Therapists today adopt and adapt therapeutic practices and philosophies that have been practiced, developed, and studied over many decades, and new modalities emerge every day. Many therapists draw elements from several modalities, tailoring their approach to helping people, and developing their own techniques over time. Our upcoming GoodTherapy.org presenter Sam Alibrando, PhD integrates aspects of psychodynamic therapy, cognitive behavioral therapy, neuropsychology, and mindfulness into his practice, among others. He has also developed the concept of the Interpersonal Triangle, drawing on the works of Wilfred Bion and Karen Horney, to illustrate how we navigate the world. We recently had the opportunity to interview Alibrando about his therapeutic techniques and theories in anticipation of his upcoming web conference.
Alibrando is a clinical psychologist and the author of Follow the Yellow Brick Road: How to Change for the Better When Life Gives You Its Worst. His continuing education presentation for GoodTherapy.org, titled “Treating the ‘Difficult’ Client: Where Power, Love, and Mindfulness Meet,” is scheduled for 9 a.m. PDT on April 10, 2015. This event is available at no additional cost to GoodTherapy.org members and is good for two CE credits. For details, or to register, please click here.
1. What do you believe to be the most important element in successful therapy?
In a phrase, the element that is most important is the therapeutic relationship. Research is clear and humbling, the variable that accounts the most for success in therapy has little to do with the therapist. Instead, factors that dictate the success of therapy have more to do with client variables, such as motivation and emotional intelligence. The most important variable for therapeutic success that actually includes the therapist has to do with the quality of the relationship between the client and the therapist. It involves such things as trust, empathy, positive regard, candidness, and being present.
2. Which types of therapy influence your work the most?
I was heavily influenced by psychoanalytic thinking from the graduate school where I received my doctorate. Likewise, my personal therapist at the time was a psychoanalyst. Therefore, theories related to object-relations and relational psychoanalysis formed a strong basis for my work as a therapist. I also have a notable interest and respect for complex adaptive systems theory. Today I am particularly fond of the use of mindfulness in psychotherapy. As an organizational consultant and executive coach, I still use my psychodynamic theory to understand a leader, team, or organization, but I find myself using more cognitive-behavioral applications in a work context.
3. Tell us about a psychologist, past or present, whom you greatly admire.
Even though most therapists have never heard of him, I believe that Wilfred Bion was one of the greatest psychoanalytic minds of the 20th And I am not alone. Neville Symington considered Bion as possibly “the greatest psychoanalytic thinker … after Freud.” First of all, he is one of the main contributors to my Interpersonal Triangle model. He suggested that there are three ways to connect or “link” to others, either through love, hate, or knowing. This idea, in combination with Karen Horney’s three relational movements (moving-toward, moving-against, and moving-away, respectively), gave birth to the Interpersonal Triangle. Bion’s further development of the “knowing” link formed his very comprehensive theories of thinking, which anticipated—decades later—the most popular notion of mindfulness that we appreciate today.
As a group therapist and someone who has taught group processes at a graduate school, I also admire Bion’s groundbreaking work with groups and group processes (some readers may have heard of Tavistock). He is also known for his one-liners. One of my favorite one-liners is his prescription to start each session “without memory or desire,” in order to truly hear where the patient is.
4. Can you tell us more about your Interpersonal Triangle model?
I suggest that there are three dimensions of the interpersonal world that I label Power, Love, and Knowing (or Mindfulness). I base this assumption on several sources, all of which point to three modalities or dimensions, regardless of the questions the psychologists were asking or their theoretical orientation. My original source was Karen Horney’s Our Inner Conflicts, in which she describes the three ways we move relationally: We move-against (Power), we move-toward (Love) and we move-away (Knowing or Mindfulness). These three dimensions are analogous to their referent physical dimension where height is power or moving-against (Self-orientation), width is love or moving-toward (Other-orientation) and depth is knowing / mindfulness or moving-away (Truth-orientation).
These discrete interpersonal dimensions, however, are interconnected to the extent that we cannot truly understand one outside the context of the other two. Therefore I connect them graphically with lines, creating a triangle—an interpersonal triangle, if you may.
Each dimension can be positive or negative in its relational impact. For example, codependency is a form of a negative Love. And the ability to set healthy boundaries is an example of positive Power.
Problems arise, of course, when the negative aspects of any of the three movements throw us out of healthy balance. This is what makes any of us “difficult.” Using a process that I call “working the triangle,” clients (and therapists) facing difficulties can be helped to get back into a healthy balance or, as I like to call it, their “relational sweet spot.” This is always a challenge however, because of the reactivity of the “emotional brain.”
5. What is the emotional brain?
When I introduce to general audiences the idea of the “emotional brain,” I often use the acronym L.I.A.R. to portray the psychological importance of this region of the brain on behavioral and especially emotional reactivity:
- Limbic: The emotional brain “resides” in the limbic system of the brain—a complex set of brain structures directly under the cerebrum that includes the hippocampus, amygdala, and the cingulate gyrus. The limbic system supports a variety of functions including adrenaline flow, long-term memory, motivation, and most importantly, emotion and behavior. It is an affective—thus reactive—part of the brain (rather than proactive part of the brain, which we find mostly in the prefrontal cortex).
- Intense: By design, the emotional brain is intense and dynamic. The feelings aroused are often strong enough to get our attention and at times to motivate us to act or, all too often, react.
- Automatic: The emotional brain is automatic, it is activated involuntarily as a reflex or instinct, without thought. In other words, the emotional brain reacts unconsciously. Interestingly, we can often replace the word “unconscious” with the word “automatic,” and the meaning does not change.
- adult brains are now known to be “elastic,” meaning we can change the brain. But it takes a lot of work—like we do in psychotherapy—to create that change.
Again, using the process of “working the triangle” in therapy helps both the client and (when necessary) the therapist get back into balance.
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