Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx

THE THERAPEUTIC USE
OF OPTIMAL STRESS:
PRECIPITATING DISRUPTION
IN ORDER TO TRIGGER REPAIR
ALSO KNOWN AS
THE THERAPEUTIC USE OF OPTIMAL
STRESS TO PROVOKE RECOVERY
ALSO KNOWN AS
NO PAIN, NO GAIN 
MARTHA STARK, MD
MarthaStarkMD @ HMS.Harvard.edu
CENTER FOR PSYCHOTHERAPY AND PSYCHOANALYSIS OF NEW JERSEY
SUNDAY, SEPTEMBER 30, 2018
THIS MATERIAL IS COPYRIGHTED 1

PREVIEW
THE THERAPEUTIC USE OF “OPTIMAL STRESS”
TO PROVOKE RECOVERY
THE TASK OF THE CHILD (GROWING UP)
THE TASK OF THE PATIENT (GETTING BETTER)
TRANSFORMATION OF DYSFUNCTIONAL DEFENSE
INTO MORE FUNCTIONAL ADAPTATION
WHERE ID WAS, THERE SHALL EGO BE
WHERE DEFENSE WAS, THERE SHALL ADAPTATION BE
AN ONGOING PROCESS INVOLVING
HEALING CYCLES OF DISRUPTION AND REPAIR
THE THERAPIST WILL PRECIPITATE DISRUPTION
IN ORDER TO TRIGGER REPAIR
BY WAY OF “OPTIMALLY STRESSFUL” INTERVENTIONS THAT
ALTERNATELY CHALLENGE AND THEN SUPPORT THE DEFENSE
5

PREVIEW
ITERATIVE CYCLES OF DESTABILIZATION
IN REACTION TO THE CHALLENGE
AND RESTABILIZATION
IN RESPONSE TO THE SUPPORT AND BY
TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE
AT EVER – HIGHER LEVELS OF
FUNCTIONALITY AND ADAPTIVE CAPACITY
IN ESSENCE
BY CHALLENGING DEFENSES TO WHICH
THE PATIENT HAS LONG CLUNG,
PSYCHODYNAMIC PSYCHOTHERAPY OFFERS
THE PATIENT AN OPPORTUNITY
ALBEIT A BELATED ONE
TO PROCESS, INTEGRATE, AND ADAPT
TO PREVIOUSLY UNMASTERED
AND THEREFORE DEFENDED AGAINST
EARLY – ON EXPERIENCES
6

THE SANDPILE MODEL
AND THE PARADOXICAL
IMPACT OF STRESS
7

THE “SANDPILE MODEL” OF CHAOS THEORY
SPEAKS TO THE CUMULATIVE IMPACT
OVER TIME
OF ENVIRONMENTAL STRESSORS
ON AN OPEN SYSTEM
MORE SPECIFICALLY
THIS SIMULATION MODEL OFFERS
AN ELEGANT VISUAL METAPHOR FOR
HOW ALL OF US ARE CONTINUOUSLY
REFASHIONING OURSELVES
AT EVER – HIGHER LEVELS OF
COMPLEXITY AND INTEGRATION …
8

NOT JUST
“IN SPITE OF”
STRESSFUL INPUT
FROM THE OUTSIDE BUT
“BY WAY OF”
THAT INPUT 
9

AMAZINGLY ENOUGH
THE GRAINS OF SAND BEING STEADILY ADDED
TO THE GRADUALLY EVOLVING SANDPILE
ARE THE OCCASION FOR BOTH
ITS DISRUPTION AND ITS REPAIR
NOT ONLY DO THE GRAINS OF SAND BEING ADDED
PRECIPITATE PARTIAL COLLAPSE OF THE SANDPILE
BUT THEY BECOME THE MEANS BY WHICH THE
SANDPILE WILL BE ABLE TO BUILD ITSELF BACK UP
EACH TIME AT A NEW LEVEL OF HOMEOSTASIS
THE SYSTEM WILL THEREFORE HAVE BEEN ABLE
NOT ONLY TO “MANAGE” THE IMPACT
OF THE STRESSFUL INPUT
BUT ALSO TO “BENEFIT FROM” THAT IMPACT
10

AND AS THE SANDPILE EVOLVES,
AN UNDERLYING PATTERN
WILL BEGIN TO EMERGE,
CHARACTERIZED BY
ITERATIVE CYCLES OF
DISRUPTION AND REPAIR,
DESTABILIZATION AND RESTABILIZATION,
DEFENSIVE COLLAPSE
AND ADAPTIVE RECONSTITUTION …
11

… AT EVER – HIGHER LEVELS OF
INTEGRATION,
BALANCE,
AND HARMONY
12

WHERE DEFENSE WAS,
THERE SHALL
ADAPTATION BE
13

THE DEVELOPMENTAL PROCESS
AND THE THERAPEUTIC PROCESS
WHERE DEFENSE WAS, THERE ADAPTATION SHALL BE
ID – EGO
ID DRIVE – EGO STRUCTURE
ID NEED – EGO CAPACITY
NEED – CAPACITY
DEFENSIVE NEED – ADAPTIVE CAPACITY
DEFENSIVE REACTION – ADAPTIVE RESPONSE
REACTION – RESPONSE
DEFENSE – ADAPTATION
14

INDEED, EGO PSYCHOLOGY IS
FOUNDED ON THE PREMISE THAT
THE EGO DEVELOPS OUT OF NECESSITY
… THAT IT EVOLVES AS AN ADAPTATION TO
THE EXIGENCIES OF THE ID,
THE IMPERATIVES OF THE SUPEREGO,
AND THE DEMANDS OF EXTERNAL REALITY
ALL OF WHICH ARE ENVIRONMENTAL STRESSORS
WHETHER INTERNAL OR EXTERNAL
TO WHICH THE EGO WILL EITHER
REACT DEFENSIVELY OR RESPOND ADAPTIVELY
15

YIN AND YANG – COMPLEMENTARY (NOT OPPOSING) FORCES
FOR EXAMPLE, SHADOW CANNOT EXIST WITHOUT LIGHT
DEFENSES
DYSFUNCTIONAL
UNHEALTHY
RIGID
UNEVOLVED
ADAPTATIONS
MORE FUNCTIONAL
MORE HEALTHY
MORE FLEXIBLE
MORE EVOLVED
16

IN ESSENCE
ADAPTATION
IS A STORY ABOUT
MAKING A VIRTUE
OUT OF NECESSITY 
17

THE ULTIMATE GOAL OF PSYCHODYNAMIC PSYCHOTHERAPY
TO FACILITATE THE PROCESSING AND
INTEGRATING OF STRESSFUL EXPERIENCES
IN BOTH THE THERE – AND – THEN AND THE HERE – AND – NOW
FROM DEFENSIVE REACTION
TO ADAPTIVE RESPONSE
FROM DEFENSE
TO ADAPTATION
FROM DYSFUNCTIONAL DEFENSE
TO MORE FUNCTIONAL ADAPTATION
FROM DYSFUNCTIONAL ACTIONS, REACTIONS, AND INTERACTIONS
TO MORE FUNCTIONAL WAYS OF BEING AND DOING
FROM DYSFUNCTION
TO FUNCTIONALITY
FROM UNHEALTHY NEED
TO HEALTHY CAPACITY
18

FROM EXTERNALIZING BLAME
TO TAKING OWNERSHIP
FROM WHINING AND COMPLAINING
TO BECOMING PROACTIVE
FROM BEING EVER CRITICAL
TO BECOMING MORE COMPASSIONATE
FROM DISSOCIATING
TO BECOMING MORE PRESENT
FROM FEELING VICTIMIZED
TO BECOMING MORE EMPOWERED
FROM BEING JAMMED UP
TO MOBILIZING ONE’S ENERGIES
IN THE PURSUIT OF ONE’S DREAMS
FROM DENYING
TO CONFRONTING HEAD – ON
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE 19

GROWING UP (THE TASK OF THE CHILD)
AND GETTING BETTER (THE TASK OF THE PATIENT)
CAN ALSO BE DESCRIBED AS
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 FOR INTERNAL SELF – REGULATION
THE NEED TO HOLD ON INTO
THE CAPACITY TO LET GO
20

PSYCHODYNAMIC SYNERGY
(MARTHA STARK 2018)
FOUR MODES OF
THERAPEUTIC ACTION
MUTUALLY ENHANCING
NOT MUTUALLY EXCLUSIVE
THE THERAPIST WILL BE ABLE TO OPTIMIZE HER
EFFECTIVENESS IF SHE IS ABLE TO TRANSITION
MOMENT BY MOMENT FROM ONE “STANCE” TO THE NEXT
DEPENDING UPON HER ASSESSMENT
OF THE “POINT OF EMOTIONAL URGENCY”
ALTERNATELY FUNCTIONING AS “NEUTRAL OBJECT,”
“EMPATHIC SELFOBJECT,” “AUTHENTIC SUBJECT,”
AND “FACILITATING PRESENCE” 21

PSYCHODYNAMIC SYNERGY
MODEL 1
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2
THE DEFICIENCY – COMPENSATION PERSPECTIVE
OF SELF PSYCHOLOGY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “ABSENCE OF GOOD”
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “PRESENCE OF BAD”
MODEL 4
AN EXISTENTIAL – HUMANISTIC PERSPECTIVE
22

MODEL 1 – STRUCTURAL CONFLICT
THE NEUROTIC DEFENSE OF
RELENTLESS CONFLICTEDNESS
MODEL 2 – STRUCTURAL DEFICIT
THE NARCISSISTIC DEFENSE OF
RELENTLESS NEED FOR VALIDATION
AND EXTERNAL REINFORCEMENT
MODEL 3 – RELATIONAL CONFLICT
THE CHARACTER DISORDERED DEFENSE OF
RELENTLESS EXTERNALIZATION
AND DENIAL OF RESPONSIBILITY
MODEL 4 – RELATIONAL DEFICIT
THE SCHIZOID DEFENSE OF
RELENTLESS DESPAIR
AND PSYCHIC RETREAT
23

DYSFUNCTIONAL INTERNAL DYNAMICS
NEUROTIC CONFLICTEDNESS
RELENTLESS PURSUIT OF THE UNATTAINABLE
NARCISSISTIC VULNERABILITY
DYSFUNCTIONAL RELATIONAL DYNAMICS
NOXIOUS RELATEDNESS
RELENTLESS DESPAIR ABOUT
AUTHENTIC BEING – IN – THE – WORLD
NONRELATEDNESS
24

MODEL 1 – KNOWLEDGE
1 – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S INTERNAL DYNAMICS (1)
THERAPIST AS NEUTRAL OBJECT (0)
MODEL 2 – EXPERIENCE
1½ – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S AFFECTIVE EXPERIENCE (1)
THERAPIST AS EMPATHIC SELFOBJECT (½)
MODEL 3 – RELATIONSHIP
2 – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S RELATIONAL DYNAMICS (1)
THERAPIST AS AUTHENTIC SUBJECT (1)
MODEL 4 – MOMENTS OF MEETING
½ – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S TERROR OF BEING FOUND (½)
THERAPIST AS FACILITATING PRESENCE (0)
25

MODEL 1 – COGNITIVE
ENHANCEMENT OF KNOWLEDGE “WITHIN”
ULTIMATELY, A STRONGER, WISER,
AND MORE EMPOWERED EGO
MODEL 2 – AFFECTIVE
PROVISION OF CORRECTIVE EXPERIENCE “FOR”
ULTIMATELY, A MORE CONSOLIDATED,
ACCEPTING, AND COMPASSIONATE SELF
MODEL 3 – RELATIONAL
ENGAGEMENT IN RESPONSIBLE RELATIONSHIP “WITH”
ULTIMATELY, A MORE ACCOUNTABLE SELF – IN – RELATION
MODEL 4 – EXISTENTIAL
CREATION OF MOMENTS OF MEETING “BETWEEN”
ULTIMATELY, MORE AUTHENTIC BEING – IN – THE – WORLD
AND A MORE ACCESSIBLE PRIVATE SELF
26

THE THERAPEUTIC ACTION
MODEL 1
FROM RESISTANCE TO ACKNOWLEDGING
PAINFUL TRUTHS ABOUT ONESELF
TO AWARENESS OF THOSE PAINFUL TRUTHS
MODEL 2
FROM RELENTLESS HOPE AND REFUSAL TO GRIEVE
PAINFUL TRUTHS ABOUT ONE’S OBJECTS
TO ACCEPTANCE OF THOSE PAINFUL TRUTHS
MODEL 3
FROM COMPULSIVE AND UNWITTING RE – ENACTMENT
OF UNMASTERED RELATIONAL TRAUMAS
TO ACCOUNTABILITY FOR ONE’S DYSFUNCTIONAL
ACTIONS, REACTIONS, AND INTERACTIONS
MODEL 4
FROM RELENTLESS DESPAIR AND SCHIZOID RETREAT
TO AUTHENTIC MOMENTS OF MEETING
AND EMOTIONAL ACCESSIBILITY 27

ALL FOUR MODELS ARE RELEVANT
FOR BOTH “TRAIT” AND “STATE”
MODEL 1 FEATURES “NEUROTIC PERSONALITIES”
BUT IS ALSO RELEVANT WHEN, IN THE MOMENT,
A PATIENT IS “RESISTANT” AND “NOT AWARE”
AND WILL BENEFIT FROM A “CONFLICT STATEMENT”
MODEL 2 FEATURES “NARCISSISTIC PERSONALITIES”
A PATIENT IS “RELENTLESS” AND “NOT ACCEPTING”
AND WILL BENEFIT FROM A “DISILLUSIONMENT STATEMENT”
MODEL 3 FEATURES “CHARACTER DISORDERS”
A PATIENT IS “RE – ENACTING” AND “NOT ACCOUNTABLE”
AND WILL BENEFIT FROM AN “ACCOUNTABILITY STATEMENT”
MODEL 4 FEATURES “SCHIZOID PERSONALITIES”
A PATIENT IS “RETREATING” AND “NOT ACCESSIBLE”
AND WILL BENEFIT FROM A “FACILITATION STATEMENT”
28

IN WHAT FOLLOWS
THE OPERATIVE CONCEPT
WILL BE
OPTIMAL STRESS
29

BAD STUFF HAPPENS
BUT IT WILL BE HOW WELL THE PATIENT
IS ABLE TO PROCESS, INTEGRATE,
AND ADAPT TO ITS IMPACT
PSYCHOLOGICALLY, PHYSIOLOGICALLY, AND ENERGETICALLY
THAT WILL MAKE OF IT
EITHER A GROWTH – DISRUPTING TRAUMA
THAT OVERWHELMS BECAUSE IT IS “TOO MUCH”
“TRAUMATIC STRESS”
OR A GROWTH – PROMOTING OPPORTUNITY
THAT MAKES POSSIBLE TRANSFORMATION AND RENEWAL
“OPTIMAL STRESS”
30

THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE
WILL OVERWHELM AND PLUMMET
THE PATIENT INTO FURTHER DECLINE
BECAUSE IT WILL BE “TOO MUCH”
TO BE PROCESSED AND INTEGRATED
TRAUMATIC STRESS
TOO LITTLE CHALLENGE
WILL OFFER “TOO LITTLE” IMPETUS FOR
TRANSFORMATION AND GROWTH
BUT JUST THE RIGHT AMOUNT OF CHALLENGE
WILL PROVIDE “JUST THE RIGHT AMOUNT” OF LEVERAGE
NEEDED TO PROVOKE, AFTER INITIAL DISRUPTION,
RECONSTITUTION AT A HIGHER LEVEL OF
INTEGRATION, FUNCTIONALITY, AND ADAPTIVE CAPACITY
OPTIMAL (NONTRAUMATIC) STRESS
31

WITH THE THERAPIST’S FINGER
EVER ON THE PULSE OF THE
PATIENT’S LEVEL OF ANXIETY
AND CAPACITY TO TOLERATE
FURTHER CHALLENGE
THE THERAPIST WILL
THEREFORE REPEATEDLY
CHALLENGE WHENEVER POSSIBLE
BY DIRECTING THE PATIENT’S ATTENTION
TO WHERE THE PATIENT IS NOT
AND SUPPORT WHENEVER NECESSARY
BY RESONATING EMPATHICALLY
WITH WHERE THE PATIENT IS
32

ALL WITH AN EYE TO CREATING
JUST THE RIGHT LEVEL
OF DESTABILIZING ANXIETY
AND INCENTIVIZING STRESS
OPTIMAL STRESS
THEREBY OPTIMIZING THE
PATIENT’S POTENTIAL FOR
TRANSFORMATION AND GROWTH
BECAUSE …
33

WHETHER FUNCTIONAL OR DYSFUNCTIONAL
SELF – ORGANIZING
(CHAOTIC) SYSTEMS
LIKE THE PATIENT’S LONG – ESTABLISHED AND
DEEPLY ENTRENCHED “DEFENSIVE STRUCTURES”
ARE INHERENTLY
RESISTANT TO CHANGE
“SELF – ORGANIZING SYSTEMS
RESIST PERTURBATION”
CHARLES KREBS (2013)
34

WHICH MEANS THAT
UNLESS A “CHAOTIC” SYSTEM
IS SUFFICIENTLY “PERTURBED”
THAT IS, SUFFICIENTLY “STRESSED”
BY INPUT FROM THE OUTSIDE,
THEN IT WILL MAINTAIN ITS STATUS QUO
AND AS THIS RELATES TO THE PATIENT
UNLESS THE PATIENT’S DYSFUNCTIONAL
DEFENSES ARE SUFFICIENTLY
“CHALLENGED” BY THE THERAPIST,
THEN THERE WILL BE INSUFFICIENT
IMPETUS FOR THEIR DESTABILIZATION
AND LIMITED OPPORTUNITY FOR
THEIR EVENTUAL RESTABILIZATION
AS MORE FUNCTIONAL ADAPTATIONS
35

IT TOOK ME YEARS TO APPRECIATE SOMETHING
THAT IS AT ONCE BOTH PROFOUND AND OBVIOUS
INDEED, IT WILL BE
INPUT FROM THE OUTSIDE
AND THE PATIENT’S CAPACITY TO
PROCESS, INTEGRATE, AND ADAPT
TO THE IMPACT OF THIS INPUT
THAT WILL ULTIMATELY ENABLE
THE PATIENT TO GET BETTER
36

BUT MORE IMPORTANTLY
IT WILL BE “STRESSFUL”
INPUT FROM THE OUTSIDE
AND THE PATIENT’S CAPACITY TO
PROCESS, INTEGRATE, AND ADAPT
TO THE IMPACT OF THIS “STRESS”
THAT WILL ULTIMATELY PROVOKE
THE PATIENT’S RECOVERY
37

