Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for January, 2012

Anna Freud and Adolescence: Continued

Posted by Dr. Vollmer on January 18, 2012

   Can someone remember their adolescence and report that to their therapist/analyst? That is the question that Anna Freud poses in her 1958 paper entitled “Adolescence”. There is a well-known amnesia for early childhood, likely because the hippocampus has not fully formed, and as such, narrative, or linear memory is not possible. The amnesia in adolescence is different, Anna Freud says. She points out that the “height of elation or depth of despair, the quickly rising enthusiasms, the utter hopelessness, the burning-or at other times sterile-intellectual and philosophical preoccupations, the yearning for freedom, the sense of loneliness, the feeling of oppression by the parents, the impotent rages or active hates directed against the adult world, the erotic crushes….the suicidal fantasies” are largely forgotten, or “difficult to revive.” In a humble way, she continues “this partial failure to reconstruct adolescence might account for some of the gaps in our appraisal of the mental processes during this period.”

   Once again, I am reminded of the privilege of seeing adolescents first hand, in addition to relying on the reconstruction of adolescence by my adult patients. Marlo, a fifteen-year old girl, “hates” her parents and she wants to “run away.” She continues, “my dad is clueless and my mom is intrusive. That is a bad combination. I want my mom to get out of my business, and my dad is so detached, I can’t stand him.” “It sounds like you have no comfort at home,” I say, trying to grasp the loneliness she feels with her parents. “Yes, if it were not for my friends, I would not know how I could survive,” she says, grateful for her peer support. “It is great that you have friends who understand you,” I say, wondering where I fit into her mental life. Am I thought of as a peer who understands her, or a parent who has poor boundaries, or does this vary from session to session? “So, do you feel like I understand you?” I ask, treading lightly so as not to sound like I am competing with the love she has for her mom, but at the same time, wanting to see how she works therapy into her inner world. “I really appreciate the opportunity to talk about how I feel. My friends are great, but sometimes I get annoyed with them, and it is nice to talk to you about that,” Marlo says with honesty and directness.

  Will Marlo remember her intense feelings towards her parents as she develops into an adult? Anna Freud says no. She might report those feelings, but she is unlikely to re-live those emotional highs and lows. Therapy brings out infantile feelings, she reminds us, but it does not bring back adolescent feelings. That is so interesting. There is a protected time where the passions of youth come and go, and are not remembered or re-experienced in full color. This notion makes me hope that I get to see Marlo again as an adult. I suspect her relationship with her parents will be comfortable, with good boundaries. I suspect she will only have vague memories of her discomfort in her teenage years. I hope I get the opportunity to see that for myself.

Posted in Adolescence, Psychoanalysis | 2 Comments »

Adolescence: Anna Freud Style

Posted by Dr. Vollmer on January 17, 2012

 

Thinking about adolescence from a psychoanalytic point of view, brings us to Sigmund’s Freud’s paper on the “Three Essays on Sexuality.”https://shirahvollmermd.wordpress.com/2010/01/23/three-essays-on-the-theory-of-sexuality-freud-1905-revisited/. Essentially, infantile sexuality which is focused on the erotogenic zones (oral, anal and phallic) become transferred to new sexual aims, meaning that in adolescence, the emerging adult begins to focus on “objects” or love interests outside of his/her family. Sigmund Freud wrote about what every mother talks about on the playground. That is that the behavior moms look at in their toddlers between the ages of two and five, are likely predictors of adolescent behavior. The stubborn toddler is thought of as “oh, my goodness, he is going to be a difficult adolescent,” the mother fears as she takes his toys away. There is a notion, perhaps started by Sigmund Freud in 1905, that after age six, there will be a quiet period until puberty, but then the difficulties will re-emerge, only this time, with the force and power of an adult-sized being.

