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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
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).

Conclusion
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

Sandy
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.

Conclusion
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
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.

Conclusion
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.

Conclusion
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
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.

Conclusion
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.



























Monday, December 4, 2017

Parallel Losses For the Psychotherapist and the Client

Loss and grief are an unfortunate part of life, and it's one of the reasons why many people come to therapy (see my articles: Who Are You After Your Parents Die?,  Grief: The Emotional Impact of Losing Both of Your Parents and Coping With Grief).  There are often times in psychotherapy when the psychotherapist and the client are going through parallel losses.  In fact, this phenomenon occurs more often than most people would think (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

Parallel Losses For the Psychotherapist and the Client
This parallel process between the psychotherapist and client often benefits the therapeutic work because, through her empathy, the therapist has more to give to the client because she is going through a similar process.

In order for this process to be healing for the client, the therapist must be trained and skilled at being able to experience the client's suffering while, at the same time, dipping into her own experience briefly without getting lost in her experience.  

The psychotherapist's focus must be mainly on the client and, while their experiences might be similar in some ways, the therapist can't assume that the client's experience is exactly the same as the therapist's experience.

From my own experience as a psychotherapist and from what colleagues have told me about their experiences, it's often the case that a client comes to therapy at the same time that a therapist is having a similar experience.

Depending upon the psychotherapist's theoretical orientation, the therapist probably won't share her loss with the client, especially if it will impinge on their work, because the therapy is focused on the client and not the therapist.

There might be times when it is therapeutic for the therapist to share a similar personal experience with the client, but only if it is in the service of furthering their work together.

Let's take a look at how this parallel process between therapist and client shows up in therapy in the following fictional vignette:

Fictional Vignette: Parallel Losses For the Psychotherapist and the Client

Lois
Lois began therapy because her mother, who had advanced Alzheimer's, was rapidly decompensating both physically and mentally.  

Parallel Losses For the Psychotherapist and the Client
Her mother began showing signs of dementia about 10 years before.

Until recently, the decline had been slow and her mother still knew Lois and Lois' siblings.  But a month prior to Lois starting therapy, her mother was becoming increasingly confused and no longer recognized Lois and other family members.

The doctor at the skilled nursing facility where Lois' mother lived told Lois and her siblings that her mother's condition was worsening, and they discussed the treatment plan, including advanced directives.

Lois and her mother were close, and it was excruciating for Lois to see her mother deteriorate over time.  Prior to the dementia, her mother had been very sharp and active, so it was especially difficult for Lois to watch the mother she knew slowly disappear.

She found support at an Alzheimer's support group, but she found her visits to see her mother increasingly difficult.

Knowing that her mother's life would soon be coming to an end, Lois knew that she would need more than her support group.  She needed the one-on-one support of a psychotherapist.

From the first therapy session, Lois felt understood and cared about by her therapist (see my article: The Creation of the "Holding Environment" in Therapy).

In addition to helping Lois cope with emotional pain of watching her mother decompensate due to Alzheimer's disease, the therapist also provided Lois with practical information. 

Lois felt fortunate that she found a psychotherapist who was so knowledgeable about loss, grief and the practical issues involved with having a family member who has dementia.

Little did Lois know that her psychotherapist also had a mother who was suffering with advanced Alzheimer's disease, and they were both going through a parallel process.

Lois' therapist wondered if it would be therapeutically beneficial for her to disclose to Lois that she was also going through a similar situation.  But she sensed, based on things that Lois told her, that Lois needed something different from her at this point in time--she needed to feel that her therapist was outside the world of Alzheimer's disease, nursing homes and hospitals.

As a result, her therapist decided that there would be no therapeutic benefit to disclosing her personal situation to Lois, so she kept it to herself.  She didn't want to impinge on Lois' experience.

Even though her therapist didn't disclose her personal situation to Lois, Lois felt that her therapist was present with her in a way that she had never felt before with her other therapists--as if her therapist really understood what Lois was going through--and this was healing for Lois.

Two months before Lois' mother died, her therapist called her to let her know that she would have to cancel their next two appointments because she had a loss in her family.  

