How do you know if therapy is working?

It can sometimes be confusing to know if therapy is working, or if it is still working for you over a long period of time.  Sometimes, when we begin going to therapy, it can seem like things are getting worse.  This is something that is valuable to notice and it may be an indicator that the therapy is working, as things can get worst before they get better. Below are some key indicators that therapy is working for you, as slow and long as the process may sometimes seem.

•You feel relieved.

•You feel understood by your therapist.

•You feel safe talking about your life.

•Things start to slowly shift in your life for the better, if not immediately, than within the first Six months.

•You can both like and dislike your therapist at times, because you feel safe enough to have both positive and negative feelings with them.

•You can talk about deeper and deeper things as time goes on.

•You start to think about what to talk about in your next session during the week.

•You miss a week and can’t wait to go the next week.

•You begin to feel more secure because you know that you can rely on therapy to open up your feelings. 

Bianca Aarons LMFT is a licensed psychotherapist in San Francisco through the auspices of the Grateful Heart Holistic Therapy Center. Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at, email her at, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.


Thoughts and Advice on Better Understanding and Coping with an Overly Used Label and Tolerating the Pain of a “Narcissistic” Interaction. 

Over the last couple of years, I’ve begun to see a revolution of articles on the topic of Narcissistic personality disorder. I would say that Narcissism is a fairly common disorder to varying degrees and intensities within our generation and the generation before us; it’s not a new disorder. Why, then, is everyone talking about it? I’ve also have more recently started to see articles on the overuse of Narcissism, on the reframe of  “The Narcissist and The Empath” interactions, and on the general meaning of using narcissism as a way to pathologize someone else.

I must admit that I myself am guilty of overusing this word, or using this word as an excuse for very uncomfortable feelings that I am experiencing toward someone when I have felt used by someone or swindled by someone. I am a psychotherapist, I have learned the INS and the OUTS of the meaning of Narcissism, and I can recognize “a narcissist” in a heartbeat based on what I know. So throughout the years of my training, I’ve really began to own why I feel the need to use that word to describe someone, and what pain within me I am defending against, what narcissistic injuries of my own I may be displacing by pathologizing someone else.


Who is a narcissist, what is narcissism, and why are some people narcissistic while others are not?? There are several ways of understanding it.  First of all, lets be clear here:  Everyone should be a narcissist at a young age. This is the appropriate age to experience “Healthy Narcissism”. Think about a baby or a toddler.  It is totally and absolutely essential for a baby or a toddler to be extremely selfish and self centered, for years at a time, and it is the job of a mother to provide absolute and utter selflessness to the extent that they can, in order to buffer an infant from experiencing the pain of not having their needs met. If and when this is achieved, a young child can slowly start to consider the needs of their parent, and therefor, later in life, be able to see past their own needs with other people and partners in their life. When this phase of development is missed, it can continue to be unmet into an adult age, thus on-setting the personality disorder that we know as Narcissistic Personality Disorder. It takes being held emotionally to know how to hold others emotionally.

When talking about Narcissistic personality disorder, I would like to make several things very clear. First of all, everyone can be narcissistic in situations or interactions where they feel threatened; i.e. everyone should have the ability to be narcissistic to some extent.   Second of all, narcissism is very much so on a spectrum or a continuum. This continuum can range from “healthy narcissistic behavior” on least extreme end to “sociopathic behavior” on the most extreme end.

There are two main types of Narcissism, known as Deflated (Vulnerable) Narcissism and Grandiose Narcissism. Let’s look at Grandiose Narcissism first, as it is the easiest type of narcissism to identify.  We have all come into contact with a grandiose narcissist at some point or another. They are highly talented, successful, attractive people. They are highly desirable. They seem to have it all: Looks, money, and a successful career. They want to be, or are, famous; and because everyone idealizes them, wants to be friends with them, are willing to bend backwards for them, they lose the necessary accountability for behaving kindly toward other human beings.  Everything is about them because they can get whatever they want. They are very controlling, and thus, will only be in a relationship with someone who is selfless, who can easily be controlled, who is willing to sacrifice their own needs to be with someone “famous” or “special” or “amazing”.  How do we feel when we are in a relationship with someone like this? Usually, one feels constantly afraid that they will be abandon. Or they feel idealized “you are the most beautiful, you are the most special” and then devalued “there are a million people who are better than you and can meet my needs better than you”. And at the root of all of this is a harsh, vicious aggression. After all, controlling someone else can be a form of hatred. Also, someone who is narcissistic will often immediately feel attacked when confronted, and will very quickly have a counter attack. What happens the second you have a need with a grandiose narcissist? They leave you, of course, if this need points to them needing to change their ways in any way, shape or form.

