When Just "Moving On" or "Starting Over" Isn't the Answer to Your Problems

There are times when "moving on" or "starting over" isn't the answer to resolving your problems.  The reason why is that, in those instances, there are underlying reasons for your problems, and if you don't understand how and why those problems developed in the first place, you're more likely to repeat the same problems.  I've been writing about infidelity lately, and this is the type of problem that requires a deeper look, so I'll use this as an example in this article (see my articles: Coping With Secrets and Lies in Your Relationship, Infidelity: Cheating on Your Husband Even Though You're Not the Type and Infidelity: Your Spouse Cheated on You. Should You Stay or Should You Go?).

When Just "Moving On" and "Starting Over" Isn't the Answer to Your Problems 

When a problem occurs that makes you feel uncomfortable, it's tempting to want to sweep the problem under the rug by saying you want to "move on" without exploring what contributed to the problem (see my article: Discovering the Unconscious Issues at the Root of Your Problems and Therapy Can Help You to Stop Sweeping Uncomfortable Problems Under the Rug).

This is most likely to happen when you feel ashamed of your behavior, as in the case of infidelity.  But if you brush this problem aside, even if you apologize to your partner, you and your partner are missing a valuable opportunity to discover the underlying reasons for what happened.  You might also be minimizing your partner's feelings of betrayal, sadness and anger.

Without that understanding, you're leaving the underlying issues for the problem in place and there to be activated again in the future.

While no one likes to admit that they made a mistake, taking responsibility for your behavior is part of being a mature adult.

While you might be very ashamed and feel guilty for your behavior and you might think that these feelings alone will prevent you from making the same mistake again, it's more than likely that the problem will reoccur due to the unconscious underlying reasons.

This is why it's so important to get help from a licensed mental health professional, who can help you to discover what the unconscious reasons were and how to prevent this problem in the future.

Fictional Clinical Vignette: 
When Just "Moving On" or "Starting Over" Isn't the Answer to Your Problems: Infidelity
The following clinical vignette illustrates these points using the example of infidelity.  However, there are many other problems, besides infidelity, that are similar in terms of there being underlying issues that need to be discovered and understood.

Ann and Bruce
When Bruce discovered that his wife, Ann, was having an affair with a coworker, he was devastated.

Married for several years and with two children, they knew they wanted to stay together rather than throwing away the life they had together.  But they each had different ideas about how to overcome their problems.

After Bruce discovered pictures of Ann having sex with her coworker, Jim, on Ann's phone, he was devastated.  He trusted Ann completely, and the thought that Ann would cheat on him never crossed his mind, so he was shocked and upset when he found the pictures.

He told Ann that he wanted to forgive her and to remain in their relationship, but he didn't think he could without understanding why this happened.  And since Ann, who expressed her regret and shame, said she didn't know why she got sexually involved with another man, Bruce told her that they needed to go to couples counseling.

Ann resisted the idea for several weeks after Bruce discovered the affair.  She told Bruce that she thought they should "move on" rather than talk about these issues in couples counseling.  She tried to reassure him that she would never cheat on him again, but Bruce wasn't convinced.

After a few weeks where they were barely talking to one another and realizing that this was affecting their two young children, Ann agreed very reluctantly to go for couples counseling.

Bruce sought the couples counselor and made the appointment.  He left his office early on the first day of their appointment and waited for Ann, who was 15 minutes late.

The psychotherapist obtained basic information from them, including the nature of the presenting problem and why they were seeking couples counseling.  Bruce provided most of the information while Ann sat looking sullen.  She barely made eye contact with Bruce or the psychotherapist.

When the therapist asked Ann why she was there, Ann said that she came because Bruce wanted to do couples counseling, but she didn't see the need for it.  As far as she was concerned, they should "just start over," especially since she acknowledged her mistake and made a promise not to do it again.

When Just "Moving On" or "Start Over" Isn't the Answer to Your Problems

The therapist could see that Ann was very ashamed and this was getting in Ann's way of being open and honest in the session.

She provided Ann and Bruce with psychoeducation about couples counseling and discussed some of the ground rules--speaking from your own experience, not interrupting the other person when s/he is speaking, and showing up for regular weekly appointments (see my article: Why It's Important for Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

Then, the therapist explained why it's important to discover the underlying issues involved in the infidelity, and she stressed that there are always underlying reasons.

