Analyzing to Understand

but Envisioning Possibilities

to Incentivize Action


Martha Stark, MD / Faculty, Harvard Medical School


In the words of Soren Kierkegaard –

“Life can only be understood backwards;

but it must be lived forwards.”


Neuroscientists had long believed that once a new experience, especially a traumatic one, had been stored in long-term memory, it would be permanently installed. Perhaps it could then be modified by subsequent experiences, but its essence would nonetheless remain intact, lurking just beneath the surface as a somatic memory ever vulnerable to being reactivated and re-experienced – thereby reinforcing its intensity – before once again returning to body consciousness.


This was very much in keeping with the postulate advanced in 1949 by the neuropsychologist Donald Hebb, namely, “Neurons that fire together, wire together” – meaning that reactivated and re-experienced memories are simply reinforced through repetition – never resolved.


But we now know that, as it happens, this is not the whole story. Were it to be, then we would certainly be doing our patients a grave disservice were we to be ever busy inviting them, in the treatment, to revisit – and re-experience – their early-on traumas – without then offering them, as an alternative, something new, different, and compellingly better.


Indeed, “cathartic release through abreaction” – unaccompanied by a specific antidote – is no longer as much in vogue as it once was...


So, what more do we now know about how we can help our patients manage their early-on implicitly held traumatic experiences? What more do we now know about how we can help our patients update the maladaptive narratives that they, as young children, had constructed in a desperate attempt to make sense of those traumatic experiences?


Fortunately, over the course of the past two decades, a dedicated group of trailblazing cognitive neuroscientists, dissatisfied with the deterministic idea that memories (like diamonds) are forever, have been using advanced neuroimaging techniques (including functional MRIs, scanning microscopy, and an amazing new technology called optogenetics) to map what happens in the brain when a thought is being thought, a feeling felt, and a memory remembered. Their focus has been on how old memories – consolidated in long-term memory (and distributed in networks throughout the corticolimbic system, including the dorsolateral prefrontal cortex, hippocampus, and amygdala) – can be subsequently updated and reconsolidated.


Indeed, these researchers are discovering that the brain, in response to ongoing new experience, is continuously adapting – by modifying itself at the level of the neural synapse – in order to stay current and relevant. This learning process (involving both the destruction of old neural networks and the construction of new ones) speaks to the adaptive capacity of the brain and the dynamic nature of memory – in essence, the brain’s remarkable neuroplasticity!


...aptly described by the psychiatrist Norman Doidge as “the brain that changes itself.”


More specifically, neuroscientists have recently made the groundbreaking discovery that when memories are reactivated and re-experienced, the network of synapses encoding these memories will become unlocked for a time-limited period. This unlocking, or deconsolidation, signals the opening of a reconsolidation window – a brief window of opportunity when memories become transiently fragile and sensitive to modification by environmental input.


Both this dedicated group of cognitive neuroscientists who study memory reconsolidation in their laboratories and the similarly impassioned group (spearheaded by Bruce Ecker and David Feinstein) of neuroscientifically inclined clinicians who study it in their offices agree that four to six hours is the critical time frame for the destabilized synapses encoding the traumatic memories to remain malleable and therefore vulnerable to updating by new experience, such that these synapses – under the right circumstances – can be rewired and the traumatic memories they encode reprogrammed.


More specifically, neuroimaging studies demonstrate that opening the transient four- to six-hour reconsolidation window is initiated by the action of several types of glial cells residing in the brain’s extracellular matrix. These neuroimmune cells (primarily astrocytes and microglia) are now known to play the critically important role of regulating synaptic connectivity. They do this by way of either their contraction (which will facilitate the propagation of nerve impulses from pre-synaptic to post-synaptic membranes) or their expansion (which will inhibit the transmission of nerve impulses across the synaptic gap).


So, when a memory is reactivated, the glial cells surrounding the synaptic gap will shrink and the complex web of synapses encoding the reactivated memory will become temporarily deconsolidated / unlocked / neurologically depotentiated, such that something new can be introduced.


If the something new that is introduced is a positive experience that disconfirms the conditioned expectation of something negative and if that mismatch is presented repeatedly enough and forcefully enough within that time-limited period of four to six hours, then the new experience (and the fresh perspectives to which it gives rise) will ultimately overwrite the temporarily destabilized synapses and, in their place, prompt the locking in, or reconsolidation, of new synapses encoding updated narratives.