When they resumed work together, Lois expressed her condolences to her therapist.  She didn't ask if the person who died was close to her therapist because she already felt overwhelmed by her own emotions.  Sensing that Lois didn't want to know, her therapist didn't divulge that her mother had just died from complications of Alzheimer's.

When Lois got the call from the nursing home that her mother died the night before, she was grief stricken.  All along she was grieving for the changes in her mother.  Somehow, she thought that, since she anticipated her mother's death.  She knew she would be upset, but she didn't think she would be so upset.

After their father died a few years earlier, Lois' siblings looked to her for advice because she was the oldest, and now it was no different with their mother's death.  They looked to her for guidance and emotional support, so Lois was glad to have her weekly therapy sessions so she could get her own emotional support from her therapist.

Lois resumed her therapy sessions a week after her mother died, and she was relieved to feel enveloped in the caring and empathetic environment that her therapist created for her (see my articles: Why is Empathy Important in Psychotherapy? and The Psychotherapist's Empathic Attunement to Unconscious Communication in the Therapy Session).  

Parallel Losses For the Psychotherapist and the Client

She could feel her therapist's attunement to her, and there were times in her sessions when she felt she didn't even need to talk.  It was enough to be there and feel her therapist's empathy.  

Aside from her advanced clinical training and experience, her therapist also had her own therapy that she relied on for her support through the grief process.  

Her therapist had many years of experience helping clients to cope with grief.  As she listened to Lois talk about her feelings, she recognized the parallel experiences between them.  She sensed the similarities as well as the differences in their relationships with their mothers and their experiences of grief.

Just as Lois found these therapy sessions to be healing, her therapist also had an internal experience of how healing these sessions were for herself.

Conclusion
It's not unusual for a psychotherapist and client who are working together in therapy to be having a parallel experience--whether it's about loss, happy experiences, personal relationships or any other experiences.

Most of the time, if the psychotherapist is skilled, experienced and can contain her own experiences with appropriate boundaries, the client can benefit from going through this parallel experience with the therapist--whether the client knows about the parallel experience or not.

There are times when even the most skilled psychotherapists must be aware of their own limitations and not take on certain clients because they are aware that they have a particular emotional vulnerability to whatever the client is going through and the therapy wouldn't be beneficial for the client.  Usually these instances are more the exception than the rule.

The therapist usually makes a decision on a case-by-case basis, depending upon the client's needs and the therapist's comfort level with disclosure, whether or not to disclose her own experience.  For instance, in substance abuse treatment, therapists often reveal their own history with substance abuse because this is an accepted practice in substance abuse treatment.

Psychotherapists' disclosure is a topic where there are many different views.  While the therapist is expected to be genuine and no longer expected to be a "blank screen" with her client, the decision to disclose personal information or not must be viewed in light of whether it would be of therapeutic benefit to the client and not solely for the therapist's benefit.

Getting Help in Therapy
Whether or not to start therapy can be a challenging decision (see my articles: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent and Psychotherapy and Beginner's Mind).

Finding a licensed mental health professional who is right for you is a process (see my articles: How to Choose a Psychotherapist).

When you and your psychotherapist are a good match, you can benefit from your work together in ways that might exceed your expectations (see my article: The Benefits of Psychotherapy).

The healing process in therapy can lead to emotional breakthroughs and 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).

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: My Articles About Psychotherapy.












Sunday, December 3, 2017

Mutual Enactments Between the Client and the Psychotherapist in Psychotherapy

In a prior article, Why Your Psychotherapist Can't Be Your Friend, I began a discussion about the roles of the psychotherapist and client in therapy, which included the concept of mutual enactments in therapy.  In this article, I will delve deeper into the concept of mutual enactments with a clinical vignette that illustrates these concepts.

Mutual Enactments Between the Client and the Psychotherapist in Psychotherapy

Before I go any further, I think it would be helpful to have a definition of "enactments" in the therapy setting.

