Relationships: Is Your Partner Stuck in a Codependent Relationship with An Ex?

Codependency and Problems with Letting Go of the Ex Are Not Unusual:

Is Your Partner Stuck in a Codependent Relationship with His Ex?

As a psychotherapist in New York City who sees individuals and couples with relationship problems, this is a problem that I hear about often: The client is in a relationship with a person who is wonderful in every other way, except that they still maintain regular contact with a former romantic partner, who is dependent upon them, and this creates problems in the current relationship (see my article: Are You In a Codependent Relationship With Your Ex?).

The dependence is often an emotional dependence or it can be a dependence related to basic every day things. But the point is that the ex still relies heavily on the partner, who is reluctant to set boundaries with their ex.

This can be a thorny issue to contend with and often leads to hurt feelings and, in some cases, the breakup of the current relationship.

When there are Children Involved:
Of course, there are times when this problem is unavoidable--specifically, when there are children involved. 

If you begin a relationship with someone who has children from a former relationship, you know (although you might not like it) that your partner must talk to his ex about matters relating to the children.

This is what a responsible parent does, and it requires a good dose of understanding, compassion and patience on your part to deal with this situation. 

It helps a lot if you feel secure in your relationship and you know that you can trust your partner to maintain appropriate boundaries with their ex, basing their contact solely on the children's welfare without blurring the lines.

This is a dynamic that I help individuals and couples with in individual psychotherapy and couples counseling. These are issues that people deal with in blended families, but that's not the focus of this particular posting.

How the Former Relationship Affects the Current Relationship:
The particular dynamic that I'm addressing has more to do with someone who leaves his relationship (where there are no children), enters into a new romantic relationship but, for whatever reason, he finds it extremely difficult to sever his ties with his former girlfriend or wife.

If you're in a new relationship with someone (whether it's with a boyfriend or a girlfriend) who can't or won't let go of his former partner and it's affecting your relationship, I don't need to tell you that you're in a challenging situation.

I'm not even talking about situations where there is actual infidelity going on with the former partner. I'm focusing on the situation where your partner still makes and receives calls to his ex, still gets together with her (without you), and where this interferes with your relationship.

I know that there are situations where maintaining contact with ex partners doesn't interfere with the current relationships. I've had clients who divorce, both people remarry and maintain friendships with their ex-husbands and ex-wives.

Not only is it not a problem, but the couples enjoy going out together, they vacation together, and they value the friendship. The boundaries are clear, and it isn't a problem for anyone.

I'm mostly referring to situations where, for all intents and purposes, the prior romantic relationship has ended, but the two people who were involved decide to try to maintain a friendship. So, for example, in this type of situation, you begin a new relationship and you find that your boyfriend is still very focused on his ex.

 Maybe they've ended the romantic and sexual aspects of their relationship, but (even though they might not admit it) they're still very emotionally dependent upon each other: He still feels that he must have her advice before he makes any major decisions, she still calls him frequently to help her with her problems, and so on. And if it happens frequently enough and it starts to impact your relationship, there you are, feeling left out and, possibly, feeling like you're having an affair with your own boyfriend.

Feelings Don't Always End When the Former Relationship Ends:
Just because two people have broken up doesn't mean that there might not still be strong emotional feelings between them. It's usually better to know about this before you enter a new relationship with someone. Then, you have the option of deciding whether you can handle a relationship with someone who still has strong emotional ties with his or her ex.

As I mentioned earlier, for some people, it's not a problem because there is a recognition that the girlfriend or wife in the new relationship is primary and, usually, when this type of situation works out well, the new girlfriend is included in any plans and it's clear that the former romantic relationship has developed into a real friendship and it's not a threat to the new relationship.

 Anyway, the point is that the end of a relationship doesn't necessarily mean the end of feelings. And if your boyfriend (or girlfriend) is unwilling and/or unable to be clear about whether you or the ex is primary, that's when problems develop.

The following vignette, which is a composite of many clients' stories over the years with all identifying information changed, is an example of the type of problem that I'm addressing:

Susan and John
When Susan met John, he had broken off his relationship with Jane about six months before. Susan and John began dating and they hit it off right away. They both felt a strong romantic connection that was different from anything either of them had experienced before. Their relationship seemed ideal--with the exception of one thing: He still maintained frequent contact with Jane.

When Your Boyfriend is Stuck in a Codependent Relationship with His Ex

John was very upfront from the start that he and Jane wanted to remain friends. They had been together for five years, and they still cared about each other, even though they weren't romantic or sexual any more. At first, since everything else seemed to be going so well, Susan told herself that it was admirable that John and Jane were able to maintain a friendship. But, over time, she began to resent John's frequent contact with Jane, especially as it began to interfere with her relationship with John. It seemed that things were not quite what they appeared to be at first. Susan never felt that John was cheating on her, per se. But she sensed that now that Jane knew that John was seeing someone new, Jane called John more frequently and seemed to depend on him more.

Whether it involved household repairs, late night talks about how lonely she felt or about her personal problems or wanting to get together with John (without Susan), more and more, Susan began to feel that Jane was taking up a lot more time than Susan felt comfortable with, and she was resenting it. Susan sensed that Jane still wanted to maintain an emotional hold on John, even though he was in a new relationship, and she sensed something manipulative in the way that Jane played on John's feelings of guilt for having ended the relationship with Jane. She also sensed that, for whatever reason, John was caught up in this dynamic.

When Susan talked to John about this, he responded by trying to reassure Susan that nothing romantic was going on between him and Jane and Susan had nothing to worry about. He seemed unable to see how much time Jane was taking up and how this affected his new relationship with Susan.

