Martha Stark MD – 22 Jun 2018 – A Heart Shattered, Relentless Despair, and A Life Unlived.pptx
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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.
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Martha Stark MD – 11 Feb 2022 – A Heart Shattered, The Private Self, and A Li...
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
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 – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
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 – 2 Nov 2022 – Relentless Hope – The Refusal to Grieve.pptx
This document provides an overview and analysis of the concept of "relentless hope", which refers to clinging to unrealistic hope as a defense mechanism to avoid grieving disappointment. The document discusses how relentless hope fuels both masochism and sadism in relationships as the patient refuses to accept limits and separateness from others. Their relentless pursuit of unattainable goals stems from introjecting "bad" childhood objects and splitting them into exciting and rejecting parts.
Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptx
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 – 14 Nov 2021 – A Heart Shattered, The Private Self, and A Li...
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
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.
Recommended
Martha Stark MD – 11 Feb 2022 – A Heart Shattered, The Private Self, and A Li...
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptx
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...
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 – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptx
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 – 2 Nov 2022 – Relentless Hope – The Refusal to Grieve.pptx
This document provides an overview and analysis of the concept of "relentless hope", which refers to clinging to unrealistic hope as a defense mechanism to avoid grieving disappointment. The document discusses how relentless hope fuels both masochism and sadism in relationships as the patient refuses to accept limits and separateness from others. Their relentless pursuit of unattainable goals stems from introjecting "bad" childhood objects and splitting them into exciting and rejecting parts.
Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptx
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 – 14 Nov 2021 – A Heart Shattered, The Private Self, and A Li...
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their hearts shattered – only then to find themselves overwhelmed by a terrifying sense of alienation and harrowing loneliness. Instead of relentless hope, their experience is of relentless despair.
Clinical vignettes will be offered that demonstrate how the therapist, ever attuned to the patient’s intense ambivalence about remaining hidden vs. becoming found, can help the patient overcome her dread of surrender to resourceless dependence (Khan 1972) such that there can be moments of authentic meeting (Guntrip 1969) between patient and therapist that restore purpose, direction, and meaning to an existence that might otherwise have remained desolate, impoverished, and desperately lonely.
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx
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 – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
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 – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
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 – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
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 – 29 Apr 2022 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychodynamic psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope arises in the context of surviving disappointment and heartbreak. By the same token, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
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 – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
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 – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
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 – 24 Sep 2021 – A Heart Shattered, The Private Self, and Rele...
This document discusses the experience of patients who have developed a "false self" due to early childhood trauma or an inability to have their emotional needs met. It explores how therapy can help such patients access their "true self" by providing an environment where the patient can feel in control and absolutely dependent on the therapist without fear of abandonment. Several case studies and songs are referenced that illustrate the disconnect between a person's public and private selves when early heartbreak or lack of a supportive caregiver has occurred. The goal of the therapeutic approach presented is to allow patients to repair damaged parts of themselves by experiencing reliable care and empathy from their therapist.
Martha Stark MD – 19 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
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 – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Patients
who
have
never
fully
confronted – and grieved – the
pain
of
their
early-on heartbreak
will
often
cling
tenaciously
to
their
hope
that
perhaps
someday
the
object
of their
desire
will
be
forthcoming.
But
there
are
others
who,
in
the
aftermath
of
their
early-on
heartbreak,
will
find
themselves
withdrawing
completely
from
the
world
of
objects – their
heart
shattered...
To
protect
themselves
against
being
once
again
devastated,
this
latter
group
of patients
will
retreat,
withdraw,
detach
themselves
from
relationships – psychic
retreat, schizoid
withdrawal,
emotional
detachment
from
the
world
of
people,
from
life
itself – only
then
to
find
themselves
overwhelmed
by
intense
feelings
of
isolation,
alienation, and
emptiness – the
competent,
accomplished,
cheerful,
compliant
false
(public)
self
they present
to
the
world
belying
the
truth
that
lies
hidden
within,
namely,
not
only
their private
turmoil,
tormented
heartbreak,
harrowing
loneliness,
and
annihilating
terror
but also
their
stymied
creativity
and
desperate
(albeit
conflicted)
longing
for
meaningful connectedness
with
the
world.