THERAPEUTIC INTERVENTIONS MUST
THEREFORE BE NOT ONLY SUPPORTIVE
BUT ALSO SUFFICIENTLY CHALLENGING
THAT THEY WILL PROVIDE THE IMPETUS
NEEDED FOR DESTABILIZATION OF
THE PATIENT’S DEFENSIVE STRUCTURES
THERE WILL THEN BE OPPORTUNITY
FOR EVENTUAL RESTABILIZATION AT A
HIGHER LEVEL OF FUNCTIONALITY
AND ADAPTIVE CAPACITY
AS A RESULT OF JUMPSTARTING
THE PATIENT’S INNATE CAPACITY
TO SELF – CORRECT IN THE
FACE OF THE OPTIMAL CHALLENGE
38

IN ESSENCE
AGAINST A BACKDROP OF
EMPATHIC ATTUNEMENT
AND AUTHENTIC ENGAGEMENT
THE THERAPIST
BY WAY OF ONGOING “OPTIMALLY STRESSFUL” INTERVENTIONS
WILL REPEATEDLY PRECIPITATE
RUPTURE IN ORDER TO TRIGGER REPAIR
THEREBY GENERATING HEALING CYCLES
OF RUPTURE AND REPAIR
EVER STRONGER AT
THE BROKEN PLACES
39

IT IS NOT SO MUCH GRATIFICATION AS
FRUSTRATION AGAINST A BACKDROP OF GRATIFICATION
OPTIMAL FRUSTRATION
IT IS NOT SO MUCH SUPPORT AS
CHALLENGE AGAINST A BACKDROP OF SUPPORT
OPTIMAL STRESS
IT IS NOT SO MUCH EMPATHY AS
EMPATHIC FAILURE AGAINST A BACKDROP OF EMPATHY
OPTIMAL DISILLUSIONMENT
THAT WILL PROVIDE THE THERAPEUTIC
LEVERAGE NEEDED TO PROVOKE
AFTER INITIAL DESTABILIZATION
EVENTUAL RESTABILIZATION
AT EVER – HIGHER LEVELS OF …
40

AWARENESS
MODEL 1
ACCEPTANCE
MODEL 2
ACCOUNTABILITY
MODEL 3
ACCESSIBILITY
MODEL 4
ALL OF WHICH ARE ADAPTATIONS
TO THE “STRESS OF LIFE”
41

AND SO IT IS THAT
THE THERAPEUTIC ACTION OF
PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT
AN OPPORTUNITY
ALBEIT A BELATED ONE
TO PROCESS, INTEGRATE, AND
ADAPT TO EXPERIENCES THAT HAD
ONCE BEEN OVERWHELMING …
AND THEREFORE DEFENDED AGAINST
42

… BUT THAT CAN NOW
WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE PATIENT’S
RELATIONSHIP WITH A THERAPIST
WHO FUNCTIONS ALTERNATELY AS
NEUTRAL OBJECT (MODEL 1)
EMPATHIC SELFOBJECT (MODEL 2)
AUTHENTIC SUBJECT (MODEL 3)
FACILITATING PRESENCE (MODEL 4)
BE PROCESSED, INTEGRATED,
AND ADAPTED TO
THEREBY ENABLING THE PATIENT TO EXTRICATE HERSELF
FROM THE BONDS OF HER INFANTILE ATTACHMENTS
AND HER AMBIVALENTLY CATHECTED DYSFUNCTION
43

AS WE SHALL SOON SEE
THERE ARE FOUR APPROACHES TO
TRANSFORMING DEFENSE INTO ADAPTATION
AND FOUR OPTIMAL STRESSORS THAT FACILITATE THIS “ACTION”
MODEL 1 – RESISTANCE INTO AWARENESS
BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE
THE EXPERIENCE OF GAIN – BECOME – PAIN
MODEL 2 – RELENTLESSNESS INTO ACCEPTANCE
BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT
THE EXPERIENCE OF GOOD – BECOME – BAD
MODEL 3 – RE – ENACTMENT INTO ACCOUNTABILITY
BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION
THE EXPERIENCE OF BAD – BECOME – GOOD
MODEL 4 – RETREAT INTO ACCESSIBILITY
BY WORKING THROUGH THE STRESS OF INFANTILE DEPENDENCE
THE EXPERIENCE OF HIDDEN – BECOME – FOUND 44

“OPTIMALLY STRESSFUL”
INTERVENTIONS
INITIALLY
ANXIETY – PROVOKING
BUT ULTIMATELY
GROWTH – PROMOTING
45

MODEL 1 CONFLICT STATEMENTS
ARE DESIGNED TO ENCOURAGE
THE “RESISTANT” PATIENT
TO STEP BACK FROM THE
IMMEDIACY OF THE MOMENT
IN ORDER TO TAKE STOCK OF
BOTH HER INVESTMENT IN
MAINTAINING THINGS AS THEY ARE
AND THE PRICE SHE PAYS FOR DOING SO
46

MODEL 2 DISILLUSIONMENT STATEMENTS
ARE DESIGNED TO FACILITATE
THE NECESSARY GRIEVING THAT
THE “RELENTLESS” PATIENT
MUST DO
AS SHE BEGINS TO CONFRONT
PAINFUL REALITIES ABOUT
THE OBJECTS OF HER DESIRE
THEIR LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
47

MODEL 3 ACCOUNTABILITY STATEMENTS
ARE DESIGNED TO ENCOURAGE
THE “RE – ENACTING” PATIENT
TO TAKE RESPONSIBILITY FOR
THE UNMASTERED RELATIONAL TRAUMAS
THAT SHE IS COMPULSIVELY
AND UNWITTINGLY
REPLAYING ON THE STAGE OF HER LIFE
48

MODEL 4 FACILITATION STATEMENTS
ARE DESIGNED TO HIGHLIGHT
THE “RETREATING” PATIENT’S
INTENSE AMBIVALENCE ABOUT
EXPERIENCING AUTHENTIC
MOMENTS OF MEETING
BECAUSE OF EARLY – ON
SHATTERING HEARTBREAK –
AMBIVALENCE FUELED BY
THE PATIENT’S LONGING TO BE SEEN
AND TERROR OF BEING FOUND
49

MODEL 1
CONFLICT
STATEMENTS
50

MODEL 1
CLASSICAL PSYCHOANALYSTS TEND
TO FOCUS ON INTERNAL CONFLICT
BETWEEN ANXIETY – PROVOKING ID DRIVES
AND ANXIETY – ASSUAGING EGO DEFENSES
BUT I HAVE FOUND IT A LITTLE MORE
CLINICALLY USEFUL TO CONCEPTUALIZE
THIS DRIVE – DEFENSE CONFLICT
AS ONE THAT EXISTS BETWEEN
ANXIETY – PROVOKING BUT
ULTIMATELY EMPOWERING FORCES
PRESSING “YES”
AND ANXIETY – ASSUAGING
(DEFENSIVE) COUNTERFORCES
INSISTING “NO”
51

“OPTIMALLY STRESSFUL” CONFLICT STATEMENTS
ALTERNATELY CHALLENGE AND THEN SUPPORT
THEY FIRST CHALLENGE BY
SPEAKING TO THE PATIENT’S
“ADAPTIVE CAPACITY TO KNOW”
CERTAIN ANXIETY – PROVOKING REALITIES
AND THEN
WITH COMPASSION AND NEVER JUDGMENT
SUPPORT BY RESONATING
EMPATHICALLY WITH THE PATIENT’S
“DEFENSIVE NEED TO AVOID KNOWING”
THOSE UNCOMFORTABLE TRUTHS
52

BE IT SOME UNCOMFORTABLE TRUTH ABOUT
HER INTERNAL DYNAMICS,
THE PRICE SHE PAYS FOR MAINTAINING
HER DYSFUNCTIONAL STATUS QUO,
OR THE THERAPEUTIC
WORK SHE HAS YET TO DO
THE PATIENT DOES INDEED KNOW,
“BUT” WOULD RATHER NOT
AND THEREFORE,
MADE ANXIOUS,
SHE DEFENDS
53

STRATEGICALLY DESIGNED TO GENERATE
DESTABILIZING TENSION WITHIN THE PATIENT
BETWEEN HER KNOWLEDGE OF
ANXIETY – PROVOKING BUT ULTIMATELY
GROWTH – PROMOTING (AND EMPOWERING) REALITIES
AND THE DEFENSES SHE MOBILIZES
IN ORDER TO EASE THAT ANXIETY
THEIR FORMAT
“YOU KNOW THAT … , BUT YOU FIND YOURSELF … ”
FIRST THE THERAPIST CHALLENGES
BY HIGHLIGHTING AN ANXIETY – PROVOKING REALITY
AND THEN SHE SUPPORTS
BY RESONATING EMPATHICALLY WITH
THE PATIENT’S ANXIETY – ASSUAGING DEFENSE
54

“YOU KNOW THAT … , BUT YOU FIND YOURSELF … ”
THE THERAPIST FIRST CHALLENGES BY SPEAKING
DIRECTLY TO THE PATIENT’S OBSERVING EGO AND
ADAPTIVE CAPACITY TO KNOW SOME PAINFUL TRUTH
WHICH WILL INCREASE THE PATIENT’S ANXIETY
BUT THEN SUPPORTS BY RESONATING EMPATHICALLY
WITH THE PATIENT’S EXPERIENCING EGO AND
DEFENSIVE NEED TO DENY SUCH KNOWING
WHICH WILL DECREASE THE PATIENT’S ANXIETY
THE PATIENT DOES INDEED KNOW,
“BUT” WOULD RATHER NOT
AND THEREFORE, MADE ANXIOUS, SHE DEFENDS
AND “FINDS HERSELF” THINKING, FEELING, OR DOING WHATEVER
SHE MUST IN ORDER TO PRESERVE THE STATUS QUO OF THINGS
55

ANXIETY – PROVOKING BUT ULTIMATELY
AWARENESS – PROMOTING INTERVENTIONS
FIRST THE REALITY (THAT IS, WHAT THE PATIENT REALLY DOES KNOW)
AND THEN THE DEFENSE / THE RESISTANCE (AND WHAT IS FUELING IT)
“YOU KNOW THAT ULTIMATELY YOU’LL NEED TO LET JOSE GO
BECAUSE HE, LIKE YOUR DAD, REALLY ISN’T AVAILABLE IN THE WAY
THAT YOU WOULD HAVE WANTED HIM TO BE; BUT, FOR NOW,
ALL YOU CAN THINK ABOUT IS HOW DESPERATELY YOU WANT TO BE
WITH HIM AND HOW HORRIBLE IT WOULD BE TO LOSE HIM.”
“YOU KNOW THAT EVENTUALLY YOU’LL NEED TO MAKE YOUR
PEACE WITH THE REALITY OF JUST HOW LIMITED YOUR MOTHER IS;
BUT YOUR FEAR IS THAT WERE YOU EVER TO LET YOURSELF
REALLY FEEL THE PAIN OF THAT, YOU WOULD NEVER RECOVER.”
“YOU KNOW THAT SOMEDAY YOU’LL HAVE TO LET SOMEBODY IN
IF YOU’RE EVER TO HAVE A MEANINGFUL RELATIONSHIP; BUT,
IN THE MOMENT, THE THOUGHT OF MAKING YOURSELF THAT
VULNERABLE IS SIMPLY INTOLERABLE. THERE’S NO WAY YOU’RE
WILLING TO RUN THE RISK OF BEING HURT EVER AGAIN.”
56

JUST AS WITH THE EVER – EVOLVING
SANDPILE MODEL OF CHAOS THEORY
SO TOO THE MODEL 1 THERAPIST WILL
BE GENERATING ITERATIVE
CYCLES OF DISRUPTION AND REPAIR
BY WAY OF STRATEGICALLY DESIGNED
CONFLICT STATEMENTS THAT ALTERNATELY
CHALLENGE AND THEN SUPPORT
THEREBY PROVIDING BOTH IMPETUS
AND OPPORTUNITY FOR THE
MODEL 1 PATIENT GRADUALLY TO
EVOLVE FROM “DEFENSIVE RESISTANCE”
TO EVER – HIGHER LEVELS
OF “ADAPTIVE AWARENESS”
57

ONGOING CHALLENGE AND THEN SUPPORT
ANXIETY – PROVOKING, THEN ANXIETY – ASSUAGING
COGNITIVE, THEN AFFECTIVE
HEAD, THEN HEART
KNOWLEDGE, THEN EXPERIENCE
OBJECTIVE, THEN SUBJECTIVE
OBSERVING EGO, THEN EXPERIENCING EGO
ADULT, THEN CHILD
RATIONAL, THEN IRRATIONAL
RESPONSE, THEN REACTION
LEFT BRAIN, THEN RIGHT BRAIN
ADAPTIVE CAPACITY, THEN DEFENSIVE NEED
ADAPTATION, THEN DEFENSE
58

“YOU KNOW THAT ULTIMATELY YOU WILL NEED TO CONFRONT –
AND GRIEVE – THE REALITY THAT TOM IS NOT AVAILABLE IN THE
WAYS THAT YOU WOULD HAVE WANTED HIM TO BE AND THAT
UNTIL YOU MAKE YOUR PEACE WITH THAT PAINFUL REALITY
YOU WILL CONTINUE TO BE MISERABLE; BUT, IN THE MOMENT,
ALL YOU CAN THINK ABOUT IS HOW ANGRY YOU ARE THAT
HE DOESN’T TELL YOU MORE OFTEN THAT HE LOVES YOU.”
“YOU KNOW THAT YOU WON’T FEEL TRULY FULFILLED UNTIL YOU
ARE ABLE TO GET YOUR THESIS COMPLETED; BUT YOU CONTINUE
TO STRUGGLE, FEARING THAT WHATEVER YOU MIGHT WRITE
JUST WOULDN’T BE GOOD ENOUGH OR CAPTURE WELL
ENOUGH THE ESSENCE OF WHAT YOU ARE TRYING TO SAY.”
“YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA IS
TO SURVIVE, YOU WILL NEED TO TAKE AT LEAST SOME
RESPONSIBILITY FOR THE PART YOU PLAY IN THE
INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE ARE HAVING;
BUT YOU TELL YOURSELF THAT IT ISN’T REALLY
YOUR FAULT BECAUSE IF SHE WEREN’T SO PROVOCATIVE,
THEN YOU WOULDN’T HAVE TO BE SO VINDICTIVE!” 59

BY CALLING THE PATIENT’S ATTENTION TO
THE CONFLICT THAT EXISTS WITHIN HER
BETWEEN THE “OBJECTIVE REALITY”
THAT SHE “KNOWS” WITH HER HEAD
AND THE “SUBJECTIVE EXPERIENCE”
THAT SHE “FEELS” WITH HER HEART
CAN BE STRATEGICALLY FORMULATED
TO PRECIPITATE (DEFENSIVE) DISRUPTION
IN ORDER TO TRIGGER (ADAPTIVE) REPAIR
60

“YOU KNOW THAT EVENTUALLY YOU’LL NEED TO FACE THE REALITY THAT
YOUR MOTHER WAS NEVER REALLY THERE FOR YOU AND THAT YOU WON’T
GET BETTER UNTIL YOU LET GO OF YOUR HOPE THAT MAYBE SOMEDAY
YOU’LL BE ABLE TO MAKE HER CHANGE; BUT YOU’RE NOT QUITE YET
READY TO DEAL WITH ALL THE PAIN AROUND THAT BECAUSE YOU ARE
AFRAID THAT YOU MIGHT NEVER SURVIVE THE HEARTBREAK AND DESPAIR
YOU WOULD FEEL WERE YOU TO FACE THAT DEVASTATING REALITY.”
“YOU KNOW THAT YOUR NEED FOR YOUR CHILDREN TO UNDERSTAND YOUR
PERSPECTIVE MIGHT BE A BIT UNREALISTIC; BUT YOU TELL YOURSELF THAT
YOU HAVE A RIGHT TO THEIR RESPECT – AND THEIR FORGIVENESS.”
“YOU’RE COMING TO UNDERSTAND THAT YOUR ANGER CAN PUT PEOPLE OFF;
BUT YOU TELL YOURSELF THAT YOU HAVE A RIGHT TO BE AS ANGRY AS
YOU WANT BECAUSE OF HOW MUCH YOU HAVE SUFFERED OVER THE YEARS.”
“YOU KNOW THAT IF YOU ARE EVER TO GET ON WITH YOUR LIFE, YOU’LL
HAVE TO LET GO OF YOUR CONVICTION THAT YOUR CHILDHOOD SCARRED
YOU FOREVER; BUT IT’S HARD NOT TO FEEL LIKE DAMAGED GOODS WHEN
YOU GREW UP IN A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN
AND NASTY MOTHER WHO WAS ALWAYS CALLING YOU A LOSER.”
61

IN ORDER TO INCREASE THE PATIENT’S AWARENESS OF
HER AMBIVALENT ATTACHMENT TO HER DYSFUNCTION
THE MODEL 1 THERAPIST
ALTERNATELY CHALLENGES BY HIGHLIGHTING
WHAT THE PATIENT IS COMING TO UNDERSTAND
AS THE PRICE SHE PAYS
FOR CLINGING TO HER DYSFUNCTION
A “PRICE PAID” THAT FUELS
THE PATIENT’S AGGRESSIVE CATHEXIS OF THE DEFENSE
AND THEN SUPPORTS BY RESONATING EMPATHICALLY
WITH WHAT THE THERAPIST IS COMING TO
UNDERSTAND AS THE INVESTMENT THE PATIENT HAS
IN HOLDING ON TO HER DYSFUNCTION EVEN SO
AN “INVESTMENT IN” THAT FUELS
THE PATIENT’S LIBIDINAL CATHEXIS OF THE DEFENSE
BACK AND FORTH – BACK AND FORTH
IN AN EFFORT TO MAKE THE AMBIVALENTLY HELD DEFENSE
LESS EGO – SYNTONIC AND MORE EGO – DYSTONIC 62

IN ESSENCE
STRIVE TO CREATE INCENTIVIZING TENSION WITHIN
THE PATIENT BETWEEN HER DAWNING AWARENESS
OF JUST HOW COSTLY HER DEFENSES ARE
WITH AN EYE TO MAKING THEM MORE EGO – DYSTONIC
AND HER NEW – FOUND UNDERSTANDING
OF JUST HOW INVESTED SHE HAS BEEN
IN HOLDING ON TO THEM EVEN SO
WITH AN EYE TO HIGHLIGHTING HOW EGO – SYNTONIC THEY ARE
ULTIMATELY
THE EVER – INCREASING INTERNAL DISSONANCE
RESULTING FROM HER EVER – EVOLVING AWARENESS
OF BOTH THE COST AND THE BENEFIT
OF MAINTAINING HER ATTACHMENT
TO HER DYSFUNCTIONAL DEFENSES
WILL GALVANIZE HER TO TAKE ACTION
IN ORDER TO RESOLVE THE INTERNAL TENSION
63

