Shirah Vollmer MD

The Musings of Dr. Vollmer

Therapeutic Ambition

Posted by Dr. Vollmer on April 6, 2016

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In today’s class we discussed how the goals of the patient are not necessarily the same goals of the therapist. Typically, the patient wants symptom relief, whereas the dynamic psychotherapist wants an understanding of the symptoms in order to achieve a deeper sense of well-being. The patient thinks short-term, while the therapist thinks long-term. This, as Howard Levine MD describes is “therapeutic ambition”. As a parent tries to help a child have a bright future, so a therapist helps the patient, not just in the here and now, but in their future as well. “I just want to stop binging,” Kelly, age fifty, tells me. “I want to understand what binging means to you,” I reply. Through understanding the behavior can lose the power, the compulsive action, as Kelly may no longer feel the need to abuse her body in that way. As I have gotten to know Kelly, we have come to understand that for her, binging was a sign of rebellion, against her rigid and judgmental mom. In an indirect way she was punishing her mom by binging such that as she understood this, she no longer felt the need to eat in this out of control fashion. The therapeutic ambition manifested as a desire for Kelly to understand herself better, in contrast to Kelly’s goal of eating normally. Although Kelly reached her goal, the method had to do with uncovering unconscious motivations and desires, rather than focusing on her diet and exercise routine. Holding to bigger picture is what deep therapeutic work is about. Moving away from symptoms towards unconscious mental processes is the basis for the work. Easy to say and hard to do. that is how the class ended.

2 Responses to “Therapeutic Ambition”

  1. Shelly said

    In the long run, aren’t your goals (those of the therapist and the patient) the same? While the patient wants to stop a certain behavior, the therapist wants to understand the motives of the patient so the patient can stop that behavior as well.

    • Not exactly. The patient wants symptom relief. The therapist wants a different way of managing their world which is more resilient and more expansive. The issue is short-term versus long-term goals. Sometimes the patient wants both, but usually they are focused on the immediate issues. Thanks.

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