What is Toxic Stress?

Stress is a common response to daily experiences in life--both positive and negative.  It can be beneficial when it motivates you to make positive changes in your life.  

What is Toxic Stress?

However, when stress is chronic and overwhelming and you don't have internal resources or emotional support to deal with stress, it can become toxic stress (see my article: Responding Instead of Reacting to Stress).

This article will focus on the connection between toxic and trauma as it begins in early childhood and continues into adulthood (see my article: Stress Management: Taking Time For Self Care).

What Are the Different Types of Stress?

• Positive Stress: Positive stress is also known as eustress. Positive stress responses are normal responses to infrequent, short lived and mild stressful experiences. During childhood, if a child is given emotional support to deal with positive stress, the child develops motivation and resilience.  Over time, as a child develops skills to deal with positive stressors, the child also develops self confidence.  Examples of positive stress for children include:

• Meeting new people
• Learning a new task
• Learning a new game or hobby

• Tolerable Stress: Tolerable stress is more frequent, sustained and severe.  Tolerable stress has more of an impact on the mind and body as compared to positive stress. With emotional support, once the tolerable stress is removed, a child's mind and body usually return to their normal level of functioning.  Examples of tolerable stress for children include:

• Parental divorce
• Death of a loved one

• Toxic Stress: Toxic stress often begins in childhood where prolonged exposure to stress has a damaging effect on a child's mind and body. When children are exposed to unrelenting stress without emotional support, the mind and body are often unable to recover. Toxic stress is related to adverse childhood experiences (see below) also known as ACEs. Examples of toxic stress include:

• Abuse
• Emotional neglect
  
• Poverty
• Food scarcity
• Poor health
• Violence
• family dysfunction including, but not limited to, caregivers with substance abuse or mental health conditions

What Are Adverse Childhood Experiences (ACEs)?

Adverse childhood experiences (ACEs) are potentially traumatic events, as mentioned above, that occur in childhood (ages 0-17 years) that can result in toxic stress.

Toxic stress related to ACEs can result in health and mental health problems especially if these experiences are unmitigated by emotional support from loved ones.

How Common Are Adverse Childhood Experiences (ACEs)?

Unfortunately, ACEs are common.

Adverse Childhood Experiences and Toxic Stress

Approximately 64% of adults reported they had at least one experience with ACEs and about 17.3% of adults reported having four or more experiences as children with ACEs. 

All children are potentially at risk for ACEs, but ACEs are more likely to occur with girls, racial minorities and in families where adults are unemployed or unable to work.

What is the Effect of ACEs and Toxic Stress?

Without emotional support ACEs and toxic stress can result in one or more of the following problems:

• Permanent damaging effects to brain architecture

• Epigenetic change alteration (modifications to DNA which determine whether genes are turned on or off)

• Long term health consequences, including

• Immune dysregulation
• Persistent inflammatory state and health conditions related to inflammation
• Increased risk for cancer and heart disease
• Other chronic health problems

• Long term mental health consequences, including:

• Anxiety
  
• Depression
• Emotional dysregulation
• Other mental health problems

How Do ACEs and Toxic Stress Effect Adults?

Adults who grew up exposed to ACEs without emotional support are more likely to get into unhealthy relationships.

Toxic Stress and Adult Relationship Problems

Without emotional and mental health support, this can have a traumatic intergenerational traumatic impact where one generation after the next form unstable relationships.

Adults who experienced ACEs as children have an increased risk for having an unstable work history, financial problems, debt and other related problems.

How to Reduce the Risk of ACEs and Toxic Stress

Adverse childhood experiences (ACEs) are preventable.  

The Centers for Disease Control and Prevention (CDC) is the national public health agency for the U.S.  It is a federal agency under the Health and Human Services Department.

The CDC recommends the following steps to prevent ACEs:

• Strengthening family financial security
• Implementing family-friendly work policies
• Promoting public education campaigns to educate people about ACEs
• Promoting legislative approaches to reduce corporal punishment
• Promoting bystander approaches
• Promoting men and boys as allies in prevention
• Implementing early childhood programs to ensure a strong start for children
• Implementing high quality child care
• Promoting preschool enrichment with family involvement
• Teaching social-emotional learning
• Teaching safe dating and relationship skills
• Teaching parenting and healthy family relationship skills
• Developing mentor programs
• Developing after school programs
• Developing enhanced primary care
• Developing victim-centered services
• Developing treatment approaches to reduce the harm of ACEs
• Developing treatment to prevent problem behavior and future involvement in violence
• Developing family-centered treatment for substance abuse

Getting Help in Therapy

As an adult, if you have been impacted by toxic stress, you could benefit from seeking help in therapy.

