What is Accelerated Experiential Dynamic Psychotherapy (AEDP) and How Does AEDP Heal Trauma - Part 2

In Part 1 of this topic, I began a preliminary discussion about Accelerated Experiential Dynamic Psychotherapy (AEDP) and how it works.  In the current article, I provide a clinical vignette to illustrate how AEDP works.

AEDP Heals Trauma

As mentioned in Part 1, AEDP was developed by Dr. Diana Fosha, and AEDP is based on many different disciplines, including:

• attachment theory
• affective neuroscience
• trauma research
• developmental research
• mind-body/somatic therapy
• emotion therapy
• phenomonology (the study of subjective experience)
• transformational studies

Clinical Vignette: AEDP in a Therapy Session
The following clinical vignette is a composite of many different cases where AEDP is used to heal trauma:

Ted
Before Ted sought help from an AEDP therapist, he had been in many different types of therapy over the years.  He explained to his AEDP therapist that, although he developed intellectual insight into his problems in his prior therapies, nothing changed for him on an emotional level (see my article: Healing From the Inside Out: Why Insight Isn't Enough to Heal Trauma).

He said he was still struggling with crippling shame that had a negative impact on his personal life as well as his career (see my article: Healing Shame in Therapy).

Ted explained that he was about to turn 45 and he was worried that he would never overcome the shame he had since childhood.  He said he decided to try AEDP because a friend had a very good experience with it.

His AEDP therapist started the consultation by being empathetic and welcoming, which helped to put Ted at ease.  As part of AEDP, she noticed how Ted's facial expression, gestures and body language conveyed the shame he said he was struggling with for many years.

As Ted got more comfortable in the session, he told his therapist, "I'm surprised that I can feel so comfortable with you so quickly.  Usually it takes me at least a few weeks to feel comfortable enough to open up."

Part of the AEDP therapist's role is noticing and emphasizing the somatic markers for positive feelings.  So, to amplify Ted's feeling of comfort, his therapist asked Ted where he noticed that feeling of comfort in his body (see my article: The Body Offers a Window Into the Unconscious Mind).

Ted took a moment to notice where he felt the sense of comfort in his body and then he put his hand over his stomach, "I feel it in my gut."  In response, his therapist asked Ted if he would be willing to stay with that sensation of comfort, and he nodded.

Ted closed his eyes and allowed himself to relax into that sensation of comfort, and his therapist noticed that his whole body relaxed.  Then, after a minute or so, Ted said that along with that feeling of comfort, he was now beginning to feel sad because he recognized that it was so rare for him to feel this way.

Ted's AEDP therapist knew that this is a typical response during the initial stage of therapy for people who have experienced trauma.  The positive feeling often brings up sadness when people compare the positive feeling with the emotional deprivation they experienced in the past.

After a few moments, the feeling of sadness subsided, and Ted's therapist observed that he had just gone through a wave of emotion.  She explained that emotions usually come in waves, similar to waves in the ocean with a surge, a peak and then an ebbing away of emotion.

Ted was able to return to the feeling of comfort and a sense of openness. He said he was usually anxious and guarded in most situations, but he didn't feel that way in this therapy session (see my article: The Creation of the Holding Environment in Therapy).

By the end of the session, his therapist explored with Ted what it was like to have this experience of comfort, which was so rare for him.  Ted said it helped him to feel safe in the session--a feeling that he rarely had anywhere.

Then, his therapist, who understood that AEDP is a relational experience between the client and the therapist and observed Ted's openness, asked Ted what it was like to have this sense of comfort and to have it with her.  Ted responded that he was surprised and pleased. He said he hadn't expected to feel this way with her, especially during an initial therapy consultation.

This type of exploration is called "metaprocessing" in AEDP.  Part of the value of doing metaprocessing is that it brings it brings together both right brain (emotions) and left brain (putting words to feelings) processing.  Another part is that, as previously mentioned, it emphasizes the importance of the therapeutic relationship between the client and the therapist.

Over time, Ted talked about shame he felt as a child with a highly critical father.  His therapist helped Ted to develop the internal resources to deal with the trauma work they would be doing on his shame.  All the while, she continued to pay attention to Ted's emotions and she titrated the work so that it wouldn't be overwhelming for Ted.

During one AEDP session, Ted talked about feeling angry with his father for shaming him at a big family gathering when he was five years old after Ted spilled juice on his clothes. He remembered that his father got very upset and yelled at him for being "so stupid and clumsy." He said this memory was typical of many memories where his father shamed him.

He also remembered feeling so deeply ashamed that he wanted to run and hide.  In addition, even at that young age, he sensed how intimidated everyone was, including his mother, by the father's temper and bullying behavior.

As part of helping Ted to feel a positive experience he could use as a resource, his therapist asked Ted to remember a time when he was feeling proud of himself.  She told him that it could be from any time in his life.

In response, Ted thought about that for a few moments, and then he said he felt proud on the day he graduated from college.  He told his therapist that he graduated with honors, and one of his professors, who was kind and encouraging, helped him to adjust to being away at college.  He recounted how seeing that professor on graduation day made him feel so cared about and proud.

His therapist recognized that Ted was ready to do a "portrayal" (imaginary work, similar to Gestalt chair work) with regard to his anger towards his father, and the professor as well as his sense of pride on graduation day would be good internal resource for Ted.  So, she asked Ted to stay with those positive feelings.

