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Anthony Quintiliani, Ph.D, LADC

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March 23, 2017 By Admin

Even More Psychoanalytic Gems

Psychoanalytic Gems – Even More

D. W. Winnicott has made significant clinical contributions to both building therapeutic alliance and maintaining a positive, helpful focus in psychotherapy. Below I have noted various approaches to
use in your therapy.  Use of these “gems” requires considerable knowledge and skill by the therapist.  Here is the list:

  1. Respect the client’s agency, and do nothing to exert direct control over her/him.
  2. Continue to support personal goals, striving, and motivation in your client.  Promote healthy maturational processes in this growth.
  3. If you understand how, use transitional space/transitional objects in our therapy to enhance positive emotional holding and nurturing of the client’s true self. Build more safety.
  4. Work to improve the client’s self-identifications, self-image, and self-objects. Where helpful note that initial introjections are the product of attachment experience. They occupy both intrapsychic and interpersonal space and time.
  5. Introduce playful free association as a method in your therapy. Use interpretation only when it is helpful.
  6. Support directly the client’s need for “continuity of being” in both therapy and day-to-day life experiences. This often includes integration of the true self and false self.
  7. Use gentle reflection to help move insight into action: changes in thoughts, emotions, and behaviors.
  8. Notice both transference and cuntertransference experiences in therapy. Use these to better understand your client, as well as yourself.
  9. When possible enhance the client’s safe use of self soothing behaviors as a form of “primal satisfaction.”
  10. Help your client to integrate fragments of unhelpful past experiences.  This process should help to enhance the presence of a coherent self-narrative.   Such narratives often involve early traumatic experiences, and may be activated in the here-and-now of therapy.
  11. Do whatever is possible to re-integrate the sense of a secure self.  Maintain a safe and accepting therapeutic environment to do so.

For more refer to  Giovacchini, P. L. (1990). Tactics and Techniques in Psychoanalytic Therapy. Vol. 3, The Implications of Winnicott’s Contributions. Northvale, NJ: J. Aronson, pp.1- 243.

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: D.W. Winnicott, Featured, MIndfulness, People, Psychoanalytical Psychotherapy, Psychotherapists, Psychotherapy, Therapist, Therapy Tagged With: CLINICAL, D.W.WINNICOTT, PSYCHOTHERAPY, THERAPISTS

March 20, 2017 By Admin

Psychoanalytic Gems – Again

More Psychoanalytic Gems –

D.W. Winnicott

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, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: D.W. Winnicott, Featured, Psychoanalytical Psychotherapy, Psychotherapy Tagged With: D.W.WINNICOTT, DR ANTHONY QUINTILIANI, PSYCHOANALYTICAL, PSYCHOTHERAPY

June 28, 2016 By Admin

Clinical “Gems” in Psychoanalytic Psychotherapy

 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 MINDFUL HAPPINESS_gemsinsight. 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 treatment of other clinical conditions: depression, anxiety, eating disorders, and self-medicative addictions.  Along with skilled mindfulness training and practice with a mindfully-experienced therapist, psychoanalytic gems may be helpful to clients suffering from limbic-dominated habit actions, urges and related brain plasticity realities; again, skilled applications of informed mindfulness and yoga, along with the “gems,” may improve the BIG FIVE common co-occurring clinical MINDFUL HAPPINESS_Bigfiveconditions: trauma, addictions, depression, anxiety, and eating disorders. The clinical value of the gems rests in the reality that they may be used in both long-term traditional psychoanalytic psychotherapy AND in short-term interventions within cognitive-behavioral therapy, acceptance and commitment therapy, mindfulness-based cognitive therapy, and mindfulness-based stress reduction. In this first of a series of posts on this topic I will simply list the eleven so-called gems.

In my clinical experience with various forms of psychotherapy and clinical supervision over the past 30 years I have found the following psychoanalytic gems to be very helpful for many of my clients – almost all of whom suffered from complex co-occurring disorders.  What is of more importance is the fact that I never considered myself to be a psychoanalytically-oriented psychotherapist; that approach simply required too long a treatment period to be effective, and it seriously challenged the level of specific cognitive-mental capacities of many of my clients.  I was skilled in various evidence-based therapies, to which I added these “gems.” I did require additional clinical supervision in this advanced integrative therapy process.

Here is my list.

  1. Cultivating the psychoanalytic clinical alliance – the therapeutic relationship
  2. Strategic and limited ab-reaction experiences
  3. Conscious and unconscious linking of childhood wishes into the present relationship
  4. Object and self-object internalization and their presentations in therapy
  5. Re-synthesis of “repressed” failed object relations
  6. Frames of clinical reliability and honest concerns in clinical interactions
  7. Balanced perceptions of self in reality with self and with others – the true and false selves
  8. Corrective emotional experience regarding distorted object representations
  9. Cognitive-behavioral applications of formulated insights – moving the insights into actions
  10. Strategic and limited therapeutic regressions and re-enactments
  11. Uses of conscious projective identification processes (perhaps the most important skills of all)

In the series of posts to follow, I will elaborate the what, how and what-ifs of these “gems.”

By 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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