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Wednesday, December 13, 2017

Developmental Trauma: Living in the Present As If It Were the Past

My prior articles about psychological trauma discussed how unresolved childhood trauma, also known as developmental trauma, affects traumatized individuals as adults (see my article: Overcoming Trauma: When the Past is in the Present).  In this article, I'm focusing specifically on how developmental trauma often affects clients' relationship with their psychotherapist, especially during the early stage of psychotherapy.

Developmental Trauma: Living in the Present As If It Were the Past
In his paper, Developmental Trauma Disorder, trauma expert Bessel van der Kolk, MD indicated that developmental trauma, which includes abuse and neglect, is probably this country's biggest public health challenge.

He estimated that approximately 3,000,000 children are reported as being abused or neglected per year--and these are only the cases that are reported.  Many cases go unreported, so that number is probably much higher.

According to Dr. van der Kolk, approximately 80% of these cases are the result of abuse and neglect by the children's own parents.  As a result, developmental trauma is a significant problem in this country, and much remains to be done.

Since untreated trauma does not simply go away when children become adults, it's important to understand the impact of trauma (see my article: Untreated Trauma is a Serious Issue With Negative Consequences).

What is Developmental Trauma?
Before going into more clinical material, let's define "developmental trauma."

Developmental trauma occurs in childhood. It causes overwhelming stress for the child, especially when the stress is not alleviated by the parents.  This includes:
  • physical abuse
  • emotional abuse
  • sexual abuse
  • physical neglect
  • emotional neglect

The dysfunction in the home can include, among other things:
  • mental illness
  • substance abuse
  • domestic violence
  • an incarcerated relative
  • divorce
Developmental trauma is also called Adverse Childhood Experiences (ACE) and has serious long term health and mental health implications (see ACE Childhood Study).

Since adults, who experienced Adverse Childhood Experiences, were unable to trust their parents, who were supposed to love and protect them as children, it makes sense that they often have problems trusting people in their adult relationships, including their psychotherapist (see my article: Adults Who Were Neglected or Abused as Children Often Have Problems With Trust).

What Are the Clinical Implications in Therapy For Adults With Developmental Trauma?
For adults, who experienced developmental trauma as children, it takes a lot of courage to come to therapy to be emotionally vulnerable enough to work through their trauma (see my article: Starting Therapy to Overcome Untreated Trauma and Developing the Courage to Change).

It's not surprising that these adults often come to therapy with a great deal of ambivalence and mistrust (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Since most trauma-informed psychotherapists recognize these dynamics, they are aware of the importance of trying to establish a trusting relationship with these clients.

It's not unusual for these individuals to go from one psychotherapist to the next as soon as they feel emotionally vulnerable in therapy--especially since they often come to therapy unconsciously anticipating that the therapist will fail them in the same way that their parents failed them.

Their unconscious anticipatory fear that the psychotherapist will fail them in much the same way that their parents failed them usually indicates that they are living in the present as if it were the past.

The following fictional clinical vignette, which represents a common scenario for adults with developmental trauma, illustrates these points:

Fictional Clinical Vignette: Living in the Present As If It Were the Past

Nina, who was in her mid-30s, began therapy after her relationship with John ended six months after they started dating.

John ended the relationship because of Nina's jealous accusations.  John vehemently denied that he was cheating, but Nina didn't believe him.

Developmental Trauma: Living in the Present As If It Were the Past

Although they got along well during their first three months together, Nina began to suspect that John was cheating after their relationship became more emotionally intimate in their fourth month together.

Even though she saw no direct signs of John's infidelity, her suspicions alone were enough for her to assume that he was cheating, and she was relentless in her accusations.

When she came for her first session with her therapist, Nina expressed regret that she had destroyed her relationship with John with no objective evidence that he was cheating.  In hindsight, she understood her mistake and why John got fed up.

She also explained to her therapist that this was her pattern in relationships--she always assumed that her boyfriend at the time was cheating, even when there were no objective signs of infidelity.

When she came to therapy the following week for her second session, Nina had a completely different take on why her relationship with John ended.

She told her therapist, "All men cheat and since all men cheat, I know that John was cheating on me.  He ended the relationship because I called him on it and he didn't like it."

When her therapist attempted to explore Nina's feelings about the relationship in the current therapy session versus what Nina said in the first session, Nina acknowledged that she had initially said that  she had made a mistake with John.  But she maintained that she was wrong in her first session and what she felt today was the truth, "Men can't be trusted."

Her therapist realized that, although Nina did a 180 degree turnaround from her first therapy session to her second session a week later, she knew that Nina did not meet the clinical criteria for multiple personality disorder or, as it is now called, Dissociative Identity Disorder (DID).

She recognized Nina's turnaround as a matter of shifting self states, which is a dissociative process, but not as dissociative as DID (see my article: How Shifting Self States Can Affect You For Better or Worse).

And, while everyone has shifting self states to some degree, people who are not traumatized usually have barely perceptible shifts as compared to people with unresolved trauma.

So the fact that Nina had a completely different view about the demise of her relationship when she returned to therapy on the second week was understandable considering her history of childhood trauma.

When Nina talked about her childhood, she vacillated between idealizing and denigrating her mother.

When she idealized her mother, Nina thought that her mother could do no wrong.  But when she denigrated her mother, she blamed her mother for not leaving the father, who had a long history of cheating on the mother.  Once again, her therapist understood these shifts as being part of Nina's shifting self states which were emotionally unintegrated.

Nina also had a long history of aborting therapy.  She explained to her current therapist that she had seen 10 therapists in the last two years, and she left each one when she felt that she couldn't trust the therapist (see my article: When Clients Leave Psychotherapy Prematurely).

Based on what Nina told her, her current therapist could see that Nina's pattern was that she left therapy as soon as the therapeutic work intensified and she felt too vulnerable.  Before that, Nina tended to idealize her therapists.  But once the work progressed and came close to her core traumatic issues, Nina became fearful, she developed a mistrust for the therapist and left therapy abruptly.

Forewarned of Nina's pattern in therapy, her therapist knew that there was a real possibility that Nina might abort the current therapy--even if it seemed like she developed a trusting relationship with the therapist before they processed Nina's traumatic experiences.

During most of her therapy sessions, Nina made it clear to her therapist that she understood that her traumatic childhood, including her father's infidelity, impacted her ability to have lasting relationships with men.

Most of the time, she expressed regret for her mistrust and wanted to "...hurry up and get over my trauma, since I'm not getting any younger and I'd like to get married and have children."

Nina sought therapy with her current therapist because the therapist specialized in working with trauma using EMDR Therapy.  Nina wanted to try EMDR therapy because she heard that it tends to work faster than regular talk therapy.

On the days when Nina acknowledged how her childhood history affected her adult relationships, she was in a hurry to get relief from her traumatic symptoms.

But on the days when she came to therapy blaming "all men for being dogs," she disavowed any connection between her childhood history and the demise of her relationships.  Once again, her shifting perspective was due to her shifting self states.