THE MODEL 1 THERAPIST THEREFORE
REPEATEDLY HIGHLIGHTS BOTH
“PRICE PAID” (PAIN) AND “INVESTMENT IN” (GAIN)
AS LONG AS THE “GAIN” IS
GREATER THAN THE “PAIN”
EGO – SYNTONIC GREATER THAN EGO – DYSTONIC
THE PATIENT WILL “MAINTAIN” THE DEFENSE
AND “REMAIN” ENTRENCHED
BUT AS A RESULT OF THE PATIENT’S EVER – EVOLVING AWARENESS
ONCE THE “PAIN” BECOMES GREATER THAN THE “GAIN”
EGO – DYSTONIC GREATER THAN EGO – SYNTONIC
THE STRESS AND “STRAIN” OF THE
COGNITIVE AND AFFECTIVE DISSONANCE
BETWEEN “PAIN” AND “GAIN”
WILL PROVIDE THE IMPETUS NEEDED
FOR THE PATIENT GRADUALLY …
64

… TO RELINQUISH HER ATTACHMENT
TO THE DYSFUNCTIONAL DEFENSE
THEREBY
RESOLVING THE
STRUCTURAL CONFLICT
NEUROTIC / INTRAPSYCHIC CONFLICT
THAT HAD EXISTED
BETWEEN THE THWARTED
BUT ULTIMATELY GROWTH – PROMOTING
ID DRIVE
AND THE GROWTH – IMPEDING
EGO DEFENSE
65

AS A RESULT OF “WORKING THROUGH”
THE PATIENT’S “RESISTANCE”
THE NOW STRONGER
AND MORE AWARE EGO
WILL BE BETTER ABLE TO “REGULATE”
THE ID’S NOW TAMER AND
MORE MANAGEABLE ENERGIES
SUCH THAT,
NO LONGER THWARTED,
THEIR POWER CAN BE HARNESSED
AND CHANNELED INTO
CONSTRUCTIVE ENDEAVORS
AND WORTHY PURSUITS
66

IN OTHER WORDS
ONGOING USE OF MODEL 1
CONFLICT STATEMENTS
WILL GENERATE HEALING CYCLES OF
DISRUPTION
IN REACTION TO THE CHALLENGE
AND REPAIR
IN RESPONSE TO THE SUPPORT
AT EVER – HIGHER LEVELS
OF ADAPTIVE CAPACITY
SUCH THAT ID “ENERGY” ONCE
“REINED IN” BY EGO “RESISTANCE”
CAN BE FREED UP AND PUT TO GOOD USE
67

FREUD’S “HORSE AND RIDER” IS
INDEED AN APT METAPHOR FOR THE
THERAPEUTIC ACTION IN MODEL 1
FREUD’S RIDER
A NOW STRONGER AND MORE EMPOWERED EGO BY VIRTUE OF THE
GREATER AWARENESS IT HAS OF ITS INTERNAL CONFLICTEDNESS
BECOMES MORE SKILLED AT HARNESSING
THE QUANTUM POWER OF THE HORSE
A NOW BETTER REGULATABLE ID BY VIRTUE OF
THE WORKING THROUGH PROCESS, WHICH HAS
TAMED, MODIFIED, AND INTEGRATED ITS ENERGIES
SUCH THAT HORSE AND RIDER
WILL NOW BE ABLE TO MOVE FORWARD
HARMONIOUSLY AND MORE IN SYNC
NO LONGER IN CONFLICT BUT IN COLLABORATION
68

IN ESSENCE
THE DEFENSIVE NEED TO
“REIN THE HORSE IN”
WILL HAVE BECOME
GRADUALLY TRANSFORMED INTO
THE ADAPTIVE CAPACITY TO
“GIVE THE HORSE FREE REIN”
AS STRUCTURAL CONFLICT EVOLVES
INTO STRUCTURAL COLLABORATION
AND “JAMMED UP” EVOLVES INTO
“EMPOWERED” AND “ACTUALIZED”
69

PARENTHETICALLY
AS WE SIT WITH OUR PATIENTS
THERE IS ALWAYS TENSION WITHIN US AS WELL
DIALECTICAL TENSION BETWEEN
ON THE ONE HAND
OUR VISION OF WHO WE THINK THE PATIENT COULD BE
WERE SHE BUT ABLE / WILLING TO MAKE HEALTHIER CHOICES
AND ON THE OTHER HAND
OUR RESPECT FOR THE REALITY OF WHO SHE IS
AND FOR THE CHOICES, NO MATTER HOW UNHEALTHY,
THAT SHE “FINDS HERSELF” MAKING
WE ARE THEREFORE ALWAYS STRUGGLING TO FIND
AN OPTIMAL BALANCE WITHIN OURSELVES
BETWEEN WANTING THE PATIENT TO CHANGE
AND ACCEPTING THE REALITY OF WHO SHE IS
70

IMPORTANTLY
BY LOCATING WITHIN THE PATIENT
THE CONFLICT BETWEEN
HER ANXIETY – PROVOKING KNOWLEDGE
OF A DISTRESSING REALITY AND
HER ANXIETY – ASSUAGING NEED
TO AVOID DEALING WITH IT,
THE THERAPIST IS DEFTLY SIDESTEPPING
THE POTENTIAL FOR CONFLICT
BETWEEN THE PATIENT AND HERSELF
71

WHEN THE THERAPIST INTRODUCES A CONFLICT STATEMENT WITH
“YOU KNOW THAT … ”
SHE IS FORCING THE PATIENT TO TAKE RESPONSIBILITY
FOR WHAT THE PATIENT REALLY DOES KNOW
BUT IF THE THERAPIST
IN A MISGUIDED ATTEMPT TO URGE THE PATIENT FORWARD
RESORTS SIMPLY TO TELLING THE PATIENT
WHAT THE THERAPIST KNOWS,
NOT ONLY DOES THE THERAPIST RUN
THE RISK OF FORCING THE PATIENT
TO BECOME EVEN MORE ENTRENCHED
IN HER DEFENSIVE STANCE OF PROTEST
BUT ALSO THE THERAPIST WILL BE
ROBBING THE PATIENT OF ANY INCENTIVE
TO TAKE RESPONSIBILITY
FOR HER OWN DESIRE TO GET BETTER
72

TO REPEAT
THE THERAPIST
WHO IS ABLE TO RESIST THE TEMPTATION TO
“GET BOSSY” BY OVERZEALOUSLY ADVOCATING
FOR THE PATIENT TO DO THE “RIGHT” THING
WILL BE ABLE MASTERFULLY TO
AVOID GETTING DEADLOCKED IN A
POWER STRUGGLE WITH THE PATIENT
SUCH A STRUGGLE CAN EASILY ENOUGH ENSUE
WHEN THE THERAPIST TAKES IT UPON HERSELF
TO REPRESENT THE “VOICE OF REALITY”
A STANCE THAT THEN LEAVES
THE PATIENT NO OPTION BUT
TO BECOME THE “VOICE OF OPPOSITION”
73

IT TRULY IS AN UNTENABLE SITUATION FOR
THE THERAPIST TO BE THE ONE REPRESENTING
THE HEALTHY (ADAPTIVE) “VOICE OF YES”
AND FOR THE PATIENT, MADE ANXIOUS, TO BE THEN
STUCK IN THE POSITION OF HAVING TO COUNTER WITH
THE UNHEALTHY (DEFENSIVE) “VOICE OF NO”
AND SO IT IS THAT IN THE FIRST PART OF
A CONFLICT STATEMENT, THE THERAPIST HIGHLIGHTS WHAT
THE PATIENT, AT LEAST ON SOME LEVEL, REALLY DOES KNOW
IN ESSENCE
BY LOCATING THE CONFLICT SQUARELY WITHIN THE PATIENT
AND NOT IN THE INTERSUBJECTIVE FIELD BETWEEN
THERAPIST AND PATIENT, CONFLICT STATEMENTS FORCE
THE PATIENT TO TAKE OWNERSHIP OF BOTH SIDES
OF HER AMBIVALENCE ABOUT GETTING BETTER
BOTH THE “YES FORCES” AND THE “NO COUNTERFORCES”
MOBILIZED IN REACTION TO THOSE “YES FORCES”
74

ALSO NOTE THE IMPLICIT MESSAGE DELIVERED BY THE
THERAPIST IN THE SECOND PART OF A CONFLICT STATEMENT
WHEN SHE USES SUCH TEMPORAL EXPRESSIONS AS
“FOR NOW” – “RIGHT NOW”
“AT THE MOMENT” – “IN THE MOMENT”
“AT THIS POINT IN TIME”
WHICH SHE WILL DO WHEN SHE IS ADDRESSING THE
PATIENT’S “INVESTMENT IN” THE DYSFUNCTIONAL DEFENSE
“YOU KNOW YOU’RE PAYING A STEEP PRICE FOR YOUR REFUSAL TO STOP
SMOKING, OF PARTICULAR CONCERN BECAUSE OF YOUR RECURRENT LUNG
INFECTIONS; BUT, IN THE MOMENT, YOU FIND YOURSELF FEELING THAT
YOU SIMPLY MUST HAVE THE CIGARETTES IN ORDER TO RELIEVE THE
MASSIVE ANXIETY THAT YOU ARE FEELING BECAUSE OF THE LAWSUIT.”
THE THERAPIST IS ATTEMPTING TO HIGHLIGHT THE FACT
THAT EVEN IF, FOR NOW, THE PATIENT WOULD SEEM TO BE
INVESTED IN PROTESTING HER RIGHT TO MAINTAIN THINGS AS
THEY ARE, AT ANOTHER POINT IN TIME THAT COULD CHANGE
75

IN SUM
“OPTIMALLY STRESSFUL”
CONFLICT STATEMENTS
ARE DESIGNED TO PROVOKE
THE RELINQUISHMENT OF
DYSFUNCTIONAL DEFENSES
BY GENERATING COGNITIVE
AND AFFECTIVE DISSONANCE
THE WISDOM OF THE BODY IS SUCH
THAT IT CANNOT TOLERATE THE
DISTRESS OF DISEQUILIBRIUM FOR AN
EXTENDED PERIOD OF TIME AND WILL
THEREFORE BE “PROVOKED” TO TAKE
ACTION IN ORDER TO RESOLVE THE
INTERNAL TENSION AND RESTORE ORDER
76

ULTIMATELY, IT WILL BE THE
PATIENT’S EVER – EVOLVING
CAPACITY TO RECOGNIZE
THE FUNDAMENTAL CONFLICT
BETWEEN COST AND BENEFIT
THAT WILL SIMPLY FORCE HER
TO RELINQUISH HER DYSFUNCTION
THAT IS, TO SURRENDER
HER UNHEALTHY DEFENSES
DESPITE THEIR ERSTWHILE ROBUSTNESS
IN FAVOR OF HEALTHIER ADAPTATIONS
AS SHE EVOLVES FROM
“DEFENSIVE RESISTANCE”
TO “ADAPTIVE AWARENESS”
AND EXPANDED CONSCIOUSNESS 77

NATURE vs. NURTURE
I – IT vs. I – THOU
RELATIONSHIPS
MODEL 1 vs.
MODEL 2
AND MODEL 3
78

MODEL 1
WHAT DERIVES FROM
WITHIN THE CHILD
NATURE
MODEL 2 AND MODEL 3
WHAT DERIVES FROM
WITHIN THE RELATIONSHIP
BETWEEN PARENT AND CHILD
NURTURE
79

AS WE HAVE JUST SEEN
CLASSICAL PSYCHOANALYSTS
CONCEIVE OF PSYCHOPATHOLOGY
AS DERIVING FROM THE PATIENT
IN WHOM THERE IS THOUGHT TO BE
INTERNAL CONFLICT BETWEEN
A WEAK EGO AND AN UNTAMED ID
BUT SELF PSYCHOLOGISTS
AND OBJECT RELATIONS THEORISTS
CONCEIVE OF PSYCHOPATHOLOGY
AS DERIVING FROM THE PARENT
AND THE PARENT’S FAILURE
OF THE CHILD
80

IN OTHER WORDS
SELF PSYCHOLOGISTS AND
OBJECT RELATIONS THEORISTS FOCUS
NOT SO MUCH ON NATURE
THE PROVINCE OF MODEL 1
AS ON NURTURE
THE PROVINCE OF MODEL 2 AND MODEL 3
WHETHER
THE QUALITY OF PARENTAL CARE
MODEL 2
OR THE MUTUALITY OF FIT
BETWEEN PARENT AND CHILD
MODEL 3
81

BUT PLEASE NOTE
THE CRITICAL DISTINCTION
BETWEEN
QUALITY OF PARENTAL CARE
A STORY ABOUT “GIVE”
WHICH MAKES OF MODEL 2
A 1½ – PERSON PSYCHOLOGY
AND MUTUALITY OF FIT
A STORY ABOUT “GIVE – AND – TAKE”
WHICH MAKES OF MODEL 3
A 2 – PERSON PSYCHOLOGY
82

MODEL 2
AN “I – IT” RELATIONSHIP
A 1 – WAY RELATIONSHIP BETWEEN
SOMEONE WHO GIVES AND SOMEONE WHO TAKES
MODEL 3
AN “I – THOU” RELATIONSHIP
A 2 – WAY RELATIONSHIP INVOLVING
GIVE – AND – TAKE, MUTUALITY,
RECIPROCITY, AND COLLABORATION
MARTIN BUBER (1923)
83

IMPORTANTLY
AS THE ETIOLOGY HAS SHIFTED
FROM NATURE (MODEL 1) TO
NURTURE (MODEL 2 AND MODEL 3),
SO TOO THE LOCUS OF THE
THERAPEUTIC ACTION HAS SHIFTED
FROM
“INSIGHT BY WAY OF INTERPRETATION”
TO
“A CORRECTIVE EXPERIENCE BY
WAY OF THE REAL RELATIONSHIP”
THAT IS, FROM WITHIN THE PATIENT
TO WITHIN THE RELATIONSHIP
BETWEEN THERAPIST AND PATIENT
84

BUT ALTHOUGH THERE ARE
STILL SOME WHO WRITE ABOUT
“A CORRECTIVE EXPERIENCE BY
WAY OF THE REAL RELATIONSHIP,”
THIS TELESCOPES TWO DIFFERENT CONCEPTS AND
OBFUSCATES THE CRITICAL DISTINCTION BETWEEN
A THERAPY RELATIONSHIP
THAT INVOLVES GIVE
AND A THERAPY RELATIONSHIP
THAT INVOLVES GIVE – AND – TAKE
A “CORRECTIVE EXPERIENCE”
IN THE FIRST INSTANCE (MODEL 2)
A “REAL RELATIONSHIP”
IN THE SECOND (MODEL 3)
85

MODEL 2 THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT DID NOT DO
DEPRIVATION AND NEGLECT
“ABSENCE OF GOOD”
DEFICIENCY
INTERNALLY RECORDED IN THE FORM OF
STRUCTURAL DEFICIT AND IMPAIRED CAPACITY
TO BE A GOOD PARENT UNTO ONESELF
DEFICITS THAT THEN GIVE RISE TO
DESPERATE SEARCHES FOR A NEW GOOD PARENT
“RELENTLESS PURSUITS” IN AN EFFORT
TO COMPENSATE FOR EARLY – ON
PARENTAL ERRORS OF OMISSION
86

MODEL 3 THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT DID DO
TRAUMA AND ABUSE
“PRESENCE OF BAD”
TOXICITY
INTERNALLY RECORDED AND STRUCTURALIZED IN
THE FORM OF PATHOGENIC INTROJECTS
THAT ARE THEN “COMPULSIVELY AND UNWITTINGLY”
DELIVERED INTO ONE’S RELATIONSHIPS AGAIN
AND AGAIN IN DESPERATE ATTEMPTS TO
ENCOUNTER DIFFERENT OUTCOMES THIS NEXT TIME
“COMPULSIVE REPETITIONS” IN AN EFFORT
TO CORRECT FOR EARLY – ON
PARENTAL ERRORS OF COMMISSION
87

MODEL 2
CORRECTIVE
PROVISION
vs.
MODEL 3
AUTHENTIC
ENGAGEMENT
88

MODEL 2 EMPATHIC ATTUNEMENT
AS AN EMPATHIC SELFOBJECT
“DECENTERS” FROM HER OWN EXPERIENCE,
JOINS ALONGSIDE THE PATIENT, AND
“TAKES ON” THE PATIENT’S EXPERIENCE
BUT ONLY “AS IF” IT WERE HER OWN
BECAUSE IT NEVER ACTUALLY
BECOMES HER OWN
89

MODEL 3 AUTHENTIC ENGAGEMENT
AS AN AUTHENTIC SUBJECT
REMAINS VERY MUCH “CENTERED”
WITHIN HER OWN EXPERIENCE AND
ALLOWS THE PATIENT’S EXPERIENCE
TO “ENTER INTO” HER
THEREBY TAKING IT ON “AS” HER OWN AND
ALLOWING HERSELF TO BE CHANGED BY IT
THE MODEL 3 THERAPIST “USES” HER “SELF”
TO FIND, AND TO BE FOUND BY, THE PATIENT
90

MODEL 2
THE THERAPIST PROVIDES
A CORRECTIVE EXPERIENCE
“FOR” THE PATIENT
MODEL 3
THE THERAPIST PARTICIPATES
IN A REAL RELATIONSHIP
“WITH” THE PATIENT
91

AS WE SHALL SEE
THE THERAPIST’S PARTICIPATION
MODEL 3
WILL ALMOST INVARIABLY
RESULT IN THE THERAPIST’S
PARTICIPATION AS
THE OLD BAD OBJECT
BECAUSE OF THE PATIENT’S EVER – PRESENT
“COMPULSIVE AND UNWITTING” NEED
THAT IS, HER REPETITION COMPULSION
TO RE – CREATE THE EARLY – ON UNMASTERED
RELATIONAL FAILURES IN THE HERE – AND – NOW
ENGAGEMENT WITH HER THERAPIST
92

THE REPETITION COMPULSION
BOTH UNHEALTHY AND HEALTHY COMPONENTS
THE UNHEALTHY COMPONENT HAS TO DO
WITH THE PATIENT’S NEED TO HAVE
MORE OF SAME, NO MATTER HOW
DYSFUNCTIONAL, BECAUSE THAT IS
ALL THE PATIENT HAS EVER KNOWN
HAVING SOMETHING DIFFERENT WOULD CREATE ANXIETY
BUT THE HEALTHY PIECE HAS TO DO WITH
THE PATIENT’S NEED TO ACHIEVE BELATED
MASTERY OF THE PARENTAL FAILURES
93

