Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations

In prior articles about developmental trauma, I discussed that it's not unusual for adults, who have  developmental trauma from childhood, to have problems putting words to their feelings and sensations (see my article:  Developmental Trauma: Living in the Present As If It Were the Past and Developmental Trauma: "This is Who I Am" vs "This is What I Do").  In this article, I'm focusing more on this clinical issue.

Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations 

For infants to develop neurologically and emotionally, their primary caregiver (usually the mother) must be emotionally attuned to the infant.  Beyond providing basic physical care, the mother must enter into an intersubjective dynamic with the infant where she interacts in an emotionally nurturing way.

Over time, this emotional attunement facilitates the infant's brain development, especially the right side of the brain which is the dominant side of the brain up until the third year of life.

Since the right side of the brain is already activated for infants, they learn quickly using the right side until the age of about 3 when dominance shifts from the right side to the left side of the brain.

The right side of the brain is involved in the processing of social-emotional information, the facilitation of attachment functions, and regulating bodily and emotional states.

If the primary caregiver's provides "good enough" emotional responses to the baby's movements, gestures and sounds, the baby will develop a secure attachment bond to the primary caregiver and, as an adult, will have the capacity to form healthy relationships with other adults.

But if the primary caregiver does not provide these emotional responses to the baby or provides them in an inconsistent or disorganized manner, the baby develops an insecure attachment to the caregiver, which has negative implications later on for adult relationships.

In addition, if the infant is neglected in this way or abused by the caregiver, there are also negative implications for emotional regulation as well as the ability to identify feelings and sensations.

Needless to say, these deficits in the ability to identify feelings and sensations have serious consequences for the adult's inner world as well as the ability to form healthy relationships.

Clients, who start psychotherapy because they're having problems understanding themselves and forming relationships and who often blame themselves for their problems, usually don't make the connection between early neglect or abuse and their current problems, which is why it's so important for psychotherapist's to provide this psychoeducation to them (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

Providing these clients with psychoeducation isn't a matter of blaming the mother or the primary caregiver, who often had an early history of abuse or neglect.  It's a first step in helping the clients to understand the origin of their problems.

Also, if they have children, having this psychoeducation helps them to understand the importance of forming a secure attachment bond with their own children so the problems don't continue into the next generation (see my article:  Psychotherapy and Intergenerational Trauma).

Unfortunately, many adults who have problems identifying their feelings and sensations never make it to therapy.  For some people, it's a matter of shame.  They think that, somehow, their problems are their own fault, and their parents might have communicated this to them when they were children.

Other people with developmental trauma don't come to therapy because they're confused about their problems and they think they have to be able to articulate their problems or they can't be helped.  They don't know that most psychotherapists will start at whatever point they find themselves when they begin therapy, and therapists will help clients to  understand these problems as they work towards resolution.

Then again, there are other practical issues involving health insurance and other financial concerns that keep so many people out of therapy in general.

Let's take a look at a fictional vignette, which illustrates the issues that are so common to this problem.

Fictional Vignette: Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations

Amy
Amy started psychotherapy when she was in her early 30s because she had problems sustaining romantic relationships (see my article: The Psychotherapy Session: A Unique Intersubjective Experience and The Psychotherapist's Empathic Attunement Can Be Emotionally Reparative For the Client).

Overcoming Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations

Attractive and intelligent, Amy had no problems meeting and dating men that she was interested in.  Typically, her problems began a few months into the relationship when the relationship became more emotionally intimate.

At that point, Amy became unsure of herself.  She usually knew when she was sexually attracted to a man and she enjoyed the sex during the first few weeks of the relationship.  But as the relationship intensified, she felt confused about what she felt for her boyfriend and she no longer enjoyed sex.

This left Amy and whoever she was dating at the time confused and frustrated.  And when these issues didn't clear up, the relationship would fall apart.

After a recent breakup where Amy found herself in this predicament again, she decided that she needed help in therapy.

At first, she was unsure how to describe her family background.  However, over time, it emerged that she was the only child of a single teenage mother, who sent Amy to live with an elderly great aunt shortly after Amy was born.

As an adult, Amy learned from relatives that this great aunt, who suffered with a multitude of medical problems, was barely able to care for Amy.

After the first year, the great aunt sent Amy to live with Amy's mother's sister, a woman who struggled with major depression her whole life and who resented taking care of Amy.

Throughout her childhood Amy was shifted from one relative to the next in different states around the country until she was 10 and her mother was in a better position financially to take care of her.

Since Amy's mother made no effort to maintain a relationship with Amy, Amy described how awkward it was for both of them.

Although her mother provided her with food and shelter, her mother didn't know how to develop a mother-child relationship with Amy because she never had that experience with her own mother.  She treated Amy was if Amy was a small adult with no understanding of what Amy needed from her.

If Amy was upset, her mother, who didn't know how to soothe Amy, would tell her, "If you're upset, it's your own fault."

When Amy was 18, she got a scholarship to an out of state college and jumped at the chance to get away from her mother.  After college, she got a job and moved in with women she knew from college, and she hardly saw her mother after that.

Amy's last relationship ended in much the same way that her other relationships ended.  She and Tom met through friends.  There was a strong attraction between them from the start.  But after a few months, Amy felt confused about whether she still liked Tom or not.

Tom was confused and couldn't understand the change in Amy, and Amy couldn't explain what happened. Soon after that, Tom ended the relationship and Amy felt she was to blame, once again, for a relationship not working out.

