How Contemporary Psychotherapy Has. Changed - Part 2

In Part 1 of this topic, I gave a history of the early psychoanalytic views of psychotherapists' reactions to clients (also known as countertransference) and gave an overview of more contemporary views on this subject.

How Contemporary Psychotherapy Has Changed

There are many ways for psychotherapists to share their reactions with the client--too numerous to write about in one blog article.

In this article, which is Part 2, I provide an example of contemporary psychotherapy with a fictional clinical vignette which illustrates one way that the psychotherapist's willingness to share her views with the client can accelerate the work in therapy and help to heal the client.

Fictional Clinical Vignette: Psychotherapists' Reactions to Clients

Nina
After struggling on her own for years with low self esteem, Nina began psychotherapy again to deal with this issue which was getting in the way of her personal life and her career.

She had been in therapy a few times before in the past and, although she developed intellectual insight into her problems, nothing changed for her.  Overall, her experiences in her prior therapy were not good because her psychotherapists tended to remain silent, and this made Nina feel uncomfortable.  But she decided to give psychotherapy another chance with a psychotherapist who was recommended to her.

As Nina was providing her psychotherapist with a family history, she discussed feeling unlovable in her family, especially after her younger brother was born (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

She explained to her therapist that she found out as an adult that after her birth, her mother was depressed and unable to care for Nina, so Nina's maternal grandmother and various aunts took turns caring for her.

She also found out that after her younger brother was born a year later, her parents were ecstatic to have a boy.  They had always wanted a boy to carry the family name.  And, whereas Nina continued to be shuttled off to various relatives for care, her brother was treated as precious and special throughout his life.

Apparently, by the time Nina's brother was born, the mother was no longer depressed, but she never bonded with Nina.  Her focus tended to be on the brother.  Her father also doted on the brother.  So, from a young age, Nina felt there must be something wrong with her since her parents practically ignored her, and she grew up feeling unworthy of love.

Although she loved her brother, Nina felt angry and resentful towards him.  Intellectually, she knew it wasn't his fault if her parents favored him over her but, on an emotional level, even at a young age, she had fantasies that he would die from a mysterious cause and then her parents would love her more.  These fantasies, which continued into adulthood, caused Nina to feel guilt and shame.

Although she dated in college, at the age of 33, Nina had never been in a long term romantic relationship. Whenever a man expressed interest in her beyond casual dating, Nina would begin finding faults with him in her mind and, eventually, she would end their dating relationship.

At the same time, Nina said, she was very lonely, and when she wasn't dating anyone, she longed to be in a serious relationship.  She would tell herself that she wouldn't be so critical of the next man she dated, but it was an ongoing cycle (An Emotional Dilemma: Wanting and Dreading Love).

Psychotherapists' Reactions to Clients 

The psychotherapist listened to Nina's history with compassion.  She recognized that Nina was caught in a dilemma of wanting love at the same time that she dreaded it.  She wondered if Nina would be able to form a therapeutic alliance with her to do the work or if the therapeutic relationship would be too threatening to Nina.

She also recognized that Nina used the defense mechanism of avoidance in her relationships with men. She could see that this was a necessary emotional survival strategy that Nina developed unconsciously when she was child to ward off the overwhelming feelings of hurt and still maintain a tenuous attachment to her parents (see my article: Understanding Internal and External Defense Mechanisms).

With regard to her career, Nina explained, she lacked confidence in her ideas in a field that was very competitive.  As a result, junior staff, who had much less experience but who were more willing to take risks in presenting their ideas, were getting promoted ahead of Nina, which was discouraging for her.

In the next psychotherapy session, the psychotherapist noticed when Nina spoke, she tended to defensively avert her gaze, and she decided to ask Nina if she recognized this about herself.  At first, Nina hesitated, and then she responded that other people also told her this.  When her therapist asked her if she had any insight into what caused her to do this, at first, Nina said she didn't know (see my article: The Therapist's Empathic Attunement Can Be Emotionally Reparative For the Client).

Her psychotherapist decided to explore this further with Nina, and asked Nina if she feared what she might see in her therapist's eyes.  In response, Nina looked directly at the therapist and then looked away again.

Her therapist asked Nina what she saw when she looked into her eyes, and Nina responded that she saw a lot of compassion and empathy, which she liked, but she was not accustomed to it.

Her psychotherapist decided to share her reaction with Nina regarding the neglect that Nina experienced when she was a child by telling Nina that she was moved by what she said in the first session.  By sharing her genuine reaction about Nina, her therapist hoped this would be the beginning of a positive relationship, although she was aware that Nina might feel a little uncomfortable.

The therapist's disclosure to Nina was in stark contrast to the more traditional stance in psychotherapy  that she had experienced with her prior therapists.  In the traditional stance, the psychotherapist wouldn't disclose any personal reactions about the client because it would be considered "overly gratifying."  But, in this case, the psychotherapist, who worked in a contemporary way, used her clinical judgment with the hopes of forming a positive relationship with Nina.

When Nina heard her psychotherapist's words, she looked up and smiled, "Thank you.  No one has ever said that to me. I can see that you really are moved, and that feels good."

As they continued to work together in therapy, the psychotherapist saw that Nina sometimes minimized the neglect that she experienced in ways which Nina, unknowingly diminished her own self worth.  Minimization was another defense mechanism that Nina used.

