Martha Stark MD – 13 Apr 2023 – The Therapeutic Use of Optimal Stress to Provoke Recovery.pptx

THE THERAPEUTIC USE
OF OPTIMAL STRESS
TO PROVOKE RECOVERY
NO PAIN / NO GAIN 
MARTHA STARK, M.D.
Faculty, Harvard Medical School
MarthaStarkMD @ SynergyMed.solutions
April 2023
Doctoral Counseling Program at AGST Philippines
With deepest appreciation for BILL KIRWAN, Ph.D.
Dr. Tine and Sharen Winar
© 2023 Martha Stark, M.D.
1

THERAPEUTIC MODALITIES THAT HAVE
“DEEP AND ENDURING PSYCHODYNAMIC CHANGE”
AS THEIR ULTIMATE GOAL
FOR EXAMPLE, PSYCHOANALYSIS AND OTHER “DEPTH PSYCHOLOGIES,”
INCLUDING – BUT NOT LIMITED TO – ACT, IFS, EMDR, ISTDP, AEDP, EFT, NLP,
SENSORIMOTOR PSYCHOTHERAPY, SOMATIC EXPERIENCING, AND PSYCHOMOTOR PSYCHOTHERAPY
MUST ULTIMATELY BE ABLE TO TRANSFORM
“PSYCHOLOGICAL RIGIDITY”
INTO “PSYCHOLOGICAL FLEXIBILITY”
IN THE EVOCATIVE WORDS OF ACCEPTANCE AND COMMITMENT THERAPY (ACT)
AND “LOW – LEVEL DEFENSE”
INTO “HIGHER – LEVEL / MORE EVOLVED DEFENSE”
IN THE MORE TRADITIONAL WORDS OF PSYCHOANALYSIS AND EGO PSYCHOLOGY
SUCH THAT THE PATIENT
WHATEVER HER STARTING POINT / WHATEVER HER INITIAL LEVEL OF FUNCTIONALITY
WHATEVER HER DIAGNOSIS
WILL BECOME EVER BETTER ABLE
– OVER TIME –
TO MANAGE THE MYRIAD “STRESSORS” IN HER LIFE
TO WHICH SHE IS BEING CONTINUOUSLY EXPOSED
EVER MORE ADEPT AT “RESPONDING ADAPTIVELY AND MINDFULLY”
INSTEAD OF “REACTING DEFENSIVELY AND MINDLESSLY” 3

4
THE ULTIMATE GOAL OF DEEP TREATMENTS
EVER – LESS PSYCHOLOGICAL RIGIDITY
EVER – MORE PSYCHOLOGICAL FLEXIBILITY

OVERVIEW
IN ORDER TO ADVANCE THE PATIENT
FROM RIGID DEFENSE TO MORE FLEXIBLE ADAPTATION
AGAINST A BACKDROP OF EMPATHIC ATTUNEMENT
THE THERAPIST WILL REPEATEDLY
OFFER THE PATIENT
OPTIMALLY STRESSFUL INTERVENTIONS
– JUST THE RIGHT COMBINATION OF CHALLENGE AND SUPPORT –
STRATEGICALLY DESIGNED TO GENERATE
DESTABILIZING INTERNAL TENSION AND HOMEOSTATIC IMBALANCE
BY JUXTAPOSING
– IN AN EMBODIED (LIVED) FASHION –
ANXIETY – PROVOKING CHALLENGE OF THE DEFENSE
WITH ANXIETY – ASSUAGING SUPPORT OF IT
THEREBY CREATING
GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
THE WORKING THROUGH OF WHICH
– IN ORDER TO RESOLVE THE INTERNAL TENSION
AND RESTORE THE HOMEOSTATIC BALANCE –
WILL ADVANCE THE PATIENT
TO EVER – HIGHER AND MORE EVOLVED LEVELS
OF RESILIENCE AND ADAPTIVE CAPACITY
5

MORE SPECIFICALLY
OPTIMALLY STRESSFUL INTERVENTIONS WILL
– ALTERNATELY AND REPEATEDLY –
FIRST “CHALLENGE” THE DEFENSE
BY DIRECTING THE PATIENT’S ATTENTION
TO WHERE SHE ISN’T
BUT WHERE THE THERAPIST
WOULD WANT HER TO GO
– SALMAN AKHTAR’S “DISRUPTIVE ATTUNEMENT” (2018) –
AND THEN “SUPPORT” THE DEFENSE
BY RESONATING EMPATHICALLY
WITH WHERE THE PATIENT IS
– SALMAN AKHTAR’S “HOMEOSTATIC ATTUNEMENT” (2018) –
IN ESSENCE
THE THERAPIST
WILL BE GENERATING
DESTABILIZING TENSION
WITHIN THE PATIENT
BY FIRST INCREASING HER ANXIETY
– WITH CHALLENGE –
AND THEN DECREASING IT
– WITH SUPPORT –
7

8
STRATEGIC LEVERAGING OF THE PATIENT’S ANXIETY
ALTERNATELY INCREASING IT BY CHALLENGING THE DEFENSE
AND THEN DECREASING IT BY SUPPORTING THE DEFENSE
TO INCENTIVIZE TRANSFORMATION AND GROWTH

IN ESSENCE
PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT
BOTH IMPETUS AND OPPORTUNITY
– ALBEIT BELATEDLY –
TO MASTER TRAUMATIC EXPERIENCES
THAT HAD ONCE BEEN OVERWHELMING
– AND, THEREFORE, DEFENDED AGAINST –
BUT THAT CAN NOW
– WITH THE BENEFIT OF THE THERAPIST’S LOVING SUPPORT
AND BY TAPPING INTO THE PATIENT’S UNDERLYING RESILIENCE,
INNATE CAPACITY TO ADAPT TO STRESS,
AND INTRINSIC STRIVING TOWARDS HEALTH –
BE REVISITED, REPROCESSED, AND REFRAMED
SUCH THAT GROWTH – IMPEDING DEFENSES
– ONCE NECESSARY FOR SURVIVAL –
CAN BE GRADUALLY TRANSFORMED
INTO GROWTH – PROMOTING ADAPTATIONS
FROM “SAME OLD, SAME OLD”
TO “SOMETHING NEW, DIFFERENT, AND BETTER”
FROM THE “SOBERING REALITY” OF “WHAT IS”
TO THE “ENLIVENING POSSIBILITY” OF “WHAT COULD BE”
SUCH THAT THE PATIENT WILL HAVE BECOME
STRONGER AT THE BROKEN PLACES 9

HOW ARE
DEFENSES
HERE
BEING
DEFINED
13

PLEASE NOTE
I DO NOT “LIMIT” DEFENSES
TO THE WELL – KNOWN
AND MORE TRADITIONAL ONES
AT ONE END OF THE CONTINUUM
“LOW – LEVEL DEFENSES”
FOR EXAMPLE
REPRESSION, REGRESSION, DENIAL,
DISSOCIATION, DISPLACEMENT, PROJECTION,
ISOLATION OF AFFECT, INTELLECTUALIZATION,
AND REACTION FORMATION
AT THE OTHER END
“HIGHER – LEVEL” OR “MORE MATURE DEFENSES”
THAT ARE “MORE ADAPTIVE” AND “MORE SOCIALLY ACCEPTABLE”
FOR EXAMPLE
SUBLIMATION, HUMOR, ALTRUISM,
HUMILITY, AND POSITIVE IDENTIFICATIONS
14

