Mind-Body Connection: Responding Instead of Reacting to Stress

Stress is a normal part of life. As long as we're alive, we'll have a certain amount of stress in our lives. An optimal amount of stress is often helpful to motivate us to accomplish our goals. But what happens when stress exceeds the optimal level and we feel overwhelmed?

Mind-Body Connection: Responding Instead of Reacting to Stress

Many people who become overwhelmed by stress have maladaptive ways of coping. Rather than responding to stress by taking a moment to catch their breath, they react in negative ways that cause them to feel worse. Usually, their maladaptive reactions aren't intentional. It's more a matter that they've never learned healthy ways to manage their stress.

The following vignette, which represents a composite of many cases to preserve confidentiality, illustrates how you can learn to respond rather than react to stress:

Tammy:
By the time Tammy came to see me in my private practice in NYC, she described her life as being "a complete mess." She appeared tense and exhausted. Her marriage was on a downward spiral. And boss was threatening to fire her if she didn't get help.

Mind-Body Connection: Responding Instead of Reacting to Stress

Tammy said that, up until two years ago, her life had been "fine." Her 20 year marriage to Tom had its "ups and downs," but they were generally happy.

But when Tammy's company began laying off employees due to the recession, she was faced with having to take on a lot more responsibilities and spending more time at work. This meant that she spent a lot less time at home with her husband, and she hardly saw her friends. At first, her husband was understanding, but as time went on, her husband began to complain that he hardly ever saw her.

Tammy tried bringing work home, spending early evenings with her husband and then focusing on her work late at night after he went to bed, but then she was exhausted and irritable the next day. After a few days of this, she could hardly get out of bed, and she began snapping at home and at work.

Tammy didn't know what to do, so she tried just working harder, but she kept feeling that she was falling further and further behind in her work. Her boss was complaining at work, and her husband was complaining at home. She felt completely unappreciated by everyone and as if she was caught in this vortex that she couldn't get out of no matter what she did.

She knew that her relationship with her husband was deteriorating, and she worried about this. But she said she felt like a hamster on a wheel--like she was running, but staying in the same place.

When she tried to talk to her boss about it, she completely lost it and began shouting at him. She said she was just as startled by her reaction as he was. Since he knew that this was uncharacteristic of her, he told her that he would overlook her outburst for now, but she had better get help. He also told her that he was going to redistribute some of her work to other employees because it was obvious that she was overwhelmed by stress.

Initially, Tammy was relieved that her workload would be lightened, but then she began to worry about this. She described herself as a "perfectionist" and she felt that she "should" be able to manage all of her work assignments as well as maintain her relationship with her husband. So, even after Tammy had more time to relax, she still felt like she was on a never ending treadmill because her mind kept churning, berating herself for not being able to handle everything. She just couldn't give herself a break.

Before Tammy came to see me, she had never considered what she could do to manage her stress. The concept of stress management was completely foreign to her. Initially, when we began to talk about it, she seemed skeptical. This didn't fit in with her idea that she should be able to handle everything and she shouldn't have to do anything to manage her stress. She felt that if she had to engage in stress management, she was "weak."

But after Tom spoke to Tammy, telling her that he was considering a separation, Tammy began to seriously consider that she needed to make some changes. She didn't want to lose her marriage so, with some hesitation, Tammy became more open to learning how to respond to stress rather than becoming reactive. She also had to learn to manage her harsh and rigid expectations of herself, which meant doing some family of origin work where these unrealistic expectations were first developed.

Tammy began by learning to observe her breath. She was surprised to observe that there were times when she was hardly breathing or she was breathing in a very shallow way. Learning healthy breathing techniques helped to calm her down significantly.

After she learned to breath properly, Tammy and I worked on helping her to observe herself in stressful situations. Over time, she realized that she often reacted to stressful situations without thinking, which often made these situations worse for her and for those around her. She learned some simple techniques for stopping herself from reacting and shifting out of her reactive mode into a more responsive mode. She learned that by stopping, sometimes for only a few seconds, she was able to modulate her emotions, calm herself, and respond on a more even keel.

As Tammy learned to be more responsive and less reactive, she began to feel better about herself and more in control. She was also getting compliments from her husband, her boss and her colleagues, who noticed the positive changes in her.

Mind-Body Connection: Responding Instead of Reacting to Stress

During this upward spiral, Tammy became more willing to explore other ways to manage her stress through meditation and yoga. And for the first time in five years, she and Tom planned a vacation together to rekindle their relationship.

Getting Help in Therapy
Without realizing it, the negative effects of reacting rather than responding to stress can creep up on you until you find yourself in an unmanageable situation.

Rather than waiting until stress feels overwhelming, it helps to work with a professional who can help you to change the way that you're handling stress. Very often, once you learn to respond to stress rather than becoming reactive, your overall sense of well being improves and so do your relationships.

