Shirah Vollmer MD

The Musings of Dr. Vollmer

New Office

Posted by Dr. Vollmer on July 25, 2018

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I am proud to announce that as of September 1, 2018, I will be in my new office. This new space gives extra privacy for patients, as there are no offices nearby. Email me or text me at 3107804992 for more information.

Posted in About Me | 4 Comments »

Adding On….And Movin’ Around…

Posted by Dr. Vollmer on July 6, 2018

http://www.pri-med.com/globals/Faculty/V/vollmer-shirah.aspx#sm.0001dcru4j43kf0pyjx2qs3r1e3hx

 

Recent & Upcoming Conference Sessions

losangeles

Regional Conference Los Angeles

The Worried Well: Anxiety Disorders in Primary Care

Thursday, November 1, 2018

7:30 AM – 8:30 AM

REGISTER 
atlanta georgia

Pri-Med Atlanta

The Worried Well: Anxiety Disorders in Primary Care

Monday, October 29, 2018

7:30 AM – 8:30 AM

REGISTER 
Pri-Med® Philadelphia | Continuing Medical Education (CME/CE) | Philadelphia, PA

Regional Conference Philadelphia

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, October 2, 2018

7:30 AM – 8:30 AM

REGISTER 
Pri-Med® Dearborn | Continuing Medical Education (CME/CE) | Dearborn, MI

Regional Conference Dearborn

The Worried Well: Anxiety Disorders in Primary Care

Friday, September 21, 2018

4:00 PM – 4:45 PM

REGISTER 
Pri-Med® Indianapolis | Continuing Medical Education (CME/CE) | Indianapolis, IN

Regional Conference Indianapolis

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, September 18, 2018

2:15 PM – 3:00 PM

REGISTER 
Pri-Med® Nashville | Continuing Medical Education (CME/CE) | Nashville, TN

Regional Conference Nashville

The Worried Well: Anxiety Disorders in Primary Care

Friday, August 24, 2018

2:15 PM – 3:00 PM

REGISTER 
Pri-Med® Washington, DC | Continuing Medical Education (CME/CE)

Regional Conference Washington, DC

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, August 21, 2018

7:30 AM – 8:30 AM

REGISTER 
Pri-Med® Phoenix | Continuing Medical Education (CME/CE) | Phoenix, AZ

Regional Conference Phoenix

The Worried Well: Anxiety Disorders in Primary Care

Thursday, August 16, 2018

2:15 PM – 3:00 PM

REGISTER 
Pri-Med® Santa Clara | Continuing Medical Education (CME/CE) in Santa Clara, CA

Regional Conference Santa Clara

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, July 17, 2018

2:15 PM – 3:00 PM

REGISTER 
Pri-Med® Irving | Continuing Medical Education (CME/CE) | Irving, TX

Regional Conference Irving

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, June 26, 2018

7:30 AM – 8:30 AM

Pri-Med® Seattle | Continuing Medical Education (CME/CE) | Seattle, WA

Regional Conference Seattle

The Worried Well: Anxiety Disorders in Primary Care

Monday, June 18, 2018

2:15 PM – 3:00 PM

Pri-Med® Chicago | Continuing Medical Education (CME/CE) | Chicago, IL

Regional Conference Chicago

The Worried Well: Anxiety Disorders in Primary Care

Thursday, June 7, 2018

7:30 AM – 8:30 AM

Pri-Med® West |Continuing Medical Education (CME) | Anaheim, CA

West Annual Conference

The Old and The Restless: Adult ADHD

Friday, June 1, 2018

5:00 PM – 5:45 PM

South

South Annual Conference

The Worried Well: Anxiety Disorders in Primary Care

Sunday, February 11, 2018

2:20 PM – 3:00 PM

Posted in Anxiety, Primary Care | 1 Comment »

Mental Health Specialists

Posted by Dr. Vollmer on June 4, 2018

https://study.com/articles/Mental_Health_Specialist_Job_Description_Duties_and_Requirements.html

 

Image result for mental health specialist

 

