Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Slides.pptx

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Martha Stark MDFaculty, Harvard Medical School / Integrative Psychiatrist and Holistic Psychoanalyst / Originator and Developer, The Psychodynamic Synergy Paradigm: A C.A.R.E. Approach to Deep Healing em Harvard Medical School
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BY WAY OF REVIEW MODEL 1 THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS A 1 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S INTERNAL DYNAMICS AND POSITS INSIGHT, WISDOM, AWARENESS, EMPOWERMENT, AND ACTUALIZATION OF INHERITED POTENTIAL AS THE ULTIMATE THERAPEUTIC GOAL MODEL 2 THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND OTHER DEFICIT THEORIES A 1½ – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S AFFECTIVE EXPERIENCE AND POSITS ACCEPTANCE OF THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY AS THE ULTIMATE THERAPEUTIC GOAL 1
BY WAY OF REVIEW MODEL 3 THE CONTEMPORARY RELATIONAL (OR INTERSUBJECTIVE) PERSPECTIVE A 2 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S RELATIONAL DYNAMICS AND POSITS ACCOUNTABILITY AS THE ULTIMATE THERAPEUTIC GOAL MODEL 4 THE EXISTENTIAL PERSPECTIVE A ½ – PERSON PSYCHOLOGY THAT EMPHASIZES AN INDIVIDUAL’S STRUGGLE TO FIND MEANING, PURPOSE, AND DIRECTION IN LIFE AND POSITS ACCESSIBILITY AND THE FORGING OF MEANINGFUL ATTACHMENTS TO THE WORLD OF ANIMATE OBJECTS AS THE ULTIMATE THERAPEUTIC GOAL 2
AN OVERVIEW PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 1 CONFLICT STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RESISTANT” PATIENT TO STEP BACK FROM THE IMMEDIACY OF THE MOMENT IN ORDER TO TAKE STOCK OF BOTH HER INVESTMENT IN MAINTAINING THINGS AS THEY ARE AND THE PRICE SHE PAYS FOR DOING SO 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 3
PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RE – ENACTING” PATIENT TO TAKE RESPONSIBILITY FOR THE DYSFUNCTIONAL RELATIONAL DYNAMICS (THE RESIDUA OF UNMASTERED CHILDHOOD DRAMAS) THAT SHE IS COMPULSIVELY AND UNWITTINGLY REPLAYING ON THE STAGE OF HER LIFE MODEL 4 FACILITATION STATEMENTS ARE DESIGNED TO HIGHLIGHT THE “RETREATING” PATIENT’S INTENSE AMBIVALENCE ABOUT EVEN BEING IN RELATIONSHIP – THE FACT THAT SHE LONGS TO BE SEEN AND UNDERSTOOD BUT IS TERRIFIED OF BEING FOUND 4
MORE GENERALLY MODEL 1 USES CONFLICT STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER INTERNAL CONFLICTEDNESS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE SELF INTO THE ADAPTIVE CAPACITY TO BE AWARE OF THOSE ANXIETY – PROVOKING TRUTHS MODEL 2 USES DISILLUSIONMENT STATEMENTS TO FACILITATE THE PATIENT’S GRIEVING OF INTOLERABLY PAINFUL DISAPPOINTMENTS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE OBJECT INTO THE ADAPTIVE CAPACITY TO ACCEPT THOSE DISILLUSIONING TRUTHS 5
MORE GENERALLY MODEL 3 USES ACCOUNTABILITY STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER TENDENCY TO RE – PLAY UNMASTERED CHILDHOOD DRAMAS ON THE STAGE OF HER LIFE AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED CHILDHOOD DRAMAS INTO THE ADAPTIVE CAPACITY TO BE ACCOUNTABLE FOR HER ACTIONS, REACTIONS, AND INTERACTIONS AND MODEL 4 USES FACILITATION STATEMENTS TO HIGHLIGHT NOT ONLY THE PATIENT’S TERROR OF BEING ONCE AGAIN DESTROYED BY AN ANNIHILATING OBJECT BUT ALSO HER DESPERATE LONGING TO RE – ENGAGE WITH THE WORLD AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RETREAT INTO THE ADAPTIVE CAPACITY TO BE ACCESSED AND, AS A RESULT, TO BE ABLE TO TOLERATE MOMENTS OF MEANINGFUL MEETING 6
PREVIEW FOUR MODES OF THERAPEUTIC ACTION FOUR APPROACHES TO TRANSFORMING DEFENSE INTO ADAPTATION FOUR OPTIMAL STRESSORS THAT FACILITATE THIS ACTION TRANSFORMATION OF RESISTANCE INTO AWARENESS AND ACTUALIZATION OF POTENTIAL BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE (THE EXPERIENCE OF GAIN – BECOME – PAIN) TRANSFORMATION OF RELENTLESSNESS INTO ACCEPTANCE BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT (THE EXPERIENCE OF GOOD – BECOME – BAD) TRANSFORMATION OF RE – ENACTMENT INTO ACCOUNTABILITY BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION (THE EXPERIENCE OF BAD – BECOME – GOOD) TRANSFORMATION OF RETREAT INTO ACCESSIBILITY BY WORKING THROUGH THE STRESS OF ABSOLUTE DEPENDENCE (THE EXPERIENCE OF HIDDEN – BECOME – FOUND) 7
STRUCTURAL CONFLICT RESISTANCE BECOMES TRANSFORMED INTO AWARENESS AND ACTUALIZATION OF POTENTIAL STRUCTURAL DEFICIT RELENTLESSNESS BECOMES TRANSFORMED INTO ACCEPTANCE RELATIONAL CONFLICT RE – ENACTMENT BECOMES TRANSFORMED INTO ACCOUNTABILITY RELATIONAL DEFICIT RETREAT BECOMES TRANSFORMED INTO ACCESSIBILITY NEUROTIC ~ NARCISSISTIC ~ CHARACTER DISORDERED ~ SCHIZOID 8
TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 1 DEFENSIVE REACTION – RESISTANCE TO AWARENESS OF ONE’S DYSFUNCTIONAL INTERNAL DYNAMICS ADAPTIVE RESPONSE – AWARENESS AND ACTUALIZATION OF POTENTIAL MODEL 2 DEFENSIVE REACTION – RELENTLESSNESS (RELENTLESS HOPE) AND REFUSAL TO CONFRONT – AND GRIEVE – CERTAIN INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY ADAPTIVE RESPONSE – ACCEPTANCE OF ONE’S ULTIMATE POWERLESSNESS TO MAKE THE OBJECT CHANGE 9
TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 3 DEFENSIVE REACTION – COMPULSIVE AND UNWITTING RE – ENACTMENT OF DYSFUNCTIONAL RELATIONAL DYNAMICS RESULTING FROM UNMASTERED EARLY – ON TRAUMAS ADAPTIVE RESPONSE – ACCOUNTABILITY FOR ONE’S ACTIONS, REACTIONS, AND INTERACTIONS MODEL 4 DEFENSIVE REACTION – PSYCHIC RETREAT AND SCHIZOID WITHDRAWAL ADAPTIVE RESPONSE – ACCESSIBILITY AND ATTACHMENT 10
PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT AN OPPORTUNITY ALBEIT A BELATED ONE TO MASTER EXPERIENCES THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST BUT THAT CAN NOW WITH ENOUGH SUPPORT FROM THE THERAPIST AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE AND CAPACITY TO COPE WITH STRESS BE PROCESSED AND INTEGRATED AND ULTIMATELY ADAPTED TO 11
WITH THE THERAPIST’S FINGER EVER ON THE PULSE OF THE PATIENT’S ANXIETY AND CAPACITY TO TOLERATE FURTHER CHALLENGE THE THERAPIST WILL THEREFORE CHALLENGE WHENEVER POSSIBLE BY DIRECTING THE PATIENT’S ATTENTION TO WHERE THE PATIENT IS NOT “DISRUPTIVE ATTUNEMENT” AND SUPPORT WHENEVER NECESSARY BY RESONATING WITH WHERE THE PATIENT IS “HOMEOSTATIC ATTUNEMENT” 12
CHALLENGE BY WAY OF ANXIETY – PROVOKING INTERPRETIVE STATEMENTS THAT CALL INTO QUESTION DEFENSES TO WHICH THE PATIENT HAS LONG CLUNG IN ORDER TO PRESERVE HER PSYCHOLOGICAL EQUILIBRIUM THEREBY INCREASING HER ANXIETY SUPPORT BY WAY OF ANXIETY – ASSUAGING EMPATHIC STATEMENTS THAT HONOR THOSE SELF – PROTECTIVE DEFENSES THEREBY DECREASING HER ANXIETY 13
MODEL 1 – STRUCTURAL CONFLICT THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS SIGMUND FREUD, ANNA FREUD, HEINZ HARTMANN, DAVID RAPAPORT, ERNST KRIS, AND RUDOLPH LOEWENSTEIN MODEL 2 – STRUCTURAL DEFICIT THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL ABSENCE OF GOOD HEINZ KOHUT, ERNEST WOLF, ARNOLD GOLDBERG, MICHAEL BALINT, AND PAUL / ANNA ORNSTEIN 14
MODEL 3 – RELATIONAL CONFLICT THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL PRESENCE OF BAD W R D FAIRBAIRN, STEPHEN MITCHELL, JESSICA BENJAMIN, DARLENE EHRENBERG, AND JAY GREENBERG MODEL 4 – RELATIONAL DEFICIT THE EXISTENTIAL PERSPECTIVE WITH ITS EMPHASIS ON DREAD, ANGST, DESPAIR, SUFFERING, AND SEARCH FOR MEANINGFUL CONNECTION HARRY GUNTRIP, ARNOLD MODELL, MASUD KHAN, JOHN BOWLBY, THOMAS OGDEN, ROLLO MAY, AND VIKTOR FRANKL 15
MODEL 1 – STRUCTURAL CONFLICT ACCELERATOR / BRAKE ~ START / STOP FORCES PRESSING “YES” AND RESISTIVE COUNTERFORCES INSISTING “NO” MODEL 2 – STRUCTURAL DEFICIT INTERNAL ABSENCE OF GOOD ~ DEPRIVATION AND NEGLECT IMPAIRED CAPACITY TO BE A GOOD PARENT UNTO ONESELF MODEL 3 – RELATIONAL CONFLICT INTERNAL PRESENCE OF BAD ~ TRAUMA AND ABUSE COMPULSIVE RE – ENACTMENT OF UNRESOLVED CHILDHOOD DRAMAS ON THE STAGE OF ONE’S LIFE MODEL 4 – RELATIONAL DEFICIT A HEART SHATTERED PSYCHIC RETREAT, SCHIZOID WITHDRAWAL, AND SOLITARY SUFFERING RESULTING FROM THE EXPERIENCE OF ANNIHILATING, HEART – SHATTERING RESPONSES FROM THE OBJECT 16
THERAPEUTIC ACTION MODEL 1 – COGNITIVE ENHANCEMENT OF KNOWLEDGE “WITHIN” MODEL 2 – AFFECTIVE PROVISION OF CORRECTIVE EXPERIENCE “FOR” MODEL 3 – RELATIONAL ENGAGEMENT IN AUTHENTIC RELATIONSHIP “WITH” MODEL 4 – EXISTENTIAL EMERGENCE OF MEANINGFUL MOMENTS OF MEETING “BETWEEN” AND CREATION OF TRANSITIONAL SPACE “BETWEEN” 17
MODEL 1 – NEUROTIC WOODY ALLEN, JERRY SEINFELD’S AND JASON ALEXANDER’S CHARACTERS ON SEINFELD, AND MONK MODEL 2 – NARCISSISTIC MADONNA, KIM KARDASHIAN, KANYE WEST, AND DONALD TRUMP MODEL 3 – CHARACTER DISORDERED GEORGE AND MARTHA IN WHO’S AFRAID OF VIRGINIA WOOLF? MODEL 4 – SCHIZOID PRIVATE (TRUE) SELF / ADDICTIONS / SOCIAL (FALSE) SELF GRETA GARBO, KATHARINE HEPBURN, JOHNNY CARSON, AND GREGORY HOUSE, MD (FROM THE TV SHOW HOUSE) 18
MODEL 1 – NEUROTIC THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS, AVOIDANCE, AND PARALYSIS, LEADING TO UNACTUALIZED POTENTIAL MODEL 2 – NARCISSISTIC THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE, LEADING TO UNREQUITED LOVE AND CONSTANT HEARTBREAK MODEL 3 – CHARACTER DISORDERED THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE AND BITTERNESS, LEADING TO UNACKNOWLEDGED ANGER AND AGGRESSION AND A SENSE OF ONESELF AS EVER THE VICTIM MODEL 4 – SCHIZOID THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR AND PROFOUND HOPELESSNESS, LEADING TO UNMITIGATED LONELINESS, SILENT SUFFERING, SOLIPSISTIC WITHDRAWAL, SCHIZOID DETACHMENT, PSYCHIC DEADNESS, AND INNER EMPTINESS 19
COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION KAREN HORNEY’S INTERPERSONAL TRENDS MOVEMENT INWARD ~ TOWARDS ~ AGAINST ~ AWAY SYMPATHETIC ACTIVATION FREEZE ~ FEED / FUCK ~ FIGHT ~ FLIGHT MODES OF RELATEDNESS NEUROTIC ~ NARCISSISTIC ~ NOXIOUS ~ NONRELATEDNESS NUMBERS OF PEOPLE INVOLVED 1 – PERSON ~ 1½ – PERSON ~ 2 – PERSON ~ ½ – PERSON THERAPEUTIC STANCE NEUTRALITY ~ EMPATHY ~ AUTHENTICITY ~ DEPENDABILITY / DEVOTION A PSYCHOLOGY OF THE … EGO ~ SELF ~ SELF – IN – RELATION ~ PRIVATE SELF 20
KAREN HORNEY DESCRIBES THREE “INTERPERSONAL TRENDS” MOVEMENT INWARD MODEL 1 MOVEMENT TOWARDS MODEL 2 MOVEMENT AGAINST MODEL 3 MOVEMENT AWAY MODEL 4 21
FOUR Fs OF “SYMPATHETIC ACTIVATION” FOUR BASIC DRIVES RELATED TO SURVIVAL FIGHT OR FLIGHT OR FREEZE AND, OF COURSE, FEED / REPRODUCE FREEZE MODEL 1 (MOVEMENT INWARD) FEED / FUCK MODEL 2 (MOVEMENT TOWARDS) FIGHT MODEL 3 (MOVEMENT AGAINST) FLEE MODEL 4 (MOVEMENT AWAY) 22
MODES OF RELATEDNESS MODEL 1 – NEUROTIC RELATEDNESS THE CONFLICT – RIDDEN NEUROTIC PATIENT STRUGGLES TO MOVE FORWARD IN HER LIFE BUT IS JAMMED UP AND UNABLE TO EMPOWER HERSELF BY MOBILIZING HER ID ENERGIES IN THE SERVICE OF HER EGO MODEL 2 – NARCISSISTIC RELATEDNESS THE DEFICIT – RIDDEN NARCISSISTIC PATIENT NEEDS HER OBJECTS TO “COMPLETE” HER BY PROVIDING MIRRORING CONFIRMATION OF HER PERFECTION AND / OR BY ALLOWING HER TO FUSE WITH THEM IN FANTASY SUCH THAT SHE CAN THEN PARTAKE OF THEIR PERFECTION MODEL 3 – NOXIOUS RELATEDNESS UNDER THE SWAY OF HER REPETITION COMPULSION, THE CHARACTER DISORDERED PATIENT DELIVERS HER UNMASTERED CHILDHOOD DRAMAS (THAT IS, HER DYSFUNCTIONAL RELATIONAL DYNAMICS) INTO HER RELATIONSHIPS AND THEN COMPULSIVELY AND UNWITTINGLY RE – ENACTS THEM ON THE STAGE OF HER LIFE MODEL 4 – NONRELATEDNESS FOR FEAR OF BEING SHATTERED BY YET ANOTHER CATASTROPHICALLY ANNIHILATING RESPONSE FROM THE OBJECT, THE SCHIZOID PATIENT WITHDRAWS FROM ALL RELATIONSHIPS AND IS RELUCTANT TO BE FOUND23
MODEL 1 – 1 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S INTERNAL DYNAMICS THERAPIST AS A NEUTRAL OBJECT / OBJECTIVE OBSERVER OBJECTIVITY OF A SURGEON / BLANK SCREEN MODEL 2 – 1½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE EXPERIENCE (ESPECIALLY THE PAIN OF HER GRIEF) THERAPIST AS AN EMPATHIC SELFOBJECT OR GOOD OBJECT MODEL 3 – 2 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S RELATIONAL DYNAMICS THERAPIST AS AN AUTHENTIC SUBJECT OR A RELATIONAL OBJECT (AND, AT THE END OF THE DAY, INEVITABLY A BAD OBJECT) MODEL 4 – ½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE NONRELATEDNESS THERAPIST AS A RELIABLE, NONDEMANDING, STEADY, DEPENDABLE, CONSISTENT, TRUSTWORTHY, LOVING, AND DEVOTED PRESENCE 24
THERAPEUTIC STANCE MODEL 1 – NEUTRALITY MODEL 2 – EMPATHY MODEL 3 – AUTHENTICITY MODEL 4 – RELIABILITY ~ DEPENDABILITY ~ DEVOTION 25
EMPATHY VS. AUTHENTICITY THERE IS A CRITICAL DISTINCTION BETWEEN THE EMPATHIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 2 HAT AND THE AUTHENTIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 3 HAT MODEL 2 IS ABOUT THE THERAPIST’S EMPATHIC IMMERSION IN THE PATIENT’S INTERNAL WORLD THE EMPATHIC THERAPIST “DECENTERS” (ATWOOD AND STOLOROW 1984) FROM HER OWN EXPERIENCE, JOINS ALONGSIDE THE PATIENT, AND ENTERS INTO THE PATIENT’S INTERNAL EXPERIENCE – BUT TAKES IT ON ONLY “AS IF” IT WERE HER OWN BECAUSE IT NEVER ACTUALLY BECOMES HER OWN EMPATHY IS NOT ABOUT THE THERAPIST WHO HAS DECENTERED FROM HER OWN EXPERIENCE IT IS ABOUT THE PATIENT 26
EMPATHY VS. AUTHENTICITY MODEL 3 IS ABOUT THE THERAPIST’S AUTHENTIC PARTICIPATION IN A REAL RELATIONSHIP WITH THE PATIENT UNLIKE THE EMPATHIC THERAPIST, WHO DECENTERS FROM HER OWN EXPERIENCE, THE AUTHENTIC THERAPIST REMAINS VERY MUCH CENTERED IN HER OWN EXPERIENCE AND ALLOWS THE PATIENT’S EXPERIENCE TO ENTER INTO HER, WHICH SHE THEN TAKES ON “AS” HER OWN THIS DYNAMIC IS AT THE HEART OF PROJECTIVE IDENTIFICATION THE MEAT AND POTATOES OF CONTEMPORARY RELATIONAL THEORY AND, AS WE SHALL LATER SEE, AT THE HEART OF INTROJECTIVE IDENTIFICATION AS WELL 27
A PSYCHOLOGY OF THE … MODEL 1 EGO GOAL ~ A STRONGER, WISER, AND MORE EMPOWERED EGO MODEL 2 SELF GOAL ~ A MORE CONSOLIDATED, ACCEPTING, AND COMPASSIONATE SELF MODEL 3 SELF – IN – RELATION GOAL ~ A MORE PRESENT AND ACCOUNTABLE SELF – IN – RELATION MODEL 4 PRIVATE SELF / ADDICTED SELF / FALSE SELF GOAL ~ A LESS PROTECTED AND MORE ACCESSIBLE TRUE SELF 28
RECURRING THEMES MODEL 1 AVOIDANCE ~ PARALYSIS MODEL 2 SHAME ~ CONTEMPT EMPTY, SHAME – FILLED DEPRESSION PATIENT NEEDS TO BE ABLE TO “GRIEVE” MODEL 3 ANGER ~ AGGRESSION ~ GUILT ANGRY, GUILT – RIDDEN DEPRESSION PATIENT NEEDS TO BE ABLE TO “RAGE” MODEL 4 SECRETS ~ LIES PRETENSIONS ~ CONCEALMENTS PROFOUND DESPAIR ~ SOLITARY SUFFERING 29
ALTHOUGH THE FOCUS IN EACH IS DIFFERENT ALL FOUR OF MY MODELS INVOLVE AS THEIR STARTING POINT THE INTERNAL PRICE PAID BY THE CHILD BECAUSE OF TRAUMATIC FRUSTRATION BY THE PARENT MODEL 1 REINFORCEMENT OF INFANTILE NEED IN THE FACE OF ITS TRAUMATIC FRUSTRATION MODEL 2 FAILURE TO INTERNALIZE GOOD IN THE FACE OF TRAUMATIC “ABSENCE OF GOOD” MODEL 3 INTROJECTION OF BAD IN THE FACE OF TRAUMATIC “PRESENCE OF BAD” MODEL 4 SHATTERING OF THE HEART IN THE FACE OF CATACLYSMIC HEARTBREAK AND LOSS 30
THE STARTING POINT IN MODEL 1 DEFENSIVELY REINFORCED INFANTILE (LIBIDINAL AND AGGRESSIVE) DRIVES RESULTING FROM THE DRIVE OBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE DRIVES THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) DRIVES AS THEY ARISE IN THE CONTEXT OF THE TREATMENT WHICH WILL ULTIMATELY RESULT IN ADAPTIVE INTEGRATION OF THOSE (ID) DRIVES NOW TAMED AND MODIFIED INTO HEALTHY PSYCHIC (EGO) STRUCTURE WHICH WILL THEN ALLOW FOR THE REDIRECTING OF THEIR NOW BETTER REGULATED ENERGY INTO MORE CONSTRUCTIVE PURSUITS AND ACTUALIZATION OF POTENTIAL BY A NOW MORE SKILLED EGO DRIVE (HORSE) AND DEFENSE (RIDER) NO LONGER WORKING IN CONFLICT BUT IN COLLABORATION 31
THE STARTING POINT IN MODEL 2 STRUCTURAL DEFICIT AND IMPAIRED CAPACITY RESULTING FROM THE SELFOBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE NEED TO HAVE A PERFECT PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) NARCISSISTIC NEED TO FIND THE PERFECT PARENT AS IT ARISES IN THE CONTEXT OF THE RELATIONSHIP WITH THE SELFOBJECT THERAPIST WHICH WILL ULTIMATELY RESULT IN ADAPTIVE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS WHICH WILL THEN ALLOW FOR THE FILLING IN OF STRUCTURAL DEFICIT, DEVELOPMENT OF A MORE ROBUST CAPACITY TO BE A GOOD PARENT UNTO HERSELF, ACCRETION OF HEALTHY PSYCHIC STRUCTURE, AND CONSOLIDATION OF A MORE COHESIVE SELF GRIEVING OPTIMAL DISILLUSIONMENT WILL TRANSFORM THE DEFENSIVE NEED FOR EXTERNAL REGULATION OF THE SELF INTO THE ADAPTIVE CAPACITY TO BE INTERNALLY SELF – REGULATING 32
THE STARTING POINT IN MODEL 3 INTERNAL DEMONS AND A SENSE OF INNER BADNESS RESULTING FROM INTROJECTION OF THE DYSFUNCTIONAL RELATIONAL DYNAMIC CHARACTERIZING THE CHILD’S EARLY – ON RELATIONSHIP WITH THE TRAUMATICALLY ABUSIVE PARENT INTERNAL BAD OBJECTS / PATHOGENIC INTROJECTS THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE TURBULENCE THAT WILL INEVITABLY ARISE AT THE “INTIMATE EDGE” (EHRENBERG 1992) OF AUTHENTIC RELATEDNESS ONCE THE PATIENT DELIVERS HER PATHOGENIC INTROJECTS INTO THE RELATIONSHIP WITH HER THERAPIST WHICH WILL ULTIMATELY RESULT IN GRADUAL MODIFICATION OF THEIR TOXICITY BY WAY OF SERIAL DILUTIONS WHICH WILL THEN ALLOW FOR TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED EARLY – ON RELATIONAL TRAUMAS INTO THE ADAPTIVE CAPACITY TO HOLD HERSELF ACCOUNTABLE AND TO ENGAGE IN HEALTHY, AUTHENTIC RELATEDNESS 33
THE STARTING POINT IN MODEL 4 A HEART SHATTERED, SCHIZOID WITHDRAWAL, AND PSYCHIC RETREAT RESULTING FROM OVERWHELMINGLY DEVASTATING HEARTBREAK EXPERIENCED AT THE HANDS OF A DEVASTATINGLY ANNIHILATING PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE PATIENT’S FEAR OF BEING FOUND BY, BECOMING ABSOLUTELY DEPENDENT UPON, AND EXPERIENCING MOMENTS OF MEETING WITH THE THERAPIST THE THERAPIST’S PROVISION OF RELIABLE, NONDEMANDING, STEADY, CONSISTENT, TRUSTWORTHY, AND DEVOTED PRESENCE FOR A PATIENT WHO IS INTENSELY AMBIVALENT ABOUT ENGAGEMENT ~ ON THE ONE HAND, DESPERATELY LONGING TO BE KNOWN BUT, ON THE OTHER HAND, TERRIFIED OF BEING FOUND WILL ULTIMATELY RESULT IN REDUCED TERROR, DREAD, DESPAIR, RESIGNATION, ISOLATION, AND ALIENATION TOLERATING ABSOLUTE DEPENDENCE WILL TRANSFORM THE DEFENSIVE NEED TO STAY HIDDEN INTO THE ADAPTIVE CAPACITY TO BE FOUND 34
