Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for December, 2013

NYer Contest

Posted by Dr. Vollmer on December 30, 2013

You know, it is still going to be your fault.

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See You in 2014!

Posted by Dr. Vollmer on December 19, 2013

Thanks for your readership!

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Tragic Lives Beget Tragic Endings: How Can We Stop This?

Posted by Dr. Vollmer on December 18, 2013

Viola Vanclief died while under the foster care of Kiana Barker.

“One day in 2010, after hours of heavy drinking, Barker burst into Viola’s room and beat her, according to a witness’ court testimony. When Barker was pulled away, the little girl was on the floor, struggling to breathe, the witness said.

Viola died a day later at the age of 2, her body covered in red and purple bruises.”

State officials slapped Woods’ agency with what they said was the maximum penalty — a $150 fine. Barker was convicted of second-degree murder and is awaiting sentencing.,0,5583241.htmlstory#axzz2nqVKHGS0

In my ongoing dismay of foster care in Los Angeles, today’s LA Times, has a heartbreaking exposure of the privatization of our foster care system. These vulnerable children, taken away from their allegedly abusive and/or neglectful parents are thrown into a system which can be  greedy, neglectful, and abusive, at times, creating an arc of a tragic beginning followed by a tragic ending. My question is why we do not put more resources towards these children? Can child psychiatrists be more helpful? In Los Angeles, foster care, at least part of it, became private, subject to a profit motive, where children were like widgets, where more children, like more widgets, created more money, and quality, or altruistic motivation, was taken out of the equation, in exchange for dollars and cents. As a result, or so it seems, children were taken care of by people with known criminal records, leading to big bucks for those who organized the system and brought children into high-risk homes. How do we, as a county, accept this? Further, those monitoring the system, the social workers, were paid poorly and told to limit their caseloads, such that many of them, had multiple “full-time” jobs, thereby questioning their ability to do any of those jobs with quality. Again, how do we not bleed for these innocent children? How do we not see that their tragedy is our tragedy? How do we not see that those who want to foster parents need to be vetted rigorously and thoroughly? How do we not understand that these children need to be groomed either for reunification or adoption? To be abused and/or neglected in foster care is a body blow to children who have been taken away from their biological parents. How can these children grow up to be optimistic adults when from such an early age, disappointment has led to more disappointment? These children will have a difficult, if not impossible, journey to trust, and as such, they are vulnerable to depression and antisocial behavior. Without trust, there is no civilized society. Treating these children poorly impacts all of us. It is that simple. We need to be more civilized.

Posted in Foster Children | 4 Comments »

Narcissism And Blame

Posted by Dr. Vollmer on December 17, 2013


Rainer, from my previous post, is irritated with John, her husband, when he challenges her plan of action. “I am going to call the plumber,” she says about the leaky toilet. “No, don’t do that,” John says, “maybe I can fix it.” Rainer, unwilling to listen to John’s point of view, claims that life is never “easy” because she is always questioned. “Maybe it is hard for you to tolerate other ideas,” I say, wondering about Rainer’s narcissism; her sense that her ideas are always the best ideas and a question of her ideas makes her nervous and insecure. “Well, yes, I have to agree with you,” Rainer says, as she quickly sees her own flaw; her sense that she cannot accept a discussion about her plan of action. Rainer sees and feels her narcissism, giving her shame about herself, but also relief that John is not as “bad as I thought,” she says, with sadness, as she implies that now she feels like the “bad one”. This realization that Rainer’s anger towards John is a defense against her own personality weakness. To Rainer, questioning her decision to call a plumber, makes her feel small and insignificant, and since John should know that, he should not offer an alternative idea. Giving the light of day to these notions helps Rainer see the absurdity of her need to have John go along with all of her decisions. “The ‘N’ word is a tough one,” I say, referring to the pain of recognizing one’s own narcissism. “Yea, I am going to go home and plop on the couch,” Rainer says, expressing her exhaustion after seeing herself in this painful way.

Posted in Narcissism | 6 Comments »

New Yorker Entry

Posted by Dr. Vollmer on December 16, 2013


I thought it was a bomb.

