Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for March, 2011

The Mother Substitute

Posted by Dr. Vollmer on March 31, 2011

   Vince, twenty-six, had a hostile relationship with his mom who was single for most of Vince’s childhood. Vince’s dad lived two-hundred miles away, remarried when Vince was three and he started a new family, resulting in little connection with Vince. Vince yelled, screamed and hit his mom when he experienced frustration with school or with friends. After difficult high school years and a few difficult college years, Vince settled down into a stable academic life where he began to do well in school. At the same time, Vince connected with his high school girlfriend, Lenah, and as they did in adolescence, they re-started their abusive relationship where Vince would yell, scream and occasionally hit Lenah in times where Vince felt unhappy or angry. Lenah, a young woman without a history of platonic or romantic relationships was seemingly grateful for Vince’s attention, even though Vince was abusive from time to time.

   “It seems like Lenah has become a substitute for your mom,” I say to Vince, highlighting the obvious parallel that Vince seems to need to be abusive to someone since he seems unable to contain his anxieties; he seems to need to externalize them by becoming aggressive, historically to his mom and currently to Lenah.”Well, yes, I can see why you say that,” Vince responds calmly. “Lenah puts up with it, so how bad could it be?” Vince asks, to my dismay. “The fact that Lenah takes your abuse does not make it acceptable behavior,” I say, hoping that he will see the obvious. “I don’t know,” Vince responds, “I have gotten so much better.” Vince says, referring to our work together, but also trying to get me to change the subject. “Yes, I can hear that, but there is no excuse to hit Lenah because you are frustrated with your family or you are frustrated with school.” I say, again, stating the obvious, but realizing that saying words out loud can sometimes shake people into looking at their sadism. “Yes, of course, but sometimes I can’t help myself.” Vince says, as if that is a good alibi. “I don’t believe that,” I say, explaining that he can control his behavior. “Well, yes, maybe, but I have been behaving this way for so many years with my mom.” Vince says, as if history should excuse the present. “I understand that. I understand that your mom did not set a limit with you about your aggression and now you have trouble limiting yourself, but at the same time, you are old enough to exert impulse control so that you do not hurt people.” I say, again trying to reinforce how important it is for her to contain her anxieties in a way where she can share them, but not act on them. “I don’t know Dr. Vollmer. I hear what you are saying and I don’t like it. I will think about it though,” Vince says, as if to reassure me that we are still on the same team.

Posted in Psychotherapy, Relationships | 2 Comments »

Superego

Posted by Dr. Vollmer on March 30, 2011

 Glenn, twenty, steals from his parents, uses and deals illegal substances and does frequent tagging, his parents tell me. “Where is his superego? Where is the part of him that has prosocial values? Why does he seem so comfortable with breaking the law?” I ask, knowing there are no answers. Freud taught us that the superego is the heir to the oedipus comples, meaning that a child develops prosocial values as a result of working through his ambivalent relationships with his parents. A child identifies with the parent of the same sex and throught that identification, a child develops a moral compass. In addition, the “father figure” is often thought to inspire motivation and drive, whereas the “mother figure” inspires nurturing and consideration for others. Yet, some kids, whose parents are exemplary role models, whose parents are emotionally attentive to allow the child to grow up understanding their inner and outer lives, still seem to function in the absence of a superego, in the absence of a conscience. These kids tend to identify with role models in their lives who also do antisocial activities, so in essence they have found parent-substitutes on which they can mirror their lives and their values. How or why this happens is a mystery. Genetics have a lot to do with it, but exactly what the genes do to a child to make them find role models with very different values than their parents is hard to say. The environment is also relevant in that there could have been an empathic failure which inspired the child to look outside of his family for identifications. There are no answers, only more questions. Parents often feel filled with guilt and fear, understandably, but not necessarily logically. It is not so easy to say that the parents’ misstep led to a child’s antisocial behaviors, although that could be true. The profile of children who engage in illegal activities are varied and inconsistent. We have to be humble and say we just don’t understand it; we can float hypotheses, but there is no certainty. Superego problems are tough; that is certain.