“IF THE THERAPIST DOES NOT PARTICIPATE
AS A NEW GOOD OBJECT,
THE THERAPY MAY NEVER GET UNDER WAY.
“BUT IF HE DOES NOT PARTICIPATE
AS THE OLD BAD ONE,
IT MAY NEVER END.”
JAY GREENBERG (1986)
I WOULD WANT TO ADD, HOWEVER, THAT
IF THE THERAPIST DOES NOT PARTICIPATE
AS THE OLD BAD OBJECT,
THE THERAPY MAY NEVER GET UNDER WAY.
BUT IF SHE DOES NOT PARTICIPATE
AS A NEW GOOD ONE,
IT MAY NEVER END.
94

BOTH OF WHICH
CAPTURE BEAUTIFULLY
THE DELICATE BALANCE
THAT EXISTS BETWEEN
THE THERAPIST’S PARTICIPATION
AS A NEW GOOD OBJECT
SO THAT THERE CAN BE A STARTING OVER
AND THE THERAPIST’S PARTICIPATION
AS THE OLD BAD ONE
SO THAT THERE CAN BE AN OPPORTUNITY
TO ACHIEVE BELATED MASTERY OF THE
INTROJECTED RELATIONAL TRAUMAS
95

IN OTHER WORDS, OVER THE COURSE OF A TREATMENT,
THE PATIENT SHOULD HAVE AN
OPPORTUNITY TO EXPERIENCE HER
THERAPIST AS BOTH A NEW GOOD
OBJECT AND THE OLD BAD ONE
MODEL 2 – STRUCTURAL GROWTH
BY WORKING THROUGH
ILLUSION FOLLOWED BY DISILLUSIONMENT
“HOPE FOR GOOD” FOLLOWED BY
“NOT AS GOOD AS THE PATIENT WOULD HAVE WANTED”
MODEL 3 – STRUCTURAL MODIFICATION
BY WORKING THROUGH
DISTORTION FOLLOWED BY REALITY
“EXPECTATION OF BAD” FOLLOWED BY
“NOT AS BAD AS THE PATIENT HAD FEARED”
96

UNLIKE MODEL 2, WHICH PAYS SCANT
ATTENTION TO THE PATIENT’S PROACTIVITY
IN RELATION TO THE THERAPIST,
MODEL 3 ADDRESSES ITSELF SPECIFICALLY TO THE
FORCE – FIELD CREATED BY THE PATIENT WHO
UNDER THE SWAY OF HER REPETITION COMPULSION
AND FOR REASONS BOTH HEALTHY AND “NOT”
IS EVER INTENT UPON RE – CREATING
THROUGH PROJECTIVE IDENTIFICATION
THE EARLY – ON UNMASTERED RELATIONAL TRAUMA
BY DRAWING THE THERAPIST IN TO PARTICIPATING
IN WAYS SPECIFICALLY DETERMINED BY THE
PATIENT’S EARLY – ON DEVELOPMENTAL HISTORY
PATRICK CASEMENT (1992)
INTERNALLY RECORDED AND STRUCTURALIZED
IN THE FORM OF PATHOGENIC INTROJECTS
AND “DYSFUNCTIONAL RELATIONAL CONFIGURATIONS” 97

MODEL 2
THE NEED TO “FIND NEW GOOD”
DISPLACEMENT OF THIS NEED
WILL GIVE RISE TO “ILLUSION”
(POSITIVE MISPERCEPTION OF REALITY)
AND “POSITIVE TRANSFERENCE”
MODEL 3
THE NEED TO “REFIND OLD BAD”
PROJECTION OF PATHOGENIC INTROJECT
WILL GIVE RISE TO “DISTORTION”
(NEGATIVE MISPERCEPTION OF REALITY)
AND “NEGATIVE TRANSFERENCE”
98

“ABSENCE OF GOOD” (MODEL 2)
AND
“PRESENCE OF BAD” (MODEL 3)
GENERALLY GO HAND IN HAND
FOR EXAMPLE, THE CHILD WHO WAS RARELY PRAISED
WAS PROBABLY ALSO OFTEN CRITICIZED
THE CHILD WHO WAS RARELY ADMIRED
WAS PROBABLY ALSO OFTEN DEVALUED
BUT THESE SITUATIONS ARE NOT
HANDLED THE SAME WAY CLINICALLY
MODEL 2 INVOLVES “POSITIVE TRANSFERENCE”
(AND “POSITIVE TRANSFERENCE DISRUPTED”)
MODEL 3 INVOLVES “NEGATIVE TRANSFERENCE”
99

MODEL 2
WORKING THROUGH
“POSITIVE TRANSFERENCE DISRUPTED”
STRUCTURAL GROWTH
ADD “NEW GOOD”
FILL IN DEFICIT
CONSOLIDATE THE SELF
vs.
MODEL 3
WORKING THROUGH
“NEGATIVE TRANSFERENCE”
STRUCTURAL MODIFICATION
CHANGE “OLD BAD”
DETOXIFY INTERNAL DEMONS
100

AS WE HAD EARLIER DISCUSSED
THE THERAPEUTIC ACTION
IN MODEL 1 INVOLVES
WORKING THROUGH
THE STRESS OF GAIN – BECOME – PAIN
AS DYSFUNCTIONAL DEFENSES
– ONCE EGO – SYNTONIC –
ARE REPEATEDLY CHALLENGED
AND RENDERED INCREASINGLY
EGO – DYSTONIC
101

BUT THE THERAPEUTIC ACTION IN MODEL 2
INVOLVES WORKING THROUGH
THE STRESS OF GOOD – BECOME – BAD
AS THE PATIENT’S DEFENSIVE NEED TO CLING
TO ILLUSION IS REPEATEDLY CHALLENGED AND
GRADUALLY REPLACED BY MORE ACCURATE
(AND SOBERING) PERCEPTIONS OF REALITY
AND THE THERAPEUTIC ACTION IN MODEL 3
THE STRESS OF BAD – BECOME – GOOD
AS THE PATIENT’S DEFENSIVE NEED
TO CLING TO DISTORTION
BECAUSE THAT IS ALL SHE HAS EVER KNOWN
IS REPEATEDLY CHALLENGED AND
GRADUALLY REPLACED BY MORE ACCURATE
(AND LESS TOXIC) PERCEPTIONS OF REALITY
102

MORE SPECIFICALLY
THE THERAPEUTIC ACTION IN MODEL 2
POSITIVE TRANSFERENCE DISRUPTED
DISILLUSIONMENT
THEREBY TRANSFORMING RELENTLESS HOPE
INTO SERENE ACCEPTANCE
NEGATIVE TRANSFERENCE
DETOXIFICATION
THEREBY TRANSFORMING RE – ENACTMENT
INTO ACCOUNTABILITY
103

WORKING THROUGH THE STRESS OF GOOD – BECOME – BAD
A STORY ABOUT “CONFRONTING”
– AND “GRIEVING” –
THE REALITY OF THE “LIMITATIONS, SEPARATENESS,
AND IMMUTABILITY” OF THE PATIENT’S “OBJECTS”
BOTH PAST AND PRESENT
OPTIMAL DISILLUSIONMENT
ADAPTIVE TRANSMUTING INTERNALIZATION
INCREMENTAL ACCRETION OF PSYCHIC STRUCTURE
GRADUAL FILLING IN OF STRUCTURAL DEFICIT
EVENTUAL TRANSFORMATION OF THE PATIENT’S
RELENTLESS PURSUIT OF THE UNATTAINABLE
INTO SERENE ACCEPTANCE OF PAINFUL REALITIES
ABOUT THE OBJECTS OF HER DESIRE
104

WORKING THROUGH THE STRESS OF BAD – BECOME – GOOD
A STORY ABOUT NEGOTIATING THE VARIOUS
“MUTUAL ENACTMENTS” AND “THERAPEUTIC IMPASSES”
THAT WILL INEVITABLY ARISE AT THE “INTIMATE EDGE”
(DARLENE EHRENBERG 1992) OF “AUTHENTIC ENGAGEMENT” AS
A RESULT OF THE PATIENT’S “PROJECTIVE IDENTIFICATIONS”
THE THERAPIST’S PROVISION OF CONTAINMENT BY VIRTUE OF HER
CAPACITY BOTH TO RELENT AND TO HOLD HERSELF ACCOUNTABLE
INCREMENTAL “RELATIONAL DETOXIFCATION” OF
THE PATIENT’S “INTERNAL DEMONS” BY WAY OF
“SERIAL DILUTIONS” AND BY VIRTUE OF THE THERAPIST’S
CAPACITY TO PROCESS AND INTEGRATE ON BEHALF
OF A PATIENT WHO TRULY DOES NOT KNOW HOW
EVENTUAL TRANSFORMATION OF THE PATIENT’S
COMPULSIVE AND UNWITTING RE – ENACTMENTS
INTO ACCOUNTABILITY FOR HER DYSFUNCTIONAL
ACTIONS, REACTIONS, AND INTERACTIONS
105

PLEASE NOTE THE FOLLOWING CRITICALLY IMPORTANT CLINICAL DISTINCTION
“NEGATIVE TRANSFERENCE” vs. “POSITIVE TRANSFERENCE DISRUPTED”
WHEREAS MODEL 3 “NEGATIVE TRANSFERENCE”
INVOLVES “PROJECTION OF PATHOGENIC INTROJECT”
AND “NEGATIVE MISPERCEPTION” OF REALITY
(“DISTORTION”)
MODEL 2 “POSITIVE TRANSFERENCE”
INVOLVES “DISPLACEMENT OF NEED”
AND “POSITIVE MISPERCEPTION” OF REALITY
(“ILLUSION”)
WHEREAS MODEL 3 “NEGATIVE TRANSFERENCE”
MUST BE WORKED THROUGH BY
“NEGOTIATING AT THE INTIMATE EDGE”
MODEL 2 “POSITIVE TRANSFERENCE”
NEED NOT BE WORKED THROUGH
ONLY ITS “DISRUPTIONS” ARE WORKED THROUGH BY
“GRIEVING THE REALITY OF DISILLUSIONMENT”
“OPTIMAL DISILLUSIONMENT”
106

THE THERAPIST’S CAPACITY BOTH
TO TOLERATE “BEING SEEN AS BAD” (MODEL 2)
AND TO TOLERATE “BEING MADE BAD” (MODEL 3)
IF THE MODEL 2 THERAPIST CANNOT
TOLERATE “BREAKING THE PATIENT’S HEART”
EVERY NOW AND AGAIN,
THE THERAPIST WILL BE ROBBING THE PATIENT
OF THE OPPORTUNITY ADAPTIVELY TO INTERNALIZE
MISSING PSYCHOLOGICAL FUNCTIONS
VIA OPTIMAL DISILLUSIONMENT AND TRANSMUTING INTERNALIZATION
SO TOO IF THE MODEL 3 THERAPIST
REFUSES TO PARTICIPATE EVERY
NOW AND AGAIN AS SOMEONE WHO
“INITIALLY RE – TRAUMATIZES BUT ULTIMATELY RELENTS,”
THE THERAPIST WILL BE ROBBING THE PATIENT
OF THE OPPORTUNITY TO REWORK
HER INTROJECTED BOLUSES OF TOXICITY
VIA SERIAL DILUTION 107

FINALLY
CENTER STAGE FOR BOTH
SELF PSYCHOLOGISTS (MODEL 2)
AND RELATIONAL THEORISTS (MODEL 3)
ARE “INEVITABLE EMPATHIC FAILURES” (MODEL 2)
AND “INEVITABLE RELATIONAL FAILURES” (MODEL 3)
BUT THE TWO MODELS CONCEIVE OF
SUCH FAILURES VERY DIFFERENTLY
SELF PSYCHOLOGISTS (MODEL 2)
CONTEND THAT FAILURES ARE
UNAVOIDABLE BECAUSE THE
THERAPIST IS NOT, AND CANNOT
BE EXPECTED TO BE, PERFECT
108

BUT MOST RELATIONAL THEORISTS (MODEL 3)
BELIEVE THAT THE THERAPIST’S FAILURES
ARE A STORY ABOUT NOT JUST THE
THERAPIST AND HER LACK OF PERFECTION
BUT ALSO THE PATIENT AND THE PATIENT’S
EXERTING OF PRESSURE ON THE THERAPIST
TO PARTICIPATE IN OLD “FAMILIAL AND
THEREFORE FAMILIAR” (STEPHEN MITCHELL 1988) WAYS
IN OTHER WORDS
THE RELATIONAL THERAPIST’S FAILURES
ARE SEEN AS CO – CREATED,
AS OCCURRING IN THE CONTEXT OF AN
ONGOING, CONTINUOUSLY EVOLVING RELATIONSHIP
BETWEEN TWO PEOPLE, AND AS SPEAKING TO THE
PATIENT’S UNCONSCIOUS NEED TO BE FAILED –
SO THAT SHE CAN ACHIEVE BELATED MASTERY
OF HER UNRESOLVED RELATIONAL TRAUMAS
109

MODEL 2
THE
CORRECTIVE – PROVISION
PERSPECTIVE
OF SELF PSYCHOLOGY AND
OTHER “DEFICIT” THEORIES
110

MODEL 2
CORRECTIVE – PROVISION MODEL
DEFICIENCY – COMPENSATION MODEL
THE MODEL 2 EMPATHIC THERAPIST
PROVIDES THE “HOLDING” AND THE
“BEING MET” THAT WERE NOT
PROVIDED CONSISTENTLY AND
RELIABLY BY THE PARENT
THIS REPARATION FUNCTIONS
AS A SYMBOLIC CORRECTIVE
FOR THE EARLY – ON
DEPRIVATION AND NEGLECT
111

AS PREVIOUSLY NOTED
ALTHOUGH SOME MODEL 2 THEORISTS
BELIEVE THAT IT IS THIS EXPERIENCE
OF GRATIFICATION ITSELF THAT IS
COMPENSATORY AND ULTIMATELY HEALING,
MOST BELIEVE THAT IT IS THE OPTIMAL STRESS
CREATED BY THE EXPERIENCE OF FRUSTRATION
AGAINST A BACKDROP OF GRATIFICATION
FRUSTRATION (DISILLUSIONMENT) PROPERLY GRIEVED
THAT IS, OPTIMAL DISILLUSIONMENT
THAT MOST EFFECTIVELY
PROMOTES STRUCTURAL GROWTH
AND DEVELOPMENT OF CAPACITY
112

AGAIN
IF THERE IS NO THWARTING OF DESIRE,
THEN THERE WILL BE NOTHING
THAT NEEDS TO BE MASTERED AND
THEREFORE NO IMPETUS FOR ADAPTIVE
TRANSMUTING INTERNALIZATION
BUT WORKING THROUGH THE THWARTING
OF DESIRE WILL ENABLE THE PATIENT TO
ACCEPT THE REALITY THAT SHE WILL NEVER
BE ABLE TO HAVE ALL THAT SHE SHOULD
HAVE HAD AS A CHILD AND FOR WHICH
SHE HAS SPENT A LIFETIME SEARCHING
BUT THAT WHAT SHE HAS
IS “GOOD ENOUGH”
113

I AM HERE REMINDED OF
THE NEW YORKER CARTOON
IN WHICH A GENTLEMAN,
SEATED IN A RESTAURANT
NAMED THE DISILLUSIONMENT CAFÉ,
IS AWAITING THE ARRIVAL OF HIS ORDER
THE WAITER RETURNS TO
HIS TABLE AND ANNOUNCES,
“YOUR ORDER IS NOT READY,
AND NOR WILL IT EVER BE.”
114

GRIEVING IS A PROTRACTED PROCESS THAT
TRANSFORMS THE PATIENT’S REFUSAL TO CONFRONT
THE PAIN OF HER GRIEF ABOUT THE OBJECT’S LIMITATIONS,
SEPARATENESS, AND IMMUTABILITY INTO THE CAPACITY TO
TOLERATE AND ACCEPT THOSE INESCAPABLE REALITIES
IN THE CONTEXT OF THE TREATMENT, IT INVOLVES
WORKING THROUGH OPTIMAL DISILLUSIONMENT
THAT IS, POSITIVE TRANSFERENCE DISRUPTED
BY CONFRONTING THE PAIN OF HER GRIEF,
ADAPTIVELY INTERNALIZING THE GOOD THAT HAD
BEEN THERE PRIOR TO THE DISRUPTION
IF YOU CANNOT ALWAYS COUNT ON EXTERNAL PROVISION,
BEST THAT YOU INTERNALIZE WHATEVER GOOD YOU CAN
SO THAT IT WILL ALWAYS BE THERE FOR YOU
AND ARRIVING ULTIMATELY AT A PLACE OF SERENE
ACCEPTANCE, FORGIVENESS, AND INNER PEACE
115

GRIEVING
GENUINE GRIEVING REQUIRES OF US THAT, AT LEAST
FOR PERIODS OF TIME, WE BE FULLY PRESENT WITH
THE ANGUISH OF OUR GRIEF, THE PAIN OF OUR REGRET,
AND THE INTENSITY OF THE RAGE WE EXPERIENCE
WHEN CONFRONTED WITH SOBERING REALITIES ABOUT
OURSELVES, OUR RELATIONSHIPS, AND OUR WORLD
WE MUST NOT ABSENT OURSELVES FROM OUR GRIEF;
WE MUST ENTER INTO AND EMBRACE IT
WE CANNOT EFFECTIVELY GRIEVE WHEN WE ARE
DISSOCIATED, MISSING IN ACTION, OR FLEEING THE SCENE
WE NEED TO BE ENGAGED, IN THE MOMENT,
MINDFUL OF ALL THAT IS GOING ON INSIDE US,
GROUNDED, FOCUSED, AND IN THE HERE – AND – NOW
IF WE ARE IN DENIAL, CLOSED, SHUT DOWN, NUMB,
REFUSING TO FEEL, OR PROTESTING THE UNFAIRNESS
OF IT ALL, THEN NO REAL GRIEVING CAN BE DONE
116

“GRIEF IS
NATURE’S WAY
OF HEALING
A BROKEN HEART”
(ROBERTA BECKMANN 1991)
117

MODEL 2
DISILLUSIONMENT
STATEMENTS,
GRIEVING,
AND
ADAPTIVE
TRANSMUTING
INTERNALIZATION
118

RESONATING WITH THE PATIENT’S
MOMENT – TO – MOMENT EXPERIENCE
MIGHT OFFER THE PATIENT ANY OF THE FOLLOWING
“I WONDER IF IT BREAKS YOUR HEART … ”
“IT SOUNDS AS IF IT BREAKS YOUR HEART … ”
“IT SEEMS AS IF IT BREAKS YOUR HEART … ”
“IT MUST BREAK YOUR HEART … ”
BUT PERHAPS IT WOULD BE BETTER
SIMPLY TO CUT TO THE CHASE WITH
“IT BREAKS YOUR HEART … ”
119

