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Anthony Quintiliani, Ph.D, LADC

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March 26, 2017 By Admin

How to Improve Client/Patient Collaboration

Improving Client/Patient Collaboration  in Treatment

To improve collaboration between you and your clients/patients, simply practice the following behaviors as your norms.  See the

list below, and practice, practice, practice.

  1. Present with an attitude of helpfulness and authentic caring. Empathy and authentic concern are required.
  2. Recognize the reality that clients/patients are at different levels of readiness to make changes – almost alway NOT where you are in the process.
  3. Know how to use cognitive-behavioral therapies, mindfulness-based stress reduction, deepo psychodynamics in alliance building, and other effective approaches.
  4. Complete a cost-benefit analysis grid with the person, and work with pros/cons of staying the same vs changing.
  5. Do whatever you can to enhance the quality of the clinical relationship.
  6. Act within an understanding of equality; you are not able to control any person who is suffering.
  7. Provide psychoeducation where needed.
  8. Anticipate barriers to making desired changes; offer concrete support and help in doing so.
  9. Your clinical interventions should be evidence-based for a higher probability of success.
  10. Use the person’s personal hopes, goals, and motivations.
  11. Use task analysis as a behavioral method to break down larger tasks into smaller, more manageable tasks.
  12. Be willing to try harm reduction when people appear pre-contemplative in stages of change.
  13. Provide direct feedback, with more emphasis on reinforcing praise rather than scolding.
  14. Remain in the Middle Way regarding too much/too little expected change, as well as the timing and time required for any changes to occur.
  15. Be highly mindful of both your own emotion regulation and that of the person you are working with. Practice emotion regulation skills often.
  16. Intervene quickly in anxiety, depression, substance misuse, and trauma.  Intervene carefully, intelligently, and again with evidence-based actions.
  17. Remember in crisis situations that  safety is first, stabilization is second.
  18. Identify people, places, and things that help and hinder progress into healthier life patterns.
  19. Monitor serious symptoms and act accordingly.  If medications are required, be part of the monitoring system and do “check-ins” often.
  20. Use self-help groups if the client/patient finds them helpful.  One needs to participate to know the correct answer here.
  21. Do GOOD self-care and get effective clinical supervision when needed.

For more information refer to Daley, D. C. and Zuckoff, A. (1999). Improving Treatment Compliance: Counseling and Systems Strategies for Substance Abuse and Dual Disorders. Center City, MINN. Hazelden.

Anthony R. Quintiliani, PhD., LADC

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

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ANTHONY QUINTILIANI, Clinicians, Counselor Activites, Featured, Ideas & Practices, Leadership, MIndfulness, Practices, Self -Kindness, Self Care, Self Compassion, Self Esteem, Stress Reduction, Therapist, Therapy, Thoughts & Opinions, Training

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 

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

January 17, 2016 By Admin

Emptiness – Infinite Space Immaterial Sphere

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 practitioners have reported mental beauty, positive affective attitudes, kindness, benevolence, generosity, and liberation happiness. The meditation below also requires that we utilize Mindful Happiness - The Brahma-Viharasawakening factors such as mindfulness, concentration, joy, energy, letting go, and tranquility. Hopefully, your practice of this compassion meditation will also reduce your sense of a solid, impermanent self as it leads you to experience the sphere of infinite space. Caution: If at any time you experience the discomfort of extreme dissociation, decide whether to continue or stop.  If you stop, simply rest in good self-care. Breathe and relax. If you feel that you desire the company of another person, invite a supportive meditator to share this experience with with. The following meditation is based on the Chinese Agamas, especially the Samyukta Agama as presented by Bhikku Analayo.  I have modified the presentation to enhance the practicality of practice.

