Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘Relationships’ Category

Piano Lessons/Psychotherapy: Striking Similarities

Posted by Dr. Vollmer on April 8, 2013

 

In this week’s New Yorker, Jeremy Denk writes about his piano teachers, as he also talks about in the video above. He talks about his teachers changing his life, enabling him to hold on to paradoxical advice. One teacher tells him to follow his intuition, whereas another tells him to pay attention to detail. Holding on to these notions is the challenge of creating great music, he says. So, working with the emotional interior requires working with  the same contradiction. One must learn to be free to fantasize, while at the same time, maintain the responsibility and regimentation of a civilized society. What struck me most about this article was how his mentors shaped him,but also humiliated him,  in ways which he struggles to describe, in a parallel fashion to psychotherapists who try to understand their patients, while at the same time, not shame them. Once again the relationship, the attachment, the respect, creates personal and professional growth. Although these connections often cause great inner turmoil, they also create a lasting impression of loving advice and guidance. Music is the window into the soul, so it makes sense that learning music and going to psychotherapy are strikingly similar activities.

Posted in Mentorship, music and the mind, Musings, Relationships | Leave a Comment »

The Forgotten Aunt

Posted by Dr. Vollmer on April 2, 2013

 

Zoe, from my previous post about siblings, gets the sudden, although not surprising news that her father is in the hospital. Sean, eighty-six, has multiple medical problems, but still, it always catches Zoe by surprise when there is a medical incident. This time, Sean had pneumonia, requiring an inpatient stay. Zoe goes to visit and she begins to wonder about her dad’s sister, an aunt, that she has no memory of ever meeting. Sean tells Zoe to call Aunt Fay, and so within minutes, both Zoe and Fay are crying on the telephone. Fay, ninety-two, tells Zoe that she thinks about her every day and that she has kept up on Zoe’s life by her daily phone calls to Sean. Upon hearing about Sean’s pneumonia, Fay immediately says “it is because he is with all  those women. You have to tell him to slow down.” Fay tells Zoe, as if the two of them are close. Zoe leaves from seeing her dad deteriorate suddenly, with sadness, along with the odd happiness of “meeting” her 92-year-old aunt. Zoe talks to me about her mixed feelings with a heavy heart, both in terms of her dad’s deterioration and in terms of her yearning for a part of her family she never met. Zoe explains to me that her mother, Claudia, did not like Fay. Claudia never allowed her children to spend time with her, and Sean, although very close to Fay, agreed. Zoe, still recovering from her emotional wounds from Berkeley, is further faced with her family dynamics in which there were deep divides. Suddenly Zoe has another memory from her conversation with Fay. “You know she said that my mom never let us meet because we looked alike and we are both really pretty. It was such a strange comment, but I do look like my dad’s side of the family, and that could have something to do with why my mom treated me poorly.” Zoe says, with wonder, as if she does not quite believe her own words. Zoe is now immersed in more family dynamics because she cares for her dad, but this forces her to interact with her siblings. I listen and I imagine Zoe’s subjectivity. I imagine Zoe, with her dad’s illness, thrown back to her childhood memories, which bring up lies, betrayals, and heartless attempts to create children who reflect well on their parents. Once again, listening is a deep experience, like reading a good novel, takes me to a deep place, filled with my thoughts and associations to Zoe, both the Zoe of the present and the Zoe of the past.

Posted in Families, Psychoanalysis, Psychotherapy, Relationships | 4 Comments »

Is Dating About Marketing?

Posted by Dr. Vollmer on March 4, 2013

“Maybe dating online is about marketing,” I say to Cara, forty-seven. At first, she looks at me surprised, as if to say that she is in psychotherapy to understand her dynamics and not to get strategic advice about the internet. I understand her look, but I am thinking that the “connections” people make with online dating create a projective experience. At first, there seems to be the tremendous hope that with a few clicks they will meet their “soul mate”. Then, there seems to be the tremendous anger when the “other” disappoints in some way. The associations to each email create tremendous vulnerability. Rejection is felt when this electronic other does not respond promptly or warmly, and yet, this electronic other is not a known entity, merely a fantasy created by electronics. “Many people post who they want to be, not necessarily who they are,” I say, trying to understand how such intense feelings can be generated by such shallow “relationships.” My question is meant to understand the emotional meaning of the search for the “other,” and hence the painful feelings which seem to follow when the email chain breaks down. Cara begins to understand what I mean, but she looks to me for reassurance that she will find someone eventually. Fear runs through the room at those moments. The omnipresent notion that we cannot know or control our future rises, yet again. The anxiety of not knowing is often made better by trusting someone who seems to “know”. In this case, Cara has given me that job. If I tell her she will find someone, she will calm down, as she trusts me. On the other hand, if I tell her that she is looking for reassurance, when, in fact, none can be given, then her anxiety will increase. I explain to her my dilemma and she understands, but she still wants me to tell her that her future is bright. “The more you pay attention to your own needs, the better your life will be.” I say, pointing out that she can control her behavior towards herself. “Maybe marketing yourself bypasses the fear which inhibits your search,” I say, again wondering that perhaps her anxiety is interfering with her openness to new relationships. “Yes, I am almost phobic, at this point,” as she sees how she has limited her search to criteria that almost no one can meet. “OK, I am glad I came today,” she says, as if in the beginning she was not so sure. “You helped me a lot.” she repeats as she walks out the door. Cara appreciated our discussion because she began to see how she was adding in her own fantasies about these people, which then led to pain and self-doubt.

