EMDR is a Transformative Therapy for Trauma, But There Are a Few Exceptions

As a trauma therapist in private practice in New York City for over 20 years, I have been using EMDR therapy regularly since 2005 with excellent results.  I have found EMDR therapy to be a powerful and transformative therapy to help clients to overcome traumatic experiences.  I've also written several articles about EMDR therapy.  See my articles:

• What is EMDR Therapy?
• How EMDR Therapy Works: EMDR and the Brain
• Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs

Over the last 13 years, I have seen many clients for EMDR therapy for developmental and shock trauma.

EMDR is a Transformative Therapy For Trauma, But There Are a Few Exceptions

Clinically Assessing Clients For EMDR Therapy
As part of the initial consultation, I talk to clients about the types of trauma experiences where EMDR is effective which, fortunately, are most.  However, there are some exceptions when EMDR therapy would be contraindicated or where clients need more preparation to do EMDR, which is the focus of this article.

If a client comes to me for an initial consultation for EMDR therapy and reveals one of these contraindicated exceptions, I will discuss this with the client and will usually, if possible, provide him or her with another alternative recommendations.  If I don't do the particular alternative therapy that is needed, I usually offer to help this person to find another referral.

Although the exceptions to doing EMDR aren't many, when a client comes for a consultation and is told that EMDR therapy is contraindicated, this can be disappointing, especially since s/he may have heard about EMDR from a medical doctor, friends and the efficacy of EMDR to help resolve trauma.

But it's important for a psychotherapist who specializes in helping clients to resolve trauma to be a responsible and ethical therapist, even if the client will be disappointed and annoyed.

It's better to be honest with the client rather than go along with the client's wishes and place the client in harm's way or waste their time and money.

When is EMDR Therapy Contraindicated and When Is Additional Preparation Needed to Do EMDR?
For all EMDR therapy, after the initial consultation and a session or more to get family history, there is a preparation stage to help the client to develop the necessary internal resources and coping strategies to prepare to do EMDR.  However, there are times when EMDR is either contraindicated or additional preparation, beyond the usual, is needed.

The following is a list of the most common issues:

• Clients Who Are Psychiatrically Unstable:  Clients, who are psychiatrically unstable, need to be stabilized first before doing EMDR therapy or almost any other type of outpatient psychotherapy.  Clients who are actively suicidal, homicidal, too emotionally fragile, or who have some other serious psychiatric condition that is causing significant emotional impairment, need a period of stabilization, and after stabilization, they will need to develop the internal resources before EMDR can be considered.  Once clients are stabilized and they have the inner resources to do trauma work (of any kind), the psychotherapist can reevaluate clients to see if EMDR therapy would be the therapy of choice.

• Clients Who Are in An Unsafe or Unstable Home Environment:  Clients, who are in an unsafe or unstable home environment where they are being physically abused or they are the ones who are abusing a spouse or family member, are not ready to do trauma therapy.  They might need other types of help first, including but limited to:  supportive psychotherapy, domestic violence treatment, legal advocacy from an domestic violence agency, services from a child welfare agency, batterers' program and so on.  It would be irresponsible for a psychotherapist who does trauma therapy to ignore the fact that a client is in an unsafe home environment or is creating an unsafe environment.

• Clients Who Are Actively Abusing Alcohol, Drugs or Other Addictive or Self Destructive Behavior: Clients who are actively abusing alcohol, drugs or engaging in other addictive or self destructive behavior are often not candidates for EMDR therapy until they have had a period of sobriety.  When clients are engaging in self destructive behavior as a maladaptive way of coping, chances are good that, if they began to delve into traumatic memories, they might become more symptomatic and their addictive or self destructive behavior would become worse.  This is a situation where the EMDR psychotherapist would have to evaluate on a case-by-case basis.  There are some clients in this situation who could benefit from the EMDR protocol that is specifically designed for addictive behavior (if the psychotherapist is trained in this type of EMDR).  However, even in those circumstances, the client would have to already have the necessary inner resources and there might be a significant period of preparation work before traumatic memories can be processed with EMDR.

