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 – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...Martha Stark MD
As you sit with your clients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our clients. Whether working within (1) the interpretive perspective of classical psychoanalytic theory, (2) the corrective-provision perspective of self psychology, or (3) the intersubjective perspective of contemporary relational theory, we are always busy deciding when we should highlight the healthy forces within our clients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.”
With our finger always on the pulse of the level of the client’s anxiety, we are indeed ever focused, be it consciously or unconsciously, on whether we think the client will be able to tolerate further (anxiety-provoking) challenge or will require additional (anxiety-assuaging) support – a critically important balance that is needed if the therapeutic endeavor is to be advanced.
To illustrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the client’s “defensive need” to maintain “same old, same old” and the client’s “adaptive capacity” to embrace “something new, different, and better.”
Clinical vignettes will be offered demonstrating judicious and ongoing use of these “optimally stressful” interventions that alternately support and then challenge the defense, thereby galvanizing advancement of the client, over time, from psychological rigidity (defense) to psychological flexibility (adaptation).
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our clients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of these interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 28 Apr 2023 – Seminar 2 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptxMartha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD
This document discusses the therapeutic use of optimal stress to provoke recovery from psychological defenses to more adaptive responses. It argues that psychodynamic psychotherapy can help patients master past traumatic experiences by superimposing an acute stressor to trigger healing cycles of disruption and repair. This allows defenses to gradually evolve into more flexible adaptations through iterative cycles of destabilization caused by therapeutic challenges, followed by restabilization due to support. The goal is to transform "rigid defense" into "flexible adaptation" and help patients thrive rather than just survive.
Martha Stark MD – 21 Jan 2023 – MASTER CLASS Part 1 – The Art and The Science...Martha Stark MD
As you sit with your clients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our clients. Whether working within (1) the interpretive perspective of classical psychoanalytic theory, (2) the corrective-provision perspective of self psychology, or (3) the intersubjective perspective of contemporary relational theory, we are always busy deciding when we should highlight the healthy forces within our clients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.”
With our finger always on the pulse of the level of the client’s anxiety, we are indeed ever focused, be it consciously or unconsciously, on whether we think the client will be able to tolerate further (anxiety-provoking) challenge or will require additional (anxiety-assuaging) support – a critically important balance that is needed if the therapeutic endeavor is to be advanced.
To illustrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the client’s “defensive need” to maintain “same old, same old” and the client’s “adaptive capacity” to embrace “something new, different, and better.”
Clinical vignettes will be offered demonstrating judicious and ongoing use of these “optimally stressful” interventions that alternately support and then challenge the defense, thereby galvanizing advancement of the client, over time, from psychological rigidity (defense) to psychological flexibility (adaptation).
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our clients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of these interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 11 Feb 2023 – The Art and The Science of Interpretation.pptxMartha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 28 Apr 2023 – Seminar 2 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Prov...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 21 Apr 2023 – 1st of 3 Experiential Workshops on The Art an...Martha Stark MD
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.
On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between accepting the reality of who our patients are and wanting them to change.
Whether we are working within the interpretive framework of classical psychoanalytic theory, the corrective-provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are therefore ever busy deciding – whether consciously or unconsciously – if we should “be with our patients where they are” (Akhtar’s homeostatic attunement) or “direct their attention to elsewhere” (Akhtar’s disruptive attunement) – a critically important balance that is needed if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a number of broadly applicable “template” interventions that juxtapose both the patient’s “defensive need” to maintain “same old same old” and the patient’s “adaptive capacity” to allow for “something new, different, and better.” Clinical vignettes will be offered that demonstrate judicious and ongoing use of these “optimally stressful” interventions that alternately support and challenge the defense, thereby galvanizing advancement of the patient, over time, from psychological rigidity to psychological flexibility.
If indeed the therapeutic goal is deep and sustained psychodynamic change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress within our patients that there will be both impetus and opportunity for them, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – 22 Feb 2023 – A Handy Reference Guide for all Therapists.pptxMartha Stark MD
Although you believe that you are offering your clients plenty of support, do you sometimes worry that you might not be offering them quite enough challenge?
My workshop will teach you to "construct" a number of "growth-incentivizing interventions" specifically designed to "catalyze" deep and enduring psychodynamic change in your clients – by facilitating their advancement, whatever their diagnosis, from “less healthy” rigidity (defense) to “more healthy” flexibility (adaptation). These interventions can be strategically formulated to offer just the right balance between anxiety-provoking challenge and anxiety-relieving support.
I will be providing you with a set of "therapeutic tools" – both "minimally stressful" and "optimally stressful" interventions – that you will be able to call upon during universally relevant, pivotal “clinical moments” with your clients.
These interventions will “incentivize” your client to (1) confront anxiety-provoking truths about her “self,” (2) grieve anxiety-provoking truths about the “objects of her desire,” (3) take ownership of anxiety-provoking truths about her “relational self,” and (4) expose anxiety-provoking truths about her “private self.”
Martha Stark MD – 17 Feb 2023 – Seminar 1 – A How-To Playbook for the Middle ...Martha Stark MD
Peter Giovacchini (1986) once wrote – “The poorest understood and two most enigmatic words in psychoanalysis are working through.”
And Patricia Coughlin (2022) recently wrote – “Like the middle game in chess, there is no playbook to guide us.”
It took me 48 years to get here and a lot of encouragement from my students, but my presentation over the course of our two sessions will represent a rather bold effort on my part to conceptualize a broad strokes framework for this “middle game” in psychodynamic psychotherapy when deep and enduring characterological / structural change is the ultimate goal – in essence, a “how-to playbook” for how longstanding, deeply entrenched “defensive reactions” that impede growth can be progressively worked through and ultimately transformed into “adaptive responses” that promote growth.
The process of advancing from rigid defense to more flexible adaptation is never a straight-line progression. Rather, evolving from psychological rigidity to psychological flexibility will involve the therapist’s strategic provision of not just “support” but an artfully conceived combination of “challenge” and “support” – namely, “optimal stress.”
The ongoing therapeutic provision of this “optimal stress” will give rise to healing cycles of disruption (in reaction to the challenge) and repair (in response to the support) – and, eventually, progression from less-healthy defense to more-healthy adaptation.
Over the course of the two sessions, I will be exploring the use of three specific groups of interventions – growth-promoting interventions that (always with compassion and never judgment) either (1) “support” the rigid defense (to demonstrate empathic attunement), (2) “challenge” and then “support” the rigid defense (to generate destabilizing stress and incentivizing dissonance), or (3) “support” the more flexible adaptation (to celebrate and reinforce the new normal).
The strategic design of these “playbook interventions” is both an art (involving intuition) and a science (involving analytic finesse). Throughout both presentations, I will be sharing a number of vignettes that will demonstrate the application of these theoretical constructs to clinical practice.
Martha Stark MD – 10 Jun 2022 – From Defense to Adaptation.pptxMartha Stark MD
This document discusses the therapeutic use of optimal stress to provoke recovery from psychological defenses to more adaptive responses. It argues that psychodynamic psychotherapy can help patients master past traumatic experiences by superimposing an acute stressor to trigger healing cycles of disruption and repair. This allows defenses to gradually evolve into more flexible adaptations through iterative cycles of destabilization caused by therapeutic challenges, followed by restabilization due to support. The goal is to transform "rigid defense" into "flexible adaptation" and help patients thrive rather than just survive.
Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science ...Martha Stark MD
The document outlines Martha Stark's psychodynamic synergy paradigm, which utilizes five therapeutic models to catalyze psychological change. It focuses on the first three models: 1) the interpretive perspective of classical psychoanalysis, 2) the corrective provision perspective of self psychology, and 3) the intersubjective perspective of contemporary relational theory. The therapeutic actions of these three models involve "working through" optimal stress created by interventions that alternate between challenge and support. Model 1 uses interpretations to resolve internal conflicts. Model 2 helps patients grieve disappointments. Model 3 promotes taking accountability in relationships. The goal across all three is to transform patients from rigidity to flexibility.
Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Sli...Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD
Are you wishing that you had a better grasp of psychodynamic concepts and their application to the clinical hour? With an emphasis always on the translation of theory into practice, in this 2-hour intensive training Dr. Martha Stark will be highlighting the three major psychoanalytic schools:
(Model 1) the 1-person perspective of classical psychoanalysis – a “cognitive” approach that emphasizes “enhancement of knowledge” and “interpreting”;
(Model 2) the 1½-person perspective of self psychology – an “affective” approach that emphasizes “provision of experience” and “grieving”; and
(Model 3) the 2-person perspective of contemporary relational theory – a “relational” approach that emphasizes “engagement in relationship” and “negotiating mutual enactment.”
Martha is particularly interested in (1) how the “therapeutic process” between patient and therapist evolves over time, (2) what happens moment-to-moment in the intersubjective space between patient and therapist, (3) how healing cycles of disruption and repair can be generated when the therapist alternately challenges the patient’s defense and then supports it, and (4) how the ongoing provision of “optimal stress” can ultimately “incentivize” deep, enduring, characterological change in the patient.
In order to facilitate this advancement of the patient from psychological rigidity to psychological flexibility and from defensive reaction to adaptive response, Martha will be teaching three “optimally stressful” template statements – Model 1 “conflict statements,” Model 2 “disillusionment statements,” and Model 3 “accountability statements” – all of which are strategically designed to “precipitate disruption” in order to “trigger repair,” thereby healing unmastered early-on relational traumas and deeply embedded emotional injuries.
Martha will be presenting several brief clinical vignettes to demonstrate the transformation of “resistance” into “awareness” (Model 1), “relentless hope” into “acceptance” (Model 2), and “re-enactment” into “accountability” (Model 3).
Martha Stark MD – 8 Oct 2021 – The Transformative Power of Optimal Stress – P...Martha Stark MD
The therapeutic provision of “optimal stress” – against the backdrop of an empathically attuned and authentically engaged therapy relationship – is sometimes the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries. Ongoing challenge will destabilize and support will then prompt restabilization at ever-higher levels of resilience and adaptive capacity.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
Martha Stark MD – 7 Mar 2020 – Precipitating Disruption to Trigger Repair.pptxMartha Stark MD
This document discusses the transformative power of optimal stress in precipitating disruption to trigger repair. It describes how controlled damage or optimally stressful interventions can provoke recovery by challenging defenses and supporting the patient. This process involves iterative cycles of destabilization in reaction to challenges, followed by restabilization in response to support, allowing the patient to reintegrate at higher levels of functionality and adaptive capacity. The goal is to transform dysfunctional defenses into more functional adaptations through challenging defenses and tapping into the patient's resilience in the context of an empathic therapy relationship.
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...Martha Stark MD
Superimposing an acute physical injury on top of a chronic one is sometimes exactly what the body needs in order to heal.
But just as with the body, where a condition might not heal until it is made acute, so too with the mind. The therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – can be the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will galvanize the patient to action and provoke healing.
With our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we can formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is a firm belief in the underlying resilience patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from less-evolved defensive reaction to more-evolved adaptive response.
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD
The document discusses the therapeutic use of optimal stress to provoke recovery in psychotherapy. It argues that superimposing an acute stress or disruption on top of a chronic issue can help the body or mind heal. This concept of "controlled damage" or "optimal stress" can trigger the innate ability to self-repair. The therapist can use optimally stressful interventions that alternately challenge and support defenses to facilitate iterative cycles of destabilization and restabilization, allowing the patient to process experiences and adapt at higher levels of functioning. The goal is to transform dysfunctional defenses into more functional adaptations through this process of disruption and repair.
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptxMartha Stark MD
The document discusses the transformative power of optimal stress in triggering recovery and healing. It argues that superimposing an acute stress or injury on top of a chronic one can help the body heal. This is likened to wound debridement, which removes damaged tissue and provokes healing by mildly aggravating the area. Similarly in the mind, providing optimal stress in the context of an empathic therapy relationship can help overcome resistance to change. The goal of psychotherapy is to facilitate processing of stressful experiences from defensive reactions to adaptive responses, and from dysfunction to functionality.
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...Martha Stark MD
This document discusses the transformative power of optimal stress in psychotherapy. It argues that precipitating disruption through optimally stressful interventions can trigger repair and healing in patients, analogous to how physical injuries sometimes need to be aggravated to promote healing. Three models of therapeutic action are described:
1) The interpretive perspective focuses on the patient's internal dynamics and conflicts.
2) Self psychology perspectives focus on correcting deficient early experiences and providing empathic support.
3) Relational theories emphasize authentic engagement and accountability in the therapeutic relationship.
The document suggests these approaches can be used synergistically based on the patient's immediate needs, to help transform dysfunctional defenses into more functional adaptations over the course of treatment.
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...Martha Stark MD
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 13 Nov 2022 – Part 1 – The Art and The Science of Interpret...Martha Stark MD
This document outlines Martha Stark's presentation on conceptualizing a framework for the "middle game" of psychodynamic psychotherapy. The presentation focuses on four key elements: staying attuned to a patient's anxiety level and understanding it's okay to sometimes increase or decrease anxiety; generating optimal stress through the right balance of challenge and support to incentivize changing defenses into adaptations; developing comfort with challenging and supporting unhealthy defenses as well as celebrating new, healthier adaptations; and using minimally and optimally stressful interventions. The goal is transforming psychological rigidity into flexibility through therapeutic provision of optimal stress.
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD
My most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model (Model 5 of my Psychodynamic Synergy Paradigm) that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (whether real or simply envisioned). A constructivist model at heart, this freshly minted model features a quantum-neuroscientific approach to healing “analysis paralysis.”
This newest addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD
If deep and enduring psychodynamic change is the ultimate goal of treatment, then periodically juxtaposing seemingly contradictory “forces” (Hegel’s thesis and antithesis) will eventually jump-start the patient’s “adaptive recovery” by creating optimally stressful, growth-incentivizing “mismatch experiences.”
I will be proposing use of something to which I refer as a “conflict statement” – a clinically useful and almost universally applicable therapeutic intervention strategically designed to target internal conflictedness between anxiety-provoking (but ultimately growth-promoting) forces pressing “yes” and anxiety-relieving (but growth-impeding) resistant counterforces defending “no.”
The stress and strain of the “destabilizing dissonance” hereby created will provide the “therapeutic leverage” needed for the patient gradually, over time, to relinquish the tenacity of her rigid attachment to the defense in favor of a more flexible adaptation – a “compromise position” that will “reconcile their common truths” (Hegel’s synthesis) and transform conflict into collaboration.
The strategic construction of conflict statements requires of the therapist that she be able both to support the patient’s defense by “being with the patient where she is” and to challenge the patient’s defense by “directing the patient’s attention to where the therapist would want her to go.” I will be offering specific clinical examples to demonstrate the impact of these powerfully impactful psychotherapeutic interventions. No pain, no gain…
Martha Stark MD – 13 Nov 2022 – Part 2 – The Art and The Science of Interpret...Martha Stark MD
As you sit with your patients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our patients. In truth, most of our patients are “conflicted” about most things most of the time. Whether working within the interpretive perspective of classical psychoanalytic theory, the corrective-provision perspective of self psychology, or the intersubjective perspective of contemporary relational theory, we are therefore ever busy deciding when we should highlight the healthy forces within patients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.” When should we “be with them where they are” and when should we “direct their attention to elsewhere”? – or can we perhaps do both at the same time?