Amy's therapist provided Amy with psychoeducation during the initial stage of psychotherapy.  She also explained to Amy that core emotional issues tend to come up as a romantic relationship becomes more emotionally intimate, which would explain why Amy began having problems when her relationships became more intimate.

In addition, Amy's therapist explained how psychotherapy could help Amy.

With regard to Amy's developmental trauma, her therapist explained that, as a result of Amy's childhood history where her caregivers were unable to form an emotional attachment with Amy, Amy experienced emotional neglect (see my article: What is Childhood Emotional Neglect? and How Your Attachment Style Affects Your Relationship).

Her therapist also explained that when she went to live with her mother, Amy experienced emotional abuse because her mother blamed Amy whenever Amy had problems and, due to her own lack of maternal nurturing, her mother didn't know how to nurture Amy.

As a result of these issues, Amy never developed the skills she needed to form intimate adult attachments.  Amy's developmental trauma also had negative implications for Amy being able to identify her feelings and sensations.

Since Amy's psychotherapist used mind-body oriented psychotherapy, like Somatic Experiencing, she was able to help Amy to begin to identify her feelings using her body (see my article: Somatic Experiencing: Tuning Into the Mind-Body Connection).

For instance, Amy learned to recognize that when she felt fearful, which was often, her stomach would clinch.  She also learned that when she felt angry, she felt a tightness in her throat.

Using this mind-body oriented "bottom up" approach, rather than a "top down" approach which is used in cognitive behavioral therapy (CBT), Amy's therapist helped Amy to recognize her feelings and to be able to put words to those feelings.

This work in therapy was neither quick nor easy since Amy was working to overcome early developmental trauma and to develop skills that she never developed early on.

As time went on and Amy got better at connecting to her body to identify feelings and sensations, she and her therapist were able to process her early developmental trauma using EMDR therapy (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR and the Brain).

Over time, as Amy became more adept at connecting with her emotions, she also developed better relationship skills.  When she entered into a new relationship, she was able to remain connected to herself emotionally and physically as well as being attuned to her boyfriend.

Rather than shutting down emotionally and physically, as she did in the past, Amy was able to remain open in herself and her boyfriend as the relationship became more serious.  Eventually, she and her boyfriend moved in together and they began talking about getting married.

Conclusion
When an infant's needs aren't met because the primary caregiver is unable or unwilling to meet those needs or because there has been multiple and inconsistent caregiving over time, the infant's brain development, in particular the right brain, suffers.

These developmental deficits have negative implications for adult relationships and often result in the individual being unable to identify feelings and sensations.

There is now a greater understanding of developmental trauma due to infant research and the development of trauma-informed therapy.  Within the last 20 years or so, there has also been many advances in psychotherapy to help clients to overcome developmental trauma.

Getting Help in Therapy
A skilled trauma-informed psychotherapist can help clients to overcome developmental trauma.

Trauma treatment modalities, such as Somatic Experiencing and EMDR therapy, help clients to overcome developmental trauma.

Somatic Experiencing and other Somatic psychotherapies help clients to begin to identify their feelings and sensations.

EMDR therapy helps to process traumatic experiences.

If the problems described in this article resonate with you, you owe it to yourself to get help from a trauma-informed psychotherapist (see my article: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than continuing to suffer internally and in your interpersonal relationships, you could work with a trauma-informed psychotherapist to overcome your problems.

By resolving your trauma, you free yourself from a history that has been an obstacle to your happiness.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients to overcome developmental trauma so they could go on to lead happier 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.

How to Talk to Your Psychotherapist When Something is Bothering You About Your Therapy

In a prior article, I discussed the importance of psychotherapists providing clients with psychoeducation during the initial stage of therapy.  

I also stressed that it's up to the psychotherapist to check in with the client periodically to find out how the therapy is going from the client's perspective.  

This helps to avoid premature endings in therapy where the client leaves therapy abruptly out of frustration (see my article: When Clients Leave Therapy Prematurely).  

I also indicated that if the therapist doesn't check in, the client can initiate a conversation with the therapist.  But all too often the client has difficulty being assertive enough to initiate this conversation.  So, in this article, I'm focusing on how to talk to your therapist when something is bothering you about the therapy.

How to Talk to Your Psychotherapist

Why Might You Be Having Problems Initiating a Conversation With Your Psychotherapist?

Being Unable to Identify Feelings and Sensations Due to Early Developmental Trauma
Many clients who have difficulty initiating a conversation with their psychotherapist about the therapy also have the same difficulties in other relationships.  This is often a presenting problem for coming to therapy.

Many clients who have problems letting others know that something is wrong never developed this skill as a child because it was discouraged at home when they were growing up.

For instance, if a client grew up in a home where his parents communicated, either explicitly or implicitly, that everything that went wrong in the household was the child's fault, not theirs, this client will probably assume that problems in the therapy are his fault because he wasn't "good enough" or lovable enough for his parents and now he's not "good enough" for his therapist (see my article: Do You Feel Unlovable?).

Many adult clients, who experienced developmental trauma, including abuse or neglect (or both), have difficulty identifying their feelings.  They might know that "something isn't right," but they don't know what it is (see my articles: Developmental Trauma: Living in the Present As If It Were the Past and When You "Just Don't Feel Right" and It's Hard to Put Your Feelings Into Words).

In most cases, these clients' primary caregiver wasn't attuned to them as babies, which is crucial for physical and emotional development as well as being able to identify feelings and sensations, and so they didn't develop these skills.