• Clients Who Are Unable to Engage in Dual Awareness in the Psychotherapy Session:  In order for trauma therapy to be safe and effective, clients must be able to maintain dual awareness in the therapy session.  In other words, they must be able to focus on the traumatic memory they are working on with their psychotherapist and also be aware of their here-and-now circumstances--that they are in a psychotherapist's office and not back in the traumatic situation.  So, for instance, if a client begins processing a traumatic memory with an EMDR therapist and the client plunges into the memory, she loses all consciousness of where she is, and she thinks she is actually back in that situation--rather than that she is with a psychotherapist, EMDR and other forms of trauma therapy are contraindicated.  There might be more preparatory work that needs to be done first to help the client to maintain dual awareness or, if that doesn't work, the client might not be ready for EMDR.  This might include clients who have DID (Dissociative Identity Disorder) where they become highly dissociative or switch into alters or clients who get thrown into flashbacks and have no awareness of where they are.

• Clients With Certain Eye Problems:  Clients who have certain eye problems might need clearance from their doctors in order to do EMDR.  As an alternative, the psychotherapist can use other forms of bilateral stimulation (BLS) like tappers, tapping, listening to music that alternates from one ear to the other.

• Clients With Certain Head Injuries:  Clients who have certain head injuries might need to get medical clearance from their doctors before doing EMDR.

• Clients Who Are Unable or Unwilling to Adhere to EMDR Therapy Recommendations and the Therapy Frame:  EMDR therapy is a weekly therapy.  There if often a lot that comes up in session and between sessions so if clients are unwilling or unable to come to weekly sessions, they should seek another type of therapy.  In general, consistency in therapy is necessary for any form of psychotherapy to be effective.

• Clients Who are Looking For a "Quick Fix":  Although EMDR therapy tends to be faster and more effective than regular talk therapy, it's not a "quick fix." Some clients come for an initial EMDR consultation with misconceptions about EMDR.  There are a few circumstances where EMDR therapy can be effective in 10-12 sessions.  These circumstances are rare.  They usually involve shock trauma where there were no other traumatic events prior to the shock trauma.  Even when clients come to EMDR therapy thinking that they have no other underlying trauma, in the course of doing EMDR therapy other underlying traumatic experiences might arise that are related to the current presenting problem.   In those cases, it is best to work on the underlying trauma or the client could get emotionally triggered again under similar circumstances (see my article: Beyond the Band Aid Approach to Overcoming Psychological Problems).

• Clients Who Are Engaged in Lawsuits Related to Their Trauma Should Consult With Their Lawyer First:  Clients who have a pending lawsuit are often advised by their attorneys not to do EMDR therapy before their case is settled.  There can be many reasons for this, but one of the main reasons is that if a client goes to trial after the trauma has been resolved, it might be difficult to convince a judge and/or jury that s/he was traumatized because they will not be exhibiting any traumatic symptoms.  This is more of a legal issue than a clinical issue.  However, many clients, who have lawsuits are unaware of this.  So, it's advisable to consult with your attorney first.

• Other Clients Who Need a Significant Preparatory Phase in Therapy Before Processing Traumatic Memories:  Aside from the other conditions already discussed above about clients who would need significant preparatory work, there are other conditions that might require preparatory work and reassessment.  One example of this might be clients who are unable to identify the emotions that they are experiencing.  This is important because in EMDR clients are asked to identify the emotions that they are experiencing now with regard to their traumatic memories.  If clients are so cut off from their emotions, as part of their preparation for doing EMDR, they will need help to identify their emotions (see my article: Experiential Psychotherapy Can Facilitate Emotional Development and Developing Internal Resources and Coping Strategies).  Another example might be clients who have personality disorder traits and who are emotionally unstable.  

Conclusion
EMDR is an evidence-based therapy that can help clients to overcome traumatic experiences.  This includes longstanding trauma that has not responded to other forms of psychotherapy.

There are a few circumstances where EMDR therapy is either contraindicated or where preparatory work, beyond the usual preparation, must be done first in order to determine if clients can do EMDR. This is part of the psychotherapist's clinical and ethical responsibility.

An EMDR therapist continues to assess the client during the initial consultation and throughout EMDR processing for situations that might arise in the therapy where EMDR might need to be combined with other forms of therapy to be effective (e.g., Somatic Experiencing or clinical hypnosis) as part of an integrative psychotherapy.

Although I have included the most common examples of where EMDR therapy is either contraindicated or additional preparation is needed first, there might be a few other circumstances.

Getting Help in Therapy
If you have been struggling with unresolved problems on your own, you could benefit from seeking help from a licensed mental health professional (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Working through your traumatic problems could free you from history and allow you to 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.