Getting Help in Therapy

Working with a skilled psychotherapist, who has an expertise with toxic stress and trauma, can help you to overcome the damaging effects of toxic stress.

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

About Me

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

As a trauma therapist, I have helped many individual adults and couples overcome the impact of toxic stress and trauma.

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

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

    

Your Psychotherapist Thinks About You Between Sessions

I had my first experience with therapy when I was 18 years old.  I wanted to move out on my own to be independent, but I also felt ambivalent about being on my own, so I sought help from a psychoanalyst who had a lot of experience working with teenagers.

After a few months of therapy, I was able to move out to a women's residence in Greenwich Village which was recommended by my therapist. This turned out to be the best decision I could have made for myself.  Not only was it affordable at the time, but it also enabled me to grow in ways I couldn't have imagined at the time.  

Your Therapist Thinks About You Between Sessions

An added benefit was that the residence was just a few short blocks from my therapist's office, so it felt safe to be close to his office.  But I also had mixed feelings about being so close because I wondered if I would run into him on the street and whether this would be uncomfortable for me or for him (I never did run into him).

I often wondered if my therapist thought about me between sessions, which I didn't have the courage to ask him at the time. But I obviously hoped that he did because it would have meant to me that he thought I was important enough to think about--even when I wasn't in his office.

My therapist and I had our ups and downs, but overall it was a very positive experience (see my article: Ruptures and Repairs in Therapy).

That therapy ended successfully five years later, and I can look back on that experience as having had a profound impact in my life.  That experience also made me want to become a therapist.

Many years later, after graduate school, I attended the same psychoanalytic postgraduate training program where my former therapist taught and supervised.  

Sadly, he died several years before I entered the program, so he never knew I chose that program, but I often thought about him while I was in training, walking the same corridors he walked through and sitting in the same classrooms and consultation rooms.

During my first year of training, I was shocked to stumble upon articles my former therapist had written about his adolescent clients. I can still remember my heart was pounding when I found the folder in the institute's library with his name on it.  

Most of the articles were written during the same time period when I was in therapy with him, which filled me with hope and dread.  The hopeful part of me wondered: Would I find articles about me? And the part that felt dread also wondered: Would I find articles about me!?!

I felt like I had discovered a hidden treasure that might make me happy because he might have actually thought enough about me to write an article. Or, it could be disappointing: There's nothing in the articles about me. And why not?

Without reading the articles, I photocopied them in a hurry and placed the folder back in the library drawer. 

I know now that my feelings weren't unique. Any therapist or therapist-in-training who has ever sat in the audience for a talk given by their therapist knows the mixture of hope and dread that a presentation might be about them.

I also know now that therapists must get consent from their clients before discussing their case in a paper, book or presentation.  

But I didn't know this at the start of my postgraduate psychoanalytic training, so when I started reading my former therapist's articles, I read through them quickly to see if any of the cases even remotely sounded like mine.  But, for better or worse, none of them did, and I was filled with a combination of relief and disappointment.  

I was relieved to not feel so emotionally exposed by reading anything about myself that would reflect poorly on me or how he felt about me.  And, at the same time, I felt disappointed not to find myself in any of these articles because I wondered: Did he think about me at all between sessions?

Why Your Therapist Thinks About You Between Sessions

Now that I've been a psychotherapist for over 20 years, I know that therapists do think about their clients between sessions.  

So, if you've ever wondered about this, here are several reasons why your therapist probably thinks about you between therapy sessions:

• Reflecting on Therapy Sessions: Most therapists take the time between sessions to reflect on their sessions with clients. They think about their interactions with clients, any interventions they attempted and how to plan for the next session. They also think about whatever the sessions might have brought up for them personally and professionally. This is a valuable part of therapists' training and helps therapists to help their clients.

• Seeking Consultations: Therapists in training must be in supervision in order to become licensed. But even after a therapist has a license, she will have times when she seeks professional consultations. These consultations are usually with a therapist who has more experience in an area the consultee doesn't have.  To protect confidentiality, the therapist who is seeking the consultation doesn't reveal the client's name but provides basic information. Even seasoned psychotherapists seek consultations when they think it could benefit their clients.