 

 

Posted in Relationships | 7 Comments »

Seeing Signs: Is Pessimism So Bad?

Posted by Dr. Vollmer on February 28, 2013

Relationships evolve, with foreshadowing in the beginning, honeymoon stage, where upon reflection, we are usually not surprised when a dear friend, a loved one, lets us down. Heather and Claire are new girlfriends. They were off to a club, but Heather forgot to write the address so they never made it to their intended destination. Claire was angry and disappointed with Heather and they had a verbal altercation. Weeks later, Heather has “forgotten” the incident and feels that Claire is a deep and close friend, even though they have known each other for two months. “I think you should be thoughtful about Claire and understand her sensitivities,” I say, trying to help Heather have a clear view of the dynamics of this friendship. “Why are you so pessimistic?” Heather asks me, as if I had said that since Claire was intolerant of your mistake then the relationship is going to have problems. “It is interesting that you call me pessimistic, since I was not thinking in those terms, but I do think that seeing a sign that says ‘potholes ahead’ does not make one pessimistic.” Heather understood that, but she also expressed how much she wants to be close friends with Claire. “Wanting a friendship is not the same thing as having a friendship, so you will see how things deepen over time,” I say, trying to help Heather see that relationships are a journey which need to be monitored, but  can’t be controlled.  Heather knows this, but she also is yearning for the security of a loyal relationship. This yearning is both shameful and exciting for her. She is happy to have a new connection, but her neediness makes her feel bad about herself. A part of her wishes she did not need friends, and in this shame, she is hoping she can have a ‘fast friend’ so that her yearning does not scare anyone away. Heather’s  wish and  fear for  connection are fighting internally. Consciousness of this battle will help. Heather, reluctantly, would agree.

Posted in Psychoanalysis, Psychotherapy, Relationships | 8 Comments »

Does Therapy Ruin A Marriage?

Posted by Dr. Vollmer on January 24, 2013

Ten students, two absent, made for a vibrant class discussion last evening. My class is titled  “Psychoanalytic Technique”. My students have engaged in a two-year Psychoanalytic Psychotherapy program, in which they attend class from 5:30 pm to 10:00 pm every Wednesday night for two years, with a two month break in the summer.  There are psychiatrists, social workers, MFTs and psychologists, all together with a common purpose: trying to understand how to help folks who suffer. As per my previous posts, our class began with understanding Transference. Yet, as the conversation unfolded, in ways that are interesting to reconstruct, we went down a path in which we outlined how if one person in a couple goes into treatment, that it could, cause significant relationship tension for a variety of reasons. If, for example, there is a ‘idealizing transference’ then the partner in the relationship could begin to feel competitive with the therapist. Alternatively, if the patient experiences significant personal growth, then he/she may turn to his/her partner and feel a large emotional disparity in terms of their maturity levels. Of course, this change in maturity level can happen in any relationship, but psychotherapy is one way in which that can happen. “Should the therapist feel good or feel bad if patients who come to therapy without conscious issues with their life-partner, but over time, develop these issues?” One student asks, highlighting the dilemma, that therapy, as the movie suggests is a “Dangerous Method”. “Therapy is a journey,” I say, “and so we never quite know where we are headed. As Freud instructed his patients, therapy is like a train ride where we narrate what we see out the window, not knowing what is coming next.” My students were sophisticated and intelligent, and clearly dedicated to their work. These classes don’t increase their prestige or their fees. This is a labor of love, for all involved. Yet, at the same time, all of us in the room are aware that our good intentions sometimes cause others, either in the consultation room, and/or their collaterals, significant distress. “Personal growth is a challenging experience,” I say, “and next week we will talk about ‘resistance,’ the unconscious fight against such a challenge.” I do learn by teaching. The adage holds up.

