Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for March, 2012

Guilt Dribble

Posted by Dr. Vollmer on March 30, 2012

Milly, age seventy-nine, is conflicted about her two grandchildren, ages seven and nine. She favors the nine-year old boy, Moe, the son of her son Matt, over the seven-year old girl Nona, the daughter of her daughter Olivia. When it is obvious that she favors Moe, which then bothers Olivia, Milly will call Olivia obsessively to say that she does not favor Moe, even though deep down she feels she does. Olivia understands that Matt was her favorite child, but at the same time, she resists this notion. “Those phone calls are guilt dribble,” I say, highlighting the issue that the conflict is so layered that Milly seems to deal with her mixed feelings by trying to persuade Olivia that Olivia’s perceptions are wrong, even though they are not. “I know, right,” Olivia tells me. Olivia understands cognitively that her mom plays favorites, but emotionally she tries to get her mom to make her and her daughter a higher priority in her life. The “guilt dribble” as I called it gives Olivia hope that Milly can change her ways, because Milly gives Olivia a lot of attention after she spends a lot of time and energy with Moe. To see this energy as “guilt dribble” casts a different light since Olivia is hoping that this “guilt dribble” is actually Milly reflecting on her own behavior in an effort to change her patterns. By contrast, I emphasize that  the “guilt dribble” cements the pattern in further, in that the pattern is for Milly to play favorites and then dribble her guilt on to Olivia. Olivia sobs in despair. She cannot change Milly, her mom. I remind her that the hope is in herself. That, she can change.

Posted in Guilt, Psychotherapy | 2 Comments »

The Car Accident

Posted by Dr. Vollmer on March 29, 2012

Louise and her dad come in for their weekly visit with looks on their faces which speaks to a traumatic event. Louise, age six, says “we have been through a lot,” in a way that conveys she does not want to tell me all of her news in one sentence. Although only six, she seems to want me to guess as to what might have happened to her. She is teasing me, in a playful way. Larry, her fifty-year old dad, chimes in, “we had a car accident.” Larry’s tone and body movements are different than usual; he is more tense and uptight. Louise jumps in, “we got to ride in a big truck,” she says with excitement for the novelty of riding in a tow truck. Larry, who is not the focus of the treatment, concerns me in his demeanor. He has the appearance of “shell shock,” I tell him. It is the look of stiffness and detachment. Louise, on the other hand, appears relaxed and happy. Louise has some behavioral problems at school, but through our work together, as Larry tells me, she has calmed down quite a bit. “I have to say I am concerned about you, Larry,” I say, trying to walk the fine line of expressing a clinical judgment to someone who has not consented to be my patient. “Yea, it was pretty scary. I had Louise in the car and I just can’t believe how close we were,” stopping his sentence right before he seemed about to say how close they were to dying. “I can certainly imagine how terrifying that is,” I say, understanding that the motor vehicle accident broke through Larry’s denial about the finite quality to our lives. I know the accident was recent and that with time, Larry is likely to restore his old defense mechanisms, but I want to tell him that if this “shell shock” quality does not go away, then he should seek professional consultation. I am not exactly sure how to say this, so I end up saying, “let’s meet next week without Louise and see where we are.” Traumas are openings for the re-working of internal structure, but first they create a numbness that speaks to future suffering when the numbness wears off. “I am glad Louise is doing better,” I say refocusing our work back to Louise, but still concerned about Larry. “Yea,” Larry says with a flatness that is uncharacteristic for him. We stop on that heavy note of flatness.

Posted in Child Psychiatry, Psychoanalysis, Psychotherapy, Trauma | 4 Comments »