In fact, the repeated and dramatic juxtaposition of old bad learned expectations with new good envisioned possibilities will create jolting – and potentially therapeutic – “violations of expectation.”


In the neuroscientific literature, violations of expectation are referred to as prediction errors or novelty detection; in the clinical literature, they are referred to as mismatch or juxtaposition experiences.


Intuitively, the idea that abruptly, rapidly, unexpectedly, and decisively introducing an element of surprise in order to provoke change certainly makes sense, as does the idea that when new information directly contradicting a previous learning is repeatedly juxtaposed with what had come to be expected, the old memory will eventually be forced adaptively to update itself.


In essence, therapeutic memory reconsolidation will be taking place once the glial cells return to their swollen state and lock in, or reconsolidate, a more relevant narrative that reflects a fresh, more adaptive, healthier perspective – a narrative that will then become incorporated into the intrinsic fabric of the patient’s life and, going forward, become the new filter through which she experiences self, others, and the world.


To the point here are the pithy words of the neuroscientist Iryna Ethell (2018), “To learn we must first forget.” In other words, only when one door closes can another one open.


When therapeutic memory reconsolidation updates a traumatic memory, what is it that changes and what is it that remains the same? Importantly, the fact of the event underlying the traumatic memory will not change, that is, the episodic memory itself will remain intact. What will change, however, will be the affective coloring of the experience, how the patient positions herself in relation to it, and the narratives she constructs as a result of it.


By way of example, when Maria was a young girl, she had experienced frequent emotional abuse at the hands of her rageful, alcoholic father and, in a desperate attempt to make sense of that abuse, she had decided that it must have been she who was the bad one, she who was at fault.


But within the context of her secure attachment to an empathically attuned and authentically engaged therapist – a colleague of mine – who understood the transformational power of therapeutic memory reconsolidation, Maria was fortunate enough to be offered a rapid-fire series of disconfirming experiences that repeatedly and forcefully challenged Maria’s conditioned expectation of being always to blame.


These juxtaposition experiences took place in conjunction with reactivated memories of her father’s abuse, such that Maria was eventually able to update her self-negating narrative. No longer did she experience herself as ever at risk of being abused. Instead, Maria came to realize that it was her alcoholic father who had been a victimizer and she the collateral victim.


Importantly, despite now having an updated narrative that offered a fresh, more reality-based perspective, Maria still remembered the fact of her father’s abusive rages but she was no longer convinced that she had deserved the abuse and that the world was a dangerous and unpredictable place. In essence, she was able to re-interpret the entire scenario as a story not about herself as ever vulnerable to being abused by outside, malevolent forces but about her father as an often out-of-control alcoholic who would periodically fly into irrational and unjustified rages.


And so, more generally, how might the concept of therapeutic memory reconsolidation be relevant for those of our patients who are entrenched in outdated, maladaptive, disempowering narratives that, although once necessary for survival, have long since outlived their usefulness and are now impeding growth?


For example, what about patients who have come to understand their lives backward but, despite having been in years of long-term, in-depth treatment, remain stuck and unfulfilled and are not living their lives forward?


In fact, it could be said that such patients are suffering from a form of analysis paralysis. They might indeed now have more insight and, on some level, their lives might indeed now be working better for them as a result; but, on another level, they are not loving, working, and playing to their greatest capacity nor taking action specifically designed to fulfill their dreams.


A prime example of thwarted potential as a result of outdated and disempowering narratives was a young man I saw in consultation a long time ago – a man who had been in a psychodynamic treatment (and on medication) for many years and had indeed come to understand himself deeply but was still very stuck in his life and desperately unhappy. He reported to me that every day after work he would sit in the dark in his living room, hour after hour, doing nothing, his mind blank. By his side would be his stereo and a magnificent collection of his favorite classical music. The flick of a switch and he would feel better – and yet, night after night, overwhelmed by immobilizing despair, he would never once touch that switch.


It was this young man’s story and the sobering stories of countless others who have found themselves paralyzed in their efforts to move forward in their lives that prompted me to expand my Psychodynamic Synergy Paradigm (with its four, already established models – classical psychoanalytic, self psychological, contemporary relational, and existential-humanistic) to include a fifth model – one that would more explicitly address a patient’s “analysis paralysis” and “inaction.” This fifth mode of therapeutic action privileges not analyzing in order to understand but envisioning possibilities in order to incentivize action.


