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Anthony Quintiliani, Ph.D, LADC

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March 22, 2020 By Admin

ACT – The Absolute Basics; Acceptance & Commitment Therapy

ACT – The Absolute Basics; Acceptance & Commitment Therapy

In this post I begin a series of writing dealing with ACT, Acceptance and Commitment Therapy. The details below are basic, but perhaps just enough to develop more interest in learning about ACT. Here we go!

1) Act, developed mainly by Steven Hayes Ph.D.and based on a foundation of Relational Frame Theory, uses both language and cognition as key components of therapy. However, ACT goes much further than RFT.

2) Act utilizes the Hexaflex Model to ground the therapy process. Within this model ACT focuses on flexible contact with the present moment, no matter what that contact is. It suggests that acceptance of difficulties works better than avoidance of them, in fact showing how avoidance of personal problems often makes condition worse emotionally. Self-as-context is emphasized. The focus is on cognition, emotion, and behavior of the person seeking help. Values are used in congruence with motivation, and cognitive diffusion is taught to free the person from deep “stuckness” in unhelpful thoughts. Finally, once a behavioral action plan is agreed upon, ACT works to obtain clear commitment to action by the person who is suffering. In summary, ACT does its best to reduce/eliminate cognitive and behavioral inflexibility. Ultimately, ACT strives to enhance and expand psychological flexibility on the part of the person seeking help.

3) ACT emphasizes the utter importance of a strong clinical relationship, alliance and trust in therapy. Without such a therapeutic relationship, it is unlikely there will be constructive, positive change.

4) Act utilizes helpful metaphors and reinforcing clinical interventions to support positive change. Act intends to reduce the power on unhelpful verbal rules used by the person hoping to change. For example, ACT notes the hopeless futility of avoiding personal problems and works to get the person unstuck from unhelpful thoughts, emotions, and behaviors. With both personal acceptance of your own cognition, emotion, and behavior (they are important but they are NOT you) – and commitment to valued actions – ACT hopes to improve what needs to be changed in a collaborative relationship.

5) ACT skill building occurs in interactive experiential actions and experiments; ACT pays close attention to positive changes that may occur. In the process ACT is both interpersonal and intrapersonal in nature. With costs-benefits analysis and various forms of behavioral functional analysis, ACT supports personal goals and improved stimulus control via contingencies of reinforcement (very behavioral here).

6) ACT has shown effectiveness in dealing with depression, anxiety, and addictions. More recently, ACT has modified its approach to improve outcomes in trauma treatment. In this process ACT recognizes self-medication contingencies, the role of avoidance in making things worse, as well as intrusive cognitions, emotions, and behaviors. Act hopes to use skillful means (mindfulness in acceptance and defusion) to reduce rigid reactions and fears. Act is flexible enough to complement other forms of evidence-based therapies.

For more information refer to Harris, R. (2019). ACT Made Simple. Oakland, CA: New Harbinger Publications or the various articles and book written by Steven Hayes on this topic.

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  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ACT - Acceptance & Commitment Therapy, Featured, Therapy Tagged With: ACCEPTANCE AND COMMITMENT THERAPY, ACT, ANTHONY QUINTILIANI, MINDFUL HAPPINESS, MINFUL HAPPINESS, THERAPY.

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

October 30, 2018 By Admin

Setting Emotional Boundaries from Work to Life

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:

  1. Are you taking care of your own physical, psychological, spiritual, and emotional needs?
  2. Are you using mindfulness, self-compassion, clinical supervision, or journaling to get to know how you are doing?
  3. Are you valuing yourself enough regarding self-rewards, positive self-talk, cognitive and behavioral restructuring?
  4. Are you giving yourself time to experience some form of creativity?
  5. What about your spiritual self?
  6. Do you spend quality time in nature, among the awe of it all?
  7. Are you involved in the type of quality relationship you desire?
  8. 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.