The Obsessive Friend

Posted by Dr. Vollmer on March 28, 2012

“I am sitting there at lunch, thinking to myself, why am I friends with her?” Laney, age fifty-five,  tells me her angst about her friend Mallory, age sixty. “She goes on and on and it is not that I am bored, since she tells  me interesting stories, it is just that she does not give me any room for me to think about my own life. When she does ask me questions about my kids or my work, she asks it in an obsessive way where she is more concerned about details than the big picture. I mean she will ask me where my son has lunch when I am trying to talk about my son’s wife. She often misses the main idea of what I am trying to say and that really bothers me. Of course, sometimes she does not do that, so I am confused. One thing for sure, though, is that I have never known anyone to tell stories with so much detail. I just feel so crowded out by our conversations.” Laney explains to me with sadness that her ten-year friendship with Mallory is now so unsatisfying. “What drew you together?” I ask, as with any dyad there is attraction, sometimes followed by repulsion. “Well, I was lonely and I hated my life, so when she did all the talking it was a relief, but now that I am feeling better there are things I want to talk about. So, unlike before, now her obsessive story-telling is annoying and not a relief.” Laney explains to me. “So, your relationship may not be durable in the sense that it worked when you were feeling bad, but it does not work well when you feel better. ” I say, echoing Laney’s lament. “Do you think you can talk to her about that?” I ask. “Well, I have tried, but Mallory seems to need me to listen and I used to do that, and my guess is that the relationship does not work well for her if I can’t be patient and listen to her obsessive storytelling,” Laney elaborates. “So, you think you have come to the end of the road?” I ask, expressing the sadness in that idea. “I don’t know. I just don’t know.” Laney says, expressing inner turmoil.

Once again, I am left to wonder how relationships endure change. The state of mind that brings two people together is bound to change and how some relationships can adapt to those changes, whereas other relationships crumble, intrigues me. My suspicion is that relationships which are formed when two people are in a good state of mind have a better prognosis, since a safety net is developed where they can move through varying moods and traumatic experiences, but fall back to the good times when they forged a relationship. By contrast, relationships that are formed when one or both people are emotionally needy are more vulnerable, since if the emotionally needy person becomes more stable, he/she is  likely to no longer find that the relationship meets his/her needs. Laney and Mallory are a sad example.

Posted in Friendship, Psychotherapy, Relationships | 5 Comments »

Hurt People, Hurt People

Posted by Dr. Vollmer on March 27, 2012

Wounded adults become wounded parents who then wound their children and the intergenerational transmission of trauma continues. Psychotherapy hopes to interrupt this pattern and thereby not only help the patient, but future generations to come. Leah, thirty-seven, has a thirteen-year old daughter Sophie, and no husband. Leah is divorced, but her daughter is the product of artificial insemination which occurred after her break-up with her husband. Leah constantly “worries” about Sophie in the same way that Leah’s mom hovered over Leah. Leah understands this, but she feels she can’t help herself. She comes to me with the hope that she will be a better parent than her mom, along with the hope that she will feel more relaxed around Sophie. Together, over many years, Leah and I explore her identification with her mom, along with her inability to separate from her. We also explore Leah’s relationship with me, and particularly how Leah has unconsciously assumed that I am judging and evaluating Leah in the same way that her mom has over the years. “OK, to get psychoanalytic about this,” Leah says, “I think I have always thought of you as my mom and I have always thought that you were judging everything about me: my clothes, my hair, my interpersonal skills. It is only recently that I have come to see that I am assuming that, and that maybe that is not true.” Leah explains to me with a sense of contentment that I rarely see her exhibit. I sit there listening attentively, but feeling no need to respond, as Leah has taken over the work of our psychotherapy/psychoanalysis. She has begun to develop an observing ego such that she can appreciate how her dynamics, her assumptions about other people,  are getting in the way of enjoying her life. “Hurt people, hurt people when they do not develop distance from themselves,” I say, reminding Leah that she is beginning to break the chain.

Posted in Psychoanalysis, Psychotherapy, Trauma | 2 Comments »

