Shirah Vollmer MD

The Musings of Dr. Vollmer

Gifts in Psychotherapy

Posted by Dr. Vollmer on January 23, 2010

This next blog will be about moving moments in psychotherapy.

Yesterday, I received a gift in psychotherapy. This gift was not wrapped and there was no card. This was the gift of insight. A young patient of mine comes in announcing that she did not sleep at all last night. I wonder about why she did not sleep, knowing that our psychotherapeutic work was intense and both of us needed to function on all cylinders. At first, I attributed her behavior to her age. I thought she is on vacation from school and as with many young people they drink and hang out with their friends to all hours of the night. As the session went on, we discussed family issues, school issues and friend issues. At the end of the session she announced that she did not sleep last night so that I would worry about her. She wanted to appear impaired externally so that I would know what is going on with her internally. I was stunned.

Communication comes in many ways such as verbal, nonverbal, direct and indirect. For example, some patients try to hurt themselves as a way of telling their therapist that the treatment is going poorly. In this instance, my patient was telling me that she was thinking about our work together. She was thinking about how much she wanted me to know about her internal state. She realized that telling me her internal state may not be as powerful as showing me her brain which was “filled with cotton”. At the very last moment of our time together yesterday, she let me know in a sweet way that she really wanted to work on herself. She really wanted my help.

Doorknob comments are statements made as the patient is walking out the door. They are interesting because they do not allow the therapist to respond. They force the listener to hold on to it until the next session. In many ways, doorknob comments are often the most powerful comments made in a session. In this case, the doorknob comment came to me as a gift. This was a gift which left me feeling like we were getting deeper. We were developing a more meaningful relationship which would ultimately help her help herself. As she said that she wanted to have a sleepless night before coming to see me so that I would understand what she experiences, I felt the power of her hope in our relationship. The warmth of the season was here.

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