Impasse or Pseudo-impasse in the Psychotherapy of an Inhibited Writer

Abstract

This paper describes the interactions of a patient and her therapist in the course of psychoanalytic psychotherapy, during which there occurred two significant impasse enactments. At first sight, each resembled a classical impasse. On further review of the case, the interactions took on a different texture that we have described as a pseudo-impasse in the course of the therapy. The enactments took the form of an abrupt cessation of the therapy in which the patient terminated and then later returned, thereby giving a more intense rhythm to the therapy. The patient, described as a sexually inhibited novelist with symptoms of panic and anxiety, said at the outset that she was never able to express strong feelings for fear of criticism. Central issues included a number of conflicts: the manner of referral in which her friend (who was also a friend of the therapist) was instrumental; the grief for her dead mother and her lost sister; and overt conflict with her critical father. These conflicts became re-enacted within the interactions between herself and her therapist. The stages of therapy could best be described as at first wishing her therapist to be her "sin eater," and, subsequently, her idealized, loving, nonjudgemental parent. We understand the pseudo-impasses to represent psychotherapeutically framed developmental steps.

Conceptual and Technical Aspects of Psychoanalytic Enactment: A Systematic Review

“…According to Cassorla (, p. 1155), ‘[E] nactments may occur in the analysis of these kinds of patients as part of the “natural history” of the analytical process’. No opposition to this characterization of inevitability was found, although some authors make no mention at all of inevitability (Chused, ; Feldman, ; Almond, ; Burnstein & Cheifetz, ; LaFarge, ; Stern, ; Bohleber et al ., ).…”

“…The intensity of the conflict interferes in the understanding of what is happening, and this leads to failures in sublimation. A blockage sets in that results in a reduction of reflective space (Jacobs, 1986;Chused, 1990;Reed, 1997;Feldman, 1997;Bateman, 1998;Hirsch, 1998;Burnstein & Cheifetz, 1999;Friedman & Natterson, 1999;Cassorla, 2001Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Goldberg, 2002;LaFarge, 2004;Varga, 2005;Bonovitz, 2009;Stern, 2009;Ginot, 2009;Pagano, 2012;Strauss, 2012;Boston Change Process Study Group, 2013;Sapisochin, 2013;Bohleber et al, 2013;Nos, 2014).…”

“…Feelings of responsibility may confuse an analyst and lead her to act according to meanings that are not yet clearly identified in the situation, thus weakening her therapeutic posture. Enactments therefore consist of obstructive interactions with collusions or states of impasse, making analytic evolution difficult (Chused, 1991;McLaughlin, 1991;Levine, 1994;Reed, 1997;Feldman, 1997;Bateman, 1998;Hirsch, 1998;Burnstein & Cheifetz, 1999;Allen, 2002;Frank, 2002;Wurmser, 2003;Gerson, 2004;LaFarge, 2004;Zanocco, De Marchi & Pozzi, 2006;Ivey, 2008;Stern, 2009;Bonovitz, 2009;Ginot, 2009;Steiner, 2011;Pagano, 2012;Strauss, 2012;Skogstad, 2013;Sapisochin, 2013;Cassorla, 2001Cassorla, , 2008Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Bohleber et al, 2013;Nos, 2014;Safran & Kraus, 2014).…”

“…The analyst or therapist is able to 'go off stage' and warn of the different roles that are being played, then transmit to the patient the possibility of developing the ability to broaden his insights. The formerly frightening defences against facing the trauma are now recognized and can be better structured (White, 1992;Levine, 1994;Reed, 1997;Katz, 1998;Bateman, 1998;Burnstein & Cheifetz, 1999;Friedman & Natterson, 1999;Allen, 2002;Ivey, 2008;Steiner, 2011;Pagano, 2012;Strauss, 2012;Sapisochin, 2013;Cassorla, 2001Cassorla, , 2008Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Coren, 2015;Tuch, 2015). The understanding of the transference and countertransference is thus broadened (Freud, 1905(Freud, , 1910(Freud, , 1912, as is the awareness of projective identification, defence mechanisms (Klein, 1946) and the communication potential of the relationships established in the analytic field (Bion, 1961;Baranger & Baranger, 1961-62).…”

“…The recognition of the occurrence of enactments and their impact on therapeutic relationships is always in retrospect. By retracing and reflecting on the associations that occurred in the setting, meanings of the analytic event can be formulated by either member of the dyad (Smith, 1990;Levine, 1994;Burnstein & Cheifetz, 1999;Friedman & Natterson, 2006;Sullivan, 2007;Cassorla, 2001Cassorla, , 2008Ivey, 2008;Bonovitz, 2009;Strauss, 2012;Sapisochin, 2013;Nos, 2014).…”