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Modes of Therapeutic Action [Kindle Edition]

Martha Stark
4.0 out of 5 stars  See all reviews (1 customer review)

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Book Description

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

Product Description


Martha Stark has brought together the three fundamental theories about how therapy works that prevail in our field at present, and has shrewdly drawn out the virtues of each. Her own integrated conception is at once sophisticated and practical. Therapists of every level of experience will profit from it. Engaging and convincing clinical vignettes bring Stark's concepts alive, illustrating them in a way that resonates with a practitioner's experience. Modes of Therapeutic Action is a no-nonsense, deeply human, eminently useful study of what really thappens in a successful psychotherapy. -- Owen Renik, M.D. A remarkable book. Stark illustrates the therapeutic action of the major psychoanalytic theoretical paradigms with many vignettes that clinicians will readily be able to recognize from their own practices. The clinical moments are described with extraordinary candor and vividness. This integration of theory and practice makes the book both highly relevant clinically, and extremely instructive theoretically. -- Anna Ornstein, M.D. and Paul H. Ornstein, M.D. In a time of quick fixes, Martha Stark's book on the modes of therapeutic action is a treasure that examines the very soul of the healing process. Honoring and integrating the contributions of separate schools of psychoanalytic thought, she squarely places the shared humanness of therapist and patient at the center of all therapeutic change. I have never read a better book about the essential complexity and beauty of the therapeutic process. -- Bessel A. van der Kolk, M.D. With Modes of Therapeutic Action, Martha Stark has taken the fledgling field of comparative psychoanalysis into a new and important domain. She develops in great detail a framework for contrasting and exploring the major contemporary models of the analytic process. She takes us underneath the slogans and banners of the various schools so that we may compare their underlying concepts and presuppositions. And she demonstrates what different technical systems actually look like in live action by presenting a remarkably rich array of clinical examples. This book will contribute to the enrichment of both the thinking and clinical sensibility of clinicians at all levels of experience and sophistication. -- Stephen A. Mitchell, Ph.D.

About the Author

Martha Stark, M.D., a graduate of the Harvard Medical School and the Boston Psychoanalytic Institute, is a psychiatrist/psychoanalyst in private practice in Newton Centre, Massachusetts. Dr. Stark is on the faculty of both the Boston Psychoanalytic Institute and the Massachusetts Institute for Psychoanalysis. She is also a Clinical Instructor in Psychiatry at the Harvard Medical School, has a teaching appointment at the Massachusetts Mental Health Center, and is on the faculty of the Center for Psychoanalytic Studies at the Massachusetts General Hospital.

Product details

  • Format: Kindle Edition
  • File Size: 3478 KB
  • Print Length: 384 pages
  • Publisher: Jason Aronson, Inc. (1 April 1999)
  • Sold by: Amazon Media EU S.à r.l.
  • Language: English
  • ASIN: B00272MS5Y
  • Text-to-Speech: Enabled
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  • Word Wise: Not Enabled
  • Average Customer Review: 4.0 out of 5 stars  See all reviews (1 customer review)
  • Amazon Bestsellers Rank: #539,215 Paid in Kindle Store (See Top 100 Paid in Kindle Store)
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Most Helpful Customer Reviews
7 of 7 people found the following review helpful
It's not often read a book on clinical theory and practice from start to finish. This book was an excellent exception and I am a wiser psychotherapist for having read it.
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Most Helpful Customer Reviews on (beta) 4.5 out of 5 stars  4 reviews
19 of 19 people found the following review helpful
5.0 out of 5 stars A Bountiful Harvest for Therapists 6 Nov. 2009
By Edward J. Gutfreund Jr. - Published on
Format:Paperback|Verified Purchase
This book is among my five most favorite books in my therapy library. Prioritizing this list would be as impossible as ranking your own children. Modes of Therapeutic Action is a brilliant articulation of therapeutic theory, and a highly motivating invitation to be flexible and theoretically inclusive as a therapist in order to "optimize therapy" (Martha Stark's term).

You get the seed of the work in the introduction: Three stances--(1) classic psychoanalytic objective analysis for the benefit of the client's insight into structural conflicts, (2) self-psychology and object relations orientation to provide corrective experience for client's deficits, and (3) therapist as authentic subject for the sake of understanding the client's relational dynamics. She notes that each is of great value, yet none, she points out is "self-sufficient."

This seed is a lot to digest. The good news is that as I have let the seed germinate in myself it has grown and developed. The roots spiral deep for clarification, and branch off as the complexity is revealed. As the book unfolds, this "plant" blossoms. Its flower is a beautiful and colorful articulation of the necessity of blending these classic approaches to optimize therapy. I would add that the personal stretch that this flexibility requires offers a great tool for professional and personal development.