As part of the therapeutic process, Nina's therapist was the "container" for these different self states (see my article: The Holding Environment in Psychotherapy).

She knew that, even when Nina was in a hurry to process her childhood trauma, Nina wasn't ready.  Nina needed to develop internal resources and a greater sense of emotional integration before she would be ready to process her childhood trauma--otherwise, she would be flooded with anxiety and completely overwhelmed by the trauma therapy.

Her therapist also helped Nina to recognize her different self states by doing Ego States therapy (also known as Parts Work therapy) with Nina.  In this type of therapy, the therapist helps the client to get to know each of her shifting self states in order to foster greater emotional integration.

Nina understood most of the time that the internal resourcing and the Ego States therapy was preparation to eventually process her traumatic memories.  But there were times when she came to therapy feeling angry with her therapist for "dragging out the process and not helping me to get over my trauma."

During those times, Nina was ambivalent about her therapist and about the therapy.  Nina feared that she was being "duped" by the therapist and that she shouldn't trust the therapist.  She threatened to leave therapy and accused her therapist of being "no better than all the other therapists that I've had before."

But Nina and her therapist weathered these storms and, most of the time, Nina was able to see that her doubts and mistrust were the result of a particular self state that got triggered when she became anxious about the therapy (see my article: Coping With Trauma: Becoming Aware of Your Emotional Triggers and Expanding Your Window of Tolerance in Therapy).

She could see that what she was experiencing was the result of her traumatic past which she was living out in the present with her therapist.

Along the way, there was enactments in therapy, as there often are with clients who have been traumatized:  There were several sessions in a row where Nina "forgot" to bring a check to pay her therapist, she "forgot" to come to her sessions, and she was annoyed when her therapist held her accountable for her broken appointments.

All of these enactments were unconscious on Nina's part and were part of her dissociative shifting self states.

Most of the time, her therapist did not get caught up in these enactments but, being human, there was one time when she found herself right in the middle of an enactment with Nina: Nina's therapist had to take a couple of weeks off for a medical procedure.  She made a conscious decision not to disclose her medical problem, which was not serious, to Nina because she assessed that Nina was not ready emotionally to handle this disclosure.  She also wanted to preserve her right to privacy by not disclosing her medical problem.

When her therapist told Nina that she had to take a couple of weeks off, Nina exploded.  She was angry because she felt she was being abandoned by her therapist and with only a couple of weeks notice (see my article: Abandonment Issues Can Get Triggered While Your Therapist is Away).

Nina's therapist had little notice from her doctor that she needed this medical procedure, which could not wait, so she couldn't provide Nina with more notice.  But her therapist didn't want to reveal this to Nina because, as previously mentioned, she thought Nina was too emotionally fragile at that point.

Her therapist did the best she could under the circumstances to contain Nina's upset as well as her own feelings of being misunderstood.  But, after two sessions where Nina ranted about the two week break, her therapist told Nina in an angry tone that she would have a backup therapist that could consult during that two week break.

Even though her therapist got caught up in a mutual enactment by talking to Nina in an angry tone, something shifted for Nina where she stopped ranting and realized that she was being unreasonable (see my article: Mutual Enactments in Psychotherapy Between Client and Psychotherapist).

They were able to talk about what had just happened between them, and Nina expressed that, while she didn't like that her therapist spoke to her in an angry tone, she could feel the genuine nature of her therapist's upset and this caused her to "wake up" and see her therapist as a "normal human being" with her own experiences and feelings.  This was a major breakthrough for Nina.

As I mentioned in an earlier article about enactments, there are times when mutual enactments can have a positive effect on the therapy if the therapist is able to repair the rupture between the therapist and client and they come to a new understanding of their therapeutic relationship (see my article: Ruptures and Repairs in Psychotherapy).

Of course, although these enactments can be repaired and advance the therapeutic work, a therapist should never plan an enactment.

Gradually, over time, Nina became much more perceptive of when she was going through a self state shift.  She had developed a much more observing sense of self so that she could step back, even when she was in a mistrustful state, and see, "It's happening again," which made it easier for her to be more objective and shift into a more emotionally balanced state.

Developmental Trauma: Living in the Present As If It Were the Past

As Nina became more emotionally integrated with fewer dramatic self state shifts, she was now ready to process her earlier traumatic experiences using EMDR therapy.

By processing her childhood trauma in therapy, eventually, Nina freed herself from her traumatic history so that she was no longer living in the present as if she were in the past.

Reenacting unresolved childhood trauma is an unconscious process.

These reenactments occur in personal relationships, work relationships, and in the client's relationship with his or her psychotherapist.

There are times when traumatized clients are able to get a glimpse into these reenactments in therapy but, due to the nature of their shifting self states, this new understanding can be tenuous and change back and forth over time until the client becomes more emotionally integrated as a result of the work in therapy.

A skilled trauma-informed psychotherapist understands that clients often go back and forth in their understanding of their problems because the shifting self states are unconscious.

Developing a trusting relationship with a traumatized client is of the utmost importance before any processing of trauma occurs.

The therapist must also help the client to develop the necessary internal resources and coping skills before processing trauma.

Each client is unique as to when he or she feels safe enough in therapy and prepared to do the therapeutic work.

When a client has worked through developmental trauma, s/he is free to live life without constantly reenacting the past.

Getting Help in Therapy
Making the decision to start therapy is an important step which most people don't take lightly, especially people with a history of trauma (see my article: The Benefits of Psychotherapy).

People with developmental trauma often come to therapy after they have had a series of major disappointments or setbacks in their life.

It takes courage to face a painful history of trauma, and most trauma-informed psychotherapists are aware of this and the clinical implications for the client (see my article: How to Choose a Psychotherapist).

If you think you might be living in the present as if it were the past, you owe it to yourself to get help from a licensed trauma-informed mental health professional.

Although the therapeutic work isn't quick or easy, once you have worked through the trauma, you can live a more fulfilling life without the burden of your past.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients to overcome trauma so they could go on to live a more fulfilling life.

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

To set up a consultation, call me at (212) 726-1006 or email me.

Tuesday, December 12, 2017

How Your Attachment Style Affects Your Relationship

In her book, Hold Me Tight: Seven Conversations For a Lifetime of Love, marriage and family therapist, Sue Johnson, discusses, among other things, how attachment styles impact relationships and how to overcome relational dynamics that might be ruining your relationship (see my article: Telltale Signs That You and Your Spouse Are Growing Apart).

How Your Attachment Style Affects Your Relationship

Before going much further, I think it would be useful to define the term "attachment styles."

What Are Attachment Styles?
Your attachment style is how you relate to people.

Your attachment style is developed during infancy and it is formed based on your relationship with your primary caregivers (usually your parents).

The four attachment styles for adults are:
  • secure
  • insecure - anxious-preoccupied
  • insecure - dismissive-avoidant
  • insecure - fearful-avoidant
Based on the names of the categories above, it's obvious that the healthiest attachment style is the secure attachment style.

Although much has been written about attachment theory, I'm focusing more on the practical aspects of understanding attachment styles in relationships rather than the theory, so this is a basic explanation of attachment styles.