SO HOW DO WE HELP THE PATIENT GRIEVE?
ARE DESIGNED TO FACILITATE THE GRIEVING
OF A PATIENT WHO IS BEGINNING TO
ACKNOWLEDGE THE PAIN OF HER GRIEF
FIRST THE THERAPIST CHALLENGES
BY SPEAKING TO THE DISILLUSIONING REALITY THAT
THE PATIENT IS GRADUALLY COMING TO ACKNOWLEDGE
AND THEN THE THERAPIST SUPPORTS
BY RESONATING EMPATHICALLY WITH
THE PATIENT’S EXPERIENCE OF HEARTBREAK
“YOU ARE COMING TO KNOW THAT … ,
AND IT BREAKS YOUR HEART … ”
“YOU ARE BEGINNING TO REALIZE THAT PROBABLY YOUR FATHER,
AN ALCOHOLIC FOR OVER 35 YEARS NOW, WILL PROBABLY
NEVER BE WILLING TO ACKNOWLEDGE THAT HE HAS A SERIOUS
DRINKING PROBLEM, AND THAT BREAKS YOUR HEART.” 120

MODEL 2 DISILLUSINOMENT STATEMENTS CAN
ALSO INCLUDE A HIGHLIGHTING OF WHAT
THE PATIENT “HAD SO HOPED” COULD BE …
THEREBY BOTH ACKNOWLEDGING THE
“HOPE THAT HAD BEEN”
AND REINFORCING THE REALITY THAT
THIS HOPE IS NO LONGER A VIABLE OPTION
“YOU KNOW THAT … , AND IT BREAKS YOUR HEART
BECAUSE YOU HAD SO HOPED THAT … ”
“YOU KNOW THAT ULTIMATELY YOU WILL NEED
TO LET JOSE GO BECAUSE HE, LIKE YOUR DAD,
REALLY ISN’T AVAILABLE IN THE WAY
THAT YOU WOULD HAVE WANTED HIM TO BE,
AND IT BREAKS YOUR HEART BECAUSE YOU HAD SO
HOPED THAT, WITH HIM, IT WOULD BE DIFFERENT.”
121

“YOU KNOW THAT EVENTUALLY YOU WILL NEED TO MAKE YOUR
PEACE WITH THE REALITY THAT YOUR MOTHER IS VERY LIMITED
IN TERMS OF HER CAPACITY TO HOLD HERSELF ACCOUNTABLE.
BUT WHEN YOU LET YOURSELF GO THERE, THE PAIN GOES
SO DEEP THAT YOU WONDER HOW YOU’LL SURVIVE. YOU HAD
SO HOPED THAT SHE WOULD SOMEDAY APOLOGIZE.”
“YOU KNOW THAT EVENTUALLY YOU WILL NEED TO LET GO OF
YVONNE BECAUSE SHE REALLY IS NOT CAPABLE OF BEING IN
AN INTIMATE RELATIONSHIP RIGHT NOW. AND THE PAIN OF THAT
HURTS SO MUCH BECAUSE YOU HAD SO DESPERATELY WANTED
THINGS TO WORK OUT. WHEN IT WAS GOOD, IT WAS SO GOOD!”
“ON SOME LEVEL, YOU KNEW THAT EVENTUALLY YOU
WOULD NEED TO CONFRONT THE REALITY THAT YOUR
FATHER WOULD PROBABLY NEVER ACCEPT YOU. BUT,
EVEN SO, YOU HAD DESPERATELY HOPED THAT PERHAPS
HE MIGHT SOMEDAY RELENT, WHICH IS WHY THE PAIN
OF HIS MOST RECENT REJECTION GOES SO DEEP.”
122

“YOU KNOW THAT EVENTUALLY YOU WILL NEED TO FACE
THE REALITY THAT YOUR FATHER WILL NEVER CHANGE, AND
THAT BREAKS YOUR HEART. YOU HAD SO HOPED HE WOULD.”
“YOU ARE BEGINNING TO RECOGNIZE THAT TONY WILL
NEVER BE ABLE TO LOVE YOU IN THE WAY THAT YOU
WOULD HAVE WANTED HIM TO, AND THAT IS DEVASTATING.”
“AS YOU BEGIN TO ADMIT TO YOURSELF THAT PROBABLY
ELANA WILL NEVER BE RIGHT FOR YOU, IT MAKES
YOU VERY SAD BECAUSE YOU HAD SO HOPED THAT SHE
WOULD EVENTUALLY COME ’ROUND TO LOVING YOU.”
“IN THOSE MOMENTS WHEN YOU LET YOURSELF REMEMBER
JUST HOW LIMITED YOUR FATHER IS AND JUST HOW DEFENSIVE
HE BECOMES WHENEVER YOU TRY TO HOLD HIM ACCOUNTABLE,
IT FEELS TOTALLY OVEWHELMING AND DEVASTATING.
YOU HAD SO HOPED THAT YOU COULD GET HIM TO TAKE AT
LEAST SOME RESPONSIBILITY FOR HIS ABUSIVE BEHAVIOR.”
123

DISILLUSIONMENT STATEMENTS ARE OF COURSE
ALSO USED FOR WORKING THROUGH
DISRUPTED POSITIVE TRANSFERENCES
BECAUSE THEY FACILITATE THE PATIENT’S ACCESSING OF
HER GRIEF ABOUT THE THERAPIST’S LACK OF PERFECTION
FIRST THE THERAPIST HIGHLIGHTS THE PATIENT’S
ILLUSIONS ABOUT THE THERAPIST’S PERFECTION
AND THEN THE THERAPIST RESONATES EMPATHICALLY
WITH THE PATIENT’S EXPERIENCE OF DISILLUSIONMENT
DISAPPOINTMENT IN THE FACE OF THE THERAPIST’S IMPERFECTIONS
DISILLUSIONMENT STATEMENTS CAN THEREFORE BE
USED TO HIGHLIGHT THE DISCREPANCY BETWEEN
THE ILLUSION OF THE THERAPIST AS INFALLIBLE
AND THE REALITY OF THE THERAPIST AS FALLIBLE
124

“SOMETIMES YOU WOULD WISH THAT I COULD KNOW WHAT YOU
WERE THINKING WITHOUT YOUR HAVING TO ARTICULATE IT, WHICH
IS WHY IT MAKES YOU SAD WHEN I DON’T ALWAYS GET IT RIGHT.”
“ALTHOUGH YOU KNEW IT WOULD TAKE TIME, YOU HAD HOPED
THAT YOU WOULD BE FEELING BETTER AFTER THESE SEVERAL WEEKS
OF THERAPY, SO IT BOTHERS YOU THAT YOU STILL FEEL BAD.”
“YOU WERE SO HOPING THAT I WOULD NOT MAKE THE SAME KINDS OF
MISTAKES THAT EVERYONE ELSE IN YOUR LIFE HAS MADE, WHICH IS
WHY IT MAKES YOU VERY SAD THAT I TOO HAVE NOW LET YOU DOWN.”
“YOU HAD WANTED SO MUCH FOR ME TO BE ABLE TO MAKE
IT ALL BETTER, AND IT UPSETS YOU TERRIBLY THAT I DON’T
SEEM TO BE ABLE TO MAKE YOUR PAIN GO AWAY.”
“ON SOME LEVEL, YOU KNEW THAT I DIDN’T HAVE ALL THE ANSWERS.
EVEN SO, YOU WERE HOPING THAT I MIGHT, WHICH IS WHY IT ANGERS
YOU WHEN I DON’T ALWAYS HAVE ANSWERS TO YOUR QUESTIONS.”
125

A HIGHLIGHTING OF
THE PATIENT’S ILLUSION
HER RELENTLESS HOPE
A HIGHLIGHTING OF
THE REALITY OF THE PATIENT’S DISILLUSIONMENT
THE DISILLUSIONING REALITY THAT THE PATIENT TRULY DOES KNOW
EVEN THOUGH IT STILL MAKES HER SOMEWHAT ANXIOUS
EMPATHIC RESONATING WITH
THE PAIN OF THE PATIENT’S GRIEF
“A PART OF YOU WOULD SO HAVE WANTED TO HAVE A PERSONAL
RELATIONSHIP WITH ME; BUT ANOTHER PART OF YOU KNOWS THAT
THE THERAPY RELATIONSHIP IS NOT ABOUT FRIENDSHIP PER SE; AND
THAT BREAKS YOUR HEART. IT MAKES YOU FEAR THAT YOU WILL
NEVER GET OVER THE PAIN OF FEELING SO ALONE IN THIS WORLD.”
“A PART OF YOU FINDS YOURSELF WANTING TO KNOW EVER MORE
ABOUT ME AND MY FAMILY; BUT ANOTHER PART OF YOU
UNDERSTANDS THE NEED FOR LIMITS IN OUR RELATIONSHIP; AND
EVEN THE THOUGHT OF THAT IS ABSOLUTELY DEVASTATING.” 126

IF THE EXPERIENCE OF
DISILLUSIONING HEARTBREAK
THE STRESSFUL EXPERIENCE OF GOOD – BECOME – BAD
CAN BE ADEQUATELY
PROCESSED AND INTEGRATED
THAT IS, GRIEVED
THE PATIENT WILL ADAPTIVELY INTERNALIZE
THOSE SELFOBJECT FUNCTIONS
THAT THE OBJECT HAD BEEN PERFORMING
PRIOR TO ITS DISILLUSIONMENT OF HER
TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS
THEREBY FILLING IN DEFICIT
AND CONSOLIDATING THE SELF
FROM “SOME HOLES” TO “WHOLESOME” 
127

THESE STRUCTURE – BUILDING
INTERNALIZATIONS
WILL ENABLE THE PATIENT
TO PRESERVE INTERNALLY
A PIECE OF
THE ORIGINAL EXPERIENCE
OF EXTERNAL GOODNESS
(THUS THEIR ADAPTIVE VALUE)
128

AT THE END OF THE DAY
MODEL 2 IS ABOUT THE PATIENT’S
CONFRONTING – AND GRIEVING –
THE REALITY OF THE OBJECT’S
LIMITATIONS, SEPARATENESS,
AND IMMUTABILITY
AND, AFTER RELENTING, FORGIVING, INTERNALIZING,
SEPARATING, LETTING GO, AND MOVING ON,
ARRIVING ULTIMATELY AT A PLACE
OF SERENE ACCEPTANCE
IN THE PROCESS,
ALSO MAKING HER PEACE WITH THE
REALITY OF THE LIMITS OF HER POWER
TO FORCE HER OBJECTS TO CHANGE
129

MODEL 3
THE
INTERSUBJECTI VE
PERSPECTIVE
OF CONTEMPORARY
RELATIONAL THEORY
130

THE LOCUS OF THE THERAPEUTIC
ACTION IN THIS RELATIONAL
MODEL ALWAYS INVOLVES
MUTUALITY OF INFLUENCE –
BOTH THERAPIST AND PATIENT
CONTINUOUSLY CHANGING
BY VIRTUE OF BEING IN
RELATIONSHIP WITH EACH OTHER
131

CLASSICAL PSYCHOANALYSTS
SPEAK OF SUPEREGO INTROJECTS
A CRITICAL SUPEREGO INTROJECT
OR A HARSHLY PUNITIVE SUPEREGO INTROJECT
AND WHERE ONCE THE ABUSIVE PARENT HAD RAILED AGAINST THE CHILD,
NOW THAT DYNAMIC GETS PLAYED OUT BETWEEN SUPEREGO AND EGO
(WITH THE SUPEREGO RAILING AGAINST THE EGO)
BUT I FIND IT TO BE MORE CLINICALLY USEFUL TO CONCEIVE
OF SUCH PATHOGENIC INTROJECTS AS EXISTING IN PAIRS
CRITICIZER AND CRITICIZEE / VICTIMIZER AND VICTIM / SEDUCER AND SEDUCEE
AND AS GIVING RISE TO DYSFUNCTIONAL RELATIONAL DYNAMICS
THE THERAPEUTIC ACTION IN MODEL 3 THEN BECOMES
A STORY ABOUT NEGOTIATING THE TURBULENCE THAT
WILL INEVITABLY EMERGE AT THE INTIMATE EDGE
OF AUTHENTIC ENGAGEMENT BETWEEN THERAPIST AND
PATIENT ONCE THE PATIENT DELIVERS THE DYSFUNCTIONAL
RELATIONAL DYNAMIC OF HER THERE – AND – THEN
INTO THE HERE – AND – NOW OF THE TRANSFERENCE
AND WHERE ONCE THE ABUSIVE PARENT HAD RAILED AGAINST THE CHILD,
NOW THAT DYNAMIC GETS PLAYED OUT BETWEEN THERAPIST AND PATIENT
(WITH BOTH ULTIMATELY RAILING AGAINST EACH OTHER) 132

THE RELATIONAL MODEL
CONCEIVES OF THE PATIENT
AS AN AGENT,
AS PROACTIVE,
AS INTENTIONED
IN HER ACTIVITIES,
AND AS THEREFORE
ACCOUNTABLE
AND EMPOWERED
133

IN FACT
THE PATIENT’S ACTIVITY IN RELATION
TO THE THERAPIST IS SEEN AS AN
ENACTMENT
THE UNCONSCIOUS INTENT OF WHICH IS TO
ENGAGE THE THERAPIST IN SOME FASHION
EITHER
BY ELICITING (PROVOKING) FROM THE THERAPIST
A “FAMILIAL AND THEREFORE FAMILIAR” REACTION
OR
BY COMMUNICATING TO THE THERAPIST SOMETHING
DEEPLY IMPORTANT (BUT NOT YET “OWNED”)
ABOUT THE PATIENT’S TOXIC INTERNAL WORLD
134

TWO PHASES OF A PROJECTIVE IDENTIFICATION
(MARTHA STARK 1999)
THE INDUCTION PHASE COMMENCES ONCE THE PATIENT
PROJECTS ONTO THE THERAPIST SOME ASPECT OF THE PATIENT’S
EXPERIENCE THAT HAS BEEN TOO TOXIC FOR THE PATIENT TO
PROCESS AND INTEGRATE AND THEN EXERTS PRESSURE ON THE
THERAPIST TO ACCEPT THAT PROJECTION, THEREBY INDUCTING
THE THERAPIST INTO THE PATIENT’S ENACTMENT
THE RESOLUTION PHASE IS USHERED IN ONCE THE THERAPIST
STEPS BACK FROM HER PARTICIPATION IN WHAT HAS BECOME A
MUTUAL ENACTMENT AND BRINGS TO BEAR HER OWN,
MORE – EVOLVED CAPACITY TO PROCESS AND INTEGRATE ON
BEHALF OF THE PATIENT, WHO TRULY DOES NOT KNOW HOW –
SUCH THAT WHAT IS THEN RE – INTROJECTED BY THE PATIENT CAN
BE MORE EASILY ASSIMILATED INTO HEALTHY PSYCHIC STRUCTURE
AND, IF ALL GOES WELL, THESE CYCLES WILL HAPPEN
REPEATEDLY, THE NET RESULT OF WHICH WILL BE GRADUAL
DETOXIFICATION OF THE PATIENT’S INTERNAL TOXICITY
135

ALTHOUGH INEVITABLY THE THERAPIST WILL
FAIL THE PATIENT IN SOME OF THE SAME
WAYS THAT THE PARENT HAD FAILED HER,
ULTIMATELY THE THERAPIST WILL CHALLENGE THE
PATIENT’S PROJECTIONS BY LENDING ASPECTS OF
HER “OTHERNESS” OR HER “EXTERNALITY”
(DONALD WINNICOTT 1965)
TO THE INTERACTION
SUCH THAT THE PATIENT
WILL HAVE THE EXPERIENCE OF SOMETHING THAT
IS “OTHER – THAN – ME” AND CAN THEN TAKE THAT IN
IN ESSENCE, THE THERAPIST WILL
CHALLENGE THE PATIENT’S PROJECTIONS
BY LENDING ASPECTS OF HER OWN GREATER
CAPACITY TO PROCESS AND INTEGRATE,
SUCH THAT THE PATIENT WILL HAVE THE
EXPERIENCE OF BEING ABLE TO TAKE IN
SOMETHING THAT IS NOW MORE PROCESSED,
LESS TOXIC, AND MORE MANAGEABLE
136

WHAT THE PATIENT INTROJECTS
WILL BE AN AMALGAM,
PART CONTRIBUTED BY THE THERAPIST
SOMETHING MORE PROCESSED AND LESS TOXIC
AND PART CONTRIBUTED BY THE PATIENT
THE ORIGINAL PROJECTION
PARENTHETICALLY
IN THE PSYCHOANALYTIC LITERATURE
“INTERNALIZE” TENDS TO IMPLY “POSITIVE”
AS IN “TRANSMUTING INTERNALIZATION”
WHEREAS “INTROJECT” TENDS TO IMPLY “NEGATIVE”
AS IN “PATHOGENIC INTROJECT”
137

NEGOTIATING AT THE INTIMATE EDGE WILL GENERALLY INVOLVE THESE
SERIAL DILUTIONS
GRADUATED DETOXIFICATION
ITERATIVE CYCLES OF
INDUCTION AND RESOLUTION
“MORE OF SAME” AND THEN “SOMETHING NEW”
WILL HAPPEN REPEATEDLY
RESULTING ULTIMATELY IN
STRUCTURAL MODIFICATION
NOTE THAT IT IS THE SECOND (RESOLUTION) PHASE
OF THE PROJECTIVE IDENTIFICATION
THAT CONSTITUTES THE CHALLENGE
AND THE FIRST (INDUCTION) PHASE THAT REINFORCES
AND SUPPORTS THE DYSFUNCTIONAL STATUS QUO
138

A SUCCESSFUL
PROJECTIVE IDENTIFICATION
INVOLVES SYMBOLIC
REPETITION OF THE
ORIGINAL RELATIONAL
TRAUMA BUT WITH
A MUCH HEALTHIER
RESOLUTION THIS TIME
139

CONTEMPORARY RELATIONAL THEORY
POSTULATES THAT IT IS
NOT ONLY INEVITABLE
BUT ALSO NECESSARY
AND THEREFORE DESIRABLE
THAT ULTIMATELY THE THERAPIST
WILL FAIL THE PATIENT
AND IN THE VERY WAYS THAT
THE PATIENT MOST NEEDS
TO BE FAILED
IF SHE IS EVER TO HAVE
THE OPPORTUNITY TO MODIFY
HER INTERNAL DEMONS
140