One day Nina talked about something that occurred when she was five years old.  She said she overheard her mother tell a maternal aunt that she felt Nina was a "burden." Her psychotherapist could see that there was a moment when Nina felt sad.  But then Nina swept her feelings under the rug by minimizing the incident, "My mother was probably having a bad day, so I shouldn't feel bad about that.  Anyway, it happened a long time ago."

Rather than allowing Nina to discount her own feelings about overhearing such a hurtful remark from her mother, her psychotherapist said in an empathetic tone, "That would be a nightmare for a five year old to hear her mother say" (with emphasis on the word "nightmare").

Nina seemed surprised by her psychotherapist's reaction.  As she allowed her therapist's words to sink in, she began to cry, "Yeah, it was.  I went back to my room and cried myself to sleep.  You're the only person that I've ever told this to."

Her psychotherapist explored with Nina what it was like for her to hear her therapist express her reaction to what happened as "a nightmare."  In response, Nina said that it felt good to have someone who understands what it was like because, back when she was five, she had no one.  She said she felt it gave her "permission" to feel her emotions rather than trying to ward them off.

Then, her psychotherapist explained that, even though this incident and many more like this happened a long time ago, these experiences had a significant impact on Nina emotionally and they were at the root of her problems (see my article: Understanding Why You're Affected By Trauma That Happened a Long Time Ago).

During the course of her therapy, there were many more instances where Nina's therapist used her reactions to Nina to help her to overcome defensive strategies that worked when she was a child but were now creating problems for her.

Over time, Nina was able to catch herself as she was about to use a defense mechanism to ward off uncomfortable feelings.  This allowed the work in therapy to deepen.

When Nina was ready, her psychotherapist suggested that they use EMDR therapy to help Nina to overcome her unresolved childhood trauma and also work on current problems (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

The work in therapy was neither quick nor easy.  But over time, Nina became increasingly comfortable with her psychotherapist's more contemporary way of working, as compared to the more tradition way of her prior therapists.

She found her psychotherapist's expressions of compassion and empathy to be healing, and this allowed Nina to open up more in therapy.

After a while, Nina was able to feel on a deep level that she had been a lovable child, and it wasn't her fault if her parents were so unloving towards her.  This understanding was not just an intellectual understanding--she felt it deeply.

Gradually, Nina became more self confident.  She no longer feared developing a loving, committed relationship with a man.  So, when she met someone that she really liked and who cared for her too, she didn't push him away like she did in the past.  She allowed the relationship to grow and flourish, and she was able to accept her own feelings and that he cared about her without feeling threatened by the emotions.

She also became more confident in presenting her ideas at work, which her director noticed.  Eventually, she received the promotion that she had wanted for such a long time.

Conclusion
In traditional psychotherapy, psychotherapists don't divulge their reactions to their clients.  They attempt to maintain a neutral stance.

In my clinical opinion, there is no such thing as a neutral stance--no matter how much a psychotherapist attempts to hide what s/he feels.  Even if a psychotherapist attempts to maintain a neutral stance, clients can be very perceptive and sense what a psychotherapist is feeling.

Attempting a neutral stance is not only outmoded, in opinion, it's actually hurtful for the client, especially a client who was raised in an abusive or neglectful environment as a child.  In many ways, attempts at therapist neutrality are often retraumatizing for the client.

But, even though the field has progressed, many psychotherapists are still being trained to be neutral with their clients, as I was when I was trained more than 20 years ago.

This doesn't mean that a psychotherapist should share whatever comes to her mind without regard for how it will affect the client.  That could be equally hurtful.  Instead, a psychotherapist needs to make clinical judgment calls with each client and in each session with each client as to what would be helpful for the therapist to share and what would not.

For many clients, as in the fictional vignette above, having a psychotherapist who can, in effect, go back in time with them to explore the client's history in a compassionate and empathetic way, is a healing experience that they might never have experienced before.  It helps the client to open up and accelerates the work in therapy.

Getting Help in Therapy
Many people, who experienced early trauma, never come to therapy because they're fearful of being retraumatized (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist with good clinical judgment and who is trained in trauma therapy can provide the client with a healing experience that allows them to work through early traumatic experiences (see my article: How to Choose a Psychotherapist).

If you have unresolved trauma that is having a negative impact on your life, you owe it to yourself to get help from an experienced trauma therapist.

Working through your trauma can free you from your history and allow you to live a more fulfilling life.

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 am a trauma therapist, who works with individual adults and couples.

I have helped many clients to overcome past and current trauma so they can move on to live happier 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.

How Contemporary Psychotherapy Has Changed - Part 1

In the past, in classical Freudian psychoanalysis, as it was practiced in the United States, psychoanalysts in training were taught to be neutral towards their clients and avoid any outward display of their personal feelings about the client (referred to as countertransference).

How Contemporary Psychotherapy Has Changed

At that time, the psychoanalyst sat behind the client with the client lying down on the couch. The idea was that the client wouldn't be distraction by seeing the psychoanalyst, so the client could free associate, and the psychoanalyst could focus on listening to the client rather than looking at the client.

