Shirah Vollmer MD

The Musings of Dr. Vollmer

“Exit Lines”

Posted by Dr. Vollmer on February 6, 2013

“Exit lines” as Glen Gabbard MD likes to say, or “doorknob comments” are another “royal road” to the unconscious. The comments as one leaves the therapy office are often so revealing, as this is the opportunity for the patient to get the last word, without time for challenge or deeper thought. “You got up early this morning,” one fictional patient says at the end of our 7:00 am appointment, making me think that in her mind, it was hard for her to come today. Maybe she wanted me to appreciate that she made a large effort to make this early time. Alternatively, maybe she wanted to show appreciation for me making time for her. There is always the question of bringing up the “exit line” at a future session, but by that time, the feeling in the room is gone. There is power in the “exit line” as it resembles getting the “last word” in on an argument. It is the final punch at the end of a long fight. It leaves me with wonder and curiosity. Sometimes it leaves me with difficult feelings which I am not able to discuss with the patient until the next session so I am left to stew. Universally, it helps me understand a very important  dynamic in the relationship.

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10 Responses to ““Exit Lines””

  1. Ashana M said

    I wonder if there is also a move towards the simply human, and an acknowledgement that in a few seconds, the relationships we have with others will not be therapeutic ones, but ordinary. I think that is where my mind moves as I leave. Within moments, I will be making small talk with a drugstore cashier and not analyzing my thoughts and feelings or even feeling much of anything. Leaving involves preparing mentally for that shift.

    • Shirah said

      Yes, this transition is very challenging and as such, it provides a window into personality. As you say, some folks focus on how they are going to change their brain from analytic mode to task mode, whereas others use the time to poke at the relationship with the therapist. Of course, folks do different things, at different times, but examining the patterns in this transition is ripe for understanding psychodynamics. Thanks.

  2. Paul said

    This is very interesting. I agree with you and I would add, from my experiences as a patient in psychoanalytic psychotherapy last year, that sometimes I would leave the room realizing that the beginning and the end of the hour fit together as if they were a whole.

    • Shirah said

      That’s great, Paul. The therapy sandwich….opening ceremonies….closing ceremonies….good grist for that therapeutic mill. Thanks.

  3. Jon said

    The words for leave-taking can have many a meaning. From “farewell” to “until we meet again”, from “be gone” to ”good-bye” the words themselves are laced with nuance. However, there is even more to the exit line of your 7AM fictional patient. Saying the unsaid is but part of the dynamic. The best of luck in further understanding.

    Anon, Jon

  4. Shelly said

    In the case of your fictional patient, I would think that she is showing her appreciation to you for getting up early to fit her in to your schedule. Of course, the tone and body language says it all, however, you are right that doorknob statements don’t give you time to fully analyze every comment made. But in therapy, do you necessarily analyze every single comment, or the whole picture and one’s actions?

    • Shirah said

      The doorknob comment often has more meaning than other interactions in that there is often an unconscious manipulation where the therapist has to sit with the feeling that is left, without an immediate opportunity for discussion and understanding. Thanks.

  5. jo said

    I feel like my late session comments are often just the result of poor timing. ‘m never able to open with something that is tough for me to express — I have to work up to it and be comfortable, and even then it might take me 10 minutes to spit it out. That means that sometimes it’s time to leave before it can be explored more fully. I try to remind myself to bring serious issues up earlier in the session, but I don’t always make that happen.

    • Shirah said

      Hi Jo,
      Your comment points to a possible unconscious avoidance of a very sensitive issue, which, as you imply, you are reflecting on. The fact that you sometimes “make that happen” probably suggests that at those times, the material is not as emotionally threatening. Thanks for chiming in.

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