Martha Stark MD – 28 Apr 2023 – Seminar 2 – A How-To Playbook for the Middle Game in Psychodynamic Psychotherapy.pptx

A HOW – TO PLAYBOOK
FOR THE MIDDLE GAME
IN PSYCHODYNAMIC PSYCHOTHERAPY
“LIKE THE MIDDLE GAME IN CHESS,
THERE IS NO PLAYBOOK TO GUIDE US”
PATRICIA COUGHLIN (2022)
MARTHA STARK MD
Faculty, Harvard Medical School
MarthaStarkMD @ SynergyMed.solutions
April 2023 – SEMINAR 2
International Association for Relational Psychoanalysis and Psychotherapy (IARPP)
AUSTRALIA
With heartfelt thanks to LEENA CHAUGULE and MEG CARLEY
for hosting this FUNDRAISER for UKRAINIAN PSYCHOTHERAPISTS!
© 2023 Martha Stark MD

THE “POOREST UNDERSTOOD”
AND
“TWO MOST ENIGMATIC WORDS”
IN PSYCHOANALYSIS
ARE “WORKING THROUGH”
PETER GIOVACCHINI (1986)
“THIS WORKING – THROUGH OF
THE RESISTANCES < DEFENSES >
MAY IN PRACTICE
TURN OUT TO BE
AN ARDUOUS TASK
FOR THE SUBJECT
OF THE ANALYSIS
AND A TRIAL OF PATIENCE
FOR THE ANALYST”
SIGMUND FREUD (1914)
3

WHAT FOLLOWS IS MY RATHER BOLD ATTEMPT TO FORMULATE
AN “OVERARCHING CONCEPTUAL FRAMEWORK”
– TO WHICH I WILL BE REFERRING AS MY “TRANSFORMATION PLAYBOOK” –
FOR THE “WORKING THROUGH” PROCESS
– THE “MIDDLE GAME” –
AND IN ANY “DEPTH PSYCHOLOGY”
FOR WHICH THE ULTIMATE GOAL
IS PROFOUND AND ENDURING HEALING
– AN EVER – EVOLVING “PROCESS” THAT WILL REQUIRE
BOTH TOP – DOWN (THOUGHTS DOWN TO BODILY SENSATIONS)
AND BOTTOM – UP (BODILY SENSATIONS UP TO THOUGHTS)
“REPROCESSING OF OLD” AND “PROCESSING OF NEW” STRESSORS –
I WILL THEREFORE BE PRESENTING
A THEORETICAL FRAMEWORK
THAT OUTLINES A SERIES OF STEPS
WHEREBY PSYCHOLOGICAL RIGIDITY
– RIGID AND UNEVOLVED DEFENSE –
– “SAME OLD, SAME OLD” –
– THE SOBERING AND CONDITIONED REALITY OF “WHAT IS” / OF “OLD BAD” –
CAN BE INCREMENTALLY TRANSFORMED
INTO PSYCHOLOGICAL FLEXIBILITY
– MORE FLEXIBLE AND MORE EVOLVED ADAPTATION –
– “SOMETHING NEW, DIFFERENT, AND BETTER” –
– THE ENLIVENING AND QUANTUM POSSIBILITY OF “WHAT COULD BE” / OF “NEW GOOD” – 6

WORKING THROUGH INVOLVES A SERIES
OF STEPS
ALTHOUGH SOME OF MY LITTLE FRIENDS

MY TRANSFORMATION PLAYBOOK
FOR THE WORKING THROUGH PROCESS
A “TRIPARTITE” APPROACH THAT DISTINGUISHES THREE STAGES
THE BEGINNING GAME
“MINIMALLY STRESSFUL” INTERVENTIONS
THAT IDENTIFY THE PLAYERS
AND SET THE STAGE FOR THE ACTION THAT WILL FOLLOW
THE MIDDLE GAME
– THE FOCUS OF MY PRESENTATION HERE –
“OPTIMALLY STRESSFUL” INTERVENTIONS
THAT JUXTAPOSE VARIOUS OF THE PLAYERS
TO CREATE GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
ALONG WITH FOSTERING “DUAL AWARENESS”
– THE SIMULTANEOUS PRESENCE OF BOTH AN OBSERVING SELF AND AN EXPERIENCING SELF –
THE END GAME
“NO STRESS” INTERVENTIONS
THAT CELEBRATE AND APPLAUD “ADAPTIVE RESOLUTION”
– EVEN IF ONLY TEMPORARY AND / OR MAKESHIFT –
AND AN “ACTIONABLE GAME PLAN”
– USUALLY ACCOMPANIED BY A SATISFYING “CLICK OF RECOGNITION” –
AND THEN THE ENTIRE SEQUENCE WILL BE REPLAYED AGAIN AND AGAIN
UNTIL THE PRESENTING PROBLEM HAS BECOME A NON – ISSUE
AND SOME OTHER PROBLEM
– NOW UNEARTHED –
CAN BE ADDRESSED

IN ESSENCE
THE WORKING THROUGH PROCESS
IS DESIGNED
TO ADVANCE THE PATIENT FROM
“PSYCHOLOGICAL RIGIDITY”
TO “PSYCHOLOGICAL FLEXIBILITY”
IN THE EVOCATIVE WORDS OF ACCEPTANCE AND COMMITMENT THERAPY (ACT)
AND “LOW – LEVEL DEFENSE”
TO “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”
10

AS WE SHALL SOON SEE
IN ORDER TO ADVANCE THE PATIENT
FROM “UNHEALTHY” DEFENSIVE REACTIONS
TO “EVER – MORE HEALTHY” ADAPTIVE RESPONSES
AGAINST THE BACKDROP OF EMPATHIC RESONANCE AND A THERAPEUTIC ALLIANCE
THE THERAPIST WILL REPEATEDLY OFFER THE PATIENT
OPTIMALLY STRESSFUL INTERVENTIONS
– JUST THE RIGHT COMBINATION OF CHALLENGE AND SUPPORT –
STRATEGICALLY DESIGNED TO GENERATE
DESTABILIZING INTERNAL DISSONANCE AND HOMEOSTATIC IMBALANCE
BY JUXTAPOSING
– IN AN “EMBODIED FASHION” / “LIVED EXPERIENCE” IN THE MOMENT –
“HEALTHY” – BUT ANXIETY – PROVOKING – CHALLENGE OF THE PATIENT’S DEFENSES
WITH “LESS HEALTHY” – BUT ANXIETY – ASSUAGING – SUPPORT OF THEM
THEREBY CREATING
GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
THE ONGOING WORKING THROUGH OF WHICH
– NEEDED TO RESOLVE THE INTERNAL TENSION AND RESTORE THE HOMEOSTATIC BALANCE –
WILL FORCE THE PATIENT TO RE – EQUILIBRATE
AT EVER – HIGHER AND EVER – MORE EVOLVED LEVELS
OF RESILIENCE AND ADAPTIVE CAPACITY
11

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

HOW ARE
DEFENSES
HERE
BEING DEFINED
14

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
15

RATHER
I DEFINE DEFENSES “MORE BROADLY”
AS SPEAKING TO ANY OF THE
“SELF – PROTECTIVE MECHANISMS”
THAT WE MOBILIZE WHEN WE ARE 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”
16

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

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.