Posted in marriage, Psychoanalysis, Psychotherapy, Relationships, Teaching, Teaching Psychoanalysis | 7 Comments »

The Cost of Therapy

Posted by Dr. Vollmer on January 15, 2013

Alexander, seventy-two is spending his retirement money on therapy. His friends and family tell him he is “crazy”. “They don’t understand that I have very strange and bothersome thoughts and I have no one to talk to about that.” Alex explains to me, even though I know that. He is feeling defensive and misunderstood by his village. “On the one hand I know these people care and they are trying to help me so that I don’t run out of money, but on the other hand, they have no idea what I struggle with internally.” He tells me, again, even though we have discussed this many times. I hear the loneliness of someone who has such invisible suffering that no one, other than a mental health professional, can understand. The torture of brain suffering is beyond the comprehension of most people, even beyond some trained in the helping profession. Plus, friends and family presume to know his financial situation and this presumption hurts Alex’s feelings since he feels demeaned that they do not respect his decision-making. “Maybe you have lead them to believe that you have financial problems so they are confused why you invest so much of your resources into psychotherapy.” I say, knowing that he does need to be careful with his money, but at the same time, therapy, for Alex, is a life-line. “Yes, I do complain about money, but this expense is not optional for me. At least it does not feel that way.” Alex explains, mostly to himself. I am left feeling privileged with my medical training. Years of seeing how the brain can cause so much invisible misery has sensitized me to Alex’s issue. He suffers in ways, if he were to explain to his loved ones, would only alienate them and scare them away. Understanding goes a really long way, particularly for Alex.

Posted in Psychoanalysis, Psychopathology, Psychotherapy, Relationships | 7 Comments »

Liquid Courage

Posted by Dr. Vollmer on January 3, 2013

As we enter into 2013, the party season winds down, and the social demands diminish. I am left to reflect on how people connect with one another, and how alcohol, for some, provides much needed disinhibition in order to allow for a certain amount of emotional intimacy. The fear of rejection is so powerful, for some, that talking to people, especially those that are not part of daily existence, can be frightening. Yet, with a glass of wine, social ease can be  available. This intrigues me. Does the alcohol suppress the frontal lobe, such that a more authentic self comes through? Would Freud say that the wine diminishes the harsh superego which judges every word? Or, is there a social pressure to drink, just to be one of the gang?

Desiree, a fifty-year old patient (fictional, of course), said she could not bring herself to go to her best friend’s holiday party because her dog passed away three months ago, and so she “just could not face anyone.” The grief, I imagine, took away her access to her social courage. She did not imagine alcohol could fix this problem. Her melancholia turned her inward. She knew her friend would be deeply hurt if she did not go, but she also knew that this time of mourning, was a time for the self to trump the friendship. She felt guilty for not going, but she also felt entitled to take time for herself. If I think to myself that her child died, then I am sympathetic to Desiree’s perspective. Desiree does not forecast that going to this holiday party will not only support her dear friend, but in turn, she will feel loved and supported as well. By contrast, Desiree sees the party as a drain of her already depleted self. This mourning period is no time to muster up courage; she convinces herself. I continue to be intrigued. Liquid courage only goes so far.

Posted in Holidays, Parties, Psychotherapy, Relationships | 6 Comments »

Vague Speech: What’s Up With That?

Posted by Dr. Vollmer on December 11, 2012

“I talked to some people, about some things,”Whit, fifty-five, says to his wife after they gave a big holiday party. “Could you be more vague?” she responds with complete frustration, as Whit relates this interaction to me.  “Communication is so important to relationships, that vague communication can feel like a distancing move,” I say, sympathizing with Whit’s wife’s point. ” I just do not think in specific terms,” Whit explains to me. “I could tell you all about the food at the party, but I don’t remember people’s names, and I don’t always remember what we talk about.” Whit says, showing me that his brain works very differently than his wife’s brain, in that she remembers conversation and people, but not necessarily the specifics of the food or the wine. “Yes, but you need to be sensitive to your audience,” I say, reminding Whit that he should know his wife will get frustrated if he speaks in vague language. “Yes, my default position is to feel like a ghost, even at my own parties,” Whit explains to me. “So the vagueness mirrors your feeling that you are not a part of things.” I say, deepening my understanding of Whit’s struggles with fitting in. Suddenly I feel for Whit. I imagine what it is like to throw a party and not feel like a valued participant. I switch from empathizing with his wife, to feeling for Whit and his lifelong experience of being on the periphery. “Learning communication skills is valuable, but perhaps the bigger issue for you Whit, is to enhance your sense of confidence and value. Maybe this will improve your relationship with your wife.” I say, pointing out that confidence will not only help Whit individually, but it will help his relationship, and in turn, that will help Whit even further. “Language is the window to the soul.” I say, using a cliché, but at the same time, understanding how Whit’s vagueness spoke volumes about his emotional interior. Once again I am reminded of the importance of working both outside in, and inside out.

