Shirah Vollmer MD

The Musings of Dr. Vollmer

Do Therapists Really Care? A Commenter Responds…My First Guest Blogger!

Posted by Dr. Vollmer on January 28, 2013


I suppose every Zach has his own reasons, but I can say for myself that the idea that a therapist cared about me in a personal way came to me only with profound astonishment.  It is, after all, your job to help your clients.  It isn’t your job to care.  That’s a bonus I don’t ask for or expect, and you give it to your patients only because that’s the kind of person you are.

Understanding that people care just because they do is such a difficult idea for me, if I really think about it, my head hurts a little at the strangeness of it–like how my students feel when they are exposed to a very advanced type of math. Because it is not quite solidly in my mind that other people have the capacity to care in a sustained way. I grew up surrounded by people who interacted with others solely to use them, and who mimicked an appearance of care for personal gain or just to look good to themselves.

It isn’t that I think people can’t care about me, but that I’m not clear that others can care about anyone.  My model of normal human behavior and thinking continues to be, to some extent, grossly pathological–I still assume people’s insides to be vast emotional wastelands, although I do know better.

If the issue for Zach in your mind is about care, then I would guess some element of that may be at play: he grew up with profoundly selfish people, and still assumes emotional callousness and disengagement are what he can expect from others.  If you disrupt that view by being caring, it may even frighten him, as that means he lives in a world he now does not understand and cannot trust himself to be able to navigate  safely or successfully.

A world in which people care is not necessarily a safer world to Zach.  It can seem dangerous.  Selfish people have flattened inner worlds, and less complex desires and responses.  They may be violent and homicidal, but they will be predictably violent.  They can be managed with a little attention and skill.  Caring people are complex.  There’s no telling what they will do.

To see the fictional Zach narrative, check out…

13 Responses to “Do Therapists Really Care? A Commenter Responds…My First Guest Blogger!”

  1. Ashana M said

    Thanks for letting me guest-blog!

  2. Jon said

    Understand a new view point, especially when that view point is diametrically opposed to one’s basic assumption of the world’s workings, can be frightening, or even incomprehensible. To Zach the idea that someone might care about another for no personal gain seems to be a mix of those understandings. And yet, there is such a world view. Zach will have to stretch his mind to gain understanding. Such mind stretching (as opposed to the standard vernacular of psychotherapy of shrinking) will be painful in the experience but beneficial in the outcome.

  3. […] Do Therapist’s Really Care? […]

  4. Shelly said

    Whoa, was I confused about what was going on here, or what? A little intro about who the blogger was, what she was writing about, and in what manner she was referencing the fictional Zach might have helped….

    • Shirah said

      Noted! I have a feeling that AshanaM will be a guest blogger in the future, as well, and so I will add the context that you so rightly say I need. Sorry for the confusion.

  5. Mimi said

    Just responding to the surprise at feeling cared for – by your guest blogger… As a therapist for over 20 years, I’ve never not cared about a client! Even clients who are tough and challenging, I’ve always found a redeaming property and understood that their behavior is usually based in pain (especially hate). I think most therapists are like me.

    • Shirah said

      Hi Mimi,
      With all due respect, there is caring and there is caring. In other words, there are levels of caring, and as such, different patients detect, or expect, different levels of caring. Sometimes there is a match between expectations and the level of caring, but more often than not, there is a mis-match which can lead to a struggle in the relationship. I agree with you that most people in the field set out to help people and to care about those they try to help. Yet, life sets in, and the difficulties in the therapist’s personal life, combined with the difficulties in the patient’s life, can make this feeling of “caring” very hard to detect. Unconscious behaviors on the therapist, like quickly changing the subject, can make the patient feel uncared for, even if the therapist feels that they care about their patient. This discrepancy can create an internal crisis in the patient, as he might feel a painful repetition from previous authority figures, in that his words do not seem to matter. The “play space” no longer feels fun, and so the patient wants to flee, and unconsciously speaking, maybe the therapist does too. Thanks for chiming into this conversation.

      • Ashana M said

        There may also be a type of caring that a patient who assumes the therapist does not care can continue to not see, caring that can be ignored as merely being professional or giving an appearance of care that isn’t very deep. There is nothing wrong with that level of caring, but it doesn’t always impact the patient very much for that reason.

        Acts that have jarred me out of my assumptions have been in some way extra and were things I did not expect: a post-it note on a bill when I missed an appointment saying “I hope you’re okay,” a loaned umbrella on a rainy day, a glass of water at the start of the session. The element of surprise forced me to re-examine my assumptions.

        And it took a long time for that to shift my general assumption about therapists, as these events were years apart. Knowing one therapist in the past had cared did not make me start work with a new therapist assuming she would care. With each person, I had to start again.

        • Shirah Vollmer said

          Hi Ashana,
          I think you bring up the excellent point that it is the “surprise” event which makes you take a double take. I think this “surprise” event is not something that is calculated by the therapist and hence it would also be a “surprise” to the therapist that the umbrella, the post-it or the glass of water was such a pivotal event. Thanks.

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