Leaving Therapy Prematurely: Overcoming the Urge for a "Flight Into Health"

In a prior article, When Clients Leave Therapy Prematurely,  I wrote about clients leaving therapy before they've completed the work.  In this article, I'm focusing on a particular dynamic called a "flight into health" where a client avoids any further exploration of his or her problems out of fear with a temporary cessation of symptoms that brought the client into therapy in the first place.

Psychotherapy: Overcoming the Urge for a "Flight to Health"

Often, this "flight into health" is unconscious.  It is based on a fear of further in-depth work on the presenting problem.  At the time, the client is convinced that s/he is feeling better and no longer needs to come to therapy.

S/he is usually unaware that what's really happening is that s/he has convinced him or herself that everything is fine now.  But, usually, s/he is suppressing the symptoms, and the suppression of these symptoms can only be maintained for so long before they come to the surface again.

There are some clients who go through this time after time with different therapists and they are unaware of what they're doing, so they can be in and out of therapy many times.

In many cases, these clients haven't developed the necessary internal resources and coping skills to do the work (see my article:  Developing Internal Resources and Coping Skills).

Let's take a look at a fictional vignette, based on many different cases, to understand how this plays out:

Lynn:
Lynn had been in therapy several times as an adult.  Each time she started therapy, she came for the same reason:  to deal with a history of physical abuse by her mother when she was a child.

Psychotherapy: Overcoming the Urge For a "Flight Into Health"

Her pattern was that she would remain in therapy for several sessions, and when she and her therapist began to speak about how angry and sad she felt about the physical abuse, she would suddenly "feel better" and decide that she no longer needed to be in therapy.

Against her therapist's advice, she would leave, feeling somewhat relieved to have talked about the abuse.  But within a few months, she would begin feeling depressed and anxious about her childhood abuse and decide to try a different therapist.

From her perspective, the prior therapies "didn't work" because she began feeling anxious and depressed again.  She didn't realize that she had fooled herself each time into thinking her problem was resolved when, in fact, it wasn't.

Instead, on an unconscious level, she suppressed her anxiety and depression, and covered it over with a lot of activity to mask her feelings.  She would plan many trips, outings, and social events to keep herself distracted and exhausted.

But after a while, this defensive behavior no longer worked for her and she felt disappointed that her old feelings were back.

When she talked about her prior attempts to get help in therapy with her latest therapist, she expressed her sadness and disappointment that prior therapists were unable to help her.

When the therapist discerned what was happening, she explained the concept of "flight into health" to Lynn as a way to help Lynn to understand her history in therapy.  Somewhat skeptical, Lynn listened, but she didn't feel it applied to her.

She wanted to begin immediately by delving into her traumatic history.

But suspecting that Lynn might be having problems with containing difficult emotions, her therapist told her that it was important to start with building the internal resources to do the work.

Her therapist explained that, without the internal resources and the necessary coping skills, Lynn could become easily overwhelmed and want to leave therapy by convincing herself that she was "feeling better" when, in fact, not much had changed.

Her therapist spent several sessions teaching Lynn how to calm herself with a breathing exercise, the Safe Place exercise, and certain mindfulness exercises.

She also helped Lynn with various containment exercises, including a visualization exercise where Lynn imagined that, before she left each session, she could place her uncomfortable feelings and reactions into an imaginary box with a lid on it that was kept in the therapist's office ready and waiting for the next time that Lynn came to therapy.

Initially, Lynn felt impatient with this preparation phase of therapy.  But when they began working on a memory about the early childhood physical abuse, using EMDR (Eye Movement Desensitization and Reprocessing) and Lynn began to feel overwhelmed, her therapist reminded her to use her internal resources, including the breathing, internal resources and visualizations.

By using her internal resources, Lynn was able to calm herself and contain difficult emotions.  She also made good use of the imaginary box with the lid that allowed her to imagine that she was leaving this traumatic memory and the difficult emotions associate with it with her therapist.  In other words, she didn't have to take it with her.

By the Lynn completed therapy, she felt the difference between her usual "flight into health," which was a defense against completing the work and actually overcoming the trauma.  In hindsight, she realized that whenever she thought she was "feeling better" before, it was only temporary.

Psychotherapy: Overcoming the Urge For a "Flight Into Health"

Lynn and her therapist went back to the traumatic early childhood memories again and Lynn no longer felt upset by them.  She felt compassion for herself as a child, but she no longer felt anxious or depressed.

Her therapist followed up with Lynn several months later, and Lynn told her that their work was holding.

Conclusion
While it's understandable that no one wants to dwell on traumatic memories, the reason why people come to therapy is that these memories are getting in the way of their leading the life that they want.

Emotional trauma doesn't resolve itself on its own (see my article:  ).

Without working through the trauma in therapy, it continues to have a strong impact on your current life.

A "flight into health" is an unconscious defense mechanism that clients use when their fear becomes  too much for them.  They convince themselves that they're "better" when, in fact, "feeling better" is a self generated feeling and only temporary.  Sooner or later, the problem makes itself felt again.

Preparation to do trauma work is essential to help the client to deal with the difficult emotions that can come up.  When clients have developed the necessary internal resources and tools beforehand, the trauma work is usually tolerable.

