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Disruptions & Interruptions in Treatment

Clinical Impasse Series

With Salman Akhtar & Zack Eleftheriadou (Chair)

In this five-part series we explore why, with some clients, the therapy ‘gets stuck’. 

A therapeutic impasse can lead to self-doubt among therapists, as well as concerns that the client may terminate the therapy prematurely. We aim to demonstrate that these challenging moments can offer great insights for both client and therapist, if they can be worked through.

More recently impasses, collisions, and collusions have been acknowledged as inherent and valuable aspects of clinical practice. This means that the experience of getting stuck or encountering a therapeutic impasse can actually help the therapist to understand more about the client's inner world and potentially shed light on how the histories of both the client and therapist are interacting unconsciously. Identifying, naming, and making sense of these clinical impasses can serve as a way forwards

Our speakers cover themes including the recognising unconscious dynamics between therapist and patient which maintain a stasis in the therapy, the impact of intergenerational transmissions on progress, the phenomenon of "othering" within the context of relational psychoanalysis and racialized enactments, and the delicate art of being affected by the therapeutic process without becoming overwhelmed by it.

The primary objective for this series is to support therapists' capacity to navigate and work through these challenging phases. By participating in this series, therapists can gain the confidence and skills necessary to effectively address moments when they and their clients find themselves in the challenging position of feeling "stuck."


Salman Akhtar- Disruptions & Interruptions in Treatment 

This presentation will open by defining and distinguishing ' Interruptions' and 'Disruptions'. Devoting greater attention to the latter, the presentation shall highlight six psychodynamic triggers that set it into motion. This includes unconscious guilt, anxious retreat from higher level conflicts, envious and sadomasochistic attack on the therapist's calm and creativity, fear of separation from the therapist by improvement, shift in the patient's structural organization from a conflict-based to a deficit-based sector and failure of analyst's empathy and attunement. Therapeutic interventions directed at resolving each type of 'disruption' will be discussed and the various proposals made shall be anchored in psychoanalytic developmental theory and highlighted with the help of clinical vignettes. 

Discussion with Zack Eleftheriadou

Zack will discuss the presentation with the speaker and draw out some themes for exploration inspiring the group discussion.

Q&A with participants