Shirah Vollmer MD

The Musings of Dr. Vollmer

Explaining Psychotherapy

Posted by Dr. Vollmer on November 13, 2014


Stephen Mitchell,, says that “clinical psychoanalysis is fundamentally about people and their difficulties in living, about a relationship that is committed to deeper self-understanding, a richer sense of personal meeting, and a greater degree of freedom.”

There is no mention of diagnoses, or psychopathology, but rather his emphasis is on the universal need to grow and develop as a human being. To leave one’s idiom, as Christopher Bollas says,

“In Being a Character, Bollas also argued that everybody had their own idiom for life—a blend between the psychic organisation which from birth forms the self’s core, and the implied logic of the familial way of relating into which we are then raised.[8)

As adults, Bollas considered we spend our time looking for objects of interest—human or material—which can serve to enhance our particular idioms or styles of life—perpetually “meeting idiom needs by securing evocatively nourishing objects”.[9] Being willing to risk exposure to such transformational objects was for Bollas an essential part of a healthy life: the readiness to be metamorphosed by one’s interaction with the object world.[10]

The contrast was a refusal of development and self-invention, of open-endedness: the state of psychic stagnation. Bollas saw in what he called the anti-narcissist a willed refusal to use objects for the development of his/her own idiom, and a consequent foreclosure of the true self.[11] The result can lead to what Adam Phillips called “the core catastrophe in many of Bollas’s powerful clinical vignettes…being trapped in someone else’s (usually the parents’) dream or view of the world”.[12]

Bollas was however well aware of the converse danger of expecting too much from the role of the transformational object, especially as found within the transference.[13]

Miley, once again, comes to mind, as the anti-narcissist described above. She does not seek out new relationships, resulting, as Dr. Bollas says, in a “foreclosure of the true self.” Miley’s “depression” as some might call it, is more deeply thought about in terms of inhibitions in the ego, resulting from deep fear of guilt, which in turn, cause loneliness and despair. It is not that medication cannot help Miley, because antidepressants do give her relief from her tense emotional state, but they do not give her permission to pull back from taking care of her parents, and allow herself personal growth through new, meaningful relationships. The guilt that Miley feels serves to inhibit her from pushing out from underneath her unconscious constriction. Miley, by her report, has difficulties in living, which through our relationship which is committed to looking at the underlying dynamics of her suffering, she and I can come to an understanding of her inhibitions and thereby allow herself to  make more choices, and thereby give her a greater sense of personal freedom. Freud said that the libido was working so hard in repressing unconscious thoughts, in Miley’s case of her  unconscious guilt for not devoting her life to her parents, that there was no room, no broadband, left for her  libido to exert its power towards feeling desire and love. Psychotherapy, Freud would say, involves working at lifting the repression, so that the libido is free to  expand outwards. Miley’s issue with “psychic stagnation” seems a much more fitting description than “Major Depression”.

4 Responses to “Explaining Psychotherapy”

  1. Shelly said

    How do you work past the guilt? You can keep telling Miley that she is an adult and free to make her own life, that her parents didn’t treat her right when she was young and therefore while she has a responsibility to them on the one hand, she has a responsibility to herself on the other. And there you will come to the impasse: Miley will say that she just can’t let go, and you will insist that she can. And then what?

    • Then we come to, what is technically called, working through, meaning hammering out together the issue of balance between responsibility to parents and responsibility to oneself. Slowly, repetitively, Miley and I, together, come to see that, like using an ice pick, her guilt is slowly chipped away, such that she can see that she can have more balance in her life. This is a non-linear process of utilizing her observing ego, the part of herself that can see her situation more objectively, to understand that her guilt is ruling her life, and it behooves her to come to understand that responsibility is different than complete selflessness. Thanks.

  2. Eleanor said

    Shirah it was my experience in the long arduous process of “working through”…(i.e.: approaching everything from every angle and every possible viewpoint..over and over and over….) that frees one up to become one’s “true self”. Not only this but these skills in thinking in many shades of gray instead of in black and white, gives one the ability to continue to learn and grow and when necessary “rework” life’s experiences with the added wisdom of age and experience. Truly a gift of the psychodynamic methods.

    • Yes, shades of gray are challenging for all of us, particularly in times of stress, and creating a spectrum of thoughts and feelings is a luxury of the human condition, in which we are able to think in multiplicities. Many things can be true simultaneously, and we all know that, but we forget that when the world becomes frightening. Thanks.

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