Instead
of
relentless
hope,
which
figures
prominently
in
my
Model
2
(an
absence
of good
model
that
focuses
on
the
patient’s
relentless
pursuit
of
new
good),
and
its
cousin relentless
outrage,
which
figures
prominently
in
my
Model
3
(a
presence
of
bad
model that
focuses
on
the
patient’s
compulsive
re-enactment
of
old
bad
in
the
face
of
frustrated desire),
the
experience
of
being-in-the-world
for
these
latter
(Model
4)
patients
will
be one
of
relentless
despair – a
profound
hopelessness
that
they
keep
hidden
behind
the false
self
they
present
to
the
world,
a
self-protective
armor
that
masks
the
deeply entrenched
brokenness
and
thwarted
potential
of
the
true
self
(Stark
2017).
Whereas
the
relentless
hope
of
the
Model
2
patient
and
the
relentless
outrage
of
the Model
3
patient
speak
to
the
patient’s
intense
(albeit
maladaptive)
engagement
with
the world
of
objects,
the
relentless
despair
of
the
Model
4
patient
speaks
to
the
patient’s
utter lack
of
any
real
engagement
with
the
world
of
objects.
Martha Stark MD – 13 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a stance to which we desperately cling in order not to have to feel the pain of our disappointment in the object, the hope a defense against grieving; our relentless outrage is the stance to which we resort in those moments of dawning recognition that, despite our best efforts and most fervent desire, the object of our intense desire might never be forthcoming after all; and our relentless despair is the stance to which we retreat when our hearts have been shattered and it hurts too much to do anything but withdraw from the world – and, even, from life itself.
The masochistic defense of relentless hope, the sadistic defense of relentless outrage, and the schizoid defense of relentless despair all speak to our refusal to confront – and grieve – the limitations, separateness, and immutability of the object.
Psychodynamic psychotherapy offers patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope arises in the context of surviving disappointment…
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...
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.
Susceptibility
The document discusses the concept of susceptibility in homeopathy. It provides definitions from homeopathic scholars on susceptibility as the body's ability to receive impressions and react to stimuli. Susceptibility plays a role in health and disease and determines how the body will respond to remedies. There are different types of susceptibility including natural, morbid, and artificial susceptibility induced by medicines. Factors like constitution, age, habits modify one's susceptibility. Homeopathy aims to restore normal susceptibility through similar remedies to cure diseases.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
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 – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
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 – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...
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 – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
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 – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
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...
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…
More Related Content
Similar to Martha Stark MD – 22 Jun 2018 – A Heart Shattered, Relentless Despair, and A Life Unlived.pptx
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
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 – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
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 – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
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 – 29 Apr 2022 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychodynamic psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope arises in the context of surviving disappointment and heartbreak. By the same token, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
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 – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
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 – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
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 – 24 Sep 2021 – A Heart Shattered, The Private Self, and Rele...
This document discusses the experience of patients who have developed a "false self" due to early childhood trauma or an inability to have their emotional needs met. It explores how therapy can help such patients access their "true self" by providing an environment where the patient can feel in control and absolutely dependent on the therapist without fear of abandonment. Several case studies and songs are referenced that illustrate the disconnect between a person's public and private selves when early heartbreak or lack of a supportive caregiver has occurred. The goal of the therapeutic approach presented is to allow patients to repair damaged parts of themselves by experiencing reliable care and empathy from their therapist.
Martha Stark MD – 19 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a defense to which patients cling in order not to have to feel the pain of their disappointment in the object – the hope a defense ultimately against grieving. The refusal to deal with the pain of their grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which such patients pursue it, both the relentlessness of their hope that they might yet be able to make the object over into what they would want it to be and the relentlessness of their outrage in those moments of dawning recognition that, despite their best efforts and most fervent desire, they might never be able to make that actually happen.
Psychotherapy offers these patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope will arise in the context of surviving their disappointment and heartbreak. In truth, it could be said that maturity involves transforming the infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
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 – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Patients
who
have
never
fully
confronted – and grieved – the
pain
of
their
early-on heartbreak
will
often
cling
tenaciously
to
their
hope
that
perhaps
someday
the
object
of their
desire
will
be
forthcoming.
But
there
are
others
who,
in
the
aftermath
of
their
early-on
heartbreak,
will
find
themselves
withdrawing
completely
from
the
world
of
objects – their
heart
shattered...
