The Impossible Situation? Impasse as Psychotherapeutic Paralysis, Possibility, and Progress

Psychotherapeutic impasse has long been understood in the clinical literature as treatment stagnation and even failure, both from one-person and two-person psychodynamic perspectives. However, there is a dearth of empirical research that delves deeper to understand this complex and rich phenomenon. Using semi-structured interviews with nine psychodynamic therapists speaking about individual adult patients, this study examined experiences of impasse to better understand treatments that become embroiled in a kind of paralysis. Qualitative analyses revealed dyads where patients were conceptualized as struggling chronically with negative feelings about themselves and others, and who experienced traumatic personal histories. Impasse in and of itself was often felt as a confusing, overwhelming presence for therapists, which made it difficult at times for them to find their psychotherapeutic footing. Results also indicated that significant progress was made in each treatment, with strong therapeutic bonds forged; and that impasse is a complex and varied experience that is not useful nor accurate to simply reduce to stagnation and failure. While it is critical to understand the limitations of psychotherapy to improve theory and technique with suffering patients in challenging treatments, a wholesale negative conceptualization of impasse unintentionally robs clinicians of a deeper appreciation for the complexity of the psychotherapeutic process contained within this phenomenon. It also threatens to obfuscate myriad positive outcomes and future potential that exists or might come to exist in these treatments