Martha Stark MD – 4 Feb 2023 – MASTER CLASS Part 2 – The Art and The Science of Interpretation.pptx

THE ART AND THE SCIENCE
OF INTERPRETATION
ACCESSING YOUR RIGHT BRAIN’S INTUITIVE GIFTEDNESS
AND YOUR LEFT BRAIN’S ANALYTIC FINESSE
(2 – Hour) MASTER CLASS Part 1 – Saturday / January 21, 2023
(1 – Hour) Q&A FOLLOW – UP SESSION – Saturday / January 28, 2023
(2 – Hour) MASTER CLASS Part 2 – Saturday / February 4, 2023
MARTHA STARK MD
Faculty, Harvard Medical School
MarthaStarkMD @ SynergyMed.solutions
With deepest appreciation to
Adele Yaron, Robert Downes, and The Relational School
for hosting my upcoming Zoom sessions
© 2023 Martha Stark MD
1

2 – Hour MASTER CLASS Part 2
Saturday / February 4, 2023
2

BY WAY OF A BRIEF REVIEW OF MASTER CLASS Part 1
MY PSYCHODYNAMIC SYNERGY PARADIGM
A C.A.R.E. APPROACH TO DEEP HEALING
FEATURES FIVE “MODES OF THERAPEUTIC ACTION”
FIVE DIFFERENT APPROACHES TO
“CATALYZING” TRANSFORMATION
OF PSYCHOLOGICAL RIGIDITY
INTO PSYCHOLOGICAL FLEXIBILITY
3

MY PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
– A SYNERGISTIC APPROACH TO DEEP HEALING –
FIVE INTERDEPENDENT AND MUTUALLY ENHANCING
“MODES OF THERAPEUTIC ACTION”
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
MODEL 4 – NURTURING OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS, SECURING THE ATTACHMENT,
AND EASING EXISTENTIAL ANGST
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH
TO OVERCOMING ANALYSIS PARALYSIS AND “STUCKNESS”
4

MY PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
A C.A.R.E. APPROACH TO DEEP HEALING
Cognitive – Affective – Relational – Existential
MODEL 1 – COGNITIVE
“STRUCTURAL CONFLICT” – CLASSICAL PSYCHOANALYTIC
MODEL 2 – AFFECTIVE
“STRUCTURAL DEFICIT” – SELF PSYCHOLOGICAL
MODEL 3 – RELATIONAL
“RELATIONAL CONFLICT” – CONTEMPORARY RELATIONAL
MODEL 4 – EXISTENTIAL
“RELATIONAL DEFICIT” – EXISTENTIAL – HUMANISTIC
MODEL 5 – CONSTRUCTIVIST
“NEURAL ENTRENCHMENT” – QUANTUM – NEUROSCIENTIFIC
ALL FIVE PSP MODELS CAPITALIZE UPON
THE THERAPEUTIC PROVISION OF OPTIMAL STRESS
TO ADVANCE THE PATIENT
FROM LONGSTANDING, DEEPLY ENTRENCHED, MALADAPTIVE RIGIDITY
TO NEWFOUND, MORE EVOLVED, MORE ADAPTIVE FLEXIBILITY
WITH AN EYE TO INCENTIVIZING
DEEP AND SUSTAINED CHARACTEROLOGICAL CHANGE 5

BUT OUR FOCUS TODAY WILL BE ON THE FIRST THREE MODELS
– THE THREE MAJOR PSYCHOANALYTIC SCHOOLS –
– KNOWLEDGE, EXPERIENCE, AND RELATIONSHIP –
THE FIRST OF WHICH IS CLASSICAL
THE SECOND AND THIRD OF WHICH ARE MORE CONTEMPORARY
MODEL 1
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
– SIGMUND FREUD / ANNA FREUD / HEINZ HARTMANN / DAVID RAPAPORT –
MODEL 2
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “ABSENCE OF GOOD”
– RESULTING FROM “RELATIONAL DEPRIVATION AND NEGLECT” –
– HEINZ KOHUT / MICHAEL BALINT / PAUL AND ANNA ORNSTEIN –
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “PRESENCE OF BAD”
– RESULTING FROM “RELATIONAL TRAUMA AND ABUSE” –
– STEPHEN MITCHELL / JAY GREENBERG / JESSICA BENJAMIN / JEAN BAKER MILLER –
6

CLASSICAL PSYCHOANALYTIC
SELF PSYCHOLOGICAL
CONTEMPORARY RELATIONAL
SIMILARLY (AND REASSURINGLY!)
ALLAN SCHORE (2022) HAS HIGHLIGHTED
WHAT HE DESCRIBES AS A “PARADIGM SHIFT”
– OVER THE COURSE OF THE YEARS –
FROM “LEFT BRAIN” CONSCIOUS COGNITION
MY MODEL 1
TO “RIGHT BRAIN” UNCONSCIOUS EMOTIONAL PROCESSES
MY MODEL 2
AND “RIGHT BRAIN” UNCONSCIOUS RELATIONAL DYNAMICS
MY MODEL 3
7

MODEL 1
COGNITIVE / “HEAD” / THOUGHTS
TARGET THE PATIENT’S “INTERNAL CONFLICTEDNESS”
AND RELUCTANCE TO “ACKNOWLEDGE”
ANXIETY – PROVOKING “TRUTHS”
ABOUT THE “SELF”
MODEL 2
AFFECTIVE / “HEART” / FEELINGS
TARGET THE PATIENT’S “RELENTLESS PURSUITS”
AND RELUCTANCE TO “CONFRONT AND GRIEVE”
ABOUT THE “OBJECTS OF HER DESIRE”
MODEL 3
RELATIONAL / “HAND” / BEHAVIORS
TARGET THE PATIENT’S “COMPULSIVE RE – ENACTMENTS”
AND RELUCTANCE TO “TAKE OWNERSHIP OF”
ABOUT THE “RELATIONAL SELF”
8

9
HEAD
MODEL 1
HEART
MODEL 2
HANDS
MODEL 3

CLASSICAL PSYCHOANALYSIS
THE THERAPEUTIC ACTION FOCUSES ON “INTERPRETING”
ANXIETY – PROVOKING TRUTHS
ABOUT THE PATIENT’S “SELF”
– AND FEATURES OPTIMALLY STRESSFUL CONFLICT STATEMENTS –
SELF PSYCHOLOGY AND OTHER DEFICIT THEORIES
THE THERAPEUTIC ACTION FOCUSES ON “GRIEVING”
ABOUT THE PATIENT’S “OBJECTS OF DESIRE”
– AND FEATURES OPTIMALLY STRESSFUL DISILLUSIONMENT STATEMENTS –
CONTEMPORARY RELATIONAL THEORY
THE THERAPEUTIC ACTION FOCUSES ON “OWNING”
ABOUT THE PATIENT’S “RELATIONAL SELF”
– AND FEATURES OPTIMALLY STRESSFUL ACCOUNTABILITY STATEMENTS –
10

MODEL 1 – INTERPRETING
THE THERAPEUTIC ACTION INVOLVES
“RESOLVING INTERNAL CONFLICT”
BY “INTERPRETING THE RESISTANCE”
FROM “RESISTANCE” TO “AWARENESS”
MODEL 2 – GRIEVING
ADAPTIVELY “INTERNALIZING EXTERNAL GOOD”
BY “GRIEVING DISAPPOINTMENT”
FROM “RELENTLESS HOPE” TO “ACCEPTANCE”
MODEL 3 – NEGOTIATING
“DETOXIFYING INTERNAL BADNESS”
BY “NEGOTIATING AT THE ‘INTIMATE EDGE’ OF RELATEDNESS”
DARLENE EHRENBERG (1992)
FROM “RE – ENACTMENT” TO “ACCOUNTABILITY”
11

OVERVIEW
THE THERAPEUTIC ACTION IN ALL THREE MODELS
INVOLVES “WORKING THROUGH” THE “OPTIMAL STRESS”
CREATED BY THE THERAPIST’S INTERVENTIONS
– WHICH ALTERNATELY CHALLENGE AND THEN SUPPORT –
WHETHER THE OPTIMAL STRESSOR IS “COGNITIVE DISSONANCE,”
“AFFECTIVE DISILLUSIONMENT,” OR “RELATIONAL DETOXIFICATION”
MODEL 1 – COGNITIVE DISSONANCE
“WORKING THROUGH” THE “STRESS” OF “GAIN – BECOME – PAIN”
– “EGO – SYNTONIC – BECOME – EGO – DYSTONIC” –
THEREBY TRANSFORMING “RESISTANCE” INTO “AWARENESS”
MODEL 2 – AFFECTIVE DISILLUSIONMENT
“WORKING THROUGH” THE “STRESS” OF “GOOD – BECOME – BAD”
– “ILLUSION – BECOME – DISILLUSIONMENT” / “POSITIVE TRANSFERENCE DISRUPTED” –
THEREBY TRANSFORMING “RELENTLESS HOPE” INTO “ACCEPTANCE”
MODEL 3 – RELATIONAL DETOXIFICATION
“WORKING THROUGH” THE “STRESS” OF “BAD – BECOME – GOOD”
– “DISTORTION – BECOME – REALITY” / “NEGATIVE TRANSFERENCE” –
THEREBY TRANSFORMING “RE – ENACTMENT” INTO “ACCOUNTABILITY”
I AM HERE REMINDED OF PHILIP BROMBERG’S (1998) “SAFE BUT NOT TOO SAFE”
DESCRIPTION OF THE (OPTIMAL) THERAPEUTIC RELATIONSHIP 12

MODEL 1
THE
INTERPRETIVE
PERSPECTIVE
OF
CLASSICAL
PSYCHOANALYSIS
“STRUCTURAL CONFLICT”
BETWEEN “ANXIETY – PROVOKING”
– BUT ULTIMATELY “GROWTH – PROMOTING” –
FORCES PRESSING “YES”
AND “ANXIETY – RELIEVING”
– BUT “GROWTH – IMPEDING” –
COUNTERFORCES DEFENDING “NO”
14

MOST OF OUR PATIENTS ARE CONFLICTED
ABOUT MOST THINGS MOST OF THE TIME
WITH ONE PART OF THEM
INVESTED IN MAINTAINING “SAME OLD, SAME OLD”
AND ANOTHER PART OF THEM BEGINNING TO APPRECIATE
– ALBEIT IT WITH EVER – INCREASING ANXIETY –
BOTH THE “PRICE PAID” FOR THAT MISPLACED LOYALTY
AND THE “ENLIVENING POSSIBILITY” OF
“SOMETHING NEW, DIFFERENT, AND BETTER”
MODEL 1 CONFLICT STATEMENTS
ARE UNIVERSALLY APPLICABLE INTERVENTIONS
THAT TARGET THESE STATES OF
“INTERNAL DIVIDEDNESS” OR “CONFLICTEDNESS”
ON THE ONE HAND
HIGHLIGHTING THE PATIENT’S EVER – EVOLVING “AWARENESS”
OF HER “INVESTMENT IN” “SAME OLD, SAME OLD”
ON THE OTHER HAND
HIGHLIGHTING THE PATIENT’S EVER – EVOLVING “AWARENESS”
OF THE “PRICE PAID” FOR THAT INVESTMENT
AND OF THE “POTENTIAL”
FOR “SOMETHING NEW, DIFFERENT, AND BETTER”
15