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

THE RELATIONSHIP BETWEEN DEFENSE AND ADAPTATION
IS CLEARLY 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”
20

AT THE END OF THE DAY
THE “THERAPEUTIC ACTION”
WILL INVOLVE TRANSFORMATION OF
RIGID DEFENSE INTO MORE FLEXIBLE ADAPTATION
TRANSFORMATION OF
“OLD BAD,” DISEMPOWERING, AND MALADAPTIVE NARRATIVES
– ABOUT SELF, OTHERS, AND THE WORLD –
CONSTRUCTED BY AN “OVERWHELMED” CHILD
DESPERATELY ATTEMPTING TO “MAKE MEANING” OF HER WORLD
BOTH THE RELATIONAL DEPRIVATION AND NEGLECT
– “TOXIC ABSENCE OF GOOD” –
AND THE RELATIONAL TRAUMA AND ABUSE
– “TOXIC PRESENCE OF BAD” –
TO WHICH SHE WAS BEING CONTINUOUSLY EXPOSED
INTO “NEW GOOD,” EMPOWERING, AND MORE ADAPTIVE NARRATIVES
– ABOUT SELF, OTHERS, AND THE WORLD –
CONSTRUCTED BY A NOW MORE “RESOURCED” ADULT
IN A LOVINGLY SUPPORTIVE THERAPY RELATIONSHIP
– NARRATIVES THAT ARE NOW MORE REALITY – BASED AND HOPE – INFUSED –
22

FROM
GROWTH – IMPEDING
TRAUMATIC STRESS
AND THE DEFENSIVE REACTIONS
TO WHICH IT WILL GIVE RISE
THE EXPERIENCE OF A CHILD ON HER OWN
TO
GROWTH – PROMOTING
OPTIMAL STRESS
AND THE ADAPTIVE RESPONSES
THAT WILL THEN BE POSSIBLE
THE GOAL FOR AN ADULT IN TREATMENT
TRAUMATIC STRESS INHIBITS GROWTH
OPTIMAL STRESS STIMULATES GROWTH
23

OVERVIEW OF MY TRANSFORMATION PLAYBOOK
WHEREBY RIGID DEFENSES
– “OLD BAD,” DISEMPOWERING, MALADAPTIVE NARRATIVES –
WILL GRADUALLY EVOLVE INTO MORE FLEXIBLE ADAPTATIONS
– “NEW GOOD,” MORE EMPOWERING, MORE REALITY – BASED NARRATIVES –
MUCH AS A CATERPILLAR INCREMENTALLY MORPHS INTO A BUTTERFLY
IN THE BEGINNING OF THE CHILD’S LIFE ARE
“TOXIC FORMATIVE EXPERIENCES”
– DEVELOPMENTAL TRAUMAS –
FROM WHICH SO MUCH ELSE WILL DERIVE
– BOTH “BAD” (MORE IMMEDIATELY) AND “GOOD” (IN THE LONG RUN) –
TRAUMATIC STRESSORS THAT
– AT THE TIME –
WERE SIMPLY “TOO MUCH”
FOR THE CHILD
– LACKING BOTH PARENTAL SUPPORT AND INTERNAL RESOURCES –
TO PROCESS, INTEGRATE, AND ADAPT TO
AND TO WHICH THE CHILD THEREFORE
– IN ORDER TO SURVIVE –
WAS FORCED TO REACT DEFENSIVELY
24

BUT AS AN ADULT IN TREATMENT
– WITH NOW THE BENEFIT OF NOT ONLY MORE INTERNAL RESOURCES
AS A RESULT OF LIFE EXPERIENCE
BUT ALSO THE LOVING SUPPORT OF A GOOD THERAPIST
ABLE TO PROVIDE OPTIMAL (GROWTH – INCENTIVIZING) CHALLENGE –
THOSE EARLY – ON, TRAUMATICALLY STRESSFUL,
GROWTH – IMPEDING EXPERIENCES
CAN BE “WORKED THROUGH” / “REPROCESSED”
IN OTHER WORDS
REVISITED
RE – EXPERIENCED / RE – ENACTED
– IN AN EMBODIED (BODILY FELT SENSE) FASHION –
GRIEVED
AND RECONTEXTUALIZED
SUCH THAT THOSE EARLY – ON, UNMASTERED EXPERIENCES
ONCE TRAUMATICALLY STRESSFUL AND GROWTH – IMPEDING
AND SOMETHING TO WHICH THE PATIENT (AS A CHILD)
HAD HAD NO CHOICE BUT TO REACT DEFENSIVELY AND MALADAPTIVELY
WILL BECOME OPTIMALLY STRESSFUL AND GROWTH – PROMOTING
AND SOMETHING TO WHICH THE PATIENT (AS AN ADULT IN TREATMENT)
WILL NOW BE ABLE TO RESPOND ADAPTIVELY AND MORE HEALTHILY
DESCRIBED IN THE LITERATURE AS “POSTTRAUMATIC GROWTH”
CALHOUN AND TEDESCHI (2012)
25

HOW DOES FREUD
USE THE METAPHOR
OF HORSE AND RIDER
TO EXPLAIN
THIS WORKING
THROUGH PROCESS
THE GRADUATED EASING OF DEFENSE INTO ADAPTATION
AS “CONFLICT” SEGUES INTO “COLLABORATION”
26

FREUD’S (1937) “HORSE AND RIDER” IS INDEED
AN APT METAPHOR FOR THE WORKING THROUGH PROCESS
WHEREBY “THE ID IS TAMED” AND “THE EGO STRENGTHENED”
– SUCH THAT RIGID DEFENSE CAN BE GRADUALLY REPLACED BY MORE FLEXIBLE ADAPTATION –
INITIALLY
FREUD’S INEXPERIENCED RIDER
– AN UNDEVELOPED EGO –
WILL BE MADE ANXIOUS BY HER UNTAMED HORSE
– A DYSREGULATED ID –
BUT AS A RESULT OF WORKING THROUGH
FREUD’S NOW MORE EXPERIENCED AND MORE EMPOWERED RIDER
– A NOW STRONGER AND MORE DEVELOPED EGO –
WILL NOW BE BETTER ABLE TO TAKE IN STRIDE
HER NOW TAMER HORSE
– A NOW BETTER REGULATED ID –
INSTEAD OF (DEFENSIVELY) “REINING HER HORSE IN”
SHE WILL NOW BE ABLE (ADAPTIVELY) TO “GIVE HER HORSE FREE REIN”
AND TO HARNESS ITS POWER
BY CHANNELING ITS NOW MORE MODULATED ENERGY
INTO CONSTRUCTIVE ENDEAVORS AND HEALTHY PURSUITS
THINK “SUBLIMATION”
AND FREUD’S SURGEON
WHO WAS ONCE A YOUNG CHILD PLAYING WITH KNIVES
27

