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    • Building a strong therapeutic alliance with patientsForming a strong connection with patients can decrease burnout, increase job satisfaction, and lead to better patient outcomes. Focusing on building a safe and supportive environment can foster healing and growth.

      Developing a strong therapeutic alliance with patients is crucial for both the mental health professional and the patient. This connection can help decrease burnout, increase job satisfaction, and lead to better patient outcomes. The ability to form a therapeutic alliance is especially important when working with patients who have more difficult attachment styles or emotional regulation issues. Research consistently supports the significance of the therapeutic alliance, and it can even be a determining factor in a therapist's effectiveness. By focusing on building a strong connection with patients, mental health professionals can create a safe and supportive environment that fosters healing and growth.

    • The power of the therapeutic relationshipThe attachment relationship between therapist and patient helps patients process and regulate emotions, providing a sense of connection and understanding, leading to improved emotional well-being.

      The therapeutic relationship between a therapist and patient plays a crucial role in helping patients process and regulate their emotions, particularly those with a history of early attachment issues. During therapy sessions, patients share disorganized memories and emotions, which can be helped to make sense of and organized through the attachment relationship with the therapist. This attachment provides a sense of less loneliness and isolation, allowing patients to feel less burdened by their memories. The process of therapy helps patients catabolize negative emotions and memories, and the therapist's connection and understanding plays a significant role in the organization and insertion of new emotions into these memories. The therapeutic relationship also impacts the patient's perception of the world and can help change the expression of genes related to stress and emotion regulation. In summary, the attachment relationship between therapist and patient is a powerful tool in the therapeutic process, helping patients process and regulate emotions, and providing a sense of connection and understanding that can lead to improved emotional well-being.

    • Understanding Emotions: Adaptive Mechanisms for Survival and Well-beingEmotions are complex experiences serving survival functions, influencing thoughts, behaviors, and health. Understanding their adaptive roles can improve self-regulation and approach them with curiosity rather than judgment.

      Emotions and feelings are complex and multifaceted experiences that serve important functions in our survival and well-being. They can be difficult to identify and can manifest differently from person to person. Emotions are built from reactions that promote our survival and can be adaptive mechanisms for preserving ourselves and our loved ones. They influence our biology and can last varying lengths of time. Emotions are not good or bad, but rather problem-solving mechanisms. Childhood development is focused on enhancing self-regulation, which is a skill that improves over time. Emotions play a significant role in our lives, influencing our thoughts, behaviors, and physical health. Understanding and accepting the adaptive functions of emotions can help us approach them with curiosity rather than judgment.

    • Creating a Secure Attachment in the First YearThe first year of a child's life is crucial for forming a secure attachment with their caregiver through co-regulation, influencing emotional regulation and the development of the right inferior frontal cortex.

      The essential task in the first year of a child's life is creating a secure attachment with their caregiver. This attachment is formed through a process of co-regulation, where the mother or caregiver attunes to the infant's emotions and needs, creating a dyad that predicts the type of attachment style the child will develop. Secure attachment is characterized by mirroring and synchronous responses between mother and child, while insecure attachment occurs when the mother fails to respond appropriately. This attachment style influences the development of the right inferior frontal cortex, which encodes patterns of connection and emotional regulation. Understanding these patterns can help in therapeutic work with individuals who struggle to form secure attachments. The self-organization of the developing brain occurs in the context of a relationship with another self, highlighting the importance of early attachment experiences.

    • Healing from mental health conditions benefits from human relationships and long-term therapyLong-term therapies like mentalization-based therapy, dialectical behavioral therapy, and transference-focused therapy significantly improve borderline personality disorder, with up to 80% no longer meeting diagnostic criteria and reduced suicidal thoughts, due to the therapeutic alliance and emotional regulation tools provided.

