Impasses in Psychoanalysis

WALLERSTEIN CONNECTED THE NATURE of the therapeutic action of psychoanalysis with its obverse, the nature of obstacles to therapeutic change. Freud (1937) emphasized as impediments to therapeutic success: the severity of early trauma, the constitutional strength of the instincts, and ego alterations or deformations. Wallerstein indicated that our literature has attended far more to consideration of the therapeutic action of psychoanalysis than to the topic of this panel—our difficulties and failures. Treatment research has focused on constructive changes during treatment and on attempts to explore how such changes have been accomplished. Study of therapeutic action and intervention in psychoanalysis has attended primarily to treatment success rather than to analytic failure. Wallerstein pointed to a trend during the past 30 years away from emphasis on psychoanalytic cure, toward a more modest assessment of the potential for psychoanalytic treatment of effect change. Anna Freud's 1968 Freud Anniversary Lecture at the New York Psychoanalytic Institute encouraged analysts to learn from the "difficulties, obstacles, and setbacks" of analysis. Wallerstein praised Etchegoyen's (1991) discussion of impasses. Etchegoyen distinguishes between slow working through and arrested working through or genuine impasse. He considers three types of impasse: acting out ("anti-task") intended to obstruct remembering; negative therapeutic reaction ("anti-achievement") designed to undo analytic progress; anti-insight ("reversible perspective") aimed toward analytic misunderstanding. This last type of impasse is regarded as a will to misunderstand so as not to acquire insight and change; it reflects the patient's destructive attitude toward analysis. Wallerstein differentiated the panelists' understanding of impasses from Welsh's chronic enduring sadomasochistic transference to Schwaber's more common micro-impasses, which require careful analytic understanding, to Renik's disc