She also emphasized that discovering the reasons is not the same as condoning or justifying the infidelity.  Rather than condoning or justifying, knowing the reasons for the infidelity would provide them with a chance to make changes in themselves as individuals as well as making changes in the relationship.

At the end of the session, they talked about scheduling their next appointment, but Ann said she didn't bring her work appointments with her, so she would need to wait until the next day in order to be able to make an appointment.  She made a commitment to call the therapist on the following day with information about when both she and Bruce would be available.

But the next day came and went without Ann contacting the therapist.  When Bruce asked Ann about it, she told him that she forgot to check her work schedule, so she would have to wait another day.  She knew she had a few tentative meetings at work and a possible upcoming business trip, so she wanted to wait until she had more information about these work events before she contacted the therapist.

Bruce expressed his frustration to Ann.  He felt that Ann was procrastinating and putting her work life ahead of their marriage.  He was also concerned because the man that Ann had an affair with still worked with Ann.

After they argued, Ann contacted the therapist the next day with a sense of resentment, and she made their next appointment.

During their next appointment, Ann was surprised that their therapist asked her what she got out of having the affair--what made her happy about it?  Ann hesitated to answer, and Bruce squirmed in his seat.

Seeing they were uncomfortable, the therapist explained that even though she understood that Ann felt remorseful for the affair and made a commitment that she would never cheat again, it was still important to understand what Ann felt she gained from the affair in order to discover why it happened and what changes could be made so it wouldn't happen again.

After the therapist explained the importance of understanding this issue, Bruce said he understood and, although he was uncomfortable, he realized that he had the same questions, but he didn't know how to ask Ann.

Ann hesitated a few seconds before she answered and then, looking down at the floor, she said she wasn't proud of her behavior.  In fact, she said, she felt very ashamed, which is what was making it difficult to talk about it.

She explained that her coworker, Jim, had been flirting with her for a while before they got involved. At first, she made light of Jim's comments or she laughed it off.  But then they were thrown together on a project, so they had to work closely together.

Over time, she explained, she felt flattered by Jim's attention and she began to feel attracted to him.  After a while, she began flirting back with him and she liked how their flirting made her feel.  She hadn't flirted with anyone in several years, and it made her feel sexy and attractive (see my article: The Connection Between Infidelity and the Need to Feel Desirable).

Then, in the middle of Ann telling her story, she stopped and said to the therapist, "I want you to know what I told Bruce after he found out about the affair.  He's been a wonderful husband and father.  He's been very good to me.  I love him and I know he loves me.  The affair isn't his fault."

Taking a deep breath, Ann continued:  After a few weeks of spending time with Jim and flirting, she realized that she missed him when she wasn't around him, so she would find reasons to text or email when they weren't at work.

After a while, Jim was texting her on a regular basis when they weren't together and she would respond to his flirty texts.  Soon after that, they went on a business trip together.  After a few drinks, "one thing lead to another and we slept together."

She expressed feeling very guilty and ashamed, but she also wasn't ready to stop having sex with Jim.  When she was with him, she felt attractive, free and sexy--something she had not felt in her marriage for many years.  At the time, she liked the way she felt with Jim, and she didn't want to give it up.  She never intended to hurt Bruce.

She thought she had hidden the pictures they took of themselves having sex.  In hindsight, she realized that this was a reckless thing to do but, at the time, it felt like fun.  Had she known that Bruce would find these pictures, she never would have agreed to taking them.

As Bruce listened, he began to cry, "You and I haven't had sex in more than a year.  With all the stress that you've been under with your job, taking care of our kids, and all other responsibilities, I thought I was being considerate of you by not pressuring you for sex.  It's not that I didn't want it--it was just that I thought you weren't interested in sex anymore.  You can't even imagine how hurt I feel knowing that you were having sex with another man and feeling sexy and attractive with him when I was getting your tired, irritable self" (see my article: Have You and Your Spouse Stopped Having Sex?).

At that point, Ann got up to leave, but the therapist urged her to stay and talk about what was going on for her at that moment.

Ann sat back down and looked at the floor, "This is torture for me and for Bruce.  I know you said it's important to understand the underlying reasons that contributed to the infidelity, but I'm having a very hard time with this."

In their next session, Bruce talked about how he wanted to have back the sexual wife that Ann had been when they first got married.  He talked about how they used to have sex almost every day when they first got married and then, gradually, the sex diminished until they got to a point when they weren't having sex anymore.

Ann explained that she felt like a different person when she was with Jim.  She didn't have to think about the kids or her responsibilities at home.  She felt free for the first time in a long time.  She also felt like "a new woman."

