Impasse and Interpretation: Therapeutic and Anti-Therapeutic Factors in the Psycho-Analytic Treatment of Psychotic, Borderline, and Neurotic Patients

Rosenfeld's last book, published shortly after his death as the first volume of the New Library of Psychoanalysis, looks back on a lifetime of work with psychotic, borderline and neurotic patients and asks why some analyses succeed and others reach an impasse. Its four parts treat the analyst's own contribution to successful and unsuccessful treatment, the influence of narcissism on the analyst's task, the influence of projective identification on the analyst's task, and a conclusion. Rosenfeld argues that an impasse is not necessarily a sign of the patient's incurability: it can arise from the analyst's misunderstanding, and it can be worked through. He gives more weight than in his earlier work to the patient's real trauma, warns that rigid or misplaced interpretation can repeat that trauma in the analysis, and distinguishes thick-skinned from thin-skinned narcissistic patients. The book caused controversy among his colleagues; a reviewer in the British Journal of Medical Psychology judged it useful both to the author's critics and to those who followed his approach.