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 – 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.
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 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 – 31 Mar 2022 – The Art and The Science of Interpretation.pptxMartha 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 – 18 Mar 2022 – The Art and The Science of Interpretation.pptxMartha 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 – 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 – 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 – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha 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 – 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.
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 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 – 31 Mar 2022 – The Art and The Science of Interpretation.pptxMartha 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 – 18 Mar 2022 – The Art and The Science of Interpretation.pptxMartha 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 – 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 – 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 – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha 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 – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD
This document discusses the therapeutic use of optimal stress to provoke recovery from psychological defenses to more adaptive responses. It argues that psychodynamic psychotherapy can help patients master past traumatic experiences by superimposing an acute stressor to trigger healing cycles of disruption and repair. This allows defenses to gradually evolve into more flexible adaptations through iterative cycles of destabilization caused by therapeutic challenges, followed by restabilization due to support. The goal is to transform "rigid defense" into "flexible adaptation" and help patients thrive rather than just survive.
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 – 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.
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...Martha Stark MD
As you sit with your clients, 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 clients. Whether working within (1) the interpretive perspective of classical psychoanalytic theory, (2) the corrective-provision perspective of self psychology, or (3) the intersubjective perspective of contemporary relational theory, we are always busy deciding when we should highlight the healthy forces within our clients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.”
With our finger always on the pulse of the level of the client’s anxiety, we are indeed ever focused, be it consciously or unconsciously, on whether we think the client will be able to tolerate further (anxiety-provoking) challenge or will require additional (anxiety-assuaging) support – a critically important balance that is needed if the therapeutic endeavor is to be advanced.
To illustrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the client’s “defensive need” to maintain “same old, same old” and the client’s “adaptive capacity” to embrace “something new, different, and better.”
Clinical vignettes will be offered demonstrating judicious and ongoing use of these “optimally stressful” interventions that alternately support and then challenge the defense, thereby galvanizing advancement of the client, over time, from psychological rigidity (defense) to psychological flexibility (adaptation).
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 clients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of these 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 – 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 – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD
My most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model (Model 5 of my Psychodynamic Synergy Paradigm) that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (whether real or simply envisioned). A constructivist model at heart, this freshly minted model features a quantum-neuroscientific approach to healing “analysis paralysis.”
This newest addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
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 – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptxMartha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
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.
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.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD
Are you wishing that you had a better grasp of psychodynamic concepts and their application to the clinical hour? With an emphasis always on the translation of theory into practice, in this 2-hour intensive training Dr. Martha Stark will be highlighting the three major psychoanalytic schools:
(Model 1) the 1-person perspective of classical psychoanalysis – a “cognitive” approach that emphasizes “enhancement of knowledge” and “interpreting”;
(Model 2) the 1½-person perspective of self psychology – an “affective” approach that emphasizes “provision of experience” and “grieving”; and
(Model 3) the 2-person perspective of contemporary relational theory – a “relational” approach that emphasizes “engagement in relationship” and “negotiating mutual enactment.”
Martha is particularly interested in (1) how the “therapeutic process” between patient and therapist evolves over time, (2) what happens moment-to-moment in the intersubjective space between patient and therapist, (3) how healing cycles of disruption and repair can be generated when the therapist alternately challenges the patient’s defense and then supports it, and (4) how the ongoing provision of “optimal stress” can ultimately “incentivize” deep, enduring, characterological change in the patient.
In order to facilitate this advancement of the patient from psychological rigidity to psychological flexibility and from defensive reaction to adaptive response, Martha will be teaching three “optimally stressful” template statements – Model 1 “conflict statements,” Model 2 “disillusionment statements,” and Model 3 “accountability statements” – all of which are strategically designed to “precipitate disruption” in order to “trigger repair,” thereby healing unmastered early-on relational traumas and deeply embedded emotional injuries.
Martha will be presenting several brief clinical vignettes to demonstrate the transformation of “resistance” into “awareness” (Model 1), “relentless hope” into “acceptance” (Model 2), and “re-enactment” into “accountability” (Model 3).
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD
The document outlines Martha Stark's psychodynamic synergy paradigm, which utilizes five therapeutic models to catalyze psychological change. It focuses on the first three models: 1) the interpretive perspective of classical psychoanalysis, 2) the corrective provision perspective of self psychology, and 3) the intersubjective perspective of contemporary relational theory. The therapeutic actions of these three models involve "working through" optimal stress created by interventions that alternate between challenge and support. Model 1 uses interpretations to resolve internal conflicts. Model 2 helps patients grieve disappointments. Model 3 promotes taking accountability in relationships. The goal across all three is to transform patients from rigidity to flexibility.
Martha Stark MD – 29 Apr 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.
Psychodynamic 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 arises in the context of surviving disappointment and heartbreak. By the same token, 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.
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
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 – 4 May 2023 – Practical Clinical Interventions for Incentivi...Martha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
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.
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.
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 – 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 – 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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Similar to Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolving Psychodynamic Process.pptx
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD
This document discusses the therapeutic use of optimal stress to provoke recovery from psychological defenses to more adaptive responses. It argues that psychodynamic psychotherapy can help patients master past traumatic experiences by superimposing an acute stressor to trigger healing cycles of disruption and repair. This allows defenses to gradually evolve into more flexible adaptations through iterative cycles of destabilization caused by therapeutic challenges, followed by restabilization due to support. The goal is to transform "rigid defense" into "flexible adaptation" and help patients thrive rather than just survive.
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 – 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.
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...Martha Stark MD
As you sit with your clients, 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 clients. Whether working within (1) the interpretive perspective of classical psychoanalytic theory, (2) the corrective-provision perspective of self psychology, or (3) the intersubjective perspective of contemporary relational theory, we are always busy deciding when we should highlight the healthy forces within our clients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.”
With our finger always on the pulse of the level of the client’s anxiety, we are indeed ever focused, be it consciously or unconsciously, on whether we think the client will be able to tolerate further (anxiety-provoking) challenge or will require additional (anxiety-assuaging) support – a critically important balance that is needed if the therapeutic endeavor is to be advanced.
To illustrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the client’s “defensive need” to maintain “same old, same old” and the client’s “adaptive capacity” to embrace “something new, different, and better.”
Clinical vignettes will be offered demonstrating judicious and ongoing use of these “optimally stressful” interventions that alternately support and then challenge the defense, thereby galvanizing advancement of the client, over time, from psychological rigidity (defense) to psychological flexibility (adaptation).
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 clients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of these 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 – 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 – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD
My most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model (Model 5 of my Psychodynamic Synergy Paradigm) that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (whether real or simply envisioned). A constructivist model at heart, this freshly minted model features a quantum-neuroscientific approach to healing “analysis paralysis.”
This newest addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
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 – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptxMartha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
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.
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.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD
Are you wishing that you had a better grasp of psychodynamic concepts and their application to the clinical hour? With an emphasis always on the translation of theory into practice, in this 2-hour intensive training Dr. Martha Stark will be highlighting the three major psychoanalytic schools:
(Model 1) the 1-person perspective of classical psychoanalysis – a “cognitive” approach that emphasizes “enhancement of knowledge” and “interpreting”;
(Model 2) the 1½-person perspective of self psychology – an “affective” approach that emphasizes “provision of experience” and “grieving”; and
(Model 3) the 2-person perspective of contemporary relational theory – a “relational” approach that emphasizes “engagement in relationship” and “negotiating mutual enactment.”
Martha is particularly interested in (1) how the “therapeutic process” between patient and therapist evolves over time, (2) what happens moment-to-moment in the intersubjective space between patient and therapist, (3) how healing cycles of disruption and repair can be generated when the therapist alternately challenges the patient’s defense and then supports it, and (4) how the ongoing provision of “optimal stress” can ultimately “incentivize” deep, enduring, characterological change in the patient.