AS WE KNOW, “MINIMALLY STRESSFUL” STATEMENTS
SECURE THE ATTACHMENT AND LAY THE GROUNDWORK
BUT DO NOT SPECIFICALLY CATALYZE DEEP AND ENDURING CHANGE
“OPTIMALLY STRESSFUL” CONFLICT STATEMENTS,
HOWEVER, ARE STRATEGICALLY DESIGNED
TO OFFER AN ARTFUL COMBINATION OF
CHALLENGE
– BY HIGHLIGHTING EITHER THE “PRICE PAID” FOR “OLD BAD”
AND / OR THE “ENLIVENING POSSIBILITY” OF “NEW GOOD” –
AND SUPPORT
– BY RESONATING EMPATHICALLY WITH THE “INVESTMENT IN” “OLD BAD” –
THE NET RESULT OF THIS
INTUITIVELY TITRATED BLEND OF
CHALLENGE
– WHICH PROVOKES THE PATIENT’S ANXIETY –
AND SUPPORT
– WHICH EASES IT –
WILL BE THE GENERATION OF
GALVANIZING OPTIMAL STRESS
NECESSARY IF DEEP AND ENDURING
PSYCHODYNAMIC CHANGE IS THE ULTIMATE GOAL
16

17
STRATEGIC “LEVERAGING"
OF THE PATIENT’S ANXIETY
TO “INCENTIVIZE” TRANSFORMATION

“LEVERAGING” THE PATIENT’S ANXIETY
ON THE ONE HAND
“MINIMALLY STRESSFUL” STATEMENTS ARE STRATEGICALLY DESIGNED
TO “BE WITH THE PATIENT WHERE SHE IS”
– “HOMEOSTATIC ATTUNEMENT” –
– “SUPPORT” THAT WILL DECREASE HER ANXIETY –
THE NET RESULT OF WHICH WILL BE
TO “PROMOTE THE THERAPEUTIC ALLIANCE,”
“SECURE THE ATTACHMENT,” AND “SET THE STAGE”
ON THE OTHER HAND
“OPTIMALLY STRESSFUL” STATEMENTS ARE STRATEGICALLY DESIGNED
FIRST TO “DIRECT THE PATIENT’S ATTENTION
TO WHERE WE WOULD WANT HER TO GO”
– “DISRUPTIVE ATTUNEMENT” –
– “CHALLENGE” THAT WILL INCREASE HER ANXIETY –
AND THEN TO “BE WITH THE PATIENT WHERE SHE IS”
– “SUPPORT” THAT WILL DECREASE HER ANXIETY –
THE NET RESULT OF WHICH WILL BE
TO “CREATE INTERNAL TENSION AND DISSONANCE”
AND, THEREBY, “INCENTIVIZING LEVERAGE”
SALMAN AKHTAR (2012)
18

19
DO I CHALLENGE? OR SUPPORT?
OR PERHAPS DO BOTH?

INDEED WE ALL FIND OURSELVES SOMETIMES
VERY CONFUSED ABOUT WHAT TO DO NEXT!
20

“WORKING THROUGH THE RESISTANCE”
OPTIMALLY STRESSFUL
MODEL 1 CONFLICT STATEMENTS
“YOU KNOW THAT … , BUT (MADE ANXIOUS)
YOU FIND YOURSELF THINKING / FEELING / DOING
IN ORDER NOT TO HAVE TO KNOW … ”
21

TWO KINDS OF CONFLICT
– “CONVERGENT” AND “DIVERGENT” –
A. KRIS (1985)
DIVERGENT CONFLICT – “EITHER / OR” SITUATIONS
TWO “MUTUALLY EXCLUSIVE” FORCES
SHALL I WEAR MY BLUE DRESS OR MY RED DRESS TONIGHT?
CONVERGENT CONFLICT – “BOTH / AND” SITUATIONS
ONE OF THE FORCES
– AN ANXIETY – PROVOKING (ID) “FORCE” –
PROMPTS MOBILIZATION OF A SECOND FORCE
– AN ANXIETY – RELIEVING (EGO) “COUNTERFORCE” –
YOU KNOW THAT SOMETIMES YOU FEEL ANGRY WITH YOUR WIFE
– THE ANXIETY – PROVOKING “FORCE” –
BUT YOU (MADE ANXIOUS) WOULD RATHER NOT THINK ABOUT THAT RIGHT NOW
– THE DEFENSIVE “COUNTERFORCE” –
YOU KNOW THAT YOUR MOTHER WILL PROBABLY NEVER APOLOGIZE
– THE ANXIETY – PROVOKING “FORCE” –
BUT YOU (MADE ANXIOUS) FIND YOURSELF
CONTINUING TO HOPE THAT PERHAPS SOMEDAY SHE WILL
– THE DEFENSIVE “COUNTERFORCE” –
22

THE “STRUCTURAL CONFLICTS”
– aka “NEUROTIC CONFLICTS” OR “INTRAPSYCHIC CONFLICTS” –
OF CLASSICAL PSYCHOANALYTIC THEORY ARE
“CONVERGENT CONFLICTS”
MODEL 1 CONFLICT STATEMENTS ARE DESIGNED
TO ADDRESS THESE “CONVERGENT (“BOTH / AND”) CONFLICTS”
WITH AN EYE TO GENERATING INTERNAL TENSION
BETWEEN ANXIETY– PROVOKING (BUT ULTIMATELY GROWTH – PROMOTING) FORCES
AND ANXIETY – RELIEVING (BUT GROWTH – IMPEDING) RESISTANT COUNTERFORCES
“YOU KNOW THAT YOUR MOTHER
WILL PROBABLY NEVER APOLOGIZE
BUT YOU FIND YOURSELF CONTINUING TO HOPE
THAT PERHAPS SOMEDAY SHE WILL.”
MODEL 1 CONFLICT STATEMENTS ARE NOT DESIGNED
TO ADDRESS “DIVERGENT (“EITHER / OR”) CONFLICTS”
YOU WOULD NOT ADVANCE THE CAUSE MUCH
WERE YOU TO SAY TO YOUR PATIENT
“YOU KNOW THAT YOU COULD
WEAR YOUR BLUE DRESS TONIGHT
BUT YOU FIND YOURSELF THINKING THAT PERHAPS
YOU SHOULD WEAR YOUR RED DRESS INSTEAD.”
23

“WORKING THROUGH THE RESISTANCE” 📕 📕
OPTIMALLY STRESSFUL CONFLICT STATEMENTS
ARE STRATEGICALLY DESIGNED
FIRST TO INCREASE ANXIETY
BY “CHALLENGING” THE DEFENSE
YOU HAVE THE “ADAPTIVE CAPACITY” TO “KNOW” ... ,
AND THEN TO DECREASE ANXIETY
BY “SUPPORTING” THE DEFENSE
BUT YOU HAVE THE “DEFENSIVE NEED” TO “RESIST” THAT “KNOWING” ...
ALL WITH AN EYE
FIRST TO “MAKING EXPLICIT”
THE CONFLICT WITHIN THE PATIENT
BETWEEN THE “HEALTHY PART” OF HER
– THAT DOES INDEED “KNOW” –
AND THE “LESS – HEALTHY PART” OF HER
– THAT “RESISTS” THAT “KNOWING” –
AND THEN TO “GENERATING GROWTH – INCENTIVIZING DISSONANCE”
BETWEEN THOSE TWO “PARTS” OF HER “SELF – EXPERIENCE”
24

OPTIMALLY STRESSFUL MODEL 1 CONFLICT STATEMENTS
FIRST “CHALLENGE” BY “DIRECTING THE PATIENT’S ATTENTION TO WHERE YOU WANT HER TO GO”
AND THEN “SUPPORT” BY “RESONATING EMPATHICALLY WITH WHERE SHE IS”
“YOU KNOW THAT IF YOU ARE EVER TO GET ON
WITH YOUR LIFE, YOU’LL HAVE TO LET GO OF YOUR CONVICTION
THAT YOUR CHILDHOOD SCARRED YOU FOREVER. BUT IT’S HARD
NOT TO FEEL LIKE DAMAGED GOODS WHEN YOU GREW UP
IN A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN AND NASTY
MOTHER WHO KEPT TELLING YOU THAT YOU WERE A LOSER.”
“YOU’RE COMING TO UNDERSTAND THAT
YOUR ANGER CAN PUT PEOPLE OFF.
BUT YOU TELL YOURSELF THAT
YOU HAVE A RIGHT TO BE AS ANGRY AS YOU WANT
BECAUSE OF HOW MUCH YOU HAVE HAD TO SUFFER
OVER THE COURSE OF THE YEARS.”
“YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA
IS TO SURVIVE, YOU’LL NEED TO TAKE AT LEAST SOME
RESPONSIBILITY FOR THE PART YOU’RE PLAYING IN THE
INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE HAVE BEEN HAVING.
BUT YOU TELL YOURSELF THAT IT ISN’T REALLY
YOUR FAULT BECAUSE IF SHE WEREN’T SO PROVOCATIVE,
THEN YOU WOULDN’T HAVE TO BE SO VINDICTIVE!” 25

PLEASE NOTE
AS TEMPTING AS IT MIGHT BE
FOR THE THERAPIST TO HIGHLIGHT
– IN THE FIRST PORTION OF HER CONFLICT STATEMENT –
SOMETHING THAT SHE WOULD WISH
THE PATIENT ALREADY KNEW,
IF THE PATIENT REALLY
DOES NOT YET KNOW IT,
THEN IT IS BETTER
THAT THE THERAPIST
RESIST HER TEMPTATION
TO “LEAD THE WITNESS”
IN THAT WAY
“YOU KNOW THAT YOUR UNRESOLVED FEELINGS ABOUT YOUR DAD ARE
MAKING IT DIFFICULT FOR YOU TO FIND AN APPROPRIATE LIFE PARTNER ... ”
SAYING THIS TO SOMEONE WHO DOES NOT ACTUALLY KNOW THIS
RUNS THE RISK OF MAKING THE PATIENT EVEN MORE DEFENSIVE
FURTHERMORE, THAT’S “CHEATING”! – SO IT’S NOT FAIR ...
26

BY LOCATING WITHIN THE PATIENT
THE CONFLICT BETWEEN
WHAT SHE (ADAPTIVELY) “KNOWS”
AND WHAT SHE, MADE ANXIOUS,
(DEFENSIVELY) “FINDS HERSELF”
“THINKING, FEELING, OR DOING”
IN ORDER NOT TO HAVE TO CONFRONT
THAT “ANXIETY – PROVOKING REALITY,”
THE THERAPIST IS DEFTLY SIDESTEPPING
THE POTENTIAL FOR CONFLICT
BETWEEN HERSELF AND THE PATIENT
MORE SPECIFICALLY
WHEN THE THERAPIST INTRODUCES
A CONFLICT STATEMENT WITH
“YOU KNOW THAT … , ”
SHE IS FORCING THE PATIENT
TO TAKE RESPONSIBILITY
FOR WHAT THE PATIENT
– ALBEIT BEGRUDGINGLY –
REALLY DOES KNOW 27

