As you sit with your clients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our clients. Whether working within (1) the interpretive perspective of classical psychoanalytic theory, (2) the corrective-provision perspective of self psychology, or (3) the intersubjective perspective of contemporary relational theory, we are always busy deciding when we should highlight the healthy forces within our clients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.”
With our finger always on the pulse of the level of the client’s anxiety, we are indeed ever focused, be it consciously or unconsciously, on whether we think the client will be able to tolerate further (anxiety-provoking) challenge or will require additional (anxiety-assuaging) support – a critically important balance that is needed if the therapeutic endeavor is to be advanced.
To illustrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the client’s “defensive need” to maintain “same old, same old” and the client’s “adaptive capacity” to embrace “something new, different, and better.”
Clinical vignettes will be offered demonstrating judicious and ongoing use of these “optimally stressful” interventions that alternately support and then challenge the defense, thereby galvanizing advancement of the client, over time, from psychological rigidity (defense) to psychological flexibility (adaptation).
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our clients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of these interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...Martha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 28 Apr 2023 – Seminar 2 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD
Are you wishing that you had a better grasp of psychodynamic concepts and their application to the clinical hour? With an emphasis always on the translation of theory into practice, in this 2-hour intensive training Dr. Martha Stark will be highlighting the three major psychoanalytic schools:
(Model 1) the 1-person perspective of classical psychoanalysis – a “cognitive” approach that emphasizes “enhancement of knowledge” and “interpreting”;
(Model 2) the 1½-person perspective of self psychology – an “affective” approach that emphasizes “provision of experience” and “grieving”; and
(Model 3) the 2-person perspective of contemporary relational theory – a “relational” approach that emphasizes “engagement in relationship” and “negotiating mutual enactment.”
Martha is particularly interested in (1) how the “therapeutic process” between patient and therapist evolves over time, (2) what happens moment-to-moment in the intersubjective space between patient and therapist, (3) how healing cycles of disruption and repair can be generated when the therapist alternately challenges the patient’s defense and then supports it, and (4) how the ongoing provision of “optimal stress” can ultimately “incentivize” deep, enduring, characterological change in the patient.
In order to facilitate this advancement of the patient from psychological rigidity to psychological flexibility and from defensive reaction to adaptive response, Martha will be teaching three “optimally stressful” template statements – Model 1 “conflict statements,” Model 2 “disillusionment statements,” and Model 3 “accountability statements” – all of which are strategically designed to “precipitate disruption” in order to “trigger repair,” thereby healing unmastered early-on relational traumas and deeply embedded emotional injuries.
Martha will be presenting several brief clinical vignettes to demonstrate the transformation of “resistance” into “awareness” (Model 1), “relentless hope” into “acceptance” (Model 2), and “re-enactment” into “accountability” (Model 3).
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD
The document outlines Martha Stark's psychodynamic synergy paradigm, which utilizes five therapeutic models to catalyze psychological change. It focuses on the first three models: 1) the interpretive perspective of classical psychoanalysis, 2) the corrective provision perspective of self psychology, and 3) the intersubjective perspective of contemporary relational theory. The therapeutic actions of these three models involve "working through" optimal stress created by interventions that alternate between challenge and support. Model 1 uses interpretations to resolve internal conflicts. Model 2 helps patients grieve disappointments. Model 3 promotes taking accountability in relationships. The goal across all three is to transform patients from rigidity to flexibility.
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD
This document discusses the therapeutic use of optimal stress to provoke recovery from psychological defenses to more adaptive responses. It argues that psychodynamic psychotherapy can help patients master past traumatic experiences by superimposing an acute stressor to trigger healing cycles of disruption and repair. This allows defenses to gradually evolve into more flexible adaptations through iterative cycles of destabilization caused by therapeutic challenges, followed by restabilization due to support. The goal is to transform "rigid defense" into "flexible adaptation" and help patients thrive rather than just survive.
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptxMartha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...Martha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 28 Apr 2023 – Seminar 2 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD
Are you wishing that you had a better grasp of psychodynamic concepts and their application to the clinical hour? With an emphasis always on the translation of theory into practice, in this 2-hour intensive training Dr. Martha Stark will be highlighting the three major psychoanalytic schools:
(Model 1) the 1-person perspective of classical psychoanalysis – a “cognitive” approach that emphasizes “enhancement of knowledge” and “interpreting”;
(Model 2) the 1½-person perspective of self psychology – an “affective” approach that emphasizes “provision of experience” and “grieving”; and
(Model 3) the 2-person perspective of contemporary relational theory – a “relational” approach that emphasizes “engagement in relationship” and “negotiating mutual enactment.”
Martha is particularly interested in (1) how the “therapeutic process” between patient and therapist evolves over time, (2) what happens moment-to-moment in the intersubjective space between patient and therapist, (3) how healing cycles of disruption and repair can be generated when the therapist alternately challenges the patient’s defense and then supports it, and (4) how the ongoing provision of “optimal stress” can ultimately “incentivize” deep, enduring, characterological change in the patient.
In order to facilitate this advancement of the patient from psychological rigidity to psychological flexibility and from defensive reaction to adaptive response, Martha will be teaching three “optimally stressful” template statements – Model 1 “conflict statements,” Model 2 “disillusionment statements,” and Model 3 “accountability statements” – all of which are strategically designed to “precipitate disruption” in order to “trigger repair,” thereby healing unmastered early-on relational traumas and deeply embedded emotional injuries.
Martha will be presenting several brief clinical vignettes to demonstrate the transformation of “resistance” into “awareness” (Model 1), “relentless hope” into “acceptance” (Model 2), and “re-enactment” into “accountability” (Model 3).
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD
The document outlines Martha Stark's psychodynamic synergy paradigm, which utilizes five therapeutic models to catalyze psychological change. It focuses on the first three models: 1) the interpretive perspective of classical psychoanalysis, 2) the corrective provision perspective of self psychology, and 3) the intersubjective perspective of contemporary relational theory. The therapeutic actions of these three models involve "working through" optimal stress created by interventions that alternate between challenge and support. Model 1 uses interpretations to resolve internal conflicts. Model 2 helps patients grieve disappointments. Model 3 promotes taking accountability in relationships. The goal across all three is to transform patients from rigidity to flexibility.
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD
This document discusses the therapeutic use of optimal stress to provoke recovery from psychological defenses to more adaptive responses. It argues that psychodynamic psychotherapy can help patients master past traumatic experiences by superimposing an acute stressor to trigger healing cycles of disruption and repair. This allows defenses to gradually evolve into more flexible adaptations through iterative cycles of destabilization caused by therapeutic challenges, followed by restabilization due to support. The goal is to transform "rigid defense" into "flexible adaptation" and help patients thrive rather than just survive.
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptxMartha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD
This document discusses the transformative power of optimal stress in precipitating disruption to trigger repair. It describes how controlled damage or optimally stressful interventions can provoke recovery by challenging defenses and supporting the patient. This process involves iterative cycles of destabilization in reaction to challenges, followed by restabilization in response to support, allowing the patient to reintegrate at higher levels of functionality and adaptive capacity. The goal is to transform dysfunctional defenses into more functional adaptations through challenging defenses and tapping into the patient's resilience in the context of an empathic therapy relationship.
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 20 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.
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD
The document discusses the therapeutic use of optimal stress to provoke recovery in psychotherapy. It argues that superimposing an acute stress or disruption on top of a chronic issue can help the body or mind heal. This concept of "controlled damage" or "optimal stress" can trigger the innate ability to self-repair. The therapist can use optimally stressful interventions that alternately challenge and support defenses to facilitate iterative cycles of destabilization and restabilization, allowing the patient to process experiences and adapt at higher levels of functioning. The goal is to transform dysfunctional defenses into more functional adaptations through this process of disruption and repair.
Martha Stark MD – 16 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 – 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 – 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 – 13 Nov 2022 – Part 2 – The Art and The Science of Interpret...Martha Stark MD
As you sit with your patients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our patients. In truth, most of our patients are “conflicted” about most things most of the time. Whether working within the interpretive perspective of classical psychoanalytic theory, the corrective-provision perspective of self psychology, or the intersubjective perspective of contemporary relational theory, we are therefore ever busy deciding when we should highlight the healthy forces within patients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.” When should we “be with them where they are” and when should we “direct their attention to elsewhere”? – or can we perhaps do both at the same time?
With our finger ever on the pulse of the level of the patient’s anxiety, we are indeed always focused on whether we think the patient will be able to tolerate further (anxiety-provoking) challenge and/or will require additional (anxiety-assuaging) support – a critically important balance that is necessary if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a universally applicable intervention that targets the patient’s state of internal dividedness or conflictedness – between healthy but anxiety-provoking forces pressing for “something new and better” and less healthy but anxiety-assuaging (defensive) counterforces insisting upon “same old same old.” Brief and more extended clinical vignettes will be offered that demonstrate use of these optimally stressful “conflict statements” that are specifically designed to facilitate development of the patient’s dual awareness.
If indeed the analytic goal is deep, enduring, characterological change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress that there will be both impetus and opportunity for the patient, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 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 – 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 – 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 – 13 Nov 2022 – Part 1 – The Art and The Science of Interpret...Martha Stark MD
This document outlines Martha Stark's presentation on conceptualizing a framework for the "middle game" of psychodynamic psychotherapy. The presentation focuses on four key elements: staying attuned to a patient's anxiety level and understanding it's okay to sometimes increase or decrease anxiety; generating optimal stress through the right balance of challenge and support to incentivize changing defenses into adaptations; developing comfort with challenging and supporting unhealthy defenses as well as celebrating new, healthier adaptations; and using minimally and optimally stressful interventions. The goal is transforming psychological rigidity into flexibility through therapeutic provision of optimal stress.
Martha Stark MD – 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 – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD
My most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model (Model 5 of my Psychodynamic Synergy Paradigm) that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (whether real or simply envisioned). A constructivist model at heart, this freshly minted model features a quantum-neuroscientific approach to healing “analysis paralysis.”
This newest addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...Martha Stark MD
This most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (both real and simply envisioned).
A constructivist model at heart, the freshly minted Model 5 of my Psychodynamic Synergy Paradigm is a quantum-neuroscientific approach to healing “analysis paralysis.” This most recent addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
Indeed, over the course of the past two decades, a dedicated group of cognitive neuroscientists, ever intent upon teasing out the neural mechanisms underlying the dynamic nature of memory, have been using advanced neuroimaging techniques to deepen their understanding of the brain’s remarkable neuroplasticity, that is, the brain’s innate capacity continuously and adaptively to reorganize itself in response to ongoing environmental stimulation – although, and especially in the case of traumatic experiences, only if certain conditions are met.
More specifically, repeated embodied juxtaposition of the reactivated experience of something old and bad with the intentioned experience of something new and good will create decisive – and potentially transformational – mismatch experiences. If these mismatch experiences are repeated often enough, forcefully enough, and joltingly enough within the critical time frame of four to six hours, then the ongoing violations of conditioned expectation will eventually trigger energetic disentanglement of the patient’s toxic past from her present and quantum advancement of the patient from entrenched inaction to intentioned action as growth-impeding and disempowering narratives are replaced by growth-promoting and empowering ones.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
To the point here are the pithy words of the neuroscientist Iryna Ethell (2018), “To learn we must first forget.”
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 – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD
If deep and enduring psychodynamic change is the ultimate goal of treatment, then periodically juxtaposing seemingly contradictory “forces” (Hegel’s thesis and antithesis) will eventually jump-start the patient’s “adaptive recovery” by creating optimally stressful, growth-incentivizing “mismatch experiences.”
I will be proposing use of something to which I refer as a “conflict statement” – a clinically useful and almost universally applicable therapeutic intervention strategically designed to target internal conflictedness between anxiety-provoking (but ultimately growth-promoting) forces pressing “yes” and anxiety-relieving (but growth-impeding) resistant counterforces defending “no.”
The stress and strain of the “destabilizing dissonance” hereby created will provide the “therapeutic leverage” needed for the patient gradually, over time, to relinquish the tenacity of her rigid attachment to the defense in favor of a more flexible adaptation – a “compromise position” that will “reconcile their common truths” (Hegel’s synthesis) and transform conflict into collaboration.
The strategic construction of conflict statements requires of the therapist that she be able both to support the patient’s defense by “being with the patient where she is” and to challenge the patient’s defense by “directing the patient’s attention to where the therapist would want her to go.” I will be offering specific clinical examples to demonstrate the impact of these powerfully impactful psychotherapeutic interventions. No pain, no gain…
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Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD
This document discusses the transformative power of optimal stress in precipitating disruption to trigger repair. It describes how controlled damage or optimally stressful interventions can provoke recovery by challenging defenses and supporting the patient. This process involves iterative cycles of destabilization in reaction to challenges, followed by restabilization in response to support, allowing the patient to reintegrate at higher levels of functionality and adaptive capacity. The goal is to transform dysfunctional defenses into more functional adaptations through challenging defenses and tapping into the patient's resilience in the context of an empathic therapy relationship.
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 20 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.
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD
The document discusses the therapeutic use of optimal stress to provoke recovery in psychotherapy. It argues that superimposing an acute stress or disruption on top of a chronic issue can help the body or mind heal. This concept of "controlled damage" or "optimal stress" can trigger the innate ability to self-repair. The therapist can use optimally stressful interventions that alternately challenge and support defenses to facilitate iterative cycles of destabilization and restabilization, allowing the patient to process experiences and adapt at higher levels of functioning. The goal is to transform dysfunctional defenses into more functional adaptations through this process of disruption and repair.
Martha Stark MD – 16 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 – 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 – 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 – 13 Nov 2022 – Part 2 – The Art and The Science of Interpret...Martha Stark MD
As you sit with your patients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our patients. In truth, most of our patients are “conflicted” about most things most of the time. Whether working within the interpretive perspective of classical psychoanalytic theory, the corrective-provision perspective of self psychology, or the intersubjective perspective of contemporary relational theory, we are therefore ever busy deciding when we should highlight the healthy forces within patients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.” When should we “be with them where they are” and when should we “direct their attention to elsewhere”? – or can we perhaps do both at the same time?
