Shirah Vollmer MD

The Musings of Dr. Vollmer

Clinical Moments

Posted by Dr. Vollmer on September 10, 2015

New Center for Psychoanalysis

 

Moments of decision-making in psychotherapy: how are decisions made? What do you comment on? What do you ignore? When do you interrupt? When do you listen? These are the daily questions which arise for a psychotherapist. The New Center for Psychoanalysis, under the brilliant leadership of Lynn Kuttnauer PhD has initiated these monthly meetings to talk openly about how to think about how to listen. I am honored to be invited to do the last one for the 2015 calendar year. Now, I need to think about how to shine a light on this question. I could illustrate a brilliant decision I made, or make it look that way, or I could present from a point of humility, where I am honestly not sure what to do. As Freud says about dreams, the telling of a dream is a secondary revision, as the dream is the first draft. So, too, in teaching, I am consciously and unconsciously framing my clinical vignettes with an agenda to make myself look both competent and questioning. This is a delicate balance, particularly in teaching psychotherapy where the road map is clouded with conflicting theories as to how the mind works. Candor has always been my strong suit. I have counted on authenticity as my strongest tool, both in the struggle of psychotherapy, and in the struggle to convey complicated ideas. Not knowing, I teach my students, is our strongest foundation. We know, we do not know, and as such, we can enter into contemplation and reflection without rigid ideas or preconceived outcomes. This humility is what distinguishes us from other practitioners, particularly the “T” therapies in which they convey a confidence about how to heal. I have no such confidence, only Irving Yalom’s notion of the “fellow traveler”. I can accompany you on the journey, but I can’t say I know where we are going. “Clinical Moments” gives me the opportunity to push this idea forward. I will take it.

2 Responses to “Clinical Moments”

  1. Shelly said

    Bravo, Shirah! I love how you put it here. I wish you much luck in your talk for the Center. However, in industry, such humility and lack of answers could be seen as lack of self-esteem. How would you answer that question if it were posed to you? If you do not have the answers to questions when asked, then how can you be seen as a professional in your field? In any area of industry, one needs to be assertive, self-confident, and have the answers at your fingertips. I realize that you are not in industry–you are in the healing profession. But how can you balance your absolute self-confidence and knowledge with your humility?

    • Yes, yes, this stance of “not-knowing” is very contextual. Confidence, and even over-confidence is appropriate in a work setting in which “not knowing” produces anxiety as opposed to curiosity. The audience is crucial here. In the context of psychotherapy, the patient comes to learn about how they messed up their lives, or at least, what they can do, going forward, to put themselves on a better path. As such, the goal is to step back, be curious, bring up questions, and float answers in a way that allows for a playfulness with ideas. In a corporate environment, money is spent on getting results and certainty is seen as competence, and so here, the goal is to present information in a confident way, while at the same time, being open to learning new information. The “game” if you will, has different rules, and the art of living, is understanding how the rules differ from context to context. The flexibility to shift gears in thinking is a skill set that is very valuable, but not discussed enough, in my opinion. One needs to modify one’s attitude based on how the system works and who yields the power. On the one hand, this might sound slimy, but on the other hand, it is a skill set which, if ethics are monitored closely, can help people adapt to changing circumstances. On the other hand, sometimes change does not allow for adaptation, in which case another avenue needs to be pursued. Thanks.

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