By Their Psychotherapist

This part of her that unconsciously destroyed her relationships was so dissociated that it operated as if it were not a part of her at all.  She would tell her therapist, "It's as if it's 'not me' acting in the relationship--as if I'm in a dream and I only wake up after I've damaged the relationship beyond repair."

Sandy talked to her therapist about her fear that if her friends or a potential boyfriend ever really got to know the "real me," they wouldn't like her and they wouldn't want to be around her (see my article: Overcoming the Fear That People Won't Like You If They Knew the "Real You").

Her therapist was aware that, most likely, if Sandy had this fear with others, she probably had this fear with the therapist as well because this is a common experience with clients who have this fear.

When her therapist attempted to explore whether Sandy had this same fear with her, Sandy denied it.  But her therapist sensed that this fear was out of Sandy's current awareness and Sandy wasn't ready to recognize it.

A few weeks later, when her therapist told Sandy that she would be going on vacation in a couple of months for three weeks, Sandy became highly anxious.  She struggled with her internal conflict of  wanting to suppress this fear and wanting to talk about it.

A week later, when Sandy came for her next session, she told her therapist that she was having nightmares about being a young child who was being accompanied by a woman in a subway station.  Sandy didn't recognize this woman, but in the dream this woman seemed to be a nanny or some sort of caregiver.  Suddenly, in the dream, the woman, who was accompanying her, disappeared and Sandy was lost and confused in the crowded subway station.  She didn't know where to go or what to do and she began to panic.

Each time that she had this dream, Sandy told her therapist, she woke up startled and couldn't go back to sleep.  Her heart was pounding and her thoughts were racing.  Even hours after she woke up, she still felt a sense of dread that was residue from her dream.

Sandy and her therapist explored the meaning of the dream, especially as these dreams began right after her therapist told Sandy that she would be going on vacation in a couple of months for three weeks.

Sandy's first reaction was that she felt ashamed.  On the one hand, she knew, logically, that her therapist deserved to go on vacation, as everyone does.  But, on the other hand, a part of her feared that her therapist wouldn't come back or that if she came back, she would decide that Sandy was "just too much" for her and end the therapy.  Then, Sandy would be left on her own, feeling abandoned and not knowing what to do.

Given Sandy's childhood history of her father disappearing one night (never to return) and her mother's major depression where she was barely able to function, it was understandable that Sandy would have a fear of abandonment because she had been traumatized by each of her parent's abandonment--the physical abandonment by her father and the emotional abandonment by her mother.

This fear of abandonment was what was getting in the way of Sandy having a lasting relationship.  She unconsciously sabotaged the relationship to end it because she wanted a sense of control of the end rather than waiting for her boyfriend at the time to abandon her.

Sandy's fear of being abandoned by her therapist was now out in the open for her and her therapist to work on.  Sandy knew that she didn't completely believe that her therapist would abandon her--it was only a part of her that felt this way, but it was a powerful part (see my article: Reclaiming a Lost Part of Yourself).

As Sandy and her therapist talked more about her fear, she felt the fear somewhat subside.  She was aware that her fear was based on her childhood trauma of real abandonment (not just fear of abandonment).  So, over time, Sandy and her therapist were able to process her early trauma, which was the origin of her fear (see my article: Psychotherapy to Overcome Your Unresolved Childhood Trauma) and, gradually, the fear of being abandoned as an adult began to subside.

Conclusion
People who have a childhood history of emotional or physical abandonment often have a fear that important people in their life, including their psychotherapist, will abandon them.

At first, the fear might not be explicit.  It might be just under the surface and come to light through dreams or other unconscious material.

Before clients realize that they have this fear, the fear can get played out in other ways, like missed appointments, or in some cases by the client aborting therapy altogether rather than, from their point of view, risk being abandoned by the therapist (see my article: When Clients Leave Therapy Prematurely).

Once the fear is out in the open, clients often recognize that there is a part of them that has this fear.  In other words, they're not completely convinced that the therapist will abandon them--it's more like a disavowed part (or self state) contains this fear.

Becoming aware that what they fear has already happened in their childhood and that this has created a relational lens through which their fear is projected onto current relationships is helpful.