With our finger ever on the pulse of the level of the patient’s anxiety, we are indeed always focused on whether we think the patient will be able to tolerate further (anxiety-provoking) challenge and/or will require additional (anxiety-assuaging) support – a critically important balance that is necessary if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a universally applicable intervention that targets the patient’s state of internal dividedness or conflictedness – between healthy but anxiety-provoking forces pressing for “something new and better” and less healthy but anxiety-assuaging (defensive) counterforces insisting upon “same old same old.” Brief and more extended clinical vignettes will be offered that demonstrate use of these optimally stressful “conflict statements” that are specifically designed to facilitate development of the patient’s dual awareness.
If indeed the analytic goal is deep, enduring, characterological change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress that there will be both impetus and opportunity for the patient, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...Martha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Hildegard Peplau was an influential American nurse who developed the theory of interpersonal relations, emphasizing the nurse-client relationship as the foundation of nursing practice. She identified four phases of the therapeutic nurse-client relationship: orientation, identification, exploitation, and resolution. Peplau's theory focused on the dynamic interaction between nurses and clients and challenged the traditional view of nurses as passive caregivers. Her work established nursing as a therapeutic process and helped elevate the professional status of nursing.
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
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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.
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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 – 6 Jun 2022 – The Ever-Evolving Psychodynamic Process – From...Martha Stark MD
Are you wishing that you had a better grasp of psychodynamic concepts and their application to the clinical hour? With an emphasis always on the translation of theory into practice, in this 2-hour intensive training Dr. Martha Stark will be highlighting the three major psychoanalytic schools:
(Model 1) the 1-person perspective of classical psychoanalysis – a “cognitive” approach that emphasizes “enhancement of knowledge” and “interpreting”;
(Model 2) the 1½-person perspective of self psychology – an “affective” approach that emphasizes “provision of experience” and “grieving”; and
(Model 3) the 2-person perspective of contemporary relational theory – a “relational” approach that emphasizes “engagement in relationship” and “negotiating mutual enactment.”
Martha is particularly interested in (1) how the “therapeutic process” between patient and therapist evolves over time, (2) what happens moment-to-moment in the intersubjective space between patient and therapist, (3) how healing cycles of disruption and repair can be generated when the therapist alternately challenges the patient’s defense and then supports it, and (4) how the ongoing provision of “optimal stress” can ultimately “incentivize” deep, enduring, characterological change in the patient.
In order to facilitate this advancement of the patient from psychological rigidity to psychological flexibility and from defensive reaction to adaptive response, Martha will be teaching three “optimally stressful” template statements – Model 1 “conflict statements,” Model 2 “disillusionment statements,” and Model 3 “accountability statements” – all of which are strategically designed to “precipitate disruption” in order to “trigger repair,” thereby healing unmastered early-on relational traumas and deeply embedded emotional injuries.
Martha will be presenting several brief clinical vignettes to demonstrate the transformation of “resistance” into “awareness” (Model 1), “relentless hope” into “acceptance” (Model 2), and “re-enactment” into “accountability” (Model 3).
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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.
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This document discusses the transformative power of optimal stress in precipitating disruption to trigger repair. It describes how controlled damage or optimally stressful interventions can provoke recovery by challenging defenses and supporting the patient. This process involves iterative cycles of destabilization in reaction to challenges, followed by restabilization in response to support, allowing the patient to reintegrate at higher levels of functionality and adaptive capacity. The goal is to transform dysfunctional defenses into more functional adaptations through challenging defenses and tapping into the patient's resilience in the context of an empathic therapy relationship.
Martha Stark MD – 20 Mar 2020 – Holistic Psychotherapy – Knowledge, Experienc...Martha Stark MD
Superimposing an acute physical injury on top of a chronic one is sometimes exactly what the body needs in order to heal.
But just as with the body, where a condition might not heal until it is made acute, so too with the mind. The therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – can be the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in patients with longstanding emotional injuries.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will galvanize the patient to action and provoke healing.
With our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we can formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is a firm belief in the underlying resilience patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from less-evolved defensive reaction to more-evolved adaptive response.
Martha Stark MD – May 2022 – Modes of Therapeutic Action – Enhancement of Kno...Martha Stark MD
The document discusses the therapeutic use of optimal stress to provoke recovery in psychotherapy. It argues that superimposing an acute stress or disruption on top of a chronic issue can help the body or mind heal. This concept of "controlled damage" or "optimal stress" can trigger the innate ability to self-repair. The therapist can use optimally stressful interventions that alternately challenge and support defenses to facilitate iterative cycles of destabilization and restabilization, allowing the patient to process experiences and adapt at higher levels of functioning. The goal is to transform dysfunctional defenses into more functional adaptations through this process of disruption and repair.
Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 27 Oct 2017 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 26 - 27 Apr 2019 – My Psychodynamic Synergy Paradigm – A C....Martha Stark MD
Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement).
Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process.
review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance.
the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing.
working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.
Martha Stark MD – 23 Mar 2019 – Contemporary Psychodynamic Psychotherapy.pptxMartha Stark MD
The document discusses the transformative power of optimal stress in triggering recovery and healing. It argues that superimposing an acute stress or injury on top of a chronic one can help the body heal. This is likened to wound debridement, which removes damaged tissue and provokes healing by mildly aggravating the area. Similarly in the mind, providing optimal stress in the context of an empathic therapy relationship can help overcome resistance to change. The goal of psychotherapy is to facilitate processing of stressful experiences from defensive reactions to adaptive responses, and from dysfunction to functionality.
Martha Stark MD – 16 Apr 2020 – Holistic Psychotherapy – Healing the MindBody...Martha Stark MD
This document discusses the transformative power of optimal stress in psychotherapy. It argues that precipitating disruption through optimally stressful interventions can trigger repair and healing in patients, analogous to how physical injuries sometimes need to be aggravated to promote healing. Three models of therapeutic action are described:
1) The interpretive perspective focuses on the patient's internal dynamics and conflicts.
2) Self psychology perspectives focus on correcting deficient early experiences and providing empathic support.
3) Relational theories emphasize authentic engagement and accountability in the therapeutic relationship.
The document suggests these approaches can be used synergistically based on the patient's immediate needs, to help transform dysfunctional defenses into more functional adaptations over the course of treatment.
Martha Stark MD – 28 Feb 2022 – From Defense to Adaptation – The Ever-Evolvin...Martha Stark MD
The document discusses using optimal stress in psychotherapy to transform rigid defenses into more flexible adaptations. It presents the psychodynamic process as involving cycles of disruption and repair. The therapist provokes disruption of defenses through optimally stressful interventions in order to trigger repair and adaptation. Three models are presented - classical psychoanalysis focuses on interpreting truths to strengthen awareness; self psychology focuses on grieving truths about others to build acceptance; and relational theory focuses on owning interpersonal truths to develop accountability. Empathic and conflict statements are used to both challenge and support defenses, generating optimal stress for change.
Martha Stark MD – 30 Sep 2018 – The Transformative Power of Optimal Stress.pptxMartha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Martha Stark MD – 13 Nov 2022 – Part 1 – The Art and The Science of Interpret...Martha Stark MD
This document outlines Martha Stark's presentation on conceptualizing a framework for the "middle game" of psychodynamic psychotherapy. The presentation focuses on four key elements: staying attuned to a patient's anxiety level and understanding it's okay to sometimes increase or decrease anxiety; generating optimal stress through the right balance of challenge and support to incentivize changing defenses into adaptations; developing comfort with challenging and supporting unhealthy defenses as well as celebrating new, healthier adaptations; and using minimally and optimally stressful interventions. The goal is transforming psychological rigidity into flexibility through therapeutic provision of optimal stress.
Martha Stark MD – 24 Jun 2022 – Understanding Life Backward but Envisioning P...Martha Stark MD
My most recent – and 9th – book features an action-based, solution-focused, future-oriented psychodynamic model (Model 5 of my Psychodynamic Synergy Paradigm) that conceives of the mind as holding infinite potential and of memory as dynamic and continuously updating itself on the basis of new experience (whether real or simply envisioned). A constructivist model at heart, this freshly minted model features a quantum-neuroscientific approach to healing “analysis paralysis.”
This newest addition to my therapeutic armamentarium was inspired, at least in part, by my deep dive immersion in the groundbreaking scientific discovery that when implicitly held traumatic memories are reactivated in an embodied fashion, the network of neural synapses encoding these procedurally organized memories will become deconsolidated for a time-limited period. This synaptic unlocking – fueled by repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities – will create both impetus and opportunity for rewiring the brain and reprogramming the mind.
In sum, Model 5 uses this newly revitalized, brain-based phenomenon of therapeutic memory reconsolidation to explore the various ways in which a patient can replace outdated, maladaptive, fear-infused, past-focused, immobilizing traumatic narratives with updated, more reality-based, more hopeful, future-oriented, incentivizing narratives that will inspire action and actualization of potential.
Martha Stark MD – Model 1 – The Interpretive Perspective of Classical Psychoa...Martha Stark MD
If deep and enduring psychodynamic change is the ultimate goal of treatment, then periodically juxtaposing seemingly contradictory “forces” (Hegel’s thesis and antithesis) will eventually jump-start the patient’s “adaptive recovery” by creating optimally stressful, growth-incentivizing “mismatch experiences.”
I will be proposing use of something to which I refer as a “conflict statement” – a clinically useful and almost universally applicable therapeutic intervention strategically designed to target internal conflictedness between anxiety-provoking (but ultimately growth-promoting) forces pressing “yes” and anxiety-relieving (but growth-impeding) resistant counterforces defending “no.”
The stress and strain of the “destabilizing dissonance” hereby created will provide the “therapeutic leverage” needed for the patient gradually, over time, to relinquish the tenacity of her rigid attachment to the defense in favor of a more flexible adaptation – a “compromise position” that will “reconcile their common truths” (Hegel’s synthesis) and transform conflict into collaboration.
The strategic construction of conflict statements requires of the therapist that she be able both to support the patient’s defense by “being with the patient where she is” and to challenge the patient’s defense by “directing the patient’s attention to where the therapist would want her to go.” I will be offering specific clinical examples to demonstrate the impact of these powerfully impactful psychotherapeutic interventions. No pain, no gain…
Martha Stark MD – 13 Nov 2022 – Part 2 – The Art and The Science of Interpret...Martha Stark MD
As you sit with your patients, do you sometimes find yourself at a loss for words?
From moment to moment, we are continuously making choices about how best to position ourselves in relation to our patients. In truth, most of our patients are “conflicted” about most things most of the time. Whether working within the interpretive perspective of classical psychoanalytic theory, the corrective-provision perspective of self psychology, or the intersubjective perspective of contemporary relational theory, we are therefore ever busy deciding when we should highlight the healthy forces within patients that are pressing “yes” and when we should target the unhealthy (resistive) counterforces that are defending “no.” When should we “be with them where they are” and when should we “direct their attention to elsewhere”? – or can we perhaps do both at the same time?
With our finger ever on the pulse of the level of the patient’s anxiety, we are indeed always focused on whether we think the patient will be able to tolerate further (anxiety-provoking) challenge and/or will require additional (anxiety-assuaging) support – a critically important balance that is necessary if the analytic endeavor is to be advanced.
To demonstrate the translation of these theoretical constructs into clinical practice, I will be proposing a universally applicable intervention that targets the patient’s state of internal dividedness or conflictedness – between healthy but anxiety-provoking forces pressing for “something new and better” and less healthy but anxiety-assuaging (defensive) counterforces insisting upon “same old same old.” Brief and more extended clinical vignettes will be offered that demonstrate use of these optimally stressful “conflict statements” that are specifically designed to facilitate development of the patient’s dual awareness.
If indeed the analytic goal is deep, enduring, characterological change, then it behooves all of us to become comfortable with the concept of provoking – with our interventions – enough incentivizing anxiety and destabilizing stress that there will be both impetus and opportunity for the patient, ultimately, to transform rigid defense into more flexible adaptation. The strategic formulation of interpretations specifically designed to generate this optimal stress is indeed both an art and a science.
Martha Stark MD – Oct 2019 – The Transformative Power of Optimal Stress – Pre...Martha Stark MD
Psychodynamic psychotherapy affords the patient an opportunity – albeit a belated one – to master experiences that had once been overwhelming, and therefore defended against, but that can now, with enough support from the therapist and by tapping into the patient's underlying resilience and inherent capacity to cope with stress, be processed, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unmastered early-on relational traumas” replaced by "accountability," "retreat and resignation" replaced by "accessibility," and “relentless despair” replaced by “awakened hope.”
The focus throughout will be on the interface between theory and clinical practice.
Hildegard Peplau was an influential American nurse who developed the theory of interpersonal relations, emphasizing the nurse-client relationship as the foundation of nursing practice. She identified four phases of the therapeutic nurse-client relationship: orientation, identification, exploitation, and resolution. Peplau's theory focused on the dynamic interaction between nurses and clients and challenged the traditional view of nurses as passive caregivers. Her work established nursing as a therapeutic process and helped elevate the professional status of nursing.
Similar to Martha Stark MD – 4 May 2023 – Practical Clinical Interventions for Incentivizing Change.pptx (20)
Martha Stark MD – Clinical Interventions – Chapter 2 of my WORKING WITH RESIS...Martha Stark MD
In order to demonstrate the ways in which the concepts of conflict and resistance can be applied to the clinical situation, let us think about the following three situations:
1. The patient is obviously upset but is trying hard not to cry.
2. The patient knows that her therapist will not laugh at her but finds herself fearing that the therapist might.
3. The patient is upset with her therapist and knows, on some level, that she must eventually confront the reality of just how disappointed she really is, but she would like to think that she could get better without having to do that.
In our interventions in these three situations of conflict, we have three options, and we must decide from moment to moment which to choose.
Martha Stark MD – 2019 A Heart Shattered, The Private Self, and A Life Unlive...Martha Stark MD
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the object of their desire will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the world of objects – their heart shattered...
To protect themselves against being once again devastated, this latter group of patients will retreat, withdraw, detach themselves from relationships – psychic retreat, schizoid withdrawal, emotional detachment from the world of people, from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant false (public) self they present to the world belying the truth that lies hidden within, namely, not only their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror but also their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of relentless hope, which figures prominently in my Model 2 (an absence of good model that focuses on the patient’s relentless pursuit of new good), and its cousin relentless outrage, which figures prominently in my Model 3 (a presence of bad model that focuses on the patient’s compulsive re-enactment of old bad in the face of frustrated desire), the experience of being-in-the-world for these latter (Model 4) patients will be one of relentless despair – a profound hopelessness that they keep hidden behind the false self they present to the world, a self-protective armor that masks the deeply entrenched brokenness and thwarted potential of the true self (Stark 2017).
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense (albeit maladaptive) engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s utter lack of any real engagement with the world of objects.
Many a patient, as a child, has suffered great heartache at the hands of a misguided, even if well-intentioned, parent, be it in the form of psychological trauma and abuse (too much bad) or emotional deprivation and neglect (not enough good). Such a patient may never have had occasion to confront the pain of her grief about the parent's unwitting but devastating betrayal of her. Instead, she has defended herself against the pain of her heartache by pushing it, unprocessed, out of her awareness and clinging instead to the illusion of her parent (or a stand-in for her parent) as good and as ultimately forthcoming if she (the patient) could but get it right.