INDEED
AS THE RIDER – EGO – IS STRENGTHENED
AND THE HORSE – ID – TAMED
THE “DEFENSIVE NEED” TO
“REIN THE HORSE IN”
WILL BE INCREMENTALLY TRANSFORMED INTO
THE “ADAPTIVE CAPACITY” TO
“GIVE THE HORSE FREE REIN”
AS CONFLICT
EASES INTO
COLLABORATION
28

HOW DOES FREUD’S METAPHOR
OF HORSE AND RIDER
APPLY TO THE INTIMATE RELATIONSHIP
BETWEEN PROBLEMATIC DEFENSE
AND MORE ADAPTIVE RESOLUTION
IN OTHER WORDS
WHAT IS MEANT
WHEN WE SUGGEST
THAT THE PROBLEM
HOLDS ELEMENTS
OF THE SOLUTION
30

IN THE PHYSIOLOGICAL REALM
SYMPTOMS SIGNAL THAT A BODY UNDER ATTACK
IS STRUGGLING TO RECOVER ITS HOMEOSTATIC BALANCE
FOR EXAMPLE
ACUTE INFLAMMATION
– A SIGN THAT THE IMMUNE SYSTEM AND THE HEALING CASCADE HAVE BEEN ACTIVATED –
GIVES RISE TO PROBLEMATIC SYMPTOMS
BUT, PARADOXICALLY, IT IS THIS VERY INFLAMMATION
THAT WILL ALSO “HOLD THE SOLUTION”
ADMITTEDLY, INFLAMMATION WAS PART OF THE INITIAL PROBLEM
BUT IT WILL ALSO BECOME PART OF THE EVENTUAL SOLUTION
INASMUCH AS IT IS A CRITICALLY IMPORTANT PART OF THE HEALING PROCESS
AS ANOTHER EXAMPLE
FEVER
– A SIGN THAT THE IMMUNE SYSTEM AND THE HEALING CASCADE HAVE BEEN ACTIVATED –
IS THE BODY’S SELF – PROTECTIVE REACTION TO AN INFECTION
BUT, PARADOXICALLY, IT IS ALSO A CRITICALLY IMPORTANT PART
OF WHAT WILL ULTIMATELY HEAL THE BODY
A 1989 STUDY – DORAN et al. – ON CHILDREN WITH CHICKENPOX
REVEALED THAT THOSE TREATED WITH ANTIPYRETICS
– TO REDUCE THEIR FEVERS –
TOOK LONGER TO HEAL THAN THOSE WHOSE FEVERS WERE LEFT UNTREATED
HERE, TOO, THE FEVER CREATED AN INITIAL PROBLEM
BUT IT ALSO BECAME PART OF THE EVENTUAL SOLUTION
SYMPTOMS SPEAK TO THE BODY’S VALIANT EFFORTS TO HEAL ITSELF 31

26
… the meaning of fever in the pandemic era …
… fever augments the performance of immune cells …
… trials suggest a survival benefit from fever …
… we advise that fever should be allowed to run its course …
Sylwia Wrotek et al. (2020)

SIMILARLY IN THE PSYCHOLOGICAL REALM
DEFENSES SPEAK TO THE PSYCHE’S VALIANT EFFORTS TO HEAL ITSELF
DEFENSIVE REACTIONS TO STRESSORS SIGNAL THAT A PSYCHE UNDER ATTACK
IS STRUGGLING TO RECOVER ITS HOMEOSTATIC BALANCE
DEFENSES “HOLD ELEMENTS” OF THE ADAPTIVE SOLUTION
DEFENSES, ONCE A PROBLEM, ARE NOW PART OF THE SOLUTION
IN ESSENCE, DEFENSES BECOME THE “MEANS TO AN END” BY PROVIDING
THE IMPETUS FOR MOVEMENT TOWARDS A HEALTHIER RESOLUTION
FOR EXAMPLE, A PERSON WHO, AS A CHILD, WAS MADE TO FEEL TERRIBLE ABOUT HERSELF
BECAUSE SHE WAS CONSTANTLY BEING BULLIED
MIGHT, AS AN ADULT, BECOME AN ADVOCATE FOR CHILDREN’S RIGHTS
OR A PERSON WHO, AS A CHILD, SUFFERED EITHER DEPRIVATION AND NEGLECT
AND / OR TRAUMA AND ABUSE AT THE HANDS OF HER PARENTS
MIGHT, AS AN ADULT, BECOME A PSYCHOTHERAPIST
IN ESSENCE
THE DEFENSE DEMANDS THAT WE PAY PROPER ATTENTION TO
WHATEVER THE UNDERLYING TRAUMATIC STRESSORS WERE THAT
HAD PROMPTED MOBILIZATION OF THE DEFENSE IN THE FIRST PLACE
THOSE STRESSORS CAN THEN BE WORKED THROUGH IN THERAPY
– REVISITED, REPROCESSED, AND REFRAMED –
SUCH THAT A HEALTHIER, LESS COSTLY, AND
MORE ADAPTIVE RESOLUTION CAN ULTIMATELY BE ACHIEVED
FROM TRAUMATIC STRESSORS TO OPTIMAL STRESSORS
AND FROM DEFENSIVE REACTIONS TO ADAPTIVE RESPONSES 33

OPTIMALLY STRESSFUL
GROWTH – INCENTIVIZING
INTERVENTIONS
STRATEGICALLY DESIGNED
TO OFFER
JUST THE RIGHT BALANCE
BETWEEN ANXIETY – PROVOKING CHALLENGE
AND ANXIETY – ASSUAGING SUPPORT
THE WORKING THROUGH OF WHICH
WILL BE THE WAY THAT
“REINED IN” AND “RIGID”
WILL GRADUALLY EASE INTO
“FREER” AND “MORE FLEXIBLE”
35

MORE SPECIFICALLY
WITH THE THERAPIST’S FINGER EVER ON THE PULSE
OF THE LEVEL OF THE PATIENT’S ANXIETY
AND CAPACITY TO TOLERATE FURTHER CHALLENGE
THE THERAPIST WILL ALTERNATELY AND REPEATEDLY
FIRST “CHALLENGE” THE MALADAPTIVE 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” (2012) –
AND THEN “SUPPORT” THE MALADAPTIVE DEFENSE
BY RESONATING EMPATHICALLY WITH WHERE THE PATIENT IS
– SALMAN AKHTAR’S “HOMEOSTATIC ATTUNEMENT” (2012) –
IN ESSENCE
THE THERAPIST WILL BE INTENTIONALLY GENERATING
GROWTH – INCENTIVIZING, DESTABILIZING TENSION WITHIN THE PATIENT
BY FIRST INCREASING HER ANXIETY
– WITH CHALLENGE –
AND THEN DECREASING IT
– WITH SUPPORT –
BECAUSE WITHOUT SUFFICIENT CHALLENGE,
THERE WILL BE NO IMPETUS FOR GROWTH
BUT WITHOUT ADEQUATE SUPPORT,
THERE WILL BE NO SUCH OPPORTUNITY
36

