Abstract
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and their maladaptive defenses. On the one hand, we respect our patients and the choices they find themselves (defensively) making; on the other hand, we have a vision of who we think they could be, were they able/willing to make healthier (more adaptive) choices. Whether working within the interpretive framework of classical psychoanalysis, the corrective- provision framework of self psychology, or the intersubjective framework of contemporary relational theory, we are ever busy deciding whether to attune to patients’ current states (“homeostatic attunement”) or challenge them toward growth (“disruptive attunement”). With an emphasis on translating theory into practice, Martha Stark will highlight the importance of tailoring interventions to patients’ anxiety levels, creating “optimally stressful” experiences that offer just the right balance between anxiety-evoking challenge of the patient’s defenses and anxiety-assuaging support of them. Clinical examples will illustrate how strategic disruptions and repairs guide patients through stages of growth: from resistance to awareness, relentless hope to acceptance, and re-enactment to accountability. This material will be based on Martha’s award winning book, Modes of Therapeutic Action, a staple in psychoanalytic and psychodynamic training
programs worldwide.
Learning Objectives
At the end of this presentation, participants will be able to:
1. Design an optimally stressful conflict statement that both challenges and supports the patient’s defense.
2. Construct an optimally stressful disillusionment statement that facilitates the patient’s grieving and coming to terms with a painful reality.
3. Explain the distinction between “being with patients where they are” and “directing their attention to elsewhere.”
Biography
Martha Stark, MD, a graduate of Harvard Medical School and the Boston Psychoanalytic Institute, is a holistic (adult and child) psychiatrist and integrative psychoanalyst in private practice in Boston, MA, and Clearwater Beach, FL. Sheserves as Co-Founder and Co-Director of the Center for Psychoanalytic Studies at William James College and has previously held faculty positions at Boston Psychoanalytic Institute and Massachusetts Institute for Psychoanalysis. Martha is the originator/developer of The Stark Method of Psychodynamic Synergy: A Multifaceted Approach to Deep Embodied Healing. She has authored nine highly acclaimed books on the integration of psychodynamic theory into clinical practice, including Modes of Therapeutic Action: Knowledge, Experience, and Relationship, which received Jason Aronson's prestigious Book of the Year Award in 1999. Several of Martha's books have become required reading in psychoanalytic and psychotherapy training programs in the US and abroad. Board Certified by the American Association of Integrative Medicine, Martha also contributes chapters to integrative medicine textbooks and articles to peer-reviewed toxicology/environmental medicine journals.
References
Coughlin P. 2022. Facilitating the process of working through in psychotherapy: Mastering the middle game. Routledge.
Ecker, B. (2015). Memory reconsolidation understood and misunderstood. International Journal of Neuropsychotherapy, 3(1), 2-46.
Lilliengren, P. (2017). Comprehensive compilation of randomized controlled trials (RCTs) involving psychodynamic treatments and interventions. Psychotherapy, 70, 97-110.
Stark, M. 1999. Modes of therapeutic action: Enhancement of knowledge, provision of experience, and engagement in relationship. Jason Aronson.
Stark, M. (2014). Optimal stress, psychological resilience, and the sandpile model. In S. Rattan, E & Le Bourg (Eds.), Hormesis in health and disease. CRC Press/Taylor & Francis.