Rather than going from one therapy to the next, clients can complete the work and go on to lead more fulfilling lives without the affect of the earlier trauma.

Getting Help in Therapy
If you recognize yourself in this article, you owe it to yourself and your loved ones to get help with a therapist who can assist you with the necessary initial preparation.   The time spent doing on preparation before trauma work is well spent in the long run (see my article: The Benefits of Therapy).

Rather than spending the rest of your life carry the burden of your emotional trauma and having it get in the way of leading a happy life, you can learn to contain and tolerate the emotions that arise so that you can resolve the trauma (see my article: How to Choose a Therapist).

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

Growing Up Feeling Invisible and Emotionally Invalidated

Healthy emotional development is based on parental attunement and secure attachment. 

See my articles: 

How the Early Attachment Bond Affects Adult Relationships

What is Childhood Emotional Neglect?

When children grow up in a family where a chronic lack of attunement and their feelings are invalidated, they often grow up feeling invisible as children as well as feeling invisible later on as adults.

Growing Up Feeling Invisible and Emotionally Invalidated

By "invisible" I mean feeling left out, unlovable, excluded, unimportant, ignored, and passed over.

Many of these same children, who grew up feeling invisible and emotionally invalidated in their families continue to feel that way as adults.  They grow up with negative core beliefs about themselves, including:  "I'm not important," "I'm unlovable,""I'm powerless" and so on (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

Without realizing it, many people with these core beliefs perpetuate the problem by withdrawing emotionally if they are in a social situation.  

People around them will often think they are picking up social cues that they're not approachable, so they hesitate to connect with them.

Growing Up Feeling Invisible and Emotionally Invalidated

This often becomes a cycle where people with negative core beliefs eventually avoid social situations because they don't realize that people around them are reading into their facial expressions and overall demeanor that they want to be left alone.

To make matters even more complicated, people with negative core beliefs about themselves are often ambivalent about whether they want to be approached or not.

There is usually a part of them that craves social connection and another part that is fearful of it based on their experiences of feeling rejected from an early age.

See my articles:  

Untreated Emotional Trauma Can Have Serious Emotional Consequences

An Emotional Dilemma: Wanting and Dreading Love

This can leave these individuals feeling lonely, on the one hand, but afraid of making social connections on the other hand (see my article:  Overcoming Loneliness and Social Isolation).

When the loneliness is greater than the fear, people with negative core beliefs about themselves often seek help in therapy.  

It's a brave step for these individuals, who expect to be rejected and abandoned, to seek help in therapy.  If their own parents couldn't provide them with the emotional attunement and validation that they needed, it's hard to believe that a psychotherapist, who starts out as a stranger, would do it.

For many people in this situation, it's a last ditch effort to turn around a lonely, unhappy life, and if they've never been in therapy before, they're taking a leap of faith that they can make themselves emotionally vulnerable in therapy (see my article: Fear of Being Emotionally Vulnerable).

Let's take a look at a fictionalized scenario to illustrate some of these issues and to see how these problems can be overcome in therapy:

Pam

Pam came to therapy when she was in her early 30s.

She thought about seeking help in therapy since she was in her early 20s, but her fear of being disappointed and emotionally abandoned by a therapist kept her from seeking help.  

What precipitated her coming to therapy was that her last close friend, who wasn't married, had gotten engaged and she was preoccupied with her fiancé and her wedding plans to the extent that she spent less time with Pam.  This made Pam feel very lonely, and she realized that if she didn't overcome her fear of being rejected and abandoned that she would ensure that she would be alone for the rest of her life.  

The fear of being alone for the rest of her adult life was greater than her fear of being disappointed and emotionally abandoned in therapy, so she obtained a referral from her doctor and set an appointment.

Pam was intelligent and she had a lot of insight into her negative beliefs about herself and how these beliefs developed from a young age.

Even though she could see where her problems began and how they were affecting her as an adult, she had little faith that anything, including therapy, could make a difference for her.  But she didn't know what else to do so, at the recommendation of her doctor and her close friends, she kept the appointment.

She was very apprehensive while she sat in the therapist's reception area waiting for the initial consultation. She was tempted to get up and leave, but before she knew it, the therapist came in to the reception area to get her (see my article:  Starting Therapy: It's Not Unusual to Feel Anxious and Ambivalent).

The therapist started the session by asking Pam what brought her to this consultation and what she hoped to get out of therapy.  Pam knew the therapist was going to ask her this, but when she attempted to speak, she felt overcome with sadness and shame and choked back tears in order to speak.

Seeing that Pam was having a hard time, the therapist told Pam to take her time. She helped Pam to feel more comfortable by normalizing her experience and telling her that many people feel uncomfortable during the initial consultation, so Pam's reaction wasn't unusual.

Pam took a deep breath and spoke about how afraid she was that she would be alone in life.  She had three close friends, all of whom were either married or engaged and this precipitated an emotional crisis for Pam.  

Even though she was happy for her friends, she couldn't help comparing herself to them and feeling like she was coming up short because she had never been in a serious relationship before.  Worse still, her friends weren't as available to her as when they were all single.  All of this combined to make Pam feel anxious that she would be alone and lonely for the rest of her life.

