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Papernik, D.S. (2001). Hidden Faults: Recognizing and Resolving Therapeutic Disjunctions: Steven A. Frankel, M.D. Madison, CT: Psychosocial Press, 2000. 212 pp.. Psychoanal Q., 70(4):903-904.

(2001). Psychoanalytic Quarterly, 70(4):903-904

Hidden Faults: Recognizing and Resolving Therapeutic Disjunctions: Steven A. Frankel, M.D. Madison, CT: Psychosocial Press, 2000. 212 pp.

Review by:
Daniel S. Papernik

Steven A. Frankel has created a candid and thoughtful clinical monograph in which he explores the concept, recognition, and treatment of “therapeutic disjunctions.” Disjunctions are “intervals in psychotherapy or psychoanalysis when therapists and patients miss and confuse each other, or are deflected from their goal because they collude in order to minimize their differences” (p. 2). A patient, for example, may laugh when feeling disappointed and bitter. The therapist misperceives, believing that the patient is amused. Only the patient is aware of the disjunction. Then the therapist soothes the patient with a soft stroking of the next words and the disjunction is obscured. As the author says, “for good, honest therapeutic work to proceed, the disjunction will need to be recognized” (p. 3).

Breaches in rapport are inevitable in any psychoanalysis or psychotherapy. It is Frankel's thesis that only when disjunctions are recognized and analyzed can therapeutic progress occur. To support his contention, the author makes use of extensive clinical examples. He is frank and open in describing his own failures of empathy and understanding, as well as the subsequent self-analytic work and work with the patient to reestablish a therapeutic relationship. It is only when the analyst or therapist accepts not knowing that understanding and resolution can begin. Throughout Hidden Faults, Frankel demonstrates the recognition and mending of disjunctions.

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