What To Expect From Your First Therapy Session

Therapy | July 18, 2011

Is this your first time in counseling or therapy? How do you know what to expect from the therapist or counselor? Or what to expect of yourself? Whatever your reasons for seeking help, you will feel better and see faster results if you know what to expect from your first therapy session.

The Basic Session. Most therapy sessions last 45 minutes, however, sometimes the session may be extended. Couples counseling sessions are sometimes an hour.  People come to therapy for a number of reasons; therefore, there is no formula for what happens during a session. You are a unique individual and your treatment will be treated as such.

Be prepared. Before going into a therapy session, try to describe the specific issue that brought you and how you feel about it.  The most important thing is to say what is on your mind, and what is bothering you.  The more open and honest you can be with yourself and your therapist in the first session, the easier it will be to develop a treatment plan and goals for feeling better.

What will we talk about? We will talk about whatever is important to you or whatever is on your mind. Are you stressed, anxious, and depressed or having difficulty with a transition in life? Therapists are trained to ask the right question, but we cannot read minds. A particular issue probably led you to seek counseling and it is important for the therapist to understand how you experience your emotional life.

Ending a Session. In the last few minutes of a therapy session it is common to review what has information has been discovered, and then come up with a treatment plan. This is a good time to ask questions about the process or anything that was not clearly understood. The more you understand the process the more like you are to be comfortable in future counseling sessions.

It is important to have realistic expectations of the first therapy session. The first session is generally a consultation about gathering information and developing the therapeutic connection. A strong trusting relationship with the therapist and the environment will be beneficial for treatment to reach the end goal of feeling better as quickly as possible. Many people feel immediate relief after the first consult, but every case is different and how often you return will depend on your situation and how often you would like to come in. As you become comfortable there is no shortage of topics you may discuss.

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When does Healthy Self-Regard Turn into Narcissism?

Reference | April 21, 2011

A certain amount of self-regard is healthy. Clearly low self-worth causes psychological pain and suffering, but when does high self-regard turn into Narcissism?

Narcissistic Personality Disorder (NPR) is a form of pathological narcissism recognized by the DSM-V and first recognized by the famous psychoanalyst Heinz Kohut in the 1960s, and affects about 1% of the population. NPR is not a diagnosis to be thrown around lightly; it is considered a constellation of behaviors that are long-standing and continuous from young adulthood, creating a personality presentation that can be described as rigid, and while not necessarily permanent, very difficult to change. As described by Kohut and other theorists, some of the essential qualities of NPD have been characterized as an inflated sense of self-importance, a lack of empathy for others, and an insatiable need for attention from everyone around them. Unfortunately, the line between high self-worth and narcissism gets blurred as narcissists have incredible influence in the highest reaches of our society. Narcissists, by their nature, believe that they “deserve” money, power, fame and attention, and as such tend toward professions where they can control others and receive almost constant praise and adulation from others, such as politics, law, finance, or even medicine. And since narcissists are very good at getting what they want, there is a positive feedback loop for them to continue with this behavior, no matter how destructive. Since many admire this brio, at least at a distance, this keeps the wheels in motion. Think Bernie Madoff.

So can having just narcissistic traits be advantageous?

My answer is a very careful, qualified yes. A need to get to the top, confidence, a strong sense of self, and even a need for praise can help a person navigate successfully through the world as it is defined in the modern world. But it is absolutely crucial to distinguish between those with some narcissism, or a very strong sense of self-regard, and NPD. NPD is a personality disorder- individuals who suffer from it are exploitive and will cause significant distress to others. For example, an individual with narcissistic traits will often not be a great partner in a relationship since they do not have a lot of understanding and empathy for their significant other. But when the relationship is over, they will not cause significant distress to their ex since their somewhat inflated sense of self-regard is in tact. If anything, it is difficult for the person with narcissistic traits to really grieve the loss of the relationship because they tend not to feel the softer emotions such as warmth, love and regard for others. Someone suffering from NPD, on the other hand, will often feel an intense narcissistic wound and even rage when a relationship ends, and can become abusive to the other person.

So what creates NPD?

There is no strong evidence pointing to a genetic predisposition for the disorder. Psychodynamic theorists and evidence points toward early attachment difficulties between mother and child, as well as a correlation between emotional abuse and trauma. What we do know for sure is that it is much more common in men and women, and it is far more common in modern, western societies. Traditional male behaviors, such as aggression and power seeking are more amenable to narcissism, and increased materialism, increased image consciousness, and a decrease in community life create conditions that support narcissistic behaviors.

