Progress in Psychotherapy Isn't Linear

Clients who are new to psychotherapy often don't know what to expect, which is why it's important for psychotherapists to provide psychoeducation about how psychotherapy works (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).  One important aspect of psychotherapy to understand is that progress in therapy usually isn't linear, which is the topic of this article.

Progress in Psychotherapy Isn't Linear

Defining the Presenting Problem: Understanding Big T and Small T Trauma
It's understandable that clients want to see that they're making progress in therapy, especially if they've been suffering with longstanding problems.

When a client is in therapy, it's important for the client and the psychotherapist to understand the nature of the presenting problem.  That makes it easier to set therapy goals and to measure progress in treatment.  This might take a while to reveal itself as the client comes to therapy and gives the therapist information about the history of the problem and how it's affecting her now.

Usually, the narrower the problem, the easier it is to make progress and resolve the problem in therapy.  For instance, if a client comes to therapy after she has been robbed and, prior to the robbery everything was basically going well with no history of prior trauma, this is a simpler case than someone who comes to therapy with longstanding unresolved trauma from childhood (also known as developmental trauma).

Saying that it's a simpler case is in no way meant to minimize the traumatic experience of being robbed.  But compared to an adult client with a long history of being abused and neglected as a child, it's a less complex case.

With regard to definitions of trauma, the unresolved developmental trauma would be considered a "Big T trauma" and the one-time traumatic event, like getting robbed, where there was no prior trauma, is considered a "Small T trauma" (see my article: Big T and Small T Trauma).

For Small T trauma, the goals are usually more narrowly defined. These might include: The client being able to walk down the same street where she was robbed without fear or being able to leave the house without fear.  If someone who was robbed is very frightened, this is important and it might seem daunting.  But relative to Big T trauma, the scope is narrower.

For Big T trauma, the goals are more complex and might be multi-layered.  For instance, a client who was abused and neglected as a child might be fearful of experiencing his feelings.  He might have constricted affect and not even understand his feelings because he had to protect himself as a child so he wouldn't feel so vulnerable.  This, in turn, usually leads to problems in adult relationships.  So, you can see that Big T trauma is more complex, and there will be layers of trauma to work on.

Understanding the scope of the problem involves exploration.  For instance, a client might begin therapy by saying that she has a problem communicating with others.  This is, of course, a very general definition of a problem, and the psychotherapist would need to ask questions to make it more specific:  Does she have problems talking to everyone or only people at work?  Is the problem related to a medical issue or is it a psychological issue or both?  When did the problem start?  How does the client experience this problem?  How is this problem affecting the client internally and interpersonally?  And so on.

As the client and psychotherapist explore these questions and the history of the problem, they might discover that the problem is longstanding and the client cannot remember a time when she didn't have this problem, even as a child.

As they continue to explore this issue, they might discover that the problem is pervasive in all areas of the client's life.  The client reveals that all possible medical issues have been ruled out and the client's doctor recommended that the client seek psychological help.  Furthermore, the client reveals that whenever she has to speak, whether it's one-on-one or in a group, she becomes panicky and she has had a few panic attacks recently.

It soon becomes clear that the client's problem talking to others is a symptom of a much larger problem, and her anxiety is related to longstanding unresolved trauma.  As a result, the problem is much more complex than the client originally thought.  This sounds like Big T trauma, and it will require further exploration to discover the root of the problem.

In contrast to Big T trauma, if a client came to therapy and says she has problems speaking up at staff meetings ever since her boss humiliated her in a prior staff meeting, but she never had this problem before, she never has this problem in any other situation, and there is no developmental trauma, this is probably a Small T trauma.  It's not multi-layered like Big T trauma, and the goals in therapy would probably be narrower and more easily achieved.

The Circular Nature of Progress in Therapy
Even when a client has had a significant breakthrough in therapy in a prior therapy session, he might come in the next week experiencing many of the same problem that he did before the breakthrough.

You might ask:  "Why is this?"

Well, there are many reasons.  One reason is that many clients need at least a few "Aha!" moments in therapy in order for breakthroughs to stick.

Another reason is that, even when a client really wants to make progress in therapy and resolve his problems, there is almost always ambivalence and some anxiety about changing.  For many clients, the "devil" (or problem) they know is easier to deal with than the "devil" they don't know (change) (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Many clients will tell their therapists that they are fearful of who they would be if they didn't have a longstanding problem because they've had the problem for so long, and they've learned to identify with their problem as if it's a part of themselves.

As a result, a client might have to go over the same material several times or more before the change "holds" and remains.  They might have to circle back many times to rework the same or various aspects of the same problem.  Along the way, other aspects of the issues they're struggling with might come to the surface in order to get worked through.

This is one of the main reasons why progress isn't usually linear.  Most of the time it's circular:  Two steps forward and one step back.

For people who are in recovery for addiction, one of the first things that they learn in recovery is that relapse is part of the process.  Many clients new to recovery will hear this and say that they have made a firm commitment to their recovery and they will never relapse.  But being human means that clients often do go back a step or two before they can go forward.

It's no different for most other problems that people come to therapy to resolve.  And the more complex the problem, the more likely that progress will be circular and not linear.

Conclusion
Most clients who are new to psychotherapy expect that their progress will be a linear progression, like a straight arrow, where they keep making progress and never backslide.  But this is rarely the case, especially if their problems are longstanding and complex.

Understanding the problem, the problem's history, how it affects the client now, and so on, is important to setting therapy goals.  The simpler the problem, the easier it will be to resolve, so Small T trauma is less complex than Big T trauma and will be more readily resolved, all other things being equal.

Sometimes, the client either doesn't know what the problem is or thinks the problem is narrower than it is.  As the client and psychotherapist explore the problem, they can define the problem better to understand if it is a new problem which is narrow in scope or if it is a multi-layered problem with a long history, which makes it much more complex.

Assuming that clients come to therapy on a regular basis and they are working with a skilled psychotherapist, most clients' progress is circular rather than linear--two steps forward and one step back.  The more complex the problem, the more likely that clients will occasionally have setbacks (see my article:  Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).  This is human nature.

