1. THE TRANSFORMATIVE POWER
OF OPTIMAL STRESS:
PRECIPITATING DISRUPTION
TO TRIGGER REPAIR
ALSO DESCRIBED AS
THE THERAPEUTIC USE OF OPTIMAL
STRESS TO PROVOKE RECOVERY
“NO PAIN, NO GAIN” 
MARTHA STARK, MD
MarthaStarkMD @ HMS.Harvard.edu
Christian Association for Psychological Studies (CAPS)
SATURDAY, MARCH 23, 2019 ~ 2:00 – 5:00 pm
© 2019 Martha Stark, MD
1

2. 2

3. 3

4. THE ART OF PRECIOUS SCARS
4

5. LONG INTRIGUING TO ME
HAS BEEN THE IDEA
THAT SUPERIMPOSING
AN ACUTE PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES EXACTLY
WHAT THE BODY NEEDS
IN ORDER TO HEAL
IN ESSENCE
“CONTROLLED DAMAGE”
TO “PROVOKE HEALING”
5

6. BY WAY OF EXAMPLE
THE PRACTICE OF WOUND DEBRIDEMENT
TO ACCELERATE HEALING SPEAKS
DIRECTLY TO THIS CONCEPT OF
“CONTROLLED DAMAGE”
TO “TRIGGER REPAIR”
NOT ONLY DOES DEBRIDEMENT
PREVENT INFECTION BY REMOVING
FOREIGN MATERIAL AND DAMAGED TISSUE
FROM THE SITE OF THE WOUND
BUT ALSO IT PROMOTES HEALING
BY MILDLY AGGRAVATING THE AREA,
WHICH WILL IN TURN
“JUMPSTART” THE BODY’S INNATE ABILITY
TO “SELF – REPAIR” IN THE FACE OF CHALLENGE
6

7. JUST AS WITH THE BODY
WHERE A CONDITION MIGHT NOT
HEAL UNTIL IT IS MADE ACUTE
SO TOO WITH THE MIND
INDEED
OVER TIME I HAVE COME
TO APPRECIATE THAT
THE THERAPEUTIC PROVISION
OF “OPTIMAL STRESS”
AGAINST THE BACKDROP OF
AN EMPATHICALLY ATTUNED
AND AUTHENTICALLY ENGAGED
THERAPY RELATIONSHIP …
7

8. … IS SOMETIMES
THE MAGIC INGREDIENT
NEEDED TO OVERCOME
THE SEEMINGLY
INTRACTABLE
RESISTANCE TO CHANGE
SO FREQUENTLY
ENCOUNTERED
IN OUR THERAPY PATIENTS
MARTHA STARK (2008, 2012, 2014)
8

9. 9

10. 10

11. PREVIEW
THE THERAPEUTIC USE OF “OPTIMAL STRESS”
TO “PROVOKE RECOVERY”
THE TASK OF THE CHILD (GROWING UP)
THE TASK OF THE PATIENT (GETTING BETTER)
TRANSFORMATION OF DYSFUNCTIONAL DEFENSE
INTO MORE FUNCTIONAL ADAPTATION
WHERE ID WAS, THERE SHALL EGO BE
WHERE DEFENSE WAS, THERE SHALL ADAPTATION BE
AN ONGOING PROCESS INVOLVING
HEALING CYCLES OF DISRUPTION AND REPAIR
THE THERAPIST WILL PRECIPITATE DISRUPTION
IN ORDER TO TRIGGER REPAIR
BY WAY OF “OPTIMALLY STRESSFUL” INTERVENTIONS THAT
ALTERNATELY CHALLENGE AND THEN SUPPORT THE DEFENSE
11

12. PREVIEW
ITERATIVE CYCLES OF DESTABILIZATION
IN REACTION TO THE CHALLENGE
AND RESTABILIZATION
IN RESPONSE TO THE SUPPORT AND BY
TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE
AT EVER – HIGHER LEVELS OF
FUNCTIONALITY AND ADAPTIVE CAPACITY
IN ESSENCE
BY CHALLENGING DEFENSES TO WHICH
THE PATIENT HAS LONG CLUNG,
PSYCHODYNAMIC PSYCHOTHERAPY OFFERS
THE PATIENT AN OPPORTUNITY
– ALBEIT A BELATED ONE –
TO PROCESS, INTEGRATE, AND ADAPT
TO PREVIOUSLY UNMASTERED
AND THEREFORE DEFENDED AGAINST
EARLY – ON EXPERIENCES
12

13. 13

14. THE SANDPILE MODEL
AND THE PARADOXICAL
IMPACT OF STRESS
14

15. THE “SANDPILE MODEL” OF CHAOS THEORY
SPEAKS TO THE CUMULATIVE IMPACT
OVER TIME
OF ENVIRONMENTAL STRESSORS
ON AN OPEN SYSTEM
MORE SPECIFICALLY
THIS SIMULATION MODEL OFFERS
AN ELEGANT VISUAL METAPHOR FOR
HOW ALL OF US ARE CONTINUOUSLY
REFASHIONING OURSELVES
AT EVER – HIGHER LEVELS OF
COMPLEXITY AND INTEGRATION …
15

16. NOT JUST
“IN SPITE OF”
STRESSFUL INPUT
FROM THE OUTSIDE
BUT
“BY WAY OF”
THAT INPUT 
16

17. AMAZINGLY ENOUGH
THE GRAINS OF SAND BEING STEADILY ADDED
TO THE GRADUALLY EVOLVING SANDPILE
ARE THE OCCASION FOR BOTH
ITS DISRUPTION AND ITS REPAIR
NOT ONLY DO THE GRAINS OF SAND BEING ADDED
PRECIPITATE PARTIAL COLLAPSE OF THE SANDPILE
BUT ALSO THEY BECOME THE MEANS BY WHICH THE
SANDPILE WILL THEN BE ABLE TO BUILD ITSELF BACK UP
EACH TIME AT A NEW LEVEL OF HOMEOSTASIS
THE SYSTEM WILL THEREFORE HAVE BEEN ABLE
NOT ONLY TO “MANAGE” THE IMPACT
OF THE STRESSFUL INPUT
BUT ALSO TO “BENEFIT FROM” THAT IMPACT
17

18. AND AS THE SANDPILE EVOLVES,
AN UNDERLYING PATTERN
WILL BEGIN TO EMERGE,
CHARACTERIZED BY
ITERATIVE CYCLES OF
DISRUPTION AND REPAIR,
DESTABILIZATION AND RESTABILIZATION,
DEFENSIVE COLLAPSE
AND ADAPTIVE RECONSTITUTION …
18

19. … AT EVER – HIGHER LEVELS OF
INTEGRATION,
BALANCE,
AND HARMONY
19

20. 20

21. WHERE DEFENSE WAS,
THERE SHALL
ADAPTATION BE
21

22. THE DEVELOPMENTAL PROCESS
AND THE THERAPEUTIC PROCESS
WHERE ID WAS, THERE SHALL EGO BE
WHERE DEFENSE WAS, THERE SHALL ADAPTATION BE
ID – EGO
ID DRIVE – EGO STRUCTURE
ID NEED – EGO CAPACITY
NEED – CAPACITY
DEFENSIVE NEED – ADAPTIVE CAPACITY
DEFENSIVE REACTION – ADAPTIVE RESPONSE
REACTION – RESPONSE
DEFENSE – ADAPTATION
22

23. INDEED, EGO PSYCHOLOGY IS
FOUNDED ON THE PREMISE THAT
THE EGO DEVELOPS OUT OF NECESSITY
… THAT IT EVOLVES AS AN ADAPTATION TO
THE EXIGENCIES OF THE ID,
THE IMPERATIVES OF THE SUPEREGO,
AND THE DEMANDS OF EXTERNAL REALITY
ALL OF WHICH ARE ENVIRONMENTAL STRESSORS
WHETHER INTERNAL OR EXTERNAL
TO WHICH THE EGO WILL EITHER
REACT DEFENSIVELY OR RESPOND ADAPTIVELY
23

24. YIN AND YANG – COMPLEMENTARY (NOT OPPOSING) FORCES
FOR EXAMPLE, SHADOW CANNOT EXIST WITHOUT LIGHT
DEFENSES
DYSFUNCTIONAL
UNHEALTHY
RIGID
UNEVOLVED
ADAPTATIONS
MORE FUNCTIONAL
MORE HEALTHY
MORE FLEXIBLE
MORE EVOLVED
24

25. A PRIME EXAMPLE OF DEFENSE
WHEN THE IMPACT ON A CHILD
OF HER PARENT’S ABUSIVENESS
IS SIMPLY “TOO MUCH” FOR THE CHILD
TO PROCESS, INTEGRATE, AND ADAPT TO
THE CHILD MAY FIND HERSELF
DEFENSIVELY REACTING
BY DISSOCIATING
OVER TIME, DISSOCIATION WILL EMERGE
AS HER CHARACTERISTIC DEFENSIVE
STANCE IN LIFE WHENEVER
SHE FEELS THREATENED
25

26. A PRIME EXAMPLE OF ADAPTATION
BUT WHEN THE IMPACT ON A CHILD
OF HER PARENT’S ABUSIVENESS
IS ULTIMATELY ABLE TO BE MASTERED
THAT IS, PROCESSED AND INTEGRATED
THE CHILD MAY ADAPTIVELY
RESPOND BY BECOMING
AN ADVOCATE FOR THE RIGHTS
OF HER LITTLE SISTER AND
OF OTHERS WHOM SHE SENSES
MIGHT BE AT RISK
26

27. IN THE PHYSIOLOGICAL REALM
A PRIME EXAMPLE OF ADAPTATION
IS COLLATERALIZATION
WHEN THERE IS ATHEROSCLEROTIC
CORONARY ARTERY DISEASE
THE DEVELOPMENT OF NEW CORONARY
ARTERIES TO SUPPLY THE HEART
WITH THE NUTRIENTS AND OXYGEN
IT NEEDS TO FUNCTION
THIS ADAPTATION MAY ENABLE THE PATIENT
TO AVERT A POTENTIAL HEART ATTACK
27

