Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Powerpoint accompanying workshop session from the Homeless and Housing Coalition of Kentucky's 2013 conference. Presented by Kristi Jedlicki and Sarah Buckler, Phoenix Health Care Clinic
This training focuses on using Strengths-based Case Management with homeless and formerly-
homeless clients to help them focus on solutions to the challenges they face, rather than
solely on the challenges and barriers to reaching their goals. The case manager and the
client work together to identify and utilize the client’s strengths to set both short-term and long-term goals in a
number of areas, such as life skills, education, employment, housing, and recovery.
This document discusses interpersonal attraction and why people are drawn to others. There are two main reasons for affiliation - social comparison and social exchange. Social comparison involves evaluating ourselves by comparing to similar others, while social exchange means seeking relationships where rewards outweigh costs. Additionally, people are motivated by five core social motives - belongingness, understanding, controlling, self-enhancement, and trust. Factors like proximity, similarity, and physical attractiveness can influence attraction. People prefer others who are similar in attitudes and validate their self-views due to desires for social comparison, familiarity, and cognitive consistency.
Explains the process by which we receive, interpret, analyze, remember and use information about the social world. Also attempts to explain the process of attribution and common errors we often commit in social perception.
Biopsychosocial spiritual model and geetaRajeev Kumar
The document discusses the Biopsychosocial-Spiritual (BPSS) model of health and existence. It explains that the model has evolved from earlier biological models to recognize psychosocial and spiritual factors. The BPSS model understands that health is influenced by one's whole existence, including physical, mental, social and spiritual dimensions. The document then discusses what the Bhagavad Gita says about existence according to the BPSS model. It explains that the Gita sees humans as more than just the physical body, and that biological, psychological, social and spiritual factors all influence health and well-being. The Gita's teachings on reincarnation and karma are also connected to the BPSS model's understanding of existence
This document discusses social cognition and related topics including motivation and social processing goals, personal control, and social situations and social competence. Some key points include:
- Personal goals and priorities shift across the lifespan from achievement to balance to reevaluation.
- Older adults emphasize emotional goals by focusing on positive emotions and avoiding negative ones.
- Personal control involves both primary control of external actions and secondary cognitive control of the self. Both types of control strategies are important for well-being.
- Social contexts can facilitate cognition and memory in older adults, such as through collaborative problem solving and storytelling with others.
This document discusses mental health and mental illness. It defines mental health as a state of well-being and balance between an individual and their environment according to the WHO. Key aspects of mental health include emotional intelligence, self-awareness, and resiliency. Mental illness is defined as maladaptive responses to stressors that interfere with daily life. Biological, psychological, and social factors can all contribute to mental illness. These include genetics, brain chemistry, trauma, and environmental stressors. The document provides an overview of the complex factors that influence both mental health and mental illness.
Clinical Psychology. By Theresa Lowry-Lehnen. Lecturer of Psychology.Theresa Lowry-Lehnen
The document provides information about the field of clinical psychology. It discusses several key points:
- Clinical psychology involves the study and application of psychology to understand, prevent, and relieve psychologically-based distress. Central to its practice are psychological assessment and psychotherapy.
- Clinical psychologists work within various therapy models to form a therapeutic alliance with clients and encourage new ways of thinking, feeling, and behaving. The major therapeutic perspectives are psychoanalytic, cognitive behavioral, existential-humanistic, and family systems therapy.
- Clinical psychologists are trained in psychological assessment, different therapy approaches, and analyzing psychometric tests. They draw from multiple approaches in their work with clients.
This summarizes the main ideas about the field
This document provides an overview of crisis theory and concepts from various theorists. It discusses the origins and key components of crisis theory as developed by Lindemann, Caplan, and others. Caplan's homeostasis concept of crisis as an upset to one's steady state is described. The document also outlines stages of a crisis reaction according to Caplan and others, including an initial threat, rise in tension, mobilization of solutions, and potential breakdown or restoration of equilibrium. Characteristics of crises and the subjective nature of crisis appraisal are also summarized.
Powerpoint accompanying workshop session from the Homeless and Housing Coalition of Kentucky's 2013 conference. Presented by Kristi Jedlicki and Sarah Buckler, Phoenix Health Care Clinic
This training focuses on using Strengths-based Case Management with homeless and formerly-
homeless clients to help them focus on solutions to the challenges they face, rather than
solely on the challenges and barriers to reaching their goals. The case manager and the
client work together to identify and utilize the client’s strengths to set both short-term and long-term goals in a
number of areas, such as life skills, education, employment, housing, and recovery.
This document discusses interpersonal attraction and why people are drawn to others. There are two main reasons for affiliation - social comparison and social exchange. Social comparison involves evaluating ourselves by comparing to similar others, while social exchange means seeking relationships where rewards outweigh costs. Additionally, people are motivated by five core social motives - belongingness, understanding, controlling, self-enhancement, and trust. Factors like proximity, similarity, and physical attractiveness can influence attraction. People prefer others who are similar in attitudes and validate their self-views due to desires for social comparison, familiarity, and cognitive consistency.
Explains the process by which we receive, interpret, analyze, remember and use information about the social world. Also attempts to explain the process of attribution and common errors we often commit in social perception.