To
protect
themselves
against
being
once
again
devastated,
this
latter
group
of patients
will
retreat,
withdraw,
detach
themselves
from
relationships – psychic
retreat, schizoid
withdrawal,
emotional
detachment
from
the
world
of
people,
from
life
itself – only
then
to
find
themselves
overwhelmed
by
intense
feelings
of
isolation,
alienation, and
emptiness – the
competent,
accomplished,
cheerful,
compliant
false
(public)
self
they present
to
the
world
belying
the
truth
that
lies
hidden
within,
namely,
not
only
their private
turmoil,
tormented
heartbreak,
harrowing
loneliness,
and
annihilating
terror
but also
their
stymied
creativity
and
desperate
(albeit
conflicted)
longing
for
meaningful connectedness
with
the
world.
Instead
of
relentless
hope,
which
figures
prominently
in
my
Model
2
(an
absence
of good
model
that
focuses
on
the
patient’s
relentless
pursuit
of
new
good),
and
its
cousin relentless
outrage,
which
figures
prominently
in
my
Model
3
(a
presence
of
bad
model that
focuses
on
the
patient’s
compulsive
re-enactment
of
old
bad
in
the
face
of
frustrated desire),
the
experience
of
being-in-the-world
for
these
latter
(Model
4)
patients
will
be one
of
relentless
despair – a
profound
hopelessness
that
they
keep
hidden
behind
the false
self
they
present
to
the
world,
a
self-protective
armor
that
masks
the
deeply entrenched
brokenness
and
thwarted
potential
of
the
true
self
(Stark
2017).
Whereas
the
relentless
hope
of
the
Model
2
patient
and
the
relentless
outrage
of
the Model
3
patient
speak
to
the
patient’s
intense
(albeit
maladaptive)
engagement
with
the world
of
objects,
the
relentless
despair
of
the
Model
4
patient
speaks
to
the
patient’s
utter lack
of
any
real
engagement
with
the
world
of
objects.
Martha Stark MD – 13 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Relentless hope is a stance to which we desperately cling in order not to have to feel the pain of our disappointment in the object, the hope a defense against grieving; our relentless outrage is the stance to which we resort in those moments of dawning recognition that, despite our best efforts and most fervent desire, the object of our intense desire might never be forthcoming after all; and our relentless despair is the stance to which we retreat when our hearts have been shattered and it hurts too much to do anything but withdraw from the world – and, even, from life itself.
The masochistic defense of relentless hope, the sadistic defense of relentless outrage, and the schizoid defense of relentless despair all speak to our refusal to confront – and grieve – the limitations, separateness, and immutability of the object.
Psychodynamic psychotherapy offers patients an opportunity, albeit belatedly, to grieve their early-on heartbreak – in the process transforming the defensive need to hold on into the adaptive capacity to relent, to forgive, to accept, to separate, to let go, and to move on. Realistic hope arises in the context of surviving disappointment…
Clinical vignettes will be offered that highlight the translation of theory into practice and demonstrate the use of “disillusionment statements” to facilitate the grieving that needs to be done in order to transform relentless pursuit of the unattainable into sober, mature acceptance.
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...
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.
Susceptibility
The document discusses the concept of susceptibility in homeopathy. It provides definitions from homeopathic scholars on susceptibility as the body's ability to receive impressions and react to stimuli. Susceptibility plays a role in health and disease and determines how the body will respond to remedies. There are different types of susceptibility including natural, morbid, and artificial susceptibility induced by medicines. Factors like constitution, age, habits modify one's susceptibility. Homeopathy aims to restore normal susceptibility through similar remedies to cure diseases.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
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 – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
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 – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...
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 – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
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.
Similar to Martha Stark MD – 22 Jun 2018 – A Heart Shattered, Relentless Despair, and A Life Unlived.pptx (20)
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...
Martha Stark MD – 29 Apr 2022 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 29 Apr 2022 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptx
Martha Stark MD – 24 Sep 2021 – A Heart Shattered, The Private Self, and Rele...
Martha Stark MD – 24 Sep 2021 – A Heart Shattered, The Private Self, and Rele...
Martha Stark MD – 19 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 19 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 24 Mar 2022 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptx
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...