Even though she was lonely and wanted very much to be in a relationship, she was also afraid of getting hurt and disappointed.  This made it difficult for her to put herself in social situations or to sign on to social dating sites to meet men.

She told the therapist that she was seeking help because she knew she couldn't overcome her ambivalence on her own and, even though it was difficult to believe that therapy could help, there was a part of her that wanted to give it a chance.

Pam sensed that the therapist was listening to her attentively and compassionately, which helped her to express her feelings, even though it was still difficult.

Towards the end of the session, the therapist explained how she worked in a contemporary way and that it was important to her that her clients feel emotionally safe before they began processing their innermost feelings.

She explained that, for some people, it takes time to build a strong therapeutic alliance with the therapist and that this was crucial to doing the work.

She also explained how the mind-body connection was important to the way that she worked (see my article:  (see my article: Mind-Body Oriented Psychotherapy: The Body Offers a Window Into the Unconscious Mind).

After the first session, Pam realized that she felt a little better.  She felt relieved to finally put her feelings into words and speak with someone who was compassionate and seemed to understand her.

See my articles:  

The Creation of the Holding Environment in Therapy

The Therapist's Empathic Attunement Can Be Emotionally Reparative For Clients

During the next session, Pam spoke about her family history, including growing up with parents who were preoccupied with their own lives and who often dismissed Pam's early childhood emotional needs as being "childish." 

There was no recognition that what Pam wanted and needed was what any child needed--to feel their loving attention and emotional attunement.  Instead, they invalidated her feelings to the point where Pam grew up questioning whether her feelings were valid or even real. She often felt invisible to her parents and to others and that her feelings weren't important.

As an only child, Pam spent much of her time at home alone while her parents were focused on work projects.  To cope with her loneliness, she often lost herself in imaginary games and stories where she had many brothers and sisters to play with and a fairy godmother who anticipated all of her needs.

This was a creative attempt for a small child, but it was no substitute for having nurturing parents.

Being shy and feeling badly about herself made it difficult for her to make friends.  Fortunately, there were outgoing students in her classes who saw Pam's kindness and intelligence and who went out of their way to befriend her.

When she was in college, she dated a few men, but these relationships never lasted more than a few months.  Most of the young men that she dated had similar traits to her parents, self involved and lacking in empathy, so these relationships were unsatisfying to Pam.

Three young women in college befriended Pam, and Pam remained friends with them after they graduated.  Over time, Pam realized how much these friends cared about her and how much she cared about them.  She valued these friendships and they were like the sisters that she never had.

But, over time, as each woman got into a serious relationship, they had less time for Pam.  She still saw them and spoke to them by phone, but it wasn't the same.  As mentioned earlier, after the last remaining single friend got engaged, Pam feared that she would be alone.

Pam's therapist validated her feelings, which was a relief to Pam.  But there was also a part of her that felt she was being "childish" and making too big a deal out of these things.

When she told the therapist that this is how part of her felt, her therapist recognized that this part of Pam was speaking to Pam in Pam's mother's voice, the voice that Pam had internalized from childhood (see my articles: Understanding the Different Aspects of Yourself That Make You Who You Are and Overcoming the Internal Critic).

The therapist spoke to Pam about how traumatic it was for a young child to have to fend for herself emotionally and the impact that this had on Pam's adult life.

She spoke to Pam about doing EMDR therapy to process the trauma and helping Pam to develop the necessary coping skills before processing began (see my articles:  How EMDR Therapy Works: EMDR and the Brain.

Pam was feeling increasingly more comfortable with her therapist and she felt ready to work on coping skills, which is called resourcing in EMDR (see my article:  Coping Strategies in Mind-Body Oriented Psychotherapy).

But there was still a part of her that was ambivalent and fearful about trusting the therapist and allowing herself to be emotionally vulnerable.

When she spoke to her therapist about this, her therapist helped Pam to understand that even though this part might seem "negative" to Pam, this part was actually attempting to be protective.

They mutually decided that it was important to work with this part first to address the fears and help this part to feel comfortable.  

Pam's therapist explained that the preparation work would be gradual to help Pam to develop the skills she needed to work on the trauma.  Her therapist wanted Pam to have these necessary skills so that she would have the wherewithal to deal with whatever came up when they processed the trauma of growing up with parents who were unable to give Pam what she needed emotionally.

Pam didn't mind that the preparation work was gradual because, along the way, she was seeing progress in her ability to talk about feelings that she had buried as a child.

By the time Pam was ready to do EMDR, she focused on an early memory of feeling alone and lonely as a young child (see my articles: Looking at Your Childhood Trauma History From an Adult Perspective).

As Pam processed this memory with EMDR, initially, she couldn't believe that she could ever feel better about it.  Pam and her therapist focused on same memory for a few months because there were so many related experiences.  

As she continued to do EMDR therapy, Pam noticed that she felt less upset about the memory and, in general, she was feeling better about herself.