Importantly, a growing body of evidence supports the finding that simply visualizing (or envisioning) something, even though it occurs entirely in the mind, is almost as effective as actually doing it. For example, according to a study done at the Cleveland Clinic, participants were able to strengthen muscles just by visualizing physical movement. This impact simply required concentrated mental practice, namely, “the cognitive rehearsal of a physical activity <without accompanying movement>.” In fact, a recent study demonstrated that subjects wanting to master a particular skill were able to decrease by 50% the number of actual practice hours required if they were able to visualize mastery of it.


In any event, it was as a supplement to my four models that Model 5 (which relies for its effectiveness upon the brain-based strategy of therapeutic memory reconsolidation) was birthed. Model 5 is an action-based, solution-focused, goal-directed, future-oriented model that directly and boldly confronts a patient’s seemingly intractable inertia – with an eye to empowering the patient to take control of her life by constructing new, more adaptive, and more reality-based narratives.


My Psychodynamic Synergy Paradigm therefore now includes five modes of therapeutic action. And therapists, using this paradigm, will probably find themselves – over the course of each session – shift back and forth from one model to the next based upon what they, in the moment, intuitively sense is the point of emotional urgency for the patient, that is, whether the limelight is on the patient's resistance to gaining insight (the classical psychoanalytic perspective of Model 1), on her relentless pursuit of the unattainable and her relentless hope (the self psychological perspective of Model 2), on her re-enactment of unmastered early-on relational traumas on the stage of her life (the contemporary relational perspective of Model 3), on her retreat from the world and her relentless despair (the existential-humanistic perspective of Model 4), or on her refractory inertia, her refusal to change, and her relentless inaction (the quantum-neuroscientific perspective of Model 5).


In other words, my Psychodynamic Paradigm is a synergistic approach to treatment – one that involves the complex interplay of all five models, each gaining momentum by virtue of advancement in the other four. In essence, the models are interdependent – none more important than any of the others.


We have just seen how Model 5, from a neuroscientific perspective, conceives of memory as dynamic and as continuously updating itself on the basis of new experience – in other words, the transformational power of therapeutic memory reconsolidation.


But, as it happens, Model 5 is also a quantum model because it is all about “mystical entanglements,” “limitless possibilities,” and “the power of intentionality.”


More specifically, relevant in Model 5 is the wave-particle duality of quantum theory, which has it that once an invisible wave of energy (which holds limitless possibilities) interacts with the eye of an observer, it will collapse into a single visible particle – at which point potential will become actual and envisioned will become reality.


The quantum biologist Bruce Lipton writes, “…the universe is created by our observations.” Lipton is here reinforcing the extraordinarily uplifting and liberating idea that the quantum realm contains unbounded possibilities and that every precious moment in time holds infinite potential – which highlights the fact that almost anything is possible if we can but get clear on what we actually want for ourselves in life, can disentangle ourselves energetically from disempowering connectedness with past negativity, and can consciously and coherently direct positive intention and empowering energy in a new direction and to a preferred future – such that we will be able to create ourselves anew.


In the words of Henry Ford, “Whether you think you can, or you think you can’t – you’re right” – a deceptively simple aphorism that speaks directly to the profound impact of our intentionality on what is subsequently actualized and a poignant reminder of our power to create our own destiny – a primary focus in Model 5.


Another quantum concept embraced by my freshly minted model is the mystical concept of quantum entanglement.


As a point of reference – Freud used the concept of adhesiveness of the id (fueled as it is by both libidinal and aggressive energies) to explain the tenacity with which patients unwittingly cling – albeit ambivalently – to their infantile attachments, relentless pursuits, and compulsive repetitions, thereby entangling them with the dysfunction of their past.


My Model 5 attempts to find a more contemporary way to explain why a patient’s present – though decades later – might be still infiltrated by the toxicity of her bygone past. Indeed, the concept of quantum entanglement fits the bill. Albert Einstein, after struggling for years to understand the laws governing the mysterious nonlocal forces that characterize quantum interactions between entities that are separated in time and space, famously derided this strange phenomenon by dubbing it spooky action at a distance – shorthand for capturing the essence of these enigmatic interactions that defy the laws of Newtonian physics.


But if indeed we implicate quantum entanglement in the adhesiveness of the patient to outdated, disempowering narratives, then from this it follows that an important piece of the therapeutic action in Model 5 will involve quantum disentanglement of the patient from the inertia-perpetuating narratives with which she has been energetically coupled since childhood.


