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I wish to start by outlining the general lay-out of this paper. It consists of several almost self-contained parts and this will not make the main argument easy to follow. The reason for this structure is that on several occasions I shall have to clear away certain established ways of looking at, and thinking about, well authenticated clinical observations before I can start on the next stage of my train of thought.
Before beginning our journey, let us agree that all of us, the readers as well as the writer of this paper, are fairly reliable analysts who do not make elementary mistakes; that is, all of us give fairly correct interpretations at fairly sensible times and the material produced by our patients is usually worked through—as far as possible—on several, both genital and pregenital, levels, both in the transference and in the reality.
Having agreed on this, perhaps we may also admit that all of us, reliable and experienced analysts, occasionally have difficult patients vis-à-vis whom we feel puzzled and uncertain and—according to rumours circulating in every Branch Society of our International Association—even the most experienced and most skilled analysts among us have occasional failures.
How can this be so, i.e. what is the theoretical explanation of this unpleasant fact? On the whole the reasons for our difficulties and failures may be grouped under three headings. They may be due to (a) our inadequate technique, (b) the difficulties inherent either in the patient's personality or in his illness, and (c) a bad 'fit' between our otherwise adequate technical skill and the otherwise curable intrinsic qualities of the case. In this paper I shall discuss only headings (b) and (c).
The first question we have to deal with asks why some patients are more difficult to handle than others or, why some analyses are less rewarding to the analyst—and to his patients—than others. Let us formulate the same question in a different way which might enable us to tackle i