Therapy's Best (By Howard Rosenthal) - Part V Summary

* Accomplished therapists are modest.

* Accomplished therapists seemingly enjoy enhanced longevity.

* Accomplished therapists enjoyed, repected, and valued their education although they often went in totally new directions after graduation.

* When accomplished therapists created their novel ideas or systems of therapy, they were initially ostracized by their peers.

* Accomplished therapists truly believe in their strategies even when they are diametrically opposed to other experts.

* Accomplished therapists often became famous or achieved uncommon notoriety after the publication of a highly successful book.
Robert Alberti - Your Perfect Right/Write; Albert Ellis - Reason and Emotion in Psychotherapy; Guide to Rational Living; Ray & Dorothy Becvar - Marriage Counseling; Richard Bolles - What Color Is Your Parachute?; Ray Corsini - Current Psychotherapies; Sam T. Gladding - Counseling: The Comprehensive Profession; William Glasser - Reality Therapy; Muriel James - Born to Win; Jeffrey Kottler & Jon Carlson - Mummy at the Dining Room Table; Edwin Shneidman - Deaths of Man

* Accomplished therapists often don't take their theories as literal as academicians.

* Accomplished therapists position themselves in the therapeutic marketplace.

* Since accomplished therapists are often highly critical of rival modes of treatment they are only selectively eclectic or integrative in their approach.

* Accomplished therapists often didn't set out to be an expert in their particular area of expertise.

Therapy's Best (By Howard Rosenthal) - Part IV

* Jeffrey Kottler - On Being a Therapist; Compassionate Therapy: Working with Difficult Clients; Travel That Can Change Your Life; Doing Good; and Making Changes Last. The Last Victim. What makes a very fine therapist - besides being moral, ethical, kind, caring, and other such qualities - is that we've each discovered our own unique way of helping that fits our personality, interpersonal style, clinical situation, and client population.

* Al Mahrer on Experiential Therapy - actualization forces, Adlerian social interest, Jungian polarities, deep-seated frustrations leading to aggressions, Allportian traits, behavior patterns shaped by positive and negative reinforcements, the unfortunate residue of pathological parents, the defining effects of my birth order, the soci0cultural imprinting of my background, and my unconscious wish. I learned the contents of my psyche.
Experiencing; The Complete Guide to Experiential Psychotherapy; Becoming the Person You can Become: The Complete Guide to Self-Transformation
1) Discover the deeper potential for experiencing; 2) Welcome, accept, cherish the deeper potential for experiencing; 3) Undergo a qualitative shift into being the deeper potential for experiencing in the context of recent, earlier, and remote life scenes; 4) Be the qualitatively whole new person in scenes from the forthcoming new post-session world.
Open the session by being able to unlock the usual controls, set aside the usual state of vigilant self-awareness and self-consciousness, free oneself of rigidly clining to the person one rigidly clings to being, entering a state of openness and readiness for deep-seated wholesale change.
1) Let go of, disengage from the continuing person you are and have probably always been, and to 2) throw yourself into fully and completely being the whole person who is the living, breathing deeper potential for experiencing that you had discovered.

* Nancy McWilliams on Psychoanalysis: We each have to do this work in a way that is authentic, that is true to our idiosyncratic self. Psychotherapy attracts rather androgynous people.
www.nancymcwilliams.com

* Lia Nower on Gambling Addiction: personality profile - impulsive, intensity seeking, addicted to other substances, and typically depressed or anxious, risk-taking behavior in childhood with abuse, neglect, and addicting caregivers.
1). initially for socialization, the addictive nature of variable ratio reinforcement; 2) family instability, low self-esteem or significant life losses, depression or anxiety, and/or comorbid addictions; 3) serious personality pathology, mood disorders, terrible childhoods, histories of antisocial behavior, and comorbid addictions, ADHD, risk-taking, impulsivity (biological components)
Be realistic. Gambling ~ fun, excitement, meaning, hope. You can't take that away from a person without replacing it.