 

Posted in Psychoanalysis, Psychotherapy, Relationships | 2 Comments »

Parental Guilt

Posted by Dr. Vollmer on November 29, 2012

“I want you to know we have a normal family,” Maureen says to me, as she admits her twelve-year old to the psychiatric hospital for serious substance abuse issues. I did not ask her about her family, so her comment made me pause. You mean, you feel very guilty, I wanted to say, but I did not have the history with Maureen which would have enabled me to speak my mind. “Parental guilt is overwhelming,” I say to my students, thinking about Maureen. “Parents feel guilty, generally speaking, no matter what happens to their children, and when this guilt is added on to things they really feel they did wrong, then they have guilt squared,” I say, trying to explain that a part of parental guilt is about understanding the enormous  responsibility of another human being, whereas another part of guilt could be a knowing negligence when it comes to parenting. “When the guilt can come to the light of day, parents often feel uniquely understood,” I say to my students. “No one wants to talk to them about their guilt. Most well-meaning friends and family want to jump in and quickly reassure the mom that she did the best she could.” I say, emphasizing that the role of a mental health professional who works with children and families, is to demonstrate the understanding of the really difficult feelings which can bubble up during a mental health crises. Reassurance does not help because the parent often feels like their friends do not really understand how deeply bad they feel. Further, the loved ones often do not want to acknowledge the depth of the guilt because it can trigger in the listener their own sense of guilt towards their children. “The default assumption, until you get more information, is that the parent is feeling guilty when they see you.” I say to my students who are  rookie child psychiatrists. “Probing for that guilt is the art of our profession,” I say, thinking to myself that in some ways, this is a lost art, but also hoping that maybe, I and many of my colleagues, are slowly bringing this art back to the field. “No one wants to feel guilty, but worse than that, no one wants to feel alone in their guilt.” I say, pointing out that feeling misunderstood is worse than feeling guilty. “Understanding guilt is tricky, because you need to empathize without agreeing or disagreeing with their own sense of negligence.” I say, emphasizing that understanding guilt is a challenge.  “I hear you,” I respond to Maureen, acknowledging that I hear her statement about her family, but I am also hinting that I understand that there could be a subtext.

 

Posted in Guilt, Parenting, Psychoanalysis, Psychotherapy, Relationships | 2 Comments »

Re-Posting A Popular Post: The Report Card

Posted by Dr. Vollmer on November 20, 2012

Betsy, age ten, a patient of mine  since she was six years old, comes into my office with her mom, Gloria.  Betsy and I play catch and talk about her summer. She tells me about the books she is reading, her friends, shesays that she hates camp, and she is nervous about going back to school next month. Given Betsy’s long history of anxiety, poor eye contact, poor social relationships, poor behavior at school, I am  pleased at our relaxed interchange. The appointment winds up with our usual routine. Gloria  and I make the next appointment. Gloria reaches into her purse, and says “here  is Betsy’s report card. It is really good.” Gloria has handed me Betsy’s report cards for years, but this is the first time she announced it in front of Betsy. Dramatically, Betsy became irritable, angry, and rude. She grabbed the envelope out of my hand and said “this is none of your business.” Gloria says, “Betsy, I have given her report cards for years.” Betsy gets more upset. “She is not related to me, so she should not see my report card,” Betsy screams. Gloria responds “but it is a really good report card, what is the problem?” “It is just none of her business,” Betsy screams louder. “Just pay her and let’s go,” Betsy says.

Why did Betsy get so mad about me seeing her report card? I speculated to myself that this is an issue of intimacy. Betsy and I, although we have known each other for many years,  is not comfortable sharing herself with me in that way. As such, she felt violated that her mom exposed a part of herself, her report card, that she was not ready to share. I understood Betsy’s discomfort and I felt bad that I was a party to it. At the same time, at the time of the interaction, I was surprised by her strong reaction. Betsy’s sensitivity helped me understand her relationships. She enjoys interacting with others, but she is also afraid that getting too close to people could result in painful humiliation. Even though her report card was good, she seemed afraid that my reaction would make her feel bad. Betsy’s anger might have protected her from having to suffer from my unsatisfactory response to her school evaluation. In another context, Betsy might be seen as bipolar, or quick to anger, but had this happened, Betsy would have been misunderstood. Her hair-trigger response was not a “manic” experience; rather it was a response which protected her ego. In the end,  Gloria and I felt sad that Betsy was so upset; it was a hard learning experience.

Posted in Child Psychiatry, Child Psychotherapy, Parenting, Psychotherapy, Relationships | 7 Comments »

 
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