Exploring the Secondary Gains of Codependency

In prior posts to this psychotherapy blog, I've defined and explored codependency from the vantage point of relationships where there is substance abuse in the family as well as in other codependent relationships (see the link to one of those earlier articles at the end of this article). In this article, I would like to explore the secondary gains of codependency in relationships.

Exploring the Secondary Gains of Codependency

 What do we mean by "secondary gains" in codependent relationships?
When we talk about the secondary gains in codependent relationships, we're usually referring to the hidden benefits that are derived from engaging in codependent behavior. The reason I described them as "hidden" is because these behaviors are often unconscious and are often not seen for what they are by the people involved in codependent relationships.

However, at times, some people are aware of it, just below the surface of their awareness. And, even though they might be complaining about another person's dependence on them or how dependent they are on someone else, both people involved are usually getting something out of maintaining the codependency--even when they don't realize it. These so-called secondary gains might not be psychologically healthy, but often both people involved want to maintain the status quo on some level.

A composite vignette, which represents a combination of many psychotherapy clients with all identifying information changed to protect confidentiality, might help to illustrate the secondary gains involved with maintaining codependency:

Edward:
When Edward started psychotherapy, he talked about feeling exhausted by all of the demands that he felt people in his life placed on him--his adult son, other relatives, coworkers, his boss at work, and even his ex-wife. He talked about wishing that he could get away from everyone and everything so that he could just rest. He felt physically and emotionally depleted.

We started Edward's psychotherapy sessions by exploring his relationship with his adult son, Tom, an unemployed 25 year old man who lived at home with Edward. According to Edward, Tom was an honor student in college. 

Everyone thought that Tom showed a lot of promise and they expected that Tom would be successful in whatever career that he decided to pursue. However, after Tom graduated from college, he never pursued any work. Instead, he moved back in with Edward and he spent most days playing video games and watching TV. Tom's girlfriend got tired of waiting for him to make a life for himself, so she broke up with him. Since that time, Tom dated a few women, but he was not focused on relationships.

Edward expressed his sadness, worry and disappointment to me that Tom was just "loafing around the house" instead of "trying to do something with his life." However, as we continued to explore the dynamics in Edward's relationship with his son, Tom, another picture began to emerge next to Edward's account of his concern and disappointment. As this other picture emerged, it became apparent that Edward relied on Tom for his emotional needs and vice versa.

After his divorce, which occurred while Tom was in college, Edward stopped seeing friends, he didn't date, his social life just stopped. His life consisted of going to work and coming home and doing more work. He held a position as a senior vice president of a large company, and he worked long days. Most of his social contact was with clients that he entertained during the week. He also spent weekends immersed in his work. By most people's standards, Edward was a workaholic.

As we continued to discuss Edward's relationship with his son, Tom, we explored how, over time, Edward began to depend on Tom emotionally to fulfill his social needs: After the divorce, Edward began to visit Tom at college a couple of weekends out of the month. He considered Tom to be his "buddy" and expected Tom to forgo other social events at his college when Edward came to visit him.

When Tom was in his senior year, Edward told him that there would be "plenty of time" to look for a job and, anyway, Edward earned a lot of money, so he could support Tom until he found the "right job." Throughout college, Edward paid for Tom's tuition, an expensive apartment off campus, and he gave him generous amounts of money every month so Tom never had to work or be concerned about money.

Over time, as we traced back the development of Edward's relationship with his son, this other hidden picture began to emerge along side of Edward's concern for Tom's idleness. It wasn't that Edward was not concerned about his son. Rather, both pictures were true: Edward loved his son very much, he wanted him to be a success and, without realizing it, he also wanted to have a mutually dependent relationship with his son.

Initially, Edward had some difficulty with seeing both sides of this picture. If we had a split screen movie available to us and we could project on it the two sides of Edward's feelings and his actions, this is what we would see: On one side, Edward was the encouraging father telling Tom that it was important for him to do his best and go out to make a life for himself. On the other side, the side that Edward was not aware of, Edward was the father who tended to make life too easy for Tom so that Tom never had to venture out on his own. If we looked closer at that side of the split screen, we would also see that Tom was deriving secondary gains to keeping Tom dependent upon him because, underneath it all, Edward felt lonely and he was emotionally dependent on his son.

As we explored both sides of this so-called split screen image of Edward's relationship with his son, Edward was only able to see one side--the side where he encouraged Tom to go out into the world and make his own way. He would often say in those early psychotherapy sessions with me, "But I tell Tom to go out and get a job all the time. I want him to have his own life." 

While it was certainly true that Edward did tell Tom these things and even made efforts through his many business contacts to get Tom a job, Edward also behaved in ways to keep Tom dependent on him: He continued to be very generous with money, he never had any expectations of Tom doing anything around the house, and so on. So, it was a picture filled with ambiguity as Edward gave mixed messages to Tom.

Denial is a common reaction in codependent relationships. None of us like to think of ourselves as holding back another person for our own emotional needs, especially people that we love. So, Edward's denial was no different than many other people in similar situations. However, gradually, over time, as Edward learned to become more psychologically-minded and developed more emotional insight into his relationship with his son, he began to see how he had created a codependent relationship with Tom.

It took a while before Edward could tolerate the feelings that this engendered in him so that he could let go of his denial and look at both sides of the picture. However, once his denial began subsiding, he also started to see how he also created codependent relationships with the other people. He began to realize that he couldn't fulfill his emotional needs by controlling his son with money and attention. He also realized that, often, his behavior was not consistent with his words.

