Shirah Vollmer MD

The Musings of Dr. Vollmer

The Opening

Posted by Dr. Vollmer on July 12, 2011

   “So, how are you?” Jayme, a fifty-year old female patient comes in to open her session, knowing that I won’t answer the question in any meaningful way, but also clearly uncomfortable with starting the session. “I am fine,” I say, looking back at her as if to say that we are here to talk about you. “Well, I just want to tell you how helpful you have been to me,” Jayme says, with both gratitude and nervousness. She seems to continue to struggle to tell me what is bothering her; I am thinking that she is probably trying to try to warm up the room so we can dig in. We are both quiet, but as per my previous post, I am thinking that this slow to warm-up session will likely end with a doorknob comment. It seems that something is weighing on Jayme, but her anxiety is inhibiting her from being more direct. She starts talking about her work, but I am still not feeling the emotional intensity behind her comments, leading me to think that she is still being avoidant of a more difficult issue. As time ticks on, she eventually tells me, with tears in her eyes, how unappreciated she feels by her family. She says “I do so much for them, but I don’t think they get it. They treat me like I am invisible.” I am feeling her sadness causing me to respond to her feeling by saying “I can feel how down you feel and I wonder if some of that is that not only does your family not appreciate your efforts, but maybe, in addition, you  do not appreciate yourself.” She looks at me; we both look at the clock. “It was difficult to get going today,” I say, implying that we have to stop and that is too bad, since we are just beginning to get into her dynamics. “I am going to be fine,” she says, as if she is reassuring both of us. I was wrong-no doorknob comment.

2 Responses to “The Opening”

  1. Shelly said

    What makes you think that Jayme doesn’t appreciate herself? Is that from previous sessions with her, or from what she didn’t say? How can you read behind her words? I would think the feeling invisible and feeling unappreciated were very strong indicators of how she really felt in her family. In therapy, can you begin a session by saying, “Unless you have something more pressing you’d like to talk about, I’d like to explore where we left off in our last session about your feelings of invisibility and unappreciation by your family?”

    • Shirah said

      I guess you could say it was a hunch, or maybe an intuition. In addition, I was wondering if Jayme’s concern that her family was not appreciating her was actually a projection of how she felt about herself. It was something that I thought was worth exploring. Yes, I agree that her feelings of being unappreciated probably have historical roots, as well as being activated in her present life. Yes, I can take control of the opening, and sometimes I do, but I am also aware that by doing that, I miss out on understanding the patient’s style of communication.

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