Shirah Vollmer MD

The Musings of Dr. Vollmer

Transitioning From Therapy To Life

Posted by Dr. Vollmer on April 9, 2013


Whitney, sixty-one, long-time patient, ends each session with “so, what should I do?” Over the years, I have come to hear that question as a signal which tells me that transitioning from therapy back to life is challenging for her, as well as for many patients. The comfort of getting honest with one’s feelings makes it hard to leave, and go into a life in which social graces demand a certain amount of deception. The relief of authenticity is palpable for some, and especially for Whitney. The question she asks, feels to me, to be “how can I feel good when I leave here?” I hear the pain of the uncertainties in her life. Her son is getting divorced. She has a health scare. Her finances are rocky. In my office, we share the anxieties, whereas with her friends and family, she maintains good cheer. Some colleagues call this transition the “insult” of psychotherapy, because telling patients they have to stop talking can feel assaultive. The notion that time is up, potentially narcissistically injures a deep unconscious which needs to feel endlessly fascinating and engaging. Whitney deals with this “insult” by hoping to take away a concrete notion, while at the same time, knowing that I am not going to answer her question directly. Sometimes I say, “you should make sure that you are taking care of yourself,” knowing that this is a very general comment, and not what she is looking for from me, but also knowing that she appreciates the reminder. Maybe I should respond “it is really hard to leave,” with the understanding that although it does not answer her question, it addresses a possible underlying motivation to her inquiry.  We know each other well enough to engage in this kind of  indirect conversation. I will try that.

7 Responses to “Transitioning From Therapy To Life”

  1. Shelly said

    Yes, I’m sure it is hard for Whitney to transission back to real life after being in the cocoon of your office, however the phrase, “So, what should I do?” doesn’t necessarily mean she realizes that it’s time to transition back to real life. If it were me, I would really want an answer to that question, for that is what I would be paying my therapist for: answers. After spending so much time talking about the issues, I would want a concrete plan on how to deal with the day-to-day struggles that I was facing, even if I knew ahead of time that the therapist wouldn’t directly answer that question. A therapist isn’t just a sounding board, a place where people can spill their guts and their feelings, for people can speak to best friends or their family dogs as well. Why can’t a therapist just make life simple and answer the question?

    • Jon said

      Shelly’s ending question brings to mind an old joke. Two psychiatrists meet out on a walk. One says “Hello.” The other thinks to himself, “I wonder what he meant by that?”

    • Shirah Vollmer said

      I do not think the issue is avoiding concrete questions, but rather the issue that with Whitney, she knows what she should do, but she is looking for reassurance. It feels like she is looking to hold on to the therapy as she leaves my office. This is a subtext to her question, which speaks to her underlying anxieties. The challenge of my blog is for me to communicate how that feeling in the consultation room translates into non-linear responses. These non-linear responses enables Jon to cite jokes about psychiatrists, Thanks, Jon and Shelly.

    • Ashana M said

      Shelly, Some therapists will. Some therapists will devise a plan and give you specific homework. If that’s the way an individual prefers to work, that approach is out there. It isn’t how everyone works. It isn’t usually how psychoanalysts work.

      I have a specific plan for myself, and it involves practicing particular skills, spending time with certain traumatic memories, and examining important ideas or constructs. I prefer to work that way. Having goals and a way to achieve them allows me to monitor my progress, and that enables me to maintain a level of motivation for the difficult work I need to do that I don’t think I would otherwise be able to sustain for as long as I have. I approach self-work very much as learning, which seems to be working. I know how to teach.

      • Shelly said

        Thanks, Ashana. I appreciate hearing your approach. I also know how Shirah works and wanted to know if this is the norm in psychiatry or not.

  2. Sunflower said

    I love this post. I know that I, as an analysand, have caught myself in that “one-hand-on-the-door” situation where I apparently long for “just a little bit more time, please!” I believe it’s unconscious when we do it–e.g. blurting out as I exit, “Oh yes, I am going to be calling you about needing to cancel some appointments in a few weeks.” Clearly, this bespeaks the desire for more time in session (particularly when I’m just recently cracking open some major walls/secrets), and really this isn’t that “fair” to the therapist to introduce this type of topic on the way out. Fair or not, it’s human. And I tell my analyst, “I know, I know–one hand on the door.” So we both smile and she says, “We’ll talk about it [next time, when appropriate, during a session not after it].” lol

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