For a while, Susan tried to be understanding. She loved John, she trusted him, but she also had a bad feeling about the dynamic between John and Jane. Then, one night, John was staying over with Susan and they were starting to be intimate. It was close to 11 PM when John received a call on his cell phone from Jane. Susan asked John not to take the call, but he gave her a pained look and said that if Jane was calling at this time, it must be important. He asked Susan to be understanding, and he took the call. From her side of the bed, Susan could hear Jane sobbing on the other end. Susan felt the now-familiar anger and resentment welling up in her. John could see that Susan was getting annoyed, but he gave her a helpless shrug, as if to say, "I can't abandon Jane. She needs me" and took the call in the other room.

A half hour later, when John came back into the bedroom, Susan pretended to be sleeping. She felt too hurt and angry to talk to John, and she didn't want to have a late night argument with him. So, they each slept on either side of the bed and feelings were tense the next morning before they each left for work.

This was the situation when Susan and John began coming for couples counseling. Susan felt that she was in a terrible dilemma--she loved John and she knew that he loved her, but she couldn't tolerate how his friendship with Jane was affecting their relationship. For his own reasons, having to do with his history with a dependent mother and his complicated relationship with Jane, John was unwilling to give up his friendship with Jane.

 He loved Susan, he didn't want to hurt her, and he didn't want to ruin the relationship, but he felt tangled in a strong emotional web with Jane, and he said he couldn't let go of his friendship with her or even set limits with her constant emotional demands. He had an intellectual understanding that he was in a dysfunctional and codependent relationship with Jane, but he didn't know what to do.

It was a very sad and painful situation for both Susan and John. John began his own individual psychotherapy to deal with his family history which was a big part of the problem. Over time, he began to see that each time that Jane called in crisis, he felt emotionally triggered in the same way that he felt with his mother who had been overly dependent on him when he was a child. In many ways, John was "primed" for the codependent situation with Jane due to his family history, and this was primarily why he had such a hard time letting go of Jane or even setting limits with her.

As John began to work through those earlier issues, he developed greater awareness and insight into the current situation and realized, on a deep emotional level, that he was caught up in a codependent situation with Jane and it was ruining his relationship with Susan.

Although it was difficult for him, he began setting limits with Jane, letting her know that his relationship with Susan was primary--no more late night crisis calls, no more getting together without Susan, and so on. Jane did not respond well to this type of limit setting and, eventually, she decided to sever her ties with John. Over time, John dealt with the loss of this friendship in his own individual psychotherapy, how it related to his family history and, over time, his relationship with Susan began to thrive again.

It Takes a Commitment from Both People in the Relationship:
This vignette illustrates that couples can work out problems when one or both of them can't let go for a former partner.

 It takes a big commitment from both people, a willingness to work on this issue in couples counseling, an understanding of the underlying psychological dynamics that are often involved in this type of situation beyond the current people involved, a recognition and acknowledgement that the friendship with the ex is having an impact on the current relationship and, ultimately, a commitment to the current relationship as being primary and a recognition that, if the friendship with the ex cannot be modified so that it's not adversely impacting the current relationship, that relationship needs to end.

Unfortunately, not all relationships that have this problem end well. Sometimes, there's just too much unfinished business with the former partner or spouse. Other times, the partner who is maintaining an enmeshed or codependent relationship with the ex refuses to see it for what it is and thinks the current partner is being unreasonable. Sometimes, it just gets too complicated. But it's more likely to work out if you don't wait too long to try to get help.

Getting Help in Therapy: 
If you find yourself in the type of situation that I've described in this posting, whether you're the person with the partner who is stuck in a codependent relationship with your ex or you're in a relationship with someone who can't let go, recognize that you're not alone.

Getting Help in Therapy

This is a phenomenon that often occurs in relationships, and you and your partner could benefit from attending couples counseling. If your partner or spouse is unwilling to attend couples counseling, you could benefit from seeking help in individual psychotherapy.

Also see my article: Are You Stuck in a Codependent Relationship with an Ex?

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and Sex Therapist who works with many individuals and couples who have successfully worked through relationship problems.

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

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

Healing Old Emotional Childhood Wounds that are Affecting Your Relationships

As a psychotherapist in New York City, I see many clients in both individual psychotherapy and couples counseling who are struggling with old, unresolved childhood wounds that are affecting their current relationships. 

Healing Old Emotional Childhood Wounds Affecting Your Relationships

Most people know, at least on an intellectual level, that their unresolved family of origin issues have the potential to impact their current relationships. But when you've actually experienced how powerful these old emotional wounds are when they get triggered in current relationships, you have a deeper emotional understanding of their adverse impact in your intimate relationship.

Often, these old emotional wounds remain buried for a long time and don't get triggered until you're in an intimate relationship. The closer you are to your spouse or partner, the more likely it is that issues like fear of emotional abandonment, fear of not being lovable, and other similar feelings will arise in your relationship. 

The reason for that is that you're most vulnerable emotionally when you're in an intimate relationship. When you're experiencing these issues in your relationship, it's often difficult to know if you're feeling these emotions due to problems in the current relationship, past family of origin issues, or they represent some combination of the two.

One clue that these feelings are connected to unresolved emotional issues from the past is that your emotional reactions in your current relationship are out of proportion to the situation. Obviously, to recognize this, you must have some degree of insight and objectivity or, at least, be willing to talk it over with a trust family member or friend who can offer an insightful perspective.

The following scenario, which is a composite of different clients with all identifying information changed, illustrates how unresolved childhood emotional issues can get triggered and cause problems in a current relationship:

Tom:
Tom was a man in his mid-30s. He and Jennifer had been in a relationship for two years. They were talking about getting married. But, at the point when Tom came to see me for individual psychotherapy, they were arguing and Jennifer expressed serious concerns about whether they should stay together.

As Tom explained it, they were very happy together until Jennifer took a job where she had to travel to the West Coast every couple of months. Whenever Tom heard that Jennifer had a business trip coming up, he would become highly anxious, irritable and argumentative with Jennifer.

