Shirah Vollmer MD

The Musings of Dr. Vollmer

Seeming Sad

Posted by Dr. Vollmer on February 28, 2010

     Peter, a 64-year-old former teacher, current school administrator, reflected on his forty-year career saying “I could not do as much as I had hoped because of the politics”. I commented on his tone by saying “you seem so sad”. Peter then said “you know, you have said that to me before and I have really thought about it, but I just don’t feel sad about it”. As Peter responded to my observation, I felt he was expressing even more sadness than in his opening statement.

    As a therapist, my job is to listen to content and tone at the same time. Sometimes, as in this vignette, I feel that the content and tone are synchronous. Other times, I have a strange sensation of feeling that the content and the tone are not matching up. In Peter’s case, I felt the tone and content to fall in line with each other, but Peter did not feel it that way.  The tension between the content and tone reminds me of  math. If we assume for a moment that the patient’s  content is a constant,   my perception of the patient’s tone is variable A and the patient’s perception of his tone is variable B. Sometimes I say A, the patient says B, and we puzzle over why we have different perceptions. Once in a while, I say A, the patient says B, but then I can see that I am off the mark, so I come around to seeing B.  The reverse can also happen, where I say A, the patient says B, and in further discussion, the patient changes from B to A. Needless to say, the time course involved in discussing A and B is also highly variable. That is, sometimes this discussion happens in one session, sometimes this discourse occurs over many weeks, months or years.

     Thinking about tone, or more technically speaking, affect, is one of the most important parts of my job. One of my former professors taught me that affect was like weather in that it is the background to all that is said in a session. To put it another way, whereas Freud said that dreams are the royal road to the unconscious, I put forth that tone is that royal road as well.  Tone allows me to peek into parts of the patient’s experience that he may or may not be aware of. The critic would say that perhaps I misread the tone and hence I falsely suggest to the  patient that he is feeling something that he is not. That is a serious and important criticism; indeed, it is a hazard of my work. Having said that, discerning tone is a skill that I cherish; a skill that I have honed over many years.

    As Peter looks back over forty years of his professional life and feels disappointed, his grief is enormous. My theory is that the grand nature of this reflection causes him to split off the sadness from the ability to state his impressions of his career. To meld the content with the feelings is just too challenging now. I need to respect his need to split the content off from his feelings. At the same time, I need to point out that his feelings are being conveyed to me, even though he is not feeling them now.  This is tricky business. If Peter is splitting off his feelings because he would be overwhelmed by them, then my pointing out to him that he seems sad as he is talking to me, could push him into a psychological space he is not ready to cope with. Once again, I need to be mindful that my words, however well meaning, could be harmful. On the other hand, a gentle push into merging his thoughts with his feelings could yield a more integrated and healthier mind. I have a narrow path.

2 Responses to “Seeming Sad”

  1. Shelly said

    Are you saying that by examining the sadness he feels by not accomplishing what he’d wanted to in his 40-year career, he would be healthier? What if really doesn’t feel sad about it, but rather, means something else entirely that you might have missed? Then you are pushing on buttons that have nothing behind them, and are missing the things that actually do have some meaning? What if he is musing over a career path that his parents were against, or something else entirely….and he has not yet articulated them?

    • Yes, those are all possibilities. Yes, I am saying that it is healthier to have a more integrated sense of one’s experience, even if it is massively unpleasant. I agree that it is not clear whether he is repressing his feelings or whether I am picking up on something else. The unfolding is yet to happen. This is called hypothesis testing, where I have an idea, I test it out, and the exploration begins.

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