Martha Stark MD – 13 Nov 2022 – Part 1 – The Art and The Science of Interpretation.pptx

THE ART AND THE SCIENCE
OF INTERPRETATION
“LIKE THE MIDDLE GAME IN CHESS,
THERE IS NO PLAYBOOK TO GUIDE US”
PATRICIA COUGHLIN (2022)
MARTHA STARK MD
Faculty, Harvard Medical School
MarthaStarkMD @ HMS.Harvard.edu
Sunday / November 13, 2022
Baltimore Society for Psychoanalytic Studies
THANK YOU, CAMAY WOODALL 😊
© 2022 Martha Stark MD
1

MY PRESENTATION TODAY REPRESENTS
MY RATHER BOLD EFFORT TO CONCEPTUALIZE
A “BROAD STROKES FRAMEWORK” FOR
THIS “MIDDLE GAME” IN PSYCHODYNAMIC PSYCHOTHERAPY
IN ESSENCE, A “HOW – TO PLAYBOOK” FOR “WORKING THROUGH”
THE TRANSFORMATION OF “DEFENSE” INTO “ADAPTATION”
AT THE HEART OF WHICH ARE THE FOLLOWING FOUR ELEMENTS –
STAYING EVER ATTUNED TO THE LEVEL OF THE PATIENT’S ANXIETY
AND UNDERSTANDING THAT IT IS OK TO “LEVERAGE” IT
BY SOMETIMES INCREASING IT AND SOMETIMES DECREASING IT
AGAINST THE BACKDROP OF “EMPATHIC ATTUNEMENT” AND “SECURE ATTACHMENT,”
GENERATING “OPTIMAL STRESS”
– JUST THE RIGHT COMBINATION OF “CHALLENGE” AND “SUPPORT” –
TO “INCENTIVIZE” THE TRANSFORMATION OF “DEFENSE” INTO “ADAPTATION”
DEVELOPING COMFORT, THEREFORE, WITH
BOTH “CHALLENGING” AND “SUPPORTING”
THE PATIENT’S LONGSTANDING “UNHEALTHY DEFENSES”
APPRECIATING THE IMPORTANCE
OF “SUPPORTING” AND “CELEBRATING”
THE PATIENT’S HARD – EARNED “HEALTHIER ADAPTATIONS” 2

LEARNING OBJECTIVES
DESCRIBE THE “RATIONALE” FOR
“SOMETIMES BEING WITH THE PATIENT WHERE SHE IS”
– “HOMEOSTATIC ATTUNEMENT” – (SALMAN AKHTAR (2012))
AND “SOMETIMES DIRECTING HER ATTENTION TO ELSEWHERE”
– “DISRUPTIVE ATTUNEMENT” – (SALMAN AKHTAR (2012))
DESIGN A “MINIMALLY STRESSFUL” EMPATHIC INTERVENTION
THAT “SUPPORTS” THE DEFENSE
CONSTRUCT AN “OPTIMALLY STRESSFUL” CONFLICT STATEMENT
THAT ALTERNATELY “CHALLENGES” AND THEN “SUPPORTS” THE DEFENSE
DISTINGUISH BETWEEN “MINIMALLY STRESSFUL”
INTERVENTIONS THAT “SUPPORT” THE DEFENSE
AND “OPTIMALLY STRESSFUL” INTERVENTIONS
THAT BOTH “CHALLENGE” AND “SUPPORT” THE DEFENSE
CREATE A “CELEBRATORY” STATEMENT
THAT “SUPPORTS” THE NEWFOUND ADAPTATION
SUMMARIZE THE REASON THAT “OPTIMAL STRESS”
PROVIDES BOTH “IMPETUS” AND “OPPORTUNITY”
FOR “DEEP AND ENDURING PSYCHODYNAMIC CHANGE”
I HAVE NO FINANCIAL CONFLICTS OF INTEREST
OR, AS ERIC PLAKUN WOULD SAY,
PERHAPS I HAVE PSYCHOLOGICAL CONFLICTS BUT NO FINANCIAL CONFLICTS 3

2 – SLIDE OVERVIEW
THE “THERAPEUTIC PROVISION” OF “OPTIMAL STRESS”
NECESSARY IF “DEEP AND ENDURING PSYCHODYNAMIC CHANGE”
IS THE ULTIMATE GOAL OF TREATMENT
“CHALLENGE” THAT OFFERS “IMPETUS”
AND “SUPPORT” THAT OFFERS “OPPORTUNITY”
FOR TRANSFORMATION AND GROWTH
SUCH THAT
“RIGID DEFENSE” WILL BE REPLACED BY “MORE FLEXIBLE ADAPTATION”
“DEFENSIVE REACTION” WILL BE REPLACED BY “ADAPTIVE RESPONSE”
“SAME OLD, SAME OLD” NARRATIVES
WILL BE REPLACED BY “SOMETHING NEW, DIFFERENT, AND BETTER”
THE “DEFENSIVE NEED” FOR “OLD BAD”
WILL BE REPLACED BY THE “ADAPTIVE CAPACITY” FOR “NEW GOOD”
TWO PRIMARY INTERVENTIONS –
(1) “MINIMALLY STRESSFUL” “CLARIFYING” INTERVENTIONS
WHICH “PROVIDE SUPPORT” AND “SET THE STAGE”
(2) “OPTIMALLY STRESSFUL” “GROWTH – INCENTIVIZING” INTERVENTIONS
WHICH “PROVIDE CHALLENGE AND SUPPORT” AND “GENERATE THERAPEUTIC LEVERAGE”
THE CONSTRUCTION OF WHICH IS
BOTH A “SCIENCE” AND AN “ART” 4

5
THE “SCIENCE” AND THE “ART” OF DESIGNING
“MINIMALLY STRESSFUL” INTERVENTIONS
– THAT “PROVIDE SUPPORT” AND “SET THE STAGE” –
AND “OPTIMALLY STRESSFUL” INTERVENTIONS
– THAT “INCENTIVIZE DEEP AND ENDURING CHANGE” –

2 – SLIDE OVERVIEW
THE “GENERATION” OF ONGOING “HEALING CYCLES” OF
“DISRUPTION” AND “REPAIR”
WHICH WILL CREATE “HOMEOSTATIC IMBALANCE”
A STATE OF “DISEQUILIBRIUM”
THAT CANNOT, HOWEVER, BE TOLERATED FOR LONG
PROMPTING “RESTORATION OF EQUILIBRIUM”
– “RE – EQUILIBRATION” –
BUT EACH TIME
AT A NEW – MORE – EVOLVED – LEVEL OF
“HOMEOSTASIS” AND “ADAPTIVE CAPACITY”
AS A RESULT OF THE “SYNERGY” OF
THE THERAPIST’S “EXTERNAL SUPPORT”
AND THE PATIENT’S “INTERNAL RESOURCES”
THAT IS, THE PATIENT’S “UNDERLYING RESILIENCE,”
THE “WISDOM OF HER BODY” – WALTER B. CANNON (1932)
HER “INNATE STRIVING TOWARDS HEALTH,”
AND HER “INTRINSIC CAPACITY TO ADAPT TO (OPTIMAL) STRESS”
EVENTUAL “TRANSFORMATION” OF “PSYCHOLOGICAL RIGIDITY”
INTO “PSYCHOLOGICAL FLEXIBILITY”
REINFORCEMENT OF “INNATE RESILIENCE” WITH “ADAPTIVE RESILIENCE” 6

7
“COME TO
THE EDGE”
AN EVOCATIVE POEM
BY
CHRISTOPHER
LOGUE
(1969)
CAPTURES
THE
ESSENCE
OF OUR
CAPACITY
TO ADAPT
TO STRESS
… WHEN
PUSH
COMES
TO SHOVE

8
AND HERE
WE SEE
A SWEET
LITTLE GIRL
WITH
ANGEL WINGS
“What if I fall?”
“Oh, but my darling,
what if you fly?”
A TENDER
POEM
BY e.h.

“NUANCED PHRASEOLOGY”
“YOU FIND YOURSELF”
WHEN A PATIENT IS HAVING AN “ANXIETY – PROVOKING” FEELING
BUT HAVING TROUBLE “ACKNOWLEDGING” IT
THE THERAPIST CAN ALWAYS SAY SOMETHING LIKE
“YOU FIND YOURSELF FEELING REALLY ANGRY RIGHT NOW.”
INSTEAD OF “YOU ARE FEELING REALLY ANGRY RIGHT NOW.”
THE THERAPIST IS INDIRECTLY LETTING THE PATIENT “OFF THE HOOK” A BIT
BY INTIMATING THAT THE PATIENT’S ANGER MIGHT WELL BE
SOMETHING THAT HAS COME UPON HER (TAKEN HER BY SURPRISE)
AND SOMETHING FOR WHICH SHE IS, THEREFORE, NOT ENTIRELY RESPONSIBLE
PARADOXICALLY, THE PATIENT MIGHT WELL THEN BE ABLE
MORE EASILY TO “ACKNOWLEDGE” THE “ANXIETY – PROVOKING” FEELING
“YOU WOULD RATHER NOT” / “YOU WOULD RATHER”
BY SAYING THAT THE THERAPIST KNOWS THE PATIENT
“WOULD RATHER NOT” OR “WOULD RATHER” BE FEELING WHAT SHE IS FEELING,
THE THERAPIST IS INDIRECTLY HIGLIGHTING THE PATIENT’S “AGENCY”
AND, HERE TOO, ATTEMPTING TO MAKE IT A BIT EASIER FOR THE PATIENT
THEN TO “ACKNOWLEDGE” THE “ANXIETY – PROVOKING” FEELING
“YOU WOULD PROBABLY RATHER NOT BE FEELING ANGRY
BUT, EVEN SO, FIND YOURSELF FEELING REALLY ANGRY RIGHT NOW.”
INSTEAD OF “YOU ARE FEELING REALLY ANGRY RIGHT NOW.” 9

“FOR NOW” / “AT THIS POINT IN TIME” / “RIGHT NOW” / “AT THIS MOMENT”
HERE THE THERAPIST IS USING A LITTLE BIT OF “SUBLIMINAL STIMULATION”
TO HIGHLIGHT THE FACT THAT PERHAPS, AT SOME LATER POINT IN TIME,
THE PATIENT MIGHT BE ABLE TO TAKE HEALTHY ACTION
INSTEAD OF REMAINING STUCK
“EVEN THOUGH YOU STOPPED LOVING YOUR WIFE YEARS AGO,
AT THIS POINT IN TIME, YOU CAN’T IMAGINE EVER LEAVING HER.”
INSTEAD OF “EVEN THOUGH YOU STOPPED LOVING YOUR WIFE YEARS AGO,
YOU CAN’T IMAGINE EVER LEAVING HER.”
“EVERY NOW AND THEN” / “SOMETIMES” / “PERHAPS” / “ON SOME LEVEL” / “A LITTLE”
“MAYBE” / “POSSIBLY” / “AT TIMES” / “A PART OF YOU” / “SOME PART OF YOU”
THE THERAPIST CAN USE “QUALIFIERS” TO “LIMIT” THE “INTENSITY”
OF SOMETHING THAT IS “ANXIETY – PROVOKING,”
THEREBY “PERHAPS” MAKING IT EASIER FOR THE PATIENT TO “ACKNOWLEDGE”
“SOMETIMES YOU FIND YOURSELF FEELING ANGRY.”
INSTEAD OF “YOU ARE FEELING ANGRY.”
“A PART OF YOU IS ENRAGED.” INSTEAD OF “YOU ARE ENRAGED.”
“EVERY NOW AND THEN PERHAPS YOU FIND YOURSELF FEELING A LITTLE ANGRY.”
INSTEAD OF “YOU ARE FEELING ANGRY.”
“I AM REALIZING” INSTEAD OF “I REALIZE”
“I REALIZE” IS MORE “STATIC” – “I AM REALIZING” IS MORE “DYNAMIC”
AND HIGHLIGHTS AN ONGOING “PROCESS” 10