Problems With Experiencing Positive Emotions: When Good Feelings Feel Bad

Problems with experiencing positive emotions, like happiness, are often related to unresolved developmental trauma (see my article: (see my articles: Developmental Trauma: Living in the Present As If It Were the Past and Are You Afraid to Allow Yourself to Feel Happy?).

Problems With Experiencing Positive Emotions: When Good Feelings Feel Bad

Why Do People Have Problems With Positive Emotions?
Although it might seem unusual for people to feel uncomfortable with positive emotions, this often occurs with adults because they have lived most of their lives experiencing so-called negative emotions, and they are usually hypervigilant about when the next traumatic experience will occur.  So, even when things are going well, they are uncomfortable and waiting for the "next shoe to drop" (see my article: Adults Who Were Traumatized As Children Are Often Afraid to Experience Their Feelings).

In  other words, negative emotions, such as fear, anxiety, and sadness are part of their usual experience.  This has been the norm for them.  When they have experiences where they begin to feel happy, this will usually make them feel anxious or fearful which, in turn, makes it difficult for them to experience happiness.

Not only are they be suspicious of positive emotions because they're waiting for something bad to happen, but positive emotions can also make them aware on a deep level of the emotional deprivation they experienced in the past.

So, for instance, someone who is leery of positive emotions due to unresolved trauma, might feel deep sadness when s/he gets a hug from a friend.

Although this reaction might sound counterintuitive, for the person with unresolved trauma related to childhood emotional neglect, the hug is a visceral reminder of the love and affection they didn't receive as children.  This reaction is an emotional trigger as opposed to an objective response, and it happens in an instant.  It can be confusing for both the person getting the hug and the person giving the hug.

Fictional Clinical Vignette: Problems With Experiencing Positive Emotions: When Good Feelings Feel Bad
The following fictional clinical vignette illustrates how someone with unresolved trauma can experience positive emotions as uncomfortable due to unresolved trauma:

Jane
After entering into a new romantic relationship, Jane began psychotherapy to deal with emotions that confused her.

Jane, who was in her mid-30s, told her psychotherapist that she had never been in a relationship before.  Prior to this new relationship, she dated men briefly, but she longed to be with someone in a monogamous relationship. But since she and the man that she was dating, Dan, decided to be in an exclusive relationship, she felt anxious and sad.

Problems With Experiencing Positive Emotions: When Good Feelings Feel Bad

She explained to her therapist that Dan was a wonderful man, and he treated her well.  She had no complaints about him.  While they were dating casually, she and Dan had a good time together.  They had a lot in common, and sex was great.

But once the relationship became more emotionally intimate, Jane became anxious whenever she was about to see Dan.  Whereas sex had been wonderful before they were emotionally intimate, now sex was difficult for her.  She felt almost on the verge of panic when they made love.  Sometimes, she would have to tell him that she needed to stop.  Although he was very caring and considerate, Jane feared that if she didn't overcome her fear and anxiety, she would ruin the relationship (see my article: An Emotional Dilemma: Wanting and Dreading Love).

Her fear and anxiety confused her.  She didn't understand why she felt these emotions now when all along she had hoped that they would become more serious.  But now that they were more serious, her emotions felt out of control.

The part that confused her the most was that whenever she would start to feel happy when she was with Dan, she would begin to feel anxious.  She couldn't understand why feeling happy would make her anxious.  It made no sense to her.

As her psychotherapist listened to her childhood history, she realized that Jane was suffering with unresolved development trauma.  Jane described a childhood of emotional neglect.  Both parents were emotionally distant and spent little time with Jane, who was an only child, and who was often lonely.

The family lived from one emotional and financial crisis to another and life was very chaotic.  They also moved around a lot, so whenever Jane made friends at school, she would have to give them up because the family moved to another state.

Jane had never been in therapy before.  Throughout her life, she overcame many obstacles, and she obtained a college degree with no encouragement or financial help from her parents.  She was also successful in her career.

She had lots of friends, but the one thing that she had always felt she was missing in her life was a relationship.  Aside from wanting the companionship, Jane also wanted to have children, and she was very aware of her age and the possibility that if she waited much longer to have children, she might not be able to have them.

Jane's psychotherapist provided her with psychoeducation about developmental trauma.  She also recommended that they work on helping her to manage her here-and-now problems as well as working on the root of her problem, which was her childhood emotional neglect.

