Mindful Happiness

Anthony Quintiliani, Ph.D, LADC

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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  

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New Edition of Mindful Happiness in Production…Coming soon!

 

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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!

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Power of Silence in Retreats and Therapy

 Retreats and Therapy:  The Power of Silence

E. Kubler-Ross once noted that people need to more often revisit silence within themselves and realize all of life’s purposes include learning from our despairing experiences.  Suffering may be a hidden source of being blessed with new inner knowledge. Personal suffering if not too, too great may also strengthen us from the inside out. Recently Amoda Maa Jeevan  has informed us that there are many core meanings of being in silence at meditation retreats.   To make things more clear I will simply list some of her conclusions. Here are things to keep in mind about silence at retreats and therapy. Most spiritual traditions use it as a primary process.

  1. Silence allows our minds to rest and interpersonal contact to be reduced. It brings us back to ourselves.
  2. Silence helps us obtain relief from day-to-day stressors, pressures, and busyness.
  3. Silence may contribute to higher consciousness and personal transformation.
  4. Silence may be a curative elixir against troubling thoughts, emotions, behaviors, struggles, preferences, resentments, and general suffering.
  5. Silence may open doorways to calm and clarity.
  6. Silence reminds us to remain in the present moment no matter what happens. Silence thus helps us to get out of the past and have less fear of the future.
  7. Silence may free us from over-identification and even projective identification with various forms of psychological attachment, disappointment, betrayal, and pain.
  8. Silence, as a fundamental meditation teaching, may open up healing of self from trauma, fear, addictions, and other destructive emotions.
  9. Silence is a form of essential nature, and it allows greater depth of self-inquiry.
  10. Silence may help to liberate us from typical painful psychological past attachments and fears of the future. Thus it may unblock our energies and emotional movements.
  11. Silence brings us to the gate of surrender, where we may decide to enter deeply into the self-loving, self-cherishing container of the self. It helps float us slowly into the areas of past pain and suffering, but this time with new soothing energies from within. Rupert Spira in Being Aware of Being Aware, sees silent  conscious knowing (awareness) as being a constant while the known is always impermanent/changing.

For more information refer to Amoda Maa Jeevan (2017). Embodied Enlightenment: Living Your Awakening in Every Moment. Oakland, CA: New Harbinger Publications/Non-Duality Press.

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!

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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  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

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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!