Challenging Therapies: Getting Unstuck Working with Highly Anxious Patients

Challenging Therapies: Getting Unstuck Working with Highly Anxious Patients

We all have treatments where we feel stuck or stymied.  Often feeling stuck or stymied comes when we are working with patients with severely dysregulated anxiety and/or compulsive symptoms.  This course is designed to help you discover the underlying emotional patterns in our patients that give rise to these symptoms. We will also help you to look at your own personal vulnerabilities to get stuck or stymied with certain kinds of symptoms or patients.

The first key to getting unstuck or interrupting the pattern of being stymied is to focus on the therapist’s resources.   When we are stuck we feel we have our hands tied behind our back, we are in a bind, there is nowhere to turn, and we often become discouraged and frustrated.  We are not well resourced and we are not feeling confident and competent. When this happens, we tend to focus on and even get entangled with the patient’s symptoms and anxiety which are only the tip of the iceberg. It is exhausting to feel helpless, ineffective and useless.  We need to get unstuck inside ourselves, to access the full range of our own Underling Proactive Primary Emotional Resources and then we will be able to approach the process in new ways.

This course will help you identify your own underlying emotional resources that are not ‘on line’ and thus not available to help you have the energy and clarity you need to take charge of your own responses and reactions to the patient’s anxiety and symptoms.  Examples of these resources that are not on line are our own SEEKING, PLAY, and CARE brain systems.  It is very hard to access those resources when we are frightened, overwhelmed, feeling incompetent, and/or frustrated.

The course will then go into depth about how you can use those resources to let go of your expectations of yourself and the process to be a new kind of balance.  In that balance, we can approach the patient and the process with a ‘beginner’s mind’ [Zen Buddhism] “In the beginner’s mind there are many possibilities, in the expert’s mind there are few.” [Suzuki].   It is challenging to utilize this balance knowing that it will involve interrupting the patient’s behavioral habits, projections and provocations.  It is difficult to not only tolerate but to welcome the patient’s frequent anger, mockery, distain, criticism, terror, and threats that arise when they feel off-balance, out of their comfort zone, and in a state of incoherence.  However, with this emotional balance we can more readily trust in ourselves, the process and our patients. We can approach every symptom and phenomena with fascination and curiosity.  Ultimately, we can invite our patients into a similar nonconscious emotional balance enabling them to get unstuck inside themselves.  Together we can discover their Underlying Proactive Primary Emotions Reactivated within the Therapy.

This will open the door to new discoveries, novel adaptive emotional experiences and emotional memory reconsolidation.  These processes and treatments utilize seven different types of neuroplasticity and will change the structure of their brain.  This process is exciting, disorienting and at times terrifying as our patients let go of previous maladaptive nonconscious coping mechanisms.  The shared discovery process enables a unique kind of synergistic collaboration that can be transformative in often unimagined ways.

The perspective of differentiation and integration of nonconscious emotional brain systems will give the participants new tools and approaches:

1] Expand your emphasis and trust in the Therapeutic Attachment Relationship

2] Tap into your own subtle Underlying Proactive Primary Emotional Resources such as SEEKING, CARE, Connection, Safeness

3]  Simultaneously Activate multiple emotional generators to enable you and the patient to override the nonconscious emotional constraints

4] Have a ‘beginners mind’ to approach the process with maximal openness and potential.

5] You do not need a lot of knowledge to be very successful with this approach and perspective.  Even in the hands of novices it is very effective.

There will be clinical demonstrations of uncovering Underlying Proactive Primary Emotional Resources by reviewing video-recordings of therapy sessions.  All of the attendees will be able to participate in the careful detection of Underlying Proactive Primary Emotional Resources and assess their relevance and meaning to the clinical process at that moment in the session.  Then we will discuss how to use that information and evidence to propose interventions and facilitate Neuroplasticity.  There will be therapy exercises with the presenters to demonstrate the differentiation and integration of Underlying Proactive Primary Emotional Resources.  We will have exercises for each of the participants to experience and to practice this therapeutic approach.

Learning Objectives

1] What are 3 reasons therapists are vulnerable to get stuck with highly anxious patients

2] Name 5 internal resources you can access to move forward through challenging predicaments in therapy

3] What are 3 Underlying Proactive Primary Emotional Resources in the patient that can help us move forward?

Therapeutic Process of CIMBS is called: NeuroPhysioPsychoTherapy.  Neuro– refers to our active interventions to maximize neuroplasticity for long term learning and specific interventions to activate multiple neurotransmitters to facilitate the therapeutic process.  Physio- refers to our observations of psychophysiological phenomena to adjust our therapeutic process and redirect our interventions in response to psychophysiological shifts.  Psycho- refers to our careful attention to 6 different psychological Brain Systems and to our therapeutic process that explicitly meets the psychological needs of the patient.

Therapeutic Elements: CIMBS incorporates all of the change elements that are a part of the following evidence based therapies:  CBT [desensitization, cognitive restructuring, behavioral change], mindfulness based CBT, affect activation and cognitive restructuring of EDT [Experiential Dynamic Therapy and STDP] therapies [we were co-investigators in prospective evidence based EDT psychotherapy study],  and we use the interruption and rebalancing of EMDR.  In addition we utilize Empirically supported relationship elements since therapy relationships make substantial and consistent contributions to outcome results.

Therapeutic Outcomes:  Our goal is to enable our patients/clients to become the author of their own lives, capable of making the best of any situation, continuously learning and growing to the full extent of the neuroplasticity of their brains and fulfilling their lives.

Workshop Leaders: The Sheldons 

Albert [Terry] Sheldon M.D. is a Clinical Professor of Psychiatry at the University of Washington, Seattle and has conducted research and taught psychotherapy for 25 years. He has trained in many psychotherapeutic modalities including CBT, EMDR, hypnosis, group therapy, systems oriented therapy, psychodynamic, and in short-term dynamic psychotherapy. Dr Sheldon received a three year Bush Medical Fellowship to pursue research in psychotherapy.

Beatriz Garcia-Arteaga Sheldon M.Ed.Psych. Graduated from McGill University, Montreal where she also completed postgraduate specialization in Intensive Short Term Dynamic Psychotherapy. She has had her clinical practice in Seattle and Vancouver, BC for 25 years. She has trained and supervised clinical counselors, psychologists and psychiatrists for the past 15 years.

The Sheldons were both clinical investigators in a recently published multi-centered evidence based research study of Short-Term Dynamic Psychotherapy. Now they have joined together to pioneer a different therapeutic paradigm.