AT THE END OF THE DAY AND WHETHER EXPLICITLY OR IMPLICITLY
“THERAPEUTIC MODALITIES” THAT HAVE
“DEEP AND ENDURING PSYCHODYNAMIC CHANGE”
AS THEIR ULTIMATE GOAL
FOR EXAMPLE, PSYCHOANALYSIS AND OTHER “DEPTH PSYCHOLOGIES,”
INCLUDING ACT, IFS, EMDR, ISTDP, AEDP, EFT, NLP, SENSORIMOTOR PSYCHOTHERAPY,
SOMATIC EXPERIENCING, PSYCHOMOTOR PSYCHOTHERAPY, HYPNOTHERAPY, etc.
MUST BE ABLE TO “CATALYZE” TRANSFORMATION OF
(1) “PSYCHOLOGICAL RIGIDITY” INTO “PSYCHOLOGICAL FLEXIBILITY”
– IN THE EVOCATIVE WORDS OF ACCEPTANCE AND COMMITMENT THERAPY (ACT) –
(2) “LOW – LEVEL DEFENSE” INTO “HIGHER – LEVEL DEFENSE”
OR “RIGID DEFENSE” INTO “MORE FLEXIBLE ADAPTATION”
– IN THE MORE TRADITIONAL WORDS OF PSYCHOANALYSIS AND EGO PSYCHOLOGY –
SUCH THAT THE PATIENT
– WHATEVER HER “STARTING POINT” / WHATEVER HER “DIAGNOSIS” –
WILL, OVER TIME, BECOME EVER – BETTER ABLE
TO MANAGE THE MYRIAD “STRESSORS” IN HER LIFE
– EVER – BETTER ABLE TO “RESPOND ADAPTIVELY” THAN TO “REACT DEFENSIVELY” –
MY “PSYCHOANALYTICALLY INFORMED”
PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
IS A “DEPTH PSYCHOLOGY” IN THIS TRADITION
12

PLEASE NOTE
I DO NOT “LIMIT” DEFENSES
TO THE WELL – KNOWN AND MORE TRADITIONAL ONES
AT ONE END OF THE CONTINUUM – “LOW – LEVEL DEFENSES”
– FOR EXAMPLE, REPRESSION, REGRESSION, DENIAL, DISSOCIATION, DISPLACEMENT,
PROJECTION, ISOLATION OF AFFECT, INTELLECTUALIZATION, AND REACTION FORMATION –
AT THE OTHER END – “HIGHER – LEVEL OR MORE MATURE DEFENSES”
THAT ARE “MORE ADAPTIVE AND SOCIALLY ACCEPTABLE”
– FOR EXAMPLE, SUBLIMATION, HUMOR, ALTRUISM, HUMILITY, AND POSITIVE IDENTIFICATION –
RATHER
I DEFINE DEFENSES “MORE BROADLY” AS SPEAKING TO
ANY OF THE “SELF – PROTECTIVE MECHANISMS” THAT WE MOBILIZE
WHEN WE ARE MADE ANXIOUS IN THE FACE OF STRESSORS
– WHETHER INTERNAL STRESSORS OR EXTERNAL ONES –
AT ONE END OF THE CONTINUUM –
WHAT HAPPENS “REFLEXIVELY” WHEN WE ARE CONFRONTED WITH STRESSORS
THAT “OVERWHELM” US WITH ANXIETY
– TO WHICH I REFER AS “LOW – LEVEL DEFENSES” OR “RIGID DEFENSES”
AT THE OTHER END –
WHAT HAPPENS “MORE REFLECTIVELY” WHEN WE ARE CONFRONTED WITH STRESSORS
THAT WE ARE ABLE TO “TAKE IN OUR STRIDE”
– TO WHICH I REFER AS “HIGHER – LEVEL DEFENSES” OR “MORE FLEXIBLE ADAPTATIONS” –
AND, AGAIN, THE THERAPEUTIC GOAL WILL BE TO
TRANSFORM THESE “MINDLESS DEFENSES” INTO “MORE MINDFUL ADAPTATIONS”
13

WITH IT BEING UNDERSTOOD THAT
THE RELATIONSHIP BETWEEN
DEFENSE AND ADAPTATION
IS A YIN – YANG RELATIONSHIP
THESE ARE COMPLEMENTARY – NOT OPPOSING – FORCES
FOR EXAMPLE, LIGHT CANNOT EXIST WITHOUT SHADOW
ALTHOUGH DEFENSES MIGHT ONCE
HAVE BEEN NECESSARY
FOR THE PATIENT TO “SURVIVE,”
AS DEFENSES BECOME
“UPGRADED” TO ADAPTATIONS,
THE PATIENT BECOMES
BETTER ABLE TO “THRIVE”
THE THERAPEUTIC ACTION
IS INDEED DESIGNED
TO TRANSFORM “SURVIVING” INTO “THRIVING”
14

BRIEFLY
THE PSYCHODYNAMIC SYNERGY PARADIGM
FEATURES FIVE “MODES OF THERAPEUTIC ACTION”
FIVE DIFFERENT APPROACHES
TO “CATALYZING” TRANSFORMATION
OF “PSYCHOLOGICAL RIGIDITY”
INTO “PSYCHOLOGICAL FLEXIBILITY”
17

THE PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
– A SYNERGISTIC APPROACH TO HEALING –
FIVE INTERDEPENDENT AND MUTUALLY ENHANCING
“MODES OF THERAPEUTIC ACTION”
MODEL 1 – ENHANCEMENT OF KNOWLEDGE “WITHIN”
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
MODEL 2 – PROVISION OF EXPERIENCE “FOR”
THE CORRECTIVE – PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
MODEL 3 – ENGAGEMENT IN RELATIONSHIP “WITH”
THE INTERSUBJECTIVE PERSPECTVE
OF CONTEMPORARY RELATIONAL THEORY
MODEL 4 – FACILITATION OF SURRENDER “TO”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
MODEL 5 – ENVISIONING OF POSSIBILITIES “BEYOND”
A QUANTUM – NEUROSCIENTIFIC APPROACH
TO OVERCOMING ANALYSIS PARALYSIS
18

THE PSYCHODYNAMIC SYNERGY PARADIGM (PSP)
“STRUCTURAL CONFLICT” – CLASSICAL PSYCHOANALYTIC
COGNITIVE
“STRUCTURAL DEFICIT” – SELF PSYCHOLOGICAL
AFFECTIVE
“RELATIONAL CONFLICT” – CONTEMPORARY RELATIONAL
RELATIONAL
“RELATIONAL DEFICIT” – EXISTENTIAL – HUMANISTIC
EXISTENTIAL
“STRUCTURAL DISSOCIATION” – QUANTUM – NEUROSCIENTIFIC
CONSTRUCTIVIST
ALL FIVE PSP MODELS CAPITALIZE UPON
THE “THERAPEUTIC PROVISION” OF “OPTIMAL STRESS”
TO ADVANCE THE PATIENT
FROM “RIGID DEFENSE” TO “MORE FLEXIBLE ADAPTATION”
WITH AN EYE TO INCENTIVIZING
“DEEP AND SUSTAINED PSYCHODYNAMIC CHANGE”
19

OVER THE COURSE OF A THERAPY HOUR
PSP THERAPISTS WILL FIND THEMSELVES SHIFTING BACK AND FORTH
FROM ONE MODEL TO THE NEXT
BASED UPON WHAT THEY “INTUITIVELY SENSE” IS
THE “POINT OF EMOTIONAL URGENCY” FOR THE PATIENT
– THAT IS, WHAT IS MOST “EMOTIONALLY FRAUGHT” FOR HER IN THE MOMENT –
WHETHER HER “RESISTANCE” TO GAINING INSIGHT
INTO WHAT UNDERLIES HER INTERNAL CONFLICTEDNESS
(MODEL 1 – STRUCTURAL CONFLICT)
HER “RELENTLESS PURSUIT” OF THE UNATTAINABLE
IN A DESPERATE ATTEMPT TO FILL IN FOR MISSING PIECES
(MODEL 2 – STRUCTURAL DEFICIT)
HER “RE – ENACTMENT” OF UNMASTERED EARLY – ON
RELATIONAL TRAUMAS ON THE STAGE OF HER LIFE
(MODEL 3 – RELATIONAL CONFLICT) STEPHEN MITCHELL (1988)
HER “RETREAT” FROM THE WORLD AND “RELENTLESS DESPAIR”
(MODEL 4 – RELATIONAL DEFICIT)
OR HER “REFRACTORY INERTIA,” “RELENTLESS INACTION,”
AND “ROOTEDNESS TO THE SPOT”
(MODEL 5 – “STRUCTURAL DISSOCIATION” (JANINA FISHER (2017)) /
“NEURAL ENTRENCHMENT” / “QUANTUM ENTANGLEMENT”) 21

MODEL 1 – “STRUCTURAL CONFLICT”
NEUROTIC CONFLICTEDNESS
MODEL 2 – “STRUCTURAL DEFICIT”
OF SELF PSYCHOLOGY
NARCISSISTIC VULNERABILITY / WOUNDEDNESS / ENTITLEMENT
MODEL 3 – “RELATIONAL CONFLICT”
THE INTERSUBJECTIVE PERSPECTVE
NOXIOUS RELATEDNESS
MODEL 4 – “RELATIONAL DEFICIT”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
NONRELATEDNESS
MODEL 5 – “STRUCTURAL DISSOCIATION”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO OVERCOMING INERTIA
NONACTION
IN TRUTH, WE ARE ALL A LITTLE
NEUROTIC, NARCISSISTIC, NOXIOUS IN OUR RELATEDNESS,
NONRELATED, AND NONACTUALIZED 22

AGAIN, FIVE PSYCHODYNAMIC SYNERGY PARADIGM (PSP) “MODELS”
FIVE INTERDEPENDENT “MODES OF THERAPEUTIC ACTION”
FIVE “OPTIMALLY STRESSFUL” “GROWTH – INCENTIVIZING” INTERVENTIONS
– ALL OF WHICH TARGET THE PATIENT’S “DEFENSES” IN ORDER TO
ADVANCE HER FROM “PSYCHOLOGICAL RIGIDITY” TO “PSYCHOLOGICAL FLEXIBILITY” –
MODEL 1 – COGNITIVE
CONFLICT STATEMENTS
– FROM “RESISTANCE” TO “AWARENESS” –
MODEL 2 – AFFECTIVE
DISILLUSIONMENT STATEMENTS
– FROM “RELENTLESS HOPE” TO “ACCEPTANCE” –
MODEL 3 – RELATIONAL
ACCOUNTABILITY STATEMENTS
CONTAINING STATEMENTS
THE “RULE OF THREE”
– FROM “RE – ENACTMENT” TO “ACCOUNTABILITY” –
MODEL 4 – EXISTENTIAL
FACILITATION STATEMENTS
– FROM “RELATIONAL ABSENCE” TO “AUTHENTIC PRESENCE” –
MODEL 5 – CONSTRUCTIVIST
QUANTUM DISENTANGLEMENT STATEMENTS
– FROM “REFRACTORY INERTIA” / “ANALYSIS PARALYSIS”
TO “ACTION” AND “ACTUALIZATION OF POTENTIAL” – 24

BUT OUR PRIMARY FOCUS TODAY WILL BE ON
THE THREE MAJOR PSYCHOANALYTIC SCHOOLS
– KNOWLEDGE, EXPERIENCE, AND RELATIONSHIP –
THE FIRST OF WHICH IS CLASSICAL
THE SECOND AND THIRD OF WHICH ARE MORE CONTEMPORARY
MODEL 1
– SIGMUND FREUD / ANNA FREUD / HEINZ HARTMANN / DAVID RAPAPORT –
MODEL 2
OF SELF PSYCHOLOGY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “ABSENCE OF GOOD”
– RESULTING FROM “RELATIONAL DEPRIVATION AND NEGLECT” –
– HEINZ KOHUT / MICHAEL BALINT / PAUL AND ANNA ORNSTEIN –
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL “PRESENCE OF BAD”
– RESULTING FROM “RELATIONAL TRAUMA AND ABUSE” –
– STEPHEN MITCHELL / JAY GREENBERG / JESSICA BENJAMIN / JEAN BAKER MILLER –
25