There was no quick fix for Edward in his psychotherapy sessions. Over time, he began to change his behavior so that, even when he felt the urge to keep Tom dependent upon him, he learned not to give into it. He worked hard in psychotherapy to find fulfillment in his own life outside of his relationship with his son and in his work. Gradually, he began to socialize more, develop new interests, develop new friendships, and he even began dating. He started delegating more of his work to his subordinates and not taking work home.

Even though he was going out more, he had new found energy. He was no longer exhausted and emotionally depleted. Also, as his message and his behavior became more consistent with Tom, Tom learned, gradually, to become more independent. He started working at a job where there was potential for moving up in the company. He also began forming healthy relationships with other men and women his age, so he was not as emotionally and financially dependent on Edward any more.

Over time, Edward also learned to change the codependent dynamics in his other relationships. By the way, not everyone in Edward's life was happy about this change because they had come to rely on this dynamic as well. However, Edward learned to focus more on himself and not on trying to please and control others. Over time, these other people had to accept it if they wanted to remain in Edward's life.

Most of the time, progress in psychotherapy is not linear--like a straight arrow that keeps going upward. Usually, when people start making progress, their progress is more like a spiral--a few steps forward and one or two steps backwards. 

It takes time to change ingrained ways of thinking and behaving. The roots of codependency often go deep in a person's history and those issues must be overcome as well. It was no different for Edward and other clients. But, on the whole, when he left psychotherapy, Edward had learned a lot, on an intellectual as well as on an emotional level, about codependency and watching for the pitfalls of the secondary gains associated with codependency.

Getting Help in Therapy
The secondary gains of codependency and other behaviors are often difficult to see when you're in the middle of a codependent relationship. 

It requires an ability to look at the whole picture and not just one side. Overcoming denial can be a challenge, but it also often leads to emotional breakthroughs.

If you think you might be engaging in codependent behavior, you could benefit from seeing a licensed psychotherapist who has expertise in codependent relationships.

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

I work with individual adults and couples.

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

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

Overcoming Adult Separation Anxiety Disorder

Up until about 15 years ago, separation anxiety disorder was mostly discussed in psychotherapy literature as it related to children, not as a problem that adults have. And, yet separation anxiety disorder is a phenomenon that has been experienced by adults for hundreds (if not thousands) of years. 

Now that it is more widely recognized and treated by psychotherapists, there is a greater recognition that adult separation anxiety disorder is a problem that exists in about 6-7% of the adult population, which is significant.

Overcoming Adult Separation Anxiety Disorder

Traditionally, separation anxiety has been viewed as a normal development in some infants starting at about the age of seven or eight months when babies begin to become aware that their caregivers are separate from them. 

As most children develop over time, they realize that even though their caregivers might leave the room, they still exist and will come back. For most children, this resolves separation anxiety, unless they have anxious caregivers, there are problems with bonding with their caregivers, or there is some other disorder or problem that causes them to feel anxious when their caregivers leave them.

Episodic Separation Anxiety vs. Separation Anxiety Disorder:
It's not unusual to have some degree of separation anxiety as an adult at certain points in your life (e.g., after the death of someone close to you or when experiencing other losses). This would be considered episodic separation anxiety. However, adult separation anxiety disorder is a recurrent and persistent problem that is not linked to anything objective that is going on in a person's life at the time.

Typical symptoms of adult separation anxiety disorder are:

• Recurrent excessive worry about separating from a place or a person that you are close to (like a spouse)
• Persistent and recurring fear about losing people close to you or that something bad will happen to them (when there is no objective reason for feeling this way)
• Recurrent reluctance to go to school or work or go elsewhere due to fear of separating from someone close
• Persistent and excessive fear of being alone
• Persistent and excessive fear or reluctance of going to sleep without having someone who is close to you in the house or nearby
• Repeated complaints about headaches and other physical symptoms when you are separated from the person or people that you are close to
• Recurrent nightmares about separation
• This anxiety causes significant impairment in one or more major areas of your life (e.g., your relationships, work life or in other significant areas).
• These symptoms last a month or more, and they are not attributable to any other physical or emotional causes.

The following fictionalized scenario is an example of adult separation anxiety disorder:
Maureen was a married woman in her mid-30s when she started psychotherapy to deal with separation anxiety disorder. She had gone to her primary care doctor, at the insistence of her husband, because she would become extremely anxious and worried whenever her husband wanted to do anything on his own or when he was not around her for even a short period of time.

Overcoming Adult Separation Anxiety Disorder

It didn't matter if they had spent the entire day together and he wanted to go out for a short walk on his own to clear his mind. Maureen would become extremely anxious and worried at just the thought of her husband being away from her. She would become upset, tearful and angry if he told her that he preferred to go out on his own for his walk and not with her. She was convinced that something awful would happen to him (e.g., he would get hit by a car or someone would kill him or kidnap him) and she would never see him again.

At work, she would call him several times a day to "check in" and if she couldn't reach him, she would panic: What if something happened to him and no one knew how to contact her? When she finally reached him, she was a nervous wreck and this would anger him. He felt that she was too "clingy," "needy" and "insecure," and he told her that if she didn't get help, he didn't know how much longer he could deal with this.

