From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...Martha Stark MD
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
Martha Stark MD – 20 May 2022 – Practical Clinical Interventions for Incentiv...Martha Stark MD
Do you sometimes wish that you had a “cheat sheet” to which you could periodically refer in order to figure out how best to respond to particular situations with which your patients were struggling? Do you sometimes wish that you had easy access to a “therapeutic toolkit” that would enable you to intervene in ways that would achieve meaningful results?
I have formulated a number of broadly applicable interventions designed to challenge whatever “defenses” the patient might have mobilized – in the moment – to protect herself from having to know sobering truths about her “conflicted self,” her “unrelenting objects,” her “irresponsible self-in-relation,” her “impenetrable self,” and/or her “unactualized self.”
In essence, my lecture will provide you with an arsenal of therapeutic interventions to be utilized for specific, universally relevant, clinical moments – be it the patient’s reluctance to confront anxiety-provoking realities about the forces and counterforces in conflict within her, her refusal to confront sobering realities about the objects of her desire, her reluctance to hold herself accountable for what she is compulsively and unwittingly re-enacting on the stage of her life, her fear of delivering the most vulnerable and private aspects of her “self” into intimate relationships and into life itself, and her resistance to mobilizing her energies in order to actualize her potential and realize her dreams.
Armed with “optimally stressful” interventions, you will be able to use these specialized tools to incentivize change and handle, with finesse, just about any situation that might arise during the clinical hour. Participants will receive my newly created “clinical intervention guide” (in the form of a handy “cheat sheet”).
Martha Stark MD – 13 Nov 2022 – Part 1 – The Art and The Science of Interpret...Martha Stark MD
This document outlines Martha Stark's presentation on conceptualizing a framework for the "middle game" of psychodynamic psychotherapy. The presentation focuses on four key elements: staying attuned to a patient's anxiety level and understanding it's okay to sometimes increase or decrease anxiety; generating optimal stress through the right balance of challenge and support to incentivize changing defenses into adaptations; developing comfort with challenging and supporting unhealthy defenses as well as celebrating new, healthier adaptations; and using minimally and optimally stressful interventions. The goal is transforming psychological rigidity into flexibility through therapeutic provision of optimal stress.
Martha Stark MD – 19 May 2023 – 2nd of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 13 Nov 2022 – Part 2 – The Art and The Science of Interpret...Martha Stark MD
As you sit with your patients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our patients. In truth, most of our patients are “conflicted” about most things most of the time. Whether working within the interpretive perspective of classical psychoanalytic theory, the corrective-provision perspective of self psychology, or the intersubjective perspective of contemporary relational theory, we are therefore ever busy deciding when we should highlight the healthy forces within patients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.” When should we “be with them where they are” and when should we “direct their attention to elsewhere”? – or can we perhaps do both at the same time?
With our finger ever on the pulse of the level of the patient’s anxiety, we are indeed always focused on whether we think the patient will be able to tolerate further (anxiety-provoking) challenge and/or will require additional (anxiety-assuaging) support – a critically important balance that is necessary if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a universally applicable intervention that targets the patient’s state of internal dividedness or conflictedness – between healthy but anxiety-provoking forces pressing for “something new and better” and less healthy but anxiety-assuaging (defensive) counterforces insisting upon “same old same old.” Brief and more extended clinical vignettes will be offered that demonstrate use of these optimally stressful “conflict statements” that are specifically designed to facilitate development of the patient’s dual awareness.
If indeed the analytic goal is deep, enduring, characterological change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress that there will be both impetus and opportunity for the patient, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 24 Sep 2021 – A Heart Shattered, The Private Self, and Rele...Martha Stark MD
This document discusses the experience of patients who have developed a "false self" due to early childhood trauma or an inability to have their emotional needs met. It explores how therapy can help such patients access their "true self" by providing an environment where the patient can feel in control and absolutely dependent on the therapist without fear of abandonment. Several case studies and songs are referenced that illustrate the disconnect between a person's public and private selves when early heartbreak or lack of a supportive caregiver has occurred. The goal of the therapeutic approach presented is to allow patients to repair damaged parts of themselves by experiencing reliable care and empathy from their therapist.
Martha Stark MD – 28 Apr 2023 – Seminar 2 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...Martha Stark MD
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
Martha Stark MD – 20 May 2022 – Practical Clinical Interventions for Incentiv...Martha Stark MD
Do you sometimes wish that you had a “cheat sheet” to which you could periodically refer in order to figure out how best to respond to particular situations with which your patients were struggling? Do you sometimes wish that you had easy access to a “therapeutic toolkit” that would enable you to intervene in ways that would achieve meaningful results?
I have formulated a number of broadly applicable interventions designed to challenge whatever “defenses” the patient might have mobilized – in the moment – to protect herself from having to know sobering truths about her “conflicted self,” her “unrelenting objects,” her “irresponsible self-in-relation,” her “impenetrable self,” and/or her “unactualized self.”
In essence, my lecture will provide you with an arsenal of therapeutic interventions to be utilized for specific, universally relevant, clinical moments – be it the patient’s reluctance to confront anxiety-provoking realities about the forces and counterforces in conflict within her, her refusal to confront sobering realities about the objects of her desire, her reluctance to hold herself accountable for what she is compulsively and unwittingly re-enacting on the stage of her life, her fear of delivering the most vulnerable and private aspects of her “self” into intimate relationships and into life itself, and her resistance to mobilizing her energies in order to actualize her potential and realize her dreams.
Armed with “optimally stressful” interventions, you will be able to use these specialized tools to incentivize change and handle, with finesse, just about any situation that might arise during the clinical hour. Participants will receive my newly created “clinical intervention guide” (in the form of a handy “cheat sheet”).
Martha Stark MD – 13 Nov 2022 – Part 1 – The Art and The Science of Interpret...Martha Stark MD
This document outlines Martha Stark's presentation on conceptualizing a framework for the "middle game" of psychodynamic psychotherapy. The presentation focuses on four key elements: staying attuned to a patient's anxiety level and understanding it's okay to sometimes increase or decrease anxiety; generating optimal stress through the right balance of challenge and support to incentivize changing defenses into adaptations; developing comfort with challenging and supporting unhealthy defenses as well as celebrating new, healthier adaptations; and using minimally and optimally stressful interventions. The goal is transforming psychological rigidity into flexibility through therapeutic provision of optimal stress.
Martha Stark MD – 19 May 2023 – 2nd of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 13 Nov 2022 – Part 2 – The Art and The Science of Interpret...Martha Stark MD
As you sit with your patients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our patients. In truth, most of our patients are “conflicted” about most things most of the time. Whether working within the interpretive perspective of classical psychoanalytic theory, the corrective-provision perspective of self psychology, or the intersubjective perspective of contemporary relational theory, we are therefore ever busy deciding when we should highlight the healthy forces within patients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.” When should we “be with them where they are” and when should we “direct their attention to elsewhere”? – or can we perhaps do both at the same time?
With our finger ever on the pulse of the level of the patient’s anxiety, we are indeed always focused on whether we think the patient will be able to tolerate further (anxiety-provoking) challenge and/or will require additional (anxiety-assuaging) support – a critically important balance that is necessary if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a universally applicable intervention that targets the patient’s state of internal dividedness or conflictedness – between healthy but anxiety-provoking forces pressing for “something new and better” and less healthy but anxiety-assuaging (defensive) counterforces insisting upon “same old same old.” Brief and more extended clinical vignettes will be offered that demonstrate use of these optimally stressful “conflict statements” that are specifically designed to facilitate development of the patient’s dual awareness.
If indeed the analytic goal is deep, enduring, characterological change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress that there will be both impetus and opportunity for the patient, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 24 Sep 2021 – A Heart Shattered, The Private Self, and Rele...Martha Stark MD
This document discusses the experience of patients who have developed a "false self" due to early childhood trauma or an inability to have their emotional needs met. It explores how therapy can help such patients access their "true self" by providing an environment where the patient can feel in control and absolutely dependent on the therapist without fear of abandonment. Several case studies and songs are referenced that illustrate the disconnect between a person's public and private selves when early heartbreak or lack of a supportive caregiver has occurred. The goal of the therapeutic approach presented is to allow patients to repair damaged parts of themselves by experiencing reliable care and empathy from their therapist.
