Shirah Vollmer MD

The Musings of Dr. Vollmer

Psychotherapy: Push/Pull

Posted by Dr. Vollmer on January 31, 2013

“You seemed to be afraid to cry,” I say to a fictional seventy-three year old lady patient, Courtney,  who looks so sad and yet so restrained, at the same time. “I have never cried in front of anyone” she says, almost with pride. “You mean you have never allowed yourself to cry in front of anyone,” I say, underscoring her agency and her need for control. “Crying seems to represent for you an opening of a sphincter which, for you, feels very distasteful, almost like diarrhea. You do not see crying as a means of communicating your feelings.” I say, showing her that she has tied together tears with disgust, rather than intimacy. Courtney reminds me that she is in my office because she wants to change her emotional interior, while at the same time, her fear of change inhibits her from experiencing life in a new way. This battle, this conflict, creates the uphill feeling in psychotherapy. A deep appreciation for this approach/avoidance, I tell my students, is the key to developing patience and understanding in the midst of what might seem like stagnation. Helping Courtney move from a fixed place in which she rigidly refuses to cry in front of anyone, to a play space, a more flexible mental space, where she can consider that crying in front of others may not only be acceptable, it could also help her feel more connected to her world, more accepted for who she is and how she feels. This “play space” is the area where patients can contemplate another way to interact in the world. This contemplation, this imaginative experience, expands the emotional landscape,  happens with a sense of safety and security that Courtney and I have developed with time and repetition. In essence, psychotherapy is a simple idea with a difficult implementation.

18 Responses to “Psychotherapy: Push/Pull”

  1. Jon said

    Playing and play spaces are important in so many ways. Playing is the process and play spaces are the areas where one comes to have an understanding of oneself and an understanding of both “the other” and other things. In this play space, the fictional Courtney can learn to become more empathic by safely allowing herself something that she would normally not. Here is where learning takes place, and how learning takes place. Playing is, after all, really the first real step of the scientific process, and science is a way of trying to understand the world. Sadly, “The Scientific Process” it mis-taught in schools. “Create a hypothesis,” one is told, but how can one create a hypothesis in vacuole? One must play first!

    So, we see the parallels again. Psychotherapy, like science, can be considered “a simple idea with a difficult implementation.”

  2. Shelly said

    Has fictional Courtney ever been in the presence of friends who cry? Does she accept that others have feelings that they might want to share with her and they might be afraid to because she might be less than accepting? For if Courtney doesn’t allow herself to cry in front of others, then she might be the same way with others–i.e. giving other people the feeling that crying isn’t allowed by them either?

    • Shirah Vollmer said

      Bulls eye! Yes, Courtney’s constriction of emotion, impairs her capacity to become more intimate with her friends. Her need to stay in control of her emotions gives her friends the message that they need to be in control of theirs. Deepening one’s experience of oneself allows for deeper connection with others. Thanks.

  3. Ashana M said

    It’s hard for me to comprehend the idea of psychotherapy as a “play space.” It is so emphatically a matter of life or death to me. I cannot conceive of play.

    • Shirah Vollmer said

      Over time, as the “life or death” aspect of therapy recedes, then you might be able to experience psychotherapy as a place free from the typical constrictions of social interactions and hence a space for ideas, fantasies and elaborate imaginative activities. Of course, this is a back and forth process, where sometimes psychotherapy can be “life or death” whereas at other times it is a play space. Thanks.

  4. Reblogged this on ON THE WIRE.

  5. Ashana M said

    I have been mulling Courtney’s situation over for some time, as I can relate to her to some extent–it’s also been difficult for me to openly display some emotions with others, although unlike her I don’t feel any pride in that. It seems to me she was quite eloquently expressing her feelings to you: her intense sorrow and at the same time her tremendous sense of constraint. I wonder what would happen if you asked what that constraint felt like. For some people, being able to control displays of emotions is comforting. It suggests boundaries and containment, like a comfortable and safe cage, and it also suggests that the emotions themselves can be kept under control. For others, it is deadening, and the sense of it is of confinement and suffocation. Her pride in it sounds like collusion with an important other who was disgusted by her feelings, or alternatively had displays of emotions that disgusted Courtney..

    I know being able to carefully manipulate my displays of emotion kept me alive or prevented me from being very seriously injured for a lot of my growing up years. At the same time, I witnessed how out-of-control emotional states led to harming others. Unlike Courtney, I feel ashamed and saddened at the degree of duplicity I was able to engage in from an early age. I wish I could have been honest and dead rather than dishonest and alive. Excessive restraint represents other losses to me–the loss of authenticity, integrity, spontaneity, trust, and an ability to connect with others.

    • Shirah said

      Dear Ashana M,
      You describe Winnicott’s notion of a “false self” so clearly. The idea of having “two selves,” one for others to see and for you to feel is a very painful experience, as you so aptly describe. You also describe how therapy can enhance one’s world by providing “authenticity, integrity, spontaneity, trust and an ability to connect with others.” You also seem to connect with fictional Courtney in interesting and helpful ways. Thanks.

      • Ashana M said

        I am glad what I said was helpful.

      • Ashana M said

        I should add that I don’t believe in the concept of “false” and “true” selves. All of our performances of ourselves stem from desires and feelings we authentically hold. When Winnicott describes the sense of deadness and falseness that can arise, he’s talking about what happens when we cut off our awareness of our internal experience–our authentic feelings and desires.But we are the writers and directors of our own performances. The self always bleeds through in our work, and the performance always derives from real feelings and desires, even when we have lost access to them.

        In my case, I am describing two distinct and conflicting sets of real desires and feelings: one, an intense desire to live, to keep going, and to have hope for the future; the other, an equally strong desire to give up. It was important for a long time to suppress that desire to give up, but that doesn’t make it more real. Both are real. The desire to live was the source of a carefully controlled exterior, but I am not confusing that exterior with a self.

        The pain for me is in accepting what that desire to live led me to do, but we all have our vulnerabilities that can be used by someone else to manipulate and control us–attachment to a loved one, country, religion, an ideal, fear, hunger, pain. Very few of us would not make deals with the devil if it came to it. I made mine.

        • I think you are saying that you don’t have a “false” self because you have an awareness of all of your states of being. You describe your conflict vividly, and although painful, it illustrates a universal principle of the push/pull of life itself. Thank you for sharing.

          • Ashana M said

            I am saying I don’t believe the idea of “false” selves and “true” selves is an adequate frame for understanding people and their performances of themselves in general–not that they exist, but that I don’t have one. Awareness is unrelated to this. I think we will need to disagree about that.

            I very much hope my experience is not universal. Most people never find themselves in the hands of the devil. They don’t need to know what deals they would be willing to make or what price they would pay for their souls. I am glad of that.

            • Shirah said

              Yes, I do understand that you don’t have a false self, but you do acknowledge that others experience that.
              I do think that your experience is both universal and extreme. The intensity illustrates what other people experience on a much quieter level.

            • Ashana M said

              Again, I am not saying I don’t have a false self (or a “true” self, either, for that matter). I am saying I don’t find the construct of “false” and “true” selves useful or adequate.

              You, however, do find them useful, which means you see me as having a “true” self and possibly a “false” self. That is fine. We do not need to see me in the same way.

              I very much hope my experience is not universal, and that others are not having experiences like mine in a quieter way. You do. We can see that differently also.


  6. OK…different minds, different ideas…that is what blogging and psychotherapy is all about….

  7. Ashana M said

    🙂 That, we agree on.

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