Focusing on Your Inner Self is More Effective to Overcome Shame Than Focusing on Your Outer Looks

Although most people aren't aware of it, shame is often at the root of many emotional problems (see my article: Healing Shame in Psychotherapy and Overcoming Shame That Keeps You From Starting Therapy).  Many people focus exclusively on their appearance, in an attempt to overcome shame.  While it might help to a certain extent to deal with external issues, shame is usually deeply rooted and without getting to the root of the problem internally, it's difficult to overcome shame that's having a negative effect on your life.

Focusing on Your Inner Self is More Effective to Overcome Shame Than Only Focusing on Your Outer Looks

People often associate shame with external issues, like their appearance.  As result, they try to overcome their shame by trying to deal with these external issues alone rather than looking within themselves to discover the internal roots of their shame.

While it would be helpful, for example, to lose weight for health reasons and it might to feel better, when someone feels ashamed of themselves, focusing only on his or her appearance usually doesn't get to the root of the problem.

Our culture, which glorifies youth and beauty, tends to shame middle aged and older men and woman, especially women.  As a result, women tend to be more susceptible to feeling shamed of themselves as they are.

For instance, older women often complain in therapy about feeling "invisible" in a world that elevates youth and denigrates aging.  And, while it's probably true that not as many people are admiring a woman who is older, as compared to when she was younger, it is also probably true that how she feels about herself and what she projects to the world contributes to this feeling of invisibility (see my article: Making Peace With the Aging Process).

The solution that many people seek, especially women, is to seek products or surgical procedures, like face lifts and breast augmentation as a way of feeling less ashamed of how they're aging.

But these products and procedures usually only give temporary, if any, relief from shame. They  reinforce the idea that you're not alright the way you are and you need to continue to make changes to your outer appearance in order to feel better about yourself.

Fictional Clinical Vignette 

Focusing on Your Inner Self is More Effective to Overcome Shame Than Focusing on Your Outer Looks
The following fictional vignette illustrates these points:

Cindy
Cindy started therapy because she was suffering with debilitating shame.

A year before she sought help from a psychotherapist, Cindy contemplated having a face lift because she couldn't stand looking in the mirror and seeing that her facial skin was sagging.

But after she discussed it with her husband, who still found Cathy to be beautiful, and considering the risks of surgery, she decided against plastic surgery.

Then, Cindy focused on losing weight, even though her doctor told her that she didn't need to lose weight for health reasons.  She thought she would feel better about herself if she lost 10 pounds.  But after she lost 10 pounds, she still felt ashamed of herself.

Next, she attempted temporary non-surgical procedures and creams to firm up her facial skin.  Although the procedure combined with the weight loss reduced the appearance of sagging skin, Cindy still felt deeply ashamed and it was affecting her personal life as well as her career.

She felt so unattractive that she no longer wanted to have sex with her husband, even though he still thought she was attractive and sexy.  No amount of reassurance from her husband helped, and after a while, they began to argue about the lack of sexual intimacy in their marriage (see my article: Have You and Your Spouse Stopped Having Sex?).

At work, she no longer liked to go out on sales calls because she assumed that her customers would prefer to see a young, attractive salesperson rather than an older woman.  As a result, she was making fewer sales visits to customers and this reduced her compensation.  Her boss also complained and told her that she needed to have more customer contact to bring in business.

Not knowing what else to do, Cindy saw her medical doctor to seek advice, and he recommended that Cindy attend psychotherapy.

Cindy told her new psychotherapist that, as far back as she could remember, even when she was a child, she felt ashamed of herself.  But after she went into menopause, she felt increasingly unattractive and ashamed.

Her therapist asked Cindy about her family background and she described parents who were highly critical of Cindy and her siblings.  Her mother, who suffered from low self esteem herself, was especially critical of Cindy, who looked a lot like her mother.

Cindy explained to her therapist that her mother often criticized Cindy for how she looked--her weight, her clothes, her posture and overall demeanor.

In hindsight, Cindy realized that her mother was also highly self critical. Her mother criticized Cindy for all the things she felt self conscious about herself.  Looking back on it, Cindy recognized that her mother was projecting her own insecurities and shame onto Cindy.  But as a child, she felt defenseless against the onslaught of criticism.

Cindy told her therapist that, by the time she turned 18, "I blossomed from an ugly duckling into a very attractive young woman."  Feeling attractive, she felt more self confident, especially after she went away to college and no longer heard her mother's criticism on a daily basis.

In college, Cindy overcame her shyness as she became aware that she was sexually attractive to men.  This also made her feel more confident around men, especially after she became sexual.

After she graduated college, she met the man who eventually became her husband.  She said he was "head over heels about me when we first started dating."  She indicated that, even now, he continued to tell her that he thought she was beautiful and sexy, but she didn't believe it, especially when she looked in the mirror.

Looking back on her life, Cindy realized that most of her self confidence was based on her appearance so that as she got older, her confidence began to falter again, just as it did when she felt like "an ugly duckling" as a child.

When she was younger, even though she did well in college and she was told by her professors that she was intelligent, she assumed that her looks were what got her by.  And now that she was older, she felt like she had nothing to offer.

"I know this sounds shallow, "Cindy said to her therapist, "but it's how I was raised and what I have believed for all my life.  But now these feelings are threatening to ruin my marriage and my career, so I know I need to do something to overcome them."

Cindy's psychotherapist provided Cindy with psychoeducation about shame and how traumatic her parents' criticism of her were when she was younger.  She also provided psychoeducation about how psychotherapy could help (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

The therapist explained that Cindy internalized her mother's criticism and her mother's own shame and this was traumatic.  She recommended that they focus the therapy on overcoming this early trauma.

Using EMDR therapy, over time, Cindy and her therapist worked on helping her to overcome the shame that was instilled in her at an early age (see my articles: How EMDR Works: Part 1: EMDR and the Brain and How EMDR Works: Part 2: Overcoming Trauma).

Gradually, Cindy became aware that not only was she still attractive but, more important than that, she had much more to offer than looks--she had intelligence, generosity, warmth and creativity.

Focusing on Your Inner Self is More Effective to Overcome Shame Than Focusing Only on Your Outer Looks

Eventually, Cindy began to feel sexual again and she and her husband went on vacation to rekindle their relationship.  She also felt more confident about making sales visits to her customers, which increased her compensation

Conclusion:
Many people use their looks to try to boost their confidence and compensate for their shame.  But looks change, so they are not a reliable source for overcoming shame.

