Sexually Compulsive Behavior as a Split Off Part of the Self

Sexually compulsive behavior often involves a split off part of the self that feels like a "not me" part (see my articles:  Overcoming Sexual Addiction in Therapy, Overcoming Internet and Porn Addiction, Sexual Addiction: Is a Compulsion For Viewing Internet Porn Ruining Your Marriage?, Infidelity: Married, Bored and Cheating Online, Infidelity on Social Media Sites, The Counterphobic Defense and Hypersexuality and Rationalization as a Form of Denial and Self Deception).  Often, although not always, that part is the result of an emotionally traumatic history.

Sexually Compulsive Behavior as a Split Off Part of the Self

People, who engage in sexually compulsive behavior, usually seek help in psychotherapy after there have been consequences for their behavior:  a spouse discovers multiple affairs, an employer confronts an employee about viewing online pornography at work, and so on.

Needless to say, there is usually a great deal of shame involved once a spouse or an employer confronts this type of behavior.  Combined with the fact that most people, including spouses and employers, don't understand sexually compulsive behavior and see it as a "moral failing," this just adds to the shame and makes it difficult for people to get help in therapy.

Prior to facing consequences and getting help, people who engage in sexually compulsive behavior often have little awareness of what triggers their behavior or the underlying psychological issues.

In therapy, people with sexual compulsions will often describe their behavior as feeling "split off" or separate from how they see themselves (see my article: Understanding the Different Parts of Yourself That Make You Who You Are and Parts Work in Therapy: Is a Split Off Part of Yourself Running Your Life?).

For the purposes of this article, when I refer to a "split off" part from the self, I'm not referring to multiple personality disorder (now called Dissociative Identity Disorder or DID), although there are people with DID who are sexually compulsive.

To clarify, it's important to understand that dissociation occurs on a wide spectrum with DID occurring at the far end of the spectrum and more common forms of dissociation, like daydreaming, which we all do, as occurring on the other end.  There are some forms of dissociation which are actually helpful (see my article: How Compartmentalization Can Be Used as a Healthy Short Term Coping Strategy).

Between a common form of dissociation, like daydreaming and the other end of the spectrum of DID, there's everything in between.  So, the type of "split off" that I'm referring to is on the spectrum--far less than DID but more than just simple daydreaming.

To varying degrees, everyone has some split off parts that are just outside of their awareness and not considered a major problem. It's a matter of degree.

One of the goals of any psychotherapy is to help clients to become more psychologically integrated in order to bring split off parts into awareness.  The more psychologically integrated a person is, the healthier he or she is.

To simplify matters in the fictionalized vignette below, I discuss a fictionalized male client; however, women also engage in sexually compulsive behavior.

Ken
Ken began therapy after his wife discovered that he was watching pornography compulsively at night and contacting women online for sexually explicit discussions after his wife went to sleep.  Based on the computer browser history, she could see that this was a regular activity for Ken.

Sexually Compulsive Behavior as a Split Off Part of the Self

Prior to this discovery, his wife thought that Ken wasn't interested in sex because they had not had sex in many months.  But after she discovered Ken's online activity, she felt very upset, hurt and betrayed by him.  She gave him an ultimatum:  Get help or she would leave him.

When Ken came for his first therapy session, it was evident that he was very ashamed of his behavior.  He could barely look the therapist in the eye, and he had a lot of difficulty communicating why he was seeking help.  After several false starts, he told the therapist that he was there because his wife gave him the ultimatum and, after 20 years of marriage, he didn't want to lose his wife.

During the early phase of therapy, Ken rationalized his behavior by saying that he didn't see anything wrong with looking at pornography online or contacting women he didn't know for "harmless flirtation."  He said that these women lived in other parts of the country and he had no intention of ever meeting up with them, so he didn't see it as cheating on his wife.

As part of his early history, Ken revealed to his therapist that he began secretly looking at his father's Playboy magazines when he was nine years old and left alone at home while his parents went out.  He remembered the first time that he looked at the pictures of naked women in sexually provocative poses and how thrilling it was for him to secretly masturbate while fantasizing about these women.

As he continued to reveal his early history, he told his therapist that his parents often left him alone and, as an only child, he was lonely.  From other details that he revealed, his therapist realized that Ken wasn't just left alone a lot--he was emotionally neglected by his parents (see my articles:  What is Childhood Emotional Neglect? and What is the Connection Between Childhood Emotional Neglect and Problems Later on in Adult Relationships? and Growing Up Feeling Invisible and Emotionally Invalidated).

Fantasizing about the women in the magazine and imagining that he was with them made Ken feel less alone when his parents were out.  It was soothing to him, and he continued to look at porn from that time on with the same effect of feeling comforted and less alone.

Ken never revealed to his wife that he liked to look at pornography.  For him, it was a secret activity that belonged only to him, and he never discussed it with anyone.  He also assumed that his wife wouldn't understand and, based on her reaction, his fears were confirmed.

He somewhat resented that his wife was giving him this ultimatum to get help and he felt she was being unreasonable, "Why can't she just leave me alone about this?  I'm not hurting anyone."

Due to Ken's level of denial about his problems and the effect it had on his marriage, his therapist knew that he would probably leave therapy if she confronted him directly (see my article: When Clients Leave Therapy Prematurely and Clients Struggling With Shame Can Leave Therapy Abruptly).

Instead, initially, she took a more empathic approach and remained close to Ken's emotional experience and, at times, she made observations that she thought he could tolerate.

Although Ken stopped looking at pornography and contacting women at home, he didn't tell his therapist or wife that he used his computer at work to continue engaging in sexually compulsive behavior (although, at that point, he didn't see it as being sexually compulsive).  Ken rationalized to himself that he worked for a very large company with thousands of employees, so he didn't think he would get caught by the IT department.

