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, integrated, and ultimately adapted to. This opportunity for belated mastery of traumatic experiences and transformation of defense into adaptation speaks to the power of the transference, whereby the here-and-now is imbued with the primal significance of the there-and-then.
Ultimately, the therapeutic goal is to transform less-evolved defense into more-evolved adaptation – from externalizing blame to taking ownership, from whining and complaining to becoming proactive, from dissociating to becoming more present, from feeling victimized to becoming empowered, from being jammed up to harnessing one's energies and then channeling them into the pursuit of one's dreams, from denial to confronting head-on, from being critical to becoming more compassionate, and from cursing the darkness to lighting a candle.
Growing up (the task of the child) and getting better (the task of the patient) are therefore a story about transforming need into capacity – the need for immediate gratification into the capacity to tolerate delay, the need for perfection into the capacity to tolerate imperfection, the need for external regulation of the self into the capacity to be internally self-regulating, and the need to hold on into the capacity to let go.
In sum, it could be said that, as a result of intensive psychodynamic psychotherapy, "resistance" will be replaced by "awareness" and "actualization of potential," "relentless pursuit of the unattainable" replaced by "acceptance," "re-enactment of unresolved childhood dramas" replaced by "accountability," and "retreat and resignation" replaced by "accessibility."
As a contemporary relational psychoanalyst, my longstanding clinical interest has long been in something to which I refer as "relentless hope" – the hope a defense, ultimately, against grieving.
Our refusal to deal with the pain of our grief about the "object of our desire" will fuel the relentlessness with which we pursue it – both the relentlessness of our hope that we might yet be able to make the object over into what we would want it to be and the relentlessness of the outrage we experiences in those moments of dawning recognition that, despite her best efforts and most fervent desire, we might never be able to make that actually happen.
In other words, what fuels our relentless pursuit of the object is our refusal to accept the reality that it is not now, and nor will it ever be, all that we would have wanted it to be.
So, at bottom, what ignites our relentlessness is the fact of the object's existence as separate from ours, as outside the sphere of our omnipotence (1985, Donald W. Winnicott, MATURATIONAL PROCESSES AND THE FACILITATING ENVIRONMENT), and as therefore unable to be either possessed or controlled.
In truth, it is this very immutability of the object – the fact that the object cannot be forced to change – that provides the propulsive fuel for our relentless pursuit.
Even in the face of incontrovertible evidence to the contrary, the object of our desire will be pursued with a vengeance, the intensity of this pursuit deriving from our entitled conviction that the object could give it (where the object but willing), should give it (because that is our due), and would give it (were we but able to get it right).
Along these lines, Elvin Semrad (2003, Susan Rako, SEMRAD: THE HEART OF A THERAPIST) has said, "Pretending that something can be when it can't is how people break their hearts."
On a lighter note, I am here reminded of one of my favorite THE NEW YORKER cartoons, in which a gentleman, seated at a table in a restaurant named "The Disillusionment Cafe," is awaiting the arrival of his order. The waiter returns to his table and announces, "Your order is not ready, and nor will it ever be."
If we are ever to transform our need to hold on into the capacity to let go, we must ultimately confront – and mourn – the pain of our grief about all the disappointing objects we have encountered along the way, grief against which we have spent a lifetime unconsciously defending ourselves – in the process, finally relenting, forgiving, and evolving to a place of sober, mature acceptance. Only once we have been able, finally, to master and integrate the dissociated grief will be able to relinquish our relentless and infantile pursuit of that which can never be.
Perhaps it could be said that maturity is achieved once we have transformed our need to have the world (and ourselves) be a certain way into the capacity to accept things as they are – once we have transformed our defensive need to deny painful truths into the adaptive capacity to confront them, grieve them, and ultimately accept them. It could therefore be said that maturity is a hard-earned adaptation to the impact of devastating truths – it requires the acceptance of heartbreaking realities that sober and sadden.