Overcoming shame requires deeper work into the root of the shame.

Shame often begins early in life and usually has a traumatic source.

Getting Help in Psychotherapy
Working through the source of the trauma in psychotherapy usually helps you to overcome shame that is having a negative impact on our life (see my article: The Benefits of Psychotherapy).

If shame and trauma are having a negative impact on your life, you owe it to yourself to get help from a licensed mental health professional (see my article: How to Choose a Psychotherapist).

Experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis are usually an effective way to overcome shame as opposed to regular talk therapy (see my article: Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs and EMDR Therapy When Talk Therapy Isn't Enough).

If you're experiencing the negative effects of shame and emotional trauma, rather than suffering on your own, you owe it to yourself to get help from a licensed psychotherapist who is skilled at experiential therapy and helping clients to overcome shame and trauma.

Once you have overcome the shame and trauma that are creating obstacles in your life, you can lead a more fulfilling life.

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 am a trauma-informed psychotherapist, and one of my specialties is helping clients to overcome shame and 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.

Ethical Issues With Using Managed Care For Psychotherapy

In a prior article, I discussed why it has become so difficult to find a psychotherapist in New York City on managed care panels.

This is a problem not just in New York City but all over the country.  In the current article, I'm expanding this discussion to include ethical issues involved with using managed care for psychotherapy.

Ethical Issues With Using Managed Care For Psychotherapy

The purpose of this article is to provide information to clients who are considering using their managed care benefit to attend psychotherapy so that clients can be informed consumers.

Ethical Issues About Using Managed Care For Psychotherapy
Managed care companies' main focus is saving money.  Although most managed care companies would deny it, their allegiance is to their shareholders--not to their subscribers.  When saving money is the main focus, this inevitably leads to certain ethical problems, including:

• Problems With Client's Privacy/Confidentiality:  When a psychotherapist enters into a contractual agreement with a managed care company, she will, most likely, have to share your confidential information with managed care representatives because it is demanded by the managed care company.  In effect, not only is the confidential information shared with the representative on the phone (or sometimes by mail or on the insurance company's website), but the information also becomes available to hundreds of other employees at the managed care company.  This is becoming even more of a problem than when I wrote the about this before because in the last few years there have been breaches in confidentiality when insurance companies sites were hacked.  This exposed thousands of insurance subscribers to having their personal information used illegally, possibly including information about their psychotherapy sessions.

• Problems With the Intrusive Nature of Managed Care: Managed care representatives often contact in network psychotherapists to find out why clients are still in therapy; to make "suggestions" about how psychotherapists should change clients' treatment plans, including referring clients for medication, even when clients have made it clear that they're not interested in medication; and, possibly reducing the frequency of sessions from weekly to every other week or less.  Often, the managed care representatives demand that psychotherapists justify their clients' treatment in writing in order for clients to be able to continue in therapy.  This often involves the representatives asking for detailed personal information about the clients' problems; what else the clients have attempted to do, aside from going to therapy (e.g., joining support groups, seeing a psychiatrist, etc) and so on. 

• Potential Conflicts of Interest For Psychotherapists on Managed Care Panels: To save money, managed care companies prefer short term treatment, even, at times, when clients are in crisis or very depressed and they need longer term treatment.  Many psychotherapists who are on managed care panels are aware that they are more likely to get referrals from managed care if they do brief therapy--even when clients need more intensive therapy.  This often leads to psychotherapists, who are on managed care panels, making decisions based on their financial needs rather than the needs of their clients.  In other words, if a psychotherapist is aware that a managed care company prefers psychotherapists who do brief treatment, he will be placed in an ethical dilemma because he knows that the managed care companies will look at their records to see which therapists only keep clients for a short period of time before terminating treatment so, in the long term, it is in his financial interest to keep clients for only a few sessions so he can get more referrals from the managed care company.  This often leads to poor treatment because the psychotherapist might only be focused on "shoring up" clients rather than helping the client to make meaningful change.  Clients might "feeling better" for a short time and then, after a while, they need to go back several other times to the prior therapist or to a new therapist because their problems were not resolved in short term therapy.  It also discourages clients from seeking help in therapy because, after going through several cycles of short term therapy with poor results, clients will often conclude that "therapy doesn't work" rather than that their therapist might have been pressured by managed care to provide suboptimal care.  This is not to say that all psychotherapists on managed care will choose less than optimal care because many will do what is best for the client, but it is a potential ethical dilemma.

Ethical Issues With Using Managed Care For Psychotherapy

• Potential Problems With Quality of Care:  As mentioned above, when psychotherapists on managed care panels are pressured by the insurance company to provide short term therapy, even when the client needs longer term therapy, the quality of care often suffers.  In order to justify longer treatment, psychotherapists often must go through a lengthy and time consuming process of providing increasingly more detailed information as to why clients need more therapy sessions.  Not only is this time consuming for the therapist, it also compromises confidentiality, as mentioned above.

• Pressure From Managed Care Regarding Medication:  As mentioned above, managed care companies often pressure psychotherapists to refer clients to psychiatrists for medication, even if the clients do not want to take medication and, in many cases, do not need medication.  Often, the representatives making these clinical "recommendations" are Bachelor's level employees, if that, and far less qualified to make these clinical decisions than the psychotherapist treating the client.  Once again, the focus is on saving money rather than  providing quality of care for clients.  

• Restricted Choice of Psychotherapists:  In order to save money, most managed care panels are narrow with a restricted number of psychotherapists listed by zip code.  This saves the managed care company money because there are fewer psychotherapists to choose from and the ones who are on the panel, who are often are other managed care panels, are forced to take many clients in their private practice in order to make financial ends meet due to low managed care reimbursement.  This usually meets that it is very hard to find a psychotherapist in your area who has openings because therapists are all booked up.  Also, many of the therapists (although not all) are new therapists who are starting their private practice and willing to take managed care until they can build their practice.  