Usually, Jennifer's business trips lasted no more than a week. But during the time when Jennifer was away, Tom became despondent and he had a terrible feeling of foreboding that he would never see Jennifer again. Neither Jennifer nor Tom understood why Tom was experiencing such strong emotional reactions. At first, she tried to be empathetic and console him. However, after a while, Jennifer felt frustrated and questioned whether she could be happy with Tom as a lifelong partner.

As Tom and I discussed his childhood history, I discovered that his father would often disappear for months at a time without warning, leaving the Tom, his mother, and his younger brother in a state of emotional and financial chaos. It became clear that whenever Jennifer left for a business trip, Tom's old, unresolved trauma was getting triggered and he was feeling the same fear and sadness that he experienced when he was a child. Realizing this on an intellectual level helped Tom to realize that he wasn't "crazy," but that knowledge alone did not prevent his fears.

Over time, Tom and I worked on his unresolved issues using EMDR (Eye Movement Desensitization and Reprocessing) and clinical hypnosis. Using these two powerful psychotherapeutic treatment modalities helped Tom to work through his trauma so that he was no longer triggered.

The real test came when Jennifer went on her next business trip. Tom was amazed that, despite fearing that he might have one of his usual traumatic reactions, he felt all right about Jennifer leaving. 

 It was the first time, since she started traveling, that he wasn't in a panic, he didn't feel despondent, and he didn't feel abandoned by her. He felt completely free of his former traumatic symptoms. Jennifer was also greatly relieved. Within six months, they got married. When I followed up with Tom six months later, he reported that he continued to feel symptom free and they were happy together.

Often, when dealing with unresolved childhood trauma, regular talk therapy is not enough to overcome these problems. Talk therapy might provide intellectual insight into the trauma and what triggers the traumatic symptoms. But, often, it is not enough to heal old emotional wounds. 

 Within the last 10-15 years, research has shown that, when it comes to healing trauma, mind-body oriented psychotherapy is usually more effective than regular talk therapy. Both EMDR and clinical hypnosis are considered forms of mind-body psychotherapy.

Many clients who are already in regular talk therapy will often come to an EMDR therapist or hypnotherapist for adjunctive therapy, where their current psychotherapist is the primary therapist and the EMDR therapist or hypnotherapist provides treatment in collaboration with the primary psychotherapist.

Getting Help in Therapy
When choosing a psychotherapist, EMDR therapist or a hypnotherapist, always choose a licensed mental health professional. 

 Also, there is a big difference with regard to training and professional background between a "hypnotist" and a hypnotherapist. 

 As the name implies, a hypnotherapist is a licensed therapist and a hypnotist is usually someone who has learned hypnosis techniques but who does not have the therapeutic background and expertise to deal with emotional issues.

About Me
I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist.

I have helped many clients in individual therapy as well as in couples therapy to overcome unresolved emotional trauma that is adversely affecting their current relationships.

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

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

Psychotherapy and Compassionate Self Acceptance

As a psychotherapist in New York City, I have found that one of the major challenges for people who begin psychotherapy is overcoming their own critical and judgmental beliefs and assumptions about themselves. When I work with clients who have developed a harsh sense of self, I often begin by talking to them about how psychotherapy can help them to become more mindful, attuned and compassionate towards themselves.

Psychotherapy and Compassionate Self Acceptance

Low Self Esteem, Lack of Self Compassion and Self Acceptance, and the Development of the "False Self":
Many clients who begin psychotherapy to overcome low self esteem want to find a way to feel better about themselves. As their psychotherapy unfolds, often, what comes to light is that they have rejected parts of themselves that they have come to hate. Hate is a strong word, but it is usually apt for the type of self loathing that these clients have come to feel for parts of themselves over time.

This lack of self acceptance and self loathing is not always obvious to see at first. Sometimes, it manifests itself in a critical and judgmental attitude towards others. Other times, it shows itself through a need to be "perfect" themselves and to have others be "perfect." Very often, this self loathing and lack of compassion for oneself can be seen when people develop a "false self" when they are interacting with others.

Donald Winnicott and the "False Self"
Donald Winnicott, a British Object Relations psychoanalyst and pediatrician, was one of the first psychotherapists who developed a theory about the "false self."

In his developmental model of the "false self," Winnicott posits that, early on, when parenting is "good enough" a baby learns to relate to his or her primary caregiver in an authentic and loving way.

"Good enough" is the operative term here, since parenting can never be perfect and parents cannot always be perfectly attuned to their children.

However, according to Winnicott, when the primary caregiver (usually the mother) is sufficiently and lovingly attuned to the baby, the baby is usually able to thrive emotionally and, over time, learns to relate well to others as well as to him or herself. However, when the primary caregiver is unable to connect emotionally with the baby, either because he or she is depressed or for some other reason, the infant feels rejected and develops a "false self" to try to elicit the caregiver's love and attention.

People who have developed a "false self" often describe themselves as feeling "empty" or "hollow" and have difficulty relating to themselves as people who are worthy of love and compassion. They also often have difficulty relating to others because their own critical judgments and self loathing gets projected onto others: What they unconsciously cannot accept in themselves becomes intolerable when they sense these qualities in others.

So, over time, in psychotherapy, it becomes apparent that low esteem, depression, anxiety and other emotional problems are often connected to a lack of compassionate self acceptance for oneself and the development of a "false self." It may seem somewhat contradictory, but until you can accept the parts of yourself that you don't like, they're difficult to change.

The following is a vignette which represents a composite of several psychotherapy cases where a client has a "false self":

Carol:
Carol began psychotherapy because she felt that her life was "meaningless." She was in her mid-30s and she had never had a romantic relationship that lasted for more than a year. She described herself as feeling that she "existed" but she was "not really living." She could only express this feeling in the vaguest of terms, but the feeling was strong in her. Her emotional world felt flat--no passion, no real highs or lows.

