Construction of a Childhood
Posted by Dr. Vollmer on October 31, 2014
“I can’t remember my childhood,” Aly, twenty-one tells me. “Memory is an interesting experience,” I say, reminding both of us that we have a narrative memory, or explicit memory, in which we can recall stories, and we have implicit memory, where we recall feelings and then construct a story. “Through psychotherapy,” I say to Aly, “memories return, because the way you treat this relationship, and the way you convey information, might give you insight into how your parents treated you and how you felt about them.” I say, explaining that one major value of psychotherapy is the opportunity to construct a narrative of childhood, that because of psychic pain, has been, up until now, too difficult to recall. The support of psychotherapy allows the memories to flow because the pain can be metabolized. The “material” of the session provides both therapist and patient the opportunity to look at the narrative in a way which allows for multiple meanings, one of which, might relate to opening memories from childhood. Ina, sixty, comes to mind. “I was mad at my husband for telling me how to drive, but I know where that comes from. I hated that my father always told me what to do. I just hated him for that because he never trusted my judgment.” Ina, without my prompting, spontaneously saw how her irritation with her husband was also a “memory” of her feelings towards her father, many decades ago. The past lives in the present, as Faulkner so famously says. History comes alive through daily conflicts, irritations, and sudden emotions. Psychotherapy leverages that truth towards a deeper understanding of the history of one’s childhood. In so doing, Ina, Aly, and so many patients grow to understand their distortions of their present, because of their past. This insight leads to a more empowered ego, with fewer feelings of blame and victimhood.
Shirah Vollmer MD 
Eleanor said
Shirah, this is an excellent post on explaining, in simple terms, how the dynamics of psychodynamic and psychoanalytic therapy work to help patients gain insight and the ability to change over time. If only more people were interested. If I try to bring this type of “thinking” and longtime interest and fascination of mine into casual conversation with friends, most family members, acquaintances, etc. folks usually change the subject. And expecting insurance companies to pay for longer term therapy with a “provider” seems beyond reach these days. If people aren’t interested in, and possibly intimidated by this approach, how in the world can both psychiatry and insurance companies make changes toward more support for psychodynamic approaches?
Shelly said
Eleanor, I’ve come to realize that most people are not all that introspective. It is for that reason that your efforts in discussing such topics fall flat. It takes a very special personality, one who really cares about the dynamics of interactions and how the past interplays on the present, to be able to talk freely about this with you. I don’t think that we will ever change insurance companies to invest financially in this since they want quick fixes and not long, drawn-out talk therapy, however if people are interested in paying out of pocket, it may be worth the money.
Eleanor said
Yes Shelly I agree. I think insurance reimbursement for this kind of therapy is a hopeless cause. And today’s psychiatry, as Shirah keeps saying, is moving toward “quicker treatments”. I am continually reminded that we humans all have built in resistances to thinking in psychodynamic terms…discomfort it you will….. and in the long run this reflects attitudes on the part of the general public including insurance providers and probably some of the incoming psychiatry residents who would rather stay with the quick fixes, medications, and avoid any introspective depth work……sadly.
Dr. Vollmer said
Hello Eleanor and Shelly..thank you for chiming into this conversation. To summarize the issue, I would say that the cycle has been that in 1988 when Prozac arrived on the scene, there was a hope (a wish, as Freud would say), that psychiatry could pivot to pill mills and people would experience symptomatic relief. As one would imagine, this is a partial truth, but in so doing, psychiatry training programs, by and large, diminished their emphasis on psychotherapeutic listening, such that when the pendulum swings back to understanding the importance of listening, my fear is that the majority of psychiatrists, and mental health practitioners in general, will be ill-equipped to introduce the patient to his own mind. As such, insurance companies are not the major problem, although that is a separate issue. The problem is that we need to train practitioners who will in turn, “train” patients to be curious about their mental apparatus, both in the present and the past. The curiosity needs to link past with present so that there is a more in-depth understanding of behavior and symptoms. I am suddenly reminded of a joke. “The past came into the present, and it was tense.” The practitioner needs to carry the patient through this mental exploration as the journey is often fraught with anxieties and sadness. Yet, as the journey proceeds, greater depth and equanimity is almost inevitable. Thanks again.