Under the sway of her repetition compulsion, the patient – as she struggles through her life – will find herself delivering into each new relationship her desperate hope that perhaps this time, were she to be but good enough, want it badly enough, or suffer deeply enough, she might yet be able to transform this new object of her relentless desire into the perfect parent she should have had as a child – but never did (Stark 1994a, 1994b, 1999, 2015).
As long as the patient continues her relentless pursuits, however, and refuses to come to terms with the reality of the limitations, separateness, and immutability of the people in her world – and the limits of her power to make them change – then she will be consigning herself to a lifetime of chronic frustration, heartache, and unremitting feelings of impotent rage and profound despair.
Elvin Semrad (Rako 1983) captures this poignantly with the following: “Pretending that <something> can be when it can’t is how people break their heart.”
Martha Stark MD – 2016 How Does Psychotherapy Work?.pdfMartha Stark MD
I have always found the following quote from Gary Schwartz’s 1999 The Living Energy Universe to be inspirational: “One of science’s greatest challenges is to discover certain principles that will explain, integrate, and predict large numbers of seemingly unrelated phenomena.” So too my goal has long been to be able to tease out overarching principles – themes, patterns, and repetitions – that that are relevant in the deep healing work that we do as psychotherapists.
Drawing upon concepts from fields as diverse as systems theory, chaos theory, quantum mechanics, solid-state physics, toxicology, and psychoanalysis to inform my understanding, on the pages that follow I will be offering what I hope will prove to be a clinically useful conceptual framework for understanding how it is that healing takes place – be it of the body or of the mind. More specifically, I will be speaking both to what exactly provides the therapeutic leverage for healing chronic dysfunction and to how we, as psychotherapists, can facilitate that process?
Just as with the body, where a condition might not heal until it is made acute, so too with the mind. In other words, whether we are dealing with body or mind, superimposing an acute injury on top of a chronic one is sometimes exactly what a person needs in order to trigger the healing process.
More specifically, the therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – is often the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in our patients with longstanding emotional injuries and scars.
Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will serve simply to reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will “galvanize to action” and provoke healing. I refer to this as the Goldilocks Principle of Healing.
And so it is that with our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity.
Behind this “no pain, no gain” approach is my firm belief in the
underlying resilience that patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from dysfunctional defensive reaction to more functional adaptive response.
Martha Stark MD – 2015 The Transformative Power of Optimal Stress.pdfMartha Stark MD
Freud’s interest was in the internal conflict that exists between, on the one hand, untamed id drives (most notably sexual and aggressive ones) clamoring for gratification and release and, on the other hand, the defenses mobilized by an undeveloped ego made anxious by the threatened breakthrough of those drives – conflict that will create neurotic suffering and interfere with the capacity to derive pleasure and fulfillment from love, work, and play (Freud 1926).
Using as a springboard Freud’s premises of drive-defense conflict as the source of a person’s difficulties in life and of the goal of treatment as therefore transformation of id energy into ego structure so that primitive defenses can be relinquished and conflict resolved – “Where id was, there shall ego be” (Freud 1923), I will go on to broaden Freud’s conceptualization of neurotic conflict to encompass, more generally, growth-impeding tension between anxiety-provoking but ultimately health-promoting internal forces pressing yes and anxiety- assuaging internal counterforces defending no.
The aim of treatment will then become (1) to tame the id so that its now more manageable energy can be redirected into more constructive channels and used to power the pursuit of healthier endeavors and (2) to strengthen the ego so that it will become both better able to cope with the multitude of anxiety-provoking stressors (internal and external) to which it is being continuously exposed and more skilled at harnessing id energy to fuel actualization of potential. In essence, a tamer id and a stronger ego will enable the patient to cope with the stress of life (Selye 1978) by adapting instead of defending – “Where defense was, there shall adaptation be.”
In the treatment situation, the therapist will offer psychotherapeutic interventions specifically designed to precipitate disruption in order to trigger repair (Stark 2008, 2012, 2014). To be effective against dysfunctional defenses that have become firmly entrenched over time, despite having long since outlived their usefulness, these therapeutic interventions must be optimally stressful. In other words, they must be strategically formulated to offer just the right combination of challenge and support.
Martha Stark MD – 1994 A Primer on Working with Resistance.pdfMartha Stark MD
Every day after work, a very depressed young man sits in the dark in his living room hour after hour, doing nothing, his mind blank. By his side is his stereo and a magnificent collection of his favorite classical music. The flick of a switch and he would feel better- and yet night after night, overwhelmed with despair, he just sits, never once touching that switch.
I would like to suggest that we think of this man as being in a state of internal conflict (although he may not, at this point, be aware of such conflict). He could turn on his stereo, but he does not. He could do something that would make him feel better, but he does nothing. Within this man is tension between what he "should" let himself do and what he finds himself doing instead.
In general, patients both do and don't want to get better. They both do and don't want to maintain things as they are. They both do and don't want to get on with their lives. They both are and aren't invested in their suffering. They are truly conflicted about all the choices that confront them.
The patient may protest that he desperately wants to change. He does and he doesn't. He may insist that he would do anything in order to feel better. Well, yes and no. On some level, everybody wants things to be better, but few are willing to change.
Drive theory conceives of conflict as involving internal tension between id impulse insisting "yes" and ego defense protesting "no" (with the superego coming down usually on the side of the ego). In Ralph Greenson's (1967) words: "A neurotic conflict is an uncon- scious conflict between an id impulse seeking discharge and an ego defense warding off the impulse's direct discharge or access to consciousness" (p. 17).
Although drives are considered part of the id, affects (drive derivatives) are thought to reside in the ego; in fact, the ego is said to be the seat of all affects. When Freud writes of psychic conflict between the id and the ego, it is understood that sometimes he is referring to conflict between an id drive and an ego defense and sometimes he is referring to conflict between an anxiety-provoking affect (in the ego but deriving from the id) and an ego defense.
Martha Stark MD – 1994 Working with Resistance.pdfMartha Stark MD
This book is about the patient’s resistance and his refusal to grieve. Drawing upon concepts from classical psychoanalysis, object relations theory, and self psychology, I present a model of the mind that takes into consideration the relationship between unmourned losses and how such losses are internally recorded – as both absence of good (structural deficit) and presence of bad (structural conflict). These internal records of traumatic disappointments sustained early on give rise to forces that interfere with the patient’s movement toward health – forces that constitute, therefore, the resistance.
Within the patient is a tension between that which the patient should let himself do/feel and that which he does/feels instead. Patient and therapist, as part of their work, will need to be able to understand and name, in a profoundly respectful fashion, both sets of forces –both those healthy ones, which impel the patient in the direction of progress, and those unhealthy resistive ones, which impede such progress. As part of the work to be done, the patient must eventually come to appreciate his investment in his defenses, how they serve him, and the price he pays for holding on to them.
My interest is in the interface between theory and practice –the ways in which theoretical constructs can be translated into the clinical situation; to that end, I suggest specific, prototypical interventions for each step of the working-through process.
My contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects. Instead, he protects himself from the pain of knowing the truth about his objects by clinging to misperceptions of them; holding on to his defensive need not to know enables him not to feel his grief.
To the extent that the patient is defended, to that extent will he be resistant to doing the work that needs ultimately to be done – grief work that will enable him to let go of the past, let go of his relentless pursuit of infantile gratification, and let go of his compulsive repetitions. Only as the patient grieves, doing now what he could not possibly do as a child, will he get better.
I believe that mental health has to do with the capacity to experience one’s objects as they are, uncontaminated by the need for them to be otherwise. A goal of treatment, therefore, is to transform the patient’s need for his objects to be other than who they are into the capacity to accept them as they are.
Martha Stark MD – 28 Oct 2017 – Relentless Despair – Model 4.pptxMartha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – 10 Dec 2016 – Limbic Kindling and Hypersensitivity to Stres...Martha Stark MD
Over the course of the decades, my own approach has become much more integrative and holistic – one that appreciates the complex interdependence of mind and body and the critical role played by the impact of stress on the MindBodyMatrix.
The living system – the ground regulation system – the divine matrix – the web of life – a liquid crystal through which information and energy flow.
More specifically, I will be speaking to the role played by limbic kindling and the resultant hypersensitivity to stress that is a hallmark of depressed patients.
Martha Stark MD – 20 Oct 2021 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 10 Sep 2012 – Relentless Hope – The Refusal to Grieve.pptxMartha Stark MD
Relentless hope is a defense to which the patient clings in order not to have to feel the pain of her disappointment in the object, the hope a defense ultimately against grieving. The patient’s refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) fuels the relentlessness with which she pursues it, both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of her outrage in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen. It will be suggested that maturity involves transforming this infantile need to have one’s objects be other than who they are into the healthy capacity to accept them as they are.
Drawing upon four modes of therapeutic action (enhancement of knowledge "within," provision of experience "for," engagement in relationship "with," and facilitation of flow "throughout"), Martha will offer a number of prototypical interventions specifically designed to facilitate transformation of the patient’s “defensive” need to possess and control the object (and, when thwarted, to punish the object by attempting to destroy it) into the “adaptive” capacity to relent, grieve, accept, forgive, internalize, separate, let go, and move on. Martha will also offer a number of clinical vignettes that speak to the power of an integrative approach that focuses on accountability and development of the capacity to relent (on the parts of both patient and therapist), the ultimate goal being to transform defensive need into adaptive capacity – the defensive need to re-enact old dramas again and again into the adaptive capacity to do it differently this time…
Martha Stark MD – 5 Jun 2021 – A Heart Shattered and Relentless Despair.pptxMartha Stark MD
This document provides an overview of a seminar on an existential-humanistic approach to healing brokenness and easing despair in patients. The seminar will focus on Model 4 patients who have experienced early heartbreak and withdrawal from relationships due to a "shattered heart". It will discuss helping patients overcome dread of emotional surrender and providing an opportunity to "regress in order to redo" early experiences. The presenter's psychodynamic synergy paradigm incorporates five therapeutic models, including one focused on patients experiencing relentless despair and nonrelatedness due to early relational failures.
Martha Stark MD – 26 Jun 2009 – The Overwhelmed Heart.pptxMartha Stark MD
This document discusses coronary artery disease and the impact of stress on heart health. It notes that coronary artery disease often develops silently and can cause sudden death in some cases. Chronic stress can damage blood vessels and cause plaque buildup over time by increasing blood pressure and viscosity. Psychological stress, depression, obesity, and other risk factors place cumulative stress on the heart and compromise its ability to adapt. Maintaining the heart's resilience by reducing stressors and replenishing nutrients is important for cardiovascular health.
Martha Stark MD – 21 Feb 2009 – The Wisdom of the Matrix – From Chaos to Cohe...Martha Stark MD
The document discusses how coherence emerges from chaos in complex adaptive systems like living organisms. It argues that through ongoing cycles of disruption and repair, such systems can self-organize and evolve from disorder to higher levels of order and coherence in response to environmental inputs. The ability of a system to process and integrate stressors over time determines whether it progresses towards health or disease.
Martha Stark MD – 26 Jun 2009 – Murmur of the Heart.pptxMartha Stark MD
traumatic stress – stress that the system cannot process and must therefore defend against
optimal stress – stress that the system can process, integrate, and ultimately adapt to, although always at some cost to the system
it's how well the living system (the MindBodyMatrix) is able to manage the cumulative impact of the myriad environmental stressors to which it is being continuously exposed that will make of them either traumatic events or growth opportunities
and that ability to manage stress is a story about the system's ability to process, integrate, and adapt to the impact of environmental challenge, input from the outside that either threatens to overwhelm the system or prompts the system to mobilize its ability to heal itself
Martha Stark MD – 4 Jun 2010 – EMFs and the Excitotoxic Cascade.pptxMartha Stark MD
Unexplained Chronic Illness
Martin Pall's compelling conceptualization of the excitotoxic cascade and its pivotal role in both the initiation and the perpetuation of chronic multisystem illnesses
one or more short-term stressors
chemical sensitivity – pesticides and organic solvents
chronic fatigue – bacterial and viral infections
fibromyalgia – physical traumas
PTSD – severe psychological traumas
to which the body responds with an outpouring of
excitotoxins (glutamate)
inflammatory factors (cytokines and eicosanoids)
free radicals (nitric oxide)
stress-induced outpouring of endogenous excitotoxins, inflammatory cytokines, and free radicals sets in motion (in certain susceptible individuals) the nitric oxide / peroxynitrite cycle
a viciously destructive, self-propagating cycle involving
immune stimulation, inflammatory cytokines, membrane destabilization, synaptic overactivity, opening of calcium-permeable channels, massive calcium influx, etc.
and culminating in chronic illness
Martha Stark MD – 22 Jun 2018 – A Heart Shattered, Relentless Despair, and A ...Martha Stark MD
An anonymous quote but very to the point is the following:
I gave you a part of me that I knew you could break – but you didn’t.
Patients who have never fully confronted – and grieved – the pain of their early-on heartbreak will often cling tenaciously to their hope that perhaps someday the “object of their desire” will be forthcoming. But there are others who, in the aftermath of their early-on heartbreak, will find themselves withdrawing completely from the “world of objects” – their heart shattered…
To protect themselves from being once again devastated, these latter patients retreat, withdraw, detach themselves from relationships, from the world – psychic retreat, schizoid withdrawal, emotional detachment from life itself – only then to find themselves overwhelmed by intense feelings of isolation, alienation, and emptiness – the competent, accomplished, cheerful, compliant “false (public) self” that they present to the world belying the truth of what lies hidden, namely, their private turmoil, tormented heartbreak, harrowing loneliness, and annihilating terror as well as their stymied creativity and desperate (albeit conflicted) longing for meaningful connectedness with the world.
Instead of “relentless hope” (which figures prominently in my Model 2, with its focus on the patient’s “relentless pursuits”) and, when thwarted, “relentless outrage” (which figures prominently in my Model 3, with its focus on the patient’s “compulsive repetitions”), the experience-of-being-in-the-world for these latter (Model 4) patients will be one of “relentless despair” – a “profound hopelessness” that they keep masked by a self-protective “false self” armor that obscures their underlying brokenness and the “thwarted potential” of their “true self.”
Whereas the relentless hope of the Model 2 patient and the relentless outrage of the Model 3 patient speak to the patient’s intense – albeit maladaptive – engagement with the world of objects, the relentless despair of the Model 4 patient speaks to the patient’s complete lack of any real engagement with the world of objects.
Martha Stark MD – 24 Sep 2021 – A Heart Shattered, The Private Self, and Rele...Martha Stark MD
This document discusses the experience of patients who have developed a "false self" due to early childhood trauma or an inability to have their emotional needs met. It explores how therapy can help such patients access their "true self" by providing an environment where the patient can feel in control and absolutely dependent on the therapist without fear of abandonment. Several case studies and songs are referenced that illustrate the disconnect between a person's public and private selves when early heartbreak or lack of a supportive caregiver has occurred. The goal of the therapeutic approach presented is to allow patients to repair damaged parts of themselves by experiencing reliable care and empathy from their therapist.
Martha Stark MD – 21 May 2021 – The Refusal to GrieveMartha Stark MD
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.
