What is Transference in Psychotherapy?

I have discussed transference in prior articles (see my articles: Psychotherapy and the Positive Transference and Psychotherapy and the Erotic Transference).  I wanted to discuss transference in more detail in this article so that clients who are in therapy or thinking about going to therapy will have a better understanding of this concept.

What is Transference in Psychotherapy?

The concept of transference was originally developed by Sigmund Freud when he was developing psychoanalysis.  He described various forms of transference in psychotherapy, including the positive transference, negative transference, erotic transference, parental transference and so on.

Here is a simple explanation of transference for psychotherapy clients who might be curious:  Typically, transference occurs when the client unconsciously "transfers" feelings that s/he had during childhood from her primary caregiver to the current psychotherapist.

Since this phenomenon is unconscious on the client's part, s/he usually isn't aware that these old feelings are being superimposed on the relationship with the psychotherapist.

If the transference is positive, it usually means that the client and psychotherapist have a good therapeutic relationship and, in most cases, the therapy is going well.

If the transference is negative, it means that there is some conflict between the client and the psychotherapist or some obstacle in the therapeutic work, and the client has negative feelings about the therapist.

During the course of therapy, the client's transference can switch back and forth between positive and negative or other forms of transference.

Many clients aren't aware of the term "transference" because the term is a form of psychotherapy jargon, and most therapist would find a more accessible way of talking about the therapeutic relationship with the client without resorting to jargon.

But clients who are interested in psychotherapy and possibly thinking about becoming a psychotherapist will often read this term and wonder what it means.

Transference is not a phenomenon that is exclusive to psychotherapy.  We all experience various forms of transference all the time in our personal and work relationships.

For instance, if you resented your authoritative father as a child, you might unconsciously "transfer" the feelings of resentment from your father to your boss at work and develop a negative transference for your boss--regardless of whether your boss is authoritative or not.

This doesn't mean that you still don't resent your authoritative father.  It just means that your boss is a person who is in authority in your life, and regardless of whether your boss has an authoritative personality or not, on an unconscious level, you have similar feelings towards your boss (and possibly other authority figures) as you did (or do) towards your father (see the vignette in my article: Contemporary Psychotherapy: Redefining the Traditional View of "Resistance" in Therapy).

Similarly, if your boss unconsciously reminds you of your grandfather, who was kind to you, you might develop a positive transference for your boss without even realizing how your feelings for your boss are connected to your grandfather.

Many psychotherapy clients "fall in love" with their psychotherapists.  I put "fall in love" in quotes because they're not actually in love with the therapist.

Most of the time, their feelings are based on a fantasy of what it might be like to have a personal relationship with the therapist.

This fantasy might have nothing to do with what it might actually be like to have a personal relationship with the psychotherapist (see my article: Why Your Psychotherapist Can't Be Your Friend).

Clients who experience an erotic transference for their therapist often worry and feel ashamed of their feelings, but this is a common experience in therapy.  Usually, the erotic transference dissipates over time as the client gets a better sense of the therapist as a ordinary person, the client develops more objective feelings for the therapist, and the client finds other attainable love interests in the "real world."

Although transference is an important concept in psychotherapy, not all feelings towards your therapist are about transference and it's important to be aware of this.

For instance, if your psychotherapist has said or done something in therapy that bothers you, your feelings shouldn't be dismissed by the therapist as being only about transference.

The real issue between you and the therapist needs to be addressed (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Psychotherapy).

In future articles, I'll discuss other forms of transference.

Conclusion
Everyone experiences transference in all kinds of relationships--not just their relationship with their psychotherapist.

Transference usually happens on an unconscious level.

If you're in therapy and you're uncomfortable with your transferential feelings for your psychotherapist, you can talk to your therapist about it.

Psychotherapists are usually open to talking about transference, and you'll probably feel better to get these feelings out in the open.

Getting Help in Therapy
If you're feeling stuck in your life or you're unable to overcome a problem on your own, you could benefit from attending psychotherapy (see my article: The Benefits of Psychotherapy).

Rather than suffering on your own, you owe it to yourself to get help from a licensed mental health professional (see my article: How to Choose a Psychotherapist).

Whether you need emotional support or if you need help overcoming psychological trauma, a skilled psychotherapist can help you overcome the obstacles that are keeping you from living a more fulfilling life.