Although there are various definitions for enactments, depending upon whether psychotherapists are Classical or contemporary Relational psychotherapists, I prefer the definition given by Fonya Lord Helm in a chapter, "Enactments Leading to Insight for Patient, Therapist and Supervisor" in Enactment: Toward a New Approach to the Therapeutic Relationship edited by Steven J. Ellman and Michael Moskowitz, which is:

"An enactment is any action occurring during the psychotherapy or psychoanalysis that repeats an earlier similar experience or fantasy and communicates feeling...by nonverbal means in a way that will draw the therapist or analyst into a nonverbal communication" (p. 157).

In the past, the term "acting out" was used instead of "enactments," and this usually referred to the client's impulsive and improper behavior.  Although the emphasis was on the client's acting out behavior, it's also generally understood that psychotherapists can act out as well.

The term "acting out" is used less these days because of its pejorative connotation and also because the behavior is viewed from the psychotherapist's perspective in the type of hierarchical therapy where the therapist is seen as being "neutral" and "abstinent" as opposed to a more contemporary relational view of mutuality between therapist and client.

The contemporary view of enactments is that they are generally unconscious on the part of both the psychotherapist and the client.

In the past, enactments were seen solely as "mistakes" in therapy.  Now enactments are viewed most by therapists as an unavoidable part of therapy.

Whereas the ideal is to strive for no (or few) enactments, from a practical and therapeutic perspective, the reality is that there will be enactments, whether they are big or small and, once they occur, the therapist can discuss these enactments to further the work.

Although the focus in this article is on enactments between psychotherapists and clients, it's important to understand that enactments occur in everyday relationships, including romantic relationships, familial relationships, friendships and work relationships.

At this point, in addition to the vignette I provided in the last article, the following vignette will shed light on this dynamic between therapists and clients.

Fictional Vignette:  Mutual Enactments Between the Client and the Psychotherapist in Psychotherapy:

Liz
Liz, who was in her mid-30s, started therapy because she had longstanding problems in romantic relationships.

Although she had no problems meeting men, her problems began once the relationship became serious because she had difficulty trusting men in intimate relationships.

Her lack of trust in these relationships would manifest in her insecurity and jealousy with Liz imagining that her boyfriend at the time was cheating on her--even when she had no objective reason to think this.

When Liz began to feel jealous and insecure, she had difficulty separating her feelings from facts (see my articles:  Overcoming the Insecurity and Jealousy That's Ruining Your Relationship and Discovering That Your Feelings Aren't Facts).

Instead of observing and exploring her feelings with her boyfriend, she behaved as if her feelings were true and accused him of cheating.  She was so caught up in her emotions that she had no awareness that she was projecting her feelings onto the situation.  As far as she was concerned, when she felt her boyfriend was cheating, it must be true.

The pattern was that she would feel overwhelmed with jealousy and insecurity, accuse her boyfriend of cheating, he would be genuinely shocked and then he would try to defend himself against these accusations.

But no amount of denial or proof would dissuade Liz of her convictions that her boyfriend was unfaithful to her.

The more her boyfriend denied cheating and showed her proof, for instance, that he was with male friends at a basketball game, the more convinced Liz was that her boyfriend was lying.  And if her boyfriend refused to respond to her accusations, she also saw that as proof that he was guilty of infidelity.  So, there was no way to resolve this problem.

This is an example of an enactment in an intimate relationship.  It has many of the same qualities as enactments in therapy, which I'll discuss later.

As would be expected, this dynamic tended to erode the positive aspects of the relationship and would soon doom the relationship.  Her then-boyfriend would accuse her of being jealous and controlling, and she was convinced that he was trying to turn the tables on her when he was really the guilty one.

After each relationship was over, Liz had some insight into the fact that her accusations were irrational and she would have regrets.  But, by that time, the situation had gotten so bad that her ex-boyfriend no longer wanted to hear from her--let alone resume the relationship.

Every time Liz began to a new relationship, she vowed to herself that she wouldn't ruin it by making baseless accusations of infidelity.  But when she became jealous and insecure, the feelings were so powerful that she would lose all perspective.