   Anna Freud, the youngest child of Sigmund Freud, added on to our understanding of adolescence in that she focused on the ego’s job in adolescence to master the inner drive tensions. In other words, she helped us to understand that adolescent turmoil was normal and necessary for adult development. The inner tensions of the drives (push forward in development) which seem to quiet down in latency (ages six to ten), resurge in adolescence. To put it another way, adolescence represents a time when depth of thought is born. The young adult must contend with sexual pressures which drive him towards love relationships and professional development to support his independence from his familial bonds. Failure of adolescence causes persistent immaturity which can take the form of sociopathy, poor relationships, or a psychological merging with the family of origin, thereby preventing a psychological separation and the development of a more sophisticated being.

    I like thinking about adolescence because not only do I teach about it, I also live with the struggles every day, both through my adolescent patients, and through my older clients who have gotten stuck in adolescence, giving them tremendous anxiety about moving forward in their lives. For example, an increase in narcissism is inevitable and helpful in the beginning of adolescence, but one hopes that as time goes on, the person begins to have deeper empathy for others. This cannot always happen because for some, the security necessary to leave oneself behind as he/she begins to deeply care for another is simply too scary. The person feels too emotionally deprived to intensely care for others.

  Lee, age forty-one, never married is a good example. He is lonely, on the one hand, but the thought of thinking about someone else gives him anxiety to the point of panic. He is “sure” that if he lived with a woman, his life would be ruined. She might expect him to make more money, keep a cleaner house, go out to social events, and those expectations, according to Lee, might “ruin” his life, such that he is too scared to even date women. At the same time, Lee is deeply caring for his parents, to the point where he vacations with them, and he spends every Sunday night at their house having dinner. I would say that Lee is stuck in latency. He cannot seem to move beyond his childlike life of having his parents as his primary love objects. The thought of psychological separation gives him panic. My more biologically minded colleagues might suggest that Lee has Panic Disorder, or some sort of Anxiety Disorder, and although I can see that point of view, I also see that Lee needs to work on his inner tensions of struggling with his ego. That is, he needs to take care of his ego such that he can manage his own needs and the needs of another, outside of his family of origin, in a way that is both satisfying and fulfilling. As he learns to do that, he will no longer experience anxiety at the thought of going out on a date. I am in favor of Lee taking medication to help him with his anxiety, as long as he also understands that as he masters his internal world, the expectation is that he will no longer need his medication. Anna Freud helped us to understand Lee. Thanks, Anna.

 

Posted in Adolescence, Psychoanalysis | 3 Comments »

Electronic Medical Records: Do You Want Fries With That?

Posted by Dr. Vollmer on January 16, 2012

  The Affordable Care Act, the digitization of our world, and the changing delivery of health care all comes together to roll out electronic medical records, now active at Kaiser, and soon to be active in almost every primary care setting, certainly by 2014. To be clear, I think that this will be a net positive for patient care. Medical information will be helpful to emergency room visits, doing health maintenance, and tracking prescriptions. I am optimistic about the benefits for the vast majority of patients who now have fragmented care, or no care at all. My concern is how will electronic medical records change the joy in the practice of medicine. Will taking care of patients retain the fun, if a menu comes down for every patient, reminding the provider to remind the patient to wear his seatbelt when he drives in his car? Again, I think it is a good idea, and it will help, for the computer to prompt the physician to remember preventive medicine questions, as preventing accidents, for example, is a very important part of health care. Now, though, that conversation, stems from a general concern for the patient, usually discussed, at a visit where critical medical issues have already been addressed. Yes, of course, the computer eliminates the human error, inherent in trying to remember too many things, especially when the provider has too many patients. At the same time, the fun in patient care, at least for me (and I am not a primary care doctor, I understand that) is the spontaneity of conversation, which is based on a deep training of important questions which are well-timed to the moment of most open communication. For example, there is a big difference if you tell a patient to stop smoking in a rote fashion, as opposed to telling them to stop smoking after they just told you that their uncle died from lung cancer. I fear that this art of persuasion will be lost with the advent of electronic medical records. In so doing, I fear the fun of patient care will diminish considerably. Sure, there is an upside. Efficiency is going to make the doctors feel better, as inefficiency, in the current system is degrading and demoralizing to physicians. Balancing it out though, I still fear that this roll out will be a net gain for patients and a net loss for providers. As with so many of my grim predictions, I really hope I am wrong.