Working Through Emotional Trauma With EMDR Therapy

The work was not easy or quick because the feeling of being invisible and unlovable as a child was so pervasive throughout her childhood.  But, gradually, the trauma was processed and worked through (see my articles:Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

Gradually, Pam felt more confident in herself and she began socializing more.  Unlike how she felt for most of her life, she now felt that she not only wanted to be in a relationship but she deserved to be with someone who loved her and treated her well.

Eventually, Pam met someone whom she loved and who loved her very much.

Conclusion

Healthy emotional development is predicated on developing a secure attachment with emotionally attuned parents.

When a child grows up with parents who are dismissive of their feelings and when there are no other mitigating factors (e.g., a loving grandparent, aunt or uncle), the child's emotional needs often become unbearable for her to contain.  

This often results in a child burying their feelings because it becomes too hurtful to continue to have unmet emotional needs.

Children who have unmet emotional needs usually grow up to be adults who feel unworthy of love.  This makes it difficult for them to form relationships with others.

Under these circumstances, adults often feel lonely and want social connections, but they are also very afraid of being rejected.  This ambivalence gets played out in an internal tug of war within the adult of wanting and yet dreading love.

As in the fictionalized scenario about Pam, these individuals are often afraid to come to therapy because they fear making themselves emotionally vulnerable in therapy.  This is understandable because if your own parents couldn't be attuned to your needs, why would you think that a stranger (the therapist) would be?

Often, when the fear of being alone for the rest of their lives is greater than the fear of trusting a therapist, these individuals come to therapy, albeit with much trepidation.

A skilled therapist can help these clients to develop the necessary therapeutic alliance so they can begin preparing to process the early trauma.

The preparation stage in any trauma therapy is crucial.  To jump into processing the trauma before the client has developed the necessary skills to do the work can be retraumatizing.

Talk therapy is often of limited help when it comes to processing these types of early trauma.  Clients will become knowledgeable about the source of their trauma, but often nothing changes.

Experiential therapy, like EMDR therapy, is more effective in helping clients to overcome psychological trauma, whether it is a one-time trauma or pervasive developmental trauma.

Getting Help in Therapy

People with pervasive childhood trauma take a leap of faith when they come to therapy.

Often, they don't know what to expect or if they will feel better or worse by coming to therapy.

It's a good idea to consider the first session to be a consultation to talk about your problem in a broad way and to ask the therapist questions.

You might feel that you want to rush into processing your traumatic experiences, but a skilled therapist will first help you to develop the necessary skills to do the work so that the work isn't retraumatizing.

Rather than suffering on your own, seek help from an experienced trauma therapist who can help you to work through your unresolved problems so you can live a happier, more fulfilling life (see my articles:  The Benefits of Therapy and How to Choose a Psychotherapist).

About Me

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

One of my specialties is helping adult clients to overcome traumatic experiences that are having a negative impact on their lives.

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

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

Coping with Seasonal Affective Disorder (SAD)

Seasonal affective disorder, also known as SAD, affects many people during the fall and winter months when there is a decrease in sunlight.

Coping With Seasonal Affective Disorder (SAD)

What Are Some of the Symptoms of Seasonal Affective Disorder?

• Experiencing depressive symptoms during the fall and winter, and no depressive symptoms during the other seasons
• Sleeping more than usual
• Increased appetite
• Experiencing a decrease in energy
• Losing interest in activities that you usually enjoy
• Experiencing problems focusing

What Can You Do to Cope With Seasonal Affective Disorder?

• Try to get as much sunlight as you can, including going out for a walk during the day, keeping shades or blinds open to get maximum exposure to light, spending time near a window at work and going away, if you can to sunnier vacation spots.
• Exercise at a level that is right for you to raise your endorphin levels.
• Try doing gentle yoga to elevate your mood.
• Spend time with close friends and family doing activities that you enjoy.
• Eat nutritious meals and limit caffeine.
• Consider light therapy.
• Manage your stress

Coping with Seasonable Affective Disorder: Get As Much Light As You Can

Coping with Seasonal Affective Disorder (SAD):  Consider Light Therapy

If none of the above suggestions work, it's a good idea to see your medical doctor to rule out medical issues that cause depressive symptoms.

For instance, many people who have an undiagnosed thyroid condition, can have depressive symptoms, but once their thyroid is stabilized, they are no longer depressed.  So, it's a good idea to rule out medical problems first.

If you have ruled out medical problems and the suggestions above for dealing with SAD aren't working for you, consider seeing a psychotherapist to determine if you have Seasonal Affective Disorder or if you have a different form of depression, such a major depressive disorder or dysthymia (see my article: How to Choose a Psychotherapist and What is the Difference Between Sadness and Depression?)

Getting Help in Therapy
An experienced psychotherapist can help you to develop resources for dealing with seasonal affective disorder so that you are better able to cope with the decrease in light during the fall and winter.

Seeing a psychotherapist, who knows how to work with SAD can make such a difference in the quality of your life.

If you're suffering with SAD, get help today.

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

I have helped many clients who suffer with SAD to overcome SAD symptoms.

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.

Books: "Tea With Winnicott" at 87 Chester Square

In the book, Tea With Winnicott, Brett Kahr imagines what it might be like to bring back the British psychoanalyst and pediatrician, Donald W. Winnicott, who died in 1971, to interview him about his life and his work.