In the prophetic words of Lao Tzu, “If you do not change direction, you may end up where you are heading.”


My recognition of the critical role played by quantum disentanglement in decoupling the patient from self-limiting beliefs constructed early on in life was inspired, in part, by my exposure to the concept of cognitive defusion. This construct, central to the therapeutic action in Acceptance and Commitment Therapy (ACT) and akin to quantum disentanglement, is a technique that involves not only the patient’s distancing of herself from the maladaptive patterns of thinking that have come to define her experience of self, others, and the world but also her acceptance of the possibility that there are alternative perspectives and more adaptive ways of acting, reacting, and interacting. In essence, ACT embraces the idea that thoughts are just thoughts and need not define who we are or how we behave; thoughts are no more powerful than what we allow them to be.


In sum, my Psychodynamic Synergy Paradigm, which now includes not only the psychodynamically informed Models 1 – 4 (with their emphasis on understanding life backward) but also my quantum-neuroscientific Model 5 (with its emphasis on living life forward), is indeed an integrative approach to the psychotherapy of patients with procedurally embedded emotional injuries and relational scars resulting from unmastered traumatic experiences in their past, compromising the quality of their lives in the present, and undermining their dreams for the future.


My Psychodynamic Synergy Paradigm is an approach that aims to advance patients from psychological rigidity to psychological flexibility – from defense to adaptation – from mindless reaction to mindful response – such that once patients have come to understand their lives backward and their compulsion to repeat, they can focus on envisioning new possibilities, committing to change, and taking action to live their lives forward.


Whereas Models 1 – 4 focus on the relationship between the past and the present, Model 5 focuses on the relationship between the present and the future.


Whereas Models 1 – 4 are in the tradition of understanding our history as our destiny (which we are condemned to repeat unless we can remember it), Model 5 focuses on our destiny as our choice (which is ours to design if, in the present, we can but take embodied ownership of our need to extricate ourselves from the quantum ties that bind us to our past so that we can construct new narratives for ourselves going forward).


Model 5 focuses on envisioned possibilities, taking ownership of our need to change, mindfully tuning in to outdated and disempowering verbal narratives and, in the words of Pat Ogden, somatic narratives, setting coherent and embodied intention, self-empowerment, committing to action, personal agency, freedom, choice, crafting our destiny, realizing our dreams, and actualizing our potential. Model 5 is neither deterministic nor fatalistic – it is a constructivist model that, at heart, empowers, liberates, and inspires hope.


Put simply, whereas Models 1 – 4 require that the patient take ownership of her past, Model 5 requires that she take ownership of her future.


Furthermore – On the one hand, Models 1 – 4 emphasize insight into the early-on relational traumas shaping the patient’s misperceptions of self, others, and the world. These defensive misconstructions of reality are then gradually tamed, modified, and integrated as the patient slowly evolves (in Model 1) from resistance to awareness, (in Model 2) from relentless pursuit of the unattainable to acceptance, (in Model 3) from re-enactment of dysfunctional relational dynamics to accountability, and (in Model 4) from relational absence to authentic presence.


On the other hand, Model 5 conceives of the narratives that the patient has constructed in a desperate attempt to make sense of her world as potentially able to be rewritten, interpreted anew, and completely redone. These transcripts, which underlie the patient’s psychic inertia and thwarted potential, are thought not to seal her fate but to hold the potential for reconfiguring her future and for advancing her from refractory inertia to action and actualization of her dreams.


Please note that all 5 “rigid defenses” begin with the letter “R” – (Model 1) resistance, (Model 2) relentless hope, (Model 3) re-enactment, (Model 4) relational absence, and (Model 5) refractory inertia – and all 5 “adaptations” begin with the letter “A” – (Model 1) awareness, (Model 2) acceptance, (Model 3) accountability, (Model 4) authentic presence, and (Model 5) action and, ultimately, actualization of potential.


To demonstrate the difference between the therapeutic action in Models 1 – 4 and the therapeutic action in Model 5, I offer the following clinical example. Consider the case of a patient who resists venturing into new social situations for fear of being shamed by others.


Models 1 – 4 would focus on exploring the historical roots of the patient’s irrational fear and on then gradually working through whatever parental errors of omission (in the form of deprivation and neglect) and parental errors of commission (in the form of trauma and abuse) might have given rise to it. And grieving might well play a pivotal role.


