Overcoming Your Unresolved Childhood Trauma

Many people avoid seeking psychological help for past childhood trauma because they fear that it will be too emotionally overwhelming for them. 

Overcoming Unresolved Childhood Trauma

While it is understandable that someone with childhood trauma would feel this way, the emotional consequences of not dealing with past childhood trauma often far outweigh whatever emotional upset involved with seeking psychological help and overcoming the trauma.

Emotional trauma, by definition, is overwhelming when it occurs, whether it is a single incident of trauma or complex trauma where there was an array of traumatic events.

Dealing with Trauma as an Adult vs. Dealing with Trauma as a Child:
When we're children and we experience emotional trauma, we don't have the emotional or cognitive abilities to cope. A child's emotional system can be easily overwhelmed by emotional trauma, especially if there isn't a competent and caring adult to help the child. 

Children often react to emotional trauma by dissociating the event (numbing themselves emotionally). They might become very quiet, and what's going on for them in their internal emotional world might not be apparent to adults. 

Other children, who dissociate traumatic events, might appear to be functioning at their normal level because they compartmentalize the event, and the effects might not surface until they are adults. Other children act out at home or at school, and this is a signal to parents and teachers that something is wrong, and the child needs help.

While it's true that a child usually lacks the ability to deal with emotional trauma, that same person as an adult usually have coping abilities that he or she didn't have to deal with the same trauma as a child. Often, adults who fear dealing with their childhood emotional trauma fear that they will feel as overwhelmed now as they felt as children.

The fear that dealing with their trauma will be too much for them is often an unconscious fear that they will feel the same feelings in the same exact way as they did when they were children. But, because it's an unconscious fear, what is usually overlooked is that the thing that they fear has already happened. In other words, there is no distinction for them in their internal emotional world that what happened was then and this is now. They might know on an intellectual level that "that was then and this is now," but they don't feel it emotionally.

In addition, adults who fear dealing with their prior childhood trauma often don't know that most psychotherapists who have an expertise in dealing with trauma have careful ways of working to help clients so they usually don't feel as emotionally overwhelmed as when these adults were children.

How I Work with Trauma:
When I work with a client who has unresolved childhood emotional trauma, I usually start by making sure that this client has the emotional ability to deal with working through the trauma. As part of the early work, I assess for these capabilities.

If I find that a client lacks the internal emotional resources to deal with the trauma, the early work will be helping the client to develop these internal resources. Internal resources that allow clients to cope with whatever comes up are very important in trauma work.

An example of an internal resource would be the ability to calm yourself by going to a safe or calm place in your mind where you can relax and let go of overwhelming emotions. It's also important for clients to have external resources to help them cope, such as being able to talk to close friends and caring family members, meditating, going to yoga class or the gym or other helpful external ways to manage stress.

Also, when I am working with clients who have unresolved trauma, I usually work in a way where the traumatic experiences are titrated so clients are less likely to feel overwhelmed. This titration usually involves dealing with the trauma by working through manageable pieces of the trauma.

After clients have developed internal resources, if they begin to feel overwhelmed in session as we're working on the trauma, I help them to switch from the beginnings of that overwhelming emotion back to their internal resources until they feel safe enough to go back to dealing with the trauma. So, in other words, I help clients to "pendulate" between their overwhelming feelings to a calmer state.

The Negative Consequences of Not Dealing with Unresolved Trauma:
Whether we realize it or not, past unresolved trauma often has negative consequences in our lives. Depending upon the trauma, the following is a list of the negative consequences that people often experience when they do not work through their trauma in therapy:

People with unresolved trauma often suffer from higher rates of anxiety and depression as compared to the general population. Their anxiety or depression make it difficult for them to perform their daily activities of living and compromise their close relationships. This often results in loss of relationships or loss of jobs.

Untreated emotional trauma can result in fear of getting close to other people. This might mean that the people with unresolved trauma fear getting involved in intimate relationships or they are unable to form close friendships. They might keep people at a distance from them because of their fear of getting hurt again, which could cause them to feel lonely and sad.

Even when people with unresolved trauma do get involved in intimate relationships, they often, unconsciously, choose people who will be emotionally and or physically abusive to them in similar ways to how they were abused as children. This often happens repeatedly, even though these people might tell themselves that they don't want to choose abusive partners again.

People who have unresolved trauma often have higher rates of substance abuse problems, as compared to the general population. They often use alcohol or drugs to numb their overwhelming emotions.

Unresolved trauma often results in physical problems, including high blood pressure, headaches, asthma attacks and other medical problems. Even though people with unresolved trauma might not be consciously thinking about or remembering their trauma, their bodies "remember" the trauma in ways that make them sick physically.

Many medical doctors who are savvy about the mind-body connection and how trauma affects people on both emotional and physical levels will refer their patients for psychotherapy with psychotherapists who have an expertise in trauma. But many doctors are not knowledgeable about the mind-body connection, and they continue to treat their patients only on a physical level with medication. The medication, while important, is only treating the physical symptoms of trauma--it's not helping the patients to resolve the trauma.

People with unresolved trauma often feel less resilient so they have a hard time "bouncing back" from current problems. They're so overwhelmed with the old trauma that they haven't dealt with that new problems are often too much for them. 

So, other people, who might not know that a person has prior unresolved trauma, might think that this person is overreacting to current problems. They might not see that this person is reacting not only to current problems but that the unresolved trauma is getting triggered too. To outsiders, these people often appear to be behaving in emotionally irrational ways. The person with the unresolved trauma might not understand himself or herself what's happening and it can be frightening.

Unresolved trauma is often passed on from one generation to the next. Of course, this isn't intentional. It happens unconsciously as children often absorb their parents' fears. This can happen even if a parent never talks to his or her child about what happened to the parent when he or she was younger. 

It happens because children are often exquisitely attuned to what's happening emotionally to their parents and they "pick up" on trauma more easily than most people realize. 

For instance, this is often seen among children of Holocaust survivors or survivors of other man-made or natural disasters. The parents might never talk about their experiences, but children can often intuit that their parents have overwhelming fears. When they sense this, they often grow up to feel that the world is not a safe place for them, and something bad and overwhelming could happen at any time.

The above list will begin to give you an idea of how unresolved trauma can affect you and those that you love.

The following scenario is a composite of many different cases and should serve to illustrate the consequences of unresolved trauma as well as how trauma therapy can help:

Ann:
When Ann was 21, she was relieved to be able to move out of her parents' home. She had lived all of her life with an alcoholic father who was emotionally and physically abusive to her as a child and a mother who was extremely passive and emotionally beaten down herself from her husband's abuse. 

After saving up enough money to get her own apartment, Ann vowed that she would look upon her childhood as a chapter in her life that she was closing, never to be looked at again. Moving out for Ann was a new beginning and she never wanted to look back at the abuse that she experienced growing up.

Ann took a lot of satisfaction in being able to set up her apartment the way that she wanted and the freedom of coming and going as she pleased without anyone, like her abusive father, being able to tell her what to do or to put her down.

Ann had a couple of friends that she talked to and socialized with now and then. But, usually, she felt too afraid to form close or intimate relationships. When she was growing up, she could never bring friends over because she never knew when her father was going to be in an alcoholic rage and she felt too ashamed to allow other people outside of the family to see this. So, she might go to other children's houses to play, but she never invited them to her house.

Often, this became uncomfortable because children would ask her about her parents and her home, and she didn't know what to say. She felt too embarrassed to tell them that her father drank a lot and he was abusive, so she would make up excuses, even though she knew that the other children didn't always believe her. At times, she would overhear some of the children talking and laughing about her and her parents, and this hurt her feelings and made her want to keep to herself.

As an adult, Ann's two friends would often tell her that they felt that she was emotionally distant from them. They liked her and wanted to get closer to her, but they felt that she managed to keep her distance. Whenever this topic came up, Ann felt very uncomfortable. She had a sense that what her friends were saying was true, but she found it was too emotionally overwhelming to deal with it, so she denied it to herself and to them. At the same time, she felt very lonely and wanted and needed to feel close to someone, but she was too afraid to allow herself to get close to anyone.

Then, one day, when Ann was out with her two friends at a bar, she met Bill. Bill was so friendly and charming that Ann found him hard to resist, in spite of her usual very cautious nature. From the moment that she met Bill, Ann felt that there was something so familiar about him, as if she had known him for years. She had never felt this way before, and she was amazed and taken off guard.