They talked about what changes they could make as individuals and as a couple so that they could improve their sex life.  Bruce had a few suggestions about allowing his parents to take the children more often so they would have time to themselves to rekindle their sexual relationship.

But Ann wasn't open to this.  She said she didn't like the idea of sending the children to their paternal grandparents, even though they liked to visit their grandparents and their grandparents would love to have them over more often.  So, they were at an impasse.

After a few more sessions where Bruce came up with more ideas for them to rekindle their relationship, including going away together without the children, and Ann coming up with reasons why Bruce's suggestions wouldn't work, Ann refused to continue in couples therapy (see my article: When Clients Leave Therapy Prematurely).

So, Bruce came on his own.  When Bruce returned to therapy on his own, he was still hopeful that he and Ann could rekindle the passion between them.  But, as time went on, he told the therapist that Ann went back to being "shut down."  Now, she refused to talk about their problems and she didn't even want to have the occasional sex that they once had.

As time went by, Bruce felt increasingly disheartened.  Ann refused to come back to therapy and she also refused to discuss things between them.  She went back to saying that she thought they should "move on" with their lives and she promised she would never cheat on him again.

Several months later, Bruce discovered texts between Ann and Jim that began a month before.  It was also clear that they had resumed their affair.  When he confronted Ann about it, she tried to deny it at first.  But when Bruce showed her the texts that he found, she admitted that she resumed the affair with Jim, and she apologized again.

But Bruce was too hurt and angry to remain in the household, so he moved out.  He needed time to think on his own.  He also asked Ann not to contact him while he was deciding what he wanted to do.

When Bruce spoke to the therapist about it, he realized that he no longer wanted to be with Ann.  He knew he couldn't trust her anymore, and he wanted a divorce.  They talked about how he would tell Ann and how they could both approach their children.

A few weeks later, Bruce told Ann that he wanted a divorce.  She begged him not to leave her, but he told her that it was too late.  He still loved her, but without trust, he couldn't stay with her.  Soon after that, he hired a divorce attorney and recommended to Ann that she do the same.

Bruce continued in therapy to work through his feelings of betrayal, anger, sadness and loss.  Even though he would have preferred to have nothing to do with Ann ever again, he knew they would need to have at least a civil relationship because of the children, so he also worked on this in his therapy.

Conclusion
There are some problems that require delving below the surface to understand the unconscious reasons that contributed to the problem.  Infidelity is one of those problems.

All too often either one or both people in the relationship want to sweep the problems under the rug.  Shame often is a big contributing factor.

Making a decision to "move on" or "start over" doesn't change the underlying reasons for the problem.  That decision only pushes down those underlying factors.  It doesn't get rid of them.

With infidelity, in particular, men and women often cheat on their partners because they get to experience themselves in a different way when they are in an affair--attractive, sexy, carefree, unencumbered by the day-to-day issues involved in maintaining a relationship and a family.

Although this might sound superficial, for the person who has the affair, it represents a renewed sense of self, a sense of self that all too often has disappeared.

Even when you make a commitment to yourself and to your partner that you won't engage in infidelity again, these underlying reasons become compelling factors in continuing or resuming an affair--unless you work in therapy to understand them and find ways to try to create an atmosphere in your relationship where you can experience that sense of yourself--even though it can be challenging.

This doesn't mean that every person who has an affair will cheat again.  But when you don't address the underlying issues on both sides that contributed to the affair, chances are that these underlying reasons will get activated again and result in a continuation or resumption of infidelity.

Getting Help in Therapy
Shame keeps many people out of therapy (see my article: Overcoming Shame: Is Shame Keeping You From Starting Therapy?).

It takes courage to ask for help (see my article: Developing the Courage to Change and Overcoming Your Fear of Asking For Help).

If you've tried unsuccessfully to work out your problems on your own, you owe it to yourself to get help from a licensed mental health professional (see my articles:  The Benefits of Psychotherapy and How to Choose a Psychotherapist)..

Getting help sooner rather than later is often the key to resolving 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.

Movies: "A Fantastic Woman:" Maintaining Dignity and Self Respect in a Hostile World

Sebastian Lelio's film, "A Fantastic Woman," which has been nominated for the Academy Awards Best Foreign Film category, is about a transwoman, Marina (wonderfully portrayed by Daniela Vega) and her perseverance in maintaining her dignity and demanding respect as a human being, despite the grief of losing her romantic partner and dealing with prejudice and harassment.