IF THE THERAPIST NEVER ALLOWS HERSELF
TO BE DRAWN IN TO PARTICIPATING
WITH THE PATIENT IN HER RE – ENACTMENTS,
WE SPEAK OF A FAILURE OF
ENGAGEMENT AND LOST OPPORTUNITY
IF, HOWEVER, THE THERAPIST ALLOWS
HERSELF TO BE DRAWN IN TO THE
PATIENT’S INTERNAL DRAMAS BUT THEN
GETS OVERWHELMED, LOSES HER WAY,
AND CANNOT FIND HER WAY OUT,
WE SPEAK OF A FAILURE OF CONTAINMENT
AND POTENTIAL RE – TRAUMATIZATION
141

THE THERAPIST MUST BE ABLE
TO PROVIDE CONTAINMENT
THE RELATIONAL THERAPIST MUST BE ABLE
NOT ONLY TO TOLERATE BEING MADE
INTO THE PATIENT’S OLD BAD OBJECT
BUT ALSO
ONCE THE THERAPIST HAS
ALLOWED HERSELF TO BE DRAWN
IN TO PARTICIPATING IN WHAT HAS
BECOME A MUTUAL ENACTMENT
TO EXTRICATE HERSELF BY STEPPING BACK
WHICH WILL ENABLE HER TO RECOVER
HER OBJECTIVITY AND THEREBY
HER THERAPEUTIC EFFECTIVENESS
142

BUT IN ORDER TO PROVIDE EFFECTIVE CONTAINMENT
THE THERAPIST MUST HAVE
THE CAPACITY TO RELENT
IN OTHER WORDS, THE THERAPIST MUST HAVE
BOTH THE WISDOM TO RECOGNIZE
AND THE INTEGRITY TO ACKNOWLEDGE
CERTAINLY TO HERSELF AND PERHAPS TO THE PATIENT AS WELL
HER OWN PARTICIPATION IN THE DRAMA
THAT IS BEING PLAYED OUT BETWEEN THEM
ON THE STAGE OF THE TREATMENT
IN ESSENCE
THE THERAPIST MUST HAVE THE CAPACITY
BOTH TO RELENT AND TO HOLD HERSELF
ACCOUNTABLE FOR HER ENACTMENTS
143

INVOLVE INTERPRETING THE
PATIENT’S ENACTMENTS AS AN EFFORT
EITHER TO DRAW THE THERAPIST IN TO PARTICIPATING
AS THE “ABUSIVE” PARENT THE PATIENT HAD
BY WAY OF BEHAVIOR ON THE PATIENT’S PART
THAT IS UNCONSCIOUSLY DESIGNED
TO ELICIT AN “ABUSIVE” REACTION FROM THE THERAPIST
THIS IS A “DIRECT NEGATIVE TRANSFERENCE” IN WHICH
THE THERAPIST IS MADE INTO THE “ABUSIVE” PARENT AND THE
PATIENT ONCE AGAIN ASSUMES THE ROLE OF THE “ABUSED” CHILD
OR TO GET THE THERAPIST TO UNDERSTAND FIRSTHAND
WHAT IT WAS LIKE FOR THE PATIENT GROWING UP
BY WAY OF BEHAVIOR ON THE PATIENT’S PART
THAT INVOLVES UNCONSCIOUSLY DOING UNTO THE THERAPIST WHAT THE
“ABUSIVE” PARENT HAD DONE UNTO THE PATIENT AS A CHILD
THIS IS AN “INVERTED NEGATIVE TRANSFERENCE” IN WHICH
THE PATIENT ASSUMES THE ROLE OF THE “ABUSIVE” PARENT
AND THEN BECOMES “ABUSIVE” TO THE THERAPIST IN AN
EFFORT TO GET THE THERAPIST TO UNDERSTAND WHAT
IT WAS LIKE FOR THE PATIENT AS A CHILD GROWING UP 144

CAN BE INTRODUCED IN ANY OF THE FOLLOWING WAYS
“IT OCCURS TO ME THAT, BY WAY OF YOUR
BEHAVIOR IN HERE WITH ME, YOU ARE HELPING
ME TO UNDERSTAND SOMETHING THAT
I HAD NEVER BEFORE ENTIRELY UNDERSTOOD … ”
“I THINK THAT YOU HAVE BEEN TRYING TO
COMMUNICATE SOMETHING IMPORTANT TO ME
THAT I HAD BEEN REFUSING TO SEE … ”
“I WONDER IF MY DIFFICULTY APPRECIATING
JUST HOW DESPERATE YOU WERE MADE
YOU FEEL THAT YOU HAD TO DO SOMETHING
DRAMATIC IN ORDER TO GET MY ATTENTION … ”
145

THE THERAPIST IS HERE HOLDING HERSELF
ACCOUNTABLE FOR HER CONTRIBUTION
TO THE PATIENT’S “ACTING OUT” / “ENACTMENT”
FRAMING THE PATIENT’S
PROVOCATIVE ENACTMENT IN THIS WAY
NAMELY, THAT IT IS AN UNDERSTANDABLE REACTION TO THE
THERAPIST’S INABILITY / REFUSAL TO UNDERSTAND SOMETHING
IMPORTANT ABOUT THE PATIENT’S INTERNAL EXPERIENCE
MAY THEN MAKE IT A LITTLE EASIER
FOR THE PATIENT HERSELF TO TOLERATE
BEING HELD ACCOUNTABLE
IN OTHER WORDS
WHEN THE THERAPIST ACKNOWLEDGES
HER PART, THE PATIENT MAY THEN
BE BETTER ABLE TO ACKNOWLEDGE
HER OWN PART WITHOUT LOSING FACE
146

FOCUS ON THE HERE – AND – NOW
ENGAGEMENT
THE RELATIONAL THERAPIST’S INTEREST
IS IN FACILITATING THE PATIENT’S
CAPACITY FOR HEALTHY RELATEDNESS
BOTH BY ENHANCING THE PATIENT’S
UNDERSTANDING OF WHAT SHE
PLAYS OUT IN HER RELATIONSHIPS
AND BY PROVIDING THE PATIENT WITH
THE EXPERIENCE OF BEING FOUND
THIS CAN ONLY BE DONE IF THE
THERAPIST CAN BRING HER OWN
AUTHENTIC SELF INTO THE ROOM
147

THE RELATIONAL THERAPIST MUST BE
FULLY PRESENT AND FULLY ENGAGED
IN THE THERAPEUTIC ENCOUNTER
“UNLESS THE THERAPIST AFFECTIVELY
ENTERS THE PATIENT’S RELATIONAL MATRIX
OR, RATHER, DISCOVERS HIMSELF WITHIN IT
– UNLESS THE THERAPIST IS IN SOME
SENSE CHARMED BY THE PATIENT’S
ENTREATIES, SHAPED BY THE PATIENT’S
PROJECTIONS, ANTAGONIZED AND
FRUSTRATED BY THE PATIENT’S DEFENSES –
THE TREATMENT IS NEVER FULLY
ENGAGED, AND A CERTAIN DEPTH WITHIN
THE ANALYTIC EXPERIENCE IS LOST.”
(STEPHEN MITCHELL 1988)
148

IN OTHER WORDS
IF THERAPIST AND PATIENT ARE TO FIND EACH
OTHER AS “SUBJECTS,” THEN BOTH MUST DARE
TO BRING THEMSELVES INTO THE ROOM
TO THAT END, THE RELATIONAL THERAPIST
USES HER “AUTHENTIC” SELF TO PARTICIPATE
IN THE THERAPEUTIC ENCOUNTER
SHE STRIVES TO REMAIN CENTERED IN, AND
EVER ATTUNED TO, HER OWN INTERNAL PROCESS
OR SUBJECTIVITY SO THAT SHE CAN USE HER
COUNTERTRANSFERENCE (HER EXPERIENCE OF SELF)
TO FIND, AND TO BE FOUND BY, THE PATIENT
THE THERAPIST’S ATTENTION IS THEREFORE
ALWAYS DIRECTED TO THE HERE – AND – NOW
ENGAGEMENT (OR LACK THEREOF) BETWEEN THEM
DARLENE EHRENBERG’S “INTIMATE EDGE”
DANIEL STERN’S “NOW MOMENTS” 149

SO THE THERAPIST MAY CHOOSE TO SHARE SOMETHING ABOUT
HER EXPERIENCE OF BEING IN THE ROOM WITH THE PATIENT
“I WONDER IF THE FRUSTRATION AND HELPLESSNESS
I AM FEELING NOW IN RELATION TO YOU IS SIMILAR
TO THE FRUSTRATION AND HELPLESSNESS YOU HAVE
TALKED OF FEELING IN RELATION TO YOUR FATHER.”
“YOU TELL ME SOMETHING ABOUT YOURSELF. I AM
JUST IN THE PROCESS OF DIGESTING IT AND STORING
IT FOR FURTHER UNDERSTANDING OF YOU AND THEN
ALONG YOU COME – WHAM! – AND TELL ME THAT
WHAT I HAVE DIGESTED AND STORED INSIDE ME
DID NOT COME FROM YOU AT ALL. THE PROBLEM I
FIND IS HOW TO LIVE WITH THE DESPAIR I FEEL
OCCASIONED BY YOUR DISAPPEARANCES.”
(CHRISTOPHER BOLLAS 1989)
150

OR, AS IRWIN HOFFMAN (2001) HAS SUGGESTED, IF
THE THERAPIST IS AWARE OF FEELING CONFLICTED IN
RELATION TO THE PATIENT, SHE MAY CHOOSE TO SHARE
THE FACT OF THIS CONFLICTEDNESS WITH THE PATIENT
“I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’”
HERE THE THERAPIST IS EXPRESSING ALOUD THE CONFLICT
WITH WHICH SHE IS STRUGGLING – A CONFLICT THAT MIGHT
WELL BE REFLECTIVE OF THE PATIENT’S INTERNAL DIVIDEDNESS
“I AM TEMPTED TO GIVE YOU THE ADVICE FOR
WHICH YOU ARE LOOKING, BUT MY FEAR IS THAT
WERE I TO DO SO, I WOULD BE ROBBING YOU OF
THE IMPETUS TO FIND YOUR OWN ANSWERS.”
“I FIND MYSELF FEELING ANGRY AT YOU FOR BEING LATE
AND WANTING TO TELL YOU HOW IT IMPACTS ME, BUT THEN
IT OCCURS TO ME THAT IT MIGHT BE MORE IMPORTANT
FOR US TO UNDERSTAND WHAT YOU MIGHT BE TRYING
TO COMMUNICATE BY WAY OF YOUR LATENESS.” 151

“I AM TEMPTED TO RESPOND TO YOUR REQUEST BY
SAYING THAT OF COURSE YOU CAN BORROW ONE OF
THE MAGAZINES IN MY WAITING ROOM, BUT I AM ALSO
REALIZING THAT WERE I SIMPLY TO SAY OK, WE
MIGHT LOSE AN OPPORTUNITY TO UNDERSTAND SOMETHING
MORE ABOUT YOU AND, PERHAPS, ABOUT US.”
TO A PATIENT WHO SAYS HE WANTS THE THERAPIST’S
APPROVAL REGARDING HIS DECISION TO TERMINATE
– A TERMINATION THAT THE THERAPIST THINKS IS PREMATURE –
“I AM TEMPTED SIMPLY TO OFFER YOU THE APPROVAL YOU
ARE SEEKING – IT IS, AFTER ALL, IMPORTANT THAT YOU DO
WHAT FEELS RIGHT FOR YOU. BUT I AM ALSO AWARE
OF FEELING, WITHIN MYSELF, THAT THE TIME IS TOO SOON
AND THAT WERE I TO SUPPORT YOUR DECISION TO LEAVE,
I MIGHT ULTIMATELY BE DOING YOU A DISSERVICE.”
152

THE THERAPIST MAY CHOOSE TO FOCUS
THE PATIENT’S ATTENTION ON WHAT IS
TRANSPIRING IN THE ROOM BETWEEN THEM
“THERE SEEMS TO BE A LOT OF
TENSION BETWEEN US TODAY.”
“WE ARE BOTH SAD THAT THINGS DIDN’T
TURN OUT AS WE HAD HOPED THEY WOULD.”
“I AM GUESSING THAT WE ARE BOTH
FEELING FRUSTRATED AND A LITTLE
CONFUSED. LET’S REWIND SO THAT
WE CAN THINK ABOUT WHERE WE
MIGHT HAVE GOTTEN OFF TRACK.”
153

THE THERAPIST MAY ENCOURAGE THE PATIENT TO
ELABORATE UPON HER EXPERIENCE OF THE THERAPIST’S
CONTRIBUTION TO WHAT IS HAPPENING IN THE ROOM
IN MODEL 3, THE PATIENT’S TRANSFERENCE IS
ALWAYS THOUGHT TO HAVE CONTRIBUTIONS FROM
BOTH PATIENT AND THERAPIST AND THEREFORE
TO BE CO – CONSTRUCTED OR CO – CREATED
TO THAT END, THE RELATIONAL THERAPIST MIGHT ASK
“IS THERE SOMETHING I HAVE DONE OR SAID THAT
HAS LED YOU TO BELIEVE THAT I DON’T CARE?”
“HAVE YOU NOTICED ANYTHING ABOUT ME THAT WOULD
SEEM TO SUGGEST MY DISCOMFORT WITH YOUR DECISION?”
I AM HERE REMINDED OF MY PATIENT WHO TOLD ME THAT
HE THOUGHT I WAS BEING “UNCONSCIOUSLY CRITICAL” OF HIM!
ULTIMATELY, WE BOTH LAUGHED …
154

THE THERAPIST MAY DRAW THE PATIENT’S ATTENTION
TO WHAT THE THERAPIST THINKS THE
PATIENT IS CONTRIBUTING TO THE INTERACTION
“I WONDER IF, BY WAY OF YOUR LATENESS, YOU ARE
TRYING TO COMMUNICATE SOMETHING TO ME ABOUT
HOW DIFFICULT IT IS FOR YOU TO BE HERE. IF THAT
WERE INDEED THE CASE, I WOULD NOT WANT TO DO
YOU THE DISSERVICE OF SIMPLY DISMISSING IT.”
“SOMETIMES IT SEEMS THAT, WHEN YOU’RE
VULNERABLE AND TELLING ME SOMETHING VERY
IMPORTANT, AFTER A LITTLE WHILE YOU BECOME
VERY STILL AND I LOSE TRACK OF YOU. I WONDER
IF, IN THAT STILLNESS, YOU ARE ATTEMPTING TO
SHOW ME HOW YOU, AS A CHILD, WERE SOMETIMES
ABANDONED AFTER AN INTENSE CONNECTION.”
155

MODEL 3 IS ABOUT ACCOUNTABILITY AND THEREFORE EMPOWERMENT
THE RULE OF THREE (MARTHA STARK 2016)
WHENEVER A PATIENT SAYS OR DOES SOMETHING THAT
THE MODEL 3 THERAPIST EXPERIENCES AS PROVOCATIVE
A “PROVOCATIVE ENACTMENT”
IN ORDER TO FORCE THE PATIENT TO TAKE OWNERSHIP
OF WHAT SHE IS IMPLICITLY ATTEMPTING TO COMMUNICATE,
THE THERAPIST MIGHT ASK THE PATIENT ANY OF THE FOLLOWING
“HOW ARE YOU HOPING THAT I WILL RESPOND?”
WHICH ADDRESSES THE ID
“HOW ARE YOU FEARING THAT I MIGHT RESPOND?”
WHICH ADDRESSES THE SUPEREGO
“HOW ARE YOU IMAGINING THAT I WILL RESPOND?”
WHICH ADDRESSES THE EGO
ALL THREE RELATIONAL INTERVENTIONS DEMAND OF THE PATIENT
THAT SHE MAKE HER INTERPERSONAL INTENTIONS MORE EXPLICIT
AND THAT SHE TAKE RESPONSIBILITY FOR HER PROVOCATIVE ENACTMENT
156

IN SUM
THE RELATIONAL PERSPECTIVE
OF MODEL 3 IS A STORY
ABOUT TRANSFORMING
THE PATIENT’S DEFENSIVE NEED
TO PLAY OUT HER
UNMASTERED RELATIONAL DRAMAS
COMPULSIVELY AND UNWITTINGLY
ON THE STAGE OF HER LIFE
INTO THE ADAPTIVE CAPACITY TO
TAKE OWNERSHIP OF HER
DYSFUNCTIONAL WAYS OF ACTING,
REACTING, AND INTERACTING
157

MODEL 4
THE
EXISTENTIAL – HUMANISTIC
PERSPECTIVE
A HEART SHATTERED,
THE PRIVATE SELF,
AND RELENTLESS DESPAIR
“I GAVE YOU A PART
OF ME THAT I KNEW
YOU COULD BREAK –
BUT YOU DIDN’T”
158

MODEL 4 IS A STORY ABOUT
SCHIZOID WITHDRAWAL
BECAUSE OF TRAUMATIC
EARLY – ON HEARTBREAK
MODEL 4 IS NOT A STORY
ABOUT PEOPLE
“ON THE AUTISM SPECTRUM”
159

THE STRESS OF GAIN – BECOME – PAIN
THE STRESS OF GOOD – BECOME – BAD
THE STRESS OF BAD – BECOME – GOOD
THE STRESS OF HIDDEN – BECOME – FOUND
AS THE PATIENT’S DEFENSIVE “DENIAL OF OBJECT
NEED” IS CHALLENGED BY THE EXPERIENCE OF
MOMENTS OF MEETING AND GRADUALLY REPLACED
BY MORE AUTHENTIC BEING – IN – THE – WORLD
160

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
161

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, 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
162

WHEREAS THE RELENTLESS HOPE
OF THE MODEL 2 PATIENT
AND THE RELENTLESS OUTRAGE
SPEAK TO THE PATIENT’S INTENSE
– ALBEIT MALADAPTIVE –
ENGAGEMENT WITH THE WORLD OF OBJECTS,
THE RELENTLESS DESPAIR
SPEAKS TO THE PATIENT’S UTTER
LACK OF ANY REAL ENGAGEMENT
WITH THE WORLD OF OBJECTS
163

RELEVANT HERE IS
VIKTOR FRANKL’S “EXISTENTIAL DESPAIR”
MAN’S SEARCH FOR MEANING (1997)
D = S – M
“EXISTENTIAL DESPAIR” EQUALS
“SUFFERING” WITHOUT “MEANING”
MY SLIGHT PARAPHRASE
“RELENTLESS DESPAIR” EQUALS
“SOLITARY SUFFERING” WITHOUT
“MEANINGFUL MOMENTS OF MEETING”
I BELIEVE THAT “MOMENTS OF MEETING”
ARE AN IMPORTANT PART
OF WHAT GIVE LIFE ITS MEANING
164