After a few moments, Ted was able to identify a feeling of calm and confidence in his gut as he thought about these positive memories.  His therapist asked Ted to stay with those positive feelings and, after a few seconds, Ted said he felt these positive emotions getting stronger and he noticed that they were expanding from his gut to his throat.

His therapist asked Ted if he would like hold onto that sense of calm and confidence, the image of that professor, and imagine talking to his father in that earlier memory. Ted said he would be willing to do this, so he went back into that memory where his father was berating him at the family gathering.

His therapist helped him to stay within his calm and comforted adult self to look at his humiliated child self, and Ted responded, "I'm looking at that child and I feel sad for him.  I'm also feeling protective towards him.  He didn't deserve to be treated that way.  He was only a child."

With the image of his professor in his mind and the positive emotions he was feeling as his adult self, Ted imagined himself confronting his father, "Stop yelling at him. He's only a child."  He imagined that his father was so surprised and speechless because no one ever confronted him in this way.

Then, Ted imagined taking his child self in his arms hugging him and rubbing his back.  As he did this, his therapist asked Ted to switch his consciousness to being his child self to feel what it was like to receive this comfort and love, and Ted said that, as his child self, he could relax into that hug and he felt protected (see my article: Having a Dialogue With the Different Parts of Yourself).

Afterwards, his therapist helped Ted to process what this experience was like for him, and Ted said he never felt this way before.  He said that he felt comforted and calm, and he also felt happy and strong to be able to confront his father.  He told his therapist that it wasn't nearly as scary as he thought it would be, especially because he imagined coming from a confident stance with his supportive professor with him.  He also said he felt his therapist's presence, which also helped him during this portrayal where he confronted his father.

His therapist explained that doing parts work, which is working with the various aspects of himself, including the adult self, child self and other parts of himself, is part of AEDP (see my article: Understanding the Different Aspects of Yourself That Make You Who You Are).

Whenever his AEDP therapist did parts work as part of a portrayal, she made sure that Ted was coming from an internally resourced, strong, confident place within himself first.

AEDP therapists know that clients often felt alone when they were going through the original trauma, so, as therapists, they need to be present and resonate with clients as they are processing trauma to undo that feeling of aloneness.  This allows the client to have a new experience with the memory of trauma so that they no longer feel alone with it.  This is part of reworking the trauma.

Gradually, Ted overcame the crippling shame that held him back in his personal life and in his career.  Not only did he have insight into his problems, but he also felt the healing benefits of AEDP as an experiential therapy.

Conclusion
The goal of AEDP is not just to help clients to develop insight--although insight is important.  The goal of AEDP is to help clients to transform and heal.

The vignette above illustrates some ways that AEDP therapists help clients to heal.

As mentioned in my prior prior article, AEDP is an evidence-based, cutting edge, experiential therapy.  It incorporates many different approaches, and AEDP therapists work in an empathetic and dynamic way.

AEDP interventions are designed to help the client to access a feeling of strength and calm by using positive memories and resources (like the positive memories in the vignette above) as a lens through which to approach traumatic memories.

Getting Help in Therapy
If you have been struggling to overcome problems, you're not alone.  Help is available to you (see my article: What is a Trauma Therapist?).

The AEDP Institute has a directory of AEDP therapists in the US and all over the world.

Rather than struggling on your own, seek help from an AEDP therapist so you can live a more fulfilling life.

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

I work with individual adults and couples.

I am currently providing teletherapy sessions, which are also known as online therapy, telemental health and telehealth (see my article: The Advantages of Online Therapy).

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 regular business hours or email me.

What is Accelerated Experiential Dynamic Psychotherapy (AEDP) and How Does AEDP Heal Trauma? Part 1

Accelerated Experiential Dynamic Psychotherapy (AEDP) is a cutting edge, evidence-based, in-depth therapy that focuses on the healing and transformation of clients' traumatic experiences (see my article: What is a Trauma Therapist?).

What is Accelerated Experiential Dynamic Psychotherapy (AEDP)?

What is Accelerated Experiential Dynamic Psychotherapy (AEDP)?
AEDP was developed by New York City-based psychotherapist and researcher, Dr. Diana Fosha, who wrote the book The Transforming Power of Affect: A Model of Accelerated Change.

AEDP is based on many different disciplines, including:

• attachment theory
• affective neuroscience
• trauma research
• developmental research 
• mind-body/somatic therapy
• emotion theory
• phenomonology 
• transformational studies

How Does AEDP Heal Trauma?
The primary goal of AEDP therapy is to help clients to have a transformative experience in order to  overcome psychological trauma. 

An AEDP therapist recognizes that the original experience of the trauma left clients feeling alone and overwhelmed, so one of primary goals of AEDP therapy is to "undo aloneness" in the therapy (see my article: What is the Corrective Emotional Experience in Therapy?).

In contrast to a more traditional psychotherapists, AEDP therapists are active and dynamic participants in the therapy with their clients.

Active empathy is also one of the hallmarks of AEDP therapy so that clients have a felt sense of being cared about by the therapist (see my article: Why is Empathy Important in Psychotherapy?).

In doing so, the therapist is directly involved with helping clients to bear the weight of overcoming traumatic experiences (see my article: The Healing Potential of the Therapist's Empathic Attunement).

In contrast to many traditional psychotherapists, who tend to pathologize the original strategies clients developed to cope with trauma, an AEDP therapist recognizes that these strategies helped clients to get through overwhelming experiences as best as they could at the time (see my article: A Strengths Based Perspective in Psychotherapy).