* Edwin S. Shneidman on Suicidal Patients - Ten Psychological Commonalities of Suicide
A working, positive transference relationship is what, in my opinion, keeps chronically dysphoric pessimistic patients alive. What is needed is a safe sanctuary for exploration, for nonjudgmental disputation, for modeling with someone who affirms life's values.
The patient's proclivity for constriction of mental thought, all or nothing thinking; the therapist should have his third ear attuned to the word only, perhaps the most dangerous word in the suicidal patient's vocabulary. What is called for is to break up the binary way of thinking and to widen the patient's conceptual blinders.
Make a list of options. "And you can always commit suicide, but there is no reason to do that today." "Now, let's look at our list, and would you please rank order them from the absolutely least acceptable on up to the least distasteful."
The least-undesirable-choice-under-these-circumstances
Postvention
Pay close attention to the language.
The therapist's task is often not to take the question at face value but to change the question so it can be answered in a more life-affirming way.

* Henry A. Murray

Therapy's Best (By Howard Rosenthal) - Part III

* Jon Carlson - The truth is that CLs are a lot like us when we go to a doctor. We want to get in and get out and get our help and get on with our life.
- Advice: Be patient with yourself. Becoming a good therapist takes time. Practice. Get supervision. Read books. Learn different ways to work with people, as you will encounter many different types of people.
- Loss is so very different for different people. It is important to understand how one formulates the loss and whether or not he or she is really having a difficult time.

* Raymond J. Corsini - Six Therapists and One Client;

* Albert Ellis on REBT - Unconditional self-acceptance (USA). Unconditional other-acceptance (UOA), Unconditional life-acceptance (ULA)

* Robert & Lisa Firestone on Voice Therapy - Separation theory; express self-attacks in the second person in a dialogue format and react emotionally. (1) verbalizing the self-critical inner voices and releasing the accompanying feelings; (2) developing insights regarding their sources; (3) formulating corrective suggestions for important changes in life.
deep-feeling release therapy - primal therapy

* Samuel T. Gladding on Creativity

* William Glasser on Choice Theory, the new Reality Therapy - controlling ourselves; Counseling with Choice Theory: The New Reality Therapy, I get rid of criticizing, blaming, complaining, nagging, threatening, punishing, and briding. Fibromyalgia: Hope from a Completely New Direction

* Les Greenberg on Emotion Focused Therapy - www.emotionfocusedtherapy.org; core emotions need to be brought into awareness to change them. Both the therapeutic relationship and the specific change processes are seen as important in promoting change. warm, supportive, empathic, validating; access and transform affects; dyadic regulation of affect; access adaptive emotions to promote change, resilience, and strength; Empathic attunement to affect and differential intervention to promote emotional processing. Intervening at the level of the moment-by-moment processes or by asking someone to pay attention to what's going on inside his or her body which is making a specific moment-by-moment intervention. Or suggesting a larger task such as asking someone to imagine a significant other in an empty chair and engage in the a dialogue with the imagined other in order to facilitate a particular kind of processing found to be most helpful for that type of problem state. Emotion is needed to change emotion. Know which emotions to change and which to be changed by. Increase emotional awareness and help people with their affect regulation with reflecting on emotions to make sense of them and on transforming emotion with emotion. Change in meaning; create meaning by dialectically synthesizing influences from biology and culture;
1) bonding and awareness (empathic attunement & CL's emotional awareness); 2) evoking and exploring (evocation is not used until regulation is achieved); 3) constructing alternatives (making sense & generating new adaptive emotions); 4) Consolidating new meaning.
Acceptance of emotion -- Learning to tolerate and regulate unpleasant emotions - evaluate our own emotions

* Muriel James on Transactional Analysis & Gestalt --> redecision therapy - Good therapy is educational and good education is therapeutic. In transactional analysis theory, typical responses from the Child ego state to criticism, advice, or encouragement, are compliance, rebellion, or withdrawal.
Spiritual dimension of life; self-reparenting/self-remodeling your inner parent; Breaking Free & It's Never Too Late to Be Happy
"I wonder if by any chance it could be true, or partly true, what I and/or my client is saying?"
"What do you want that will enhance your life?"
"What do YOU need to do to get what you want?"
"What are you WILLING to do?"
For positive change, contracts to think of options, and organize a plan of action using the Adult ego state, are often useful.