  1. Begin with a brief period of loving kindness meditation, then shift into a brief self-compassion meditation dealing with personal suffering you have experienced – suffering you know other people have also experienced.
  2. Now with calming breath, continue with loving kindness and compassion for specific people you know, then to specific groups, ending with suffering that all people experience in life. May all beings be safe, healthy, happy and at ease.
  3. Continue to practice, but now work on reducing the perception of space between you and others who suffer.
  4. Now practice by reducing your attachment to personal possessions. Concentrate and contemplate on the personal meaning of this attachment-reducing practice. Notice your resistance or lack of readiness. Let go!
  5. Now practice reducing your emotional clinging to your physical body. Reduce, reduce, reduce!
  6. Allow yourself to move your perception BEYOND your personal experiencing of the SELF, your self.
  7. Drop your self-cherishing and self-centeredness as you work very hard to expand your authentic caring about other people and their happiness. Place them first; place yourself last. This is challenging!
  8. Now we are ready for a HUGE leap! Practice letting go of your self-attachment to your ego. Experiment with letting go of attachment and experience – even perceiving your mind and its actions. Go blank!
  9. You have probably experienced some reduced perceptual energy as you cultivate moving gradually toward emptiness of self, emptiness of mind, emptiness in general.
  10. Experience the flavor of being in a boundless compassion as you experience moving BEYOND your physical mind and physical body.  You have entered the experiential edge of boundless emptiness. Where is the self now?
  11. Imagine experiencing (without self conceptions) compassionate movement toward and into the sphere of infinite space. Notice the feeling as you approach emptiness.
  12. Being well on your way into emptiness, experience sympathetic joy for others with good fortune.  Personalize this via specific people you may know. Notice as you begin to enter the sphere of infinite consciousness.  Notice without evaluation the feeling of being so far out there!  Just notice. Perhaps there is a floating feeling.
  13. Being even more on your way into emptiness, notice the experience of deep equanimity – moving closer to the sphere of nothingness. Remain in that space for a moment.
  14. Relax in your blissful state of joy.  Rest in your present awareness and notice your personal joy in liberation.
  15. Rest now.  Allow in whatever helps you most in this experience. Just BE as you are now! Notice the joy.

Samyukta Agama-Mindful Happiness

For more information refer to Analayo, Bhikku. (2015). Compassion and Emptiness in Early Buddhist Meditation. Cambridge, UK: Windhorse Publications, pp. 1-74.

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: Activities, ANTHONY QUINTILIANI, Benefits of Meditation, Benefits of Mindfulness, Counselor Activites, Featured, Meditation, Meditation Activities, Mindfulness Training, Practices, Training Tagged With: DR ANTHONY QUINTILIANI, EMPTINESS, MEDITATION, MINDFULNESS

August 20, 2015 By Admin

A Self-Compassion Meditation for Counselors and Therapists

Counseling/Psychotherapy with Self-Compassion

MindfulHappiness_BenefitsofGroupMeditation

Please begin by ending all conversations, and PLEASE shut-off your phones and/or laptops.  Simply be for a moment in the quietude of your inner self. Please close your eyes if you wish to do so. Contemplate the sacred nature of your profession – saving lives, reducing suffering, being a constant object, practicing ethically, and befriending so many people with so much emotional pain. You practice a sacred profession!

Let’s begin our meditation.  STOP at any time if you feel strong discomfort doing this practice or if you simply are not yet ready for it. Loosen your jaw.

  1. As you sit open up your heart to both self-respect and self-love (at least liking yourself) for the sacred help you give to people. You provide huge reserves of compassion for others in your work.
  2. Imagine a person’s face. A person you have helped in the past.  Notice facial details and facial emotions.
  3. Mellow yourself back a bit and take several slow, deep, calming breaths (polyvagal and unresolved trauma cautions).  Feel the breaths going in and out at very slow rates. Feel the breath at your nostrils, in your chest and in your abdomen.  Notice the movement.
  4. Be ONE with the inner gratitude you may feel, and find deeper silence in the spaces between thoughts and between breaths.  Focus on the quiet spaces!
  5. As you sit and breath be in private solitude.  Enjoy being here now, and take just a few moments going beyond cognitive noise and rest deeply as you can in self-compassion about your own suffering and self-care in your own meditation.  Now it is your time for self-compassion.
  6. You may contemplate a bit about your own experiences of suffering, but PLEASE do not get into story-lines and strong images about it. In fact, do your best to ALLOW your own pain to drift gently out of your body on each out-breath you make.  Gently and lovingly extend your out breath at an even amount on your exhalations. Breathe in to the count of 5; hold to the point of five; and, exhale to the count of eight.  Practice a little in inner silence.
  7. As you breathe out ALLOW the feelings of your inner pain and suffering to leave your body (if you wish) and enter the vast, endless, universe. The universe contains all it needs to hold your negative energies.  Let the negative energies GO on the exhalations!
  8. Radically accept that you will be mindful of joy, boredom, and suffering in the future.  Now, however, you have a new tool to use that empowers you to reduce secondary suffering (what our thoughts and emotions do with primary, unavoidable suffering to prolong our pain).  Take a few more slow, deep, calm breaths.  Be with it!  Be it!
  9. Take a few more calm breaths and slowly open your eyes.  Return your body, mind and soul back to this group – here now.

Limited processing to follow.

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 blow to Order 

Mindful Happiness cover designs.indd

MindfulHappiness_Amazon           mindful-happiness_barnes_and_noble

Filed Under: Activities, Compassion, Counselor Activites, Featured, Meditation, Meditation Activities, Self Compassion Tagged With: COUNSELOR MEDITATION ACTVIIE, DR ANTHONY QUINTILIANI. TRAINING, MINDFUL HAPPINESS, SELF COMPASSION

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