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Couple Friends

Posted by Dr. Vollmer on December 16, 2013

What happens when you don’t like your husband’s friends? Do you pretend you do or do you make a fuss? If you make a fuss, do you feel guilty about that? Rainer, thirty-three, comes to mind. She has sleepless nights every time she and her husband go to dinner with her husband’s college roommate and his wife. She has not linked those two events together, but after many months of working with her, we have connected those dots. “Maybe you have trouble with your dinner dates?” I say, giving her permission to not like all comers. “Yes, but what am I going to do? Should I tell John (husband) that I won’t go any more? That would not come down well,” she says, suggesting that she has thought about this before. “Why can’t you tell John how you feel?” I say, suggesting that the holding in of feelings, seems to leak out in her slumber time. “He will get mad,” she says, as if to end the conversation. “Ok” I say, “so you tip-toe around him to avoid his anger?” I say, suggesting that anger can be a form of control. “I feel like a bad person for not liking his friends,” she says, making me pause. “That is curious,” I say, wondering how she leaps from not liking his friends to being a bad person. “I am thinking that if you do not have the same feelings as  your husband has, then there must be something wrong with you. It is as if you do not feel entitled to have your viewpoint of the world.” I say, seeing Rainer in a new light. “Yes, I think you are telling me I have low self-esteem, and I have to agree with you, ” she says in a sad and reflective way.

Posted in Friendship | 5 Comments »

Expressing Disappointment: Experiencing Relief

Posted by Dr. Vollmer on December 13, 2013


Carrie, seventy, does not like that I sometimes cross my arms as I listen to her. “I feel like you are being judgmental,” she says, about my body language. “Gee, I did not know that I was making you feel judged,” I respond with surprise and concern. The next session, Carrie tells me, uncharacteristically, that she was very much looking forward to seeing me today. “Is that because you told me how I upset you and I was able to hear that?” I ask, thinking that perhaps she feels relief, as she seemed afraid that giving me negative feedback would make me feel defensive and not concerned. Her predicted outcome did not happen, and as such, she felt closer to me. “I suppose that in your life, you have never had the experience of expressing disappointment, or pain, and then receiving more curiosity, as opposed to anger and defensiveness.” I say, knowing that Carrie comes from a family in which only positive things can be said, and negative ideas are thought to reflect poorly on the person feeling negativity. The idea that a negative idea could be heard was a novel experience for her; one that made her relax and hopeful that she no longer had to live a life of pretend where everyone always made her happy. Honesty and authenticity bring positive feelings, when they can be heard and understood, even if the honest and authentic feelings are unpleasant. This is one of the many nuances of psychotherapy. Expressing oneself is grist for the therapeutic mill, and even after Carrie’s many decades of existence, she can still experience life, and relationships, in a new way, with a new outcome. She is a poster child for the value of late-life psychotherapy. Suddenly, she looked so much younger. The anxiety of holding in negativity aged her, and in kind, expressing herself honestly seemed to return her to a youthful appearance. Relief is a marvelous feeling.

Posted in Psychoanalysis, Psychotherapy | 4 Comments »

Emptiness Of Unemployment

Posted by Dr. Vollmer on December 12, 2013


Shayna, twenty-three has never perceived a bump in her road. She did well in school, went to an Ivy League college, majored in a humanity, and is now searching for a job in the publishing business, knowing well that the business is drying up and her prospects are poor. She has returned to her parent’s house, with contentment. She is not burning to move out, or to move on, for that matter. Her life feels “empty” but not “boring”. She entertains herself with her friends who are in similar situations. She could go to graduate school, but “why should I waste all that money?” She tells me, as if she is echoing her parents. She has a boyfriend in town, who is hard-working, at a steady job in the technology world, and he pays for their entertainment, but “I am not comfortable,” she says, expressing ambivalence about their financial inequality. “Maybe you are scared you won’t find the job that satisfies you, so you are stuck in a place where movement is more threatening than stasis.” I say, highlighting her apparent challenge to become an adult and commit to a profession which both makes her happy and provides financial independence. ” I do not feel fear,” she says directly, “but I do feel stuck,” she responds, letting me know that her surface is paralysis, and under that surface is foggy to her. “I guess I am scared,” she continues, as she thinks about my comment. “I have never not gotten what I wanted, so I am not sure how I cope with disappointment,” she says with admirable candor and courage. “Maybe the adventure is to be open to coping with disappointment and/or enjoying your next chapter.” I say, highlighting her uncertainty that she may get rejected from jobs, and/or she may not like the job she lands. “I am stuck now,” she says, “but I am also afraid of getting stuck in a job that makes all my time feel wasted and not creative,” she says opening up our discussion of her inhibitions and her fears. “Which kind of stuck do you prefer?” I say, encouraging her to make more conscious choices about her behavior, as right now she seems to be  unconsciously choosing to not pursue jobs very aggressively in order not to land a job which makes her feel like she is selling her soul.  “I guess I prefer my current situation,” she says, with hesitation and uncertainty about her response. Stasis versus movement, comes to my mind. Inertia is powerful, and yet upon reflection, can feel like a wasted opportunity. “We need to think about this more deeply,” I say, as I toy with how to approach her fear-based inertia.