28. THYROID DYSFUNCTION
THE BODY ADAPTS BY REDISTRIBUTING ITS
BLOOD FLOW FROM LESS ESSENTIAL
TO MORE ESSENTIAL ORGAN SYSTEMS
THUS THE THIN FRAGILE SKIN, DRY BRITTLE HAIR,
AND TELLTALE LOSS OF THE OUTER THIRD OF THE
EYEBROWS SO CHARACTERISTIC OF HYPOTHYROIDISM
ACIDIC INTERNAL ENVIRONMENT
THE BODY ADAPTS BY LEACHING CALCIUM FROM
ITS BONES IN AN EFFORT TO BUFFER THE ACIDITY
THE GOOD NEWS WILL BE THE RESTORATION
OF ACID – BASE BALANCE IN THE BODY
THE BAD NEWS WILL BE THE POTENTIAL FOR
DEMINERALIZATION OF THE BONES AND
DEVELOPMENT OF OSTEOPENIA / OSTEOPOROSIS 28

29. IN ESSENCE
ADAPTATION
IS A STORY ABOUT
MAKING A VIRTUE
OUT OF NECESSITY 
29

30. THE ULTIMATE GOAL OF PSYCHODYNAMIC PSYCHOTHERAPY
TO FACILITATE THE PROCESSING AND
INTEGRATING OF STRESSFUL EXPERIENCES
IN BOTH THE THERE – AND – THEN AND THE HERE – AND – NOW
FROM DEFENSIVE REACTION
TO ADAPTIVE RESPONSE
FROM DEFENSE
TO ADAPTATION
FROM DYSFUNCTIONAL DEFENSE
TO MORE FUNCTIONAL ADAPTATION
FROM DYSFUNCTIONAL ACTIONS, REACTIONS, AND INTERACTIONS
TO MORE FUNCTIONAL WAYS OF BEING AND DOING
FROM DYSFUNCTION
TO FUNCTIONALITY
FROM UNHEALTHY NEED
TO HEALTHY CAPACITY
30

31. FROM EXTERNALIZING BLAME
TO TAKING OWNERSHIP
FROM WHINING AND COMPLAINING
TO BECOMING PROACTIVE
FROM BEING EVER CRITICAL
TO BECOMING MORE COMPASSIONATE
FROM DISSOCIATING
TO BECOMING MORE PRESENT
FROM FEELING VICTIMIZED
TO BECOMING MORE EMPOWERED
FROM BEING JAMMED UP
TO MOBILIZING ONE’S ENERGIES
IN THE PURSUIT OF ONE’S DREAMS
FROM DENYING
TO CONFRONTING HEAD – ON
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE 31

32. GROWING UP (THE TASK OF THE CHILD)
AND GETTING BETTER (THE TASK OF THE PATIENT)
CAN ALSO BE DESCRIBED AS
TRANSFORMING NEED INTO CAPACITY
THE NEED FOR IMMEDIATE GRATIFICATION INTO
THE CAPACITY TO TOLERATE DELAY
THE NEED FOR PERFECTION INTO
THE CAPACITY TO TOLERATE IMPERFECTION
THE NEED FOR EXTERNAL REGULATION OF THE SELF INTO
THE CAPACITY FOR INTERNAL SELF – REGULATION
THE NEED TO HOLD ON INTO
THE CAPACITY TO LET GO
32

33. 33

34. PSYCHODYNAMIC SYNERGY
MARTHA STARK (2018)
MODEL 1
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2
THE DEFICIENCY – COMPENSATION PERSPECTIVE
OF SELF PSYCHOLOGY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “ABSENCE OF GOOD”
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “PRESENCE OF BAD”
MODEL 4
AN EXISTENTIAL – HUMANISTIC PERSPECTIVE
34

35. PSYCHODYNAMIC SYNERGY
FOUR “MODES” OF
THERAPEUTIC ACTION
MUTUALLY ENHANCING
NOT MUTUALLY EXCLUSIVE
RELEVANT FOR BOTH
SHORT – TERM AND LONG – TERM THERAPY
THE THERAPIST WILL BE ABLE TO OPTIMIZE
HER THERAPEUTIC EFFECTIVENESS IF
– MOMENT BY MOMENT –
SHE IS ABLE TO TRANSITION SEAMLESSLY
– BACK AND FORTH –
FROM ONE “MODE” TO THE NEXT …
35

36. … DEPENDING UPON HER ASSESSMENT
OF THE “POINT OF EMOTIONAL URGENCY”
DEMONSTRATED BY THE PATIENT
WHETHER “THE PATIENT’S LIMITED
INSIGHT INTO WHY SHE IS SO JAMMED UP”
(MODEL 1)
“HER REFUSAL TO ACCEPT CERTAIN DISAPPOINTING
REALITIES ABOUT PEOPLE IN HER LIFE”
(MODEL 2)
“HER RELUCTANCE TO HOLD HERSELF ACCOUNTABLE
FOR WHAT SHE PLAYS OUT IN HER RELATIONSHIPS”
(MODEL 3)
“HER RELUCTANCE TO BRING HER
TRUE SELF INTO THE ROOM”
(MODEL 4)
36

37. MODEL 1 – STRUCTURAL CONFLICT
THE NEUROTIC DEFENSE OF
RELENTLESS CONFLICTEDNESS
MODEL 2 – STRUCTURAL DEFICIT
THE NARCISSISTIC DEFENSE OF
RELENTLESS NEED FOR VALIDATION
AND EXTERNAL REINFORCEMENT
(RELENTLESS HOPE)
MODEL 3 – RELATIONAL CONFLICT
THE CHARACTER DISORDERED DEFENSE OF
RELENTLESS EXTERNALIZATION
AND DENIAL OF RESPONSIBILITY
MODEL 4 – RELATIONAL DEFICIT
THE NIHILISTIC DEFENSE OF
SCHIZOID RETREAT
AND RELENTLESS DESPAIR
37

38. MODEL 1 – STRUCTURAL CONFLICT
DYSFUNCTIONAL INTERNAL DYNAMICS
NEUROTIC CONFLICTEDNESS
MODEL 2 – STRUCTURAL DEFICIT
RELENTLESS PURSUIT OF THE UNATTAINABLE
NARCISSISTIC VULNERABILITY
MODEL 3 – RELATIONAL CONFLICT
DYSFUNCTIONAL RELATIONAL DYNAMICS
NOXIOUS RELATEDNESS
MODEL 4 – RELATIONAL DEFICIT
RELENTLESS DESPAIR ABOUT
AUTHENTIC BEING – IN – THE – WORLD
NONRELATEDNESS
38

39. MODEL 1 – KNOWLEDGE
1 – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S INTERNAL DYNAMICS (1)
THERAPIST AS NEUTRAL OBJECT (0)
MODEL 2 – EXPERIENCE
1½ – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S AFFECTIVE EXPERIENCE (1)
THERAPIST AS EMPATHIC SELFOBJECT (½)
MODEL 3 – RELATIONSHIP
2 – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S RELATIONAL DYNAMICS (1)
THERAPIST AS AUTHENTIC SUBJECT (1)
MODEL 4 – MOMENTS OF MEETING
½ – PERSON PSYCHOLOGY
FOCUS ON PATIENT’S TERROR OF BEING FOUND (½)
THERAPIST AS FACILITATING PRESENCE (0)
39

40. MODEL 1 – COGNITIVE
ENHANCEMENT OF KNOWLEDGE “WITHIN”
ULTIMATELY, A STRONGER, WISER,
AND MORE EMPOWERED EGO
MODEL 2 – AFFECTIVE
PROVISION OF CORRECTIVE EXPERIENCE “FOR”
ULTIMATELY, A MORE CONSOLIDATED,
ACCEPTING, AND COMPASSIONATE SELF
MODEL 3 – RELATIONAL
ENGAGEMENT IN HEALTHY RELATIONSHIP “WITH”
ULTIMATELY, A MORE ACCOUNTABLE SELF – IN – RELATION
MODEL 4 – EXISTENTIAL
CREATION OF MOMENTS OF MEETING “BETWEEN”
ULTIMATELY, MORE AUTHENTIC BEING – IN – THE – WORLD
AND A MORE ACCESSIBLE TRUE SELF
40

41. THE THERAPEUTIC ACTION
MODEL 1
FROM RESISTANCE TO ACKNOWLEDGING
PAINFUL TRUTHS ABOUT ONESELF
TO AWARENESS OF THOSE PAINFUL TRUTHS
MODEL 2
FROM RELENTLESS HOPE AND REFUSAL TO GRIEVE
PAINFUL TRUTHS ABOUT ONE’S OBJECTS
TO ACCEPTANCE OF THOSE PAINFUL TRUTHS
MODEL 3
FROM COMPULSIVE AND UNWITTING RE – ENACTMENT
OF UNMASTERED RELATIONAL TRAUMAS
TO ACCOUNTABILITY FOR ONE’S DYSFUNCTIONAL
ACTIONS, REACTIONS, AND INTERACTIONS
MODEL 4
FROM RELENTLESS DESPAIR AND PSYCHIC RETREAT
TO EMOTIONAL ACCESSIBILITY
AND AUTHENTIC MOMENTS OF MEETING 41

42. ALL FOUR MODELS ARE RELEVANT FOR BOTH
(MOMENTARY) “TRAIT” AND (MORE SUSTAINED) “STATE”
MODEL 1 FEATURES “NEUROTIC CONFLICTEDNESS”
AND IS RELEVANT WHEN, IN THE MOMENT,
THE PATIENT IS “RESISTANT” AND / OR “NOT AWARE”
THUS A “CONFLICT STATEMENT”
MODEL 2 FEATURES “NARCISSISTIC VULNERABILITY”
AND IS RELEVANT WHEN, IN THE MOMENT,
THE PATIENT IS “RELENTLESS” AND / OR “NOT ACCEPTING”
THUS A “DISILLUSIONMENT STATEMENT”
MODEL 3 FEATURES “NOXIOUS RELATEDNESS”
AND IS RELEVANT WHEN, IN THE MOMENT,
THE PATIENT IS “RE – ENACTING” AND / OR “NOT ACCOUNTABLE”
THUS AN “ACCOUNTABILITY STATEMENT”
MODEL 4 FEATURES “NONRELATEDNESS”
AND IS RELEVANT WHEN, IN THE MOMENT,
THE PATIENT IS “RETREATING” AND / OR “NOT ACCESSIBLE”
THUS A “FACILITATION STATEMENT”
42