With our finger ever on the pulse of the level of the patient’s anxiety, we are indeed always focused on whether we think the patient will be able to tolerate further (anxiety-provoking) challenge and/or will require additional (anxiety-assuaging) support – a critically important balance that is necessary if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a universally applicable intervention that targets the patient’s state of internal dividedness or conflictedness – between healthy but anxiety-provoking forces pressing for “something new and better” and less healthy but anxiety-assuaging (defensive) counterforces insisting upon “same old same old.” Brief and more extended clinical vignettes will be offered that demonstrate use of these optimally stressful “conflict statements” that are specifically designed to facilitate development of the patient’s dual awareness.
If indeed the analytic goal is deep, enduring, characterological change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress that there will be both impetus and opportunity for the patient, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 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 – 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 – 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 – 13 Nov 2022 – Part 1 – The Art and The Science of Interpret...Martha Stark MD
This document outlines Martha Stark's presentation on conceptualizing a framework for the "middle game" of psychodynamic psychotherapy. The presentation focuses on four key elements: staying attuned to a patient's anxiety level and understanding it's okay to sometimes increase or decrease anxiety; generating optimal stress through the right balance of challenge and support to incentivize changing defenses into adaptations; developing comfort with challenging and supporting unhealthy defenses as well as celebrating new, healthier adaptations; and using minimally and optimally stressful interventions. The goal is transforming psychological rigidity into flexibility through therapeutic provision of optimal stress.
Martha Stark MD – 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 – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD
My most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model (Model 5 of my Psychodynamic Synergy Paradigm) that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (whether real or simply envisioned). A constructivist model at heart, this freshly minted model features a quantum-neuroscientific approach to healing “analysis paralysis.”
This newest addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...Martha Stark MD
This most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (both real and simply envisioned).
A constructivist model at heart, the freshly minted Model 5 of my Psychodynamic Synergy Paradigm is a quantum-neuroscientific approach to healing “analysis paralysis.” This most recent addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
Indeed, over the course of the past two decades, a dedicated group of cognitive neuroscientists, ever intent upon teasing out the neural mechanisms underlying the dynamic nature of memory, have been using advanced neuroimaging techniques to deepen their understanding of the brain’s remarkable neuroplasticity, that is, the brain’s innate capacity continuously and adaptively to reorganize itself in response to ongoing environmental stimulation – although, and especially in the case of traumatic experiences, only if certain conditions are met.
More specifically, repeated embodied juxtaposition of the reactivated experience of something old and bad with the intentioned experience of something new and good will create decisive – and potentially transformational – mismatch experiences. If these mismatch experiences are repeated often enough, forcefully enough, and joltingly enough within the critical time frame of four to six hours, then the ongoing violations of conditioned expectation will eventually trigger energetic disentanglement of the patient’s toxic past from her present and quantum advancement of the patient from entrenched inaction to intentioned action as growth-impeding and disempowering narratives are replaced by growth-promoting and empowering ones.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
To the point here are the pithy words of the neuroscientist Iryna Ethell (2018), “To learn we must first forget.”
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 – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science of Interpretation.pptx (20)
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD
If deep and enduring psychodynamic change is the ultimate goal of treatment, then periodically juxtaposing seemingly contradictory “forces” (Hegel’s thesis and antithesis) will eventually jump-start the patient’s “adaptive recovery” by creating optimally stressful, growth-incentivizing “mismatch experiences.”
I will be proposing use of something to which I refer as a “conflict statement” – a clinically useful and almost universally applicable therapeutic intervention strategically designed to target internal conflictedness between anxiety-provoking (but ultimately growth-promoting) forces pressing “yes” and anxiety-relieving (but growth-impeding) resistant counterforces defending “no.”
The stress and strain of the “destabilizing dissonance” hereby created will provide the “therapeutic leverage” needed for the patient gradually, over time, to relinquish the tenacity of her rigid attachment to the defense in favor of a more flexible adaptation – a “compromise position” that will “reconcile their common truths” (Hegel’s synthesis) and transform conflict into collaboration.
The strategic construction of conflict statements requires of the therapist that she be able both to support the patient’s defense by “being with the patient where she is” and to challenge the patient’s defense by “directing the patient’s attention to where the therapist would want her to go.” I will be offering specific clinical examples to demonstrate the impact of these powerfully impactful psychotherapeutic interventions. No pain, no gain…
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
Many a patient, as a child, has suffered great heartache at the hands of a misguided, even if well-intentioned, parent, be it in the form of psychological trauma and abuse (too much bad) or emotional deprivation and neglect (not enough good). Such a patient may never have had occasion to confront the pain of her grief about the parent's unwitting but devastating betrayal of her. Instead, she has defended herself against the pain of her heartache by pushing it, unprocessed, out of her awareness and clinging instead to the illusion of her parent (or a stand-in for her parent) as good and as ultimately forthcoming if she (the patient) could but get it right.
Under the sway of her repetition compulsion, the patient – as she struggles through her life – will find herself delivering into each new relationship her desperate hope that perhaps this time, were she to be but good enough, want it badly enough, or suffer deeply enough, she might yet be able to transform this new object of her relentless desire into the perfect parent she should have had as a child – but never did (Stark 1994a, 1994b, 1999, 2015).
As long as the patient continues her relentless pursuits, however, and refuses to come to terms with the reality of the limitations, separateness, and immutability of the people in her world – and the limits of her power to make them change – then she will be consigning herself to a lifetime of chronic frustration, heartache, and unremitting feelings of impotent rage and profound despair.
Elvin Semrad (Rako 1983) captures this poignantly with the following: “Pretending that <something> can be when it can’t is how people break their heart.”
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdfMartha Stark MD
I have always found the following quote from Gary Schwartz’s 1999 The Living Energy Universe to be inspirational: “One of science’s greatest challenges is to discover certain principles that will explain, integrate, and predict large numbers of seemingly unrelated phenomena.” So too my goal has long been to be able to tease out overarching principles – themes, patterns, and repetitions – that that are relevant in the deep healing work that we do as psychotherapists.
Drawing upon concepts from fields as diverse as systems theory, chaos theory, quantum mechanics, solid-state physics, toxicology, and psychoanalysis to inform my understanding, on the pages that follow I will be offering what I hope will prove to be a clinically useful conceptual framework for understanding how it is that healing takes place – be it of the body or of the mind. More specifically, I will be speaking both to what exactly provides the therapeutic leverage for healing chronic dysfunction and to how we, as psychotherapists, can facilitate that process?
Just as with the body, where a condition might not heal until it is made acute, so too with the mind. In other words, whether we are dealing with body or mind, superimposing an acute injury on top of a chronic one is sometimes exactly what a person needs in order to trigger the healing process.
More specifically, the therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – is often the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in our patients with longstanding emotional injuries and scars.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will serve simply to reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will “galvanize to action” and provoke healing. I refer to this as the Goldilocks Principle of Healing.
And so it is that with our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is my firm belief in the
underlying resilience that patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from dysfunctional defensive reaction to more functional adaptive response.
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdfMartha Stark MD
Freud’s interest was in the internal conflict that exists between, on the one hand, untamed id drives (most notably sexual and aggressive ones) clamoring for gratification and release and, on the other hand, the defenses mobilized by an undeveloped ego made anxious by the threatened breakthrough of those drives – conflict that will create neurotic suffering and interfere with the capacity to derive pleasure and fulfillment from love, work, and play (Freud 1926).
Using as a springboard Freud’s premises of drive-defense conflict as the source of a person’s difficulties in life and of the goal of treatment as therefore transformation of id energy into ego structure so that primitive defenses can be relinquished and conflict resolved – “Where id was, there shall ego be” (Freud 1923), I will go on to broaden Freud’s conceptualization of neurotic conflict to encompass, more generally, growth-impeding tension between anxiety-provoking but ultimately health-promoting internal forces pressing yes and anxiety- assuaging internal counterforces defending no.
The aim of treatment will then become (1) to tame the id so that its now more manageable energy can be redirected into more constructive channels and used to power the pursuit of healthier endeavors and (2) to strengthen the ego so that it will become both better able to cope with the multitude of anxiety-provoking stressors (internal and external) to which it is being continuously exposed and more skilled at harnessing id energy to fuel actualization of potential. In essence, a tamer id and a stronger ego will enable the patient to cope with the stress of life (Selye 1978) by adapting instead of defending – “Where defense was, there shall adaptation be.”
In the treatment situation, the therapist will offer psychotherapeutic interventions specifically designed to precipitate disruption in order to trigger repair (Stark 2008, 2012, 2014). To be effective against dysfunctional defenses that have become firmly entrenched over time, despite having long since outlived their usefulness, these therapeutic interventions must be optimally stressful. In other words, they must be strategically formulated to offer just the right combination of challenge and support.
Martha Stark MD – 1994 A Primer on Working with Resistance.pdfMartha Stark MD
Every day after work, a very depressed young man sits in the dark in his living room hour after hour, doing nothing, his mind blank. By his side is his stereo and a magnificent collection of his favorite classical music. The flick of a switch and he would feel better- and yet night after night, overwhelmed with despair, he just sits, never once touching that switch.
I would like to suggest that we think of this man as being in a state of internal conflict (although he may not, at this point, be aware of such conflict). He could turn on his stereo, but he does not. He could do something that would make him feel better, but he does nothing. Within this man is tension between what he "should" let himself do and what he finds himself doing instead.
In general, patients both do and don't want to get better. They both do and don't want to maintain things as they are. They both do and don't want to get on with their lives. They both are and aren't invested in their suffering. They are truly conflicted about all the choices that confront them.
The patient may protest that he desperately wants to change. He does and he doesn't. He may insist that he would do anything in order to feel better. Well, yes and no. On some level, everybody wants things to be better, but few are willing to change.
Drive theory conceives of conflict as involving internal tension between id impulse insisting "yes" and ego defense protesting "no" (with the superego coming down usually on the side of the ego). In Ralph Greenson's (1967) words: "A neurotic conflict is an uncon- scious conflict between an id impulse seeking discharge and an ego defense warding off the impulse's direct discharge or access to consciousness" (p. 17).
Although drives are considered part of the id, affects (drive derivatives) are thought to reside in the ego; in fact, the ego is said to be the seat of all affects. When Freud writes of psychic conflict between the id and the ego, it is understood that sometimes he is referring to conflict between an id drive and an ego defense and sometimes he is referring to conflict between an anxiety-provoking affect (in the ego but deriving from the id) and an ego defense.
Martha Stark MD – 1994 Working with Resistance.pdfMartha Stark MD
This book is about the patient’s resistance and his refusal to grieve. Drawing upon concepts from classical psychoanalysis, object relations theory, and self psychology, I present a model of the mind that takes into consideration the relationship between unmourned losses and how such losses are internally recorded – as both absence of good (structural deficit) and presence of bad (structural conflict). These internal records of traumatic disappointments sustained early on give rise to forces that interfere with the patient’s movement toward health – forces that constitute, therefore, the resistance.
Within the patient is a tension between that which the patient should let himself do/feel and that which he does/feels instead. Patient and therapist, as part of their work, will need to be able to understand and name, in a profoundly respectful fashion, both sets of forces –both those healthy ones, which impel the patient in the direction of progress, and those unhealthy resistive ones, which impede such progress. As part of the work to be done, the patient must eventually come to appreciate his investment in his defenses, how they serve him, and the price he pays for holding on to them.
My interest is in the interface between theory and practice –the ways in which theoretical constructs can be translated into the clinical situation; to that end, I suggest specific, prototypical interventions for each step of the working-through process.
My contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects. Instead, he protects himself from the pain of knowing the truth about his objects by clinging to misperceptions of them; holding on to his defensive need not to know enables him not to feel his grief.
To the extent that the patient is defended, to that extent will he be resistant to doing the work that needs ultimately to be done – grief work that will enable him to let go of the past, let go of his relentless pursuit of infantile gratification, and let go of his compulsive repetitions. Only as the patient grieves, doing now what he could not possibly do as a child, will he get better.
I believe that mental health has to do with the capacity to experience one’s objects as they are, uncontaminated by the need for them to be otherwise. A goal of treatment, therefore, is to transform the patient’s need for his objects to be other than who they are into the capacity to accept them as they are.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...Martha Stark MD
Over the course of the decades, my own approach has become much more integrative and holistic – one that appreciates the complex interdependence of mind and body and the critical role played by the impact of stress on the MindBodyMatrix.
The living system – the ground regulation system – the divine matrix – the web of life – a liquid crystal through which information and energy flow.
More specifically, I will be speaking to the role played by limbic kindling and the resultant hypersensitivity to stress that is a hallmark of depressed patients.
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptxMartha Stark MD
This document provides an overview of a seminar on an existential-humanistic approach to healing brokenness and easing despair in patients. The seminar will focus on Model 4 patients who have experienced early heartbreak and withdrawal from relationships due to a "shattered heart". It will discuss helping patients overcome dread of emotional surrender and providing an opportunity to "regress in order to redo" early experiences. The presenter's psychodynamic synergy paradigm incorporates five therapeutic models, including one focused on patients experiencing relentless despair and nonrelatedness due to early relational failures.
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptxMartha Stark MD
This document discusses coronary artery disease and the impact of stress on heart health. It notes that coronary artery disease often develops silently and can cause sudden death in some cases. Chronic stress can damage blood vessels and cause plaque buildup over time by increasing blood pressure and viscosity. Psychological stress, depression, obesity, and other risk factors place cumulative stress on the heart and compromise its ability to adapt. Maintaining the heart's resilience by reducing stressors and replenishing nutrients is important for cardiovascular health.
