Leadership Archives - Mindful Happiness

October 30, 2018 By Admin

Setting Emotional Boundaries from Work to Life

Anthony R. Quintiliani, Ph.D., LADC

Sometimes setting emotional boundaries from the psychotherapy room to your life outside of work can be a difficult thing to do. Shifting from “experience near empathy” (Kohut), “unconditional positive regard” (Rogers), “hovering attention” (Freud), “the holding environment” in “intersubjective space” (Winnicott), and compassionate awareness to emotional distancing, separation, and dispassion is no easy task. In more in-depth clinical interactions, the process of projective identification between therapist and client may drain your emotional resources; sometimes being “as if” you were the experiencer of your client’s pain and suffering can take a serious toll on your own emotional resources. At time the therapist’s own emotional life lacks the quality of connection experienced in the therapy session. Success in setting emotional boundaries is a very important self-care skill. It may determine your success, failure, joy, or misery in the clinical work you do. It will definitely prevent most case of “burn out.”

Therapists may wish to complete a brief self-care assessment at the end of each emotionally demanding day. Some things to check are as follows:

Are you taking care of your own physical, psychological, spiritual, and emotional needs?
Are you using mindfulness, self-compassion, clinical supervision, or journaling to get to know how you are doing?
Are you valuing yourself enough regarding self-rewards, positive self-talk, cognitive and behavioral restructuring?
Are you giving yourself time to experience some form of creativity?
What about your spiritual self?
Do you spend quality time in nature, among the awe of it all?
Are you involved in the type of quality relationship you desire?
Be sure to act on your own behalf if you find problems in the above areas.

Another very powerful process is to develop improving self-compassion for yourself, often blurring the inner boundaries of your own emotional life experience and the clinical work you do. Therapists are, in the end, only people with a set of specific helping skills. We suffer just like other people do. Hopefully, our training and experience have given us a bit of a positive edge here. Here are some things you may wish to consider to improve your own level of self-compassion.

Using mindful awareness, observe the level and intensity of your self-criticism.
Let go of personal resistance to being real, being your true self.
Get out of your head! Get out of the past!
Do loving kindness meditation often.
Recognize your own difficult emotions (shame, anger, revenge, trying to control others, etc.), and simply be with them as a sacred part of who you are and be real about it. Use emotion regulation to improve things.
Practice much more self-appreciation.
Do not dwell on the pain and suffering of your past. All that stuff probably made you a stronger person.
Welcome and LOVE all of you, with special attention to the sacred quality of your own life suffering.
When you experience or re-experience anxiety, depression, addictive behaviors, or trauma – hold an open, soft heart for it. Then make changes to improve your life experience.
Always get help when you need it, and do your best not to dwell on what you have little control over.
Be certain too make changes to improve self-compassion regarding any problem areas above.

Fo more information refer to Norcross, J. C. and VandenBos, G. R. (2018). Leaving it at the Office: A Guide to Psychotherapist Self-Care. New York: Guilford. Neff, K. and Germer, C. (2018). The Mindful Self-Compassion Workbook: A Proven Way to Accept Yourself, Build Inner Strength, and Thrive. New York: Guilford.

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

New Edition of Mindful Happiness in Production…Coming soon!

April 1, 2017 By Admin

The Power of Interpersonal Mindfulness

Interpersonal Mindfulness

Various forms of mindfulness-based compassion training help us to care more about the needs, happiness, and health of other people. However, direct applications of interpersonal mindfulness activates these influences into direct action on behalf of others. Thus, if lucky, we learn to care more about others and less about ourselves. The self-centered ego gives way to compassionate tolerance. Buddhist practices and meditations may improve our interpersonal relations, both intimate and distant. Today our world, nation, regions, and families are locked in bitter conflict; the entitled view of “my ideas are right” holds sway and prevents any forward movement for negotiated co-existence of different ideas and people. If we hope to save ourselves as well as our world, we MUST practice more interpersonal mindfulness. Such practices of random acts of kindness, general compassion, taking in suffering and giving out joy, tolerance, openness to differences, general gratitude and others all support more inter-personally cooperative thoughts and behaviors. Such thoughts and behaviors will improve self, dyads, relationship, family, community, race, ethnic group, religion, state, nation, and world. The need for this shift is highly urgent! We must change our being from greed, aversion, and hate to generosity, inclusivity, and love. If not our species and our world may fail.

In some ways this conflictual existence is the outcome of our old limbic brain structures (my own survival above all else), and our aggressive greediness as a species. According to very old Buddhists writings, one thing we can do right now if practice deep, active listening. By listening more to others and their opinions, and talking less about ourselves, we may achieve an emotional balance of mutuality. Basic mutuality (we are BOTH important) may lead to more deep listening and personal reflections of what is happening right now in this present moment. What, exactly, is it that is upsetting me? What, exactly, is it that may lead to mutual satisfaction here now? Begin your changes by starting with yourself. Notice what conflictual inner self-messages continue to play and re-play themselves over and over again in your own mind. Begin by listening to your own inner conflicts, and work at listening and reflecting deeply on both sides of this dynamic. Work on a solution, even if it is not a perfect one. First practice more radical acceptance with your own inner conflicts, then gently move to outer conflicts – begin gently with significant others. Practice, practice, practice and practice more. There cannot be a winner! Once you feel the sensations and emotions of successful compromise, begin to practice beyond intimate circles and into your general world environments. It is all about sharing your love and acceptance of self with others, and being for the betterment of others. On this path also practice good self-care.