Ann and Bill began dating, and she found herself falling in love with him quickly. Her friends, who thought that Ann would never allow anyone to get that close to her, were thrilled that she met someone who was so loving and attentive towards her. Ann felt like a whole new world had opened up for her both internally and externally, and she realized that she had never felt this way before.

A year or so later, Ann and Bill decided to get married. Ann dreaded having Bill meet her parents, but she had visited Bill's parents numerous times, and she knew she couldn't avoid having Bill meet her parents indefinitely. On the day that Ann brought Bill to meet her parents, Ann's mother greeted them at the door looking anxious. She told them that Ann's father wasn't feeling well and he was upstairs in the bedroom sleeping.

Ann knew instantly that this meant that her father was sleeping off an alcoholic binge. She felt very angry that her father couldn't stay sober long enough to meet Bill, but she kept these feelings to herself and tried to make the best of it. Her mother made an effort to appear chipper and carefree, but she looked like a nervous wreck. 

When Ann saw how her mother was acting, she felt very ashamed. All of her old childhood fears of allowing other people to meet her parents came rushing to the surface. She felt that bringing Bill to her parents' home was a big mistake. For his part, Bill was his usual charming self and he handled the situation well.

Throughout dinner, Ann felt like she was part of some surreal play in which all of the characters were playing their parts and doing their best to ignore the emotional environment around them. After they finished dinner, Ann couldn't wait to leave, so she turned down her mother's dessert and made up an excuse to leave early. 

Ann felt that her mother said all the right things to encourage them to stay, but Ann felt that, underneath it all, her mother was just as relieved to have them leave. Once she was out the door, Ann breathed a sigh of relief and she and Bill went back to her apartment.

After they got married, things seemed to be going well, at first. But, over time, Ann began to suspect that Bill had a drinking problem that he had managed to keep hidden from her while they were dating. At first, she didn't want to see how much Bill was drinking when he got home from work. She made excuses to herself about his behavior because it was too much for her to see.

But one night it all came to a head at a dinner in their home with Ann's two friends and their boyfriends. Bill started out the evening being charming, gracious host, but as he continued to drink, he became loud and argumentative. Ann felt close to tears, and she put her head down and hoped the evening would pass quickly. But before the night was over, Bill nearly punched one of the friend's boyfriends, and Ann's guests left abruptly with her friends telling her that they would call her tomorrow.

At first, Ann told herself that this was only one night and Bill had never behaved in this way before. Bill was very apologetic and promised her that it would never happen again. She forgave him, called her friends to apologize, and she decided to put the whole incident behind her as if it had never happened. 

But these incidents began to happen more regularly whenever they had his or her friends over, as Bill began to drink more and more. And Ann was beginning to run out of excuses that she made to herself and to her guests for Bill's behavior. 

Finally, after an incident where Bill got so drunk that he was abusive to her in front of their guests, shouting at her and attempting to take a swing at her, Ann couldn't remain in denial any longer. One of Bill's friends grabbed hold of Bill and told him to calm down or he would call the police. Then, he helped Bill to stagger up to the bedroom where he fell into a drunken stupor.

After that night, Ann had the painful realization that she had married a man who was a lot like her father. She could hardly believe that Bill had this other side to him that she had never seen before when they were dating. She also couldn't believe that she was behaving just like her mother with the same resignation, passivity, and denial. Even though she had told herself when she was growing up that she would never be like her mother and never marry anyone like her father, here she was in the same situation that she vowed she would never be in.

Subsequently, Ann made what were some painful decisions for her: She decided to find a psychotherapist who could help her. She also told Bill that he needed to go to an alcohol program and go to A.A. if he wanted to save their marriage. 

Bill was not at all open to getting help and told her that he felt he could control his drinking on his own. A part of Ann felt that if Bill wasn't going to get help, why should she? After all, in her eyes, he was the one with the problem. But Ann was in an emotional crisis, and she didn't want to confide in her friends so, with some resentment towards Bill, she found a psychotherapist who specialized in the problems that she felt overwhelmed by and started therapy.

Her psychotherapist, who was a trauma expert, helped Ann to develop coping skills that she never had. Her therapist knew that Ann was not ready to leave her marriage, even though she was in an emotionally abusive relationship. 

Trauma Therapy

So, she helped Ann to deal with the day-to-day crises in her marriage, and she told Ann about Al-Anon and encouraged her to attend. As Ann developed better coping skills, she began to feel stronger emotionally and more able to deal with the problems in her marriage. When Bill continued to refuse to get help, Ann proposed a trial separation, which Bill did not want. He realized that Ann was serious and he could lose her, so he began attending an outpatient substance abuse program and going to A.A.

As the situation at home calmed down, Ann's therapist helped her to explore her childhood issues which had lead Ann, unconsciously, to repeat her childhood trauma in her adult life. Whenever Ann began to feel overwhelmed by emotions that felt like they were going to overtake her, she was able to tell her therapist and her therapist helped her to manage those feelings by temporarily entering into a meditative state to calm down until she felt calm enough to continue dealing with the childhood trauma.

As Ann's therapist helped her to "pendulate" back and forth from discomfort to comfort, Ann began to realize that she could manage and, eventually, overcome these emotions that she had avoided dealing with for years. Ann's therapist also helped Ann to deal with her childhood trauma in "manageable bites" so that Ann didn't feel like she was on a runaway train of emotional trauma.

As Ann continued in her therapy, she learned about the mind-body connection in trauma. She learned that the body holds the memories of the trauma, even when she wasn't consciously thinking about it. She began to realize that her headaches and body aches were often the result of her tremendous efforts to hold back these traumatic memories from consciousness, and when she allowed herself to deal with the trauma in a manageable way, she often felt calmer and her body felt less tense than when she braced herself against feeling her feelings.

As she continued in her therapy work and her marriage improved, Ann realized that she had kept her world very small because of her trauma and shame. Gradually, she began to allow others to get to know her better. Her friends began to comment that she seemed more relaxed and open with them. While her trauma work in therapy wasn't easy, she began to discover that it was easier for her to deal with it than to continue to avoid it, so she felt encouraged to continue.

Overcoming Childhood Trauma
The above composite account of a psychotherapy case illustrates how unresolved childhood trauma can continue to affect an adult even when that person is no longer in their old environment. It also demonstrates that there is hope and the possibility of living a more meaningful life when people make a choice to get psychological help to overcome their trauma rather than continuing to avoid it out of fear.

Getting Help in Therapy
If you have unresolved trauma, you owe it to yourself and the people that you love to get psychological help from a licensed mental health professional who has an expertise in trauma. 

The renewed energy and peace of mind that people regain after they have overcome unresolved trauma usually outweighs the discomfort of working out these problems in therapy.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, and EMDR therapist who works with trauma using mind-body psychotherapy.

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

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

Also, see my article:  Overcoming Childhood Trauma that Affects Your Adult Relationships

Coping with a Spouse Who Has Borderline Personality Disorder

Generally, as a psychotherapist, I tend not to think of people in terms of diagnoses. People are more complicated than that, and looking at people only in terms of diagnoses tends to be reductionistic and pathologizing.

Coping With a Spouse Who Has Borderline Personality Disorder

While a mental health diagnosis will not capture the complexity of a particular human being, there are times when it is helpful to understand and cope with people who are close to you who are suffering with emotional problems. It's also important to understand yourself in relation to this person, what's happening to you in this relationship and steps that you might need to take to protect yourself emotionally, physically, and financially.

As I mentioned in my previous post, borderline personality disorder (BPD) is a serious mental health problem. It's often hard to understand for the person who has borderline personality traits as well as his or her loved ones. As with any mental health diagnosis, borderline personality disorder is on a continuum. There are certain people who have various traits and not others, and there are also people who meet the full criteria for the disorder.

Living with a spouse who has borderline personality traits can be extremely challenging. Usually, it means that you're living in a very chaotic emotional environment where you've not sure if you're losing your mind or your spouse is "going crazy."

How Do You Know If Your Spouse Has Borderline Personality Traits?
Listed below are some questions that you can ask yourself. While it's understandable that, if you're not a licensed mental health professional, you're not qualified to diagnosis anyone, but the questions below will help you to begin to understand what you might be dealing with in your relationship:

Does your spouse or partner become irrationally angry or enraged at the drop of a hat over relatively minor issues?

Do you feel like your spouse goes back and forth at various times between idealizing you and devaluing you?

When your spouse becomes angry with you, does he or she "forget" everything that is good about you and your relationship so that you feel that he or she has done a complete "180"?