At the end of the day, psychotherapy is ultimately a story about the belated processing of unmastered experience and the grieving of early-on heartbreak.
"Everybody has a secret
that would break your heart."
"People don't run out of dreams.
People just run out of time."
~ Glenn Frey (The Eagles)
Martha Stark, MD
A PRIMER ON
Martha Stark, MD
Martha Stark, MD
Publications by Martha Stark, MD
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Martha Stark, MD
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"I Want My Mommy"
"YouTube ~ How I Became a Holistic Psychoanalyst
and Integrative Medicine Specialist"
Today's Practitioner / Advancing Integrative Care
Published Article in Dose-Response ~
Alina's Miraculous Release from
the Tyranny of Obsessive Love
SynergyMed for MindBodyHealth
Integrating Traditional and Nontraditional Solutions
INDIVIDUAL SUPERVISION / CONSULTATION
(both in person and remotely)
SUPERVISION / CONSULTATION / STUDY GROUPS
(both in person and remotely)
With a focus always on the application of theory to practice, my supervision groups offer psychodynamic therapists a comfortable and safe haven to explore the “use of self” to find, and be found by, the patient.
My particular interest is in “accountability” and transformation of the “need to hold on” into the “capacity to relent” (relevant for both patient and therapist).
I have developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis, the deficiency-compensation perspective of self psychology and other deficit theories, the intersubjective perspective of contemporary relational theory, and an existential perspective. I work with these four modes of therapeutic action – PsychodynamicSynergy for MindBodyHealth – in my seven books on the application of theoretical constructs to clinical practice and in the supervision that I do.
As part of the work to be done, therapist and patient must be able to understand and name, in a profoundly respectful fashion, both those healthy forces that impel the patient in the direction of progress and those unhealthy resistive counterforces that impede such progress. Before a defense can be relinquished, patients must come to appreciate both their investment in the defense and the price they pay for holding onto it.
I will be proposing specific "optimally stressful" interventions for each step of the process by which the defenses can be worked through and transformed into adaptations. For example, conflict statements are empathic interventions that highlight the conflict within patients between their knowledge of reality (informed by their present) and their experience of reality (informed by their past). It will be the internal tension created through the patient's awareness of this discrepancy that will provide, ultimately, the impetus for change.
Within the context of safety provided by the relationship with their therapist, patients will be able, finally, to feel the pain against which they have spent a lifetime defending themselves. As they begin to confront the reality of the parental limitations, they will begin to let go of the defenses around which their resistance has organized itself. Only as patients grieve, doing now what they could not possibly do as a child, will they get better.
I would like to borrow from Stephen A. Mitchell a wonderful anecdote that captures the essence of the quintessential struggle in which all of us therapists are engaged as we attempt to master our art. Mitchell (1988, RELATIONAL CONCEPTS IN PSYCHOANALYSIS) writes: "<Stravinsky> had written a new piece with a difficult violin passage. After it had been in rehearsal for several weeks, the solo violinist came to Stravinsky and said he was sorry, he had tried his best, <but> the passage was too difficult; no violinist could play it. Stravinsky said, 'I understand that. What I am after is the sound of someone trying to play it.'"
As therapists, our work is exquisitely difficult and finely tuned – and often we will not be able to get it just right. Perhaps, however, we can console ourselves with the thought that it is the effort we make to get it just right that ultimately counts.
UNDERSTANDING LIFE BACKWARD
BUT LIVING IT FORWARD:
Analyzing to Understand
but Envisioning Possibilities
to Incentivize Action
by Martha Stark, MD
Do you wish you had a better way to describe what you do everyday in your psychotherapy office?
Do you wish you had a better grasp of psychodynamic concepts and their application to clinical situations?
If so, then please consider signing up for my online intensive 4-week PSYCHODYNAMIC PSYCHOTHERAPY MASTER CLASS entitled UNDERSTANDING LIFE BACKWARD BUT LIVING IT FORWARD: Analyzing to Understand but Envisioning Possibilities to Incentivize Action – a Continuing Education Activity (18 CE credits) sponsored by the Center for Psychoanalytic Studies at William James College.