Movies: "A Fantastic Woman:" Maintaining Dignity and Self Respect Despite a Hostile World 

Marina and her boyfriend, Orlando (portrayed by Fernando Reyes) live together in Orlando's apartment in Santiago, Chile.  They are a happy, loving couple who are kind and generous to each other.  But one night Orlando gets sick suddenly and Marina takes him to the hospital.

Within a couple of hours, Orlando dies from a brain aneurysm.  Alone with no one to console her at that point, Marina deals with the shock and grief on her own.

Since she fears losing her job as a waitress if she does not show up, she goes to work that day and acts as if nothing happened while her heart is breaking.

She also has to deal with close-minded hospital staff, abusive police officers and Orlando's emotionally and physically aggressive relatives who don't understand why Orlando, who was married before and has a young child, was with a transwoman.

We don't learn a lot about Marina's personal history or much about her family background, except that she has a sister and brother in law who take her in after Orlando's family kicks her out of Orlando's apartment after his death.

We do learn that she has not received her identification card yet indicating that she is a woman so, as far as the outside world is concerned, she is a man.

She is also subject to humiliating and degrading acts by the police who, ostensibly, want to "help" her in case she was abused in her relationship with Orlando (despite the fact that she tells them that she was not abused).

The one bright spot in her life is her love of music and singing.  And, despite all the obstacles that are thrown in her way, Marina perseveres.

Marina grieves for Orlando, but she also knows that life goes on, and she is committed to persevering with her singing career as well as do what she can to make ends meet financially.  She will survive and thrive on her own terms.

Ultimately, A Fantastic Woman is an inspiring movie due to Marina's resilience and uncompromising demand for respect as a human being--even if people don't understand her.

It's wonderful, for a change, to see a movie about a transwoman triumphs.

If you haven't seen this movie, it's well worth seeing for the acting, wonderful plot, and inspiration.

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 work with individual adults and couples.

One of my specialties is working with LGBTQ clients.

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.

Resources:
The LGBT Center in New York City
National Center For Transgender Equality
Transgender Law Center
Gender Proud

Relationships: Gaslighting and Infidelity

In previous articles, I've discussed various aspects of infidelity.

See my articles: 

Infidelity: Married, Bored and Cheating Online

Infidelity on Social Media Sites

Infidelity - Your Spouse Cheated on You: Should You Stay or Should You Go?

Getting Involved in a Love Triangle to Avoid Dealing With Problems in Your Relationship 

Broken Promises: Surviving Infidelity

I'm focusing on a particular aspect that often occurs when there is infidelity, which is gaslighting, in this article.

Relationships: Gaslighting and Infidelity

In her book, The State of Affairs: Rethinking Infidelity, Esther Perel, discusses, among other things, the psychological concept of gaslighting and how people who are cheating on their partners use this form of psychological abuse to hide affairs (see my article: Are You Being Gaslighted in Your Relationship?).

What Is Gaslighting?
Before going any further, let's start with a definition of gaslighting.

As I mentioned in my prior article, the term stems from a 1944 film called Gaslight with Charles Boyer and Ingrid Bergman.  In the movie, Boyer's character tries to manipulate his wife (Bergman) into thinking that she is losing her mind by secretly making the gaslights in their home flicker on and off. Since the wife trusts him and she doesn't know that her husband is manipulating her, she begins to doubt her perception of things, which is what he wants.

A contemporary situation involving gaslighting and infidelity involves a partner manipulating the other partner by lying about an affair.  The partner, who is having the affair, might be so convincing that the partner being cheated on doubts his or her own perception--even when there's clear evidence of the infidelity.

It might seem incredible that someone would doubt his or her own perception, especially when there's evidence of cheating.  But it's important to understand that the person cheating is often very convincing and the person being cheated on is often in denial about what's going on.

Being in denial is understandable when you consider that to acknowledge an affair could not only ruin the relationship and life as the two people in it have known it.  It also raises many questions:  Who is this person you're in a relationship with that you thought you knew?  What's real?  Is the whole relationship false?  Can the relationship survive?  Do you want to try to salvage the relationship? (see my article: Betrayal: Coping With the Sudden Realization That You Don't Know Your Spouse).

A Fictional Clinical Vignette:  Gaslighting and Infidelity:
Ann
Ann began therapy shortly after she found out that her romantic partner of 10 years, Rob, had been cheating on her for their entire relationship.

