Impasse or Pseudo-impasse in the Psychotherapy of an Inhibited Writer

This paper describes the interactions of a patient and her therapist in the course of psychoanalytic psychotherapy, during which there occurred two significant impasse enactments. At first sight, each resembled a classical impasse. On further review of the case, the interactions took on a different texture that we have described as a pseudo-impasse in the course of the therapy. The enactments took the form of an abrupt cessation of the therapy in which the patient terminated and then later returned, thereby giving a more intense rhythm to the therapy.

The patient, described as a sexually inhibited novelist with symptoms of panic and anxiety, said at the outset that she was never able to express strong feelings for fear of criticism. Central issues included a number of conflicts: the manner of referral in which her friend (who was also a friend of the therapist) was instrumental; the grief for her dead mother and her lost sister; and overt conflict with her critical father. These conflicts became re-enacted within the interactions between herself and her therapist. The stages of therapy could best be described as at first wishing her therapist to be her “sin eater,” and, subsequently, her idealized, loving, nonjudgmental parent. We understand the pseudo-impasses to represent psychotherapeutically framed developmental steps.