IF, INSTEAD, THE THERAPIST
– IN A MISGUIDED ATTEMPT TO URGE THE PATIENT FORWARD –
RESORTS SIMPLY
TO TELLING THE PATIENT
WHAT THE THERAPIST KNOWS,
NOT ONLY
WILL THE THERAPIST
BE RUNNING THE RISK
OF FORCING THE PATIENT
TO BECOME EVER – MORE ENTRENCHED
IN HER DEFENSIVE STANCE OF PROTEST
BUT THE THERAPIST WILL ALSO
BE DEPRIVING THE PATIENT
OF ANY INCENTIVE
TO TAKE RESPONSIBILITY
FOR HER OWN DESIRE TO GET BETTER
28

IN OTHER WORDS
AS A RESULT OF
THE JUDICIOUS AND ONGOING USE
OF CONFLICT STATEMENTS
THAT FORCE THE PATIENT
TO BECOME AWARE OF
– AND TO TAKE RESPONSIBILITY FOR –
HER STATE OF “INTERNAL DIVIDEDNESS”
ABOUT, FOR EXAMPLE, GETTING BETTER
– IN OTHER WORDS, HER “AMBIVALENCE” –
THE THERAPIST WILL BE ABLE
MASTERFULLY TO AVOID GETTING DEADLOCKED
IN A POWER STRUGGLE WITH THE PATIENT
A POWER STRUGGLE THAT
CAN EASILY ENOUGH ENSUE
IF THE THERAPIST TAKES IT UPON HERSELF
TO REPRESENT THE (ADAPTIVE) “VOICE OF REALITY”
BY OVERZEALOUSLY ADVOCATING FOR THE PATIENT
TO DO THE “RIGHT / HEALTHY” THING
– A STANCE THAT THEN LEAVES THE PATIENT, MADE ANXIOUS,
NO CHOICE BUT TO BECOME THE (DEFENSIVE) “VOICE OF OPPOSITION” –
29

PLEASE ALSO NOTE THE IMPLICIT MESSAGE
DELIVERED BY THE THERAPIST
IN THE SECOND PART
OF A CONFLICT STATEMENT
WHEN SHE USES SUCH “TEMPORAL EXPRESSIONS” AS
“FOR NOW” / “RIGHT NOW” / “AT THE MOMENT”
“IN THE MOMENT” / “AT THIS POINT IN TIME”
WHICH SHE WILL DO
WHEN SHE IS ADDRESSING
THE PATIENT’S “INVESTMENT”
IN THE “DYSFUNCTIONAL DEFENSE”
THE THERAPIST IS ATTEMPTING
TO HIGHLIGHT THE FACT
THAT EVEN IF, FOR NOW,
THE PATIENT WOULD SEEM TO BE
ENTRENCHED IN PROTESTING
HER NEED TO MAINTAIN THINGS
AS THEY ARE,
AT ANOTHER POINT IN TIME,
THAT COULD CHANGE
30

FIRST “CHALLENGE” THE DEFENSE TO “PROVOKE” ANXIETY
AND THEN “SUPPORT” THE DEFENSE TO “EASE” IT
“YOU KNOW THAT ULTIMATELY
YOU WILL NEED TO CONFRONT AND GRIEVE THE REALITY
THAT TOM, LIKE YOUR DAD, IS NOT AVAILABLE
IN THE WAYS THAT YOU WOULD HAVE WANTED HIM TO BE
AND THAT UNTIL YOU MAKE YOUR PEACE
WITH THAT PAINFUL REALITY
YOU WILL CONTINUE TO BE MISERABLE.
BUT, IN THE MOMENT, ALL YOU CAN THINK ABOUT
IS WHAT YOU CAN DO TO MAKE HIM LOVE YOU MORE.”
“YOU KNOW THAT SOMEDAY
YOU WILL HAVE TO LET SOMEBODY IN
IF YOU’RE EVER TO HAVE
A MEANINGFUL RELATIONSHIP.
BUT, AT THE MOMENT, THE THOUGHT
OF MAKING YOURSELF THAT VULNERABLE
IS SIMPLY OUT OF THE QUESTION.
THERE IS ABSOLUTELY NO WAY
YOU ARE WILLING TO RUN THE RISK
OF BEING HURT EVER AGAIN.”
31

PARTICULARLY USEFUL FOR “WORKING THROUGH”
THE PATIENT’S “CONFLICTEDNESS”
ABOUT REMAINING ENTRENCHED IN “OLD BAD”
ARE TWO SPECIFIC TYPES OF CONFLICT STATEMENTS
“YOU – KNOW – IT – COULD – BE – BETTER”
CONFLICT STATEMENTS
WHICH HIGHLIGHT
THE “ANXIETY – PROVOKING – BUT ENLIVENING – POSSIBILITY”
OF “NEW GOOD”
AND
“PRICE – PAID”
CONFLICT STATEMENTS
WHICH HIGHLIGHT
THE “ANXIETY – PROVOKING COST”
OF “OLD BAD”
BOTH TYPES ARE STRATEGICALLY DESIGNED
TO GENERATE “GROWTH – INCENTIVIZING DISSONANCE”
32

“YOU – KNOW – IT – COULD – BE – BETTER”
CONFLICT STATEMENTS
TO CREATE
“INTERNAL DISSONANCE”
BETWEEN
THE “ENLIVENING POSSIBILITY”
OF “NEW GOOD”
AND THE “SOBERING REALITY”
OF “OLD BAD”
33

MORE SPECIFICALLY
IN ORDER TO GENERATE TENSION WITHIN THE PATIENT
BETWEEN HER “EVER – EVOLVING AWARENESS”
OF THE DISCREPANCY BETWEEN
THE “POSSIBILITY” OF “SOMETHING NEW, DIFFERENT, AND BETTER”
AND THE “REALITY” OF “SAME OLD, SAME OLD”
WHENEVER POSSIBLE
THE THERAPIST WILL THEREFORE OFFER
“YOU – KNOW – IT – COULD – BE – BETTER” CONFLICT STATEMENTS
THAT HIGHLIGHT BOTH “POSSIBILITY” AND “REALITY”
“YOU KNOW THAT < POSSIBILITY > ... ,
BUT YOU REMAIN < REALITY > EVEN SO ... ”
“YOU KNOW THAT < SOMETHING NEW, DIFFERENT, AND BETTER > ... ,
BUT YOU REMAIN < SAME OLD, SAME OLD > EVEN SO ... ”
IN THE HOPE OF GALVANIZING THE PATIENT
TO “TAKE ACTION”
TO “ACTUALIZE” THE “ENVISIONED POSSIBILITY”
34

MODEL 1
“YOU – KNOW – IT – COULD – BE – BETTER” CONFLICT STATEMENTS
FIRST “CHALLENGE” THE DEFENSE BY “DIRECTING THE PATIENT’S ATTENTION”
TO THE “POSSIBILITY” OF “NEW GOOD”
AND THEN “SUPPORT” THE DEFENSE BY “RESONATING EMPATHICALLY”
WITH THE “REALITY” OF “OLD BAD”
“YOU KNOW THAT IT WOULD BE SO MUCH MORE REWARDING
FOR YOU WERE YOU TO GET A JOB THAT CAPITALIZED UPON
YOUR STRENGTHS AND UPON WHAT YOU MOST ENJOY DOING,
NAMELY, CONNECTING WITH PEOPLE. BUT YOU FIND
YOURSELF HESITATING BECAUSE IT IS SIMPLY TOO OVERWHELMING
TO THINK ABOUT LOSING THE FINANCIAL SECURITY THAT YOU HAVE
IN YOUR CURRENT POSITION AND HAVE WORKED SO HARD TO ACHIEVE .”
“YOU KNOW THAT YOU WILL NOT ACTUALLY BE HAPPY UNTIL
YOU GET OUT OF THE TOXIC RELATIONSHIP WITH JORGE
AND LET YOURSELF FIND SOMEONE WHO WILL REALLY
APPRECIATE – AND LOVE – YOU. BUT THE THOUGHT OF
ENDING IT WITH JORGE, WHEN YOU HAVE SPENT SO MANY
YEARS TRYING TO MAKE IT WORK, IS ABSOLUTELY DEVASTATING –
AND YOUR FEAR IS THAT YOU SIMPLY WOULDN’T SURVIVE.”
35

“PRICE – PAID”
CONFLICT STATEMENTS
TO CREATE
“INTERNAL DISSONANCE”
BETWEEN
THE “PAIN / COST”
OF “OLD BAD”
AND THE (SECONDARY) “GAIN / BENEFIT”
OF “OLD BAD”
36

MORE SPECIFICALLY
IN ORDER TO SPOTLIGHT THE “AMBIVALENCE” OF
THE PATIENT’S “ATTACHMENT” TO HER “DEFENSE”
AND TO GENERATE TENSION WITHIN THE PATIENT
BETWEEN HER “EVER – EVOLVING AWARENESS” OF
BOTH THE “COST” AND THE “BENEFIT”
OF CLINGING TO THE DEFENSE
WHENEVER POSSIBLE
THE THERAPIST WILL THEREFORE OFFER
“PRICE – PAID” CONFLICT STATEMENTS
THAT HIGHLIGHT BOTH THE “PAIN” AND THE “GAIN”
“YOU KNOW THAT < PAIN > ... ,
BUT YOU REMAIN < GAIN > EVEN SO ... ”
“YOU KNOW THAT < PRICE PAID > ... ,
BUT YOU REMAIN < INVESTED IN > EVEN SO ... ”
IN THE HOPE OF MAKING THE “AMBIVALENTLY HELD DEFENSE”
“LESS EGO – SYNTONIC” AND “MORE EGO – DYSTONIC”
AND OF THEREFORE GALVANIZING THE PATIENT TO “TAKE ACTION”
TO “RESOLVE THE INTERNAL DISSONANCE”
AND “RESTORE THE HOMEOSTATIC BALANCE”
37

MODEL 1
“PRICE – PAID” CONFLICT STATEMENTS
FIRST “CHALLENGE” THE DEFENSE BY “DIRECTING THE PATIENT’S ATTENTION”
TO THE “PAIN / COST / PRICE PAID” FOR “OLD BAD”
AND THEN “SUPPORT” THE DEFENSE BY “RESONATING EMPATHICALLY”
WITH THE (SECONDARY) “GAIN / BENEFIT / PAY OFF” OF “OLD BAD”
“YOU KNOW THAT YOU ARE PAYING A STEEP PRICE
FOR YOUR REFUSAL TO STOP SMOKING –
OF PARTICULAR CONCERN
BECAUSE OF YOUR RECURRENT LUNG INFECTIONS.
BUT, AT THIS POINT, YOU ARE NOT QUITE YET PREPARED TO
TAKE THAT STEP BECAUSE YOU FEEL YOU HAVE SO LITTLE
ELSE IN YOUR LIFE THAT GIVES YOU ANY REAL PLEASURE.”
“YOU KNOW THAT YOU WILL NEED SOMEDAY
TO GET SERIOUS ABOUT LOSING THE EXTRA WEIGHT
BECAUSE IT REALLY IS BEGINNING TO IMPACT YOUR HEALTH.
BUT, RIGHT NOW, YOU CAN’T IMAGINE BEING ABLE
TO PUT YOURSELF ON A RESTRICTIVE DIET
BECAUSE YOU ARE ALREADY FEELING SO DEPRIVED
IN ALL THE OTHER AREAS OF YOUR LIFE.”
38