These unconscious feelings overpowered her.   Once these feelings dominated her, she believed them to be true until she was out of the relationship.

When she discussed these dynamics with her therapist, she expressed sincere regret for the heartache that she caused in her boyfriends and herself and a strong desire to stop this behavior.

Mutual Enactments Between the Client and Psychotherapist in Psychotherapy

Her therapist sensed that Liz's regret as well as her sorrow for destroying her relationships. Her therapist was aware that, since this dynamic was unconscious at the time when it occurred, Liz was unable to control it.  She was also aware that Liz lacked the objectivity as well as the verbal skills to address this in her relationship when she was overwhelmed by these feelings.

Her therapist recognized Liz's behavior in her relationships as being enactments.  She also knew that there would probably be enactments in the therapy, and she would need to try to be aware of as they occurred.

Since Liz had been in therapy before, Liz knew that her family history, which was chaotic and dysfunctional, contributed to her inability to sustain romantic relationships.  But knowing this did nothing for her in terms of her enactments in her relationships (see my article: Intellectual Insight Isn't Enough to Change Problems).

From Liz's perspective, her prior experiences with therapy were disappointing.  The pattern was that the therapy would go well at the beginning, and then Liz would realize that she didn't trust the therapist.

Since she was unable to communicate her feelings of mistrust directly to her prior therapists in the past, she aborted therapy without discussing it, and she didn't respond to their outreach calls or letters (see my article: When a Client Leaves Therapy Prematurely).  These abrupt endings to her therapy were also enactments on her part.

After hearing about her previous history in therapy, Liz's therapist was aware that Liz might end this therapy abruptly too if she developed negative feelings towards her (also known as the negative transference).

Her therapist also wondered how much the prior therapists contributed to these enactments because of their own frustration and negative feelings about these dynamics.  She was aware that she would need to be vigilant about her own feelings about their therapy (known as countertransference) to minimize her own unconscious contribution to mutual enactments.

During the first few months, therapy went well.  Liz showed up on time for all her therapy appointments, she was compliant with paying her fee on time, she reflected on their sessions between sessions, and she discussed her reflections at subsequent sessions.

Her therapist enjoyed working with Liz and looked forward to their sessions.  Liz was intelligent and articulate about the issues they discussed, and she even kept a journal between sessions to write down her thoughts (see my articles: The Benefits of Journal Writing Between Therapy Sessions and Journal Writing Helps Relieve Stress and Anxiety).

But a month before her therapist was due to go on vacation for two weeks and she mentioned that she would be away, her therapist noticed an abrupt change in Liz's demeanor.  Whereas normally, Liz was relaxed in session, immediately after her therapist told her about the break, Liz looked tense and suspicious.

Her therapist mentioned her vacation in a month's time at the beginning of the session because she wanted to allow time for them to discuss any feelings that Liz might have about the break.

Her therapist could see from the abrupt change in Liz's demeanor that Liz had a negative reaction to the upcoming break, but Liz refused to talk about it when her therapist asked her about it.

From her silence and refusal to talk, her therapist was aware that she was witnessing an enactment on Liz's part, and she hoped not to get caught in a mutual enactment.

Based on Liz's history of relational problems, her therapist knew that Liz's reaction was probably unconscious on her part and Liz lacked the necessary insight and communication skills to talk about her feelings rather than enacting them in her sullen, uncommunicative behavior.  She knew it would be useless to explain this to Liz at the moment because Liz wasn't receptive to hearing an explanation.

Her therapist was aware that she was on the horns of a dilemma:  Liz was unconsciously trying to control her in the session by not talking and trying to make her feel guilty about leaving Liz (similar to how Liz tried to control her relationships with her former boyfriends).

Her therapist was also aware that, similar to Liz's dynamics with her former boyfriends, if the therapist attempted to encourage Liz to discuss her feelings, Liz would resent her and view her with increased suspicions.  But if she remained silent, Liz would feel that was too emotionally depriving and interpret that to mean that her therapist didn't care.

Ether way, her therapist would be engaging in a mutual enactment so she would have to decide quickly in the moment which course of action would be least disruptive to the therapy and might result in furthering the work.

