Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for February 19th, 2013

“Understanding and Being Understood”

Posted by Dr. Vollmer on February 19, 2013

Does the patient want to be understood, or rather, to understand? So, Martha Stark MD poses the question. Helping the patient be curious about his internal world is the job of the therapist, yet, at the same time, there needs to be a sensitivity to the patient in so much internal crisis that understanding is too large in the moment. In those moments, being understood trumps understanding. Self-psychologists frame this issue as gratifying a need versus helping a patient understand the need. The classic example being the therapist leaving for vacation. The therapist has two choices. He can tell the patient where he is going, which is gratifying the patient’s curiosity, or he can explore why the patient cares where he is going on break,  as a way of stimulating the  patient’s understanding of his  need to stay connected with the therapist despite their physical separation from one another. Of course, this is a fake choice, as the therapist could say “I am going to tell you where I am going on vacation, but before I do that, I am wondering why that is important to you.” Such a two-part answer addresses both the requested gratification, the ‘being understood,’ as well as helping the patient with ‘understanding’ of his emotional interior. Hence the patient can be gratified and stimulated, at the same time.

Lynda, fifty-four, consistently puts her needs behind others. She is always helping her friends, her family and even people she meets once or twice. Inevitably, she is resentful of the “other” for not recognizing her sacrifice. “On the one hand, you want me to be sympathetic to your good nature in which you are a very giving person, and yet, on the other hand, you want me to help you be more protective of yourself and you want me to help you understand why it is hard for you to assert your own needs.” In this compound statement, I am both gratifying her need to be seen as a ‘nice person’ as well as understanding her unconscious plea to help her be a more ‘self-protective’ person. As with all of therapy, there is a constant duality. There is the duality of change versus stability and now we add on, by saying that one facet of this duality is the need to be  understood, which is part of maintaining stability, and the other part of duality, which is helping the patient understand himself,  the first step towards changing. It is this dance between support and challenge, which is the to and fro of psychotherapy. Nonlinear is the modern word for such a dance. The tension which ensues creates the dynamics of the experience. The wrong call, the wrong dance move, creates pain and suffering. The margins are narrow. The work is hard.

Posted in Teaching, Teaching Psychoanalysis | 7 Comments »

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