Even more helpful is the processing of the original trauma so that the fear of being abandoned doesn't get triggered in current close relationships.

Getting Help in Therapy
Fear of being abandoned is one of the major reasons why clients come to therapy, especially if this fear is being enacted in important adult relationships.

Clients often don't recognize that they have this fear about their therapists until there is an upcoming separation, like the therapist's vacation.

When the fear comes to light in therapy, there is an opportunity to work on this issue because it's alive in the therapy.

Just knowing logically that the fear of abandonment is from a prior trauma, although helpful, isn't enough to overcome this fear.  The client and therapist need to do trauma-informed therapy to process the original trauma so that the fear no longer gets enacted in current relationships.

If you're struggling with fear of abandonment in your close relationships, you could benefit from working with a licensed trauma-informed mental health professional who can help you to overcome this fear (see my articles: The Benefits of Therapy and How to Choose a Psychotherapist).

Once you no longer fear being abandoned, you can live your life with a greater sense of ease and well-being.  You can also live a more fulfilling life.

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

I have helped many clients overcome a history of trauma, including a fear of being abandoned.

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.












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Developmental Trauma: Living in the Present As If It Were the Past

My prior articles about psychological trauma discussed how unresolved childhood trauma, also known as developmental trauma, affects traumatized individuals as adults (see my article: Overcoming Trauma: When the Past is in the Present).  In this article, I'm focusing specifically on how developmental trauma often affects clients' relationship with their psychotherapist, especially during the early stage of psychotherapy.

Developmental Trauma: Living in the Present As If It Were the Past

In his paper, Developmental Trauma Disorder, trauma expert Bessel van der Kolk, MD indicated that developmental trauma, which includes abuse and neglect, is probably this country's biggest public health challenge.

He estimated that approximately 3,000,000 children are reported as being abused or neglected per year--and these are only the cases that are reported.  Many cases go unreported, so that number is probably much higher.

According to Dr. van der Kolk, approximately 80% of these cases are the result of abuse and neglect by the children's own parents.  As a result, developmental trauma is a significant problem in this country, and much remains to be done.

Since untreated trauma does not simply go away when children become adults, it's important to understand the impact of trauma (see my article: Untreated Trauma is a Serious Issue With Negative Consequences).

What is Developmental Trauma?
Before going into more clinical material, let's define "developmental trauma."

Developmental trauma occurs in childhood. It causes overwhelming stress for the child, especially when the stress is not alleviated by the parents.  This includes:

• physical abuse
• emotional abuse
• sexual abuse
• physical neglect
• emotional neglect

The dysfunction in the home can include, among other things:

• mental illness
• substance abuse
• domestic violence
• an incarcerated relative
• divorce

Developmental trauma is also called Adverse Childhood Experiences (ACE) and has serious long term health and mental health implications (see ACE Childhood Study).

Since adults, who experienced Adverse Childhood Experiences, were unable to trust their parents, who were supposed to love and protect them as children, it makes sense that they often have problems trusting people in their adult relationships, including their psychotherapist (see my article: Adults Who Were Neglected or Abused as Children Often Have Problems With Trust).

What Are the Clinical Implications in Therapy For Adults With Developmental Trauma?
For adults, who experienced developmental trauma as children, it takes a lot of courage to come to therapy to be emotionally vulnerable enough to work through their trauma (see my article: Starting Therapy to Overcome Untreated Trauma and Developing the Courage to Change).

It's not surprising that these adults often come to therapy with a great deal of ambivalence and mistrust (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Since most trauma-informed psychotherapists recognize these dynamics, they are aware of the importance of trying to establish a trusting relationship with these clients.

It's not unusual for these individuals to go from one psychotherapist to the next as soon as they feel emotionally vulnerable in therapy--especially since they often come to therapy unconsciously anticipating that the therapist will fail them in the same way that their parents failed them.

Their unconscious anticipatory fear that the psychotherapist will fail them in much the same way that their parents failed them usually indicates that they are living in the present as if it were the past.

The following fictional clinical vignette, which represents a common scenario for adults with developmental trauma, illustrates these points:

Fictional Clinical Vignette: Living in the Present As If It Were the Past
Nina

Nina, who was in her mid-30s, began therapy after her relationship with John ended six months after they started dating.