WHEN, IN THE MOMENT, THE SPOTLIGHT IS ON THE PATIENT AS … NEUROTICALLY CONFLICTED / JAMMED UP / STUCK PARALYZED BY DYSFUNCTIONAL INTERNAL DYNAMICS THINK MODEL 1 NARCISSISTICALLY VULNERABLE / NEEDY EVER BUSY LOOKING TO THE OUTSIDE FOR EXTERNAL PROVISION, VALIDATION, AND REINFORCEMENT THINK MODEL 2 NOXIOUSLY ENGAGED / SELF – SABOTAGING SELF – DEFEATING / SELF – INDULGENT / SELF – DESTRUCTIVE RE – ENACTING DYSFUNCTIONAL RELATIONAL DYNAMICS THINK MODEL 3 NONRELATED AFFECTIVELY / INACCESSIBLE / HIDDEN DISCONNECTED / DETACHED / ENCAPSULATED IN A COCOON IMPENETRABLE / SELF – PROTECTIVE ISOLATION THINK MODEL 4 35
COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION ROLE OF THE TRANSFERENCE NOT PARTICULARLY RELEVANT ~ POSITIVE ~ NEGATIVE ~ COCOON 1 – PERSON vs. 2 – PERSON DEFENSES PROTECT THE EGO FROM THE ID ~ PROTECT THE SELF FROM THE OBJECT OPTIMAL STRESSORS DISSONANCE ~ DISILLUSIONMENT ~ DETOXIFICATION ~ DEPENDENCE OPTIMALLY STRESSFUL STATEMENTS CONFLICT ~ DISILLUSIONMENT ~ ACCOUNTABILITY ~ FACILITATION SPOTLIGHT IN THE MOMENT RESISTANT ~ RELENTLESS ~ RE – ENACTING ~ RETREATING NOT AWARE ~ NOT ACCEPTING ~ NOT ACCOUNTABLE ~ NOT ACCESSIBLE 36
ROLE OF THE TRANSFERENCE MODEL 1 MORE RELEVANT THAN THE TRANSFERENCE IS THE FACT OF THE INTERNAL CONFLICTEDNESS BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING RESISTIVE COUNTERFORCES MODEL 2 POSITIVE TRANSFERENCE (DISPLACEMENT ~ ILLUSION) POSITIVE TRANSFERENCE DISRUPTED (DISILLUSIONMENT) MODEL 2½ POSITIVE TRANSFERENCE ACTUALIZED (DISPLACIVE IDENTIFICATION) MODEL 3 NEGATIVE TRANSFERENCE (PROJECTION ~ DISTORTION) NEGATIVE TRANSFERENCE ACTUALIZED (PROJECTIVE IDENTIFICATION) MODEL 4 COCOON TRANSFERENCE (DENIAL OF OBJECT NEED) 37
1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 1 – PERSON DEFENSES MOBILIZED TO PROTECT THE EGO FROM THE ID (REPRESSION ~ INTELLECTUALIZATION ~ REACTION FORMATION) MODELS 2, 3, AND 4 2 – PERSON DEFENSES MOBILIZED TO PROTECT THE SELF FROM THE OBJECT (RELENTLESS HOPE AND ENTITLEMENT ~ RELENTLESS OUTRAGE THE DEFENSE OF AFFECTIVE NONRELATEDNESS ~ ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY ~ DENIAL OF OBJECT NEED) 38
1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 FOCUSES ON INTRAPSYCHIC (1 – PERSON) DEFENSES MOBILIZED BY THE EGO IN AN EFFORT TO PROTECT ITSELF AGAINST THREATENED BREAKTHROUGH OF DYSREGULATED AND ANXIETY – PROVOKING ID FORCES THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE EGO AND THE ID MODEL 2 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING DISAPPOINTED BY ITS SELFOBJECTS THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE SELF AND THE SELFOBJECT 39
1 – PERSON vs. 2 – PERSON DEFENSES MODEL 3 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF – IN – RELATION IN AN EFFORT TO PROTECT ITSELF AGAINST BEING ABUSED BY ITS OBJECTS THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE SELF – IN – RELATION AND THE RELATIONAL OBJECT MODEL 4 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE PRIVATE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING SHATTERED BY A CATASTROPHICALLY DEVASTATING OBJECT THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE PRIVATE SELF AND THE WORLD OF ANIMATE OBJECTS 40
THERAPEUTIC ACTION MODEL 1 WORKING THROUGH THE RESISTANCE TO AWARENESS OF INTERNAL CONFLICTEDNESS MODEL 2 FACILITATING THE GRIEVING OF INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT MODEL 3 NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT MODEL 4 OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE 41
ACHIEVED BY WAY OF WORKING THROUGH THE OPTIMAL STRESS OF … MODEL 1 COGNITIVE DISSONANCE THE EXPERIENCE OF “GAIN – BECOME – PAIN” “EGO – SYNTONIC – BECOME – EGO – DYSTONIC” MODEL 2 AFFECTIVE (OPTIMAL) DISILLUSIONMENT THE EXPERIENCE OF “GOOD – BECOME – BAD” “ILLUSION – BECOME – DISILLUSIONMENT” MODEL 3 RELATIONAL DETOXIFICATION THE EXPERIENCE OF “BAD – BECOME – GOOD” MODEL 4 ABSOLUTE DEPENDENCE THE EXPERIENCE OF “HIDDEN – BECOME – FOUND” 42
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 1 CONFLICT STATEMENTS TO FACILITATE RESOLUTION OF THE PATIENT’S INTERNAL CONFLICT BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING DEFENSIVE COUNTERFORCES BY HIGHLIGHTING THE DISSONANCE BETWEEN FIRST WHAT (WITH HER HEAD) THE PATIENT KNOWS … AND THEN WHAT (WITH HER HEART) SHE FINDS HERSELF THINKING, FEELING, OR DOING IN ORDER NOT TO HAVE TO KNOW … “YOU KNOW THAT YOU COULD ALWAYS ASK FOR HELP; BUT, IN THE MOMENT, MAKING YOURSELF THAT VULNERABLE – BY ADMITTING THAT YOU MIGHT NEED SOMEONE – IS SIMPLY OUT OF THE QUESTION. YOU’VE BEEN DISAPPOINTED TOO MANY TIMES IN THE PAST TO BE WILLING TO TAKE SUCH A RISK NOW. ” (WHICH ADDRESSES CONVERGENT CONFLICT) 43
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 2 DISILLUSIONMENT STATEMENTS TO FACILITATE GRIEVING LOSSES AND DISAPPOINTMENTS “OPTIMAL DISILLUSIONMENT” BY FIRST HIGHLIGHTING THE ILLUSION (THE RELENTLESS HOPE), THEN ADDRESSING THE REALITY OF THE DISILLUSIONMENT, AND FINALLY RESONATING WITH THE PAIN OF THE PATIENT’S GRIEF “YOU WOULD HAVE WANTED JOSE TO BE ABLE TO LOVE YOU IN THE WAY THAT YOUR DAD NEVER DID; BUT YOU ARE COMING TO REALIZE THAT HE JUST CAN’T BECAUSE HE IS SO TERRIFIED OF COMMITMENT; AND KNOWING THIS BREAKS YOUR HEART.” (FIRST THE ILLUSION, BUT THEN THE DISILLUSIONING REALITY, AND FINALLY HER DEVASTATING GRIEF ABOUT IT) THE RESULT OF WHICH WILL BE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS AND THE FILLING IN OF DEFICIT 44
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS TO FOSTER “TAKING OWNERSHIP” AND TO FACILITATE “NEGOTIATING AT THE INTIMATE EDGE” (EHRENBERG 1992) BY HIGHLIGHTING THE CONTRIBUTIONS OF BOTH PATIENT AND THERAPIST TO THE CO – CREATED DYSFUNCTIONAL RELATIONAL DYNAMIC THAT IS BEING PLAYED OUT BETWEEN THEM “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.” IN THE AFTERMATH OF A PROVOCATIVE ENACTMENT ON THE PART OF THE PATIENT “HOW WERE YOU HOPING I WOULD RESPOND?” (ID) “HOW WERE YOU AFRAID I MIGHT RESPOND?” (SUPEREGO) “HOW WERE YOU IMAGINING THAT I WOULD RESPOND?” (EGO) 45
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 4 FACILITATION STATEMENTS TO ADDRESS THE PATIENT’S CONFLICT BETWEEN HER LONGING TO BE KNOWN AND UNDERSTOOD AND HER TERROR OF BEING FOUND AS WELL AS HER AMBIVALENCE ABOUT EVEN LIVING IN A WORLD THAT SHE EXPERIENCES AS EMPTY AND DEVOID OF MEANING OR PURPOSE “A PART OF YOU WOULD WANT DESPERATELY TO BE SEEN AND UNDERSTOOD; BUT ANOTHER PART OF YOU IS TERRIFIED OF BEING FOUND.” “A PART OF YOU WOULD WANT TO BE ABLE TO FIND A REASON TO GO ON LIVING; BUT ANOTHER PART OF YOU IS QUITE SURE THAT THERE IS NO MEANING TO BE FOUND.” (BOTH OF WHICH ADDRESS DIVERGENT CONFLICT) 46
WHEN THE FOCUS IS ON THE PATIENT AS “RESISTANT” AND / OR “NOT AWARE,” THINK MODEL 1 AND CONFLICT STATEMENTS TO MAKE THE PATIENT “MORE AWARE” WHEN THE FOCUS IS ON THE PATIENT AS “RELENTLESS” AND / OR “NOT ACCEPTING,” THINK MODEL 2 AND DISILLUSIONMENT STATEMENTS TO MAKE THE PATIENT “MORE ACCEPTING” WHEN THE FOCUS IS ON THE PATIENT AS “RE – ENACTING” AND / OR “NOT ACCOUNTABLE,” THINK MODEL 3 AND ACCOUNTABILITY STATEMENTS TO MAKE THE PATIENT “MORE ACCOUNTABLE” WHEN THE FOCUS IS ON THE PATIENT AS “RETREATING” AND / OR “NOT ACCESSIBLE,” THINK MODEL 4 AND FACILITATION STATEMENTS TO MAKE THE PATIENT “MORE ACCESSIBLE” 47
MODEL 1 RESOLUTION OF STRUCTURAL CONFLICT INVOLVING DYSFUNCTIONAL INTERNAL DYNAMICS TAMING THE ID AND STRENGTHENING THE EGO SUCH THAT STRUCTURAL CONFLICT BECOMES STRUCTURAL COLLABORATION MODEL 2 STRUCTURAL GROWTH / ADDING NEW GOOD MAKING GOOD A DEFICIENCY / FILLING IN DEFICIT SUCH THAT STRUCTURAL DEFICIT BECOMES STRUCTURAL CONSOLIDATION MODEL 3 RESOLUTION OF RELATIONAL CONFLICT INVOLVING DYSFUNCTIONAL RELATIONAL DYNAMICS STRUCTURAL MODIFICATION / CHANGING OLD BAD DETOXIFYING INTERNAL TOXICITY SUCH THAT RELATIONAL CONFLICT BECOMES RELATIONAL COLLABORATION MODEL 4 EMERGENCE OF MOMENTS OF MEETING SUCH THAT RELATIONAL DEFICIT BECOMES MEANINGFUL ENGAGEMENT WITH THE WORLD OF PEOPLE 48
THE THERAPEUTIC ACTION IN ALL FOUR MODES WILL INVOLVE WORKING THROUGH THE OPTIMAL STRESS CREATED BY INTERVENTIONS THAT ALTERNATELY CHALLENGE AND THEN SUPPORT INTERVENTIONS STRATEGICALLY DESIGNED TO TARGET / HIGHLIGHT / GENERATE MODEL 1 – COGNITIVE DISSONANCE MODEL 2 – AFFECTIVE DISILLUSIONMENT MODEL 3 – RELATIONAL DETOXIFICATION MODEL 4 – ABSOLUTE DEPENDENCE THE WORKING THROUGH OF WHICH WILL RESULT ULTIMATELY IN RECONSTITUTION AT EVER – HIGHER LEVELS OF AWARENESS / ACTUALIZATION OF POTENTIAL, ACCEPTANCE, ACCOUNTABILITY, AND ACCESSIBILITY 49
MATURITY INVOLVES DEVELOPING THE CAPACITY … MODEL 1 TO KNOW AND ACCEPT THE SELF, INCLUDING ITS PSYCHIC SCARS MODEL 2 TO KNOW AND ACCEPT THE OBJECT, INCLUDING ITS PSYCHIC SCARS MODEL 3 TO TAKE RESPONSIBILITY FOR THE DYSFUNCTION DELIVERED INTO ONE’S RELATIONSHIPS AND, MORE GENERALLY, INTO ONE’S LIFE MODEL 4 TO OVERCOME ONE’S TERROR OF BEING FOUND SO THAT MOMENTS OF MEETING CAN BE TOLERATED AND, EVEN, FOUND TO GIVE MEANING AND PURPOSE TO LIFE 50
PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION 51
PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS DYSFUNCTIONAL INTERNAL DYNAMICS NEUROTIC CONFLICTEDNESS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD RELENTLESS PURSUIT OF THE UNATTAINABLE NARCISSISTIC VULNERABILITY MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD DYSFUNCTIONAL RELATIONAL DYNAMICS NOXIOUS RELATEDNESS MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION RELENTLESS DESPAIR ABOUT AUTHENTIC BEING – IN – THE – WORLD NONRELATEDNESS 52
MODEL 1 ~ STRUCTURAL CONFLICT THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS AVOIDANCE, PARALYSIS, AND UNACTUALIZED POTENTIAL MODEL 2 ~ STRUCTURAL DEFICIT THE NARCISSISTIC DEFENSE OF RELENTLESS NEED FOR VALIDATION AND EXTERNAL PROVISION INSATIABLE HUNGER MODEL 3 ~ RELATIONAL CONFLICT THE CHARACTER DISORDERED DEFENSE OF RELENTLESS EXTERNALIZATION AND DENIAL OF RESPONSIBILITY DYSFUNCTIONAL RELATEDNESS, A SENSE OF ONESELF AS EVER THE VICTIM, AND A DECREASED SENSE OF PERSONAL AGENCY MODEL 4 ~ RELATIONAL DEFICIT THE SCHIZOID / NIHILISTIC DEFENSE OF RELENTLESS DESPAIR UNRELENTING LONELINESS, SCHIZOID WITHDRAWAL, EXISTENTIAL ANGST, RETREAT AND RESIGNATION, EMOTIONAL DETACHMENT, INNER EMPTINESS, PSYCHIC DEADNESS, SOLITARY SUFFERING, ANNIHILATION TERROR, DENIAL OF OBJECT NEED, ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY, AFFECTIVE NONRELATEDNESS, IMPENETRABILITY, OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT, AND THE ONGOING STRUGGLE TO RECONCILE THE DIALECTICAL TENSION BETWEEN THE NEED TO BE MET AND THE FEAR OF BEING FOUND AND BETWEEN LIFE AS MEANINGFUL AND LIFE AS ABSURD AND POINTLESS 53
PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT FROM RESISTANCE TO AWARENESS MODEL 2 ~ STRUCTURAL DEFICIT FROM RELENTLESS HOPE TO ACCEPTANCE MODEL 3 ~ RELATIONAL CONFLICT FROM RE – ENACTMENT TO ACCOUNTABILITY MODEL 4 ~ RELATIONAL DEFICIT FROM RETREAT TO ACCESSIBILITY FROM RELENTLESS DESPAIR TO AWAKENED HOPE FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FROM NIHILISTIC REJECTION OF EXISTENCE TO EXISTENTIAL ACCEPTANCE OF ITS DUALITIES 54
HOW THE THERAPIST POSITIONS HERSELF MOMENT BY MOMENT THE OPTIMAL THERAPEUTIC STANCE WILL BE ONE THAT IS CONTINUOUSLY SHIFTING SOMETIMES SPONTANEOUS AND UNPLANNED SOMETIMES MORE CONSIDERED AND DELIBERATE SOMETIMES THE THERAPIST WILL FIND HERSELF UNWITTINGLY DRAWN IN TO PARTICIPATING IN A CERTAIN WAY BUT AT OTHER TIMES THE THERAPIST WILL MAKE A MORE CONSCIOUS CHOICE BASED ON WHAT SHE SENSES THE PATIENT MOST NEEDS IN THE MOMENT IN ORDER TO HEAL 55
IF, IN THE MOMENT, THE PATIENT IS PRIMARILY “NOT AWARE” THEN MODEL 1 CONFLICT STATEMENTS “NOT ACCEPTING” THEN MODEL 2 DISILLUSIONMENT STATEMENTS “NOT ACCOUNTABLE” THEN MODEL 3 ACCOUNTABILITY STATEMENTS “NOT ACCESSIBLE AND / OR NOT AUTHENTIC” THEN MODEL 4 FACILITATION STATEMENTS 56
MODEL 1 ~ STRUCTURAL CONFLICT OBJECTIVE NEUTRALITY CONFLICT STATEMENTS ~ FROM RESISTANCE TO AWARENESS WORKING THROUGH THE RESISTANCE COGNITIVE DISSONANCE ~ THE STRESS OF GAIN – BECOME – PAIN MODEL 2 ~ STRUCTURAL DEFICIT EMPATHIC ATTUNEMENT DISILLUSIONMENT STATEMENTS ~ FROM RELENTLESS HOPE TO ACCEPTANCE GRIEVING OPTIMAL DISILLUSIONMENT ~ THE STRESS OF GOOD – BECOME – BAD MODEL 3 ~ RELATIONAL CONFLICT AUTHENTIC ENGAGEMENT ~ SHARED MIND AND SHARED HEART ACCOUNTABILITY STATEMENTS ~ FROM RE – ENACTMENT TO ACCOUNTABILITY NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC RELATEDNESS RELATIONAL DETOXIFICATION ~ THE STRESS OF BAD – BECOME – GOOD MODEL 4 ~ RELATIONAL DEFICIT SOULFUL PRESENCE ~ ROCK – SOLID RELIABILITY AND STALWART DEPENDABILITY FACILITATION STATEMENTS ~ FROM RETREAT TO ACCESSIBILITY FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE IN ORDER TO FACILITATE THE EMERGENCE OF MOMENTS OF MEETING ABSOLUTE DEPENDENCE ~ THE STRESS OF HIDDEN – BECOME – FOUND DIALECTICAL TENSION ~ THE STRESS OF DENIAL – OF – EXISTENCE – BECOME – ACCEPTANCE – OF – ITS – DUALITIES 57
FOUR MODES OF THERAPEUTIC ACTION MODEL 1 ~ STRUCTURAL CONFLICT MODEL 2 ~ STRUCTURAL DEFICIT MODEL 3 ~ RELATIONAL CONFLICT MODEL 4 ~ RELATIONAL DEFICIT 58
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN” THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS A DRIVE – DEFENSE MODEL THAT PRIVILEGES THE CURATIVE POWER OF INSIGHT IT IS A 1 – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON THE PATIENT AND THE INTERNAL WORKINGS OF HER MIND THE THERAPIST IS NOT SUPPOSED TO BRING “WHO SHE IS” INTO THE ROOM – AND, IF SHE DOES, IT IS CALLED COUNTERTRANSFERENCE 59
MODEL 2 – PROVISION OF CORRECTIVE EXPERIENCE “FOR” THE DEFICIENCY – COMPENSATION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD (DEFICIENCY) AND THEREFORE POSITS CORRECTIVE – PROVISION AS THE CURATIVE AGENT IT IS A 1½ – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON THE PATIENT AND HER RELATIONSHIP WITH A THERAPIST WHOM SHE EXPERIENCES AS EITHER AN EMPATHIC SELFOBJECT WHEN THE FRAME OF REFERENCE IS SELF PSYCHOLOGY OR A GOOD OBJECT / GOOD MOTHER WHEN THE FRAME OF REFERENCE IS OBJECT RELATIONS THEORY BUT WHETHER DESCRIBED AS AN EMPATHIC SELFOBJECT OR A GOOD OBJECT, IN MODEL 2 THE THERAPIST IS CONSIDERED A HALF PERSON BECAUSE IT IS NOT WHO SHE IS THAT MATTERS BUT WHAT SHE CAN PROVIDE 60
MODEL 3 – ENGAGEMENT IN AUTHENTIC RELATIONSHIP “WITH” THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD (TOXICITY) AND POSITS COLLABORATIVE NEGOTIATION OF THE TURBULENCE THAT WILL INEVITABLY EMERGE AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT BETWEEN PATIENT AND THERAPIST AS THE TRANSFORMATIVE AGENT IT IS A 2 – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON PATIENTS AND THERAPISTS WHO RELATE TO EACH OTHER AS “REAL” PEOPLE IN MODEL 3 THE THERAPIST IS CONSIDERED A WHOLE PERSON 61
MODEL 4 – CREATION OF TRANSITIONAL SPACE “BETWEEN” AN EXISTENTIAL – HUMANISTIC PERSPECTIVE THAT EMPHASIZES EITHER (1) CATASTROPHICALLY ANNIHILATING EARLY – ON DISAPPOINTMENTS AND LOSSES THAT SHATTER THE HEART OR (2) FUNDAMENTAL INSECURITY ABOUT EXISTENCE THE NET RESULT OF WHICH WILL BE SCHIZOID WITHDRAWAL, PSYCHIC RETREAT, RELENTLESS DESPAIR, EXISTENTIAL ANGST, AND FEELINGS OF ALIENATION AND ESTRANGEMENT AND POSITS “MOMENTS OF MEETING” AS NECESSARY TO RESTORE PURPOSE AND DIRECTION TO AN OTHERWISE EMPTY AND MEANINGLESS EXISTENCE IT IS A ½ – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON PATIENTS WHO DENY THEIR NEED FOR OBJECTS AND CLING INSTEAD TO THEIR ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY IN MODEL 4 THE THERAPIST IS THOUGHT TO FUNCTION AS A FACILITATING ENVIRONMENT ~ A SOULFUL PRESENCE 62
HOW DOES THE THERAPIST ARRIVE AT UNDERSTANDING AND HOW DOES SHE THEN INTERVENE? AS A NEUTRAL OBJECT THE MODEL 1 THERAPIST POSITIONS HERSELF OUTSIDE THE THERAPEUTIC FIELD THE BETTER TO OBSERVE THE PATIENT HER FOCUS IS ON THE PATIENT’S INTERNAL DYNAMICS SHE COMES TO KNOW BY OBSERVING AND REFLECTING UPON WHAT SHE SEES SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS CONFLICT STATEMENTS WITH AN EYE TO ADVANCING THE PATIENT’S KNOWLEDGE OF HER INTERNAL DYNAMICS “THE PATIENT GETS BETTER ONCE THE PATIENT HAS COME TO KNOW ALL THAT THE ANALYST KNOWS WHICH IS WHAT THE PATIENT HAD UNCONSCIOUSLY KNOWN ALL ALONG” (LACAN) THE ULTIMATE GOAL IS RESOLUTION OF THE PATIENT’S STRUCTURAL CONFLICTS AND ACTUALIZATION OF INHERITED POTENTIAL 63
AS AN EMPATHIC SELFOBJECT THE MODEL 2 THERAPIST JOINS ALONGSIDE THE PATIENT IN ORDER TO IMMERSE HERSELF IN THE PATIENT’S SUBJECTIVE REALITY HER FOCUS IS ON THE PATIENT’S AFFECTIVE EXPERIENCE SHE COMES TO KNOW BY DECENTERING FROM HER OWN EXPERIENCE, ENTERING INTO THE PATIENT’S EXPERIENCE, AND THEN TAKING IT ON – BUT ONLY “AS IF” IT WERE HER OWN BECAUSE IT NEVER ACTUALLY BECOMES HER OWN SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS DISILLUSIONMENT STATEMENTS WITH AN EYE TO VALIDATING THE PATIENT’S EXPERIENCE AND, MORE SPECIFICALLY, TO PROVIDING THE PATIENT WITH AN OPPORTUNITY TO CONFRONT THE PAIN OF HER GRIEF ABOUT THE DISILLUSIONING REALITY THAT THE OBJECTS IN HER WORLD WERE NOT, AND WILL NEVER BE, ALL THAT SHE WOULD HAVE WANTED THEM TO BE THE ULTIMATE GOAL IS THE FILLING IN OF THE PATIENT’S STRUCTURAL DEFICITS BY WAY OF ADAPTIVE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS 64
AS AN AUTHENTIC SUBJECT (OR RELATIONAL OBJECT) THE MODEL 3 THERAPIST REMAINS VERY MUCH CENTERED WITHIN HER OWN EXPERIENCE AND USES THAT EXPERIENCE THAT IS, HER COUNTERTRANSFERENCE TO DEEPEN HER UNDERSTANDING OF THE PATIENT HER FOCUS IS ON THE PATIENT’S RELATIONAL DYNAMICS AND THE HERE – AND – NOW ENGAGEMENT BETWEEN THEM SHE NOT ONLY ALLOWS THE PATIENT’S EXPERIENCE TO ENTER INTO HER WHICH SHE THEN (REACTIVELY) TAKES ON “AS” HER OWN THAT IS, PROJECTIVE IDENTIFICATION BUT ALSO IS ABLE TO ENTER INTO THE PATIENT’S EXPERIENCE WHICH SHE THEN (PROACTIVELY) TAKES ON “AS” HER OWN THAT IS, INTROJECTIVE IDENTIFICATION SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS ACCOUNTABILITY STATEMENTS AND RELATIONAL INTERVENTIONS WITH AN EYE TO ADVANCING THE PATIENT’S KNOWLEDGE OF HER RELATIONAL DYNAMICS AND / OR TO DEEPENING THE CONNECTION BETWEEN THE TWO OF THEM 65