"Tea With Winnicott" at 87 Chester Square

The book is part of a series called Interviews with Icons, which are "posthumous interviews" with famous psychoanalysts.

In a poignant, imagined dialogue, Brett Kahr, who also wrote D.W. Winnicott: A Biographical Portrait, does an imaginary interview with Winnicott at Winnicott's consulting room at 87 Chester Square in London.

The book is wonderfully illustrated by Alison Bechtel.

Winnicott's former secretary makes them tea and sandwiches as they delve into the most important aspects of his life.

When I was in psychoanalytic training 20 years ago, I remember being drawn to Winnicott's books and papers more than any other theorist that we read. He has influenced my work more than any other psychoanalyst.

Through his writing, you could sense Winnicott's unique compassionate understanding about adults and infants (he was also a pediatrician), and he has been a valuable guide for new and experienced therapists all over the world.

"Tea With Winnicott" at 87 Chester Square

Kahr's book is organized in a way that helps clinicians and clients alike understand how Winnicott's early life influenced his theories about infants and adults.

Even experienced therapists, who have read Winnicott's papers and the various biographies about him, will find interesting stories about his personal life and his work.

Since it appears that Winnicott's mother, although loving and kind, was also depressed, there has been speculation that this might have influenced Winnicott's choice to become a psychoanalyst.

The section about Winnicott's early life shows how his own childhood influenced his psychoanalytic theories, especially the fact that he came from a loving home surrounded by his mother and other women in the household.

In his time, Winnicott had to navigate between the two predominant theorists of his time, Anna Freud and Melanie Klein.  Kahr provides interesting insights into what was going on in the psychoanalytic world at that time and how Winnicott was able to form the "Middle School."

Reading "Tea With Winnicott," you can easily imagine yourself sitting for a chat with this approachable psychotherapist and immersing yourself in his world.  The book is entertaining and accessible.

Much of what we now take for granted about raising a child and mother-child relationships originated with Winnicott.  His phrase "the good enough mother" conveyed that a mother didn't need to be "perfect," she just needed to be good enough.

His philosophy about the mother-child relationship was similar to his philosophy about the therapist-client relationship with regard to creating a safe, holding environment and repairing any ruptures in the relationship (see my articles:  The Creation of the Holding Environment in Psychotherapy and On Being Alone).

In the late 1930s, Winnicott did broadcasts on the BBC radio where he addressed mothers in a personal and reassuring way.  His talks weren't about giving advice to mother.  Instead, his talks provided mothers with basic information about an infant's needs and how to foster a loving, safe environment for the baby.

These BBC talks were very popular.  It was evident that Winnicott respected mothers and never talked down to them.  During his time, he reached millions of listeners.

"Tea With Winnicott" at 87 Chester Square

The "interview" also deals with some controversial issues, including Winnicott's relationship with Masud Khan, who was an analysand as well as a colleague of Winnicott's.  It also deals with his first marriage to his wife, Alice.

Although Winnicott died in 1971, leaving behind many volumes of books and letters that he wrote, he  still remains one of the most influential and popular psychoanalysts all these years later.

I highly recommend this book to anyone who is interested in Winnicott or the history of psychoanalysis and psychotherapy.

The format of the book is ideal for making a play, and I hope that someone will take on the project of producing the play in NYC.

About Me
I am a NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapists who works with individuals and adults.

I am also psychoanalytically trained and work in a contemporary, dynamic and collaborative way.

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.

An Unconscious Identification with a Loved One Can Create an Obstacle to Change

People who start therapy often wonder why it's so hard to change, so I want to address one of the major reasons why people have problems changing, which is an unconscious identification with a loved one.

An Unconscious Identification With a Loved One Can Create an Obstacle to Change

From the time that we're infants, we learn to identify with our caregivers, usually our parents.  Even as adults, we can continue to identify with loved ones.

The identification can include values, opinions, thoughts, feelings, habits and lifestyle choices.

The following fictional vignette, which is a composite of many different cases, provides an example of someone who comes to therapy to make a change, but who encounters an obstacle within himself that makes it difficult for him to change.

Rick
Rick came to therapy after his doctor advised him to stop smoking or he would face increasingly debilitating health consequences in addition to the ones he was already experiencing, including severe headaches, problems breathing and a persistent cough that wouldn't go away (see my article:  Do You Want to Stop Smoking?).

Struggling with Health Consequences of Smoking 

Before coming to therapy, Rick tried to stop smoking on his own.  But even though he wasn't feeling well because he was smoking two packs of cigarettes a day for several years, he couldn't stop.

He tried the nicotine patch and nicotine gum.  He tried to go "cold turkey," but nothing worked for him.  His wife pleaded with him to stop, to no avail.

Rick came for clinical hypnosis as a last resort.  He didn't have much faith that hypnosis would help him, but he was feeling desperate and decided to give it a try.

I began, as I often do with people who want to stop smoking, by asking Rick about his motivation to stop smoking.  He told me that he knew that he "should" because of his doctor's warning and his wife was also unhappy about his smoking.