John ended the relationship because of Nina's jealous accusations.  John vehemently denied that he was cheating, but Nina didn't believe him.

Developmental Trauma: Living in the Present As If It Were the Past

Although they got along well during their first three months together, Nina began to suspect that John was cheating after their relationship became more emotionally intimate in their fourth month together.

Even though she saw no direct signs of John's infidelity, her suspicions alone were enough for her to assume that he was cheating, and she was relentless in her accusations.

When she came for her first session with her therapist, Nina expressed regret that she had destroyed her relationship with John with no objective evidence that he was cheating.  In hindsight, she understood her mistake and why John got fed up.

She also explained to her therapist that this was her pattern in relationships--she always assumed that her boyfriend at the time was cheating, even when there were no objective signs of infidelity.

When she came to therapy the following week for her second session, Nina had a completely different take on why her relationship with John ended.

She told her therapist, "All men cheat and since all men cheat, I know that John was cheating on me.  He ended the relationship because I called him on it and he didn't like it."

When her therapist attempted to explore Nina's feelings about the relationship in the current therapy session versus what Nina said in the first session, Nina acknowledged that she had initially said that  she had made a mistake with John.  But she maintained that she was wrong in her first session and what she felt today was the truth, "Men can't be trusted."

Her therapist realized that, although Nina did a 180 degree turnaround from her first therapy session to her second session a week later, she knew that Nina did not meet the clinical criteria for multiple personality disorder or, as it is now called, Dissociative Identity Disorder (DID).

She recognized Nina's turnaround as a matter of shifting self states, which is a dissociative process, but not as dissociative as DID (see my article: How Shifting Self States Can Affect You For Better or Worse).

And, while everyone has shifting self states to some degree, people who are not traumatized usually have barely perceptible shifts as compared to people with unresolved trauma.

So the fact that Nina had a completely different view about the demise of her relationship when she returned to therapy on the second week was understandable considering her history of childhood trauma.

When Nina talked about her childhood, she vacillated between idealizing and denigrating her mother.

When she idealized her mother, Nina thought that her mother could do no wrong.  But when she denigrated her mother, she blamed her mother for not leaving the father, who had a long history of cheating on the mother.  Once again, her therapist understood these shifts as being part of Nina's shifting self states which were emotionally unintegrated.

Nina also had a long history of aborting therapy.  She explained to her current therapist that she had seen 10 therapists in the last two years, and she left each one when she felt that she couldn't trust the therapist (see my article: When Clients Leave Psychotherapy Prematurely).

Based on what Nina told her, her current therapist could see that Nina's pattern was that she left therapy as soon as the therapeutic work intensified and she felt too vulnerable.  Before that, Nina tended to idealize her therapists.  But once the work progressed and came close to her core traumatic issues, Nina became fearful, she developed a mistrust for the therapist and left therapy abruptly.

Forewarned of Nina's pattern in therapy, her therapist knew that there was a real possibility that Nina might abort the current therapy--even if it seemed like she developed a trusting relationship with the therapist before they processed Nina's traumatic experiences.

During most of her therapy sessions, Nina made it clear to her therapist that she understood that her traumatic childhood, including her father's infidelity, impacted her ability to have lasting relationships with men.

Most of the time, she expressed regret for her mistrust and wanted to "...hurry up and get over my trauma, since I'm not getting any younger and I'd like to get married and have children."

Nina sought therapy with her current therapist because the therapist specialized in working with trauma using EMDR Therapy.  Nina wanted to try EMDR therapy because she heard that it tends to work faster than regular talk therapy.

On the days when Nina acknowledged how her childhood history affected her adult relationships, she was in a hurry to get relief from her traumatic symptoms.

But on the days when she came to therapy blaming "all men for being dogs," she disavowed any connection between her childhood history and the demise of her relationships.  Once again, her shifting perspective was due to her shifting self states.

As part of the therapeutic process, Nina's therapist was the "container" for these different self states (see my article: The Holding Environment in Psychotherapy).