Psychotherapy and Compassionate Self Acceptance

She worked as an attorney for a nonprofit social service agency, and her employer valued her work because she worked very hard advocating for the clients and often won her cases. However, even though she knew that she was highly esteemed in her organization, she could not feel good about herself at work or in any other part of her life.

In describing her childhood history, she emphasized that she felt she had good parents and she denied any abuse or big traumatic events. As such, she had a hard time understanding why she felt the way she did, "If my parents beat me, I could understand why I feel this way about myself, but they didn't, so there must be something very wrong with me."

It soon became apparent in psychotherapy that underneath that flat sense of meaninglessness, Carol had a strong sense of self loathing. Most of the time, she was able to push down those feelings of self hatred by working long hours and keeping herself distracted. However, as she talked about herself in a judgmental and critical way, it became evident that she lacked a sense of acceptance and compassion for herself.

She ran roughshod over herself with a sense of perfectionism and judgement that was truly soul crushing. No matter how much external praise she received from others, she never felt that anything she did was good enough. She spent a lot of time ruminating about what she perceived as her personal flaws or how she "could have done it better." She was her own worst taskmaster with standards that were unattainable.

In discussing her family history in more depth, it turned out that her parents, who were highly-regarded Ivy League college professors, were rather critical and emotionally distant with Carol. They provided her with everything that she needed on a material level, but they gave Carol the overarching message again and again that what they truly valued in her was her accomplishments in school. There was little sense that they valued her just as she was as a person.

Carol learned as a child that if she got very good grades and tried to be as "perfect" as she could, her parents would praise her efforts. But if she fell short in any way, as all of us do at some point or another because we're human, they found this intolerable.

Carol was also very aware that her mother, who stayed home with Carol until she was five years old and started school, had a lot of resentment about this. Her mother would have preferred to be teaching her classes and continuing her research than staying home with a helpless, dependent baby.

Carol had heard her mother lament many times about how the time she spent away from her field was detrimental to her career and that she was never able to regain the stature that she had prior to staying home with Carol.

Carol's father concurred with her mother about this. One can only surmise that Carol's mother's anger about her role as a mother probably did not allow her to be as emotionally attuned to Carol as an infant. And throughout Carol's childhood, neither parent demonstrated much emotional attunement for Carol as a child who deserved love for herself, without having to perform to their impossibly high standards.

Prior to starting psychotherapy, Carol had never questioned her parents' attitude towards her. The feeling that she was somehow to blame for her mother's lost professional opportunities and that she needed to perform to gain her parent's love and attention was so deeply ingrained at such a young age that it had become a strong part of Carol.

And even though her parents had somewhat mellowed as they aged and they no longer had such a punitive attitude towards Carol, it didn't matter because Carol had internalized their critical and judgmental attitude on such a deep and unconscious level that she was now doing it to herself.

Over time, Carol was able to see how she had developed a "false self" to please her parents. And even though this "false self" might have developed due to her parents lack of emotional attunement, she realized that it was now her responsibility, as an adult, to overcome the emotional obstacles that kept her from accepting herself just as she is.

It was a real challenge for her, but Carol began to question her harsh, punitive attitude towards herself. She mourned for the inner child part of herself who didn't get the unconditional love that she deserved.

She also began to learn to love that part of herself that she had learned to hate--the part that needed to be loved for herself and not for her "accomplishments." As she did this, she began to feel more authentic.

She no longer felt that she was performing a role or just going through the motions in her life. Life became richer and more meaningful as she became more emotionally attuned to herself. She also learned to forgive her parents and she developed better relationships with them as she recognized that they were no longer the punitive, emotionally withholding parents that she grew up with.

As they aged, they went through their own emotional transformation and she learned to relate to them as they are now and not how they were when she was a child.

As Carol became more compassionate and accepting towards herself, she felt better about herself.

Psychotherapy and Compassionate Self Acceptance

Accepting that she was human, she could make mistakes, she no longer needed to be "perfect," her self worth did not have to be based on her accomplishments, and that she deserved love, enabled her to open up others in an authentic way that she had never experienced before.

Eventually, she was able to open up to a relationship with a man who loved for her for herself, and they developed a healthy, loving and stable marriage.

Getting Help in Therapy
If you are struggling with your own critical and judgmental beliefs and assumptions about yourself, you could benefit from participating in psychotherapy with a licensed mental health professional. Although it can be a challenge, you can learn to develop a more self accepting and compassionate sense of self so you can improve your relationship with yourself and others.

I am a licensed NYC psychotherapist, hypnotherapist and Somatic Experiencing therapist. I have helped many clients to develop a more self accepting and compassionate sense of self.

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.

Relationships: Oxytocin, Trust and Empathy

After I wrote my post yesterday about psychotherapy, gratitude and balance, which was in keeping with the Thanksgiving holiday, I read a fascinating article by Nancy Angier in the Science Times section of the NY Times that piqued my interest. The article is called 
The Biology Behind the Milk of Human Kindness.

Relationships: Oxytocin, Trust and Empathy

Research Links Oxytocin to Increased Levels of Trust and Empathy
Ms. Angier discusses new research linking the hormone, oxytocin, to increased levels of trust and empathy. (Oxycotin is a naturally-occurring neurotransmitter in mammals--not to be confused with the drug, Oxycodan).

Relationships: Oxytocin, Trust, Empathy

Prior to this research, researchers have long known that oxytocin has aided in child birth (many doctors inject women in labor with oxytocin to induce labor), breast feeding, and that it usually increases naturally during sexual arousal and orgasm.

Oxytocin Facilitates Bonding and Has Implications For Relationships
Researchers have also known that increased levels of oxytocin facilitates bonding between mothers and babies in humans and other mammals. It is also generally accepted that when there is sexual chemistry between two people, there are high levels of oxytocin and when there is a lack of sexual chemistry, there are lower levels of oxycotin.

Oxytocin Facilitates Bonding and Has Implications For Relationships

However, this new research, which links increased levels of oxytocin with a greater capacity for trust and empathy has important implications for our relationships.