BY WAY OF DEMONSTRATION (AND TO WHET YOUR APPETITES A BIT)
OPTIMALLY STRESSFUL – MODEL 1 – “CONFLICT STATEMENTS”
ARE DESIGNED TO RESOLVE “INTERNAL CONFLICT” BY FOSTERING “AWARENESS”
– THEY ALTERNATELY INCREASE ANXIETY AND THEN DECREASE IT –
“YOU KNOW THAT YOUR MOTHER WILL NEVER APOLOGIZE,
BUT YOU FIND YOURSELF CONTINUING TO WISH THAT SHE WOULD.”
“YOU KNOW THAT SOMEDAY YOU’LL HAVE TO LET SOMEBODY
IN IF YOU’RE EVER TO HAVE A MEANINGFUL RELATIONSHIP.
BUT, AT THE MOMENT, THE THOUGHT OF MAKING YOURSELF
THAT VULNERABLE IS SIMPLY OUT OF THE QUESTION.
YOU’VE SIMPLY BEEN HURT TOO MANY TIMES IN THE PAST.”
OPTIMALLY STRESSFUL – MODEL 2 – “DISILLUSIONMENT STATEMENTS”
ARE DESIGNED TO FACILITATE “GRIEVING” AND ULTIMATELY “ACCEPTANCE”
– THEY TOO ALTERNATELY INCREASE ANXIETY AND THEN DECREASE IT –
“YOU HAD SO HOPED THAT I WOULD TELL YOU WHAT TO DO,
BUT YOU ARE BEGINNING TO REALIZE THAT I DON’T SIMPLY
GIVE YOU ANSWERS – AND IT INFURIATES YOU.”
“YOU HAD SO HOPED THAT YOUR MOTHER WOULD APOLOGIZE,
BUT YOU ARE BEGINNING TO ACCEPT THAT SHE SIMPLY
DOES NOT HOLD HERSELF ACCOUNTABLE AND PROBABLY NEVER WILL –
WHICH IS BOTH ENRAGING AND DEVASTATING.”
26

OPTIMALLY STRESSFUL – MODEL 3 – “ACCOUNTABILITY STATEMENTS”
THE “RULE OF THREE”
IS DESIGNED TO INSIST THAT THE “RE – ENACTING” PATIENT
TAKE RESPONSIBILITY FOR HER “PROVOCATIVE ENACTMENTS”
MORE SPECIFICALLY, THE “RULE OF THREE” BECOMES RELEVANT
WHENEVER A PATIENT SAYS OR DOES SOMETHING
THAT THE THERAPIST EXPERIENCES AS PROVOCATIVE
– A “PROVOCATIVE ENACTMENT” –
IN ORDER TO COMPEL THE PATIENT TO TAKE OWNERSHIP OF
WHAT SHE IS “PLAYING OUT” ON THE STAGE OF THE TREATMENT,
THE THERAPIST CAN ASK THE PATIENT ANY OF THE FOLLOWING –
“HOW ARE YOU HOPING THAT I WILL RESPOND?”
WHICH ADDRESSES THE ID
“HOW ARE YOU FEARING THAT I MIGHT RESPOND?”
WHICH ADDRESSES THE SUPEREGO
“HOW ARE YOU IMAGINING THAT I WILL RESPOND?”
WHICH ADDRESSES THE EXECUTIVE FUNCTIONING OF THE EGO
– THE DORSOLATERAL PREFRONTAL CORTEX (DLPFC) OF THE BRAIN –
ALL THREE “RELATIONAL INTERVENTIONS” DEMAND OF THE PATIENT
THAT SHE MAKE HER “INTERPERSONAL INTENTIONS” MORE EXPLICIT
27

OPTIMALLY STRESSFUL – MODEL 3 – “ACCOUNTABILITY STATEMENTS”
CAN BE INTRODUCED IN ANY OF THE FOLLOWING WAYS –
“IT OCCURS TO ME THAT, BY WAY OF YOUR
BEHAVIOR IN HERE WITH ME, YOU ARE HELPING
ME TO UNDERSTAND SOMETHING THAT
I HAD NEVER BEFORE ENTIRELY UNDERSTOOD … ”
“I THINK THAT YOU HAVE BEEN TRYING TO
COMMUNICATE SOMETHING IMPORTANT TO ME
THAT I HAD BEEN REFUSING TO SEE … ”
“I WONDER IF MY DIFFICULTY APPRECIATING
JUST HOW DESPERATE YOU WERE MADE
YOU FEEL THAT YOU HAD TO DO SOMETHING
DRAMATIC IN ORDER TO GET MY ATTENTION … ”
DON’T HESITATE TO ”THROW YOURSELF UNDER THE BUS”
28

TO “LAY THE GROUNDWORK” FOR THE INTRODUCTION OF
THESE “ANXIETY – PROVOKING”
BUT “GROWTH – INCENTIVIZING” INTERVENTIONS
THE THERAPIST CAN CALL UPON ANY NUMBER OF
“MINIMALLY STRESSFUL” “CLARIFYING” INTERVENTIONS
THAT WILL NOT ONLY “PROVIDE SUPPORT”
BUT ALSO “MOVE THE BALL FORWARD” A BIT
BY GENTLY “TEASING OUT” SOME OF THE “LESS – THAN – HEALTHY”
“RECURRING THEMES, PATTERNS, AND REPETITIONS” IN THE PATIENT’S LIFE
INTEGRATION STATEMENTS
PATH – OF – LEAST – RESISTANCE STATEMENTS
DAMAGED – FOR – LIFE STATEMENTS
COMPENSATION STATEMENTS
ENTITLEMENT STATEMENTS
MASOCHISM STATEMENTS
SADISM STATEMENTS
PARADOXICAL INTERVENTIONS
EMPATHIC STATEMENTS
29

IN ESSENCE
“SUPPORT” BY NONJUDGMENTALLY “SPOTLIGHTING”
SOME OF THE “REALLY DIFFICULT TRUTHS” IN THE PATIENT’S LIFE
– THE “LESS – THAN – HEALTHY” AND “USUALLY – DEFENSIVE”
OF WHICH SHE IS “AT LEAST PARTIALLY” AWARE
BUT ABOUT WHICH SHE IS “NOT PARTICULARLY” ANXIOUS –
“JOINING THROUGH THE TRUTH”
TERRY REAL (2020)
THESE “CLARIFYING” INTERVENTIONS
WHICH “SUPPORT”
BY “BEING WITH THE PATIENT WHERE THE PATIENT IS”
“SET THE STAGE” FOR THE INTRODUCTION OF
“OPTIMALLY STRESSFUL”
“GROWTH – INCENTIVIZING” INTERVENTIONS
WHICH WILL BOTH “CHALLENGE”
BY “DIRECTING THE PATIENT’S ATTENTION TO WHERE THE THERAPIST WANTS HER TO GO”
AND “SUPPORT”
BY “BEING WITH THE PATIENT WHERE SHE IS”
THEREBY “TARGETING” DEFENSES OF WHICH THE PATIENT
IS FULLY AWARE, PARTIALLY AWARE, AND NOT AWARE
– WHICH (HOPEFULLY) WILL MAKE HER “OPTIMALLY” ANXIOUS – 30

31
“OPTIMALLY
STRESSFUL”
INTERVENTIONS
TARGET
CONSCIOUS
DEFENSES,
PRECONSCIOUS
DEFENSES,
AND
UNCONSCIOUS
DEFENSES

BY WAY OF DEMONSTRATION (AND TO WHET YOUR APPETITES A BIT)
FOR THOSE PATIENTS WHO ARE HAVING TROUBLE
HOLDING IN MIND SIMULTANEOUSLY BOTH
THE “GOOD” AND THE “BAD” ASPECTS OF THEIR EXPERIENCE
IN OTHER WORDS
PATIENTS WITH TENUOUSLY ESTABLISHED
“LIBIDINAL OBJECT CONSTANCY” / “EVOCATIVE MEMORY CAPACITY”
“HARD TO REMEMBER” / “HARD TO IMAGINE”
“WHEN YOU’RE FEELING THIS BAD,
IT’S HARD TO REMEMBER THAT YOU HAD EVER FELT GOOD
AND IT’S HARD TO IMAGINE THAT YOU COULD EVER FEEL GOOD AGAIN.”
“WHEN YOUR HEART IS BREAKING AS IT IS NOW,
YOU CAN’T IMAGINE THAT YOU COULD EVER DARE TO TRUST AGAIN.”
“WHEN YOU’RE FEELING THIS ANGRY AT ME,
IT’S HARD TO REMEMBER THAT YOU USED TO FEEL GOOD ABOUT ME
AND EVEN LOOKED FORWARD TO COMING.”
“WHEN YOU FEEL THIS DESPAIRING,
YOU CAN’T REMEMBER EVER HAVING HAD ANY HOPE WHATSOEVER.”
32

ALSO BY WAY OF DEMONSTRATION (AND TO WHET YOUR APPETITES A BIT)
FOR THOSE PATIENTS WHO ARE
“REACTING DEFENSIVELY”
RATHER THAN
“RESPONDING ADAPTIVELY”
EASIER TO “REACT DEFENSIVELY”
THAN TO “RESPOND ADAPTIVELY”
“IT’S EASIER TO GIVE UP THAN TO KEEP FIGHTING
FOR WHAT YOU REALLY BELIEVE IN.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS DISEMPOWERED
THAN TO TAKE OWNERSHIP OF THE POWER
AND AGENCY THAT YOU ACTUALLY DO HAVE.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS HAVING NO
ACCOUNTABILITY THAN TO TAKE RESPONSIBILITY FOR YOUR LIFE.”
“IT’S EASIER TO HOLD ON TO THE HOPE THAT YOUR HUSBAND
MIGHT SOMEDAY CHANGE THAN TO CONFRONT
THE REALITY THAT HE PROBABLY NEVER WILL.”
33

WHATEVER THE “STARTING POINT” / WHATEVER THE “DIAGNOSIS”
FROM “PSYCHOLOGICAL RIGIDITY”
TO “PSYCHOLOGICAL FLEXIBILITY”
FROM “MINDLESS AND REFLEXIVE DEFENSE”
TO “MORE MINDFUL AND REFLECTIVE ADAPTATION”
FROM “DEFENSE”
WHEN “LIFE STRESSORS”
CANNOT BE EFFECTIVELY MANAGED
TO “ADAPTATION”
WHEN “LIFE STRESSORS”
CAN BE MORE EASILY TAKEN IN STRIDE
THE ULTIMATE GOAL OF TREATMENT
IN “DEPTH PSYCHOLOGIES”
IS TO FACILITATE DEVELOPMENT OF
EVER – MORE “RESILIENCE,” “ADAPTABILITY,” “FLEXIBILITY,”
“VARIABILITY,” “FLUIDITY OF FLOW,” AND TOM BRADY’S “PLIABILITY”
FROM “INNATE RESILIENCE” TO “ADAPTIVE RESILIENCE”
PLEASE NOTE THAT THE GOAL
IS NOT SPECIFICALLY TO TARGET SYMPTOMS 35

WE CANNOT AVOID SUFFERING
BUT WE CAN CHOOSE HOW WE COPE WITH IT, FIND MEANING IN IT,
AND MOVE FORWARD WITH RENEWED PURPOSE
EXISTENTIAL PSYCHIATRIST VIKTOR FRANKL IS REPUTED TO HAVE WRITTEN
“BETWEEN STIMULUS AND RESPONSE IS A SPACE.
IN THAT SPACE IS OUR POWER TO CHOOSE OUR RESPONSE.
IN OUR RESPONSE LIES OUR GROWTH AND OUR FREEDOM.”
AS THIS APPLIES TO THE CLINICAL SITUATION
IN THAT SPACE IS OUR POWER
EITHER TO “REACT DEFENSIVELY”
– BY WALLOWING IN OUR DESPAIR AND ABNEGATING RESPONSIBILITY FOR OUR LIVES –
OR TO “RESPOND ADAPTIVELY”
– BY ACKNOWLEDGING THAT, DESPITE OUR DESPAIR, FROM THIS POINT FORWARD
THE MEANING WE MAKE OF OUR LIVES IS ENTIRELY UP TO US –
NOT ONLY DO WE HAVE THE FREEDOM TO CREATE THAT MEANING
BUT WE ALSO HAVE THE RESPONSIBILITY TO DO SO
IT HAS BEEN SUGGESETED THAT 10% OF WHAT HAPPENS TO US IS “LIFE”
BUT 90% IS HOW WE “REACT” OR “RESPOND” TO IT
36