How Contemporary Psychoanalysis and Psychotherapy Have Changed
Of course, as most contemporary psychoanalysts and psychotherapists know these days, Freud may have espoused a neutral stance on paper but, by all accounts, he was warm and personal with his clients in person.  He would often walk with them in his garden or have them over in his home.  But American classical psychoanalysts followed Freud's written word rather than his actual practice.

I believe this is why traditional psychoanalysis came to view the psychoanalyst's reactions (or countertransference) to the client as being something to overcome rather rather than the reactions being useful clinical information about what the therapist was intuiting about the client and their therapeutic relationship.

Fortunately, this has changed significantly and most contemporary analysts and psychotherapists view their reactions to the client as being a useful part of the therapy which can be shared with the client when it is clinically appropriate to do so.

In many ways, this has freed up the psychotherapist to be more emotionally accessible to the client.  It opens up a new avenue for the therapist to use him or herself in a new way.  It also helps to create more of an egalitarian relationship with the client when the psychotherapist is more accessible and shares reactions when they are useful to the client.

In addition, for clients who grew up in an abusive or neglectful environment as children, interacting with a psychotherapist who is free to be more open and emotionally accessible is a welcome change from what traumatized them as children (see my article: The Psychotherapist's Empathic Attainment Can Be Emotionally Reparative For the Client).

But it also makes being a psychotherapist more complicated.  Without the strict practice of the psychotherapist taking a neutral stance with the client, the psychotherapist has to make many more clinical judgment calls about when and how to be more open with clients.  There is always the chance that if the psychotherapist shares his or her reaction to the client that the psychotherapist might make a clinical mistake and share something that the client isn't ready to hear.

Although there is room for error in this more contemporary and open way of working in psychotherapy, I believe it's a refreshing change from the old traditional way.

Under the traditional way, too many clients, who grew up in abusive or neglectful homes were retraumatized by psychotherapists who remained silent most of the time, and these therapists only made occasional comments or interpretations, which could take a long time--weeks, possibly months.

I believe that, generally, clients in psychotherapy need a more empathetic and emotionally accessible psychotherapist who is comfortable sharing his or her reactions to the client when it is clinically appropriate.

I say "generally" because, occasionally, there are clients who still want a traditional stance of neutrality and prefer that the psychotherapist not speak or speak very little.  

Although this is not what most clients usually seek, there are some clients who felt so impinged upon by one or both parents that a psychotherapist who is more interactive would feel like another impingement to them.  In those cases, it's up to the psychotherapist to respect the client's wishes or, if this way of working is so foreign to the psychotherapist, s/he would have to make a referral to another psychotherapist.

The Psychotherapist's Responsibility For Ruptures and Repairs in Psychotherapy
With regard to the possibility of the psychotherapist making mistakes, mistakes can usually be repaired between the psychotherapist and the client (see my article:  Ruptures and Repairs in Psychotherapy).

In fact, it's inevitable that, as a human being first and a psychotherapist second, a therapist will make some mistakes with some clients, especially since psychotherapy is as much an art as it is a science.

Hopefully, these "mistakes" are few and far between and don't involve ethical issues or boundary violations (see my article: Boundary Violations and Sexual Exploitation in Psychotherapy).

Aside from ethical mistakes, which are more serious than the usual mistakes, the mistakes that I'm referring to are clinical mistakes, possibly with the regard to the timing of a comment or a misunderstanding between the client and psychotherapist.

Whatever is involved with the clinical mistake, it's up to the psychotherapist to acknowledge the mistake and make reparations by giving a heartfelt apology to the client and working together with the client to repair their therapeutic relationship.

Most clients are aware that psychotherapists make mistakes at times, and they are able to work through these issues.  If they came from homes where parents never acknowledged mistakes, let alone make attempts at reparations, the process of reparation in psychotherapy can be a healing experience for clients.

In my next article, I'll continue this discussion with regard to the types of reactions or countertransference that contemporary psychotherapists often share with clients (see my article: How Contemporary Psychotherapy Has Changed - Part 2).

Getting Help in Psychotherapy
Attending psychotherapy is a unique experience that provides an opportunity to get to know yourself better, overcome traumatic experiences, and work through current and past problems (see my article: The Benefits of Psychotherapy).

Choosing a psychotherapist often involves meeting with more than one psychotherapist to determine who you feel most comfortable with before you begin the therapeutic process (see my article: How to Choose a Psychotherapist).

If you have been struggling on your own with an unresolved problem, you could benefit from working with a skilled psychotherapist who can help you to work through your problem so you can live a more meaningful an fulfilling life.

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 in a contemporary way with individual adults and couples, and I provide a empathetic and supportive environment.

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.

Letting Go of Hope That is Based on Denial

Being hopeful and optimistic can improve your mood, your outlook on your personal life and the world around you.  But when hope is based on denial, this can only lead to disappointment and disillusionment.

Letting Go of Hope That is Based on Denial

For instance, it can be challenging to allow yourself to know when you're in an unhealthy relationship that isn't going to change.  This is especially difficult when you really love someone and you want things to work out between you.

You naturally want to give the person you're with and the relationship every chance to improve.  But after a certain point, you probably know deep down that things aren't going to change and you're just avoiding the inevitable (see my article: Wishful Thinking Often Leads to Poor Relationship Choices).

The first step to overcoming this problem, especially if this is a pattern for you, is to become aware that you're avoiding seeing the situation objectively.  If you're having difficulty doing this on your own, a trusted friend or family member might be helpful (see my article: Letting Go of Unrealistic Fantasies of a Happy Future in an Unhappy Relationship).