For more complex problems, if there is progress, it can usually be seen over time by comparing how clients were when they first started therapy to how they are feeling, thinking and behaving now.

With regard to making progress in therapy, knowing what to expect in terms of this going forward/occasionally going backward dynamic helps clients to have reasonable expectations of themselves and their therapy.

Getting Help in Therapy
Making a decision to change and asking for help in therapy are courageous initial step (see my article: Developing the Courage to Change).

If you have been struggling with unresolved problems, you owe it to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to overcome your problems so that you can live a more fulfilling life, free from the history of your problems (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.

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

The two most prevalent forms of psychotherapy for trauma are "top down" and "bottom up" psychotherapy.  The focus of this article will be to distinguish between these two types of psychotherapy and how each approach works with trauma therapy.

What the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

The Top-Down Psychotherapy Approach in Trauma Therapy

Top down psychotherapy is a form of psychotherapy that is most used in the US.  With top down therapy, the basic premise is that if you change how you think, you will change how you feel. 

In top down psychotherapy, like cognitive behavioral therapy (CBT), the psychotherapist helps you to see the distortions in your thinking and change your behavior.

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

Top down psychotherapy focuses on the neocortex part of the brain, which is the part of the brain in charge of executive functioning.

One of the advantages of CBT is that it is easy to teach new psychotherapists.  It's not as complex as many of the experiential bottom-up approaches to therapy.

In my professional experience as a trauma therapist for more than 20 years, top down psychotherapy can work well for people under certain circumstances.  For instance, people who have phobias and who go for CBT often have good overcomes.

However, with regard to trauma therapy, I have found that many people don't overcome their traumatic experiences with CBT.  One important reason for this is that trauma therapy needs to focus on the limbic system in the brain where the trauma is stored--not on the neocortex, which is the focus of CBT.

I have found that when you focus on the neocortex in trauma therapy, the therapist can help the client to develop insight into their problems, but the trauma, which resides in the limbic system remains unresolved.

So, with CBT, the client has insight into the trauma, but nothing changes on an emotional level.  The client continues to be symptomatic for trauma.  In addition, the client is often confused as to why he isn't feeling better if he now has insight into his problem because he doesn't understand that insight isn't enough.

The Bottom-Up Psychotherapy Approach in Trauma Therapy

In the bottom-up psychotherapy approach in trauma therapy, there is more of a recognition of the importance of mind-body connection in resolving traumatic experiences (see my article: Mind-Body Oriented Psychotherapy).

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

Bottom-up psychotherapy is also known as experiential psychotherapy (see my article: Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone).

The bottom-up psychotherapy approach focuses on the limbic system of the brain where traumatic experiences are stored and where symptoms get triggered (see my articles: Coping With Emotional Trauma: Becoming Aware of Your Triggers).

Various forms of bottom-up psychotherapy approaches, which are experiential forms of therapy, deal with psychological trauma in different ways, and these include:

Somatic Experiencing focuses on the body discharging trauma-related energy through the body.  So, for instance, if someone is holding onto the trauma in the form of tension in her shoulders, the therapist might help the client to discharge this energy from the shoulders.  This usually happens in subtle ways (see my article: The Body Offers a Window Into the Unconscious Mind).

In EMDR Therapy (Eye Movement Desensitization and Reprocessing), there is a desensitization to the traumatic experience and a reconsolidation of the traumatic memories.  EMDR therapy posits that everyone is capable of adaptively processing information, including traumatic memories.   EMDR facilitates this processing (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Clinical Hypnosis, also known as hypnotherapy, posits that all hypnosis is self hypnosis (see my article: All Hypnosis is Self Hypnosis).  The psychotherapist who is a hypnotherapist facilitates the process of helping the client to achieve a relaxing state in order to make the connection between the mind and the body to change traumatic experiences.  This always the client's unconscious experiences to become conscious (see my article: Clinical Hypnosis: Bridge Back to Heal Emotional Wounds).

Conclusion

Over the years, I have used both top-down and bottom-up psychotherapy approaches to help clients to overcome traumatic experiences.

My experience has been that bottom-up psychotherapy approaches are more effective in helping client to overcome trauma than top-down approaches.

 I also want to emphasize that even when I use a bottom up approach to therapy, depending upon the needs of the client, I usually at least some top down form of therapy.

Getting Help in Therapy

The effect of traumatic memories often gets worse over time without psychological help (see my article: The Benefits of Psychotherapy).

If you have been struggling with unresolved trauma, you could benefit from working with a psychotherapist who uses a bottom-up approach to trauma therapy (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, and I have helped many clients to overcome their traumatic experiences.

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.

Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

In prior articles, Anger as a Secondary Emotion and Boredom as a Secondary Emotion: Understanding the Underlying Emotions in Therapy, I wrote about anger and boredom in terms of secondary emotions.  In the current article, I will discuss focus on how understanding and expressing primary emotions could save your relationship.

How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

Understanding Primary and Secondary Emotions in a Relationship
In a relationship where one person has an anxious attachment style and the other partner has an avoidant attachment style, each person will probably express their dissatisfaction and frustration with the relationship in different ways (see my article:  How Your Attachment Style Affects Your Relationship).

If one or both people in a relationship misunderstand what's being communicated, it could jeopardize the relationship, especially if both people are locked into a rigid, dysfunctional way of relating.

This is why it's so important to look beyond the surface of what's being expressed to understand the possible hurt and longing that is hidden beyond the surface.

Couples therapy with a licensed psychotherapist, who understands attachment styles and primary and secondary emotions, can help avoid misunderstandings and a possible breakup.

Fictional Vignette: How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship
The following fictional vignette illustrates how couples, who are locked into a dysfunctional interactive pattern, can learn to understand and express primary emotions by seeking help in couples counseling:

May and John
May and John, who were married for 10 years, decided to seek help in couples counseling because their relationship had devolved from a loving, nurturing relationship to an ongoing battle of accusations and counter-accusations.

May explained to their couples therapist that the problems began a couple of years ago when John took a new job where he had to spend a lot of extra hours at work.  When he came home, she said, he was exhausted, and all he wanted to do was eat supper, watch a little TV and then go to sleep.

