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 – 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 – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...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 – 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 – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptxMartha Stark MD
The document discusses the transformative power of optimal stress in triggering recovery and healing. It argues that superimposing an acute stress or injury on top of a chronic one can help the body heal. This is likened to wound debridement, which removes damaged tissue and provokes healing by mildly aggravating the area. Similarly in the mind, providing optimal stress in the context of an empathic therapy relationship can help overcome resistance to change. The goal of psychotherapy is to facilitate processing of stressful experiences from defensive reactions to adaptive responses, and from dysfunction to functionality.
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD
This document discusses the transformative power of optimal stress in precipitating disruption to trigger repair. It describes how controlled damage or optimally stressful interventions can provoke recovery by challenging defenses and supporting the patient. This process involves iterative cycles of destabilization in reaction to challenges, followed by restabilization in response to support, allowing the patient to reintegrate at higher levels of functionality and adaptive capacity. The goal is to transform dysfunctional defenses into more functional adaptations through challenging defenses and tapping into the patient's resilience in the context of an empathic therapy relationship.
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...Martha Stark MD
Superimposing an acute physical injury on top of a chronic one is sometimes exactly what the body needs in order to heal.
But just as with the body, where a condition might not heal until it is made acute, so too with the mind. The therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – can be the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will galvanize the patient to action and provoke healing.
With our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we can 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 a firm belief in the underlying resilience 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 less-evolved defensive reaction to more-evolved adaptive response.
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 – 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 – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...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 – 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 – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptxMartha Stark MD
The document discusses the transformative power of optimal stress in triggering recovery and healing. It argues that superimposing an acute stress or injury on top of a chronic one can help the body heal. This is likened to wound debridement, which removes damaged tissue and provokes healing by mildly aggravating the area. Similarly in the mind, providing optimal stress in the context of an empathic therapy relationship can help overcome resistance to change. The goal of psychotherapy is to facilitate processing of stressful experiences from defensive reactions to adaptive responses, and from dysfunction to functionality.
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD
This document discusses the transformative power of optimal stress in precipitating disruption to trigger repair. It describes how controlled damage or optimally stressful interventions can provoke recovery by challenging defenses and supporting the patient. This process involves iterative cycles of destabilization in reaction to challenges, followed by restabilization in response to support, allowing the patient to reintegrate at higher levels of functionality and adaptive capacity. The goal is to transform dysfunctional defenses into more functional adaptations through challenging defenses and tapping into the patient's resilience in the context of an empathic therapy relationship.
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...Martha Stark MD
Superimposing an acute physical injury on top of a chronic one is sometimes exactly what the body needs in order to heal.
But just as with the body, where a condition might not heal until it is made acute, so too with the mind. The therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – can be the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will galvanize the patient to action and provoke healing.
With our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we can 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 a firm belief in the underlying resilience 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 less-evolved defensive reaction to more-evolved adaptive response.
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 – 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 – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD
The document discusses the therapeutic use of optimal stress to provoke recovery in psychotherapy. It argues that superimposing an acute stress or disruption on top of a chronic issue can help the body or mind heal. This concept of "controlled damage" or "optimal stress" can trigger the innate ability to self-repair. The therapist can use optimally stressful interventions that alternately challenge and support defenses to facilitate iterative cycles of destabilization and restabilization, allowing the patient to process experiences and adapt at higher levels of functioning. The goal is to transform dysfunctional defenses into more functional adaptations through this process of disruption and repair.
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...Martha Stark MD
This document discusses the transformative power of optimal stress in psychotherapy. It argues that precipitating disruption through optimally stressful interventions can trigger repair and healing in patients, analogous to how physical injuries sometimes need to be aggravated to promote healing. Three models of therapeutic action are described:
1) The interpretive perspective focuses on the patient's internal dynamics and conflicts.
2) Self psychology perspectives focus on correcting deficient early experiences and providing empathic support.
3) Relational theories emphasize authentic engagement and accountability in the therapeutic relationship.
The document suggests these approaches can be used synergistically based on the patient's immediate needs, to help transform dysfunctional defenses into more functional adaptations over the course of treatment.
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 – 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 – 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 – 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 – 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 – 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 – 30 Sep 2018 – 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 – 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.
The document discusses the concept of susceptibility in homeopathy. It provides definitions from homeopathic scholars on susceptibility as the body's ability to receive impressions and react to stimuli. Susceptibility plays a role in health and disease and determines how the body will respond to remedies. There are different types of susceptibility including natural, morbid, and artificial susceptibility induced by medicines. Factors like constitution, age, habits modify one's susceptibility. Homeopathy aims to restore normal susceptibility through similar remedies to cure diseases.
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 – 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 – 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 – 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.
DISASTER IS AN BREAK IN THE NORMAL LIFE OF AN INDIVIDUAL, IT INCLUDES THE NURSES WHO ARE AFFECTED BY THE DISASTER. AS A NURSE WE MUST BE ABLE TO PROTECT OUR SELF AND OUR FAMILY AND ALSO MUST BE ABLE TO HELP AND DO OUR DUTY TO THE COMMUNITY. THIS SLIDE WILL GIVE US AN OUTLINE OF PROCEDURES THAT ONE MUST FOLLOW DURING A DISASTER AND ALSO THE EMERGENCY TOOLS AND PAPERS NEEDED TO PERFORM OUR JOB AS AN REGISTERED NURSE.