AGAIN AND WHETHER EXPLICITLY OR IMPLICITLY
“THERAPEUTIC MODALITIES” DESIGNED TO “CATALYZE”
WILL ULTIMATELY ADVANCE THE PATIENT
– BY WAY OF ONGOING “HEALING CYCLES” OF “DISRUPTION” AND “REPAIR” –
– RARELY “STRAIGHT – LINE” PROGRESSION –
FROM “PSYCHOLOGICAL RIGIDITY”
TO “PSYCHOLOGICAL FLEXIBILITY”
FROM MINDLESS TO MORE MINDFUL
FROM THOUGHTLESS TO MORE THOUGHTFUL
FROM REFLEXIVE TO MORE REFLECTIVE
FROM AUTOMATIC TO MORE INTENTIONAL
FROM DYSFUNCTIONAL TO MORE FUNCTIONAL
FROM SUBCONSCIOUS TO MORE CONSCIOUS
FROM SUBCORTICAL TO MORE CORTICAL
FROM DORSAL VAGAL SHUTDOWN TO VENTRAL VAGAL SOCIAL ENGAGEMENT
STEPHEN PORGES (2017)
FROM SIMPLY SURVIVING TO ACTUALLY THRIVING
FROM LESS HEALTHY TO MORE HEALTHY
FROM LESS EVOLVED TO MORE EVOLVED
FROM “RIGID DEFENSE” TO “MORE FLEXIBLE ADAPTATION”
FROM “DEFENSE” TO “ADAPTATION”
38

39
LIFE
IS ABOUT
NOT
“DEFENSIVELY”
WAITING FOR
THE STORM
TO PASS
BUT
“ADAPTIVELY”
LEARNING
TO DANCE
IN THE RAIN

AS WE SHALL SOON SEE
THE PSP “WORKING THROUGH PROTOCOL” WILL INVOLVE
“WORKING THROUGH GROWTH – IMPEDING RIGIDITY” 📕📕
SUCH THAT “DEFENSIVE NEED” WILL BE “TAMED”
AND “ADAPTIVE CAPACITY” “STRENGTHENED”
– “TAME” THE “NEED” AND “STRENGTHEN” THE “CAPACITY” –
WHICH HARKENS BACK TO FREUD’S WELL – KNOWN GOAL OF “WORKING THROUGH”
IN ORDER TO “TAME THE ID” AND “STRENGTHEN THE EGO”
BY WAY OF EXAMPLES
TAME THE “DEFENSIVE NEED” FOR ILLUSION AND RELENTLESS HOPE
AND STRENGTHEN THE “ADAPTIVE CAPACITY” FOR ACCEPTANCE AND REALISTIC HOPE
TAME THE “DEFENSIVE NEED” TO EXPERIENCE THE WORLD AS ALWAYS VICTIMIZING
AND STRENGTHEN THE “ADAPTIVE CAPACITY” TO TAKE OWNERSHIP
OF BEING SOMETIMES PROVOCATIVE
TAME THE “DEFENSIVE NEED” TO RETREAT SELF – PROTECTIVELY FROM THE WORLD
AND STRENGTHEN THE “ADAPTIVE CAPACITY” TO VENTURE FORTH EVEN SO
TAME THE “DEFENSIVE NEED” TO KEEP DOING SAME OLD, SAME OLD
AND STRENGTHEN THE “ADAPTIVE CAPACITY” TO ENVISION
SOMETHING NEW, DIFFERENT, AND BETTER
TAME THE “DEFENSIVE NEED” TO WHINE AND COMPLAIN ABOUT LIFE’S INJUSTICES
AND STRENGTHEN THE “ADAPTIVE CAPACITY” TO APPRECIATE
THE GOOD THAT LIFE DOES HAVE TO OFFER
40

AGAIN
ON THE ONE HAND, DEFENSES ARE MOBILIZED WHEN WE ARE
CONFRONTED WITH SITUATIONS THAT OVERWHELM US WITH ANXIETY
ON THE OTHER HAND, ADAPTATIONS BECOME POSSIBLE WHEN WE HAVE
BUILT UP ENOUGH RESILIENCE THAT WE CAN TAKE THAT ANXIETY IN OUR STRIDE
FROM “LESS – EVOLVED NEED”
TO “MORE – EVOLVED CAPACITY”
FROM “DEFENSIVE NEED”
TO “ADAPTIVE CAPACITY”
FROM THE DEFENSIVE NEED FOR IMMEDIATE GRATIFICATION
TO THE ADAPTIVE CAPACITY TO TOLERATE DELAY
FROM THE DEFENSIVE NEED FOR PERFECTION
TO THE ADAPTIVE CAPACITY TO TOLERATE IMPERFECTION
FROM THE DEFENSIVE NEED FOR EXTERNAL REGULATION OF THE SELF
TO THE ADAPTIVE CAPACITY FOR INTERNAL SELF – REGULATION
FROM THE DEFENSIVE NEED TO HOLD ON
TO THE ADAPTIVE CAPACITY TO LET GO
41

FROM EXTERNALIZING BLAME TO TAKING OWNERSHIP
FROM WHINING AND COMPLAINING TO BECOMING PROACTIVE
FROM DENYING TO CONFRONTING HEAD – ON
FROM BEING CRITICAL TO BECOMING MORE COMPASSIONATE
FROM DISSOCIATING TO BECOMING MORE PRESENT
FROM FEELING VICTIMIZED TO TAKING RESPONSIBILITY
FROM CURSING THE DARKNESS TO LIGHTING A CANDLE
FROM BEING DISEMPOWERED AND CONFINED
TO BEING MORE EMPOWERED AND EXPANSIVE
FROM BEING JAMMED UP
TO MOBILIZING ONE’S ENERGIES IN THE PURSUIT OF ONE’S DREAMS
FROM “DEFENSIVE REACTION” TO “ADAPTIVE RESPONSE”
FROM “OUTDATED NARRATIVES” TO “UPDATED NARRATIVES”
ABOUT SELF, OTHERS, AND THE WORLD
FROM “SAME OLD, SAME OLD”
TO “SOMETHING NEW, DIFFERENT, AND BETTER”
42

43
When I let go
of the
SAME OLD
SAME OLD
that I am,
I become the
SOMETHING
NEW
DIFFERENT
AND
BETTER
that I
might be.

JON FREDERICKSON (2017) OFFERS
DEFENSES ARE THE LIES WE TELL OURSELVES
TO AVOID FEELING
THE PAIN IN OUR LIVES
ADAPTATIONS ARE THE ADJUSTMENTS WE EMBRACE
TO MAKE THE BEST OF (BEST OF, BEST OF)
A BAD SITUATION (BAD SITUATION)
GLADYS KNIGHT & THE PIPS (1973) / MARTHA STARK (2022)
EITHER WE – MADE ANXIOUS – “REACT” TO STRESSORS BY “DEFENDING”
RESISTANCE (MODEL 1), RELENTLESS HOPE (MODEL 2), RE – ENACTMENT (MODEL 3)
OR WE – MORE RESILIENT – “RESPOND” TO STRESSORS BY “ADAPTING”
AWARENESS (MODEL 1), ACCEPTANCE (MODEL 2), ACCOUNTABILITY (MODEL 3)
ALL THREE “Rs” ARE DEFENSES MOBILIZED
TO AVOID DEALING WITH “PAINFUL TRUTHS”
ABOUT THE SELF, ONE’S OBJECTS,
AND THE SELF – IN – RELATION (OR THE RELATIONAL SELF)
ALL THREE “As” ARE ADAPTATIONS
ACCEPTED AS NECESSARY IN ORDER
EFFECTIVELY TO MANAGE THE “STRESS OF LIFE”
HANS SELYE (1978)
44

IN ESSENCE
ADAPTATION
IS A STORY ABOUT
MAKING A VIRTUE
OUT OF NECESSITY 
46

“CONTROLLED DAMAGE”
TO THE “BODY”
IN ORDER TO
“JUMP – START HEALING”
48

IN THE PHYSIOLOGICAL REALM
SUPERIMPOSING AN ACUTE PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES EXACTLY WHAT THE BODY NEEDS
IN ORDER TO HEAL
IN ESSENCE
“CONTROLLED DAMAGE” TO “PROVOKE HEALING”
BY WAY OF EXAMPLES
HIGH – INTENSITY INTERVAL TRAINING (HIIT) / INTERMITTENT FASTING
ISCHEMIC PRECONDITIONING / INTERMITTENT HYPOXIC TRAINING / HYPERBARIC OXYGEN
HOMEOPATHIC REMEDIES / VACCINES AND OTHER IMMUNOTHERAPIES / MEDICINAL PLANTS
DERMABRASION / FRAXEL LASER TREATMENTS / RADIOFREQUENCY MICRONEEDLING
PLATELET – RICH PLASMA (PRP) / PLATELET – RICH FIBRIN (PRF)
VAMPIRE GUM REJUVENATION / BOTOX / STEM CELL FACELIFTS
ELECTROCONVULSIVE THERAPY (ECT) / TRANSCRANIAL MAGNETIC STIMULATION (TMS)
CARDIAC DEFIBRILLATION
PULSE WAVE THERAPIES (SHOCKWAVE THERAPY AND SOUND THERAPY)
ACUPUNCTURE / ACUPRESSURE / CUPPING
RED LIGHT THERAPY / INFRARED SAUNAS / CRYOTHERAPY
BRAIN TEASERS AND MENTAL EXERCISES
IT IS BECAUSE OF “INNATE RESILIENCE”
THAT “OPTIMALLY CHALLENGING” A “COMPROMISED BODILY SYSTEM”
WILL JUMP – START “ADAPTIVE RECOVERY”
AND “REINFORCE” THE SYSTEM’S UNDERLYING HEALTH 49

IN OTHER WORDS
IF THE SYSTEM HAS
ENOUGH “INNATE – UNDERLYING – RESILIENCE”
“MODERATE AMOUNTS OF STRESS”
WILL “PROVOKE MODEST OVERCOMPENSATION”
“INTERMITTENT EXPOSURES” WILL “PROMPT ADAPTATION”
“MILD AGGRAVATIONS” WILL “STIMULATE THE HEALING CASCADE”
ALL OF WHICH STRESSORS ARE, IN ESSENCE, ACTIVATING
THE “HEALING RESPONSE” / THE “HORMETIC RESPONSE”
“ADAPTIVE RECOVERY” IS THE MANIFESTATION
OF A “HORMETIC – BIPHASIC – DOSE – RESPONSE”
AND SPEAKS TO THE SYSTEM’S ABILITY TO “ADAPT TO (OPTIMAL) STRESS”
HORMESIS IS A LITTLE – KNOWN BUT ALMOST UNIVERSAL DOSE – RESPONSE
PHENOMENON CHARACTERIZED BY “BENEFIT” ALONG ONE PORTION
OF THE DOSE – RESPONSE CURVE AND “COST” ALONG ANOTHER
IN THE WELL – KNOWN WORDS OF PARACELSUS (1999) –
“THE DIFFERENCE BETWEEN A MEDICINE AND A POISON
IS THE DOSAGE THEREOF.”
CERTAINLY RELEVANT FOR “DOSES OF STRESS”
IN OTHER WORDS, THE “REACTION / RESPONSE TO STRESS”
DOES NOT DEMONSTRATE “STRAIGHT – LINE PROGRESSION”
50

MORE SPECIFICALLY
THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE
WILL OVERWHELM AND PLUMMET THE SYSTEM
INTO FURTHER DECLINE
BECAUSE IT WILL BE “TOO MUCH”
TO BE PROCESSED, INTEGRATED, AND ADAPTED TO
TRAUMATIC STRESS
TOO LITTLE CHALLENGE
WILL OFFER “TOO LITTLE” IMPETUS AND OPPORTUNITY
FOR TRANSFORMATION AND GROWTH,
SERVING INSTEAD SIMPLY
TO REINFORCE THE – DYSFUNCTIONAL – STATUS QUO
BUT JUST THE RIGHT AMOUNT OF CHALLENGE
WILL PROVIDE “JUST THE RIGHT AMOUNT”
OF “LEVERAGE” NEEDED TO PROVOKE
– AFTER INITIAL DISRUPTION –
EVENTUAL RE – EQUILIBRATION
AT A HIGHER LEVEL
OF INTEGRATION, FUNCTIONALITY,
AND ADAPTIVE CAPACITY
OPTIMAL – NONTRAUMATIC – STRESS 51

