Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for March, 2012

Success or Failure?

Posted by Dr. Vollmer on March 21, 2012

Socializing and meeting new people is always stimulating, but being a psychotherapist/psychiatrist/psychoanalyst, meeting new people can sometimes cause startle and deep reflection. “Oh, Shirah Vollmer, I know you, you treated me and my wife twenty years ago,” Raul says, causing me to startle. ” Did I help?” I ask, slightly scared of the answer, but curious at the same time. “Well, that depends on who you ask,” Raul says. “My wife thought you were brutal, but I really appreciated your courage to tell her that she was part of the problem. She did not want to hear that, so we did not come back, but I have always appreciated you for that.” Raul says, as another person enters into our conversation. I realize instantly that I cannot continue this dialogue. There is still patient/doctor confidentiality, even though Raul brought it up in a public setting. I am left to wondering if Raul is still married to that wife. What exactly did I say to her? Would I have said that now that I have twenty-two years of experience? Raul was happy to meet me, but at the same time, his affect was rather flat. He did not seem as frustrated as I was that the conversation got side-tracked. A Los Angeles experience, I say to myself. We live in a big city where chance encounters are grist for great stories, except my stories are private, left to my fictionalizing them on these posts. I want to think that in twenty-two years of working with people that my tact and timing has improved; that I have grown in my incisiveness. How much of that thought is wishful thinking and how much of that is a reasonable response to the seasoning that occurs with time? I am not sure. I have no closure, only interesting and mesmerizing thoughts.

Posted in Parenting, Psychotherapy, Relationships | 2 Comments »

Unconscious Living

Posted by Dr. Vollmer on March 20, 2012

Arthur, fifty-eight, goes to work every day. He works in the financial industry and he helps people build wealth. He is single, never married, and profoundly self-centered, as his “friends” report to him. Arthur’s closest relationship is to his mother, an elderly woman who is cognitively intact, but physically frail. Arthur’s father is in a skilled nursing facility, dying from Parkinson’s Disease and Dementia. Arthur reports to me that he is “desperate” for a girlfriend and yet, he feels completely clueless as to why he can’t find a mate. “Maybe it is hard for you to listen to other people,” I say, pointing out that communication skills are important for human connection. “I do listen,” Arthur protests loudly and angrily. “Well, sometimes I notice that you have a hard time listening to me. I begin to speak and you interrupt and change the subject back to how hard your life is given that you are so lonely.” I say, trying to gently point out that he may think he is listening, but the point that he hears for a few minutes and then changes the topic to his own concerns, demonstrates that it is hard for him to stay present with the other person’s thoughts or feelings.

Arthur is not aware that he has poor listening skills, even though he has been told this by multiple important people in his life. Arthur believes that he does listen, so he is confused as to why he is getting this feedback. “Maybe unconsciously listening to others makes you anxious, so in a deep way, you have to refer the subject back to yourself in order to calm yourself down. Maybe all of this is happening at such a deep level that you are not aware of being so self-referential.” I say, trying to talk about how unconscious anxiety can lead to behaviors that one is not aware of. “You are confusing me,” Arthur says. “Yea, I can see that, but maybe if you mull it over, you will begin to understand how one’s mind can work on such deep levels that some parts of communication become outside of your awareness. “I don’t know if that is interesting, or I am just not getting it, but it seems way too abstract for me.” Arthur says with a tone of deep frustration and anger. “Maybe you need to relax a bit so that you can allow yourself to consider these ideas. Your anger may be getting in the way of your understanding.” I say, noting that his low frustration tolerance is another barrier to working deeply. Considering unconscious processes requires a frustration tolerance, since these ideas are uncertain and fuzzy. Arthur leaves abruptly, showing me his discontent. “See ya tomorrow,” I say. “Yep,” he responds without a smile. His anger is conscious. His anxiety is deeper.

Posted in Psychoanalysis, Psychotherapy, Unconscious Living | 2 Comments »

Parties

Posted by Dr. Vollmer on March 19, 2012

I am curious about how a group of friends get together and spend time. Is it activity based or socially based? That is, do the group come together to do the same thing, like to ski or to play bridge, or does the group come together to share food and conversation. If the gathering is activity based, then generally speaking, people will feel that they fit in based on their perceived competency in the activity. On the other hand, if the activity is socially based, the ones who are more socially skilled will feel more at ease. Of course, this situation gets more complicated in that the more socially skilled folks are often the more sensitive folks so they can be more bothered by what they are perceiving to be unconscious processes at play. The layers of social interaction intrigue me, needless to say.