RATHER
I DEFINE DEFENSES “MORE BROADLY”
AS SPEAKING TO ANY OF THE
“SELF – PROTECTIVE MECHANISMS”
THAT WE MOBILIZE WHEN MADE ANXIOUS
IN THE FACE OF STRESSORS
– PSYCHOLOGICAL, PHYSIOLOGICAL, AND ENERGETIC –
AT ONE END OF THE CONTINUUM
WHAT HAPPENS “REFLEXIVELY”
WHEN WE ARE CONFRONTED WITH STRESSORS
THAT “OVERWHELM” US WITH ANXIETY
TO WHICH I REFER AS “LOW – LEVEL DEFENSES”
OR “RIGID DEFENSES”
AT THE OTHER END
WHAT HAPPENS “MORE REFLECTIVELY”
WHEN WE ARE CONFRONTED WITH STRESSORS
THAT WE ARE MORE EASILY ABLE TO “TAKE IN OUR STRIDE”
TO WHICH I REFER AS “HIGHER – LEVEL DEFENSES”
OR “MORE FLEXIBLE ADAPTATIONS”
AT ONE END OF THE CONTINUUM – “DEFENSIVE REACTIONS”
AT THE OTHER END – “ADAPTIVE RESPONSES”
15

EITHER WE
– MADE ANXIOUS –
“REACT” TO STRESSORS BY “DEFENDING”
“DEFENSIVE REACTION”
OR WE
– MORE RESILIENT –
“RESPOND” TO STRESSORS BY “ADAPTING”
“ADAPTIVE RESPONSE”
16

17
LIFE IS
NOT ABOUT
“DEFENSIVELY”
WAITING FOR
THE STORM
TO PASS
BUT ABOUT
“ADAPTIVELY”
LEARNING
TO DANCE
IN THE RAIN

WHAT IS THE
RELATIONSHIP
BETWEEN DEFENSE
– DEFENSIVE REACTION TO STRESSOR –
AND ADAPTATION
– ADAPTIVE RESPONSE TO STRESSOR –
18

THE RELATIONSHIP BETWEEN DEFENSE AND ADAPTATION
IS A YIN – YANG RELATIONSHIP
THESE SELF – PROTECTIVE MECHANISMS
ARE COMPLEMENTARY – NOT OPPOSING – FORCES
FURTHERMORE
ALL DEFENSES HAVE AN ADAPTIVE COMPONENT
JUST AS ALL ADAPTATIONS SERVE A DEFENSIVE FUNCTION
NONETHELESS AND MORE GENERALLY
ALTHOUGH DEFENSES MIGHT ONCE
HAVE BEEN NECESSARY
FOR THE PATIENT TO “SURVIVE,”
AS RIGID DEFENSES BECOME UPGRADED
TO MORE FLEXIBLE ADAPTATIONS,
THE PATIENT BECOMES
EVER BETTER ABLE TO “THRIVE”
THE THERAPEUTIC ACTION
IS INDEED DESIGNED
TO TRANSFORM “RIGIDITY” INTO “FLEXIBILITY”
AND “SURVIVING” INTO “THRIVING”
19

A DRAMATIC DEMONSTRATION OF THE DIRECT RELATIONSHIP
BETWEEN FLEXIBILITY AND THRIVING
DECADES AGO, TWO OBSTETRICIANS
MADE AN INTRIGUING DISCOVERY
ABOUT THE PARADOXICAL RELATIONSHIP
BETWEEN REGULARITY OF FETAL HEART RATE
AND FETAL MORTALITY
THEY DISCOVERED THAT
– COUNTERINTUITIVELY –
THE MORE METRONOME – LIKE THE HEARTBEAT,
THE LESS LIKELY THE FETUS WOULD BE TO SURVIVE
WHEREAS THE GREATER THE HEART RATE VARIABILITY,
THE MORE LIKELY THE FETUS WOULD BE TO THRIVE
IN OTHER WORDS
VARIABILITY, ADAPTABILITY, FLEXIBILITY,
RESILIENCE, AND TOM BRADY’S PLIABILITY
ARE CRITICALLY IMPORTANT
FOR THE HEALTH OF
BOTH BODY AND MIND
HON AND LEE (1965)
21

WE CANNOT AVOID SUFFERING
BUT WE CAN CHOOSE HOW WE COPE WITH IT, FIND MEANING IN IT,
AND MOVE FORWARD WITH RENEWED PURPOSE
“BETWEEN STIMULUS AND RESPONSE IS A SPACE.
IN THAT SPACE IS OUR POWER TO CHOOSE OUR RESPONSE.
IN OUR RESPONSE LIES OUR GROWTH AND OUR FREEDOM.”
AUTHOR UNKNOWN
– ALTHOUGH OFTEN MISATTRIBUTED TO THE EXISTENTIAL PSYCHIATRIST VIKTOR FRANKL –
AS THIS APPLIES TO THE CLINICAL SITUATION
IN THAT SPACE IS OUR POWER
EITHER TO “REACT DEFENSIVELY”
– BY WALLOWING IN OUR DESPAIR AND ABNEGATING RESPONSIBILITY FOR OUR LIVES –
OR TO “RESPOND ADAPTIVELY”
– BY ACKNOWLEDGING THAT, DESPITE OUR DESPAIR, FROM THIS POINT FORWARD
THE MEANING WE MAKE OF OUR LIVES IS ENTIRELY UP TO US –
NOT ONLY DO WE HAVE THE FREEDOM TO CREATE THAT MEANING
BUT WE ALSO HAVE THE RESPONSIBILITY TO DO SO
IT HAS BEEN SUGGESETED THAT 10% OF WHAT HAPPENS TO US IS “LIFE”
BUT 90% IS HOW WE “REACT” OR “RESPOND” TO IT
22

23
Between stressor
and what follows
is a space.
In that space
lies our freedom
and our power
to choose
what we will do.
We can either
react defensively
or
respond adaptively.

26
When I let go
of the
SAME OLD
SAME OLD
that I am,
I become the
SOMETHING
NEW
DIFFERENT
AND
BETTER
that I
might be.

WHAT IS
MEANT
BY
CONTROLLED
DAMAGE
TO
JUMP – START
HEALING
27

JUST AS A FIELD OF GRASS
CAN BE BURNED
IN ORDER TO STIMULATE IT
TO GROW BACK
GREENER, HEALTHIER, AND MORE LUSH
THAN BEFORE
SO TOO
“CONTROLLED DAMAGE”
TO THE BODY
CAN PROVOKE
THE “HEALING CASCADE”
28

IN THE PHYSIOLOGICAL REALM
SUPERIMPOSING AN ACUTE PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES EXACTLY WHAT THE BODY NEEDS
IN ORDER TO HEAL
BY WAY OF EXAMPLES
HIGH – INTENSITY INTERVAL TRAINING (HIIT) / INTERMITTENT FASTING
ISCHEMIC PRECONDITIONING / INTERMITTENT HYPOXIC TRAINING / HYPERBARIC OXYGEN
HOMEOPATHIC REMEDIES / VACCINES AND OTHER IMMUNOTHERAPIES / MEDICINAL PLANTS
DERMABRASION / FRAXEL LASER TREATMENTS / RADIOFREQUENCY MICRONEEDLING
PLATELET – RICH PLASMA (PRP) / PLATELET – RICH FIBRIN (PRF)
VAMPIRE GUM REJUVENATION / BOTOX / STEM CELL FACELIFTS
ELECTROCONVULSIVE THERAPY (ECT) / TRANSCRANIAL MAGNETIC STIMULATION (TMS)
CARDIAC DEFIBRILLATION / PULSE WAVE THERAPIES
ACUPUNCTURE / ACUPRESSURE / CUPPING
RED LIGHT THERAPY / INFRARED SAUNAS / CRYOTHERAPY
BRAIN TEASERS AND MENTAL EXERCISES
WHEN THE BODY IS OPTIMALLY CHALLENGED,
– NO MATTER HOW COMPROMISED IT MIGHT BE IN ITS FUNCTIONALITY –
ADAPTIVE RECOVERY WILL BE TRIGGERED
BECAUSE OF THE BODY’S INNATE RESILIENCE
29