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

I have helped many clients learn to respond rather than react to stress so they could lead more fulfilling lives.

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

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

Psychotherapy and Beginner's Mind

"In the beginner's mind, there are many possibilities, in the expert's mind there are few."
Shunryu Suzuki

Psychotherapy and Beginner's Mind

What is "Beginner's Mind"?
Beginner's Mind, also called Shoshin in Japanese in Zen Buddhism, is maintaining an attitude of openness and curiosity, even when you're considered to be at an advanced level of whatever you're doing, whether it's spiritual, emotional, interpersonal, or just living your daily life.

I'm not a Buddhist, but I like the concept of Beginner's Mind because it reminds us not to prejudge ideas, people or places. In this way, we remain open to the experience. If you think you already know, then your mind is closed off to new possibilities, even when you're an "expert" in the field. We can think of many ideas and inventions that wouldn't have been created if their creators had gone along with accepted wisdom at the time of what people thought they "knew" about what was possible and what wasn't.

I believe that Beginner's Mind is a state that we can continually remind ourselves about and bring ourselves back to in our daily living. It's not a place where you "arrive" and then can forget about it. It's normal to revert back to old habits and ways of thinking beause they're so ingrained in us.

Self Compassion and Beginner's Mind:
Rather than berate ourselves for falling back into the same old habits, as we are apt to do, it's far better to acknowledge our humanity and bring ourselves back to the practice of Beginner's Mind, as we do when we meditate and we find our minds wandering.

Psychotherapy and Beginner's Mind

During meditation, when we find our minds wandering, we bring our attention back to our breath or whatever we were focusing on before we got distracted. With practice, it's possible to get better at maintaining our attention.

In the same way, practicing Beginner's Mind can improve our abllity to cultivate this state of mind over time.

We're not looking for perfection, only an increased awareness.

With Beginner's Mind, We Don't Throw Away Our Experiences and Skills:
We're also not looking to throw away what we already know when we talk about Beginner's Mind. So, for instance, if we're crossing the street or driving a car, we don't want to approach these activities as a complete beginner. If we were in plane, we wouldn't want the pilot to forget about experience and abandon all of his or her skills. The same would be true if we're having surgery. We would want the surgeon to be experienced and know what he or she is doing. We want to use the skills that we have and pay attention.

It's more about creating a balance between using what we know and also being open and curious to new things.

Beginner's Mind and Children:
It's wonderful to observe children, especially infants from about six months to a year old, as they explore their world. Everything is new and exciting to them. A simple spoon can be an object of complete wonder and fascination as something to look at, put in the mouth, bang on a table or hurl in the air.

I remember being a very curious child who wondered about a lot of things and asked a lot of questions. Somewhere around the first or second grade, I learned in school that it was better, in the teacher's eyes, to have "the right answer" rather than to question or wonder about things. 

It seemed that whenever the teacher had a question, a sea of hands would go up and if someone gave "the wrong answer," the teacher went on to the next student until she heard the "right answer" and then she rewarded the student with a smile and praise. There was no rewarding smile or praise for "the wrong answer" or encouragement for working your way through the process so that you could learn and grow, possibly by starting out being wrong and learning from there. The emphasis was on knowing and being "right."

Hopefully, this has changed in schools and teachers are more interested in developing curious minds and not people with "the right answer," which tends to stunt curiosity and creativity.

Being a Beginner as an Graduate Intern:
When I was an intern in graduate school, as I've mentioned in earlier blog posts, my internship was working primarily with men who were homeless in a homeless drop-in center. The atmosphere at this drop-in center could best be described as organized chaos with hundreds of clients with many complex challenges.

After a three week training by the internship clinical supervisor, we began our work with these clients. At the time, I was transitioning from the human resources field and I was working full time at a commercial bank, where I worked with investment bankers, going to my classses on Saturdays, and doing my internship in the evenings from 5:30 PM-8:30 PM every evening during the week. It was a very busy schedule.

I remember thinking then, more than I had ever experienced before, that I didn't like being a beginner. Nothing in my work history, education or personal therapy had prepared me for the experience of working with clients who needed so much with regard to housing, their physical health, their emotional health, and the need to connect interpersonally.

I felt completely unskilled and found myself often thinking that these clients really needed someone who was far more experienced and skilled than I was as a complete beginner. I felt like they were being cheated.

I wish that I had known about Beginner's Mind at that time. Of course, the clinical supervisor was there for part of the time and we had weekly supervision. But most of the time, when I was in the moment with these clients, I didn't know what I was doing, especially at the beginning of the internship.

I think most of the interns felt this way during that internship, and we often talked to each other and our supervisor about it. Our supervisor had a completely different view. He thought that the clients really benefitted from having beginners assist them because most of us didn't have very many preconceived ideas about the work or about the clients. He thought that we could approach the clients with open minds, and he encouraged us to maintain a sense of openness and curiosity. Again and again, he emphasized being curious and open, the same concept as Beginner's Mind, although he never called it that.

