Preparation for Analysis in the Face of Massive Resistance: A Clinical Symposium*

The psychoanalytic literature of the past decade is a cacophony of suggested approaches to the “hard to treat” patient. In the U.S., , , , , , Kernberg (, ), , , , , and , among others, have contributed divergent ideas about the nature of the underlying psycho-pathologies, chaotic transferences, and potential countertrans-ference snares that are characteristic of various segments of this very heterogeneous population. From abroad, , Joseph (, ), , , and , to name a few, have each added their distinctive understandings to the mixture of messages about technique and theory. How is one to choose? How does one position oneself in relation to the particular patient in the consulting room today, with the special problems he or she presents?

In the privacy of our offices, each of us does the best we can in treating patients whose psychopathology seems to require techniques different from the psychoanalytic ones we were trained to use. Usually, we stick to the techniques we know, sometimes watching them fail in situations they were not designed to cope with. Sometimes we find ourselves in emotionally troubled waters as countertransference