Relentless hope is a stance to which we desperately cling in order not to have to feel the pain of our disappointment in the object, the hope a defense against grieving; our relentless outrage is the stance to which we resort in those moments of dawning recognition that, despite our best efforts and most fervent desire, the object of our intense desire might never be forthcoming after all; and our relentless despair is the stance to which we retreat when our hearts have been shattered and it hurts too much to do anything but withdraw from the world – and, even, from life itself.
The masochistic defense of relentless hope, the sadistic defense of relentless outrage, and the schizoid defense of relentless despair all speak to our refusal to confront – and grieve – the limitations, separateness, and immutability of the object.
Psychodynamic psychotherapy offers patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope arises in the context of surviving disappointment…
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
Martha Stark MD – 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 – 19 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 2 Nov 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
This document provides an overview and analysis of the concept of "relentless hope", which refers to clinging to unrealistic hope as a defense mechanism to avoid grieving disappointment. The document discusses how relentless hope fuels both masochism and sadism in relationships as the patient refuses to accept limits and separateness from others. Their relentless pursuit of unattainable goals stems from introjecting "bad" childhood objects and splitting them into exciting and rejecting parts.
Martha Stark MD – 29 Apr 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychodynamic psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope arises in the context of surviving disappointment and heartbreak. By the same token, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
Martha Stark MD – 13 Apr 2023 – Grieving the Loss of Relentless Hope and Evol...Martha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 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.
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 – 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 – 19 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 2 Nov 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
This document provides an overview and analysis of the concept of "relentless hope", which refers to clinging to unrealistic hope as a defense mechanism to avoid grieving disappointment. The document discusses how relentless hope fuels both masochism and sadism in relationships as the patient refuses to accept limits and separateness from others. Their relentless pursuit of unattainable goals stems from introjecting "bad" childhood objects and splitting them into exciting and rejecting parts.
Martha Stark MD – 29 Apr 2022 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychodynamic psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope arises in the context of surviving disappointment and heartbreak. By the same token, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
Martha Stark MD – 13 Apr 2023 – Grieving the Loss of Relentless Hope and Evol...Martha Stark MD
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 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.
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 – 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 – 19 May 2023 – 2nd of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 14 Nov 2021 – A Heart Shattered, The Private Self, and A Li...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 11 Feb 2022 – A Heart Shattered, The Private Self, and A Li...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 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 – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...Martha Stark MD
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
Martha Stark MD – 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 – 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.
This document discusses the constituents and determinants of human acts. It defines human acts as those that proceed from reason and free will, as opposed to spontaneous biological processes. The key constituents are knowledge, which allows for discernment of good and evil, and freedom of will. Moral determinants include the object/end of the act, any circumstances involved, and the end intended by the agent. Factors like ignorance, error, passion, and habits can impact the degree of freedom and voluntariness in an act.
Martha Stark MD – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 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.
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 – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
This document discusses different types of delusions that may be present in patients. It describes 8 specific types of delusions: 1) delusion of grandiosity, 2) delusion of persecution, 3) delusion of reference, 4) delusion of control, 5) delusion of guilt, 6) delusion of self-accusation, 7) delusion of poverty/worthlessness, and 8) delusion of nihilism/negation. For each delusion, it provides a brief explanation of the false fixed belief held by the patient.
Martha Stark MD – 20 May 2022 – Practical Clinical Interventions for Incentiv...Martha Stark MD
Do you sometimes wish that you had a “cheat sheet” to which you could periodically refer in order to figure out how best to respond to particular situations with which your patients were struggling? Do you sometimes wish that you had easy access to a “therapeutic toolkit” that would enable you to intervene in ways that would achieve meaningful results?
I have formulated a number of broadly applicable interventions designed to challenge whatever “defenses” the patient might have mobilized – in the moment – to protect herself from having to know sobering truths about her “conflicted self,” her “unrelenting objects,” her “irresponsible self-in-relation,” her “impenetrable self,” and/or her “unactualized self.”
In essence, my lecture will provide you with an arsenal of therapeutic interventions to be utilized for specific, universally relevant, clinical moments – be it the patient’s reluctance to confront anxiety-provoking realities about the forces and counterforces in conflict within her, her refusal to confront sobering realities about the objects of her desire, her reluctance to hold herself accountable for what she is compulsively and unwittingly re-enacting on the stage of her life, her fear of delivering the most vulnerable and private aspects of her “self” into intimate relationships and into life itself, and her resistance to mobilizing her energies in order to actualize her potential and realize her dreams.
Armed with “optimally stressful” interventions, you will be able to use these specialized tools to incentivize change and handle, with finesse, just about any situation that might arise during the clinical hour. Participants will receive my newly created “clinical intervention guide” (in the form of a handy “cheat sheet”).
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
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.
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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.
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From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
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Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 11 Feb 2022 – A Heart Shattered, The Private Self, and A Li...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 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 – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...Martha Stark MD
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
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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 – 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.
This document discusses the constituents and determinants of human acts. It defines human acts as those that proceed from reason and free will, as opposed to spontaneous biological processes. The key constituents are knowledge, which allows for discernment of good and evil, and freedom of will. Moral determinants include the object/end of the act, any circumstances involved, and the end intended by the agent. Factors like ignorance, error, passion, and habits can impact the degree of freedom and voluntariness in an act.
Martha Stark MD – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 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.
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 – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
This document discusses different types of delusions that may be present in patients. It describes 8 specific types of delusions: 1) delusion of grandiosity, 2) delusion of persecution, 3) delusion of reference, 4) delusion of control, 5) delusion of guilt, 6) delusion of self-accusation, 7) delusion of poverty/worthlessness, and 8) delusion of nihilism/negation. For each delusion, it provides a brief explanation of the false fixed belief held by the patient.
Martha Stark MD – 20 May 2022 – Practical Clinical Interventions for Incentiv...Martha Stark MD
Do you sometimes wish that you had a “cheat sheet” to which you could periodically refer in order to figure out how best to respond to particular situations with which your patients were struggling? Do you sometimes wish that you had easy access to a “therapeutic toolkit” that would enable you to intervene in ways that would achieve meaningful results?