Clients, who have difficulty identifying feelings and sensations, have difficulty putting words to their experiences.  They need a psychotherapist who is highly attuned to what is going on with them in therapy and who can help them to develop the ability to identify and express feelings and sensations, including unconscious feelings (see my articles: The Therapist's Empathic Attainment and The Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

If they don't have a highly attuned psychotherapist who can help them to become attuned to the mind-body connection, these clients often feel like they're "not doing therapy right" and this engenders guilt and shame in them.

Clients who were raised in a family where they were placed in the role of caregiving their parents will often unconsciously try to take care of their psychotherapist.  They are often hypervigilant to the  therapist's every facial expression and body language for "clues" as to what might be going on with the therapist and what they think the therapist needs from them, similar to the role they were in as a child with their parents.

Just as they did as children with their parents, these clients try to anticipate the therapist's needs and try to find ways to accommodate the therapist instead of allowing the therapist to help them.  Even though this is a role reversal for the client, the client feels comfortable with in it because it's familiar.

That being said, a skilled therapist will recognize this and address it so the client can learn to allow the therapist to take care of the client's needs.  At first, this might not be easy for the client because he never developed that trust and comfort with his parents as a child, and it's hard to trust as an adult.

Psychotherapist and Client Mismatch
Another common reason for clients not being able to address issues about therapy with their psychotherapist is that the client and therapist are a mismatch.  They're not a "good fit" for each other.

What does it mean that the client and therapist aren't a good match?  It means that, for whatever reason, the client and therapist don't "click."

As I've mentioned in prior articles, every therapist is not for every client.  Even an award-winning psychotherapist, who has published books and articles and is recognized as an expert in her field, might not be the right therapist for a particular client.  This doesn't mean that there's something wrong with the therapist or the client.  It just means they're not a good combination to work together.

This mismatch can make it difficult for the client to communicate with the therapist because they're not on the same wavelength.

If there is a mismatch between the therapist and the client and the client knows he wants to leave, it's still important for the client to address this with the therapist, if the therapist doesn't address it first, rather than aborting therapy without saying anything.

Why is it important to address a mismatch rather than aborting therapy?  Well, the therapeutic relationship, although different from most relationships, is still a relationship, and just like it's important not to suddenly walk out on other relationships, it's also important not to leave therapy without a word.

The importance of talking to the therapist has more to do with learning to speak up for yourself than it does for sparing the therapist's feelings.  Although it's important to be considerate of the therapist, it's more important to be considerate of yourself.  And when you walk out of a relationship without a word, you don't feel good about it.  So, you speak up mostly out of consideration for yourself--not for the therapist.

Boundary Violations
There are also instances where there have been boundary violations between the client and the therapist, including sexual boundary violations.  Needless to say, when this occurs, the therapy is ruined and beyond repair (see my article: Boundary Violations and Sexual Exploitation in Psychotherapy).

No matter who initiated the boundary violation, the therapist or the client, the therapist is always responsible.  It's important to leave that therapy to get help from an seasoned, ethical psychotherapist who can help you deal with the traumatic aftermath of the violation.

Transference Issues
There might also be transference issues that get in the way of the client communicating with the psychotherapist. This means that the client might be experiencing the psychotherapist as a parental figure and this hasn't been addressed in the therapy.

For instance, if the client had highly authoritative, punitive parents as a child and he unconsciously experiences the therapist as another authority figure who will fail him like his parents did, the client might have the same difficulty addressing this in therapy as he did with his parents.  This, of course, assumes that the therapist isn't behaving in an punitive, authoritative manner.  If the therapist is behaving in an punitive and authoritative manner, this isn't a good match for this client or any other client for that matter.

There are many other reasons why a client might be having problems addressing issues about the therapy with his therapist, but the ones I've cited are among the main ones.

How to Talk to Your Psychotherapist If Something is Bothering You About the Therapy

Writing It Down First
If you're having problems articulating the issues you have about the therapy to your therapist, you could benefit from writing about it before you attempt to discuss it with your therapist.  This isn't a substitute for talking to your therapist.  It's just an initial step to take to clarify your thoughts.  You still need to have the discussion with your therapist in person.

If even writing about your problems in therapy feels too daunting to you, you can try writing a story about these issues as if they were happening to someone else.  When you externalize the problem as if it's about someone else in a story, it feels a little less personal and you might find ways to think about it that you don't when you're writing about yourself.

Talking About It: It Doesn't Have to Be "Perfect"
Finding your voice might be difficult, but don't assume that you have to communicate the problem "perfectly" in order to be understood.  Just starting the dialog is often a good beginning, even if all you say is, "I think I'm having problems with the therapy."  This lets the therapist know that there's an issue and she can help you to identify and express it.

Making a Decision About the Therapy - A Consultation With Another Therapist Might Help
In many cases, once the problems are out on the table, things can be cleared up, especially if there was a misunderstanding on the therapist's part or the client's part or both.

But if the problem you're having in therapy can't be cleared up and you're not sure what to do, you can have a consultation with another therapist to try to clarify what's going on in your therapy.  The consultation can be done with or without your current therapist.

I usually recommend that clients let their therapist know if they're going for a consultation with another therapist.  But there might be reasons why you don't let your therapist know, especially if there have been serious boundary violations in your therapy.

Whether you go for a consultation with another therapist or not, at some point, you'll need to make a decision as to whether this therapy is working for you or not.

This can be a difficult decision, and there's no magic answer as what to do and when to do it.  Depending upon your particular situation, it can be complicated.