Maureen's primary care doctor recognized the symptoms of adult separation anxiety disorder. He told her that he was not qualified to treat her, and he advised Maureen to see a licensed psychotherapist. Maureen's therapist took a detailed psychosocial history and provided Maureen with psychoeducational material about adult separation anxiety disorder.

They also began using clinical hypnosis to help Maureen to calm herself and to internalize a felt sense of a loving, caring figure in her life (in this case, it was her grandmother) that she could call on in her mind when she felt extremely anxious. After a while, she was able to mentally call on this loving person in her mind with ease and feel a secure attachment to her.

Overcoming Adult Separation Anxiety Disorder

Maureen worked hard in therapy and attended her sessions regularly. She learned that there would be no quick fix for her problem. However, over time, with the help of her therapist, Maureen's separation anxiety dissipated and her relationship with her husband improved.

Why Clinical Hypnosis?
There are many ways to treat adult separation anxiety. Clinical hypnosis is a safe and effective form of therapy. It allows you to relax enough to get to the unconscious causes of the problem. You maintain a dual awareness of the here-and-now as well as whatever comes up in the clinical hypnosis session. It also allows you to discover if you are being triggered by other prior events in your life.

Clinical hypnosis is usually faster than regular talk therapy--although, for adult separation anxiety disorder, it's important to understand that this is not a 3-5 session treatment. Separation anxiety disorder is a complex problem and requires a lengthier treatment, even with clinical hypnosis, than some of the other problems that lend themselves to short-term hypnosis treatment, like smoking cessation.

When seeking clinical hypnosis treatment, always make sure that the person you plan to see is a licensed mental health practitioner and not a lay "hypnotist." As I've mentioned in prior blog posts about clinical hypnosis (also known as hypnotherapy), there is a big difference with regard to the education, clinical expertise and skills between a hypnotherapist and a lay "hypnotist."

If You Suffer with Adult Separation Anxiety, Seek Help from a Licensed Psychotherapist:
If you suffer from adult separation anxiety, the people around you might not understand what is happening to you. They might tell you that you're being dramatic or immature. They might also tell you that you "just need to get over it." But for you, the symptoms are very real and painful. Rather than suffering alone, you could benefit from seeing a licensed psychotherapist who has experience working with clients who suffer with adult separation anxiety disorder.

There are many ways in psychotherapy to work with clients who have separation anxiety, including a combination of cognitive behavioral treatment, psychodynamic psychotherapy, EMDR and clinical hypnosis. You want to find a therapist who tailors treatment to the individual client's needs.

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

I have helped many clients overcome adult separation anxiety.

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.

Your Anxiety or Depression Could Be Having a Negative Effect on Your Relationships

As a psychotherapist in New York City, I often see clients who begin psychotherapy after spouses or partners have spoken to them about how their anxiety or depression are affecting their relationships at home. Often, people don't recognize that they might be experiencing depression or anxiety until someone close to them or someone at work tells them about the impact that it's having with people around them.

Anxiety and Depression Could Be Having a Negative Effect on Your  Relationships

The following vignette is a composite of a psychotherapy client who began psychotherapy after his wife spoke to him about his anxiety and depression and how it was affecting his relationshp with her and their children. All identifying information has been changed to protect confidentiality:

Jack:
Jack was a man in his late 50s. He and his wife were married for over 20 years and they had two teenage children.

When Jack first came to see me in my psychotherapy private practice, he talked about how his wife had a difficult talk with him a few weeks before, telling him how his depressed and anxious mood affected their relationship as well as his relationship with their children.

After their talk, Jack realized that he was having many of the typical symptoms of depression and anxiety that he had heard about on TV commercials about antidepressants and that he had read about: insomnia, irritability, a feeling of foreboding that something bad was going to happen to him, decreased appetite, feeling like he wanted to isolate himself, and feeling sad and anxious most of the time. He had been feeling this way for months, but he hated to go to the doctor and he thought it would eventually pass.

Anxiety and Depression Could Be Having a Negative Effect on Your Relationships: Jack and His Wife Had a Talk

After his wife spoke to him and told him that she was finding it difficult to be around him and his children were trying to avoid him when he came home from work, in hindsight, he recognized that his depressed and anxious mood was getting worse.

He realized that, in many ways, he had been in denial about his anxiety and depression. He also realized that his mood was affecting his relationships with his colleagues and subordinates at work. Since he did not want to alienate his family or his colleagues any further, he went to his primary care doctor.

Jack was almost hoping that his doctor would find a medical reason for his depressed and anxious mood. He also hoped that, even if his doctor couldn't attribute his mood to anything medically wrong with him, at least, maybe the doctor could give him a pill to help him feel better.

But, to Jack's surprise, his doctor ruled out any medical cause for his mood and counseled Jack that medication alone is not as effective for anxiety and depression as psychotherapy with medication or even psychotherapy alone. He provided Jack with psychoeducational material about depression and anxiety, advised him to try psychotherapy first before he tried medication, and gave him my telephone number to set up an appointment for psychotherapy.

Jack procrastinated calling my office for a couple of weeks, going back and forth in his mind whether he felt that he really "needed" psychotherapy. He called his doctor again and his doctor urged him not to wait--to call my office and begin psychotherapy. Jack had been going to his doctor for a long time, and he trusted doctor so, even though he had some misgivings about psychotherapy, he decided to follow his advice.

When Jack came for his initial psychotherapy consultation, I asked him if he had ever felt this way before. Jack thought about it and realized that he had felt depressed and anxious off and on since he was a child. He had never thought about it before, but my question made him realize that he had at least five or six prior episodes of depression and anxiety in the past.