Does your spouse engage in emotional "cut offs" with you or his or her family members or friends with little provocation?

Do you often feel that you're "walking on egg shells" with your spouse because you fear that things you might say or do will cause him or her to become extremely angry and possibly violent?

Do you often find yourself avoiding certain topics because you're afraid that your spouse will have an angry or violent reaction?

Do you often feel misunderstood by your spouse and your efforts to try to clarify things that you've said or done are not heard or understood by your spouse?

Do you often feel manipulated and controlled by your spouse?

Are you fearful of asking your spouse for what you need emotionally because you're afraid that your spouse will accuse you of being "too demanding"?

Do you often feel that your spouse changes his or her mind a lot so that you're not sure what he or she wants from you?

Does your spouse accuse you of doing or saying things that you never did or said?

Does your spouse seem to go from trusting you to being highly suspicious and distrustful of you for no apparent reason?

Do you often find it difficult to plan social activities because of your spouse's changing moods, impulsivity, and unpredictability?

Over time, do you often feel like you're living with "Dr. Jekyll and Mr. Hyde"?

Does your spouse often seem very charming and engaging to other people, but when you're alone with your spouse, you see a completely different side of him or her that most people don't see?

Does your spouse abuse alcohol or drugs or engage in gambling or sexual addiction as a way to cope?

Does your spouse often accuse you of not caring for him or her so that you feel that no love or caring is ever enough?

Does your spouse vacillate between wanting to be emotionally or financially rescued to cutting you off emotionally?

Do you find that you and your spouse often go through frequent breakups and reconciliations?

Do you find that your spouse engages in a lot of "all or nothing" or "black and white" thinking and there often doesn't seem to be any middle ground in his or her thinking, especially when he or she is angry?

If you've tried to leave the relationship, has your spouse tried to use charm, manipulation or even physical violence to keep you from leaving?

Does he or she threaten to commit suicide or threaten to hurt you if you leave?

It's important to understand that the above characteristics are often common to many different types of emotional problems, not just borderline personality disorder. So that, as a non-mental health practitioner, you're not going to be able to analyze or diagnosis your spouse. Also, while your spouse does not need to have all of these traits, having one or two of these traits does not mean that your spouse has borderline personality disorder. The above list is meant to give you an idea of what you might be dealing with in your relationship.

The following fictionalized scenario, which is not about any particular person, is an example of some of the problems involved in a relationship with someone who has borderline personality disorder traits:

Mary and John:
When Mary met John in their senior year of college, she thought he was one of the most charming and thoughtful people that she had ever met. She felt completely swept off her feet by him. She had also never felt so close to anyone before. No one had ever made her feel so terrific before. He thought that almost everything that she did was wonderful. When her friends met him, they also really liked him and found him to be very charming and engaging. He was funny and very generous. Often, when people met him for the first time, they would say that they felt he was so familiar to them, as if they had known him for a long time.

Before introducing Mary to his family, he warned her that his family tended to be very chaotic. He told her, "In my family, you need a score card to keep track of who's angry with whom and who's not talking to whom, but I'm sure they'll love you just as I do."

When Mary met John's family, which consisted of his parents and five brothers and sisters, Mary realized that what John had told her about them was accurate. Although they welcomed her with open arms, there was a lot of tension in the air between family members. 

She noticed that certain siblings were barely talking to each other and there seemed to be various alliances between certain siblings against other siblings. At various points in her visit, arguments suddenly erupted for no apparent reason, making Mary feel very uncomfortable. 

But, just as quickly as these arguments erupted, they also subsided just as quickly. John's mother said to Mary, "Don't mind us. This is just how we are. We fight, we stop talking to each other for months at a time, but we love each other and we always make up--until we begin fighting again"

Within a few months of having met each other, Mary and John got married. Mary was sure that she had never been happier and she had never felt so loved and appreciated in her life as she felt with John. During the first month or so, Mary felt like she was living with a prince and John treated her like his queen. He brought her flowers. He told her that he thought she was the best wife and lover that a man could ever have. He praised everything that she did.

Then, one day, without warning, all of this seemed to change. John was under a lot of stress at work and he felt that his boss was harassing him. Mary had never seen John in such an anxious and angry state. 

When she got home from work, she found John pacing the room back and forth. He told her that his boss was on his back and he was thinking of quitting his job. Mary was very surprised to hear John say this because during the first few months that John worked with this particular boss, John had nothing but praise for him. John often talked about what a great future he felt he had with the company and how much he loved his job.

Since John would often tell Mary how much he valued her advice, she began to tell John that maybe his boss was in a bad mood that day and things would probably go back to being as good as they usually are tomorrow. She was putting away grocery when she saw John whirl around with a look of rage on his face that she had never seen before. Then, John yelled at her, "Who's side are you on!?! Are you taking my boss's side!?!"

Mary was so shocked and dumbfounded by John's reaction that she dropped the eggs on the floor, which only made John more angry, "Oh God, Mary! What the hell are you doing? Look at this mess! You always make a mess of things! Can't you do anything right!?! And what do you know about my job. You're always putting me down! Why aren't you ever on my side!?!" Then, John suddenly walked out of the apartment, leaving Mary feeling like she was in the middle of a nightmare.

While John was gone, Mary tried to calm herself. She had never seen John like this before. She thought about what he had said. She could not ever remember putting John down or not being on his side. She couldn't understand how or why he would say these things.

About a half hour later, Mary received a call from John's mother. She told Mary that John had come to her house and he was talking to her and the rest of the family about the argument. She told Mary, "You know, Mary, John is very sensitive and you should try not to get him angry because he explodes. You're his wife. You should try to be supportive of him and not put him down. I thought you were different." Mary worked hard to contain her own anger about this intrusive call. She didn't want to explain herself to John's mother, so she decided to wait until he got home to talk to him.

When John came home a few hours later, he seemed like his old self again. He brought her flowers and told her that he was sorry that he lost his temper. He told her that he didn't mean all the things that he said, and he wanted to make up with her. Mary was confused, but she was glad that John was "himself" again and she thought that his overreaction earlier that evening might have been due to his being under a lot of stress at work. 

She decided to leave well enough alone and not bring up anything about John's boss or his work or the phone call from his mother that evening. That night, John and Mary made passionate love and, once again, Mary felt that no one had ever loved her as much as John.

Over the next few weeks, everything seemed back to normal again--until John had an argument with his mother. Once again, John was pacing back and forth and he was very angry and upset. There were numerous calls back and forth between John and his mother where they were yelling at each other, crying, and hanging up the phone. 

As Mary watched things unfold, she told John, "Try not to let your mother affect you so much. Why don't you just let things simmer down before you call your mother again." John responded by losing his temper with Mary, "What are you talking about!?! My mother is the best mother a son could have. She's not bothering me! You're the one who's bothering me. You're never on my side. You're the worst wife a man could have! Why don't you leave me alone!?! I don't know why I ever married you!" Then, John stormed out of the apartment.

As these scenes became more frequent, Mary began to realize that John had serious emotional problems, and that his family was very dysfunctional. She became very vigilant when she got home to try to "read" John' s mood because she never knew when he was going to be his charming, loving self or when he would be angry and demeaning of her. 

She also began avoiding certain topics that she knew would make John angry to avoid dealing with his temper. But as careful as she tried to be, she was still subject to John's impulsive and destructive rage which often came for no apparent reason. She also often felt misunderstood by him, and when she tried to explain herself, John dismissed whatever she said when he was in an angry or anxious mood.

Over time, Mary began to realize that John stopped being as attentive to her needs. When she tried, very tactfully, to bring this up with John, he lashed out at her because he felt criticized, "Oh, like I don't have enough going on at work and dealing with my family! Now, you're going to make demands of me too! You're too demanding! I can't deal with it, Mary! You have to stop!" Mary began to explain that she often felt lonely and she couldn't understand what happened to their relationship. Hearing that, John's anger escalated and he began breaking things around the apartment.

Mary became so frightened that she started to run out, but John caught her by the arm and began begging her not to leave. He dissolved into tears and promised her that he would change, "You have to help me, Mary. I need your help. Don't leave me." At that point, Mary had already seen enough of this behavior to know that John was unable to keep his promises to change. She told him that she thought they both needed to get help and if he didn't get help, she would leave.

Since John had a very strong fear of being abandoned, he complied with her wishes. He asked his family doctor for a referral, and his doctor referred him to a DBT therapist who specializes in working with people who have borderline personality traits. Mary also began her own individual psychotherapy to deal with her issues in their relationship.