If you haven't read Ms. Angier's article in Science Times, I recommend that you take a look at it to understand the connection between oxytocin and our ability to feel trust and empathy in our relationships (see link that I have provided at the top of this post).

About Me

I am a NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

One of my specialities is helping individuals and couples to enhance their personal and work-related relationships.

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.

Balance, Gratitude and the Evolution of Contemporary Psychotherapy

A common myth about psychotherapy, especially among people who have never been in in-depth psychotherapy before, is that clients primarily "complain" to their psychotherapists about their families and their lives or come in to "fix" a particular problem. 

Balance, Gratitude and the Evolution of Contemporary Psychotherapy

This is a very narrow view of psychotherapy and does not take into account the full richness and experience of the in-depth psychotherapy process as a place where clients, in addition to resolving particular problems, often find balance and gratitude in their lives, their relationships and for themselves as well.

During this Thanksgiving season, when we tend to be more aware of the people and things in our lives that we are grateful for, I'd like to focus in this post on how in-depth psychotherapy often leads to a greater sense of balance and gratitude.

Often, when people first begin psychotherapy, they either come for a particular problem or they have a sense that "something is wrong" in their lives, but they don't know what it is. In our culture, our tendency is to approach problems in a logical, linear way: identify the problem, analyze the various options, chose an option, fix the problem, and the process is finished.

There's nothing wrong with this approach and, in many instances, it works very well. It also often works well for some specific problems in psychotherapy and hypnosis, like smoking cessation or overcoming a particular fear or phobia. However, in-depth psychotherapy can be so much more than this for people who are interested in finding a greater sense of balance and contentment in their lives.

How Contemporary Psychotherapy Has Evolved Over the Years:
As psychotherapy has evolved over the years, there has been more of an emphasis on cultivating and building a more balanced sense of self. As opposed to more classical ways of working in psychotherapy where the emphasis was primarily on uncovering and working through problems, contemporary psychotherapists also help clients to build a stronger sense of self.

This is done, in part, through the development of clients' internal resources. These internal resources can take many different forms. Sometimes, they're coping abilities that clients have had all along but have been overlooked and under utilized. Often, they're internal resources, or parts of ourselves, that are discovered and developed during the psychotherapy process.

When people are depressed or anxious, it's common to focus on what's wrong or missing in their lives. This is understandable. Often, under these circumstances, their view starts out being narrow until they begin to feel some relief from their anxiety-related or depressive symptoms in a supportive psychotherapy treatment environment.

In contemporary in-depth psychotherapy, clients can begin the process of building a stronger sense of equanimity: a greater capacity to soothe themselves, love and value themselves more, appreciate subtle and richer aspects of themselves, and develop a stronger sense of identity.

With a greater sense of balance for themselves often comes an increased capacity to value and have a greater sense of gratitude and compassion in their relationships, their work, and other important areas in their lives. So, what might have started as a narrow view at the start of psychotherapy begins to open up and broaden to include a more holistic and nuanced view of themselves and others: Not just what's wrong--but what's right too.

Keeping a Gratitude Journal:
I often recommend to clients that they keep a gratitude journal as a way to start developing a greater awareness and appreciation for the positive things that occur in their lives on a daily basis. 

The gratitude journal can be a simple list of two, three or more things that you feel grateful for each day. Over time, cultivating a sense of gratitude, even for the small things in life, can help to create a greater sense of balance, appreciation, and compassion in how we see our world as well as how we see ourselves.

About Me
I am a psychotherapist and hypnotherapist in New York City. 

I have helped many clients to develop a greater sense of self and an increased sense of balance and gratitude in their 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.

Getting the Most Out of Your Psychotherapy Sessions

As a psychotherapist in New York City, I often see clients who are coming to psychotherapy for the first time or clients who have been in therapy before where they didn't have a positive outcome.

Getting the Most Out of Your Therapy Sessions

Participating in psychotherapy involves a commitment of time, effort, and money. If you've never participated in psychotherapy or if your prior therapy experience was not a positive one, you might not know what to expect from your therapist or what your therapist expects of you. So, I usually like to talk to new clients about this so they can understand the treatment frame and they can get the most out of their sessions with me.

Choosing a psychotherapist:

A Good Therapeutic Relationship:
If you're trying to find a psychotherapist in a large city like NYC, you usually have many therapists available to you, especially if you have the ability to go outside of your managed care network.

Generally, the most important factor in choosing a psychotherapist is whether or not you feel a rapport with him or her. This might not be evident immediately. It takes time to build a professional rapport with your therapist. Having a good therapeutic working relationship is usually the best predictor of whether or not your therapy will be successful.

It's important to feel that your therapist has empathy and cares about you within the bounds of the professional treatment relationship.

Not every therapist is for every client. Someone else might really like a particular therapist and establish a good rapport with that therapist, whereas you might feel that you're not connecting with that same therapist. It doesn't mean that there's anything wrong with you or necessarily wrong with the therapist. It means that we're all unique and what works for one person might not work for someone else. Usually, after a few sessions, you can tell intuitively if you're connecting with a particular therapist.

Establishing a good therapeutic relationship doesn't mean that you're always going to "feel good" in your psychotherapy sessions. After all, the change process can be challenging and you might be discussing topics that bring up uncomfortable emotions. So, it's important to distinguish between those feelings and the overall rapport you feel with your therapist.

Different Types of Psychotherapy:
Aside from feeling a rapport with your therapist, there are also many different types of psychotherapy.

As a psychotherapist, I work in many different ways, depending upon the needs of the client: psychodynamic psychotherapy, cognitive behavioral treatment (CBT), EMDR (eye movement, desensitization and reprocessing), clinical hypnosis (also known as hypnotherapy), and Somatic Experiencing are among the different treatment modalities that I use.

