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An important tension animates Failures in Psychoanalytic Treatment, a timely collection of essays edited by Joseph Reppen and Martin Schulman. This tension is evident in the title: note the plural—failures— rather than the singular, failure. Roughly half of the thirteen essays are about failures—particular cases that went or ended badly. The other chapters deal more broadly with the concept of failure in psychoanalysis, a subject about which I will say more. In addition, the editors offer a brief introduction in which they concisely survey the history and variety of psychoanalytic definitions of clinical failure (and success), as well as reviewing major ideas about the common causes of failure. This summary is particularly useful in light of the surprising fact that most of the contributors focus on the causes of failure but say little about how they define it.
The authors of the “failures” essays (including Wallerstein, Tabin, and Paniagua, among others) reflect on what went wrong in their cases, and provide readers plenty of material to come to their own conclusions about how and why the treatments failed. Most of these cases ended up in what could be thought of as sadomasochistic stalemates. (Interestingly, these entanglements frequently focused on analytic frame issues such as fees and schedules.) It is tempting to respond to these cases, as the contributors note that we often tend to do, as a supervisor might. In other words, there is a pull to look for mistakes by the analyst that could account for the outcome. Many of the authors retrospectively supervise themselves this way in their discussions. And, indeed, in virtually every case, the failure could rather easily be explained either by countertransference blind spots or by “unanalyzable” characteristics of the patient.
Such a reading is legitimate, I think, but limited. First, it leaves out the intriguing question as to whether such blind spots are ubiquitous—