There is a recognition that the clients' strategies saved them from being completely overwhelmed by traumatic events.  There is also a recognition in AEDP that, although these coping strategies were the best that clients could do at the time, they no longer serve clients and, instead, they are now obstacles to living a full life.

How Does an AEDP Therapist Work?
AEDP's stance is that from the get-go everyone has an internal capacity to heal.  They believe that this internal capacity to heal is inherent in everyone.  So, an AEDP therapist helps clients to access this inherent healing capacity.

This means that the therapist helps clients to access their self-at-best in order to begin processing trauma (see my article: Developing Internal Resources in Experiential Therapy). So, part of the AEDP therapist's job is to help clients to access these untapped internal resources.

From an AEDP perspective, there are many ways to help clients to tap into these internal resources.  For instance, the AEDP therapist might help clients to remember times when they felt strong and confident, which would be an experience of their self-at-best.

This would include helping clients to have an emotional, embodied experience--not just an intellectual experience--of what it's like to feel strong and confident based on clients' own memories.

This is important because we now know that positive transformation, which is the primary goal of AEDP therapy, occurs on an embodied, emotional level--not just by intellectual insight alone.  In other words, clients need to have a visceral and emotional sense of transformation.

From this experience of feeling strong and confident, clients are able to approach traumatic memories in a more internally resourced way.

AEDP helps clients to overcome obstacles to healing, including maladaptive coping strategies, so that their true, authentic selves can emerge (see my articles: Becoming Your True Self and Living Authentically).

See Part 2 of this topic.

Getting Help With AEDP Therapy
If you have been struggling emotionally, you're not alone.

An AEDP therapist can help you to heal from trauma.

The AEDP Institute maintains an international directory of AEDP psychotherapists in the United States and all over the world.

Rather than struggling on your own, seek help from an AEDP therapist so you can heal from trauma and live a more fulfilling life.

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

I work with individual adults and couples.

I believe that everyone has an inherent capacity to heal from trauma, and the therapist's role is to help clients access that ability to heal.

I am currently providing teletherapy, which is also known as online therapy, telemental health and telehealth (see my article: The Advantages of Online Therapy).

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 regular business hours or email me.

How to Talk to Your Partner About Sex - Part 2

I began a discussion on how to talk to your partner about sex in my prior article with suggestions, including do's and don'ts to introduce the topic with your partner. In this article, I'm providing a clinical vignette to illustrate typical sexual problems in a relationship and how a couple is able to work through these problems in couples therapy.

How to Talk to Your Partner About Sex

A Common Problem: It Can Be Hard to Talk About Sexual Problems With a Partner
As an experienced therapist who works with individuals and couples, I have found that many people have difficulty talking to their partner about sex, especially when there are problems.  Even in relationships where people have been together for many years, they often feel shy or awkward to talk about sex with a partner.

Why Is It Hard to Talk About Sex With a Partner?
There are many reasons why people feel uncomfortable and avoid talking about sex, including:

• Cultural or Religious Taboos: It's not unusual for people, who were raised in a particular religion or culture where talking about sex is taboo--even with a spouse of many years, to experience difficulty in expressing their sexual needs or talking about sexual problems.

• Family History: For people raised in a family where sex was seen as "dirty" or secret, talking about sexual problems can be challenging. Also, in families where there were poor boundaries around sex (e.g., parents walking around naked in front of children or having sex in front of or within earshot of children), these children often grow up to be adults who experience problems with sex in their relationship.

• Sexual Trauma: When there is unresolved sexual trauma (for either a man or woman regardless of sexual orientation), it's often difficult to separate out the traumatic experience from the current relationship.  The act of being sexual in the current relationship can trigger memories of being sexually abused, which makes it hard to talk about sex or to even engage in sexual activities with a partner.

• Body Shame: Many people, especially women, feel ashamed of their body. There are many reasons for this, including a history of being shamed about their body, sexual abuse, popular and unrealistic images of men's and women's bodies, etc. So, talking about sex, which involves the body, feels too embarrassing.  

• Fear of Being Rejected: For many people the idea of initiating a discussion about sex with their partner brings up fears of being rejected. Their fear might involve an outright rejection of them or a fear that their partner might also have things they don't like about them with regard to their sex life. This fear often inhibits people from bringing up the topic of sex.

There are also countless other reasons why people avoid talking about sex with their partner.  This avoidance ensures that the problem probably won't be resolved with the possible effect that the couple grows apart (see my article: Relationships: How to Get Closer When the Two of You Have Grown Apart).

Clinical Vignette: How to Talk to Your Partner About Sex
The following fictional vignette is a composite of many different cases so that there are no identifying features of any one person or couple. This case illustrates the sexual presenting problem, the effect of the problem on the relationship, and how it gets resolved in couples therapy.

Amy and Joe
By the time Amy and Joe came to couples therapy, they were already considering divorce.  In their mid-40s and married for 20 years with children, they decided to try couples therapy to see if they could salvage their relationship before they filed for divorce.

Just like many other couples who come to couples therapy, Joe and Amy told their couples therapist that they had "communication problems."  For many couples, presenting their problem to the couples therapist as a communication problem takes away some of the shame and awkwardness they feel about coming to couples therapy (see my article: Mental Health Awareness: Reducing the Stigma of Going to Therapy).

Their couples therapist recognized that, in a general way, they did have communication problems, but this description of their problem was too vague.

