Meeting Clients Where They Are in Their Process

One of the first clinical lessons that beginning psychotherapists learn from their clinical supervisors when they work with psychotherapy clients is "meeting clients where they are."  This is a reminder that a psychotherapist might have good ideas about where the therapy needs to go, but if the therapist is getting ahead of the client, it's going to be detrimental to the client and to the therapeutic work.  The therapist needs to listen to the client to discover where the client is and be empathically attuned to the client (see my articles: The Therapist's Empathic Attunement Can Be Emotionally Reparative For the Client, Psychotherapy: The Importance of Therapists Listening and Learning From the Client and Why is Empathy Important in Psychotherapy?).

Meeting Clients Where They Are

Even experienced psychotherapists can sometimes forget, in their sincere concern to help clients in therapy, that getting ahead of the client isn't useful to the client or the work in therapy.

For example, clients often come in with a particular presenting problem, but the therapist might sense that the presenting problem is really something else.

In this example, the therapist is often right, but if she gets ahead of the client and tries to steer the client in another direction before the client is ready, the client will either get confused or feel unheard and leave.

As a result, even when an experienced psychotherapist senses that there is another issue that is a bigger problem than the one the client presents, the therapist needs to proceed in a tactful and gentle way.

Rather than rushing in with astute psychological insights, the psychotherapist first needs to assess the client for what s/he might be ready for, especially at the beginning stage of psychotherapy, and then decide how to proceed.

The following fictional clinical vignette will demonstrate these issues:

Fictional Clinical Vignette: Starting Where the Client Is in Psychotherapy

Ned
When Ned began attending psychotherapy, he told his new psychotherapist that he wanted to improve how he communicated in his relationship so he and his girlfriend could get along better.

Ned described a relationship dynamic where his girlfriend, Jane, liked to talk about their relationship from time to time, especially when she thought they had problems, but Ned hated these talks.

He felt that his girlfriend usually made "a big deal out of nothing" and he told her this.  At first, when she told him that this hurt her feelings, Ned didn't understand.  But after they argued about this a few times and Jane threatened to leave him, he decided he had better improve his communication skills.

As his psychotherapist listened to Ned describe how he often dismissed other loved ones' concerns, she suspected that there were deeper issues involved, but she also knew that if she brought this up with Ned too soon, she would alienate him, so she waited for the right moment when she thought he would be more receptive.

At the point when Ned and his psychotherapist formed a good working relationship in therapy, his psychotherapist explored with Ned what he thought was going on for him in this relationship.  She recognized that Ned seemed more open to this type of exploration at that point.

Ned responded by telling his therapist that, even though he no longer dismissed Jane's concerns, he still couldn't understand why she wanted to talk about the relationship.  He thought he was being much more considerate with Jane by not dismissing her concerns.

His therapist helped Ned to put himself in Jane's shoes to try to understand what was bothering her.  He thought about it and said that Jane said she would like to get closer to him, but she felt that he pushed her away emotionally.

As he thought about it more from Jane's point of view, he acknowledged that too much closeness frightened him and maybe this was why he dismissed Jane's concerns.

Over time, as Ned and his therapist continued to explore these issues, Ned realized that he could only take so much closeness with Jane and after that, he was uncomfortable.  That's when he dismissed her concerns and, in effect, created distance between himself and Jane.

He was now realizing that whenever he did this, this made Jane anxious and the more anxious she became, the more she wanted to talk about the relationship so they could get closer.  But the more she  wanted closeness, the more distant he felt.  So, this became the cycle that they were caught in.

Meeting Client Where They Are

Earlier in the therapy, his psychotherapist suspected that Ned and Jane had two very different attachment styles.  It appeared to her that Jane had an anxious attachment style and Ned had a dismissive attachment style (see my article: How Your Attachment Style Affects Your Relationship).

As his therapist talked to Ned about this and provided him with psychoeducation about attachment styles, it was as if a light went off in his head.  Suddenly, this made sense to him and he was motivated to work on the problems in his relationship (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation).