43. HOW DO WE KNOW WHICH MODEL TO USE?
PSYCHODYNAMIC PSYCHOTHERAPY IS LIKE BALLROOM DANCING
THERE IS A LEADER AND A FOLLOWER
THE PATIENT LEADS AND, FOR THE MOST PART, WE FOLLOW
I HAVE COMPLETE FAITH IN THE “THERAPEUTIC PROCESS”
AND CONFIDENCE THAT THE PATIENT WILL
LEAD US TO WHERE SHE NEEDS US TO GO
HER NEUROTIC CONFLICTEDNESS (MODEL 1)
HER NARCISSISTIC VULNERABILITY (MODEL 2)
HER NOXIOUS RELATEDNESS (MODEL 3)
AND / OR HER NONRELATEDNESS (MODEL 4)
AND THIS “POINT OF EMOTIONAL URGENCY” WILL CONTINUOUSLY SHIFT
I “GIVE” STATEMENTS AND RARELY “ASK” QUESTIONS
BECAUSE I AM MORE INTERESTED IN “GIVING” TO THE PATIENT
THAN IN “ASKING” OF HER THAT SHE “GIVE” TO ME (ANSWERS)
MOMENT BY MOMENT, AS WE LISTEN, WE ARE CONTINUOUSLY DECIDING
WHETHER TO “SUPPORT” BY BEING WITH THE PATIENT WHERE SHE IS
OR TO “CHALLENGE” BY DIRECTING HER ATTENTION TO ELSEWHERE
OUR GOAL ~ AN OPTIMAL BALANCE BETWEEN THE TWO
OPTIMAL STRESS 43

44. 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
44

45. 45

46. IN WHAT FOLLOWS
THE OPERATIVE CONCEPT
WILL BE
OPTIMAL STRESS
46

47. BAD STUFF HAPPENS
BUT IT WILL BE HOW WELL THE PATIENT
IS ABLE TO PROCESS, INTEGRATE,
AND ADAPT TO ITS IMPACT
PSYCHOLOGICALLY, PHYSIOLOGICALLY, AND ENERGETICALLY
THAT WILL MAKE OF IT
EITHER A GROWTH – DISRUPTING TRAUMA
THAT OVERWHELMS BECAUSE IT IS “TOO MUCH”
“TRAUMATIC STRESS”
OR A GROWTH – PROMOTING OPPORTUNITY
THAT MAKES POSSIBLE TRANSFORMATION AND RENEWAL
“OPTIMAL STRESS”
47

48. THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE
WILL OVERWHELM AND PLUMMET THE PATIENT INTO
FURTHER DECLINE BECAUSE IT WILL BE “TOO MUCH”
TO BE PROCESSED AND INTEGRATED
TRAUMATIC STRESS
TOO LITTLE CHALLENGE
WILL OFFER “TOO LITTLE” IMPETUS FOR TRANSFORMATION
AND GROWTH, SERVING INSTEAD SIMPLY TO
REINFORCE THE (DYSFUNCTIONAL) STATUS QUO
BUT JUST THE RIGHT AMOUNT OF CHALLENGE
WILL PROVIDE “JUST THE RIGHT AMOUNT” OF LEVERAGE
NEEDED TO PROVOKE, AFTER INITIAL DISRUPTION,
RECONSTITUTION AT A HIGHER LEVEL OF
INTEGRATION, FUNCTIONALITY, AND ADAPTIVE CAPACITY
OPTIMAL (NONTRAUMATIC) STRESS
48

49. WITH THE THERAPIST’S FINGER
EVER ON THE PULSE OF THE
PATIENT’S LEVEL OF ANXIETY
AND CAPACITY TO TOLERATE
FURTHER CHALLENGE
THE THERAPIST WILL
THEREFORE REPEATEDLY
CHALLENGE WHENEVER POSSIBLE
BY DIRECTING THE PATIENT’S ATTENTION
TO WHERE THE PATIENT IS NOT
AND SUPPORT WHENEVER NECESSARY
BY RESONATING EMPATHICALLY
WITH WHERE THE PATIENT IS
49

50. ALL WITH AN EYE TO CREATING
JUST THE RIGHT LEVEL
OF DESTABILIZING ANXIETY
AND INCENTIVIZING STRESS
OPTIMAL STRESS
THEREBY OPTIMIZING THE
PATIENT’S POTENTIAL FOR
TRANSFORMATION AND GROWTH
BECAUSE …
50

51. WHETHER FUNCTIONAL OR DYSFUNCTIONAL
SELF – ORGANIZING
(CHAOTIC) SYSTEMS
SUCH AS THE PATIENT’S LONG – ESTABLISHED AND
DEEPLY ENTRENCHED “DEFENSIVE STRUCTURES”
ARE INHERENTLY
RESISTANT TO CHANGE
AFTER ALL
“SELF – ORGANIZING SYSTEMS
RESIST PERTURBATION”
CHARLES KREBS (2013)
51

52. WHICH MEANS THAT
UNLESS A “CHAOTIC” SYSTEM
IS SUFFICIENTLY “PERTURBED”
THAT IS, SUFFICIENTLY “STRESSED”
BY INPUT FROM THE OUTSIDE,
THEN IT WILL MAINTAIN ITS STATUS QUO
AND AS THIS RELATES TO THE PATIENT
UNLESS THE PATIENT’S
“DYSFUNCTIONAL DEFENSES”
ARE SUFFICIENTLY “CHALLENGED”
BY THE THERAPIST,
THEN THERE WILL BE INSUFFICIENT
IMPETUS FOR THEIR DESTABILIZATION
(AND THUS NO POTENTIAL FOR GROWTH)
52

53. IT TOOK ME YEARS TO APPRECIATE SOMETHING
THAT IS AT ONCE BOTH OBVIOUS AND PROFOUND
INDEED, IT WILL BE
INPUT FROM THE OUTSIDE
AND THE PATIENT’S CAPACITY TO
PROCESS, INTEGRATE, AND ADAPT
TO THE IMPACT OF THIS INPUT
THAT WILL ULTIMATELY ENABLE
THE PATIENT TO GET BETTER
53

54. BUT MORE IMPORTANTLY
IT WILL BE “STRESSFUL”
INPUT FROM THE OUTSIDE
AND THE PATIENT’S CAPACITY TO
PROCESS, INTEGRATE, AND ADAPT
TO THE IMPACT OF THIS “STRESS”
THAT WILL ULTIMATELY “JUMPSTART”
THE PATIENT’S RECOVERY …
54

55. BY TAPPING INTO
THE PATIENT’S
UNDERLYING RESILIENCE,
INNATE STRIVING
TOWARDS HEALTH,
AND INTRINSIC CAPACITY
TO SELF – CORRECT
IN THE FACE OF
OPTIMAL CHALLENGE
55

56. THERAPEUTIC INTERVENTIONS
MUST THEREFORE BE
“OPTIMALLY STRESSFUL”
NOT ONLY SUPPORTIVE BUT
ALSO SUFFICIENTLY CHALLENGING
THAT THEY WILL PROVIDE
THE IMPETUS NEEDED
TO DESTABILIZE THE PATIENT’S
DYSFUNCTIONAL DEFENSES
THEREBY CREATING OPPORTUNITIES FOR
RECONSOLIDATION OF THOSE DEFENSES AT
EVER – HIGHER LEVELS OF FUNCTIONALITY
AND ADAPTIVE CAPACITY
56

57. IN ESSENCE
AGAINST A BACKDROP OF
EMPATHIC ATTUNEMENT
AND AUTHENTIC ENGAGEMENT
THE THERAPIST
BY WAY OF ONGOING “OPTIMALLY STRESSFUL” INTERVENTIONS
WILL REPEATEDLY PRECIPITATE DISRUPTION
IN ORDER TO TRIGGER RECOVERY
THEREBY GENERATING HEALING CYCLES
OF RUPTURE AND REPAIR
EVER STRONGER AT
THE BROKEN PLACES
57

58. IN OTHER WORDS
IT IS NOT SO MUCH GRATIFICATION AS
FRUSTRATION AGAINST A BACKDROP OF GRATIFICATION
OPTIMAL FRUSTRATION
IT IS NOT SO MUCH SUPPORT AS
CHALLENGE AGAINST A BACKDROP OF SUPPORT
OPTIMAL STRESS
IT IS NOT SO MUCH EMPATHY AS
EMPATHIC FAILURE AGAINST A BACKDROP OF EMPATHY
OPTIMAL DISILLUSIONMENT
THAT WILL PROVIDE THE THERAPEUTIC
LEVERAGE NEEDED TO PROVOKE
AFTER INITIAL DESTABILIZATION
EVENTUAL RESTABILIZATION
AT EVER – HIGHER LEVELS OF …
58

59. AWARENESS
MODEL 1
ACCEPTANCE
MODEL 2
ACCOUNTABILITY
MODEL 3
ACCESSIBILITY
MODEL 4
ALL OF WHICH ARE ADAPTATIONS
TO THE “STRESS OF LIFE”
59

60. IN ITS ESSENCE
THE THERAPEUTIC ACTION OF
PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT
AN OPPORTUNITY
– ALBEIT A BELATED ONE –
TO PROCESS, INTEGRATE, AND
ADAPT TO EXPERIENCES THAT HAD
ONCE BEEN OVERWHELMING
AND THEREFORE DEFENDED AGAINST …
60

61. … BUT THAT CAN NOW
WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE PATIENT’S
RELATIONSHIP WITH HER THERAPIST
WHO FUNCTIONS ALTERNATELY AS
NEUTRAL OBJECT (MODEL 1)
EMPATHIC SELFOBJECT (MODEL 2)
AUTHENTIC SUBJECT (MODEL 3)
FACILITATING PRESENCE (MODEL 4)
BE PROCESSED, INTEGRATED,
AND ADAPTED TO
THEREBY ENABLING THE PATIENT TO
EXTRICATE HERSELF FROM THE BONDS OF HER
INFANTILE ATTACHMENTS, RELENTLESS PURSUITS,
AND COMPULSIVE REPETITIONS
61

62. 62

63. FOUR APPROACHES TO
TRANSFORMING DEFENSE
INTO ADAPTATION
AND FOUR OPTIMAL STRESSORS
THAT REPRESENT
THE “CUTTING EDGE” OF
THE “THERAPEUTIC ACTION”
COGNITIVE DISSONANCE (MODEL 1)
AFFECTIVE DISILLUSIONMENT (MODEL 2)
RELATIONAL DETOXIFICATION (MODEL 3)
EXISTENTIAL DEPENDENCE (MODEL 4)
63