• Diagnosis and Stigma: Managed care for psychotherapy is usually based on medical necessity, which means that a client must have a diagnosis that the managed care company deems necessary to cover this client.  As a result, psychotherapists must provide a diagnosis to the managed care company for each client that the managed care company will accept.  Once again, this brings up issues around confidentiality and privacy because these diagnoses are on the managed care computer system.  Also, as mentioned above, when a managed care company's website is hacked, the client's confidential information, including diagnosis, could be exposed (see my article: see my article: Psychotherapy: You Are Not Defined By Your Diagnosis).

What to Do to Avoid or Mitigate These Problems With Managed Care
Obviously, there are many clients who must use their managed care plan because they cannot afford to self pay for therapy.  If this is the case for you, you should, at least, enter into this process knowing what is at stake.  If this is the only way that you can access mental health treatment, it's better to use your managed care insurance than not to go to therapy at all.

Steps To Take to Be An Informed Consumer

• Find Out If Your Company Has a Health Savings Plan:  This is an alternative to using your managed care benefit that many people use.  Your human resources or health benefits representative should be able to tell you if your company has a health savings plan, if you are eligible for the plan, and how to use it.  If your company does not have health savings plan, you and other employees can advocate for this benefit.  Express your concerns to your concerns about these issues and find out what steps the company can take to remedy them.

• Find Out If Your Insurance Allows Out of Network Psychotherapy: When you go out of network, your benefit is not managed by the managed care company, although there might be some restrictions with regard to the deductible and how much the insurance will reimburse you depending upon the plan that your company negotiated with the insurance company.  If your company does not offer out of network benefits, you and other employees can advocate for it.

• Discuss Your Concerns With Your Psychotherapist: If your company does not have a health savings plan, out of network benefits or if you really need to use your managed care benefit, speak with your therapist about your concerns regarding diagnosis, confidential/privacy and quality of care.  You have a right to know the diagnosis that your psychotherapist is submitting to the managed care company.  You also have a right to know what information your therapist is providing to the managed care company if the insurance representative indicates to your therapist that they must do a review of your case.  You can stipulate what you want/do not want shared.  However, be aware that if your therapist does not share information that the managed care company considers necessary to approve additional sessions, you might not be able to continue in therapy.  This is another ethical dilemma.

Ethical Issues With Using Managed Care For Psychotherapy

• Consider Your Priorities:  Only you know your financial situation.  There are times when you might be forced to use your managed care health benefit to access therapy because you cannot afford to pay out of pocket.  This is understandable.  But it is often worthwhile to look at your priorities and assess how your spending your money and how you want to spend your money.  Take a look at your budget and make decisions based on what is important to you.  At certain times, it might be worth it to you to forgo certain expenses, like buying packs of cigarettes or buying expensive coffee in order to have quality mental health treatment.  

• Consider Sliding Fee Scale Mental Health:  There are certain mental health centers that offer sliding scale therapy based on household income.  Most of them will request proof of household income in order to assess your fee.  Many of the psychoanalytic institutes have referral services to their candidates in training where you can see a licensed psychotherapist in their training program for a reduced fee.  These students are usually supervised by senior clinicians.

Getting Help in Therapy
Many people need to use their managed care health benefit in order to access psychotherapy.  However, many of those same people are unaware of the issues involved with using managed care benefits for psychotherapy.

No one who needs mental health services should ever go without treatment regardless of whether you use your managed care benefits or not.   At the same time, it is important to be an informed consumer.

If you have problems that you have been unable to resolve on your own, you could benefit from seeing a skilled psychotherapist who can help you to overcome your problems (see my article: The Benefits of Psychotherapy).

A licensed psychotherapist can help you to overcome the problems that are keeping you from maximizing your potential (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: see my article: The Therapeutic Benefits of Integrative 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.

Taking Risks in Your Therapy

Many clients who are in therapy avoid expressing their reservations or negative feelings about therapy or their therapists.  Some clients, who were discouraged from expressing their feelings when they were children, continue the same pattern without even realizing it in their relationships and in their therapy as adults (see my article: Growing Up Feeling Invisible and Emotionally Invalidated).  

Deep down, they don't feel entitled to their feelings.  Other clients are afraid that they will offend or alienate their psychotherapist by expressing negative feelings.  But in order for the therapy to be alive, meaningful and valuable for clients, they need to take risks in their therapy because, if not, these unexpressed feelings contaminate the therapy and have a negative impact on the relationship between the client and the therapist (see my articles: Why Being Honest With Your Therapist is the Best Policy and How to Talk to Your Psychotherapist About Something That's Bothering You in Therapy).

Taking Risks in Your Therapy 

A Childhood History of Feeling Invisible and Undeserving
Clients who grew up in a family where they were discouraged and, possibly, even punished for expressing their feelings learn quickly to keep their feelings to themselves.  Over time, they also learn not even feel their feelings, so they are unaware of their feelings on a conscious level.

This pattern is often carried over when they become adults in their personal relationships and relationship with their psychotherapist without their even realizing it.

Therapists who recognize this pattern in clients need to provide a safe therapeutic environment (see my article: The Creation of a "Holding Environment in Psychotherapy).

Psychotherapists also need to help these clients to identify their feelings so they can express them.  Many clients, who are having the experience for the first time of expressing negative feelings might begin by having big reactions that frighten them once they begin expressing their feelings, so the therapist also needs to help these clients to manage their emotions.

Learning to express negative feelings after a lifetime of bottling them up can be challenging, so clients need to learn to respond instead of react when expressing themselves (see my article: Responding Instead of Reacting).

A Fictional Clinical Vignette: Taking Risks in Therapy
The following fictional vignette illustrates the points that I've made above and how psychotherapy can help:

Beth
Beth, who was in her early 30s, began therapy because she thought she was being taken advantage of in her two year relationship.

She told her new psychotherapist that her boyfriend, Alex, would often assume that when they went out that Beth would pay because she made more money that he did.  She said that, although she didn't mind paying sometimes, she didn't want to pay for their dinner, movies and theater tickets all the time.  She especially didn't want Alex to assume that she would always pay, which he did.  She felt that, although he made less money than she did, he made enough money to offer to pay sometimes.

Taking Risks in Your Therapy

Beth also mentioned other issues in the relationship where she felt taken advantage of.  When her psychotherapist asked Beth if she ever discussed this with Alex, Beth gave her a blank stare and then she gave all her reasons why she had not spoken to Alex about these issues, "It wouldn't make a difference anyway," "He's just like that--he won't change" and so on.