      The healing process for certain mental health conditions, particularly those related to attachment and emotion regulation, such as borderline personality disorder, benefits greatly from human relationships and long-term therapy. The brain's self-organization occurs in the context of relationships, and therapy provides an essential attachment experience and emotional regulation tools. Long-term therapies like mentalization-based therapy, dialectical behavioral therapy, and transference-focused therapy have shown significant improvements for borderline personality disorder patients, with up to 80% no longer meeting the diagnostic criteria and reduced suicidal thoughts. The therapeutic alliance and the ability to focus on emotions and maintain a relationship for an extended period are key components of these therapies' success. Additionally, research on split-brain patients demonstrates the emotional significance of images can leak across brain hemispheres, highlighting the importance of emotional connections in the healing process.

    • Understanding the Role of Emotions in TherapyEmotions, encoded in the right hemisphere, serve as practical action programs and form attachments. Therapists must regulate their own emotions and empathize with patients to strengthen the therapeutic alliance. Nonverbal cues and personal experience help therapists connect with clients effectively.

      Emotions, though often unconscious, play a crucial role in our experiences and interactions. Studies on split-brain patients reveal the right hemisphere's role in encoding good and bad emotions, often outside of verbal awareness. Emotions serve as practical action programs, helping us solve problems and form attachments. However, vulnerability and disconnection can arise, leading to intense affects and potential shame or rage. As therapists, understanding and regulating our own emotions, as well as empathizing with our patients, is essential for growth and strengthening the therapeutic alliance. By observing nonverbal cues, such as body language and facial expressions, and experiencing emotions ourselves, we can better understand and connect with others, fostering a more effective therapeutic relationship.

    • Identifying emotions through micro expressionsRecognizing joy, anger, and other emotions through micro expressions can aid in helping patients process feelings and move towards emotional growth

      Understanding and identifying emotions, especially through micro expressions, is crucial in helping patients process their feelings. Joy or happiness is characterized by a symmetrical smile with eye contraction, and is often associated with positive feelings and a desire to connect with others. Anger or frustration, on the other hand, is marked by a short tightening of the eyelids and eyebrows, and is typically a response to obstacles or threats to goals. By recognizing these emotions and exploring their underlying causes, we can help patients move towards emotional exploration and growth. For more detailed information, check out the speaker's micro expression series and emotion connection app.

    • Understanding the value of emotionsAcknowledging emotions like anger, sadness, and shame can help individuals process and work towards their goals. Encourage expression and create a safe space for processing.

      Emotions like anger, sadness, and shame are natural responses to various experiences and can provide valuable insights into what people are feeling and what they may need. When dealing with someone expressing anger, acknowledging its adaptiveness and encouraging them to put their feelings into words can help them calm down and potentially work towards achieving their goals. Sadness, as depicted in the movie "Inside Out," can bring people closer together, but those experiencing it may benefit from understanding its purpose and the importance of allowing themselves to feel it. Shame, similar to sadness, can have physical manifestations and can be particularly debilitating, especially when it stems from early experiences or trauma. It's essential to recognize the presence of shame and create a safe and accepting environment for individuals to express and process their emotions.

    • Understanding the Connection Between Shame, Trauma, Disgust, and FearShame, trauma, disgust, and fear are deeply interconnected emotions with physical manifestations. Recognizing these connections can help us better understand and respond to them in ourselves and others.

      Shame, trauma, and disgust are deeply interconnected. People may feel shame when seeking mental health services or when dealing with past traumas, which can lead to feelings of disgust towards themselves or others. Disgust is a complex emotion that can make us want to "move away, spit it out," and is often accompanied by physical sensations like wrinkling around the nose and upper lip rising. Fear, another emotion discussed, is a natural response to potential danger and serves to preserve life. It can manifest physically with tension in the middle of the face, rising eyebrows, and a rapid mouth movement. Understanding the connection between these emotions and their physical manifestations can help us better recognize and respond to them in ourselves and others.

    • Recognizing pain leads to deeper connectionsUnderstanding someone's pain through microexpressions fosters empathy, empathy leads to deeper connections, and deeper connections benefit both parties.

