SlideShare a Scribd company logo
PRACTICAL CLINICAL
INTERVENTIONS FOR
INCENTIVIZING CHANGE
MARTHA STARK, MD
Faculty, Harvard Medical School
MarthaStarkMD @ SynergyMed.solutions
Wednesday / February 22, 2023
Psychotherapy Institute of Back Bay
With great admiration for the giftedness of David Raniere, PhD
© 2023 Martha Stark MD
1
OVERVIEW
MY PSYCHODYNAMIC SYNERGY PARADIGM
A SYNERGISTIC APPROACH TO DEEP HEALING
“CLASSICAL PSYCHOANALYTIC” / “SELF PSYCHOLOGICAL”
“CONTEMPORARY RELATIONAL” / “EXISTENTIAL – HUMANISTIC”
“QUANTUM – NEUROSCIENTIFIC”
JUDICIOUS AND ONGOING USE OF
“OPTIMALLY STRESSFUL” INTERVENTIONS
STRATEGICALLY DESIGNED TO “CATALYZE” TRANSFORMATION OF
PSYCHOLOGICAL RIGIDITY INTO PSYCHOLOGICAL FLEXIBILITY
– RIGID DEFENSE INTO MORE FLEXIBLE ADAPTATION –
DEFENSIVE REACTIONS – WHAT HAPPENS “REFLEXIVELY” WHEN WE ARE
CONFRONTED WITH STRESSORS THAT “OVERWHELM” US WITH ANXIETY
ADAPTIVE RESPONSES – WHAT HAPPENS “MORE REFLECTIVELY” WHEN WE ARE
CONFRONTED WITH STRESSORS THAT WE ARE ABLE TO “TAKE IN OUR STRIDE”
PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT
BOTH “IMPETUS” AND “OPPORTUNITY” TO MASTER TRAUMATIC EXPERIENCES
THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST
BUT THAT CAN NOW BE REVISITED, REPROCESSED, AND REFRAMED
SUCH THAT GROWTH – IMPEDING DEFENSES
– ONCE NECESSARY FOR SURVIVAL –
CAN BE GRADUALLY TRANSFORMED
INTO GROWTH – PROMOTING ADAPTATIONS
“OPTIMALLY STRESSFUL” CONFLICT, DISILLUSIONMENT, AND ACCOUNTABILITY STATEMENTS
2
PLEASE NOTE THE CRITICAL ROLE PLAYED
BY GROWTH – INCENTIVIZING “OPTIMAL STRESS”
IN JUMP – STARTING RECOVERY
THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE
WILL OVERWHELM AND PLUMMET THE SYSTEM
INTO FURTHER DECLINE
BECAUSE IT WILL BE “TOO MUCH”
TO BE PROCESSED, INTEGRATED, AND ADAPTED TO
TRAUMATIC STRESS
TOO LITTLE CHALLENGE
WILL OFFER “TOO LITTLE” IMPETUS AND OPPORTUNITY
FOR TRANSFORMATION AND GROWTH,
SERVING INSTEAD SIMPLY
TO REINFORCE THE – DYSFUNCTIONAL – STATUS QUO
BUT JUST THE RIGHT AMOUNT OF CHALLENGE
WILL PROVIDE “JUST THE RIGHT AMOUNT”
OF “THERAPEUTIC LEVERAGE” NEEDED TO PROVOKE
– AFTER INITIAL DISRUPTION –
EVENTUAL RE – EQUILIBRATION
AT A HIGHER, MORE – EVOLVED LEVEL
OF INTEGRATION, FUNCTIONALITY,
AND ADAPTIVE CAPACITY
OPTIMAL – NONTRAUMATIC – STRESS 3
4
5
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” TRANSFORMATION
OF PSYCHOLOGICAL RIGIDITY
INTO PSYCHOLOGICAL FLEXIBILITY
FIVE DIFFERENT
“OPTIMALLY STRESSFUL” INTERVENTIONS
STRATEGICALLY DESIGNED
TO “CATALYZE”
THE INCREMENTAL MORPHING
OF RIGID DEFENSE
INTO MORE FLEXIBLE ADAPTATION
6
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
7
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”
8
EITHER WE
– MADE ANXIOUS –
“REACT” TO STRESSORS BY “DEFENDING”
“DEFENSIVE REACTION”
OR WE
– MORE RESILIENT –
“RESPOND” TO STRESSORS BY “ADAPTING”
“ADAPTIVE RESPONSE”
9
10
LIFE IS
NOT ABOUT
“DEFENSIVELY”
WAITING FOR
THE STORM
TO PASS
BUT ABOUT
“ADAPTIVELY”
LEARNING
TO DANCE
IN THE RAIN
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
11
12
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
UPDATED TO ADAPTATIONS,
THE PATIENT BECOMES
BETTER ABLE TO “THRIVE”
THE THERAPEUTIC ACTION
IS INDEED DESIGNED
TO TRANSFORM “SURVIVING” INTO “THRIVING” 13
14
15
MY PSYCHODYNAMIC SYNERGY PARADIGM
ALL FIVE MODELS
CAPITALIZE UPON
THE THERAPEUTIC PROVISION
OF OPTIMAL STRESS
TO ADVANCE THE PATIENT
FROM LONGSTANDING,
DEEPLY ENTRENCHED,
MALADAPTIVE RIGIDITY
– OUTDATED DEFENSE / “SAME OLD, SAME OLD” –
TO NEWFOUND,
MORE EVOLVED,
MORE ADAPTIVE FLEXIBILITY
– UPDATED ADAPTATION / “SOMETHING NEW, DIFFERENT, AND BETTER” –
THE ULTIMATE GOAL BEING
DEEP AND ENDURING PSYCHODYNAMIC CHANGE
AS ONE OF MY MENTORS ALWAYS DELIGHTED IN TELLING US,
IF THE PATIENT ASKS YOU WHERE THE BATHROOM IS,
YOU CAN TELL HER – BUT DON’T CALL IT THERAPY!
16
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
17
18
19
20
MY PSYCHODYNAMIC SYNERGY PARADIGM
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 NEURAL ENTRENCHMENT AND “STUCKNESS”
21
MY PSYCHODYNAMIC SYNERGY PARADIGM
– A C.A.R.E. APPROACH TO DEEP HEALING –
Cognitive Affective Relational Existential
MODEL 1 – COGNITIVE
“STRUCTURAL CONFLICT”
MODEL 2 – AFFECTIVE
“STRUCTURAL DEFICIT”
MODEL 3 – RELATIONAL
“RELATIONAL CONFLICT”
MODEL 4 – EXISTENTIAL
“RELATIONAL DEFICIT”
MODEL 5 – CONSTRUCTIVIST
“ANALYSIS PARALYSIS”
22
OPTIMALLY STRESSFUL INTERVENTIONS
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
CONFLICT STATEMENTS
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
DISILLUSIONMENT STATEMENTS
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
ACCOUNTABILITY STATEMENTS
MODEL 4 – NURTURING OF SURRENDER “TO”
FACILITATION STATEMENTS
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
QUANTUM DISENTANGLEMENT STATEMENTS
23
ADVANCEMENT FROM DEFENSE TO ADAPTATION
MODEL 1 – INTERPRETING
FROM “RESISTANCE” TO “AWARENESS”
MODEL 2 – GRIEVING
FROM “RELENTLESS HOPE” TO “ACCEPTANCE”
MODEL 3 – NEGOTIATING
FROM “RE – ENACTMENT” TO “ACCOUNTABILITY”
MODEL 4 – SURRENDERING
FROM “RELATIONAL ABSENCE” TO “AUTHENTIC PRESENCE”
MODEL 5 – DISENTANGLING / ENVISIONING
FROM “REFRACTORY INERTIA” TO “ACTION”
AND “ACTUALIZATION OF POTENTIAL”
24
8
26
BUT OUR FOCUS TODAY 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 –
27
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
28
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”
29
30
HEAD
MODEL 1
HEART
MODEL 2
HANDS
MODEL 3
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 –
31
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”
32
33
MODEL 1
THE
INTERPRETIVE
PERSPECTIVE
OF
CLASSICAL
PSYCHOANALYSIS
“STRUCTURAL CONFLICT”
BETWEEN “ANXIETY – PROVOKING”
– BUT ULTIMATELY “GROWTH – PROMOTING” –
FORCES PRESSING “YES”
AND “ANXIETY – RELIEVING”
– BUT “GROWTH – IMPEDING” –
COUNTERFORCES DEFENDING “NO”
34
MOST OF OUR PATIENTS ARE CONFLICTED
ABOUT MOST THINGS MOST OF THE TIME
WITH ONE PART OF THEM
INVESTED IN MAINTAINING “SAME OLD, SAME OLD”
AND ANOTHER PART OF THEM BEGINNING TO APPRECIATE
– ALBEIT IT WITH EVER – INCREASING ANXIETY –
BOTH THE “PRICE PAID” FOR THAT MISPLACED LOYALTY
AND THE “ENLIVENING POSSIBILITY” OF
“SOMETHING NEW, DIFFERENT, AND BETTER”
MODEL 1 CONFLICT STATEMENTS
ARE UNIVERSALLY APPLICABLE INTERVENTIONS
THAT TARGET THESE STATES OF
“INTERNAL DIVIDEDNESS” OR “CONFLICTEDNESS”
ON THE ONE HAND
HIGHLIGHTING THE PATIENT’S EVER – EVOLVING “AWARENESS”
OF HER “INVESTMENT IN” “SAME OLD, SAME OLD”
ON THE OTHER HAND
HIGHLIGHTING THE PATIENT’S EVER – EVOLVING “AWARENESS”
OF THE “PRICE PAID” FOR THAT INVESTMENT
AND OF THE “POTENTIAL”
FOR “SOMETHING NEW, DIFFERENT, AND BETTER”
35
“OPTIMALLY STRESSFUL” CONFLICT STATEMENTS
ARE STRATEGICALLY DESIGNED
TO OFFER AN ARTFUL COMBINATION OF
CHALLENGE
– BY HIGHLIGHTING EITHER THE “PRICE PAID” FOR “OLD BAD”
AND / OR THE “ENLIVENING POSSIBILITY” OF “NEW GOOD” –
AND SUPPORT
– BY RESONATING EMPATHICALLY WITH THE “INVESTMENT IN” “OLD BAD” –
THE NET RESULT OF THIS
INTUITIVELY TITRATED BLEND OF
CHALLENGE
– WHICH PROVOKES THE PATIENT’S ANXIETY –
AND SUPPORT
– WHICH EASES IT –
WILL BE THE GENERATION OF
GALVANIZING OPTIMAL STRESS
NECESSARY IF DEEP AND ENDURING
PSYCHODYNAMIC CHANGE IS THE ULTIMATE GOAL
36
“LEVERAGING” THE PATIENT’S ANXIETY
“OPTIMALLY STRESSFUL” STATEMENTS
ARE STRATEGICALLY DESIGNED
FIRST TO “DIRECT THE PATIENT’S ATTENTION
TO WHERE WE WOULD WANT HER TO GO”
– “DISRUPTIVE ATTUNEMENT” –
– “CHALLENGE” THAT WILL INCREASE HER ANXIETY –
AND THEN TO “BE WITH THE PATIENT WHERE SHE IS”
– “HOMEOSTATIC ATTUNEMENT” –
– “SUPPORT” THAT WILL DECREASE HER ANXIETY –
THE NET RESULT OF WHICH WILL BE
TO “CREATE INTERNAL TENSION AND DISSONANCE”
AND, THEREBY, “INCENTIVIZING LEVERAGE”
SALMAN AKHTAR (2012)
37
38
DO I CHALLENGE? OR SUPPORT?
OR PERHAPS DO BOTH?
INDEED WE ALL FIND OURSELVES SOMETIMES
VERY CONFUSED ABOUT WHAT TO DO NEXT!
39
“WORKING THROUGH THE RESISTANCE”
OPTIMALLY STRESSFUL
MODEL 1 CONFLICT STATEMENTS
“YOU KNOW THAT … , BUT (MADE ANXIOUS)
YOU FIND YOURSELF THINKING / FEELING / DOING
IN ORDER NOT TO HAVE TO KNOW … ”
40
TWO KINDS OF CONFLICT
– “CONVERGENT” AND “DIVERGENT” –
A. KRIS (1985)
DIVERGENT CONFLICT – “EITHER / OR” SITUATIONS
TWO “MUTUALLY EXCLUSIVE” FORCES
SHALL I WEAR MY BLUE DRESS OR MY RED DRESS TONIGHT?
CONVERGENT CONFLICT – “BOTH / AND” SITUATIONS
ONE OF THE FORCES
– AN ANXIETY – PROVOKING (ID) “FORCE” –
PROMPTS MOBILIZATION OF A SECOND FORCE
– AN ANXIETY – RELIEVING (EGO) “COUNTERFORCE” –
YOU KNOW THAT SOMETIMES YOU FEEL ANGRY WITH YOUR WIFE
– THE ANXIETY – PROVOKING “FORCE” –
BUT YOU (MADE ANXIOUS) WOULD RATHER NOT THINK ABOUT THAT RIGHT NOW
– THE DEFENSIVE “COUNTERFORCE” –
YOU KNOW THAT YOUR MOTHER WILL PROBABLY NEVER APOLOGIZE
– THE ANXIETY – PROVOKING “FORCE” –
BUT YOU (MADE ANXIOUS) FIND YOURSELF
CONTINUING TO HOPE THAT PERHAPS SOMEDAY SHE WILL
– THE DEFENSIVE “COUNTERFORCE” –
41
THE “STRUCTURAL CONFLICTS”
– aka “NEUROTIC CONFLICTS” OR “INTRAPSYCHIC CONFLICTS” –
OF CLASSICAL PSYCHOANALYTIC THEORY ARE
“CONVERGENT CONFLICTS”
MODEL 1 CONFLICT STATEMENTS ARE DESIGNED
TO ADDRESS THESE “CONVERGENT (“BOTH / AND”) CONFLICTS”
WITH AN EYE TO GENERATING INTERNAL TENSION
BETWEEN ANXIETY– PROVOKING (BUT ULTIMATELY GROWTH – PROMOTING) FORCES
AND ANXIETY – RELIEVING (BUT GROWTH – IMPEDING) RESISTANT COUNTERFORCES
“YOU KNOW THAT YOUR MOTHER
WILL PROBABLY NEVER APOLOGIZE
BUT YOU FIND YOURSELF CONTINUING TO HOPE
THAT PERHAPS SOMEDAY SHE WILL.”
MODEL 1 CONFLICT STATEMENTS ARE NOT DESIGNED
TO ADDRESS “DIVERGENT (“EITHER / OR”) CONFLICTS”
YOU WOULD NOT ADVANCE THE CAUSE MUCH
WERE YOU TO SAY TO YOUR PATIENT
“YOU KNOW THAT YOU COULD
WEAR YOUR BLUE DRESS TONIGHT
BUT YOU FIND YOURSELF THINKING THAT PERHAPS
YOU SHOULD WEAR YOUR RED DRESS INSTEAD.”
42
“WORKING THROUGH THE RESISTANCE” 📕 📕
OPTIMALLY STRESSFUL CONFLICT STATEMENTS
ARE STRATEGICALLY DESIGNED
FIRST TO INCREASE ANXIETY
BY “CHALLENGING” THE DEFENSE
YOU HAVE THE “ADAPTIVE CAPACITY” TO “KNOW” ... ,
AND THEN TO DECREASE ANXIETY
BY “SUPPORTING” THE DEFENSE
BUT YOU HAVE THE “DEFENSIVE NEED” TO “RESIST” THAT “KNOWING” ...
ALL WITH AN EYE
FIRST TO “MAKING EXPLICIT”
THE CONFLICT WITHIN THE PATIENT
BETWEEN THE “HEALTHY PART” OF HER
– THAT DOES INDEED “KNOW” –
AND THE “LESS – HEALTHY PART” OF HER
– THAT “RESISTS” THAT “KNOWING” –
AND THEN TO “GENERATING GROWTH – INCENTIVIZING DISSONANCE”
BETWEEN THOSE TWO “PARTS” OF HER “SELF – EXPERIENCE”
43
OPTIMALLY STRESSFUL MODEL 1 CONFLICT STATEMENTS
FIRST “CHALLENGE” BY “DIRECTING THE PATIENT’S ATTENTION TO WHERE YOU WANT HER TO GO”
AND THEN “SUPPORT” BY “RESONATING EMPATHICALLY WITH WHERE SHE IS”
“YOU KNOW THAT IF YOU ARE EVER TO GET ON
WITH YOUR LIFE, YOU’LL HAVE TO LET GO OF YOUR CONVICTION
THAT YOUR CHILDHOOD SCARRED YOU FOREVER. BUT IT’S HARD
NOT TO FEEL LIKE DAMAGED GOODS WHEN YOU GREW UP
IN A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN AND NASTY
MOTHER WHO KEPT TELLING YOU THAT YOU WERE A LOSER.”
“YOU’RE COMING TO UNDERSTAND THAT
YOUR ANGER CAN PUT PEOPLE OFF.
BUT YOU TELL YOURSELF THAT
YOU HAVE A RIGHT TO BE AS ANGRY AS YOU WANT
BECAUSE OF HOW MUCH YOU HAVE HAD TO SUFFER
OVER THE COURSE OF THE YEARS.”
“YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA
IS TO SURVIVE, YOU’LL NEED TO TAKE AT LEAST SOME
RESPONSIBILITY FOR THE PART YOU’RE PLAYING IN THE
INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE HAVE BEEN HAVING.
BUT YOU TELL YOURSELF THAT IT ISN’T REALLY
YOUR FAULT BECAUSE IF SHE WEREN’T SO PROVOCATIVE,
THEN YOU WOULDN’T HAVE TO BE SO VINDICTIVE!” 44
PLEASE NOTE
AS TEMPTING AS IT MIGHT BE
FOR THE THERAPIST TO HIGHLIGHT
– IN THE FIRST PORTION OF HER CONFLICT STATEMENT –
SOMETHING THAT SHE WOULD WISH
THE PATIENT ALREADY KNEW,
IF THE PATIENT REALLY
DOES NOT YET KNOW IT,
THEN IT IS BETTER
THAT THE THERAPIST
RESIST HER TEMPTATION
TO “LEAD THE WITNESS”
IN THAT WAY
“YOU KNOW THAT YOUR UNRESOLVED FEELINGS ABOUT YOUR DAD ARE
MAKING IT DIFFICULT FOR YOU TO FIND AN APPROPRIATE LIFE PARTNER ... ”
SAYING THIS TO SOMEONE WHO DOES NOT ACTUALLY KNOW THIS
RUNS THE RISK OF MAKING THE PATIENT EVEN MORE DEFENSIVE
FURTHERMORE, THAT’S “CHEATING”! – SO IT’S NOT FAIR ...
45
BY LOCATING WITHIN THE PATIENT
THE CONFLICT BETWEEN
WHAT SHE (ADAPTIVELY) “KNOWS”
AND WHAT SHE, MADE ANXIOUS,
(DEFENSIVELY) “FINDS HERSELF”
“THINKING, FEELING, OR DOING”
IN ORDER NOT TO HAVE TO CONFRONT
THAT “ANXIETY – PROVOKING REALITY,”
THE THERAPIST IS DEFTLY SIDESTEPPING
THE POTENTIAL FOR CONFLICT
BETWEEN HERSELF AND THE PATIENT
MORE SPECIFICALLY
WHEN THE THERAPIST INTRODUCES
A CONFLICT STATEMENT WITH
“YOU KNOW THAT … , ”
SHE IS FORCING THE PATIENT
TO TAKE RESPONSIBILITY
FOR WHAT THE PATIENT
– ALBEIT BEGRUDGINGLY –
REALLY DOES KNOW 46
IF, INSTEAD, THE THERAPIST
– IN A MISGUIDED ATTEMPT TO URGE THE PATIENT FORWARD –
RESORTS SIMPLY
TO TELLING THE PATIENT
WHAT THE THERAPIST KNOWS,
NOT ONLY
WILL THE THERAPIST
BE RUNNING THE RISK
OF FORCING THE PATIENT
TO BECOME EVER – MORE ENTRENCHED
IN HER DEFENSIVE STANCE OF PROTEST
BUT THE THERAPIST WILL ALSO
BE DEPRIVING THE PATIENT
OF ANY INCENTIVE
TO TAKE RESPONSIBILITY
FOR HER OWN DESIRE TO GET BETTER
47
IN OTHER WORDS
AS A RESULT OF
THE JUDICIOUS AND ONGOING USE
OF CONFLICT STATEMENTS
THAT FORCE THE PATIENT
TO BECOME AWARE OF
– AND TO TAKE RESPONSIBILITY FOR –
HER STATE OF “INTERNAL DIVIDEDNESS”
ABOUT, FOR EXAMPLE, GETTING BETTER
– IN OTHER WORDS, HER “AMBIVALENCE” –
THE THERAPIST WILL BE ABLE
MASTERFULLY TO AVOID GETTING DEADLOCKED
IN A POWER STRUGGLE WITH THE PATIENT
A POWER STRUGGLE THAT
CAN EASILY ENOUGH ENSUE
IF THE THERAPIST TAKES IT UPON HERSELF
TO REPRESENT THE (ADAPTIVE) “VOICE OF REALITY”
BY OVERZEALOUSLY ADVOCATING FOR THE PATIENT
TO DO THE “RIGHT / HEALTHY” THING
– A STANCE THAT THEN LEAVES THE PATIENT, MADE ANXIOUS,
NO CHOICE BUT TO BECOME THE (DEFENSIVE) “VOICE OF OPPOSITION” –
48
PLEASE ALSO NOTE THE IMPLICIT MESSAGE
DELIVERED BY THE THERAPIST
IN THE SECOND PART
OF A CONFLICT STATEMENT
WHEN SHE USES SUCH “TEMPORAL EXPRESSIONS” AS
“FOR NOW” / “RIGHT NOW” / “AT THE MOMENT”
“IN THE MOMENT” / “AT THIS POINT IN TIME”
WHICH SHE WILL DO
WHEN SHE IS ADDRESSING
THE PATIENT’S “INVESTMENT”
IN THE “DYSFUNCTIONAL DEFENSE”
THE THERAPIST IS ATTEMPTING
TO HIGHLIGHT THE FACT
THAT EVEN IF, FOR NOW,
THE PATIENT WOULD SEEM TO BE
ENTRENCHED IN PROTESTING
HER NEED TO MAINTAIN THINGS
AS THEY ARE,
AT ANOTHER POINT IN TIME,
THAT COULD CHANGE
49
OPTIMALLY STRESSFUL MODEL 1 CONFLICT STATEMENTS
FIRST “CHALLENGE” THE DEFENSE TO “PROVOKE” ANXIETY
AND THEN “SUPPORT” THE DEFENSE TO “EASE” IT
“YOU KNOW THAT ULTIMATELY
YOU WILL NEED TO CONFRONT AND GRIEVE THE REALITY
THAT TOM, LIKE YOUR DAD, IS NOT AVAILABLE
IN THE WAYS THAT YOU WOULD HAVE WANTED HIM TO BE
AND THAT UNTIL YOU MAKE YOUR PEACE
WITH THAT PAINFUL REALITY
YOU WILL CONTINUE TO BE MISERABLE.
BUT, IN THE MOMENT, ALL YOU CAN THINK ABOUT
IS WHAT YOU CAN DO TO MAKE HIM LOVE YOU MORE.”
“YOU KNOW THAT SOMEDAY
YOU WILL HAVE TO LET SOMEBODY IN
IF YOU’RE EVER TO HAVE
A MEANINGFUL RELATIONSHIP.
BUT, AT THE MOMENT, THE THOUGHT
OF MAKING YOURSELF THAT VULNERABLE
IS SIMPLY OUT OF THE QUESTION.
THERE IS ABSOLUTELY NO WAY
YOU ARE WILLING TO RUN THE RISK
OF BEING HURT EVER AGAIN.”
50
MORE SPECIFICALLY
IN ORDER TO SPOTLIGHT THE “AMBIVALENCE” OF
THE PATIENT’S “ATTACHMENT” TO HER “DEFENSE”
AND TO GENERATE TENSION WITHIN THE PATIENT
BETWEEN HER “EVER – EVOLVING AWARENESS” OF
BOTH THE “COST” AND THE “BENEFIT”
OF CLINGING TO THE DEFENSE
WHENEVER POSSIBLE
THE THERAPIST WILL THEREFORE OFFER
“PRICE – PAID” CONFLICT STATEMENTS
THAT HIGHLIGHT BOTH THE “PAIN” AND THE “GAIN”
“YOU KNOW THAT < PAIN > ... ,
BUT YOU REMAIN < GAIN > EVEN SO ... ”
“YOU KNOW THAT < PRICE PAID > ... ,
BUT YOU REMAIN < INVESTED IN > EVEN SO ... ”
IN THE HOPE OF MAKING THE “AMBIVALENTLY HELD DEFENSE”
“LESS EGO – SYNTONIC” AND “MORE EGO – DYSTONIC”
AND OF THEREFORE GALVANIZING THE PATIENT TO “TAKE ACTION”
TO “RESOLVE THE INTERNAL DISSONANCE”
AND “RESTORE THE HOMEOSTATIC BALANCE”
51
MODEL 1
“PRICE – PAID” CONFLICT STATEMENTS
FIRST “CHALLENGE” THE DEFENSE BY “DIRECTING THE PATIENT’S ATTENTION”
TO THE “PAIN / COST / PRICE PAID” FOR “OLD BAD”
AND THEN “SUPPORT” THE DEFENSE BY “RESONATING EMPATHICALLY”
WITH THE (SECONDARY) “GAIN / BENEFIT / PAY OFF” OF “OLD BAD”
“YOU KNOW THAT YOU ARE PAYING A STEEP PRICE
FOR YOUR REFUSAL TO STOP SMOKING –
OF PARTICULAR CONCERN
BECAUSE OF YOUR RECURRENT LUNG INFECTIONS.
BUT, AT THIS POINT, YOU ARE NOT QUITE YET PREPARED TO
TAKE THAT STEP BECAUSE YOU FEEL YOU HAVE SO LITTLE
ELSE IN YOUR LIFE THAT GIVES YOU ANY REAL PLEASURE.”
“YOU KNOW THAT YOU WILL NEED SOMEDAY
TO GET SERIOUS ABOUT LOSING THE EXTRA WEIGHT
BECAUSE IT REALLY IS BEGINNING TO IMPACT YOUR HEALTH.
BUT, RIGHT NOW, YOU CAN’T IMAGINE BEING ABLE
TO PUT YOURSELF ON A RESTRICTIVE DIET
BECAUSE YOU ARE ALREADY FEELING SO DEPRIVED
IN ALL THE OTHER AREAS OF YOUR LIFE.”
52
53
54
MODEL 2
THE
CORRECTIVE – PROVISION
PERSPECTIVE
OF SELF PSYCHOLOGY AND
OTHER “DEFICIT” THEORIES
“STRUCTURAL DEFICIT”
– THE “IMPAIRED CAPACITY” TO BE A “GOOD PARENT” UNTO ONESELF –
THIS “DEFICIT” CREATES THE “NEED”
THE “NEED” IS TO FIND
IN THE “HERE – AND – NOW”
THE “GOOD PARENT” WHO WAS NOT TO BE FOUND
IN THE “THERE – AND – THEN”
A “NEED” THAT THEN FUELS
