Coping With Emotional Distress By Using the Somatic Experiencing Technique of Pendulation to Calm Yourself

In my prior article, Global Pandemic Causes Significant Increase in Anxiety and Depression, according to the findings of the World Health Organization (WHO), there has been a 25% increase in pandemic-related anxiety and depression.  

WHO also indicates that this increase in anxiety and depression is probably just the tip of the iceberg.  

Given these circumstances, individuals who are struggling emotionally need a way to cope with these emotions, and one way to cope is using pendulation.

Using Pendulation to Cope With Emotional Distress

What is Pendulation and How Can It Help You to Cope With Emotional Distress?

Pendulation is a concept which is part of Somatic Experiencing (SE) (see my article: Mind-Body Oriented Therapy: Somatic Experiencing).

SE is a mind-body oriented therapy, developed by Dr. Peter Levine, which helps individuals to heal from trauma.

Pendulation is a useful technique to help individuals to cope with distressing emotions--like the pandemic-related emotions described in my previous article or any other type of distressing emotion, including emotions related to psychological trauma.

Similar to the pendulum on a clock, pendulation involves a shifting back and forth of emotions or body sensations.

Pendulation is Similar to the Movement of a Pendulum on a Clock

Specifically, you start by identifying the distressful emotion or bodily sensation you're experiencing and locate it in your body.  

After you notice the distressful emotion/sensation and where it's located in your body, you find a neutral or calm point in your body and you shift your awareness back and forth (or pendulate) between the distressful and calm experiences.

An Example of Pendulation

For instance, if you identified sadness as the distressful emotion and you locate the sadness as being in your throat where you feel a constriction (a welling up of tears), you sense into other parts of your body to find a calm or neutral point.  

Let's say you detect a sense of calmness in your chest.  You stay with that sense of calmness for a moment to give yourself a chance to experience it.

Then, move back to the sadness in your throat and stay with that for a moment before you go back to the calmness in your chest. 

As you keep going back and forth between the sadness and the calmness, you are pendulating between the two emotions.

As you continue to pendulate back and forth, notice what how the sadness changes.  There is usually a shift due to the integration of the two emotions.

If you have difficulty finding a calm or neutral place within yourself, you can find an external resource, like looking at a glass of water or looking out the window at a tree, and so on.

What If You're Unable to Identify the Distressful Emotion?

There are many individuals with a history of trauma who have difficulty identifying emotions, especially distressful ones.  

They might know they're struggling with a difficult emotion, but they don't know if it's anger, sadness or any other emotion.

If this sounds familiar to you, you can still use pendulation even if you can't identify the emotion.  

For instance, you might know you have a sinking feeling in the pit of your stomach, but you don't associate any particular emotion with that sensation.

Even without knowing the distressful emotion, you can still locate an area in your body where you don't feel that sinking feeling--where you feel neutral or calm.  Then, you can shift your awareness back and forth between those two areas.

If you're working with an SE therapist, over time, you can learn to identify your emotions.  This takes practice. 

Even before you learn to identify specific emotions, you can use pendulation as a self help technique between therapy sessions to calm yourself.

How Does Pendulation Facilitate Emotional Healing?

According to Dr. Levine, pendulation is a natural process that facilitates emotional healing within the nervous system.

As previously mentioned, the shifting back and forth allows for an integration of these emotions, which facilitates healing.  

Pendulation Facilitates Emotional Healing

Whereas before you might have felt stuck in your distress, after you learn pendulation, you feel more emotionally resourced.  

Over time, as you sense the integration of emotions, you gain confidence that you can cope with uncomfortable emotions and you won't get stuck in a distressed state.  

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

As a trauma therapist, I work with individual adults and couples (see my article: What is a Trauma Therapist?).

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.

