Dr. Patricia Gianotti

Notebook and Pen

Can you briefly describe the structure of the year-long certificate program, specifically what type of clinician could most benefit from this program?

This is a one-year certificate program for licensed clinicians who are working full time but who wish to further their training through a year-long immersion into cutting-edge theoretical developments that integrate practices from various clinical disciplines. In addition to the three, three-day residencies and six on-line webinars, participants will meet with a faculty person in small group consultation meetings on a regular basis throughout the year to discuss their own clinical case material. This program is beneficial for recently licensed therapists, both in agency and private practice settings who wish to increased their proficiency and confidence as clinicians. It also has great value for seasoned therapists who wish to refresh their clinical knowledge base or deepen their clinical proficiency using the practice techniques and small group case presentations provided throughout the year-long program.

The faculty represents expertise in a wide-range of clinical disciplines. Our approach to training is geared toward demonstrating how the application of theoretical principles can be put into action.  Our course material integrates psychodynamic theory with neurobiological advances in trauma treatment, as well as assessing the impact that inequity and marginalization have on the psyche.  

Can you talk briefly about the Four Quadrant model and how it's useful in your books and in your training of therapists?

The Four Quadrant Model is a visual graphic that illustrates the various components of the psyche, showing the relationship between the intrapsychic, interpersonal, and socio-cultural aspects of a person’s identity. The model is based on attachment theory and illustrates how attachment injuries that create feelings of shame and inadequacy produce defense patterns that are used in an attempt to compensate for trauma or deprivation that occurred in childhood. The model is useful as an assessment tool to determine the degree of rigidity or fragility of a client as well as showing how an individual’s beliefs and behaviors can lead to unrealistic expectations of self or others that often result in symptoms and/or a vicious cycle of repeated disappointments. 

Can you describe how this model and your treatment approach is helpful for therapists who wish to become even better clinicians?

We use this model to teach clinicians how to think about which interventions to use and when.  Knowing when to use any theoretical technique or intervention is critical to being an effective therapist. As a training supervisor/consultant for many clinicians in private practice as well as in my role as the Academic Director in our year-long program, I have found The Four Quadrant Model to be a powerful tool to unify how we think about case formulation as well as how to spot hidden parts of the psyche that are underdeveloped or hidden from the therapeutic interaction. This model and approach also helps clinicians identify repeated relational patterns as well as over-determined beliefs and behaviors that are unsustainable over time.

Why do you think your books and your approach is important, and what sets it apart from other approaches? 

I think the Loyola Advanced Certificate Program is important because it integrates best practices from multiple theoretical disciplines. Although we are grounded in a psychodynamic orientation, we provide a model of the psyche and a method of assessment that practitioners from non-dynamic training programs find enormously useful. We provide participants with a thorough introduction to the Four Quadrant Model which presents a picture of how people attempt to compensate and adapt to attachment injuries. However, participants are also presented with a second model, called The Healthy Self-Actualizing Model, that illustrates what a healthy self looks like throughout the life cycle. By providing two clearly illustrated visual graphics, clinicians can compare the difference between a person who presents with healthy, adaptive coping strategies vs a person who exhibits defensive coping strategies, strategies that are unsustainable over the course of the life span. Used side by side, these models become an excellent assessment tool in addition to giving clinicians a way to evaluate a client’s strengths and resilience as well. Detailed practice tools as to how to use these models are provided throughout the year, tools and techniques that show how to deepen the therapeutic inquiry process as well as strengthen the therapeutic relationship.  

What are you reading about/learning about that’s driving this research and work you’re sharing? 

I have been paying close attention to theorists who have been trying to integrate neurobiological findings that track the damage created from attachment injuries to how this affects the hard-wiring of the brain and people’s capacity for self-regulation. These findings not only must inform the way we work, it must change the way we work with our clients. Contributors in the field of trauma treatment have taken a lead in teaching us the importance of attending to somatic cues, right-brain-to-right-brain communication, and how to spot micro-dissociative episodes that happen during a session. Relationally-related psychodynamic theorists have now incorporated these findings into psychodynamic approaches, particularly when it comes to recognizing and working with enactments that stem chronic attachment ruptures and/or traumatic abuse. Using language, mirroring, metaphor, and reflective techniques that speak to a client’s implicit memory system creates a bridge that can translate unformulated experience it to symbolic form. This is one of ways that psychodynamic therapy has become more expansive and useful in the treatment of trauma.