Over time, we worked on helping Jack to overcome his depressed and anxious mood. Once he began to manage his current stress and work on the underlying issues that precipitated his depression and anxiety, Jack's relationships with his wife, children and colleagues improved. He felt better than he had in a long time.

The Impact of Anxiety and Depression on Your Relationships:  Jack's Relationship With His Wife Improved After He Began Therapy

This upward spiral, in turn, became an incentive to continue in psychotherapy and he became more internally motivated to make other improvements in his life.

Denial Can Be a Powerful Factor in People Avoiding Dealing with Depression and Anxiety:
Denial can be a powerful factor in people with depressed and anxious mood from seeking help. People often will deny to themselves that they are feeling what they are feeling.

Even if they admit to themselves that they don't feel like themselves, they also might tell themselves that their depressed and anxious feelings will go away or they attribute their mood to outside factors (e.g., the weather, their boss, their age, etc).

But it's usually harder to ignore that there's something wrong and that you need to do something about it when people close to you tell you that your mood is not just affecting you--it's having a negative affect on them as well.

Depression and Anxiety Often Go Together:
Depression and anxiety often go hand in hand. Sometimes, people start by feeling anxious and their anxiety triggers depression, and sometimes it's the other way around. Often, depression and anxiety don't go away by themselves without professional help.

Getting Help in Therapy

If you've been experiencing depression or anxiety for more than a few weeks, don't suffer alone. 

You owe it to yourself and your family to seek professional help with a licensed mental health professional.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  I work with individual adults and couples

I have helped many clients to overcome depression and anxiety.

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

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

Overcoming Low Self Esteem

As a New York City psychotherapist, I often see clients who come to psychotherapy because they want to overcome low self esteem. In my prior psychotherapy blog posts I've addressed issues of self esteem from different vantage points. In this post, I would like to discuss the link between self esteem, a sense of self mastery (also called self efficacy) and learning the life skill of self discipline.

Overcoming Low Self Esteem

The Importance of Learning Self Discipline, Self Mastery and Developing Healthy Personal Habits as Children:
Having a sense of self discipline, developing healthy personal habits, and a sense of self mastery are important to personal development and our sense of self esteem. These traits begin to develop, without our realizing it, when we're children.

When children learn to develop healthy habits like learning to put away their toys after they play, doing simple age-appropriate chores around the house, keeping their word about the commitments that they make, and so on, they're learning important life skills that are essential to their development beyond the particular chore or event that is involved. They're also learning to be responsible and deal with certain aspects of life that they might not want to do but that are essential to every day life as well as their personal growth and development.

Learning Healthy Habits as Children

When children don't learn to master certain chores or develop healthy personal habits like the importance of getting up on time, doing homework and turning it in when it's due, keeping their word about a commitment that they've made (and so on), they often have a much harder time as adults dealing with more mature issues in their work and personal lives than children who have gradually learned these life skills over time when they were growing up. Not learning these skills can also have a profound effect on a person's self esteem as well as how others view them as adults.

As a psychotherapist, I hear from many adult clients who talk about how frustrated they feel that their teenagers and young adult children have not developed healthy personal habits and self discipline and how this has affected the children's self esteem. These clients are often concerned that their children's lack of self discipline will not bode well for their chances out in the world with regard to personal relationships, school, and career.

 They fear that their children are just drifting without purpose and that they might have a hard time setting goals, holding onto a job or maintaining healthy relationships later in life. They talk about children who only want to do chores when they want to do them (or not at all), who spend most of the weekend loafing around or playing video games, who have no healthy routines, and they worry: "How is my child going to make his way in the world?"

When I hear clients who express these concerns about their teenagers or young adult children, I can understand why they're concerned. As any responsible adult knows, there are many things that we might not want to do, but we know that we must as essential parts of our lives. For instance, even if you think you have the most interesting job in the world, there are often parts of work that you don't like or you might find boring or unfulfilling.

 Imagine telling your boss that you just "didn't feel like" doing those aspects of your job, or you procrastinated doing them so that your boss had to come to you several times to ask about them, or if you pretended not to hear your boss because you were listening to your music (some of you who have teens might relate to this). After a while, you might not have that job for long. Aside from how your boss and colleagues might feel about you, you probably would not feel good about yourself and it would start to erode your self esteem.

Learning to develop healthy habits and self discipline should start gradually when you're young. Even young children can begin by learning to do simple tasks. Is it possible that they might grumble, pout or cry when you ask them to do simple things like learning to put away their toys when they're done playing? They might. They might question you as to "why" they need to do this or tell you that they don't want to do it.

They might test the boundaries with you in many ways. As a parent, you might even tell yourself that you would do it better and quicker and use that as an excuse to yourself to avoid having a confrontation with your child. But the importance of your child learning to do these simple chores is not only about the chores themselves--it's about their learning self discipline, responsibility and a sense of self mastery. They are probably too young to realize this but, as an adult, you know it.

Learning to do simple tasks, as a child, as well as learning to keep your word is also about learning to deal with your emotions when you feel annoyed and frustrated about something that you don't want to do--or just life, in general. Whether it's about learning to make your bed, practicing the piano or doing other things that you might not want to do at the moment because you're thinking about doing more interesting things, the skills that you learn by doing these tasks anyway (even when you don't want to do them) become part of your emotional development as well because you learn how to tolerate frustration.

