1. PRACTICAL
CLINICAL INTERVENTIONS
FOR INCENTIVIZING CHANGE
A “Handy Guide” for All Therapists
© 2022 – 1st edition
“LIKE THE MIDDLE GAME IN CHESS,
THERE IS NO PLAY BOOK TO GUIDE US”
PATRICIA COUGHLIN (2022)
MARTHA STARK MD
MarthaStarkMD @ HMS.Harvard.edu
Friday, May 20, 2022
“Special Topics Lecture” for
THE INTERNATIONAL PSYCHOTHERAPY INSTITUTE
© 2022 Martha Stark MD
1

2. EMPATHIC STATEMENTS
PATH – OF – LEAST – RESISTANCE STATEMENTS
INTEGRATION STATEMENTS
CONTAINING STATEMENTS
THE “RULE OF THREE”
PARADOXICAL INTERVENTIONS
THE “I CAN’T, YOU CAN, AND YOU SHOULD” DYNAMIC
DAMAGED – FOR – LIFE – AND – THEREFORE – NOT – RESPONSIBEL – NOW STATEMENTS
COMPENSATION STATEMENTS
ENTITLEMENT STATEMENTS
MASOCHISM STATEMENTS
SADISM STATEMENTS
WITNESS STATEMENTS
MODEL 1 CONFLICT STATEMENTS
MODEL 2 DISILLUSIONMENT STATEMENTS
MODEL 3 ACCOUNTABILITY STATEMENTS
MODEL 4 FACILITATION STATEMENTS
MODEL 5 QUANTUM DISENTANGLEMENT STATEMENTS
2

3. WE CANNOT AVOID SUFFERING
BUT WE CAN CHOOSE HOW WE COPE WITH IT, FIND MEANING IN IT,
AND MOVE FORWARD WITH RENEWED PURPOSE
EXISTENTIAL PSYCHIATRIST VIKTOR FRANKL IS REPUTED TO HAVE WRITTEN
“BETWEEN STIMULUS AND RESPONSE IS A SPACE.
IN THAT SPACE IS OUR POWER TO CHOOSE OUR RESPONSE.
IN OUR RESPONSE LIES OUR GROWTH AND OUR FREEDOM.”
AS THIS APPLIES TO THE CLINICAL SITUATION
IN THAT SPACE IS OUR POWER EITHER TO REACT DEFENSIVELY
– BY WALLOWING IN OUR DESPAIR
AND ABNEGATING RESPONSIBILITY FOR OUR LIVES –
OR TO RESPOND ADAPTIVELY
– BY ACKNOWLEDGING THAT, DESPITE OUR DESPAIR, FROM THIS POINT FORWARD
THE MEANING WE MAKE OF OUR LIVES IS ENTIRELY UP TO US –
NOT ONLY DO WE HAVE THE FREEDOM TO CREATE THAT MEANING
BUT WE ALSO HAVE THE RESPONSIBILITY TO DO SO
IT HAS BEEN SUGGESETED THAT 10% OF WHAT HAPPENS TO US IS “LIFE”
BUT 90% IS HOW WE REACT OR RESPOND TO IT
ALONG THESE SAME LINES, JEAN – PAUL SARTRE ONCE WROTE –
“FREEDOM IS WHAT YOU DO WITH WHAT’S BEEN DONE TO YOU”
3

4. THE “THERAPEUTIC ACTION”
IN PSYCHODYNAMIC PSYCHOTHERAPY
INVOLVES TRANSFORMING
“PSYCHOLOGICAL RIGIDITY” INTO “PSYCHOLOGICAL FLEXIBILITY”
– “RIGID DEFENSE” INTO “MORE FLEXIBLE ADAPTATION” –
THE “CUTTING – EDGE” OF THIS “THERAPEUTIC ACTION”
INVOLVES “WORKING THROUGH” “OPTIMAL STRESS”
– JUST THE RIGHT COMBINATION OF “CHALLENGE” AND “SUPPORT” –
AGAINST A SOLID BACKDROP OF “EMPATHIC ATTUNEMENT”
ONGOING USE OF “OPTIMALLY STRESSFUL”
– “GROWTH – INCENTIVIZING” –
INTERVENTIONS WILL “PRECIPITATE DISRUPTION”
– A “DEFENSIVE REACTION” TO THE “CHALLENGE” –
IN ORDER TO “JUMPSTART REPAIR”
– AN “ADAPTIVE RESPONSE” TO THE “SUPPORT” –
THEREBY GENERATING “ITERATIVE HEALING CYCLES”
OF “DISRUPTION” AND “REPAIR”
AND, OVER TIME, ADVANCEMENT OF THE PATIENT
FROM “LESS HEALTHY DEFENSE” TO “MORE HEALTHY ADAPTATION”
– FROM “SURVIVING” TO “THRIVING” – 4