Model 5, however, would focus on the patient’s fear of being shamed as outdated and maladaptive and would then repeatedly and decisively confront this learned expectation of being shamed by highlighting the possibility of experiencing, going forward, something different and compellingly better. The jolting violations of expectation resulting from this repeated and sharply contradictory juxtaposition of envisioned new good with reactivated old bad would ultimately generate enough cognitive-emotional-somatic dissonance that a new, more reality-based narrative would be locked in, or reconsolidated, in the place of the old, now-disconfirmed narrative – such that, going forward, the expectation would be not of being shamed but of being, say, accepted.


In essence, in Model 5 the adaptive updating of narratives results from ongoing, dramatic, and embodied challenging of preconceived, distorted expectations with new, more relevant experiences (whether real or simply envisioned) that violate those expectations – such that the conditioned responses will be disconfirmed and overridden by fresh, more reality-based, solution-focused, and future-oriented perspectives.


Paraphrasing only slightly the words of the psychologist and coach Carol Kauffman, “As a therapist, I follow the trail of tears to healing (my psychodynamic Models 1 –­ 4); as a coach, I follow the trail of dreams to actualization (my quantum-neuroscientific Model 5).”


As noted at the start, in the evocative words of Soren Kierkegaard (1996), “Life can only be understood backwards (Models 1 – 4); but it must be lived forwards (Model 5).”


Just as Freud (1919) eventually acknowledged that he felt “compelled” to “alloy the pure gold of analysis … with the copper of direct suggestion … and hypnotic influence,” so too I, over the course of the decades, have come to believe that the pure gold of strictly psychodynamic (as represented by my Models 1 – 4) will indeed need to be alloyed with the copper of having more explicit expectations of the patient, being more directive and solution-based, providing a more action-oriented treatment focus, and specifically targeting entrenched inaction (all of which characterize the therapeutic action in Model 5).


My quantum-neuroscientific Model 5 draws heavily upon not only Acceptance and Commitment Therapy (ACT) – with its emphasis on cognitive defusion – but also Eye Movement Desensitization and Reprocessing (EMDR) Therapy – with its emphasis on “bilateral stimulation” and “dual awareness.”


EMDR, in order to recontextualize and detoxify traumatic memories, capitalizes upon the use of bilateral alternating stimulation to engage both sides of the brain, thereby bringing to bear the analytic wisdom of the present-focused left brain on the emotional knowledge harbored in the past-focused right brain.


The EMDR patient is instructed to focus her mind’s eye on a distressing and unmastered traumatic experience, memory, or image and to let herself re-experience whatever thoughts, feelings, and sensations are evoked as she dares to remember what her body cannot forget. Alternately, repetitively, and rhythmically, the clinician then activates both sides of the patient’s brain (whether visually, auditorily, or tactilely) – right, left, right, left, right, left, and so on.


Prompting the patient both to experience the trauma (with her right brain, her experiencing ego, the emotional wisdom in her body) and to observe it (with her left brain, her observing ego, the analytic wisdom in her brain) will reinforce the patient’s capacity for dual awareness – indeed, being able to “hold awareness” of both past and present is critically important for any patient struggling not only to disentangle herself from the toxicity of the past but also to engage herself in the essence of the present moment. That was then, and this is now.


I am here reminded of a consultation I did on Lakisha, a woman who was struggling to make her peace with a trauma that she had experienced years earlier when she had accepted a ride home from a party with an attractive man whom she had just met – a man who had then attempted to rape her. He had driven her into a secluded area in the woods and tried to force himself on her. By dint of her incredible determination and instinct for survival, however, Lakisha had managed to wrest herself free, to leap out of his truck, and to flee for safety. But Lakisha was haunted by the memory of the attempted rape and was having difficulty forgiving herself for having allowed herself to be seduced into accepting a ride from this man whom she had barely known.


I did one session of EMDR on Lakisha, which, in fairly short order and felicitously, enabled her to reposition herself in relation to the traumatic event, such that instead of experiencing shame because she had allowed herself to be seduced by this man, she began to feel good about herself, her survival skills, and her ability to outsmart him. By the end of our session, Lakisha still remembered what had happened in the woods that fateful night, but it was no longer a source of excruciating pain. Rather, she reported that she was now feeling a sense of pride – and empowerment – that she had so effectively managed to save herself from being entrapped by this seductive and dangerous man.


Both EMDR and Model 5 capitalize upon the concepts of bilateral alternating stimulation and dual awareness – but they do it somewhat differently.