Posted in Musings | 2 Comments »

Narcissistic Begging

Posted by Dr. Vollmer on March 29, 2011

  Admiration, we all need it. We all seek it. The issue becomes what we want to be admired for, and who we want to admire us. Irene, twenty-five, is a musician, as is her father. She has “made it” in that she supports herself with her music, but she feels like a failure because in her mind, her dad sees her as “B-level musician”. Irene’s narcissism, her sense of herself, is defined by how her father, the man she has been trying to impress over the many years of her development, appreciates her accomplishments. Irene sends her father her music. She gives him posters that invite him to her upcoming performances, but her dad has no visible response. He responds flatly to her overtures, causing Irene to try harder to get his attention. Irene has many fans, but the fan she wants the most, her dad, remains passive and flat. Irene’s self-image in inextricably tied to her dad’s opinion of her. She cannot seem to understand why this is so, but she feels it to be so, and as a result, she continues to “beg” for admiration. Consequently, she continues to feel bad about herself; she feels hopeless. Our job together is to unwind this narcissistic begging so she can see why she needs his admiration so much. We are on the journey.

Posted in Narcissism, Psychotherapy | 2 Comments »

Teaching Trauma

Posted by Dr. Vollmer on March 24, 2011

  Teaching trauma, a great alliteration, for a challenging task. Along with a male co-teacher, I am teaching a class of three men at the psychoanalytic institute. That makes me the only woman in the room; a highly unusual situation for psychoanalytic training these days. I think I am also the youngest person in the room, which is important when one talks about trauma, since age and experience usually seasons people to have a deeper understanding of sudden life events. Nevertheless, heated discussion, maybe even to the level of arguing, ensued. What is trauma? Is it, as DSM-IV says, a sudden and unexpected loss or torture which brings up feelings of overwhelming helplessness? Or, is it the deprivation of not getting what one needs at a critical phase in one’s development? Or, is it the meaning that one assigns to what happens to them? Is that one person’s trauma is another person’s inconvenience? A good discussion, no doubt, but one that brings up almost a religious fervor as to what the “answer” is. The fervor comes from the fear that someone who watches their buddy die in combat is somehow categorized with the same person who wishes their mother was more “available” to them when they were growing up. The combat survivor often experiences a profound change to their psychic structure: a before and after experience. The adult who reflects on his childhood to discover that key ingredients were missing does not. The discussion calms down as we review the origin of the word trauma: it comes from the Greek word wound, which in turn is derived from the a word which means to pierce. The class is brought back to equilibrium. I propose a classification system: big  “T” trauma for sudden and unexpected loss or torture and little “t” trauma for the various deprivations that one feels. The class is somewhat soothed. At the end, I realized that teaching trauma has traumatic aspects, both in bringing up personal traumatic memories, and in stimulating those in others. Mastery is what is so elusive in big “T” trauma. I hope that does not apply to my class.

Posted in My Events, Psychoanalysis | 4 Comments »

The Observing Ego

Posted by Dr. Vollmer on March 23, 2011

  Veronica https://shirahvollmermd.wordpress.com/2011/03/21/the-letter/ is working on her “observing ego” I tell her. “What are you talking about?” She asks with impatience. “The part of yourself that can be yourself and observe yourself at the same time. In the movie ‘Annie Hall’ she gets out of bed, while she is still in bed. She splits into two people, and one person asks herself what the other person is doing.” I say, grateful to the media for helping me explain this concept. “Well, I do not remember that,” Veronica says, with an angry tone, letting me know through her body movements that she is feeling criticized. “I think it is helpful if we, I mean all of us, can try to see ourselves as others see us. That way, we can expand our sense of ourselves and our impact on others,” I say, trying to help Veronica see psychotherapy as a growth-promoting agent, and not an arena for unbridled negativity. “I think I see myself all the time, too much,” Veronica says, still feeling frustrated. “Yes, I think you do, but the advantage of psychotherapy is that you can now see yourself through my eyes, and as with all relationships, seeing yourself through someone else’s eyes, brings you new information about how you interface with your world.” I say, again, trying to help Veronica connect with psychotherapy in a way in which she can see our relationship as strengthening her ego and not splitting it open. “The strength of our relationship is that we can talk about your personality, but at the end of the day, we are still working together to build your interactions in the world in the way that you see fit.” In other words, I think to myself, we are working on Veronica having a more conscious existence. Veronica is still ill-at-ease. “I will see you next week,” she says, leaving with her head down. “Yes, I will see you next week,” again, using a tone to reassure her that we have a strong relationship, but indeed, now we are going through a rough patch. It is hard to have an ego, a personality, and an observing ego, an outside/inside observer, all at the same time.