Biopsychosocial spiritual model and geetaRajeev Kumar
The document discusses the Biopsychosocial-Spiritual (BPSS) model of health and existence. It explains that the model has evolved from earlier biological models to recognize psychosocial and spiritual factors. The BPSS model understands that health is influenced by one's whole existence, including physical, mental, social and spiritual dimensions. The document then discusses what the Bhagavad Gita says about existence according to the BPSS model. It explains that the Gita sees humans as more than just the physical body, and that biological, psychological, social and spiritual factors all influence health and well-being. The Gita's teachings on reincarnation and karma are also connected to the BPSS model's understanding of existence
This document discusses social cognition and related topics including motivation and social processing goals, personal control, and social situations and social competence. Some key points include:
- Personal goals and priorities shift across the lifespan from achievement to balance to reevaluation.
- Older adults emphasize emotional goals by focusing on positive emotions and avoiding negative ones.
- Personal control involves both primary control of external actions and secondary cognitive control of the self. Both types of control strategies are important for well-being.
- Social contexts can facilitate cognition and memory in older adults, such as through collaborative problem solving and storytelling with others.
This document discusses mental health and mental illness. It defines mental health as a state of well-being and balance between an individual and their environment according to the WHO. Key aspects of mental health include emotional intelligence, self-awareness, and resiliency. Mental illness is defined as maladaptive responses to stressors that interfere with daily life. Biological, psychological, and social factors can all contribute to mental illness. These include genetics, brain chemistry, trauma, and environmental stressors. The document provides an overview of the complex factors that influence both mental health and mental illness.
Clinical Psychology. By Theresa Lowry-Lehnen. Lecturer of Psychology.Theresa Lowry-Lehnen
The document provides information about the field of clinical psychology. It discusses several key points:
- Clinical psychology involves the study and application of psychology to understand, prevent, and relieve psychologically-based distress. Central to its practice are psychological assessment and psychotherapy.
- Clinical psychologists work within various therapy models to form a therapeutic alliance with clients and encourage new ways of thinking, feeling, and behaving. The major therapeutic perspectives are psychoanalytic, cognitive behavioral, existential-humanistic, and family systems therapy.
- Clinical psychologists are trained in psychological assessment, different therapy approaches, and analyzing psychometric tests. They draw from multiple approaches in their work with clients.
This summarizes the main ideas about the field
This document provides an overview of crisis theory and concepts from various theorists. It discusses the origins and key components of crisis theory as developed by Lindemann, Caplan, and others. Caplan's homeostasis concept of crisis as an upset to one's steady state is described. The document also outlines stages of a crisis reaction according to Caplan and others, including an initial threat, rise in tension, mobilization of solutions, and potential breakdown or restoration of equilibrium. Characteristics of crises and the subjective nature of crisis appraisal are also summarized.
The document discusses the ethical principles in counseling. It states that counselors have a responsibility to adhere to ethical guidelines in order to earn and maintain public trust. Counseling requires a commitment to competence, adherence to a code of conduct, and contributing to public well-being over monetary gain. The main ethical framework refers to principles of autonomy, fidelity, justice, beneficence, non-maleficence and self-respect. Specific ethical duties of counselors include maintaining client confidentiality, fostering client self-determination, acting in the client's best interest, avoiding harm, providing fair and impartial services, and respecting human rights and dignity.
Prejudice refers to prejudging someone or forming an opinion about them before knowing the relevant facts, usually in a negative way based on their group memberships. Stereotypes simplify our social world by reducing people to overgeneralized ideas about their group but can lead to prejudice when we assume certain characteristics of individuals based on their perceived group. Common types of prejudice include those based on gender, ethnicity/race, class, age, sexual orientation, disability, and more. It is important to be aware of our own prejudices and stereotypical thinking in order to prevent discrimination.
This document defines aggression and violence, and discusses various models and factors related to aggression. It begins by defining aggression as behavior intended to cause harm between individuals, which can be physical or emotional. Violence is defined as aggressive behavior using force. It then covers biological models of aggression including anatomical bases in the limbic system and hypothalamus, as well as neurotransmitters and hormones. Psychological models discussed include psychoanalytic, humanistic, and social learning theories. Social determinants of aggression highlighted include frustration, provocation, and media violence. The document concludes by covering prevention/control methods and cognitive theories of aggression.
Defense mechanisms are automatic psychological processes that protect individuals from anxiety and awareness of internal or external dangers. They can be adaptive in helping people lower anxiety to achieve goals, but can also be maladaptive and lead to distortions. Freud identified major defenses like suppression, altruism, humor, and sublimation that manage conflict on a relatively unconscious level. Defenses range from mature to neurotic to immature, with mature defenses being the most adaptive and psychotic defenses involving denial of reality.
Chronic illnesses are health conditions that last over six months. Examples include cancer, heart disease, and arthritis. Factors that contribute to chronic illnesses include heredity, lifestyle, and environment. People with chronic illnesses have ongoing needs related to employment, financial support, health care, housing, and self-esteem. Their socioeconomic status, age, and any disabilities can impact their ability to access resources to manage their condition.
Conflict arises from perceived incompatibilities between parties and can be exacerbated by social dilemmas, competition, injustice and misperception. Key causes of conflict include pursuing self-interest at the expense of others in social dilemmas, win-lose competition fostering negative views of opponents, perceived inequity in outcomes, and biases that lead parties to see themselves positively and opponents negatively. Peace can be achieved through contact between parties, cooperation on shared goals, open communication to find mutually agreeable solutions, and conciliation where one party makes unilateral concessions to build trust.
This document discusses guilt and provides interventions to help people deal with guilt. It defines guilt and explores its impacts. It identifies sources of guilt such as childhood experiences, religious teachings, and existential issues. The document provides activities people can do to address guilt, such as writing guilt slips, keeping a guilt journal, reframing situations, and using affirmations. It emphasizes that identifying sources of guilt is the first step and that holding onto guilt weighs people down.
