Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘Attachment’ Category

Re-Posting Because of Today’s LA Times: Father Boyle

Posted by Dr. Vollmer on January 26, 2014,0,3300815.column#axzz2rYqlcmp4

Previous LA Times….,0,5754852.column

Father Gregory Boyle, a jesuit priest, , and reminds me of my earlier post Father Boyle knew intuitively that when gang members can find an alternative sense of belonging they can find a new way to be in the world. He proves, through his life’s work, the value of attachment. He invests emotional energy in “kids” who have never “experienced dignity before.” By dignity, he means that when one begins to respect the individuality of these gang members, then the adolescent can change their lives and contribute to society. He gives them work skills and in so doing he proves to the ex-gang members that they have hope to make their lives better. In my mind, he re-parents these young adults such that these youngsters can “navigate the treacherous waters of their lives.” As Father Boyle says “people say I give them a second chance, but I say, it is really a first chance.” “Gang members are coming from a place of despair” he says. Without formal mental health training, Father Boyle recognizes the essential need to have a family that instills hope in the future. He teaches coping skills, parenting skills, and responsibility such that they can deal with the challenges of their world. His work inspires therapists to work on a one on one basis to change lives, by believing in their client, such that the client can eventually change course and live in the world in a new way. Inspiring.

Posted in Adolescence, Aggression, Anger, Attachment, Belonging, community psychoanalysis, gangs, Musings | 8 Comments »

Mom Dies. Appointments Missed. What’s Up?

Posted by Dr. Vollmer on September 4, 2012

Sherry’s mom, age seventy-five, just passed away after a short battle with a brain tumor. Uncharacteristically, Sherry misses multiple appointments. I wait for her, and then about five minutes before our appointment will end, she calls to say she can’t come. She overslept, there was too much traffic, or she just did not make it out of bed. “This seems to be related to your mom’s passing,” I say, knowing what a huge and devastating loss this has been for her. “Yea, maybe, but I don’t see how,” Sherry says in a barely audible tone over the telephone. “Maybe you are just withdrawing since you feel that attachments are so fleeting.” I say, pointing out that loss of important people make it hard to stay connected with others for fear of losing them too.  “Maybe I just should not come any more,” Sherry says, not seeming to really mean what she says. “I don’t think now is a good time to make decisions,” I say, stating the obvious, but also knowing that Sherry might be looking for reassurance that I still want to be a part of her life. “Yea, of course,” Sherry says, “but I have to get my act together,” she states with anger towards herself. “You will,” I say, feeling that this is a deep period of grief, which at some point, not sure when, will pass.

Posted in Attachment, Psychoanalysis, Psychotherapy | 8 Comments »

Parenting Your Spouse

Posted by Dr. Vollmer on August 29, 2012

Lizelle, fifty-four, three grown children, is staring what some folks term the “third chapter,” the time in life where her kids are financially independent, living outside the nest, and she now has the opportunity to explore more self-centered activities. Here parents are elderly, but independent. She has no grandchildren. Her vision of this phase of her life was one in which she would “find herself,” meaning she would discover a passion. She imagined a life where she re-lived her adolescence, exploring things she never ventured into before. To her surprise, her husband , Tom, of thirty years, steadily employed, began to appear sluggish, although he denied any mood symptoms. Lizelle felt like she had to parent Tom. “I can’t believe it. I feel like I have to get him off the couch and introduce him to ‘after-work activities,’ in the same way that I pushed my daughter into not just coming home from school and vegetating in front of the computer. I feel like I have to insist that he find something he enjoys outside the house. This makes me feel like I have a child and not a husband,” Lizelle laments.  “Maybe part of marriage is parenting one’s spouse from time to time,” I say, contradicting the notion that Tom is childlike, and introducing the notion that marriages have many different modes, and one mode that can pop up is a parent/child type of interaction. “This can go both ways. The need for nurturing does not mean that your marriage is bad.” I say, trying to help Lizelle look at her situation from a different perspective. “I think you are frustrated because in your fantasy life you became an adolescent, so you did not factor that you are still responsible for your husband so you are not as independent as you thought you would be.” “Yes,” Lizelle responds enthusiastically. “I managed to create a fantasy in which I was single.” Lizelle says, laughing at herself, while she realizes that it is obvious that in relationships, people need each other from time to time. “I think I am just a selfish human being,” Lizelle says with a tone of sarcasm, but also expressing a wish that she could be more selfish. “That is not a bad thing,” I say, noting that there is a time for selfishness, in addition to a time for nurturing. “The balance is the challenge.” I say. “Yea, yea, yea,” Lizelle responds.