Posted in Electronic Medical Records, Medical Training, Primary Care, Professional Development | 10 Comments »

The Sweet Relationship

Posted by Dr. Vollmer on January 13, 2012

Nile and Shoshi, https://shirahvollmermd.wordpress.com/2012/01/12/feeling-important/ are “doing better, ” as Shoshi reports to me. Shoshi reports “Nile asked me how he could handle himself better and I told him that he jumped to the wrong assumption about my behavior about getting the frequent flier miles. I suggested to him that he should have asked me about why I got miles for one child and myself, but not for him. If he had asked me, and not assumed that he was not important, we could have worked it out. I think that our work together in here has helped me see that people come to conclusions based on their underlying opinion of themselves, and then they look to their environment to prove their point. Thinking of things that way, I could see why Nile got mad at me and I could explain to him how he could have done things differently.” Shoshi tells me with gratitude for how our relationship has helped her marriage. “What did Nile say?” I asked, with curiosity about his defensiveness. “He said that he wished he could have thought to ask me about it. I thought it was so sweet the way he could see that he jumped to conclusions, rather than getting more information about the situation. That really touched me. ” Shoshi tells me in a way in which so contrasts with her anger and disappointment from the day before. “It sounds like you are saying that this therapy experience has opened your eyes to how self-esteem impacts relationship by interfering with open communication. Nile’s self-esteem obstructed his inquisitiveness. You were able to point that out to him and he was able to hear that. That is a very nice example how psychotherapy with you, actually helps Nile as well, and thereby helps your marriage.” I say, risking sounding too self-serving and egotistical. “That’s right,” Shoshi says, affirming our currently positive relationship.  “I know you and I have been through hard times, but today we get to appreciate our work together.” I say, highlighting the ups and downs of all relationships, including, and maybe, especially, ours. “The positive turn in your relationship with Nile has shed positive lights in our direction, and my guess is that the reverser happens as well.” I say, illustrating the bidirectional nature of how positive relationships beget other positive relationships and vice versa. “Yep, it is a good day, all around,” Shoshi says as she leaves my office, with elevated spirits and a palpable joy for life.

Posted in Psychotherapy, Relationships | 4 Comments »

Re-Posting: Mom’s Birthday

Posted by Dr. Vollmer on January 12, 2012

Today is my mom’s birthday. It is hard to think about a birthday when the person who was born is no longer with us. Normally, I would wake up and call my mom and I would wish her a happy birthday and for many years she would say “well, it is better than the alternative”. Even though my mom passed away in 2008, I am still thinking about calling her.

My mom was born in 1925. She often told me that she was a depression baby. By that she meant that she grew up in the Great Depression. As we all know, the Great Depression was a severe worldwide economic depression in the decade preceding World War II. In most countries it started in about 1929 and lasted until the late 1930s or early 1940s. In 1933 the unemployment in the United States rose to 25% and in some countries rose as high as 33%.  The depression originated in the United States, starting with the stock market crash of October 29, 1929, but then spread to almost every country in the world. In today’s terms, we would say “it went global”.

The cause of the Great Depression is not clear, but two economists of the 1920s, Waddill Catchings and William Trufant stated that since the economy produced more than it consumed, there was an unequal distribution of wealth throughout the 1920s, causing the Great Depression. The end of this economic downturn seems more straight forward. Most people think that the Great Depression ended with the advent of World War II. America’s late entry into the war in 1941, when my mom was 16, finally eliminated the last effects from the Great Depression. Unemployment rate went below 10%.

For years, when my mom described herself as a “depression baby” I had no idea what she meant. I knew that she grew up in poverty. I knew that when I went to visit my grandparents, her parents, I slept at night with my hands over my ears so that I would not hear the gunshots in the neighborhood. I understood that her childhood was rough. I also understood that she attributed her challenges to the economic conditions of the country. However, what I did not understand is whether other people, born in her era, saw themselves in the same way.