• Making Referrals: A therapist might make a referral to a colleague or to another healthcare professional, including a referral to a medical doctor, physical therapist, a therapist who specializes in certain issues or another healthcare professional. These referrals are made only if you agree and provide your consent.  For instance, if your therapist isn't a trauma therapist and you need a referral for trauma therapy, she might recommend that you seek help with an EMDR therapist.

• Feeling Moved By a Client in Session: Most therapists are caring human beings so they're often moved by what happens in sessions with their clients. Seeing a client making an emotional breakthrough is one of the most rewarding things a therapist can experience in session, so therapists will often think about those moments between sessions with compassion and awe.

Conclusion

As an 18 year old new to therapy and, later in life, as a therapist in training, I wondered if my former therapist thought about me between sessions.  

Now, as an experienced psychotherapist, I know that he did because most therapists hold their clients in their hearts and minds between sessions.

About Me

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

Getting to Know the Many Parts of Yourself in Parts Work Therapy

Parts Work therapy assumes that everyone has many different aspects as part of their psychological world (see my article: What You Resist Persists: The More You Resist What You Don't Like About Yourself, the More It Persists).

Getting to Know the Many Parts of Yourself in Parts Work Therapy

This article focuses on how you can understand your internal world and the role of Parts Work in overcoming psychological problems.

What is Parts Work and How Is It Different From Traditional Therapy?

Parts Work is a broad category for different types of therapy including but not limited to:

• Gestalt therapy
• Ego States Therapy
  
• Internal Family Systems (IFS)
• Voice Dialogue therapy
• Jungian archetypes

Each of these modalities has its own unique method for helping you to access your internal world of parts and to heal traumatized parts.

Getting to Know the Many Parts of Yourself in Parts Work Therapy

What each of these modalities has in common is an understanding that psychological healing involves more than developing psychological insight into your unresolved problems. 

Beyond insight, it involves getting to know your psychological landscape and giving a voice to the many different facets of yourself.

Unlike some traditional forms of psychotherapy, which assume certain thoughts and emotions are negative or unwanted, Parts Work is nonjudgmental and fosters a sense of acceptance for all parts of yourself.  

Compassionate self acceptance allows you to have a gentler way of approaching aspects of yourself related to unresolved problems.

Rather than trying to get rid of the parts of yourself you don't like, Parts Work allows you to integrate these parts in a healthy way by:

• Giving a voice to each part
• Allowing each part to communicate what it needs and what it fears
• Understanding how and why each part gets triggered
• Developing a healthy relationship with each part to foster psychological integration and healing

How I Use Parts Work With Clients

I have many different ways of helping clients to overcome unresolved problems, including problems related to complex trauma.

• Parts Work (Ego States therapy and Internal Family Systems as described in this article) 

• EMDR Therapy (Eye Movement Desensitization and Reprocessing)

• AEDP (Accelerated Experiential Dynamic Psychotherapy)

• Hypnotherapy

• Somatic Experiencing

To choose a particular modality, I assess which type of therapy is best for a client's needs in collaboration with the client.  

As a therapist who integrates many different modalities, I often integrate different types of therapy based on the needs of the client.

For instance, as a trauma therapist, I might assess that EMDR therapy is the best way to begin with a particular client. 

Even though I have chosen EMDR to start, I'm aware clients often encounter an obstacle along the way and we will need to overcome this block to continue with EMDR.  This obstacle is referred to as an emotional block.

The metaphor that is often associated with encountering a block in EMDR is one where a moving train is blocked due to fallen tree on the tracks.  The train can't proceed until the tree (or block) is removed, so this is where Parts Work can be integrated with EMDR to overcome an obstacle in the treatment.

By exploring the obstacle through Parts Work, the client and I can discover the nature of this blocking part and what it needs. Often, it's a matter of asking the part to step aside (metaphorically), but it's also possible that the part needs more attention before it will allow the EMDR therapy to proceed.

In traditional therapy, a blocking part would be considered a defense mechanism such as resistance.  Rather than interpreting this obstacle as something negative to be gotten rid of, Parts Work approaches the blocking part with compassion to work with it directly in a kind and gentle way.  

If I'm using Parts Work as the primary modality, I help the client to have a complete experience of the part using the Somatic Experiencing concept called SIBAM:

• Sensation: What information is the client getting from their body? This could include sensations in any part of the body as well as muscle tension.

