Effective Strategies for Overcoming Engagement Barriers in Therapy Sessions

1. Barriers to Engagement CHAPTER 6 Yes No Resolve by conversation Initiate Process Assess Front of System No Signals Active Feelings Defense Anxiety CHAPTER 7 Take History Striated CPD or Smooth No Signals Signals Search for Cause of no signals Press on and Clarify Defense Press on Feelings Reduce Anxiety Monitor Parameters: Degree of Rise, Discharge pathways, defense patterns, syntonic vs dystonic, height of thresholds Psychodiagnostic Assessment Go Flat: thresholds to CPD, Primitive defense, Repression Feel Feelings Defend High Resistance Mild to Moderate Fragility Severe Fragility High Resistance with Repression Moderate Resistance Low Resistance Clarify challenge Defense Head on Collision Syntonic dystonic Small then bigger breakthroughs of CTF Strengthen and Follow UTA Psychic Integration: overcome splits, Projection to make integrated but anxious person Clarify challenge defense Press to feelings. Follow UTA Handle Tactical Defense Focus on Grief Graded Format: Cycles of Pressure or Bracing And Recapitulation Monitor thresholds Focus on Guilt about rage to build capacity CHAPTERS 12-16 1-5 Sessions Process grief Repeated unlocking Working through to termination in 5-20 Sessions Repeated unlocking Working through to Phase of termination in 20-40 Sessions ISTDP Treatment Repeated partial then major unlocking Working through to Phase of termination in 50-150 Sessions A Abbass 2018

2. Barriers to Engagement Yes No Resolve by conversation Initiate Process Assess Front of System No Signals Active Feelings Defense Anxiety Take History Striated CPD or Smooth No Signals Signals Search for Cause of no signals A Abbass 2018

3. Press on and Clarify Defense Press on Feelings Reduce Anxiety Monitor Parameters: Degree of Rise, Discharge pathways, defense patterns, syntonic vs dystonic, height of thresholds Psychodiagnostic Assessment Go Flat: thresholds to CPD, Primitive defense, Repression Feel Feelings Defend Mild to Moderate Fragility Severe Fragility High Resistance with Repression High Resistance Moderate Resistance Low Resistance A Abbass 2018

4. Mild to Moderate Fragility Severe Fragility High Resistance with Repression High Resistance Moderate Resistance Low Resistance Clarify challenge defense Press to feelings. Follow UTA Clarify challenge Defense Head on Collision Syntonic dystonic Small then bigger breakthroughs of CTF Strengthen and Follow UTA Handle Tactical Defense Focus on Grief Psychic Integration: overcome splits, Projection to make integrated but anxious person Graded Format: Cycles of Pressure or Bracing And Recapitulation Monitor thresholds Focus on Guilt about rage to build capacity 1-5 Sessions Process grief Repeated unlocking Working through to termination in 5-20 Sessions Repeated unlocking Working through to Phase of termination in 20-40 Sessions ISTDP Treatment Repeated partial then major unlocking Working through to Phase of termination in 50-150 Sessions A Abbass 2018