Shirah Vollmer MD

The Musings of Dr. Vollmer

Is Therapy Work?

Posted by Dr. Vollmer on January 21, 2016

Talking about oneself brings relief and a struggle. The thrill of being listened to is counterbalanced by the shame of sounding “silly, inappropriate, consumed with minutia,” my fictional patient Adie reports. Psychotherapy as an opportunity to expose past experiences continues to stimulate me. I have never thought that Adie was inarticulate and yet, in her mind, she deeply fears that she cannot put words together in an interesting way. Hence she often sits in silence, with a pained look on her face. She often leaves sessions exhausted, even when she begins with high energy. “Today seems like it has exhausted you,” I say, and she quickly responds, “this is a lot of work for me.” I feel for Adie that she cannot see psychotherapy as a release, but rather she sees it as a medicine she has to take to get better, but the journey is one of endurance. Adie has never been listened to. No one in her life, by her report, has ever taken a keen interest in her thoughts, and so the opportunity for that interest makes her anxious and uncomfortable. We talk a lot about how traumatic it has been for her to want to be listened to but at the same time, she is too fearful to talk. She is caught in a never-ending bind, which, together we are slowly trying to unwind. Some days are better than others. Today was hard. Work for both of us.

7 Responses to “Is Therapy Work?”

  1. I think therapy is hard, hard work. Bring vulnerable enough to talk about stuff that was done to me and stuff that I have done and wondering how the therapist will receive what I am saying is tough. But, the relief of her reactions and acceptance makes therapy very rewarding hard work. Finding out how strong and brave I can be is a great benefit of therapy for me. So, yes, therapy is work. It can exhaust me for the rest of the day. But the benefits far outweigh my exhaustion.

    • Shirah said

      Hi Pattyspathtohealing!

      Thank you for chiming in. The physical exhaustion as a result of psychotherapy interests me. I appreciate you disclosing your experience as I want to think more about that. Thanks Again!

  2. Ashana M said

    If the patient has any interest in the psychotherapist, then of course it will be work. There are some patients who really aren’t particular interested: they speak as if the therapist is merely a set of eyes and ears directed towards them. They don’t make any effort to imagine the mind of the other or communicate their own experiences in a way that takes into account the mind of the other. For those patients, therapy is easy. They understand their own state; they say what it is. It is not more complicated than that. They get a thrill from a feeling of being heard and understood although they may not have made themselves understood: they also don’t make the effort to take in disconfirming information that perhaps the therapist did not understand.

    However, if the patient cares enough to try to communicate, it involves a great deal of work. One has to understand one’s own state, imagine the mind of the other, and then formulate a way to explain one’s own state so that the other can understand one’s own. It’s very cognitively demanding. Cognitive empathy is something we are constantly developing as we come into contact with others with different minds than our own. It is work to develop though, and it develops in proportion to our willingness to make the effort of taking a perspective.

  3. Shelly said

    Imagining that I were Adie for a minute, I might think that what I had to say was not worth listening to. Therefore, it would be a great deal of work putting together my thoughts and expressing myself in a way to make the listener, or you (Shirah, in this case) feel that it was worth the effort and time to listen. No wonder Adie feels exhausted and it is called “work”. She must feel that she needs to prove herself worthy each and every time she meets with you.

    • You are describing one type of “transference” where the patient assumes the role of performer, as if the therapy hour is a demand for the patient to entertain the therapist. Understanding this dynamic would be the “work” of therapy. Thanks, as always.

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