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

Contemporary Psychotherapy: Redefining the Traditional View of "Resistance" in Therapy

The concept of resistance in psychotherapy originated with Sigmund Freud while he was developing psychoanalysis.  He noticed that some clients refused to talk about certain aspects of their life or, from Freud's perspective, they unconsciously behaved in uncooperative ways that sabotaged the therapy.  Ever since that time, the concept of resistance has taken on a negative connotation and, in my professional opinion, is pathologizing of the client.  

In an earlier article,  Reconceptualizing the So-Called "Help Rejecting Client", I discussed the importance of depathologizing this concept because calling the client "help rejecting" is neither helpful to the client nor to the therapist to understand what's going on in therapy.  Similarly, in this article, I'm advocating for psychotherapists to redefine resistance in therapy and to take a more nuanced look at what's going on.

Contemporary Psychotherapy: Redefining the Traditional View of "Resistance" in Therapy

The Traditional View of Resistance in Psychotherapy
Freud conceptualized resistance to be any unconscious behavior by the client in therapy that was, from his perspective, oppositional and uncooperative.

He indicated that there could be different types of resistance, including transference resistance where the client responds to the psychotherapist as if the therapist is someone from the client's past (typically, parents), self sabotage, ego resistance where the client regresses to an earlier stage of development, repression where the client unconsciously pushes down memories that s/he is avoiding, and other similar forms of so-called resistance.

There might still be psychotherapists, including Classical psychoanalysts, who see the concept of resistance in the same way that Freud did, but many more contemporary psychotherapists have taken a less pathologizing perspective of resistance, and I include myself among those contemporary therapists.

Depathologizing the Concept of Resistance in Contemporary Psychotherapy: Shifting Self States
The traditional way of looking at resistance sees the psychotherapist as being authoritative, someone who knows what's best for the client.  Looking at it from that perspective, when a client is being resistant, the therapist's view is that the client isn't following what the therapist says is best for him or her.

Needless to say, this traditional way of working with clients in therapy is from a time when there was little to no mutuality in psychotherapy between the client and the therapist.  The therapist was seen as the expert and the client needed to follow the therapist's ways of working or, it was believed, the client wouldn't get better.  This way of working tended to shame the client.

During the last 20 or so years, there have been many changes to psychotherapy and, fortunately, this traditional way of seeing the therapist as the authority figure and the client as being in a subordinate position is, for the most part, not practiced any more.

Most contemporary psychotherapists work in a collaborative way.  There is a recognition that psychotherapists don't have all the answers and that the client and therapist need to work together in therapy (see my article: Why It's Important For Your Therapist NOT Have All the Answers).

In my opinion, along with working in a collaborative way, it's also important to recognize that there are two people in the room and there's an intersubjective experience between the client and the therapist (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

Rather than the psychotherapist being the all-knowing authority figure, I believe it is much more helpful for the therapist to use her clinical skills and expertise to be attuned to what is going on with client in the therapy session and help the client to formulate his or her own understanding (see my article: The Psychotherapist's Empathic Attunement).

This is a much more client-centered way of working in psychotherapy and tends to help the client to feel more comfortable with the therapist and the therapeutic process, as opposed to the former traditional stance in therapy where the psychotherapist was the authority figure and was "always right."

In a prior article, Understanding the Different Aspects of Yourself That Make You Who You Are, I discussed that we all have many different aspects of self (or self states) that make us who we are, and these self states are continuously shifting in all of us (see my article: How Your Shifting Self States Can Affect You For Better or Worse).

Depending on the person, these self states often shift in a barely perceptible way because they are integrated as part of the person's overall makeup of who s/he is.  Or, in some cases, they might be less integrated, which would mean that shifts in self states might be more intense and noticeable.

As I've mentioned in other articles, when I discuss self states that are shifting, I'm not referring to multiple personality disorder or, as it's currently known, dissociative identify disorder.  I'm referring to shifting self states as a natural part of what occurs in everyone.

When we look at the concept of resistance in psychotherapy as part of shifting self states, it's a much more useful way of looking at it.  Rather than seeing the client as being resistant, when we take into account shifting self states, we can see that there are different parts of the client that might feel different ways about a particular part of therapy.

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

Contemporary Psychotherapy: Redefining the Traditional View of "Resistance" in Therapy

Ken
Ken began psychotherapy because he felt stuck in his personal life and in his career.

