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Impasse and Innovation in Psychoanalysis provides an opportunity to examine major alterations in technique in the psychoanalytic treatment of difficult patients. The reader can observe the clinical application of John Gedo's ideas about technical flexibility by studying four relatively detailed case presentations. The material, drawn from a seminar given by the authors at the Chicago Institute for Psychoanalysis, allows the reader to listen in on a lightly edited transcript of the proceedings. As a result, the text comes alive clinically; it is varied, imprecise, self-contradictory, and full of the enthusiasm of the participants.
More than anything else, Impasse and Innovation in Psychoanalysis looks at the integration of theory and clinical technique from the perspective of the hierarchy of models of the mind developed by Gedo (Gedo and Goldberg 1973). Four cases are presented in detail, and different technical challenges and their management are discussed. The format includes an introductory comment by Gehrie, then the clinical presentation and seminar discussion, followed by a lengthier commentary by Gehrie highlighting the main issues and problems addressed in the discussion of each case. This is followed by a sequence of notes in which Gedo elaborates on relevant matters brought up in the seminars, and by Gedo's consideration of issues pertinent to the clinical material but not discussed sufficiently by the seminar participants. This format allows the reader vicarious participation in a clinical seminar led by a distinguished and opinionated clinical innovator.
The book has as its guiding principles many of Gedo's ideas regarding flexibility and technique. A basic premise underlying all of the discussions is Gedo's insistence that a detailed diagnosis of level of