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In a manner of presentation less formal than frequently seen in this forum, Sue Nathanson Elkind presented “Resolving Impasses in Therapeutic Situations,” a chapter from a forthcoming book on supervision, as well as material from her current consultation practice. Her controversial subject, the utilization of consultant, was a dramatic departure for most of the audience.
According to Elkind, the tools available to most of us for resolving impasses in treatment are quite limited and almost never involve direct intervention by a third party. In her role as consultant, Elkind stresses that she is careful not to intrude upon the therapeutic relationship, and remains a respectful distance from it, yet is available to both therapist and patient for feedback.
Since there exists no model for this work, Elkind relies on the current relationship between patient and therapist, as well as on the entrenched historical material. In her consultations, Elkind attempts to create a safe holding environment in which primary vulnerability and the quality of the relational mode, including their transference and countertransference implications, can be revealed. Once uncovered, further options become available to both patient and therapist. These include a referral to another therapist, continuing to work through the impasse with the present therapist, or on some occasions, the postponement of legal action. Although what makes for success in the process of working through a seemingly unbreachable impasse is not entirely known, Elkind, in her current explorations, has found that both patient and therapist report feeling an immeasurable amount of relief through the understanding, validation, and empowerment that result from her consultations.
Elkind's topic generated heated discussion. Many in the audience voiced their appreciation that the issue of impasse and ruptured therapeutic relationship is acknowledged by the author as a two-party responsibility. There was excitement at the possibilit