MODEL 1
WHETHER CREATING TENSION
WITHIN THE PATIENT
BY REPEATEDLY HIGLIGHTING
THE “DISCONNECT” BETWEEN
THE “ENLIVENING POSSIBILITY”
OF “NEW GOOD”
AND THE “SOBERING REALITY”
OF “OLD BAD”
OR
THE “PAIN / COST”
OF “OLD BAD”
AND THE “GAIN / BENEFIT”
OF “OLD BAD”
THE THERAPIST WILL BE
GRADUALLY SHIFTING THE BALANCE
FROM THE “GAIN” OF “OLD BAD”
– THE “PAY OFF” –
TO THE “PAIN” OF “OLD BAD”
– THE “PRICE PAID” –
39

“YOU KNOW IT COULD BE BETTER
AND YOU KNOW YOU PAY A PRICE,
BUT YOU REMAIN INVESTED EVEN SO”
IN ESSENCE
ARE STRATEGICALLY FORMULATED
TO GENERATE “COGNITIVE (AND AFFECTIVE) DISSONANCE”
BETWEEN
THE “ADAPTIVE CAPACITY” FOR “AWARENESS”
– YOU KNOW IT COULD BE BETTER AND YOU KNOW YOU PAY A PRICE –
AND THE “DEFENSIVE NEED” TO “RESIST” THAT AWARENESS
AND TO REMAIN ENTRENCHED EVEN SO
– BUT YOU REMAIN INVESTED EVEN SO –
40

A MNEMONIC TO HELP YOU REMEMBER 😊
WHERE “OLD BAD” DEFENSES WERE,
THERE SHALL “NEW GOOD” ADAPTATIONS BE
AS LONG AS THE “GAIN” IS
GREATER THAN THE “PAIN”
– THE DEFENSE MORE “EGO – SYNTONIC” THAN “EGO – DYSTONIC” –
THE PATIENT WILL “MAINTAIN” THE DEFENSE
AND “REMAIN” ENTRENCHED
BUT AS A RESULT
OF THE PATIENT’S “EVER – EVOLVING AWARENESS”
OF BOTH THE “COST” AND THE “BENEFIT”
ONCE THE “PAIN” BECOMES
GREATER THAN THE “GAIN”
– THE DEFENSE MORE “EGO – DYSTONIC” THAN “EGO – SYNTONIC” –
THE STRESS AND “STRAIN” OF THE
“COGNITIVE (AND AFFECTIVE) DISSONANCE”
– THEREBY CREATED –
BETWEEN THE “PAIN” AND THE “GAIN”
WILL BE SUCH THAT
IT WILL PROVIDE THE “IMPETUS” NEEDED
FOR THE PATIENT GRADUALLY … 42

… TO “RELINQUISH HER ATTACHMENT”
TO THE “DYSFUNCTIONAL DEFENSE”
IN ORDER TO
“RESOLVE THE STRUCTURAL CONFLICT”
AND “RESTORE THE HOMEOSTATIC BALANCE”
AS A RESULT OF THIS WORKING THROUGH
OF THE DEFENSE / THE RESISTANCE
THE “NOW STRONGER” AND “MORE INSIGHTFUL” EGO
WILL BE BETTER ABLE TO “REGULATE”
THE ID’S “NOW TAMER” AND “MORE MANAGEABLE” ENERGIES
– AGAIN, FREUD’S WELL – KNOWN “TAME THE ID” AND “STRENGTHEN THE EGO” –
SUCH THAT
– NO LONGER THWARTED BY AN “OVERWHELMED” EGO MADE ANXIOUS –
THE ID’S “POWER” CAN BE “HARNESSED”
BY THE “NOW MORE EMPOWERED” EGO
AND “CHANNELED” INTO
“CONSTRUCTIVE ENDEAVORS”
AND “WORTHWHILE PURSUITS”
– THE ID’S “MODULATED ENERGY”
NOW PROVIDING THE “PROPULSIVE FUEL”
FOR “FORWARD MOVEMENT” –
43

IN OTHER WORDS
ONGOING USE OF OPTIMALLY STRESSFUL CONFLICT STATEMENTS
WILL HAVE “TAMED THE ID” AND “STRENGTHENED THE EGO”
SUCH THAT “ID ENERGY”
– ONCE “REINED IN” BY “EGO RESISTANCE” –
WILL NOW BE “FREED UP” ENOUGH
THAT IT CAN BE USED TO “EMPOWER”
THE “REALIZATION OF LIFE GOALS”
– FOR EXAMPLE, FREUD’S “SUBLIMATION” –
FREUD’S (1937) “HORSE AND RIDER”
IS INDEED AN APT METAPHOR
FOR THE “THERAPEUTIC ACTION” IN MODEL 1
AS A RESULT OF THE WORKING THROUGH PROCESS
FREUD’S RIDER
– A “NOW STRONGER” AND “MORE EMPOWERED” EGO –
WILL HAVE BECOME “MORE SKILLED”
AT “HARNESSING THE POWER” OF THE HORSE
– A “NOW BETTER REGULATABLE” ID –
SUCH THAT HORSE AND RIDER
WILL BE ABLE TO MOVE FORWARD
HARMONIOUSLY AND IN SYNC
– NO LONGER IN “CONFLICT” BUT IN “COLLABORATION” –
44

INDEED
AS THE HORSE (ID) IS “TAMED”
AND THE RIDER (EGO) “STRENGTHENED”
THE “DEFENSIVE NEED” TO
“REIN THE HORSE IN”
WILL HAVE BECOME
INCREMENTALLY TRANSFORMED INTO
THE “ADAPTIVE CAPACITY” TO
“GIVE THE HORSE FREE REIN”
AS “STRUCTURAL CONFLICT”
IS RESOLVED
AND EASES INTO
“STRUCTURAL COLLABORATION”
45

MODEL 2
THE
CORRECTIVE – PROVISION
PERSPECTIVE
OF SELF PSYCHOLOGY AND
OTHER “DEFICIT” THEORIES
“STRUCTURAL DEFICIT”
– THE “IMPAIRED CAPACITY” TO BE A “GOOD PARENT” UNTO ONESELF –
THIS “DEFICIT” CREATES THE “NEED”
THE “NEED” IS TO FIND
IN THE “HERE – AND – NOW”
THE “GOOD PARENT” WHO WAS NOT TO BE FOUND
IN THE “THERE – AND – THEN”
A “NEED” THAT THEN FUELS
THE “RELENTLESSNESS” OF THE PATIENT’S “PURSUITS”
47

THE “THERAPEUTIC ACTION” IN MODEL 2
A CORRECTIVE – PROVISION MODEL
– A DEFICIENCY – COMPENSATION MODEL –
YES, THE MODEL 2 THERAPIST
PROVIDES THE “HOLDING”
AND THE “BEING MET EMPATHICALLY”
THAT WERE NOT
CONSISTENTLY AND RELIABLY
PROVIDED BY THE PARENT
THIS REPARATION FUNCTIONS
AS A “SYMBOLIC CORRECTIVE”
FOR THE EARLY – ON
“RELATIONAL DEPRIVATION AND NEGLECT”
THE EARLY – ON “FAILURES IN ENVIRONMENTAL PROVISION”
BUT THERE IS MORE ...
48

ALTHOUGH SOME MODEL 2 THEORISTS
BELIEVE THAT IT IS
THE “EXPERIENCE OF GRATIFICATION” ITSELF
THAT WILL BE “COMPENSATORY”
AND ULTIMATELY HEALING
MOST BELIEVE THAT IT IS
THE “OPTIMAL STRESS” CREATED BY
THE “EXPERIENCE OF FRUSTRATION
AGAINST A BACKDROP OF GRATIFICATION”
FRUSTRATION – DISILLUSIONMENT – PROPERLY GRIEVED
– THAT IS, “OPTIMAL DISILLUSIONMENT” –
HOWARD BACAL’S (1998) “OPTIMAL RESPONSIVENESS”
THAT WILL PROVIDE
BOTH “IMPETUS” AND “OPPORTUNITY”
FOR “FILLING IN OF STRUCTURAL DEFICIT”
AND “CONSOLIDATION OF THE SELF”
49

AFTER ALL
IF THERE IS NO “THWARTING OF DESIRE,”
THEN THERE WILL BE NOTHING
THAT NEEDS TO BE MASTERED
AND THEREFORE NO “IMPETUS”
FOR “INTERNALIZING” WHATEVER “GOOD SUPPLIES”
– “ENVIRONMENTAL PROVISIONS” –
THERE HAD BEEN PRIOR TO BEING “THWARTED”
THESE “TRANSMUTING INTERNALIZATIONS”
ARE INDEED “ADAPTIVE”
– TRANSMUTING SIGNIFIES “STRUCTURE – BUILDING” –
HEINZ KOHUT (1966)
INASMUCH AS THEY MAKE IT POSSIBLE
FOR THE PATIENT TO “PRESERVE INTERNALLY”
A PIECE OF THE “ORIGINAL EXPERIENCE”
OF “EXTERNAL GOODNESS”
50

OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS
FACILITATE THE “NECESSARY GRIEVING” OF “DISAPPOINTMENTS”
“YOU HAD SO HOPED THAT … ,
BUT YOU ARE BEGINNING TO REALIZE THAT … ,
AND IT DEVASTATES / ENRAGES YOU … ”
THE THERAPEUTIC GOAL IS TO CREATE “GALVANIZING TENSION”
BETWEEN “DEFENSIVE NEED” FOR “RELENTLESS HOPE”
AND “ADAPTIVE CAPACITY” TO “CONFRONT, GRIEVE, AND ACCEPT”
FIRST “HIGHLIGHT” WHAT “HAD BEEN”
THE PATIENT’S “ILLUSION”
– “DEFENSIVE NEED” FOR “RELENTLESS HOPE” –
THEN “HIGHLIGHT” THE “REALITY”
OF THE PATIENT’S “DISILLUSIONMENT”
– “ADAPTIVE CAPACITY” TO “CONFRONT” –
FINALLY, “RESONATE EMPATHICALLY”
WITH THE “PAIN” OF THE PATIENT’S “GRIEF”
– “ADAPTIVE CAPACITY” TO “FEEL” THE ACTUAL “HEARTBREAK” –
51

