Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for February, 2015

Should I Become A Training Analyst?

Posted by Dr. Vollmer on February 11, 2015

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1993-2001, the years that I did psychoanalytic training. Eight challenging years involving heavy reading of the psychoanalytic literature,  four control cases, meaning patients that came multiple times a week, associated with weekly consultation with a senior psychoanalyst. I had four years of formal classes, followed by elective seminars with multiple case discussions and theoretical discussions. All of this was finalized by four papers (one on each patient), along with an oral examination proving that I had mastery of the material. After this long journey, September 9, 2001, I spoke at my graduation, thinking that this was the end of my long journey of being a student. I expressed deep gratitude to my teachers and mentors who had shepherded me through years of deep emotional growth and widening my worldly perspective. Since 2001 I have paid forward by voluntarily teaching at different psychoanalytic institutes and at UCLA. I have carried the baton, emphasizing the value of psychoanalytic thinking to help those who suffer. Now, fourteen years later, I am faced with another opportunity for growth. The New Center for Psychoanalysis is offering an expedited pathway towards becoming a training analyst, which means that if I join a study group, develop a committee to review my work, I can qualify to take an oral examination with my three person committee, along with a fourth person who will come from out of town to evaluate me. If I pass, I will then be on the list of training and supervising analysts, which means that I can help therapists become analysts, by treating them as patients, and/or supervising their case material. This leap represents a dilemma for me. On the one hand, I very much want to pay forward the efforts that I received through my analytic training. On the other hand, I am not sure that becoming a training and supervising analyst is necessary for that goal. On balance though, joining a study group is a good idea. I want to stay stimulated and engaged in my work. That is my first step, and I think I will take it.

Posted in Psychoanalysis, Teaching Psychoanalysis | 6 Comments »

NYer Cartoon Contest

Posted by Dr. Vollmer on February 9, 2015

 

I am feeling out of place.

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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.

 

Posted in Listening, Psychotherapy, Teaching, Teaching Psychoanalysis | 2 Comments »

Learning Patterns of Interaction

Posted by Dr. Vollmer on February 4, 2015

“The child tends to carry over into later situations the patterns he first learned to know. The rigidity with which these original patterns are retained depends upon the nature of the child’s experience. If this has been of a traumatic character so that spontaneity has been blocked and further emotional development has been inhibited, the original orientation will tend to persist. Discrepancies may be rationalized or repressed…..The little child who grows more and more negativitistic, because of injuries and frustrations, evokes more and more hostility in his environment. Some people are so injured that they are not able to make use of kindliness or decency when it does come their way. They meet the world as if it were potentially menacing…..Despairing of real joy in living, they develop secondary neurotic goals which give a pseudo-satisfaction…When the reference frames are made conscious, then reality gradually becomes undistorted. ” Janet MacKenzie Rioch MD

 

Nellie, sixty-three, comes to mind. She is ALWAYS angry, bitter and expressing stories of unfairness and persecution, be it about herself or a member of her family. She has no ability for spontaneity. Many might see her as dour. She is obese, which she attributes to those “dumb doctors which gave me medicines that made me fat,” despite the fact that she has been obese since childhood, long before she had to take chronic medication. She got into a fight with her sister because she was SURE that her sister wanted to harm her kids, even though she had no evidence for this. Nellie is not psychotic. In fact, she functions as a high-level executive, although she works independently and no one reports to her. Yet, when it comes to her personal relationships she is quite certain that all of her friends and relatives use her for their own needs, and have no feelings of love for her, while at the same time, she states she has no feelings of love for them either. Nellie’s emotional world is characterized by feelings of paranoia and victimhood. Going back to her childhood, she describes her mother as very similar to herself. The world, according to Nellie’s mother, was one in which everyone else was happy, but not her (meaning Nellie’s mother). Nellie’s mother raised her children to be financially successful, but she did not instill in them a sense of love for themselves or each other. Consequently, Nellie describes her relationship with her six siblings as distant, but in touch. She also tells me that she, and ALL of her siblings have expressed an emptiness, despite academic and financial success.