Her therapist decided to share her dilemma with Liz, "I can see that you have feelings about the upcoming break in our therapy sessions.  I'd like us to be able to talk about that, but just now when I encouraged you to talk, you've remained silent.  I feel myself on the horns of dilemma.  Just like the dynamics in your romantic relationships, on the one hand, if I encourage you to talk, you see that as further proof that I'm doing something wrong and I don't care about you. But if I remain silent, you see that as proof that your feelings aren't important to me and I don't care about you.  Either way, you think I don't care.  Can you see my dilemma?"

Listening to her therapist express her dilemma softened Liz a bit.  She seemed to relax a little, and she nodded her head as if she understood what her therapist meant.

In the past, her therapist had spoken to Liz about what happened to her when she became jealous of her boyfriends as her being caught in a "vortex" of overwhelming emotions.

This idea of being stuck in a vortex came to Liz's mind now, and she told her therapist that she wasn't sure what she was feeling, but she felt as if her emotions were overpowering her.

Recognizing her new ability to even verbalize that she was overwhelmed and caught up by powerful emotions in the here and now represented significant progress for Liz.

Her therapist asked Liz to describe the vortex to her and she said she hoped to be able to help Liz to step out of the vortex.

Liz described feeling like she was in a whirlwind of powerful emotions that threatened to overtake her.  She said it was like being in the middle of a storm and she described those feelings.

Her therapist pointed out that Liz's ability to describe this whirlwind meant that Liz wasn't completely caught up in it--part of her was somewhat objective and could step out of the storm, even if it was momentarily, to observe herself in the storm.

Liz gave a barely perceptible nod to indicate that she agreed that she sensed a shift in her--something she had never experienced in the past.  She was able to say that, she wasn't sure why, but she felt unhappy about her therapist's announcement that they would be taking a break for two weeks when her therapist went on vacation.

Although Liz was unhappy about the upcoming break, she was pleased that she had achieved some objectivity about herself and her feelings by being able to observe herself, and she attributed this to their work together so far and her therapist telling her about the dilemma.

In the sessions that followed, Liz and her therapist continued to deal with Liz's unhappiness about the upcoming break and how abandoned she would feel (see my article: Coping With Trauma: Becoming Aware of Your Emotional Triggers and Old Abandonment Issues Can Get Triggered When Your Psychotherapist is Away).

Gradually, Liz made tentative connections between her feelings about the upcoming break and her distrust of her parents, especially her father, whom she described as a "philanderer" and "a rolling stone" who often disappeared from the household for months at a time (see my article:  Reacting to the Present Based on Your Traumatic Experience of the PastUnderstanding Why You're Affected By Trauma From a Long Time Ago and Overcoming Trauma: When the Past is in the Present).

Liz also made connections between her feelings of abandonment with her boyfriends when she felt jealous and her feelings of abandonment with her father.

With the help of her therapist, she realized that in the past, on an unconscious level, she sabotaged her relationships because she feared being abandoned, and she would rather end the relationship herself than endure the pain of being left (see my articles: Fear of Abandonment: Leaving Your Relationship Because You're Afraid of Being Abandoned and Fear of Abandonment Can Occur Even in a Stable Relationship).

This realization led to Liz's recognition that, on an unconscious level, she behaved similarly with her therapists.  Her fear of being abandoned by her therapists resulted in mistrust and caused her to leave therapy abruptly.

Liz and her current therapist talked about the possibility that Liz might be tempted to leave this therapy, in much the same way that she left her prior therapies, when her therapist went on vacation.

In the past, Liz had never contemplated this possibility prior to leaving therapy.  Instead of talking about her fear of being abandoned by her therapists in the past, she enacted her fear instead by leaving.  Unconsciously, her fear caused her to leave them before they left her.

Liz told her therapist that she didn't want to leave this therapy, but she had a fear that her therapist might not come back.  She knew this fear was irrational, and she discussed this with her therapist, but the feelings were so strong, she didn't know how to keep them from overwhelming her.