It took a long time and it wasn't easy, but John learned how to cope with his overwhelming feelings of anger and fear of abandonment. There were many times when John wanted to leave therapy because he felt the therapist didn't understand him. Then, there were times when he thought his therapist was the best therapist in the world. Mary also learned to take care of herself in their relationship. Over time, their relationship began to improve. The family dynamics in John's family never changed, but John and Mary learned not to get so caught up in them.

The above scenario represents a somewhat optimistic outcome of living with a spouse who has borderline personality disorder. Not every relationship turns out that well. For instance, people with borderline personality disorder often refuse to get help. It's hard for them to see that they have a problem, and they often blame everyone else. In other cases, they might go back and froth between blaming others and blaming themselves.

If you're the spouse who is on the receiving end of this behavior, it can be very hard, if not impossible, to deal with on an ongoing basis. One of the most challenging aspects of this type of relationship is that you often can't see when your spouse is going to shift from being loving and thinking that you're wonderful to being angry and blaming and accusing you of being the worst spouse ever.

When you go through these sudden ups and downs with your spouse, you might feel like you're on an emotional roller coaster. You might also feel that you hardly recognize this person, who is supposed to be your spouse, when he or she makes these sudden emotional shifts.

While there is a place for compassion and understanding, you should never allow someone to emotionally abuse you or your children. Remember that the person with borderline personality disorder traits is responsible for his or her behavior. If there is abuse, especially physical abuse, you need to make a safety plan for yourself and your children to be able to leave the household quickly, if needed, and go somewhere where you feel safe.

Getting Help in Therapy
Even if your spouse refuses to get help, you probably need help yourself to deal with a spouse who has borderline personality traits. 

Only you can decide how much is too much and if you want to stay or leave, but by seeing a licensed mental health professional, you can sort this out and learn what your role is in participating in this relationship.

About Me

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

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.

Understanding and Coping with Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health diagnosis with a wide spectrum.

There are people who have borderline personality traits who are considered high functioning (i.e., they are able to hold a job and might even be very successful in their careers; they have intense emotional upsets, including intense anger, but they are able to recover from them relatively quickly; and their relationships are usually chaotic, but they're not extremely chaotic).

Understanding and Coping with Borderline Personality Disorder

However, someone who has intense borderline personality traits often will not be high functioning (i.e., they might have problems maintaining a job; they usually have very intense emotional upsets and it takes them longer to recover; their anger can turn to rage very quickly; they might even become violent; and they tend to have extremely chaotic relationships).

If someone who is usually high functioning is under an inordinate amount of stress that leads to a feelings of emotional fragility, their symptoms can worsen very quickly.

In order to understand borderline personality disorder, it's important to understand BPD traits. Although each person is unique, the following traits are usually associated with BPD:

Relationships and Fear of Abandonment:
People with BPD tend to have intense and chaotic relationships with a lot of conflict. These conflictual relationships often include ongoing cycles of breakups and reconciliations with the same people. People with BPD also often go from idealizing a loved one to completely devaluing him or her and this change can be very sudden.

Borderline Personality Disorder and Fear of Abandonment

Underlying these emotional dynamics is a strong fear of being abandoned by loved ones. Understanding this fear, which might not be apparent when the person with BPD is angry or rageful, is one of the keys to understanding his or her behavior. Often this fear originates from an early history of emotional abandonment, neglect or abuse making the person with BPD vulnerable to real or imagined threats of abandonment as an adult.

Loved ones are often shocked and bewildered at the ability of a person with BPD to do a "180" with sudden mood shifts. This might involve a sudden change from this person being loving and kind to being angry and rejecting, often with little provocation.

People with BPD will often alternate between wanting to be "rescued" emotionally, where they might be very clingy with their loved ones, to severing ties with their loved ones due to a real or imagined slights.

Emotions:
People with BPD often experience strong emotional instability, especially when under stress. BPD is associated with intense feelings of anger, rage, sadness, and feelings of emptiness, which can be extremely overwhelming.

People With Borderline Personality Disorder Are Often on an Emotional Roller Coaster

They are often on an emotional "roller coaster" with frequent "ups and downs" for no obvious reason. There are often frequent and sudden mood shifts which might frighten the person with BPD as well as their loved ones.

Sense of Self:
People with BPD often do not have a stable sense of self. They might experience themselves as being happy one moment and then sad the next moment for no apparent reason.

Behavior:
Borderline personality disorder is usually associated with impulsive behavior. People with BPD might engage in impulsive shopping sprees, sexual behavior, alcohol or drug abuse, gambling, cutting themselves, bingeing and purging food, violence or they might make impulsive suicide attempts.

People With Borderline Personality Disorder Often Engage in Substance Abuse

Aside from being impulsive and engaging in risky behavior, people with BPD frequently engage in "cutting off" or severing relationships precipitously. They also have a low tolerance for frustration which can lead to angry outbursts or violent behavior.

Thinking:
For people with BPD, their thinking is usually as chaotic as their emotions which, of course, go hand in hand. They might become highly suspicious or paranoid. They might also dissociate (i.e., "space out" or get numb) as a defense against intolerable feelings. Often, their thinking and perceptions can be distorted. Also, they tend to think in "all or nothing" terms.

What Causes Borderline Personality Disorder?
Research has shown that there seems to be both genetic and environmental components to the development of borderline personalty disorder. With regard to genetics, it's often the case that a person with BPD has at least one parent who also has BPD. In terms of the environment, there is often emotional neglect or abuse in early childhood.

What to Do if You or a Loved One Has Borderline Personality Disorder:  Get Help
If you or a loved one has BPD, it's important to get help. Since BPD is often confused with bipolar disorder and ADHD, it's important to start with an evaluation by a psychiatrist who is a good diagnostician. If a person who has BPD is drinking or abusing drugs, the substance abuse problem needs to be addressed and stabilized in an appropriate dual diagnosis program.

For people with BPD, Dialectical Behavioral Treatment (DBT) is often the best form of psychotherapy either in a group setting or in individual treatment. Although I am not trained in DBT, I have heard from many colleagues and clients that DBT is often very effective. In NYC, you can contact the American Institute for Cognitive Therapy (http://www.cognitivetherapynyc.com/) for a referral to a DBT therapist.

For loved ones who are struggling to deal with spouses or other family members who have BPD, it's important to understand that BPD is a mental health disorder and to try to have some compassion for the person with BPD. However, it's also very important that you take care of yourself at the same time. And if there is the potential for violence, first and foremost, you must have an escape route to ensure your safety as well as the safety of your children.

Being in a relationship with someone who has BPD can be very challenging. It can often lead to feelings of anger or despair. Only you can decide if you want to remain in the relationship or not, and you might need the help of a licensed mental health professional to decide what's best for you. In a future post, I'll write specifically about people who are in relationships with loved ones who have BPD.

About Me

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

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

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

Overcoming Habitual Negative Thinking

Have you ever taken the time to observe your thought patterns? Stepping back to observe how you think and the kinds of thoughts that might be dominating your conscious mind can provide an interesting window into what might be driving your attitudes and behaviors about yourself and others as well the types of decisions you're making.

Overcoming Habitual Negative Thinking

Very often, we might not notice these patterns in ourselves and we might not think about it until someone else, usually a person who is close to us, points it out to us. That person might point out that we are compulsive worriers or that we tend to engage in a lot of negative thinking or some other type of habitual thinking.

How to Develop the Ability to Observe Your Own Thoughts:
Developing the ability to observe our own thought patterns might sound like it would be easy. But it assumes that you have developed a certain awareness in yourself and that you're able to step back from your own habitual ways of thinking to look at your own thought process. For most people who are learning to do this, initially, they might find it easier to recognize their thought patterns after the fact.

For instance, a person who has just had an argument with his or her spouse, might think about what lead to the argument in the first place once the situation has calmed down. In one situation, a husband might realize that he was already feeling irritable when he snapped at his wife. In another situation, a wife might realize that she was anticipating that her husband was about to say something that would annoy her, so she reacted with anger. Whatever the situation might be, it requires an ability to temporarily let go of your reactions and the content of whatever you reacted to in order to turn inward to observe what's going on inside you.

Overcoming Habitual Negative Thinking: Developing the Ability to Observe Your Thoughts

Many people develop this ability of turning inward with relative ease. Usually, these are people who tend to be psychologically minded and curious about their own thought process and how if affects their behavior. They might have learned to do this as part of their own psychological development while they were growing up. Perhaps their parents taught them to think about their behavior when they were growing up. Or, if they didn't grow up with this ability, they might have learned it as part of their psychological development in psychotherapy or through a meditative practice. However this ability is developed, it's very useful to help us grow and develop within ourselves as well as in our relationships.