Whatever your level of expertise, this rigorous course of study will allow you to learn remotely – and at your own pace – from the comfort and convenience of your home.
This intensive MASTER CLASS features my most current and innovative thinking about the actual "process" of healing – relevant for both mind and body and both short-term and long-term therapeutic work.
Theoretical material as well as brief – and extended – clinical vignettes will be offered in order to demonstrate the interweaving of theory with practice.
I will be teaching from 300+ PowerPoint Slides (available to participants 24/7) that are being continuously revised and updated. And I will be giving you a comprehensive list of recommended readings to accompany the material to which you are being exposed.
In addition, there will be an online forum featuring "threaded discussions" and moderated in a way that not only encourages the lively exchange of theoretical / clinical material but also provides the impetus for "playing" with ideas.
Over the course of the entire month, I will be maintaining a very active online presence, thoughtfully responding to all comments / reflections / questions.
There will also be a final one-hour "live" Q&A webinar, which will give us an opportunity to "meet" face to face.
I am so looking forward to this MASTER CLASS in October 2022 – it is such a fun way for me both to teach and to learn and, interestingly, offers participants an intriguing combination of intimacy and anonymity.
RECOMMENDED READINGS IN INTEGRATIVE PSYCHIATRY
Bak, P. 1999. How nature works: the science of self-organized criticality. Gottingen, Germany: Copernicus Publications.
Becker, R., and Selden, G. 1998. The body electric: electromagnetism and the foundation of life. New York, NY: William Morrow and Company / HarperCollins.
Buchanan, M. 2000. Ubiquity: why catastrophes happen. New York, NY: Three Rivers Press.
Cannon, W. B. 1932. The wisdom of the body. New York, NY: W. W. Norton & Co.
Capra, F. 1997. The web of life: a new scientific understanding of living systems. New York, NY: Anchor Books.
Greger, M. 2015. How not to die: discover the foods scientifically proven to prevent and reverse disease. New York, NY: Flatiron Books.
Ho, M. W. 2008. The rainbow and the worm: the physics of organisms. Singapore, China: World Scientific Publishing Company.
Kauffman, S. 1995. At home in the universe: the search for the laws of self-organization and complexity. New York, NY: Oxford University.
Lipton, B. 2007. The biology of belief: unleashing the power of consciousness, matter & miracles. Carlsbad, CA: Hay House.
McEwen, B. S. 1998. Stress, adaptation, and disease: Allostasis and allostatic load. Ann NY Acad Sci 840:33-44.
McTaggart, L. 2008. The field: the quest for the secret force of the universe. New York, NY: Harper Perennial.
Oschman, J. 2000. Energy medicine: the scientific basis. London, England: Churchill Livingstone.
Pischinger, A. 1991. Matrix and matrix regulation: basis for a holistic theory in medicine. Madrid, Spain: Medicina Biologica.
Randolph, T., and Moss, R. 1990. An alternative approach to allergies: the new field of clinical ecology unravels the environmental causes of mental and physical ills. New York, NY: William Morrow Paperbacks.
Sapolsky, R. M. 1994. Why zebras don’t get ulcers. New York, NY: W. H. Freeman and Co.
Selye, H. 1978. The stress of life. New York, NY: McGraw-Hill Book Co.
Strogatz, S. 1994. Nonlinear dynamics and chaos: with applications to physics, biology, chemistry, and engineering. Cambridge, MA: Perseus Books.
December 2016. "Inflammation and Depression: When the Domain of Pain Is the Brain." 24th Annual World Congress on Anti-Aging Medicine. Las Vegas, NV.
January 2017. "The Therapeutic Use of Optimal Stress: Stronger at the Broken Places." The Academy of Comprehensive Integrative Medicine. Dallas, TX.
January 2017. "Inflammation and Depression: When the Domain of Pain Is the Brain." The Academy of Comprehensive Integrative Medicine. Dallas, TX.