I have formulated a number of broadly applicable interventions designed to challenge whatever “defenses” the patient might have mobilized – in the moment – to protect herself from having to know sobering truths about her “conflicted self,” her “unrelenting objects,” her “irresponsible self-in-relation,” her “impenetrable self,” and/or her “unactualized self.”
In essence, my lecture will provide you with an arsenal of therapeutic interventions to be utilized for specific, universally relevant, clinical moments – be it the patient’s reluctance to confront anxiety-provoking realities about the forces and counterforces in conflict within her, her refusal to confront sobering realities about the objects of her desire, her reluctance to hold herself accountable for what she is compulsively and unwittingly re-enacting on the stage of her life, her fear of delivering the most vulnerable and private aspects of her “self” into intimate relationships and into life itself, and her resistance to mobilizing her energies in order to actualize her potential and realize her dreams.
Armed with “optimally stressful” interventions, you will be able to use these specialized tools to incentivize change and handle, with finesse, just about any situation that might arise during the clinical hour. Participants will receive my newly created “clinical intervention guide” (in the form of a handy “cheat sheet”).
Similar to Martha Stark MD – 13 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx (17)
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
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 – Oct 2019 – The Transformative Power of Optimal Stress – Pre...Martha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...Martha Stark MD
Over the course of the decades, my own approach has become much more integrative and holistic – one that appreciates the complex interdependence of mind and body and the critical role played by the impact of stress on the MindBodyMatrix.
The living system – the ground regulation system – the divine matrix – the web of life – a liquid crystal through which information and energy flow.
More specifically, I will be speaking to the role played by limbic kindling and the resultant hypersensitivity to stress that is a hallmark of depressed patients.
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptxMartha Stark MD
This document discusses coronary artery disease and the impact of stress on heart health. It notes that coronary artery disease often develops silently and can cause sudden death in some cases. Chronic stress can damage blood vessels and cause plaque buildup over time by increasing blood pressure and viscosity. Psychological stress, depression, obesity, and other risk factors place cumulative stress on the heart and compromise its ability to adapt. Maintaining the heart's resilience by reducing stressors and replenishing nutrients is important for cardiovascular health.
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...Martha Stark MD
The document discusses how coherence emerges from chaos in complex adaptive systems like living organisms. It argues that through ongoing cycles of disruption and repair, such systems can self-organize and evolve from disorder to higher levels of order and coherence in response to environmental inputs. The ability of a system to process and integrate stressors over time determines whether it progresses towards health or disease.
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptxMartha Stark MD
traumatic stress – stress that the system cannot process and must therefore defend against
optimal stress – stress that the system can process, integrate, and ultimately adapt to, although always at some cost to the system
it's how well the living system (the MindBodyMatrix) is able to manage the cumulative impact of the myriad environmental stressors to which it is being continuously exposed that will make of them either traumatic events or growth opportunities
and that ability to manage stress is a story about the system's ability to process, integrate, and adapt to the impact of environmental challenge, input from the outside that either threatens to overwhelm the system or prompts the system to mobilize its ability to heal itself
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptxMartha Stark MD
Unexplained Chronic Illness
Martin Pall's compelling conceptualization of the excitotoxic cascade and its pivotal role in both the initiation and the perpetuation of chronic multisystem illnesses
one or more short-term stressors
chemical sensitivity – pesticides and organic solvents
chronic fatigue – bacterial and viral infections
fibromyalgia – physical traumas
PTSD – severe psychological traumas
to which the body responds with an outpouring of
excitotoxins (glutamate)
inflammatory factors (cytokines and eicosanoids)