The future of psychiatry involves less direct patient care, or so says James Phelps MD of the Samaritan Health System in Oregon. MHS, or mental health specialists, an un-licensed position takes the history, reports to the psychiatrist who then makes suggestions to the primary care physician. Am I missing something? The nuance of the narrative is lost without a skilled listener. Medicine, not just psychiatry, is losing this narrative and replacing it with symptom checklists which right now can be done by college graduates, but in the future, is likely to be done by computer. Large systems of care such as Kaiser or UCLA are going to absorb the liability making doctors less fearful about making recommendations without taking  their own history. No license means no regulation, no specific training and no mandate for continuing education.  I have said on this blog many times how appalled I am that the listening skills of a psychiatrist are no longer valued, but the creation of this new position is a new low for me.  The listening bar has been lowered such that diagnosis and treatment is based solely on symptoms, without any room for, dare I say, intuition. Listening, I trust, will always be valued by patients, but clearly it is not valued by health care delivery systems. Medicine has gone corporate. I know this is not all bad, but for those who have mental suffering, it certainly is bad. Patients with difficult feelings need to be heard. They need to control their narrative. They need to understand themselves. Being evaluated by a mental health specialist will not accomplish that, and for that, I am very sad.

Posted in Psychiatry in Transition | 2 Comments »

Goin’ On The Road

Posted by Dr. Vollmer on June 4, 2018

http://www.pri-med.com/medical-conferences/2018/regional-conference-chicago/agenda/sessions/QMONYA0EDUEF.aspx#sm.0001dcru4j43kf0pyjx2qs3r1e3hx

 

Regional Conference Chicago

Chicago, IL | June 7-8, 2018

McCormick Place–West

The Worried Well: Anxiety Disorders in Primary Care

Description

This talk will cover the assessment and treatment of anxiety disorders in a primary care setting, while incorporating new diagnostic issues incorporated in the DSM5. Signs and symptoms of generalized anxiety, panic and social anxiety disorders will be discussed, along with risk factors and available therapy options.

Learning Objectives

Classify anxiety disorders according to DSM5 guidelines

Choose a psychopharmacological agent to treat anxiety disorders

Manage patient anxiety in a busy clinical practice

Apply strategies to take patients off anti-anxiety medication


Speakers

Shirah Vollmer, MD

Shirah Vollmer, MD is a Clinical Professor of Psychiatry at the David Geffen UCLA School of Medicine. She is a board certified child and adult psychiatrist and she is a psychoanalyst. . Dr. Vollmer is a child, adolescent and adult psychiatrist and psychoanalyst in private practice in Westwood Village, California.

 

Posted in Musings | Leave a Comment »

Editor Job: Returns…

Posted by Dr. Vollmer on April 24, 2018

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Being on a board, often means being bored. Talking about budgets and money management and grant proposals can get dry and tedious. And so, I ask myself repeatedly, why I have stayed on this board, the Psychiatry Clinical Faculty at UCLA for over 15 years. You can read my editor’s note below to see the answer to that question, as I find our overall purpose both meaningful and essential to the next generation.

 

 

 

https://www.pcfala.net/

 

 

As Editor of this newsletter, I am so pleased to see how we, as psychiatry clinical faculty, have continued to pass the baton to our students to say that psychotherapy still matters, and it still matters that it is done by psychiatrists. Our board works tirelessly, now under the leadership of Dr. Sones, to give the adult residents from UCLA, from Harbor, and from Olive View/Sepulveda, along with the child fellows in these programs, the support they need to grow professionally into psychiatrists who are skilled with listening, thoughtfulness and deep caring of patients who need our help. We do this by offering them psychotherapy for a very reduced fee. We do this by offering as much supervision as they choose to partake, and we do this by giving them didactics which center around the doctor/patient relationship. We do this by having meetings and social gatherings throughout the year to remind them that they are part of a larger psychiatric community, and now we added on by offering mentorship to young trainees who want career guidance. This newsletter is a way of saying thank you for all you do and to remind you that your efforts are not just valuable, but essential, to our mission to promote the training and development of well-rounded psychiatrists. During the year, we soldier on, but as we review our work in this publication, we have a chance to reflect on our value as an organization. Indeed, we need to soldier on. The trainees need us. Thank you again for all you do.

Posted in Psychiatry in Transition | 2 Comments »

Holding On To Suffering…Is It Funny?