Martha Stark MD – 13 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 13 Nov 2021 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....
Martha Stark MD – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...
Martha Stark MD – 2 Jun 2023 – 3rd of 3 Experiential Workshops on The Art and...
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Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...
More from Martha Stark MD
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...
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...
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 – 2017 Relentless Hope.pdf
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?.pdf
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.pdf
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.pdf
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.pdf
This book is about the patient’s resistance and his refusal to grieve. Drawing upon concepts from classical psychoanalysis, object relations theory, and self psychology, I present a model of the mind that takes into consideration the relationship between unmourned losses and how such losses are internally recorded – as both absence of good (structural deficit) and presence of bad (structural conflict). These internal records of traumatic disappointments sustained early on give rise to forces that interfere with the patient’s movement toward health – forces that constitute, therefore, the resistance.
Within the patient is a tension between that which the patient should let himself do/feel and that which he does/feels instead. Patient and therapist, as part of their work, will need to be able to understand and name, in a profoundly respectful fashion, both sets of forces –both those healthy ones, which impel the patient in the direction of progress, and those unhealthy resistive ones, which impede such progress. As part of the work to be done, the patient must eventually come to appreciate his investment in his defenses, how they serve him, and the price he pays for holding on to them.
My interest is in the interface between theory and practice –the ways in which theoretical constructs can be translated into the clinical situation; to that end, I suggest specific, prototypical interventions for each step of the working-through process.
My contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects. Instead, he protects himself from the pain of knowing the truth about his objects by clinging to misperceptions of them; holding on to his defensive need not to know enables him not to feel his grief.
To the extent that the patient is defended, to that extent will he be resistant to doing the work that needs ultimately to be done – grief work that will enable him to let go of the past, let go of his relentless pursuit of infantile gratification, and let go of his compulsive repetitions. Only as the patient grieves, doing now what he could not possibly do as a child, will he get better.
I believe that mental health has to do with the capacity to experience one’s objects as they are, uncontaminated by the need for them to be otherwise. A goal of treatment, therefore, is to transform the patient’s need for his objects to be other than who they are into the capacity to accept them as they are.
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
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 – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
the stress response – general adaptation syndrome – acute and chronic stress – biphasic dose-response – Walter B. Cannon – Hans Selye – upstream approach – ferreting out underlying causes – antecedent priming ("sensitizing") factors – limbic kindling – hypersensitivity to stress – reversible epigenetic modifications – lifestyle choices – environmental exposures – homeostasis – allostasis – the ground regulation system – the wisdom of the body – regulatory capacity - dysregulation – activated neuroendocrine system – upregulated hypothalamic – pituitary – adrenal "stress" axis – anti-inflammatory cortisol – desensitized cortisol receptors – activated neuroimmune system – upregulated macrophages (in the body0 and microglia (in the brain) – pro-inflammatory cytokines – inflammation in body and brain – depression – inflammatory biomarkers – natural (neuroprotective) anti-inflammatories
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...
Over the course of the decades, my own approach has become much more integrative and holistic – one that appreciates the complex interdependence of mind and body and the critical role played by the impact of stress on the MindBodyMatrix.
The living system – the ground regulation system – the divine matrix – the web of life – a liquid crystal through which information and energy flow.
More specifically, I will be speaking to the role played by limbic kindling and the resultant hypersensitivity to stress that is a hallmark of depressed patients.
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
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.pptx
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 – 26 Jun 2009 – The Overwhelmed Heart.pptx
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...
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.pptx
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.pptx
Unexplained Chronic Illness
Martin Pall's compelling conceptualization of the excitotoxic cascade and its pivotal role in both the initiation and the perpetuation of chronic multisystem illnesses
one or more short-term stressors
chemical sensitivity – pesticides and organic solvents
chronic fatigue – bacterial and viral infections
fibromyalgia – physical traumas
PTSD – severe psychological traumas
to which the body responds with an outpouring of
excitotoxins (glutamate)
inflammatory factors (cytokines and eicosanoids)
free radicals (nitric oxide)
stress-induced outpouring of endogenous excitotoxins, inflammatory cytokines, and free radicals sets in motion (in certain susceptible individuals) the nitric oxide / peroxynitrite cycle
a viciously destructive, self-propagating cycle involving
immune stimulation, inflammatory cytokines, membrane destabilization, synaptic overactivity, opening of calcium-permeable channels, massive calcium influx, etc.