5. DEFENSES ARE THE LIES WE TELL OURSELVES
TO AVOID FEELING THE PAIN IN OUR LIVES
JON FREDERICKSON (2017)
ADAPTATIONS ARE THE ADJUSTMENTS WE EMBRACE
TO MAKE THE BEST OF (BEST OF, BEST OF)
A BAD SITUATION (BAD SITUATION)
GLADYS KNIGHT & THE PIPS (1973) / MARTHA STARK (2022)
ADAPTATIONS ARE A STORY ABOUT
MAKING A VIRTUE OUT OF NECESSITY
DEFENSES
RIGID / LESS FUNCTIONAL / LESS HEALTHY / LESS EVOLVED
ADAPTATIONS
MORE FLEXIBLE / MORE FUNCTIONAL / MORE HEALTHY / MORE EVOLVED
ALTHOUGH DEFENSES MIGHT ONCE
HAVE BEEN NECESSARY FOR THE PATIENT TO SURVIVE
THEY MUST ULTIMATELY BE TRANSFORMED
INTO ADAPTATIONS IF THE PATIENT IS TO THRIVE
5

6. EMPATHIC STATEMENTS
“EXPERIENCE – NEAR” NOT “EXPERIENCE – DISTANT”
WHAT’S IN THE PATIENT’S CONSCIOUSNESS NOT HER UNCONSCIOUS
MY PRIMARY FOCUS THROUGHOUT EVERY SESSION IS ON
THE PATIENT’S “AFFECT” – MOMENT BY MOMENT
EMPATHIC STATEMENTS TEASE OUT BOTH THE “AFFECT”
AND THE “ASSOCIATED THEME OR NARRATIVE”
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 NARRATIVES THAT WILL ULTIMATELY NEED TO BE “UPDATED”
“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 THE SESSION.” 6

7. PLEASE NOTE THAT INSTEAD OF
“I WONDER IF IT IS PAINFUL TO BE FEELING SO INVISIBLE.”
OR
“IT SOUNDS AS IF IT IS PAINFUL TO BE FEELING SO INVISIBLE.”
OR
“IT SEEMS AS IF IT IS PAINFUL TO BE FEELING SO INVISIBLE.”
YOU COULD SIMPLY SAY
“IT IS PAINFUL TO BE FEELING SO INVISIBLE.”
FOLLOWED BY AN IMPLIED QUESTION MARK
THEREBY SIGNALING THAT YOU ARE VERY OPEN
TO HAVING YOUR STATEMENT AMENDED
EMPATHIC STATEMENTS CAN BE GENERALIZED
“IT IS PAINFUL TO BE FEELING ALWAYS SO INVISIBLE.”
EMPATHIC STATEMENTS THAT HIGHLIGHT AN EXPERIENCE
IN THE “PRESENT” CAN BE “EXTENDED” TO THE “PAST”
“IT IS PAINFUL TO HAVE BEEN FEELING
SO INVISIBLE FOR SO LONG NOW.”
7

8. PATH – OF – LEAST – RESISTANCE STATEMENTS
FOR 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.”
8

9. INTEGRATION STATEMENTS
FOR PATIENTS WHO ARE HAVING TROUBLE HOLDING IN MIND
SIMULTANEOUSLY BOTH THE “GOOD” AND THE “BAD”
ASPECTS OF THEIR EXPERIENCE
IN OTHER WORDS
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 RIGHT NOW, YOU
CAN’T IMAGINE THAT YOU COULD EVER DARE TO TRUST AGAIN.”
”WHEN YOU’RE FEELING THIS DEVASTATED, IT’S HARD
TO REMEMBER THAT YOU USED TO FEEL GOOD IN HERE
WITH ME AND LOOKED FORWARD TO COMING.”
“WHEN YOU FEEL THIS DESPAIRING, YOU CAN’T REMEMBER
EVER HAVING HAD ANY HOPE WHATSOEVER.”
9

10. CONTAINING STATEMENTS
FOR (BORDERLINE) PATIENTS WHO NEED “CONTAINMENT”
FIRST “RESONATE WITH THEIR (DYSREGULATED) AFFECT”
THEN “HIGHLIGHT THE (CONTAINING) REALITY
THAT THEY DO – ALBEIT RELUCTANTLY – KNOW”
“PERHAPS YOU WOULD WISH THAT YOU COULD STAY; BUT, AS YOU
KNOW, OUR TIME IS UP AND WE DO NEED TO STOP.”
“WHEN YOU GET ANGRY LIKE THIS, YOU THINK ABOUT QUITTING;
BUT WE BOTH KNOW THAT SOMEDAY YOU’RE
GOING TO HAVE TO STOP RUNNING.”
“YOU JUST CAN’T SHAKE THIS CONVICTION THAT IF YOU FEEL
HURT BY ME, THEN YOU GET TO DO ANYTHING YOU WANT, INCLUDING
BREAKING THE RULES, WHICH YOU AND I BOTH KNOW WE NEED TO
HAVE IN ORDER FOR OUR RELATIONSHIP TO CONTINUE.”
“AT TIMES LIKE THIS, YOU THINK ABOUT NEVER COMING BACK
BECAUSE IT HURTS SO MUCH TO BE HERE; BUT WE BOTH KNOW THAT,
IF YOU’RE EVER GOING TO GET BETTER, THEN SOMEDAY YOU’RE
GOING TO HAVE TO GIVE SOMEBODY A SECOND CHANCE.”
10

