You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
“Difficult” patients have received a great deal of attention in the psychoanalytic literature. It has been “difficult” patients, like Kohut's (1968, 1971) Miss F, who have stretched the limits of existing clinical and theoretical knowledge resulting in new conceptualizations, such as those of self psychology and intersubjectivity. Brandchaft and Stolorow, in their article entitled “The Difficult Patient” (1988), point out that “the therapist's ability to deepen his reflective self-awareness when faced with difficult patients can enable him to recognize and decenter from recurrent patterns in himself that, in general, limit his ability to comprehend his patient's experiences of him from within their own subjective frames of reference” (p. 93).
In the case of “difficult patients,” what is often experienced by both analyst and patient as so difficult (what most often produces the stormy impasses we associate with such patients) is the occurrence of what Stolorow and Atwood (1992) refer to as intersubjective disjunction. At these times, the patient's experience of the situation (and especially of the analyst) is sharply at odds with that of the analyst. This is particularly uncomfortable when the patient attributes qualities to the analyst that are disowned and thus become an onslaught on the analyst's sense of his own identity. If the analyst, in order to preserve what Stolorow and Atwood refer to as his own “organizing principles,” treats the patient's view as a distortion, then he invalidates the patient's experience, thus provoking an understandable rage.