MARTIN HEIDEGGER’S “INAUTHENTIC EXISTENCE”
THE IMPORTANCE OF “AUTHENTICITY”
AS GIVING MEANING, PURPOSE, WORTHWHILENESS,
AND DIRECTION TO LIFE
AUTHENTIC BEING – IN – THE – WORLD REFERS
TO THE ATTEMPT TO LIVE ONE’S LIFE
ACCORDING TO THE NEEDS OF ONE’S INNER BEING
RATHER THAN TO THE DEMANDS OF ONE’S EARLY
CONDITIONING OR OF SOCIETY
AUTHENTIC BEING – IN – THE – WORLD ALWAYS
INVOLVES THIS ELEMENT OF FREEDOM AND CHOICE
“INAUTHENTICITY” REFERS TO LIVING ONE’S LIFE
AS DETERMINED BY OUTSIDE FORCES,
EXPECTATIONS, PRESSURES, AND DEMANDS
165

KELLY CLARKSON
HER EMOTIONALLY RAW, VULNERABLE,
AND HAUNTINGLY BEAUTIFUL SONGS
SPEAK OF THE HEARTBREAK
AND SUBSEQUENT SHUTDOWN
THAT SHE EXPERIENCED BECAUSE OF HER
FATHER’S TRAUMATIC ABANDONMENT OF HER
AND HER FAMILY WHEN SHE WAS SIX YEARS OLD
THE ESSENCE OF WHICH SHE CAPTURES
IN HER WELL – KNOWN SONG ENTITLED
“BECAUSE OF YOU”
WHERE SHE MAKES REFERENCE TO
THE “FALSE SELF” THAT SHE NOW PRESENTS
TO THE WORLD IN ORDER TO COVER
THE PAIN OF THAT EARLY – ON HEARTBREAK
AT THE HANDS OF HER FATHER
166

RICHARD CORY
BY EDWIN ARLINGTON ROBINSON
THIS NARRATIVE POEM ALSO CAPTURES
POIGNANTLY THE GREAT DIVIDE THAT CAN
EXIST BETWEEN THE PUBLIC (OR FALSE) SELF
AND THE PRIVATE (OR TRUE) SELF
ON THE SURFACE OF THINGS
RICHARD CORY APPEARS TO HAVE IT ALL
RICHES, GRACE, IMPECCABLE GOOD MANNERS,
CHARM, GLITTER, IMPERIAL GOOD LOOKS
BUT DESPITE HIS REGAL BEARING AND ENVIABLE WEALTH,
HIS LIFE IS EMPTY AND INTERNALLY IMPOVERISHED
AND “ONE CALM SUMMER NIGHT”
HE SIMPLY GOES HOME AND
“PUTS A BULLET THROUGH HIS HEAD”
TO END IT ALL
167

SIMON AND GARFUNKEL’S WELL – KNOWN “I AM A ROCK” (1966)
CAPTURES TO PERFECTION THE ESSENCE OF THE
MODEL 4 PATIENT’S EXPERIENCE OF BEING – IN – THE – WORLD
A WINTER’S DAY ~ IN A DEEP AND DARK ~ DECEMBER
I AM ALONE ~ GAZING FROM MY WINDOW TO THE STREETS BELOW
ON A FRESHLY FALLEN SILENT SHROUD OF SNOW
I AM A ROCK ~ I AM AN ISLAND
I’VE BUILT WALLS ~ A FORTRESS DEEP AND MIGHTY
THAT NONE MAY PENETRATE
I HAVE NO NEED OF FRIENDSHIP, FRIENDSHIP CAUSES PAIN
IT’S LAUGHTER AND IT’S LOVING I DISDAIN
DON’T TALK OF LOVE ~ BUT I’VE HEARD THE WORDS BEFORE
IT’S SLEEPING IN MY MEMORY
I WON’T DISTURB THE SLUMBER OF FEELINGS THAT HAVE DIED
IF I NEVER LOVED I NEVER WOULD HAVE CRIED
I HAVE MY BOOKS ~ AND MY POETRY TO PROTECT ME
I AM SHIELDED IN MY ARMOR
HIDING IN MY ROOM, SAFE WITHIN MY WOMB
I TOUCH NO ONE AND NO ONE TOUCHES ME
AND A ROCK FEELS NO PAIN ~ AND AN ISLAND NEVER CRIES 168

DONALD WINNICOTT’S FALSE SELF
A SELF – PROTECTIVE DEFENSIVE ARMOR
MOBILIZED EARLY – ON IN LIFE TO PROTECT THE
PRIVACY OF THE “TRUE SELF” FROM IMPINGEMENT
BY A MATERNAL ENVIRONMENT PERCEIVED AS
INTRUSIVE AND POTENTIALLY DANGEROUS
THE PERSON WHO EVENTUALLY DEVELOPS
A “FALSE SELF” NEVER HAD THE EXPERIENCE
OF A “GOOD – ENOUGH MOTHER”
ABLE TO PROVIDE A PROTECTIVE ENVELOPE
A “FACILITATING OR HOLDING ENVIRONMENT”
WITHIN WHICH HER YOUNG CHILD’S “INHERITED
POTENTIAL” COULD BECOME ACTUALIZED
169

AT A TIME WHEN IT IS AGE – APPROPRIATE
FOR THE INFANT TO HAVE A MOTHER UPON
WHOM SHE CAN “ABSOLUTELY DEPEND”
– AN “UNFALTERINGLY RELIABLE” MOTHER ABLE TO
RECOGNIZE AND RESPOND TO HER INFANT’S EVERY NEED –
THE MOTHER’S INABILITY TO
“MEET THE OMNIPOTENCE”
OF HER YOUNG CHILD WILL BE
ABSOLUTELY ANNIHILATING
AS A RESULT, THE NASCENT TRUE SELF OF THE INFANT
THE POTENTIAL SOURCE OF SPONTANEITY AND CREATIVITY
WILL GO INTO HIDING, AVOIDING AT ALL COSTS THE POSSIBILITY
OF EXPOSING ITSELF WITHOUT BEING SEEN OR RESPONDED TO
ITS ESSENCE WILL REMAIN “INCOMMUNICADO”
ITS CORE UNRECOGNIZED, UNACKNOWLEDGED, UNDEVELOPED
DESPERATE TO BE KNOWN BUT TERRIFIED OF BEING FOUND
170

WHAT THEN CRYSTALLIZES OUT WILL BE A FALSE SELF
A PUBLIC (OR SOCIAL) SELF THAT GRADUALLY BECOMES
EVER MORE ADEPT AT ACCOMMODATING ITSELF
CHAMELEON – LIKE
TO WHATEVER IT SENSES IS EXPECTED OF IT
ALL THE WHILE KEEPING HIDDEN ITS UNDERLYING
ANGUISH AND BROKEN – HEARTED DESPAIR
THE PERSON WILL LIVE, BUT THE EXISTENCE WILL BE EMPTY,
HOLLOW, SHALLOW, FALSE, EMPTY, AND TERRIFYINGLY LONELY
IT WILL BE A LIE
ONE BASED ON COMPLIANCE AND CONFORMITY
NOT ONE BASED ON AUTHENTICITY OR TRUTH
THE PERSON WILL MAKE A SHOW OF BEING REAL,
BUT IT WILL ONLY BE “AS IF” SHE IS REAL
BECAUSE HER LIFE WILL BE A SHAM, A CHARADE,
A PART SHE IS PLAYING, A BORROWED IDENTITY –
ONE ASSUMED FOR THE OCCASION
171

A LIFE UNLIVED
SECRETS
LIES
PRETENSIONS
CONCEALMENTS
DECEPTIONS
172

AMY AND HER NEED
FOR OMNIPOTENT CONTROL
I PRESENT NOW A CLINICAL VIGNETTE THAT
DEMONSTRATES THE POWERFULLY
HEALING IMPACT OF A THERAPIST’S
WILLINGNESS TO HONOR HER PATIENT’S
NEED FOR OMNIPOTENT CONTROL
OF HER OBJECTS
WHEN THAT EGO NEED HAS BEEN
TRAUMATICALLY THWARTED EARLY – ON
EVEN IF INADVERTENTLY
BY AN IMPINGING AND ANNIHILATING
MATERNAL ENVIRONMENT
173

AMY AND HER NEED
MORE SPECIFICALLY
THIS CASE SPEAKS TO THE
TRANSFORMATIVE POWER OF REVISITING
PLAYFULLY
THE MATURATIONAL STAGE OF
“ABSOLUTE DEPENDENCE”
IN ORDER TO CORRECT FOR
EARLY – ON TRAUMATIC
FRUSTRATION OF THE CHILD’S
DEFENSIVELY REINFORCED
“EGO NEED TO BE MET”
174

AMY AND HER NEED
AT THE END OF THE DAY
I BELIEVE THAT WHAT WAS TRANSFORMATIVE
FOR AMY WAS MY ABILITY TO CREATE A
SAFE SPACE INTO WHICH SHE COULD DELIVER
WHAT MOST NEEDED TO BE DELIVERED,
NAMELY, HER NEED TO BE ABLE
TO FEEL IN CONTROL SO THAT SHE
WOULD BE ABLE TO RISK BECOMING
“ABSOLUTELY DEPENDENT” ON ME
A STAND – IN FOR HER MOTHER
WITHOUT HAVING TO FEAR A
CATASTROPHICALLY ANNIHILATING RESPONSE
THAT WOULD SHATTER HER HEART
175

I GAVE YOU A PART OF ME
THAT I KNEW YOU COULD BREAK –
BUT YOU DIDN’T
IT IS ONLY RECENTLY THAT I HAVE COME
TRULY TO APPRECIATE HOW POWERFULLY
HEALING IT CAN BE FOR A PATIENT
WHOSE HEART WAS FRAGMENTED EARLY – ON
BY AN IMPINGING MATERNAL ENVIRONMENT
TO BE GIVEN AN OPPORTUNITY
IN THE HERE – AND – NOW ENGAGEMENT WITH HER THERAPIST
TO BE IN CONTROL
AS MUCH AS IS POSSIBLE
AN OPPORTUNITY TO BECOME
“ABSOLUTELY DEPENDENT” ON SOMEONE
WHOSE STALWART RELIABILITY AND
UNCONDITIONAL PREDICTABILITY THE
PATIENT IS COMING, OVER TIME, TO TRUST
176

MICHAEL BALINT’S (1992)
“BENIGN REGRESSION TO DEPENDENCE”
FOR THOSE PATIENTS WHO HAVE DEVELOPED
A “BASIC FAULT” BECAUSE OF FAILURE
IN THE EARLY – ON ENVIRONMENTAL PROVISION,
BALINT SPEAKS TO THE THERAPEUTIC VALUE OF
“BENIGN REGRESSION TO DEPENDENCE”
AND OF ALLOWING FOR A
“HARMONIOUS INTERPENETRATING MIX – UP”
SO THAT, AT LEAST FOR A WHILE, THE PATIENT CAN
HAVE THE SELF – AND LIFE – AFFIRMING EXPERIENCE
OF BEING PEACEFULLY MERGED WITH ANOTHER
A “NEW BEGINNING”
177

ALONG THESE SAME LINES
CHRISTOPHER BOLLAS’S (1989)
“ORDINARY REGRESSION TO DEPENDENCE”
A REGRESSION THAT WILL BE
“ARRESTED BY THE THERAPIST’S INTERPRETATIONS”
BUT “FOSTERED BY THE THERAPIST’S RECEPTIVITY”
WINNICOTT’S
“REGRESSION TO ABSOLUTE DEPENDENCE”
BALINT’S
“BENIGN REGRESSION IN THE SERVICE OF THE EGO”
AND BOLLAS’S
“ORDINARY REGRESSION TO DEPENDENCE”
CAPTURE THE ESSENCE OF WHAT I BELIEVE IS AT THE HEART
OF WHAT WE MUST “PROVIDE” FOR OUR MODEL 4 PATIENTS
NAMELY, AN OPPORTUNITY TO EXPERIENCE
“THERAPEUTIC REGRESSION TO DEPENDENCE”
AN OPPORTUNITY TO “REGRESS IN ORDER TO REDO”
178

KEITH URBAN AND CARRIE UNDERWOOD
I AM HERE REMINDED OF
KEITH URBAN AND CARRIE UNDERWOOD’S
BEAUTIFUL DUET CALLED “THE FIGHTER”
IN WHICH A WOMAN
HERE REPRESENTING THE MODEL 4 PATIENT
WHOSE “PRECIOUS HEART” HAS BEEN
BROKEN AT AN EARLIER TIME IN HER LIFE
KEEPS ASKING FOR, AND NEEDING,
REASSURANCE THAT WERE SHE TO FALL,
WERE SHE TO CRY, WERE SHE TO BE SCARED,
HER MAN
HERE REPRESENTING THE MODEL 4 THERAPIST
WOULD BE THERE TO CATCH HER
AND TO HOLD HER TIGHT
179

IN A BRILLIANT 1972 PAPER PUBLISHED IN THE
INTERNATIONAL JOURNAL OF PSYCHOANALYSIS
MASUD KHAN WRITES ABOUT THE IMPORTANCE
OF GIVING PATIENTS WHO HAVE
EMOTIONALLY WITHDRAWN FROM THE
WORLD OF OBJECTS AN OPPORTUNITY TO
“OVERCOME THEIR DREAD OF SURRENDER
TO RESOURCELESS DEPENDENCE”
ON THE THERAPIST
AN EMOTIONAL SURRENDER THAT HOPEFULLY
WILL BE EXPERIENCED BY THE PATIENT AS
“TRANSCENDENT” AND “TRANSFORMATIVE”
AND NOT SIMPLY AS A “DEFEAT”
KHAN’S “RESOURCELESS DEPENDENCE” IS AKIN TO
WINNICOTT’S “ABSOLUTE DEPENDENCE,”
BALINT’S “BENIGN REGRESSION,”
AND BOLLAS’S “ORDINARY REGRESSION” 180

ARNOLD MODELL’S (1996) “DENIAL OF OBJECT NEED” AND
“ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY”
PARTICULARLY RELEVANT FOR UNDERSTANDING
MODEL 4 PATIENTS IS ARNOLD MODELL’S BEAUTIFULLY
FINE – TUNED RENDERING OF PATIENTS WHO
HAVE PSYCHICALLY RETREATED FROM THE WORLD
OF OBJECTS IN ORDER TO PROTECT THE
“COHESIVENESS OF A PRECARIOUSLY ESTABLISHED SELF”
FROM BEING “SHATTERED” BY AN “INTOLERABLY
UNEMPATHIC RESPONSE” FROM THE OBJECT
MODELL SUGGESTS THAT TO AVOID POTENTIAL
“DISSOLUTION OF THE INTEGRITY AND COHERENCE”
OF A “FRAGILE SELF,” SUCH PATIENTS WILL ASSUME
A “STANCE OF SELF – PROTECTIVE ISOLATION” –
A DEFENSIVE POSTURE SUPPORTED BY “ILLUSIONS
OF GRANDIOSE SELF – SUFFICIENCY,” “DENIAL OF OBJECT
NEED,” AND “AFFECTIVE NONRELATEDNESS”
181

MODELL HIGHLIGHTS THAT IT IS CRITICALLY
IMPORTANT FOR THE THERAPIST
TO BE EXQUISITELY ATTUNED TO
THE PATIENT’S INTENSE AMBIVALENCE
ABOUT BEING IN RELATIONSHIP
CONFLICT BETWEEN BEING FOUND
AND REMAINING HIDDEN
INDEED
ALTHOUGH A PART OF THE PATIENT YEARNS
TO BE KNOWN AND SEEN BY THE THERAPIST,
ANOTHER PART OF THE PATIENT ZEALOUSLY
GUARDS THE SACROSANCTITY OF HER PRIVACY,
KEEPING HIDDEN WHAT MOST MATTERS TO HER,
REFUSING TO LET ANYONE IN
182

EVER APPRECIATING, HOWEVER, THAT THERE
IS AT LEAST A PART OF THE PATIENT
THAT YEARNS TO BE SEEN,
THE MODEL 4 THERAPIST MUST USE
HER INTUITION TO DECIDE WHETHER,
IN THE MOMENT, THE PATIENT IS
WANTING TO BE FOUND OR NEEDING,
AT LEAST FOR THE TIME BEING,
TO REMAIN HIDDEN, NOT KNOWN, NOT SEEN
TO BE INTIMATE IS TO RUN THE RISK
OF HAVING ONE’S HEART SHATTERED,
BUT TO BE SEPARATE IS TO RUN THE RISK
OF EGO DISSOLUTION AND FRAGMENTATION OF THE SELF
THE DILEMMA FOR SUCH PATIENTS IS HOW TO BE A PART
OF THE WORLD WITHOUT BEING DESTROYED,
BUT HOW TO BE APART
FROM THE WORLD WITHOUT DISAPPEARING
183

R D LAING’S DIVIDED SELF
LAING, A STUDENT OF EXISTENTIALISM AND LONG INTERESTED
IN THE EXPERIENCE OF BEING – IN – THE – WORLD,
WRITES ABOUT THE “DIVIDED SELF” AS SPEAKING
TO THE DEFENSIVE “SPLIT IN THE SELF” THAT
DEVELOPS IN SOME PATIENTS AS A
REACTION TO “ONTOLOGICAL INSECURITY” (1960)
ONTOLOGICAL INSECURITY SPEAKS TO THE
LACK OF MEANING, ORDER, AND CONTINUITY
IN ONE’S LIFE AND CONSEQUENT INSECURITY
ABOUT ONE’S EXISTENCE
SPLITTING OF THE SELF IS THEN AN
ATTEMPT TO MANAGE THE DEEP ANXIETY
AND DREAD THAT ARISE FROM THIS
UNCERTAINTY ABOUT THE HUMAN CONDITION
AND THE STATE OF THE WORLD IN GENERAL
184

DONALD BURNHAM’S NEED – FEAR DILEMMA
ALSO RELEVANT HERE ARE THE FORMULATIONS
OF DONALD BURNHAM, AN AMERICAN PSYCHIATRIST
WHO (SOME FIFTY YEARS AGO) WAS OBSERVING
THAT MANY OF THE INPATIENTS WITH WHOM HE
WAS WORKING AT CHESTNUT LODGE IN MARYLAND,
WERE STRUGGLING WITH SOMETHING TO WHICH
HE REFERRED AS THE “NEED – FEAR DILEMMA” (1969)
ALSO AN APT CONCEPT FOR THE INTERNAL
DIVIDEDNESS THAT CHARACTERIZES MODEL 4 PATIENTS
THESE “SCHIZO – DYNAMICS” SPEAK TO
BOTH THE PATIENT’S DESPERATE NEED TO
FIND CONNECTION AND MERGER WITH OTHERS
AND HER EQUALLY INTENSE FEAR OF BEING
DESTROYED AND CONSUMED IN THE PROCESS
185