AS A RELIABLE / NON – DEMANDING / SOULFUL PRESENCE AND FACILITATING / HOLDING ENVIRONMENT UPON WHOM THE PATIENT CAN BECOME “ABSOLUTELY DEPENDENT” SUCH THAT EVENTUALLY THE PATIENT HAVING OVERCOME HER DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE AND HER DENIAL OF OBJECT NEED AND HAVING WORKED THROUGH HER INTENSE AMBIVALENCE ABOUT BEING FOUND WILL BENIGNLY REGRESS TO HARMONIOUS INTERPENETRATING MIX – UP WITH HER THERAPIST – “REVISITING TO REDO” – THE MODEL 4 THERAPIST “MEETS THE OMNIPOTENCE” OF HER PATIENT BY “RECOGNIZING AND RESPONDING” TO HER EVERY GESTURE EVEN HAVING ANTICIPATED IT THEREBY ENABLING THE PATIENT TO FEEL MORE SECURE, MORE SAFE, AND MORE IN CONTROL SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS FACILITATION STATEMENTS WITH AN EYE TO CREATING OPPORTUNITIES FOR “MOMENTS OF MEETING” THAT WILL GIVE MEANING TO A LIFE THAT MIGHT OTHERWISE HAVE REMAINED DESOLATE, BARREN, IMPOVERISHED, AND DESPERATELY LONELY 66
PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS DYSFUNCTIONAL INTERNAL DYNAMICS NEUROTIC CONFLICTEDNESS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD RELENTLESS PURSUIT OF THE UNATTAINABLE NARCISSISTIC VULNERABILITY MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD DYSFUNCTIONAL RELATIONAL DYNAMICS NOXIOUS RELATEDNESS MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION RELENTLESS DESPAIR ABOUT AUTHENTIC BEING – IN – THE – WORLD NONRELATEDNESS 67
MODEL 1 ~ STRUCTURAL CONFLICT THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS AVOIDANCE, PARALYSIS, AND UNACTUALIZED POTENTIAL MODEL 2 ~ STRUCTURAL DEFICIT THE NARCISSISTIC DEFENSE OF RELENTLESS NEED FOR VALIDATION AND EXTERNAL PROVISION INSATIABLE HUNGER MODEL 3 ~ RELATIONAL CONFLICT THE CHARACTER DISORDERED DEFENSE OF RELENTLESS EXTERNALIZATION AND DENIAL OF RESPONSIBILITY DYSFUNCTIONAL RELATEDNESS, A SENSE OF ONESELF AS EVER THE VICTIM, AND A DECREASED SENSE OF PERSONAL AGENCY MODEL 4 ~ RELATIONAL DEFICIT THE SCHIZOID / NIHILISTIC DEFENSE OF RELENTLESS DESPAIR UNRELENTING LONELINESS, SCHIZOID WITHDRAWAL, EXISTENTIAL ANGST, RETREAT AND RESIGNATION, EMOTIONAL DETACHMENT, INNER EMPTINESS, PSYCHIC DEADNESS, SOLITARY SUFFERING, ANNIHILATION TERROR, DENIAL OF OBJECT NEED, ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY, AFFECTIVE NONRELATEDNESS, IMPENETRABILITY, OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT, AND THE ONGOING STRUGGLE TO RECONCILE THE DIALECTICAL TENSION BETWEEN THE NEED TO BE MET AND THE FEAR OF BEING FOUND AND BETWEEN LIFE AS MEANINGFUL AND LIFE AS ABSURD AND POINTLESS 68
PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT FROM RESISTANCE TO AWARENESS MODEL 2 ~ STRUCTURAL DEFICIT FROM RELENTLESS HOPE TO ACCEPTANCE MODEL 3 ~ RELATIONAL CONFLICT FROM RE – ENACTMENT TO ACCOUNTABILITY MODEL 4 ~ RELATIONAL DEFICIT FROM RETREAT TO ACCESSIBILITY FROM RELENTLESS DESPAIR TO AWAKENED HOPE FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FROM NIHILISTIC REJECTION OF EXISTENCE TO EXISTENTIAL ACCEPTANCE OF ITS DUALITIES 69
IF, IN THE MOMENT, THE PATIENT IS PRIMARILY “NOT AWARE” THEN MODEL 1 CONFLICT STATEMENTS “NOT ACCEPTING” THEN MODEL 2 DISILLUSIONMENT STATEMENTS “NOT ACCOUNTABLE” THEN MODEL 3 ACCOUNTABILITY STATEMENTS “NOT ACCESSIBLE AND / OR NOT AUTHENTIC” THEN MODEL 4 FACILITATION STATEMENTS 70
MODEL 1 ~ STRUCTURAL CONFLICT OBJECTIVE NEUTRALITY CONFLICT STATEMENTS ~ FROM RESISTANCE TO AWARENESS WORKING THROUGH THE RESISTANCE COGNITIVE DISSONANCE ~ THE STRESS OF GAIN – BECOME – PAIN MODEL 2 ~ STRUCTURAL DEFICIT EMPATHIC ATTUNEMENT DISILLUSIONMENT STATEMENTS ~ FROM RELENTLESS HOPE TO ACCEPTANCE GRIEVING OPTIMAL DISILLUSIONMENT ~ THE STRESS OF GOOD – BECOME – BAD MODEL 3 ~ RELATIONAL CONFLICT AUTHENTIC ENGAGEMENT ~ SHARED MIND AND SHARED HEART ACCOUNTABILITY STATEMENTS ~ FROM RE – ENACTMENT TO ACCOUNTABILITY NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC RELATEDNESS RELATIONAL DETOXIFICATION ~ THE STRESS OF BAD – BECOME – GOOD MODEL 4 ~ RELATIONAL DEFICIT SOULFUL PRESENCE ~ ROCK – SOLID RELIABILITY AND STALWART DEPENDABILITY FACILITATION STATEMENTS ~ FROM RETREAT TO ACCESSIBILITY FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE IN ORDER TO FACILITATE THE EMERGENCE OF MOMENTS OF MEETING ABSOLUTE DEPENDENCE ~ THE STRESS OF HIDDEN – BECOME – FOUND DIALECTICAL TENSION ~ THE STRESS OF DENIAL – OF – EXISTENCE – BECOME – ACCEPTANCE – OF – ITS – DUALITIES 71
MODEL 4 ~ RELATIONAL DEFICIT THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION ATTACHMENT INSECURITY ~ INAUTHENTIC BEING – IN – RELATIONSHIP ONTOLOGICAL INSECURITY ~ INAUTHENTIC BEING – IN – THE – WORLD FROM SCHIZOID RETREAT TO ACCESSIBILITY / EMOTIONAL AVAILABILITY FROM RELENTLESS DESPAIR TO AUTHENTIC BEING – IN – THE – WORLD AND AWAKENED HOPE (HOPE THAT WAS THERE ALL ALONG, WAITING TO BE FOUND) FROM RESIGNATION TO A LIFE LIVED FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FACILITATION STATEMENTS ~ RESONATE EMPATHICALLY WITH THE DUALITIES OF EXISTENCE, RECONCILE THE DIALECTICAL TENSION BETWEEN POLARITIES, AND EVOLVE TO A HIGHER LEVEL OF INTEGRATION, COMPLEX UNDERSTANDING, AND DYNAMIC BALANCE FROM OPPOSITION TO COMPLEMENTARITY EVOLVE FROM THE DICHOTOMIZATION OF “EITHER / OR” “A PART OF YOU NEEDS … , BUT ANOTHER PART OF YOU FEARS …” TO THE COMPLEMENTARITY OF “BOTH / AND” “YOU HAVE THE FEAR AND THE DESPAIR … , BUT, AS YOU KNOW, YOU DO HAVE A CHOICE …” JUST AS IN QUANTUM MECHANICS, WHERE PARTICLES AND WAVES ARE THOUGHT TO BE DIFFERENT MANIFESTATIONS OF A SINGLE REALITY DEPENDING UPON THE OBSERVER’S PERSPECTIVE FROM LAING’S “DIVIDED SELF” TO BROMBERG’S “MULTIPLICITY OF SELF” 72
PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT AN OPPORTUNITY ALBEIT A BELATED ONE TO MASTER EXPERIENCES THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST BUT THAT CAN NOW WITH ENOUGH SUPPORT FROM THE THERAPIST AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE AND CAPACITY TO COPE WITH STRESS BE PROCESSED AND INTEGRATED AND ULTIMATELY ADAPTED TO
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 CHALLENGE WHENEVER POSSIBLE BY DIRECTING THE PATIENT’S ATTENTION TO WHERE THE PATIENT IS NOT “DISRUPTIVE ATTUNEMENT” AND SUPPORT WHENEVER NECESSARY BY RESONATING WITH WHERE THE PATIENT IS “HOMEOSTATIC ATTUNEMENT”
CHALLENGE BY WAY OF ANXIETY – PROVOKING INTERPRETIVE STATEMENTS THAT CALL INTO QUESTION DEFENSES TO WHICH THE PATIENT HAS LONG CLUNG IN ORDER TO PRESERVE HER PSYCHOLOGICAL EQUILIBRIUM THEREBY INCREASING HER ANXIETY SUPPORT BY WAY OF ANXIETY – ASSUAGING EMPATHIC STATEMENTS THAT HONOR THOSE SELF – PROTECTIVE DEFENSES THEREBY DECREASING HER ANXIETY
FOUR SCHOOLS OF PSYCHOANALYTIC THOUGHT STRUCTURAL CONFLICT RESISTANCE BECOMES TRANSFORMED INTO AWARENESS STRUCTURAL DEFICIT RELENTLESSNESS BECOMES TRANSFORMED INTO ACCEPTANCE RELATIONAL CONFLICT RE – ENACTMENT BECOMES TRANSFORMED INTO ACCOUNTABILITY RELATIONAL DEFICIT RETREAT BECOMES TRANSFORMED INTO ACCESSIBILITY NEUROTIC ~ NARCISSISTIC ~ CHARACTER DISORDERED ~ SCHIZOID
PREVIEW FOUR MODES OF THERAPEUTIC ACTION FOUR APPROACHES TO TRANSFORMING DEFENSE INTO ADAPTATION FOUR OPTIMAL STRESSORS THAT FACILITATE THIS ACTION TRANSFORMATION OF RESISTANCE INTO AWARENESS AND ACTUALIZATION OF POTENTIAL BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE (THE EXPERIENCE OF GAIN – BECOME – PAIN) TRANSFORMATION OF RELENTLESSNESS INTO ACCEPTANCE BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT (THE EXPERIENCE OF GOOD – BECOME – BAD) TRANSFORMATION OF RE – ENACTMENT INTO ACCOUNTABILITY BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION (THE EXPERIENCE OF BAD – BECOME – GOOD) TRANSFORMATION OF RETREAT INTO ACCESSIBILITY BY WORKING THROUGH THE STRESS OF ABSOLUTE DEPENDENCE (THE EXPERIENCE OF HIDDEN – BECOME – FOUND)
TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 1 DEFENSIVE REACTION – RESISTANCE TO AWARENESS OF ONE’S DYSFUNCTIONAL INTERNAL DYNAMICS ADAPTIVE RESPONSE – AWARENESS AND ACTUALIZATION OF POTENTIAL MODEL 2 DEFENSIVE REACTION – RELENTLESS PURSUIT OF THE UNATTAINABLE AND REFUSAL TO CONFRONT – AND GRIEVE – CERTAIN INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY ADAPTIVE RESPONSE – ACCEPTANCE OF ONE’S ULTIMATE POWERLESSNESS TO MAKE THE OBJECT CHANGE
TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 3 DEFENSIVE REACTION – COMPULSIVE AND UNWITTING RE – ENACTMENT OF DYSFUNCTIONAL RELATIONAL DYNAMICS RESULTING FROM UNMASTERED EARLY – ON TRAUMAS ADAPTIVE RESPONSE – ACCOUNTABILITY FOR ONE’S ACTIONS, REACTIONS, AND INTERACTIONS MODEL 4 DEFENSIVE REACTION – PSYCHIC RETREAT, SCHIZOID WITHDRAWAL, AND DETACHMENT ADAPTIVE RESPONSE – ACCESSIBILITY AND ATTACHMENT
MODEL 1 – STRUCTURAL CONFLICT THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS SIGMUND FREUD, ANNA FREUD, HEINZ HARTMANN, DAVID RAPAPORT, ERNST KRIS, AND RUDOLPH LOEWENSTEIN MODEL 2 – STRUCTURAL DEFICIT THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL ABSENCE OF GOOD HEINZ KOHUT, ERNEST WOLF, ARNOLD GOLDBERG, MICHAEL BALINT, AND PAUL / ANNA ORNSTEIN
MODEL 3 – RELATIONAL CONFLICT THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL PRESENCE OF BAD W R D FAIRBAIRN, STEPHEN MITCHELL, JESSICA BENJAMIN, DARLENE EHRENBERG, AND JAY GREENBERG MODEL 4 – RELATIONAL DEFICIT THE EXISTENTIAL PERSPECTIVE WITH ITS EMPHASIS ON DREAD, ANGST, DESPAIR, SUFFERING, AND SEARCH FOR MEANINGFUL CONNECTION HARRY GUNTRIP, ARNOLD MODELL, MASUD KHAN, JOHN BOWLBY, THOMAS OGDEN, ROLLO MAY, AND VIKTOR FRANKL
MODEL 1 – STRUCTURAL CONFLICT ACCELERATOR / BRAKE ~ START / STOP FORCES PRESSING “YES” AND RESISTIVE COUNTERFORCES INSISTING “NO” MODEL 2 – STRUCTURAL DEFICIT INTERNAL ABSENCE OF GOOD ~ DEPRIVATION AND NEGLECT IMPAIRED CAPACITY TO BE A GOOD PARENT UNTO ONESELF MODEL 3 – RELATIONAL CONFLICT INTERNAL PRESENCE OF BAD ~ TRAUMA AND ABUSE COMPULSIVE RE – ENACTMENT OF UNRESOLVED CHILDHOOD DRAMAS ON THE STAGE OF ONE’S LIFE MODEL 4 – RELATIONAL DEFICIT A HEART SHATTERED PSYCHIC RETREAT, SCHIZOID WITHDRAWAL, AND SOLITARY SUFFERING RESULTING FROM THE EXPERIENCE OF CATACLYSMICALLY ANNIHILATING RESPONSES FROM THE OBJECT
THERAPEUTIC ACTION MODEL 1 – COGNITIVE ENHANCEMENT OF KNOWLEDGE “WITHIN” MODEL 2 – AFFECTIVE PROVISION OF CORRECTIVE EXPERIENCE “FOR” MODEL 3 – RELATIONAL ENGAGEMENT IN AUTHENTIC RELATIONSHIP “WITH” MODEL 4 – EXISTENTIAL EMERGENCE OF MEANINGFUL MOMENTS OF MEETING “BETWEEN” AND CREATION OF TRANSITIONAL SPACE “BETWEEN”
MODEL 1 – NEUROTIC DYSFUNCTIONAL INTERNAL DYNAMICS MODEL 2 – NARCISSISTIC RELENTLESS PURSUIT OF THE UNATTAINABLE MODEL 3 – CHARACTER DISORDERED DYSFUNCTIONAL RELATIONAL DYNAMICS MODEL 4 – SCHIZOID IMPENETRABILITY
MODEL 1 – NEUROTIC WOODY ALLEN, JERRY SEINFELD’S AND JASON ALEXANDER’S CHARACTERS ON SEINFELD, AND MONK MODEL 2 – NARCISSISTIC MADONNA, KIM KARDASHIAN, KANYE WEST, AND DONALD TRUMP MODEL 3 – CHARACTER DISORDERED GEORGE AND MARTHA IN WHO’S AFRAID OF VIRGINIA WOOLF? MODEL 4 – SCHIZOID TRUE (PRIVATE) SELF / FALSE (PUBLIC) SELF GRETA GARBO, KATHARINE HEPBURN, JOHNNY CARSON, AND GREGORY HOUSE, MD (FROM THE TV SHOW HOUSE)
MODEL 1 – NEUROTIC THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS, LEADING TO AVOIDANCE, PARALYSIS, AND UNACTUALIZED POTENTIAL MODEL 2 – NARCISSISTIC THE NARCISSISTIC DEFENSE OF RELENTLESS NEED FOR VALIDATION AND EXTERNAL PROVISION, LEADING TO INSATIABLE HUNGER THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE, LEADING TO UNREQUITED LOVE AND CONSTANT HEARTBREAK
MODEL 3 – CHARACTER DISORDERED THE CHARACTER DISORDERED DEFENSE OF RELENTLESS EXTERNALIZATION AND DENIAL OF RESPONSIBILITY, LEADING TO DYSFUNCTIONAL RELATIONSHIPS AND A SENSE OF ONESELF AS EVER THE VICTIM THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE, LEADING TO UNCOMPROMISING ANGER, SELF – RIGHTEOUS INDIGNATION, RESENTMENT, AND BITTERNESS MODEL 4 – SCHIZOID THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR AND PROFOUND HOPELESSNESS, LEADING TO UNMITIGATED LONELINESS, WITHDRAWAL, DETACHMENT, SUFFERING, PSYCHIC DEADNESS, INNER EMPTINESS, AND OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT
COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION MODE OF RELATEDNESS NEUROTIC ~ NARCISSISTIC ~ NOXIOUS ~ NONRELATEDNESS NUMBER OF PEOPLE 1 – PERSON ~ 1½ – PERSON ~ 2 – PERSON ~ ½ – PERSON THERAPIST’S STANCE NEUTRALITY ~ EMPATHY ~ AUTHENTICITY ~ DEPENDABILITY / DEVOTION A PSYCHOLOGY OF THE … EGO ~ SELF ~ SELF – IN – RELATION ~ PRIVATE SELF
KAREN HORNEY DESCRIBES THREE “INTERPERSONAL TRENDS” MOVEMENT INWARDS MODEL 1 MOVEMENT TOWARDS MODEL 2 MOVEMENT AGAINST MODEL 3 MOVEMENT AWAY MODEL 4
FOUR BASIC DRIVES RELATED TO SURVIVAL “SYMPATHETIC ACTIVATION” FREEZE MODEL 1 (MOVEMENT INWARDS) FUCK MODEL 2 (MOVEMENT TOWARDS) FIGHT MODEL 3 (MOVEMENT AGAINST) FLEE MODEL 4 (MOVEMENT AWAY)
CLINGING, AVERSION, AND IGNORING ZEN MASTER JAN CHOZEN BAYS, MD AS A PEDIATRICIAN HE HAS EXAMINED HUNDREDS OF NEWBORN BABIES SOME “ARE BORN WANTING SENSORY EXPERIENCES” AND “ARE UPSET IF THEY DON’T GET THEM” (MODEL 2) OTHERS “ARE BORN ANGRY AND UPSET AT THE WORLD” (MODEL 3) STILL OTHERS “JUST LIKE TO GO UNCONSCIOUS AND, IF DISTRESSED, GO TO SLEEP” (MODEL 4)
MODES OF RELATEDNESS MODEL 1 – NEUROTIC RELATEDNESS THE CONFLICT – RIDDEN NEUROTIC PATIENT STRUGGLES TO MOVE FORWARD IN HER LIFE BUT IS JAMMED UP AND UNABLE TO EMPOWER HERSELF BY HARNESSING HER ID ENERGIES IN THE SERVICE OF HER EGO MODEL 2 – NARCISSISTIC RELATEDNESS THE DEFICIT – RIDDEN NARCISSISTIC PATIENT NEEDS HER OBJECTS TO “COMPLETE” HER BY PROVIDING MIRRORING CONFIRMATION OF HER PERFECTION AND / OR BY ALLOWING HER TO FUSE WITH THEM IN FANTASY SUCH THAT SHE CAN THEN PARTAKE OF THEIR PERFECTION MODEL 3 – NOXIOUS RELATEDNESS UNDER THE SWAY OF HER REPETITION COMPULSION, THE CHARACTER DISORDERED PATIENT DELIVERS HER UNMASTERED CHILDHOOD DRAMAS (THAT IS, HER DYSFUNCTIONAL RELATIONAL DYNAMICS) INTO HER RELATIONSHIPS AND THEN COMPULSIVELY AND UNWITTINGLY RE – ENACTS THEM ON THE STAGE OF HER LIFE MODEL 4 – NONRELATEDNESS FOR FEAR OF BEING SHATTERED BY YET ANOTHER CATACLYSMICALLY ANNIHILATING RESPONSE FROM THE OBJECT, THE SCHIZOID PATIENT WITHDRAWS FROM ALL RELATIONSHIPS, DESPERATE TO REMAIN HIDDEN
MODEL 1 – 1 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S INTERNAL DYNAMICS THERAPIST AS A NEUTRAL OBJECT / AN OBJECTIVE OBSERVER A BLANK SCREEN WITH THE OBJECTIVITY OF A SURGEON MODEL 2 – 1½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE EXPERIENCE (ESPECIALLY THE PAIN OF HER GRIEF) THERAPIST AS AN EMPATHIC SELFOBJECT / A GOOD OBJECT MODEL 3 – 2 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S RELATIONAL DYNAMICS THERAPIST AS AN AUTHENTIC SUBJECT / A RELATIONAL OBJECT (AND, AT THE END OF THE DAY, INEVITABLY A BAD OBJECT) MODEL 4 – ½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE NONRELATEDNESS THERAPIST AS A RELIABLE, NONDEMANDING, STEADY, DEPENDABLE, CONSISTENT, TRUSTWORTHY, LOVING, AND DEVOTED PRESENCE
THERAPIST’S STANCE MODEL 1 – NEUTRALITY MODEL 2 – EMPATHY MODEL 3 – AUTHENTICITY MODEL 4 – RELIABILITY ~ DEPENDABILITY ~ DEVOTION
EMPATHY VS. AUTHENTICITY THERE IS A CRITICAL DISTINCTION BETWEEN THE EMPATHIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 2 HAT AND THE AUTHENTIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 3 HAT MODEL 2 IS ABOUT THE THERAPIST’S EMPATHIC IMMERSION IN THE PATIENT’S INTERNAL WORLD THE EMPATHIC THERAPIST “DECENTERS” (ATWOOD AND STOLOROW 1984) FROM HER OWN EXPERIENCE, JOINS ALONGSIDE THE PATIENT, AND ENTERS INTO THE PATIENT’S INTERNAL EXPERIENCE – BUT TAKES IT ON ONLY “AS IF” IT WERE HER OWN BECAUSE IT NEVER ACTUALLY BECOMES HER OWN EMPATHY IS NOT ABOUT THE THERAPIST WHO HAS DECENTERED FROM HER OWN EXPERIENCE IT IS ABOUT THE PATIENT
EMPATHY VS. AUTHENTICITY MODEL 3 IS ABOUT THE THERAPIST’S AUTHENTIC PARTICIPATION IN A REAL RELATIONSHIP WITH THE PATIENT UNLIKE THE EMPATHIC THERAPIST, WHO DECENTERS FROM HER OWN EXPERIENCE, THE AUTHENTIC THERAPIST REMAINS VERY MUCH CENTERED IN HER OWN EXPERIENCE AND ALLOWS THE PATIENT’S EXPERIENCE TO ENTER INTO HER, WHICH SHE THEN TAKES ON “AS” HER OWN THIS DYNAMIC IS AT THE HEART OF PROJECTIVE IDENTIFICATION THE MEAT AND POTATOES OF CONTEMPORARY RELATIONAL THEORY AND, AS WE SHALL LATER SEE, AT THE HEART OF INTROJECTIVE IDENTIFICATION AS WELL
A PSYCHOLOGY OF THE … MODEL 1 EGO GOAL ~ A STRONGER, WISER, AND MORE EMPOWERED EGO MODEL 2 SELF GOAL ~ A MORE CONSOLIDATED, ACCEPTING, AND COMPASSIONATE SELF MODEL 3 SELF – IN – RELATION GOAL ~ A MORE PRESENT AND ACCOUNTABLE SELF – IN – RELATION MODEL 4 PRIVATE SELF / ADDICTED SELF / PUBLIC SELF GOAL ~ A LESS PROTECTED AND MORE ACCESSIBLE TRUE SELF
RECURRING THEMES MODEL 1 AVOIDANCE ~ PARALYSIS MODEL 2 SHAME ~ CONTEMPT EMPTY, SHAME – FILLED DEPRESSION PATIENT NEEDS TO “GRIEVE” MODEL 3 ANGER ~ AGGRESSION ~ GUILT ANGRY, GUILT – RIDDEN DEPRESSION PATIENT NEEDS TO “RAGE” MODEL 4 SECRETS ~ LIES PRETENSIONS ~ CONCEALMENTS PROFOUND DESPAIR ~ SOLITARY SUFFERING
ALTHOUGH THE FOCUS IN EACH IS DIFFERENT ALL FOUR OF MY MODELS INVOLVE AS THEIR STARTING POINT THE INTERNAL PRICE PAID BY THE CHILD BECAUSE OF TRAUMATIC FRUSTRATION BY THE PARENT MODEL 1 REINFORCEMENT OF INFANTILE NEED IN THE FACE OF ITS TRAUMATIC FRUSTRATION MODEL 2 FAILURE TO INTERNALIZE GOOD IN THE FACE OF TRAUMATIC “ABSENCE OF GOOD” MODEL 3 INTROJECTION OF BAD IN THE FACE OF TRAUMATIC “PRESENCE OF BAD” MODEL 4 SHATTERING OF THE HEART IN THE FACE OF CATACLYSMIC HEARTBREAK AND LOSS
THE STARTING POINT IN MODEL 1 DEFENSIVELY REINFORCED INFANTILE (LIBIDINAL AND AGGRESSIVE) DRIVES RESULTING FROM THE DRIVE OBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE DRIVES THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) DRIVES AS THEY ARISE IN THE CONTEXT OF THE TREATMENT WHICH WILL ULTIMATELY RESULT IN ADAPTIVE INTEGRATION OF THOSE (ID) DRIVES NOW TAMED AND MODIFIED INTO HEALTHY PSYCHIC (EGO) STRUCTURE WHICH WILL THEN ALLOW FOR THE REDIRECTING OF THEIR NOW BETTER REGULATED ENERGY INTO MORE CONSTRUCTIVE PURSUITS AND ACTUALIZATION OF POTENTIAL BY A NOW MORE SKILLED EGO DRIVE (HORSE) AND DEFENSE (RIDER) NO LONGER WORKING IN CONFLICT BUT IN COLLABORATION
THE STARTING POINT IN MODEL 2 STRUCTURAL DEFICIT AND IMPAIRED CAPACITY RESULTING FROM THE SELFOBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE NEED TO HAVE A PERFECT PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) NARCISSISTIC NEED TO FIND THE PERFECT PARENT AS IT ARISES IN THE CONTEXT OF THE RELATIONSHIP WITH THE SELFOBJECT THERAPIST WHICH WILL ULTIMATELY RESULT IN ADAPTIVE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS WHICH WILL THEN ALLOW FOR THE FILLING IN OF STRUCTURAL DEFICIT, DEVELOPMENT OF A MORE ROBUST CAPACITY TO BE A GOOD PARENT UNTO HERSELF, ACCRETION OF HEALTHY PSYCHIC STRUCTURE, AND CONSOLIDATION OF A MORE COHESIVE SELF GRIEVING OPTIMAL DISILLUSIONMENT WILL TRANSFORM THE DEFENSIVE NEED FOR EXTERNAL REGULATION OF THE SELF INTO THE ADAPTIVE CAPACITY TO BE INTERNALLY SELF – REGULATING