Therapy's Best (By Howard Rosenthal) - Part II Job Hunting Special

* Richard Nelson Bolles on Job-Hunting: Resume --> Interview --> Job; "A resume is something you should never send ahead, but always leave behind (after the interview)." Customize it by the information through the interview.

* Interview tips: 1) Try to let the interviewer speak half the time; while you speak the other half. 2) When you are asked a question by the interviewer, your answer to each question should last between twenty seconds to two minutes. No more. If you need more time for that question, say, "I could amplify this if you wish." 3) Put yourself in the chair; and mind-set, of the interviewer.

* A resource to help the employer instead of a job beggar. Think primarily of what he or she can do for the employer, not primarily about what the employer can do for him or her. Send a thank-you note after the interview.

* www.jobhuntersbible.com

* Transferable skills - advising, budgeting, developing, illustrating, auditing, coordinating, diagnosing, fixing, lecturing, driving, negotiating, painting, planning, recruiting, selling, singing, typing, troubleshooting, writing, etc.

* Career & Vocational Counselors: It is not your "techniques" that are most helpful to your CLs. It is your empathy and your compassion. For example, it is your ties to the internal world of spirit, not your knowledge of salaries in the workplace, which makes you the most helpful.

Therapy's Best (By Howard Rosenthal) - Part I

* Robert Alberti on Assertiveness: teach a self-expressive style that is respectful of others; Pay attention to the "real world" of your clients/patients. Find out what really goes on in the lives of your patients/clients, and help them to discover or develop the tools they need to become the persons they want to be.

* Dorothy & Ray Becvar on Marriage Counseling: Our marriage works because we have never let the honeymoon end, meaning that we have remained aware of the importance of nurturing our relationship. What we share is mutual acceptance, respect, support, and unconditional love. - practice: interdependence, process rather than content, mutual influence/therapists perturb, behaviors as logical in context, subjectivity as inevitable, the uniqueness of each client system, the focus is on the ways in which problems are being maintained and a related search for solutions. There is awareness of the storied nature of reality and the participation of each person in its creation; both/and complementaries are valued.
Referring to clients as "resistant" or "not wanting to change" or "in denial" is evidence of the violation of the systemic paradigm. It is very difficult in therapy to get "resistance" unless one is pushing or pulling. It is a recursive dance - it cannot be otherwise from a systemic perspective.
Paradoxical injunction & Therapeutic double bind
Shared awareness - whatever we create, we do it together. So, if Ray is a "tad out of line," I always must consider my part in the process and recognize that if I want him to change, I also must be willing to change.

* Milton H. Erickson was fond of saying that peopel come in with problems they cannot solve and that what we would do was give them problems they could solve. Strength focused, abilities within self and social system to resolve problems; evoke & utilize them in the service of change

* Bob Bertolino on Solution-Oriented Brief Therapy: focus on competencies, abilities, and strengths, search for differences, exceptions, and solutions to problems, emphasize the present and the future, and view therapists and clients as being coexperts and collaborators in all aspects of the therapeutic milieu. SOBT draws attention to what people are capable of as opposed to what they are incapable of.
A future focus as helpful (Duncan, Miller, & Sparks, 2004; Miller, Duncan, & Hubble, 1997; Wampold, 2001); By working with cleints to create or rehabilitate a sense of the future we can learn what they want different in their lives. The miracle question is but one way of helping to gain a future focus. (Alfred Adler - the Question; Milton Erickson's pseudo-orientation in time - the Crystal Ball) "Let's say that as a result of us meeting together, the problem that brought you here was resolved. How would you know?" or "How will you know when the problem is no longer a problem? What specifically will be better?" or "How will you know when you no longer need to come to therapy? What will be different?"
Help clients to determine what they want different in their lives and then figure out how to make the visions come to fruition.
Exception questions are designed to orient clients to times when their concerns or problems are less dominating or absent altogether from their lives. "Tell me about a time when the problem would typically occur, but it didn't." or "How far back would you have to go to find a time when the problem didn't affect you the way it has recently? What was different?" "It seems like you've really been struggling with your concern. And as I sit here, I wonder how you've managed to make it to work on time everyday this week. How have you done it?"
CLs convince clinicians of their strengths, abilities, resources, and coping skills through actions they have already taken.
Language & Interactions; the impact of context; help CLs to "restory" or "reauthor" new narratives of hope and change
The human element in therapy. It is important to have a good understanding of the CL's story, what his or her concerns are, what their ideas are as to how change has occurred in the past and how it might occur in the future, and what strengths, abilities, and resources the CL brings into the therapeutic milieu that we can help him/her to utilize in the service of change. What CL wants; what CLs see as influences on their problems and then working with them in ways that match those perspectives;
* The miracle questions; * scaling questions; * the first session task
We ask CLs to teach us about their lives, their traditions, their rituals, and so on. We then work with CLs in ways that are respectful of how they live and breathe in the world.
We take the time to learn from clients what their concerns are and then continue this collaborative process by creating and offering ways of addressing their concerns that fit with their views.
Strengthening the therapeutic relationship and alliance
Give permission for internal experience but not permission for actions that may be harmful to self or others - "It's okay to be so angry at your mom that you'd like to yell at her and it's not okay to yell at her."
Positive change is always possible. Be hopeful and realistic. H.O.P.E. Humanism, Optimism, Possibilities, Expectancy
Be a good speaker - First, always be respectful of the audience. Acknowledge other's point of view. Don't embarrass them if they ask a question that seems out of context, inappropriate, or something you've already answered. Always treat people with respect and be genuine. Next, you can't be an expert on everything. ... Use multiple ways of engaging people. Visual, Auditory, or Kinesthetic. Learn from evaluations.

