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The following is a discussion of the preceding paper but also includes commentary on Resolving Impasses in Therapeutic Relationships. New York: Guilford Press, 1992, 335 p.
Every once in a while something is written without precedent, something that provides the clinician with a new tool and frames phenomena in such a way as to multiply understanding and open therapeutic options and dialogue. Sue Nathanson Elkind presents us with such work.
I first encountered Elkind's writings at the April 1993 meeting of Division 39 of the American Psychological Association, where she gave the preceding paper. I listened, skeptically at first, wary about the entrance of a consultant into the therapeutic relationship and concerned that it could undo the essential elements of the therapeutic situation. But as Elkind went on, she anticipated all of my doubts and answered them one by one. I was convinced. It was then that I could let myself fully appreciate Elkind's originality in outlining the problem of mismatches, impasses, and treatment failures, a problem more common than we generally acknowledge. I was impressed by Elkind's sensitivity to both patient and therapist in these ordeals and the disciplined creativity with which she had developed a consultation practice, part of her contribution to the solution. I eagerly read her book Resolving Impasses in Therapeutic Relationships. My reading furthered my respect for the author and her mission.
Elkin's work addresses the underpinnings of binds we get into with our patients and ourselves. These stem from the idealized notions we have of ourselves in our work and of the potential of treatment. Elkind believes that therapists/analysts and patients alike retain the potential to be wounded in an area of primary vulnerability. A good enough analysis does not eliminate