The Positive Ripple Effect

I've been reading Dr. Irvin D. Yalom's latest book, Staring at the Sun, which I recommend. Dr. Yalom is a highly-regarded psychiatrist and author who has written several books, including Love's Executioner and When Nietzsche Wept, among others. He has a psychotherapy private practice in California and he specializes in Existential Psychotherapy. While I'm not an Existentialist, I like Yalom's latest book.  

The Positive Ripple Effect

In Chapter 4, Yalom discusses "the ripple effect," the effect that we have on others and how that effect ripples out throughout individuals' social network, often from one generation to the next. He indicates that, when people are struggling with the transience of life, it often helps them to think about the positive effects that they have had on others and how that effect continues to ripple out beyond their immediate social circle in ways that they often don't even realize. Knowing that something you did or said can have a positive rippling effect, sometimes going from one generation to the next, often helps mitigate fears about the transient nature of life.

In addition, the Framingham Heart Study, conducted by Nicholas Christakis of Harvard University, looked at 5,000 people who were followed over a 20 year period. One of the findings was that there was a ripple effect of happiness that spreads within social circles due to the phenomenon known as emotional contagion, where the happy emotions felt by those at the center of the social circle are spread out to the rest of the social network, similar to the concentric circles that you see if you toss a pebble in a pond. Of course, emotional contagion works the other way too--unhappiness can also spread within the social network.

The following vignettes, which are composites of various cases, are examples of the positive ripple effect and emotional contagion factor that I have witnessed in my psychotherapy private practice (all identifying information has been changed to protect confidentiality):

Alice:
Alice, who was a clinical social worker, was hired as a director for a social service agency that provided services to the homeless. When she was hired, her predecessor, who was retiring, warned her that morale in the agency was low and many of the caseworkers were unmotivated. By nature, Alice was a positive, upbeat person. No Pollyanna, she had worked in the social service field for many years and she was well aware of the challenges that social workers and caseworkers faced. She had no illusions that her job would be easy.

On her first day, she noticed immediately how unhappy and unmotivated the employees were. Their unhappiness was palatable and hung in the air with a dull heaviness. During the first week, she met with each employee to find out how they felt about their job and any recommendations they had for improvements. What she found was that most employees, especially those who had been there for several years, felt very pessimistic about the impact that they could have with the homeless population. They gave many examples of homeless clients returning again and again after they were domiciled, high alcohol and drug relapse rates, and the frustration of dealing with a cumbersome bureaucracy.

Alice was very concerned about the emotional contagion factor among employees as well as the effect it would have on clients. Within the first few months, she set about making changes to streamline bureaucracy and unnecessary paperwork and implement other important changes. Unlike her predecessor, who spent the last several years waiting for her retirement and who remained distant from employees and clients, Alice was very hands-on. She made sure that she was at the center of things and accessible to everyone.

Initially, her employees found her pleasant, but they were wary of her optimistic nature. However, over time, she started to gradually win them over, especially after she implemented a program where formerly homeless clients, who had gone on to further their education, get good jobs, and felt happy with their lives now, came back to talk to the staff and current homeless clients at the agency. 

These presentations helped to inspire both the caseworkers and the homeless clients. The staff got to see the positive impact that they had on former clients. Many of the current homeless clients at the agency felt hopeful that they too could make positive changes in their lives. 

All of them witnessed the ripple of effect of the staff's efforts and how it continued to have an effect on the former clients' children, the children's friends, and beyond. After a while, morale improved substantially and staff and clients alike began volunteering to work on projects to help improve the physical environment at the center (e.g., painting, putting up artwork, and making repairs). All of this served to have an upward spiraling effect.

Ralph:
Ralph was going through a particularly difficult time in his life. He and his wife had just separated and now he only saw his children on the weekends. He felt sad and pessimistic about his life. As the holidays approached, he dreaded having to attend an upcoming family reunion. He didn't know how he would respond if family members, who knew of his marital separation, asked him about it. He wanted to avoid the whole thing, but he knew this would be upsetting to his parents and other relatives and he didn't want to be alone, so he made the trip back home, expecting the worst.

As he anticipated, some of his relatives asked about the marital separation and it reinforced Ralph's feeling of being a failure in his marriage. This feeling of being a failure clouded his view of himself in just about every other area, even though, in reality, he was successful in his work and he had many friends and family members who cared about him.

