The psychotherapeutic impasse

A psychotherapeutic impasse can arise when the therapist's treatment goals differ from those of his patient, when the therapy prescribed is inappropriate, when there is failure of rapport, or when an antitherapeutic alliance arises. Countertransference, adverse transference reactions, and transference gratification can stalemate therapy. For resolution, one must diagnose the cause of the impasse, and apply the appropriate treatment measure, which may be clarification, confrontation, interpretation, transfer, or some form of splitting the transference. Splitting of the transference is useful in the treatment of severely regressive transference reactions and allows for expression of the hostile feelings which were previously acted out or defended against by regression. Some impasse situations require consultation, ongoing supervision, or therapy for the therapist.