Quintiliani’s Brief Life Experience Screening
Years ago, when I received a rather large number of managed care referrals for adolescent “treatment failures” and their families, I soon realized that typical screening, assessment and therapy was NOT working well. I tried so, so hard to reach these young people – all experiencing extreme psychological suffering with little hope for relief. Suicide risk was high, uncomfortably high! Nothing seemed to work very well; cognitive, behavioral, and mindfulness interventions fell short of the goals. My alliance building skills did work, but other than a meaningful and emotional relationship there was very little positive change in their cognition, emotion, or behavior. For the most part my young clients did show up, so I guess the therapeutic relationship was a motivating factor. For some, legal consequences may have been a factor. After ample frustration, I decided to start fresh; I decided to break things down into logical, sequenced patterns in their lives. Behavioral task analysis was helpful, but insufficient for success. Then in a meditation, it came to me as clear as a Vermont summer sky. There were some fluffy clouds. Below I will share what worked much better, and how to use it as a transitional screening and treatment strategy. Ok, get ready for a lot of letters!
Hx – Mp – CEB – VAKGO – I-S – Rels: This represents what I came up with to reach these young clients, and how we collaboratively discovered deficits/problems and more than a few solutions. The administration format is quite simple: Simply move through the letters (and their meanings), and as you do ask for the major negative/unhelpful memory/characteristic/experience the person remembers. After each entry, asks for the major positive/helpful memory/characteristic/experience the person remembers. When you complete the screening you will have highly significant self-report about core live processes and major life experiences – both unhelpful and helpful. Allow me to clarify each step. The process is voluntary, and the client may stop at any time. Be sure to obtain informed consent. Stick with the dyadic formula – both negative and positive experiences. The negatives are problems to be resolved via relationship and skills; the positives are sources of personal strengths to help resolve problems. Obtain information up to the present; this wide window of time will allow the person to include all significant experiences they are willing to share with you.
Hx (History): involves early attachment, object relations, educational experiences, medical and psychological issues. Simply ask for a significant problem and a significant benefit for each area noted.
Mp (Mind Perception): involves personal reflections about significant life events and emotional responses/reactions to them. Emphasize how the person utilized perceptual processes in these experiences. Are they anxious and/or depressed? Are they open to change? Are they at all optimistic? Are they pessimistic?
CEB (Cognition, Emotion and Behavior): involves highly significant unhelpful and helpful experiences in thinking, feeling, and acting. What are the dominant negative and positive repeating thoughts, emotions, and behaviors? Keep behavioral reinforcement and conditioning in mind for the behavioral area. Special attention may be required for addictions (substances, processes, eating, cellphone, self-harming, etc.).
VAKGO (Sensory – Visual, Auditory, Kinesthetic, Gustatory, Olfactory): involves the past experiences of sensory processing. What are the most unhelpful and helpful recalled sensory experiences the person has had? Be sure to ask about negatives and positives for each sensory category. Interoception may be important: they ability to perceive and interpret internal body sensations is a special sensory attribute. Caution: Since serious traumatic experiences are processed and recalled most often via the CEB and VAKGO categories, be sensitive to client readiness to share. Be prepared to stop and become more psychodynamically supportive.
I-S (Intuition and Spirituality): involves the person’s history of negative and positive experiences regarding their intuition and their spirituality. Since some people are not at all spiritual, go easy on this category. Some people, however, are highly spiritual with and without formal religious practice. This may be an area of primary strength for some people.
Rels (Relationships): involves the negative and positive nature of significant relationships in the person’s life.This is also the core area where all of the above categories may become quite integrated. Most people experience pain and suffering as well as joy and happiness via their interpersonal relationships – the more significant, the more powerful.
Summary: Now you have a sheet of paper that notes significant aspects of a client’s history (up to the present), as well as significant areas of suffering and happiness. Work on working through and witnessing the suffering, and be sure to help your client improve their ability to use mindful skills to improve their future. Feel free to integrate other evidence-based therapies into the process. The process is trans-theoretical, but one that fits common human experiences across various domains. Good luck on this. Hope it is helpful to you and your clients.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness