1. GRIEVING THE LOSS
OF RELENTLESS HOPE
AND EVOLVING
TOWARDS ACCEPTANCE
MARTHA STARK MD
MarthaStarkMD @ HMS.Harvard.edu
Thursday, April 13, 2023 – 5:10 – 5:55 pm (ET)
CHA Department of Psychiatry
© 2023 Martha Stark MD
1

2. TWO OF MY FAVORITE CONCEPTS
OPTIMAL STRESS
– NOT ALL STRESS IS “BAD” –
TRAUMATIC STRESS IS “BAD”
BUT OPTIMAL STRESS IS “GOOD”
RELENTLESS HOPE
– NOT ALL HOPE IS “GOOD” –
REALISTIC HOPE IS “GOOD”
BUT RELENTLES HOPE IS “BAD”
2

3. OVERVIEW
RELENTLESS HOPE AS A DEFENSE AGAINST GRIEVING THE REALITY
OF THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
FAIRBAIRN’S “SEDUCTIVE” – EXCITING / REJECTING – OBJECT
AS AN EXPLANATION FOR THE “AMBIVALENCE” OF
THE PATIENT’S ATTACHMENT TO THE “BAD” OBJECT
– AND THE “ADHESIVENESS” OF THAT ATTACHMENT –
“OPTIMALLY STRESSFUL” GROWTH – INCENTIVIZING
DISILLUSIONMENT STATEMENTS
TO FACILITATE THE GRIEVING OF DISILLUSIONMENT
– AND THE LOSS OF ILLUSIONS – RELENTLES HOPE – ABOUT THE “OBJECT OF ONE’S DESIRE” –
GRIEVING AS TAKING OWNERSHIP OF BOTH DEVASTATION AND RAGE
“ADAPTIVE INTERNALIZATIONS” AS A RESULT OF GRIEVING
– WHEREBY WHATEVER “GOOD” THE OBJECT HAD OFFERED WILL BE TAKEN IN –
ULTIMATELY, EVOLUTION OF THE PATIENT
TO SOBER, MATURE ACCEPTANCE OF THE HARSH REALITY
THAT IT WAS WHAT IT WAS AND IS WHAT IT IS
BUT ALSO APPRECIATION
3

4. “PRETENDING
THAT IT CAN BE
WHEN IT CAN’T
IS HOW PEOPLE
BREAK THEIR HEARTS”
ELVIN SEMRAD (2003)
4

5. RELENTLESS HOPE
MARTHA STARK (2017)
A DEFENSE TO WHICH
THE PATIENT CLINGS
IN ORDER
NOT TO HAVE TO FEEL
THE PAIN OF HER DISAPPOINTMENT
IN THE OBJECT
THE HOPE A DEFENSE
ULTIMATELY AGAINST GRIEVING
5

6. THE PATIENT’S REFUSAL TO DEAL WITH
THE PAIN OF HER GRIEF ABOUT THE OBJECT
FUELS THE RELENTLESSNESS
WITH WHICH SHE PURSUES IT
BOTH THE RELENTLESSNESS OF HER HOPE
– THINK “LIBIDO” –
THAT SHE MIGHT YET BE ABLE
TO MAKE THE OBJECT OVER INTO WHAT
SHE WOULD WANT IT TO BE
AND THE RELENTLESSNESS OF THE OUTRAGE
– THINK “AGGRESSION” –
SHE EXPERIENCES IN THOSE MOMENTS
OF DAWNING RECOGNITION THAT
– DESPITE HER BEST EFFORTS AND MOST FERVENT DESIRE –
SHE MIGHT NEVER BE ABLE
TO MAKE THAT ACTUALLY HAPPEN
6

7. EQUALLY IMPORTANTLY
WHAT FUELS THE RELENTLESSNESS
OF THE PATIENT’S PURSUIT
IS THE FACT THAT THE OBJECT
IS OUTSIDE THE SPHERE OF HER OMNIPOTENCE
– THINK WINNICOTT –
AND IS THEREFORE UNABLE
TO BE EITHER POSSESSED OR CONTROLLED
INDEED
UNDERLYING THE PATIENT’S RELENTLESS PURSUIT IS
AN “ILLUSION” THAT SHE HAS “OMNIPOTENT CONTROL”
OVER THE OBJECT OF HER DESIRE
AN ILLUSION OFTEN ACCOMPANIED BY
AN ENTITLED SENSE THAT SOMETHING IS HER DUE
7