Even though people develop their attachment style early in life, it is possible to change how you relate.

How Do Attachment Styles Affect Relationships?
When two people come together in a relationship, they interact with each other based on their attachment style.

Although this might not be evident at first, once the relationship becomes more emotionally intimate, each person will interact with the other based on the attachment style they developed at an early age (this assumes that neither person has been to therapy and has not made any changes).

Most people have little to no aware of their particular attachment style.  They behave in a relationship in a way that feels right to them or their behavior might be unconscious.

The best way for me to demonstrate attachment styles in a relationship is through a fictionalized vignette:

Fictional Vignette:  How Your Attachment Style Affects Your Relationship:

Mary and Joe
Mary and Joe, who were both in their early 30s, were dating exclusively for a year.

During the early part of their relationship, they got along well and decided to be monogamous to see if their relationship would develop.

After six months, Mary suggested that they talk about where their relationship was going (see my article:  Dating: Is It Time to Have the Talk?).

Although she didn't want to rush things between them, she knew that she wanted to get married eventually and have children, and she was increasingly conscious of her age and that her "biological clock was ticking." All of this made her feel anxious.

Joe was open to having this talk.  He had also been thinking about talking about their relationship, but he probably would have waited a few more months.

At first, it was awkward for each of them to begin this discussion.  So, Mary began by saying that she loved Joe, she was happy in their relationship and she could see them getting married and having children together.  Then, she waited anxiously for Joe to respond.

Joe listened to Mary, and he responded that he loved her very much and he could also see them getting married and having a family "eventually," but he wasn't ready to make that commitment at this point.

When Mary asked him when he thought he would be able to make this commitment, Joe thought about it and then told Mary that he didn't know.  Even though he felt their relationship was heading in the direction of getting married and having a family, it just didn't feel right to him at the moment to make that commitment.

Mary was disappointed to hear Joe say this.  She had hoped that he would, at least, tell her that he wanted to set a date for them to get engaged.

When she told Joe this, he said he would be open to their living together and seeing how things worked out.  And, then, if things worked out for them, he would feel comfortable talking about getting engaged.

On one level, this made sense to Mary but, on another level, she also had a nagging doubt that if she and Joe moved in together that he would never ask her to get married.  She was aware that she felt this way based on how her mother talked about couples who lived together (her mother would say, "Why buy the cow when the milk is free?").

Over the next few weeks, they talked about this impasse several times, and Mary tried as best as she could to put aside her doubts.  They decided that even though they both had their own apartments, it would be better to find another place together that was neither hers nor his.

Two months later, they found an apartment that they both liked, and they moved in together.

Mary had hoped that when they moved in together, they would spend most of their free time together.    But Joe wanted to continue to go out with his friends a few nights a week and even sometimes on weekends, which left little time for Joe and Mary to spend together.  Mary realized that they were seeing each other less than before they lived together.

When Mary complained that they weren't spending as much time together as she would like, Joe dismissed her feelings as out of hand.  He told her that he felt they spent plenty of time together and he wasn't willing to give out his nights out with the guys (see my article: New Relationships: Time Together vs Time Apart).

As time went on, Mary felt increasingly upset and anxious about Joe's time away from her.  She felt that it meant he didn't care about her.  Her reasoning was: If Joe cared about me, he would want to spend as much time as possible with me (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

At the same time, Joe felt increasingly annoyed with what he perceived as Mary's demands on his time.  He couldn't understand why she was "making such a big deal" out of the time he spent with his friends.  He assured her that he wasn't seeing other women. What more could she want?

How Your Attachment Style Affects Your Relationship

The more Joe dismissed Mary's feelings, the more insecure and unlovable she felt.  She also blamed herself for going against her feelings that she shouldn't move in with Joe unless he made more of a commitment.  She saw Joe's dismissive comments about her feelings as proof that she made a mistake.

One Friday night when Joe came home from playing pool with his friends, he was shocked to discover that Mary had packed her bags and she was ready to go home to her family.

Mary was sitting on the couch in tears, "I'm not happy.  It must be my fault that you don't care about me, but I don't know how to fix it.  I think it's better if I leave."

When Joe got over the initial shock of seeing Mary with her bags packed, he sat next to her on the couch and told her not to be so hasty.  He suggested that they talk before she moved out, which she agreed to do.

Then, Joe explained that he likes his independence.  He said he didn't want to feel hemmed in by their relationship.  He still wanted to have friends and spend time with them.  He thought part of the problem was that Mary didn't spend more time with her friends and because of this, she was too emotionally dependent upon him.

Mary disagreed with Joe.  She told him that, as far as she was concerned, he was her primary relationship and more important than her friends, but it was clear to her that he didn't feel this way.

Joe thought that Mary was being too "clingy," but he didn't want to tell her this because he knew that she was feeling bad enough already.  He wondered to himself if he even wanted to be in relationship.  He never felt a real need for a relationship.  He preferred to be independent and on his own, but he also didn't want to be lonely, and when he met Mary, he fell in love with her.

Joe and Mary didn't resolve anything that night, but they agreed to continue to talk about it, so Mary unpacked and she stayed.

After a few days, when Mary felt her anxiety escalating again, she told Joe that she thought they could benefit from going to couples counseling.  Joe groaned inwardly when he heard Mary say this.  He didn't think they needed couples counseling, but he could see that she was very anxious and he didn't want to lose her, so he agreed to go.

After a few sessions of couples counseling, their couples counselor talk to them about attachment styles.  She said her impression was that Mary had an anxious-preoccupied attachment style and Joe had a dismissive-avoidant style.  She also told them that it was not unusual for people with these attachment styles to be attracted to each other.

Their therapist helped them to recognize their attachment styles and how it was impacting their relationship.  She also helped them to begin to make changes.

Since attachment styles are ingrained, it was not easy or quick work in couples counseling, but Joe and Mary made progress.

Mary learned to deal with her insecurities in the relationship, and Joe learned that his dismissive manner was a defense mechanism that kept him from getting closer to Mary.  He also learned that what he saw as "independence" was part of the defense mechanism.  Each of them learned to communicate about what they needed from the other.

How Your Attachment Style Affects Your Relationship
Joe recognized that he was spending much of his free time with his friends to avoid getting too close to Mary.  He saw that, even though he loved her, he was also afraid of getting hurt.  So, he agreed to spend only one night with his friends and spend the rest of his free time with Mary.  This increased their emotional intimacy and made him feel more vulnerable, but he was able to talk about this in the couples counseling.

Mary recognized that part of her unconscious attraction to Joe was that he was avoidant.  His avoidance seemed to confirm how she felt about herself--that she was unlovable.  So, Mary dealt with her longstanding feelings of being an unlovable person and with their new level of emotional intimacy.

As they continued to work on these issues in couples counseling, which was challenging, they were both happier in their relationship.

Most people have little to no knowledge of their attachment styles or that they are relating in a particular way with other people.

As mentioned earlier, attachment styles develop at an early age based on the relationship that infants have with their primary caregivers.

