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Modell, A.H. (1991). Impasse and Interpretation: By Herbert Rosenfeld. New York and London: Tavistock, 1987, 324 pp., $35.00.. J. Amer. Psychoanal. Assn., 39:248-250.

(1991). Journal of the American Psychoanalytic Association, 39:248-250

Impasse and Interpretation: By Herbert Rosenfeld. New York and London: Tavistock, 1987, 324 pp., $35.00.

Review by:
Arnold H. Modell, M.D.

Herbert Rosenfeld, who died in November 1986 at the age of seventy-six, was one of a small group of analysts, both in England and in America, who devoted their careers to the psychoanalytic treatment of the schizophrenic patient. Rosenfeld's most original contribution has been the description of certain confusional states in chronic schizophrenia that made it impossible for the patient to differentiate between the good and bad object. Melanie Klein, building upon Rosenfeld's work, attributed this confusion to envy which interfered with the normal splitting into love and hate and into the good and bad object. Rosenfeld's contributions to the psychoanalysis of schizophrenia were presented in an earlier volume, Psychotic States. In contrast, Impasse and Interpretation refers not only to psychotic illness, but includes as well Rosenfeld's work with borderline patients and those with severe narcissistic character disorders.

For analysts of my own and earlier generations, who were trained before there were any effective drugs for the treatment of schizophrenia, it was not uncommon to attempt to use the psychoanalytic method alone to treat schizophrenic patients. The results were apt to be heart-breaking; in many cases the course of the illness was unaffected by our heroic efforts. But as a recompense, one invariably learned something that could be placed in the service of those less severely ill patients, the borderline cases or those with severe character disorders. It is this type of experience that Rosenfeld attempts to convey to us. He tells us: "I have always been interested in the patient who is difficult to treat." The case histories presented here are those of the most difficult patients to be found in psychoanalysis. Impasse and Interpretation contains many richly detailed and beautifully presented histories and vignettes of Rosenfeld's own cases and those whose treatment he supervised. There is no question that Rosenfeld was a master clinician of unusual sensitivity and courage.

As Rosenfeld was a student of Melanie Klein, I had anticipated that, regarding matters of technique, he would recommend early, deep, and possibly confrontational interpretations.

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