To help Jane manage her current anxiety related to her fear of positive feelings and emotional intimacy, they used Somatic Experiencing.  Using a current memory of a time when she became fearful when she was with Dan, her psychotherapist worked in a gentle way that felt manageable to Jane to help her to calm herself.

Her therapist helped Jane to become aware of the parts of her body that became anxious (her throat and stomach) and the parts of her body that felt calm (her legs).  Using the mind-body connection and visualization, Jane imagined a very slow transfer of energy--one molecule at a time--from her legs to her throat and stomach (see my article: The Body Offers a Window Into the Unconscious Mind).

Over time, Jane became adept at using visualization to transfer the sense of calmness to the anxious parts of her body, and she was amazed that she could do this.

After Jane learned to do this on her own, she and her psychotherapist did Ego States therapy where Jane imagined that she was working with her "inner child" to provide love and affection to the younger part of herself that was emotionally neglected.

This was more challenging for Jane.  By doing this work, she realized that a part of her felt that she was unlovable and she didn't deserve to have love and affection.  They had to work for many months for Jane to overcome the feeling of being unlovable (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

After Jane was able to feel she was deserving of love, she and her psychotherapist used EMDR therapy to work on her unresolved childhood trauma, which also involved months of therapy (see my article: How EMDR Works: EMDR Therapy and the Brain).

Although the work was difficult, Jane came regularly and she stuck with it because she wanted to have a healthy relationship with Dan.  Even though she had not completed therapy yet, along the way, Jane was making progress and she was feeling more comfortable with positive emotions and the emotional intimacy in her relationship with Dan.

By the time she completed psychotherapy, Jane felt she was a lovable person and she deserved to be happy.  She had also worked through her history of trauma, and she was also able to tolerate positive emotions in her relationship. She and Dan were also getting closer, and she had no problems with this.

Conclusion
Problems with positive emotions are often the result of unresolved developmental trauma.

Along with the fear of positive emotions, many people are also afraid of emotional intimacy, which makes them feel emotionally vulnerable.

Trauma therapy, like Somatic Experiencing and EMDR therapy can help to resolve developmental trauma.  Ego States therapy (also called Parts Work) is also helpful to be able to work with parts of the self that are fearful.

Getting Help in Therapy
Many people who have experienced childhood trauma have problems experiencing positive emotions.

Rather than living your entire life struggling with this fear, you owe it to yourself to get help in trauma therapy (see my article: The Benefits of Psychotherapy).

A skilled trauma therapist can help you to overcome your fear so that you can live a more fulfilling life (see my article: How to Choose a Psychotherapist).

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

I work with individual adults and couples.

I am a trauma therapist who has helped many clients to overcome trauma.

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

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

Understanding the Healthy Needs Underlying an Addiction

In prior articles, I've addressed issues related to addiction and recovery.  See my articles:

• People Who Abuse Alcohol Often Don't Get the Help They Need
• Sexual Addiction: Is a Compulsion For Looking at Porn Ruining Your Relationship?
• Sexually Compulsive Behavior as a Split Off Part of Yourself
• Overcoming Grief Gambling
• Learn to Stop Overspending as a Way to Deal With Uncomfortable Feelings   
• Early Recovery: You've Stopped Drinking. Now What?
• Early Recovery: Overcoming Feelings of Loss and Emptiness
• Early Recovery: Focusing on the "People" Part of People, Places and Things
• Early Recovery: What If 12 Step Meetings Are Too Overwhelming For You?
• Boredom as a Relapse Trigger
• Overcoming the Temptation to Use "Liquid Courage" to Cope With Social Situations

In this article, I'm focusing on understanding the healthy needs underlying addictive behavior.

Understanding the Healthy Needs Underlying an Addiction

Why Is It Important to Understand the Healthy Needs Underlying an Addiction?

People who are involved in addictive behavior, whether it's drinking, drugging, gambling, sexual addiction, overspending or any other addiction, tend to feel shame and guilt about their behavior.  This is often exacerbated by well-intentioned loved ones who don't understand and tell them, "Why don't you just stop?" 

As a result of the guilt and shame they feel, many people who engage in addictive behavior don't get the help that they need, which often leads to an eventual downward spiral.  When they're not feeling guilty and ashamed, they might be in denial about the extent of their problem, colluding with their well-intentioned loved ones by telling themselves, "I can just stop whenever I want to."