64. THE FOUR APPROACHES TO
TRANSFORMING DEFENSE INTO ADAPTATION
AND THE FOUR OPTIMAL STRESSORS
THAT WILL FACILITATE THIS “ACTION”
MODEL 1 – RESISTANCE INTO AWARENESS
BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE
CREATED BY THE EXPERIENCE OF GAIN – BECOME – PAIN
MODEL 2 – RELENTLESSNESS INTO ACCEPTANCE
BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT
CREATED BY THE EXPERIENCE OF GOOD – BECOME – BAD
MODEL 3 – RE – ENACTMENT INTO ACCOUNTABILITY
BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION
CREATED BY THE EXPERIENCE OF BAD – BECOME – GOOD
MODEL 4 – RETREAT INTO ACCESSIBILITY
BY WORKING THROUGH THE STRESS OF EXISTENTIAL DEPENDENCE
CREATED BY THE EXPERIENCE OF LOST – BECOME – FOUND 64

65. THE PATIENT’S FOUR CHALLENGES
MODEL 1 – COGNITIVE DISSONANCE
THE PATIENT MUST RESOLVE THE INTERNAL DISEQUILIBRIUM
SHE WILL EXPERIENCE WHEN DEFENSES ONCE
EGO – SYNTONIC BECOME INCREASINGLY EGO – DYSTONIC
MODEL 2 – AFFECTIVE DISILLUSIONMENT
THE PATIENT MUST CONFRONT DISAPPOINTING
REALITIES ABOUT THE OBJECTS OF HER DESIRE
MODEL 3 – RELATIONAL DETOXIFICATION
THE PATIENT MUST NEGOTIATE AT THE “INTIMATE EDGE”
OF AUTHENTIC ENGAGEMENT WITH THE THERAPIST
DARLENE EHRENBERG (1992)
MODEL 4 – EXISTENTIAL DEPENDENCE
ONTOLOGICAL DEPENDENCE
THE PATIENT MUST OVERCOME HER DREAD OF RELYING UPON
THE THERAPIST FOR HER VERY EXISTENCE / HER VERY IDENTITY
FABRICE CORREIA (2014) 65

66. IN ORDER TO FACILITATE THE “THERAPEUTIC ACTION”
“OPTIMALLY STRESSFUL”
INTERVENTIONS
ALTERNATELY CHALLENGE
AND SUPPORT
ANXIETY – PROVOKING
BUT ULTIMATELY
GROWTH – PROMOTING
66

67. MODEL 1 CONFLICT STATEMENTS
ARE DESIGNED TO ENCOURAGE
THE “RESISTANT” PATIENT
TO STEP BACK FROM THE
IMMEDIACY OF THE MOMENT
IN ORDER TO GAIN INSIGHT INTO
BOTH HER INVESTMENT IN
MAINTAINING THINGS AS THEY ARE
EGO – SYNTONIC
AND THE PRICE SHE PAYS FOR DOING SO
EGO – DYSTONIC
67

68. MODEL 2 DISILLUSIONMENT STATEMENTS
ARE DESIGNED TO FACILITATE
THE NECESSARY GRIEVING THAT
THE “RELENTLESS” PATIENT
MUST DO
AS SHE BEGINS TO CONFRONT
PAINFUL REALITIES ABOUT
THE OBJECTS OF HER DESIRE
THEIR LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
68

69. MODEL 3 ACCOUNTABILITY STATEMENTS
ARE DESIGNED TO ENCOURAGE
THE “RE – ENACTING” PATIENT
TO TAKE RESPONSIBILITY FOR
THE UNMASTERED RELATIONAL TRAUMAS
THAT SHE IS COMPULSIVELY
AND UNWITTINGLY
REPLAYING ON THE STAGE OF HER LIFE
69

70. MODEL 4 FACILITATION STATEMENTS
ARE DESIGNED TO HIGHLIGHT
THE “RETREATING” PATIENT’S
INTENSE AMBIVALENCE ABOUT
EXPERIENCING AUTHENTIC
MOMENTS OF MEETING
BECAUSE OF EARLY – ON
SHATTERING HEARTBREAK –
AMBIVALENCE FUELED BY
THE PATIENT’S LONGING TO BE SEEN
AND TERROR OF BEING FOUND
70

71. TO REVIEW
“CONFLICT STATEMENT”
WHEN THE SPOTLIGHT IS ON THE PATIENT AS
“NOT AWARE” OR “NOT ACTUALIZED” (MODEL 1)
“DISILLUSIONMENT STATEMENT”
WHEN THE SPOTLIGHT IS ON THE PATIENT AS
“NOT ACCEPTING” (MODEL 2)
“ACCOUNTABILITY STATEMENT”
OR “RELATIONAL INTERVENTION”
WHEN THE SPOTLIGHT IS ON THE PATIENT AS
“NOT ACCOUNTABLE” (MODEL 3)
“FACILITATION STATEMENT”
WHEN THE SPOTLIGHT IS ON THE PATIENT AS
“NOT ACCESSIBLE” (MODEL 4)
71

72. 72

73. MODEL 1
CONFLICT
STATEMENTS
AND THE CREATION OF
COGNITIVE AND AFFECTIVE DISSONANCE
BETWEEN THE “PAIN” AND THE “GAIN”
73

74. MODEL 1
CLASSICAL PSYCHOANALYSTS TEND
TO FOCUS ON INTERNAL CONFLICT
BETWEEN ANXIETY – PROVOKING ID DRIVES
AND ANXIETY – ASSUAGING EGO DEFENSES
BUT I HAVE FOUND IT A LITTLE MORE
CLINICALLY USEFUL TO CONCEPTUALIZE
THIS DRIVE – DEFENSE CONFLICT
AS ONE THAT EXISTS BETWEEN
ANXIETY – PROVOKING BUT
ULTIMATELY EMPOWERING FORCES
PRESSING “YES”
AND ANXIETY – ASSUAGING
(DEFENSIVE) COUNTERFORCES
INSISTING “NO”
74

75. MODEL 1 CONFLICT STATEMENTS
“OPTIMALLY STRESSFUL” CONFLICT STATEMENTS
ALTERNATELY CHALLENGE AND THEN SUPPORT
THEY FIRST CHALLENGE BY
SPEAKING TO THE PATIENT’S
“ADAPTIVE CAPACITY TO KNOW”
AN ANXIETY – PROVOKING REALITY
AND THEN
WITH COMPASSION AND NEVER JUDGMENT
SUPPORT BY RESONATING
EMPATHICALLY WITH THE PATIENT’S
“DEFENSIVE NEED TO AVOID KNOWING”
THAT UNCOMFORTABLE TRUTH
75

76. BE IT AN ANXIETY – PROVOKING TRUTH ABOUT
HER INTERNAL OR RELATIONAL DYNAMICS,
THE PRICE SHE PAYS FOR
MAINTAINING HER DEFENSES,
OR THE THERAPEUTIC
WORK SHE HAS YET TO DO
THE PATIENT DOES INDEED KNOW,
“BUT” WOULD RATHER NOT
AND THEREFORE,
MADE ANXIOUS,
SHE DEFENDS
76

77. MODEL 1 CONFLICT STATEMENTS
STRATEGICALLY DESIGNED TO GENERATE
DESTABILIZING TENSION WITHIN THE PATIENT
BETWEEN HER KNOWLEDGE OF
ANXIETY – PROVOKING BUT AWARENESS – ENHANCING,
GROWTH – PROMOTING, AND
ULTIMATELY EMPOWERING REALITIES
AND THE DEFENSES SHE MOBILIZES
IN ORDER TO EASE THAT ANXIETY
THEIR FORMAT
“YOU KNOW THAT … , BUT YOU FIND YOURSELF … ”
FIRST THE THERAPIST CHALLENGES
BY HIGHLIGHTING AN ANXIETY – PROVOKING REALITY
AND THEN SHE SUPPORTS
BY RESONATING EMPATHICALLY WITH
THE ANXIETY – ASSUAGING DEFENSE
77

78. MODEL 1 CONFLICT STATEMENTS
“YOU KNOW THAT … , BUT YOU FIND YOURSELF … ”
THE THERAPIST FIRST CHALLENGES BY SPEAKING
DIRECTLY TO THE PATIENT’S OBSERVING EGO AND
ADAPTIVE CAPACITY TO KNOW SOME PAINFUL TRUTH
WHICH WILL INCREASE THE PATIENT’S ANXIETY
BUT THEN SUPPORTS BY RESONATING EMPATHICALLY
WITH THE PATIENT’S EXPERIENCING EGO AND
DEFENSIVE NEED TO DENY SUCH KNOWING
WHICH WILL DECREASE THE PATIENT’S ANXIETY
THE PATIENT DOES INDEED KNOW,
“BUT” WOULD RATHER NOT
AND THEREFORE, MADE ANXIOUS, SHE DEFENDS
AND “FINDS HERSELF” THINKING, FEELING, OR DOING WHATEVER
SHE MUST IN ORDER TO PRESERVE THE STATUS QUO OF THINGS
78

79. ANXIETY – PROVOKING BUT ULTIMATELY
AWARENESS – ENHANCING INTERVENTIONS
FIRST THE REALITY (THAT IS, WHAT THE PATIENT REALLY DOES KNOW)
AND THEN THE DEFENSE / RESISTANCE (AND WHAT IS FUELING IT)
“YOU KNOW THAT ULTIMATELY YOU’LL NEED TO LET JOSE GO
BECAUSE HE, LIKE YOUR DAD, REALLY ISN’T AVAILABLE IN THE WAY
THAT YOU WOULD HAVE WANTED HIM TO BE; BUT, FOR NOW,
ALL YOU CAN THINK ABOUT IS HOW DESPERATELY YOU WANT TO BE
WITH HIM AND HOW HORRIBLE IT WOULD BE TO LOSE HIM.”
“YOU KNOW THAT EVENTUALLY YOU’LL NEED TO MAKE YOUR
PEACE WITH THE REALITY OF JUST HOW LIMITED YOUR MOTHER IS;
BUT YOUR FEAR IS THAT WERE YOU EVER TO LET YOURSELF
REALLY FEEL THE PAIN OF THAT, YOU WOULD NEVER RECOVER.”
“YOU KNOW THAT SOMEDAY YOU’LL HAVE TO LET SOMEBODY IN
IF YOU’RE EVER TO HAVE A MEANINGFUL RELATIONSHIP; BUT,
IN THE MOMENT, THE THOUGHT OF MAKING YOURSELF THAT
VULNERABLE IS SIMPLY INTOLERABLE. THERE’S NO WAY YOU’RE
WILLING TO RUN THE RISK OF BEING HURT EVER AGAIN.”
79