STRATEGIC LEVERAGING DURING THE MIDDLE GAME
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

THE MOST POWERFUL THERAPEUTIC TOOLS
DURING THE MIDDLE GAME
ARE THESE OPTIMALLY STRESSFUL INTERVENTIONS
INTERVENTIONS THAT ARE DELIBERATELY FORMULATED
TO PRECIPITATE DISRUPTION IN ORDER TO JUMP – START REPAIR
IN ESSENCE
THESE DESTABILIZING – BUT GROWTH – INCENTIVIZING – INTERVENTIONS
ARE EFFECTIVELY SUPERIMPOSING
AN “ACUTE” INJURY ON TOP OF A “CHRONIC” ONE
IN ORDER TO TRIGGER THE PATIENT’S HEALING RESPONSE
INDEED
THESE “ACUTELY STRESSFUL” THERAPEUTIC INTERVENTIONS
WILL EVENTUALLY PROMPT THE PATIENT
– IN THE CONTEXT OF FEELING SAFE, HELD, AND UNDERSTOOD BY HER THERAPIST –
TO RETRIEVE, REACTIVATE, RE – ENACT, REPROCESS, AND RECONTEXTUALIZE
AT LEAST SOME OF THE UNRESOLVED TRAUMATIC EXPERIENCES
THAT HAD GIVEN RISE
– IN THE FIRST PLACE –
TO HER RIGID AND MALADAPTIVE DEFENSES
– DEFENSES THAT SOON BECAME “CONDITIONED / HABITUAL” AND ULTIMATELY “CHRONIC” –
(HER MODUS OPERANDI)
38

THE THERAPEUTIC ACTION, THEREFORE, INVOLVES
JUDICIOUS AND ONGOING USE OF
OPTIMALLY STRESSFUL, GROWTH – INCENTIVIZING INTERVENTIONS
STRATEGICALLY DESIGNED TO GENERATE
“MISMATCH EXPERIENCES” FOR THE PATIENT,
THE WORKING THROUGH – AND RESOLUTION – OF WHICH
WILL REQUIRE OF THE PATIENT THAT SHE
REVISIT EXPERIENCES THAT HAD ONCE BEEN TRAUMATIC
BUT THAT CAN NOW
– WITH THE SUPPORT OF HER THERAPIST AND BY TAPPING INTO HER INTERNAL RESERVES –
BE REWORKED
– RE – ENACTED, GRIEVED, REPROCESSED, REFRAMED –
SUCH THAT SHE WILL ULTIMATELY BE ABLE
TO “REPOSITION” HERSELF IN RELATION TO THE TRAUMA
– ABLE NOW TO RESPOND ADAPTIVELY INSTEAD OF REACTING DEFENSIVELY –
IN OTHER WORDS
THE PATIENT WILL BE RETURNING
– IN AN EMBODIED (FELT SENSE) FASHION –
TO THE SCENE OF THE ORIGINAL CRIME BUT WILL NOW
– IN THE CONTEXT OF A THERAPY RELATIONSHIP THAT WILL INVOLVE BOTH
THE “RE – EXPERIENCING OF OLD BAD” AND THE “EXPERIENCING OF NEW GOOD” –
BE ABLE TO NEGOTIATE A DIFFERENT AND BETTER ENDING
– AN ADAPTIVE RESOLUTION –
39

IN ESSENCE
IT WILL BE
THIS “INCENTIVIZED” RETURN TO
THE SCENE OF THE ORIGINAL CRIME
THAT WILL CREATE
BOTH IMPETUS AND OPPORTUNITY
FOR A “REDO” OF THOSE
EARLY – ON TRAUMATIZING EXPERIENCES
– AS THE PATIENT COMPULSIVELY AND UNWITTINGLY RE – ENACTS THEM
AT THE “INTIMATE EDGE” IN HER RELATIONSHIP WITH THE THERAPIST –
DARLENE EHRENBERG (1992)
SUCH THAT
ULTIMATELY A MUCH DIFFERENT AND MUCH HEALTHIER
OUTCOME CAN BE NEGOTIATED
AGAIN
FROM GROWTH – INHIBITING TRAUMATIC STRESS
TO GROWTH – STIMULATING OPTIMAL STRESS
AND, THEREFORE,
FROM DEFENSIVE REACTIONS
TO ADAPTIVE RESPONSES
40

TO REVIEW
THE REWORKING OF EARLY – ON,
UNMASTERED DEVELOPMENTAL TRAUMAS
– RELIVING, RE – EXPERIENCING, GRIEVING, AND REFRAMING
THE ORIGINAL, INTOLERABLY PAINFUL SCENARIOS
IN THE CONTEXT OF A SOLID THERAPEUTIC ALLIANCE –
WILL ENABLE THE PATIENT
TO “REPOSITION” HERSELF
IN RELATION TO THEM
SUCH THAT THOSE DISSOCIATED EXPERIENCES
– ONCE TRAUMATICALLY STRESSFUL, OVERWHELMING, AND GROWTH – IMPEDING –
CAN BE INTEGRATED AND ADAPTED TO
AS A RESULT OF WHICH
“MINDLESS, CONDITIONED DEFENSIVENESS”
WILL BE TRANSFORMED INTO
“MORE MINDFUL, INTENTIONED ADAPTABILITY”
FROM “CONSTRICTED” AND “DEFENDED”
TO “EXPANSIVE” AND “WIDE OPEN”
41

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

OPTIMALLY STRESSFUL
INTERVENTIONS
ARE
STRATEGICALLY
DESIGNED
TO GENERATE
GROWTH – INCENTIVIZING
“MISMATCH EXPERIENCES”
45

IN ESSENCE
OPTIMALLY STRESSFUL INTERVENTIONS JUXTAPOSE
TWO SEEMINGLY IRRECONCILABLE ENTITIES
– TWO DIAMETRICALLY OPPOSED ENERGIES / FORCES / PERSPECTIVES / STANCES –
FOR EXAMPLE
THE ANXIETY – PROVOKING
– BUT ENLIVENING –
QUANTUM POSSIBILITY OF “WHAT COULD BE”
WITH THE ANXIETY – ASSUAGING
– BUT SOBERING –
CONDITIONED REALITY OF “WHAT IS”
WITH AN EYE TO CREATING GROWTH – INCENTIVIZING “MISMATCH EXPERIENCES”
– THAT CAN THEN BE WORKED THROUGH AND ADAPTIVELY RESOLVED –
OR, AS ANOTHER EXAMPLE,
THE ANXIETY – PROVOKING
– BUT HEARTWARMING –
EXPERIENCE OF THE THERAPIST’S LOVE, SUPPORT, AND CARING IN THE PRESENT
WITH THE ANXIETY – ASSUAGING
– BECAUSE “OH – SO – FAMILIAR” –
MEMORY OF THE PARENT’S TOXICITY IN THE PAST
– THE “RELATIONAL EXPECTATION OF BEING FAILED” –
THE JUXTAPOSITION OF WHICH
– WHEN WORKED THROUGH –
WILL CONSTITUTE A “CORRECTIVE EMOTIONAL < RELATIONAL > EXPERIENCE”
IN THE WORDS OF ALEXANDER AND FRENCH (1947)
46

ALWAYS WITH AN EYE TO FOSTERING “DUAL AWARENESS”
OPTIMALLY STRESSFUL INTERVENTIONS WILL BE JUXTAPOSING
ANXIETY – PROVOKING CHALLENGE THAT SPEAKS
– WHETHER DIRECTLY OR INDIRECTLY AND WHETHER EXPLICITLY OR IMPLICITLY –
TO THE PATIENT’S “ADAPTIVE CAPACITY”
– BY APPEALING TO THE “HEALTHY” PART OF THE PATIENT
THAT UNDERSTANDS THE “PRICE PAID”
FOR REMAINING INVESTED IN “SAME OLD, SAME OLD”
AND / OR THAT YEARNS
FOR “SOMETHING NEW, DIFFERENT, AND BETTER” –
√WITH ANXIETY – ASSUAGING SUPPORT THAT SPEAKS
– WHETHER DIRECTLY OR INDIRECTLY AND WHETHER EXPLICITLY OR IMPLICITLY –
TO THE PATIENT’S “DEFENSIVE NEED”
– BY EMPATHICALLY HIGHLIGHTING THE “LESS HEALTHY” PART OF THE PATIENT
THAT REMAINS INVESTED IN MAINTAINING “SAME OLD, SAME OLD” –
IN ESSENCE
THE THERAPIST WILL BE GENERATING GROWTH – INCENTIVIZING
“MISMATCH EXPERIENCES” FOR THE PATIENT BY JUXTAPOSING
SOMETHING “HEALTHY”
– BUT ANXIETY – PROVOKING –
WITH SOMETHING “LESS HEALTHY”
– BUT ANXIETY – ASSUAGING –
47

DOES NEUROSCIENCE
SUPPORT THE IDEA THAT
– UNDER THE RIGHT CIRCUMSTANCES
AND WHEN REPEATEDLY JUXTAPOSED –
A HEALTHIER
“NEW, DIFFERENT, AND BETTER”
NARRATIVE
WILL ULTIMATELY REPLACE
THE MORE PROBLEMATIC
“SAME OLD, SAME OLD”
NARRATIVE
49

INDEED
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 HEBB’S POSTULATE
– ADVANCED IN 1949 BY THE NEUROPSYCHOLOGIST DONALD HEBB –
“NEURONS THAT FIRE TOGETHER, WIRE TOGETHER”
MEANING THAT REACTIVATED AND RE – EXPERIENCED MEMORIES
ARE SIMPLY REINFORCED THROUGH REPETITION
– AND NEVER RESOLVED –
BUT WE NOW KNOW THAT, FORTUNATELY, THIS IS NOT THE WHOLE STORY
WERE THIS TO BE THE CASE
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 50

FORTUNATELY
OVER THE COURSE OF THE PAST SEVERAL DECADES,
A DEDICATED GROUP OF TRAILBLAZING COGNITIVE NEUROSCIENTISTS
– DISSATISFIED WITH THE DETERMINISTIC IDEA THAT MEMORIES ARE FOREVER –
HAVE BEEN USING ADVANCED NEUROIMAGING TECHNIQUES
– INCLUDING FUNCTIONAL MRIs, SCANNING MICROSCOPY, AND OPTOGENETICS –
TO MAP OUT WHAT HAPPENS IN THE BRAIN
WHEN A THOUGHT IS BEING THOUGHT, A FEELING FELT,
AND A MEMORY REMEMBERED IN AN “EMBODIED” (LIVED) FASHION
THEIR FOCUS HAS BEEN ON HOW OLD MEMORIES
– ESPECIALLY, IMPLICITLY HELD TRAUMATIC MEMORIES CONSOLIDATED IN LONG – TERM MEMORY
AND DISTRIBUTED IN NETWORKS THROUGHOUT THE CORTICOLIMBIC SYSTEM –
(“IMPLICIT RELATIONAL KNOWING”)
CAN BE SUBSEQUENTLY UPDATED AND RECONSOLIDATED
INDEED
THESE RESEARCHERS ARE DISCOVERING THAT THE BRAIN
– IN RESPONSE TO ONGOING NEW EXPERIENCE AND INFORMATION –
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 – 51

MORE SPECIFICALLY
NEUROSCIENTISTS HAVE RECENTLY MADE THE GROUNDBREAKING DISCOVERY
THAT WHEN IMPLICITLY HELD MEMORIES
ARE REACTIVATED AND RE – EXPERIENCED IN AN EMBODIED (LIVED) FASHION,
THE NETWORK OF SYNAPSES ENCODING THESE MEMORIES
WILL BECOME UNLOCKED FOR A TIME – LIMITED PERIOD
THIS UNLOCKING – OR DECONSOLIDATION – SIGNALS
THE OPENING UP 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 (2015) AND DAVID FEINSTEIN (2019) –
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 AND INFORMATION
SUCH THAT THESE SYNAPSES CAN BE REWIRED
– UNDER THE RIGHT CIRCUMSTANCES –
AND THE TRAUMATIC MEMORIES THEY ENCODE REPROGRAMMED
52

TRAUMA EXPERIENCED
MEMORY OF TRAUMA ENCODED
UNSTABLE UNTIL CONSOLIDATED (AND STORED) IN LONG – TERM MEMORY
MEMORY RETRIEVED, REACTIVATED IN AN EMBODIED FASHION,
AND DECONSOLIDATED (UNLOCKED)
DESTABILIZED MEMORY NOW VULNERABLE TO BEING UPDATED
BY THE INTRODUCTION OF NEW EXPERIENCE / INFORMATION
NEW MEMORY RECONSOLIDATED (LOCKED IN)

57
The essential ingredients of therapeutic change include –
(1) reactivating old memories;
(2) engaging in new emotional experiences that are incorporated into these reactivated memories
via the process of reconsolidation; and
(3) reinforcing the integrated memory structure by practicing a new way of behaving and
experiencing the world in a variety of contexts.
Leslie Greenberg et al. (2015) – Developer of Emotion – Focused Therapy

WHERE DOES MY
PSYCHODYNAMIC SYNERGY
PARADIGM
COME INTO PLAY
55

MY PSYCHODYNAMIC SYNERGY PARADIGM
FIVE INTERDEPENDENT AND MUTUALLY ENHANCING “MODES OF THERAPEUTIC ACTION”
THE PATIENT WILL ADVANCE THROUGH ITERATIVE HEALING CYCLES
OF DISRUPTION AND REPAIR
BY WAY OF WORKING THROUGH
GENERATED BY DESTABILIZING, OPTIMALLY STRESSFUL INTERVENTIONS
SUCH THAT DEFENSE IS INCREMENTALLY TRANSFORMED INTO ADAPTATION
DEFENSES – THE FIVE “Rs” / ADAPTATIONS – THE FIVE “As”
MODEL 1 – “RESISTANCE” TO “AWARENESS”
THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS
MODEL 2 – “RELENTLESS HOPE” TO “ACCEPTANCE”
THE CORRECTIVE – PROVISION PERSPECTIVE OF SELF PSYCHOLOGY
MODEL 3 – “RE – ENACTMENT” TO “ACCOUNTABILITY”
THE INTERSUBJECTIVE PERSPECTVE OF CONTEMPORARY RELATIONAL THEORY
MODEL 4 – “RELATIONAL ABSENCE” TO “AUTHENTIC PRESENCE”
AN EXISTENTIAL – HUMANISTIC APPROACH
TO MENDING BROKENNESS AND EASING EXISTENTIAL ANGST
MODEL 5 – “REFRACTORY INERTIA” TO “ACTION / ACTUALIZATION”
A QUANTUM – NEUROSCIENTIFIC APPROACH TO ANALYSIS PARALYSIS
56

MOMENT – TO – MOMENT
THE “POINT OF EMOTIONAL URGENCY” WILL SHIFT
WHICH WILL SUGGEST THE MODEL(S) THAT WILL BE MOST RELEVANT
FOR UNDERSTANDING THE PATIENT’S UNDERLYING PSYCHODYNAMICS
AND FOR THEN SELECTING THE APPROACH THAT WILL BE MOST USEFUL IN THAT MOMENT
MODEL 1
NEUROTIC CONFLICTEDNESS – CONFLICT STATEMENTS
TO HIGHLIGHT INTERNAL CONFLICTEDNESS / AMBIVALENCE
MODEL 2
NARCISSISTIC WOUNDEDNESS – DISILLUSIONMENT STATEMENTS
TO FACILITATE GRIEVING OF DISILLUSIONMENT
MODEL 3
NOXIOUS RELATEDNESS – ACCOUNTABILITY STATEMENTS
TO NEGOTIATE MUTUAL ENACTMENTS AT THE “INTIMATE EDGE” OF RELATEDNESS
MODEL 4
NONRELATEDNESS – FACILITATION STATEMENTS
TO HIGHLIGHT NEED / FEAR OF ENGAGEMENT WITH LIFE ITSELF
MODEL 5
NONACTUALIZATION – QUANTUM DISENTANGLEMENT STATEMENTS
TO JUXTAPOSE “OLD BAD” WITH “NEW GOOD”
57

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!” 58

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 THAT 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 ENRAGES AND DEVASTATES YOU.”
59

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 MOTHER – NAMELY, THE
FEELING WE BOTH HAVE THAT NO MATTER WHAT EITHER OF US MIGHT
DO, IT WOULDN’T MEET 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 MOTHER 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) 60

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 THAT 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 SPEND THE REST OF YOUR LIFE AND WITH WHOM YOU
COULD SHARE WHATYOU HOLD MOST DEAR; 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.”
61

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 PHOBIC ABOUT DRIVING
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.”
62

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”
“MY MOTHER ATTACKED ME MERCILESSLY FROM AGE 10 TO AGE 15 WITH UNFOUNDED
ACCUSATIONS AND CRUEL STATEMENTS, LIKE THAT I WAS A “WHORE” AND A “TART” –
ALL BECAUSE WHEN I WAS 10 YEARS OLD THE BOY NEXT DOOR HAD MOLESTED ME
AND I HAD WRITTEN IT DOWN IN MY DIARY – WHICH SHE READ! SHE MADE THIS
MOLESTATION MY FAULT AND ATTACKED ME FOR 5 YEARS WITH THOSE CRUEL
ACCUSATIONS. BACK THEN, I PROTESTED FEEBLY, CRYING AND SAYING IT WAS
UNTRUE – BUT BECAUSE I WAS A CHILD, I BECAME BRAINWASHED WITH HER VIEW OF ME.
IT MADE ME FEEL SO HORRIBLE ABOUT MYSELF AND MY BODY. I NEVER COULD FIGHT HER.
SHE WAS JUST TOO SCARY. SOMETIMES I WOULD HAVE TIGHTNESS IN MY CHEST AND
TROUBLE BREATHING WHEN I WAS AROUND HER. BUT I NEEDED A MOTHER, AND I
GUESS I NEEDED THE ILLUSION THAT SHE CARED FOR MY WELL – BEING.
HER SADISTIC WORDS FORMED MY CORE BELIEFS ABOUT ME AS A GUILTY,
UNACCEPTABLE PERSON WHO SHOULD FEEL TERRIBLE SHAME. EVERY SINGLE DAY, I STILL
EXPERIENCE SELF – DENIGRATING THOUGHTS AND FEELINGS OF NOT – OKAY – NESS.
“BUT WITH THERAPY, I AM BEGINNING TO ENVISION A DAY WHEN I WILL BE ABLE TO FEEL
STRONG, OUTRAGED, ENRAGED, AND POWERFUL ENOUGH TO REJECT THIS PACK OF LIES
WITH FIERCE SELF – PROTECTIVENESS. I AM BEGINNING TO ENVISION MYSELF FIGHTING,
FIGHTING HARD AGAINST HER TOXIC ATTACKS OF THE PAST – AND MOVING BEYOND THEM
INTO FREEDOM. JUST THINKING THIS WAY HAS LED ME TO START TO TALK BACK
FIERCELY TO THE CRAPPY THOUGHTS ABOUT MYSELF WHEN THEY CROP UP INSIDE ME.
I GET NOW THAT THEY ARE DISTORTED, PERVERSE, AND UNTRUE. I COMMIT TO REJECTING
HER LIES AND FALSE APPRAISALS AND TO REPLACING THEM WITH THE TRUTH – THAT I AM
A FINE PERSON WHO IS JUST AS WORTHY AS ANYONE. I WILL COMMIT TODAY TO ALLOWING
MYSELF TO CULTIVATE THE SEEDS OF MY POWER. I COMMIT TO EMERGING A FREE
AND AUTHENTIC ME, FUTURE – LOOKING, AND ALIVE TO MY TRUE SELF AND PURPOSE.” 63

HOW DOES THE
SANDPILE MODEL
OF CHAOS THEORY
OFFER A
COMPELLING “VISUAL”
FOR EVOLUTION
OF THE PATIENT
AS A RESULT OF
THE CUMULATIVE IMPACT OF
THESE OPTIMALLY
STRESSFUL INTERVENTIONS
64

THE WORKING THROUGH PROCES IS NEVER ABOUT SIMPLE
STRAIGHT – LINE PROGRESSION FROM DEFENSE TO ADAPTATION
– FROM LESS EVOLVED TO MORE EVOLVED –
RATHER, WORKING THROUGH IS ABOUT THE “EMERGENCE” OF
ITERATIVE HEALING CYCLES OF DISRUPTION AND REPAIR
– DEFENSIVE DESTABILIZATION AND ADAPTIVE RESTABILIZATION –
AT EVER – MORE EVOLVED LEVELS OF
RESILIENCE AND ADAPTIVE CAPACITY

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 A METAPHOR
FOR THE ITERATIVE HEALING CYCLES
OF DISRUPTION AND REPAIR
THAT CHARACTERIZE THE THERAPEUTIC ACTION
66

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
68

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)
69

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
70

HOW DOES
THE GOLDILOCKS
PRINCIPLE
HIGHLIGHT
THE CRITICAL ROLE
PLAYED BY
GETTING IT JUST RIGHT
WITH RESPECT TO
EXPOSING THE PATIENT
TO STRESS
72

THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE
WILL OVERWHELM AND PLUMMET THE SYSTEM
– AT LEAST TEMPORARILY –
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
HANS SELYE’S “EUSTRESS” (1978)
73

