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Marshall Donnelley's book, Treatment Resistance: A Patient Perspective (2023) recounts a 13-year journey through outpatient psychotherapy and hospital-based treatment. It serves a sobering reflection on the challenges our field faces in providing relief for a segment of the patient population. As an “expert by experience”, Mr. Donnelley provides a first-person account of the discomfort, pain, and frustration of stalled treatment. Reflections on what he found to be the least helpful qualities of his therapists (hubris, dogmatism, rigidity, and complacency) parallel aspects of psychoanalytic debates on extending the parameters to meet the needs of so called “unanalyzable” patients who did not benefit from traditional psychoanalysis.
Historically, analysts' dedication to treating the treatment resistant patient, who were not wedded to orthodoxy, spurred innovation and expansion of technique over the last century. And yet, treatment resistant psychiatric conditions persist. This article takes up three elements: