Impasses in psychoanalysis: overcoming resistance in situations of stalemate

Many impasses occur in treatment when the patient fears that analysis will repeat frightening or disappointing experiences. These stalemates result from the patient's conviction that the analyst has confirmed a preexisting belief that is central to the patient's primary conflict. Frequently, this belief involves an unacceptable or frightening self- or object representation. At these times, intense resistance and strong negative transference/countertransference reactions may develop. Impasses are differentiated from these strong negative reactions only by virtue of the fact that they remain unanalyzed. The factors that create these negative states can best be understood in instances where the potential impasse is resolved. When impasses persist, most often patients leave treatment. Under these circumstances, we can try retrospectively to understand what has gone wrong, but without the patient's confirmation, our conclusions must remain speculative. Four cases illustrate varying degrees of analysis and resolution of resistance and transference/countertransference binds.