Disruptions in the course of psychotherapy and psychoanalysis

doi:10.1017/CBO9780511544439.007

6 - Disruptions in the course of psychotherapy and psychoanalysis

Published online by Cambridge University Press: 14 August 2009

Edited by

Salman Akhtar and

Salman Akhtar: Affiliation:
Professor of Psychiatry Jefferson Medical College, Supervising and Training Analyst, Psychoanalytic Center of Philadelphia, Philadelphia, PA, USA
Bert van Luyn: Affiliation:
Symfora Group, The Netherlands
Salman Akhtar: Affiliation:
Thomas Jefferson University, Philadelphia
W. John Livesley: Affiliation:
University of British Columbia, Vancouver

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Summary

Things never do go smoothly in suicides, weddings, and courtships

(Mark Twain)

In an aphoristic statement, the quintessentially American psychoanalyst Harry Stack Sullivan is known to have said: “Beware of smoothly going therapy.” At one level, we all attest to the wisdom of this statement. At another level, however, we continue to hold on to the idea that psychotherapeutic endeavors could or should go on without a hitch. Clinical experience shows us otherwise. Our patients “disappoint” us. They walk out, act out, and drop out, leaving us baffled, embarrassed or even resentful.

Keeping this in mind, it seems imperative that we attempt to understand what such “disruptions” mean, how they arise, what their dynamics are, and how they can be mended. Other questions also need to be faced; for instance: Are all disruptions “bad?” Do disruptions happen in the course of all psychotherapies or only in the treatments of patients with severe character pathology? Are disruptions avoidable? Are there developmental prototypes for disruptions? In other words, are there normative aspects to the disruptions of dialog between a patient and his or her therapist? And, finally, can disruptions ever be an indication that the treatment is progressing well?

The search for preliminary answers to these questions forms the impetus of this chapter. In it, I will (1) offer a definition of the concept of “disruption,” (2) bring together the models of its etiology that seem scattered throughout psychoanalytic literature, (3) describe various manifestations of disruptions with the help of brief clinical vignettes, (4) discuss the technical dilemmas in dealing with these difficult clinical situations, and (5) seek to anchor my recommendations in some child-development observations.

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Type: Chapter
Information: Severe Personality Disorders , pp. 93 - 108

DOI: https://doi.org/10.1017/CBO9780511544439.007 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

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