Although individuals with some narcissistic traits can be viewed as having a strong sense of self-regard, a sense of self-worth can be seen as a much larger, important thing than simply being ambitious and wanting to get to the top. Those with high self-regard are not simply a list of their accomplishments; they treat people well, value their relationships, enjoy art, and engage in meaningful activity, to name a few. There has to be more to a sense of self than a person’s narcissism.

If you want to explore your issues of self-worth or narcissism are in the Orange County, Irvine, or Newport Beach areas, please call Jennifer De Francisco, MPA, MSW, LCSW at (949) 251-8797.

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The High and Lows of The Very Sensitive Person, or the “Artistic Temperament”

Depression | April 20, 2011

Have you known someone (maybe you) who seems to be more affected by life’s ups and downs than most people? A film about genocide can leave them absolutely shaken, or a beautiful piece of art can give them an exaltation than few experience. They may stay in bed for days after writing a piece of poetry or having a difficult fight with a friend. Some psychologists call this the “artistic temperament”; others call it being very sensitive. Some might call it simply being neurotic. What is it? First, is not simply an issue of getting your feelings hurt easily, but a whole way of subjectively experiencing the world differently than most of the population. And it can be a very good thing.

Sensitivity and Creativity

In fact, there has long been a connection between neuroticism and creativity. The mania of bipolar disorder for composers, writers, and artists has been shown to heighten imaginative and creative powers that are simply not accessed by people not suffering from the condition. Think Lord Byron, Alexander Hamilton, and Jimi Hendrix. Unfortunately, because of their soaring creativity and often unparalleled artistic productiveness, the artistically gifted strongly resist taking medication to manage their condition. It dampens their creative juices, and they feel lifeless and dead when medicated. At the same time, mood stabilizers provide sleep enhancement, and relief from depression and suicidal impulses. It is their Sophie’s choice to be either a chemical balanced and artistically numb average joe or to be an artistic powerhouse with almost preternatural powers on the verge of being mentally unhinged.

For the very sensitive person who does not necessarily suffer from Bipolar Disorder the jury is out on how much of this sensitivity is nurture, nature, or a delicate dance between the two. What clear is that once very sensitive people reach adult age, they are generally hard-wired as such; this sensitivity is integral to who they are and how they experience the world and interact with others. Very sensitive people, in general, simply feel things differently, and more strongly. Studies show that they look at art work and photographs for longer periods of time, and feel more deeply moved by it, and remember more detail of the work. They are also more affected by the moods of others, and often have a better intuitive sense of what others are thinking and feeling, and whether or not they are in pain; in fact, they can often find the feelings of others so strong that they are overwhelmed by them, and in extreme cases can feel the feelings of others so strongly that they end up feeling things” for” them.

The Benefits of Sensitivity

Does this mean being highly sensitive is always bad thing? Certainly not. But if you are a very sensitive person, you are probably already know that you are different, and may feel some sense of marginalization and isolation because of it. You may compensate for this feeling by withdrawing from social situations or overcompensating with false bravado. And if you feel things too strongly, it can be hard to function in a world that does not experience things so acutely as you do. These feelings need to be managed, and if you can accept your feelings of being different, and perhaps think of it as a gift, there are plenty of advantages to being Very Sensitive.

For example, most certainly the very sensitive are more acutely attuned to both internal and external stimuli, and this includes the feelings of themselves and of other people. This tends to make very sensitive people more conscientious and attentive to other people. This sensitivity makes you a better friend and intimate. Also, if developed in the right way it is the foundation for leadership and positions of prominence. People want to follow those that assimilate information well, are intuitive, understand them, and will do the right thing. Very Sensitive people are such people.

Very sensitive people also have a rich imaginative life and inner world. They tend to be more creative, and often possess talents that are one of a kind-think Jim Carrey, Marcel Proust and Robert De Niro. It takes a special kind of talent to express the pain that they feel so intensely and universalize it for the rest of us.

Very sensitive people, with all of their gifts, need to value their own unique insight and subjective experience. Since they see and experience the world differently and more intensely, their gift can be highly valuable to friends, family, and those out in the world if the very sensitive person values these gifts in themselves.

If you need help managing and appreciating your sensitivity, Jennifer De Francisco practices psychotherapy in the Orange County, Irvine and Newport Beach area.  Please feel free to contact her at (949) 251-8797.

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The Misconceptions about Marriage and about Being Single

Life Guides, Marriage | April 18, 2011

There can be a lot of stigma to single life, especially in Orange County, with its family-oriented values and norms. It can be especially difficult in the cities of South Orange County, Irvine and Newport Beach, where it can seem that everyone is married, and if you are not, you are socially the odd man out. As a clinician who practices marriage and couples counseling, I obviously believe strongly in marriage and its benefits. It is time, however, that we take a more nuanced look at the marital state and some misconceptions about being single.

