Case Presentation

THE PATIENT WAS 22 WHEN she began treatment and seven years later (with a year's interruption when she was in graduate school), we hit a stalemate or impasse which seriously undermined my understanding of what I thought we had accomplished. During this period, which lasted for six to 10 months, I could not see my way out of, or into, the knot that this woman and I seemed tied in. At times, I seriously thought I had completely misjudged what this woman was all about, or, if analysis could help her. Eventually, my despair matched the patient's. Ordinarily under these circumstances I talk to a colleague, but as I will describe, I was not truly aware of what was happening.

Before I present the clinical material, I think it is important to state why I have chosen this particular difficult time in a longterm treatment situation where there had been many periods of no apparent movement except in varying kinds of regressive behavior and feeling states. Yet I did not conceptualize those times as a stalemate.

In those earlier years, the level of her anxiety, the nightmarish qualities of her dreams, the profound conflicts she experienced in so much of her living seemed reason enough for improvement to be slow and arduous. And then, of course, there was always so much more to understand, an idea that was always comforting to me. Moreover, we had a good working relationship which would withstand the vicissitudes of her demands, her periods of rage at the slow progress she felt she was making, and her despair and anguish over what she felt was her lost life. Thus, no matter how convinced she would become at my failure to help her, she always managed to see me as an ally, however inept. For my part, I always felt that we could talk to each other no matter how tumultuous her life became or intense and negative the interaction between us. Thus, I never considered long periods of stasis as impasses, but simply that these were the problems inherent in working with this young w