In addition to shame and guilt often creating obstacles to getting help, these feelings frequently get in the way of any self exploration about the underlying issues related to the addictive behavior. Or, the person who is abusing substances attributes only negative reasons for the abuse, "I'm a bad person" or "I'm unworthy" or "I'm unlovable" and so on.

Understanding the healthy needs underlying the addiction enables the person engaged in addictive behavior to have more self compassion and begin to explore other ways that s/he could satisfy these needs.  Secondarily, it can also help loved ones to have more compassion for the person struggling with an addiction.

Fictional Clinical Vignette: Understanding the Healthy Needs Underlying an Addiction

The following fictional clinical vignette illustrates how understanding and separating the healthy need from the addictive behavior helps the client:

Jack

Originally, Jack started psychotherapy to deal with longstanding anxiety and feelings of low self worth (see my article: Overcoming Feelings of Inadequacy).

Jack told his psychotherapist that he couldn't remember a time, even as a child, when he didn't feel anxious.  As the oldest of four children, Jack was his mother's confidante even when he was five or six years old (see my article: Children's Roles in Dysfunctional Families).

His mother tended to be anxious mostly about the family's financial well-being.  She worried that Jack's father's gambling problem would be the financial ruin of the family, and she tended to lean on Jack for emotional support, which was developmentally beyond what he could do.  All of this was emotionally overwhelming for him.

Jack attributed much of his longstanding anxiety to worrying about his parents and siblings and feeling inadequate for being unable to be the kind of emotional support that is mother needed.

In hindsight, as an adult, Jack understood that a young child wouldn't be able to take on such an emotional burden.  But this was an intellectual understanding.  On an emotional level, he continued to feel that he should have, somehow, risen to meet his mother's needs.  So, there was a split between what he knew intellectually and what he felt emotionally, which he acknowledged.

Jack had been in therapy before and he achieved insight into his problems, but it didn't change how he felt, and it didn't change his struggle with anxiety.

That's why when he decided to attend psychotherapy again, he chose experiential psychotherapy, as opposed to regular talk therapy, with the hope of having a different experienced in therapy and a possible resolution to his struggling with anxiety.

As a start, his experiential psychotherapist worked with Jack to help him develop better coping skills and internal resources to deal with his anxiety, which was helpful.  

Then, they talked about how to help him with his unresolved childhood trauma, which resulted in Jack's posttraumatic stress disorder (PTSD).  His psychotherapist provided Jack with psychoeducation about the various therapeutic possibilities in experiential therapy, including Somatic Experiencing, EMDR therapy, and clinical hypnosis.  

This was a few months into the therapy, and it was around this time that Jack admitted to his therapist that he had been smoking marijuana for over 20 years--since he was 13 years old.

He felt so ashamed and guilty about smoking marijuana that, originally, during the initial consultation when his therapist asked Jack about addictive behavior, Jack denied it.  But now that he had more of a rapport with his therapist, he wanted to be honest with her (see my article: Why It's Important to Be Honest With Your Psychotherapist). 

He was also understandable concerned about the affect of doing trauma work on his addiction and vs. versa.  

His psychotherapist told Jack that she appreciated how difficult it was for him to admit to her that he abused marijuana and that he wasn't forthcoming about it initially.  She also told him that, in addition to understanding the harmful effects of chronic marijuana use, it was important to understand the healthy underlying needs related to Jack's addiction.

Jack told his psychotherapist that during his annual medical check up, he had recently spoken to his doctor about his marijuana use, which consisted of smoking 2-3 blunts per day several times a week, and his doctor told him that the marijuana was probably contributing to Jack's anxiety.

His doctor explained that chronic marijuana use increased the risk of anxiety and depression because it appeared to inhibit the chemical dopamine in the brain.  He also provided Jack with information about the research that substantiated these facts.  In addition, his doctor recommended that Jack stop using marijuana and tell his psychotherapist about his use.

Jack said that, until he tried to stop on his own, he always believed that he could stop smoking marijuana whenever he wanted to stop.  That's what he told himself and his wife,who wanted him to stop.  But when he attempted to stop on his own, he discovered that, although he didn't have a physical addiction to the drug, he realized that he had a psychological dependency, and he couldn't go more than a day without smoking marijuana.

