A wide-ranging review of the past 60 years of clinical practice (i.e. Baldwin, Wampold & Imel, 2007) shows that the number one factor for therapeutic success is a high-quality alliance between therapist and client, and a clarity around the goals and tasks of therapy. In this article we will provide:

  1. a meta-conceptual framework explaining the spectrum of therapists’ influence over the course of therapy
  2. specific questions, stemming from humanistic sciences (Maslow & Rogers, 1979), which help clients be more empowered, build more autonomy and trust of their own capacity

 

Meta-conceptual framework of clinical interventions

The initial goal of therapy is to help the therapist gain the client’s trust to build a strong alliance and raise epistemic confidence (the clients’ confidence in themselves to find their own solutions). This involves a progressive development of intimacy and trust between the therapist and client, which can be realized with the following options of therapeutic possibilities (see Diagram 1).

 

Diagram 1. Spectrum of therapeutic interventions as a client becomes more empowered.

 

Diagram 1 represents the spectrum of therapeutic interventions from more power-rich (though not power-over) to more empowering forms. This map is linear, and helpful to understand the overall journey of a client, with specific clinical interventions. However, it is important to note that as organisms, with our complex structure and non-linear cycles, we will need far more attunement and sensitivity than a simplistic formula such as this one to succeed in empowering our clients. Nevertheless, this may initially provide a helpful structure.

 

When a client is severely unwell, it will be helpful to provide a strong frame and use our suggestive authority to help strengthen their socio-emotional container. The interventions of persuasion (i.e. “you will need to take medication”), requests ( i.e. “please make sure you go for a walk in nature everyday”)and advice-giving (i.e. “I would recommend that you have some rest after our session”) will tend to fall in this category.

 

Solution oriented proposals will orient our clients strongly towards the positive, the constructive, the skilfull (i.e. “imagine you were able to achieve your goal, how would that be for you?”). It helps support a deeper sense of embodiment, confidence and belief in their agency and ability.

 

The 4 R’s follow: reformulate, recontextualize, review, and reinforce:

  • Reformulate: using an impressionist form and tone, reflecting/mirroring back to the client what has been heard to show the therapist understands what they have shared and helps build/restore the therapist-client collaboration and dance. Reformulations also help structure the narrative and/or present emotion, key points can be amplified, emphasize the posture of curiosity and not-knowing, the therapist can also make helping additions and use different wordings to broaden the discourse, while checking the client shares these developments. In most reformulations, there is the formulation of a relatively complex hypothesis relevant to the client.  These are sub-categories of reformulation:
    1. Simple repetition (parrot): reflect back word-for-word what the client shared, as precisely as possible (usually for high arousal disclosures).
    2. Verification: verifying the meaning of certain sentences, feelings, descriptions 
    3. Simple reflections: neutral reformulation
    4. Double reflections: repeating two often contradictory points of view or experiences to underline ambivalence (refrain from using “but”)
  • Recontextualise: help bring greater precision and specificity to the client’s situation (difficulty or ease). Asking for examples or situations that are space and time bound enables a crossover from a more conceptual, verbalized cognitive generality to an embedded and embodied experience. This promotes a re-centering of attention on the experiential qualities of the discourse/narrative and allows give opportunities for the client to feel recognized and understood by the therapist.  Here are some examples:
    • Could you give me a recent example of what you are describing?”
    • “When was the last time this occurred?”
    • “How does this manifest in your daily life?”
  • Review/Recap: summarise the client’s sharings to make sure they have been understood. They can occur at any time and may be very brief (2-3 sentences) or quite in-depth (a few minutes). Recapping helps the client feel understood and build a common vision and therapeutic alliance. They can be particularly useful at the end of a session to start slowing down and reducing new input into the session, as well as revisiting some of the key themes and moments of the session. The client participation can also be encouraged by asking them to review the session(s) themselves, saying for example:
    • “What have been the key learnings/takeaways/experiences from this session?”
    • “What do you make of all of this?”
    • “In one word, how would you sum today’s exchange together?”
  • Reinforce: positive reinforcement is part of a shaping and conditioning paradigm which aims at increasing the level of confidence in certain pattern, thereby raising the probability of that skillful behaviour to arise again. It is a powerful tool initially to strengthen the therapeutic alliance, and then supports the client’s feeling of self-efficacy. They offer important spaces for satisfaction, appreciation and celebration in the midst of the client recounting challenging situations. One can reinforce:
    • Facts: underline a client’s action or behaviour in the past or in the present, which they have done or refrained from doing.
    • People: emphasize the helpful qualities present as the client is sharing.
    • Affect: recognizing suffering, normalizing it and offering encouragement and compassion (i.e. “in this situation, it is normal to feel…”)