Based on Rick's tone and the shrug of his shoulders, I could tell that his internal motivation wasn't strong, and he admitted this.  His motivation was mostly external as opposed to a strong internal motivation that is often needed to help people to stop smoking or to make other difficult changes.

 I took a history of Rick's use of tobacco, including his many attempts to stop on his own (see my article:  Becoming a Successful Nonsmoker).

We also discussed his pattern of smoking (when he smokes, what time, how often, etc) with the idea of using "pattern interruption" as a way to help him to break his habit.

As part of the pattern interruption, Rick agreed to change cigarette brands and to change where he smoked.  Interrupting the pattern in the rituals that Rick had for smoking was somewhat successful.  He was able to reduce his use from two packs to a pack a day and, a few sessions later, he reduced it to half a pack per day.

This was more than Rick had ever been able to do on his own.  He was also surprised that his cravings were reduced.  But, try as he might, he couldn't stop smoking altogether, and I realized that there was probably a strong unconscious underlying reason that was undermining our efforts.

In order to discover what Rick liked about smoking, he agreed to allow me to do a hypnotic induction.  While in a light hypnotic state, Rick expressed feeling very relaxed and, at the same time, he maintained a dual awareness of both his relaxed state and that he was sitting on a couch in my office.

I asked Rick to go back in his mind to the first time that he smoked and enjoyed it.  Rick remembered a pleasant summer day sitting on his grandfather's porch with his father and grandfather.  He remembered that it was after a great dinner that his grandmother had made and his grandfather was telling funny stories about his childhood.

He remembered how they all joked and laughed and how he realized that day how much he loved his father and grandfather.  He was particularly aware on that day of the strong bond he felt with them and how being allowed to sit with them, while the women in the family were in the house, made him feel proud, as if he was part of this exclusive "club"for the men in the family.

Many other similar happy memories of being with his grandfather and father came to his mind.  Just thinking of those memories brought tears to Rick's eyes.

Afterwards, as part of the debriefing in the session, Rick talked about how surprised he was to realize that when he smoked, he continued to feel a bond with his father and grandfather, both of whom he missed very much since they died.

No wonder it was so hard for Rick to give up smoking.  He had an unconscious identification with his father and grandfather through smoking cigarettes and it helped him feel connected to them even though they were both dead.

As he continued to talk about these two important men in his family, Rick said they were the two most important people in his life.  Then, he cried to think that he might give up this habit that kept him feeling connected to them.

During the next session, Rick and I talked about the strong bond that he felt with his teenage sons.  He often spent a lot of time with his sons and it was obvious that he was proud of them and loved them very much.

I asked Rick how he would feel if his sons began smoking.  Rick dismissed this idea.  He said that, even though he smoked, he had always told his sons not to smoke, and they promised him they never would start.  The idea of his sons smoking was so disturbing to him that he couldn't even consider the idea.

I told Rick, as tactfully as I could, that children learn more from what they see their parents do than what their parents tell them to do.  And, just like he started smoking as a way to bond with his father and grandfather, his children could do the same.

Rick acknowledged that this could happen, but he doubted that it would.  But if it did, he would never want to pick up a cigarette again because seeing his sons smoke would upset him too much.

By the end of that session, Rick began thinking about his place in the family--now that his father and grandfather were gone, he was the patriarch in the family and he wanted to set a good example for his sons.

When Rick came back the following week, he looked upset.  He told me that he was shocked to learn from his wife that his younger son, John was smoking and he had been keeping it a secret--until Rick's wife found a pack of cigarettes in John's pants pocket as she was sorting the laundry.

He said that after she told him about their son smoking, he sat by himself in the kitchen for a long feeling sad and upset.

How an Unconscious Identification with a Loved One Can Create an Obstacle to Change

He knew that if he confronted his son in an angry way, it would seem hypocritical to John.  So, he decided that, once and for all, he was going to give up smoking.  Hearing that his younger son had taken up smoking provided Rick with the motivation he needed to stop.  With the help of hypnotic suggestions, and his motivation to change Rick was able to stop smoking.

Several months later, when I followed up with Rick, he told me that he continued to be a successful nonsmoker and, shortly after he stopped, his son, John, also stopped.  Rick told me how proud he felt that he could "kick the habit" and he thought that his father and grandfather would also be very proud of him.  That feeling--that his father and grandfather would be proud of him--was another strong motivator for him to remain a successful nonsmoker.

Conclusion
Although the vignette above is a composite of many different cases, it has been my experience that, in many instances, an unconscious identification with a loved one can create an obstacle to change.

These identifications are usually not apparent at first.  A therapist, who is skilled at doing discovery work, can help clients to uncover the unconscious obstacle.

An Unconscious Identification with a Loved One Can Create an Obstacle to Change

As in the case with "Rick," a behavior or habit that represents a strong identification is often hard to change.

But, similar to the vignette above, if clients discover an even more compelling reason to change, as "Rick," that reason can help to transcend the original obstacle.

Getting Help in Therapy
Obstacles to change often include conscious and unconscious factors.

It is usually difficult to discover the unconscious factors on your own, which is one of the reasons why people come to therapy.

If you've having difficulty making changes, you could benefit from working with a skilled therapist who has experience helping clients to discover and overcome unconscious obstacles.