80. JUST AS WITH THE EVER – EVOLVING
SANDPILE MODEL OF CHAOS THEORY
SO TOO THE MODEL 1 “INTERPRETIVE”
THERAPIST WILL BE GENERATING ITERATIVE
CYCLES OF DISRUPTION AND REPAIR
BY WAY OF STRATEGICALLY DESIGNED
CONFLICT STATEMENTS THAT ALTERNATELY
CHALLENGE AND THEN SUPPORT
THEREBY PROVIDING BOTH IMPETUS
AND OPPORTUNITY FOR THE
MODEL 1 PATIENT GRADUALLY TO
EVOLVE FROM “DEFENSIVE RESISTANCE”
TO EVER – HIGHER LEVELS
OF “ADAPTIVE AWARENESS”
80

81. ONGOING CHALLENGE AND THEN SUPPORT
ANXIETY – PROVOKING, THEN ANXIETY – ASSUAGING
COGNITIVE, THEN AFFECTIVE
HEAD, THEN HEART
KNOWLEDGE, THEN EXPERIENCE
OBJECTIVE, THEN SUBJECTIVE
OBSERVING EGO, THEN EXPERIENCING EGO
ADULT, THEN CHILD
RATIONAL, THEN IRRATIONAL
RESPONSE, THEN REACTION
LEFT BRAIN, THEN RIGHT BRAIN
ADAPTIVE CAPACITY, THEN DEFENSIVE NEED
ADAPTATION, THEN DEFENSE
81

82. MODEL 1 CONFLICT STATEMENTS
“YOU KNOW THAT ULTIMATELY YOU WILL NEED TO CONFRONT –
AND GRIEVE – THE REALITY THAT TOM IS NOT AVAILABLE IN THE
WAYS THAT YOU WOULD HAVE WANTED HIM TO BE AND THAT
UNTIL YOU MAKE YOUR PEACE WITH THAT PAINFUL REALITY
YOU WILL CONTINUE TO BE MISERABLE; BUT, IN THE MOMENT,
ALL YOU CAN THINK ABOUT IS HOW ANGRY YOU ARE THAT
HE DOESN’T TELL YOU MORE OFTEN THAT HE LOVES YOU.”
“YOU KNOW THAT YOU WON’T FEEL TRULY FULFILLED UNTIL YOU
ARE ABLE TO GET YOUR THESIS COMPLETED; BUT YOU CONTINUE
TO STRUGGLE, FEARING THAT WHATEVER YOU MIGHT WRITE
JUST WOULDN’T BE GOOD ENOUGH OR CAPTURE WELL
ENOUGH THE ESSENCE OF WHAT YOU ARE TRYING TO SAY.”
“YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA IS
TO SURVIVE, YOU WILL NEED TO TAKE AT LEAST SOME
RESPONSIBILITY FOR THE PART YOU PLAY IN THE
INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE ARE HAVING;
BUT YOU TELL YOURSELF THAT IT ISN’T REALLY
YOUR FAULT BECAUSE IF SHE WEREN’T SO PROVOCATIVE,
THEN YOU WOULDN’T HAVE TO BE SO VINDICTIVE!” 82

83. BY CALLING THE PATIENT’S ATTENTION TO
THE CONFLICT THAT EXISTS WITHIN HER
BETWEEN THE “OBJECTIVE REALITY”
THAT SHE “KNOWS” WITH HER HEAD
AND THE “SUBJECTIVE EXPERIENCE”
THAT SHE “FEELS” WITH HER HEART
MODEL 1 CONFLICT STATEMENTS
CAN BE STRATEGICALLY FORMULATED
TO PRECIPITATE (DEFENSIVE) DISRUPTION
IN ORDER TO TRIGGER (ADAPTIVE) REPAIR
83

84. MODEL 1 CONFLICT STATEMENTS
“YOU KNOW THAT EVENTUALLY YOU’LL NEED TO FACE THE REALITY THAT
YOUR MOTHER WAS NEVER REALLY THERE FOR YOU AND THAT YOU WON’T
GET BETTER UNTIL YOU LET GO OF YOUR HOPE THAT MAYBE SOMEDAY
YOU’LL BE ABLE TO MAKE HER CHANGE; BUT YOU’RE NOT QUITE YET
READY TO DEAL WITH ALL THE PAIN AROUND THAT BECAUSE YOU ARE
AFRAID THAT YOU MIGHT NEVER SURVIVE THE HEARTBREAK AND DESPAIR
YOU WOULD FEEL WERE YOU TO FACE THAT DEVASTATING REALITY.”
“YOU KNOW THAT YOUR NEED FOR YOUR CHILDREN TO UNDERSTAND YOUR
PERSPECTIVE MIGHT BE A BIT UNREALISTIC; BUT YOU TELL YOURSELF THAT
YOU HAVE A RIGHT TO THEIR RESPECT – AND THEIR FORGIVENESS.”
“YOU’RE COMING TO UNDERSTAND THAT YOUR ANGER CAN PUT PEOPLE OFF;
BUT YOU TELL YOURSELF THAT YOU HAVE A RIGHT TO BE AS ANGRY AS
YOU WANT BECAUSE OF HOW MUCH YOU HAVE SUFFERED OVER THE YEARS.”
“YOU KNOW THAT IF YOU ARE EVER TO GET ON WITH YOUR LIFE, YOU’LL
HAVE TO LET GO OF YOUR CONVICTION THAT YOUR CHILDHOOD SCARRED
YOU FOREVER; BUT IT’S HARD NOT TO FEEL LIKE DAMAGED GOODS WHEN
YOU GREW UP IN A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN
AND NASTY MOTHER WHO WAS ALWAYS CALLING YOU A LOSER.”
84

85. IN ORDER TO INCREASE THE PATIENT’S AWARENESS OF
HER AMBIVALENT ATTACHMENT TO HER DYSFUNCTION
THE MODEL 1 “INTERPRETIVE” THERAPIST
ALTERNATELY CHALLENGES BY HIGHLIGHTING
WHAT THE PATIENT IS COMING TO UNDERSTAND
AS THE PRICE SHE PAYS
FOR CLINGING TO HER DYSFUNCTION
A “PRICE PAID” THAT FUELS
HER AGGRESSIVE CATHEXIS OF THE DEFENSE
AND THEN SUPPORTS BY RESONATING EMPATHICALLY
WITH WHAT THE THERAPIST IS COMING TO
UNDERSTAND AS THE INVESTMENT THE PATIENT HAS
IN HOLDING ON TO HER DYSFUNCTION EVEN SO
AN “INVESTMENT IN” THAT FUELS
HER LIBIDINAL CATHEXIS OF THE DEFENSE
BACK AND FORTH – BACK AND FORTH
IN AN EFFORT TO MAKE THE AMBIVALENTLY HELD DEFENSE
LESS EGO – SYNTONIC AND MORE EGO – DYSTONIC 85

86. IN ESSENCE
MODEL 1 CONFLICT STATEMENTS
STRIVE TO CREATE INCENTIVIZING TENSION WITHIN
THE PATIENT BETWEEN HER DAWNING AWARENESS
OF JUST HOW COSTLY HER DEFENSES HAVE BECOME
WITH AN EYE TO MAKING THEM MORE EGO – DYSTONIC
AND HER NEW – FOUND UNDERSTANDING
OF JUST HOW INVESTED SHE HAS BEEN
IN HOLDING ON TO THEM EVEN SO
WITH AN EYE TO HIGHLIGHTING HOW EGO – SYNTONIC THEY HAVE BEEN
ULTIMATELY
THE EVER – INCREASING INTERNAL DISSONANCE
RESULTING FROM HER EVER – EVOLVING AWARENESS
OF BOTH THE COST AND THE BENEFIT
OF MAINTAINING HER ATTACHMENT
TO HER DYSFUNCTIONAL DEFENSES
WILL GALVANIZE HER TO TAKE ACTION
IN ORDER TO RESOLVE THE INTERNAL TENSION
86

87. TO THAT END
THE MODEL 1 THERAPIST THEREFORE
REPEATEDLY HIGHLIGHTS BOTH
THE “PRICE PAID” (PAIN) AND THE “INVESTMENT IN” (GAIN)
AS LONG AS THE “GAIN” IS
GREATER THAN THE “PAIN”
EGO – SYNTONIC GREATER THAN EGO – DYSTONIC
THE PATIENT WILL “MAINTAIN” THE DEFENSE
AND “REMAIN” ENTRENCHED
BUT AS A RESULT OF THE PATIENT’S EVER – EVOLVING AWARENESS
OF BOTH THE “PRICE PAID” AND THE “INVESTMENT IN”
ONCE THE “PAIN” BECOMES GREATER THAN THE “GAIN”
EGO – DYSTONIC GREATER THAN EGO – SYNTONIC
THE STRESS AND “STRAIN” OF THE
COGNITIVE AND AFFECTIVE DISSONANCE
BETWEEN THE “PAIN” AND THE “GAIN”
WILL PROVIDE THE IMPETUS NEEDED
FOR THE PATIENT GRADUALLY … 87

88. … TO RELINQUISH HER ATTACHMENT
TO THE DYSFUNCTIONAL DEFENSE
THEREBY
RESOLVING THE
STRUCTURAL CONFLICT
NEUROTIC / INTRAPSYCHIC CONFLICT
THAT HAD EXISTED
BETWEEN THE UNTAMED
BUT ULTIMATELY GROWTH – PROMOTING
ID DRIVE
AND THE RESISTIVE
GROWTH – IMPEDING BUT ANXIETY – RELIEVING
EGO DEFENSE
88

89. AS A RESULT OF WORKING THROUGH
THE RESISTANCE / DEFENSE
THE NOW STRONGER
AND MORE INSIGHTFUL EGO
WILL BE BETTER ABLE TO “REGULATE”
THE ID’S NOW TAMER AND
MORE MANAGEABLE ENERGIES
SUCH THAT,
NO LONGER THWARTED,
THEIR POWER CAN BE HARNESSED
BY THE EGO AND CHANNELED INTO
CONSTRUCTIVE ENDEAVORS
AND WORTHWHILE PURSUITS
THEIR MODULATED ENERGY NOW PROVIDING THE
PROPULSIVE FUEL FOR ACTUALIZATION OF POTENTIAL
89