While no relationship is perfect, when both people have a secure attachment style, generally, they tend not to have the kind of problems that people with insecure attachment have.

Although attachment styles are ingrained from an early age, people can change how they relate if they attend individual therapy or couples counseling with a knowledgeable psychotherapist.

Getting Help in Therapy
If you're having problems in a romantic relationship or in your relationships with other people, it could be related attachment styles.

A skilled psychotherapist can help you to understand your attachment style, how it developed and how you can change how you relate to others (see my article: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Although changing how you relate to others can be challenging, you will be happier with yourself and others if you learn to relate in a healthier way.

Rather than continuing to do what doesn't work for you, you could benefit from getting help from a licensed mental health professional who is knowledgeable about attachment styles.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

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

To set up a consultation, call me at (212) 726-1006 or email me

Monday, December 11, 2017

Coping With the Family "Ghosts" in Your Psychotherapy Sessions

It's a common experience for clients attending psychotherapy sessions to feel guilty and ashamed when they talk about their family to their psychotherapists.  For many clients, it can feel like there are family "ghosts" in the room listening to them (see my articles: When "Family Loyalty" Gets in the Way of Your Psychotherapy SessionsOvercoming the Guilt You Feel For Not Being Able to Heal Your Parents' Emotional WoundsOvercoming Dysfunctional Ways of Relating in Your Family and Overcoming Shame in Psychotherapy).

Coping With the Family "Ghosts" in Your Psychotherapy Sessions

Clients, who grew up in families where they were told not to talk about the family beyond the confines of the family home, often feel they are being disloyal to their family when they speak to their therapist about family members (see my article: Toxic Family Secrets).

Most psychotherapists under this phenomenon and try to help clients to deal with their ambivalence about, on the one hand feeling the need to talk about their family history and, on the other hand, feeling as if they're violating a family rule.

Some clients can feel so guilty and ashamed that it feels like family members are hovering over their sessions like ghosts that are eavesdropping on what they're saying to their therapist.

If this is happening to you, the best way to deal with this is to talk to your therapist about it because talking about it helps to bring light to the situation and this usually helps to alleviate guilt and shame.

Let's take a look at a fictional vignette that addresses these issues:

Fictional Vignette:  Coping With the Family "Ghosts" in Your Psychotherapy Sessions:

Meg started psychotherapy after attending another family gathering where her father got drunk again.

Although she loved her family very much, she was fed up with her father's alcoholism, her mother's excuses for her father, and her brother's obliviousness to what was going on in the household.

These family visits were so unpleasant that Meg was considering avoiding them in the future because she felt so sad and angry afterwards.

When her father was sober, he was kind and considerate.  But after he had a few drinks, he became a different person.  He became critical and argumentative of Meg's mother, brother and Meg, and he spoiled the family dinner.

Whenever Meg complained to her mother about these incident, her mother made excuses for her father.  She would say that he was going through a rough time or that he was under a lot of stress.  But, as Meg pointed out to her mother, her father had a long history of excessive drinking.  Meg remembered her father getting drunk like this when Meg was a child.

Meg's brother told Meg that when their father got nasty after a few drinks, he would "zone out" and not pay attention.  This is how he coped.

When Meg spoke to her therapist about the family dynamic, she began to feel guilty that she was saying negative things about her family, especially her father.  She had never been to therapy before, and she felt as if she were betraying her family by talking about them.

Coping With the Family "Ghosts" in Your Psychotherapy Sessions
 While she was describing the last family visit where her father got drunk, Meg was overcome with anxiety.  She felt as if her mother, father and brother were in the room with her and they could hear everything that she was saying (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Overcome with guilt and shame, Meg told her therapist, "I really do come from a good family, and my father has been very good to me.  My mother too.  They're good people.  I don't want you to think that they're these people who are totally dysfunctional."

Meg's therapist could see what was going on with Meg, and she asked her if she was feeling guilty for talking about her family.

Meg was able to talk about her guilty and shame for talking about her family, especially her father, and her ambivalence about being in therapy at all.

Her therapist normalized Meg's feelings and told her that many clients feel this way, especially when they start therapy.

After that, Meg was able to talk about each family member's strengths as well as their problems, including her father.

She was also able to say more about how the family dynamic affected her rather than concentrating on each family member's dynamics.

As she focused on her own response to her family members, Meg felt more entitled to her own feelings.  She also felt entitled to take care of herself in these situations.

Over time, Meg and her therapist focused on helping Meg to heal from these longstanding problems.

Meg also came to accept that she couldn't change her family--she could only change herself (see my articles: Getting to Know the Only Person You Can Change: Yourself).

It's common for clients in therapy to feel guilty and ashamed when they talk about family dynamics in therapy.

For many people, talking about their family outside of the family home can feel like they're betraying their family.

The guilt and shame that they feel is projected outward so that it feels like there are family "ghosts" in the therapy session seeing and hearing everything the clients say.

Being able to talk to your therapist about your guilt, shame and feelings that you're betraying your family is the best way to dispel these feelings.

Psychotherapy is not just about venting or criticizing your family--it's really about how your family history affects you and what you and your therapist can do to help you to heal (see my article: Psychotherapy is More Than Just Venting: Understanding Content and Process in Therapy).

Getting Help in Therapy
Many people, who could benefit from psychotherapy, never come because of their misconceptions and fears about the process (see my article: Common Myths About Psychotherapy: Going to Therapy Means You're Weak).

One particular phenomenon that clients often deal with in therapy, especially clients who are new to the therapy process, is their ambivalence, guilt and shame about talking to their therapist about their family dynamics.

If you're in therapy and you haven't told your therapist about these feelings, you would probably feel a sense of relief from being open about your feelings.

If you've been on the fence about attending therapy to deal with your problems, you might be surprised to know that therapy is more than just venting about your family--it's about you (see my article: Self Care: Feeling Entitled to Take Care of Yourself).

Rather than struggling on your own, you could benefit from working with a licensed mental health professional who can help you to work through your problems (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Working through your family history can free you to live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients to overcome the obstacles getting in their way from maximizing their potential.

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

To set up a consultation, call me at (212) 726-1006 or email me.

How Therapy Can Help You to Overcome Loneliness

I've written prior articles about being alone, isolated and lonely, including:  Overcoming Loneliness and Social IsolationWhen There's Loneliness and Lack of Intimacy in Your RelationshipOn Being Alone and Emotional Strategies That No Longer Work For You: "I don't need anyone." 
In this article, I'm focusing on loneliness and some ways that you might be getting in your own way with regard to connecting with others.

Overcoming Loneliness in Therapy

Everyone Feels Lonely At Some Point
Loneliness is an issue for everyone at some point in their lives.

Whether you're in a relationship or not or whether you have lots of close friends or not, it's a fact of life that sooner or later you'll feel lonely.

Just because you have people around you doesn't mean that you feel connected to them or that these relationships are meeting your emotional needs.

Although everyone experiences loneliness at some point, there's a difference between feeling lonely occasionally and feeling lonely most of the time.