and culminating in chronic illness
Martha Stark MD – 21 May 2021 – The Refusal to Grieve
This document discusses the concept of "relentless hope" as a defense mechanism used by patients to avoid grieving disappointments. It establishes that relentless hope is fueled by a refusal to grieve bad objects from one's past that were introjected. When dawning recognition occurs that the object cannot be possessed or controlled, patients react with sadism by lashing out angrily at themselves or the object. The document examines the psychodynamics of sadomasochism in relationships through the lens of Fairbairn's work on intense attachments to bad objects.
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...
Superimposing an acute physical injury on top of a chronic one is sometimes exactly what the body needs in order to heal.
But just as with the body, where a condition might not heal until it is made acute, so too with the mind. The therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – can be the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will galvanize the patient to action and provoke healing.
With our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we can formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is a firm belief in the underlying resilience patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from less-evolved defensive reaction to more-evolved adaptive response.
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...
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.
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Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptx
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Martha Stark MD – 22 Sep 2017 – Neuroinflammation and Depression – When the D...
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Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx
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Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptx
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptx
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...
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Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptx
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Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptx
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Martha Stark MD – 21 May 2021 – The Refusal to Grieve
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- 1. A HEART SHATTERED, RELENTLESS DESPAIR, AND THE UNLIVED LIFE Martha Stark MD Master Series in Clinical Practice ~ William James College Friday, June 22, 2018 ~ 9:00 am – 4:30 pm MarthaStarkMD@HMS.Harvard.edu 1
- 2. MODEL 4 A HEART SHATTERED AND THE UNLIVED LIFE THE PRIVATE (TRUE) SELF vs. THE PUBLIC (FALSE) SELF AN EXISTENTIAL – HUMANISTIC APPROACH TO THE THERAPEUTIC ACTION RELENTLESS DESPAIR ABOUT AUTHENTIC BEING – IN – THE – WORLD FROM NIHILISTIC REJECTION OF EXISTENCE TO EXISTENTIAL ACCEPTANCE OF ITS DUALITIES RESONATE EMPATHICALLY WITH THE INTRINSIC CONFLICT BETWEEN “BEING FOUND vs. REMAINING HIDDEN” DONALD BURNHAM’S “NEED – FEAR DILEMMA” “NEED TO BE MET vs. FEAR OF BEING FOUND” LONGING FOR MEANINGFUL AND AUTHENTIC MOMENTS OF MEETING vs. TERROR OF BEING FOUND AND DESPAIR ABOUT AUTHENTIC BEING – IN – THE – WORLD 2