Discovering the unconscious obstacle is an initial step.  Developing the motivation to transcend the obstacle is what often leads to transformation.

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

Stress Management: Taking Time Out For Self Care

When life gets hectic and stressful, it's easy to forget about the importance of self care. At those times, many people try to get through the stressful time by plowing through rather than taking care of themselves (see my article: Staying Emotionally Grounded During Stressful Times).

Stress Management: Taking Time Out For Self Care

For other people, it's a matter of not feeling entitled to take care of themselves (see my article:  Self Care: Feeling Entitled to Take Care of Yourself).

Not feeling entitled to self care is often part of a larger problem that is usually longstanding.  This could involve a tendency to put others first, being unfamiliar with the concept of self care or a tendency to be a perfectionist to the point of exhaustion (see my article:The Connection Between Perfectionism and Core Shame).

Needless to say, a lack of self care often leads to burnout, whether it involves personal stressors or work-related stressors (see my article: Managing Your Stress: What Are the Telltale Signs of Burnout?).

Many people come to therapy when they get to the point where they feel they just can't cope any more.

The following fictional vignette illustrates how a lack of self care can lead to bigger problems, and how therapy can help:

Nina
Nina came to therapy after she developed stress-related health problems, including debilitating headaches, chest pains related to anxiety as well as insomnia.

Self Care: Taking Time Out to Take Care of Yourself

At her doctor's recommendation, she took off a month from work, which she had resisted doing for a long time.  But when her doctor warned her that her symptoms would get worse unless she took time off to relax and regroup, she knew she had to do it.

During that time, she stopped having headaches and panic attacks, but she began to feel depressed at home without her usual demanding work schedule.

When she consulted with her doctor again, she told her to get help in therapy, so she started therapy a week after she began her break from work.

Nina was a perfectionist since she was a child.  If she didn't do things perfectly at school and at home, she felt she was a failure.  There was no in between.   She was a straight A student, but she derived no joy or satisfaction from her accomplishments because she felt this was what was expected of her--she had to be perfect.

Both of her parents were perfectionists as well.  Before they retired,  both of them were rewarded in their fields for their perfectionism.  Her mother was a well-respected lawyer and her father was a top surgeon in his field.  So, Nina grew up in a household where there was a lot of pressure to be "the best."

Nina did very well in college and in graduate school.  She found it relatively easy to be at the top of her class.

Then, she came to NYC and entered into a highly competitive field that attracted the top people in her  field from all over the world.  Even though she came from a highly competitive family, she never experienced this type of competition.  She felt like she had to always be on her toes to stay on top.

She was rewarded with the respect of her superiors as well as monetarily for her long hours at work but, as previously mentioned, the pace was taking its toll on her health.

Self Care: Taking Time Out to Take Care of Yourself

When her therapist mentioned self care, Nina wasn't even sure what her therapist meant.  She wasn't even sure where to begin.

Her therapist taught Nina breathing exercises and how to meditate, and she recommended that Nina practice for a short time everyday to get into the habit of taking care of herself.

Initially, this felt so unfamiliar to Nina that she felt guilty taking the time to de-stress instead of working or "doing something productive."

When she felt her mind wandering, her sense of perfectionism got in her way because she was sure that she "wasn't doing it right," which almost felt unbearable to her.

It took a lot of practice and a lot of encouragement from her therapist for her to stay on track with her self care practices.

Once she was able to practice meditation and breathing with less difficulty, her therapist helped Nina to work on her perfectionism.

Nina learned that underneath the perfectionism there was core shame.

Working on her shame was more challenging because it was uncomfortable for her.  But her therapist helped Nina to see that this is a common problem and shame is often at the core of emotional problems for many people.

Self Care: Taking Time Out to Take Care of Yourself

When Nina went back to work, she got into the habit of taking time each morning to do her breathing exercises and meditation, even if she only did it for 10 minutes.

Nina also made a conscious decision that her health was more important to her than her next promotion and that if getting that promotion meant compromising her health, it wasn't worth it.  So, she reduced the hours that she put in at work.

Nina and her therapist continued to work on Nina's longstanding sense of shame that fueled her perfectionism.  Her therapist used a combination of EMDR (Eye Movement Desensitization and Reprocessing) and Somatic Experiencing.

Over time, Nina was able to work through her feelings of shame.

Eventually, she decided that her current profession no longer suited her and she began to train for a less stressful profession.

She continued to engage in the self care techniques that were helping her to cope, and she learned that she didn't have to be "perfect" at it.

Along the way, Nina developed a greater sense of self worth and an appreciation for life that she never felt before.

Getting Help in Therapy
If you're struggling with stress, anxiety or depression, you're not alone.

Many stress-related health problems can develop if you learn how to take care of yourself on a physical and emotional level.

If you've never developed strategies for self care or you don't feel entitled to take care of yourself, you could benefit from working with a therapist who specializes in helping clients to overcome these problems (see my article:  The Benefits of Therapy).

Rather than waiting until you are experiencing burnout or health problems, get help from a licensed mental health professional so you can begin to live a more satisfying life.

