Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for January, 2011

Scratching The Wound-II

Posted by Dr. Vollmer on January 31, 2011

 Jesse, has another friend Ralph, sixty-five, single, who has no romantic interest in Jesse, but they consider themselves “close friends”. “Ralph, like Miriam, scratches my wounds too,” Jesse tells me, wondering what this pattern is about. “What do you mean?” I ask, also thinking why Jesse finds herself in relationships which make her feel bad about herself. “Well, Ralph knows that I hate it when he repeats himself over and over. I tell him that he does not need to suggest the same restaurants all the time, or tell me the same stories over and over. I explain that in that repetition is a certain irritation, a certain hostility, a certain fear of talking about new or different topics. At first, he says he understands, but inevitably each conversation has the same irritating subjects. Ralph then senses my irritation and then he withdraws. Ultimately, he feels that I have withdrawn from him, but in fact, he withdrew from me since he cannot seem to understand that his tone suggests that he is angry and fearful of the world and that is very difficult to deal with. ” Jesse conveys her analysis of the situation with angst and discomfort. She is clearly tortured in this relationship, but at the same time, she does not want to break it off. “How can I help you?” I ask, wondering if Jesse has an idea about what she is looking for from me. “I need to understand why Ralph gets to me so much. I know I am sensitive to his feelings, but that sensitivity makes me feel his anger and irritation, and then that is hard on me, but I don’t understand why I can’t distance myself from his feelings.” Jesse says with terrible dismay and discouragement. “It feels like it does with Miriam in that you have a sensitive area, you tell her not to touch it, and she touches it anyway and then you feel helpless because you can’t make the pain go away.” I say, knowing that Jesse understands this, but wanting her to know that I see that too. “Maybe if your wounds heal, then there would be nothing for Ralph or Miriam to hurt,” I say, keeping with the metaphor of physical injury. “Well, yes, of course,” Jesse says, “but I don’t understand these wounds, so how are they going to heal?” Jesse says with frustration. “I know that is our job to work on those wounds,” I say, making a plea for patience. “Yea, we do need to work on those, but at the moment, all I can think about is how frustrated I am with Ralph.” Jesse says with anger and impatience. “I can understand that Ralph is bringing things up for you which is both curious and disturbing. Maybe we can see Ralph as a tool to help us explore your sensitivities.” I say, trying to prove that looking at how Ralph makes her mad can illuminate the inner workings of her mind. “Ralph as a tool, I like that,” Jesse says with good and relaxed humor. “I am glad your tone has shifted,” I say, happy to end on a lighter note. “Me too” Jesse says, looking at me like our session was quite  the journey.

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Scratching The Wound

Posted by Dr. Vollmer on January 30, 2011

    Jesse, forty-one, female loves her female friend Miriam, age forty. They have been colleagues for fifteen years, and good friends for the last ten. Their friendship began as they both had recently become single; both left relationships that were exquisitely painful. Both were consciously fearful of being alone for the rest of their lives. Miriam has a ten-year old son; Jesse has no kids. Together, they tried to comfort one another through their painful break-ups. Miriam comes to me saying “I have to break-up with Jesse.” She says tearfully, to my surprise. “What happened?” I asked, thinking that there must have been a triggering event. “I just feel like when I have a sore point, something I feel bad about, Miriam keeps reminding me of it and it feels to me that she picks at my wounds relentlessly.” Jesse tells me, giving me a clue that she has thought a lot about her dynamics with Miriam. “Why do you think she would do that?” I ask, wanting to pull out her thinking. “I think she is not aware of it. My guess is that on a very deep level she wants to see me squirm. I think she feels really bad about herself and one of the ways she copes is by making other people feel bad about themselves.” Jesse says, again, telling me that she must be spending a lot of time piecing together a narrative to explain what is happening in their friendship. “You mean that unconsciously speaking, Miriam is looking for a mirror. She wants to see in you, what she feels all the time.” I say, wanting to use different words to enhance her narrative. “Yes,” Jesse says tentatively. “It is so hard to know,” I say, emphasizing Jesse’s uncertainty, but at the same time, encouraging her to think about the dynamics of her friendship as a way to find peace in her relationship. “The one thing that is clear to you, it seems, is that when you are with Miriam, you feel like she is scratching at your wounds, and that is a very interesting description. As such, I could imagine how you may avoid her.” I say, thinking that physical wounds can be so much easier to deal with because you can watch the healing process. I begin to think that many people notice in themselves that they pick at their own wounds, but this is the first time I am hearing this phenomena described in the context of a relationship. “What if you talked to Miriam about this?” I asked, although I was pretty sure about the answer. “She would just deny it and say I am too sensitive,” Jesse responds quickly, again, as if she thought about that before. “Well, I can see your dilemma. On the one hand, you value your relationship with Miriam and you want to preserve it and deepen it, but on the other hand, oftentimes when you are with her, you are aware that you feel worse about yourself.” I say, again outlining the dilemma, without giving a solution. “Yes,” Jesse says, “that is what I am up against.” Jesse’s tone expresses relief, which I take to mean that my understanding her predicament is helpful to her. “One hopes friends protect one’s wounds, not scratch them, but of course, it does not always work out that way.” I say, noting her disappointment, but also noting that friendships are not as simple as they sound.

