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MOST ANALYSTS ARE FAMILIAR with what happens when a treatment situation gets bogged down. The same issues are discussed over and over, unrelated issues are raised, and both patient and analyst become repetitively monotonous. An atmosphere of boredom pervades the situation; a feeling of not being understood. The sense of dissatisfaction which characterizes the bogged-down treatment ranges from a vague unease to a marked feeling of despair.
The customary reasons given for this unproductive experience may be characterized as either hopeless or hopeful. Hopeless reasons are the patient is (1) diagnostically unsuitable; or (2) is too regressed. Seemingly hopeful reasons are (1) unconscious, abstruse dynamics will emerge eventually or, (2) transference-countertransference issues have not been sufficiently clarified and need to be explored.
It is our contention that these "reasons" are usually invoked because of stereotyped preconceptions. Therefore, the analysis will become unproductive. Stating the "hopeless" reasons leads to either stopping treatment or making treatment non-analytic. On the other hand, waiting for dynamics to emerge will perpetuate the original dilemma. "Optimistically, " pursuing transference-countertransference issues, with the hope of discovering some new subtle issue, will lead to increased entanglement without enhancing clarity.
All or any of the above reasons may certainly be true; however we have found that a much more frequent cause of bogged-down treatment lies in the failure of the analyst to elicit a coherent overview of the patient in the beginning of treatment.
Pari passu with the analyst's developing his perspective about the patient, he comes to understand how the patient experiences the