At one point, his cousin, Mark approached him. Ralph had not seen Mark in many years, and he groaned inwardly, anticipating that Mark would ask him about Ralph's separation. Mark asked Ralph to take a walk with him around the garden so they could talk. Ralph thought, "Here it comes. He's going to ask me about my marriage." But to Ralph's amazement, Mark told him that he's been wanting to thank him for a long time, and it was way past time to express his gratitude on the positive effect that he had on his life.

At first, Ralph could not imagine what Mark was talking about. Then, Mark proceeded to talk about his incarceration in a federal prison for stealing checks from the mail while he was a postal employee. 

Initially, this made Ralph feel uncomfortable. However, Mark persisted, "I want to thank you for a letter you sent me while I was in prison that really turned my life around." Ralph had a vague recollection of sending Mark a letter, but he could not remember the details. Mark went on, "When you encouraged me to not give up, to use my experience to learn and grow, I really took that to heart. I saved that letter and read it over and over again. It got me through some difficult times in prison and motivated me to get my degree while I was in prison and to find a sense of peace and spirituality. Thank you so much. I've always remembered your words, and I tell my children the same thing when they go through difficult times."

Ralph was stunned and didn't know what to say. Just then, Mark's 13 year old son, Bobby, came out into the garden. Ralph had never met Bobby because he had not seen Mark or his family in many years. When Mark said, "Bobby, this is your cousin, Ralph," Bobby flashed a big smile and looked visibly excited. He said, "Oh, wow! Hi Ralph. It's great to meet you. Dad and I have talked about you a lot. He always tells me, whenever I feel like giving up, what you wrote to him and how much it helped him. Thanks so much."

Ralph felt very moved and held back tears. He had no idea that he had such a positive effect on his cousin and his cousin's family. Before going back into the house, he called his wife, Laura, and asked her if she wanted to try to work things out. To his surprise, she said she was going to call him and ask him the same thing. After three months of couples counseling, they worked out their differences, they got back together again and were happier than ever.

Whether we realize it or not, we often have a positive rippling effect on others around us who then pass on this effect to others. When we become anxious about the impermanence of life, the transient nature of all things, or other stressors in our lives, it helps to think about the positive effect that we can have in our social circles that often lives on from one generation to the next.

Next Article: Creating the Positive Ripple Effect

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  

I work with individuals and couples.  

I have helped many clients to overcome obstacles so they can lead more fulfilling lives.

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

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

Coping with Secrets and Lies in Your Relationship

Couples often come to couples counseling after one of them discovers secrets, lies or betrayal by his or her partner. Once trust is breached, it's difficult to restore it without the help of a licensed mental health professional who works with couples.

Secrets and Lies in a Relationship

Clinical Vignettes
The following stories are examples of couples who struggled with betrayal in their relationship and came to couples counseling to work on these issues. All examples in this post, as well as all other posts, are composites of actual cases with all identifying information changed to protect confidentiality.

Larry and Barbara:
Soon after they got married, Barbara discovered that Larry had significant credit card debt that he had not revealed to her. Barbara felt betrayed because they had talked about their personal finances, and she thought they had each shared all the important information that each needed to know. It wasn't until they wanted to buy a house that Larry, who felt very ashamed of his debt, revealed that he had poor credit. After that, Barbara wondered what else Larry might not have told her. When they began couples counseling, they were barely talking to one another and their marriage was spiraling down. However, over time, with Larry working hard in couples counseling to regain Barbara's trust, they re-established communication, and they were able to salvage their marriage.

Maureen and Cathy:
Maureen and Cathy moved in together after dating for two years. Soon after they were living together, Maureen sensed that Cathy was not being honest with her about Cathy's relationship with her ex. Maureen knew that Cathy maintained a cordial relationship with her ex, Mary, but she soon discovered (by looking at Cathy's cell phone bills) that Cathy was in contact with her ex a lot more than Maureen realized. When she confronted Cathy about it, Cathy became angry that Maureen was snooping on her. Maureen became furious that Cathy led her to believe that she and Mary only had limited contact, when, in fact, Cathy was talking to Mary several times a week.

Cathy denied that anything romantic was going on any more between her and Mary, and Maureen believed her. But Maureen felt betrayed that Cathy lied to her. Cathy countered that she felt Maureen wouldn't understand that Mary was going through a difficult time and she wanted to be supportive of her. When they came to couples counseling, each of them was polarized in their position. Maureen was ready to walk out on their relationship, but she decided to give it a last-ditch effort in couples counseling.

