The psychoanalytic impasse

In the study of impediments to the success of psychoanalysis as a treatment method, the character structure of the analysand has received the most attention. Psychoanalysis has come to be used for the treatment of an ever-widening range of psychopathological states, and the analysts have become confronted with a greater incidence and variety of clinical situations which can develop into therapeutic obstacles. Whether the psychoanalytic impasse will become a therapeutic stepping-stone or an obstacle to treatment often depends upon the emotional response of the therapist and his resultant behavior. Accordingly, there has been a heightened interest in the study of countertransference. Some therapists equate the psychoanalytic treatment of patients with severe character deformations with "wild" analysis and therefore feel needless guilt and anxiety when they attemtp to treat patients who suffer from them; thus they increase the likelihood of their becoming therapeutic obstacles. We have considered the psychoanalytic impasse as an inevitable aspect of the analytic sequence and discussed countertransference reactions in this context. Technical complications resulting from adverse countertransference reactions are examined both in terms of the patient's provocations and responses in the analyst. Among the analyst's responses, three were emphasized: (1) helpless fellings which represent the patient's helplessness and vulnerability; (2) rage reactions; and (3) profound anxiety reactions. The patient's need to construct and environment similar to the early traumatic environment within the analysis can become a very difficult situation for a therapist. The resolution or at least understanding of these interactions becomes equivalent to the lifting of infantile amnesia, a step which has been considered the essence of psychoanalytic resolution. Thus, adverse reactions can become keys to the gaining of fundamental insights, permitting the analytic process to continue its inevitable course.