What is Habitual Negative Thinking?
Well, first of all, habitual means that it tends to be a recurring pattern. These thoughts aren't the occasional, random thoughts that might pop up in your head. They're ongoing and persistent ways of thinking that tend to be negative without any objective or verifiable evidence to substantiate them.

Examples of habitual negative thinking might be: "Nothing ever goes right." "Whenever I try to do something, something always goes wrong." "I'm never going to amount to anything, so why bother to try." And I'm sure you can think of many others. As you can see from just these few examples and others that you might think of, it's a negative way of looking at yourself, others, and the world in general.

Why Is Habitual Negative Thinking Harmful?
If we think of our thoughts as determining our action, we can begin to see how habitual negative thinking can become a major obstacle in our lives. So, if your particular habitual thought pattern is that "Nothing ever goes right," you can begin to see how this would affect you if you're thinking about making changes in your life, in your relationships, your career, and so on. Before you can even take the first step to make changes that might be necessary and important, you'll feel discouraged because "if nothing ever goes right," why bother? These habitual negative thoughts keep you stuck in whatever situation you might find yourself in, leaving you feeling hopeless and without a solution.

The following fictionalized scenario is an example of how habitual negative thinking is a problem, how it developed, and how it can be overcome:

Tom:
As an only child, Tom grew up in a household with two very angry parents. His parents were constantly arguing with each other, hurling accusations at each other and, after their arguments, often not talking for days at a time. When Tom was a young child and his parents began arguing, he would go into his room and put his pillow over his ears. But, try as he might, these arguments were so loud that he could still hear them.

Whenever this happened, Tom would get very frightened, but there was no one to talk to about it because his parents were consumed with their anger for each other. Even after the loud arguments stopped, each of his parents would be smoldering in separate parts of the house. When the loud arguing stopped, Tom would open his door a crack and listen for a minute, and if he didn't hear any more arguing, he would tiptoe out of his room gingerly, hoping to go unnoticed. His parents never hit him or physically abused him in any way. They provided for his basic needs. But they were totally unaware of how their heated arguments affected Tom.

Once Tom felt the coast was clear, he would come downstairs. Often, he would sit at the kitchen table and watch his mother cook. After one of those loud arguments, his mother would often bang pots on the stove and slam cabinet doors, making Tom wince. He would sit quietly, waiting to see what happened next before he dared to say anything. Often, at those times, his mother would say, "Life stinks" or some other similar comment. Tom was never quite sure if she was talking to him or talking to herself because his mother had a far away look in her eyes. At the same time, his mother would put a glass of milk in front of him and encourage him to drink it so even though she wasn't looking at him, he knew that she was aware of his presence.

Afterwards, he usually went down to the basement where his father had his tool shop to see what his father was doing. His father would usually retreat to his tool shop after one of these arguments and tinker around. Tom would sit at the edge of one of the steps and watch his father work. When his father realized that Tom was there, he would often say to him, "Don't ever get married Tommy. You'll regret it. Nothing you do will ever be right, according to your wife. "

These scenes occurred with such frequency that Tom grew up to be a very anxious child and a pessimistic young man. Not only were his parents giving him these ongoing negative messages, but they were so consumed and angry with each other that they weren't present for Tom emotionally. They were so overburdened by their own unhappiness that they didn't take the time to encourage him in any way or to give him hope about his future.

Without realizing it, these constant arguments and negative messages formed Tom's way of thinking about himself, others and the world in general. Tom went through life just "getting by." He was an average student in school, and he made a few friends along the way, but he had no hopes or dreams for the future. His expectations for himself and for others remained low. He didn't try out for sports or initiate any projects on his own because his thought, "Why bother? It's not going to work out."

All of this came to a head when he was in his mid-20s and he met Carol. He was attracted to Carol and sensed that there was something special about her, but he was too anxious to ask her out. Being an outgoing and confident young woman, Carol liked Tom and she asked him out on a date. As they continued to see each other, Carol was the one who continued to initiate steps to take their relationship to the next level. But, after a while, she became frustrated with what she sensed was Tom's ambivalence and fear to develop a relationship with her. She also began to see how pessimistic he was and how he held himself in general. So, she talked to him about it and suggested that he start psychotherapy.

The idea of participating in psychotherapy was daunting to Tom and, at first, he brushed it off by telling Carol that he didn't believe in psychotherapy and he didn't think it would make a difference for him. But Carol persisted and, after a while, Tom realized that his relationship with Carol was on the line and he didn't want to lose her. So, very reluctantly, Tom sought out a psychotherapist for individual therapy.

At first, Tom's motivation was external and was driven by his fear of losing Carol. But as his therapy progressed and Tom learned to observe his own thoughts and how they affected him and his relationship, he became more internally motivated. This didn't happen over night. It was more of a gradual process. But as he began to realize that he had particular negative thoughts that were habitual, he became curious about his internal world. He also began to realize why he often felt anxious and fearful much of the time.

As he became more self observant and curious, he started questioning his perceptions about himself, others and about life. He began to see the distortions in his thinking and that, often, there was no objective evidence for why he thought the way that he did.

Overcoming Habitual Negative Thinking

It was hard, at first, to make changes in his thought patterns because they were so ingrained in him. As he did this, he began to open up to new experiences, both emotionally in his internal world as well as externally in his relationship with Carol and his attitudes about the world around him. He found it to be a liberating experience as he let go of the thoughts and attitudes that he internalized from his parents and developed his own way of thinking. This, in turn, helped to improve his relationship with Carol and enabled Tom to venture out more into the world to take risks. Overall, he felt happier than he had ever been.

The above example is one way that a person can develop negative habitual thinking. It's relatively easy to see a connection between Tom's home environment when he was growing up and how formative it was in his development. However, often, it's not as obvious to see. Sometimes, the factors that influence of the development of negative habitual thinking are much more subtle and not as obvious to see. Often, these connections are hard to make on your own without the help of a trusted friend or partner or the help of a licensed mental health professional.

Overcoming Habitual Negative Thinking:

The first step in overcoming any negative habit is to become aware of it. Often, it takes courage to step back from your own ingrained way of thinking to question yourself about whether your way of thinking has distortions and if, objectively, they're accurate.

Often, people wait until there is the potential for some loss, either involving a relationship or a career before they seek help to overcome habitual negative thinking. Sometimes, it takes a crisis or the threat of a crisis to bring people into therapy to work on this issue. It's not ideal in terms of overcoming a problem but, for many people, it's what finally motivates them to get help.

Many people learn to overcome habitual negative thinking. They might start out with a lot of mixed feelings about the process, but if they have a sense of curiosity and a willingness to look at their own thought process to make changes, they're often successful.

Getting Help in Therapy
If you think you engage in habitual negative thinking, you could benefit from working with a licensed mental health professional to overcome this problem. Often, just starting the process of talking to a psychotherapist can begin to open up your mind to new possibilities. It takes a certain amount of courage and hope that you might not readily feel, but often taking the first step can lead you to take other important steps along the way.

About Me

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

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.

Boundary Violations and Sexual Exploitation in Psychotherapy

Boundary violations between psychotherapists and clients often begin on the "slippery slope" with inappropriate self-disclosure by the therapist. In this article, I will focus on when boundary violations occur where there is sexual exploitation of clients by their psychotherapists.

Boundary Violations and Sexual Exploitation in Psychotherapy

What Are "Boundaries" in Psychotherapy?
The term "boundaries" in psychotherapy is a metaphorical term that refers to the definition and professional structure of the psychotherapy relationship. It defines the psychotherapeutic relationship as being different from a personal relationship or a friendship. The boundaries of the psychotherapeutic relationship include, but are not limited to, the time that the psychotherapist and client spend together in a professional setting, the fee arrangement, the psychotherapist's self-disclosure, the type and frequency of between-session phone calls, the prohibitions with regard to physical touch, and other related issues.

The purpose of maintaining appropriate professional boundaries in psychotherapy is, first and foremost, to protect the client from inappropriate behavior by the therapist which can be psychologically harmful. Secondly, maintaining appropriate professional boundaries also protects the therapist with regard to accusations of unethical and illegal behavior which could result in malpractice lawsuits, professional sanctions and, in the worst cases, revocation of professional licenses and/or arrests.

