How Emotional Access Improves Performance with Kristin Osborn

Join us as we discuss how tapping into one’s emotions and actually experiencing full emotional range is a key ingredient in improving one’s performance.  Kristin brings a wealth of clinical experience in helping people overcome their affect phobias.  We’re going down the rabbit hole today, and Kristin is there to help guide us through some complex topics.

Listen to the podcast:

*recorded December 15, 2020

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Theoretical Reinforcement

‘Leigh McCullough is among psychology history’s most unifying and underestimated theorists. And we had her among us. Leigh died of ALS in 2012.’

Jørn Hokland
March 1, 2021

In the last post, Hillestad criticizes those who claim reinforcement as the only explanation, ie as a one-factor explanation. I agree with this critique, but in the same epistemological ditch we find many of the school fathers of psychology; the clinging to The one principle by which all other (s) principles can be reduced or dissolved. To put it bluntly – Skinner reduced Piaget’s development to reinforcement, just as Piaget reduced reinforcement to development, and Freud reduced free will to deterministic drive, as May dissolved psychological causality in the great freedom. The pattern is the school father who admittedly reveals one important psychological factor, but who at the same time shows a divisive need to claim that all other (s) basic factors are wrong. Hillestad is therefore right that psychology needs a multi-factor theory. But he gives the impression that no one has succeeded in this. Then Hillestad forgets the theorist at Harvard Medical School, also Professor II at NTNU and head of research at Modum Bad – not a divisive school father, but a unifying woman: Leigh McCullough.

It turned out to be valuable that McCullough was already trained in behavioral therapy when she began her apprenticeship with psychoanalyst Habib Davanloo. By studying his patient videos, Davanloo had found that defenses can be effectively detected and blocked, so that the patient in connection with his therapist experiences intense breakthroughs to repressed emotions and memories, with rapid symptom relief as a result. When McCullough saw and learned this, psychoanalysis merged with behavioral therapy: Attachment feelings are the phobic object, defenses are evasive responses, and Davanloo’s ISTDP is at its core exposure therapy with response prevention (in itself a revolutionary method discovered by another woman, Mary Cover Jones, also known as the mother of behavioral therapy).

With the affect phobia theory, Leigh McCullough contributed to a learning-theoretical reformulation of psychoanalytic theory: Sigmund Freud’s anxiety theory (that unconscious emotions trigger anxiety that drives defense against emotions), Anna Freud’s ego psychology (about defense diversity), Bowlby’s attachment theory (which expands Sigmund’s effective method. In addition to affecting phobia formulation, McCullough alleviated ISTDP by down-regulating intense anxiety with CBT interventions, and in the book Treating Affect Phobia (McCullough et al., 2004), she removed the I from ISTDP. In Changing Character (1995) she also went a long way in an intertheoretical reduction of Malan’s conflict triangle (Freud’s anxiety theory) to learning theory: first that emotions learn to trigger anxiety through Pavlovian conditioning (trigging that can be desensitized by Jonesian exposure),

The only thing Changing Character seemed to lack as a complete multi-factor theory, and which Leigh discussed during his stay at NTNU in the early 2000s, was a cognitive theory for the formation of the inner structure of the defenses. Here she showed interest in Piaget’s studies of children’s cognitive development, especially that learning of objects and causality are inextricably intertwined. Causal texture was already explored by Tolman and Brunswik as strategy learning, and what else is defense than causal strategies for avoidance and achievement? Leigh McCullough had a rare ability to find and collect the gold nuggets from the scattered gravel roofs of psychology.

Anyone who had the pleasure of watching Leigh do therapy knows with what warmth and respect she met the patient. In book form, the humanistic in short-term dynamic therapy is well expressed in Jon Frederickson’s Co-Creating Change (2013), where the patient is repeatedly given the choice between either using their habitual but now conscious defense, or knowing the emotional somatic component and impulse and becoming free – an existential choice.

Leigh McCullough’s original contribution does not lie in the specific interventions – here, like eclectics, she picks up freely from the toolbox. And with modern ISTDP adaptations for fragile and high-resistance patients, this is a more complete model than Leigh’s STDP. But both ISTDP and eclecticism etc. lack deep theoretical integration: Leigh left behind an ingeniously simple multi-factor explanation that gathers most of the basic principles our school fathers divided the subject into. And we had her among us. Leigh died of ALS in 2012.

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Short-Term Psychodynamic Psychotherapy

By Allen Eppel

This book is an easy-to-use guide to short-term psychodynamic psychotherapy for early career practitioners and students of mental health. Written by an expert psychiatric educator, this book is meticulously designed to emphasize clarity and succinctness to facilitate quality training and practice. Developed in a reader-friendly voice, the text begins by introducing the theoretical underpinnings of psychodynamic psychotherapy. Topics include the principles of attachment theory, the dual system theory of emotion processing, decision theory, choice point analysis and a critical review of the research literature. The book then shifts its focus to a description in a manualized format of the objectives and tasks of each phase of therapy within the framework of the engagement, emotion-processing and termination phases. The book concludes with a chapter on psychodynamically informed clinical practice for non-psychotherapists.

Short-Term Psychodynamic Psychotherapy is the ultimate tool for the education of students, residents, trainees, and fellows in psychiatry, psychology, counseling, social work, and all other clinical mental health professions.

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The Client Who Changed Me: Stories of Therapist Personal Transformation

By Jeffrey A. Kottler, Ph. D., Jon Carlson, Psy.D., Ed.D.

Although the impact that clients can have on therapists is well-known, most work on the subject consists of dire warnings: mental health professionals are taught early on to be on their guard for burnout, compassion fatigue, and countertransference. However, while these professional hazards are very real, the scholarly focus on the negative potential of the client-counselor relationship often implies that no good can come of allowing oneself to get too close to a client’s issues. This sentiment obscures what every therapist knows to be true: that the client-counselor relationship can also effect powerful positive transformations in a therapist’s own life.