My dad, born in 1927 into a poor family, had a very different outlook. He saw himself as a very lucky young man. He served in World War II, went to college on the GI Bill, and poof, his life changed. My dad’s focus has been, and continues to this day, to be on how fortunate he was to be able to take advantage of this government program. My father often tells me how college was amongst the best years of his life.

So, as a psychiatrist I wonder how two people, born into similar economic circumstances, grew up to review their early years so differently. Clearly, there are many many factors which determine one’s formative experiences. My question though is why my mom attributed her challenges to the economy. My mom spoke about how poor people suffer in ways that affluent people do not understand. It is not that rich people do not have their challenges, it is only that people in different economic classes cannot really understand each other, even if they think they can.

I remember when I was little and the Pritikin diet had just hit the public’s eye. The diet promoted grains, with some, but not much protein. My mom laughed, saying that when the food is associated with poverty, no one wants any part of it, but now that some fancy doctor is saying it is good for you, everyone wants to eat like poor people.

My mom never wanted any presents for her birthday, but she did want me to call her. She wanted me to remind her that I was happy she was still here. At the same time, even though in her adult years, her economic life was characterized by booms and busts, her birthday seemed to be a painful reminder of her adversities. She understood that her childhood was challenging on many levels. Eventually, I began to understand that when she said she was a “depression baby” she was saying that the challenges of the country were woven together with her personal challenges of her family dynamics. I came to appreciate the wonders of the double meaning of depression: psychological and economic. This is no coincidence.

My mom taught me a lot. Today I appreciate her wisdom. In particular, I embrace her point that people in different economic circumstances do not really understand each other. The longer I live, and the longer I work with people who are suffering, the more I understand that she was right. Happy birthday mom

https://shirahvollmermd.wordpress.com/2010/01/24/moms-birthday/

Posted in Grief, Parenting, Relationships | 6 Comments »

Feeling Important

Posted by Dr. Vollmer on January 12, 2012

Nile and Shoshi, both fifty, have been married for twenty-five years. Their two children are both in college, so their empty nest is unevenly empty for Shoshi, but less so for Nile. Nile seems to appreciate that Shoshi can focus on him more now that the children have sprung loose. Shoshi, by contrast,  at first felt lonely when her last child went to college a year ago, but over time, she has come to appreciate her freedom. She never saw herself as a caretaker for Nile, so it did not occur to her that Nile would become more emotionally needy when the kids went to college. Shoshi plans the family trips, for the four of them. She recently planned a trip to the Caribbean, and as she booked the plane flights, she signed up for miles for herself and one of her two children. She did not take the extra step to find out the mileage number for her husband and older child. She figured that they could add the miles on the back-end of their trip. As she thought about it, she could see that this might be insensitive, but she was still stunned by Nile’s reaction. “I am tired of feeling like a second class citizen,” Nile tells Shoshi, which Shoshi then relates to me. Shoshi explains that it seems like Nile let loose about years and years of feeling like the children came first. Nile, according to Shoshi, never stood up for himself, but at the same time, he gets mad when he does not feel important. Shoshi feels that Nile does not understand this dynamic, so he is constantly feeling victimized by Shoshi.

  “Did you explain to Nile that he is important to you?” I ask, wondering if Shoshi does not understand her role in their dynamic. “No, I got defensive, of course,” Shoshi laughs at herself. “I can see how Nile got his feelings hurt, but at the same time, I am very busy and I planned the trip, and I did not do one detail, and I feel like it is not fair to get down my throat about that.” Shoshi explains to me her pent up resentment about feeling misunderstood with regards to the work of trip-planning. “Yes, but if Nile needs to feel important, taking the time to do these details might be important symbolism for him that you care about him,” I explain. “Yea, I see that, but I wish he would talk to me that way, rather than being fixated on the miles. Nile does not explain himself very well and he does not know how to create an environment where others treat him like an important person.” Shoshi says, throwing the dirt back on to her husband. “That may be, ” I say, “but the issue for us is that you could understand that he needs to feel like he matters, and taking care of details, is one way for him to feel that way.” I say, bringing the conversation back to Shoshi’s insensitivities and away from Nile’s inarticulateness. “I see that now, but I did not see that last night,” Shoshi says, with a feeling of regret and dismay. “Maybe you should tell Nile how you feel now that you have the benefit of distance from your argument,” I say, stating the obvious. “Maybe,” she says, with characteristic arrogance in that it is hard for her to apologize, especially to Nile, where she seems to need to feel superior. “Think about it,” I say, encouraging her to slowly change the dynamics of their long-standing marriage. “Everyone needs to feel important,” I say, reminding her that Nile’s needs are understandable and sympathetic. “Yes, but I also think it is Nile’s responsibility to assert himself in a way in which he commands respect,” Shoshi says defensively. “That may be, but you can still deal with your side of the equation,” I say. “Of course, that is true,” Shoshi reluctantly agrees.