She knew that, even when Nina was in a hurry to process her childhood trauma, Nina wasn't ready.  Nina needed to develop internal resources and a greater sense of emotional integration before she would be ready to process her childhood trauma--otherwise, she would be flooded with anxiety and completely overwhelmed by the trauma therapy.

Her therapist also helped Nina to recognize her different self states by doing Ego States therapy (also known as Parts Work therapy) with Nina.  In this type of therapy, the therapist helps the client to get to know each of her shifting self states in order to foster greater emotional integration.

Nina understood most of the time that the internal resourcing and the Ego States therapy was preparation to eventually process her traumatic memories.  But there were times when she came to therapy feeling angry with her therapist for "dragging out the process and not helping me to get over my trauma."

During those times, Nina was ambivalent about her therapist and about the therapy.  Nina feared that she was being "duped" by the therapist and that she shouldn't trust the therapist.  She threatened to leave therapy and accused her therapist of being "no better than all the other therapists that I've had before."

But Nina and her therapist weathered these storms and, most of the time, Nina was able to see that her doubts and mistrust were the result of a particular self state that got triggered when she became anxious about the therapy (see my article: Coping With Trauma: Becoming Aware of Your Emotional Triggers and Expanding Your Window of Tolerance in Therapy).

She could see that what she was experiencing was the result of her traumatic past which she was living out in the present with her therapist.

Along the way, there was enactments in therapy, as there often are with clients who have been traumatized:  There were several sessions in a row where Nina "forgot" to bring a check to pay her therapist, she "forgot" to come to her sessions, and she was annoyed when her therapist held her accountable for her broken appointments.

All of these enactments were unconscious on Nina's part and were part of her dissociative shifting self states.

Most of the time, her therapist did not get caught up in these enactments but, being human, there was one time when she found herself right in the middle of an enactment with Nina: Nina's therapist had to take a couple of weeks off for a medical procedure.  She made a conscious decision not to disclose her medical problem, which was not serious, to Nina because she assessed that Nina was not ready emotionally to handle this disclosure.  She also wanted to preserve her right to privacy by not disclosing her medical problem.

When her therapist told Nina that she had to take a couple of weeks off, Nina exploded.  She was angry because she felt she was being abandoned by her therapist and with only a couple of weeks notice (see my article: Abandonment Issues Can Get Triggered While Your Therapist is Away).

Nina's therapist had little notice from her doctor that she needed this medical procedure, which could not wait, so she couldn't provide Nina with more notice.  But her therapist didn't want to reveal this to Nina because, as previously mentioned, she thought Nina was too emotionally fragile at that point.

Her therapist did the best she could under the circumstances to contain Nina's upset as well as her own feelings of being misunderstood.  But, after two sessions where Nina ranted about the two week break, her therapist told Nina in an angry tone that she would have a backup therapist that could consult during that two week break.

Even though her therapist got caught up in a mutual enactment by talking to Nina in an angry tone, something shifted for Nina where she stopped ranting and realized that she was being unreasonable (see my article: Mutual Enactments in Psychotherapy Between Client and Psychotherapist).

They were able to talk about what had just happened between them, and Nina expressed that, while she didn't like that her therapist spoke to her in an angry tone, she could feel the genuine nature of her therapist's upset and this caused her to "wake up" and see her therapist as a "normal human being" with her own experiences and feelings.  This was a major breakthrough for Nina.

As I mentioned in an earlier article about enactments, there are times when mutual enactments can have a positive effect on the therapy if the therapist is able to repair the rupture between the therapist and client and they come to a new understanding of their therapeutic relationship (see my article: Ruptures and Repairs in Psychotherapy).

Of course, although these enactments can be repaired and advance the therapeutic work, a therapist should never plan an enactment.

Gradually, over time, Nina became much more perceptive of when she was going through a self state shift.  She had developed a much more observing sense of self so that she could step back, even when she was in a mistrustful state, and see, "It's happening again," which made it easier for her to be more objective and shift into a more emotionally balanced state.

Developmental Trauma: Living in the Present As If It Were the Past

As Nina became more emotionally integrated with fewer dramatic self state shifts, she was now ready to process her earlier traumatic experiences using EMDR therapy.

By processing her childhood trauma in therapy, eventually, Nina freed herself from her traumatic history so that she was no longer living in the present as if she were in the past.