Initially, Jack was focused on the negative consequences to his addiction:  He feared making himself more anxious and developing depressive symptoms; he noticed some problems with his memory,which he and his doctor attributed to long-term marijuana use; he was tired of "being in a fog"most of the time; he was concerned that his wife might get fed up with his addiction and leave him; and he was also concerned about how much money he was spending on marijuana, which he would rather spend on other things that he and his wife wanted to do--like saving for a down payment on a house.

In addition, Jack was aware that he and his therapist wouldn't be able to work on his unresolved trauma until he was sober.  His therapist explained that until he had a period of sobriety, it wouldn't be wise to start trauma therapy because when disturbing issues came up in therapy, Jack might feel an increased need to go home and smoke marijuana.

Also, even if Jack gave up smoking marijuana, his therapist explained, he might take up another form of addiction, like drinking excessively or gambling or some other form of addictive behavior (see my article: Understanding Cross Addiction: Substituting One Addiction For Another).

His psychotherapist acknowledged that these were all very important factors for Jack to consider.  In addition, she also asked Jack to consider what he got out of smoking marijuana.  Jack said he had never thought about this before. But, as they continued to explore what he got out of smoking marijuana, Jack realized that it used to help him to feel more comfortable in social situations--although, lately, it wasn't helping him as much because the chronic use made him anxious.

Jack and his psychotherapist continued to explore this healthy need underlying his drug abuse.  At first, it was difficult for Jack to separate the healthy need from the unhealthy consequences of his using the drug.  Whenever they began to explore how important it was for Jack to feel connected to his friends and what he got out of these friendships, he would revert back to shaming himself about his addiction.

It took a while before Jack could set aside his guilt and shame to separate out the healthy need from the unhealthy use.  His psychotherapist would continuously bring Jack back to separating out the healthy need--what Jack was attempting to accomplish by using marijuana.

Eventually, when he was able to put aside his guilt and shame, he began to appreciate the healthy need while, at the same time, acknowledging the unhealthy aspects of abusing the drug.

As he developed a deeper and more self compassionate understanding, he became less judgmental about his use and more open to discovering other ways to become feel more comfortable socially.  In order for Jack to get to this point, it was necessary for him to work with his therapist to reduce his shame and guilt.

Once Jack had a sustained period of abstinence and he didn't engage in any other addictive behavior, he and his psychotherapist began to work on his unresolved childhood trauma.

Conclusion
People who engage in addictive behavior are often, initially, in denial about their problem.  Once they are no longer in denial, it's not unusual for them to experience guilt and shame as they deal with the consequences of their abuse to themselves and their family members.

If they remain stuck in guilt and shame without appreciating the healthy underlying needs that contribute to the addiction, it's usually harder for them to stop the addictive behavior because they get caught in a cycle of shame and abuse.

With the help of a skilled psychotherapist, they can begin to separate out the healthy need from the abuse.  An appreciation for the healthy need helps the client to be more self compassionate with less guilt and shame.  It also usually provides an opening for healthier behavior to take care of those needs.

Getting Help in Therapy
If you're struggling with unhealthy addictive behavior, you could benefit from getting help in psychotherapy (see my article: The Benefits of Psychotherapy).

A psychotherapist who has experience with working with addiction and helping clients to understanding their healthy needs can help you to overcome addictive behavior (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, seek help from a skilled mental health professional.

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 from 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 Experiential Psychotherapy Can Facilitate Emotional Development in Adult Clients

In prior articles, I've discussed experiential psychotherapy and how it helps clients in therapy to overcome emotional problems, including:

• Experiential Psychotherapy and the Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind

• What's the Difference Between Top-Down and Bottom-Up Approaches to Psychotherapy?

• Using Somatic Psychotherapy When the Client Has No Words to Describe the Problem

• Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone

How Experiential Psychotherapy Can Facilitate Emotional Development

In this article, I'm focusing on how experiential psychotherapy can facilitate emotional development in adult clients who who grew up in childhood homes where there was no one to share and help process emotional experiences.

Tracking Clients' Emotional Expression During the Psychotherapy Sessions 
A psychotherapist who practices experiential psychotherapy usually tracks clients' emotional expression as they talk about the issues that brought them to therapy.  She does this by watching and listening to clients and how they expresses themselves as they talk about traumatic experiences.

Some of the problem areas that an experiential psychotherapist will track will include the clients' use of defense mechanisms:

• Clients, who use the defense mechanism of isolation of affect as their primary defense mechanism, will often talk about traumatic experiences with little to no emotion.  They might relate a horrendous family history in the same matter-of-fact tone that they would give a news report from another part of the world. When the therapist is tracking the clients' emotional expression, she will detect this disconnect between emotions and a traumatic experience, and this will inform her as to where the work needs to focus.

