Shirah Vollmer MD

The Musings of Dr. Vollmer

The Shame of Ambivalence

Posted by Dr. Vollmer on December 6, 2016

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The grey areas of life tend to be the most anxiety provoking. The desire for a black and white world is universal, and this desire increases under stress. Tolerating mixed feelings, as a parent, as a spouse, as a professional, is the challenge of deepening one’s psychic existence. Tomorrow, as we explore the prospect of building a psychoanalytic practice with new students in the profession, we will discuss how, just like with our patients, the biggest obstacle may not be the fees requested from patients, the time required from the patient, but rather self-sabotage, the reluctance in these students to push forward with their stated goal for career development. Clearly, the patient has fears about deepening psychic work in that the digging up of past experiences can be fraught with pain and anxiety, but perhaps less well known, is the fear in the analyst which makes the psychoanalyst half-halfheartedly promote intense psychological discoveries. According to Roy Schafer, becoming an analyst entails an unending effort that includes tolerating confusing uncertainties about our understanding of our patients and our role in effecting therapeutic change. In other words, the psychoanalyst, but first accept a lack of understanding of his patient, and second accept that if he does understand his patient, he may not be able to bring about symptom relief, or psychic growth. According to RS Wille, the analyst must trust in the relationship between patient and analyst and in the analytic setting as sources of meaning. He suggests that in varying degrees, all analysts struggle to maintain their analytic identity. Lena Ehrlich says we, as psychoanalysts have a reluctance “to recognize the limitations of our influence and how, despite our best efforts, our patients are ultimately responsible for how they lead their lives.” This is challenging work because the psychic arena, the material in the office, as described by Parsons is make up of “symbolism, fantasy, transference and unconscious meaning.” As such, psychic reality becomes the domain, a reality that cannot be proven by fact, but rather can feel right, or resonate with the patient. It is this search for resonance which guides the work, but this search comes with great humility, that resonance may or may not reflect deep meaning. In essence, working as a psychoanalyst stems from a conviction, not a science, not a religion, but a conviction, that engaging with people in a deep way, keeping the patient’s interest in the foreground, allows for psychic growth. This conviction is shake-able, and so we, as psychoanalysts, must allow ourselves to question and consider alternatives, while at the same time, remind ourselves that all intense relationships are ambivalent, even therapeutic ones.

2 Responses to “The Shame of Ambivalence”

  1. Shelly said

    Sorry, but which part of this piece had to do with the shame of ambivalence? I did read about humility, I read about conviction, and ambivalence, but not about shame. And who is supposed to feel the shame, the patient or the therapist?

    • I agree that the title did not come out in the piece. I had intended to say that for a therapist to state that he may not like his work, can, in some psychoanalytic circles, be a shameful admission, as the unspoken rule of psychoanalytic institutes is that working analytically is a huge privilege and therefore it should be cherished and not wished away. There needs to be more room for honesty in the profession, as embracing ambivalence is a hallmark of analytic work, while at the same time, expressing ambivalence about work is not, generally speaking, acceptable.

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