THE “RELENTLESSNESS” OF THE PATIENT’S “PURSUITS”
55
THE “THERAPEUTIC ACTION” IN MODEL 2
A CORRECTIVE – PROVISION MODEL
– A DEFICIENCY – COMPENSATION MODEL –
YES, THE MODEL 2 THERAPIST
PROVIDES THE “HOLDING”
AND THE “BEING MET EMPATHICALLY”
THAT WERE NOT
CONSISTENTLY AND RELIABLY
PROVIDED BY THE PARENT
THIS REPARATION FUNCTIONS
AS A “SYMBOLIC CORRECTIVE”
FOR THE EARLY – ON
“RELATIONAL DEPRIVATION AND NEGLECT”
THE EARLY – ON “FAILURES IN ENVIRONMENTAL PROVISION”
BUT THERE IS MORE ...
56
ALTHOUGH SOME MODEL 2 THEORISTS
BELIEVE THAT IT IS
THE “EXPERIENCE OF GRATIFICATION” ITSELF
THAT WILL BE “COMPENSATORY”
AND ULTIMATELY HEALING
MOST BELIEVE THAT IT IS
THE “OPTIMAL STRESS” CREATED BY
THE “EXPERIENCE OF FRUSTRATION
AGAINST A BACKDROP OF GRATIFICATION”
FRUSTRATION – DISILLUSIONMENT – PROPERLY GRIEVED
– THAT IS, “OPTIMAL DISILLUSIONMENT” –
HOWARD BACAL’S (1998) “OPTIMAL RESPONSIVENESS”
THAT WILL PROVIDE
BOTH “IMPETUS” AND “OPPORTUNITY”
FOR THE “FILLING IN OF STRUCTURAL DEFICIT”
AND THE “CONSOLIDATION OF THE SELF”
57
AFTER ALL
IF THERE IS NO “THWARTING OF DESIRE,”
THEN THERE WILL BE NOTHING
THAT NEEDS TO BE MASTERED
AND THEREFORE NO “IMPETUS”
FOR “INTERNALIZING” WHATEVER “GOOD SUPPLIES”
– “ENVIRONMENTAL PROVISIONS” –
THERE HAD BEEN PRIOR TO BEING “THWARTED”
THESE “TRANSMUTING INTERNALIZATIONS”
ARE INDEED “ADAPTIVE”
– TRANSMUTING SIGNIFIES “STRUCTURE – BUILDING” –
HEINZ KOHUT (1966)
INASMUCH AS THEY MAKE IT POSSIBLE
FOR THE PATIENT TO “PRESERVE INTERNALLY”
A PIECE OF THE “ORIGINAL EXPERIENCE”
OF “EXTERNAL GOODNESS”
58
OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS
FACILITATE THE “NECESSARY GRIEVING” OF “DISAPPOINTMENTS”
“YOU HAD SO HOPED THAT … ,
BUT YOU ARE BEGINNING TO REALIZE THAT … ,
AND IT DEVASTATES / ENRAGES YOU … ”
THE THERAPEUTIC GOAL IS TO CREATE “GALVANIZING TENSION”
BETWEEN “DEFENSIVE NEED” FOR “RELENTLESS HOPE”
AND “ADAPTIVE CAPACITY” TO “CONFRONT, GRIEVE, AND ACCEPT”
FIRST “HIGHLIGHT” WHAT “HAD BEEN”
THE PATIENT’S “ILLUSION”
– “DEFENSIVE NEED” FOR “RELENTLESS HOPE” –
THEN “HIGHLIGHT” THE “REALITY”
OF THE PATIENT’S “DISILLUSIONMENT”
– “ADAPTIVE CAPACITY” TO “CONFRONT” –
FINALLY, “RESONATE EMPATHICALLY”
WITH THE “PAIN” OF THE PATIENT’S “GRIEF”
– “ADAPTIVE CAPACITY” TO “FEEL” THE ACTUAL “HEARTBREAK” –
59
OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS
“YOU HAD SO HOPED THAT I WOULD TELL YOU WHAT TO DO.
BUT YOU ARE BEGINNING TO REALIZE THAT I DON’T SIMPLY
GIVE YOU THE ANSWERS – AND IT INFURIATES YOU.”
“YOU HAD SO HOPED THAT YOUR DAUGHTER
WOULD REACH OUT TO YOU WHEN YOU WERE SICK.
BUT YOU ARE BEGINNING TO REALIZE THAT,
FOR NOW, YOU ARE NOT A TOP PRIORITY FOR HER –
AND IT IS A DEVASTATING LOSS.”
“YOU WOULD SO HAVE WISHED THAT I COULD KNOW WHAT YOU
WERE THINKING WITHOUT YOUR HAVING TO SAY IT.
BUT YOU ARE COMING TO SEE THAT IT DOES NOT ALWAYS
WORK THIS WAY – AND THAT BREAKS YOUR HEART.”
“YOU HAD SO HOPED THAT YOUR HUSBAND WOULD ASK
YOU HOW HE COULD HELP WITH THE DINNER PREPARATIONS.
BUT YOU ARE STARTING TO GET IT THAT OFFERING
TO HELP WITH HOUSEHOLD THINGS LIKE THAT IS NOT
HIS THING – AND IT SADDENS AND UPSETS YOU TERRIBLY.”
60
OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS
“YOU HAD SO HOPED THAT WE COULD HAVE A PERSONAL
RELATIONSHIP. BUT YOU ARE COMING TO REALIZE, ALBEIT
RELUCTANTLY, THAT A THERAPY RELATIONSHIP IS NOT REALLY
ABOUT FRIENDSHIP PER SE – AND THAT BREAKS YOUR HEART.”
“YOU HAD SO HOPED THAT YOUR MOTHER WOULD APOLOGIZE. BUT
YOU ARE BEGINNING TO ACCEPT THAT SHE SIMPLY DOES NOT HOLD
HERSELF ACCOUNTABLE, WHICH IS BOTH ENRAGING AND DEVASTATING.”
“ALTHOUGH YOU KNEW IT WOULD TAKE TIME, YOU HAD HOPED THAT YOU
WOULD BE FEELING BETTER AFTER THESE SEVERAL WEEKS OF THERAPY.
IT REALLY UPSETS YOU THAT YOU ARE STILL FEELING SUCH DESPAIR.”
“YOU HAD BEEN HOPING THAT I WOULD NOT MAKE THE SAME KINDS OF
MISTAKES THAT EVERYONE ELSE IN YOUR LIFE HAS, WHICH IS WHY
IT IS SO VERY UPSETTING THAT I, TOO, HAVE NOW LET YOU DOWN.”
“ON SOME LEVEL, YOU KNEW THAT I DIDN’T HAVE ALL THE ANSWERS.
EVEN SO, YOU HAD BEEN HOPING THAT I MIGHT, AND SO IT ENRAGES
YOU WHEN I DON’T SIMPLY ANSWER YOUR QUESTIONS DIRECTLY.”
“YOU HAD SO HOPED THAT I WOULD BE ABLE TO MAKE YOUR PAIN
GO AWAY. BUT YOU ARE BEGINNING TO SEE THAT THERAPY DOES NOT
ACTUALLY WORK THAT WAY. AND IT IS ABSOLUTELY DEVASTATING.” 61
OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS
“YOU KNOW THAT EVENTUALLY YOU WILL NEED TO FACE THE REALITY
THAT YOUR FATHER WILL NEVER CHANGE, AND THIS REALIZATION
IS DEVASTATING BECAUSE YOU HAD SO HOPED THAT HE WOULD.”
“YOU ARE BEGINNING TO REALIZE THAT YOUR MOTHER WILL
NEVER UNDERSTAND JUST HOW MUCH SHE HAS HURT
YOU OVER THE COURSE OF THE YEARS. AND IT IS EXCRUCIATINGLY
PAINFUL BECAUSE YOU HAD SO HOPED THAT SOMEDAY
SHE MIGHT ACTUALLY COME TO UNDERSTAND – AND APOLOGIZE.”
“AS YOU BEGIN TO ADMIT TO YOURSELF THAT PROBABLY
PEDRO WILL NEVER BE RIGHT FOR YOU, IT MAKES
YOU INCREDIBLY SAD BECAUSE YOU HAD SO HOPED THAT HE
WOULD EVENTUALLY COME ’ROUND TO LOVING YOU.”
“IN THOSE MOMENTS WHEN YOU LET YOURSELF REMEMBER
JUST HOW LIMITED YOUR FATHER IS AND JUST HOW DEFENSIVE
HE BECOMES WHENEVER YOU TRY TO HOLD HIM ACCOUNTABLE,
IT FEELS TOTALLY OVEWHELMING AND HURTS SO MUCH.
YOU HAD SO HOPED THAT YOU COULD GET HIM TO TAKE AT
LEAST SOME RESPONSIBILITY FOR HIS ABUSIVENESS.”
62
IF ALL GOES WELL
IT WILL BE WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE RELATIONSHIP WITH HER THERAPIST
THAT THE PATIENT WILL BE ABLE, AT LAST,
TO FEEL THE PAIN AGAINST WHICH
SHE HAS SPENT A LIFETIME DEFENDING HERSELF
IN THE PROCESS
GRADUALLY TRANSFORMING
BOTH HER “RELENTLESS NEED”
TO POSSESS AND CONTROL
AND, WHEN THWARTED,
HER “RETALIATORY NEED”
TO PUNISH AND DESTROY
INTO THE “ADAPTIVE CAPACITY”
TO RELENT, TO GRIEVE, TO ACCEPT, TO FORGIVE,
TO INTERNALIZE WHAT GOOD THERE WAS,
TO SEPARATE, TO LET GO, AND TO MOVE ON
ULTIMATELY EVOLVING TO A PLACE OF
APPRECIATION AND GRATITUDE
FOR ALL THE GOOD THAT WAS (AND IS)
63
AS “EXTERNAL GOODNESS” IS INTERNALIZED
AND “STRUCTURAL DEFICIT” FILLED IN
THE “RELENTLESSNESS” WITH WHICH THE PATIENT
HAD BEEN “PURSUING” THE “OBJECTS OF HER DESIRE”
– THAT IS, HER “RELENTLESS HOPE” AND “REFUSAL TO ACCEPT”
THEIR “LIMITATIONS, SEPARATENESS, AND IMMUTABILITY” –
WILL BECOME GRADUALLY “TAMED”
AND SHE WILL EVOLVE TO A PLACE OF
“SERENE ACCEPTANCE”
OF THE SOBERING REALITY
THAT SHE WILL NEVER BE ABLE TO HAVE
ALL THAT SHE SHOULD HAVE HAD AS A CHILD
AND FOR WHICH SHE HAS SPENT
A LIFETIME SEARCHING
BUT THAT “WHAT SHE HAS” IS “GOOD ENOUGH” 😊
64
65
FROM RELENTLESS PURSUIT OF THE UNATTAINABLE
TO SOBER, MATURE ACCEPTANCE OF THE REALITY
THAT IT WAS WHAT IT WAS AND IS WHAT IT IS
GRIEVING
GENUINE GRIEVING REQUIRES OF US THAT
– AT LEAST FOR PERIODS OF TIME –
WE BE FULLY PRESENT WITH
THE ANGUISH OF OUR GRIEF, THE PAIN OF OUR REGRET,
AND THE INTENSITY OF THE RAGE WE EXPERIENCE
WHEN CONFRONTED WITH SOBERING REALITIES ABOUT
OURSELVES, OUR RELATIONSHIPS, AND OUR WORLD
WE MUST NOT ABSENT OURSELVES FROM OUR GRIEF
WE MUST ENTER INTO IT AND EMBRACE IT
WE CANNOT EFFECTIVELY GRIEVE WHEN WE ARE
DISSOCIATED, MISSING IN ACTION, OR FLEEING THE SCENE
WE NEED TO BE ENGAGED, IN THE MOMENT, EMBODIED,
MINDFUL OF ALL THAT IS GOING ON INSIDE OF US,
GROUNDED, FOCUSED, AND IN THE HERE – AND – NOW
IF WE ARE IN DENIAL, SHUT DOWN, CLOSED, NUMB,
REFUSING TO FEEL, OR PROTESTING THE UNFAIRNESS
OF IT ALL, THEN NO REAL GRIEVING CAN BE DONE
66
67
“GRIEF IS NATURE’S WAY
OF HEALING A BROKEN HEART”
ROBERTA BECKMANN (1991)
IN SUM
THE “THERAPEUTIC ACTION” IN MODEL 2
IS A PROTRACTED PROCESS THAT TRANSFORMS
THE PATIENT’S (DEFENSIVE) REFUSAL TO CONFRONT
THE REALITY OF THE OBJECT’S
LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
– WHICH FUELS THE RELENTLESSNESS WITH WHICH SHE PURSUES IT –
INTO THE (ADAPTIVE) CAPACITY TO TOLERATE
AND ACCEPT THOSE DISAPPOINTING REALITIES
IN THE CONTEXT OF THE TREATMENT
IT REQUIRES THAT THE PATIENT
WORK THROUGH HER “OPTIMAL DISILLUSIONMENT”
– THAT IS, WORK THROUGH “POSITIVE TRANSFERENCE DISRUPTED” –
BY CONFRONTING THE “PAIN OF HER GRIEF”
AND “ADAPTIVELY INTERNALIZING” THE
“GOOD THAT HAD BEEN” PRIOR TO THE “DISRUPTION”
ARRIVING ULTIMATELY AT A PLACE OF SERENE
ACCEPTANCE, FORGIVENESS, INNER PEACE, AND REALISTIC HOPE
IF YOU CANNOT ALWAYS COUNT ON RECEIVING IT FROM THE OUTSIDE,
BETTER THAT YOU INTERNALIZE
WHATEVER “EXTERNAL PROVISIONS” YOU CAN SO THAT
THEY WILL ALWAYS BE THERE FOR YOU AS “INTERNAL RESOURCES”
68
HAROLD SEARLES (1979) HAS SUGGESTED
THAT “REALISTIC HOPE”
ARISES IN THE CONTEXT OF
“SURVIVING DISAPPOINTMENT”
69
THE BAD NEWS WILL BE
THE SADNESS THE PATIENT EXPERIENCES
AS SHE BEGINS TO ACCEPT
THE SOBERING REALITY
THAT DISAPPOINTMENT
IS AN INEVITABLE AND NECESSARY
ASPECT OF RELATIONSHIP
THE GOOD NEWS, HOWEVER, WILL BE
THE WISDOM SHE ACQUIRES
AS SHE COMES TO APPRECIATE
EVER – MORE PROFOUNDLY
THE SUBTLETIES AND NUANCES OF RELATIONSHIP
AND BEGINS TO MAKE HER PEACE
WITH THE HARSH REALITY
OF LIFE’S MANY CHALLENGES
SADDER SHE WILL BE, YES, BUT ALSO WISER
70
71
AS A RESULT OF GENUINE GRIEVING
“GRIEVANCES”
– UNMOURNED DISAPPOINTMENTS –
WILL HAVE BECOME TRANSFORMED INTO
THE HEALTHY CAPACITY TO ACCEPT
THE SOBERING REALITY THAT
WE CANNOT MAKE THE PEOPLE IN OUR WORLD CHANGE
BUT THAT WE CAN
– AND MUST –
TAKE OWNERSHIP OF
– AND RESPONSIBILITY FOR –
ALL THAT WE CAN CHANGE WITHIN OURSELVES
BY THE SAME TOKEN
WE MUST COME TO TERMS WITH
THE SOBERING REALITY THAT
WE CANNOT CHANGE OUR HISTORY
BUT THAT WE CAN
– AND MUST –
CHANGE HOW WE “POSITION” OURSELVES
IN RELATION TO IT
AND HOW WE “POSITION” OURSELVES
IN OUR LIFE GOING FORWARD 72
73
“TRUE HAPPINESS
IS NOT ABOUT
GETTING WHAT YOU WANT
BUT COMING TO WANT
AND APPRECIATE
WHAT YOU HAVE.”
JAPANESE SAYING
74
75
I AM HERE REMINDED OF THE NEW YORKER CARTOON
IN WHICH A GENTLEMAN, SEATED IN A RESTAURANT
BY THE NAME OF THE DISILLUSIONMENT CAFÉ,
IS AWAITING THE ARRIVAL OF HIS ORDER
THE WAITER RETURNS TO HIS TABLE AND ANNOUNCES,
“YOUR ORDER IS NOT READY, AND NOR WILL IT EVER BE.”
76
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
FEATURES
“PATHOGENIC INTROJECTS”
“FILTERS” THAT WILL CONTAMINATE THE PATIENT’S
EXPERIENCE OF SELF, OTHERS, AND THE WORLD
AND GIVE RISE TO “RELATIONAL CONFLICT”
WHEN “DELIVERED” INTO RELATIONSHIPS
THE “HERE – AND – NOW ENGAGEMENT”
BETWEEN TWO “AUTHENTIC SUBJECTS”
AND THE “TURBULENCE” THAT WILL INEVITABLY
ARISE AT THEIR “INTIMATE EDGE”
WHEN THE THERAPIST EITHER
“REACTS DEFENSIVELY” OR “RESPONDS ADAPTIVELY”
TO THE “FORCE FIELD” CREATED BY THE PATIENT’S “PROJECTIONS”
THE “CONTRIBUTIONS” OF BOTH PARTICIPANTS
TO THE “INTERSUBJECTIVE IN – BETWEEN”
“CO – CREATION” AND “MUTUALITY OF IMPACT / INFLUENCE”
USE OF THE THERAPIST’S “AUTHENTIC SELF”
TO “FIND” – AND TO BE “FOUND BY” – THE PATIENT
77
OPTIMALLY STRESSFUL
MODEL 3 ACCOUNTABILITY STATEMENTS
– RELATIONAL INTERVENTIONS –
STRATEGICALLY DESIGNED TO TEASE OUT
TRANSFERENCE – COUNTERTRANSFERENCE ENTANGLEMENTS
PROJECTIVE IDENTIFICATIONS / “CRUNCH SITUATIONS” – PAUL RUSSELL (1980)
MUTUAL ENACTMENTS / CO – CREATED THERAPEUTIC IMPASSES
THE THERAPEUTIC ACTION
INVOLVES “NEGOTIATING”
AT THE “INTIMATE EDGE”
OF “AUTHENTIC RELATEDNESS”
THE OVERARCHING GOAL OF WHICH
IS TO TRANSFORM
COMPULSIVE AND UNWITTING “RE – ENACTMENT”
INTO “ACCOUNTABILITY”
AND “RELATIONAL MINDFULNESS”
– ON THE PARTS OF BOTH THERAPIST AND PATIENT –
DEBORAH EDEN TULL (2018)
MINDFULNESS – “PRESENT – MOMENT AWARENESS”
78
79
PROJECTIVE IDENTIFICATION
BECAUSE THE MODEL 3 THERAPIST
IS PARTICIPATING IN A
“REAL RELATIONSHIP” WITH THE PATIENT
AND BECAUSE THE PATIENT
HAS THE EVER – PRESENT
“RELATIONAL EXPECTATION” OF “BEING FAILED”
INEVITABLY THE THERAPIST
– UNCONSCIOUSLY RECEPTIVE TO THIS
“RELATIONAL NEED” ON THE PART OF THE PATIENT –
WILL FIND HERSELF UNWITTINGLY
DRAWN IN TO PARTICIPATING
AS SOME VARIANT OF
THE PATIENT’S “OLD BAD OBJECT”
– PROJECTIVE IDENTIFICATION IN ACTION –
ALTHOUGH THIS WILL OFTEN GIVE RISE TO “TURBULENCE”
AT THE INTIMATE EDGE BETWEEN THERAPIST AND PATIENT,
IT WILL ALSO CREATE BOTH “IMPETUS” AND “OPPORTUNITY”
FOR THE PATIENT TO REWORK HER “INTROJECTED BADNESS” ...
80
... BECAUSE THE PATIENT’S
COMPULSIVE AND UNWITTING RE – ENACTMENTS
ALWAYS HAVE BOTH UNHEALTHY AND HEALTHY COMPONENTS
THE UNHEALTHY COMPONENT
HAS TO DO WITH THE PATIENT’S NEED
TO HAVE MORE OF SAME
– NO MATTER HOW DYSFUNCTIONAL –
BECAUSE THAT IS ALL SHE HAS EVER KNOWN
HAVING SOMETHING DIFFERENT
WOULD CREATE ANXIETY
BECAUSE IT WOULD HIGHLIGHT THE FACT
THAT THINGS COULD BE
– AND COULD THEREFORE HAVE BEEN –
DIFFERENT
BUT THE HEALTHY PIECE
HAS TO DO WITH THE PATIENT’S NEED
TO ACHIEVE BELATED MASTERY
OF THE EARLY – ON RELATIONAL FAILURES
81
MODEL 2 VERSUS MODEL 3
UNLIKE MODEL 2, WHICH PAYS SCANT
ATTENTION TO THE PATIENT’S “PROACTIVITY”
IN RELATION TO THE THERAPIST,
MODEL 3 ADDRESSES ITSELF SPECIFICALLY TO THE
“FORCE FIELD” CREATED BY THE PATIENT WHO
– UNDER THE SWAY OF HER REPETITION COMPULSION –
IS UNWITTINGLY EVER – INTENT UPON RE – CREATING
– BY WAY OF PROJECTIVE IDENTIFICATION –
THE EARLY – ON TRAUMATIC FAILURE SITUATION
BY DRAWING THE THERAPIST IN TO PARTICIPATING
“IN WAYS SPECIFICALLY DETERMINED BY THE
PATIENT’S EARLY – ON DEVELOPMENTAL HISTORY”
PATRICK CASEMENT (1992)
ALL WITH AN EYE TO ENCOUNTERING
A BETTER OUTCOME EACH NEXT TIME
82
IN FACT
THE PATIENT MIGHT KNOW
OF NO OTHER WAY
TO GET SOME UNRESOLVED PIECE
OF HER SUBJECTIVE EXPERIENCE
UNDERSTOOD THAN BY
UNWITTINGLY RE – ENACTING IT
IN THE RELATIONSHIP WITH HER THERAPIST
AND ONLY BY WAY OF RECREATING
WITH HER THERAPIST
THE ONLY KIND OF RELATIONSHIP
SHE HAS EVER KNOWN
WILL THE PATIENT BE ABLE
– AT LAST –
TO NEGOTIATE A DIFFERENT ENDING
83
TWO PHASES OF A PROJECTIVE IDENTIFICATION
MARTHA STARK (1999)
THE “INDUCTION PHASE” COMMENCES ONCE THE PATIENT
PROJECTS ONTO THE THERAPIST SOME ASPECT OF THE PATIENT’S
EXPERIENCE THAT HAS BEEN TOO TOXIC FOR THE PATIENT TO
PROCESS AND INTEGRATE – AND THEN EXERTS PRESSURE ON THE
THERAPIST TO ACCEPT THAT PROJECTION, THEREBY INDUCTING
THE THERAPIST INTO THE PATIENT’S ENACTMENT
THE “RESOLUTION PHASE” IS USHERED IN ONCE THE THERAPIST
STEPS BACK FROM HER PARTICIPATION IN WHAT HAS BECOME A
MUTUAL ENACTMENT AND BRINGS TO BEAR HER OWN,
MORE – EVOLVED CAPACITY TO PROCESS AND INTEGRATE ON
BEHALF OF A PATIENT WHO TRULY DOES NOT KNOW HOW –
SUCH THAT WHAT IS THEN RE – INTROJECTED BY THE PATIENT CAN
BE MORE EASILY ASSIMILATED INTO HEALTHY PSYCHIC STRUCTURE
AND, IF ALL GOES WELL, THESE ITERATIVE CYCLES WILL HAPPEN
REPEATEDLY, THE NET RESULT OF WHICH WILL BE “GRADUAL
DETOXIFICATION” OF THE PATIENT’S “INTERNAL PATHOGENICITY”
84
ALTHOUGH INEVITABLY THE THERAPIST WILL
FAIL THE PATIENT IN MANY OF THE SAME
WAYS THAT THE PARENT HAD FAILED HER
ULTIMATELY, THE THERAPIST MUST CHALLENGE THE
PATIENT’S PROJECTIONS BY LENDING ASPECTS OF HER
“OTHERNESS” OR “EXTERNALITY” TO THE INTERACTION
DONALD WINNICOTT (1949)
SUCH THAT THE PATIENT WILL HAVE
THE EXPERIENCE OF SOMETHING THAT IS
“OTHER – THAN – ME” AND CAN “TAKE THAT IN”
IN ESSENCE, THE THERAPIST WILL
“CONTAIN” THE PATIENT’S PROJECTIONS
BY LENDING ASPECTS OF HER OWN, GREATER
CAPACITY TO PROCESS AND INTEGRATE
SUCH THAT THE PATIENT WILL HAVE
THE EXPERIENCE OF “TAKING IN” SOMETHING
THAT IS NOW MORE PROCESSED,
LESS TOXIC, AND MORE MANAGEABLE
85
IN ESSENCE
WHAT THE PATIENT RE – INTROJECTS
WILL BE AN “AMALGAM”
PART CONTRIBUTED
BY THE PATIENT
THE ORIGINAL
– UNPROCESSED AND TOXIC –
PROJECTION
AND PART CONTRIBUTED
BY THE THERAPIST
SOMETHING
MORE PROCESSED AND LESS TOXIC
86
CLINICAL VIGNETTE
THE “SHARING” OF GRIEF
A PATIENT’S BELOVED GRANDMOTHER
HAS JUST DIED
THE PATIENT, UNABLE TO FEEL HIS SADNESS
BECAUSE IT HURTS “TOO MUCH,”
RECOUNTS IN A MONOTONE
THE DETAILS OF HIS GRANDMOTHER’S DEATH
AS THE THERAPIST LISTENS, SHE BECOMES VERY SAD
AS THE PATIENT CONTINUES,
THE THERAPIST FINDS HERSELF UTTERING,
ALMOST INAUDIBLY, AN OCCASIONAL
“OH, NO!” AND “THAT’S AWFUL!”
AS THE HOUR PROGRESSES,
THE PATIENT HIMSELF
BECOMES INCREASINGLY SAD
87
CLINICAL VIGNETTE – THE “SHARING” OF GRIEF
IN THIS EXAMPLE, THE PATIENT IS INITIALLY UNABLE TO FEEL
THE DEPTHS OF HIS GRIEF ABOUT HIS GRANDMOTHER’S DEATH
BUT BY REPORTING THE DETAILS IN THE “MONOTONIC” MANNER IN
WHICH HE DOES, THE PATIENT IS ABLE TO GET THE THERAPIST TO FEEL
WHAT HE HIMSELF CANNOT – AND INSTEAD MUST DEFEND AGAINST
IN ESSENCE, THE PATIENT EXERTS “INTERPERSONAL PRESSURE” UPON
THE THERAPIST TO TAKE ON, AS THE THERAPIST’S OWN,
WHAT THE PATIENT DOES NOT YET HAVE THE CAPACITY TO TOLERATE
AS THE THERAPIST SITS WITH THE PATIENT AND LISTENS TO HIS STORY,
SHE FINDS HERSELF BECOMING VERY SAD, WHICH SIGNALS THE
THERAPIST’S QUIET ACCEPTANCE OF THE PATIENT’S DISAVOWED GRIEF
THE INDUCTION PHASE OF THE PROJECTIVE IDENTIFICATION
WE COULD SAY OF THE PATIENT’S SADNESS THAT IT HAS FOUND
ITS WAY INTO THE THERAPIST, WHO, ABLE TO TOLERATE WHAT
THE PATIENT FINDS INTOLERABLE, TAKES IT ON “AS HER OWN”
THE THERAPIST’S SADNESS IS THEREFORE CO – CREATED –
IN PART A STORY ABOUT THE PATIENT (AND HIS DISAVOWED GRIEF)
AND IN PART A STORY ABOUT THE THERAPIST
– IN WHOM A RESONANT CHORD HAS BEEN STRUCK – 88
CLINICAL VIGNETTE – THE “SHARING” OF GRIEF
THE THERAPIST, WITH HER GREATER CAPACITY TO EXPERIENCE
AFFECT WITHOUT NEEDING TO DEFEND AGAINST IT, IS ABLE
BOTH TO TOLERATE THE SADNESS THAT THE PATIENT FINDS