But a few months later, Ken was called into his supervisor's office where his supervisor and the Human Resources director were waiting for him.  His supervisor told him that the IT department detected that Ken was looking at pornography online and this is against company policy.

He gave Ken a warning memorandum that this behavior wouldn't be tolerated and any other infractions against the company policy could result in termination.  He also recommended that Ken get psychological help.

Ken felt deeply mortified.  He tried to tell his supervisor that someone else might have gone on his computer while he was away from his office, but neither his supervisor or the HR director believed him.  They told him to take the rest of the day off.

Although he felt humiliated about what happened at work, Ken told his therapist about it.  He acknowledged that he had been keeping this a secret from her because he wanted to continue to look at porn and he really didn't see it as a problem.

But as his therapist reflected back to him the consequences of his behavior, Ken acknowledged that he was placing his marriage and career in jeopardy.  This was the first time that Ken didn't try to hide behind his usual rationalizations.

At that point, instead of feeling like he was being forced to come to therapy to appease his wife, Ken became internally motivated to understand and overcome his behavior.  He also agreed to attend a 12 Step program for sexually compulsive individuals and to get a sponsor in that program.

Once Ken became internally motivated, the work in therapy progressed.  His therapist talked to him about cross addiction so that Ken would understand that it was not unusual for people who were trying to overcome a particular addiction to form another addiction as a way to self soothe.

His therapist helped Ken to understand the various aspects that made him who he is, including the split off parts.  This is called Parts work or Ego States work.

Ken and his therapist worked on the underlying issues that triggered his sexual addiction, including loneliness and boredom (Coping With Addiction: Boredom as a Relapse Trigger).

They also did trauma work on early childhood issues related to emotional neglect.

After Ken began making progress in therapy and he was abstinent for six months, he and his wife were ready to attend couples therapy to repair their marriage.

Conclusion
With the advent of the Internet, compulsive sexual behavior has increased dramatically.

This behavior is usually difficult to overcome on your own.

The underlying roots of the problem are often (although not always) related to early childhood trauma.

Similar to any other form addiction, denial plays a significant role because it's usually too painful to acknowledge the problem.

Shame often keeps people who need help from ever seeking help.  They attempt to resolve the problem on their own but, like other forms of addiction, sexually compulsive behavior is progressive if people don't get professional help.

Although many people start therapy because they've been given an ultimatum by a spouse or an employer, the success of treatment is usually predicated on clients become internally motivated.

The work in therapy includes helping clients to develop the internal resources to remain abstinent and to deal with underlying issues, coping mechanisms to deal with triggers, and trauma work to resolve unresolved emotional trauma.

Clients, who have problems with sexually compulsive behavior, need psychoeducation from their psychotherapists about cross addiction so that they don't stop one addiction and revert to another one (i.e., stop watching pornography compulsively online and start another form of addiction like compulsive gambling, drinking excessively, abusing drugs, etc).

Getting Help in Therapy
Although people who engage in sexually compulsive behavior often feel alone and deeply ashamed of their behavior, the best chance of their overcoming these problems is to get help in therapy with a licensed mental health professional who specializes in this area.

Rather than suffering alone, if you've been unable to overcome your problems on your own, you could benefit from the help of a licensed psychotherapist.

Aside from overcoming your addictive behavior, attending therapy can help you to grow and lead a more fulfilling 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 regular business hours or email me.

Using Somatic Psychotherapy When Clients Doesn't Know How to Express Emotions

In prior articles, I've discussed the mind-body connection and psychotherapy.

See my articles:  

Mind-Body Psychotherapy: The Body Offers a Window Into the Unconscious Mind

Clinical Hypnosis and the Mind-Body Connection

Overcoming Childhood Trauma That Affects You as an Adult

Experiential Therapy, Like EMDR, Helps to Achieve Clinical Breakthroughs).  

In this article, I'm focusing on how Somatic Psychotherapy can be used when the client has no words to describe a psychological problem.

Using Somatic Psychotherapy When the Client Has No Words

There are times when, due to the nature of the problem or for a variety of reasons, the client might not have words to describe the problem.

So, when might this happen?  

One possibility is that the traumatic event might have occurred when the client was very young so there aren't clear memories or it might have even occurred preverbially (a birth trauma would be an example of preverbal trauma).

With regard to preverbal issues, before a child can speak, she cannot symbolize her problems for herself or others because she doesn't have language, so there are no words.  

However, as I've discussed in a prior article, the body holds onto unconscious memories, and it's possible to use mind-body oriented psychotherapy (also known as Somatic Psychotherapy) to work on the problem.  More about this below.

Most forms of psychotherapy rely exclusively on words to resolve psychological problems. That's the nature of talk therapy.  The client comes to see the psychotherapist, describes the problem as best as she can and they work on the problem by exploring the current situation, getting history, and helping the client to make psychological connections and work through the problem.

But when the problem is outside of the client's conscious awareness, she might only have a vague awareness, if at all, of what the problem is.

At that point, psychotherapists who are trained to use mind-body oriented therapy, like EMDR therapy, clinical hypnosis or Somatic Experiencing, can help the client to explore the problem by using the mind-body connection.

The following fictionalized vignette illustrates how the mind-body connection can help when the client is unable to express the problem in words:

Nina
Prior to starting therapy again, Nina had been to several therapists in the past.

Although she liked her prior therapists, she didn't feel she got much out of therapy because she didn't know how to describe her problem.  She only knew that she felt extreme anxiety whenever she went home to visit her grandmother.  Other than going to her grandmother's home, she usually didn't feel anxious.

Talking about her anxiety with her prior therapists didn't help her.  They were only able to get so far, but she continued to have this extreme anxiety whenever she went on these visits.  Even talking about going on one of these visits was somewhat anxiety producing.

Nina chose her current therapist because she read articles that certain types of mind-body oriented therapy are helpful with clients where regular talk therapy hasn't been helpful.