Global Pandemic Causes Significant Increase in Anxiety and Depression

According to the World Health Organization (WHO) there has been a 25% global increase in anxiety and depression due to the COVID-19 pandemic, and they believe this is just the tip of the iceberg (see my article: The Emotional and Physical Impact of the Global Pandemic).

Pandemic Causes Increase in Anxiety and Depression

What Has Contributed to the Pandemic-Related Increase in Depression and Anxiety?

According to WHO, some of the contributing factors include the following:

• Social isolation
• Constraints in work life
• Constraints in being able to seek emotional support from loved ones and community
• Loneliness
• Fear of getting the virus
• Getting sick due to the virus, including long-term health issues
• Worrying about underlying conditions that increase vulnerability to serious illness 
• Pre-existing mental health issues
• Inability to access health care/shortage of care
• Inability to access mental health care/shortage of care
• Grief due to loss of loved ones who succumbed to the virus
• Financial worries
• Uncertainty/fear that conditions will never improve
• A sense of foreboding, helplessness or powerlessness

Health care workers and others who have been on the frontlines have been hit especially hard, which has triggered suicidal thoughts for some of them (see my article: Helping the Helpers Overcome Burnout).

In addition, according to WHO, women and children have been impacted more than men.

NAMI Advocacy For Increased Access to Mental Health Care

The National Alliance For Mental Illness (NAMI) has been advocating for increased access to mental health care.

Pandemic Causes Increase in Anxiety and Depression

In addition to their advocacy for increased access to mental health care, NAMI also offers an array of education and free support for those in need.

NAMI also has a Helpline and provides a telephone number for those in need: 

(800) 950-NAMI (6264)

Suicide Prevention Hotline: 988 Lifeline

See My Next Article: Coping With Emotional Distress By Using the Somatic Experiencing Technique of Pendulation to Calm Yourself

Getting Help in Therapy

Anxiety and depression can be mentally and physically debilitating.

If you or someone you love is struggling with anxiety or depression, help is available.

You can access help from your insurance carrier or if you don't have insurance, you can contact the NAMI Helpline (see link above).

In New York City, some of the postgraduate psychotherapy training institutes also offer low-fee or sliding scale therapy, including:

Institute For Contemporary Psychotherapy (ICP)

National Institute For Psychotherapies (NIP)

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist (see my article: 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.

 

Keeping the Spark Alive in Your Relationship

In recent years, researchers have discovered that the initial phase of a new romantic relationship is characterized by new relationship energy (NRE).  NRE refers to that intense passion you experience at the beginning of a romantic relationship, which can be exhilarating and fun (see my article: The 5 Stages of Love From Attraction to Commitment).

Keeping the Spark Alive in Your Relationship

NRE occurs during the so-called "honeymoon phase," which typically lasts up to 2-3 years or so.  

This is the phase when you spend a lot of time thinking about and yearning for that person, and when you see each other, you can't keep your hands off each other.

The Brain and New Relationship Energy 

Dr. Nan J. Wise, cognitive neuroscientist, licensed psychotherapist and certified sex therapist, explores NRE in her book, Why Sex Matters.  

According to Dr. Wise, NRE includes high levels of dopamine flooding the brain.  

Keeping the Spark Alive in Your Relationship

Dopamine plays a major role in movement, motivation, perception of reality and the ability to experience love and pleasure. 

High levels of dopamine can make you feel giddy and euphoric when you're around your partner.  

In addition, you usually experience high levels of oxytocin, often referred to as the "cuddle hormone," and vasopressin, which makes you feel emotionally and psychologically attached to your partner.

So, it's no wonder NRE makes this phase of the relationship so intense.

Tips For Keeping the Spark Alive in a Long Term Relationship

As previously mentioned, NRE eventually diminishes.

The chemicals in the brain settle down and, if your relationship endures past this phase, your feelings for each other often mature into a deeper kind of love.

Keeping the Spark Alive in Your Relationship

While it's normal for NRE to wane after a while, many couples want to know how to keep the romantic and sexual spark alive in their relationship.