She told the couples therapist that John was frequently asleep on the couch by 9 PM.  She said that, while she understood that he was tired from a long day at work, she often felt lonely because he was barely communicative during the week and when she wanted to go out on weekends, he just wanted to lounge around the apartment.

She also explained that whereas they used to have an active sex life, their sex life now was practically nonexistent.  Since they were only in their mid-30s, she felt this didn't bode well for the survival of the relationship.  She said that whenever she complained to him that he wasn't paying enough attention to her, he would remain silent and turn away from her, which infuriated her so much that she would lose her temper and begin yelling.

When he didn't walk into another room to avoid her, she said, he would sometimes also lose his temper so that they were then involved in a shouting match, both saying things that they regretted later.  Then, she said, they would usually each retreat from one another for a while--until the next argument and the cycle began again.

May said that they both wanted to have a child within the next year or so, but she didn't see how their relationship could survive.  So, on the one hand, it made her hesitant about having a baby and, on the other hand, she was aware that if she didn't have a baby soon, she might not be able to conceive because of her age.

How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

The couples therapist noticed that while May was speaking, John sat silently looking away.  She could see that John was feeling annoyed and defensive, and he had "checked out" of the session as soon as May began speaking.

She would need to get to know May and John better over time, but her first impression was that, in terms of their attachment styles, May was in the role of an anxious "pursuer" and John was in the role of an avoidant "withdrawer" in their dynamic.

When the couples therapist invited John to speak, he shrugged his shoulders, "I don't know what to say.  May knows that I'm working these crazy hours in order to advance my career so we can eventually have a house and other things that we want.  It's not that I like working long hours--it's required of me.  Then, when I get home, I need space to breathe and relax, but I feel verbally assaulted by May as soon as I walk through the door.  All she does is nag me, which is such a turnoff so, yeah, I'm not usually interested in having sex because I'm tired but also because I'm turned off by how May speaks to me.  She's just so angry all the time.  It makes me feel like a failure as a husband.  Then, I just want to be alone.  Who wants to come home to an angry person who yells at you everyday?  Not me."

The couples therapist could see that May and John were locked into a rigid negative way of relating, and neither of them were able to express the love and longing that they felt for each other.  She started by reflecting back and paraphrasing what May said and included that it was clear that, underneath her anger and yelling, was love and longing (the primary emotions) to be with John.

May nodded her head and looked over at John, who seemed a bit more engaged when he heard the couples therapist express May's primary emotions, love and longing, that were being covered over by the secondary emotion of anger.  John looked over at May and took her hand.

Then, the couples therapist paraphrased what John said about actually wanting to spend more time with May, but being required to work long hours at the office.  She paraphrased how tired he felt when he came home and that he needed a little time to unwind before interacting with May.  She also paraphrased that when May got angry and yelled at him, he didn't know what else to do, he felt like a failure as a husband so he withdrew from her.  But, in fact, he really loved her and wanted to be with her (the primary emotions).

As John listened to the couples therapist, he nodded his head to indicate that this is how he felt.  Then, he smiled at May, whose demeanor had softened as she listened to the couples therapist paraphrase what John said.

Then, May squeezed John's hand and said to him that she would be more than willing to give him time and space when he got home if she knew that he would pay attention to her after that.  In response, John gave May a hug.

This was the beginning of weekly six month couple therapy where John and May learned about each of their attachment styles and the primary emotions underneath May's anxious anger and John's defeated avoidant withdrawal.

The beginning stage of couples therapy involved helping May and John to de-escalate their emotions.  May allowed John to unwind and, rather than expressing anger and criticism, she learned to allow herself to be vulnerable enough to express to John the love and longing that she felt.

When May allowed John time to unwind when he got home and she was no longer yelling at him, he felt more comfortable approaching May and being closer to her.  He understood that, even during those times when she would occasionally yell at him, that her anger was a secondary emotion that covered over her love and longing for him and her fears that he was emotionally abandoning her.

May also began to understand that John's withdrawal didn't mean that he didn't care about her.  It meant that this was his secondary, defensive emotion in response to her anger.  She realized that underneath his withdrawn demeanor, he still loved her, but he  felt emotionally overwhelmed by what he perceived to be her angry demands (see my article:  Relationships and Communication: Are You a "Stonewaller"?).

How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

They both realized that if they were going to repair their relationship, they each needed to make it safe for each other to be emotionally vulnerable enough to express their primary emotions. This wasn't easy because they each feared getting hurt.  But over time, they allowed themselves to express their primary emotions of love and caring and their relationship improved.

Conclusion
Secondary emotions usually cover over the core primary emotions, which is related to each person's attachment style.

The secondary emotion of anger, which was demonstrated in the vignette above with how May responded to John, often covers over hurt, fear and longing.  And what appears as nonresponsive withdrawal, demonstrated by John when May got angry with him, often covers over the primary emotion of fear and feelings of inadequacy.

In the role of the "pursuer" and with an anxious attachment style, May felt exasperated by John's nonresponsiveness so her anger escalated.  In response, John, who was the "withdrawer" with an avoidant attachment style wanted to withdraw even more.  Underneath what appeared to be a non-caring stance, John was fearful and feeling inadequate.

So, they were caught in this rigid negative dance with each other and neither of them knew how to change that dance until an empathetic couples therapist helped them by allowing them to see the love and longing behind their secondary emotions and feel safe enough to express their more vulnerable emotions (see my article: Relationships: Creating a Safe Haven For Each Other).

Getting Help in Therapy
The dynamics in the vignette that I presented above are common, and it's often very difficult for a couple to overcome these dynamics on their own.

A skilled couples therapist can help each partner to feel comfortable enough to de-escalate their emotions, understand their primary emotions (as opposed to the secondary emotions that are on the surface), and express their more vulnerable feelings of love and longing for each other (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

If you and your significant other are stuck in a rigid negative cycle, you could benefit from getting help from a licensed mental health professional who works with couples.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article:  The Therapeutic Benefits of Integrative Psychotherapy).

