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When Dr. Tillman and I first spoke about my participating as a discussant on this panel, she explained that the kinds of consultations I have been providing on an outpatient basis for 10 years to patients and therapists in serious impasses have, for the past 15 years, actually been built into the initial agreement with patients who come to Austen Riggs. We wondered about the similarities and differences in our experiences with such consultations. In discussing these presentations, I will be speaking from my experience providing similar consultations in private practice to therapists and patients deadlocked in unresolvable impasses.
We have been privileged to hear four compelling presentations. I commend Dr. Piers and Dr. Tillman for their honest and courageous presentations. They both have risked the exposure that comes from sharing our most trying experiences of unresolvable impasses. Moreover, they have succeeded in describing in language what it is like to be caught in an impasse with a patient in which areas of primary vulnerability are engaged in both participants, in which each attempt by the therapist to resolve the impasse only serves to deepen it, and in which the stakes of failure, especially for patients who have already had treatment failures, are high.
Dr. Muller and Dr. Fromm have not only succeeded in clearly conceptualizing their role as consultant to both patient and therapist, but they have modeled for us the nonjudgmental, thoughtful, spacious attitude that provided an essential psychological space for Dr. Tillman and Dr. Piers and for Mr. B and Ms. A. Their compassion for both the patient and therapist and their willingness to move into these deadlocked therapeutic relationships is inspiring. Their ideas about the role of consultant are complementary, each describing a different facet. Dr. Muller elaborates on the concept of a third element that provides an essential context or ground for the patient and therapist. Dr. Fromm emphasizes the essentia