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Anthony Quintiliani, Ph.D, LADC

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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.

October 10, 2018 By Admin

Practicing Interoceptive Meditations Anthony R. Quintiliani, Ph.D., LADC

Practicing Interoceptive Meditations

Anthony R. Quintiliani, Ph.D., LADC

The mindfulness-based process and intervention of interoception (also called neuroception) has slowly moved from meditation practice into clinical practice, now being part of the recommended MBSR, ACT, and more current CBT-based therapies. The three brief meditations below are presented to expand the use of interoceptive processes in therapy practice. They are presented in very brief form, so slow down the work when using these in your therapy practice. Rather than repeating the introductory process, I will note it here. Be sure to use it in each meditation.

Begin with the following for all three meditations;

  1. Place your body into a calm and comfortable sitting or lying position.
  2. Breathe slowly and deeply for at least ten breaths. Extend the exhalation for the last three breaths.
  3. Use your imagination energy to recall a time when you were in bright, warm sunlight – feel this warmth on your skin right now. Using imagery of that time and place may be helpful here. Without thinking, just feel it.

Warm Hands Meditation

  1. While sitting comfortably, rub your hands together quite vigorously until you can feel heat in your palms.
  2. Place your warm hands on your cheeks with some pressure, and allow the warmth to penetrate into your face.
  3. Not working too hard at this, slowly and compassionately move the sensation of warmth through your body – face, neck, shoulders, arms, hands, torso, upper legs, lower legs, both feet – all the way to your toes. Do not at all be concerned about if you are doing this correctly. Simply use your personal strong intention.
  4. Rest calmly in the remembered-warmth of your sun-experience and your inner power of warm self-sensation.
  5. Rest in your personal, warm power and allow self-healing to occur.  Use your personal power NOT your thoughts.

Warm Heart Meditation

  1. Repeat step #1 from the above meditation.
  2. Place your warm hands crossed over your heart, and notice the sensation of penetrating warmth.
  3.  Consciously open up your heart chakra, feeling gentle and warm vibrations. Allow them to spread out.
  4. Allow this inner experience of sensation to kindle self-love for yourself. DO this now.
  5. Just BE you; sit there with this experience and appreciate who/what you are right here now.
  6. Do not worry at all if you are doing this correctly.  Just be with your interoceptive sensations and feelings.

Inner Warmth of Self-Healing Meditation

  1. Repeat the meditation above, and spend some time and energy intensifying the warmth if possible.
  2. Now simply and effortlessly move the warmth to any specific place in your body that needs healing.
  3. Do not think about this, just be with the experience and ALLOW it.
  4. Do not concern yourself abut whether or not you are doing this correctly. No thinking, just feeling.

You may wish to practice post-meditation journaling after you complete these three brief meditations.

These meditations were inspired by meditations lead by Thich Nhat Hanh at a Norwich University(VT) retreat and by CBT-mindfulness research at the University of California San Diego Medical School in 2017 and 2018. Refer to W. J. Sieber’s supervisory work.

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: Featured, Interoception, MBSR, Meditation, Meditation Activities, Mindful Awareness, MIndfulness, MIndfulness Activities, Mindfulness Training, Nhat Hanh Thich, Self Care, Stress Reduction Tagged With: INNER WARMTH MEDITATION, INTROCEPTION, MBSR, MEDITATION, NEUROCEPTION.MINDFULNESS, WARM HEART MEDITATION

August 23, 2017 By Admin

Beyond MBSR- Quick Start Skills

Beyond MBSR – Quick Start Skills

Self-calming for counselors and other helpers is one of the most important survival practices to master.  Self-calming consists a set of basic mindfulness skills, all of which must be practiced regularly to achieve desired emotion-regulation effects. The utility of these skills is well established in clinical research, and not only do they calm helpers but they are also excellent forclients.  Once a counselor has practiced these skills on a regular basis, it may be time to share such practices with clients. Live-practice therapy sessions are always more effective than simply “talk-therapy” about skills. Talk is cognitive, thereby impacting our executive brain more so than our body and limbic brain. Live mind-body practice impacts both the executive and limbic brain areas, and the body. In the same way that cognitive and psychodynamic interventions alone often fail to impact limbic system reactivity, these mind-body practices impact both mind and body – if we are lucky they may also impact the soul. A side-effect of regularly practiced skills may be increased personal happiness in life. These skills, if practiced regularly, will improve emotion self-regulation for most people.  Here are the skills.  This is simply an introduction, so you may have to research and learn “how to do” these skills via additional help. Be aware that if you suffer from severe physical illnesses, you may want to check with your healthcare provider before starting these practices.  The same may be true if you suffer from severe psychological conditions.