Eventually, over time, Beth came to see these "reasons" as rationalizations and excuses for her passivity.  But, at this point in her therapy, she believed her rationalizations.

It turned out that Beth had so much bottled up resentment towards Alex over the two years that they were in a relationship that she no longer wanted to be sexual with him.  But, until she came to therapy, she never made the connection between her unexpressed anger and resentment and her lack of interest in having sex with Alex.

When Beth thought about it, she said she had always been a sexual person, and she had been very sexually attracted to Alex during their first year together.

Before discussing this in therapy, she just thought that the decrease in her sexual interest was a normal part of being in a two year relationship. But now she sensed how her resentment and anger contributed to the cooling off of her feelings for Alex.

When her new psychotherapist asked Beth if she had ever been in therapy before, Beth told her that she had been in therapy with several different therapists over the last few years, but she left each of her therapists when they said or did something that she didn't like.

When her therapist asked her if she ever spoke to any of her therapists about her misgivings, Beth realized that she never did--she just left abruptly (see my article: When Clients Leave Psychotherapy Prematurely).

Beth described her parents as being emotionally distant and preoccupied with their careers.  As an only child, Beth spent much of her time alone.  She never saw her parents argue, but she also never saw them being affectionate with each other.

She remembered times when she tried to tell her mother about feeling lonely at home and at school, but her mother never wanted to hear it.

Her mother especially didn't want to hear any complaints from Beth about anything going on at home or about Beth feeling angry towards her parents.  So, eventually, Beth learned to keep her feelings to herself, and she approached her romantic relationships in the same way.

Beth's therapist helped Beth to feel comfortable in therapy and encouraged Beth to tell her if she had any misgivings about the therapy or her therapist.  She told Beth that she wanted her to be able to talk about any problems in therapy rather than Beth just disappearing from therapy as she did in her prior therapies.

As Beth continued to attend her therapy sessions, she got more comfortable with her therapist.  At one point, when Beth felt misunderstood by her therapist, Beth broached this topic with trepidation.  Beth felt that her therapist didn't understand what she was trying to say, so she got up her courage to tell her therapist.

But when she began to talk about it, she felt such uncontrollable rage welling up inside her that she couldn't get the words out.  She felt unable to breathe, her heart was pounding, and it was as if the words were stuck in her throat.

Her therapist helped Beth to calm down enough so she could breathe and feel grounded.  Then, even though she still had difficulty, Beth was able to speak clearly and articulate her feelings.

Taking Risks in Your Therapy

With the help of her psychotherapist, she also made connections between her family history of feeling  invisible and undeserving and how this affected her adult relationships.

Over time, Beth gradually became more comfortable taking risks in her therapy. She was able to speak up when she felt misunderstood or something occurred that she didn't like.  Unlike her childhood experiences with her parents, Beth saw that her therapist was open to talking about any problems in therapy and there were no negative repercussions.

Similarly, when Beth felt there was a rupture with her therapist, after she talked about it with her therapist, she also saw that these ruptures could be repaired (see my article: Ruptures and Repairs in Psychotherapy).

This helped Beth to feel more confident in other areas in her life, including her relationship with Alex.  As a result, she was able to talk to him about the areas in their relationship where she had misgivings, which helped to clear the air and also helped them to make positive changes in their relationship.

Conclusion
When clients have problems expressing negative feelings about aspects of their therapy or about their psychotherapist, there is usually a long history of this problem that goes back to childhood.

For these clients, in the short term, it's easier to leave therapy abruptly than take the risk of expressing their feelings and dealing with their fear of rejection or some form of retaliation by the therapist.  This usually results in a string of aborted therapies over time which, in the long run, is usually damaging to the client.

By the same token, these same clients often tolerate inappropriate behavior in their relationships, similar to Beth in the fictional vignette above.  Their anger and resentment have the same effect--they either leave the relationship or the relationship slowly dies because the relationship becomes buried in these unexpressed negative feelings.

If clients, who are reticent about expressing negative feelings, can learn to express these types of feeling in therapy, they can use this skill in their relationships.

At first, it might feel uncomfortable but, over time, clients can become more comfortable expressing themselves, which leads a greater sense of authenticity as well as more authentic relationships.

Getting Help in Therapy
The unspoken and, possibly unconscious, fear that it's dangerous to express negative feelings is very hard to overcome on your own because it's usually so ingrained.

A skilled psychotherapist can help you to recognize and express uncomfortable feelings in an effective way.  She can help you to develop the necessary tools so that you don't feel overwhelmed by your own feelings (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

She can also help you express yourself in an effective way--without your minimizing your feelings or overreacting in ways that would be overwhelming to you or to others and make your communication ineffective.

Rather than struggling on your own, you could benefit from getting help in psychotherapy so that you will eventually feel more comfortable and confident in yourself.

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 take risk in therapy so that they can lead more fulfilling and authentic 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.

Books: Call Me By Your Name - Part 2: The Concept of Living Parallel Lives

In my prior article about the book, Call Me By Your Name, I focused on the phrase, "Is it better to speak or to die?," a question that spurred the main character, Elio, to reveal his romantic feelings to Oliver, the graduate student staying in Elio's family's vacation home in Northern Italy.  In my current article, I'm focusing on another concept that came up in the book (but not in the movie of the same name) about living parallel lives--living the life you have chosen as well as the fantasy of the life you might have wanted on some level but did not choose.

Living Parallel Lives

There are many ambiguities in the book as well as in the movie.  But the part about living parallel lives seemed clearer to me in terms of Oliver's and Elio's enduring romantic feelings for each other even many years later.

When I read what Oliver told Elio about his own experience with parallel lives, I thought about how common this is for many people, especially with regard to relationships.

Whenever we choose one person, we are letting go of other possible choices (see my article:  Explorations in Psychotherapy of the Road Not Taken in Life).

Inevitably, many people experience regrets and a sense of loss for their relationship choices--if not immediately, then perhaps later in life.  But most people make choices given who they are and what they know about themselves, information they have about the situation, and options available to them at the time that they are making the choice.

These can be difficult choices.  Letting go of alternatives can be very challenging.  This can lead to the concept of living parallel lives--living the life chosen as well as the fantasy of the one not chosen.

Living in the 21st century, when it comes to relationships, there has never been a time when it was easier to continue to fantasize about the person you didn't choose or who didn't choose you (see my article: Relationships: Obsessing About the "One Who Got Away").

