The Analysis of a Therapeutic Failure*

At times it seems we learn more by our failures than by our successes. When men go to sum up the achievements of their lives, it is the lacks and omissions that stand forth in their memories rather than their attained glories.† In psychoanalysis and psychoanalytic therapy, however, it is exceedingly rare to publish a failure in treatment, as though it might represent a vulgarity or a breach of good judgment. But for some of us the less than satisfying working-through of a long-term psychoanalytic therapy bristles with the missed possibilities of the wrong fork taken. Understanding the failure then becomes a learning obsession and, if it cannot be labeled a form of indulgent masochism, both patient and psychotherapist can profit from it.

By the strange working of fate, two women presented themselves to me for psychotherapy at almost the exact time who upon later reflection turned out to have the most astonishing similarity in personal and problem characteristics. In a curious way I had been served up with a more or less “controlled” clinical experiment in which a single psychotherapist treated two patients who were about as similar as it is possible to be, and where, furthermore, the outcomes turned out to be as different as possible. Rebecca is a swinging therapeutic success, but Sarah is a shining failure. At the immediate outset I would have predicted just the reverse, for Rebecca was a highly complex person, but Sarah never offered more than quiet dignity and gentle withdrawal. My motivation to help, insofar as I analyzed