More Psychoanalytic Gems –

In an earlier post, I noted a list of Psychoanalytic Psychotherapy Gems, including a later post on D.W. Winnicott’s approaches to building a therapeutic alliance.  My general aversion to this form of therapy has more to do with its slowness and high costs than to its effectiveness. It is effective!  However, other approaches are faster and less expensive for clients.  Also, there is the issues of prolonged suffering while a slower therapy takes its time to work. Is there an ethical question here? When is deeper, more permanent positive change more important than reducing suffering as fast as possible? I have no answer to this question.

Here I will expand that earlier Winnicott post.  Winnicott offers a great deal to therapists about How To form and improve therapeutic alliance.  Below I have listed a dozen ideas from Winnicott’s work. These skills are beyond basic psychotherapy work; these skills require highly competent therapists with strong clinical under-pinnings to be effective.  If you are well-informed about attachment and attachment therapies,  you will see that much of what Winnicott offers relates directly to earlier attachment experience of the client. Here is my list.

1. Work very hard to develop a psychological holding environment with the client. Such an environment serves as a metaphor for positive psychological associations with protection and safety within it. Strong empathic responses with good mirroring are required.
2. Within the potential space, Winnicott suggests we work on improving interactional quality: safety, acceptance, non-impingement, and will to interact, etc.
3. Try your best to use Winnicott’s views on the middle way between merging with and separating from the client. Too much merging and too much separating causes breaks in the homeostasis of the developing alliance.  Too much merging and separating may lead to mistrust, fantasy, and stuck alliance status.
4. Always maintain a slow, gentle, compassionate attitude toward the client.
5. Act in a non-impinging manner, respecting physical and emotional boundaries as well as the client’s personal readiness to share personal stories and make changes.
6. Maintain a relaxed, confident demeanor as you facilitate both the alliance and helpful change.
7. Never use shaming techniques. Such interventions harm both the true self (inner, private) and the false self (outer, social). Both of these self-experiences are true, and both need to be engaged in therapy. The source of more dramatic improvement rests with the inner true self.
8. Work hard to understand the client’s attachment history (positives and negatives) as well as your own attachment history (positives and negatives). You are in a dyadic interaction, both coming from your own attachment histories. As the therapist, you cannot escape the outcomes of your own attachment realities.
9. Recognize that for some clients anxiety and depression are norms. Do your best to calm the anxiety (fear, discomfort) and the improve the sadness. Notice what memories and conversations activate these mood states. Utilize corrective emotional experience in session to calm anxiety and lift depression.  You are the client’s new object, so use yourself in this manner.
10. Use object constancy.  Be stable in your interactional role to foster expected outcomes of acceptance, patience, emotional support, and safety.
11. Work to improve weak and negative object related introjections in the client. If you are skilled enough, use Roger’s complete acceptance (unconditional positive regard)  and Kohut’s transmuting internalizations (perhaps a form of conscious use of projective identification process). This will be most important with clients who have unhelpful attachment and traumatic histories.  It may be even more important for the majority of such clients who have self-medicated their pain and suffering from the past. Their negative self-objects are deep inside.
12. Lastly, do your absolute best to be a “good enough” therapist. Maintaining friendly compassion, understanding, acceptance, and safety in the intersubjective space of therapy. For clients who may be less willing to engage in conversations, try using Winnicott’s indirect “squiggling” technique (only if you know how to do so).
13. For more information refer to Grolnick, S. (1990). The Work and Play of Winnicott. New York: Jason Aronson, pp. 133-166. 

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness  

New Edition of Mindful Happiness in Production…Coming soon!