Book Reviews -- Resolving Impasses in Therapeutic Relationships by Sue Nathanson Elkind

Article excerpt

Who among us psychotherapists has not wished for a book showing us how to resolve the impasses we inevitably encounter with some patients? Who among us do not, at least secretly, wonder if some of our therapeutic endeavors and their rupture might have done more harm than good for the patients? While far from providing the wished-for easy answers to the dreaded impasses, this book does provide important insights and background for psychotherapists to begin to think about resolving such impasses and preventing harmful ruptures in therapeutic relationships. Dr. Elkind, a psychologist, starts by presenting a number of case vignettes that illustrate the mismatches and impasses that occur in therapeutic relationships. These case histories, although composites, often have more than a ring of truth, perhaps indicating personal experiences or at least robust empathy. Using a relational model, the author shows how well-meaning therapists may participate in the precipitation and perpetuation of therapeutic impasse and, often, in the rupture of the relationship.

As a central concept in understanding the impasses and ruptures in psychotherapy, Dr. Elkind proposes the concept of "primary vulnerabilities." Essentially, therapy comes to an impasse or rupture when the primary vulnerabilities of either the patient, the therapist, or both have been wounded. The "realm of primary vulnerability" denotes "the kind of wounds in the context of therapeutic relationship that patients (or therapists) often experience as intolerable." The realms of primary vulnerability differ in degrees according to individual developmental history, and include fear of disintegration, issues of trust, fear of betrayal, separation, fears of failure or success, and anxiety around abandonment, rejection, and neglect. …