This document discusses how to manage fear. It explains that fear is an emotion that helped ancient humans avoid dangers and ensure survival. While fear served an important purpose evolutionarily, in modern society those threats are rare. The document outlines that fear is a physiological process triggered by external stimuli and stress hormones. It argues that while complete avoidance of triggers is impossible, fear can be managed by breaking the chain between triggers and the body's fear response through practices like meditation, exercise, diet, avoiding negative influences, and positive affirmations. The overall message is that fear cannot be avoided, but its impact can be lessened through practical self-care and lifestyle approaches.
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.
This document discusses the relationship between stress and cancer. It describes how the fight-or-flight response activates the body's stress response systems, but in modern times this response is often chronic rather than acute due to constantly stressful situations. Chronic stress can weaken the immune system and increase cancer risk over time. Psychological factors like depression, suppressed emotions, and social isolation are also associated with higher cancer rates. Learning to manage stress through techniques like meditation, yoga, and biofeedback can help reduce cancer risk and aid recovery.
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 – 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…
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Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD
The document discusses the therapeutic use of optimal stress to provoke recovery in psychotherapy. It argues that superimposing an acute stress or disruption on top of a chronic issue can help the body or mind heal. This concept of "controlled damage" or "optimal stress" can trigger the innate ability to self-repair. The therapist can use optimally stressful interventions that alternately challenge and support defenses to facilitate iterative cycles of destabilization and restabilization, allowing the patient to process experiences and adapt at higher levels of functioning. The goal is to transform dysfunctional defenses into more functional adaptations through this process of disruption and repair.
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...Martha Stark MD
This document discusses the transformative power of optimal stress in psychotherapy. It argues that precipitating disruption through optimally stressful interventions can trigger repair and healing in patients, analogous to how physical injuries sometimes need to be aggravated to promote healing. Three models of therapeutic action are described:
1) The interpretive perspective focuses on the patient's internal dynamics and conflicts.
2) Self psychology perspectives focus on correcting deficient early experiences and providing empathic support.
3) Relational theories emphasize authentic engagement and accountability in the therapeutic relationship.
The document suggests these approaches can be used synergistically based on the patient's immediate needs, to help transform dysfunctional defenses into more functional adaptations over the course of treatment.
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 – 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 – 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 – 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 – 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 – 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 – 30 Sep 2018 – 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 – 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.
The document discusses the concept of susceptibility in homeopathy. It provides definitions from homeopathic scholars on susceptibility as the body's ability to receive impressions and react to stimuli. Susceptibility plays a role in health and disease and determines how the body will respond to remedies. There are different types of susceptibility including natural, morbid, and artificial susceptibility induced by medicines. Factors like constitution, age, habits modify one's susceptibility. Homeopathy aims to restore normal susceptibility through similar remedies to cure diseases.
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 – 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 – 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 – 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.
DISASTER IS AN BREAK IN THE NORMAL LIFE OF AN INDIVIDUAL, IT INCLUDES THE NURSES WHO ARE AFFECTED BY THE DISASTER. AS A NURSE WE MUST BE ABLE TO PROTECT OUR SELF AND OUR FAMILY AND ALSO MUST BE ABLE TO HELP AND DO OUR DUTY TO THE COMMUNITY. THIS SLIDE WILL GIVE US AN OUTLINE OF PROCEDURES THAT ONE MUST FOLLOW DURING A DISASTER AND ALSO THE EMERGENCY TOOLS AND PAPERS NEEDED TO PERFORM OUR JOB AS AN REGISTERED NURSE.
This document discusses how to manage fear. It explains that fear is an emotion that helped ancient humans avoid dangers and ensure survival. While fear served an important purpose evolutionarily, in modern society those threats are rare. The document outlines that fear is a physiological process triggered by external stimuli and stress hormones. It argues that while complete avoidance of triggers is impossible, fear can be managed by breaking the chain between triggers and the body's fear response through practices like meditation, exercise, diet, avoiding negative influences, and positive affirmations. The overall message is that fear cannot be avoided, but its impact can be lessened through practical self-care and lifestyle approaches.
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.
This document discusses the relationship between stress and cancer. It describes how the fight-or-flight response activates the body's stress response systems, but in modern times this response is often chronic rather than acute due to constantly stressful situations. Chronic stress can weaken the immune system and increase cancer risk over time. Psychological factors like depression, suppressed emotions, and social isolation are also associated with higher cancer rates. Learning to manage stress through techniques like meditation, yoga, and biofeedback can help reduce cancer risk and aid recovery.
Similar to Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.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 – 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 – 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 – 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 – 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 – 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 – 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 – 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.