As of 2008, slightly more than half of the adult population in the United States was currently single. About a third of those people will never get married. In 1960, 70% of the population was married, and it was seen, culturally, as the only viable alternative. What has changed?

A lot of things, but in part has been due to a modernizing society that no longer depends on the marriage state for it economic base. Until the recent decades, women did almost all of their work inside the home. There certainly were not the modern conveniences available to them to assist with the workload that are of great help to families now, and it would have been extremely difficult for most women to work outside of the home. In urban areas, the division of labor between men and women were rather rigid: the men generally went outside into the world to make money and women stayed in the home. If you were not married, you were not part of that equation. A far greater percentage of our economy was also agriculturally based. Both men and women worked on the farm, in different capacities, and they had children, who were in turn expected to help their family keep the economic machine going when they were old enough to contribute. With the vast changes in our economic base, these familial systems have almost become defunct. In most families, women must work outside the home to make the family budget, and children certainly cannot be seen as “contributors” to the family income. With the women’s movement, a huge swath of the female population has been able to educate themselves and become close to half of the workforce outside of the home. There have also been cultural changes that have changed our attitudes to marriage. With the advent of oral contraception, women have been able to postpone having children. Social mores started to loosen. A traditional nuclear family, for better or worse, has become one of a few ways to raise a family.

While much of this is positive (and some of it less so), it has had profound effect on what marriage means to people in the 21st century. It is no longer a moral, economic, and societal necessity to get married. People get married when they feel “psychologically ready” and when it is the “right time” in their life. This usually involves a transition such as ending their formal education or being ready to have children. What it means to be “psychological ready” is a subjective issue, and this changes, since the age of marriage has been steadily rising in the United States over the last 40 years. It is current 27 years old, up from about 20 years old in the 1940s. Some people never become ready, even if they really like the idea of marriage. And we, as a society, may have to learn to be more accepting of that.

The reason that this is not the worst thing in the world, even if you are a person who really values marriage, is that it is the quality of the marriage that matters most to improving someone’s life. It has been a long-held misconception that married are healthier and enjoy higher levels of contentment than single people. The research picture is more complicated than that: happily married people do, in fact, report the greatest contentment levels in our society. Single adults, however, are not far behind. Whether they are looking for a long-term relationship or not, single people report only slightly lower contentment scores than those that are happily married. Their health is about the same. The big difference, though, comes from those individuals that those that have conflictual or unhappy marriages. They have MUCH lower contentment scores than those that are single. Marriage, then, may really improve or deteriorate your state of contentment. The research creates a much richer, complicated picture about what marriage can do for a person’s life: it may really enhance it, or it may really deteriorate its quality. As such, every person needs to decide for themselves which is the best path for them, since it appears that there is no “best way” that can be applied to all.

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Marriage Counseling in Orange County: What Makes it Different

Marriage | March 17, 2011

Marriage counseling in Newport Beach, Orange County, and Irvine may sound like it’s unnecessary with the beautiful weather and opulent life style, but with all its glamour comes unique environmental stresses. The traffic, average commute time and high cost of living can create a large amount of stress in even the healthiest of relationships.

In Orange County the average commute time is 26 minutes, many homes have two working parents and the cost of living is among the highest in the nation.  Its easy for a relationship to be effected by these outside stresses. Marriage counseling for Orange County couples is an excellent way to help relieve stress and promote healthy, long lasting relationships.

Marriage counseling helps strengthen the bond between couples — married or not — and helps them to gain a better understanding of each other. It  can provide an outlet for stress, improve communication and help improve the overall stability of a relationship.

Through marriage counseling you can:

  • Improve communication – feel heard, understood, and close to you partner
  • Resolved conflict
  • Increase passion in the relationship
  • Resolve issues regarding child-rearing
  • Learn how to blended families
  • Learn the delicate art of balancing your needs for autonomy and connection
  • Avoid the most common and corrosive relationship habits
  • Secure long term satisfaction in your relationship
  • Develop traditions of closeness & connection

Its important to remember that going to marriage counseling does not mean that your relationship is in poor condition or close to dissolution.  Partner counseling can be good maintenance for a relationship, to keep those environmental stresses at bay and keep communication open.

I offer marriage counseling in Newport Beach and Orange County, CA for couples at any stage in their relationship. My psychodynamic-based approach provides a safe environment to open and honestly share thoughts and emotions. Through developing a positive, therapeutic relationship, together you can interpret what is going on, both in your life and in the session, creating a better awareness within your relationship.

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