You might find that you like and respond best to certain forms of psychotherapy and not others. Obviously, you're not responsible and cannot be expected to know about these different forms of psychotherapy before you start therapy, but you can ask any prospective therapist about them, and he or she should be able to explain in plain English any treatment modality that he or she uses.

Choosing A Licensed Psychotherapist:
It's important that whoever you choose is a licensed mental health professional.

There are people who call themselves counselors or therapists who have no professional training, expertise or psychotherapy background. They might be very nice people but, in most states, including New York State, if they're not licensed, they're not psychotherapists.

Knowing that your therapist is licensed lets you know that he or she mets the basic professional requirements in his or her profession.

It doesn't guarantee that he or she will be a good therapist or the right therapist for you, but it demonstrates that the minimum requirements stipulated by your State have been met. It also means that the therapist is governed by a State professional licensing bureau and is ethically bound and accountable to that bureau.

If you're not sure, you can ask your therapist. You can also check with the State professional licensing board. In New York State, you can go to the Office of the Professionals - NYS Education Department: http://www.op.nysed.gov/ and go to the section for verifications.

Choosing a Psychotherapist Who Stays Up-to-Date With Current Practices:
Aside from meeting the minimum requirements for licensing, you should ask any prospective psychotherapist that you're considering about his or her background and training. Generally, you want someone who has stayed up-to-date with current practices.

Choosing a Psychotherapist

Often, clients who would be concerned about these issues when choosing a doctor, don't think about it when they're considering a psychotherapist.

So, for instance, if you needed surgery, you would want to make sure that your surgeon continued to get training beyond his or her medical school training and stayed current with state of the art medical and surgical practices, especially for your particular medical problem. You wouldn't dream of seeing a surgeon who said, "I've never done this type of surgery before, but I'm happy to try it out on you" or "It's been a long time since I've performed this surgery. I might be rusty, but I think I can muddle through."

It's no different with psychotherapy. If a prospective therapist has not continued to train beyond graduate school, in my professional opinion, this isn't a good sign.

Ethical Considerations in Psychotherapy:
Ethical considerations in psychotherapy is a vast topic. There have been many books and articles written about it. I cannot possibly do justice to this topic in one posting. 

I think the vast majority of psychotherapists are ethical and caring people who want to help their clients. However, unfortunately, there are instances where there are boundary violations which are detrimental to the client. I will touch on some important factors:

"Dual Relationships" in Psychotherapy Are Unethical:
The psychotherapeutic relationship is unlike most relationships. It's different from a friendship or a familial relationship, even though you're talking about very personal things about yourself. Your therapist is not going to be your friend, not even after you stop therapy with him or her.

Psychotherapists' code of ethics considers it a boundary violation for therapists and clients to be in "dual relationships." That means that your relationship with your therapist will be strictly professional and limited to your therapy

Even though your therapist might have a warm and friendly manner, as a mental health professional, he or she is responsibile for maintaining clear and consistent boundaries.

Getting romantically or sexually involved with clients or taking advantage of clients in other ways is strictly forbidden. If a therapist seduces you into a romantic or sexual relationship, he (or she) can lose his license. You have the right to report the therapist to his or her professional board of ethics sessions (see my article:  Boundary Violations and Sexual Exploitation in Psychotherapy).

The therapy should be focused on you. An ethical therapist will not be discussing his or her own personal problems or focusing on him or herself.

This is another way that the psychotherapeutic relationship is different from most other relationships. Depending upon the psychotherapist, most therapists do not disclose a lot of personal information, especially if the therapist works in a psychodynamic way. The primary reason for this is, once again, to keep the focus on you.

That doesn't mean that the therapist might not selectively disclose certain things about him or herself if it's in the service of furthering the treatment.

Therapists' self disclosure is also another vast topic. Generally, even the most conservative psychoanalysts today no longer believe that they are "blank screens" for clients to project their thoughts and fantasies on. However, it's important to understand that if a therapist is not disclosing personal things about himself or herself, it's usually in the service of providing the best possible treatment for you.

Ethical Issues Regarding Managed Care Fees:
If your therapist is an in network provider on your managed care insurance panel, he or she should not be asking you to pay additional money, beyond your copayment, to bring your fee in line with his or her non-managed care fee structure.

When your therapist is on a managed care panel, he or she signed a contract with the managed care company to accept their fee. The contract also stipulates how to handle missed or broken appointments. If your therapist asks for additional money beyond what is allowed in the insurance contract, this is insurance fraud and is reportable to your insurance company and your therapist's professional board of ethics.

Also, most managed care companies don't allow your psychotherapist to charge the insurance for your missed or broken appointments. This is a contractual issue between your therapist and your managed care company.

That means that, in most cases, you are often responsible for the entire fee (not just the copayment) when you have a broken appointment with your therapist. This is a topic that should be discussed at the first sssion so that you're clear about your responsibility with regard to missed appointments. If you're not clear, you can call your insurance company and ask.

Some therapists bill the managed care company for broken appointments, even though it's against their contract with the insurance company. Possibly, they feel that they're being nice to clients by not charging them or they're trying to preserve the therapeutic relationship. However well intentioned this might be, you should know that, unless an insurance contract allows for this (and I don't know of any that do) this is insurance fraud and your therapist can lose his or her license for this.

Doing Your Part in Psychotherapy:
Usually, the therapeutic hour is somewhere between 45-60 minutes per week for individual therapy, depending upon your therapist and the type of therapy. An hour out of a week is not very much time. So, if you want to get the most out of your therapy, it's important that you know what is expected of you in therapy.

Doing Your Part in Therapy

Showing up for your appointments:
This might seem obvious, and most clients don't start therapy with the intention of not showing up for their appointments. However, it's not unusual to feel ambivalent about going to therapy. Clients will often start therapy saying that they want change, but the process of change is sometimes diffiicult, and when a client and therapist begin to discuss topics that are uncomfortable, some clients begin missing appointments.