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 – 21 May 2021 – The Refusal to GrieveMartha Stark MD
This document discusses the concept of "relentless hope" as a defense mechanism used by patients to avoid grieving disappointments. It establishes that relentless hope is fueled by a refusal to grieve bad objects from one's past that were introjected. When dawning recognition occurs that the object cannot be possessed or controlled, patients react with sadism by lashing out angrily at themselves or the object. The document examines the psychodynamics of sadomasochism in relationships through the lens of Fairbairn's work on intense attachments to bad objects.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
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The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
1. THE TRANSFORMATIVE POWER
OF OPTIMAL STRESS
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE
NO PAIN / NO GAIN
MARTHA STARK, MD
MarthaStarkMD @ HMS.Harvard.edu
SMITH COLLEGE SCHOOL FOR SOCIAL WORK
Friday, June 16, 2017
1
3. WHY IS IT THAT PEOPLE KEEP PLAYING OUT
ON THE STAGE OF THEIR LIVES
THE SAME SCENARIOS AGAIN AND AGAIN –
EVEN WHEN THEY KNOW THAT THE OUTCOME
WILL BE JUST AS DISAPPOINTING THIS NEXT TIME
AS IT WAS SO MANY TIMES BEFORE?
“INSANITY IS DOING
THE SAME THING
OVER AND OVER AGAIN
AND EXPECTING
DIFFERENT RESULTS”
(ALBERT EINSTEIN)
3
4. 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!”
4
5. PEOPLE ARE TREMENDOUSLY INVESTED
IN THEIR COMPULSIVE REPETITIONS
AND THEIR RELENTLESS PURSUITS
SELF – PROTECTIVE BEHAVIORS THAT
PROTECT THEM AGAINST THE PAIN
OF ALL THE HEARTBREAK
THEY EXPERIENCED AS CHILDREN
PEOPLE HOLD ON TO THESE MALADAPTIVE DEFENSES,
WHICH HAVE LONG SINCE OUTLIVED THEIR
USEFULNESS BUT TO WHICH THEY NONETHELESS
CLING IN A MISGUIDED EFFORT TO AVOID
FEELING THE PAIN OF THEIR UNMASTERED GRIEF
5
6. FROM UNHEALTHY DEFENSE
TO HEALTHIER ADAPTATION
TRANSFORMING
THE NEED TO “DEFEND AGAINST”
INTO THE CAPACITY TO “ADAPT TO”
THE MYRIAD “STRESSORS OF LIFE”
(HANS SELYE 1974)
THE THERAPEUTIC USE OF “OPTIMAL STRESS”
TO FACILITATE THIS TRANSFORMATION
THE IMPORTANCE OF GRIEVING
ALBEIT BELATEDLY
ALL THE “STRESSORS OF CHILDHOOD”
THAT WERE NEVER FULLY GRIEVED
AT THE TIME AND “ADAPTED TO” BUT
WERE INSTEAD SIMPLY “DEFENDED AGAINST”
6
7. THE SELF – SABOTAGING
COMPULSIVE REPETITIONS AND
RELENTLESS PURSUITS TO WHICH
PEOPLE CLING TENACIOUSLY
REPRESENT THEIR BEST
EFFORT TO DEFEND THEMSELVES
AGAINST THE PAIN AND
TO KEEP THEIR HOPE ALIVE …
7
8. DEFENSES AND ADAPTATIONS
BOTH ARE SELF – PROTECTIVE MECHANISMS
MOBILIZED TO PRESERVE HOMEOSTATIC BALANCE
IN THE FACE OF ENVIRONMENTAL CHALLENGE
A YIN – YANG RELATIONSHIP
NONETHELESS
DEFENSES ARE GENERALLY LESS EVOLVED,
ADAPTATIONS MORE EVOLVED
DEFENSES ARE REFLEXIVE,
WHEREAS ADAPTATIONS ARE REFLECTIVE
WE NEED OUR DEFENSES TO SURVIVE
BUT OUR ADAPTATIONS TO THRIVE
8
9. THE OVERARCHING GOAL OF
ANY IN – DEPTH PSYCHOTHERAPY
INCREMENTAL TRANSFORMATION OF
LESS EVOLVED DEFENSE INTO
MORE EVOLVED ADAPTATION
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
THE NEED TO HOLD ON
INTO THE CAPACITY TO LET GO
9
10. THIS TRANSFORMATION OF NEED INTO CAPACITY
REQUIRES THE JUDICIOUS USE OF “OPTIMAL STRESS”
AGAINST A BACKDROP OF EMPATHIC ATTUNEMENT
AND AUTHENTIC ENGAGEMENT
SEVERAL “PROTOTYPE” STATEMENTS DESIGNED
TO PROVIDE JUST THE RIGHT COMBINATION OF
CHALLENGE
TO DESTABILIZE DEEPLY
ENTRENCHED MALADAPTIVE DEFENSES
AND SUPPORT
TO FACILITATE THEIR RESTABILIZATION
AT A HIGHER LEVEL OF ADAPTIVE CAPACITY
10
11. ONGOING USE OF THESE
OPTIMALLY STRESSFUL INTERVENTIONS
WILL GIVE RISE TO