* Bill O'Hanlon on Possibility Therapy - It helps therapists to work with cleints to acknowledge and validate their internal experience, understand their concerns and problems, identify strengths and solutions, and remain present to future-focused without downplaying the past.

MMPI-2 Basic Clinical Scale & Code Type

Prototype of elevations --> Profile definition (If the scale or code-type prototype scores are elevated at least five points higher than the next scale in the code, then rely on the descriptors for that index. However, if the profile is not well-definted, then also take into consideration the next highest score in the profile code. This secondary score might "move up" in placement in the code at retesting.) --> empirical discriptors --> Harris-Lingoes subscales.

Harris-Lingoes subscales

• an appraisal of the extent to which a patient has endorsed particular contents that served to elevate the scale in question.
• They should not be interpreted in isolation from the parent scaleonly be interpreted as an adjunct to the parent scale to provide clues about which of the scale correlates for the parent scale are most salient
• below T = 60 are probably not useful in the interpretive process.

Guideline for interpretation:

• interpreting a 1-point code involves referring to the established descriptors for the highest score
• Complex code types should be used when two or more scales reach interpretive significance and empirically derived descriptors are available for them.
• The appropriate behavior descriptors for the code should be applied. If there are not sufficient empirical descriptors to provide much information for the code type, the most appropriate 2-point code should be used and if no 2-point applies, a scale-by-scale interpretation strategy should be followed.

Case Study MTG Notes

* Case Study is a professional presentation to professional colleagues.

* It is permitted to ask a faculty member or a UCS staff for feedback.

* Consistency among assessment, data, conceptualization, treatment, and transcript.

* The purpose/focus of the transcript is not to show CL change, but to show counselor's intervention based on particular theory.

* Two types of assessment: (a) diagnosis & prognosis, such as MMPI-2, need to be administered at the initial stage of treatment; (b) therapeutic treatment, such as BDI-2, ongoing, etc.

* Two types of conceptualization: (a) professional conceptualization; (b)

Development Course through Practicum

1st practicum - anxiety within the self; all about me; the goal is to get comfortable with yourself in the session and to lower your anxiety; most of the time, struggles to conceptualize, i.e., what is the problem, what is the solution; CL does not understand what is in your head.

2nd practicum - what to translate what is in your head to CL's head; translate the conceptualization out of psychology to simple cause-solution CL can use; What happened & What to do about it;

Draw the block diagram for every CL to explain the symptom & to guide the treatment plan.

MMPI-2 Validity Indices

compliance --> omission (? or cannot says, cutoff 30) --> response pattern --> VRIN & TRIN (cutoff 80) --> L (cutoff 65) --> K & S (cutoff 65) --> F & F(B) (60-80 a large number of mental health problems; cutoff 90; 110 malingering); Elevations of more than T = 60 on the F(p) mean that this individual has endorsed considerably more mental health symptoms than most psychiatric patients do.