11. 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 ADDRESSES THE ID
“HOW ARE YOU FEARING THAT I MIGHT RESPOND?”
WHICH ADDRESSES THE SUPEREGO
“HOW DO YOU IMAGINE THAT I WILL RESPOND?”
WHICH ADDRESSES THE EXECUTIVE FUNCTIONING OF THE EGO
ALL THREE DEMAND OF THE PATIENT THAT SHE MAKE
HER “INTERPERSONAL INTENTIONS” MORE EXPLICIT
ACCOUNTABILITY AND EMPOWERMENT
11

12. PARADOXICAL INTERVENTIONS
FOR 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”
TO THE PATIENT WHO, EVEN AFTER A YEAR, HAS NOT BEEN ABLE TO
MOBILIZE HIMSELF TO UPDATE HIS RESUME – DESPITE HIS BEST INTENTIONS
“ALTHOUGH EVERY SINGLE DAY YOU DREAD GOING TO WORK AND
JUST HATE BEING THERE BECAUSE YOUR BOSS IS SUCH A JERK, YOUR
JOB DOES PROVIDE YOU WITH A FAIR BIT OF FINANCIAL SECURITY, AS YOU
HAVE OFTEN REMINDED US. SO I THINK I AM BEGINNING TO UNDERSTAND
THAT, AT THIS POINT IN YOUR LIFE, IT SIMPLY MIGHT NOT 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.” 12

13. THE “I CAN’T, YOU CAN, AND YOU SHOULD” DYANMIC
FOR 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 “VICTIM”
ILLUSION – ILLUSORY SENSE OF OBJECT AS “RESCUER”
ENTITLEMENT – ENTITLED SENSE THAT THIS IS THEIR “DUE”
ALL OF WHICH ARE DEFENSIVE REACTIONS
13

14. 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 NOW, YOU FIND YOURSELF WISHING THAT
SOMEONE WOULD UNDERSTAND AND WOULD
DO SOMETHING TO HELP EASE YOUR PAIN.”
ENTITLEMENT STATEMENTS
“BECAUSE YOU FEEL THAT IT WAS SO UNFAIR, WHAT
YOUR FATHER DID TO YOU, 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 INTERSETED.”
14

15. MASOCHISM STATEMENTS
FOR RELENTLESS PATIENTS WHO
– BECAUSE IT SIMPLY “HURTS TOO MUCH” –
REFUSE TO “CONFRONT” – AND “GRIEVE” – THE REALITY
THAT THE OBJECT OF THEIR DESIRE WILL NEVER CHANGE
AND WHO THEREFORE HOLD ON TO THEIR
DEFENSIVE “RELENTLESS HOPING AGAINST HOPE”
“BECAUSE IT IS SO PAINFUL TO HAVE TO CONFRONT THE TRUTH
ABOUT YOUR HUSBAND AND HIS ONGOING INSENSITIVITY TO YOU
AND YOUR NEEDS, YOU FIND YOURSELF CONTINUING TO HOPE
THAT PERHAPS IF YOU TRY HARD ENOUGH, ARE PERSUASIVE
ENOUGH, PERSIST LONG ENOUGH, OR SUFFER DEEPLY ENOUGH
YOU MIGHT YET BE ABLE TO COMPEL HIM TO CHANGE.”
“BECAUSE IT HURTS TOO MUCH TO CONFRONT THE REALITY THAT
YOUR MOTHER WILL NEVER BE WILLING TO APOLOGIZE FOR ALL THAT
SHE DID TO YOU WHEN YOU WERE GROWING UP, YOU KEEP HOPING
THAT IF YOU TRY HARD ENOUGH, PERSIST LONG ENOUGH, AND
SUFFER DEEPLY ENOUGH SHE MIGHT YET RELENT AND BE ABLE
TO ACKNOWLEDGE THAT SHE KNOWS SHE CAUSED YOU TERRIBLE
HEARTBREAK DURING ALL THOSE YEARS OF HER DRINKING.”
15

16. SADISM STATEMENTS
FOR RELENTLESS PATIENTS WHO
– IN THOSE MOMENTS OF DAWNING RECOGNTION THAT WHAT THEY
HAD SO DESPERATELY WANTED 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’RE FEELING THAT YOU’VE BEEN WRONGED,
YOU CAN GET PRETTY UGLY IF YOU HAVE TO!”
“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 TAKE SOME OF HER OWN MEDICINE.”
“WHEN YOU FEEL THAT YOU ARE BEING MISTREATED,
IT MAKES YOU SO ANGRY THAT YOU FEEL
YOU HAVE NO CHOICE BUT TO RESPOND IN KIND.”
16