Martha Stark MD – 28 Apr 2023 – Seminar 2 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD
If deep and enduring psychodynamic change is the ultimate goal of treatment, then periodically juxtaposing seemingly contradictory “forces” (Hegel’s thesis and antithesis) will eventually jump-start the patient’s “adaptive recovery” by creating optimally stressful, growth-incentivizing “mismatch experiences.”
I will be proposing use of something to which I refer as a “conflict statement” – a clinically useful and almost universally applicable therapeutic intervention strategically designed to target internal conflictedness between anxiety-provoking (but ultimately growth-promoting) forces pressing “yes” and anxiety-relieving (but growth-impeding) resistant counterforces defending “no.”
The stress and strain of the “destabilizing dissonance” hereby created will provide the “therapeutic leverage” needed for the patient gradually, over time, to relinquish the tenacity of her rigid attachment to the defense in favor of a more flexible adaptation – a “compromise position” that will “reconcile their common truths” (Hegel’s synthesis) and transform conflict into collaboration.
The strategic construction of conflict statements requires of the therapist that she be able both to support the patient’s defense by “being with the patient where she is” and to challenge the patient’s defense by “directing the patient’s attention to where the therapist would want her to go.” I will be offering specific clinical examples to demonstrate the impact of these powerfully impactful psychotherapeutic interventions. No pain, no gain…
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
This document discusses several concepts from pastoral care, including:
1) It describes patients sharing painful stories with chaplains about abuse, mental illness, and a desire for justice from God.
2) It discusses seeing a person as a "living human document" or "living human web" and understanding their experiences from multiple dimensions.
3) It explores the challenges caregivers may face in listening empathetically without becoming detached, and how exercising courage to enter another's suffering is important in pastoral care.
The document describes the author's journey to finding her authentic voice and overcoming a fear of being herself with others. As a child, she felt she had to conform to expectations and suppress her opinions to get her basic needs met. As an adult, she craved authentic living but was influenced by others' opinions. Through reading books on ego and self-reflection, she realized negative self-talk was affecting her self-worth and reactions. By examining her beliefs and motivations in relationships, she worked to overcome feelings of undeservingness and fill an inner hole.
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 14 Nov 2021 – A Heart Shattered, The Private Self, and A Li...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
This document discusses the concept of self-image and how it impacts our lives. It states that we each carry a mental blueprint or self-image formed from our past experiences that shapes how we see ourselves and act. It asserts that changing one's self-image can lead to a better life by allowing us to realize our potential and overcome limiting beliefs. The document encourages understanding oneself by reflecting on questions of identity, purpose, strengths and weaknesses to empower personal growth.
This document summarizes Abraham Maslow's observations about creativity in self-actualizing people based on his studies. Some key points:
1) Maslow found that creativity was not dependent on talent, genius, or productivity in a conventional sense, as many self-actualizing subjects were not prominent artists or intellectuals.
2) He observed different forms of creativity beyond conventional areas like art, including caring for a home and family, social service work, clinical practice, and business organization.
3) Maslow described self-actualizing creativity as a character trait involving openness to experience, spontaneity, expressiveness, and perception without preconceptions - resembling the creativity of children.
4)
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
- Marcus Aurelius was a Roman emperor from 161-180 CE and known for his philosophical work "Meditations".
- He learned virtues like gentleness, piety, restraint and reconciliation from his family members and teachers.
- In his writings, he emphasized living virtuously and not being disturbed by external things beyond one's control. He advised focusing on bettering oneself through reason and justice.
Marcus Aurelius was a Roman emperor from 161-180 CE who wrote meditations reflecting on stoic philosophy. He learned virtues from his family like gentleness from his grandfather, piety from his mother, and how to reconcile from his teacher Rusticus. Aurelius advised living virtuously and not being disturbed by external things or what others think. He believed all things are in constant change and that true happiness comes from living according to reason and nature.
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptxMartha Stark MD
This document provides an overview of a seminar on an existential-humanistic approach to healing brokenness and easing despair in patients. The seminar will focus on Model 4 patients who have experienced early heartbreak and withdrawal from relationships due to a "shattered heart". It will discuss helping patients overcome dread of emotional surrender and providing an opportunity to "regress in order to redo" early experiences. The presenter's psychodynamic synergy paradigm incorporates five therapeutic models, including one focused on patients experiencing relentless despair and nonrelatedness due to early relational failures.
Martha Stark MD – 11 Feb 2022 – A Heart Shattered, The Private Self, and A Li...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
THE WEED POEM...SECRETS OF THE "FORBIDDEN TRUTH"Flywiththe Wind
The poem discusses the benefits of marijuana and argues that it should not be illegal while alcohol is legal. It notes that marijuana can help with conditions like depression, anxiety, nausea, appetite loss, insomnia, and more. It suggests that marijuana was made illegal not for health reasons but because it could not be taxed like alcohol. With more research supporting medical uses and states legalizing it for tax revenue, the poem advocates for reconsidering the stigma against marijuana.
A ppt on escapism I made in senior year of high school as a project. Now that it's done, you can use it too. Use it as reference or simply plagiarize, I don't care. Better than it lying useless and ignored in my computer. I'll be glad knowing I helped a student in their time of need. School projects are useless anyway. Thank me later!
The song of ashtavakra or ashtavakra gitaGurudevaya
We have faith and devotion towards Lord; if we have the same faith and devotion towards our Master also, for those great souls only the secrets of Upanishads will be easily understood. Svetaashvatara Upanishad
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Fear is False Evidence Appearing Real. Here is a formula for fear: Inaction+ Past false evidence + Future catastrophic thinking + Snowball of thoughts and feelings = FEAR ?
Reimagining Reality: A Place for LGBTQ in the WorkplaceAlexei Orlov
Alexei Orlov believes the power of fair speech and balanced opinion is more crucial now than ever. It is important to use our imaginations better to create a new and more certain reality – that humans and kindness should always go together.
Book Review
Lethal Secrets: The Shocking Consequences of and Unsolved Problems of Artificial Insemination by Annette Baran and Rueben Pannor
http://mirahriben.blogspot.com
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
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Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD
If deep and enduring psychodynamic change is the ultimate goal of treatment, then periodically juxtaposing seemingly contradictory “forces” (Hegel’s thesis and antithesis) will eventually jump-start the patient’s “adaptive recovery” by creating optimally stressful, growth-incentivizing “mismatch experiences.”
I will be proposing use of something to which I refer as a “conflict statement” – a clinically useful and almost universally applicable therapeutic intervention strategically designed to target internal conflictedness between anxiety-provoking (but ultimately growth-promoting) forces pressing “yes” and anxiety-relieving (but growth-impeding) resistant counterforces defending “no.”
The stress and strain of the “destabilizing dissonance” hereby created will provide the “therapeutic leverage” needed for the patient gradually, over time, to relinquish the tenacity of her rigid attachment to the defense in favor of a more flexible adaptation – a “compromise position” that will “reconcile their common truths” (Hegel’s synthesis) and transform conflict into collaboration.
The strategic construction of conflict statements requires of the therapist that she be able both to support the patient’s defense by “being with the patient where she is” and to challenge the patient’s defense by “directing the patient’s attention to where the therapist would want her to go.” I will be offering specific clinical examples to demonstrate the impact of these powerfully impactful psychotherapeutic interventions. No pain, no gain…
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
This document discusses several concepts from pastoral care, including:
1) It describes patients sharing painful stories with chaplains about abuse, mental illness, and a desire for justice from God.
2) It discusses seeing a person as a "living human document" or "living human web" and understanding their experiences from multiple dimensions.
3) It explores the challenges caregivers may face in listening empathetically without becoming detached, and how exercising courage to enter another's suffering is important in pastoral care.
The document describes the author's journey to finding her authentic voice and overcoming a fear of being herself with others. As a child, she felt she had to conform to expectations and suppress her opinions to get her basic needs met. As an adult, she craved authentic living but was influenced by others' opinions. Through reading books on ego and self-reflection, she realized negative self-talk was affecting her self-worth and reactions. By examining her beliefs and motivations in relationships, she worked to overcome feelings of undeservingness and fill an inner hole.
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 14 Nov 2021 – A Heart Shattered, The Private Self, and A Li...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
This document discusses the concept of self-image and how it impacts our lives. It states that we each carry a mental blueprint or self-image formed from our past experiences that shapes how we see ourselves and act. It asserts that changing one's self-image can lead to a better life by allowing us to realize our potential and overcome limiting beliefs. The document encourages understanding oneself by reflecting on questions of identity, purpose, strengths and weaknesses to empower personal growth.
