Modes Of Therapeutic Action

How do we position ourselves, moment by moment, in relation to our patients and how do these positions inform both what we come to know about our patients and how we intervene? Do we participate as neutral object, as empathic self-object, or as authentic subject? Do we strive to enhance the patient's knowledge, to provide a corrective experience, or to work at the intimate edge? In an effort to answer these and other clinically relevant questions about the process of psychotherapeutic change, Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (Model 1), the corrective-provision perspective of self psychology and those object relations theories emphasizing the internal "absence of good" (Model 2), and the relational perspective of contemporary psychoanalysis and those object relations theories emphasizing the internal "presence of bad" (Model 3). Model I is about knowledge and insight. It is a one-person psychology because its focus is on the patient and the internal workings of her mind. Model 2 is about corrective experience. It is a one-and-a-half-person psychology because its emphasis is not so much on the relationship per se, but on the filling in of the patient's deficits by way of the therapist's corrective provision; what ultimately matters is not who the therapist is, but, rather, what she can offer. Model 3 is about relationship, the real relationship. It is a two-person psychology because its focus is on patients and therapists who relate to each other as real people; it is about mutuality, reciprocity, and intersubjectivity. Whereas Model 2 is about "give" and involves the therapist's bringing the best of who she is into the room, Model 3 is about "give-and-take" and involves the therapist's bringing all of who she is into the room. As Dr. Stark repeatedly demonstrates in numerous clinical vignettes, the three modes of therapeutic action-knowledge, experience, and relationship-are not mutually ex

How do we position ourselves, moment by moment, in relation to our patients and how do these positions inform both what we come to know about our patients and how we intervene? Do we participate as neutral object, as empathic self-object, or as authentic subject? Do we strive to enhance the patient's knowledge, to provide a corrective experience, or to work at the intimate edge? In an effort to answer these and other clinically relevant questions about the process of psychotherapeutic change, Martha Stark has developed a comprehensive theory of therapeutic action that integrates the interpretive perspective of classical psychoanalysis (Model 1), the corrective-provision perspective of self psychology and those object relations theories emphasizing the internal 'absence of good' (Model 2), and the relational perspective of contemporary psychoanalysis and those object relations theories emphasizing the internal 'presence of bad' (Model 3). Model I is about knowledge and insight. It is a one-person psychology because its focus is on the patient and the internal workings of her mind. Model 2 is about corrective experience. It is a one-and-a-half-person psychology because its emphasis is not so much on the relationship per se, but on the filling in of the patient's deficits by way of the therapist's corrective provision; what ultimately matters is not who the therapist is, but, rather, what she can offer. Model 3 is about relationship, the real relationship. It is a two-person psychology because its focus is on patients and therapists who relate to each other as real people; it is about mutuality, reciprocity, and intersubjectivity. Whereas Model 2 is about 'give' and involves the therapist's bringing the best of who she is into the room, Model 3 is about 'give-and-take' and involves the therapist's bringing all of who she is into the room. As Dr. Stark repeatedly demonstrates in numerous clinical vignettes, the three modes of therapeutic actionDknowledge, experience, and relationshipDare not mutually exclusive but mutually enhancing. If, as therapists, we can tolerate the necessary uncertainty that comes with the recognition that there is an infinite variety of possibilities for change, then we will be able to enhance the therapeutic potential of each moment and optimize our effectiveness as clinicians.

TABLE OF CONTENTS: 1. Modes of therapeutic action 2. Intervention as assessment 3. Creating opportunities for self reflection 4. Bringing defenses and unconscious mental content into awareness 5. Interaction structures in the transference countertransference 6. Supportive approaches: The uses and limitations of being helpful 7. Studying psychoanalytic therapy 8. Case studies.