Alexis, sixty-one, describes to me how uncomfortable she felt at a gathering of dear old friends who seemed to be preoccupied discussing the successes of their respective children. Alexis has two children who are doing pretty well, but Alexis derives little pleasure in sharing the successes of her kids. She would rather talk about her new interests and passions, but none of her friends seem to want to engage with her about that, at least not at this particular party. “It is hard for you to adapt to different social situations because you are so uncomfortable with yourself,” I say, causing her to look at me, at first in shock, but then with an understanding that may be true. “You are not quite comfortable with the choices your adult children have made, and so when you are in an environment when that is the topic of conversation, you begin to recoil and you want to go home,” I say, pointing out that her discomfort at this party is a window into her triggers for anxiety, her vulnerabilities. “Parties can highlight vulnerabilities,” I say, stating that social gatherings are emotionally and psychologically complicated affairs. “Yes, I guess so. It was hard to sit with my feelings, so I wanted to leave,” Alexis says with candor and shame. “I stayed and got through it and it was nice to see my friends,” she continues to say that the party was indeed a layered event for her. “It is interesting how complicated a Sunday afternoon can be,” I say, stating that within daily, ordinary activities, emotions can rise high and low. Parties, as the word implies, creates all kinds of “parts” to our emotional interior.

Posted in Friendship, Parties, Psychotherapy, Relationships | 12 Comments »

Ego-Driven Leadership Versus Heart-Driven Leadership

Posted by Dr. Vollmer on March 18, 2012

Why do people want to be leaders? I have mused over this question for many decades. Clearly motivation is layered and complex. That is a platitude, I know. Still, I think there are essentially two kinds of people who are drawn to powerful positions. One leader is looking for self-esteem. He/she is driven by an external validation that they are worthy and important people. A second kind of leader is looking to change the world by exercising their vision. Again, I know that one leader may have both qualities and this is an artificial either/or distinction, but I am making this distinction to say that in every leader, one of these two motivations dominate their decisions. In the ego-driven leader one would see moves which might hurt their followers in that decisions are motivated by blinding self-interest. In the heart-driven leader, the followers thoughts and feelings are attended to, but that does not mean that the organization grows and develops in a healthy way. A leader may be sensitive to the feelings of others, but still lack the skill of single-minded focus along with a will of steel. In my earlier days I thought all leaders were heart-driven, but with age and experience, I have come to see that this way of thinking was naïve. In deciding which leader to follow, this line of questioning, ego-driven or heart-driven, is a very important point in the decision tree. I welcome your thoughts on the matter.

Posted in leadership, Psychotherapy | 8 Comments »

Psychological Skeleton

Posted by Dr. Vollmer on March 16, 2012

Marty, forty-five, does not know which way to turn. He feels “henpecked” by his wife, doing everything she asks him to do. He feels like an inadequate father since he does not feel comfortable in the authoritarian role. He is unemployed, not sure how he wants to make his living. In essence, the major domains in his life feel scary and uncomfortable. “Maybe you are looking for a psychological skeleton,” I say, coining the phrase to imply a solid core from which decisions flow. “I don’t know what you mean,” Marty says with anger and sadness in his voice. “I mean that it feels to me that you are searching for meaning in your life, but you are not sure what is really important to you, so you live in a state of confusion and helplessness.” I say, trying to gently point out that the issues run deeply for Marty and that we have to start on a fundamental level of finding out how he can be true to himself. He understands this, but he feels angry that such an essential component of a personality seems to be lacking. Like an oncologist, sometimes I feel like I have to give people bad news, and then work with them to rebuild. It is a journey, often a long and tortuous one. Yet, when the skeleton forms, the bones can work well, and a foundation is set.

Posted in Psychoanalysis, Psychotherapy | 6 Comments »

Friends’ Kids Getting Married?

Posted by Dr. Vollmer on March 15, 2012

Corie and Kirk, friends of Beth, announce that their son, Kyle, twenty-seven, is getting married and they would like Beth and her husband to go to the wedding. “I am not old enough to go to my friends’ kids wedding,” Beth tells me in utter disbelief. The passing of time, the marking of life events, seem to catch Beth by surprise. “What does that mean that you are not old enough?” I ask, wondering what Beth is thinking about. “I just feel like I am a kid and I want to go to my friends’ weddings, not their kids,” she says, again reinforcing her wish that the next generation is not rising up, pushing her aside. “Are you feeling like you have lost your time in the sun?” I ask, thinking about how hard it is for Beth to see that younger people are beginning their lives, signaling to Beth that she has lost opportunities. “Yes, absolutely,” Beth responds with affirmation. “I feel so sad that life has passed me by and that I cannot seem to get a grip on time,” Beth says with tears generated. “I can feel your pain in thinking about the past, and that you cannot start your life again, such that seeing the next generation get married stimulates this pain for you. “Yea, I need to embrace middle-age,” Beth says, reminding me that she believes that half of her adult life is over. “How would you do that?”I ask, wondering why she chose the word ’embrace’. “I need to see this phase in my life as the opportunity to be more self-centered, more focused on what I want to do without the responsibility of taking care of my parents or my children.” Beth says, reminding me that her kids are grown and her parents have passed away. “Transitions are hard, even good ones,” I say, empathizing with her shift from caring for elderly parents and little children, to being released from those burdens and those joys. “Watching people get married can also be hard,” I say, knowing that weddings, although generally happy events, stimulate so many layered feelings. “I hope I get happy when the wedding comes,” Beth says with characteristic humor and honesty. “I hope so too, but if you don’t, you don’t. You will feel how you will feel and you will be well-mannered about it.” I say, pointing out that her private feelings can be whatever they will be, but her public expression will share the joy of the event. “Thank you,” Beth says with uncharacteristic gratitude. “You really helped me today. I mean you help me every time I see you, but today in particular, I felt like you said some important things.” Beth says with a smile. I am not sure what was particularly helpful, but her happiness as she left was uplifting.