8. PARADOXICALLY
SUCH PATIENTS ARE NEVER RELENTLESS
IN THEIR PURSUIT OF GOOD OBJECTS
INSTEAD
THEIR RELENTLESS PURSUIT
IS OF THE BAD OBJECT
IN OTHER WORDS
IT IS NEVER ENOUGH THAT THE PATIENT SIMPLY FIND
A NEW GOOD OBJECT TO COMPENSATE
FOR HOW BAD THE OLD ONE HAD BEEN
RATHER
THE COMPELLING NEED BECOMES FIRST TO CREATE
– OR, MORE ACCURATELY, TO RE – CREATE –
THE OLD BAD OBJECT
AND THEN TO PRESSURE, MANIPULATE,
PROD, FORCE, COERCE
THIS OLD BAD OBJECT TO CHANGE
8

9. A POPULAR SONG
THAT SPEAKS DIRECTLY
TO THIS ISSUE
OF THE PATIENT’S
RELENTLESS NEED TO RECREATE
THE EARLY – ON TRAUMATIC FAILURE SITUATION
IS A ROCK SONG BY
THE LATE WARREN ZEVON (2007)
ENTITLED
“IF YOU WON’T LEAVE ME
I’LL FIND SOMEBODY WHO WILL”
9

10. THE PATIENT CAN REFIND THE OLD BAD OBJECT
IN ANY ONE OF THREE WAYS
SHE CAN CHOOSE A GOOD OBJECT
AND THEN EXPERIENCE IT AS BAD
– PROJECTION –
SHE CAN CHOOSE A GOOD OBJECT
AND THEN EXERT INTERPERSONAL PRESSURE ON IT
TO BECOME BAD
– PROJECTIVE IDENTIFICATION –
OR
SHE CAN SIMPLY CHOOSE A BAD OBJECT
TO BEGIN WITH
10

11. 11

12. AGAIN
CHOOSING A GOOD OBJECT
IS NOT A VIABLE OPTION
A GOOD OBJECT SIMPLY WILL NOT SATISFY
RATHER, THE PATIENT’S NEED
– FUELED BY HER REPETITION COMPULSION –
WILL BE TO RE – ENCOUNTER THE OLD BAD OBJECT
AND THEN TO COMPEL THIS BAD OBJECT
TO BECOME GOOD
WHICH WILL THEN SYMBOLICALLY CORRECT FOR
THE UNMASTERED RELATIONAL TRAUMAS
THAT THE PATIENT HAD EXPERIENCED EARLY – ON
AT THE HANDS OF THE INFANTILE OBJECT
12

13. AGAIN
THE PATIENT’S REFUSAL TO DEAL WITH
THE PAIN OF HER GRIEF ABOUT THE OBJECT
– AND THE FACT THAT IT CANNOT BE CONTROLLED –
FUELS THE RELENTLESSNESS
WITH WHICH SHE PURSUES IT
BOTH THE RELENTLESSNESS
OF HER ENTITLED SENSE
THAT SOMETHING IS HER DUE
AND THE RELENTLESSNESS
OF HER OUTRAGE
IN THE FACE OF ITS BEING DENIED
HOPING AGAINST HOPE
SHE PURSUES THE OBJECT OF HER DESIRE
WITH A VENGEANCE
REFUSING TO RELENT, REFUSING TO ACCEPT,
REFUSING TO FORGIVE
13

14. 14

15. FAIRBAIRN’S INTENSE ATTACHMENTS (1963)
“A BAD OBJECT IS INFINITELY BETTER
THAN NO OBJECT AT ALL”
ACCOUNTS IN LARGE PART
FOR THE RELENTLESSNESS
WITH WHICH PATIENTS
PURSUE THE UNATTAINABLE
BOTH THE RELENTLESSNESS
OF THEIR UNREALISTIC HOPE
AND ENTITLED SENSE
THAT SOMETHING IS THEIR DUE
AND THE RELENTLESSNESS
OF THEIR UNWAVERING OUTRAGE
IN THE FACE OF ITS BEING DENIED
15

16. MANY THEORISTS HAVE WRITTEN
ABOUT INTERNAL BAD OBJECTS TO WHICH
THE PATIENT IS FIERCELY ATTACHED
BUT FEW HAVE ADDRESSED
THE CRITICAL ISSUE OF WHAT EXACTLY
FUELS THESE INTENSE ATTACHMENTS
IT IS TO FAIRBAIRN THAT WE MUST LOOK
TO UNDERSTAND THE SPECIFIC NATURE
OF THE PATIENT’S INTENSE ATTACHMENTS
TO HER INTERNAL BAD OBJECTS
ATTACHMENTS THAT MAKE IT DIFFICULT
FOR HER TO SEPARATE FROM THEM
WHICH SHE MUST DO IF SHE IS
EVER TO EXTRICATE HERSELF
FROM HER RELENTLESS PURSUITS
AND HER COMPULSIVE RE – ENACTMENTS
16

17. HOW ARE BAD EXPERIENCES
AT THE HANDS OF THE INFANTILE OBJECT
INTERNALLY RECORDED AND STRUCTURALIZED?
FAIRBAIRN WRITES –
WHEN A CHILD’S NEED FOR CONTACT
IS FRUSTRATED BY THE PARENT,
THE CHILD DEALS WITH HER FRUSTRATION
BY DEFENSIVELY INTROJECTING THE BAD PARENT
IT IS AS IF THE CHILD FINDS IT INTOLERABLY PAINFUL
TO BE DISAPPOINTED BY THE PARENT AND SO THE CHILD
– TO PROTECT HERSELF AGAINST THE PAIN OF
HAVING TO KNOW JUST HOW BAD THE PARENT REALLY IS –
INTROJECTS THE PARENT’S BADNESS
– IN THE FORM OF AN INTERNAL BAD OBJECT (PATHOGENIC INTROJECT) –
BASICALLY
THE CHILD TAKES THE BURDEN OF
THE PARENT’S BADNESS UPON HERSELF IN ORDER
NOT TO HAVE TO FEEL THE PAIN OF HER GRIEF
17

18. DEFENSIVE INTROJECTION OF THE PARENT’S BADNESS
HAPPENS ALL THE TIME IN SITUATIONS OF ABUSE
THE PATIENT WILL RECOUNT EPISODES OF
OUTRAGEOUS ABUSE AT THE HANDS OF A PARENT
AND THEN REPORT THAT SHE FEELS
NOT ANGRY AT HER PARENT BUT GUILTY
AFTER ALL
IT IS EASIER TO EXPERIENCE HERSELF AS UNWORTHY
THAN TO ALLOW HERSELF TO KNOW THE HORRID TRUTH
ABOUT HER PARENT AS HAVING BEEN ABUSIVE
IN OTHER WORDS
IT IS EASIER TO EXPERIENCE HERSELF AS BAD
AND AS HAVING DESERVED THE ABUSE
FOR HAVING SOMEHOW PROVOKED IT / FOR HAVING GOTTEN IN THE WAY
FOR HAVING HAD TOO MANY NEEDS / FOR HAVING BEEN TOO DIFFICULT
OR, EVEN, FOR HAVING BEEN BORN
THAN TO CONFRONT THE INTOLERABLY
PAINFUL REALITY THAT THE PARENT
SHOULD NEVER HAVE DONE WHAT SHE DID
18

19. MORE GENERALLY
A CHILD WHOSE HEART HAS BEEN BROKEN
BY HER PARENT WILL DEFEND HERSELF
AGAINST THE PAIN OF HER DISAPPOINTMENT BY
TAKING ON THE PARENT’S BADNESS AS HER OWN
THEREBY ENABLING HER TO PRESERVE
THE ILLUSION OF HER PARENT AS GOOD
AND AS ULTIMATELY FORTHCOMING
IF SHE – THE CHILD – COULD BUT GET IT RIGHT
IN ESSENCE
BY DEFENSIVELY INTROJECTING THE BAD PARENT,
THE CHILD IS ABLE TO MAINTAIN AN ATTACHMENT
TO HER ACTUAL PARENT
AND, AS A RESULT, IS ABLE TO HOLD ON
TO HER “UNRELENTING” HOPE – AN ILLUSION – THAT
PERHAPS SOMEDAY, SOMEHOW, SOME WAY,
WERE SHE TO BE BUT GOOD ENOUGH,
TRY HARD ENOUGH, AND SUFFER DEEPLY ENOUGH,
SHE MIGHT YET BE ABLE
TO COMPEL HER PARENT TO CHANGE
19