Learning about the concrete services that the clients needed came a lot easier than beginning to understand the emotional fallout of being homeless, and most of the clients had long trauma histories.

Spending my days working on Park Avenue with investment bankers and my evenings with the poverty-stricken clients made both worlds seem unreal after a while because each world seemed so extreme. It also struck me as unreal that I could walk just a few blocks from Park Avenue to this homeless drop-in center and I was in a completely different world, but this is so true of many areas in New York City and other large cities.

Psychotherapy and Beginner's Mind

Over time, I realized that my supervisor was right. I began to see many experienced social service workers who were jaded and somewhat inured at the center. Many of them were burnt out and just trying to survive themselves on low wages.

But most of the interns felt they had to be on their toes all of the time. We knew that we were beginners. We also knew that, often, we didn't even know what we didn't know. But most of us were ready to roll up our sleeves and do what needed to be done, trying to remain curious and keeping an open mind.

Not only did we learn a lot from our supervisor, but we learned even more from our clients. I was amazed at how generous most of the clients were, considering their circumstances, to share whatever information they had from being in and out of different social service systems over the years or learning about the law while incarcerated.

Most of the clients were truly grateful that we spent time and effort with them. And, even though there was violence at times at the center among the clients, while I was there, I never witnessed any violence towards any of the interns. The clients seemed to have adopted us as their "students," even though most of us were older than them, they were protective, and most had a genuine affection for us. It was an experience that I'll never forget.

Being a Beginner as a Psychotherapist:
After I completed graduate school, I went on for postgraduate training at a psychoanalytic instiitute. It was one of the most intense, rigorous, and fascinating educational experiences of my life. It was considered an "immersion" experience because we attended classes, supervision, our own 3x per week personal psychoanalysis while seeing clients for psychotherapy at the same time.

Once again, I was a beginner, especially the first year, with all of the feelings of anxiety, humility, and confusion that went with that experience. During the first year, most of us felt like we were in a fish bowl, being observed by our instructors, supervisors, as well as our clients.

Many of the clients who came to the institute were feeling depressed, anxious, panic stricken, challenged by difficult relationships, and traumatized by their childhoods, among other problems.

During the first few months, I was more frightened than I would've admitted to my supervisors or teachers, about what might come up in a psychotherapy session--maybe something that I wouldn't know how to handle. Of course, as new therapists, we were not alone and there was an entire institute of seasoned professionals to call on--eventually. But in the moment when each of us were sitting with clients in an office, we were alone and on our own.

I still didn't know about Beginner's Mind or meditation at that time. I felt that I was expected to know, even though I often didn't know. And each week, each of us were on the "hot seat" at least once or twice in our individual supervisions or group supervisions to present a client's case, verbatim (what the client said, what we said to the client).

I don't want to make it sound like we were being grilled as new therapists because we weren't. Most of supervisors and instructors were kind and compassionate people who had gone through the same training that we were going through. I think, as new therapists, who wanted to help our clients and who wanted to seem competent to our instructors and supervisors, we put most of the pressure on ourselves. This also served to keep us on our toes to be diligent about finding out about situations that we didn't know about or to understand unfamiliar concepts.

I remember thinking to myself, once again, that these clients deserved to be seeing someone else--a therapist with a lot more experience and knowledge than I had. Even though there was no secret that this was a postgraduate training center, I wondered how many clients really knew that they were seeing psychotherapists in training. I suspect that many of them thought that if you were seated in the psychotherapy room and you were seeing them, you must know what you're doing, which only added to the pressure the trainees felt.

By the second year, we were over the period of "baptism by fire" of the first year. Many of us were continuing with the same clients and we were feeling a little more confident, still new, but not so worried about the proverbial fish bowl.

Part of what came next in training was that we had to become more proficient at diagnosis. While the psychodynamic processs was the emphasis of training and, fortunately, diagnosis was not the major focus of psychoanalytic training, it was still significant.

While I think it's important to be able to diagnosis to a certain extent, especially if clients have major depression, bipolar disorder, ADHD, or other problems that have a strong biological component and where medication might be needed, focusing exclusively on diagnosis is very limiting to the work.

When you're first learning about diagnoses, it's an occupational hazard that not only do you feel you often see the diagnoses in your clients, but you begin to see it in your friends, family, loved ones (much to their chagrin), and in yourself.

I can laugh now when I think that it was not unusual in that early stage of training for new therapists who became friends to say to each other, "Do you think I suffer with narcissistic personality disorder?" or "I think I have some borderline personality disorder traits."

I've heard that medical interns go through similar experiences. I think this happens when you're so immersed in learning about the diagnoses that you think you see them everywhere.