ALTHOUGH THERE IS OBVIOUSLY A CONTINUUM IN
TERMS OF THE CAPACITY TO BE ENGAGED IN THE WORLD
THE MODEL 4 PATIENT’S EXPERIENCE OF
OVERWHELMING HELPLESSNESS AND TERROR HAS
A LOT IN COMMON, IN ITS EXTREME FORM, WITH
MELANIE KLEIN’S “PSYCHOTIC ANXIETY”
MARGARET MAHLER’S “ORGANISMIC DISTRESS”
WILFRED BION’S “NAMELESS DREAD”
MAX SCHUR’S “PRIMARY ANXIETY”
JOHN FROSCH’S “BASIC ANXIETY”
MARGARET LITTLE’S “ANNIHILATION ANXIETY”
HEINZ KOHUT’S “DISINTEGRATION ANXIETY”
DONALD WINNICOTT’S “UNTHINKABLE ANXIETY”
WINNICOTT’S “FEAR OF BREAKDOWN” MAY ALSO
BE RELEVANT HERE, ALTHOUGH WINNICOTT
POSTULATES THAT THIS FEAR OF BREAKDOWN
IS ACTUALLY THE FEAR OF A BREAKDOWN
THAT HAS ALREADY HAPPENED BUT THAT
COULD NOT BE EXPERIENCED AT THE TIME 186

MODEL 4
FACILITATION
STATEMENTS
187

INSPIRED BY LAING’S CONCEPT OF THE DIVIDED SELF;
BURNHAM’S CONCEPT OF THE NEED – FEAR DILEMMA;
THE PSYCHOANALYTIC CONTRIBUTIONS OF
FAIRBAIRN, GUNTRIP, WINNICOTT, BALINT, KHAN,
BOLLAS, AND MODELL; AND THE PHILOSOPHICAL
CONTRIBUTIONS OF HEIDEGGER AND FRANKL
I HAVE DESIGNED A PSYCHOTHERAPEUTIC
INTERVENTION FOR PATIENTS WHO
– WHETHER MOMENTARILY (STATE) OR MORE CHARACTEROLOGICALLY (TRAIT) –
HAVE NOT ONLY
SELF – PROTECTIVELY RETREATED
FROM ENGAGEMENT
WITH THE WORLD OF OBJECTS
BUT ALSO
NIHILISTICALLY RETREATED
FROM LIFE ITSELF
188

HIGHLIGHT NOT ONLY THE PATIENT’S
TERROR OF BEING ONCE AGAIN DESTROYED
BY AN ANNIHILATING OBJECT
BUT ALSO HER DESPERATE LONGING
TO RE – ENGAGE WITH THE WORLD
“A PART OF YOU IS DESPERATE TO BE SEEN,
KNOWN, AND UNDERSTOOD; BUT ANOTHER
PART OF YOU IS TERRIFIED OF BEING FOUND.”
“A PART OF YOU LONGS FOR CONNECTION
WITH OTHERS; BUT YOU HOLD BACK FOR
FEAR OF BEING ONCE AGAIN DEVASTATED.”
IN SPEAKING TO THE VARIOUS LAYERS OF THE
PATIENT’S EXPERIENCE OF BEING – IN – THE – WORLD,
FACILITATION STATEMENTS RESPECT THE COMPLEXITY OF
THE PATIENT’S EXPERIENCE OF BEING – ENGAGED – IN – LIFE
189

“YOUR FEEL DESPERATELY LONELY AND DISCONNECTED FROM
PEOPLE AND WOULD WISH THAT YOU COULD FEEL THAT YOU
BELONGED SOMEWHERE; BUT YOU FIND YOURSELF HOLDING
BACK FOR FEAR OF BEING DEVASTATINGLY DISAPPOINTED
AND WITH A SHATTERED HEART ONCE AGAIN.”
“A PART OF YOU WOULD WANT TO BE ABLE TO FIND
SOMETHING THAT COULD MAKE YOUR LIFE FEEL MORE
MEANINGFUL; BUT ANOTHER PART OF YOU FEARS THAT
IT IS SIMPLY NOT IN THE CARDS FOR YOU EVER TO
FIND ANY REAL PLEASURE IN LIFE OR IN COMPANIONSHIP.”
“A PART OF YOU WISHES THAT YOU COULD SIMPLY ENJOY
BEING WITH PEOPLE; BUT ANOTHER PART OF YOU FEELS
SO EMPTY AND INADEQUATE THAT YOU CANNOT IMAGINE
EVER BEING ABLE TO BE COMFORTABLE AROUND PEOPLE.”
“A PART OF YOU LONGS TO HAVE A PARTNER WITH WHOM
YOU COULD SHARE YOUR LIFE; BUT ANOTHER PART OF YOU
CRINGES AT THE THOUGHT OF PUTTING YOURSELF OUT
THERE AND MAKING YOURSELF THAT VULNERABLE.” 190

WITH HER FINGER EVER ON THE PULSE OF
THE PATIENT’S LEVEL OF ANXIETY AND
CAPACITY TO TOLERATE FURTHER CHALLENGE,
THE THERAPIST
– USING HER INTUITION TO DETERMINE
WHEN THE MOMENT MIGHT BE RIGHT –
WILL THEREFORE OFFER FACILITATION
STATEMENTS IN AN EFFORT TO ENCOURAGE
THE MODEL 4 PATIENT TO BECOME AWARE OF
– AND TAKE RESPECTFUL OWNERSHIP OF –
BOTH SIDES OF HER AMBIVALENCE ABOUT
BEING – IN – THE – WORLD, BEING PRESENT,
BEING CONNECTED, BEING AUTHENTIC,
BEING ALIVE, AND HAVING HOPE
191

“A PART OF YOU WOULD WANT TO BE ABLE
TO TRUST ME; BUT ANOTHER PART OF YOU HOLDS
BACK FOR FEAR OF BEING BETRAYED. TOO MANY
PEOPLE HAVE ALREADY SHATTERED YOUR
WORLD BY PROMISING AND THEN NOT DELIVERING.”
“A PART OF YOU IS DESPERATE TO BE ABLE TO FEEL
THAT YOU BELONG IN THE WORLD; BUT ANOTHER PART
OF YOU IS TERRIFIED THAT YOU WILL ALWAYS FEEL THAT
YOU ARE ON THE OUTSIDE AND HAVE NO PLACE HERE.”
“A PART OF YOU VERY MUCH WANTS TO GET BETTER AND
RECOGNIZES THAT COMING IN EVERY WEEK AND SHARING
WHATEVER YOU MIGHT BE FEELING PROBABLY GIVES YOU
THE BEST CHANCE OF MAKING THAT HAPPEN; BUT ANOTHER
PART OF YOU IS EXHAUSTED, DISCOURAGED, AND NOT
AT ALL SURE THAT YOU HAVE IT IN YOU TO KEEP TRYING.”
192

BY WAY OF REVIEW
THE MODEL 4
OFFERS PROFOUNDLY RESPECTFUL,
“OPTIMALLY STRESSFUL” FACILITATION
STATEMENTS THAT HIGHLIGHT THE PATIENT’S
INTERNAL CONFLICTEDNESS BETWEEN
REMAINING HIDDEN AND BEING FOUND
PROVIDES A NONDEMANDING, RELIABLE,
DEPENDABLE, PREDICTABLE PRESENCE THAT HONORS
THE PATIENT’S AMBIVALENCE ABOUT BEING IN
RELATIONSHIP WITH THE THERAPIST AND GIVES HER
THE OPPORTUNITY TO REGULATE THEIR INTERPERSONAL
SPACE AND DEGREE OF EMOTIONAL INTIMACY
IN ESSENCE
THE THERAPIST “MEETS THE OMNIPOTENCE” OF THE PATIENT
BY RECOGNIZING AND RESPONDING TO HER EVERY NEED
SUCH THAT THE PATIENT WILL BE ABLE TO FEEL
(AND BE) MORE IN CONTROL OF HER ENVIRONMENT 193

THE THERAPEUTIC ACTION IN MODEL 4 INVOLVES
CREATING A “SAFE SPACE” INTO WHICH THE
PATIENT, OVER TIME, WILL BE ABLE TO
DELIVER WHAT MOST MATTERS TO HER
OFFERING THE PATIENT AN OPPORTUNITY TO
BECOME “ABSOLUTELY DEPENDENT” UPON SOMEONE
WHOM SHE COMES TO EXPERIENCE, AT LEAST
FOR A WHILE, AS “ABSOLUTELY NECESSARY”
FOR HER SENSE OF SAFETY IN THIS WORLD
WHICH WILL, OF NECESSITY, INVOLVE HELPING
HER OVERCOME HER “DREAD OF SURRENDER
TO RESOURCELESS DEPENDENCE”
PROVIDING A “HOLDING (OR FACILITATING)
ENVIRONMENT” THAT WILL FOSTER
EMERGENCE OF THE PATIENT’S “TRUE” SELF
IMPLICITLY INVITING THE PATIENT TO ENTER INTO A
“HARMONIOUS INTERPENETRATING MIX – UP” (BALINT 1992)
SUCH THAT THERAPIST AND PATIENT
CAN BECOME PEACEFULLY MERGED 194

FROM SCHIZOID WITHDRAWAL, PSYCHIC RETREAT,
AFFECTIVE NONRELATEDNESS, EMOTIONAL DETACHMENT,
EXISTENTIAL ANGST, RELENTLESS DESPAIR,
HAUNTING LONELINESS, AND A LIFE “UNLIVED”
TO MEANINGFUL MOMENTS OF MEETING THAT
RESTORE PURPOSE, MEANING, AND DIRECTION TO AN
EXISTENCE THAT WOULD OTHERWISE HAVE REMAINED
DESOLATE, IMPENETRABLE, BARREN, AND EMPTY
AND A HEART THAT WOULD OTHERWISE HAVE
REMAINED BROKEN AND INCONSOLABLE
FROM DENIAL OF OBJECT NEED SUPPORTED
BY ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY
TO ACKNOWLEDGMENT OF VULNERABILITY
AND OF THE NEED FOR OBJECTS
195

WHETHER BALINT’S “HARMONIOUS INTERPENETRATING MIX – UP”
OR WINNICOTT’S “IN – BETWEEN SPACE,” “TRANSITIONAL AREA,”
“POTENTIAL SPACE,” OR “INTERMEDIATE AREA OF EXPERIENCE,”
ALL OF THE MODEL 4 CONCEPTS SPEAK TO THE CO – CREATION
OF A SYNERGISTIC AND MYSTICAL “SPACE – BETWEEN”
CONTAINING INTERLOCKING ASPECTS
OF BOTH PATIENT AND THERAPIST
IN THE WORDS OF PRAGLIN (2006)
THIS TRANSFORMATIVE “IN – BETWEEN” IS A
“MEETING – GROUND OF POTENTIALITY AND AUTHENTICITY” –
LOCATED NEITHER SOLELY WITHIN THE PATIENT
NOR SOLELY WITHIN THE THERAPIST
IN ORDER TO CREATE THIS POWERFULLY HEALING TRANSITIONAL SPACE
THE MODEL 4 THERAPIST MUST, FOR THE MOST PART, SIMPLY STAY
OUT OF THE WAY AND ALLOW HERSELF TO BE CONTROLLED
(AND DELIGHT IN THAT) – OFFERING NO RESISTANCE AND FOSTERING
AN ATMOSPHERE OF SAFETY, RELIABILITY, AND DEPENDABILITY
SHE IS A “SOULFUL PRESENCE”
WHO ASKS VERY LITTLE OF THE PATIENT
196

TO SUMMARIZE THE FEATURES OF THE MODEL 4 PATIENT’S
EXPERIENCE OF BEING – IN – THE – WORLD
RAW HEARTBREAK ~ HARROWING LONELINESS ~ RELENTLESS DESPAIR
SCHIZOID WITHDRAWAL ~ EXISTENTIAL ANGST
RETREAT, RESIGNATION, AND DEFEAT ~ EMOTIONAL DETACHMENT
INNER EMPTINESS ~ INTERNAL IMPOVERISHMENT
PSYCHIC DEADNESS ~ SOLITARY SUFFERING ~ CRIPPLING ANXIETY
ANNIHILATION TERROR ~ DREAD ~ PANIC ~ ATTACHMENT INSECURITY
ONTOLOGICAL INSECURITY ~ A SHATTERED SOUL
A FRACTURED HEART ~ BROKENNESS ~ SPIRITUAL ISOLATION
RECLUSIVENESS ~ SUBSTANCE ABUSE AND OTHER PRIVATE ADDICTIONS
PERVERSIONS ~ IDIOSYNCRATIC PREOCCUPATIONS
AN ACTIVE, RICH, AND INTRICATELY DETAILED FANTASY LIFE
DESPERATION ~ A BLACK HOLE ~ COLD SOLITUDE ~ IMPENETRABILITY
INACCESSIBILITY ~ PROFOUND HOPELESSNESS ~ UTTER DESOLATION
A VULNERABLE, FRAGILE, AND TENUOUSLY ESTABLISHED SELF
OVERWHELMING HELPLESSNESS ~ DENIAL OF OBJECT NEED
ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY ~ AFFECTIVE NONRELATEDNESS
DEFENSIVE QUEST FOR AN ILLUSORY SELF – SUFFICIENCY
A DIVIDED SELF ~ A PRIVATE SELF ~ A FALSE SELF
LIES ~ SECRETS ~ PRETENSIONS ~ CONCEALMENTS ~ DISSEMBLING
INAUTHENTIC BEING – IN – RELATIONSHIP ~ INAUTHENTIC BEING – IN – THE – WORLD
OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT
A LIFE UNLIVED AND DEVOID OF MEANINGFUL MOMENTS OF AUTHENTIC
MEETING WITH OTHERS ~ THE ONGOING STRUGGLE TO RECONCILE THE
DIALECTICAL TENSION BETWEEN THE NEED TO BE MET AND THE FEAR OF
BEING FOUND AND BETWEEN EXISTENCE AS MEANINGFUL AND AS ABSURD 197

IN THOSE MOMENTS
WHEN THE SPOTLIGHT IS ON THE PATIENT
AS “NOT AWARE” OR “NOT ACTUALIZED” (MODEL 1),
THINK “CONFLICT STATEMENT”
IN THOSE MOMENTS
AS “NOT ACCEPTING” (MODEL 2),
THINK “DISILLUSIONMENT STATEMENT”
IN THOSE MOMENTS
AS “NOT ACCOUNTABLE” (MODEL 3),
THINK “ACCOUNTABILITY STATEMENT”
OR “RELATIONAL INTERVENTION”
IN THOSE MOMENTS
AS “NOT ACCESSIBLE” (MODEL 4),
THINK “FACILITATION STATEMENT”
199

OPTIMAL STRESS
STRONGER AT THE BROKEN PLACES
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A BEAUTY NEVER ACHIEVED BY THINGS UNBROKEN?
IF A BONE IS FRACTURED AND THEN HEALS,
THE AREA OF THE BREAK WILL BE STRONGER
THAN THE SURROUNDING BONE
AND WILL NOT AGAIN EASILY FRACTURE
ARE WE TOO NOT STRONGER AT OUR BROKEN PLACES?
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A QUIET STRENGTH WE ACQUIRE
FROM SURVIVING ADVERSITY AND HARDSHIP
AND MASTERING THE EXPERIENCE OF
DISAPPOINTMENT, HEARTBREAK, AND DEVASTATION?
AND, THEN, WHEN WE FINALLY RISE ABOVE IT,
DON’T WE RISE UP IN QUIET TRIUMPH,
EVEN IF ONLY WE NOTICE … 201

PSYCHODYNAMIC
SYNERGY
REVIEW
206

FOUR MODES OF THERAPEUTIC ACTION
207

MODEL 1 – ENHANCEMENT OF KNOWLEDGE
“WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
A DRIVE – DEFENSE MODEL
THAT PRIVILEGES
THE CURATIVE POWER OF INSIGHT
IT IS A 1 – PERSON PSYCHOLOGY
BECAUSE ITS FOCUS
IS ON THE PATIENT AND THE
INTERNAL WORKINGS OF HER MIND
THE THERAPIST IS NOT SUPPOSED TO
BRING “WHO SHE IS” INTO THE ROOM –
AND, IF SHE DOES,
IT IS CALLED COUNTERTRANSFERENCE
208

MODEL 2 – PROVISION OF CORRECTIVE EXPERIENCE
“FOR”
THE DEFICIENCY – COMPENSATION PERSPECTIVE
OF SELF PSYCHOLOGY AND THOSE OBJECT
RELATIONS THEORIES THAT EMPHASIZE
INTERNAL ABSENCE OF GOOD (DEFICIENCY)
AND THEREFORE POSITS
CORRECTIVE – PROVISION AS THE CURATIVE AGENT
IT IS A 1½ – PERSON PSYCHOLOGY
BECAUSE ITS FOCUS IS ON THE PATIENT AND HER
RELATIONSHIP WITH A THERAPIST WHOM SHE EXPERIENCES
AS EITHER AN EMPATHIC SELFOBJECT
WHEN THE FRAME OF REFERENCE IS SELF PSYCHOLOGY
OR A GOOD OBJECT / GOOD MOTHER
WHEN THE FRAME OF REFERENCE IS OBJECT RELATIONS THEORY
BUT WHETHER DESCRIBED AS AN EMPATHIC SELFOBJECT
OR A GOOD OBJECT, IN MODEL 2 THE THERAPIST IS
CONSIDERED A HALF PERSON BECAUSE IT IS NOT WHO
SHE IS THAT MATTERS BUT WHAT SHE CAN PROVIDE 209

MODEL 3 – ENGAGEMENT IN AUTHENTIC RELATIONSHIP
“WITH”
THE INTERSUBJECTIVE PERSPECTIVE OF
CONTEMPORARY RELATIONAL THEORY AND THOSE
OBJECT RELATIONS THEORIES THAT EMPHASIZE
INTERNAL PRESENCE OF BAD (TOXICITY)
AND POSITS COLLABORATIVE NEGOTIATION
OF THE TURBULENCE THAT WILL
INEVITABLY EMERGE AT THE INTIMATE EDGE
OF AUTHENTIC ENGAGEMENT
AS THE TRANSFORMATIVE AGENT
IT IS A 2 – PERSON PSYCHOLOGY
BECAUSE ITS FOCUS IS ON PATIENTS
AND THERAPISTS WHO RELATE
TO EACH OTHER AS “REAL” PEOPLE
IN MODEL 3 THE THERAPIST
IS CONSIDERED A WHOLE PERSON
210

Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptx

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