Shirah Vollmer MD

The Musings of Dr. Vollmer

Sick One: Healthy One, No Way!

Posted by Dr. Vollmer on October 21, 2013

Heinrich Racker says “the first distortion of truth in ‘the myth of the analytic situation’ is that analysis is an interaction between a sick person and a healthy one. The truth is that it is an interaction between two personalities, in both of which the ego is under pressure.”

This concept of “egos in the ring” as I like to say, is often resisted, as Kathleen, seventy-one, likes to say, “well you are the expert,” to which I respond, “I can’t possibly be the expert about your internal experience, but together, maybe we can come closer to understanding that.” So, Kathleen, based on her upbringing, needs to see me as the omnipotent one, needing an idealized helper who guides her through her life, and I, the professional, educated for many years, and yet, still insisting that there is no one truth, only a way of understanding her psychic landscape. This struggle, as I like to teach my students, is the “working through,” the experience of re-framing long-held beliefs in which one feels anxious, dependent and insecure, rather than the confidence to gather one’s internal experience to make thoughtful and measured decisions. So, unlike other professional/patient relationships, the psychotherapeutic relationship has no expert, only a willing guide through the sometimes dark internal world, of the curious. The stripping of the expert job, again, does not sit well with massive systems which try to pinhole psychotherapy into small bits, as this “egos in the ring” is not a small bit, but a decisively nonlinear activity.

7 Responses to “Sick One: Healthy One, No Way!”

  1. Ashana M said

    It seems to me that this isn’t entirely honest. On the one hand, the client “needs” to see you a omnipotent, but how you see the therapeutic process is “the truth.” And it is indeed one truth, although you claim that there isn’t a single truth. The “one truth” is that “long-held beliefs in which one feels anxious, dependent, and insecure need to be reframed,” and this is achieved–as you’ve said in other post–through listening and “deep” understanding. If the idea that the psychotherapist isn’t an expert is often resisted, then both of you are resisting it.

    • I think we need to define an “expert.” On the one hand, there are two flawed people in the room, agreeing to struggle with one of their internal lives, while at the same time, understanding that both people have very flawed internal landscapes. The asymmetry allows one to look at the other, without the burden, of having to live out unconscious agendas. However, the patient is the ultimate arbiter of the experience. In a similar way, a primary care physician tries to help a patient, but it is only the patient who knows how he actually feels. Thanks.

  2. Holly said

    The image of the patient trying to plumb her unconscious with the analyst’s guidance brings to my mind the fictional Virgil guiding Dante into the underworld. In both cases, a certain fearlessness (on the parts of both parties in the dyads) is required to make the trip into the subterranean regions where one does not know what one will find.

  3. Shelly said

    If the patient knew how to plumb the unconscious, they wouldn’t come to the therapist, would they? Therefore, you are the expert. The patient isn’t saying that you are the expert about them, they are saying that you are the expert in guiding.

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