This document discusses health psychology and stress. It defines health using the WHO definition and describes health psychology as concerned with behaviors affecting health. It discusses the biopsychosocial model of health and focuses on AIDS in the Philippines, noting social factors like commercial sex and meth use that increase risk. It defines stress and stressors, describes the General Adaptation Syndrome stages of alarm, resistance, and exhaustion. It also discusses coping strategies like problem-focused and emotion-focused coping, defense mechanisms, positive thinking, religion, and stress management programs. Finally, it notes culture can shape stress experiences and coping choices.
Principles of ethical standard in couples and familybrendabriseno
The document discusses ethical standards for couples and family therapy. It outlines that therapists must follow their professional affiliation's ethics codes as well as any state standards. Key ethical principles discussed include responsibility to clients through confidentiality, professional competence, responsibilities in relationships with students/supervisees, research participants, and the profession. Therapists must maintain standards in financial arrangements, advertising, and accurately representing their qualifications. The overall goal of these standards is to protect clients and support the profession.
The document discusses family systems therapy and outlines key concepts including viewing the family as an interdependent system, assessing family structure and dynamics around power, boundaries, roles and rules, and using structural interventions like mapping the family system and enactments to restructure problematic interaction patterns and balance boundaries. The goal of therapy is to help the executive subsystem function effectively by resolving issues, developing complementary roles and problem-solving skills, and balancing boundaries between family members and subsystems.
Prejudice has cognitive, affective, and behavioral components known as stereotypes, prejudice, and discrimination. Stereotypes are beliefs about social groups while prejudice consists of negative feelings toward those groups. Discrimination involves differential actions toward group members. Gender stereotypes see women as kind but dependent and men as assertive but insensitive. Prejudice and discrimination stem from threats to social groups, such as threats to status, resources, or self-esteem. Changing attitudes requires addressing the underlying emotions that drive prejudice.
This was released as Episode 373 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
This document discusses various techniques used in counseling and psychotherapy, including:
1. Prescribing tasks and directives to foster new ways of thinking and behaving.
2. Challenging symptoms, worldviews, and pushback through techniques like empty chair work and sculpting relationships.
3. Using genograms to provide context and track patterns across generations to better understand presenting problems.
It then provides examples of six techniques using chairs as props, such as open forums, decision making, and making emotions controllable. The benefits of these techniques in counseling are also summarized.
- Prejudice involves negative prejudgments or feelings toward others based on their group membership rather than their individual attributes. It can stem from emotional, social, cognitive, and personality factors.
- Stereotypes are overgeneralized beliefs about groups. They can be positive or negative and become problems when incorrectly applied to individuals. Stereotype threat describes how awareness of negative stereotypes can undermine performance.
- The fundamental attribution error involves explaining others' behaviors based mainly on internal factors rather than external situational influences. This satisfies the just-world hypothesis that people get what they deserve.
Psychological impact of chronic illness2Omar Moatamed
Chronic illness can cause psychological stress and impact coping abilities. It involves a cognitive appraisal of the illness in relation to one's resources. While it may cause anxiety, depression, guilt or anger, social support and personality can mediate these effects. Common emotional reactions include denial, anger, depression, and acceptance through various stages. Multimodal interventions aim to help patients adjust, manage stress and pain, learn coping skills, and strengthen family communication. Chronic illness strongly impacts social and emotional well-being, and better coping is linked to improved prognosis and health outcomes.
This is a slideshow explaining the importance of protecting patient privacy and confidentiality. This slideshow is for education and training purposes only.
http://positivetranceformations.com.au/blog/the-five-stages-of-grief-2/ According to Dr Kübler-Ross, there are five well-defined stages in the grief process, all of which are important parts of the way that we react to the inevitable loss that life brings. If we are unable to express grief during any stage of the process, the grief can become blocked or bottled up, and will need to be released later.
The document provides an overview of Emotionally Focused Therapy (EFT) for couples, describing its theoretical underpinnings in experiential and systemic approaches as well as attachment theory. EFT uses a three stage, nine step framework to assess negative interaction cycles, access underlying emotions, create new bonding experiences, and consolidate secure attachment between partners. The therapist aims to develop trust, soften rigid positions, and facilitate new solutions through enactments and emotional engagement.
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
The document discusses the ethical principles in counseling. It states that counselors have a responsibility to adhere to ethical guidelines in order to earn and maintain public trust. Counseling requires a commitment to competence, adherence to a code of conduct, and contributing to public well-being over monetary gain. The main ethical framework refers to principles of autonomy, fidelity, justice, beneficence, non-maleficence and self-respect. Specific ethical duties of counselors include maintaining client confidentiality, fostering client self-determination, acting in the client's best interest, avoiding harm, providing fair and impartial services, and respecting human rights and dignity.
Prejudice refers to prejudging someone or forming an opinion about them before knowing the relevant facts, usually in a negative way based on their group memberships. Stereotypes simplify our social world by reducing people to overgeneralized ideas about their group but can lead to prejudice when we assume certain characteristics of individuals based on their perceived group. Common types of prejudice include those based on gender, ethnicity/race, class, age, sexual orientation, disability, and more. It is important to be aware of our own prejudices and stereotypical thinking in order to prevent discrimination.
