Mindful Happiness

Anthony Quintiliani, Ph.D, LADC

  • Home
  • Dr. Anthony Quintiliani
    • About
  • Mindful Happiness
  • Mindful Expressions Meditation CD
  • Contact

October 2, 2019 By Admin

Essential Knowledge for Clinical Supervisors

Essential Knowledge for Clinical Supervisors

This post will include information and skills dealing with research on role induction practices, quality of clinical supervision, psychodynamics of alliance, and progress measurement.  Since the information and skills for all these topics is complex, I will do my best to keep it as clear as possible. This information aims to improve existing clinical supervision practices.

Reducing anxiety of less experienced supervisees by role induction strategies

  1. First of all clarify both supervisee and supervisor roles, expectations, behaviors, skills, rights, responsibilities, and clinical development.
  2. Support supervises via clear information on process and skills training about cognitive, behavioral and emotional processes, skills, and clinical expectations.
  3. Include lowering anxiety and improving competence as ongoing clinical supervision activities. Measure them!
  4. Work directly on supervisees self-awareness capacities.
  5. Clinical and psychological development issues may exist; adjust clinical supervision to fit these parameters.
  6. Improvement in supervisees clinical competence and psychological health are ongoing goals.
  7. Important variables that impact success or failure are supervisor competence and supervisee openness to growth and emotional regulation patterns.
  8. Keep the quality of supervision in mind, and participate in mutual evaluation and openness to feedback. For best results keep supervisee input about the supervisor as anonymous as possible. Otherwise, supervisee anxiety will increase.
  9. Recall that ethics requires that there be a reasonably detailed supervision contract.
  10. Effective clinical supervision often translates into effective psychotherapy, which leads to improved client progress, better job satisfaction and self-esteem.

The Importance of clinical, evidence-based and psychodynamic training

  1. Perhaps the single most important aspect of effective clinical supervision is the quality of the alliance. This is a parallel process with the therapy itself.
  2. With improved training in psychodynamic alliance-building skills comes client self-reports of experiencing a stronger therapeutic alliance in therapy. Keep in mind the training is cognitive, behavioral, and affective in nature. It is experienced!
  3. Research is mixed about the differences in alliance quality regarding psychodynamic training vs other training (CT, CBT, humanistic, interpersonal, etc.). The study noted suggests that improved emphasis on psychodynamics skills and processes ends with a better therapy alliance, which is consistent with better outcomes for clients. Although other studies refute this finding, it does appear to be logical that a training program specializing in psychodynamic therapy would produce better outcomes for psychodynamics, thus perhaps a better clinical alliance.
  4. Manualized psychodynamic therapy training also showed substantial improvement in the clinical alliance and the amount of psychodynamic skills being used in therapy.

Comparative quality of clinical supervision and its implications

  1. Research including over 300 clinicians concluded that 69-79% received inadequate clinical supervision.
  2. What is more concerning is that the same research noted that 25-40% of clinicians received harmful clinical supervision.
  3. At other measurement times 51-55% of clinicians noted that they received exceptionally helpful clinical supervision. Last I heard a 50% range is a grade of F. We need to work on improving this reality!
  4. Research also supports that there are great differences between supervisee perceptions vs objective criteria used effectively to measure comparative quality of clinical supervision. So the indication is to use both – supervisee anonymous evaluation and direct observation and measurement of clinical performance.
  5. 86-92% of clinicians did receive some form of clinical supervision but both the regularity and quality varied.

The reality of using progress monitoring measures for clinician development

  1. The use of clinical progress monitoring measures regarding client clinical change improves outcomes. However they are used rarely.
  2. Clinicians noted that the use of such measures in therapy required technical expertise, additional costs, time in the session,  some
  3. increased anxiety, and was sometimes accompanied by negative responses from clients, other clinicians, and managers.
  4. There were few differences in use and barriers between agency clinicians and private practice clinicians.
  5. Since the benefits of progress monitoring in clinical practice is well established and is often part of evidence-based endorsements for therapies, it is important to increase the use of progress monitoring.
  6. Furthermore, the lack of progress monitoring may have negative impacts on clients and third-party payments for therapy.

