Shirah Vollmer MD

The Musings of Dr. Vollmer

Fellow Travelers

Posted by Dr. Vollmer on April 16, 2015

Irving Yalom MD,, states that psychotherapists are “fellow travelers” with their patients on the journey of self-discovery, as the patient struggles with the existential issues of death, meaning, isolation and freedom. This is a wonderful characterization of the intimacy in psychotherapy, as, despite the asymmetry in the doctor/patient relationship, there is still a sense of sharing the road together. This is the contradiction in therapy, which is to say that on the one hand the patient travels alone in that only he is sharing is the intimate details of his inner world, and yet on the other hand there is a joining together of the experience as the patient narrates his tale. Leon, sixty-four, comes to mind, as I work with him around the slow decline of his ninety-seven year old father, whom I only imagine, having never met him. Yet, through Leon, through a son’s perspective. I come to understand his father. In that way Leon and I are fellow travelers on the journey which witnesses the slow exit of his father. This sense of joining between patient and therapist, the sharing of interest in the changing emotional landscape, gives way to a unique relationship in which the external world, the decline of his father does not change, but the internal world, the world of sharing feelings does change. Feelings, once shared, become owned, and in so doing, define the person who has those feelings. A deepening of the self ensues, as feelings are expressed in psychotherapy, as, at times in friendship, both travelers have a greater connection to each other, and to themselves.  Giving the patient permission to express feelings opens the path towards traveling together, which for some people, is virgin territory. The “fellow travelers” notion gives the imagery of journeys, and sites, yet to be seen, with a sense of discovery and wonder. This contrasts with the T therapies (CBT, DBT, FFT), in which the answers are given, sometimes even before the questions are asked, and hence there is no discovery and hence there is no excitement. Dr. Yalom speaks to this old-fashioned notion of “letting the patient matter,” meaning developing a doctor/patient relationship, or more specifically a doctor/patient traveling relationship. I join hands with him with the hope of creating a chain of physicians who want to be “fellow travelers” with their patients.

9 Responses to “Fellow Travelers”

  1. Ashana M said

    I think psychodynamic therapists also have preconceived answers. They are just drawn from a different set. It’s part of how they as listeners protect themselves from the pain of witnessing the patient’s distress.

    • Some do, Ashana, but not all.. Openness is hard. Listening is hard. These are goals that many of us hold in high esteem.

      • Eleanor said

        Shirah, certainly not all psychoanalysts have the same skills, talents and abilities and some are more adept at sensitive listening skills without having set answers, than others. In selecting a psychodynamic therapist how does one go about finding out just who would be the best “fit” for their case? My daughter and were extremely fortunate as we both had a patient/ analyst “fit” that was best for both of us for various reasons and in different ways. We were lucky but I would guess this doesn’t always happen in referrals. Suggestions?

        • Hi Eleanor,
          Finding a good “fit” is indeed a tricky process because the unconscious attraction to an analyst could be a repetition of finding unfulfilling or destructive relationships. Having said that, my suggestion is to interview three analysts who have had good training experiences (ie review their educational background) and then make a decision from there. A combination of good training along with a good intuitive sense of the person will usually put you on a good track. Thanks.

          • Eleanor said

            Thanks Shirah….Yes I agree intuition can be very helpful. My daughter was initially referred to an analyst by another of her medical physicians. It became clear at the consultation that this was not the person (a bit harsh and very clinical) that would have worked well for our family. The analyst possibly felt the same (?) as my daughter was referred to a fellow analyst who worked well with her situation. I was referred from there. So yes gut feelings are important as is knowledge about training….( I knew vey little about the analytic perspective back then).

      • Ashana M said

        I have gotten that impression largely from reading your blog.

  2. Shelly said

    I agree with you that psychiatrists are “fellow travelers.” I adore Irvin Yalom’s books, they are so well thought out and give me great insight into the mind of both patients and therapists alike. Does it ever make your patients uneasy this “inequality” in your relationship? That you know everything about them and the workings of their mind, their faults and foibles, but they know nothing of you and yours? Do they ever feel uneasy with the fact that yours isn’t really a “friendship” but a professional relationship, even though it may seem otherwise?

    • Yes, coping with the asymmetry in the relationship is one of the challenges in the work. At the same time, being together, even without self-disclosure, gives patients a good sense of who I am and how I think, so in that way there is mutuality and understanding of how we are fellow travelers who come from different perspectives and yet, now are traveling together. In other words, hearing me speak my thoughts about what is going on with them (the patient) often reveals my internal process, and in that way patients get to know me as well.

      • Eleanor said

        The therapeutic relationship is an interesting dynamic and the asymmetry was actually comforting to me and helped me, the patient, feel safe and understood. In my experiences this asymmetry made it easier for me to “internalize” the ability to later look at myself, “when need be” from a more objective “observing” stand point and get enough “distance” from my emotional reactions, projections, reactions to projections, etc. etc. and thus have a better capacity make hopefully wiser judgements. (I know this sounds a little confusing so hope this makes some sense 🙂

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