INTOLERABLE AND TO PROCESS AND INTEGRATE IT
WHICH INITIATES THE RESOLUTION PHASE OF THE PROJECTIVE IDENTIFICATION
THE THERAPIST “FEELS” IT BUT IS “NOT OVERWHELMED” BY IT
IT IS THE THERAPIST’S ABILITY TO TOLERATE THE INTOLERABLE
THAT MAKES THE PATIENT’S PREVIOUSLY UNMANAGEABLE
FEELINGS MORE MANAGEABLE FOR HIM
INDEED, THE PATIENT’S GRIEF BECOMES LESS TERRIFYING BY
VIRTUE OF THE FACT THAT THE THERAPIST HAS BEEN ABLE
TO CONTAIN IT BY CARRYING THAT GRIEF ON THE PATIENT’S BEHALF
A MORE ASSIMILABLE VERSION OF THE PATIENT’S SADNESS IS THEN
RETURNED TO THE PATIENT IN THE FORM OF THE THERAPIST’S
HEARTFELT UTTERANCES – “OH, NO!” AND “THAT’S AWFUL!”
SUCH THAT THE PATIENT FINDS HIMSELF NOW ABLE
TO BEAR THE PAIN OF HIS OWN GRIEF
– NOW ABLE TO CARRY THAT PAIN ON HIS OWN BEHALF –
– NOW ABLE TO TOLERATE WHAT HAD ONCE BEEN INTOLERABLE – 89
CLINICAL VIGNETTE – “GREAT TAN, BITCH!”
THE PATIENT, JANET, IS A 31 – YEAR – OLD MARRIED WOMAN
WHO HAS A HISTORY OF DIFFICULT RELATIONSHIPS
WITH ALMOST EVERYONE IN HER LIFE
SHE IS PARTICULARLY TROUBLED BY
HER LACK OF CLOSE WOMEN FRIENDS
JANET HAS BEEN WORKING HARD IN THE TREATMENT,
HAS MADE SUBSTANTIAL GAINS IN HER PROFESSIONAL LIFE,
AND HAS VERY MUCH IMPROVED THE QUALITY
OF HER RELATIONSHIP WITH HER HUSBAND
JANET AND HER THERAPIST (A WOMAN) HAVE HAD
A GOOD, RELATIVELY UNCONFLICTED RELATIONSHIP
JANET CLEARLY LIKES, AND IS RESPECTFUL OF, THE THERAPIST
UPON THE THERAPIST’S RETURN FROM A WEEK – LONG VACATION
IN FLORIDA, JANET, AT THE END OF THE SESSION AND JUST
AS SHE IS LEAVING, TURNS BACK TO HER THERAPIST AND,
AS HER PARTING SHOT, BLURTS OUT, “GREAT TAN, BITCH!”
THE THERAPIST, TAKEN ABACK AND AT A LOSS FOR WORDS,
SAYS NOTHING, SMILES LAMELY, AND NODS GOODBYE
90
ALTHOUGH DURING THE SESSION THE THERAPIST (MADE ANXIOUS)
HAD “REACTED DEFENSIVELY” BY “GOING BLANK,”
BETWEEN SESSIONS THE THERAPIST IS ABLE TO “RECOVER HER
THERAPEUTIC EFFECTIVENESS” BY “STEPPING BACK” ENOUGH
FROM HER EXPERIENCE OF HAVING BEEN “SLAMMED”
THAT – NOW LESS ANXIOUS – SHE IS ABLE TO “RESPOND ADAPTIVELY”
AND, THEREFORE, OPENS THE NEXT SESSION WITH –
“WE HAVE TALKED A LOT ABOUT HOW UPSETTING
IT IS FOR YOU TO HAVE SO FEW WOMEN FRIENDS.
“I THINK THAT NOW, IN LIGHT OF WHAT HAPPENED
AT THE END OF OUR LAST SESSION,
I AM COMING TO UNDERSTAND SOMETHING
THAT I HAD NEVER BEFORE COMPLETELY UNDERSTOOD.
“WHEN YOU LEFT LAST TIME,
YOUR PARTING WORDS WERE ‘GREAT TAN, BITCH!’
“I WONDER IF, BY SAYING THAT, YOU WERE TRYING
TO SHOW ME WHAT SOMETIMES HAPPENS FOR YOU
WHEN YOU FEEL CLOSE TO A WOMAN
AND THEN FIND YOURSELF BECOMING COMPETITIVE.”
HERE THE THERAPIST IS COURAGEOUSLY USING HER “EXPERIENCE OF SELF”
– HER COUNTERTRANSFERENTIAL REACTION OF “BEING PUT OFF” –
TO “SHINE A LIGHT ON” A CRITICALLY IMPORTANT PIECE
OF THE PATIENT’S “DYSFUNCTIONAL RELATIONAL DYNAMICS”
91
MUCH IS REQUIRED OF THE MODEL 3 THERAPIST
FOR HER TO BE ABLE EVENTUALLY TO
“RESPOND ADAPTIVELY” INSTEAD OF “REACTING DEFENSIVELY”
TO THE PATIENT’S DELIVERY OF
HER “DYSFUNCTIONAL RELATIONAL DYNAMICS”
INTO THE THERAPEUTIC RELATIONSHIP
THE THERAPIST MUST FIRST BE ABLE
TO TOLERATE “BEING MADE INTO”
THE PATIENT’S “OLD BAD OBJECT”
AND ONCE SHE HAS ALLOWED HERSELF
TO BE DRAWN IN TO PARTICIPATING
IN WHAT CAN SOMETIMES BECOME
A VERY MESSY
TRANSFERENCE / COUNTERTRANSFERENCE
ENTANGLEMENT,
SHE MUST THEN BE ABLE
TO “EXTRICATE” HERSELF
BY STEPPING BACK
WHICH WILL ENABLE HER TO RECOVER HER “OBJECTIVITY”
AND, THEREBY, HER “THERAPEUTIC EFFECTIVENESS”
92
IN ESSENCE
THE THERAPIST MUST HAVE
THE “CAPACITY TO RELENT”
FURTHERMORE
THE THERAPIST MUST HAVE
BOTH THE “WISDOM TO RECOGNIZE”
AND THE “INTEGRITY TO ACKNOWLEDGE”
– CERTAINLY TO HERSELF
AND PERHAPS TO THE PATIENT AS WELL –
HER OWN PARTICIPATION IN THE DRAMA
THAT IS BEING PLAYED OUT BETWEEN THEM
ON THE STAGE OF THE TREATMENT
IN OTHER WORDS
THE THERAPIST MUST HAVE THE “CAPACITY”
BOTH TO “RELENT”
AND TO “HOLD HERSELF ACCOUNTABLE”
FOR HER “COUNTERTRANSFERENTIAL ENACTMENT”
93
IN ESSENCE
PROJECTIVE IDENTIFICATION
INVOLVES SYMBOLIC
REPETITION OF THE
ORIGINAL RELATIONAL TRAUMA
BUT WITH A MUCH HEALTHIER
RESOLUTION THIS TIME
– “ADAPTIVE RESOLUTION” –
AT THE END OF THE DAY
THE HALLMARK OF
A SUCCESSFUL PROJECTIVE IDENTIFICATION
IS THE THERAPIST’S CAPACITY TO TOLERATE
WHAT THE PATIENT FINDS INTOLERABLE
94
THE OPTIMALLY STRESSFUL “RULE OF THREE”
IS DESIGNED TO INSIST THAT THE “RE – ENACTING” PATIENT
TAKE RESPONSIBILITY FOR HER “PROVOCATIVE ENACTMENTS”
MORE SPECIFICALLY, THE “RULE OF THREE” BECOMES RELEVANT
WHENEVER A PATIENT SAYS OR DOES SOMETHING
THAT THE THERAPIST EXPERIENCES AS PROVOCATIVE
– A “PROVOCATIVE ENACTMENT” –
IN ORDER TO COMPEL THE PATIENT TO TAKE OWNERSHIP OF
WHAT SHE IS “PLAYING OUT” ON THE STAGE OF THE TREATMENT,
THE THERAPIST CAN ASK THE PATIENT ANY OF THE FOLLOWING –
“HOW ARE YOU HOPING THAT I WILL RESPOND?”
WHICH ADDRESSES THE ID
“HOW ARE YOU FEARING THAT I MIGHT RESPOND?”
WHICH ADDRESSES THE SUPEREGO
“HOW ARE YOU IMAGINING THAT I WILL RESPOND?”
WHICH ADDRESSES THE EXECUTIVE FUNCTIONING OF THE EGO
– THE DORSOLATERAL PREFRONTAL CORTEX (DLPFC) OF THE BRAIN –
ALL THREE “RELATIONAL INTERVENTIONS” DEMAND OF THE PATIENT
THAT SHE MAKE HER “INTERPERSONAL INTENTIONS” MORE EXPLICIT
95
OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
MORE GENERALLY, THE THERAPIST MIGHT CHOOSE TO SHARE –
SOMETHING ABOUT HER OWN EXPERIENCE
OF BEING IN THE ROOM WITH THE PATIENT
OR HER OWN STATE OF INTERNAL CONFLICTEDNESS
AS A RESULT OF SOMETHING HAPPENING BETWEEN THEM
ALTERNATIVELY, THE THERAPIST MIGHT CHOOSE TO HIGHLIGHT –
HOW THE PATIENT GETS OTHERS TO DO UNTO HER
IN THE HERE – AND – NOW
SOME VERSION OF WHAT HAD BEEN DONE UNTO HER
IN THE THERE – AND – THEN
– “DIRECT NEGATIVE TRANSFERENCE” –
WITNESS, FOR EXAMPLE, THE CONCEPT OF “DOER AND DONE TO”
JESSICA BENJAMIN (2017)
OR HOW THE PATIENT DOES UNTO OTHERS
IN THE HERE – AND – NOW
SOME VERSION OF WHAT HAD BEEN DONE UNTO HER
IN THE THERE – AND – THEN
– “INVERTED NEGATIVE TRANSFERENCE” –
WITNESS, FOR EXAMPLE, THE CONCEPT OF “IDENTIFICATION WITH THE AGGRESSOR”
SANDOR FERENCZI (1995) / ANNA FREUD (1979)
96
AS ADDITIONAL EXAMPLES
OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
THE THERAPIST MIGHT CHOOSE TO SHARE SOMETHING ABOUT
HER EXPERIENCE OF BEING IN THE ROOM WITH THE PATIENT
“IT WOULD SEEM THAT I AM IN THE DOG HOUSE THESE DAYS!”
“I WONDER IF THE FRUSTRATION AND HELPLESSNESS
I AM FEELING NOW IN RELATION TO YOU IS SIMILAR
TO THE FRUSTRATION AND HELPLESSNESS YOU HAVE
SPOKEN OF HAVING FELT IN RELATION TO YOUR FATHER.”
“YOU TELL ME SOMETHING ABOUT YOURSELF. I AM
JUST IN THE PROCESS OF DIGESTING IT AND STORING
IT FOR FURTHER UNDERSTANDING OF YOU AND THEN
ALONG YOU COME – WHAM! – AND TELL ME THAT
WHAT I HAVE DIGESTED AND STORED INSIDE ME
DID NOT COME FROM YOU AT ALL. THE PROBLEM I
FIND IS HOW TO LIVE WITH THE DESPAIR I FEEL
OCCASIONED BY YOUR DISAPPEARANCES.”
CHRISTOPHER BOLLAS (1989) 97
OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
CAN BE INTRODUCED IN ANY OF THE FOLLOWING WAYS –
“IT OCCURS TO ME THAT, BY WAY OF YOUR
BEHAVIOR IN HERE WITH ME, YOU ARE HELPING
ME TO UNDERSTAND SOMETHING THAT
I HAD NEVER BEFORE ENTIRELY UNDERSTOOD … ”
“I THINK THAT YOU HAVE BEEN TRYING TO
COMMUNICATE SOMETHING IMPORTANT TO ME
THAT I HAD BEEN REFUSING TO SEE … ”
“I WONDER IF MY DIFFICULTY APPRECIATING
JUST HOW DESPERATE YOU WERE MADE
YOU FEEL THAT YOU HAD TO DO SOMETHING
DRAMATIC IN ORDER TO GET MY ATTENTION … ”
DON’T HESITATE TO “THROW YOURSELF UNDER THE BUS”
98
OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
AS IRWIN HOFFMAN (2001) HAS SUGGESTED
IF THE THERAPIST IS AWARE OF FEELING CONFLICTED IN
RELATION TO THE PATIENT, SHE MAY CHOOSE TO SHARE
THE FACT OF THIS CONFLICTEDNESS WITH THE PATIENT
“I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’”
HERE THE THERAPIST IS EXPRESSING ALOUD THE CONFLICT WITH
WHICH SHE IS STRUGGLING – A CONFLICT THAT MIGHT WELL BE
REFLECTIVE OF THE PATIENT’S OWN INTERNAL STATE OF DIVIDEDNESS
“I AM TEMPTED TO GIVE YOU THE ADVICE FOR
WHICH YOU ARE LOOKING, BUT MY FEAR IS THAT
WERE I TO DO SO, I WOULD BE ROBBING YOU OF
THE IMPETUS TO FIND YOUR OWN ANSWERS.”
“I FIND MYSELF FEELING ANGRY WITH YOU FOR BEING SO OFTEN
LATE AND WANTING YOU TO UNDERSTAND HOW IT IMPACTS ME.
BUT THEN IT OCCURS TO ME THAT IT MIGHT BE MORE IMPORTANT
FOR US TO TRY TO UNDERSTAND WHAT YOU MIGHT BE WANTING
TO COMMUNICATE TO ME BY WAY OF YOUR FREQUENT LATENESS.”
99
“I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’”
OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
“I AM TEMPTED TO RESPOND TO YOUR REQUEST BY
SAYING THAT OF COURSE YOU CAN BORROW ONE OF
THE MAGAZINES IN MY WAITING ROOM. BUT I AM ALSO
REALIZING THAT WERE I SIMPLY TO SAY ‘OK,’ WE MIGHT
THEN LOSE AN OPPORTUNITY TO UNDERSTAND SOMETHING
MORE ABOUT YOU AND, PERHAPS, ABOUT US.”
TO A PATIENT WHO SAYS SHE WANTS THE THERAPIST’S
APPROVAL REGARDING HER DECISION TO TERMINATE
– A TERMINATION THAT THE THERAPIST THINKS IS PREMATURE –
“I AM TEMPTED SIMPLY TO OFFER YOU THE APPROVAL YOU
ARE SEEKING – IT IS, AFTER ALL, IMPORTANT THAT YOU DO
WHAT FEELS RIGHT FOR YOU. BUT I AM ALSO AWARE
OF FEELING, WITHIN MYSELF, THAT THE TIME IS TOO SOON
AND THAT WERE I TO SUPPORT YOUR DECISION TO LEAVE,
I MIGHT ULTIMATELY BE DOING YOU A DISSERVICE.”
100
OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
“I WONDER IF THIS FEELING I HAVE IN RELATION
TO YOU THAT NO MATTER WHAT I SAY IT WON’T BE
GOOD ENOUGH IS LIKE THE FEELING YOU HAVE SPOKEN
OF HAVING HAD IN RELATION TO YOUR FATHER,
FOR WHOM NOTHING WAS EVER GOOD ENOUGH.”
“I FIND MYSELF FEELING SO ANGRY AT YOUR MOTHER.
I WONDER IF SOME OF THOSE FEELINGS ARE ACTUALLY
A STORY ABOUT FEELINGS YOU HAVE ABOUT YOUR MOTHER –
FEELINGS YOU WOULD RATHER NOT HAVE TO ACKNOWLEDGE.”
“IT OCCURS TO ME THAT WE HAVE MANAGED TO RECREATE
IN HERE THE VERY SAME DYNAMIC THAT HAD CHARACTERIZED YOUR
RELATIONSHIP WITH YOUR DOUBLE – BINDING FATHER –
NAMELY, THE FEELING WE BOTH HAVE THAT
NO MATTER WHAT EITHER OF US MIGHT DO,
IT WOULDN’T GET THE OTHER’S APPROVAL!
BUT ALL OF THIS, PAINFUL AS IT IS, GIVES US AN OPPORTUNITY
TO EXPERIENCE, FIRSTHAND, HOW TOXIC
THE RELATIONSHIP WITH YOUR FATHER REALLY WAS –
EXCEPT THAT NOW WE CAN DO SOMETHING ABOUT IT!”
101
MODEL 3 IS ULTIMATELY A STORY ABOUT
THE THERAPIST’S “USE” OF HER “AUTHENTIC SELF”
– HER “COUNTERTRANSFERENCE” –
TO PROVIDE “CONTAINMENT”
AND THEREBY TO FACILITATE “MODIFICATION” OF
THE PATIENT’S “SENSE OF SELF” AS “BAD”
MORE SPECIFICALLY
MODIFYING THE PATIENT’S
“SENSE OF SELF” AS “BAD”
WILL REQUIRE “TOUGHING IT OUT”
AT THE “INTIMATE EDGE”
OF “AUTHENTIC RELATEDNESS”
BOTH PARTICIPANTS
BRINGING HEART AND SOUL TO
THE “INTERSUBJECTIVE IN – BETWEEN”
SUCH THAT THIS TIME
THERE CAN INDEED BE A “DIFFERENT OUTCOME”
102
AT THE END OF THE DAY
THE RELATIONAL PERSPECTIVE
OF MODEL 3 IS A STORY
ABOUT TRANSFORMING
THE PATIENT’S “DEFENSIVE NEED”
TO RE – ENACT
– COMPULSIVELY AND UNWITTINGLY –
HER UNMASTERED EARLY – ON
RELATIONAL DRAMAS
ON THE STAGE OF HER LIFE
INTO THE “ADAPTIVE CAPACITY”
TO TAKE RESPONSIBILITY FOR
HER DYSFUNCTIONAL WAYS OF
ACTING, REACTING, AND INTERACTING
103
104
IN CLOSING
I WOULD LIKE TO BORROW FROM STEPHEN MITCHELL (1988)
A WONDERFUL ANECDOTE THAT CAPTURES THE ESSENCE
OF THE QUINTESSENTIAL STRUGGLE IN WHICH ALL OF US
ARE ENGAGED AS WE ATTEMPT TO MASTER OUR ART
MITCHELL WRITES –
“<STRAVINSKY> HAD WRITTEN A NEW PIECE WITH A DIFFICULT
VIOLIN PASSAGE. AFTER IT HAD BEEN IN REHEARSAL FOR
SEVERAL WEEKS, THE SOLO VIOLINIST CAME TO STRAVINSKY
AND SAID HE WAS SORRY, HE HAD TRIED HIS BEST, <BUT> THE
PASSAGE WAS TOO DIFFICULT; NO VIOLINIST COULD PLAY IT.
STRAVINSKY SAID, ‘I UNDERSTAND THAT. WHAT I AM AFTER
IS THE SOUND OF SOMEONE TRYING TO PLAY IT.’”
AS THERAPISTS, OUR WORK IS EXQUISITELY DIFFICULT
AND FINELY TUNED – AND OFTEN WE WILL NOT BE ABLE
TO GET IT JUST RIGHT – PERHAPS, HOWEVER, WE CAN
CONSOLE OURSELVES WITH THE THOUGHT THAT
IT IS THE EFFORT WE MAKE TO GET IT JUST RIGHT
THAT WILL ULTIMATELY COUNT
105
106
IF YOU WOULD LIKE
TO BE ON MY
MAILING LIST,
PLEASE EMAIL ME AT
MarthaStarkMD @
SynergyMed.solutions
TO LET ME KNOW
107
REFERENCES
Akhtar, S. 2012. Psychoanalytic listening: Methods, limitations, and
innovations. New York, NY: Routledge / Taylor & Francis Group.
Bacal, H. 1998. Optimal responsiveness: How therapists heal their
patients. Northvale, NJ: Jason Aronson.
Bak, P. 1996. How nature works: The science of self-organized
criticality. New York: Springer Publishing.
Beckmann, R. 1991. Children who grieve: A manual for conducting
support groups. Learning Publications.
Benjamin, J. 2017. Beyond doer and done to: Recognition theory,
intersubjectivity, and the third. London and New York: Routledge
(Taylor & Francis Group).
Bollas, C. 1989. The shadow of the object: Psychoanalysis of the
unthought known. New York: Columbia University Press.
Brach, T. 2004. Radical acceptance: Embracing your life with the heart
of a Buddha. New York: Random House.
108
Bromberg, P. M. Standing in the spaces: Essays on clinical process,
trauma, and dissociation. Hillsdale, NJ: The Analytic Press.
Calabrese, E. J. Hormesis: A conversation with a critic. Environmental
Health Perspectives 2009 Sep;117(9):1339-1343.
Cannon, W. B. 1932. The wisdom of the body. New York: W. W. Norton
& Co.
Casement, P. 1992. Learning from the patient. New York: Guilford
Press.
Coughlin, P. 2022. Facilitating the process of working through in
psychotherapy: Mastering the middle game. London and New York:
Routledge (Taylor & Francis Group).
Ehrenberg, D. 1992. The intimate edge: Extending the reach of
psychoanalytic interaction. New York: W. W. Norton & Co.
Ferenczi, S. 1995. The clinical diary of Sandor Ferenczi. Cambridge,
MA: Harvard University Press.
Fisher, J. 2017. Healing the fragmented selves of trauma survivors:
Overcoming internal self-alienation. London and New York: Routledge
(Taylor & Francis Group).
109
Freud, A. 1979. The ego and the mechanisms of defense: The writings
of Anna Freud. Madison, CT: International Universities Press.
Freud, S. 1914. Remembering, repeating and working through (Further
recommendations on the technique of psycho-analysis II). Standard
Edition of the Complete Psychological Works of Sigmund Freud,
Volume XII (1911-1913). London, UK: Hogarth Press.
Giovacchini, P. 1986. Developmental disorders: The transitional space
in mental breakdown and creative integration. Northvale, NJ: Jason
Aronson.
Goleman, D. 2007. Social intelligence: The new science of human. New
York: Bantam Books.
Hemingway, E. 1929. A farewell to arms. New York: Charles Scribner’s
Sons.
Hoffman, I. 2001. Ritual and spontaneity in the psychoanalytic process.
Abingdon-on-Thames, UK: Routledge / Taylor & Francis.
110
Keats, J. 1991. Lyric Poems. Mineola, NY: Dover Publications.
Kohut, H. 1966. Forms and transformations of narcissism. Journal of
the American Psychoanalytic Association 14(2):243-272.
Krebs, C. 2013. Energetic kinesiology: Principles and practice. London,
UK: Handspring Publishing.
Kris, A. Resistance in convergent and in divergent conflicts.
Psychoanalytic Quarterly 1985 (Oct);54(4):537-68.
Leibenluft, E., Wehr, T. 1992. Is sleep deprivation useful in the
treatment of depression? The American Journal of Psychiatry 149(2),
159-168.
Mattson, M. P. Lifelong brain health is a lifelong challenge: From
evolutionary principles to empirical evidence. Ageing Research
Reviews 2015;20:37-45.
Mitchell, S. 1988. Relational concepts in psychoanalysis: An
integration. Cambridge, MA: Harvard University Press.
Nelson, P. 1993. There’s a hole in my sidewalk: The romance of self
discovery. Hillsboro, OR: Beyond Words Publishing.
111
Paracelsus, T. 2004. The archidoxes of magic. Turner R (trans).
Temecula, CA: Ibis Publishing.
Real, T. 2022. Us: Getting past you and me to build a more loving
relationship. Santa Monica, CA: Goop Press.
Russell, P. 1980. The theory of the crunch (unpublished manuscript).
Searles, H. 1979. The development of mature hope in the patient-
therapist relationship. In Countertransference and Related Subjects:
Selected Papers, pp. 479-502. New York: International Universities
Press.
Selye, H. 1978. The stress of life. New York: McGraw-Hill Book Co.
Singer, T. & Tusche, A. 2013. Neuroeconomics: Chapter 27.
Understanding others: Brain mechanisms of theory of mind and
empathy. Cambridge, MA: Academic Press.
Stark, M. 1994a. Working with resistance. Northvale, NJ: Jason
Aronson.
112
----- 1994b. A primer on working with resistance. Northvale, NJ: Jason
Aronson.
----- 1999. Modes of therapeutic action: Enhancement of knowledge,
provision of experience, and engagement in relationship. Northvale,
NJ: Jason Aronson.
----- 2015. The transformative power of optimal stress: From cursing
the darkness to lighting a candle (International Psychotherapy
Institute eBook). www . FreePsychotherapyBooks . org
Tull, D. 2018. Relational mindfulness: A handbook for deepening our
connection with ourselves, each other, and the planet. Somerville, MA:
Wisdom Publications.
Winnicott, D. W. 1949. Hate in the counter-transference. International
Journal of Psychoanalysis 30:69-74.
Zevon, W. 1996. I’ll sleep when I’m dead. Burbank, CA: Elektra
Records.
113