* ? or Cannot Says - cut off 30 (raw score)

* L (lying; faking good) - cut off 65 (T score)

* F (faking bad) - cut off 90 (T score) exaggerated symptom presentation

* K (test defensiveness) - cut off 70 (T score)
In practice, K does not really improve empirical discrimination over non-K corrected scores (Archer, Fontaine, & McCrae, 1998; Sines, Baucom, & Gruba, 1979).

* Yea-saying and nay-saying: If 20% or less of the items are endorsed in the true or false direction, the protocol is likely to be invalid.

* VRIN (Variable Response Inconsistency scale) - random responding

* TRIN (True Response Inconsistency scale) - TRIN-T > 80 respond inconsistently in the true direction; TRIN-F

* S (superlative self-presentation scale) - defensiveness; high S responders are viewed by their spouses as emotionally well-controlled and generally free of pathological behavior features.

Case Study

Assessment
* Better to use objective assessment instruments
* MMPI, SEL-90, NEO, MCMI-III, etc.

Close Encounters (by Robert Winer, M.D.)

Close Encounters: A Relational View of the Therapeutic Process

Chapter 3 The Relational Dimension

* Melanie Klein: Projective identification - the way in which the infant, while in a state of mind in which splitting is the predominant way of organizing experience, disowns disturbing aspects of the self or "bad" internal objects and experiences those aspects as though they are in the mother. This serves both to rid temporarily the infant of an intolerable experience, and to locate that which is disowned in another where it can be controlled. For Klein, this was an intrapsychic event, the elaboration of a phantasy. Phantasy, for Klein, was the mental structure through which experience was organized.

* Bion (1959) - The analyst is affected by the projective operations of his patient: "The analyst feels he is being manipulated so as to be playing a part, no matter how difficult to recognize, in somebody else's phantasy," unless the analyst is so taken over by the situation that he loses insight into the fact that the patient is evoking what the analyst is feeling and experiences the projected bad object as actually a part of himself.

* Bion (1959) - Projective identification was a central aspect of communication between infant and mother, and that the mother's failure to be open to the infant's projections could be a basis for later illness.

* Kleinians firmly place the patient at the center of the field: she is the source of intentionality and the cause of her own distress distress, and the work of analysis will be to make manifest her phantasies as revealed in the transference.

* Putting the mechanism of projective at the center of the analytic interchange means recognizing that the analyst is continually being worked on by his patient, maneuvered and manipulated to feel, to think, and to act in particular ways that at least in the short run serve the patient's needs. The analyst's task is to permit invasion and resist capture.

* Segal (1973) - If the patient is to sort out what is external and what is internal, how far his view of the world is coloured by omnipotent phantasy, he can only do so if the analyst remains unaltered in his basic function by the patient's projections. ... The patient was setting a test, testing the analyst's capacity to hold the situation, trying both to subvert her and to evoke a containing response, and the analyst took in both sides of the projective identification and then responded in a therapeutically useful way by ending the hour on time. She felt the tension of conflicting pressures, worked it through within herself, and responded in a constructive way.

Donald Winnicott

* Within the "holding environment" provided by the mother, the pair exist in a state approaching seamless oneness. Over time, as the mother resonates with her baby's wants and needs, he becomes attuned to his functions and desires, begins to experience them as his own, and thus evolves a nascent sense of selfhood. At the same time, the mother's inevitable small failures and lapses in respnsiveness also promote her infant's development of a sense of separateness.

* In some measures, however, the mother's inevitable inability to responsively "go on being" with her baby will lead him to experience her as "impinging." Play now stops as he becomes preoccupied with the need to meet her needs. He manufactures a "false self" based on compliance with what he takes to be her needs and his "true self" goes into hiding (Winnicott, 1960). The false self will become the face presented to the outside world, the instrument through which relationships will be managed.

* Ogden (1986) - To the extent that the mother is able to allow the child freedom to play "in the presence of the absent mother [without her impingement]" (p. 182), he will come to internalize the mother-as-holding-environment and develop the capacity to be self-soothing. To the extent that she cannot grant her child this space because of her own needs, she interferes with this movement and promotes an addiction to herself as an omnipotent object, thereby disrupting the child's progress toward autonomy.