 Shortly after they started couples counseling, Cathy came to understand that lying to her partner was a betrayal, regardless of how much she thought Mary needed her. She realized that she had to put her relationship first and she was genuinely remorseful. Maureen, in turn, realized that she shouldn't snoop on Cathy. A few months later, Cathy set appropriate boundaries with Mary. When she saw Mary, she either saw her with Maureen or she let Maureen know that she was spending time with Mary. Both Maureen and Cathy learned to regain trust in each other.

John and Bill:
John and Bill were together for 15 years when John discovered that Bill had recently begun having secret chats in online sexual chat rooms. When John confronted Bill about his activities online, Bill was very contrite. He insisted that he only engaged in sexual fantasy online, and he never met any of these men in person. John was so stunned and angry by Bill's behavior that he didn't know what to believe. 

He felt betrayed by Bill's secrecy, and he thought about ending the relationship. But Bill convinced him to go to couples counseling to deal with their problems. While in couples counseling, Bill told John that he felt neglected by him sometimes, and he liked the attention he got online in the chat rooms. Rather than acting out, Bill learned how to express his feelings to John. He came to see that secretly participating in online chats was a form of infidelity. Over time, John forgave Bill and they were able to strengthen their relationship in couples counseling and re-establish trust.

Getting Help in Therapy
Dealing with secrets, lies and betrayal in your relationship and regaining trust can be very challenging.

If you and your partner are having a difficult time regaining trust in your relationship as a result secrecy, lies or some form of betrayal, you could benefit from couples counseling with a licensed mental health professional who works with couples.

About Me

I am a licensed psychotherapist and couples counselor in NYC. I have helped many couples to work through problems in their relationship.

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

To set up a consultation, you can call me at (917) 742-2624 or email me.

Coping with Blended Family Issues

Blended families, where children from different relationships, come together as a result of a second marriage or relationship, are becoming more and more common.

Coping With Blended Family Issues

Blended families have certain challenges that other families don't have. When you bring together children from two different relationships, certain conflicts can emerge as everyone gets adjusted to the new relationship and the combination of two different families. With a certain amount of forethought and planning, many of these issues can be resolved.

The following examples, which are composites of actual cases with all identifying information changed to protect confidentiality, illustrate some of the challenges that blended families might face:

Sam and Martha:
Sam and Martha were both in their mid-50s when they got married. It was the second marriage for both of them. Each of them had adult children from their previous marriages. A year after they got married, they bought a home together. They were both very happy in their marriage and in their new home. Six months after they moved in, Sam's daughter, Nina, a single mother of three children, lost her job and couldn't afford to stay in their apartment.

When she approached her father, Sam, about staying with him and Martha temporarily until she could get another job, Martha and Sam agreed to allow her to move in with them. However, nine months later, Nina was still living in their house with her children, and she was not making any effort to find another job. Martha was getting irritated and talked to Sam. He agreed that Nina was not living up to their agreement, and he agreed to talk to her. But Sam found himself unable to talk to Nina because he felt guilty about not being around when she was growing up.

So, he kept putting off having the talk with her, and Martha was getting increasingly annoyed. She felt taken advantage of by Nina, and she resented Sam's passivity. By the time they came for couples counseling, Martha was talking about divorce and Sam was despondent, caught between his daughter and his wife. After a few sessions, they realized that they allowed Nina to move in without a well-thought out plan. Although they couldn't go back to undo that mistake, they talked how to resolve this situation in a way that would preserve their marriage and try not to alienate Nina.

Sam also entered into his own individual therapy to deal with his guilty feelings about not being around for Nina when she was a child. Soon, they came up with a reasonable plan that they both agreed to, and Sam presented it to Nina. Nina felt hurt initially, but she eventually came to understand that Martha and Sam wanted their home back. So, within two months, she found another job and moved into her own apartment with her children. The tension between Martha and Sam was resolved, and they were closer than before, and Sam was able to make amends with Nina for neglecting her as a child.

Betty and John:
Betty and John met each other in a bereavement group that they were attending to grieve the loss of their spouses. What started out as a supportive friendship turned into a romantic relationship within a few months. Betty had two teenager daughters and John had a seven year old son and a five year old daughter. After they got married, they all moved into Betty's house because it was larger than John's house.

Problems between the children from this blended family began almost immediately. Betty's daughters resented John's younger children and felt annoyed when they wanted to hang around when their friends from high school came over. John's younger children felt left out and would cry and act out. Betty was home all day and so she had to deal with these conflicts. She found herself caught in the middle between her children on one side and John and his children on the other side.