For more information refer to Ellis, M. V., Hutman, H., Chapin, J. (2015). Reducing supervisee anxiety…Journal of Counseling Psychology, 62, No. 4, 608-620. Hilsenroth, M. J., Kivlighan, D. M., Slavin-Mulford, J. (2015). Structured supervision of graduate clinicians in psychodynamic psychotherapy…Journal of Counseling Psychology, 62, No. 2, 173-183. Ellis, M. V., Creaner, M., Hutman, H., Timulak, L. A comparative study of clinical supervision… Journal of Counseling Psychology, 62,  No. 4, 621-631. Ionita, G., Fitzpatrick, M., Tomaro, J., Chen, V. V., Ovington, L. (2015). Challenges in using progress monitoring measures…Journal of Counseling Psychology, 63,  No. 2, 173-182.

Anthony R. Quintiliani, PhD., LADC  

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton SanghaChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Clinical Alliance, Clinical Practice, Clinical Supervison, Featured, Training Tagged With: CLINICAL DEVELOPMENT, CLINICAL SUPERVISION, EVIDENCED BASED

March 17, 2016 By Admin

Best Possible Clinical Alliance

Winnicott’s Ideas – Best Possible Clinical Alliance

To develop and maintain a strong clinical alliance it is best to follow some of the well-known clinical advice on this topic.  Rogers, Kohut, Winnicott and many others have suggested just how to do so.  Here are some general clinical recommendations for mindfulhappiness-winnicottenhancing the clinical alliance.

  1. Develop authentic respect for the client.
  2. Share power and responsibility for the outcomes – all the outcomes.
  3. Maintain a cooperative and supportive demeanor. Smile!
  4. As much as is possible maintain “unconditional positive regard.”
  5. Utilize deep, contemplative listening with clear mindfulness.
  6. Be reasonably flexible regarding real-world client situations.
  7. Directly reinforce HOPE as you push gently for increased self-efficacy.
  8. Be very patient!
  9. Be in authentic compassion for the client’s pain and suffering, and allow your own reactions.
  10. Use evidence-based approaches in your psychotherapy, while also being creative.
  11. Always apologize when you have made errors, harmed the frame of psychotherapy, or unintentionally harmed the client – DO NO HARM is the rule.
  12. Support the client’s belief and relief from his/her spiritual understandings and practices.
  13. Be nice! Treat the client as you would like to be treated.

Now let’s examine some more complex ideas and practices as recommended by W. D. Winnicott.  In this brief article I will only note the suggestion without much detail.  If you have questions, please feel free to email them to me at anthony@mindfulhappiness.org  Here is his list.

  1. Work hard to assist the client in improving their “sense of self” in “going-on-being” as a “good enough” person.
  2. Stabilize the client’s “secure base” (Bowlby) in a “secure holding environment” within the therapy dyad.
  3. Allow the defenses of the “false self” to exist as you enhance “object constancy” in the clinical relationship.
  4. Support the client’s true self development “as a potentiality” in the therapy.
  5. Pay mindful attention to the client’s mind-body presentations, realizing that both cognitive/verbal/executive parts of self are as important as emotional(sensation)/experiential parts of the self. People communicate consciously and unconsciously via multiple areas of human functioning.
  6. Learn about and respond appropriately to the client’s interoceptive world as false and true selves activate in object related transferences. Here sensations, emotions, inner feelings may be very important.
  7. Use stronger empathy and conscious projection within the empathic relationships as to allow safety in regression into the client’s past object related/attachment failures.
  8. Experiment actively by being a good “transitional object” in “potential space” so the client can utilize you as an outside object in a real relationship. Hope for strong internalization by the client.
  9. Foster the client’s security, safety, trust and courage in your clinical interactions.
  10. Maintain a tight therapy frame regarding time, space, expectations, payment (within reason), roles, boundaries, etc.
  11. Use the process of projective identification consciously in therapy (not clearly noted by Winnicott but suggested indirectly).
  12. As Winnicott noted “stay alive, stay awake.”