Here are some tips:

• Keep Joy Alive: The ability to experience joy together is important, especially for a long term relationship that will, inevitably, go through ups and downs.  The ability to laugh together is important to maintaining the vitality in your relationship.  In addition, finding new and novel ways to be with each other can also keep the joy alive.  This could include you and your partner being more playful with each other and exploring new fantasies.

• Engage in Open Communication: Being able to give and receive feedback openly is important to keeping the spark alive.  This means being open to hearing feedback which might not always be positive without getting defensive as well as your ability to talk openly and tactfully with your partner about how you feel about all aspects of your relationship, including sex (see my articles: How to Talk to Your Partner About Sex - Part 1 and Part 2).

• Show Your Love and Affection: Rather than holding back, nurture your relationship, show your love for your partner by being physically affectionate, allowing yourself to show you're happy to reconnect with them when you've been apart, being emotionally and sexually generous in ways that are pleasing to both of you, making loving eye contact with your partner, establishing relationship goals, being aware of your peak erotic experiences as a couple, and finding other ways that are meaningful to both of you (see my articles: What Are the 5 Love Languages? and What If You and Your Partner Have Different Love Languages?).

• Be Open to New Experiences: Whether this means exploring new interests, ideas or places or finding new and exciting ways to be sexual, being open to new experiences helps to keep the spark alive in your relationship (see my article: Being Open to New Experiences).

• Be Your Own Person: Rather than merging together, find that balance between being your own person and being part of your relationship.  Maintain your own identity and interests as well as those you share with your partner.  Learn to compromise about time together and time apart.  Not only will being your own person allow you each to grow as individuals, but you'll both have something unique to bring to your relationship.  

• Be Generous: It's easy to take one another for granted, especially in a long term relationship, so it's important to show your appreciation and to be kind and emotionally generous.  Instead of keeping score, pick your battles and know when to overlook certain things that aren't important in the long run.  Know your partner's love maps and talk about your own.

Getting Help in Therapy

Everyone needs help at some point.  

If you have been unable to resolve your problems on your own, you could benefit from working with a licensed psychotherapist.

A skilled therapist can help you to develop the tools and skills you need to live a more fulfilling life.

So rather than struggling on your own, seek help from a licensed mental health professional who has the expertise and experience to help you.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist.

I am a sex positive therapist who works with individual adults and couples (see my article: What is Sex 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.

Embracing Your Internal Contradictions and Paradoxes

In prior articles, I've discussed how people are complex with many different internal aspects, including contradictory and paradoxical aspects (see my articles: Understanding the Different Aspects of Yourself That Make You Who You Are).  

Embracing Your Internal Contradictions and Paradoxes

Why Is It So Hard to Accept Contradictions and Paradoxes?

The idea of contradictory and paradoxical internal aspects is unsettling for many people.   I'm hoping this article, which is the first part of this subject, will help to normalize these concepts.

On the one hand, life might seem easier when everything remains the same.  Similarly, if things are going well from their perspective, people often prefer their loved ones to remain the same.  It makes it easier for them to know what to expect.  

On the other hand, whether we like it or not, people do change.  This includes making positive changes in psychotherapy that can be challenging for their loved ones (see my article: Your Family Might Not Be Supportive of the Positive Changes You're Making in Your Life as You Heal From Trauma).

We All Contain a Multiplicity of Selves

We all contain within us a multiplicity of selves. Some of those parts are in sync and others are contradictory.

Audre Lorde, who described herself as black, lesbian, mother, warrior and poet, once said, 

 "Only by learning to live in harmony with your contradictions can you keep it all afloat."

In “Song of Myself," Walt Whitman, essayist, poet and journalist, wrote, “Do I contradict myself?/Very well, then I contradict myself (I am large, I contain multitudes)."

Duality and Contradictions in Mythology

Mythology has many examples of duality and contradictions.