This document summarizes Abraham Maslow's observations about creativity in self-actualizing people based on his studies. Some key points:
1) Maslow found that creativity was not dependent on talent, genius, or productivity in a conventional sense, as many self-actualizing subjects were not prominent artists or intellectuals.
2) He observed different forms of creativity beyond conventional areas like art, including caring for a home and family, social service work, clinical practice, and business organization.
3) Maslow described self-actualizing creativity as a character trait involving openness to experience, spontaneity, expressiveness, and perception without preconceptions - resembling the creativity of children.
4)
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
- Marcus Aurelius was a Roman emperor from 161-180 CE and known for his philosophical work "Meditations".
- He learned virtues like gentleness, piety, restraint and reconciliation from his family members and teachers.
- In his writings, he emphasized living virtuously and not being disturbed by external things beyond one's control. He advised focusing on bettering oneself through reason and justice.
Marcus Aurelius was a Roman emperor from 161-180 CE who wrote meditations reflecting on stoic philosophy. He learned virtues from his family like gentleness from his grandfather, piety from his mother, and how to reconcile from his teacher Rusticus. Aurelius advised living virtuously and not being disturbed by external things or what others think. He believed all things are in constant change and that true happiness comes from living according to reason and nature.
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptxMartha Stark MD
This document provides an overview of a seminar on an existential-humanistic approach to healing brokenness and easing despair in patients. The seminar will focus on Model 4 patients who have experienced early heartbreak and withdrawal from relationships due to a "shattered heart". It will discuss helping patients overcome dread of emotional surrender and providing an opportunity to "regress in order to redo" early experiences. The presenter's psychodynamic synergy paradigm incorporates five therapeutic models, including one focused on patients experiencing relentless despair and nonrelatedness due to early relational failures.
Martha Stark MD – 11 Feb 2022 – A Heart Shattered, The Private Self, and A Li...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
THE WEED POEM...SECRETS OF THE "FORBIDDEN TRUTH"Flywiththe Wind
The poem discusses the benefits of marijuana and argues that it should not be illegal while alcohol is legal. It notes that marijuana can help with conditions like depression, anxiety, nausea, appetite loss, insomnia, and more. It suggests that marijuana was made illegal not for health reasons but because it could not be taxed like alcohol. With more research supporting medical uses and states legalizing it for tax revenue, the poem advocates for reconsidering the stigma against marijuana.
A ppt on escapism I made in senior year of high school as a project. Now that it's done, you can use it too. Use it as reference or simply plagiarize, I don't care. Better than it lying useless and ignored in my computer. I'll be glad knowing I helped a student in their time of need. School projects are useless anyway. Thank me later!
The song of ashtavakra or ashtavakra gitaGurudevaya
We have faith and devotion towards Lord; if we have the same faith and devotion towards our Master also, for those great souls only the secrets of Upanishads will be easily understood. Svetaashvatara Upanishad
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Fear is False Evidence Appearing Real. Here is a formula for fear: Inaction+ Past false evidence + Future catastrophic thinking + Snowball of thoughts and feelings = FEAR ?
Reimagining Reality: A Place for LGBTQ in the WorkplaceAlexei Orlov
Alexei Orlov believes the power of fair speech and balanced opinion is more crucial now than ever. It is important to use our imaginations better to create a new and more certain reality – that humans and kindness should always go together.
Book Review
Lethal Secrets: The Shocking Consequences of and Unsolved Problems of Artificial Insemination by Annette Baran and Rueben Pannor
http://mirahriben.blogspot.com
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Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
Many a patient, as a child, has suffered great heartache at the hands of a misguided, even if well-intentioned, parent, be it in the form of psychological trauma and abuse (too much bad) or emotional deprivation and neglect (not enough good). Such a patient may never have had occasion to confront the pain of her grief about the parent's unwitting but devastating betrayal of her. Instead, she has defended herself against the pain of her heartache by pushing it, unprocessed, out of her awareness and clinging instead to the illusion of her parent (or a stand-in for her parent) as good and as ultimately forthcoming if she (the patient) could but get it right.
Under the sway of her repetition compulsion, the patient – as she struggles through her life – will find herself delivering into each new relationship her desperate hope that perhaps this time, were she to be but good enough, want it badly enough, or suffer deeply enough, she might yet be able to transform this new object of her relentless desire into the perfect parent she should have had as a child – but never did (Stark 1994a, 1994b, 1999, 2015).
As long as the patient continues her relentless pursuits, however, and refuses to come to terms with the reality of the limitations, separateness, and immutability of the people in her world – and the limits of her power to make them change – then she will be consigning herself to a lifetime of chronic frustration, heartache, and unremitting feelings of impotent rage and profound despair.
Elvin Semrad (Rako 1983) captures this poignantly with the following: “Pretending that <something> can be when it can’t is how people break their heart.”
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdfMartha Stark MD
I have always found the following quote from Gary Schwartz’s 1999 The Living Energy Universe to be inspirational: “One of science’s greatest challenges is to discover certain principles that will explain, integrate, and predict large numbers of seemingly unrelated phenomena.” So too my goal has long been to be able to tease out overarching principles – themes, patterns, and repetitions – that that are relevant in the deep healing work that we do as psychotherapists.
Drawing upon concepts from fields as diverse as systems theory, chaos theory, quantum mechanics, solid-state physics, toxicology, and psychoanalysis to inform my understanding, on the pages that follow I will be offering what I hope will prove to be a clinically useful conceptual framework for understanding how it is that healing takes place – be it of the body or of the mind. More specifically, I will be speaking both to what exactly provides the therapeutic leverage for healing chronic dysfunction and to how we, as psychotherapists, can facilitate that process?
Just as with the body, where a condition might not heal until it is made acute, so too with the mind. In other words, whether we are dealing with body or mind, superimposing an acute injury on top of a chronic one is sometimes exactly what a person needs in order to trigger the healing process.
More specifically, the therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – is often the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in our patients with longstanding emotional injuries and scars.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will serve simply to reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will “galvanize to action” and provoke healing. I refer to this as the Goldilocks Principle of Healing.
And so it is that with our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is my firm belief in the
underlying resilience that patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from dysfunctional defensive reaction to more functional adaptive response.
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdfMartha Stark MD
Freud’s interest was in the internal conflict that exists between, on the one hand, untamed id drives (most notably sexual and aggressive ones) clamoring for gratification and release and, on the other hand, the defenses mobilized by an undeveloped ego made anxious by the threatened breakthrough of those drives – conflict that will create neurotic suffering and interfere with the capacity to derive pleasure and fulfillment from love, work, and play (Freud 1926).
Using as a springboard Freud’s premises of drive-defense conflict as the source of a person’s difficulties in life and of the goal of treatment as therefore transformation of id energy into ego structure so that primitive defenses can be relinquished and conflict resolved – “Where id was, there shall ego be” (Freud 1923), I will go on to broaden Freud’s conceptualization of neurotic conflict to encompass, more generally, growth-impeding tension between anxiety-provoking but ultimately health-promoting internal forces pressing yes and anxiety- assuaging internal counterforces defending no.
The aim of treatment will then become (1) to tame the id so that its now more manageable energy can be redirected into more constructive channels and used to power the pursuit of healthier endeavors and (2) to strengthen the ego so that it will become both better able to cope with the multitude of anxiety-provoking stressors (internal and external) to which it is being continuously exposed and more skilled at harnessing id energy to fuel actualization of potential. In essence, a tamer id and a stronger ego will enable the patient to cope with the stress of life (Selye 1978) by adapting instead of defending – “Where defense was, there shall adaptation be.”
In the treatment situation, the therapist will offer psychotherapeutic interventions specifically designed to precipitate disruption in order to trigger repair (Stark 2008, 2012, 2014). To be effective against dysfunctional defenses that have become firmly entrenched over time, despite having long since outlived their usefulness, these therapeutic interventions must be optimally stressful. In other words, they must be strategically formulated to offer just the right combination of challenge and support.