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

Why It's Important For Psychotherapists NOT to Have "All the Answers" in Therapy

There was a time in the history of psychotherapy when traditional psychotherapists believed they had  "the answers" for their clients (see my article: A Therapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

Back then, it was assumed a client would come in, free associate to whatever was on his or her mind, and when the time was right, the therapist would make an interpretation as to what was going on for the client.

If the client didn't accept the therapist's interpretation, the client would usually be thought of as being "resistant" (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

Fortunately, times have changed and most contemporary therapists work in a more collaborative way with clients.  And yet, there are still many clients who come to therapy who expect the therapist to have "all the answers" to their problems.

Not only is it a distortion of what goes on in therapy to think that a therapist is all-knowing, it's also counterproductive.

And, it's likely that any therapist who presents him or herself as knowing all the answers won't be listening to the client or helping the client to develop his or her own ability to develop insight and inner knowledge.

Self exploration and personal discovery is part of the psychotherapeutic process.  And while it's understandable that some clients want "the answer" to their problems from the therapist, it's not realistic or helpful.

Although psychotherapists, who have advanced training in psychoanalytic or psychodynamic therapy, are trained to do in-depth therapy, they are neither mind readers nor fortunate tellers, so they don't have "all the answers" to your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

Knowledgeable, skilled therapists can facilitate clients' self exploration and help them to develop the psychological skills to overcome problems and lead a healthier life.

If they're trained as trauma therapists, which not all therapists are, they can also help clients to overcome psychological trauma.

But psychotherapists also need to get to know clients over time, and it would be presumptuous and foolhardy for any therapist to assume that she knows from the start what would be best for the client.

If the therapist assumes that she already knows the answers to the client's problems before there is any psychological exploration, this usually means that the therapist isn't taking the time to listen empathically and to get to know the client.

In my professional opinion, as a psychodynamically trained therapist who has gone on to do advanced trauma training, psychotherapy is an intersubjective experience (see my article:The Therapy Session: A Unique Intersubjective Experience).

It takes time for the client and therapist to develop a therapeutic rapport and this doesn't always happen.  Not every therapist is for every client, and most therapists recognize that it's not always a "good fit" with every client.

Most therapists know that each client is unique and, even when it appears that a particular client might have a similar problem to other clients, there's never a one-size-fits-all approach that will work for every client.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

A skilled therapist also knows that part of creating a therapeutic rapport is creating a "holding environment," as initially explained by British psychoanalyst, Donald Winnicott, where the client feels safe (see my article: The Creation of the Holding Environment in Therapy).

A skilled therapist also knows that she must listen empathically to what the client is saying on both a  conscious and unconscious level in order to begin to understand what's happening with the client (see my articles: Psychotherapy: Therapists Should Listen and Learn From Their Clients and The Therapist's Empathic Attunement to the Client)

By listening empathically, the therapist is actually learning from the client about the client rather than the other way around where the therapist makes premature interpretations as to what's going on.

It's also the therapist's job to help the client to develop the skills to tolerate the ambiguity of what's going on in therapy, especially during the initial stage of therapy when it might not be so clear.

In other words, some clients come in with a specific problem and while the resolution might not be clear, the problem is clearer than when clients come in a state of general malaise and they're not sure what's going on (see my article:  When You Just Don't Feel Right, It's Hard to Put Your Feelings Into Words).

For the client, developing skills to tolerate ambiguity might include self soothing techniques or other forms of coping skills (see my article:  Developing Coping Skills in Therapy).

There are no quick fixes in psychotherapy, even with some of the more advanced forms of trauma therapy, which tend to be shorter than some forms of talk therapy when there is psychological trauma (see my article: Beyond the "Band Aid" Approach to Overcoming Psychological Problems).

If you're new to psychotherapy, it helps to have realistic expectations of your therapist and of the psychotherapy process.

Generally speaking, the more complex the problem, the longer it takes to work it through in therapy, although therapy shouldn't be an interminable process where you feel you're not making any progress.

Rather than giving you the answers, a skilled therapist helps you to get to know yourself, grow psychologically, and learn how to work through your problems.

Why It's Important For Psychotherapists Not to Have "All the Answers" in Therapy

I recommend that you take your time when you're choosing a psychotherapist (see my article:How to Choose a Psychotherapist).

As part of the process of finding a therapist, you might want to see several therapists to determine which one you feel the most comfortable with before you delve into therapy.

And, as I mentioned before, even highly respected, reputable therapists are not always a "good fit" for everyone, so trust your intuition when making a choice.

Getting Help in Therapy
Many people avoid seeking help in therapy because they believe in common myths and distortions about therapy (see my articles: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak" and Common Myths About Psychotherapy: Therapy Takes a Very Long Time).

It's takes time to develop a sense of trust and safety in therapy, especially if you've had early childhood experiences where you were abused or neglected.

Getting Help in Therapy

Psychotherapy can be a  transformative and dynamic process if you approach it with a sense of openness and curiosity about yourself, choose a therapist who is right for you, and approach therapy with realistic expectations (see my articles: Psychotherapy and Beginners Mind, Starting Therapy With a Sense of Curiosity and Openness and Experiential Therapy Can Be a Transformative Experience That Helps to Achieve Emotional Breakthroughs).

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

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

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