Her therapist taught Liz some self soothing techniques to help her to take care of herself (see my article: Self Soothing Techniques to Use When You're Feeling Distressed).

She also encouraged Liz to continue to write in her journal between sessions to have a way to discharge some of these emotions.

In addition, prior to going on vacation for two weeks, her therapist gave Liz the name of a therapist who would be covering her cases in case Liz needed to talk during their two week break.  Then, they confirmed their next appointment in two weeks.

During the two week break, Liz struggled with her fears of abandonment.  She knew that the intensity of these feelings were triggered by her earlier experiences of being abandoned again and again by her father when he went to live with other women for months at a time.

But, even though she recognized the origin of her feelings, she still felt overwhelmed.  She thought about calling the therapist who was on-call while her therapist was away, but she didn't feel comfortable doing this.

Each day Liz's feelings about abandonment got stronger, and she wrote about her feelings in her journal.  She hoped the days would go quickly so she could talk to her therapist about these feelings when her therapist returned.

But on the day when Liz was supposed to return to therapy, she "forgot" to go to her session.  The day came and went without Liz realizing that she missed her appointment.

When Liz came in for her next therapy session, she and her therapist discussed why Liz missed her appointment, which was another enactment.

Liz recognized that she had unconsciously forgot her appointment because she was angry that her therapist was aware and she felt abandoned.

Being able to talk more comfortably about her feelings was further progress for Liz in therapy.

Mutual Enactments Between the Client and Psychotherapist in Psychotherapy

At that point, her therapist recommended that they begin work on the trauma that was being triggered in Liz's relationships and in her therapies, which was her family history, especially her history of being abandoned over and over by her father (see my articles: Healing Old Emotional Childhood Wounds That Are Affecting Current Relationships ).

Liz agreed that it was time that she dealt with the source of her problems.

Conclusion
In the clinical vignette above, both the psychotherapist and client engaged in mutual enactments in the therapy.

Even when the therapist anticipated that there would be enactments, based on Liz's history, she found herself in a dilemma in the therapy where an enactment would be inevitable, and shared her dilemma with the client.

When the therapist shared her dilemma with the client, the therapist attempted to make the unconscious conscious for Liz by putting the dilemma into words rather than just behavior.

Even though Liz wasn't able to discuss the dynamic at that point, she began to become aware of her feelings and how they affected her therapist and the therapy.  This was a major shift for Liz, who had never recognized these dynamics before.

Recognizing a mutual enactment won't necessarily prevent future mutual enactments, as illustrated in the above vignette.

The therapist was aware of the possibility that there would be probably be an enactment on Liz's part after the therapist came back from vacation.

Due of their professional training and their own psychoanalysis, most therapists are more aware of mutual enactments prior to their client's awareness.  But, being human, psychotherapist also engage in enactments from time to time, as illustrated in the vignette.

Many psychotherapists agree that it's not a matter of if they and their clients will occasionally get caught up in enactments--it's more a matter of when.

What's most important is how therapists use these enactments, after they have occurred, to shed light on the unconscious processes that are going on between the therapist and the client. The therapist can then use this new awareness to further the therapeutic work and help the client to make breakthroughs.

Getting Help in Therapy
Mutual enactments are common in relationships of all kinds.

When mutual enactments occur in personal relationships, the people in the relationship often don't have the wherewithal to make these unconscious dynamics conscious, so they continue to engage in enactments which can be damaging to the relationships.

When enactments occur in psychotherapy, they are usually related to the client's earlier personal history.

The behavior related to the enactment will continue to repeat itself until the therapist helps the client to become aware of the enactments and they work on the underlying issues instead of enacting them unconsciously.

If you realize that you continue to engage in destructive patterns in your relationships, you might be enacting unconscious behavior from the past.

Rather than continuing to behave in an unconscious way that has a negative impact on your relationships as well as your sense of self, you could benefit from working with a psychotherapist who is skilled in identifying and working through enactments, including mutual enactments (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

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

I have helped many clients to learn to recognize unconscious feelings so they can discuss them and work through them in therapy rather than enacting them.

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.