Martha Stark MD – 1994 A Primer on Working with Resistance.pdfMartha Stark MD
Every day after work, a very depressed young man sits in the dark in his living room hour after hour, doing nothing, his mind blank. By his side is his stereo and a magnificent collection of his favorite classical music. The flick of a switch and he would feel better- and yet night after night, overwhelmed with despair, he just sits, never once touching that switch.
I would like to suggest that we think of this man as being in a state of internal conflict (although he may not, at this point, be aware of such conflict). He could turn on his stereo, but he does not. He could do something that would make him feel better, but he does nothing. Within this man is tension between what he "should" let himself do and what he finds himself doing instead.
In general, patients both do and don't want to get better. They both do and don't want to maintain things as they are. They both do and don't want to get on with their lives. They both are and aren't invested in their suffering. They are truly conflicted about all the choices that confront them.
The patient may protest that he desperately wants to change. He does and he doesn't. He may insist that he would do anything in order to feel better. Well, yes and no. On some level, everybody wants things to be better, but few are willing to change.
Drive theory conceives of conflict as involving internal tension between id impulse insisting "yes" and ego defense protesting "no" (with the superego coming down usually on the side of the ego). In Ralph Greenson's (1967) words: "A neurotic conflict is an uncon- scious conflict between an id impulse seeking discharge and an ego defense warding off the impulse's direct discharge or access to consciousness" (p. 17).
Although drives are considered part of the id, affects (drive derivatives) are thought to reside in the ego; in fact, the ego is said to be the seat of all affects. When Freud writes of psychic conflict between the id and the ego, it is understood that sometimes he is referring to conflict between an id drive and an ego defense and sometimes he is referring to conflict between an anxiety-provoking affect (in the ego but deriving from the id) and an ego defense.
Martha Stark MD – 1994 Working with Resistance.pdfMartha Stark MD
This book is about the patient’s resistance and his refusal to grieve. Drawing upon concepts from classical psychoanalysis, object relations theory, and self psychology, I present a model of the mind that takes into consideration the relationship between unmourned losses and how such losses are internally recorded – as both absence of good (structural deficit) and presence of bad (structural conflict). These internal records of traumatic disappointments sustained early on give rise to forces that interfere with the patient’s movement toward health – forces that constitute, therefore, the resistance.
Within the patient is a tension between that which the patient should let himself do/feel and that which he does/feels instead. Patient and therapist, as part of their work, will need to be able to understand and name, in a profoundly respectful fashion, both sets of forces –both those healthy ones, which impel the patient in the direction of progress, and those unhealthy resistive ones, which impede such progress. As part of the work to be done, the patient must eventually come to appreciate his investment in his defenses, how they serve him, and the price he pays for holding on to them.
My interest is in the interface between theory and practice –the ways in which theoretical constructs can be translated into the clinical situation; to that end, I suggest specific, prototypical interventions for each step of the working-through process.
My contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects. Instead, he protects himself from the pain of knowing the truth about his objects by clinging to misperceptions of them; holding on to his defensive need not to know enables him not to feel his grief.
To the extent that the patient is defended, to that extent will he be resistant to doing the work that needs ultimately to be done – grief work that will enable him to let go of the past, let go of his relentless pursuit of infantile gratification, and let go of his compulsive repetitions. Only as the patient grieves, doing now what he could not possibly do as a child, will he get better.
I believe that mental health has to do with the capacity to experience one’s objects as they are, uncontaminated by the need for them to be otherwise. A goal of treatment, therefore, is to transform the patient’s need for his objects to be other than who they are into the capacity to accept them as they are.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...Martha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...Martha Stark MD
Over the course of the decades, my own approach has become much more integrative and holistic – one that appreciates the complex interdependence of mind and body and the critical role played by the impact of stress on the MindBodyMatrix.
The living system – the ground regulation system – the divine matrix – the web of life – a liquid crystal through which information and energy flow.
More specifically, I will be speaking to the role played by limbic kindling and the resultant hypersensitivity to stress that is a hallmark of depressed patients.
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptxMartha Stark MD
This document discusses coronary artery disease and the impact of stress on heart health. It notes that coronary artery disease often develops silently and can cause sudden death in some cases. Chronic stress can damage blood vessels and cause plaque buildup over time by increasing blood pressure and viscosity. Psychological stress, depression, obesity, and other risk factors place cumulative stress on the heart and compromise its ability to adapt. Maintaining the heart's resilience by reducing stressors and replenishing nutrients is important for cardiovascular health.
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...Martha Stark MD
The document discusses how coherence emerges from chaos in complex adaptive systems like living organisms. It argues that through ongoing cycles of disruption and repair, such systems can self-organize and evolve from disorder to higher levels of order and coherence in response to environmental inputs. The ability of a system to process and integrate stressors over time determines whether it progresses towards health or disease.
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptxMartha Stark MD
traumatic stress – stress that the system cannot process and must therefore defend against
optimal stress – stress that the system can process, integrate, and ultimately adapt to, although always at some cost to the system
it's how well the living system (the MindBodyMatrix) is able to manage the cumulative impact of the myriad environmental stressors to which it is being continuously exposed that will make of them either traumatic events or growth opportunities
and that ability to manage stress is a story about the system's ability to process, integrate, and adapt to the impact of environmental challenge, input from the outside that either threatens to overwhelm the system or prompts the system to mobilize its ability to heal itself
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptxMartha Stark MD
Unexplained Chronic Illness
Martin Pall's compelling conceptualization of the excitotoxic cascade and its pivotal role in both the initiation and the perpetuation of chronic multisystem illnesses
one or more short-term stressors
chemical sensitivity – pesticides and organic solvents
chronic fatigue – bacterial and viral infections
fibromyalgia – physical traumas
PTSD – severe psychological traumas
to which the body responds with an outpouring of
excitotoxins (glutamate)
inflammatory factors (cytokines and eicosanoids)
free radicals (nitric oxide)
stress-induced outpouring of endogenous excitotoxins, inflammatory cytokines, and free radicals sets in motion (in certain susceptible individuals) the nitric oxide / peroxynitrite cycle
a viciously destructive, self-propagating cycle involving
immune stimulation, inflammatory cytokines, membrane destabilization, synaptic overactivity, opening of calcium-permeable channels, massive calcium influx, etc.
and culminating in chronic illness
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
2. OVERVIEW
EMPATHIC STATEMENTS
HEARTFELT STATEMENTS, NOT HEADY QUESTIONS
STATEMENTS THAT SUPPORT BY RESONATING EMPATHICALLY,
MOMENT BY MOMENT, WITH WHAT THE PATIENT IS ACTUALLY FEELING
HIGHLIGHTING NOT ONLY THE PATIENT’S AFFECT
BUT ALSO THE “STORIES” THAT SHE, AS A YOUNG CHILD,
HAD CONSTRUCTED IN A DESPERATE ATTEMPT TO MAKE SENSE
OF THE DEPRIVATION, NEGLECT, TRAUMA, AND ABUSE
TO WHICH SHE WAS BEING EXPOSED
NARRATIVES THAT HAVE NOW BECOME THE GO – TO (DISTORTED) FILTERS
THROUGH WHICH SHE EXPERIENCES SELF, OTHERS, AND THE WORLD
EXPERIENCE – NEAR, NOT EXPERIENCE – DISTANT
MANIFEST CONTENT, NOT LATENT CONTENT
CONFLICT STATEMENTS
TO FACILITATE THE DEVELOPMENT OF “DUAL AWARENESS”
ARTFULLY TITRATED BLEND OF CHALLENGE AND SUPPORT
TO CREATE “DESTABILIZING ANXIETY” AND INCENTIVIZING “OPTIMAL STRESS”
ITERATIVE HEALING CYCLES OF DISRUPTION (IN REACTION TO THE CHALLENGE)
AND REPAIR (IN RESPONSE TO THE SUPPORT)
GRADUAL REPLACEMENT OF OLD BAD NARRATIVES THAT LIMIT
WITH NEW GOOD NARRATIVES THAT OFFER MORE FREEDOM
AS PSYCHOLOGICAL RIGIDITY AND DEFENSIVE NEED
ARE GRADUALLY TRANSFORMED INTO
PSYCHOLOGICAL FLEXIBILITY AND ADAPTIVE CAPACITY 2
3. THE MEDICAL MODEL OF ”ASKING QUESTIONS”
TO “FERRET OUT THE TRUTH”
THE GOAL BEING TO “MAKE CONSCIOUS THE UNCONSCIOUS”
AND TO HELP THE PATIENT GAIN INSIGHT INTO
THE INNER WORKINGS OF HER MIND;
RECURRING THEMES, PATTERNS, AND REPETITIONS;
AND THE IMPACT OF HER PAST ON HER PRESENT
A “HEADY QUESTION” LIKE –
“THIS SENSE YOU HAVE OF BEING JUDGED BY YOUR FRIEND –
IS THAT PERHAPS A FAMILIAR FEELING FROM WAY BACK?”
