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Hidden Faults, by Steven A. Frankel, is an accessible, highly readable text that explicates the author's personal journey as a psychoanalyst. It focuses on the nature and repair of therapeutic disjunctions—that is, “failures in interpersonal engagement that foreclose understanding” (p. xii). Frankel explores the therapist's effort to study and work with these ruptures, emphasizing that disjunctions, although inevitable, must be repaired if the therapy is to proceed in a useful way. Indeed, he argues that their resolution is crucial to the change process. The bulk of the book details Frankel's engagement with a number of difficult patients, describing the various clinical shapes that disjunctions can take and illustrating both his and his patients' efforts to resolve them. His vivid vignettes disclose his own contributions to disjunction as he carefully tracks the evolution of difficult therapeutic interchanges that can freeze or derail the treatment.
Frankel strongly emphasizes the collaborative therapeutic relationship, although he acknowledges that “the most seriously disturbed patients need to sustain blatant illusions” (p. 136) and may use disjunctions as organizing tools. Yet from my perspective, ongoing disjunctions sometimes represent crucial reenactments of early dissociated object experiences, or desperate yet necessary attempts to ward off affective contact or intimacy. In these instances, the therapist's attunement and attempts to repair disjunctions may excessively threaten the patient's experience of emotional autonomy. Frankel could have addressed more fully those times when patients need to experience therapist or process as unhelpful—or even toxic—for long periods of time.
Working within a relational framework, Frankel views affiliation as a primary motivation, and he emphasizes the need of both therapist and patient eventually to restore rapport by seeking attunement. His main theoretical concept is of a self and object (SO) model linking