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

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

Learning to Accept That You Can't Control Your Loved Ones

While it's understandable that you would want to spare your loved ones from experiencing pain or misfortune, if you try to control the lives of people close to you, you will need to learn what many other people have learned before you--you can't control anyone else's life. 

Psychotherapy can help you to understand why you have a need to do this, help you work through the issues involved and to eventually accept that you need to focus on yourself (see my articles: When Someone You Love Rejects Your Help and Avoiding Codependency With Your Children).

Learning to Accept That You Can't Control Your Loved Ones 

If you think you can see clearly what a loved one needs and your offer to help is rejected, it can be a very difficult thing to accept.  Your intention, of course, is to help, but if your loved one doesn't want your help, you will need to back off--no matter how noble your intentions might be (see my article: Overcoming the Need to Be Everyone's Caretaker).

This can be especially difficult with close family members when you're anxious about their well-being and how they're living their lives.  But when your loved ones tell you that they don't want your help and they're of legal age and competent enough to make their own decisions, you could ruin your relationship by continuing to push.

I see many clients in my psychotherapy private practice in New York City who feel anxious and heartbroken that family members refuse to take their advice or allow them to help.  Their family members see their offer to help as being controlling behavior.

The more they try to help, the more their loved ones push them away.  In some cases, a family member can become estranged because of the strain of this dynamic.

Fictional Clinical Vignette:  Learning to Accept That You Can't Control Your Loved Ones
The following fictional clinical vignette illustrates this dilemma and how psychotherapy can help:

After Beth found out from her older daughter, Nell, that her 21 year old son, Rich, was abusing painkillers, she spoke to her son and offered to arrange to send him to a drug rehabilitation center.  Although Rich didn't deny that he was abusing painkillers, he was annoyed that his older sister divulged this information to their mother, brushed off his mother's suggestion and told her that he knew that he could stop on his own, without help, at any time.

In Beth's family of origin, her father and older brother both abused drugs and alcohol.  This caused Beth, her mother and Beth's siblings much suffering when Beth was a child.  Her father and brother both eventually got clean and sober when Beth was in her 20s, but their addictions precipitated a divorce between the mother and father and alienation with most other family members.

Since Beth's mother was incapacitated most of the time by her depression, as the oldest child, Beth assumed responsibility for her family at an early age.  By the time she was 12, she was cooking and cleaning for her family because her mother stayed in bed all day.  And sometimes Beth went to the local bar to find either her father or brother (or sometimes both) to bring them back home (see my article: Dynamics of Adult Children of Dysfunctional Families).

At the time, Beth didn't think this was unusual. She didn't understand that she was functioning as a parentified child.  She saw herself as being "strong" and able to handle whatever came up in the family.  At a young age, she felt she could resolve any family problem (see my article: Children's Roles in Dysfunctional Families).

Beth was the one, when she was in her early 20s, who arranged, at various times, for her father and brother to attend inpatient treatment.  When her father's primary counselor at the rehabilitation center explained the concept of codependency to Beth and recommended that she attend Al-Anon meetings, Beth dismissed this.  Her feeling was that she wasn't the one with the problems, so she didn't see why she should go to Al-Anon meetings.

When Beth couldn't persuade Rich to go to inpatient treatment, she asked her father to come speak with Rich.  By this time, her father had over 20 years of sobriety and he was still active in the 12 Step community.  He spoke with Rich one-on-one and tried to persuade him to get help, but Rich was angry that his mother told his grandfather about his addiction, and he stopped talking to Beth.

Beth worried about Rich night and day.  She hardly slept.  She blamed herself for divorcing his father, who was an active alcoholic who broke contact with Beth, Nell and Rich.  She thought about all the things that she "should" have done to prevent her son from getting addicted to painkillers, and she continued to try to persuade him to get help--to no avail.

Several weeks later, Beth received a call from the police that Rich was in a car accident and he was arrested for driving while impaired.  He explained that her son was taken to the hospital where he would be medically evaluated and and evaluated for a detox.

After Beth got off the phone, she was so upset that she was shaking.  She blamed herself for not doing more for Rich.  She felt she could have prevented this accident and arrest, but she wasn't forceful or persuasive enough.

At the hospital, she found out that, aside from minor bruises, Rich wasn't seriously injured and no one else was hurt.  The doctors told her that it would take about 10 days or so to detox Rich from the painkillers.  During that time, Beth hired an attorney, who recommended to Rich that, as soon as he was able, he go to a drug rehabilitation center to deal with his addiction and to show the judge that he was serious about getting clean.

Rich completed the hospital detox and a 28 day stay at a rehabilitation center.  Since it was his first offense, the judge agreed that Rich should go to rehab and a court representative would monitor his treatment.

While he was in rehab, Beth and Nell went to visit him twice.  They met with the primary counselor, who recommended Al-Anon for them.  Both Beth and Nell scoffed at the idea.

Following inpatient treatment, Rich attended outpatient treatment and he went to 12 Step meetings with his grandfather.  Eventually, he obtained a sponsor and he began to turn his life around.

Even though Rich was doing much better, Beth continued to relive the moment she received the phone call from the police officer.  She ruminated about how her son could have been killed in that car accident and she blamed herself.  This went on for months, until finally, Beth's best friend, who listened to Beth blame herself over and over again, recommended that Beth seek help in therapy.

Normally, Beth wouldn't even consider attending psychotherapy, but she knew she needed to do something, and she didn't know what else to do.  She was a nervous wreck, and she couldn't sleep.  So she contacted a psychotherapist to begin therapy.

Learning to Accept That You Can't Control Your Loved Ones

After Beth told her psychotherapist about Rich's addiction, how she tried to help him and how guilty she felt, about the car accident and her family's history with addiction, Beth's psychotherapist explained to Beth that her traumatic family history was getting played out with her son.  She told Beth that she functioned as the family rescuer in her family of origin and she was trying to function in that same role with her adult son, but it wasn't working.

Her psychotherapy explained the concepts of codependency to Beth and helped Beth to make connections between her family history and her current situation with Rich.  She also explained to Beth that she functioned as a parentified child in her family because neither her mother or father were able to function as parents.