Contemporary Psychotherapy: Redefining the Traditional Concept of "Resistance" in Therapy 

He was unable to sustain a relationship for more than a few months.  After that initial stage of dating, Ken would become fearful of being engulfed in his relationship and he would end it.  Afterwards, he would have regrets, but his fear of engulfment kept him from trying to reconcile his former relationship.  Then, the pattern would begin again with the next person.

At 32, Ken was starting to despair that he could ever be in a long-term relationship.  He was afraid  that his fear of engulfment would continue to sabotage any potential relationship and he would be alone.

With regard to his career, Ken was a middle-level manager, and he usually had problems with his superiors.  Intellectually, he understood that there was a hierarchy at his company, and he understood the reason for the hierarchy.  But on an emotional level, he resented it, and he would sometimes challenge his bosses in subtle and not so subtle ways at staff meetings, which tended to cause problems for him.

Ken was told by the senior vice president at his company that he was viewed as a hard worker and a creative thinker, which was valued at the company, but his "attitude" towards his superiors was getting in the way of his career advancement.

The senior vice president told Ken that, even though Ken was seen as being capable of advancing in terms of his work and creativity, he was also seen as "difficult" and some of the senior managers were hesitant about having Ken as a direct report.  He advised Ken to work on changing his attitude because if he didn't change, he was probably jeopardizing his future with the company.

Deep down, Ken knew that the senior vice president was right.  He knew he could be provocative at times with his boss.  After these incidents, Ken wasn't sure what came over him.  He regretted his behavior and he would apologize to his boss.

Even though his boss was very understanding, Ken knew that he couldn't continue to do this and survive at the company.  He knew he needed to understand himself better and change.

He explained to his current psychotherapist that he had been in therapy in his late teens and early 20s, and he found it to be a discouraging experience.  He would often challenge his psychotherapist's interpretations and it caused friction in their relationship, especially when his therapist called Ken "resistant."

That therapy ended when Ken felt too ashamed to continue, and both Ken and his therapist ended the therapy feeling frustrated.  This experience in psychotherapy kept Ken away from therapy--until now.  He decided to give therapy another chance because he knew he wouldn't be able to change without help.

When Ken's current psychotherapist heard Ken describe his family background, she began to understand what might be contributing to his problems in relationships and in his career.

Ken grew up as the older of two sons.  His father, who was a successful attorney, tended to be cold and authoritative with everyone in the family, including Ken.  Ken said, "My father definitely ruled the roost and everyone had to fall in line with what he wanted, and I resented this."

Ken's mother tended to be overly protective and "smothering" of Ken and his brother.  Even when he was a child, Ken felt overwhelmed and engulfed by his mother's anxious ministrations.

In his teens, even though he loved them, Ken often felt angry with his parents.  He would frequently argue with them and, once, almost came to blows with his father.  By that time he was 18, he was relieved to go away to college to get away from both parents.

Ken's current psychotherapist explained that she worked in a contemporary way that is interactive and collaborative (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation in Psychotherapy).

His therapist also explained the concept of shifting self states to help Ken understand his ambivalence about relationships and his career.  Specifically, it seemed to her that part of Ken wanted to be in a long-term relationship, but part of him was fearful.  The part of Ken that was fearful would become dominant as the relationship got serious and this part contributed to the demise of the relationship (see my article: Wanting and Dreading a Relationship).

Similarly, his psychotherapist explained, that it seemed that part of him wanted to be more cooperative with his boss at work, but another part resented that the boss was an authority figure, and this part would dominate at times and get Ken into trouble.

Then, rather than assuming that she was right, his therapist asked Ken if what she said resonated with him.

Ken responded by saying that he never thought of himself as being made up of different parts, and this idea intrigued him.  As he thought about it, he could see how the different aspects of himself interacted with others at various times.

His therapist also explained that it seemed as if these parts of him that were creating problems for him were based on his earlier experiences, and these parts were actually trying to protect him from feeling overwhelmed like he felt when he was younger.  But now, these parts were getting in his way (see my article: Understanding Why You're Still Affected By Trauma That Occurred a Long Time Ago and Coping With Trauma: Becoming Aware of Triggers).

Since Ken was open to the idea, his therapist recommended that they do Ego States work, which is an experiential form of therapy, to help him to differentiate the different parts of himself, understand when they get triggered, and address the fears that were contained in these parts.

