Shirah Vollmer MD

The Musings of Dr. Vollmer

Mental Representation

Posted by Dr. Vollmer on April 5, 2016

The psychotherapists’ technique of waiting and responding is contrasted with waiting and meeting. Can the patient trust what comes to his mind, that spontaneity of thought? This requires the capacity to tolerate uncomfortable thoughts and feelings. On the other side of the room, the practitioner of psychoanalytic therapy must have both patience in listening as well as clinical intuition to say what comes to mind. In saying what comes to mind, either as the therapist or the patient, one must risk an uncertain outcome as to how it will be received. This courage. as I often talk about in these posts, comes from a mental representation that negative feedback, either one’s own, or from the listener, can be tolerated and digested. In other words, the ego is not shattered, merely bruised. This work is based on the basic tenet that so much of what we do and what we say has layers of meaning, only a fraction of which, we are aware of. Being able to listen to ourselves is the first step towards listening to others. Defenses rise up as we are scared to get in touch with our own minds, causing painful anxiety and self-sabotaging behaviors which are designed to numb ourselves from ourselves. Josie, fifty-one, comes to mind. She is a woman who has a very rigid life. She is trapped in her routines in a way which makes her feel confined and bored. When I ask her to tell me more about her feelings, she says “I have said it all. There is nothing left to say,” further enforcing her notion that she is boring and confined. “Your mind is confined, as well as your behaviors,” I say, hoping to help her see how she imposes barrier to her thinking which leads her to see herself as shallow. “You say that a lot,” she tells me, with the tone that she needs to hear this  repeatedly, with the hope that one day she will understand better as to why she is so blocked. Josie is engaged in the treatment. She wants to have a fuller  life, while at the same time, her fear of change, and all of what that means to her, is inhibiting her mental exploration. Articulating this internal struggle is our work. One day, I believe, Josie will know herself significantly better.

2 Responses to “Mental Representation”

  1. Shelly said

    Aren’t you afraid of affronting your patient? What happens if the patient doesn’t receive the criticism well? What if you add to their pain?

    • Yes, yes..that is the work of the therapist…to take that risk with the hope of greater happiness down the road. It is that risk taking that distinguishes in-depth psychotherapy from more traditional supportive psychotherapy. That fear is very present but it is offset by the hope of living life in a deeper, more meaningful way. Thanks.

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