Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for October 27th, 2011

Therapeutic Ambivalence

Posted by Dr. Vollmer on October 27, 2011

  Maria,, thirty-three, comes to her monthly appointments “confessing” how she changed her dosages of medication. Her sister is a primary care physician, so she often “consults” with her and then changes her pharmacology accordingly. “You have problems trusting me,” I say, making her instantly uncomfortable. “I come here for a long time. I could get my medications from my internist, but I choose to come to you,” Maria says, bringing up some good points. “Yes, but at the same time, you feel the need to make your own decisions about medications, rather than discuss the issues with me. Both are true: you put a lot of faith in me, and you don’t want to be dependent on me, so you work independently.” I say, showing her the layers of her mind. “I guess I should go back up on the medication,” Maria says, as if I am concretely telling her to return to the dosage I prescribed. “The dose is not the important thing here at this moment. The important aspect of our conversation is your ambivalence in our relationship, which might reflect on how you have ambivalence in other relationships as well.” I say, trying to highlight the underlying issue of communication versus unilateral decision-making. I am trying to talk about her mixed feelings in our relationship which manifest themselves by her adjusting her dosage,  independent of my opinion. Maria looks like she wants to think about what I am saying. She leaves with some agitation, but she also looks like she appreciated the challenge to her thinking. Doing psychopharmacology, like in all doctor-patient interactions, bring up the issue of relationships, bringing to the forefront issues of communication and trust. Once again, the notion that a psychiatrist can “just do meds” is ill-founded. Understanding dynamics is critical to all relationships which are so loaded with deep underlying issues. Maria and I have work to do-psychodynamic work, that is.

Posted in Psychopharmacology, Psychotherapy | 4 Comments »

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