This volume deals with a fundamental issue that all clinicians face at some time or other: the therapeutic impasse. What should you do when sessions with a client seem hopelessly mired, or when the client feels that you have done something so egregious that therapy goes awry? How about an abrupt rupture: when you find the angry or hostile feelings directed toward you to be so intolerable that you decide to terminate?
Based on years of clinical and consultation work, Sue Nathanson Elkind presents a theoretical framework for understanding and working with the relational knots that occur between therapists and their patients. Asserting that such episodes are unavoidable pivotal events in therapeutic relationships, she provides a map of the wide range of predicaments that can arise, including:
* Mismatches between therapist and patient
* Stalemates resulting from patient-therapist collusion
* Irreconcilable conflicts or power struggles
* Breaches in the attachment bond
* Untimely terminations
Elkind demonstrates how patients and therapists function as relational partners. Without blame and with compassion for inevitable difficulties, she describes how impasses arise when these partnerships become rigid, operate outside of conscious awareness, or when the vulnerabilities and defenses of the patient and the therapist intersect in problematic ways. Her concepts of primary vulnerabilities and relational modes benefit both parties: Rather than automatically pathologizing the patient, they empower the patient and humanize the therapist by recognizing normal human limitations.
The final section of the book presents an in-depth discussion of a form of consultation for therapeutic impasses that may include both the patient and the therapist. Demonstrating how both may suffer when the therapeutic dyads function in isolation, Elkind advocates setting up a relational network through the presence of a consultant. Vignettes of actual consultations of this type for a wide range of problems illustrate how such consultations work, what functions they can serve, and what their limitations are.
Featuring stories that often are not told because of the feelings of shame and failure that arise for therapists and patients caught in therapeutic impasses, this book is compelling reading. It fills a gap in the literature by comprehensively addressing a common, but rarely discussed, aspect of the profession. As such, it is an important volume for both experienced and novice clinicians regardless of theoretical persuasion. Bringing theoretical issues to life through its clinical vignettes, it also serves as an excellent text for graduate and postgraduate courses in psychology, counseling, psychiatry, and psychiatric social work.
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Sue Nathanson Elkind, Ph.D., is a Phi Beta Kappa graduate of Wellesley College and received her doctorate in psychology from the University of California, Berkeley. She teaches and supervises at the Psychotherapy Institute, Berkeley, and is on the attending staff of Mount Zion Hospital in San Francisco. In addition to writing journal articles and book reviews, she is the author of Soul Crisis, a book about the psychological and emotional complexity of abortion and other crises related to reproduction. Currently, she has a private practice in psychotherapy and consultation in the San Francisco Bay area.
"Elkind has written a powerful, innovative book on therapeutic impasses, a subject that is so central, so pervasive, and so inevitable in the kind of work therapists do." --Irene P. Stiver, Ph.D.
"Sue Elkind has found a way of giving voice to the silenced and hidden in human relations. I love this book for its courage in naming, its revolutionary way of exploring, what really goes on between people. I found it gripping, moving, and filled with insights that extend far beyond the therapeutic sphere." --Kim Chernin, author of The Hungry Self
"This is an extraordinary book. In it, Sue Nathanson Elkind explores an all too common problem in psychotherapy: the impasses and woundings that occur in a process that, we generally assume, should lead to growth and healing....Her understanding of psychotherapy in genuine human terms--instead of the technicalized approach that has become the parlance of current training and practice--results in a compelling study of the basic ingredients of all human relationships, both those that enhance growth and those that end in hurt....
Using absorbing, detailed clinical material, Elkind takes us through the kinds of impasses, mismatches and woundings that many therapists--and patients--will find agonizingly familiar. And she introduces a method of consultation to these problems that can help rescue some faltering therapeutic relationships, or lead to growth, rather than permanent injury for both parties, in those cases where treatment is halted....Thus, this book will be of enormous value to any therapist who wishes to `reach in' and work more deeply, and to any individual thinking of taking the kind of intensive look at themselves and their lives offered by psychotherapy." --Jonathan H. Slavin, Ph.D., President, Massachusetts Institute for Psychoanalysis, Inc.
"Using a relational perspective on impasses in therapy, Dr. Elkind has deftly interwoven lucid theoretical exposition and compassionate clinical application. Her concepts of intersecting primary vulnerabilities, of secondary wounding, and of consultation directed to the relationship will have enormous usefulness for therapists and for their patients." --Ellen Y. Siegelman, author of Metaphor and Meaning in Psychotherapy
"Provides important insights and background for psychotherapists to begin to think about resolving such impasses and preventing harmful ruptures in therapeutic relationships." (American Journal of Psychotherapy 1992-09-06)
"For therapists, whose work is long term, intensive, and within the psychodynamic framework, Elkind has taken a significant step in examining painful therapeutic impasses and in suggesting some resolutions. Both clinical researchers and practitioners can and should proceed with further steps." (Contemporary Psychology 1992-09-06)
"This carefully written and highly readable work makes a powerfully needed contribution to the meager literature on the role of consultation in psychoanalytic psychotherapy. Furthermore, it convinces the reader of the value and efficacy of a model of the therapeutic relationship in which impasses and woundings are seen as inevitable and not inherently pathological. As such, it beautifully illustrates our shifting perspectives on countertransference..." (Clinical Social Work Journal 1992-09-06)
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