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Anthony Quintiliani, Ph.D, LADC

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March 16, 2019 By Admin

Psychodynamics of Alliance – Therapeutic Relationship Enhancement

Psychodynamics of Alliance – Therapeutic Relationship Enhancement

This post includes basic considerations, processes, and clinical skills necessary for developing a strongly positive clinical alliance and therapeutic relationship in therapy.  Here the alliance is required for any substantial change in psychotherapy, and the therapeutic relationship rides the quality of the initial alliance to expand and inter-penetrate the emotional b0nds between the client and the therapist. The combination of strong initial alliance and highly positive therapeutic relationship is a powerful enhancement for personal growth and positive change in therapy. However, it is doubtful that these factors alone will bring about meaningful change in the problem/s that brought the client into therapy. Without them, there will be no meaningful change.

Emotional Bonding and Therapeutic Presence Requires:

  1. Intentional empathic attachment by the therapist;
  2. Meaningful collaboration on important tasks and behaviors;
  3. Emotional exposure in safety, and emotional containment as needed;
  4. The client experiences being heard, cared about, and accepted unconditionally;
  5. The therapist provides a strong positive “holding environment” within “intersubjective space” (Winnicott);
  6. A social and psychological environment of mutual respect, compassion, and trust exists;
  7. The therapist may become a secure attachment (re-attachment) figure in this emotionally intimate process;
  8. The therapist’s “unconditional positive regard” is experienced and projected into the psychodynamic space (Rogers);
  9. The therapist may improve attunement with the client’s inner experience, emotions, and needs (Kohut); and,
  10. Within safety and trust both projection and projective identification occur (Alonso) as reciprocal introjective processes to ensure the potential for “going on being” (Winnicott).

Additional Specific Behaviors by the Therapist:

  1. Providing direct emotional support verbally and non-verbally;
  2. Holding a delicate balance in idealized projections;
  3. Rapid repair of emotional ruptures, and taking responsibility for same;
  4. Various forms of direct and indirect validation;
  5. Careful, strategic use of silence;
  6. Maintaining empathic understanding despite any negative countertransference;
  7. Working to improve “experience-near empathy” (Kohut);
  8. Acting on opportunities to improve the quality of object relations here and now;
  9. Serving as a “good mother” (or father) figure (Klein); and,
  10. Careful ongoing reflection on emotional, verbal, projective, transference, and countertransference processes.

Desired Self-Development Outcomes for the Client:

  1. Improved insight;
  2. Improved self-confidence and sense of security;
  3. Improved skills in mindful awareness;
  4. Reduced fixations on negative cognitive, emotional, and behavioral experiences in the past and present;
  5. Improved internal structure as well as object constancy and relatedness;
  6. More positive introjected experiences in therapy and in life;
  7. Reduced repetitive defensive and emotionally reactive patterns;
  8. Stronger, more positive sense of personhood; and,
  9. More effective views about self in the world of interpersonal life.

Caution: Most psychodynamic and psychoanalytic therapies place primary emphasis on the clinical relationship between the therapist and the client, and less emphasis on actual cognitive and behavioral change in presenting problems. Therefore, it may be a moral (not ethical) question as to whether a therapists uses only these approaches. It may be best to integrate them with a well researched evidence-based therapy. For supportive reviews see the work of Mark Solms, Edward Tronick, and C.A. Alfonso, R.C. Friedman, & J.I. Downey (Eds.) (2018). Advances in Psychodynamics Psychiatry. For a strong critique see Richards, A. (June, 2018). Psychoanalysis in trouble…Psychoanalytic Review, 102(3), June, 2018.

