THE HOLDING and THE PROVOCATION: Navigating the Edge Between Support and Challenge in Contemporary Psychodynamic Therapy

THE HOLDING and THE PROVOCATION: Navigating the Edge Between Support and Challenge in Contemporary Psychodynamic Therapy is organized by University of Miami Miller School of Medicine Division of Continuing Medical Education and will be held from Feb 16 - 20, 2026 at The Sunny Miami Sunny Isles Beach, Curio Collection by Hilton, Sunny Isles Beach, Florida, United States of America.

Description:
From moment to moment, we are continuously deciding how best to position ourselves in relation to our patients and the maladaptive defenses to which they cling – once necessary for them to survive but now interfering with their ability to thrive.

On the one hand, we have respect for our patients and for the choices, no matter how unhealthy, that they find themselves continuously making; on the other hand, we have a vision of who we think they could be were they but able/willing to make healthier choices for themselves. Indeed, we are always struggling to find an optimal balance within ourselves between wanting our patients to change and accepting the reality of who our patients are.

Whether we are working within the interpretive framework of classical psychoanalytic theory (a 1-person psychology with its emphasis on “interpreting resistance,” “developing insight,” and “resolving internal conflict”), the corrective-provision framework of self psychology (a 1½-person psychology with its emphasis on “absence of good,” “grieving heartbreak,” and “filling in deficit”), or the intersubjective framework of contemporary relational theory (a 2-person psychology with its focus on “presence of bad,” “negotiating the in-between,” and “resolving relational conflict”), we are ever busy deciding whether we should “be with our patients where they are” (Herzog’s homeostatic attunement) or “direct their attention to elsewhere” (Herzog’s disruptive attunement) – a critically important balance that is necessary if the analytic endeavor is to be advanced.

Ever appreciating the importance of translating theory into practice, Martha will highlight the ways in which the therapist's ongoing attunement to the level of the patient's anxiety can be used to construct “optimally stressful” interventions that offer just the right balance between anxiety-provoking challenge of the patient's defensive structures (in order to provide impetus for their destabilization) and anxiety-assuaging support of them (in order to provide opportunity for their restabilization at a more robust level of resilience and adaptive capacity).

Snippets of clinical material will be offered that demonstrate how judicious, strategic, and ongoing use of these growth-incentivizing “mismatch experiences” will generate iterative healing cycles of disruption and repair and, ultimately, evolving of the patient from “resistance" to "awareness" (Model 1), "relentless hope" to "acceptance" (Model 2), and "re-enactment" to "accountability" (Model 3). 

The material presented will be based upon Martha's award-winning Modes of Therapeutic Action – “required reading” (both in the US and around the world) for candidates in psychoanalytic training institutes and students in psychodynamic psychotherapy programs.

Objectives:
Upon completion of this activity, participants will be able to: 

• Highlight the distinction between defensive, mindless reactions and adaptive, mindful responses.
• Explain the importance of cultivating dual awareness.
• Clarify the importance of generating and working through optimally stressful but growth-incentivizing “mismatch experiences.”
• Elaborate upon the reason that “optimally stressful” interventions provide both impetus and opportunity for transformation and growth.
• Design an optimally stressful conflict statement that both challenges and supports the patient’s defense.
• Construct an optimally stressful disillusionment statement that facilitates the patient’s grieving and coming to terms with a painful reality.
• Formulate an optimally stressful accountability statement that spotlights one of the patient’s dysfunctional relational patterns.
• Speak to the distinction between “being with patients where they are” and “directing their attention to elsewhere.”
• Explain the useful of the Rule of Three.
• Clarify the difference between projection and projective identification.
• Describe the relationship between the elaborated paragraph and the narcissistic alliance.
• Elaborate upon the concept of “no pain / no gain.