free radicals (nitric oxide)
stress-induced outpouring of endogenous excitotoxins, inflammatory cytokines, and free radicals sets in motion (in certain susceptible individuals) the nitric oxide / peroxynitrite cycle
a viciously destructive, self-propagating cycle involving
immune stimulation, inflammatory cytokines, membrane destabilization, synaptic overactivity, opening of calcium-permeable channels, massive calcium influx, etc.
and culminating in chronic illness
Martha Stark MD – 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 – 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 – 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 – 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.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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
2. LEARNING OBJECTIVES
UPON COMPLETION OF THIS PROGRAM,
PARTICIPANTS WILL BE ABLE TO –
ESTABLISH WHY RELENTLESS HOPE IS A DEFENSE
IDENTIFY WHAT THE RELENTLESS PATIENT
IS REFUSING TO CONFRONT
REVIEW THE ROLE OF GRIEVING
DEMONSTRATE THE IMPORTANCE OF RELENTING
AND EVOLVING ULTIMATELY TO A PLACE
OF SERENE ACCEPTANCE
NO RELEVANT FINANCIAL RELATIONSHIPS
2
3. “PRETENDING
THAT IT CAN BE
WHEN IT CAN’T
IS HOW PEOPLE
BREAK THEIR HEARTS”
ELVIN SEMRAD (2003)
3
4. RELENTLESS HOPE
MARTHA STARK (2017)
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
4
5. THE PATIENT’S REFUSAL TO DEAL WITH
THE PAIN OF HER GRIEF ABOUT THE 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 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
5
6. IN ESSENCE
WHAT FUELS THE PATIENT’S RELENTLESSNESS
– BOTH HER RELENTLESS HOPE (LIBIDO)
AND HER RELENTLESS OUTRAGE (AGGRESSION) –
IS HER REFUSAL TO SIT WITH
THE PAIN OF HER DISAPPOINTMENT
IN THE OBJECT
AN OBJECT SHE EXPERIENCES AS BAD
BY VIRTUE OF THE FACT
THAT IT IS NOT ALL THAT SHE
WOULD HAVE WANTED IT TO BE
6
7. BUT EVEN MORE FUNDAMENTAL
IS THE FACT OF THE OBJECT’S EXISTENCE
AS SEPARATE FROM HERS
AS OUTSIDE THE SPHERE OF HER OMNIPOTENCE
– WINNICOTT (1965) –
AND AS THEREFORE UNABLE
TO BE EITHER POSSESSED OR CONTROLLED
THIS ILLUSION OF OMNIPOTENT CONTROL
OVER THE OBJECTS OF HER DESIRE
IS OFTEN ACCOMPANIED BY THE ENTITLED SENSE
THAT SOMETHING IS HER DUE
7
8. WHENEVER A PATIENT
COMPLAINS BITTERLY
ABOUT FEELING HELPLESS
IT OFTEN SPEAKS
TO HER NEED TO FORCE
THE OBJECT TO CHANGE
– IN SOME WAY THAT THE OBJECT
COULD TECHNICALLY CHANGE –
AND TO OUTRAGED FRUSTRATION
AT BEING CONFRONTED
WITH THE IMMUTABILITY OF THE OBJECT
AND THE LIMITS OF HER POWER
TO MAKE THAT OBJECT CHANGE
8
9. PARADOXICALLY
SUCH PATIENTS ARE NEVER RELENTLESS
IN THEIR PURSUIT OF GOOD OBJECTS
INSTEAD
THEIR RELENTLESS PURSUIT
IS OF THE BAD OBJECT
THE COMPELLING NEED BECOMES FIRST
TO RE – CREATE
THE OLD BAD OBJECT
AND THEN
TO PRESSURE, MANIPULATE,
PROD, FORCE, COERCE
THIS OLD BAD OBJECT TO CHANGE
9
10. THE PATIENT CAN REFIND THE OLD BAD OBJECT
IN ANY ONE OF THREE WAYS
SHE CAN CHOOSE A GOOD OBJECT
AND THEN EXPERIENCE IT AS BAD
– PROJECTION –
SHE CAN CHOOSE A GOOD OBJECT
AND THEN EXERT PRESSURE ON IT
TO BECOME BAD
– PROJECTIVE IDENTIFICATION –
OR
SHE CAN SIMPLY CHOOSE A BAD OBJECT
TO BEGIN WITH
10
11. CHOOSING A GOOD OBJECT
IS NOT A VIABLE OPTION
A GOOD OBJECT SIMPLY WILL NOT SATISFY
HER NEED
– FUELED BY THE REPETITION COMPULSION –
IS TO RE – ENCOUNTER THE OLD BAD OBJECT
AND THEN TO COMPEL THIS BAD OBJECT
TO BECOME GOOD
WHICH WILL THEN SYMBOLICALLY CORRECT FOR
THE UNMASTERED RELATIONAL TRAUMAS
THAT THE PATIENT HAD EXPERIENCED EARLY ON
AT THE HANDS OF THE INFANTILE OBJECT
11
12. AGAIN
THE PATIENT’S REFUSAL TO DEAL WITH
THE PAIN OF HER GRIEF ABOUT THE OBJECT
FUELS THE RELENTLESSNESS
WITH WHICH SHE PURSUES IT
BOTH THE RELENTLESSNESS
OF HER ENTITLED SENSE
THAT SOMETHING IS HER DUE
AND THE RELENTLESSNESS
OF HER OUTRAGE
IN THE FACE OF ITS BEING DENIED
HOPING AGAINST HOPE
SHE PURSUES THE OBJECT OF HER DESIRE
WITH A VENGEANCE –
REFUSING TO RELENT, REFUSING TO ACCEPT,
REFUSING TO FORGIVE
12
14. FAIRBAIRN’S INTENSE ATTACHMENTS (1963)
“A BAD OBJECT IS INFINITELY BETTER
THAN NO OBJECT AT ALL”
ACCOUNTS IN LARGE PART
FOR THE RELENTLESSNESS
WITH WHICH PATIENTS
PURSUE THE UNATTAINABLE
BOTH THE RELENTLESSNESS
OF THEIR UNREALISTIC HOPE
AND ENTITLED SENSE
THAT SOMETHING IS THEIR DUE
AND THE RELENTLESSNESS
OF THEIR UNRELENTING OUTRAGE
IN THE FACE OF ITS BEING DENIED
14
15. MANY THEORISTS HAVE WRITTEN
ABOUT INTERNAL BAD OBJECTS
TO WHICH THE PATIENT IS ATTACHED
BUT FEW HAVE ADDRESSED
THE CRITICAL ISSUE OF WHAT
EXACTLY FUELS THESE ATTACHMENTS
IT IS TO FAIRBAIRN THAT WE MUST LOOK
TO UNDERSTAND THE SPECIFIC NATURE
OF THE PATIENT’S ATTACHMENT
TO HER INTERNAL BAD OBJECTS
AN ATTACHMENT THAT MAKES IT DIFFICULT
FOR HER TO SEPARATE FROM
THE INFANTILE OBJECT
AND THEREBY TO EXTRICATE HERSELF
FROM HER RELENTLESS PURSUITS
AND HER COMPULSIVE RE – ENACTMENTS
15
16. HOW ARE BAD EXPERIENCES
AT THE HANDS OF THE INFANTILE OBJECT
INTERNALLY RECORDED AND STRUCTURALIZED?
FAIRBAIRN WRITES –
WHEN A CHILD’S NEED FOR CONTACT
IS FRUSTRATED BY HER MOTHER,
THE CHILD DEALS WITH HER FRUSTRATION
BY INTROJECTING THE BAD MOTHER
BASICALLY
THE CHILD TAKES THE BURDEN
OF HER MOTHER’S BADNESS
UPON HERSELF
IN ORDER NOT TO HAVE TO FEEL
THE PAIN OF HER GRIEF
16
17. DEFENSIVE INTROJECTION OF THE PARENT’S BADNESS
HAPPENS ALL THE TIME IN SITUATIONS OF ABUSE
THE PATIENT WILL RECOUNT EPISODES OF
OUTRAGEOUS ABUSE AT THE HANDS OF A PARENT
AND THEN REPORT THAT SHE FEELS
NOT ANGRY AT THE PARENT BUT GUILTY
IT IS EASIER TO EXPERIENCE HERSELF AS BAD
– AND UNLOVABLE –
THAN TO ALLOW HERSELF TO KNOW THE HORRID TRUTH
ABOUT HER PARENT AS BAD
– AND UNLOVING –
IT IS EASIER TO EXPERIENCE HERSELF
AS HAVING DESERVED THE ABUSE THAN TO
CONFRONT THE INTOLERABLY PAINFUL REALITY
THAT HER PARENT SHOULD NEVER
HAVE DONE WHAT SHE DID
17
18. A CHILD WHOSE HEART HAS BEEN BROKEN
BY HER PARENT WILL DEFEND HERSELF
AGAINST THE PAIN OF HER DISAPPOINTMENT BY
TAKING IN THE PARENT’S BADNESS AS HER OWN
THEREBY ENABLING HER TO PRESERVE
THE ILLUSION OF HER PARENT AS GOOD
AND AS ULTIMATELY FORTHCOMING
IF SHE (THE CHILD) COULD BUT GET IT RIGHT
BY INTROJECTING THE BAD PARENT
THE CHILD IS ABLE TO MAINTAIN
AN ATTACHMENT TO HER ACTUAL PARENT
AND, AS A RESULT, IS THEN ABLE
TO HOLD ON TO HER HOPE THAT
PERHAPS SOMEDAY, SOMEHOW, SOME WAY,
WERE SHE TO BE BUT GOOD ENOUGH,
SHE MIGHT YET BE ABLE
TO COMPEL THE PARENT TO CHANGE
18
19. BUT WHAT DOES FAIRBAIRN SUGGEST
IS THE SPECIFIC NATURE
OF THE CHILD’S INTENSE ATTACHMENT
TO THIS INTERNAL BAD OBJECT?
ACCORDING TO FAIRBAIRN
A BAD PARENT IS A PARENT WHO FRUSTRATES
HER CHILD’S LONGING FOR CONTACT
BUT A SEDUCTIVE PARENT
– WHO FIRST SAYS YES AND THEN SAYS NO –
IS A VERY BAD PARENT
THEREFORE, WHEN THE CHILD HAS BEEN FAILED
BY A PARENT WHO IS SEDUCTIVE,
THE CHILD
– AS HER FIRST LINE OF DEFENSE –
WILL INTROJECT THIS EXCITING
BUT ULTIMATELY REJECTING PARENT
19
20. FAIRBAIRN’S CONCEPT OF SPLITTING
IS TO BE DISTINGUISHED FROM
KERNBERG’S CONCEPT OF BORDERLINE SPLITTING
WHICH HAS IT THAT OBJECTS ARE
PRE – AMBIVALENTLY EXPERIENCED
AS EITHER ALL GOOD
– AND THEREFORE LIBIDINALLY CATHECTED –
OR ALL BAD
– AND THEREFORE AGGRESSIVELY CATHECTED –
KERNBERG’S CONCEPT OF SPLITTING
EXPLAINS THE BORDERLINE’S
TENUOUSLY ESTABLISHED LIBIDINAL OBJECT CONSTANCY
– THAT IS, THE BORDERLINE’S IMPAIRED CAPACITY
TO HOLD IN MIND BOTH GOOD AND BAD AT THE SAME TIME –
WHICH IS WHY BORDERLINES HAVE SO MUCH DIFFICULTY
INTERNALIZING GOOD – IN THE MOMENT OF OUTRAGED UPSET
THEY CANNOT REMEMBER THE GOOD THAT HAD BEEN
20
21. SPLITTING IS THE SECOND LINE OF DEFENSE
ONCE FAIRBAIRN’S BAD OBJECT IS INSIDE,
IT IS SPLIT INTO TWO PARTS
THE EXCITING OBJECT
THAT OFFERS THE ENTICING PROMISE
OF RELATEDNESS
AND THE REJECTING OBJECT
THAT ULTIMATELY FAILS TO DELIVER
IS THE REJECTING (DEPRIVING) OBJECT
A GOOD OBJECT OR A BAD OBJECT
IS THE EXCITING (ENTICING) OBJECT
A GOOD OBJECT OR A BAD OBJECT
21
22. SPLITTING OF THE EGO GOES HAND IN HAND
WITH SPLITTING OF THE OBJECT
THE SO – CALLED LIBIDINAL EGO
ATTACHES ITSELF
TO THE EXCITING OBJECT
AND LONGS FOR CONTACT,
HOPING AGAINST HOPE
THAT THE OBJECT
WILL BE FORTHCOMING
THE ANTILIBIDINAL EGO
– WHICH IS A REPOSITORY FOR ALL THE HATRED
AND DESTRUCTIVENSS THAT HAVE ACCUMULATED
AS A RESULT OF FRUSTRATED LONGING –
ATTACHES ITSELF
TO THE REJECTING OBJECT
AND RAGES AGAINST IT
22
23. SO WHAT THEN
IS THE SPECIFIC NATURE
OF THE PATIENT’S ATTACHMENT
TO THE BAD OBJECT?
IT IS, OF COURSE,
IT IS BOTH LIBIDINAL
AND ANTILIBIDINAL
– OR AGGRESSIVE –
IN NATURE
THE BAD OBJECT
IS BOTH
LOVED
– BECAUSE IT EXCITES –
AND HATED
– BECAUSE IT REJECTS –
23
24. AGAIN
KERNBERG’S GOOD OBJECT
IS AN OBJECT THAT GRATIFIES AND
IS THEREFORE LIBIDINALLY CATHECTED
BUT WHEN THAT OBJECT FRUSTRATES,
IT BECOMES A BAD OBJECT
THAT IS THEN AGGRESSIVELY CATHECTED
THE OBJECT IS THEREFORE EITHER
A GOOD OBJECT OR A BAD OBJECT
AND IS EITHER LOVED OR HATED
– PRE – AMBIVALENCE –
24
25. BY CONTRAST
FAIRBAIRN’S GOOD OBJECT
IS AN OBJECT THAT GRATIFIES AND
IS THEREFORE LIBIDINALLY CATHECTED
BUT WHEN THAT OBJECT FRUSTRATES,
IT BECOMES A BAD OBJECT
THAT IS BOTH LIBIDINALLY
AND AGGRESSIVELY CATHECTED
– AND IS THEREFORE BOTH LOVED AND HATED –
FAIRBAIRN’S ATTACHMENT TO THE
BAD OBJECT IS THEREFORE AMBIVALENT
– WHICH EXPLAINS THE PATIENT’S RELUCTANCE
TO RELINQUISH HER ATTACHMENT TO IT –
25
26. A STORY THAT GUNTRIP RECOUNTS
FAIRBAIRN HAD ONCE ASKED A CHILD
WHOSE MOTHER WOULD BEAT HER CRUELLY,
“WOULD YOU LIKE ME TO FIND YOU
A NEW, KIND MOMMY?
