Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘Resistance’ Category

Scary Feelings

Posted by Dr. Vollmer on February 13, 2013

“How are you?” I ask, Whitney, fifty-seven. “I don’t know,” she responds, as she says each time I see her. “You need not to know your feelings,” I say, changing her words slightly to give her more of a sense of agency. It is not that she does not know her feelings, as she believes, as she takes a passive stance, but rather, it is more that she NEEDS not to know her feelings, since she is scared by them. Whitney’s husband of twenty-two years passed away two years ago. Her kids are grown and independent. She has a boyfriend. She works as a therapist. Yet, her feelings remain “not knowable” to her as she walks in my office. She then agrees. “Of course, I need not to know my feelings. I miss my husband terribly and so if I get too close to those feelings, I will hurt my boyfriend’s feelings, and my kids think I should be over that by now.” She says, defending her position of detaching from her feelings. “Yes, but you can feel them in here,” I say, pointing out the obvious, that my office, this play space, enables her to be free to talk about her feelings without fear of judgment or hurt feelings. “Yes, but then I have to leave, and my feelings do not just zip up as soon as I leave your office,” she reminds me that the transition out of my office can be quite challenging and she has to be mindful of that. “Yes, I understand that, but the price you pay for being detached from your feeling is also a large one.” I say, pointing out that there is a challenge in  both feeling and not feeling her inner world. “What do you mean about the price?” she asks, wondering about my choice of words. “The price of not experiencing the texture of life.” I say, even though I know she knows that. “I think it is worth the price,” she responds, keeping my choice of words. “Well that is where you are today, but you might not feel that way tomorrow.’ I say, pointing out that the ‘price’ might change for her with time and distance from her husband’s passing. Making her aware of the “price” is making her more conscious of her unconscious decision not to feel her feelings. The word price is carefully chosen to suggest that she is deciding how she interfaces with her world. Agency is established. Victim-hood recedes.

Posted in Feelings, Resistance, Teaching Psychoanalysis, Unconscious Living | 7 Comments »

Wanting Change/Wanting Stability: Push/Pull Continued

Posted by Dr. Vollmer on February 5, 2013

As Bromberg says, every patient enters into the consultation room with the internal dialogue saying “I’m here because I’m in trouble, but the trouble I’m in is not something I need rescuing from, even though it may look that way. However, I fully expect you to try to cure me and I’m prepared to defeat you. I don’t have an illness; I am my illness and I won’t let you cure me of being who I am.” In other words, the patient comes, as Phillip Bromberg PhD continues, “for a secure nest in which to stay safe and accepted forever, not having to bear the discomfort of the new and unfamiliar, while at the same time, looking for metamorphosis (growth, movement, transition).” Bromberg continues to describe this paradox by suggesting that the fear of therapy is represented by Prometheus, the Titan who in trying to create a better civilization, ultimately was punished and tormented. Bromberg says that therapy moves along by “enhancing the patient’s perceptual capacity….creating a change in the structure of his personality organization.”

Clarissa, fifty-five, an endocrinologist, wants to retire. She has plenty of financial resources, so that is not the issue. What stops her is her perception that her parents will disapprove of that decision. “My parents immigrated from India so that I could be a doctor. They would be devastated if I stopped working. They would feel that they wasted their life supporting my education, only to see it used for such a brief period of time.” Clarissa says, clinging to her need to please her parents, while at the same time, hoping that our work together will free her from the shackles of parental affirmations. “You have quite the dilemma on your hands,” I say. “You can please yourself or you can please your parents, but in this moment, it feels impossible to do both, or even to reach a compromise.” “There is no way I am going to upset my folks,” she insists, as if I have just told her to disregard their opinion. “I can see that option feels very uncomfortable for you,” I say, again, highlighting her conflict. Clarissa’s inner tension has come to light in my office. She is at war with herself. I am not championing her to retire, nor am I supporting her belief that she needs to keep her parents content, but I am listening to her struggle and helping her consciously make decisions which will impact her future. Her dynamics with her parents have been life-long. Changing those relationships are really scary. At the same time, Clarissa is flirting with the option to have a life of flexibility and relaxation which she has longed for, for many years. I do not know how she will sort out her conflict, but I am interested in helping her explore this internal process.

 

See also…

 

https://shirahvollmermd.wordpress.com/2013/01/31/psychotherapy-pushpull/

 

Posted in Resistance, Teaching, Teaching Psychoanalysis | 11 Comments »

“Object Usage”

Posted by Dr. Vollmer on January 30, 2013

Phillip Bromberg in his book, “Standing in the Spaces” (1998)  quotes a dream from a patient to illustrate Winnicott’s concept of “object usage”.