Unlike the 1980s, when Elio and Oliver had their romance, there's so much information now online that you can keep up with what is going on with your ex and continue to fantasize about what your life might have been like if you were still with that person.

Spoiler Alert:  If you haven't read the book, you might want to stop reading at this point.

As I mentioned in my prior article, unlike the movie, the book is written from Elio's perspective, so it's important to keep in mind that his perspective might not be accurate.  Like anyone else, his view could be distorted.

When they met many years later and Oliver talked to Elio about his own experience of living parallel lives--his actual life with his wife and family and his fantasy of what life might have been like if he remained with Elio, Elio seemed surprised that he was still on Oliver's mind all this time later.  Not only is Elio on Oliver's mind, but Oliver keeps track of Elio's career, what is going on in Elio's life, and what has gone on with Elio's parents.

The words "cor cordium" (translated as "heart of hearts") comes up twice in the book.

The first time is when Oliver was staying with Elio and his family as a graduate student and Oliver and Elio were in town to pick up the Italian translation of Oliver's manuscript. Oliver asked Elio if he knew who drowned in that area.  Elio, who was precocious for his age, responded that it was the poet, Shelley.

Then, Oliver asked Elio if he knew what Shelley's wife and friends did when they found Shelley's body.  Elio responded "cor cordium" referring to when Shelley's friend seized Shelley's heart before it was consumed in the fire as it was being cremated on the shore.  The same two words were engraved on Shelley's gravestone.

Oliver's response was to ask Elio, "Is there anything you don't know?"  At that point, Elio saw his chance to seize the moment to reveal to Oliver, rather cryptically, that he had romantic feelings for Oliver.

The second time that "cor cordium" came up was when they met many years later and Oliver revealed that he kept the framed postcard of a place called Monet's berm that he took from Elio's room when he stayed in Elio's home as a graduate student. This is significant because Monet's berm is the place where Oliver and Elio first kissed and Elio revealed his feelings for him.

The prior history of the framed postcard was that a prior graduate student, who stayed with Elio's family, found it at a flea market in Paris and sent it to Elio as a souvenir.  This prior student had written on the back of the postcard, "Think of me someday."  When Oliver left Elio's family home in Italy, he took the framed postcard with him to remind him of the day that Elio revealed his feelings for him on Monet's berm.

Oliver showed Elio that he kept the framed postcard in his office where he saw it everyday.  He said he added his own inscription to the back and hoped to send it back to Elio.

At first, when Elio asked Oliver what he wrote, Oliver told Elio that he wanted it to be a surprise when he sent it back to Elio.  But when Elio told him that he didn't like surprises, Oliver revealed that he wrote "cor cordium" on the back of the card.

The framed postcard of Monet's berm was part of Oliver's parallel life of fantasizing about their romance with Elio.

There is much that is ambiguous about the book and the movie.  Possibly, the author, Andre Aciman, meant the story to be ambiguous because of Oliver and Elio's feelings were conflicted at times.

It is unclear why Oliver chose the conventional life that he did with his on-again/off-again relationship with his then-girlfriend.  One possibility is revealed earlier in the book when Oliver was very conflicted about getting sexually involved with Elio.  He told Elio that they should not talk about such things when Elio lets him know how he feels about him, as if a man loving another man is a taboo subject.

Oliver's emotional conflict was revealed in several other ways:  After they kissed, he told Elio that, until that point, they were "good" (before they got sexually involved) and he wanted to be "good," the implication being that getting sexually involved would be "bad" or wrong.

In addition, since Oliver was about to become a professor, he had more to lose professionally if he were in a gay relationship (this was the 1980s).

He also told Elio that, unlike Elio's parents who were more liberal and accepting of Elio and Oliver's  love for each other, Oliver's father would be alarmed if he knew that Oliver got involved with a man.  Oliver said his father would take him to a correctional facility if he found out.

Then, of course, there's the age difference of 17 vs 24, which at that stage of life made a big difference, and the geographic distance between them with Elio being in Europe and Oliver in New York City at that point.

For all of his bravado and outward appearance of confidence, Oliver lacked confidence at that stage in his life, as Elio's father astutely observed.  So, that in addition to all the other obstacles of remaining involved with Elio, Oliver might not have felt confident enough to be in a gay relationship with all the problems there would have been in the 1980s.

Neither the book nor the movie reveal if Oliver had any prior involvement with men.  My sense is that, even though Oliver might have known he was bisexual, he probably never acted on his feelings for men before Elio.

Or, it was also possible that Oliver never had these feelings for men before (as opposed to Elio, who revealed in the book that he had attractions for men, but never acted on them).

This is part of the problem when the issue is viewed from a gender binary perspective where people are seen as being either gay, straight or bisexual.  When there is ambiguity as there is in Call Me By Your Name, the problem with the gender binary perspective adds to the confusion.

In any case, neither Elio nor Oliver have completely suppressed their feelings for each other, even though this is difficult given that they are not together and they each feel sad about that.

The end of the book was also ambiguous and seemed to hint at a possible sequel.

If there is a sequel, will Elio and Oliver get together years later or will they continue to live separate but parallel lives where they still love each other but are not directly involved in each other's lives?

It's anyone's guess.

I believe the book as well as the movie have great general appeal because, regardless of sexual orientation, the inner conflicts that Oliver and Elio experience about love and loss are universal themes.

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.

One of my specialties is helping people, heterosexual and LGBTQ, to overcome problems in their lives and their relationships.

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.

Books: Call Me By Your Name: Part 1: Is It Better to Speak or to Die?

In a prior article, I discussed Andre Aciman's book, Enigma Variations.  In this article, I'm focusing on an earlier book by Andre Aciman, Call Me By Your Name.  

After I saw the beautiful movie, Call Me By Your Name, I wanted to know more about the two main characters, Elio and Oliver (portrayed by Timothee Chalamet and Armie Hammer, respectively, in the movie), so I read Andre Aciman's book by the same name.

Is It Better to Speak or to Die?

Both the movie and the book are a sensual feast: a lush Italian countryside, a beautiful villa, sunshine, a seemingly endless summer, delicious food, an abundance of Italian wine, the scents of flowers and herbs, beautiful music, the warmth of the sun, the beach, and sensual bodies.

