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The Clinical Impasse

Letha Cole, MD

Few treatment situations are as humbling or frustrating to negotiate as the clinical impasse. According to Ted Jacobs, stalemates necessitate that psychoanalysts relinquish some of their set ideas and alter their traditional approaches. It was further suggested that progress in treatment depended not only on analyst’s recognition of the countertransferences, but also on the continued working through of them by means of sustained self-analytic efforts. Lew Aron also advocated for modifications of the psychoanalytic stance in working through a stalemate, but he operated from an intersubjective model in doing so. He suggested that the creation of a third point of reference may give the patient greater access to the inner workings of the analyst’s mind, thereby opening up psychic space for self-reflection and mentalization. Melanie Suchet suggested that the way through impasse, even with a psychotic patient, depends on an intersubjective shift prompted by the analysts’ recognition of their own dissociation. All three authors offered clinical examples illustrating their theories and techniques.

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