They might not even realize that they're missing appointments because of their discomfort. Emotional discomfort and ambivalence can show up in many different guises: "forgotten" appointments, missing therapy because you feel "tired," and other reasons that might mask an unconscious wish to avoid change. Clients might also begin arriving late for their appointments as an unconscious way to avoid dealing with the process of change.

Thinking About What You Discussed in Therapy Between Sessions:
As I've mentioned, the therapeutic hour is brief compared to the rest of the time in your week. If you want to get the most out of therapy, it's important to think about what you and your therapist have discussed. That means taking time during the week to think or journal about the issues and feelings that come during and after your session.

It's also important to apply whatever you've learned in your every day life. Your therapy will be of little value to you if you have insights in your therapy session, but you forget them once you've left the therapist's office. Also, pay attention to whatever emotions come up between sessions and let your therapist know, even if you might feel uncomfortable. Chances are, if you're seeing an experienced, licensed mental health professional, he or she has already dealt with these issues before.

Doing Homework:
As a psychotherapist, I usually don't give a lot of homework to most clients between sessions. However, at times, I might recommend reading an article or a book, practicing something that has been learned in the session (like meditation or self hypnosis) or I might ask a client to journal or reflect on a particular issue or emotion. I might recommend attending a 12 Step meeting, getting a sponsor, etc.

I might also come to an agreement with a client to take a particular step or action to further the process.

For instance, if a client has problems with procrastination, it's important to talk about it and try to understand it but, ultimately, the client needs to take certain steps in order to overcome this problem. So, we might come to an agreement about what the next step might be to further the process along. Among other things, doing homework between sessions helps to bridge one session with another. A week might not seem like a long time, but in psychotherapy, it can be very long--enough time to forget or put out of your mind what you and your therapist have discussed. So, finding ways to bridge that time can be very valuable.

One posting about how to get the most out of your psychotherapy sessions is not enough to cover all the relevant topics. However, if you're thinking about starting therapy or if you're already in therapy, I hope this posting will be a good start for you and get you thinking about it.

About Me.

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

I have helped many clients to 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.

EMDR Therapy for "Big T" and "Smaller t" Trauma

As a New York City psychotherapist who is an EMDR therapist, I see clients for EMDR treatment for both "Big T" and "Smaller t" trauma. I will clarify what I mean by "Big T" and "Smaller t" trauma below.

What is EMDR?
First, as I have written about in earlier posts, I want to reiterate that EMDR (Eye Movement Desensitization and Reprocessing) is a form of psychotherapy which has been found to be effective for healing trauma. Francine Shapiro, Ph.D., who is a psychologist, developed EMDR in the late 1980s.

EMDR Therapy For "Big T" and "Smaller t" Trauma

Since that time, EMDR has been one of the most well-researched forms of psychotherapy for posttraumatic stress disorder (PTSD) and other types of trauma. It has been recognized as a safe and effective form of treatment by the Veteran's Administration, the American Psychiatric Association, the International Society for Traumatic Stress Studies, the Israeli National Council for Mental Health and the United Kingdom Department of Health, among other mental health organizations.

EMDR uses bilateral stimulation of the right and left brain hemispheres (through eye movements, alternate taping, bilateral music, and other similar methods) to activate the brain's "information processing system" to heal trauma.

When we are overcome by experiences that produce overwhelming emotional and physical reactions, often, our minds are unable to process these experiences.

Under certain circumstances, which are unique to each person, these overwhelming experiences can produce adverse reactions, like debilitating depression, anxiety and other psychological difficulties. EMDR allows clients to reprocess these experiences, allowing us to get to the root of these emotional processes, and usually produces a long-term cure.

EMDR therapists, who have advanced training, know how to work with clients in a way so that they are not overwhelmed with the EMDR reprocessing. Each client's experience is unique.

Generally speaking, high levels of emotional reaction tend to dissipate with EMDR treatment. Also, an experienced EMDR therapist makes sure that clients are well prepared for EMDR processing before the actual processing begins by working with clients to develop internal resources (coping skills) to deal with any uncomfortable reactions that might take place during the reprocessing of emotional trauma.

What is the Difference Between "Big T" and "Smaller t" Trauma?
EMDR is usually associated with what is referred to in psychological literature as "Big T" trauma. However, it seems that it is less well known that EMDR is usually very effective for "Smaller t" trauma as well.

"Big T" Trauma
When we refer to "Big T" trauma, we are usually referring to trauma that occurs during war or natural disaster, rape, kidnapping, physical attack, and other similar types of trauma. These types of trauma are usually so overwhelming for most people that they are unable to cope.

An example, of this is the Vietnam or Iraqi veteran who has witnessed atrocities during war and who comes home, relives these atrocities through flashbacks, where it adversely affects his or her ability to function in every day life.

Another example of "Big T" trauma is when a woman who has been raped continues to have nightmares about the rape; she ruminates about what happened, reliving the event over and over again in her mind.

She might be too afraid to start new relationships or to even go outside.

Generally, "Smaller t" trauma is trauma that is more subtle than "Big T" trauma.

An example of "Smaller t" trauma can occur when we're children and we witness events that are upsetting and overwhelming to us because our child-like minds are unable to understand or process these events.

An example of a "Smaller t" trauma could be when a child witnesses loud arguments between his parents and he fears that they are going to get a divorce. As a child under these circumstances, it's normal to be concerned about his safety and well-being. After all, he worries about what will become of him and who's going to take care of him if his parents are not together.

These kinds of experiences can leave a mark on a child's psyche, leaving him vulnerable to feeling anxious, depressed, or insecure later on in life.

There are many other everyday examples of "Smaller t" trauma that people often don't recognize at the time when they're occurring. The emotional damage that has been done often does not show up until later on in life. Sometimes the events that led up to these problems later on are apparent and, other times, they're not. Either way, EMDR is usually an effective form of therapy to overcome the effects of "Smaller t" trauma.