More Related Content

What's hot

Role of management in nursing profession
Role of management in nursing professionRole of management in nursing profession
Role of management in nursing profession
chettinad college of nursing
 
Structural family therapy
Structural family therapyStructural family therapy
Structural family therapy
chellyphant
 
Counselling Skills for Managers
Counselling Skills for ManagersCounselling Skills for Managers
Counselling Skills for Managers
koshyligo
 
LPC Models and Techniques in Clinical Supervision
LPC Models and Techniques in Clinical SupervisionLPC Models and Techniques in Clinical Supervision
LPC Models and Techniques in Clinical Supervision
Glenn Duncan
 
Centralisation and Decentralisation
Centralisation and DecentralisationCentralisation and Decentralisation
Centralisation and Decentralisation
Aijaz Aryan
 
McGregor Theory x & y
McGregor Theory x & yMcGregor Theory x & y
McGregor Theory x & y
Devraj Chamlagai
 
Leadership theories
Leadership theoriesLeadership theories
Leadership theories
Dennis Cana
 
Lecture 4 strategic family therapy
Lecture 4 strategic family therapyLecture 4 strategic family therapy
Lecture 4 strategic family therapy
Newham College University Centre Stratford Newham
 
Lecture 6 systemic therapy with individuals
Lecture 6 systemic therapy with individualsLecture 6 systemic therapy with individuals
Lecture 6 systemic therapy with individuals
Newham College University Centre Stratford Newham
 
authority relationships: delegation and decentralization
authority relationships: delegation and decentralizationauthority relationships: delegation and decentralization
authority relationships: delegation and decentralization
ivani katal
 
Motivation
MotivationMotivation
Motivation
Shahi Raz Akhtar
 
Delegation of authority and decentralization
Delegation of authority and decentralizationDelegation of authority and decentralization
Delegation of authority and decentralization
AMALDASKH
 
Organizational behaviour (Stress Management)
Organizational behaviour (Stress Management)Organizational behaviour (Stress Management)
Organizational behaviour (Stress Management)
Lila Bear
 
Concepts, principles and functions of management
Concepts, principles and functions of managementConcepts, principles and functions of management
Concepts, principles and functions of management
Chitwan Medical College, School of Nursing
 
Organisation climate and Change
Organisation climate and ChangeOrganisation climate and Change
Organisation climate and Change
ANOOPA NARAYANAN
 
Fiedler's contingency model
Fiedler's contingency modelFiedler's contingency model
Fiedler's contingency model
irenepaul
 
Delegation.ppt
Delegation.pptDelegation.ppt
Delegation.ppt
EVEN15
 
Behavioral theories
Behavioral theories Behavioral theories
Behavioral theories
Jawaria Hussain
 
Kyko - an integrated model of personality profile
Kyko -  an integrated model of personality profile Kyko -  an integrated model of personality profile
Kyko - an integrated model of personality profile
Bernard Ah Thau Tan
 
Henri Fayol's Function Approach and General Administrative Theory
Henri Fayol's Function Approach and General Administrative TheoryHenri Fayol's Function Approach and General Administrative Theory
Henri Fayol's Function Approach and General Administrative Theory
Khalid Raza Khan
 

What's hot (20)

Role of management in nursing profession
Role of management in nursing professionRole of management in nursing profession
Role of management in nursing profession
 
Structural family therapy
Structural family therapyStructural family therapy
Structural family therapy
 
Counselling Skills for Managers
Counselling Skills for ManagersCounselling Skills for Managers
Counselling Skills for Managers
 
LPC Models and Techniques in Clinical Supervision
LPC Models and Techniques in Clinical SupervisionLPC Models and Techniques in Clinical Supervision
LPC Models and Techniques in Clinical Supervision
 
Centralisation and Decentralisation
Centralisation and DecentralisationCentralisation and Decentralisation
Centralisation and Decentralisation
 
McGregor Theory x & y
McGregor Theory x & yMcGregor Theory x & y
McGregor Theory x & y
 
Leadership theories
Leadership theoriesLeadership theories
Leadership theories
 
Lecture 4 strategic family therapy
Lecture 4 strategic family therapyLecture 4 strategic family therapy
Lecture 4 strategic family therapy
 
Lecture 6 systemic therapy with individuals
Lecture 6 systemic therapy with individualsLecture 6 systemic therapy with individuals
Lecture 6 systemic therapy with individuals
 
authority relationships: delegation and decentralization
authority relationships: delegation and decentralizationauthority relationships: delegation and decentralization
authority relationships: delegation and decentralization
 
Motivation
MotivationMotivation
Motivation
 
Delegation of authority and decentralization
Delegation of authority and decentralizationDelegation of authority and decentralization
Delegation of authority and decentralization
 
Organizational behaviour (Stress Management)
Organizational behaviour (Stress Management)Organizational behaviour (Stress Management)
Organizational behaviour (Stress Management)
 
Concepts, principles and functions of management
Concepts, principles and functions of managementConcepts, principles and functions of management
Concepts, principles and functions of management
 
Organisation climate and Change
Organisation climate and ChangeOrganisation climate and Change
Organisation climate and Change
 
Fiedler's contingency model
Fiedler's contingency modelFiedler's contingency model
Fiedler's contingency model
 
Delegation.ppt
Delegation.pptDelegation.ppt
Delegation.ppt
 
Behavioral theories
Behavioral theories Behavioral theories
Behavioral theories
 
Kyko - an integrated model of personality profile
Kyko -  an integrated model of personality profile Kyko -  an integrated model of personality profile
Kyko - an integrated model of personality profile
 
Henri Fayol's Function Approach and General Administrative Theory
Henri Fayol's Function Approach and General Administrative TheoryHenri Fayol's Function Approach and General Administrative Theory
Henri Fayol's Function Approach and General Administrative Theory
 

Similar to Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptx

Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
Martha Stark MD
 
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptxMartha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD
 
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...
Martha Stark MD
 
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
Martha Stark MD
 
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
Martha Stark MD
 
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptxMartha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
Martha Stark MD
 
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...
Martha Stark MD
 
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
Martha Stark MD
 
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptx
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptx
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptx
Martha Stark MD
 
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...
Martha Stark MD
 
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
Martha Stark MD
 
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
Martha Stark MD
 
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptx
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptx
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptx
Martha Stark MD
 
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...
Martha Stark MD
 
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...
Martha Stark MD
 
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...
Martha Stark MD
 
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
Martha Stark MD
 
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
Martha Stark MD
 
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
Martha Stark MD
 
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...
Martha Stark MD
 

Similar to Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptx (20)

Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
 
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptxMartha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
 
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...
 
