Shirah Vollmer MD

The Musings of Dr. Vollmer

The Fallible Therapist

Posted by Dr. Vollmer on February 5, 2015

Rupture and repair-that is the motto for psychotherapy where there is an understanding that both patient and therapist have difficulty listening and with this difficulty comes narcissistic injury, the feeling of not being heard, and so repair is necessary to move forward. This is the work of Jessica Benjamin PhD, and others in what they have come to call “relational psychoanalysis” which predates the more modern term of “intersubjectivity”. The challenge of deep listening comes with the inevitable failure, the inevitable intrusion of one’s own thoughts and not that of the “other”. Sure, one can think both in terms of one’s own thoughts and the patient’s thoughts at the same time, but in times of stress, this is more challenging.

Nellie, from my previous post, comes to mind. She believes the world to be an angry, bitter place, one which no one, including her family of origin, and the family that she has created, cares about what she has to say. As a patient, she also does not believe that I listen, and often, accuses me of spending time with her to “make money,” without any verbal recognition that there could be more than one reason that I try to help her. Sometimes, I, in fact, am not listening, as evidence by my comment which misses her point. Her anger rises with my shame and guilt. She is right, I realize, that I lost track of the conversation, and so now I need to apologize. This is linear, and yet, as psychoanalysis was first unfolding in the United States, an apology from a therapist was almost unheard of, because, as the thinking went, this apology shut down the anger in the patient which needed to unravel to get a clue into the inner workings of her mind. Thanks, however, to the relational psychoanalysts of the 60s and 70s, the apology from the therapist, was termed a “repair,” an act of kindness to restore the trust in the relationship. This “repair” was essential to validating that the patient was “unseen” in those moments, and that was a result of a disconnected therapist, in that moment. To express the universality of ruptures in all relationships is to demonstrate that relationships involve frustration and pain, because it is impossible for the attunement to be omnipresent. The analytic apology gives permission to the analyst to lose track, as it gives permission to the patient, to also lose track of himself, as well. Losing track is not a fatal flaw, only a temporary detour on the journey towards shared understanding. Timing is everything. I am practicing in the right era.


2 Responses to “The Fallible Therapist”

  1. Shelly said

    Thinking about this, I would imagine that a patient might feel that all her negative feelings of herself are validated if the therapist’s mind would wander during the session. “See? Even my THERAPIST thinks I’m boring!” might be the thought of one. An apology might help, but it wouldn’t stop the repetitive self-condemnation by your injured patient. Thoughts?

    • Yes, this is the bind of psychotherapy. The patient has a pre-conceived notion of himself, then enacts that with the therapist and proves himself right. The art of this work is to help the patient understand that the pattern, although it involves both parties, there is an element in which relationships become a self-fulfilling prophecy. When there is enough trust and enough relaxation to be able to take a bird’s eye view of oneself, then change can ensue. This bird’s eye view is the best hope for stopping the repetitive self-condemnation. Thanks.

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