Relationships: Gaslighting and Infidelity

She had her suspicions during the last year, especially after she received a call from Rob's former secretary, Jane, who told Ann that Rob and she had been having an affair for a year and he broke it off because Jane was demanding that he leave Ann to be with her.  Jane told Ann that, when she was his secretary, Jane was aware that Rob had many affairs, and she thought Ann should know.

Ann could hear that Jane was angry and hurt.   Ann realized that, even if there was any truth to Jane's story, Jane was getting back at Rob by calling Ann.

When Ann confronted Rob about the call from Jane, he got angry and indignant with Ann.  He told her that he just couldn't believe that Ann would even think that he would do such a thing.  He said Jane was making up this story because he rejected her when she came on to him.  Then, he told Ann he thought she was incredibly gullible for even entertaining such an idea.

Ann felt terrible and apologized to Rob.  She told him that she was sorry that she ever doubted him.  But after he left her apartment, he ignored her calls and texts for a few days until he was ready to accept her apology.

A few weeks later, Ann received an email from Jane.  At first, Ann was going to delete the email without even opening it.  But she was curious, so she opened it.

Ann was shocked that Jane's email contained pictures of her and Rob together having sex.  Jane gave dates, times and names of hotels when she was with Rob.  Ann realized that Rob told her he was away on business trips on those dates.  But according to the information that Jane sent, Rob was in town with Jane.

When Rob came over that night, Ann showed him the email from Jane and Rob blew up.  He told her that Jane was obviously a very disturbed woman, he wasn't the man in the picture, and Jane obviously Photoshopped the pictures to make it seem like it was him, but it wasn't him.

Before he stormed out of Ann's apartment, Rob told her that he needed time to think.  He said he was very hurt and he wasn't sure if he wanted to remain in a relationship with a woman who insinuated that he was a cheater and a liar.

Afterwards, Ann was confused.  Even though she loved Rob and she wanted to be with him, she wanted to know the truth, so she contacted Jane and met her for lunch the next day.

After their lunch together, Ann's head was reeling.  Jane showed Ann more texts with sexual messages from Rob.  She also told Ann that she heard from other women, who were also having affairs with Rob, and she showed Ann those emails as well.

Ann felt so betrayed.  She wondered if Rob ever loved her and if anything about their relationship was real.  She also felt like a fool for ignoring the obvious signs that he was cheating.

Feeling lonely and confused, Ann called her best friend, Liz and told her what happened.  Liz came over and comforted Ann as best as she could.  When Liz asked Ann what she was going to do, Ann said she wasn't sure.  She didn't know if she wanted to break up with Rob or tell him that she wanted to go to couples counseling to try to salvage their relationship.

Ann could tell that Liz thought she should break up with Rob, but Liz was hesitant about giving advice.  At that point, Ann was so shocked, she couldn't think straight.

When Rob called Ann a few days later, she asked him to come over so they could talk.  Before Rob arrived, Ann hoped that when she confronted him with what she knew from Jane that Rob would admit that he cheated with Jane and other women and they could agree to go to couples counseling.

But when she confronted him with the new information that she now had, Rob blew up again and went into a rant--calling her names and berating her for believing "such nonsense."

At that point, since Rob couldn't acknowledge the affair--much less express his remorse--Ann was devastated.  She knew that their relationship was over.  When she told Rob that she couldn't trust him, so their relationship was over, he continued to act angry and indignant.  Ann was amazed at how he was still trying to manipulate her and how he had manipulated her all along.

Now, sitting in front of her new psychotherapist, aside from feeling angry, Ann felt ashamed that she allowed Rob to fool her.  Her psychotherapist explained gaslighting to Ann and told her that she was having a common response.

Over time, Ann worked in therapy to overcome the traumatic experience of feeling betrayed by Rob.  Her current trauma was exacerbated by her family history, which included her father cheating on her mother.

Aside from working on the current trauma and the history of family trauma, Ann and her psychotherapist also worked on Ann overcoming her shame and building back her self esteem.

Conclusion
Gaslighting is often part of infidelity.  The person who is cheating manipulates in order to keep the affair a secret.

Many relationships cannot withstand the combination of infidelity and gaslighting, especially if the person who is cheating doesn't ultimately admit cheating and doesn't feel genuine remorse for the pain that s/he caused the other partner.

However, many relationships survive infidelity and gaslighting when the person who was cheating stops having the affair(s) and the couple work towards strengthening their relationship and rebuilding trust, if possible, in couples counseling.