The problem with too much of a focus on diagnosis is that you can reduce the client to a particular set of behaviors and dynamics. It becomes too easy to rely on the American Psychiatric DSM (Diagnostic and Statistical Manual) and forget that you have a client in front of you who is multi-dimensional and multi-faceted in many ways. People are too complex to reduce them to a few lines in a manual. And when we reduce people to a diagnosis, it's easy to lose compassion for them.

The other problem is that when a therapist reduces a client to a diagnosis, it's often the opposite of keeping an open mind because the therapist can think that she or he knows, using only the diagnosis, what's going on with the client. It's the opposite of Beginner's Mind. It's far better to remain open and curious about what's going on, holding onto any particular diagnosis in a tentative way, if it's relevant, keeping in mind that this might not be correct, it could change, each person is unique and that not all people with a particular diagnosis are the same.

Beginner's Mind as a Psychotherapist:
I don't want to sound like I'm presenting myself as someone who has reached the pinnacle of using Beginner's Mind. Far from it. I still need to remind myself to be open and curious, but I think I remember more often now beforehand rather than remembering after the fact. Now that I have more experience, I'm also more willing to be wrong, as compared to when I was new to the field years ago.

Part of the job of any experienced psychotherapist is to approach each client and each new session with Beginner's Mind, even if they don't call it that. Skilled therapists who are willing to use their skills and their intuition are usually better therapists than therapists who think they always know what's going on with clients.

Therapists are only human and it's easy to make the mistake by assuming that you absolutely know. It's a far better approach for therapists to consider ideas that they might have as possibilities, not to get wedded to them, so that, if they're wrong, these possibilities can be thrown out and the therapist can learn from the client what's really going on.

If they're right and their skills and intuition have lead them in the right direction for the benefit of the client, that's great. But assuming, as a therapist, that you're always right is a big mistake (as it would be for anyone). It's better to start with Beginner's Mind. And if a therapist forgets, as I sometimes do and must remind myself, it's better to acknowledge it and bring yourself back to an open mnd. This is a humbling, but necessary process.

Being a Smart Consumer of Mental Health Services:
It's a delicate balance and an ongoing challenge. Clients, of course, want therapists that are licensed, experienced and skilled. Licensure, skills and experience count, just as they do for a doctor, a pilot, or a teacher. Before there was licensure, anyone could call him or herself a psychotherapist in NY, but now that there's licensure, it's no longer legal to call yourself a psychotherapist if you don't have a license.

Getting Help in Therapy
As a smart consumer of mental health services, you want to know that your therapist is qualified to treat you. I've seen many clients hurt when they went to unlicensed, inexperienced and unskilled people for psychological problems. Unfortunately, there are some people who advertise themselves as coaches or New Age counselors, offering "quick fixes," who are working outside the scope of their skills and knowledge, and this is often hurtful to clients.

 If you want to find out more about Beginner's Mind and how you can develop more of an openness and curiosity about life, I suggest you read a book called Zen Mind, Beginner's Mind by Shunryu Suzuki. As I mentioned previously, I'm not a Buddhist, and I've found the concept of Beginner's Mind to be valuable. Even if you're not a Buddhist and you have no interest in Buddhism, you could benefit from reading this book to learn more about Beginner's Mind.

About Me

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

Psychotherapy for Shock Trauma

In my last blog post, Understanding Shock Trauma, I discussed shock trauma, including the types of traumatic events that can cause shock trauma and its symptoms. In this blog post, I will discuss psychotherapy and shock trauma and the treatment modalities that I find most effective in my psychotherapy private practice in New York City.

Psychotherapy for Shock Trauma

Psychotherapy for Shock Trauma - Initial Phase: Assessment and Developing Resources
When clients come to me to be treated for shock trauma, I assess each client with regard to the nature of the trauma and their internal and external resources. Before any processing of the trauma can begin, clients must have adequate internal and external resources or the trauma processing could be overwhelming for them.

What are Internal and External Resources?
When I refer to internal resources, I'm referring to a person's coping abilities. If the client doesn't have sufficient coping abilities, I assist them to develop them. Internal resources can be any of the following: an ability to meditate or calm oneself by taking calming breaths, visualizations of relaxing places, visualizations of supportive people in their lives, memories or associations of times in their lives when they felt good about themselves (confident, powerful, competent) and so on.

External resources can include friends, family, loved ones, mentors, coaches, or pets. If a client is in recovery for substance abuse or some other form of addiction, it could include 12 Step meetings, peers in 12 Step meetings, and sponsors.

Psychotherapy Treatment Modalities:
When dealing with trauma, I usually use mind-body oriented psychotherapy such as Somatic Experiencing, clinical hypnosis, or EMDR, depending upon the needs of the client. Sometimes, depending upon the needs of the client, I might use a combination of these treatment modalities. The treatment plan is a collaborative effort with the client.