INSTEAD OF AN “EMPATHIC STATEMENT” LIKE –
“ … SO PAINFUL – THIS FEELING OF BEING ALWAYS JUDGED … ”
A “HEADY QUESTION” LIKE –
“HOW DID YOU FEEL WHEN YOUR FATHER
KEPT CALLING YOU A LOSER?”
INSTEAD OF AN “EMPATHIC STATEMENT” LIKE –
“ … DEVASTATING AND ABSOLUTELY ENRAGING
WHEN YOUR FATHER KEPT CALLING YOU A LOSER … ” 3
4. “HEADY QUESTIONS” RUN THE RISK
OF ELICITING SOMEWHAT “HEADY ANSWERS”
MORE “HEADY” THAN “HEARTFELT”
MORE “COGNITIVE” THAN “EXPERIENTIAL” OR “EMBODIED”
OVER THE COURSE OF THE YEARS
I HAVE COME TO APPRECIATE THAT WHATEVER THE TREATMENT
– WHETHER CRISIS INTERVENTION, TRAUMA WORK,
SHORT – TERM INTENSIVE, OR LONG – TERM IN – DEPTH –
IT WILL GENERALLY BE MORE EFFECTIVE WHEN
– MOMENT BY MOMENT –
OUR FOCUS IS NOT ON OURSELVES
AND WHAT WE WANT TO FIND OUT
BUT ON THE PATIENT,
WHAT SHE IS EXPERIENCING,
AND WHAT SHE WANTS US TO KNOW
FOR THE MOST PART
I LET THE PATIENT LEAD – AND I FOLLOW
I MAKE STATEMENTS – AND DON’T ASK QUESTIONS
4
5. I TAKE MY CUES FROM THE PATIENT
LISTENING ALWAYS WITH COMPASSION AND NEVER JUDGMENT
– WITH BOTH “HEAD” AND “HEART” –
TO EVERYTHING THE PATIENT IS TELLING ME
– NO MATTER HOW SEEMINGLY IRRELEVANT IT MIGHT BE –
I WILL THEN OFFER “EMPATHIC STATEMENTS” THAT HIGHLIGHT
“WHAT THE PATIENT IS ACTUALLY FEELING”
AND “ABOUT WHAT”
STATEMENTS THAT OFTEN END WITH AN IMPLIED QUESTION MARK
WHEREBY I AM SIGNALING THAT I AM VERY OPEN
TO HAVING MY RENDERING OF THINGS
EDITED, CORRECTED, OR REVISED
IN ORDER TO MAKE IT A MORE ACCURATE REFLECTION
OF WHAT THE PATIENT IS ACTUALLY SAYING
AND WANTING ME TO KNOW
5
6. EXAMPLES OF EMPATHIC STATEMENTS
“ … HARD TO KNOW WHERE TO BEGIN
WHEN EVERYTHING FEELS SO OVERWHELMING … ”
“ … UNCOMFORTABLE TO BE HERE WHEN YOU’RE NOT SURE
THE THERAPY IS REALLY HELPING ANYWAY … ”
“ … UPSETTING TO BE FEELING THIS OUT OF CONTROL … ”
ALL OF WHICH SPEAK TO BOTH
THE PATIENT’S “AFFECT” AND THE “ASSOCIATED THEME”
IN OFFERING THE PATIENT EMPATHIC STATEMENTS,
I AM, OF COURSE, “GIVING” HER SOMETHING
RATHER THAN “ASKING” OF HER THAT SHE “GIVE” ME SOMETHING
NAMELY, ANSWERS TO MY QUESTIONS
“ … TIRED OF THINKING ABOUT WHETHER YOU SHOULD STAY OR GO … ”
“ … DEEP DESPAIR ABOUT EVER BEING ABLE TO FIND A TRUE SOULMATE … ”
“ … TERRIFIED THAT YOU WILL BE DISAPPOINTED … ”
“ … TERRIFIED THAT YOU YOURSELF WILL DISAPPOINT … ”
“ … CONFUSED ABOUT HOW BEST TO USE THE SESSION … ”
6
7. EMPATHIC STATEMENTS THAT HIGHLIGHT
WHAT THE PATIENT IS EXPERIENCING
IN A “SPECIFIC CONTEXT”
“ … PAINFUL TO BE FEELING SO MISUNDERSTOOD BY JUANITA … ”
CAN THEN USUALLY BE “GENERALIZED”
“ … PAINFUL TO BE FEELING ALWAYS SO MISUNDERSTOOD … ”
BY THE SAME TOKEN
EMPATHIC STATEMENTS THAT HIGHLIGHT
WHAT THE PATIENT IS EXPERIENCING
IN THE “PRESENT”
“ … PAINFUL TO BE FEELING SO MISUNDERSTOOD … ”
CAN THEN USUALLY BE “EXTENDED” TO THE “PAST”
“ … PAINFUL TO HAVE BEEN FEELING
SO MISUNDERSTOOD FOR SO LONG NOW … ”
7
8. PLEASE NOTE THAT INSTEAD OF
“I WONDER IF IT IS PAINFUL TO BE FEELING SO UNLOVABLE”
OR
“IT SOUNDS AS IF IT IS PAINFUL TO BE FEELING SO UNLOVABLE”
OR
“IT SEEMS AS IF IT IS PAINFUL TO BE FEELING SO UNLOVABLE”
YOU COULD SIMPLY SAY
“ … PAINFUL TO BE FEELING SO UNLOVABLE … ”
FOLLOWED BY AN IMPLIED QUESTION MARK
THEREBY SIGNALING THAT YOU ARE VERY OPEN
TO HAVING YOUR STATEMENT AMENDED
I DO MY BEST TO ELIMINATE EXTRA WORDS
AT THE BEGINNING OF MY EMPATHIC STATEMENTS
SO THAT I CAN CUT RIGHT TO THE CHASE
“ … PAINFUL TO BE FEELING SO UNLOVABLE … ”
EXTRA WORDS THAT RUN THE RISK
OF PUTTING TOO MUCH DISTANCE
BETWEEN YOU AND THE PATIENT
8
9. EMPATHIC STATEMENTS ARE “EXPERIENCE – NEAR”
– NOT “EXPERIENCE – DISTANT” –
AND ARE DESIGNED TO “VALIDATE” OR “REINFORCE”
THE PATIENT’S ACTUAL “EXPERIENCE” IN THE MOMENT
WHAT’S IN HER CONSCIOUSNESS
OR, PERHAPS, HER PRECONSCIOUS
THEY ARE NOT DESIGNED TO TARGET HER UNCONSCIOUS
I HONOR WHAT THE PATIENT IS ACTUALLY TELLING ME
AND DON’T TRY TO READ BETWEEN THE LINES
OR TO INTERPRET WHAT I THINK MIGHT LIE
BENEATH THE SURFACE
I FOCUS MORE ON THE “MANIFEST CONTENT”
THAN ON THE “LATENT CONTENT”
MY “DEFAULT MODE” ARE THESE EMPATHIC STATEMENTS
THAT FOCUS MORE ON HELPING THE PATIENT TO “FEEL UNDERSTOOD”
THAN ON HELPING HER TO “UNDERSTAND”
SHE, FEELING SUPPORTED, WILL THEN BE MORE INCLINED TO DELVE
MORE DEEPLY INTO WHAT IS REALLY GOING ON INSIDE HER
9
10. BECAUSE EMPATHIC STATEMENTS HIGHLIGHT
NOT ONLY THE PATIENT’S “AFFECT” IN THE MOMENT
BUT ALSO THE “STORY” THAT GOES WITH IT
“ … FEARFUL ALWAYS OF BEING JUDGED … ”
“ … WORRIED ABOUT WHAT I MIGHT BE THINKING … ”
ONGOING USE OF THESE STATEMENTS
NOT ONLY WILL ENABLE THE PATIENT TO FEEL
UNDERSTOOD, VALIDATED, AND SUPPORTED
BUT ALSO WILL START TO GIVE SHAPE
TO THE “FILTERS” THROUGH WHICH
SHE INTERPRETS HER LIFE …
THESE EMPATHIC STATEMENTS DO NOT SPECIFICALLY
”INCENTIVIZE” STRUCTURAL TRANSFORMATION AND GROWTH,
BUT THEY DO LAY THE GROUNDWORK FOR SUBSEQUENT
“OPTIMALLY STRESSFUL” INTERVENTIONS THAT WILL
10
11. EMPATHIC STATEMENTS ARE “MAKING EXPLICIT”
THE MALADAPTIVE, DISEMPOWERING NARRATIVES
THAT THE PATIENT HAD CONSTRUCTED AS A YOUNG CHILD
IN A DESPERATE ATTEMPT TO MAKE SENSE OF
THE TRAUMA AND ABUSE / THE DEPRIVATION AND NEGLECT
TO WHICH SHE WAS BEING EXPOSED
“ … SO AFRAID OF BEING PUNISHED … ”
“ … EXCRUCIATINGLY PAINFUL TO BE FEELING ALWAYS SO INVISIBLE … ”
“ … ENRAGING TO BE FEELING NEVER GOOD ENOUGH … ”
“ … PAINFUL TO BE FEELING SO BROKEN … ”
“STORIES” THE PATIENT HAD “MADE UP”
IN AN EFFORT TO UNDERSTAND
BUT “MADE – UP STORIES” THAT HAVE NOW GENERALIZED
FROM THE SMALL (HER NUCLEAR FAMILY)
TO THE ALL (THE WORLD AROUND HER)
“NARRATIVES” THAT HAVE BECOME THE “GO – TO”
DISTORTED FILTERS, OR LENSES, THROUGH WHICH
SHE EXPERIENCES SELF, OTHERS, AND THE WORLD
11
12. THE PATIENT COMES IN, STATING THAT SHE IS VERY UPSET
ABOUT SOMETHING THAT HAD HAPPENED THE PREVIOUS NIGHT
BUT ALSO STATING VERY CLEARLY THAT
SHE DOES NOT WANT TO TALK ABOUT IT
“OH DEAR! WHAT HAPPENED?”