Posted in Psychotherapy | 9 Comments »

The Letter

Posted by Dr. Vollmer on March 21, 2011

Veronica, sixty-two, writes me a letter before her weekly appointment. I have known Veronica for fifteen years, but this letter writing activity is only within the last six months. She has termed our current chapter as a “crisis,” meaning that she feels that I have “gotten too hard” on her. The letters always reassure me that she will see me at our weekly time. She is as reliable as they come. Still, the prose portrays the agony she experiences between our sessions. She feels like I “have lost patience with her.” In fact, I have been more direct in my comments, which I believe she has taken as character assaults, and not as understanding her character. As usual in my work, there is a very narrow path between character assassination and insight. Helping Veronica develop an “observing ego” as Freud would say, is my task. Veronica’s need to see herself in a brighter light than I see her, at times, creates her despair, creates the “crisis”. On the one hand, Veronica has deep trust in my opinions; she told me that. On the other hand, she sees my current view of her as “harsh and far from how I see myself.” “Therapy can be hard because we have to face our demons,” I say. “That is too trite. You are better than that,” she tells me. “If I say you are not taking responsibility for your own life and that rings true, then there is something to think about. If that does not ring true, then I am off-base. If it rings true sometimes, but not all the time, then it gives you agony, so maybe that is what you are going through.” I say, helping her see herself in layers. Veronica is not happy. “We are in a crisis,” she repeats.

Posted in Psychotherapy | 5 Comments »

‘I Want To Belong, But Not To My Family’

Posted by Dr. Vollmer on March 16, 2011

Marty, thirty-three, left home when he was seventeen, never to return again. By that I mean that he was angry with his family since he did not share their political or religious values. He decided, during his early adolescence, that as soon as he could “he would get out of here,” he said to himself. Marty went to college, taught English in Japan, worked for UPS, then traveled extensively in South America. Recently, he has “settled” in Los Angeles, working as a high school teacher. Marty complains of a vague sense of “uneasiness”. “I don’t belong anywhere,” he says with complete despair. “I want to belong, but not to my family,” he explains. “I was angry when I left and I am still angry,” Marty continues. “Maybe you were angry because you did not feel that they cherished you and so it is not so much that you left, but rather that you felt like an orphan within your family and so you left because you felt unwanted,” I speculate. “Gee, that is worse than I thought. I am glad I came here today-not,” Marty says, letting me know that I might have given him too much to think about. “It is very painful to feel like an orphan. Maybe it was less painful to see yourself as angry because that way you are in control of the situation,” I say, again speculating about why he feels so disenfranchised from his family. “Yea, I used to be angry, but now I am just uncomfortable,” Marty says, again struggling for words to describe his lonely, disconnected feelings. “It would be nice to find comfort,” I say, implying that his current relationships maybe an opportunity. “Yes, but I have not ever felt comfort, so I can’t imagine feeling it now,” Marty says, with a sad tone. “Well, maybe you can start imagining. Maybe that is the first step,” I say. “Maybe” Marty replies, sounding skeptical.