We've all witnessed or experienced two year old children when they are having temper tantrums. The parent who is able to withstand the child's temper tantrum with love and patience, while the parent stands his or her ground, is helping that child to develop emotionally. For instance, when a child doesn't want to leave the park when it's time to go home or doesn't want to get in the carriage and a parent sets limits with the child (in a loving way), that child, without realizing it, is gradually developing a tolerance for acceptable amounts of frustration.

In these situations, the child has tested the boundaries with his mother, the mother demonstrates that she knows best, the child has a temper tantrum for a while (maybe a long while) but, in the end, the child learns that he must do something that he doesn't want to do.

 More importantly, he learns that he has survived in this ordeal, and that his mother has survived as well (although she might feel inwardly exasperated), and he learns that his mother still loves him and he still loves her. Can the two year old articulate these lessons? No. But, over time, we see the evidence of this in his personal development as he grows and continues to learn these important lessons in life skills. We can see it as the child learns to take on bigger, more complex age-appropriate responsibilities as they grow. We also see it in their sense of confidence.

Similarly, when a child learns life skills like keeping her word and following through with commitments , she will be better equipped as an adult to maintain her adult commitments. But when a child doesn't learn to develop these skills when they're younger, it's harder for them to keep their commitments when they're adults.

 If they haven't learned to develop a sense of the importance of keeping commitments and they only do certain things when they want to do them, they will probably struggle as adults. Lacking guidance from their parents as a child, they won't have internalized it as an adult. They will lack the internal emotional resources to deal with commitments and their only own internal "guide" might be whether they feel like it or not, which won't be acceptable in many circumstances in the outside world.

Lacking these internal resources as an adult will also affect how they feel about themselves. It's hard to feel confident, resourceful, and effective as an adult if your only guide to dealing with your responsibilities and commitments is whether you feel like it or not. You're definitely on shaky ground if this is your compass for functioning in the world. After a while, as friends, romantic partners and work supervisors refuse to put up with this, it reinforces an internal sense of incompetence and failure.

Conversely, when children learn to stick with their commitments and see the results of their efforts and diligence, it increases their self esteem and sense of self mastery.

 For instance, the child who learns to stick with practicing the piano on a regular basis (even though he would prefer to play video games at the moment) begins to make the link between practice, being diligent and responsible and a sense of self mastery. He sees that, over time, his time and effort has led to being able to play a certain piece of music with increasing skill. It becomes gratifying to him.

He also learns to translate this into other areas of his life: Studying and doing his homework, which might be boring in the short term, produces better academic results. Better academic results often leads to a more successful career. These life skills become an important part of his personal growth and development as well as his sense of self confidence.

It's certainly possible to learn to develop these life skills as an adult. I often work with clients in my psychotherapy practice helping them to learn these skills and this leads to a greater sense of self esteem. However, it's harder to learn when you're an adult and, often, by the time an adult comes to psychotherapy to deal with self esteem issues related to the lack of these related life skills, they have often struggled for a while in their relationships and career.

Getting Help in Therapy
If you're struggling with a sense of low esteem and you see that continuing on the same path has hindered your personal growth, you might benefit from working with a licensed psychotherapist.

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

I work with individual adults and couples.

I have helped many clients to overcome low self esteem to lead more fulfilling lives.

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

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

How to Reduce Emotional Reactivity in Your Relationship

In my prior psychotherapy blog posts I've discussed codependency in terms of the relationship between the person who has a substance abuse problem and the spouse or partner who does not. This is the classic example of codependency.

Reducing Emotional Reactivity in Your Relationship

As I've mentioned in those prior posts, the term codependency originated in the substance abuse field, however, the use of the term codependency has since expanded to include other relationships where there is no alcohol or drug addicted behavior. In this psychotherapy blog post, I would like to discuss the topic of overcoming excessive emotional reactivity to achieve emotional balance. Even if you're not in a codependent relationship, you might benefit from reading this post to learn how to be less emotionally reactive in your relationship.

Codependent Relationships:
Now that we recognize that codependency can exist in any relationship and there need not be alcohol, drugs, gambling or other addictive behavior involved, we have learned to expand our definition of codependency and recognize these dynamics in many different types of relationships. I will confine myself in this post to romantic relationships, but it is understood that codependency can exist in many different types of relationships.

As I've mentioned in my prior psychotherapy blog posts, when I discuss codependency, I'm not talking about relationships where there is normal dependency--like taking care of an elderly parent, a young child or someone who is disabled. I'm specifically addressing relationships where both people are mature and able-bodied, but one or both people are overly dependent on the other person in an unhealthy way.

In codependent relationships, one or both people usually over function for the other person in certain ways, often, in an effort not to deal with their own emotional issues. So that if one person is overly focused on the other person and overcompensating for that person, he has taken the focus off himself and his own issues. Often, what looks like purely altruistic behavior is also a defense to avoid dealing with his or her own problems ("I'm not the one with the problems--it's him"). In prior posts, I've given composite examples of codependent dynamics in relationships, so I won't repeat them here.

Why do People Become Overreactive in Codependent Relationships?
Often, people who are emotionally reactive haven't learned how to control their emotions. So that when things don't go their way or when old problems persist, they often become emotionally overreactive and have a great deal of difficulty maintaining their composure. 

