Shirah Vollmer MD

The Musings of Dr. Vollmer

Push/Pull: The Compromise in Psychotherapy

Posted by Dr. Vollmer on February 11, 2013

1912 Freud said “Resistance represents a compromise between the forces that are striving toward recovery and the opposing ones.” Glen Gabbard MD added on to say “the way the patient opposes a therapist provides valuable information about the patient’s intrapsychic life.” He continues “circling the wagons against the potential intrusion of the therapist may seem like the safest course of action.” Returning to Freud, he found that what often inhibited free association was the feelings about the analyst. Thus, the notion of transference as resistance. At the same time, transference revealed how the past repeated itself in the present. As Friedman says transference is the “necessary (and troublesome) vehicle conveying unconscious material into the field of analytic operations.” The task, Freud came to state, is not to get rid of the resistance but to help patients develop a divided consciousness so that they could observe and reflect on their minds. In this divided consciousness there is permission to have wishes, fantasies, conflicts and desires.

Marissa, sixty-four, excitedly talks about her visit with her son and then suddenly she falls silent. “I noticed that you stopped talking right after you mentioned his girlfriend. Any thoughts about that?” I say, seeing her silence as a resistance which was triggered by her uncomfortable feelings with her potential future daughter in law. In making this comment I am encouraging Marissa to be curious about the occurrence of the silence/resistance right after a specific event that is being recounted to me. If I had a deeper relationship with Marissa I might suggest that her silence is related to her fear that I am being judgmental. If I made such a comment, then I would be working in the transference. The compromise here is that her silence when she brought up her son’s girlfriend was a hint, if you will, that this was a subject that has deep meaning for her. She wanted me to know this was a sensitive topic, but the way she let me know was by going mute; it was indirect. In the same way an “exit line” is a compromise between opening a discussion of an important topic and then not having the opportunity to explore it in that moment. The therapist’s  understanding of the challenge of being a patient, allows for patience with the “chosen” compromise.

6 Responses to “Push/Pull: The Compromise in Psychotherapy”

  1. A therapist with a pen said

    You explain this experience in the consulting room in a very clear manner. Thank you. While it can be easy to use the word “transference” in a conversation, to understand it by firsthand experience is often much more complicated.

    • Shirah said

      Yes. To teach these concepts is rather straight forward, especially when compared to living them, on either side of that proverbial couch! Thanks!

  2. Jon said

    Tying together two topics… In the play “Freud’s Last Session” the line is used to the effect that “What you don’t say is as important as what you do say.” You also used that well as a comeback in the “Talkback” after the play. Here we have another example in Marissa. What she does not say is also quite important. However, in the process of therapy, you now exhibit a way of beginning to talk about that which is not. Here is indeed part of the art of your craft.

    • Shirah said

      Yes, Jon, but I am adding on to say that not only is is that what you don’t say that matters, it is also when you don’t say it. Thanks, as always.

  3. Shelly said

    Perhaps Marissa’s silence means that she doesn’t want to see herself as a potential judgemental mother-in-law, not that she doesn’t want you to see her as judgemental? What I mean is, silences can be read any number of ways and it is very hard to divine what they mean without further thought and discussion. It really is a shame that I couldn’t have been there for the play and the Talkback. It seems I could have learned so much from both.

    • Shirah said

      Yes, I agree. We are left to speculate about the meaning of Marissa’s silence. The hope is that this speculation encourages a “divided consciousness” where Marissa speculates with us as well. It is in this speculation that ideas are played with and creativity of the mind opens up.
      You made me smile, bringing in the Talkback to this discussion, as I have told my analytic colleagues that “Freud’s Last Session” was a way to introduce Freudian ideas to a lay audience without the shame which is sometimes associated with analytic work. The play, like a dream, was a way to give all of us permission to flirt with ideas, without feeling like we need to worry that others will think we are “nuts”. In other words, as Freud would say, the play, like a dream, took away our censor, so we could “play”. Thanks. Maybe the play will come to your neck of the woods.

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