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10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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3. LEARNING OBJECTIVES
SUMMARIZE THE REASON THAT “OPTIMAL STRESS”
NAMELY, JUST THE RIGHT BALANCE BETWEEN
ANXIETY – PROVOKING “CHALLENGE” AND ANXIETY – ASSUAGING “SUPPORT”
PROVIDES BOTH “IMPETUS” AND “OPPORTUNITY”
FOR “DEEP AND ENDURING PSYCHODYNAMIC CHANGE”
COMPOSE A “MINIMALLY STRESSFUL” STATEMENT
THAT “SUPPORTS” BY “JOINING” THE DEFENSE
EXPLAIN HOW THESE “MINIMALLY STRESSFUL” INTERVENTIONS
– FEATURED DURING THE “BEGINNING GAME” –
SET THE STAGE FOR THE THERAPEUTIC ACTION THAT WILL FOLLOW
CONSTRUCT AN “OPTIMALLY STRESSFUL” STATEMENT
THAT ALTERNATELY “CHALLENGES” AND THEN “SUPPORTS” THE DEFENSE
DESCRIBE HOW THESE “OPTIMALLY STRESSFUL” INTERVENTIONS
– FEATURED DURING THE “MIDDLE GAME” –
CREATE GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
– THE WORKING THROUGH OF WHICH WILL ADVANCE THE PATIENT
FROM RIGID DEFENSE TO MORE FLEXIBLE ADAPTATION –
I HAVE NO FINANCIAL CONFLICTS OF INTEREST
OR, AS ERIC PLAKUN WOULD SAY,
PERHAPS I HAVE PSYCHOLOGICAL CONFLICTS BUT NO FINANCIAL CONFLICTS
3
5. MY PSYCHODYNAMIC SYNERGY PARADIGM
A C.A.R.E. APPROACH TO DEEP HEALING
Cognitive – Affective – Relational – Existential
FOUR INTERDEPENDENT AND MUTUALLY ENHANCING
“MODES OF THERAPEUTIC ACTION”
MODEL 1 – COGNITIVE
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2 – AFFECTIVE
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
MODEL 3 – RELATIONAL
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
MODEL 4 – EXISTENTIAL
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING DESPAIR
5
6. THERAPEUTIC MODALITIES THAT HAVE
DEEP AND ENDURING PSYCHODYNAMIC CHANGE
AS THEIR ULTIMATE GOAL
FOR EXAMPLE, PSYCHOANALYSIS AND OTHER “DEPTH PSYCHOLOGIES,”
INCLUDING – BUT NOT LIMITED TO – ACT, IFS, EMDR, ISTDP, AEDP, EFT, NLP,
SENSORIMOTOR PSYCHOTHERAPY, SOMATIC EXPERIENCING, AND PSYCHOMOTOR PSYCHOTHERAPY
MUST ULTIMATELY BE ABLE TO TRANSFORM
“PSYCHOLOGICAL RIGIDITY”
INTO “PSYCHOLOGICAL FLEXIBILITY”
IN THE EVOCATIVE WORDS OF ACCEPTANCE AND COMMITMENT THERAPY (ACT)
AND “LOW – LEVEL DEFENSE”
INTO “HIGHER – LEVEL / MORE EVOLVED DEFENSE”
IN THE MORE TRADITIONAL WORDS OF PSYCHOANALYSIS AND EGO PSYCHOLOGY
SUCH THAT THE PATIENT
WHATEVER HER STARTING POINT / WHATEVER HER INITIAL LEVEL OF FUNCTIONALITY
WHATEVER HER DIAGNOSIS
WILL BECOME EVER BETTER ABLE
– OVER TIME –
TO MANAGE THE MYRIAD “STRESSORS” IN HER LIFE
TO WHICH SHE IS BEING CONTINUOUSLY EXPOSED
EVER MORE ADEPT AT “RESPONDING ADAPTIVELY AND MINDFULLY”
INSTEAD OF “REACTING DEFENSIVELY AND MINDLESSLY” 6
7. THE ULTIMATE GOAL OF DEEP TREATMENTS
EVER – LESS PSYCHOLOGICAL RIGIDITY
EVER – MORE PSYCHOLOGICAL FLEXIBILITY
8.
9. INDEED
THE THERAPEUTIC ACTION
IN ALL FOUR OF MY PSYCHODYNAMIC MODELS
– CLASSICAL PSYCHOANALYTIC, SELF PSYCHOLOGICAL,
CONTEMPORARY RELATIONAL, AND EXISTENTIAL – HUMANISTIC –
DOES INDEED INVOLVE ADVANCEMENT OF THE PATIENT
– THROUGH ITERATIVE HEALING CYCLES OF DISRUPTION AND REPAIR –
FROM RIGID DEFENSE TO MORE FLEXIBLE ADAPTATION
– FROM “SAME OLD, SAME OLD” TO “SOMETHING NEW, DIFFERENT, AND BETTER” –
MODEL 1 – FROM “RESISTANCE” TO “AWARENESS”
A COGNITIVE APPROACH THAT FOCUSES ON “INTERPRETING”
MODEL 2 – FROM “RELENTLESS HOPE” TO “ACCEPTANCE”
AN AFFECTIVE APPROACH THAT FOCUSES ON “GRIEVING”
MODEL 3 – FROM “RE – ENACTMENT” TO “ACCOUNTABILITY”
A RELATIONAL APPROACH THAT FOCUSES ON “NEGOTIATING”
MODEL 4 – FROM “RELATIONAL ABSENCE” TO “AUTHENTIC PRESENCE”
AN EXISTENTIAL APPROACH THAT FOCUSES ON “SURRENDERING”
9
10. When I let go
of the
“defensive”
SAME OLD
SAME OLD
that I am,
I become the
“adaptive”
SOMETHING
NEW
DIFFERENT
AND
BETTER
that I
might be.
11. THE PATIENT’S CONTINUOUSLY SHIFTING
“POINTS OF EMOTIONAL URGENCY”
WILL INFORM THE THERAPIST’S CHOICE
OF THE MODEL(S) THAT WILL BE MOST RELEVANT
– MOMENT – TO – MOMENT –
FOR UNDERSTANDING
THE PATIENT’S UNDERLYING PSYCHODYNAMICS
AND FOR THEN SELECTING
THE APPROACH THAT WILL BE MOST USEFUL
MODEL 1
NEUROTIC CONFLICTEDNESS – CONFLICT STATEMENTS
TO HIGHLIGHT INTERNAL CONFLICTEDNESS / AMBIVALENCE
MODEL 2
NARCISSISTIC VULNERABILITY – DISILLUSIONMENT STATEMENTS
TO FACILITATE GRIEVING OF DISILLUSIONMENT / DISAPPOINTMENT
MODEL 3
NOXIOUS RELATEDNESS – ACCOUNTABILITY STATEMENTS
TO FACILITATE NEGOTIATION OF MUTUAL ENACTMENTS
AT THE “INTIMATE EDGE” OF RELATEDNESS
DARLENE EHRENBERG (1992)
MODEL 4
NONRELATEDNESS – FACILITATION STATEMENTS
TO HIGHLIGHT NEED / FEAR OF ENGAGEMENT WITH THE WORLD / LIFE ITSELF
11
13. PLEASE NOTE
I DO NOT “LIMIT” DEFENSES
TO THE WELL – KNOWN
AND MORE TRADITIONAL ONES
AT ONE END OF THE CONTINUUM
“LOW – LEVEL DEFENSES”
FOR EXAMPLE
REPRESSION, REGRESSION, DENIAL,
DISSOCIATION, DISPLACEMENT, PROJECTION,
ISOLATION OF AFFECT, INTELLECTUALIZATION,
AND REACTION FORMATION
AT THE OTHER END
“HIGHER – LEVEL” OR “MORE MATURE DEFENSES”
THAT ARE “MORE ADAPTIVE” AND “MORE SOCIALLY ACCEPTABLE”
FOR EXAMPLE
SUBLIMATION, HUMOR, ALTRUISM,
HUMILITY, AND POSITIVE IDENTIFICATIONS
13
14. RATHER
I DEFINE DEFENSES “MORE BROADLY”
AS SPEAKING TO ANY OF THE
“SELF – PROTECTIVE MECHANISMS”
THAT WE MOBILIZE WHEN MADE ANXIOUS
IN THE FACE OF STRESSORS
– PSYCHOLOGICAL, PHYSIOLOGICAL, AND ENERGETIC –
AT ONE END OF THE CONTINUUM
WHAT HAPPENS “REFLEXIVELY”
WHEN WE ARE CONFRONTED WITH STRESSORS
THAT “OVERWHELM” US WITH ANXIETY
TO WHICH I REFER AS “LOW – LEVEL DEFENSES”
OR “RIGID DEFENSES”
AT THE OTHER END
WHAT HAPPENS “MORE REFLECTIVELY”
WHEN WE ARE CONFRONTED WITH STRESSORS
THAT WE ARE MORE EASILY ABLE TO “TAKE IN OUR STRIDE”
TO WHICH I REFER AS “HIGHER – LEVEL DEFENSES”
OR “MORE FLEXIBLE ADAPTATIONS”
AT ONE END OF THE CONTINUUM – “DEFENSIVE / CONDITIONED REACTIONS”
AT THE OTHER END – “ADAPTIVE / RESILIENT RESPONSES”
14
15. EITHER WE
– MADE ANXIOUS –
“REACT” TO STRESSORS BY “MINDLESSLY DEFENDING”
“DEFENSIVE REACTION”
OR WE
– MORE RESILIENT –
“RESPOND” TO STRESSORS BY “MORE MINDFULLY ADAPTING”
“ADAPTIVE RESPONSE”
16. THE RELATIONSHIP BETWEEN DEFENSE AND ADAPTATION
IS A YIN – YANG RELATIONSHIP
THESE SELF – PROTECTIVE MECHANISMS
ARE COMPLEMENTARY – NOT OPPOSING – FORCES
FURTHERMORE
ALL DEFENSES HAVE AN ADAPTIVE COMPONENT
JUST AS ALL ADAPTATIONS SERVE A DEFENSIVE FUNCTION
NONETHELESS AND MORE GENERALLY
ALTHOUGH DEFENSES MIGHT ONCE
HAVE BEEN NECESSARY
FOR THE PATIENT TO “SURVIVE,”
AS RIGID DEFENSES BECOME UPGRADED
TO MORE FLEXIBLE ADAPTATIONS,
THE PATIENT BECOMES
EVER BETTER ABLE TO “THRIVE”
THE THERAPEUTIC ACTION
IS INDEED DESIGNED
TO TRANSFORM “RIGIDITY” INTO “FLEXIBILITY”
AND “SURVIVING” INTO “THRIVING”
16
19. THE WORKING THROUGH PROCESS
IN PSYCHODYNAMIC PSYCHOTHERAPY
THREE STAGES THAT ARE BOTH REPETITIOUS AND PROGRESSIVE
– “ASCENDING SPIRAL STAIRCASE” –
THE BEGINNING GAME
“MINIMALLY STRESSFUL” INTERVENTIONS
THAT TEASE OUT THE VARIOUS DEFENSES
– THE RECURRING AND PROBLEMATIC THEMES, PATTERNS, AND REPETITIONS –
IN ORDER TO IDENTIFY THE PLAYERS AND SET THE STAGE
FOR THE THERAPEUTIC ACTION THAT WILL FOLLOW
THE MIDDLE GAME
“OPTIMALLY STRESSFUL” INTERVENTIONS
THAT ALTERNATELY CHALLENGE AND THEN SUPPORT THE DEFENSE
IN ORDER TO CREATE
GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
THE END GAME
“NO STRESS” INTERVENTIONS
THAT CELEBRATE AND APPLAUD “ADAPTIVE RESOLUTION”
– EVEN IF ONLY TEMPORARY AND / OR MAKESHIFT –
BECAUSE THE SEQUENCE WILL PROBABLY NEED
TO BE REPEATED AGAIN AND AGAIN
UNTIL THE PROBLEMATIC ISSUE HAS BEEN
MORE THOROUGHLY PROCESSED, INTEGRATED, AND ADAPTED TO
21. THE WORKING THROUGH PROCESS
– THE MIDDLE GAME –
WITH THE STAGE HAVING BEEN ALREADY SET DURING THE BEGINNING GAME
AND AGAINST THE BACKDROP OF EMPATHIC RESONANCE BETWEEN PATIENT AND THERAPIST
THE THERAPIST WILL REPEATEDLY OFFER THE PATIENT
OPTIMALLY STRESSFUL INTERVENTIONS
– JUST THE RIGHT COMBINATION OF CHALLENGE AND SUPPORT –
STRATEGICALLY DESIGNED TO GENERATE
DESTABILIZING INTERNAL DISSONANCE
AND HOMEOSTATIC IMBALANCE
ACCOMPLISHED BY JUXTAPOSING
ANXIETY – PROVOKING CHALLENGE OF THE DEFENSE
WITH ANXIETY – ASSUAGING SUPPORT OF IT
THEREBY CREATING GROWTH – INCENTIVIZING
“MISMATCH EXPERIENCES”
THE ONGOING WORKING THROUGH OF WHICH
– IN ORDER TO RESOLVE THE INTERNAL TENSION
AND RESTORE THE HOMEOSTATIC BALANCE –
WILL INCREMENTALLY ADVANCE THE PATIENT
TO EVER – HIGHER AND EVER – MORE EVOLVED LEVELS
OF RESILIENCE AND ADAPTIVE CAPACITY
21
22. STRATEGIC LEVERAGING OF THE PATIENT’S ANXIETY
ALTERNATELY INCREASING IT BY CHALLENGING THE DEFENSE
AND THEN DECREASING IT BY SUPPORTING (JOINING) THE DEFENSE
TO GENERATE GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
24. THE WORKING THROUGH PROCES IS NEVER ABOUT A SIMPLE
STRAIGHT – LINE PROGRESSION FROM DEFENSE TO ADAPTATION
– FROM LESS EVOLVED TO MORE EVOLVED –
RATHER, WORKING THROUGH IS ABOUT THE EMERGENCE OF
ITERATIVE HEALING CYCLES OF DESTABILIZATION AND RESTABILIZATION
AT EVER – MORE EVOLVED LEVELS OF
RESILIENCE, COMPLEXITY, AND ADAPTIVE CAPACITY
27. NUANCED PHRASEOLOGY
“YOU FIND YOURSELF”
WHEN THE PATIENT IS
HAVING AN “ANXIETY – PROVOKING” FEELING
BUT HAVING TROUBLE “ACKNOWLEDGING” IT
“YOU FIND YOURSELF FEELING PRETTY ANGRY RIGHT NOW.”
INSTEAD OF
“YOU ARE FEELING PRETTY ANGRY RIGHT NOW.”