17. “YOU FIND YOURSELF”
FOR PATIENTS WHO ARE REACTING DEFENSIVELY
INSTEAD OF RESPONDING ADAPTIVELY
“YOU WOULD RATHER” / “YOU WOULD RATHER NOT”
USED TO EMPHASIZE THE PATIENT’S “CHOICE”
TO REACT DEFENSIVELY INSTEAD OF RESPONDING ADAPTIVELY
“FOR NOW” / “AT THIS POINT IN TIME”
A LITTLE BIT OF SUBLIMINAL STIMULATION
USED TO “INTIMATE” THAT PERHAPS, AT SOME LATER POINT IN TIME,
THE PATIENT MIGHT BE ABLE TO RESPOND ADAPTIVELY
INSTEAD OF REACTING DEFENSIVELY
“QUALIFIERS” TO “LIMIT” THE “INTENSITY”
OF “ANXIETY – PROVOKING” CONCEPTS
“SOMETIMES” / “PERHAPS” / “ON SOME LEVEL” / “MAYBE”
“POSSIBLY” / “AT TIMES” / “A PART OF YOU” / “SOME PART OF YOU”
“I AM REALIZING” INSTEAD OF “I REALIZE”
“I REALIZE” IS MORE “STATIC” – A MOMENT IN TIME
“I AM REALIZING” IS MORE DYNAMIC – AND HIGHLIGHTS A “PROCESS”
17

18. WITNESS STATEMENTS
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 IT IS SOMETIMES
EVEN MORE VALIDATING AND REASSURING TO BE ABLE TO
KNOW THAT HOW LONELY AND SAD YOU ARE IS BEING “SEEN”
18

19. 19

20. THE PSYCHODYNAMIC SYNERGY PARADIGM
AN INTEGRATIVE APPROACH TO HEALING
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
STRUCTURAL CONFLICT
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
STRUCTURAL DEFICIT
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
RELATIONAL CONFLICT
MODEL 4 – FACILITATION OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
RELATIONAL DEFICIT
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO INERTIA
ANALYSIS PARALYSIS 20

21. THE PERSPECTIVE
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
COGNITIVE
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
AFFECTIVE
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
RELATIONAL
MODEL 4 – FACILITATION OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
EXISTENTIAL
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO INERTIA
CONSTRUCTIVIST
21

22. BY WAY OF “WORKING THROUGH” “OPTIMALLY STRESSFUL” INTERVENTIONS
THE PATIENT ADVANCES THROUGH “ITERATIVE HEALING CYCLES”
OF “DISRUPTION” AND “REPAIR”
SUCH THAT DEFENSE IS GRADUALLY TRANSFORMED INTO ADAPTATION
DEFENSES – THE FIVE “Rs” / ADAPTATIONS – THE FIVE “As”
MODEL 1 – “RESISTANCE” TO “AWARENESS”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2 – “RELENTLESS HOPE” TO “ACCEPTANCE”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
MODEL 3 – “RE – ENACTMENT” TO “ACCOUNTABILITY”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
MODEL 4 – “RELATIONAL ABSENCE” TO “AUTHENTIC PRESENCE”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
MODEL 5 – “REFRACTORY INERTIA” TO “ACTION / ACTUALIZATION”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO ANALYSIS PARALYSIS
22

23. MOMENT BY MOMENT
THE “POINT OF EMOTIONAL URGENCY” DICTATES THE “GO – TO” MODEL
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
WHEN THE PATIENT IS “RESISTANT” AND “NOT AWARE”
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
WHEN THE PATIENT IS “RELENTLESS” AND “NOT ACCEPTING”
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
WHEN THE PATIENT IS “RE – ENACTING” AND “NOT ACCOUNTABLE”
MODEL 4 – FACILITATION OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
WHEN THE PATIENT IS “RETREATING” AND “NOT ACCESSIBLE”
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO INERTIA
WHEN THE PATIENT AS “IN A RUT” AND ”NOT TAKING ACTION” 23

24. IN TRUTH, WE ARE ALL A LITTLE
NEUROTIC, NARCISSISTIC, NOXIOUS, NONRELATED, AND NONACTUALIZED
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
NEUROTIC CONFLICTEDNESS
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
NARCISSISTIC VULNERABILITY
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
NOXIOUS RELATEDNESS
MODEL 4 – FACILITATION OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO HEALING BROKENNESS AND EASING EXISTENTIAL ANGST
NONRELATEDNESS
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO INERTIA
NONACTION 24

25. OPTIMAL STRESSORS – THE FIVE “Ds”
THE “CUTTING EDGE” OF THE “THERAPEUTIC ACTION”
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
(COGNITIVE) DISSONANCE
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
(AFFECTIVE) DISILLUSIONMENT
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
(RELATIONAL) DETOXIFICATION
MODEL 4 – FACILITATION OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
(EXISTENTIAL) DEPENDENCE
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO INERTIA
(QUANTUM) DISENTANGLEMENT 25