“I was leaning out of a window on the top floor of a tall building that was in flames. A fireman was climbing up a ladder to rescue me and I was throwing rocks at him.”

Bromberg explains the dream. “A person may feel himself so psychologically incapacitated and at risk in the world of people, that it is indeed similar to living alone in a burning building from which he needs to be rescued. But that particular burning building is the only one that exists as a self, and one’s individual selfhood, no matter how painful or unadaptive, must be protected at all cost as part of any rescue operation.” Hence, Winnicott’s “object usage” means that the therapist must respect the patient’s need to “throw rocks”. Some psychoanalysts call this phenomena “resistance,” but Bromberg prefers “object usage”.

A fictional patient comes to my mind.  Louise, fifty-five, lesbian, mother of two, professional comes in describing her relationship to Harry, sixty-four, single, never married, a plumber. “Harry treats me like I am his mother. He acts like I am extremely interested in everything that happens to him, but he hardly ever listens to me, and he hardly ever seems to care what is going on in my life. The relationship is so one-sided that I feel so angry when I am around him.” Louise says, clearly caring for Harry, but also really frustrated with the relationship. “It sounds like Harry is using you as a caring bosom, because he must need that, but he does not have insight into the fact that you may not want to be that for him.” I say, thinking about Winnicott’s concept of “object usage.” As with Harry and Louise, all relationships, to some extent, involve using the other person to get our personal needs met and thereby not seeing the other person as a unique individual. The more one can gain insight into their “object usage,” the more their relationships can deepen into a process of interpersonal exploration. “Do you think if you confronted Harry that the relationship is feeling lopsided, that maybe then things could get better?” I ask, wondering if Louise can help Harry get some insight into how the relationship feels to her. “I have tried that, and it helps for a short time, but then things go back to this mother/child dynamic.” Louise says, with obvious anger in her voice. “You are in a tough spot, because it sounds like the relationship has hit a wall,” I say, mirroring her frustration. “Relationships work better when ‘objects’ are appreciated and not ‘used’ ” I say, throwing in some jargon about their dynamic. “Yep,” Louise says, with the joy of feeling understood.

 

 

 

Posted in Resistance, Teaching, Teaching Psychoanalysis, Winnicott | 6 Comments »

Resistance

Posted by Dr. Vollmer on January 29, 2013

Martha Stark MD says “the pioneers of psychotherapy quickly learned that an unconscious psychological force worked against a patient’s conscious desire for cure. This impediment to change was captured in the term resistance. Each new understanding of resistance opened a door to fresh clinical challenges.” Sheldon Roth MD wrote in his Foreword to Dr. Stark’s book, “success in working through resistance reawakens the dormant possibility of that frail, but intensely human quality-choice.” Dr. Stark continues, “my contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects.”

A fictional patient comes to mind. Becky, fifty-one, went to visit her father, eighty-five, in his assisted living facility. “My dad told me that my mom would not let him hold me on his lap when I was little because my mom was afraid he would sexually abuse me, but then again, he changed all of my diapers. I just got sick listening to this.” Becky says, with the disbelief that new family dysfunction can be uncovered all these years into her adulthood. “It is hard for you to fathom how your mom prevented your dad from showing love to you,” I say, to which Becky quickly changes the subject. Becky’s resistance in that moment was a clear indication that at that moment, she could not emotionally process the fact that her mom consciously made her life more difficult by telling her father not to be loving towards her. She also could not begin to process that her dad accepted her mom’s distorted reality. He could have insisted on having his children on his lap. Becky moved on to talking about her problems at work. This was not the time to unpack her experience visiting her dad that day. Her resistance was too great. It seemed that she was not ready to grieve the absence of a loving father figure from a very early age. She also was not ready to grieve the loss of a mother who wanted her child to grow up with two loving and caring parents. We will come back to these issues, but now she wants to focus on the lighter issues of work stress. Dr. Stark notes that anxiety must be “titrated”. Becky did this for herself by changing the subject. She wanted to preserve her status quo with her dad. Later on, I suspect, she wil be at a point where she wants to understand her family history, so she can stop being disappointed with what she did not get. As Jon pointed out, time is necessary for this resistance to fade. Patience, as he also says, is key.

 

 

 

Posted in Resistance, Teaching, Teaching Psychoanalysis | 4 Comments »

 
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