They might lash out by losing their temper, act out by cheating on their partner, get even by overspending or running up a credit card, cry uncontrollably to make their partners feel guilty, make threats, or engage in other dramatic displays of behavior. Aside from the fact that they're having problems managing their emotions, often, this emotional reactivity is meant to control the other person's behavior. And, while it might work in the moment, it's usually ineffective in the long run.

Detaching with Love:
Al-Anon is a 12 Step program for loved ones who are in relationships with people who have alcohol problems or who suffer with other addictive behavior. There is a concept in the Al-Anon literature called "detaching with love." I think this is one of the most misunderstood Al-Anon concepts that often confuses people and it's worth spending a little time defining what this means and how it can be put to good practice in almost any relationship (whether there is addictive behavior involved or not).

The concept of "detaching with love" addresses the emotional reactivity that is often involved in many relationships. I think this idea is often misunderstood because people who are highly reactive often feel that it means that they have to be cold, cruel, hard or they don't care about their partners. They might also feel that if they "detach with love," it means that they're not allowed to feel their feelings. However, this is a big misconception.

When we talk about "detaching with love,"we're really talking about still caring and loving your partner, but maintaining your emotional equilibrium when there's a problem between the two of you. It means that when there's an argument or tension in the relationship, you're able to step back, take the time to calm down (and, possibly, take a break, if needed) before reacting emotionally. It doesn't mean that you don't feel your feelings or that you're not entitled to your feelings. Rather, it means that you stop, calm yourself and think before you react emotionally.

Why is it Important to Overcome Emotional Reactivity?
Often, when people feel angry with their partners, their first instinct is to lash out in anger, especially if it involves an ongoing problem, whether we're talking about addictive behavior, jealousy or other problems. However, even if you get a sense of immediate gratification from lashing out emotionally, it quickly dissipates because your behavior usually makes the situation worse.

When you react emotionally, without stopping to think and calm yourself first, you say or do the first thing that comes to your mind. This is an impulsive gesture, which often leads to regret. Often, as soon do you say or do whatever has come to your mind, you feel badly about it. But, by then, the words are out and they cannot be taken back. That often leads the argument or problem to be taken into other unintended directions. At the very least, it doesn't solve the problem. Worse still, being overly reactive usually becomes habitual, which means the more you do it, the more likely you are to continue to do it.

Recognizing the Physical and Emotional Cues as a First Step to Becoming Less Reactive and to Develop Emotional Equilibrium
If you've grown up in a family where there was a high degree of emotional reactivity, being highly reactive might seem normal to you. But you have only to look at the results that it produces in your relationship (and the history in your family) and how you feel afterwards to realize that being highly reactive is not serving you or your relationship well.

Learning to develop emotional equilibrium takes time, practice and a good deal of patience, but it's worth the effort. The first step is to become aware of the feelings and physical cues within yourself that proceed your emotional reactivity. For some people, this might include certain physical reactions like clenched fists, tension in your stomach or other parts of the body, a strong feeling of energy surging through your body, feeling flushed, hands trembling, feeling lightheaded, feeling like you're going to explode, and other similar reactions. You might also notice your thoughts going in a certain volatile direction ("I hate him," "She's so stupid," "Why is he doing this to me?" etc).

When I discuss this with clients in my psychotherapy practice in NYC during the early stage of therapy, many clients will often tell me that there are no prior warnings or cues for them that they're about to lose their temper or overreact emotionally. However, I usually respond to them by saying that that there are, in fact, warning signals--they just haven't learned to recognize them yet. We know this because we recognize that there is a connection between the mind and the body, meaning that your thoughts and physical sensations are connected. Learning to recognize the warning signals or cues to emotional reactivity requires that you slow down. You might be justified in feeling angry or upset, but your anger doesn't entitle you to lose your temper or say or do things that you'll regret later.

Stress Management:
In order to learn to slow down, you need to find other ways to reduce your stress. Everyone is different, so each person must find his or her own way to handle stress, whether that means learning to meditate, taking a yoga class, going for regular walks, remembering to breath deeply, counting to 10, playing with your pet, talking to close friends, praying, attending an Al-Anon meeting, or whatever other healthy activity you decide to do to reduce your stress and level of frustration. If you're managing your daily stress so that it doesn't build up and spill over, you're less likely to lose your temper or overreact emotionally.

Once you're engaging in healthy stress management activities, you can learn to slow yourself down so that you begin to see and feel the cues that precede an overreaction. Once you recognize those cues, then you can make a deliberate choice as to how you want to handle the situation instead of being at the mercy of your emotions.

Learning to Separate Your Feelings about Your Partner's Behavior from How You Feel About Your Partner:
Once you've calmed down enough to gain some perspective, you might recognize that you still love your spouse or partner, but you don't like his or her behavior. That's an important distinction. Not liking his or her behavior is different from not liking your partner.

Ultimately, you might decide that the relationship isn't working and you might leave. However, you will have gone through the decision making process in a more emotionally balanced way rather than reacting impulsively. Breakups that occur on an impulse often bring the people back to Square One. They often feel that there was something important missing when they broke up, that they made the decision without thinking, and then they reconcile. But, often, nothing changes in the relationship. So, they are left with the same problem that they started with, and the cycle continues: anger, breakup, reconciliation, anger, and so on.

When you "detach with love" from your partner, you are stepping back emotionally to take a breath, calm yourself, and get some perspective on the situation. You're also taking care of yourself during this time because you recognize that becoming emotionally overwrought on a regular basis has physical and emotional consequences for you, your partner and also your children, if there are children involved.