Using Somatic Psychotherapy When the Client Has No Words to Describe the Problem

Nina's current therapist worked with Nina to help her to explore the sensations and emotions that she felt in her body using a technique called the Affect Bridge in clinical hypnosis (also known as hypnotherapy).

Nina was able to tell her therapist that, aside from the anxiety she felt, she also felt a tightening in her stomach when she thought about those visits.

Over time, as Nina and her therapist continued to explore these emotions and sensations, Nina realized that her anxiety about going to her grandmother's house was longstanding--ever since she was a young child.

Further exploration in her therapy sessions revealed that Nina felt most anxious about her grandmother's basement.

Then, gradually, over the course of months, as Nina became more attuned to what she was experiencing, she remembered that she saw a man molesting her cousin, Betty, one day in the basement.  At the time, Nina became so frightened that she ran upstairs and she was too afraid to tell anyone what she saw.

Since memories tend to be unreliable, even memories that are associated with the mind-body connection, Nina called Betty and she began speaking to her about her anxiety when she visited their grandmother's home.

She didn't know how to ask Betty about whether she was sexually molested or not, but she didn't have to because Betty told her that she also felt very uncomfortable going there and then she told Nina what happened:  A handyman who came to do repairs was in the basement when Betty went down there.

He seemed nice at first, but after talking to her for a few minutes, he grabbed her and touched her breasts.  As soon as she was able to pull away, Betty ran upstairs, but she never told anyone what happened--until she had this conversation with Nina.

Then, Nina told her that she recently remembered in therapy that she was on the basement steps when she saw this man molesting Betty, but she was also too afraid to tell anyone, so she ran.

Nina and Betty talked for a long time and Betty was able to confirm the details that Nina remembered in her therapy.  They were also able to be emotionally supportive of each other.

When Nina had her next therapy session, she told her therapist that Betty confirmed the memory.

Her therapist told her that, even though Nina wasn't the one who was molested, that it was emotionally traumatizing to see her cousin being molested.

From that point on, now that they knew they had a valid memory, her therapist used EMDR therapy to help Nina to work through the trauma.

Conclusion
There can be times when, for a variety of reasons, psychotherapy clients are unable to express their problem in words.  In some cases, there are no words and in other cases the issues might be unclear.

Using a mind-body oriented therapy can get to unconscious issues that regular talk therapy often cannot.  The reason for this is that the body offers a window into the unconscious mind.

Mind-Body Connection: Using Somatic Psychotherapy When the Client Has No Words to Describe the Problem

It can take a while before a client becomes accustomed to accessing emotions and sensations through the body, but many clients become adept at this over time.

Clients who are already in talk therapy and who want to remain with their current therapist can have adjunctive therapy sessions with a therapist who uses mind-body oriented psychotherapy (see my article: What is Adjunctive Therapy?).

In that case, the talk therapist is the primary therapist and the mind-body oriented therapist is the secondary therapist.

For clients considering adjunctive therapy, it's best to start by talking to your primary therapist about it.

Getting Help in Therapy
If you're finding that regular talk therapy hasn't been helpful to you, you might consider a form of somatic psychotherapy (How to Choose a Psychotherapist).

We know so much more now about the connection between the mind and the body than we ever knew before, and psychotherapists who use various forms of somatic psychotherapy usually know how to help clients to access unconscious issues.

Rather than suffering on your own, you could benefit from getting help from a psychotherapist who uses somatic psychotherapy.

The first step is to set up a consultation.

About Me
I am a licensed New York 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 or email me.

How Psychotherapy Helps You to Become More Self Reflective

In a prior article, Discovering That Your Feelings Aren't Facts, I discussed that many clients begin psychotherapy with an inability to distinguish between their feelings and objective reality.  It's as if they're looking through a distorted lens based on their own feelings.

How Psychotherapy Helps You to Become More Self Reflective

I also discussed that psychotherapy provides an opportunity to become more self reflective, objective and emotionally aware, which often leads to a more fulfilling life.  In this article, I'm going into more detail about how clients in therapy can learn to develop these skills.

The Observing Ego, Clinical Hypnosis and Hypnoprojectives
In psychotherapy there's a term called the "observing ego," which is the ability to stand both inside your experience as well as outside your experience at the same time.

It's as if there were two of you--one that feels your internal experience and one that stands just a little behind and above you that can experience your internal experience, see yourself and observe the external circumstances of your situation.

As a hypnotherapist, there is a hypnoprojective exercise that I sometimes use when I use clinical hypnosis with clients that helps them to enhance their observing ego and ability to self reflect.

I ask the client to imagine herself seated in a movie theatre.

The client arrives just before the movie starts and finds a comfort seat as she waits for the movie to begin.  Everything else--the temperature in the movie theatre and the general atmosphere--are comfortable.

As the movie begins, she realizes that it's about a character who is similar to her in many ways and who has the same presenting problem that brought the client into therapy.

The Observing Ego, Clinical Hypnosis and Hypnoprojectives

At the same time that the client is seated and watching the movie, there is another part of her that is in the projection booth who is observing the part of her that's seated.  The part in the projection booth also has a view of the entire theatre and she is watching the movie.

The benefit of using a hypnoprojective is the client often develops insight into her problem by externalizing the problem to the movie screen and making it concrete.  By making the movie about someone else, the client has an opportunity to be more objective.

Also, the relaxed state of hypnosis allows the client access to unconscious information that she normally wouldn't have access to in a fully awakened state.

With regard to our discussion about an ability to self reflect and developing the observing ego, the part of the client who is in the projection booth is an observing ego.

This part has the unique perspective of having both the internal and external experiences and has a full view of everything.  The part in the projection booth is also watching the part seated in the theatre and often develops insight into that part of herself.