26. AGAINST THE BACKDROP OF “EMPATHIC ATTUNEMENT”
THE PSYCHODYNAMIC SYNERGY PARADIGM
INVOLVES STRATEGIC AND ONGOING USE OF “OPTIMALLY STRESSFUL”
INTERVENTIONS DESIGNED TO “INCENTIVIZE” ENDURING CHANGE
BY ALTERNATELY “CHALLENGING” AND THEN “SUPPORTING”
THE PATIENT’S (UNHEALTHY) DEFENSES
SUCH THAT DEFENSES – ONCE “EGO – SYNTONIC” –
BECOME INCREASINGLY “EGO – DYSTONIC”
THE INTERNAL TENSION CREATED BY THIS “DISSONANCE”
BETWEEN “EGO – SYNTONIC” (GAIN) AND “EGO – DYSTONIC” (PAIN)
CAN ONLY BE RESOLVED AND HOMEOSTASIS RESTORED
ONCE THE WISDOM OF THE BODY PROMPTS MOBILIZATION OF
(HEALTHIER) ADAPTATIONS IN THE PLACE OF THE (UNHEALTHY) DEFENSES
26
ADAPTATION
DEFENSE
OPTIMAL STRESSOR
THE TRIANGLE OF SYNERGY
FEATURES FIVE APPROACHES
TO TRANSFORMING
DEFENSE INTO ADAPTATION
BY WAY OF “WORKING THROUGH”
FIVE OPTIMAL STRESSORS

27. THE TRIANGLE OF SYNERGY
27
ADAPTATIONS
(1) awareness
(2) acceptance
(3) accountability
(4) authentic presence
(5) action / actualization
DEFENSES
(1) resistance
(2) relentless hope
(3) re-enactment
(4) relational absence
(5) refractory inertia
OPTIMAL STRESSORS
(1) cognitive dissonance – gain – become – pain
(2) affective disillusionment – good – become – bad
(3) relational detoxification – bad – become – good
(4) existential dependence – lost – become – found
(5) quantum disentanglement – old bad – become – new good

28. WHERE DEFENSE WAS, THERE SHALL ADAPTATION BE
AS LONG AS THE “GAIN” IS GREATER THAN THE “PAIN”
– MORE “EGO – SYNTONIC” THAN “EGO – DYSTONIC” –
THE PATIENT WILL “MAINTAIN” THE DEFENSE
AND “REMAIN” ENTRENCHED
BUT AS A RESULT OF “WORKING THROUGH” THE
“OPTIMAL STRESS” OF “GROWTH – INCENTIVIZING” INTERVENTIONS
THAT ALTERNATELY AND REPEATEDLY
“CHALLENGE” AND THEN “SUPPORT” THE PATIENT’S DEFENSES
THE “PAIN” WILL ULTIMATELY BECOME
GREATER THAN THE “GAIN”
– MORE “EGO – DYSTONIC” THAN “EGO – SYNTONIC” –
AT WHICH POINT
THE (OPTIMAL) STRESS AND “STRAIN” OF THE “DISSONANCE”
BETWEEN “PAIN” AND “GAIN” / “COST” AND “BENEFIT”
WILL BE SUCH THAT THE PATIENT WILL BE “GALVANIZED”
TO TAKE ACTION TO RESOLVE THE INTERNAL TENSION
ACCOMPLISHED BY WAY OF REPLACING “COSTLY DEFENSES”
WITH “MORE BENEFICIAL ADAPTATIONS” 28

29. THE “CUTTING EDGE” OF THE “THERAPEUTIC ACTION”
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
WORKING THROUGH THE OPTIMAL STRESS OF “GAIN – BECOME – PAIN”
BY WAY OF INTERPRETING
(COGNITIVE) DISSONANCE
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
WORKING THROUGH THE OPTIMAL STRESS OF “GOOD – BECOME – BAD”
BY WAY OF GRIEVING
(AFFECTIVE) DISILLUSIONMENT
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
WORKING THROUGH THE OPTIMAL STRESS OF “BAD – BECOME – GOOD”
BY WAY OF NEGOTIATING AT THE “INTIMATE EDGE” (DARLENE EHRENBERG)
(RELATIONAL) DETOXIFICATION
MODEL 4 – FACILITATION OF SURRENDER “TO”
WORKING THROUGH THE OPTIMAL STRESS OF “LOST – BECOME – FOUND”
BY WAY OF FACILITATING “ANALYTIC ONENESS” (OFRA ESHEL)
(EXISTENTIAL) DEPENDENCE
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
WORKING THROUGH THE OPTIMAL STRESS OF “OLD BAD – BECOME – NEW GOOD”
BY WAY OF THERAPEUTIC MEMORY RECONSOLIDATION
(QUANTUM) DISENTANGLEMENT 29