Its will not be easy to implement all of these alliance-holding strategies.  However, the more mindful and skilled psychotherapists are about them, the better the strength and resilience of the clinical alliance will be.  Work hard; accept the rewards; be happy!

For more details refer to Fromm, M. G. and Smith, B. L. (Eds.). (1989). The Facilitating Environment: Clinical Applications of Winnicott’s Theory. Madison, CN: International Universities Press, pp. 6-8, 25-26, 55-87, 77-78, 145-171, 489-515.

By Anthony R. Quintiliani, PhD., LADC

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

Author of Mindful Happiness  

CLICK HERE  or any image below to Order 

Mindful Happiness cover designs.indd

MindfulHappiness_Amazon           mindful-happiness_barnes_and_noble

 

Filed Under: ANTHONY QUINTILIANI, Clinical Alliance, Counselor Activites, Featured, Ideas & Practices, Training Tagged With: CLINICAL ALLIANCE, DONALD WINNNICOTT

Twitter

Mindful Happiness -Currently in Production

Mindful Happiness Posts

The Failed “War on Drugs” – Let’s Try Treatment On Demand and Fund It The New York based Drug Policy Alliance (drugpolicy.org) and other sources have provided some important information about our failed drug and alcohol policies. Here are a few astounding facts.  The United Stares has about 5% of the world’s population, but it […]

Zen Buddhist Practices – Egolessness In our practice we often inquire, and sometimes experience, the no-self and/or egolessness. What is egolessness? Who and what do we think we are? Some say that when we die the essence but not the ego lives on into new experiences. Karma and re-birth are givens in this spiritual view. […]

Mindful Happiness Explores – The Miracle of Mirror Neurons Between 1996 and 2000 researchers (Gallese and Rizzolatti) at the University of Parme in Italy discovered what are now called mirror neurons. Neuroscientists speculate that mirror neurons (reportedly in the Broca’s area of the prefrontal cortex) activate perceptual responses for internal motor-emotional responses.  Thus mirror neurons […]

Taoist Meditation on Healing Colors of Light In Taoist views the four seasons (five if you include “Indian Summer”) are strongly associated with emotional moods and bodily energies. Healing colored light is also part of this viewpoint. For each of the colors we use, follow the process noted below. Sit quietly and breathe calmly. Circle […]

-The Word, Sound, Meditation, and Music are all Timeless A Tribute to Elvis Presley and his Music The word has been associated with human consciousness.  The word requires the energy of sound to hear it.  Meditation places us in a most receptive state of mind and body; it allows us to be open to our […]

Laughter to Support you in Suffering As we all know life is filled with joy, suffering, and neutrality or boredom. This is THE WAY IT IS! Or, as a very good old friend often reminded me: “It is what it is!”  In Buddhism we preach a middle way in various areas of practice; the same […]

A Radical Feminist in her Time Over 800 years ago Hildegard of Bingen presented radical viewpoints on women-power and male-dominance in the Christian Church, stone/gem healing, meditation, insight and intellect, the web of life or planetary oneness, being in nature, environmentalism, and personal stories of suffering, etc.  Despite her outspoken manner and her popularity among […]

 Psychoanalytic Psychotherapy “gems” In my opinion there are about eleven such “gems” in psychoanalytic psychotherapy.  Use of these interventions in various types of psychotherapy may improve clinical outcomes beyond insight. Although these curative interventions have often been associated with treatment of psychological trauma, object loss, and inner conflict, they may also be useful in the […]

Gurdjieff’s The Fourth Way to Consciousness: Background A core teachings is that there are three ways of being: the fakir (master of the physical body); the monk (master of faith and feeling); and, the yogi (master of mind development).  A key goal is to KNOW yourself at the deepest levels.  To KNOW is to be, […]