TO WHICH THE CHILD HAD
IMMEDIATELY RESPONDED WITH,
“NO, I WANT MY OWN MOMMY!”
FAIRBAIRN INTERPRETED THE CHILD’S RESPONSE
AS SPEAKING TO THE INTENSITY OF
NOT ONLY THE ANTILIBIDINAL TIE TO THE BAD OBJECT
BUT ALSO THE LIBIDINAL TIE TO THE BAD OBJECT
THE IDEA BEING THAT THE DEVIL YOU KNOW
IS BETTER THAN THE DEVIL YOU DON’T KNOW
AND CERTAINLY BETTER THAN NO DEVIL AT ALL
26
27. THE THIRD LINE OF DEFENSE
IS REPRESSION
– REPRESSION OF THE EGO’S ATTACHMENT
TO THE EXCITING / REJECTING OBJECT –
ACCORDING TO FAIRBAIRN
AT THE CORE OF THE REPRESSED IS
NOT AN IMPULSE, NOT A TRAUMA, NOT A MEMORY
RATHER
AT THE CORE OF THE REPRESSED IS
A FORBIDDEN RELATIONSHIP
AN INTENSELY CONFLICTED RELATIONSHIP
WITH A BAD OBJECT
THAT IS BOTH LOVED AND HATED
BUT BECAUSE THE ATTACHMENT IS REPRESSED,
THE PATIENT MAY BE UNAWARE
THAT BOTH SIDES EXIST
27
28. WHAT THIS MEANS CLINICALLY
IS THAT PATIENTS
WHO ARE RELENTLESS IN THEIR PURSUIT
OF THE BAD (EXCITING / REJECTING) OBJECT
MUST ULTIMATELY ACKNOWLEDGE
BOTH THEIR INTENSE LONGING
FOR THE OBJECT
AND THEIR OUTRAGED HATRED
OF THE OBJECT IN THE AFTERMATH
OF ITS FAILURE OF THEM
AND SO IT IS TO FAIRBAIRN THAT WE TURN
IN ORDER BETTER TO APPRECIATE
THAT THE INTENSITY OF THE PATIENT’S
ATTACHMENT TO THE BAD OBJECT
IS FUELD BY AMBIVALENCE
28
29. ALTHOUGH FAIRBAIRN’S CLAIM
IS THAT HE IS WRITING
ABOUT SCHIZOID PERSONALITIES,
I BELIEVE THAT THE MANNER
IN WHICH HE CONCEPTUALIZES
THE “ENDOPSYCHIC SITUATION” OF THESE
SO – CALLED SCHIZOID PERSONALITIES
CAPTURES, IN A NUTSHELL,
THE PSYCHODYNAMICS
OF SADOMASOCHISTIC PATIENTS
MY CONTENTION WILL BE THAT
THE PATIENT’S RELENTLESS PURSUIT
OF THE BAD OBJECT HAS BOTH
MASOCHISTIC AND SADISTIC COMPONENTS
29
30. PARENTHETICALLY
MY INTEREST IS NOT SPECIFICALLY
IN HOW SADOMASOCHISM
GETS PLAYED OUT IN THE SEXUAL ARENA
RATHER
I CONCEIVE OF SADOMASOCHISM AS BEING
A DYSFUNCTIONAL RELATIONAL DYNAMIC
THAT WILL GET PLAYED OUT
– TO A GREATER OR LESSER EXTENT –
IN MOST OF THE RELENTLESS PATIENT’S
SIGNIFICANT RELATIONSHIPS
30
31. THE PATIENT’S RELENTLESS HOPE
– WHICH FUELS HER MASOCHISM –
IS THE STANCE TO WHICH
SHE DESPERATELY CLINGS
IN ORDER TO AVOID CONFRONTING
CERTAIN INTOLERABLY PAINFUL REALITIES
ABOUT THE OBJECT AND ITS SEPARATENESS
THE PATIENT’S RELENTLESS OUTRAGE
– WHICH FUELS HER SADISM –
IS THE STANCE TO WHICH
SHE RESORTS IN THOSE MOMENTS
OF DAWNING RECOGNITION
THAT THE OBJECT IS SEPARATE
AND CANNOT BE FORCED
TO BE SOMETHING IT ISN’T
31
32. THE MASOCHISTIC DEFENSE
OF RELENTLESS HOPE
AND THE SADISTIC DEFENSE
OF RELENTLESS OUTRAGE
GO HAND IN HAND
AND BOTH SPEAK TO THE PATIENT’S
REFUSAL TO CONFRONT THE TRUTH
ABOUT THE BAD (IMMUTABLE) OBJECT
32
33. MASOCHISM IS A STORY
ABOUT THE PATIENT’S HOPE
HER RELENTLESS HOPE
– HER HOPING AGAINST HOPE –
THAT PERHAPS
SOMEDAY, SOMEHOW, SOME WAY
WERE SHE TO BE BUT GOOD ENOUGH,
TRY HARD ENOUGH,
BE PERSUASIVE ENOUGH,
PERSIST LONG ENOUGH,
SUFFER DEEPLY ENOUGH,
OR BE MASOCHISTIC ENOUGH,
SHE MIGHT YET BE ABLE TO EXTRACT
FROM THE OBJECT
THE RECOGNITION AND LOVE
DENIED HER AS A CHILD
33
34. EVEN IN THE FACE OF INCONTROVERTIBLE
EVIDENCE TO THE CONTRARY,
THE PATIENT PURSUES THE OBJECT
OF HER DESIRE WITH A VENGEANCE
THE INTENSITY OF THIS RELENTLESS PURSUIT
FUELED BY HER ENTITLED CONVICTION
THAT THE OBJECT COULD GIVE IT
– WERE THE OBJECT BUT WILLING –
SHOULD GIVE IT
– BECAUSE THAT IS THE PATIENT’S DUE –
AND WOULD GIVE IT
– WERE SHE BUT ABLE TO GET IT RIGHT –
THE PATIENT’S INVESTMENT IS NOT SO MUCH
IN THE SUFFERING PER SE
AS IT IS IN HER WILLINGNESS TO SUFFER IF NEED BE
BECAUSE OF HER PASSIONATE HOPE
THAT PERHAPS THIS NEXT TIME …