THE THERAPEUTIC USE OF OPTIMAL STRESS
TO PROVOKE RECOVERY
DEPRIVING YOURSELF OF HALF A NIGHT’S SLEEP ONCE A WEEK
PREFERABLY THE SECOND HALF OF THE NIGHT (FOR EXAMPLE, FROM 3 TO 7 AM)
CAN PRODUCE A RAPID, EVEN IF SHORT – LIVED,
RESTABILIZATION OF MOOD AND RECOVERY FROM DEPRESSION
THE “STRESS” OF INTERRUPTING NORMAL SLEEP PATTERNS
MAY “RESYNCHRONIZE DISTURBED CIRCADIAN RHYTHMS”
LEIBENLUFT AND WEHR (1992)
INTERMITTENT FASTING
A 36 – HOUR WATER FAST ONCE A WEEK
(FOR EXAMPLE, FROM AFTER DINNER ON MONDAY EVENING
TO BEFORE BREAKFAST ON WEDNESDAY MORNING)
CAN SO SIGNIFICANTLY REDUCE THE TOTAL BODY BURDEN
THAT MENTAL CLARITY AND FOCUS CAN BE IMPROVED DRAMATICALLY
AND A SENSE OF OVERALL WELL – BEING RESTORED
INTERMITTENT FASTING IS ALSO ASSOCIATED WITH INCREASED LEVELS
OF BRAIN – DERIVED NEUROTROPHIC FACTOR (BDNF)
DEPLETED LEVELS OF WHICH ARE THOUGHT TO BE ASSOCIATED WITH DEPRESSION
MARK MATTSON (2023)
INTERESTINGLY, THE ONLY TYPE OF “CALORIE – RESTRICTION” DIET
THAT WILL NOT SLOW DOWN YOUR METABOLISM IS INTERMITTENT FASTING
30

MORE SPECIFICALLY
OPTIMAL CHALLENGE OF THE BRAIN WILL
SHARPEN MENTAL ACUITY, DECELERATE COGNITIVE DECLINE,
AND COMBAT THE EFFECTS OF AGING ON THE BRAIN
JUST AS ATHLETES CAN IMPROVE THEIR “PHYSICAL FITNESS” BY
OPTIMALLY CHALLENGING THEIR BODIES WITH “PHYSICAL EXERCISE”
SO, TOO, ALL OF US CAN IMPROVE OUR “BRAIN FITNESS” BY
OPTIMALLY CHALLENGING OUR MINDS WITH “BRAIN TEASERS”
FOR EXAMPLE, MATHEMATICAL PUZZLES, WORD GAMES,
CROSSWORD PUZZLES, LOGIC PROBLEMS, AND MEMORY CHALLENGES
ANY MENTAL EXERCISE REQUIRING
DELIBERATE AND CONCENTRATED EFFORT
FOR EXAMPLE, ACTIVE REPETITION, FOCUSED ATTENTION, MEDITATION,
REFLECTION, JUGGLING, OR LEARNING ANY NEW SKILL OR NEW LANGUAGE
WILL PROMOTE MENTAL AGILITY AND FORESTALL THE
INEXORABLE DECLINE IN MENTAL CAPACITY AS WE AGE
IN ADDITION TO PUZZLES AND GAMES,
OUR BRAINS WILL BE STIMULATED WHENEVER WE ARE EXPOSED TO SITUATIONS
THAT ARE NEW, UNUSUAL, DIFFERENT, NOVEL, OR UNEXPECTED
WHEN OUR DAILY ROUTINES ARE DISRUPTED
OR WHEN WE COMBINE TWO SENSES
– A FORM OF CROSS – TRAINING FOR THE BRAIN –
LIKE SIMULTANEOUSLY LISTENING TO MUSIC AND SMELLING FLOWERS,
WATCHING A SUNSET AND TAPPING OUR FINGERS,
OR PRINTING WITH ONE HAND WHILE CURSIVE WRITING WITH THE OTHER
32

JUST AS WITH THE BODY
– WHERE A CHRONIC CONDITION MIGHT NOT HEAL UNTIL IT IS MADE ACUTE –
SO TOO WITH THE MIND
INDEED, OVER TIME I HAVE COME TO APPRECIATE THAT
ONGOING “THERAPEUTIC PROVISION” OF JUST THE RIGHT
COMBINATION OF CHALLENGE AND SUPPORT
NAMELY, “OPTIMAL STRESS”
WILL SOMETIMES BE THE
“DESTABILIZING PROVOCATION” NEEDED
BOTH TO OVERCOME THE INHERENT
“RESISTANCE TO CHANGE”
SO FREQUENTLY ENCOUNTERED
IN EVEN OUR MOST WELL – INTENTIONED PATIENTS
AND TO TRANSFORM THEIR “DEFENSIVE NEED”
TO MAINTAIN THINGS AS THEY ARE
– “SAME OLD, SAME OLD” –
INTO THE “ADAPTIVE CAPACITY” TO EVOLVE
TO “SOMETHING NEW, DIFFERENT, AND BETTER”
33

NEUROSCIENTIST CHARLES KREBS (2013) WRITES
“OPEN, SELF – ORGANIZING, COMPLEX ADAPTIVE
(CHAOTIC) SYSTEMS RESIST PERTURBATION”
EXAMPLES OF “CHAOTIC SYSTEMS” INCLUDE
ROAD TRAFFIC, OCEAN TURBULENCE,
SAND DUNES, AND THE SELF – PROTECTIVE MECHANISMS
MOBILIZED BY ANXIOUS PATIENTS
DESPERATELY ATTEMPTING
TO MANAGE THE “STRESSORS” IN THEIR LIVES
WHICH IS TO SAY THAT
NO MATTER HOW COMPROMISED
THEY MIGHT BE IN THEIR FUNCTIONALITY
“SELF – ORGANIZING SYSTEMS”
– FUELED AS THEY ARE BY THEIR HOMEOSTATIC TENDENCY
TO REMAIN CONSTANT OVER TIME –
ARE INHERENTLY “RESISTANT TO CHANGE”
35

IN OTHER WORDS
PATIENTS
– MUCH AS THEY MIGHT PROTEST THEIR “DESIRE TO CHANGE” –
HAVE AN “INNATE INERTIA”
THAT MUST BE OVERCOME
IF THEY ARE EVER
TO BE RELEASED ENERGETICALLY
FROM THE TOXICITY OF THEIR PAST
AND EMPOWERED
TO EMBRACE LOVE, WORK, AND PLAY
TO THEIR GREATEST POTENTIAL
GOING FORWARD
36

A HUMOROUS EXAMPLE OF “RESISTANCE TO CHANGE”
A SATURDAY NIGHT LIVE SKIT IN WHICH
TWO MEN ARE SEATED AROUND A FIRE
CHATTING AND ONE SAYS TO THE OTHER
“YOU KNOW HOW WHEN YOU STICK
A POKER IN THE FIRE
AND LEAVE IT IN FOR A LONG TIME,
IT GETS REALLY, REALLY HOT?
AND THEN YOU STICK IT IN YOUR EYE,
AND IT REALLY, REALLY HURTS?
I HATE IT WHEN THAT HAPPENS!
I JUST HATE IT WHEN THAT HAPPENS!”
37