Taking a Look at Whether You're Open to Connecting With Others
People who feel pervasive loneliness often feel that they're flawed in some way and that other people wouldn't want to connect with them, so this prevents them from connecting with others (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

Feeling unlovable isn't a feeling that people are usually aware of on their own.  It's often an underlying feeling that they don't become aware of until they start therapy to overcome their loneliness.

The way that these feelings of being unlovable usually come to the surface is through an exploration in therapy.

When all the practical reasons for not connecting with others have been set aside, it's not unusual for people to discover that they're deeply ambivalent about connecting with others because they believe they're flawed in some way and that others will reject them (see my article: Overcoming Fear of Rejection).

At that point, in most cases, it's a matter of working through these underlying issues of feeling unlovable so that they can connect with others.

A Fictionalized Vignette About Overcoming Loneliness in Therapy

For most of her life, Sandy felt alone and lonely.

At the point when she came to therapy, she was in her late 30s and feeling close to despair.  She didn't really believe that therapy could help her, but she didn't know what else to do, so she started therapy with a lot of ambivalence (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Overcoming Loneliness in Therapy

Sandy told her therapist that she grew up as an only child with parents who were distant and cold with her and with each other.  With no other relatives close by, Sandy spent much of her time at home alone.

She grew up feeling that her parents thought she was "defective" in some way, and she was aware that they didn't really want any children.  She assumed that she was "an accident" (see my articles: What is Childhood Emotional Neglect? and What is the Connection Between Childhood Emotional Neglect and Problems Later On in Adult Relationships?).

When she started school, Sandy kept to herself.  She didn't think the other children would like her, so she didn't make an effort to make friends.

There was one girl in her first grade class, Betty, who was very outgoing and who befriended Sandy.  She would often invite Sandy over to her home after school where Sandy was surprised to see that Betty's parents were loving and affectionate with Betty.  This was in sharp contrast to Sandy's  experience with her own parents, and it made her aware that she lived in an unhappy household.

Even though Betty went out of her way to seek out Sandy, Sandy was sure that it would only be a matter of time before Betty would drop her as a friend--as soon as Betty discovered the "real Sandy" (see my article: Overcoming the Fear That People Won't Like You If They Knew the "Real You").

Since Betty was outgoing and popular with other children, she included Sandy into her group.  But Sandy felt like she was only tagging along and still felt like an outsider (see my article: Feeling Like an Outsider).

Unfortunately, a year later, Betty and her family moved out of state, and Sandy withdrew from the other children in Betty's group after Betty was gone.  Then, she went back to keeping to herself.

By the time she went to high school, Sandy made a few friends.  Although she would socialize with her friends, she always feared that her friends would abandon her.

In college, Sandy dated a few men.  She usually chose men who were narcissistic and who didn't treat her well because she didn't have a sense that she deserved to be treated well.

Sandy drifted from one short-term relationship to the next with long periods in between when she spent a lot of time on her own and feeling lonely.

By the time she was in her late 30s, she felt hopeless that she would ever be in a healthy relationship and she feared that she would always be alone.  This is what brought her into therapy.

After she revealed her history to her therapist and gave her therapist many "reasons" why she thought she would be lonely for the rest of her life, her therapist helped Sandy to see how she was creating obstacles for herself.

The biggest obstacle for Sandy was that she felt unlovable and undeserving.  This feeling was so strong that no amount of talking about it could dissuade her.

Her therapist talked to Sandy about working through her early experience of emotional neglect and feelings of being unlovable using EMDR therapy (see my article: What is EMDR Therapy?)

At first, Sandy was reluctant to work on these issues because she was convinced that her situation was hopeless.  But her therapist also knew that Sandy's self perception was longstanding since childhood and that she was, understandably, afraid to let go of these perceptions.

When she was ready, Sandy agreed to try EMDR therapy.  Her attitude was "I have nothing to lose, so I'll try it."

Gradually, over time, Sandy came to see that her feelings of being unlovable were rooted in her experience with her parents, who were incapable of being loving.

For the first time in her life, she was able to step back emotionally to see that her parents were the ones who had problems, and their problems were part of intergenerational trauma:  Their parents were unable to be loving and their grandparents had the same problem--all related to a long history of unresolved trauma in both families (see my article: Psychotherapy and Intergenerational Trauma).

Recognizing that she wasn't inherently flawed for the first time, Sandy felt a new sense of freedom.  She thought back in her life to all the people who cared about her and she realized that they found her to be a lovable person--so she wasn't unlovable.

Overcoming Loneliness in Therapy

Although this new self perception freed Sandy to see herself in a new way and to venture beyond her usual social comfort zone, she also felt some regret that she had wasted so much time burdened by her negative feelings about herself.  So, she mourned this loss.  But she also made more of an effort to connect with others.

As she felt better about herself, she experienced an upward spiral:  Her new sense of self esteem allowed her to be more social, and as she extended herself, people were open to connecting with her.  And the more people were open to connecting with other, the more confident she felt.

For many people, overcoming loneliness is a matter of overcoming longstanding negative views about themselves.

Feelings of being unlovable are usually unconscious, so these underlying feelings remain hidden until a skilled therapist can assist to gently help to unearth them.

Trauma therapy, like EMDR therapy, is an effective way to overcome trauma and the related negative beliefs about yourself.

Getting Help in Therapy
It can be very challenging to come to terms with the fact that you might be getting in your own way when it comes to overcoming loneliness.

This isn't to say that feeling unlovable or undeserving are the only reasons why people feel lonely, but when loneliness is pervasive in your life, these are often unconscious underlying reasons.

Rather than suffering on your own and feeling hopeless and helpless, you could benefit from working with a skilled psychotherapist who can help you to work through these issues so you can be free from your history.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works 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 (212) 726-1006 or email me.

Sunday, December 10, 2017

Using Imagery as a Powerful Tool in Trauma Therapy

In prior articles, I discussed how developing internal and external resources are helpful in processing psychological trauma (see my articles: Developing Internal Resources and Coping SkillsCoping Strategies in Mind-Body PsychotherapyThe Therapeutic Benefits of Integrative PsychotherapyUsing Your Imagination as a Powerful Tool For Change, and Understanding Your Shifting Self States).   One of the many resources that I use when doing trauma therapy is imagery, which is the subject of this article.

Using Imagery as a Powerful Tool in Trauma Therapy

As an integrative psychotherapist, I often combine various treatment modalities when it's beneficial to  the individual client.

The key to being able to combine treatment modalities in an integrative psychotherapy is to have a good foundation in a particular type of psychotherapy and professional training in the other modalities.

As I've mentioned in other articles, my original postgraduate training is in psychoanalysis and psychodynamic psychotherapy, and I work in a contemporary, dynamic and interactive way.

After using psychoanalysis and psychodynamic psychotherapy for several years, I could see that it had certain limitations--just as all therapy modalities do.

Although my personal experience in psychoanalysis was very effective in helping me to resolve traumatic experiences, that was nearly 20 years ago, times have changed and most clients don't want to come to therapy for multiple sessions per week for several years as I did.