THE THERAPIST IS INDIRECTLY
LETTING THE PATIENT “OFF THE HOOK” A BIT
BY INTIMATING THAT THE PATIENT’S ANGER
MIGHT WELL BE SOMETHING THAT HAS
COME UPON HER (AS IF TAKEN HER BY SURPRISE)
AND, THEREFORE, SOMETHING FOR WHICH
SHE IS NOT ENTIRELY RESPONSIBLE
PARADOXICALLY
THE PATIENT MIGHT WELL THEN
BE MORE EASILY ABLE TO “ACKNOWLEDGE”
THE “ANXIETY – PROVOKING” FEELING
27
28. NUANCED PHRASEOLOGY
“YOU WOULD PROBABLY RATHER NOT”
WHEN THE THERAPIST SAYS
SHE KNOWS THAT THE PATIENT
“WOULD PROBABLY RATHER NOT”
BE FEELING WHAT SHE IS FEELING,
THE THERAPIST, HERE TOO, IS INDIRECTLY
LETTING THE PATIENT “OFF THE HOOK” A BIT
THEREBY PERHAPS MAKING IT
A LITTLE EASIER FOR THE PATIENT
THEN TO “ACKNOWLEDGE”
THE “ANXIETY – PROVOKING” FEELING
“YOU WOULD PROBABLY RATHER NOT
BE FEELING ANGRY
BUT, EVEN SO, FIND YOURSELF
FEELING PRETTY ANGRY RIGHT NOW.”
INSTEAD OF
“YOU ARE FEELING
PRETTY ANGRY RIGHT NOW.”
28
29. NUANCED PHRASEOLOGY
“I AM REALIZING”
INSTEAD OF
“I REALIZE”
“I AM REALIZING”
IS MORE “DYNAMIC”
AND SUGGESTS
AN “ONGOING PROCESS”
OF “EVOLVING AWARENESS”
“I REALIZE”
IS MORE “STATIC”
29
30. NUANCED PHRASEOLOGY
“FOR NOW” / “AT THIS POINT IN TIME”
“RIGHT NOW” / “AT THIS MOMENT”
HERE THE THERAPIST IS USING
A LITTLE BIT OF
“SUBLIMINAL STIMULATION”
TO HIGHLIGHT THE FACT THAT PERHAPS,
AT SOME LATER POINT IN TIME,
THE PATIENT MIGHT WELL BE ABLE
TO TAKE HEALTHIER (MORE ADAPTIVE) ACTION
INSTEAD OF REMAINING (DEFENSIVELY) STUCK
“EVEN THOUGH YOU STOPPED LOVING
YOUR WIFE YEARS AGO,
AT THIS POINT IN TIME
YOU CAN’T IMAGINE EVER LEAVING HER.”
INSTEAD OF
“EVEN THOUGH YOU STOPPED LOVING
YOUR WIFE YEARS AGO,
YOU CAN’T IMAGINE EVER LEAVING HER.”
30
31. NUANCED PHRASEOLOGY
“EVERY NOW AND THEN” / “SOMETIMES”
“PERHAPS” / “ON SOME LEVEL” / “A LITTLE”
“MAYBE” / “POSSIBLY” / “AT TIMES”
“A PART OF YOU” / “SOME PART OF YOU”
THE THERAPIST CAN USE “QUALIFIERS”
TO “LIMIT” THE “INTENSITY” OF SOMETHING
THAT IS “ANXIETY – PROVOKING,”
THEREBY “PERHAPS” MAKING IT EASIER
FOR THE PATIENT THEN TO “ACKNOWLEDGE” IT
“SOMETIMES YOU FIND YOURSELF FEELING A LITTLE ANGRY.”
INSTEAD OF “YOU ARE FEELING ANGRY.”
“A PART OF YOU IS ENRAGED.”
INSTEAD OF “YOU ARE ENRAGED.”
“EVERY NOW AND THEN PERHAPS
YOU FIND YOURSELF FEELING A LITTLE ANGRY.”
INSTEAD OF “YOU ARE FEELING ANGRY.”
31
32. NUANCED PHRASEOLOGY
“I SEE” INSTEAD OF “I HEAR”
THE THERAPIST MAKES EXPLICIT THAT
SHE IS A WITNESS TO WHAT THE PATIENT IS FEELING
“I SEE HOW MUCH PAIN YOU ARE IN.”
“I SEE HOW DESPERATELY YOU WANT TO GET BETTER.”
NOTE THE SUBTLE DISTINCTION BETWEEN
“I SEE HOW LONELY YOU ARE FEELING.”
AND “I HEAR HOW LONELY YOU ARE FEELING.”
“I SEE HOW SAD YOU BECOME WHEN YOU TALK ABOUT
YOUR MOTHER AND HOW SHE NEVER UNDERSTOOD.”
AND “I HEAR HOW SAD YOU BECOME WHEN YOU TALK ABOUT
YOUR MOTHER AND HOW SHE NEVER UNDERSTOOD.”
IT FEELS GREAT TO BE ABLE TO KNOW
THAT HOW LONELY AND SAD YOU ARE IS BEING “HEARD”
BUT SOMETIMES IT IS EVEN MORE VALIDATING
AND REASSURING TO BE ABLE TO KNOW
THAT HOW LONELY AND SAD YOU ARE IS BEING “SEEN”
32
33. NUANCED PHRASEOLOGY
THE “ACT” CONCEPT OF “COGNITIVE DEFUSION” CAN BE VERY USEFUL
ONE OF THE GOALS OF WHICH IS TO CHANGE THE WAY
THE PATIENT RELATES TO HER THOUGHTS
– THAT IS, HOW SHE POSITIONS HERSELF IN RELATION TO THEM –
COGNITIVE DEFUSION PROMOTES “NOTICING” THE THOUGHT
RATHER THAN “GETTING CAUGHT UP IN” OR “BUYING INTO” THE THOUGHT
– LETTING THOUGHTS COME AND GO RATHER THAN HOLDING ONTO THEM –
DEFUSION INVITES THE PATIENT TO “THINK ABOUT THINKING”
AND TO REALIZE THAT SHE IS
CONTINUOUSLY “VERBALLY CONSTRUCTING” HER WORLD
IT IS ABOUT NOT CHANGING THE THOUGHT BUT RELATING DIFFERENTLY TO IT
“YOU ARE HAVING THE THOUGHT THAT YOU ARE BROKEN.”
“YOU ARE NOTICING THAT YOU ARE HAVING THE THOUGHT
THAT YOU ARE BROKEN.”
“YOU FIND YOURSELF THINKING THAT YOU ARE BROKEN.”
ALL OF WHICH ARE DESIGNED TO ENCOURAGE DEVELOPMENT
OF THE PATIENT’S “REFLECTING SELF” OR “OBSERVING EGO”
33
34. MORE SPECIFICALLY
“DUAL AWARENESS” IS BEING FOSTERED
WHEN THE PATIENT IS BEING ASKED
TO DIRECT HER ATTENTION
TO WHAT SHE IS EXPERIENCING IN THE MOMENT
AT THE SAME TIME THAT SHE IS BEING ENCOURAGED
TO STEP BACK FROM THAT EXPERIENCE
IN ORDER TO DETACH HERSELF FROM IT,
RECOVER PERSPECTIVE, AND REFLECT UPON IT
IN THE PSYCHOANALYTIC LITERATURE
THIS DISTINCTION
BETWEEN “EXPERIENCING” SOMETHING AND “OBSERVING” IT
IS DESCRIBED AS A “SPLIT IN THE EGO”
BETWEEN THE EXPERIENCING
– OR PARTICIPATING –
EGO
AND THE OBSERVING
– OR REFLECTING –
EGO
RICHARD STERBA (1934) / LESTON HAVENS (1976)
“DUAL AWARENESS” IS ONE OF THE GOALS OF ANY TREATMENT
34
35. NUANCED PHRASEOLOGY
AS WE SHALL LATER SEE
RELEVANT FOR OPTIMALLY STRESSFUL INTERVENTIONS
DESIGNED TO “PROMOTE AWARENESS”
ARE THE IMPACTFUL WORDS “YOU KNOW THAT … ”
WHICH HIGHLIGHT “ANXIETY – PROVOKING REALITIES”
THAT THE PATIENT REALLY DOES KNOW
– EVEN IF SHE WOULD RATHER NOT –
“YOU KNOW THAT I DON’T ANSWER THOSE KINDS OF QUESTIONS,
BUT YOU FIND YOURSELF WISHING THAT I DID.”
INSTEAD OF
“I DON’T ANSWER THOSE KINDS OF QUESTIONS … ”
“YOU KNOW THAT YOU COULD ASK YOUR NEIGHBOR
TO KEEP HIS BARKING DOG INSIDE,
BUT YOU FIND YOURSELF HESITATING FOR FEAR OF GETTING HIM ANGRY.”
INSTEAD OF
“YOU COULD ASK YOUR NEIGHBOR TO KEEP HIS BARKING DOG INSIDE … ”
YOU ARE NOT TELLING THE PATIENT WHAT “YOU” KNOW
RATHER, YOU ARE INSISTING THAT THE PATIENT
“TAKE OWNERSHIP” OF WHAT “SHE” KNOWS!
– EVEN IF IT MAKES HER ANXIOUS –
35
36. NUANCED PHRASEOLOGY
ALSO AS WE SHALL LATER SEE
RELEVANT FOR OPTIMALLY STRESSFUL INTERVENTIONS
DESIGNED TO FACILITATE THE “GRIEVING OF DISILLUSIONMENT”
ARE THE IMPACTFUL WORDS “YOU HAD HOPED THAT … ”
STRATEGIC USE OF THE “PAST PERFECT (PLUPERFECT) TENSE”
HIGHLIGHTS THE REALITY THAT SOMETHING THE PATIENT
“HAD BEEN HOPING FOR” IS BECOMING NO LONGER A VIABLE OPTION
“YOU HAD HOPED THAT I WOULD TELL YOU WHAT YOU SHOULD DO
BUT YOU ARE BEGINNING TO REALIZE
THAT I DON’T SIMPLY OFFER ADVICE
AND THAT ANGERS AND UPSETS YOU TERRIBLY.”
“YOU HAD HOPED THAT YOUR MOTHER MIGHT SOMEDAY APOLOGIZE
BUT YOU ARE BEGINNING TO REALIZE
THAT PROBABLY SHE NEVER WILL
AND THAT BREAKS YOUR HEART.”
“YOU HAD HOPED THAT YOUR HUSBAND WOULD ASK YOU
HOW YOUR DAY HAD GONE
BUT YOU ARE STARTING TO REALIZE THAT HE NEVER DOES ASK
AND PROBABLY NEVER WILL
AND THAT REALIZATION IS ABSOLUTELY DEVASTATING.”
THESE KINDS OF STATEMENTS ARE DESIGNED TO HELP THE PATIENT
ADVANCE ULTIMATELY FROM “RELENTLESS HOPE” TO “ACCEPTANCE”
36
39. MINIMALLY STRESSFUL INTERVENTIONS
ARE DESIGNED TO ELICIT “LITTLE OR NO” ANXIETY
NOT ONLY DO THEY SUPPORT THE PATIENT
BUT THEY ALSO ADVANCE THE BALL A BIT
BY GENTLY TEASING OUT AND BRINGING INTO FOCUS
SOME OF THE “DEFENSIVE” AND “LESS – THAN – HEALTHY”
RECURRING THEMES, HABITUAL PATTERNS,
AND CONDITIONED REPETITIONS
IN THE PATIENT’S LIFE
INTEGRATION STATEMENTS
2 “PARTS” – BOTH / AND STATEMENTS
PATH – OF – LEAST – RESISTANCE STATEMENTS
DAMAGED – FOR – LIFE STATEMENTS
COMPENSATION STATEMENTS
ENTITLEMENT STATEMENTS
MASOCHISM STATEMENTS
SADISM STATEMENTS
PARADOXICAL INTERVENTIONS
YOU – WOULD – WISH STATEMENTS
EMPATHIC STATEMENTS
39
40. IN OTHER WORDS
MINIMALLY STRESSFUL
“CLARIFYING” INTERVENTIONS
SUPPORT BY SPOTLIGHTING
– ALWAYS WITH COMPASSION AND NEVER WITH JUDGMENT –
SOME OF THE
“PAINFUL AND DIFFICULT TRUTHS”
IN THE PATIENT’S LIFE
“JOINING THROUGH THE TRUTH”
TERRY REAL (2020)
40
41. MINIMALLY STRESSFUL INTERVENTIONS
INTEGRATION STATEMENTS
FOR THOSE PATIENTS WHO ARE HAVING TROUBLE
HOLDING IN MIND SIMULTANEOUSLY BOTH
THE “GOOD” AND THE “BAD” ASPECTS OF THEIR EXPERIENCE
IN OTHER WORDS
PATIENTS WITH TENUOUSLY ESTABLISHED
“LIBIDINAL OBJECT CONSTANCY” / “EVOCATIVE MEMORY CAPACITY”
“HARD TO REMEMBER” / “HARD TO IMAGINE”
“WHEN YOU’RE FEELING THIS BAD,
IT’S HARD TO REMEMBER THAT YOU HAD EVER FELT GOOD
AND IT’S HARD TO IMAGINE THAT YOU COULD EVER FEEL GOOD AGAIN.”
“WHEN YOUR HEART IS BREAKING AS IT IS NOW,
YOU CAN’T IMAGINE THAT YOU COULD EVER DARE TO TRUST AGAIN.”
“WHEN YOU’RE FEELING THIS ANGRY AT ME,
IT’S HARD TO REMEMBER THAT YOU USED TO FEEL GOOD ABOUT ME
AND EVEN LOOKED FORWARD TO OUR SESSIONS.”
“WHEN YOU FEEL THIS DESPAIRING,
YOU CAN’T REMEMBER EVER HAVING HAD ANY HOPE WHATSOEVER.”
41
42. MINIMALLY STRESSFUL INTERVENTIONS
2 “PARTS” – BOTH / AND STATEMENTS
FOR THOSE PATIENTS WHO ARE ABLE TO HOLD IN MIND
BOTH THE “GOOD” AND THE “BAD” ASPECTS OF THEIR EXPERIENCE
BUT ARE “AMBIVALENT” / “CONFLICTED” ABOUT SOMEONE OR SOMETHING
AND ARE STRUGGLING EITHER TO MAKE A DECISION
OR TO COME TO TERMS WITH SIMPLY “BEING AMBIVALENT”
IN OTHER WORDS
PATIENTS WHO ARE FEELING “TWO WAYS” ABOUT AN ISSUE
– WHEN BOTH “SIDES” ARE “REASONABLE ENOUGH OPTIONS” –
“A PART OF YOU” / “ANOTHER PART OF YOU”
“A PART OF YOU THINKS ALL THE TIME ABOUT STOPPING THE AFFAIR,
BUT ANOTHER PART OF YOU IS STILL ENJOYING EVERY MINUTE OF IT.”
“A PART OF YOU IS PROFOUNDLY DISAPPOINTED, HURT, AND ANGRY
AT YOUR HUSBAND, BUT ANOTHER PART OF YOU DOES KNOW
THAT HE IS A MAN WHOM YOU DEEPLY CHERISH, ADORE, AND LOVE.”
“A PART OF YOU IS TEMPTED TO STOP TREATMENT BECAUSE
IT COSTS SO MUCH, BUT ANOTHER PART OF YOU KNOWS THAT
YOUR THERAPY HAS BEEN VERY HELPFUL AND THAT YOU MIGHT
BE MAKING A HUGE MISTAKE WERE YOU SIMPLY TO QUIT RIGHT NOW.”