“YOU HAD SO HOPED THAT I WOULD TELL YOU WHAT TO DO.
BUT YOU ARE BEGINNING TO REALIZE THAT I DON’T SIMPLY
GIVE YOU THE ANSWERS – AND IT INFURIATES YOU.”
“YOU HAD SO HOPED THAT YOUR DAUGHTER
WOULD REACH OUT TO YOU WHEN YOU WERE SICK.
BUT YOU ARE BEGINNING TO REALIZE THAT,
FOR NOW, YOU ARE NOT A TOP PRIORITY FOR HER –
AND IT IS A DEVASTATING LOSS.”
“YOU WOULD SO HAVE WISHED THAT I COULD KNOW WHAT YOU
WERE THINKING WITHOUT YOUR HAVING TO SAY IT.
BUT YOU ARE COMING TO SEE THAT IT DOES NOT ALWAYS
WORK THIS WAY – AND THAT BREAKS YOUR HEART.”
“YOU HAD SO HOPED THAT YOUR HUSBAND WOULD ASK
YOU HOW HE COULD HELP WITH THE DINNER PREPARATIONS.
BUT YOU ARE STARTING TO GET IT THAT OFFERING
TO HELP WITH HOUSEHOLD THINGS LIKE THAT IS NOT
HIS THING – AND IT SADDENS AND UPSETS YOU TERRIBLY.”
52

“YOU HAD SO HOPED THAT WE COULD HAVE A PERSONAL
RELATIONSHIP. BUT YOU ARE COMING TO REALIZE, ALBEIT
RELUCTANTLY, THAT A THERAPY RELATIONSHIP IS NOT REALLY
ABOUT FRIENDSHIP PER SE – AND THAT BREAKS YOUR HEART.”
“YOU HAD SO HOPED THAT YOUR MOTHER WOULD APOLOGIZE. BUT
YOU ARE BEGINNING TO ACCEPT THAT SHE SIMPLY DOES NOT HOLD
HERSELF ACCOUNTABLE, WHICH IS BOTH ENRAGING AND DEVASTATING.”
“ALTHOUGH YOU KNEW IT WOULD TAKE TIME, YOU HAD HOPED THAT YOU
WOULD BE FEELING BETTER AFTER THESE SEVERAL WEEKS OF THERAPY.
IT REALLY UPSETS YOU THAT YOU ARE STILL FEELING SUCH DESPAIR.”
“YOU HAD BEEN HOPING THAT I WOULD NOT MAKE THE SAME KINDS OF
MISTAKES THAT EVERYONE ELSE IN YOUR LIFE HAS, WHICH IS WHY
IT IS SO VERY UPSETTING THAT I, TOO, HAVE NOW LET YOU DOWN.”
“ON SOME LEVEL, YOU KNEW THAT I DIDN’T HAVE ALL THE ANSWERS.
EVEN SO, YOU HAD BEEN HOPING THAT I MIGHT, AND SO IT ENRAGES
YOU WHEN I DON’T SIMPLY ANSWER YOUR QUESTIONS DIRECTLY.”
“YOU HAD SO HOPED THAT I WOULD BE ABLE TO MAKE YOUR PAIN
GO AWAY. BUT YOU ARE BEGINNING TO SEE THAT THERAPY DOES NOT
ACTUALLY WORK THAT WAY. AND IT IS ABSOLUTELY DEVASTATING.” 53

“YOU KNOW THAT EVENTUALLY YOU WILL NEED TO FACE THE REALITY
THAT YOUR FATHER WILL NEVER CHANGE, AND THIS REALIZATION
IS DEVASTATING BECAUSE YOU HAD SO HOPED THAT HE WOULD.”
“YOU ARE BEGINNING TO REALIZE THAT YOUR MOTHER WILL
NEVER UNDERSTAND JUST HOW MUCH SHE HAS HURT
YOU OVER THE COURSE OF THE YEARS. AND IT IS EXCRUCIATINGLY
PAINFUL BECAUSE YOU HAD SO HOPED THAT SOMEDAY
SHE MIGHT ACTUALLY COME TO UNDERSTAND – AND APOLOGIZE.”
“AS YOU BEGIN TO ADMIT TO YOURSELF THAT PROBABLY
PEDRO WILL NEVER BE RIGHT FOR YOU, IT MAKES
YOU INCREDIBLY SAD BECAUSE YOU HAD SO HOPED THAT HE
WOULD EVENTUALLY COME ’ROUND TO LOVING YOU.”
“IN THOSE MOMENTS WHEN YOU LET YOURSELF REMEMBER
JUST HOW LIMITED YOUR FATHER IS AND JUST HOW DEFENSIVE
HE BECOMES WHENEVER YOU TRY TO HOLD HIM ACCOUNTABLE,
IT FEELS TOTALLY OVEWHELMING AND HURTS SO MUCH.
YOU HAD SO HOPED THAT YOU COULD GET HIM TO TAKE AT
LEAST SOME RESPONSIBILITY FOR HIS ABUSIVENESS.”
54

TWO KINDS OF DISILLUSIONMENT STATEMENTS
“GRIEVANCE STATEMENTS”
FOR PATIENTS WHO ARE STILL CLINGING TO
THEIR “DEFENSIVE NEED” TO “AVOID GRIEVING”
– THAT IS, THEIR “REFUSAL TO GRIEVE” –
THE “REALITY” OF THE OBJECT’S “DISILLUSIONMENT” OF THEM
INSTEAD OF CONFRONTING – AND GRIEVING – THAT PAINFUL REALITY,
THEY ARE FILLED WITH “GRIEVANCES” AGAINST THE OBJECT
AND “RELENTLESS – SELF – RIGHTEOUS – OUTRAGE”
“YOU HAD SO HOPED THAT YOUR MOTHER WOULD EVENTUALLY APOLOGIZE
BUT YOU ARE BEGINNING TO REALIZE THAT
PROBABLY SHE NEVER WILL AND THE INJUSTICE OF HER
REFUSAL TO APOLOGIZE FILLS YOU WITH OUTRAGE.”
“GRIEVING STATEMENTS”
FOR PATIENTS WHO HAVE ADVANCED TO THE STAGE WHERE
THEY HAVE THE “ADAPTIVE CAPACITY” TO “CONFRONT AND GRIEVE”
THE “REALITY” OF THE OBJECT’S “DISILLUSIONMENT” OF THEM
“YOU HAD SO HOPED THAT YOUR MOTHER WOULD EVENTUALLY APOLOGIZE
BUT YOU ARE BEGINNING TO REALIZE THAT
PROBABLY SHE NEVER WILL AND THAT REALIZATION ABSOLUTELY
DEVASTATES YOU, ANGERS YOU, AND BREAKS YOUR HEART.”
55

IF ALL GOES WELL
IT WILL BE WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE RELATIONSHIP WITH HER THERAPIST
THAT THE PATIENT WILL BE ABLE, AT LAST,
TO FEEL THE PAIN AGAINST WHICH
SHE HAS SPENT A LIFETIME DEFENDING HERSELF
IN THE PROCESS
GRADUALLY TRANSFORMING
BOTH HER “RELENTLESS NEED”
TO POSSESS AND CONTROL
AND, WHEN THWARTED,
HER “RETALIATORY NEED”
TO PUNISH AND DESTROY
INTO THE “ADAPTIVE CAPACITY”
TO RELENT, TO GRIEVE, TO ACCEPT, TO FORGIVE,
TO INTERNALIZE WHAT GOOD THERE WAS,
TO SEPARATE, TO LET GO, AND TO MOVE ON
ULTIMATELY EVOLVING TO A PLACE OF
APPRECIATION AND GRATITUDE
FOR ALL THE GOOD THAT WAS (AND IS)
56

AS “EXTERNAL GOODNESS” IS INTERNALIZED
AND “STRUCTURAL DEFICIT” FILLED IN
THE “RELENTLESSNESS” WITH WHICH THE PATIENT
HAD BEEN “PURSUING” THE “OBJECTS OF HER DESIRE”
– THAT IS, HER “RELENTLESS HOPE” AND “REFUSAL TO ACCEPT”
THEIR “LIMITATIONS, SEPARATENESS, AND IMMUTABILITY” –
WILL BECOME GRADUALLY “TAMED”
AND SHE WILL EVOLVE TO A PLACE OF
“SERENE ACCEPTANCE”
OF THE SOBERING REALITY
THAT SHE WILL NEVER BE ABLE TO HAVE
ALL THAT SHE SHOULD HAVE HAD AS A CHILD
AND FOR WHICH SHE HAS SPENT
A LIFETIME SEARCHING
BUT THAT “WHAT SHE HAS” IS “GOOD ENOUGH” 😊
57

58
FROM RELENTLESS PURSUIT OF THE UNATTAINABLE
TO SOBER, MATURE ACCEPTANCE OF THE REALITY
THAT IT WAS WHAT IT WAS AND IS WHAT IT IS

GRIEVING
GENUINE GRIEVING REQUIRES OF US THAT
– AT LEAST FOR PERIODS OF TIME –
WE BE FULLY PRESENT WITH
THE ANGUISH OF OUR GRIEF, THE PAIN OF OUR REGRET,
AND THE INTENSITY OF THE RAGE WE EXPERIENCE
WHEN CONFRONTED WITH SOBERING REALITIES ABOUT
OURSELVES, OUR RELATIONSHIPS, AND OUR WORLD
WE MUST NOT ABSENT OURSELVES FROM OUR GRIEF
WE MUST ENTER INTO IT AND EMBRACE IT
WE CANNOT EFFECTIVELY GRIEVE WHEN WE ARE
DISSOCIATED, MISSING IN ACTION, OR FLEEING THE SCENE
WE NEED TO BE ENGAGED, IN THE MOMENT, EMBODIED,
MINDFUL OF ALL THAT IS GOING ON INSIDE OF US,
GROUNDED, FOCUSED, AND IN THE HERE – AND – NOW
IF WE ARE IN DENIAL, SHUT DOWN, CLOSED, NUMB,
REFUSING TO FEEL, OR PROTESTING THE UNFAIRNESS
OF IT ALL, THEN NO REAL GRIEVING CAN BE DONE
59

60
“GRIEF IS NATURE’S WAY
OF HEALING A BROKEN HEART”
ROBERTA BECKMANN (1991)

IN SUM
THE “THERAPEUTIC ACTION” IN MODEL 2
IS A PROTRACTED PROCESS THAT TRANSFORMS
THE PATIENT’S (DEFENSIVE) REFUSAL TO CONFRONT
THE REALITY OF THE OBJECT’S
LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
– WHICH FUELS THE RELENTLESSNESS WITH WHICH SHE PURSUES IT –
INTO THE (ADAPTIVE) CAPACITY TO TOLERATE
AND ACCEPT THOSE DISAPPOINTING REALITIES
IN THE CONTEXT OF THE TREATMENT
IT REQUIRES THAT THE PATIENT
WORK THROUGH HER “OPTIMAL DISILLUSIONMENT”
– THAT IS, WORK THROUGH “POSITIVE TRANSFERENCE DISRUPTED” –
BY CONFRONTING THE “PAIN OF HER GRIEF”
AND “ADAPTIVELY INTERNALIZING” THE
“GOOD THAT HAD BEEN” PRIOR TO THE “DISRUPTION”
ARRIVING ULTIMATELY AT A PLACE OF SERENE
ACCEPTANCE, FORGIVENESS, INNER PEACE, AND REALISTIC HOPE
IF YOU CANNOT ALWAYS COUNT ON RECEIVING IT FROM THE OUTSIDE,
BETTER THAT YOU INTERNALIZE
WHATEVER “EXTERNAL PROVISIONS” YOU CAN SO THAT
THEY WILL ALWAYS BE THERE FOR YOU AS “INTERNAL RESOURCES”
61