THE STARTING POINT IN MODEL 3 INTERNAL DEMONS AND A SENSE OF INNER BADNESS RESULTING FROM INTROJECTION OF THE DYSFUNCTIONAL RELATIONAL DYNAMIC CHARACTERIZING THE CHILD’S EARLY – ON RELATIONSHIP WITH THE TRAUMATICALLY ABUSIVE PARENT INTERNAL BAD OBJECTS / PATHOGENIC INTROJECTS THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE TURBULENCE THAT WILL INEVITABLY ARISE AT THE “INTIMATE EDGE” (EHRENBERG 1992) OF AUTHENTIC RELATEDNESS ONCE THE PATIENT DELIVERS HER PATHOGENIC INTROJECTS INTO THE RELATIONSHIP WITH HER THERAPIST WHICH WILL ULTIMATELY RESULT IN GRADUAL MODIFICATION OF THEIR TOXICITY BY WAY OF SERIAL DILUTIONS WHICH WILL THEN ALLOW FOR TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED EARLY – ON RELATIONAL TRAUMAS INTO THE ADAPTIVE CAPACITY TO HOLD HERSELF ACCOUNTABLE AND TO ENGAGE IN HEALTHY, AUTHENTIC RELATEDNESS
THE STARTING POINT IN MODEL 4 A HEART SHATTERED, SCHIZOID WITHDRAWAL, AND PSYCHIC RETREAT RESULTING FROM OVERWHELMINGLY DEVASTATING HEARTBREAK EXPERIENCED AT THE HANDS OF A DEVASTATINGLY ANNIHILATING PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE PATIENT’S FEAR OF BEING FOUND BY, OF BECOMING ABSOLUTELY DEPENDENT UPON, AND OF EXPERIENCING MOMENTS OF MEETING WITH THE THERAPIST THE THERAPIST’S PROVISION OF RELIABLE, DEPENDABLE, NONDEMANDING, STEADY, CONSISTENT, TRUSTWORTHY, AND DEVOTED PRESENCE FOR A PATIENT WHO IS INTENSELY AMBIVALENT ABOUT ENGAGEMENT ON THE ONE HAND, DESPERATELY LONGING TO BE KNOWN BUT, ON THE OTHER HAND, TERRIFIED OF BEING FOUND WILL ULTIMATELY RESULT IN REDUCED TERROR, DREAD, DESPAIR, RESIGNATION, ISOLATION, AND ALIENATION TOLERATING ABSOLUTE DEPENDENCE WILL TRANSFORM THE DEFENSIVE NEED TO STAY HIDDEN INTO THE ADAPTIVE CAPACITY TO BE FOUND
WHEN, IN THE MOMENT, THE SPOTLIGHT IS ON THE PATIENT AS … NEUROTICALLY CONFLICTED / JAMMED UP / STUCK PARALYZED BY DYSFUNCTIONAL INTERNAL DYNAMICS THINK MODEL 1 NARCISSISTICALLY VULNERABLE / NEEDY EVER BUSY LOOKING TO THE OUTSIDE FOR EXTERNAL PROVISION, VALIDATION, AND REINFORCEMENT THINK MODEL 2 NOXIOUSLY ENGAGED / SELF – SABOTAGING SELF – DEFEATING / SELF – INDULGENT / SELF – DESTRUCTIVE RE – ENACTING DYSFUNCTIONAL RELATIONAL DYNAMICS THINK MODEL 3 NONRELATED AFFECTIVELY / INACCESSIBLE / HIDDEN DISCONNECTED / DETACHED / ENCAPSULATED IN A COCOON IMPENETRABLE / SELF – PROTECTIVELY ISOLATED THINK MODEL 4
COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION ROLE OF THE TRANSFERENCE NOT PARTICULARLY RELEVANT ~ POSITIVE ~ NEGATIVE ~ COCOON 1 – PERSON vs. 2 – PERSON DEFENSES PROTECT THE EGO FROM THE ID vs. PROTECT THE SELF FROM THE OBJECT OPTIMAL STRESSORS DISSONANCE ~ DISILLUSIONMENT ~ DETOXIFICATION ~ DEPENDENCE OPTIMALLY STRESSFUL STATEMENTS CONFLICT ~ DISILLUSIONMENT ~ ACCOUNTABILITY ~ FACILITATION SPOTLIGHT IN THE MOMENT RESISTANT ~ RELENTLESS ~ RE – ENACTING ~ RETREATING NOT AWARE ~ NOT ACCEPTING ~ NOT ACCOUNTABLE ~ NOT ACCESSIBLE
ROLE OF THE TRANSFERENCE MODEL 1 MORE RELEVANT THAN THE TRANSFERENCE IS THE FACT OF THE INTERNAL CONFLICTEDNESS BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING RESISTIVE COUNTERFORCES MODEL 2 POSITIVE TRANSFERENCE (DISPLACEMENT ~ ILLUSION) POSITIVE TRANSFERENCE DISRUPTED (DISILLUSIONMENT) MODEL 2½ POSITIVE TRANSFERENCE ACTUALIZED (DISPLACIVE IDENTIFICATION) MODEL 3 NEGATIVE TRANSFERENCE (PROJECTION ~ DISTORTION) NEGATIVE TRANSFERENCE ACTUALIZED (PROJECTIVE IDENTIFICATION) MODEL 4 COCOON TRANSFERENCE (DENIAL OF OBJECT NEED)
1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 1 – PERSON DEFENSES MOBILIZED TO PROTECT THE EGO FROM THE ID (REPRESSION ~ INTELLECTUALIZATION ~ REACTION FORMATION) MODELS 2, 3, AND 4 2 – PERSON DEFENSES MOBILIZED TO PROTECT THE SELF FROM THE OBJECT (RELENTLESS HOPE AND ENTITLEMENT ~ RELENTLESS OUTRAGE THE DEFENSE OF AFFECTIVE NONRELATEDNESS ~ ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY ~ DENIAL OF OBJECT NEED)
1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 FOCUSES ON INTRAPSYCHIC (1 – PERSON) DEFENSES MOBILIZED BY THE EGO IN AN EFFORT TO PROTECT ITSELF AGAINST THREATENED BREAKTHROUGH OF DYSREGULATED AND ANXIETY – PROVOKING ID FORCES THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE ID AND THE “ANXIOUS” EGO MODEL 2 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING DISAPPOINTED BY ITS SELFOBJECTS THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE SELF AND THE “GOOD” OBJECT
1 – PERSON vs. 2 – PERSON DEFENSES MODEL 3 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF – IN – RELATION IN AN EFFORT TO PROTECT ITSELF AGAINST BEING ABUSED BY ITS OBJECTS THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE SELF – IN – RELATION AND THE “BAD” OBJECT MODEL 4 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE PRIVATE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING SHATTERED BY A CATACLYSMICALLY DEVASTATING OBJECT THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE PRIVATE SELF AND THE “ANNIHILATING” OBJECT
THERAPEUTIC ACTION MODEL 1 WORKING THROUGH THE RESISTANCE TO AWARENESS OF INTERNAL FORCES / COUNTERFORCES GIVING RISE TO NEUROTIC CONFLICTEDNESS MODEL 2 FACILITATING THE GRIEVING OF INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT OF ONE’S DESIRE MODEL 3 NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT MODEL 4 OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE
ACHIEVED BY WAY OF WORKING THROUGH THE OPTIMAL STRESS OF … MODEL 1 COGNITIVE DISSONANCE THE EXPERIENCE OF “GAIN – BECOME – PAIN” “EGO – SYNTONIC – BECOME – EGO – DYSTONIC” MODEL 2 AFFECTIVE (OPTIMAL) DISILLUSIONMENT THE EXPERIENCE OF “GOOD – BECOME – BAD” “ILLUSION – BECOME – DISILLUSIONMENT” MODEL 3 RELATIONAL DETOXIFICATION THE EXPERIENCE OF “BAD – BECOME – GOOD” MODEL 4 ABSOLUTE DEPENDENCE THE EXPERIENCE OF “HIDDEN – BECOME – FOUND”
ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING STATEMENTS CONFLICT STATEMENTS DISILLUSIONMENT STATEMENTS ACCOUNTABILITY STATEMENTS FACILITATION STATEMENTS
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 1 CONFLICT STATEMENTS TO FACILITATE RESOLUTION OF THE PATIENT’S INTERNAL CONFLICT BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING DEFENSIVE COUNTERFORCES BY HIGHLIGHTING THE DISSONANCE BETWEEN FIRST WHAT (WITH HER HEAD) THE PATIENT KNOWS … AND THEN WHAT (WITH HER HEART) SHE FINDS HERSELF THINKING, FEELING, OR DOING IN ORDER NOT TO HAVE TO KNOW … “YOU KNOW THAT YOU COULD ALWAYS ASK FOR HELP; BUT, IN THE MOMENT, MAKING YOURSELF THAT VULNERABLE – BY ADMITTING THAT YOU MIGHT NEED SOMEONE – IS SIMPLY OUT OF THE QUESTION. YOU’VE BEEN DISAPPOINTED TOO MANY TIMES IN THE PAST TO BE WILLING TO TAKE SUCH A RISK NOW. ” (WHICH ADDRESSES CONVERGENT CONFLICT)
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 2 DISILLUSIONMENT STATEMENTS TO FACILITATE GRIEVING LOSSES AND DISAPPOINTMENTS “OPTIMAL DISILLUSIONMENT” BY FIRST HIGHLIGHTING THE ILLUSION (THE RELENTLESS HOPE), THEN ADDRESSING THE REALITY OF THE DISILLUSIONMENT, AND FINALLY RESONATING WITH THE PAIN OF THE PATIENT’S GRIEF “YOU WOULD HAVE WANTED JOSE TO BE ABLE TO LOVE YOU IN THE WAY THAT YOUR DAD NEVER DID; BUT YOU ARE COMING TO REALIZE THAT HE JUST CAN’T BECAUSE HE IS SO TERRIFIED OF COMMITMENT; AND KNOWING THIS BREAKS YOUR HEART.” (FIRST THE ILLUSION, BUT THEN THE DISILLUSIONING REALITY, AND FINALLY HER DEVASTATING GRIEF ABOUT IT) THE RESULT OF WHICH WILL BE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS AND THE FILLING IN OF DEFICIT
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS TO FOSTER “TAKING OWNERSHIP” AND TO FACILITATE “NEGOTIATING AT THE INTIMATE EDGE” (EHRENBERG 1992) BY HIGHLIGHTING THE CONTRIBUTIONS OF BOTH PATIENT AND THERAPIST TO THE CO – CREATED DYSFUNCTIONAL RELATIONAL DYNAMIC THAT IS BEING PLAYED OUT BETWEEN THEM “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.” IN THE AFTERMATH OF A PATIENT’S PROVOCATIVE ENACTMENT “HOW WERE YOU HOPING I WOULD RESPOND?” (ID) “HOW WERE YOU AFRAID I MIGHT RESPOND?” (SUPEREGO) “HOW WERE YOU IMAGINING THAT I WOULD RESPOND?” (EGO)
MODEL 3 ALTHOUGH INITIALLY THE THERAPIST MAY INDEED FAIL THE PATIENT IN MUCH THE SAME WAY THAT THE PATIENT’S PARENT HAD FAILED HER, ULTIMATELY THE THERAPIST WILL CHALLENGE THE PATIENT’S PROJECTIONS BY LENDING ASPECTS OF HER “OTHERNESS,” OR, AS WINNICOTT WOULD HAVE SAID, HER “EXTERNALITY” TO THE INTERACTION, SUCH THAT THE PATIENT WILL HAVE THE EXPERIENCE OF SOMETHING THAT IS “OTHER – THAN – ME” AND CAN TAKE THAT IN
MODEL 3 THE THERAPIST WILL CHALLENGE 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 BEING ABLE TO TAKE IN SOMETHING THAT IS NOW MORE PROCESSED, LESS TOXIC, AND MORE MANAGEABLE
MODEL 3 IN OTHER WORDS, BECAUSE THE THERAPIST IS NOT, IN FACT, AS BAD AS THE PARENT HAD BEEN AND IS ABLE TO BRING TO BEAR HER OWN, MORE EVOLVED CAPACITY TO PROCESS AND INTEGRATE ON BEHALF OF A PATIENT WHO TRULY DOES NOT KNOW HOW, THERE CAN BE A BETTER OUTCOME – A REPETITION OF THE ORIGINAL TRAUMA BUT WITH A MUCH HEALTHIER RESOLUTION THIS TIME, THE REPETITION LEADING TO MODIFICATION OF THE PATIENT’S INTERNAL WORLD AND INTEGRATION ON A HIGHER LEVEL OF ADAPTIVE CAPACITY AND RELATIONAL MATURITY
PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 4 FACILITATION STATEMENTS TO ADDRESS THE PATIENT’S CONFLICT BETWEEN HER LONGING TO BE KNOWN AND UNDERSTOOD AND HER TERROR OF BEING FOUND AS WELL AS HER AMBIVALENCE ABOUT LIVING IN A WORLD THAT SHE EXPERIENCES AS EMPTY AND DEVOID OF MEANING AND PURPOSE “A PART OF YOU WOULD WANT DESPERATELY TO BE SEEN AND UNDERSTOOD; BUT ANOTHER PART OF YOU IS TERRIFIED OF BEING FOUND.” “A PART OF YOU WOULD WANT TO BE ABLE TO FIND A REASON TO GO ON LIVING; BUT ANOTHER PART OF YOU IS QUITE SURE THAT THERE IS NO MEANING TO BE FOUND.” (BOTH OF WHICH ADDRESS DIVERGENT CONFLICT)
WHEN THE FOCUS IS ON THE PATIENT AS “RESISTANT” AND / OR “NOT AWARE,” THINK MODEL 1 AND CONFLICT STATEMENTS TO MAKE THE PATIENT “MORE AWARE” WHEN THE FOCUS IS ON THE PATIENT AS “RELENTLESS” AND / OR “NOT ACCEPTING,” THINK MODEL 2 AND DISILLUSIONMENT STATEMENTS TO MAKE THE PATIENT “MORE ACCEPTING” WHEN THE FOCUS IS ON THE PATIENT AS “RE – ENACTING” AND / OR “NOT ACCOUNTABLE,” THINK MODEL 3 AND ACCOUNTABILITY STATEMENTS TO MAKE THE PATIENT “MORE ACCOUNTABLE” WHEN THE FOCUS IS ON THE PATIENT AS “RETREATING” AND / OR “NOT ACCESSIBLE,” THINK MODEL 4 AND FACILITATION STATEMENTS TO MAKE THE PATIENT “MORE ACCESSIBLE”
MODEL 1 RESOLUTION OF STRUCTURAL CONFLICT INVOLVING DYSFUNCTIONAL INTERNAL DYNAMICS TAMING THE ID AND STRENGTHENING THE EGO SUCH THAT STRUCTURAL CONFLICT BECOMES STRUCTURAL COLLABORATION MODEL 2 STRUCTURAL GROWTH / ADDING NEW GOOD MAKING GOOD A DEFICIENCY / FILLING IN DEFICIT SUCH THAT STRUCTURAL DEFICIT BECOMES STRUCTURAL CONSOLIDATION MODEL 3 RESOLUTION OF RELATIONAL CONFLICT INVOLVING DYSFUNCTIONAL RELATIONAL DYNAMICS STRUCTURAL MODIFICATION / CHANGING OLD BAD DETOXIFYING INTERNAL TOXICITY SUCH THAT RELATIONAL CONFLICT BECOMES RELATIONAL COLLABORATION MODEL 4 EMERGENCE OF MOMENTS OF MEETING SUCH THAT RELATIONAL DEFICIT BECOMES MEANINGFUL ENGAGEMENT WITH THE WORLD OF ANIMATE OBJECTS
THE THERAPEUTIC ACTION IN ALL FOUR MODELS WILL INVOLVE WORKING THROUGH THE OPTIMAL STRESS CREATED BY INTERVENTIONS THAT ALTERNATELY CHALLENGE AND THEN SUPPORT INTERVENTIONS STRATEGICALLY DESIGNED TO TARGET / HIGHLIGHT / GENERATE MODEL 1 – COGNITIVE DISSONANCE MODEL 2 – AFFECTIVE DISILLUSIONMENT MODEL 3 – RELATIONAL DETOXIFICATION MODEL 4 – ABSOLUTE DEPENDENCE THE WORKING THROUGH OF WHICH WILL RESULT ULTIMATELY IN RECONSTITUTION AT EVER – HIGHER LEVELS OF AWARENESS / ACTUALIZATION OF POTENTIAL, ACCEPTANCE, ACCOUNTABILITY, AND ACCESSIBILITY
MATURITY INVOLVES DEVELOPING THE CAPACITY … MODEL 1 TO KNOW AND ACCEPT THE SELF, INCLUDING ITS PSYCHIC SCARS MODEL 2 TO KNOW AND ACCEPT THE OBJECT, INCLUDING ITS PSYCHIC SCARS MODEL 3 TO TAKE RESPONSIBILITY FOR THE DYSFUNCTION DELIVERED INTO ONE’S RELATIONSHIPS AND, MORE GENERALLY, INTO ONE’S LIFE MODEL 4 TO OVERCOME ONE’S TERROR OF BEING FOUND SO THAT MOMENTS OF MEETING CAN BE TOLERATED AND, EVEN, FOUND TO GIVE MEANING AND PURPOSE TO LIFE
BY WAY OF REVIEW MODEL 1 THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS A 1 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S INTERNAL DYNAMICS AND POSITS INSIGHT, WISDOM, AWARENESS, EMPOWERMENT, AND ACTUALIZATION OF INHERITED POTENTIAL AS THE ULTIMATE THERAPEUTIC GOALS MODEL 2 THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND OTHER DEFICIT THEORIES A 1½ – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S AFFECTIVE EXPERIENCE AND POSITS ACCEPTANCE OF THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY AS THE ULTIMATE THERAPEUTIC GOAL
BY WAY OF REVIEW MODEL 3 THE CONTEMPORARY RELATIONAL (OR INTERSUBJECTIVE) PERSPECTIVE A 2 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S RELATIONAL DYNAMICS AND POSITS ACCOUNTABILITY AS THE ULTIMATE THERAPEUTIC GOAL MODEL 4 THE EXISTENTIAL PERSPECTIVE A ½ – PERSON PSYCHOLOGY THAT EMPHASIZES AN INDIVIDUAL’S STRUGGLE TO FIND MEANING, PURPOSE, AND DIRECTION FOR A LIFE THAT WOULD OTHERWISE BE DESOLATE, BARREN, AND EMPTY AND POSITS ACCESSIBILITY AND THE FORGING OF MEANINGFUL ATTACHMENTS TO THE WORLD OF ANIMATE OBJECTS AS THE ULTIMATE THERAPEUTIC GOALS
AN OVERVIEW PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 1 CONFLICT STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RESISTANT” PATIENT TO STEP BACK FROM THE IMMEDIACY OF THE MOMENT IN ORDER TO TAKE STOCK OF BOTH HER INVESTMENT IN MAINTAINING THINGS AS THEY ARE AND THE PRICE SHE PAYS FOR DOING SO 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
PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RE – ENACTING” PATIENT TO TAKE RESPONSIBILITY FOR THE DYSFUNCTIONAL RELATIONAL DYNAMICS (THE RESIDUA OF UNMASTERED CHILDHOOD DRAMAS) THAT SHE IS COMPULSIVELY AND UNWITTINGLY REPLAYING ON THE STAGE OF HER LIFE MODEL 4 FACILITATION STATEMENTS ARE DESIGNED TO HIGHLIGHT THE “RETREATING” PATIENT’S INTENSE AMBIVALENCE ABOUT EVEN BEING IN RELATIONSHIP – THE FACT THAT SHE LONGS TO BE SEEN AND UNDERSTOOD BUT IS TERRIFIED OF BEING FOUND
MORE GENERALLY MODEL 1 USES CONFLICT STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER INTERNAL CONFLICTEDNESS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE SELF INTO THE ADAPTIVE CAPACITY TO BE AWARE OF THOSE ANXIETY – PROVOKING TRUTHS MODEL 2 USES DISILLUSIONMENT STATEMENTS TO FACILITATE THE PATIENT’S GRIEVING OF INTOLERABLY PAINFUL DISAPPOINTMENTS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE OBJECT INTO THE ADAPTIVE CAPACITY TO ACCEPT THOSE DISILLUSIONING TRUTHS
MORE GENERALLY MODEL 3 USES ACCOUNTABILITY STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER TENDENCY TO RE – PLAY UNMASTERED CHILDHOOD DRAMAS ON THE STAGE OF HER LIFE AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED CHILDHOOD DRAMAS INTO THE ADAPTIVE CAPACITY TO BE ACCOUNTABLE FOR HER ACTIONS, REACTIONS, AND INTERACTIONS AND MODEL 4 USES FACILITATION STATEMENTS TO HIGHLIGHT NOT ONLY THE PATIENT’S TERROR OF BEING ONCE AGAIN DESTROYED BY AN ANNIHILATING OBJECT BUT ALSO HER DESPERATE LONGING TO RE – ENGAGE WITH THE WORLD AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RETREAT INTO THE ADAPTIVE CAPACITY TO BE ACCESSED AND, AS A RESULT, TO BE ABLE TO TOLERATE MOMENTS OF MEANINGFUL MEETING
THE HEALING PROCESS IN ALL FOUR MODELS PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT AN OPPORTUNITY ALBEIT A BELATED ONE TO MASTER STRESSFUL EXPERIENCES THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST BUT THAT CAN NOW WITH ENOUGH SUPPORT FROM THE THERAPIST AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE AND CAPACITY TO SELF – CORRECT IN THE FACE OF ENVIRONMENTAL CHALLENGE BE PROCESSED, INTEGRATED, AND ULTIMATELY ADAPTED TO AT THE END OF THE DAY THE HEALING PROCESS WILL INVOLVE TRANSFORMATION OF DEFENSE INTO ADAPTATION BY WAY OF WORKING THROUGH THE IMPACT OF OPTIMALLY STRESSFUL PSYCHOTHERAPEUTIC INTERVENTIONS CONFLICT STATEMENTS (MODEL 1) ~ DISILLUSIONMENT STATEMENTS (MODEL 2) ACCOUNTABILITY STATEMENTS (MODEL 3) ~ FACILITATION STATEMENTS (MODEL 4) 130
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Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Slides.pptx

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Dr. Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (which speaks to the power of insight); the corrective-provision perspective of self psychology and other deficit theories (which speaks to the importance of corrective experience as compensation for early-on deficiencies); and the contemporary relational perspective (which speaks to mutual enactment and negotiation by both patient and therapist of the entanglements that will inevitably emerge at the intimate edge of their authentic engagement). Her focus throughout the seminar will be on the interface between theory and practice; and Dr. Stark will demonstrate, by way of numerous clinical vignettes and prototypical interventions, the ways in which the three modes of therapeutic action (knowledge, experience, and relationship) can be used to accelerate the healing process. review of basic constructs: knowledge, experience, relationship as curative factors; “supporting” by being with the patient where she is vs. “challenging” by directing her attention to elsewhere; the therapeutic process as involving recursive cycles of defensive collapse and adaptive reconstitution at ever higher levels of integration and balance. the process of transforming defense into adaptation; the importance of awareness (wisdom), acceptance, and accountability; therapist as neutral object, empathic selfobject, authentic subject; prototypical interventions specifically designed to facilitate the grieving process and to accelerate the healing. working through the negative transference and disruptions to the positive transference; transforming infantile need into mature adult capacity; focusing on the contributions of both patient and therapist to the relational dynamics at their intimate edge; use of instructor’s process recordings to demonstrate the role of knowledge, experience, and relationship in strengthening the ego, consolidating the self, and resolving relational difficulties.

