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Part I of this book consists almost wholly of self-contained chapters, and this will not make the main argument easy to follow. I had to adopt this structure because on several occasions I had to clear away some established ways of looking at, and thinking about, well-authenticated clinical observations before I could start on the next stage of my train of thought.
Before beginning our journey, let us agree that all of us, the readers as well as the writer, are fairly reliable analysts who do not make elementary mistakes; that is, all of us give fairly correct interpretations at fairly sensible times and work through the material produced by our patients, as far as possible, on several, both genital and pre-genital, levels, both in the transference and in reality.
Having agreed on this, perhaps we may also admit that all of us occasionally have difficult patients vis-à-vis whom we feel puzzled and uncertain and that — according to rumours circulating in every Branch Society of our International Association — even the most experienced and most skilled analysts among us have occasional failures.
How can this be so; and what is the explanation of this unpleasant fact? On the whole the reasons for our difficulties and failures may be grouped under three headings. They may be due (a) to our inadequate technique, (b) to the difficulties inherent either in the patient's personality or in his illness, and (c) to a bad ‘fit’ between our otherwise adequate technical skill and the otherwise curable intrinsic qualities of the case.
The first question we have to deal with is why some patients are more difficult to treat than others, or why some analyses are less rewarding to the analyst — and to his patients — than others. Let us