Once a week psychoanalysis/psychodynamic psychotherapy, which is now the norm, lacks the same intensity as multiple sessions per week.  As a result, the transference/countertransference issues are not as intense, and generally it takes longer in once a week sessions to resolve trauma.

This is what prompted me to study EMDR Therapy, clinical hypnosis and Somatic Experiencing.

For many clients, who don't want to wait years for relief from their traumatic symptoms, these therapy modalities work faster than psychoanalysis/psychodynamic therapy in helping clients to overcome trauma.

This doesn't mean that I don't use my psychodynamic understanding while working with a client.  I still listen and pay attention for the client's unconscious process and transference/countertransference issues as I integrate other forms of therapy.

Before I go into how I use imagery, I want to clarify that the client doesn't need to be good at visualizing to use imagery.

Many clients, who say they can't visualize, are able to get a "felt sense" of images and this is just as useful in therapy.  Other clients who have difficulty visualizing have other senses that work, including an intuitive sense of the image, which can be very powerful.

Using Imagery as a Powerful Tool in Trauma Therapy
Imagery is a powerful resource in psychotherapy, especially when working with psychological trauma.

Imagery comes alive when the therapist helps the client to amplify and enhance the imagery.

The following fictional vignette demonstrates how imagery helps to process trauma:

Nick started therapy because he was having a difficult time asserting himself in his marriage and in his work-related relationships.

Using Imagery as a Powerful Tool in Trauma Therapy

He told his therapist that ever since he was a child, he lacked confidence in himself and this lack of confidence had a profound effect on his life.

In his personal relationships, before he got married, Nick had a hard time asserting himself when he was attracted to a woman.  Throughout college, he had difficulty feeling confident enough to ask women out on a date.  Most of the time, he would go out with women who asked him out.

In his senior year, he met a woman, Jenna, that he really liked. He lacked the self confidence to ask her out, but he soon discovered that she was interested in him when Jenna asked him to go out for dinner.

Jenna was the one who initiated sex and, 10 years later in their marriage, she was still the one who initiated sex and all their activities, including social activities and vacations.  This was causing problems in their relationship because Jenna complained that she was tired of always being the one to take charge.  She wanted him to take charge sometimes.

Nick understood why Jenna was unhappy with his lack of assertiveness, but he didn't know how to change.

Nick was also having problems advancing in his career.  Other people that he trained and who knew less than Nick, were getting promoted into more senior positions because they knew how to advance their ideas and themselves with their superiors.

When Nick discussed his family history with his therapist, he described a neglectful and critical parents.  He was the younger of two sons, and his parents tended to dote on their older son and to ignore or criticize Nick.

They often compared Nick unfavorably to his older brother, John, and generally discouraged Nick.

Over time, Nick felt that he had nothing of value to offer, and he tended to remain quiet while his older brother got all the praise.

He often felt as a child that he was "a mistake" and that his parents didn't really want to have another child.  This was confirmed by his mother in a tactless admission on her part when Nick turned 21 and left home.

Until he began therapy, Nick never associated this critical, neglectful parent with his lack of confidence and assertiveness.  He also never realized that he had been traumatized by these early experiences.

As he discussed this with his therapist, he said this made sense to him, but he asked, "Now that I know this, how can I change it?"

Based on her experience as a trauma therapist, his therapist told Nick that, although his awareness was an important step, it was only the first step.  She recommended that they revisit his memories using imagery as a tool in trauma therapy.

One of Nick's touchstone memories was of his father telling Nick to "Be quiet" when he wanted to tell his family about an award he received at school for a science project.

Not only did his father tell Nick to "Be quiet," he also told him that "No one's interested in hearing about your award." Then his father turned to Nick's older brother, John, and asked him how his day went at school, and both his father and mother listened to John with admiration.

As a result of many similar experiences with his parents, Nick felt "I'm not important" and "I'm powerless."  These feelings remained with him as an adult.

Nick's therapist recommended that they use imagery to go back to that touchstone memory to see how Nick's experience of himself might change if he could imagine himself having a powerful ally in that situation.

At first, Nick couldn't think of anyone to be an ally to rework this memory.  Then, he remembered his science teacher, who recommended Nick for the award and who often complimented him on his work.

His therapist asked Nick to go back into the touchstone memory and to imagine what his science teacher might have said if he had been with Nick when his father told Nick to be quiet.  She asked Nick to describe the scene in the present tense.  She also helped Nick to amplify the imagery so he could experience it more vividly.

Nick closed his eyes and imagined himself back at home with his family.  He also imagined that he invited his science teacher, Mr. Ross, to dinner that night and Mr. Ross was sitting next to Nick when Nick brought up his science award, "Mr. Ross is there sitting next to me.  When he hears my father tell me to be quiet, he interrupts my father and says, 'Now wait a minute--this is a very important award at the school and Nick's science project was by far the best project the school has seen in years.  I can't sit here and allow you to be dismissive of Nick and this wonderful honor.  Nick deserves much better than this.  I don't have children but, boy, if I had a son like Nick, I would never tell him to be quiet.'"

Nick's therapist could see that Nick's demeanor changed as he imagined Mr. Ross standing up for him.  His chin was raised, his posture was more erect and he had a smile on his face.

Then he explains to his therapist, "Both of my parents have always had a lot of respect for teachers, and they liked Mr. Ross so they would listen to him.

Then Nick goes back into his memory, "So, when they hear Mr. Ross say this, both of my parents look embarrassed and they look at me in a different way.  Then, my father says, 'I'm sorry for interrupting you, son.  Tell us more about your award."

Nick's therapist helped Nick to amplify the shift he was experiencing and to anchor that new feeling in his body.

Nick and his psychotherapist did many similar exercises in therapy using imagery for other traumatic touchstone memories.

Using Imagery as a Powerful Tool in Trauma Therapy

Gradually, Nick was able to internalize the feeling that he is a worthwhile and lovable person.  Over time, as he gained more confidence in himself.

To his wife's delight, he took more of an initiative in terms of their sex life and social activities together.

With regard to his career, Nick and his therapist used imagery to rehearse scenes with his manager where Nick would be more assertive in advancing his ideas.  This allowed Nick to present himself and his ideas with increased confidence, which resulted in praise and promotion with a substantial pay increase.

Every client is unique and their needs in therapy are different, which is why it's helpful for therapists to have a number of different modalities to use to help clients to overcome their problems.

Imagery can be a powerful tool in trauma therapy.  It is one of many tools that trauma therapists can use to help clients to transform traumatic experiences.

When clients use imagery in therapy to imagine the help of powerful figures, such as mentors, wise people, nurturing people or whatever type of figure would be helpful, this can help to create new neural networks in the brain that facilitate change.

Using imagery can help clients to see themselves in a different way and allows them to transform their unresolved trauma.

Getting Help in Therapy
If you have unresolved traumatic experiences, rather than continuing to suffer on your own, you could benefit from working with a trauma therapist (see my article: The Benefits of Psychotherapy).

Once you're free of your trauma, you will have a greater sense of well-being and lead a more fulfilling life (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I work in an integrative way depending upon the needs of each client.