Ok.  Lets take a second to look at deflated narcissism, or the “vulnerable” narcissist. This person is very kind in most cases, they try very hard to please others, and they are overly concerned about how you view them. They are deeply insecure, very fragile, they may constantly ask you if they did something wrong, if you don’t like them, if others don’t like them. They are overly self-involved buy not in an ego driven way. They are preoccupied with themselves, but in a way where they must constantly check whether or not you hate them. This person is in a victim role, is a wounded person, a person who cannot take care of you when you are going through something because they themselves need to be taken care of. This person is ALWAYS the wounded one.  In a relationship with them, there is no space for you to be wounded. Often times these partners or parents are actually quite sweet until you are mad at them for something. They are then too fragile already to admit their mistakes, take on a holding, apologetic role, or let you be a total mess when you are going through something. Lets say that you go through something really serious and traumatizing; you are raped, you lose a close family member, you are held at gunpoint. It would be quite easy to fall into a narcissistic role during a time like this, when you need to be held.  That is what Healthy Narcissism in adulthood looks like. But when you are always the deflated narcissist, it seems that you cannot easily bounce back from your wounded place, and narcissism is more of a permanent position for you.


I would like to point out something that may seem very obvious at this point in my article. The disorder can be set in stone, or it can be fluid. People go through things. People can change. Nothing is set in stone. Narcissism seems to sprout out of some deep, early wounding, and it can be inflamed when something bad happens to us. Why do people who are narcissistic seem to have friends? Yes, look closely; they are not narcissistic with everyone. There is a special interaction between you and them that seems to exasperate this dynamic. What does that say about you? It really is a question to bring to a therapy treatment. But, in short, there is probably someone in your life who is very narcissistic. Or, you probably have some narcissism in relation to this person that is exasperated in this interaction. Sometimes two wounded people can create that.  You don’t have this problem in all of your relationships, and neither do they.


How do you repel a narcissistic person? The first question to ask is, are you sure that you don’t want a relationship with them anymore? This is of the most difficult questions to ask of course, as some of these relationships are probably very special, deep, eye opening, and meaningful. The thing is that, maybe not so unlike you, people who are wounded can also be some of the most creative, special, well-liked people from afar. Often times Narcissistic people are very productive and very successful people. Losing this relationship may actually be quite sad to you. Can the relationship survive? Or has it reached a point that it is too painful, too confusing, and too hard to work through?  Once you have decided, from your heart, that this person isn’t working for you anymore, the next step is to confront them, of course. When confronting someone gently, kindly, softly, the message may not get across. Any negative finger pointed at someone who is truly narcissistic, with a full blast of all of that rage that you have been holding in or all of that blame that you have been directing at yourself instead, will surely insult them to the point of no return. Anytime you directly call someone who is narcissistic out on what they have done, how they have impacted you, why you are so angry at them, that will probably be the end of your relationship for a long time, but probably forever. Be careful what you wish for in this decision. On the rare occasion that they aren’t actually narcissistic, you may be pleasantly surprised to have your anger held and your feelings acknowledged. But it is likely that you’ve at this point been hoping for that fantasy to become true for too long to wait any longer.


Don’t be fooled into thinking that your work here is done once this person is out of your life.  More relationships like this will come if you don’t acknowledge and attempt to heal your own narcissistic wounds. There is something within you that somehow attracts this situation. Honestly, not to be a typical psychotherapist, but it probably has to do with your parents or some other close family member. If someone is so intolerable to you that you must not have them in your life anymore, then that means you have unbearable feelings within you that must also be confronted. Therapy is one of the best places to chip away at the defenses that keep you from accessing this pattern and mastering it.