  1. Mindfulness Breathing Techniques – Try calm, slow, deep abdominal breathing as a practice. Once mastered add exhalation extension; extend the exhalation slightly and maintain a similar length of the breath extension as you practice. Try mid-line breathing; imagine your breath entering your nose and moving on the mid-line of the body to your lungs and eventually into your hara, or deep abdomen. If you are experiencing low mood, you may want to try excitatory breathing; breathe in and out fast and completely. See if it improves your mood. Lastly, experiment with happiness breath; each time you take a long, slow, deep breath recall a pleasant memory from your past.  Be sure the memory is an authentic one, one without mood-altering substances.
  2. Buddha’s Best Friends – I have added to this list. Your always helpful “best friends” are your calming breath, your smile, your standing body, sitting body, moving body, and lying body.  All these practices have positive neurobiological effects. Try them to see if you feel better.
  3. Mindful Movement – It is often very helpful to practice yoga, tai chi, qi gong, and walking meditation.  Instructional classes are often available at the community level
  4. Middle-Way Practices – Do your best to remain in the middle way regarding most human interactions and experiences.  Being in extremes, especially in emotional experiences, is generally unhealthy for us all. When you catch yourself at extreme ends of experience and reactivity, breathe calmly and take control over your executive brain. Move your thoughts, emotions, and behaviors towards the more moderate position. This is especially important in all interpersonal relationships.
  5. The First and Second Arrows of Suffering – We all suffer, and we all will suffer. This is simply part of life.  When a horrible things happens to you (the first arrow), there is usually nothing you can do about it.  Some good old radical acceptance may be helpful.  However, human suffering is deepened and prolonged because we often do not have emotion regulation skills. The second arrow generally causes longer and deeper suffering than the first arrow – even when the first is traumatic. The second arrow is what our mind and body do after the first arrow. Our negative thoughts and emotions (also action urges in behavior) set us up to suffer even more and for longer periods of time. We need to practice middle way moderation and executive control over emotional/behavioral reactivity when we are upset. Regular meditation and/or yoga will help improve your emotional capacities here.
  6. Gratitude – Best to practice regular gratitude for what you do have now rather than crave and react to what you wish you had now. This reactive stance causes more suffering, especially unhappiness, envy, and greed. Did you eat today? Did you sleep in a bed last night? Is your overall health moderately good?  Do you have a job?  How about having a or several friends? Is there a family member you care about and/or who cares about you. Take a moment for gratitude for things you may be taking for granted because you have them in your life.
  7. Self-Compassion Practices – Since humans suffer, we tend to become stuck in the past (may relate to “repetition compulsion”) and either fearful to craving for the future.  Being out of the present moment increases angst and sometimes unhappiness. Only by being in the present moment can you exert your human power in arising and falling experiences. It is OK to practice self-compassion for your suffering, but do not wallow in it and get stuck in it.  Just face it, and realize all humans suffer in their lives.  We also have joy! This suffering will pass.
  8. Body Scanning Practice –  This can be a very powerful practice. Simply start with your toes or the top-center of your head, and allow yourself to feel the “feeling” of directed and strong attention.  Simply move down or up the body, placing strong attention/awareness on various parts of the body.  The attention and subtle feelings alone may be relaxing.  I prefer guided practices with a touch of suggestion. As you move down or up the body, add the idea of “feeling” a subtle, relaxation sensation at each point. DO NOT look for it, just do it and see.
  9. Loving Kindness Meditation – This is my favorite meditation, and one that is popular all over the world. You will have to research the complete steps. Here I will simply get you started. Begin with yourself and say slowly: may I be safe…healthy…free from suffering…happy…living with ease. Try to feel inside the appropriate inner experience and inner sensations of each step. Now do it for a significant other. Then end by doing it again for yourself. There are many steps, so look into this if you enjoy the effects.
  10. Radical Acceptance – When primary suffering hits (you are wounded by the first arrow), do you best to recognize that we all suffer, and sometimes there is little one can do about it.  We need time to grieve and mourn losses and emotional pain. Radical acceptance simply recognized a reality in the moment. Use your mind-body-heart-soul systems to move beyond suffering – it takes time. Along with radical acceptance, you may wish to use RAIN process – recognize what is going on emotionally for you, accept it in the moment, inquire about why you feel this way, and use the concept on non-self (or the fact that all experiences even life are impermanent, so things will change, arise and fall). This bad experience arises and falls away in time.
  11. Mindful Journaling – When you practice mindfulness in everyday life, when you meditate or do yoga, it is often helpful to write some thoughts and emotions about your practice in your “special” personal journal. Journaling about ONLY positives can be a very helpful practice.  My many years of clinical experience have taught me that writing negatives in one’s journal can be far less helpful. If you decide to do this add ritual to it; be mindful in seeking out the right journal for you to write in.  You could also make your own journal if you wish.
  12. Your Best Parts of Self – Take time each day to note one or two positives about your day and about YOU. Our limbic-brain tends to keep us locked in negatives and critical/fearful mind. So we need to exert some emotional and cognitive energy to alter that pattern. It is good practice to list a couple positive traits you noticed in yourself reach day.  It is a BIG deal!