One of the common misconceptions about infidelity is that it only occurs in relationships where the person who is cheating is unhappy.  Contrary to this common misconception, many people go outside their relationship even when they still love their partner and are basically happy in the relationship.

The reasons for the infidelity are numerous and vary with each relationship.  While no reason can justify infidelity, an understanding of why it occurred can be helpful to each person whether they decide to stay together or not.

Often, it has more to do with how the person who is cheating feels about him or herself or how s/he wants to feel (see my article: The Connection Between Infidelity and the Need to Feel Desirable).

Getting Help in Therapy
If you are struggling in your relationship, you owe it to yourself to get help (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to work through the complicated emotions that are usually experienced after infidelity and gaslighting have been discovered (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.

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

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

How Far Do You Want to Go in Your Psychotherapy?

In a prior article, Psychotherapy is an Active Process: The More Engaged You Are In It, the More You Get Out of It, one of the issues that I discussed briefly was the decision as to how far you want to go in psychotherapy--everything from symptom relief to delving deeper into your unconscious process to get to the root of your problem.

How Far Do You Want to Go in Psychotherapy?

As I mentioned in that article, each client makes this decision in consultation with the psychotherapist.  But, ultimately, the decision is up to the client.

If you're new to psychotherapy, you might not understand what your choices are and the implications of these choices.  So, I will provide describe different types of therapy.

Choices in Psychotherapy
The following scenarios describe various choices in psychotherapy for the same client, Ted, at various points in his life:

Short Term Symptom Relief Therapy:  When you choose short term symptom relief, you're usually choosing brief therapy to get rid of a symptom and you're not delving deeper into the problem once you start to feel better.  Ted had his first experience of attending psychotherapy when he saw a psychotherapist to deal with his panic attacks.  Since Ted wasn't interested at that point in more than symptom relief, his psychotherapist taught him how to do breathing exercises and to meditate.  Within a few weeks, Ted was feeling better and he decided to end therapy (see my articles: Tips For Overcoming Panic Attacks, What is the Difference Between Fear and Anxiety? and Getting Help in Therapy For Anxiety Disorders).

Longer Term Symptom Relief Therapy: Longer term symptom relief is therapy that is longer than short term therapy but shorter than more intensive therapy.  Ted managed well with what he learned in his short term therapy for a few months.  Then, he began a stressful new job and became symptomatic again.  He returned to therapy with the same psychotherapist, and he told her that he still wanted only symptom relief, but he was willing to stay in therapy for a longer period of time to deal with his panic attacks.  Since he stopped doing the breathing exercises and the meditation, his psychotherapist reinforced the stress management techniques she taught him when he first came to her.  She also added more coping techniques so he could deal with the current stressors on his job.  When he felt better and he was no longer experiencing panic attacks, he told his therapist that he wanted to leave therapy.  He understood that he could return in the future.

EMDR Trauma Therapy: Ted returned to his psychotherapist a year later.  He rarely had panic attacks anymore and when he had them, he knew how to calm himself.  However, he was now experiencing persistent anxiety after he met his father again for the first time since he was a young child.  Their meeting was fraught with tension on both sides.  Ted's father wanted to reconcile their relationship, but Ted was leery because he had a lot of resentment towards his father for abandoning the family.  In addition, Ted realized that his boss had similar characteristics to his father, and Ted was getting emotionally triggered whenever he had to work closely with his boss.  His psychotherapist recommended that they do EMDR therapy to work on the unresolved trauma as well as the current situation with his boss.  She explained to Ted that EMDR therapy tends to be faster and more effective than regularly talk therapy.  Gradually, Ted was able to work through his traumatic reactions within a year of beginning EMDR therapy.  He realized that he could have stayed in therapy to develop deeper insights into himself, but he told his therapist that he would return if he felt the need for delving deeper (see my articles: What is EMDR Therapy?, How EMDR Works - Part 1: EMDR and the Brain, How EMDR Works - Part 2: Overcoming Trauma, and What is Adjunctive EMDR Therapy?).