M
Martha Stark MDFaculty, Harvard Medical School / Integrative Psychiatrist and Holistic Psychoanalyst / Originator and Developer, The Psychodynamic Synergy Paradigm: A C.A.R.E. Approach to Deep Healing em Harvard Medical School

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Martha Stark MD – Comprehensive Overview of the 4 Models – A Potpourri of Slides.pptx

  • 1. BY WAY OF REVIEW MODEL 1 THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS A 1 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S INTERNAL DYNAMICS AND POSITS INSIGHT, WISDOM, AWARENESS, EMPOWERMENT, AND ACTUALIZATION OF INHERITED POTENTIAL AS THE ULTIMATE THERAPEUTIC GOAL MODEL 2 THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND OTHER DEFICIT THEORIES A 1½ – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S AFFECTIVE EXPERIENCE AND POSITS ACCEPTANCE OF THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY AS THE ULTIMATE THERAPEUTIC GOAL 1
  • 2. BY WAY OF REVIEW MODEL 3 THE CONTEMPORARY RELATIONAL (OR INTERSUBJECTIVE) PERSPECTIVE A 2 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S RELATIONAL DYNAMICS AND POSITS ACCOUNTABILITY AS THE ULTIMATE THERAPEUTIC GOAL MODEL 4 THE EXISTENTIAL PERSPECTIVE A ½ – PERSON PSYCHOLOGY THAT EMPHASIZES AN INDIVIDUAL’S STRUGGLE TO FIND MEANING, PURPOSE, AND DIRECTION IN LIFE AND POSITS ACCESSIBILITY AND THE FORGING OF MEANINGFUL ATTACHMENTS TO THE WORLD OF ANIMATE OBJECTS AS THE ULTIMATE THERAPEUTIC GOAL 2
  • 3. AN OVERVIEW PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 1 CONFLICT STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RESISTANT” PATIENT TO STEP BACK FROM THE IMMEDIACY OF THE MOMENT IN ORDER TO TAKE STOCK OF BOTH HER INVESTMENT IN MAINTAINING THINGS AS THEY ARE AND THE PRICE SHE PAYS FOR DOING SO 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 3
  • 4. PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RE – ENACTING” PATIENT TO TAKE RESPONSIBILITY FOR THE DYSFUNCTIONAL RELATIONAL DYNAMICS (THE RESIDUA OF UNMASTERED CHILDHOOD DRAMAS) THAT SHE IS COMPULSIVELY AND UNWITTINGLY REPLAYING ON THE STAGE OF HER LIFE MODEL 4 FACILITATION STATEMENTS ARE DESIGNED TO HIGHLIGHT THE “RETREATING” PATIENT’S INTENSE AMBIVALENCE ABOUT EVEN BEING IN RELATIONSHIP – THE FACT THAT SHE LONGS TO BE SEEN AND UNDERSTOOD BUT IS TERRIFIED OF BEING FOUND 4
  • 5. MORE GENERALLY MODEL 1 USES CONFLICT STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER INTERNAL CONFLICTEDNESS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE SELF INTO THE ADAPTIVE CAPACITY TO BE AWARE OF THOSE ANXIETY – PROVOKING TRUTHS MODEL 2 USES DISILLUSIONMENT STATEMENTS TO FACILITATE THE PATIENT’S GRIEVING OF INTOLERABLY PAINFUL DISAPPOINTMENTS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE OBJECT INTO THE ADAPTIVE CAPACITY TO ACCEPT THOSE DISILLUSIONING TRUTHS 5
  • 6. MORE GENERALLY MODEL 3 USES ACCOUNTABILITY STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER TENDENCY TO RE – PLAY UNMASTERED CHILDHOOD DRAMAS ON THE STAGE OF HER LIFE AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED CHILDHOOD DRAMAS INTO THE ADAPTIVE CAPACITY TO BE ACCOUNTABLE FOR HER ACTIONS, REACTIONS, AND INTERACTIONS AND MODEL 4 USES FACILITATION STATEMENTS TO HIGHLIGHT NOT ONLY THE PATIENT’S TERROR OF BEING ONCE AGAIN DESTROYED BY AN ANNIHILATING OBJECT BUT ALSO HER DESPERATE LONGING TO RE – ENGAGE WITH THE WORLD AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RETREAT INTO THE ADAPTIVE CAPACITY TO BE ACCESSED AND, AS A RESULT, TO BE ABLE TO TOLERATE MOMENTS OF MEANINGFUL MEETING 6
  • 7. PREVIEW FOUR MODES OF THERAPEUTIC ACTION FOUR APPROACHES TO TRANSFORMING DEFENSE INTO ADAPTATION FOUR OPTIMAL STRESSORS THAT FACILITATE THIS ACTION TRANSFORMATION OF RESISTANCE INTO AWARENESS AND ACTUALIZATION OF POTENTIAL BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE (THE EXPERIENCE OF GAIN – BECOME – PAIN) TRANSFORMATION OF RELENTLESSNESS INTO ACCEPTANCE BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT (THE EXPERIENCE OF GOOD – BECOME – BAD) TRANSFORMATION OF RE – ENACTMENT INTO ACCOUNTABILITY BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION (THE EXPERIENCE OF BAD – BECOME – GOOD) TRANSFORMATION OF RETREAT INTO ACCESSIBILITY BY WORKING THROUGH THE STRESS OF ABSOLUTE DEPENDENCE (THE EXPERIENCE OF HIDDEN – BECOME – FOUND) 7
  • 8. STRUCTURAL CONFLICT RESISTANCE BECOMES TRANSFORMED INTO AWARENESS AND ACTUALIZATION OF POTENTIAL STRUCTURAL DEFICIT RELENTLESSNESS BECOMES TRANSFORMED INTO ACCEPTANCE RELATIONAL CONFLICT RE – ENACTMENT BECOMES TRANSFORMED INTO ACCOUNTABILITY RELATIONAL DEFICIT RETREAT BECOMES TRANSFORMED INTO ACCESSIBILITY NEUROTIC ~ NARCISSISTIC ~ CHARACTER DISORDERED ~ SCHIZOID 8
  • 9. TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 1 DEFENSIVE REACTION – RESISTANCE TO AWARENESS OF ONE’S DYSFUNCTIONAL INTERNAL DYNAMICS ADAPTIVE RESPONSE – AWARENESS AND ACTUALIZATION OF POTENTIAL MODEL 2 DEFENSIVE REACTION – RELENTLESSNESS (RELENTLESS HOPE) AND REFUSAL TO CONFRONT – AND GRIEVE – CERTAIN INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY ADAPTIVE RESPONSE – ACCEPTANCE OF ONE’S ULTIMATE POWERLESSNESS TO MAKE THE OBJECT CHANGE 9
  • 10. TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 3 DEFENSIVE REACTION – COMPULSIVE AND UNWITTING RE – ENACTMENT OF DYSFUNCTIONAL RELATIONAL DYNAMICS RESULTING FROM UNMASTERED EARLY – ON TRAUMAS ADAPTIVE RESPONSE – ACCOUNTABILITY FOR ONE’S ACTIONS, REACTIONS, AND INTERACTIONS MODEL 4 DEFENSIVE REACTION – PSYCHIC RETREAT AND SCHIZOID WITHDRAWAL ADAPTIVE RESPONSE – ACCESSIBILITY AND ATTACHMENT 10
  • 11. PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT AN OPPORTUNITY ALBEIT A BELATED ONE TO MASTER EXPERIENCES THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST BUT THAT CAN NOW WITH ENOUGH SUPPORT FROM THE THERAPIST AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE AND CAPACITY TO COPE WITH STRESS BE PROCESSED AND INTEGRATED AND ULTIMATELY ADAPTED TO 11
  • 12. WITH THE THERAPIST’S FINGER EVER ON THE PULSE OF THE PATIENT’S ANXIETY AND CAPACITY TO TOLERATE FURTHER CHALLENGE THE THERAPIST WILL THEREFORE CHALLENGE WHENEVER POSSIBLE BY DIRECTING THE PATIENT’S ATTENTION TO WHERE THE PATIENT IS NOT “DISRUPTIVE ATTUNEMENT” AND SUPPORT WHENEVER NECESSARY BY RESONATING WITH WHERE THE PATIENT IS “HOMEOSTATIC ATTUNEMENT” 12
  • 13. CHALLENGE BY WAY OF ANXIETY – PROVOKING INTERPRETIVE STATEMENTS THAT CALL INTO QUESTION DEFENSES TO WHICH THE PATIENT HAS LONG CLUNG IN ORDER TO PRESERVE HER PSYCHOLOGICAL EQUILIBRIUM THEREBY INCREASING HER ANXIETY SUPPORT BY WAY OF ANXIETY – ASSUAGING EMPATHIC STATEMENTS THAT HONOR THOSE SELF – PROTECTIVE DEFENSES THEREBY DECREASING HER ANXIETY 13
  • 14. MODEL 1 – STRUCTURAL CONFLICT THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS SIGMUND FREUD, ANNA FREUD, HEINZ HARTMANN, DAVID RAPAPORT, ERNST KRIS, AND RUDOLPH LOEWENSTEIN MODEL 2 – STRUCTURAL DEFICIT THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL ABSENCE OF GOOD HEINZ KOHUT, ERNEST WOLF, ARNOLD GOLDBERG, MICHAEL BALINT, AND PAUL / ANNA ORNSTEIN 14
  • 15. MODEL 3 – RELATIONAL CONFLICT THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL PRESENCE OF BAD W R D FAIRBAIRN, STEPHEN MITCHELL, JESSICA BENJAMIN, DARLENE EHRENBERG, AND JAY GREENBERG MODEL 4 – RELATIONAL DEFICIT THE EXISTENTIAL PERSPECTIVE WITH ITS EMPHASIS ON DREAD, ANGST, DESPAIR, SUFFERING, AND SEARCH FOR MEANINGFUL CONNECTION HARRY GUNTRIP, ARNOLD MODELL, MASUD KHAN, JOHN BOWLBY, THOMAS OGDEN, ROLLO MAY, AND VIKTOR FRANKL 15
  • 16. MODEL 1 – STRUCTURAL CONFLICT ACCELERATOR / BRAKE ~ START / STOP FORCES PRESSING “YES” AND RESISTIVE COUNTERFORCES INSISTING “NO” MODEL 2 – STRUCTURAL DEFICIT INTERNAL ABSENCE OF GOOD ~ DEPRIVATION AND NEGLECT IMPAIRED CAPACITY TO BE A GOOD PARENT UNTO ONESELF MODEL 3 – RELATIONAL CONFLICT INTERNAL PRESENCE OF BAD ~ TRAUMA AND ABUSE COMPULSIVE RE – ENACTMENT OF UNRESOLVED CHILDHOOD DRAMAS ON THE STAGE OF ONE’S LIFE MODEL 4 – RELATIONAL DEFICIT A HEART SHATTERED PSYCHIC RETREAT, SCHIZOID WITHDRAWAL, AND SOLITARY SUFFERING RESULTING FROM THE EXPERIENCE OF ANNIHILATING, HEART – SHATTERING RESPONSES FROM THE OBJECT 16
  • 17. THERAPEUTIC ACTION MODEL 1 – COGNITIVE ENHANCEMENT OF KNOWLEDGE “WITHIN” MODEL 2 – AFFECTIVE PROVISION OF CORRECTIVE EXPERIENCE “FOR” MODEL 3 – RELATIONAL ENGAGEMENT IN AUTHENTIC RELATIONSHIP “WITH” MODEL 4 – EXISTENTIAL EMERGENCE OF MEANINGFUL MOMENTS OF MEETING “BETWEEN” AND CREATION OF TRANSITIONAL SPACE “BETWEEN” 17
  • 18. MODEL 1 – NEUROTIC WOODY ALLEN, JERRY SEINFELD’S AND JASON ALEXANDER’S CHARACTERS ON SEINFELD, AND MONK MODEL 2 – NARCISSISTIC MADONNA, KIM KARDASHIAN, KANYE WEST, AND DONALD TRUMP MODEL 3 – CHARACTER DISORDERED GEORGE AND MARTHA IN WHO’S AFRAID OF VIRGINIA WOOLF? MODEL 4 – SCHIZOID PRIVATE (TRUE) SELF / ADDICTIONS / SOCIAL (FALSE) SELF GRETA GARBO, KATHARINE HEPBURN, JOHNNY CARSON, AND GREGORY HOUSE, MD (FROM THE TV SHOW HOUSE) 18
  • 19. MODEL 1 – NEUROTIC THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS, AVOIDANCE, AND PARALYSIS, LEADING TO UNACTUALIZED POTENTIAL MODEL 2 – NARCISSISTIC THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE, LEADING TO UNREQUITED LOVE AND CONSTANT HEARTBREAK MODEL 3 – CHARACTER DISORDERED THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE AND BITTERNESS, LEADING TO UNACKNOWLEDGED ANGER AND AGGRESSION AND A SENSE OF ONESELF AS EVER THE VICTIM MODEL 4 – SCHIZOID THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR AND PROFOUND HOPELESSNESS, LEADING TO UNMITIGATED LONELINESS, SILENT SUFFERING, SOLIPSISTIC WITHDRAWAL, SCHIZOID DETACHMENT, PSYCHIC DEADNESS, AND INNER EMPTINESS 19
  • 20. COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION KAREN HORNEY’S INTERPERSONAL TRENDS MOVEMENT INWARD ~ TOWARDS ~ AGAINST ~ AWAY SYMPATHETIC ACTIVATION FREEZE ~ FEED / FUCK ~ FIGHT ~ FLIGHT MODES OF RELATEDNESS NEUROTIC ~ NARCISSISTIC ~ NOXIOUS ~ NONRELATEDNESS NUMBERS OF PEOPLE INVOLVED 1 – PERSON ~ 1½ – PERSON ~ 2 – PERSON ~ ½ – PERSON THERAPEUTIC STANCE NEUTRALITY ~ EMPATHY ~ AUTHENTICITY ~ DEPENDABILITY / DEVOTION A PSYCHOLOGY OF THE … EGO ~ SELF ~ SELF – IN – RELATION ~ PRIVATE SELF 20
  • 21. KAREN HORNEY DESCRIBES THREE “INTERPERSONAL TRENDS” MOVEMENT INWARD MODEL 1 MOVEMENT TOWARDS MODEL 2 MOVEMENT AGAINST MODEL 3 MOVEMENT AWAY MODEL 4 21
  • 22. FOUR Fs OF “SYMPATHETIC ACTIVATION” FOUR BASIC DRIVES RELATED TO SURVIVAL FIGHT OR FLIGHT OR FREEZE AND, OF COURSE, FEED / REPRODUCE FREEZE MODEL 1 (MOVEMENT INWARD) FEED / FUCK MODEL 2 (MOVEMENT TOWARDS) FIGHT MODEL 3 (MOVEMENT AGAINST) FLEE MODEL 4 (MOVEMENT AWAY) 22
  • 23. MODES OF RELATEDNESS MODEL 1 – NEUROTIC RELATEDNESS THE CONFLICT – RIDDEN NEUROTIC PATIENT STRUGGLES TO MOVE FORWARD IN HER LIFE BUT IS JAMMED UP AND UNABLE TO EMPOWER HERSELF BY MOBILIZING HER ID ENERGIES IN THE SERVICE OF HER EGO MODEL 2 – NARCISSISTIC RELATEDNESS THE DEFICIT – RIDDEN NARCISSISTIC PATIENT NEEDS HER OBJECTS TO “COMPLETE” HER BY PROVIDING MIRRORING CONFIRMATION OF HER PERFECTION AND / OR BY ALLOWING HER TO FUSE WITH THEM IN FANTASY SUCH THAT SHE CAN THEN PARTAKE OF THEIR PERFECTION MODEL 3 – NOXIOUS RELATEDNESS UNDER THE SWAY OF HER REPETITION COMPULSION, THE CHARACTER DISORDERED PATIENT DELIVERS HER UNMASTERED CHILDHOOD DRAMAS (THAT IS, HER DYSFUNCTIONAL RELATIONAL DYNAMICS) INTO HER RELATIONSHIPS AND THEN COMPULSIVELY AND UNWITTINGLY RE – ENACTS THEM ON THE STAGE OF HER LIFE MODEL 4 – NONRELATEDNESS FOR FEAR OF BEING SHATTERED BY YET ANOTHER CATASTROPHICALLY ANNIHILATING RESPONSE FROM THE OBJECT, THE SCHIZOID PATIENT WITHDRAWS FROM ALL RELATIONSHIPS AND IS RELUCTANT TO BE FOUND23
  • 24. MODEL 1 – 1 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S INTERNAL DYNAMICS THERAPIST AS A NEUTRAL OBJECT / OBJECTIVE OBSERVER OBJECTIVITY OF A SURGEON / BLANK SCREEN MODEL 2 – 1½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE EXPERIENCE (ESPECIALLY THE PAIN OF HER GRIEF) THERAPIST AS AN EMPATHIC SELFOBJECT OR GOOD OBJECT MODEL 3 – 2 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S RELATIONAL DYNAMICS THERAPIST AS AN AUTHENTIC SUBJECT OR A RELATIONAL OBJECT (AND, AT THE END OF THE DAY, INEVITABLY A BAD OBJECT) MODEL 4 – ½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE NONRELATEDNESS THERAPIST AS A RELIABLE, NONDEMANDING, STEADY, DEPENDABLE, CONSISTENT, TRUSTWORTHY, LOVING, AND DEVOTED PRESENCE 24
  • 25. THERAPEUTIC STANCE MODEL 1 – NEUTRALITY MODEL 2 – EMPATHY MODEL 3 – AUTHENTICITY MODEL 4 – RELIABILITY ~ DEPENDABILITY ~ DEVOTION 25
  • 26. EMPATHY VS. AUTHENTICITY THERE IS A CRITICAL DISTINCTION BETWEEN THE EMPATHIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 2 HAT AND THE AUTHENTIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 3 HAT MODEL 2 IS ABOUT THE THERAPIST’S EMPATHIC IMMERSION IN THE PATIENT’S INTERNAL WORLD THE EMPATHIC THERAPIST “DECENTERS” (ATWOOD AND STOLOROW 1984) FROM HER OWN EXPERIENCE, JOINS ALONGSIDE THE PATIENT, AND ENTERS INTO THE PATIENT’S INTERNAL EXPERIENCE – BUT TAKES IT ON ONLY “AS IF” IT WERE HER OWN BECAUSE IT NEVER ACTUALLY BECOMES HER OWN EMPATHY IS NOT ABOUT THE THERAPIST WHO HAS DECENTERED FROM HER OWN EXPERIENCE IT IS ABOUT THE PATIENT 26
  • 27. EMPATHY VS. AUTHENTICITY MODEL 3 IS ABOUT THE THERAPIST’S AUTHENTIC PARTICIPATION IN A REAL RELATIONSHIP WITH THE PATIENT UNLIKE THE EMPATHIC THERAPIST, WHO DECENTERS FROM HER OWN EXPERIENCE, THE AUTHENTIC THERAPIST REMAINS VERY MUCH CENTERED IN HER OWN EXPERIENCE AND ALLOWS THE PATIENT’S EXPERIENCE TO ENTER INTO HER, WHICH SHE THEN TAKES ON “AS” HER OWN THIS DYNAMIC IS AT THE HEART OF PROJECTIVE IDENTIFICATION THE MEAT AND POTATOES OF CONTEMPORARY RELATIONAL THEORY AND, AS WE SHALL LATER SEE, AT THE HEART OF INTROJECTIVE IDENTIFICATION AS WELL 27
  • 28. A PSYCHOLOGY OF THE … MODEL 1 EGO GOAL ~ A STRONGER, WISER, AND MORE EMPOWERED EGO MODEL 2 SELF GOAL ~ A MORE CONSOLIDATED, ACCEPTING, AND COMPASSIONATE SELF MODEL 3 SELF – IN – RELATION GOAL ~ A MORE PRESENT AND ACCOUNTABLE SELF – IN – RELATION MODEL 4 PRIVATE SELF / ADDICTED SELF / FALSE SELF GOAL ~ A LESS PROTECTED AND MORE ACCESSIBLE TRUE SELF 28
  • 29. RECURRING THEMES MODEL 1 AVOIDANCE ~ PARALYSIS MODEL 2 SHAME ~ CONTEMPT EMPTY, SHAME – FILLED DEPRESSION PATIENT NEEDS TO BE ABLE TO “GRIEVE” MODEL 3 ANGER ~ AGGRESSION ~ GUILT ANGRY, GUILT – RIDDEN DEPRESSION PATIENT NEEDS TO BE ABLE TO “RAGE” MODEL 4 SECRETS ~ LIES PRETENSIONS ~ CONCEALMENTS PROFOUND DESPAIR ~ SOLITARY SUFFERING 29
  • 30. ALTHOUGH THE FOCUS IN EACH IS DIFFERENT ALL FOUR OF MY MODELS INVOLVE AS THEIR STARTING POINT THE INTERNAL PRICE PAID BY THE CHILD BECAUSE OF TRAUMATIC FRUSTRATION BY THE PARENT MODEL 1 REINFORCEMENT OF INFANTILE NEED IN THE FACE OF ITS TRAUMATIC FRUSTRATION MODEL 2 FAILURE TO INTERNALIZE GOOD IN THE FACE OF TRAUMATIC “ABSENCE OF GOOD” MODEL 3 INTROJECTION OF BAD IN THE FACE OF TRAUMATIC “PRESENCE OF BAD” MODEL 4 SHATTERING OF THE HEART IN THE FACE OF CATACLYSMIC HEARTBREAK AND LOSS 30
  • 31. THE STARTING POINT IN MODEL 1 DEFENSIVELY REINFORCED INFANTILE (LIBIDINAL AND AGGRESSIVE) DRIVES RESULTING FROM THE DRIVE OBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE DRIVES THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) DRIVES AS THEY ARISE IN THE CONTEXT OF THE TREATMENT WHICH WILL ULTIMATELY RESULT IN ADAPTIVE INTEGRATION OF THOSE (ID) DRIVES NOW TAMED AND MODIFIED INTO HEALTHY PSYCHIC (EGO) STRUCTURE WHICH WILL THEN ALLOW FOR THE REDIRECTING OF THEIR NOW BETTER REGULATED ENERGY INTO MORE CONSTRUCTIVE PURSUITS AND ACTUALIZATION OF POTENTIAL BY A NOW MORE SKILLED EGO DRIVE (HORSE) AND DEFENSE (RIDER) NO LONGER WORKING IN CONFLICT BUT IN COLLABORATION 31
  • 32. THE STARTING POINT IN MODEL 2 STRUCTURAL DEFICIT AND IMPAIRED CAPACITY RESULTING FROM THE SELFOBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE NEED TO HAVE A PERFECT PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) NARCISSISTIC NEED TO FIND THE PERFECT PARENT AS IT ARISES IN THE CONTEXT OF THE RELATIONSHIP WITH THE SELFOBJECT THERAPIST WHICH WILL ULTIMATELY RESULT IN ADAPTIVE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS WHICH WILL THEN ALLOW FOR THE FILLING IN OF STRUCTURAL DEFICIT, DEVELOPMENT OF A MORE ROBUST CAPACITY TO BE A GOOD PARENT UNTO HERSELF, ACCRETION OF HEALTHY PSYCHIC STRUCTURE, AND CONSOLIDATION OF A MORE COHESIVE SELF GRIEVING OPTIMAL DISILLUSIONMENT WILL TRANSFORM THE DEFENSIVE NEED FOR EXTERNAL REGULATION OF THE SELF INTO THE ADAPTIVE CAPACITY TO BE INTERNALLY SELF – REGULATING 32
  • 33. THE STARTING POINT IN MODEL 3 INTERNAL DEMONS AND A SENSE OF INNER BADNESS RESULTING FROM INTROJECTION OF THE DYSFUNCTIONAL RELATIONAL DYNAMIC CHARACTERIZING THE CHILD’S EARLY – ON RELATIONSHIP WITH THE TRAUMATICALLY ABUSIVE PARENT INTERNAL BAD OBJECTS / PATHOGENIC INTROJECTS THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE TURBULENCE THAT WILL INEVITABLY ARISE AT THE “INTIMATE EDGE” (EHRENBERG 1992) OF AUTHENTIC RELATEDNESS ONCE THE PATIENT DELIVERS HER PATHOGENIC INTROJECTS INTO THE RELATIONSHIP WITH HER THERAPIST WHICH WILL ULTIMATELY RESULT IN GRADUAL MODIFICATION OF THEIR TOXICITY BY WAY OF SERIAL DILUTIONS WHICH WILL THEN ALLOW FOR TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED EARLY – ON RELATIONAL TRAUMAS INTO THE ADAPTIVE CAPACITY TO HOLD HERSELF ACCOUNTABLE AND TO ENGAGE IN HEALTHY, AUTHENTIC RELATEDNESS 33
  • 34. THE STARTING POINT IN MODEL 4 A HEART SHATTERED, SCHIZOID WITHDRAWAL, AND PSYCHIC RETREAT RESULTING FROM OVERWHELMINGLY DEVASTATING HEARTBREAK EXPERIENCED AT THE HANDS OF A DEVASTATINGLY ANNIHILATING PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE PATIENT’S FEAR OF BEING FOUND BY, BECOMING ABSOLUTELY DEPENDENT UPON, AND EXPERIENCING MOMENTS OF MEETING WITH THE THERAPIST THE THERAPIST’S PROVISION OF RELIABLE, NONDEMANDING, STEADY, CONSISTENT, TRUSTWORTHY, AND DEVOTED PRESENCE FOR A PATIENT WHO IS INTENSELY AMBIVALENT ABOUT ENGAGEMENT ~ ON THE ONE HAND, DESPERATELY LONGING TO BE KNOWN BUT, ON THE OTHER HAND, TERRIFIED OF BEING FOUND WILL ULTIMATELY RESULT IN REDUCED TERROR, DREAD, DESPAIR, RESIGNATION, ISOLATION, AND ALIENATION TOLERATING ABSOLUTE DEPENDENCE WILL TRANSFORM THE DEFENSIVE NEED TO STAY HIDDEN INTO THE ADAPTIVE CAPACITY TO BE FOUND 34
