The Psychodynamic Synergy Paradigm:

A C.A.R.E.S. Approach to Deep Healing

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C – Cognitive

A – Affective

R – Relational

E – Existential

S – Synaptic

 

Martha Stark, MD – Fall 2023

Lecturer on Psychiatry (part-time) / Harvard Medical School

 

“Five Interdependent Modes of Therapeutic Action”

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Models 1, 2, 3, 4, and 5 all focus on transforming “psychological rigidity” into “psychological flexibility,” more specifically, “rigid defense” into “more flexible adaptation.”

 

At the end of the day, in all 5 Models the “therapeutic action” will involve creating – against the backdrop of empathic attunement and a solid therapeutic alliance – optimally stressful, growth-incentivizing “mismatch experiences” by provocatively “juxtaposing” the sobering and conditioned reality of “what is” with the enlivening and quantum possibility of “what could be.”

 

“Working through” these destabilizing “violations of expectation” will provide both “impetus” and “opportunity” for the patient to relinquish her “attachment” to old bad “defensive rigidity” in favor of new good “adaptive flexibility” such that internal tension can be resolved and homeostatic balance restored – in the process advancing the patient to ever more evolved levels of resilience and adaptive capacity.

 

Please note that in all 5 Models the defense starts with the letter “R,” the adaptation starts with the letter “A,” and the optimal stressor starts with the letter “D” – which makes my Psychodynamic Synergy Paradigm RAD!!

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Model 1 – the interpretive perspective of classical psychoanalytic theory

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The therapeutic action facilitates transformation of “resistance” (the defense) into “awareness” (an adaptation).

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The cutting edge of the work involves “cognitive dissonance” (the optimal stressor).

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Model 2 – the corrective-provision perspective of self psychology and other “deficit” theories

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The therapeutic action facilitates transformation of “relentless hope” (the defense) into “acceptance” (an adaptation).

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The cutting edge of the work involves “affective (optimal) disillusionment” (the optimal stressor).

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Model 3 – the intersubjective perspective of contemporary relational theories

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The therapeutic action facilitates transformation of “re-enactment” (the defense) into “accountability” (an adaptation).

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The cutting edge of the work involves “relational detoxification” (the optimal stressor).

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Model 4 – an existential-humanistic approach to mending brokenness and easing existential angst

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The therapeutic action facilitates transformation of “relational absence” (the defense) into “authentic presence” (an adaptation).

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The cutting edge of the work involves “existential dependence” (the optimal stressor).

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Model 5 – a quantum-neuroscientific approach to “analysis paralysis” and neural entrenchment

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The therapeutic action facilitates transformation of “refractory inertia” (the defense) into “action” and “actualization of potential” (an adaptation).

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The cutting edge of the work involves “quantum disentanglement” (the optimal stressor).

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FIVE PERSPECTIVES –

Model 1 – the interpretive perspective of classical psychoanalytic theory

Model 2 – the corrective-provision (or deficiency-compensation) perspective of self psychology and other “deficit” theories

Model 3 – the intersubjective perspective of contemporary relational theories

Model 4 – an existential-humanistic approach to mending brokenness and easing existential angst

Model 5 – a quantum-neuroscientific approach to analysis paralysis, inertia, and inaction

 

THE THERAPEUTIC ACTION AS –

Model 1 – enhancement of knowledge “within”

Model 2 – provision of experience “for”

Model 3 – engagement in relationship “with”

Model 4 – nurturing of surrender “to” and moments of meeting “between”

Model 5 – envisioning of possibilities “beyond”

 

THE POINT OF EMOTIONAL URGENCY –

Model 1 – neurotic conflictedness

Model 2 – narcissistic vulnerability and woundedness

Model 3 – noxious relatedness and compulsive, unwitting re-enactment

Model 4 – nonrelatedness

Model 5 – nonaction and narratives that are outdated and disempowering

 

FOCUS – A C.A.R.E.S. Approach to Deep Healing

Model 1 – Cognitive

Model 2 – Affective

Model 3 – Relational

Model 4 – Existential

Model 5 – Synaptic and Shapeshifting

 

