Complications in Connectedness: Introduction to “Reaching the Difficult-to-Connect-With Patient”

In the following set of articles, Steven Stern, Donna M. Orange, and David Wallin address the clinical challenge of working with patients with whom the analyst finds it difficult to connect. These articles were originally presented as a plenary session at the 2013 International Association for Psychoanalytic Self Psychology Conference in Chicago. Inspired by the conference theme of “Forms and Transformations of Connectedness,” Stern envisioned and organized this panel, titling it “Reaching the Difficult-to-Connect-With Patient.” At the conference, there emerged a vigorous discussion among the panelists, and between the panelists and the audience. The spirit behind this publication is to extend that dialogue. In addition to the three articles presented at the plenary, this set of articles includes a new reply by Stern to the two discussants.

In the first article, Stern presents his nine-year treatment of a woman, Linda, whom he formulates as resistant to the kind of deep connection that he believed necessary for her to accomplish what she was seeking in treatment. She told him, “I want to feel vulnerable and connected” but warned she could be “controlling and slippery.” Stern responded to her plea that he should hold her “feet to the fire” and not let her slip away. They engaged in a struggle and, ultimately, an affective bond emerged when Stern least anticipated it. His open account of the clinical process provides the basis for thoughtful and engaging discussion.

Orange speaks to Stern’s case from an intersubjective, self psychological perspective. She emphasizes how the analyst’s theoretical convictions about connectedness can contribute to the struggle between analyst and patient. She advises the analyst to hold theories lightly and explores why it may be difficult clinically to maintain this stance. And last, Stern, in his r