For instance, if you have a history of going from one therapist to the next in a relatively short period of time, there might be other issues going on.  You might get skittish in therapy at the point when you and the therapist are getting to core issues.  If you recognize this pattern, you would do well to think about what's really going on and if you're constantly avoiding dealing with core issues.

Another reason why it's difficult to make a decision of whether you should stay or leave a particular therapy is that, if you're new to therapy, you might not have a basis for comparison to know if the therapy isn't going well or if you had different expectations of therapy.

This gets back to what I discussed in my prior article about having psychoeducation during the early stage of therapy.  But even with psychoeducation, it can be a tough decision to make.

But once you've made the decision of whether to stick with your current therapist or see a different therapist, as I mentioned before, it's important to communicate your decision with your therapist if you've decided to end the therapy rather than just leaving without talking about it.

Getting Help in Therapy
If you've been struggling with a problem on your own and you haven't been able to resolve it, you could benefit form working with a skilled mental health professional who can help you to work through the problem (see my article:  The Benefits of Psychotherapy).

The first step is to make an appointment for a consultation with a therapist, and it's often the hardest step for most people.

At the consultation, you'll have an opportunity to talk about your presenting problem in a broad way and ask the therapist questions.

You might even ask for another consultation to have more time to find out how the therapist works and, more importantly, to get a better sense of the therapist to see if you think the two of you are a good match (see my article: How to Choose a Psychotherapist).

Being able to free yourself in therapy from the problematic parts of your personal history will allow you to live in a more meaningful way with a greater sense of well-being.

About Me
I am a New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrated Psychotherapy).

I work with individual adults and couples.

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

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

Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works

No one knows how to "do therapy" before they've ever been in therapy.  Even clients who have been in therapy before need psychoeducation about the particular therapy modalities that the current therapist uses and how these modalities work.  

So it's important for the therapist to provide clients with this information during the initial stage of psychotherapy (see my articles at the end of this article).

Why It's Important For Therapists to Provide Clients With Psychoeducation About How Psychotherapy Works

It's common for clients to begin therapy with a certain degree of anxiety.  But when clients have an idea of what to expect in therapy, it helps to ease their anxiety.

It's also important, if possible, for clients to say what they would like to get out of therapy.  I say "if possible," because there are times when clients start psychotherapy and they're not sure what they want from therapy or they might only have a vague idea or, during the initial stage of psychotherapy, they might not know how to articulate their needs and they might need help from the therapist to explore and define their needs (see my article: When You "Just Don't Feel Right" and It's Hard to Put Your Feelings Into Words).  

Psychoeducation About How Psychotherapy Works

The type of information that the therapist provides will depend on the type of therapy that she does.

It's helpful for clients to know how particular treatment modalities work and why it's more effective to work with a psychotherapist than it is to talk to a friend (see my article:  How Talking to a Psychotherapist is Different From Talking to a Friend).  

The following topics, which are listed by therapy modality, are some of the most important areas to discuss as part of the psychoeducation process.

Psychoanalysis and Psychodynamic Psychotherapy 

If the therapist does psychoanalysis or psychodynamic psychotherapy, she might talk to the client about transference/countertransference issues (see my article: Psychotherapy and the Positive Transference).

She will also probably discuss the importance of the unconscious mind, dreams, and the intersubjective process in therapy.

See my articles:

Making the Unconscious Conscious, Discovering the Unconscious Emotions at the Root of Your Problems

The Therapy Session: A Unique Intersubjective Experience, Embodied Imagination Dreamwork

Transforming Nightmares Through Creative Dreamwork

Working With Dreams to Develop Your Creative Imagination

Also, within psychoanalysis and psychodynamic psychotherapy, there are various ways of working.  For instance, I work as a Relational psychotherapist, which is a contemporary, interactive form of psychoanalytic/psychodynamic psychotherapy. Another psychotherapist who does psychoanalysis might use a Classical Freudian method or do Kleinian therapy, and so on.

EMDR Therapy 

If the therapist does EMDR therapy, she could talk about how EMDR can resolve trauma through memory reconsolidating and what are considered Big-T and Small-T trauma.

See my articles: 

What is EMDR Therapy?, 

Overcoming Trauma With EMDR Therapy

When the Past is in the Present

Big T and Smaller T Trauma 

What is Adjunctive EMDR Therapy

Somatic Experiencing/Somatic Psychotherapy

If the therapist uses Somatic Experiencing or Somatic Psychotherapy, she would probably talk about the mind-body connection, and how the body holds unconscious memories.

See my articles: 

Mind-Body Oriented Psychotherapy

Somatic Experiencing

The Body Offers a Window Into the Unconscious Mind

What is Somatic Psychotherapy?

Clinical Hypnosis (also known as Hypnotherapy)

If the therapist uses clinical hypnosis, she would probably not only explain hypnosis, but she would also dispel some of the myths about hypnosis that have been perpetuated in movies and TV programs (i.e., the myth that hypnosis is a form of "mind control") and also about how clients maintain a dual awareness during hypnosis about being in the here-and-now as well as in the space of whatever comes up in the hypnosis.

See my articles: 

What is Clinical Hypnosis?

Clinical Hypnosis and the Mind-Body Connection

Hypnosis and Creative Visualization to Manage Stress 

All Hypnosis is Self Hypnosis).

Cognitive Behavioral Therapy (CBT)

For the therapist who uses cognitive-behavioral therapy (also known as CBT), depending upon the problem, she might explain how desensitization works or why there's usually homework in CBT treatment.  She would probably explain when she uses CBT.  For instance, I use CBT for phobias and certain forms of anxiety.