Posted in Attachment, Parenting, Psychoanalysis, Psychotherapy, Relationships | 5 Comments »

The “A” Team

Posted by Dr. Vollmer on July 17, 2012

“I would have been happy if my mom did not die when I was twelve,” Eliot, age thirty, says with a bold and straightforward sense of truthfulness, without the expected sadness that such a strong statement implies. “I have a lot of friends, but I just don’t feel supported,” Fred, age twenty-five, says about his emotional well-being, implying that his family of origin has emotionally abandoned him. Both Eliot and Fred lack the “A-team” I tell them, saying that a parental support system is something that one needs throughout life. There is this craving for nurturing and care taking that only a parental figure can provide. This parental love, I explain, is this asymmetrical relationship where the parental figure wants to see the childlike figure flourish to the best of his ability. This relationship is sometimes created in adulthood  through mentorship,  through marriage, and/or through psychotherapy, but friendships rarely create that kind of sustained nurturing. The lack of this parental feeling creates in both Eliot and Fred a sense of “missing,” despite having so many other important relationships in their lives. “It is hard to tell people that you wish you had parents, meaning people in your life who cared for you in that nurturing way,” I say to Eliot, as he begins to cry. The loneliness of this missing, and the difficulty in conveying this absence, is so deeply painful. “Everyone needs an ‘A’ team,” I repeat to Fred, who often wonders why he is so despairing at times. “Yea, and I don’t have one,” he says with dismay, communicating that his family of origin has let him down and that he does not feel like our relationship serves that function for him. “Maybe you will be able to create one,” I say, hinting that he can cultivate relationships, including ours, to help himself feel more loved and cared for.

Posted in Attachment, Loneliness, Psychoanalysis, Psychotherapy | 4 Comments »

Slippery Attachment

Posted by Dr. Vollmer on June 13, 2012

Sherry, fifty-three, says “if I am gone for three sessions, I think you will forget about me.” Stunned, I look at her. “I know we have worked together for seven years and I know that I have never missed an appointment, but I still think that if I did not come, you would no longer think about me.” “You really feel that our attachment is that slippery,” I say, amazed on the one hand, but aware that her primary attachments to her early caretakers were unstable and this is a likely explanation for how she feels about our relationship. “Yes, I do,” she responds with a seriousness and a sadness which makes me feel for her. I think about what it must be like to  feel that our relationship could evaporate almost instantaneously. I am aware that the world must feel so scary if all attachments seem so fragile. Suddenly, I think of her anxiety in a new way. I see that she is unable to create a safety network of relationships because she has no faith in their stability. Her introverted nature, and her poor treatment of her friendships now begins to make sense to me. One has to have a belief that friendships, that connections, are vital to well-being, in order to preserve and nurture relationships. Our work together gives her hope that maybe, just maybe, I will give her a foundation in which to believe that relationships can be stable, fulfilling and growth-promoting. Sometimes Sherry believes this and sometimes she does not. The wave of trust floats in and out of our relationship-right now, but hopefully not forever.

Posted in Attachment, Psychoanalysis, Psychotherapy, Relationships | 2 Comments »

Re-Posting Since I Am Wonderin’ When Is It Witholding and When Is It Lying?

Posted by Dr. Vollmer on May 4, 2012

Monte,, dismayed over Marla’s lack of support for his teaching, wonders with Marla, before they “broke up” how he will ever be able to take part in teaching so long as Marla is the person he is supposed to turn to for help. After all, Marla is the head of the faculty committee.  Marla agrees that this is an “issue”. Monte and Marla then sever their relationship, leaving Monte adrift. Eventually, Monte finds other avenues to direct his professional energies and he settles into a new routine.