Grief Work in Therapy:  Grief work is focused specifically on helping a client to grieve and mourn a loss.  It can be short term or long term.  With regard to Ted, a couple of years later, Ted found out that his father died.  At the time, they were not speaking because they were not able to reconcile their relationship.  When he received the call that his father died, Ted felt profoundly sad for the loss of his father as well as the loss of not ever having a father that met his emotional needs.  He also felt sad because any chance of reconciling their relationship was gone, and he felt very guilty about this as well.  He returned to his psychotherapist and they did grief work to help Ted get through this difficult time.  Between sessions, Ted kept a journal and wrote about his feelings about his father.  He also organized a photo album with pictures of his father and himself from when Ted was younger.  He was able to work through his grief, and he let his therapist know that he was feeling better and he wanted to discontinue therapy (see my articles: Grief: Coping With the Loss of a Loved One: Common Reactions, Complicated Grief, The Theme of Complicated Grief For a Mother in the Movie, Phantom Thread, Holding Onto Grief as a Way to Stay Connected to a Deceased Love One and Trying to Understand Your Father).

Contemporary Psychodynamic Psychotherapy: Psychodynamic psychotherapy is a form of psychoanalysis.  Generally, it focuses on the unconscious mind and might include dreams and daydreams.  It usually also includes exploring transference issues.  When Ted returned to therapy, he felt lost.  He had just ended an enmeshed two year relationship with a woman that he loved very much when they first started seeing each other.  Gradually, they grew apart, and Ted sensed that he contributed significantly to the demise of the relationship because he had problems committing to his then-girlfriend.  He believed that he had issues with trust and this is what made it difficult for him to make a long term commitment.  He felt he was now ready to delve deeper into his unconscious mind to get to know himself better.  He agreed to attend open ended contemporary psychodynamic psychotherapy with the understanding that he could leave therapy whenever he wished; however, his therapist recommended that it would be better to work together towards termination in therapy when the time came.  Sometimes, Ted brought in dreams to discuss with his therapist.  He was also interested in exploring the unconscious underpinnings of his problems.  Gradually, his therapist helped Ted to make connections between his original panic attacks, his history of childhood emotional neglect, the loss of his father, and his problems with making a commitment in a relationship.  Ted also felt more emotionally integrated in contemporary psychodynamic psychotherapy (see my article: Discovering the Unconscious Emotions at the Root of Your Problems and What Unconscious Decisions Have You Made That Are Impacting Your Life?).

Conclusion:
The scenarios above show how one person can choose various forms of psychotherapy over a period of time depending upon the problem and what the client is ready to deal with at the time.

Each form of therapy mentioned above serves a particular purpose and could be appropriate at various times in a client's life.

Getting Help in Psychotherapy
When you decide that you would like to attend psychotherapy, the first step is to contact a psychotherapist for a consultation (see my article: The Benefits of Psychotherapy).

During the consultation, you give an overview of your problem and asks the psychotherapist questions about how she works, what type of therapy she does, her expertise and so on.

The psychotherapist will usually make a recommendation within a few sessions as to what form of therapy she thinks would be best for the client given his or her particular problems.  There are usually a few different ways to work, as outlined above, and depending upon the therapist's expertise.

The choice as to which type of psychotherapy is generally up to the client, unless the therapist thinks that the client needs a higher level of care or a different type of therapy.

Over time, as shown in the examples above, a client can return for different types of therapy (assuming that the therapist does these different forms of therapy) or the client can go to a different therapist (see my article: Returning to Therapy).

If you have been unable to resolve problems on your own, you could benefit from seeing a licensed mental health professional to help you to resolve your problems (see my article:  How to Choose a Psychotherapist).

Freeing yourself from problems that are hindering you from maximizing your potential can lead to living a more fulfilling and meaningful 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.

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.

Psychotherapy is an Active Process: The More You're Engaged in Your Therapy, the More You'll Get Out of It

As I tell clients who come to see me in my psychotherapy private practice in New York City, psychotherapy is an active process.  The more you're engaged in your therapy, the more you'll get out of it (see my article: Getting the Most Out of Your Psychotherapy Sessions).

Psychotherapy is an Active Process: The More You're Engaged in Your Therapy, the More You'll Get Out of It 

What Does It Mean to Be "Actively Engaged" in Your Therapy?
Many clients who are in psychotherapy for the first time think that psychotherapy is a passive process, but this isn't the case for contemporary psychotherapy.

New clients, who have never been in psychotherapy before, need psychoeducation from their psychotherapists in order to understand how to be actively engaged in psychotherapy (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

Being actively engaged in your psychotherapy sessions means more than just showing up, although, of course, on the most basic level, that's important.  But beyond showing up, you will get much more out of your psychotherapy sessions by:

• Being Open-minded and Curious About Your Therapy:  Psychotherapy isn't something that is "done" to you.  Your psychotherapist has certain skills and experience to help you overcome your problems but, as you know, your therapist doesn't have a magic wand to make your problems disappear, so you will get much more out of your therapy sessions if you begin therapy by being open-minded and curious about the psychotherapy process (see my article: Starting Psychotherapy With a Sense of Curiosity and Openness).