Bianca Aarons LMFT is a licensed psychotherapist in San Francisco through the auspices of the Grateful Heart Holistic Therapy Center. Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at, email her at, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.


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When Fear Shows Itself: Part 2

Thoughts on Working Through Fear.

Baby steps.  That is how you must work through fear, a belief that you are not safe, the terror that it may happen again. The question becomes, How? How do I confront terror? Because as you now know if you have been in an accident, have lost a loved one suddenly, have experienced an abusive relationship, have been sexually abuse, or even have just gotten your heart broken, you may find that you are now afraid that it will happen again. Perhaps at any new moment or with any new person you meet. 


When we have a fear response it often gets stored in the body. Let’s say you have always loved riding your bike until recently, when a car accidentally merged into you and you’ve broken a bone. During the time that it’s taken you to heal, you have replayed the event over and over again in your head. Every time you are in a car and see a bike next to the car you are in, you now replay your accident and are afraid that the biker will be hit.  This is a form of post traumatic stress related to your accident. You’ve always had great associations with bike riding. Now, when you are riding, it is as if every car that passes you on your bike is going to hit you. Maybe you no longer enjoy riding your bike because your bike rides now induce small panic attacks and uncommon spells of fear. Maybe this is an indicator that you should stop riding your bike forever, but probably not.


How do you work through this??? Well, by riding your bike, of course.  We must do the exact thing that scares us in order to learn to not be afraid again. Maybe the first time, or first twenty times, of riding your bike will be terrifying after your accident. But each new time that you ride your bike and not get into an accident is proof that you are in fact safe to ride your bike again. Does this mean that you wont ever get into a bike accident again? I’m sorry, but no. There is some innocence that has been lost when bad things happen to us. We must move through the world with a different awareness that we may not be completely safe.


Confronting your fear is the only way that you will work through it. And how you choose to take this task into your own hands is completely in your control. When you realize that when and how you confront your fear can be your choice, you take some of your power back that you lost when something bad happened to you, totally out of your control.


As a therapist, I specialize in sexual abuse trauma and PTSD related to abusive relationships and incidents where people have been raped, taken advantage of, and exposed to painful relationships with partners and/or caregivers.  Part of what is so painful about this type of betrayal within relationship is that it makes it hard to trust others again. Unfortunately, something that can be so sweet, so good, so exciting and passionate, is now paired with fear. That inherent innocence that we are all capable of when trusting another person has been taken away; now when trying to trust another, all one can think about is what might go wrong if they do. One of the scariest parts of post-traumatic stress in a relationship is that it feels like what happened before may be happening again, whether it is being cheated on or being abused. These feelings and fears make it very difficult to date and/or trust again in relationships.


So again, when working through fear, many would like to jump in and get it over with. I recommend baby steps toward confronting the fear. There are many layers to traumatic incidents that must be explored. When we go into the fear and tell our stories all at once, we may not be resourced; we may not be able to titrate our feelings, bring ourselves out of the fear if we need a break. That is why it’s helpful to have another person to share with. Therapy can be incredibly useful to begin to navigate ones’ needs around healing an event like this. I notice that when one talks about a traumatic event in therapy, they often forget that they can feel ok again. I will often remember something that they told me they enjoy, such as friends, family, or a happy memory, and I will remind them of this to bring them back to an ok place.  Other resources may include yoga, chocolate, your dog, a book… you get the point. Everyone has their own unique resources that feel good to them. Therapy can be used to identify what your resources are, so when you experience that fear again while dating, while riding your bike, and within relationships, you now have a map to resource yourself. When we confront the fear, we often return to the fear state that we were in when the traumatic event happened; maybe this is a freeze response, maybe it’s a flight response. Maybe we cling again to someone like we did before, even if they aren’t who we need. It’s really important to learn how to breathe, and it’s really helpful to have someone you trust to tell you to breathe again, and to help you identify what’s happening.


It might seem like you will never recover, like you will be afraid forever. I want to tell you that your fear can be worked through. Your decisions are possibly being made out of a place of fear, but as you confront your demons, you can begin to make decisions out of a place of love again. Just as the seasons change, our emotions can too, with gentleness and a guiding hand.