OR THE ROCK SONG
BY THE LATE WARREN ZEVON (1996)
ENTITLED
“IF YOU WON’T LEAVE ME
I’LL FIND SOMEBODY WHO WILL”
WHICH SPEAKS TO THE NEED
WE ALL HAVE TO RECREATE
THE “FAMILIAL AND THEREFORE FAMILIAR”
STEPHEN MITCHELL (1988)
BECAUSE THAT IS ALL WE HAVE EVER KNOWN
HAVING SOMETHING DIFFERENT
WOULD CREATE ANXIETY
BECAUSE IT WOULD HIGHLIGHT THE FACT
THAT THINGS COULD BE
– AND COULD THEREFORE HAVE BEEN –
DIFFERENT
38

I AM HERE REMINDED OF PORTIA NELSON’S
AUTOBIOGRAPHY IN 5 SHORT CHAPTERS (2012)
WHICH HIGHLIGHTS BOTH
OUR DEFENSIVE NEED TO “MAINTAIN THINGS AS THEY ARE”
AND OUR ADAPTIVE CAPACITY ULTIMATELY TO “CHANGE”
CHAPTER 1
I WALK DOWN THE STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I FALL IN
I AM LOST … I AM HELPLESS
IT ISN’T MY FAULT
IT TAKES FOREVER TO FIND A WAY OUT
CHAPTER 2
I WALK DOWN THE SAME STREET
I PRETEND I DON’T SEE IT
I FALL IN AGAIN
I CAN’T BELIEVE I AM IN THE SAME PLACE
BUT IT ISN’T MY FAULT
IT STILL TAKES A LONG TIME TO GET OUT
39

CHAPTER 3
I SEE IT IS THERE
I STILL FALL IN … IT’S A HABIT
MY EYES ARE OPEN
I KNOW WHERE I AM
IT IS MY FAULT
I GET OUT IMMEDIATELY
CHAPTER 4
I WALK AROUND IT
CHAPTER 5
I WALK DOWN ANOTHER STREET
40

ONGOING AND JUDICIOUS USE
OF OPTIMALLY STRESSFUL
THERAPEUTIC INTERVENTIONS
MUST THEREFORE OFFER PATIENTS
ENOUGH CHALLENGE
THAT THERE WILL BE IMPETUS
FOR DESTABILIZATION
OF THEIR DYSFUNCTIONAL DEFENSES
BUT ENOUGH SUPPORT
THAT THERE WILL BE OPPORTUNITY
FOR RESTABILIZATION
OF THOSE SELF – PROTECTIVE MECHANISMS
AT EVER – HEALTHIER LEVELS
OF FUNCTIONALITY AND ADAPTABILITY
41

INDEED, WE ALL FIND OURSELVES SOMETIMES
VERY CONFUSED ABOUT WHAT TO DO NEXT!
43

WITH THE THERAPIST’S FINGER
EVER ON THE PULSE OF THE
PATIENT’S LEVEL OF ANXIETY
AND CAPACITY TO TOLERATE
FURTHER CHALLENGE
THE THERAPIST WILL
THEREFORE REPEATEDLY
CHALLENGE WHENEVER POSSIBLE
BY DIRECTING THE PATIENT’S ATTENTION
TO WHERE THE PATIENT IS NOT
BUT TO WHERE THE THERAPIST
WOULD WANT THE PATIENT TO GO
– SALMAN AKHTAR’S (2018) “DISRUPTIVE ATTUNEMENT” –
AND SUPPORT WHENEVER NECESSARY
BY RESONATING EMPATHICALLY
WITH WHERE THE PATIENT IS
– SALMAN AKHTAR’S (2018) “HOMEOSTATIC ATTUNEMENT” –
44

45
JUST
THE
RIGHT
DOSES
OF
CHALLENGE
AND
SUPPORT
TO
CATALYZE
GROWTH
“DOSED”
STIMULATION

IT COULD BE SAID THAT
WITHOUT SUPPORT, THERAPY NEVER BEGINS
BUT WITHOUT CHALLENGE, THERAPY NEVER ENDS
ALTERNATIVELY
WITHOUT CHALLENGE, THERAPY NEVER BEGINS
BUT WITHOUT SUPPORT, THERAPY NEVER ENDS
BY THE SAME TOKEN, IT COULD BE SAID THAT
WITHOUT EMPATHY, THERAPY NEVER BEGINS
BUT WITHOUT EMPATHIC FAILURE, THERAPY NEVER ENDS
OR
WITHOUT EMPATHIC FAILURE, THERAPY NEVER BEGINS
BUT WITHOUT EMPATHY, THERAPY NEVER ENDS
IN ESSENCE
WITHOUT SUFFICIENT CHALLENGE,
THERE WILL BE NO IMPETUS FOR GROWTH
BUT WITHOUT ADEQUATE SUPPORT,
THERE WILL BE NO SUCH OPPORTUNITY
– THE MORAL OF THE STORY –
YOU NEED TO PROVIDE BOTH CHALLENGE AND SUPPORT
FROM BEGINNING TO END
46

IN OTHER WORDS
IT IS NOT SO MUCH EMPATHY AS
EMPATHIC FAILURE AGAINST A BACKDROP OF EMPATHY
“OPTIMAL DISILLUSIONMENT”
IT IS NOT SO MUCH GRATIFICATION AS
FRUSTRATION AGAINST A BACKDROP OF GRATIFICATION
“OPTIMAL FRUSTRATION”
IT IS NOT SO MUCH SUPPORT AS
CHALLENGE AGAINST A BACKDROP OF SUPPORT
“OPTIMAL STRESS”
THAT WILL PROVIDE THE “THERAPEUTIC LEVERAGE”
NEEDED TO “PROVOKE” ALTERNATING CYCLES
OF DESTABILIZATION AND THEN RESTABILIZATION
AT EVER – MORE ROBUST LEVELS OF “ADAPTIVE CAPACITY”
“DEEP AND ENDURING PSYCHODYNAMIC CHANGE”
REQUIRES THIS ONGOING GENERATION OF
“DESTABILIZING ANXIETY” AND “INCENTIVIZING STRESS”
47

48
JUDICIOUS USE OF OPTIMAL STRESS PROVIDES
FOR THE PATIENT TO EVOLVE
– THROUGH HEALING CYCLES OF DISRUPTION AND RECOVERY –
FROM “ILLNESS” TO “WELLNESS”

HOW DOES THE
SANDPILE MODEL
OF CHAOS THEORY
OFFER A COMPELLING “VISUAL”
FOR EVOLUTION OF THE PATIENT
THROUGH ITERATIVE HEALING CYCLES
OF DESTABILIZATION
FOLLOWED BY RESTABILIZATION
AT EVER – MORE EVOLVED LEVELS
OF COMPLEXITY AND DYNAMIC BALANCE
AS A RESULT OF
THE CUMULATIVE IMPACT OF
OPTIMALLY STRESSFUL
INTERVENTIONS 50

THE PARADOXICAL IMPACT OF STRESS
THE “SANDPILE MODEL” OF CHAOS THEORY
OFFERS AN ELEGANT VISUAL DEMONSTRATION
OF THE CUMULATIVE IMPACT
– OVER TIME –
OF ENVIRONMENTAL STRESSORS
ON OPEN SYSTEMS
– THINK “HOURGLASS” –
I USE THIS “SANDPILE MODEL”
WHICH SIMULATES THE EVOLUTION
– OVER TIME –
OF OPEN, SELF – ORGANIZING CHAOTIC SYSTEMS
– LIKE THE STOCK MARKET, NEURAL NETWORKS, HURRICANES –
AS AN ANALOGY
FOR THE ITERATIVE HEALING CYCLES
OF DISRUPTION AND REPAIR
THAT CHARACTERIZE THE THERAPEUTIC ACTION
IN PSYCHODYNAMIC PSYCHOTHERAPY
51