• Clients, who use minimization as their defense mechanism, might have more of a range of emotional expression when they talk about traumatic experiences but, at some point, they might cut off their emotions and minimize the impact of the trauma ("My father use to beat me, but that's how it was back then in a lot of families.  Every parent did it, so I guess I shouldn't complain").  By noting that the client began by relating the trauma experience with emotion and then defensively cutting off the emotion by minimizing the negative impact of the trauma, the psychotherapist notes how the client wards off feelings, and she can work with the client on this.

• Intellectualization is another defense mechanism that clients often use when they are defending against feeling the emotional pain related to traumatic experiences.  Rather than allow themselves to feel the pain, they cut off their emotions by relating their trauma in a logical way with little to no affect.  The experiential psychotherapist will notice this defense mechanism and work towards helping the client to connection emotionally to the trauma so the trauma can get worked through.

• Other clients are not sure how they feel about their traumatic experiences.  They might have a very narrow range of affect because there was no one available when they were growing up to help them process difficult emotions.  As an emotional survival strategy, when they were children, these clients learned to feel as little as possible, especially emotions that made them feel uncomfortable, to keep from being overwhelmed and maintain an attachment to their parents.  As adults, they might not be able to identify their so-called "negative emotions," so the psychotherapist will know that this will be part of the work.

There are many other examples where a psychotherapist, who practices experiential psychotherapy, will detect clients' problems with emotions and use the therapy to help facilitate emotional development, but the examples above give you an idea of the type of problems that can come up that indicate a need for help with emotional development.

With tact and empathy, an experiential psychotherapist can begin to talk to clients who are having problems with experiencing and expressing their emotions and address their defense mechanisms.

This would include psychoeducation about how these defense mechanisms were necessary earlier in life to survive emotionally, but they are now getting in the way.

Facilitating Emotional Development in Experiential Psychotherapy
This is important because if clients continue to use defense mechanisms to ward off their emotions, their emotions remain constricted and buried under their defenses, so that the psychotherapist and the clients cannot get to the core emotions involved in the problem in order to resolve the trauma.

Depending upon the particular client and the type of defense mechanisms that they use, some of the ways that the experiential psychotherapist will facilitate emotional development would be by:

• Establishing a strong therapeutic alliance in therapy so the client realizes that, unlike when s/he was a child and felt alone with uncomfortable emotions, s/he now has a caring psychotherapist who will be a "witness" to the client's history and provide emotional support.

• Empathically attuning to the client and paying attention to the client's conscious and unconscious communication in the therapy sessions.

• Helping the client to be aware of how s/he uses defense mechanisms to avoid feeling certain emotions ("I'm wondering if you're aware of how you tend to look away and drift off when you talk about the emotional neglect that you experienced as a child?)"

• Asking the client, when s/he is ready, to try to not use the defense mechanism that s/he usually uses to see what that's like.  If the client says that it would be unbearable to experience these emotions, the psychotherapist will not push the client beyond where s/he can go, but would take smaller steps to facilitate emotional development.

• Helping the client to expand his or her window of tolerance if the client has only a limited threshold for experiencing difficult emotions.  

• Assisting the client to identify emotions by helping him or her to locate emotions in the body ("I notice that your hands are clenched and your jaw looks tight when you talk about how your mother humiliated you in front of your friends when you were a child.  When you focus on your clenched hands and tight jaw, what emotions are you feeling?").  This helps the client to connect emotions within the body, which will assist the client to identify and express emotions.

Engaging in Metaprocessing of Experiential Therapy in the Session
For clients who were abused or neglected as children, emotional development in psychotherapy is ultimately healing and allow for the working through of unresolved trauma.

But along the way, it can be challenging, so the experiential psychotherapist will do metaprocessing with clients at the end of the therapy session to discuss how clients experienced the work.

This helps the client to understand his or her reactions to the work in therapy, and it also allows them integrate the changes that they are  making.  Some examples might include:

• "You did a lot of good work today in session.  What was it like for you to begin to experience emotions that you have been avoiding for most of your life?"

• "You were able to feel the grief of your loss today for the first time.  What was that like for you?

• "You were able to talk about things that you haven't been able to discuss before.  What was that experience like for you today?"