34
35. SADISM IS THEN
THE RELENTLESS PATIENT’S REACTION
TO THE LOSS OF HOPE SHE EXPERIENCES
IN THOSE MOMENTS OF DAWNING RECOGNITION
THAT SHE IS NOT ACTUALLY GOING TO GET
WHAT SHE HAD SO DESPERATELY WANTED
AND FELT SHE NEEDED TO HAVE
IN ORDER TO GO ON
IN THOSE MOMENTS
OF ANGUISHED HEARTBREAK
WHEN SHE IS CONFRONTED HEAD – ON
WITH THE INESCAPABLE REALITY
OF THE OBJECT’S SEPARATENESS
AND REFUSAL TO RELENT
35
36. THE HEALTHY RESPONSE TO THE LOSS OF HOPE
IS TO CONFRONT THE PAIN
OF ONE’S DISAPPOINTMENT
GRIEVE THE LOSS OF ONE’S ILLUSIONS
ABOUT THE OBJECT
AND ADAPTIVELY INTERNALIZE
WHATEVER GOOD
THERE WAS IN THE RELATIONSHIP
A GROWTH – PROMOTING PROCESS
DESCRIBED IN SELF PSYCHOLOGY
AS TRANSMUTING
– OR STRUCTURE – BUILDING –
INTERNALIZATION
BUT THE RELENTLESS PATIENT DOES SOMETHING ELSE …
36
37. WITH THE DAWNING RECOGNITION
THAT THE OBJECT CAN BE
NEITHER POSSESSED AND CONTROLLED
NOR MADE OVER INTO WHAT
SHE WOULD HAVE WANTED IT TO BE,
THE RELENTLESS PATIENT WILL REACT
WITH THE SADISTIC UNLEASHING
OF A TORRENT OF ABUSE DIRECTED
TOWARDS HERSELF AND / OR
TOWARDS THE DISAPPOINTING OBJECT
– WHETHER IN ACTUAL FACT AND / OR IN FANTASY –
SHE WILL ALTERNATE BETWEEN
ENRAGED PROTESTS AT HER OWN INADEQUACY
AND SCATHING REPROACHES AGAINST THE OBJECT
FOR HAVING THWARTED HER DESIRE
SADISM IS THE RELENTLESS PATIENT’S
REACTION TO THE LOSS OF HOPE 37
38. CLINICAL VIGNETTE
SO IF A PATIENT SUDDENLY BECOMES ABUSIVE,
WHAT QUESTION MIGHT THE THERAPIST POSE
SUPPOSE THE THERAPIST ASKS THE PATIENT
“HOW DO YOU FEEL THAT I HAVE FAILED YOU?”
AT LEAST THE THERAPIST WILL HAVE KNOWN
ENOUGH TO ASK THE QUESTION
BUT SHE IS ALSO INDIRECTLY SUGGESTING
THAT THE ANSWER WILL BE PRIMARILY
A STORY ABOUT THE PATIENT
– AND THE PATIENT’S DISTORTED PERCEPTION
OF HAVING BEEN FAILED –
BETTER THEREFORE TO ASK
“HOW HAVE I FAILED YOU?”
38
39. NOW SHE WILL BE SIGNALING
HER RECOGNITION OF THE FACT THAT
SHE HERSELF MIGHT HAVE CONTRIBUTED
TO THE PATIENT’S EXPERIENCE
OF DISILLUSIONMENT AND HEARTACHE
INDEED
THE THERAPIST MUST HAVE
BOTH THE WISDOM TO RECOGNIZE
AND THE INTEGRITY TO ACKNOWLEDGE
THE PART SHE HERSELF
MIGHT HAVE PLAYED IN THE DRAMA
BEING RE – ENACTED BETWEEN THEM
BY FIRST HAVING SEDUCTIVELY STOKED
THE FLAMES OF THE PATIENT’S DESIRE
AND THEN HAVING DEVASTATED THE PATIENT
THROUGH HER FAILURE, ULTIMATELY, TO DELIVER
39
40. IN ANY EVENT
THE SADOMASOCHISTIC CYCLE
WILL BE REPEATED ONCE
THE (SEDUCTIVE) OBJECT
THROWS THE PATIENT A FEW CRUMBS
THE SADOMASOCHIST
– EVER HUNGRY FOR SUCH MORSELS –
WILL BECOME ONCE AGAIN HOOKED
AND REVERT TO HER ORIGINAL
– MASOCHISTIC –
STANCE OF SUFFERING,
SACRIFICE, AND SURRENDER
IN A REPEAT ATTEMPT TO GET
WHAT SHE SO DESPERATELY WANTS
AND FEELS SHE MUST HAVE
40
41. A CLINICAL VIGNETTE
EMPATHIC GRUNTS
THIS VIGNETTE IS ABOUT
A SADOMASOCHISTIC PATIENT
WHO WAS RELENTLESS
IN HIS PURSUIT OF THAT WHICH
– AT LEAST ON SOME LEVEL –
HE KNEW HE COULD NEVER HAVE
BUT TO WHICH HE
NONETHELESS FELT ENTITLED
A MAN WHO HAD NOT YET CONFRONTED
THE PAIN OF HIS EARLY – ON HEARTACHE
IN RELATION TO HIS FATHER
41
42. I HAVE COME INCREASINGLY TO APPRECIATE
THAT WHEN A PATIENT IS IN THE THROES
OF HER RELENTLESS PURSUIT OF THE THERAPIST
IT IS USUALLY A STORY ABOUT NOT ONLY
THE PATIENT BUT ALSO THE THERAPIST
THE PATIENT’S CONTRIBUTION HAS TO DO, ADMITTEDLY,
WITH HER REFUSAL TO TAKE “NO” FOR AN ANSWER
BUT THE THERAPIST WILL OFTEN HAVE BEEN
INADVERTENTLY CONTRIBUTING BY WAY OF HER
UNWITTING SEDUCTIVENESS
WHEREBY SHE INITIALLY OFFERS THE ENTICING PROMISE
– WHETHER EXPLICITLY OR IMPLICITLY –
OF “YES” ONLY LATER TO RESCIND THAT OFFER
