Hidden Faults: Recognizing and Resolving Therapeutic Disjunctions

Abstract

STEVEN A. FRANKEL: Hidden Faults: Recognizing and Resolving Therapeutic Disjunctions. Madison, CT: Psychosocial Press, 2000, 212 pp., $35.00, ISBN 1-887841-37-7. Asymmetries and disjunctions exist inherently in all human relationships, in varying degrees. After all, each human being, like a snowflake, is exquisitely unique and, therefore, perfect interpersonal attunement tends to be an illusory ideal that is achieved, at best, on a transient and somewhat precarious basis. The author of this book, a psychoanalyst in private practice, devotes his thoughts and theories to the task of identifying and resolving the fissures, impasses, and stalemates that ineluctably arise in therapy when patient and therapist fail to understand and empathize with one another. Frankel dynamically examines the sources of therapeutic disjunctions by using a descriptive model he calls the self and object unit model, A central tenet of this model is its recognition of the basic human striving for affiliation. As patient and therapist enter an intimately connected affiliation, they are encumbered by many personalities or selves (i.e., introjects from the past) and thus they must simultaneously contend, often on an unconscious level, with intense and complex feelings, affects, memories and fantasies that blur their perception and understanding of the other. Disjunctions in the therapeutic relationship, as Frankel points out, can be recognized by several distinguishing trends: the therapeutic process becomes superficial, bogs down, or lapses into confusion; a contentiousness arises in the therapeutic relationship; the therapist begins to feel alienated from the patient; or, patient and therapist have colluded in a conflict with the outside world to the detriment of the patient. Obviously, such trends, once they gain momentum, serve to impede and undermine the progress of the treatment. Although acknowledging and facing a serious disjunction between the patient and therapist can be a daunting prospect for both principals, Frankel is optimistic about the challenge, providing certain conditions are met. First, therapists must accept and tolerate, with genuine humility, their own cognitive and affective states of not knowing, using them as catalysts for essential inquiries into the emotional lives of their patients, as well as generative opportunities to learn and grow as therapists. In order to pursue the quest for greater therapeutic understanding the therapist first establishes what Frankel calls the facilitating relationship, therapeutic activity that largely furthers the patient's needs and the therapy itself. As rapport and trust develop, the therapist then can shift to a more analytic stance, forming with the patient an analyzing relationship, which might be viewed, as Frankel states, as the equivalent of the observing ego that provides a liberating sense of clarity and mastery. Safeguarding this process, Frankel reminds us, is the vigilance of the patient and the therapist alike who are seeking to mend disjunctions to the best of their abilities, sometimes augmented by the services of an outside consultant who can more objectively assist in the reparative endeavor. Naturally, therapists should not be relying upon their patients to conduct the therapy or be the primary agents of the reparative work, but, as Frankel correctly states, patients will often assume that arduous task anyway, often quite effectively and creatively, to the relief and dismay of their therapists. In this respect the patient becomes, at least during the disjunctive interlude, therapist to the therapist. …