Shirah Vollmer MD

The Musings of Dr. Vollmer

Workable Surface

Posted by Dr. Vollmer on October 9, 2013

 

 

“Workable surface is defined as those aspects of the clinical surface that lend themselves well to the exploration of unconscious dynamics or genesis”

J Am Psychoanal Assoc. 1991;39(3):669-85.

Patient’s surface, clinical surface, and workable surface.

Source

Psychoanalytic Association of Madrid.

 

Ernestine, twenty-seven, continues to have inappropriate relationships with men. By inappropriate, I do not mean men that physically abuse her, but I do  mean men that do not show her respect. Tom, Sergey, Ed, and Steve, have all not returned her phone calls, not shown up for dates, and had other women while claiming to be exclusive. Ernestine gets angry at the suggestion that she is somehow involved, or responsible, for this pattern. Understanding her psychodynamics which lead her to choose men which hurt her deeply is not at the “workable surface.” In essence, her anger serves as a temporary barrier to probing what this pattern is about for her. After many months of working together, she surprisingly asks, “do you think I am re-enacting the disappointment with my dad?” Suddenly,   we approach the “workable surface” in which we can begin to explore how this theme in her relationships with men, harkens back to her earlier relationship with her paternal parent. Ernestine needed to allow for this discussion to take place at a time in her mental space where she was open to understanding how the past may be infecting the present. Previous to this session, Ernestine would have felt blamed for her poor choices, rather than understood. Once again, dose, tact and timing are the critical points in the job of a psychotherapist. Hurried treatment, or limited sessions, do not allow for this unfolding process to occur, and hence my worry about the future of psychiatry/psychotherapy. One needs time and patience to develop a “workable surface”. Even if funds are limited, we need to explain to future patients that twelve sessions may help, but it may also be just the beginning of a deeper exploration. Unless we, as therapists, reinforce this notion, then I am afraid that our mental health delivery system is broken.

2 Responses to “Workable Surface”

  1. Shelly said

    You’ve hit upon something very important with this blog, I think. If a patient feels blame and shame from someone with whom one chooses to reveal one’s deepest secrets, how do you think you can ever develop a relationship with them? The workable surface you write about isn’t always one way: it is built together between therapist and patient. It is easy for the therapist to continuously “blame” the patient by saying that the patient has built up such strong defenses that they aren’t ready to “hear the truth,” however once again, that “workable surface” implies that the therapist:patient relationship is a place that the two need to work together. If a therapist cannot work without blaming or shaming then they need to be in another profession.

    • Yes, indeed. Working in the space, the “play space” where both therapist and patient can see the issues without fear of judgment or shame is the narrow path, the challenge, of psychotherapy. The delicate situation demands a great deal of training and experience, which, unfortunately, is not always required for licensure. Thanks.

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