Loving Kindness Meditation from The Buddha Loving Kindness Meditation (hereafter LKM) is, perhaps, one of the most popular meditation practices in the world. What many practitioners do not know is that one form of it came directly from The Buddha. Along with LKM wisdom we also are guided by the enlightened words of The Dalai […]

Beads: Significance in Spiritual and Religious Practices The significance of religious and spiritual practices in the world is enormous.  Christian, Muslim, Hindu, and Buddhist practitioners make up the overwhelming majority of the world’s population. The  CIA estimates are that Christians (33%), Muslims (23%), Hindus (14%) and Buddhist (7%) make up the majority of religious followers. […]

Meditation Process in Chan Buddhism Chan Master Changlu’s The Deportmant for Sitting Meditation  (12th century China) is a clear and helpful set of instruction. 1) It begins with the making of a personal vow for great compassion, personal liberation, and samadhi – all for the purpose of delivering sentient beings from their suffering and to their […]

Introducing Your Clients to Brief Meditations Psychotherapists often ask  about ways to introduce mindfulness and meditation to clients.  There are other posts on this Blog that offer basic introductory information on both content and process. Here I will simply introduce you to four brief, basic meditations for clients suffering from anxiety and/or depression, along with […]

Journaling and Grief Process Regular brief journaling may be helpful in your grief and horror regarding significant personal losses of self and/or others. Here are the various ways it may be helpful to you. Writing and reading about your personal loss experience may help you to make sense of the process, and at the same […]

Zen Buddhist Emptiness and Christian Centering Prayer Recently Ken McLeod presented “Freedom of Choice” as a way to differentiate forms of spiritual materialism and emotional escapism from serious Buddhist practice.  He noted The Heart Sutra negations. There is no attainment for bodhisattvas as they pursue the perfection of wisdom. Ultimately, everything is empty. He refers […]

Facing Addiction in America On November 17,  2016 The Surgeon General of The United States (Dr. Vivik Murthy) issued THE FIRST Surgeon General Report on our addictions problems. Since addictions in America may well be the single most threatening condition facing the nation’s health and economy, as well as casting strong doubt about a good […]

Mindful Solidarity with Standing Rock Sioux Earth Protectors The Standing Rock Sioux earth protectors are fighting earth destruction, environmental degradation, oil profiteering, and corporate greed.  Yes, I suppose finding huge reserves of crude helps many people become employed in the Dakotas. This is important. But other earth-wise activity (more solar for example) would be far […]

Emptiness – Meditation Practice The Brahma-Viharas (higher abodes) include four powerful meditation practices ( Loving Kindness/Maitri or Metta; Compassion/Karuna; Sympathetic Joy/Mudita; and, Equanimity/Upekkha) that involve boundless radiation outwardly all the way into the infinite universe. These boundless or infinite space meditations, working with deep absorption and projecting kindness outwardly, may lead to positive changes. Experienced […]

Happiness #3 – More Characteristics Here I will continue the discussion on common characteristics of personal happiness. As you read these posts, please do your best to experiment with these characteristics.  See if you can experience more happiness without a frantic search for it. Ultimately it is about a special form of human love. Here […]

Cognitive Defusion in Mindfulness Psychotherapy A well-meaning therapist might ask: What is cognitive defusion. Well this practice, as used in Acceptance and Commitment Therapy, is beyond cognitive restructuring of cognitive distortions and automatic negative thoughts ( I call “Red Ants”). The practice concretely de-literalizes the personal truth and meaning of unhelpful, repetitive thoughts and words. […]

Mindful Categories

Mindful Happiness Pages

  • About
  • Contact
  • Dr. Anthony Quintiliani
  • Mindful Expressions Meditation CD
  • Mindful Happiness
  • Site Map

Copyright © 2023 · Mindful Happiness