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
 
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
 
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptxMartha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
 
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...
 
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
 
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptx
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptx
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptx
 
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...
 
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
 
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
 
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptx
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptx
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptx
 
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...
 
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...
 
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...
 
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
 
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
 
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
 
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...
 

More from Martha Stark MD

Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
Martha Stark MD
 
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...
Martha Stark MD
 
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Martha Stark MD
 
Martha Stark MD – 2017 Relentless Hope.pdf
Martha Stark MD – 2017 Relentless Hope.pdfMartha Stark MD – 2017 Relentless Hope.pdf
Martha Stark MD – 2017 Relentless Hope.pdf
Martha Stark MD
 
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdf
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdfMartha Stark MD – 2016 How Does Psychotherapy Work?.pdf
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdf
Martha Stark MD
 
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdf
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdfMartha Stark MD – 2015 The Transformative Power of Optimal Stress.pdf
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdf
Martha Stark MD
 
Martha Stark MD – 1994 A Primer on Working with Resistance.pdf
Martha Stark MD – 1994 A Primer on Working with Resistance.pdfMartha Stark MD – 1994 A Primer on Working with Resistance.pdf
Martha Stark MD – 1994 A Primer on Working with Resistance.pdf
Martha Stark MD
 
Martha Stark MD – 1994 Working with Resistance.pdf
Martha Stark MD – 1994 Working with Resistance.pdfMartha Stark MD – 1994 Working with Resistance.pdf
Martha Stark MD – 1994 Working with Resistance.pdf
Martha Stark MD
 
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
Martha Stark MD
 
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD
 
Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
Martha Stark MD
 
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...
Martha Stark MD
 
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD
 
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD
 
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD
 
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptxMartha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
Martha Stark MD
 
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptxMartha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
Martha Stark MD
 
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...
Martha Stark MD
 
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptx
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptxMartha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptx
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptx
Martha Stark MD
 
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptx
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptxMartha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptx
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptx
Martha Stark MD
 

More from Martha Stark MD (20)

Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
 
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...
 
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
 
Martha Stark MD – 2017 Relentless Hope.pdf
Martha Stark MD – 2017 Relentless Hope.pdfMartha Stark MD – 2017 Relentless Hope.pdf
Martha Stark MD – 2017 Relentless Hope.pdf
 
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdf
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdfMartha Stark MD – 2016 How Does Psychotherapy Work?.pdf
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdf
 
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdf
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdfMartha Stark MD – 2015 The Transformative Power of Optimal Stress.pdf
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdf
 
Martha Stark MD – 1994 A Primer on Working with Resistance.pdf
Martha Stark MD – 1994 A Primer on Working with Resistance.pdfMartha Stark MD – 1994 A Primer on Working with Resistance.pdf
Martha Stark MD – 1994 A Primer on Working with Resistance.pdf
 
Martha Stark MD – 1994 Working with Resistance.pdf
Martha Stark MD – 1994 Working with Resistance.pdfMartha Stark MD – 1994 Working with Resistance.pdf
Martha Stark MD – 1994 Working with Resistance.pdf
 
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
 
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
 
Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
 
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...
 
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
 
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
 
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
 
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptxMartha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
 
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptxMartha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
 
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...
 
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptx
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptxMartha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptx
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptx
 
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptx
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptxMartha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptx
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptx
 

Recently uploaded

Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...
Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...
Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...
NephroTube - Dr.Gawad
 
Surat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home Delivery
Surat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home DeliverySurat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home Delivery
Surat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home Delivery
khandiya#G05
 
Building a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical TeamBuilding a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical Team
bkling
 
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
sonamrawat5631
 
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdfYoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Stuart McGill
 
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptxOBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
Niranjan Chavan
 
MEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate careMEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate care
Debre Berhan University
 
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
hf66550
 
Prakinsons disease and its affect on eye.
Prakinsons disease and its affect on eye.Prakinsons disease and its affect on eye.
Prakinsons disease and its affect on eye.
Riya Bist
 
Interpretation of ECG - Cardiac Arrhythmias
Interpretation of ECG - Cardiac ArrhythmiasInterpretation of ECG - Cardiac Arrhythmias
Interpretation of ECG - Cardiac Arrhythmias
MedicoseAcademics
 
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdfHeart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
MedicoseAcademics
 
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsxDr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi
 
Definition of Radiotherapy Treatment Planning.pptx
Definition of Radiotherapy Treatment Planning.pptxDefinition of Radiotherapy Treatment Planning.pptx
Definition of Radiotherapy Treatment Planning.pptx
Dr. Dheeraj Kumar
 
Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960
PratibhaSonawane5
 
GAIRIKA.pptx for Rasashastra and Bhaisajya kalpana
GAIRIKA.pptx for Rasashastra and Bhaisajya kalpanaGAIRIKA.pptx for Rasashastra and Bhaisajya kalpana
GAIRIKA.pptx for Rasashastra and Bhaisajya kalpana
AparnaNandakumar12
 
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...
Niranjan Chavan
 
Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...
Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...
Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...
FFragrant
 
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
Ks doctor
 
Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...
Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...
Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...
ishaguptaji14
 
Hypothyroidism / Underactive thyroid gland presentation
Hypothyroidism / Underactive thyroid gland presentationHypothyroidism / Underactive thyroid gland presentation
Hypothyroidism / Underactive thyroid gland presentation
riyaramesh2003
 

Recently uploaded (20)

Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...
Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...
Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...
 
Surat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home Delivery
Surat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home DeliverySurat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home Delivery
Surat @Girls @ℂall 👄 XX000000XX 👄 With Cash Payment Home Delivery
 
Building a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical TeamBuilding a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical Team
 
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
 
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdfYoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
 
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptxOBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
 
MEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate careMEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate care
 
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
 
Prakinsons disease and its affect on eye.
Prakinsons disease and its affect on eye.Prakinsons disease and its affect on eye.
Prakinsons disease and its affect on eye.
 
Interpretation of ECG - Cardiac Arrhythmias
Interpretation of ECG - Cardiac ArrhythmiasInterpretation of ECG - Cardiac Arrhythmias
Interpretation of ECG - Cardiac Arrhythmias
 
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdfHeart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
 
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsxDr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
 
Definition of Radiotherapy Treatment Planning.pptx
Definition of Radiotherapy Treatment Planning.pptxDefinition of Radiotherapy Treatment Planning.pptx
Definition of Radiotherapy Treatment Planning.pptx
 
Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960
 
GAIRIKA.pptx for Rasashastra and Bhaisajya kalpana
GAIRIKA.pptx for Rasashastra and Bhaisajya kalpanaGAIRIKA.pptx for Rasashastra and Bhaisajya kalpana
GAIRIKA.pptx for Rasashastra and Bhaisajya kalpana
 
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...
 
Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...
Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...
Safeguarding Reproductive Health- Preventing Fallopian Tube Blockage After a ...
 
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
 
Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...
Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...
Delhi @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girls Se...
 
Hypothyroidism / Underactive thyroid gland presentation
Hypothyroidism / Underactive thyroid gland presentationHypothyroidism / Underactive thyroid gland presentation
Hypothyroidism / Underactive thyroid gland presentation
 

Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptx

  • 1. PRACTICAL CLINICAL INTERVENTIONS FOR INCENTIVIZING CHANGE MARTHA STARK, MD Faculty, Harvard Medical School MarthaStarkMD @ SynergyMed.solutions Wednesday / February 22, 2023 Psychotherapy Institute of Back Bay With great admiration for the giftedness of David Raniere, PhD © 2023 Martha Stark MD 1
  • 2. OVERVIEW MY PSYCHODYNAMIC SYNERGY PARADIGM A SYNERGISTIC APPROACH TO DEEP HEALING “CLASSICAL PSYCHOANALYTIC” / “SELF PSYCHOLOGICAL” “CONTEMPORARY RELATIONAL” / “EXISTENTIAL – HUMANISTIC” “QUANTUM – NEUROSCIENTIFIC” JUDICIOUS AND ONGOING USE OF “OPTIMALLY STRESSFUL” INTERVENTIONS STRATEGICALLY DESIGNED TO “CATALYZE” TRANSFORMATION OF PSYCHOLOGICAL RIGIDITY INTO PSYCHOLOGICAL FLEXIBILITY – RIGID DEFENSE INTO MORE FLEXIBLE ADAPTATION – DEFENSIVE REACTIONS – WHAT HAPPENS “REFLEXIVELY” WHEN WE ARE CONFRONTED WITH STRESSORS THAT “OVERWHELM” US WITH ANXIETY ADAPTIVE RESPONSES – WHAT HAPPENS “MORE REFLECTIVELY” WHEN WE ARE CONFRONTED WITH STRESSORS THAT WE ARE ABLE TO “TAKE IN OUR STRIDE” PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT BOTH “IMPETUS” AND “OPPORTUNITY” TO MASTER TRAUMATIC EXPERIENCES THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST BUT THAT CAN NOW BE REVISITED, REPROCESSED, AND REFRAMED SUCH THAT GROWTH – IMPEDING DEFENSES – ONCE NECESSARY FOR SURVIVAL – CAN BE GRADUALLY TRANSFORMED INTO GROWTH – PROMOTING ADAPTATIONS “OPTIMALLY STRESSFUL” CONFLICT, DISILLUSIONMENT, AND ACCOUNTABILITY STATEMENTS 2
  • 3. PLEASE NOTE THE CRITICAL ROLE PLAYED BY GROWTH – INCENTIVIZING “OPTIMAL STRESS” IN JUMP – STARTING RECOVERY THE GOLDILOCKS PRINCIPLE TOO MUCH CHALLENGE WILL OVERWHELM AND PLUMMET THE SYSTEM INTO FURTHER DECLINE BECAUSE IT WILL BE “TOO MUCH” TO BE PROCESSED, INTEGRATED, AND ADAPTED TO TRAUMATIC STRESS TOO LITTLE CHALLENGE WILL OFFER “TOO LITTLE” IMPETUS AND OPPORTUNITY FOR TRANSFORMATION AND GROWTH, SERVING INSTEAD SIMPLY TO REINFORCE THE – DYSFUNCTIONAL – STATUS QUO BUT JUST THE RIGHT AMOUNT OF CHALLENGE WILL PROVIDE “JUST THE RIGHT AMOUNT” OF “THERAPEUTIC LEVERAGE” NEEDED TO PROVOKE – AFTER INITIAL DISRUPTION – EVENTUAL RE – EQUILIBRATION AT A HIGHER, MORE – EVOLVED LEVEL OF INTEGRATION, FUNCTIONALITY, AND ADAPTIVE CAPACITY OPTIMAL – NONTRAUMATIC – STRESS 3
  • 4. 4
  • 5. 5
  • 6. 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” TRANSFORMATION OF PSYCHOLOGICAL RIGIDITY INTO PSYCHOLOGICAL FLEXIBILITY FIVE DIFFERENT “OPTIMALLY STRESSFUL” INTERVENTIONS STRATEGICALLY DESIGNED TO “CATALYZE” THE INCREMENTAL MORPHING OF RIGID DEFENSE INTO MORE FLEXIBLE ADAPTATION 6
  • 7. 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 7
  • 8. 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” 8
  • 9. EITHER WE – MADE ANXIOUS – “REACT” TO STRESSORS BY “DEFENDING” “DEFENSIVE REACTION” OR WE – MORE RESILIENT – “RESPOND” TO STRESSORS BY “ADAPTING” “ADAPTIVE RESPONSE” 9
  • 10. 10 LIFE IS NOT ABOUT “DEFENSIVELY” WAITING FOR THE STORM TO PASS BUT ABOUT “ADAPTIVELY” LEARNING TO DANCE IN THE RAIN
  • 11. 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 11
  • 12. 12
  • 13. 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 UPDATED TO ADAPTATIONS, THE PATIENT BECOMES BETTER ABLE TO “THRIVE” THE THERAPEUTIC ACTION IS INDEED DESIGNED TO TRANSFORM “SURVIVING” INTO “THRIVING” 13
  • 14. 14
  • 15. 15
  • 16. MY PSYCHODYNAMIC SYNERGY PARADIGM ALL FIVE MODELS CAPITALIZE UPON THE THERAPEUTIC PROVISION OF OPTIMAL STRESS TO ADVANCE THE PATIENT FROM LONGSTANDING, DEEPLY ENTRENCHED, MALADAPTIVE RIGIDITY – OUTDATED DEFENSE / “SAME OLD, SAME OLD” – TO NEWFOUND, MORE EVOLVED, MORE ADAPTIVE FLEXIBILITY – UPDATED ADAPTATION / “SOMETHING NEW, DIFFERENT, AND BETTER” – THE ULTIMATE GOAL BEING DEEP AND ENDURING PSYCHODYNAMIC CHANGE AS ONE OF MY MENTORS ALWAYS DELIGHTED IN TELLING US, IF THE PATIENT ASKS YOU WHERE THE BATHROOM IS, YOU CAN TELL HER – BUT DON’T CALL IT THERAPY! 16
  • 17. 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 17
  • 18. 18
  • 19. 19
  • 20. 20
  • 21. MY PSYCHODYNAMIC SYNERGY PARADIGM 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 NEURAL ENTRENCHMENT AND “STUCKNESS” 21
  • 22. MY PSYCHODYNAMIC SYNERGY PARADIGM – A C.A.R.E. APPROACH TO DEEP HEALING – Cognitive Affective Relational Existential MODEL 1 – COGNITIVE “STRUCTURAL CONFLICT” MODEL 2 – AFFECTIVE “STRUCTURAL DEFICIT” MODEL 3 – RELATIONAL “RELATIONAL CONFLICT” MODEL 4 – EXISTENTIAL “RELATIONAL DEFICIT” MODEL 5 – CONSTRUCTIVIST “ANALYSIS PARALYSIS” 22
  • 23. OPTIMALLY STRESSFUL INTERVENTIONS MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN” CONFLICT STATEMENTS MODEL 2 – PROVISION OF EXPERIENCE “FOR” DISILLUSIONMENT STATEMENTS MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH” ACCOUNTABILITY STATEMENTS MODEL 4 – NURTURING OF SURRENDER “TO” FACILITATION STATEMENTS MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND” QUANTUM DISENTANGLEMENT STATEMENTS 23
  • 24. ADVANCEMENT FROM DEFENSE TO ADAPTATION MODEL 1 – INTERPRETING FROM “RESISTANCE” TO “AWARENESS” MODEL 2 – GRIEVING FROM “RELENTLESS HOPE” TO “ACCEPTANCE” MODEL 3 – NEGOTIATING FROM “RE – ENACTMENT” TO “ACCOUNTABILITY” MODEL 4 – SURRENDERING FROM “RELATIONAL ABSENCE” TO “AUTHENTIC PRESENCE” MODEL 5 – DISENTANGLING / ENVISIONING FROM “REFRACTORY INERTIA” TO “ACTION” AND “ACTUALIZATION OF POTENTIAL” 24
  • 25. 8
  • 26. 26
  • 27. BUT OUR FOCUS TODAY 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 – 27
  • 28. 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 28
  • 29. 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” 29
  • 31. 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 – 31
  • 32. 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” 32
  • 33. 33
  • 34. MODEL 1 THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS “STRUCTURAL CONFLICT” BETWEEN “ANXIETY – PROVOKING” – BUT ULTIMATELY “GROWTH – PROMOTING” – FORCES PRESSING “YES” AND “ANXIETY – RELIEVING” – BUT “GROWTH – IMPEDING” – COUNTERFORCES DEFENDING “NO” 34
  • 35. MOST OF OUR PATIENTS ARE CONFLICTED ABOUT MOST THINGS MOST OF THE TIME WITH ONE PART OF THEM INVESTED IN MAINTAINING “SAME OLD, SAME OLD” AND ANOTHER PART OF THEM BEGINNING TO APPRECIATE – ALBEIT IT WITH EVER – INCREASING ANXIETY – BOTH THE “PRICE PAID” FOR THAT MISPLACED LOYALTY AND THE “ENLIVENING POSSIBILITY” OF “SOMETHING NEW, DIFFERENT, AND BETTER” MODEL 1 CONFLICT STATEMENTS ARE UNIVERSALLY APPLICABLE INTERVENTIONS THAT TARGET THESE STATES OF “INTERNAL DIVIDEDNESS” OR “CONFLICTEDNESS” ON THE ONE HAND HIGHLIGHTING THE PATIENT’S EVER – EVOLVING “AWARENESS” OF HER “INVESTMENT IN” “SAME OLD, SAME OLD” ON THE OTHER HAND HIGHLIGHTING THE PATIENT’S EVER – EVOLVING “AWARENESS” OF THE “PRICE PAID” FOR THAT INVESTMENT AND OF THE “POTENTIAL” FOR “SOMETHING NEW, DIFFERENT, AND BETTER” 35
  • 36. “OPTIMALLY STRESSFUL” CONFLICT STATEMENTS ARE STRATEGICALLY DESIGNED TO OFFER AN ARTFUL COMBINATION OF CHALLENGE – BY HIGHLIGHTING EITHER THE “PRICE PAID” FOR “OLD BAD” AND / OR THE “ENLIVENING POSSIBILITY” OF “NEW GOOD” – AND SUPPORT – BY RESONATING EMPATHICALLY WITH THE “INVESTMENT IN” “OLD BAD” – THE NET RESULT OF THIS INTUITIVELY TITRATED BLEND OF CHALLENGE – WHICH PROVOKES THE PATIENT’S ANXIETY – AND SUPPORT – WHICH EASES IT – WILL BE THE GENERATION OF GALVANIZING OPTIMAL STRESS NECESSARY IF DEEP AND ENDURING PSYCHODYNAMIC CHANGE IS THE ULTIMATE GOAL 36
  • 37. “LEVERAGING” THE PATIENT’S ANXIETY “OPTIMALLY STRESSFUL” STATEMENTS ARE STRATEGICALLY DESIGNED FIRST TO “DIRECT THE PATIENT’S ATTENTION TO WHERE WE WOULD WANT HER TO GO” – “DISRUPTIVE ATTUNEMENT” – – “CHALLENGE” THAT WILL INCREASE HER ANXIETY – AND THEN TO “BE WITH THE PATIENT WHERE SHE IS” – “HOMEOSTATIC ATTUNEMENT” – – “SUPPORT” THAT WILL DECREASE HER ANXIETY – THE NET RESULT OF WHICH WILL BE TO “CREATE INTERNAL TENSION AND DISSONANCE” AND, THEREBY, “INCENTIVIZING LEVERAGE” SALMAN AKHTAR (2012) 37
  • 38. 38 DO I CHALLENGE? OR SUPPORT? OR PERHAPS DO BOTH?
  • 39. INDEED WE ALL FIND OURSELVES SOMETIMES VERY CONFUSED ABOUT WHAT TO DO NEXT! 39
  • 40. “WORKING THROUGH THE RESISTANCE” OPTIMALLY STRESSFUL MODEL 1 CONFLICT STATEMENTS “YOU KNOW THAT … , BUT (MADE ANXIOUS) YOU FIND YOURSELF THINKING / FEELING / DOING IN ORDER NOT TO HAVE TO KNOW … ” 40
  • 41. TWO KINDS OF CONFLICT – “CONVERGENT” AND “DIVERGENT” – A. KRIS (1985) DIVERGENT CONFLICT – “EITHER / OR” SITUATIONS TWO “MUTUALLY EXCLUSIVE” FORCES SHALL I WEAR MY BLUE DRESS OR MY RED DRESS TONIGHT? CONVERGENT CONFLICT – “BOTH / AND” SITUATIONS ONE OF THE FORCES – AN ANXIETY – PROVOKING (ID) “FORCE” – PROMPTS MOBILIZATION OF A SECOND FORCE – AN ANXIETY – RELIEVING (EGO) “COUNTERFORCE” – YOU KNOW THAT SOMETIMES YOU FEEL ANGRY WITH YOUR WIFE – THE ANXIETY – PROVOKING “FORCE” – BUT YOU (MADE ANXIOUS) WOULD RATHER NOT THINK ABOUT THAT RIGHT NOW – THE DEFENSIVE “COUNTERFORCE” – YOU KNOW THAT YOUR MOTHER WILL PROBABLY NEVER APOLOGIZE – THE ANXIETY – PROVOKING “FORCE” – BUT YOU (MADE ANXIOUS) FIND YOURSELF CONTINUING TO HOPE THAT PERHAPS SOMEDAY SHE WILL – THE DEFENSIVE “COUNTERFORCE” – 41
  • 42. THE “STRUCTURAL CONFLICTS” – aka “NEUROTIC CONFLICTS” OR “INTRAPSYCHIC CONFLICTS” – OF CLASSICAL PSYCHOANALYTIC THEORY ARE “CONVERGENT CONFLICTS” MODEL 1 CONFLICT STATEMENTS ARE DESIGNED TO ADDRESS THESE “CONVERGENT (“BOTH / AND”) CONFLICTS” WITH AN EYE TO GENERATING INTERNAL TENSION BETWEEN ANXIETY– PROVOKING (BUT ULTIMATELY GROWTH – PROMOTING) FORCES AND ANXIETY – RELIEVING (BUT GROWTH – IMPEDING) RESISTANT COUNTERFORCES “YOU KNOW THAT YOUR MOTHER WILL PROBABLY NEVER APOLOGIZE BUT YOU FIND YOURSELF CONTINUING TO HOPE THAT PERHAPS SOMEDAY SHE WILL.” MODEL 1 CONFLICT STATEMENTS ARE NOT DESIGNED TO ADDRESS “DIVERGENT (“EITHER / OR”) CONFLICTS” YOU WOULD NOT ADVANCE THE CAUSE MUCH WERE YOU TO SAY TO YOUR PATIENT “YOU KNOW THAT YOU COULD WEAR YOUR BLUE DRESS TONIGHT BUT YOU FIND YOURSELF THINKING THAT PERHAPS YOU SHOULD WEAR YOUR RED DRESS INSTEAD.” 42
  • 43. “WORKING THROUGH THE RESISTANCE” 📕 📕 OPTIMALLY STRESSFUL CONFLICT STATEMENTS ARE STRATEGICALLY DESIGNED FIRST TO INCREASE ANXIETY BY “CHALLENGING” THE DEFENSE YOU HAVE THE “ADAPTIVE CAPACITY” TO “KNOW” ... , AND THEN TO DECREASE ANXIETY BY “SUPPORTING” THE DEFENSE BUT YOU HAVE THE “DEFENSIVE NEED” TO “RESIST” THAT “KNOWING” ... ALL WITH AN EYE FIRST TO “MAKING EXPLICIT” THE CONFLICT WITHIN THE PATIENT BETWEEN THE “HEALTHY PART” OF HER – THAT DOES INDEED “KNOW” – AND THE “LESS – HEALTHY PART” OF HER – THAT “RESISTS” THAT “KNOWING” – AND THEN TO “GENERATING GROWTH – INCENTIVIZING DISSONANCE” BETWEEN THOSE TWO “PARTS” OF HER “SELF – EXPERIENCE” 43
  • 44. OPTIMALLY STRESSFUL MODEL 1 CONFLICT STATEMENTS FIRST “CHALLENGE” BY “DIRECTING THE PATIENT’S ATTENTION TO WHERE YOU WANT HER TO GO” AND THEN “SUPPORT” BY “RESONATING EMPATHICALLY WITH WHERE SHE IS” “YOU KNOW THAT IF YOU ARE EVER TO GET ON WITH YOUR LIFE, YOU’LL HAVE TO LET GO OF YOUR CONVICTION THAT YOUR CHILDHOOD SCARRED YOU FOREVER. BUT IT’S HARD NOT TO FEEL LIKE DAMAGED GOODS WHEN YOU GREW UP IN A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN AND NASTY MOTHER WHO KEPT TELLING YOU THAT YOU WERE A LOSER.” “YOU’RE COMING TO UNDERSTAND THAT YOUR ANGER CAN PUT PEOPLE OFF. BUT YOU TELL YOURSELF THAT YOU HAVE A RIGHT TO BE AS ANGRY AS YOU WANT BECAUSE OF HOW MUCH YOU HAVE HAD TO SUFFER OVER THE COURSE OF THE YEARS.” “YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA IS TO SURVIVE, YOU’LL NEED TO TAKE AT LEAST SOME RESPONSIBILITY FOR THE PART YOU’RE PLAYING IN THE INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE HAVE BEEN HAVING. BUT YOU TELL YOURSELF THAT IT ISN’T REALLY YOUR FAULT BECAUSE IF SHE WEREN’T SO PROVOCATIVE, THEN YOU WOULDN’T HAVE TO BE SO VINDICTIVE!” 44
  • 45. PLEASE NOTE AS TEMPTING AS IT MIGHT BE FOR THE THERAPIST TO HIGHLIGHT – IN THE FIRST PORTION OF HER CONFLICT STATEMENT – SOMETHING THAT SHE WOULD WISH THE PATIENT ALREADY KNEW, IF THE PATIENT REALLY DOES NOT YET KNOW IT, THEN IT IS BETTER THAT THE THERAPIST RESIST HER TEMPTATION TO “LEAD THE WITNESS” IN THAT WAY “YOU KNOW THAT YOUR UNRESOLVED FEELINGS ABOUT YOUR DAD ARE MAKING IT DIFFICULT FOR YOU TO FIND AN APPROPRIATE LIFE PARTNER ... ” SAYING THIS TO SOMEONE WHO DOES NOT ACTUALLY KNOW THIS RUNS THE RISK OF MAKING THE PATIENT EVEN MORE DEFENSIVE FURTHERMORE, THAT’S “CHEATING”! – SO IT’S NOT FAIR ... 45
  • 46. BY LOCATING WITHIN THE PATIENT THE CONFLICT BETWEEN WHAT SHE (ADAPTIVELY) “KNOWS” AND WHAT SHE, MADE ANXIOUS, (DEFENSIVELY) “FINDS HERSELF” “THINKING, FEELING, OR DOING” IN ORDER NOT TO HAVE TO CONFRONT THAT “ANXIETY – PROVOKING REALITY,” THE THERAPIST IS DEFTLY SIDESTEPPING THE POTENTIAL FOR CONFLICT BETWEEN HERSELF AND THE PATIENT MORE SPECIFICALLY WHEN THE THERAPIST INTRODUCES A CONFLICT STATEMENT WITH “YOU KNOW THAT … , ” SHE IS FORCING THE PATIENT TO TAKE RESPONSIBILITY FOR WHAT THE PATIENT – ALBEIT BEGRUDGINGLY – REALLY DOES KNOW 46
  • 47. IF, INSTEAD, THE THERAPIST – IN A MISGUIDED ATTEMPT TO URGE THE PATIENT FORWARD – RESORTS SIMPLY TO TELLING THE PATIENT WHAT THE THERAPIST KNOWS, NOT ONLY WILL THE THERAPIST BE RUNNING THE RISK OF FORCING THE PATIENT TO BECOME EVER – MORE ENTRENCHED IN HER DEFENSIVE STANCE OF PROTEST BUT THE THERAPIST WILL ALSO BE DEPRIVING THE PATIENT OF ANY INCENTIVE TO TAKE RESPONSIBILITY FOR HER OWN DESIRE TO GET BETTER 47
  • 48. IN OTHER WORDS AS A RESULT OF THE JUDICIOUS AND ONGOING USE OF CONFLICT STATEMENTS THAT FORCE THE PATIENT TO BECOME AWARE OF – AND TO TAKE RESPONSIBILITY FOR – HER STATE OF “INTERNAL DIVIDEDNESS” ABOUT, FOR EXAMPLE, GETTING BETTER – IN OTHER WORDS, HER “AMBIVALENCE” – THE THERAPIST WILL BE ABLE MASTERFULLY TO AVOID GETTING DEADLOCKED IN A POWER STRUGGLE WITH THE PATIENT A POWER STRUGGLE THAT CAN EASILY ENOUGH ENSUE IF THE THERAPIST TAKES IT UPON HERSELF TO REPRESENT THE (ADAPTIVE) “VOICE OF REALITY” BY OVERZEALOUSLY ADVOCATING FOR THE PATIENT TO DO THE “RIGHT / HEALTHY” THING – A STANCE THAT THEN LEAVES THE PATIENT, MADE ANXIOUS, NO CHOICE BUT TO BECOME THE (DEFENSIVE) “VOICE OF OPPOSITION” – 48
  • 49. PLEASE ALSO NOTE THE IMPLICIT MESSAGE DELIVERED BY THE THERAPIST IN THE SECOND PART OF A CONFLICT STATEMENT WHEN SHE USES SUCH “TEMPORAL EXPRESSIONS” AS “FOR NOW” / “RIGHT NOW” / “AT THE MOMENT” “IN THE MOMENT” / “AT THIS POINT IN TIME” WHICH SHE WILL DO WHEN SHE IS ADDRESSING THE PATIENT’S “INVESTMENT” IN THE “DYSFUNCTIONAL DEFENSE” THE THERAPIST IS ATTEMPTING TO HIGHLIGHT THE FACT THAT EVEN IF, FOR NOW, THE PATIENT WOULD SEEM TO BE ENTRENCHED IN PROTESTING HER NEED TO MAINTAIN THINGS AS THEY ARE, AT ANOTHER POINT IN TIME, THAT COULD CHANGE 49
  • 50. OPTIMALLY STRESSFUL MODEL 1 CONFLICT STATEMENTS FIRST “CHALLENGE” THE DEFENSE TO “PROVOKE” ANXIETY AND THEN “SUPPORT” THE DEFENSE TO “EASE” IT “YOU KNOW THAT ULTIMATELY YOU WILL NEED TO CONFRONT AND GRIEVE THE REALITY THAT TOM, LIKE YOUR DAD, IS NOT AVAILABLE IN THE WAYS THAT YOU WOULD HAVE WANTED HIM TO BE AND THAT UNTIL YOU MAKE YOUR PEACE WITH THAT PAINFUL REALITY YOU WILL CONTINUE TO BE MISERABLE. BUT, IN THE MOMENT, ALL YOU CAN THINK ABOUT IS WHAT YOU CAN DO TO MAKE HIM LOVE YOU MORE.” “YOU KNOW THAT SOMEDAY YOU WILL HAVE TO LET SOMEBODY IN IF YOU’RE EVER TO HAVE A MEANINGFUL RELATIONSHIP. BUT, AT THE MOMENT, THE THOUGHT OF MAKING YOURSELF THAT VULNERABLE IS SIMPLY OUT OF THE QUESTION. THERE IS ABSOLUTELY NO WAY YOU ARE WILLING TO RUN THE RISK OF BEING HURT EVER AGAIN.” 50
  • 51. MORE SPECIFICALLY IN ORDER TO SPOTLIGHT THE “AMBIVALENCE” OF THE PATIENT’S “ATTACHMENT” TO HER “DEFENSE” AND TO GENERATE TENSION WITHIN THE PATIENT BETWEEN HER “EVER – EVOLVING AWARENESS” OF BOTH THE “COST” AND THE “BENEFIT” OF CLINGING TO THE DEFENSE WHENEVER POSSIBLE THE THERAPIST WILL THEREFORE OFFER “PRICE – PAID” CONFLICT STATEMENTS THAT HIGHLIGHT BOTH THE “PAIN” AND THE “GAIN” “YOU KNOW THAT < PAIN > ... , BUT YOU REMAIN < GAIN > EVEN SO ... ” “YOU KNOW THAT < PRICE PAID > ... , BUT YOU REMAIN < INVESTED IN > EVEN SO ... ” IN THE HOPE OF MAKING THE “AMBIVALENTLY HELD DEFENSE” “LESS EGO – SYNTONIC” AND “MORE EGO – DYSTONIC” AND OF THEREFORE GALVANIZING THE PATIENT TO “TAKE ACTION” TO “RESOLVE THE INTERNAL DISSONANCE” AND “RESTORE THE HOMEOSTATIC BALANCE” 51
  • 52. MODEL 1 “PRICE – PAID” CONFLICT STATEMENTS FIRST “CHALLENGE” THE DEFENSE BY “DIRECTING THE PATIENT’S ATTENTION” TO THE “PAIN / COST / PRICE PAID” FOR “OLD BAD” AND THEN “SUPPORT” THE DEFENSE BY “RESONATING EMPATHICALLY” WITH THE (SECONDARY) “GAIN / BENEFIT / PAY OFF” OF “OLD BAD” “YOU KNOW THAT YOU ARE PAYING A STEEP PRICE FOR YOUR REFUSAL TO STOP SMOKING – OF PARTICULAR CONCERN BECAUSE OF YOUR RECURRENT LUNG INFECTIONS. BUT, AT THIS POINT, YOU ARE NOT QUITE YET PREPARED TO TAKE THAT STEP BECAUSE YOU FEEL YOU HAVE SO LITTLE ELSE IN YOUR LIFE THAT GIVES YOU ANY REAL PLEASURE.” “YOU KNOW THAT YOU WILL NEED SOMEDAY TO GET SERIOUS ABOUT LOSING THE EXTRA WEIGHT BECAUSE IT REALLY IS BEGINNING TO IMPACT YOUR HEALTH. BUT, RIGHT NOW, YOU CAN’T IMAGINE BEING ABLE TO PUT YOURSELF ON A RESTRICTIVE DIET BECAUSE YOU ARE ALREADY FEELING SO DEPRIVED IN ALL THE OTHER AREAS OF YOUR LIFE.” 52
  • 53. 53
  • 54. 54
  • 55. MODEL 2 THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND OTHER “DEFICIT” THEORIES “STRUCTURAL DEFICIT” – THE “IMPAIRED CAPACITY” TO BE A “GOOD PARENT” UNTO ONESELF – THIS “DEFICIT” CREATES THE “NEED” THE “NEED” IS TO FIND IN THE “HERE – AND – NOW” THE “GOOD PARENT” WHO WAS NOT TO BE FOUND IN THE “THERE – AND – THEN” A “NEED” THAT THEN FUELS THE “RELENTLESSNESS” OF THE PATIENT’S “PURSUITS” 55
