Failure in the Treatment of a Psychotic Mother and Child: Aspects of Transference and Resistance*

A constant object implies far more than the capacity to sustain love for another person … it implies above all that the object is perceived and represented as it is in reality, with a minimal subjective distortion. (Bak, 1971, p. 237)

The study of a case of treatment failure may not be a gratifying task for therapists; the shadow of doubt is cast upon their professional acumen and indeed suspicion doubting the efficacy of psychotherapy enhances the ranks of the disbelievers. If the reader can pardon the audacity of a reference to Freud's (1905) case study of a treatment failure — “Dora,” there is much to be gained from an analysis of the negative therapeutic reaction. Freud's magnificent interpretation of Dora's dreams, the profound reconstruction of the past, his understanding of the symptoms and defense were of no avail as the powerful transference reactions defeated the embryonic analysis. Yet the analysis of Dora heralded Freud's (1912) early recognition of the power of the transference and its pivotal role in the methodology and theory of psychoanalysis. It became increasingly apparent that making the unconscious conscious, or interpreting repressed wishes and conflicts, could offer only superficial resolution if the past, affectively reactivated and given fresh impetus in the transference, was not treated.

The purpose of this paper is to elaborate on the frequent difficulties met by psychotherapists working either in the more depressed ghetto areas where the personality disorganization parallels the social