This document defines aggression and violence, and discusses various models and factors related to aggression. It begins by defining aggression as behavior intended to cause harm between individuals, which can be physical or emotional. Violence is defined as aggressive behavior using force. It then covers biological models of aggression including anatomical bases in the limbic system and hypothalamus, as well as neurotransmitters and hormones. Psychological models discussed include psychoanalytic, humanistic, and social learning theories. Social determinants of aggression highlighted include frustration, provocation, and media violence. The document concludes by covering prevention/control methods and cognitive theories of aggression.
Defense mechanisms are automatic psychological processes that protect individuals from anxiety and awareness of internal or external dangers. They can be adaptive in helping people lower anxiety to achieve goals, but can also be maladaptive and lead to distortions. Freud identified major defenses like suppression, altruism, humor, and sublimation that manage conflict on a relatively unconscious level. Defenses range from mature to neurotic to immature, with mature defenses being the most adaptive and psychotic defenses involving denial of reality.
Chronic illnesses are health conditions that last over six months. Examples include cancer, heart disease, and arthritis. Factors that contribute to chronic illnesses include heredity, lifestyle, and environment. People with chronic illnesses have ongoing needs related to employment, financial support, health care, housing, and self-esteem. Their socioeconomic status, age, and any disabilities can impact their ability to access resources to manage their condition.
Conflict arises from perceived incompatibilities between parties and can be exacerbated by social dilemmas, competition, injustice and misperception. Key causes of conflict include pursuing self-interest at the expense of others in social dilemmas, win-lose competition fostering negative views of opponents, perceived inequity in outcomes, and biases that lead parties to see themselves positively and opponents negatively. Peace can be achieved through contact between parties, cooperation on shared goals, open communication to find mutually agreeable solutions, and conciliation where one party makes unilateral concessions to build trust.
This document discusses guilt and provides interventions to help people deal with guilt. It defines guilt and explores its impacts. It identifies sources of guilt such as childhood experiences, religious teachings, and existential issues. The document provides activities people can do to address guilt, such as writing guilt slips, keeping a guilt journal, reframing situations, and using affirmations. It emphasizes that identifying sources of guilt is the first step and that holding onto guilt weighs people down.
This document discusses health psychology and stress. It defines health using the WHO definition and describes health psychology as concerned with behaviors affecting health. It discusses the biopsychosocial model of health and focuses on AIDS in the Philippines, noting social factors like commercial sex and meth use that increase risk. It defines stress and stressors, describes the General Adaptation Syndrome stages of alarm, resistance, and exhaustion. It also discusses coping strategies like problem-focused and emotion-focused coping, defense mechanisms, positive thinking, religion, and stress management programs. Finally, it notes culture can shape stress experiences and coping choices.
Principles of ethical standard in couples and familybrendabriseno
The document discusses ethical standards for couples and family therapy. It outlines that therapists must follow their professional affiliation's ethics codes as well as any state standards. Key ethical principles discussed include responsibility to clients through confidentiality, professional competence, responsibilities in relationships with students/supervisees, research participants, and the profession. Therapists must maintain standards in financial arrangements, advertising, and accurately representing their qualifications. The overall goal of these standards is to protect clients and support the profession.
The document discusses family systems therapy and outlines key concepts including viewing the family as an interdependent system, assessing family structure and dynamics around power, boundaries, roles and rules, and using structural interventions like mapping the family system and enactments to restructure problematic interaction patterns and balance boundaries. The goal of therapy is to help the executive subsystem function effectively by resolving issues, developing complementary roles and problem-solving skills, and balancing boundaries between family members and subsystems.
Prejudice has cognitive, affective, and behavioral components known as stereotypes, prejudice, and discrimination. Stereotypes are beliefs about social groups while prejudice consists of negative feelings toward those groups. Discrimination involves differential actions toward group members. Gender stereotypes see women as kind but dependent and men as assertive but insensitive. Prejudice and discrimination stem from threats to social groups, such as threats to status, resources, or self-esteem. Changing attitudes requires addressing the underlying emotions that drive prejudice.
This was released as Episode 373 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
This document discusses various techniques used in counseling and psychotherapy, including:
1. Prescribing tasks and directives to foster new ways of thinking and behaving.
2. Challenging symptoms, worldviews, and pushback through techniques like empty chair work and sculpting relationships.
3. Using genograms to provide context and track patterns across generations to better understand presenting problems.
It then provides examples of six techniques using chairs as props, such as open forums, decision making, and making emotions controllable. The benefits of these techniques in counseling are also summarized.
- Prejudice involves negative prejudgments or feelings toward others based on their group membership rather than their individual attributes. It can stem from emotional, social, cognitive, and personality factors.
- Stereotypes are overgeneralized beliefs about groups. They can be positive or negative and become problems when incorrectly applied to individuals. Stereotype threat describes how awareness of negative stereotypes can undermine performance.
- The fundamental attribution error involves explaining others' behaviors based mainly on internal factors rather than external situational influences. This satisfies the just-world hypothesis that people get what they deserve.
Psychological impact of chronic illness2Omar Moatamed
Chronic illness can cause psychological stress and impact coping abilities. It involves a cognitive appraisal of the illness in relation to one's resources. While it may cause anxiety, depression, guilt or anger, social support and personality can mediate these effects. Common emotional reactions include denial, anger, depression, and acceptance through various stages. Multimodal interventions aim to help patients adjust, manage stress and pain, learn coping skills, and strengthen family communication. Chronic illness strongly impacts social and emotional well-being, and better coping is linked to improved prognosis and health outcomes.