• Image: This refers to sensory impression including sight, sound, taste, taste and touch.

• Behavior: This refers to observable behavior including gestures, facial expressions and posture as well as an increase in heart rate and other visceral reactions.

• Affect: This refers to emotion and the client's felt sense experience.

• Meaning: Using language, the client puts words to the total experience of sensation, image, behavior and affect.

So, Parts Work can be used as a standalone therapy or in combination with other types of Experiential therapy like EMDR, Somatic Experiencing, AEDP and hypnotherapy.

What Are the Benefits of Parts Work?

Whether its used as a standalone therapy or in conjunction with other modalities, Parts Work is a transformational therapy.

The benefits of Parts Work include:

• Psychological Healing: Parts Work allows you to address unresolved emotional wounds and traumatic memories which are buried deep within your mind. By having a dialogue with parts you might have disavowed, you begin the healing process by integrating split off parts of yourself so that you have a more integrated experience.

Getting to Know Yourself Through Parts Work Therapy

• Compassionate Self Acceptance: Parts Work encourages a compassionate and collaborative experience with the many parts of yourself. Rather than viewing certain parts as negative or unwanted, you embrace all parts of yourself.

• Emotional Resilience: Parts Work's integrated approach allows you to enhance your emotional resilience and coping skills because your internal world is more harmonious.

• Personal Growth: Parts Work fosters personal growth through self integration. As you heal the various parts of you, you can discover new internal resources within yourself for personal growth.

• Stress Reduction: When your internal world is more integrated and harmonious, you can experience a reduction in internal conflict so you can reduce stress.

• Heal Trauma: Whether Parts Work is used as a standalone therapy or together with other modalities, it provides a structured and supportive environment to heal trauma, including unresolved childhood trauma of abuse or neglect or more recent trauma.

Getting Help in Therapy

If you're struggling with unresolved problems, you could benefit from working with a licensed mental health professional who uses Parts Work.

Getting Help in Parts Work Therapy

The many benefits of Parts Work can help you to heal from unresolved problems, including traumatic memories and complex trauma.

Rather than struggling on your own, seek help so you can overcome your personal struggles and live a more meaningful life.

About Me

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

What You Resist Persists: The More You Resist What You Don't Like About Yourself, the More It Persists

Carl Jung, a Swiss psychiatrist and psychoanalyst (1875-1961), wisely stated that what you resist not only persists--it gets stronger.

What You Resist Persists

What Happens When You Resist a Part of Yourself?

In earlier articles I've discussed that we are all made of many different parts.  As an example, on the most basic level, you often hear people say things like, "A part of me wants to go to the movies, but another part of me wants to stay home." 

This implies a basic understanding that, as humans, we're made up of a multiplicity of selves and that, at any given time, different parts (or aspects of self) emerge under different circumstances.

When you resist acknowledging a part of yourself, you're unwilling or unable to deal with that part or the negative circumstances involved.

The More You Resist, the More It Persists

Instead of working through the negative circumstances related to the part of yourself that you're resisting, you try to suppress it, which only works for a short time before that part comes to the surface again--usually stronger than before.

By suppressing this part over and over again, without realizing it, you're remaining attached to the negative circumstances related to this part instead of finding a resolution.

In other words, you use a lot of energy to keep pushing down this aspect of yourself, but it only goes outside your conscious awareness temporarily.  And you can't get rid of it because it's a part of you, so you end up in an ongoing cycle of frustration and resistance instead of resolving what you don't like.

This ongoing resistance to keep your unwanted parts out of your conscious awareness causes a vicious cycle, and it takes more and more energy to keep suppressing it. This can lead to anxiety and depression as well as health issues as stress increases.

Clinical Vignette

The following clinical vignette, which is a composite of many different cases with all identifying information removed, illustrates the concept that resistance strengthens unwanted aspects of yourself. It also shows how Parts Work can help:

Bill

When he was a child, Bill's parents were both highly critical of him.  He grew up feeling inadequate and ashamed of himself.

As a child, he unconsciously internalized this highly critical aspect of her parents, as children do under these circumstances, and throughout his childhood and adulthood, he often berated himself for minor mistakes.

As an adult, Bill found it very difficult to tolerate his Inner Critic.  Whenever he made a mistake, this part of him surfaced and made him feel so uncomfortable that he did whatever he could do suppress it.  