90. IN OTHER WORDS
ONGOING USE OF “OPTIMALLY STRESSFUL”
MODEL 1 CONFLICT STATEMENTS
WILL GENERATE HEALING CYCLES OF
DISRUPTION
IN REACTION TO THE CHALLENGE
AND REPAIR
IN RESPONSE TO THE SUPPORT
AT EVER – HIGHER LEVELS
OF ADAPTIVE CAPACITY
SUCH THAT “ID ENERGY” ONCE “REINED IN”
BY “EGO RESISTANCE” WILL BE “FREED UP”
AND CAN THEN BE USED TO “EMPOWER”
THE REALIZATION OF LIFE GOALS
90

91. FREUD’S (1937) “HORSE AND RIDER” IS
INDEED AN APT METAPHOR FOR THE
THERAPEUTIC ACTION IN MODEL 1
FREUD’S RIDER
A NOW STRONGER AND MORE EMPOWERED EGO BY VIRTUE OF THE
GREATER AWARENESS IT HAS OF ITS INTERNAL CONFLICTEDNESS
WILL NOW BE MORE SKILLED AT HARNESSING
THE QUANTUM POWER OF THE HORSE
A NOW BETTER REGULATABLE ID BY VIRTUE
OF THE WORKING THROUGH PROCESS,
WHICH HAS TAMED, MODIFIED, AND INTEGRATED ITS ENERGIES
SUCH THAT HORSE AND RIDER
WILL NOW BE ABLE TO MOVE FORWARD
HARMONIOUSLY AND IN SYNC
NO LONGER IN CONFLICT BUT IN COLLABORATION
91

92. IN ESSENCE
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 EVOLVES
INTO STRUCTURAL COLLABORATION
AND “JAMMED UP” EVOLVES INTO
“EMPOWERED” AND “ACTUALIZED”
92

93. PARENTHETICALLY
AS WE SIT WITH OUR PATIENTS
THERE IS ALWAYS TENSION WITHIN US AS WELL
DIALECTICAL TENSION BETWEEN
ON THE ONE HAND
OUR VISION OF WHO WE THINK THE PATIENT COULD BE
WERE SHE BUT ABLE / WILLING TO MAKE HEALTHIER CHOICES
AND ON THE OTHER HAND
OUR RESPECT FOR THE REALITY OF WHO SHE IS
AND FOR THE CHOICES, NO MATTER HOW UNHEALTHY,
THAT SHE “FINDS HERSELF” FEELING COMPELLED TO MAKE
WE ARE THEREFORE ALWAYS STRUGGLING TO FIND
AN OPTIMAL BALANCE WITHIN OURSELVES
BETWEEN WANTING THE PATIENT TO CHANGE
AND ACCEPTING THE REALITY OF WHO SHE IS
93

94. IMPORTANTLY
MODEL 1 CONFLICT STATEMENTS
BY LOCATING WITHIN THE PATIENT
THE CONFLICT BETWEEN
HER ANXIETY – PROVOKING KNOWLEDGE
OF A DISTRESSING REALITY AND
HER ANXIETY – ASSUAGING NEED
TO AVOID DEALING WITH IT,
THE THERAPIST IS DEFTLY SIDESTEPPING
THE POTENTIAL FOR CONFLICT
BETWEEN THE PATIENT AND HERSELF
94

95. WHEN THE THERAPIST INTRODUCES A CONFLICT STATEMENT WITH
“YOU KNOW THAT … ”
SHE IS FORCING THE PATIENT TO TAKE RESPONSIBILITY
FOR WHAT THE PATIENT REALLY DOES KNOW
BUT IF THE THERAPIST
IN A MISGUIDED ATTEMPT TO URGE THE PATIENT FORWARD
RESORTS SIMPLY TO TELLING THE PATIENT
WHAT THE THERAPIST KNOWS,
NOT ONLY DOES THE THERAPIST RUN
THE RISK OF FORCING THE PATIENT
TO BECOME EVER – MORE ENTRENCHED
IN HER DEFENSIVE STANCE OF PROTEST
BUT ALSO THE THERAPIST WILL BE
ROBBING THE PATIENT OF ANY INCENTIVE
TO TAKE RESPONSIBILITY
FOR HER OWN DESIRE TO GET BETTER
95

96. IN OTHER WORDS
AS A RESULT OF THE JUDICIOUS USE OF
CONFLICT STATEMENTS THAT FORCE THE PATIENT TO
BECOME AWARE OF, AND TAKE RESPONSIBILITY FOR,
HER OWN STATE OF INTERNAL “DIVIDEDNESS”
ABOUT GETTING BETTER
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 “VOICE OF REALITY”
AND OVERZEALOUSLY ADVOCATES
FOR THE PATIENT TO DO THE “RIGHT” THING
A STANCE THAT THEN LEAVES
THE PATIENT, MADE ANXIOUS, NO CHOICE BUT
TO BECOME THE “VOICE OF OPPOSITION”
96

97. IT IS TRULY AN UNTENABLE SITUATION FOR
THE THERAPIST TO BE THE ONE REPRESENTING
THE HEALTHY (ADAPTIVE) “VOICE OF YES”
AND FOR THE PATIENT TO BE THEN STUCK
IN THE POSITION OF HAVING TO COUNTER WITH
THE UNHEALTHY (DEFENSIVE) “VOICE OF NO”
AND SO IT IS THAT IN THE FIRST PART OF
A CONFLICT STATEMENT, THE THERAPIST HIGHLIGHTS WHAT
THE PATIENT, AT LEAST ON SOME LEVEL, REALLY DOES KNOW
EVEN THOUGH SHE MIGHT SOMETIMES BE UNWILLING / UNABLE
TO ACT IN ACCORDANCE WITH THAT KNOWLEDGE
IN ESSENCE
BY LOCATING THE CONFLICT SQUARELY WITHIN THE PATIENT
AND NOT WITHIN THE INTERSUBJECTIVE FIELD BETWEEN
PATIENT AND THERAPIST, CONFLICT STATEMENTS FORCE
THE PATIENT TO TAKE OWNERSHIP OF BOTH SIDES
OF HER AMBIVALENCE ABOUT GETTING BETTER
97

98. ALSO NOTE THE IMPLICIT MESSAGE DELIVERED BY THE
THERAPIST IN THE SECOND PART OF A CONFLICT STATEMENT
WHEN SHE USES SUCH TEMPORAL EXPRESSIONS AS
“FOR NOW” – “RIGHT NOW”
“AT THE MOMENT” – “IN THE MOMENT”
“AT THIS POINT IN TIME”
WHICH SHE WILL DO WHEN SHE IS ADDRESSING THE
PATIENT’S “INVESTMENT IN” THE DYSFUNCTIONAL DEFENSE
“YOU KNOW YOU’RE PAYING A STEEP PRICE FOR YOUR REFUSAL TO STOP
SMOKING, OF PARTICULAR CONCERN BECAUSE OF YOUR RECURRENT LUNG
INFECTIONS; BUT, IN THE MOMENT, YOU FIND YOURSELF FEELING THAT
YOU SIMPLY MUST HAVE THE CIGARETTES IN ORDER TO RELIEVE THE
MASSIVE ANXIETY THAT YOU ARE FEELING BECAUSE OF THE LAWSUIT.”
THE THERAPIST IS ATTEMPTING TO HIGHLIGHT THE FACT
THAT EVEN IF, FOR NOW, THE PATIENT WOULD SEEM TO BE
INVESTED IN PROTESTING HER RIGHT TO MAINTAIN THINGS AS
THEY ARE, AT ANOTHER POINT IN TIME THAT COULD CHANGE
98

99. IN SUM
“OPTIMALLY STRESSFUL”
CONFLICT STATEMENTS
ARE DESIGNED TO PROVOKE
THE RELINQUISHMENT OF
DYSFUNCTIONAL DEFENSES
BY GENERATING COGNITIVE
AND AFFECTIVE DISSONANCE
THE “WISDOM OF THE BODY” IS SUCH
THAT IT CANNOT TOLERATE THE
DISTRESS OF DISEQUILIBRIUM FOR ANY
EXTENDED PERIOD OF TIME AND WILL
THEREFORE BE “PROVOKED” TO TAKE
ACTION IN ORDER TO RESOLVE THE
INTERNAL TENSION AND RESTORE ORDER
99

100. ULTIMATELY, IT WILL BE THE PATIENT’S
EVER – EVOLVING CAPACITY BOTH
TO RECOGNIZE (WITH HER HEAD)
AND TO EXPERIENCE (WITH HER HEART)
THE FUNDAMENTAL CONFLICT BETWEEN
“COST” AND “BENEFIT” THAT WILL PROMPT
HER TO RELINQUISH HER DYSFUNCTION
THAT IS, TO SURRENDER
HER UNHEALTHY DEFENSES
DESPITE THEIR ERSTWHILE ROBUSTNESS
IN FAVOR OF HEALTHIER ADAPTATIONS
AS SHE EVOLVES FROM
“DEFENSIVE RESISTANCE”
TO “ADAPTIVE AWARENESS,”
EXPANDED CONSCIOUSNESS,
AND ACTUALIZED POTENTIAL
100

101. PLEASE NOTE THE CRITICAL DISTINCTION BETWEEN
EGO – PROTECTIVE ONE – PERSON DEFENSES
RELEVANT FOR MODEL 1
AND SELF – PROTECTIVE TWO – PERSON DEFENSES
RELEVANT FOR MODELS 2, 3, AND 4
ONE – PERSON (OR INTRAPSYCHIC) DEFENSES ARE MOBILIZED
BY AN EGO – MADE ANXIOUS – IN AN EFFORT TO PROTECT
ITSELF AGAINST THE THREATENED BREAKTHROUGH OF
DYSREGULATED AND ANXIETY – PROVOKING ID DRIVES
WELL – KNOWN INTRAPSYCHIC DEFENSES
REPRESSSION – INTELLECTUALIZATION – RATIONALIZATION
COMPARTMENTALIZATION – REACTION FORMATION
MOBILIZATION OF WHICH WILL GIVE RISE TO
INTERNAL, STRUCTURAL, NEUROTIC CONFLICT
HERE THE IMPORTANT RELATIONSHIP IS THE ONE
THAT EXISTS BETWEEN THE EGO AND THE ID
MODEL 1 INVOLVES THESE ONE – PERSON DEFENSES
101

