Carl, the subject of http://shirahvollmermd.wordpress.com/2010/02/05/injecting-the-dye/ came in the other day explaining an unusual situation in his life. As he was talking, I went into a reverie. I asked Carl to repeat the story. In the repetition, the story was understandable and clear. I began to wonder why I did not understand the story the first time. Was I having a focusing problem? I wondered out loud. Was Carl being vague? I was not sure. In discussing this dilemma with Carl, we clarified that Carl was free associating to his story in such a way as to make it incoherent. Carl was reporting the series of events as if it were a dream in which connecting statements do not exist.
Some people think that psychotherapy is about free association, meaning that the person should say what comes to his mind, whether it makes sense. I have called this phenomena “right brain hypertrophy” where the creative side of the brain overrules the logical, linear part of the brain. Although some psychotherapists might encourage this verbal interchange, I find that there needs to be a top-down model to the brain. The story needs to make sense. It needs to follow a logical progression of events. After the details unfold, then my patient and I can wrestle with the ideas and associations which come to mind. Without the initial structure to a story, it is hard, at least for me, to dig into the meanings.
Some patients are what I call “too left-brained”. They do not experience feelings, or associations, or ideas about their interactions in the world. As such, it is hard to have a canvas to create an inner world of motivation. Others, are “too right-brained” in that following along on their train of thought can be challenging such that it is hard to feel like we are working together. The large right-brain folks can sometimes make me feel isolated in that I feel we are in two silos. The large left-brain folks make me feel like we are about to get into the sandbox, but there is a great deal of hesitancy.
My job as a psychotherapist is to take a patient where he is at, and help him develop. For my large right brain folks, I want to help them be a little, but not a lot, more linear in their thinking. For my large left-brain folks, I want them to feel comfortable talking about ideas which may or may not make sense.
Dividing the world into two categories of people is always fun. Of course, people are more complicated than that, but thinking about left and right brain is one way to understand why people have such different struggles in their world.