Shirah Vollmer MD

The Musings of Dr. Vollmer

“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.

7 Responses to ““Understanding and Being Understood””

  1. Jon said

    As is typified by the case of Lynda, the answer to the opening question, “Does the patient want to be understood, or rather, to understand?” is an unequivocal “Yes.”

  2. Ashana M said

    I would also add what understanding? Lynda might need to understand why she believes sacrifice makes her good and where that came from, why her friends seem to expect sacrifice but then fail to reciprocate, or why sacrificing herself is not leading to stronger and more satisfying friendships the way she keeps thinking it will. It is important that she wants to be seen as a good person, but nearly everyone does.

    But “good” means different things to different people. Her definition is clearly not working for her, but being a good person ideally should make life go better for you–not worse. Understanding can be challenging, but it can also be comforting. If it’s the understanding we need, for the first time we have some control over a phenomenon that has puzzled us all our lives. Understanding allows for a sense of safety.

    Thanks again for the interesting questions.

    • Understanding motivation is what I mean. The tension between self-assertion versus selflessness is always present, and like the tention between understanding and being understood, the answer is balance. Both must be present in relatively equal doses for life to feel good. Thanks.

  3. Shelly said

    I’ve come to understand that constant selflessness and self-sacrifice is an expression of low self-esteem. To subjugate one’s wishes behind everyone else’s means that one believes that one’s needs and wants are not as important as someone else’s. Lynda must have heard these voices, perhaps from childhood, which told her to be a “good girl” (thanks, Ashana) and stop asking for things. Someone must have been ignoring her feelings or making her feel small. Of course no-one will appreciate her self-sacrifice: how can they ever build up Lynda’s self-esteem to the point where she will overcome her inner voices?

    • Yes, you nailed it. Her self-esteem can be bulit “brick by brick” as I like to say, in a slow and steady fashion, where she learns that her needs do matter and satisfying those needs leads to a calmer state of mind and that is important. Thanks.

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