THE “THERAPEUTIC USE” OF “OPTIMAL STRESS”
TO “PROVOKE RECOVERY”
DEPRIVING ONESELF OF HALF A NIGHT’S SLEEP ONCE A WEEK
PREFERABLY THE SECOND HALF OF THE NIGHT (FOR EXAMPLE, FROM 3 TO 7 AM)
CAN PRODUCE A RAPID, EVEN IF SHORT – LIVED,
RESTABILIZATION OF MOOD AND RECOVERY FROM DEPRESSION
THE “STRESS” OF INTERRUPTING NORMAL SLEEP PATTERNS
MAY “RESYNCHRONIZE DISTURBED CIRCADIAN RHYTHMS”
LEIBENLUFT AND WEHR (1992)
INTERMITTENT FASTING
A 36 – HOUR WATER FAST ONCE A WEEK
(FOR EXAMPLE, FROM AFTER DINNER ON MONDAY EVENING
TO BEFORE BREAKFAST ON WEDNESDAY MORNING)
CAN SO SIGNIFICANTLY REDUCE THE TOTAL BODY BURDEN
THAT MENTAL CLARITY AND FOCUS CAN BE IMPROVED DRAMATICALLY
AND A SENSE OF OVERALL WELL – BEING RESTORED
INTERMITTENT FASTING IS ALSO ASSOCIATED WITH INCREASED LEVELS
OF BRAIN – DERIVED NEUROTROPHIC FACTOR (BDNF)
DEPLETED LEVELS OF WHICH ARE THOUGHT TO BE ASSOCIATED WITH DEPRESSION
MARK MATTSON (2015)
PARENTHETICALLY, THE ONLY TYPE OF “CALORIE – RESTRICTING” DIET
THAT DOES NOT SLOW DOWN YOUR METABOLISM IS INTERMITTENT FASTING
53

“CREATING INJURY” TO “STIMULATE HEALING”
PROLOTHERAPY
A HIGHLY EFFECTIVE TREATMENT
FOR CHRONIC LIGAMENT AND TENDON WEAKNESS
IT INVOLVES INJECTING A MILDLY IRRITATING AQUEOUS SOLUTION
– FOR EXAMPLE, DEXTROSE, WATER, AND A LOCAL ANESTHETIC (LIDOCAINE) –
INTO THE AFFECTED LIGAMENT OR TENDON
IN ORDER TO INDUCE A MILD INFLAMMATORY REACTION
IN ESSENCE, IT WILL “TURN ON” THE BODY’S HEALING PROCESS
AND RESULT ULTIMATELY IN STRENGTHENING
OF THE DAMAGED CONNECTIVE TISSUE
AND ALLEVIATION OF CHRONIC MUSCULOSKELETAL PAIN
BY CONTRAST – CORTISONE INJECTIONS MIGHT WELL PROVIDE
IMMEDIATE PAIN RELIEF OVER THE SHORT – TERM BUT TISSUE
DESTRUCTION AND EXACERBATION OF PAIN OVER THE LONG – TERM
– BECAUSE OF THE CATABOLIC EFFECTS OF STEROID HORMONES –
PROLOTHERAPY INJECTIONS, HOWEVER, SUPPORT THE NATURAL
HEALING PROCESS BY STIMULATING THE HEALING CASCADE
– RESULTING ULTIMATELY IN OVERALL STRENGTHENING
OF THE CONNECTIVE TISSUE MATRIX AND RELIEF OF PAIN – 54

ANOTHER EXAMPLE
THE PRACTICE OF WOUND DEBRIDEMENT
TO ACCELERATE HEALING SPEAKS
DIRECTLY TO THIS CONCEPT OF
“CONTROLLED DAMAGE”
TO “TRIGGER REPAIR”
NOT ONLY DOES DEBRIDEMENT
PREVENT INFECTION BY REMOVING
FOREIGN MATERIAL AND DAMAGED TISSUE
FROM THE SITE OF THE WOUND
BUT IT ALSO PROMOTES HEALING
BY MILDLY AGGRAVATING THE AREA,
WHICH WILL IN TURN
“JUMP – START” THE BODY’S INNATE ABILITY
TO “SELF – REPAIR” IN THE FACE OF CHALLENGE
55

THE PATIENT’S INNATE
“RESISTANCE TO CHANGE”
“CHAOTIC SYSTEMS
– WHICH WE ALL ARE –
“RESIST DISRUPTION”
PROPOSED DEFINITION OF
“PSYCHODYNAMIC PSYCHOTHERAPY”
57

JUST AS WITH THE BODY
– WHERE A CHRONIC CONDITION MIGHT NOT HEAL UNTIL IT IS MADE ACUTE –
SO TOO WITH THE MIND
WHETHER CRISIS INTERVENTION, TRAUMA WORK,
SHORT – TERM INTENSIVE, OR LONGER – TERM IN – DEPTH
INDEED, OVER TIME I HAVE COME TO APPRECIATE THAT
ONGOING THERAPEUTIC PROVISION OF JUST THE RIGHT
COMBINATION OF “CHALLENGE” AND “SUPPORT”
NAMELY, “OPTIMAL STRESS”
AGAINST THE BACKDROP OF “SUPPORT” PROVIDED
BY WAY OF “MINIMALLY STRESSFUL” “CLARIFYING” INTERVENTIONS
WILL SOMETIMES BE THE “DESTABILIZING PROVOCATION” NEEDED
BOTH TO OVERCOME THE INHERENT “RESISTANCE TO CHANGE”
SO FREQUENTLY ENCOUNTERED
IN EVEN OUR MOST “WELL – INTENTIONED” PATIENTS
AND TO TRANSFORM THEIR “DEFENSIVE NEED”
TO MAINTAIN THINGS AS THEY ARE
– “SAME OLD, SAME OLD” –
INTO THE “ADAPTIVE CAPACITY” TO EVOLVE
– TO “SOMETHING NEW, DIFFERENT, AND BETTER” –
58

CHARLES KREBS (2013) HIGHLIGHTS THAT
“OPEN, SELF – ORGANIZING, COMPLEX ADAPTIVE
(CHAOTIC) SYSTEMS RESIST PERTURBATION”
EXAMPLES OF “CHAOTIC SYSTEMS” INCLUDE
ROAD TRAFFIC, OCEAN TURBULENCE, SAND DUNES,
AND THE “SELF – PROTECTIVE MECHANISMS” MOBILIZED BY ANXIOUS PATIENTS
DESPERATELY ATTEMPTING TO MANAGE THE “STRESSORS” IN THEIR LIVES
NO MATTER HOW COMPROMISED
THEY MIGHT BE IN THEIR FUNCTIONALITY
“SELF – ORGANIZING SYSTEMS”
– FUELED AS THEY ARE BY THEIR HOMEOSTATIC TENDENCY
TO REMAIN CONSTANT OVER TIME –
ARE INHERENTLY “RESISTANT TO CHANGE”
IN OTHER WORDS, OUR PATIENTS
– MUCH AS THEY MIGHT PROTEST THEIR “DESIRE TO CHANGE” –
HAVE AN “INNATE INERTIA” THAT MUST BE OVERCOME
IF THEY ARE EVER TO BE ENERGETICALLY RELEASED
FROM THE TOXICITY OF THEIR PAST
AND EMPOWERED TO EMBRACE LOVE, WORK, AND PLAY
TO THEIR GREATEST POTENTIAL GOING FORWARD
59

A HUMOROUS EXAMPLE OF “RESISTANCE TO CHANGE”
A SATURDAY NIGHT LIVE SKIT IN WHICH
TWO MEN ARE SEATED AROUND A FIRE
CHATTING AND ONE SAYS TO THE OTHER –
“YOU KNOW HOW WHEN YOU STICK
A POKER IN THE FIRE
AND LEAVE IT IN FOR A LONG TIME,
IT GETS REALLY, REALLY HOT?
AND THEN YOU STICK IT IN YOUR EYE,
AND IT REALLY, REALLY HURTS?
I HATE IT WHEN THAT HAPPENS!
I JUST HATE IT WHEN THAT HAPPENS!”
61

OR THE ROCK SONG
BY THE LATE WARREN ZEVON (1996)
ENTITLED
“IF YOU WON’T LEAVE ME
I’LL FIND SOMEBODY WHO WILL”
WHICH SPEAKS TO THE NEED
WE ALL HAVE TO RECREATE
THE “FAMILIAL AND THEREFORE FAMILIAR”
STEPHEN MITCHELL (1988)
BECAUSE THAT IS ALL WE HAVE EVER KNOWN
HAVING SOMETHING DIFFERENT
WOULD CREATE ANXIETY
BECAUSE IT WOULD HIGHLIGHT THE FACT
THAT THINGS COULD BE
– AND COULD THEREFORE HAVE BEEN –
DIFFERENT
62

I AM HERE REMINDED OF PORTIA NELSON’S
AUTOBIOGRAPHY IN 5 SHORT CHAPTERS (1993)
WHICH HIGHLIGHTS BOTH
OUR “DEFENSIVE NEED” TO “MAINTAIN THINGS AS THEY ARE”
AND OUR “ADAPTIVE CAPACITY” ULTIMATELY TO “CHANGE”
CHAPTER 1
I WALK DOWN THE STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I FALL IN
I AM LOST … I AM HELPLESS
IT ISN’T MY FAULT
IT TAKES FOREVER TO FIND A WAY OUT
CHAPTER 2
I WALK DOWN THE SAME STREET
I PRETEND I DON’T SEE IT
I FALL IN AGAIN
I CAN’T BELIEVE I AM IN THE SAME PLACE
BUT IT ISN’T MY FAULT
IT STILL TAKES A LONG TIME TO GET OUT
63

CHAPTER 3
I SEE IT IS THERE
I STILL FALL IN … IT’S A HABIT
MY EYES ARE OPEN
I KNOW WHERE I AM
IT IS MY FAULT
I GET OUT IMMEDIATELY
CHAPTER 4
I WALK AROUND IT
CHAPTER 5
I WALK DOWN ANOTHER STREET
64

SO WITH RESPECT TO OUR INTERVENTIONS
ONGOING AND JUDICIOUS USE
OF “OPTIMALLY STRESSFUL”
THERAPEUTIC INTERVENTIONS
MUST, THEREFORE, OFFER PATIENTS
ENOUGH “CHALLENGE”
THAT THERE WILL BE “IMPETUS”
FOR “DESTABILIZATION”
OF THEIR “DYSFUNCTIONAL DEFENSES”
BUT ENOUGH “SUPPORT”
THAT THERE WILL BE “OPPORTUNITY”
FOR “RESTABILIZATION”
OF THOSE “SELF – PROTECTIVE MECHANISMS”
AT EVER – HEALTHIER LEVELS
OF “FUNCTIONALITY” AND “ADAPTABILITY”
64

AGAIN
WITH THE THERAPIST’S FINGER
EVER ON THE PULSE OF THE
LEVEL OF THE PATIENT’S “ANXIETY”
AND CAPACITY TO TOLERATE
FURTHER CHALLENGE
THE THERAPIST WILL REPEATEDLY
“CHALLENGE WHENEVER POSSIBLE”
BY “DIRECTING THE PATIENT’S ATTENTION
TO WHERE SHE IS NOT”
– “DISRUPTIVE ATTUNEMENT” –
AND “SUPPORT WHENEVER NECESSARY”
BY “RESONATING EMPATHICALLY
WITH WHERE THE PATIENT IS”
– “HOMEOSTATIC ATTUNEMENT” –
SALMAN AKHTAR (2012)
AND WILL OFTEN BOTH “CHALLENGE” AND “SUPPORT”
67