The movie is a close translation of Andre Aciman's book, but it is, of necessity, more compressed. Even though the movie differs in some aspects from the book, it maintains the same emotional tone.

In the book and the movie, it's 1983 and Elio Perlman, a 17 year old boy, and his family are at their vacation home, a 17th century villa inherited from Elio's maternal grandfather in Northern Italy.  In the book, the story is told in retrospect from Elio's point of view many years after he and Oliver first met.

The Perlman family had a tradition of inviting a doctoral student every year to spend six weeks in the summer at their villa so the graduate students could complete their book manuscripts while enjoying all the villa had to offer.  In return, the students spent an hour or so each week helping Elio's father, who was a classics professor, with his paperwork.

Over the years, these graduate students maintained contact with the Perlmans by writing, sending packages for the holidays, visiting them again and remembering their summer as graduate students in their home.  The Perlmans also had many other interesting guests, gay and straight, from all walks of life, which added to the atmosphere of camaraderie and stimulating conversations at dinner.

When Elio first met 24 year old Oliver, an American graduate student from Columbia University, who was working on a manuscript about the ancient Greek philosopher, Heraclitus, Elio disliked the way Oliver said, "Later!" in such a flippant way whenever Oliver departed.

Even at the young age of 17, Elio was an introspective individual and he found Oliver to be too casual and detached.  At that point, Elio wasn't sure if he liked Oliver or not.  But as Elio continued to observe Oliver, who was a tall, handsome, muscular man, Elio found himself fascinated and obsessed with him.  He also felt an affinity for Oliver because they were both Jewish.

In the book, although Elio had enough self awareness to know that he was bisexual, he was confused by his developing romantic and sexual feelings for Oliver, and he was perplexed as to whether Oliver felt the same way about him.

Is It Better to Speak or Die?

When Oliver massaged Elio's shoulders, which Elio desired, but the feelings that Oliver's touch elicited in Elio also frightened him.  Elio jerked away because he felt himself about to go limp in surrender to Oliver.

Then there is the flirtation when Elio, who was a musical prodigy, played Bach's "Aria of the Postillon" from Capriccio on the Departure of a Beloved Brother.  Oliver was touched when he heard Elio play the aria on the guitar and then on the piano.  When Oliver asked Elio to play the aria again, Elio teased him by playing different variations of it, knowing that Oliver wanted to hear the original Bach rendition.

Is It Better to Speak or to Die?

Time was precious because Oliver would be leaving soon, so when Elio's mother, who seemed to sense Elio's dilemma, read aloud from Marguerite of Navarre's 16th century romantic Hempateron, "Is it better to speak or to die?" about a knight who was in love with a woman but was unable to express his love to her, Elio took this as a sign that he must tell Oliver how he feels.

This is a pivotal moment in the book and the movie because these words, "Is it better to speak or to die," embolden Elio to express his feelings to Oliver.  At that point, he knows that if he doesn't express his feelings, Oliver would leave and Elio would regret not speaking or knowing how Oliver felt.

This is especially relevant for gay or bisexual men and women when they're not sure if the person they're attracted to feels the same way:  Is it better to take the risk to speak or to allow the moment to pass and never know what might have been?

So often in life, for all of us, there are times when we must ask ourselves if it's worth the risk to say how we feel or to allow the moment to pass.  In this story, Elio speaks and, in retrospect, remembers one of the most poignant moments of his life.

I won't give away the rest of the book or movie.  If you haven't read the book or seen the movie, I highly recommend both.

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

I work with individual adults and couples.

One of my specialties is working with the LGBTQ population.

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.

Writing About Your Mother After Her Death

I've written about grief in prior articles, including grief after parents die (see the end of this article for a list).  In this article, I'm focusing specifically on a mother's death and how writing can help you to heal. Although I'm focusing on mothers, you can, of course, apply what I've written to fathers, brothers, sisters, a spouse or any relatives or close friends.  I'm choosing to focus on mothers in this article because, for most people, it's usually the closest relationship you have from before your birth until death.

Writing About Your Mother After Her Death

Losing a mother is one of the biggest losses that anyone will ever face.  Even if you didn't have a good relationship with your mother, you might grieve for the aspects that were positive, if there were positive aspects to your relationship with her, and also for what you wanted and didn't get from your mother.

If your mother died and you were fortunate enough to say goodbye and express your feelings before she died, afterwards you might remember something you wanted to say and didn't or a question you would have liked to ask.

If you didn't get a chance to say goodbye, you probably feel a need to say goodbye and that much more after your mother died.

Writing About Your Mother After Her Death

It's common to feel regret about unexpressed feelings or questions after the death of your mother, and you might feel despair because you can no longer express these feelings or ask these questions.

But there are other ways to deal with working through grief and dealing with unresolved feelings.  One way is to spend time writing about your mother.

Writing can be an integrating process where your thoughts, feelings, memories, dreams and daydreams come together.

Writing About Your Mother After Her Death

• Keeping a Journal: Keeping a journal of whatever feelings, memories, dreams and thoughts you have is one way to use writing to heal yourself.  The journal would only be for you to see, unless you choose to share it with people close to you or with your psychotherapist.  Write whatever comes to mind and don't censor yourself.  What comes up won't always be loving thoughts.  You might feel angry for things that happened during her life or that you feel abandoned since she died.  You might also have other feelings that you weren't aware of until you start writing.

• Writing Poetry: If you enjoy reading and writing poetry, you might find it healing to write one or more poems about your mother that capture the essence of who she was and your relationship with her.  The use of metaphor and symbols in poetry can also help to express deep feelings as well as provide a healing experience for you.

• Writing Letters to Your Mother: If there were things you would have liked to say, but you didn't, writing letters to your mother in which you express your feelings can be helpful.  You can write one letter or a series of letters about different topics.  These letters won't all necessarily be loving.  There might be letters that are angry, sad, frustrating or express whatever feels unfinished to you.  Since your emotional relationship with your mother continues to grow and change over the years, you might have different, even contradictory, feelings at various times.  For instance, at one point, you might write a letter to "tell her" about a happy occasion, like your daughter's wedding and at another point, you might write about something you're experiencing where you wish you had her support, for example, if you're going through a divorce.  You might even imagine what your mother might have said about these situations and write letters from her perspective back to you.