- 3. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION 3
- 4. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS DYSFUNCTIONAL INTERNAL DYNAMICS NEUROTIC CONFLICTEDNESS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD RELENTLESS PURSUIT OF THE UNATTAINABLE NARCISSISTIC VULNERABILITY MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD DYSFUNCTIONAL RELATIONAL DYNAMICS NOXIOUS RELATEDNESS MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION RELENTLESS DESPAIR ABOUT AUTHENTIC BEING – IN – THE – WORLD NONRELATEDNESS 4
- 5. MODEL 1 ~ STRUCTURAL CONFLICT THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS AVOIDANCE, PARALYSIS, AND UNACTUALIZED POTENTIAL MODEL 2 ~ STRUCTURAL DEFICIT THE NARCISSISTIC DEFENSE OF RELENTLESS NEED FOR VALIDATION AND EXTERNAL PROVISION INSATIABLE HUNGER MODEL 3 ~ RELATIONAL CONFLICT THE CHARACTER DISORDERED DEFENSE OF RELENTLESS EXTERNALIZATION AND DENIAL OF RESPONSIBILITY DYSFUNCTIONAL RELATEDNESS, A SENSE OF ONESELF AS EVER THE VICTIM, AND A DECREASED SENSE OF PERSONAL AGENCY MODEL 4 ~ RELATIONAL DEFICIT THE SCHIZOID / NIHILISTIC DEFENSE OF RELENTLESS DESPAIR UNRELENTING LONELINESS, SCHIZOID WITHDRAWAL, EXISTENTIAL ANGST, RETREAT AND RESIGNATION, EMOTIONAL DETACHMENT, INNER EMPTINESS, PSYCHIC DEADNESS, SOLITARY SUFFERING, ANNIHILATION TERROR, DENIAL OF OBJECT NEED, ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY, AFFECTIVE NONRELATEDNESS, IMPENETRABILITY, OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT, AND THE ONGOING STRUGGLE TO RECONCILE THE DIALECTICAL TENSION BETWEEN THE NEED TO BE MET AND THE FEAR OF BEING FOUND AND BETWEEN LIFE AS MEANINGFUL AND LIFE AS ABSURD AND POINTLESS 5
- 6. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT FROM RESISTANCE TO AWARENESS MODEL 2 ~ STRUCTURAL DEFICIT FROM RELENTLESS HOPE TO ACCEPTANCE MODEL 3 ~ RELATIONAL CONFLICT FROM RE – ENACTMENT TO ACCOUNTABILITY MODEL 4 ~ RELATIONAL DEFICIT FROM RETREAT TO ACCESSIBILITY FROM RELENTLESS DESPAIR TO AWAKENED HOPE FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FROM NIHILISTIC REJECTION OF EXISTENCE TO EXISTENTIAL ACCEPTANCE OF ITS DUALITIES 6
- 7. HOW THE THERAPIST POSITIONS HERSELF MOMENT BY MOMENT THE OPTIMAL THERAPEUTIC STANCE WILL BE ONE THAT IS CONTINUOUSLY SHIFTING SOMETIMES SPONTANEOUS AND UNPLANNED SOMETIMES MORE CONSIDERED AND DELIBERATE SOMETIMES THE THERAPIST WILL FIND HERSELF UNWITTINGLY DRAWN IN TO PARTICIPATING IN A CERTAIN WAY BUT AT OTHER TIMES THE THERAPIST WILL MAKE A MORE CONSCIOUS CHOICE BASED ON WHAT SHE SENSES THE PATIENT MOST NEEDS IN THE MOMENT IN ORDER TO HEAL 7
- 8. IF, IN THE MOMENT, THE PATIENT IS PRIMARILY “NOT AWARE” THEN MODEL 1 CONFLICT STATEMENTS “NOT ACCEPTING” THEN MODEL 2 DISILLUSIONMENT STATEMENTS “NOT ACCOUNTABLE” THEN MODEL 3 ACCOUNTABILITY STATEMENTS “NOT ACCESSIBLE AND / OR NOT AUTHENTIC” THEN MODEL 4 FACILITATION STATEMENTS 8