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...Martha Stark MD
The document discusses how coherence emerges from chaos in complex adaptive systems like living organisms. It argues that through ongoing cycles of disruption and repair, such systems can self-organize and evolve from disorder to higher levels of order and coherence in response to environmental inputs. The ability of a system to process and integrate stressors over time determines whether it progresses towards health or disease.
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptxMartha Stark MD
traumatic stress – stress that the system cannot process and must therefore defend against
optimal stress – stress that the system can process, integrate, and ultimately adapt to, although always at some cost to the system
it's how well the living system (the MindBodyMatrix) is able to manage the cumulative impact of the myriad environmental stressors to which it is being continuously exposed that will make of them either traumatic events or growth opportunities
and that ability to manage stress is a story about the system's ability to process, integrate, and adapt to the impact of environmental challenge, input from the outside that either threatens to overwhelm the system or prompts the system to mobilize its ability to heal itself
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptxMartha Stark MD
Unexplained Chronic Illness
Martin Pall's compelling conceptualization of the excitotoxic cascade and its pivotal role in both the initiation and the perpetuation of chronic multisystem illnesses
one or more short-term stressors
chemical sensitivity – pesticides and organic solvents
chronic fatigue – bacterial and viral infections
fibromyalgia – physical traumas
PTSD – severe psychological traumas
to which the body responds with an outpouring of
excitotoxins (glutamate)
inflammatory factors (cytokines and eicosanoids)
free radicals (nitric oxide)
stress-induced outpouring of endogenous excitotoxins, inflammatory cytokines, and free radicals sets in motion (in certain susceptible individuals) the nitric oxide / peroxynitrite cycle
a viciously destructive, self-propagating cycle involving
immune stimulation, inflammatory cytokines, membrane destabilization, synaptic overactivity, opening of calcium-permeable channels, massive calcium influx, etc.
and culminating in chronic illness
Martha Stark MD – 22 Jun 2018 – A Heart Shattered, Relentless Despair, and A ...Martha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
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.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
- 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
2. FREE 2 – Hour MASTER CLASS Part 1
Saturday / January 21, 2023 – 17.00 – 19.00 (UK) / 12 noon – 2:00 pm (ET)
FREE 1 – Hour Q&A FOLLOW – UP SESSION
WITH MARTHA
Saturday / January 28, 2023 – 17.00 – 18.00 (UK) / 12 noon – 1:00 pm (ET)
FREE 2 – Hour MASTER CLASS Part 2
Saturday / February 4, 2023 – 17.00 – 19.00 (UK) / 12 noon – 2:00 pm (ET)
NO NEED TO SIGN UP SEPARATELY FOR
PART 2 OR THE Q&A FOLLOW – UP SESSION
BECAUSE, IF YOU ARE READING THIS,
YOU ARE AUTOMATICALLY ENROLLED IN BOTH
YOU WILL USE THE SAME LINK
– SO PLEASE SAVE IT! –
2
3. AT THE END OF THE DAY
“THERAPEUTIC MODALITIES” THAT HAVE
“DEEP AND ENDURING PSYCHODYNAMIC CHANGE”
AS THEIR ULTIMATE GOAL
FOR EXAMPLE, PSYCHOANALYSIS AND OTHER “DEPTH PSYCHOLOGIES,”
INCLUDING – BUT NOT LIMITED TO – ACT, IFS, CORE PROCESS PSYCHOTHERAPY, EMDR, ISTDP, AEDP, EFT,
NLP, SENSORIMOTOR PSYCHOTHERAPY, SOMATIC EXPERIENCING, AND PSYCHOMOTOR PSYCHOTHERAPY
MUST BE ABLE TO “CATALYZE” TRANSFORMATION OF
(1) “PSYCHOLOGICAL RIGIDITY” INTO “PSYCHOLOGICAL FLEXIBILITY”
– IN THE EVOCATIVE WORDS OF ACCEPTANCE AND COMMITMENT THERAPY (ACT) –
(2) “LOW – LEVEL DEFENSE” INTO “HIGHER – LEVEL DEFENSE”
OR “RIGID DEFENSE” INTO “MORE FLEXIBLE ADAPTATION”
– IN THE MORE TRADITIONAL WORDS OF PSYCHOANALYSIS AND EGO PSYCHOLOGY –
SUCH THAT THE PATIENT
– WHATEVER HER “STARTING POINT” / WHATEVER HER “INITIAL LEVEL OF FUNCTIONALITY” –
WILL – OVER TIME – BECOME EVER BETTER ABLE
TO MANAGE THE MYRIAD “STRESSORS” IN HER LIFE
– EVER BETTER ABLE TO “RESPOND ADAPTIVELY” INSTEAD OF “REACTING DEFENSIVELY” –
MY “PSYCHOANALYTICALLY INFORMED”
PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
IS A “DEPTH PSYCHOLOGY” IN THIS TRADITION
3
4. WHAT WILL BE REQUIRED OF THE THERAPIST?
THAT SHE STAY EVER ATTUNED
TO THE LEVEL OF THE PATIENT’S ANXIETY
THAT SHE USE THIS LEVEL
TO GUIDE HER IN HER INTERVENTIONS
– “CHALLENGING” WHENEVER POSSIBLE TO PROVIDE “IMPETUS” –
– “SUPPORTING” WHENEVER NECESSARY TO PROVIDE “OPPORTUNITY” –
AND THAT SHE APPRECIATE
THE “TRANSFORMATIVE POWER”
OF THIS “OPTIMAL STRESS”
– NAMELY, JUST THE RIGHT COMBINATION
OF “CHALLENGE” AND “SUPPORT” –
CRITICALLY IMPORTANT IF TRANSFORMATION
OF “OUTDATED AND RIGID DEFENSE”
INTO “UPDATED AND MORE FLEXIBLE ADAPTATION”
IS THE ULTIMATE GOAL
IN SUM
WHETHER THE TREATMENT IS “SHORT – TERM” AND “INTENSIVE”
OR “LONGER – TERM” AND “BROADER – BASED,”
THE THERAPEUTIC GOAL WILL BE TO ADVANCE THE PATIENT
FROM “RIGIDITY” TO “FLEXIBILITY” / FROM “CONSTRICTED” TO “WIDE OPEN”
4
6. THE OPERATIVE CONCEPT HERE WILL BE
THE ONGOING GENERATION OF
“DESTABILIZING ANXIETY”
AND “INCENTIVIZING STRESS”
“OPTIMAL (NON – TRAUMATIC) STRESS”
HANS SELYE’S “EUSTRESS” vs. “DISTRESS” (1978)
JUST THE RIGHT COMBINATION OF
“DESTABILIZING CHALLENGE”
– TO “PROVOKE DISRUPTION” –
AND “RESTABILIZING SUPPORT”
– TO “JUMP – START REPAIR” –
6
7. PARENTHETICALLY – IN THE PHYSIOLOGICAL REALM
SUPERIMPOSING AN ACUTE PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES EXACTLY WHAT THE BODY NEEDS
IN ORDER TO HEAL
IN ESSENCE
“CONTROLLED DAMAGE” TO “PROVOKE HEALING”
BY WAY OF EXAMPLES
HIGH – INTENSITY INTERVAL TRAINING (HIIT) / INTERMITTENT FASTING
ISCHEMIC PRECONDITIONING / INTERMITTENT HYPOXIC TRAINING / HYPERBARIC OXYGEN
HOMEOPATHIC REMEDIES / VACCINES AND OTHER IMMUNOTHERAPIES / MEDICINAL PLANTS
DERMABRASION / FRAXEL LASER TREATMENTS / RADIOFREQUENCY MICRONEEDLING
PLATELET – RICH PLASMA (PRP) / PLATELET – RICH FIBRIN (PRF)
VAMPIRE GUM REJUVENATION / BOTOX / STEM CELL FACELIFTS
ELECTROCONVULSIVE THERAPY (ECT) / TRANSCRANIAL MAGNETIC STIMULATION (TMS)
CARDIAC DEFIBRILLATION
PULSE WAVE THERAPIES (SHOCKWAVE THERAPY AND SOUND THERAPY)
ACUPUNCTURE / ACUPRESSURE / CUPPING
RED LIGHT THERAPY / INFRARED SAUNAS / CRYOTHERAPY
BRAIN TEASERS AND MENTAL EXERCISES
WHEN THE BODY IS “OPTIMALLY CHALLENGED,”
NO MATTER HOW COMPROMISED IT MIGHT BE IN ITS FUNCTIONALITY
“ADAPTIVE RECOVERY” WILL BE TRIGGERED
BECAUSE OF THE BODY’S “INNATE RESILIENCE” 7
8. BY THE SAME TOKEN – IN THE PSYCHOLOGICAL REALM
THE “THERAPEUTIC PROVISION” OF “OPTIMAL STRESS”
NECESSARY IF DEEP AND ENDURING PSYCHODYNAMIC CHANGE
IS THE ULTIMATE GOAL OF TREATMENT
“CHALLENGE” THAT OFFERS “IMPETUS”
AND “SUPPORT” THAT OFFERS “OPPORTUNITY”
FOR TRANSFORMATION AND GROWTH
TWO GROUPS OF PSYCHODYNAMIC INTERVENTIONS
(1) “MINIMALLY STRESSFUL” INTERVENTIONS
DESIGNED TO “PROMOTE THE THERAPEUTIC ALLIANCE,”
“SECURE THE ATTACHMENT,” AND “SET THE STAGE”
(2) “OPTIMALLY STRESSFUL” INTERVENTIONS
DESIGNED TO “PROVIDE CHALLENGE AND THEN SUPPORT”
IN ORDER TO “GENERATE THERAPEUTIC LEVERAGE”
THE STRATEGIC CONSTRUCTION
OF THESE TWO TYPES OF INTERVENTIONS
IS BOTH A “SCIENCE” AND AN “ART”
8
9. 9
THE “SCIENCE” AND THE “ART” OF DESIGNING
“MINIMALLY STRESSFUL” INTERVENTIONS
– THAT WILL “LAY THE FOUNDATION” –
AND “OPTIMALLY STRESSFUL” INTERVENTIONS
– THAT WILL “INCENTIVIZE DEEP AND ENDURING CHANGE” –
10. MORE SPECIFICALLY
CHALLENGING THE PATIENT’S RIGID DEFENSES
– AGAINST A BACKDROP OF “EMPATHIC RESONANCE” – TANIA SINGER (2013)
WILL CREATE “HOMEOSTATIC IMBALANCE”
A STATE OF “DISEQUILIBRIUM”
THAT CANNOT, HOWEVER, BE TOLERATED FOR LONG
PROMPTING “RESTORATION OF EQUILIBRIUM”
– THAT IS, “RE – EQUILIBRATION” –
BUT EACH TIME AT A HEALTHIER LEVEL OF
“HOMEOSTASIS” AND “ADAPTIVE CAPACITY”
A LEVEL EVER – MORE EVOLVED
BECAUSE OF THE SYNERGY BETWEEN
THE THERAPIST’S “EXTERNAL SUPPORT”
AND THE PATIENT’S “INTERNAL RESOURCES”
THAT IS
HER “UNDERLYING RESILIENCE”
HER “INNATE STRIVING TOWARDS HEALTH”
HER “INTRINSIC CAPACITY TO ADAPT TO (OPTIMAL) STRESS”
THE “WISDOM OF HER BODY” – WALTER B. CANNON (1932)
10
11. THE NET RESULT OF THESE “ITERATIONS”
WILL BE THE GENERATION
OF ONGOING “HEALING CYCLES”
OF “DISRUPTION” AND “REPAIR”
– “DESTABILIZATION” AND “RESTABILIZATION” –
BUT EACH TIME AT EVER – HIGHER LEVELS OF ADAPTABILITY
SUCH THAT PSYCHOLOGICAL RIGIDITY
WILL EVENTUALLY BECOME TRANSFORMED
INTO PSYCHOLOGICAL FLEXIBILITY
– RIGID DEFENSE INTO MORE FLEXIBLE ADAPTATION –
– “SAME OLD, SAME OLD” INTO “SOMETHING NEW, DIFFERENT, AND BETTER” –
11
12. 12
THE ULTIMATE GOAL OF TREATMENT
EVER – LESS PSYCHOLOGICAL RIGIDITY
EVER – MORE PSYCHOLOGICAL FLEXIBILITY
13. WE MIGHT THEREFORE SAY OF
PSYCHODYNAMIC PSYCHOTHERAPY
THAT IT OFFERS THE FOLLOWING
PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT
BOTH IMPETUS AND OPPORTUNITY
– ALBEIT BELATEDLY –
TO MASTER TRAUMATIC 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 INTRINSIC CAPACITY TO ADAPT TO STRESS –
BE REVISITED, REPROCESSED, AND REFRAMED
SUCH THAT GROWTH – IMPEDING DEFENSES
– ONCE NECESSARY FOR SURVIVAL –
CAN BE GRADUALLY TRANSFORMED
INTO GROWTH – PROMOTING ADAPTATIONS
STRONGER AT THE BROKEN PLACES
13
17. PLEASE NOTE
I DO NOT “LIMIT” DEFENSES
TO THE WELL – KNOWN
AND MORE TRADITIONAL ONES
AT ONE END OF THE CONTINUUM
“LOW – LEVEL DEFENSES”
FOR EXAMPLE
REPRESSION, REGRESSION, DENIAL,
DISSOCIATION, DISPLACEMENT, PROJECTION,
ISOLATION OF AFFECT, INTELLECTUALIZATION,
AND REACTION FORMATION
AT THE OTHER END
“HIGHER – LEVEL” OR “MORE MATURE DEFENSES”
THAT ARE “MORE ADAPTIVE” AND “MORE SOCIALLY ACCEPTABLE”
FOR EXAMPLE
SUBLIMATION, HUMOR, ALTRUISM,
HUMILITY, AND POSITIVE IDENTIFICATIONS
17
18. RATHER
I DEFINE DEFENSES “MORE BROADLY”
AS SPEAKING TO ANY OF THE
“SELF – PROTECTIVE MECHANISMS”
THAT WE MOBILIZE WHEN MADE ANXIOUS
IN THE FACE OF STRESSORS
– WHETHER INTERNAL STRESSORS OR EXTERNAL ONES –
AT ONE END OF THE CONTINUUM
WHAT HAPPENS “REFLEXIVELY”
WHEN WE ARE CONFRONTED WITH STRESSORS
THAT “OVERWHELM” US WITH ANXIETY
TO WHICH I REFER AS “LOW – LEVEL DEFENSES”
OR “RIGID DEFENSES”
AT THE OTHER END
WHAT HAPPENS “MORE REFLECTIVELY”
WHEN WE ARE CONFRONTED WITH STRESSORS
THAT WE ARE ABLE TO “TAKE IN OUR STRIDE”
TO WHICH I REFER AS “HIGHER – LEVEL DEFENSES”
OR “MORE FLEXIBLE ADAPTATIONS”
AT ONE END OF THE CONTINUUM – “DEFENSIVE REACTIONS”
AT THE OTHER END – “ADAPTIVE RESPONSES”
18
19. FROM “DEFENSIVE REACTION” TO “ADAPTIVE RESPONSE”
FROM EXTERNALIZING BLAME TO TAKING OWNERSHIP
FROM WHINING AND COMPLAINING TO BECOMING PROACTIVE
FROM DENYING TO CONFRONTING HEAD – ON
FROM BEING CRITICAL TO BECOMING MORE COMPASSIONATE
FROM DISSOCIATING TO BECOMING MORE PRESENT
FROM FEELING VICTIMIZED TO TAKING RESPONSIBILITY
FROM CURSING THE DARKNESS TO LIGHTING A CANDLE
FROM BEING DISEMPOWERED AND RESTRICTED
TO BECOMING MORE EMPOWERED AND EXPANSIVE
FROM BEING JAMMED UP
TO MOBILIZING ONE’S ENERGIES IN THE PURSUIT OF ONE’S DREAMS
FROM “OUTDATED NARRATIVES” TO “UPDATED NARRATIVES”
ABOUT SELF, OTHERS, AND THE WORLD
FROM “SAME OLD, SAME OLD”
TO “SOMETHING NEW, DIFFERENT, AND BETTER”
19
20. EITHER WE
– MADE ANXIOUS –
“REACT” TO STRESSORS BY “DEFENDING”
“DEFENSIVE REACTION”
OR WE
– MORE RESILIENT –
“RESPOND” TO STRESSORS BY “ADAPTING”
“ADAPTIVE RESPONSE”
20
21. WE CANNOT AVOID SUFFERING
BUT WE CAN CHOOSE HOW WE COPE WITH IT, FIND MEANING IN IT,
AND MOVE FORWARD WITH RENEWED PURPOSE
“BETWEEN STIMULUS AND RESPONSE IS A SPACE.