Inwardly, Bill became highly critical of his Inner Critic, cursed it and wished he could kill it off rather than deal with it.

But whenever he thought he had succeeded in permanently suppressing this part of himself, the Inner Critic came back even stronger than before.  Then it would take much more effort for Bill to suppress it again. And, over time, this became a vicious cycle, which made Bill increasingly anxious and unhappy.

By the time Bill was in his mid-30s, he knew he needed to get help because his hatred for this part became much stronger over time and he didn't know what to do.  So, he sought help from a licensed mental health professional.

Bill's therapist did Ego States Therapy, which is a particular type of Parts Work.  She helped Bill to see that his resistance to his Inner Critic was only making matters worse. She explained that resistance wouldn't lead to a resolution.

She helped Bill to tap into the Inner Critic to befriend it and find out what that part needed.  At first, Bill was hesitant to do this because, up until that point, he had done everything he could to get away from that part.  So, the idea of doing the opposite--befriending that part--felt scary to him.  But he learned to trust his therapist and he opened himself up to do Parts Work.

Gradually, Bill realized this Inner Critic was an internalization of his parents' critical stance towards him that he took in at a young age. As he imagined talking to that part of himself, he realized that below the surface there was a sad, helpless child, his younger self.

He also learned that although the Inner Critic appeared to be hostile towards him, this part had a protective function--it wanted to protect Bill from the criticism of others.  This amazed Bill because he had never thought of the Inner Critic as being anything other than a hated part of himself.

The more he engaged in an inner dialogue with the Inner Critic, the more that part softened and Bill learned that this part didn't want to ruin his life, as Bill had always thought. This part, which was blended with a younger part who felt alone and lonely, had positive aspects to it.

Over time, Bill developed a relationship with these younger parts so they no longer felt alone and lonely because he had befriended them and during Ego States Therapy Bill imagined he could soothe these alienated parts.

Once his Inner Critic softened, Bill's psychotherapist did EMDR therapy with Bill to work on his childhood trauma.  

It took time to work on these issues, but his work in therapy helped Bill to free himself of the vicious cycle he had been caught up in and helped him to resolve his childhood trauma.

How to Stop Resisting and Make Friends With the Part of Yourself You Don't Like

• Stop Fighting With the Part: Fighting with a part is the equivalent of resistance. The more you resist, the more it persists and gets stronger.  It might sound counterintuitive, but you need to stop resisting the part.

Befriend the Parts of Yourself You Don't Like

• Establish a Dialog With the Part: The part you're resisting is a part of yourself.  Once you stop fighting with that part, recognize there's a lot more going on under the surface than you realize and the way to find out about it is to develop a caring relationship with the part.  Show compassion for that part. You can do this in Parts Work therapy or you can do it on your own by having your own dialog with the part either in your mind or, even better, in writing. If you do it in writing, it can take the form of a script where you, as your adult self, have a dialog with the Inner Critic to ask what s/he needs. Usually, once a person pays attention to an unwanted part, that part softens.  Talk to this part kindly and listen to what it says it needs.  Then, use your imagination to imagine you can give it what it needs. If it says it needs a hug, imagine that part sitting next to you so you can give it a hug (see my article: Having a Dialogue in Writing With the Different Parts of Yourself and Giving Voice to Prevously Disowned Parts of Yourself).

• Make an Effort to Be Aware of the Part on a Regular Basis: Whether you imagine a dialog once a week or once a day, make an effort to be aware of and present for that part.  Over time, your relationship with that part is likely to improve.

Getting Help in Therapy

Parts Work goes by many different names, including Ego States Therapy and Internal Family Systems (see my article: Parts Work Therapy Helps to Empower You).

If you try befriending an alienated part of yourself and you don't make progress on your own, you could benefit from working with a licensed mental health professional who does Parts Work.

Working with a skilled Parts Work therapist can help you to overcome your resistance so you can reach a resolution to your problems.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, Emotionally Focused Therapist for Couples, Ego States Therapist, Somatic Experiencing and Sex 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.

10 Tips to Help You Open Up With Your Psychotherapist

If you've never been in therapy before or if you haven't had a good experience with a prior therapist, you might find it difficult to open up with a new psychotherapist, so this article will provide you with some tips that can make it easier for you.

