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Dr Frankel begins with a description of a depressed female patient in a stalemated treatment. The patient insists that the analyst does not understand that something is wrong with her children and she rejects his counterinsistence that this view of herself is excessive depressive self-criticism. When one of the children becomes suicidal, the analyst realises that, rather than understanding the patient's mothering as she herself has been seeing it, he has been a cheerleader. Frankel had failed to distinguish neurotic from realistic guilt, and he had failed fully to appreciate that he was in a stalemate. Both errors with the patient seem to be familiar enough. Whereas most analysts might conclude that theory had been misused in the service of countertransference, Frankel focuses on the misleading focus in the current theory of therapeutic impasses or disjunctions that he believes was at the core of his difficulty.
In order to elucidate this problem, Frankel undertakes the ambitious plan to review his work over a hundred randomly chosen three- to six-month clinical segments from ten years of practice. The book can be viewed as the fruits of that research project. It is intended as both the evidence for a new theory of disjunctions and an exposition of that theory. He consistently finds that disjunctions are a failure in ‘interpersonal engagement, and one that forecloses understanding’. More controversial is the point that such failures are not entirely explained by transferences, countertransferences or projective identifications:
It is important to underscore that the psychology of one or both participants in a disjunction may be relatively free from distortions. The existence of a disjunction in that case reflects the fact that a shared understanding between the two has simply not yet been achieved. It may relate to the innocent misunderstanding of cultural and experiential differences (p. 53).
It is this ‘innocent misunderstanding’ that Frankel suggests is at the core