– WHETHER DIRECTLY OR INDIRECTLY –
HER UNINTENDED SEDUCTIVENESS WILL STOKE THE FLAMES
OF THE PATIENT’S DESIRE AND THEN DEVASTATE
THROUGH HER FAILURE, ULTIMATELY, TO DELIVER
42
43. IN OTHER WORDS
THE PATIENT’S RELENTLESSNESS
IS OFTEN CO – CREATED
WITH CONTRIBUTIONS FROM BOTH
PATIENT AND THERAPIST
THE CLINICAL VIGNETTE THAT FOLLOWS
IS ABOUT A REALLY GIFTED THERAPIST
WHOSE UNFORTUNATE REFUSAL
TO RECOGNIZE HER CONTRIBUTION TO WHAT
BECAME A TRAGICALLY STALEMATED SITUATION
BETWEEN HER AND HER PATIENT HAD
DISASTROUS CONSEQUENCES FOR THE PATIENT
THIS CLINICAL VIGNETTE
IS ENTITLED HEARTBROKEN
43
44. IF THERAPEUTIC IMPASSES
ARE EVER TO BE RESOLVED,
THEN ULTIMATELY BOTH
PATIENT AND THERAPIST
MUST BE ABLE
– AND WILLING –
TO RELENT
… AND THE THERAPIST
MIGHT NEED TO DO IT FIRST
WHICH IS WHAT I THINK
I FORTUITOUSLY DID WITH SARA,
WHEN I FINALLY RELENTED,
BROKE DOWN, AND CRIED
… WHICH THEN ENABLED SARA TO RELENT
AND SHE BEGAN TO CRY
44
45. I PRESENT NOW A CASE
THAT I WROTE IN 2012
AND HAVE ENTITLED
“THE STRUGGLE TO ACCEPT AND FORGIVE”
IT IS ACTUALLY A STORY ABOUT ME
AND IT IS A STORY ABOUT
ACCEPTANCE AND FORGIVENESS
IT TOOK ME YEARS TO UNDERSTAND
THAT THE CAPACITY TO RELENT
IS ULTIMTELY A STORY ABOUT
ACCEPTANCE AND FORGIVENESS
45
46. INTERNAL vs. RELATIONAL SADOMSOCHISTIC DYNAMICS
TO THIS POINT
OUR FOCUS HAS BEEN ON THE WAY IN WHICH
SADOMASOCHISM MANIFESTS ITSELF RELATIONALLY
AND WE HAD USED FAIRBAIRN TO HELP US UNDERSTAND
THE UNDERLYING ENDOPSYCHIC SITUATION
NAMELY
THAT THE PATIENT HAS BOTH A LIBIDINAL AND
AN AGGRESSIVE ATTACHMENT TO THE BAD OBJECT
– THUS THE AMBIVALENCE OF HER ATTACHMENT
AND THE RELENTLESSNESS OF HER PURSUIT –
THESE SAME PATIENTS HAVE BOTH A LIBIDINAL AND
AN AGGRESSIVE ATTACHMENT TO THE BAD SELF
– MANIFESTING AS SELF – INDULGENCE ON THE ONE HAND
AND SELF – DESTRUCTIVENESS ON THE OTHER –
46
47. AS AN EXAMPLE
A PATIENT WITH A SERIOUS EATING DISORDER
AFTER THE PATIENT HAS BEEN ON A
CALORIE – RESTRICTED DIET FOR A WHILE,
SHE WILL BEGIN TO FEEL DEPRIVED,
WILL BECOME RESENTFUL,
AND WILL THEN FEEL ENTITLED TO GRATIFY HERSELF
BY INDULGING IN COMPULSVE OVEREATING
WHICH WILL THEN MAKE HER FEEL GUILTY
AND PROMPT HER TO PUNISH HERSELF
BY SEVERELY RESTRICTING HER CALORIES ONCE AGAIN
WHICH WILL THEN MAKE HER FEEL DEPRIVED,
ANGRY, AND ENTITLED TO INDULGE
IN YET ANOTHER EATING BINGE
ITERATIVE CYCLES OF DEPRIVATION,
SELF – INDULGENCE, GUILT, SELF – PUNISHMENT
47
48. SADOMASOCHISM CAN BE PLAYED OUT
EITHER RELATIONALLY
– IN THE FORM OF ALTERNATING CYCLES OF
RELENTLESS HOPE AND RELENTLESS OUTRAGE –
OR INTERNALLY
– IN THE FORM OF ALTERNATING CYCLES OF
SELF – INDULGENCE AND SELF – DESTRUCTIVENESS –
AND, OF COURSE, THEY OFTEN CO – EXIST
RELATIONALLY
THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE
AND THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE
INTERNALLY
THE MASOCHISTIC DEFENSE
OF RELENTLESS SELF – INDULGENCE
AND THE SADISTIC DEFENSE
OF RELENTLESS SELF – TORMENT
48
49. WHEN SADOMASOCHISM IS PLAYED OUT RELATIONALLY,
THE PATIENT MUST ULTIMATELY CONFRONT
– AND GRIEVE –
THE REALITY OF THE OBJECT’S LIMITATIONS
AND ARRIVE AT A PLACE OF SERENE ACCEPTANCE
OF THE OBJECT’S FLAWS, IMPERFECTIONS,
AND INADEQUACIES
HAVING MADE HER PEACE WITH THE REALITY
THAT THE OBJECT IS “GOOD ENOUGH”
WHEN SADOMASOCHISM IS PLAYED OUT INTERNALLY,
THE PATIENT MUST ULTIMATELY CONFRONT
– AND GRIEVE –
THE REALITY OF HER OWN LIMITATIONS
AND ARRIVE AT A PLACE OF HUMBLE ACCEPTANCE
OF HER OWN FLAWS, IMPERFECTIONS,
AND INADEQUACIES
HAVING MADE HER PEACE WITH THE REALITY
THAT SHE HERSELF IS “GOOD ENOUGH” 49
50. CONCLUSION