* The analyst does not impinge on the patient with his own needs; he does not stand in the way of his patient's need to regress; he works to counter the patient's making him into an omnipotent object ("I retain some outside quality by not being quite on the mark - or even by being wrong" [1965, p. 167]); he tries hard not to be bright or clever; he withstands the patient's attacks without retaliating; and he does not disrupt his patient's gradual transition toward separateness. During the later stage of treatment, "the now independent ego of the patient begins to show and to assert its own individual characteristics, and the patient begins to take for granted a feeling of existing in his or her own right" (Winnicott, 1965, p. 168). To this reader it sounds like treatment is about being born.

* "Good enough" analyst - to have a capacity for objectivity and freedom from need and ambition that indeed few of us could live up to much of the time (while at the same time disingenously asserting that in doing analysis he aims at simply keeping alive, keeping well, and keeping awake).

* We might, in a spirit of Winnicott excess, say that it is the treatment designed for what he considers to be the universal illness: false selfhood brought about by maternal impingement. The lost heroine is rescued by the mother capable of tolerance.

Harry Stack Sullivan

* Where Winnicott stressed the disruption of the holding environment by the impingement of the mother's needs, which the infant had to mold himself around, Sullivan emphasized the mother's communication of anxiety to her infant, which mobilized him to develop various security operations designed to preclude the repetition of anxious experience.

* How to get heard in a way that could have an effect without scaring the patient off or intensifying his defensiveness. Being heard can hardly be taken for granted, that in fact it is a relatively rare event, that patients are so busy managing us to keep us from (what they fear will be) our traumatizing them that they can hardly pay attention to what we are saying, and that they are in fact so vulnerable to being made more anxious that the vast majority of comments we might feel inclined to make are actually likely to fulfill their prophecy.

* Deflecting the moment from his embarrassment to my asserted incompetence.

* Participant observation - both the intimacy and distance in the position from which the therapist worked.

Heinz Kohut

* The caretakers are the most notably absent in the particular regard that he has brought to our attention - that is, in terms of providing the required responsiveness to the child's narcissistic needs, and thus facilitating the development of a cohesive self.

* For Kohut, what the analyst encounters in working with a patient with a disorder of self-organization is a particular form of transference in which the patient attempts to use the analyst as a "selfobject" to perform functions that she is unable to perform for herself. In particular, her need to have her capabilities recognized and admired, and her need to idealize a parental figure will not have been adequately met during early development, leaving the child, and later the adult, unable to organize self-regard around either healthy ambitiousness or the valuing of honorable ideals. The patient will try to use - or struggle against using - her analyst to fulfill these needs. She will do this in an effort to heal herself, to fashion a self that will be sufficient.

* Task for the analyst: (1) Empathic Stances, comprehend and value the patient, value her profound and desperate efforts to cope with her lack of self-cohesion; Sensetitive to her narcissistic vulnerabilities, and not to be put off by her need to use him for mirroring and idealizing purposes. (2) interprets to the patient by paying attention to the ways in which the patient responds to his inevitable moments of empathic failure or absence.

* Simply being treated empathically may in itself be what is crucial for self0bject internalization.

* If the analyst were perfectly empathic the treatment would never proceed, because there would be no stimulus for internalization. (Winnicott - the mother's incremental failures are needed if the child is to individuate.) It is through his attention to the impact of his inevitable insensitivities that the work goes forward.

* It seems fair to say that they see the analyst's function as parenting rather than as providing understanding.

* The great impact of the self psychology movement on all analysts has been to make them more sensitive to their patients, to challenge them to notice the subtle ways in which standard procedures - silence, interpretation of resistance, insistence on meaningfulness - can become traumatic and persecutory. While it is not true that the self psychologists invented tact, they have been of great service in reminding us that we are treating people.