Even though Ned was now ready to work on this problem, his therapist knew that if she had brought up this issue at the start of therapy, Ned wouldn't have been ready to hear it, and he acknowledged as much to her when they discussed it later on in therapy.

Gradually, Ed worked on the underlying issues that caused him to feel frightened of closeness with Jane.  He was also able to tell Jane that, ultimately, he wanted to be closer to her, but he needed to take it slowly.  Jane understood, and she said that she wanted Ned to tell her when he was getting frightened, so she wouldn't keep pushing him and alienating him.

Conclusion
Starting where the client is in therapy is important for the client and the success of the therapy.

A psychotherapist needs to use her clinical skills to assess where the client is, especially at the start of therapy, so she doesn't jump ahead of the client.  She also needs to use her clinical skills to assess when the client is ready to go deeper.  The timing will be different for each client.

It's important for the client and the psychotherapist to have a good therapeutic relationship first before going any deeper in therapy.  A good therapeutic relationship means that the client trusts the therapist and would most likely be willing to look at underlying issues.

If you're in therapy and you feel your therapist is jumping ahead of you or something else in the therapy is bothering you, it's important for you to communicate this to the therapist (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Therapy).

Getting Help in Therapy
Asking for help can be challenging.  

If you're considering getting help in therapy, the first step is making an appointment for a consultation (see my article:  Tips on Overcoming Your Fear of Asking For Help).

When you choose a psychotherapist, it's important that you feel heard by the therapist (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

I usually advise clients to trust their instincts when they're trying to decide if a particular therapist is right for them.

Psychotherapy can free you from your problematic history so that you can maximize your potential, and a skilled psychotherapist can help you to overcome your problems at a pace that feels right for you.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who uses Integrative Psychotherapy to tailor the therapy to each client's needs (see my article: The Benefits of Integrative Psychotherapy).

I work with individuals 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.

Overcoming a Need to Rescue Your Loved Ones as Part of a Codependent Pattern

Many people attempt to rescue the people in their lives, especially family members and romantic partners (see my articles:  How to Stop Being the Rescuer in Your Family, Overcoming Codependency: Taking Care of Yourself First, and Overcoming the Need to Be Everyone's Rescuer).

Overcoming the Need to Rescue and Fix Your Loved Ones as Part of a Codependent Pattern

I believe most people who try to rescue others have a genuine concern for their loved ones and want the best for them.  Their intention comes from a good place within them.

At the same time, there are problems involved with rescuing.  One problem is that there are usually underlying emotional issues involved for the rescuers which causes them to feel compelled to fix others. They avoid dealing with their problems by focusing on others instead of themselves.

Another problem is that this dynamic often causes problems in relationships because the person, who is the "rescuee," often doesn't want to be rescued or fixed.  This is bound to cause friction.

Even if they do want to be rescued, the problem is that this dynamic keeps both people from facing their problems and growing and developing as mature, responsible adults.

Usually people who try to rescue others have developed this pattern first with their families and then it carries over into other relationships.

Let's take a look at a fictional vignette which illustrates this dynamic:

Fictional Vignette: Trying to Rescue and Fix Your Loved Ones:

Nina
As the oldest in her family, Nina's parents and siblings relied on her to resolve family problems from the time she was a young child.

From the time Nina was seven or eight years old, Nina's mother, who was a single parent, often confided to Nina about her problems.  She treated Nina as if she were a close friend rather than a child (see my article: Why Your Child Can't Be Your Best Friend).

Even after they were grown, Nina's siblings relied on Nina to bail them out when they got into trouble or needed money.

Helping her mother and siblings often meant that Nina would put herself in a financial bind, but she found it impossible to say no to them.

When she started dating Ed, Nina recognized that he drank too much, but she liked him a lot and she thought, "I can change him" (see my articles: Relationships: "I'll Change Him After We Get Married.")

Little did she know that Ed didn't want to stop drinking, and he resented her suggestions that she could help him.  After a few months, Ed's resentment led to his breaking up with Nina, which upset her.