When she told her daughters to be patient with the younger children, they got angry with her and they felt that she cared more about John's children than them. When she told the younger children to play on their own and not to barge in on her daughters and their friends, John's children sulked and complained to John when he got home from work.

Then, John would get irritated with Betty. She felt she was in a no-win situation. When they came to couples counseling, John and Betty were both exhausted and frustrated with the situation and wondering if they had made a mistake by getting married. However, after a few couples counseling sessions, they learned that they needed to come up with a united front to deal with these blended family issues.

They also came to appreciate just how difficult it is for children to deal with the loss of a parent at the same time that they are adjusting to a new blended family. They soon came up with a compromise that allowed the teenagers to have their privacy at certain times as well as family outings where everyone came together for a good time.

Getting Help in Therapy
Blending family issues can be problematic but, with the assistance of a licensed mental health professional, they can often be resolved.

If you and your partner are struggling with blended family issues that you cannot resolve on your own, it might be beneficial to attend couples counseling to work out these issues and save your relationship.

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

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

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

Developing Internal Resources and Coping Skills

Whether you realize it or not, you have internal resources and coping abilities that you can tap into when you're facing a challenging situation or life event. Very often, the question is how to access these internal resources and coping abilities when you need them the most.

Developing Internal Resources and Coping Skills

As a psychotherapist in New York City, I see many clients who are overwhelmed after trying to deal with problems on their own. Often, by the time they come to therapy, they're feeling emotionally depleted and defeated by their problems. 

As a psychotherapist, I treat each client as an individual and I don't have a standard way of working with all clients. However, often, as a start, I find it useful to help clients to access their own confidence, internal resources and coping abilities to deal with whatever obstacles they're facing.

What Are Internal Resources?
Our internal resources are made up of the various internal aspects of ourselves that have the emotional strength, compassion, confidence and overall wherewithal to deal with the issues that we're facing. When we're able to remember and re-experience these internal aspects in a deep way, we can use them as part of our coping strategies to face our problems. This might not be enough to actually resolve our problems, but it's a good way to start.

Examples of Internal Resources:

Remembering a time when you felt the inner emotional fortitude to deal with a particular problem or fear with courage and confidence. This might have been a time when, initially, you didn't think you could find it within yourself to deal with this problem but, ultimately, you did, and you felt good about that. How can you take that experience of yourself and use it to deal with whatever problem you're facing now?

Remembering someone special in your life (e.g., a teacher, mentor, friend, family member, psychotherapist, coach) who helped you when you faced a particular obstacle.
This might involve recalling some advice this person gave you or how supported you felt when this person helped you. What might this person say to you now in your current situation?

If you can't think of anyone in particular that helped you in the past, you can also think about other people that you admire, possibly people in your every day life, a character from a movie or a historical figure, and ask yourself what that person might do.
You could close your eyes and imagine what that person might tell you or what it might feel like to be that person in the particular situation that you're dealing with now.

Developing Internal Resources and Coping Skills

What If You Can't Access Your Internal Resources?
Sometimes, just remembering that you've faced similar or worse problems in the past or remembering how an important person in your life might have helped you, is enough to help you access your internal resources and coping skills.

However, there are other times when you might feel so "stuck" in your particular problem that just the act of remembering these experiences on your own is not enough to help you. At those times, it's often helpful to work with a licensed mental health professional who can help you to rediscover your internal resources and coping abilities so that you can overcome the problems that you're facing.

How I Work to Help Clients to Access Their Internal Resources and Coping Abilities:
As I mentioned before, as a psychotherapist, I see each client as a unique person, and I don't have a particular approach that I use with all clients. However, I often find it very helpful to use Richard Schwartz's Internal Family Systems model to help clients to overcome internal conflicts and rediscover their coping abilities.

The name "Internal Family Systems" can be misleading, and you might think that it involves bringing your family into treatment. However, this is not the case.

The main idea in Richard Schwartz's theory is that we all have internal parts (or aspects of ourselves) that we can access and use to help us. When I use the term "internal parts," I'm referring to our inner emotional world.

We often see these internal parts when we're having a debate with ourselves about a particular problem or question: "A part of me wants to sleep later in the morning, but another part of me knows I feel better when I get up early and go to the gym."

One of the reasons why I like the Internal Family Systems model is that it's a gentle, positive, optimistic, strengths-based theory. As opposed to many other psychological theories that look at what's wrong with a person, Internal Family Systems looks at what's right. It also puts us in touch with our internal core selves.

When I'm helping clients to access these internal parts, I will often help them to get into a relaxed meditative state or I use clinical hypnosis.