52
THE SANDPILE
MODEL
OF CHAOS THEORY
Bak (1996)
ITERATIVE CYCLES
OF DESTABILIZATION
AND RESTABILIZATION
AT EVER – HIGHER
LEVELS
OF COMPLEXITY
AND DYNAMIC BALANCE
A COMPELLING
“VISUAL”
FOR THE
CUMULATIVE IMPACT
OF OPTIMAL STRESS

THE PARADOXICAL IMPACT OF STRESS
BOTH THE “SANDPILE MODEL”
AND THE “THERAPEUTIC ACTION”
FEATURE THE “EMERGENCE”
– OVER TIME –
OF “ITERATIVE CYCLES”
OF “DESTABILIZATION”
– A “DEFENSIVE REACTION” TO THE “CHALLENGE” –
AND “RESTABILIZATION”
– AN “ADAPTIVE RESPONSE” TO THE “SUPPORT”
AS THESE “CHAOTIC SYSTEMS” EVOLVE
TO EVER – MORE RICHLY TEXTURED LAYERS
OF RESILIENCE, COMPLEXITY,
INTEGRATION, AND DYNAMIC BALANCE
NOT JUST “IN SPITE OF”
ENVIRONMENTAL STRESSORS
BUT “BY WAY OF”
THOSE STRESSORS
53

HOW IS IT THAT
ONGOING EVOLUTION
IS POSSIBLE
NOT JUST
“IN SPITE OF”
BUT
“BECAUSE OF”
THE CYCLES
OF DISRUPTION
AND REPAIR
54

AMAZINGLY ENOUGH
THE GRAINS OF SAND
BEING STEADILY ADDED
TO THE GRADUALLY EVOLVING SANDPILE
– MUCH LIKE THE OPTIMALLY STRESSFUL INTERVENTIONS
THAT WE OFFER OUR PATIENTS –
ARE THE OCCASION
FOR BOTH “DISRUPTION” AND “REPAIR”
NOT ONLY DO THE GRAINS OF SAND
– OPTIMALLY STRESSFUL, GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES” –
PERIODICALLY PRECIPITATE
PARTIAL COLLAPSES OF THE SANDPILE
– DESTABILIZATION OF THE PATIENT’S DEFENSES –
(DESCRIBED AS “MINOR AVALANCHES” IN CHAOS THEORY)
BUT THEY ALSO BECOME
THE MEANS BY WHICH THE SANDPILE
– THE PATIENT’S INFRASTRUCTURE –
WILL THEN BE ABLE TO BUILD ITSELF BACK UP
– ITS STRUCTURAL INTEGRITY REINFORCED –
(EACH TIME AT A MORE RESILIENT LEVEL OF HOMEOSTASIS)
55

THE SYSTEM
– THE PATIENT –
WILL THEREFORE HAVE BEEN ABLE
NOT ONLY TO “MANAGE”
THE IMPACT OF THE STRESSFUL INPUT
BUT ALSO TO “BENEFIT FROM” THAT IMPACT
FROM DEFENSIVE COLLAPSE
TO ADAPTIVE RECONSOLIDATION
AT EVER – MORE ROBUST LEVELS
THE IRREGULARITIES IN THE SANDPILE
– MUCH LIKE THE SCARS WE BEAR –
POIGNANT REMINDERS
OF THE MINOR COLLAPSES
– INJURIES –
WE HAVE ALL SUSTAINED
– OVER TIME –
BUT, ULTIMATELY, TRIUMPHANTLY OVERCOME
56

HOW DOES
THE GOLDILOCKS
PRINCIPLE
HIGHLIGHT
THE CRITICAL ROLE
PLAYED BY
GETTING IT JUST RIGHT
WITH RESPECT TO
EXPOSURE TO STRESSORS
58

THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE
WILL OVERWHELM AND PLUMMET THE SYSTEM
INTO FURTHER DECLINE
BECAUSE IT WILL BE “TOO MUCH”
TO BE PROCESSED, INTEGRATED, AND ADAPTED TO
TRAUMATIC STRESS
TOO LITTLE CHALLENGE
WILL OFFER “TOO LITTLE” IMPETUS AND OPPORTUNITY
FOR TRANSFORMATION AND GROWTH,
SERVING INSTEAD SIMPLY
TO REINFORCE THE – DYSFUNCTIONAL – STATUS QUO
BUT JUST THE RIGHT AMOUNT OF CHALLENGE
WILL PROVIDE “JUST THE RIGHT AMOUNT”
OF “THERAPEUTIC LEVERAGE”
NEEDED TO PROVOKE
– AFTER INITIAL DISRUPTION –
EVENTUAL RE – EQUILIBRATION
AT A HIGHER, MORE EVOLVED LEVEL
OF INTEGRATION, FUNCTIONALITY,
AND ADAPTIVE CAPACITY
OPTIMAL – NONTRAUMATIC – STRESS
59

STRESS IS WHEN
YOU WAKE UP SCREAMING
AND THEN YOU REALIZE
YOU HAVEN’T FALLEN
ASLEEP YET
ANONYMOUS
61

WHERE DOES MY
PSYCHODYNAMIC SYNERGY
PARADIGM
COME INTO PLAY
62

MY PSYCHODYNAMIC SYNERGY PARADIGM
FEATURES FIVE INTERDEPENDENT
– AND MUTUALLY ENHANCING –
APPROACHES
TO ADVANCING THE PATIENT
FROM RIGID DEFENSE
– “SAME OLD, SAME OLD” –
TO MORE FLEXIBLE ADAPTATION
– “SOMETHING NEW, DIFFERENT, AND BETTER” –
MODEL 1
CLASSICAL PSYCHOANALYTIC (1970 – 1980)
MODEL 2
SELF PSYCHOLOGICAL (1980 – 1990)
MODEL 3
CONTEMPORARY RELATIONAL (1990 – 2000)
MODEL 4
EXISTENTIAL – HUMANISTIC (2000 – 2010)
MODEL 5
QUANTUM – NEUROSCIENTIFIC (2010 – 2020)
63

ALL FIVE MODELS
MAKE USE OF “OPTIMAL STRESS”
THAT IS, JUST THE RIGHT BALANCE BETWEEN
ANXIETY – PROVOKING CHALLENGE AND ANXIETY – ASSUAGING SUPPORT
TO CATALYZE TRANSFORMATION OF
RIGID DEFENSE INTO MORE FLEXIBLE ADAPTATION
MODEL 1
THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS
RESISTANCE INTO AWARENESS
MODEL 2
THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY
RELENTLESS HOPE INTO ACCEPTANCE
MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE OF CONTEMPORARY RELATIONAL THEORY
RE – ENACTMENT INTO ACCOUNTABILITY
MODEL 4
AN EXISTENTIAL – HUMANISTIC APPROACH TO DISCONNECTION FROM SELF AND FROM LIFE ITSELF
RELATIONAL ABSENCE INTO AUTHENTIC PRESENCE
MODEL 5
A QUANTUM – NEUROSCIENTIFIC APPROACH TO “ANALYSIS PARALYSIS”
REFRACTORY INERTIA INTO ACTUALIZING ACTION
64

– A C.A.R.E. APPROACH TO DEEP HEALING –
Cognitive Affective Relational Existential
MODEL 1 – COGNITIVE
ENHANCEMENT OF KNOWLEDGE “WITHIN”
WORKING THROUGH INVOLVES “INTERPRETING INTERNAL CONFLICTEDNESS”
– ACCORDING TO SIGMUND FREUD –
MODEL 2 – AFFECTIVE
PROVISION OF EXPERIENCE “FOR”
WORKING THROUGH INVOLVES “GRIEVING RELENTLESS HOPE”
– ACCORDING TO MARTHA STARK –
MODEL 3 – RELATIONAL
ENGAGEMENT IN RELATIONSHIP “WITH”
WORKING THROUGH INVOLVES “NEGOTIATING THE TURBULENCE
THAT WILL INEVITABLY ARISE AT THE INTIMATE EDGE”
– ACCORDING TO DARLENE EHRENBERG –
MODEL 4 – EXISTENTIAL
NURTURING OF SURRENDER “TO”
WORKING THROUGH INVOLVES
“OVERCOMING THE DREAD OF SURRENDER TO ANALYTIC ONENESS”
– ACCORDING TO MASUD KHAN AND OFRA ESHEL –
MODEL 5 – CONSTRUCTIVIST
ENVISIONING OF POSSIBILITIES “BEYOND”
WORKING THROUGH INVOLVES
“DISENTANGLING, ENVISIONING, AND COMMITTING TO ACTION”
– ACCORDING TO BRUCE ECKER –
65