HOW IS IT THAT
THESE ITERATIVE
HEALING CYCLES
WILL ADVANCE
THE PATIENT
TO EVER – HIGHER
LEVELS OF
ADAPTIVE CAPACITY
AND RESILIENCE
AND NOT SIMPLY
RETURN THE PATIENT
TO HER STARTING POINT
75

SIMILARLY
WHY DOES THE JAPANESE ADAGE
“FALL DOWN SEVEN TIMES
STAND UP EIGHT”
– ALTHOUGH INSPIRATIONAL –
NOT DO FULL JUSTICE BY
EVOLUTIONARY PROCESSES

STATES OF DIS – EQUILIBRIUM
– PROVOKED BY OPTIMALLY STRESSFUL, GROWTH – INCENTIVIZING,
DESTABILIZING “MISMATCH EXPERIENCES” –
CANNOT BE TOLERATED
FOR EXTENDED PERIODS OF TIME
EVENTUALLY PROMPTING
“RESTORATION” OF THE SYSTEM’S “EQUILIBRIUM”
– THAT IS, “RE – EQUILIBRATION” –
BUT EACH TIME
THE RECOVERY OF DYNAMIC BALANCE
WILL RETURN THE PATIENT
NOT TO THE STARTING POINT
BUT TO A HEALTHIER
AND MORE EVOLVED LEVEL
OF HOMEOSTASIS
AND ADAPTIVE CAPACITY …
77

… BECAUSE OF THE GROWTH – PROMOTING SYNERGY BETWEEN
THE THERAPIST’S “EXTERNAL PROVISION”
IN THE FORM OF BOTH
THE BACKGROUND EMPATHIC RESONANCE THAT SHE OFFERS
AND HER OPTIMALLY STRESSFUL INTERVENTIONS
THAT BOTH CHALLENGE AND SUPPORT
AND THE PATIENT’S “INTERNAL RESOURCES”
HER “UNDERLYING RESILIENCE”
HER “INTRINSIC STRIVING TOWARDS HEALTH”
HER “INBORN CAPACITY TO ADAPT TO STRESS”
HER “INNATE DRIVE TO HEAL”
THE “INNER WISDOM OF HER BODY” – WALTER B CANNON (1963)
IN OTHER WORDS
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”
THERE WILL NOT JUST BE A RETURN TO WHAT HAD BEEN
BUT, RATHER, THE PROGRESSION TO SOMETHING MORE EVOLVED
– A CHARACTERISTIC OF “ANTIFRAGILE” SYSTEMS –
78

ANTIFRAGILITY
IS A PROPERTY OF EVOLUTIONARY SYSTEMS
WHEREBY, OVER TIME, THEY INCREASE
THEIR CAPACITY TO THRIVE
AS A RESULT OF SURVIVING
“STRESS, SHOCKS, VOLATILITY, TURMOIL, NOISE,
MISTAKES, FAULTS, ATTACKS, OR FAILURES”
THE CONCEPT WAS DEVELOPED
BY NASSIM NICHOLAS TALEB IN HIS 2014 BOOK
ANTIFRAGILE: THINGS THAT GAIN FROM DISORDER
IN TALEB’S WORDS
“ANTIFRAGILITY IS BEYOND RESILIENCE OR ROBUSTNESS.
THE RESILIENT RESISTS SHOCKS AND STAYS THE SAME;
THE ANTIFRAGILE GETS BETTER.”
AN ANTIFRAGILE SYSTEM WILL THEREFORE
BECOME STRONGER
EVERY TIME SOMETHING GOES WRONG
79

PARENTHETICALLY
MOST EVOLUTIONARY PROCESSES
– AND NOT JUST THE WORKING THROUGH PROCESS IN PSYCHODYNAMIC PSYCHOTHERAPY –
INVOLVE THE GENERATION OF “ITERATIVE” CYCLES
– IMPLYING ADVANCEMENT TOWARDS EVER – MORE EVOLVED AND NUANCED REFINEMENT –
OF DESTABILIZATION AND RESTABILIZATION
AND, AS SUCH, DEMONSTRATE ANTIFRAGILITY
TO NAME A FEW
THE DEVELOPMENTAL PROCESS
THE GROWTH PROCESS
THE PROCESS OF CHANGE
THE CREATIVE PROCESS
THE WRITING PROCESS
THE PROCESS OF LEARNING
PREPARING A NEW SET OF POWERPOINT SLIDES 
BEING EXPOSED TO NEW INFORMATION 
NEGOTIATING A NEW RELATIONSHIP
NEGOTIATING ANY RELATIONSHIP
ADAPTING TO EVER – CHANGING ENVIRONMENTAL CONDITIONS
TRANSITIONING FROM CATERPILLAR TO BUTTERFLY
80

SPEAKING OF EVOLVING TO EVER – MORE NUANCED LEVELS OF REFINEMENT
HOW CAN
HEGEL’S DIALECT
– THESIS, ANTITHESIS, AND SYNTHESIS –
AND AN ASCENDING
SPIRAL STAIRCASE
– WITH A SERIES OF LANDINGS FROM BOTTOM TO TOP –
BE USED
TO ADVANCE
OUR UNDERSTANDING
OF THE
WORKING THROUGH PROCESS
81

HEGEL’S DIALECTIC
IS A PHILOSOPHICAL METHOD BY WHICH THE CONTRADICTION
BETWEEN TWO DIAMETRICALLY OPPOSED
AND SEEMINGLY IRRECONCILABLE ENTITIES
– A PROPOSITION (THESIS) AND ITS NEGATION (ANTITHESIS) –
IS RESOLVED AT A HIGHER, MORE REFINED LEVEL OF TRUTH
– A SYNTHESIS –

THE SYNTHESIS WILL ALWAYS CONTAIN
ELEMENTS OF BOTH THESIS AND ANTITHESIS

THE SYNTHESIS THAT RESULTS FROM RECONCILING
THESIS AND ANTITHESIS WILL THEN BECOME A NEW THESIS
– ALONG WITH A NEW CORRELATIVE ANTITHESIS –
AND THE PROCESS
– THE “FRACTAL PATTERN” –
WILL START ALL OVER AGAIN
– FRACTAL SIGNIFIES THE REPETITION OF SIMILAR PATTERNS THROUGHOUT –
Version 1, Version 2, Version 3, etc.