Dr. Stark's vignettes are wonderfully transparent stories of her own work. They consistently remind me of my own growing edges as a therapist. She makes it clear that our humanity, with its gifts, failures and limits, all contribute to the therapeutic equation. The more we, as therapists, recognize what we are doing as we do it, the better off everyone concerned is.

Among her highlights are the way she talks about pure empathy and its requirement to truly step outside of oneself and into another's world. This is contrasted with authenticity that requires staying soundly connected to oneself and allowing that awareness to be known. Such shifts of consciousness can be missed. I know how it takes great attention to stay present to the moment-to-moment barrage of stimuli that arise in the therapeutic relationship. So, this is a book about consciousness as much as about therapeutic theory and practice. Her words are like a good meditation teacher saying, "stay awake."

Besides the three stances she helps to navigate difficult realms such as transference and countertransference. She makes it clear that they are about the client and about the therapist as they co-create the relationship. No one gets off the hook from having to bring things to consciousness if the therapy is to progress. She gives insight and support to work with clients' relentless pressure to have therapists be what they expect based on influences of their developmental filters. And she explains how therapists' inevitable failures are also an important part of the process. These ideas and her very practical suggestions are worthy of serious contemplation. Her discussions of projections, projective identification, therapeutic seductiveness, and other complicated and potentially entangling aspects of the therapeutic relationship are equally insightful and give practical suggestion.
This book is a humbling reminder that my humanity as a therapist is an essential component of helping those who are courageous enough to bring their deepest vulnerabilities to me in search of gaining what they need.

I have used this book in a course I teach at Xavier University. There I offer concentration exercises, consciousness exercises and artistic activity to study mindful attention--in stillness, in action, and in relationship. These exercises simulate therapy situations that help students learn deeper aspects of themselves in the therapeutic relationship. This helps them to attune to themselves authentically, and to self-observe technically what is happening. I value Dr. Stark's theoretical backdrop for the experiential learning students engage in.

Some parts have been challenging to me. I still have a few unfinished sections to study. If there is a critique it is that I find it difficult at times to decompress the dense material, and I have to keep remembering important distinctions in order to integrate the whole of it. Yet this is like criticizing the Yosemite Valley or Grand Canyon that recall hikers, climbers and photographers back again and again to get new experience and perspective.

I am deeply grateful to Martha Stark for what she has written. Even after many years of practice, understanding therapy remains complex. Modes of Therapeutic Action has helped me in my work, and has helped my students to wake up and to practice being present to what they do in ways that they did not know were possible for them. Like anything important staying awake takes practice and study. So I keep recognizing that I must regularly sit quiet, notice, allow the chatter to settle, and allow my perceptions to sharpen. This book helps.

Finally, this work reveals Martha Stark as a person who appears to live in her three modes: with the precise scholarship of a passionate scientist, the compassionate attunement of a good-enough parent, and the honest, vulnerable openness of a deeply trusted colleague or friend. I am thrilled to own this book. I could write much more, but do not want to delay your decision to purchase it. And, I can't wait for her new book to come out about Optimal Stress. I heard a little preview in a lecture she gave at UCLA, and it sounds like it is going to be another one to get right away.
12 of 15 people found the following review helpful
5.0 out of 5 stars Awsome! 18 Feb. 2006
By Dave - Published on
Martha Stark does an incredible job summarizing the basic modes of therapeutic theory/technique. this has allowed me to re-frame the way I do therapy, and facilitates my ability to be aware of and shift between different modes of therapeutic technique, even within the same session.
17 of 23 people found the following review helpful
5.0 out of 5 stars Another insightful, useful book from Martha Stark 29 Mar. 2000
By A Customer - Published on
Format:Hardcover|Verified Purchase
Modes of Theraputic Action continues the train of thought Dr. Stark began in her previous book Working with Resistance. While professional therapists are the target audience for the book I found much here to deepen my understanding of the theraputic process as a client. The clinical vingettes Dr. Stark has chosen to share are particularly helpful. Dr. Stark's writing style is clear, concise and deeply thoughtful. A marvelous book that will give you new insights into the theraputic process.
3.0 out of 5 stars Stark's writing and metaphors are clear and easy to read 14 Oct. 2014
By Stephanie S. - Published on
Format:Paperback|Verified Purchase
Stark's writing and metaphors are clear and easy to read. Stark parses out some of the more subtle and not-so-subtle distinctions between different modes of therapy in a way that makes sense to the reader. Unfortunately, Stark's tendency of repetition makes these clear distinctions less so, as she repeats herself to the point of confusion.
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