Posted in Friendship, Musings | 2 Comments »


Posted by Dr. Vollmer on January 28, 2011

  Courtney, forty, feels “horribly guilty” for leaving her marriage of ten years. She has four children under the age of six, but she quickly adds “I don’t feel guilty for what I did to my kids; I feel guilty for what I did to my ex-husband, Cassidy. “What do you mean?” I ask, feeling confused since I have known Courtney for the last five years and I watched her process of deciding that she needed to get a divorce and it seemed to me that she was fairly measured as she went through the break-up of her marriage. “Well, I did not stand up for myself. I did not tell Cassidy that my needs were not getting met. I did not tell him that I needed him to spend more time with me. I was passive-aggressive. I punished him for not reading my mind and I am really sorry about that,” Courtney says with a flatness, that is inconsistent with her use of the word “guilt”. “Do you think it is too late to express your remorse to him?” I ask, knowing that I am thinking towards the future, and not reflecting on the past. “Yes, it is way too late. Cassidy won’t speak to me. He is really wounded by my behavior and I understand that,” Courtney says, again with the flatness of a business negotiation, as opposed to conveying the emotional richness of a personal relationship. “I hear your words,” I say, “but I don’t feel your agony. The tone that I am hearing does not correspond to a feeling of guilt and remorse.” I say, wondering if she will understand my point, without getting defensive. “Yes, I know what you mean, ” Courtney says. “I feel like it is too late for me to do anything and I have to move on with my life, so I am not allowing myself to feel the feelings, even though I am allowing myself to think the thoughts.” I am hit by her insight. “You have cognitive guilt, without emotional guilt; that is what you are telling me. That is very interesting.”  I say, trying to digest the layers of her mind. “Maybe some of the cognitive guilt will go deep down and cause you some emotional guilt, as well,” I say, thinking that the feelings may come later, even though they seem to be absent at the moment. “I hope not.” she says. “Yea, it might be pretty painful,” I say, knowing that guilt is a challenging experience, but at the same time, knowing that conscious guilt is less malignant than unconscious guilt.

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Erroneous Assumptions

Posted by Dr. Vollmer on January 27, 2011

  Chelsea, is convinced that I am “bored” by her stories. “What makes you say that?” I ask, thinking about whether I am bored, distracted, interested, or captivated, knowing that at different times I experience all of those feelings. “Well, I just can’t imagine anyone would be interested in what I have to say, especially after lunch, when I am sure you would much rather take a nap.” Chelsea says, giving me a clue that her word “bored” comes more from an internal state of feeling “boring,” and not coming from experiencing me, experiencing her stories. “Tell me more about that,” I say, wanting to hear why she can’t imagine that I might be interested in what she has to say. “Well, my dad was a fireman, and so I was always around these really big guys, and I always felt really small,” Chelsea says, giving me a visual image of her as a child, being overlooked, both literally and figuratively. “So, you never felt like your parents were paying attention to what you had to say,” I comment, knowing that I am probably overstating her situation. “Well, not never, but I felt like they paid more attention to my brother, so I learned to keep my thoughts private.” Chelsea says, adding a component of gender to our discussion. “So, it is fair to say that your past might be influencing your present when you say that I must be bored,” I respond, highlighting to Chelsea that her erroneous assumption about my attitude comes from her past and not from the present, a transference interpretation, some might say. “Hard to say,” Chelsea responds, not agreeing with my idea, but willing to consider it. “Well, think about it, and see what comes up for you,” I say, ending our session with an obvious, and maybe unnecessary, statement.