In order to facilitate this advancement of the patient from psychological rigidity to psychological flexibility and from defensive reaction to adaptive response, Martha will be teaching three “optimally stressful” template statements – Model 1 “conflict statements,” Model 2 “disillusionment statements,” and Model 3 “accountability statements” – all of which are strategically designed to “precipitate disruption” in order to “trigger repair,” thereby healing unmastered early-on relational traumas and deeply embedded emotional injuries.
Martha will be presenting several brief clinical vignettes to demonstrate the transformation of “resistance” into “awareness” (Model 1), “relentless hope” into “acceptance” (Model 2), and “re-enactment” into “accountability” (Model 3).
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD
The document outlines Martha Stark's psychodynamic synergy paradigm, which utilizes five therapeutic models to catalyze psychological change. It focuses on the first three models: 1) the interpretive perspective of classical psychoanalysis, 2) the corrective provision perspective of self psychology, and 3) the intersubjective perspective of contemporary relational theory. The therapeutic actions of these three models involve "working through" optimal stress created by interventions that alternate between challenge and support. Model 1 uses interpretations to resolve internal conflicts. Model 2 helps patients grieve disappointments. Model 3 promotes taking accountability in relationships. The goal across all three is to transform patients from rigidity to flexibility.
Martha Stark MD – 29 Apr 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.
Psychodynamic 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 arises in the context of surviving disappointment and heartbreak. By the same token, 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.
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
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 – 4 May 2023 – Practical Clinical Interventions for Incentivi...Martha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
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.
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.
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 – 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.
Similar to Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolving Psychodynamic Process.pptx (20)
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 – 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
Martha Stark MD – 22 Jun 2018 – A Heart Shattered, Relentless Despair, and A ...Martha 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.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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.
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
5. PREVIEW
RELEVANT FOR BOTH CHILD (GROWING UP)
AND PATIENT (GETTING BETTER)
THE THERAPEUTIC USE OF “OPTIMAL STRESS”
TO “PROVOKE” TRANSFORMATION AND GROWTH
TRANSFORMATION OF DYSFUNCTIONAL DEFENSE
INTO MORE FUNCTIONAL ADAPTATION
WHERE ID WAS, THERE SHALL EGO BE
WHERE DEFENSE WAS, THERE SHALL ADAPTATION BE
AN ONGOING PROCESS INVOLVING
HEALING CYCLES OF DISRUPTION AND REPAIR
THE THERAPIST WILL PRECIPITATE DISRUPTION
IN ORDER TO TRIGGER REPAIR
BY WAY OF “OPTIMALLY STRESSFUL” INTERVENTIONS THAT
ALTERNATELY CHALLENGE AND THEN SUPPORT THE DEFENSE
5
6. PREVIEW
THE DEVELOPMENTAL PROCESS
AND THE THERAPEUTIC PROCESS
FROM PSYCHOLOGICAL RIGIDITY
TO PSYCHOLOGICAL FLEXIBILITY
FROM DEFENSIVE REACTION
TO ADAPTIVE RESPONSE
FROM OUTDATED DEFENSE
TO UPDATED ADAPTATION
WHERE DEFENSE WAS,
THERE SHALL ADAPTATION BE
6
7. PREVIEW
THREE MODELS
IN MY PSYCHODYNAMIC SYNERGY PARADIGM
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
COGNITVE – STRENGTHENING OF THE “EGO”
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
AFFECTIVE – CONSOLIDATION OF THE “SELF”
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
RELATIONAL – ACCOUNTABILITY FOR THE “SELF – IN – RELATION”
7
8. PREVIEW
FROM RIGID DEFENSE TO MORE FLEXIBLE ADAPTATION
DEFENSES – THE THREE “Rs”
ADAPTATIONS – THE THREE “As”
MODEL 1 – “RESISTANCE” TO “AWARENESS”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2 – “RELENTLESS HOPE” TO “ACCEPTANCE”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
MODEL 3 – “RE – ENACTMENT” TO “ACCOUNTABILITY”
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
8
9. PREVIEW
THREE APPROACHES TO
TRANSFORMING DEFENSE INTO ADAPTATION
THREE OPTIMAL STRESSORS – THE THREE “Ds”
MODEL 1 – “RESISTANCE” TO “AWARENESS”
BY WORKING THROUGH THE STRESS OF
“COGNITIVE DISSONANCE”
THE EXPERIENCE OF GAIN – BECOME – PAIN
MODEL 2 – “RELENTLESS HOPE” TO “ACCEPTANCE”
BY WORKING THROUGH THE STRESS OF
“AFFECTIVE DISILLUSIONMENT”
THE EXPERIENCE OF GOOD – BECOME – BAD
MODEL 3 – “RE – ENACTMENT” TO “ACCOUNTABILITY”
BY WORKING THROUGH THE STRESS OF
“RELATIONAL DETOXIFICATION”
THE EXPERIENCE OF BAD – BECOME – GOOD
9
10. PREVIEW
FROM RIGID DEFENSE TO MORE FLEXIBLE ADAPTATION
FROM CURSING THE DARKNESS TO LIGHTING A CANDLE
MODEL 1 – “RESISTANCE” TO “AWARENESS”
CLASSICAL PSYCHOANALYSIS
THE THERAPEUTIC ACTION FOCUSES ON “INTERPRETING”
ANXIETY – PROVOKING TRUTHS ABOUT THE “SELF”
MODEL 2 – “RELENTLESS HOPE” TO “ACCEPTANCE”
SELF PSYCHOLOGY
THE THERAPEUTIC ACTION FOCUSES ON “GRIEVING”
ANXIETY – PROVOKING TRUTHS ABOUT THE “OTHER”
MODEL 3 – “RE – ENACTMENT” TO “ACCOUNTABILITY”
CONTEMPORARY RELATIONAL THEORY
THE THERAPEUTIC ACTION FOCUSES ON “TAKING OWNERSHIP OF”
ANXIETY – PROVOKING TRUTHS ABOUT THE “SELF – IN – RELATION”
10
11. PREVIEW
BY WAY OF “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS
THAT SUPERIMPOSE AN ACUTE INJURY ON TOP OF A CHRONIC ONE
– THEREBY TRIGGERING HEALING CYCLES OF DISRUPTION AND REPAIR –
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
– FROM OUTDATED DEFENSE TO UPDATED ADAPTATION – 11
13. MY PSYCHODYNAMIC SYNERGY PARADIGM FEATURES
THREE “OPTIMALLY STRESSFUL” STATEMENTS
CORRESPONDING TO EACH OF THE THREE MODELS
– CLASSICAL PSYCHOANALYTIC, SELF PSYCHOLOGICAL,
AND CONTEMPORARY RELATIONAL –
BUT THESE “INCENTIVIZINGLY DESTABILIZING” STATEMENTS
WILL BE MOST EFFECTIVE IF OFFERED AGAINST
THE BACKDROP OF “EMPATHIC STATEMENTS”
THAT FIRST RESONATE EMPATHICALLY WITH WHAT
THE PATIENT IS ACTUALLY FEELING IN THE MOMENT
AND THEN HIGHLIGHT THE “THEME” OR “NARRATIVE”
ASSOCIATED WITH THAT FEELING
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
13
14. 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 … ”
14
15. 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 … ”
15
16. 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 RUN THE RISK OF PUTTING TOO MUCH DISTANCE
BETWEEN THE THERAPIST AND THE PATIENT
16
17. EMPATHIC STATEMENTS ARE “EXPERIENCE – NEAR”
– NOT “EXPERIENCE – DISTANT” –
AND ARE DESIGNED TO “VALIDATE” OR “REINFORCE”
WHEREVER THE PATIENT MIGHT BE IN THE MOMENT
WHAT IS IN HER CONSCIOUSNESS
OR PERHAPS HER PRECONSCIOUS
THEY ARE NOT DESIGNED TO TARGET HER UNCONSCIOUS
WITH EMPATHIC STATEMENTS
I AM HONORING WHAT THE PATIENT IS TELLING ME
AND NOT TRYING TO READ BETWEEN THE LINES
OR TO INTERPRET WHAT I THINK MIGHT LIE
BENEATH THE SURFACE
MY FOCUS IS 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 17
18. 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
THE PATIENT 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
18
19. 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
19
20. LET US IMAGINE THAT THE PATIENT IS TRYING HARD
TO END HER RELATIONSHIP WITH AN ABUSIVE BOYFRIEND
BUT IS TERRIFIED OF BEING ALONE AGAIN
“ … FRIGHTENING TO THINK ABOUT ENDING
THE RELATIONSHIP AND BEING ALONE AGAIN –
TERRIFIED THAT YOU SIMPLY WOULDN’T SURVIVE … ”
HERE WE ARE OFFERING THE PATIENT AN “EMPATHIC STATEMENT”
IN WHICH WE ARE “RESONATING EMPATHICALLY” WITH HER TERROR
NAMELY, WITH THE “UNHEALTHY (DEFENSIVE) COUNTERFORCE”
THAT IS GETTING IN THE WAY OF THE “(ADAPTIVE) HEALTHY FORCE”
THAT KNOWS SHE SHOULD END THE ABUSIVE RELATIONSHIP
ALTERNATIVELY, WE COULD OFFER HER
AN “OPTIMALLY STRESSFUL” “CONFLICT STATEMENT”
“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.”
