Introduction by Sara Sheftel

Twenty-three years have elapsed since this paper was published. When he wrote it, Dr. Spotnitz asked June Bernstein and me to edit it. He also asked me to provide relevant case material to supplement his own. I found the paper helpful at the time because it gave me the freedom and the courage to dismiss those patients with whom I had not been able to develop the sort of beneficial therapeutic relationship Spotnitz describes. The greater value of this paper lies in its excellent recommendations to analysts on the beginning of treatment.

Dr. Spotnitz tells us that “the primary resistance that has to be resolved in the beginning of the analysis is the following: “is the patient willing to work towards constructive goals?” He adds: “When this is not possible the analysis is bound to end up in failure unless