Shirah Vollmer MD

The Musings of Dr. Vollmer

Reverie In Psychotherapy

Posted by Dr. Vollmer on October 3, 2013

 

 

Thomas Ogden describes psychotherapy and/or psychoanalysis as an opportunity for reverie. He quotes R. M. Rilke, 1904…

 

“I hold this to be the highest task of two people; that each should stand guard over the solitude of the other.”

 

He also reminds us that Debussy felt that “music is the space between the notes.”

 

Dr. Ogden reminds us that not only do we have sexual body parts which are private, we have mental processes which are also private, to be shared or not, as we see fit. This idea that psychotherapy promotes a reverie, a private internal world, argues against Freud’s fundamental rule that we must instruct our patients to tell us what is on their mind. No, Dr. Ogden says emphatically, we must help our patients expand their reveries and then choose what they want to share with us. Freud issued a demand that Ogden sees as counter-therapeutic when our goal as therapists is to encourage and guide whether than dictate. Depressed, anxious, obsessive, and hysterical patients do not have a reverie, because their symptoms hijack their brain such that they are constricted in what they “choose” to think about. Here, the word choice implies an unconscious choice, where for mysterious reasons, the patient’s brain is on shut-down, and as such, they are limited in their ability to access their own brain. It is as if they have a very large house but all the rooms are locked, and the patient is afraid to find the key, because she fears what she will find, so she limits herself to one very small room, where she knows where everything is located.

 

Dr. Ogden says get that key and have the patient see the exploration of the house, the brain, as a reverie, as a source for more thinking, rather than a place in which they fear will be so painful they will get stuck in the pain. The irony here, is the patient is stuck, but they fear moving forward because they might get stuck in a different way and that change is frightening. The concept of the reverie is that nothing sticks, and all ideas are free-floating, a place of interest and curiosity, rather than pain and suffering. To be curious is to think, whereas to feel pain is to constrict and be self-centered. Guiding patients to curiosity, away from their symptom focus, is the heart of psychotherapy, Other kinds of psychotherapy work the other way. They focus on the symptoms and discourage curiosity. One could say that they complement each other and patients can benefit from both. To that, I would agree, but long-term relief comes from thinking about thinking and challenging our patients to question what their symptoms mean to them; to use the symptom as a spring-board to reverie.

Marissa, twenty, in times of stress,  picks at her skin. At first, I focus on symptom-substitution and I encourage her to wear a rubber band around her wrist, so she can pull at that in exchange for picking at her skin. Second, I get curious with her about why she thinks she picks, and what this means for her. With time, Marissa begins to talk about painful physical abuse she experienced as a child, and how when she thinks about that, she has the urge to pick, but that she was not aware of this dynamic for many years. Marissa begins to take her urge to pick as a sign that she is floating into childhood memories of abuse, and she is slowly able to feel and experience these memories, as she would a movie or a dream,  fulling knowing that she is part of her reverie (as opposed to dissociation), with the ego strength to understand that although she was a victim as a child, her adult self is not a victim. If I had only offered her the rubber band, and if I had only focused on her triggers, I would not have helped her learn to tolerate memories, very painful memories, as a reverie, important parts of her history, but only part of her present in the form of recollections, and not new experiences. This work of embracing the past, without it being brought forward into repetition in the present, is the hard work of psychotherapy.

see also…https://shirahvollmermd.wordpress.com/2012/09/07/the-play-space-a-place-to-be-thought-about/

2 Responses to “Reverie In Psychotherapy”

  1. Shelly said

    Interesting. I have three children and a friend who pick their lips and each of them say that they do it to self-soothe. None of them say that the picking brings about any reminders of stress or past memories; in fact, just the opposite. Isn’t skin-picking similar to nail biting or cuticle picking? I pick my cuticles when I’m stressed, but the stress is always in all aspects of current life. Does Marissa think about her past and that is the trigger to her skin-picking? What happens if she thinks about her present or future? Does it mean she doesn’t skin pick?

    • If they are self-soothing, then there is a stressor that needs attention. The idea is that current stressors trigger past stressors and so nail-biting, or skin-picking, is the symptom which is the cue to both present and past upsets. One cannot have present stressors without triggering past stressors. In other words, when someone passes away, the grief is not just for that person, and that relationship, but it is also a trigger for all previous losses. If Marissa thinks about her stressors, past and present, then at that point, she has the choice to pick or not. Understanding and awareness (bringing ideas to consciousness) allows people the opportunity to choose their antidote, be it skin-picking, or calling or friend, or diving into the chocolate. Thanks.

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