68
JUST
THE
RIGHT
DOSES
OF
“CHALLENGE”
AND
“SUPPORT”
TO
CATALYZE
“GROWTH”
“DOSED
STIMULATION”

IT COULD BE SAID THAT
WITHOUT SUPPORT, THERAPY NEVER BEGINS
BUT WITHOUT CHALLENGE, THERAPY NEVER ENDS
ALTERNATIVELY
WITHOUT CHALLENGE, THERAPY NEVER BEGINS
BUT WITHOUT SUPPORT, THERAPY NEVER ENDS
BY THE SAME TOKEN, IT COULD BE SAID THAT
WITHOUT EMPATHY, THERAPY NEVER BEGINS
BUT WITHOUT EMPATHIC FAILURE, THERAPY NEVER ENDS
OR
WITHOUT EMPATHIC FAILURE, THERAPY NEVER BEGINS
BUT WITHOUT EMPATHY, THERAPY NEVER ENDS
IN ESSENCE
WITHOUT SUFFICIENT CHALLENGE,
THERE WILL BE NO IMPETUS FOR GROWTH
BUT WITHOUT ADEQUATE SUPPORT,
THERE WILL BE NO SUCH OPPORTUNITY
– THE MORAL OF THE STORY –
YOU NEED TO PROVIDE BOTH “CHALLENGE” AND “SUPPORT”
FROM BEGINNING TO END
69

IN OTHER WORDS
IT IS NOT SO MUCH EMPATHY AS
EMPATHIC FAILURE AGAINST A BACKDROP OF EMPATHY
“OPTIMAL DISILLUSIONMENT”
IT IS NOT SO MUCH GRATIFICATION AS
FRUSTRATION AGAINST A BACKDROP OF GRATIFICATION
“OPTIMAL FRUSTRATION”
IT IS NOT SO MUCH SUPPORT AS
CHALLENGE AGAINST A BACKDROP OF SUPPORT
“OPTIMAL STRESS”
THAT WILL PROVIDE THE “THERAPEUTIC LEVERAGE”
NEEDED TO “PROVOKE” ALTERNATING CYCLES
OF DESTABILIZATION AND THEN RESTABILIZATION
AT EVER – MORE ROBUST LEVELS OF “ADAPTIVE CAPACITY”
REQUIRES THIS ONGOING GENERATION OF
“DESTABILIZING ANXIETY” AND “INCENTIVIZING STRESS”
70

71
JUDICIOUS USE OF “OPTIMAL STRESS” PROVIDES
BOTH “IMPETUS” AND “OPPORTUNITY”
FOR THE PATIENT TO EVOLVE
– THROUGH “HEALING CYCLES” OF “DISRUPTION” AND “RECOVERY” –
FROM “ILLNESS” TO “WELLNESS”

TO REITERATE
NO MATTER WHERE THE PATIENT’S “STARTING POINT”
OR WHATEVER HER “LEVEL OF FUNCTIONALITY”
STRATEGICALLY FORMULATED
“OPTIMALLY STRESSFUL” INTERVENTIONS
WILL ALWAYS HAVE THERAPEUTIC IMPACT
BECAUSE THEY WILL BE “TAPPING INTO”
(1) THE PATIENT’S INNATE RESILIENCE
(2) THE “WISDOM OF HER BODY”
(3) HER INTRINSIC STRIVING TOWARDS HEALTH
(4) HER INBORN CAPACITY TO SELF – CORRECT
IN THE FACE OF OPTIMAL CHALLENGE
AGAIN, IT WILL BE THE ONGOING “SYNERGY”
BETWEEN THE THERAPIST’S “EXTERNAL SUPPORT”
– “ENVIRONMENTAL PROVISION” –
AND THE PATIENT’S “INTERNAL RESOURCES”
THAT WILL ENABLE THE PATIENT
– IN THE AFTERMATH OF EACH “PERTURBATION” –
TO RECONSTITUTE AT EVER – HEALTHIER LEVELS
OF “DYNAMIC BALANCE” AND “ADAPTIVE CAPACITY”
THEREBY REINFORCING “INNATE RESILIENCE”
WITH “ADAPTIVE RESILIENCE” 71

TO REVIEW
THE CUTTING – EDGE OF THE “THERAPEUTIC ACTION”
INVOLVES PROVIDING JUST THE RIGHT DOSES OF
“CHALLENGE” AND “SUPPORT”
SUCH THAT THERE WILL BE JUST THE RIGHT BALANCE BETWEEN
“DESTABILIZATION” OF THE “DYSFUNCTIONAL STATUS QUO”
AND ITS “RESTABILIZATION” AT A “MORE FUNCTIONAL LEVEL”
AND SO THAT PATIENTS
WON’T HAVE TO REMAIN ENTRENCHED IN “SAME OLD, SAME OLD,”
WON’T HAVE TO KEEP STICKING HOT POKERS IN THEIR EYES,
WON’T HAVE TO KEEP SETTING THEMSELVES UP
TO BE ABANDONED BY PEOPLE THEY LOVE,
AND WON’T HAVE TO KEEP FALLING INTO DEEP HOLES IN SIDEWALKS
WHENEVER POSSIBLE
– AND ALWAYS AGAINST THE BACKDROP OF “SUPPORT” AND “SECURE ATTACHMENT” –
THE THERAPIST WILL THEREFORE
“PRECIPITATE DISRUPTION” IN ORDER TO “TRIGGER REPAIR”
BY WAY OF “OPTIMALLY STRESSFUL” INTERVENTIONS
THAT EFFECTIVELY SUPERIMPOSE
AN ACUTE – “GROWTH – INCENTIVIZING” – INJURY
ON TOP OF A CHRONIC – “GROWTH – IMPEDING” – ONE
THEREBY TAPPING INTO THE SYSTEM’S
“UNDERLYING RESILIENCE”
AND “INTRINSIC STRIVING TOWARDS HEALTH” 73

PROPOSED DEFINITION FOR “PSYCHODYNAMIC PSYCHOTHERAPY”
BY WAY OF “OPTIMALLY STRESSFUL”
THERAPEUTIC INTERVENTIONS
THAT SUPERIMPOSE AN ACUTE INJURY
ON TOP OF A CHRONIC ONE
– THEREBY TRIGGERING “HEALING CYCLES” OF “DISRUPTION” AND “REPAIR” –
PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT
BOTH “IMPETUS” AND “OPPORTUNITY”
– ALBEIT BELATEDLY –
TO MASTER TRAUMATIC EXPERIENCES
THAT HAD ONCE BEEN OVERWHELMING
– AND, THEREFORE, DEFENDED AGAINST –
BUT THAT CAN NOW
– WITH ENOUGH SUPPORT FROM THE THERAPIST
AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE
AND INTRINSIC CAPACITY TO ADAPT TO STRESS –
BE REVISITED, REPROCESSED, AND REFRAMED
SUCH THAT GROWTH – IMPEDING DEFENSES CAN BE
GRADUALLY UPGRADED TO GROWTH – PROMOTING ADAPTATIONS
STRONGER AT THE BROKEN PLACES 74

THE SANDPILE MODEL
AND
THE “PARADOXICAL IMPACT”
OF “OPTIMAL STRESS”
79

THE PARADOXICAL IMPACT OF STRESS
THE “SANDPILE MODEL” OF CHAOS THEORY
OFFERS AN ELEGANT VISUAL DEMONSTRATION
OF THE CUMULATIVE IMPACT
– OVER TIME –
OF ENVIRONMENTAL STRESSORS
ON OPEN SYSTEMS
– THINK “HOURGLASS” –
I USE THIS “SANDPILE MODEL”
WHICH SIMULATES THE EVOLUTION
– OVER TIME –
OF OPEN, SELF – ORGANIZING (CHAOTIC) SYSTEMS
– LIKE THE STOCK MARKET, NEURAL NETWORKS, WATERFALLS –
AS A VISUAL METAPHOR
FOR THE “THERAPEUTIC ACTION”
OF “PSYCHODYNAMIC PSYCHOTHERAPY”
80

81
THE SANDPILE MODEL
OF CHAOS THEORY
PER BAK (1996)
ITERATIVE CYCLES
OF DESTABILIZATION
AND RESTABILIZATION
AT EVER – HIGHER LEVELS
OF INTEGRATION
AND COMPLEXITY
A VISUAL METAPHOR FOR
THE CUMULATIVE IMPACT
– OVER TIME –
OF OPTIMAL STRESS
ON MIND AND BODY

THE PARADOXICAL IMPACT OF STRESS
BOTH THE “SANDPILE MODEL”
AND THE “THERAPEUTIC ACTION”
FEATURE THE “EMERGENCE”
– OVER TIME –
OF “ITERATIVE CYCLES”
OF “DESTABILIZATION”
– A “DEFENSIVE REACTION” TO THE “CHALLENGE” –
AND “RESTABILIZATION”
– AN “ADAPTIVE RESPONSE” TO THE “SUPPORT”
AS THESE “CHAOTIC SYSTEMS” EVOLVE
TO EVER – MORE RICHLY TEXTURED LAYERS
OF RESILIENCE, COMPLEXITY,
INTEGRATION, AND DYNAMIC BALANCE
NOT JUST “IN SPITE OF”
ENVIRONMENTAL STRESSORS
BUT “BY WAY OF”
THOSE STRESSORS
82

HOW SO?
AMAZINGLY ENOUGH
THE GRAINS OF SAND BEING STEADILY ADDED
TO THE GRADUALLY EVOLVING SANDPILE
– MUCH LIKE THE “OPTIMALLY STRESSFUL” INTERVENTIONS
THAT WE ARE STEADILY OFFERING OUR PATIENTS –
ARE THE OCCASION FOR
BOTH “DISRUPTION” AND “REPAIR”
NOT ONLY DO THE GRAINS OF SAND
– SO, TOO, OUR THERAPEUTIC INTERVENTIONS –
PERIODICALLY PRECIPITATE
PARTIAL COLLAPSES OF THE SANDPILE
– DESTABILIZATION OF THE PATIENT’S DEFENSES –
(DESCRIBED AS “MINOR AVALANCHES” IN CHAOS THEORY)
BUT THEY ALSO BECOME
THE MEANS BY WHICH THE SANDPILE
– THE PATIENT’S INFRASTRUCTURE –
WILL THEN BE ABLE TO BUILD ITSELF BACK UP
– ITS STRUCTURAL INTEGRITY REINFORCED –
(EVERY TIME AT A MORE – RESILIENT LEVEL OF HOMEOSTASIS)
83

THE SYSTEM
– THE PATIENT –
WILL THEREFORE HAVE BEEN ABLE
NOT ONLY TO “MANAGE”
THE IMPACT OF THE STRESSFUL INPUT
BUT ALSO TO “BENEFIT FROM” THAT IMPACT
FROM “DEFENSIVE COLLAPSE”
TO “ADAPTIVE RECONSOLIDATION”
AT EVER – MORE ROBUST LEVELS
THE IRREGULARITIES IN THE SANDPILE
– MUCH LIKE THE SCARS WE ALL BEAR –
POIGNANT REMINDERS
OF THE “MINOR COLLAPSES”
– INJURIES –
WE HAVE ALL SUSTAINED
– OVER TIME –
BUT, ULTIMATELY, TRIUMPHANTLY OVERCOME
84

OPTIMAL STRESS
STRONGER AT THE BROKEN PLACES
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A BEAUTY NEVER ACHIEVED BY THINGS UNBROKEN?
IF A BONE IS FRACTURED AND THEN HEALS,
THE AREA OF THE BREAK WILL BE STRONGER
THAN THE SURROUNDING BONE
AND WILL NOT AGAIN EASILY FRACTURE
ARE WE, TOO, NOT STRONGER AT OUR BROKEN PLACES?
AND DO WE NOT ACQUIRE A QUIET STRENGTH
FROM SURVIVING ADVERSITY AND HARDSHIP
AND MASTERING THE EXPERIENCE OF
DISAPPOINTMENT, HEARTBREAK, AND DEVASTATION?
AND, THEN, WHEN WE FINALLY RISE ABOVE IT,
DON’T WE RISE UP IN QUIET TRIUMPH,
EVEN IF ONLY WE NOTICE …
86

