Shirah Vollmer MD

The Musings of Dr. Vollmer

Creativity in Psychotherapy

Posted by Dr. Vollmer on November 3, 2014

 

Cookbook therapies, as I call them, such as Cognitive Behavioral Therapy, theoretically speaking, are independent of practitioner, such that all providers give, more or less, the same service. Hmmm…sounds like a franchise. By contrast, psychodynamic psychotherapy lends itself to creativity, and hence there are no metrics, since there is no standardization. Standards in medical care, generally speaking, are positive. A person with chest pain in Omaha should get the same evaluation that he would get in Los Angeles, and yet, historically speaking, that was not true. Creating a centralized, replicable, mode of evaluating medical symptoms makes an enormous amount of sense, yet it has taken us many decades to get here. This change towards unification of health care will have an enormous benefit to millions of people and I salute this change.

Having said that, standardizing mental health care is not as meaningful, and is, in fact, harmful, both to patients and practitioners. From the provider’s point of view, the field has gone from creative to rote. The fun in providing rote care eludes me. From the patient’s point of view, the field has gone from inaccessible to most people, to more accessible, but  with limited benefits. This shift towards limiting time spent in psychotherapy, limits clinician latitude. This latitude leads to uncertainty, not just in the patient, or the insurance company, but also in the clinician. Certainty and consistency are comforting, even if the tools are not deeply helpful. This is a large dilemma. Certainty and consistency provide relief, particularly with anxiety, but long-term gain comes with accepting uncertainty. Psychodynamic psychotherapy provides the consistency and reliability of appointments, without giving the patient the false notion of certainty that the psychotherapeutic tools are effective. Like panty hose, one size does not fit all, or even most, but rather individuality and uniqueness needs to be embraced for the good, the bad and the ugly inherent in the human condition. As I teach my students, we may not know how to help as many people as we would like, but unlike our behaviorally oriented colleagues, we have a better understanding of what the difficulties are.

6 Responses to “Creativity in Psychotherapy”

  1. Shelly said

    I agree with you, but an open-ended time frame to explore the psyche with your patients can be very frightening. I heard once that “therapy is a gift one gives oneself.” Well, how long? It is not in the patient’s best interest to limit it to 20, 30, or even 40 sessions with a psychiatrist, according to some specialists who believe that long-term therapy is the key. Yes, it limits clinician latitude, but it also doesn’t allow your patients to get on with their lives without your guidance to have year-long relationships with you (with 2-3 sessions per week or more).

    • So, we have reached a crossroads, you and I, in our discussion of the human mind. On the one hand, long-term psychotherapy can promote dependence and thereby stunt emotional development, since the emotion is directed to the therapy, and not to their “outside” life, yet, on the other hand, long-term anxieties are not likely to be helped with short-term treatment. Depth of experience, along with the critical developmental years of childhood, can create deep problems in living which requires a deep view into them, in order to move forward. So, can long-term psychotherapy hinder development? Of course. Yet, sometimes, not all the time, but sometimes, long-term psychotheapy is the best option under very grueling circumstances. In other words, we are both right. The short answer is that it is a case by case basis, and sometimes long-term psychotherapy makes sense, and sometimes it does not. As I said, like pantyhose, one size does not fit all. Thanks.

  2. Eleanor said

    I’ll comment also here….most definitely I can’t speak for anyone else, but many years ago after my daughter was born with Spina Bifida and later developed Epilepsy (which she eventually unexpectedly died of her sophomore year in college) I was overwhelmed and desperately needed some really expert help, and frankly my disabled daughter did too. We ended up with with separate child/adult analysts. I was extremely comforted that there were NO “time limits” whatsoever on treatment. My daughter had 2-3 day a week psychodynamic psychotherapy the last 11 years of her life beginning at age 10. LOL…honestly I won’t even begin to say how many years I was in 5 day a week psychoanalysis but it was effective…very much so, and I had an analyst willing to stay with it. To this day, if and when I need it, I can pull up conversations in my head I had in analysis from 25 or 30 years ago….. There are advantages to long term treatment if one is willing. The only issue that is really problematic for people who would benefit from lengthly treatment is payment….. (and everything for myself and daughter had to come “out of pocket”. As Shelly mentioned, treatment can be a “gift to oneself” and in this case my daughter also. )

    • Thank you, Eleanor for sharing your experience. Your story helps other understand that some struggles are soothed by an open-ended professional relationship which allows for healing very deep wounds. It is nice to have you in my community. Thanks again.

  3. Eleanor said

    One other consideration I might add in defence of the need for extended treatment is the genetic component . In my case I had a significant genetic influence with my mother who unfortunately in later years lived with one of the most severe on going cases of major depressive illness one can possibly imagine. Genetics can add to the complexity of psychotherapeutic treatments.

    • Yes, indeed, Eleanor. This multiplicity of factors determining mental suffering is why I strongly feel that mental health practitioners must be strongly versed in science, as well as knowledgeable in the arts and creative expression.

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