ONGOING AND JUDICIOUS USE
OF OPTIMALLY STRESSFUL,
GROWTH – INCENTIVIZING INTERVENTIONS
STRATEGICALLY DESIGNED
TO CREATE DESTABILIZING,
DISCONFIRMATORY “MISMATCH EXPERIENCES”
MODEL 1 – CONFLICT STATEMENTS
WORKING THROUGH THE STRESS OF “COGNITIVE DISSONANCE”
MODEL 2 – DISILLUSIONMENT STATEMENTS
WORKING THROUGH THE STRESS OF “AFFECTIVE DISILLUSIONMENT”
MODEL 3 – ACCOUNTABILITY STATEMENTS
WORKING THROUGH THE STRESS OF “RELATIONAL DETOXIFICATION”
MODEL 4 – FACILITATION STATEMENTS
WORKING THROUGH THE STRESS OF “EXISTENTIAL DEPENDENCE”
MODEL 5 – QUANTUM DISENTANGLEMENT STATEMENTS
WORKING THROUGH THE STRESS OF “QUANTUM DISENTANGLEMENT”
66

HOW DO
OPTIMALLY
STRESSFUL
INTERVENTIONS
PROVIDE
BOTH
CHALLENGE
AND
SUPPORT
OF
DEFENSE
68

GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
– DESTABILIZING VIOLATIONS OF EXPECTATION –
WHAT’S COLORED “BLUE” REFERS TO SOMETHING “HEALTHIER”
WHAT’S COLORED “RED” REFERS TO SOMETHING “LESS HEALTHY”
MODEL 1
YOU KNOW THAT YOUR MOTHER
WILL PROBABLY NEVER APOLOGIZE
– ANXIETY – PROVOKING CHALLENGE –
BUT YOU KEEP HOPING THAT SHE WILL
– ANXIETY – ASSUAGING SUPPORT –
MODEL 2
YOU HAD SO HOPED
THAT JOSE WOULD LEAVE HIS WIFE
BUT YOU ARE BEGINNING TO GET IT
THAT PROBABLY HE NEVER WILL,
WHICH BOTH ENRAGES AND DEVASTATES YOU
69

MODEL 3
YOU HAD ASSUMED THAT I TOO,
LIKE YOUR FATHER, WOULD BE CRITICAL
THAT NOT ALL RELATIONSHIPS WORK THAT WAY
MODEL 4
A PART OF YOU
LONGS TO BE SEEN, HEARD, AND UNDERSTOOD
BUT ANOTHER PART OF YOU
IS TERRIFIED OF BEING FOUND
MODEL 5
I HATE MY BODY AND AM CONVINCED THAT
NOBODY COULD EVER FIND ME ATTRACTIVE
BUT I CAN ENVISION A TIME WHEN I MIGHT BECOME
MORE COMFORTABLE IN MY BODY
WERE I TO COMMIT TO
EXERCISING MORE REGULARLY AND EATING MORE HEALTHILY
70

AS WE HAVE SEEN
ANXIETY – PROVOKING CHALLENGE
WILL ALMOST INEVITABLY BE A STORY
ABOUT ENVISIONING THE ENLIVENING POSSIBILITY OF
“SOMETHING NEW, DIFFERENT, AND BETTER”
WHEREAS ANXIETY – ASSUAGING SUPPORT
WILL ALMOST INEVITABLY BE A STORY
ABOUT RESONATING EMPATHICALLY WITH
THE CONDITIONED NEED FOR “SAME OLD, SAME OLD”
MODEL 1
YOU KNOW THAT YOUR MOTHER
WILL PROBABLY NEVER APOLOGIZE
– INTRODUCING THE POSSIBILITY OF “SOMETHING MORE REALITY – BASED” –
BUT YOU KEEP HOPING THAT SHE WILL
– RESONATING WITH THE NEED FOR “SAME OLD, SAME OLD” –
MODEL 2
YOU HAD SO HOPED
THAT JOSE WOULD LEAVE HIS WIFE
THAT PROBABLY HE NEVER WILL,
WHICH BOTH ENRAGES AND DEVASTATES YOU
71

MODEL 3
YOU HAD ASSUMED THAT I TOO,
LIKE YOUR FATHER, WOULD BE CRITICAL
– RESONATING WITH THE RELATIONAL EXPECTATION OF “SAME OLD, SAME OLD” –
THAT NOT ALL RELATIONSHIPS WORK THAT WAY
MODEL 4
A PART OF YOU
LONGS TO BE SEEN, HEARD, AND UNDERSTOOD
– INTRODUCING THE POSSIBILITY OF A “HEALTHIER” WAY OF RELATING –
BUT ANOTHER PART OF YOU
IS TERRIFIED OF BEING FOUND
MODEL 5
I HATE MY BODY AND AM CONVINCED THAT
NOBODY COULD EVER FIND ME ATTRACTIVE
– RESONATING WITH THE “SAME OLD, SAME OLD” NARRATIVE –
BUT I CAN ENVISION A TIME WHEN I MIGHT BECOME
MORE COMFORTABLE IN MY BODY
WERE I TO COMMIT TO
EXERCISING MORE REGULARLY AND EATING MORE HEALTHILY
– INTRODUCING THE POSSIBILITY OF A “NEW, DIFFERENT, AND BETTER” NARRATIVE –
72

HOW
ABOUT
A FEW
MORE
EXAMPLES
OF
OPTIMALLY
STRESSFUL
STATEMENTS
73

OPTIMALLY STRESSFUL MODEL 1 CONFLICT STATEMENTS
DESTABILIZING JUXTAPOSITION OF “ADAPTIVE CAPACITY TO KNOW”
WITH “DEFENSIVE NEED TO RESIST THAT KNOWING”
“YOU KNOW THAT IF YOU ARE EVER TO GET ON
WITH YOUR LIFE, YOU’LL HAVE TO LET GO OF YOUR CONVICTION
THAT YOUR CHILDHOOD SCARRED YOU FOREVER. BUT IT’S HARD
NOT TO FEEL LIKE DAMAGED GOODS WHEN YOU GREW UP
IN A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN AND NASTY
MOTHER WHO KEPT TELLING YOU THAT YOU WERE A LOSER.”
“YOU’RE COMING TO UNDERSTAND THAT
YOUR ANGER CAN PUT PEOPLE OFF.
BUT YOU TELL YOURSELF THAT
YOU HAVE A RIGHT TO BE AS ANGRY AS YOU WANT
BECAUSE OF HOW MUCH YOU HAVE HAD TO SUFFER
OVER THE COURSE OF THE YEARS.”
“YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA
IS TO SURVIVE, YOU’LL NEED TO TAKE AT LEAST SOME
RESPONSIBILITY FOR THE PART YOU’RE PLAYING IN THE
INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE HAVE BEEN HAVING.
BUT YOU TELL YOURSELF THAT IT ISN’T REALLY
YOUR FAULT BECAUSE IF SHE WEREN’T SO PROVOCATIVE,
THEN YOU WOULDN’T HAVE TO BE SO VINDICTIVE!” 56