Since most literature focuses on "Big T" trauma like PTSD, I would like to focus on "Smaller t" trauma in this post to illustrate its effects and how EMDR can help. The following vignette is a composite of many cases with all identifying information changed to protect confidentiality:

John:
When John first came to treatment, he was in his late 30s. He worked as an attorney in a large corporate law firm. Like most attorneys in his law firm, John hoped to become a partner one day in his firm.

Generally, he liked corporate law and enjoyed working with his clients. However, he felt very anxious around his boss because his boss was a bully. Whenever his boss felt that John fell below what was considered an acceptable rate of "billable hours," he berated him in the most demeaning way.

John understood the importance of "billable hours" and knew what was expected of him. He felt that, overall, he was a knowledgeable and capable attorney. However, whenever his boss berated him, John felt emotionally paralyzed.

John felt his confidence plummet and he would ruminate for days about whatever his boss told him. His colleagues experienced the same bullying from the boss and, although they were concerned about it, they were not as affected by it as John.

John recognized this and he knew he needed to get help or his boss's tirades continued to be detrimental to him. He realized that his reaction to his boss's comments were out of proportion to the current situation.

The First Phase of EMDR Treatment: During the first phase of EMDR treatment with John, I obtained a detailed history from John about his background. From his family history, I learned that John's father was very much like his boss. He was hypercritical of John and often berated him, leaving him feeling like he could never please his father. If John came home with a report card with all A's and one B, John's father focused on the "B" and berated him for not getting an "A" in that subject, leaving John to feel badly about himself.

Developing Coping Skills: During that initial phase of treatment, I also helped him to develop basic coping skills. Since he didn't do anything to manage his stress, John began working out and going to yoga class. I also taught John to meditate.

In addition, we developed internal resources that he could use during EMDR processing. For instance, John learned to think about and visualize certain "protective" figures from his life (his grandfather, a kind uncle, his nurturing older sister, as well as a lifelong friend and confidant). Through EMDR processing, we worked to help John to internalize these protective figures in such a way that he could "call on them" (essentially, remember, visualize and sense them) when he felt emotional distress either in the psychotherapy session or outside. Just using these internal resources whenever he had to deal with his difficult boss helped John tremendously.

EMDR Processing: During the next phase of treatment, John chose a particular incident that occurred at work with his boss and we began to process that incident using EMDR eye movements. 

Before the processing, John rated this incident as a "9" out of a possible 10 in terms of how emotionally disturbing it was to him (with 0 being no disturbance and10 being the highest level of disturbance). So, overall, it started out as being very disturbing to him. 

However, as we continued to do EMDR processing, the incident became less and less disturbing. It gradually went down to a 5 for John. He felt relieved, compared to how he felt originally, but it was still disturbing. Further processing of that incident did not decrease John's level of disturbance.

When Processing of Trauma Gets Blocked: When the level of processing gets "blocked" (meaning that it stays at a certain level of disturbance and it won't go down to 0 or 1), it generally means there is underlying trauma that is feeding into the current situation and is making it more emotionally charged than it might normally be. Having already obtained John's family background, I was aware that John's relationship as a boy with his father was probably feeding into his current problems and activating his emotional response.

The Difference Between EMDR and Regular Talk Therapy for Trauma: If we were doing regular talk therapy, we might have discussed John's relationship with his father and how if affected him now.

It probably would have been enlightening to John but, usually, this would only remain as an intellectual insight. In other words, it's interesting and informative to know, but it doesn't produce any change. And therein lies the problem with regular talk therapy and trauma.

In addition to my EMDR training, I'm also trained as a psychoanalyst, so I understand and value psychodynamic treatment for most problems. However, when it comes to trauma, regular talk therapy is often limited in terms of resolving and healing trauma.

Processing the Earlier Trauma that Triggers the Current Trauma: So, knowing that there were probably earlier memories that were feeding into and triggering John's emotional reaction to his current situation, we did what is known in EMDR as a "float back."

During a "float back," the client thinks back to an earlier time when he might have experienced these same feelings. An experienced EMDR therapist might have a sense of what those memories might be, but he or she doesn't make any suggestions about them. The EMDR therapist allows the client to come up with whatever he or she remembers or senses.

In John's case, his earliest memory of feeling the same way as he did in his current situation was when his father berated him during Little League practice. According to John, he struck out each time that he was up at the plate during a big game with a rival team.

Afterwards, he was feeling bad enough, but when his father yelled at him in front of his team mates and the other parents, John was mortified. John rated his level of disturbance as being a "10" for this memory. Gradually, as we continued to process the memory with EMDR, his level of disturbance went down to a "0." When it went down to 0, he, of course, remembered the memory with all of the details, but he no longer felt disturbed by it.

Resolution of the Trauma: After we processed this earlier memory, which was emblematic of his experiences with his father, we went back to the current situation with his boss. As is usually the case, having reprocessed the earlier "Smaller t" trauma produced a "0" in terms of John's level of emotional experience in the current situation.

John was really surprised and greatly relieved. He was able to go back to work, deal with his boss, and when his boss saw that he could no longer intimidate John the way he used to, he stopped ranting at him and chose to bully another more vulnerable attorney instead.

EMDR Follow Up: When John checked in with me several months later, he told me that the results of our work continued to hold. He also said that his self esteem was now higher than it ever had been and his boss told him that he was on track to become a partner, which made John feel very happy.

The above vignette is one brief example that demonstrates how EMDR can work. Everyone's experience of EMDR is unique.

EMDR is an effective treatment for dealing with trauma, and it is usually faster than regular talk therapy.

Getting Help in EMDR Therapy
If you have unresolved trauma, you could benefit from working with an experienced EMDR therapist who is a licensed psychotherapist.

About Me
I am a New York City licensed psychotherapist and EMDR therapist.

I work with individual adults and couples.

I have helped many clients resolve both "Big T" and "Smaller t" trauma.

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.