Nellie treats me like I am using her to make money. She comes, with ambivalence, and wonders aloud, saying “you obviously want to make money off of me, so it is not in your best interest for me to get better.” I respond, “it must be hard for you to imagine that I care about helping people and that might trump my need to make money,” suggesting that although making money is important, the satisfaction of people developing independence and autonomy is also important to me. I am also hoping to slowly instill in Nellie a sense that her bitter remark towards me could be symptomatic of her frame of reference, where no love was ever exchanged, and people were seen as objects to advance one’s standing in the world.

Nellie’s mother, apparently, seemed to use her children to reflect well on her, rather than allow them to develop self-empowerment and creativity, such that their accomplishments felt empty. Nellie, by my formulation, was an object to her mother, and as such, with that kind of emotional deprivation, she has carried the flag forward, continuing to see her relationships as objects, as people who can get her somewhere in life, rather than as people she can enjoy and cherish. Without consciousness, Nellie will continue her life repeating this pattern of seeing people who have no feelings for others, but only have the ambition which mandates that they use people to advance themselves. Psychotherapy and psychoanalysis are pattern busters. Patterns are exposed, allowing the person to see the pattern in which they are living, and thereby giving them an option to make new patterns, new kinds of relationships. Life does not have to be a repetition.

Posted in Psychotherapy, Teaching, Teaching Psychoanalysis, Transference | 2 Comments »

Life As a Repetition of Feelings

Posted by Dr. Vollmer on February 2, 2015

Love is experienced for someone today in terms of the love felt for someone in the past. as Freud would explain feelings. More recent psychoanalysts, such as Janet Mackenzie Rioch MD  has stated that relationships do not repeat, but they expand on prior relationships. New relationships feel so awesome, because, she would say, they extend the interior of the individual. Old relationships, from childhood, she likens to hypnosis, as certain repetitive messages become etched in one’s identity, such as “you are dumb, you are a nuisance, you always make mistakes, mother loves a good boy who does what I tell him.” Since the child has no other frame of reference about himself, he typically adopts the characterization which is repeated the most. This hypnotic “spell” as Dr. Rioch explains, becomes the transference in psychoanalysis. The adult patient feels like a nuisance, even though the therapist does not experience the patient in that way. Or, the patient makes himself a nuisance to the therapist in order to communicate that is how he is used to being seen. This is why the analytic work is to not be authoritarian, so as to allow the patient to display how he works with the idea of authority. In so doing, both the patient and the therapist can learn about the childhood hypnotic state which has shaped his view of himself.

Colt, forty-one, comes to mind. He comes from a family of published authors. Both his parents and his four siblings have achieved both financial and literary success with their writing, but he does not seem to be able to find his way. He teaches English, and he enjoys that, but he believes himself to be intellectually inferior, not just in terms of his family, but in terms of the world. He does not see that he was in a “hypnotic trance” as he was made to feel inferior because he did not pursue a writing career. As he explores his past, he relates to me, that in his family, writing was the only measure of intelligence, and since he did not have a passion for writing, he believed himself to be dumb. As he sits with me, he is “absolutely certain” that I see him as intellectually inferior, when, in fact, I am in awe of his wit, and his humor, which I take as evidence of his superior intellect. I cannot reassure Colt that I find him stimulating. I mean I could say that, and he would listen, but he would experience me as “trying to make him feel better, because that is what I am paid to do.,” as he has told me in the past. Instead my approach is to help him see how he thinks, to examine his own language, so that he can see that he is generating interesting ideas. Plus, I attack, gently, his certainty, about his intellectual inferiority, and propose a new way of understanding that the message given to him by his family, may, in fact, not be an adequate reflection of his strengths and weaknesses. Perhaps his family never studied him to know his intelligence, but with a high narcissistic endowment, the family thought that since he was not like them, he must be inferior. In other words, together, Colt and I can come to see that beliefs about himself which he has held on to tightly, may, in fact, be generated by people who did not really know him. “Consider the source,” I want to say early in our work together. As time goes on, our relationship strengthens, so  I do say it.  Colt gets it and opens his mind to a new look in the mirror. The work is slow, but over time, the change is huge.

Posted in Psychoanalysis, Teaching, Teaching Psychoanalysis, Transference | 4 Comments »

 
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