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The phrase turning point, Morris Peltz began, is used by colleagues to indicate “a moment of movement or a change in direction” or, alternatively, a decision to end the analysis. The phrase is usually invoked in stalled analyses with very difficult patients. Turning points may be initiated by analyst or analysand. The problems leading up to them are manifold. The patient may rigidly cling to a view of the analyst and/or himself, or to a fantasy of the manner in which analysis helps, either of which defies analysis. These may belie intense anxiety about overly intense affects and about exploring unconscious conflicts, or a reluctance to give up the possibility of instinctual satisfaction. The analyst, too, may be unwilling to give up cherished aspects of technique or perspectives on the patient, despite the latter's regression.
Peltz proceeded to describe many facets of turning points and provided clinical vignettes pertinent to the impasses from which they arise. Either patient or analyst may come to feel that an analysis has never successfully begun, has become stalled, or has had deleterious consequences. Such experiences, which are extremely frustrating and painful, may occur at any time. They frequently result in a forceful confrontation over the merits of continuing the analysis.
Some impasses follow longer periods of analysis and are signaled by an array of clinical phenomena. The analyst may experience boredom or restlessness. Interventions are repetitive and without effect. The patient is no less symptomatic, self-defeating, or self-destructive. The analyst assumes a hostile stance toward the patient or is excessively preoccupied with the progress of the analysis, giving rise to parapraxes (one analyst locked himself out of his car, representing a wish to lock the patient out). Recognizing the meanings of these occurrences, nonoccurrences, actions,