APA: Research Reveals Psychotherapy Is Effective But Underutilized

According to the American Psychological Association (APA), research reveals that psychotherapy is an effective treatment for that helps to reduce not only mental health problems but also improves long term health.  

Yet, despite this research, according to the APA, mental health treatment has decreased over the last 10 years or so as more people attempt to rely on psychotropic medication for their emotional problems (see link below for the APA article).

Research Reveals Psychotherapy is Effective But Underutilized

The article cites the findings of 50 peer-reviewed studies that demonstrate psychotherapy's effectiveness across age and racial groups.

According to the APA article, research has shown that a combination of psychotherapy and medication is effective in treating anxiety and medication.

In my experience as a psychotherapist, I've found that many clients who might think, initially, that they might need to be on medication are often helped with psychotherapy alone combined with exercise or yoga.  Of course, each client is different and what works for one client might not work for another.  But this is also true for psychotropic medication.

The APA article also indicates that research has shown that the positive effects of psychotherapy often last longer than psychotropic medication.

Also, psychotherapy is often effective for teaching clients life skills that the clients benefit from long after they have completed psychotherapy.

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.

Research Shows Psychotherapy is Effective But Underutilized

Are Your "Cold Feet" Just Common Pre-Wedding Jitters or a Cause For Concern?

It's not unusual for people who are about to get married to feel a little anxious about taking such a life-changing step in their lives.  We often refer to this as "having cold feet" or "pre-wedding jitters," and most people recognize this as a common experience.  But how do you know if what you're experiencing is just "pre-wedding jitters" or if what you're sensing are "red flags" about the marriage?

Are Your "Cold Feet" Just Common Pre-Wedding Jitters of a Cause For Concern

Many couples find it helpful to go to pre-marital counseling to talk about their hopes and expectations about their upcoming marriage.

Pre-marital counseling provides an opportunity to discuss important issues like, for example, your views about: 

• what it means to be married
• how you feel about sex
• whether you want to have children or not
• if your religious or spiritual beliefs are in synch with each other
• how you want to conduct your financial affairs

Pre-marital counseling is also usually the place where people raise any concerns they might have about the other person or about how well suited they are as a couple to get married.  

Are You Experiencing Common Pre-Wedding Jitters or Sensing Red Flags?
Attending pre-marital counseling can help you to determine if what you're experiencing is just common pre-wedding jitters (so-called "cold feet") or if your anxiety is a signal that something might be wrong in your relationship that could cause problems in a marriage.

Don't ignore or override your concerns.  It's better to express your concerns before you get married than to go through with the wedding and have regrets later.


If you're just experiencing the kind of "cold feet" that people often feel before getting married, you can set your mind at ease before the wedding.

But if there are real concerns, you also have an opportunity to try to work these issues out, if they can be worked out, before you get married.

If you're trying to determine if your anxiety is normal pre-wedding jitters or if you're sensing "red flags" about getting married, it's best to seek a counselor who is a licensed mental health professional who can be objective and who has experience working with couples.

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


photo credit: sergcot via photopin cc

Are Toxic Secrets Ruining Your Relationship?

The ability to maintain privacy and healthy boundaries is a part of normal development.  As part of normal development, you don't divulge very personal details about yourself indiscriminately to people you're not close to in your life.  But when you keep secrets, especially toxic secrets, from your spouse, you can ruin your relationship.

Are Toxic Secrets Ruining Your Relationship?

What Is a Toxic Secret?

The following list are examples of toxic secrets:

• You're having an extramarital affair
• You're drinking excessively or using drugs when the rest of the household is asleep
• You're overextended on credit cards and you haven't told your spouse
• You have a bank account that you've never told your spouse about
• You're being audited by the IRS and you haven't told your spouse
• You have a child from another relationship that you've never told you're spouse about
• You've lost your job, but you haven't revealed it to your spouse yet

I'm sure you can think of many more examples of toxic secrets, but this gives you an idea of what I'm referring to in this blog article.

How Can a Toxic Secret Ruin Your Relationship?
People who maintain toxic secrets from their spouse are often in denial about the effect on their relationship of maintaining these secrets.  They often think they can keep secrets indefinitely and it won't have any affect, especially if their spouse never finds out.

But even if your spouse never finds out about your secret, it can still have a detrimental effect on your relationship.

For one thing, it creates a lot of tension and makes the secret keeper guarded and defensive with the spouse.

If you're leery about your spouse finding out about a secret, you're going to be very cautious to do everything you can to maintain that secret.  This means you're must be careful about everything you say and do so that you don't reveal the secret, which can create a lot of anxiety and guilt for you.

