Mindful Happiness

Anthony Quintiliani, Ph.D, LADC

By

Clinical Practice in Times of Uncertainty

In Times of Uncertainty; Clinical Practice

H. Colodro and J. Oliver provide sound advice in their new book, A Guide to Self-Care for Practitioners in Times of Uncertainty. This 2020 New Harbinger publication is loaded with helpful suggestions on surviving, even thriving, in our time of struggle. Their core questions include: What do my clients need most now? Am I able to provide what is needed and do so effectively? What might I do regarding my own uncertainty and struggles? Here are some of their suggestions.

  1. Spend some time daily practicing self-compassion.
  2. Know what you are facing, and if you are in a position (emotionally) to provide what is needed.
  3. Recognize the effects of chronic stress on yourself and your clients. Make adjustments as needed.
  4. Work smart! Work with only what you have some control over and not what is beyond your control.
  5. Be sure to take good care of yourself: sleeping, eating, attending, worrying, being aware, obtaining social-emotional support, meditating/doing yoga, and holding onto a strong sense of consciousness.
  6. Check in with yourself. Ask: How am I doing right now? Why did I react emotionally to that? etc.
  7. Release yourself from a “fix-it” mentality. Rather focus on emotion regulation, stability, and safety.
  8. Be there with your own, personal losses, sadness and fear. Deal with these and seek help when needed.
  9. If appropriate, include happiness-enhancing activities and skills in your therapy.
  10. Recognize the reality of impermanence in all things, including current problems and yourself.
  11. Settle into a more self-caring flexible outlook. If possible, work less. Take breaks! Do not over-extend.
  12. If you experience psychological exhaustion or failure in behavioral activation, seek support and consider doing more telehealth rather than live, person-to-person therapy. Cut back if necessary.
  13. Follow all guidelines regarding masks, gloves, social distancing, disinfecting, etc.
  14. Consider using “good enough” standards in your work in these times. See D.W. Winnicott for details.
  15. Remain safe, calm, competent, and helpful in your work.
  16. Consider using the same breathing training techniques you teach to your clients on yourself.
  17. When you feel stuck or sucked-into the craziness of the times, use CBT-M (CBT with mindfulness) on yourself.
  18. If you feel overwhelmed, hopeless, etc. seek your own clinical help.

Refer to Colodro, H. and Oliver, J. (2020). A Guide to Self-Care for Practitioners in Times of Uncertainty. Oakland, CA: New Harbinger Publications.

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!

By

Mindfulness Skills and Psychotherapy Outcomes

Mindfulness Skills and Psychotherapy Outcomes

There are at least ten good reasons why mindfulness training and regular practice may improve psychotherapy outcomes. These reasons assume the training is presented by a well-trained clinician-mindfulness practitioner. Of course improved outcomes also depend upon the client’s motivation and energy to actually practice mindfulness skills on a regular basis. One way to ensure this is to integrate such practices into every therapy session. Here is the list.

  1. Intention: Mutual intention to learn and practice mindfulness skills is required. Intention may also carry over to the client’s desire to make changes for the better. For both parties regular practice opens doorways to improved emotion regulation and awareness as well as possible spiritual development.
  2.  Attention: Attention is required for regular mindfulness practice. Such attentional improvements may help clients notice more clearly unhelpful patterns in cognition, emotion, behavior, and sensation. This also applies to therapists, who may find these skills improve their acuity in noticing small but important problems and changes in client behaviors.
  3. Awareness: Intention and attention tend to improve one’s level of awareness – for both positive and negative experiences. Awareness skills may be open or focused. Improved awareness of unhelpful experiences may challenge clients, but it will also help both parties to see more clearly what is important and what changes are needed. When awareness is matched with behavioral task analysis, it allow clear measurement of progress.
  4. Emotion Regulation: Improvement in emotion regulation is, perhaps, the single most beneficial change for both clients and therapists. Integrating various approaches from mindfulness-based therapies will ensure ample opportunity to practice emotion regulation, which is the single most problematic issue in most common problem areas (anxiety, depression, trauma, addictions, chronic pain).
  5. Mindfulness-Based Skills: Mindfulness-based therapies (MBSR, MBCT, ACT, etc.) offer a wide array of skill practices for both clients and therapist. Therefore, it is possible to match client needs with appropriate skill practices in sessions and  at home. Also the “self” of both parties is more strongly present in such practices. Who is this observer experiencing these conditions and situations of life.
  6. Subject-Object Observation: In the many problems people experience it is possible to match client needs with a specific set of mindfulness skills. The ongoing practice of subject-object observation (often without evaluation) allows various transformational experiences for clients. One that is most common is that thoughts, emotions, behaviors, and sensation are internal and external experiences that the “I” is having.  However, such experience is NOT-ME, they are simply current experiences in life. They are impermanent. The same is true for therapists. Also therapist may be able to use this formal process to investigate the quality of the therapeutic relationship and its core alliance. Transference and countertransference responses are Important!
  7. Interoception: Along with emotion regulation interoception skill, or the ability to recognize internal body sensations arising and the emotions that follow, is highly valuable in therapy. This allows both clients and therapists to recognize precursors to problematic thoughts, emotions, behaviors, and sensations. It enables a short window of time to act to prevent or mitigate negative experiences. It also brings in awareness of somatosensory experiences. Our sensory experiences are what we “are” in life.  Awareness os the “me.”
  8. There is ample, high quality research supporting the use of mindfulness skills in improving both depression and anxiety. Google it.
  9. There is high quality research supporting the use of mindfulness skills in improving chronic pain. Google it.
  10. There is good evidence supporting the use of mindfulness skills in improving both trauma symptoms and challenges, as well as improving addictive behaviors. These improvements come mainly from improved awareness,  emotional self-regulation, and interoceptive practices.