During the debriefing after the hypnoprojective hypnotic exercise, clients will often say that they're surprised that they were able to see their problem and the solution with much more clarity (see my article: The Unconscious Mind: The "Symptom" Contains the Solution).

Mindfulness Meditation
I often recommend that clients practice mindfulness meditation as another way to become more self reflective and develop an observing ego (see my article: Psychotherapy and the Mindful Self).

Mindfulness Meditation As a Way to Become More Self Reflective and Develop an Observing Ego

For beginners, it's often easier to follow a mindfulness recording, like the recordings developed by mindfulness expert Jon Kabat Zinn, as a way to start.

Aside from helping you with emotional regulation, mindfulness meditation also helps you to develop and improve your self awareness.

With regular practice, mindfulness meditation can help you to reduce stress, improve your autoimmune system, improve concentration and memory, and increase emotional intelligence.

The Observing Ego: The Ability to Remain Rooted in Your Experience At the Same Time As You Stand Just Outside Your Experience
Hypnoprojectives and mindfulness meditation are two ways to develop an observing ego.

Aside from these powerful tools, being open to your therapist's observations can also give you a new perspective beyond your subjective experience.  It allows you to consider an alternative to your subjective state at the same time that you're rooted in your own experience.

This is one of the benefits of being in therapy (see my article: The Benefits of Psychotherapy).

Consider the Following Fictionalized Scenario About the Observing Ego in a Psychotherapy Session:
Ella comes to therapy in a bad mood.  She tells her therapist that she's feeling pessimistic about a new relationship because the man she's dating seemed preoccupied and distracted when they spoke last night.

Based on her pessimistic feelings about the relationship, Ella's thoughts are off the races:  She just knows that he's going to break up with her, and if he breaks up with her, she won't meet anyone else as nice as he is, and then she'll be alone for the rest of her life.

How Psychotherapy Helps You to Become More Self Reflective

Her therapist recognizes this as one of Ella's recurring patterns that creates problems in her life: Ella  assumes that her feelings are facts.

So, her therapist asks Ella a series of questions to help Ella to develop a more observing ego:  Did anything negative happen between her and her boyfriend?  Did he say that he didn't want to date her anymore?  What other evidence is there to support Ella's feelings?  What makes Ella assume that her feelings are facts?

Ella reflects upon her therapist's questions, and she becomes aware that she is projecting her own anxiety and negativity onto her boyfriend.  She realizes that she has no objective reason to believe that her boyfriend will break up with her.

Later that day, Ella's boyfriend calls her and apologizes for being distracted on the phone the night before.  He tells her that he was worried about a work problem, but that problem has since been resolved and he is feeling better.  When they see each other later that night, her boyfriend is his usual affectionate, attentive self.

How Psychotherapy Helps You to Become More Self Reflective

When Ella returns to her next therapy session, she tells her therapist that she realizes that she fell back into her recurring pattern of believing that her feelings were facts.  She feels frustrated that she continues to regress into this old pattern from time to time.

But, at the same time, Ella also recognizes that she doesn't fall back into this old pattern nearly as much as she used to before she came to therapy, so she is aware that she has made progress in therapy.

Ella made a commitment to her therapist to increase her mindfulness meditation practice and to also practice stepping outside her experience when she's tempted to project her negative feelings again.

Conclusion
The ability to self reflect is essential to being a self aware adult.  Without the ability to self reflect, you're more likely to look at yourself and others through the distorted lens of your own perceptions.

One of the benefits of psychotherapy is that it helps you to develop the ability to self reflect by developing an observing ego.  This is often a one-step-forward-two steps-back process as you develop this skill (see my article: Setbacks Are a Normal Part of Psychotherapy Along the Road to Healing).

The more you practice developing an observing ego, the better you'll get at using it.

Getting Help in Therapy
We all have our blind spots (see my article: Overcoming Your Emotional Blind Spots).

Often, we don't realize that we have a particular blind spot until we're able to stand outside our experience and reflect on it.

Psychotherapy provides a unique intersubjective experience where an attuned therapist can help you to overcome your blind spots, negative projections and your confusion about your feelings being facts (see my article:  The Psychotherapy Session: A Unique Intersubjective Experience).

Rather than struggling on your own, you can get the help you need with a skilled psychotherapist (see my article: The Psychotherapist's Empathic Attunement Can Be Emotionally Reparative For the Client).

Psychotherapy can help you to free yourself from recurring negative patterns that are keeping you stuck.

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 to lead more 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.

Discovering That Your Thoughts and Feelings Aren't Facts

There are many clients who begin psychotherapy believing that their feelings are facts--whether it's their feelings about themselves or others.  For those clients, psychotherapy offers an opportunity to develop an ability to self reflect so they can stop confusing their feelings with facts and develop emotional intelligence.

See my articles:  

Developing Emotional Intelligence

Creating Time For Self Reflection

Gaining a New Perspective in Psychotherapy About Yourself and Others

The Benefits of Psychotherapy

Discovering that Your Thoughts and Feelings Aren't Facts

Intuition and gut feelings are certainly important, and this isn't what I'm referring to when I say that feelings aren't facts.

I'm referring to believing that distorted feelings and thoughts are facts and the need to develop an ability to take a step back from your feelings to question whether what you feel is objectively true.

When you don't self reflect and question whether you're being objective, you run the risk of attributing meanings to yourself and others that are false, which can create problems in your life.

Examples of Feelings Not Being Facts:

• Tom noticed that his supervisor had an angry look on his face when he looked in Tom's direction.  As a result, Tom assumed that his supervisor was angry with him, and he avoided his supervisor for the rest of the week.  At the end of the week, Tom's supervisor told him that he realized that Tom was avoiding him and he wanted to talk to him about it.  During that same conversation, his supervisor told Tom that he was angry because their director was making unreasonable demands of him.  At that point, Tom realized that his supervisor's angry look had nothing to do with Tom and that Tom's original feeling about the situation was inaccurate.