Low Self-Esteem or Disorganized: Hard To Tell

Posted by Dr. Vollmer on March 26, 2012

Elisa, thirty, misses appointments, forgets to pay her bills, does not return phone calls, and has trouble completing tasks. She suffers from ADHD, takes stimulants which she reports as “very helpful,” but she remains disorganized and thereby rude to her friends and family. As we explore her behavior, which occurs intermittently with our appointments as well, Elisa comes to the understanding that she runs her life in a “crisis mode.” By that she means that when they are just about to shut off her electricity, then she will pay her bill. Before that, “I just don’t see the need,” she says with a flat affect, seemingly uncaring that her two kids will have to suffer if the electricity gets shut off. “It seems like you need adrenaline to carry out a task?” I ask, noticing that the heat of a crisis bolts her into action. “Yes, absolutely, I have always been that way,” she responds rapidly. “Maybe that the adrenaline has to compensate for your general low sense of yourself and your general sense of unworthiness, such that you do not feel compelled to do the activities of daily living unless there is an immediate consequence which looms large.” I say, noticing that maybe layered over her ADHD is a sense that life is not much fun, that she is not much fun, if she has to be ordinary. “The sense that one has that it is OK to do ordinary things is often derived from a sense that one is OK. If you don’t have a sense that you are OK, maybe then you do not see the value in showing up and being a person of your word. Maybe you don’t think your word means much because you don’t feel that you mean much.” I say, again showcasing that perhaps if she had a larger view of her self-importance, maybe then she would comprehend why it is important to other people that she does what she says she will do. If she thinks low of herself, she may think that her word is not valued and therefore she is not obligated to follow through. I wonder. Elisa looks back at me mystified and unsure as to what I am talking about. “I don’t know what you are saying, but I will sure try to think about it,” she responds. “That is all I ask. Think about it.” I say, expressing hope that maybe through chewing on my idea,  Elisa can come up with her own ideas as to why she has trouble being responsible. She left confused, but also with a look of curiosity and reflection that made me think that we were involved in a deep journey.

Posted in ADHD, Psychoanalysis, Psychotherapy | 11 Comments »

New Blog Tab: Supervision

Posted by Dr. Vollmer on March 26, 2012


Check it out!!!

Posted in Blogosphere Fans, Supervision | Leave a Comment »

The Analytic Separation

Posted by Dr. Vollmer on March 25, 2012


Seeing a therapist/analyst multiple times a week arises the incisive question of separations, be that from death, disease, retirement or vacation. How does that kind of emotional dependency play out when faced with an interruption of the routine? This is perhaps the hardest and most challenging aspect of analytic work, both for the patient and the therapist. If the therapist talks too much about an impending separation then he/she risks seeming to have an elevated sense of self-importance. On the other hand, if no mention is made of an upcoming separation, then the insensitivity of the analyst is both painful and revealing of an avoidant pattern in the analyst. Should the thought of this dependency, played out in the anticipation and then actual distance make potential patients flee the scene? Clearly, I think not, as this separation is ripe with windows into previous dependencies, both for the patient and the analyst. The art of psychoanalysis is to deal with these separations both in a sensitive way, but also in a way which might, with some patients, heal previous wounds of callous departures.

Although I intend this post to be the beginning of a long discussion-intermittent, as most of my discussions tend to be-I would like to begin by citing an example of Dr. Mor, a psychoanalyst, many people joke about being “less and not more”. Dr. Mor appears to feel overwhelming guilt when he goes on vacation, yet at the same time, he takes on average of eight weeks per year, sometimes divided over two-week vacations, and sometimes a month-long. Ernie, a long-term patient of Dr. Mor’s, explains to him that his apparent  guilt for going on vacation, as evidenced by the awkward and uncomfortable way in which he (Dr. Mor) announces his upcoming separation,  mandates him (Ernie) to soothe Dr. Mor’s ill-feeling. Ernie is not left with any space to experience his feelings as he feels compelled to make sure that Dr. Mor does not “fall apart” from his guilt.

Ernie comes to me for consultation with regards to his relationship with Dr. Mor. “It sounds like, as with so many relationships, the more narcissistic person in the couple mandates all the attention, since his fragility makes you behave in a way in which you cannot be authentic.” I say, highlighting that although we all have narcissistic needs, if these needs enter into the forefront of a relationship in a large way, then these needs crowd out the narcissistic needs of the other.  In essence, the more narcissistic person in the relationship is the more domineering. This domineering quality often leaves the other person feeling stifled and constricted.