Most of the existing psychodynamic literature approaches the treatment process from one particular theoretical perspective or another. Yet, what contemporary psychotherapists need most is practical information that transcends individual perspectives. After all, they must be able to treat patients who suffer from structural conflict, structural deficit, and relational conflict, and they must be able to understand the theories of therapeutic action associated with these concepts of psychopathology in relation to one another. Originally published in 1996, Understanding Therapeutic Action: Psychodynamic Concepts of Cure both surveys different theories of therapeutic action and offers an integrative model of treatment. Editor Lawrence E. Lifson has brought together contributors who are among the leading theoreticians and practitioners of psychodynamic psychotherapy. Their chapters’ cover all the major perspectives on therapeutic action and are organized into sections covering structural and object relations theories; the self as the focus of therapeutic action; and an integrative approach to the concept of cure. The emphasis throughout is on the translation of theory into clinical practice, with attention given to the contributions of patient and therapist alike in the curative process. Providing clinicians with a comprehensive overview and synthesis of the different models of therapeutic action, this collection is an illuminating exercise in comparative psychotherapy and a valuable tool for enhancing the applicability and effectiveness of clinical work.

This groundbreaking book addresses a critical aspect of the occupational therapy practice—the art and science of building effective therapeutic relationships with clients. A distinguished clinician, scientist, and educator, Renée Taylor, PhD, has defined a conceptual practice model, the Intentional Relationship Model, to identify how the client and the therapist each contribute to the unique interpersonal dynamic that becomes the therapeutic relationship. She emphasizes how therapists must act deliberately, thoughtfully, and with vigilant anticipation of the challenges and breakthroughs that have the potential to influence the course of the relationship.

"Martha Stark's primer on resistance is a unique book. It takes as the heart of the clinical problem the patient's reluctance to change, that ubiquitous and paradoxical phenomenon of our work in which people come to us asking for help in changing, and then do their level best to keep change from happening... This is a work which is at once a practical guide and a theoretical tour de force. Readers who journey in this slim volume with Dr. Stark will return from their travels to their practice much educated, having encountered new ideas and old ones in new forms, better able to face the everyday travails of psychotherapy." –David E. Scharff, M.D. "Every so often a book emerges from the vast sea of analytic writings that startles in its creativity and usefulness. A Primer on Working with Resistance is just such a book. Dr. Stark is as clear as a bell. She manages complex theoretical concepts with sophistication and great sensitivity for the material. For example, the distinctions she makes between convergent and divergent conflict, or between illusion and distortion, are elegant. The question and answer format of the book is reassuring for the beginner, and a delight for the more experienced reader as well." –Anne Alonso, Ph.D., Harvard Medical School A Jason Aronson Book

Breaking Negative Thinking Patterns is the first schema-mode focused resource guide aimed at schema therapy patients and self-help readers seeking to understand and overcome negative patterns of thinking and behaviour. Represents the first resource for general readers on the mode approach to schema therapy Features a wealth of case studies that serve to clarify schemas and modes and illustrate techniques for overcoming dysfunctional modes and behavior patterns Offers a series of exercises that readers can immediately apply to real-world challenges and emotional problems as well as the complex difficulties typically tackled with schema therapy Includes original illustrations that demonstrate the modes and approaches in action, along with 20 self-help mode materials which are also available online Written by authors closely associated with the development of schema therapy and the schema mode approach

The Biological Action of Physical Medicine: Controlling the Human Body's Information System challenges the contemporary way of thinking of diagnostics and therapy "from the outside." Drawing on 30 years of independent comprehensive research, this reference provides a universal and scientifically acceptable physiological theory, explaining the mode of action of methods of physical medicine as well as the underlying physiological mechanisms. Scientific research described in this book explains the universal neurophysiological foundation of all the respective methods, including organ electrodermal diagnostics (OED), thermotherapy (heat, cryostimulation), phototherapy (infrared, ultraviolet, laser), ultrasound therapy, electrotherapy (from transcutaneous electric nerve stimulation to electromagnetic field therapies), magnetotherapy, and mechanical nerve stimulation (acupuncture, reflexive massage, cupping, high-pressure hydrotherapy). A better understanding of physical medicine's modes of action not only insures better clinical results, but also illuminates pain mechanisms and our understanding of the functioning of the nervous system. Fully explains the important therapeutic modalities of genuine physical medicine as well as the underlying physiological mechanisms Shows how to access and control the diagnostic information circulating in the sensory nervous system