DOES NOT HONOR WHAT THE PATIENT HAS JUST SAID
A MORE “EMPATHIC (EXPERIENCE – NEAR) RESPONSE” MIGHT BE –
“RIGHT NOW, IT JUST FEELS TOO UPSETTING
TO TALK ABOUT WHAT HAPPENED LAST NIGHT … ”
TO WHICH THE PATIENT MIGHT RESPOND WITH –
“AND I’M AFRAID TO TALK ABOUT IT
BECAUSE I FEEL SO ASHAMED”
TO WHICH WE MIGHT THEN RESPOND WITH –
“YOU WORRY ABOUT HOW YOU MIGHT BE JUDGED …”
OR, FOCUSING ON THE TRANSFERENCE,
“YOU WORRY ABOUT HOW I MIGHT JUDGE YOU … ”
12
13. AS NOTED EARLIER
WE COULD THEN OFFER THE MORE “GENERAL” –
“YOU FIND YOURSELF OFTEN WORRYING
ABOUT HOW YOU MIGHT BE JUDGED … ”
OR WE COULD HIGHLIGHT
THE PROBABLE “GENETIC UNDERPINNINGS” –
“YOU HAVE ALWAYS FOUND YOURSELF WORRYING
ABOUT HOW YOU MIGHT BE JUDGED –
AFTER ALL, YOUR DAD WAS A PRETTY HARSH CRITIC ... ”
AGAIN, WE ARE BEGINNING TO “MAKE EXPLICIT”
SOME OF THE OLD BAD NARRATIVES
ABOUT SELF, OTHERS, AND THE WORLD
THAT THE PATIENT HAD CONSTRUCTED EARLY ON
BEGINNING TO HIGLIGHT THE SPECIFICS OF
OUTDATED, MALADAPTIVE NARRATIVES THAT ARE
PROBABLY MORE IMPORTANT THAN THE SPECIFICS OF
WHAT HAD ACTUALLY HAPPENED THE PREVIOUS EVENING
13
14. … OLD BAD NARRATIVES
THAT ARE DISEMPOWERING,
DISTORTED, AND LIMITING
AND THAT WILL EVENTUALLY NEED TO BE UPDATED
AND REPLACED WITH NEW GOOD NARRATIVES
THAT ARE MORE EMPOWERING,
MORE REALITY – BASED, MORE AFFIRMING –
AND OFFER GREATER FREEDOM
PARENTHETICALLY
ONCE IT HAS BEEN “MADE EXPLICIT” THAT THE PATIENT
WAS HESITATING FOR FEAR OF BEING JUDGED
– A SELF – SABOTAGING NARRATIVE THAT HAS “LIMITED”
THE “EXPANSIVENESS” OF HER GROWTH SINCE CHILDHOOD –
SHE WILL PROBABLY END UP TALKING ABOUT
WHAT HAD ACTUALLY HAPPENED ANYWAY
“DEFENSE ANALYSIS” vs. “ID CONTENT”
“WORKING WITH THE RESISTANCE” 📕 📕 14
15. MOST PEOPLE ARE CONFLICTED ABOUT
MOST THINGS MOST OF THE TIME
WITH ONE PART OF THEM INVESTED IN
“SAME OLD SAME OLD” (OLD BAD)
AND ANOTHER PART OF THEM ABLE TO ENVISION
“SOMETHING NEW AND BETTER” (NEW GOOD)
“CONFLICT STATEMENTS” –
A UNIVERSALLY APPLICABLE INTERVENTION
THAT TARGETS THE PATIENT’S STATE OF
INTERNAL DIVIDEDNESS OR CONFLICTEDNESS
BETWEEN HEALTHY BUT ANXIETY – PROVOKING FORCES
PRESSING FOR “SOMETHING NEW AND BETTER”
AND LESS HEALTHY BUT ANXIETY – ASSUAGING
(DEFENSIVE) COUNTERFORCES
INSISTING UPON “SAME OLD SAME OLD”
15
16. “EMPATHIC STATEMENTS” OFFER “SUPPORT”
BUT “CONFLICT STATEMENTS”
ARE STRATEGICALLLY DESIGNED
TO OFFER AN ARTFUL COMBINATION OF
“CHALLENGE”
– BY INTRODUCING THE POSSIBILITY OF (ADAPTIVE) CHANGE –
AND “SUPPORT”
– BY RESONATING EMPATHICALLY WITH THE PATIENT’S
(DEFENSIVE) INVESTMENT IN STAYING THE SAME –
THE NET RESULT OF THIS
INTUITIVELY TITRATED BLEND OF
“CHALLENGE”
– WHICH WILL PROVOKE THE PATIENT’S ANXIETY –
AND “SUPPORT”
– WHICH WILL EASE IT –
WILL BE THE GENERATION OF
INCENTIVIZING “OPTIMAL STRESS”
NECESSARY IF DEEP, ENDURING, CHARACTEROLOGICAL
TRANSFORMATION AND RENEWAL IS THE ULTIMATE GOAL
16
17. “SELF – ORGANIZING (COMPLEX ADAPTIVE) SYSTEMS
– LIKE US –
RESIST PERTURBATION”
CHARLES KREBS (2013)
THERE MUST BE ENOUGH “CHALLENGE”
TO A DYSFUNCTIONAL (CHAOTIC) SYSTEM
THAT THERE WILL BE “IMPETUS” FOR
DESTABILIZATION OF ITS (DYSFUNCTIONAL) STATUS QUO
BUT ENOUGH “SUPPORT”
THAT THERE WILL BE “OPPORTUNITY”
FOR ITS RESTABILIZATION
AT A HEALTHIER LEVEL OF FUNCTIONALITY
“SUPPORT” REINFORCED BY TAPPING INTO
THE PATIENT’S UNDERLYING RESILIENCE
AND INNATE ABILITY TO SELF – CORRECT
IN THE FACE OF OPTIMAL CHALLENGE
17
18. OPTIMALLY STRESSFUL “CONFLICT STATEMENTS”
ARE THEREFORE DESIGNED
FIRST TO INCREASE ANXIETY BY
“CHALLENGING” THE DEFENSE
AND THEN TO DECREASE ANXIETY BY
“SUPPORTING” THE DEFENSE
ALL WITH AN EYE TO “MAKING EXPLICIT”
THE CONFLICT WITHIN THE PATIENT
BETWEEN THE HEALTHY PART OF HER
THAT HAS THE “ADAPTIVE CAPACITY”
TO KNOW WHAT’S REAL / WHAT’S TRUE
AND THE LESS HEALTHY PART OF HER
THAT HAS THE “DEFENSIVE NEED”
TO RESIST THAT KNOWING
“YOU KNOW THAT EVENTUALLY YOU WILL NEED
TO MAKE YOUR PEACE WITH THE REALITY
OF JUST HOW LIMITED YOUR MOTHER IS;
BUT YOUR FEAR IS THAT WERE YOU EVER TO LET
YOURSELF REALLY FEEL THE PAIN OF THAT,
YOU WOULD NEVER RECOVER.” 18
19. “YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA
IS TO SURVIVE, YOU’LL NEED TO TAKE AT LEAST
SOME RESPONSIBILITY FOR THE PART YOU’RE PLAYING
IN THE INCREDIBLY ABUSIVE FIGHTS
THAT YOU AND SHE ARE HAVING;
BUT YOU TELL YOURSELF THAT IT ISN’T REALLY YOUR FAULT
BECAUSE IF SHE WEREN’T SO PROVOCATIVE,
THEN YOU WOULDN’T HAVE TO BE SO VINDICTIVE!”