Ego States Therapy (Parts work)

For the psychotherapist who does Ego States therapy (also known as Parts work), she could talk to the client about the different aspects of the self, dissociation, and shifting self states. 

See my articles: 

Parts Work in Therapy: Is a Split Off Part of Yourself Running Your Life?  

How Shifting Self States Can Affect You For Better or Worse).

Integrative Psychotherapy

If the therapist uses Integrative Psychotherapy, as I do, she would explain how she integrates the various treatment modalities for the most effective treatment.

See my articles: 

The Therapeutic Benefits of Integrative Psychotherapy 

Contemporary Psychoanalysis and EMDR Therapy: A Powerful Combination to Overcome Trauma).

Treatment Frame

There are other issues to be discussed during the initial stage of therapy, including the treatment frame (the fee, length of sessions, policies about missed sessions and payment of fees, and so on) so the expectations are clear at the beginning of therapy.

Feedback to and From the Psychotherapist

I believe psychotherapy should be a collaborative process between the client and the therapist.

One of the best predictors of a good outcome in therapy, regardless of the treatment modality, is a good rapport between the therapist and the client, which develops over time.

The Importance of Feedback to and From the Psychotherapist

Regardless of the therapist's experience and skills, if the client and therapist aren't a "good fit," chances are that the therapy won't go well.  That being said, as previously mentioned, most clients feel anxious at the start of therapy because it's uncomfortable for them to talk to a stranger--even the most empathetic stranger, so the client might need to give the process time before deciding if it's a "good fit" or not.

Most therapists are aware that not every therapist is for every client, so they're not offended if the client feels it's not a "good match."   

An open dialog between the client and the therapist is important, especially with regard to whether the therapy is working for the client.  It's important for the therapist to know what's working and what's not working.  

If the client was already informed about the treatment modalities that the therapist uses and how these modalities usually work for the client's presenting problem, he will not be as likely to expect a "quick fix" for a complicated problem.

But if there are areas that might need to be adjusted or if there are things that the therapist might not be aware of (e.g., the client becomes highly activated between sessions and has problems sleeping), this dialog provides the therapist with information to make adjustments to the therapy, if necessary (see my article: Asking For What You Need in Therapy).

If the client doesn't initiate this dialog, I believe it's important for the psychotherapist to "check in" with the client every so often.

Not only does an open dialog provide the client with the important message that the psychotherapist wants and welcomes feedback--even negative feedback--it also reduces the possibility that the client, who has problems expressing his feelings, will leave therapy prematurely (see my article: Ruptures and Repairs in Therapy and When Clients Leave Therapy Prematurely).

The client can also ask for feedback from the therapist about how the therapist thinks the therapy is going from the therapist's perspective.  This helps the client to understand the therapist's thinking about their work together (see my article: A Psychotherapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Getting Help in Therapy

As I've mentioned in prior articles, it takes courage to admit you have a problem, even admitting it to yourself, and to get help (see my article: Developing the Courage to Change).

When you know that continuing to do what you've been doing that hasn't worked for you is prolonging your suffering, you owe it to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

Rather than becoming overwhelmed by the process, it's important to take it one step at a time.  After you've acknowledged to yourself that you have a problem, the next step is to contact a psychotherapist for a consultation (see my article: How to Choose a Psychotherapist). 

During the consultation, you can give an overview of your problem and ask the therapists questions.

An experienced psychotherapist can help you to work through your problem so you can liberate yourself from your history and have a sense of well-being.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who provides integrative psychotherapy to individual adults and couples.

To find out more about me, visit my website:

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

Also See My Articles:

Psychotherapy is More Than Just Venting

Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent

Common Myths About Psychotherapy: Therapy Takes a Long Time

Common Myths About Psychotherapy: Going to Therapy Means You're "Weak"

Common Myths About Psychotherapy: Therapy is All Talk and No Action).

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

Many people who are recovering from addiction don't understand the concept cross addiction, which is substituting one addiction for another (see my other articles about substance abuse:  Recovery: Maintaining a Balanced Life,  "Liquid Courage:" Overcoming the Temptation to Abuse Alcohol to Cope With Social Situations, The Myth About Having to "Hit Bottom" to Change, and Coping With Addiction: Boredom as a Relapse Trigger).

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

The reason it's so important to understand cross addiction is that people who have a history of addiction often switch from one addiction to another, especially when they're under stress.

So, for instance, if someone who has been sober from alcohol for a few years suddenly finds himself under a lot of stress at work, instead of picking up a drink, he might start to abuse prescription drugs or gamble compulsively or engage in some other form of addiction.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

It's easy to fool yourself into thinking that you can dabble with another addiction because it's not your primary addiction.

But when you're under a lot of stress and you haven't developed adequate skills, if you have a history of addiction, you're more likely to either relapse with your primary addiction or engage in cross addiction.

Let's take a look at a fictional vignette to see how this plays out:

Fictional Vignette: Recovery: Understanding Cross Addiction: Substituting One Addiction For Another:

Connie:
Connie was sober from alcohol for two years.  During that time, she struggled to maintain her sobriety, but with the help of her psychotherapist and her sponsor, she celebrated her second year as a sober person.

Soon after she celebrated her second anniversary of sobriety, she left Alcoholics Anonymous and told her psychotherapist that she wanted a break from therapy.

A few months later, her mother fell, broke her hip and had to go to an inpatient physical rehabilitation center.  When her mother got home, she needed Connie's help because she wasn't able to take care other daily needs.