IN THAT SPACE IS OUR POWER TO CHOOSE OUR RESPONSE.
IN OUR RESPONSE LIES OUR GROWTH AND OUR FREEDOM.”
AUTHOR UNKNOWN
– ALTHOUGH OFTEN MISATTRIBUTED TO THE EXISTENTIAL PSYCHIATRIST VIKTOR FRANKL –
AS THIS APPLIES TO THE CLINICAL SITUATION
IN THAT SPACE IS OUR POWER
EITHER TO “REACT DEFENSIVELY”
– BY WALLOWING IN OUR DESPAIR AND ABNEGATING RESPONSIBILITY FOR OUR LIVES –
OR TO “RESPOND ADAPTIVELY”
– BY ACKNOWLEDGING THAT, DESPITE OUR DESPAIR, FROM THIS POINT FORWARD
THE MEANING WE MAKE OF OUR LIVES IS ENTIRELY UP TO US –
NOT ONLY DO WE HAVE THE FREEDOM TO CREATE THAT MEANING
BUT WE ALSO HAVE THE RESPONSIBILITY TO DO SO
IT HAS BEEN SUGGESETED THAT 10% OF WHAT HAPPENS TO US IS “LIFE”
BUT 90% IS HOW WE “REACT” OR “RESPOND” TO IT
21
23. WITH IT BEING UNDERSTOOD THAT
THE RELATIONSHIP BETWEEN DEFENSE AND ADAPTATION
IS A YIN – YANG RELATIONSHIP
THESE “SELF – PROTECTIVE MECHANISMS”
ARE COMPLEMENTARY – NOT OPPOSING – FORCES
FOR EXAMPLE, LIGHT CANNOT EXIST WITHOUT SHADOW
FURTHERMORE
ALL DEFENSES HAVE AN ADAPTIVE COMPONENT
JUST AS ALL ADAPTATIONS SERVE A DEFENSIVE FUNCTION
NONETHELESS AND MORE GENERALLY
ALTHOUGH DEFENSES MIGHT ONCE
HAVE BEEN NECESSARY
FOR THE PATIENT TO “SURVIVE,”
AS DEFENSES BECOME
UPGRADED TO ADAPTATIONS,
THE PATIENT BECOMES
BETTER ABLE TO “THRIVE”
THE THERAPEUTIC ACTION
IS INDEED DESIGNED
TO TRANSFORM “SURVIVING” INTO “THRIVING” 23
27. AS A PRELUDE TO LEARNING ABOUT
“MINIMALLY STRESSFUL” INTERVENTOINS
THAT “TEASE OUT” AND GENTLY “NAME”
THE PATIENT’S DEFENSES
IN ORDER TO “PROMOTE A THERAPEUTIC ALLIANCE,”
“SECURE THE ATTACHMENT,” AND “SET THE STAGE”
AND “OPTIMALLY STRESSFUL” INTERVENTOINS
THAT WILL “CHALLENGE” THE PATIENT’S DEFENSES
AND THEN “SUPPORT” THEM
IN ORDER TO “CREATE THERAPEUTIC LEVERAGE”
AND ULTIMATELY TRANSFORMATION
OF DEFENSE INTO ADAPTATION
IS SOMETHING TO WHICH I REFER AS
“NUANCED PHRASEOLOGY”
27
29. NUANCED PHRASEOLOGY
“YOU FIND YOURSELF”
WHEN THE PATIENT IS
HAVING AN “ANXIETY – PROVOKING” FEELING
BUT HAVING TROUBLE “ACKNOWLEDGING” IT
“YOU FIND YOURSELF FEELING PRETTY ANGRY RIGHT NOW.”
INSTEAD OF
“YOU ARE FEELING PRETTY ANGRY RIGHT NOW.”
THE THERAPIST IS INDIRECTLY
LETTING THE PATIENT “OFF THE HOOK” A BIT
BY INTIMATING THAT THE PATIENT’S ANGER
MIGHT WELL BE SOMETHING THAT HAS
COME UPON HER (AS IF TAKEN HER BY SURPRISE)
AND, THEREFORE, SOMETHING FOR WHICH
SHE IS NOT ENTIRELY RESPONSIBLE
PARADOXICALLY
THE PATIENT MIGHT WELL THEN
BE ABLE MORE EASILY TO “ACKNOWLEDGE”
THE “ANXIETY – PROVOKING” FEELING
29
30. NUANCED PHRASEOLOGY
“YOU WOULD PROBABLY RATHER NOT”
WHEN THE THERAPIST SAYS
SHE KNOWS THAT THE PATIENT
“WOULD PROBABLY RATHER NOT”
BE FEELING WHAT SHE IS FEELING,
THE THERAPIST IS INDIRECTLY
LETTING THE PATIENT “OFF THE HOOK” A BIT
AND, HERE TOO, ATTEMPTING TO MAKE IT
A LITTLE EASIER FOR THE PATIENT
THEN TO “ACKNOWLEDGE”
THE “ANXIETY – PROVOKING” FEELING
“YOU WOULD PROBABLY RATHER NOT
BE FEELING ANGRY
BUT, EVEN SO, FIND YOURSELF
FEELING PRETTY ANGRY RIGHT NOW.”
INSTEAD OF
“YOU ARE FEELING
PRETTY ANGRY RIGHT NOW.”
30
31. NUANCED PHRASEOLOGY
“I AM REALIZING”
INSTEAD OF
“I REALIZE”
“I AM REALIZING”
IS MORE “DYNAMIC”
AND SUGGESTS
AN “ONGOING PROCESS”
OF “EVOLVING AWARENESS”
“I REALIZE”
IS MORE “STATIC”
31
32. NUANCED PHRASEOLOGY
“FOR NOW” / “AT THIS POINT IN TIME”
“RIGHT NOW” / “AT THIS MOMENT”
HERE THE THERAPIST IS USING
A LITTLE BIT OF “SUBLIMINAL STIMULATION”
TO HIGHLIGHT THE FACT THAT PERHAPS,
AT SOME LATER POINT IN TIME,
THE PATIENT MIGHT BE ABLE
TO TAKE HEALTHY ACTION
INSTEAD OF REMAINING STUCK
“EVEN THOUGH YOU STOPPED LOVING
YOUR WIFE YEARS AGO,
AT THIS POINT IN TIME,
YOU CAN’T IMAGINE EVER LEAVING HER.”
INSTEAD OF
“EVEN THOUGH YOU STOPPED LOVING
YOUR WIFE YEARS AGO,
YOU CAN’T IMAGINE EVER LEAVING HER.”
32
33. NUANCED PHRASEOLOGY
“EVERY NOW AND THEN” / “SOMETIMES”
“PERHAPS” / “ON SOME LEVEL” / “A LITTLE”
“MAYBE” / “POSSIBLY” / “AT TIMES”
“A PART OF YOU” / “SOME PART OF YOU”
THE THERAPIST CAN USE “QUALIFIERS”
TO “LIMIT” THE “INTENSITY” OF SOMETHING
THAT IS “ANXIETY – PROVOKING,”
THEREBY “PERHAPS” MAKING IT EASIER
FOR THE PATIENT THEN TO “ACKNOWLEDGE” IT
“SOMETIMES YOU FIND YOURSELF FEELING A LITTLE ANGRY.”
INSTEAD OF “YOU ARE FEELING ANGRY.”
“A PART OF YOU IS ENRAGED.”
INSTEAD OF “YOU ARE ENRAGED.”
“EVERY NOW AND THEN PERHAPS
YOU FIND YOURSELF FEELING A LITTLE ANGRY.”
INSTEAD OF “YOU ARE FEELING ANGRY.”
33
34. NUANCED PHRASEOLOGY
“I SEE” INSTEAD OF “I HEAR”
THE THERAPIST MAKES EXPLICIT THAT
SHE IS A WITNESS TO WHAT THE PATIENT IS FEELING
– “I SEE HOW MUCH PAIN YOU ARE IN.” –
“I SEE HOW DESPERATELY YOU WANT TO GET BETTER.” –
NOTE THE SUBTLE DISTINCTION BETWEEN
“I SEE HOW LONELY YOU ARE FEELING.”
AND “I HEAR HOW LONELY YOU ARE FEELING.”
“I SEE HOW SAD YOU BECOME WHEN YOU TALK ABOUT
YOUR MOTHER AND HOW SHE NEVER UNDERSTOOD.”
AND “I HEAR HOW SAD YOU BECOME WHEN YOU TALK ABOUT
YOUR MOTHER AND HOW SHE NEVER UNDERSTOOD.”
IT FEELS GREAT TO BE ABLE TO KNOW
THAT HOW LONELY AND SAD YOU ARE IS BEING “HEARD”
BUT SOMETIMES IT IS EVEN MORE
VALIDATING AND REASSURING TO BE ABLE TO KNOW
THAT HOW LONELY AND SAD YOU ARE IS BEING “SEEN”
34
35. NUANCED PHRASEOLOGY
SOMETIMES USEFUL WILL BE THE “ACT” CONCEPT OF “COGNITIVE DEFUSION”
ONE OF THE GOALS OF WHICH IS TO CHANGE THE WAY
THE PATIENT “RELATES TO” HER THOUGHTS
– THAT IS, HOW SHE “POSITIONS HERSELF IN RELATION TO” THEM –
COGNITIVE DEFUSION PROMOTES “NOTICING” THE THOUGHT
RATHER THAN “GETTING CAUGHT UP IN” OR “BUYING INTO” THE THOUGHT
– LETTING THOUGHTS COME AND GO RATHER THAN HOLDING ONTO THEM –
DEFUSION INVITES THE PATIENT TO “THINK ABOUT THINKING”
AND TO REALIZE THAT SHE IS
CONTINUOUSLY “VERBALLY CONSTRUCTING” HER WORLD
IT IS ABOUT NOT CHANGING THE THOUGHT BUT RELATING DIFFERENTLY TO IT
“YOU ARE HAVING THE THOUGHT THAT YOU ARE BROKEN.”
“YOU ARE NOTICING THAT YOU ARE HAVING THE THOUGHT
THAT YOU ARE BROKEN.”
“YOU FIND YOURSELF THINKING THAT YOU ARE BROKEN.”
ALL OF WHICH ARE DESIGNED TO ENCOURAGE DEVELOPMENT
OF THE PATIENT’S “REFLECTING SELF” OR “OBSERVING EGO”
35
36. MORE SPECIFICALLY
“DUAL AWARENESS” IS BEING FOSTERED
WHEN THE PATIENT IS BEING ASKED
TO DIRECT HER ATTENTION
TO WHAT SHE IS EXPERIENCING IN THE MOMENT
AT THE SAME TIME THAT SHE IS BEING ENCOURAGED
TO STEP BACK FROM THAT EXPERIENCE
IN ORDER TO DETACH HERSELF FROM IT,
RECOVER PERSPECTIVE, AND REFLECT UPON IT
IN THE PSYCHOANALYTIC LITERATURE
THIS DISTINCTION
BETWEEN “EXPERIENCING” SOMETHING AND “OBSERVING” IT
IS DESCRIBED AS A “SPLIT IN THE EGO”
BETWEEN THE EXPERIENCING
– OR PARTICIPATING –
EGO
AND THE OBSERVING
– OR REFLECTING –
EGO
RICHARD STERBA (1968) / LESTON HAVENS (1976)
“DUAL AWARENESS” IS ONE OF THE GOALS OF ANY TREATMENT
36
37. NUANCED PHRASEOLOGY
AS WE SHALL LATER SEE
RELEVANT FOR OPTIMALLY STRESSFUL INTERVENTIONS
DESIGNED TO “PROMOTE AWARENESS”
ARE THE IMPACTFUL WORDS “YOU KNOW THAT … ”
WHICH HIGHLIGHT “ANXIETY – PROVOKING REALITIES”
THAT THE PATIENT REALLY DOES KNOW
– EVEN IF SHE WOULD RATHER NOT –
“YOU KNOW THAT I DON’T ANSWER THOSE KINDS OF QUESTIONS,
BUT YOU FIND YOURSELF WISHING THAT I DID.”