  1. Using mindful awareness, observe the level and intensity of your self-criticism.
  2. Let go of personal resistance to being real, being your true self.
  3. Get out of your head! Get out of the past!
  4. Do loving kindness meditation often.
  5. 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.
  6. Practice much more self-appreciation.
  7. Do not dwell on the pain and suffering of your past. All that stuff probably made you a stronger person.
  8. Welcome and LOVE all of you, with special attention to the sacred quality of your own life suffering.
  9. 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.
  10. Always get help when you need it, and do your best not to dwell on what you have little control over.
  11. 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 SanghaChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

 

Filed Under: Boundries, Featured, Leadership, MBSR, Mindful Awareness, MIndfulness, Self -Kindness, Self Care, Self Compassion, Self Esteem, Spiriuality, Stress Reduction, Therapist, Therapy, Well Being Tagged With: EMOTIONAL BOUNDRIES, MBSR, SELF CARE, THERAPY.

September 19, 2018 By Admin

Preverbal Trauma – Therapy Problems

Preverbal Trauma – Therapy Problems

A. R. Quintiliani, Ph.D., LADC

Preverbal trauma (hereafter PVT) is one of the most pervasively troubling human conditions. PVT occurs when a preverbal child is exposed to parental, caretaker, or other forms of abuse. This abuse may be sexual, physical, or emotional. This form of abuse is so destructive because the child has no cognitive/executive/verbal ways to understand and respond to the experience. The long-term bio-psycho-social-spiritual effects of PVT are quite difficult to treat effectively. One reason for this is that some therapist are determined to utilize their favorite approaches (mainly forms of pure talk-therapy and psychodynamic holding) despite the limited effectiveness that these forms of therapy results in. Still worse for the client is generic talk therapy, often a mixture of various talk-therapy components but no actual evidence-based method of helping. Remember it is our obligation to Do No Harm and to use therapeutic interventions beyond alliance that are effective. There may be moral if not ethical implications here.

It is best to keep in mind that both The American Psychological Association and The Agency of Healthcare Research and Quality found recently that correctly applied CBT is the therapy of choice for most forms of trauma. These investigations were thorough and completed in an independent manner. The APA is a professional guild group representing the interests of psychologists, but the AHRQ is a semi-governmental research arm looking into how we spend healthcare dollars. Their main concern is that we spend healthcare funds doing evidence-based interventions with good outcomes. In the interest of research, of course other therapies have been found to be effective with trauma. To mention a few, these are EMDR, DBT, PET, and, Briere’s self-trauma therapy with slow, complete exposure work. MBSR and ACT may be helpful regarding emotional dysregulation in traumatic re-experiencing and self-empowerment. Of course effective attachment therapy with very specific object relations correctives is also helpful.

The following list contains many conditions that make PVT difficult to treat. These suggest that therapy modifications may be needed. The effects of PVT may include:

  1. The non-verbal experience itself;
  2. Somatics of ACEs;
  3. Unexplained body sensations and feelings;
  4. Unexplained bodily awareness;
  5. Problems with long-term memory formation about the event/s;
  6. Visual observation without clear cognitive understanding;
  7. Painful and uncomfortable sensory experiences without apparent causation;
  8. Possible increased limbic fear reactions without clear rationale;
  9. Emotion dysregulation without grounding about specific stimuli and variables;
  10. Parts-of-body reactions without clear causes;
  11. Classically conditioned emotional responses without clear conscious cause and effects; and
  12. Brain sensitivity to future traumatic experiences.

Hopefully this list will encourage you to re-examine the form of therapy you may be using for PVT. Hopefully, this list of intense suffering of a child due to PVT will motivate you to use an evidence-based approach.

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  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ANTHONY QUINTILIANI, Featured, Preverbal Trauma, Therapy, Trauma Tagged With: PREVERBAL TRAUMA, PVT, RECOVERY, THERAPY.