This is a slideshow explaining the importance of protecting patient privacy and confidentiality. This slideshow is for education and training purposes only.
http://positivetranceformations.com.au/blog/the-five-stages-of-grief-2/ According to Dr Kübler-Ross, there are five well-defined stages in the grief process, all of which are important parts of the way that we react to the inevitable loss that life brings. If we are unable to express grief during any stage of the process, the grief can become blocked or bottled up, and will need to be released later.
The document provides an overview of Emotionally Focused Therapy (EFT) for couples, describing its theoretical underpinnings in experiential and systemic approaches as well as attachment theory. EFT uses a three stage, nine step framework to assess negative interaction cycles, access underlying emotions, create new bonding experiences, and consolidate secure attachment between partners. The therapist aims to develop trust, soften rigid positions, and facilitate new solutions through enactments and emotional engagement.
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...Martha Stark MD
As you sit with your clients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our clients. Whether working within (1) the interpretive perspective of classical psychoanalytic theory, (2) the corrective-provision perspective of self psychology, or (3) the intersubjective perspective of contemporary relational theory, we are always busy deciding when we should highlight the healthy forces within our clients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.”
With our finger always on the pulse of the level of the client’s anxiety, we are indeed ever focused, be it consciously or unconsciously, on whether we think the client will be able to tolerate further (anxiety-provoking) challenge or will require additional (anxiety-assuaging) support – a critically important balance that is needed if the therapeutic endeavor is to be advanced.
To illustrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the client’s “defensive need” to maintain “same old, same old” and the client’s “adaptive capacity” to embrace “something new, different, and better.”
Clinical vignettes will be offered demonstrating judicious and ongoing use of these “optimally stressful” interventions that alternately support and then challenge the defense, thereby galvanizing advancement of the client, over time, from psychological rigidity (defense) to psychological flexibility (adaptation).
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our clients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of these interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD
The document outlines Martha Stark's psychodynamic synergy paradigm, which utilizes five therapeutic models to catalyze psychological change. It focuses on the first three models: 1) the interpretive perspective of classical psychoanalysis, 2) the corrective provision perspective of self psychology, and 3) the intersubjective perspective of contemporary relational theory. The therapeutic actions of these three models involve "working through" optimal stress created by interventions that alternate between challenge and support. Model 1 uses interpretations to resolve internal conflicts. Model 2 helps patients grieve disappointments. Model 3 promotes taking accountability in relationships. The goal across all three is to transform patients from rigidity to flexibility.
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptxMartha Stark MD
The document discusses the transformative power of optimal stress in triggering recovery and healing. It argues that superimposing an acute stress or injury on top of a chronic one can help the body heal. This is likened to wound debridement, which removes damaged tissue and provokes healing by mildly aggravating the area. Similarly in the mind, providing optimal stress in the context of an empathic therapy relationship can help overcome resistance to change. The goal of psychotherapy is to facilitate processing of stressful experiences from defensive reactions to adaptive responses, and from dysfunction to functionality.
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...Martha Stark MD
Superimposing an acute physical injury on top of a chronic one is sometimes exactly what the body needs in order to heal.
But just as with the body, where a condition might not heal until it is made acute, so too with the mind. The therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – can be the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will galvanize the patient to action and provoke healing.
With our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we can formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is a firm belief in the underlying resilience patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from less-evolved defensive reaction to more-evolved adaptive response.
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD
This document discusses the transformative power of optimal stress in precipitating disruption to trigger repair. It describes how controlled damage or optimally stressful interventions can provoke recovery by challenging defenses and supporting the patient. This process involves iterative cycles of destabilization in reaction to challenges, followed by restabilization in response to support, allowing the patient to reintegrate at higher levels of functionality and adaptive capacity. The goal is to transform dysfunctional defenses into more functional adaptations through challenging defenses and tapping into the patient's resilience in the context of an empathic therapy relationship.
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD
The document discusses the therapeutic use of optimal stress to provoke recovery in psychotherapy. It argues that superimposing an acute stress or disruption on top of a chronic issue can help the body or mind heal. This concept of "controlled damage" or "optimal stress" can trigger the innate ability to self-repair. The therapist can use optimally stressful interventions that alternately challenge and support defenses to facilitate iterative cycles of destabilization and restabilization, allowing the patient to process experiences and adapt at higher levels of functioning. The goal is to transform dysfunctional defenses into more functional adaptations through this process of disruption and repair.
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD
Are you wishing that you had a better grasp of psychodynamic concepts and their application to the clinical hour? With an emphasis always on the translation of theory into practice, in this 2-hour intensive training Dr. Martha Stark will be highlighting the three major psychoanalytic schools:
(Model 1) the 1-person perspective of classical psychoanalysis – a “cognitive” approach that emphasizes “enhancement of knowledge” and “interpreting”;
(Model 2) the 1½-person perspective of self psychology – an “affective” approach that emphasizes “provision of experience” and “grieving”; and
(Model 3) the 2-person perspective of contemporary relational theory – a “relational” approach that emphasizes “engagement in relationship” and “negotiating mutual enactment.”
Martha is particularly interested in (1) how the “therapeutic process” between patient and therapist evolves over time, (2) what happens moment-to-moment in the intersubjective space between patient and therapist, (3) how healing cycles of disruption and repair can be generated when the therapist alternately challenges the patient’s defense and then supports it, and (4) how the ongoing provision of “optimal stress” can ultimately “incentivize” deep, enduring, characterological change in the patient.