The Client Who Changed Me is Jeffrey Kottler and Jon Carlson’s testimony to the significant and often life-changing ways in which therapists have been changed by their patients. Kottler and Carlson draw not only upon their own extensive experience – between them, they have more than fifty years in the field – but also upon lengthy interviews with dozens of the country’s foremost therapists and theorists. This novel work presents readers with a truly unique perspective on the business of therapy: not merely how it appears externally, but how practitioners experience it internally. Although these stories paint a complex and multi-layered portrait of the client-counselor relationship, they all demonstrate the profound and unexpected rewards that the profession has to offer.

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Psykoterapi – De sex grundläggande kompetenserna

Författare: Leif Havnesköld, Birgitta Elmquist

Denna bok handlar om psykoterapi. Den skiljer sig dock från många andra metodböcker i ämnet genom att den inte utgår från en specifik inriktning, metod eller skolbildning. I stället beskrivs sex empiriskt grundade kärnkompetenser som, oavsett inriktning, är gemensamma för det goda kliniska arbetet. Boken presenterar dessa kärnkompetenser och hur de kan utvecklas under hela den psykoterapeutiska karriären. De handlar om:• att kunna tillämpa en teoretiskt övergripande, sammanhållen förklaringsmodell för personlighetsutveckling • och psykopatologi• att kunna skapa och bevara en god terapeutisk relation• att ha en modell för klinisk bedömning och konceptualisering • att genomföra själva behandlingen och att använda strategier och interventioner• att kunna avsluta och evaluera behandlingen• att vara medveten om intersektionalitet samt kulturella och etiska aspekters påverkan i psykoterapi.Psykoterapi – de sex grundläggande kompetenserna riktar sig till blivande psykoterapeuter under olika faser av sin utbildning i psykoterapi, blivande psykologer samt till kliniskt verksamma psykologer och psykoterapeuter. Den kan också fungera som stöd och inspiration för lärare och handledare i psykoterapi.


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Can Robots Train Therapists?

Furhat Robotics

Psychotherapy is a notoriously hard discipline to practice and perfect due to a lack of ‘standardized patients’. Robert Johansson, Associate Professor of Psychology at Stockholm University is convinced Furhat is the perfect solution to this problem. With the unparalleled expressivity and conversational capabilities of the Furhat platform, Robert plans to build several virtual standardized patients that can be used to train therapists.

Read more about Robert’s vision – and how robots can help us understand human suffering

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Dr Jonathan Egan and the Journey of Returning to the Self!

From the Therapy Talks Podcast

Show Notes:
Chris talks to Dr Jonanthan Egan about fearing our emotions, the Therapy model Affect phobia and how we can return to the world of living from defensive holding and avoidance of feeling.  He brings a wealth of invaluable experience to the conversation and looks at the challenges of burnout for therapists and how we can move beyond this. A fascinating and insightful conversation.

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The Art of Living Virtually – For Now

By Kristin Osborn

As a student of self-care, I’ve identified what works for me and I’ve integrated it into my daily schedule. After weeks of isolation due to the pandemic, here are four activities that have helped :

  • Taking walks
  • Developing a daily schedule with set breaks
  • Allowing time to experience my emotions
  • Connecting with others.

Una McClusky, author of Transference and Countertransference from an Attachment Perspective, stresses the importance for care providers to connect with others. I’ve taken her message to heart, integrating as many moments of connection into my daily routine. Previously, I might have shied away from the ringing phone, hoping to hold onto some silence in the middle of a busy schedule. Now I’m encouraging myself to move forward, pick up the phone, and connect.

Recently, I converted a 2-day workshop into a virtual conference. A resulting benefit was that it opened up ongoing communications with psychiatry residents, psychotherapists, nurses, physicians and students from around the world.

I also taught an online course with psychiatry residents at UC San Diego — the Basics of Affect Phobia Therapy. I felt it was essential not only to demonstrate how these principles can be used with their patients, but also with themselves to experience less anxiety and more connection.

Launching an online community

A few weeks ago, we launched Therapist Affect Phobia Community — a weekly online forum which provides a way for mental health professionals to exchange observations, learn from one another, receive support and connect. Dr. Michael Alpert, a psychiatrist from NYC, joined me as a guest one week. He explained why it can be difficult seeing our faces online, then demonstrated a technique we can use remotely at home. To practice this exercise, you’ll need to look at your reflection in the mirror, or through your phone/computer. As you look at yourself, pay close attention to your eyes and ask yourself these questions:

  • What are you noticing as you see yourself?
  • Can you accept what you are seeing?
  • What could be a barrier to accepting yourself?
  • What feelings are you experiencing toward yourself?
  • When have you felt like this in the past?

I volunteered to help Dr. Alpert demonstrate this technique then looked at my face on the Zoom video window. Immediately I noted the tiredness in my eyes. I explained that I felt as though I looked older, wiser and concerned.

Dr. Alpert asked me to pay attention to my tiredness. I felt tears come to the surface and I experienced sadness. He asked me if I was feeling more compassionate toward myself, but instead, my sadness deepened. I realized I was experiencing loss. I was missing what was familiar — my offices, my clients, my friends, my colleagues and I was feeling worried — worried about finances, my well-being and not knowing what life will look like post-pandemic.

After our forum ended, I noticed that I was teary at times and experienced discomfort. The next morning, I experienced separation anxiety with my trainees online and felt deeply sad at the loss of our in-person connection.

However, it’s important to note, that while connecting with one another, we were all feeling more alive, less tired.

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