Knowing that many couples come to couples therapy because they're either having problems with sex or money (or both), the therapist normalized this by asking each of them specific questions, including questions about their sexual satisfaction in the relationship.  She had already informed them, when they called for the consultation, that a sexual assessment was part of the initial stage of therapy, so they were aware that they would be asked these questions.

Initially, both Amy and Joe hesitated before they responded.  They looked at each other awkwardly as if to get a response from the other as to what they should say.

In response, the therapist told them that problems with sex is a common reason for coming to couples therapy for many couples.  Once again, this was a way of normalizing the topic of sex by letting them know that it's a common problem for many couples.

In response, Amy laughed nervously, "Gee. I didn't know that. I always assumed that everyone else is having 'swinging off the chandeliers' sex every night."

With a reddened face and looking down at the floor (rather than at Amy or the therapist), Joe said, "So, you think everyone else is having more and better sex than we are?"

Amy just looked away rather than respond, so Joe, who was sitting right next to Amy on the therapist's couch, said, "You're not saying anything, so I'm guessing that you have a problem with our sex life that you haven't told me about. Is that right?"

Looking away from Joe, Amy winced, "Well..."  And then she stopped and looked at the therapist as if for guidance.

So, the therapist stepped in at that point and said, "It seems to me that you both still care about each other--otherwise, you wouldn't be here. When you contacted me for the consultation, I mentioned to you that I get a sexual history from each person in the relationship for every couple that I see.  Why don't we start with me getting a sexual history from each of you" (see my article: Why It's Important to Talk to Your Therapist About Sexual Problems).

Based on the sexual history assessment that the therapist did for Joe and Amy, she found out the following salient facts:

• Neither Joe nor Amy had much sexual experience with each other or with others before they got married.
• Despite their limited sexual experience prior to marriage, each of them assumed, before they got married, that their sex life would work out on its own without having to talk about sex and without having to put in any effort.
• Both of them felt awkward talking about sex with each other and would prefer to avoid it if they could.
• Amy's family was very religious and neither parent ever talked to her about sex. Sex was considered a taboo subject in her family. She found out about sex by reading books when she was a teenager, but she never discussed what she read with anyone.
• Amy didn't get her period until she was almost 14 years old. She was self conscious at school because all the other girls had already developed breasts, but she was "flat chested" (her words). As a result, the boys in her junior high school often teased and body shamed her about this, which made her feel even more ashamed. She never told anyone about this until now.
• Joe's family was the opposite of Amy's family: His parents had very loose boundaries. They often walked around naked in front of Joe and his siblings.  They would also have sex in the living room after they thought Joe and his siblings were asleep.  But, in fact, Joe and his brothers and sisters would hear them and feel uncomfortable and embarrassed.
• Ever since he entered into puberty, Joe felt ashamed of his penis size.  When he was in high school, the other boys in the locker room would brag about having big penises and about their sexual conquests. This made Joe feel ashamed.  The few times that he was sexual with other women, before he met Amy, he never wanted women to see his penis, so he always insisted on having sex in the dark.  He secretly feared that, due to the size of his penis, he couldn't satisfy women sexually, which contributed to his shame about sex and his sexual awkwardness--even with Amy.
• Both of them denied a history of sexual trauma or abuse.
• Joe had a vague sense that he wasn't satisfying Amy sexually, but he felt too ashamed to talk to her about it.
• Amy often "zoned out" during the rare occasions when she and Joe had sex. She rarely had an orgasm, and she usually couldn't wait until it was over.
• Neither of them felt comfortable talking about sex initially, but answering the therapist's questions from her sexual assessment made each of them realize that they weren't the only couple who had these problems.
• Both denied any extramarital affairs during the marriage.
• Both of them eventually admitted that they were dissatisfied with their sex life together, but both felt too ashamed to discuss it before coming to couples therapy.

Gradually, Amy and Joe were able to open up more about their sex life in couples therapy.  Amy was the first one to broach the topic of their almost nonexistent sex life in the last several years.  After hearing Amy speak, Joe said, "I thought you didn't want to have sex, so I didn't want to bother you."  In response, Amy turned to Joe and said, "That's weird--because I thought you weren't interested and I didn't want to bother you about it."

Over time, they were able to talk about being somewhat satisfied with their sex life when they first got married.  Each of them acknowledged that this changed after they had their second child.  They often felt too exhausted to have sex and they also stopped prioritizing their sex life--until it dwindled to having sex, on average, once every few months.

The more they were able to talk about their sexual history, the freer each of them became to talk about the problems in their sex life.  Prior to this, they weren't sure what caused them to drift apart (leading to talk about a divorce).  Each of them just assumed that the other wasn't interested in the marriage anymore.

They each said that they still felt sexually attracted to the other.  They also agreed to go away on a relaxing vacation to rekindle their relationship.

When they returned, they seemed much closer. They also told their couples therapist that they made love several times while they were away on their weeklong vacation.

Amy talked about being bold enough to bring sex toys on their vacation, which they had fun using. She said she had more consistent orgasms while they were away.  In addition, she told their couples therapist that she had developed a new appreciation for her body, including her small breasts, and sh realized that Joe still found out attractive.

Joe talked about being more sexually adventurous about exploring different sexual positions.  He also discussed that they engaged in oral sex for the first time, both fellatio and cunnilingus, and they found it fun and enjoyable.

Using Emotionally Focused Therapy (EFT) For Couples, their therapist helped them to identify and change the patterns in their relationship that were causing problems for them.  They continued to make progress and they each made a commitment to save their relationship by continuing in their couples therapy.

