Integrative Psychotherapy: Psychotherapy and Somatic Mindfulness to Overcome Developmental Trauma

When I work with clients who have unsolved psychological trauma, I often discover that their awareness of their body is cut off due to the dissociation, a defense mechanism which used to cope with trauma (see my articles:Psychotherapy to Overcome Your Past Childhood Trauma, What Happens When You Numb Yourself to Your Traumatic Past?, and Untreated Emotional Trauma Can Have Serious Consequences.  Part of the initial stage of trauma work in therapy is helping clients to gradually reconnect with their bodies by using Somatic Experiencing.  And part of Somatic Experiencing is learning to develop somatic mindfulness, which is reconnecting the mind and the body that disconnected after the trauma (see my article: Mind-Body Oriented Psychotherapy: The Body Offers a Window Into the Unconscious Mind.

Integrative Psychotherapy: Psychotherapy and Somatic Mindfulness to Overcome Developmental Trauma 

When childhood trauma, also known as developmental trauma, is overwhelming, one of the defense mechanisms is dissociation.

Dissociation is useful at the time because it keeps the child from being overwhelmed, especially if there was no one at the time to help soothe the child.

But the problem with dissociation is that it not only cuts off the negative feelings related to the trauma--it also cuts off positive feelings.  As a result, this disconnection between the mind and the body can make everything feel muted.

Helping clients with somatic mindfulness is a gradual approach of necessity, especially if there was severe childhood trauma. Since the dissociation protected the child from being overwhelmed with emotion, a gentle approach is needed so that reconnecting with thoughts, feelings, and body sensations doesn't become overwhelming.

Somatic mindfulness can start with helping with client to notice where they feel their feelings in the body.  If someone is really disconnected from his or her body, the process of helping him or her to reconnect might start with the body and just noticing what s/he feels and then trying to link the feelings to the sensations in the body.

I usually start wherever the client can start and wherever s/he can start is fine.  If a client notices that she feels a tightness in her throat, but she doesn't know what feeling is associated with that tightness, we will work with that and see what comes up.

Sometimes a client might think of a color or shape.  Sometimes a client notices that the tightness moves to another part of the body--like from the throat to the jaw.  Other times, a particular memory might come up.

What's happening is that the client is starting to reconnect the mind with the body and, in doing so, the dissociation is starting to dissipate.

For many clients, the cut off between the mind and the body is a partial cutoff.  For instance, the client might notice that she feels connected to the upper part of her leg, but she has little to no sensation in the lower part of the leg.  Using Somatic Experiencing, I can assist the client to reconnect to the lower part of the leg so that the energy begins to flow to that part of the body again.

Somatic mindfulness helps clients to become aware of their bodies again.  Ultimately, over time, it can be re-energizing so clients feel alive again--possibly after many years of feeling disconnected from their bodies.

Getting Help in Therapy
If you've been struggling with unresolved trauma on your own, you're not alone.

There is so much more that is known now about the mind-body connection and how trauma-informed therapy can help to resolve trauma.

Unresolved trauma can take the joy out of life.  Rather than suffering alone, you could get help from a licensed mental health professional who can help you to overcome your unresolved trauma (see my article: The Benefits of Psychotherapy).

By working through unresolved trauma, you can lead a more meaningful and fulfilling  life.

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 and I specialize in helping clients to overcome trauma.

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.

See my article: 
Integrative Psychotherapy: Psychotherapy and Somatic Mindfulness to Overcome Developmental Trauma - Part 2

What is Traumatic Narcissism?

In his insightful and informative book, Traumatic Narcissism: Relational Systems of Subjugation, psychoanalyst Daniel Shaw, LCSW explores the relational dynamic between highly narcissistic parents and their children as well as other dyads and groups where there is relational narcissism, like couples, the relationship between a psychoanalytic supervisor and a supervisee, cults and so on.

What is Traumatic Narcissism?

In his book, Escape From Freedom, Erich Fromm (1900-1980), a psychoanalyst and social philosopher, addresses a similar dynamic, which he calls "malignant narcissism."

Having grown up in Frankfurt, Germany, Fromm was one of the most influential thinkers of his time.  When the Nazis came to power, Fromm left Germany to come to the United States, but the rise of fascism influenced his thoughts, and he writes about the malignant nature of narcissism in Escape From Freedom.

Daniel Shaw references Erich Fromm., but he emphasizes not only that narcissism is traumatic, but that it is relational  and intergenerational (see my article: Psychotherapy and Intergenerational Trauma).

The Intergenerational Nature of Traumatic Narcissism: Long Days' Journey Into Night
As an example of the intergenerational nature of traumatic narcissism, Shaw discusses Eugene O'Neill's play, Long Day's Journey Into Night.