I've discussed clinical hypnosis in detail in prior posts (see post dated May 31, 2009). As a reminder, I'll reiterate that when you're seeing a licensed mental health professional who is trained in hypnotherapy, clinical hypnosis is a safe and very effective tool in therapy.

You maintain dual awareness of the here-and-now as well as whatever you're working on in hypnosis, and you're in complete control at all times. Clinical hypnosis can help you to access your internal resources because it allows you to experience your unconscious mind where your internal resources are located.

For more information about Richard Schwartz's Internal Family System, you can visit his web site: http://www.selfleadership.org/.

Getting Help in Therapy
If you feel like you're stuck emotionally and you're unable to overcome the emotional challenges that you're currently facing, you could benefit from seeing a licensed psychotherapist.

Getting Help in Therapy

I'm a licensed psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing in New York City who works with individuals and couples. 

I have helped many clients to access their own internal resources and coping abilities to overcome their problems.

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

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

Relationships: When Love Doesn't Conquer All

When most people enter into a new relationship, they experience that heady, passionate time when they feel invincible and that nothing could get in their way because they're so deeply in love with each other. So, it can be very disappointing, after these heady feelings subside, to discover that, contrary to popular myths, love doesn't always conquer all, and it's often not enough for a relationship to survive and withstand the many challenges couples face today.

Relationships: When Love Doesn't Conquer All

The following scenarios, which are composites of actual cases with all identifying information changed to protect confidentiality, are typical examples of couples who enter into couples counseling:

Bill and Sandra met in college. They fell deeply in love after dating for a few months. While they were dating, they became aware that they had significant differences in terms of their values and goals in life: Sandra wanted children and Bill was not sure; Bill was a spender and Sandra was a saver; Sandra had a few close friends and preferred to stay home most of the time, and Bill was very outgoing, enjoyed going out and liked meeting new people, and so on. Even though they were aware of these differences, they believed that, since they were so deeply in love, their love would carry them through and they would work out these differences.

However, four years after they got married, even though they still loved each other very much, they were arguing a lot about these differences. They were each disappointed, hurt and confused as to why, if they cared about each other so much, their relationship was not working out.

Greg and Denise met while they were each going through a divorce. They were both in their mid-40s. Initially, the relationship began as a friendship, where they consoled and supported each other. But it quickly turned romantic, and when each of them was free, they got married. Denise considered herself to be a spiritual person. She went to church on a regular basis and she was involved in various church committees. She was aware that Greg considered himself to be an atheist, but she overlooked this and thought she could change it after they got married.

Relationships: When Love Doesn't Conquer All

Two years into their marriage, they began arguing about religion. Denise was disappointed that Greg refused to participate in her church services and that he was not even willing to reconsider his views on religion. Greg was angry and felt badgered by Denise because he was upfront about his atheism and he thought she accepted it, only to find out that she held a secret hope that he would change.

Lisa and Robert seemed like the "ideal couple" to their friends. They were both very in love and devoted to one another. They had similar values, and they shared of vision and a plan for what they wanted their life to be like together. But after Lisa and Robert had their first child, they began to drift apart. They had both looked forward to having children, but the reality of having a baby turned out to be very different from what each of them had anticipated. Both of them were sleep deprived from the baby waking up crying several times a night, which caused them to be irritable with each other. Robert also felt that Lisa spent so much time doting on the baby that she hardly paid attention to him. He felt neglected. They hardly went out any more, and he felt they were in a rut. Each of them thought, "How could this have happened to us?"

Margaret and Karen met at a mutual friend's birthday party. They fell in love almost immediately. After dating for six months, they moved into Margaret's apartment, since it was much larger than Karen's and more convenient to each of their jobs. Soon after moving in, they began arguing and getting into power struggles about the apartment.

Karen wanted to make a few changes so she could feel comfortable and make the apartment feel that it was as much hers as it was Margaret's. But Margaret liked things just as they were and saw no need to change anything. They both felt disappointed that they were arguing about what seemed like petty things when they knew that they cared about each other very much. But they didn't know how to get passed this problem.

Getting Help in Therapy
If you and your partner are having ongoing arguments, if the two of you can't seem to overcome the obstacles in your relationship, you could benefit from couples counseling. 

An experienced couples counselor can help you to overcome these obstacles to either decide to stay together or to split up in an amicable way without the usual anger and bitterness that is associated with breakups and divorce.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. I help individuals and couples to overcome obstacles that are keeping them from leading fulfilling lives.

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

To set up an appointment, call me at (917) 742-2624 during regular business hours or email me.