Opening Up With Your Therapist

10 Tips For Opening Up With Your Psychotherapist

• 1. Start By Choosing a Therapist Who is Right For You: The most important consideration when you're ready to go to therapy is whether you and any potential therapist you might choose are a good fit. Starting with a new therapist can be an adjustment--especially if you've never been in therapy before. It's a unique relationship where the focus is on you. Before committing to therapy with any particular therapist, you can attend a consultation with a therapist to see if you feel comfortable her. You might not be certain after one consultation, but you can usually tell after a few sessions. Even after you have chosen a therapist, it takes a while to build a rapport with a therapist because you're talking about the most emotionally vulnerable aspects of your life, so give it time. Also, make sure the therapist has the expertise you need for your problems (see my article: How to Choose a Psychotherapist).

• 2. Think About What You Want to Talk About Before Your Sessions: If you want to get the most out of your therapy sessions, take some time before the session to reflect on what you want to talk about.  Many clients find it helpful to make notes for themselves so they use their time well in session. There are also many other clients who prefer to be more spontaneous in session because that's what works best for them. But if you have problems opening up to talk about yourself, prior reflection can be helpful (see my article: Getting the Most Out of Your Therapy Sessions).

• 3. Talk About Your Fear or Anxiety About Opening Up to Your Therapist: Most therapists know that clients often have a hard time opening up, especially if they weren't encouraged to talk about their feelings when they were growing up. A skilled therapist can help you to get comfortable enough to explore your fear or anxiety about opening up so you can eventually open up.  If a therapist is a mind-body oriented therapist, she can help you to get more comfortable with breathing or grounding exercises.

• 4. Consider Your Therapy Sessions a Collaboration Between You and Your Therapist: Therapy is a team effort.  Gone are the days when therapists just listened to you talk and after a while made an interpretation that was supposed to unlock profound insights. These days therapy is much less hierarchical and there's a recognition that clients and therapists work together in therapy to make it a meaningful experience. Although your therapist can help you to speak about difficult topics, you have the responsibility for initiating what you want to talk about.  Therapists aren't advisors, so they won't provide you with answers to your problems, but they can help you through the process (see my article: Psychotherapy as a Collaborative Effort Between Client and Therapist).

Opening Up With Your Therapist

• 5. Take Some Time Before the Session to Relax, If Possible: It's understood that most people lead busy lives, but if it's possible for you to take even a few minutes before your session, do some breathing or stretching to help you relax before the session starts.

• 6. Keep Your Therapy Appointments on a Regular Basis and Come On Time: In order to keep the momentum going in your therapy, you need to come regularly. It's understood that you might have to cancel once in a while (make sure you know your therapist's cancellation policy), but weekly sessions are generally the expectation.  Coming on time allows you to have the full benefit of the therapy time because sessions start and end at the appointed time, so if you're late, you won't get a full session (see my article: How to Keep the Momentum Going in Your Therapy).

• 7, Keep the Focus on Your Sessions Without Distractions During Your Appointment: This means you don't have any other distractions (e.g., phones, pets, etc) so you can stay focused on your session. If you're having an online session, make sure you have absolute privacy. Therapy sessions where you don't have privacy are considered unethical and therapists won't conduct a session under those circumstances. 

Opening Up With Your Therapist

• 8. Recognize That Therapy is a Process: You might not feel comfortable divulging the most vulnerable parts of yourself during the initial stage of therapy and that's alright. Give it time.  If you have issues opening up about a particular topic that you would like to work on, tell your therapist about your difficulty so she can help you to get comfortable (see my article: Progress in Therapy Isn't Linear and Setbacks Are a Normal Part of Therapy on the Road to Healing).

• 9. Opening Up Usually Gets Easier Over Time: Assuming you and your therapist are a good match, opening up usually becomes easier over time as you build a rapport with your therapist and develop trust and confidence.  This is also part of the process.

• 10. Talk About the Therapy With Your Therapist: If you're not sure about the process, talk to your therapist about it. Whether you're in the initial stage of therapy or you have been attending for a while, you can talk to your therapist about how you think therapy is going.  Many therapists do a check-in with clients periodically to see how the clients are feeling about the therapy, but you can talk about the therapy at any time, especially if there's something you don't understand or an area where you and your therapist don't agree. It's also a good idea to talk about the therapeutic relationship and whether you think it's going well.  If there's anything you feel went wrong in a session, bring it up so it can be addressed as soon as possible (see my article: Ruptures and Repairs in Therapy).