THE FOCUS –

Model 1 – structural conflict

Model 2 – structural deficit

Model 3 – relational conflict

Model 4 – relational deficit

Model 5 – neural entrenchment

 

DEFENSES –

Model 1 – neurotic defenses

Model 2 – narcissistic defenses

Model 3 – characterological defenses

Model 4 – schizoid defenses and illusions of grandiose self-sufficiency

Model 5 – entrenched, conditioned, and disempowering narratives about self, others, and the world

 

THE PATIENT AS –

Model 1 – a (neurotically) conflicted self

Model 2 – a (narcissistically) vulnerable self

Model 3 – a (noxiously) re-enacting self

Model 4 – a (nonrelated) private self

Model 5 – a (nonactualized) entrenched self

 

THE PATIENT AS –

Model 1 – neurotically conflicted and jammed up

Model 2 – relentlessly pursuing and ever in search of the unattainable

Model 3 – compulsively and unwittingly re-enacting

Model 4 – hidden, lost, despairing, alienated

Model 5 – entrenched, disempowered, stuck

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THE THERAPEUTIC ACTION AS –

Model 1 – knowledge

Model 2 – experience

Model 3 – relationship

Model 4 – surrender

Model 5 – possibilities

 

THE THERAPEUTIC ACTION AS –

Model 1 – interpreting resistance

Model 2 – grieving relentless hope

Model 3 – negotiating re-enactments at the intimate edge (the intersubjective in-between)

Model 4 – overcoming the dread of surrender to analytic oneness and a blissful state of peaceful merger

Model 5 – release from the toxicity of the past and envisioning of possibilities for the future

 

THE LANGUAGE OF –

Model 1 – ego (strength)

Model 2 – self (consolidation)

Model 3 – self-in-relation (accountability)

Model 4 – private self or true self vs. social self or false self

Model 5 – conditioned self or disempowered self vs. future self, possible self, or envisioned self

 

THE NUMBER OF PEOPLE –

Model 1 – 1-person psychology

Model 2 – 1½-person psychology

Model 3 – 2-person psychology

Model 4 – 2-as-1 or analytic oneness

Model 5 – the synergy of 2 and the whole as greater than the sum of its parts

 

THE THERAPIST AS –

Model 1 – neutral object

Model 2 – empathic selfobject or good “mother” or good object

Model 3 – authentic subject or relational object

Model 4 – facilitating environment or devoted presence

Model 5 – visionary alchemist or reality-based, action-oriented, goal-directed, solution-focused, future-oriented catalyst

 

PRIVILEGING OF THE THERAPIST’S –

Model 1 – neutrality and objectivity

Model 2 – empathy

Model 3 – authenticity

Model 4 – devotion and accommodation

Model 5 – vision 

 

PROTOTYPICAL INTERVENTIONS –

Model 1 – conflict statements

Model 2 – disillusionment statements

Model 3 – accountability statements, relational interventions, Rule of Three

Model 4 – facilitation statements

Model 5 – quantum disentanglement statements

 

OPTIMAL STRESS provides both impetus and opportunity for –

Model 1 – gain-become-pain (as ego-syntonic becomes ego-dystonic)

Model 2 – good-become-bad (as illusion becomes disillusionment)

Model 3 – bad-become-good (as distortion becomes more reality-based)

Model 4 – lost-become-found (as hidden becomes seen)

Model 5 – entangled-become-disentangled (as envisioned becomes actualized)

 

 

*analytic oneness – Ofra Eshel

*moments of meeting – Harry Guntrip

*affective nonrelatedness – Arnold Modell

*relational conflict – Stephen Mitchell

*grandiosely self-sufficient – Arnold Modell

*intimate edge – Darlene Ehrenberg

*dread of surrender – Masud Khan

*blissful state of peaceful merger – Michael Balint

*self-in-relation – Stone Center (Wellesley College)

*facilitating environment – D.W. Winnicott

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