Rather than talking about the different parts of himself, Ken would experience these parts in Ego States work (see my article: Experiential Therapy Helps to Achieve Psychological Breakthroughs).

At first, Ken agreed that this was a good idea, and he was enthusiastic about it.  But soon after they started doing Ego States work, Ken got anxious and he wanted to stop.

When his therapist attempted to explore with Ken what happened, Ken told her that he didn't know--he just didn't want to do it.

His therapist explained that she respected his choice.  She just wanted to understand and help Ken understand what shifted for him.  She said that if Ken was open to this exploration, it might help him to understand what shifted for him in terms of shifting self states.

The particular memory they were working on was an experience Ken had with his former girlfriend when he felt overwhelmed by her suggestion that they talk about where their relationship was going.  He remembered feeling the same as when he was younger and he felt engulfed by his mother.

It was at the point when Ken wanted to stop doing this experiential work and he said to his therapist, "I know you're going to tell me that I'm being 'resistant' just like my prior therapist used to say to me."

But Ken was surprised that his current therapist told him that she didn't find it especially helpful to tell clients that they're being "resistant."  Instead, she went back to the concept of shifting self states and that a particular self state, whose motive might be protective, might be the cause of this change in him.

Ken was relieved that his therapist wasn't blaming him, and he became less defensive.  This allowed him to think about what shifted for him internally as they were doing Ego States work.  As he calmed down, he realized that he thought of his mother while they were working with the memory and he remembered how he felt so overwhelmed by his mother when she was too much for him.

His therapist said she understood and introduced the idea of internal resources.  As part of developing internal resources, she asked Ken if he could imagine someone who could have been helpful to him when he felt engulfed by his mother (see my article: Using Imagery as a Powerful Tool in Therapy).

Ken thought about it for a few minutes and said he thought his uncle, his mother's brother, would have been helpful.  In fact, when his uncle was around and he saw Ken's mother being intrusive with Ken, he would tell Ken's mother to relax and she would back off.  But, unfortunately, he wasn't always around.

Ken's therapist asked Ken if he would be willing to imagine his uncle being here with him now when he went back into that memory.  Ken agreed, and he was surprised that by using his imagination and sensing his uncle was with him, he felt calmer.  At that point, with the help of this internal resource, they were able to go back to doing the Ego States work.

As they continued to work together doing Ego States work and discussing it afterwards, Ken developed a better understanding of himself.  He also noticed a positive shift in how he interacted with his boss at work, and his boss commented that he noticed it too.

When Ken began dating again, he recognized when a fearful self state was about to get in the way and he was able to calm himself.  He also continued to explore this issue with his psychotherapist.  This allowed Ken to remain in a relationship with a woman that he really liked.

Overall, Ken felt calmer and more emotionally integrated at work and in his romantic relationship.

Conclusion
In my opinion as a psychotherapist, the traditional view of resistance is not helpful to the client, the therapist or to the work in therapy.

It tends to be an all-or-nothing concept that doesn't take into account that people are much more nuanced in their behavior.

As I mentioned before, calling a client "resistant" is pathologizing. This also makes it shaming, which creates a lot more problems for the client in therapy.

Taking a more contemporary view in psychotherapy and seeing what might be called "resistance" as shifting self states helps the therapist and the client to understand ambivalence and to work through that ambivalence with the parts of the client that are getting in the way.

Getting Help in Therapy
If you feel stuck in your life, even though you really want to make changes, you might be struggling with self states that are ambivalent about the change.

Ego States therapy is one way to work in therapy to help to distinguish the different self states involved in the ambivalence, give them "a voice," and work towards overcoming whatever fear might be contained in the particular self state.

When you're able to overcome the obstacles in your way, you can live a more fulfilling and meaningful life free from your earlier problematic history (see my article: The Benefits of Psychotherapy).

Rather than blaming yourself or remaining stuck, you could benefit from working with an experienced contemporary psychotherapist who works in a non-pathologizing way (see my article:  How to Choose a Psychotherapist).

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who tends to work in an integrative way in therapy (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients, in a nonjudgmental and interactive way, to overcome the obstacles that are keeping them from leading a more fulfilling 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 regular business hours or email me.