102. BY CONTRAST
TWO – PERSON (OR INTERPERSONAL) DEFENSES ARE MOBILIZED
BY THE “SELF” – MADE ANXIOUS – IN AN EFFORT TO
PROTECT ITSELF AGAINST BEING FAILED BY THE OBJECT
LESS WELL – KNOWN (BUT JUST AS IMPORTANT) ARE INTERPERSONAL DEFENSES
THE NARCISSISTIC NEED FOR VALIDATION BY A MIRRORING SELFOBJECT
THE NARCISSISTIC NEED TO FUSE IN FANTASY WITH AN IDEALIZED SELFOBJECT
THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE
THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE
PROJECTIVE IDENTIFICATION – THE NEED FOR OMNIPOTENT CONTROL OF THE OBJECT
ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY – THE DENIAL OF OBJECT NEED
THE DEFENSE OF SELF – PROTECTIVE ISOLATION – AFFECTIVE NONRELATEDNESS
THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR
ALL OF WHICH ARE TWO – PERSON DEFENSES MOBILIZED TO
PROTECT THE VULNERABLE SELF FROM BEING FAILED,
DISAPPOINTED, VICTIMIZED, OR ANNIHILATED BY THE OBJECT
NOW THE IMPORTANT RELATIONSHIP IS THE ONE
THAT EXISTS BETWEEN THE SELF AND THE OBJECT
MODELS 2, 3, AND 4 INVOLVE THESE TWO – PERSON DEFENSES
102

103. 103

104. NATURE vs. NURTURE
I – IT vs. I – THOU
RELATIONSHIPS
MODEL 1 vs.
MODELS 2 AND 3
104

105. MODEL 1
WHAT DERIVES FROM
WITHIN THE CHILD
NATURE
MODELS 2 AND 3
WHAT DERIVES FROM
WITHIN THE RELATIONSHIP
BETWEEN PARENT AND CHILD
NURTURE
105

106. AS WE HAVE JUST SEEN
CLASSICAL PSYCHOANALYSTS
CONCEIVE OF PSYCHOPATHOLOGY
AS DERIVING FROM THE PATIENT
IN WHOM THERE IS THOUGHT TO BE
INTERNAL CONFLICT BETWEEN
AN UNTAMED ID AND A WEAK EGO
BUT SELF PSYCHOLOGISTS
AND RELATIONAL THEORISTS
CONCEIVE OF PSYCHOPATHOLOGY
AS DERIVING FROM THE PARENT
AND THE PARENT’S FAILURE
OF THE CHILD
106

107. IN OTHER WORDS
SELF PSYCHOLOGISTS AND
RELATIONAL THEORISTS FOCUS
NOT SO MUCH ON NATURE
THE PROVINCE OF MODEL 1
AS ON NURTURE
THE PROVINCE OF MODELS 2 AND 3
WHETHER
THE QUALITY OF PARENTAL CARE
MODEL 2
OR THE MUTUALITY OF FIT
BETWEEN PARENT AND CHILD
MODEL 3
107

108. BUT PLEASE NOTE
THE CRITICAL DISTINCTION
BETWEEN
QUALITY OF PARENTAL CARE
A STORY ABOUT “GIVE”
WHICH MAKES OF MODEL 2
A 1½ – PERSON PSYCHOLOGY
AND MUTUALITY OF FIT
A STORY ABOUT “GIVE – AND – TAKE”
WHICH MAKES OF MODEL 3
A 2 – PERSON PSYCHOLOGY
108

109. MODEL 2
AN “I – IT” RELATIONSHIP
A 1 – WAY RELATIONSHIP BETWEEN
SOMEONE WHO GIVES
AND SOMEONE WHO TAKES
MODEL 3
AN “I – THOU” RELATIONSHIP
A 2 – WAY RELATIONSHIP INVOLVING
GIVE – AND – TAKE, MUTUALITY,
RECIPROCITY, AND COLLABORATION
MARTIN BUBER (2000)
109

110. THIS DISTINCTION IS CRITICAL
BECAUSE A RELATIONSHIP
BETWEEN SOMEONE WHO ACTIVELY PROVIDES
AND SOMEONE WHO IS
THE PASSIVE RECIPIENT OF SUCH PROVISION
MODEL 2
IS A FAR CRY FROM
THE “MORE SUBSTANTIVE” RELATIONSHIP
THAT EXISTS BETWEEN
TWO “REAL” PEOPLE
MODEL 3
AN INTERSUBJECTIVE RELATIONSHIP
INVOLVING TWO SUBJECTS,
BOTH OF WHOM CONTRIBUTE TO WHAT
TRANSPIRES AT THEIR “INTIMATE EDGE”
110

111. AS WE SHALL SEE
THE EMPHASIS IN MODEL 2 IS THEREFORE
NOT SO MUCH ON THE RELATIONSHIP PER SE
AS IT IS ON THE FILLING IN OF
THE PATIENT’S DEFICITS BY WAY OF
THE THERAPIST’S CORRECTIVE PROVISION
OR, PERHAPS MORE ACCURATELY,
THE FILLING IN OF DEFICIT BY WAY OF
WORKING THROUGH FAILURES
IN THE ENVIRONMENTAL PROVISION
BY CONTRAST
THE EMPHASIS IN MODEL 3 IS
TRULY ON A “2 – WAY” RELATIONSHIP
BETWEEN TWO AUTHENTIC SUBJECTS
111

112. IMPORTANTLY
AS THE ETIOLOGY HAS SHIFTED
FROM NATURE (MODEL 1) TO
NURTURE (MODELS 2 AND 3),
SO TOO THE LOCUS OF THE
THERAPEUTIC ACTION HAS SHIFTED
FROM
“INSIGHT BY WAY OF INTERPRETATION”
TO
“A CORRECTIVE EXPERIENCE BY
WAY OF THE REAL RELATIONSHIP”
THAT IS, FROM WITHIN THE PATIENT
TO WITHIN THE RELATIONSHIP
BETWEEN THERAPIST AND PATIENT
112

113. BUT ACTUALLY
ALTHOUGH THERE ARE
STILL SOME WHO WRITE ABOUT
“A CORRECTIVE EXPERIENCE BY
WAY OF THE REAL RELATIONSHIP,”
THIS TELESCOPES TWO DIFFERENT CONCEPTS AND
OBFUSCATES THE CRITICAL DISTINCTION BETWEEN
A THERAPY RELATIONSHIP
THAT INVOLVES GIVE
AND A THERAPY RELATIONSHIP
THAT INVOLVES GIVE – AND – TAKE
A “CORRECTIVE EXPERIENCE”
IN THE FIRST INSTANCE (MODEL 2)
A “REAL RELATIONSHIP”
IN THE SECOND (MODEL 3)
113

114. IMPORRTANTLY
WHEREAS MODEL 2 THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT DID NOT DO
DEPRIVATION AND NEGLECT
“ABSENCE OF GOOD”
DEFICIENCY
INTERNALLY RECORDED IN THE FORM OF
STRUCTURAL DEFICIT AND IMPAIRED CAPACITY
TO BE A GOOD PARENT UNTO ONESELF
DEFICITS THAT THEN GIVE RISE TO THE
DESPERATE SEARCH FOR A NEW GOOD PARENT
“RELENTLESS PURSUITS” IN AN EFFORT
TO COMPENSATE FOR EARLY – ON
PARENTAL ERRORS OF OMISSION
114

115. MODEL 3 THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT DID DO
TRAUMA AND ABUSE
“PRESENCE OF BAD”
TOXICITY
INTERNALLY RECORDED AND STRUCTURALIZED IN
THE FORM OF PATHOGENIC INTROJECTS
THAT ARE THEN “COMPULSIVELY AND UNWITTINGLY”
DELIVERED INTO ONE’S RELATIONSHIPS AGAIN
AND AGAIN IN DESPERATE ATTEMPTS TO
ENCOUNTER DIFFERENT AND BETTER OUTCOMES
“COMPULSIVE REPETITIONS” IN AN EFFORT
TO CORRECT FOR EARLY – ON
PARENTAL ERRORS OF COMMISSION 115

116. AS IT HAPPENS
“ABSENCE OF GOOD” (MODEL 2)
AND
“PRESENCE OF BAD” (MODEL 3)
GENERALLY GO HAND IN HAND
BY WAY OF EXAMPLES
THE CHILD WHO WAS RARELY PRAISED
AND THEREFORE DEVELOPED “STRUCTURAL DEFICIT”
WAS PROBABLY ALSO OFTEN CRITICIZED
AND THEREFORE DEVELOPED “PATHOGENIC INTROJECTS”
THE CHILD WHO WAS RARELY ADMIRED
AND THEREFORE DEVELOPED “STRUCTURAL DEFICIT”
WAS PROBABLY ALSO OFTEN DEVALUED
AND THEREFORE DEVELOPED “PATHOGENIC INTROJECTS”
BUT THESE SITUATIONS ARE NOT
HANDLED THE SAME WAY CLINICALLY
116

117. AS WE SHALL SEE IN THE NEXT SECTION
MODEL 2
“ABSENCE OF GOOD”
– STRUCTURAL DEFICIT –
WILL CREATE THE NEED TO “FIND NEW GOOD”
DISPLACEMENT OF THIS NEED
WILL GIVE RISE TO “ILLUSION”
– POSITIVE MISPERCEPTION OF REALITY –
AND “POSITIVE TRANSFERENCE”
THE THERAPEUTIC ACTION IN MODEL 2
WILL THEN INVOLVE WORKING THROUGH
– BY WAY OF GRIEVING –
NOT “POSITIVE TRANSFERENCE”
BUT “DISRUPTED POSITIVE TRANSFERENCE”
117

118. MODEL 3
“PRESENCE OF BAD”
– PATHOGENIC INTROJECTS –
WILL CREATE THE NEED TO “RE – FIND OLD BAD”
PROJECTION OF PATHOGENIC INTROJECT
WILL GIVE RISE TO “DISTORTION”
– NEGATIVE MISPERCEPTION OF REALITY –
AND “NEGATIVE TRANSFERENCE”
THE THERAPEUTIC ACTION IN MODEL 3
WILL THEN INVOLVE WORKING THROUGH
– BY WAY OF NEGOTIATING AT THE
INTIMATE EDGE OF AUTHENTIC ENGAGEMENT –
“NEGATIVE TRANSFERENCE”
118