Returning to Therapy

It's not unusual for people to return to psychotherapy, over the course of a lifetime, for a second or third treatment (or more) to deal with the same issues, often on a deeper level or in a different way. Many times, the first therapy might have been to develop coping skills to deal with a particular issue and subsequent treatments are for developing greater emotional insight into the problem.

Returning to Therapy

The following scenarios, which are composite accounts of actual cases (with all identifying information changed to protect confidentiality) are examples of clients returning to psychotherapy to deal with the same issues or emotional patterns in a different way:

Scenario 1:
When John attended psychotherapy sessions in his late 20s, his girlfriend of five years had just left him. After the breakup, John was highly anxious and depressed. He was also very isolated and lonely because his relationship with Jane had been everything to him. At that point, John had never participated in psychotherapy before. He had always thought that a person had to be "crazy" or "weak" to seek out the help of a psychotherapist. However, he did some research on his own and read that most people who attend psychotherapy were "normal" people who wanted to work on their problems with a mental health professional who could help them in ways that friends and family members could not.

Returning to Therapy

During the first psychotherapy session, John talked about the relationship, and about his anxiety and depression following the breakup. The psychotherapist explained how she worked and answered general questions about psychotherapy and her professional background, training and experience. John attended weekly sessions for about three months and, gradually, he began to feel better. He no longer felt anxious or depressed, and he was beginning to date again. At the point when he decided to leave therapy, he and his therapist were just beginning to deal with his codependent patterns in relationships. However, after his anxiety and depressive symptoms subsided, John no longer felt motivated to attend therapy.

His psychotherapist talked to John about remaining in psychotherapy so he could gain emotional insight into his patterns and he would not continue to repeat them in his next relationship, but John decided that he was "feeling good," he no longer felt anxious or depressed, and all of this talk about codependency was bringing him down, so he left therapy. He felt that as long as he knew that he behaved in ways that were codependent, he would "just stop" behaving in that way and it shouldn't be a problem. He told his therapist, "I know what to do now" and he left treatment.

After he left therapy, John began dating someone new, and they entered into a relationship almost immediately. A year later, his girlfriend broke up with him, telling him that she found him "too needy." John was upset, but he used the coping strategies that he learned in psychotherapy to deal with his depression and anxiety. Soon afterwards, he entered into another relationship with a woman who was an active alcoholic. 

He thought he could help Mary to overcome her alcoholism and, deep down, he felt that she would never leave him because he thought she needed him. Mary was unemployed and broke at the time. She moved in with John within a few weeks and John supported her. After several months, Mary began attending A.A., at the urging of her psychotherapist. She obtained a sponsor and began forming sober friendships in the program. Three months later, Mary found a good job and she decided that she wanted to be single again, so she broke up with John.

This time John was devastated. He never saw it coming. He tried to use the coping strategies that he learned in psychotherapy, but his self confidence plummeted after this last breakup. He bought self help books to try to understand what he was doing wrong and to bolster his confidence, but the self help books didn't help him. 

Reluctantly, he called his former therapist and returned to therapy. John began therapy again with the sole motivation that he wanted to "feel good" again. However, over time, he began to understand that while "feeling good" was important, psychotherapy was about more than just "feeling good" and he needed to look at some of the underlying issues involved with his codependency.

Over time, John developed an understanding that "knowing what to do" in an intellectual sense was not the same as having a deeper, emotional understanding and getting to the root of his problems so that he could change his patterns. So, when he began to feel better again and he was tempted to leave therapy, rather than giving in to this temptation, he stayed to do the deeper work to overcome his codependency.

When he entered into the next relationship with Susan, he was tempted to leave again because he felt that, for sure, this new woman was "the one." He felt happy for the first time in a long time. From his perspective, he thought, "Why should I stay in therapy? I feel very happy now." 

However, soon after they got together, John recognized the early signs of codependency in his relationship. He realized that he was falling into the same old patterns again, and he was able to work on these issues with his therapist. He learned to avoid the same codependent pitfalls from the past, and he gained a deeper emotional understanding of the origins of his problems.

With the help of his psychotherapist, his own diligence in going to his therapy sessions on a regular weekly basis, and applying what he learned, John's relationship began to flourish into a mature, stable, healthy relationship. He and Susan also began forming friendships outside the relationship so they were no longer solely dependent on their relationship for all of their emotional needs.

He worked through his family of origins issues that were at the root of his codependency problems; he no longer had the need for Susan to depend on him; and, he felt that he had grown as a person. 

