Shirah Vollmer MD

The Musings of Dr. Vollmer

Hate Me Now: Love Me Later

Posted by Dr. Vollmer on February 14, 2012

“Are you that brutal with your patients?” A friend of mine asks, referring to my occasional directness, with little cushion to provide for good feeling. “Yes, sometimes, to penetrate defensiveness, a certain straightforward honesty, although initially painful, might create an inner change which will lead to deep appreciation in the future. This long-term approach to psychotherapy is in direct contrast to a more supportive kind of psychotherapy in which the goal is the immediate relief of suffering. Clearly, this is not an either/or proposition. There can be support in the midst of a more long-term approach to psychic change.

“You have a way of sabotaging your relationships by checking out as soon as the relationship gets too intimate,” I say to Sarah, age thirty-two, a long-term patient. Anger ensues. “You do not support me. You are always criticizing me. I am trying to find a boyfriend, and all I get from you is negativity.” “I can see that I really upset you by my comment and I certainly did not mean to do that. I did mean to try to look at how your behavior might be getting in the way of your desire for intimacy.” I say, knowing that I want to help Sarah develop an observing ego. Her anger concerns me, but at the same time, I see this as a process that we are working through, and so I don’t need to immediately quiet her experience of my comment.  

The argument here is that if my comment caused so much anger, maybe I overstepped in my observation, in that my tact or timing was poor. This is always a question that I ask myself. In the case with Sarah, the follow-up is positive. Over time, Sarah came to see how she became scared in relationships, causing her to “pull out” by being judgmental and critical of her significant other. She came to appreciate our discussion of her self-sabotaging nature, even though in the moment, she was incredibly angry and disappointed with what she perceived to be a very critical and unsupportive comment. As Sarah and I reflected, that was a “hate me now, love me later” comment. We laughed. For me, it was a nice Valentine’s Day present.

4 Responses to “Hate Me Now: Love Me Later”

  1. Jon said

    There must be a fine art to understanding how direct to be with a patient. Over time, I assume it becomes instinctual, but an instinct that must be continuously honed. Your interactions as described with Sarah seem most successful.

    I would guess that not being direct enough does not provoke the changes required in a patient; the patient has not understood the nature of the inner change needed. Conversely, being too direct also does not provoke the changes required in a patient; the patient has not confronted the nature of the inner change needed, but becomes defensive instead.

    Does this match what you have observed in your practice?

    • Well said, Jon! You have eloquently stated the narrow path of what we call “interpretation,” the process of feeding back to a patient what might be their inner psychic process which leads them to this point in their lives. If too stark, then the wall goes up, and no change is possible-only anger and hurt. If too gentle, then there is no push for change. The narrow path of what we in the child development world call “optimal frustration” is what we seek. Thank you for articulating this process in such a wonderful way.

  2. Shelly said

    How are you sure your patients won’t get frustrated by the immediate pain and quit therapy? Sometimes people think only in the short term, looking for a quick fix. If the pain is more than the gain, oftentimes people give up. Introspection is hard and people resist change. Aren’t you afraid of losing patients by telling them things they don’t want to hear?

    • I trust that our relationship can weather the potential storm. In other words, I time my confrontation to be at a time where it seems to me that we have built up enough good will that the patient understands that I am trying to be helpful, although I am being painful in the moment.
      As one of my professors once explained to me, “if you can’t risk losing the treatment, then you are not working hard enough.” In other words, certain treatment situations warrant taking that risk. The courage of a well-timed interpretation is part of the challenge of my work. You clearly understand this from your comment. Thanks.

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