You might also misunderstand simple things that your spouse says and even an innocent question like, "Where are you?" might cause you a great deal of distress if you think your spouse is questioning your whereabouts because he or she is trying to find out your secret.  This could make you irritable and jumpy which, in itself, can cause problems in your relationship.

Keeping toxic secrets can also cause health problems.  The guilt and stress involved with keeping a toxic secret can take a physical toll of the secret keeper.  Over time, this can cause stress-related illnesses.

On the other hand, if your spouse finds out about your toxic secret and s/he doesn't find out about it from you, at the very least, it will probably cause a great deal of emotional pain, anger and mistrust.

Many couples don't survive the kind of blow to their relationship involved with a spouse discovering a toxic secret.  Often, the spouse who feels betrayed doesn't regain the trust needed to remain in the relationship.

Getting Help in Therapy
Of course, no one can tell you what to do with regard to keeping secrets from your spouse.  

But if you think that keeping secrets from your spouse is eroding the emotional intimacy in your relationship or if your spouse has discovered your secret and this has become a major obstacle to the stability of your relationship, you owe it to yourself to get help.

Don't wait until it's too late.  The negative impact of toxic secrets has a way of getting worse over time.

A skilled mental health professional who has experience working with this type of issue can help you and your spouse to work through this problem if both of you want to salvage your relationship.

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.

Overcoming the Fear of Falling In Love and Getting Hurt Again

I see many clients who have had their hearts broken in prior relationships and who fear falling in love and getting hurt again.

Overcoming the Fear of Falling in Love and Getting Hurt Again

An article that I read in the New York Times Modern Love section called:  "Fear of Surrendering Again: Ready In Case the Other Shoe Drops" by Julia Anne Miller is a good example of how people often fear getting hurt again in a new relationship (see link below).

Even when people really yearn to love and be loved again, an overwhelming fear of being retraumatized in a new relationship can keep them from getting involved with someone new.

The following fictionalized vignette, which is a composite of many cases with no identifying information revealed, is an example of how someone can yearn to be in a relationship again but needs help to overcome the fear of getting hurt again:

Lee
When Lee first came to see me, she had been dating Bob, a man she met at a friend, Beth's wedding, for several months.  It had been several years since she had been in a serious relationship. She was in her early 40s, and after getting hurt in her marriage and a subsequent long term relationship, she was sure she was through with dating and relationships.

And then she met Bob.

Lee smiled to herself as she thought about Beth, even on her wedding day, orchestrating this meeting by placing Lee next to Bob at the singles' table.  Beth was forever trying to set up introductions for Lee to eligible men and Lee was forever rejecting Beth's efforts.  Now, at last, knowing that Lee was coming on her own to the wedding, Beth had a chance to use her match making skills.

Normally, Lee would be annoyed by Beth's efforts to match her up with a man, but not this time.

Lee wasn't sure what there was about Bob that made her want to reconsider remaining single.  Sure, he was good looking, intelligent, kind, funny and successful.  But there was something else.

When she looked in his eyes, she felt that she just might be able to trust him.  But what if she was wrong?

After her last breakup, which was particularly painful, she preferred to bury herself in her work during the week and see friends or stay home alone on the weekends.  She had resigned herself to remaining single for the rest of her life.  She considered getting a cat, but that was the extent of willingness to make another commitment to a living being.

After 10 years of marriage, her husband (now ex), who everyone agreed seemed like the most caring and trustworthy man alive, ended up leaving her for a woman he met at work.  Her last boyfriend, who also seemed sweet and kind, decided, after six years, he wanted to be free to date other women.  Lee felt she would never get over the pain of that breakup.

Having experienced such excruciating emotional pain in our prior relationships, how could she know if she could trust Bob?

Then, there was her father, who was in and out of the household, constantly cheating on Lee's mother and then coming back to ask for forgiveness whenever things didn't work out with his last girlfriend.  Although Lee understood that her mother was financially dependent upon the father, she still felt anger and resentment towards her mother for taking him back again and again.  She spent most of her childhood and adolescence hating her father, and she only reconciled with him after he was diagnosed with advanced cancer, just before he died--the ultimate abandonment.

We spent much of our early work together helping Lee to rebuild her sense of resilience.  She understood that there were no guarantees in relationships.  Her biggest fear was that if her relationship with Bob didn't work out, she would spiral down into a deep depression and she wouldn't be able to function.

