Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for February 10th, 2014

Diagnostic Countertransference

Posted by Dr. Vollmer on February 10, 2014


The patient is crying. The analyst is bored. What is the problem? There is a lack of affective, or emotional, attachment. To say that the patient is split off from his feelings is going to generate “blame the patient” approach to psychotherapy. To say that the analyst is “burnt out” is going to “blame the lousy doctor”. The question, for my students, is how to tell the difference, or determine the gradient where there is some sense of how this discord has come about. Luis, seventy-one, comes to mind. He insists he is not worried about aging, and yet, he frequently reminds me that he is “doing pretty well for a man of my age.” This inconsistency triggers in me a sense of confusion and internal movement. I am not feeling for Luis as a result of my internal sense of being twisted, not in a manipulative way, but in a defensive way. He tells me how hard his life is, given his elderly parents, his sick wife, and his lack of contact with his adult children. I hear his challenges, but his presentation makes me think of lists, and order, and numbers, rather than the stressors of caretaking and the feeling of abandonment. My “diagnosis” if you will, is that Luis has split off his feelings from this words, such that in an unconscious ways, the way he copes is to flatten out his feelings but maintain the verbal narrative which conveys his distress like a shopping list. As I recognize this split, my job becomes to help him stitch together feelings with words, such that he has more compassion, both for himself and for others. The absence of my feelings point me towards his psychological split, and hence I am using my countertransference to help me understand his coping skills. In the case of Luis, the patient sounds bored, and the analyst is confused. The challenge is to help Luis be more engaged with himself, so that other people, in this instance, me, can be more connected to him. This work of engagement will ultimately help Luis deepen his relationships and thereby help him cope with his responsibilities. Luis would tell you that his problem is the external issues of his parents, his wife and his children. I would tell you that a deeper issue for Luis is his need to split off feelings from words, such that he is unable to get nourishment from others.

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NYer Cartoon

Posted by Dr. Vollmer on February 10, 2014


I am trying to kill my inner child.

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