One of my specialties is helping clients to overcome trauma, and I use many creative therapeutic tools, including imagery.

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

To set up a consultation, call me at (212) 726-1006 or email me.

See My Other Articles About Psychological Trauma.

Thursday, December 7, 2017

How Your Shifting Self States Can Affect You For Better or Worse

I have discussed self states in prior articles (see my articles: Understanding the Different Aspects of Yourself That Make You Who You AreParts Work in Therapy: Is a Split Off Part of Yourself Running Your Life?Learning to Nurture Your Inner Child, and Experiencing Your Future Self: The Self You Want to Become.  In this article, I'm focusing on how your self states shift in various ways and how you can use these shifting self states to feel more confident and resilient.

How Shifting Self States Can Affect You For Better or Worse

What Are Shifting Self States?
As I discussed in a prior article, even though people tend to think of themselves as unitary beings, in fact, everyone has a multiplicity of selves or self states.

Self states are on a continuum.  For the purposes of this article, when I refer to self states, I'm not referring to multiple personality disorder or dissociative identity disorder, which is a diagnosis on the far end of the spectrum of self states.  I'm referring to everyone's common experience of different aspects of themselves.

The reason why people aren't usually conscious of these self states is because a particular self state usually predominates at any given time and the other self states tend to recede.

So, the self states tend to shift in a barely perceptible way, and this is a common phenomenon for everyone.

An Example of a Shifting Self State
Andy was feeling confident in himself as he approached the theatre where he was about to audition.  He had practiced his lines with his acting coach, and he really felt he understood the role and how to approach it.  His acting coach told him that this part was made for Andy, and he encouraged Andy to go to the audition.

How Shifting Self States Can Affect You For Better or Worse
But just before he went on stage to recite the lines from the play, Andy remembered the first time that his mother came to see him in a play and how critical she was afterwards.  She told him that his performance was the worst thing she had ever seen and she advised him against an acting career.

Whereas Andy had been walking with his head up, chest out, and whistling a tune before he got to the theatre, when he remembered what his mother said, his demeanor changed to reflect the shift in his self state:  He looked down at the ground, his posture was slightly hunched and all he could think about was that he wasn't going to pass the audition.

Discussion About the Example of a Shifting Self State
In the fictional example above, Andy was feeling confident in himself initially.  He received positive feedback from his acting coach and he felt and projected his confidence.  At that point, Andy was in a particular self state where he felt sure of himself.

But when he thought about the negative comments that his mother made to him, his self state shifted without Andy realizing it.  He no longer felt confident and this was reflected in his inner sense of self as well as in his body language and outer presentation.  This switch in self states was unconscious--it happened outside of Andy's awareness.

How to Use Shifting Self States to Enhance Your Sense of Self
As a trauma therapist, I assist clients with internal and external resourcing as part of the preparation for doing trauma work.

One way to do internal resourcing, which I often use, is called imaginal interweaves as developed by Laurel Parnell, Ph.D. (see my article: Developing a More Resilient Self in Therapy).

Imaginal interweaves are a tool to help clients to feel confident, lovable and other positive aspects by imagining powerful, nurturing and wise figures.  These figures can be people that clients know or they can be from books, movies, TV programs or other fictional characters.  They can also be superheroes if this feels meaningful to the client.

The kind of imaginal interweaves that clients choose depend upon the negative beliefs that they have about themselves.  For example, if they have a particular self state that predominates that makes them feel they're "unlovable," they will choose imaginal interweaves that will help them to feel the opposite--that they're lovable (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

If I'm using EMDR Therapy, I would use this particular modality's bilateral stimulation (eye movements or tapping) to reinforce these imaginal interweaves so that they are amplified for the client (i.e., the client can feel these interweaves as self states within themselves).

Another therapeutic resourcing tool I use before processing psychological trauma is asking clients to remember times when they felt confident (as in the fictional example above where Andy remembered his experience with his acting coach).

Usually, I recommend that clients bring in at least 10 or so positive memories when they felt good about themselves and I use bilateral stimulation to reinforce these self states.

Then, when we're processing the traumatic experience, if the client needs these internal resources because s/he is having difficulty in the processing, we can call upon these imaginal interweaves or positive memories to help the client to shift self states so we can resume processing.

For the person who isn't in therapy, s/he can also become aware of shifting self states.  Admittedly, this isn't easy because the shifts usually happen so imperceptibly.  It will take some time and effort to recall experiences where it happened in the past (as in the fictional example above) and making an effort to recognize it when it occurs in the present.

How Your Shifting Self States Can Affect You For Better or Worse

In his book, Awakening the Dreamer, Philip Bromberg gives an examples of shifting self states. According to Bromberg, researchers did a study using the game "Trivial Pursuit" where they told one group to imagine themselves as professors, and they told the other group to imagine themselves as "soccer hooligans" (the term used in the book) before they answered questions from "Trivial Pursuit."  The group that imagined themselves as professors did far better than the group that imagined themselves as "soccer hooligans."

The participants who imagined themselves to be professors and took on that self state are similar to my fictional example of Andy who initially was confident when his self state was connected to the memory of the encouragement he received from his acting coach.  This self state was reflected in his confident internal sense of self as well as in his overall demeanor.  Similar to the group who thought of themselves as professors, this was Andy's confident self state in that moment.

As I mentioned earlier, this is only the preparation stage of working through trauma in psychotherapy, but it is a powerful part of the work that can help to overcome obstacles when the trauma is being processed in therapy.

Unfortunately, most people tend to unconsciously concentrate on negative images and memories of themselves which shifts them into a negative self state.  But, with practice, you can also learn to focus on positive images and memories.

Self states are usually unconscious and difficult to perceive in the moment.  They're easier to detect retrospectively.

Shifting self states are even more difficult to detect.  However, once you become aware that everyone has shifting self states, you can begin to focus on become sensitized to the particular self state that you're in and how your self states switch.

When you become aware of the shifting self states and realize that you can use your imagination with positive memories from your life or imaginal figures, you can try to switch your self state.

Getting Help in Therapy
There are people who have experienced serious traumatic events in their lives where it has become too difficult to overcome a predominant negative self state.

When this occurs, this is not about a "weakness" or any other type of deficit.  It just means that the traumatic experiences were so overwhelming that they dominate the individual's life and they need to be processed in therapy.

If you are struggling with unresolved trauma, rather than struggling on your own, you could benefit from working with a trauma-informed psychotherapist who can help you to overcome the trauma (see my article: How to Choose a Psychotherapist).

Working through unresolved trauma can free you from your traumatic history so you can lead a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.  

I tend to integrate various forms of therapy depending upon the particular needs of each client (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients to overcome psychological trauma.

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

To set up a consultation, call me at (212) 726-1006 or email me.