• Lynn had a feeling that the new woman, Jane, in her book club was arrogant and standoffish.  One day one of the other women in the group invited Lynn and Jane for coffee.  During their conversation, Jane mentioned that she tended to be shy and quiet, especially around people that she didn't know well, and this often caused people to think that she was standoffish.  Jane said she welcomed the opportunity to join them for coffee to get to know them better.  After that, Jane was much more friendly in the group, and Lynn realized that she misinterpreted Jane's quiet demeanor for arrogance.  She realized that her original feelings about Jane weren't true.

• After her boyfriend ended their relationship, Rena had a strong feeling that she would never be in another relationship.  She assumed that she would be alone for the rest of her life because no one else would want to be with her.  This made her feel lonely, sad and hopeless.  But a few months later, Rena met a man at her friend's party and they began dating.  As their relationship developed, Rena realized that, even though her feelings had been strong that she would never meet anyone else and that she would be alone for the rest of her life, these feelings weren't objectively true because she was now in a new and wonderful relationship.

As in the examples above, feelings--even strong feelings--are often disproved by life's circumstances.  But a change in circumstances doesn't always occur, and people who believe that their feelings are facts remain convinced.

Discovering That Your Thoughts and Feelings Aren't Facts

When people have strong feelings and beliefs that make them unhappy, they often come to therapy to deal with their unhappiness.

One of the goals of therapy is to help clients to step back from their feelings, reassess their feelings objectively and develop insight.  By developing the ability to step back to self reflect and stand outside of personal feelings and beliefs, clients in psychotherapy can develop emotional intelligence.

This can be very challenging for clients when their beliefs that feelings are facts has been longstanding.  They might have learned to identify with their feelings so strongly that it becomes difficult to see beyond these feelings.

Conclusion
It's easy to confuse feelings with facts, especially when you have strong feelings about yourself or others.

Rather than being swept up by feelings and taking action based solely on your feelings, you can learn to become more self reflective.  By being more self reflective, you have an opportunity to be more objective.  And by being more objective, you can see yourself and others in a more accurate way.

Developing this ability on your own can be difficult, especially if you've been in the habit of believing that your feelings are always objectively true.

A skilled psychotherapist can help clients to become more aware of their feelings and beliefs so that they become more self reflective and objective.

Getting Help in Therapy
Most people come to therapy because they feel stuck in some way.

People who believe that their feelings are objectively true have an opportunity in therapy to develop more insight into how they think and how their feelings and thoughts are affecting them.

If you feel stuck in your life, you owe it to yourself to get help in therapy with a skilled psychotherapist who can help you to overcome the obstacles that are getting in the way of your having a fulfilling life.

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 to develop insight into their thoughts and feelings so they can change 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.

Comfort Objects From Infancy Through Adulthood

In prior articles, I've discussed Donald Winnicott's contributions to the field of psychology (see my articles: The Creation of the Holding Environment in Psychotherapy, Books: Tea With Winnicott at 87 Chester Square, Understanding the False Self and On Being Alone).  As a pediatrician and psychoanalyst, Winnicott also contributed the idea of the child's need for comfort objects (also called transitional objects).  But comfort objects are not only for babies--they play an important role throughout our lives.

When Donald Winnicott discussed transitional objects in the mid-20th century, there was little understanding of these concepts among pediatricians and mental health professionals.  The field of child psychology was still relatively new and many people saw children as little adults rather than children who had their own emotional and developmental needs.

According to Winnicott, the baby is comforted by an object, usually a blanket or a soft toy (like a teddy bear)) that is soothing to the baby to hold.

The transitional object helps to soothe the baby when the mother is not holding the baby.

These transitional objects also help the baby, as the baby is developing, to create a transitional space between the times when the baby is with the mother and other times when she is not.

As I mentioned before, transitional objects are usually associated with children, but we all benefit from having transitional objects throughout the life cycle.

Let's explore these concepts further in a fictionalized vignette:

Alan
As a baby, Alan liked to hold onto his favorite blanket as he was falling asleep.  Sometimes, his mother would watch him fall asleep while he was gently chewing on the blanket or a soft toy.

Comfort Objects From Infancy Through Adulthood

Whenever Alan's mother tried to take the blanket from him to wash it, Alan would cry so hard that she would give it back to him.

When she asked Alan's pediatrician about this, he told her that this is a common reaction that babies have at this stage.  He explained that the baby likes to hold, smell, and chew on the blanket (or whatever comfort object the baby prefers) and likes it just the way it is--smells and all.  So, he told her not to worry about it.

When Alan was about three years old, he had a teddy bear that was his comfort object.  He dragged that teddy bear all over the house with him.

When he was in his room, Alan would listen to his mother in the kitchen washing the dishes and talking to her friend.  At this stage of his development, it was enough for Alan to hear his mother and know that she was only a short distance away even though he couldn't see her.  He had his teddy bear to comfort him.

Alan did well when he started school.  He got along well with the other children and he really liked his teacher, Ms. Jones.

Towards the end of the school year, Ms. Jones began talking to the children about all the wonderful things they would learn next year.  She also told them that they would have a different teacher.

Until then, Alan hadn't thought about not being in the classroom with Ms. Jones and the idea of not being with her frightened him.

When he got home, he told his parents that he didn't want to go to the next grade because he wanted to remain with Ms. Jones.  His parents understood that this was a common reaction that children have, especially if they really like their first teacher, so they tried to comfort him by telling him that Ms. Jones would still be around and he would see her in school.

Ms. Jones also knew that Alan and many of the children in her class were unhappy about not having her as a teacher the following year, so they continued to talk about this in school.  She assured them that she would be around and told them where they could find her during the day.