Lee had witnessed her mother become incapacitated by depression after Lee's father left the household for the third time.  Lee bore the brunt of taking care of her three younger siblings.  She vowed to herself that she would never allow a man to make her feel so depressed.  Even in her darkest moments after her marriage, as devastated as she felt, she was still able to go to work, take care of her apartment and function in life.

But after her last relationship, she wasn't sure she could bounce back again from another disappointment if Bob hurt her.

On the one hand, when she became especially fearful, she was tempted at times to call it off with Bob.  On the other hand, most of the time, she knew she wanted to be with him and see where their relationship would go.

We also worked on helping Lee heal from her prior childhood trauma as well as the losses she experienced in her marriage and last relationship.  This was hard work for Lee, but it enabled her to experience her relationship with Bob as separate from those other disappointments, so she could experience it as new and not as being part of a string of disappointments.

Lee also learned to trust her judgment again.  Over time, she was able to open up more with Bob and allow their relationship to grow without feeling the oppressive fear she felt before.

Getting Help in Therapy
There are so many people who close themselves off to the possibility of falling in love again because they fear they'll get hurt.  Even though they might be lonely, their fear overwhelms any possibility of finding happiness with someone new.

If you're someone who would like to have someone special in your life, but you're overwhelmed by fear based on your experiences from the past, you owe it to yourself to get help.

A skilled mental health professional can help you heal from your losses and develop a greater sense of resilience and self confidence.

About Me

I am a licensed New York City 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.

Modern Love: Fear of Surrendering Again: Ready In Case the Other Shoe Drops

Psychotherapists Need to Stop Labeling and Stigmatizing the So-Called "Help Rejecting" Client and Be More Creative Instead

One of the most unhelpful labels that a therapist can pin on a client is the so-called "help rejecting client" or, worse still, "the help rejecting complainer."

Stop Labeling and Stigmatizing the So-Called "Help Rejecting" Client

No matter how a therapist tries to qualify these labels by saying that he or she understands that the client isn't intentionally rejecting the therapist's recommendations or that the client is responding this way out of fear, there's no way around it, these labels are pejorative and damaging to the therapeutic work.  And I can't help feeling that using these labels is a way of blaming the client, making him "wrong" and making the therapist "right."

Generally speaking, clients who are referred to as "help rejecting" are often seen as finding reasons why interventions the therapist attempts in treatment won't work or responding to the therapist's treatment recommendations with, "Yes, but..."

No doubt, when this happens, it's frustrating for the therapist and the client.

Reconceptualizing the So-Called "Help Rejecting Client"
I think it's time that mental health professionals reconceptualize these outmoded labels and begin to "think outside the box."

Better yet, I think we should "retire" the terms "help rejecting client" and "help rejecting complainer" in much the same way we retire certain baseball uniform numbers.  Let's agree to stop using these labels.

I'm not saying that therapists are actually calling clients "help rejecting" to their faces.  It's more of a term used in psychotherapy literature, although I've also seen it written about in certain therapy blogs for the lay public.

Many people might disagree with me, but I think that even if a therapist never utters the words "He's a help rejecting client,"just thinking about the client in this way has the potential to sabotage the therapy.  After all, if the client is "help rejecting" and the therapist's job is to help, what's left to do?

The Client's Fear and Ambivalence
There are clients who are ambivalent about treatment and about making changes.

If you've lived your entire life relating in a certain way and engaging in certain behavior, even if behaving in these ways has caused a lot of emotional pain, it's scary to venture into unknown territory to change.

If a client is afraid to make a change, it's up to the therapist to help the client to feel safe.  The old maxim of "starting where the client is" comes to mind.

This could mean that the therapist might need to get out of his or her "comfort zone" to try something different.  It could mean working in a different way from how he or she would.  This is why it's important to have many different ways of working because therapy can't be a one-size-fits-all endeavor.

It could also mean seeking a consultation with a more seasoned therapist.

In some cases, the therapy might take longer than the therapist and client anticipated.  At times, it might be frustrating for both the therapist and the client.  But the therapist can't go any faster than the client is willing to go.

Engaging the Motivated Part of the Client That Wants Help
Most people understand that, as human beings, we're complex.  Even when we say we want to change, there's often a part of us that doesn't want to change at all.

It's up to the therapist to understand the part of the client that fears change and to engage the part of the client that came in wanting help.

At the start of therapy, the more dominant aspect of the client might be rejecting what the therapist has to offer.  But, usually, underneath the fear and ambivalence there's an aspect of the client that wants to change but doesn't know how.

After all, if a client spends the time and money to come to therapy every week, there must be some aspect of him or herself that wants to change or s/he wouldn't be there.