At that point, he and his therapist talked about John terminating therapy. They spent about a month going through the termination process to help John consolidate the gains that he made in therapy, and then John and his psychotherapist mutually agreed that it was time for him to end treatment. His therapist told him that he could come back in the future. A couple of years later, John and Susan got married and they continued to have a stable and happy relationship.

Scenario 2:
Kathy, who was in her early 20s, began attending psychotherapy sessions to deal with the death of her grandmother. Kathy was close to her grandmother and she took the loss very hard. Several months before Kathy began psychotherapy, her grandmother was home recuperating from a heart attack and Kathy would come to see her everyday after work to check in on her. 

Over time, her grandmother got stronger and she was soon able to take care of herself and get back to her regular activities. At that point, assured that her grandmother no longer needed her help, Kathy decided to go on a week long vacation with her friends to the Bahamas.

Returning to Therapy

Kathy and her friends were having a wonderful time in the Bahamas when she got back to their hotel and found a message to call her mother immediately. When she called her mother, she found out that her grandmother had a massive heart attack that day, and she had died. Kathy was devastated. She blamed herself for going away and thought, "Maybe if I had been there, she might not have died."

After a couple of months of therapy, Kathy grieved the loss of her grandmother. She also came to understand, in an intellectual way, that there would have been nothing she could have done to save her grandmother from her massive heart attack and death. After all, she wasn't a doctor. Everything her psychotherapist told her made logical sense to her. Soon after that, she cancelled her appointments and she left treatment against her therapist's clinical advice.

Several years later, Kathy got married to Paul. They were both very happy in their marriage. One day, during the third year of her marriage, Paul began having chest pains. Kathy broke out into a cold sweat and felt panicky. She was afraid that Paul was having a massive heart attack, just like her grandmother. 

She could barely think straight, but she managed to call 911. After an extensive battery of tests, the doctor told Kathy and Paul that Paul's heart was very healthy and overall he was in good physical shape, but he had acid reflux and the symptoms were often similar to the symptoms of a heart attack. Paul was greatly relieved. Kathy was somewhat relieved, but she worried and feared that the doctors might be wrong.

After that, Kathy was afraid to go to work or to leave Paul, who worked from home, for any length of time. At first, Paul was understanding. He was taking his acid reflux medication and he told her that he was feeling fine. 

But nothing he said soothed Kathy's nerves. She called him at home numerous times from her job and would often come home early to check on him. She also refused to have sex with him because she was afraid that he would have a heart attack, even though the doctors had assured them that his symptoms had nothing to do with his heart. Finally, Paul told Kathy that he thought she needed to get help.

On the one hand, on an intellectual level, Kathy realized that her worrying and her behavior was excessive. But her feelings made her worried thoughts feel very real to her, and this was confusing. 

On the other hand, she didn't want to ruin her marriage with Paul, so she returned to see her former psychotherapist. She felt somewhat ashamed to return to therapy because she thought her problems "should have been fixed" after the first therapy. She was afraid that her therapist would think that she was "stupid." But she learned from her psychotherapist that returning to therapy to deal with the same issue, on a deeper level, was very common, and she felt relieved.

Kathy also discovered that her current worries were being "triggered" by the death of her grandmother. Even though she had grieved this loss during her first treatment, she had not dealt, on a deeper emotional level with the trauma of how helpless and guilty she felt while she was away and her grandmother died. 

She also realized that, during her first treatment, she went as far as she could at the time on an intellectual and logical level. But these other traumatic feelings had not surfaced in the first treatment.

When she realized this in her second psychotherapy treatment, Kathy was glad to know that she wasn't "going crazy" and that there was an explanation for her excessive worrying. It made sense to her. 

At that point, knowing this, she was about to leave therapy again, but her psychotherapist recommended that she stay to work on the trauma on an emotional level. Over time, Kathy learned the difference between intellectual insight and emotional insight. 

She realized that it was not enough to have intellectual insight. Her psychotherapist used a combination of clinical hypnosis and EMDR treatment to help Kathy process the original trauma. By the time Kathy and her psychotherapist mutually agreed that she had processed the original trauma, Kathy was no longer worrying about Paul's health. They began to have sex again, and they became closer than ever.

Over the course of a lifetime, old problems can resurface in new ways. Sometimes, there are residual issues that remain hidden and don't surface in the original psychotherapy treatment. Also, over time, as we mature and grow, we have a greater capacity for emotional insight (as opposed to only intellectual insight) and so we can approach old problems with a deeper understanding to resolve them.