For more information refer to Quintiliani, A. R. (2014). Mindful Happiness…Shelburne, VT: Red Barn Books. This book is being revised and expanded at this time.

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: Activities, Featured, MBSR, MIndfulness, Stress Reduction Tagged With: MBSR, MINDFUL BASED STRESS REDUCTION, MINDFUL HAPPINESS

August 10, 2017 By Admin

Wise Mind and the Neuroscience of Mindfulness Anthony R. Quintiliani, Ph.D., LADC

Wise Mind and the Neuroscience of Mindfulness Practice

What is wise mind? Marsha M. Linehan developed this clinical process in her work on dialectical behavior therapy. Wise mind is the middle way between rational/reasonable mind and emotional mind; it allows us to live with balanced reason and emotion in daily interactions. When practiced regularly, it may reduce suffering from excessive stress, shame, guilt, and traumatic life experiences. One key benefit is that wise mind’s effects on emotion regulation may reduce the need to self-medicate, a core cause for all addictions. Rather than simply depending on sensory pleasures for short-term escape from pain and/or a fleeting experiences of joy/happiness, wise mind may improve radical acceptance, sensory soothing, and responding inter-personally with wisdom (kindness, respect, compassion). A valued possible outcome is increased authentic, longer-term happiness.

More Details: Wise mind mindfulness practices, along with regular meditation and/or yoga, allow us to pursue personal aspirations and goals using both reason and emotion. Whereas emotion is the juice of life (both pleasant and unpleasant), reason gives us logical strategies and methods to meet personal goals and satisfy needs. This combination of mindfulness skills may also reduce emotion dysregulation and impulsivity. When such mindfulness practices are used in skilled psychotherapy with home practice, it may lead to improvements in depression, anxiety, the effects of trauma, addictions, and eating disorders.  Various well-constructed meta-analyses have demonstrated that mindfulness practice (mainly regular  meditation) produced positive effects on depression, anxiety, chronic pain and emotion regulation. It is important to note that all these conditions may become precursors for addictions, including smartphone addiction. By 2007 it was estimated that nearly ten percent of Americans (30,000,000 people) practiced meditation; add to this other mindfulness practices like yoga, qi gong, and tai chi and that number may double.  By 2015 mindfulness-based practices were well-integrated into various skilled therapies: mindfulness-based stress reduction (improves depression, anxiety, chronic pain, and emotion regulation), dialectical behavior therapy (improves emotion regulation, self-soothing, and impulsivity), mindfulness-based cognitive therapy (50% eduction in relapse for repeated serious depressive episodes), mindfulness-based relapse prevention (for addictions), and acceptance and commitment therapy. The key variable was clear: if clients practiced regularly, they improved their clinical conditions, but if clients did not practice, they did not improve their clinical conditions. Therefore, two things are very important: doing regular practice in psychotherapy sessions, and the clinician being a regular mindfulness practitioner.

Mindfulness and the Brain:  Key neuroscience findings suggest that regular practice of meditation (and/or yoga) may result in profound brain changes. Some findings are that regular practice may weaken the limbic systems’s reactivity via lower firing rate and neuronal power, strengthen the frontal and prefrontal executive/emotional functions via better intention, attention, awareness, and concentration, and possibly improve right-left brain integration. It has been suggested that prefrontal activation increases levels of B-endorphin, a pain reducing opiate. Prefrontal activation may also improve experienced pleasure and reduce breathing rate so relaxation is experienced directly. When people pay close attention to positive stories they tell themselves and/or positive emotional memories, serotonin levels may increase. Thus mindfulness practices enhance the experience of happiness.  However, if people get stuck into paying attention to negative stories and negative emotional memories, the level of serotonin is reduced. Yes, being chronically stuck in the suffering of your past always makes emotional experience worse.