On the last day of class, Ms. Jones took pictures with each student and allowed them to keep them.

Alan carried around his picture with Ms. Jones throughout the summer.  He also kept it in his shirt pocket on the first day of class.  Even though he missed Ms. Jones, he felt comforted by looking at the picture.

As Alan matured into a young adult, he made friends and he became more independent from his parents.  Although he continued to be close to his parents, he spent more time with his friends.

Like most people, Alan had other transitional objects throughout his lifetime.  After he graduated college, he wore his college ring.  And after his grandfather died, Alan wore his grandfather's watch.

Comfort Objects From Infancy Through Adulthood

Eventually, Alan got married.  His wife took a temporary assignment out of state for a few months.  Whenever he felt himself missing his wife, he would look at a picture of her that he kept on his nightstand and that helped him to feel a little better.

Conclusion
People use comfort objects, also known as transitional objects, throughout their lifetime.

Comfort objects help to soothe people during times of transition or stressful times.

A comfort object is a very personal thing and each individual will choose the objects that are most soothing to them.

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 send me an email.

The Therapeutic Benefits of Integrative Psychotherapy

Integrative psychotherapy is a client-centered approach to therapy that combines various forms of psychotherapy depending upon the needs of each client and the skills of the psychotherapist (see my article: The Benefits of Psychotherapy).

The Therapeutic Benefits of Integrative Psychotherapy

Psychotherapists, who use integrative psychotherapy, choose the types of therapy that they combine for each client.

As a psychotherapist, I combine a psychodynamic approach with various forms of mind-body oriented psychotherapy, including EMDR therapy, clinical hypnosis, Somatic Experiencing and Ego States work.

The benefit of using integrative psychotherapy is that the psychotherapist has many different ways that she works so that she can find the approach that is best suited for each client.

Integrated psychotherapy can be used together or separately at different points in therapy.

Let's take a look at a fictionalized vignette to see how integrative psychotherapy can be used:

Pat
Pat came to therapy to work on unresolved childhood trauma that was affecting her in her relationships.

She had heard from a friend, who was in EMDR therapy, that EMDR was effective in helping her friend to overcome emotional trauma, so Pat requested EMDR therapy.

Pat chose a psychotherapist who practices integrated psychotherapy, which included EMDR therapy, among other treatment modalities.

The Therapeutic Benefits of Integrative Psychotherapy

After the initial consultation and the history taking sessions, her therapist discussed the preparation phase of EMDR where the therapist assists the client to develop internal resources to deal with whatever might come up in EMDR therapy.  This is called the resourcing phase of EMDR therapy.

Since the therapist was also trained in clinical hypnosis, after discussing hypnosis with Pat, the therapist helped Pat to imagine a relaxing place (see my article: Safe Place Meditation).

While Pat was in a relaxed hypnotic state, she imagined herself on the beach and, using hypnosis, her therapist helped her to engage all her senses (sight, sound, smell, taste, physical sensation, hearing) to make the image as vivid as possible.

Afterwards, Pat said she felt very relaxed and she could use this image of the beach if anything came up in EMDR therapy that was disturbing to her.

Using clinical hypnosis, her therapist also helped Pat to imagine various friends and loved ones that had qualities that she liked (a nurturing person, a wise person, and a powerful person).  These are called imagine interweaves and they are also part of the resourcing phase of EMDR therapy.

Pat and her therapist talked about touchstone memories that related to the unresolved trauma, so Pat chose certain memories that reflected how emotionally neglected and invisible she felt as a child (see my article: What is Childhood Emotional Neglect? and Growing Up Feeling Invisible and Emotionally Invalidated).

Pat chose a memory that was emblematic of her parents neglecting her emotionally, and her therapist asked her, as part of the EMDR Therapy protocol, what negative belief she had about herself as it related to this memory.

Pat thought about it for a moment, and then she said, "It makes me feel unlovable, and I've felt this way my whole life" (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

As Pat and her therapist began working on the memory using EMDR, they came to an obstacle in the work.  Although Pat made clinical improvements until then, she was unable to get beyond a certain point in the therapy.

This is a common problem in trauma therapy, and her therapist helped Pat to explore if there was a particular belief (called a blocking belief in EMDR) that kept Pat from making further progress in their work.

Using Somatic Experiencing, her therapist helped Pat to explore what the blocking belief might be.

At first, Pat couldn't come up with anything.  But when her therapist asked Pat to sense into her body and see what she felt when she thought about the trauma being resolved, Pat said that she felt a tightening in her stomach (see my article: The Body Offers a Window Into the Unconscious Mind).

Her therapist helped Pat to describe this tight feeling in her stomach and to put words to this feeling.  Pat responded by saying, "I don't deserve to be loved."

As soon as she said this, Pat wanted to take it back.  She said, "I'm surprised that this is what came up because I don't feel this way completely."

Pat's therapist helped Pat to understand that we all have different aspects that make up who we are, and that there can be parts of ourselves that feel a certain way and other parts that don't (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

In Pat's case, there was a significant part of her that felt that she didn't deserve to be loved, and until her therapist could work with this part, their work together would remain blocked.

Using a combination of clinical hypnosis and Ego States work (also called Parts work), her therapist helped Pat to give a voice to this part who felt undeserving of love.  It turned out to be a very young part that had internalized her parents' emotional neglect and believed that Pat was unlovable.

By asking Pat to imagine this young aspect of herself sitting next to her, her therapist helped Pat to understand this part.

Using Ego States work, her therapist helped Pat to embody this young part so she could express what this young part needed.  Then, her therapist asked Pat to switch back to her adult self and to imagine her adult self holding and nurturing the younger part.  Then, she asked Pat to embody the child part and to feel the love that was coming from the adult part of her.

Since this was a very ingrained blocking belief, Pat and her therapist continued to do Ego States work  for several sessions until the younger part felt nurtured and deserving of love.