Practice letting go of harsh self-centered judgments and learn to appreciate both similarities and differences – even BIG differences. After all, impermanence is real – as is the time-limited life you now have. Better to work at compassion and openness NOW. Better to work on caring about others and loving people NOW. Our total interdependence causes great energetic frictions at times. Learn how to find the MIDDLE WAY and encourage others to follow that path. The subtle energies of love and the very powerful energies of hatred both have immense influence in our lives. Live for love! Live to reduce hatred and reed! Be authentically intelligent and kind-hearted in your relatively short life.

For more information refer to Musho Hamilton, D. (2017). The Zen of You and Me: A Guide to Getting Along with Just About Anyone. Boulder, CO: Shambhala Publications.

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!

March 30, 2017 By Admin

Helping Therapists Work with Diversity

Help For Therapists: Working with Diversity

Clinical interventions, especially strongly evidence-based interventions, impact clients via new skills and practices in mind-body clinical realities. No matter how good (or “good enough” ) a clinical intervention is it requires a highly positive, active therapeutic relationship. As ample research suggests, a strong and positive therapeutic relationship in therapy enhances client trust and courage – thus expanding their experimenting with new ways of being, thinking, and doing. A huge problem is establishing such a therapeutic relationship is the inability of some therapist to bond with diverse people – people not exactly like the therapist. Below I will present information from clinical and social psychology about
what general variables/differences to be most mindful about. This information will be noted in three categories: Universals; Group Differences; and, Individual Self-Development (within groups). If therapists practice paying more attention to some of these basic realities in their clients, the expectation is that their therapeutic relationship/alliance will improve along with their clinical outcomes.

UNIVERSALS: Here is the listing – Similar Life Experiences/History, Biological Similarities, Social Similarities, Psychological Similarities, Emotional Similarities, Self-Awareness Valences, Use of Symbols, Use of Art, Compassion and Aggression, Love and Hate, and, Differences in the Above. Noticing, being mindful of, and using these realities in therapy should improve alliance and clinical outcomes.

GROUP DIFFERENCES AND SIMILARITIES: Here is the listing – Gender, SES, Age, Geography, Race, Ethnicity, Culture, Abilities, Disabilities, Religion, Marital Realities, Sexual Orientation, Urban/Rural, Education, Environmental Exposure (good/bad), etc. Again, therapists who are highly mindful of these realities will do their best to integrate them into their work with clients. Good work here will improve the alliance and clinical outcomes.

INDIVIDUAL SELF-DEVELOPMENT: Here is the list – Genetic Transfer, Modeling Transfer, Familial Transfer, and All Non-Shared Experiences in Life. Therapist who make it a norm to differentiate carefully between individuals in therapy – and who actively use these differences in their work – will most likely experience stronger emotional ties/alliances and better clinical outcomes.

If you have not been fully conscious of using such differences and similarities in working with your clients, you may want to select a few variables and begin. Begin NOW!

For more information refer to Pomerantz, A. M. (2017). Clinical Psychology: Science, Practice, and Culture. Los Angeles, CA: SAGE Publications, pp. 69-93. See also the DSM-V emphasis on culture and diversity in treatment.

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!

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.

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

Author of Mindful Happiness

New Edition of Mindful Happiness in Production…Coming soon!

December 17, 2016 By Admin Leave a Comment

Supervision and Self-Care in Trauma Therapy

Today there is an ever-increasing demand for effective trauma therapy. Our American clinical history on this matter leaves much to be desired. John N. Briere and Cheryl B. Lanktree offer important suggestions on how to use clinical supervision and self-care in your clinical work with clients suffering from serious psychological trauma. Here in a nutshell is what they noted. For a more detailed review, please read the cited material on your own.

Supervision and self-care include the following:

Supervisors work on emotional reactions common in trauma therapy;
Guidance and working through unhelpful thoughts, feelings and behaviors;
Use of clinical documentation as a metaphor for structure and true liability protection;
Problematic boundary issues;
Obtaining social-emotional support from others, especially a clinical team;
Participating in personal psychotherapy as needed;
Using mindfulness skills (especially T. Brach’s 2013 RAIN process) in trauma work – both with clients and as self-care;
As a reminder RAIN includes Recognition, Acceptance, Investigation, and Non-Identification when dealing with highly stressful immediate experiences;
Maintaining a personal practice of effective self-care in your work and in your life outside of work.

In addition, they note specific and repeated clinical interactions that help clients but may also deplete emotional and energetic resilience in therapists. These include attention to:

Caretaker issues – supports, emotions, energy;
General environmental and relational safety;
Specific risks regarding dangerous behaviors;
Anxiety, depression, grief, anger and other emotionally dysregulating conditions;
Poor sell-concept, low self-esteem, and various self-identity problems;
Various acting out and acting in situations;
Suicidal and self-harm risks and behaviors;
Consequences of various attachment problems and deficits;
Social, school, and family adjustment conditions;
Various somatization complaints; and,
Psychosexual preoccupation, stress, and behaviors.

It is quite obvious that while working with these serious conditions and symptoms, trauma therapists would remain at considerably high risk for vicarious traumatization. Thus, the need to maintain regular effective clinical supervision and good self-care practices are of utmost importance to psychological survival of the therapist.

For more information refer to Lanktree, C. B. and Briere, J. N. (2017). Treating Complex Trauma in Children and Their Families: An Integrative Approach. Los Angeles,CA: SAGE Publications, pp. 220-246.

By Anthony R. Quintiliani, PhD., LADC

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

Author of Mindful Happiness