STRESS IS WHEN
YOU WAKE UP SCREAMING
AND THEN YOU REALIZE
YOU HAVEN’T FALLEN
ASLEEP YET
ANONYMOUS
88

AGAIN, THE THERAPIST MUST KEEP HER FINGER EVER
ON THE PULSE OF THE LEVEL OF THE PATIENT’S “ANXIETY”
AND CAPACITY TO TOLERATE FURTHER CHALLENGE
– THAT IS, ON THE PATIENT’S CAPACITY TO TOLERATE
“OPTIMALLY STRESSFUL” INTERVENTIONS THAT JUXTAPOSE “CHALLENGE” AND “SUPPORT” –
TO “LAY THE GROUNDWORK” FOR THE INTRODUCTION OF
THESE “ANXIETY – PROVOKING” BUT “GROWTH – INCENTIVIZING” INTERVENTIONS
THE THERAPIST CALLS UPON ANY NUMBER OF “JOINING THROUGH THE TRUTH”
THAT WILL NOT ONLY “PROVIDE SUPPORT”
BUT ALSO “MOVE THE BALL FORWARD” A BIT
BY GENTLY “TEASING OUT” SOME OF THE “LESS – THAN – HEALTHY”
DAMAGED – FOR – LIFE STATEMENTS
SADISM STATEMENTS
EMPATHIC STATEMENTS
ALL OF WHICH NONJUDGMENTALLY HIGHLIGHT SOME OF
THE “RATHER PAINFUL AND DIFFICULT TRUTHS” IN THE PATIENT’S LIFE 88

89
DESIGNING “MINIMALLY STRESSFUL” “CLARIFYING” INTERVENTIONS
THAT TEASE OUT
“RECURRING THEMES, PATTERNS, AND REPETITIONS”

FOR THOSE PATIENTS WHO ARE HAVING TROUBLE
HOLDING IN MIND SIMULTANEOUSLY BOTH
THE “GOOD” AND THE “BAD” ASPECTS OF THEIR EXPERIENCE
IN OTHER WORDS
PATIENTS WITH TENUOUSLY ESTABLISHED
“LIBIDINAL OBJECT CONSTANCY” / “EVOCATIVE MEMORY CAPACITY”
“HARD TO REMEMBER” / “HARD TO IMAGINE”
“WHEN YOU’RE FEELING THIS BAD,
IT’S HARD TO REMEMBER THAT YOU HAD EVER FELT GOOD
AND IT’S HARD TO IMAGINE THAT YOU COULD EVER FEEL GOOD AGAIN.”
“WHEN YOUR HEART IS BREAKING AS IT IS NOW,
YOU CAN’T IMAGINE THAT YOU COULD EVER DARE TO TRUST AGAIN.”
“WHEN YOU’RE FEELING THIS ANGRY AT ME,
IT’S HARD TO REMEMBER THAT YOU USED TO FEEL GOOD ABOUT ME
AND EVEN LOOKED FORWARD TO COMING.”
“WHEN YOU FEEL THIS DESPAIRING,
YOU CAN’T REMEMBER EVER HAVING HAD ANY HOPE WHATSOEVER.”
90

FOR THOSE PATIENTS WHO ARE
“REACTING DEFENSIVELY”
RATHER THAN
“RESPONDING ADAPTIVELY”
EASIER TO “REACT DEFENSIVELY”
THAN TO “RESPOND ADAPTIVELY”
“IT’S EASIER TO GIVE UP THAN TO KEEP FIGHTING
FOR WHAT YOU REALLY BELIEVE IN.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS DISEMPOWERED
THAN TO TAKE OWNERSHIP OF THE POWER
AND AGENCY THAT YOU ACTUALLY DO HAVE.”
“IT’S EASIER TO EXPERIENCE YOURSELF AS HAVING NO
ACCOUNTABILITY THAN TO TAKE RESPONSIBILITY FOR YOUR LIFE.”
“IT’S EASIER TO HOLD ON TO THE HOPE THAT YOUR HUSBAND
MIGHT SOMEDAY CHANGE THAN TO CONFRONT
THE REALITY THAT HE PROBABLY NEVER WILL.” 91

THE “I CAN’T, YOU CAN, AND YOU SHOULD” DYANMIC
FOR THOSE PATIENTS WHO EXPERIENCE THEMSELVES AS
SO “DAMAGED” FROM WAY BACK THAT THEY CAN’T
IMAGINE BEING HELD ACCOUNTABLE FOR THEIR LIVES NOW
DAMAGED – FOR – LIFE – AND – THEREFORE
– NOT – RESPONSIBLE – NOW STATEMENTS
WHO FIND THEMSELVES, THEREFORE, LOOKING TO OTHERS
TO “COMPENSATE” THEM FOR THE EARLY – ON “DAMAGE”
AND WHO
– QUITE FRANKLY –
FEEL THAT THIS “COMPENSATION” IS THEIR DUE
DISTORTION – DISTORTED SENSE OF SELF AS “NOT HAVING”
ILLUSION – ILLUSORY SENSE OF OBJECT AS “HAVING”
ENTITLEMENT – ENTITLED SENSE THAT “GETTING” IS THEIR “DUE”
ALL OF WHICH ARE DEFENSIVE REACTIONS
92

DAMAGED – FOR – LIFE – AND – THEREFORE
– NOT – RESPONSIBLE – NOW STATEMENTS
“YOU FEEL SO DAMAGED BECAUSE OF ALL
THE ABUSE YOU SUFFERED AS A CHILD THAT
YOU CANNOT IMAGINE EVER BEING ABLE TO DO
ANYTHING NOW TO MAKE YOUR LIFE BETTER.”
“WHEN YOU ARE FEELING DESPERATE, AS YOU
ARE NOW, YOU FIND YOURSELF WISHING THAT
SOMEONE WOULD UNDERSTAND JUST HOW BAD YOU FEEL
AND DO SOMETHING TO HELP EASE YOUR PAIN.”
“BECAUSE YOU FEEL THAT WHAT YOUR FATHER DID TO YOU
WAS SO UNFAIR, DEEP DOWN YOU HARBOR
THE CONVICTION THAT THE WORLD NOW OWES YOU.”
“BECAUSE YOUR MOTHER NEVER UNDERSTOOD YOU AND
LEFT YOU SO MUCH ON YOUR OWN, YOU’RE NOW FEELING
THAT UNLESS SOMEONE IS WILLING TO GO MORE THAN
HALFWAY, THEN YOU’RE SIMPLY NOT INTERESTED.” 93

FOR THOSE PATIENTS WHO
– BECAUSE IT SIMPLY “HURTS TOO MUCH” –
REFUSE TO “CONFRONT” – AND “GRIEVE” – THE REALITY
THAT THE “OBJECT OF THEIR DESIRE” WILL NEVER CHANGE
INSTEAD, THEY HOLD ON TO THEIR
DEFENSIVE – AND RELENTLESS – “HOPING AGAINST HOPE”
“BECAUSE IT IS SO PAINFUL TO HAVE TO CONFRONT THE TRUTH
ABOUT YOUR HUSBAND AND HIS ONGOING INSENSITIVITY TO YOU
AND YOUR FEELINGS, YOU FIND YOURSELF CONTINUING TO HOPE
THAT PERHAPS, IF YOU TRY HARD ENOUGH, ARE PERSUASIVE
ENOUGH, PERSIST LONG ENOUGH, AND SUFFER DEEPLY ENOUGH,
THEN YOU MIGHT YET BE ABLE TO COMPEL HIM TO CHANGE.”
“BECAUSE IT HURTS TOO MUCH TO CONFRONT THE REALITY THAT
YOUR FATHER WILL NEVER BE WILLING TO APOLOGIZE FOR ALL THAT
HE DID TO YOU WHEN YOU WERE GROWING UP, YOU KEEP HOPING
THAT IF YOU TRY HARD ENOUGH, PERSIST LONG ENOUGH, AND
SUFFER DEEPLY ENOUGH, THEN HE MIGHT YET RELENT AND BE WILLING
TO ACKNOWLEDGE THAT HE KNOWS HE CAUSED YOU TERRIBLE
HEARTBREAK DURING ALL THOSE YEARS OF HIS DRINKING.”
94

SADISM STATEMENTS
FOR THOSE PATIENTS WHO
– IN THOSE MOMENTS OF DAWNING RECOGNTION THAT WHAT THEY
HAD SO DESPERATELY WANTED AND FELT THEY NEEDED TO HAVE
IN ORDER TO SURVIVE IS SIMPLY NOT GOING TO HAPPEN –
ARE DEFENSIVELY PRONE TO EXPERIENCING THEMSELVES
AS HAVING BEEN “MISTREATED” AND / OR “VICTIMIZED”
THEY WILL OFTEN THEN FIND THEMSELVES FEELING THAT THEY
EITHER HAVE NO CHOICE BUT TO RETALIATE
OR ARE ENTITLED TO RETALIATE
“WHEN YOU’RE FEELING THAT YOU’VE BEEN WRONGED,
YOU CAN GET PRETTY UGLY IF YOU HAVE TO!”
“WHEN YOUR MOTHER IS DOING HER ‘USUAL,’
IT HURTS SO MUCH TO BE FEELING SO MISUNDERSTOOD
THAT YOU FIND YOURSELF THINKING ABOUT
WHAT YOU CAN DO TO HURT HER BACK.
YOU WANT TO HER GET A TASTE OF HER OWN MEDICINE.”
“WHEN YOU FEEL THAT YOU ARE BEING MISTREATED,
IT MAKES YOU SO ANGRY THAT YOU FEEL
YOU HAVE NO CHOICE BUT TO RESPOND IN KIND.” 95

FOR THOSE PATIENTS WHO ARE DEEPLY ENTRENCHED
IN MAINTAINING “SAME OLD, SAME OLD”
ALTHOUGH THE PATIENT HAS BEEN GIVING “LIP SERVICE” TO WANTING
TO CHANGE, IT IS CLEAR FROM WHAT THE PATIENT IS ACTUALLY DOING
THAT THE PATIENT IS NOT, IN FACT, PREPARED TO CHANGE
THE THERAPIST THEREFORE “LETS GO” OF HER OWN “NEED”
FOR THE PATIENT TO CHANGE AND “ACCEPTS” THE REALITY THAT
THE PATIENT IS NOT PREPARED TO CHANGE – AT LEAST “NOT FOR NOW”
IN ESSENCE, THE THERAPIST “GOES WITH THE RESISTANCE” BY
“PRESCRIBING THE SYMPTOM”
“I THINK I AM BEGINNING TO SEE WHY YOU FEEL THAT YOU CANNOT
AFFORD TO TRUST ANYONE. BASED ON WHAT YOU’RE TELLING ME ABOUT
THE NUMBERS OF TIMES YOUR TRUST HAS BEEN BETRAYED AND YOUR
HEART BROKEN IN THE PAST, I CAN NOW UNDERSTAND WHY YOU FEEL
THAT YOU SIMPLY MIGHT NEVER FIND SOMEONE WITH WHOM YOU
WOULD WANT TO SPEND THE REST OF YOUR LIFE. ALTHOUGH IT
MIGHT MEAN BEING ALONE FOREVER, AT LEAST YOU’LL KNOW
THAT NO ONE WILL EVER BE ABLE TO HURT YOU EVER AGAIN.” 96