Posted in Friendship, Psychotherapy, Relationships | 2 Comments »

Loving Dr. Seuss

Posted by Dr. Vollmer on March 14, 2012

Posted in Cartoons, Child Psychiatry, Child Psychotherapy | 2 Comments »

The Guilty Parent

Posted by Dr. Vollmer on March 14, 2012

Shana, fifty-six, feels guilty for how she raised her son, Maxx, currently twenty-five. She saw her husband, Tom, Maxx’s father, physically and emotionally abuse him, and this was a major reason for their subsequent divorce, but she cannot forgive herself for not protecting Maxx when he was little. “Maybe you can apologize to Maxx,” I say, understanding that a retrospective analysis of parenting mistakes can be extraordinarily painful. “I can do that,” Shana replies, “but it won’t change how much  Tom hurt Maxx’s self-esteem. ” “Yes, that’s true, but it will still help him to know that you have been thinking about him and that you understand some of the underpinnings of his self-doubt. “Yes, but how do I forgive myself?” Shana asks in a desperate fashion, as if forgiveness will be instantaneous as opposed to gradual. “Forgiveness is a journey,” I remind her. “Not a nice journey,” she responds with tears. “Right, it is hard to see how one’s behavior caused harm to people who depended on us,” I say, understanding that the nurturing role is fraught with misgivings and missteps.  “Understanding Maxx is very important, even if it means understanding how you let him down,” I say, promoting the notion that grasping Maxx’s psychic building blocks will go a long way to help Maxx. Like psychotherapy where understanding is a  tool for healing, understanding one’s child is  a key ingredient for his/her  future self-confidence.

Posted in Parenting, Psychoanalysis, Psychotherapy | 2 Comments »

Yesterday’s Blog Stats: Country Information-New and Cool!

Posted by Dr. Vollmer on March 13, 2012

Country Views
United States FlagUnited States 113
Australia FlagAustralia 14
United Kingdom FlagUnited Kingdom 8
Switzerland FlagSwitzerland 8
Turkey FlagTurkey 7
Canada FlagCanada 7
Philippines FlagPhilippines 5
Finland FlagFinland 4
Israel FlagIsrael 4
Germany FlagGermany 3
Italy FlagItaly 2

Posted in Blogosphere Fans, Musings | 2 Comments »

College Drinking

Posted by Dr. Vollmer on March 13, 2012

http://www.cspinet.org/booze/collfact1.htm

 

Frankie, nineteen, sophomore in college, says that partying begins Thursday nights and goes through Sunday night. By partying she means binge drinking and marijuana use. This, she says, is the “college experience”. I know this. I am concerned about this, but the issue in my mind is that if it happens across the country, at just about every college, then when is the behavior concerning? Most of these kids, and likely Frankie too, will graduate college and go on to satisfying careers. Alcohol will not likely be a dominant part of her future life experience. Yet, for some “kids” this binge drinking and marijuana use will not stop, such that they will develop long-term substance abuse issues. It is not clear to me which “kids” are at particular risk, although family history is certainly one important factor. I also imagine that the intensity of partying is another factor. There is a range of drug use among college students, such that I suspect that those who push that range repeatedly are more likely to have life long problems.

“I am glad I started drinking in high school,” Frankie tells me, “because I know how to control myself.” “You mean those who did not drink in high school are learning their limits in college, and they are learning the hard way since there are no parents around to help with self-regulation.” I say, agreeing with Frankie that high school is such an important time to begin to learn good decision-making because parents still have a substantial influence over the superego, the part of the personality that decides right from wrong. In essence, parents, during those tender teenage years, can still exert external control as a way of encouraging internal control. To put it another way, curfews, close monitoring, and rules at home, assist a teenager in learning the importance of self-care and self-regulation. Being too impulsive can lead to self-harm, parents tell their teenagers by making sure that the rules of coming home and school attendance are followed. Sure, some adolescence are naturally good at self-regulation, but for those that want to cater to their impulses, they need rule-enforcing parents to help them help themselves. Frankie nailed it. I think.

Posted in Adolescence, Psychotherapy | Leave a Comment »

 
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