Buying tomatoes at the local Farmer’s Market, Monte runs into Gigi, a colleague, who tells Monte that Marla has retired and now she  is going to be taking over the leadership  in the next academic year . Monte, stunned, says “when did this come down?” Gigi says, “oh, we got together and we decided this about a year ago.” Monte, still almost speechless says “has this been announced?” Gigi says “well, at a meeting, I told people.” “So, there was no email announcement?” Monte asks. “Right, it was not handled well” Gigi agrees.

Monte goes back in time in his mind and determines that Marla could have told him that there would be a regime change, thereby allowing  Monte  to  have the option to stay involved on the committee. “Why didn’t Marla tell me that?” he asks himself.  As in,, Monte realizes that information is power. So long as Marla has knowledge that Monte does not have, Marla can feel in control. To let Monte know that there is going to be a regime change, weakens Marla’s place of authority. Monte understands that Marla, for her own reasons, needed to hold on to the power of knowing something that other people did not know. Monte believed that Marla had a hard time giving up the power and so to say it aloud was difficult for Marla. Still, Monte felt that Marla was being cruel to let Monte suffer in this way.

Personality, the way a person interfaces with his world, is often learned in layers. Even though Monte had known Marla for years, this aspect of  Marla’s personality where she used  information as a source of power, was new to Monte. However, in thinking over their relationship, Monte began to realize that there had been other sensitive times when Marla was withholding. He remembered that sometimes Marla would have a long vacation planned and “forget” to tell him well in advance. Monte began to reframe this “forgetting” as yet another example of Marla withholding. Monte wonders whether Marla’s need to exercise power in this way is a reflection of Marla’s overwhelming sense of impotence. In thinking about it, Monte began to have some sympathy for Marla, but at the same time, he was angry and hurt over her behavior. Despite years of an intense relationship with Marla, Monte felt that this chance encounter at the Farmer’s Market added yet another dimension. Despite Monte’s pain, Monte could stand back and see the layers to the deceit and the cruelty. Maybe Marla helped him after all.

Posted in Attachment, Monte Marla, personal growth, Personality, Psychoanalysis, Psychotherapy | 5 Comments »

The Aggressive Child

Posted by Dr. Vollmer on February 7, 2012

Daniel, six, with a two-year old brother, Jonathan, knew that Jonathan was the favorite. He was angry when Jonathan was born, very angry. Daniel acted out his anger with aggression, which further confirmed to Daniel’s parents, that he was the “bad child.” This was my theory as to why Daniel was so violent, both at school and at home. Many teachers, family members, and other professionals saw his aggression as either part of a “spectrum” disorder or an impulse-control disorder such as ADHD. In my office, Daniel was indeed quite aggressive. He would take off his shoes so that he could throw them at me. Yet, I saw his aggression as a way that he communicated that his emotional needs were not getting met, and he needed me to understand that. I explained to Daniel that throwing his shoes was unacceptable in that I did not want to get hurt and I  did not want him to hurt others. We could use my pillows to “play” in a way which might get out some of his aggression, but we could not use the pillows to hurt each other. He understood the fine line between physical play and aggression. Eventually, Daniel calmed down in my office, but he continued his aggression at school and at home. With that in mind, I began seeing his parents on a monthly basis. Both the mother and father agreed that Jonathan was a “much easier child,” suggesting that they did favor him at home. Jonathan made them feel like competent parents, whereas Daniel, partly because he was the first-born, and partly because he was more prone to acting out, made them feel like they were “parental failures”. I worked with the parents to help them see that as they felt like “parental failures”  where it came to Daniel, they then unconsciously encouraged Daniel to be aggressive as a way of denying their role in his behavior. As Daniel got into more trouble at school, the parents felt more relief that Daniel had “issues,” thereby taking away their feeling of “parental failure”. The cycle of parental inadequacy leading to the unconscious wish for Daniel to show that his issues are “organic” and not environmental caused the downward spiral of increasingly difficult behaviors. However, I pointed out to them that although Daniel’s behavior is getting worse, in my office, his behavior is getting better, suggesting that with appropriate limits, Daniel can calm down. Winnicott’s idea of a holding environment comes alive again. Daniel felt “held” in my office, so he did not need to be aggressive in order to feel understood that his emotional needs were not getting met. Daniel’s parents, for complicated reasons, were not able to create this “holding” environment at home. Violence is often a communication tool; a tool to wake up those around that the aggressor needs attention. Sometimes people do not want to be woken up. My work is to find a way to gently nudge a “wake-up” in these parents. I suspect that when I do arouse these parents, Daniel will be “cured”. We will see.

Posted in Aggression, Attachment, Child Psychiatry, Child Psychotherapy, Parenting, Play, Winnicott | 4 Comments »

Birth Order

Posted by Dr. Vollmer on January 4, 2012

   Marty, now fifty-four,  was born the third of four children and the second boy. His parents, Bob and Marilyn, did not set out to have a large family, but “somehow it happened,” Marty relates to me. Marty’s older brother Warren, the first-born son, seemed to be the boy his parents always dreamed of. He was smart, athletic, social and motivated for financial success. Marty, by contrast, struggled in school, did not like sports, and was painfully lost about his future. As an adult, Marty’s insecurities are painful. He never feels entitled to assert his opinion. He quietly resents that other people in his life, his kids, his wife, steamroll his ideas, making him feel foolish for making even minor suggestions, like where to go for dinner.

  “Maybe the circumstances of your birth have something to do with your insecurities now,” I suggest. “Maybe if you were the first-born boy, you might have felt more cherished and hence you might have had more confidence in your ideas.” Marty looks at me with dismay and confusion. “You mean to say that my parents messed up my life because they liked my brother more?” Marty asks with disbelief. “I mean that maybe in the context of your family, your strengths were not in the foreground and so you were made to feel like you had to blend in or else you would be an unwanted part of the family. As a result of having to blend in, you never formed your own opinions, and as such, you now do not feel entitled to be assertive with your ideas.” I say, suggesting this as a possible explanation as to why he always feels invisible in his current nuclear family.

“You are terrible to suggest that my parents’ did not love me,” Marty says, as if I want to ruin his idealized image of his parents. “I am not saying they did not love you, but I am saying that they might have loved you in a different way if you were born in a different order.” “I will chew on that and then poop it out,” Marty says, trying to lighten our discussion, but also reassuring me that he will think about what I am saying. “Let me know how that goes for you,” I say, continuing with our fun word play with the notion that good food turns into feces.

Posted in Attachment, Birth Order, Siblings | 4 Comments »

‘Why Do I Want To See You Everyday?’

Posted by Dr. Vollmer on October 4, 2011

    Luke, twenty-four, comes twice a week and has for six years. He has dedicated himself, with the financial support of his parents, to “working on himself.” He is never late; he never forgets, despite our changing times given his changing work and school schedule. He is my prime example of how our next generation can be responsible, reliable and motivated for self-improvement. Over the past six years he has “hated me,” “loved me” and he has felt that I was “annoying and too motherly” towards him. Positive feelings, negative feelings, neutral feelings never seem to change his commitment to our process. He almost dropped out of high school since he could hardly get out of bed to go to school, but now he is in medical school, soon to be a caretaker of others who need his services. His parents told me that they feared that with all of this psychotherapy he might want to become a psychiatrist, as if that would be a bad outcome. Luckily for them, he is on his way to being a surgeon. As he says, “I have little interest in talking to people. I would hate to have to deal with people like me who yell and scream at you like you are their mother.” I almost felt that to be an apology for our many rough times together, but he has no need for remorse. We agree that we are engaged in an honest struggle of working together, and frustration and anger, are inevitable. Both of us have shared behaviors that make us  wish we could have been more circumspect and controlled.

   “Why do I want to see you everyday,” Luke asks me in a way that was sweet, endearing and challenging. “You are evolving and you are having growing pains,” I say, explaining that he is now going through an emotional growth spurt where he is trying to decide which of his many flirtatious encounters he wants to pursue as a more serious long-term relationship. With a huge smile, he says “gee thanks, Dr. Vollmer. That makes me so happy to hear that.” Suddenly, I framed Luke’s pain as a means to a deeper end, and so suddenly he went from feeling bad about his indecisiveness to good about his thoughtfulness. Luke has had a lot of trouble with relationships. He has often liked girls who like him, rather than considering his own feelings towards them. Consequently, he has grown quickly dissatisfied with most of his intimate experiences. As we explore his own desires in a relationship, he has become more cautious about entering into monogamous love affairs. Now, Luke has to tolerate loneliness in ways in which he defended against before by constantly being in unsatisfying relationships. His perceived need to see me daily reflects his new challenge to manage these difficult feelings. I saw the growth and then commented on it in a way in which we did not have to meet more often; we just had to understand the need.