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Clients often start psychotherapy with some degree of ambivalence--often a mixture of hope and fear.  The hope is that they will be able to work through their problems in therapy.  When clients come to therapy to deal with unresolved developmental trauma, the fear is that the psychotherapist might fail them, as they were failed in their earliest relationships with their parents, and they will be retraumatized (see my articles: Developmental Trauma: Living in the Present As If It Were the Past, Starting Psychotherapy: It's Not Unusual to Feel Anxious and Ambivalent,  Clients' Fears About Being Abandoned By Their Psychotherapist, Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About Psychotherapy, and Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations).

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

As I've mentioned in other articles, it's always important for the psychotherapist to establish a rapport with the client.  This is especially true when clients come to therapy to work through developmental trauma where they might have been neglected, abused or betrayed in some way. These clients often expect to be retraumatized in their personal relationships as well as in their client-therapist relationship.

Even when there seems to be a good therapeutic alliance between the client and the therapist, this rapport can be fragile and subject to sudden changes depending upon how vulnerable the client feels in a particular session, so the therapist needs to be aware that there can be these sudden changes.

If the client develops a positive transference to the psychotherapist and there is some misunderstanding, the client, who is ever vigilant for possible betrayal, can suddenly develop a negative transference when he thinks that the therapist is behaving in a similar way to his parents.

Many times this fear is unconscious on the client's part, and he might not know that he is reacting to the therapist as if the therapist was the parent who abused, neglected and betrayed him (this assumes that the therapist is really not being abusive, neglectful or betraying the client).

These ruptures are usually reparable if the therapist understands what's happening between her and the client and the client allows for the repair (see my article: Ruptures and Repairs in Psychotherapy).

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

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Agnes

Agnes was in her early-30s when she began psychotherapy. 

During the consultation, Agnes explained to the therapist that she felt like she was "just drifting" in her life without purpose.  She said she felt "dead" inside.  She had a history of several unhappy romantic relationships and many unsatisfying dead end jobs, including her current job.  

Coming to therapy was her first attempt to explore these issues.  In the past, she considered attending psychotherapy, but each time she would dismiss this idea because she feared being betrayed in therapy.

But lately she felt so miserable and her friends were tired of hearing her complain.  Even when they were willing to listen, she didn't find them to be helpful.  She thought they didn't understand what she was going through and their suggestions were simplistic.  So, she decided to try therapy, hoping that she would feel better, but dreading that it would be another bad experience.  

She described her family history as "a nightmare."  Her father was a severe alcoholic, and her mother was in denial about the severity of the father's drinking.  She described her mother as being in her own "fantasy world" where everything was "rosy."  Even when her father lost one job after the next because of his alcoholism, her mother blamed the bosses for firing the father.  

As the older of two children, Agnes felt she had to contain all her worries by herself because her mother was unable to talk to her about Agnes' concerns.  

Her mother would minimize Agnes' fears by telling Agnes that she was being "dramatic" or a "worry wort."  Agnes' brother, who was 10 years younger than her, didn't understand what was going on, so Agnes felt alone and she suffered from terrible anxiety.

From the time she was a child, she worried about things going wrong.  Even when things were going relatively well, she worried that there could be a sudden downturn and she would be devastated.

She was offered jobs that were commensurate with her education and skills, but she never felt confident enough to accept them.  Instead, she took low level, low paying because they didn't cause her to feel such fear and anxiety.

When she recently turned 31, she had a sudden awakening that she didn't want to just "drift" in life any more.  She wanted to get married and have a family, but she was afraid to date because her prior relationships were so awful.  

She also wanted to work in a more interesting job because she was bored at her current job.  Money wasn't an issue because her father left her a trust fund when he died, but she feared that one day when she was older that she would look back on her life and have many regrets because she was too afraid to take risks.

Recently, a family friend, who knew of Agnes' advanced education and skills, offered Agnes what she  considered to be her "dream job."  But she was highly ambivalent about taking it.  She feared that if she didn't do well, she wouldn't be able to face the family friend or her mother and brother.

So, her dilemma was whether she should stay in her current, boring job where she was underemployed or if she should take the risk and accept the family friend's job offer.

Agnes also talked about coming to therapy as being a "risk."  She chose her psychotherapist based on a recommendation from her primary care doctor, but she feared that the therapist would be another disappointment in a long line of disappointments throughout her life.