Although Connie and her mother had a conflictual relationship, Connie agreed to move in with her mother temporarily to help her.  She knew that other siblings, who also had conflicts with their mother, wouldn't be willing to do it and her mother really needed help.

The stress of taking care of her mother and working a full time job took a toll on Connie after a few weeks (see my article: Are You Experiencing Chronic Stress and Unaware of It?).

There were times when she wanted to tell her mother to fend for herself, but she knew her mother couldn't be alone, so she tolerated her mother's emotional abuse.

Connie was often tempted to have a drink, but she knew that if she had one, she wouldn't be able to stop, so she refrained from drinking.  But she started using food to soothe her stress, and she gained 20 pounds within a few months.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

When she went to the doctor for her annual checkup, her doctor couldn't believe that Connie had put on so much weight since the last time he saw her.

Knowing that Connie had a history of alcohol abuse, her doctor asked her if she was overeating.  When Connie told him that she was "stress eating" at her mother's home, he talked to her about cross addiction and recommended that she get back into therapy.

Connie had never heard of cross addiction.  Before she saw her doctor, she thought that as long as she didn't touch alcohol, she was doing well.  But when her doctor explained cross addiction to her, it made sense to Connie, and she knew she needed to take care of herself (see my article: Self Care For Caregivers).

The next day, Connie called a family meeting with her siblings and explained to them that they needed to pitch in.  She could no longer take on the sole responsibility of being her mother's caregiver.

At first, her siblings balked, but Connie insisted that either they help her out or she would hire a home attendant for their mother.

None of Connie's siblings wanted a home attendant in their mother's home, so they agreed to work out a schedule so they could take turns taking care of their mother.  Since there were seven of them, they each took a day, and sharing the responsibility made it less stressful.

Once her siblings were involved, Connie went back to her former psychotherapist to deal with her stress eating and unresolved issues about her mother (see my article: Returning to Therapy).

She also resumed attending Alcoholics Anonymous meetings, and she contacted her old sponsor on a daily basis.

With emotional support and reduced stress, Connie was able to get back on track so she could eat in a healthy way again and lose the weight she gained.

She also had a new appreciation for how stress could put her at risk for cross addiction.

Conclusion
The term "cross addiction" refers to substituting one addiction for another.

The fictional vignette above highlights how important it is to recognize your particular vulnerability to cross addiction and also the importance of self care, self help meetings, and getting help in therapy.

Getting Help in Therapy
Setbacks are part of recovery and part of psychotherapy (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).

If you've had a setback in your recovery, it's important to get help before the problem progresses (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist, who is knowledgeable about addictions, can help you to get back on track again (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, contact a licensed mental health professional who has an expertise in addictions so you can remain healthy.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to establish and maintain their recovery.

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

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

Understanding the Difference Between "I Can't" and "I Won't"

Understanding the difference between "I can't" and "I won't" is often the key to successfully making lasting changes in your life.  While "I can't" means you're not capable of doing it, "I won't" implies a choice--in other words, you're not willing to do it (see my article: Fear of Making Changes, Making Changes: Are You Creating Obstacles For Yourself Without Even Realizing It? and Making Changes: Overcoming Ambivalence).

Understanding the Difference Between "I Can't" and "I Won't"

Often, when people really mean "I won't," they say, "I can't."

For instance, when someone, who he wants to give up smoking, says, "I can't," he's saying that he thinks it will be too hard for him to do it so he chooses not to do.  Although he might not see it that way, if his psychotherapist explored the meaning of "I can't," it usually comes down to choosing not to do it (see my article: Becoming a Successful Nonsmoker).

While it's understandable that change can be scary, when you say, "I can't" it tends to foreclose any discussion about the obstacles that are getting in the way.  Whereas if you say, "I won't do it because I'm afraid that I'll fail" or "I won't do it because I'm too ashamed to admit that it's a problem," that leaves an opening for an exploration of the internal obstacles getting in the way.

The Clinical Implications of "I Can't" and "I Won't" in Psychotherapy

People often come to therapy because they want to make a change in their life.  Usually, they've tried on their own to make changes, but they run into obstacles.

Even though many people begin psychotherapy because they want to make changes, once there is a possibility for change, they often experience ambivalence because there are core issues that need to be addressed that are getting in the way.

If fear and shame are involved, and they often are, an inner conflict develops between the desire to change and the desire to remain the same and not work through the necessary obstacles to be able to change.  

The other possibility, when faced with fear and shame, is that the status quo begins to look good to the client for a while ("Maybe things aren't so bad in my life after all") until the client realizes, once again, that he really needs to change.

At that point, the client's psychotherapist can help the client, if the client is willing, to face the internal obstacles to making the change.  If the client isn't willing to explore his ambivalence, he might leave therapy prematurely (see my article: When Clients Leave Therapy Prematurely).

Let's take a look at a fictional vignette which illustrates these dynamics in therapy:

Ed

After Ed's father died, he became a compulsive gambler as a way to distract himself from his grief (see my article: Overcoming Grief Gambling).

His gambling began with March Madness and quickly progressed to other sports (see my article: Compulsive Gamblers: Beware of March Madness).

At first, when basketball season ended and he began betting on baseball games, he told himself that he would stop gambling at the end of the baseball season.  Then baseball season came and went and he was gambling on football games, and he continued to bargain with himself about stopping.

When the bookmaker refused to take any more bets from Ed because Ed owed him money, Ed got panicky.

Without the highs and lows of gambling as a distraction from his grief, he felt overwhelmed with anxiety and sadness, and this was a "wake up call" for Ed.  He knew he needed help, so he contacted a therapist who specialized in addiction.