As I mentioned in my prior article, it is always the therapist's responsibility to maintain appropriate professional boundaries in treatment, regardless of whatever the client might do or the type of therapy.

How Often Do Boundary Violations Occur in Psychotherapeutic Relationships?
It is difficult to come up with accurate numbers because many boundary violations, especially sexual exploitation, are not reported. Many clients feel ashamed and blame themselves for the boundary violations.

Most boundary violations occur with male therapists who are older, more established, and also well trained. This is not to say that boundary violations never occur with female psychotherapists. However, based on available data, it seems to be less prevalent. In the US, it is estimated that nearly half of all malpractice suits are related to psychotherapists' sexual exploitation of clients and most of these suits are against psychiatrists.

The good news is that these type of boundary violations seem to have decreased somewhat over the years, possibly due to stiffer penalties, professional sanctions, refusal of malpractice insurance companies to provide insurance to therapists who have transgressed with clients, and better training. While this is good news, even one boundary violation between a therapist and a client is one too many.

Non-Sexual Boundary Violations that Can Lead Down the "Slippery Slope" to Sexual Exploitation:

Excessive self-disclosure: See prior blog post

Dual relationships:
Most mental health professionals' codes of ethics prohibit dual relationships because it is recognized that this is usually harmful for the client. The psychotherapeutic relationship should be the only relationship between therapist and client. Even when the dual relationship is not sexual, it violates the professional boundary between therapist and client. For instance, if a therapist has a client who happens to be stock broker, the therapist should not ask the client for stock market advice and, it goes without saying, that the therapist shouldn't ask the client to handle his or her money for stock market transactions. Once the professional boundaries have been breached, the treatment is placed at risk for even greater boundary violations.

Too Many Unnecessary Phone Calls Between Sessions:
While most therapists recognize the necessity of some phone calls between sessions to reschedule appointments or to help clients who are in a particular crisis, most therapists also know that too many unnecessary phone calls between sessions should be explored during in-person sessions with the client. Needless to say, I'm not talking about clients who are home bound or sick and have phone sessions with their therapists. Rather, I'm referring to clients who might not understand the professional treatment frame and who want to treat their therapist like a friend. As in all of these examples, it's up to the therapist to address the issue and set appropriate limits.

Therapist's Failure to Maintain the Treatment Frame:
While it is understood that there are times when certain clients might need extra time in a therapy session due to a crisis or they might need a temporary fee agreement due to financial necessity, when the therapist fails to maintain the treatment frame on a frequent basis with a particular client, this is usually indicative of the therapist's boundary violation in the treatment, which might be conscious or unconscious on the therapist's part.

I often work with clients on a sliding scale basis, when I have available open slots to do so. I have also extended my services to longstanding clients on a pro bono basis for a limited amount of time when they've lost their jobs. However, in all these instances, I've carefully considered the particular circumstances of the client and the nature of our professional relationship to make sure that I'm not enacting a boundary violation by giving "special treatment" to certain clients. If it's clear that a client can afford to pay the full fee, I see no reason to provide a sliding scale fee and I would see this as an unprofessional enactment with the client.

Touching or Frequent Hugs:
As a matter of course, I do not touch my clients. I am very aware that, for many clients, touching has particular inappropriate implications, especially for clients who were sexually abused, and even more so in cases of incest. The therapeutic relationship can often take on the appearance and feeling of a parent-child relationship. It's very important for the client to feel that he or she can trust the therapist. No matter how non-hierarchical or egalitarian a therapist might try to be, the client-therapist relationship is, by definition, an unequal relationship where the therapist has more power than the client--even in therapy relationships where the client is a therapist.

Like most examples, there are some limited exceptions. At the conclusion of a long-term therapy relationship, many clients spontaneously hug their therapists. This is usually an expression of their gratitude and caring for the therapist. While I don't initiate these hugs, I would not hurt a client's feelings by trying to ward off a hug under these circumstances.

The problems with touching and frequent hugs is that they can easily develop into more inappropriate seductive touching of an intimate or sexual nature, once again, crossing the therapeutic boundaries of treatment.

The above list is certainly not exhaustive, but it represents some of the more common non-sexual boundary violations that often lead to sexual boundary violations.

To illustrate the points that I have made above, the following fictionalized account is an example of a sexual boundary violation between a psychotherapist and his client:

Betty began attending psychotherapy sessions with Dr. Smith after she lost the third job in a row for getting sexually involved with her supervisor. Dr. Smith was highly recommended to her by a friend as a psychiatrist who was both a psychotherapist and psychopharmacologist.

Betty, who was in her mid-20s, had never been in therapy before, so she didn't know what to expect. Dr. Smith talked to her about what would be expected of her with regard to the treatment frame (i.e., coming to sessions regularly and on time, paying fees in a timely manner, the length of treatment sessions, and other related issues). He also talked to her about his professional obligations with her.

After several sessions, Betty began to have erotic feelings for Dr. Smith, which is not unusual in psychotherapy. This is often part of clients' transferential feelings for their therapist. Most of the time, these tranferential feelings have little to do with the therapist and more to do with the client's underlying, unconscious issues.

Betty tended to be seductive in her relationships with most people, including her professors, work supervisors and other authority figures in her life. At that point in the therapy, she was unaware of how she attempted to sexualize her relationships. So, it was not surprising when she began to come to therapy with revealing, low-cut blouses and short skirts.

When Dr. Smith addressed and explored this seductive behavior in therapy, Betty wasn't sure how to respond to this. In the past, due to her seductive nature and the fact that she was extremely attractive, most people responded to her seduction by engaging in sex with her. Although she usually felt powerful at first, these sexual encounters ended up being emotional disasters for her. It was the cause of many problems for her in college as well as in her work relationships with supervisors.

As the therapy progressed, it came to light that Betty had been sexually abused by her maternal uncle from the time that she was 10 until she was in her late teens. According to Betty, it began with inappropriate touching and progressed to sexual intercourse when she was in her teens. As an only child of a single, alcoholic mother, Betty craved attention and she was easy prey for her uncle, who lived with Betty and her mother.

Although she felt that her uncle's sexual attention was wrong, she was vulnerable to him because she was an emotionally neglected child. She also told herself that she must be "special" for her uncle to want to spend time with her in this way, so she never told anyone about it. The only reason that the incest stopped was because as Betty got older, her uncle, who turned out to be a pedophile with other children too, no longer found her sexually exciting. As is often the case with pedophiles, he needed to enact his sexual transgressions with children so he stopped approaching Betty in a sexual manner. And, even though she attempted to seduce him back into their incestuous relationship to get his attention, he "abandoned" her, presumably, for a younger child.

Having been sexually violated at such a young age, Betty learned to sexualize most of her relationships with men when she wanted attention. As a result, she continued to enact the sexual transgressions as an adult but, instead of being the one who was seduced, she took on the role of the sexual aggressor, albeit with adults and not children, to continue to get attention and gratify her emotional needs.

When Dr. Smith did not respond to her sexually provocative clothing in session, she began calling him between sessions "to chat." Dr. Smith responded to her calls by telling her that, unless she had an urgent matter or she needed to change an appointment time, she should wait for their next therapy session to talk to him. Undeterred, Betty began leaving frequent voicemail messages for Dr. Smith late at night, letting him know that she was thinking of him and couldn't wait to see him again.

At that point, Dr. Smith consulted with his former, more experienced clinical supervisor to get clinical advice on how to handle this client. His supervisor knew Dr. Smith well and knew him to be an ethical psychiatrist. However, he also knew that Dr. Smith was going through a tumultuous divorce, he was lonely, and he could be vulnerable to Betty's seduction. He reminded Dr. Smith of his professional and ethical obligations under their professional code of conduct. Then, he asked Dr. Smith about his countertransferential feelings for Betty. Dr. Smith admitted to his supervisor that he found Betty very attractive and sexually tantalizing, as most men probably would. However, he told his supervisor that he didn't want to cross the professional boundary with this client.

Dr. Smith's supervisor told him that if he could work out this issue with Betty, it could be an important breakthrough in her treatment and she could deal with the original incest rather than continuing to engage in sexual enactments. However, he also told him that if he thought that he might violate the therapist-client professional boundaries with Betty, he should refer her to another therapist, preferably a woman. Dr. Smith's supervisor knew that Dr. Smith had a narcissistic streak to his personality, and he assured him that referring the client to another therapist would not be considered a professional failure. Rather, it would be a wise move to protect the client and to protect himself from crossing the professional boundary, especially at a time when Dr. Smith was in so much emotional turmoil himself and he was feeling lonely.