20
21. “EMPATHIC STATEMENTS” OFFER “SUPPORT”
BUT “CONFLICT STATEMENTS”
ARE STRATEGICALLLY DESIGNED
TO OFFER AN ARTFUL COMBINATION OF
“CHALLENGE”
– BY INTRODUCING THE POSSIBILITY OF 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
21
22. “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
WHEN YOU GREW UP IN A HORRIBLY ABUSIVE HOUSEHOLD
WITH A MEAN AND NASTY MOTHER
WHO KEPT TELLING YOU THAT YOU WERE A FAILURE.”
“YOU KNOW THAT, ULTIMATELY, YOU’LL NEED TO LET MIGUEL GO
BECAUSE HE, LIKE YOUR DAD, REALLY ISN’T AVAILABLE
IN THE WAYS THAT YOU WOULD HAVE WANTED HIM TO BE;
BUT, FOR NOW, ALL YOU CAN THINK ABOUT IS HOW DESPERATELY
YOU NEED HIM AND HOW HORRIBLE IT WOULD BE TO LOSE HIM.”
“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.”
22
23. THESE “OPTIMALLY STRESSFUL” STATEMENTS
ARE 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.” 23
24. THE ULTIMATE GOAL OF CONFLICT STATEMENTS
DEVELOPMENT OF 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
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
24
26. THE RELATIONSHIP BETWEEN DEFENSE AND ADAPTATION
YIN AND YANG
COMPLEMENTARY – NOT OPPOSING – FORCES
FOR EXAMPLE, SHADOW CANNOT EXIST WITHOUT LIGHT
DEFENSES
DYSFUNCTIONAL / UNHEALTHY
RIGID / UNEVOLVED
ADAPTATIONS
MORE FUNCTIONAL / MORE HEALTHY
MORE FLEXIBLE / MORE EVOLVED
ALTHOUGH DEFENSES MIGHT
ONCE HAVE BEEN NECESSARY
FOR THE PATIENT TO SURVIVE,
THEY MUST ULTIMATELY
BE REPLACED BY ADAPTATIONS
IF THE PATIENT IS TO THRIVE
26
27. THE ULTIMATE GOAL OF PSYCHODYNAMIC PSYCHOTHERAPY
IS TO FACILITATE THE INCREMENTAL PROCESSING
AND INTEGRATING OF STRESSFUL EXPERIENCES
IN BOTH THE “THERE – AND – THEN” AND THE “HERE – AND – NOW”
FROM DEFENSIVE REACTION
TO ADAPTIVE RESPONSE
FROM RIGID AND OUTDATED DEFENSE
TO MORE FLEXIBLE AND UPDATED ADAPTATION
FROM DYSFUNCTIONAL DEFENSE
TO MORE FUNCTIONAL ADAPTATION
FROM DYSFUNCTIONAL ACTIONS, REACTIONS, AND INTERACTIONS
TO MORE FUNCTIONAL WAYS OF BEING AND DOING
FROM UNHEALTHY NEED
TO HEALTHY CAPACITY
FROM DISEMPOWERING AND RESTRICTIVE
TO MORE EMPOWERING AND EXPANSIVE 27
28. FROM EXTERNALIZING BLAME
TO TAKING OWNERSHIP
FROM WHINING AND COMPLAINING
TO BECOMING PROACTIVE
FROM DENYING
TO CONFRONTING HEAD – ON
FROM BEING CRITICAL
TO BECOMING MORE COMPASSIONATE
FROM DISSOCIATING
TO BECOMING MORE PRESENT
FROM FEELING VICTIMIZED
TO TAKING OWNERSHIP
FROM BEING JAMMED UP
TO MOBILIZING ONE’S ENERGIES
IN THE PURSUIT OF ONE’S DREAMS
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE 28
29. GROWING UP (THE TASK OF THE CHILD)
AND GETTING BETTER (THE TASK OF THE PATIENT)
CAN ALSO BE DESCRIBED AS
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 FOR
INTERNAL SELF – REGULATION
THE NEED TO HOLD ON
INTO THE CAPACITY TO LET GO
29
31. MY PSYCHODYNAMIC SYNERGY PARADIGM
IS AN INTEGRATIVE APPROACH TO HEALING
FEATURING THREE INTERDEPENDENT
– MUTUALLY ENHANCING (NOT MUTUALLY EXCLUSIVE) –
MODES OF THERAPEUTIC ACTION
MODEL 1
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “ABSENCE OF GOOD”
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “PRESENCE OF BAD”
31
32. MODEL 1 – COGNITIVE
ENHANCEMENT OF KNOWLEDGE “WITHIN”
ULTIMATELY, A STRONGER, WISER,
AND MORE EMPOWERED “EGO”
MODEL 2 – AFFECTIVE
PROVISION OF EXPERIENCE “FOR”
ULTIMATELY, A MORE CONSOLIDATED
AND COMPASSIONATE “SELF”
MODEL 3 – RELATIONAL
ENGAGEMENT IN RELATIONSHIP “WITH”
ULTIMATELY, A MORE ACCOUNTABLE
“SELF – IN – RELATION”
32
33. MODEL 1 – THINKING
1 – PERSON PSYCHOLOGY
FOCUSES ON THE PATIENT’S INTERNAL DYNAMICS
MODEL 2 – FEELING
1½ – PERSON PSYCHOLOGY
FOCUSES ON THE PATIENT’S AFFECTIVE EXPERIENCE
MODEL 3 – DOING
2 – PERSON PSYCHOLOGY
FOCUSES ON THE PATIENT’S RELATIONAL DYNAMICS
HEAD, HEART, AND HAND
33
34. IN TRUTH
WE ARE ALL A LITTLE
NEUROTIC, NARCISSISTIC,
AND NOXIOUS IN OUR RELATEDNESS
MODEL 1 – KNOWLEDGE
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
NEUROTIC CONFLICTEDNESS
MODEL 2 – EXPERIENCE