The ancient Greek myth of Demeter and Persephone is one example:  Demeter, who is the goddess of the harvest, provides bountiful crops so that the Greeks had plenty of food to eat.  She is also the goddess who oversees the cycle of life and fertility.  

But when her daughter, Persephone is abducted by the god of the Underworld, Hades, Demeter is so bereft that she becomes the goddess of hunger and starvation as she wanders the Earth searching for Persephone and, in doing so, neglecting the crops.

Eventually, Zeus, who the chief deity of the Greek pantheon and Demeter's father, intervenes. 

He knows people can't make sacrifices to the gods if they don't have food to eat. So, he reaches a compromise with Hades and Demeter so that Persephone spends most of the year on Earth with Demeter and part of the year with Hades.  According to this myth, this is why we have different seasons, including spring and winter.

Similarly, in Hindu mythology, the goddess Kali has the power to destroy and to create.  Even though she appears in many stories about destruction, Kali is also the goddess of creation.  

The myth about Kali recognizes there can be no creation without destruction.  It is a cycle.  Accordingly, she is a powerful goddess, who is believed to have existed before time and who will continue to exist after time ends.

What is the Difference Between a Paradox and a Contradiction?

In contemporary times, aside from the complexities of being human, life is filled with contradictions and paradoxes.  

This can be confusing at times, but understanding and accepting these concepts can also make life richer.

Although people often use these two words interchangeably, they have different meanings.

Most people know the meaning of a contradiction.  A contradiction involves conflicting elements within the same system.  

An example of a contradiction can be seen in a job search process where a person can't get a job without job experience, but they can't get experience without a job.

A paradox is more complex.  It's something that is seemingly contradictory but, upon deeper investigation, you discover the truth in it.  

I gave an example of a paradox in my article Anxiety as an Emotional Aphrodisiac where anxiety is usually thought of as inhibiting sexual desire, but for many people, it serves as an aphrodisiac which increases desire.

Other Examples of Paradoxes:

• People need both stability and change to grow.
• A couple often needs some distance in order to feel closer to each other.
• To earn money you need to spend money.
• Sometimes you have to take a step back to move forward.
• No decision becomes a decision.

Embracing Contradictions and Paradoxes

In my article, Do You Want to Change? Start By Accepting Yourself as You Are, I introduced a paradox.  

The article goes on to look closer at the concept of self acceptance and what it means in the context of wanting to change.  

Starting with acceptance allows you to acknowledge how you are at that point in time.  It doesn't mean you're complacent or that you've given up on changing.  

When you want to change, starting with acceptance is a part of the process.

If you don't start by accepting yourself as you are, including your contradictions and paradoxes, you're more likely to have a negative attitude about yourself which can sabotage any efforts you make to change.

Getting Help in Therapy

Self compassion and acceptance can be challenging for many people.

If you are struggling with accepting your contradictions, you're not alone.  

A skilled psychotherapist, who has the expertise to help clients to achieve self acceptance as part of a larger change process can help you to live a more meaningful and fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing and Sex Therapist.

I work with individual adults and couples.

I have helped many clients to achieve self acceptance while they are on the path of transformation.

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.

Trauma and the Fawn Response: A Clinical Vignette

In my prior article, Trauma and the Fawn Response: People Pleasing to Avoid or Diffuse Conflict, I began a discussion about fawning and how it's a response to trauma.  

As I mentioned in that article, generally, people are more familiar with the three other trauma responses: fight, flight and freeze, but not as much with the fawn response.

Trauma and the Fawn Response

The current article will expand upon this topic by giving a clinical vignette that illustrates a typical example of the fawn response and how experiential therapy, like EMDR therapy, can help a client to overcome this traumatic response.