119. 119

120. MODEL 2
CORRECTIVE
PROVISION
“FOR”
vs.
MODEL 3
AUTHENTIC
ENGAGEMENT
“WITH”
120

121. MODEL 2 EMPATHIC ATTUNEMENT
THE MODEL 2 THERAPIST
AS AN EMPATHIC SELFOBJECT
“DECENTERS” FROM HER OWN EXPERIENCE,
JOINS ALONGSIDE THE PATIENT, AND
“TAKES ON” THE PATIENT’S EXPERIENCE
BUT ONLY “AS IF” IT WERE HER OWN
BECAUSE IT NEVER ACTUALLY
BECOMES HER OWN
121

122. MODEL 3 AUTHENTIC ENGAGEMENT
THE MODEL 3 THERAPIST
AS AN AUTHENTIC SUBJECT
REMAINS VERY MUCH “CENTERED”
WITHIN HER OWN EXPERIENCE AND
ALLOWS THE PATIENT’S EXPERIENCE
TO “ENTER INTO” HER
THEREBY TAKING IT ON “AS” HER OWN AND
ALLOWING HERSELF TO BE CHANGED BY IT
THE MODEL 3 THERAPIST “USES” HER “SELF”
TO FIND, AND BE FOUND BY, THE PATIENT
122

123. MODEL 2
AS AN EMPATHIC SELFOBJECT
THE THERAPIST PROVIDES
A CORRECTIVE EXPERIENCE
“FOR” THE PATIENT
MODEL 3
AS AN AUTHENTIC SUBJECT
THE THERAPIST PARTICIPATES
IN A REAL RELATIONSHIP
“WITH” THE PATIENT
123

124. AS WE SHALL SEE
THE THERAPIST’S PARTICIPATION
AS AN AUTHENTIC SUBJECT
MODEL 3
WILL ALMOST INEVITABLY
RESULT IN THE THERAPIST’S
PARTICIPATION AS
THE “OLD BAD OBJECT”
BECAUSE OF THE PATIENT’S EVER – PRESENT
“COMPULSIVE AND UNWITTING” NEED
THAT IS, HER REPETITION COMPULSION
TO RE – CREATE THE EARLY – ON UNMASTERED
RELATIONAL FAILURES IN THE HERE – AND – NOW
ENGAGEMENT WITH HER THERAPIST
124

125. THIS “NEED TO BE FAILED”
ASPECTS OF WHICH ARE “UNHEALTHY”
ASPECTS OF WHICH ARE “HEALTHY”
WILL PROMPT THE PATIENT TO EXERT
“INTERPERSONAL PRESSURE”
JAMES GROTSTEIN (1976)
ON THE MODEL 3 THERAPIST
TO CONFORM TO THE PATIENT’S
“RELATIONAL EXPECTATION”
OF ENCOUNTERING “BAD”
AND SO IT IS THAT
THE “RELATIONAL THERAPIST”
IN HER CAPACITY AS AN “AUTHENTIC SUBJECT”
WILL PARTICIPATE AS SOME VARIANT
OF THE “OLD BAD OBJECT”
125

126. AS WE KNOW
THE REPETITION COMPULSION
HAS BOTH UNHEALTHY AND HEALTHY COMPONENTS
THE UNHEALTHY COMPONENT HAS
TO DO WITH THE PATIENT’S NEED
TO HAVE MORE OF SAME
– NO MATTER HOW DYSFUNCTIONAL –
BECAUSE THAT IS ALL
THE PATIENT HAS EVER KNOWN
HAVING SOMETHING DIFFERENT WOULD CREATE ANXIETY
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 PARENTAL FAILURES 126

127. “IF THE THERAPIST DOES NOT PARTICIPATE
AS A NEW GOOD OBJECT,
THE THERAPY MAY NEVER GET UNDER WAY.
“BUT IF HE DOES NOT PARTICIPATE
AS THE OLD BAD ONE,
IT MAY NEVER END.”
JAY GREENBERG (1986)
I WOULD WANT TO SUPPLEMENT THIS WITH
“IF THE THERAPIST DOES NOT PARTICIPATE
AS THE OLD BAD OBJECT,
THE THERAPY MAY NEVER GET UNDER WAY.
“BUT IF SHE DOES NOT PARTICIPATE
AS A NEW GOOD ONE,
IT MAY NEVER END.”
MARTHA STARK (1994)
127

128. BOTH OF WHICH
CAPTURE BEAUTIFULLY
THE DELICATE BALANCE
THAT EXISTS BETWEEN
THE THERAPIST’S PARTICIPATION
AS A “NEW GOOD OBJECT”
SO THAT THERE CAN BE A STARTING OVER
A “NEW BEGINNING” (MICHAEL BALINT 1987)
AND THE THERAPIST’S PARTICIPATION
AS THE “OLD BAD ONE”
SO THAT THERE CAN BE AN OPPORTUNITY
TO ACHIEVE BELATED MASTERY OF THE
INTROJECTED RELATIONAL TRAUMAS
AND THE “DYSFUNCTIONAL RELATIONAL DYNAMICS” TO
WHICH THOSE INTROJECTED TRAUMAS HAVE GIVEN RISE
128

129. IN OTHER WORDS, OVER THE COURSE OF A TREATMENT,
THE PATIENT SHOULD HAVE AN OPPORTUNITY
TO EXPERIENCE HER THERAPIST AS BOTH
A “NEW GOOD OBJECT” AND THE “OLD BAD ONE”
MODEL 2 – STRUCTURAL GROWTH
ADD NEW GOOD TO COMPENSATE FOR DEFICIENCY
BY WORKING THROUGH
THE EXPERIENCE OF GOOD – BECOME – BAD
ILLUSION FOLLOWED BY DISILLUSIONING REALITY
“HOPE FOR GOOD” FOLLOWED BY
“NOT AS GOOD AS WOULD HAVE BEEN DESIRED”
MODEL 3 – STRUCTURAL MODIFICATION
CHANGE OLD BAD TO CORRECT FOR TOXICITY
BY WORKING THROUGH
THE EXPERIENCE OF BAD – BECOME – GOOD
DISTORTION FOLLOWED BY DETOXIFYING REALITY
“EXPECTATION OF BAD” FOLLOWED BY
“NOT AS BAD AS HAD BEEN FEARED”
129

130. AS WE HAD EARLIER DISCUSSED
THE THERAPEUTIC ACTION
IN MODEL 1 INVOLVES
WORKING THROUGH
THE STRESS OF GAIN – BECOME – PAIN
AS DYSFUNCTIONAL DEFENSES
– ONCE EGO – SYNTONIC –
ARE REPEATEDLY CHALLENGED
AND RENDERED INCREASINGLY
EGO – DYSTONIC
130

131. BUT THE THERAPEUTIC ACTION IN MODEL 2
INVOLVES WORKING THROUGH
THE STRESS OF GOOD – BECOME – BAD
AS THE PATIENT’S DEFENSIVE NEED TO CLING
TO ILLUSION IS REPEATEDLY CHALLENGED AND
GRADUALLY REPLACED BY MORE ACCURATE
(AND SOBERING) PERCEPTIONS OF REALITY
AND THE THERAPEUTIC ACTION IN MODEL 3
INVOLVES WORKING THROUGH
THE STRESS OF BAD – BECOME – GOOD
AS THE PATIENT’S DEFENSIVE NEED
TO CLING TO DISTORTION
– THE LURE OF THAT WHICH IS KNOWN –
IS REPEATEDLY CHALLENGED AND
GRADUALLY REPLACED BY MORE ACCURATE
(AND LESS TOXIC) PERCEPTIONS OF REALITY
131

132. THE THERAPEUTIC ACTION IN MODEL 2
WORKING THROUGH “POSITIVE TRANSFERENCE DISRUPTED”
A STORY ABOUT “CONFRONTING”
– AND “GRIEVING” –
THE REALITY OF THE “LIMITATIONS, SEPARATENESS,
AND IMMUTABILITY” OF THE PATIENT’S “OBJECTS”
BOTH PAST AND PRESENT
OPTIMAL DISILLUSIONMENT
ADAPTIVE TRANSMUTING INTERNALIZATION
INCREMENTAL ACCRETION OF PSYCHIC STRUCTURE
AND ADAPTIVE CAPACITY
GRADUAL FILLING IN OF STRUCTURAL DEFICIT
EVENTUAL TRANSFORMATION OF THE PATIENT’S
RELENTLESS PURSUITS OF THE UNATTAINABLE
INTO SERENE ACCEPTANCE OF PAINFUL REALITIES
ABOUT THE OBJECTS OF HER DESIRE 132

133. THE THERAPEUTIC ACTION IN MODEL 3
WORKING THROUGH THE “NEGATIVE TRANSFERENCE”
A STORY ABOUT “NEGOTIATING” THE VARIOUS
“MUTUAL ENACTMENTS” AND “THERAPEUTIC IMPASSES”
THAT WILL INEVITABLY ARISE AT THE
“INTIMATE EDGE” OF “AUTHENTIC ENGAGEMENT” AS
A RESULT OF THE PATIENT’S PROJECTIVE IDENTIFICATIONS
THE THERAPIST’S PROVISION OF “CONTAINMENT”
BY VIRTUE OF HER CAPACITY BOTH
TO RELENT AND TO HOLD HERSELF ACCOUNTABLE
INCREMENTAL “RELATIONAL DETOXIFCATION” OF
THE PATIENT’S “TOXIC INTERNAL BOLUSES” BY WAY OF
“SERIAL DILUTION” AND BY VIRTUE OF THE THERAPIST’S
CAPACITY TO PROCESS AND INTEGRATE ON BEHALF
OF A PATIENT WHO TRULY DOES NOT KNOW HOW
EVENTUAL TRANSFORMATION OF THE PATIENT’S
COMPULSIVE AND UNWITTING DRAMATIC RE – ENACTMENTS
INTO ACCOUNTABILITY FOR HER DYSFUNCTIONAL
ACTIONS, REACTIONS, AND INTERACTIONS 133

134. AGAIN, PLEASE NOTE THE CRITICALLY IMPORTANT
CLINICAL DISTINCTION BETWEEN
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