20. AGAIN
AS FAIRBAIRN WRITES –
“A RELATIONSHIP WITH A BAD OBJECT
IS INFINITELY BETTER
THAN NO RELATIONSHIP AT ALL”
BECAUSE ALTHOUGH THE OBJECT IS BAD,
THE CHILD CAN AT LEAST STILL
“RELENTLESSLY” HOPE
THAT THE OBJECT
MIGHT SOMEDAY BECOME GOOD
20

21. BUT WHAT DOES FAIRBAIRN SUGGEST
IS THE SPECIFIC NATURE
OF THE CHILD’S INTENSE ATTACHMENT
TO THIS INTERNAL BAD OBJECT?
ACCORDING TO FAIRBAIRN
A BAD PARENT IS A PARENT WHO FRUSTRATES
HER CHILD’S LONGING FOR CONTACT
BUT, FAIRBAIRN WRITES, A SEDUCTIVE PARENT
– WHO FIRST SAYS “YES” AND THEN SAYS “NO” –
IS A VERY BAD PARENT
FAIRBAIRN’S INTEREST IS IN THESE VERY BAD PARENTS
– THESE SEDUCTIVE PARENTS –
THEREFORE, WHEN THE CHILD HAS BEEN FAILED
BY A PARENT WHO IS SEDUCTIVE,
THE CHILD
– AS HER FIRST LINE OF DEFENSE –
WILL INTROJECT THIS EXCITING
BUT ULTIMATELY REJECTING PARENT
21

22. SPLITTING IS THE SECOND LINE OF DEFENSE
ONCE THE BAD OBJECT IS INSIDE,
IT IS SPLIT INTO TWO PARTS
THE EXCITING OBJECT
THAT OFFERS THE ENTICING PROMISE
OF A SPECIAL RELATIONSHIP
AND THE REJECTING OBJECT
THAT ULTIMATELY FAILS TO DELIVER
IS THE REJECTING – DEPRIVING – OBJECT
A GOOD OBJECT OR A BAD OBJECT?
IS THE EXCITING – ENTICING – OBJECT
A GOOD OBJECT OR A BAD OBJECT?
22

23. SPLITTING OF THE EGO GOES HAND IN HAND
WITH SPLITTING OF THE OBJECT
*NOTE THAT FAIRBAIRN DOES NOT CONCEIVE OF THE ID
AS SEPARATE FROM THE EGO
RATHER, HE POSITS THE EXISTENCE OF AN EGO THAT HAS
NOT ONLY INTERNAL OBJECTS
BUT ALSO ITS OWN RESERVOIR OF ENERGY
– BOTH LIBIDO AND AGGRESSION –
SO FAIRBAIRN’S EGO IS A DYNAMIC STRUCTURE
– A STRUCTURE WITH ITS OWN ENERGY –
FAIRBAIRN’S LIBIDINAL EGO ATTACHES ITSELF
TO THE EXCITING OBJECT AND LONGS FOR CONTACT,
HOPING AGAINST HOPE THAT THE OBJECT
WILL BE FORTHCOMING
FAIRBAIRN’S ANTILIBIDINAL EGO
– WHICH IS A REPOSITORY FOR ALL THE HATRED AND DESTRUCTIVENSS
THAT HAVE ACCUMULATED AS A RESULT OF THE FRUSTRATED LONGING –
ATTACHES ITSELF TO THE REJECTING OBJECT
AND RAGES AGAINST IT
23

