Shirah Vollmer MD

The Musings of Dr. Vollmer

Affective Intensity

Posted by Dr. Vollmer on November 29, 2016

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And so begins again my class entitled “Building A Psychoanalytic Practice”. Some might call this a marketing class, in that the class is designed to help students deepen their work by transitioning some of their patients from once a week to multiple times a week. In so doing, an analysis, or deep psychological work, can occur. The focus of the class is to help students see the barriers, both conscious and unconscious, to working analytically, on both sides of the proverbial couch. One of these barriers is that more frequent visits invite an affective intensity which can be frightening to both the patient and the therapist.  Feeling shame or guilt, for example, can be deeply painful and de-stabilizing, and so there is often a strong desire to paper over these feelings with directives, platitudes and a lot of time between sessions. Increasing frequency makes the sessions less of a “dear diary” and more about “what is really going on here?” Looking down into the bowels of the mind, ultimately results in a more mature view of the world, but in the short-term increases anxiety and causes psychological discomfort. Dealing with difficult feelings, even if it is for the greater good, is the challenge of analytic work. Hence, as I said in my last post, this work is not a “lifestyle specialty,” but rather it demands the capacity to handle so many different types of feelings, the ability to listen and feel, in a way which is both empathic and thought-provoking. The therapist, the psychoanalyst, must facilitate the exploration, the archaeological dig, as Freud called it, in a way which titrates the associated feelings such that the patient is  stimulated to reflect on himself, but not overwhelmed and paralyzed by the experience. At the same time, the analyst needs to use his intuition to comment on how seemingly unrelated events, may, in fact, be related on a psychological level. It is this weaving of the affective domain with the cognitive domain which makes the work of the psychoanalyst challenging on many levels. Like starting chemotherapy, both the patient and the physician might be frightened about what untoward effects might happen, and yet, there are few other choices, for some, if they want to rid themselves of their poor judgment and self-sabotaging behaviors.

2 Responses to “Affective Intensity”

  1. Shelly said

    How do your new, psychoanalytic students actually become prepared to lead the patients on this journey? They themselves are too inexperienced to help their patient in any way. Yes, I know it takes years and years to learn the techniques necessary, but that doesn’t mean that they don’t do it in their training. What about the patients they are treating while they’re learning?

    • That is an excellent question. The class I am teaching entitled “Building A Psychoanalytic Practice” was initially taught to 3rd year students (there are 4 years of classes), but they said they wanted it earlier in their curriculum, so then it was moved to the 2nd year, and they said the same thing, and so then it was moved to the 1st year and so now I have 1st year students (they start in September..so they are very new). Indeed, I am finding it a challenge because learning psychoanalytic technique should proceed building a psychoanalytic practice, so I add technique issues into my class, but I need to think about whether that makes sense or not. In essence, this class is a work in progress. The patients are exchanging a low-fee for having a therapist in training. There are issues there, as you can imagine, but mostly, it is a win-win situation. Thanks, as always.

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