Ernie is mesmerized by my understanding, but still stuck in a tremendous amount of pain and anguish. He now understands that Dr. Mor has “crowded him out,” leaving Ernie to feel compelled to shore up Dr. Mor, at Ernie’s personal expense. Yet, Ernie has grown under Dr. Mor’s care and so he has a very painful dilemma. “Why don’t you see how you feel during this upcoming separation?” I ask Ernie. “That’s a good idea.” Ernie replies. “Dr. Mor has helped me reflect on my internal process, so in a weird way, he has helped me see how he hurts me.” Ernie replies both grateful and aggravated with Dr. Mor at the same time “Mixed feelings,” I say, highlighting the layered and deeply conflicted feelings that Ernie is feeling. “Let the dimension of time, see how these feelings play out for you,” I say, thinking of my previous post about the “Etch-A-Sketch Brain”. “Time is a wonderful opportunity to see how your internal workings play out for you. ” I say, trying not to say the platitude that time heals all wounds, but to say that time is an added benefit for reflection. “You can both reflect in the moment and over time, and see how that goes for you,” I say, emphasizing that being mindful of one’s own mind, not just during meditation, but over time, is both fascinating and useful to making good decisions. “The separation might be good for you,” I say. “Yep, surprisingly so,” Ernie replies.

Posted in Analytic Separation, Narcissism, Psychoanalysis | 4 Comments »

The Blogoshpere Surprise: Guess Where You Can Find Me?

Posted by Dr. Vollmer on March 25, 2012

American Psychoanalytic Association

Thanks, Eleanor!!/American.psychoanalysis?sk=wall


Posted in Blogosphere Fans, Psychoanalysis | Leave a Comment »

The Etch-A-Sketch Brain

Posted by Dr. Vollmer on March 23, 2012

Nilu, forty-two, married, two teenage kids, is constantly put down by her mother. One session she says “My mother is so mean to me. She tells me what a terrible mother I am to my kids. She tells me that I am fat, and ugly and I am lucky that my husband is still married to me.” The next session, the next day, she states “I feel so close to my mom. I am so lucky to have her in my life. I talk to her every day and I am fortunate.” As the Etch-A-Sketch image has made the news, I begin to imagine the process. Nilu’s painful relationship with her mom is evident by her need to constantly erase each experience so that she can believe she has a good support system. Her dissociation, her forgetting, from one day to the next is a coping mechanism that speaks to the pain of her relationship with her mom. This dissociation also speaks to the fragmented nature of her personality; a need to divide each event into forgettable parts in order to cope from minute to minute or from hour to hour. The integration of the meanness of her mother with the notion that this is the woman who raised her threatens the integrity of her sense of self. Seeing Nilu frequently, helps me help her see how she is fragmented in her thinking leading to dissociation and magical thinking. The Etch-A-Sketch brain implies deep psychological pain. Our work is challenging and deep, but the alternative would mean that Nilu continue to be a shell of human; one who cannot make decisions for herself. One who is dependent on her mother’s approval for every left and right turn in her life. The more permanent her memories can be, the more Nilu can begin to develop her own sense or herself. I hope to move her from an Etch-A-Sketch brain to a three-dimensional sculpture brain-one with depth and facets.

Posted in Psychoanalysis, Psychotherapy | 6 Comments »

Inertia and Denial: The Case for Psychoanalysis

Posted by Dr. Vollmer on March 22, 2012


“Why did you want me to come more often?” Harold, forty-two, asks me after working with me for ten years. Inertia and denial,” I responded quickly. “When I see you less often, you lapse into old patterns of unconscious living, so the more we can focus the light on the issues, the more we can battle the forces of both inertia and denial.” I repeat. As Freud taught us, the mind is tug of war between wanting to grow and develop and wanting to maintain the status quo, maintain our current defense system. This to and fro of the mind creates a need for what Kohut called “working through,” meaning the necessary repetition of looking at how one’s behaviors and judgments messes with their own enjoyment of their lives. The “internal saboteur,” and yet another term for describing how so often the individual is their own worst enemy. The more intensely one can focus on internal conflicts, the more likely a healthy resolution can happen. This is a simple concept. Almost anything, when done repetitively and consistently will improve: tennis, hiking, yoga are all examples of this. So, psychotherapy fits in to this paradigm as well.

Posted in Psychopathology, Psychotherapy | 8 Comments »

%d bloggers like this: