Posted by Dr. Vollmer on March 5, 2014
Anger, frustration, rage, what is the difference? All speak to a profound sense of helplessness and confusion. Molly, thirty-three comes to mind. She just lost her job in the midst of her painful divorce and lengthy custody battle. She yells, seemingly unconsciously, about how her life is so bad and it will never get better. “Do you know that you are yelling?” I ask, because in her screaming she seems detached from her inner world. “I am not angry. I am frustrated,” Molly insists. “Is that an important distinction?” I ask, wondering why she is parsing out her ill feelings. “Maybe culturally speaking, it is not acceptable for a woman to be angry, but it is acceptable to be frustrated?” I suggest, as she thinks about her words. “I just never thought my life would be this way,” Molly says, with the tone suggesting the rage associated with the injustice of the world. “What did you expect?” I ask, wondering why she thought her life would unfold smoothly. “I went to school to have a stable job and I married a man who I thought I could spend the rest of my life with.” she says, as if someone broke the contract which said that Molly was going to have all that she imagined. “It is hard for you to wrestle with your relationship going sour and your job going sour at the same time?” I say, suggesting that all of life involves risk, which, perhaps, Molly denied, up until the time that the pieces began to tumble. “Yes, I was in horrible denial,” she agrees readily, “but what am I supposed to do now?” She begins to scream again. “Maybe if you could reflect on how you got here, you could move forward in a thoughtful way,” I say, knowing that she is hoping I would give her a specific directive, but also knowing that she needs to calm down in order to think clearly. “It is hard when I am so worried about money,” she says. “Well, it will even be harder if you do not slowly consider how you want to navigate this next chapter in your life. The more control you have in making these decisions, the less angry or frustrated you will feel. Molly calmed down. She seemed to envision taking charge of her life, and in this fantasy, she could diminish her tension. Once again, the mind is a wonderful place to visit, even when the journey begins with a horrible sense of constriction.
Posted in Anger, Psychotherapy, Relationships | 2 Comments »
Posted by Dr. Vollmer on August 14, 2012
Shai and Claire, girlfriends for forty years, now in their sixties, just “broke up” Shai tells me with sorrow. “Claire is just angry all the time. It is not my fault that her life did not turn out the way she wanted it to, but she seems to take that out on me and I can’t take it any more. ” I think about unconscious anger, the anger that comes out with the smallest frustration. The anger that seems so disproportionate to the situation. This is the anger that Shai describes in Claire. “Has it gotten worse over the years?” I ask Shai. “Well, it seems to. It actually got worse when I stopped being so accomodating. I used to dance around her anger and try to do things that made her happy so she would not get angry, but it turns out that I always felt like I was disappointing her no matter how hard I tried. ” Shai describes the frustration of what felt like to her to be a one-sided relationship which now she seems to have reached her limit. “It sounds like you feel like you made the right decision about ending the relationship.” I say, detecting Shai’s resolution that she had lost her patience with Claire. “Oh, absolutely, I feel like I made a good decision, but I am still sad about it,” Shai says. “It is like a break up of a romantic relationship. You may have decided to end it, but that does not mean that you are not suffering terribly.” I say, highlighting that friendships can be more intense than long term sexual relationships. “Yea, I feel like I am suffering quite a bit. I am angry with myself for not ending it sooner. I put up with her anger for years.” Shai says, reflecting back on her tolerance for hostility, which she believes decreased the quality of her life. “Why do you think you put up with it?” I ask, wondering about her perception that this was a masochistic relationship for her. “I think that I felt close to her for so many years that I did not want to lose the relationship, so I tried to tell myself that her anger was not so bad, but it was. She sucked me dry. Every time I was with her, I just felt her anger so strongly that it made me really unhappy to be with her. At the same time, we are fond of one another, so it was hard to balance out these conflicting factors. Nevertheless, I feel like life is too short to feel that anger, so I want to move on.” Shai says, with torture in her voice, since she sounds less certain that she is making the right decision. “Why don’t you see how it feels to not talk to her for a while, and then decide if you want to get back together or not?” I say, trying to help her see that time may or may not change her opinion, but she should stay open to that. “I don’t know. At this moment I know that her anger just grates at me, so I can’t take it.” Shai repeats, with the gravity of knowing that long-term friendships cannot be replaced.
Posted in Anger, Friendship, Psychotherapy | 2 Comments »
Posted by Dr. Vollmer on May 1, 2012
Larissa, fifty-eight, got angry at her son for not telling her that he was engaged. Paulene, thirty-three, got angry with her best friend for not calling her back. Luke, sixty-two, got angry with his wife for “never being home.” Each one had a similar philosophy, which was, in essence, “what can I do?” To which, I respond, “you can metabolize your anger. You can see your feeling state as a journey in which if you focus on your feelings you can then understand what it is that upsets you, such that over time, you can make a good decision about whether to confront the other person or not.” I say, with each one looking at me as if the word “metabolize” does not belong next to anger. I strive to describe a process in which there is an internal path which is set off by a hurt feeling. This path gives one information about oneself as well as about the “other.” If one begins this contemplation, with the understanding that over time, new ideas, new feelings, will rise to the surface, then one begins a journey of curiosity and exploration. By contrast, feeling helpless, feeling like one has to accept the hurt, pushes one’s internal state out of awareness, making one vulnerable to unconscious acts of hostility and revenge. Larissa refused to contribute to her son’s wedding, although she denied that her withholding of money was related to her hurt feelings. Paulene did not go to her friend’s birthday party, but again, denied that her absence was related to her friend’s unresponsiveness. Luke “forgets” his anniversary. Understanding feelings, allowing time and reflection to attempt to sort out internal and external factors, deepens one’s sense of oneself, and thereby humanity. Like food going down the esophagus, and ultimately, in a different form, coming out the anus, feelings need to be digested and the toxins need to be expelled.
Posted in Anger, Psychoanalysis, Psychotherapy | 4 Comments »
Posted by Dr. Vollmer on February 8, 2012
Daniel https://shirahvollmermd.wordpress.com/2012/02/07/the-aggressive-child/ is out of control in that he throws chairs when he gets frustrated with his video games. He punches his mother when she asks him to do homework. Is the problem a parenting issue or a mental health problem or both? Although seemingly complex, the issues become straightforward. All children, especially aggressive children, need to have very clear limits: a “holding environment” as Winnicott has taught us. By clear limits, I mean that Daniel has to be told that hitting is not acceptable. He needs help to use his words when he gets frustrated. He needs to be exposed to video games which are age-appropriate. He needs to have guidance with self-regulation when it comes to eating and sleeping. The parents need to make sure that he eats well and has a regular bedtime. They also need to make sure that the school is attending to his academic and emotional needs. Finally, they need to make sure that Daniel is exposed to playdates so that he has the opportunity to learn social behaviors from his peers. When all of this is in place, and Daniel still has problems with frustration and aggression, then the discussion about diagnosis and medication management needs to begin. It is not that Daniel’s parents are responsible for Daniel’s aggression, it is that Daniel’s parents can provide the basic nurturing environment such that we can see that even with a clear “holding environment” whether Daniel can control his impulses. It is hard to know if Daniel can control his impulses when the environment is chaotic and unpredictable. In this latter circumstance, many kids, with or without a mental illness, become anxious and physical. I think I am stating the obvious, and yet controversy ensues. What am I missing?
Posted in Aggression, Anger, Child Development, Child Psychotherapy, Mother/Child Relationships, Neurobiology of Behavior, Parenting, Winnicott | 6 Comments »
Posted by Dr. Vollmer on September 14, 2011
Lateness is an interesting phenomena. Some folks are chronically late, whereas others are always on time. Typically, patients are one or the other. Few people in my experience are occasionally late. Of course, there are issues of traffic and parking, but prompt folks allow space for that, and tardy folks always feel surprised by those factors. Talking to tardy patients about their tardiness usually makes them defensive. I often hear “well, you get paid the same, why do you care?” My response is often, “no one likes to be kept waiting,” although I say that, knowing that this is not new information. I am also aware that the hostility in the comment might need to be addressed.
Cynthia, sixty-four, is consistently twenty minutes late. She is neither hostile or apologetic, but rather she laughs at herself as she walks in, while she says, “I think of your start-time as a suggested time, rather than an actual time.” She then launches into her concerns about her marriage, and how troubled she is by her relationship. I think about addressing her lateness, or dealing with the issue that she presents to me. Most of the time, I dealt with the subject that she presented, but after ten years, I wanted to discuss her time management issues, even though she did not seem particularly concerned about her use of our time together. As I suggested that her tardiness affected our ability to talk about her problems, since we have less time to do that, she responded with intense anger. “You know that I am always late. You know there is nothing I can do about that. You have known this for ten years. Why are you picking on me now? Do you want to get rid of me as a patient?” Cynthia says, looking deeply hurt that I confronted her. “I do feel that our relationship can handle this confrontation. I wanted to talk about your tardiness for a long time, and I thought that since your life was relatively stable, this would be a good time to talk about that.” I say, knowing that Cynthia is feeling fragile since I held up a mirror to her tardiness.
“If I came on time, would things be better?” Cynthia says with hostility and sarcasm. She is implying that more time with me would not be more helpful. “I don’t know, but we could try that out.” I say, trying to explore her ambivalence towards me. “I am not happy with how our relationship has changed.” Cynthia says, referring to my confrontation about her time management. “I can see that,” I say, wondering how this chapter in our long relationship will play out. My inserting this agenda into our session had a bigger impact than I had imagined. Upon reflection though, I can see that Cynthia’s chronic tardiness must be deeply rooted in chronic pain which causes her to avoid getting help from her therapist. Her defensiveness supports that conclusion. I hope we can work our way through this. Time can be a sensitive subject.
Posted in Anger, Psychotherapy | 8 Comments »
Posted by Dr. Vollmer on July 22, 2011
Claire, sixty, calls her girlfriend Shai, opening the conversation with “you didn’t call me back.” Shai did not know that she owed Claire a phone call and besides that, she was annoyed at the hostility directed at her. They had a short conversation, followed by Shai calling Claire back and opened the conversation with “I felt like you scolded me.” Claire, completely taken aback, says “what are you talking about? I thought you were going to call me back and you did not and so I called you.” Shai, knowing that she did not say she would call Claire back said “well, first of all you did not listen to me when I told you I was not going to call you back. Second, it is hard on me when you start a conversation in such a hostile tone.” Claire, again, shocked by this discussion continues to be defensive, “gee, I don’t know how else to put it. You did not call me back and I thought you would.” Shai, amazed at Claire’s lack of social skills, says “the problem is your tone is very hostile.” The conversation took a major shift. Claire replied, “I do feel angry that people don’t respond to me, but I did not know I was expressing that in the phone conversation.” Shai, immediately warmed up to Claire. “I can certainly understand how bad it feels not to be responded to.” Shai has now changed from feeling contempt for Claire, to very bonded with her feeling that she is dangling in the world without a feeling of being important to someone. By the end of the conversation, Shai and Claire were really glad they were friends. Shai ended the conversation by saying “it is so nice to be able to be real with someone. Most of the time, I just suck it up when someone hurts me, but you and I have been friends so long, I did not want to carry around this resentment. I am really glad I called you back.” Claire agreed heartily. Once again, anger was a passing stage from a bond almost breaking to a bond deepening.
Posted in Anger, Friendship | 2 Comments »
Posted by Dr. Vollmer on July 21, 2011
Karen, sixty-two, sees me twice a week, like clockwork. Recently, I had to change one of her times, an action I resist, but I had no choice. “That’s OK, I will just come one time next week. It does not matter.” Karen says, with hostility that hits me in a way that is consistent with her quiet way of being angry. The following session she says “I don’t know what to talk about,” again, I am feeling a passive-aggressive feeling where she resigns from initiating a discussion, but she is mad that not more happens in psychotherapy.
“I have been thinking about our last session,” I say, making her look surprised. “When I was sorry to have to change our schedule, you said it did not matter and that made me think that you were angry.” I said, expecting her to be taken aback by my comment, but instead she said “of course, I am angry. Wouldn’t you be?” “I am not sure what you mean,” I say, knowing that Karen’s style is to obscure what she is talking about by not telling me her entire thought. “My life is ruined. My husband walked out on me. My kids are doing their own things. I am old. I am fat. I am lonely. Of course, I am angry.” Karen says, with tears running down her face. The tone changed dramatically. Her sadness came through after her anger subsided. Instead of feeling devalued by Karen, I began to feel her pain. She was struggling and her anger was her defense.
“I can see why you are angry,” I said. “It seems like your life is not what you expected it to be; not what you want it to be.It also seems like you don’t feel much hope that you can make it better.” I said, feeling like I was understanding her feeling state. I began to learn more about her childhood, as she told me how she felt her life was going to turn out when she was growing up. She wanted to share with me how she felt about her mom and dad. I felt like we surprisingly opened up a new chapter in our relationship. She did not seem angry. She was comfortable sharing her history. Anger is pretty interesting; there is always some deeply meaningful material behind it. Anger, to me, feels like a door. Sometimes they are hard to open, sometimes pretty easy, but either way, when you can get in, there are rooms to explore.
Posted in Anger, Psychotherapy | 5 Comments »