Shirah Vollmer MD

The Musings of Dr. Vollmer

“I Really Look Forward To Therapy”

Posted by Dr. Vollmer on May 29, 2012

Can psychotherapy be exciting? Laura, forty-nine, has come to psychotherapy for two years. By her report, each visit gives her a sense of hope and enthusiasm. This feeling is particularly remarkable given that Laura is late over fifty percent of the time, added on to the fact that Laura constantly states “I have no idea what I am supposed to say in here.” Yet, she also repeatedly states “I really look forward to therapy.” The complicated nature of our relationship is apparent, but what is most notable is the opportunity Laura has for self-expression. This opportunity is unique in her world of feeling looked over and dismissed. One might wonder that given her enthusiasm for this process, why is she consistently late. The lateness, is multi-determined, but suffice it to say that it represents her self-sabotage-evidence that she is not worthy of undivided attention and care. Yet, at the same time, she deeply appreciates this opportunity because she recognizes how important it is to her self-confidence and engagement in life. Anecdotally speaking, therapy works-at least for Laura.

4 Responses to ““I Really Look Forward To Therapy””

  1. jo said

    Interesting — if I valued something so much, I’d be there on time or early. Any chance she is just habitually late for everything (like several people I know). Also, off-topic, how do you feel about requesting insurance reimbursement for clients who are in therapy for the primary purpose of increasing self-confidence and engaging in life? As a client, I struggle with this issue. Thanks!

    • Hi Jo,
      Yes, there is an element of habitual lateness, which, again, seems a sign of self-sabotage.
      Yes, again, that insurance reimbursement is quite a complicated issue in that some people come to therapy as a life-line, whereas others come more for self-confidence. There is a continuum of need, as with any service. I do not have a clear answer for you. I think the issues are too complex to say yes or no. Thanks.

  2. Shelly said

    If a patient has no particular topic in mind for a session, can you ask pointed questions to lead to a topic that you wish to discuss? And as a further question to Jo’s question, does insurance only reimburse if there is some medically-relevant diagnosis attached to the sessions, but not if a patient wishes to increase confidence and engagement in life?

    • Yes, initiating a session is part of the art of psychotherapy. Waiting for something to bubble up versus jumping in with a question can frame the interaction and so it needs to be done thoughtfully and carefully. The insurance reimbursement question is not so clear, as our diagnoses are not so clear. Thanks, as always.

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