The play, which was released after O'Neill's death (at his request), is recognized as being fairly autobiographical about Eugene O'Neill's life with his family.  This is an excellent example of the corrosive effect of traumatic narcissism in a family.

Long Day's Journey Into Night depicts the tragic story of the Tyrones, which includes the mother, Mary Tyrone, who is addicted to morphine; the father, James Tyrone, who was once regarded as a talented actor who threw away his chance for lasting success in the theatre; the brilliant older son, Jamie Tyrone, who can't hold a job or enter into a romantic relationship and who also can't stop drinking; and Edmund Tyrone, the youngest son, who also has a drinking problem and suffers from tuberculosis.  Edmund is generally believed to be the character that represents Eugene O'Neill.

The action in the play all takes place in a day.

Mary, who recently came back from inpatient treatment for morphine addiction, is a broken woman in her 50s, who relapses on morphine soon after she is released from treatment.  In her morphine stupor, Mary dreams of the days when she wanted to be a nun or a concert pianist.

Although the rest of the family accepts that the youngest son, Edmund Tyrone, has tuberculosis and he will soon need to go to a sanitarium to recover, Mary can't bring herself to accept her son's illness.  Despite what the doctor's says about the severity of Edmund's medical problem, she dismisses the doctor's medical evaluation calling him a "quack."

Due to her narcissistic preoccupation, Mary tells Edmund that he is being overly dramatic and he's attention seeking--even when he has fits of coughing where it's obvious that he is very sick.

The husband and the sons tiptoe around Mary because they're aware of her emotional fragility and her strong sense of denial.

In the meantime, Mary is immersed in what her life could have been and the disappointment it turned out to be--living in a house that's not "a real home," having to contend with difficult servants who aren't up to par as compared to her neighbor's servants, and sacrificing her life to her husband's former acting career.

Aside from daydreaming about what her life could have been if she had not married Jame Tyrone, she idealizes her father and her life with her family.  She makes it clear to her husband and her children that, as a child, she was accustomed to a much finer life than the one she has now.

No one is spared her barbs, which are delivered in a passive aggressive tone.  She blames her husband and his acting tours for the death of their two year old child (a child who was born after Jamie and before Edmund).  She also believes that if she had not allowed her husband to persuade her to go on tour with him, their son would have survived.

She especially blames her older son, Jamie--she thinks that when he was a young child he intentionally went near the baby while he was contagious with measles knowing that this would kill the baby.

Mary ruminates about all of this out loud to her husband and Edmund.  All the while, Edmund is very sick and could die, but she doesn't see this.

Until it has become quite obvious to him that she has relapsed, the younger son, Edmund, wants to believe that his mother will keep her promise to stay off morphine--even though she has never kept this promise before.  So, when he realizes that she has relapsed, not only does he feel invisible to her, he also feels betrayed.

The father, James, who grew up in a poor family where he had to help support his mother and siblings at a young age, is anxious about money--even though he is in a much better financial position now.  He lives with his early trauma as if he was still in it.  His wife and sons are angered by his stinginess, and his stinginess is also reflected in his emotional relationships with them.

James Tyrone also ruminants about his glory days when he was handsome, when he was a recognized Shakespearean actor and how he threw it all away.  Now it's too late.

Both parents, who are nearly always in a dissociated state of old memories, are so self involved that they create a toxic environment in the home, and the parents and sons survive in this atmosphere by remaining in a drunken or morphine-induced stupor.

In his book, Daniel Shaw also discusses that he did further research on Eugene O'Neill and discovered that O'Neill abandoned his second wife and disowned his children.  So, the intergenerational traumatic narcissism continued on to the next generation with two of O'Neill's children committing suicide.

This is an excellent, well-researched book if you want to understand the relational nature of traumatic narcissism and how it often permeates a family and perpetuates itself from one generation to the next.

Getting Help in Therapy
Many clients start psychotherapy because of the experiences they have had with traumatic narcissism.

Traumatic narcissism can leave a child feeling invisible and emotionally invalidated, which the child carries with him/her into adulthood (see my article: Growing Up Feeling Invisible and Emotionally Invalidated).

If you are suffering from the effects of growing up neglected or abused, you owe it to yourself to get help from a licensed psychotherapist, who can help you to work through your traumatic past so you can live a meaningful, fulfilling life (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who uses integrative psychotherapy to develop a unique treatment plan for each client  depending upon the client's needs (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.






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What is the Negative Transference in Psychotherapy?

In prior articles, I've discussed the positive transference, the erotic transference and the parental transference.  

Today I'm focusing on the negative transference and how it plays out in therapy (see my article: What is Transference in Psychotherapy?).  

What is the Negative Transference in Psychotherapy?

What is the Negative Transference in Psychotherapy?
The most basic explanation for the negative transference, which was first identified by Sigmund Freud when he was developing psychoanalysis, is that it is a term used in psychotherapy for the negative feelings that a client projects onto his therapist.

Just like the other forms of transference, the negative transference is usually an unconscious projection of negative feelings that the client "transfers" from early childhood relationships onto the psychotherapist (see my article: Discovering the Unconscious Emotions At the Root of Your Current Problems).

Although the client might be aware that he has similar hostile feelings towards his therapist as he did for a parent, he might not be aware that he is projecting these feelings onto the therapist.

Also, as I mentioned in earlier articles, transference in general is a normal part of relationships outside of therapy.  It's not just a phenomenon that occurs in therapy.

For instance, spouses can develop negative transferential feelings for each other, especially when one or both of them says something that triggers an emotional response related to a hostile relationship with a parent.

Another example is of an employee who has a negative transference for a boss that's based on a hostile relationship with a parent.

And so on.

Working Through the Negative Transference in Psychotherapy
The negative transference can show up in all kinds of ways in psychotherapy.  It can be a hostile projection that a client feels towards the therapist that is short lived or it can go on for a long time.

The negative transference is a dynamic that clients and their psychotherapist can work through in therapy.

As I mentioned in a prior article, it's important to distinguish transferential feelings from more objective feelings.

In other words, if a client has negative feelings towards his psychotherapist, it's not always about transference.  It's possible that the psychotherapist said or did something that caused the client to develop these negative feelings that is unrelated to transference and, if so, the therapist needs to own up to this and apologize (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Your Therapy).

But, assuming that the problem is related to a negative transference, the client and therapist can often work through the hostile projections that the client places on the therapist--although it's not always easy and the working through will depend upon the particular client-therapist relationship.

Let's take a look at a fictional vignette, which is representative of a common situation in therapy where the client starts out with a positive transference for his psychotherapist, develops a negative transference and, ultimately, the therapist and client work through the negative transference.

Fictional Vignette:  Working Through the Negative Transference in Psychotherapy

Ed
Ed began psychotherapy because he was upset about a recent breakup with his girlfriend.

He tried in vain to reconcile with his former girlfriend of four years, but she refused to reconcile.  This left Ed feeling confused and very sad, especially since he didn't understand why his girlfriend broke up with him.

Initially, Ed felt comfortable with his therapist.  He found her to be empathetic and emotionally supportive.  He told his therapist that he was surprised that he actually looked forward to his psychotherapy session each week because he felt understood and cared about.

At that point, Ed had a positive transference for his psychotherapist and the sessions were going well.

When Ed thought about why he liked his therapist so much, he realized that she reminded him of his aunt, who used to take care of him after school until his mother came home from work.  He loved his aunt because, not only was she nurturing, she was also fun to be around.  He preferred being with his aunt to being with his mother, whom he considered cold and highly critical.

One day, during a psychotherapy session, while Ed and his therapist were talking about his confusion as to why his girlfriend left him and why she refused to reconcile, his therapist attempted to explore with Ed if he could think of anything that he might have said or done that might have contributed to the problem.

What is the Negative Transference in Psychotherapy?

Immediately after his psychotherapist asked Ed this question, she could see a shift in Ed.  His face turned white and he looked stricken.  His body became rigid and he sat very straight up in his chair as if he had just been attacked by the therapist (see my article: Shifting Self States).

When she asked the question, the therapist was trying to help Ed to explore his own thoughts and feelings about what might have happened between him and his girlfriend.  But she could see from Ed's intense reaction that he felt stung, so she attempted to address this with Ed, but he was too angry to listen to her.

Before the psychotherapist could talk to Ed about his reaction and explain the reason for her question, he told her that he was shocked that she would ask him such a question, "This is what my mother used to do!  She blamed me for everything!  Now, you're doing it. I thought you were on my side."

During the next couple of weeks when Ed came to therapy, he was either outwardly angry or quietly sullen.  It was obvious to the therapist that Ed was now experiencing a negative transference and he was projecting his angry feelings about his mother onto her.  She realized that she asked Ed this question too soon because he wasn't ready to deal with it.

Ed ignored his therapist's initial attempts to address his hostile feelings for her and each week he wavered as to whether he would continue in the therapy with her or not.  He said he was considering trying to find another therapist who would be more empathetic towards him and who would not criticize him.

After a few weeks, Ed calmed down somewhat and he was able to have a discussion about their therapeutic relationship.  Although he acknowledged that, at first, he felt comfortable with her, now he wasn't sure if he trusted her or not.