30. THE “GOAL” OF THE “THERAPEUTIC ACTION”
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
GOAL – AWARENESS OF ANXIETY – PROVOKING TRUTHS
ABOUT THE “SELF”
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
GOAL – ACCEPTANCE OF ANXIETY– PROVOKING TRUTHS
ABOUT THE “OBJECT”
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
GOAL – ACCOUNTABILITY FOR ANXIETY – PROVOKING TRUTHS
ABOUT THE “SELF – IN – RELATION” (STONE CENTER)
MODEL 4 – FACILITATION OF SURRENDER “TO”
GOAL – ARTICULATION OF ANXIETY – PROVOKING TRUTHS
ABOUT THE “PRIVATE SELF”
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
GOAL – ACTUALIZATION OF ANXIETY – PROVOKING TRUTHS
ABOUT THE “FUTURE SELF”
30

31. IN ESSENCE
BY WAY OF “OPTIMALLY STRESSFUL”
“INCENTIVIZING” CLINICAL INTERVENTIONS
PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT
BOTH “IMPETUS” AND “OPPORTUNITY”
– ALBEIT BELATEDLY –
TO MASTER TRAUMATIC EXPERIENCES
THAT HAD ONCE BEEN OVERWHELMING
– AND, THEREFORE, DEFENDED AGAINST –
BUT THAT CAN NOW
– WITH ENOUGH SUPPORT FROM THE THERAPIST
AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE,
INTRINSIC STRIVING TOWARDS HEALTH,
AND INNATE CAPACITY TO ADAPT TO (OPTIMAL) STRESS –
BE REVISITED, REPROCESSED, AND REFRAMED
SUCH THAT GROWTH – IMPEDING DEFENSES CAN GRADUALLY
ADVANCE TO GROWTH – PROMOTING ADAPTATIONS
31

32. 32

33. “THE POOREST UNDERSTOOD”
AND
“THE TWO MOST ENIGMATIC WORDS
IN PSYCHOANALYSIS”
ARE “WORKING THROUGH”
PETER GIOVACCHINI (1986)
“THIS WORKING THROUGH OF
THE RESISTANCES < DEFENSES >
MAY IN PRACTICE
TURN OUT TO BE
AN ARDUOUS TASK
FOR THE SUBJECT
OF THE ANALYSIS
AND A TRIAL OF PATIENCE
FOR THE ANALYST”
SIGMUND FREUD (1914)
33

34. “BUT” / “AND”
TO HIGHLIGHT DIFFERENT “PARTS” OF THE PATIENT’S SELF – EXPERIENCE
MODEL 1 CONFLICT STATEMENTS (COGNITIVE)
“ADAPTIVE CAPACITY” FOR “AWARENESS”
BUT “DEFENSIVE NEED” TO “RESIST”
MODEL 2 DISILLUSIONMENT STATEMENTS (AFFECTIVE)
“DEFENSIVE NEED” FOR “RELENTLESS HOPE”
BUT “ADAPTIVE CAPACITY” TO “CONFRONT”
AND “ADAPTIVE CAPACITY” TO “GRIEVE”
MODEL 3 ACCOUNTABILITY STATEMENTS (RELATIONAL)
“DEFENSIVE NEED” TO “RE – ENACT”
BUT “ADAPTIVE CAPACITY” FOR “ACCOUNTABILITY”
MODEL 4 FACILITATION STATEMENTS (EXISTENTIAL)
“ADAPTIVE CAPACITY” FOR “AUTHENTIC PRESENCE”
BUT “DEFENSIVE NEED” FOR “RELATIONAL ABSENCE”
MODEL 5 QUANTUM DISENTANGLEMENT STATEMENTS (CONSTRUCTIVIST)
“DEFENSIVE NEED” FOR “OLD BAD NARRATIVES”
BUT “ADAPTIVE CAPACITY” FOR “NEW GOOD NARRATIVES”
34

35. 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 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.”
35

36. 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, LIKE YOUR DAD, REALLY ISN’T AVAILABLE IN THE WAYS
THAT YOU WOULD HAVE WANTED HIM TO BE; 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.”
36

37. 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” –
FINALLY “RESONATE EMPATHICALLY”
WITH THE PAIN OF THE PATIENT’S “GRIEF”
– “ADAPTIVE CAPACITY” TO “FEEL” THE ACTUAL “HEARTBREAK” –
37

38. 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 SADDENS AND UPSETS YOU.”
“YOU HAD SO HOPED THAT YOUR MOTHER WOULD APOLOGIZE,
BUT YOU ARE BEGINNING TO ACCEPT THAT SHE SIMPLY
DOES NOT HOLD HERSELF ACCOUNTABLE –
IT IS BOTH ENRAGING AND DEVASTATING.”
38

39. MODEL 2 DISILLUSIONMENT STATEMENTS (AFFECTIVE)
“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 ARTICULATE IT;
BUT YOU ARE COMING TO SEE THAT IT DOES NOT ALWAYS
WORK THAT WAY; AND THAT MAKES YOU VERY SAD.”
“ALTHOUGH YOU KNEW IT WOULD TAKE TIME, YOU HAD HOPED THAT YOU
WOULD BE FEELING BETTER AFTER THESE SEVERAL WEEKS OF THERAPY.
SO IT REALLY UPSETS YOU THAT YOU ARE STILL FEELING BAD.”
“YOU WERE SO HOPING THAT I WOULD NOT MAKE THE SAME KINDS OF
MISTAKES THAT EVERYONE ELSE IN YOUR LIFE HAS, WHICH IS WHY
IT MAKES YOU VERY SAD THAT I TOO HAVE NOW LET YOU DOWN.”
“ON SOME LEVEL, YOU KNEW THAT I DIDN’T HAVE ALL THE ANSWERS.
EVEN SO, YOU WERE HOPING THAT I MIGHT, WHICH IS WHY IT ANGERS
YOU SO MUCH WHEN I DON’T SIMPLY ANSWER YOUR QUESTIONS DIRECTLY.”
“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.” 39

40. 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.”
40

41. 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 REACTING / RESPONDING –
THE THERAPIST MAY CHOOSE TO SHARE –
SOMETHING ABOUT HER EXPERIENCE
OF BEING IN THE ROOM WITH THE PATIENT
HER 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 41

42. 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 … ”
42

43. 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 YOU HAVE
TALKED OF FEELING IN RELATION TO YOUR FATHER.”
“YOU TELL ME SOMETHING ABOUT YOURSELF. I AM
JUST IN THE PROCESS OF DIGESTING IT AND STORING
IT FOR FURTHER UNDERSTANDING OF YOU AND THEN
ALONG YOU COME – WHAM! – AND TELL ME THAT
WHAT I HAVE DIGESTED AND STORED INSIDE ME
DID NOT COME FROM YOU AT ALL. THE PROBLEM I
FIND IS HOW TO LIVE WITH THE DESPAIR I FEEL
OCCASIONED BY YOUR DISAPPEARANCES.”
CHRISTOPHER BOLLAS (1989) 43

44. 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 MAY CHOOSE TO SHARE
THE FACT OF THIS CONFLICTEDNESS WITH THE PATIENT
“I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’”
HERE THE THERAPIST IS EXPRESSING ALOUD THE CONFLICT WITH
WHICH SHE IS STRUGGLING – A CONFLICT THAT MIGHT WELL BE
REFLECTIVE OF THE PATIENT’S OWN INTERNAL STATE OF DIVIDEDNESS
“I AM TEMPTED TO GIVE YOU THE ADVICE FOR
WHICH YOU ARE LOOKING, BUT MY FEAR IS THAT
WERE I TO DO SO, I WOULD BE ROBBING YOU OF
THE IMPETUS TO FIND YOUR OWN ANSWERS.”
“I FIND MYSELF FEELING ANGRY WITH YOU FOR BEING SO OFTEN
LATE AND WANTING YOU TO UNDERSTAND HOW IT IMPACTS ME,
BUT THEN IT OCCURS TO ME THAT IT MIGHT BE MORE IMPORTANT
FOR US TO TRY TO UNDERSTAND WHAT YOU MIGHT BE TRYING
TO COMMUNICATE TO ME BY WAY OF YOUR FREQUENT LATENESS.”
44

45. 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.”
45

46. 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 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!”
46

47. MODEL 4 FACILITATION STATEMENTS (EXISTENTIAL)
ARE SPECIFICALLY DESIGNED TO HIGHLIGHT
– WITH COMPASSION AND NEVER JUDGMENT –
THE INTENSE AMBIVALENCE THE MODEL 4 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.”
47

48. MODEL 4 FACILITATION STATEMENTS (EXISTENTIAL)
“A PART OF YOU IS DESPERATE TO BE ABLE TO FEEL THAT
YOU ARE PART OF THE WORLD; BUT ANOTHER PART
OF YOU IS SIMPLY NOT WILLING TO RISK IT.”
“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 ON THE OUTSIDE 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.”
48

49. 49

50. MODEL 5 QUANTUM DISENTANGLEMENT STATEMENTS
(CONSTRUCTIVIST)
JUXTAPOSE
ARTICULATION
OF THE PATIENT’S
THOUGHTS, FEELINGS, AND BODILY SENSATIONS
THAT EMERGE WHEN OLD BAD MEMORIES
ARE MINDFULLY RETRIEVED
AND ARTICULATION
OF THE PATIENT’S INTENTIONED ENVISIONING
OF ALTERNATIVE NEW GOOD POSSIBILITIES,
HER TAKING OWNERSHIP
OF HER NEED THEREFORE TO CHANGE,
AND HER COMMITMENT TO ACTUALIZING
WHAT REALLY MATTERS TO HER
GOING FORWARD
50