24. PARENTHETICALLY
FAIRBAIRN’S CONCEPT OF SPLITTING IS TO BE DISTINGUISHED
FROM KERBNERG’S (1995) CONCEPT OF SPLITTING
FOR KERNBERG, SPLITTING
– WHICH IS WHAT THE BORDERLINE DOES –
INVOLVES THE PRE – AMBIVALENT EXPERIENCE
OF OBJECTS AS EITHER ALL GOOD
– AND THEREFORE LIBIDINALLY CATHECTED –
OR ALL BAD
– AND THEREFORE AGGRESSIVELY CATHECTED –
PLEASE NOTE
KERNBERG’S CONCEPT OF SPLITTING
EXPLAINS THE BORDERLINE’S
TENUOUSLY ESTABLISHED LIBIDINAL OBJECT CONSTANCY
– THAT IS, THE BORDERLINE’S IMPAIRED CAPACITY
TO HOLD IN MIND SIMULTANEOUSLY BOTH GOOD AND BAD –
WHICH IS WHY BORDERLINES
HAVE SO MUCH DIFFICULTY INTERNALIZING GOOD
IN THE MOMENT OF OUTRAGED UPSET,
THEY CANNOT REMEMBER THE GOOD THAT HAD BEEN
AND CANNOT, THEREFORE, INTERNALIZE IT
24

25. BACK TO FAIRBAIRN
SO WHAT, THEN, IS THE SPECIFIC NATURE
OF THE PATIENT’S INTENSE ATTACHMENT
TO THE BAD OBJECT?
IT IS, OF COURSE, AMBIVALENT!
IT IS BOTH LIBIDINAL
AND ANTILIBIDINAL
– OR AGGRESSIVE –
IN NATURE
THE BAD OBJECT IS BOTH
LOVED
– BECAUSE IT EXCITES –
(WHICH IS WHY IT IS LIBIDINALLY CATHECTED)
AND HATED
– BECAUSE IT REJECTS –
(WHICH IS WHY IT IS AGGRESSIVELY CATHECTED)
25

26. IN ANY EVENT
THE THIRD LINE OF DEFENSE IS REPRESSION
– UNCONSCIOUS REPRESSION OF THE EGO’S ATTACHMENT
TO THE EXCITING / REJECTING OBJECT –
ACCORDING TO FAIRBAIRN, THEN,
AT THE CORE OF THE REPRESSED IS
NOT AN IMPULSE, NOT A TRAUMA, NOT A MEMORY
BUT A FORBIDDEN RELATIONSHIP
– AN INTENSELY CONFLICTED RELATIONSHIP
WITH A BAD OBJECT THAT IS BOTH LOVED AND HATED –
OVER TIME, THIS AMBIVALENT ATTACHMENT TO THE
“INTERNAL OBJECT” WILL BE COMPULSIVELY RE – ENACTED
ON THE STAGE OF THE PATIENT’S LIFE
SUCH THAT SHE WILL FIND HERSELF REACTING TO THE
“EXTERNAL OBJECTS OF HER DESIRE”
WITH BOTH LONGING AND AVERSION
ALTHOUGH BECAUSE THE ATTACHMENT IS REPRESSED,
THE PATIENT MIGHT BE UNAWARE THAT BOTH SIDES EXIST
26

27. WHAT THIS MEANS CLINICALLY IS THAT
PATIENTS WHO ARE RELENTLESS
IN THEIR PURSUIT OF THE
BAD – EXCITING / REJECTING – OBJECT
MUST ULTIMATELY ACKNOWLEDGE
BOTH THEIR INTENSE HUNGER FOR THE OBJECT
AND THEIR OUTRAGED HATRED OF THE OBJECT
BECAUSE IT FAILS THEM REPEATEDLY
IT WAS THEREFORE TO FAIRBAIRN
THAT WE TURNED
IN ORDER BETTER TO APPRECIATE
THAT THE INTENSITY
OF THE PATIENT’S ATTACHMENT
TO THE BAD OBJECT
IS FUELED BY AMBIVALENCE
27

28. 28

29. ALTHOUGH FAIRBAIRN’S CLAIM
IS THAT HE IS WRITING
ABOUT SCHIZOID PERSONALITIES,
I BELIEVE THAT THE MANNER
IN WHICH HE CONCEPTUALIZES
THE “ENDOPSYCHIC SITUATION” OF THESE
SO – CALLED SCHIZOID PERSONALITIES
CAPTURES, IN A NUTSHELL,
THE PSYCHODYNAMICS
OF SADOMASOCHISTIC PATIENTS
IN FACT
MY CONTENTION WILL BE THAT
THE PATIENT’S RELENTLESS PURSUIT
OF THE BAD OBJECT HAS BOTH
MASOCHISTIC AND SADISTIC COMPONENTS
29