Posted in Belonging, Psychotherapy | 4 Comments »

What is Wrong With Me? I Don’t Like Hiking

Posted by Dr. Vollmer on March 15, 2011

 Marjorie, https://shirahvollmermd.wordpress.com/2010/09/21/45-year-old-female-single-never-married-is-something-wrong/, in a striking way to her previous session months ago, insists that she is a “weirdo” because unlike all of her friends and her family, she does not enjoy hiking. “It is like a kid who does not like ice cream,” she says as if she has just proved how strange she feels. “Yea, but a kid who does not like ice cream is not strange,” I say, pointing out the narrowness of her thinking and her determination to make herself into an oddity and not embrace the woman she is. “Yea, but I think I am going to like hiking, but every time I go, I have a really bad time,” Marjorie says with tears in her eyes. “It makes you so sad to think that you are not the person that other people expect you to be,” I say, trying to connect with her teariness. “Yes, I have been fighting that my whole life,” she says, continuing to cry. “Maybe it is time to accept yourself, even love yourself,” I say, knowing that the words sound trite, yet they are still meaningful. “Right, like that will ever happen,” Marjorie says with frustration and despair. “It could happen,” I say calmly. “It just might come about,” I repeat quietly. “After all these years of being in the world, I just can’t imagine that,” Marjorie says, now in a calm tone. “Yes, some things expand the imagination,” I say, trying to widen her brain. “I am not counting on that,” Marjorie says, although I think she is more hopeful than she lets on; at least I hope that.

Posted in Psychotherapy | 2 Comments »

Monte and Marla: The Cancellation

Posted by Dr. Vollmer on March 11, 2011

   Monte and Marla reconnect, yes, despite Monte’s better judgment. https://shirahvollmermd.wordpress.com/2011/02/25/monte-and-marlathe-drama-returns/. They agree to meet: in two weeks, Thursday at 3:00 pm. The Tuesday prior to the appointment, Marla calls, unapologetically and cancels the appointment. “I am going out-of-town,” Marla says in a flat tone to Monte, seemingly not mindful that Monte might have changed his schedule to make that appointment work and not mindful of Monte’s possible feelings of disappointment. Monte pauses, thinks to himself, whether he should call Marla out on her insensitivity or whether she should not it to himself and let it go.

      After an extended silence, Monte decides to say in a calm fashion, “gee, when I cancel appointments I feel very bad about it, but you seem to cancel with little regard for how I might be feeling right now, and with little regard for the effort I made in carving out that time.” Marla, as she often does, begins to get angry, and says “of course, I am upset I have to do this.” Monte, staying calm, although feeling aggressive says “well, it is so interesting that you cancel an appointment and now you are angry that you are not understood. That is messed up. Actually, that is narcissistic, since you manage to turn a situation in which you assault me with a cancellation, but now, you feel assaulted. It is amazing how every situation turns into a drama in which you are injured.” Marla is silent for a few seconds, but then she says “guilty, as charged.” “It is not about guilt,” Monte responds quickly, “it is about thinking about my feelings and not yours.” Monte responded that way because the word “guilt” struck him as a deeper narcissistic experience for Marla as now she is wrapped up with feeling bad about herself, and not trying to connect with Monte’s experience. “The problem,” Monte continues “is not the cancellation, but how you keep giving me examples of how you think about your own inner experience, but you are incapable, or uninterested, in considering mine.”  “I think about your experience all the time,” Marla responds with shock at Monte’s comment. “Well, you don’t express that very well, or rather, not at all,” Monte responds, feeling angst that on the one hand Marla says how important Monte is to her, but on the other hand, the conversation feels so one-sided.

    Monte begins to thinks to himself if the reason for the cancellation matters. He concludes in his head that Marla probably is taking time off to spend time with her grandchildren while they are on Spring break. Marla, according to Monte, is too arrogant to confess that, as such an admission would make Marla “too human” and it is Monte’s impression that Marla tries to brand herself as extremely devoted to her work, and in keeping that branding she would not state the reason for the cancellation. Monte is left where he began; understanding the destructive nature of this relationship on his sense of himself, and feeling let down, yet again, by Marla’s insensitivity.  As in Sartre’s play ‘No Exit’ http://en.wikipedia.org/wiki/No_Exit with his most famous line “hell is other people,” Monte’s desire from Marla for validation parallels Garcin’s persistence with Ines. The bind continues.

Posted in Monte Marla, Psychotherapy | 4 Comments »

NYT: Ahhhhhhhhhhh

Posted by Dr. Vollmer on March 10, 2011

 

http://well.blogs.nytimes.com/2011/03/06/less-talk-more-medicine/?apage=10#comment-656468

Posted in Media Coverage | 3 Comments »

 
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