In order to facilitate this advancement of the patient from psychological rigidity to psychological flexibility and from defensive reaction to adaptive response, Martha will be teaching three “optimally stressful” template statements – Model 1 “conflict statements,” Model 2 “disillusionment statements,” and Model 3 “accountability statements” – all of which are strategically designed to “precipitate disruption” in order to “trigger repair,” thereby healing unmastered early-on relational traumas and deeply embedded emotional injuries.
Martha will be presenting several brief clinical vignettes to demonstrate the transformation of “resistance” into “awareness” (Model 1), “relentless hope” into “acceptance” (Model 2), and “re-enactment” into “accountability” (Model 3).
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD
This document discusses the therapeutic use of optimal stress to provoke recovery from psychological defenses to more adaptive responses. It argues that psychodynamic psychotherapy can help patients master past traumatic experiences by superimposing an acute stressor to trigger healing cycles of disruption and repair. This allows defenses to gradually evolve into more flexible adaptations through iterative cycles of destabilization caused by therapeutic challenges, followed by restabilization due to support. The goal is to transform "rigid defense" into "flexible adaptation" and help patients thrive rather than just survive.
Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivi...Martha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...Martha Stark MD
This document discusses the transformative power of optimal stress in psychotherapy. It argues that precipitating disruption through optimally stressful interventions can trigger repair and healing in patients, analogous to how physical injuries sometimes need to be aggravated to promote healing. Three models of therapeutic action are described:
1) The interpretive perspective focuses on the patient's internal dynamics and conflicts.
2) Self psychology perspectives focus on correcting deficient early experiences and providing empathic support.
3) Relational theories emphasize authentic engagement and accountability in the therapeutic relationship.
The document suggests these approaches can be used synergistically based on the patient's immediate needs, to help transform dysfunctional defenses into more functional adaptations over the course of treatment.
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...Martha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD
My most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model (Model 5 of my Psychodynamic Synergy Paradigm) that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (whether real or simply envisioned). A constructivist model at heart, this freshly minted model features a quantum-neuroscientific approach to healing “analysis paralysis.”
This newest addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 7 Apr 2022 – Understanding Life Backward but Living It Forw...Martha Stark MD
This most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (both real and simply envisioned).
A constructivist model at heart, the freshly minted Model 5 of my Psychodynamic Synergy Paradigm is a quantum-neuroscientific approach to healing “analysis paralysis.” This most recent addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
Indeed, over the course of the past two decades, a dedicated group of cognitive neuroscientists, ever intent upon teasing out the neural mechanisms underlying the dynamic nature of memory, have been using advanced neuroimaging techniques to deepen their understanding of the brain’s remarkable neuroplasticity, that is, the brain’s innate capacity continuously and adaptively to reorganize itself in response to ongoing environmental stimulation – although, and especially in the case of traumatic experiences, only if certain conditions are met.
More specifically, repeated embodied juxtaposition of the reactivated experience of something old and bad with the intentioned experience of something new and good will create decisive – and potentially transformational – mismatch experiences. If these mismatch experiences are repeated often enough, forcefully enough, and joltingly enough within the critical time frame of four to six hours, then the ongoing violations of conditioned expectation will eventually trigger energetic disentanglement of the patient’s toxic past from her present and quantum advancement of the patient from entrenched inaction to intentioned action as growth-impeding and disempowering narratives are replaced by growth-promoting and empowering ones.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
To the point here are the pithy words of the neuroscientist Iryna Ethell (2018), “To learn we must first forget.”
Similar to Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptx (20)
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD
If deep and enduring psychodynamic change is the ultimate goal of treatment, then periodically juxtaposing seemingly contradictory “forces” (Hegel’s thesis and antithesis) will eventually jump-start the patient’s “adaptive recovery” by creating optimally stressful, growth-incentivizing “mismatch experiences.”
I will be proposing use of something to which I refer as a “conflict statement” – a clinically useful and almost universally applicable therapeutic intervention strategically designed to target internal conflictedness between anxiety-provoking (but ultimately growth-promoting) forces pressing “yes” and anxiety-relieving (but growth-impeding) resistant counterforces defending “no.”
The stress and strain of the “destabilizing dissonance” hereby created will provide the “therapeutic leverage” needed for the patient gradually, over time, to relinquish the tenacity of her rigid attachment to the defense in favor of a more flexible adaptation – a “compromise position” that will “reconcile their common truths” (Hegel’s synthesis) and transform conflict into collaboration.
The strategic construction of conflict statements requires of the therapist that she be able both to support the patient’s defense by “being with the patient where she is” and to challenge the patient’s defense by “directing the patient’s attention to where the therapist would want her to go.” I will be offering specific clinical examples to demonstrate the impact of these powerfully impactful psychotherapeutic interventions. No pain, no gain…
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
Many a patient, as a child, has suffered great heartache at the hands of a misguided, even if well-intentioned, parent, be it in the form of psychological trauma and abuse (too much bad) or emotional deprivation and neglect (not enough good). Such a patient may never have had occasion to confront the pain of her grief about the parent's unwitting but devastating betrayal of her. Instead, she has defended herself against the pain of her heartache by pushing it, unprocessed, out of her awareness and clinging instead to the illusion of her parent (or a stand-in for her parent) as good and as ultimately forthcoming if she (the patient) could but get it right.
