Shirah Vollmer MD

The Musings of Dr. Vollmer

Analytic Attitude

Posted by Dr. Vollmer on March 30, 2016

Symptoms have meaning. This is the analytic attitude, or more specifically there is an underlying reason why human suffering happens. Distress can be aided by medication, but, it can also be understood in terms of past experiences interfering with the present. The more one thinks about suffering, the deeper one can go in terms of understanding the origins and thereby tame the experience by putting into historical context. Going deeper requires intensifying the treatment, and so this is how psychoanalysis, or intensive psychotherapy, can be helpful to those in distress. If going deeper seems frightening to the patient, to the therapist or to both parties, the therapy will become stagnant and perhaps terminate with the notion that there is nothing more to be done. Stimulating deeper treatment can be initiated by the patient or the therapist, and either way, requires great courage since there is  uncertainty as to what that deeper exploration will uncover. Tolerating this uncertainty with the hope of a calmer, and more expansive life can yield a satisfying treatment experience. And so my class has begun. A stimulating conversation ensued, with much disagreement about whether the above makes sense or not.

4 Responses to “Analytic Attitude”

  1. Cindy Sherbon said

    Love your musings, Dr. Vollmer! I think going deeper first rests on the shoulders of the analyst. An analyst must be doing his or her own deep work to tolerate and contain what the analysand brings to the process in order for the psychoanalytic work to deepen to it’s full capacity.

  2. Shelly said

    I wonder once again if it is the patient or the physician who suggests the need for meeting more frequently? If it is the patient, you must ask yourself, why? Is it from a place of a need to be better understood, to overcome a difficult place in their lives or a medical emergency? If it is the physician who suggests it, why? And finally, what if the deeper exploration becomes so painful that the patient quits the analysis in its entirety? Then both of you will have lost, no?

    • You raise excellent points, Shelly. The notation of who brings up intensifying the treatment helps to understand the dynamics of the patient/doctor relationship. The subsequent dynamics will be shaped by this. Your second point that psychoanalytic work can go South because the patient or the therapist might have trouble tolerating the intense emotion is a known risk of deeper work. Yes, intensifying the treatment, could, in retrospect, turn out to be a bad call, but as is so true in many aspects of medical care, risks are taken, meaning the patient could get better, have no change, or, get worse. Without the ability to take this risk, there is no hope for help. It is the courage to take this risk which defines the work, on both sides of the couch, with the greater risk being taken by the patient. I often tell my students that psychoanalysis is comparable to oncology in that the physician gives powerful drugs which could cure the patient of a horrible disease or it could give the patient great suffering, with little benefit. There is no way to know ahead of time, so the question is whether the patient wants to take that risk. This is, as you suggest, a very large and scary decision. Thanks.

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