Psychotherapy for Shock Trauma - Processing the Trauma:
Once the client has developed adequate resources, I titrate the trauma work so that it is performed in manageable pieces. (Titration means in manageable doses.) When dealing with the trauma, we're dealing with the reptilian brain (see prior blog post about the triune brain). The reptilian brain processes about 7x slower than the neo-cortex, so trauma work is, by necessity, slower than other types of work that is done in psychotherapy. If the therapist goes too quickly, the reptilian part of the client's brain will be overwhelmed and it will be to0 much for the client.

I help the client to move gently back and forth between manageable emotional activation related to the trauma and a calm emotional state so that the trauma work remains in a tolerable range.

The client is the best judge in terms of what he or she experiences in trauma work, so the client is in charge, and I am guided by his or her feedback during sessions.

Psychotherapy for Shock Trauma - The Goal of Treatment:
Using one of the mind-body oriented psychotherapy treatment modalities, the goal is for the client to process the trauma and to discharge the trauma-related "stuck" energy which is being held in the body so that the client can return to at least as good a level of his or her former level of overall functioning or better.

The discharge of "stuck" energy can come in many forms, including breathing out stressful energy, perspiring, yawning, experiencing tingling, and other forms of discharge. The client often senses when he or she has discharged the trauma-related energy that has been "stuck" in the body because there is a sense of calm or relief for the particular piece of trauma work that has been worked on.

Psychotherapy for Shock Trauma - Developing Self Compassion:
Many clients who begin trauma work blame themselves for what happened to them. They get caught up in negative cycles of self talk where they berate themselves, telling themselves that they should have known better or they shouldn't have gone to a particular place, etc. This only exacerbates their trauma symptoms.

During treatment, I help clients to realize that they're not to blame for what happened to them or for their trauma symptoms. Helping clients to develop self compassion is also part of the way I work with traumatized clients from the beginning so they don't get caught in negative cycles of self blame.

About Me

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

I work with individual adults and couples.

I have helped many clients to overcome traumatic events in their lives, including shock and developmental trauma, so that they can go on to lead productive and meaningful lives.

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

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

Understanding Shock Trauma

What is Shock Trauma?
As opposed to developmental trauma, which develops over time when traumatic events overwhelm a child, shock trauma occurs usually from an overwhelming one-time event. Shock trauma can occur to an adult or a child. It can occur from experiencing the traumatic event or witnessing it. The traumatic event is usually sudden, unexpected and has a distinct beginning and end.

Understanding Shock Trauma

Many people describe their experience of shock trauma as if their whole world has been turned upside down. They describe it as if the rug has been pulled out from under their feet. Often, their perspective of their internal world and the world around them changes and they feel unsafe and that life is very unpredictable.

As with any overwhelming event, the trauma is not in the event itself, but in the way the person experiences the event. As a result, two people can experience the same event and one person might become traumatized while the other person does not.

What Type of Events Cause Shock Trauma?
There are many different types of events, which can cause shock trauma, including:

• accidents
• natural disasters
• acts of war
• assaults
• falls
• invasive medical procedures, and so on

Understanding Shock Trauma

What Are the Symptoms of Shock Trauma?
Each person has his or her own individual experience with regard to shock trauma. These symptoms can include:

• anger
• anxiety
• panic attacks
• depression
• a sense of helplessness
• a sense of hopelessness
• a need to be vigilant all or most of the time
• flashbacks
• nightmares
• isolation
• loss of interest in activities that used to be pleasurable
• exhaustion

In my next blog post, I will discuss psychotherapy for shock trauma and the treatment modalities that I find most effective in my psychotherapy private practice in NYC.

About Me

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

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.

See my article:  Psychotherapy For Shock Trauma

Trauma, the Triune Brain & Somatic Experiencing

What is the Triune Brain?
The triune brain is made up of three parts that developed in humans through evolution over time. Triune means "three in one."

Trauma, the Triune Brain and Somatic Experiencing

There is the reptilian brain, the mammalian brain, and the cognitive brain. All three parts of the brain inter-relate and communicate with each other. The reptilian brain developed first and it is the oldest part of the brain. The mammalian brain developed next, and the cognitive brain developed last in evolution.

I will discuss the reptilian brain last since this is the part of the brain that carries trauma when a person has been overwhelmed by a traumatic event.

The Cognitive Brain:
The cognitive brain is located in the pre-frontal or neo-cortex part of the brain. As mentioned earlier, this was the last part of the brain to develop through evolution. The cognitive brain is responsible for thoughts, planning, language, logic and awareness.

The Mammalian Brain:
The mammalian brain was the second part of the brain to develop through evolution. It is located in the middle brain. The mammalian brain mediates feelings, relationships, nurturing, images, and unconscious activity, including dreams and play. The mammalian brain fosters attachment between caregivers and infants when there is good enough caregiving. It also fosters empathy between individuals.