INSTEAD OF
“I DON’T ANSWER THOSE KINDS OF QUESTIONS … ”
“YOU KNOW THAT YOU COULD ASK YOUR NEIGHBOR TO KEEP HIS BARKING DOG INSIDE,
BUT YOU FIND YOURSELF HESITATING FOR FEAR OF GETTING HIM ANGRY.”
INSTEAD OF
“YOU COULD ASK YOUR NEIGHBOR TO KEEP HIS BARKING DOG INSIDE … ”
YOU ARE NOT TELLING THE PATIENT WHAT “YOU” KNOW
RATHER, YOU ARE INSISTING THAT THE PATIENT
“TAKE OWNERSHIP” OF WHAT “SHE” KNOWS!
– EVEN IF IT MAKES HER ANXIOUS –
37
38. NUANCED PHRASEOLOGY
AS WE SHALL LATER SEE
RELEVANT FOR OPTIMALLY STRESSFUL INTERVENTIONS
DESIGNED TO FACILITATE THE “GRIEVING OF DISILLUSIONMENT”
ARE THE IMPACTFUL WORDS “YOU HAD HOPED THAT … ”
STRATEGIC USE OF THE “PAST PERFECT (PLUPERFECT) TENSE”
HIGHLIGHTS THE REALITY THAT SOMETHING THE PATIENT
“HAD BEEN HOPING FOR” IS BECOMING NO LONGER A VIABLE OPTION
“YOU HAD HOPED THAT I WOULD TELL YOU WHAT YOU SHOULD DO
BUT YOU ARE BEGINNING TO REALIZE
THAT I DON’T SIMPLY OFFER ADVICE
AND THAT ANGERS AND UPSETS YOU TERRIBLY.”
“YOU HAD HOPED THAT YOUR MOTHER MIGHT SOMEDAY APOLOGIZE
BUT YOU ARE BEGINNING TO REALIZE
THAT PROBABLY SHE NEVER WILL
AND THAT BREAKS YOUR HEART.”
“YOU HAD HOPED THAT YOUR HUSBAND WOULD ASK YOU
HOW YOUR DAY HAD GONE
BUT YOU ARE STARTING TO REALIZE THAT HE NEVER DOES ASK
AND PROBABLY NEVER WILL
AND THAT REALIZATION IS ABSOLUTELY DEVASTATING.”
THESE KINDS OF STATEMENTS ARE DESIGNED TO HELP THE PATIENT
ADVANCE ULTIMATELY FROM “RELENTLESS HOPE” TO “ACCEPTANCE”
38
41. THE “THERAPEUTIC ACTION”
IN PSYCHODYNAMIC PSYCHOTHERAPY
TWO GROUPS OF PSYCHODYNAMIC INTERVENTIONS
(1) “MINIMALLY STRESSFUL” INTERVENTIONS
DESIGNED TO “PROMOTE A THERAPEUTIC ALLIANCE,”
“SECURE THE ATTACHMENT,” AND “SET THE STAGE”
(2) “OPTIMALLY STRESSFUL” INTERVENTIONS
DESIGNED TO “PROVIDE BOTH CHALLENGE AND SUPPORT,”
THEREBY “GENERATING INTERNAL TENSION AND THERAPEUTIC LEVERAGE”
THE STRATEGIC CONSTRUCTION OF THESE
TWO TYPES OF INTERVENTIONS
IS BOTH A “SCIENCE” AND AN “ART”
41
42. OVER THE COURSE OF THE YEARS
I HAVE COME TO APPRECIATE
THAT WHATEVER THE TREATMENT
WHETHER CRISIS INTERVENTION, TRAUMA WORK,
SHORT – TERM INTENSIVE, OR LONGER – TERM BROADER – BASED
IT WILL GENERALLY BE MORE EFFECTIVE
TO “MAKE STATEMENTS” THAN TO “ASK QUESTIONS”
“QUESTIONS” RUN THE RISK
OF ELICITING SOMEWHAT “HEADY ANSWERS”
– MORE “INTELLECTUAL” THAN “HEARTFELT” –
FOR THE MOST PART THEREFORE
I LET THE PATIENT “LEAD” AND I “FOLLOW”
I “MAKE STATEMENTS” AND DON’T “ASK QUESTIONS”
IN OFFERING THE PATIENT STATEMENTS
I AM, OF COURSE, “GIVING” HER SOMETHING
RATHER THAN “ASKING” OF HER
THAT SHE “GIVE” ME SOMETHING
– NAMELY, ANSWERS TO MY QUESTIONS –
42
43. BUT WHEN MIGHT QUESTIONS BE USEFUL?
WHEN YOU ARE DOING AN INTAKE
OR GATHERING INFORMATION ABOUT THE PATIENT’S HISTORY
WHEN YOU FEEL THAT YOU SIMPLY MUST HAVE MORE CONCRETE DATA POINTS
IN ORDER TO UNDERSTAND WHAT THE PATIENT IS TALKING ABOUT
WHENEVER POSSIBLE, HOWEVER, TRY TO SIT WITH “NOT ALWAYS KNOWING THE SPECIFICS”
“NEGATIVE CAPABILITY” – THE CAPACITY TO TOLERATE UNCERTAINTY AND “NOT – KNOWING”
A TERM COINED BY THE ROMANTIC POET JOHN KEATS (1991)
AND INSTEAD TRY TO “GIVE” THE PATIENT A HEARTWARMING STATEMENT THAT
REFLECTS YOUR “EMPATHIC ATTUNEMENT” TO WHAT SHE IS FEELING OR SAYING
FOR EXAMPLE, TO A PATIENT WHOSE MOTHER WAS ALWAYS JUDGMENTAL
AND WHO IS NOW TALKING ABOUT HOW AWFUL IT FEELS
TO BE CONSTANTLY JUDGED BY HER GIRLFRIEND
INSTEAD OF
“IS THAT THE WAY YOU FELT IN RELATION TO YOUR MOTHER?”
– WHICH RUNS THE RISK OF ELICITING A RATHER “HEADY” ANSWER OR “I GUESS SO” –
BE PATIENT – PERHAPS OFFER HER SOMETHING LIKE
“IT ALWAYS FEELS AWFUL TO BE JUDGED.”
OR
“AN ALL – TOO – FAMILIAR – AND – AWFUL FEELING –
THAT FEELING OF BEING ALWAYS JUDGED …”
– WHICH WILL PROBABLY ELICIT A MORE HEARTFELT AND APPRECIATIVE RESPONSE –
AND MIGHT, INDEED, CREATE SPACE FOR HER TO “ASSOCIATE TO” HER JUDGMENTAL MOTHER
AND, IF POSSIBLE, MINIMIZE YOUR USE OF “SAY MORE” 43
44. THREE SPECIFIC QUESTIONS THAT MIGHT BE USEFUL
OVER TIME AND AS A RESULT OF MY IMMERSION IN SOME
OF THE SHORT – TERM, INTENSIVE APPROACHES TO TREATMENT,
I HAVE COME TO APPRECIATE THE VALUE OF THREE “GENERIC” QUESTIONS
– ESPECIALLY USEFUL FOR PATIENTS WHO ARE HAVING TROUBLE STARTING THEIR SESSIONS
OR HAVING TROUBLE “FOCUSING” ON WHAT THEY MIGHT WANT FROM THEIR TREATMENT –
SO, AT THE BEGINNING OF THE SESSION, I MIGHT ASK –
“HOW WOULD YOU WANT TO USE YOUR TIME IN HERE TODAY?”
AT THE END OF THE SESSION, I WILL THEN OFTEN ASK –
“DO YOU FEEL THAT YOU USED YOUR TIME IN HERE TODAY
IN THE WAY THAT YOU WOULD HAVE WANTED TO?”
AND
“WHAT IS YOUR TAKE – AWAY FROM YOUR TIME IN HERE TODAY?”
LIKE IT OR NOT
– AND, ACTUALLY, IT IS SOMETIMES APPRECIATED –
PATIENTS COME TO EXPECT THESE SOMEWHAT CHALLENGING QUESTIONS
WHAT’S IMPORTANT IS THAT THESE QUESTIONS
– WHICH ARE DESIGNED TO “FOCUS” THE PATIENT’S ATTENTION –
ARE BEING ASKED
– AND NOT EVEN SO MUCH THE ACTUAL ANSWERS –
44
46. “MINIMALLY STRESSFUL” INTERVENTIONS
ARE DESIGNED TO ELICIT “LITTLE OR NO” ANXIETY
“BE WITH THE PATIENT WHERE SHE IS”
– HOMEOSTATIC ATTUNEMENT –
NOT ONLY DO THEY “SUPPORT” THE PATIENT
BUT THEY ALSO “ADVANCE THE BALL” A BIT
BY GENTLY “TEASING OUT” AND “BRINGING INTO FOCUS”
SOME OF THE “DEFENSIVE” AND “LESS – THAN – HEALTHY”
“RECURRING THEMES, PATTERNS, AND REPETITIONS”
IN THE PATIENT’S LIFE
INTEGRATION STATEMENTS
2 “PARTS” – BOTH / AND STATEMENTS
PATH – OF – LEAST – RESISTANCE STATEMENTS
DAMAGED – FOR – LIFE STATEMENTS
COMPENSATION STATEMENTS
ENTITLEMENT STATEMENTS
MASOCHISM STATEMENTS
SADISM STATEMENTS
PARADOXICAL INTERVENTIONS
YOU – WOULD – WISH STATEMENTS
EMPATHIC STATEMENTS
46
48. 48
THE DESIGN OF “MINIMALLY STRESSFUL” INTERVENTIONS
THAT SPOTLIGHT
PROBLEMATIC “RECURRING THEMES, PATTERNS, AND REPETITIONS”
49. MINIMALLY STRESSFUL INTERVENTIONS
INTEGRATION STATEMENTS
FOR THOSE PATIENTS WHO ARE HAVING TROUBLE
HOLDING IN MIND SIMULTANEOUSLY BOTH
THE “GOOD” AND THE “BAD” ASPECTS OF THEIR EXPERIENCE
IN OTHER WORDS
PATIENTS WITH TENUOUSLY ESTABLISHED
“LIBIDINAL OBJECT CONSTANCY” / “EVOCATIVE MEMORY CAPACITY”
“HARD TO REMEMBER” / “HARD TO IMAGINE”
“WHEN YOU’RE FEELING THIS BAD,
IT’S HARD TO REMEMBER THAT YOU HAD EVER FELT GOOD
AND IT’S HARD TO IMAGINE THAT YOU COULD EVER FEEL GOOD AGAIN.”
“WHEN YOUR HEART IS BREAKING AS IT IS NOW,
YOU CAN’T IMAGINE THAT YOU COULD EVER DARE TO TRUST AGAIN.”
“WHEN YOU’RE FEELING THIS ANGRY AT ME,
IT’S HARD TO REMEMBER THAT YOU USED TO FEEL GOOD ABOUT ME
AND EVEN LOOKED FORWARD TO COMING.”
“WHEN YOU FEEL THIS DESPAIRING,
YOU CAN’T REMEMBER EVER HAVING HAD ANY HOPE WHATSOEVER.” 49
50. MINIMALLY STRESSFUL INTERVENTIONS
2 “PARTS” – BOTH / AND STATEMENTS
FOR THOSE PATIENTS WHO ARE “AMBIVALENT” / “CONFLICTED”
ABOUT SOMEONE OR SOMETHING
AND ARE STRUGGLING EITHER TO MAKE A DECISION
OR TO COME TO TERMS WITH SIMPLY “BEING AMBIVALENT”
– THAT IS, “HAVING MIXED FEELINGS” WITHOUT FEELING THE NEED TO “TAKE ACTION” –
IN OTHER WORDS
PATIENTS WHO ARE FEELING “TWO WAYS” ABOUT AN ISSUE
– WHEN BOTH “SIDES” ARE “REASONABLE OPTIONS” –
“A PART OF YOU” / “ANOTHER PART OF YOU”
“A PART OF YOU THINKS ALL THE TIME ABOUT STOPPING THE AFFAIR,
BUT ANOTHER PART OF YOU IS STILL ENJOYING EVERY MINUTE OF IT.”
“A PART OF YOU IS PROFOUNDLY DISAPPOINTED, HURT, AND ANGRY
AT YOUR HUSBAND, BUT ANOTHER PART OF YOU DOES KNOW
THAT THIS IS A MAN WHOM YOU DEEPLY CHERISH, ADORE, AND LOVE.”
“A PART OF YOU IS TEMPTED TO STOP TREATMENT BECAUSE
IT COSTS SO MUCH, BUT ANOTHER PART OF YOU KNOWS THAT
YOUR THERAPY HAS BEEN VERY HELPFUL AND THAT YOU MIGHT
BE MAKING A HUGE MISTAKE WERE YOU SIMPLY TO QUIT RIGHT NOW.”
“A PART OF YOU REMAINS HURT, DISAPPOINTED, AND UNFORGIVING,
BUT ANOTHER PART OF YOU IS WANTING TO FIND A WAY TO FORGIVE ME.” 50
51. MINIMALLY STRESSFUL INTERVENTIONS
PATH – OF – LEAST – RESISTANCE STATEMENTS
FOR THOSE PATIENTS WHO ARE
“REACTING DEFENSIVELY”
RATHER THAN
“RESPONDING ADAPTIVELY”
EASIER TO “REACT DEFENSIVELY”
THAN TO “RESPOND ADAPTIVELY”
“IT’S EASIER TO GIVE UP THAN TO KEEP FIGHTING
FOR WHAT YOU REALLY BELIEVE IN.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS DISEMPOWERED
THAN TO TAKE OWNERSHIP OF THE POWER
AND AGENCY THAT YOU ACTUALLY DO HAVE.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS HAVING NO
ACCOUNTABILITY THAN TO TAKE RESPONSIBILITY FOR YOUR LIFE.”
“IT’S EASIER TO HOLD ON TO THE HOPE THAT YOUR HUSBAND
MIGHT SOMEDAY CHANGE THAN TO CONFRONT
THE REALITY THAT HE PROBABLY NEVER WILL.” 51
52. THE “I CAN’T, YOU CAN, AND YOU SHOULD” DYNAMIC
FOR THOSE PATIENTS WHO EXPERIENCE THEMSELVES AS
SO “DAMAGED” FROM WAY BACK THAT THEY CAN’T
IMAGINE BEING HELD ACCOUNTABLE FOR THEIR LIVES NOW
DAMAGED – FOR – LIFE – AND – THEREFORE
– NOT – RESPONSIBLE – NOW STATEMENTS
WHO FIND THEMSELVES THEREFORE LOOKING TO OTHERS
TO “COMPENSATE” THEM FOR THE EARLY – ON “DAMAGE”
COMPENSATION STATEMENTS
AND WHO
– QUITE FRANKLY –
FEEL THAT THIS “COMPENSATION” IS THEIR DUE
ENTITLEMENT STATEMENTS
DISTORTION – DISTORTED SENSE OF SELF AS “NOT HAVING”
ILLUSION – ILLUSORY SENSE OF OBJECT AS “HAVING”
ENTITLEMENT – ENTITLED SENSE THAT “GETTING” IS THEIR “DUE”
ALL OF WHICH ARE DEFENSIVE REACTIONS
52
53. MINIMALLY STRESSFUL INTERVENTIONS
DAMAGED – FOR – LIFE – AND – THEREFORE
– NOT – RESPONSIBLE – NOW STATEMENTS
“YOU FEEL SO DAMAGED BECAUSE OF ALL
THE ABUSE YOU SUFFERED AS A CHILD THAT
YOU CANNOT IMAGINE EVER BEING ABLE TO DO
ANYTHING NOW TO MAKE YOUR LIFE BETTER.”
COMPENSATION STATEMENTS
“WHEN YOU ARE FEELING DESPERATE, AS YOU
ARE RIGHT NOW, YOU FIND YOURSELF WISHING THAT
SOMEONE WOULD UNDERSTAND JUST HOW BAD YOU FEEL
AND WOULD DO SOMETHING TO HELP EASE YOUR PAIN.”
ENTITLEMENT STATEMENTS
“BECAUSE YOU FEEL THAT WHAT YOUR FATHER DID TO YOU
WAS SO UNFAIR, DEEP DOWN YOU HARBOR
THE CONVICTION THAT THE WORLD NOW OWES YOU.”
“BECAUSE YOUR MOTHER NEVER UNDERSTOOD YOU AND
LEFT YOU SO MUCH ON YOUR OWN, YOU’RE NOW FEELING
THAT UNLESS SOMEONE IS WILLING TO GO MORE THAN
HALFWAY, THEN YOU’RE SIMPLY NOT INTERESTED.” 53
54. MINIMALLY STRESSFUL INTERVENTIONS
MASOCHISM STATEMENTS
FOR THOSE PATIENTS WHO
– BECAUSE IT SIMPLY “HURTS TOO MUCH” –
REFUSE TO “CONFRONT” – AND “GRIEVE” – THE REALITY
THAT THE “OBJECT OF THEIR DESIRE” WILL NEVER CHANGE
INSTEAD, THEY HOLD ON TO THEIR
DEFENSIVE – AND RELENTLESS – “HOPING AGAINST HOPE”
“BECAUSE IT IS SO PAINFUL TO HAVE TO CONFRONT THE TRUTH
ABOUT YOUR HUSBAND AND HIS ONGOING INSENSITIVITY TO YOU
AND YOUR FEELINGS, YOU FIND YOURSELF CONTINUING TO HOPE
THAT PERHAPS, IF YOU TRY HARD ENOUGH, ARE PERSUASIVE
ENOUGH, PERSIST LONG ENOUGH, AND SUFFER DEEPLY ENOUGH,
THEN YOU MIGHT YET BE ABLE TO COMPEL HIM TO CHANGE.”
“BECAUSE IT HURTS TOO MUCH TO CONFRONT THE REALITY THAT
YOUR FATHER WILL NEVER BE WILLING TO APOLOGIZE FOR ALL THAT
HE DID TO YOU WHEN YOU WERE GROWING UP, YOU KEEP HOPING
THAT IF YOU TRY HARD ENOUGH, PERSIST LONG ENOUGH, AND
SUFFER DEEPLY ENOUGH, THEN HE MIGHT YET RELENT AND BE WILLING
TO ACKNOWLEDGE THAT HE KNOWS HE CAUSED YOU TERRIBLE
HEARTBREAK DURING ALL THOSE YEARS OF HIS DRINKING.”
54
55. MINIMALLY STRESSFUL INTERVENTIONS
SADISM STATEMENTS
FOR THOSE PATIENTS WHO
– IN THOSE MOMENTS OF DAWNING RECOGNTION THAT WHAT THEY
HAD SO DESPERATELY WANTED AND FELT THEY NEEDED TO HAVE
IN ORDER TO SURVIVE IS SIMPLY NOT GOING TO HAPPEN –
ARE DEFENSIVELY PRONE TO EXPERIENCING THEMSELVES
AS HAVING BEEN “MISTREATED” AND / OR “VICTIMIZED”
THEY WILL OFTEN THEN FIND THEMSELVES FEELING THAT THEY
EITHER HAVE NO CHOICE BUT TO RETALIATE
OR ARE ENTITLED TO RETALIATE
“WHEN YOU FEEL THAT YOU HAVE BEEN WRONGED,
YOU CAN GET PRETTY UGLY IF YOU HAVE TO!”
“WHEN YOUR MOTHER IS DOING HER ‘USUAL,’
IT HURTS SO MUCH TO BE FEELING SO MISUNDERSTOOD
THAT YOU FIND YOURSELF THINKING ABOUT
WHAT YOU CAN DO TO HURT HER BACK.
YOU WANT HER TO GET A TASTE OF HER OWN MEDICINE.”
“WHEN YOU FEEL THAT YOU ARE BEING MISTREATED,
IT MAKES YOU SO ENRAGED THAT YOU FEEL
YOU HAVE NO CHOICE BUT TO RESPOND IN KIND.” 55
56. MINIMALLY STRESSFUL INTERVENTIONS
PARADOXICAL INTERVENTIONS
FOR THOSE PATIENTS WHO ARE DEEPLY ENTRENCHED
IN MAINTAINING “SAME OLD, SAME OLD”
ALTHOUGH THE PATIENT HAS BEEN GIVING “LIP SERVICE” TO WANTING
TO CHANGE, IT IS CLEAR FROM WHAT THE PATIENT IS ACTUALLY DOING
THAT THE PATIENT IS NOT, IN FACT, PREPARED TO CHANGE
THE THERAPIST THEREFORE “LETS GO” OF HER OWN “NEED”
FOR THE PATIENT TO CHANGE AND “ACCEPTS” THE REALITY THAT
THE PATIENT IS NOT PREPARED TO CHANGE – AT LEAST “NOT FOR NOW”
IN ESSENCE, THE THERAPIST “GOES WITH THE RESISTANCE” BY
“PRESCRIBING THE SYMPTOM”
“I THINK I AM BEGINNING TO SEE WHY YOU FEEL THAT YOU
CANNOT AFFORD TO TRUST ANYONE. BASED UPON WHAT YOU
HAVE BEEN TELLING ME ABOUT THE NUMBERS OF TIMES
YOUR TRUST HAS BEEN BETRAYED AND YOUR HEART BROKEN
IN THE PAST, I CAN NOW UNDERSTAND WHY YOU FEEL THAT YOU
SIMPLY MIGHT NEVER WANT TO OPEN YOUR HEART AGAIN. ALTHOUGH
IT MIGHT MEAN BEING ALONE FOREVER, AT LEAST YOU WILL
KNOW THAT NO ONE WILL BE ABLE TO HURT YOU EVER AGAIN.” 56
57. MINIMALLY STRESSFUL INTERVENTIONS
PARADOXICAL INTERVENTIONS
IN ESSENCE, THE THERAPIST USES HER “EMPATHIC UNDERSTANDING”
OF THE PATIENT TO OFFER HER A PARADOX
TO THE PATIENT WHO, EVEN AFTER A YEAR, HAS NOT BEEN ABLE TO MOBILIZE
HIMSELF TO UPDATE HIS RESUME – DESPITE HIS PROCLAIMED INTENTION TO DO SO
“YES, EVERY SINGLE DAY YOU DREAD GOING TO WORK, YOU HATE YOUR
BOSS, AND YOUR JOB IS INCREDIBLY TEDIOUS. BUT, AS YOU HAVE SAID
REPEATEDLY, IT DOES PROVIDE YOU WITH FINANCIAL SECURITY AND A SENSE
OF BELONGING. SO I THINK I AM BEGINNING TO APPRECIATE THAT,
AT THIS POINT IN YOUR LIFE, PERHAPS IT DOES NOT REALLY MAKE SENSE
FOR YOU TO BE MOVING FORWARD WITH APPLYING FOR A NEW JOB.
PERHAPS AT SOME POINT IN THE FUTURE, BUT NOT RIGHT NOW.”
TO A DESPERATELY UNHAPPY 45 – YEAR – OLD MAN MARRIED FOR 20 YEARS
“YOU HATE IT THAT YOUR WIFE ABUSES YOU IN ALL THE
WAYS THAT SHE DOES. AND YOU STOPPED LOVING HER YEARS AGO.
BUT, AS YOU HAVE OFTEN EXPLAINED, WHEN YOU START
TO THINK ABOUT HOW OLD AND TIRED YOU FEEL, YOU FIND YOURSELF
THINKING THAT PERHAPS IT IS SIMPLY TOO LATE – THAT THE TIME
TO HAVE LEFT HER MIGHT ALREADY HAVE COME AND GONE. UNDERSTOOD.”
IF THE PATIENT IS MADE ANGRY BY THE THERAPIST’S PARADOXICAL INTERVENTIONS,
THEN THE PATIENT’S ANGER MIGHT WELL EMPOWER HER –
MIGHT WELL PROVIDE THE NECESSARY MOTIVATION (OR IMPETUS)
FOR HER TO TAKE ACTION – IF ONLY TO PROVE THE THERAPIST WRONG!
57
58. MINIMALLY STRESSFUL INTERVENTIONS
YOU – WOULD – WANT / YOU – WOULD – WISH STATEMENTS
HERE THE THERAPIST IS GIVING THE PATIENT THE “BENEFIT OF THE DOUBT”
USING A LITTLE BIT OF “SUBLIMINAL STIMULATION”
TO HIGHLIGHT THE FACT THAT THE THERAPIST THINKS THERE IS INDEED
A HEALTHY PART OF THE PATIENT THAT “WOULD WANT” TO BE ABLE
TO DO A BETTER JOB OF MANAGING THINGS IN HER LIFE
INSTEAD OF ALWAYS SABOTAGING HERSELF
ADMITTEDLY, THE THERAPIST IS “LEADING THE WITNESS” A BIT
BY “PUTTNG HEALTHY WORDS IN THE PATIENT’S MOUTH”
BUT IT IS ALL BEING DONE WITH AN EYE
TO HELPING THE PATIENT ACCESS HER “LEADING EDGE”
“YOU WOULD WANT TO BE ABLE TO FORGIVE YOUR HUSBAND
BUT ARE JUST NOT QUITE YET PREPARED TO DO THAT.”
“YOU WOULD WANT TO BE ABLE TO GET YOUR HOUSE IN ORDER
BUT FIND YOURSELF FIGHTING IT EVERY STEP OF THE WAY.”
“YOU WOULD WANT TO BE ABLE TO HAVE A RICHER, MORE FULFILLING LIFE
BUT HOLD BACK FROM VENTURING OUT
FOR FEAR OF BEING TERRIBLY DISAPPOINTED.”
