Shirah Vollmer MD

The Musings of Dr. Vollmer

Focusing The Patient’s Attention

Posted by Dr. Vollmer on February 20, 2013

One of the goals of analytic work is to extend the province of the ego, and more specifically, to make the patient more aware of his distortions. With Lynda, from my previous post, with her unrelenting selflessness, I could say “you are determined to do for others and then resent your friends for not appreciating  you.” The words “you are determined” changes her from a victim to the author of her own experience. In this new narrative, she is now able to contemplate that this dynamic which she resents is of her own creation, and hence subject to change. These simple words, “you are determined” is the basis for therapeutic intervention which empowers the patient to take more control over his life. So, I am off to teach these concepts. This will be my last class for these ten engaged and enthusiastic students. I will miss them, as teaching is one way I express my agency, my desire to do what makes me happy.

4 Responses to “Focusing The Patient’s Attention”

  1. Ashana M said

    I wonder about these kinds of statements. The first thing that comes to mind is that they don’t seem to me to cast Lynda as the author of her own experiences–it seems to me you are of it as the therapist. You are telling her who and what she is. It is also in the habitual present tense, as if this is simply a part of her personality. And it seems to me people often take these kinds of statements this way: not as invitations to change, but as proof of the hopelessness of the problem–you are simply that way, like being introverted or fond of vanilla ice cream and maybe you can modify it a bit, but you are basically stuck with it. If I am talking to myself about patterns in my behavior, I never use the present habitual. I always use the past perfect or the past progressive. “I have been determined to do for others…” for example. Or even “It has been difficult for me to accept my friends don’t appreciate my sacrifices.” As if the moment of change is exactly now, because it should be now.

    I don’t wonder about the validity of the insight, but about the phrasing. I just wonder if there are ways to do this that suggest more agency to the client.

    Enjoy your last night with your students.

    • Thanks…..I think the point is that “complaining” turns to “contemplation” and the discussion centers around how to do this. My idea of saying “you are determined” is to kick off a conversation about how to turn Lynda’s passive remarks into active ones. Thanks again for your thoughts.

  2. Shelly said

    Interestingly enough, I tend to agree with Ashana in that when the therapist says “You are determined,” it seems critical and perhaps Lynda will take this in a negative light. If it were me and I were senstive about it, I might begin to censor what I said in the play space. Someone who seems selfless and giving because of low self-esteem probably has a very fragile ego and criticism from someone I respect and admire (you) might hurt me terribly. Food for thought.

    • Good food for thought, indeed! Yes, the sensitivity of helping someone without hurting them is a fine line, or a narrow path, as I like to say to my students. There is no doubt that in an effort to be helpful, deep hurt can be inflicted. As with chemotherapy, the treatment is meant to cure a very difficult disease, but sometimes people die from the treatment. The balance in psychotherapy is just as delicate. Tone and trust tend to mitigate the potentially negative effects of the words themselves, but not always. Hopefully when harm is done, there can be mending and re-grouping. As one of my teachers imparted to me, there is risk in this business, and if you can’t take the risk, then you miss out on possible gain. Thanks.

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