Shirah Vollmer MD

The Musings of Dr. Vollmer

The Internal Analytic Frame

Posted by Dr. Vollmer on April 13, 2016

Parsons (2007) suggest that “the analytic setting exists internally as a structure in the mind of the analyst”; it is “a psychic arena in which reality is defined by such concepts as symbolism, fantasy, transference and unconscious meaning”. Whereas the external frame is focused on time and money, the internal frame is defined by privileging the notion that so much of human motivation is beyond awareness and as such, our behaviors confuse us, depress us, and sabotage us leading to uncomfortable feeling states. The combined effort of patient and therapist to understand motivation, often based on repressed past experiences, leads to an opening up of mental doors and a release of compulsive behaviors. In so doing, the patient not only gets symptom relief, but also a way of being in the world which feels expansive and exciting as opposed to constricted and limiting. As with Lacey from my previous post, the notion of limited time and money is often a metaphor for the limitations of one’s mental existence. It was only when she hurt her knee that she could see the parallel between physical limping and mental limping. Complicated knee injuries often require intensive work with a physical therapist, and so complicated mental suffering requires intensive work with a psychotherapist. The meaning of the symptoms is the holy grail, not the resolution of them. As such, diagnostic classification is far less important than a case by case approach to mental suffering. Geneticists like to say that depression is a “heterogeneous disorder”; a phrase I find amusing given that a “heterogeneous disorder” means that each case stands alone and to date, no one can identify a common thread. Psychoanalysts, on the other hand, search for the underlying meaning and importance of this psychic suffering.   Haley, sixty-one, comes to mind. She lost her husband twenty years ago, and by her report “she misses him every day and she is sad all the time.” “Why do you think you need to keep him top of mind?” I ask, wondering what her husband meant to her. Would she feel she betrayed him if she were to feel happy again? I wonder silently. Her sadness persists for a reason; a reason she is yet to understand. The conviction that together, Haley and I can come up with some ideas about why she remains psychically glued to her late husband, is the internal analytic frame. I do not mean to say that Haley could not benefit from medication, but that does not change the notion that deeper understanding of her symptoms will free her up to have multiple feelings and  in so doing she will be less stuck in her sadness. This invisible conviction, this internal analytic frame,  is the backbone of deep psychoanalytic work, regardless of the frequency of visits.

2 Responses to “The Internal Analytic Frame”

  1. Shelly said

    What would happen if you gently suggested to Haley what you so eloquently wrote in this blog, i.e. “Would Haley feel she betrayed her husband if she were to feel happy again?” Perhaps initially after his death, she felt sad and worried that her feeling happy was a sort of betrayal, but then she simply got used to it. Maybe she worried about how people would perceive her and her marriage if she “got on with life,” and that’s why she, 20 years later, can’t move on. Or maybe it really is a chemical imbalance and she simply needs medication. Yes, all the maybes are the fun of psychoanalysis and the reason why Haley needs help.

    • Your question is the work…asking a question..not to be “right” but to see how it lands on her. The intense observation after I venture a thought creates further inquiry as to what my idea meant to her and how she heard it. It is not that I am looking for Hayley to agree with me, but I am looking to stimulate a conversation, to speak the unspeakable, as a way of taming difficult and complicated feelings. All of the above could be true, so the goal is understanding the layers and helping in ways which alleviate suffering, which, as you say, might include medication.

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