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
NARCISSISTIC VULNERABILITY
MODEL 3 – RELATIONSHIP
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
NOXIOUS RELATEDNESS
34
35. MODEL 1
WHERE RESISTANCE WAS,
THERE SHALL AWARENESS BE
MODEL 2
WHERE RELENTLESSNESS WAS,
THERE SHALL ACCEPTANCE BE
MODEL 3
WHERE RE – ENACTMENT WAS,
THERE SHALL ACCOUNTABILITY BE
35
37. BAD STUFF HAPPENS
BUT IT WILL BE HOW WELL THE PATIENT
IS ABLE TO PROCESS, INTEGRATE,
AND ADAPT TO ITS IMPACT
PSYCHOLOGICALLY, PHYSIOLOGICALLY, AND ENERGETICALLY
THAT WILL MAKE OF IT
EITHER A GROWTH – DISRUPTING TRAUMA
THAT OVERWHELMS BECAUSE IT IS “TOO MUCH”
AND PLUMMETS THE PATIENT INTO FURTHER DECLINE
OR A GROWTH – PROMOTING OPPORTUNITY
THAT MAKES POSSIBLE TRANSFORMATION AND RENEWAL
37
38. THE OPERATIVE CONCEPT HERE WILL BE
THE ONGOING GENERATION OF
“DESTABILIZING ANXIETY”
AND “INCENTIVIZING STRESS”
“OPTIMAL STRESS”
HANS SELYE’S “EUSTRESS” vs. “DISTRESS” (1978)
THE CREATION OF
JUST THE RIGHT BALANCE
BETWEEN “CHALLENGE”
– TO PROVOKE “DISRUPTION” –
AND “SUPPORT”
– TO JUMPSTART “REPAIR” –
38
39. IN THE PHYSICAL REALM
SUPERIMPOSING AN ACUTE PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES EXACTLY WHAT THE BODY NEEDS
IN ORDER TO HEAL
IN ESSENCE
“CONTROLLED DAMAGE” TO “PROVOKE HEALING”
BY WAY OF EXAMPLES
HIGH – INTENSITY INTERVAL TRAINING (HIIT) / INTERMITTENT FASTING
ELECTROCONVULSIVE THERAPY (ECT) / TRANSCRANIAL MAGNETIC STIMULATION (TCM)
CARDIAC DEFIBRILLATION
ACUPUNCTURE / ACUPRESSURE / CUPPING
RED LIGHT THERAPY / INFRARED SAUNAS / CRYOTHERAPY
HOMEOPATHIC REMEDIES / VACCINES AND OTHER IMMUNOTHERAPIES
PLATELET – RICH PLASMA (PRP) / PLATELET – RICH FIBRIN (PRF)
DERMABRASION / FRAXEL LASER TREATMENTS
BRAIN TEASERS AND MENTAL EXERCISES
HYPERBARIC OXYGEN
“PRECIPITATE DISRUPTION” TO “TRIGGER (ADAPTIVE) RECOVERY”
39
40. A PRIME EXAMPLE OF “CREATING INJURY” TO “STIMULATE HEALING”
PROLOTHERAPY
A HIGHLY EFFECTIVE TREATMENT
FOR CHRONIC LIGAMENT AND TENDON WEAKNESS
IT INVOLVES INJECTING A MILDLY IRRITATING AQUEOUS SOLUTION
– e. g., DEXTROSE, WATER, AND A LOCAL ANESTHETIC (LIDOCAINE) –
INTO THE AFFECTED LIGAMENT OR TENDON
IN ORDER TO INDUCE A MILD INFLAMMATORY REACTION
IN ESSENCE, IT WILL “TURN ON” THE BODY’S HEALING PROCESS
AND RESULT ULTIMATELY IN STRENGTHENING
OF THE DAMAGED CONNECTIVE TISSUE
AND ALLEVIATION OF CHRONIC MUSCULOSKELETAL PAIN
BY CONTRAST – CORTISONE INJECTIONS MIGHT WELL PROVIDE
IMMEDIATE PAIN RELIEF OVER THE SHORT – TERM BUT TISSUE
DESTRUCTION AND EXACERBATION OF PAIN OVER THE LONG – TERM
– BECAUSE OF THE CATABOLIC EFFECTS OF STEROID HORMONES –
PROLOTHERAPY INJECTIONS, HOWEVER, SUPPORT THE NATURAL
HEALING PROCESS BY STIMULATING THE HEALING CASCADE
– RESULTING ULTIMATELY IN OVERALL STRENGTHENING
OF THE CONNECTIVE TISSUE MATRIX AND RELIEF OF PAIN – 40
41. JUST AS WITH THE BODY
– WHERE A CHRONIC CONDITION MIGHT NOT HEAL UNTIL IT IS MADE ACUTE –
SO TOO WITH THE MIND
INDEED
OVER TIME I HAVE COME TO APPRECIATE THAT
WHETHER CRISIS INTERVENTION / TRAUMA WORK
SHORT – TERM INTENSIVE / LONGER – TERM IN – DEPTH
THE THERAPEUTIC PROVISION OF JUST
THE RIGHT COMBINATION OF “CHALLENGE” AND “SUPPORT”
NAMELY, “OPTIMAL STRESS”
– AGAINST THE BACKDROP OF SECURE ATTACHMENT,
EMPATHIC ATTUNEMENT, AUTHENTIC ENGAGEMENT,
AND A COLLABORATIVE ALLIANCE –
IS SOMETIMES THE “DESTABILIZING PROVOCATION” NEEDED
BOTH TO OVERCOME THE RESISTANCE TO CHANGE
SO FREQUENTLY ENCOUNTERED IN OUR PATIENTS
AND TO TRANSFORM THE DEFENSIVE NEED
TO MAINTAIN THINGS AS THEY ARE
INTO THE ADAPTIVE CAPACITY TO EVOLVE 41
42. A HUMOROUS EXAMPLE OF THIS “RESISTANCE TO CHANGE”
A SATURDAY NIGHT LIVE SKIT IN WHICH
TWO MEN ARE SEATED AROUND A FIRE
CHATTING AND ONE SAYS TO THE OTHER –
“YOU KNOW HOW WHEN YOU STICK
A POKER IN THE FIRE AND LEAVE IT IN
FOR A LONG TIME,
IT GETS REALLY, REALLY HOT?
AND THEN YOU STICK IT IN YOUR EYE,
AND IT REALLY, REALLY HURTS?
I HATE IT WHEN THAT HAPPENS!
I JUST HATE IT WHEN THAT HAPPENS!”