Given all of Agnes' fears about therapy, she and her therapist decided that they would take it slow.  Agnes' preference was to deal with the career issue first since she had to give her family friend an answer soon.

During their sessions together, Agnes went back and forth as to what she wanted to do about the job offer.  In one session, she said she planned to take the job.  In another session, she changed her mind and said she was too afraid to take the risk.

As they talked about her need to make a decision and how difficult this was for her, Agnes' therapist helped Agnes to see the connection between her early history and her fear of taking what she perceived to be a big risk.

Agnes began to understand how overwhelmed and emotionally neglected she was as a child since neither parent was able to be emotionally supportive.

It was understandable that Agnes, who felt so insecure about most things since she was a child, would also be fearful of making a change in her career.  She had little confidence in her decision making process in part because she was so invalidated as a child (see my article: Growing Up Feeling Invisible and Emotionally Invalidated).

After a few weeks, Agnes expressed feeling comfortable in therapy.  She felt that her therapist understood her and was emotionally supportive.  

Soon after that, Agnes told the family friend that she would accept the job.  At first, she was relieved that she made a decision and she was no longer going back and forth in her mind.  

But shortly afterwards, she was overcome with anxiety and fear:  Was she taking on more than she could do?  Would she disappoint the family friend?  If she didn't succeed, would she feel like a failure in front of family and friends?

Whenever Agnes spoke with her therapist about her decision, she felt better.  She was almost defiant about "showing" her mother that she could do better.  She also knew that she could leave the job if it didn't work out and no one needed to know what happened.  

But she continued to ruminate about her decision, going back and forth in her mind even though she had already told the family friend that she accepted the position.  Her rumination caused her to lose sleep because she was so worried.

One day, Agnes showed up at her psychotherapist's office on the wrong day.  When her therapist saw her in the waiting room, she called Agnes into her office to talk to her for a moment and to let her know that her appointment was for the next day.  She explained that she couldn't see Agnes today because she already had other clients scheduled.

At that point, Agnes became furious.  She insisted that her appointment was for that day, and she blamed the therapist for being confused, "I knew I couldn't trust you.  You're just like my parents--so unreliable.  I knew you would betray me.  I don't think you're the right therapist for me" and with that she stormed out of the office.

Agnes' therapist called Agnes that evening after she saw her other clients.  When Agnes answered the phone, she sounded calmer.  She told her therapist that she realized afterwards that she was the one who was confused about the day, and she apologized.

During the course of Agnes' therapy, there were several more similar incidents.  Whenever an incident occurred, Agnes was sure that her therapist had betrayed her in some way.  

But when she calmed down and she and her therapist were able to talk calmly, Agnes realized that she had misjudged the situation and that her fear of being betrayed was always just under the surface waiting to erupt.

As Agnes and her therapist were able to repair their relationship after each incident, Agnes became more trusting of her therapist.  As time went on, these incidents decreased and there was more time between each incident.

In the meantime, Agnes was doing well at her new job.  This gave her more confidence, although she was still afraid sometimes that she would fail.  

When Agnes was ready and she felt more stable in her relationship with her therapist, she and her therapist began to work on her developmental trauma using EMDR therapy (see my articles: What is EMDR Therapy? and  How EMDR Therapy Works: EMDR Therapy and the Brain).

Developmental Trauma: The Client's Hopes and Fear in Psychotherapy

Over time, she was able to work through her traumatic childhood so that the trauma didn't continue to get played out in her adult life.

As she felt more comfortable and secure, she also started dating again, and she felt more hopeful about being in a long-term relationship.

Conclusion

People who have experienced developmental trauma often expect to be abused, neglected, disappointed or betrayed in some way in their adult relationships.

Many people, who have unresolved developmental trauma, tend to be vigilant so they won't be caught off guard when the disappointment comes.  Even when things are going relatively well in their life, their fears can dominate their emotions.

Clients with developmental trauma usually come to therapy hoping that they will find relief from their problems, but many of them also dread that their therapist will betray them in some way.  

Even if the client with developmental trauma develops a positive transference with the therapist, even a minor misunderstanding can cause the client to regress to feeling suspicious and fearful again.

Under these circumstances, there can be many incidents of ruptures and repairs between the therapist and the client--if the client will allow the repair.  Some clients just leave therapy precipitously and never allow for the repair (see my article: When Clients Leave Psychotherapy Prematurely).