• Writing a Short Story: If you grew up with your mother and had an ongoing relationship with her, you probably know a lot of stories about her life and your relationship with her.  Some of them might be sad and some might be humorous.  Capturing these experiences in a short story or two can help you to relive those experiences and to heal emotionally.  Even if you have to fill in certain parts of the story because you don't know what the whole story, you can imagine part of it and write about that part of it from your imagination.  

• Writing a Collection of Short Stories:  If you have many stories that you want to remember, you can write a collection of stories that you either keep for your own private use or share with family members and close friends.  How you use these stories is up to you.  If you write a collection of short stories, it can include stories that you know about from the time your mother was an infant (maybe she told you stories that she heard from her mother about infancy) until her death or you can choose certain significant milestones of her life to write about.  Each chapter can be about a different time in her life.  Although this might sound daunting, you don't have a deadline, so you're not under any pressure to complete this project by a specific date.  You can write these stories whenever you feel like it and you have time.  Once again, capturing these stories in writing can be a healing process.  

• Writing a Memoir:  Maybe you want to focus specifically on your relationship with your mother from your point of view and your relationship with her rather than about her personal life.  Writing a memoir doesn't have to capture her whole life or your whole life with your mother.  It can include whatever experiences are meaningful to you that you want to write about.  Once again, if you're doing this for yourself, there's no rush and no pressure.

Overcoming Obstacles to Writing
You might read these suggestions and say, "But I'm not a writer..."

Even if you've never kept a journal and never attempted any particular writing project, you can still write.

The problem that most people have with writing is getting started because they think their writing won't be good enough or that it should look and sound a certain way.

But, remember, you're doing this for yourself to help you with your grief, so no one will be judging your writing, except maybe you if you happen to be particularly critical of yourself.

To overcome this obstacle, I usually recommend that people do free associative writing to get the words to start flowing before you begin any of the writing suggestions above.

Just like in free association in the psychoanalytic sense, when you do free associative writing, you're just writing whatever comes to mind and you keep going.  You're not stopping to fix punctuation or grammar.  You're just letting it all pour out.

The intent is to help you to relax and get into the flow of writing.

If you have some time before you get started with your day, the best time to do free associative writing is in the morning before you're completely awake and before your defenses and fears take hold.

If nothing comes to mind at first, choose a word, any word, and write whatever comes to mind.  It can be any word at all, even if it seems trivial at first.  For instance, if you've just woken up and you're staring at your box of corn flakes and you can't think of a word, write down "corn flakes" and keep going from there and don't stop for at least 5-10 minutes.

Don't go back to critique it.  That's not the  point.  What you wrote might appear be a word salad.  That's okay.  Let it be whatever it is.

If you happen to come upon an idea that you want to include in your writing about your mother then, by all means, go back and use that piece.

In Julia Cameron's book, The Artist's Way, she has suggestions about a form of free associative writing that she calls the morning pages.  You can follow this method or any other free associative method that feels right for you.

You might also want to look at a book by Marion Milner (pseudonym: Joanna Field) called A Life of One's Own where she writes about her own personal growth process and how she used a diary for self exploration.

Conclusion
There are many different approaches that you can take, possibly even ones that I haven't included in this article, to express your grief in writing or memorialize your mother.

Writing about grief is usually an integrative process so that it helps you to bring together the many different feelings you have about your mother and your relationship with your mother.

When you're ready to write about your mother, it can be a healing experience that gets you through the mourning process and beyond.

Getting Help in Therapy
As I've mentioned in previous articles, losing your mother is one of the most difficult, if not the most difficult, loss that you will experience.

If you've having problems grieving for your mother or you're stuck in the mourning process, you could benefit from seeing a licensed mental health professional to help you through this process (see my article: The Benefits of Psychotherapy).

Grief and mourning are unique for each person.

A skilled psychotherapist can help you to work through this loss so that you can work through the loss and heal (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 to work through their grief.

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.

Also see:

Inconsolable Grief About a Mother's Death

Grief in Waiting After a Parent's Death

Allowing Room For Grief

Grief: You Continue to Have a Relationship With Your Parents Even After They Die

The Theme of Complicated Grief For a Mother in the Movie, Phantom Thread

Relationships: Is Your Partner's Behavior Kindness or Controlling Behavior?

I've written about relationship issues in prior articles (see my articles: How Your Attachment Style Affects Your Relationship and Fear of Being Emotionally Vulnerable).  In this article, I'm focusing on the difference between kindness vs. controlling behavior (see my article: Changing Maladaptive Behavior That No Longer Works For You: Controlling Behavior).

Relationships: Kindness or Controlling Behavior?

Over the years, I've met many individual adults and couples where the issue of kindness vs. controlling behavior has come up.  Usually, one or both partners in a relationship weren't sure if what they were experiencing from their partner was kindness, controlling behavior or some combination of the two.

Fictionalized Vignette:  Relationships - Kindness or Controlling Behavior
The following fictionalized vignette is an example of this problem and how psychotherapy can help:

Sara and John
Sara and John, who were together for a year, came to couples therapy because they were having disagreements about what Sara saw as John's controlling behavior and what John saw as his being kind to Sara.

Six months into their relationship, Sara took a job where she had to travel internationally a few times a month.

When Sara began traveling, John asked her to provide him with all the information regarding her flights, arrival time, and hotel.  He also asked her to call call or text him when her plane landed.

At first, Sara wasn't completely comfortable with John's request, but she didn't want John to worry, so she provided him with the information beforehand and would usually call him or send a text message to him when her plane landed.

But there were a few times when she was with colleagues and they were in a hurry to get to a meeting with a customer, so she didn't have time to text John immediately.

She felt she always tried to be considerate of him, so she didn't delay more than 10-15 minutes.  But, when she couldn't reach him immediately, by the time she turned on her phone, she already had a few panicky text messages from John wondering if she was okay.

During those times, John would also call her at the same time that she was texting him, and she didn't have privacy to talk because she was with her colleagues.

After this happened a few times, Sara tried to explain to John that she would always try to text or call as soon as she could, but when he panicked and she had to try to calm him down, he was adding to the stress she was already experiencing on the trip.

John told Sara that he felt hurt that she was experiencing him as adding to her stress when, from his perspective, he was being kind and caring.  He said he didn't want to be controlling.  He cared about her and he just wanted to make sure that she was safe.