See also….

Posted in Adolescence, Attachment, Feelings, Psychotherapy, Relationships | 16 Comments »

Relationship Drama

Posted by Dr. Vollmer on September 16, 2011

      Joe, twenty-two, Jaclyn, also twenty-two,  just had a big fight in their apartment in New York. Jaclyn was throwing dishes at him. Joe was telling her she is “crazy.” Jaclyn, by her report, goes to see a psychiatrist shortly thereafter and she is diagnosed with bipolar disorder and placed on the mood stabilizer Lamictal. She calls her parents who are “very uncomfortable with mental health care,” as Jaclyn reports, and they begin to embrace this diagnosis. They read about it. They tell their friends. They give her a lot of support now that they see her issues as “medical.”  A few months later, Joe and Jaclyn go at it again. This time, Jaclyn wants to come home to Calabassas. I see Jaclyn and I question her bipolar diagnosis. “It seems to me that you had stress in your relationship and you became violent. I am not hearing any other history of bipolar symptoms,” I say, thinking that this is a common problem, where heated emotional moments in a young person get characterized quickly as bipolar disorder; at least that is the way it seems to me, of late. “I am hearing that you and Joe were hurting each other feelings, and one time you responded to those hurt feelings with violent behavior.” I say, trying to show Jaclyn that her behavior might be a result of her pain in the relationship, and not necessarily a chronic mental illness.

     Serena and Enzo, also both twenty-two, also just got in a big argument, where Serena was physically attacking Enzo while he was driving. “It was dangerous and scary,” Serena reports to me. “I just lost it with him. I was so mad. I asked him to take me home, but he wouldn’t so I started to hit him. I just could not control myself.” Serena tells me with some regret, but also with a sense of justification. In the past, Serena has been diagnosed with Borderline Personality Disorder, but I did not agree.  As such, I said,  “it sounds like you were so disappointed that you needed Enzo to see how you were feeling, and that you wanted to go home, such that when he ignored your plea, you became very frustrated. That frustration, led to violence, which you used to do as a small child towards your siblings, and now you are doing it with Enzo.” I say, trying to help Serena understand that she was in pain because of Enzo’s poor responsiveness, but her tendency towards violence, seems to stem from patterned behaviors which she did as a child. “In other words,” I continue, “this episode with Enzo, where he did not listen to you, reminded you of so many times when your mom did not listen to you, such that in the past you would have taken that frustration out on your little brothers, here you took it out on Enzo.”   

   The quick trigger to diagnosing bipolar disorder, or personality disorder in young adults often stems from the heated nature of their relationships. Both Jaclyn and Serena acted strongly to hurt feelings within the context of disappointments with their boyfriends. This strong reaction does not give evidence of a psychiatric diagnosis, but rather the reaction sheds light into the psychodynamics of Jaclyn and Serena. They are each acting out the past and the present, within the framework of a loving relationship. Their behavior helps me to understand how their minds work in the event of stress and disappointment. It does not give me reason to think that they are mentally ill. Young people are new to relationships, and as such, they bring an intensity which often leads to the roller coaster quality of their dynamics. Time, experience and maturity tend to mellow them out with age. The diagnoses do not disappear as they enter the next developmental phase; this is the value of waiting to see how the next chapter plays out before placing a diagnostic label on an emerging adult. My hunch is that both Jaclyn and Serena will be fine. They are struggling with how to maintain love in their lives, while still feeling strong and valued. I admire their energy in defending their sense of themselves, even though this energy may be misplaced at times. These tender relationships will shape their emotional lives; it is my privilege to be on the sidelines.

Posted in Anger, Attachment, Psychotherapy | 2 Comments »

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