Whereas EMDR harnesses the power of the brain’s analytic wisdom to facilitate desensitization and reprocessing of traumatic experiences held in body consciousness, Model 5 harnesses the power of the brain’s intentionality to facilitate updating the mindfully accessed verbal and somatic narratives that had been constructed as a result of those traumatic experiences.


More specifically, at the heart of the therapeutic action in Model 5 is the neuroplastic synergy of bottom-up mindfulness (that is, paying attention to the present moment and the wisdom of the body, always with compassion and never judgment, in order to unearth the self-limiting and disempowering narratives that are fueling the patient’s analysis paralysis) and top-down intentionality (that is, setting the intention to commit to action that will enable the patient, going forward, to live more in harmony with the vision that she has for her future).


The backbone of Model 5 are quantum disentanglement statements – optimally stressful interventions that are repeated again and again by the patient and always with heartfelt embodied conviction. These statements – co-created by patient and therapist – are strategically designed to generate cognitive, emotional, and somatic dissonance in the patient by prompting her to hold in mind, simultaneously, both the memory of old bad (accessed by way of mindful awareness) and the vision of new good (introduced by way of embodied intentionality) – thereby creating jolting and decisive mismatch experiences between implicitly held learned expectations and explicitly held envisioned possibilities.


As an example of a quantum disentanglement statement –


“I hate my disgusting body and feel a stabbing pain in my heart and a sickening feeling in my gut whenever I think about how my father would stare at me, and always with such contempt. I feel deep despair about ever being able to feel comfortable in my ugly body.


“But I can imagine that someday I might be able to go out into the world feeling better about myself, carrying myself with dignity and pride, and no longer needing to keep myself or my body hidden. I know that I therefore need to change how I position myself in relation to food and I am determined to get serious about intermittent fasting because embracing a more responsible way of eating is the gift that I am hereby committing to give myself.”


The patient repeats this statement and variations of it – over and over in rapid-fire succession and with ever more resolute commitment – alternately verbalizing first the mindfully reactivated old bad and then the intentionally embraced new good.


The therapist encourages the patient to pay especial attention to, and to make explicit, the somatic elements, physical sensations, visceral reactivity, and sensorimotor perceptions that are being evoked as she begins to remember what her body has never forgotten. As Bessel van der Kolk highlights, the body always remembers.


Indeed, the somatic narrative (held in the patient’s body) is just as important as the verbal narrative (held in the patient’s mind). Bessel, in his inimitable style, has said, “Talking is everything and nothing.” Let me reframe that slightly – “The verbal narrative is important, but it doesn’t tell the whole story – because the somatic narrative also needs to be told.”


As another example of a co-created Model 5 quantum disentanglement statement –


“I always worry that no one will listen to me because I was never allowed to speak up in my family. I was always silenced and made to feel invisible. My body trembles and my vocal cords tighten as I remember how irrelevant I felt – and now I feel so much tension and pressure in my chest. I just hated being pushed to the side and being told that I did not matter.


“But I can envision the possibility of someday feeling good enough about who I am that I will be able to present myself to the world without apology and without self-consciousness. Of course, I know that I will need to start taking risks that, to this point, I have avoided taking because I was so afraid. But I know that I need to speak up and let my voice be heard. I've got this! I can do it!”


TO CONCLUDE – In the quantum-neuroscientific approach of Model 5, it is hoped that the optimal stress generated by the cognitive-emotional-somatic dissonance between learned expectation and envisioned possibility will provide both impetus for unlocking old bad disempowering narratives and opportunity for locking in new good empowering narratives in their place – in other words, therapeutic memory reconsolidation.


If treatment involves only reactivation of old bad (as can sometimes happen with “cathartic release through abreaction”), then there will be little opportunity to replace old bad with new good. By the same token, if treatment involves only embracing new good (as can sometimes happen with approaches that are more strength-based), then there will be little impetus to replace old bad with new good.


Indeed, whereas the psychodynamically informed Models 1 – 4 involve understanding life backward and appreciating that the patient’s history is her destiny, the constructivist Model 5 involves living life forward and appreciating that the patient has within her the power to design her destiny – such that she will be able to embrace love, work, and play to her greatest potential going forward and, ultimately, be able to fulfill her dreams.


FINALLY – Ann Landers’s (1996) simple but profound advice is very much to the point here, “Nobody gets to live life backward. Look ahead, that is where your future lies.”



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