 

May this article be for the benefit of all beings.

You can learn more about the application of these evolutionary and systemic models, their associated neuroscientific empirical research, practice and interventions along with time for practice in our workshops, courses and trainings at www.neurosystemics.org. 

Together we go further.

 

References

Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of consulting and clinical psychology, 75(6), 842.

Maslow, A. H., & Rogers, C. (1979). Humanistic psychology. Journal of Humanistic Psychology, 19(3), 13-26.

One of the most important benefits of a group is co-regulation, and the good news it that our brains are neurally wired for it. Regulation is the ability to skillfully balance and assume volitional capacity on a particular system (i.e. attention, breathing, emotions, cognition and/or a group of people). In NeuroSystemics we have a gradual, step-by -step and “holonistic” approach to co-regulation, which can be understood in 3 steps: (i) sensing into and embodying the fullness of one’s immediate experience through all possible channels, (ii) strengthening and rooting a solid sense of self-esteem and goal-oriented directionality and choicefulness in individuals and (iii) inquiring into each of the participants’ experience in the group, and containing the complexity and diversity of resonance to allow a coherent sense of wholeness to emerge. Let us describe each of these stages in more detail.

 

(i) Sensing into and embodying the fullness of one’s immediate experience through all possible channels

In NeuroSystemics, we consider the content of one’s present moment experience to be subdivided in 6 possible ways, understood in the acronym MOSAIC:

  • Meaning: Narrative, personality & biography
  • Orientation: Present moment sensing of the environment
  • Sensation: perception of physiology
  • Affect: Feeling tones, emotions & moods
  • Image: Mental images & imaginal constructs
  • Consciousness: Knowing faculty of the mind

The main regulatory agent in this first stage in our clients’ consciousness, their capacity for kindly awareness and compassionate mindfulness. As our clients, in their own intra-psychic ways, are able to sense into their different channels and cultivate nervous system bandwidth to sustain attention in each of them, increased connectivity between each of the channels occur. Our clients go from sensing to sense-making:

 

(ii) Strengthening and rooting a solid sense of self-esteem and goal-oriented directionality & choicefulness in individuals

As our clients build more networks between the MOSAIC channels of their immediate experience, feel more embodied and oriented to the here-and-now, it’s possible to engage in a deeper exploration of the ‘meaning’ channel by investigating our individual clients’ narratives, personality and life-stories they have and need to share. This enables a robust sense of self-esteem and self-drives. As our clients make more sense of their immediate embodied experience, they are then able to make clearer choices in their lives. Collectively with the MOSAIC networks of our clients’ immediate experience, these psycho-biological processes function as a springboard to enter a group setting.

 

(iii) Inquiring into each of the participants’ experience in the group, and containing the complexity and diversity of resonance to allow a coherent sense of wholeness to emerge.

In the same way that an individual breathes in and breathes out, groups, as social organisms, breathe in when attention is given to the whole group (horizontal inquiry) and breathes out when focus is given to one individual in particular (vertical inquiry). Each individuals’ MOSAIC is then supported to network within its own channels, as well as co-networking with other individuals through the therapist’s active linking between them:

 

Therapists go through a 3-step process to help

  1. individuals in the group differentiate themselves, their MOSAICs, archetypic forms of self-esteem and idiosyncratic drives
  2. facilitate intergroup communications in order to contain the growing complexity of views, opinions, backgrounds, feelings, sensate experiences
  3. enable coherent moments emerging to be valued and embodied in individuals and the group-as-a-whole.

