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 enhancing the clinical alliance.
- Develop authentic respect for the client.
- Share power and responsibility for the outcomes – all the outcomes.
- Maintain a cooperative and supportive demeanor. Smile!
- As much as is possible maintain “unconditional positive regard.”
- Utilize deep, contemplative listening with clear mindfulness.
- Be reasonably flexible regarding real-world client situations.
- Directly reinforce HOPE as you push gently for increased self-efficacy.
- Be very patient!
- Be in authentic compassion for the client’s pain and suffering, and allow your own reactions.
- Use evidence-based approaches in your psychotherapy, while also being creative.
- Always apologize when you have made errors, harmed the frame of psychotherapy, or unintentionally harmed the client – DO NO HARM is the rule.
- Support the client’s belief and relief from his/her spiritual understandings and practices.
- 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 firstname.lastname@example.org Here is his list.
- Work hard to assist the client in improving their “sense of self” in “going-on-being” as a “good enough” person.
- Stabilize the client’s “secure base” (Bowlby) in a “secure holding environment” within the therapy dyad.
- Allow the defenses of the “false self” to exist as you enhance “object constancy” in the clinical relationship.
- Support the client’s true self development “as a potentiality” in the therapy.
- 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.
- 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.
- 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.
- 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.
- Foster the client’s security, safety, trust and courage in your clinical interactions.
- Maintain a tight therapy frame regarding time, space, expectations, payment (within reason), roles, boundaries, etc.
- Use the process of projective identification consciously in therapy (not clearly noted by Winnicott but suggested indirectly).
- 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, Vermont
Author of Mindful Happiness
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