Dr. Smith agreed to consider the wise advice of his clinical supervisor. He knew that he actually felt more tempted than he admitted to his supervisor to breach the professional boundaries of the relationship, but he also knew that he would perceive himself as a failure in this case if he referred Betty to a colleague, and he was determined to work through the transferential and countertransferential issues in this case.

As treatment continued, Betty continued to be seductive with Dr. Smith. The more he attempted to maintain the treatment frame, the more determined she appeared to be to violate it. He attempted to talk to Betty about her uncle's sexual abuse, but she would find ways to bring the conversation back to her erotic feelings for Dr. Smith.

During that same time, Dr. Smith was feeling increasing emotional pressure from his divorce proceedings, which became nasty and heated. He was receiving email messages from his wife telling him that she thought he was "less than a man" and he was "spineless." His lawyer encouraged him to settle on his wife's demands and put the whole thing behind him, but Dr. Smith didn't want to give up the battle.

This resulted in many sleepless nights, poor appetite, and the beginning of his isolation from friends, family and colleagues. Within a few months, he felt like an emotional wreck. He knew that he should probably take a short sabbatical from his private practice, but he didn't want to admit that he needed a rest, so he continued to see clients, including Betty.

At the end of a particularly difficult week where he had gotten very little sleep and he was emotionally and physically exhausted, Dr. Smith saw Betty for her usual weekly session. As usual, she was wearing a sexually provocative outfit and she talked to him about her erotic feelings for him. Whereas in the past, she limited herself to telling him that she was "turned on" by him and would like to have sex with him, this time, she was more sexually explicit. Dr. Smith felt himself getting sexually aroused, but he maintained his professional demeanor. However, by the end of the session, when Dr. Smith and Betty stood up for her to leave, she locked the door and began kissing him on the mouth. Emotionally depleted by his personal problems, Dr. Smith gave in to Betty's sexual advances during that session.

By the time Betty left, Dr. Smith began to panic and he called his clinical supervisor for an emergency session. His clinical supervisor met with Dr. Smith, reprimanded him for violating the client-therapist boundary, and told him that he needed to apologize to Betty and tell her that he could no longer see her and he would refer her to a female therapist. He told him take a sabbatical from his private practice, seek his own personal therapy to deal with this transgression and with his overwhelming personal problems, and consult with a malpractice attorney in case Betty took action against him.

He also told Dr. Smith that he was obligated to report this sexual exploitation to their ethics board who would investigate the case. In addition, he told Dr. Smith that if he did not agree to follow all of these recommendations, he would also report that to their professional ethics board immediately and advocate for his license to be suspended.

Dr. Smith felt a lot of remorse for crossing the client-therapist boundary. He knew that, regardless of his personal problems and regardless of how seductive Betty was, as a mental health professional, he was responsible for maintaining the professional boundary between them.
When he apologized to Betty and told her that he could not see her again, she was crushed. This boundary violation and termination of treatment represented a repetition of her earlier problems with her uncle. Dr. Smith referred Betty to a seasoned female colleague, admitting that he had violated the therapeutic relationship and expressing his remorse.

Over time, Betty was able to work through the sexual exploitation in her therapeutic relationship with Dr. Smith as well as the original incest with her uncle. It was not easy or quick, and Betty also tested the professional boundaries with the new therapist. However, ultimately, her therapy was a success.

Dr. Smith took a sabbatical from his private practice. He entered into his own personal therapy to deal with the boundary violation as well as his divorce and loneliness. He also consulted with a malpractice attorney. After long and careful consideration, he decided to change his career focus from his psychotherapy private practice to psychotherapy research.

As this fictionalized scenario demonstrates, even when the psychotherapist is determined to maintain professional boundaries and seeks out clinical supervision to deal with the erotic transference and countertransference, there are so many personal and professional factors that can jeopardize a treatment.

Psychotherapists need to be emotionally attuned to their own professional and personal vulnerabilities before they slide down the "slippery slope" of crossing boundaries with a client.

Although the fictionalized account that I presented was between a heterosexual therapist and client, these boundary violations also occur among gay and lesbian therapists and clients.

In most cases, sexual exploitation in psychotherapy doesn't occur immediately. It usually follows after minor boundary violations turn into larger violations, culminating in the most egregious violation of sexual exploitation.

Also, in many cases where there is sexual exploitation in therapy, the psychotherapist, and not the client, is the aggressor. So, it goes both ways.

I intentionally presented a fictionalized account where the client is seductive and has a history of seducing authority figures due to childhood incest because this is a common scenario. Also, I wanted to demonstrate that even if cases where clients are extremely seductive, the therapist is the one who is still accountable for maintainng profesional boundaries.

If you are a psychotherapist who has crossed professional boundaries with your client, it is very important that you seek clinical supervision, no matter how long youve been practicing or how experienced you are. In most cases, therapists who have violated clients' boundaries should also seek their own personal therapy to work through these issues and do some soul searching as to whether they are in the right profession.

If you are a client who has been sexually exploited in therapy, don't suffer in shame alone. Although it might be hard for you to trust another therapist again, first, seek out a psychotherapy recommendation from your doctor or a trusted friend to work through this abuse.

Second, if you should decide to take legal action against this therapist for what he or she did to you and because you suspect that the therapist might be perpetrating this inappropriate behavior with other clients, seek out the advice of the ethnics board for the professional organization with whom the therapist is affiliated. So, it would be the American Psychiatric Association for psychiatrists, the American Psychological Association for psychologists, and the National Association of Social Workers for clinical social workers. You can also seek out the advice of the ethnics department for the State licensing board, who provides licensure for that particular profession. You can find this information online for your particular State.

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

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.

Asking for Forgiveness: The Power of Making Amends

Making amends is an important process in the addiction and mental health recovery as well as in many religions and in life in general. Recognizing that we have hurt other people, our behavior has had consequences for ourselves and for others, feeling sincere remorse, expressing our remorse, where appropriate, and asking for forgiveness are important parts of that process.

Asking for Forgiveness: The Power of Making Amends

Making amends can seem like a daunting process, especially if our transgressions have been recurrent and longstanding. As we come to terms with what we did, there is often a lot of shame associated with this recognition. As such, part of the process of making amends is to be able to forgive ourselves, which is often harder than asking someone else to forgive us.

When we're contemplating making amends, it's often helpful to work through this process with someone else: a sponsor (if you're in A.A. or one of the other alcohol or addictions 12 Step programs), a psychotherapist, or a trusted mentor or friend. Their support, knowledge and expertise can be invaluable as you struggle to sort out what you did, who you hurt, whether it's the right time to contact the person or persons you've offended, and how to go about making amends.

It's also important to realize that just because you have decided to make amends doesn't mean that the other person is ready to hear from you or to accept your apology. When we're considering making amends, we might enter into vivid memories of what we did in such a powerful way that we feel like we're reliving these old experiences, even though it might be many years later. But just because we might be in that emotional state doesn't mean that the other person is there too.

So, when we're thinking about making amends, it's important to use good judgment about the "who, when, where, why, how and what" involved. And, if you're either early in your recovery or in the early stage of whatever process you might be going through, you might not have developed good enough judgment yet about how to make amends. So, you might not realize that, in some cases, making amends might cause more harm than good, and you want to be mindful of this as you're going through this process.

But assuming that you've given your decision careful thought and you realize that asking for forgiveness is the right thing to do, how do you go about making amends?

Recognizing that every situation is different, the following is one particular scenario. It is representative of many different cases and not related to any one particular person. After I outline this scenario, I'll go over the steps that are often helpful when you're in the process of making amends.

Robert:
Robert was in his early 50s when he admitted to himself that he needed help for his out of control drinking and drug addiction. While he was getting help, he was also diagnosed with bipolar disorder. Until then, Robert knew that his life was out of control and that he had struggled with alcohol and prescription drug addiction for many years, but he had no idea that he had bipolar disorder.

During his inpatient dual diagnosis rehab, where he was detoxed from alcohol and painkillers and stabilized on drugs for his bipolar disorder, he had a chance to work on many of his addiction-related issues with the rehab counselor and his peers. At that point, Robert began to feel the emotional weight of how much he had hurt his family when he was active in his addiction and unstabilized with his mood disorder.

It helped him tremendously to be in a supportive environment where other people were going through a similar process, and he realized that he was not alone. However, he still felt somewhat overwhelmed when he thought about the pain that he had caused his wife and children.