51. MODEL 5 QUANTUM DISENTANGLEMENT STATEMENT (CONSTRUCTIVIST)
“I HAVE SO MUCH SHAME ABOUT MY BODY
AND FEEL SO MUCH PAIN IN MY HEART
WHENEVER I THINK ABOUT HOW MY FATHER
WOULD LOOK AT ME – ALWAYS WITH SUCH
CONTEMPT AND DISGUST. I FEEL DEEPLY DESPAIRING
ABOUT EVER BEING ABLE TO FEEL AT HOME IN MY BODY.
BUT I CAN IMAGINE THAT SOMEDAY I MIGHT BE ABLE
TO GO OUT INTO THE WORLD LOOKING GOOD,
CARRYING MYSELF WITH DIGNITY AND PRIDE,
AND NO LONGER NEEDING TO KEEP MYSELF HIDDEN.
I KNOW THAT I WILL NEED TO CHANGE HOW I POSITION
MYSELF IN RELATION TO EATING, AND I AM DETERMINED
TO DO THAT. I AM HEREBY COMMITTING TO GETTING
SERIOUS ABOUT INTERMITTENT FASTING ON A MORE
CONSISTENT BASIS BECAUSE I KNOW THAT EMBRACING
A MORE RESPONSIBLE WAY OF EATING
WILL MAKE ALL THE DIFFERENCE IN THE WORLD.”
51

52. MODEL 5 QUANTUM DISENTANGLEMENT STATEMENT (CONSTRUCTIVIST)
“I ALWAYS WORRY THAT NO ONE WILL LISTEN TO ME.
I DON’T FEEL THAT I HAVE A RIGHT TO SPEAK MY TRUTH.
I WAS NEVER ALLOWED TO SPEAK UP IN MY FAMILY
AND WAS ALWAYS SILENCED. I WAS MADE TO FEEL
INVISIBLE – AND SO IRRELEVANT. I REMEMBER HOW
AWFUL IT FELT TO BE SO IGNORED ALL THE TIME.
MY BODY TREMBLES AS I REMEMBER – AND I FEEL TENSION
IN MY CHEST. I JUST HATED BEING PUSHED TO THE SIDE
AND BEING TOLD THAT I DID NOT MATTER. IT BROKE MY HEART.
BUT I CAN ENVISION THE POSSIBILITY OF SOMEDAY FEELING
GOOD ENOUGH ABOUT WHO I AM THAT I WILL BE ABLE TO
PRESENT MYSELF TO THE WORLD WITHOUT APOLOGY AND
WITHOUT SELF – CONSCIOUSNESS. I WILL HAVE A VOICE AND
WILL USE IT TO EXPRESS HOW I REALLY FEEL. I KNOW THAT
I WILL NEED TO START TAKING RISKS THAT, TO THIS POINT,
I HAVE AVOIDED TAKING BECAUSE I WAS SO AFRAID. I HAVE
BEEN SO CONTROLLED BY MY FEAR, BUT I KNOW THAT I NEED
TO SPEAK UP AND LET MY VOICE BE HEARD. I AM SO TIRED OF
HOLDING MYSELF BACK AND BEING ALWAYS IN THE SHADOWS.”
52

53. MODEL 5 QUANTUM DISENTANGLEMENT STATEMENT (CONSTRUCTIVIST)
“I WANT TO CURL UP AND DIE WHEN I THINK ABOUT HOW MY
MOTHER NEVER PAID ATTENTION TO ME, NEVER LOVED ME,
AND SIMPLY THOUGHT OF ME AS AN OBJECT IN HER WAY.
AND NOW I FIND MYSELF SO OFTEN FEELING INSIGNIFICANT
AND UNCARED FOR AND KEEPING MYSELF DISTANT FROM
OTHERS. IT PAINS ME SO MUCH TO REALIZE HOW MUCH I
HAVE MISSED OUT ON BECAUSE OF HOW AFRAID I AM
OF BEING UNLOVABLE AND REJECTED. I FEEL SUCH SADNESS
AND GRIEF AND ANGER AND PAIN IN MY HEART WHEN
I REMEMBER MY FRIGHTENED AND LONELY SELF,
IGNORED BY MY MOTHER AND WANTING TO DIE.
BUT I AM BEGINNING TO SEE THE POSSIBILITY THAT SOMEDAY
I MIGHT FEEL LESS AFRAID, LESS ALONE, LESS SAD,
AND MORE HOPEFUL ABOUT FEELING CONNECTED TO THE
WORLD. AFTER ALL, IT IS NOT AS COLD AND LONELY AND
DANGEROUS AS THE WORLD I KNEW WHEN I WAS GROWING
UP. I HAVE BEEN TAKING SOME DIFFICULT STEPS TO REACH
OUT. AND I KNOW I MUST CONTINUE TO DO SO, DESPITE
MY FEARS. I SO WANT MY LIFE TO FEEL MORE COMFORTABLE,
WARMER, AND MUCH MORE UNDER MY CONTROL.”
53

54. 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
54

55. 55
THANK YOU!
STUART AND HIS BROTHER STEWART

56. IF YOU WOULD
LIKE TO BE ON
MY MAILING LIST
(AND ARE NOT YET),
PLEASE EMAIL ME AT
MarthaStarkMD @
HMS.Harvard.edu
56