Conclusion
Regardless of sexual orientation, age, race or other identifying factors, sexual problems are common in many relationships.

There can be many factors that contribute to the problems, which can be addressed and overcome in either individual or couples therapy.

The fictional vignette presented above gave a particular set of problems, but there are many other types of sexual problems.

Getting Help in Therapy
If you and your partner are having sexual problems, rather than avoiding the problems, you owe it to yourselves to get help.

Resolving the sexual problems in your relationship can rekindle and salvage your relationship.  So rather than waiting, get help from an experienced therapist who works on these issues so you can have a more satisfying relationship.

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

I work with individual adults and couples.

I have helped many individuals and couples overcome problems related to sex, including sexual trauma.

I am currently providing teletherapy, also known as online therapy, telemental health and telehealth (see my article: The Advantages of Online Therapy).

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 to Talk to Your Partner About Sex - Part 1

Let's face it--talking to your partner about sex can be hard, especially when you're not satisfied with your sex life. But the basis of any good relationship is good communication, whether it's about sex, money, changes in your life or anything else that's significant (see my articles: Have You and Your Spouse Stopped Having Sex?,  What is Sexual Desire Discrepancy? and Overcoming Sexual Desire Discrepancy).

How to Talk to Your Partner About Sex

You know that not talking about the problem isn't going to make it go away. If anything, this problem usually gets worse because your needs aren't getting met, the dynamics aren't changing, and you're probably becoming increasingly resentful about the problem.  

Since the problem isn't going to go away by itself, it's better to address the problem instead of avoiding it, as many couples do. If anything, talking about improving your sex life can bring the two of you closer together.

Talking to Your Partner About Sex: Do's and Don'ts:

• Be Sensitive to the Timing of Your Discussion: Don't talk to your partner about problems in your sex life during or after sex. Bringing up a discussion about the problems in your sex life either while you're having sex or just after you have sex is bound to make your partner feel defensive and hurt.  Instead, find a time when you're both getting along--possibly over dinner if you have privacy or some other neutral time.

• Don't Start Out Angry, Criticizing or Blaming: One of the worst things you can do when you want to talk to your partner about sex is to start out by accusing your partner of not loving you, blaming your partner for sexual problems (after all, there are two people involved) or accusing your partner of having an affair (unless you have good reason to believe this and then this should be a separate conversation).  If you start out angry, blaming or criticizing, as many people do out of their own anxiety about the topic, you're not going to resolve the problem, and you will probably create even bigger problems. 

• Don't Throw the "Kitchen Sink" Into the Discussion: Limit your conversation to your sex life. Now isn't the time to list all your grievances about the relationship. Not only is that counterproductive to getting the problem resolved, it also complicates the discussion with too many problems to tackle at once.

• State the Problem in a Positive and Tactful Way: Instead of saying something like, "I think you don't love me anymore because we hardly have sex," state the problem in a positive way, "When we have sex, I feel closer to you. What can we do to have sex more often?" This doesn't mean that you demand sex when your partner is exhausted or has had a bad day. That will, rightfully, come across as selfish and uncaring. Instead, part of the discussion might be the best times for the two of you to have sex when you're both ready for it and have the privacy for it.

• Take the Awkwardness Out of Talking About Sex: If you feel comfortable enough with your partner, instead of approaching your discussion in a stiff and constricted way, depending upon what the problems is, you can be seductive. For instance, if you want your spouse to kiss you in a certain way, you can suggest it in a playful, seductive way, "I just love it when you kiss my neck. It really turns me on.  Can we try that?"

• Take Responsibility For Your Part in the Sexual Dynamic: There might be aspects of your sex life that your partner isn't pleased about.  So, when you open a dialogue about your sex life, be open to hearing things that your partner might want to change. Don't get defensive or angry. Just be open and curious to listen to what your partner tells you.  

• Be Aware That There Can Be Physical or Trauma-Related Problems Involved: Sexual problems aren't always about a lack of desire. Sometimes there are physical problems that might need to be addressed.  For instance, some men have a low libido due to low testosterone levels, which might need to be addressed medically.  Similarly, some women experience sexual intercourse as painful for a variety of reasons, including: problems with lubrication or vulvodynia (painful intercourse due to yeast infections or pelvic inflammatory disease). A history of sexual abuse for either partner could also be a factor. If there are physical issues that either you or your partner haven't addressed until now, seek medical or psychological help.

• Be Aware That Talking About Sex Isn't a "One and Done" Discussion: If you want to have a good sex life with your partner, having open and honest communication about sex is an ongoing dynamic.  Even if you resolve your current problems, things change. This doesn't mean that you have to talk to your partner about sex everyday.  But having a discussion about sex periodically can make it easier to talk about sex.  For instance, you or your partner might want to try something new in your sex life, like adding sex toys, different sexual positions, and so on. As mentioned earlier, the two of you might even find fun and sexy ways to talk about sex that will spice up your sex life.

• Be Aware That Religion, Culture or Family History Might Be an Obstacle to Talking About Sex: In many religions, cultures and families, sex is a taboo issue.  If your partner was raised in an environment where it was considered wrong to talk about sex, you'll need to be aware of and sensitive to this.  You might even preface your discussion by acknowledging that you're aware that your partner was raised to believe that talking about sex is taboo.  Even if your partner no longer believes that sex is a taboo subject, s/he might still feel some guilt or shame about talking about it.  It's better to acknowledge this so you can get it out in the open. Then, you and your partner can try to find a way to talk about your sex life in the context of being in a loving relationship and wanting your relationship to succeed.  