January 2017. "The Therapeutic Use of Optimal Stress: Precipitating Disruption to Trigger Repair." Brookhaven Institute for Psychoanalysis. Fogelsville, PA.
March 2017. "The Therapeutic Action of Psychodynamic Psychotherapy: Current Concepts of Cure." Boston, MA.
March 2017. "Modes of Therapeutic Action: Knowledge, Experience, and Relationship." McLean Hospital. Belmont, MA.
April 2017. "The Transformative Power of Optimal Stress: From Cursing the Darkness to Lighting a Candle." ONLINE Psychotherapy BOOT CAMP through the Center for Psychoanalytic Studies at William James College.
May 2017. "The Schizoid Defense of Relentless Despair: A Heart Shattered and The Private Self." Master Series in Clinical Practice at William James College. Newton, MA.
June 2017. "The Therapeutic Use of Optimal Stress to Provoke Healing: Stronger at the Broken Places." 3rd International Conference entitled "Integration of Psychotherapy in the Disintegrating World." Polish Society for Psychotherapy Integration. Warsaw, Poland.
June 2017. "Thomas: A Case of Introjective Identification." 3rd International Conference entitled "Integration of Psychotherapy in the Disintegrating World." Polish Society for Psychotherapy Integration. Warsaw, Poland.
June 2017. "Relentless Hope: The Refusal to Grieve." Professional Education Seminars at Smith College School for Social Work. Northampton, MA.
July 2017. "Healing the Environment to Heal the Body." Academy of Comprehensive Integrative Medicine. Dallas, TX.
September 2017. "Neuroinflammation and Depression: When the Domain of Pain Is the Brain." InnoVision Professional Media, Inc. Minneapolis, MN.
October 2017. "The Therapeutic Use of Optimal Stress to Provoke Recovery: From Cursing the Darkness to Lighting a Candle." Centre for Treatment of Sexual Assault and Childhood Trauma. Ottawa, Canada.
November 2017. "The Schizoid Defense of Relentless Despair: A Heart Shattered and The Private Self." Rhode Island Association for Psychoanalytic Psychologies. Providence, RI.
March 2018. "A Heart Shattered, Relentless Despair, and The Unlived Life." Western Massachusetts and Albany Association for Psychoanalytic Psychology. Stockbridge, MA.
March 2018. "The Private Self." McLean Hospital. Belmont, MA.
March 2018. "The Therapeutic Action of Psychodynamic Psychotherapy: Current Concepts of Cure." Boston, MA.
April 2018. "The Transformative Power of Optimal Stress." ONLINE Psychotherapy BOOT CAMP through the Center for Psychoanalytic Studies at William James College.
June 2018. "A Heart Shattered and The Unlived Life." Master Series in Clinical Practice at William James College. Newton, MA.
September 2018. "The Transformative Power of Optimal Stress: From Cursing the Darkness to Lighting a Candle." Center for Psychotherapy and Psychoanalysis of New Jersey. Madison, NJ.
October 2018. "Wise Mind / Wise Body: The Neuroplastic Synergy of Mindfulness and Intentionality." InnoVision Professional Media, Inc. St. Louis Park, MN.
February 2019. "A Heart Shattered, Relentless Despair, and The Unlived Life." Oklahoma Society for Psychoanalytic Studies. Oklahoma City, OK.
March 2019. "The Transformative Power of Optimal Stress: Precipitating Disruption to Trigger Repair." Christian Association for Psychological Studies. Irving, TX.
April 2019. "The Transformative Power of Optimal Stress: Precipitating Disruption to Trigger Repair." Griffin Memorial Hospital. Norman, OK.
May 2019. "The Therapeutic Action of Psychodynamic Psychotherapy: Current Concepts of Cure." Boston, MA.
October 2019. "The Transformative Power of Optimal Stress." ONLINE Psychotherapy BOOT CAMP through the Center for Psychoanalytic Studies at William James College.