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False Attributions

Posted by Dr. Vollmer on January 26, 2011

  It is possible that Chelsea suffers from false attributions. She wants to see her role in Lindsay’s decisions, when in fact she has none. How does this happen? I wonder. The wish to impose order on to a world which otherwise would feel chaotic is understandable. Feeling like one caused a catastrophe is often preferable to feeling that it was a random event and as such, false attributions are a common coping mechanism. The issue becomes whether Chelsea is willing to entertain the notion that there is a false attribution going on, or if she is going to rigidly adhere to her belief that Lindsay’s life choices are a direct result of her “poor parenting.” Given the uncertainties, it is helpful for Chelsea to consider different causalities. Broader thinking is my goal. Mind expansion, an exercise worth doing. Interesting, at least; helpful, at best. I think Chelsea is game.

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Parenting Narcissism

Posted by Dr. Vollmer on January 25, 2011

Chelsea, fifty-nine, complains that since her twenty-year old daughter, Lindsay, did not go to college she is “denied the pride of most parents.” She says in a way which transmits a sense of deprivation and unfairness. “Maybe you are inflating your sense of importance, meaning that whether Lindsay goes to college may not relate to your parenting skills. Maybe motivation is genetic and at the moment, her drive is not very high and as such, she is genetically pre-programmed to do the least amount of work and still get by.” I say, trying to highlight that a lot of behavior is genetically determined, and yet, when things turn out well parents often take pride, even though cause and effect is not clear. “That is really hard for me to digest,” Chelsea says, letting me know that no matter how many times I emphasize genetics, she is not going to let go of her disappointment she feels  in herself, that Lindsay has not gone to college. “You need to feel like you could have done a better job, but I am not sure why you are so determined to feel that way.” I say, trying to highlight her overarching tendency to feel guilty.  “I am not either,” Chelsea says, with great sadness and reflection.

Posted in Musings, Parenting | 2 Comments »

‘I Don’t Mind it When My Dad Dates, but My Mom, Ooh Yick’

Posted by Dr. Vollmer on January 24, 2011

  Jared, fourteen, goes back and forth between his divorced parents every three or four days. He has done this since he was nine, after his parents were fighting loudly in front of him “day and night.” “The good news” he says, “is that now they are civil with one another.” “Do they have significant others in their lives?” I ask, wondering how that would be for him. “Well, my dad has dated three women for substantial periods of time and I am OK with that, but my mom, if she were ever to date, I could not handle it. I don’t mind it when my dad dates, but my mom, ooh yick.” “What do you think the difference is?” I ask, thinking about the oedipal situation where a boy’s love for his mom is intense and rivalrous. “I don’t know” Jared says, “all I know is how I feel.” I am thinking about how sweet Jared is that he can share his intense love for his mother with me. I am also aware how unconscious he is about his love for his mom in that he knows how he feels, but he cannot articulate that his love for his mom is qualitatively different than the love for his dad; it is a different relationship. I wonder if I should point that out, but as the time goes by, the subject changes to his social challenges at school. I am sure we will revisit this fascinating oedipal pull; it is so compelling.

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Icing Out

Posted by Dr. Vollmer on January 20, 2011

   Maureen,, came in complaining about her friend, or rather her ex-friend Leslie. Maureen and Leslie used to walk around the park every Saturday morning for the past seven years. Their walk was a ritual. Maureen showed up at Leslie’s house at 7:00 am. Leslie would always be ready to go. They would walk in a square. The first leg, they talk about their respective marital relationship. The second leg they talk about what movies they saw that week on Netflix. The third leg they would talk about how fat they felt.  Finally, in the home stretch, they would talk about what was coming up for them in the following week.