Returning to psychotherapy, whether you return to your original psychotherapist or you choose to see someone new who might have a different way of working, is not anything to feel ashamed about.

Returning to therapy doesn't mean that you failed in your original psychotherapy treatment or that you were inadequate in any way. Sometimes, it might mean that you left therapy prematurely. Usually, when this happens, people think that "feeling better" means that the problem has been resolved. But what it might really mean is that some of the worst symptoms have subsided, but that none of the underlying issues that caused the problem have changed. It might also mean that your psychotherapist or counselor was not skilled in the particular issue that you were dealing with at the time.

Also, often, as you mature and your life changes, it means that you now have the emotional capacity and you are ready to deal with a particular problem on a deeper level to resolve it.

About Me

I am a licensed psychotherapist, hypnotherapist and EMDR therapist in New York City.

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

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

Also, see article:  When Clients Leave Psychotherapy Prematurely

Finding Inner Peace During Uncertain Times

In Harvard psychologist Daniel Gilbert 's op-ed piece in the New York Times called What You Don't Know Makes You Nervous he wrote that most people feel worse when they think that something bad might happen than when they know something bad will happen.

Finding Inner Peace During Uncertain Times

Initially, this concept might not  seem to make sense, and you might think, "But wouldn't you feel worse if you knew for sure that something bad was going to happen?" However, according to Dr. Gilbert, what the research shows is that when people know that something bad will happen, after their initial reactions of fear, shock, anger or whatever other feelings bad news brings up, most people can then mobilize themselves to take action to deal with the bad news, as opposed to just worrying about it.

For most of us, knowing what we're up against is better than the uncertainty of not knowing. According to Dr. Gilbert, "...we can't come to terms with circumstances whose terms we don't know. An uncertain future leaves us stranded in an unhappy present with nothing to do but wait" (see Daniel Gilbert, Ph.D.)

Taking action, whether it's changing our behavior, changing our attitudes, or making plans, helps us to feel better and find our emotional balance again.

How to Find Inner Peace During Uncertain Times:
Considering that many people today are living in uncertain times, how do we find and maintain inner peace and happiness to sustain us through the uncertainty?

To start, based on Dr. Gilbert's research findings, if it's possible to find out whether you'll be facing bad news, in most cases, it's better to get the information than to avoid dealing with it.

So, for instance, if you're worried about a health concern, rather than procrastinating and avoiding going to the doctor, it's better to be proactive, go to the doctor and either relieve yourself of the anxiety by finding out that you're fine or finding out what you need to do to get better.

Finding Inner Peace During Uncertain Times

I'm bringing up this particular example because many people avoid going to the doctor when they fear they're going to get bad news. But, in most cases, the earlier an illness is addressed, the more likely it is that you'll have a better outcome.

If there is no way to find out if you're going to be facing bad news (let's say, you fear that you might get laid off from your job, but no one knows for sure), then you need to find ways to maintain emotional and physical balance to sustain yourself through this uncertain time. If it's important to you, this also includes spiritual balance.

This could mean finding time during the day to meditate; exercise at the appropriate level for you, possibly taking a yoga class; and maintaining regular contact with supportive friends and family. Managing your stress is crucial. In particular, yoga can be a good stress reliever and restorer of balance and calm. It also means eating nutritious meals and getting enough rest.

When you feel anxious about what could happen, it also helps to remember times when you've actually dealt successfully with adversity in the past. Most of us are usually more resilient than we realize during hard times. If you think about it, you'll also probably realize that there were many times when you worried endlessly about something that never happened.

The Serenity Prayer
Knowing what we can control and what we can't can also help to relieve anxiety. You don't have to believe in God, a Higher Power or be a spiritual person at all to benefit from remembering the Serenity Prayer that says, in part:

"God grant me the serenity to accept the things I cannot change; courage to change the things I can and wisdom to know the difference." When we can distinguish what we can and can't control, it helps us to either take action to make changes or to do what we can to relax and stay calm while events unfold.

Serenity Prayer

If you find that you're already doing all of the things that I've recommended in this post and you're still struggling with anxiety, you might benefit from seeing a licensed psychotherapist to help you get through times of uncertainty. Sometimes, even brief treatment to help you develop better coping skills can be very beneficial and can make the difference between feeling overwhelmed with anxiety and maintaining a sense of peace.

About Me
I'm a licensed NYC psychotherapist, hypnotherapist, and EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.  

I have helped many clients to overcome anxiety and uncertainty so that they can lead happier lives.

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

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