Posted by Dr. Vollmer on April 17, 2018

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Posted in Cartoons | 2 Comments »

Critical Thinking: A Therapeutic Goal

Posted by Dr. Vollmer on February 26, 2018

 

 

 

Critical thinking — what the philosopher John Dewey called the ability “to maintain the state of doubt and to carry on systematic and protracted inquiry,” is the goal of reflection. To modify Dr. Dewey’s quote, psychotherapy/psychoanalysis aims to help the patient develop critical thinking about one’s own mind and about the minds of those that influenced them. “I am not interested in symptoms” I say, in a provocative manner, to my class, knowing that saying that contradicts all of their previous education in psychotherapy. “I am also not interested in symptom-relief,” I say, taking it one step further. “What I am interested in,” I say, “is how the patient is thinking about his life and why those symptoms are manifesting at the particular time, and in the particular way, in which they do. ”

Karen, sixty-two, comes to mind. She has what could be called Generalized Anxiety Disorder, and I prescribe her medication, so in that sense, I am interested in symptom-relief, but mostly I am curious why she has to worry. I am helping her be curious as to why her mind is preoccupied with worry. The key words are “has to”. As I understand anxiety, it is often a symptom of a deeper issue of insecurity and loneliness  and I would like to explore that with her. I want to explore that with her in a way that makes her curious about it in a way which generates a  “systematic and protracted inquiry” and which carries on both inside and outside my office. This is what I do, and this is what I teach. Sure, I tell patients with anxiety to try yoga, meditation, and dietary interventions, but that is merely the beginning, because as time progresses, the issue becomes, “so what is really go on here?” To that question, there are endless answers, requiring a “systematic and protracted inquiry.” Dr. Dewey, may he rest in peace, is my hero.

Posted in Anxiety Disorders, Teaching, Teaching Psychoanalysis, Unconscious Living, understanding | 4 Comments »

Gender Health?

Posted by Dr. Vollmer on January 11, 2018

https://www.uclahealth.org/med-peds-care/gender-health-program

 

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With deep respect for UCLA as an institution, and with deep respect for my training which has entirely occurred at UCLA, and with deep respect for the many departments within UCLA that I have been affiliated, I am quite curious and, dare I say, skeptical, about a “gender health program”. Reflecting back on my training in the 1980s (yea, I am getting old, I know), UCLA was doing transgender surgery, mostly in the department of urology. Mostly they were turning male genitalia into female genitalia. Other tertiary care medical centers were doing this too, and so this was a “standard of care” a phrase which has now been replaced by “evidenced-based medicine”. In the early 90s they stopped doing this surgery and so patients seeking a change in genitalia sought private practice doctors, both here in LA and around the world. Medical tourism was a popular notion among male-female transgender folks as they could pay out of pocket a fraction of the cost in another country, and that would include their airfare, a fancy hotel, and an American trained physician working in another country (usually their birth country). Somewhere around 2010, the “medicalization” of transgender patients took off, with the example being in LA, that children’s hospital started a clinic…

http://www.chla.org/the-center-transyouth-health-and-development and then pediatricians throughout LA, when faced with a patient who expressed discomfort with their gender, would be sent to Children’s Hospital. The assumption is that CHLA is a good hospital and so, therefore, they must appropriately deal with transgender issues, since most pediatricians have no training in this area. Somehow, UCLA seems to want to join the party, and so the Gender Health Program is born. I say this, with the complete disclosure that I am not aware of the politics, or the motivation behind opening this clinic, but I do enjoy speculating publicly (to my 50 or so readers), as to how transgender issues seem to come and go within the medical profession. Having Gender Dysphoria..as opposed to Gender Identity Disorder (GID)..see below

 

GID was reclassified to gender dysphoria by the DSM5. … The American Psychiatric Association, publisher of the DSM5, states that “gender nonconformity is not in itself a mental disorder. The critical element ofgender dysphoria is the presence of clinically significant distress associated with the condition.

 

…is a mental disorder. I am not sure that I agree that those who have distress over their gender are mentally ill. Sure, they need a prescription for hormones, and possibly surgery, to change their gender, so they do need medical care, but whether they need mental health care has more to do with individual preference. A patient, for example, might have extreme distress over the size of their nose, but they don’t need to see a psychiatrist if they opt for rhinoplasty to attempt to minimize their distress. I know this statement is very controversial when it comes to gender, but I think this argument is worth consideration. If the patient is curious as to why their nose distresses them so much, then mental health intervention makes sense, but if there is no curiosity, then mental health care is harder to execute. In the 70s being gay meant you had a mental illness. That quickly got fixed when psychiatrists realized the absurdity of that notion. Being bisexual, or uncertain of your sexuality, is also not a mental illness. So, I would say that being uncertain about your gender is not a diagnosis, but only a nodal point, which suggests thinking about how to proceed. As with all big decisions, we, as psychiatrists, can help people through them, but it is also true that people make big decisions without our help and do just fine.

Returning to the Gender Health Program, I can see the advantage of pooling patient populations in order to develop an expertise. I can also see the marketing advantage that the program makes people feel like they will have a place of understanding. My issue is that Gender Health is a made-up term. I wish they would call it a Gender Program. I am not sure what Health has to do with it, as the patient may not be sick to begin with.