Under the sway of her repetition compulsion, the patient – as she struggles through her life – will find herself delivering into each new relationship her desperate hope that perhaps this time, were she to be but good enough, want it badly enough, or suffer deeply enough, she might yet be able to transform this new object of her relentless desire into the perfect parent she should have had as a child – but never did (Stark 1994a, 1994b, 1999, 2015).
As long as the patient continues her relentless pursuits, however, and refuses to come to terms with the reality of the limitations, separateness, and immutability of the people in her world – and the limits of her power to make them change – then she will be consigning herself to a lifetime of chronic frustration, heartache, and unremitting feelings of impotent rage and profound despair.
Elvin Semrad (Rako 1983) captures this poignantly with the following: “Pretending that <something> can be when it can’t is how people break their heart.”
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdfMartha Stark MD
I have always found the following quote from Gary Schwartz’s 1999 The Living Energy Universe to be inspirational: “One of science’s greatest challenges is to discover certain principles that will explain, integrate, and predict large numbers of seemingly unrelated phenomena.” So too my goal has long been to be able to tease out overarching principles – themes, patterns, and repetitions – that that are relevant in the deep healing work that we do as psychotherapists.
Drawing upon concepts from fields as diverse as systems theory, chaos theory, quantum mechanics, solid-state physics, toxicology, and psychoanalysis to inform my understanding, on the pages that follow I will be offering what I hope will prove to be a clinically useful conceptual framework for understanding how it is that healing takes place – be it of the body or of the mind. More specifically, I will be speaking both to what exactly provides the therapeutic leverage for healing chronic dysfunction and to how we, as psychotherapists, can facilitate that process?
Just as with the body, where a condition might not heal until it is made acute, so too with the mind. In other words, whether we are dealing with body or mind, superimposing an acute injury on top of a chronic one is sometimes exactly what a person needs in order to trigger the healing process.
More specifically, the therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – is often the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in our patients with longstanding emotional injuries and scars.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will serve simply to reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will “galvanize to action” and provoke healing. I refer to this as the Goldilocks Principle of Healing.
And so it is that with our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is my firm belief in the
underlying resilience that patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from dysfunctional defensive reaction to more functional adaptive response.
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdfMartha Stark MD
Freud’s interest was in the internal conflict that exists between, on the one hand, untamed id drives (most notably sexual and aggressive ones) clamoring for gratification and release and, on the other hand, the defenses mobilized by an undeveloped ego made anxious by the threatened breakthrough of those drives – conflict that will create neurotic suffering and interfere with the capacity to derive pleasure and fulfillment from love, work, and play (Freud 1926).
Using as a springboard Freud’s premises of drive-defense conflict as the source of a person’s difficulties in life and of the goal of treatment as therefore transformation of id energy into ego structure so that primitive defenses can be relinquished and conflict resolved – “Where id was, there shall ego be” (Freud 1923), I will go on to broaden Freud’s conceptualization of neurotic conflict to encompass, more generally, growth-impeding tension between anxiety-provoking but ultimately health-promoting internal forces pressing yes and anxiety- assuaging internal counterforces defending no.
The aim of treatment will then become (1) to tame the id so that its now more manageable energy can be redirected into more constructive channels and used to power the pursuit of healthier endeavors and (2) to strengthen the ego so that it will become both better able to cope with the multitude of anxiety-provoking stressors (internal and external) to which it is being continuously exposed and more skilled at harnessing id energy to fuel actualization of potential. In essence, a tamer id and a stronger ego will enable the patient to cope with the stress of life (Selye 1978) by adapting instead of defending – “Where defense was, there shall adaptation be.”
In the treatment situation, the therapist will offer psychotherapeutic interventions specifically designed to precipitate disruption in order to trigger repair (Stark 2008, 2012, 2014). To be effective against dysfunctional defenses that have become firmly entrenched over time, despite having long since outlived their usefulness, these therapeutic interventions must be optimally stressful. In other words, they must be strategically formulated to offer just the right combination of challenge and support.
Martha Stark MD – 1994 A Primer on Working with Resistance.pdfMartha Stark MD
Every day after work, a very depressed young man sits in the dark in his living room hour after hour, doing nothing, his mind blank. By his side is his stereo and a magnificent collection of his favorite classical music. The flick of a switch and he would feel better- and yet night after night, overwhelmed with despair, he just sits, never once touching that switch.
I would like to suggest that we think of this man as being in a state of internal conflict (although he may not, at this point, be aware of such conflict). He could turn on his stereo, but he does not. He could do something that would make him feel better, but he does nothing. Within this man is tension between what he "should" let himself do and what he finds himself doing instead.
In general, patients both do and don't want to get better. They both do and don't want to maintain things as they are. They both do and don't want to get on with their lives. They both are and aren't invested in their suffering. They are truly conflicted about all the choices that confront them.
The patient may protest that he desperately wants to change. He does and he doesn't. He may insist that he would do anything in order to feel better. Well, yes and no. On some level, everybody wants things to be better, but few are willing to change.
Drive theory conceives of conflict as involving internal tension between id impulse insisting "yes" and ego defense protesting "no" (with the superego coming down usually on the side of the ego). In Ralph Greenson's (1967) words: "A neurotic conflict is an uncon- scious conflict between an id impulse seeking discharge and an ego defense warding off the impulse's direct discharge or access to consciousness" (p. 17).
Although drives are considered part of the id, affects (drive derivatives) are thought to reside in the ego; in fact, the ego is said to be the seat of all affects. When Freud writes of psychic conflict between the id and the ego, it is understood that sometimes he is referring to conflict between an id drive and an ego defense and sometimes he is referring to conflict between an anxiety-provoking affect (in the ego but deriving from the id) and an ego defense.
