The Analyst's Sham(E): Collapsing into a One-Person System

The susceptibility of being affectively impacted and regulated by the patient is situated at the very base of the analyst-patient relationship.

Not one of us escapes the experience of failure and the shame that often accompanies it. Sometimes it happens like this: We are struggling with an impasse that is not being resolved. Every time we seem to undo one knot, two others appear in its place. We find ourselves suddenly—or not so suddenly—angry and frustrated with our patient at the same time we sense we are failing him. We consult with our colleagues, once again centering ourselves, creating a new strategy, only to fall into a similar conundrum two sessions down the road. Eventually, the patient leaves treatment, perhaps in a rage or perhaps even through mutual agreement. We are left without enough awareness of our contribution to the impasse, yet feeling we were part of something that went very wrong. Or maybe it happens, without any warning that is obvious to us, a patient walks out mid-treatment and never comes back. For years to come we may find ourselves at odd moments pondering what happened—stymied because, of course, we cannot conclude anything definitive without the participation of the patient. And my guess is that most of us have