He felt that by asking him whether he knew of anything that he might have said or done that could  have contributed to the end of the relationship, his therapist was assuming that the breakup was all his fault.  And since he lived with his mother's withering criticism during his childhood, he found it especially hurtful that his therapist would make this "accusation" in therapy, a place where he should feel safe.

By the third week, Ed was more subdued.  He told his therapist that he received an email from his ex, who finally responded to him and gave him the reasons why she ended the relationship.  She told him that, before now, she wasn't ready to address his questions about the breakup, especially since she had been telling him about these problems throughout their relationship.

Ed went on to tell his psychotherapist that his ex gave him many examples of his lack of consideration for her.  When he read her email, he remembered that she had made these same complaints many times before, but he had never taken her complaints seriously.  Now, he realized that he took his ex and their former relationship for granted when they were together, and he also realized that he was at fault.

The email hit him like "a ton of bricks." But after reading it, he knew that he wanted to change this aspect of himself that tended to disregard the other person's feelings when he was in a relationship.  He recognized that he had this problem in his prior relationships, and he didn't want to continue to perpetuate this dynamic in a future relationship.

Then, Ed told his therapist that he now understood why she was attempting to help him explore what he might have done that contributed to the relationship, and he realized that she wasn't criticizing him.  He realized that, in fact, his therapist was trying to help him.

After that, Ed and his therapist were able to talk about the dynamic in his former relationship, including his part in the demise of the relationship.

He was also able to talk about his traumatic relationship with his mother and how he feared her criticism when he was a child.  He discussed how he was never able to talk to his mother about her hostility because she would never acknowledge it, and she always blamed him.  As a result, there was no way to reconcile things between them whenever she berated him.

After he and his therapist talked about what happened between them, Ed realized that he got emotionally triggered when he heard his therapist's question (see my article: Coping With a History of Trauma: Becoming Aware of Emotional Triggers).

With his therapist's help, Ed was able to distinguish his relationship with his mother from his relationship with her.  He could see that they were too very different relationships (see my article: Working Through Emotional Trauma: Learning to Separate "Then" From "Now").

He could see that, whereas he and his mother couldn't repair their relationship whenever she berated him, he and his therapist could work through difficulties between them (see my article: Ruptures and Repairs in Therapy).

Since his mother never admitted to a mistake and his father was mostly absent, Ed never experienced this kind of dyadic repair as a child, and he was moved and grateful to experience this in therapy.

These discussions allowed Ed and his psychotherapist to work through the negative transference.

Over time, Ed and his therapist had other transferential ups and downs in therapy, but they were able to work through these incidents.

His therapist also spoke to Ed about transference and explained transference reactions were a common experience in therapy as well as in other areas of people's lives (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation in Therapy).

Conclusion
Transference is ubiquitous.  It's not just a phenomenon that occurs in psychotherapy.

When a negative transference develops in psychotherapy, the value of working through the transference, aside from preserving the therapeutic relationship, is that the client can explore his negative projections, own them, and form a more objective relationship with his psychotherapist.

Working through the negative transference can be challenging for both the client and the psychotherapist.

When he is experiencing the negative transference, the client can be in a state of high agitation and might not be able to process his feelings or hear what the therapist has to say.

But as the negative transference gets worked through in therapy, the client gets to experience, possibly for the first time, that these kinds of issues can be worked out.  Like "Ed" in the fictional vignette, it is often a transformative experience.

For the therapist, who is obviously human and doesn't want to be disliked, it can be difficult to feel the client's intense dislike or hatred.  But a skilled psychotherapist also knows that she isn't there to be "liked," she's there to be helpful to the client, which can mean tolerating the client's hostility until they can work out these issues.

Getting Help in Therapy
It takes courage to ask for help (see my article: Tips on Overcoming Your Fear of Asking For Help).

The advantage of going to therapy, as opposed to relying solely on family and friends, is that the psychotherapist is a trained, objective person who will give you her undivided attention at a time and in a place that is devoted to you each week (see my article: The Benefits of Psychotherapy).

Many people, who could benefit from psychotherapy, don't come to therapy because they fear being emotionally vulnerable.

This is why it's so important to have an initial consultation to get a sense of the psychotherapist and if you and she would be a good match (see my article How to Choose a Psychotherapist).

If you've been struggling with a problem for a while and you've been unable to resolve it on your own, you could benefit from seeking help from a licensed mental health professional.

Rather than continuing to struggle on your own, you could work through your problems in therapy and then move on to live a more fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

I use an integrative approach in therapy to develop the treatment plan that works for each individual client (see my article: The Therapeutic Benefits of Integrated Psychotherapy).

I work with individual adults and couples in an interactive and collaborative way.

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

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

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.