Conclusion

You can usually get a sense of whether you and your therapist are a good match.  If it's not a good match, you can tell your therapist rather than ghosting her. Experienced therapist are aware that every therapist isn't for every client, so this shouldn't be a problem.

Most clients get comfortable opening up over time, but if you have a particularly difficult time and you're aware that you and your therapist are a good match, bring up your difficulty in your therapy session.

Your therapist can help you to identify and work on overcoming whatever emotional obstacles might be getting in your way.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT therapist (for couples), Somatic Experiencing and sex 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.

Many Women Don't Tell Their Male Partners When They Have Pain During Intimacy

Painful intercourse is a common problem for many women of all ages. Unfortunately, instead of telling their partner about the pain, more than 50% of women endure the pain without ever mentioning it (see my article: Getting Help in Sex Therapy For Painful Sex).

Why Women Don't Talk About Painful Intercourse

Why Don't Women Tell Their Partners They're Having Pain During Intercourse?

When researchers asked women why they didn't tell their male partners about painful sex, they received the following responses from women:

• They thought pain was "normal" during sex (it's not).

• They felt pain wasn't worth mentioning because the pain wasn't severe.

• They were concerned that if they told their male partner they had pain during intercourse, it would mean they wouldn't have intercourse at all.

Why Women Don't Talk About Painful Intercourse

• They prioritized their male partner's pleasure over their own discomfort--even if it meant they would keep experiencing painful sex every time.

• They felt too embarrassed to talk about painful sex with their partner, so they would rather endure the pain than talk about it.

• They didn't want to make their partner feel uncomfortable.

• They didn't want any awkwardness between them and their partner.

• They thought they just needed to "power through" intercourse--even though it's painful.

• They didn't know they could engage in other sexual activities that could be just as sexually satisfying for them and their partner and that sex involves more than just intercourse.

What Causes Painful Intercourse For Women?

There can be many reasons why a women experience painful interourse.  

To determine the reason for the pain in their particular case, women need to consult with a knowledgeable sexual health professional (not all primary care doctors or even gynecologists are knowledgeable about painful sex).  

Some potential causes for painful sex include:

• Lack of sufficient lubrication during sexual intercourse, which cause irritation and pain

• Insufficient sexual arousal because women and their male partners rush through sex without taking the time to ensure women are sufficiently aroused for sexual intercourse

• Longstanding resentment due to relationship conflict which gets in the way of sexual pleasure and, in turn, can result in painful intercourse

• Undiagnosed vaginismus, resulting in muscle spasms at the entrance of the vagina which either restrict entrance or clamp shut the vagina

• Pain around the vulva, the outer part of women's genitals, which is called vulvodynia which can result in pain, irritation, a burning sensation, soreness or rawness.

• Vaginal infections, including a yeast infection or bacterial infection (vaginosis)

• Vaginal dryness due to menopause

• Vulvar Vestibulitis, an inflammation of the vestibular glands just outside the vagina

• Birth control pills as a cause of sexual pain due to biochemical changes

• Other medical conditions, such as uterine prolapse, endometriosis, interstitial cystitis, irritable bowel syndrome (IBS) and other gynecological problems can lead to painful sex

• Other medical problems 

What Can Women Do to Deal With Painful Intercourse?

• Talk to your partner (see my article: How to Talk to Your Partner About Sex - Part 1 and Part 2

Talk to Your Partner About Painful Intercourse

• Seek help from a knowledgeable gynecologist or a sexual health professional

• Seek help from a pelvic floor specialist

• Seek help from a sex therapist, especially if the problem involves sexual anxiety, unresolved resentment toward a partner or other unresolved emotional issues, including a history of sexual abuse

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy that focuses on sexual issues for individuals and couples (see my article: What is Sex Therapy?)

Seek Help in Sex Therapy

Individual adults and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

There is no sex, nudity or physical exams during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?).

Rather than struggling on your own, seek help from a licensed mental health professional who is a sex therapist so you can have a more fulfilling sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, trauma therapist (including EMDR, AEDP, Somatic Experiencing), Emotionally Focused Therapy Couples Therapist and Sex 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.

Is It True That "Real Men" Are Always Ready to Get It Up?

In my previous article, Overcoming Problems With Anxiety-Related Erectile Dysfunction, I focused specifically on how stress and anxiety can make it difficult for men to get and stay hard and how sex therapy can help with this problem.

Is It True That "Real Men" Are Always Ready to Get It Up?