“A PART OF YOU REMAINS HURT, DISAPPOINTED, AND UNFORGIVING,
BUT ANOTHER PART OF YOU IS WANTING TO FIND A WAY TO FORGIVE ME.”
42
43. MINIMALLY STRESSFUL INTERVENTIONS
PATH – OF – LEAST – RESISTANCE STATEMENTS
FOR THOSE PATIENTS WHO ARE
“REACTING DEFENSIVELY”
RATHER THAN
“RESPONDING ADAPTIVELY”
EASIER TO “REACT DEFENSIVELY”
THAN TO “RESPOND ADAPTIVELY”
“IT’S EASIER TO GIVE UP
THAN TO KEEP FIGHTING FOR WHAT YOU REALLY BELIEVE IN.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS DISEMPOWERED
THAN TO TAKE OWNERSHIP OF THE POWER
AND AGENCY THAT YOU ACTUALLY DO HAVE.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS HAVING NO ACCOUNTABILITY
THAN TO TAKE RESPONSIBILITY FOR YOUR LIFE.”
“IT’S EASIER TO HOLD ON TO THE HOPE
THAT YOUR HUSBAND MIGHT SOMEDAY CHANGE
THAN TO CONFRONT THE REALITY THAT HE PROBABLY NEVER WILL.”
43
44. THE “I CAN’T, YOU CAN, AND YOU SHOULD” DYNAMIC
FOR THOSE PATIENTS WHO EXPERIENCE THEMSELVES AS
SO “DAMAGED” FROM WAY BACK THAT THEY CAN’T
IMAGINE BEING HELD ACCOUNTABLE FOR THEIR LIVES NOW
DAMAGED – FOR – LIFE – AND – THEREFORE
– NOT – RESPONSIBLE – NOW STATEMENTS
WHO FIND THEMSELVES THEREFORE LOOKING TO OTHERS
TO “COMPENSATE” THEM FOR THE EARLY – ON “DAMAGE”
COMPENSATION STATEMENTS
AND WHO
– QUITE FRANKLY –
FEEL THAT THIS “COMPENSATION” IS THEIR DUE
ENTITLEMENT STATEMENTS
DISTORTION – DISTORTED SENSE OF SELF AS “NOT HAVING”
ILLUSION – ILLUSORY SENSE OF OBJECT AS “HAVING”
ENTITLEMENT – ENTITLED SENSE THAT “GETTING” IS THEIR “RIGHT”
ALL OF WHICH ARE DEFENSIVE REACTIONS
44
45. MINIMALLY STRESSFUL INTERVENTIONS
DAMAGED – FOR – LIFE – AND – THEREFORE
– NOT – RESPONSIBLE – NOW STATEMENTS
“YOU FEEL SO DAMAGED BECAUSE OF ALL
THE ABUSE YOU SUFFERED AS A CHILD THAT
YOU CANNOT IMAGINE EVER BEING ABLE TO DO
ANYTHING NOW TO MAKE YOUR LIFE BETTER.”
COMPENSATION STATEMENTS
“WHEN YOU ARE FEELING DESPERATE, AS YOU
ARE RIGHT NOW, YOU FIND YOURSELF WISHING THAT
SOMEONE WOULD UNDERSTAND JUST HOW BAD YOU FEEL
AND WOULD DO SOMETHING TO HELP EASE YOUR PAIN.”
ENTITLEMENT STATEMENTS
“BECAUSE YOU FEEL THAT WHAT YOUR FATHER DID TO YOU
WAS SO UNFAIR, DEEP DOWN YOU HARBOR
THE CONVICTION THAT THE WORLD NOW OWES YOU.”
“BECAUSE YOUR MOTHER NEVER UNDERSTOOD YOU AND
LEFT YOU SO MUCH ON YOUR OWN, YOU’RE NOW FEELING
THAT UNLESS SOMEONE IS WILLING TO GO MORE THAN
HALFWAY, THEN YOU’RE SIMPLY NOT INTERESTED.”
45
46. MINIMALLY STRESSFUL INTERVENTIONS
MASOCHISM STATEMENTS
FOR THOSE PATIENTS WHO
– BECAUSE IT SIMPLY “HURTS TOO MUCH” –
REFUSE TO “CONFRONT” – AND “GRIEVE” – THE REALITY
THAT THE OBJECT OF THEIR DESIRE WILL NEVER CHANGE
INSTEAD, THEY HOLD ON TO THEIR
DEFENSIVE – AND RELENTLESS – “HOPING AGAINST HOPE”
“BECAUSE IT IS SO PAINFUL EVEN TO THINK ABOUT CONFRONTING
THE TRUTH ABOUT YOUR HUSBAND AND HIS ONGOING INSENSITIVITY
TO YOU AND YOUR FEELINGS, YOU FIND YOURSELF CONTINUING
TO HOPE THAT PERHAPS, IF YOU TRY HARD ENOUGH, ARE PERSUASIVE
ENOUGH, PERSIST LONG ENOUGH, AND SUFFER DEEPLY ENOUGH,
THEN YOU MIGHT YET BE ABLE TO COMPEL HIM TO CHANGE.”
“BECAUSE IT HURTS TOO MUCH TO CONFRONT THE REALITY THAT
YOUR FATHER WILL NEVER BE WILLING TO APOLOGIZE FOR ALL THAT
HE DID TO YOU WHEN YOU WERE GROWING UP, YOU KEEP HOPING
THAT IF YOU TRY HARD ENOUGH, PERSIST LONG ENOUGH, AND
SUFFER DEEPLY ENOUGH, THEN HE MIGHT YET RELENT AND BE WILLING
TO ACKNOWLEDGE THAT HE KNOWS HE CAUSED YOU TERRIBLE
HEARTBREAK DURING ALL THOSE YEARS OF HIS DRINKING.”
46
47. MINIMALLY STRESSFUL INTERVENTIONS
SADISM STATEMENTS
FOR THOSE PATIENTS WHO
– IN THOSE MOMENTS OF DAWNING RECOGNTION THAT WHAT THEY
HAD SO DESPERATELY WANTED AND FELT THEY NEEDED TO HAVE
IN ORDER TO SURVIVE IS SIMPLY NOT GOING TO HAPPEN –
ARE DEFENSIVELY PRONE TO EXPERIENCING THEMSELVES
AS HAVING BEEN “MISTREATED” AND / OR “VICTIMIZED”
THEY WILL OFTEN THEN FIND THEMSELVES FEELING THAT THEY
EITHER HAVE NO CHOICE BUT TO RETALIATE
OR ARE ENTITLED TO RETALIATE
“WHEN YOU FEEL THAT YOU HAVE BEEN WRONGED,
YOU CAN GET PRETTY UGLY IF YOU HAVE TO!”
“WHEN YOU FEEL THAT YOU ARE BEING MISTREATED,
IT MAKES YOU SO ENRAGED THAT YOU FEEL
YOU HAVE NO CHOICE BUT TO LASH BACK.”
“WHEN YOUR MOTHER IS DOING HER ‘USUAL,’
IT HURTS SO MUCH TO BE FEELING SO MISUNDERSTOOD
THAT YOU FIND YOURSELF THINKING ABOUT
WHAT YOU CAN DO TO HURT HER BACK.
SHE SHOULD HAVE TO GET A TASTE OF HER OWN MEDICINE.”
47
48. MINIMALLY STRESSFUL INTERVENTIONS
PARADOXICAL INTERVENTIONS
FOR THOSE PATIENTS WHO ARE DEEPLY ENTRENCHED
IN MAINTAINING “SAME OLD, SAME OLD”
ALTHOUGH THE PATIENT HAS BEEN GIVING “LIP SERVICE” TO WANTING
TO CHANGE, IT IS CLEAR FROM WHAT THE PATIENT IS ACTUALLY DOING
THAT THE PATIENT IS NOT, IN FACT, PREPARED TO CHANGE
THE THERAPIST THEREFORE “LETS GO” OF HER OWN “NEED”
FOR THE PATIENT TO CHANGE AND “ACCEPTS” THE REALITY THAT
THE PATIENT IS NOT PREPARED TO CHANGE – AT LEAST “NOT FOR NOW”
IN ESSENCE, THE THERAPIST “GOES WITH THE RESISTANCE” BY
“PRESCRIBING THE SYMPTOM”
“I THINK I AM BEGINNING TO SEE WHY YOU FEEL THAT YOU
CANNOT AFFORD TO TRUST ANYONE. BASED UPON WHAT YOU
HAVE BEEN TELLING ME ABOUT THE NUMBERS OF TIMES
YOUR TRUST HAS BEEN BETRAYED AND YOUR HEART BROKEN
IN THE PAST, I CAN NOW UNDERSTAND WHY YOU FEEL THAT YOU
SIMPLY MIGHT NEVER WANT TO OPEN YOUR HEART AGAIN. ALTHOUGH
IT MIGHT MEAN BEING ALONE FOREVER, AT LEAST YOU WILL
KNOW THAT NO ONE WILL BE ABLE TO HURT YOU EVER AGAIN.”
48
49. MINIMALLY STRESSFUL INTERVENTIONS
PARADOXICAL INTERVENTIONS
IN ESSENCE, THE THERAPIST USES HER “EMPATHIC UNDERSTANDING”
OF THE PATIENT TO OFFER HER A PARADOX
TO THE PATIENT WHO, EVEN AFTER A YEAR, HAS NOT BEEN ABLE TO MOBILIZE
HIMSELF TO UPDATE HIS RESUME – DESPITE HIS PROCLAIMED INTENTION TO DO SO
“YES, EVERY SINGLE DAY YOU DREAD GOING TO WORK, YOU HATE YOUR
BOSS, AND YOUR JOB IS INCREDIBLY TEDIOUS. BUT, AS YOU HAVE SAID
REPEATEDLY, IT DOES PROVIDE YOU WITH FINANCIAL SECURITY AND A SENSE
OF BELONGING. SO I THINK I AM BEGINNING TO APPRECIATE THAT,
AT THIS POINT IN YOUR LIFE, PERHAPS IT DOES NOT REALLY MAKE SENSE
FOR YOU TO BE MOVING FORWARD WITH APPLYING FOR A NEW JOB.
PERHAPS AT SOME POINT IN THE FUTURE, BUT NOT RIGHT NOW.”
TO A DESPERATELY UNHAPPY 45 – YEAR – OLD MAN MARRIED FOR 20 YEARS
“YOU HATE IT THAT YOUR WIFE ABUSES YOU IN ALL THE
WAYS THAT SHE DOES. AND YOU STOPPED LOVING HER YEARS AGO.
BUT, AS YOU HAVE OFTEN EXPLAINED, WHEN YOU START
TO THINK ABOUT HOW OLD AND TIRED YOU FEEL, YOU FIND YOURSELF
THINKING THAT PERHAPS IT IS SIMPLY TOO LATE – THAT THE TIME
TO HAVE LEFT HER MIGHT ALREADY HAVE COME AND GONE. UNDERSTOOD.”
IF THE PATIENT IS MADE ANGRY BY THE THERAPIST’S PARADOXICAL INTERVENTIONS,
THEN THE PATIENT’S ANGER MIGHT WELL EMPOWER HER –
MIGHT WELL PROVIDE THE NECESSARY MOTIVATION (OR IMPETUS)
FOR HER TO TAKE ACTION – IF ONLY TO PROVE THE THERAPIST WRONG!
49
50. MINIMALLY STRESSFUL INTERVENTIONS
YOU – WOULD – WANT / YOU – WOULD – WISH STATEMENTS
HERE THE THERAPIST IS GIVING THE PATIENT THE “BENEFIT OF THE DOUBT”
USING A LITTLE BIT OF “SUBLIMINAL STIMULATION”
TO HIGHLIGHT THE FACT THAT THE THERAPIST THINKS THERE IS INDEED
A HEALTHY PART OF THE PATIENT THAT “WOULD WANT” TO BE ABLE
TO DO A BETTER JOB OF MANAGING THINGS IN HER LIFE
INSTEAD OF ALWAYS SABOTAGING HERSELF
ADMITTEDLY, THE THERAPIST IS “LEADING THE WITNESS” A BIT
BY “PUTTNG HEALTHY WORDS IN THE PATIENT’S MOUTH”
BUT IT IS ALL BEING DONE WITH AN EYE
TO HELPING THE PATIENT ACCESS HER “LEADING EDGE”
“YOU WOULD WANT TO BE ABLE TO FORGIVE YOUR HUSBAND
BUT ARE JUST NOT QUITE YET PREPARED TO DO THAT.”
“YOU WOULD WANT TO BE ABLE TO GET YOUR TAXES DONE
BUT FIND YOURSELF FIGHTING IT EVERY STEP OF THE WAY.”
“YOU WOULD WANT TO BE ABLE TO HAVE A RICHER, MORE FULFILLING LIFE
BUT HOLD BACK FROM VENTURING OUT
FOR FEAR OF BEING TERRIBLY DISAPPOINTED.”
“YOU WOULD WISH THAT YOU COULD BE MORE ON TOP OF YOUR GAME
BUT FIND YOURSELF CONTINUALLY FEELING OVERWHELMED
AND LOSING YOUR WAY.”
50
51. MINIMALLY STRESSFUL INTERVENTIONS
EMPATHIC STATEMENTS
ARE ALSO DESIGNED TO ELICIT “LITTLE OR NO” ANXIETY
BUT THEY ARE IN A CLASS OF THEIR OWN
THEY ARE MY “DEFAULT MODE” AND WHERE I SPEND MUCH OF MY TIME
THEY “TEASE OUT” AND “BRING INTO FOCUS”
– MOMENT – TO – MOMENT –
BOTH THE PATIENT’S “AFFECT”
AND THE “NARRATIVE”
WITH WHICH THAT AFFECT IS ASSOCIATED
FORMULATING THESE EMPATHIC STATEMENTS
REQUIRES OF THE THERAPIST THAT SHE BE
“ATTENTIVELY LISTENING” AND “EMPATHICALLY ATTUNED”
TO WHATEVER THE PATIENT IS “EXPERIENCING” IN THE MOMENT
THE THERAPIST’S STANCE HERE IS PROBABLY BEST DESCRIBED
AS ONE OF HAVING AN “AGENDALESS PRESENCE”
– IN THE WORDS OF DANIEL GOLEMAN (2007) –
AND OF BEING A “MINDFUL WITNESS”
– IN THE WORDS OF TARA BRACH (2004) –
THESE EMPATHIC STATEMENTS REASSURE THE PATIENT
THAT SHE IS BEING UNDERSTOOD AND THAT SHE IS NOT ALONE
51
52. EMPATHIC STATEMENTS
“EXPERIENCE – NEAR” NOT “EXPERIENCE – DISTANT”
WHAT’S IN THE PATIENT’S CONSCIOUSNESS NOT HER UNCONSCIOUS
THE GOAL OF THESE STATEMENTS IS
TO HELP THE PATIENT “FEEL UNDERSTOOD”
NOT TO HELP THE PATIENT “UNDERSTAND”
BUT THESE STATEMENTS
WILL START TO GIVE SHAPE
TO THE “FILTERS” THROUGH WHICH
THE PATIENT IS INTERPRETING HER WORLD
“OLD BAD” DISEMPOWERING NARRATIVES THAT WILL ULTIMATELY
NEED TO BE UPDATED TO “NEW GOOD” EMPOWERING NARRATIVES
“IT’S HARD TO KNOW WHERE TO BEGIN
WHEN EVERYTHING FEELS SO OVERWHELMING.”