  • 56. THE “THERAPEUTIC ACTION” IN MODEL 2 A CORRECTIVE – PROVISION MODEL – A DEFICIENCY – COMPENSATION MODEL – YES, THE MODEL 2 THERAPIST PROVIDES THE “HOLDING” AND THE “BEING MET EMPATHICALLY” THAT WERE NOT CONSISTENTLY AND RELIABLY PROVIDED BY THE PARENT THIS REPARATION FUNCTIONS AS A “SYMBOLIC CORRECTIVE” FOR THE EARLY – ON “RELATIONAL DEPRIVATION AND NEGLECT” THE EARLY – ON “FAILURES IN ENVIRONMENTAL PROVISION” BUT THERE IS MORE ... 56
  • 57. ALTHOUGH SOME MODEL 2 THEORISTS BELIEVE THAT IT IS THE “EXPERIENCE OF GRATIFICATION” ITSELF THAT WILL BE “COMPENSATORY” AND ULTIMATELY HEALING MOST BELIEVE THAT IT IS THE “OPTIMAL STRESS” CREATED BY THE “EXPERIENCE OF FRUSTRATION AGAINST A BACKDROP OF GRATIFICATION” FRUSTRATION – DISILLUSIONMENT – PROPERLY GRIEVED – THAT IS, “OPTIMAL DISILLUSIONMENT” – HOWARD BACAL’S (1998) “OPTIMAL RESPONSIVENESS” THAT WILL PROVIDE BOTH “IMPETUS” AND “OPPORTUNITY” FOR THE “FILLING IN OF STRUCTURAL DEFICIT” AND THE “CONSOLIDATION OF THE SELF” 57
  • 58. AFTER ALL IF THERE IS NO “THWARTING OF DESIRE,” THEN THERE WILL BE NOTHING THAT NEEDS TO BE MASTERED AND THEREFORE NO “IMPETUS” FOR “INTERNALIZING” WHATEVER “GOOD SUPPLIES” – “ENVIRONMENTAL PROVISIONS” – THERE HAD BEEN PRIOR TO BEING “THWARTED” THESE “TRANSMUTING INTERNALIZATIONS” ARE INDEED “ADAPTIVE” – TRANSMUTING SIGNIFIES “STRUCTURE – BUILDING” – HEINZ KOHUT (1966) INASMUCH AS THEY MAKE IT POSSIBLE FOR THE PATIENT TO “PRESERVE INTERNALLY” A PIECE OF THE “ORIGINAL EXPERIENCE” OF “EXTERNAL GOODNESS” 58
  • 59. OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS FACILITATE THE “NECESSARY GRIEVING” OF “DISAPPOINTMENTS” “YOU HAD SO HOPED THAT … , BUT YOU ARE BEGINNING TO REALIZE THAT … , AND IT DEVASTATES / ENRAGES YOU … ” THE THERAPEUTIC GOAL IS TO CREATE “GALVANIZING TENSION” BETWEEN “DEFENSIVE NEED” FOR “RELENTLESS HOPE” AND “ADAPTIVE CAPACITY” TO “CONFRONT, GRIEVE, AND ACCEPT” FIRST “HIGHLIGHT” WHAT “HAD BEEN” THE PATIENT’S “ILLUSION” – “DEFENSIVE NEED” FOR “RELENTLESS HOPE” – THEN “HIGHLIGHT” THE “REALITY” OF THE PATIENT’S “DISILLUSIONMENT” – “ADAPTIVE CAPACITY” TO “CONFRONT” – FINALLY, “RESONATE EMPATHICALLY” WITH THE “PAIN” OF THE PATIENT’S “GRIEF” – “ADAPTIVE CAPACITY” TO “FEEL” THE ACTUAL “HEARTBREAK” – 59
  • 60. OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS “YOU HAD SO HOPED THAT I WOULD TELL YOU WHAT TO DO. BUT YOU ARE BEGINNING TO REALIZE THAT I DON’T SIMPLY GIVE YOU THE ANSWERS – AND IT INFURIATES YOU.” “YOU HAD SO HOPED THAT YOUR DAUGHTER WOULD REACH OUT TO YOU WHEN YOU WERE SICK. BUT YOU ARE BEGINNING TO REALIZE THAT, FOR NOW, YOU ARE NOT A TOP PRIORITY FOR HER – AND IT IS A DEVASTATING LOSS.” “YOU WOULD SO HAVE WISHED THAT I COULD KNOW WHAT YOU WERE THINKING WITHOUT YOUR HAVING TO SAY IT. BUT YOU ARE COMING TO SEE THAT IT DOES NOT ALWAYS WORK THIS WAY – AND THAT BREAKS YOUR HEART.” “YOU HAD SO HOPED THAT YOUR HUSBAND WOULD ASK YOU HOW HE COULD HELP WITH THE DINNER PREPARATIONS. BUT YOU ARE STARTING TO GET IT THAT OFFERING TO HELP WITH HOUSEHOLD THINGS LIKE THAT IS NOT HIS THING – AND IT SADDENS AND UPSETS YOU TERRIBLY.” 60
  • 61. OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS “YOU HAD SO HOPED THAT WE COULD HAVE A PERSONAL RELATIONSHIP. BUT YOU ARE COMING TO REALIZE, ALBEIT RELUCTANTLY, THAT A THERAPY RELATIONSHIP IS NOT REALLY ABOUT FRIENDSHIP PER SE – AND THAT BREAKS YOUR HEART.” “YOU HAD SO HOPED THAT YOUR MOTHER WOULD APOLOGIZE. BUT YOU ARE BEGINNING TO ACCEPT THAT SHE SIMPLY DOES NOT HOLD HERSELF ACCOUNTABLE, WHICH IS BOTH ENRAGING AND DEVASTATING.” “ALTHOUGH YOU KNEW IT WOULD TAKE TIME, YOU HAD HOPED THAT YOU WOULD BE FEELING BETTER AFTER THESE SEVERAL WEEKS OF THERAPY. IT REALLY UPSETS YOU THAT YOU ARE STILL FEELING SUCH DESPAIR.” “YOU HAD BEEN HOPING THAT I WOULD NOT MAKE THE SAME KINDS OF MISTAKES THAT EVERYONE ELSE IN YOUR LIFE HAS, WHICH IS WHY IT IS SO VERY UPSETTING THAT I, TOO, HAVE NOW LET YOU DOWN.” “ON SOME LEVEL, YOU KNEW THAT I DIDN’T HAVE ALL THE ANSWERS. EVEN SO, YOU HAD BEEN HOPING THAT I MIGHT, AND SO IT ENRAGES YOU WHEN I DON’T SIMPLY ANSWER YOUR QUESTIONS DIRECTLY.” “YOU HAD SO HOPED THAT I WOULD BE ABLE TO MAKE YOUR PAIN GO AWAY. BUT YOU ARE BEGINNING TO SEE THAT THERAPY DOES NOT ACTUALLY WORK THAT WAY. AND IT IS ABSOLUTELY DEVASTATING.” 61
  • 62. OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS “YOU KNOW THAT EVENTUALLY YOU WILL NEED TO FACE THE REALITY THAT YOUR FATHER WILL NEVER CHANGE, AND THIS REALIZATION IS DEVASTATING BECAUSE YOU HAD SO HOPED THAT HE WOULD.” “YOU ARE BEGINNING TO REALIZE THAT YOUR MOTHER WILL NEVER UNDERSTAND JUST HOW MUCH SHE HAS HURT YOU OVER THE COURSE OF THE YEARS. AND IT IS EXCRUCIATINGLY PAINFUL BECAUSE YOU HAD SO HOPED THAT SOMEDAY SHE MIGHT ACTUALLY COME TO UNDERSTAND – AND APOLOGIZE.” “AS YOU BEGIN TO ADMIT TO YOURSELF THAT PROBABLY PEDRO WILL NEVER BE RIGHT FOR YOU, IT MAKES YOU INCREDIBLY SAD BECAUSE YOU HAD SO HOPED THAT HE WOULD EVENTUALLY COME ’ROUND TO LOVING YOU.” “IN THOSE MOMENTS WHEN YOU LET YOURSELF REMEMBER JUST HOW LIMITED YOUR FATHER IS AND JUST HOW DEFENSIVE HE BECOMES WHENEVER YOU TRY TO HOLD HIM ACCOUNTABLE, IT FEELS TOTALLY OVEWHELMING AND HURTS SO MUCH. YOU HAD SO HOPED THAT YOU COULD GET HIM TO TAKE AT LEAST SOME RESPONSIBILITY FOR HIS ABUSIVENESS.” 62
  • 63. IF ALL GOES WELL IT WILL BE WITHIN THE CONTEXT OF SAFETY PROVIDED BY THE RELATIONSHIP WITH HER THERAPIST THAT THE PATIENT WILL BE ABLE, AT LAST, TO FEEL THE PAIN AGAINST WHICH SHE HAS SPENT A LIFETIME DEFENDING HERSELF IN THE PROCESS GRADUALLY TRANSFORMING BOTH HER “RELENTLESS NEED” TO POSSESS AND CONTROL AND, WHEN THWARTED, HER “RETALIATORY NEED” TO PUNISH AND DESTROY INTO THE “ADAPTIVE CAPACITY” TO RELENT, TO GRIEVE, TO ACCEPT, TO FORGIVE, TO INTERNALIZE WHAT GOOD THERE WAS, TO SEPARATE, TO LET GO, AND TO MOVE ON ULTIMATELY EVOLVING TO A PLACE OF APPRECIATION AND GRATITUDE FOR ALL THE GOOD THAT WAS (AND IS) 63
  • 64. AS “EXTERNAL GOODNESS” IS INTERNALIZED AND “STRUCTURAL DEFICIT” FILLED IN THE “RELENTLESSNESS” WITH WHICH THE PATIENT HAD BEEN “PURSUING” THE “OBJECTS OF HER DESIRE” – THAT IS, HER “RELENTLESS HOPE” AND “REFUSAL TO ACCEPT” THEIR “LIMITATIONS, SEPARATENESS, AND IMMUTABILITY” – WILL BECOME GRADUALLY “TAMED” AND SHE WILL EVOLVE TO A PLACE OF “SERENE ACCEPTANCE” OF THE SOBERING REALITY THAT SHE WILL NEVER BE ABLE TO HAVE ALL THAT SHE SHOULD HAVE HAD AS A CHILD AND FOR WHICH SHE HAS SPENT A LIFETIME SEARCHING BUT THAT “WHAT SHE HAS” IS “GOOD ENOUGH” 😊 64
  • 65. 65 FROM RELENTLESS PURSUIT OF THE UNATTAINABLE TO SOBER, MATURE ACCEPTANCE OF THE REALITY THAT IT WAS WHAT IT WAS AND IS WHAT IT IS
  • 66. GRIEVING GENUINE GRIEVING REQUIRES OF US THAT – AT LEAST FOR PERIODS OF TIME – WE BE FULLY PRESENT WITH THE ANGUISH OF OUR GRIEF, THE PAIN OF OUR REGRET, AND THE INTENSITY OF THE RAGE WE EXPERIENCE WHEN CONFRONTED WITH SOBERING REALITIES ABOUT OURSELVES, OUR RELATIONSHIPS, AND OUR WORLD WE MUST NOT ABSENT OURSELVES FROM OUR GRIEF WE MUST ENTER INTO IT AND EMBRACE IT WE CANNOT EFFECTIVELY GRIEVE WHEN WE ARE DISSOCIATED, MISSING IN ACTION, OR FLEEING THE SCENE WE NEED TO BE ENGAGED, IN THE MOMENT, EMBODIED, MINDFUL OF ALL THAT IS GOING ON INSIDE OF US, GROUNDED, FOCUSED, AND IN THE HERE – AND – NOW IF WE ARE IN DENIAL, SHUT DOWN, CLOSED, NUMB, REFUSING TO FEEL, OR PROTESTING THE UNFAIRNESS OF IT ALL, THEN NO REAL GRIEVING CAN BE DONE 66
  • 67. 67 “GRIEF IS NATURE’S WAY OF HEALING A BROKEN HEART” ROBERTA BECKMANN (1991)
  • 68. IN SUM THE “THERAPEUTIC ACTION” IN MODEL 2 IS A PROTRACTED PROCESS THAT TRANSFORMS THE PATIENT’S (DEFENSIVE) REFUSAL TO CONFRONT THE REALITY OF THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY – WHICH FUELS THE RELENTLESSNESS WITH WHICH SHE PURSUES IT – INTO THE (ADAPTIVE) CAPACITY TO TOLERATE AND ACCEPT THOSE DISAPPOINTING REALITIES IN THE CONTEXT OF THE TREATMENT IT REQUIRES THAT THE PATIENT WORK THROUGH HER “OPTIMAL DISILLUSIONMENT” – THAT IS, WORK THROUGH “POSITIVE TRANSFERENCE DISRUPTED” – BY CONFRONTING THE “PAIN OF HER GRIEF” AND “ADAPTIVELY INTERNALIZING” THE “GOOD THAT HAD BEEN” PRIOR TO THE “DISRUPTION” ARRIVING ULTIMATELY AT A PLACE OF SERENE ACCEPTANCE, FORGIVENESS, INNER PEACE, AND REALISTIC HOPE IF YOU CANNOT ALWAYS COUNT ON RECEIVING IT FROM THE OUTSIDE, BETTER THAT YOU INTERNALIZE WHATEVER “EXTERNAL PROVISIONS” YOU CAN SO THAT THEY WILL ALWAYS BE THERE FOR YOU AS “INTERNAL RESOURCES” 68
  • 69. HAROLD SEARLES (1979) HAS SUGGESTED THAT “REALISTIC HOPE” ARISES IN THE CONTEXT OF “SURVIVING DISAPPOINTMENT” 69
  • 70. THE BAD NEWS WILL BE THE SADNESS THE PATIENT EXPERIENCES AS SHE BEGINS TO ACCEPT THE SOBERING REALITY THAT DISAPPOINTMENT IS AN INEVITABLE AND NECESSARY ASPECT OF RELATIONSHIP THE GOOD NEWS, HOWEVER, WILL BE THE WISDOM SHE ACQUIRES AS SHE COMES TO APPRECIATE EVER – MORE PROFOUNDLY THE SUBTLETIES AND NUANCES OF RELATIONSHIP AND BEGINS TO MAKE HER PEACE WITH THE HARSH REALITY OF LIFE’S MANY CHALLENGES SADDER SHE WILL BE, YES, BUT ALSO WISER 70
  • 71. 71
  • 72. AS A RESULT OF GENUINE GRIEVING “GRIEVANCES” – UNMOURNED DISAPPOINTMENTS – WILL HAVE BECOME TRANSFORMED INTO THE HEALTHY CAPACITY TO ACCEPT THE SOBERING REALITY THAT WE CANNOT MAKE THE PEOPLE IN OUR WORLD CHANGE BUT THAT WE CAN – AND MUST – TAKE OWNERSHIP OF – AND RESPONSIBILITY FOR – ALL THAT WE CAN CHANGE WITHIN OURSELVES BY THE SAME TOKEN WE MUST COME TO TERMS WITH THE SOBERING REALITY THAT WE CANNOT CHANGE OUR HISTORY BUT THAT WE CAN – AND MUST – CHANGE HOW WE “POSITION” OURSELVES IN RELATION TO IT AND HOW WE “POSITION” OURSELVES IN OUR LIFE GOING FORWARD 72
  • 73. 73
  • 74. “TRUE HAPPINESS IS NOT ABOUT GETTING WHAT YOU WANT BUT COMING TO WANT AND APPRECIATE WHAT YOU HAVE.” JAPANESE SAYING 74
  • 75. 75 I AM HERE REMINDED OF THE NEW YORKER CARTOON IN WHICH A GENTLEMAN, SEATED IN A RESTAURANT BY THE NAME OF THE DISILLUSIONMENT CAFÉ, IS AWAITING THE ARRIVAL OF HIS ORDER THE WAITER RETURNS TO HIS TABLE AND ANNOUNCES, “YOUR ORDER IS NOT READY, AND NOR WILL IT EVER BE.”
  • 76. 76
  • 77. MODEL 3 THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY FEATURES “PATHOGENIC INTROJECTS” “FILTERS” THAT WILL CONTAMINATE THE PATIENT’S EXPERIENCE OF SELF, OTHERS, AND THE WORLD AND GIVE RISE TO “RELATIONAL CONFLICT” WHEN “DELIVERED” INTO RELATIONSHIPS THE “HERE – AND – NOW ENGAGEMENT” BETWEEN TWO “AUTHENTIC SUBJECTS” AND THE “TURBULENCE” THAT WILL INEVITABLY ARISE AT THEIR “INTIMATE EDGE” WHEN THE THERAPIST EITHER “REACTS DEFENSIVELY” OR “RESPONDS ADAPTIVELY” TO THE “FORCE FIELD” CREATED BY THE PATIENT’S “PROJECTIONS” THE “CONTRIBUTIONS” OF BOTH PARTICIPANTS TO THE “INTERSUBJECTIVE IN – BETWEEN” “CO – CREATION” AND “MUTUALITY OF IMPACT / INFLUENCE” USE OF THE THERAPIST’S “AUTHENTIC SELF” TO “FIND” – AND TO BE “FOUND BY” – THE PATIENT 77
  • 78. OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS – RELATIONAL INTERVENTIONS – STRATEGICALLY DESIGNED TO TEASE OUT TRANSFERENCE – COUNTERTRANSFERENCE ENTANGLEMENTS PROJECTIVE IDENTIFICATIONS / “CRUNCH SITUATIONS” – PAUL RUSSELL (1980) MUTUAL ENACTMENTS / CO – CREATED THERAPEUTIC IMPASSES THE THERAPEUTIC ACTION INVOLVES “NEGOTIATING” AT THE “INTIMATE EDGE” OF “AUTHENTIC RELATEDNESS” THE OVERARCHING GOAL OF WHICH IS TO TRANSFORM COMPULSIVE AND UNWITTING “RE – ENACTMENT” INTO “ACCOUNTABILITY” AND “RELATIONAL MINDFULNESS” – ON THE PARTS OF BOTH THERAPIST AND PATIENT – DEBORAH EDEN TULL (2018) MINDFULNESS – “PRESENT – MOMENT AWARENESS” 78
  • 79. 79
  • 80. PROJECTIVE IDENTIFICATION BECAUSE THE MODEL 3 THERAPIST IS PARTICIPATING IN A “REAL RELATIONSHIP” WITH THE PATIENT AND BECAUSE THE PATIENT HAS THE EVER – PRESENT “RELATIONAL EXPECTATION” OF “BEING FAILED” INEVITABLY THE THERAPIST – UNCONSCIOUSLY RECEPTIVE TO THIS “RELATIONAL NEED” ON THE PART OF THE PATIENT – WILL FIND HERSELF UNWITTINGLY DRAWN IN TO PARTICIPATING AS SOME VARIANT OF THE PATIENT’S “OLD BAD OBJECT” – PROJECTIVE IDENTIFICATION IN ACTION – ALTHOUGH THIS WILL OFTEN GIVE RISE TO “TURBULENCE” AT THE INTIMATE EDGE BETWEEN THERAPIST AND PATIENT, IT WILL ALSO CREATE BOTH “IMPETUS” AND “OPPORTUNITY” FOR THE PATIENT TO REWORK HER “INTROJECTED BADNESS” ... 80
  • 81. ... BECAUSE THE PATIENT’S COMPULSIVE AND UNWITTING RE – ENACTMENTS ALWAYS HAVE BOTH UNHEALTHY AND HEALTHY COMPONENTS THE UNHEALTHY COMPONENT HAS TO DO WITH THE PATIENT’S NEED TO HAVE MORE OF SAME – NO MATTER HOW DYSFUNCTIONAL – BECAUSE THAT IS ALL SHE HAS EVER KNOWN HAVING SOMETHING DIFFERENT WOULD CREATE ANXIETY BECAUSE IT WOULD HIGHLIGHT THE FACT THAT THINGS COULD BE – AND COULD THEREFORE HAVE BEEN – DIFFERENT BUT THE HEALTHY PIECE HAS TO DO WITH THE PATIENT’S NEED TO ACHIEVE BELATED MASTERY OF THE EARLY – ON RELATIONAL FAILURES 81
  • 82. MODEL 2 VERSUS MODEL 3 UNLIKE MODEL 2, WHICH PAYS SCANT ATTENTION TO THE PATIENT’S “PROACTIVITY” IN RELATION TO THE THERAPIST, MODEL 3 ADDRESSES ITSELF SPECIFICALLY TO THE “FORCE FIELD” CREATED BY THE PATIENT WHO – UNDER THE SWAY OF HER REPETITION COMPULSION – IS UNWITTINGLY EVER – INTENT UPON RE – CREATING – BY WAY OF PROJECTIVE IDENTIFICATION – THE EARLY – ON TRAUMATIC FAILURE SITUATION BY DRAWING THE THERAPIST IN TO PARTICIPATING “IN WAYS SPECIFICALLY DETERMINED BY THE PATIENT’S EARLY – ON DEVELOPMENTAL HISTORY” PATRICK CASEMENT (1992) ALL WITH AN EYE TO ENCOUNTERING A BETTER OUTCOME EACH NEXT TIME 82
  • 83. IN FACT THE PATIENT MIGHT KNOW OF NO OTHER WAY TO GET SOME UNRESOLVED PIECE OF HER SUBJECTIVE EXPERIENCE UNDERSTOOD THAN BY UNWITTINGLY RE – ENACTING IT IN THE RELATIONSHIP WITH HER THERAPIST AND ONLY BY WAY OF RECREATING WITH HER THERAPIST THE ONLY KIND OF RELATIONSHIP SHE HAS EVER KNOWN WILL THE PATIENT BE ABLE – AT LAST – TO NEGOTIATE A DIFFERENT ENDING 83
  • 84. TWO PHASES OF A PROJECTIVE IDENTIFICATION MARTHA STARK (1999) THE “INDUCTION PHASE” COMMENCES ONCE THE PATIENT PROJECTS ONTO THE THERAPIST SOME ASPECT OF THE PATIENT’S EXPERIENCE THAT HAS BEEN TOO TOXIC FOR THE PATIENT TO PROCESS AND INTEGRATE – AND THEN EXERTS PRESSURE ON THE THERAPIST TO ACCEPT THAT PROJECTION, THEREBY INDUCTING THE THERAPIST INTO THE PATIENT’S ENACTMENT THE “RESOLUTION PHASE” IS USHERED IN ONCE THE THERAPIST STEPS BACK FROM HER PARTICIPATION IN WHAT HAS BECOME A MUTUAL ENACTMENT AND BRINGS TO BEAR HER OWN, MORE – EVOLVED CAPACITY TO PROCESS AND INTEGRATE ON BEHALF OF A PATIENT WHO TRULY DOES NOT KNOW HOW – SUCH THAT WHAT IS THEN RE – INTROJECTED BY THE PATIENT CAN BE MORE EASILY ASSIMILATED INTO HEALTHY PSYCHIC STRUCTURE AND, IF ALL GOES WELL, THESE ITERATIVE CYCLES WILL HAPPEN REPEATEDLY, THE NET RESULT OF WHICH WILL BE “GRADUAL DETOXIFICATION” OF THE PATIENT’S “INTERNAL PATHOGENICITY” 84
  • 85. ALTHOUGH INEVITABLY THE THERAPIST WILL FAIL THE PATIENT IN MANY OF THE SAME WAYS THAT THE PARENT HAD FAILED HER ULTIMATELY, THE THERAPIST MUST CHALLENGE THE PATIENT’S PROJECTIONS BY LENDING ASPECTS OF HER “OTHERNESS” OR “EXTERNALITY” TO THE INTERACTION DONALD WINNICOTT (1949) SUCH THAT THE PATIENT WILL HAVE THE EXPERIENCE OF SOMETHING THAT IS “OTHER – THAN – ME” AND CAN “TAKE THAT IN” IN ESSENCE, THE THERAPIST WILL “CONTAIN” THE PATIENT’S PROJECTIONS BY LENDING ASPECTS OF HER OWN, GREATER CAPACITY TO PROCESS AND INTEGRATE SUCH THAT THE PATIENT WILL HAVE THE EXPERIENCE OF “TAKING IN” SOMETHING THAT IS NOW MORE PROCESSED, LESS TOXIC, AND MORE MANAGEABLE 85
  • 86. IN ESSENCE WHAT THE PATIENT RE – INTROJECTS WILL BE AN “AMALGAM” PART CONTRIBUTED BY THE PATIENT THE ORIGINAL – UNPROCESSED AND TOXIC – PROJECTION AND PART CONTRIBUTED BY THE THERAPIST SOMETHING MORE PROCESSED AND LESS TOXIC 86
  • 87. CLINICAL VIGNETTE THE “SHARING” OF GRIEF A PATIENT’S BELOVED GRANDMOTHER HAS JUST DIED THE PATIENT, UNABLE TO FEEL HIS SADNESS BECAUSE IT HURTS “TOO MUCH,” RECOUNTS IN A MONOTONE THE DETAILS OF HIS GRANDMOTHER’S DEATH AS THE THERAPIST LISTENS, SHE BECOMES VERY SAD AS THE PATIENT CONTINUES, THE THERAPIST FINDS HERSELF UTTERING, ALMOST INAUDIBLY, AN OCCASIONAL “OH, NO!” AND “THAT’S AWFUL!” AS THE HOUR PROGRESSES, THE PATIENT HIMSELF BECOMES INCREASINGLY SAD 87
  • 88. CLINICAL VIGNETTE – THE “SHARING” OF GRIEF IN THIS EXAMPLE, THE PATIENT IS INITIALLY UNABLE TO FEEL THE DEPTHS OF HIS GRIEF ABOUT HIS GRANDMOTHER’S DEATH BUT BY REPORTING THE DETAILS IN THE “MONOTONIC” MANNER IN WHICH HE DOES, THE PATIENT IS ABLE TO GET THE THERAPIST TO FEEL WHAT HE HIMSELF CANNOT – AND INSTEAD MUST DEFEND AGAINST IN ESSENCE, THE PATIENT EXERTS “INTERPERSONAL PRESSURE” UPON THE THERAPIST TO TAKE ON, AS THE THERAPIST’S OWN, WHAT THE PATIENT DOES NOT YET HAVE THE CAPACITY TO TOLERATE AS THE THERAPIST SITS WITH THE PATIENT AND LISTENS TO HIS STORY, SHE FINDS HERSELF BECOMING VERY SAD, WHICH SIGNALS THE THERAPIST’S QUIET ACCEPTANCE OF THE PATIENT’S DISAVOWED GRIEF THE INDUCTION PHASE OF THE PROJECTIVE IDENTIFICATION WE COULD SAY OF THE PATIENT’S SADNESS THAT IT HAS FOUND ITS WAY INTO THE THERAPIST, WHO, ABLE TO TOLERATE WHAT THE PATIENT FINDS INTOLERABLE, TAKES IT ON “AS HER OWN” THE THERAPIST’S SADNESS IS THEREFORE CO – CREATED – IN PART A STORY ABOUT THE PATIENT (AND HIS DISAVOWED GRIEF) AND IN PART A STORY ABOUT THE THERAPIST – IN WHOM A RESONANT CHORD HAS BEEN STRUCK – 88