         Maureen says “Leslie won’t return my phone calls and I don’t know why.” “What did you say in your message?” I ask her, wondering if Maureen unwittingly triggered some hurtful feelings in Leslie. “Well, I had to cancel one walk because my dog got sick, so I wanted to make sure we were on for the following week, but she did not call me back, so I guess we are not walking. It has been three weeks since Curly, my dog, had to go to the vet, so I have not heard from her in a really long time.”  “Wow” I say, “that has to be so unsettling. Were you surprised that Leslie was not worried about your dog?” I ask, thinking that their intense friendship is likely to include a deep affection for Maureen’s pet. “Damn right” Maureen says loudly, as if she was not thinking about that now, but she was mad about that before. “So you think Leslie is icing you out, but you don’t know why.” I say, understanding that not knowing, uncertainty, is hard to handle in a deep relationship. “Are you going to call her again?” I ask, wondering if Maureen is going to pursue or withdraw. “I don’t know,” Maureen says with agony. “I need to think about that.” “Has Leslie ever done this before?” I ask, wondering about the history of their relationship. “Not to me, ” Maureen says, “but she has told me she has done this to other close friends.” “So, icing out is part of her pattern of relationships?” I ask, thinking about this dynamic of intensity, followed by sudden retreat. “Yea, maybe it is her pattern, but I can’t help but think what I did wrong,” Maureen says, trying harder to understand what Leslie is thinking and feeling. “Uncertainty is really hard” I say, trying to soothe Maureen, but knowing that in this moment, she is agitated and inconsolable.

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Posted by Dr. Vollmer on January 19, 2011

    ‘Childhood Anxiety Disorders,’ that is what I went to talk to parents of children at the early childhood center at UCLA today at noon. Ten questions from parents; six about nail-biting. I go through my mantras. Children should be exuberant about their lives. Anxiety is normal in children, but it is a problem if it interferes with social or school functioning. Anxiety disorders in children is divided into six categories, according to our current diagnostic manual. Five of those disorders are the same as adult anxiety disorders. Medications are helpful, but they are a last resort. Mindfulness, for children and adults, along with deep breathing should be tried first.

    After that came the questions. “What should I do with my three year old who bites his nails?” “First” I say, “be an observer of your child. Determine what settings the nail-biting gets better or worse. Determine if your child seems to self-soothe by nail-biting. See how bad it is over time.” The parents nod in recognition that they have heard all that before. “The question,” I say, “is whether the nail-biting is a window into internal distress, and if so, how severe that distress might be.” “This is a field of subjectivity,” one mother says, expressing distress about the subject. “Absolutely,” I say. “Parenting is subjective. You have to use your intuition, your reflective functioning, to speculate about the internal state of your child.” I guess she was a scientist, since she looked at me with dismay. “It is hard to be a parent,” I say, trying to redeem myself in her eyes. She smiled and she seemed to relax. I think to myself that maybe next time I will stick with symptoms and checklists and avoid talking about internal states. Then, I think again, and say, no, maybe I will start with nail-biting as a symptom which might indicate distress, but it might also indicate the ability to self-soothe. Nail-biting, like all childhood anxieties, are curiosities demanding further exploration before intervention. I will stick with that.

Posted in Anxiety Disorders, Child Psychotherapy, Musings | 6 Comments »

‘I Am A Fish In A Net’

Posted by Dr. Vollmer on January 18, 2011

Maureen, fifty-two, could not decide to stay with her boyfriend of five years or leave him. She was also terribly unhappy with her job, but she was afraid to look for a new one. To add to that, Maureen wanted to take a trip, but she was not sure where she wanted to go. “I am a fish in a net,” she said, so clearly describing her experience. “How are you going to get free?” I ask, wondering what her thoughts are. “I don’t know, I am really stuck,” Maureen says, in a predictable fashion. The image of being that fish in the net really stuck with  me. To imagine, feeling like you have been caught and now you are struggling to get out, but the outsiders see you as having no hope of escape. The torment, the angst, seemed horrible to me. Once again, I had no answers, only a very deep pause, enabling me to imagine her experience.

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