Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for March 26th, 2012

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!!!

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