Understanding the Difference Between "I Can't" and "I Won't"

During the initial consultation, Ed told his psychotherapist that he knew he needed to stop gambling because he was in debt for thousands of dollars and he didn't want to get any further in debt.

At that point, Ed didn't make the connection between his gambling and his fear of facing his grief over his father's death.  He only knew that he couldn't go on gambling and getting more and more in debt.

When Ed and his psychotherapist talked about when the gambling started, Ed told her that he gambled a little when he was in high school, but nothing compared to his current level of gambling.

As they traced back the origin of his compulsive gambling, Ed was able to see that it began soon after his father died.  Reluctantly, he began to put the pieces together, and he understood that he used gambling as a way to distract himself from his grief.

His therapist recommended that, in addition to coming to therapy, he also attend Gamblers Anonymous groups (G.A.), but Ed didn't think this was necessary.  He told his therapist that he would "just stop."  He believed, "I can stop whenever I want to."

Understanding the Difference Between "I Can't" and "I Won't"

His therapist decided, at that point, not to challenge Ed or insist on G.A.  She told him that they could see how he did with coming to therapy and not attending G.A.

Ed managed not to gamble for the first week, but he felt overwhelmed by anxiety and sadness, so since his bookmaker refused to take his bets until Ed paid off his debt, he told himself that he would "just place one more bet" on an Internet poker site using his credit card.

After placing the first bet, Ed felt he still had his gambling compulsion "under control," so he placed another bet and another--until he was gambling online nearly every day.

Although he felt ashamed about it, he knew that if he wasn't honest with his therapist, he would be wasting his time in therapy, so he admitted that he was now gambling online nearly everyday.

His therapist explained the brain chemistry involved with gambling and other forms of addiction and why continuing to gamble would make it that much harder to stop.

His therapist recommended that they work on coping skills so that Ed could manage his urges.  She also recommended that he identify the triggers that made him want to gamble.

Ed knew that he had a problem tolerating his anxiety and sadness related to his father's death.  Until now, he didn't realize the magnitude of his gambling problem and what it would take to overcome his problem.

He agreed to practice mindfulness meditation at least once a day, but he didn't follow through with his commitment.  Instead, he gave into his urge to gamble, telling himself each time, "This will be the last time."

When he returned to see his psychotherapist, Ed acknowledged that he didn't listen to any of the mindfulness recordings that he downloaded on his phone.

He also admitted that he was still gambling, and he was beginning to feel hopeless about overcoming his gambling addiction.   He asked his therapist, "Isn't there any easier way?" (see my articles: Beyond the Band Aid Approach in Therapy).

His therapist recommended that Ed come twice a week to therapy, attend G.A. meetings and get a sponsor in G.A.  She also explained to Ed that, when he was ready, they could work on the underlying trigger, the grief that he was avoiding.

In addition, she discussed how, if he followed her recommendations, he would probably be able to build up his tolerance for his uncomfortable feelings so they would no longer feel intolerable to him (see my article:  Expanding Your Window of Tolerance in Therapy to Overcome Emotional Problems).

At that point, Ed threw up his hands and told his therapist, "I can't.  I can't do this."

When his therapist explained the difference between "I can't" and "I won't," at first, Ed continued to maintain that he couldn't do what needed to be done to overcome his gambling addiction.

But as they continued to explore whether he was really incapable of overcoming his gambling addition or he was unwilling to give it up, Ed reluctantly admitted that he was unwilling.

At that point, his therapist and Ed had a basis to discuss his unwillingness to give up gambling and unwillingness to deal with his grief.

Over time, the more Ed talked to his therapist about his emotional struggles, the more he was able to see that he was creating obstacles for himself.  So, he followed his therapist's recommendations to practice mindfulness meditation every day, he began attending G.A. meetings, and he obtained a sponsor.

After attending a G.A. meeting, Ed told his therapist that he was surprised to discover how many people were in a similar predicament specifically related to grief gambling.  When he heard other people in G.A. speak about their guilt, shame and overwhelming sadness, he understood what they were talking about.

Gradually, Ed began to talk to his therapist about his grief.  At first, he was afraid that he would be overwhelmed, but he was surprised to discover that he actually felt better after he talked about it.

Understanding the Difference Between "I Can't" and "I Won't"

As Ed dealt with his unresolved mourning in therapy, he felt no desire to gamble.  He paid off his debts and even began to save money.

Over time, Ed was also able to see that he used the idea of "I can't" as a way to avoid dealing with his uncomfortable feelings.  Now he could see the difference between "I can't" and "I won't" and it was an important lesson in other areas of his life.

Conclusion
Even when people really want to change and they come to therapy to get help with making a change, ambivalence often sets in as the process begins (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

At that point, they're likely to say, "I can't" when they really mean "I won't."

Although making a change can be scary, it's a conscious choice and, by the same token, so is not making a change.

Fear and shame are usually the underlying obstacles as to why people are unwilling to take the necessary steps to change.

This is especially common for people who grew up in a family where they didn't have the emotional support they needed when faced with difficulties as a child.

On an unconscious level, they fear that they will be as overwhelmed by emotion as they were as children, but this is rarely the case.  For one thing, as an adult, there is a greater capacity to tolerate emotions (as compared to when they were children).  And, for another thing, as an adult, they have the wherewithal to ask for help.

Making a change that's challenging is often a gradual process:  One step forward and two steps back.     Along the way, there are usually setbacks before you succeed (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).