HAROLD SEARLES (1979) HAS SUGGESTED
THAT “REALISTIC HOPE”
ARISES IN THE CONTEXT OF
“SURVIVING DISAPPOINTMENT”
62

THE BAD NEWS WILL BE
THE SADNESS THE PATIENT EXPERIENCES
AS SHE BEGINS TO ACCEPT
THE SOBERING REALITY
THAT DISAPPOINTMENT
IS AN INEVITABLE AND NECESSARY
ASPECT OF RELATIONSHIP
THE GOOD NEWS, HOWEVER, WILL BE
THE WISDOM SHE ACQUIRES
AS SHE COMES TO APPRECIATE
EVER – MORE PROFOUNDLY
THE SUBTLETIES AND NUANCES OF RELATIONSHIP
AND BEGINS TO MAKE HER PEACE
WITH THE HARSH REALITY
OF LIFE’S MANY CHALLENGES
SADDER SHE WILL BE, YES, BUT ALSO WISER
63

AS A RESULT OF GENUINE GRIEVING
“GRIEVANCES”
– UNMOURNED DISAPPOINTMENTS –
WILL HAVE BECOME TRANSFORMED INTO
THE HEALTHY CAPACITY TO ACCEPT
THE SOBERING REALITY THAT
WE CANNOT MAKE THE PEOPLE IN OUR WORLD CHANGE
BUT THAT WE CAN
– AND MUST –
TAKE OWNERSHIP OF
– AND RESPONSIBILITY FOR –
ALL THAT WE CAN CHANGE WITHIN OURSELVES
BY THE SAME TOKEN
WE MUST COME TO TERMS WITH
THE SOBERING REALITY THAT
WE CANNOT CHANGE OUR HISTORY
BUT THAT WE CAN
– AND MUST –
CHANGE HOW WE “POSITION” OURSELVES
IN RELATION TO IT
AND HOW WE “POSITION” OURSELVES
IN OUR LIFE GOING FORWARD 65

“TRUE HAPPINESS
IS NOT ABOUT
GETTING WHAT YOU WANT
BUT COMING TO WANT
AND APPRECIATE
WHAT YOU HAVE.”
JAPANESE SAYING
67

68
I AM HERE REMINDED OF THE NEW YORKER CARTOON
IN WHICH A GENTLEMAN, SEATED IN A RESTAURANT
BY THE NAME OF THE DISILLUSIONMENT CAFÉ,
IS AWAITING THE ARRIVAL OF HIS ORDER
THE WAITER RETURNS TO HIS TABLE AND ANNOUNCES,
“YOUR ORDER IS NOT READY, AND NOR WILL IT EVER BE.”

MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
FEATURES
“PATHOGENIC INTROJECTS”
“FILTERS” THAT WILL CONTAMINATE THE PATIENT’S
EXPERIENCE OF SELF, OTHERS, AND THE WORLD
AND GIVE RISE TO “RELATIONAL CONFLICT”
WHEN “DELIVERED” INTO RELATIONSHIPS
THE “HERE – AND – NOW ENGAGEMENT”
BETWEEN TWO “AUTHENTIC SUBJECTS”
AND THE “TURBULENCE” THAT WILL INEVITABLY
ARISE AT THEIR “INTIMATE EDGE”
WHEN THE THERAPIST EITHER
“REACTS DEFENSIVELY” OR “RESPONDS ADAPTIVELY”
TO THE “FORCE FIELD” CREATED BY THE PATIENT’S “PROJECTIONS”
THE “CONTRIBUTIONS” OF BOTH PARTICIPANTS
TO THE “INTERSUBJECTIVE” “IN – BETWEEN”
“CO – CREATION” AND “MUTUALITY OF IMPACT / INFLUENCE”
USE OF THE THERAPIST’S “AUTHENTIC SELF”
TO “FIND” – AND TO BE “FOUND BY” – THE PATIENT
70

OPTIMALLY STRESSFUL
MODEL 3 ACCOUNTABILITY STATEMENTS
– RELATIONAL INTERVENTIONS –
STRATEGICALLY DESIGNED TO TEASE OUT
TRANSFERENCE – COUNTERTRANSFERENCE ENTANGLEMENTS
PROJECTIVE IDENTIFICATIONS / “CRUNCH SITUATIONS” – PAUL RUSSELL (1980)
MUTUAL ENACTMENTS / CO – CREATED THERAPEUTIC IMPASSES
THE THERAPEUTIC ACTION
INVOLVES “NEGOTIATING”
AT THE “INTIMATE EDGE”
OF “AUTHENTIC RELATEDNESS”
THE OVERARCHING GOAL OF WHICH
IS TO TRANSFORM
COMPULSIVE AND UNWITTING “RE – ENACTMENT”
INTO “ACCOUNTABILITY”
AND “RELATIONAL MINDFULNESS”
– ON THE PARTS OF BOTH THERAPIST AND PATIENT –
DEBORAH EDEN TULL (2018)
MINDFULNESS – “PRESENT – MOMENT AWARENESS”
71

PROJECTIVE IDENTIFICATION
BECAUSE THE MODEL 3 THERAPIST
IS PARTICIPATING IN A
“REAL RELATIONSHIP” WITH THE PATIENT
AND BECAUSE THE PATIENT
HAS THE EVER – PRESENT
“RELATIONAL EXPECTATION” OF “BEING FAILED”
INEVITABLY THE THERAPIST
– UNCONSCIOUSLY RECEPTIVE TO THIS
“RELATIONAL NEED” ON THE PART OF THE PATIENT –
WILL FIND HERSELF UNWITTINGLY
DRAWN IN TO PARTICIPATING
AS SOME VARIANT OF
THE PATIENT’S “OLD BAD OBJECT”
– PROJECTIVE IDENTIFICATION IN ACTION –
ALTHOUGH THIS WILL OFTEN GIVE RISE TO “TURBULENCE”
AT THE “INTIMATE EDGE” BETWEEN THERAPIST AND PATIENT,
IT WILL ALSO CREATE BOTH “IMPETUS” AND “OPPORTUNITY”
FOR THE PATIENT TO REWORK HER “INTROJECTED BADNESS” ...
73

... BECAUSE THE PATIENT’S
COMPULSIVE AND UNWITTING RE – ENACTMENTS
ALWAYS HAVE BOTH UNHEALTHY AND HEALTHY COMPONENTS
THE UNHEALTHY COMPONENT
HAS TO DO WITH THE PATIENT’S NEED
TO HAVE MORE OF SAME
– NO MATTER HOW DYSFUNCTIONAL –
BECAUSE THAT IS ALL SHE HAS EVER KNOWN
HAVING SOMETHING DIFFERENT
WOULD CREATE ANXIETY
BECAUSE IT WOULD HIGHLIGHT THE FACT
THAT THINGS COULD BE
– AND COULD THEREFORE HAVE BEEN –
DIFFERENT
BUT THE HEALTHY PIECE
HAS TO DO WITH THE PATIENT’S NEED
TO ACHIEVE BELATED MASTERY
OF THE EARLY – ON RELATIONAL FAILURES
74

MODEL 2 VERSUS MODEL 3
UNLIKE MODEL 2, WHICH PAYS SCANT
ATTENTION TO THE PATIENT’S “PROACTIVITY”
IN RELATION TO THE THERAPIST,
MODEL 3 ADDRESSES ITSELF SPECIFICALLY TO THE
“FORCE FIELD” CREATED BY THE PATIENT WHO
– UNDER THE SWAY OF HER REPETITION COMPULSION –
IS UNWITTINGLY EVER – INTENT UPON RE – CREATING
– BY WAY OF PROJECTIVE IDENTIFICATION –
THE EARLY – ON TRAUMATIC FAILURE SITUATION
BY DRAWING THE THERAPIST IN TO PARTICIPATING
“IN WAYS SPECIFICALLY DETERMINED BY THE
PATIENT’S EARLY – ON DEVELOPMENTAL HISTORY”
PATRICK CASEMENT (1992)
ALL WITH AN EYE TO ENCOUNTERING
A BETTER OUTCOME EACH NEXT TIME
75

IN FACT
THE PATIENT MIGHT KNOW
OF NO OTHER WAY
TO GET SOME UNRESOLVED PIECE
OF HER SUBJECTIVE EXPERIENCE
UNDERSTOOD THAN BY
UNWITTINGLY RE – ENACTING IT
IN THE RELATIONSHIP WITH HER THERAPIST
AND ONLY BY WAY OF RECREATING
WITH HER THERAPIST
THE ONLY KIND OF RELATIONSHIP
SHE HAS EVER KNOWN
WILL THE PATIENT BE ABLE
– AT LAST –
TO NEGOTIATE A DIFFERENT ENDING
76

TWO PHASES OF A PROJECTIVE IDENTIFICATION
MARTHA STARK (1999)
THE “INDUCTION PHASE” COMMENCES ONCE THE PATIENT
PROJECTS ONTO THE THERAPIST SOME ASPECT OF THE PATIENT’S
EXPERIENCE THAT HAS BEEN TOO TOXIC FOR THE PATIENT TO
PROCESS AND INTEGRATE – AND THEN EXERTS PRESSURE ON THE
THERAPIST TO ACCEPT THAT PROJECTION, THEREBY INDUCTING
THE THERAPIST INTO THE PATIENT’S ENACTMENT
THE “RESOLUTION PHASE” IS USHERED IN ONCE THE THERAPIST
STEPS BACK FROM HER PARTICIPATION IN WHAT HAS BECOME A
MUTUAL ENACTMENT AND BRINGS TO BEAR HER OWN,
MORE – EVOLVED CAPACITY TO PROCESS AND INTEGRATE ON
BEHALF OF A PATIENT WHO TRULY DOES NOT KNOW HOW –
SUCH THAT WHAT IS THEN RE – INTROJECTED BY THE PATIENT CAN
BE MORE EASILY ASSIMILATED INTO HEALTHY PSYCHIC STRUCTURE
AND, IF ALL GOES WELL, THESE ITERATIVE CYCLES WILL HAPPEN
REPEATEDLY, THE NET RESULT OF WHICH WILL BE “GRADUAL
DETOXIFICATION” OF THE PATIENT’S “INTERNAL PATHOGENICITY”
77

