Book
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.
Main ideas
- A therapeutic impasse may stem from the analyst's contribution and misunderstanding, not only from the patient's pathology, and it can be worked through.
- Narcissism and projective identification shape the analyst's task and can drive treatment toward success or failure.
- The patient's real trauma matters, and rigid or misplaced interpretation risks re-traumatizing the patient within the analysis.
- Narcissistic patients differ: thick-skinned patients are defended and insensitive, while thin-skinned patients are fragile and easily hurt.
What it shows
- 1971
Herbert Rosenfeld introduced Destructive narcissism
In his 1971 congress paper Rosenfeld set the destructive aspect of narcissism beside the libidinal one he had described in 1964: an idealization of the omnipotent destructive parts of the self, organized like a gang against the dependent self. He returned to it in the chapter on destructive narcissism and the death instinct in Impasse and Interpretation (1987).
- 1987
Herbert Rosenfeld introduced Thick-skinned and thin-skinned narcissism
In the Afterthought that closes Impasse and Interpretation, Rosenfeld distinguished thick-skinned narcissistic patients, who need firm interpretation, from thin-skinned ones, who may be retraumatized by premature interpretation of their destructiveness.
- 1947
Herbert Rosenfeld developed Projective identification
Rosenfeld's 1947 case was the first clinical paper to use Klein's newly named projective identification, and he later sorted its forms by motive: communicative projections the analyst can contain, as against evacuative and controlling ones aimed at denying separateness and dependence.
- 1971
Destructive narcissism derives from Death drive
Rosenfeld framed destructive narcissism as a clinical approach to Freud's theory of the life and death instincts: the idealized destructive narcissistic organization is where, in his account, the death instinct shows itself in the clinic.