 

 

Posted in Gender | 2 Comments »

Patient Sculpting

Posted by Dr. Vollmer on December 19, 2017

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Hans Loewald  discusses the idea of patient sculpting, meaning that the therapist imagines the patient without his neurosis, and in so doing, imagines the patient having a more fulfilling life. What would the patient be like if he did not live out the guilt of his parents, for example. Lewis, sixty-six comes to mind. He is the son of holocaust survivors. Parents who instilled in him a sense that the world is a frightening place and he must be suspicious at all times. Lewis has embraced this philosophy unwittingly, living his life in constant fear, but not exactly understanding what he is afraid of. Imagining Lewis without anxiety is what some theoreticians call an “analytic stance”. If Lewis could come to understand that he “inherited” this fear from the trauma his parents experienced, then he could begin to separate out his reality from theirs. In so doing, Lewis could come to experience life in a more relaxed and engaging manner. Moreover, his physical symptoms of irritable bowel and intermittent headaches might improve substantially. A patient without anxiety uncovers the goodness of his soul, as anxiety can obscure that. Keeping the vision provides hope for patients. All of this is not spoken, and yet, magically transmitted between therapist and patient. How to teach these concepts is challenging and yet also very fulfilling. As with sculpture, each student has to find his method. The art of psychotherapy lies in its creativity and in its uniqueness with each therapist/patient dyad. There, I have said it again.

 

https://en.wikipedia.org/wiki/Hans_Loewald

Posted in Psychoanalysis, Psychotherapy, Teaching, Teaching Psychoanalysis | 4 Comments »

Why Is It Hard To Stay Curious?

Posted by Dr. Vollmer on December 5, 2017

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The therapist, as Hans Loewald says, holds in mind an image of the patient without neurotic distortions. In other words, the therapist can see how the patient mis-perceives his universe, and in so doing, causes himself to suffer, and so it stands to reason that if perceptions could be more accurate, or less historical, then the patient would suffer a lot less. In other words, we, as humans, unconsciously feel that current situations are triggering past situations, and so we react as we did in the past, without the benefit of a more mature mind. The therapist, mindful of this distortion, envisions the patient with a more mature mind, and thereby imagines a patient with a more fulfilling life. This imagination creates therapeutic zeal, which in the right amount, can carry the therapist and the patient through hard therapeutic times, but if the therapeutic zeal tilts to a more self-centered approach by the therapist than that zeal can kill the treatment. This brings me to my class tomorrow. We will discuss how to imagine patients without symptoms, without being overbearing or inserting one’s own agenda. The sweet spot of curiosity without a specific agenda is the gift we give to our patients. Yet, it is hard to stay curious. Maybe we didn’t sleep well. Maybe we are burnt out. Maybe the patient is boring. Maybe we have too many acute issues on our plate and there is not enough bandwidth to think about someone else’s problems. Maybe we are  hungry. My class is designed to talk about ways in which we mess ourselves up, and by we I mean we therapists. That perhaps building a psychoanalytic practice, or a psychotherapy practice is not what we want to be doing. Can we express that out loud? Maybe we have serious ambivalence. Here, we as therapists, believe that talking about ambivalence is the key to bringing authenticity and depth to one’s inner life, and yet, at the same time, we feel shame in talking about our own ambivalence towards the profession. This ambivalence changes every moment, with every patient, and with the maturing practice and yet, how do we talk about that without feeling shame and without worrying about getting referrals. Do we pretend to always be curious, when, in fact, there are times when we lose our curiosity, when we just want to go home or we just do not want to get out of bed? If authenticity is our holy grail, then we need to be authentic with ourselves, and our trusted colleagues. We have to hold in mind ourselves, with the humanity to know that we do not always show up for patients in the way that we might hope we do. Despite many hours of training, and despite many hours of reading theory, and despite our own treatment, we fail patients, or we are less than optimum, at times. Psychoanalytic work helps us with the concept of repair. We try to repair, knowing that we are flawed. That repair can be a healing process does not justify the fact that we let people down, in subtle ways, in every hour, and with every patient. This is a field of humility. I like to say. We know we do not know what we are doing, and yet, we are motivated to keep trying to do things better and better. We are motivated to stay curious, and then to be curious as to why we lose curiosity. That’s what we do, and for that, patients are helped through the human suffering that brought them to our offices. Or, I should say, we hope for that.

Posted in Teaching, Teaching Psychoanalysis | 4 Comments »

 
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