30. PARENTHETICALLY (AND IMPORTANTLY)
MY INTEREST IS NOT SPECIFICALLY
IN HOW SADOMASOCHISM
GETS PLAYED OUT IN THE SEXUAL ARENA
RATHER
I CONCEIVE OF SADOMASOCHISM
AS A DYSFUNCTIONAL RELATIONAL DYNAMIC
THAT WILL GET PLAYED OUT
– TO A GREATER OR LESSER DEGREE –
IN MOST OF THE RELENTLESS PATIENT’S
SIGNIFICANT RELATIONSHIPS
30

31. THE PATIENT’S RELENTLESS HOPE
– WHICH FUELS HER MASOCHISM –
IS THE STANCE TO WHICH
SHE DESPERATELY CLINGS
IN ORDER TO AVOID CONFRONTING
INTOLERABLY PAINFUL REALITIES
ABOUT THE OBJECT AND ITS IMMUTABILITY
AND HER RELENTLESS OUTRAGE
– WHICH FUELS HER SADISM –
IS THE STANCE TO WHICH
SHE RESORTS IN THOSE MOMENTS
OF DAWNING RECOGNITION
THAT THE OBJECT IS SEPARATE
AND CANNOT BE FORCED
TO BE SOMETHING IT ISN’T
31

32. THE MASOCHISTIC DEFENSE
OF RELENTLESS HOPE
AND THE SADISTIC DEFENSE
OF RELENTLESS OUTRAGE
GO HAND IN HAND
AND BOTH SPEAK TO THE PATIENT’S
REFUSAL TO CONFRONT THE TRUTH
ABOUT THE BAD – IMMUTABLE – OBJECT
32

33. MORE SPECIFICALLY
MASOCHISM IS A STORY ABOUT THE PATIENT’S HOPE
HER RELENTLESS HOPE
– HER HOPING AGAINST HOPE –
THAT PERHAPS SOMEDAY, SOMEHOW, SOME WAY
WERE SHE TO BE BUT GOOD ENOUGH,
TRY HARD ENOUGH, BE PERSUASIVE ENOUGH,
PERSIST LONG ENOUGH, SUFFER DEEPLY ENOUGH,
OR BE MASOCHISTIC ENOUGH,
SHE MIGHT YET BE ABLE TO EXTRACT FROM THE OBJECT
– SOMETIMES THE PARENT HERSELF,
SOMETIMES A STAND – IN FOR THE PARENT –
THE RECOGNITION AND LOVE DENIED HER AS A CHILD
IN OTHER WORDS
THAT SHE MIGHT YET BE ABLE TO COMPEL
THE IMMUTABLE OBJECT TO RELENT
33

34. AND, SO, EVEN IN THE FACE OF INCONTROVERTIBLE
EVIDENCE TO THE CONTRARY,
THE PATIENT WILL PURSUE THE OBJECT
OF HER DESIRE WITH A VENGEANCE
THE INTENSITY OF THIS RELENTLESS PURSUIT
FUELED BY HER ENTITLED CONVICTION
THAT THE OBJECT COULD GIVE IT
– WERE THE OBJECT BUT WILLING –
SHOULD GIVE IT
– BECAUSE THAT IS THE PATIENT’S DUE –
AND WOULD GIVE IT
– WERE SHE – THE PATIENT – BUT ABLE TO GET IT RIGHT –
THE PATIENT’S INVESTMENT IS NOT SO MUCH
IN THE SUFFERING PER SE
AS IT IS IN HER WILLINGNESS TO SUFFER
BECAUSE OF HER PASSIONATE HOPE
THAT PERHAPS EACH NEXT TIME …
34