“IT’S UNCOMFORTABLE TO BE HERE WHEN YOU’RE NOT SURE
THE THERAPY IS REALLY HELPING ANYWAY.”
“YOU’RE TERRIFIED OF BEING DISAPPOINTED AGAIN.”
“IT’S UPSETTING TO BE FEELING THIS OUT OF CONTROL.”
“YOU’RE CONFUSED ABOUT HOW BEST TO USE YOUR SESSION.”
52
53. I TAKE MY CUES FROM THE PATIENT
AND AM THEREFORE GENERALLY ONE STEP BEHIND HER – NOT AHEAD
LISTENING ALWAYS WITH COMPASSION AND NEVER JUDGMENT
– WITH BOTH “HEAD” AND “HEART” –
TO EVERYTHING THE PATIENT IS TELLING ME
– NO MATTER HOW SEEMINGLY IRRELEVANT IT MIGHT APPEAR TO BE –
– NO DETAIL TOO TRIVIAL TO BE IGNORED OR FORGOTTEN –
I WILL THEN OFFER THESE EMPATHIC STATEMENTS
THAT HIGHLIGHT
“WHAT THE PATIENT IS ACTUALLY FEELING RIGHT THEN”
AND “ABOUT WHAT”
STATEMENTS THAT OFTEN END WITH AN IMPLIED QUESTION MARK
WHEREBY I AM SIGNALING THAT I AM VERY OPEN TO HAVING
MY RENDERING OF THINGS EDITED, CORRECTED, OR REVISED
IN ORDER TO MAKE IT A MORE ACCURATE REFLECTION OF WHAT
THE PATIENT IS ACTUALLY SAYING AND WANTING ME TO KNOW
THE “AFFECT” DOES NOT NEED TO BE A “BIG DRAMATIC EMOTION” LIKE
ANGER / OUTRAGE – FEAR / PANIC / DESPERATION
SADNESS / DESPAIR – DISGUST / HORROR – SHAME / GUILT / REGRET
IT CAN BE SOMETHING “MORE UNDERSTATED” LIKE
CONFUSED / NOT KNOWING FOR SURE / LOST – UPSET / CONCERNED / WORRIED
UNCOMFORTABLE / WEARY / BURDENED – DISAPPOINTED / FRUSTRATED
WOULD RATHER NOT / WOULD WISH
53
54. WITH RESPECT TO THE “FRAMING” OF AN EMPATHIC STATEMENT
PLEASE NOTE THAT INSTEAD OF
“I WONDER IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT SOUNDS AS IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT SEEMS AS IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT MUST BE PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
YOU COULD SIMPLY SAY
“IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
FOLLOWED BY THE IMPLIED QUESTION MARK
AGAIN, THEREBY SIGNALING THAT YOU ARE VERY OPEN
TO HAVING YOUR STATEMENT AMENDED
I DO MY BEST TO ELIMINATE EXTRA WORDS AT THE BEGINNING
OF THE STATEMENT SO THAT I CAN CUT RIGHT TO THE CHASE
“IT BREAKS YOUR HEART THAT SHE DOESN’T SEEM TO CARE.”
EXTRA WORDS RUN THE RISK OF PUTTING TOO MUCH DISTANCE
BETWEEN THE PATIENT AND THE THERAPIST
54
55. OPTIMALLY
STRESSFUL
INTERVENTIONS
– THE MIDDLE GAME –
ALTERNATELY AND REPEATEDLY
“BE WITH THE PATIENT WHERE SHE IS”
– “HOMEOSTATIC ATTUNEMENT” –
“DIRECT HER ATTENTION TO
WHERE YOU WOULD WANT HER TO GO”
– “DISRUPTIVE ATTUNEMENT” –
SALMAN AKHTAR (2012)
55
56. OPTIMALLY STRESSFUL INTERVENTIONS
ARE DESIGNED TO GENERATE
“DESTABILIZING STRESS”
BY JUXTAPOSING
– WHETHER DIRECTLY OR INDIRECTLY AND WHETHER EXPLICITLY OR IMPLICITLY –
ANXIETY – PROVOKING CHALLENGE OF THE DEFENSE
WITH ANXIETY – ASSUAGING SUPPORT OF THE DEFENSE
TO CREATE GROWTH – INCENTIVIZING
“MISMATCH EXPERIENCES”
MODEL 1 CONFLICT STATEMENTS
– CLASSICAL PSYCHOANALYTIC –
MODEL 2 DISILLUSIONMENT STATEMENTS
– SELF PSYCHOLOGICAL –
MODEL 3 ACCOUNTABILITY STATEMENTS
– CONTEMPORARY RELATIONAL –
MODEL 4 FACILITATION STATEMENTS
– EXISTENTIAL – HUMANISTIC –
56
57. MODEL 1 CONFLICT STATEMENTS (COGNITIVE)
“YOU KNOW THAT ... , BUT YOU FIND YOURSELF THINKING,
FEELING, OR DOING IN ORDER NOT TO HAVE TO ... ”
GOAL – TO FACILITATE RESOLUTION OF INTRAPSYCHIC CONFLICT
BY CREATING “INCENTIVIZING” TENSION
BETWEEN “ADAPTIVE CAPACITY” FOR “AWARENESS”
AND “DEFENSIVE NEED” TO “RESIST”
“YOU KNOW THAT YOUR MOTHER WILL NEVER APOLOGIZE,
BUT YOU FIND YOURSELF CONTINUING TO WISH THAT SHE WOULD.”
“YOU KNOW THAT IF YOU ARE EVER TO GET ON WITH YOUR LIFE,
THEN YOU WILL NEED TO LET GO OF YOUR CONVICTION THAT YOUR
CHILDHOOD SCARRED YOU FOR LIFE. BUT IT’S HARD NOT TO FEEL
LIKE DAMAGED GOODS WHEN YOU GREW UP IN A HORRIBLY ABUSIVE
HOUSEHOLD WITH A NASTY MOTHER WHO KEPT CALLING YOU A LOSER.”
“YOU KNOW THAT ULTIMATELY YOU WILL NEED TO CONFRONT AND
GRIEVE THE REALITY THAT JUAN, LIKE YOUR DAD, IS NOT AVAILABLE
IN THE WAYS THAT YOU WOULD HAVE WANTED HIM TO BE AND
THAT UNTIL YOU MAKE YOUR PEACE WITH THAT PAINFUL REALITY
YOU WILL CONTINUE TO BE MISERABLE. BUT, IN THE MOMENT, ALL YOU
CAN THINK ABOUT IS WHAT YOU CAN DO TO MAKE HIM LOVE YOU MORE.”
57
58. MODEL 1 CONFLICT STATEMENTS (COGNITIVE)
“YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA
IS TO SURVIVE, YOU’LL NEED TO TAKE AT LEAST
SOME RESPONSIBILITY FOR THE PART YOU’RE PLAYING
IN THE INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE 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!”
“YOU KNOW THAT I DON’T ANSWER THOSE KINDS OF QUESTIONS.
BUT YOU FIND YOURSELF CONTINUING TO HOPE THAT I WILL.”
“YOU KNOW THAT, ULTIMATELY, YOU’LL NEED TO LEAVE MIGUEL
BECAUSE HE KEEPS BREAKING YOUR HEART.
BUT YOUR FEAR IS THAT WERE YOU TO LET HIM GO,
YOU WOULD SIMPLY NOT SURVIVE.”
“YOU’RE COMING TO UNDERSTAND THAT YOUR ANGER CAN PUT
PEOPLE OFF. BUT YOU TELL YOURSELF THAT YOU HAVE A RIGHT
TO BE AS ANGRY AS YOU WANT BECAUSE OF HOW MUCH
YOU HAVE HAD TO SUFFER OVER THE COURSE OF THE YEARS.”
“YOU KNOW THAT SOMEDAY YOU’LL HAVE TO LET SOMEBODY
IN IF YOU’RE EVER TO HAVE A MEANINGFUL RELATIONSHIP.
BUT, AT THE MOMENT, THE THOUGHT OF MAKING YOURSELF
THAT VULNERABLE IS SIMPLY OUT OF THE QUESTION.”
58
59. MODEL 2 DISILLUSIONMENT STATEMENTS (AFFECTIVE)
“YOU HAD SO HOPED THAT … ,
BUT YOU ARE BEGINNING TO REALIZE THAT … ,
AND IT DEVASTATES / ENRAGES YOU … ”
GOAL – TO FACILITATE GRIEVING
BY CREATING “INCENTIVIZING” TENSION
BETWEEN “DEFENSIVE NEED” TO “AVOID CONFRONTING”
AND “ADAPTIVE CAPACITY” TO “CONFRONT, GRIEVE, AND ACCEPT”
FIRST “HIGHLIGHT” WHAT “HAD BEEN”
THE PATIENT’S “ILLUSION”
– “DEFENSIVE NEED” FOR “RELENTLESS HOPE” –
THEN “HIGHLIGHT” THE “REALITY”
OF THE PATIENT’S “DISILLUSIONMENT”
– “ADAPTIVE CAPACITY” TO “CONFRONT” THE “REALITY” –
AND THEN “RESONATE EMPATHICALLY”
WITH THE PAIN OF THE PATIENT’S “GRIEF”
– “ADAPTIVE CAPACITY” TO “FEEL” THE ACTUAL “HEARTBREAK” –
59
60. MODEL 2 DISILLUSIONMENT STATEMENTS (AFFECTIVE)
“YOU HAD SO HOPED THAT I WOULD TELL YOU WHAT TO DO,
BUT YOU ARE BEGINNING TO REALIZE THAT I DON’T SIMPLY
GIVE YOU ANSWERS – AND IT INFURIATES YOU.”
“YOU HAD SO HOPED THAT YOUR DAUGHTER
WOULD REACH OUT TO YOU WHEN YOU WERE SICK,
BUT YOU ARE BEGINNING TO REALIZE THAT,
FOR NOW, YOU ARE NOT A TOP PRIORITY FOR HER –
AND IT IS A DEVASTATING LOSS.”
“YOU HAD SO HOPED THAT YOUR HUSBAND WOULD ASK
YOU HOW HE COULD HELP WITH THE DINNER PREPARATIONS,
BUT YOU ARE STARTING TO APPRECIATE THAT OFFERING
TO HELP WITH HOUSEHOLD THINGS LIKE THAT IS NOT
HIS THING – AND IT UPSETS AND SADDENS YOU.”
“YOU HAD SO HOPED THAT YOUR MOTHER WOULD APOLOGIZE,
BUT YOU ARE BEGINNING TO ACCEPT THAT SHE SIMPLY
DOES NOT HOLD HERSELF ACCOUNTABLE –
WHICH IS BOTH ENRAGING AND DEVASTATING.”
60
61. MODEL 2 DISILLUSIONMENT STATEMENTS (AFFECTVE)
“YOU HAD SO HOPED THAT WE COULD HAVE A PERSONAL RELATIONSHIP;
BUT YOU ARE COMING TO REALIZE, ALBEIT RELUCTANTLY,
THAT A THERAPY RELATIONSHIP IS NOT REALLY ABOUT
FRIENDSHIP PER SE; AND THAT BREAKS YOUR HEART.”
“YOU WOULD SO HAVE WISHED THAT I COULD KNOW WHAT YOU
WERE THINKING WITHOUT YOUR HAVING TO SAY IT;
BUT YOU ARE COMING TO SEE THAT IT DOES NOT ALWAYS
WORK THAT WAY; AND THAT MAKES YOU VERY SAD.”
“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.”
61
62. MODEL 2 DISILLUSIONMENT STATEMENTS (AFFECTIVE)
“YOU KNOW THAT EVENTUALLY YOU WILL NEED TO FACE THE
REALITY THAT YOUR FATHER WILL NEVER CHANGE, AND THAT
BREAKS YOUR HEART BECAUSE YOU HAD SO HOPED THAT HE WOULD.”
“YOU ARE BEGINNING TO REALIZE THAT YOUR MOTHER WILL
NEVER UNDERSTAND JUST HOW MUCH SHE HAS HURT
YOU OVER THE COURSE OF THE YEARS, AND IT’S ABSOLUTELY
DEVASTATING BECAUSE YOU HAD SO HOPED THAT SOMEDAY
SHE MIGHT ACTUALLY COME TO UNDERSTAND – AND APOLOGIZE.”
“AS YOU BEGIN TO ADMIT TO YOURSELF THAT PROBABLY
JUANITA WILL NEVER BE RIGHT FOR YOU, IT MAKES
YOU INCREDIBLY 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 HURTS SO MUCH.
YOU HAD SO HOPED THAT YOU COULD GET HIM TO TAKE AT
LEAST SOME RESPONSIBILITY FOR HIS ABUSIVENESS.”
62
63. MODEL 3 ACCOUNTABILITY STATEMENTS (RELATIONAL)
TRANSFERENCE / COUNTERTRANSFERENCE ENTANGLEMENTS
PROJECTIVE IDENTIFICATIONS – MUTUAL ENACTMENTS
CO – CREATION OF THERAPEUTIC IMPASSES
GOAL – TO BRING THE FOCUS INTO THE HERE – AND – NOW OF
WHAT’S GETTING RE – ENACTED BY THE PATIENT IN THE TRANSFERENCE
– TO WHICH THE THERAPIST, IN HER TURN, IS
COUNTERTRANSFERENTIALLY REACTING / RESPONDING –
THE THERAPIST MAY CHOOSE TO SHARE –
SOMETHING ABOUT HER EXPERIENCE
OF BEING IN THE ROOM WITH THE PATIENT
HER OWN STATE OF INTERNAL CONFLICTEDNESS
AS A RESULT OF SOMETHING HAPPENING BETWEEN THEM
HER SENSE THAT SHE HAS BEEN MADE TO FEEL
– IN RELATION TO THE PATIENT IN THE HERE – AND – NOW –
SOME VERSION OF WHAT THE PARENT MUST HAVE FELT
IN RELATION TO THE PATIENT IN THE THERE – AND – THEN
HER SENSE THAT SHE HAS BEEN MADE TO FEEL
– IN RELATION TO THE PATIENT IN THE HERE – AND – NOW –
SOME VERSION OF WHAT THE PATIENT MUST HAVE FELT
IN RELATION TO THE PARENT IN THE THERE – AND – THEN
63
64. MODEL 3 ACCOUNTABILITY STATEMENTS
CAN BE INTRODUCED IN ANY OF THE FOLLOWING WAYS
“IT OCCURS TO ME THAT, BY WAY OF YOUR
BEHAVIOR IN HERE WITH ME, YOU ARE HELPING
ME TO UNDERSTAND SOMETHING THAT
I HAD NEVER BEFORE ENTIRELY UNDERSTOOD … ”
“I THINK THAT YOU HAVE BEEN TRYING TO
COMMUNICATE SOMETHING IMPORTANT TO ME
THAT I HAD BEEN REFUSING TO SEE … ”
“I WONDER IF MY DIFFICULTY APPRECIATING
JUST HOW DESPERATE YOU WERE MADE
YOU FEEL THAT YOU HAD TO DO SOMETHING
DRAMATIC IN ORDER TO GET MY ATTENTION … ”
64
65. AS ADDITIONAL EXAMPLES
MODEL 3 ACCOUNTABILITY STATEMENTS (RELATIONAL)
THE THERAPIST MAY CHOOSE TO SHARE SOMETHING ABOUT
HER EXPERIENCE OF BEING IN THE ROOM WITH THE PATIENT
“IT WOULD SEEM THAT I AM IN THE DOG HOUSE THESE DAYS!”