A few months later, she became friendly with Tom, who worked in the same restaurant where Nina worked.  At first, they were friends.  But, as time went on, their friendship turned into a romance.

Shortly after Nina began dating Tom, she discovered that he had serious financial problems even though he did well as the bartender at the restaurant.

When Nina offered to lend him money and make a budget for him, Tom felt ashamed and told her that he didn't need her help.  But Nina persisted, which resulted in Tom ending their relationship.

Soon after they broke up, Tom left the restaurant and took a job somewhere else because it was too uncomfortable for both of them to work in the same place after they broke up.  This saddened Nina because she felt she lost a lover and a friend.

Right after Tom ended their relationship, Nina began getting headaches and backaches, which she never had before.  Her doctor ruled out any medical problems and suggested that it might be related to emotional problems.  He suggested that she seek out help from a psychotherapist.

As Nina described her family history and her romantic relationships, she and her psychotherapist discussed her need to try to fix others--even when these people didn't want it.

Nina said that she felt she could see others' problems much clearer than them could, and she wanted to help.  She took pride in being the "go to" person to be relied upon, "I'm the one everyone comes to for help in my family."

When her psychotherapist asked Nina who she went to when she had a problem, Nina acknowledged that she usually didn't go to anyone--not even her close friends--because it made her feel too uncomfortable.

Over time, as Nina and her therapist continued to discuss these issues in their psychotherapy sessions,  Nina realized how much she was neglecting herself by trying so hard to help others.

Since she gave her adult siblings so much money, she had little for herself.  She had not even bought herself a new coat in several years because her youngest brother had a gambling problem and she was constantly giving him money to bail him out.  She thought it would be "cruel" to allow him to face the consequences of his actions.

She also paid her mother's bills, even though her mother had a good job and could afford to pay her own bills, "Ever since I began working, I've just always paid my mother's bills."

When her therapist asked Nina to think about her situation as if it were someone else's story, Nina thought about her it for the first time, "It's just what I've always done, and I've never thought about it before."

But as she considered the personal sacrifices that she was making, she realized that she couldn't continue to do this.  She knew it would be hard for her to stop and for her family, "How will my family get along without my help?  They're not used to taking care of themselves."

What really convinced Nina that she needed to change was when she realized that she was focusing so much on other people so that she wouldn't focus on herself.

Nina's psychotherapist provided Nina with information about codependency so Nina could understand this is a dynamic and the ways to overcome it (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation).

Nina's psychotherapist also told her about how Al-Anon  meetings can help to overcome codependency.  Nina tried a few meetings, but she felt too overwhelmed by what others shared, so she decided not to continue and read the literature instead (see my article: The Early Stage of Recovery: What to Do If 12 Step Meetings Are Too Overwhelming For You?).

As difficult as it was for Nina, she and her therapist came up with a plan to deal with her codependency:  Over the next several months, she would gradually stop contributing as much financially to her family so they had time to work on becoming more independent and she had time to learn how to stop rescuing them.  Nina realized that, although she thought she was helping them, she was really fostering an unhealthy dependency and they would never learn to take care of themselves.

She was aware that her mother and siblings would protest because this would be a big change for them, and they wouldn't like it.

At the same time, Nina and her therapist began to explore the underlying reasons why Nina felt compelled to take care of others.  She discovered that she felt a need to have control over her siblings and her boyfriends because things were so chaotic when she was growing up.  Taking care of others and feeling in control helped her to have a sense of stability.

She began to understand that her intention for wanting stability in her family was a good one, but the codependent dynamic was hurting her and her family and her former boyfriends.

As part of Nina's plan, she told her family about the plan.  Initially, Nina's mother and siblings were angry with her and they refused to talk to her. They felt like she was being cruel, even though the plan would take place over several months.

But things gradually turned around.  During that time, Nina's mother became more conscious of how she spent money and took over her own bills.  After a several months, she told Nina that she felt a sense of pride that she could manage on her own because she never thought she would be capable of doing it.