OPTIMALLY STRESSFUL MODEL 2 DISILLUSIONMENT STATEMENTS
DESTABILIZING JUXTAPOSITION OF “DEFENSIVE NEED FOR RELENTLESS HOPE”
WITH “ADAPTIVE CAPACITY TO CONFRONT THE REALITY OF DISILLUSIONMENT”
AND “ADAPTIVE CAPACITY TO GRIEVE AND EVOLVE TO A PLACE OF ACCEPTANCE”
“YOU HAD SO HOPED THAT I WOULD TELL YOU WHAT TO DO.
BUT YOU ARE BEGINNING TO REALIZE THAT I DON’T SIMPLY
GIVE YOU THE ANSWERS – AND IT INFURIATES YOU.”
“YOU HAD SO HOPED THAT YOUR DAUGHTER
WOULD REACH OUT TO YOU WHEN YOU WERE SICK.
BUT YOU ARE BEGINNING TO REALIZE THAT,
FOR NOW, YOU ARE NOT A TOP PRIORITY FOR HER –
AND IT IS A DEVASTATING LOSS.”
“YOU WOULD SO HAVE WISHED THAT I COULD KNOW WHAT YOU
WERE THINKING WITHOUT YOUR HAVING TO SAY IT.
BUT YOU ARE COMING TO SEE THAT IT DOES NOT ALWAYS
WORK THIS WAY – AND THAT BREAKS YOUR HEART.”
“YOU HAD SO HOPED THAT WE COULD HAVE A PERSONAL
RELATIONSHIP. BUT YOU ARE COMING TO REALIZE, ALBEIT
RELUCTANTLY, THAT A THERAPY RELATIONSHIP IS NOT REALLY
ABOUT FRIENDSHIP PER SE – AND THAT BREAKS YOUR HEART.”
75

OPTIMALLY STRESSFUL MODEL 3 ACCOUNTABILITY STATEMENTS
DESTABILIZING JUXTAPOSITION OF “DEFENSIVE NEED TO RE – ENACT”
WITH “ADAPTIVE CAPACITY FOR ACCOUNTABILITY”
“I WONDER IF THIS FEELING I HAVE IN RELATION TO YOU THAT
NO MATTER WHAT I SAY IT WON’T BE GOOD ENOUGH IS LIKE
THE FEELING YOU HAVE SPOKEN OF HAVING HAD IN RELATION
TO YOUR FATHER, FOR WHOM NOTHING WAS EVER GOOD ENOUGH.”
“IT OCCURS TO ME THAT WE HAVE MANAGED TO RECREATE IN HERE
THE VERY SAME DYNAMIC THAT HAD CHARACTERIZED YOUR
RELATIONSHIP WITH YOUR DOUBLE – BINDING FATHER – NAMELY, THE
FEELING WE BOTH HAVE THAT NO MATTER WHAT EITHER OF US MIGHT
DO, IT WOULDN’T GET THE OTHER’S APPROVAL! BUT ALL OF THIS,
FRUSTRATING AS IT IS, GIVES US AN OPPORTUNITY TO EXPERIENCE,
FIRSTHAND, HOW TOXIC THE RELATIONSHIP WITH YOUR FATHER REALLY
WAS – EXCEPT THAT NOW WE CAN DO SOMETHING ABOUT IT!”
“YOU TELL ME SOMETHING ABOUT YOURSELF. I AM JUST IN THE PROCESS
OF DIGESTING IT AND STORING IT FOR FURTHER UNDERSTANDING
OF YOU AND THEN ALONG YOU COME – WHAM! – AND TELL ME
THAT WHAT I HAVE DIGESTED AND STORED INSIDE ME DID NOT COME
FROM YOU AT ALL. THE PROBLEM I FIND IS HOW TO LIVE WITH THE
DESPAIR I FEEL OCCASIONED BY YOUR DISAPPEARANCES.”
CHRISTOPHER BOLLAS (1989) 76

OPTIMALLY STRESSFUL MODEL 4 FACILITATION STATEMENTS
DESTABILIZING JUXTAPOSITION OF “ADAPTIVE CAPACITY TO LONG FOR AUTHENTIC ENGAGEMENT”
WITH “DEFENSIVE NEED TO RETREAT FROM MOMENTS OF MEETING”
“A PART OF YOU YEARNS TO BE SEEN, KNOWN, UNDERSTOOD;
BUT ANOTHER PART OF YOU IS TERRIFIED OF BEING FOUND.”
“YOU FEEL DESPERATELY LONELY AND DISCONNECTED FROM PEOPLE
AND WOULD WISH YOU COULD FEEL THAT YOU BELONGED
SOMEWHERE; BUT YOU FIND YOURSELF HOLDING BACK
FOR FEAR OF BEING DEVASTATINGLY DISAPPOINTED
AND LEFT ONCE AGAIN WITH A SHATTERED HEART.”
“A PART OF YOU DESPERATELY WISHES THAT YOU COULD FIND
JOY IN BEING ALIVE; BUT ANOTHER PART OF YOU IS SO
OVERWHELMED WITH DESPAIR ABOUT THE ABSURDITY OF IT ALL
THAT YOU CANNOT IMAGINE EVER BEING ABLE TO EXPERIENCE
ANYTHING EVEN REMOTELY CLOSE TO GENUINE HAPPINESS.”
“A PART OF YOU LONGS TO HAVE A PARTNER WITH WHOM
YOU COULD SHARE WHAT YOU HOLD MOST DEAR AND COULD
SPEND THE REST OF YOUR LIFE; BUT ANOTHER PART OF YOU
CRINGES AT THE THOUGHT OF PUTTING YOURSELF OUT THERE –
IT JUST FEELS TOO RISKY TO OPEN YOUR HEART TO POSSIBILITIES.”
77

OPTIMALLY STRESSFUL MODEL 5 QUANTUM DISENTANGLEMENT STATEMENTS
DESTABILIZING JUXTAPOSITION OF “DEFENSIVE NEED TO REMAIN ENTRENCHED IN SAME OLD, SAME OLD”
WITH “ADAPTIVE CAPACITY TO ENVISION POSSIBILITIES, TAKE OWNERSHIP OF THE NEED TO CHANGE,
AND COMMIT TO ACTION IN ALIGNMENT WITH SOMETHING NEW, DIFFERENT, AND BETTER”
“EVEN THOUGH MY RIGHT BRAIN IS TERRIFIED OF DRIVING BECAUSE
I CAN’T SHAKE THE MEMORY OF WHAT HAD HAPPENED WHEN MY
FATHER WAS DRIVING DRUNK AND WE HAD A TERRIBLE ACCIDENT
AND I VOMITED BECAUSE I WAS SO INCREDIBLY UPSET, MY LEFT
BRAIN KNOWS THAT IF I DRIVE CAREFULLY AND PAY CLOSE ATTENTION,
THEN THERE IS NO NEED FOR ME TO BE AFRAID
BECAUSE I AM A GOOD DRIVER AND AM ALWAYS VERY CAREFUL.”
“EVEN THOUGH I GENERALLY ASSUME THAT PEOPLE WILL BE CRITICAL
OF ME BECAUSE MY PARENTS WERE SO UNRELENTINGLY JUDGMENTAL,
I CAN ENVISION THE POSSIBILITY THAT SOMEDAY I MIGHT BE ABLE
TO FREE MYSELF OF MY SELF – CONSCIOUSNESS AND TAKE
MORE OWNERSHIP OF MY RIGHT TO BE HERE ON THIS EARTH.”
“EVEN THOUGH I FEEL SO ALIENATED FROM EVERYBODY BECAUSE
I WAS NEVER MADE TO FEEL THAT I BELONGED WHEN I WAS A KID,
I CAN ENVISION THE POSSIBILITY OF SOMEDAY BEING ABLE
TO FEEL LESS ALIENATED. I TAKE OWNERSHIP OF MY NEED
TO PUT MYSELF OUT THERE MORE AND I HEREBY COMMIT
TO BEING MORE ACTIVELY ENGAGED IN MY LIFE GOING FORWARD.”
78

