7. The Problem of Impasse in Psychoanalytic Treatment

I have always been interested in patients who were difficult to treat and in finding out why some analyses ended in an impasse or failure. In Chapter 6 I illustrated how sometimes a mute deadly force constantly caused negative therapeutic reactions in my patient, Jill. Only after a very long time, as she seemed to feel more able to turn towards life, did a murderer appear in her dreams who was trying to murder her. In other cases the open appearance of murderousness, whether it is directed against the analyst or against people in outside life, is a serious problem, particularly if the patient tries to put this murderousness or criminality into action. Such patients seem to feel no regard for life and have no concern about their murderousness, making analysis very difficult.

I remember one such patient, Sheila, who was seen apparently successfully for about four years before a severe impasse developed. She had improved during the analysis but had not succeeded in reaching the perfect state of health and achievement to which she felt entitled. As a result she began to feel so disappointed and cheated by the analysis that she decided to take revenge on her analyst. He was blamed for withholding the perfect treatment from her. She therefore started planning how to murder him in such a perfect way that he could not possibly defend himself against her intention. The problem of analysing such a patient was related to the fact that she put all her pride and sense of achievement into her planning of this perfect crime, preventing her analyst from mobilizing in her any positive feelings or awareness which might weaken her resolve. In such situations there is a real danger that the analyst will have to stop working with a patient, so that the analysis will have to end in an