RECURSIVE CYCLES OF DISRUPTION
IN REACTION TO THE ANXIETY – PROVOKING CHALLENGE
AND REPAIR
IN RESPONSE TO THE ANXIETY – ASSUAGING SUPPORT
HEALING CYCLES OF
DISRUPTION AND REPAIR
AT EVER – HIGHER LEVELS
OF AWARENESS, ACCEPTANCE,
ACCOUNTABILITY, AND ACCESSIBILITY
11
12. NO PAIN
NO STRESS OR STRAIN
NO GAIN
MY FIRM BELIEF IN THE UNDERLYING RESILIENCE
THAT PATIENTS WILL INEVITABLY DISCOVER
WITHIN THEMSELVES WHEN FORCED TO TAP INTO
THEIR INBORN ABILITY TO SELF – CORRECT
IN THE FACE OF ENVIRONMENTAL CHALLENGE
12
13. SUPERIMPOSING AN ACUTE
PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES
EXACTLY WHAT THE BODY
NEEDS IN ORDER TO HEAL
“CONTROLLED DAMAGE”
TO PROVOKE HEALING
13
14. MILD AGGRAVATIONS TO STIMULATE
THE HEALING CASCADE
IMMUNOTHERAPIES (VACCINATIONS)
HOMEOPATHIC REMEDIES
ACUPUNCTURE
PROLOTHERAPY
WOUND DEBRIDEMENT
DERMABRASION
FRAXEL LASER TREATMENTS
DEFIBRILLATION
CARDIOVERSION
ELECTROSHOCK THERAPY (ECT)
DEEP BRAIN STIMULATION (DBS)
14
15. MODERATE AMOUNTS OF STRESS
TO PROVOKE
MODEST OVERCOMPENSATION
HIGH – INTENSITY INTERVAL TRAINING (HIIT)
OPTIMAL CHALLENGE OF THE BRAIN
STRESSING THE MIND WITH BRAIN TEASERS
AND MENTAL EXERCISES REQUIRING
DELIBERATE AND CONCENTRATED EFFORT
IN ORDER TO SHARPEN MENTAL ACUITY,
DECELERATE COGNITIVE DECLINE,
AND COMBAT THE EFFECTS OF AGING
15
16. DEPRIVING YOURSELF OF HALF A NIGHT’S SLEEP
PREFERABLY THE SECOND HALF OF THE NIGHT
CAN PRODUCE A RAPID, EVEN IF TEMPORARY,
RESTABILIZATION OF MOOD
AND RECOVERY FROM DEPRESSION
(LEIBENLUFT AND WEHR 1992)
A 36 – HOUR WATER FAST ONCE A WEEK
CAN SO SIGNIFICANTLY REDUCE THE
TOTAL BODY BURDEN THAT MENTAL CLARITY
AND FOCUS CAN BE IMPROVED DRAMATICALLY
DUKE UNIVERSITY MEDICAL CENTER
DISCOVERED THAT IF YOU DO 40 MINUTES OF
AEROBIC EXERCISE DURING THE DAY,
THEN YOU WILL NEED 40 MINUTES LESS
OF SLEEP THAT NEXT NIGHT
(BLUMENTHAL et al. 1999)
16
17. THE THERAPEUTIC VALUE
OF CONTROLLED DAMAGE
WHETHER PHYSICAL, MENTAL, OR EMOTIONAL
AN APPROACH SPECIFICALLY GEARED
TOWARDS MOBILIZING THE BODY’S
INTRINSIC ABILITY TO RENEW ITSELF
IN THE FACE OF ENVIRONMENTAL IMPINGEMENT
WHETHER REAL OR IMAGINED
A CONDITION MIGHT NOT HEAL
UNTIL IT IS MADE ACUTE
17
18. THE THERAPEUTIC USE
OF OPTIMAL STRESS
TO PROVOKE RECOVERY
BY ACTIVATING
THE LIVING SYSTEM’S
INNATE ABILITY
TO HEAL ITSELF
STRONGER AT THE BROKEN PLACES
18
19. STRESS IS WHEN
YOU WAKE UP SCREAMING
AND THEN YOU REALIZE
YOU HAVEN’T FALLEN
ASLEEP YET
ANONYMOUS
19
21. STRESSFUL STUFF HAPPENS
BUT IT WILL BE HOW WELL WE ARE
ULTIMATELY ABLE TO MANAGE ITS IMPACT
THAT WILL MAKE ALL THE DIFFERENCE
IN OTHER WORDS
IT WILL BE HOW WELL WE ARE
ULTIMATELY ABLE TO COPE WITH THE
IMPACT OF STRESS IN OUR LIVES
THAT WILL EITHER
DERAIL OUR DEVELOPMENT
WHEN ALL WE KNOW HOW TO DO IS TO REACT DEFENSIVELY
OR TRIGGER OUR GROWTH
ONCE WE HAVE BECOME BETTER ABLE TO RESPOND ADAPTIVELY
TO THE MYRIAD DISAPPOINTMENTS, FRUSTRATIONS,
AND LOSSES WITH WHICH LIFE CONFRONTS US
21
22. PSYCHODYNAMIC PSYCHOTHERAPY
OFFERS THE PATIENT AN OPPORTUNITY
ALBEIT A BELATED ONE
TO MASTER STRESSFUL 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 SELF – CORRECT
IN THE FACE OF ENVIRONMENTAL CHALLENGE
BE PROCESSED, INTEGRATED,
AND ULTIMATELY ADAPTED TO
22
23. FROM DEFENSIVE REACTION
TO ADAPTIVE RESPONSE
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 DENIAL
TO CONFRONTING HEAD – ON
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE
23
24. COME TO THE EDGE
SPEAKS TO BOTH THE UNIVERSAL RESISTANCE
TO LETTING GO OF WHAT IS FAMILIAR
AND THE POTENTIAL CAPACITY (WITHIN ALL OF US)
NOT ONLY TO ADAPT TO, BUT ALSO TO
BENEFIT FROM, BEING OPTIMALLY CHALLENGED
COME TO THE EDGE.