The Therapeutic Benefits of Integrative Psychotherapy

At that point, the blocking belief was resolved, and they were able to go back to doing EMDR therapy without any further problems.

Conclusion
Integrative psychotherapy combines various forms of therapy based on the client's needs and the psychotherapist's knowledge and skills.

The fictionalized vignette above demonstrates how various forms of therapy, including EMDR therapy, Somatic Experiencing, clinical hypnosis and Ego States work can be combined based on the needs of a particular client.

Not every therapist uses integrative psychotherapy.  So, in the case above, for a psychotherapist who only does EMDR therapy, she might have to use another approach to overcome the blocking belief.

In my experience, using integrative psychotherapy offers the therapist the best possible tools to help the client overcome problems that come up in the work, and it is more effective than just using one treatment modality, especially since there is no "one size fits all" form of therapy that works for every client.

Getting Help in Therapy
If you've decided that you could benefit from attending psychotherapy, it's good to be an informed consumer, which means educating yourself about the various forms of therapy (see my article: How to Choose a Psychotherapist).

When you see a psychotherapist for an initial consultation, you can ask the therapist how she works and what treatment modalities she uses.

In my professional opinion as a psychotherapist, an integrative approach that includes various mind-body oriented therapies is the most effective approach for most clients.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I use an integrative approach that combines mind-body oriented therapy with psychodynamic therapy.  

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 or email me.

The Holding Environment in Therapy: Maintaining a Safe Environment for the Client

In a prior article, I began a discussion about the holding environment in therapy (see my article: The Creation of the Holding Environment in Therapy).  As I mentioned in that article, the idea that the psychotherapist creates a safe therapeutic holding environment for the client was developed by British psychoanalyst, Donald Winnicott (for more on Winnicott, see my article: Books: "Tea With Winnicott" at 87 Chester Square).  In this article, I'm focusing on a particular aspect of the holding environment, which is the therapist's ability to keep the work emotionally manageable for the client.

The Holding Environment in Therapy

As an example, it's often the case that clients come to therapy because they're not feeling good about themselves.  This can be a lifelong problem or a new development for a client.  Either way, the client might focus on the aspects of himself that he is unhappy about and miss the fact that he has many strengths.

A skilled psychotherapist will usually see the client's strengths, even when the client is unaware of these strengths.  

The challenge for the psychotherapist is when to talk to the client about his strengths.

Timing is everything.  If the therapist brings up the client's strengths too early in therapy, the client, who has a particularly negative view of himself, will often minimize or dismiss the idea that he has these strengths (see my article: Overcoming the Internal Critic).

Some clients, who are focused on what they perceive as emotional deficits in themselves, might even think the therapist is being disingenuous when she tries to talk to them about their strengths (see my article: A Strengths-Based Perspective in Psychotherapy).  

In many cases, on an unconscious level, these clients are too afraid to consider the possibility that they have strengths.  Rather being overwhelmed by their fear, they protect themselves emotionally by remaining stuck in their denial.

It's important that the psychotherapist not interpret the client's reluctance as "resistance."  This comes across as judgmental.  It would only make the client feel uncomfortable and it's not helpful to the work.

If the therapist doesn't know how to handle the client's fear,  this could lead to the client leaving therapy prematurely to avoid dealing with uncomfortable feelings (see my article:  When Clients Leave Therapy Prematurely).

So, the skilled psychotherapist, who is aware that it would be premature to talk to the client about his strengths, must keep these observations to herself until the time is right.  This requires the therapist to be emotionally attuned to the client (see my article: The Psychotherapist's Empathic Attunement).

Even with self critical clients who are willing to explore the possibility that they have strengths, they might perceive their strengths on an intellectual level but not on a deeper emotional level.

For these clients, the therapist might broach the topic of the client's strengths, let the client know that she (the therapist) sees these qualities and will hold a space for them until the client can accept this on an emotional level.

This is a way for the therapist to create a safe holding environment for the client because the client knows that the therapist holds onto these observations until the client is ready.

Let's take a look at a fictional vignette that illustrates these points:

John

John had been in and out of therapy for many years.

He usually attended a few sessions with a therapist, and then he aborted therapy because he felt the therapist didn't understand him.

John struggled with depression, including low self esteem, since he was a child.  He grew up in a household where both parents were mostly preoccupied and paid little attention to John, who was an only child.

John's father often criticized him and told John that he would never amount to anything.  His father's critical comments were so frequent that John internalized them and, over time, believed them.  John's mother was depressed and withdrawn, and she was emotionally unavailable to him.

When he was in school, his teachers often told John that he had a lot of potential, but he was not trying.  From John's depressed perspective, he didn't see a reason to try since he believed his father that he wouldn't ever amount to anything.

As an adult, John drifted from one job to another.  Since he never expected to do well, he put little effort into his work, which resulted in disappointment for him.

John also had very low expectations about relationships.  He had a few close friends, but his romantic relationships didn't last beyond a few months.

He would go through long periods when he didn't even try to meet anyone, but then his loneliness caused him to try again with the same low expectations.  It was an ongoing cycle.

By the time John came to therapy again, he felt he was at a low point.  He was already in his mid-30s and he felt he had nothing to look forward to in his life.

The Holding Environment in Therapy

He told his current therapist at the start of therapy that he left his prior therapists because they were unable to see him as he was.  He felt that each of them saw him as they wanted him to be, which frustrated him.

He appreciated that his former therapists were "nice people" and they tried to speak to him about his personal strengths, but he didn't believe what they were saying.  He wasn't sure if they were mistaken or if they were intentionally trying to boost his confidence in a false way.  

Either way, whether the therapist was well-meaning but wrong or whether the therapist was only trying to boost his confidence and didn't really believe he had strengths, John found these discussions intolerable and he would abort therapy.