ALTHOUGH INEVITABLY THE THERAPIST WILL
FAIL THE PATIENT IN MANY OF THE SAME
WAYS THAT THE PARENT HAD FAILED HER
ULTIMATELY, THE THERAPIST MUST CHALLENGE THE
PATIENT’S PROJECTIONS BY LENDING ASPECTS OF HER
“OTHERNESS” OR “EXTERNALITY” TO THE INTERACTION
DONALD WINNICOTT (1949)
SUCH THAT THE PATIENT WILL HAVE
THE EXPERIENCE OF SOMETHING THAT IS
“OTHER – THAN – ME” AND CAN “TAKE THAT IN”
IN ESSENCE, THE THERAPIST WILL
“CONTAIN” THE PATIENT’S PROJECTIONS
BY LENDING ASPECTS OF HER OWN, GREATER
CAPACITY TO PROCESS AND INTEGRATE
SUCH THAT THE PATIENT WILL HAVE
THE EXPERIENCE OF “TAKING IN” SOMETHING
THAT IS NOW MORE PROCESSED,
LESS TOXIC, AND MORE MANAGEABLE
78

IN ESSENCE
WHAT THE PATIENT RE – INTROJECTS
WILL BE AN “AMALGAM”
PART CONTRIBUTED
BY THE PATIENT
THE ORIGINAL
– UNPROCESSED AND TOXIC –
PROJECTION
AND PART CONTRIBUTED
BY THE THERAPIST
SOMETHING
MORE PROCESSED AND LESS TOXIC
79

CLINICAL VIGNETTE
THE “SHARING” OF GRIEF
A PATIENT’S BELOVED GRANDMOTHER
HAS JUST DIED
THE PATIENT, UNABLE TO FEEL HIS SADNESS
BECAUSE IT HURTS “TOO MUCH,”
RECOUNTS IN A MONOTONE
THE DETAILS OF HIS GRANDMOTHER’S DEATH
AS THE THERAPIST LISTENS, SHE BECOMES VERY SAD
AS THE PATIENT CONTINUES,
THE THERAPIST FINDS HERSELF UTTERING,
ALMOST INAUDIBLY, AN OCCASIONAL
“OH, NO!” AND “THAT’S AWFUL!”
AS THE HOUR PROGRESSES,
THE PATIENT HIMSELF
BECOMES INCREASINGLY SAD
80

CLINICAL VIGNETTE – THE “SHARING” OF GRIEF
IN THIS EXAMPLE, THE PATIENT IS INITIALLY UNABLE TO FEEL
THE DEPTHS OF HIS GRIEF ABOUT HIS GRANDMOTHER’S DEATH
BUT BY REPORTING THE DETAILS IN THE “MONOTONIC” MANNER IN
WHICH HE DOES, THE PATIENT IS ABLE TO GET THE THERAPIST TO FEEL
WHAT HE HIMSELF CANNOT – AND INSTEAD MUST DEFEND AGAINST
IN ESSENCE, THE PATIENT EXERTS “INTERPERSONAL PRESSURE” UPON
THE THERAPIST TO TAKE ON, AS THE THERAPIST’S OWN,
WHAT THE PATIENT DOES NOT YET HAVE THE CAPACITY TO TOLERATE
AS THE THERAPIST SITS WITH THE PATIENT AND LISTENS TO HIS STORY,
SHE FINDS HERSELF BECOMING VERY SAD, WHICH SIGNALS THE
THERAPIST’S QUIET ACCEPTANCE OF THE PATIENT’S DISAVOWED GRIEF
THE INDUCTION PHASE OF THE PROJECTIVE IDENTIFICATION
WE COULD SAY OF THE PATIENT’S SADNESS THAT IT HAS FOUND
ITS WAY INTO THE THERAPIST, WHO, ABLE TO TOLERATE WHAT
THE PATIENT FINDS INTOLERABLE, TAKES IT ON “AS HER OWN”
THE THERAPIST’S SADNESS IS THEREFORE CO – CREATED –
IN PART A STORY ABOUT THE PATIENT (AND HIS DISAVOWED GRIEF)
AND IN PART A STORY ABOUT THE THERAPIST
– IN WHOM A RESONANT CHORD HAS BEEN STRUCK – 81

CLINICAL VIGNETTE – THE “SHARING” OF GRIEF
THE THERAPIST, WITH HER GREATER CAPACITY TO EXPERIENCE
AFFECT WITHOUT NEEDING TO DEFEND AGAINST IT, IS ABLE
BOTH TO TOLERATE THE SADNESS THAT THE PATIENT FINDS
INTOLERABLE AND TO PROCESS AND INTEGRATE IT
WHICH INITIATES THE RESOLUTION PHASE OF THE PROJECTIVE IDENTIFICATION
THE THERAPIST “FEELS” IT BUT IS “NOT OVERWHELMED” BY IT
IT IS THE THERAPIST’S ABILITY TO TOLERATE THE INTOLERABLE
THAT MAKES THE PATIENT’S PREVIOUSLY UNMANAGEABLE
FEELINGS MORE MANAGEABLE FOR HIM
INDEED, THE PATIENT’S GRIEF BECOMES LESS TERRIFYING BY
VIRTUE OF THE FACT THAT THE THERAPIST HAS BEEN ABLE
TO CONTAIN IT BY CARRYING THAT GRIEF ON THE PATIENT’S BEHALF
A MORE ASSIMILABLE VERSION OF THE PATIENT’S SADNESS IS THEN
RETURNED TO THE PATIENT IN THE FORM OF THE THERAPIST’S
HEARTFELT UTTERANCES – “OH, NO!” AND “THAT’S AWFUL!”
SUCH THAT THE PATIENT FINDS HIMSELF NOW ABLE
TO BEAR THE PAIN OF HIS OWN GRIEF
– NOW ABLE TO CARRY THAT PAIN ON HIS OWN BEHALF –
– NOW ABLE TO TOLERATE WHAT HAD ONCE BEEN INTOLERABLE – 82

CLINICAL VIGNETTE – “GREAT TAN, BITCH!”
THE PATIENT, JANET, IS A 31 – YEAR – OLD MARRIED WOMAN
WHO HAS A HISTORY OF DIFFICULT RELATIONSHIPS
WITH ALMOST EVERYONE IN HER LIFE
SHE IS PARTICULARLY TROUBLED BY
HER LACK OF CLOSE WOMEN FRIENDS
JANET HAS BEEN WORKING HARD IN THE TREATMENT,
HAS MADE SUBSTANTIAL GAINS IN HER PROFESSIONAL LIFE,
AND HAS VERY MUCH IMPROVED THE QUALITY
OF HER RELATIONSHIP WITH HER HUSBAND
JANET AND HER THERAPIST (A WOMAN) HAVE HAD
A GOOD, RELATIVELY UNCONFLICTED RELATIONSHIP
JANET CLEARLY LIKES, AND IS RESPECTFUL OF, THE THERAPIST
UPON THE THERAPIST’S RETURN FROM A WEEK – LONG VACATION
IN FLORIDA, JANET, AT THE END OF THE SESSION AND JUST
AS SHE IS LEAVING, TURNS BACK TO HER THERAPIST AND,
AS HER PARTING SHOT, BLURTS OUT, “GREAT TAN, BITCH!”
THE THERAPIST, TAKEN ABACK AND AT A LOSS FOR WORDS,
SAYS NOTHING, SMILES LAMELY, AND NODS GOODBYE
83

ALTHOUGH DURING THE SESSION THE THERAPIST (MADE ANXIOUS)
HAD “REACTED DEFENSIVELY” BY “GOING BLANK,”
BETWEEN SESSIONS THE THERAPIST IS ABLE TO “RECOVER HER
THERAPEUTIC EFFECTIVENESS” BY “STEPPING BACK” ENOUGH
FROM HER EXPERIENCE OF HAVING BEEN “SLAMMED”
THAT – NOW LESS ANXIOUS – SHE IS ABLE TO “RESPOND ADAPTIVELY”
AND, THEREFORE, OPENS THE NEXT SESSION WITH –
“WE HAVE TALKED A LOT ABOUT HOW UPSETTING
IT IS FOR YOU TO HAVE SO FEW WOMEN FRIENDS.
“I THINK THAT NOW, IN LIGHT OF WHAT HAPPENED
AT THE END OF OUR LAST SESSION,
I AM COMING TO UNDERSTAND SOMETHING
THAT I HAD NEVER BEFORE COMPLETELY UNDERSTOOD.
“WHEN YOU LEFT LAST TIME,
YOUR PARTING WORDS WERE ‘GREAT TAN, BITCH!’
“I WONDER IF, BY SAYING THAT, YOU WERE TRYING
TO SHOW ME WHAT SOMETIMES HAPPENS FOR YOU
WHEN YOU FEEL CLOSE TO A WOMAN
AND THEN FIND YOURSELF BECOMING COMPETITIVE.”
HERE THE THERAPIST IS COURAGEOUSLY USING HER “EXPERIENCE OF SELF”
– HER COUNTERTRANSFERENTIAL REACTION OF “BEING PUT OFF” –
TO “SHINE A LIGHT ON” A CRITICALLY IMPORTANT PIECE
OF THE PATIENT’S “DYSFUNCTIONAL RELATIONAL DYNAMICS”
84

MUCH IS REQUIRED OF THE MODEL 3 THERAPIST
FOR HER TO BE ABLE EVENTUALLY TO
“RESPOND ADAPTIVELY” INSTEAD OF “REACTING DEFENSIVELY”
TO THE PATIENT’S DELIVERY OF
HER “DYSFUNCTIONAL RELATIONAL DYNAMICS”
INTO THE THERAPEUTIC RELATIONSHIP
THE THERAPIST MUST FIRST BE ABLE
TO TOLERATE “BEING MADE INTO”
THE PATIENT’S “OLD BAD OBJECT”
AND ONCE SHE HAS ALLOWED HERSELF
TO BE DRAWN IN TO PARTICIPATING
IN WHAT CAN SOMETIMES BECOME
A VERY MESSY
TRANSFERENCE / COUNTERTRANSFERENCE
ENTANGLEMENT,
SHE MUST THEN BE ABLE
TO “EXTRICATE” HERSELF
BY STEPPING BACK
WHICH WILL ENABLE HER TO RECOVER HER “OBJECTIVITY”
AND, THEREBY, HER “THERAPEUTIC EFFECTIVENESS”
85

IN ESSENCE
THE THERAPIST MUST HAVE
THE “CAPACITY TO RELENT”
FURTHERMORE
THE THERAPIST MUST HAVE
BOTH THE “WISDOM TO RECOGNIZE”
AND THE “INTEGRITY TO ACKNOWLEDGE”
– CERTAINLY TO HERSELF
AND PERHAPS TO THE PATIENT AS WELL –
HER OWN PARTICIPATION IN THE DRAMA
THAT IS BEING PLAYED OUT BETWEEN THEM
ON THE STAGE OF THE TREATMENT
IN OTHER WORDS
THE THERAPIST MUST HAVE THE “CAPACITY”
BOTH TO “RELENT”
AND TO “HOLD HERSELF ACCOUNTABLE”
FOR HER “COUNTERTRANSFERENTIAL ENACTMENT”
86