AS WE SIT WITH OUR PATIENTS
THERE IS ALWAYS TENSION WITHIN US AS WELL
DIALECTICAL TENSION BETWEEN
ON THE ONE HAND
OUR VISION OF WHO WE THINK THE PATIENT COULD BE
WERE SHE BUT ABLE / WILLING TO MAKE HEALTHIER CHOICES
AND ON THE OTHER HAND
OUR RESPECT FOR THE REALITY OF WHO SHE IS
AND FOR THE CHOICES, NO MATTER HOW UNHEALTHY,
THAT SHE “FINDS HERSELF” FEELING COMPELLED TO MAKE
WE ARE THEREFORE ALWAYS STRUGGLING TO FIND
AN OPTIMAL BALANCE WITHIN OURSELVES
BETWEEN WANTING THE PATIENT TO CHANGE
AND ACCEPTING THE REALITY OF WHO SHE IS
80

A NEW EARTH: AWAKENING TO YOUR LIFE’S PURPOSE
BY ECKART TOLLE (2008)
TOLLE WRITES –
“AFTER TWO DUCKS GET INTO A FIGHT, WHICH NEVER LASTS LONG,
THEY WILL SEPARATE AND FLOAT OFF IN OPPOSITE DIRECTIONS.
THEN EACH DUCK WILL FLAP ITS WINGS VIGOROUSLY A FEW TIMES
< AS IF TO PROCESS THE INTERNAL TENSION >, THUS RELEASING THE
SURPLUS ENERGY THAT < HAD > BUILT UP DURING THE FIGHT.
AFTER THEY FLAP THEIR WINGS, THEY < WILL > FLOAT ON PEACEFULLY,
AS IF NOTHING HAD EVER HAPPENED.”
TOLLE GOES ON TO WRITE –
“WE ARE A SPECIES THAT HAS LOST ITS WAY.
EVERYTHING NATURAL, EVERY FLOWER OR TREE, AND EVERY ANIMAL
HAVE IMPORTANT LESSONS TO TEACH US IF
WE < COULD BUT LET OURSELVES > STOP, LOOK, AND LISTEN.
OUR DUCK’S LESSON IS THIS: FLAP YOUR WINGS –
< LET GO > –
AND RETURN TO THE ONLY PLACE OF POWER: THE PRESENT MOMENT.”
PROCESS, INTEGRATE, AND MOVE ON,
STRONGER FOR HAVING HAD THE STRESSFUL EXPERIENCE
AND TRANSCENDED IT …
81

OUR PATIENTS CAN INDEED
BE “SET FREE”
IF WE BUT HAVE THE COURAGE
TO OFFER THEM
OPTIMALLY STRESSFUL INTERVENTIONS
THAT WILL PROVIDE
FOR THEM TO ADVANCE
THROUGH ITERATIVE HEALING CYCLES
OF DISRUPTION
– IN REACTION TO OUR CHALLENGE –
AND REPAIR
– IN RESPONSE TO OUR SUPPORT
AND BY TAPPING INTO THEIR INNATE ABILITY
TO SELF – CORRECT IN THE FACE OF OPTIMAL CHALLENGE –
AT EVER HIGHER LEVELS
OF RESILIENCE AND ADAPTABILITY
SUCH THAT
THEY WILL NO LONGER HAVE
THE NEED TO CURSE THE DARKNESS
BECAUSE THEY WILL NOW HAVE
THE CAPACITY TO LIGHT A CANDLE 
83

OPTIMAL STRESS
STRONGER AT THE BROKEN PLACES
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A BEAUTY NEVER ACHIEVED BY THINGS UNBROKEN?
IF A BONE IS FRACTURED AND THEN HEALS,
THE AREA OF THE BREAK WILL BE STRONGER
THAN THE SURROUNDING BONE
AND WILL NOT AGAIN EASILY FRACTURE
ARE WE, TOO, NOT STRONGER AT OUR BROKEN PLACES?
AND IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A QUIET STRENGTH WE ACQUIRE
FROM SURVIVING ADVERSITY AND HARDSHIP
AND MASTERING THE EXPERIENCE OF
DISAPPOINTMENT, HEARTBREAK, AND DEVASTATION?
AND, THEN, WHEN WE FINALLY RISE ABOVE IT,
DON’T WE RISE UP IN QUIET TRIUMPH,
EVEN IF ONLY WE NOTICE …
84

80
“COME TO
THE EDGE”
AN EVOCATIVE POEM
BY
CHRISTOPHER
LOGUE
(1969)
CAPTURES
THE
ESSENCE
OF OUR
CAPACITY
TO ADAPT
TO STRESS
… WHEN
PUSH
COMES
TO SHOVE

88
THANK YOU!
STUART AND HIS BROTHER STEWART

IF YOU HAVE ANY QUESTIONS
OR WOULD LIKE TO BE
ON MY MAILING LIST
PLEASE EMAIL ME AT
MarthaStarkMD @
HMS.Harvard.edu
89

REFERENCES
Akhtar, S. 2018. Comprehensive dictionary of psychoanalysis.
Philadelphia, PA: Routledge (Taylor & Francis Group).
Bak, P. 1999. How nature works: The science of self-organized
criticality. Gottingen, Germany: Copernicus Publications.
Blumenthal, J. A., et al. Effects of exercise training on older patients with
major depression. Arch Intern Med 1999;159(19):2349-2356.
Ecker, B. 2015. Memory reconsolidation understood and misunderstood.
Int J of Neuropsychotherapy Jan;3(1):2-46.
Ehrenberg, D. 1992. The intimate edge: Extending the reach of psychoanalytic
interaction. New York: W. W. Norton & Company.
Eshel, O. 2019. The emergence of analytic oneness: Into the heart of psychoanalysis.
Abingdon, Oxfordshire, England: Routledge (Taylor & Francis Group).
Freud, S. 1990. The ego and the id – The standard edition of the complete psychological
works of Sigmund Freud. New York: W. W. Norton & Company.
Hon, E. H., and S. T. Lee. Electronic evaluations of the fetal heart rate patterns preceding
fetal death: Further observations. Am J Obstet Gynecol 1965;87:814-826.
Khan, M. 2011. The privacy of the self. London, England: Karnac Books.
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Krebs, C. 1998. A revolutionary way of thinking: From a near fatal accident
to a new science of healing. Melbourne, Australia: Hill of Content.
Leibenluft, E., and T. A. Wehr. Is sleep deprivation useful in the treatment
of depression? Am J Psychiatry 1992;149(2):159-168.
Matson, M. 2023. The intermittent fasting revolution: The science of optimizing health
and enhancing performance. Cambridge, MA: The MIT Press.
Mitchell, S. 1988. Relational concepts in psychoanalysis: An integration.
Cambridge, MA: Harvard University Press.
Nelson, P. 2012. There’s a hole in my sidewalk: The romance of
self-discovery. New York: Atria Books.
Stark, M. Hormesis, adaptation, and the sandpile model.
Crit Rev Toxicol 2008;38(7):641-644.
Stark, M. The sandpile model: Optimal stress and hormesis.
Dose Response 2012;10(1):66-74.
Tolle, E. 2008. A new earth: Awakening to your life’s purpose.
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Zevon, W. 1996. I’ll sleep when I’m dead. Burbank, CA: Elektra Records.
91

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