* Kohut (1971) - Empathy, especially when it is surrounded by an attitude of wanting to cure directly through the giving of loving understanding, may indeed become basically overbearing and annoying; i.e., it may rest on the therapist's unresolved omnipotence fantasies. Provided, however, that the analyst has largely come to terms with his wish to cure directly through the magic of his loving understanding and is indeed not patronizing toward the patient (i.e., he recognizes empathy as a tool of observation and of appropriate communication), the mere fact that the patient dropped his defenses against the possibility of being empathically understood and responded to expose him to the archaic fear of earliest disappointments [which in turn are worked with]. (p. 307)

* Empathy is clearly in the service of a larger undertaking and not a technical approach in itself.


Chapter 4 The Thinker and the Kiss

* Paradox - To become an individual, I must be capable of relatedness, for otherwise my individuality is a shell and I live in schizoid refuge. To be related, I must be capable of standing alone, for otherwise relatedness melts into merger.

* If the schizoid is the paradigmatic unrelated individual, the borderlin could be taken as the opposite pole, the unindividuated relational.

* Reading and rereading Ohio Impromptu, I find in it a moving description of the struggle to mourn, to separate, to join, to become a person.

* It is the paradox of our work that we come together with our patients, that we enable them to love us and to accept our love for them, so that they can bear to be alone. The kiss created by the thinker; the thinker created by the kiss.

Paperwork Tips - Sept 14

* Try to be congruent with how it is done in real life. The Grown-Up Way vs. The Trainee Way :-)

* Issues discussed, methods/techniques used; progress observed/reported.

* Be concrete. Focus on behavior and behavior change. Point out change of thinking but link to behavior.

* Indicate your work, without referring "I" an "we" overly frequently. "With encouragement ... " "The CL was open to suggestions/alternatives ... " "After alternatives were presented, ..."

* Make the transition. "The primary focus of the session is ... Additional issues discussed include ..."

* Avoid jargon, such as "process (talk about), dynamics (interactions), instill hope (set up expectations), reframe (describe what the CL views as a weakness as a strength by proposing a different perspective), reinstate, ..."

* Be efficient.

* Description - What Happened? Assessment - What do you make of it? interpretation; progress or not; continuation; switch of focus; a stumbling block; going in circles; Plan - What comes next? Homework check in, info to provide, actions to take, etc. "She agreed to ..." "After some discussion, the CL decided ... " ;

* "Strengths were identified to demonstrate the CL's ability to ... "

* Some words to use: conclude, accept, agree, indicate, demonstrate, etc.

Sexual Trauma, Termn., etc. - Sept. 10

* A potential script: "Do you want to tell me what happened? Some feel safe to talk about it and experience a sense of relief after talking; others are not ready to talk yet; and still some never want to talk about it. You need to decide it yourself and I respect your decision. If and when you reach a new place, you can let me know as well."

* "Can you tell me a little bit about it so that I can get a general idea?"

* "How does it affect your life right now?"

* Deal with the immediate here-and-now. "How is it like to come and talk with me?" (Some can talk right away; the others need to test me out.)

* Present options and alternatives. Let them choose and support their choice. Empower. Restore a sense of control, agency, and predictability (safety).

* Mini-experiences. "I decided and then it happened this way." Provide feedback to help gain the insight.

* Believe them, their experience, and how they see it.

* No control vs. feel control; no control ~ anxiety, helplessness; control ~ responsibility, self-blaming.

* When people feel out of control, people generally cope by one of two ways. (1) "should"s, self-blaming -> lowered anxiety, but increased depression; 2) anxiety, (encourage the CL to hang in there if appropriate). The CL's mistake vs. the other person's mistake; boundary; responsibility (self vs. other).

* "You know I can't tell you how to live your life." :0) Decision making; not ready; sit with the unsettledness;

* Check in. Everything is going well. "Did you get what you came here for? Is there something else you would like to work on right now?" "If somethings comes up in the future, you can always come back."

* NEVER work harder than the CL.

* Support. Reflect. Encourage. Point out past accomplishment.

Clinical Paperwork Tips - Sept 13

* For the description section of the progress notes, group the information according to theme instead of chronology and the session content.

Initial Assessment Report

Please include:

* year in school, any ethnic information, as well as hometown info when relevant;
* explicitly list the stressors present in the CL's life;
* reason for the CL to come at the present time;
* the CL's reaction and interpretation of the events.

Feeling Words

Common Negative Feeling Words: http://eqi.org/cnfs.htm

More Feeling Words: http://eqi.org/fw.htm