John's current therapist could see how self critical he was.  She also saw that he had many strengths.  But she also heard John loud and clear that he was unable to even consider that he had strengths, and she knew, based on what he was telling her, that if she tried to broach this with him, he would leave therapy, as he did in the past.  So she waited until he was ready.

Until then, his therapist remained attuned to John's experience and reflected back to him what he told her.  In doing this, she showed John that she understood how he felt about himself, and for the first time in his life, John felt that he was finally seeing a therapist who understood him.

In the meantime, his therapist held onto her perception of the many strengths she saw in John over time.  She waited until she saw a possible opening to explore this with him.

Gradually, as John felt more comfortable with his therapist, he opened up more with her, and she continued to let him know that she understood how he felt by mirroring back to him.

One day, John came to therapy in an agitated state.  He told his therapist that his new supervisor complimented John on a project.

John's first reaction was to get angry because he thought his supervisor was lying to him or he was trying to manipulate John in some way.

But as he thought about it, John said that he knew his supervisor wasn't a manipulative person, so he doubted that this was the reason for his compliment.  He said that maybe his supervisor was just trying to make him feel good--like some of John's prior therapists.  

Whatever the supervisor's intentions, John found it difficult to sit there and listen to his supervisor's compliments.  He said nothing to his supervisor but, for some reason, John realized, it brought up a lot of shame and sadness for him.

During the next several sessions, John continued to talk about this because his supervisor came to him again and told him that he really liked his work.  This continued to baffle John.

Over time, John became more open to exploring this issue and his own sadness and shame.  He was able to connect his negative feelings about himself to his critical father.

During that time, his therapist continued to maintain an open and empathetic stance with John, allowing John to draw his own conclusions (see my article: Why is Empathy Important in Therapy).

She knew that if she intervened prematurely, John would shut down emotionally and he might leave therapy.  She had to wait until he was ready.

Then, one day John came in and told his therapist that his supervisor took him to lunch.  John was surprised that he enjoyed talking to his supervisor over lunch.  He was also surprised to realize that his supervisor liked him and that his praise really was genuine.

As John opened up more emotionally in therapy, he allowed himself to feel his sadness about being a disappointment to his father.  He wished he could have had a father who was more like his supervisor--a kind and generous man.

As he continued to discuss this in therapy, John became aware that his father was a disappointed, bitter man, and his father didn't feel good about himself.

As he looked at his childhood from an adult perspective, he realized that his father was projecting his own negative feelings about himself onto John (see my article: Looking at Your Childhood Trauma From an Adult Perspective).

This led to John questioning whether his father's perceptions about him were accurate, "Maybe I'm not such a loser after all.  What do you think?"

At that point, his therapist realized that John created a small opening for them to be able to discuss the possibility that he wasn't "a loser" and he might have positive qualities.  She also knew that this was a tentative opening that could shut down if she rushed in because John might get overwhelmed, so she had to be cautious.

His therapist said she observed positive qualities in him, and she explored with him whether he would be open to discussing this.  John responded by shifting in his seat and telling her that it felt uncomfortable but, at the same time, there was a part of him that wanted to talk about it.

Gradually, John was able to explore his feelings.  He trusted his therapist enough to know that she wasn't going to lie, hurt him or try to manipulate him.

His therapist relied on John to tell her whether their discussions about his strengths felt too uncomfortable, and he told his therapist when he felt uncomfortable.  In this way, his therapist was able to maintain an emotionally safe environment for John in their sessions.

The Holding Environment in Therapy

Over time, John developed the emotional tolerance to discuss seeing himself in a positive light.  This was new and scary for him at first, but he was starting to feel better about himself.

By being attuned to John, his therapist was able to provide him with feedback about his positive qualities in "manageable doses" for him.  She respected his feedback when he told her that he was beginning to feel overwhelmed, and she would not push him beyond where he could go emotionally.

Working with John in this way, over time, his therapist was able to help John to mourn what he didn't get as a child and to develop more self confidence (see my article: Psychotherapy and Compassionate Self Acceptance).

Conclusion

There are many ways for a psychotherapist to create a therapeutic holding environment for a client.

One way, as I have discussed in this article, is to keep the therapeutic work manageable for the client.

To create a holding environment, the therapist must be emotionally attuned to the client and intuitively sense when the client is ready to explore uncomfortable issues.  She must also ask the client for feedback.

When the client provides a tentative opening, a skilled therapist doesn't rush in.  She helps to facilitate an exploration that is manageable for the client.

In this way, by being attuned and titrating the work, the therapist helps the client to make progress in therapy.  In other words, going slowly in these particular cases, is more effective than trying to get under the client's defenses and overwhelming the client.

From the outside, it might appear that the work is going too slowly, but with regard to the client's internal world the client is developing the internal resources for more in-depth work.  

Not every client has these particular problems, and in many cases the therapist senses that she can make observations early in therapy without jeopardizing the work.  But for clients who aren't ready, premature explorations often lead to premature endings in therapy because the client aborts therapy.

Getting Help in Therapy

Many people, who could be helped in therapy, never come to therapy and struggle on their own without success.

Finding the "right fit" with a particular therapist might be a matter of trial and error as you interview various therapists (see my article: How to Choose a Psychotherapist).  

I usually tell prospective clients to follow their own instincts when choosing a therapist and not to remain with a therapist if their gut feeling is telling them that it's not working out.  However, if you have a long history of aborting therapy prematurely, it might be worth considering that you're avoiding dealing with certain issues in therapy.

Rather than struggling on your own, you could benefit from seeing an experienced therapist who can help you to work through the problems that are keeping you stuck.

By working through problems that are keeping you stuck, you can lead a more fulfilling life.

About Me

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

I work in an empathetic, attuned and respectful manner with clients to help them to overcome their problems and maximize their potential.

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.