Shirah Vollmer MD

The Musings of Dr. Vollmer

‘Should I Waste My Time in Therapy?’

Posted by Dr. Vollmer on December 14, 2011

Stacy, fifty-seven, has had two prior “failed” analyses, by her report. Her last treatment experience ended when she was thirty-five. Now, her kids are grown. She is married to the same man for over thirty years, and although she used to work full-time as an attorney, she is now on disability for vague, nonspecific complaints, which “over ten doctors” have not figured out what is wrong with her, but one of them, apparently, filled out the paper work for disability. She has lots of time on her hands, and she has the financial resources for psychotherapy. She also complains that her family of origin still haunts her significantly, to the point where she cannot stop thinking about how her mother, in particular, was harmful to her sense of herself. Stacy has few friends, as she considers friends a “waste of time.” She is often physically active without any limitations, but there are times she does not feel like exercising so she has periods where she is sedentary.

“Therapy is not going to help me,” she says, as if inviting me to argue with her as to how it might. I hear in that comment the narcissism in which she believes that her problems are beyond the pale-too complicated for therapy. Even in her issues, she needs to feel special, I begin to think to myself. It seems like she struggles to feel ordinary and as such, she cannot enter into the “ordinary” experience of being a patient and asking for help, even though she has some insight into her chronic suffering. “Why don’t you give it a try and see how it feels?” I ask, suggesting that therapy is not a black and white experience. “You can make of it what you want,” I say, suggesting that with all creative experiences, what you put into it, determines, in part, what you get out of it. “Yes, but maybe there is something better that I should be doing,” she says, again, inviting me to argue with her. “What would that be?” I say, wondering what she is thinking. “Oh, I don’t know,” she says with a touch of anger. “Of course, there is an opportunity cost of going to psychotherapy, if that is what you mean,” I say, highlighting the fact that I understand the risk of psychotherapy, both practically and emotionally, but I only mention the practical risk by mentioning the opportunity cost. I think as I say that, that she is scared of going into psychotherapy and that is why she is inviting me to argue with her. She wants me to reassure her that things won’t get worse, which of course, they could.

Stacy’s ambivalence about psychotherapy is utterly painful. Her tone suggests an angst of deep pain-so deep that going to psychotherapy is really scary. Now her psychological pain seems masked by her vague, non-specific physical symptoms which led to her going on disability. Therapy might uncover that her physical symptoms stem from deeper psychological wounds of feeling unloved and unloveable,  thereby causing her to make decisions in her life in which she was fighting to feel loved, but it never worked. Had she felt loveable, maybe she would have taken a different path. Insights can cause deep regret. Stacy seems to know that and she is scared. At the same time, she is uncomfortable in her body and she feels lost and empty inside. I don’t think she is ready for therapy yet, but we will see.

6 Responses to “‘Should I Waste My Time in Therapy?’”

  1. Shelly said

    Why does Stacy’s comment, “Therapy is not going to help me,” seem narcissistic to you? Perhaps it is simply a fear being expressed out loud, after two “failed attempts” of psycotherapy. Indeed, if everything a patient says in therapy is judged as narcissistic (i.e. all about me, I think that I’m better than everyone else which really disguises a feeling of insecurity), then what better purpose is there for psycotherapy? In other words, is it right to judge a patient by what she says and label her with an offending diagnosis because she is scared (even if this is a fictional account)?

    • Shirah said

      Tone is the answer to your question. The words “therapy is not going to help me,” makes sense, but Stacy said it in the context that her pain is too great for any one person to help her. Yes, it felt like a narcissistic defence, or protection from pursuing the underlying elements to her pain. You say I am judging patient’s as narcissistic as opposed to understanding that their sense of themselves is so fragile that they exude their pain by being so disparaging of others. I must have not written it clearly if you got the idea that narcissism was a perjorative label, rather than a means of understanding human suffering.

  2. Danny said

    Hi Dr Shirah, what do you mean at the end of the post by saying that she is not ready for therapy yet ? what would prepare her then ? thanks

    • Hi Danny,
      I mean that her hostility towards the process, might be a defense, in that she is scared to take the risk of therapy and then feel painful regret for certain big decisions that she made in her life. When and if her hostility subsides, then she might be open to the process. Sometimes, a bigger crisis has to happen for someone to be open to the challenges that psychotherapy presents. Thanks. SV

  3. HI Disequlirbrium1,
    Thank you for your comments. The point of this post was to illustrate how fear can manifest as criticism. I agree, generally speaking, that our psychiatric lexicon can be used to hurt people, rather than help people. In specific though, this post was not intended to denigrate this potential patient, but rather it was intended to illustrate some possible underpinnings of hostility.

  4. Discussant said

    I think that the reasonable and humane conclusion to draw from Stacy’s case is that she would like some help, but doesn’t see psychotherapy as the place to get it.

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