But first, let's recap by giving examples of the fawning response:

Signs of Fawning Behavior:

The following behaviors are some of the most common signs of fawning behavior:

• Having problems being assertive and saying no
• Being overly compliant on a regular basis to avoid or diffuse conflict
• Having trouble setting boundaries
• Being overly apologetic
• Sacrificing your own needs to prioritize the needs of others
• Denying emotional and/or physical needs on a regular basis
• Compromising your values to align yourself with others
• Feeling guilty when you feel angry towards others because you don't feel entitled to your feelings
• Trying to "fix" or rescue others from their problems
• Attempting to control others or their choices so you can feel emotionally safe
• Gushing with praise or being overly complimentary toward someone--even when it's not how you actually feel--in order to appease someone
• Holding back feelings or opinions on a regular basis in order not to make others feel uncomfortable
• Changing your response or opinions to comply or be in synch with others
• Going out of your way to people-please to avoid or diffuse conflict
• Assuming responsibility for others' discomfort when it's not your fault
• Flying under the radar (making yourself small) to avoid getting attention
• Experiencing chronic pain or illness due to the stress of the trauma response
• Spacing out or dissociating when you feel uncomfortable in a social situation

Clinical Vignette: Fawning as a Trauma Response

The following clinical vignette, which is a composite of many different cases with all identifying information removed, provides an example of fawning as a trauma response and how EMDR therapy helped:

Jane

After her closest friend, Dee, confronted Jane about her fawning behavior, Jane sought help in therapy to work on this issue.

Jane, who was in her early 30s, told her therapist that Dee expressed concern about Jane's people pleasing behavior.  Dee said she sensed that Jane tended to have problems being assertive and setting boundaries in her personal life as well at work.  

She also pointed out to Jane that she had a tendency to put the needs of other people before her own which led to Jane sacrificing what she really wanted.  

In addition, Dee told Jane that she was often overly complimentary towards people they both knew and Dee was aware that Jane really didn't feel this way.  Dee indicated that Jane was gushing in an overly complimentary way, which came across as disingenuous and confused and annoyed people.

Jane told her therapist that it was hurtful to hear Dee say these things, but when she thought about it, she realized Dee was right.  But she didn't know why she responded to people with fawning behavior or how to stop it.

When Jane spoke to her therapist about her family history, she described her father as being overly critical with an explosive temper and her mother as being overly compliant with the father's wishes.  

Her only sibling, who was an older sister, moved out as soon as she turned 18 because she had a conflictual relationship with their father and she was frustrated with her mother's passive, compliant behavior.

Although her father had never become physically violent, Jane was afraid of his explosive temper and, similar to her mother, she learned to go along with whatever her father wanted rather than assert her needs--even when she was old enough to make her own decisions.

Jane also realized that her people pleasing behavior extended to other family members as well as friends, colleagues and romantic partners.

As she continued to discuss this issue in her therapy sessions, Jane realized that, not only was her fawning annoying people, it also had consequences for her because she often felt disconnected from her emotions during those times.

Her therapist provided Jane with psychoeducation as to how fawning was related to unresolved trauma.  

In addition, the more they talked about it, the clearer it became to Jane that her childhood fear of her father's explosive temper was an unresolved trauma for her.

After Jane's therapist provided Jane with information about EMDR (Eye Movement Desensitization and Reprocessing) therapy and how it helped clients to overcome trauma, they agreed to use EMDR as the treatment modality (see my article: Experiential Therapy, Like EMDR, Helps Achieve Emotional Breakthroughs).

As Jane processed her traumatic memories about her father's temper and how her fawning behavior developed as a response to that trauma, she felt an emotional and psychological shift occurring within her over time.

The therapeutic work was neither quick nor easy, but Jane gradually felt she was freed from her history of trauma and her defensive need to fawn over others.  This allowed Jane to assert of her own needs and to be more authentic in her relationships.

Conclusion

The fawn response is a common response to trauma.  

Most of the time, fawning, which is used to avoid or diffuse potential confrontations, is an unconscious behavior, and when clients work on this issue in therapy, they become more aware of it (see my article: Making the Unconscious Conscious).

