Mobilizing Synthetic Capacities
Posted by Dr. Vollmer on February 4, 2013
To quote my commenter, Ashana M says,”.”As the memories become richer, more coherent, and more organized, I am bothered less by them and have fewer symptoms. The disturbance of nightmares seems to me to be about trying to organize and knit together the memory, rather than about trying to remove emotion from them.” Ashana describes beautifully the necessity to have “synthetic capacities” in order to grow from a psychotherapeutic experience. Unlike other forms of psychotherapy, symptom relief is not the initial goal, but rather a byproduct of understanding past and present emotional injuries. With this deep understanding comes compassion and relief. Both the patient and the therapist must engage in forming a layered narrative to help put one’s emotional interior into perspective. Otherwise, symptoms percolate up from deep within, and although these symptoms can be pushed down through distraction, medication and relaxation techniques, ultimately they will continue to come and go until there is a window into the nature of their origin and a sewing together of one’s past and present. Since to say out loud that the goal of symptom relief is secondary to developing a coherent narrative, is to challenge the current day view that dealing with the here and now trumps any effort to “dig up” the past. Ashana teaches us that a rich memory is a beautiful thing, despite how painful it may be at the same time. By inference, she tells us that shallow memories are bound to plague us with unexplainable and confusing symptoms. I am particularly enamored by her words since one often thinks that the patient is a passive participant in psychotherapy, but as she clearly states, developing “richer” memories is a process of synthesis. Clearly, the “work” of psychotherapy is on both ends. This is a two-person process which, I bet, Jon will chime in to tell us the “physics” of it all.
See also..http://wp.me/pMaFJ-Qa
Shirah Vollmer MD 
A therapist with a pen said
Hi Shirah, So the experience of patient and therapist creating narratives together in the session depends on much more than what is called the here and now transference. The therapeutic action that is ultimately unconscious work between two selves seems much too deep to fit into conceptual terms. Paul
Dr. Vollmer said
Hello Paul!
Yes, I agree that the therapeutic action is “too deep” to fit into conceptual terms, but one of the points of this blog is to attempt to talk about the layers of the “therapeutic action” as a way of opening up a discussion of ideas. Thanks for chiming in.
Paul Mahlum said
Thanks for saying that, and I think it is a very important point to talk about. I am afraid I was too vague. I will try to clarify what I wrote and add that in describing therapeutic action in that way my intention was simply to refer to its layers of complexity.
Dr. Vollmer said
Thanks, Paul. Yes, as a fellow blogger, I understand the struggle to be a clear writer.
Ashana M said
I am deeply honored.
Dr. Vollmer said
I am glad you are honored. Your words nailed my point, so thanks!
Mobilizing Synthetic Capacities « The Daily Headache said
[…] So, I was quoted on Dr. Shirah Vollmer’s blog and wanted to share it: Mobilizing Synthetic Capacities. […]
Jon said
“Chime in!”
As for “the ’physics’ of it all,” let us see that a fundamental understanding is by far more powerful than a superficial understanding. Thus, “symptom relief” qua symptom relief not as a cure to the root problem is of course superficial. An understanding that is based, as Ashana M states on “richer, more coherent, and more organized” memories is well on its way to becoming a more fundamental understanding.
[To be explicit about the analogy, physics is to be understood as fundamental understandings of the physical world.]
“Chime out!”
Dr. Vollmer said
Yes! At the risk of patting my own back (narcissitic rubbing), I knew, Jon, that you would, as you did in being “explicit” develop the parallel to Physics. I assume your “chiming out” is really a pause until our next interchange.
Jon said
Chime!!! ;>}~
Shelly said
So the patient and therapist together weave the memories into a coherent pattern. What is the role of the therapist in this journey? A tour guide? Listener? Guru? What is the role of the patient? Someone who brings forth the memories without understanding? Where does the understanding come from? Does the therapist have all the answers? Why does the therapist turn to the patient for the answers if the patient has the questions to begin with?
Dr. Vollmer said
Yes.
The therapist helps sort out the feelings from the defenses against the feelings. This is an arduous and lengthy process.
The patient has to allow himself to be on an exploration with an anticipation of delayed gratification.
The understanding comes from analyzing the feelings along with the experiences.
Of course the therapist does not have all the answers, but he has the ability to see the narrative without the interference of deep pain.
The patient and the therapist both have the questions and the speculations, as opposed to “answers”, albeit from different perspectives. Together, they can construct a narrative which has deep meaning.
Thanks.
Ashana M said
I am interested in what Dr. Vollmer says, as we see this from different perspectives. In my mind, nothing is really required of the therapist but the role of sympathetic witness, although knowing the terrain and having answers would be nice bonuses.
The process itself–trying to articulate one’s experiences to someone else–forces the individual to organize their experiences. Debriefing trauma to nearly anyone helps. My cat is thinking of setting up her own practice. I keep saying there’s this thing about language, but being language-impaired, she doesn’t listen to me. 🙂 Some therapists are able to offer a broader view or a different perspective. Some are very good at asking exactly the right question at the right time and letting the question move you in the right direction. Others provide mirroring in just the right way. Every therapist has their own set of skills and strengths. Any of it can help.
I have needed to read substantially to find my answers. I didn’t have any answers or much insight of my own, and no one else I knew had them either. I don’t think that’s always the case, and I haven’t always been able to take the best advantage of therapy, as its structure repeats in some ways the conditions of interrogation and torture: you are in a room alone with someone, the room is often windowless or the windows are shuttered, there are no witnesses to what will happen in that room, and no one will believe you if you something terrible happens there.
It has been difficult for me to engage with a therapist in a way that does not repeat the same kinds of responses that worked for me under conditions of captivity: complete compliance, complete resistance, or simply not being there. I have spent a great number of hours in therapy attempting to force myself to stop visually tracing patterns in the carpet and not knowing how. I needed to learn real skills in order to move forward from that position.
I don’t think my experience is typical, but it does encompass reactions to some of the most extreme forms of trauma.
Shirah said
Wow…Ashana M you bring up the sensitive issue that therapy may recreate trauma…or as you say so well…”there are no witnesses to what will happen in that room, and no one will believe you if something terrible happens there.” That is a very good point. I need to think about that further.
Ashana M said
There is probably no way of ever knowing what might activate very intense traumas. The best that might be possible is to recognize that it’s happening.
I have found for myself that it’s most helpful if I stop trying to think in any kind of intellectual or analytical way until I am less dissociated. I understand that traumatic responses suppress activity in the pre-frontal cortex, and this feels about right to me. I do go on thinking sometimes, but it’s nonsense–my thoughts are such low quality at those times they are worthless. And thinking them distracts from what I really need to be doing, which is interrupting the traumatic response. I did have to let of my discomfort at not knowing why I was feeling the way I did or what had set it in motion at least initially
Shirah said
Good point. Trauma interferes with cognitive functioning. That seems clear, but your personal narrative helps to illustrate this point more vividly. Thanks.
ON THE WIRE JOURNAL said
Reblogged this on ON THE WIRE.
Ashana M said
The dilemma is that trauma interferes with cognitive functioning, but that is what we have come there to do, and for some of us that turn towards analysis and cognition is habit. It takes a particular kind of effort to remember not to do it and to do something else instead that makes the cognitive functioning possible again, especially if the functioning is deceptively limping along and turning out thoughts that are unhelpful. I also had to learn what that something else was.
Shirah said
Yes, I see that. Coping with severe trauma requires the brain to pause, and re-boot in a way in which it can function and not shut down. Thanks again.