If you continue to avoid dealing with the situation even with the help of loved ones, you could benefit from seeking help in psychotherapy where an objective mental health professional can help you to see what you can't or won't see.

Once you have admitted to yourself that you're in denial about an unhealthy relationship that isn't going to change, your psychotherapist can help you to understand how your current situation might be based on earlier experiences so you can understand why holding on has become so compelling to you.

Having this understanding doesn't resolve your problems, but it helps you to have more self compassion rather than beating yourself up or feeling ashamed.

Then, when you're ready, your psychotherapist can help you to take the necessary steps to get out of a situation where you have been stuck and help you deal with the emotional aftermath (see my article: Overcoming the Heartbreak of a Breakup).

A Fictional Clinical Vignette: Letting Go of Hope That is Based on Denial
The following fictional clinical vignette illustrates how a skilled psychotherapist can help you to overcome your denial about an unhealthy relationship:

Amy
Prior to starting psychotherapy, Amy frequently spoke to her close friends over the course of her two year relationship to get advice.  Her friends gave her the same consistent message:  Her boyfriend was mistreating her and, by staying in her relationship, she wasn't taking care of herself.

Amy had spoken to her friends so many times that she knew they were getting tired of hearing from her about the same problems, especially since she would come to them when she was upset about her relationship with Jim, listen to their advice and then disregard what they had to say.  It had become a self destructive cycle, and Amy knew that she needed help.

She told her psychotherapist that she was happy in her relationship with Jim during the first few months, but shortly after that, he became verbally abusive with her when he was drunk.  She said that Jim said mean and hurtful things to her that he didn't remember when he was sober.

When she confronted him about his hurtful comments to her when he was sober, he would apologize and promise her that it wouldn't happen again.  But these incidents were becoming more frequent as he got drunk more often, and he refused to get help.

There was an incident where Jim got drunk and verbally abusive with Amy during a visit to see Amy's family.  Afterwards, Amy's parents told her that she was welcome to come see them, but they didn't want Jim in their home again.

Amy's friends also told her that they didn't like being around Jim when he was verbally abusive with her, and they told her that they would be willing to get together with her, but they didn't want to be around Jim.

Over time, Amy felt more and more caught between Jim and her loved ones.  He was also offended that her family and friends didn't want him around.

Although, on some level, Amy understood her loved ones' reactions to Jim, she also resented her them because she felt they were putting her in a difficult situation. This was another area where Amy was in denial and she was unable to see that they weren't the ones who were putting her in a difficult situation--she was making a choice to be with Jim, despite his verbal abuse, and she didn't see how her choice affected her relationships.

If she spent time with friends or family and she didn't include Jim, he would get angry with her.
From his perspective, she was siding with other people over him. If she tried to convince her loved ones to include Jim, she ended up getting into arguments with them because they were adamant that they didn't want him around.

By the time Amy came to therapy, she said she didn't know what to do.  On the one hand, she loved Jim and she didn't want to leave him.  But being with him meant limiting her time with friends and family because they didn't want him around and he didn't like that he wasn't included.  On the other hand, she could see that his drinking and his behavior were getting worse, and he adamantly refused to get help.

Amy's psychotherapist could see that, as things stood, Amy was in denial about the severity of her problems related to Jim and she was staying in this relationship at a significant cost to her personal well-being and her social support network.  But her therapist also knew that Amy hoped that the problem would somehow get better on it's own, so Amy wasn't ready to let go of the relationship.

Her psychotherapist also sensed that the root to Amy's problems was deeper than the current situation, which is why Amy was having such a problem acknowledging what everyone else could see and why she remained in denial.

Amy talked in therapy about wanting to "be there" for Jim and hoping that she would one day be able to convince him to get help.  She felt that if she left him, she would be abandoning him when he was at a low point and she couldn't do this (see my article: Overcoming Codependency: Taking Care of Yourself First).

As Amy and her therapist continued to explore her current situation, her therapist asked Amy if she had ever felt this way before.  In response, Amy thought about her therapist's question, and she said that when she was younger, her paternal grandfather lived with the family and he had a serious drinking problem.

When he was sober, he was a kind, gentle man.  But when he was drunk, he was mean and nasty.  Unfortunately, his drinking progressed and he refused to get help.  Her parents, who were fed up, asked the grandfather to leave the household, which upset Amy.  She was afraid that if her grandfather was on his own, his problems would get worse.

So, even though she was only 17 at the time, Amy took the problem on her shoulders and decided that it was up to her to help her grandfather.  In hindsight, Amy realized that her grandfather only gave lip service to getting into alcohol treatment.  But at the time, she took him at his word and she was relieved.

A few weeks after her grandfather agreed to get help but failed to do so, he had an alcohol-related stroke, and he never recovered.  Amy explained to her psychotherapist that this was a devastating experience for her, and she blamed herself for not convincing her grandfather to get help earlier.

Until Amy discussed this with her psychotherapist, she never made the connection between how she reacted to her grandfather's problems and how she related to Jim's problems.  After she saw the connection, she was stunned, and it was the subject of the next several psychotherapy sessions.