WE MIGHT FALL.
COME TO THE EDGE.
IT’S TOO HIGH!
COME TO THE EDGE!
AND THEY CAME,
AND HE PUSHED,
AND THEY FLEW …
(CHRISTOPHER LOGUE 1968)
24
26. VIKTOR FRANKL (2006)
“BETWEEN STIMULUS AND RESPONSE
IS A SPACE.
IN THAT SPACE IS OUR POWER
TO CHOOSE OUR RESPONSE.
IN OUR RESPONSE LIES
OUR GROWTH AND OUR FREEDOM.”
… IN THAT SPACE LIES OUR POWER
TO CHOOSE WHETHER WE
REACT DEFENSIVELY OR RESPOND ADAPTIVELY
WHETHER WE CLING TO OUR
COMPULSIVE REPETITIONS AND RELENTLESS PURSUITS
IN ORDER TO AVOID THE PAIN OF OUR GRIEF
OR WHETHER WE DARE TO TAKE THE LEAP …
26
27. CHAOS THEORY
(STROGATZ 1994; KAUFMAN 1995)
IN ORDER BETTER TO UNDERSTAND
THE PATIENT’S RELUCTANCE TO
RELINQUISH HER MALADAPTIVE DEFENSES
THE PATIENT IS AN
“OPEN, SELF – ORGANIZING CHAOTIC SYSTEM”
CHAOTIC SYSTEMS
ALTHOUGH SEEMINGLY RANDOM
HAVE AN UNDERLYING ORDEREDNESS
THAT WILL EMERGE AS THE SYSTEM
EVOLVES AND “SELF – ORGANIZES”
27
28. NO MATTER HOW COMPROMISED THEY
MIGHT ULTIMATELY BECOME,
FUELED AS THEY ARE BY THEIR HOMEOSTATIC
TENDENCY TO REMAIN CONSTANT OVER TIME,
CHAOTIC SYSTEMS
ONCE “ORGANIZED”
ARE INHERENTLY RESISTANT TO CHANGE
THEY HAVE AN INERTIA
AND A ROBUST ORDEREDNESS
THAT MUST BE OVERCOME
IF THE SYSTEM IS EVER TO
“RE – ORGANIZE” ITSELF
28
29. “SELF – ORGANIZING SYSTEMS
RESIST PERTURBATION”
(CHARLES KREBS 2006)
PATIENTS MUST BE SUFFICIENTLY STRESSED
BY INPUT FROM THE OUTSIDE
THAT THERE WILL BE IMPETUS
FOR THE PATIENT’S MALADAPTIVE,
SELF – SABOTAGING DEFENSES
TO BECOME DESTABILIZED
AND THEREFORE OPPORTUNITY
FOR THE EMERGENCE OF MORE ADAPTIVE,
SELF – PROTECTIVE MECHANISMS
29
30. THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE WILL BE TOO
OVERWHELMING FOR THE PATIENT
TO PROCESS AND INTEGRATE
TRAUMATIC STRESS
TOO LITTLE CHALLENGE WILL PROVIDE TOO
LITTLE IMPETUS FOR TRANSFORMATION
AND GROWTH BECAUSE THERE WILL
BE NOTHING THAT NEEDS TO BE MASTERED
30
31. THE GOLDILOCKS PRINCIPLE
BUT JUST THE RIGHT
AMOUNT OF CHALLENGE
JUST THE RIGHT AMOUNT OF STRESS
EUSTRESS (HANS SELYE 1974)
OPTIMAL STRESS
WILL OFFER JUST THE
RIGHT COMBINATION OF
CHALLENGE AND SUPPORT
NEEDED TO OPTIMIZE
THE POTENTIAL FOR
TRANSFORMATION AND GROWTH
31
32. IN AN EFFORT TO GET IT JUST RIGHT,
THE THERAPIST WILL KEEP HER FINGER ON
THE PULSE OF THE PATIENT’S ANXIETY
AND CAPACITY TO TOLERATE FURTHER STRESS
WHENEVER POSSIBLE
THE THERAPIST WILL CHALLENGE
THEREBY INCREASING THE PATIENT’S ANXIETY
WHENEVER NECESSARY
THE THERAPIST WILL SUPPORT
THEREBY DECREASING THE PATIENT’S ANXIETY
THEREBY TITRATING THE LEVEL OF STRESS
THAT THE PATIENT WILL EXPERIENCE
32
33. PARACELSUS (2004)
IN REFLECTING UPON THE STRESSFUL IMPACT
ON THE BODY OF AN EXTERNAL AGENT
THE DIFFERENCE BETWEEN
A POISON AND A MEDICATION
IS THE DOSAGE THEREOF
IT WILL ALSO BE THE SYSTEM’S
CAPACITY TO PROCESS, INTEGRATE,
AND ULTIMATELY ADAPT TO THE
IMPACT OF THE STRESSOR THAT WILL
ULTIMATELY MAKE THE DIFFERENCE
BETWEEN TRAUMATIC STRESS
AND OPTIMAL STRESS
33
34. SO A POISON IS NOT ALWAYS TOXIC
AND NOR IS A MEDICINE ALWAYS THERAPEUTIC
