by Martha Stark, MD / Faculty, Harvard Medical School


Patients who are caught up in their “relentless pursuit of the unattainable” demonstrate something to which I refer as the “I can’t, you can, and you should” dynamic.


More specifically, patients with this dynamic harbor an underlying conviction that they are so damaged from way back that they cannot be held accountable now (“I can’t”), will only get better by way of input from the outside (“you can”), and are entitled to such help (“you should”).


Until the (often unconscious) operation of such a dynamic has been made explicit by the therapist, the patient may be unable to make any real progress in either the therapy or her life.


Although there may be some external compliance on the patient’s part, it will only be “as if” she is getting better because, deep down, she will still be invested in seeing herself as a helpless victim and as therefore not accountable and in seeing you (her therapist) as the one who will provide her with the means to feel better.


First, a point of clarification – illusions (the province of my Model 2) speak to positive misperceptions of the object and distortions (the province of my Model 3) speak to negative misperceptions of the object.


So I have developed several interventions specifically designed to facilitate resolution of these stalemated situations characterized by the patient’s refrain of “I can’t” (distortion), “you can” (illusion), and “you should” (entitlement).


These interventions target the patient’s distortions, illusions, and entitlement – defenses to which the patient clings as unconscious justification for her refusal to take responsibility for her life.


But as long as she holds fast to her distorted sense of herself as “unable,” her illusory sense of her objects as “able,” and her entitled sense that this is her due, she will remain entrenched in her relentless pursuit of that which she can never have and she will be destined to feel chronically frustrated, angry, and desperately stuck.


Again, if the patient is ever to be able to move forward in her life, her underlying distortions, illusions, and entitlement must be made explicit and she must be “held accountable,” which the therapist will attempt to do by way of damaged-for-life, compensation, and entitlement statements.




Damaged-for-life-and-therefore-not-responsible-now statements attempt to highlight the patient’s distorted perception of herself as irreparably damaged from way back and as therefore unable to do anything now to correct for that damage.


"Deep down inside you feel so damaged because of the abuse you suffered as a child that you cannot imagine ever being able to do anything now to make your life better."


"Because you feel you got such a bum deal as a kid, you can't imagine that you'll ever be able to compensate now for the damage that was done to you then."


"You are so angry about all the bad luck you've had along the way that you feel you have no choice but to give up." 


"You feel so incapacitated, so impaired, so handicapped that you have trouble imagining that you could ever do anything to make things different."




Compensation statements attempt to highlight the patient’s illusory belief that others have it to give.


Whereas a damaged-for-life statement speaks to the patient’s distortions (her misperceptions of herself as a helpless victim), a compensation statement highlights the patient’s illusions (her magical belief that her objects will be able to give her the answers, the love, the know-how, the things she would need in order to feel better).


In other words, many patients believe that because of early-on deprivation and neglect, they are now limited in terms of their own resources and must therefore rely upon input from the outside in the here-and-now in order to compensate for what was lacking in the there-and-then.  So they find themselves looking to their objects to provide what they think they will need in order to rectify the damage sustained early on.


"You are feeling that you have come to the end of what you can do on your own and, at this point, are desperately wishing that somebody else would be willing to step up to the plate in order to help you out.”

"At times like this, when you’re feeling completely defeated, despairing, and exhausted, you find yourself thinking that you’ll never, ever get better unless someone else is willing to come through for you – for a change.”


"When you are feeling desperate, as you are now, you find yourself wishing that someone would understand and would do something to help ease your pain."


Parenthetically, if the therapist is in collusion with the patient’s illusion, that is, if the therapist shares the patient’s belief that the patient will get better only by way of input from the outside (most notably from the therapist), then it will be much more difficult for the therapist to facilitate the patient’s grieving, which is ultimately what the patient must do if she is ever to move beyond her stuck place.




Entitlement statements make explicit not only the patient’s wish for input from the outside but also her entitled sense that it is her right to have someone make up the difference to her.  In other words, because she feels so cheated from way back, the patient truly believes that she is now entitled to compensation in the here-and-now to make up for the early-on environmental failures.


"Because you feel that it was so unfair, what your father did to you, deep down inside 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."


Entitlement statements not only highlight the fact of the patient’s entitlement but also contextualize it as a reasonable enough reaction to early-on privation, deprivation, and insult.


"Your father never supported you and was always critical; so, at this point, you are convinced that you won’t be able to move forward in your life until he can acknowledge that he was wrong and that he now owes you an apology."




In sum, it is crucial that the patient’s (often unconscious) sense of entitlement be recognized and made explicit.  Many patients who have reached some kind of impasse in their therapy and/or their lives hold fast to their conviction that they have gone not only as far as they can go but also as far as they should have to go – and that it is now up to someone else to take it from here.


They believe that since it was not their fault then, it should not be their responsibility now.


Admittedly, it was not their fault then – but it is their responsibility now.  And if they don’t do it, no one else will.


For the patient’s resistance to be overcome, her underlying distortions, illusions, and entitlement must therefore be made explicit and the patient held accountable, which the therapist attempts to do by way of these damaged-for-life, compensation, and entitlement statements.