- 9. MODEL 1 ~ STRUCTURAL CONFLICT OBJECTIVE NEUTRALITY CONFLICT STATEMENTS ~ FROM RESISTANCE TO AWARENESS WORKING THROUGH THE RESISTANCE COGNITIVE DISSONANCE ~ THE STRESS OF GAIN – BECOME – PAIN MODEL 2 ~ STRUCTURAL DEFICIT EMPATHIC ATTUNEMENT DISILLUSIONMENT STATEMENTS ~ FROM RELENTLESS HOPE TO ACCEPTANCE GRIEVING OPTIMAL DISILLUSIONMENT ~ THE STRESS OF GOOD – BECOME – BAD MODEL 3 ~ RELATIONAL CONFLICT AUTHENTIC ENGAGEMENT ~ SHARED MIND AND SHARED HEART ACCOUNTABILITY STATEMENTS ~ FROM RE – ENACTMENT TO ACCOUNTABILITY NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC RELATEDNESS RELATIONAL DETOXIFICATION ~ THE STRESS OF BAD – BECOME – GOOD MODEL 4 ~ RELATIONAL DEFICIT SOULFUL PRESENCE ~ ROCK – SOLID RELIABILITY AND STALWART DEPENDABILITY FACILITATION STATEMENTS ~ FROM RETREAT TO ACCESSIBILITY FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE IN ORDER TO FACILITATE THE EMERGENCE OF MOMENTS OF MEETING ABSOLUTE DEPENDENCE ~ THE STRESS OF HIDDEN – BECOME – FOUND DIALECTICAL TENSION ~ THE STRESS OF DENIAL – OF – EXISTENCE – BECOME – ACCEPTANCE – OF – ITS – DUALITIES 9
- 10. MODEL 4 ~ RELATIONAL DEFICIT THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION ATTACHMENT INSECURITY ~ INAUTHENTIC BEING – IN – RELATIONSHIP ONTOLOGICAL INSECURITY ~ INAUTHENTIC BEING – IN – THE – WORLD FROM SCHIZOID RETREAT TO ACCESSIBILITY / EMOTIONAL AVAILABILITY FROM RELENTLESS DESPAIR TO AUTHENTIC BEING – IN – THE – WORLD AND AWAKENED HOPE (HOPE THAT WAS THERE ALL ALONG, WAITING TO BE FOUND) FROM RESIGNATION TO A LIFE LIVED FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FACILITATION STATEMENTS ~ RESONATE EMPATHICALLY WITH THE DUALITIES OF EXISTENCE, RECONCILE THE DIALECTICAL TENSION BETWEEN POLARITIES, AND EVOLVE TO A HIGHER LEVEL OF INTEGRATION, COMPLEX UNDERSTANDING, AND DYNAMIC BALANCE FROM OPPOSITION TO COMPLEMENTARITY EVOLVE FROM THE DICHOTOMIZATION OF “EITHER / OR” “A PART OF YOU NEEDS … , BUT ANOTHER PART OF YOU FEARS …” TO THE COMPLEMENTARITY OF “BOTH / AND” “YOU HAVE THE FEAR AND THE DESPAIR … , BUT, AS YOU KNOW, YOU DO HAVE A CHOICE …” JUST AS IN QUANTUM MECHANICS, WHERE PARTICLES AND WAVES ARE THOUGHT TO BE DIFFERENT MANIFESTATIONS OF A SINGLE REALITY DEPENDING UPON THE OBSERVER’S PERSPECTIVE FROM LAING’S “DIVIDED SELF” TO BROMBERG’S “MULTIPLICITY OF SELF” 10
- 11. THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION RONALD FAIRBAIRN ~ AMBIVALENT ATTACHMENT TO THE BAD (EXCITING / REJECTING) OBJECT A BAD OBJECT IS INFINITELY BETTER THAN NO OBJECT AT ALL MARTIN HEIDEGGER ~ INAUTHENTIC AND AUTHENTIC EXISTENCE DONALD WINNICOTT ~ ABSOLUTE DEPENDENCE ~ THE NEED FOR OMNIPOTENT CONTROL GOOD ENOUGH MOTHER ~ ENVIRONMENTAL PROVISION ~ CONTINUITY OF BEING ALONE IN THE PRESENCE OF ~ PRIMARY ALONENESS ~ TRANSITIONAL SPACE FALSE SELF THAT PROTECTS THE TRUE SELF FROM IMPINGEMENT MICHAEL BALINT ~ BENIGN REGRESSION TO DEPENDENCE ~ BASIC FAULT ~ A NEW BEGINNING HARMONIOUS INTERPENETRATING MIX – UP HARRY GUNTRIP ~ SCHIZOID WITHDRAWAL, EMOTIONAL DETACHMENT, AND INABILITY TO EXPERIENCE MOMENTS OF AUTHENTIC MEETING VIKTOR FRANKL ~ MAN’S SEARCH FOR MEANING ~ DESPAIR EQUALS SUFFERING WITHOUT MEANING BETWEEN STIMULUS AND RESPONSE IS A SPACE ALBERT CAMUS ~ ACCEPTING ABSURDITY AROUSES A REVOLT THAT CAN BECOME FRUITFUL DONALD BURNHAM ~ NEED – FEAR DILEMMA ~ SCHIZO – DYNAMICS MASUD KHAN ~ PRIVACY OF THE SELF ~ DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE R D LAING ~ DIVIDED SELF ~ ONTOLOGICAL INSECURITY ARNOLD MODELL ~ DENIAL OF OBJECT NEED ~ ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY SELF – PROTECTIVE ISOLATION ~ MASSIVE AFFECT BLOCK 1 – PERSON vs. 2– PERSON DEFENSES DEFENSE OF AFFECTIVE NONRELATEDNESS TO AVOID DISSOLUTION OF THE INTEGRITY AND COHESIVENESS OF A PRECARIOUSLY ESTABLISHED SELF BY AN IMPINGING AND POTENTIALLY DESTRUCTIVE OBJECT 11