Tuesday, December 5, 2017

Developmental Trauma: "This is Who I Am" vs "This is What I Do"

Developmental trauma occurs over time starting in childhood (as compared to shock trauma, which is usually an event).  Developmental trauma can occur when young children learn who they are from their parents, who might value certain aspects of the child and not others.  According to Philip Bromberg in his book, Awakening the Dreamer: Clinical Journeys, the aspects of the child that are not validated by the parents, become dissociated "not me" parts of the self and the parts that are valued become, "This is who I am."

Developmental Trauma: "This is Who I Am" vs "This is What I Do"

According to Bromberg, one of the reasons that developmental trauma is significant is that it shapes the child's core self through the attachment patterns that the child develops with the primary caregiver.

In order for the child to maintain a sense of core self as s/he matures, s/he has to preserve the early attachment patterns with the primary caregiver, which includes the aspects of self that were validated to the exclusion of the aspects that weren't.  This pattern continues as the child becomes an adult and  forms new relationships with significant others later in life.

When adults, who have a history of developmental trauma, come to therapy, they often have no awareness of the aspects of themselves that are dissociated due to the early invalidation in their attachment pattern with the primary caregiver.

When they were children, not only did they have to do what the primary caregiver needed them to do, they also had to be who the caregiver needed them to be with regard to the aspects that the caregiver validated.

To help these individuals to become more self reflective and aware that they're continuing to be who their primary caretaker needed them to be and that aspects of themselves have been sacrificed, the therapist helps these clients to see themselves within the enactments in therapy (for more about enactments, see my articles: Mutual Enactments Between the Psychotherapist and the Client in Psychotherapy and Why Your Psychotherapist Can't Be Your Best Friend).

With the increased awareness that develops in psychotherapy, these clients can learn to distinguish "This is who I am" from "This is what I do."

Being able to make this distinction is crucial for these clients to be able to make the changes in themselves that they're hoping to make.

The following fictional clinical vignette illustrates these concepts:

Fictional Vignette:  Developmental Trauma: "This is Who I Am" vs "This is What I Do:"

Ted came to therapy because he was having problems in his relationship with his wife.

Initially, Ted told his therapist that his issues as communication problems with his wife.  He said they frequently argued about money, and his wife saw him as a tightwad.  Although he acknowledged that he could be overly thrifty at times and he wanted to salvage his marriage, he saw his thriftiness as, "This is who I am" and he saw no way to change it.

Developmental Trauma: "This is Who I Am" vs "This is What I Do"
It became apparent, as the therapist listened to his early history, that Ted's mother was also thrifty and she encouraged Ted to do everything he could to save his money.  He told the therapist that his mother praised him for being parsimonious and told him, "You're just like me," which pleased Ted very much as a child.

He also told his therapist a story about how he bought flowers for his third grade teacher with birthday money that he saved.  He loved his teacher and he was thrilled to see how happy she was when he gave her the flowers.

But when he got home and told his mother about it, she scolded him for "wasting" his money.  She told him, "Saving your money is important."

Ted told many similar childhood stories where he was initially elated to give a gift to someone and then he felt ashamed when his mother scolded him and refused to talk to him for the rest of the day when she found out that he used his money to give a gift to someone.

Ted learned early on that if he wanted to remain in his mother's good graces, he would have to conform to her way of thinking.

As an adult, Ted felt he learned a valuable lesson from his mother when he was a child.  But now his wife was complaining because he had such a hard time spending money even when it came to giving birthday gifts to his wife.

Although Ted understood somewhat why his wife was upset, he told his therapist, "My wife wants to change me, but she just doesn't understand that this is who I am."

He was concerned because his wife's birthday was coming up and he was sure that she wanted a gift from him.  He wanted to "keep the peace," so he planned to get her a gift, but he felt he was going against a basic part of himself in order to do it.

His therapist suggested that Ted buy his wife a gift and they could talk about how he felt afterwards.

A week after Ted gave his wife the gift, he came to his therapy session looking upset.  He told his therapist that, even though it was against his basic sense of self, he bought his wife something that she had been hinting about, a makeup mirror in the shape of a shell.  She was so happy that she threw her arms around Ted and kissed him, but Ted felt miserable for going against his sense of self.

Ted's therapist explored Ted's feelings about giving his wife this gift that she really wanted, and Ted told his therapist that he felt he disappointed his mother--even though his mother had been dead for more than 10 years, "My mother would have been angry with me if she was still alive and, even though she's been gone for several years, I feel like I let her down."

Ted's therapist tried to help Ted to remember how he felt as a child when he gave his teacher the flowers and he saw how happy she was.  Ted remembered that he felt happy, but he couldn't separate out this part of the memory from how unhappy his mother was afterwards.

He recalled other childhood memories when he wanted a certain toy or picture book, and his mother discouraged him from having them.  She told him that it would be a waste of money.  After a while, Ted stopped allowing himself from even wanting these things.

Looking back on those memories, Ted knew that his family was upper middle class, so his mother could well afford to buy him these things, so he wondered why his mother discouraged him from wanting toys or books, "At first, it made me feel sad, but then I learned to do without them and not want them any more."

His therapist noted to herself that this was the first time that Ted reflected on his mother's dynamics and how it affected him.

Gradually, over time, Ted became more self reflective and he began to make the distinction between who he is as a person and his behavior.  He realized that, when he was a child, he was too afraid to go against his mother's wishes because she would ignore him when she was displeased.

Resolving Developmental Trauma in Therapy: "This is What I Do and I Can Change."
More importantly, Ted realized in therapy that he was still trying to hold onto his mother's love by behaving the way she wanted him to behave.  It was his way of holding onto her even though she was gone.

As his therapy progressed, Ted realized that he no longer had to behave in a way that would honor the memory of his mother.  And, as he came to terms with this, other aspects of himself that were invalidated by his mother, came alive.

Not only was he more generous with his wife, but he also allowed himself to want and have things again, which was liberating for him.

When aspects of children are invalidated by their primary caregiver, children learn to disavow these aspects.  This is part of developmental trauma.

On an unconscious level, children dissociate these aspects in order to maintain the attachment with the caregiver, which is essential to children's sense of well-being.

This disavowal comes at a great cost to children as they grow up unconsciously dissociating parts of themselves to maintain the attachment.

Children who learn to maintain only the aspects of themselves that are validated by their caregiver and disavow the aspects that are invalidated continue this pattern as adults and believe, "This is who I am."  This makes change difficult for them because they believe that their behavior is intrinsic to who they are.

Developing the necessary self awareness to realize that who they think they are is really not an intrinsic part of themselves and it's really their behavior is usually a gradual process in therapy.

Being able to separate out "who I am" from "what I do" can be a freeing experience because it allows the true self to emerge (see my article:  Becoming Your True Self).

Getting Help in Therapy
If you're having problems changing because you believe that your problematic behavior is part of who you are, you could benefit from seeking help from a licensed psychotherapist (see my article: The Benefits of Psychotherapy).

Self awareness is the first step in making changes

Developing the necessary awareness and insight into ingrained problems is often a gradual process, and a skilled mental health professional can help you in your journey (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Benefits of Integrative Psychotherapy).

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

To set up a consultation, call me at (212) 726-1006 or email me.

See my other articles about Psychotherapy.