Her brother, who gambled, got help from a psychotherapist who specialized in working with people with compulsive gambling problems.  He also began attending Gamblers Anonymous and got a sponsor.  He had a few "slips" along the way, but he took responsibility for them and felt better about himself.

Nina's other siblings got more serious about finding work and, after a few months, they were each employed and taking more responsibility for themselves.

Even though Nina developed insight into her codependent patterns, she had to remain aware of her problem at first or she knew she could easily fall back into her old ways.

Nina and her therapist worked on the underlying issues related to her childhood trauma, including how overwhelmed she felt as a child by the chaos in the household, using EMDR therapy (see my article: What is EMDR Therapy?).

As Nina dealt with her own underlying issues, her headaches and backaches went away.  As her doctor suggested, what appeared to be solely medical problems were related to her emotional problems.

Overcoming the Need to Rescue Your Loved Ones as Part of a Codependent Pattern

Working through her early trauma helped Nina to make healthier choices in her relationships (see my article: Choosing Healthier Romantic Relationships).

Conclusion
Trying to rescue and fix others is damaging to the rescuer as well as the people the rescuer wants to help.

A pattern of rescuing behavior usually involves codependency, which keeps the rescuers from focusing on their own problems because they're so busy trying to rescue others.

This pattern is often a blind spot for people who are codependent, but it can be worked through in therapy (see my article: Overcoming Your Blind Spots).

Changing patterns isn't easy or quick, but when people begin to see how beneficial these changes are for themselves and others, they realize that it's worthwhile.

Getting Help in Therapy
If this article resonates with you, you could benefit from getting help from a licensed mental health professional who specializes in helping people overcome codependency (see my article: The Benefits of Psychotherapy).

Dealing with the underlying issues at the root of the problem and freeing yourself from a traumatic history allows you and your loved ones to grow and flourish.

Rather than suffering on your own, you could get the help you need from a skilled psychotherapist (see my article: How to Choose a Psychotherapist).

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

I have helped many clients to overcome their codependent patterns as they work through the traumatic roots of their problems.

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. 

Integrative Psychotherapy: Discovering the Root of Self Abandonment

In prior articles, I've discussed fear of abandonment where it involves a fear of being abandoned by other people.

See my articles: 

How Psychotherapy Can Help You to Overcome Your Fear of Abandonment 

The Connection Between Abandonment Issues and Codependency

Fear of Abandonment: Leaving Your Relationship Because You're Afraid of Being Abandoned).  

There is also another common issue around abandonment that involves always being the "giver" to the point where it's hurtful to oneself, which is a self abandonment, the focus of this article.

Integrative Psychotherapy: Discovering the Root of Self Abandonment 

Self Abandonment: Always Being the Giver to the Person Who is Always the Taker
Many people, who focus on others more than they focus on themselves, tend to be givers to people where there is little to no reciprocity in their relationship.  As a result, the people who are givers are always giving and the people who are receiving are always taking.  This is a typical codependent relationship  (see my article: Overcoming Codependency).

While others, who are outside of this situation, might see the imbalance in this type of relationship, the person who is the giver rarely, if ever, notices the problem.  They're so focused on giving that they emotionally abandon themselves on behalf of others, especially others who are all too willing to take advantage of them.

The following fictional vignette illustrates this dynamic:

Tania
Tania began therapy after a tumultuous breakup with her last boyfriend.

She and Ray were dating on and off for four years.  During that time, Tania lost several friends, who didn't like Ray and who were constantly telling Tania to leave him.  They were tired of hearing Tania complain about the on again off-again relationship with Ray.

The breakup occurred after Ray lost his job again, and Tania couldn't afford to give him any more money.

Prior to that, Tania had given Ray thousands of dollars over the years every time he was terminated from a job, and he never paid her back.  But she was unable to help him this time because it would have meant she couldn't pay her own bills.

She explained to her psychotherapist that Ray interpreted this as Tania not caring about him, and he ended their relationship and refused to talk to Tania, which upset her.

