Shirah Vollmer MD

The Musings of Dr. Vollmer

Twice A Week?

Posted by Dr. Vollmer on September 15, 2011

    When should someone come twice a week for psychotherapy? Like so many questions in my field, there is no solid answer, only more questions. Candace, fifty-three, is in a lot of distress. She can hardly get motivated to do the things that in the past have given her enjoyment. She has withdrawn from her friends. She no longer gets pleasure out of reading. She feels like life is not “a lot of fun.” There are no obvious stressors in Candace’s life. She is married, and although she has issues with her marriage, that relationship is very stable. She has a good job which she says is “fine”. Her parents are healthy. Her adult children are doing well. Financially, she is comfortable, although occasionally she worries about having enough money to live on, once she retires. Candace sees me once a week, reluctantly. By her account, “who wants to spend their life in a psychiatrist’s office?” She says, as if there is no other way to view her visits to me, other than that they are unpleasant in the short-run, but maybe they will benefit her in the long-run. I countered. “Sometimes people feel relief in here. They are grateful for the opportunity to talk about things that they can’t talk about anywhere else, but I guess you do not experience that.” I say, trying to point out to her that she does not allow herself to settle into our relationship with comfort and ease, but rather she tortures herself for having to come to see me. “Well, yes, I can see that,” Candace says with deep thoughtfulness. “In fact, maybe if you came twice a week, we could understand better why the vitality in your life seems to have disappeared.” I say, thinking that I need a helmet to protect myself, given her reluctance to come once a week and now I am proposing that we double our time together. Candace looks at me stunned. “Well, I certainly will think about that, but my first reaction is no way,” she says reinforcing her previous statement that she can barely allow herself the time to come once a week. “Yes, think about it. I know the issue is not time or money, but rather whether you think it would be worthwhile.” I say, stating the issue in stark terms. “Yes, that is right,” Candace says with angst and sensitivity to my suggestion. She is caught with an internal struggle of seeing the benefit of coming, but judging that twice a week, implies to her, that she is more severely ill than she first thought. For Candace, the decision revolves around accepting the need to talk to someone about tender issues in her life.  This is hard for her. She wants to feel independent, that she can handle things on her own. At the same time, she is not handling things on her own well, since the pleasure in life has evaporated. She is stuck in the dilemma. We will keep talking about it, once a week.

3 Responses to “Twice A Week?”

  1. Shelly said

    Maybe Candace is simply bored with her life? What do you define as “distress” in her life? If coming to see you is painful once a week, why would you suggest her coming twice a week, even if in the long run, she could gain back the enjoyment in her life?

    • Boredom, like other symptoms, suggests internal discomfort. Candace has a push/pull relationship with psychotherapy, so I suggest increasing the frequency to see if this will help her with her internal pain.

  2. Margery says….Thank you, I’ve been searching for details about this topic for ages and yours is the best I’ve discovered so far.

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