IN ESSENCE
PROJECTIVE IDENTIFICATION
INVOLVES SYMBOLIC
REPETITION OF THE
ORIGINAL RELATIONAL TRAUMA
BUT WITH A MUCH HEALTHIER
RESOLUTION THIS TIME
– “ADAPTIVE RESOLUTION” –
AT THE END OF THE DAY
THE HALLMARK OF
A SUCCESSFUL PROJECTIVE IDENTIFICATION
IS THE THERAPIST’S CAPACITY TO TOLERATE
WHAT THE PATIENT FINDS INTOLERABLE
87

OPTIMALLY STRESSFUL MODEL 3 CONTAINING STATEMENTS
FOR THOSE 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.”
“AT TIMES LIKE THIS, YOU THINK ABOUT NEVER COMING BACK
BECAUSE IT HURTS TOO MUCH TO BE HERE;
BUT WE BOTH KNOW THAT,
IF YOU’RE EVER TO GET BETTER, THEN SOMEDAY YOU’RE
GOING TO HAVE TO GIVE SOMEBODY A SECOND CHANCE.”
“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.”
88

THE OPTIMALLY STRESSFUL “RULE OF THREE”
IS DESIGNED TO INSIST THAT THE “RE – ENACTING” PATIENT
TAKE RESPONSIBILITY FOR HER “PROVOCATIVE ENACTMENTS”
MORE SPECIFICALLY, THE “RULE OF THREE” BECOMES RELEVANT
WHENEVER A PATIENT SAYS OR DOES SOMETHING
THAT THE THERAPIST EXPERIENCES AS PROVOCATIVE
– A “PROVOCATIVE ENACTMENT” –
IN ORDER TO COMPEL THE PATIENT TO TAKE OWNERSHIP OF
WHAT SHE IS “PLAYING OUT” ON THE STAGE OF THE TREATMENT,
THE THERAPIST CAN ASK THE PATIENT ANY OF THE FOLLOWING –
“HOW ARE YOU HOPING THAT I WILL RESPOND?”
WHICH ADDRESSES THE ID
“HOW ARE YOU FEARING THAT I MIGHT RESPOND?”
WHICH ADDRESSES THE SUPEREGO
“HOW ARE YOU IMAGINING THAT I WILL RESPOND?”
WHICH ADDRESSES THE EXECUTIVE FUNCTIONING OF THE EGO
– THE DORSOLATERAL PREFRONTAL CORTEX (DLPFC) OF THE BRAIN –
ALL THREE “RELATIONAL INTERVENTIONS” DEMAND OF THE PATIENT
THAT SHE MAKE HER “INTERPERSONAL INTENTIONS” MORE EXPLICIT
89

OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
MORE GENERALLY, THE THERAPIST MIGHT CHOOSE TO SHARE –
SOMETHING ABOUT HER OWN EXPERIENCE
OF BEING IN THE ROOM WITH THE PATIENT
OR HER OWN STATE OF INTERNAL CONFLICTEDNESS
AS A RESULT OF SOMETHING HAPPENING BETWEEN THEM
ALTERNATIVELY, THE THERAPIST MIGHT CHOOSE TO HIGHLIGHT –
HOW THE PATIENT GETS OTHERS TO DO UNTO HER
IN THE HERE – AND – NOW
SOME VERSION OF WHAT HAD BEEN DONE UNTO HER
IN THE THERE – AND – THEN
– “DIRECT NEGATIVE TRANSFERENCE” –
WITNESS, FOR EXAMPLE, THE CONCEPT OF “DOER AND DONE TO”
JESSICA BENJAMIN (2017)
OR HOW THE PATIENT DOES UNTO OTHERS
IN THE HERE – AND – NOW
SOME VERSION OF WHAT HAD BEEN DONE UNTO HER
IN THE THERE – AND – THEN
– “INVERTED NEGATIVE TRANSFERENCE” –
WITNESS, FOR EXAMPLE, THE CONCEPT OF “IDENTIFICATION WITH THE AGGRESSOR”
SANDOR FERENCZI (1995) / ANNA FREUD (1979)
90

AS ADDITIONAL EXAMPLES
THE THERAPIST MIGHT CHOOSE TO SHARE SOMETHING ABOUT
HER EXPERIENCE OF BEING IN THE ROOM WITH THE PATIENT
“IT WOULD SEEM THAT I AM IN THE DOG HOUSE THESE DAYS!”
“I WONDER IF THE FRUSTRATION AND HELPLESSNESS
I AM FEELING NOW IN RELATION TO YOU IS SIMILAR
TO THE FRUSTRATION AND HELPLESSNESS YOU HAVE
SPOKEN OF HAVING FELT IN RELATION TO YOUR FATHER.”
“YOU TELL ME SOMETHING ABOUT YOURSELF. I AM
JUST IN THE PROCESS OF DIGESTING IT AND STORING
IT FOR FURTHER UNDERSTANDING OF YOU AND THEN
ALONG YOU COME – WHAM! – AND TELL ME THAT
WHAT I HAVE DIGESTED AND STORED INSIDE ME
DID NOT COME FROM YOU AT ALL. THE PROBLEM I
FIND IS HOW TO LIVE WITH THE DESPAIR I FEEL
OCCASIONED BY YOUR DISAPPEARANCES.”
CHRISTOPHER BOLLAS (1989) 91

CAN BE INTRODUCED IN ANY OF THE FOLLOWING WAYS –
“IT OCCURS TO ME THAT, BY WAY OF YOUR
BEHAVIOR IN HERE WITH ME, YOU ARE HELPING
ME TO UNDERSTAND SOMETHING THAT
I HAD NEVER BEFORE ENTIRELY UNDERSTOOD … ”
“I THINK THAT YOU HAVE BEEN TRYING TO
COMMUNICATE SOMETHING IMPORTANT TO ME
THAT I HAD BEEN REFUSING TO SEE … ”
“I WONDER IF MY DIFFICULTY APPRECIATING
JUST HOW DESPERATE YOU WERE MADE
YOU FEEL THAT YOU HAD TO DO SOMETHING
DRAMATIC IN ORDER TO GET MY ATTENTION … ”
DON’T HESITATE TO “THROW YOURSELF UNDER THE BUS”
92

AS IRWIN HOFFMAN (2001) HAS SUGGESTED
IF THE THERAPIST IS AWARE OF FEELING CONFLICTED IN
RELATION TO THE PATIENT, SHE MAY CHOOSE TO SHARE
THE FACT OF THIS CONFLICTEDNESS WITH THE PATIENT
“I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’”
HERE THE THERAPIST IS EXPRESSING ALOUD THE CONFLICT WITH
WHICH SHE IS STRUGGLING – A CONFLICT THAT MIGHT WELL BE
REFLECTIVE OF THE PATIENT’S OWN INTERNAL STATE OF DIVIDEDNESS
“I AM TEMPTED TO GIVE YOU THE ADVICE FOR
WHICH YOU ARE LOOKING, BUT MY FEAR IS THAT
WERE I TO DO SO, I WOULD BE ROBBING YOU OF
THE IMPETUS TO FIND YOUR OWN ANSWERS.”
“I FIND MYSELF FEELING ANGRY WITH YOU FOR BEING SO OFTEN
LATE AND WANTING YOU TO UNDERSTAND HOW IT IMPACTS ME.
BUT THEN IT OCCURS TO ME THAT IT MIGHT BE MORE IMPORTANT
FOR US TO TRY TO UNDERSTAND WHAT YOU MIGHT BE WANTING
TO COMMUNICATE TO ME BY WAY OF YOUR FREQUENT LATENESS.”
93

“I WANT TO TELL YOU ‘X,’ BUT I AM AFRAID THAT ‘Y.’”
“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.”
94

“I WONDER IF THIS FEELING I HAVE IN RELATION
TO YOU THAT NO MATTER WHAT I SAY IT WON’T BE
GOOD ENOUGH IS LIKE THE FEELING YOU HAVE SPOKEN
OF HAVING HAD IN RELATION TO YOUR FATHER,
FOR WHOM NOTHING WAS EVER GOOD ENOUGH.”
“I FIND MYSELF FEELING SO ANGRY AT YOUR MOTHER.
I WONDER IF SOME OF THOSE FEELINGS ARE ACTUALLY
A STORY ABOUT FEELINGS YOU HAVE ABOUT YOUR MOTHER –
FEELINGS YOU WOULD RATHER NOT HAVE TO ACKNOWLEDGE.”
“IT OCCURS TO ME THAT WE HAVE MANAGED TO RECREATE
IN HERE THE VERY SAME DYNAMIC THAT HAD CHARACTERIZED YOUR
RELATIONSHIP WITH YOUR DOUBLE – BINDING FATHER –
NAMELY, THE FEELING WE BOTH HAVE THAT
NO MATTER WHAT EITHER OF US MIGHT DO,
IT WOULDN’T GET THE OTHER’S APPROVAL!
BUT ALL OF THIS, PAINFUL AS IT IS, GIVES US AN OPPORTUNITY
TO EXPERIENCE, FIRSTHAND, HOW TOXIC
THE RELATIONSHIP WITH YOUR FATHER REALLY WAS –
EXCEPT THAT NOW WE CAN DO SOMETHING ABOUT IT!”
95

MODEL 3 IS ULTIMATELY A STORY ABOUT
THE THERAPIST’S “USE” OF HER “AUTHENTIC SELF”
– HER “COUNTERTRANSFERENCE” –
TO PROVIDE “CONTAINMENT”
AND THEREBY TO FACILITATE “MODIFICATION” OF
THE PATIENT’S “SENSE OF SELF” AS “BAD”
MORE SPECIFICALLY
MODIFYING THE PATIENT’S
“SENSE OF SELF” AS “BAD”
WILL REQUIRE “TOUGHING IT OUT”
AT THE “INTIMATE EDGE”
OF “AUTHENTIC RELATEDNESS”
BOTH PARTICIPANTS
BRINGING HEART AND SOUL TO
THE “INTERSUBJECTIVE IN – BETWEEN”
SUCH THAT THIS TIME
THERE CAN INDEED BE A “DIFFERENT OUTCOME”
96

AT THE END OF THE DAY
THE RELATIONAL PERSPECTIVE
OF MODEL 3 IS A STORY
ABOUT TRANSFORMING
THE PATIENT’S “DEFENSIVE NEED”
TO RE – ENACT
– COMPULSIVELY AND UNWITTINGLY –
HER UNMASTERED EARLY – ON
RELATIONAL DRAMAS
ON THE STAGE OF HER LIFE
INTO THE “ADAPTIVE CAPACITY”
TO TAKE RESPONSIBILITY FOR
HER DYSFUNCTIONAL WAYS OF
ACTING, REACTING, AND INTERACTING
97

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
100

THE END OF MASTER CLASS Part 2
Saturday / February 4, 2023
101

IF YOU WOULD LIKE
TO BE ON MY
MAILING LIST,
PLEASE EMAIL ME AT
MarthaStarkMD @
SynergyMed.solutions
TO LET ME KNOW
AND MY WEBSITE IS
www.SynergyMed.solutions
103

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