Posted in Empty Nest, Relationships | 3 Comments »

Friendship Up

Posted by Dr. Vollmer on January 11, 2012

   So often, I hear about friendships gone South. Life-long friends who suddenly, or gradually, part ways. The sadness, the loss, and the grief are sometimes profoundly disturbing to both parties, yet the irreconcilable differences, the hurt feelings, prevent obstacles to reconciliation. Today, I heard an “up” story, one that also comes up in psychotherapy in that the consultation room is an area for airing one’s feelings, be they good or bad, or confusing or scary. Lisa, my patient, aged fifty, and Maya, also fifty, went to high school together, but they were not close. They never spent time together after school. They did not know each other’s families, and they did not have close friends in common. Nevertheless, they were fond of one another. There was no contact, “as one would expect” Lisa tells me, until Maya started planning their 30th High School reunion. Lisa tells me “of course, I would never go. I was fat and ugly and isolated in high school, so why should I go?” she asks me rhetorically. Yet, Lisa responded to Maya’s plea to attend, by saying that she would love to get together, just the two of them and “catch up.” This started a surprising three-year friendship which continues to deepen and surprise both Lisa and Maya. Over the last three years they have become familiar with each other’s spouses, children and parents. The usual middle-age discussions of getting kids off to college and then paying for it, followed by the more serious discussion of aging and dead parents. Lisa says, “I don’t think I have found a new friend in about ten years. I don’t know if Maya counts as a new friend, since I knew her so long ago, but she feels like a new friend.” Lisa relates with youthful enthusiasm for finally finding a friend she trusts. “It sounds like you and Maya are falling in love,” I say, highlighting my theme that platonic friendships can be deeply meaningful. “I guess you could say that,” Lisa says, accepting the loving nature of her feelings. “I am happy for you,” I say, emphasizing what a wonderful feeling she must be experiencing. “Thanks,” she says. “It is nice to share something positive for a change,” she says, reminding me of all the tough times we have gone through together. “Oh yea,” I say, mirroring her feelings about that.

 

See also…https://shirahvollmermd.wordpress.com/2012/01/08/fictional-friends/

                     https://shirahvollmermd.wordpress.com/2011/12/16/selfish-friendships/

Posted in Friendship, Psychotherapy | 2 Comments »