The Reptilian Brain:
The reptilian brain developed first during the evolutionary development of the brain, and it can be found in species from reptiles to humans. It is the oldest part of the brain in terms of the development of the triune brain. The reptilian brain sits at the base of the skull. It's responsible for instincts, including the sympathetic nervous system's survival instinct of fight-flight-freeze when there is perceived danger.

When a person perceives him or herself to be in danger, emotions and physiological energy are generated by the reptilian brain so that the person can take action. When this energy is not discharged (through flight or flight), it is stored in the person's muscle tissue. This emotion and energy are imprinted in the nervous system. This is what we mean when we refer to "trauma." Trauma is usually associated with feelings of powerlessness and helplessness.

Somatic Experiencing and the Trauma Vortex:
According to Peter Levine, Ph.D., who developed Somatic Experiencing, this trauma-related energy, which has not been discharged, can be conceptualized as being part of a trauma vortex.

Trauma, the Triune Brain and Somatic Experiencing 

The trauma vortex is a metaphor to describe what happens when trauma-related energy is "stuck" and has not been discharged. The trauma-related energy saps the person of vitality. This energy is trapped and unavailable for other life-affirming and life-enhancing activities.

Somatic Experiencing and the Healing Vortex:
Just as we can conceptualize the trauma vortex as the place where trauma-related energy is stuck, in Somatic Experiencing, we can also conceptualize the metaphor of a healing vortex.

The Somatic Experiencing therapist helps the client to develop this positive, healing energy to counteract the negative experience of the trauma vortex. The healing vortex can be any positive experiences, associations, memories, visualizations, and felt sense experiences that the traumatized person develops in Somatic Experiencing therapy.

The Somatic Experiencing therapist facilitates the healing process by "titrating" the processing of the trauma in therapy. "Titration" in this context means that the trauma is processed in manageable doses so it does not overwhelm the client or retraumatize him or her.

Trauma, the Triune Brain and Somatic Experiencing

Gradually, over time, the client, who is in Somatic Experiencing therapy, develops a greater capacity for self containment. By tracking the client's physiological and emotional experiences in treatment and with the use of titration, the Somatic Experiencing therapist helps the client to expand this capacity over time, so that as treatment unfolds, the client is better able to tolerate processing the trauma with increased coping abilities and a greater capacity for resilience.

When trauma is being processed, the therapist is dealing with the client's reptilian brain, where the trauma is stored. Compared to the cognitive brain (neo-cortex), the reptilian brain processes information 7x slower. This is why trauma work must be done in manageable pieces because if too much trauma work is done too soon, the reptilian brain becomes easily overwhelmed.

Somatic Experiencing is a mind-body oriented psychotherapy and it is one of the safest and most effective ways to process emotional trauma.

To find out more about Somatic Experiencing, visit the Somatic Experiencing website: http://www.traumahealing.com.

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

Experiential Psychotherapy and the Mind-Body Connection

In recent years, increasingly, many psychotherapists have come to realize that mind-body oriented psychotherapy offers opportunities for healing that regular talk therapy alone often does not offer. 

There are different types of experiential psychotherapy, including clinical hypnosis, EMDR (Eye Movement Desensitization and Reprocessing), Somatic Experiencing, all of which I have used in my psychotherapy private practice in New York City.

Many Experiences of Talk Therapy, But No Change:
Many clients come to see me feeling discouraged. Often, they have made many attempts on their own and attempts in regular talk therapy to make changes in their lives, but these attempts have not resulted in change.

Experiential Psychotherapy and the Mind-Body Connection

Often, clients in regular talk therapy develop intellectual insight into their problems, but there is no emotional insight. They can explain why they have the problems that they have, but no healing has taken place.

Why is this? Usually, it's because regular talk therapy alone often doesn't penetrate beyond our conscious minds. It involves our intellect which, of course, is important for any type of change that we might be contemplating. But for many problems, this isn't enough. The treatment needs to go beyond the surface to a more visceral level.

Why is Experiential Psychotherapy More Effective Than Regular Talk Therapy?
Mind-body oriented psychotherapy will often access deeper levels of consciousness because we can feel the treatment occurring on a visceral level. 

It's not just a matter of talking about the problem on an intellectual level. Mind-body oriented psychotherapy helps clients to change from the inside out. Clients are taught how to recognize where they feel their emotions in their body, and this helps them to access deeper levels of consciousness as well as enabling them to change at a deeper level.

I'm not saying that regular talk therapy doesn't ever work. My early training is as a psychoanalyst and I still practice psychodynamic psychotherapy. However, for many problems, this type of therapy is not enough, which is why so many psychoanalysts and psychodynamic psychotherapists have learned various types of mind-body oriented psychotherapy.

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

LGBTQ Relationships: Dealing with Homophobia in Families

As a psychotherapist in New York City, I've worked with many LGBTQ in couples counseling as well as in individual therapy where their families have not accepted that they're gay or that they're in a gay or lesbian relationship. The families' disapproval often causes individuals in gay and lesbian relationships to feel that they have to choose between spending time with their partners and spending time with their families.