 

 

According to Porges & Buczynski (2011), feeling safe in groups activates a number of brain networks, including:

  • The limbic system supported through acceptance, nonjudgment and empathy
  • Neo-cortical circuitry, enabling memory reprocessing and restructuring, leading to the formation of more secure attachment patterns.

Group therapy can provide the safe and accepting environment that allows dissociated implicit memories to be held in kindness long enough to receive the disconfirming experience that is offered by the group’s growing capacity to resonate with and meet distressed individual members (Siegel, 2018). In this way, the group members learn to co-regulate one another and function as a unified whole, a social organism.

In NeuroSystemics, therefore, we link between intra-personal integration at the individual level (vertical inquiry) to inter-personal integration (horizontal inquiry). This dialectic between vertical and horizontal mechanics enable an omni-directional process of integration to enable group members to be fully oneself while embedded in the oneness of the group. By connecting to participants, containing interactions and cohering emergent insights and experiences in a paced, gentle and inviting progression, neural wholeness emerges.

 

 

May this article be for the benefit of all being.

 You can learn more about the application of these evolutionary and systemic models, their associated neuroscientific empirical research, practice and interventions along with time for practice in our workshops, courses and trainings at www.neurosystemics.org/event-calendar.

 

 

 

References

Porges, S. W., & Buczynski, R. (2011). The polyvagal theory for treating trauma. Webinar, June, 15, 2012.

Siegel, D., (2018) in Badenoch, B., & Gantt, S. P. (Eds.). (2018). The interpersonal neurobiology of group psychotherapy and group process. Routledge.

 

If you would like to further your grounding in the foundations of Soulmaking Dharma and that whole paradigm,  Rob Burbea would suggest that you consider joining Catherine’s online Foundations of Soulmaking Dharma course (Oct 20 – Dec 20 2019; see Barre Center for Buddhist Studies BCBS program for more info). The intention for Catherine’s online […]

Le mercredi 5 décembre 2018, à la CCIG Chambre de Commerce et d’Industrie de Genève, Benoît Chappuis et Boaz Feldman, qui ont travaillé avec de nombreux avocats des Barreaux Genevois et Vaudois ont proposé une intervention pour éclairer quelques élément sur ce thème.

Mindfulness for children – major child protection project.

“Part 2 – Mindfulness for children” kicked off in September 2018 with an intensive onsite training in Chisinau (Moldova) this past November 2018. The program was facilitated by Sarah Silverton and Monica and was based on « the Present ».

Sarah has been involved in mindfulness teaching and training for more than 20 years and was a member of the Bangor University (UK), Centre for Mindfulness Research and Practice training team for 17 years. Sarah has been working in Mindfulness in Schools for 8 years. She is the co-author of Paws b curriculum (Mindfulness in Schools Project in the UK). She has since moved on to develop an innovative Mindfulness program that supports educators to share their mindfulness practice with children in a very organic manner – ‘ The Present’.

Participants are so happy that they can take home caring and innovative methods for the benefit of hundreds of children and support them to DREAM, ACHIEVE, REALISE, EXPRESS (DARE)  !

“Ultimately, we want children to grow up to become happy and responsible adults, capable of achieving their full potential in life. We want children to have the courage to strive for their dreams and, if they encounter obstacles, the resilience to try again” (DARE Project director, Caritas Vienna).

 

Every day, billions of dollars are wasted and thousands of deals are lost because employees are overwhelmed, burned out, or simply no longer care to make efforts that advance their organisation.

As you’re faced with employee burnout, the blending of cultures and generations, and the consistent push for innovation, you’re also challenged to rethink old ideas and discover new methods for achieving sustainable success.

Boaz presented at the Happy at Work Forum in May 2018 for corporate executives to gain knowledge, develop practical tools and regain energy for a more resilient business world.