EVER ATTUNED TO THE IMPORTANCE OF CREATING
AN OPTIMAL BALANCE BETWEEN CHALLENGE AND SUPPORT,
WE MUST CONTINUOUSLY KEEP OUR FINGER
ON THE PULSE OF THE LEVEL OF THE PATIENT’S ANXIETY
ALWAYS FOCUSING
ON WHETHER WE THINK THE PATIENT WILL BE ABLE
TO TOLERATE FURTHER (ANXIETY – PROVOKING) CHALLENGE
– IN WHICH CASE WE WILL INTRODUCE MORE CHALLENGE –
OR WILL REQUIRE ADDITIONAL (ANXIETY – ASSUAGING) SUPPORT
– IN WHICH CASE WE WILL OFFER MORE SUPPORT –
19
20. INDEED, IT COULD BE SAID THAT
WITHOUT SUPPORT, THERAPY NEVER BEGINS
BUT WITHOUT CHALLENGE, THERAPY NEVER ENDS
ALTERNATIVELY
WITHOUT CHALLENGE, THERAPY NEVER BEGINS
BUT WITHOUT SUPPORT, THERAPY NEVER ENDS
BY THE SAME TOKEN, IT COULD BE SAID THAT
WITHOUT EMPATHY, THERAPY NEVER BEGINS
BUT WITHOUT EMPATHIC FAILURE, THERAPY NEVER ENDS
OR
WITHOUT EMPATHIC FAILURE, THERAPY NEVER BEGINS
BUT WITHOUT EMPATHY, THERAPY NEVER ENDS
THEREFORE
CHALLENGE WHENEVER POSSIBLE
– BY DIRECTING THE PATIENT’S ATTENTION TO WHERE SHE IS NOT –
SUPPORT WHENEVER NECESSARY
– BY LANDING WHERE THE PATIENT IS –
20
21. LET US IMAGINE THAT A PATIENT
IS TRYING HARD TO END HER RELATIONSHIP
WITH AN ABUSIVE BOYFRIEND BUT
IS TERRIFIED OF BEING ALONE AGAIN
“ … TERRIFYING TO THINK ABOUT ENDING
THE RELATIONSHIP AND BEING ALONE AGAIN –
SCARED TO DEATH THAT YOU SIMPLY WOULDN’T SURVIVE … ”
WHERE WE ARE RESONATING EMPATHICALLY WITH HER TERROR,
NAMELY, WITH THE “UNHEALTHY COUNTERFORCE”
THAT IS GETTING IN THE WAY OF THE “HEALTHY FORCE”
THAT KNOWS SHE SHOULD END THE ABUSIVE RELATIONSHIP
ALTERNATIVELY, WE COULD OFFER THE FOLLOWING
“OPTIMALLY STRESSFUL” INTERVENTION
“YOU KNOW THAT ULTIMATELY YOU WILL NEED
TO END THE RELATIONSHIP WITH JORGE
BECAUSE HE TREATS YOU SO SHABBILY;
BUT YOU ARE NOT QUITE YET READY TO DO THAT
BECAUSE YOU ARE TERRIFIED OF BEING ALONE AGAIN –
SCARED TO DEATH THAT YOU SIMPLY WOULDN’T SURVIVE.”
21
22. TO REVIEW
CONFLICT STATEMENTS FIRST SPEAK TO
THE PATIENT’S
“ADAPTIVE (AND GROWTH – PROMOTING) CAPACITY”
TO KNOW AN ANXIETY – PROVOKING TRUTH
AND THEN RESONATE EMPATHICALLY WITH
THE PATIENT’S
“DEFENSIVE (AND GROWTH – IMPEDING) NEED”
TO AVOID THAT KNOWING
IN OTHER WORDS
THEY FIRST “CHALLENGE” THE DEFENSE
BY DIRECTING THE PATIENT’S ATTENTION
TO WHERE SHE ISN’T BUT WHERE WE WANT HER TO GO
– SALMAN AKHTAR’S “DISRUPTIVE ATTUNEMENT” –
AND THEN “SUPPORT” THE DEFENSE
BY LANDING WHERE THE PATIENT IS
– SALMAN AKHTAR’S “HOMEOSTATIC ATTUNEMENT”
SALMAN AKHTAR (2012)
22
23. BY LOCATING WITHIN THE PATIENT CONFLICT BETWEEN
WHAT SHE “KNOWS” AND WHAT SHE, MADE ANXIOUS,
FINDS HERSELF (DEFENSIVELY) “THINKING, FEELING, OR DOING”
IN ORDER NOT TO HAVE TO CONFRONT THAT REALITY,
THE THERAPIST IS DEFTLY SIDESTEPPING THE POTENTIAL
FOR CONFLICT BETWEEN HERSELF AND THE PATIENT
MORE SPECIFICALLY
WHEN THE THERAPIST INTRODUCES A CONFLICT STATEMENT WITH
“YOU KNOW THAT … , ” SHE IS FORCING THE PATIENT TO TAKE
RESPONSIBILITY FOR WHAT THE PATIENT REALLY DOES KNOW
IF, INSTEAD, THE THERAPIST
– IN A MISGUIDED ATTEMPT TO URGE THE PATIENT FORWARD –
RESORTS SIMPLY TO TELLING THE PATIENT
WHAT THE THERAPIST KNOWS,
NOT ONLY DOES THE THERAPIST RUN THE RISK OF FORCING
THE PATIENT TO BECOME EVER – MORE ENTRENCHED
IN HER DEFENSIVE STANCE OF PROTEST
BUT THE THERAPIST WILL ALSO BE DEPRIVING THE PATIENT
OF ANY INCENTIVE TO TAKE RESPONSIBILITY
FOR HER OWN DESIRE TO GET BETTER 23
24. IN OTHER WORDS
AS A RESULT OF THE JUDICIOUS USE OF CONFLICT STATEMENTS
THAT FORCE THE PATIENT TO BECOME AWARE OF
– AND TO TAKE RESPONSIBILITY FOR –
HER OWN STATE OF INTERNAL “DIVIDEDNESS” ABOUT GETTING BETTER
– IN OTHER WORDS, HER AMBIVALENCE –
THE THERAPIST WILL BE ABLE MASTERFULLY TO AVOID
GETTING DEADLOCKED IN A POWER STRUGGLE WITH THE PATIENT –
A POWER STRUGGLE THAT CAN EASILY ENOUGH ENSUE
IF THE THERAPIST TAKES IT UPON HERSELF
TO REPRESENT THE “VOICE OF REALITY”
AND OVERZEALOUSLY ADVOCATES FOR THE PATIENT
TO DO THE “RIGHT / HEALTHY” THING
– A STANCE THAT THEN LEAVES THE PATIENT, MADE ANXIOUS,
NO CHOICE BUT TO BECOME THE “VOICE OF OPPOSITION”
“YOU’RE COMING TO UNDERSTAND THAT
YOUR ANGER CAN PUT PEOPLE OFF;
BUT YOU TELL YOURSELF THAT
YOU HAVE A RIGHT TO BE AS ANGRY AS YOU WANT
BECAUSE OF HOW MUCH YOU HAVE SUFFERED
OVER THE COURSE OF THE YEARS.”