This behavior is often misunderstood by others.  They might sense that something is "off" or disingenuous, but they might not understand why.

Experiential therapy, like EMDR, allows clients to work through the underlying issues related to the trauma (see my article: Why Experiential Therapy is More Effective Than Talk Therapy to Overcome Trauma).

Getting Help in Therapy

Unresolved trauma often takes a toll on your self esteem and your relationships.

Seeking help with a licensed mental health professional who has an expertise in helping clients to overcome trauma can help free you from your traumatic history so you can lead a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist.

I work with individual adults and couples, and I have helped many clients to overcome trauma (see my article: What is a Trauma Therapist?).

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.

Trauma and the Fawn Response: People Pleasing to Avoid or Diffuse Conflict

Fight, flight and freeze are the trauma responses that are usually discussed in trauma literature.  

In addition to these responses, Peter Walker, MA, a family therapist, coined the term "fawning" as another common trauma response to diffuse or avoid conflict (see my article: Unresolved Trauma: Living in the Present as if it Were the Past).

Trauma and the Fawn Response

Understanding Fight, Fight and Freeze as Trauma Responses

Before describing the fawn response, let's review the other three trauma responses: Fight, flight and freeze.

• Fight - Confront the Threat: The fight response involves anger and confrontation. This could be either verbal or physical and involves high energy.

• Flight - Run from the Threat: The flight response involves anxiety, avoidance and fleeing from the threat. It also includes high energy.

• Freeze - Shutdown to Block Out the Threat: The freeze response can include physical and/or emotional numbing and dissociation.  For animals in the wild, it's also called "playing possum" and it's often a powerful survival response to an imminent threat from a predator (the animal appears to be dead, which would make the predator lose interest).  This shutdown is a low energy response. For humans it often involves an involuntary response that includes feeling cold or numb, heaviness in the limbs, holding their breath and a sense of dread or foreboding.

Understanding Fawn as a Trauma Response

The fawn response usually develops due to unresolved childhood trauma, which is also known as developmental trauma (see my article: Looking at Your Childhood Trauma From an Adult Perspective).

The fawn response involves appeasing, which includes codependency, people-pleasing and lack of boundaries to avoid conflict or threat.  

The person who is fawning prioritizes the other person's needs over their own.  In some cases, the person is unaware of their own needs because they're so accustomed to putting the other people's needs first.

Fawning often develops as a psychological survival strategy for a child who is being abused or neglected. The child learns early on that appeasing the parent(s), even if it means sacrificing their own needs will diminish a threat--whether the threat is emotional or physical.

Signs of Fawning Behavior:

The following behaviors are some of the most common signs of fawning behavior:

• Having problems being assertive and saying "no"
• Being overly compliant on a regular basis to avoid or diffuse conflict
• Having trouble setting boundaries
• Being overly apologetic
• Sacrificing your own needs to prioritize the needs of others
• Denying emotional and/or physical needs on a regular basis
• Compromising your values to align yourself with others
• Feeling guilty when you feel angry towards others because you don't feel entitled to your feelings
• Trying to "fix" or rescue others from their problems
• Attempting to control others or their choices so you can feel emotionally safe
• Gushing with praise or being overly complimentary toward someone--even when it's not how you actually feel--in order to appease someone
• Holding back feelings or opinions on a regular basis in order not to make others feel uncomfortable
• Changing your response or opinions to comply or be in synch with others
• Going out of your way to people-please to avoid or diffuse conflict
• Assuming responsibility for others' discomfort when it's not your fault
• Flying under the radar (making yourself small) to avoid getting attention
• Experiencing chronic pain or illness due to the stress of the trauma response
• Spacing out or dissociating when you feel uncomfortable in a social situation

Since the fawn response to trauma is a big topic, I'll continue this discussion in my next article (see my article: Trauma and the Fawn Response: A Clinical Vignette).