Encouraging the Client to Retain Therapeutic Gains Between Sessions
Defense mechanisms that have been used for a lifetime to ward off uncomfortable feelings don't just disappear after a few sessions.  They have been clients' default mode and will often reappear between sessions and sometimes even in the same session, which is why it's so important for experiential psychotherapists to metaprocess with clients at the end of the session.

Many clients, who have unresolved trauma, often walk out of the therapy session and forget the therapeutic gains they made during the session.  It's as if they leave these gains and their memories of the session in the therapy room.

It can be frustrating for clients when they return for their next session and they realize that they have little to no memory of what they experienced in the prior session.  They might feel like they're starting at "Square One" again at each session.

To try to help clients to retain the therapeutic gains they achieved, experiential psychotherapists often encourage clients to keep a journal between psychotherapy sessions (see my article: The Benefits of Journal Writing Between Psychotherapy Sessions).

By writing about their thoughts, emotions, fantasies, memories, physical reactions and whatever else comes up related to the therapy session, clients are more likely to retain and integrate the therapeutic gains achieved in the prior therapy session so they're ready to continue the work in their next session.

Helping Clients to Reflect On and Consolidate Therapeutic Gains
Many clients who come to therapy to resolve trauma are in significant emotional pain and they are, understandably, in a hurry to work through traumatic experiences.  As a result, they might have unrealistic ideas about how long it will take in therapy to resolve problems they have had for a lifetime.

An experiential psychotherapist helps clients to realize that therapy isn't something that is "done" to them.  It is a collaboration between the therapist and the client, and each client is different in terms of how long it will take to resolve traumatic experiences.

The experiential psychotherapist is constantly assessing and reassessing the client in terms of what s/he needs from the therapist and how far s/he can go without being overwhelmed by the work.

This is an important clinical judgment call the therapist has to make in order to keep the work moving as long as it is emotionally tolerable for the client.  It would be detrimental to the work and retraumatizing for the client if the therapist attempted to push the client too quickly.

Many clients, who want to work through trauma, come to therapy after avoiding it for many years.  So, after they acknowledge that they need help, they want to make up for lost time and they're unaware of the negative clinical implications of moving too quickly and being emotionally overwhelmed in therapy.

So, an experiential psychotherapist will help the client to reflect on the work that has been done so far.  She will remind the client of where the client started in therapy (i.e., unable to tolerate uncomfortable emotions) and how far s/he has come (i.e., able to tolerate increasingly difficult emotions).

Why is this important?

For one thing, many traumatized clients have difficulty giving themselves credit for positive achievements, especially if they grew up in households were "perfection" was considered the norm.  So, it's important for the psychotherapist to remind the client of his or her progress so s/he can have a sense of pride about it.

Another issue is, as mentioned before, that clients, who have an unrealistic idea of the time frame for overcoming their traumatic experiences, often need a reminder of how far they have come from where they started.

If they're only focused on, "I'm not where I want to be yet," they will be likely to run roughshod over themselves--in much the same way as they were treated by their parents when they were children.

An experiential psychotherapist will provide clients with psychoeducation that progress in therapy isn't linear, respond to their concerns ("My friend completed EMDR therapy in only 10 sessions.  Why am I still processing my trauma with EMDR?) and remind them not to compare themselves to others because everyone is different.

Conclusion
Clients who have a traumatic history often have problems experiencing their emotions.

For some clients, this means that they are unable to feel what they are experiencing because of defense mechanisms they developed in childhood as part of a much-needed emotional survival strategy at the time.

Other clients will have only a narrow range of emotions that they allow themselves to experience (e.g., they can experience anger and frustration, but allowing themselves to feel sadness makes them feel too vulnerable).

The experiential psychotherapist tends to work differently than most talk therapists by helping the client to not just talk about their problems but to work through their issues in a more in-depth experiential way.

Experiential psychotherapy, like EMDR therapy, Somatic Experiencing and clinical hypnosis, is more effective than regular talk therapy.

Getting Help in Therapy
Most people who have a history of emotional trauma are unaware of how their history is impacting their current life.  As a result, they never seek the help they need in therapy (see my article: The Benefits of Psychotherapy).

If you have been struggling with unresolved problems, you owe it to yourself to get help from a skilled experiential psychotherapist (see my article: How to Choose a Psychotherapist).

Once you free yourself from a traumatic history, 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 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.

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.