Tania told her therapist that she would have given Ray the money if she could have afforded it, but she just couldn't do it.  She felt hurt and sad that Ray thought she didn't care.

As Tania and her therapist talked about Tania's history of relationships, it became evident that Tania had a similar pattern in all of her past relationships.  She would give and give until until she couldn't give anymore, then her boyfriend at the time would leave her (see my article: Unhealthy Relationships: Bad Luck or Poor Choices?).

Despite her friends trying to tell Tania that Ray and the other boyfriends were taking advantage of her, Tania didn't see it when she first started therapy.  She felt that her friends didn't understand the men that she dated and why she sacrificed so much for each of them (see my article: Could It Be That Your Friends See Things About Your Lover That You Don't See?).

When she was describing her family history to her psychotherapist, she said she was raised in a religious household where the emphasis was on putting others first.  She felt that she was practicing the beliefs that she was raised with, but her parents and siblings didn't agree.  They felt she was carrying it too far because she wasn't taking care of herself.

Tania's psychotherapist practiced Integrative Psychotherapy, which included an integration of psychodynamic therapy and other forms of therapy, including EMDR therapy, Somatic Experiencing, clinical hypnosis, and Ego States work, also known as Parts work (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

Her therapist recommended that she and Tania explore the part of her that tended to give so much to others--to the point of hurting herself--and to expect little to nothing in return.

In doing Ego States therapy, Tania was able to sense the part of her that felt she had to give to others even when it had a negative impact on her.  While she was in a relaxed state, Tania went back to a memory with Ray where she gave him her last $2,000 so that she had little money for herself.  She had so little that she had to cut back on seeing her friends until she got paid later in the month.

When she was back in that memory, Tania remembered feeling she must help Ray, even though it came as a big sacrifice to her.

As she got back into that self state, she remembered having a moment of doubt before she gave she gave Ray the money but, at the time, she quickly brushed that feeling aside because it made her feel guilty.  Rather than brushing that feeling aside during the therapy session, her therapist asked her to stay with it and see what else came up.

As Tania held together both feelings--the feeling that she must give the money to Ray and the feeling of doubt that she had--Tania felt the inner conflict, which was mildly uncomfortable for her.  But she was able to tolerate the inner conflict while she was with her therapist, so she stayed with it and gave that doubting part of voice, "If that part could speak, it would say, 'Don't give him the money.  He always loses his job and you bail him out even when bailing him out hurts you'" (see my article: Shifting Self States).

Immediately after allowing this doubting part to express itself, Tania told her therapist that she felt guilty for feeling this way, "This is what my family and friends were saying."

It was clear to Tania and her psychotherapist that this doubting part was small in terms of the influence that it had on her and especially in comparison to the part of her that felt compelled to give.

But after she expressed the doubts that made her feel so guilty, she was surprised that she also felt more relaxed.  She realized that this conflict between these two parts of herself were going on inside for a long time, but she never allowed herself to feel the doubting part for long.

Over time, as Tania and her psychotherapist continued to do Ego States work, Tania discovered other parts of her that were angry and sad.

The sad part of her contained feelings that she wasn't allowing herself to feel before she started therapy--sadness for herself that she gave so much and got so little in return.  The angry part, which she also suppressed until now, was angry with Ray and her prior boyfriends for not appreciating her more.

She also discovered another part of her that was very young and felt unlovable (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

The part that felt unlovable was at the root of her need to always give to her boyfriends.  That part felt that since she was unlovable, she had to keep giving so that these men would love her.  But she realized that it never worked out that way.

Not only did her boyfriends not appreciate her, but when she had no more to give, they left her.  So, she experienced self abandonment as well as abandonment by them.

Tania worked hard in therapy to distinguish these conflicted inner states and to separate the parts of herself from her religion.  She even spoke with her minister about her pattern of giving so much to her boyfriends and getting little to nothing in return.  He told her that Ray and the others took advantage of her and she needed to take care of herself first.

Over time, Tania was able to see that, before these men ever left her, she abandoned herself because she felt so unlovable and unworthy, so she and her therapist used a technique in clinical hypnosis called the Affect Bridge to trace back when she started to feel this way.