Getting  Help in Therapy
It takes courage to make a major change (see my article: Developing the Courage to Change).

There are some changes that feel so daunting that you might need help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

If you've been struggling on your own to make a change in your life, you could benefit from seeing a licensed psychotherapist who has experience helping people to overcome obstacles to change (see my article: How to Choose a Psychotherapist)

Everyone needs help at some point in his or her life, and getting help from a skilled psychotherapist could make all the difference between making a successful change or not.

The choice is yours.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to overcome the obstacles that were getting in the way of making a major change in their life.

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.

How a Crisis Can Bring About Positive Change in Your Life

Sooner or later in life, everyone has to cope with a crisis.  It doesn't matter how much you try to avoid crises, they are an unfortunate part of life.  Sometimes, you can see a crisis coming in advance and prepare for it.

See my articles: Fear of Making Changes

Standing at the Crossroad: Fear of Making Major Life Decisions

Preparing Emotionally For Major Changes in Your Life  

Other times, a crisis occurs when you least expect it.  But in many cases crises can be opportunities to make changes that are, ultimately, for the better.

How a Crisis Can Bring About Positive Change in Your Life

People who are able to reframe crises into a possibility for an opportunity are better able to get through the chaos that crisis often brings (see my article: Developing a Positive Perspective About Reframing).

Let's take a look at some fictional scenarios, which represent common occurrences, that illustrates these points:

How a Crisis Can Bring About Positive Change in Your Life

Jim

Jim worked as a senior manager for his firm for over 25 years.  He had a good relationship with his boss and with his colleagues, who praised his work.  He thought he would ride out his last years at this company until retirement and then he planned to start his own consulting business.  But a few years before Jim planned to retire, he was laid off due to budget cuts.  His boss and his human resources director assured him that it had nothing to do with the quality of his work.

At first, Jim was paralyzed in fear.  He wasn't sure what he would do.  So much of his identity was tied up with his job (see my article: When Job Loss Means Loss of Identity).  When he told his wife about the layoff, she encouraged Jim to start his consulting company now and "Go for it!"  Although he was afraid, at first, within a year, he was making more money in his consulting business than he made at his former job, and he had more time to spend with his family.  So, what he initially experienced as a crisis turned out to be a blessing in disguise.

Betty

Betty was in a stagnant relationship that was going nowhere for a few years.  Although she wanted to get married and have children, she was afraid to leave her current relationship because she thought she would never meet anyone else.  Her rationale was, "The devil you know is better than the devil you don't know" and so she remained in this unhappy relationship (see my article: Are You Too Afraid to Leave an Unhappy Relationship?).  One evening, over dinner, her boyfriend, Ted, told her that he wanted to breakup.  He accepted a job out of state, and he didn't want to have a long distance relationship, so he thought it was better to end their relationship.  At first, Betty panicked.  Even though she was dissatisfied with the relationship, at least she had someone to have dinner with and to go to the theatre.  Now, she would have no one.  During the first few months after the breakup, Betty mourned the end of her relationship.

How a Crisis Can Bring About Positive  Change in Your Life

Shortly after that, a close friend introduced her to someone new, John.  After dating for a few months, Betty and her new boyfriend decided to be exclusive, and she realized that she was happier in this relationship than she had ever been.  Had she and Ted remained together, she would never started dating John.  What initially felt like a major crisis in her life turned out to be a positive change.

Donna

Donna had always enjoyed good health for most of her life.  But shortly after her 40th birthday, she had a mild heart attack and was hospitalized.  After she was discharged, her cardiologist spoke to her about her stressful lifestyle, including a stressful job that she hated and an unhealthy diet where she mostly ate on the run.  He told her that she would have to make changes to her lifestyle or she could have a massive heart attack, especially since there was a history of heart problems in her family (see my article: How Medical Problems Can Change How You Feel About Yourself).

Donna spoke with her husband about the changes she was thinking about--including leaving her stressful job.  Her husband encouraged her to do what she had always wanted to do--become a yoga teacher.  So, when she quit her job, and when her cardiologist gave his approval, Donna began a yoga training program.  Soon after she completed the yoga training, she began working for a local yoga studio, a job that she loved.  In retrospect, she realized that she probably would never have quit her stressful job to do what she really wanted if she had not had the heart attack.

Conclusion

Making changes in your life, even under the best of circumstances, can be challenging.  We often become comfortable with what's familiar, even if it's not what we want.

Making changes during a crisis is even more challenging because we're often not prepared for the crisis.  It can be like a tsunami that comes upon us suddenly.  

Being flexible, being able to reframe a crisis into an opportunity (if possible), and having emotional support can help you to make positive changes. 

But there are times when the crisis is so overwhelming that it is traumatic.

In other words, it's beyond what you can handle, and you might need help from a skilled mental health professional to help you to get through the crisis and come out of it more resilient than before.

Getting Help in Therapy

Everyone needs help at some point in his or her life.

Sometimes, friends and family, who are well-meaning, aren't helpful because they're part of the crisis or they're fearful of change so they can't see opportunities or alternatives.

When you're overwhelmed by a crisis, you could benefit from working with a skilled mental health professional who can help you to recognize your strengths and help you to regroup (see my article: The Benefits of Therapy).

Rather than struggling on your own, if you feel overwhelmed by a crisis in your life, seek help from an experienced psychotherapist who can help you to overcome the current obstacles so you can live a more fulfilling life (see my article: How to Choose a Psychotherapist).

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

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

I have helped many clients to overcome their problems so they could maximize their potential and live the life they want to live.

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