Conclusion
Reenacting unresolved childhood trauma is an unconscious process.

These reenactments occur in personal relationships, work relationships, and in the client's relationship with his or her psychotherapist.

There are times when traumatized clients are able to get a glimpse into these reenactments in therapy but, due to the nature of their shifting self states, this new understanding can be tenuous and change back and forth over time until the client becomes more emotionally integrated as a result of the work in therapy.

A skilled trauma-informed psychotherapist understands that clients often go back and forth in their understanding of their problems because the shifting self states are unconscious.

Developing a trusting relationship with a traumatized client is of the utmost importance before any processing of trauma occurs.

The therapist must also help the client to develop the necessary internal resources and coping skills before processing trauma.

Each client is unique as to when he or she feels safe enough in therapy and prepared to do the therapeutic work.

When a client has worked through developmental trauma, s/he is free to live life without constantly reenacting the past.

Getting Help in Therapy
Making the decision to start therapy is an important step which most people don't take lightly, especially people with a history of trauma (see my article: The Benefits of Psychotherapy).

People with developmental trauma often come to therapy after they have had a series of major disappointments or setbacks in their life.

It takes courage to face a painful history of trauma, and most trauma-informed psychotherapists are aware of this and the clinical implications for the client (see my article: How to Choose a Psychotherapist).

If you think you might be living in the present as if it were the past, you owe it to yourself to get help from a licensed trauma-informed mental health professional.

Although the therapeutic work isn't quick or easy, once you have worked through the trauma, you can live a more fulfilling life without the burden of your past.

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

I have helped many clients to overcome trauma so they could go on to live a more fulfilling life.

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 or email me.

How Therapy Can Help You to Overcome Loneliness

I've written prior articles about being alone, isolated and lonely, including:  Overcoming Loneliness and Social Isolation, When There's Loneliness and Lack of Intimacy in Your Relationship, On Being Alone and Emotional Strategies That No Longer Work For You: "I don't need anyone." 
In this article, I'm focusing on loneliness and some ways that you might be getting in your own way with regard to connecting with others.

Overcoming Loneliness in Therapy

Everyone Feels Lonely At Some Point
Loneliness is an issue for everyone at some point in their lives.

Whether you're in a relationship or not or whether you have lots of close friends or not, it's a fact of life that sooner or later you'll feel lonely.

Just because you have people around you doesn't mean that you feel connected to them or that these relationships are meeting your emotional needs.

Although everyone experiences loneliness at some point, there's a difference between feeling lonely occasionally and feeling lonely most of the time.

Taking a Look at Whether You're Open to Connecting With Others
People who feel pervasive loneliness often feel that they're flawed in some way and that other people wouldn't want to connect with them, so this prevents them from connecting with others (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

Feeling unlovable isn't a feeling that people are usually aware of on their own.  It's often an underlying feeling that they don't become aware of until they start therapy to overcome their loneliness.

The way that these feelings of being unlovable usually come to the surface is through an exploration in therapy.

When all the practical reasons for not connecting with others have been set aside, it's not unusual for people to discover that they're deeply ambivalent about connecting with others because they believe they're flawed in some way and that others will reject them (see my article: Overcoming Fear of Rejection).

At that point, in most cases, it's a matter of working through these underlying issues of feeling unlovable so that they can connect with others.

A Fictionalized Vignette About Overcoming Loneliness in Therapy

Sandy
For most of her life, Sandy felt alone and lonely.

At the point when she came to therapy, she was in her late 30s and feeling close to despair.  She didn't really believe that therapy could help her, but she didn't know what else to do, so she started therapy with a lot of ambivalence (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Overcoming Loneliness in Therapy

Sandy told her therapist that she grew up as an only child with parents who were distant and cold with her and with each other.  With no other relatives close by, Sandy spent much of her time at home alone.

She grew up feeling that her parents thought she was "defective" in some way, and she was aware that they didn't really want any children.  She assumed that she was "an accident" (see my articles: What is Childhood Emotional Neglect? and What is the Connection Between Childhood Emotional Neglect and Problems Later On in Adult Relationships?).

When she started school, Sandy kept to herself.  She didn't think the other children would like her, so she didn't make an effort to make friends.