Posted in unemployment | 4 Comments »

Depression as a Whole in the “Self”

Posted by Dr. Vollmer on December 11, 2013

I struggle with this concept of depression, as I struggle to define it, to treat it, and to clump it into a category, as it means such different things to different people. As per my last post, there is no certainty in “knowing”. A disease versus a symptom, a subject of a previous post, puts me in the symptom camp, where depression is a state of mind, indicating deeper issues and conflicts. As a symptom, it is a window into a deficiency of one’s identity and hope for oneself.

Gaby, fifty-one, jumps to mind. Her daughter, Sari did not get into her first choice law school, throwing Gaby into a mental state of despair. Gaby was angry at her estimation of injustice, and she was sad that Sari had to cope with disappointment, given how hard Sari has worked her entire life. “Yes, but this rejection has gotten to you in such a deep way. I would like to understand that better,” I say, hoping to clarify why this rejection letter has sent Gaby into a very dark place. “Sari deserves better,” she insists, with a tone of bitterness, making me wonder if Gaby had disappointments in her life, which this letter has now triggered. “When I was her age, I did not get the job I wanted, even though I deserved it, and I do not think I have gotten past that,”

Gaby spontaneously reads my mind, as she brings up her previous disappointments. “So Sari’s news is bringing up a very sensitive, and raw part of your past,” I say, thinking, once again, how the past lives in the present. “The fact that you did not get the job promotion seems to have been your symbol of unfairness, and it seems like you have focused on that event as the pivotal experience which caused you to be less successful than you imagined you would be and now you project that experience on to Sari’s future.” I say, outlining how Gaby has organized her life around not getting this promotion, such that experiences which smell of unfairness, brings her back to this bitter and angry place. “Yes, I know Sari will have her own experience and I also know that getting passed over for a promotion did not define my entire professional life, but it did feel to me, at the time, that I was very limited in my career and I felt painfully stuck and angry.” Gaby says, with frankness, and understandable frustration. “I could not move for a better job because I had a family. My kids were in school and my husband liked his job.” She says, anticipating my question that she could have searched for a new job by casting a wider net. “Accepting that limitation has been very hard for you, ” I say, thinking about her necessary journey of acceptance and self-love. “Yes, indeed. I guess I am not over it,” she says, as she looks at me with a sense of knowing that she has work to do.

Posted in depression | 6 Comments »


Posted by Dr. Vollmer on December 10, 2013


Epistemology, theory of knowledge, is rubbing me today. What is knowing? Cara, seventy, comes to mind, as she tells me that after visiting her husband’s elderly mother, her husband sobbed. “How do you know he sobbed?” I asked, with the history that Cara often reads into her husband’s emotions, even while he denies he feels them. “He was blowing his nose a lot,” she said. “Did you ask him how he was feeling?” I asked, knowing the answer, as we have been around this bend before. “Yes, he said he was congested,” she said, still convinced that he was crying. “Why do you not take him at his word? I am not sure I am familiar with anyone who cries who is not aware of crying.” I say, trying to probe into her conviction that her husband’s report of congestion translates into her certainty that he is crying. “Well, I don’t know,” she says in frustration, with hostility and defensiveness.

I  jump to the concept of projection, that Cara wants her husband to be a feeling, sensitive person, who cries at the impending demise of his mother, but by his report, he has no such feelings. Wanting something becomes having something if one can deceive oneself long enough and hard enough, which ultimately leads to psychological pain and suffering, when one has to see that the lie is internal. We betray ourselves and then we pay.

So, what is knowing? Why doesn’t Cara believe her husband when she says he is congested? Why does she get defensive if I wonder aloud about her misperception, about her possible wish? Generally speaking, wishes and fears dominate our mental landscape, and we are forced to integrate those with external validators of experience. As we cross a bridge in the wilderness, we say “it is safe” but then we fall from the bridge and we have to revise this notion to say “I thought (and wished) it was safe.” If we encourage others to go on that bridge and they get hurt, then we are vulnerable to guilt, as our “knowing” betrayed us and harm ensued. Forgiveness must enter the scene as we understand that there are different levels of “knowing” and, as such, we are subject to error and negative consequence.

Returning to Cara, my challenge to her that her “knowing” may, in fact, be “wishing,” leading her to anger, thereby creates our struggle  to determine what her husband’s tears might mean to her. Knowledge, meaning, wishes and fears, all wrap together to create our inner being. The more we can open up to our mental fallibility, the more we can hold on to equilibrium and mental fiber. Epistemology keeps us humble.

Posted in Psychotherapy, Teaching, Teaching Psychoanalysis, Unconscious Living | 6 Comments »

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