STRESS IS NOT ALWAYS BAD
OPTIMAL STRESS
AND NOR IS HOPE ALWAYS GOOD
RELENTLESS HOPE
(STARK 1994, 1999, 2014)
THE REFUSAL TO CONFRONT
– AND GRIEVE –
THE REALITY OF THE OBJECT’S
LIMITATIONS, SEPARATENESS,
AND IMMUTABILITY
34
35. THE SANDPILE MODEL AND
THE PARADOXICAL IMPACT OF STRESS
(BAK 1996)
TO DEMONSTRATE THE CUMULATIVE
IMPACT OVER TIME OF ENVIRONMENTAL
STRESSORS ON OPEN SYSTEMS
AN ELEGANT VISUAL METAPHOR FOR
HOW WE ARE CONTINUOUSLY REFASHIONING
OURSELVES AT EVER – HIGHER LEVELS OF
RESILIENCE AND ADAPTIVE CAPACITY
NOT JUST IN SPITE OF STRESSFUL INPUT
FROM THE OUTSIDE
BUT BY WAY OF THAT INPUT
(STARK 2012, 2014)
35
36. THE GRAINS OF SAND BEING STEADILY
ADDED TO A GRADUALLY EVOLVING
SANDPILE ARE THE OCCASION FOR
BOTH ITS DISRUPTION AND ITS REPAIR
NOT ONLY DO THE GRAINS OF SAND
BEING ADDED PRECIPITATE PARTIAL COLLAPSE
OF THE SANDPILE, BUT ALSO THEY BECOME
THE MEANS BY WHICH THE SANDPILE
IS THEN ABLE TO BUILD ITSELF BACK UP
EACH TIME AT A NEW LEVEL OF HOMEOSTASIS
THE SYSTEM WILL THEREFORE HAVE
BEEN ABLE NOT ONLY TO MANAGE
THE IMPACT OF THE STRESSFUL INPUT
BUT ALSO TO BENEFIT FROM THAT IMPACT
36
37. AND AS THE SANDPILE EVOLVES
AN UNDERLYING PATTERN
WILL BEGIN TO EMERGE
ITERATIVE CYCLES OF DISRUPTION AND REPAIR
DESTABILIZATION AND RESTABILIZATION
DEFENSIVE COLLAPSE AND ADAPTIVE RECONSTITUTION
AT EVER – HIGHER LEVELS OF
INTEGRATION AND DYNAMIC BALANCE
37
38. ALTERNATELY CHALLENGE AND THEN SUPPORT
TO PROVOKE HEALING CYCLES OF DISRUPTION AND REPAIR
JUST AS THE GRAINS OF SAND BEING
SYSTEMATICALLY ADDED
TO THE EVER – EVOLVING SANDPILE
ARE CONTINUOUSLY
“PRECIPITATING DISRUPTION IN ORDER TO TRIGGER REPAIR,”
SO TOO THE SYSTEMATIC USE OF
THERAPEUTIC INTERVENTIONS THAT
ALTERNATELY BREAK DOWN AND THEN BUILD UP
WILL PROVIDE BOTH IMPETUS AND OPPORTUNITY
FOR RESTRUCTURING THE PATIENT’S
DYSFUNCTIONAL DEFENSES
AT EVER – HIGHER LEVELS OF
RESILIENCE AND ADAPTIVE CAPACITY
38
39. CONFLICT STATEMENTS
DESIGNED TO HIGHLIGHT
THE INHERENT CONFLICT
THAT EXISTS WITHIN THE PATIENT
BETWEEN WHAT SHE “KNOWS”
IN HER HEAD
TO BE THE PRICE SHE PAYS
FOR CLINGING TO HER
COMPULSIVE REPETITIONS
AND RELENTLESS PURSUITS
AND WHAT SHE “FEELS”
IN HER HEART
WHEN CHALLENGED TO LET THEM GO
39
40. CONFLICT STATEMENT
“YOU KNOW THAT EVENTUALLY YOU WILL
NEED TO FACE THE REALITY THAT
YOUR MOTHER WILL NEVER BE ALL THAT
YOU WOULD HAVE WANTED HER TO BE
AND THAT YOU WILL NOT BE ABLE
TO MOVE ON IN YOUR LIFE UNTIL YOU
LET GO OF YOUR HOPE THAT SHE WILL;
BUT, IN THE MOMENT, YOU ARE TERRIFIED
THAT YOU WOULD NOT SURVIVE THE
HEARTBREAK AND DESPAIR YOU WOULD
FEEL WERE YOU FORCED TO CONFRONT
THAT DEVASTATING TRUTH.”
CHALLENGE TO INCREASE THE ANXIETY
SUPPORT TO DECREASE IT
40
41. CONFLICT STATEMENT
“YOU KNOW THAT IF YOU ARE EVER
TO BE ABLE TO MOVE FORWARD IN
YOUR LIFE THEN YOU WILL NEED TO
LET ANKA GO BECAUSE SHE REALLY
IS NOT AVAILABLE IN THE WAYS THAT
YOU WOULD HAVE WANTED HER TO BE;
BUT YOU KEEP HOPING THAT
MAYBE, JUST MAYBE,
SOMEDAY SHE WILL CHANGE.”