Learning to be Less Emotionally Reactive Can be Difficult:
Learning to be less reactive and develop emotional equilibrium can be very challenging. Even after you've begun to make progress in developing more emotional balance in your life, it's not unusual for there to be lapses into old behavior. 

If being emotionally reactive has been a lifelong pattern, it's understandable that you might have some lapses in the process. (Of course, when I talk about lapses that are understandable, I'm not referring to domestic violence. If your anger leads to physical violence, you need immediate help to deal with your problems with anger management and, in the meantime, that might mean that you and your partner separate so that you're both safe.)

If you recognize that you've reverted to old behavior, rather than giving up, be compassionate with yourself and recommit to maintaining emotional balance. When you think about it, you might realize that you've stopped doing the things that helped you to stay emotionally balanced in the first place. It's easy to become complacent, especially after you've had a certain amount of success. So, re-establish the routines or healthy behaviors that helped you and begin again.

What to Do if You're Unable to Reduce Your Emotional Reactivity
If you've tried the suggestions that I've outlined above (including attending Al-Anon if you are in a relationship with an person addicted to alcohol or drugs) and you find that you're still unable to achieve emotional equilibrium, you might benefit from seeing a licensed psychotherapist who has expertise with codependent relationships.

About Me
I am a psychotherapist in NYC who has helped many individuals and couples to become less emotionally reactive so that they can develop emotional balance in their relationships.

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.

Clinical Hypnosis and Perception of Time

There was an article in the New York Times' Science section called, "Where Did the Time Go? Do Not Ask The Brain" by Benedict Carey that discussed our perception of time (http://www/nytimes.com/2010/01/05/health/05mind.html). 

Clinical Hypnosis and Perception of Time

The article reminded me that our perception of time is also different when we experience clinical hypnosis, also known as hypnotherapy.

As a psychotherapist and hypnotherapist in NYC, clients, who experience clinical hypnosis in my private practice, will often tell me that they experience time differently in hypnosis.

Even though clinical hypnosis clients maintain a dual awareness (meaning that they are in a relaxed state and they are aware of everything going on in the here-and-now around them as well as what they are experiencing in the hypnotic state), they often experience a certain timelessness in hypnosis.

This is essentially because clinical hypnosis helps to access the unconscious mind, and there is no time in the unconscious. The unconscious is timeless. Whether we're experiencing what happened 20 years ago or what happened yesterday, the unconscious doesn't make a distinction.

The other phenomenon that occurs in clinical hypnosis is that, whereas it might take weeks, months or even years to resolve certain problems (phobias, smoking cessation, anxiety, depression, and other problems) in regular talk therapy, including cognitive behavioral therapy (CBT), very often, issues are resolved in 1-3 sessions in clinical hypnosis, depending upon the complexity of the issue.

This is is because, through clinical hypnosis, our unconscious minds can access the answers to our problems. We often don't know exactly how it happens, but it's not unusual, after a clinical hypnosis session, for the answers to our problem to come to us, seemingly, out of the blue. Of course, it's not really out of the blue or magical at all. It's the power of our own unconscious mind to access the solution through clinical hypnosis.

Getting Help in Therapy
Remember, when considering clinical hypnosis, there is a big difference between a lay "hypnotist" and a hypnotherapist with regard to training, skills, clinical expertise, and licensure. 

Always choose a licensed mental health professional who has advanced training in clinical hypnosis.

About Me

I am a psychotherapist and hypnotherapist in NYC. I have helped many clients overcome problems through clinical hypnosis.

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.

Explorations in Psychotherapy of the Road Not Taken in Life

As a psychotherapist in New York City, I see many clients who come to psychotherapy to explore decisions that they are currently faced with or decisions that they've already made and how those decisions are affecting their lives. 

 These decisions often involve whether to take one path or another in their personal lives or in their careers, whether to stay or leave their relationships, or how to handle a particular crisis in their lives.

Explorations of the Road Not Taken

One of my favorite poems is "The Road Not Taken" by Robert Frost. I remember first reading this poem in high school. It had meaning for me then, and it still has meaning for me now in my own life as well as in my work as a psychotherapist when it often comes to mind.

The Road Not Taken - By Robert Frost
Two roads converged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down as far as I could
To where it bent in the undergrowth.

Then took the other just as fair
And having perhaps the better claim
Because it was grassy and wanted wear,
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black,
Oh, I marked the first one for another day!
Yet knowing how way leads on to way
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I,
I took the one less traveled by
And that made all the difference.

We all come to forks in the road at different points in our lives where we have to make decisions. At the time, we might not know where our decisions might ultimately lead later on in our lives. We make these decisions with whatever information we have, based on whatever is going on in our lives at the time, as well as our own psychological make up at that point.

The following vignette is an example of a client who comes to psychotherapy to deal with "the road not taken" in his life and the particular dilemma that he faced when he came to therapy. As always, this example is a composite of various clients with all identifying information changed to protect confidentiality:

When Bill first came to see me in my psychotherapy private practice, he was a successful oncologist and surgeon in his late 40s. He was recognized as one of the top oncologists in NYC who specialized in a particular form of cancer. He was well respected by colleagues, sought after by patients, very successful financially, and he loved his wife and children. Yet, he was deeply unhappy.