As Beth listened to her psychotherapist, she realized that this all made sense, but she didn't know how to stop trying to control her son.  She explained to her psychotherapist that, even though he was randomly tested at his outpatient program, all his tests were negative and he seemed to be doing well, she continued to try to monitor his behavior.  She worried whenever he went out and she was vigilant for any signs of a relapse.  This created tension between Beth and her son, and he told her that he planned to move out with sober friends as soon as he found a job.

Beth's psychotherapist recommended that Beth start focusing on herself, specifically learning to de-stress with meditation and breathing exercises that her psychotherapist taught her.  She also recommended that Beth work on her unresolved childhood trauma with EMDR therapy (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR and the Brain).

Beth had little confidence that her psychotherapist's recommendations would work, but she didn't know what else to do, so she practiced the meditation and breathing exercises.  She also began taking a yoga class and she developed a wind down routine to sleep better.

When Rich told Beth that he found a new full time job and he had plans to move in with sober friends, she became highly anxious.  When she saw her psychotherapist, she fretted that if Rich moved out, she wouldn't be able to monitor how he was doing and she would worry all the time.

Her psychotherapist was empathetic towards Beth.  She understood that Beth was experiencing anxiety about the current situation and her history of family trauma with two addicted family members was also getting triggered.

By the next session, Beth and her psychotherapist began processing her recent traumatic experience with her son's addiction to help Beth's mind and nervous system to get caught up with the fact that her son was actually doing well and she was the one who was still stuck at the point when she found out that her son was abusing painkillers.

Over time, EMDR therapy helped Beth to "update" her emotional experience with her son.  Before doing EMDR, Beth knew objectively that her son was sober and he was doing much better.  But on an emotional level, she was still stuck back in that moment when Nell told her that Rich was abusing painkillers and also in the moment when she got the call from the police officer.

After doing EMDR therapy, over time, Beth gradually worked through her traumatic family history.  She felt compassion for the young child that she had been when she was taking on adult responsibilities for her family.  She could look back now and realize what an impossible task that was and what a toll it took on her emotionally.

Learning to Accept That You Can't Control Your Loved Ones

After Beth worked through her history of trauma, she and her psychotherapist tackled her current worries about her son.  

Having worked through the earlier history of trauma, working on her feelings about her son was, although not easy, easier than she would have expected.  She was able to know and feel that Rich was doing better.  

She told her psychotherapist that she could now feel the uselessness of her worrying (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

She also felt and accepted on an emotional level that she couldn't control her son or anyone else--she could only control herself.  Although this made her feel sad in a way, she said she also felt relieved because she knew there was nothing for her to do now.

Beth continued to focus on herself.  She eventually went to Al-Anon meetings to get group support to help her not to backslide.

After she stopped trying to monitor Rich's behavior, Beth and Rich got closer and they were able to repair their mother-son relationship.

Conclusion
Accepting that you can't control your loved ones' life can be one of your biggest challenges, especially if you grew up being a parentified child as in the fictional vignette above.

You can offer your loved ones love and emotional support, but you can't live their lives for them or try to control what they do.

By focusing too much on your loved ones' problems, you not only risk alienating them, but you also risk neglecting yourself.

Sometimes, you have accept that your loved ones can do what's necessary to take care of themselves when they're ready.

Getting Help in Therapy
If you try to control your loved ones' behavior, you might have a long history of trying to rescue family members in your family of origin.  

If you were successful in rescuing family members, you might really  believe you can also control loved ones in their current life.  If you were unsuccessful in rescuing family members, you might feel compelled to "get it right this time" in your current situation.

Trying to control loved ones when they reject your help, as in the scenario above, is counterproductive and the situation tends to spiral down.

A skilled psychotherapist can help you to overcome codependency issues so that you can stop trying to control what you can't control and focus on taking care of yourself (see my article: The Benefits of Psychotherapy).

A trauma therapist can help you to overcome trauma related to the current situation as well as unresolved trauma related to the past (see my article: How to Choose a Psychotherapist).

Once you accept that you can't control anyone else and learn to let go, you can feel freer and live 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.

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.

Breaking the Family Code of Silence in a Dysfunctional Family

One of the hallmarks of many dysfunctional families is that there is a family code of silence about the family's dysfunctional behavior.  This can include enabling addiction, sexual abuse, physical and emotional abuse and other dysfunctional behavior.  Breaking the family code of silence and how psychotherapy can help is the subject of this article (see my article: Dynamics of Adult Children of Dysfunctional Families).

Breaking the Family Code of Silence in a Dysfunctional Family

Children who grow up in dysfunctional families learn relatively quickly that there are certain subjects that the family doesn't discuss, and there are consequences for breaking this code of silence, including being punished, ostracized or identified as "family problem" or scapegoat (see my article: The Role of the Family Scapegoat and Children's Roles in Dysfunctional Families).

Young children have no choice in most circumstances than to go along with the dysfunctional behavior.  After all, they are completely dependent upon the family so that being an outcast is unthinkable.

There are some young children who take the risk of confiding in another adult--like a teacher, mentor or family member outside the immediate family, but this doesn't always lead to positive results, especially since, in most cases the child continues to live in the household and will suffer repercussions for revealing family secrets (see my article: Toxic Family Secrets).

Maintaining a code of silence about dysfunctional family behavior often becomes the norm for these children when they become adults.  Confronting the dysfunction can still feel risky--even if the adult child is no longer part of the household and no longer dependent upon the family.

The inner conflict of wanting to confront dysfunctional behavior vs. the fear of breaking the family code of silence is often a topic for clients in psychotherapy.

Fictional Clinical Vignette: Breaking the Family code of Silence in a Dysfunctional Family
After dating for a year, Megan and John began talking about getting married.  They were both in their mid-30s, they both wanted children and since their relationship was going so well, they agreed that they didn't want to have a lengthy engagement.  They agreed that they would rather plan to get married some time in the following year.

When Megan met John's parents for the first time, she was welcomed into their home with warmth and acceptance.  It was evident that they were happy that the couple was talking about getting married.