Using the concept of "one day at a time," Robert was able to acknowledge that he hurt wife and children, as well as hurting himself, but not think too far into the future or too far into the past so that he was not completely overwhelmed with his shame and sense of remorse. He was also able to hang onto the idea that making amends would be a process that he could work out with a sponsor and in his after care treatment with a psychotherapist.

During family day at the rehab, Robert's wife and his two teenage daughters came to attend the educational series and to have sessions with Robert and his counselor. Robert's oldest son, John, who was in his 20s and living on his own, refused to come. John had gone through the worst of Robert's alcohol and drug binges and his rageful manic episodes, and he was unwilling to see or speak to Robert. Although it was very hurtful to Robert, he realized that he had no choice but to accept that his son wasn't ready and might not ever be ready to forgive him, and he could not control his son's feelings or behavior.

During Robert's sessions with his counselor and family, he acknowledged that he had caused his family a great deal of emotional pain, financial loss, and general upheaval in their lives. He also acknowledged that he realized that it might take a long time, if ever, before they trusted him again because he had breached their trust so many times. Robert expressed his sincere remorse, he took responsibility for his actions without making excuses for himself, and asked them to forgive him, if they could. He also told them that he realized that this would be a process and it wouldn't happen over night.

Robert's wife, Kathy, who had been very supportive of Robert during their 30 year marriage, talked to him about how important it was to her for Robert to finally acknowledge that he had a problem and that he hurt her and their children over the years with his addictive behavior and out of control manic episodes of rage, overspending, lost jobs, and the general chaos of their lives. She told him that she had loved him throughout their problems together and she still loved him. She was willing to start the healing process, but she knew that she would need time for her to trust him again. She also acknowledged that she was part of the dynamic and might have contributed to the overall chaos, and she wanted to understand this better by going to Al-Anon. But, overall, she was happy that he was getting help, and she hoped that she could trust that his remorse was genuine and he would continue in his recovery after he got out of the rehab.

Robert's older daughter, Susan, talked about how his dual diagnosis problems had affected her, and how she feared that she might become an alcoholic, a drug addict, or she might be diagnosed with bipolar disorder one day too. She struggled to put words to feelings because this was all new to her, but she told him that she loved him and she wanted him to get better.

Robert's youngest child, Beth, was very anxious. She cried through most of the meeting, and she told Robert that she wanted to understand what was going on with him, but she didn't. She and Susan both agreed that they would go to Al-A-Teen meetings.

After Robert was discharged from the rehab, he began attending A.A. meetings, he obtained a sponsor, and he started seeing a psychiatrist for medication and a psychotherapist for psychotherapy. At times, he felt overwhelmed, but most of the time, he was grateful for the support he was receiving.

Over time, Robert made efforts to reach out to his son through letters because his son refused to take his calls. Writing these letters to his oldest child, acknowledging that he had hurt him, expressing his remorse, and vowing to try to make it up to him, if his son was willing, was one of
hardest things that Robert had ever done in his life. Doing it while he was also new to sobriety and new to the knowledge that he was bipolar was also a challenge for him. There were many days where Robert was tempted to pick up a drink or call his old dealer to get painkillers. During those times, he reached out to his sponsor and his therapist, as well as peers in his support network, to just get through the day.

John acknowledged Robert's letters with his own responses, where he expressed his own anger, sadness, and lack of trust for Robert. John wasn't sure that he wanted to accept his father's apology or that he wanted to forgive him. He was afraid that if he forgave him, Robert would think that "everything was okay" and Robert might disappoint him again. But he agreed, for now, to keep the lines of communication open through these letters and he held out the possibility that he might be willing to talk to Robert in the future.

Robert offered to talk to John, when and if John was ready, about anything that John might want to know about Robert's addiction and mental illness. He was very careful to make this offer not as an excuse for his behavior, but as a way for John to understand the background of these problems. But during the first few months of Robert's recovery, John wasn't interested or ready for any explanations.

In the meantime, Robert continued to work on improving his relationships with his wife and daughters. It was a slow, painful process but, over time, he felt that his relationships with his wife and daughters were getting closer. He also sensed that they were beginning to trust him.

Robert also continued to work on forgiving himself. He knew that he couldn't turn back time to undo all the damage that he had done, and this was a hard concept for him to come to terms with. But he continued to work on his recovery, meet with his sponsor, attend his psychotherapy sessions on a weekly basis, see his psychiatrist and take his medication.

About a year after Robert completed his rehab, he received a call from his son. It was so unexpected that Robert hardly knew what to say. John told him that he still felt a lot of anger and ambivalence towards him, but he also recognized that, underneath his anger and sadness, he still loved his father and he wanted to begin the healing process between them. Robert felt that this was one of the happiest days of his life, and he was very grateful to his son.

The scenario above gives you a glimpse of how complicated the process of making amends can be. As I mentioned earlier, everyone's situation and process will be different, but there are certain steps that can be gleaned from this that might be helpful to you or someone that you know.

Steps Towards Making Amends


Say That You Were Wrong:
For some people, saying, "I was wrong" or "I'm sorry" is one of the hardest things that they can do.

Acknowledging to yourself and to the people that you hurt that you were wrong is a powerful first step. As previously mentioned, you need to use good judgment about this and make sure that if you're contacting someone to apologize, you won't do more harm than good. This isn't always obvious, but one possible example of many might be in a situation where your interjecting yourself back into someone's life might be too hurtful to them and their loved ones. For instance, if you've had an affair with someone who was married and contacting this person might place his or her marriage or family situation in jeopardy, it would probably not be a good idea to contact this person.

In all other cases, it's important that your apology is sincere. Express your remorse for what you did--without making excuses for your behavior. The minute someone senses that you're making excuses for your behavior, he or she will doubt the sincerity of your apology.

Now, making excuses is different from providing them with information about what was happening to you at the time--if they want to know. You can ask them if they want to know, and if they don't, you must respect that and not impose it on them. Above all, your intention should be to say you're sorry.

Say (and mean) that You Won't Do It Again:
For many people, when they hear someone apologize, the first thing that comes to their minds is the question of whether they can trust that person again. They might want to forgive the person who is making amends, but because trust has been broken in the past, they might be afraid to trust again.

When you're new to addiction recovery or to dealing with your mental health diagnosis, you might feel shaky yourself about whether you can live up to your words that you won't do it again. So, it might be necessary for you and the person that you're asking forgiveness of to put certain structures in place to help ensure that it won't happen again.

For example, if one of the things that you're asking forgiveness for is your compulsive gambling and that you spent the family's savings on your gambling addiction, one of the structures that you might put in place with your spouse is that he or she will handle the money. This can be an informal agreement or, if necessary, you might give your spouse power of attorney over the family finances, if this is appropriate. This can provide a feeling of safety for you and your family that even though you're sincere about not wanting to transgress again in this area, the particular structure that you've put in place will also support that effort.

Ask What You Can Do to Try to Make Up for Your Behavior:
Restitution is an important part of making amends. While you and your loved ones cannot go back in time to undo what has already been done, you can find out what your loved ones might want to help make up for the hurt that you have caused.

Even in situations where your loved ones can't bring themselves to forgive you and they are unwilling to allow you to make up for what you did, it can still be important for your own health and well-being to find ways to make restitution in your life.

This could mean that, when you've had enough time in your recovery, that you become a sponsor to people who are new to recovery to share your hope and wisdom, you volunteer your time to helping others, or that you find other ways to try to give back to others, even when you're unable to give back directly to the people that you've hurt.

Recognize that making amends is a process for yourself as well. You don't have to do it perfectly, although reflection and consideration before you start this process is an important step.

Also, recognize that other people don't always understand what it means to forgive. Some people might have the impression that by saying that they forgive you, they're telling you that what you did was all right with them, and they don't want to give you this impression. So, the people that you're asking for forgiveness from might have to go through their own process with this to understand what you mean and what it means for them.

When you first begin to recognize how much you've hurt others, you might only see the very top layer of hurts that go very deep. Over time, you might develop a deeper understanding of the implications of your behavior for yourself and others, and this brings its own challenges.

As previously mentioned, making amends can bring up a lot of feelings of shame and sadness, and I recommend that you find healthy support when you're going through this process.

About Me

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

I work with individual adults and couples.

I have helped many clients to go through the process of asking for forgiveness and making amends.

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

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

Also, see my article:
When Your Efforts to Make Amends Are Rejected