Shirah Vollmer MD

The Musings of Dr. Vollmer

Fundamental Rule

Posted by Dr. Vollmer on October 1, 2013

http://www.answers.com/topic/fundamental-rule

 

I am excited to teach my class about how to listen, although that is not what it is called, but perhaps I should change the name. “Fundamentals of Technique” is the title of my upcoming class to psychoanalytic candidates who want to expand their thinking. Although I was once a candidate (not sure why they are not called students), I am amazed at the time, energy, and dedication of this endeavor. These students, all licensed professionals,  will take four hours out of their work-week for classes, along with four hours of reading per week, along with individual supervision and additional lectures, with the hope of learning how to be better therapists. So, I feel the responsibility to make their time matter. We will begin with what Freud termed the “fundamental rule” and what I call, learning to listen. The patient is encouraged to pretend she is on a train ride, and then she is supposed to describe what she sees out the window. The train is the internal world, what pops into mind. The idea is that as one rides in a train, it is impossible to mention everything that one sees, so one must consciously or unconsciously pick and choose what to illustrate verbally. So too, the internal world is full of images, ideas, feelings, bodily states, and it is interesting and notable what the patient pulls from that deep well of the brain. What is said, is as important, as what is not said. The order, the words, the tone, the prosody, all come together in a narrative which begins a process of understanding the patient’s brain, again, with all of its complexity kept in mind. As Psychiatry changes and evolves, it is this “fundamental rule” which is violated, and hence it is my plea that we return to it.

Clarissa, thirty-three, wants to talk about her son. She has three sons, but she only wants to talk about one of them. Sam, the one she brings to the light of day, is neither challenging to raise or difficult to get along with. In fact, it is Lee, her other son who presents questions and concerns for her. Yet, in session, she focuses on Sam. On the one hand, this is a clear example of avoidance, but on the other hand, it is an example of how she wants me to see her as a good mother who has produced a high quality child. Her avoidance, as the sessions go on, is centered around her shame that Lee is about to be kicked out of his elementary school. She can only see Sam out of her train window, because Lee creates too much glare, too much narcissistic injury. One could see this as a transference reaction, as she is convinced that if she spoke about Lee and his problems, then I would think less of her. This conviction is the heart of our work, as it stems from her own feelings about parenting and her self-worth. “I am curious why you do not speak about your other children,” I say, beginning to touch her narrative in a way that both of us must question how she got here. This absence, this negative space, becomes a curiosity, for us to explore, with the comfort of knowing that there are no answers, only ideas.

4 Responses to “Fundamental Rule”

  1. Ashana M said

    I doubt she cares all that much what you think. She probably just likes how it feels to talk about Sam. For many people, the performance is aimed at an audience of one.

  2. Jon said

    I would guess that in addition to enjoying talking about Sam, Clarissa does not enjoy talking about Lee. The positive space and vibe of a “Sam discussion” could be much more appealing than the negative space and vibe of a “Lee discussion.” The astute listener – read Shirah – understands the significance of these contours and tones.

    • Ashana M said

      I agree. What’s interesting about this is the mismatch between their expectations of one another. So, Shirah assumes that Clarissa is trying to present a positive image of herself by talking about the child who reflects well on her parenting. In reality, talking only about Sam presents a negative view of herself to Shirah: it presents a fragile, cowardly self fearful of the pain of engaging in the problems with Lee. Clarissa might be really clueless about how other people’s minds really work, her performance is not about other people, or she’s not really trying to present a positive imagine of herself.

      • Shelly said

        Ashana, I wouldn’t say cowardly so much as fearful. Sometimes it is simply overwhelming to constantly think and plan for the problem child that one needs to self-soothe by speaking about the healthy child. Presenting one’s successes is an effort to self-preserve, not to impress. It is entirely an unconscious thing, most of the time.

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