In my next article, I'll provide a clinical vignette to illustrate some of the problems mentioned above and to show how these problems can be resolved (see my article: How to Talk to Your Partner About Sex - Part 2).

Getting Help in Therapy
Some couples are unable to resolve sexual problems in their relationship, and they need help to be able to talk about sex.

An experienced couples therapist can help you to improve your communication about your sex life.

Rather than avoiding the problem, seek help with a licensed mental health professional who works with couples.  

Resolving problems in your sex life can help you to have a more satisfying sex life and a happier relationship.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing therapist and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples (see my article: What is Emotionally Focused Therapy (EFT) For 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.

     




     

The Benefits of Laughter For Your Health and Mental Health

You've probably heard the saying, "Laughter is the best medicine" which hints at the physical and mental health benefits of laughter.  In the past, I wrote an article, Humor Can Be Helpful in Psychotherapy, which explored how humor can sometimes increase the effectiveness of therapy.  In this article, I'm focusing on how laughter benefits both your physical and mental health.

The Benefits of Laughter For Your Health and Mental Health

The Benefits of Laughter For Your Health and Mental Health
Laughter is beneficial for your mind and your body because it:

• strengthens your immune system
• elevates your mood
• reduces pain
• protects you against the harmful effects of stress
• inspires hope
• helps you to connect and bond with others
• keeps you grounded
• relaxes your body
• eases stress and anxiety
• strengthens resilience (see my article: Developing Resilience)
• diffuses anger
• reduces inhibitions
• helps you to feel recharged and energized
• increases your ability to use your imagination and increases creativity (see my article: Using Positive Imagination to Cope)

Adults Need to Seek More Opportunities For Laughter
Most children tend to laugh many times a day.  However, adults tend to be more serious, and they don't laugh as much as children. Therefore, adults, who want the health and mental health benefits of laughter, need to seek out more opportunities to laugh.

You can seek out these opportunities to include more laughter in your life by:

• watching a funny movie or TV show
• watching standup comedy
• playing games with friends
• spending time with people who are funny
• playing with your pet
• reading a funny story
• sharing a funny cartoon with friends 
• engaging in laughing yoga
• being grateful for what you have
• being "silly"
• taking an improv class
• sharing true stories about yourself with others (see my article: The Psychological Benefits of Storytelling)

Examples of How to Bring More Laughter Into Your Life

Sue
After realizing that she wasn't having as much fun as she used to, Sue decided to join an improv class, which was recommended by a friend. She had never taken an improv class before and, initially, she felt intimidated. But on her first day of class, she discovered that most other people in the class had never done improv or any type of comedy before, and they were feeling just as inhibited as she was feeling. By the second class, she realized she really liked her instructor, who made learning improv fun easy.  So, after a while, Sue opened up more and allowed herself to just have fun. She realized that she had not laughed so much in years, and she decided to take the next improv class when it was over.

Jim
Although he enjoyed painting in his free time, Jim found it to be too solitary an activity, especially since he already spent a lot of time on his own as an online editor.  He didn't look forward to spending even more time alone doing his artwork.  However, at the suggestion of a neighbor, he offered a free art class to the children in his apartment building, and while he was working with the children, he realized that not only were they having fun, but he was also having fun with them.  This group activity with children helped him to feel energized, and it allowed him to spend time alone doing his own artwork.

Conclusion
As mentioned above, there are many physical health and mental health benefits to laughter.

Sometimes, you need to experiment with different activities to find one that you enjoy.  If you approach this exploration with a sense of curiosity and playfulness, you'll discover an activity that's just right for you. In addition, you'll begin to experience the benefits of laughter.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex therapist (see my article: The Benefits of Integrative Therapy).

I provide teletherapy, also known as online therapy, telemental health or telehealth for clients (see my article:  The Advantages of Online Therapy).

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

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

Overcoming Shame With Experiential Therapy

In my prior article I began a discussion about shame being at the root of most psychological problems.  In this article I'll give a clinical vignette and discuss how experiential therapy helps clients to overcome shame (see my article: Healing Shame in Therapy).

Overcoming Shame With Experiential Therapy

Clinical Vignette: Shame is at the Root of Most Emotional Problems
The following clinical vignette about resolving shame in therapy with experiential therapy is a composite of numerous cases:

Joe
When he first came to therapy, Joe told his therapist that he felt he wasn't where he wanted to be in his life, "I'm not satisfied with any part of my life. I'm going to be 35 years old in a few months, and I'm not where I should be in my personal life or in my career. By the time my older brother, Sam, was my age, he was already married with two kids and he was one of the top salespeople at his company.  I feel like a loser."

Joe went on to say that whenever he got together with his family for Sunday dinners, his parents talked about being proud of Sam, but they never talked about about being proud of him.  He said, "Ever since I was boy, my mother and father talked about feeling proud of Sam, and I just had to sit and listen to them gloat about him.  They never said they felt proud of me."

From Joe's description, it appeared that Sam was the "golden child" in the family and Joe was the neglected child.  He said he felt he never measured up to his brother's accomplishments (see my article: Growing Up Feeling Invisible and Emotionally Invalidated and Children's Roles in Dysfunctional Families).

