Accountability Statements and the "Rule of Three"

Model 3 ~ The Contemporary Relational Perspective

 

by Martha Stark, MD / Faculty, Harvard Medical School

 

The Model 3 therapist uses her “self,” that is, her countertransference, to inform her understanding of the patient.

 

And once the therapist becomes aware of the fact that she is beginning to react countertransferentially to the patient’s transferential re-enactments, therapist and patient together – with shared heart and mind – can negotiate their way out of what has become a mutual enactment. In the process they will find that both survive; in essence, they will discover the indestructibility of both.

 

Although the therapist should always attempt to withstand the patient’s efforts to draw her in to participating in the patient’s dramatic re-enactments, relational theories of therapeutic action postulate that it is not only inevitable but also necessary (and therefore desirable) that ultimately the therapist will fail the patient – and in the very ways that the patient most needs to be failed if she is ever to detoxify her internal badness, rework her internalized traumas, and overcome her internal demons – in other words, if there is ever to be structural change.

 

For example, whenever a patient says or does something that the therapist experiences as provocative, I describe it as a “provocative enactment.”

 

In order to get the patient to take ownership of what she is implicitly attempting to communicate, the therapist has the option of asking 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 ego

 

All three relational interventions demand of the patient that she make her interpersonal intentions more explicit – in other words, that she take responsibility for her provocative enactment.

 

There are actually numbers of relational interventions (also known as accountability statements) within the therapist’s armamentarium that she can use to address the dysfunctional relational dynamics that the patient – in an effort to achieve mastery of her unmastered early-on relational traumas – will compulsively, unwittingly, and continuously re-enact on the stage of the treatment.

 

Model 3 accountability statements can involve, for example, interpreting the patient’s enactments as an effort either to draw the therapist in to participating as the abusive parent the patient had (by way of behavior on the patient’s part that is unconsciously designed to elicit an abusive reaction from the therapist) or to get the therapist to understand firsthand what it was like for the patient growing up (by way of behavior on the patient’s part that involves unconsciously doing unto the therapist some version of what the abusive parent had once done unto the patient as a child).

 

In the first instance (whereby the patient draws the therapist in to participating as the abusive parent the patient had), this is a “direct negative transference” – in which the therapist is made into the abusive parent and the patient once again assumes the role of the abused child.

 

In the second instance (whereby the patient gets the therapist to understand firsthand what it was like for the patient growing up), this is an “inverted negative transference” – in which the patient assumes the role of the abusive parent and then behaves as such in relation to the therapist in an effort to get the therapist to understand.

 

On the one hand, it is certainly daunting to imagine that a therapist might ever become even a little abusive in relation to her patient. On the other hand, if the patient had an abusive parent, and therefore introjected the victimizer-victim relational dynamic, but the therapist does not allow herself to be drawn in to participating countertransferentially in whatever way the patient might need her to, then the therapist will be robbing the patient of a prime opportunity to rework her sense of herself as bad and of the world as bad by playing out the dysfunctional dynamic of self-sabotage and victimization on the stage of her life.

 

Indeed it might well be only by way of recreating with her therapist the only kind of relationship she has ever known that the patient will be able at last to negotiate with her therapist a different ending.

 

© 2020  Martha Stark, MD ~ Founder / CEO, SynergyMed for MindBodyHealth ~ 617.244.7188 ~ MarthaStarkMD@HMS.Harvard.edu


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