Shirah Vollmer MD

The Musings of Dr. Vollmer

Blind Spots In Psychotherapy

Posted by Dr. Vollmer on January 29, 2014


A good therapist fails. How do we understand this? What, anyway, is a “good therapist”? Is there a “good therapist” or a “good therapist-patient fit”? These are the questions which have no answers, but generate more questions. Often, when I am asked for a referral, I think about “fit” but I recognize that this is largely an intuitive process which involves educated guessing. The dyad brings up issues for both the patient and the therapist, and if the injuries in the patient hit close to injuries in the therapist, this can cause a “blind spot” as James McLaughlin has described. Monte and Marla come to mind. Monte and Marla, both psychiatrists have been working together for many decades. By working together I mean that Monte has sought guidance from Marla for his career, but the relationship has bled into personal matters as well. Monte grew up in a family where he felt he had to please his parents. So did Marla. When Monte spoke about his narcissistic parents, Marla defended his parents by saying “they did the best they could,” thereby making Monte feel dismissed. Monte came to see me, and in our work together we postulated that perhaps Marla could not help Monte cope with being unseen by his parents because Marla has never resolved this very same issue with her parents. The collision of these two traumatic experiences created a blind spot in Marla which caused Monte considerable distress. Unresolved traumas create a defensiveness when a similar situation is described, either in film, in literature or in person. So too, with psychotherapy, unresolved issues in the therapist, can lead to a coldness when these same issues are presented by the patient. This coldness is a way for the therapist to avoid the deep pain associated with her past. It is a wish to think that therapists have resolved all of their issues such these blind spots never happen. They do happen, making the  hope in the ability of the therapist to come to recognize the deficit and try to move the therapy forward. Like my last cartoon post, like life, we want the path of psychotherapy to be linear, but in fact, it goes up and down.

7 Responses to “Blind Spots In Psychotherapy”

  1. Shelly said

    Shirah, your blogs always teach me so many things and this one is no exception. I’ve described to you many things over the years and at last I understand my painful interactions with an adviser I had a few years ago. You’ve hit the nail on the head and I understand it now! I can’t tell you how much better I feel because everyone told me that I had been imagining things. This blog is proof to me that I had not and the reasons behind it.

  2. Eleanor said

    Shirah I have a question here..just how important in the grand scale of things would you say a thorough personal training analysis is in the psychodynamic treatment of patients? I would say it is indispensable but I tend to be narrow minded and overly opinionated on this subject. I know an analysis as a component of training by a skilled practitioner isn’t a be all end all, but it helps one recognize their own problem areas and hopefully blind spots in the interaction with their patients.

    • Yes, a personal analysis is critical to therapeutic work, as this not only illuminates potential blind spots, but by seeing the blind spots in one’s own therapist, one develops a deeper understanding, as Shelly describes, just how painful these blind spots can be. As you correctly add on, the analysis is not an “end all” as each therapeutic dyad brings up interesting and difficult issues which are unique. The hope is that the analysis, along with deep understanding of the literature gives one tools to accept and understand limitations in oneself and others. Thanks.

      • Eleanor said

        I’ve often wished organization such as the American Psychoanalytic and others would produce educational leaflets (written so the lay person can understand) on what to look for when seeking psychotherapy. Leaflets that would briefly explain the importance of such things as addressing early life experiences in treatment, why a therapist should have a training analysis themselves, and that time limits on sessions to 10 or 20 meetings as the insurance companies would like, is usually not in the best interests of the patient, etc etc…. Educational leaflets like these in physicians offices, in clinics, in hospitals…really anywhere, would be immensely helpful because in my experience so many people just have no clue, unfortunately.

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