Therapists Need to Be Creative
Gone are the days when the therapist can take a "neutral stance" with the client.  Good riddance to the days when the therapist sat back and just said, "Uh huh," retraumatizing the client as he poured out his problems!

Therapists need to learn to be creative in their work to help the work come alive.  They need to be a presence in the therapy room rather than being neutral.

Clinical Hypnosis and Somatic Experiencing
There are many creative ways to overcome therapeutic impasses with clients who are ambivalent and/or fearful about change.

I often find clinical hypnosis and Somatic Experiencing to very useful in helping clients to soothe the part of themselves that fears change and connect with the aspect of themselves that wants to change.

Talking about these aspects of self without helping clients to connect to where they're feeling these emotions in the body is very limited.  Talking about it often becomes an intellectual exercise that doesn't lead to actual change.

Helping the client to have a "felt sense" of these conflicting aspects of him or herself makes the therapy come alive in a way that regular talk therapy often doesn't.

Helping Clients to Use Their Imagination
Helping the client to use his or her imagination in an embodied way can open the door for the client to have a "felt sense" of internal and external resources to invoke.

Over time, clients can learn to use these resources to have a corrective emotional experience that wasn't available to them before.  At that point, the client has access to more of him or herself to do the work to make changes.

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.

Overcoming the Insecurities That Are Ruining Your Relationship

I've seen many clients in my psychotherapy office in New York City, both individuals and couples, where personal insecurities were having a negative effect on their relationship.  Often, this takes the form of one or both people needing constant reassurance that they are loved by their partner.

When Needing Constant Reassurance in Your Relationship Becomes a Negative Habit
Needing constant reassurance about your relationship can become a negative habit.  This dynamic can ruin a relationship fast.  It can be exhausting, especially when the person doing the reassuring realizes that no amount of reassurance will alleviate his or her partner's insecurities.

Overcoming the Insecurities That Are Ruining Your Relationship

The following fictionalized vignette is an example of where one person's insecurities in a relationship can have a negative impact:

Jane and Bob:
After Jane and Bob were dating for three months, they realized that they had fallen in love and decided to become exclusive with each other.

As soon as Jane realized that she was in love with Bob, she started feeling insecure:  Did he really love her or was he just telling her this?  Would he meet another woman at work, where there were so many attractive women, and leave her?

When they were together, Jane was vigilant as to whether Bob was looking at other women.  If she thought she saw him looking at another woman, she would panic and ask him for assurances that he loved her.  At first, Bob was flattered and reassured Jane.

But when it kept happening nearly every time that they went out, he began to feel irritated and he told her she had nothing to worry about, and it was annoying for him to feel pressured to constantly reassure her.  This only made Jane feel worse.

Jane's insecurities got worse over time.  If Bob didn't call her back immediately, she wondered if he was with someone else.  When she mentioned this to Bob, he got angry.  He asked her if he had given her any reason to think this.

When Jane calmed down, she knew, in reality, that Bob wouldn't cheat on her.  But once doubt crept into her mind, she had a hard time containing her worries and keeping it to herself. She felt compelled to ask him about it.

After a while, Bob got frustrated and told Jane that she should go to therapy to deal with this.  Jane knew that Bob was right--she was having a problem and if she didn't overcome these insecurities, their relationship wouldn't last.  So, she sought the help of a licensed mental health professional.

During her therapy, Jane realized that a lot of her insecurities stemmed from feelings of abandonment from childhood.  Jane's mother was in and out of her life from the time Jane was born.  So, Jane needed to work through this early loss and her fears of abandonment so she wouldn't displace her fears on Bob.

Jane also developed better coping skills in therapy.  As she was working on her earlier trauma, she learned how to contain her fears and insecurities so she no longer blurted them out to Bob.  Soon, they were getting along much better and talking about moving in together.

Getting Help in Therapy
Assuming that your romantic partner doesn't give you any objective reasons to feel insecure about your relationship, your insecurities might be linked to unresolved childhood issues.  It's hard to see this on your own because your fears and insecurities often feel so real in the current situation, even though they're really part of an earlier trauma.

You could benefit from getting help from a licensed mental health professional who can assist you to work through your fears and insecurities.

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.

The Allure of the Extramarital Affair

For many people who are unhappy or having problems in their marriage, the possibility of an extramarital affair is very tempting.  In many cases, it's a way of distracting themselves and finding a new and exciting sex partner to take their minds off their marital problems.

