Shirah Vollmer MD

The Musings of Dr. Vollmer

Inertia and Denial: The Case for Psychoanalysis

Posted by Dr. Vollmer on March 22, 2012

Shrinks

“Why did you want me to come more often?” Harold, forty-two, asks me after working with me for ten years. Inertia and denial,” I responded quickly. “When I see you less often, you lapse into old patterns of unconscious living, so the more we can focus the light on the issues, the more we can battle the forces of both inertia and denial.” I repeat. As Freud taught us, the mind is tug of war between wanting to grow and develop and wanting to maintain the status quo, maintain our current defense system. This to and fro of the mind creates a need for what Kohut called “working through,” meaning the necessary repetition of looking at how one’s behaviors and judgments messes with their own enjoyment of their lives. The “internal saboteur,” and yet another term for describing how so often the individual is their own worst enemy. The more intensely one can focus on internal conflicts, the more likely a healthy resolution can happen. This is a simple concept. Almost anything, when done repetitively and consistently will improve: tennis, hiking, yoga are all examples of this. So, psychotherapy fits in to this paradigm as well.

8 Responses to “Inertia and Denial: The Case for Psychoanalysis”

  1. Melanie said

    Hi Shirah,

    This post struck me today. I am a few weeks shy of my 3 year “anniversary” of my therapist (analyst) “inviting” me (in her words) into the world of psychoanalysis 4 times a week (previously once a week and occassionally twice a week face-to-face therapy). I think after all of this time, the “inertia and denial” is still there whether internally — as in — do I need to see her so often (I have been trying for months to decrease my sessions to 3 days a week, as recently as this past Monday night, and she hasn’t “allowed” that to happen yet — question after question after question of why now on Monday night leading to hurt feelings, etc on Tuesday night and clearing the air about it last night) and externally — as in — my close friends who know about my standing appointments almost every week night must think this has to come to an end eventually (with the caveat that my fiance supports me 1000% and my family doesn’t know anything about this expensive endeavor in both time and money because they would think I am nuts). I remember being taken aback when I was “invited.” She said you have been coming once a week for 1.5 years now and twice a week a couple of times a month for a while and I think we can understand your mind better with more intensive psychoanalysis as opposed to weekly psychotherapy. My thought was still, “why do you want me to come more often?”. And that thought is still present when I try to “quit” (whether quittng altogether — as a defense mechanism to the intensity of the work or reducing our sessions by 1 day a week for whatever reason may be on my mind at the time). To her credit, we have learned/understood and are still learning/understanding my mind based on the ability to see other often. It is a mutual benefit to patient and therapist because we both learn from each other and teach other.

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    • Hi Melanie,
      I am so glad you chimed into this discussion and that you felt comfortable sharing your experiences. The internet allows the shame, and the shock from many folks in both the lay public and the mental health world promote by being critical of psychoanalytic work. My hope is that the more we can talk openly about therapeutic experiences, the more there will be tolerance for different ways of helping folks who are struggling to better their lives. Thank you again for commenting on this post.

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  2. Shelly said

    Shirah, since most patients do not have their insurance paying 100% of psychotherapy fees and they end of paying portions out of pocket, do you take the financial aspect into consideration when inviting your patients to increase their sessions with you? What if your patients do not accept the invitation, do you consider it a “denial” as if they are fighting your recommendation? Perhaps they wish to spend their time elsewhere, i.e. at work, with their families, doing more leisure activities, etc…? I cannot imagine spending 4 days a week in psychotherapy. Where do people simply have the time for it???? Yes, as you say, it may better their lives in the long run, but in the short-run, don’t they have other obligations too?

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    • Melanie said

      Hi Shelly,

      Being one those patients who spend 4 nights a week in psychoanalysis (therapy – whatever one wants to call it), I understand your perspective (it took me a long time to tell anyone because of that perceived judgment). You say: “Perhaps they wish to spend their time elsewhere, i.e. at work, with their families, doing more leisure activities, etc…? I cannot imagine spending 4 days a week in psychotherapy. Where do people simply have the time for it????” Yes, as you say, it may better their lives in the long run, but in the short-run, don’t they have other obligations too?”.