But if the client and therapist can work on repairing the relationship, this is healing for the client because her childhood experience was usually that there were no repairs, only ruptures, so seeing that ruptures in therapy can be repaired is healing for the client.

Over time, if the client stays in therapy, a consistently positive relationship can develop between the client and the psychotherapist and can create an opening to develop other positive relationships.

Getting Help in Therapy

One of the most difficult things for many clients with developmental trauma to do is to come to therapy (see my article:  The Benefits of Psychotherapy).

For these clients, balancing hope and fear can be challenging.

Clients with developmental trauma often come to therapy when the emotional pain they're experiencing is greater than their fear.

Over time, if the client and the therapist are a good match, these issues can be worked through in therapy and the unresolved developmental trauma can be gradually resolved (see my article: How to Choose a Psychotherapist).

If the issues that I've described in this article resonate with you, you owe it to yourself to find a skilled psychotherapist who has experience working with developmental trauma.

Once you are free from your traumatic history, a huge emotional burden will be lifted from you.  It can improve how you feel about yourself, your outlook for the future, and your relationships.  

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 work through their traumatic experiences so they can live more fulfilling lives.

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

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

Looking Happy on the Outside, But Feeling Broken on the Inside

Looking happy on the outside, but feeling broken on the inside is a common experience for people who are depressed but who want to appear as if nothing is wrong (see my article: How to Stop Pretending to Feel Happy When You Don't).

Looking Happy on the Outside, But Feeling Broken on the Inside

In many cases, it's not just a matter of putting on a facade for other people--people who smile on the outside but actually feel depressed are also often attempting to convince themselves that there's nothing wrong.  They use the happy outer expression as a defense mechanism to hide their depression from themselves as well as from others.

In other cases, people, who might be out of touch with their feelings, are unaware that they feel depressed.  But, at times, they might notice that there's a disconnect between how they appear to others and what they feel inside.

When they do sense their depression, they often brush it off, so the disconnect between how they appear and how they feel deep down is maintained.

The old saying, "You can't judge a book by it's cover" applies to this problem.  The person who gives the impression of being the happiest might be the person who is really dying inside.

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

Fictional Clinical Vignette: Looking Happy on the Outside, But Feeling Broken on the Inside:

Toni
Toni was considered a "dynamo" by her friends and colleagues.  She had a dynamic presence among colleagues and friends.  She headed up new projects at work with gusto, mentored new colleagues with enthusiasm, and she often entertained friends at home.

She was always smiling, laughing and cheerful, offering valuable advice and encouragement.  No one would ever know that she felt broken inside.

When she was alone, Toni felt restless and irritable.  She didn't like to have free time because the sadness that was welling up inside her threatened to overtake her emotionally, so she always found things to do to keep herself busy and distracted (see my article: Are You "Keeping Busy" to Avoid Painful Emotions?)

At 32, she was on track to get a promotion to a senior position at work, and she was taking on more and more responsibilities from her director.  As the work piled on and her personal schedule got busier, she was beginning to feel exhausted.

There were times at the end of the day that she just went home and collapsed in bed.  She felt physically and emotionally depleted, but she told no one, not even her close friends, that she felt burnt out (Managing Your Stress: What Are the Signs of Burnout?).

After several months at this pace, Toni found it harder and harder to keep up her facade of being happy all the time.

There were times when she couldn't contain her tears and she closed the door to her office to cry.  Then, she would wipe her eyes, open her door, and go back out trying to appear cheerful.

Looking Happy on the Outside, But Feeling Broken on the Inside

But the exhaustion soon took it's toll, and Toni began getting headaches.

When she saw her doctor and he ruled out any serious medical problems, he told her that he suspected that she was under too much stress and she would soon burn out if she didn't make changes to her lifestyle.

Her doctor recommended that Toni use stress management techniques, like meditation, to reduce her stress.

Toni tried to follow her doctor's recommendations.  She got meditation recordings, including mindfulness meditation, and tried to listen to these recordings at least once a day, as her doctor recommended.  He also told her to come back to see him in a month.

But whenever she listened to the meditation recordings, she would break down crying, and she didn't know why.  So, she stopped listening to the meditation recordings, and when she went back to her doctor and told him about her reaction, he recommended that she see a psychotherapist.