For more information refer to Aguirre, B. & Galen, G. (2017). Mindfulness for Borderline Personality Disorder…Oakland, CA: New Harbinger Publications.

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: Benefits of Mindfulness, Featured, Marsha Linehan, MBSR, Meditation, Mindful Awareness, MIndfulness, Mindfulness Training Tagged With: MARSHA LINEHAN, MBSR, MINDFUL BASED STRESS REDUCTION, NEUROSCIENCE, PRACTICE

March 11, 2017 By Admin

Object Relations Therapy for Trauma

Trauma: Object Relations Therapy

Object relations therapists, D. W. Winnicott especially, have presented a logical analysis on how to provide object-relations-oriented therapy to people suffering from the effects of psychological trauma. Such attachment-based trauma therapy provides support and healing from trauma, loss and long-term trauma-effects.  The interventions below combine the best of object relations therapy, mindfulness therapy (MBSR, ACT), and cognitive-behavioral therapy. Here is the listing of therapeutic functions and interventions.

  1. Provide support for “going-on-being” in the therapeutic alliance and the therapy itself. (Winnicott)
  2. Unconditional positive regard is a must. (Rogers)
  3. Recognize, work with and work through the splitting process as it activates in therapy. (Lineman)
  4. Safely and with effective skill help to re-connect the person with safe transitional space. (Winnicott)
  5. Carefully build and monitor the emotional “holding environment” in both alliance and therapy. (Rogers, Winnicott)
  6. Include contextual stimuli and symbols of the traumatic experience, from very general to specific and shift slowly over time. (Briere)
  7. Once there is a firm alliance and safety in the therapy, be more specific in exposure to traumatic experiences – monitor carefully. (Briere)
  8. In all exposure work, best to utilize SUDs scores from 0 to 100 – larger range between numbers allows deeper investigation and specificity.
  9. Work hard to understand and utilize body-based communications. (Ogden, Fisher, van der Kolk)
  10. Use mindfulness attention and skills (MBSR, ACT) to remain in The Middle Way between traumatic re-exposure and the safety of “going-on-being.” (Briere, van der Kolk)
  11. Check in with the experiences of transference and countertransference as you use images and defenses to support progress. (A. Freud)
  12. Use multi-sensory interventions in gentle, safe, re-exposure to traumatic materials – using one step removed and cognitive processes first. (Quintiliani)
  13. If skilled in its use, utilize the Attachment-CABs-VAKGO-IS-Rels formula for interventions. (Quintiliani – see mindfulhappiness.org for more details)
  14. Using items #s 8-13 above, aim for development of a safe cognitive schema and narrative clarification about the traumatic event/s.
  15. Work closely with the person to help them internalize the growth-benefits of all of the above. Take time with this process.
  16. Be a “good object” and always return to safety over and over again – check-in and stabilizes often.
  17. Slowly and with safety move up the hierarchy of trauma exposure process, possibly experiencing the full array of sensory experience. (Briere, Foa)
  18. Listen, support emotionally, radically accept, validate and understand the process and the person. This is your best way to develop a “good enough” self-object via “transmuting internalization.” (Kohut)  Various mindfulness and CBT skills will be used here.
  19. Use mindfulness and good CBT to make space for acceptance and validation for post-traumatic growth. (Lineman)
  20. Help to impact these positive changes into a “different” memory system as you expand and deepen the narrative.
  21. Support and directly reinforce (behaviorally) the improved self – a “felt sense” of a healthier self psychologically and physically.
  22. Place more and more safety into the transitional space, and generalize this process into therapy and life practices.
  23. Finally, expand the person’s capacity for pleasure, joy, self-esteem, success and HAPPINESS before therapy ends.

For more information refer to Savage Scharff, J. and Scharff, D. E. (1994).  Object Relations Therapy of Physical and Sexual Trauma. Northvale, NJ: J. Aronson.

Note: The ideas have been presented in this text, but I have added more current interventions and details based on new research and treatments.

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: Activities, Featured, MIndfulness, MIndfulness Activities, Mindfulness Training, Object Relations Therapy, Therapy, Trauma Tagged With: ACT, COGNITIVE BEHAVIORAL THERAPY, D.W.WINNICOTT, MBSR, MINDFULNESS, OBJECT RELATIONS THERAPY, THERAPY., TRAUMA

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