Once they discovered the earliest memory of Tania feeling unlovable, which was part of her childhood, they were able to use EMDR therapy to work through the trauma related to unresolved childhood issues.

Conclusion
With regard to abandonment issues, most of the focus in psychotherapy tends to be on how clients feel abandoned by others.

But many clients also abandon themselves when they become overly giving with people who take advantage of them.  Each client has his or her own underlying reasons as to why they continue to engage in this dynamic.

Integrative psychotherapy, which includes a combination of different types of therapy depending upon the needs of the client, is often effective in getting to the root of these problems so they can be worked on and resolved.

In the fictional vignette above, the therapy began with psychodynamic therapy (essentially talk therapy) and then the psychotherapist used Ego States therapy to help the client to understand the various parts of herself involved in this self defeating dynamic.

In this vignette, initially, the client was much more aware of the part of herself that felt compelled to keep giving to boyfriends, even when they were unappreciative.

As Tania and her therapist were able to distinguish other parts of herself that she had suppressed in the past, she discovered a sad part and an angry part that were in conflict with the giving part.

The Affect Bridge, a technique in clinical hypnosis, allowed the client to trace back the earliest memory related to the over-giving part which felt unworthy and unlovable.  As a result, they discovered the root of the problem.

Using EMDR therapy, they were able to process this earlier developmental trauma so that it no longer affected Tania.

Although this work is summarized briefly of necessity since this is a blog article, the therapeutic work involved is neither quick nor easy since it usually involves many layers of history.  But it tends to be faster and more effective than just talk therapy alone.

Getting Help With Integrative Psychotherapy
Integrative psychotherapy gives the psychotherapist and the client much more flexibility to use different types of therapy to get to the root of the problem and resolve it.

Using psychodynamic or talk therapy alone could take years to get to the root of this type of problem, which is a common problem for many people.

If the dynamics in this article resonate for you, you could benefit from getting help from a licensed mental health professional who practices Integrative Psychotherapy.

Rather than continuing to engage in self defeating patterns, you could work through these issues in Integrative Psychotherapy and free yourself from your traumatic history (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 in a collaborate way with each client to develop the most effective psychotherapy plan.

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.

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

In a prior article, Integrative Psychotherapy: Psychotherapy and Somatic Mindfulness to Overcome Developmental Trauma - Part 1, I began a discussion about how I use somatic mindfulness with developmental trauma.  In this article, I'll provide a clinical picture of using the somatic mindfulness, which is an aspect of Somatic Experiencing, as part of an integrative approach in psychotherapy (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

Integrative Psychotherapy: Psychotherapy and Somatic Mindfulness to Overcome Developmental Trauma

The following fictional vignette is an example of how somatic mindfulness can be used in integrative psychotherapy to help a client overcome unresolved early childhood trauma.

Fictional Vignette: Integrative Psychotherapy: Psychotherapy and Somatic Awareness to Overcome Developmental Trauma

Meg
Meg had been in therapy before and talked about her childhood trauma.  But even though her prior psychotherapists were empathetic and supportive, Meg continued to feel negatively affected by her unresolved trauma.  She continued to feel fearful of being in a serious, committed romantic relationship because she had problems with trust.

When she spoke with a friend, who was seeing a psychotherapist who used a mind-body integrated psychotherapy approach, Meg decided to look for her own therapist who used an integrative psychotherapy approach.

Meg explained to her new psychotherapist that she witnessed domestic violence between her parents when she was growing up.  Although her father never hit Meg, she grew up with a fear of trusting men.

As a result, whenever a relationship became serious, on an unconscious level, she would find a way to sabotage the relationship.  The subsequent break was a relief to her at first.  But soon after that she regretted it.

Her previous therapy helped Meg to gain insight into how she destroyed her relationships and the connection with her childhood trauma, but it didn't help her to stop doing ruining her relationships.

Now that she was in her early 30s, Meg wanted to get married and have children, but she feared that if she kept sabotaging her relationships, she would be alone.