• Asking Your Psychotherapist Questions: Whether you're new to psychotherapy or you've attended therapy in the past, if there's anything that you don't understand or you have questions about, ask your therapist.  It's your therapy.  You're spending your hard earned money and time to be in therapy.  It's important that you understand what's going on and what you might expect.

• Understanding That Psychotherapy is a Process: Psychotherapy is different from going to see your medical doctor who might give you a shot or a prescription so you can overcome your problem.  Psychotherapy is an individualized process that unfolds over time.  Each psychotherapy client's process will be unique.  When psychotherapy is going well, the work in therapy usually builds on itself over time.

• Considering How Far You Want to Go in Psychotherapy: Sometimes, I compare psychotherapy to home repair as a metaphor.  When you make home repairs, you decide if you want to do a little painting and spruce up the place or if you want to do major repairs.  It's the same with psychotherapy.  Your psychotherapist can make recommendations and you would do well to consider them.  But, ultimately, it's up to you whether you want symptom relief or you want to get to the root of your problems.  You might be alright with symptom relief now and maybe you'll consider delving deeper your next time in therapy.  Or, you might want to delve deeper now so that you overcome your problems beyond symptom relief.  Similarly, you can make choices as to whether you want to focus on short term or long term goals.  Once again, it's up to you--not your therapist.

• Spending Time Reflecting on Your Psychotherapy Sessions: If you want to get more out of your psychotherapy sessions, rather than forgetting what came up in your session once you leave therapy, spend time reflecting on your thoughts and feelings soon after the therapy session.  Even though you've left the session, the process continues to go on for you in your mind unconsciously.  That means, whether you realize it or not, you're never in the same place when you return for your next session.  Why not try to reflect on what's changing for you by thinking about it between sessions?

• Spending Time Writing Between Psychotherapy Sessions: Writing between sessions is something I recommend to my clients because it helps you to reflect on what's happening for you and how you're changing as a result of your therapy.  Many clients ask, "How will I know if psychotherapy is helping me to change?"  One way is to reflect and write about what comes up for you between sessions and the changes that you notice.  You can choose whether or not you share your writing with your psychotherapist or not.  Aside from writing, some people draw pictures or write stories--whatever works for you to help you to be actively engaged in the process between sessions (see my article: The Benefit of Journal Writing Between Psychotherapy Sessions).

Psychotherapy is an Active Process: Journal Writing Between Therapy Sessions

• Talking to Your Psychotherapist About Something That's Bothering You About the Therapy: Maybe you're changing in ways that you don't understand.  Maybe something got triggered in your last session. Maybe your therapist said something that you didn't like or you misunderstood.  Maybe your therapist misunderstood you.  A lot can happen in a therapy session.  Your therapist might sense that you're having a problem, but maybe she won't, especially if you're good at hiding when things bother you.  In that case, how will your therapist know unless you tell her?  You need to provide feedback to your therapist whether she elicits it from you or not (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Therapy).

• Understanding That "Feeling Better" Might Not Necessarily Mean Your Problems Are Resolved:  As I stated above, it's up to you to decide if you want symptom relief or you want to work deeper on your problems.  If you decide that you want symptom relief, you need to understand that this might mean, even though you're "feeling better," your problems might not necessarily be resolved--depending upon what you want to get out of therapy.  If you know this and you're okay with it, the choice is yours.  However, as an informed consumer, it's important to know what you have opted to do once you've decided that you want to end therapy (see my article: Starting to Feel Better in Therapy).

Conclusion
Psychotherapy is an active process for the client and the psychotherapist.

The more you're actively engaged in your psychotherapy sessions during and in between sessions, the more you'll get out of your therapy.

Getting Help in Therapy
The decision to start psychotherapy, especially if you've never been in therapy before, can be a difficult one.

It takes courage to take steps to change (see my article: Developing the Courage to Change).

If you've been unsuccessful in overcoming your problems on your own, you could benefit from seeing a licensed mental health professional (see my article: The Courage to Change).

A skilled psychotherapist can help you to identify and work through your problems so that you can live a more meaningful life (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 in a dynamic, interactive and collaborative way 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.

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.