IN ESSENCE, THE THERAPIST USES HER “EMPATHIC UNDERSTANDING”
OF THE PATIENT TO OFFER HER A PARADOX
TO THE PATIENT WHO, EVEN AFTER A YEAR, HAS NOT BEEN ABLE TO MOBILIZE
HIMSELF TO UPDATE HIS RESUME – DESPITE HIS PROCLAIMED INTENTION TO DO SO
“ALTHOUGH EVERY SINGLE DAY YOU DREAD GOING TO WORK,
YOU HATE YOUR BOSS, AND YOUR JOB IS INCREDIBLY TEDIOUS, IT DOES
PROVIDE YOU WITH FINANCIAL SECURITY, AS YOU OFTEN REMIND US.
SO, I THINK I AM BEGINNING TO APPRECIATE THAT, AT THIS POINT
IN YOUR LIFE, PERHAPS IT DOESN’T REALLY MAKE SENSE FOR YOU
TO BE MOVING FORWARD WITH APPLYING FOR A NEW JOB.
PERHAPS AT SOME POINT IN THE FUTURE, BUT NOT RIGHT NOW.”
TO A DESPERATELY UNHAPPY 45 – YEAR – OLD MAN MARRIED FOR 20 YEARS
“YOU HATE IT THAT YOUR WIFE ABUSES YOU IN ALL THE
WAYS THAT SHE DOES. AND YOU TELL ME REPEATEDLY THAT YOU
STOPPED LOVING HER LONG AGO. BUT THEN YOU BEGIN
TO THINK ABOUT HOW OLD AND TIRED YOU FEEL AND
DECIDE THAT PERHAPS IT IS TOO LATE, THAT THE TIME
TO HAVE LEFT HER MIGHT ALREADY HAVE COME AND GONE.”
IF THE PATIENT IS MADE ANGRY BY THE THERAPIST’S PARADOXICAL INTERVENTION,
THEN THE PATIENT’S ANGER MIGHT WELL EMPOWER HER –
MIGHT WELL PROVIDE THE NECESSARY MOTIVATION (OR IMPETUS)
FOR HER TO TAKE ACTION – IF ONLY TO PROVE THE THERAPIST WRONG!
97

WITNESS STATEMENTS
THE THERAPIST MAKES EXPLICIT THAT
SHE IS A WITNESS TO WHAT THE PATIENT IS FEELING
– “I SEE HOW MUCH PAIN YOU ARE IN.” –
“I SEE HOW DESPERATELY YOU WANT TO GET BETTER.” –
NOTE THE SUBTLE DISTINCTION BETWEEN
“I SEE HOW LONELY YOU ARE FEELING.”
AND “I HEAR HOW LONELY YOU ARE FEELING.”
“I SEE HOW SAD YOU BECOME WHEN YOU TALK ABOUT
YOUR MOTHER AND HOW SHE NEVER UNDERSTOOD.”
AND “I HEAR HOW SAD YOU BECOME WHEN YOU TALK ABOUT
YOUR MOTHER AND HOW SHE NEVER UNDERSTOOD.”
IT FEELS GREAT TO BE ABLE TO KNOW
THAT HOW LONELY AND SAD YOU ARE IS BEING “HEARD.”
BUT SOMETIMES IT IS EVEN MORE
VALIDATING AND REASSURING TO BE ABLE TO KNOW
THAT HOW LONELY AND SAD YOU ARE IS BEING “SEEN.”
98

“EMPATHIC STATEMENTS”
ARE MY “DEFAULT MODE”
THEY “SUPPORT”
BY “RESONATING EMPATHICALLY”
– MOMENT BY MOMENT –
WITH THE PATIENT’S “AFFECT”
AND THE “NARRATIVE”
WITH WHICH THAT AFFECT
IS ASSOCIATED
THEY ARE OFTEN “NEEDED”
TO “PROVIDE SUPPORT”
AND “LAY THE GROUNDWORK”
FOR “ANXIETY – PROVOKING”
“OPTIMALLY STRESSFUL” INTERVENTIONS
– THAT WILL BOTH “CHALLENGE” AND “SUPPORT” –
101

OVER THE COURSE OF THE YEARS
I HAVE COME TO APPRECIATE
THAT WHATEVER THE TREATMENT
– WHETHER CRISIS INTERVENTION, TRAUMA WORK,
SHORT – TERM INTENSIVE, OR LONGER – TERM IN – DEPTH –
IT WILL GENERALLY BE MORE EFFECTIVE
TO “MAKE STATEMENTS” THAN TO “ASK QUESTIONS”
“QUESTIONS” RUN THE RISK
OF ELICITING SOMEWHAT “HEADY ANSWERS”
– MORE “INTELLECTUAL” THAN “HEARTFELT” –
FOR THE MOST PART THEREFORE
I LET THE PATIENT “LEAD” AND I “FOLLOW”
I “MAKE STATEMENTS” AND DON’T “ASK QUESTIONS”
IN OFFERING THE PATIENT STATEMENTS
I AM, OF COURSE, “GIVING” HER SOMETHING
RATHER THAN “ASKING” OF HER
THAT SHE “GIVE” ME SOMETHING
– NAMELY, ANSWERS TO MY QUESTIONS –
103

SO I TAKE MY CUES FROM THE PATIENT
AND AM GENERALLY, THEREFORE, ONE STEP BEHIND HER – NOT AHEAD OF HER
LISTENING ALWAYS WITH COMPASSION AND NEVER JUDGMENT
– WITH BOTH “HEAD” AND “HEART” –
TO EVERYTHING THE PATIENT IS TELLING ME
– NO MATTER HOW SEEMINGLY IRRELEVANT IT MIGHT APPEAR TO BE –
I WILL THEN OFFER “EMPATHIC STATEMENTS”
THAT HIGHLIGHT
“WHAT THE PATIENT IS ACTUALLY FEELING RIGHT THEN”
AND “ABOUT WHAT”
STATEMENTS THAT OFTEN END
WITH AN IMPLIED QUESTION MARK
WHEREBY I AM SIGNALING THAT I AM VERY OPEN
TO HAVING MY RENDERING OF THINGS
EDITED, CORRECTED, OR REVISED
IN ORDER TO MAKE IT A MORE ACCURATE REFLECTION
OF WHAT THE PATIENT IS ACTUALLY SAYING
AND WANTING ME TO KNOW
104

EXAMPLES OF EMPATHIC STATEMENTS
“IT IS HARD TO KNOW WHERE TO BEGIN
WHEN EVERYTHING FEELS SO OVERWHELMING.”
“IT IS UNCOMFORTABLE TO BE HERE
WHEN YOU’RE NOT SURE THE THERAPY IS REALLY HELPING ANYWAY.”
“IT IS UPSETTING TO BE FEELING THIS OUT OF CONTROL.”
ALL OF WHICH SPEAK TO BOTH
THE PATIENT’S “AFFECT” AND THE “ASSOCIATED THEME”
THAT IS, THE “STORY” OR “NARRATIVE” THAT GOES WITH THE FEELING
“YOU ARE TIRED OF THINKING ABOUT
WHETHER YOU SHOULD STAY OR GO.”
“YOU HAVE SUCH DEEP DESPAIR ABOUT
EVER BEING ABLE TO FIND A TRUE SOULMATE.”
“YOU ARE TERRIFIED THAT YOU WILL BE DISAPPOINTED.”
“YOU ARE TERRIFIED THAT YOU YOURSELF WILL DISAPPOINT.”
“YOU ARE CONFUSED ABOUT HOW BEST TO USE THE SESSION.”
“YOU WORRY ABOUT WHAT I MIGHT BE THINKING.”
105

EMPATHIC STATEMENTS THAT HIGHLIGHT
WHAT THE PATIENT IS EXPERIENCING
IN A “SPECIFIC CONTEXT”
“IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD BY JUANITA.”
CAN THEN USUALLY BE “GENERALIZED”
FROM THE “SMALL” TO THE “ALL”
“IT IS PAINFUL TO BE FEELING ALWAYS SO MISUNDERSTOOD.”
BY THE SAME TOKEN
EMPATHIC STATEMENTS THAT HIGHLIGHT
WHAT THE PATIENT IS EXPERIENCING
IN THE “PRESENT”
“IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
CAN THEN USUALLY BE “EXTENDED”
TO THE “PAST”
“IT IS PAINFUL TO HAVE BEEN FEELING
SO MISUNDERSTOOD FOR SO LONG NOW.”
106

WITH RESPECT TO THE “FRAMING” OF AN “EMPATHIC STATEMENT”
PLEASE NOTE THAT INSTEAD OF
“I WONDER IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT SOUNDS AS IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT SEEMS AS IF IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
OR “IT MUST BE PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
YOU COULD SIMPLY SAY
“IT IS PAINFUL TO BE FEELING SO MISUNDERSTOOD.”
FOLLOWED BY THE IMPLIED QUESTION MARK
THEREBY SIGNALING THAT YOU ARE VERY OPEN
TO HAVING YOUR STATEMENT AMENDED
I DO MY BEST TO ELIMINATE EXTRA WORDS AT THE
BEGINNING OF MY “EMPATHIC STATEMENTS”
SO THAT I CAN CUT RIGHT TO THE CHASE
“IT BREAKS YOUR HEART THAT SHE DOESN’T SEEM TO CARE.”
EXTRA WORDS RUN THE RISK OF PUTTING TOO MUCH DISTANCE
BETWEEN THE THERAPIST AND THE PATIENT
107

EMPATHIC STATEMENTS ARE “EXPERIENCE – NEAR”
– NOT “EXPERIENCE – DISTANT” –
AND ARE “DESIGNED” TO “VALIDATE” OR “REINFORCE”
THE PATIENT’S “EXPERIENCE” IN THE MOMENT
AND TO “TEASE OUT” “RECURRING THEMES, PATTERNS, AND REPETITIONS”
IN HER CONSCIOUSNESS AND SOMETIMES HER PRECONSCIOUS
THEY ARE NOT DESIGNED TO TARGET HER UNCONSCIOUS
I AM HONORING WHAT THE PATIENT IS ACTUALLY SAYING
I AM NOT TRYING TO READ BETWEEN THE LINES
OR TO INTERPRET WHAT I THINK MIGHT LIE BENEATH THE SURFACE
I AM FOCUSING MORE ON THE “MANIFEST CONTENT”
THAN ON THE “LATENT CONTENT”
THE AIM OF THESE EMPATHIC STATEMENTS
IS TO HELP THE PATIENT “FEEL UNDERSTOOD,”
NOT TO HELP THE PATIENT “UNDERSTAND”
WHEN PATIENTS FEEL UNDERSTOOD,
THEY ARE LESS LIKELY TO GET DEFENSIVE
AND MORE LIKELY TO DELIVER INTO THE RELATIONSHIP
WHAT MOST MATTERS TO THEM
108

109
EMPATHIC
STATEMENTS
HIGHLIGHT
WHAT IS IN
THE PATIENT’S
CONSCIOUS
– OR PRECONSCIOUS –
MIND
THEY ARE
NOT DESIGNED
TO TARGET HER
UNCONSCIOUS
“OPTIMALLY
STRESSFUL”
INTERVENTIONS
ARE DESIGNED
TO DO THAT!

IN OTHER WORDS
EMPATHIC STATEMENTS
ARE SPECIFICALLY DESIGNED
NOT ONLY TO “HIGHLIGHT”
WHAT THE PATIENT IS ACTUALLY “FEELING”
BUT ALSO TO “MAKE EXPLICIT”
– AND “GIVE SHAPE TO” –
THE “STORIES” (OR “NARRATIVES”)
THAT THE PATIENT
– AS A YOUNG CHILD –
HAD CONSTRUCTED
IN A DESPERATE ATTEMPT
TO MAKE SENSE OF
THE RELATIONAL DEPRIVATION AND NEGLECT
– “ABSENCE OF GOOD” / “ERRORS OF OMISSION” –
AND THE RELATIONAL TRAUMA AND ABUSE
– “PRESENCE OF BAD” / “ERRORS OF COMMISSION” –
TO WHICH SHE WAS BEING SUBJECTED
110

BUT “MADE – UP” AND “DISEMPOWERING” STORIES
THAT HAVE NOW GENERALIZED
FROM THE “SMALL” (HER NUCLEAR FAMILY)
TO THE “ALL” (THE WORLD AROUND HER)
“NARRATIVES” THAT HAVE NOW BECOME
THE “GO – TO” DISTORTED FILTERS
THROUGH WHICH SHE EXPERIENCES
SELF, OTHERS, AND THE WORLD
AGAIN
THESE EMPATHIC STATEMENTS
DO NOT SPECIFICALLY “INCENTIVIZE”
STRUCTURAL TRANSFORMATION AND GROWTH,
BUT THEY DO “LAY THE GROUNDWORK”
FOR THE “OPTIMALLY STRESSFUL” INTERVENTIONS
THAT WILL FOLLOW
111

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Martha Stark MD – 13 Nov 2022 – Part 1 – The Art and The Science of Interpretation.pptx