  • 35. WHEN, IN THE MOMENT, THE SPOTLIGHT IS ON THE PATIENT AS … NEUROTICALLY CONFLICTED / JAMMED UP / STUCK PARALYZED BY DYSFUNCTIONAL INTERNAL DYNAMICS THINK MODEL 1 NARCISSISTICALLY VULNERABLE / NEEDY EVER BUSY LOOKING TO THE OUTSIDE FOR EXTERNAL PROVISION, VALIDATION, AND REINFORCEMENT THINK MODEL 2 NOXIOUSLY ENGAGED / SELF – SABOTAGING SELF – DEFEATING / SELF – INDULGENT / SELF – DESTRUCTIVE RE – ENACTING DYSFUNCTIONAL RELATIONAL DYNAMICS THINK MODEL 3 NONRELATED AFFECTIVELY / INACCESSIBLE / HIDDEN DISCONNECTED / DETACHED / ENCAPSULATED IN A COCOON IMPENETRABLE / SELF – PROTECTIVE ISOLATION THINK MODEL 4 35
  • 36. COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION ROLE OF THE TRANSFERENCE NOT PARTICULARLY RELEVANT ~ POSITIVE ~ NEGATIVE ~ COCOON 1 – PERSON vs. 2 – PERSON DEFENSES PROTECT THE EGO FROM THE ID ~ PROTECT THE SELF FROM THE OBJECT OPTIMAL STRESSORS DISSONANCE ~ DISILLUSIONMENT ~ DETOXIFICATION ~ DEPENDENCE OPTIMALLY STRESSFUL STATEMENTS CONFLICT ~ DISILLUSIONMENT ~ ACCOUNTABILITY ~ FACILITATION SPOTLIGHT IN THE MOMENT RESISTANT ~ RELENTLESS ~ RE – ENACTING ~ RETREATING NOT AWARE ~ NOT ACCEPTING ~ NOT ACCOUNTABLE ~ NOT ACCESSIBLE 36
  • 37. ROLE OF THE TRANSFERENCE MODEL 1 MORE RELEVANT THAN THE TRANSFERENCE IS THE FACT OF THE INTERNAL CONFLICTEDNESS BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING RESISTIVE COUNTERFORCES MODEL 2 POSITIVE TRANSFERENCE (DISPLACEMENT ~ ILLUSION) POSITIVE TRANSFERENCE DISRUPTED (DISILLUSIONMENT) MODEL 2½ POSITIVE TRANSFERENCE ACTUALIZED (DISPLACIVE IDENTIFICATION) MODEL 3 NEGATIVE TRANSFERENCE (PROJECTION ~ DISTORTION) NEGATIVE TRANSFERENCE ACTUALIZED (PROJECTIVE IDENTIFICATION) MODEL 4 COCOON TRANSFERENCE (DENIAL OF OBJECT NEED) 37
  • 38. 1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 1 – PERSON DEFENSES MOBILIZED TO PROTECT THE EGO FROM THE ID (REPRESSION ~ INTELLECTUALIZATION ~ REACTION FORMATION) MODELS 2, 3, AND 4 2 – PERSON DEFENSES MOBILIZED TO PROTECT THE SELF FROM THE OBJECT (RELENTLESS HOPE AND ENTITLEMENT ~ RELENTLESS OUTRAGE THE DEFENSE OF AFFECTIVE NONRELATEDNESS ~ ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY ~ DENIAL OF OBJECT NEED) 38
  • 39. 1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 FOCUSES ON INTRAPSYCHIC (1 – PERSON) DEFENSES MOBILIZED BY THE EGO IN AN EFFORT TO PROTECT ITSELF AGAINST THREATENED BREAKTHROUGH OF DYSREGULATED AND ANXIETY – PROVOKING ID FORCES THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE EGO AND THE ID MODEL 2 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING DISAPPOINTED BY ITS SELFOBJECTS THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE SELF AND THE SELFOBJECT 39
  • 40. 1 – PERSON vs. 2 – PERSON DEFENSES MODEL 3 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF – IN – RELATION IN AN EFFORT TO PROTECT ITSELF AGAINST BEING ABUSED BY ITS OBJECTS THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE SELF – IN – RELATION AND THE RELATIONAL OBJECT MODEL 4 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE PRIVATE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING SHATTERED BY A CATASTROPHICALLY DEVASTATING OBJECT THE IMPORTANT RELATIONSHIP IS THE ONE BETWEEN THE PRIVATE SELF AND THE WORLD OF ANIMATE OBJECTS 40
  • 41. THERAPEUTIC ACTION MODEL 1 WORKING THROUGH THE RESISTANCE TO AWARENESS OF INTERNAL CONFLICTEDNESS MODEL 2 FACILITATING THE GRIEVING OF INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT MODEL 3 NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT MODEL 4 OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE 41
  • 42. ACHIEVED BY WAY OF WORKING THROUGH THE OPTIMAL STRESS OF … MODEL 1 COGNITIVE DISSONANCE THE EXPERIENCE OF “GAIN – BECOME – PAIN” “EGO – SYNTONIC – BECOME – EGO – DYSTONIC” MODEL 2 AFFECTIVE (OPTIMAL) DISILLUSIONMENT THE EXPERIENCE OF “GOOD – BECOME – BAD” “ILLUSION – BECOME – DISILLUSIONMENT” MODEL 3 RELATIONAL DETOXIFICATION THE EXPERIENCE OF “BAD – BECOME – GOOD” MODEL 4 ABSOLUTE DEPENDENCE THE EXPERIENCE OF “HIDDEN – BECOME – FOUND” 42
  • 43. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 1 CONFLICT STATEMENTS TO FACILITATE RESOLUTION OF THE PATIENT’S INTERNAL CONFLICT BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING DEFENSIVE COUNTERFORCES BY HIGHLIGHTING THE DISSONANCE BETWEEN FIRST WHAT (WITH HER HEAD) THE PATIENT KNOWS … AND THEN WHAT (WITH HER HEART) SHE FINDS HERSELF THINKING, FEELING, OR DOING IN ORDER NOT TO HAVE TO KNOW … “YOU KNOW THAT YOU COULD ALWAYS ASK FOR HELP; BUT, IN THE MOMENT, MAKING YOURSELF THAT VULNERABLE – BY ADMITTING THAT YOU MIGHT NEED SOMEONE – IS SIMPLY OUT OF THE QUESTION. YOU’VE BEEN DISAPPOINTED TOO MANY TIMES IN THE PAST TO BE WILLING TO TAKE SUCH A RISK NOW. ” (WHICH ADDRESSES CONVERGENT CONFLICT) 43
  • 44. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 2 DISILLUSIONMENT STATEMENTS TO FACILITATE GRIEVING LOSSES AND DISAPPOINTMENTS “OPTIMAL DISILLUSIONMENT” BY FIRST HIGHLIGHTING THE ILLUSION (THE RELENTLESS HOPE), THEN ADDRESSING THE REALITY OF THE DISILLUSIONMENT, AND FINALLY RESONATING WITH THE PAIN OF THE PATIENT’S GRIEF “YOU WOULD HAVE WANTED JOSE TO BE ABLE TO LOVE YOU IN THE WAY THAT YOUR DAD NEVER DID; BUT YOU ARE COMING TO REALIZE THAT HE JUST CAN’T BECAUSE HE IS SO TERRIFIED OF COMMITMENT; AND KNOWING THIS BREAKS YOUR HEART.” (FIRST THE ILLUSION, BUT THEN THE DISILLUSIONING REALITY, AND FINALLY HER DEVASTATING GRIEF ABOUT IT) THE RESULT OF WHICH WILL BE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS AND THE FILLING IN OF DEFICIT 44
  • 45. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS TO FOSTER “TAKING OWNERSHIP” AND TO FACILITATE “NEGOTIATING AT THE INTIMATE EDGE” (EHRENBERG 1992) BY HIGHLIGHTING THE CONTRIBUTIONS OF BOTH PATIENT AND THERAPIST TO THE CO – CREATED DYSFUNCTIONAL RELATIONAL DYNAMIC THAT IS BEING PLAYED OUT BETWEEN THEM “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.” IN THE AFTERMATH OF A PROVOCATIVE ENACTMENT ON THE PART OF THE PATIENT “HOW WERE YOU HOPING I WOULD RESPOND?” (ID) “HOW WERE YOU AFRAID I MIGHT RESPOND?” (SUPEREGO) “HOW WERE YOU IMAGINING THAT I WOULD RESPOND?” (EGO) 45
  • 46. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 4 FACILITATION STATEMENTS TO ADDRESS THE PATIENT’S CONFLICT BETWEEN HER LONGING TO BE KNOWN AND UNDERSTOOD AND HER TERROR OF BEING FOUND AS WELL AS HER AMBIVALENCE ABOUT EVEN LIVING IN A WORLD THAT SHE EXPERIENCES AS EMPTY AND DEVOID OF MEANING OR PURPOSE “A PART OF YOU WOULD WANT DESPERATELY TO BE SEEN AND UNDERSTOOD; BUT ANOTHER PART OF YOU IS TERRIFIED OF BEING FOUND.” “A PART OF YOU WOULD WANT TO BE ABLE TO FIND A REASON TO GO ON LIVING; BUT ANOTHER PART OF YOU IS QUITE SURE THAT THERE IS NO MEANING TO BE FOUND.” (BOTH OF WHICH ADDRESS DIVERGENT CONFLICT) 46
  • 47. WHEN THE FOCUS IS ON THE PATIENT AS “RESISTANT” AND / OR “NOT AWARE,” THINK MODEL 1 AND CONFLICT STATEMENTS TO MAKE THE PATIENT “MORE AWARE” WHEN THE FOCUS IS ON THE PATIENT AS “RELENTLESS” AND / OR “NOT ACCEPTING,” THINK MODEL 2 AND DISILLUSIONMENT STATEMENTS TO MAKE THE PATIENT “MORE ACCEPTING” WHEN THE FOCUS IS ON THE PATIENT AS “RE – ENACTING” AND / OR “NOT ACCOUNTABLE,” THINK MODEL 3 AND ACCOUNTABILITY STATEMENTS TO MAKE THE PATIENT “MORE ACCOUNTABLE” WHEN THE FOCUS IS ON THE PATIENT AS “RETREATING” AND / OR “NOT ACCESSIBLE,” THINK MODEL 4 AND FACILITATION STATEMENTS TO MAKE THE PATIENT “MORE ACCESSIBLE” 47
  • 48. MODEL 1 RESOLUTION OF STRUCTURAL CONFLICT INVOLVING DYSFUNCTIONAL INTERNAL DYNAMICS TAMING THE ID AND STRENGTHENING THE EGO SUCH THAT STRUCTURAL CONFLICT BECOMES STRUCTURAL COLLABORATION MODEL 2 STRUCTURAL GROWTH / ADDING NEW GOOD MAKING GOOD A DEFICIENCY / FILLING IN DEFICIT SUCH THAT STRUCTURAL DEFICIT BECOMES STRUCTURAL CONSOLIDATION MODEL 3 RESOLUTION OF RELATIONAL CONFLICT INVOLVING DYSFUNCTIONAL RELATIONAL DYNAMICS STRUCTURAL MODIFICATION / CHANGING OLD BAD DETOXIFYING INTERNAL TOXICITY SUCH THAT RELATIONAL CONFLICT BECOMES RELATIONAL COLLABORATION MODEL 4 EMERGENCE OF MOMENTS OF MEETING SUCH THAT RELATIONAL DEFICIT BECOMES MEANINGFUL ENGAGEMENT WITH THE WORLD OF PEOPLE 48
  • 49. THE THERAPEUTIC ACTION IN ALL FOUR MODES WILL INVOLVE WORKING THROUGH THE OPTIMAL STRESS CREATED BY INTERVENTIONS THAT ALTERNATELY CHALLENGE AND THEN SUPPORT INTERVENTIONS STRATEGICALLY DESIGNED TO TARGET / HIGHLIGHT / GENERATE MODEL 1 – COGNITIVE DISSONANCE MODEL 2 – AFFECTIVE DISILLUSIONMENT MODEL 3 – RELATIONAL DETOXIFICATION MODEL 4 – ABSOLUTE DEPENDENCE THE WORKING THROUGH OF WHICH WILL RESULT ULTIMATELY IN RECONSTITUTION AT EVER – HIGHER LEVELS OF AWARENESS / ACTUALIZATION OF POTENTIAL, ACCEPTANCE, ACCOUNTABILITY, AND ACCESSIBILITY 49
  • 50. MATURITY INVOLVES DEVELOPING THE CAPACITY … MODEL 1 TO KNOW AND ACCEPT THE SELF, INCLUDING ITS PSYCHIC SCARS MODEL 2 TO KNOW AND ACCEPT THE OBJECT, INCLUDING ITS PSYCHIC SCARS MODEL 3 TO TAKE RESPONSIBILITY FOR THE DYSFUNCTION DELIVERED INTO ONE’S RELATIONSHIPS AND, MORE GENERALLY, INTO ONE’S LIFE MODEL 4 TO OVERCOME ONE’S TERROR OF BEING FOUND SO THAT MOMENTS OF MEETING CAN BE TOLERATED AND, EVEN, FOUND TO GIVE MEANING AND PURPOSE TO LIFE 50
  • 51. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION 51
  • 52. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS DYSFUNCTIONAL INTERNAL DYNAMICS NEUROTIC CONFLICTEDNESS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD RELENTLESS PURSUIT OF THE UNATTAINABLE NARCISSISTIC VULNERABILITY MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD DYSFUNCTIONAL RELATIONAL DYNAMICS NOXIOUS RELATEDNESS MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION RELENTLESS DESPAIR ABOUT AUTHENTIC BEING – IN – THE – WORLD NONRELATEDNESS 52
  • 53. MODEL 1 ~ STRUCTURAL CONFLICT THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS AVOIDANCE, PARALYSIS, AND UNACTUALIZED POTENTIAL MODEL 2 ~ STRUCTURAL DEFICIT THE NARCISSISTIC DEFENSE OF RELENTLESS NEED FOR VALIDATION AND EXTERNAL PROVISION INSATIABLE HUNGER MODEL 3 ~ RELATIONAL CONFLICT THE CHARACTER DISORDERED DEFENSE OF RELENTLESS EXTERNALIZATION AND DENIAL OF RESPONSIBILITY DYSFUNCTIONAL RELATEDNESS, A SENSE OF ONESELF AS EVER THE VICTIM, AND A DECREASED SENSE OF PERSONAL AGENCY MODEL 4 ~ RELATIONAL DEFICIT THE SCHIZOID / NIHILISTIC DEFENSE OF RELENTLESS DESPAIR UNRELENTING LONELINESS, SCHIZOID WITHDRAWAL, EXISTENTIAL ANGST, RETREAT AND RESIGNATION, EMOTIONAL DETACHMENT, INNER EMPTINESS, PSYCHIC DEADNESS, SOLITARY SUFFERING, ANNIHILATION TERROR, DENIAL OF OBJECT NEED, ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY, AFFECTIVE NONRELATEDNESS, IMPENETRABILITY, OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT, AND THE ONGOING STRUGGLE TO RECONCILE THE DIALECTICAL TENSION BETWEEN THE NEED TO BE MET AND THE FEAR OF BEING FOUND AND BETWEEN LIFE AS MEANINGFUL AND LIFE AS ABSURD AND POINTLESS 53
  • 54. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT FROM RESISTANCE TO AWARENESS MODEL 2 ~ STRUCTURAL DEFICIT FROM RELENTLESS HOPE TO ACCEPTANCE MODEL 3 ~ RELATIONAL CONFLICT FROM RE – ENACTMENT TO ACCOUNTABILITY MODEL 4 ~ RELATIONAL DEFICIT FROM RETREAT TO ACCESSIBILITY FROM RELENTLESS DESPAIR TO AWAKENED HOPE FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FROM NIHILISTIC REJECTION OF EXISTENCE TO EXISTENTIAL ACCEPTANCE OF ITS DUALITIES 54
  • 55. HOW THE THERAPIST POSITIONS HERSELF MOMENT BY MOMENT THE OPTIMAL THERAPEUTIC STANCE WILL BE ONE THAT IS CONTINUOUSLY SHIFTING SOMETIMES SPONTANEOUS AND UNPLANNED SOMETIMES MORE CONSIDERED AND DELIBERATE SOMETIMES THE THERAPIST WILL FIND HERSELF UNWITTINGLY DRAWN IN TO PARTICIPATING IN A CERTAIN WAY BUT AT OTHER TIMES THE THERAPIST WILL MAKE A MORE CONSCIOUS CHOICE BASED ON WHAT SHE SENSES THE PATIENT MOST NEEDS IN THE MOMENT IN ORDER TO HEAL 55
  • 56. IF, IN THE MOMENT, THE PATIENT IS PRIMARILY “NOT AWARE” THEN MODEL 1 CONFLICT STATEMENTS “NOT ACCEPTING” THEN MODEL 2 DISILLUSIONMENT STATEMENTS “NOT ACCOUNTABLE” THEN MODEL 3 ACCOUNTABILITY STATEMENTS “NOT ACCESSIBLE AND / OR NOT AUTHENTIC” THEN MODEL 4 FACILITATION STATEMENTS 56
  • 57. MODEL 1 ~ STRUCTURAL CONFLICT OBJECTIVE NEUTRALITY CONFLICT STATEMENTS ~ FROM RESISTANCE TO AWARENESS WORKING THROUGH THE RESISTANCE COGNITIVE DISSONANCE ~ THE STRESS OF GAIN – BECOME – PAIN MODEL 2 ~ STRUCTURAL DEFICIT EMPATHIC ATTUNEMENT DISILLUSIONMENT STATEMENTS ~ FROM RELENTLESS HOPE TO ACCEPTANCE GRIEVING OPTIMAL DISILLUSIONMENT ~ THE STRESS OF GOOD – BECOME – BAD MODEL 3 ~ RELATIONAL CONFLICT AUTHENTIC ENGAGEMENT ~ SHARED MIND AND SHARED HEART ACCOUNTABILITY STATEMENTS ~ FROM RE – ENACTMENT TO ACCOUNTABILITY NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC RELATEDNESS RELATIONAL DETOXIFICATION ~ THE STRESS OF BAD – BECOME – GOOD MODEL 4 ~ RELATIONAL DEFICIT SOULFUL PRESENCE ~ ROCK – SOLID RELIABILITY AND STALWART DEPENDABILITY FACILITATION STATEMENTS ~ FROM RETREAT TO ACCESSIBILITY FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE IN ORDER TO FACILITATE THE EMERGENCE OF MOMENTS OF MEETING ABSOLUTE DEPENDENCE ~ THE STRESS OF HIDDEN – BECOME – FOUND DIALECTICAL TENSION ~ THE STRESS OF DENIAL – OF – EXISTENCE – BECOME – ACCEPTANCE – OF – ITS – DUALITIES 57
  • 58. FOUR MODES OF THERAPEUTIC ACTION MODEL 1 ~ STRUCTURAL CONFLICT MODEL 2 ~ STRUCTURAL DEFICIT MODEL 3 ~ RELATIONAL CONFLICT MODEL 4 ~ RELATIONAL DEFICIT 58
  • 59. MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN” THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS A DRIVE – DEFENSE MODEL THAT PRIVILEGES THE CURATIVE POWER OF INSIGHT IT IS A 1 – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON THE PATIENT AND THE INTERNAL WORKINGS OF HER MIND THE THERAPIST IS NOT SUPPOSED TO BRING “WHO SHE IS” INTO THE ROOM – AND, IF SHE DOES, IT IS CALLED COUNTERTRANSFERENCE 59
  • 60. MODEL 2 – PROVISION OF CORRECTIVE EXPERIENCE “FOR” THE DEFICIENCY – COMPENSATION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD (DEFICIENCY) AND THEREFORE POSITS CORRECTIVE – PROVISION AS THE CURATIVE AGENT IT IS A 1½ – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON THE PATIENT AND HER RELATIONSHIP WITH A THERAPIST WHOM SHE EXPERIENCES AS EITHER AN EMPATHIC SELFOBJECT WHEN THE FRAME OF REFERENCE IS SELF PSYCHOLOGY OR A GOOD OBJECT / GOOD MOTHER WHEN THE FRAME OF REFERENCE IS OBJECT RELATIONS THEORY BUT WHETHER DESCRIBED AS AN EMPATHIC SELFOBJECT OR A GOOD OBJECT, IN MODEL 2 THE THERAPIST IS CONSIDERED A HALF PERSON BECAUSE IT IS NOT WHO SHE IS THAT MATTERS BUT WHAT SHE CAN PROVIDE 60
  • 61. MODEL 3 – ENGAGEMENT IN AUTHENTIC RELATIONSHIP “WITH” THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD (TOXICITY) AND POSITS COLLABORATIVE NEGOTIATION OF THE TURBULENCE THAT WILL INEVITABLY EMERGE AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT BETWEEN PATIENT AND THERAPIST AS THE TRANSFORMATIVE AGENT IT IS A 2 – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON PATIENTS AND THERAPISTS WHO RELATE TO EACH OTHER AS “REAL” PEOPLE IN MODEL 3 THE THERAPIST IS CONSIDERED A WHOLE PERSON 61
  • 62. MODEL 4 – CREATION OF TRANSITIONAL SPACE “BETWEEN” AN EXISTENTIAL – HUMANISTIC PERSPECTIVE THAT EMPHASIZES EITHER (1) CATASTROPHICALLY ANNIHILATING EARLY – ON DISAPPOINTMENTS AND LOSSES THAT SHATTER THE HEART OR (2) FUNDAMENTAL INSECURITY ABOUT EXISTENCE THE NET RESULT OF WHICH WILL BE SCHIZOID WITHDRAWAL, PSYCHIC RETREAT, RELENTLESS DESPAIR, EXISTENTIAL ANGST, AND FEELINGS OF ALIENATION AND ESTRANGEMENT AND POSITS “MOMENTS OF MEETING” AS NECESSARY TO RESTORE PURPOSE AND DIRECTION TO AN OTHERWISE EMPTY AND MEANINGLESS EXISTENCE IT IS A ½ – PERSON PSYCHOLOGY BECAUSE ITS FOCUS IS ON PATIENTS WHO DENY THEIR NEED FOR OBJECTS AND CLING INSTEAD TO THEIR ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY IN MODEL 4 THE THERAPIST IS THOUGHT TO FUNCTION AS A FACILITATING ENVIRONMENT ~ A SOULFUL PRESENCE 62
  • 63. HOW DOES THE THERAPIST ARRIVE AT UNDERSTANDING AND HOW DOES SHE THEN INTERVENE? AS A NEUTRAL OBJECT THE MODEL 1 THERAPIST POSITIONS HERSELF OUTSIDE THE THERAPEUTIC FIELD THE BETTER TO OBSERVE THE PATIENT HER FOCUS IS ON THE PATIENT’S INTERNAL DYNAMICS SHE COMES TO KNOW BY OBSERVING AND REFLECTING UPON WHAT SHE SEES SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS CONFLICT STATEMENTS WITH AN EYE TO ADVANCING THE PATIENT’S KNOWLEDGE OF HER INTERNAL DYNAMICS “THE PATIENT GETS BETTER ONCE THE PATIENT HAS COME TO KNOW ALL THAT THE ANALYST KNOWS WHICH IS WHAT THE PATIENT HAD UNCONSCIOUSLY KNOWN ALL ALONG” (LACAN) THE ULTIMATE GOAL IS RESOLUTION OF THE PATIENT’S STRUCTURAL CONFLICTS AND ACTUALIZATION OF INHERITED POTENTIAL 63
  • 64. AS AN EMPATHIC SELFOBJECT THE MODEL 2 THERAPIST JOINS ALONGSIDE THE PATIENT IN ORDER TO IMMERSE HERSELF IN THE PATIENT’S SUBJECTIVE REALITY HER FOCUS IS ON THE PATIENT’S AFFECTIVE EXPERIENCE SHE COMES TO KNOW BY DECENTERING FROM HER OWN EXPERIENCE, ENTERING INTO THE PATIENT’S EXPERIENCE, AND THEN TAKING IT ON – BUT ONLY “AS IF” IT WERE HER OWN BECAUSE IT NEVER ACTUALLY BECOMES HER OWN SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS DISILLUSIONMENT STATEMENTS WITH AN EYE TO VALIDATING THE PATIENT’S EXPERIENCE AND, MORE SPECIFICALLY, TO PROVIDING THE PATIENT WITH AN OPPORTUNITY TO CONFRONT THE PAIN OF HER GRIEF ABOUT THE DISILLUSIONING REALITY THAT THE OBJECTS IN HER WORLD WERE NOT, AND WILL NEVER BE, ALL THAT SHE WOULD HAVE WANTED THEM TO BE THE ULTIMATE GOAL IS THE FILLING IN OF THE PATIENT’S STRUCTURAL DEFICITS BY WAY OF ADAPTIVE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS 64
  • 65. AS AN AUTHENTIC SUBJECT (OR RELATIONAL OBJECT) THE MODEL 3 THERAPIST REMAINS VERY MUCH CENTERED WITHIN HER OWN EXPERIENCE AND USES THAT EXPERIENCE THAT IS, HER COUNTERTRANSFERENCE TO DEEPEN HER UNDERSTANDING OF THE PATIENT HER FOCUS IS ON THE PATIENT’S RELATIONAL DYNAMICS AND THE HERE – AND – NOW ENGAGEMENT BETWEEN THEM SHE NOT ONLY ALLOWS THE PATIENT’S EXPERIENCE TO ENTER INTO HER WHICH SHE THEN (REACTIVELY) TAKES ON “AS” HER OWN THAT IS, PROJECTIVE IDENTIFICATION BUT ALSO IS ABLE TO ENTER INTO THE PATIENT’S EXPERIENCE WHICH SHE THEN (PROACTIVELY) TAKES ON “AS” HER OWN THAT IS, INTROJECTIVE IDENTIFICATION SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS ACCOUNTABILITY STATEMENTS AND RELATIONAL INTERVENTIONS WITH AN EYE TO ADVANCING THE PATIENT’S KNOWLEDGE OF HER RELATIONAL DYNAMICS AND / OR TO DEEPENING THE CONNECTION BETWEEN THE TWO OF THEM 65