I WILL BE USING HEGEL’S DIALECTIC
– THESIS, ANTITHESIS, AND SYNTHESIS –
TO EMPHASIZE THAT PSYCHODYNAMIC CHANGE INVOLVES
THE SYNTHESIS OF TWO SEEMINGLY IRRECONCILABLE ENTITIES
– “DEFENSIVE REACTION” / “OLD BAD” AND “ADAPTIVE RESPONSE” / “NEW GOOD” –
AND I WILL BE USING AN ASCENDING SPIRAL STAIRCASE
– WITH A SERIES OF LANDINGS FROM BOTTOM TO TOP –
TO HIGHLIGHT THAT ALL EVOLUTIONARY PROCESSES INVOLVE
ONGOING RECONCILIATION OF EVER – EVOLVING POLAR OPPOSITES
THIS ASCENDING SPIRAL STAIRCASE IS A COMPELLING “VISUAL”
FOR THE LANDING – TO – LANDING PROGRESSION
OF THE PATIENT AS SHE SPIRALS HER WAY UP THE STAIRCASE
FROM ONE TEMPORARY “REST STOP” TO THE NEXT
EACH LANDING REPRESENTING A “COMPROMISE POSITION”
THAT WILL BE EXPERIENCED, AT LEAST FOR THE TIME BEING,
AS A “GOOD ENOUGH” “INTEGRATION OF THE CONTRARIES,”
“ADAPTIVE RESOLUTION,” “CONCILIATORY SYNTHESIS,” OR “ACTIONABLE GAME PLAN”
AND, AS SUCH, WILL OFTEN BE ACCOMPANIED
BY A SATISYING “CLICK OF RECOGNITION”
FOR BOTH PATIENT AND THERAPIST
UNTIL THE NEXT ROUND OF OPTIMALLY STRESSFUL,
BETWEEN “DEFENSIVE REACTION” AND “ADAPTIVE RESPONSE” IS INITIATED
AND THE EVER – EVOLVING WORKING THROUGH PROCESS ONCE AGAIN RESUMED
86

A POINT OF CLARIFICATION
WHERE DOES
THE SANDPILE MODEL OF CHAOS THEORY
COME INTO PLAY?
I WILL BE USING
THE SANDPILE MODEL OF CHAOS THEORY
WITH ITS ITERATIVE CYCLES OF DESTABILIZATION
– DEFENSIVE REACTION TO CHALLENGE –
AND RESTABILIZATION
– ADAPTIVE RESPONSE TO SUPPORT –
AS A “VISUAL”
FOR THE GRADUATED, STEP – BY – STEP PROGRESSION
– SOMETIMES 1 STEP FORWARD, 2 STEPS BACK OR 3 STEPS FORWARD, 1 STEP BACK –
OF THE WORKING THROUGH PROCESS
“BETWEEN LANDINGS”
EACH NEW LANDING WILL SIGNAL
THE START OF A NEW SANDPILE MODEL
87

AN ASCENDING SPIRAL STAIRCASE
– WHEREBY ONE KEEPS RETURNING TO PLACES
THAT HAD APPEARED TO BE RESOLVED AT THE
TIME
BUT THAT CAN NOW BE SEEN MORE CLEARLY
–
CAPTURES BEAUTIFULLY THE ESSENCE
OF AN EVER – EVOLVING
WORKING THROUGH PROCESS
THAT IS BOTH
REPETITIOUS AND PROGRESSIVE
THE STEPS BETWEEN LANDINGS
REPRESENTING INCREMENTAL STEPS
IN THE WORKING THROUGH PROCESS
– THE SANDPILE MODEL OF CHAOS THEORY –
AND THE LANDINGS THEMSELVES
REPRESENTING INTERMEDIATE
REST STOPS ALONG THE WAY
“ADAPTIVE RESOLUTIONS”
“CONCILIATORY SYNTHESES”
“ACTIONABLE GAME PLANS”
– USUALLY ACCOMPANIED BY
A SATISFYING “CLICK OF RECOGNITION”
ON THE PARTS OF BOTH PATIENT AND
THERAPIST –
UNTIL THE TOP LANDING IS REACHED
– WHICH WILL REPRESENT
THE ULTIMATE “SYNTHESIS”
OF THE SEEMINGLY IRRECONCILABLE

WORK IT
THROUGH
ADAPTIVELY
RESOLVE IT
HOUSTON
WE HAVE
A PROBLEM!
REPEAT

THESIS
THE PATIENT HAS A VERY
SPECIAL RELATIONSHIP
WITH HER DAD
ANTITHESIS
BUT SHE COMES TO UNDERSTAND
THAT IT IS PROBABLY INTERFERING
WITH HER ABILITY TO FIND
AN APPROPRIATE LIFE PARTNER
HER UNRESOLVED OEDIPAL LONGINGS
IN RELATION TO HER DAD
MUST BE WORKED THROUGH
SYNTHESIS
THE PATIENT ULTIMATELY
FINDS SOMEONE LIKE HER DAD
90

THESIS
THE PATIENT INDULGES HERSELF
TOO MUCH WITH FOOD
ANTITHESIS
SHE NOW HAS A SERIOUS
WEIGHT PROBLEM
THAT IS INTERFERING
WITH HER HEALTH
SHE MUST WORK THROUGH
HER FEELINGS OF DEPRIVATION
IN RELATION TO HER MOTHER
SYNTHESIS
THE PATIENT DECIDES TO TRY
INTERMITTENT FASTING
91

THESIS
THE PATIENT SMOKES
A PACK OF CIGARETTES A DAY
TO RELIEVE HER STRESS
ANTITHESIS
SHE HAS COME TO APPRECIATE
THAT HER RECURRENT LUNG INFECTIONS
ARE PROBABLY EXACERBATED BY THE SMOKING
SHE MUST TAKE MORE RESPONSIBILITY
FOR MAKING HEALTHIER LIFESTYLE CHOICES
AND LEARN BETTER WAYS TO MANAGE HER STRESS
SYNTHESIS
THE PATIENT DECIDES TO TRY
SMOKING ONLY 10 CIGARETTES A DAY
AND TO TAKE UP EXERCISE
92

THESIS
THE PATIENT HAS BEEN HAVING AN AFFAIR
WITH A MARRIED MAN AND SHE DESPERATELY WISHES
THAT HE WOULD LEAVE HIS WIFE
ANTITHESIS
HE HAS MADE IT VERY CLEAR THAT HE NEVER WILL
SHE MUST GRIEVE THE REALITY THAT
SHE WILL NEVER BE ABLE
TO HAVE HIM EXCLUSIVELY AS HER OWN
(JUST AS SHE WAS NEVER ABLE TRULY TO HAVE HER DAD)
SYNTHESIS
THE PATIENT DECIDES TO CONTINUE THE AFFAIR
BUT HER EXPECTATIONS HAVE BECOME A LITTLE MORE
REALISTIC AND SHE KNOWS THAT SHE SHOULD NOT
BE PUTTING ALL HER EGGS IN THE ONE BASKET
93

PROPOSED
DEFINITION
FOR
PSYCHODYNAMIC
PSYCHOTHERAPY
95

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
– BY VIRTUE OF THE SYNERGY BETWEEN
THE THERAPIST’S LOVING SUPPORT
AND THE PATIENT’S UNDERLYING RESILIENCE
AND INNATE CAPACITY TO ADAPT TO STRESS –
BE REVISITED, REPROCESSED, AND REFRAMED
SUCH THAT GROWTH – IMPEDING DEFENSES
– ONCE NECESSARY FOR SURVIVAL –
CAN BE GRADUALLY TRANSFORMED
INTO GROWTH – PROMOTING ADAPTATIONS
STRONGER AT THE BROKEN PLACES
97

THANK YOU!
STUART AND HIS BROTHER STEWART

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Coughlin, P. 2022. Facilitating the process of working through in
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