      Recognizing and validating another person's pain can lead to deep connections. Microexpressions, such as the unique horizontal mouth stretch during pain, can provide insight into someone's emotional state. By acknowledging their pain, we create a sense of empathy and understanding, leading to a "we" experience of shared emotion. This can result in spontaneous smiles, mirroring of emotions, and a feeling of connection. While some may use microexpression research for deceit detection, its true power lies in fostering deeper human connections. When we authentically connect with others, it benefits both parties and creates a more compassionate world.

    • Prioritize patient needs over biasesEmpathize with patients, validate feelings, and regulate emotions to create a pleasurable therapeutic experience

      As mental health professionals, it's crucial to prioritize the best interests of our patients over our own biases or self-interest. We must remain close to the evidence and present it in a persuasive way to help our patients achieve emotional health and wellness. Empathy and emotional connection are essential, but it's equally important to regulate our emotions and maintain a grounded perspective. Mirroring a patient's emotions can help build a connection, but it's crucial to put those emotions into words and not act on them. By understanding and validating our patients' feelings, we can create a pleasurable therapeutic experience. When patients feel heard and understood, they experience more pleasure, which is a sign that we're on the right track.

    • The Protective Role of ShameShame can protect us in certain situations but recognizing its adaptive functions and validating vulnerable feelings can help reduce its negative impact.

      Understanding the function of emotions, including shame, can help us approach and address them in a more productive way. Shame, for instance, may serve a protective role in hesitating to share personal information with a new doctor or in avoiding uncomfortable topics. Normalizing the experience of shame and acknowledging its adaptive functions can help reduce its negative impact. Additionally, recognizing the difficulty in sharing vulnerable feelings and putting words to them can be a step towards overcoming the hesitation. As a therapist, validating patients' fears and empathizing with their anxieties can help alleviate their shame and encourage open communication.

    • Creating a safe space for difficult conversationsAcknowledging challenges can foster meaningful connections, improving patient care and reducing burnout for healthcare professionals.

      Creating a safe and empathetic space for difficult conversations in healthcare settings can lead to meaningful connections between providers and patients. By acknowledging the challenges of discussing sensitive topics, providers can encourage patients to open up and share their experiences, fostering a stronger therapeutic relationship. The speaker, who hosts a podcast and educational resource library, emphasizes the importance of this connection in improving patient care and reducing burnout for healthcare professionals. He expresses gratitude for the community's engagement and support, which motivates him to continue providing educational resources and striving for a multiplier effect in the field. The speaker also encourages listeners to sign up for his Patreon or CME signups to support the project and receive exclusive perks, such as a high-quality coffee mug. Ultimately, the goal is to help healthcare providers connect more effectively with their patients and, in turn, provide better care to more people.

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    Related Episodes

    Therapeutic Alliance Part 1

    Therapeutic Alliance Part 1

    What is a therapeutic alliance?

    The therapeutic alliance is a collaborative relationship between the physician and the patient. Together, you jointly establish goals, desires, and expectations of your working partnership.

    Every interview with a patient, whether it’s for diagnostic, intake, evaluative, or psychopharmacology purposes, has therapeutic potential. The treatment starts from your first greeting—how you listen, empathize, and even how you say goodbye.

    It’s built from a partnership and dialogue, like any other relationship. It’s not built from medical interrogation. It’s not about pulling medical information to be able to make a diagnosis. We have to make it a positive experience for patient, so they can begin to talk about what's negative in their lives.

    The therapeutic alliance is full of meaning, and it uses every emotional transaction therapeutically. If they get angry, sad, or have fear you will abandon them, as a therapist, it’s our job to figure out how to help them through that feeling within the relationship. The doctor can express desire for the patient to share, in real time, how the patient is feeling, even about his or her relationship with the doctor.

    Why do we care?