  • 89. CLINICAL VIGNETTE – THE “SHARING” OF GRIEF THE THERAPIST, WITH HER GREATER CAPACITY TO EXPERIENCE AFFECT WITHOUT NEEDING TO DEFEND AGAINST IT, IS ABLE BOTH TO TOLERATE THE SADNESS THAT THE PATIENT FINDS INTOLERABLE AND TO PROCESS AND INTEGRATE IT WHICH INITIATES THE RESOLUTION PHASE OF THE PROJECTIVE IDENTIFICATION THE THERAPIST “FEELS” IT BUT IS “NOT OVERWHELMED” BY IT IT IS THE THERAPIST’S ABILITY TO TOLERATE THE INTOLERABLE THAT MAKES THE PATIENT’S PREVIOUSLY UNMANAGEABLE FEELINGS MORE MANAGEABLE FOR HIM INDEED, THE PATIENT’S GRIEF BECOMES LESS TERRIFYING BY VIRTUE OF THE FACT THAT THE THERAPIST HAS BEEN ABLE TO CONTAIN IT BY CARRYING THAT GRIEF ON THE PATIENT’S BEHALF A MORE ASSIMILABLE VERSION OF THE PATIENT’S SADNESS IS THEN RETURNED TO THE PATIENT IN THE FORM OF THE THERAPIST’S HEARTFELT UTTERANCES – “OH, NO!” AND “THAT’S AWFUL!” SUCH THAT THE PATIENT FINDS HIMSELF NOW ABLE TO BEAR THE PAIN OF HIS OWN GRIEF – NOW ABLE TO CARRY THAT PAIN ON HIS OWN BEHALF – – NOW ABLE TO TOLERATE WHAT HAD ONCE BEEN INTOLERABLE – 89
  • 90. CLINICAL VIGNETTE – “GREAT TAN, BITCH!” THE PATIENT, JANET, IS A 31 – YEAR – OLD MARRIED WOMAN WHO HAS A HISTORY OF DIFFICULT RELATIONSHIPS WITH ALMOST EVERYONE IN HER LIFE SHE IS PARTICULARLY TROUBLED BY HER LACK OF CLOSE WOMEN FRIENDS JANET HAS BEEN WORKING HARD IN THE TREATMENT, HAS MADE SUBSTANTIAL GAINS IN HER PROFESSIONAL LIFE, AND HAS VERY MUCH IMPROVED THE QUALITY OF HER RELATIONSHIP WITH HER HUSBAND JANET AND HER THERAPIST (A WOMAN) HAVE HAD A GOOD, RELATIVELY UNCONFLICTED RELATIONSHIP JANET CLEARLY LIKES, AND IS RESPECTFUL OF, THE THERAPIST UPON THE THERAPIST’S RETURN FROM A WEEK – LONG VACATION IN FLORIDA, JANET, AT THE END OF THE SESSION AND JUST AS SHE IS LEAVING, TURNS BACK TO HER THERAPIST AND, AS HER PARTING SHOT, BLURTS OUT, “GREAT TAN, BITCH!” THE THERAPIST, TAKEN ABACK AND AT A LOSS FOR WORDS, SAYS NOTHING, SMILES LAMELY, AND NODS GOODBYE 90
  • 91. ALTHOUGH DURING THE SESSION THE THERAPIST (MADE ANXIOUS) HAD “REACTED DEFENSIVELY” BY “GOING BLANK,” BETWEEN SESSIONS THE THERAPIST IS ABLE TO “RECOVER HER THERAPEUTIC EFFECTIVENESS” BY “STEPPING BACK” ENOUGH FROM HER EXPERIENCE OF HAVING BEEN “SLAMMED” THAT – NOW LESS ANXIOUS – SHE IS ABLE TO “RESPOND ADAPTIVELY” AND, THEREFORE, OPENS THE NEXT SESSION WITH – “WE HAVE TALKED A LOT ABOUT HOW UPSETTING IT IS FOR YOU TO HAVE SO FEW WOMEN FRIENDS. “I THINK THAT NOW, IN LIGHT OF WHAT HAPPENED AT THE END OF OUR LAST SESSION, I AM COMING TO UNDERSTAND SOMETHING THAT I HAD NEVER BEFORE COMPLETELY UNDERSTOOD. “WHEN YOU LEFT LAST TIME, YOUR PARTING WORDS WERE ‘GREAT TAN, BITCH!’ “I WONDER IF, BY SAYING THAT, YOU WERE TRYING TO SHOW ME WHAT SOMETIMES HAPPENS FOR YOU WHEN YOU FEEL CLOSE TO A WOMAN AND THEN FIND YOURSELF BECOMING COMPETITIVE.” HERE THE THERAPIST IS COURAGEOUSLY USING HER “EXPERIENCE OF SELF” – HER COUNTERTRANSFERENTIAL REACTION OF “BEING PUT OFF” – TO “SHINE A LIGHT ON” A CRITICALLY IMPORTANT PIECE OF THE PATIENT’S “DYSFUNCTIONAL RELATIONAL DYNAMICS” 91
  • 92. MUCH IS REQUIRED OF THE MODEL 3 THERAPIST FOR HER TO BE ABLE EVENTUALLY TO “RESPOND ADAPTIVELY” INSTEAD OF “REACTING DEFENSIVELY” TO THE PATIENT’S DELIVERY OF HER “DYSFUNCTIONAL RELATIONAL DYNAMICS” INTO THE THERAPEUTIC RELATIONSHIP THE THERAPIST MUST FIRST BE ABLE TO TOLERATE “BEING MADE INTO” THE PATIENT’S “OLD BAD OBJECT” AND ONCE SHE HAS ALLOWED HERSELF TO BE DRAWN IN TO PARTICIPATING IN WHAT CAN SOMETIMES BECOME A VERY MESSY TRANSFERENCE / COUNTERTRANSFERENCE ENTANGLEMENT, SHE MUST THEN BE ABLE TO “EXTRICATE” HERSELF BY STEPPING BACK WHICH WILL ENABLE HER TO RECOVER HER “OBJECTIVITY” AND, THEREBY, HER “THERAPEUTIC EFFECTIVENESS” 92
  • 93. IN ESSENCE THE THERAPIST MUST HAVE THE “CAPACITY TO RELENT” FURTHERMORE THE THERAPIST MUST HAVE BOTH THE “WISDOM TO RECOGNIZE” AND THE “INTEGRITY TO ACKNOWLEDGE” – CERTAINLY TO HERSELF AND PERHAPS TO THE PATIENT AS WELL – HER OWN PARTICIPATION IN THE DRAMA THAT IS BEING PLAYED OUT BETWEEN THEM ON THE STAGE OF THE TREATMENT IN OTHER WORDS THE THERAPIST MUST HAVE THE “CAPACITY” BOTH TO “RELENT” AND TO “HOLD HERSELF ACCOUNTABLE” FOR HER “COUNTERTRANSFERENTIAL ENACTMENT” 93
  • 94. IN ESSENCE PROJECTIVE IDENTIFICATION INVOLVES SYMBOLIC REPETITION OF THE ORIGINAL RELATIONAL TRAUMA BUT WITH A MUCH HEALTHIER RESOLUTION THIS TIME – “ADAPTIVE RESOLUTION” – AT THE END OF THE DAY THE HALLMARK OF A SUCCESSFUL PROJECTIVE IDENTIFICATION IS THE THERAPIST’S CAPACITY TO TOLERATE WHAT THE PATIENT FINDS INTOLERABLE 94
  • 95. THE OPTIMALLY STRESSFUL “RULE OF THREE” IS DESIGNED TO INSIST THAT THE “RE – ENACTING” PATIENT TAKE RESPONSIBILITY FOR HER “PROVOCATIVE ENACTMENTS” MORE SPECIFICALLY, THE “RULE OF THREE” BECOMES RELEVANT WHENEVER A PATIENT SAYS OR DOES SOMETHING THAT THE THERAPIST EXPERIENCES AS PROVOCATIVE – A “PROVOCATIVE ENACTMENT” – IN ORDER TO COMPEL THE PATIENT TO TAKE OWNERSHIP OF WHAT SHE IS “PLAYING OUT” ON THE STAGE OF THE TREATMENT, THE THERAPIST CAN ASK THE PATIENT ANY OF THE FOLLOWING – “HOW ARE YOU HOPING THAT I WILL RESPOND?” WHICH ADDRESSES THE ID “HOW ARE YOU FEARING THAT I MIGHT RESPOND?” WHICH ADDRESSES THE SUPEREGO “HOW ARE YOU IMAGINING THAT I WILL RESPOND?” WHICH ADDRESSES THE EXECUTIVE FUNCTIONING OF THE EGO – THE DORSOLATERAL PREFRONTAL CORTEX (DLPFC) OF THE BRAIN – ALL THREE “RELATIONAL INTERVENTIONS” DEMAND OF THE PATIENT THAT SHE MAKE HER “INTERPERSONAL INTENTIONS” MORE EXPLICIT 95
  • 96. OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS MORE GENERALLY, THE THERAPIST MIGHT CHOOSE TO SHARE – SOMETHING ABOUT HER OWN EXPERIENCE OF BEING IN THE ROOM WITH THE PATIENT OR HER OWN STATE OF INTERNAL CONFLICTEDNESS AS A RESULT OF SOMETHING HAPPENING BETWEEN THEM ALTERNATIVELY, THE THERAPIST MIGHT CHOOSE TO HIGHLIGHT – HOW THE PATIENT GETS OTHERS TO DO UNTO HER IN THE HERE – AND – NOW SOME VERSION OF WHAT HAD BEEN DONE UNTO HER IN THE THERE – AND – THEN – “DIRECT NEGATIVE TRANSFERENCE” – WITNESS, FOR EXAMPLE, THE CONCEPT OF “DOER AND DONE TO” JESSICA BENJAMIN (2017) OR HOW THE PATIENT DOES UNTO OTHERS IN THE HERE – AND – NOW SOME VERSION OF WHAT HAD BEEN DONE UNTO HER IN THE THERE – AND – THEN – “INVERTED NEGATIVE TRANSFERENCE” – WITNESS, FOR EXAMPLE, THE CONCEPT OF “IDENTIFICATION WITH THE AGGRESSOR” SANDOR FERENCZI (1995) / ANNA FREUD (1979) 96
  • 97. AS ADDITIONAL EXAMPLES OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS THE THERAPIST MIGHT CHOOSE TO SHARE SOMETHING ABOUT HER EXPERIENCE OF BEING IN THE ROOM WITH THE PATIENT “IT WOULD SEEM THAT I AM IN THE DOG HOUSE THESE DAYS!” “I WONDER IF THE FRUSTRATION AND HELPLESSNESS I AM FEELING NOW IN RELATION TO YOU IS SIMILAR TO THE FRUSTRATION AND HELPLESSNESS YOU HAVE SPOKEN OF HAVING FELT IN RELATION TO YOUR FATHER.” “YOU TELL ME SOMETHING ABOUT YOURSELF. I AM JUST IN THE PROCESS OF DIGESTING IT AND STORING IT FOR FURTHER UNDERSTANDING OF YOU AND THEN ALONG YOU COME – WHAM! – AND TELL ME THAT WHAT I HAVE DIGESTED AND STORED INSIDE ME DID NOT COME FROM YOU AT ALL. THE PROBLEM I FIND IS HOW TO LIVE WITH THE DESPAIR I FEEL OCCASIONED BY YOUR DISAPPEARANCES.” CHRISTOPHER BOLLAS (1989) 97
  • 98. OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS CAN BE INTRODUCED IN ANY OF THE FOLLOWING WAYS – “IT OCCURS TO ME THAT, BY WAY OF YOUR BEHAVIOR IN HERE WITH ME, YOU ARE HELPING ME TO UNDERSTAND SOMETHING THAT I HAD NEVER BEFORE ENTIRELY UNDERSTOOD … ” “I THINK THAT YOU HAVE BEEN TRYING TO COMMUNICATE SOMETHING IMPORTANT TO ME THAT I HAD BEEN REFUSING TO SEE … ” “I WONDER IF MY DIFFICULTY APPRECIATING JUST HOW DESPERATE YOU WERE MADE YOU FEEL THAT YOU HAD TO DO SOMETHING DRAMATIC IN ORDER TO GET MY ATTENTION … ” DON’T HESITATE TO “THROW YOURSELF UNDER THE BUS” 98
  • 99. OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS AS IRWIN HOFFMAN (2001) HAS SUGGESTED IF THE THERAPIST IS AWARE OF FEELING CONFLICTED IN RELATION TO THE PATIENT, SHE MAY CHOOSE TO SHARE THE FACT OF THIS CONFLICTEDNESS WITH THE PATIENT “I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’” HERE THE THERAPIST IS EXPRESSING ALOUD THE CONFLICT WITH WHICH SHE IS STRUGGLING – A CONFLICT THAT MIGHT WELL BE REFLECTIVE OF THE PATIENT’S OWN INTERNAL STATE OF DIVIDEDNESS “I AM TEMPTED TO GIVE YOU THE ADVICE FOR WHICH YOU ARE LOOKING, BUT MY FEAR IS THAT WERE I TO DO SO, I WOULD BE ROBBING YOU OF THE IMPETUS TO FIND YOUR OWN ANSWERS.” “I FIND MYSELF FEELING ANGRY WITH YOU FOR BEING SO OFTEN LATE AND WANTING YOU TO UNDERSTAND HOW IT IMPACTS ME. BUT THEN IT OCCURS TO ME THAT IT MIGHT BE MORE IMPORTANT FOR US TO TRY TO UNDERSTAND WHAT YOU MIGHT BE WANTING TO COMMUNICATE TO ME BY WAY OF YOUR FREQUENT LATENESS.” 99
  • 100. “I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’” OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS “I AM TEMPTED TO RESPOND TO YOUR REQUEST BY SAYING THAT OF COURSE YOU CAN BORROW ONE OF THE MAGAZINES IN MY WAITING ROOM. BUT I AM ALSO REALIZING THAT WERE I SIMPLY TO SAY ‘OK,’ WE MIGHT THEN LOSE AN OPPORTUNITY TO UNDERSTAND SOMETHING MORE ABOUT YOU AND, PERHAPS, ABOUT US.” TO A PATIENT WHO SAYS SHE WANTS THE THERAPIST’S APPROVAL REGARDING HER DECISION TO TERMINATE – A TERMINATION THAT THE THERAPIST THINKS IS PREMATURE – “I AM TEMPTED SIMPLY TO OFFER YOU THE APPROVAL YOU ARE SEEKING – IT IS, AFTER ALL, IMPORTANT THAT YOU DO WHAT FEELS RIGHT FOR YOU. BUT I AM ALSO AWARE OF FEELING, WITHIN MYSELF, THAT THE TIME IS TOO SOON AND THAT WERE I TO SUPPORT YOUR DECISION TO LEAVE, I MIGHT ULTIMATELY BE DOING YOU A DISSERVICE.” 100
  • 101. OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS “I WONDER IF THIS FEELING I HAVE IN RELATION TO YOU THAT NO MATTER WHAT I SAY IT WON’T BE GOOD ENOUGH IS LIKE THE FEELING YOU HAVE SPOKEN OF HAVING HAD IN RELATION TO YOUR FATHER, FOR WHOM NOTHING WAS EVER GOOD ENOUGH.” “I FIND MYSELF FEELING SO ANGRY AT YOUR MOTHER. I WONDER IF SOME OF THOSE FEELINGS ARE ACTUALLY A STORY ABOUT FEELINGS YOU HAVE ABOUT YOUR MOTHER – FEELINGS YOU WOULD RATHER NOT HAVE TO ACKNOWLEDGE.” “IT OCCURS TO ME THAT WE HAVE MANAGED TO RECREATE IN HERE THE VERY SAME DYNAMIC THAT HAD CHARACTERIZED YOUR RELATIONSHIP WITH YOUR DOUBLE – BINDING FATHER – NAMELY, THE FEELING WE BOTH HAVE THAT NO MATTER WHAT EITHER OF US MIGHT DO, IT WOULDN’T GET THE OTHER’S APPROVAL! BUT ALL OF THIS, PAINFUL AS IT IS, GIVES US AN OPPORTUNITY TO EXPERIENCE, FIRSTHAND, HOW TOXIC THE RELATIONSHIP WITH YOUR FATHER REALLY WAS – EXCEPT THAT NOW WE CAN DO SOMETHING ABOUT IT!” 101
  • 102. MODEL 3 IS ULTIMATELY A STORY ABOUT THE THERAPIST’S “USE” OF HER “AUTHENTIC SELF” – HER “COUNTERTRANSFERENCE” – TO PROVIDE “CONTAINMENT” AND THEREBY TO FACILITATE “MODIFICATION” OF THE PATIENT’S “SENSE OF SELF” AS “BAD” MORE SPECIFICALLY MODIFYING THE PATIENT’S “SENSE OF SELF” AS “BAD” WILL REQUIRE “TOUGHING IT OUT” AT THE “INTIMATE EDGE” OF “AUTHENTIC RELATEDNESS” BOTH PARTICIPANTS BRINGING HEART AND SOUL TO THE “INTERSUBJECTIVE IN – BETWEEN” SUCH THAT THIS TIME THERE CAN INDEED BE A “DIFFERENT OUTCOME” 102
  • 103. AT THE END OF THE DAY THE RELATIONAL PERSPECTIVE OF MODEL 3 IS A STORY ABOUT TRANSFORMING THE PATIENT’S “DEFENSIVE NEED” TO RE – ENACT – COMPULSIVELY AND UNWITTINGLY – HER UNMASTERED EARLY – ON RELATIONAL DRAMAS ON THE STAGE OF HER LIFE INTO THE “ADAPTIVE CAPACITY” TO TAKE RESPONSIBILITY FOR HER DYSFUNCTIONAL WAYS OF ACTING, REACTING, AND INTERACTING 103
  • 104. 104
  • 105. IN CLOSING I WOULD LIKE TO BORROW FROM STEPHEN MITCHELL (1988) A WONDERFUL ANECDOTE THAT CAPTURES THE ESSENCE OF THE QUINTESSENTIAL STRUGGLE IN WHICH ALL OF US ARE ENGAGED AS WE ATTEMPT TO MASTER OUR ART MITCHELL WRITES – “<STRAVINSKY> HAD WRITTEN A NEW PIECE WITH A DIFFICULT VIOLIN PASSAGE. AFTER IT HAD BEEN IN REHEARSAL FOR SEVERAL WEEKS, THE SOLO VIOLINIST CAME TO STRAVINSKY AND SAID HE WAS SORRY, HE HAD TRIED HIS BEST, <BUT> THE PASSAGE WAS TOO DIFFICULT; NO VIOLINIST COULD PLAY IT. STRAVINSKY SAID, ‘I UNDERSTAND THAT. WHAT I AM AFTER IS THE SOUND OF SOMEONE TRYING TO PLAY IT.’” AS THERAPISTS, OUR WORK IS EXQUISITELY DIFFICULT AND FINELY TUNED – AND OFTEN WE WILL NOT BE ABLE TO GET IT JUST RIGHT – PERHAPS, HOWEVER, WE CAN CONSOLE OURSELVES WITH THE THOUGHT THAT IT IS THE EFFORT WE MAKE TO GET IT JUST RIGHT THAT WILL ULTIMATELY COUNT 105
  • 106. 106
  • 107. IF YOU WOULD LIKE TO BE ON MY MAILING LIST, PLEASE EMAIL ME AT MarthaStarkMD @ SynergyMed.solutions TO LET ME KNOW 107
  • 108. REFERENCES Akhtar, S. 2012. Psychoanalytic listening: Methods, limitations, and innovations. New York, NY: Routledge / Taylor & Francis Group. Bacal, H. 1998. Optimal responsiveness: How therapists heal their patients. Northvale, NJ: Jason Aronson. Bak, P. 1996. How nature works: The science of self-organized criticality. New York: Springer Publishing. Beckmann, R. 1991. Children who grieve: A manual for conducting support groups. Learning Publications. Benjamin, J. 2017. Beyond doer and done to: Recognition theory, intersubjectivity, and the third. London and New York: Routledge (Taylor & Francis Group). Bollas, C. 1989. The shadow of the object: Psychoanalysis of the unthought known. New York: Columbia University Press. Brach, T. 2004. Radical acceptance: Embracing your life with the heart of a Buddha. New York: Random House. 108
  • 109. Bromberg, P. M. Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: The Analytic Press. Calabrese, E. J. Hormesis: A conversation with a critic. Environmental Health Perspectives 2009 Sep;117(9):1339-1343. Cannon, W. B. 1932. The wisdom of the body. New York: W. W. Norton & Co. Casement, P. 1992. Learning from the patient. New York: Guilford Press. Coughlin, P. 2022. Facilitating the process of working through in psychotherapy: Mastering the middle game. London and New York: Routledge (Taylor & Francis Group). Ehrenberg, D. 1992. The intimate edge: Extending the reach of psychoanalytic interaction. New York: W. W. Norton & Co. Ferenczi, S. 1995. The clinical diary of Sandor Ferenczi. Cambridge, MA: Harvard University Press. Fisher, J. 2017. Healing the fragmented selves of trauma survivors: Overcoming internal self-alienation. London and New York: Routledge (Taylor & Francis Group). 109
  • 110. Freud, A. 1979. The ego and the mechanisms of defense: The writings of Anna Freud. Madison, CT: International Universities Press. Freud, S. 1914. Remembering, repeating and working through (Further recommendations on the technique of psycho-analysis II). Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913). London, UK: Hogarth Press. Giovacchini, P. 1986. Developmental disorders: The transitional space in mental breakdown and creative integration. Northvale, NJ: Jason Aronson. Goleman, D. 2007. Social intelligence: The new science of human. New York: Bantam Books. Hemingway, E. 1929. A farewell to arms. New York: Charles Scribner’s Sons. Hoffman, I. 2001. Ritual and spontaneity in the psychoanalytic process. Abingdon-on-Thames, UK: Routledge / Taylor & Francis. 110
  • 111. Keats, J. 1991. Lyric Poems. Mineola, NY: Dover Publications. Kohut, H. 1966. Forms and transformations of narcissism. Journal of the American Psychoanalytic Association 14(2):243-272. Krebs, C. 2013. Energetic kinesiology: Principles and practice. London, UK: Handspring Publishing. Kris, A. Resistance in convergent and in divergent conflicts. Psychoanalytic Quarterly 1985 (Oct);54(4):537-68. Leibenluft, E., Wehr, T. 1992. Is sleep deprivation useful in the treatment of depression? The American Journal of Psychiatry 149(2), 159-168. Mattson, M. P. Lifelong brain health is a lifelong challenge: From evolutionary principles to empirical evidence. Ageing Research Reviews 2015;20:37-45. Mitchell, S. 1988. Relational concepts in psychoanalysis: An integration. Cambridge, MA: Harvard University Press. Nelson, P. 1993. There’s a hole in my sidewalk: The romance of self discovery. Hillsboro, OR: Beyond Words Publishing. 111
  • 112. Paracelsus, T. 2004. The archidoxes of magic. Turner R (trans). Temecula, CA: Ibis Publishing. Real, T. 2022. Us: Getting past you and me to build a more loving relationship. Santa Monica, CA: Goop Press. Russell, P. 1980. The theory of the crunch (unpublished manuscript). Searles, H. 1979. The development of mature hope in the patient- therapist relationship. In Countertransference and Related Subjects: Selected Papers, pp. 479-502. New York: International Universities Press. Selye, H. 1978. The stress of life. New York: McGraw-Hill Book Co. Singer, T. & Tusche, A. 2013. Neuroeconomics: Chapter 27. Understanding others: Brain mechanisms of theory of mind and empathy. Cambridge, MA: Academic Press. Stark, M. 1994a. Working with resistance. Northvale, NJ: Jason Aronson. 112
  • 113. ----- 1994b. A primer on working with resistance. Northvale, NJ: Jason Aronson. ----- 1999. Modes of therapeutic action: Enhancement of knowledge, provision of experience, and engagement in relationship. Northvale, NJ: Jason Aronson. ----- 2015. The transformative power of optimal stress: From cursing the darkness to lighting a candle (International Psychotherapy Institute eBook). www . FreePsychotherapyBooks . org Tull, D. 2018. Relational mindfulness: A handbook for deepening our connection with ourselves, each other, and the planet. Somerville, MA: Wisdom Publications. Winnicott, D. W. 1949. Hate in the counter-transference. International Journal of Psychoanalysis 30:69-74. Zevon, W. 1996. I’ll sleep when I’m dead. Burbank, CA: Elektra Records. 113