Megan knew that the next step would be for her to invite John to meet her family, but she dreaded the thought of John meeting her family.  Although no one in her family would admit it, her father had longstanding problems with alcohol that often resulted in unpleasant scenes at the family dinner table and during holidays.

Even though she and her parents lived nearby in New York City, Megan avoided going home, except during holiday time, and even then she sometimes made up excuses not to be around her family's dysfunctional behavior.

As a child, she loved being around her father when he was sober, which was usually early in the day.  But once he began drinking, he became verbally abusive, and no one was immune to his verbal attacks. She became very attuned to recognizing when her father was drunk and tried to stay out of his way.

She also didn't invited friends over to her house when she was a child because she never knew when her father would be drunk, and it would be too humiliating for her if her friends saw her father's behavior.

As a teenager, Megan summoned the courage to talk to her mother and her older siblings about the father's problems, but they tended to minimize the father's drinking.

Her mother told, "This is the way your father is.  There's nothing we can do to change it." And her siblings told Megan that she was "making a big thing out of nothing."  So, being outnumbered, Megan contained her rage and bided her time until she could go away to college (see my article: Being the "Different One" in Your Family).

After she graduated college, Megan moved into an apartment in Manhattan with a few of her college roommates.  She had one serious relationship with a man named Bill, before her relationship with John, when she was in her senior year of college.  She avoided introducing Bill to her family, but after she met Bill's parents and siblings a few times, she felt uncomfortable not introducing Bill to her family.

Before inviting Bill over to meet her parents, she spoke with her parents and told asked them to avoid serving or drinking alcohol when she brought Bill over.  Her parents were incensed that she would even ask this.  Even though Megan tried to be as tactful as possible, both parents objected to her "dictating" their behavior in their own home.

As a result, Megan nervously explained to Bill why she was avoiding introducing him to her parents. Although Bill said he understood, Megan always wondered after their breakup a few months later whether he was skittish about the possibility of becoming part of a family with such dysfunctional behavior.

Now that she was with John, Megan wanted very much for this relationship to work.  She had never revealed her father's alcoholism because she felt so ashamed about it.

On an intellectual level, she understood that she wasn't doing anything wrong and she didn't have a reason to feel ashamed, but the thought of John seeing her father drunk felt so humiliating.  He came from a relatively healthy family, and she wasn't sure he would understand or want to be around her family's unhealthy behavior.  And, yet, Megan still loved her family and, at that point, she didn't want to completely cut them off.

Breaking the Family Code of Silence in a Dysfunctional Family

So, feeling caught in a dilemma about what to do, she began attending psychotherapy.  Megan provided her psychotherapist with the family history, including the alcoholism, family secrets, the enabling and the family code of silence.

As she spoke to her psychotherapist, Megan began to get clearer that her father's behavior was completely unacceptable to her and, even though she loved him, she didn't want to be around him or have John around him.

Megan decided to try to talk to her mother about it one more time, so she invited her mother to lunch in a nearby restaurant one Saturday.  After the meal, she broached the topic with her mother again.  She told her mother that she loved both her and her father, but her father's drunken behavior was unacceptable to her and she didn't want to be around it.

Megan could see her mother's eyes glaze over as Megan brought up the topic of her father's drinking.  She expected her mother to "check out" during this discussion, but she persevered.  When she saw that her mother was distracting herself by looking at her phone, Megan put her hand over her mother's phone and said, "Mom, do you understand what I'm saying? I won't come over anymore until dad gets sober."

When her mother made a gesture to leave, Megan asked her to stay and to hear her out.  Reluctantly, Megan's mother sat down again and glared at Megan.  Then, her mother's eyes welled up with tears, "I know your father has a little too much to drink sometimes and he says things that he regrets later, but what can I do?"

Megan wanted to tell her mother to stand up to her father, but she didn't want to tell her mother what to do.  So, instead, she focused on herself and told her mother that she couldn't tell her what to do.  She only wanted her mother to know that she was fed up with his behavior, and she would stop coming over if he didn't get help and stop drinking.  She explained that she felt that if she continued to come to the house under the current circumstances, she would be enabling her father's behavior and she no longer wanted to do that.

She also explained that she and John were planning to get married and have children and she didn't want John or her future children to be exposed to her father's drunkeness and the family's enabling of that behavior.  Megan's mother was silent, but Megan could see that her mother was inwardly seething.

A few days later, Megan spoke with her psychotherapist about her lunch with her mother and how frustrated and angry she felt about her mother's reaction.  Despite that it was very difficult for Megan, she also felt freer and lighter after the discussion she had with her mother.  She made a commitment to herself that she would continue to stand up for herself.

Megan also had a talk with John to explain her family's problems.  Although she felt embarrassed, she was relieved that he was so understanding.  She suggested that he could meet her siblings, who were all their own, away from the family home, which he agreed to do.

In the meantime, Megan and her psychotherapist worked on her unresolved childhood trauma related to the effect of the family's dysfunctional behavior using EMDR therapy (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR and the Brain).

Over time, Megan and her psychotherapist worked through the unresolved childhood trauma with EMDR therapy, but it was neither quick nor easy.

Megan and John planned a small wedding with his family and their friends.  She invited her mother and siblings, but they refused to come because Megan excluded her father.  Although it was very difficult not to have her parents there, Megan knew she made the right decision for herself by not inviting her father.

A couple of years later, Megan was at home when she received a call from her mother that the father was in the emergency room after waking up looking jaundice.  Putting aside her resentment, Megan went to the hospital and stayed with her mother while her father was admitted to the intensive care unit.

The doctors explained to them that it appeared that Megan's father's liver was failing and they would need to do tests.  He explained that this was a very serious medical condition, and they might have to place the father in an induced medical coma.

At that point, Megan's family, including the father, had to confront the seriousness of his alcohol problems and that he might die from liver failure.  The father, who was in a great deal of pain, apologized to the mother, Megan and her siblings for upsetting them.  He held Megan's hand until he was taken away for tests.

It turned out that a medically induced coma was unnecessary, but the father needed surgery and he was warned by the doctors that if he continued to drink, he could die.