42
43. OR THE ROCK SONG
BY THE LATE WARREN ZEVON (1996)
ENTITLED
“IF YOU WON’T LEAVE ME
I’LL FIND SOMEBODY WHO WILL”
WHICH SPEAKS TO THE NEED
WE ALL HAVE TO RECREATE
THE “FAMILIAL AND THEREFORE FAMILIAR”
STEPHEN MITCHELL (1988)
BECAUSE THAT IS ALL WE HAVE EVER KNOWN
HAVING SOMETHING DIFFERENT
WOULD CREATE ANXIETY
43
44. I AM HERE REMINDED OF PORTIA NELSON’S
AUTOBIOGRAPHY IN 5 SHORT CHAPTERS (1993)
WHICH HIGHLIGHTS BOTH
OUR DEFENSIVE NEED TO MAINTAIN THINGS AS THEY ARE
AND OUR ADAPTIVE CAPACITY ULTIMATELY TO CHANGE
CHAPTER 1
I WALK DOWN THE STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I FALL IN
I AM LOST … I AM HELPLESS
IT ISN’T MY FAULT
IT TAKES FOREVER TO FIND A WAY OUT
CHAPTER 2
I WALK DOWN THE SAME STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I PRETEND I DON’T SEE IT
I FALL IN AGAIN
I CAN’T BELIEVE I AM IN THE SAME PLACE
BUT IT ISN’T MY FAULT
IT STILL TAKES A LONG TIME TO GET OUT
44
45. CHAPTER 3
I WALK DOWN THE SAME STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I SEE IT IS THERE
I STILL FALL IN … IT’S A HABIT
MY EYES ARE OPEN
I KNOW WHERE I AM
IT IS MY FAULT
I GET OUT IMMEDIATELY
CHAPTER 4
I WALK DOWN THE SAME STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I WALK AROUND IT
CHAPTER 5
I WALK DOWN ANOTHER STREET
45
46. IN TRUTH
“SELF – ORGANIZING (CHAOTIC) SYSTEMS
– LIKE ALL OF US! –
RESIST PERTURBATION”
CHARLES KREBS (2013)
THERE MUST BE ENOUGH “CHALLENGE”
TO A DYSFUNCTIONAL SYSTEM
THAT THERE WILL BE “IMPETUS”
FOR ITS DESTABILIZATION
BUT ENOUGH “SUPPORT”
THAT THERE WILL BE “OPPORTUNITY”
FOR ITS RESTABILIZATION
AT A HEALTHIER LEVEL
OF FUNCTIONALITY AND ADAPTABILITY
SUPPORT REINFORCED BY TAPPING INTO
THE SYSTEM’S UNDERLYING RESILIENCE
AND INNATE CAPACITY TO SELF – CORRECT
IN THE FACE OF OPTIMAL CHALLENGE
46
47. 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
47
48. MORE SPECIFICALLY
IT IS NOT SO MUCH EMPATHY AS
EMPATHIC FAILURE AGAINST A BACKDROP OF EMPATHY
OPTIMAL DISILLUSIONMENT
IT IS NOT SO MUCH GRATIFICATION AS
FRUSTRATION AGAINST A BACKDROP OF GRATIFICATION
OPTIMAL FRUSTRATION
IT IS NOT SO MUCH SUPPORT AS
CHALLENGE AGAINST A BACKDROP OF SUPPORT
OPTIMAL STRESS
THAT WILL PROVIDE THE THERAPEUTIC LEVERAGE
NEEDED TO PROVOKE FIRST DESTABILIZATION
AND THEN RESTABILIZATION
AT A HIGHER LEVEL OF ADAPTIVE CAPACITY
BECAUSE DEEP, ENDURING, CHARACTEROLOGICAL CHANGE
REQUIRES THIS “INCENTIVIZING” OPTIMAL STRESS
48
49. THE GOLDILOCKS PRINCIPLE OF STRESS
TOO MUCH CHALLENGE
WILL OVERWHELM AND PROMPT DEFENSE BECAUSE
IT IS “TOO MUCH” TO BE PROCESSED AND INTEGRATED
TRAUMATIC STRESS
TOO LITTLE CHALLENGE
WILL OFFER TOO LITTLE IMPETUS FOR
TRANSFORMATION AND GROWTH AND WILL SERVE SIMPLY
TO REINFORCE THE (DYSFUNCTIONAL) STATUS QUO
BUT JUST THE RIGHT AMOUNT OF CHALLENGE
WILL PROVIDE JUST THE RIGHT AMOUNT OF LEVERAGE
NEEDED TO JUMPSTART, AFTER INITIAL DISRUPTION,
RECOVERY AT A HIGHER LEVEL OF
INTEGRATION, FUNCTIONALITY, AND ADAPTIVE CAPACITY
OPTIMAL (NON – TRAUMATIC) STRESS
49
50. WITH THE THERAPIST’S FINGER
EVER ON THE PULSE
OF THE LEVEL OF THE PATIENT’S ANXIETY
AND CAPACITY TO TOLERATE FURTHER CHALLENGE
THE THERAPIST WILL THEREFORE
CHALLENGE WHENEVER POSSIBLE
BY DIRECTING THE PATIENT’S
ATTENTION TO WHERE THE PATIENT IS NOT
(SALMAN AKHTAR’S “DISRUPTIVE ATTUNEMENT”)
SUPPORT WHENEVER NECESSARY
BY LANDING WHERE THE PATIENT IS
(SALMAN AKHTAR’S “HOMEOSTATIC ATTUNEMENT”)
50
51. ALL WITH AN EYE
TO CREATING JUST THE
RIGHT LEVEL OF
“INCENTIVIZING ANXIETY”
AND “DESTABILIZING STRESS”
OPTIMAL STRESS
THEREBY OPTIMIZING THE POTENTIAL
FOR TRANSFORMATION AND GROWTH
AND MAKING POSSIBLE
DEEP, ENDURING, CHARACTEROLOGICAL CHANGE
51
52. IN ESSENCE
IT WILL BE “INPUT”
FROM THE OUTSIDE
AND THE PATIENT’S CAPACITY
TO PROCESS, INTEGRATE, AND ADAPT TO
THE IMPACT OF THIS “INPUT”
THAT WILL ULTIMATELY
ENABLE THE PATIENT
TO GET BETTER
. 52
53. BUT MORE SPECIFICALLY
IT WILL BE “STRESSFUL INPUT”
FROM THE OUTSIDE
AND THE PATIENT’S CAPACITY
TO PROCESS, INTEGRATE, AND ADAPT TO
THE IMPACT OF THIS “STRESS”
THAT WILL ULTIMATELY
PROVOKE RECOVERY
.
53
54. AND ADVANCE THE PATIENT TO
EVER – MORE EVOLVED LEVELS OF
AWARENESS
MODEL 1
ACCEPTANCE
MODEL 2
ACCOUNTABILITY
MODEL 3
54
55. THESE THREE “As” ARE A REFLECTION
OF THE PATIENT’S RESILIENCE AND HEALTH
AWARENESS OF ANXIETY – PROVOKING
TRUTHS ABOUT THE “SELF”
(MODEL 1)
ACCEPTANCE OF ANXIETY – PROVOKING
TRUTHS ABOUT THE “OBJECTS OF HER DESIRE”
(MODEL 2)
ACCOUNTABILITY FOR ANXIETY – PROVOKING
TRUTHS ABOUT THE “SELF – IN – RELATION”
(MODEL 3)
ALL THREE “As” ARE ADAPTATIONS
TO THE “STRESS OF LIFE”
55
56. AGAIN
– BY SUPERIMPOSING AN ACUTE INJURY ON TOP OF A CHRONIC ONE –
OPTIMALLY STRESSFUL THERAPEUTIC INTERVENTIONS