Toni had never been in therapy before, and she told her doctor, "I'm not a weak person.  Why should I go to therapy?"

So, her doctor, who was informed about psychotherapy, told her that it was a myth that going to therapy meant that you're a "weak person" and he also went over the other common myths about psychotherapy (see my articles:  Common Myths About Psychotherapy: Going to Therapy Means You're "Weak", Common Myths About Psychotherapy: Therapy Takes a Long Time, and Common Myths About Psychotherapy: Therapy is "All Talk and No Action").

Toni thought about her doctor's advice.  She had friends who were in therapy and who told her that they were helped by therapy, so she decided to give it a try.

During her initial consultation with her psychotherapist, Toni told her about how she was crying and she didn't know why.  She told her therapist that everyone considered her to be a happy, cheerful, successful person, but sometimes she felt like a "phony" because when she was alone, if she wasn't keeping herself busy and distracted, she felt sad.

As Toni and her therapist talked about her childhood background in subsequent sessions, Toni told her that her parents always discouraged Toni from complaining.  Her mother would encourage her to smile, and her father would tell her, "Nobody likes a sad sack."

So, whenever anything bothered Toni, she would ignore it and try to overcome the problem as best as she could.  She never talked to her parents about her problems because she knew that they would lecture her about complaining (see my article: What is Childhood Emotional Neglect?).

She also described how, over time, she became a perfectionist.  She tried to do everything "perfectly" and "perfect" became her only option.  Her perfectionism was rewarded at school, in college and in her career (see my article: Perfect vs. "Good Enough").

As she continued to talk about her underlying sadness and her need to be "perfect," Toni became more attuned to her underlying feelings.  She realized that she really wasn't happy--she was depressed and she was trying to hide it from herself and others because she felt guilty about feeling depressed, "I have no reason to be depressed" (see my article: Overcoming Guilt and Shame About Feeling Depressed).

Her therapist spoke to Toni about how shame is often the underlying issue underneath perfectionism, and Toni was able to identify with her feelings of shame that she was really less than "perfect" (see my article: Overcoming Perfectionism and The Connection Between Perfectionism and Core Shame).

Her therapist also spoke to Toni about the "false self" vs the "true self" and how at an early age children can learn to put on a facade to appear to be happy when they're not (see my articles:  Understanding the False Self - Part 1, Understanding the False Self - Part 2, and Becoming Your True Self).

In addition, her therapist spoke to Toni about depression and helped Toni to differentiate between feeling sad and feeling depressed (see my article: What is the Difference Between Sadness and Depression?).

Toni began to realize that, once she started pretending to be happy as a child, she became disconnected from her real feelings, and this continued into adulthood.

It was only after she felt the emotional and physical strain of taking on too much and trying to appear happy when she wasn't feeling happy that she started to break down crying.  She realized now that the cumulative effect was too much for her.

Toni felt relieved to have a time and place in therapy to be able to discover how she really felt.  She also appreciated that her therapist was objective and nonjudgmental.

As she continued to work through the childhood emotional neglect and the pressure to appear happy, she began to feel more genuinely herself (see my article: Living Authentically - Aligned With Your Values).

Rather than trying to be cheerful all the time with her friends, when her depressive symptoms were most acute, she spoke to her close friends about it, which was a relief.

The authenticity that Toni felt helped her to deal with the underlying issues that she had been avoiding all along.

Feeling authentic, rather than pretending to be happy, gave Toni an overall sense of well-being as she worked through her depression in therapy.

Conclusion
It's physically and emotionally exhausting to pretend to feel happy when you don't.

The strain of trying to appear happy on the outside when you feel broken on the inside usually catches up with you at some point.  The stress involved can cause medical problems.  And if you're already depressed, it can exacerbate your depression.

Getting Help in Therapy
Being able to let go of the need to appear happy all the time is letting go of a huge burden (see my article: The Benefits of Psychotherapy and The Courage to Change).

Not only does letting go of this burden help you to reduce your stress, you can also learn to feel authentic without the disconnect between your outer appearance and your inner world.

If the issues in this article resonate with you, you owe it to yourself to get help from a licensed mental health professional (see my article: How to Choose a Psychotherapist).

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 get to the root of their need to appear happy when they were feeling deeply unhappy inside.  Free of this need to appear happy, they could go on to live a more meaningful and fulfilling 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.

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.