Bianca Aarons LMFT is a licensed psychotherapist in San Francisco through the auspices of the Grateful Heart Holistic Therapy Center. Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at, email her at, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.

When Fear Shows Itself: Part 1

Understanding the Mechanisms of Fear Better.

During a deep spell of the most uncommon fear that I have ever experienced in my life, a quote showed itself to me that said, “ Fear is the only feeling that grows smaller as you move toward it.” This of course indicates that fear itself will grow bigger as we hide away from it.  It also led me to wonder, in my work, how is it possible to allow the fear to exist within us, for a long enough time, that we can tolerate leaning in towards it?

Fear, you see, is in the territory of the unknown; we cannot control it, we struggle to understand it, fear to work through it. Fear itself can be a glimmer in our minds, a hurricane that takes over our lives, an unopened package that unexpectedly opens. How fear and trauma works is a mystery that we can never fully know.

What exactly is fear? I am humbled in my limited knowledge as a psychotherapist of how fear works, but I would like to share what I have grappled to understand. Fear. On a scientific level, fear is a physiological emotional response that has been developed over millions of years as an adaptation to survival within life. Yes, the survival-of-the-fittest depend on fear responses, to this day, to survive. Once a dangerous stimulus is registered by the frontal cortex of the brain (for example a car crashing into your car or a snake in front of your next step), a signal is sent to the hippocampus and the amygdala, which then send signals to the hypothalamus. The hypothalamus releases “stress hormones”, such as adrenaline and epinephrine, which then trigger a fight-or-flight response.

Fight and flight are not the only fear responses. Lets break down the four (yes four) instinctual fear responses. Up until recently, there were three known fear responses. You have probably heard of them as they are well know: the fight, flight, and freeze responses. They are fairly self-explanatory as well. All survival mechanisms are triggered by the stress hormones.  The fight response initiates a protective, self-defensive, and sometimes violent response. An example of a fight response would be if a bird attacks you and you attempt to bat the bird away. A flight response is, well, running for your safety.  A version of this in the animal kingdom is when the Ostriches in Africa run from the lions who are gathering to attack them.  An example of this in a more convoluted, human world would be if someone fled the state that their perpetrator or attacker lives in to feel more safe.  The freeze response is demonstrated when a rabbit sees a predator. Although adrenaline is pumping through their body, they freeze to remain invisible. After they are safe, they often shake to discharge the fear and adrenaline energy that was being held in their body as they sat still, waiting for their predator to leave. Humans also have freeze responses during attacks.  For example, someone who is held at gun point may freeze, instead of trying to run or fight. Victims who have reacted with a freeze response have an especially hard time recovering from their attack. Not only did they feel helpless during the attack, but they also stored all of the fear in their bodies after the attack. The hopeless/ helpless feeling often lingers in someone's body, shaking their self-agency and their confidence that they are safe. Unlike animals, humans do not “shake” or have a mechanism to work through the stored fear energy after a freeze response. When the fear is stored in the body like this, it is often reopened during events that remind the victim of their attack. This is how post traumatic stress disorder works.

Recently, I heard through a colleague that a fourth fear response has been identified. This fear response is know as the fawn response, or as I like to call it, the “cling” response. This response seems to be an exclusively human fear response. The cling response is where the victim of abuse clings to their perpetrator, the person who is abusing them.  Think of an abusive relationship; often times, in an abusive relationship, the victim of abuse has a very difficult time leaving the relationship. Their fear response is to cling to the person abusing them, to protect themselves from more abuse. A very classic example of the cling response is Stockholm Syndrome, where a kidnapped victim comes to believe that they love their kidnapper.  This type of trauma is often replayed in a current abusive relationship, but may stem from an earlier relationship, perhaps with the victim’s parent in their childhood. This type of replaying is an example of post traumatic stress disorder and relational trauma. 

In my next blog, I will discuss more on working through fear, post traumatic stress disorder, and relational trauma.



Bianca Aarons LMFT is a licensed psychotherapist in San Francisco through the auspices of the Grateful Heart Holistic Therapy Center. Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at, email her at, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.