“PRETENDING THAT SOMETHING
CAN BE WHEN IT CAN’T IS HOW
PEOPLE BREAK THEIR HEARTS.”
(SEMRAD 1983)
41
42. CONFLICT STATEMENTS
WHEN THE THERAPIST INTRODUCES
THE STATEMENT WITH
“YOU KNOW THAT …,”
SHE IS ASKING THAT
THE PATIENT TAKE
RESPONSIBILITY FOR
WHAT THE PATIENT
ALBEIT BEGRUDGINGLY
REALLY DOES KNOW TO
BE THE PAINFUL TRUTH
42
43. CONFLICT STATEMENTS
BY LOCATING “WITHIN” THE PATIENT
THE CONFLICT BETWEEN
HER KNOWLEDGE OF AN
ANXIETY – PROVOKING REALITY
AND HER EFFORT TO DENY IT,
THE THERAPIST IS DEFTLY
SIDESTEPPING THE POTENTIAL
FOR CONFLICT “BETWEEN”
PATIENT AND THERAPIST
43
44. CONFLICT STATEMENTS
IT IS, AFTER ALL, AN UNTENABLE
SITUATION FOR THE THERAPIST TO
PUT HERSELF IN THE POSITION OF
REPRESENTING THE HEALTHY
VOICE OF “YES” AND FOR THE
PATIENT, MADE ANXIOUS, TO BE
THEN STUCK IN THE POSITION OF
HAVING TO COUNTER WITH THE
UNHEALTHY VOICE OF “NO”
44
45. CONFLICT STATEMENT
“YOU KNOW THAT IF YOU REALLY ARE
SERIOUS ABOUT FINDING YOURSELF
A LIFE PARTNER, THEN YOU WILL NEED
TO TAKE SOME RISKS AND PUT
YOURSELF OUT THERE IN A WAY
THAT YOU DO NOT ORDINARILY DO;
BUT YOU FIND YOURSELF HOLDING BACK
FOR FEAR THAT, NO MATTER HOW
HARD YOU MIGHT TRY, IT WOULD NOT
REALLY MAKE ANY DIFFERENCE ANYWAY –
THE DESPAIR GOES SO DEEP.”
45
46. BY REPEATEDLY FORMULATING CONFLICT
STATEMENTS THAT STRATEGICALLY
JUXTAPOSE THE PATIENT’S DAWNING
AWARENESS OF JUST HOW STEEP A PRICE
SHE PAYS FOR HOLDING ON TO HER DEFENSES
(THE PAIN)
AND HER NEW – FOUND APPRECIATION FOR
HOW THEY HAVE SERVED HER EVEN SO
(THE GAIN),
THE THERAPIST WILL BE ABLE TO CREATE
GALVANIZING TENSION WITHIN THE PATIENT
COGNITIVE DISSONANCE THAT WILL
ULTIMATELY BECOME THE
FULCRUM FOR THERAPEUTIC CHANGE
46
47. AS LONG AS THE GAIN IS
GREATER THAN THE PAIN,
THE PATIENT WILL MAINTAIN THE DEFENSE
AND REMAIN ENTRENCHED
BUT ONCE THE PAIN BECOMES
GREATER THAN THE GAIN
(THAT IS, ONCE THE DEFENSE BECOMES
MORE EGO – DYSTONIC THAN EGO – SYNTONIC),
THEN THE STRESS AND STRAIN THEREBY
CREATED AS A RESULT OF THE
COGNITIVE DISSONANCE BETWEEN PAIN AND GAIN
WILL PROVIDE THE IMPETUS NEEDED
FOR THE PATIENT
IN ORDER TO RESTORE HER PSYCHOLOGICAL EQUILIBRIUM
TO RELINQUISH THE UNHEALTHY DEFENSE
IN FAVOR OF A HEALTHIER ADAPTATION
47
48. THE WISDOM OF THE BODY
(CANNON 1932)
IT CANNOT TOLERATE
DISEQUILIBRIUM FOR
EXTENDED PERIODS OF TIME
AND WILL THEREFORE
BE PROMPTED TO TAKE
ACTION IN ORDER TO
RESOLVE THE TENSION
AND RESTORE THE ORDER
48
49. WHEREAS CONFLICT STATEMENTS ARE DESIGNED
TO COMPEL THE PATIENT TO LET GO
OF DEFENSES BY CREATING
INCENTIVIZING TENSION WITHIN HER,
DISILLUSIONMENT STATEMENTS
ARE DESIGNED TO FACILITATE
THE GRIEVING SHE MUST DO AS
SHE BEGINS TO CONFRONT
THE HEARTBREAKING REALITIES
AGAINST WHICH HER DEFENSES
HAVE BEEN PROTECTING HER
49
50. CONFLICT STATEMENTS AND
DISILLUSIONMENT STATEMENTS
FIRST CHALLENGE
BY SPEAKING TO
PAINFUL TRUTHS
THAT THE PATIENT REALLY
DOES KNOW TO BE TRUE
AND THEN SUPPORT
ALWAYS WITH COMPASSION AND NEVER WITH JUDGMENT
BY RESONATING EMPATHICALLY
WITH HOW THE PATIENT
IS DEALING WITH
THOSE PAINFUL REALITIES
50
51. IF DEFENSIVELY
BECAUSE THE ANXIETY IS SIMPLY TOO MUCH
A CONFLICT STATEMENT
“YOU KNOW THAT …,
BUT (MADE ANXIOUS) YOU DEFEND”
IN ORDER TO AVOID FEELING THE PAIN
IF ADAPTIVELY
BECAUSE THE ANXIETY IS MORE MANAGEABLE
A DISILLUSIONMENT STATEMENT
“YOU KNOW THAT …,
AND (LESS ANXIOUS) YOU ADAPT”
AND LET YOURSELF FEEL THE PAIN OF YOUR GRIEF
51
52. DISILLUSIONMENT STATEMENTS
“YOU ARE COMING TO UNDERSTAND THAT I
DO NOT HAVE ALL THE ANSWERS AND CANNOT
SIMPLY MAKE YOUR PAIN GO AWAY;
AND IT BREAKS YOUR HEART.”