By David Rapp, Brian Tobin, and Anthony R. Quintiliani, PhD., LADC,

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon

Filed Under: Featured, Psychodynamic, Therapist, Therapy Tagged With: EMOTIONAL BONDING, MINDFUL HAPPINESS, PSYCHODYNAMICS OF ALLIANCE, THERAPEUTIC RELATIONSHIPS

March 27, 2017 By Admin

Intervention Skills to Calm Your Anxiety

Intervention Skills to Calm Your Anxiety

It is estimated that approximately 40,000,000 American suffer from an anxiety disorders, especially generalize anxiety and panic disorder. Sometimes general “talk therapy” fails to help improve your condition; you may need cognitive-behavioral therapy with research-based mindfulness skills or dialectical behavior therapy.  CBT, MBSR, ACT and DBT are the evidence-based, recommended therapies here. Generally psychodynamic therapies

take way too long to bring about positive effects; meanwhile YOUR suffering continues. I have listed below several action-based skills  (cognitive and behavioral activation techniques) that might be helpful to you.  You will need to practice these approaches – no quick fixes. Some people also benefit from carefully prescribed and monitored medications.  Although the biological interventions is often the first effort in primary care and psychiatry, I suggest you may be better off with trying psychological skills-based interventions first. No negative side-effects.

  1. Mindfulness of the Present Moment is very important. Anxiety is often future-oriented, and depression is sometimes past-oriented. When you feel anxiety coming on, stop and place your complete awareness (intention and attention) into the present moment of the experience.  Allow it; observe it: and, activate skills like calm breathing to reduce the suffering effects.
  2. In more serious suffering, for example panic attacks, you may apply the skills noted in #1 above AND remain highly cognitive. Although it feels like you could die, you will not. In fact you may want to reframe what is happening right now. You are experiencing very strong fight-or-fight reactions in your body and mind. Remain focused on it, and recognize strongly that the F-F reaction is actually in place to keep you alive and functioning. Ground yourself, breathe calmly, and re-focus attention on your capacity to limit the attack and/or shorten its duration.
  3. Get back into cognitive mode by re-cecking your anxious thoughts about some up-coming situation.  Be in charge, cognitively. Do your best to change the valance of your thoughts from negative to neutral or positive. Work to convince yourself that “I can do this!”
  4. Learn and use various relaxation-oriented breathing techniques common in mindfulness, meditation, and yoga.  Deep calm breathing, slightly extending the exhalation, and using imagination to feel the calming breath moving through you – nose, chest, lungs, stomach. If you suffer from untreated or poorly-treated trauma, or if you have some type of polyvagal system malfunction, deep calm breathing may actually make you more anxious.  Sometimes clinicians suggest that you breathe into and out of a paper bag. See if that works for you.
  5. When your body and limbic brain area are on “out-of-control mode, try the 3-3-3 process. Go to your sense and name three things YOU see and hear; then simply name and make attentional contact with three neutral parts of your body. This should ground you.
  6. Do something different! Complete some simple task to get your mind off of the anxiety-provoking conditions and body feelings. Behavioral activation can be helpful here.
  7. As ancient mindfulness texts suggested, change your body posture. Stand up, walk around, sit down, lay down – skip if you want to. Once your body takes over in a task, your anxiety may diminish.
  8. Do not self-medicate your anxiety with alcohol or other depressant drugs, food, sexual behavior, or isolation.  Eat less sugars of all types, and reduce all caffeine intake.
  9. Socialize if you are able to do so. This can be especially helpful if you are with people who care about you.
  10. Humor may help. Smiling and laughing causes brain-based changes that may curb your anxiety (and depression).
  11. If not doing so now, seriously consider regular (daily if possible) practice of meditation, yoga, tai chi or qi gong. For many people, these practices reduce anxiety.
  12. If you are in psychological or medical treatment, but it is not working – get a second opinion or change your provider to someone more expert in anxiety disorders.

For more information refer to Quintiliani, A. R. (2014). Mindful Happiness…Shelburne, VT: Vermont Voices Press. You may want to refer to Chansky, T. E. (2012). Freeing Yourself From Anxiety…Cambridge, MA: Life Long- Perseus Books. See also Hughes, L. (March 8, 2017). How to Stop Feeling Anxious Right Now. WebMD.

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: Anxiety, Featured, Psychodynamic Tagged With: ANXIETY, MINDFUL HAPPINESS, MINDFULNESS, THERAPY.

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