He felt his parents didn't love him as much as they loved Sam, and he could understand this because, compared to Sam, "I'm nothing" (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

It was clear that Joe felt deeply ashamed of himself and he was stuck in the negative perception that he was "a loser."  It was also evident that he felt he had to earn his parents' love by accomplishing things rather than just being loved for himself.

Based on his description of the family dynamics, his feelings of toxic shame were rooted in his childhood emotional neglect (see my article:  What is Childhood Emotional Neglect? and What's the Difference Between Healthy Shame and Toxic Shame?)

Joe had lots of "shoulds" that he used to beat himself up with, "I should've tried harder to make something of myself" and "I should've chosen a profession that would have made my parents proud of me" and so on.

Although he loved being self employed as an illustrator, Joe felt ashamed whenever his father described his work in a dismissive tone as "just drawing pictures" when the father talked to family friends.  Joe compared this to how his father described Sam as being "a go-getter who is the top salesperson at his firm."

Joe said even though he got illustration work from large accounts, like major newspapers and sports teams, he felt he wasn't doing enough to promote his business because of his lack of self confidence.

With regard to relationships, he said his last girlfriend, Sue, left him two years ago, and he felt unmotivated to start dating again. Even though he often felt lonely, he said he lacked the confidence to go out and meet women.  So, he spent a lot of time alone or seeing male friends to go to sports events.

His therapist realized that Joe's shame was longstanding, and it created a major obstacle in his life.  Since she was an experiential therapist, during the initial stage of therapy, she helped Joe to build a stronger sense of self by asking him to remember positive memories about himself (see my article: Developing Internal Resources in Therapy).

At first, Joe couldn't think of any but, gradually, he remembered winning art awards in high school and college, the first time he got a major contract for his illustrations from a top sports team, and other similar memories.

As Joe talked about these moments when he felt good about himself, his therapist used Somatic Experiencing to help him to slow down and feel the sense of pride he experienced with each memory.

By helping him to slow down and notice where he felt these good feelings about himself in his body, his therapist helped Joe to intensify and integrate these good feelings (see my article: Experiential Therapy and the Mind-Body Connection).

His therapist reflected back to Joe the change she saw in him--the pride she saw on his face and in his confident posture as he dwelled on these positive memories.  Joe said that he was surprised to remember so many memories that he usually didn't think about when he was feeling bad about himself.

In his subsequent sessions, Joe said he realized that, even though he felt like "a loser" with most women, he remembered meeting a few women in recent weeks who seemed interested in getting to know him, but he felt too shy to ask for their phone numbers.

Over time, Joe and his therapist explored his shame, and he realized that, along with shame, he felt hurt and sad that his parents neglected him.  At that point, his therapist explained how EMDR therapy helps clients to overcome psychological trauma, and they used EMDR in the next phase of therapy (see my article: Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

Gradually, Joe realized that, even though he was neglected, he deserved his parents' love--not for his accomplishments but for just being himself.  Rather than feeling ashamed, Joe felt angry that he didn't get what he needed from his parents.  This was a big psychological breakthrough for Joe because, instead of blaming himself for being "a loser" and not deserving his parents love, he felt he was a person who was worthy of love.

He also realized that his parents' dynamic of praising Sam and ignoring Joe was rooted in their own psychological problems and he wasn't to blame for that.  He knew that both of his parents experienced similar family dynamics as children where they were the ones who were neglected.  At that point, along with his sadness, anger, hurt and shame, he also felt compassion for them.

As his shame was lifting, Joe felt more confident and assertive in promoting his work.

In addition, when he attended family dinners with his parents and Sam, he felt freer to talk about himself.  To his surprise, his parents noticed and commented on this positive change in him.  Although he was at a point where he no longer felt he needed his parents' approval, his parents really  saw him for the first time in a new light and they praised him.

Within several months, Joe shed his old identity of feeling like "a loser" and he was no longer feeling awkward and shy around women.  He began dating a woman he really liked.  Over time, he saw the potential for the relationship to develop into a lasting, meaningful relationship.

Conclusion
Toxic shame is rooted in early childhood neglect and trauma (see my article about Developmental Trauma).

Shame is emotionally debilitating, especially when it's as pervasive in a person's life as it was in the vignette above.  It often shows up with the person experiencing many "shoulds" about him or herself.  These "shoulds" are a clue to deep-rooted shame.

During the initial stage of experiential therapy, it's important that the therapist ensure that the client has the necessary internal resources to cope with whatever comes up in experiential therapy, like EMDR.

There are many different ways to develop internal resources depending on the needs of the client.  With strong internal resources, the client is better able to cope with whatever comes up as s/he works through feelings of shame.

Anger, hurt and sadness often accompany feelings of shame below the surface. When clients begin therapy, they're often unaware of these other emotions so, when the time is right, an experiential therapist helps the client to work through those emotions as well.

As shame and other debilitating emotions lift, clients often feel lighter and more confident. Rather than being burdened by childhood trauma, they're free from their traumatic history so they can live more authentically.

Getting Help in Therapy
Many people, who have been traumatized at a young age, are unaware of the negative impact of shame in their life.  They might be aware of feeling anxious or depressed, but shame is often suppressed because it's too difficult to face alone.

If you've been struggling with emotional problems you have been unable to resolve on your own, you could benefit from working with an experiential therapist (see my article: What's the Difference Between Top Down vs Bottom Up Therapy?).

Once you're free from the emotional burden of a traumatic childhood history, you can live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist (see my articles: The Therapeutic Benefits of Integrative Therapy and What is a Trauma Therapist?).