LGBTQ Relationships: Dealing with Homophobia in Families

Of course, there are varying degrees of acceptance--everything from outright disapproval to half hearted acceptance to fully embracing the relationship and everything in between. It can be a very heart wrenching decision as to how to handle these situations.

The following scenario is based on a composite of many cases, and it does not represent any particular couple:

Vickie and Susan:
Vickie and Susan had been living together in a committed relationship for over three years when they came to couples counseling. They were both in their early 30s and had successful professions. Susan's family lived in NYC, and Vickie's family lived out of state.

Susan tended to be "out" as a lesbian to her family, at work and in most social situations. Vickie tended to be more reserved and she only told certain people that she was a lesbian. She had never told her family directly that she was a lesbian, but she assumed that they knew and they just never discussed it.

They had many close lesbian and gay friends, both single people and couples, in NYC that they socialized with during the year. But the holiday season often presented a problem. If they were staying in NYC, there was no problem because Susan's family embraced Vickie as their daughter-in-law and made her feel at home. They would also spend time with their friends, both heterosexual and gay.

But there were certain years where Vickie missed her family and they wanted her to spend the holidays with them. In most ways, Vickie was close to her family and she loved them. She liked spending time with her parents, and her older sister. Her family had many holidays rituals that Vickie enjoyed from the time she was a young child. The problem was that, even though they knew that she lived with Susan, she had never told them explicitly that they were life partners.

Both Vickie and Susan wanted Vickie's family to recognize and honor their relationship, but Vickie was too afraid of losing her family if she actually "came out" to them and told them that Susan was her wife. For Vickie, it was one thing for it to be understood that Vickie was a lesbian without having to discuss it, and it was quite another for her to be direct about it.

At certain times, Susan and Vickie would argue about this during other times of the year. Susan wanted Vickie to be more direct and "come out" as a lesbian and introduce Susan as her wife. But their disagreements about this were never as bad as they were during the holiday season.

When Vickie and Susan started couples counseling, Vickie's family was urging her to come to see them for the holidays because they had not seen her the prior two holiday seasons. Vickie felt torn about what to do. On the one hand, she missed her family and she wanted very much to see them. On the other hand, she didn't want to hurt Susan's feelings by going without her or inviting her to come without defining their relationship to her family.

Aside from dealing with homophobia among friends and families, internalized homophobia can be just as challenging, if not more challenging for someone who is a gay man or a lesbian. And both Susan and Vickie had to be willing to look at their own internalized homophobia in couples counseling, especially Vickie, with regard to this situation.

In working through this problem in couples counseling, Susan and Vickie both made a commitment to put their relationship first. Vickie had to confront and overcome her fears about her family's reaction if she told them directly that she was a lesbian and she was in a lesbian relationship. Her worst fear was that her family would cut her off. She also had to look at how she was withholding an important part of herself from her family and the effect this was having for her own internal world, as well as the effect on Susan and their relationship.

As we worked through this issue, we came up with a plan that began by Vickie telling the person in her family who would be most receptive, her older sister. As Vickie expected, her older sister told her that she already knew that Vickie was a lesbian and she suspected that Susan was more than just a "roommate." She told Vickie that she would love to meet Susan. But she agreed with Vickie that their parents probably wouldn't be as receptive to Vickie being openly gay and bringing her partner for the holidays. She told Vickie that she was in her and Susan's corner, no matter how their parents reacted and she would be supportive.

Vickie was relieved that her sister was supportive, but she knew that talking to her parents would be more challenging. They tended to be conservative and not open to people and situations that didn't fit into their values.

Vickie decided to talk to her mother first because she felt that, even though both parents were conservative, her mother was a little more open than her father. When the day came for Vickie to have the conversation with her mother, as we discussed, she "bookended" her call by talking to her best friend first and planning to talk to her after she spoke to her mother. This helped her to feel supported.

Vickie had a plan for how she was going to broach the topic of being a lesbian in a lesbian relationship with her mother, but her mother threw her off by interrupting her and telling her about all she was doing to prepare for the holidays. Vickie listened for a while and she felt herself becoming increasingly anxious. At one point, she considered not telling her mother at all. But she didn't want to go back on her commitment to Susan and the commitment that she made in our couples counseling sessions.

After listening for more than 20 minutes to her mother go on about the holiday preparations, Vickie knew that she had to say something at that point or she might lose her nerve. So, when her mother took a breath, Vickie began by telling her mother that she was the most happy that she had ever been in her life. She was afraid that if she didn't tell her mother this from the outset, her mother might not hear it after she "came out" and talked to her about her lesbian relationship.

