Shirah Vollmer MD

The Musings of Dr. Vollmer


Posted by Dr. Vollmer on June 19, 2012

Getting stuck in treatment presents the question of who is stuck. Clearly, both the patient and the therapist are in a box, as all of the treatment is dependent on this dyadic interchange. The valence around this stalemate is often frustration, but it can be boredom or despair.  Frank, a fifty-three year old patient, started each session by saying “I don’t know what to say.” The therapist, Fred, reacted differently each time. Sometimes he would wait. Other times he would bring something up that came to his mind. Still, other times, he would say “that is interesting.” Each comment was met with silence. In a psychoanalytic sense, this reluctance to engage, and yet still show up for psychotherapy, is the classical approach/avoidance in which someone has mixed feelings about entering into a psychologically vulnerable state. Fred’s job is to try to understand both the need to approach and avoid the psychotherapy at the same time. In this endeavor, both Fred and Frank are going to develop feelings about the process. A “stuck” feeling is a challenge to move the understanding of the conflicting forces of engagement to a deeper level. Eventually, Fred decided to say “you know, I am really stuck. I don’t know how to go further in our relationship.” Frank, relieved at Fred’s willingness to be so honest said, “yea, I know I am a lot to deal with, and I have been waiting for you to fire me.” This disclosure of Fred’s painful belief that he is “a lot to deal with,” opened their relationship to explore Fred’s deeply rooted negativity about himself. The glue was dissolved, such that Fred now feels the relationship is more fluid. Frank feels better too.

4 Responses to “Stuck”

  1. Melanie said

    “A ‘stuck’ feeling is a challenge to move the understanding of the conflicting forces of engagement to a deeper level.”I like the way you say that. I can’t count the number of times that I have been “stuck.” However, at the moment when I (we — patient and therapist) become “unstuck” the work moves to a deeper level. And I truly believe that we are both happy with that accomplishment. I have personally been stuck on an issue for about 3 weeks now (skirting it in multiple ways — and actually by doing so, going places (letting my therapist in) that I never thought I’d allow myself to go). Yesterday, I finally decided to start to get unstuck (possibly because she will be on vacation for 2 weeks after this week). My therapist hasn’t pushed me on this “issue,” but she has been fully aware of how hard it is for me to work on. I was actually talking. And then she said something “wonderful” (as long as I didn’t take it personally). She said I know a lot about xyz and if we could have this discussion together (as opposed to me having it in my head 100 times), I could help you. So tonight, I am hoping that she can begin to help me. 🙂

  2. Hi Melanie,
    Wow. Thanks for sharing your “stuckness”. As you describe, psychotherapy is a nonlinear experience, and as such, the deeper work comes episodically. Thanks again.

  3. Shelly said

    Is frank’s problem of being stuck not knowing how to open himself up each session to Fred and discuss a topic? Is that what you mean by “stuck?” I know from personal experience that some people are uncomfortable speaking about themselves or about their most innermost emotions or thoughts with someone, especially if they don’t trust the therapist completely. I wouldn’t necessarily say it’s bring stuck so much as not trusting in the process as a whole. Could that be Frank’s problem?

    • Yes. The stuck feeling is ultimately a function of trust, as you say. I think the issue is how to describe a process which feels “stuck” but which, as you say, is really a function of hesitation or resistance, as the psychoanalysts like to say. The building of trust is a nonlinear process, and as such, there are fits and starts in the therapeutic process. Thanks.

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