At her current age of 32, Amy was able to look back on her experiences with her grandfather when she was 17, and she saw that she had been naive and in denial all along about her grandfather's problems and his willingness to get help. She also saw that she couldn't possibly be responsible for her grandfather at 17 or at any age.  This was the beginning of Amy developing insight into her current problems.

After that, two new incidents with Jim were pivotal in Amy's decision-making process.  The first incident occurred when Jim was arrested for drunk driving and his license was revoked.  At first, Amy couldn't understand why his license was revoked and not temporarily suspended, but then he revealed what he had never told her before--he had several arrests in the past for drunk driving that he was too ashamed to tell her about.

The second incident occurred shortly after Jim's arrest when he tried to reach Amy at work while he was drunk.  When he was unable to reach Amy directly, he became verbally abusive with the receptionist, who put the director on the phone.  In his drunken state, Jim cursed the director and threatened him.

Later that day, when the director called Amy into his office, he told her what happened and she was humiliated.  He told her that he was concerned for her and asked her if she wanted him to give her information about the company's employee assistance program so she could get help for herself. She told him that she was already in therapy and would speak with her psychotherapist about what happened.

Amy spoke about these two incidents with her therapist.  She realized that she couldn't remain with Jim anymore.  She would need to ask him to leave her apartment.  But this was very difficult for her because it was so similar to the situation with her grandfather when her parents wanted him to leave their home.

Amy talked to her psychotherapist about her dilemma.  Her psychotherapist recommended that they use EMDR therapy to work through the current situation and the original trauma related to her grandfather (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

As they began using EMDR, Amy began letting go of any false hope that she had been holding onto, and she eventually told Jim to leave.

Once Amy was out of the relationship, she was able to see clearly how deep her denial had been.  Along with dealing with the aftermath of the breakup and the loss of her grandfather in therapy, she also dealt with the shame she felt for remaining in a verbally abusive relationship with someone who was unwilling and/or unable to change.

Therapy was neither quick nor easy, but Amy felt herself gradually becoming more confident that she made the right decision by ending her relationship with Jim, and she deserved to be treated better in her next relationship.

Getting Help in Therapy
Letting go of hope that's based on denial is challenging.  The current problem often has roots in earlier problems.

Loved ones might see clearly what you're not allowing yourself to see, even though you might know on some level that you're in an unhealthy situation.

What often happens is that loved ones get tired of hearing you complain and might ask you to stop talking to them about your problems.  This can damage your relationships with friends and family, and you might feel ashamed.

Rather than suffering on your own, you owe to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

Although a psychotherapist won't tell you what to do, a skilled therapist can help you to deal with your denial, make connections to earlier experiences and assist you to take the necessary steps for your own well-being (see my article: How to Choose a Psychotherapist).

Once you're free from an unhealthy situation, you can work on restoring your self esteem in therapy and reconnecting with family and friends.

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 work through difficult problems so they can live more fulfilling lives.

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

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

Feeling Alive Again After a Period of Stagnation

In Elizabeth Strout's book, Olive Kitteridge, one of the characters named Harmon has a realization that he is feeling alive again after a long period of emotional stagnation (see my article: Recapturing a Sense of Aliveness).

Feeling Alive Again After a Period of Time

His realization happens one day when an older customer, Bessie, comes into his store and she tells him how lonely she feels.  The author describes Harmon's awakening experience as "some skin that had stood between himself and the world seemed to have been ripped away, and everything was close, and frightening."

It seems that Harmon's empathy for Bessie's loneliness touched him deeply.  After he overcomes his anxiety, he realized that he needed to make certain major life decisions (I don't want to give away the specifics because the book is worthy reading without having any spoilers from me).

As a psychotherapist, I have seen this type of awakening many times, and Elizabeth Stout gives a sensitive, insightful and realistic portrayal of how people often come to this realization.

Feeling Alive Again After a Period of Stagnation

Similar to Harmon's experience, people often realize retrospectively that they're feeling alive again.  This realization can come from simple experiences, like being able to listen to music again after a period of not being able to tolerate hearing certain music or feeling like dancing again or the experience of falling in love again.

Feeling Alive Again After a Period of Stagnation

The renewed feeling of aliveness, however it happens, is a reminder of what aliveness feels like.  For people who haven't had this sense of aliveness before, it's a new experience of how vibrant life can feel.

In retrospect, people who recapture a sense of aliveness often say that they remember feeling alive before a period of stagnation set in.

Often hard to describe, a feeling of aliveness is usually an integrated mind-body experience that can also feel transcendent.

Getting Help in Therapy
People often come to therapy because they feel that, somewhere along the way, they lost their zest for life and they want to capture a sense of aliveness again (see my article: The Benefits of Psychotherapy).

Somatic Experiencing can help people to feel alive again (see my article:Why Experiential Psychotherapy is Often More Effective Than Regular Talk Therapy).

Rather than struggling on your own, you could get help from a psychotherapist who is an experiential therapist and who uses Somatic Experiencing (see my articles: How to Choose a Psychotherapist).

Feeling alive again makes life much more meaningful and fulfilling.

About Me
I am a New York 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 recapture a sense of aliveness.

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: Lou Andreas Salome - The Audacity to Be Free

Lou Andreas Salome, who was born in 1861 in St. Petersburg, Russia, became one of the few women psychoanalysts in Sigmund Freud's inner circle.

Movies: Lou Andreas Salome - The Audacity to Be Free*

At a relatively young age, she was known for being an intellectual with unconventional ideas for her time.  Throughout her life, she had many intellectual pursuits, including psychoanalysis, and she prized her freedom and spoke up for what she believed in, which was unusual for women in her day.

The movie, Lou Andreas Salome - The Audacity to Be Free, traces her life from early childhood until old age.  Although the title of the movie emphasizes Salome's lifelong pursuit of individual freedom and creativity, it actually focuses on her role as a muse to various famous men in her life, including Rainer Maria Rilke and Friedrich Nietzsche and less on her accomplishments, which were many.

The movie focuses only briefly on her accomplishments as a psychoanalyst during the early days of psychoanalysis and her relationship with Sigmund Freud.  As a psychotherapist who is psychoanalytically trained, I would have liked more of an emphasis on her life as a psychoanalyst, especially considering that a career in psychoanalysis in her day was mostly pursued by men.

In many ways, Salome was ahead of her time with regard to understanding the importance of culture, which we take for granted now.  But in her time, the focus in psychoanalysis was on the patient's inner world, the Oedipus Complex and Freud's psychosexual model of psychoanalysis.

It's unfortunate that such an outstanding psychoanalyst, who was well-known and highly regarded internationally in her time, has been all but forgotten these days, except in some psychoanalytic circles and, even there, her books and papers go mostly unread.

Even though the movie focuses mostly on her personal relationships with men, hopefully, it will arouse curiosity about this accomplished woman who was ahead of her time.

For a more comprehensive understanding of Lou Andreas Salome, I recommend Julia Vickers' book, Lou von Salome: A Biography of the Woman Who Inspired Freud, Nietzsche and Rilke.  Although the title emphasizes her role as a muse to some of the most famous men of her time, it also gives an in-depth exploration of her childhood background, how her background influenced her lifelong intellectual pursuits, her accomplishments, and her need for freedom and equality as a woman.

Salome also wrote her own memoir called Looking Back: Memoirs where she gives her own account of her life.  This book is more of a meditation on her life than a chronological account of her life history.

There is also a book, Salome: Her Life and Her Work by Angela Livingstone, that provides a more of a history of Salome's life.

It's important to remember women psychoanalysts like Lou Andreas Salome and Karen Horney for the important contributions that they made to psychoanalysis and psychotherapy in general.

Getting Help in Therapy
If you have been feeling overwhelmed by your problems, you're not alone.  Help is available in psychotherapy (see my article: The Benefits of Psychotherapy).

Working through your problems in psychotherapy can free you from your traumatic history and allow you to live a more meaningful and fulfilling 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 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.


*Photo Credit: Shutterstock: A romantic Slavic woman in vintage dress (this is not Lou Andreas Salome).

Rediscovering in Psychotherapy What You Thought Didn't Exist

Psychotherapy often provides clients with an opportunity to rediscover in therapy what they thought didn't exist in their lives.  This is especially true in experiential therapy, like Somatic Experiencing, EMDR (Eye Movement Desensitization and Processing) therapy, and clinical hypnosis (see my articles: How EMDR Therapy Works: EMDR and the Brain, What is Adjunctive EMDR Therapy? and Overcoming Trauma With Somatic Experiencing).

Rediscovering in Psychotherapy What You Thought Didn't Exist

Clients who come to therapy to work on unresolved traumatic experiences are, understandably, focused on the negative experiences they had, especially if those traumatic experiences go back to childhood.

But in experiential psychotherapy, they often rediscover that there were also positive, life affirming experiences that they have forgotten because of the preponderance of traumatic experiences that overshadowed everything else.

Rediscovering these positive experiences doesn't negate the traumatic experiences that need to be resolved in therapy.  But it gives clients a broader perspective of their lives.  It can also help them to see that they have internal resources that they didn't know they had.

As a psychotherapist, I have been delighted to witness this experience many times with clients in therapy.  Often in the mist of processing a traumatic memory, a client will suddenly remember that there was someone who did something that helped him or her at that time--whether it was a teacher, mentor, a relative or a friend. Or they will remember a transformative experience that helped them while they were enduring the trauma.  When a client has forgotten these positive memories, the rediscovery of them in therapy can be an epiphany.

These rediscovered positive memories aren't necessarily dramatic experiences, but their rediscovery often leads to advances in the processing of the traumatic memories.

Fictional Clinical Vignette

The following fictional clinical vignette illustrates the healing effect of rediscovering positive memories within the context of processing traumatic memories:

Sandy

After a particularly difficult family visit, Sandy began psychotherapy to deal with longstanding unresolved trauma related to her childhood experiences in her family and the emotional triggers that were set off by the last family visit (see my article: Why Is It That It's Often the Healthiest Person in a Dysfunctional Family Who Seeks Help in Therapy?).

She explained to her psychotherapist that she had a contentious relationship with her parents from an early age.  She said parents often belittled her and physically abused her when she was a child, which resulted in her low self esteem and anxiety.

Rediscovering in Psychotherapy What You Thought Didn't Exist

Since moving to New York City, Sandy limited her contact with her parents because their interactions were still contentious.  But, generally, she went home a couple of times a year during the holidays to try to maintain some type of connection with them, even though these visits often left her feeling disappointed and hurt.

During the holidays in 2016, she went to visit her parents for Christmas, and she found this visit to be the most challenging of all.

She and her parents never agreed on politics, and she tended to stay away from political conversations because she knew they would lead to arguments.  But, on the first day of her visit, her parents were so elated that their candidate won the presidential election that they could barely talk about anything else to Sandy, who voted for the candidate who lost (see my article: How to Cope With Difficult Family Get-Togethers).

Sandy was already reeling from the results of the presidential election, and she wasn't prepared to deal with the usual tension in her relationship with her parents as well as hearing them gloat about the election.  Tactfully, she suggested that they change the subject because it was upsetting to her.  But, as usual, her parents paid no attention to her feelings and her mother told her that she was being "too sensitive" and a "spoiled sport."

Sandy told her therapist that hearing those two phrases triggered childhood memories when both of her parents tended to disregard her feelings by telling her that she was "too sensitive" and a "spoiled sport" (see my article: How to Cope With Getting Emotionally Triggered During Family Visits).

Even though she was an adult, she said she felt like she was a helpless child again in her family home where she could neither fight back nor flee. As a child, she would stay in her room and fantasize about the day that she would be old enough to move out.  When she graduated high school, she was relieved to go away to college, and she never moved back into the family home.  

During the family visit that occurred shortly after the presidential election, Sandy told her parents that  if they didn't stop talking about the election, she would leave.  In response, they were dismissive and continued to disregard her feelings, so she packed her things and took a cab to the airport where she spent the Christmas holiday waiting to get a flight back to New York City.

She told her psychotherapist that it was a miserable Christmas for her.  But she felt she had to take care of herself by doing what she was unable to do when she was a child--leave her parents' home.  She explained that since that visit, she was flooded by childhood memories of her mother hitting her with a belt and her father taunting her for being "a crybaby."

That's when she decided that, in addition to coping with her current problems with her parents, she needed to work through her traumatic childhood memories so these memories wouldn't continue to get triggered.

Over the next several sessions, after Sandy and her psychotherapist talked about her family history and did the preparation work for trauma therapy, they began trauma therapy using a combination of Somatic Experiencing and EMDR therapy to work on past trauma as well as current difficulties with her family (see my article: Integrating EMDR Therapy and Somatic Experiencing).

During the trauma therapy, Sandy told her psychotherapist that her childhood was one long, bleak, lonely experience with no one to help her.  Not only was she an only child, but she had little contact with other relatives, who lived out of state.  Since her parents didn't allow her to invite friends over or to go to friend's homes, Sandy often felt lonely and unlovable as a child (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

Then, one day in therapy, after they did several sets of EMDR, Sandy suddenly remembered a high school teacher, Ms. Scott, who took Sandy under her wing.  She spent time with Sandy after class and encouraged her to open her mind to possibilities beyond their town, including applying to out of state colleges (see my article: How One Person Can Make a Difference in a Traumatized Child's Life).

Sandy was moved in her therapy session by remembering the impact of her former high school teacher, "How could I have forgotten how much Ms. Scott helped me?"

She said that if it had not been for the encouragement of Ms. Scott, she probably would have never applied to colleges--much less colleges out of state--because her parents didn't believe it was necessary for her to go to college.  They told her that what was most important was for her to get a job, any job, so she could contribute to the household.

Ms. Scott helped Sandy to see that a whole new world was waiting for her.   And, when Sandy's parents refused to help her with the college application process, Ms. Scott helped her with that process as well as the financial aid process when Sandy was accepted into a college in New York City.

Sandy's psychotherapist noticed how Sandy's face lit up and how alive she seemed after she remembered Ms. Scott, so they used these experiences as internal resources to help Sandy through the processing of the trauma.

Sandy said that she had forgotten how kind and generous Ms. Scott was to her.  Looking back now on those memories, she realized that there was someone who made her feel she was worthwhile and lovable at that time.  Recapturing those feelings facilitated the processing of the past trauma as well as the current difficulties with her family.

Soon after that, Sandy contacted Ms. Scott, who had since retired but who continued to live in the same town.  Ms. Scott, who now asked Sandy to call her Betty, was delighted to hear from Sandy and they planned to get together for lunch during Betty's next visit to New York City.

Conclusion

A long history of trauma can overshadow positive experiences in a person's memory.  But experiential psychotherapy can create the therapeutic environment that leads to the rediscovery of positive, life affirming experiences even in a traumatic childhood.  The rediscovery of these memories can facilitate the processing of traumatic memories.

Getting Help in Therapy

Unresolved traumatic memories often get triggered by current experiences, which is why it's so important to work through the unresolved trauma (see my article: The Benefits of Psychotherapy).

Experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis, is usually more effective than regular talk therapy to process trauma (see my article: Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone).

Along the way, it's not unusual for clients in trauma therapy to rediscover people and experiences that they forgot about who were helpful to them in the past.  Combined with trauma therapy, those past positive memories can provide the client with the much needed internal resources to work through the trauma.  

Rather than continuing to get triggered, you owe it to yourself to get the help you need from a skilled trauma therapist (see my article: How to Choose a Psychotherapist).

Once you have worked through unresolved trauma, you can 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, 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.

Understanding Internal and External Psychological Defense Mechanisms - Part 2

In a prior article, I began a discussion by describing internal and external psychological defense mechanisms.  To illustrate the points that I made in that article, I'm providing a fictional clinical vignette:

Fictional Clinical Vignette: Understanding Internal and External Psychological Defense Mechanisms
The defense mechanisms in the following fictional vignette will be identified and italicized in parenthesis to make it easier for the reader to identify (to see a full list of defense mechanisms, click on this link for the prior article):

Ted
After his girlfriend threatened to end their relationship if Ted didn't get help in therapy, Ted contacted a psychotherapist and reluctantly began psychotherapy.

Understanding Internal and External Psychological Defense Mechanisms

Ted explained to his psychotherapist that his girlfriend of two years, Amy, told him that he was too defensive and this was causing problems in their relationship.  He said that Amy indicated that she felt frustrated with him because he couldn't admit when his behavior caused problems between them.

His psychotherapist noticed that as he talked to her, Ted frequently looked away as if he was uncomfortable (non-verbal tactical defense mechanism: lack of eye contact).  He also spoke about his problems in the relationship in a vague way so that she would need to ask him to be more specific (verbal - tactical defense mechanism: vagueness).

She also noticed that Ted was sitting slumped with his arms folded across his chest and with legs crossed looking uncomfortable (non-verbal tactical defense mechanism: posture and body language).

Since Ted was only talking about what Amy thought were the problems in the relationship, the psychotherapist asked him about his opinions.  In response, after thinking about it for a minute or so, he responded by saying in a sarcastic tone, "I think things are perfect between us. (verbal - tactical defense mechanism: sarcasm).

Then, when he saw that the therapist was still waiting for his answer, he cleared his throat and said, "I'm just kidding.  Of course, I think we have problems, and I acknowledge that I can be defensive, but I think she's too hard on me" (verbal - tactical: dismissive/blaming).

Seeing that Ted was uncomfortable and highly defended, the psychotherapist realized that this was probably what Amy was dealing with in their relationship.  So, with much empathy, she decided to tactfully bring up Ted's discomfort and defensiveness in the session with her.

"I know it's difficult to begin therapy, especially during the first few sessions before you're comfortable with me.  I wonder if you've noticed that your defensiveness as we are talking," she said.

At first, Ted denied being defensive (regressive - intrapsychic: denial), so his psychotherapist pointed out the defense mechanisms that he had used so far in the therapy session at the same time that she reiterated that she understood that it's difficult to talk to a stranger about personal problems.

Ted thought about what the psychotherapist said, and he responded by beginning to talk about something unrelated to what they were discussing (verbal - tactical: changing the subject).

His therapist responded by bringing Ted back to the issue that they had been discussing and telling him that she thought it would help him to use the therapy sessions to begin to become aware of his defensive behavior.

When she asked him if he wanted the dynamic between him and Amy to improve or if he was ready to allow the relationship to end, Ted looked at her directly and said, "I don't want to lose Amy.  That's why I'm here.  I know I've been screwing up in our relationship.  It's just hard to face it."

His psychotherapist acknowledged that change is hard, especially if Ted's defensive behavior was an emotional survival strategy he learned to survive when he was younger.  In response, Ted acknowledged that he had a hard time in his family when he was growing up because both of his parents were perfectionists and he was made to feel ashamed when he made a mistake.

Over the next few sessions, the psychotherapist helped Ted to appreciate how important it was for him to use an emotional survival strategy when he was younger because it was the only way he knew how to survive with punitive parents, but that same survival strategy, defensive behavior, was no longer working for him as an adult.  In fact, she said, it's causing problems for him.

Gradually, Ted became more aware of how often he used defense mechanisms to ward off his uncomfortable feelings in the therapy sessions.  This helped him to bring that awareness to his relationship as well, so he was less defensive.

As Ted became more comfortable with his therapist over time, they worked on his unresolved childhood trauma that was at the root of his defensive behavior.  There were still times when he occasionally engaged in defensive behavior, but when he did, he was aware of it and acknowledged it to his therapist and to Amy.

Over time, Ted felt more comfortable being open with Amy and so he was less defensive.  He was able to communicate in an honest way about his feelings without being afraid that there would be the kind of repercussions that he experienced when he was a child.

Conclusion
Defense mechanisms are usually a life-saving emotional survival strategy when children are in an abusive and/or neglectful home and they have no other options.  These defense mechanisms help to ward off emotions that would have been overwhelming to a child.

But when that child becomes an adult, a propensity for defensive behavior causes problems.  The adult needs to first become aware of his defensive behavior and then learn new ways of relating and communicating.  If he has unresolved childhood trauma, he and his psychotherapist also need to work on resolving that trauma.

Getting Help in Therapy
Defensive behavior is often unconscious so the the person who engages in it is usually unaware that he is doing so.

A skilled psychotherapist, who is tactful and empathetic, can help a client become aware of his defensive dynamic and help him to learn new ways of relating (see my article: The Benefits of Psychotherapy).

A psychotherapist, who is a trauma therapist, can help the client to work through underlying unresolved trauma that is at the root of the defensive behavior (see my article: How to Choose a Psychotherapist).

If you have been experiencing the negative consequences of defensive behavior, you owe it to yourself to get help in therapy so you can free yourself of this problem.  Once you have learned healthier ways of relating and you have worked through unresolved trauma, you can lead a more meaningful and fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The 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.