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!

By

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  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

By

Taoist Meditation on Healing Colors of Light

Taoist Meditation on Healing Colors of Light

In Taoist views the four seasons (five if you include “Indian Summer”) are strongly associated with emotional moods and bodily energies. Healing colored light is also part of this viewpoint. For each of the colors we use, follow the process noted below.

  1. Sit quietly and breathe calmly.
  2. Circle your arms palms open above your head to collect the healing energy potential.
  3. Place your hands over your heart at first, then when ready move them to cup your knees and pull up a little.
  4. Allow the colored healing light to do its healing work inside you, and be open to imagination and suggestion.
  5. Smile!
  6. At the end of each color meditation, imagine releasing dark negative energies from your body.

For White Healing Light (think about courage and righteous justice), Bright Blue Healing Light (think about inner stillness, gratitude and gentleness), Bright Green Healing Light (think about kindness, generosity, and forgiveness),  Bright Red Healing Light (think about joy, happiness, honor, and love), Bright Yellow Healing Light (think about fairness, openness, and balance) AND now use any combination your wish – Follow the process noted and listen for guidance. In the combination feel whatever comes up in your upper chest, then in your heart area, and finally in your lower belly.

For more information on sound and color healing meditation, refer to C. Mantak (2009). The Six Healing Sounds: Taoist Techniques for Balancing Chi. Rochester, VT: Destiny Books [CD].

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!

 

 

By

Brief Update on America’s Opioid Problems-2020

America’s Opioid Problem-2020; A Brief Update

Unfortunately, Opioid Use Disorder (OUD) is alive and well in 2020. Today approximately 150 People are dying each day due to opioid overdose. The CDC noted that from 1999 to 2017 approximately 399,000 people died in the United States from Opioid overdose. Related to chronic pain, this is one of the greatest failures in American medicine; perhaps, now medical training (as well as all mental health and social work training) will include sufficient clinical exposure to Substance Use Disorders ((SUD). Sufficient exposure goes way beyond Motivational Interviewing. Since many recognize addictions as America’s number one healthcare problem, all healthcare providers and school counselors, social workers, psychologist, etc. should receive proper clinical training in the prevention, intervention, and treatment of SUDs. It is about time!

Although in most parts of the country opioid dependence is still quite common, there is hope. Medically Assisted Treatment is being used, which in the best cases (Vermont’s model) includes medications to help reduce opioid cravings and psychoactive effects AND counseling to resolve mental health and addictions problems that lead to OUD in the first place. I, myself, a long time ago was part of a clinical team that established the first methadone clinic in Vermont under the jurisdiction a community mental health center (The Howard Center). As Clinical Director, and with lots of clinical experience and training in co-occurring disorders and the help of many, we were ready to act. Some thought Vermont did not need such a clinic, but on our first day of operation we had a waiting list of over 100 people hoping to receive these services. There is a risk here: current funding models short-change the clinical psychosocial interventions and enhance the medical interventions. For treatment to work long-term, people need BOTH! Even if people are successful at harm reduction regarding OUD, relapse is just around the corner if they do not receive therapy for pre-existing psychological problems (anxiety, depression, trauma, other addictions, and eating disorders). It is estimated that 90% of clients who do not take MAT medications may relapse. MAT with psychosocial clinical interventions sports a success rate of about 50%, which is great considering the severity of OUD. Let’s not be penny-wise and dollar-foolish; let’s not reduce psychosocial interventions that prevent relapse and enhance long-term health status.

For more information refer to The National Psychologist, 28(1), Winter, 2020, pages 1 and 5.

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