Martha Stark MD – 1994 Working with Resistance.pdfMartha Stark MD
This book is about the patient’s resistance and his refusal to grieve. Drawing upon concepts from classical psychoanalysis, object relations theory, and self psychology, I present a model of the mind that takes into consideration the relationship between unmourned losses and how such losses are internally recorded – as both absence of good (structural deficit) and presence of bad (structural conflict). These internal records of traumatic disappointments sustained early on give rise to forces that interfere with the patient’s movement toward health – forces that constitute, therefore, the resistance.
Within the patient is a tension between that which the patient should let himself do/feel and that which he does/feels instead. Patient and therapist, as part of their work, will need to be able to understand and name, in a profoundly respectful fashion, both sets of forces –both those healthy ones, which impel the patient in the direction of progress, and those unhealthy resistive ones, which impede such progress. As part of the work to be done, the patient must eventually come to appreciate his investment in his defenses, how they serve him, and the price he pays for holding on to them.
My interest is in the interface between theory and practice –the ways in which theoretical constructs can be translated into the clinical situation; to that end, I suggest specific, prototypical interventions for each step of the working-through process.
My contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects. Instead, he protects himself from the pain of knowing the truth about his objects by clinging to misperceptions of them; holding on to his defensive need not to know enables him not to feel his grief.
To the extent that the patient is defended, to that extent will he be resistant to doing the work that needs ultimately to be done – grief work that will enable him to let go of the past, let go of his relentless pursuit of infantile gratification, and let go of his compulsive repetitions. Only as the patient grieves, doing now what he could not possibly do as a child, will he get better.
I believe that mental health has to do with the capacity to experience one’s objects as they are, uncontaminated by the need for them to be otherwise. A goal of treatment, therefore, is to transform the patient’s need for his objects to be other than who they are into the capacity to accept them as they are.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...Martha Stark MD
Over the course of the decades, my own approach has become much more integrative and holistic – one that appreciates the complex interdependence of mind and body and the critical role played by the impact of stress on the MindBodyMatrix.
The living system – the ground regulation system – the divine matrix – the web of life – a liquid crystal through which information and energy flow.
More specifically, I will be speaking to the role played by limbic kindling and the resultant hypersensitivity to stress that is a hallmark of depressed patients.
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptxMartha Stark MD
This document provides an overview of a seminar on an existential-humanistic approach to healing brokenness and easing despair in patients. The seminar will focus on Model 4 patients who have experienced early heartbreak and withdrawal from relationships due to a "shattered heart". It will discuss helping patients overcome dread of emotional surrender and providing an opportunity to "regress in order to redo" early experiences. The presenter's psychodynamic synergy paradigm incorporates five therapeutic models, including one focused on patients experiencing relentless despair and nonrelatedness due to early relational failures.
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptxMartha Stark MD
This document discusses coronary artery disease and the impact of stress on heart health. It notes that coronary artery disease often develops silently and can cause sudden death in some cases. Chronic stress can damage blood vessels and cause plaque buildup over time by increasing blood pressure and viscosity. Psychological stress, depression, obesity, and other risk factors place cumulative stress on the heart and compromise its ability to adapt. Maintaining the heart's resilience by reducing stressors and replenishing nutrients is important for cardiovascular health.
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...Martha Stark MD
The document discusses how coherence emerges from chaos in complex adaptive systems like living organisms. It argues that through ongoing cycles of disruption and repair, such systems can self-organize and evolve from disorder to higher levels of order and coherence in response to environmental inputs. The ability of a system to process and integrate stressors over time determines whether it progresses towards health or disease.
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptxMartha Stark MD
traumatic stress – stress that the system cannot process and must therefore defend against
optimal stress – stress that the system can process, integrate, and ultimately adapt to, although always at some cost to the system
it's how well the living system (the MindBodyMatrix) is able to manage the cumulative impact of the myriad environmental stressors to which it is being continuously exposed that will make of them either traumatic events or growth opportunities
and that ability to manage stress is a story about the system's ability to process, integrate, and adapt to the impact of environmental challenge, input from the outside that either threatens to overwhelm the system or prompts the system to mobilize its ability to heal itself
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptxMartha Stark MD
Unexplained Chronic Illness
Martin Pall's compelling conceptualization of the excitotoxic cascade and its pivotal role in both the initiation and the perpetuation of chronic multisystem illnesses
one or more short-term stressors
chemical sensitivity – pesticides and organic solvents
chronic fatigue – bacterial and viral infections
fibromyalgia – physical traumas
PTSD – severe psychological traumas
to which the body responds with an outpouring of
excitotoxins (glutamate)
inflammatory factors (cytokines and eicosanoids)
free radicals (nitric oxide)
stress-induced outpouring of endogenous excitotoxins, inflammatory cytokines, and free radicals sets in motion (in certain susceptible individuals) the nitric oxide / peroxynitrite cycle
a viciously destructive, self-propagating cycle involving
immune stimulation, inflammatory cytokines, membrane destabilization, synaptic overactivity, opening of calcium-permeable channels, massive calcium influx, etc.
and culminating in chronic illness
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
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
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
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
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
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
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
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
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
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
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
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
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
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.”
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
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
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
107. IF YOU WOULD LIKE
TO BE ON MY
MAILING LIST,
PLEASE EMAIL ME AT
MarthaStarkMD @
SynergyMed.solutions
TO LET ME KNOW
107
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