According to Bill, he originally wanted to be an engineer. He knew he wanted to be an engineer since he was a teenager. But, from an early age, Bill's father let him know that he wanted Bill to become a doctor. Bill's father and mother escaped their country of origin to come to the US when they were first married. Neither of them spoke English when they arrived. But they were both very intelligent and ambitious so they learned quickly, and both of them attended a top Ivy League college. Bill's mother became a scientist and his father became a professor. Both of them were successful, but Bill's father had always wanted to be a doctor. He didn't pursue a medical career due to pressures from his family for him to become a professor.

So when it came time for Bill to make a decision about choosing a major, he felt a lot of pressure from his father to choose pre-med. Bill didn't want to give up his dream to become an engineer, but he wanted very much to please his father. He described his father as a cold, reserved man who only showed any feelings towards Bill when Bill excelled in school. Bill knew that his father would be very disappointed if he didn't pursue a medical career.

So, when faced with the decision about choosing a major, Bill told himself that he would pursue a medical career but, at some point, like the narrator in "The Road Not Taken," he told himself that he would go back to college and pursue an engineering degree after he graduated from medical school. But as in the poem, "way leads to way," and life didn't turn out the way Bill had planned. He never went back to college for engineering. After he graduated from medical school with honors, he was faced with high student loan bills and a new marriage with young children. so Bill had to work hard to establish himself in his medical career and make money. He had no time, energy or money after medical school to go back to college for an engineering degree.

Bill enjoyed performing surgery and getting involved in cancer research projects. Those two aspects of his work were what he enjoyed the most. However, he really disliked the patient contact which, of course, was a big part of his work. He felt ill at ease dealing with patients' and families' emotions. He would usually leave that to the oncology social workers. And in those instances where it was apparent that nothing more could be done for a patient and the patient was facing end-of-life decisions, Bill would begin limiting his contact with the patient and the patient's family He couldn't tolerate what he perceived as a failure on his part to save the patient, and he could not deal with the patient's and family's emotions. So, he relegated that to the oncology social workers as well.

At first, Bill enjoyed the success and recognition that he received in his profession. He also knew that his father was very proud of him and boasted to his friends about "my son, the doctor." This made Bill feel happy at the time. And although Bill's father was never really affectionate with him, Bill felt that they became a little closer after Bill established himself as one of the top doctors in his field. But after Bill's father died, Bill began to feel lost, depressed and irritable. He was snapping at his wife and children, which he had never done before. He was even snapping at his staff.

But the incident that brought him into my psychotherapy office involved a particular interaction with patient and her husband after it became apparent that treatment was not going to save the patient. At first, as usual, Bill instructed one of the oncology social workers to discuss palliative care and hospice with this patient and her husband, as Bill withdrew from the case. However, the patient insisted on speaking to Bill, and she left several messages on Bill's voicemail. At that point, Bill felt it was his "ethical duty" to speak to the patient and her husband, but he felt backed into a corner.

His secretary arranged for a meeting and during that meeting the patient and her husband took Bill to task for his withdrawal at a time when the patient was facing her death. Bill listened to their complaints with increasing anxiety. He felt trapped and wanted to leave the room, but he couldn't. He kept thinking to himself: "What do they want from me? I've done the best I can. I can't do anything else for them!" When he felt he couldn't tolerate listening to them any more, he apologized to them for disappointing them and then cut them short in a curt manner, telling them that he had another patient waiting and they had to leave his office. When he looked up and saw the hurt and shock looks on their faces, he felt deeply ashamed, but he felt too emotionally paralyzed to do anything else so he let them leave.

Afterwards, when Bill got home, he began talking to his wife about what happened. He was in mid-sentence when he felt a profound sadness come over him and he began to cry. He was surprised at the depth of his feelings because he considered himself to be a logical, rational person and he was usually quite unemotional. At that point, his wife told him that she had been fearing for some time that Bill was in crisis, but she didn't think he would be open to talking about it with her. She suggested that he call the patient and her husband, apologize, and seek professional mental health, which he did.

Over the course of the next several months, Bill came to therapy on a weekly basis. The emotional crisis that he faced forced him to be more open than he ever would have been in the past. He admitted that, before coming to psychotherapy, he "didn't believe in" psychotherapy, and he thought that psychotherapy was for people who were "weak."

Over time, Bill realized that when he chose to be a doctor rather than an engineer, he sacrificed his dream, hoping desperately that his father would show him that he loved him. He dealt with his anger, sadness and resentment towards himself as well as his father. He mourned his father in a way that he had not done before. He also mourned the loss of an engineering career because he had no desire to return to college. And by the time he left treatment, he decided to focus on what he liked best, his research projects, and to stop seeing patients because he knew that he was not well suited for this. He also had a new found respect for psychotherapy.

A year after he left psychotherapy, Bill contacted me to let me know that he was doing well. He had transitioned into full time research work and he was much happier in his work life as well as at home.

Getting Help in Therapy

Attending psychotherapy with a licensed psychotherapist provides an opportunity to work through personal and career decisions, past and present, in a way that most people cannot do on their own or with loved ones.

If you're faced with decisions in your life and you're standing at a crossroads, not sure which path to take, or if you're not dealing well with the aftermath of decisions that you've already made, you could benefit from seeking the help of a licensed psychotherapist.

About Me
I am a licensed psychotherapist and hypnotherapist in NYC. 

 I have helped many individual adults and couples who are facing tough decisions or who are looking back on past decisions and how they have affected their lives.

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

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