WILL TRIGGER HEALING CYCLES OF DISRUPTION AND REPAIR
SUCH THAT PSYCHODYNAMIC PSYCHOTHERAPY
WILL AFFORD 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
– FROM OUTDATED DEFENSE TO UPDATED ADAPTATION –
56
57. STRESS IS WHEN
YOU WAKE UP SCREAMING
AND THEN YOU REALIZE
YOU HAVEN’T FALLEN
ASLEEP YET
ANONYMOUS
57
59. WHEREAS CLASSICAL PSYCHOANALYSIS
CONCEIVES OF THE PATIENT’S PSYCHOPATHOLOGY
AS DERIVING FROM THE PATIENT
– IN WHOM THERE IS PRESUMED TO BE AN IMBALANCE
OF FORCES AND THEREFORE INTERNAL CONFLICT –
BETWEEN DYSREGULATED FORCES
ARISING FROM THE ID
AND DEFENSIVE COUNTERFORCES
ARISING FROM AN EGO MADE ANXIOUS
CONTEMPORARY PSYCHOANALYSIS
CONCEIVES OF THE PATIENT’S PSYCHOPATHOLOGY
AS DERIVING FROM THE PARENT
– AND THE PARENT’S TRAUMATIC FAILURE OF THE CHILD –
I AM SPEAKING HERE TO THE DISTINCTION BETWEEN
NATURE
– WHAT DERIVES FROM WITHIN THE CHILD (MODEL 1) –
AND NURTURE
– WHAT DERIVES FROM WITHIN THE RELATIONSHIP
BETWEEN PARENT AND CHILD (MODELS 2 AND 3) –
59
60. IN OTHER WORDS
SELF PSYCHOLOGISTS AND
RELATIONAL THEORISTS FOCUS
NOT SO MUCH ON NATURE
THE PROVINCE OF MODEL 1
AS ON NURTURE
THE PROVINCE OF MODELS 2 AND 3
WHETHER
THE QUALITY OF PARENTAL CARE
MODEL 2
OR
THE MUTUALITY OF FIT
BETWEEN PARENT AND CHILD
MODEL 3
60
61. BUT PLEASE NOTE
THE CRITICAL DISTINCTION
BETWEEN
QUALITY OF PARENTAL CARE
A STORY ABOUT “GIVE”
WHICH MAKES OF MODEL 2
A 1½ – PERSON PSYCHOLOGY
AND MUTUALITY OF FIT
A STORY ABOUT “GIVE – AND – TAKE”
WHICH MAKES OF MODEL 3
A 2 – PERSON PSYCHOLOGY
61
62. MORE SPECIFICALLY
MODEL 2
AN “I – IT” RELATIONSHIP
A 1 – WAY RELATIONSHIP BETWEEN
SOMEONE WHO GIVES
AND SOMEONE WHO TAKES
MODEL 3
AN “I – THOU” RELATIONSHIP
A 2 – WAY RELATIONSHIP INVOLVING
GIVE – AND – TAKE, MUTUALITY, RECIPROCITY,
COLLABORATION, AND INTERACTIVE REGULATION
AN INTERSUBJECTIVE RELATIONSHIP
INVOLVING TWO SUBJECTS
– BOTH OF WHOM CONTRIBUTE TO WHAT TRANSPIRES
AT THEIR “INTIMATE EDGE” (DARLENE EHRENBERG) –
MARTIN BUBER (2000)
62
63. THE EMPHASIS IN MODEL 2 IS THEREFORE
NOT SO MUCH ON THE RELATIONSHIP PER SE
AS IT IS ON THE FILLING IN OF
THE PATIENT’S DEFICITS BY WAY OF
THE THERAPIST’S CORRECTIVE PROVISION
OR, PERHAPS MORE ACCURATELY,
AS IT IS ON THE FILLING IN OF
THE PATIENT’S DEFICITS BY WAY OF
WORKING THROUGH FAILURES
IN THE ENVIRONMENTAL PROVISION
AS SUCH, IT INVOLVES “DISRUPTED POSITIVE TRANSFERENCE”
AND “GRIEVING DISILLUSIONMENT”
BY CONTRAST
THE EMPHASIS IN MODEL 3 IS
TRULY ON A “2 – WAY” RELATIONSHIP
BETWEEN TWO “AUTHENTIC SUBJECTS”
AS SUCH, IT INVOLVES “NEGATIVE TRANSFERENCE”
AND “NEGOTIATING PROJECTIVE IDENTIFICATION”
63
64. WHEN A PARENT FAILS HER CHILD,
HOW IS THAT FAILURE INTERNALLY RECORDED
AND STRUCTURALIZED?
INTERESTINGLY, SOME THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS
BECAUSE OF WHAT THE PARENT “DID NOT DO”
– “ABSENCE OF GOOD” IN THE PARENT – CHILD RELATIONSHIP
GIVES RISE TO DEFICIT AND IMPAIRED CAPACITY IN THE CHILD –
MODEL 2
WHEREAS OTHER THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS
BECAUSE OF WHAT THE PARENT “DID DO”
– “PRESENCE OF BAD” IN THE PARENT – CHILD RELATIONSHIP
GIVES RISE TO INTERNAL BAD OBJECTS,
PATHOGENIC INTROJECTS,
DYSFUNCTIONAL RELATIONAL CONFIGURATIONS –
MODEL 3
64
65. MORE SPECIFICALLY
WHEREAS MODEL 2 THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT “DID NOT DO”
DEPRIVATION AND NEGLECT
“ABSENCE OF GOOD”
DEFICIENCY
INTERNALLY RECORDED IN THE FORM OF
STRUCTURAL DEFICIT AND IMPAIRED CAPACITY
TO BE A GOOD PARENT UNTO ONESELF
DEFICITS WHICH THEN GIVE RISE TO THE
DESPERATE SEARCH FOR A NEW GOOD PARENT
“RELENTLESS PURSUITS” IN AN EFFORT
TO COMPENSATE FOR EARLY – ON
“PARENTAL ERRORS OF OMISSION”
65
66. MODEL 3 THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT “DID DO”
TRAUMA AND ABUSE
“PRESENCE OF BAD”
TOXICITY
INTERNALLY RECORDED AND STRUCTURALIZED IN
THE FORM OF PATHOGENIC INTROJECTS
WHICH ARE THEN “COMPULSIVELY AND UNWITTINGLY”
RE – ENACTED ON THE STAGE OF ONE’S LIFE
– AGAIN AND AGAIN –
IN A DESPERATE ATTEMPT TO ENCOUNTER
DIFFERENT AND BETTER OUTCOMES EVERY “NEXT TIME”
“COMPULSIVE RE – ENACTMENTS” IN AN EFFORT
TO CORRECT FOR EARLY – ON
“PARENTAL ERRORS OF COMMISSION”
66
67. CENTER STAGE IN MODELS 2 AND 3 ARE
THE THERAPIST’S “INEVITABLE FAILURES” OF THE PATIENT
TO HIGHLIGHT THE DISTINCTION BETWEEN
A MODEL OF THERAPEUTIC ACTION THAT INVOLVES “GIVE”
– AND IS THEREFORE 1 – WAY –
AND A MODEL THAT INVOLVES “GIVE – AND – TAKE”
– AND IS THEREFORE 2 – WAY –
CONSIDER THE FOLLOWING –
SELF PSYCHOLOGY (MODEL 2)
CONTENDS THAT THE THERAPIST
WILL INEVITABLY FAIL HER PATIENT
BECAUSE THE THERAPIST IS ONLY HUMAN
– IS NOT, AND CANNOT BE EXPECTED TO BE, PERFECT –
BUT HOW DOES CONTEMPORARY RELATIONAL THEORY
CONCEIVE OF SUCH FAILURES?
