OPTIMALLY STRESSFUL PSYCHOTHERAPEUTIC INTERVENTIONS

by Martha Stark, MD / Faculty, Harvard Medical School

 

 

By way of review:

 

Model 1 (the interpretative 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.

 

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.

 

ANXIETY-PROVOKING BUT ULTIMATELY GROWTH-PROMOTING STATEMENTS

Conflict Statements (Model 1)

Disillusionment Statements (Model 2)

Accountability Statements (Model 3)

Facilitation Statements (Model 4)

 

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.

 

These statements aim 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 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.

 

These statements aim 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.

 

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.

 

These statements aim to increase the patient’s awareness of her tendency to replay 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.

 

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.

 

These statements aim 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.

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


www.SynergyMed.Solutions ~ www.MindBodyHealth.Solutions

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