  • 66. AS A RELIABLE / NON – DEMANDING / SOULFUL PRESENCE AND FACILITATING / HOLDING ENVIRONMENT UPON WHOM THE PATIENT CAN BECOME “ABSOLUTELY DEPENDENT” SUCH THAT EVENTUALLY THE PATIENT HAVING OVERCOME HER DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE AND HER DENIAL OF OBJECT NEED AND HAVING WORKED THROUGH HER INTENSE AMBIVALENCE ABOUT BEING FOUND WILL BENIGNLY REGRESS TO HARMONIOUS INTERPENETRATING MIX – UP WITH HER THERAPIST – “REVISITING TO REDO” – THE MODEL 4 THERAPIST “MEETS THE OMNIPOTENCE” OF HER PATIENT BY “RECOGNIZING AND RESPONDING” TO HER EVERY GESTURE EVEN HAVING ANTICIPATED IT THEREBY ENABLING THE PATIENT TO FEEL MORE SECURE, MORE SAFE, AND MORE IN CONTROL SHE THEN FORMULATES OPTIMALLY STRESSFUL INTERVENTIONS FACILITATION STATEMENTS WITH AN EYE TO CREATING OPPORTUNITIES FOR “MOMENTS OF MEETING” THAT WILL GIVE MEANING TO A LIFE THAT MIGHT OTHERWISE HAVE REMAINED DESOLATE, BARREN, IMPOVERISHED, AND DESPERATELY LONELY 66
  • 67. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT ~ 1 – PERSON PSYCHOLOGY THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS DYSFUNCTIONAL INTERNAL DYNAMICS NEUROTIC CONFLICTEDNESS MODEL 2 ~ STRUCTURAL DEFICIT ~ 1½ – PERSON PSYCHOLOGY THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL ABSENCE OF GOOD RELENTLESS PURSUIT OF THE UNATTAINABLE NARCISSISTIC VULNERABILITY MODEL 3 ~ RELATIONAL CONFLICT ~ 2 – PERSON PSYCHOLOGY THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES THAT EMPHASIZE INTERNAL PRESENCE OF BAD DYSFUNCTIONAL RELATIONAL DYNAMICS NOXIOUS RELATEDNESS MODEL 4 ~ RELATIONAL DEFICIT ~ ½ – PERSON PSYCHOLOGY THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION RELENTLESS DESPAIR ABOUT AUTHENTIC BEING – IN – THE – WORLD NONRELATEDNESS 67
  • 68. MODEL 1 ~ STRUCTURAL CONFLICT THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS AVOIDANCE, PARALYSIS, AND UNACTUALIZED POTENTIAL MODEL 2 ~ STRUCTURAL DEFICIT THE NARCISSISTIC DEFENSE OF RELENTLESS NEED FOR VALIDATION AND EXTERNAL PROVISION INSATIABLE HUNGER MODEL 3 ~ RELATIONAL CONFLICT THE CHARACTER DISORDERED DEFENSE OF RELENTLESS EXTERNALIZATION AND DENIAL OF RESPONSIBILITY DYSFUNCTIONAL RELATEDNESS, A SENSE OF ONESELF AS EVER THE VICTIM, AND A DECREASED SENSE OF PERSONAL AGENCY MODEL 4 ~ RELATIONAL DEFICIT THE SCHIZOID / NIHILISTIC DEFENSE OF RELENTLESS DESPAIR UNRELENTING LONELINESS, SCHIZOID WITHDRAWAL, EXISTENTIAL ANGST, RETREAT AND RESIGNATION, EMOTIONAL DETACHMENT, INNER EMPTINESS, PSYCHIC DEADNESS, SOLITARY SUFFERING, ANNIHILATION TERROR, DENIAL OF OBJECT NEED, ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY, AFFECTIVE NONRELATEDNESS, IMPENETRABILITY, OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT, AND THE ONGOING STRUGGLE TO RECONCILE THE DIALECTICAL TENSION BETWEEN THE NEED TO BE MET AND THE FEAR OF BEING FOUND AND BETWEEN LIFE AS MEANINGFUL AND LIFE AS ABSURD AND POINTLESS 68
  • 69. PSYCHODYNAMIC SYNERGY ~ A SYNERGY OF FOUR MODALITIES MODEL 1 ~ STRUCTURAL CONFLICT FROM RESISTANCE TO AWARENESS MODEL 2 ~ STRUCTURAL DEFICIT FROM RELENTLESS HOPE TO ACCEPTANCE MODEL 3 ~ RELATIONAL CONFLICT FROM RE – ENACTMENT TO ACCOUNTABILITY MODEL 4 ~ RELATIONAL DEFICIT FROM RETREAT TO ACCESSIBILITY FROM RELENTLESS DESPAIR TO AWAKENED HOPE FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FROM NIHILISTIC REJECTION OF EXISTENCE TO EXISTENTIAL ACCEPTANCE OF ITS DUALITIES 69
  • 70. IF, IN THE MOMENT, THE PATIENT IS PRIMARILY “NOT AWARE” THEN MODEL 1 CONFLICT STATEMENTS “NOT ACCEPTING” THEN MODEL 2 DISILLUSIONMENT STATEMENTS “NOT ACCOUNTABLE” THEN MODEL 3 ACCOUNTABILITY STATEMENTS “NOT ACCESSIBLE AND / OR NOT AUTHENTIC” THEN MODEL 4 FACILITATION STATEMENTS 70
  • 71. MODEL 1 ~ STRUCTURAL CONFLICT OBJECTIVE NEUTRALITY CONFLICT STATEMENTS ~ FROM RESISTANCE TO AWARENESS WORKING THROUGH THE RESISTANCE COGNITIVE DISSONANCE ~ THE STRESS OF GAIN – BECOME – PAIN MODEL 2 ~ STRUCTURAL DEFICIT EMPATHIC ATTUNEMENT DISILLUSIONMENT STATEMENTS ~ FROM RELENTLESS HOPE TO ACCEPTANCE GRIEVING OPTIMAL DISILLUSIONMENT ~ THE STRESS OF GOOD – BECOME – BAD MODEL 3 ~ RELATIONAL CONFLICT AUTHENTIC ENGAGEMENT ~ SHARED MIND AND SHARED HEART ACCOUNTABILITY STATEMENTS ~ FROM RE – ENACTMENT TO ACCOUNTABILITY NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC RELATEDNESS RELATIONAL DETOXIFICATION ~ THE STRESS OF BAD – BECOME – GOOD MODEL 4 ~ RELATIONAL DEFICIT SOULFUL PRESENCE ~ ROCK – SOLID RELIABILITY AND STALWART DEPENDABILITY FACILITATION STATEMENTS ~ FROM RETREAT TO ACCESSIBILITY FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE IN ORDER TO FACILITATE THE EMERGENCE OF MOMENTS OF MEETING ABSOLUTE DEPENDENCE ~ THE STRESS OF HIDDEN – BECOME – FOUND DIALECTICAL TENSION ~ THE STRESS OF DENIAL – OF – EXISTENCE – BECOME – ACCEPTANCE – OF – ITS – DUALITIES 71
  • 72. MODEL 4 ~ RELATIONAL DEFICIT THE EXISTENTIAL – HUMANISTIC APROACH TO THE THERAPEUTIC ACTION ATTACHMENT INSECURITY ~ INAUTHENTIC BEING – IN – RELATIONSHIP ONTOLOGICAL INSECURITY ~ INAUTHENTIC BEING – IN – THE – WORLD FROM SCHIZOID RETREAT TO ACCESSIBILITY / EMOTIONAL AVAILABILITY FROM RELENTLESS DESPAIR TO AUTHENTIC BEING – IN – THE – WORLD AND AWAKENED HOPE (HOPE THAT WAS THERE ALL ALONG, WAITING TO BE FOUND) FROM RESIGNATION TO A LIFE LIVED FROM RELATIONAL ABSENCE TO AUTHENTIC PRESENCE FACILITATION STATEMENTS ~ RESONATE EMPATHICALLY WITH THE DUALITIES OF EXISTENCE, RECONCILE THE DIALECTICAL TENSION BETWEEN POLARITIES, AND EVOLVE TO A HIGHER LEVEL OF INTEGRATION, COMPLEX UNDERSTANDING, AND DYNAMIC BALANCE FROM OPPOSITION TO COMPLEMENTARITY EVOLVE FROM THE DICHOTOMIZATION OF “EITHER / OR” “A PART OF YOU NEEDS … , BUT ANOTHER PART OF YOU FEARS …” TO THE COMPLEMENTARITY OF “BOTH / AND” “YOU HAVE THE FEAR AND THE DESPAIR … , BUT, AS YOU KNOW, YOU DO HAVE A CHOICE …” JUST AS IN QUANTUM MECHANICS, WHERE PARTICLES AND WAVES ARE THOUGHT TO BE DIFFERENT MANIFESTATIONS OF A SINGLE REALITY DEPENDING UPON THE OBSERVER’S PERSPECTIVE FROM LAING’S “DIVIDED SELF” TO BROMBERG’S “MULTIPLICITY OF SELF” 72
  • 73. PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT AN OPPORTUNITY ALBEIT A BELATED ONE TO MASTER EXPERIENCES THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST BUT THAT CAN NOW WITH ENOUGH SUPPORT FROM THE THERAPIST AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE AND CAPACITY TO COPE WITH STRESS BE PROCESSED AND INTEGRATED AND ULTIMATELY ADAPTED TO
  • 74. 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 CHALLENGE WHENEVER POSSIBLE BY DIRECTING THE PATIENT’S ATTENTION TO WHERE THE PATIENT IS NOT “DISRUPTIVE ATTUNEMENT” AND SUPPORT WHENEVER NECESSARY BY RESONATING WITH WHERE THE PATIENT IS “HOMEOSTATIC ATTUNEMENT”
  • 75. CHALLENGE BY WAY OF ANXIETY – PROVOKING INTERPRETIVE STATEMENTS THAT CALL INTO QUESTION DEFENSES TO WHICH THE PATIENT HAS LONG CLUNG IN ORDER TO PRESERVE HER PSYCHOLOGICAL EQUILIBRIUM THEREBY INCREASING HER ANXIETY SUPPORT BY WAY OF ANXIETY – ASSUAGING EMPATHIC STATEMENTS THAT HONOR THOSE SELF – PROTECTIVE DEFENSES THEREBY DECREASING HER ANXIETY
  • 76. FOUR SCHOOLS OF PSYCHOANALYTIC THOUGHT STRUCTURAL CONFLICT RESISTANCE BECOMES TRANSFORMED INTO AWARENESS STRUCTURAL DEFICIT RELENTLESSNESS BECOMES TRANSFORMED INTO ACCEPTANCE RELATIONAL CONFLICT RE – ENACTMENT BECOMES TRANSFORMED INTO ACCOUNTABILITY RELATIONAL DEFICIT RETREAT BECOMES TRANSFORMED INTO ACCESSIBILITY NEUROTIC ~ NARCISSISTIC ~ CHARACTER DISORDERED ~ SCHIZOID
  • 77. PREVIEW FOUR MODES OF THERAPEUTIC ACTION FOUR APPROACHES TO TRANSFORMING DEFENSE INTO ADAPTATION FOUR OPTIMAL STRESSORS THAT FACILITATE THIS ACTION TRANSFORMATION OF RESISTANCE INTO AWARENESS AND ACTUALIZATION OF POTENTIAL BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE (THE EXPERIENCE OF GAIN – BECOME – PAIN) TRANSFORMATION OF RELENTLESSNESS INTO ACCEPTANCE BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT (THE EXPERIENCE OF GOOD – BECOME – BAD) TRANSFORMATION OF RE – ENACTMENT INTO ACCOUNTABILITY BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION (THE EXPERIENCE OF BAD – BECOME – GOOD) TRANSFORMATION OF RETREAT INTO ACCESSIBILITY BY WORKING THROUGH THE STRESS OF ABSOLUTE DEPENDENCE (THE EXPERIENCE OF HIDDEN – BECOME – FOUND)
  • 78. TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 1 DEFENSIVE REACTION – RESISTANCE TO AWARENESS OF ONE’S DYSFUNCTIONAL INTERNAL DYNAMICS ADAPTIVE RESPONSE – AWARENESS AND ACTUALIZATION OF POTENTIAL MODEL 2 DEFENSIVE REACTION – RELENTLESS PURSUIT OF THE UNATTAINABLE AND REFUSAL TO CONFRONT – AND GRIEVE – CERTAIN INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY ADAPTIVE RESPONSE – ACCEPTANCE OF ONE’S ULTIMATE POWERLESSNESS TO MAKE THE OBJECT CHANGE
  • 79. TRANSFORMATION OF LESS HEALTHY DEFENSE INTO HEALTHIER ADAPTATION MODEL 3 DEFENSIVE REACTION – COMPULSIVE AND UNWITTING RE – ENACTMENT OF DYSFUNCTIONAL RELATIONAL DYNAMICS RESULTING FROM UNMASTERED EARLY – ON TRAUMAS ADAPTIVE RESPONSE – ACCOUNTABILITY FOR ONE’S ACTIONS, REACTIONS, AND INTERACTIONS MODEL 4 DEFENSIVE REACTION – PSYCHIC RETREAT, SCHIZOID WITHDRAWAL, AND DETACHMENT ADAPTIVE RESPONSE – ACCESSIBILITY AND ATTACHMENT
  • 80. MODEL 1 – STRUCTURAL CONFLICT THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS SIGMUND FREUD, ANNA FREUD, HEINZ HARTMANN, DAVID RAPAPORT, ERNST KRIS, AND RUDOLPH LOEWENSTEIN MODEL 2 – STRUCTURAL DEFICIT THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL ABSENCE OF GOOD HEINZ KOHUT, ERNEST WOLF, ARNOLD GOLDBERG, MICHAEL BALINT, AND PAUL / ANNA ORNSTEIN
  • 81. MODEL 3 – RELATIONAL CONFLICT THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY AND THOSE OBJECT RELATIONS THEORIES EMPHASIZING INTERNAL PRESENCE OF BAD W R D FAIRBAIRN, STEPHEN MITCHELL, JESSICA BENJAMIN, DARLENE EHRENBERG, AND JAY GREENBERG MODEL 4 – RELATIONAL DEFICIT THE EXISTENTIAL PERSPECTIVE WITH ITS EMPHASIS ON DREAD, ANGST, DESPAIR, SUFFERING, AND SEARCH FOR MEANINGFUL CONNECTION HARRY GUNTRIP, ARNOLD MODELL, MASUD KHAN, JOHN BOWLBY, THOMAS OGDEN, ROLLO MAY, AND VIKTOR FRANKL
  • 82. MODEL 1 – STRUCTURAL CONFLICT ACCELERATOR / BRAKE ~ START / STOP FORCES PRESSING “YES” AND RESISTIVE COUNTERFORCES INSISTING “NO” MODEL 2 – STRUCTURAL DEFICIT INTERNAL ABSENCE OF GOOD ~ DEPRIVATION AND NEGLECT IMPAIRED CAPACITY TO BE A GOOD PARENT UNTO ONESELF MODEL 3 – RELATIONAL CONFLICT INTERNAL PRESENCE OF BAD ~ TRAUMA AND ABUSE COMPULSIVE RE – ENACTMENT OF UNRESOLVED CHILDHOOD DRAMAS ON THE STAGE OF ONE’S LIFE MODEL 4 – RELATIONAL DEFICIT A HEART SHATTERED PSYCHIC RETREAT, SCHIZOID WITHDRAWAL, AND SOLITARY SUFFERING RESULTING FROM THE EXPERIENCE OF CATACLYSMICALLY ANNIHILATING RESPONSES FROM THE OBJECT
  • 83. THERAPEUTIC ACTION MODEL 1 – COGNITIVE ENHANCEMENT OF KNOWLEDGE “WITHIN” MODEL 2 – AFFECTIVE PROVISION OF CORRECTIVE EXPERIENCE “FOR” MODEL 3 – RELATIONAL ENGAGEMENT IN AUTHENTIC RELATIONSHIP “WITH” MODEL 4 – EXISTENTIAL EMERGENCE OF MEANINGFUL MOMENTS OF MEETING “BETWEEN” AND CREATION OF TRANSITIONAL SPACE “BETWEEN”
  • 84. MODEL 1 – NEUROTIC DYSFUNCTIONAL INTERNAL DYNAMICS MODEL 2 – NARCISSISTIC RELENTLESS PURSUIT OF THE UNATTAINABLE MODEL 3 – CHARACTER DISORDERED DYSFUNCTIONAL RELATIONAL DYNAMICS MODEL 4 – SCHIZOID IMPENETRABILITY
  • 85. MODEL 1 – NEUROTIC WOODY ALLEN, JERRY SEINFELD’S AND JASON ALEXANDER’S CHARACTERS ON SEINFELD, AND MONK MODEL 2 – NARCISSISTIC MADONNA, KIM KARDASHIAN, KANYE WEST, AND DONALD TRUMP MODEL 3 – CHARACTER DISORDERED GEORGE AND MARTHA IN WHO’S AFRAID OF VIRGINIA WOOLF? MODEL 4 – SCHIZOID TRUE (PRIVATE) SELF / FALSE (PUBLIC) SELF GRETA GARBO, KATHARINE HEPBURN, JOHNNY CARSON, AND GREGORY HOUSE, MD (FROM THE TV SHOW HOUSE)
  • 86. MODEL 1 – NEUROTIC THE NEUROTIC DEFENSE OF RELENTLESS CONFLICTEDNESS, LEADING TO AVOIDANCE, PARALYSIS, AND UNACTUALIZED POTENTIAL MODEL 2 – NARCISSISTIC THE NARCISSISTIC DEFENSE OF RELENTLESS NEED FOR VALIDATION AND EXTERNAL PROVISION, LEADING TO INSATIABLE HUNGER THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE, LEADING TO UNREQUITED LOVE AND CONSTANT HEARTBREAK
  • 87. MODEL 3 – CHARACTER DISORDERED THE CHARACTER DISORDERED DEFENSE OF RELENTLESS EXTERNALIZATION AND DENIAL OF RESPONSIBILITY, LEADING TO DYSFUNCTIONAL RELATIONSHIPS AND A SENSE OF ONESELF AS EVER THE VICTIM THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE, LEADING TO UNCOMPROMISING ANGER, SELF – RIGHTEOUS INDIGNATION, RESENTMENT, AND BITTERNESS MODEL 4 – SCHIZOID THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR AND PROFOUND HOPELESSNESS, LEADING TO UNMITIGATED LONELINESS, WITHDRAWAL, DETACHMENT, SUFFERING, PSYCHIC DEADNESS, INNER EMPTINESS, AND OVERWHELMING FEELINGS OF ALIENATION AND ESTRANGEMENT
  • 88. COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION MODE OF RELATEDNESS NEUROTIC ~ NARCISSISTIC ~ NOXIOUS ~ NONRELATEDNESS NUMBER OF PEOPLE 1 – PERSON ~ 1½ – PERSON ~ 2 – PERSON ~ ½ – PERSON THERAPIST’S STANCE NEUTRALITY ~ EMPATHY ~ AUTHENTICITY ~ DEPENDABILITY / DEVOTION A PSYCHOLOGY OF THE … EGO ~ SELF ~ SELF – IN – RELATION ~ PRIVATE SELF
  • 89. KAREN HORNEY DESCRIBES THREE “INTERPERSONAL TRENDS” MOVEMENT INWARDS MODEL 1 MOVEMENT TOWARDS MODEL 2 MOVEMENT AGAINST MODEL 3 MOVEMENT AWAY MODEL 4
  • 90. FOUR BASIC DRIVES RELATED TO SURVIVAL “SYMPATHETIC ACTIVATION” FREEZE MODEL 1 (MOVEMENT INWARDS) FUCK MODEL 2 (MOVEMENT TOWARDS) FIGHT MODEL 3 (MOVEMENT AGAINST) FLEE MODEL 4 (MOVEMENT AWAY)
  • 91. CLINGING, AVERSION, AND IGNORING ZEN MASTER JAN CHOZEN BAYS, MD AS A PEDIATRICIAN HE HAS EXAMINED HUNDREDS OF NEWBORN BABIES SOME “ARE BORN WANTING SENSORY EXPERIENCES” AND “ARE UPSET IF THEY DON’T GET THEM” (MODEL 2) OTHERS “ARE BORN ANGRY AND UPSET AT THE WORLD” (MODEL 3) STILL OTHERS “JUST LIKE TO GO UNCONSCIOUS AND, IF DISTRESSED, GO TO SLEEP” (MODEL 4)
  • 92. MODES OF RELATEDNESS MODEL 1 – NEUROTIC RELATEDNESS THE CONFLICT – RIDDEN NEUROTIC PATIENT STRUGGLES TO MOVE FORWARD IN HER LIFE BUT IS JAMMED UP AND UNABLE TO EMPOWER HERSELF BY HARNESSING HER ID ENERGIES IN THE SERVICE OF HER EGO MODEL 2 – NARCISSISTIC RELATEDNESS THE DEFICIT – RIDDEN NARCISSISTIC PATIENT NEEDS HER OBJECTS TO “COMPLETE” HER BY PROVIDING MIRRORING CONFIRMATION OF HER PERFECTION AND / OR BY ALLOWING HER TO FUSE WITH THEM IN FANTASY SUCH THAT SHE CAN THEN PARTAKE OF THEIR PERFECTION MODEL 3 – NOXIOUS RELATEDNESS UNDER THE SWAY OF HER REPETITION COMPULSION, THE CHARACTER DISORDERED PATIENT DELIVERS HER UNMASTERED CHILDHOOD DRAMAS (THAT IS, HER DYSFUNCTIONAL RELATIONAL DYNAMICS) INTO HER RELATIONSHIPS AND THEN COMPULSIVELY AND UNWITTINGLY RE – ENACTS THEM ON THE STAGE OF HER LIFE MODEL 4 – NONRELATEDNESS FOR FEAR OF BEING SHATTERED BY YET ANOTHER CATACLYSMICALLY ANNIHILATING RESPONSE FROM THE OBJECT, THE SCHIZOID PATIENT WITHDRAWS FROM ALL RELATIONSHIPS, DESPERATE TO REMAIN HIDDEN
  • 93. MODEL 1 – 1 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S INTERNAL DYNAMICS THERAPIST AS A NEUTRAL OBJECT / AN OBJECTIVE OBSERVER A BLANK SCREEN WITH THE OBJECTIVITY OF A SURGEON MODEL 2 – 1½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE EXPERIENCE (ESPECIALLY THE PAIN OF HER GRIEF) THERAPIST AS AN EMPATHIC SELFOBJECT / A GOOD OBJECT MODEL 3 – 2 – PERSON PSYCHOLOGY FOCUS ON PATIENT’S RELATIONAL DYNAMICS THERAPIST AS AN AUTHENTIC SUBJECT / A RELATIONAL OBJECT (AND, AT THE END OF THE DAY, INEVITABLY A BAD OBJECT) MODEL 4 – ½ – PERSON PSYCHOLOGY FOCUS ON PATIENT’S AFFECTIVE NONRELATEDNESS THERAPIST AS A RELIABLE, NONDEMANDING, STEADY, DEPENDABLE, CONSISTENT, TRUSTWORTHY, LOVING, AND DEVOTED PRESENCE
  • 94. THERAPIST’S STANCE MODEL 1 – NEUTRALITY MODEL 2 – EMPATHY MODEL 3 – AUTHENTICITY MODEL 4 – RELIABILITY ~ DEPENDABILITY ~ DEVOTION
  • 95. EMPATHY VS. AUTHENTICITY THERE IS A CRITICAL DISTINCTION BETWEEN THE EMPATHIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 2 HAT AND THE AUTHENTIC STANCE OF THE THERAPIST WHEN SHE IS WEARING HER MODEL 3 HAT MODEL 2 IS ABOUT THE THERAPIST’S EMPATHIC IMMERSION IN THE PATIENT’S INTERNAL WORLD THE EMPATHIC THERAPIST “DECENTERS” (ATWOOD AND STOLOROW 1984) FROM HER OWN EXPERIENCE, JOINS ALONGSIDE THE PATIENT, AND ENTERS INTO THE PATIENT’S INTERNAL EXPERIENCE – BUT TAKES IT ON ONLY “AS IF” IT WERE HER OWN BECAUSE IT NEVER ACTUALLY BECOMES HER OWN EMPATHY IS NOT ABOUT THE THERAPIST WHO HAS DECENTERED FROM HER OWN EXPERIENCE IT IS ABOUT THE PATIENT
  • 96. EMPATHY VS. AUTHENTICITY MODEL 3 IS ABOUT THE THERAPIST’S AUTHENTIC PARTICIPATION IN A REAL RELATIONSHIP WITH THE PATIENT UNLIKE THE EMPATHIC THERAPIST, WHO DECENTERS FROM HER OWN EXPERIENCE, THE AUTHENTIC THERAPIST REMAINS VERY MUCH CENTERED IN HER OWN EXPERIENCE AND ALLOWS THE PATIENT’S EXPERIENCE TO ENTER INTO HER, WHICH SHE THEN TAKES ON “AS” HER OWN THIS DYNAMIC IS AT THE HEART OF PROJECTIVE IDENTIFICATION THE MEAT AND POTATOES OF CONTEMPORARY RELATIONAL THEORY AND, AS WE SHALL LATER SEE, AT THE HEART OF INTROJECTIVE IDENTIFICATION AS WELL
  • 97. A PSYCHOLOGY OF THE … MODEL 1 EGO GOAL ~ A STRONGER, WISER, AND MORE EMPOWERED EGO MODEL 2 SELF GOAL ~ A MORE CONSOLIDATED, ACCEPTING, AND COMPASSIONATE SELF MODEL 3 SELF – IN – RELATION GOAL ~ A MORE PRESENT AND ACCOUNTABLE SELF – IN – RELATION MODEL 4 PRIVATE SELF / ADDICTED SELF / PUBLIC SELF GOAL ~ A LESS PROTECTED AND MORE ACCESSIBLE TRUE SELF
  • 98. RECURRING THEMES MODEL 1 AVOIDANCE ~ PARALYSIS MODEL 2 SHAME ~ CONTEMPT EMPTY, SHAME – FILLED DEPRESSION PATIENT NEEDS TO “GRIEVE” MODEL 3 ANGER ~ AGGRESSION ~ GUILT ANGRY, GUILT – RIDDEN DEPRESSION PATIENT NEEDS TO “RAGE” MODEL 4 SECRETS ~ LIES PRETENSIONS ~ CONCEALMENTS PROFOUND DESPAIR ~ SOLITARY SUFFERING
  • 99. ALTHOUGH THE FOCUS IN EACH IS DIFFERENT ALL FOUR OF MY MODELS INVOLVE AS THEIR STARTING POINT THE INTERNAL PRICE PAID BY THE CHILD BECAUSE OF TRAUMATIC FRUSTRATION BY THE PARENT MODEL 1 REINFORCEMENT OF INFANTILE NEED IN THE FACE OF ITS TRAUMATIC FRUSTRATION MODEL 2 FAILURE TO INTERNALIZE GOOD IN THE FACE OF TRAUMATIC “ABSENCE OF GOOD” MODEL 3 INTROJECTION OF BAD IN THE FACE OF TRAUMATIC “PRESENCE OF BAD” MODEL 4 SHATTERING OF THE HEART IN THE FACE OF CATACLYSMIC HEARTBREAK AND LOSS