“I WONDER IF THE FRUSTRATION AND HELPLESSNESS
I AM FEELING NOW IN RELATION TO YOU IS SIMILAR
TO THE FRUSTRATION AND HELPLESSNESS THAT YOU HAVE
SPOKEN OF HAVING FELT IN RELATION TO YOUR FATHER.”
“YOU TELL ME SOMETHING ABOUT YOURSELF. I AM
JUST IN THE PROCESS OF DIGESTING IT AND STORING
IT FOR FURTHER UNDERSTANDING OF YOU AND THEN
ALONG YOU COME – WHAM! – AND TELL ME THAT
WHAT I HAVE DIGESTED AND STORED INSIDE ME
DID NOT COME FROM YOU AT ALL. THE PROBLEM I
FIND IS HOW TO LIVE WITH THE DESPAIR I FEEL
OCCASIONED BY YOUR DISAPPEARANCES.”
CHRISTOPHER BOLLAS (1989)
65
66. MODEL 3 ACCOUNTABILITY STATEMENTS (RELATIONAL)
AS IRWIN HOFFMAN (2001) HAS SUGGESTED
IF THE THERAPIST IS AWARE OF FEELING CONFLICTED IN
RELATION TO THE PATIENT, SHE COULD CHOOSE TO SHARE
THE FACT OF THIS CONFLICTEDNESS WITH THE PATIENT
“I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’”
HERE THE THERAPIST IS EXPRESSING ALOUD THE CONFLICT WITH
WHICH SHE IS STRUGGLING – A CONFLICT THAT MIGHT WELL BE
REFLECTIVE OF THE PATIENT’S OWN STATE OF 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 WITH YOU FOR BEING SO OFTEN
LATE AND WANTING YOU TO UNDERSTAND HOW IT IMPACTS ME,
BUT THEN IT OCCURS TO ME THAT IT MIGHT BE MORE IMPORTANT
FOR US TO TRY TO UNDERSTAND WHAT YOU MIGHT BE TRYING
TO COMMUNICATE TO ME BY WAY OF YOUR FREQUENT LATENESS.”
66
67. MODEL 3 ACCOUNTABILITY STATEMENTS (RELATIONAL)
“I AM TEMPTED TO RESPOND TO YOUR REQUEST BY
SAYING THAT OF COURSE YOU CAN BORROW ONE OF
THE MAGAZINES IN MY WAITING ROOM, BUT I AM ALSO
REALIZING THAT WERE I SIMPLY TO SAY ‘OK,’ WE MIGHT
THEN LOSE AN OPPORTUNITY TO UNDERSTAND SOMETHING
MORE ABOUT YOU AND, PERHAPS, ABOUT US.”
TO A PATIENT WHO SAYS SHE WANTS THE THERAPIST’S
APPROVAL REGARDING HER DECISION TO TERMINATE
– A TERMINATION THAT THE THERAPIST THINKS IS PREMATURE –
“I AM TEMPTED SIMPLY TO OFFER YOU THE APPROVAL YOU
ARE SEEKING – IT IS, AFTER ALL, IMPORTANT THAT YOU DO
WHAT FEELS RIGHT FOR YOU. BUT I AM ALSO AWARE
OF FEELING, WITHIN MYSELF, THAT THE TIME IS TOO SOON
AND THAT WERE I TO SUPPORT YOUR DECISION TO LEAVE,
I MIGHT ULTIMATELY BE DOING YOU A DISSERVICE.”
67
68. MODEL 3 ACCOUNTABILITY STATEMENTS (RELATIONAL)
“I WONDER IF THIS FEELING I HAVE IN RELATION
TO YOU THAT NO MATTER WHAT I SAY IT WON’T BE
GOOD ENOUGH IS LIKE THE FEELING YOU HAVE SPOKEN
OF HAVING HAD IN RELATION TO YOUR FATHER,
FOR WHOM NOTHING WAS EVER GOOD ENOUGH.”
“I FIND MYSELF FEELING SO ANGRY AT YOUR MOTHER.
I WONDER IF SOME OF THOSE FEELINGS ARE ACTUALLY MORE
A STORY ABOUT FEELINGS THAT YOU HAVE ABOUT YOUR MOTHER –
FEELINGS YOU WOULD RATHER NOT HAVE TO ACKNOWLEDGE.”
“IT OCCURS TO ME THAT WE HAVE MANAGED TO RECREATE
IN HERE THE VERY SAME DYNAMIC THAT CHARACTERIZED YOUR
RELATIONSHIP WITH YOUR DOUBLE – BINDING FATHER –
THE FEELING THAT NO MATTER WHAT EITHER OF US MIGHT DO,
IT WOULDN’T GET THE OTHER’S APPROVAL!
BUT ALL OF THIS GIVES US AN OPPORTUNITY
TO EXPERIENCE, FIRSTHAND, HOW TOXIC
THE RELATIONSHIP WITH YOUR FATHER REALLY WAS –
EXCEPT THAT NOW WE CAN DO SOMETHING ABOUT IT!”
68
69. MODEL 3
THE “RULE OF THREE”
FOR THE PATIENT WHO HAS DONE
A “PROVOCATIVE ENACTMENT”
IN ORDER TO COMPEL THE PATIENT TO TAKE OWNERSHIP OF
WHAT SHE IS “PLAYING OUT” ON THE STAGE OF THE TREATMENT,
THE THERAPIST MIGHT ASK THE PATIENT ANY OF THE FOLLOWING
“HOW ARE YOU HOPING THAT I WILL RESPOND?”
WHICH SPEAKS TO THE ID
“HOW ARE YOU FEARING THAT I MIGHT RESPOND?”
WHICH SPEAKS TO THE SUPEREGO
“HOW DO YOU IMAGINE THAT I WILL RESPOND?”
WHICH SPEAKS TO THE EXECUTIVE FUNCTIONING OF THE EGO
– THE DORSOLATERAL PREFRONTAL CORTEX OF THE BRAIN –
ALL THREE DEMAND OF THE PATIENT THAT SHE MAKE
HER “INTERPERSONAL INTENTIONS” MORE EXPLICIT
ACCOUNTABILITY AND EMPOWERMENT
69
70. MODEL 4 FACILITATION STATEMENTS (EXISTENTIAL)
ARE SPECIFICALLY DESIGNED TO HIGHLIGHT
– WITH COMPASSION AND NEVER JUDGMENT –
THE INTENSE AMBIVALENCE THE PATIENT HAS
ABOUT BEING “AUTHENTICALLY ENGAGED” WITH PEOPLE
THEY EXPRESS AN APPRECIATION FOR THE COMPLEXITY
OF THE PATIENT’S EXPERIENCE OF “BEING – IN – THE – WORLD”
AND, IN SPEAKING TO DIFFERENT PARTS OF THE
PATIENT’S SELF – EXPERIENCE, HONOR THE “COLLAGE”
OF SELVES THAT CONSTITUTE THE WHOLE
“A PART OF YOU WOULD WANT DESPERATELY
TO BE SEEN AND UNDERSTOOD.
BUT ANOTHER PART OF YOU IS TERRIFIED OF BEING FOUND.”
“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 BROKEN YOUR HEART.”
70
71. MODEL 4 FACILITATION STATEMENTS (EXISTENTIAL)
“A PART OF YOU IS DESPERATE TO BE ABLE TO FEEL
THAT YOU BELONG SOMEWHERE. BUT ANOTHER PART
OF YOU IS AFRAID EVEN TO HOPE THAT
YOU MIGHT SOMEDAY FEEL AT HOME IN THE WORLD.”
“A PART OF YOU LONGS TO FIND A SOULMATE WITH WHOM YOU
WOULD BE ABLE TO SHARE WHAT MOST MATTERS TO YOU AND
WITH WHOM YOU WOULD BE ABLE TO SPEND THE REST OF
YOUR LIFE. BUT ANOTHER PART OF YOU IS CONVINCED THAT
YOU WILL ALWAYS BE LIVING IN ISOLATION
AND THAT YOU HAVE NO CHOICE BUT TO GROW OLD ALONE.”
“A PART OF YOU WOULD WANT TO BE ABLE TO FIND SOMETHING
THAT WOULD 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 ANY REAL JOY IN RELATIONSHIPS.”
“A PART OF YOU WANTS VERY MUCH TO GET BETTER AND
REALIZES THAT COMING IN EVERY WEEK 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.”
71
72. PSYCHODYNAMIC
PSYCHOTHERAPY
OFFERS THE PATIENT
AN OPPORTUNITY
TO REVISIT
TRAUMATIC EXPERIENCES
THAT HAD ONCE CREATED
THE NEED FOR DEFENSE
BUT THAT CAN NOW
BE REWORKED
SUCH THAT THERE CAN BE
A DIFFERENT ENDING THIS TIME
– AN ADAPTIVE RESOLUTION –
72
73. IN ESSENCE
PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT
BOTH IMPETUS AND OPPORTUNITY
– ALBEIT BELATEDLY –
TO MASTER TRAUMATIC EXPERIENCES
THAT HAD ONCE BEEN OVERWHELMING
– AND, THEREFORE, DEFENDED AGAINST –
BUT THAT CAN NOW
– BY VIRTUE OF THE SYNERGY BETWEEN
THE THERAPIST’S LOVING SUPPORT AND
THE PATIENT’S INNATE CAPACITY TO ADAPT TO STRESS –
BE REVISITED, REPROCESSED, AND REFRAMED
SUCH THAT GROWTH – IMPEDING DEFENSES
– ONCE NECESSARY FOR SURVIVAL –
CAN BE GRADUALLY TRANSFORMED
INTO GROWTH – PROMOTING ADAPTATIONS
STRONGER AT THE BROKEN PLACES
73
77. IN CLOSING
I WOULD LIKE TO BORROW FROM STEPHEN MITCHELL (1988)
A WONDERFUL ANECDOTE THAT CAPTURES THE ESSENCE
OF THE QUINTESSENTIAL STRUGGLE IN WHICH ALL OF US
ARE ENGAGED AS WE ATTEMPT TO MASTER OUR ART
MITCHELL WRITES –
“< STRAVINSKY > HAD WRITTEN A NEW PIECE WITH A DIFFICULT
VIOLIN PASSAGE. AFTER IT HAD BEEN IN REHEARSAL FOR
SEVERAL WEEKS, THE SOLO VIOLINIST CAME TO STRAVINSKY
AND SAID HE WAS SORRY, HE HAD TRIED HIS BEST, < BUT > THE
PASSAGE WAS TOO DIFFICULT; NO VIOLINIST COULD PLAY IT.
STRAVINSKY SAID, ‘I UNDERSTAND THAT. WHAT I AM AFTER
IS THE SOUND OF SOMEONE TRYING TO PLAY IT.’”
AS THERAPISTS, OUR WORK IS EXQUISITELY DIFFICULT
AND FINELY TUNED – AND OFTEN WE WILL NOT BE ABLE
TO GET IT JUST RIGHT – PERHAPS, HOWEVER, WE CAN
CONSOLE OURSELVES WITH THE THOUGHT THAT
IT IS THE EFFORT WE MAKE TO GET IT JUST RIGHT
THAT WILL ULTIMATELY COUNT
79. IF YOU WOULD
LIKE TO BE ON
MY MAILING LIST
(AND ARE NOT YET)
PLEASE EMAIL ME AT
MarthaStarkMD @
HMS.Harvard.edu
79
80. REFERENCES
Akhtar, S. 2012. Psychoanalytic listening: Methods, limitations, and
innovations. New York, NY: Routledge / Taylor & Francis Group.
Bollas, C. 1989. The shadow of the object: Psychoanalysis of the
unthought known. New York: Columbia University Press.
Brach, T. 2004. Radical acceptance: Embracing your life with the heart
of a Buddha. New York: Random House.
Ehrenberg, D. 1992. The intimate edge: Extending the reach of
psychoanalytic interaction. New York: W. W. Norton & Co.
Freud, A. 1979. The ego and the mechanisms of defense: The writings
of Anna Freud. Madison, CT: International Universities Press.
Freud, S. 1914. Remembering, repeating and working through (Further
recommendations on the technique of psycho-analysis II). Standard
Edition of the Complete Psychological Works of Sigmund Freud,
Volume XII (1911-1913). London, UK: Hogarth Press.
Goleman, D. 2007. Social intelligence: The new science of human
relationships. New York: Bantam Books.
80
81. Havens, L. 1976. Participant observation. Northvale, NJ: Jason
Aronson.
Hemingway, E. 1929. A farewell to arms. New York: Charles Scribner’s
Sons.
Hoffman, I. 2001. Ritual and spontaneity in the psychoanalytic
process. Abingdon-on-Thames, UK: Routledge / Taylor & Francis.
Mitchell, S. 1988. Relational concepts in psychoanalysis: An
integration. Cambridge, MA: Harvard University Press.
Real, T. 2022. Us: Getting past you and me to build a more loving
relationship. Santa Monica, CA: Goop Press.
Stark, M. 1994a. Working with resistance. Northvale, NJ: Jason
Aronson.
----- 1994b. A primer on working with resistance. Northvale, NJ: Jason
Aronson.
----- 1999. Modes of therapeutic action: Enhancement of knowledge,
provision of experience, and engagement in relationship. Northvale,
NJ: Jason Aronson.
Sterba, R. 1934. The fate of the ego in analytic therapy. International
Journal of Psychoanalysis 64:321-32. 81
Editor's Notes
Welcome. I am Dr. Martha Stark.
I thank you all for signing up for my 4-week-long PSYCHODYNAMIC PSYCHOTHERAPY BOOT CAMP entitled THE TRANSFORMATIVE POWER OF OPTIMAL STRESS: FROM CURSING THE DARKNESS TO LIGHTING A CANDLE.
The BOOT CAMP has a second title: THE THERAPEUTIC USE OF STRESS TO PROVOKE RECOVERY. Actually, the Course has a third title: NO PAIN, NO GAIN.
Although I recorded this Narrated PowerPoint Slide Show a little while ago, I am looking forward to being able to interact directly with all of you over the course of the next 4 weeks – by way of “threaded discussions” or “online chatting” about whatever questions, comments, or reflections, you might find yourself having about the material that I will be presenting each week (each of the 4 1-hour lectures will be presented in easy-to-digest 6 to 8 segments).
Interestingly, the “threaded discussions” in which we will all be participating allow for an interesting (and paradoxical) combination of intimacy and anonymity. You can participate as much or as little as you would like – and you can offer as many or as few “posts” as you would like. We just ask, please, that you limit each post to 100 words or fewer.
I will be presenting a tremendous amount of material but will be doing a lot of repeating (telling you in advance what I’m going to tell you, then telling you, and then telling you after the fact what I have told you) – but I have organized the material in these bite-size 7-10 minute segments that you can go back to review whenever you might want to.
So, please, settle in, buckle up, kick back, crank up the volume, and enjoy!