Getting Help in Therapy

Unresolved trauma can create anxiety, depression and lack of self confidence as well as other psychological problems.  

It can have a negative impact on your relationships.

Rather than struggling with unresolved trauma on your own, seek help from a licensed mental health professional (see my article: Why Experiential Therapy is More Effective For Unresolved Trauma Than Regular Talk Therapy).

Freeing yourself from your history of trauma can help you to have a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist.

I work with individual adults and couples.

As a trauma therapist, I have helped many people to overcome trauma (see my article: What is a Trauma Therapist?).

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.

Why It's Unethical and Irresponsible For Psychotherapists to Give Clinical Advice in Informal Settings

Most psychotherapists have had the experience of being in an informal setting, like at a party or at the gym, where people ask for clinical advice about a problem they're dealing with at the time.

It's Unethical and Irresponsible to Give Clinical Advice in Informal Settings

In these situations, the person usually provides a snippet of information to the therapist and hopes to get an answer to their problem.  

Most of the time, the people who are seeking clinical advice in this way see it as being innocuous. But there are important ethical and clinical implications involved if a psychotherapist gives advice under these circumstances.

So, for instance, if someone at the gym finds out that another gym member is a psychotherapist or a psychiatrist, he might say something like, "Say, I hear you're a mental health professional.  Can you tell me what I should do about my teenage son who is doing poorly in school?"  

Aside from the fact that the gym member seeking help is giving very little information and the therapist hasn't met the teen who is having the problem, if the therapist gives clinical advice, like, "Your son might be anxious" and the gym member relies on this information, things could go terribly wrong if the teen is actually depressed or misusing alcohol or drugs, and the therapist can be held responsible.

In order for a therapist to diagnose a problem, there needs to be a thorough biopsychosocial assessment and it usually takes at least several sessions to get a complete picture in a clinical setting.

So when someone briefly mentions a problem to a therapist outside of a clinical setting, it's obvious there isn't going to be a thorough assessment and there can be many possibilities as to what the problem might be.  

Here's another example: A gym member approaches another member, who happens to be a psychotherapist, and says they're having headaches. They ask the therapist if the problem might be related to stress.  The appropriate response from the therapist would be to seek help from their medical doctor first to rule out any medical problems.  

An inappropriate response would be, "It sounds like stress to me. Have you tried meditation?"

Imagine if the gym member who has headaches follows this therapist's advice, but later on finds out that the headaches were actually the result of a brain tumor.  It's clear in this case that the therapist was ethically and clinically irresponsible to have made assumptions about the problem and to have given what turned out to be inappropriate advice.

Not only could there be disastrous results for the person with the headaches, but the psychotherapist could be placing their license in jeopardy.

Most lay people understand this, especially if the therapist explains why they can't speculate on the problem or give advice.  But, at times, there are some people who don't understand.  They misunderstand and think the therapist is being evasive or withholding information.  

So, if you ever ask a psychotherapist for informal advice and the therapist's response is for you to seek help from a licensed mental health professional in a clinical setting, the therapist is not trying to get rid of you.  They're being responsible and giving you the best advice under the circumstances, which is to have your problem thoroughly evaluated by a mental health professional who is licensed and who has the skills and expertise relevant to your problem.

Getting Help in Therapy

Often, the most challenging part of seeking help in therapy is taking the first step by contacting a licensed psychotherapist.

In New York City there are many ways to seek help from a licensed mental health professional.  

If you have health insurance, you can contact your insurance carrier for a list of names of licensed professionals in your area.  

If you don't have health insurance, you can seek help from one of the many postgraduate mental health training institutes in New York City that offer the possibility of low-fee therapy depending upon your income.

There are also psychotherapy directories, like PsychologyToday.com, which have therapists listed by name, licensure, location and expertise.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing 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.

Also, see my article: Why Your Psychotherapist Can't Be Your Friend.