In the current article, I'm addressing the idea that "real men" are always ready and willing to get it up any time, any place and with anyone.  

Is this true?  In a word, no.

Problems With Getting an Maintaining an Erection Are Common

It's not true because, at some time or another, most men have problems with getting or maintaining an erection.  

It's a common problem that occurs occasionally for many reasons, which will be discussed below, and when it occurs occasionally, in most instances, once medical problems have been ruled out, it's not a cause for concern.

The idea that "real men" are always ready to get it up is a form of toxic masculinity which perpetuates psychologically destructive misinformation for men and their partners. And one of the primary reasons it's so destructive is that the logical conclusion to this myth is that a man who isn't always ready to get it up is "less than a man" or deficient in some way. 

This myth often creates feelings of shame and inadequacy for men and feelings of being sexually undesirable for their partners--regardless of sexual orientation and gender.

This myth can also perpetuate a cycle of anxiety, shame, doubt and fear that can lead to ongoing problems with erectile dysfunction (ED) when ED was never the problem to begin with.

Why Can't a Man Get Hard If He Wants to Have Sex and He Finds His Partner Sexually Desirable?

Men aren't machines so it's not a matter of pressing a button to automatically get their penis hard.

Men can find their partners very sexually desirable and still not be able to get or maintain an erection for a variety of reasons, including (but not limited to):

• Stress
• Tiredness
• Too much alcohol
• Side effects of certain medications
• Anxiety
• Depression
• Other emotional issues
• Relationship problems
• Health concerns like diabetes, high blood pressure, heart problems, poor circulation, prostate problems, age-related problems and so on
• Financial problems
• Other related issues

When a man's partner assumes that his problems with getting and maintaining an erection reflect poorly on the partner, this perception compounds the problem even further by creating stress and bad feelings in the relationship.

At that point, a man can feel even more pressure to get and stay hard because he feels his masculinity is in question and also because he doesn't want to disappoint his partner.  

But stress and pressure make it harder to get and maintain an erection, so this can become a negative cycle.

Are There Times When a "Real Man" Just Doesn't Want to Have Sex?

In a word, yes.

Why should wanting to have sex be any different from wanting to do anything else?

If we were discussing a preference for anything else--going to the movies, eating dinner at a particular restaurant, watching TV and so on, it would be obvious that there are times when people don't want to engage in an activity and other times when they don't.  

It's the same for having sex and, once again, it's not a reflection on the man or his partner.  

But, once again, if a man feels pressure because he doesn't want to have sex, he might feel he has to "man up" to have sex when he doesn't want it because he fears being judged as "less than a man" and he also doesn't want to disappoint his partner.  

To complicate matters, many men (and women) don't feel comfortable talking about sex with  their partner because they don't know how and/or they feel ashamed (see my article:  How to Talk to Your Partner About Sex - Part 1 and Part 2).

In addition, even though it's often assumed that "real men" are always ready for sex, many men experience responsive desire as opposed to spontaneous desire so, even if they're willing to have sex, they need time to get sexually aroused (see my article: Both Responsive and Spontaneous Sexual Desire Are Normal).

What If Problems With Getting Hard Are Due to Relational Problems?

There are times when men (and women) don't want to have sex because there are problems in the relationship.  This is a common problem.

It's a good idea for a man to see a urologist or sexual health doctor to first rule out any other health reasons that are affecting his ability to have an erection.  Once those problems are ruled out, the problem can be related to other problems, including relational problem with a partner.

With regard to relational problems, it makes sense that feelings of anger, sadness, hurt or emotional numbness aren't conducive to wanting sex.  

Under these circumstances, couples often need to get help both relationally and sexually from a couples therapist who is also a sex therapist to overcome problems that are creating emotional and sexual obstacles in the relationship.

Getting Help in Couples and Sex Therapy

Couples seek help in couples and sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

Getting Help in Couples and Sex Therapy

Sex therapy, in particular, is for individual adults and couples (see my article: What is Sex Therapy?

There is no nudity, sex or physical exams in sex therapy (see my article: What Are Common Misconceptions About Sex Therapy? ).

If you're having problems, rather than struggling on your own, seek help from a licensed mental health professional who has an expertise in both couples and sex therapy.

Overcoming your problems can allow you to have a more meaningful relationship and a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, trauma therapist (EMDR, AEDP, Somatic Experiencing), Emotionally Focused Couples therapist and a sex 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.