      It may be hard to believe that we patients who spend more than once a week in therapy actually spend many hours at work (50 for me), with my family (no kids yet — and that point way in the future, I will be reducing (likely have already reduced) to 1 day a week), and find the time for leisure activities as well as other obligations that have to take priority in order to live a balanced life. Is it hard to fit everything in some times? Yes definitely. But, as my time in psychoanalysis has passed (with my original thought that maybe I could it make it through the summer of 2009 and see what happened after that), I have become more flexible (as well as my therapist) in my needs to not meet every obligation. We (she) has a 7 day policy (implemented about 3 weeks after we started analysis) where in order for me not to be charged, I have to give her 7 days notice (rather than 1 day standard notice). I felt like it was punishment for me wanting to choose watching a College World Series baseball game over “spending the first 4 innings with her.” I resented her for months (resented what I refer to as “the policy”). It works though. I usually know more than a week in advance if I can’t make a session (an obligation) either because I have something leisure I want to do or family stuff or I have another obligation. The tricky part is when she cancels on me without giving me a week’s notice (that goes with the territory that stuff comes up beyond our control — and it finally played out for me a little over a year ago when I got the flu and I couldn’t give her the notice — and then we talked through it — life happens and there is wiggle room when things happen beyond one’s control). That should have been discussed from day 1, but I was too afraid and angry to go there when “the policy” was decreed (the perceived balance of power struggle between the patient and the therapist). And I know there are many skeptics out there (trust me, I vacillate all of the time should I be spending my $$$ some place else — actually saving that $$$ for the future). But psychoanalysis works. Like therapy, it is a process — tough work; but with the caveat that what can’t be fleshed out today can always be back on the table tomorrow. It allows patient and therapist again to understand the workings of the patient’s mind as well as the transference and countertransference that develops between the patient and therapist. I think I have learned the most about myself from the transference (and she has learned a lot too with her own countertransference). Can one stay in analysis forever? No. But it is a form of therapy (or at least so I have been told) that will come to an end when the patient is ready (and in my opinion, when the analysis is ready to let go as well — at least when the analysis sees that the patient has reached the point where she has done all of the hard work and is ready to use those experiences to shape her life in the future). It is a unique relationship that only patient and therapist can truly understand. Again, I understand your perspective (that is why I would NEVER tell my immediate family). I am not ashamed of my endeavor. I am not dependent on my therapist. But like Shirah said, “almost anything that, when done repetitively and consistently will improve: tennis, hiking, yoga are all examples of this.”

      Melanie

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    • Hi Shelly,
      I anticipated your concerns of time and money. Yes, there is a large expenditure of time and money when one commits to psychoanalysis and of course, there is an opportunity cost, since this time and money is not being applied to other areas of life. These are life decisions that we all make. I agree that there are limitations that one must take into account. Like anything else, priorities determine choices. If, in a very unfortunate situation, one had to have chemotherapy four times a week, and if there was a large price tag associated with it, then most people would try to find a way to do that. Having said that, there are times in life when it feels that it is important to devote that much time and energy into developing a means to make better decisions for oneself, and there are other times in life where the priorities are taking care of others, be they children, a spouse or a parent. There are no clear guidelines. The purpose of this post was to say that for some people, in some times of their lives, this type of commitment makes sense. I wanted to say that so that people who go into psychoanalysis can talk freely about their experience without the judgment of others that they are wasting their time and money. Thank you, as always.

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  3. jo said

    Dr. Vollmer,

    How do you decide to recommend additional sessions? Are you the one who usually suggests that or does the patient?

    I’ve seen my therapist for 3+ years, starting with every other week and then moving to once a week. I constantly feel pressure (internal pressure) to try reducing my sessions, but I don’t really want to do that quite yet.

    Thanks for the interesting post!

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    • Hi Jo,
      The decision to recommend additional sessions, like all psychotherapeutic decisions are based on my training, my clinical experience and my relationship with my patient. The suggestion for increasing frequency can occur both ways-my initiation or the patient’s initiation. Your conflict about the intervals in between psychotherapy sessions is a rich area of exploration. I suggest you talk about it in great depth. Having mixed feelings suggest that your internal struggle is at work, leading to a curiosity into your psychodynamics. As I have said before, ‘there is gold in them there hills.” Thanks for chiming in.

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