35. SADISM IS, THEN,
THE RELENTLESS PATIENT’S REACTION
TO THE LOSS OF HOPE SHE EXPERIENCES
IN THOSE MOMENTS OF DAWNING RECOGNITION
THAT SHE IS NOT ACTUALLY GOING TO GET
WHAT SHE HAD SO DESPERATELY WANTED
AND FELT SHE NEEDED TO HAVE
IN ORDER TO GO ON
IN THOSE MOMENTS
OF ANGUISHED HEARTBREAK AND OUTRAGE
WHEN SHE IS CONFRONTED HEAD – ON
WITH THE INESCAPABLE REALITY
OF THE OBJECT’S SEPARATENESS
AND REFUSAL TO RELENT
35

36. THE HEALTHY RESPONSE TO THE LOSS OF HOPE
IS TO CONFRONT THE PAIN
OF ONE’S DISAPPOINTMENT
GRIEVE THE LOSS OF ONE’S ILLUSIONS
ABOUT THE OBJECT
AND ADAPTIVELY INTERNALIZE
WHATEVER GOOD
THERE WAS IN THE RELATIONSHIP
A GROWTH – PROMOTING PROCESS
DESCRIBED IN SELF PSYCHOLOGY
AS TRANSMUTING
– OR STRUCTURE – BUILDING –
INTERNALIZATION
BUT THE RELENTLESS PATIENT DOES SOMETHING ELSE …
36

37. WITH THE DAWNING RECOGNITION THAT THE OBJECT
CAN BE NEITHER POSSESSED AND CONTROLLED
NOR MADE OVER INTO WHAT SHE WOULD WANT IT TO BE,
THE RELENTLESS PATIENT WILL REACT
– WHETHER IN ACTUAL FACT OR SIMPLY IN FANTASY –
WITH THE SADISTIC UNLEASHING OF A TORRENT
OF ABUSE DIRECTED EITHER TOWARDS HERSELF
– FOR HAVING FAILED TO GET WHAT SHE
HAD SO DESPERATELY WANTED –
OR TOWARDS THE DISAPPOINTING OBJECT
– FOR HAVING FAILED TO PROVIDE IT –
SHE WILL ALTERNATE BETWEEN
ENRAGED PROTESTS AT HER OWN INADEQUACY
AND SCATHING REPROACHES AGAINST THE OBJECT
FOR HAVING THWARTED HER DESIRE
IN ESSENCE
SADISM IS THE RELENTLESS PATIENT’S
REACTION TO THE LOSS OF HOPE
37

38. IN ANY EVENT
THE SADOMASOCHISTIC CYCLE
WILL BE REPEATED ONCE
THE – SEDUCTIVE – OBJECT
THROWS THE PATIENT A FEW CRUMBS
THE PATIENT
– EVER HUNGRY FOR SUCH MORSELS –
WILL BECOME ONCE AGAIN HOOKED
AND REVERT TO HER ORIGINAL
STANCE OF SUFFERING,
SACRIFICE, AND SURRENDER
IN A REPEAT ATTEMPT TO GET
WHAT SHE SO DESPERATELY WANTS
AND FEELS SHE MUST HAVE
38

39. 39

40. A CLINICAL MOMENT
SO IF, DURING A THERAPY SESSION,
THE PATIENT SUDDENLY BECOMES ABUSIVE,
WHAT QUESTION MIGHT HER THERAPIST
THINK TO POSE?
WERE THE THERAPIST TO ASK
“HOW DO YOU FEEL THAT I HAVE FAILED YOU?”
AT LEAST SHE WILL HAVE KNOWN
ENOUGH TO ASK THE QUESTION
BUT SHE WILL ALSO THEREBY BE INDIRECTLY
SUGGESTING THAT THE ANSWER WILL BE
PRIMARILY A STORY ABOUT THE PATIENT
– AND THE PATIENT’S DISTORTED PERCEPTION
OF HAVING BEEN FAILED –
IT IS BETTER, THEREFORE, THAT THE THERAPIST ASK
“HOW HAVE I FAILED YOU?”
40