67
68. IN MODEL 3, SUCH FAILURES ARE THOUGHT TO BE
NOT JUST A STORY ABOUT THE THERAPIST
– AND HER LACK OF PERFECTION –
BUT ALSO A STORY ABOUT THE PATIENT
– AND HER EXERTING OF “INTERPERSONAL PRESSURE”
ON THE THERAPIST TO PARTICIPATE
IN OLD “FAMILIAL AND THEREFORE FAMILIAR” WAYS –
STEPHEN MITCHELL (1988)
IN OTHER WORDS
THE MODEL 3 THERAPIST’S FAILURES ARE THOUGHT
NOT TO HAPPEN IN A VACUUM BUT TO BE CO – CREATED
THEY OCCUR IN THE CONTEXT OF AN
ONGOING, CONTINUOUSLY EVOLVING RELATIONSHIP
BETWEEN TWO REAL PEOPLE
AND SPEAK TO THE PATIENT’S
COMPULSIVE AND UNWITTING “NEED TO BE FAILED”
IN WAYS SPECIFICALLY DETERMINED
BY HER EARLY – ON HISTORY
PATRICK CASEMENT (1992)
68
69. WITH RESPECT TO THESE (MODEL 3) “COMPULSIVE RE – ENACTMENTS”
AS WITH EVERY REPETITION COMPULSION
THERE ARE BOTH UNHEALTHY AND HEALTHY COMPONENTS
THE UNHEALTHY COMPONENT HAS TO DO
WITH THE PATIENT’S NEED
TO HAVE MORE OF SAME
– NO MATTER HOW DYSFUNCTIONAL –
BECAUSE THAT IS ALL
THE PATIENT HAS EVER KNOWN
HAVING SOMETHING DIFFERENT WOULD CREATE ANXIETY
BECAUSE IT WOULD HIGHLIGHT THE FACT THAT THINGS
COULD BE, AND COULD THEREFORE HAVE BEEN, DIFFERENT
BUT THE HEALTHY PIECE HAS TO DO
WITH THE PATIENT’S NEED
TO ACHIEVE BELATED MASTERY
OF THE PARENTAL FAILURES
69
70. MODELS 2 AND 3
BUT WHETHER THE PATHOGENIC FACTOR
IS AN ERROR OF OMISSION (MODEL 2)
– DEPRIVATION AND NEGLECT –
OR AN ERROR OF COMMISSION (MODEL 3)
– TRAUMA AND ABUSE –
THE VILLAIN IN THE PIECE IS THOUGHT TO BE
NOT THE CHILD BUT THE PARENT
NOT SURPRISINGLY, AS THE ETIOLOGY HAS SHIFTED
– OVER THE DECADES –
FROM NATURE TO NURTURE,
SO TOO THE LOCUS OF THE THERPEUTIC ACTION
HAS SHIFTED FROM INSIGHT
TO EXPERIENCE AND RELATIONSHIP
– THAT IS, FROM WITHIN THE PATIENT (MODEL 1)
TO WITHIN THE RELATIONSHIP BETWEEN
THERAPIST AND PATIENT (MODELS 2 AND 3) –
70
72. “PRECIPITATE DISRUPTION” TO “TRIGGER RECOVERY”
“OPTIMALLY STRESSFUL”
INTERVENTIONS
ALTERNATELY CHALLENGE
THEN SUPPORT
ANXIETY – PROVOKING
IN THE SHORT – TERM
BUT GROWTH – PROMOTING
IN THE LONG – TERM
72
73. MODEL 1
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
OPTIMALLY STRESSFUL
“CONFLICT STATEMENTS”
“YOU KNOW THAT … , BUT (MADE ANXIOUS)
YOU FIND YOURSELF THINKING / FEELING / DOING
IN ORDER NOT TO HAVE TO KNOW … ”
73
74. MODEL 2
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
OPTIMALLY STRESSFUL
“DISILLUSIONMENT STATEMENTS”
“YOU HAD SO HOPED THAT … ,
BUT YOU ARE BEGINNING TO REALIZE THAT … ,
AND IT DEVASTATES / ENRAGES YOU … ”
74
75. MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
OPTIMALLY STRESSFUL
“RELATIONAL INTERVENTIONS”
HIGHLIGHT
EITHER GETTING OTHERS TO DO UNTO HER
IN THE HERE – AND – NOW
SOME VERSION OF WHAT HAD BEEN DONE UNTO HER
IN THE THERE – AND – THEN
OR DOING UNTO OTHERS
IN THE HERE – AND – NOW
SOME VERSION OF WHAT HAD BEEN DONE UNTO HER
IN THE THERE – AND – THEN
75
76. MODEL 3 – THE “RULE OF THREE”
RELEVANT WHENEVER A PATIENT SAYS OR DOES SOMETHING
THAT THE THERAPIST EXPERIENCES AS PROVOCATIVE
– A “PROVOCATIVE ENACTMENT” –
IN ORDER TO COMPEL THE PATIENT TO TAKE OWNERSHIP OF
WHAT SHE IS “PLAYING OUT” ON THE STAGE OF THE TREATMENT,
THE THERAPIST MIGHT ASK THE PATIENT ANY OF THE FOLLOWING
“HOW ARE YOU HOPING THAT I WILL RESPOND?”
WHICH ADDRESSES THE ID
“HOW ARE YOU FEARING THAT I MIGHT RESPOND?”
WHICH ADDRESSES THE SUPEREGO
“HOW ARE YOU IMAGINING THAT I WILL RESPOND?”
WHICH ADDRESSES THE EGO
ALL THREE “ACCOUNTABILITY STATEMENTS” DEMAND OF THE PATIENT
THAT SHE MAKE HER “INTERPERSONAL INTENTIONS” MORE EXPLICIT
AND THAT SHE TAKE RESPONSIBILITY FOR HER “PROVOCATIVE ENACTMENT”
76
78. MODEL 1
OPTIMALLY STRESSFUL
“CONFLICT STATEMENTS”
“YOU KNOW THAT … , BUT (MADE ANXIOUS)
YOU FIND YOURSELF THINKING / FEELING / DOING
IN ORDER NOT TO HAVE TO KNOW … ”
78
79. MODEL 1 CONFLICT STATEMENTS
ARE DESIGNED TO ENCOURAGE
THE “RESISTANT” PATIENT
TO STEP BACK FROM THE IMMEDIACY OF THE MOMENT
IN ORDER TO GAIN INSIGHT INTO
THE CONFLICT WITHIN HER
BETWEEN WHAT SHE REALLY DOES KNOW
AND HOW SHE (MADE ANXIOUS) FINDS HERSELF
(DEFENSIVELY) REACTING
IN ORDER NOT TO HAVE TO ACKNOWLEDGE IT
“YOU KNOW THAT … , BUT (MADE ANXIOUS)
YOU FIND YOURSELF THINKING / FEELING / DOING
IN ORDER NOT TO HAVE TO KNOW … ”
FIRST HIGHLIGHT HER ADAPTIVE (GROWTH – PROMOTING) CAPACITY /
THEN RESONATE EMPATHICALLY WITH
HER DEFENSIVE (GROWTH – DISRUPTING) NEED 79
80. MODEL 1 “OPTIMALLY STRESSFUL” CONFLICT STATEMENTS
“YOU KNOW THAT EVENTUALLY
YOU’LL NEED TO MAKE YOUR PEACE
WITH THE REALITY THAT YOUR FATHER
WILL NEVER BE THERE FOR YOU
IN THE WAYS THAT YOU
WOULD HAVE WANTED HIM TO BE;
BUT YOUR FEAR, IN THE MOMENT,
IS THAT WERE YOU EVER
TO LET YOURSELF REALLY FEEL
THE HEARTBREAK OF THAT,
YOU WOULD NEVER RECOVER.”