After the father recuperated from his medical problems, he agreed to go to an inpatient rehabilitation program for people who abused substances.  After he was in the program for a couple of weeks, Megan, John, her mother and siblings visited the rehab on family day.

They participated in a family education program and then they met with Megan's father and his primary counselor.  During that family session, Megan's father apologized again and made a commitment that he would do a six month outpatient chemical dependency program, attend Alcoholics Anonymous meetings, and get a sponsor so he could work on being sober.

It was an emotional meeting for everyone.  The counselor encouraged the family members to attend Al-Anon, a 12 Step anonymous program for family members who are part of an alcoholic and codependent family (see my article: Al-Anon: Beyond Reciting Slogans).

As time went on and Megan saw that her father was really serious about recovery and staying sober, she and John began attending occasional family dinners.  After many years of experiencing her father's alcoholism, it took Megan a while before she could trust that her father was serious about his recovery.

Breaking the Family Code of Silence in a Dysfunctional Family

But throughout it all, Megan felt confident that she knew what was acceptable and unacceptable behavior to her and that if her father relapsed, she knew what she needed to do to take care of herself (see my article: Is Self Care Selfish?).

Conclusion
Breaking the family code of silence can be a daunting endeavor, especially if you're the only one in your family who is willing to do it.

Years of going along with enabling behavior can numb you emotionally to dysfunctional behavior and cause you to be in denial about it.  But once you've made up your mind to place your own sense of well-being ahead of the family code of silence, you can take the necessary steps to take care of yourself, and psychotherapy can help you.

Getting Help in Therapy
It takes courage to confront longstanding family problems and how these problems affect you (see my article: Developing the Courage to Change).

If you have been struggling with the effects of dysfunctional family behavior and a code of silence around it, you could benefit from attending psychotherapy (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to identify the problems, take steps to take care of yourself, and work through the unresolved problems in therapy (see my article: How to Choose a Psychotherapist).

My experience as a psychotherapist of 20 years has been that experiential psychotherapy usually works best to overcome unresolved trauma (see my articles: Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone and  Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

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, and I have helped many clients to overcome unresolved 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.

Bait and Switch as a Form of Manipulation in Relationships: A Clinical Vignette

In my prior article, Bait and Switch as a Form of Manipulation in Relationships, I identified the signs of this dynamic and it's intentional and manipulative nature.  In this article, I'm providing a fictional clinical vignette to give more details about this phenomenon and how psychotherapy can help.

Bait and Switch as a Form of Manipulation in Relationships

Clinical Vignette: Bait and Switch as a Form of Manipulation in Relationships:
Amy
When Amy, who was in her mid-30s, met Ted at her friend, Mary's party, she was immediately attracted to his good looks, charm, intelligence, self confidence and sense of humor.

Prior to meeting Ted, she had not met anyone that she liked for over a year, and she was feeling lonely.  He called her within days of meeting her and asked her out to dinner that same week. Soon they were seeing each other on a regular basis at least 2-3 times per week.  Amy enjoyed his company and she sensed that he really liked being with her too.

She liked that Ted said he wanted to settle down and have children because she really wanted children too.  She was concerned that her "biological clock" was ticking and being with a man who wanted children was very important to her.

After they were dating for six months, Ted told Amy that he was laid off from his job.  He also told her that his lease would soon be up and he wanted them to live together.  Amy told him that she would also like them to take their relationship to the next level and agreed that he should move in.  So, Ted moved into Amy's apartment.

Bait and Switch as a Form of Manipulation in Relationships

Six months after Ted moved in, Amy had a talk with Ted about where their relationship was going (see my article: Is It Time for "the Talk"?)

Ted told Amy that he wanted to be with her for the rest of their lives, so they began talking to Amy about getting married.  They were both enthusiastic about getting married.  A month later, they got engaged and they began planning the wedding.

A couple of months before the wedding, Amy told Ted that she wanted to stop taking her birth control pills so that they could have a baby soon.  This was something that they had talked about before, but they never talked about when they wanted to try to conceive.

Ted seemed anxious when Amy spoke to him about stopping the birth control pills.  He told her that he thought it was too soon, and they should wait until he got a better job with an increase in salary before they had a baby.

Amy knew that Ted was concerned about money, but he never mentioned before that he wanted to wait to have children. After being laid off from his sales job, he took a temporary to get by until he could find a better paying job.

Amy told Ted that they could manage financially on what she earned and his income from the temporary job.  She told him the she didn't care if she was supporting both of them for a while until Ted could get on his feet financially.

She also told him that she was concerned about her age and if she would be able to conceive if they waited longer.  But Ted was adamant that he wanted to wait.  He told her that he didn't think it would be much longer before he had a better job.

Somewhat concerned and disappointed, Amy agreed that they would wait until he got a better job.  She knew that he was doing his best to search for another job and she didn't want to nag him about it.

But one day, he left his email open and she happened to see an email from an employment recruiter.  Out of curiosity, she read the email, which was open.  The recruiter said that he was having a difficult time trying to find Ted a job because he was terminated for poor job performance from his last job and, since Ted's industry was one where people had close ties, word had gotten out about Ted's termination.

Amy was surprised to read this because Ted told her that he was laid off due to cutbacks.  He hadn't told her that he was fired for poor job performance.  She decided she would ask him about it when he got home.

But when Ted got home that night, he told her that he had wonderful news.  He said that he received a a great job offer. The job would involve a lot of travel, and they needed him to start right away.

Amy was surprised and pleased to hear Ted's good news.  He was in such a good mood that she refrained from questioning him about the email from the recruiter.  She told herself that the recruiter must have made a mistake, and she and Ted celebrated the good news.

Ted started his new job a few days later, and he said he had to fly out to California for a couple of weeks immediately.  Although Amy was disappointed that the new job would involve so much travel, she was glad that Ted had a full time job that paid well again.

While Ted was in California, he called Amy to talk briefly.  He said that he couldn't talk long because he had dinner meetings and he wouldn't get back to his hotel room until late.

During one of those calls, Amy brought up having a baby again and Ted got angry, "I just started this job!  Give me a chance to get settled!" and then he hung up.  Amy didn't hear from him for the rest of the week.  She tried calling him several times, but her calls went directly to voicemail and he didn't return her calls.