I work with with individual adults and couples.

I am currently providing teletherapy, also known as telemental health, online therapy and telehealth (see my article: The Advantages of Online Therapy).

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.

Shame is at the Root of Most Emotional Problems

Shame is at the root of most psychological problems (see my articles: What's the Difference Between Healthy Shame and Toxic Shame? and Healing Shame).  I will begin an exploration of how shame develops and how psychologically debilitating it is in this article, and I will discuss how psychotherapy can help in a future article.

Shame is at the Root of Most Emotional Problems

So, when we're discussing deep-rooted shame, which is also called core shame, we're talking about toxic shame, the type of shame that erodes a sense of self and makes people feel that they are not "good enough," they are unlovable and undeserving of love (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

No one is born with shame.  Shame is rooted in childhood psychological trauma, which is also known as developmental trauma (see my article: How Developmental Trauma Affects How You Feel About Yourself). 

The Connection Between Developmental Trauma and Shame

The Connection Between Childhood Trauma and Shame
Infant research has shown that toxic shame develops in childhood and it can affect infant brain development  (see the article: Early Shame Experiences and Brain Development by Allan N. Schore, Ph.D).

An example of this is when a baby reaches out to his mother and the mother's habitual response is to turn away or ignore the baby due to the mother's emotional problems, including postpartum depression, major depression or her own unresolved trauma (see my articles: What is Childhood Emotional Neglect? and Psychotherapy and Intergenerational Trauma).

When this happens often enough, the baby learns that it is shameful to have emotional needs and, after a while, he learns to suppress these needs and to stop reaching out.

This type of developmental trauma can occur at any time in childhood. When this dynamic occurs in infancy, the trauma is preverbal, so that baby can't express the shame he feels in words.  Initially, he might cry out for the mother and even scream.

But after a while, if the mother does not respond, the baby learns to stop seeking nurturance.  If there are no mitigating factors like a nurturing father or grandparent, that baby grows up to be an adult who suppresses his emotional needs out of deep-rooted shame.

This is adaptive in childhood because the emotional pain of seeking love and nurturance when it's not forthcoming is too emotionally devastating for a child.  So, this need is suppressed in order to avoid feeling devastated.  But while this suppression is adaptive to keep the child from being overwhelmed, it's not adaptive in adulthood.

As an adult, this individual often continues to feel that he is unlovable and that even wanting love is emotionally dangerous because he believes he cannot have it, and it is too shameful to even want it. So, unconsciously, this individual not only hides his emotional needs from others.  He also hides his emotional needs from himself.

He might tell himself that he is "strong" or emotionally "independent" and he doesn't need anyone (see my article: Emotional Strategies That No Longer Work: "I Don't Need Anybody" and Seeing Yourself as "Independent" vs Allowing Yourself to Feel Your Shame).

But this is a pseudo-independence.  It's a defense mechanism to hide the emotional pain of feeling unlovable as well as to hide the shame and ambivalence that is attached to wanting to be loved at the same time that he believes he doesn't deserve it (see my articles: Reacting to the Present Based on Your Traumatic Past and An Emotional Dilemma: Wanting and Dreading Love).

This often results in an avoidant attachment style or he gets into relationships that are retraumatizing with people who hurt him.

Recreating the early trauma is an unconscious process, so it is out of the individual's awareness.  Each time this occurs it will reinforce the existing trauma that he is unlovable and undeserving of love, which intensifies the shame.

Most skilled psychotherapists know that shame is at the root of many emotional problems.  The problem might be labeled as depression, anxiety or any one of a number of other diagnoses, but at the core lies shame.

It's understandable that many clients will resist the painful process of looking at their shame in therapy because by the time they come to therapy, they have spent many years suppressing it.  But if the shame is not worked through in therapy, it will remain an unresolved emotional block (see my article: Working on Emotional Blocks in Therapy).

So, in order to help a client to uncover the shame at the root of trauma, the therapist must first develop a trusting relationship with a client.  The client must have confidence in the therapist and know that the therapist has the client's interests at heart before the therapist asks the client to begin the painful process of working through the underlying shame (see my article: The Creation of the "Holding Environment" in Therapy).

In future articles, I will continue this discussion about shame.  I will also discuss how shame is worked through in experiential therapy (see my article: What's the Difference Between "Top Down" vs "Bottom Up" Therapy?).

To read the next part of this discussion, see my article: Overcoming Shame With Experiential Therapy.

Conclusion
Toxic shame develops at an early age and it's usually at the root of most psychological problems.  Most people, who have experienced early shame, have learned to protect themselves from feeling the emotional pain of shame using defense mechanisms, like denial, for instance.

Although an individual can protect himself from becoming aware of deep-rooted shame, the effect of that shame can be pervasive in all his relationships, especially in romantic relationships where an individual can feel the most emotionally vulnerable.

Whether the individual is aware of his or her shame or not, shame doesn't usually resolve itself.  So, in order to work through shame, s/he needs the help of an experienced psychotherapist who can assist the in uncovering and working through shame.

Getting Help in Therapy
If you have been unable to resolve your problems on your own, you could benefit from working with an experienced psychotherapist.

Once you have established a trusting relationship, a skilled therapist can help you to identify and work through shame which keeps you from living fully.

Rather than suffering on your own, seek help from a licensed mental health professional who has experience helping clients to overcome shame.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: The Therapeutic Benefits of Integrative Therapy and What is a Trauma Therapist?).

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.