Since they were getting nowhere on their own with these arguments, they decided to go to couples therapy.

During their couples therapy sessions, Sara told John and their therapist that she appreciated that John cared about her, but she couldn't understand why he needed to be contacted immediately.  She explained that she was often with senior managers on these business trips, and she didn't always have privacy to try to calm John down when he panicked.

She also expressed feeling confused and annoyed that John felt the need to be contacted immediately when nothing bad had ever happened on her business trips.  She couldn't understand his behavior, and she felt it was a boundary issue between them.

As John listened to Sara during their couples therapy sessions, over time he was able to acknowledge that he worried excessively when Sara traveled, and he wasn't sure why.

Sara told their therapist that, other than these business trips, John didn't try to keep tabs on her at any other time.  He never questioned when she went out with friends or went to business meetings locally.

John said that he tried to stay calm, but 10 minutes or so before he knew Sara's plane was about to land, he would become highly anxious.

By arrival time, he was on the verge of a panic attack imaging all the things that could have gone wrong.  So, he felt he needed to hear from Sara immediately when the plane landed to help him to calm down.

Relationships: Kindness or Controlling Behavior?

When he looked back on those times when he was calm, he acknowledged that, even though he still felt that he was being kind, his behavior was excessive, but he didn't know how to calm himself once he began to panic (see my article: Tips For Coping With Panic Attacks).

During one of their couples therapy sessions, John revealed to Sara for the first time that he had a history of panic disorder, and even as a child, he worried excessively whenever his father traveled on business.  He feared that something catastrophic would occur and he would never see his father again.

Since his father was self employed, he was usually on his own, and it wasn't a problem for to call John from his hotel to let him know he landed safely.  All the while, until John got his father's call, he imagined the worst.  But once he received the call, he calmed down.

John said that his parents never took him to see a psychotherapist when he was a child because they thought he was "outgrow" his anxiety.  But he never did and it was a problem in his prior relationships before he met Sara.

John said he felt deeply ashamed of his panic attacks and, as an adult, his shame got in the way of his getting help in therapy.  Even when he was talking about this with Sara and their therapist, his face was red and he didn't make eye contact (see my article: Healing Shame in Psychotherapy).

Since John eventually acknowledged that he had a problem, the couples therapist recommended that John see an individual psychotherapist to work on his anxiety and panic attacks while he and Sara worked in couples therapy to try to resolve these issues in their relationship.

The couples therapist also taught John a few techniques to calm himself when he felt a panic attack coming on (see my articles: Developing Coping Strategies and Internal Resources).

But she said that there were probably deeper issues involved that he would need to work on with an individual psychotherapist.

After John had a few individual sessions to give his family history, his individual psychotherapist recommended that they use a clinical hypnosis technique called the "Affect Bridge" to try to get to the root of his problem.

When they used the Affect Bridge, John remembered overhearing his grandfather talk about a plane accident where the grandfather lost his best friend.

When the grandfather was telling the story to John's parents, none of them knew that John was nearby listening to the conversation, so they talked about the accident in a detailed way that they would not have if they knew that four-year old John was listening to them.

Afterwards, John and his individual psychotherapist talked about what came up during the Affect Bridge.  He said he had completely forgotten about that memory and he was amazed that it was at the root of his panic attacks when Sara traveled.

His individual therapist explained that John was getting emotionally triggered whenever Sara traveled abroad and his fears stemmed from that earlier memory.

She explained that, even though John didn't witness the plane accident that his grandfather talked about, the story was told in such vivid detail that it was almost as if John had witnessed it and he became traumatized by it (see my article: Overcoming Trauma: When the Past is in the Present).

His individual psychotherapist recommended that they use EMDR Therapy to help John to overcome the trauma that was getting triggered whenever Sara traveled.

Gradually, as John processed the memory of hearing his grandfather's tragic story, he began to be able to separate out that memory from the times when Sara traveled (see my article: Working Through Emotional Trauma: Separating "Then" From "Now").

In the meantime, Sara felt much more compassionate towards John after she realized he was getting triggered.  She told John in their couples therapy that she now understood why he would become so upset.

Until John could work through the original trauma that was getting triggered, Sara continued to call or text John so he wouldn't worry.  But when she couldn't contact him immediately, John used the techniques he learned in his therapy to stay calm.

Relationships: Kindness or Controlling Behavior?

Over time, when John worked through the original trauma with EMDR therapy, he no longer kept tabs on when Sara's plane landed and he no longer panicked.

After a while, when he was no longer symptomatic, John told Sara that it was no longer necessary for her to contact him--he could wait to hear from her whenever it was convenient for her.

Conclusion
Sometimes, it's difficult to distinguish between kindness and controlling behavior.

There are times when what is meant to be kind also has elements of controlling behavior.  Sometimes, there are more than just elements--it's mostly controlling behavior and the person who is engaging in it has little to no insight into it.

The vignette above is one example of this kindness vs. controlling behavior.

There are many other examples:

• The parents who tend to show up at their adult child and spouse's home without calling ahead to see if it's convenient for them because they want to see them--even though this feels intrusive to their adult child or the spouse.  If couple tries to set a boundary with the parents, the parents feel offended because, from their perspective, they're just trying to be "nice." Then, the adult child and the spouse feel guilty for hurting the parents (see my article: Setting Boundaries With Family Members Who Want to Interfere in Your Relationship and Learn to Stop Interfering in Your Adult Child's Relationship).

• The friend, who tends to want to help by giving unsolicited advice, and then gets angry when the friend with the problem tries to set a boundary with her (see my article: Friendships: Losing a Friend After Giving Advice).

• The overprotective boss who gets involved in her employees' personal problems and tries to resolve these problems.  When an employee, who feels the boss is being intrusive, tells the boss tactfully that she doesn't want to talk to her about it, the boss becomes offended.  From her perspective, she only wants to help.

And so on.

Getting Help in Therapy
Although you have a right to set boundaries with the other people, setting boundaries can be difficult, and these situations aren't always easy to work through on your own, especially if the person who thinks s/he is being kind takes offense to boundary setting.

If you find yourself in this type of situation and you've been unable to resolve it on your own, a skilled psychotherapist can help you to discern what's going on and how to deal with it (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Rather than struggling on your own, you could get help from a licensed mental health professional, who has experience assisting clients to overcome these problems.

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.

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.