There was one girl in her first grade class, Betty, who was very outgoing and who befriended Sandy.  She would often invite Sandy over to her home after school where Sandy was surprised to see that Betty's parents were loving and affectionate with Betty.  This was in sharp contrast to Sandy's  experience with her own parents, and it made her aware that she lived in an unhappy household.

Even though Betty went out of her way to seek out Sandy, Sandy was sure that it would only be a matter of time before Betty would drop her as a friend--as soon as Betty discovered the "real Sandy" (see my article: Overcoming the Fear That People Won't Like You If They Knew the "Real You").

Since Betty was outgoing and popular with other children, she included Sandy into her group.  But Sandy felt like she was only tagging along and still felt like an outsider (see my article: Feeling Like an Outsider).

Unfortunately, a year later, Betty and her family moved out of state, and Sandy withdrew from the other children in Betty's group after Betty was gone.  Then, she went back to keeping to herself.

By the time she went to high school, Sandy made a few friends.  Although she would socialize with her friends, she always feared that her friends would abandon her.

In college, Sandy dated a few men.  She usually chose men who were narcissistic and who didn't treat her well because she didn't have a sense that she deserved to be treated well.

Sandy drifted from one short-term relationship to the next with long periods in between when she spent a lot of time on her own and feeling lonely.

By the time she was in her late 30s, she felt hopeless that she would ever be in a healthy relationship and she feared that she would always be alone.  This is what brought her into therapy.

After she revealed her history to her therapist and gave her therapist many "reasons" why she thought she would be lonely for the rest of her life, her therapist helped Sandy to see how she was creating obstacles for herself.

The biggest obstacle for Sandy was that she felt unlovable and undeserving.  This feeling was so strong that no amount of talking about it could dissuade her.

Her therapist talked to Sandy about working through her early experience of emotional neglect and feelings of being unlovable using EMDR therapy (see my article: What is EMDR Therapy?)

At first, Sandy was reluctant to work on these issues because she was convinced that her situation was hopeless.  But her therapist also knew that Sandy's self perception was longstanding since childhood and that she was, understandably, afraid to let go of these perceptions.

When she was ready, Sandy agreed to try EMDR therapy.  Her attitude was "I have nothing to lose, so I'll try it."

Gradually, over time, Sandy came to see that her feelings of being unlovable were rooted in her experience with her parents, who were incapable of being loving.

For the first time in her life, she was able to step back emotionally to see that her parents were the ones who had problems, and their problems were part of intergenerational trauma:  Their parents were unable to be loving and their grandparents had the same problem--all related to a long history of unresolved trauma in both families (see my article: Psychotherapy and Intergenerational Trauma).

Recognizing that she wasn't inherently flawed for the first time, Sandy felt a new sense of freedom.  She thought back in her life to all the people who cared about her and she realized that they found her to be a lovable person--so she wasn't unlovable.

Overcoming Loneliness in Therapy

Although this new self perception freed Sandy to see herself in a new way and to venture beyond her usual social comfort zone, she also felt some regret that she had wasted so much time burdened by her negative feelings about herself.  So, she mourned this loss.  But she also made more of an effort to connect with others.

As she felt better about herself, she experienced an upward spiral:  Her new sense of self esteem allowed her to be more social, and as she extended herself, people were open to connecting with her.  And the more people were open to connecting with other, the more confident she felt.

Conclusion
For many people, overcoming loneliness is a matter of overcoming longstanding negative views about themselves.

Feelings of being unlovable are usually unconscious, so these underlying feelings remain hidden until a skilled therapist can assist to gently help to unearth them.

Trauma therapy, like EMDR therapy, is an effective way to overcome trauma and the related negative beliefs about yourself.

Getting Help in Therapy
It can be very challenging to come to terms with the fact that you might be getting in your own way when it comes to overcoming loneliness.

This isn't to say that feeling unlovable or undeserving are the only reasons why people feel lonely, but when loneliness is pervasive in your life, these are often unconscious underlying reasons.

Rather than suffering on your own and feeling hopeless and helpless, you could benefit from working with a skilled psychotherapist who can help you to work through these issues so you can be free from your history.

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.