Medical Aggravation

Posted by Dr. Vollmer on January 10, 2012

  Lew, thirty-three, has a rare genetic disease requiring pre-authorization for a very expensive medication which he takes by mouth once a month. He switched insurance companies because his wife lost her job, and so now that she has a new job, Lew has new insurance. Consequently, Lew had to find a new primary care physician. This physician has to connect with Lew’s insurance company to state the reason Lew needs this medication, even though Lew has been taking this medication his entire life. Doctor Lippe, a male, newly trained primary care physician, is quite personable and seemingly sensitive to Lew’s needs. Yet, the authorization does not go through and Lew begins to experience vague, non-specific complaints of fatigue, joint pain and headaches. Lew believes his insurance company is to blame, but upon further research, he discovers that his physician never filled out the needed paper work. “You need to get another primary care physician,” I tell Lew, with uncharacteristic directness. “You need a physician who will be your advocate and follow-up with the details of medical work.” I say, sharing Lew’s frustration and aggravation about this critical, although not life-threatening, delay in care. Lew has a hard time understanding my point of view. “He is so nice,” he repeats. “It is hard for you to see that Dr. Lippe might be nice in his office, but the lack of follow-through could be a bad sign for more urgent matters down the road. ” I say, forcefully and unequivocably. “Yes, it is hard for me to see that a physician might be lazy, or not motivated to help his patients, or inattentive to details,” Lew says with uncharacteristic naiveté. “Well, they can be,” I say, with such  obvious frustration about Lew’s poor medical care. “I have to think about this,” Lew says, with agony, partly because he is without his medication, and partly because of our intense discussion. “One issue is that because you did not get your medication, you are in a compromised position to advocate for yourself.” I say, understanding and articulating that medically vulnerable people are doubly hurt because first, their bodies betray them, and second, they are less able to defend themselves against incompetency and unnecessary delays. “Yes, it is hard for me to think straight right now,” Lew says, understanding his vulnerability. “I am so sorry about that,” I say, again feeling the frustration of the health care system.

Posted in Mind/Body, Primary Care | 3 Comments »

Social Awkwardness

Posted by Dr. Vollmer on January 9, 2012

Ned, thirty-three, “stiffens up” as he relates to me how his wife describes his behavior. “Well, we were watching a play, and we had to sit separately since my wife could not get two seats together. She always has me hold her cell phone. I don’t know why. She got three text messages during the play, so as soon as the play was over and we came together, I told her that her phone was going off. She got upset with me that I did not connect with her about the performance, or that I did not ask her how her seat was. She said I was socially awkward.” “Did you agree with her?” I asked, thinking that I am sympathetic to the wife’s point of view that she was probably anticipating reconnecting with her husband after the show and he was hyper-focused on making sure she knew she had messages to attend to. I could well imagine that this conflict of expectations created a large amount of tension, which had Ned been more socially astute he could have handed her the phone and asked her about the play at the same time. “Yes, of course, I am socially awkward,” Ned, readily agrees, “but I don’t know what to do about it.” Ned says with the innocence and sweetness of a child. “So, it was not intuitive for you to try to emotionally connect with her after seeing a show,” I ask, knowing the answer. “Yep, it was not intuitive,” Ned says with a confused tone as to how something like that would be intuitive. “Maybe you need to keep in mind that the moment of reconnecting, after a day’s work, or after any separation for that matter, is a sensitive time, and you should take extra care  to be attentive to your wife as a whole person, and not get so focused on one issue.” I say, stating what is obvious to most people, but what seems to need to be spelled out to Ned.

As I describe this interaction with Ned, I imagine my readers asking me about his diagnosis. Do I think Ned has Asperger’s? I imagine Shelly and Jon asking me. I think that social skills, like all skills are on a continuum, as are athletic skills, musical skills, math skills, etc. Ned’s social skills are weak, but I would not extend that to say that he has a social communication disorder. Ned is, for the most part, happily married, a father of two young children, and successful socially at work in that he gets along well with his colleagues. His issue is that he lacks social intuition that is helpful in close relationships.  However, he understands his deficit and so he is religious about coming to psychotherapy. He is motivated to make his wife feel more comfortable with him. Psychotherapy may help him be more socially conscious,  in a wooden way at first, in that he may sound rote, rather than warm, but over time, the warmth will be added to his reactions and so I am hopeful for the future of their marriage.

Posted in Asperger's Disorder, Autism, Psychotherapy, Social Skills | 8 Comments »

Fictional Friends

Posted by Dr. Vollmer on January 8, 2012

Nate and Kip, both in their sixties, see each other once in a while at garden club meetings. They like each other, but they hardly get together outside of their monthly discussion about their garden. For years, they were two single men: Nate was divorced, Kip has never been married, never lived with anyone. Eight years into their ten-year friendship, Nate fell in love and married Tracy, age sixty, with two grown children. Tracy knew that Kip was important to Nate, so she started including Kip in their family holidays, dinners and birthdays. Kip enjoyed being part of Nate’s new family. Kip, according to Tracy’s report,  created a narrative in which he and Nate were “really close” and now Tracy and her adult children were added to this “closeness.” This equilibrium lasted for about four years until Tracy started feeling distress over how Kip was impacting her family.