FIRST CHALLENGE BY HIGHLIGHTING
WHAT THE PATIENT REALLY DOES KNOW
– YOU KNOW THAT –
THEN SUPPORT BY RESONATING EMPATHICALLY
WITH HOW SHE PROTECTS HERSELF
– BUT YOU FIND YOURSELF … IN ORDER NOT TO HAVE TO KNOW –
80
81. “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 –
81
82. 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 82
83. 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,
THE THERAPIST WILL BE ABLE MASTERFULLY TO AVOID
BECOMING 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 WHICH THEN LEAVES THE PATIENT, MADE ANXIOUS,
NO CHOICE BUT TO BECOME THE “VOICE OF OPPOSITION”
“YOU KNOW THAT EVENTUALLY YOU’LL NEED TO FACE THE REALITY
THAT YOUR MOTHER WAS NEVER REALLY THERE FOR YOU
AND THAT YOU WON’T GET BETTER
UNTIL YOU LET GO OF YOUR HOPE THAT MAYBE SOMEDAY
YOU’LL BE ABLE TO MAKE HER CHANGE;
BUT YOU’RE NOT QUITE YET READY TO DEAL WITH ALL THE PAIN
AROUND THAT BECAUSE YOU ARE AFRAID THAT
YOU MIGHT NEVER SURVIVE THE HEARTBREAK AND DESPAIR
YOU WOULD FEEL WERE YOU TO FACE THAT DEVASTATING REALITY.” 83
84. 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.” 84
86. IN ORDER TO INCREASE THE PATIENT’S AWARENESS OF HER
AMBIVALENT ATTACHMENT TO HER DYSFUNCTIONAL DEFENSES
THE MODEL 1 “INTERPRETIVE” THERAPIST
FIRST CHALLENGES BY HIGHLIGHTING
WHAT BOTH THERAPIST AND PATIENT
ARE COMING TO UNDERSTAND
AS THE “PRICE” THE PATIENT IS PAYING
FOR CLINGING TO HER DEFENSES
AND THEN SUPPORTS BY RESONATING EMPATHICALLY
WITH WHAT BOTH THERAPIST AND PATIENT
ARE COMING TO UNDERSTAND
AS THE “INVESTMENT” THE PATIENT HAS
IN HOLDING ON TO THEM EVEN SO
BACK AND FORTH – BACK AND FORTH
IN AN EFFORT TO MAKE
THE PATIENT’S AMBIVALENTLY HELD DEFENSES
EVER LESS EGO – SYNTONIC AND EVER MORE EGO – DYSTONIC
86
87. IN ESSENCE
MODEL 1 CONFLICT STATEMENTS
STRIVE TO CREATE INCENTIVIZING TENSION WITHIN
THE PATIENT BETWEEN HER DAWNING AWARENESS
OF JUST HOW COSTLY HER DEFENSES HAVE BECOME
WITH AN EYE TO MAKING THEM MORE EGO – DYSTONIC
AND HER NEW – FOUND UNDERSTANDING
OF JUST HOW INVESTED SHE HAS BEEN
IN HOLDING ON TO THEM EVEN SO
WITH AN EYE TO HIGHLIGHTING HOW EGO – SYNTONIC THEY ARE
ULTIMATELY
THE EVER – INCREASING INTERNAL “DISSONANCE”
RESULTING FROM HER EVER – EVOLVING AWARENESS
OF BOTH THE COST AND THE BENEFIT
OF MAINTAINING HER ATTACHMENT
TO HER DYSFUNCTIONAL DEFENSES
WILL GALVANIZE THE PATIENT TO TAKE ACTION
IN ORDER TO RESOLVE THE INTERNAL TENSION
AND RESTORE HOMEOSTATIC BALANCE
87
88. WITH RESPECT TO THE OUTDATED DEFENSE – IN ESSENCE
THE MODEL 1 THERAPIST WILL
REPEATEDLY HIGHLIGHT BOTH
THE “PRICE PAID” (PAIN) AND THE “INVESTMENT IN” (GAIN)
AS LONG AS THE “GAIN” IS GREATER THAN THE “PAIN”
MORE EGO – SYNTONIC THAN EGO – DYSTONIC
THE PATIENT WILL “MAINTAIN” THE DEFENSE
AND “REMAIN” ENTRENCHED
BUT AS A RESULT OF THE PATIENT’S EVER – EVOLVING AWARENESS
OF BOTH THE “PRICE PAID” AND HER “INVESTMENT IN”
ONCE THE “PAIN” BECOMES GREATER THAN THE “GAIN”
MORE EGO – DYSTONIC THAN EGO – SYNTONIC
THE STRESS AND “STRAIN” OF THE
COGNITIVE AND AFFECTIVE DISSONANCE
BETWEEN THE “PAIN” AND THE “GAIN” WILL BE
SUCH THAT IT WILL PROVIDE THE IMPETUS
NEEDED FOR THE PATIENT GRADUALLY …
88
89. … TO RELINQUISH HER ATTACHMENT
TO THE DYSFUNCTIONAL DEFENSE
THEREBY
RESOLVING THE
STRUCTURAL CONFLICT
NEUROTIC / INTRAPSYCHIC CONFLICT
THAT HAD EXISTED
BETWEEN THE UNTAMED
BUT ULTIMATELY GROWTH – PROMOTING
ID FORCES
AND THE RESISTIVE
AND GROWTH – IMPEDING BUT ANXIETY – RELIEVING
EGO COUNTERFORCES
89
90. AS A RESULT OF “WORKING THROUGH”
THE DEFENSE / THE RESISTANCE
THE NOW STRONGER
AND MORE INSIGHTFUL EGO
WILL BE BETTER ABLE TO “REGULATE”
THE ID’S NOW TAMER AND
MORE MANAGEABLE ENERGIES
SUCH THAT
THEIR POWER CAN BE HARNESSED
BY THE EGO AND CHANNELED INTO
MORE CONSTRUCTIVE ENDEAVORS
AND WORTHWHILE PURSUITS
THEIR MODULATED ENERGY NOW PROVIDING THE
PROPULSIVE FUEL FOR ACTUALIZATION OF POTENTIAL
90
91. FREUD’S (1937) “HORSE AND RIDER” IS
INDEED AN APT METAPHOR FOR THE
THERAPEUTIC ACTION IN MODEL 1
FREUD’S RIDER
A NOW STRONGER AND MORE EMPOWERED EGO BY VIRTUE OF THE
GREATER AWARENESS IT HAS OF ITS INTERNAL CONFLICTEDNESS
WILL NOW BE MORE SKILLED AT HARNESSING
THE GROWTH – PROMOTING POWER OF THE HORSE
– A NOW BETTER REGULATABLE ID
BY VIRTUE OF THE WORKING THROUGH PROCESS –
WHICH HAS TAMED AND MODIFIED ITS ENERGIES
SUCH THAT HORSE AND RIDER
WILL NOW BE ABLE TO MOVE FORWARD
HARMONIOUSLY AND IN SYNC
NO LONGER IN CONFLICT BUT IN COLLABORATION
91
94. OPTIMAL STRESS
STRONGER AT THE BROKEN PLACES
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A BEAUTY NEVER ACHIEVED BY THINGS UNBROKEN?
IF A BONE IS FRACTURED AND THEN HEALS,
THE AREA OF THE BREAK WILL BE STRONGER
THAN THE SURROUNDING BONE
AND WILL NOT AGAIN EASILY FRACTURE
ARE WE TOO NOT STRONGER AT OUR BROKEN PLACES?
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A QUIET STRENGTH WE ACQUIRE
FROM SURVIVING ADVERSITY AND HARDSHIP
AND MASTERING THE EXPERIENCE OF
DISAPPOINTMENT, HEARTBREAK, AND DEVASTATION?
AND, THEN, WHEN WE FINALLY RISE ABOVE IT,
DON’T WE RISE UP IN QUIET TRIUMPH,
EVEN IF ONLY WE NOTICE …
94
99. IF YOU WOULD LIKE
TO BE ON MY
MAILING LIST,
PLEASE EMAIL ME AT
MarthaStarkMD @
HMS.Harvard.edu
TO LET ME KNOW
99
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Editor's Notes
I love this 2004 poem by Christopher Logue entitled “Come to the Edge!” – which I believe captures the essence of a system’s capacity to adapt to stressful input…
This Ernest Hemingway quote captures the essence of things –
I am here reminded of a Saturday Night Live skit in which two men are seated around a fire chatting, and one says to the other: “You know how when you stick a poker in the fire and leave it in for a long time, it gets really, really hot? And then you stick it in your eye, and it really, really hurts? I hate it when that happens! I just hate it when that happens!”
And a popular song that speaks to the need so many of us have to recreate that with which we are most familiar and, therefore, seemingly most comfortable is a rock song by the late Warren Zevon entitled “If You Won’t Leave Me I’ll Find Somebody Who Will.”
I love this 2004 poem by Christopher Logue entitled “Come to the Edge!” – which I believe captures the essence of a system’s capacity to adapt to stressful input…
And here we see a sweet little girl with angel wings – What if I fall? Oh, but my darling, what if you fly? – a poem by Erin Hanson – a 22-year-old gal from Australia