Vickie's mother reacted positively and told her that she was pleased that she was happy. Then, Vickie took a deep breath and told her mother, for the first time, that she was a lesbian and Susan is her wife. There was silence on the other end of the phone for a few long seconds. When she spoke, Vickie's mother's tone of voice had completely changed. Whereas she had been upbeat and chipper before, she spoke in a whisper and told Vickie that she must never tell her father this because he would be devastated. She also told Vickie that she never wanted to talk about this again. Then, she began to change the subject.

At that point, as planned, Vickie told her mother that she knew that it might be hard for her to understand, but it was important to her that the family accept that she is a lesbian and that she is in a committed relationship with Susan. 

Again, there was a long pause at the other end, and finally her mother told Vickie in a whisper, "We know you're a lesbian. We figured it out a long time ago. But we don't have to talk about it and you don't need to throw it in our faces. We love you very much, but you can't expect us to talk about this as if it were nothing. And you can't expect us to accept that you're in a gay relationship. If you want to invite Susan to come for the holidays, she can come, but you can't flaunt your relationship and you can't stay in the same room."

Vickie was deeply disappointed, but she was not surprised. As agreed, she told her mother that she couldn't and wouldn't come under these circumstances, and she hoped that they could talk about this in the future and try to work it out. But, for now, she was spending the holiday with Susan and her family. At that point, Vickie's mother hung up the phone, and Vickie didn't speak to her parents for over a year.

Vickie and Susan remained in couples counseling to work through the repercussions of this turn of events. It placed a strain on their relationship, but they were both committed to staying together and working things out. They also strengthened the bonds of their relationships in the lesbian and gay community so they felt supported among other gay people who had similar experiences.

Vickie's older sister was also supportive and she came to NYC to meet Susan and to spend time with them at their apartment. It meant a lot to Vickie to have her sister show support for her and her relationship, even if she wasn't talking to her parents.

Vickie's sister told her that their mother broke down and told their father, even though she had told Vickie not to say anything to him, and he was even more upset about it than their mother. When they weren't discussing it openly, prior to Vickie's call, they put the whole idea of Vickie being gay in the back of their minds. But when Vickie talked about it openly with her mother, it was too confronting for the mother. It also removed any shadow of a doubt that Vickie was a lesbian and that she was in a lesbian relationship.

The following year, Vickie's sister announced that she would host the holidays in her house and she was inviting Vickie and Susan. 

When her parents heard about this, they told her that they wouldn't come if Vickie was coming to "flaunt" her relationship with Susan--to which Vickie's sister responded, "That's up to you. But if you come, I expect you and dad to be pleasant and respectful of Vickie and Susan." She gave them a book to read that was written for parents of gay children. She also gave them information about PFLAG (Parents, Families and Friends of Lesbians and Gays).

After much chaos and commotion, the parents decided to come. Vickie and Susan were anxious, and it was obvious that when Vickie's parents came, they were also very anxious too. There were anxious and awkward moments when Vickie introduced them to Susan. But, eventually, things settled down, at least on the surface, and everyone was polite. But there was an under current of emotional strain in the air.

This was the first of many holidays where Vickie and Susan went home to see Vickie's family. Over time, Vickie's parents got to know and like Susan and Susan began to feel more comfortable with them. Vickie's parents even began to attend PFLAG meetings and talk to other parents of gay children. 

After a while, they were able to talk to Vickie more about her life with Susan. They told her that they didn't understand, but she was still their daughter, they loved her, and they wanted her to be happy. And if being happy meant that she was a lesbian and in a relationship with Susan, they accepted this.

Having gone through this ordeal together strengthened Susan's and Vickie's relationship. They both wished that Vickie's parents would more than just "accept" their relationship, but they came to terms with it, and it no longer interfered with their relationship.

For Vickie, as an individual, "coming out" as an open lesbian and telling them that her relationship with Susan came first was a huge step. It strengthened her self confidence and it was a great relief not to have this secret any more.

Conclusion
The above composite scenario is one of countless ways that lesbian and gay couples and individuals cope with homophobia in their families. 

LGBTQ Relationships: Dealing with Homophobia in Families

There is no one right way to deal with these situations. Each individual and each situation is unique.

Getting Help in Therapy
If you're a lesbian or gay man who is struggling with similar "coming out" issues, you could benefit from getting help from a psychotherapist who specializes in gay and lesbian issues. You could also benefit from seeking support from LGBT support groups.

In NYC, you can contact the LGBT Community Center: http://www.gaycenter.org.
They offer a host of services for the LGBT community, including support groups, 12 Step programs, and other special programs specifically for the LGBT community.

If you're outside of NYC, you can contact the Gay and Lesbian National Hotline for support: http://www.glnh.org.

If you're a parent of a gay, lesbian, bisexual or transgendered child, you can educate yourself and get support through Parents, Families and Friends of Lesbians and Gays. : http://www.pflag.org.

About Me

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

I work with individual adults and couples.

I have helped many gay and lesbian individuals and couples with their own "coming out" process, relationship issues, and other issues specifically related to the lesbian and gay community.

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.