Tracy comes to see me to discuss her dilemma. “Kip and Nate were never really close, but Kip likes to say he was close to Nate, so that it does not seem weird that he is now almost a member of our family. The truth, as I see it, is that Kip wants us to adopt him as our third child, and this creates a dynamic in which he feels like an added responsibility and not a friend.” Tracy relates to me, suggesting some compassion for Kip, but mostly upset and personal responsibility for creating this messy situation.  Tracy continues, “so I confronted Kip about how I wanted a more mutual friendship. I tried to explain that there needs to be more to and fro, but right now, it feels like we talk about him and his life, and he shows minimal interest in our issues. Then, I said that we both need to plan fun activities and that going out together should be a source of excitement and not dread and fear. I know I might have sounded harsh when I said that, but I wanted him to understand that his anxieties about trying new experiences was getting in our way of looking forward to getting together. Kip got mad at me and he said he did not understand what I was talking about. He said he does enjoy spending time with us and that he never complains when we get together. The truth is though, he does complain about things, but he won’t acknowledge that. ”

“It sounds like you are really frustrated,” I say to Tracy. “It also sounds like you feel that Kip is behaving in an unconscious way in that you feel that he so desperately wants to be part of your family that he has created a fiction about his past relationship with Nate. It also sounds like you now feel responsible for Kip’s well-being and you do not want that responsibility.” I say to  Tracy, reflecting back what I am hearing from her, understanding that Nate and Kip might have a very different version of this narrative. “That’s right,” Tracy says with the enthusiasm of feeling understood, “I don’t want another child, and I certainly can’t cope with someone who is not willing to honestly look at how their behavior might be impacting me. Kip makes me feel so invisible because he seems to really want me to take an interest in him in the same way that I am interested in my children, without any sense that he is my contemporary, and our relationship needs to be more even for it to continue without me feeling so resentful.”

“What does Nate think?” I ask, wondering how this triangle plays out from that angle. “Nate is not a good friend to Kip. He seems to be mildly interested in Kip’s behavior, but mostly Nate is a loner, and except for me and my children, his social thinking is fairly limited.” “So you are caught in the middle,” I say, understanding better why Tracy is so disturbed by Kip’s behaviors. “Yes, Kip is looking to me as a mother, and I guess I played along with that role for a several years, but now I am tired of it. Then, when I expressed myself, he turns to Nate, as if Nate was some sort of deep friend that wants to hear his dilemma. Further, Kip is now trying to put Nate in the middle because Nate is stuck between me and Kip and Nate does not want that either.” Tracy further deepens the complexity of this three-way relationship and how it is slowly unraveling, giving pain to all involved.

“I think it is positive the way you tried to explain to Kip your dilemmas within the relationship. I know that made him defensive, but it seemed like you might have started an honest dialogue about your relationship and if nothing else, that could give you clarity to continue-either to deepen or to withdraw from the connection. ” I say, trying to emphasize that Kip’s defensive reaction did not mean that Tracy made a bad move by trying to honestly talk about her perception of their friendship. “If Kip continues to be defensive, maybe he is not ready to continue his relationship with you right now. Maybe time will help him reflect on his role in the dynamic.” I say, reminding Tracy that initial defensiveness does not necessarily mean that the defensiveness will continue as time progresses. “I just feel awful about it,” Tracy says, with deep pain about the years they all spent together, thinking about how it might end in a sad way. “I understand that,” I say. “The three of you made a little family and that worked for a while, but now it is not working. Kip is creating a fictional history in order for this family tale to make sense to him.” I close, pointing out how fictional histories are common when people try to make sense of a painful experience.

 

See also…https://shirahvollmermd.wordpress.com/2012/01/11/friendship-up/

Posted in Friendship, Psychotherapy | 5 Comments »

 
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