May 25, 2017 By Admin

Using Cognitive Defusion in Mindfulness Psychotherapy

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. As The Buddha warned: We probably should NOT believe the distinctions of thoughts in our heads. Our strong thoughts may be our best friends or our worst enemies. In neuroscience the fact that more negative than positive thoughts occur in humans implies we are more attached to limbic reactivity and fear than to positive thoughts and emotions. When we get stuck in negative cycles of thinking, feeling and doing our right brain and limbic area dominate. A very old mindfulness belief is that you are not your thoughts, your emotions, or your behaviors; these parts of you are simply associated with your life experiences. When a client learns to defuse a though it means they have changed its linguistic structure and removed it from being cemented into their CABs, or cognition-affect-behavior cycles. In all good therapies, especially Cognitive-Behavioral Therapy and various mindfulness therapies (MBCR, DBT, MBCT, MBRP, ACT), helpers often work on truth-analysis of unhelpful, repetitive, negative thoughts patterns – especially those embedded into CABs cycles of ineffective experiences. Self-medication, isolation, and avoidance are commonly associated with these realities. Sometimes this work includes meta-cognitive analysis regarding your thoughts about your thoughts or the patterns of your thoughts. The clear logic is that the words we often tell ourselves in times of stress or fear are NOT often true. Of course, if indeed you are seriously endangered best to allow your limbic brain area to save your life. The list below will note various approaches used to defuse thoughts from our experience of being, our CABs cycles.

  1. Stay the thoughts out loud and mindfully notice the sensations, images, emotions, and associated CABs cycles that arise. Now say the words over and over again for at least half a minute. Note any changes that follow.
  2. Use scrambling of the phrase to change it grammatical brain-connections. Your brain should react a different way to the “scrambled” message. It is like changing the code of the phrase. For example: try saying “am person a bad” or “person I a bad am” instead of “I am a bad person.”  Notice what your brain-mind does now.
  3. Speed up and then slow down the rate of inner and outer speech. Try all four options; notice any relief you have obtained.
  4. Reduce then intensify your energy level when saying the phrase. Notice, again.
  5. Elongate the sounds of the key words in your phrase.  Keep elongating and notice what happens. Elongate and slow as far as you can.
  6. I like this approach. Change the most important one or two words in your phrase.  Now say the phrase out loud with one or two slightly less harsh words.  You will need to repeat this technique for effects. For example: “I am so worthless” helps solidify your brain plasticity about personal meanings and images. Try this: “Sometimes I feel worthless” or “When really bad things happen, I can feel worthless”  or “My unpleasant feeling can relate to feeling less worthwhile.”
  7. Change the language code of your key word/s. For example: change “I am a terrible person” to “I am a spanty person.” Spanty being Czech for terrible or bad.  Notice how the brain/mind/body responds to this simple change.
  8. You could also sing your statement, or say it in a foolish voice tone.
  9. I have used defusion and added body movements to the process. Here are four examples.

A) Find a spot on the floor where you try to project all your bad feelings about your repetitive phrase. You are consciously projecting the bad feeling into the spot on the floor. Now stand in it and notice how your mind body reacts. Slowly, but with some bodily energetic force, step out of the spot on the floor.  Notice the effects.

B) Stand in the same spot, and pretend you are taking off a pair of pants – BUT when you are out of the imaginary pants, immediately step aside. Notice.

C) Find a pleasant place to go for a brief walk. Enjoy the environment, but say your statement to yourself. Split your attention in two: attention to the beauty of the walk (and watch your step), and attention to repeating your phrase. Notice any changes and shifts that occur.

D) This one is out-there but fun. Energize yourself (if healthy enough) into a rapid skipping movement. At the same time say your phrase, and pay attention to where you are skipping. Your body will respond by contrasting the negative statement against the body-memory of good-old skipping. For most adults, skipping was a fun thing to do. Notice the effects.

For more information refer to: Blackledge, J. T. (2015). Cognitive Defusion in Practice: A Clinician’s Guide… Oakland, CA: Context Press/New Harbinger, pp. 3-42, 87-109, 159-162.

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: Clinical Practice, Clinicians, Cognitive Behavioral Therapy, Featured, Ideas & Practices, Meditation, Meditation Activities, Mindful Awareness, MIndfulness, MIndfulness Activities, Mindfulness Training, Psychotherapy, Therapy, Therapy Tagged With: ANTHONY QUINTILIANI, COGNITIVE DEFUSION, MINDFUL HAPPINESS, MINDFULNESS

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