Her new psychotherapist provided Meg with psychoeducation about how intellectual insight isn't enough to overcome trauma.

She also explained to Meg how she used integrative psychotherapy to help clients overcome trauma (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

Next, her therapist helped Meg to develop internal resources so that when they would eventually begin to process her traumatic experiences, Meg would be able to self soothe rather than get emotionally overwhelmed (see my article: Developing Coping Strategies in Therapy Before Processing Trauma).

In addition, her psychotherapist introduced Meg to Somatic Experiencing (SE) and the concept of somatic mindfulness, which is part of SE.

Since Meg had difficulty identifying her emotions related to her unresolved childhood trauma, her therapist slowed things down and helped Meg to begin to notice what she was feeling in her body when she talked about her early memories.

Initially, Meg had problems feeling much of anything in her body.  But, as she and her therapist continued to use Somatic Experiencing, Meg became aware of how much tension she held in her throat and jaw when she talked about these early traumatic memories.

As they focused on the tension in Meg's jaw and throat, Meg remembered how she wanted to yell at her father when she heard him hitting her mother, but she was too afraid to do it at the time.

As she continued to focus on the tension in her jaw and throat and she talked about her fear and anger related to those early memories, she felt an emotional and physical release and a relaxation in her throat and jaw.

Meg also talked about how, as a child, she wanted to run to get a neighbor to help her mother when her father was hitting  the mother, but she felt "frozen" in her room, so she couldn't move (see my article: Somatic Experiencing: Overcoming the Freeze Response Related to Trauma).

As she talked to her therapist about this, Meg became aware that she felt a numbness in her lower legs from her knees down.  This was something that Meg had never felt before.

Using a technique in Somatic Experiencing, her therapist helped Meg to imagine that she could take one molecule of energy at a time from the upper part of each leg that felt connected to her and move it to the lower parts of her leg that felt numb.  Gradually, Meg could feel the energy flowing back in her legs.  She also felt empowered.

Gradually, over time, Meg felt more connected to her body and was able to more easily connect feelings to various parts of her body in her therapy sessions.  As more parts of her body came back "online" again, she felt more empowered and energized.

There was still one particularly difficult memory that she was grappling with, so her therapist used EMDR therapy to help her to overcome the trauma related to this memory (see my article: What is EMDR Therapy?).

Gradually, as Meg worked through her earlier trauma in therapy, she was no longer afraid to be in a relationship. She was able to separate out the trauma that occurred to her in the past from her adult life now (see my article:  Working Through Emotional Trauma in Psychotherapy: Separating "Then" From "Now").

Conclusion
Integrative psychotherapy allows psychotherapists to combine the best aspects of different types of therapy to tailor the treatment plan to the needs of each client.

Combining psychotherapy and somatic mindfulness, which is a part of Somatic Experiencing, is an important aspect of integrative psychotherapy.  It allows clients, who have unresolved trauma, to begin the process of overcoming dissociation, especially dissociation which has caused a disconnection between the mind and the body.

This gentle approach to resolving trauma allows clients to work at their own pace in a safe way.

As clients re-establish a connection between the mind and the body, they are able to overcome traumatic events from the past.

Getting Help in Therapy
If you have been suffering with unresolved trauma, the past is still affecting you in the present.

An intellectual understanding of your trauma is usually not enough for you to overcome the negative impact of traumatic experiences, especially trauma that occurred in childhood.

Rather than suffering alone or continuing to feel frustrated by talk therapy, you could benefit from working with a licensed psychotherapist who uses Integrative Psychotherapy so you can free yourself from your traumatic past (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 practices Integrative Psychotherapy.

I work with individual adults and couples, and I have helped many clients to overcome their traumatic experiences.

I also work adjunctively with clients who want to maintain their relationship with their primary psychotherapist who doesn't practice Integrative Psychotherapy.

Using Integrative Psychotherapy, I work collaboratively with each client to develop the treatment plan that is best for his or her particular problems.

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.

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.