  • 100. THE STARTING POINT IN MODEL 1 DEFENSIVELY REINFORCED INFANTILE (LIBIDINAL AND AGGRESSIVE) DRIVES RESULTING FROM THE DRIVE OBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE DRIVES THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) DRIVES AS THEY ARISE IN THE CONTEXT OF THE TREATMENT WHICH WILL ULTIMATELY RESULT IN ADAPTIVE INTEGRATION OF THOSE (ID) DRIVES NOW TAMED AND MODIFIED INTO HEALTHY PSYCHIC (EGO) STRUCTURE WHICH WILL THEN ALLOW FOR THE REDIRECTING OF THEIR NOW BETTER REGULATED ENERGY INTO MORE CONSTRUCTIVE PURSUITS AND ACTUALIZATION OF POTENTIAL BY A NOW MORE SKILLED EGO DRIVE (HORSE) AND DEFENSE (RIDER) NO LONGER WORKING IN CONFLICT BUT IN COLLABORATION
  • 101. THE STARTING POINT IN MODEL 2 STRUCTURAL DEFICIT AND IMPAIRED CAPACITY RESULTING FROM THE SELFOBJECT PARENT’S EARLY – ON TRAUMATIC FRUSTRATION OF THE CHILD’S AGE – APPROPRIATE NEED TO HAVE A PERFECT PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENT’S INTENSIFIED (AND DEFENDED AGAINST) NARCISSISTIC NEED TO FIND THE PERFECT PARENT AS IT ARISES IN THE CONTEXT OF THE RELATIONSHIP WITH THE SELFOBJECT THERAPIST WHICH WILL ULTIMATELY RESULT IN ADAPTIVE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS WHICH WILL THEN ALLOW FOR THE FILLING IN OF STRUCTURAL DEFICIT, DEVELOPMENT OF A MORE ROBUST CAPACITY TO BE A GOOD PARENT UNTO HERSELF, ACCRETION OF HEALTHY PSYCHIC STRUCTURE, AND CONSOLIDATION OF A MORE COHESIVE SELF GRIEVING OPTIMAL DISILLUSIONMENT WILL TRANSFORM THE DEFENSIVE NEED FOR EXTERNAL REGULATION OF THE SELF INTO THE ADAPTIVE CAPACITY TO BE INTERNALLY SELF – REGULATING
  • 102. THE STARTING POINT IN MODEL 3 INTERNAL DEMONS AND A SENSE OF INNER BADNESS RESULTING FROM INTROJECTION OF THE DYSFUNCTIONAL RELATIONAL DYNAMIC CHARACTERIZING THE CHILD’S EARLY – ON RELATIONSHIP WITH THE TRAUMATICALLY ABUSIVE PARENT INTERNAL BAD OBJECTS / PATHOGENIC INTROJECTS THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE TURBULENCE THAT WILL INEVITABLY ARISE AT THE “INTIMATE EDGE” (EHRENBERG 1992) OF AUTHENTIC RELATEDNESS ONCE THE PATIENT DELIVERS HER PATHOGENIC INTROJECTS INTO THE RELATIONSHIP WITH HER THERAPIST WHICH WILL ULTIMATELY RESULT IN GRADUAL MODIFICATION OF THEIR TOXICITY BY WAY OF SERIAL DILUTIONS WHICH WILL THEN ALLOW FOR TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED EARLY – ON RELATIONAL TRAUMAS INTO THE ADAPTIVE CAPACITY TO HOLD HERSELF ACCOUNTABLE AND TO ENGAGE IN HEALTHY, AUTHENTIC RELATEDNESS
  • 103. THE STARTING POINT IN MODEL 4 A HEART SHATTERED, SCHIZOID WITHDRAWAL, AND PSYCHIC RETREAT RESULTING FROM OVERWHELMINGLY DEVASTATING HEARTBREAK EXPERIENCED AT THE HANDS OF A DEVASTATINGLY ANNIHILATING PARENT THE THERAPEUTIC ACTION WILL INVOLVE WORKING THROUGH THE PATIENT’S FEAR OF BEING FOUND BY, OF BECOMING ABSOLUTELY DEPENDENT UPON, AND OF EXPERIENCING MOMENTS OF MEETING WITH THE THERAPIST THE THERAPIST’S PROVISION OF RELIABLE, DEPENDABLE, NONDEMANDING, STEADY, CONSISTENT, TRUSTWORTHY, AND DEVOTED PRESENCE FOR A PATIENT WHO IS INTENSELY AMBIVALENT ABOUT ENGAGEMENT ON THE ONE HAND, DESPERATELY LONGING TO BE KNOWN BUT, ON THE OTHER HAND, TERRIFIED OF BEING FOUND WILL ULTIMATELY RESULT IN REDUCED TERROR, DREAD, DESPAIR, RESIGNATION, ISOLATION, AND ALIENATION TOLERATING ABSOLUTE DEPENDENCE WILL TRANSFORM THE DEFENSIVE NEED TO STAY HIDDEN INTO THE ADAPTIVE CAPACITY TO BE FOUND
  • 104. WHEN, IN THE MOMENT, THE SPOTLIGHT IS ON THE PATIENT AS … NEUROTICALLY CONFLICTED / JAMMED UP / STUCK PARALYZED BY DYSFUNCTIONAL INTERNAL DYNAMICS THINK MODEL 1 NARCISSISTICALLY VULNERABLE / NEEDY EVER BUSY LOOKING TO THE OUTSIDE FOR EXTERNAL PROVISION, VALIDATION, AND REINFORCEMENT THINK MODEL 2 NOXIOUSLY ENGAGED / SELF – SABOTAGING SELF – DEFEATING / SELF – INDULGENT / SELF – DESTRUCTIVE RE – ENACTING DYSFUNCTIONAL RELATIONAL DYNAMICS THINK MODEL 3 NONRELATED AFFECTIVELY / INACCESSIBLE / HIDDEN DISCONNECTED / DETACHED / ENCAPSULATED IN A COCOON IMPENETRABLE / SELF – PROTECTIVELY ISOLATED THINK MODEL 4
  • 105. COMPARE AND CONTRAST THE FOUR MODES OF THERAPEUTIC ACTION ROLE OF THE TRANSFERENCE NOT PARTICULARLY RELEVANT ~ POSITIVE ~ NEGATIVE ~ COCOON 1 – PERSON vs. 2 – PERSON DEFENSES PROTECT THE EGO FROM THE ID vs. PROTECT THE SELF FROM THE OBJECT OPTIMAL STRESSORS DISSONANCE ~ DISILLUSIONMENT ~ DETOXIFICATION ~ DEPENDENCE OPTIMALLY STRESSFUL STATEMENTS CONFLICT ~ DISILLUSIONMENT ~ ACCOUNTABILITY ~ FACILITATION SPOTLIGHT IN THE MOMENT RESISTANT ~ RELENTLESS ~ RE – ENACTING ~ RETREATING NOT AWARE ~ NOT ACCEPTING ~ NOT ACCOUNTABLE ~ NOT ACCESSIBLE
  • 106. ROLE OF THE TRANSFERENCE MODEL 1 MORE RELEVANT THAN THE TRANSFERENCE IS THE FACT OF THE INTERNAL CONFLICTEDNESS BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING RESISTIVE COUNTERFORCES MODEL 2 POSITIVE TRANSFERENCE (DISPLACEMENT ~ ILLUSION) POSITIVE TRANSFERENCE DISRUPTED (DISILLUSIONMENT) MODEL 2½ POSITIVE TRANSFERENCE ACTUALIZED (DISPLACIVE IDENTIFICATION) MODEL 3 NEGATIVE TRANSFERENCE (PROJECTION ~ DISTORTION) NEGATIVE TRANSFERENCE ACTUALIZED (PROJECTIVE IDENTIFICATION) MODEL 4 COCOON TRANSFERENCE (DENIAL OF OBJECT NEED)
  • 107. 1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 1 – PERSON DEFENSES MOBILIZED TO PROTECT THE EGO FROM THE ID (REPRESSION ~ INTELLECTUALIZATION ~ REACTION FORMATION) MODELS 2, 3, AND 4 2 – PERSON DEFENSES MOBILIZED TO PROTECT THE SELF FROM THE OBJECT (RELENTLESS HOPE AND ENTITLEMENT ~ RELENTLESS OUTRAGE THE DEFENSE OF AFFECTIVE NONRELATEDNESS ~ ILLUSIONS OF GRANDIOSE SELF – SUFFICIENCY ~ DENIAL OF OBJECT NEED)
  • 108. 1 – PERSON vs. 2 – PERSON DEFENSES MODEL 1 FOCUSES ON INTRAPSYCHIC (1 – PERSON) DEFENSES MOBILIZED BY THE EGO IN AN EFFORT TO PROTECT ITSELF AGAINST THREATENED BREAKTHROUGH OF DYSREGULATED AND ANXIETY – PROVOKING ID FORCES THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE ID AND THE “ANXIOUS” EGO MODEL 2 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING DISAPPOINTED BY ITS SELFOBJECTS THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE SELF AND THE “GOOD” OBJECT
  • 109. 1 – PERSON vs. 2 – PERSON DEFENSES MODEL 3 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE SELF – IN – RELATION IN AN EFFORT TO PROTECT ITSELF AGAINST BEING ABUSED BY ITS OBJECTS THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE SELF – IN – RELATION AND THE “BAD” OBJECT MODEL 4 FOCUSES ON INTERPERSONAL (2 – PERSON) DEFENSES MOBILIZED BY THE PRIVATE SELF IN AN EFFORT TO PROTECT ITSELF AGAINST BEING SHATTERED BY A CATACLYSMICALLY DEVASTATING OBJECT THE IMPORTANT RELATIONSHIP BEING THE ONE THAT EXISTS BETWEEN THE PRIVATE SELF AND THE “ANNIHILATING” OBJECT
  • 110. THERAPEUTIC ACTION MODEL 1 WORKING THROUGH THE RESISTANCE TO AWARENESS OF INTERNAL FORCES / COUNTERFORCES GIVING RISE TO NEUROTIC CONFLICTEDNESS MODEL 2 FACILITATING THE GRIEVING OF INTOLERABLY PAINFUL REALITIES ABOUT THE OBJECT OF ONE’S DESIRE MODEL 3 NEGOTIATING AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT MODEL 4 OVERCOMING THE DREAD OF SURRENDER TO RESOURCELESS DEPENDENCE
  • 111. ACHIEVED BY WAY OF WORKING THROUGH THE OPTIMAL STRESS OF … MODEL 1 COGNITIVE DISSONANCE THE EXPERIENCE OF “GAIN – BECOME – PAIN” “EGO – SYNTONIC – BECOME – EGO – DYSTONIC” MODEL 2 AFFECTIVE (OPTIMAL) DISILLUSIONMENT THE EXPERIENCE OF “GOOD – BECOME – BAD” “ILLUSION – BECOME – DISILLUSIONMENT” MODEL 3 RELATIONAL DETOXIFICATION THE EXPERIENCE OF “BAD – BECOME – GOOD” MODEL 4 ABSOLUTE DEPENDENCE THE EXPERIENCE OF “HIDDEN – BECOME – FOUND”
  • 112. ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING STATEMENTS CONFLICT STATEMENTS DISILLUSIONMENT STATEMENTS ACCOUNTABILITY STATEMENTS FACILITATION STATEMENTS
  • 113. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 1 CONFLICT STATEMENTS TO FACILITATE RESOLUTION OF THE PATIENT’S INTERNAL CONFLICT BETWEEN ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING FORCES AND ANXIETY – ASSUAGING BUT GROWTH – DISRUPTING DEFENSIVE COUNTERFORCES BY HIGHLIGHTING THE DISSONANCE BETWEEN FIRST WHAT (WITH HER HEAD) THE PATIENT KNOWS … AND THEN WHAT (WITH HER HEART) SHE FINDS HERSELF THINKING, FEELING, OR DOING IN ORDER NOT TO HAVE TO KNOW … “YOU KNOW THAT YOU COULD ALWAYS ASK FOR HELP; BUT, IN THE MOMENT, MAKING YOURSELF THAT VULNERABLE – BY ADMITTING THAT YOU MIGHT NEED SOMEONE – IS SIMPLY OUT OF THE QUESTION. YOU’VE BEEN DISAPPOINTED TOO MANY TIMES IN THE PAST TO BE WILLING TO TAKE SUCH A RISK NOW. ” (WHICH ADDRESSES CONVERGENT CONFLICT)
  • 114. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 2 DISILLUSIONMENT STATEMENTS TO FACILITATE GRIEVING LOSSES AND DISAPPOINTMENTS “OPTIMAL DISILLUSIONMENT” BY FIRST HIGHLIGHTING THE ILLUSION (THE RELENTLESS HOPE), THEN ADDRESSING THE REALITY OF THE DISILLUSIONMENT, AND FINALLY RESONATING WITH THE PAIN OF THE PATIENT’S GRIEF “YOU WOULD HAVE WANTED JOSE TO BE ABLE TO LOVE YOU IN THE WAY THAT YOUR DAD NEVER DID; BUT YOU ARE COMING TO REALIZE THAT HE JUST CAN’T BECAUSE HE IS SO TERRIFIED OF COMMITMENT; AND KNOWING THIS BREAKS YOUR HEART.” (FIRST THE ILLUSION, BUT THEN THE DISILLUSIONING REALITY, AND FINALLY HER DEVASTATING GRIEF ABOUT IT) THE RESULT OF WHICH WILL BE TRANSMUTING (STRUCTURE – BUILDING) INTERNALIZATIONS AND THE FILLING IN OF DEFICIT
  • 115. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS TO FOSTER “TAKING OWNERSHIP” AND TO FACILITATE “NEGOTIATING AT THE INTIMATE EDGE” (EHRENBERG 1992) BY HIGHLIGHTING THE CONTRIBUTIONS OF BOTH PATIENT AND THERAPIST TO THE CO – CREATED DYSFUNCTIONAL RELATIONAL DYNAMIC THAT IS BEING PLAYED OUT BETWEEN THEM “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.” IN THE AFTERMATH OF A PATIENT’S PROVOCATIVE ENACTMENT “HOW WERE YOU HOPING I WOULD RESPOND?” (ID) “HOW WERE YOU AFRAID I MIGHT RESPOND?” (SUPEREGO) “HOW WERE YOU IMAGINING THAT I WOULD RESPOND?” (EGO)
  • 116. MODEL 3 ALTHOUGH INITIALLY THE THERAPIST MAY INDEED FAIL THE PATIENT IN MUCH THE SAME WAY THAT THE PATIENT’S PARENT HAD FAILED HER, ULTIMATELY THE THERAPIST WILL CHALLENGE THE PATIENT’S PROJECTIONS BY LENDING ASPECTS OF HER “OTHERNESS,” OR, AS WINNICOTT WOULD HAVE SAID, HER “EXTERNALITY” TO THE INTERACTION, SUCH THAT THE PATIENT WILL HAVE THE EXPERIENCE OF SOMETHING THAT IS “OTHER – THAN – ME” AND CAN TAKE THAT IN
  • 117. MODEL 3 THE THERAPIST WILL CHALLENGE 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 BEING ABLE TO TAKE IN SOMETHING THAT IS NOW MORE PROCESSED, LESS TOXIC, AND MORE MANAGEABLE
  • 118. MODEL 3 IN OTHER WORDS, BECAUSE THE THERAPIST IS NOT, IN FACT, AS BAD AS THE PARENT HAD BEEN AND IS ABLE TO BRING TO BEAR HER OWN, MORE EVOLVED CAPACITY TO PROCESS AND INTEGRATE ON BEHALF OF A PATIENT WHO TRULY DOES NOT KNOW HOW, THERE CAN BE A BETTER OUTCOME – A REPETITION OF THE ORIGINAL TRAUMA BUT WITH A MUCH HEALTHIER RESOLUTION THIS TIME, THE REPETITION LEADING TO MODIFICATION OF THE PATIENT’S INTERNAL WORLD AND INTEGRATION ON A HIGHER LEVEL OF ADAPTIVE CAPACITY AND RELATIONAL MATURITY
  • 119. PROTOTYPICAL “OPTIMALLY STRESSFUL” THERAPEUTIC INTERVENTIONS MODEL 4 FACILITATION STATEMENTS TO ADDRESS THE PATIENT’S CONFLICT BETWEEN HER LONGING TO BE KNOWN AND UNDERSTOOD AND HER TERROR OF BEING FOUND AS WELL AS HER AMBIVALENCE ABOUT LIVING IN A WORLD THAT SHE EXPERIENCES AS EMPTY AND DEVOID OF MEANING AND PURPOSE “A PART OF YOU WOULD WANT DESPERATELY TO BE SEEN AND UNDERSTOOD; BUT ANOTHER PART OF YOU IS TERRIFIED OF BEING FOUND.” “A PART OF YOU WOULD WANT TO BE ABLE TO FIND A REASON TO GO ON LIVING; BUT ANOTHER PART OF YOU IS QUITE SURE THAT THERE IS NO MEANING TO BE FOUND.” (BOTH OF WHICH ADDRESS DIVERGENT CONFLICT)
  • 120. WHEN THE FOCUS IS ON THE PATIENT AS “RESISTANT” AND / OR “NOT AWARE,” THINK MODEL 1 AND CONFLICT STATEMENTS TO MAKE THE PATIENT “MORE AWARE” WHEN THE FOCUS IS ON THE PATIENT AS “RELENTLESS” AND / OR “NOT ACCEPTING,” THINK MODEL 2 AND DISILLUSIONMENT STATEMENTS TO MAKE THE PATIENT “MORE ACCEPTING” WHEN THE FOCUS IS ON THE PATIENT AS “RE – ENACTING” AND / OR “NOT ACCOUNTABLE,” THINK MODEL 3 AND ACCOUNTABILITY STATEMENTS TO MAKE THE PATIENT “MORE ACCOUNTABLE” WHEN THE FOCUS IS ON THE PATIENT AS “RETREATING” AND / OR “NOT ACCESSIBLE,” THINK MODEL 4 AND FACILITATION STATEMENTS TO MAKE THE PATIENT “MORE ACCESSIBLE”
  • 121. MODEL 1 RESOLUTION OF STRUCTURAL CONFLICT INVOLVING DYSFUNCTIONAL INTERNAL DYNAMICS TAMING THE ID AND STRENGTHENING THE EGO SUCH THAT STRUCTURAL CONFLICT BECOMES STRUCTURAL COLLABORATION MODEL 2 STRUCTURAL GROWTH / ADDING NEW GOOD MAKING GOOD A DEFICIENCY / FILLING IN DEFICIT SUCH THAT STRUCTURAL DEFICIT BECOMES STRUCTURAL CONSOLIDATION MODEL 3 RESOLUTION OF RELATIONAL CONFLICT INVOLVING DYSFUNCTIONAL RELATIONAL DYNAMICS STRUCTURAL MODIFICATION / CHANGING OLD BAD DETOXIFYING INTERNAL TOXICITY SUCH THAT RELATIONAL CONFLICT BECOMES RELATIONAL COLLABORATION MODEL 4 EMERGENCE OF MOMENTS OF MEETING SUCH THAT RELATIONAL DEFICIT BECOMES MEANINGFUL ENGAGEMENT WITH THE WORLD OF ANIMATE OBJECTS
  • 122. THE THERAPEUTIC ACTION IN ALL FOUR MODELS WILL INVOLVE WORKING THROUGH THE OPTIMAL STRESS CREATED BY INTERVENTIONS THAT ALTERNATELY CHALLENGE AND THEN SUPPORT INTERVENTIONS STRATEGICALLY DESIGNED TO TARGET / HIGHLIGHT / GENERATE MODEL 1 – COGNITIVE DISSONANCE MODEL 2 – AFFECTIVE DISILLUSIONMENT MODEL 3 – RELATIONAL DETOXIFICATION MODEL 4 – ABSOLUTE DEPENDENCE THE WORKING THROUGH OF WHICH WILL RESULT ULTIMATELY IN RECONSTITUTION AT EVER – HIGHER LEVELS OF AWARENESS / ACTUALIZATION OF POTENTIAL, ACCEPTANCE, ACCOUNTABILITY, AND ACCESSIBILITY
  • 123. MATURITY INVOLVES DEVELOPING THE CAPACITY … MODEL 1 TO KNOW AND ACCEPT THE SELF, INCLUDING ITS PSYCHIC SCARS MODEL 2 TO KNOW AND ACCEPT THE OBJECT, INCLUDING ITS PSYCHIC SCARS MODEL 3 TO TAKE RESPONSIBILITY FOR THE DYSFUNCTION DELIVERED INTO ONE’S RELATIONSHIPS AND, MORE GENERALLY, INTO ONE’S LIFE MODEL 4 TO OVERCOME ONE’S TERROR OF BEING FOUND SO THAT MOMENTS OF MEETING CAN BE TOLERATED AND, EVEN, FOUND TO GIVE MEANING AND PURPOSE TO LIFE
  • 124. BY WAY OF REVIEW MODEL 1 THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS A 1 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S INTERNAL DYNAMICS AND POSITS INSIGHT, WISDOM, AWARENESS, EMPOWERMENT, AND ACTUALIZATION OF INHERITED POTENTIAL AS THE ULTIMATE THERAPEUTIC GOALS MODEL 2 THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY AND OTHER DEFICIT THEORIES A 1½ – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S AFFECTIVE EXPERIENCE AND POSITS ACCEPTANCE OF THE OBJECT’S LIMITATIONS, SEPARATENESS, AND IMMUTABILITY AS THE ULTIMATE THERAPEUTIC GOAL
  • 125. BY WAY OF REVIEW MODEL 3 THE CONTEMPORARY RELATIONAL (OR INTERSUBJECTIVE) PERSPECTIVE A 2 – PERSON PSYCHOLOGY THAT FOCUSES ON THE PATIENT’S RELATIONAL DYNAMICS AND POSITS ACCOUNTABILITY AS THE ULTIMATE THERAPEUTIC GOAL MODEL 4 THE EXISTENTIAL PERSPECTIVE A ½ – PERSON PSYCHOLOGY THAT EMPHASIZES AN INDIVIDUAL’S STRUGGLE TO FIND MEANING, PURPOSE, AND DIRECTION FOR A LIFE THAT WOULD OTHERWISE BE DESOLATE, BARREN, AND EMPTY AND POSITS ACCESSIBILITY AND THE FORGING OF MEANINGFUL ATTACHMENTS TO THE WORLD OF ANIMATE OBJECTS AS THE ULTIMATE THERAPEUTIC GOALS
  • 126. AN OVERVIEW PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 1 CONFLICT STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RESISTANT” PATIENT TO STEP BACK FROM THE IMMEDIACY OF THE MOMENT IN ORDER TO TAKE STOCK OF BOTH HER INVESTMENT IN MAINTAINING THINGS AS THEY ARE AND THE PRICE SHE PAYS FOR DOING SO 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
  • 127. PROTOTYPICAL “OPTIMALLY STRESSFUL” ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING INTERVENTIONS MODEL 3 ACCOUNTABILITY STATEMENTS ARE DESIGNED TO ENCOURAGE THE “RE – ENACTING” PATIENT TO TAKE RESPONSIBILITY FOR THE DYSFUNCTIONAL RELATIONAL DYNAMICS (THE RESIDUA OF UNMASTERED CHILDHOOD DRAMAS) THAT SHE IS COMPULSIVELY AND UNWITTINGLY REPLAYING ON THE STAGE OF HER LIFE MODEL 4 FACILITATION STATEMENTS ARE DESIGNED TO HIGHLIGHT THE “RETREATING” PATIENT’S INTENSE AMBIVALENCE ABOUT EVEN BEING IN RELATIONSHIP – THE FACT THAT SHE LONGS TO BE SEEN AND UNDERSTOOD BUT IS TERRIFIED OF BEING FOUND
  • 128. MORE GENERALLY MODEL 1 USES CONFLICT STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER INTERNAL CONFLICTEDNESS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE SELF INTO THE ADAPTIVE CAPACITY TO BE AWARE OF THOSE ANXIETY – PROVOKING TRUTHS MODEL 2 USES DISILLUSIONMENT STATEMENTS TO FACILITATE THE PATIENT’S GRIEVING OF INTOLERABLY PAINFUL DISAPPOINTMENTS AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RESIST KNOWING PAINFUL TRUTHS ABOUT THE OBJECT INTO THE ADAPTIVE CAPACITY TO ACCEPT THOSE DISILLUSIONING TRUTHS
  • 129. MORE GENERALLY MODEL 3 USES ACCOUNTABILITY STATEMENTS TO INCREASE THE PATIENT’S AWARENESS OF HER TENDENCY TO RE – PLAY UNMASTERED CHILDHOOD DRAMAS ON THE STAGE OF HER LIFE AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RE – ENACT UNMASTERED CHILDHOOD DRAMAS INTO THE ADAPTIVE CAPACITY TO BE ACCOUNTABLE FOR HER ACTIONS, REACTIONS, AND INTERACTIONS AND MODEL 4 USES FACILITATION STATEMENTS TO HIGHLIGHT NOT ONLY THE PATIENT’S TERROR OF BEING ONCE AGAIN DESTROYED BY AN ANNIHILATING OBJECT BUT ALSO HER DESPERATE LONGING TO RE – ENGAGE WITH THE WORLD AND THEREBY TO PROMPT EVENTUAL TRANSFORMATION OF THE DEFENSIVE NEED TO RETREAT INTO THE ADAPTIVE CAPACITY TO BE ACCESSED AND, AS A RESULT, TO BE ABLE TO TOLERATE MOMENTS OF MEANINGFUL MEETING
  • 130. THE HEALING PROCESS IN ALL FOUR MODELS PSYCHODYNAMIC PSYCHOTHERAPY AFFORDS THE PATIENT AN OPPORTUNITY ALBEIT A BELATED ONE TO MASTER STRESSFUL EXPERIENCES THAT HAD ONCE BEEN OVERWHELMING AND THEREFORE DEFENDED AGAINST BUT THAT CAN NOW WITH ENOUGH SUPPORT FROM THE THERAPIST AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE AND CAPACITY TO SELF – CORRECT IN THE FACE OF ENVIRONMENTAL CHALLENGE BE PROCESSED, INTEGRATED, AND ULTIMATELY ADAPTED TO AT THE END OF THE DAY THE HEALING PROCESS WILL INVOLVE TRANSFORMATION OF DEFENSE INTO ADAPTATION BY WAY OF WORKING THROUGH THE IMPACT OF OPTIMALLY STRESSFUL PSYCHOTHERAPEUTIC INTERVENTIONS CONFLICT STATEMENTS (MODEL 1) ~ DISILLUSIONMENT STATEMENTS (MODEL 2) ACCOUNTABILITY STATEMENTS (MODEL 3) ~ FACILITATION STATEMENTS (MODEL 4) 130