“YOU HAD SO HOPED THAT ALEKSY WOULD
BE ‘THE ONE,’ BUT HIS ABUSIVE TREATMENT OF
YOU IS BECOMING INCREASINGLY INTOLERABLE.
YOU ARE BEGINNING TO REALIZE THAT
YOU WILL PROBABLY NEED TO LET HIM GO,
AND IT IS ABSOLUTELY DEVASTATING.”
52
53. COMPULSIVE REPETITIONS
AND RELENTLESS PURSUITS
IT IS THE PATIENT’S REFUSAL TO DEAL WITH
THE PAIN OF HER GRIEF ABOUT THE
PEOPLE WHO HAVE BROKEN HER HEART
THAT FUELS HER COMPULSIVE REPETITIONS
AND HER RELENTLESS PURSUITS
THE HOPE BEING THAT PERHAPS
THIS NEXT TIME IT WILL BE DIFFERENT
53
54. RELENTLESS HOPE AND
RELENTLESS OUTRAGE
MORE SPECIFICALLY
THE PATIENT’S REFUSAL TO GRIEVE FUELS BOTH
THE RELENTLESSNESS OF HER HOPE
THAT SHE MIGHT YET BE ABLE TO FORCE
THE OBJECT OF HER DESIRE TO CHANGE
AND THE RELENTLESSNESS OF THE OUTRAGE
SHE EXPERIENCES 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
54
55. I AM HERE REMINDED OF
THE NEW YORKER CARTOON
IN WHICH A GENTLEMAN,
SEATED IN A RESTAURANT NAMED
THE DISILLUSIONMENT CAFÉ,
IS AWAITING THE ARRIVAL
OF HIS ORDER
THE WAITER RETURNS TO HIS
TABLE AND ANNOUNCES,
“YOUR ORDER IS NOT READY,
AND NOR WILL IT EVER BE.”
55
56. BUT THE JUDICIOUS USE OF
CONFLICT STATEMENTS
THAT CHALLENGE THE PATIENT TO LET GO
AND DISILLUSIONMENT STATEMENTS
THAT SUPPORT HER AS SHE GRIEVES
WILL ENABLE THE PATIENT TO DO
NOW WHAT WAS TOO OVERWHELMING
FOR HER TO DO AT THE TIME OF THE
ORIGINAL TRAUMATIC INJURIES
AND ONGOING USE OF THESE OPTIMALLY
STRESSFUL INTERVENTIONS WILL GENERATE
HEALING CYCLES OF DISRUPTION
IN REACTION TO THE CHALLENGE
AND REPAIR
IN RESPONSE TO THE SUPPORT
56
57. WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE RELATIONSHIP
WITH HER THERAPIST,
THE PATIENT WILL BE GIVEN AN
OPPORTUNITY, AT LAST, TO CONFRONT
– AND GRIEVE –
THE PAIN OF HER EARLY – ON HEARTBREAK
PAIN AGAINST WHICH SHE HAS SPENT
A LIFETIME DEFENDING HERSELF
57
58. GENUINE GRIEVING
INVOLVES FEELING TO THE DEPTHS OF OUR
SOUL ALL THE RAGE, ANGUISH, HEARTBREAK,
SADNESS, AND REGRET THAT COME WITH
CONFRONTING EXCRUCIATINGLY PAINFUL REALITIES
ABOUT THE OBJECTS OF OUR DESIRE
BOTH PAST AND PRESENT
IT IS ULTIMATELY A STORY ABOUT
FORGIVING, RELENTING, LETTING GO,
SEPARATING, AND MOVING ON
SADDER PERHAPS BUT WISER TOO
IT IS ULTIMATELY A STORY ABOUT
SERENE ACCEPTANCE
OF SOBERING TRUTHS
58
59. IT IS WHAT IT IS – IT WAS WHAT IT WAS
AND, AT THE END OF THE DAY,
AS THE SERENITY PRAYER REMINDS US,
WE MUST ACCEPT THE THINGS
THAT WE CANNOT CHANGE,
MUST HAVE THE COURAGE TO
CHANGE THE THINGS THAT WE CAN,
AND MUST HAVE THE WISDOM
TO KNOW THE DIFFERENCE
(SIFTON 2005)
59
61. AUTOBIOGRAPHY IN 5 SHORT CHAPTERS by Portia Nelson (2012)
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
61
62. 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
62
65. 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?
AND 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 … 65
66. REFERENCES
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