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

Article excerpt

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, nonjudgmental parent. We understand the pseudo-impasses to represent psychotherapeutically framed developmental steps.

INTRODUCTION

In this paper we describe the interactions of a patient and her therapist in the course of psychoanalytic psychotherapy; certain of these interactions, or more specifically, enactments exemplify the way the progress of analytic therapies fails and comes to a halt. These enactments may resemble, at first sight, a classical impasse described in the recent psychoanalytic literature by Schwaber (1), Kantrowitz (2), and others. Initially our task in writing about this case was to add to the literature on impasse in psychotherapy, mindful of the substantial literature on impasse in psychoanalysis. We thought that the differences and contrasts between psychotherapy and psychoanalysis justified a discussion of the description and factors connected with impasses in the former. However, on further review of the case and the course of the therapy, the behaviors of the patient and the response of the therapist took on a different texture than a simple enactment of impasse as described in the literature.

Indeed, it began to appear as if the patient almost rehearsed her leavings and returnings and thereby engaged in a series of planned reconciliations with a figure from her past. The countertransference responses of the therapist may well have colluded with these behaviors of the patient. In this way we observed a different type of impasse, which is described by Maldonado in his paper on impasse in psychoanalysis (3). In his patients, the imagery and symbolization herald the onset of a suspension of the work and progression of analysis. The analyst was experienced, as well, to have participated in this state of suspension. In the case reported here, while the therapist participated to some extent, the impasse took the form of an abrupt cessation of the therapy only for the patient to return later at a time of her choice, when the work of therapy assumed a more intense rhythm. In that the cycle of cessation and return occurred twice during the course of therapy, it was almost as if it were planned or had to have happened that way, following a sustained, agreed-upon absence. Hence, our report became more interesting from this point of view as we progressed in our study and started thinking of the events in this case in a new light.

BIOGRAPHICAL SKETCH OF THE PATIENT

D. is a woman in her mid-thirties, childless by choice, and living with a common-law husband who occupies a peripheral place in the narrative of her life as she recounts it and as the therapy progresses. She is a freelance writer of romance novels. D. suffered from symptoms of panic attacks at night. …