“YOU WOULD WISH THAT YOU COULD BE MORE ON TOP OF YOUR GAME
BUT FIND YOURSELF CONTINUALLY FEELING OVERWHELMED
AND LOSING YOUR WAY.” 58
60. EMPATHIC STATEMENTS
ARE ALSO “MINIMALLY STRESSFUL”
AND, THEREFORE, DESIGNED TO ELICIT “LITTLE OR NO ANXIETY”
BUT THEY ARE IN A CLASS OF THEIR OWN
THEY ARE MY “DEFAULT MODE” AND WHERE I SPEND MUCH OF MY TIME
THEY “TEASE OUT” AND “BRING INTO FOCUS”
BOTH THE PATIENT’S “AFFECT”
AND THE “NARRATIVE”
WITH WHICH THAT AFFECT IS ASSOCIATED
FORMULATING THESE EMPATHIC STATEMENTS
REQUIRES OF THE THERAPIST THAT SHE BE
“ATTENTIVELY LISTENING” AND “EMPATHICALLY ATTUNED”
TO WHATEVER THE PATIENT IS “EXPERIENCING” IN THE MOMENT
THE THERAPIST’S STANCE HERE IS PROBABLY BEST DESCRIBED
AS ONE OF HAVING AN “AGENDALESS PRESENCE”
– IN THE WORDS OF DANIEL GOLEMAN (2007) –
AND OF BEING A “MINDFUL WITNESS”
– IN THE WORDS OF TARA BRACH (2004) –
THESE EMPATHIC STATEMENTS REASSURE THE PATIENT
THAT SHE IS BEING UNDERSTOOD AND THAT SHE IS NOT ALONE
60
63. I TAKE MY CUES FROM THE PATIENT
AND AM THEREFORE GENERALLY ONE STEP BEHIND HER – NOT AHEAD
LISTENING ALWAYS WITH COMPASSION AND NEVER JUDGMENT
– WITH BOTH “HEAD” AND “HEART” –
TO EVERYTHING THE PATIENT IS TELLING ME
– NO MATTER HOW SEEMINGLY IRRELEVANT IT MIGHT APPEAR TO BE –
– NO DETAIL TOO TRIVIAL TO BE IGNORED OR FORGOTTEN –
I WILL THEN OFFER
“EMPATHIC STATEMENTS”
THAT HIGHLIGHT
“WHAT THE PATIENT IS ACTUALLY FEELING RIGHT THEN”
AND “ABOUT WHAT”
STATEMENTS THAT OFTEN END WITH AN IMPLIED QUESTION MARK
WHEREBY I AM SIGNALING THAT I AM VERY OPEN TO HAVING
MY RENDERING OF THINGS EDITED, CORRECTED, OR REVISED
IN ORDER TO MAKE IT A MORE ACCURATE REFLECTION OF WHAT
THE PATIENT IS ACTUALLY SAYING AND WANTING ME TO KNOW
THE “AFFECT” DOES NOT NEED TO BE A “BIG AND DRAMATIC EMOTION” LIKE
ANGER / OUTRAGE – FEAR / PANIC / DESPERATION
SADNESS / DESPAIR – DISGUST / HORROR – SHAME / GUILT / REGRET
IT CAN BE SOMETHING “MORE UNDERSTATED” LIKE
CONFUSED / NOT KNOWING FOR SURE / LOST – UPSET / CONCERNED / WORRIED
UNCOMFORTABLE / WEARY / BURDENED – DISAPPOINTED / FRUSTRATED
WOULD RATHER NOT / WOULD WISH
63
64. EXAMPLES OF EMPATHIC STATEMENTS
“IT IS HARD TO KNOW WHERE TO BEGIN
WHEN EVERYTHING FEELS SO OVERWHELMING.”
“IT IS UNCOMFORTABLE TO BE HERE
WHEN YOU’RE NOT SURE THE THERAPY IS REALLY HELPING ANYWAY.”
“IT IS UPSETTING TO BE FEELING THIS OUT OF CONTROL.”
ALL OF WHICH SPEAK TO BOTH
THE PATIENT’S “AFFECT” AND THE “ASSOCIATED THEME”
THAT IS, THE “STORY” OR “NARRATIVE” THAT GOES WITH THE FEELING
“YOU ARE TIRED OF THINKING ABOUT
WHETHER YOU SHOULD STAY OR GO.”
“YOU HAVE SUCH DEEP DESPAIR ABOUT
EVER BEING ABLE TO FIND A TRUE SOULMATE.”
“YOU ARE TERRIFIED THAT YOU WILL BE DISAPPOINTED.”
“YOU ARE TERRIFIED THAT YOU YOURSELF WILL DISAPPOINT.”
“YOU ARE CONFUSED ABOUT HOW BEST TO USE THE SESSION.”
“YOU WORRY ABOUT WHAT I MIGHT BE THINKING.”
64
65. EMPATHIC STATEMENTS THAT HIGHLIGHT
WHAT THE PATIENT IS EXPERIENCING
IN A “SPECIFIC CONTEXT”
“IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD BY JUANITA.”
CAN THEN USUALLY BE “GENERALIZED”
FROM THE “SMALL” TO THE “ALL”
“IT IS PAINFUL TO BE FEELING ALWAYS SO MISUNDERSTOOD.”
BY THE SAME TOKEN
EMPATHIC STATEMENTS THAT HIGHLIGHT
WHAT THE PATIENT IS EXPERIENCING
IN THE “PRESENT”
“IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
CAN THEN USUALLY BE “EXTENDED”
TO THE “PAST”
“IT IS PAINFUL TO HAVE BEEN FEELING
SO MISUNDERSTOOD FOR SO LONG NOW.”
65
66. WITH RESPECT TO THE “FRAMING” OF AN EMPATHIC STATEMENT
PLEASE NOTE THAT INSTEAD OF
“I WONDER IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT SOUNDS AS IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT SEEMS AS IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT MUST BE PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
YOU COULD SIMPLY SAY
“IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
FOLLOWED BY THE IMPLIED QUESTION MARK
THEREBY SIGNALING THAT YOU ARE VERY OPEN
TO HAVING YOUR STATEMENT AMENDED
I DO MY BEST TO ELIMINATE EXTRA WORDS AT THE BEGINNING
OF THE STATEMENT SO THAT I CAN CUT RIGHT TO THE CHASE
“IT BREAKS YOUR HEART THAT SHE DOESN’T SEEM TO CARE.”
EXTRA WORDS RUN THE RISK OF PUTTING TOO MUCH DISTANCE
BETWEEN THE THERAPIST AND THE PATIENT
66
67. EMPATHIC STATEMENTS ARE “EXPERIENCE – NEAR”
– NOT “EXPERIENCE – DISTANT” –
AND ARE DESIGNED TO “VALIDATE” AND “RESONATE EMPATHICALLY WITH”
THE PATIENT’S “EXPERIENCE” IN THE MOMENT
AND THE “NARRATIVE” WITH WHICH THAT AFFECT IS ASSOCIATED
THEY ARE NOT DESIGNED TO TARGET HER UNCONSCIOUS
I AM HONORING WHAT THE PATIENT IS ACTUALLY SAYING
I AM NOT TRYING TO READ BETWEEN THE LINES
OR TO INTERPRET WHAT I THINK MIGHT LIE BENEATH THE SURFACE
I AM FOCUSING MORE ON THE “MANIFEST CONTENT”
THAN ON THE “LATENT CONTENT”
THE AIM OF THESE STATEMENTS
IS TO HELP THE PATIENT “FEEL UNDERSTOOD,”
NOT TO HELP THE PATIENT “UNDERSTAND”
WHEN PATIENTS FEEL UNDERSTOOD,
THEY ARE LESS LIKELY TO GET DEFENSIVE
AND MORE LIKELY TO DELIVER INTO THE RELATIONSHIP
WHAT MOST MATTERS TO THEM
– THAT IS, WHAT IS MOST “EMOTIONALLY RELEVANT” FOR THEM –
67
68. AGAIN
EMPATHIC STATEMENTS
ARE SPECIFICALLY DESIGNED
NOT ONLY TO “HIGHLIGHT”
WHAT THE PATIENT IS ACTUALLY “FEELING”
BUT ALSO TO “MAKE EXPLICIT”
– AND “GIVE SHAPE TO” –
THE “STORIES” (OR “NARRATIVES”)
THAT THE PATIENT
– AS A YOUNG CHILD –
HAD CONSTRUCTED
IN A DESPERATE ATTEMPT
TO MAKE SENSE OF
THE RELATIONAL DEPRIVATION AND NEGLECT
– “ABSENCE OF GOOD” / “ERRORS OF OMISSION” –
AND THE RELATIONAL TRAUMA AND ABUSE
– “PRESENCE OF BAD” / “ERRORS OF COMMISSION” –
TO WHICH SHE WAS BEING EXPOSED
68
69. BUT “MADE – UP” AND “DISEMPOWERING” STORIES
THAT HAVE NOW GENERALIZED
FROM THE “SMALL” (HER NUCLEAR FAMILY)
TO THE “ALL” (THE WORLD AROUND HER)
“NARRATIVES” THAT HAVE NOW BECOME
THE “GO – TO” DISTORTED FILTERS
THROUGH WHICH SHE EXPERIENCES
SELF, OTHERS, AND THE WORLD
AGAIN
THESE EMPATHIC STATEMENTS
DO NOT SPECIFICALLY “CATALYZE”
STRUCTURAL TRANSFORMATION AND GROWTH,
BUT THEY DO “LAY THE GROUNDWORK” FOR
“OPTIMALLY STRESSFUL” INTERVENTIONS THAT WILL
FACILITATE TRANSFORMATION OF RIGID DEFENSE
INTO MORE FLEXIBLE ADAPTATION
69
70. 70
WE ARE WEDDED TO NARRATIVES
CONSTRUCTED LONG AGO
IN A DESPERATE ATTEMPT
TO MAKE SENSE OF THINGS
THAT HAVE NOW BECOME THE WAY WE,
UNWITTINGLY, VIEW THE WORLD
72. BRIEFLY
MY PSYCHODYNAMIC SYNERGY PARADIGM
A C.A.R.E. APPROACH TO DEEP HEALING
FEATURES FIVE “MODES OF THERAPEUTIC ACTION”
FIVE DIFFERENT APPROACHES TO
“CATALYZING” THIS TRANSFORMATION
OF PSYCHOLOGICAL RIGIDITY
INTO PSYCHOLOGICAL FLEXIBILITY
72
73. MY PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
– A SYNERGISTIC APPROACH TO DEEP HEALING –
FIVE INTERDEPENDENT AND MUTUALLY ENHANCING
“MODES OF THERAPEUTIC ACTION”
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
MODEL 4 – NURTURING OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH
TO OVERCOMING ANALYSIS PARALYSIS AND “STUCKNESS”
73
74. MY PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
A “CARE” APPROACH TO DEEP HEALING
Cognitive – Affective – Relational – Existential
MODEL 1 – COGNITIVE
“STRUCTURAL CONFLICT” – CLASSICAL PSYCHOANALYTIC
MODEL 2 – AFFECTIVE
“STRUCTURAL DEFICIT” – SELF PSYCHOLOGICAL
MODEL 3 – RELATIONAL
“RELATIONAL CONFLICT” – CONTEMPORARY RELATIONAL
MODEL 4 – EXISTENTIAL
“RELATIONAL DEFICIT” – EXISTENTIAL – HUMANISTIC
MODEL 5 – CONSTRUCTIVIST
“NEURAL ENTRENCHMENT” – QUANTUM – NEUROSCIENTIFIC
ALL FIVE PSP MODELS CAPITALIZE UPON
THE THERAPEUTIC PROVISION OF OPTIMAL STRESS
TO ADVANCE THE PATIENT
FROM LONGSTANDING, DEEPLY ENTRENCHED, MALADAPTIVE RIGIDITY
TO NEWFOUND, MORE EVOLVED, MORE ADAPTIVE FLEXIBILITY
WITH AN EYE TO INCENTIVIZING
DEEP AND SUSTAINED CHARACTEROLOGICAL CHANGE 74
75. FIVE “OPTIMALLY STRESSFUL” “GROWTH – INCENTIVIZING” INTERVENTIONS
CORRESPONDING TO THE FIVE INTERDEPENDENT MODELS
– ALL OF WHICH TARGET THE PATIENT’S DEFENSES IN ORDER TO ADVANCE HER
FROM RIGID DEFENSE TO MORE FLEXIBLE ADAPTATION –
MODEL 1 – “COGNITION” AND “INSIGHT”
CONFLICT STATEMENTS
– FROM “RESISTANCE” TO “AWARENESS” –
MODEL 2 – “AFFECT,” “EXPERIENCE,” AND “GRIEVING”
DISILLUSIONMENT STATEMENTS
– FROM “RELENTLESS HOPE” TO “ACCEPTANCE” –
MODEL 3 – “INTERACTION,” “MUTUALITY OF IMPACT,” AND “NEGOTIATION”
ACCOUNTABILITY STATEMENTS,
CONTAINING STATEMENTS, AND THE “RULE OF THREE”
– FROM “RE – ENACTMENT” TO “ACCOUNTABILITY” –
MODEL 4 – “SURRENDERING,” “FINDING MEANING,” AND “LIVING RESPONSIBLY”
FACILITATION STATEMENTS
– FROM “RELATIONAL ABSENCE” TO “AUTHENTIC PRESENCE” –
– FROM NIHILISTIC “REJECTION OF EXISTENCE” TO
EXISTENTIAL “ACCEPTANCE OF ITS DUALITIES / POLARITIES / COMPLEMENTARITIES” –
MODEL 5 – “CONSTRUCTED NARRATIVES” AND “ENVISIONED POSSIBILITIES”
QUANTUM DISENTANGLEMENT STATEMENTS
– FROM “REFRACTORY INERTIA” AND “ANALYSIS PARALYSIS”
TO “ACTION” AND “ACTUALIZATION OF POTENTIAL” – 75
78. BUT OUR FOCUS NOW AND NEXT TIME WILL BE ON THE FIRST THREE MODELS
– THE THREE MAJOR PSYCHOANALYTIC SCHOOLS –
– KNOWLEDGE, EXPERIENCE, AND RELATIONSHIP –
THE FIRST OF WHICH IS CLASSICAL
THE SECOND AND THIRD OF WHICH ARE MORE CONTEMPORARY
MODEL 1
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
– SIGMUND FREUD / ANNA FREUD / HEINZ HARTMANN / DAVID RAPAPORT –
MODEL 2
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “ABSENCE OF GOOD”
– RESULTING FROM “RELATIONAL DEPRIVATION AND NEGLECT” –
– HEINZ KOHUT / MICHAEL BALINT / PAUL AND ANNA ORNSTEIN –
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “PRESENCE OF BAD”
– RESULTING FROM “RELATIONAL TRAUMA AND ABUSE” –
– STEPHEN MITCHELL / JAY GREENBERG / JESSICA BENJAMIN / JEAN BAKER MILLER –
78
79. MODEL 1 – COGNITIVE
CLASSICAL PSYCHOANALYTIC
MODEL 2 – AFFECTIVE
SELF PSYCHOLOGICAL
MODEL 3 – RELATIONAL
CONTEMPORARY RELATIONAL
SIMILARLY (AND REASSURINGLY!)