    We all know that some talk therapists have better outcomes than other talk therapists. What’s interesting though, is that some some psychiatrists’ placebos worked better than other psychiatrists’ active drugs. One study of NIMH data of 112 depressed patients treated by 9 psychiatrists with placebo or imipramine, found that variance in BDI score (a score that measures depression) due to medication, was 3.4% and variance due to psychiatrist was 9.1%. One-third of psychiatrists had better outcomes with the placebo than one-third had with imipramine.

    Another book argues that the therapist is more important to outcome than theory or technique. Many other studies have shown that therapeutic alliance directly correlates to success rates.

    For the rest of the blog/article go here

    Join and discuss this episode with David on Instagram: dr.davidpuder

    Twitter: @DavidPuder

    Facebook: DrDavidPuder

    Therapeutic Alliance Part 2: Meaning and Viktor Frankl’s Logotherapy

    Therapeutic Alliance Part 2: Meaning and Viktor Frankl’s Logotherapy

    Episode CME activity objectives:

    In the context of a therapeutic alliance, apply the information given in this episode to help draw out meaning in others.

    Identify who Viktor Frankl was and how his work and legacy have shaped how we understand and utilize meaning in psychiatry.

    Define psychic determinism.

    Recognize that meaning is idiosyncratic and unique to each individual.

    Recognize the multitude of ways people can find meaning in their lives and the various ways they can express and convey this.

    Summarize the various studies listed in this episode that have shown how meaning and the creation of meaning can have a positive impact.

    David Puder, M.D. has no conflicts of interest to report.

    In the celebrated book Man’s Search for Meaning, author Viktor Frankl wrote about his intimate and horrific Holocaust experience. He found that meaning often came from the prisoners’ small choices—to maintain belief in human dignity in the midst of being tortured and starved and bravely face these hardships together.

    “The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal.” - Viktor Frankl

    “We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” - Viktor Frankl

    Frankl argued that the ultimate human drive is the “will to meaning,” which could be described as the meaning to be found in the present and in the future. For example, I have had patients who are suicidal, yet they would not kill themselves, despite part of them desiring death, because they would not get to see their grandkids grow up. The meaning of the future moments and being able to help their grandkids in some small way empowers them to keep going to treatment.

    People’s meaning keeps them going, even when other drives, like sex or desire for power, are completely gone. In this way, Frankl noted, “Focus on the future, that is on the meaning to be fulfilled by the patient in his future…I speak of a will to meaning in contrast to the pleasure principle (or, as we could speak also term it, the will to pleasure) on which Freudian psychoanalysis is centered, as well as in contrast to the will to power on which Adlerian psychology, using the term ‘striving for superiority,’ is focused.”

    This idea led to the beginning of a new type of therapy—logotherapy.

    Link to full article go: here

    Link to sign up for CME go: here

    Member Login to do CME activity go: here

    What is psychodynamic theory?

    What is psychodynamic theory?

    On this week’s episode of the podcast, I interviewed Allison Maxwell, a social worker and PhD student of clinical social work. I refer patients to her regularly for psychoanalysis, and she has had a wonderful impact on their mental health journey.

    What is psychodynamic theory?

    Psychodynamic therapy is a form of talk therapy where the practitioner work focuses on the patient’s emotion, fantasies, dreams, unconscious drives and wishes, early and current life relationships, and the relationship that is forming between the patient and therapist.

    For the blog that goes with this episode, go here

    Join and discuss this episode with David on Instagram: dr.davidpuder

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    Therapeutic Alliance Part 6: Attachment Types and Application

    Therapeutic Alliance Part 6: Attachment Types and Application

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    On this week’s episode, I talk about how attachment theory can be a powerful predictor in helping someone move forward past trauma and develop attachment to their therapist in a healthy and therapeutic way.

    Link to resource library

    Connecting with the Psychotic Patient, Therapeutic Alliance Part 7

    Connecting with the Psychotic Patient, Therapeutic Alliance Part 7

    In this episode, Dr. Puder talks about the importance of therapeutic alliance in the psychiatric interview, emphasizing the need for a strong therapeutic alliance in order to help patients with psychosis continue their medication.  

     

    Link to Blog.