“GRIEVING IS NATURE’S WAY
OF HEALING A BROKEN HEART”
ROBERTA BECKMANN
A PATIENT WHO IS CAUGHT UP IN THE THROES
OF NEEDING HER OBJECTS
TO BE OTHER THAN WHO THEY ARE
MUST BE GIVEN THE OPPORTUNITY TO CONFRONT
– AND GRIEVE –
THE EXCRUCIATINGLY PAINFUL REALITY THAT
NO ONE WILL EVER BE FOR HER
THE GOOD PARENT FOR WHOM SHE HAS SPENT
A LIFETIME SEARCHING
– THE GOOD PARENT SHE SHOULD HAVE HAD EARLY – ON
BUT NEVER, CONSISTENTLY AND RELIABLY, DID –
50
51. GENUINE GRIEVING REQUIRES OF US THAT
– AT LEAST FOR PERIODS OF TIME –
WE BE FULLY PRESENT WITH
THE ANGUISH OF OUR GRIEF,
THE PAIN OF OUR REGRET,
AND THE INTENSITY OF THE RAGE
WE WILL EXPERIENCE WHEN WE ARE CONFRONTED
WITH SOBERING, SHOCKING, AND DEVASTATING
REALITIES ABOUT OURSELVES,
OUR RELATIONSHIPS, AND OUR WORLD
WE MUST NOT ABSENT OURSELVES FROM OUR GRIEF
WE MUST ENTER INTO AND EMBRACE IT
WE CANNOT EFFECTIVELY GRIEVE WHEN WE ARE DISSOCIATED
WE NEED TO BE PRESENT, ENGAGED, IN THE MOMENT,
MINDFUL OF ALL THAT IS GOING ON INSIDE OF US,
GROUNDED, FOCUSED, AND IN THE HERE – AND – NOW
OTHERWISE NO REAL GRIEVING CAN BE DONE 51
52. IF ALL GOES WELL
IT WILL BE WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE RELATIONSHIP WITH HER THERAPIST
THAT THE PATIENT WILL BE ABLE
– AT LAST –
TO FEEL THE PAIN AGAINST WHICH
SHE HAS SPENT A LIFETIME DEFENDING HERSELF
IN THE PROCESS
TRANSFORMING BOTH
HER RELENTLESS NEED TO POSSESS AND CONTROL
AND, WHEN THWARTED,
HER RETALIATORY NEED TO PUNISH AND DESTROY
INTO THE ADAPTIVE CAPACITY
TO RELENT, ACCEPT, GRIEVE, FORGIVE,
INTERNALIZE WHAT GOOD THERE WAS,
SEPARATE, LET GO, AND MOVE ON
52
53. THE BAD NEWS, OF COURSE,
WILL BE THE SADNESS THE PATIENT
EXPERIENCES AS SHE BEGINS TO ACCEPT
THE SOBERING REALITY
THAT DISAPPOINTMENT IS AN
INEVITABLE AND NECESSARY ASPECT OF RELATIONSHIP
THE GOOD NEWS, HOWEVER,
WILL BE THE WISDOM SHE ACQUIRES
AS SHE COMES TO APPRECIATE
EVER – MORE PROFOUNDLY
THE SUBTLETIES AND NUANCES OF RELATIONSHIP
AND BEGINS TO MAKE HER PEACE
WITH THE HARSH REALITY OF LIFE’S IMPERFECTIONS
SADDER PERHAPS, BUT WISER TOO
HAROLD SEARLES HAS SUGGESTED THAT
REALISTIC HOPE ARISES IN THE CONTEXT
OF SURVIVING DISAPPOINTMENT
53
54. THE NEW YORKER CARTOON
IN WHICH A GENTLEMAN SEATED AT A TABLE
IN A RESTAURANT BY THE NAME OF
THE DISILLUSIONMENT CAFÉ
IS AWAITING THE ARRIVAL OF HIS ORDER
THE WAITPERSON RETURNS TO HIS TABLE
AND ANNOUNCES,
“YOUR ORDER IS NOT READY,
AND NOR WILL IT EVER BE.”
SERENTIY PRAYER
“GOD GRANT ME THE SERENITY
TO ACCEPT THE THINGS I CANNOT CHANGE;
COURAGE TO CHANGE THE THINGS I CAN;
AND WISDOM TO KNOW THE DIFFERENCE.”
JAPANESE ADAGE
“TRUE HAPPINESS IS NOT GETTING WHAT YOU WANT
BUT COMING TO WANT WHAT YOU HAVE.”
54
56. IF YOU WOULD LIKE
TO BE ON MY
MAILING LIST,
PLEASE EMAIL ME AT
MarthaStarkMD @
HMS.Harvard.edu
TO LET ME KNOW
56
57. REFERENCES
BECKMANN R. 1991. CHILDREN WHO GRIEVE: A MANUAL FOR CONDUCTING
SUPPORT GROUPS. Learning Publications.
FAIRBAIRN W.R.D. 1963. SYNOPSIS OF AN OBJECT – RELATIONS THEORY OF
PERSONALITY. INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 44:224 – 225.
RAKO S. 2003. SEMRAD: THE HEART OF A THERAPIST. BLOOMINGTON, IN:
iUniverse.
SEARLES H. 1979. THE DEVELOPMENT OF MATURE HOPE IN THE PATIENT –
THERAPIST RELATIONSHIP. IN COUNTERTRANSFERENCE AND RELATED
SUBJECTS: SELECTED PAPERS, pp. 479 – 502. NEW YORK, NY:
International Universities Press.
STARK M. 2017. RELENTLESS HOPE: THE REFUSAL TO GRIEVE
(International Psychotherapy Institute eBook).
WINNICOTT D.W. 1965. THE MATURATIONAL PROCESSES AND THE
FACILITATING ENVIRONMENT. Madison, CT: International Universities Press.
57