ALLAN SCHORE (2022) HAS HIGHLIGHTED
WHAT HE DESCRIBES AS A “PARADIGM SHIFT”
– OVER THE COURSE OF THE YEARS –
FROM “LEFT BRAIN” CONSCIOUS COGNITION
MY MODEL 1
TO “RIGHT BRAIN” UNCONSCIOUS EMOTIONAL PROCESSES
MY MODEL 2
AND “RIGHT BRAIN” UNCONSCIOUS RELATIONAL DYNAMICS
MY MODEL 3
79
80. MODEL 1
COGNITIVE / “HEAD” / THOUGHTS
TARGET THE PATIENT’S “INTERNAL CONFLICTEDNESS”
AND RELUCTANCE TO “ACKNOWLEDGE”
ANXIETY – PROVOKING “TRUTHS”
ABOUT THE “SELF”
MODEL 2
AFFECTIVE / “HEART” / FEELINGS
TARGET THE PATIENT’S “RELENTLESS PURSUITS”
AND RELUCTANCE TO “CONFRONT AND GRIEVE”
ANXIETY – PROVOKING “TRUTHS”
ABOUT THE “OBJECTS OF HER DESIRE”
MODEL 3
RELATIONAL / “HAND” / BEHAVIORS
TARGET THE PATIENT’S “COMPULSIVE RE – ENACTMENTS”
AND RELUCTANCE TO “TAKE OWNERSHIP OF”
ANXIETY – PROVOKING “TRUTHS”
ABOUT THE “RELATIONAL SELF”
80
82. MODEL 1 – COGNITIVE
CLASSICAL PSYCHOANALYSIS
THE THERAPEUTIC ACTION FOCUSES ON “INTERPRETING”
ANXIETY – PROVOKING TRUTHS
ABOUT THE PATIENT’S “SELF”
– AND FEATURES OPTIMALLY STRESSFUL CONFLICT STATEMENTS –
MODEL 2 – AFFECTIVE
SELF PSYCHOLOGY AND OTHER DEFICIT THEORIES
THE THERAPEUTIC ACTION FOCUSES ON “GRIEVING”
ANXIETY – PROVOKING TRUTHS
ABOUT THE PATIENT’S “OBJECTS OF DESIRE”
– AND FEATURES OPTIMALLY STRESSFUL DISILLUSIONMENT STATEMENTS –
MODEL 3 – RELATIONAL
CONTEMPORARY RELATIONAL THEORY
THE THERAPEUTIC ACTION FOCUSES ON “OWNING”
ANXIETY – PROVOKING TRUTHS
ABOUT THE PATIENT’S “RELATIONAL SELF”
– AND FEATURES OPTIMALLY STRESSFUL ACCOUNTABILITY STATEMENTS –
82
83. MODEL 1 – INTERPRETING
THE THERAPEUTIC ACTION INVOLVES
“RESOLVING INTERNAL CONFLICT”
BY “INTERPRETING THE RESISTANCE”
TO ADVANCE THE PATIENT
FROM “RESISTANCE” TO “AWARENESS”
MODEL 2 – GRIEVING
THE THERAPEUTIC ACTION INVOLVES
ADAPTIVELY “INTERNALIZING EXTERNAL GOOD”
BY “GRIEVING DISAPPOINTMENT”
TO ADVANCE THE PATIENT
FROM “RELENTLESS HOPE” TO “ACCEPTANCE”
MODEL 3 – NEGOTIATING
THE THERAPEUTIC ACTION INVOLVES
“DETOXIFYING INTERNAL BADNESS”
BY “NEGOTIATING AT THE ‘INTIMATE EDGE’ OF RELATEDNESS”
DARLENE EHRENBERG (1992)
TO ADVANCE THE PATIENT
FROM “RE – ENACTMENT” TO “ACCOUNTABILITY”
83
84. OPTIMALLY STRESSFUL
MODEL 1 CONFLICT STATEMENTS
ARE DESIGNED TO ENCOURAGE
THE “RESISTANT” PATIENT
TO STEP BACK FROM THE
IMMEDIACY OF THE MOMENT
IN ORDER TO GAIN INSIGHT INTO
BOTH HER INVESTMENT IN
MAINTAINING “SAME OLD, SAME OLD”
WHICH IS WHY IT IS “EGO – SYNTONIC”
AND THE PRICE SHE PAYS FOR DOING SO
IN AN EFFORT TO MAKE IT MORE “EGO – DYSTONIC”
84
85. OPTIMALLY STRESSFUL
MODEL 2 DISILLUSIONMENT STATEMENTS
ARE DESIGNED TO FACILITATE
THE NECESSARY GRIEVING THAT
THE “RELENTLESS” PATIENT
MUST DO
AS SHE BEGINS TO CONFRONT
PAINFUL REALITIES ABOUT
THE OBJECTS OF HER DESIRE
THEIR LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
85
86. OPTIMALLY STRESSFUL
MODEL 3 ACCOUNTABILITY STATEMENTS
ARE DESIGNED TO ENCOURAGE
THE “RE – ENACTING” PATIENT
TO TAKE RESPONSIBILITY FOR
THE UNMASTERED RELATIONAL TRAUMAS
THAT SHE IS COMPULSIVELY
AND UNWITTINGLY
REPLAYING ON THE STAGE OF HER LIFE
MORE SPECIFICALLY
TO TAKE OWNERSHIP OF
THE EARLY – ON TRAUMATIC FAILURE SITUATIONS
THAT SHE IS EVER – BUSY
RECREATING IN HER CURRENT RELATIONSHIPS
86
88. OVERVIEW
THE THERAPEUTIC ACTION IN ALL THREE MODELS
INVOLVES “WORKING THROUGH” THE “OPTIMAL STRESS”
CREATED BY THE THERAPIST’S INTERVENTIONS
– WHICH ALTERNATELY CHALLENGE AND THEN SUPPORT –
INTERVENTIONS STRATEGICALLY DESIGNED TO FACILITATE
THE “WORKING THROUGH” OF AN “OPTIMAL STRESSOR”
MODEL 1 – COGNITIVE DISSONANCE
“WORKING THROUGH” THE “STRESS” OF “GAIN – BECOME – PAIN”
– “EGO – SYNTONIC – BECOME – EGO – DYSTONIC” –
THEREBY TRANSFORMING “RESISTANCE” INTO “AWARENESS”
MODEL 2 – AFFECTIVE DISILLUSIONMENT
“WORKING THROUGH” THE “STRESS” OF “GOOD – BECOME – BAD”
– “ILLUSION – BECOME – DISILLUSIONMENT” / “POSITIVE TRANSFERENCE DISRUPTED” –
THEREBY TRANSFORMING “RELENTLESS HOPE” INTO “ACCEPTANCE”
MODEL 3 – RELATIONAL DETOXIFICATION
“WORKING THROUGH” THE “STRESS” OF “BAD – BECOME – GOOD”
– “DISTORTION – BECOME – REALITY” / “NEGATIVE TRANSFERENCE” –
THEREBY TRANSFORMING “RE – ENACTMENT” INTO “ACCOUNTABILITY”
88
89. PLEASE NOTE
IF YOU DO INDEED EMBRACE THE IDEA
THAT “OPTIMAL STRESS” IS NEEDED TO INCENTIVIZE
DEEP AND SUSTAINED PSYCHODYNAMIC CHANGE,
THEN CRITICALLY IMPORTANT WILL BE
THE “WORKING THROUGH” OF
“OPTIMALLY STRESSFUL” SITUATIONS
THAT ARISE FOR THE PATIENT OUTSIDE THE TREATMENT
BUT EVEN MORE TRANSFORMATIVE WILL BE
THE “WORKING THROUGH” OF
“OPTIMALLY STRESSFUL” SITUATIONS
THAT ARISE FOR THE PATIENT INSIDE THE TREATMENT
– NAMELY, IN THE RELATIONSHIP WITH YOU –
(IN BOTH THE “TRANSFERNCE” AND THE “REAL RELATIONSHIP”)
OFFERING “WISE COUNSEL”
AND “PROBLEM – SOLVING ADVICE”
IS NOT A STORY ABOUT “WORKING THROUGH”
OR, AS ONE OF MY TEACHERS ALWAYS DELIGHTED IN TELLING US,
IF THE PATIENT ASKS YOU WHERE THE BATHROOM IS,
YOU CAN TELL THEM BUT DON’T CALL IT THERAPY!
89
90. AS WE SHALL SEE
WHAT THIS MEANS IS THAT YOU MUST BE ABLE TO TOLERATE BEING
SOMETIMES EXPERIENCED AS A “BAD OBJECT” (MODEL 2)
AND SOMETIMES EVEN MADE INTO A “BAD OBJECT” (MODEL 3)
INDEED
IF THE MODEL 2 THERAPIST CANNOT TOLERATE
– AT LEAST EVERY NOW AND THEN –
“BREAKING THE PATIENT’S HEART”
THE THERAPIST WILL BE ROBBING THE PATIENT
OF THE OPPORTUNITY “ADAPTIVELY TO INTERNALIZE”
“MISSING PSYCHOLOGICAL FUNCTIONS”
BY WAY OF “OPTIMAL DISILLUSIONMENT,” “TRANSMUTING INTERNALIZATION,”
AND “SERIAL ACCRETION” OF ”SELF STRUCTURE”
BY THE SAME TOKEN
IF THE MODEL 3 THERAPIST
REFUSES TO PARTICIPATE AS SOMEONE WHO
– AT LEAST EVERY NOW AND THEN –
“INITIALLY RE – TRAUMATIZES BUT ULTIMATELY RELENTS”
THE THERAPIST WILL BE ROBBING THE PATIENT
OF THE OPPORTUNITY “ADAPTIVELY TO REWORK”
HER “INTROJECTED BOLUSES OF TOXICITY”
BY WAY OF “PROJECTIVE IDENTIFICATION,” “RELATIONAL DETOXIFICATION,”
AND “SERIAL DILUTION” OF “PATHOGENIC INTROJECTS”
90
92. ALSO AS WE SHALL SEE
OPTIMALLY STRESSFUL INTERVENTIONS
USE THE CONJUNCTIONS “BUT” AND “AND”
TO JUXTAPOSE “PARTS” OF THE PATIENT’S “SELF – EXPERIENCE”
THEREBY CREATING INTERNAL TENSION / DISSONANCE BETWEEN
THE “LESS – HEALTHY PARTS”
THAT HAVE THE “NEED TO DEFEND” IN THE FACE OF STRESSORS
AND THE “MORE – HEALTHY PARTS”
THAT HAVE THE “CAPACITY TO ADAPT”
MODEL 1 CONFLICT STATEMENTS
– FROM “RESISTANCE” TO “AWARENESS” –
“ADAPTIVE CAPACITY” FOR “AWARENESS”
BUT “DEFENSIVE NEED” TO “RESIST”
MODEL 2 DISILLUSIONMENT STATEMENTS
– FROM “RELENTLESS HOPE” TO “ACCEPTANCE” –
“DEFENSIVE NEED” FOR “RELENTLESS HOPE”
BUT “ADAPTIVE CAPACITY” TO “CONFRONT”
AND “ADAPTIVE CAPACITY” TO “GRIEVE” AND “ACCEPT”
MODEL 3 ACCOUNTABILITY STATEMENTS
– FROM “RE – ENACTMENT” TO “ACCOUNTABILITY” –
“DEFENSIVE NEED” TO “RE – ENACT”
BUT “ADAPTIVE CAPACITY” FOR “ACCOUNTABILITY”
92
93. THE OVERARCHING AIM OF THESE
OPTIMALLY STRESSFUL INTERVENTIONS
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
“TAMING OF THE ID”
AND “STRENGTHENING OF THE EGO”
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
“FILLING IN OF DEFICIT”
AND “CONSOLIDATION OF THE SELF”
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
“DETOXIFICATION OF PATHOGENICITY”
AND “ACCOUNTABILITY FOR THE RELATIONAL SELF”
93
94. THE NET RESULT OF WORKING THROUGH
THE PATIENT’S RIGID DEFENSES
MODEL 1
A STRONGER, MORE EMPOWERED, AND MORE AWARE “EGO”
NO LONGER AS “RESISTANT” TO ACKNOWLEDGING
DISCOMFITING TRUTHS ABOUT THE “SELF”
MODEL 2
A MORE CONSOLIDATED, COMPASSIONATE, AND ACCEPTING “SELF”
NO LONGER AS “RELENTLESS” IN ITS ENTITLED PURSUIT OF
EXTERNAL PROVISION FROM THE “OBJECT”
MODEL 3
A MORE ACCOUNTABLE “RELATIONAL SELF”
NO LONGER AS COMPULSIVELY AND UNWITTINGLY “RE – ENACTING”
UNMASTERED EARLY – ON RELATIONAL TRAUMAS
AT THE INTIMATE EDGE OF RELATEDNESS
94
95. PERHAPS IT COULD BE SAID THAT
MATURITY INVOLVES DEVELOPING
THE ADAPTIVE CAPACITY …
MODEL 1
… TO KNOW AND ACCEPT THE “SELF,”
INCLUDING ITS INTERNAL SCARS
ULTIMATELY BECOMING WISER,
EVEN IF MORE SOBERED
MODEL 2
… TO KNOW AND ACCEPT THE “OBJECT,”
INCLUDING ITS LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
ULTIMATELY BECOMING MORE ACCEPTING,
EVEN IF SADDER
MODEL 3
… TO KNOW AND ACCEPT THE “SELF – IN – RELATION,”
INCLUDING ITS RELATIONAL SCARS
ULTIMATELY BECOMING MORE ACCOUNTABLE,
EVEN IF MORE BURDENED
95
96. THE END OF MASTER CLASS Part 1
Saturday / January 21, 2023
96