"The Clinical Uses of Therapeutic Disjunctions"
By Steven A. Frankel, M.D.
Article published in Psychoanalytic Psychology, 23: 56-71 (2006)

Synopsis:
Psychoanalysis is dialectical. What the patient does for the therapist, the therapist returns through his or her own initiative. The same is true for the therapist's contribution. In this intricate choreography where patient and therapist alternately or simultaneously take responsibility for restoring the integrity of the therapy, understanding is only part of the process. The tension caused by rifts in the therapy needs to be tolerated and contained, ultimately by the therapist. His or her whole-hearted willingness to understand the meaning and work through the consequences of these disjunctions follows. In our sequence, Karen incrementally increased the seriousness of her threat until I could finally hear her. Then I regulated the tone and content of my comments to let her know I cared and was contrite. Only when she could trust me again, could we explore the disruption in our work and the opportunity it offered for our shared progression.

According to this view of the therapeutic process, the patient's contribution to reviving and sustaining the therapy is often as important as the therapist's. In my opinion, the patient's role has generally been under-appreciated. This is true even with the current groundswell of psychodynamic literature on symmetry and self-disclosure.

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