Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?
- 2 The treatment of choice: what method fits whom?
- 3 Countertransference: recent developments and technical implications for the treatment of patients with severe personality disorders
- 4 Beyond management to cure: enhancing the positive dimensions of personality
- 5 Personality disorders from the perspective of child and adolescent psychiatry
- 6 Disruptions in the course of psychotherapy and psychoanalysis
- 7 Managing suicidal crises in patients with severe personality disorders
- 8 Borderline personality disorder, day hospitals, and mentalization
- 9 Pharmacotherapy of severe personality disorders: a critical review
- 10 Severe cases: management of the refractory borderline patient
- 11 Dangerous cases: when treatment is not an option
- 12 Stalking of therapists
- 13 Common elements of effective treatments
- Index
- References
6 - Disruptions in the course of psychotherapy and psychoanalysis
Published online by Cambridge University Press: 14 August 2009
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?
- 2 The treatment of choice: what method fits whom?
- 3 Countertransference: recent developments and technical implications for the treatment of patients with severe personality disorders
- 4 Beyond management to cure: enhancing the positive dimensions of personality
- 5 Personality disorders from the perspective of child and adolescent psychiatry
- 6 Disruptions in the course of psychotherapy and psychoanalysis
- 7 Managing suicidal crises in patients with severe personality disorders
- 8 Borderline personality disorder, day hospitals, and mentalization
- 9 Pharmacotherapy of severe personality disorders: a critical review
- 10 Severe cases: management of the refractory borderline patient
- 11 Dangerous cases: when treatment is not an option
- 12 Stalking of therapists
- 13 Common elements of effective treatments
- Index
- References
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.
- Type
- Chapter
- Information
- Severe Personality Disorders , pp. 93 - 108Publisher: Cambridge University PressPrint publication year: 2007
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