Book Review
Psychotherapy
Hidden Faults: Recognizing and Resolving Therapeutic
Disjunctions. Stephen Frankel. Madison (CT): Psychosocial Press;
2000. 212 p. US$35.00
Reviewer
rating*: Good
Review by Philip N Cheifetz
Ottawa, Ontario
The advent of a Freudian revisionist attitude in psychoanalysis
has heralded several different models of how therapy works. For
example, the work of Melanie Klein deviated from the classic approach
in placing the oedipus complex at an early age in the life of the
child and in offering the paranoid–schizoid and the depressive
positions as central to early development. However, only in recent
years has an almost anticlassic understanding appeared in the literature
in the schools of self-psychology, of relational therapy, and finally,
of the intersubjectivist model—the genre to which this book
belongs. This is Frankel’s second book on the technique of
therapy. Three years ago, I reviewed the first, Intricate Engagements,
in this journal. The focus of Frankel’s present monograph is
the role of the disjunction, a state of affairs that occurs during
psychoanalytic therapy and both derails and enhances the process.
This book’s relentless focus on this process makes it a most
readable new perspective on the difficulties of therapy.
The book flows like a Russian novel along the lines of Pasternak’s
Doctor Zhivago. There is a central character, who could be Doctor
Zhivago travelling on the railway across Russia in the political
context of war and revolution. He meets various people en route
who love him, need him, and abuse him, yet he stoically maintains
his empathic and steadfast clinical attitude. In Hidden Faults,
Dr Frankel has us meet several disturbed and disturbing people,
patients who come to him for therapy and psychoanalysis. He is the
central character in the lives of his patients, all of whom enter
into a disjunction with him in the process of treatment. As we read
of them, we learn of the psychoanalytic theories with which Frankel
is in accord and disaccord. For example, he hardly gives credence
to classic analytic thinking, preferring to remain with Ogden’s
concepts of the analytic third, Klein’s projective identification,
and even an acknowledgement of neuroscience—in my view, mixing
models. This is not unusual for current psychoanalytic thinking
and, to return to my analogy, is like getting to know the landscape
outside the railway car in Zhivago’s Russia. That said, there
is always a common life and therapeutic thread running through the
characters of Frankel’s patients.
For example, there is Magda, whose preoccupation with the unstable
lives of her grown offspring confuses Frankel. He thinks that this
is her way of avoiding her loneliness and traumatic past, despite
her present strengths. Here, different agendas represent the disjunction
in therapy that exists despite the illusion that all goes well in
the years they spend together. Then there is Tessa, who reluctantly
attends years of psychotherapy with Frankel, despite her insistence
that she needs to address her unhappy marriage. Her goal is to help
her husband with his irritating lack of practicality in the face
of her ambition. Yet Frankel is convinced that she should continue
individual therapy for her history of emotional deprivation, and
this assumes priority—another disjunction. Surprisingly, Frankel
ultimately sympathizes with Tessa, relents, and allows her to come
to couple counselling with her husband. He writes that the couple
therapy became vibrant and alive, in contrast to the bland individual
work he had been doing with Tessa, suggesting to the reader that
he had participated in the disjunction’s enactment.
Thus Frankel begins his journey through a landscape of disjunctions
that are ubiquitous, insidious, and illusory (that is, therapy appears
to be working when it has in fact stalled, because the partners
like each other’s company). Frankel explains the roles of facilitation,
analysis, and the (object) relation in the process of elucidating
the disjunction. He returns to the term “self-object unit”
(SO) as the way patients experience the therapist and the people
in their past. This unit is akin to signposts and station stops
en route that tell patients who they are and where they are going.
Finally, we arrive at a major junction: Frankel defines exactly
what he means by “disjunction”—a failure in the interpersonal
engagement that forecloses understanding. At this point Len, a new
patient, presents himself in the carriage with the author, bringing
a greater and more difficult challenge.
Indeed, Len comes with a predetermined disjunction that causes
him to believe he cannot be helped—that this therapy, as with
previous therapies, will not work for his despair and loneliness.
Despite some improvement, not a great deal changes for Len after
years of working with Frankel, and his cynicism about therapy remains.
Finally, in a philosophical moment, Frankel decides within himself
to continue this therapy, yet at the same time “not to know”
(here, I think he means the outcome). Like the winter landscape
in Zhivago, a lifelessness pervades this therapeutic journey, causing
an overt and disabling disjunction that both patient and therapist
are challenged to overcome—and they work to overcome it.
The characters in Frankel’s journey of disjunction management
become increasingly difficult; yet with the constant help of his
own love for his patients and his passion for his work, the difficulties
are resolved. Kate, who he distresses by attending the social function
of a friend who is also a rival of hers, is followed by Elise, whose
erotic fantasies cause him to withdraw emotionally from the therapy.
Each instance represents a colluded disjunction; yet Frankel extricates
himself by showing us how he understands the disjunction, rather
than interpreting it; thus, he joins with his patients to repair
mistakes. Finally, at the end of the journey we meet Keith, to whom
Frankel must lie when Keith demands to know whether he is paranoid
or borderline. Frankel cares for Keith, despite his severe psychopathology,
but calls this a crippling caring—crippling to both. Somehow,
being able to maintain a distance in the therapy and not to worry
about outcome enables the resolution of the disjunction, despite
the extent of its destructiveness. We all have patients that make
us wonder whether they will ever recover from their disabling interpersonal
pathology. The idea of the disjunction reassures us that inevitably
and with time and patience, and not necessarily with interpretation,
a positive change will accrue from the therapy.
This is a novel approach to an old therapeutic problem in psychoanalysis
and psychotherapy—one that has been discussed by others in
such terms as Balint’s “basic fault,” Schwaber and
others’ “acceptance of the enactment,” and Henry
Smith’s “listening to one’s inner conflicts.”
However, in Frankel’s Russian battlefield journey, we are at
one with him and his patients: we are compelled to question our
own enactments and inclinations toward self-disclosure, for better
and for worse, in the attempt to resolve the disjunctions we share
with our own patients.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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