While he was away, Amy worried about what it meant that he wasn't calling her or responding to her calls.  He had never behaved this way before and she didn't know what to expect.

When Ted got home, he was in a grumpy mood. Amy tried to talk to him, but he went into the study and closed the door.  He didn't come into their bedroom until she had already fallen asleep, and he left for work the following morning before she woke up.

Annoyed and frustrated, Amy made up her mind to ask Ted what was going on.  She couldn't believe that he would still be so annoyed with her.  But an hour before the time that he usually got home, he texted her that he would be in a late night meeting and she shouldn't wait up for him.  It worried Amy that he also told her that he wouldn't be available to talk by phone.

When Amy woke up the next morning, she realized that Ted had not come home at all.  She tried to reach him on his cellphone, but he didn't respond.

Alarmed, she texted him that she would meet him after work in front of his new office building.  Ted texted back immediately that "under no circumstances" should Amy wait for him outside his office building.  He told her that he would be home late due to late night meetings and she shouldn't wait up for him.  Amy tried to call him several times, but he didn't respond to her messages.

By now, Amy was very worried that something was seriously wrong in their relationship.  Not sure what to do, she left work early and, despite what Ted told her, she waited for him outside his office building for more than two hours.  When Ted come out of the building, she tried to reach him again, to no avail.

She asked the security guard in the building if he knew Ted's company and what floor it was on, but the security guard said he never heard of this company.  Amy thought that was odd, and she decided to go back home.

As Amy walked home feeling dejected, she was crushed to see him walking across the street with an attractive young woman on his arm.  They were busy talking and laughing so Ted didn't see Amy.  In tears, she followed them from a distance and saw them go into a residential apartment building a few blocks away.

After that, Amy knew that Ted was having an affair and their relationship was over.  But she wanted an explanation from Ted.

When he got home that night, Ted was in a good mood.  He gave Amy a hug and no longer seemed angry with her.  Hurt and angry, Amy pushed him away, "I saw you today with another woman!  What's going on?  Have you been cheating on me all along?"

Ted stepped back angrily, "What are you talking about?  I don't know who you saw, but it wasn't me."

Amy burst into tears, "Ted, I saw you with my own eyes! Why are you lying to me?  We're going to get married in a few weeks.  What are you doing?  And do you even have a job or have you been deceiving me about that too?"

Ted's manner changed.  He suddenly became cold, "Alright.  Now you know.  Are you satisfied?  I don't have a job.  I just told you that I did. And, yes, I've been seeing someone else.  I tried to protect you from all of this, but you had to be nosy."

Amy was too stunned to say a word, but Ted continued, "Look, you were the one who wanted to get married and have a baby.  I never really wanted to get married and have children.  I was trying to please you, but we're not getting along, so what's the point?  Let's just call it quits."

Amy was shocked.  It was all happening so fast.  She tried to talk to Ted, but he began packing his things, "Amy, it's over.  Move on with your life."

After he packed his things, refusing to talk to Amy, Ted left abruptly slamming the door behind him.  She called their mutual friend, Mary, in tears.

Mary listened patiently and when Amy finished talking, Mary cleared her throat and spoke hesitantly, "I'm sorry, Amy.  I heard from a friend a few years ago that he did the same thing to her.  He moved in with her when he lost his job, he proposed to her and then he left her for someone else.  She said it was like he turned into another person and blamed her.  I was hoping that Ted had changed.  You both seemed so in love, and I didn't want to spoil things by telling you.  I had no idea he would do the same thing to you.  I'm so sorry.  I should have warned you..."

Amy was numb after she heard Mary's words and she hung up the phone while Mary was still speaking.

A few days later, Amy contacted her friends, relatives and the wedding vendors to let them know that the wedding was off.  She gave no explanation.

Soon after that, Amy began psychotherapy to deal with her shock and loss.  Her psychotherapist listened empathically.  Then, she explained to Amy that it appeared that Ted had manipulated her for his own selfish reasons.  She also explained the "bait and switch" tactic that some people in relationships engage in.

Amy found out a few weeks later from an acquaintance that Ted was now living with his new girlfriend, the same woman that Amy saw on his arm.

During the next several months, Amy attended her weekly psychotherapy sessions.  She felt emotionally supported and understood by her psychotherapist.

They used EMDR therapy to work on the trauma of being manipulated and abandoned by Ted and the humiliation and sadness she felt about cancelling her wedding (see my articles: What is EMDR Therapy?, How EMDR Therapy Works: EMDR and the Brain, and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Gradually, over time, she began to work through the trauma.  She also began to understand what happened, how Ted had lied to her all along about wanting to get married and have children so that she would take him in and support him.  She also realized that she overlooked certain red flags about Ted's character.  She understood that her loneliness and desire to be in a relationship might have made her more susceptible to Ted's charisma (see my article: Relationships: Falling For Charisma Instead of Character).

After talking to other people who knew Ted, Amy found out that Ted's usual pattern was to get involved with a woman and move in with her when he was having financial problems.  They told her that he was usually unfaithful and began a relationship with a new woman before he left his current relationship.

Gradually, as Amy continued in therapy, she regained her self confidence again.  When she met another man that she really liked, she was leery of trusting him.  But, over time, she lost her fear of being in a relationship again, and she opened up to this new experience.

Conclusion
People who engage in bait and switch tactics are usually very good at manipulating other people.  They can be very charming and take advantage of people.

In some cases, like in the vignette above, they are narcissistic and often engage in gaslighting.  These traits might not emerge until later on in the relationship.

There are often red flags, but the person who is being conned often misses these red flags because of their own state of denial.

The bait and switch can be about anything, as I mentioned in my prior article.

Getting Help in Therapy
Experiencing betrayal and manipulation by someone that you love is a shocking and hurtful experience.  It's a traumatic experience that can make it difficult for you to trust again.

Working with an experienced psychotherapist can help you to overcome this traumatic experience (see my article: The Benefits of Psychotherapy).

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

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many people to overcome betrayal and loss so they can move on with their 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.