The Allure of the Extramarital Affair

An extramarital affair can be alluring.  But, ultimately, extramarital affairs often lead to even more problems and heartbreak.  Rather than trying to escape the problems in the relationship, it would be better to either try to work out the marital problems or, if the problems are irreconcilable, to end the marriage in a way that respects both you and your spouse and the love you once felt for each other.

Unfortunately, lots of people, who are unhappy in their marriage, find the possibility of an affair to be too irresistible and find out after it's too late just what a mistake it was to get involved with someone else.


The following fictionalized scenario is an example of how the allure of an extramarital affair created even worse problems:

Ted:
Ted and his wife, Mary, were married for 20 years when he met Betty at a conference.  Ted never had an extramarital affair in all  the years that he and Mary were married.  But, at the point when he met Betty, he and Mary had been having problems in their marriage for several years.

They were arguing about money and what they should do after they retired.  Mary tended to be a saver, and Ted was more of a spender.  Mary wanted to move out of state after she and Ted retired to be closer to her elderly mother, and Ted wanted to remain in NY.

Ted hated any kind of confrontation, so that whenever Mary tried to discuss these issues with Ted, he would get annoyed.  As their arguments got worse, Ted began spending more and more time at work so that by the time he got home, Mary was asleep.  He also went to the office on weekends to avoid the arguments.  So, they spent little time together, which only annoyed Mary more.

The tension between Ted and Mary had also taken a toll on their sex life.  Even when they were together at home, neither of them was in the mood to have sex.  There was too much anger and resentment between them.

Prior to their problems, Ted preferred not to go to conferences, but when his boss told him that there was a conference in L.A. and he offered to send Ted, Ted jumped at the opportunity.  On the last evening of the conference, Ted had too much to drink during the hotel happy hour. Normally, Ted wasn't a big drinker, so he didn't have a high tolerance of alcohol. That's when he met Betty.

Ted wasn't so drunk that he didn't know what he was doing.  He realized that Betty, who worked at his company in another department, was flirting with him.  He told himself that it was harmless to flirt back with her, and he told himself it wouldn't go any further.

When she invited him to her room, he told himself that he would only stay for a few minutes and then he would go back to his own room.  And so he continued to in this way, bargaining with himself that he would only kiss her and he wouldn't go any further.  But the temptation was just too great when she got undressed.  So, this is how the affair began.

When he returned to NY, he told himself that he would meet Betty for a drink and tell her that what happened in L.A. couldn't continue.  He felt guilty about cheating on his wife, but he blamed the alcohol.

Six months into the affair, Ted was still bargaining with himself--he would only see Betty one more time and then he would break it off.  But he continued to see her.  Seeing her made him feel special and the sex was the most passionate it had ever been.  Betty knew he was married and, from what Ted could see, she didn't seem to mind.

One night he came home late, and found Mary waiting up for him.  When she asked him to sit down, he was surprised to see that she looked like she had been crying.  He feared that her mother or one of her elderly relatives had died.  But after he sat down, Mary got straight to the point, "I got a call from a woman named Betty.  Is it true?"

Ted felt the blood drain from his face and he felt a mixture of shock, sadness and anger towards Betty.  Ted and Mary had a long talk about their marriage and the affair.  Ted realized, for the first time in a long time, that he still really loved his wife a lot and he didn't want to lose her.  He begged her to forgive him and promised that he would end it with Betty and never cheat on Mary again.

Mary was very upset, but she told Ted that she didn't want to throw away their 20 year marriage.  She said she wanted them to try to salvage their marriage, and she suggested they attend marriage counseling.

Ted ended his affair with Betty and asked his boss for a transfer to a different site.  His boss told him that people in the department had been gossiping about Ted's affair with Betty, and he also thought it was best for Ted to move to another department.  Ted didn't realize that people at work knew about the affair, and he felt especially ashamed that his boss knew.

Betty was angry that Ted was ending the affair.  She had hoped by calling Mary, Mary would leave Ted and then Betty could have him to herself.  She didn't realize that Ted still loved his wife and wanted to salvage their marriage.  Betty made threats to call Mary again, but she didn't.  Eventually, she stopped calling and texting him.

Mary and Ted had a lot to work on in marriage counseling, including Mary regaining trust in Ted.  Ted also had to learn to develop the ability to deal with their problems instead of running away from them.  It was hard work, and there were times when each of them wanted to stop marriage counseling.  But they both knew that if there was any chance of working out their problems, they needed to stick with it, so they did.

Getting Help in Therapy
If you and your spouse are having problems that you're unable to work out on your own, you could benefit from couples counseling.  Even if you have already decided that you want to end the relationship, a skilled couples counselor can help you to do it amicably.

About Me
I am a licensed New York City 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.