41. NOW SHE WILL BE SIGNALING HER RECOGNITION
OF THE FACT THAT SHE HERSELF MIGHT WELL
HAVE CONTRIBUTED TO THE PATIENT’S EXPERIENCE
OF DISILLUSIONMENT AND HEARTACHE
– PERHAPS BY NOT FULFILLING AN IMPLICIT PROMISE EARLIER MADE
OR BY REFUSING TO ACKNOWLEDGE HER
UNRELENTING COMMITMENT TO A CERTAIN PERSPECTIVE
OR BY FAILING TO ADMIT TO AN ERROR IN JUDGMENT
OR BY DENYING HER MISTIMING OF AN INTERPRETATION –
INDEED, THE THERAPIST MUST HAVE BOTH
THE WISDOM TO RECOGNIZE
AND THE INTEGRITY TO ACKNOWLEDGE
– CERTAINLY TO HERSELF AND PERHAPS TO THE PATIENT AS WELL –
THE PART SHE HERSELF MIGHT HAVE PLAYED
IN THE DRAMA BEING RE – ENACTED BETWEEN THEM
41

42. 42

43. OPTIMALLY STRESSFUL 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” –
43

44. OPTIMALLY STRESSFUL DISILLUSIONMENT STATEMENTS
“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.” 44

45. OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS
“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.”
45

46. OPTIMALLY STRESSFUL DISILLUSIONMENT STATEMENTS
“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.”
46

47. 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.”
47

48. 48

49. 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 IN AN EMBODIED FASHION
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
49

50. 50
“GRIEVING IS NATURE’S WAY
OF HEALING A BROKEN HEART”
ROBERTA BECKMANN (1991)

51. 51

52. 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)
52

53. 53
FROM RELENTLESS PURSUIT OF THE UNATTAINABLE
TO SOBER, MATURE ACCEPTANCE OF THE REALITY
THAT IT WAS WHAT IT WAS AND IS WHAT IT IS

54. 54

55. HAROLD SEARLES (1979) HAS SUGGESTED
THAT “REALISTIC HOPE”
ARISES IN THE CONTEXT OF
“SURVIVING DISAPPOINTMENT”
55

56. 56

57. CONCLUSION
AT THE END OF THE DAY
A PATIENT WHO IS CAUGHT UP IN THE THROES
OF NEEDING HER OBJECTS
TO BE OTHER THAN WHO THEY ARE
MUST BE GIVEN THE OPPORTUNITY TO CONFRONT
– AND GRIEVE –
THE EXCRUCIATINGLY PAINFUL REALITY THAT
NO ONE WILL EVER BE FOR HER
THE GOOD PARENT FOR WHOM SHE HAS SPENT
A LIFETIME SEARCHING
– THE GOOD PARENT SHE SHOULD HAVE HAD EARLY – ON
BUT NEVER, CONSISTENTLY AND RELIABLY, DID –
57

58. 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
58

59. 59

60. 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 60

61. “TRUE HAPPINESS
IS NOT ABOUT
GETTING WHAT YOU WANT
BUT COMING TO WANT
AND APPRECIATE
WHAT YOU HAVE.”
JAPANESE SAYING
61

62. 62
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.”

63. 63

64. REFERENCES
BECKMANN R. 1991. CHILDREN WHO GRIEVE: A MANUAL FOR CONDUCTING
SUPPORT GROUPS. Learning Publications.
FAIRBAIRN W.R.D. 1963. SYNOPSIS OF AN OBJECT – RELATIONS THEORY OF
PERSONALITY. INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 44:224 – 225.
RAKO S. 2003. SEMRAD: THE HEART OF A THERAPIST. BLOOMINGTON, IN:
iUniverse.
KERNBERG O.F. 1989. PSYCHODYNAMIC PSYCHOTHERAPY OF BORDERLINE
PATIENTS. NEW YORK, NY: Basic Books.
SEARLES H. 1979. THE DEVELOPMENT OF MATURE HOPE IN THE PATIENT –
THERAPIST RELATIONSHIP. IN COUNTERTRANSFERENCE AND RELATED
SUBJECTS: SELECTED PAPERS, pp. 479 – 502. NEW YORK, NY:
International Universities Press.
STARK M. 2017. RELENTLESS HOPE: THE REFUSAL TO GRIEVE
(International Psychotherapy Institute eBook).
WINNICOTT D.W. 1965. THE MATURATIONAL PROCESSES AND THE
FACILITATING ENVIRONMENT. Madison, CT: International Universities Press.
63

65. 65

66. 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
66