24
25. NOTE THE IMPLICIT MESSAGE DELIVERED BY THE THERAPIST
IN THE SECOND PART OF A CONFLICT STATEMENT
WHEN SHE USES SUCH TEMPORAL EXPRESSIONS AS
“FOR NOW” / “RIGHT NOW” / “AT THE MOMENT”
“IN THE MOMENT” / “AT THIS POINT IN TIME”
WHICH SHE WILL DO WHEN SHE IS ADDRESSING
THE PATIENT’S “INVESTMENT” IN THE DYSFUNCTIONAL DEFENSE
THE THERAPIST IS ATTEMPTING TO HIGHLIGHT THE FACT
THAT EVEN IF, FOR NOW, THE PATIENT WOULD SEEM TO BE
ENTRENCHED IN PROTESTING HER RIGHT TO MAINTAIN THINGS
AS THEY ARE, AT ANOTHER POINT IN TIME, THAT COULD CHANGE
“YOU KNOW THAT SOMEDAY YOU’LL HAVE TO LET SOMEBODY IN
IF YOU’RE EVER TO HAVE A MEANINGFUL RELATIONSHIP; BUT, AT
THE MOMENT, THE THOUGHT OF MAKING YOURSELF THAT VULNERABLE
IS SIMPLY OUT OF THE QUESTION. THERE’S ABSOLUTELY NO WAY
YOU’RE WILLING TO RUN THE RISK OF BEING HURT EVER AGAIN.”
“YOU KNOW THAT IF YOU ARE EVER TO GET ON WITH YOUR LIFE,
YOU’LL HAVE TO LET GO OF YOUR CONVICTION THAT YOUR
CHILDHOOD SCARRED YOU FOREVER; BUT IT’S HARD NOT TO FEEL
LIKE DAMAGED GOODS, RIGHT NOW, WHEN YOU GREW UP IN
A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN AND NASTY MOTHER
WHO KEPT TELLING YOU THAT YOU WERE A FAILURE.” 25
26. CONFLICT STATEMENTS ARE THE MAINSTAY OF
MODEL 1 IN MY PSYCHODYNAMIC SYNERGY PARADIGM
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYTIC THEORY
A THEORY THAT, AS WE KNOW, PRIVILEGES
“INSIGHT” OR “AWARENESS”
CONFLICT STATEMENTS ARE SPECIFICALLY FORMULATED
TO FACILITATE DEVELOPMENT OF NOT JUST “AWARENESS”
BUT ALSO “DUAL AWARENESS”
NAMELY, THE PATIENT’S ABILITY TO BECOME “AWARE OF”
BOTH WHAT HER “OBSERVING EGO” HAS THE
“HEALTHY CAPACITY TO KNOW”
AND WHAT HER “EXPERIENCING EGO” HAS THE
”DEFENSIVE NEED TO AVOID KNOWING”
IN OTHER WORDS
BOTH WHAT HER “REFLECTIVE SELF” “KNOWS”
AND WHAT HER “REFLEXIVE SELF,” MADE ANXIOUS,
“FINDS ITSELF (DEFENSIVELY) THINKING, FEELING, OR DOING
IN ORDER NOT TO HAVE TO KNOW”
26
27. ULTIMATELY
DUAL AWARENESS – “WISE MIND”
THE HEALTHY ABILITY TO HOLD “SIMULTANEOUS AWARENESS” OF BOTH
KNOWLEDGE AND EXPERIENCE
OBJECTIVE REALITY AND SUBJECTIVE EXPERIENCE
HEAD AND HEART
LEFT BRAIN AND RIGHT BRAIN
EXPLICIT COGNITIVE AND IMPLICIT EMOTIONAL
REASON AND EMOTION
“HERE – AND – NOW” AND “THERE – AND – THEN”
PRESENT AND PAST
NEW GOOD AND OLD BAD
PROSPECTIVE AND RETROSPECTIVE
UPDATED AND OUTDATED
RESPONSIVE AND REACTIVE
REFLECTIVE AND REFLEXIVE
MINDFUL AND MINDLESS
FLEXIBLE AND RIGID
ADAPTIVE CAPACITY AND DEFENSIVE NEED
ADAPTATION AND DEFENSE 27
28. IN CLOSING
I WOULD LIKE TO BORROW FROM STEPHEN MITCHELL (1988)
A WONDERFUL ANECDOTE THAT CAPTURES THE ESSENCE
OF THE QUINTESSENTIAL STRUGGLE IN WHICH ALL OF US
ARE ENGAGED AS WE ATTEMPT TO MASTER OUR ART
MITCHELL WRITES –
“<STRAVINSKY> HAD WRITTEN A NEW PIECE WITH A DIFFICULT
VIOLIN PASSAGE. AFTER IT HAD BEEN IN REHEARSAL FOR
SEVERAL WEEKS, THE SOLO VIOLINIST CAME TO STRAVINSKY
AND SAID HE WAS SORRY, HE HAD TRIED HIS BEST, <BUT> THE
PASSAGE WAS TOO DIFFICULT; NO VIOLINIST COULD PLAY IT.
STRAVINSKY SAID, ‘I UNDERSTAND THAT. WHAT I AM AFTER
IS THE SOUND OF SOMEONE TRYING TO PLAY IT.’”
AS THERAPISTS, OUR WORK IS EXQUISITELY DIFFICULT
AND FINELY TUNED – AND OFTEN WE WILL NOT BE ABLE
TO GET IT JUST RIGHT – PERHAPS, HOWEVER, WE CAN
CONSOLE OURSELVES WITH THE THOUGHT THAT
IT IS THE EFFORT WE MAKE TO GET IT JUST RIGHT
THAT ULTIMATELY COUNTS
28
30. IF YOU WOULD
LIKE TO BE
ON MY MAILING LIST,
PLEASE EMAIL ME AT
MarthaStarkMD @
HMS.Harvard.edu
30
31. REFERENCES
Akhtar S. 2012. Psychoanalytic listening: Methods, limitations, and
innovations. New York, NY: Routledge / Taylor & Francis Group.
Freud S. 1923. The ego and the id. New York: W. W. Norton & Co.
Krebs C. 2013. Energetic kinesiology: Principles and practice.
Middletown, NY: Handspring Publishing.
Stark M. 1999. Modes of therapeutic action: Enhancement of
knowledge, provision of experience, and engagement in relationship.
Northville, NJ: Jason Aronson.
Winnicott DW. 1965. The maturational processes and the facilitating
environment. Madison, CT: International Universities Press.
31
Editor's Notes
Welcome. I am Dr. Martha Stark.
I thank you all for signing up for my 4-week-long PSYCHODYNAMIC PSYCHOTHERAPY BOOT CAMP entitled THE TRANSFORMATIVE POWER OF OPTIMAL STRESS: FROM CURSING THE DARKNESS TO LIGHTING A CANDLE.
The BOOT CAMP has a second title: THE THERAPEUTIC USE OF STRESS TO PROVOKE RECOVERY. Actually, the Course has a third title: NO PAIN, NO GAIN.
Although I recorded this Narrated PowerPoint Slide Show a little while ago, I am looking forward to being able to interact directly with all of you over the course of the next 4 weeks – by way of “threaded discussions” or “online chatting” about whatever questions, comments, or reflections, you might find yourself having about the material that I will be presenting each week (each of the 4 1-hour lectures will be presented in easy-to-digest 6 to 8 segments).
Interestingly, the “threaded discussions” in which we will all be participating allow for an interesting (and paradoxical) combination of intimacy and anonymity. You can participate as much or as little as you would like – and you can offer as many or as few “posts” as you would like. We just ask, please, that you limit each post to 100 words or fewer.
I will be presenting a tremendous amount of material but will be doing a lot of repeating (telling you in advance what I’m going to tell you, then telling you, and then telling you after the fact what I have told you) – but I have organized the material in these bite-size 7-10 minute segments that you can go back to review whenever you might want to.
So, please, settle in, buckle up, kick back, crank up the volume, and enjoy!