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Elkind, S.N. (1994). The Consultant's Role in Resolving Impasses in Therapeutic Relationships. Am. J. Psychoanal., 54(1):3-13.
(1994). American Journal of Psychoanalysis, 54(1):3-13
The Consultant's Role in Resolving Impasses in Therapeutic Relationships
Sue Nathanson Elkind, Ph.D.
For the past ten years, I have been investigating unresolvable impasses in therapy and ruptured terminations: times when therapeutic relationships founder in deadlocks; when patients are wounded and cannot recover; and when the therapeutic relationship ruptures, leaving the patient feeling harmed and beyond help, and the therapist1 feeling helpless, whether relieved or regretful.
I have found that experiences of serious impasses, wounding, and rupture are more common than we acknowledge. A survey I conducted in 1987 among 330 therapist members of the Psychotherapy Institute in Berkeley, California, revealed that 53 percent of the respondents had been patients in a therapy that had ended in a rupture. Of these, 72 percent were left feeling harmed by the experience. I would like to see resources provided for patients and therapists who have been grappling alone with these distressing and often devastating experiences.
I have also found that serious impasses and ruptures occur most often when both patients' and therapists' primary vulnerabilities and defenses intersect in unmanageable ways. Primary vulnerability is a concept I discuss at length in my book, Resolving Impasses in Therapeutic Relationships(Guilford Publications, 1992), but for our purposes I will simply rely on your intuitive sense of its meaning. I am referring to a core issue, for example, abandonment, trust, envy, that is often shaped early in development, influenced by the temperament, personality, and circumstances of infant and caretaker through cumulative interactions. We each have primary vulnerabilities—only their content, our defenses to manage them, and our awareness of them vary.
Since the late 1980s I have been receiving and responding to an increasing number of requests to serve as a consultant to patients and therapists in dyads who are grappling with unresolvable impasses, or who are trying to make sense of ruptures that have already occurred.
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