A therapeutic relationship can be entirely intact and trusting while the work itself stays stuck.This page covers that specific territory: impasse, collision, and technical difficulty in psychoanalytic and psychodynamic practice. It’s organized in two parts — contemporary titles first, followed by the classical and historical literature that shaped how the field thinks about impasse in the first place.
Most of these books assume some psychoanalytic training already. This page is for clinicians deepening an existing practice, not an introduction to the approach itself.
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Contemporary
Conundrums and Predicaments in Psychotherapy and Psychoanalysis: The Clinical Moments Project
Edited by Richard Tuch and Lynn S. Kuttnauer, Routledge, 2018
This is the most structurally distinctive book on the page. It features twelve clinical moments, each written up by the treating analyst at the exact point they felt stuck and unsure how to proceed, followed by commentary from two of twenty-five invited expert analysts responding from different theoretical traditions.
The point isn’t to settle on the right answer. The editors are explicit that the goal is illuminating the implicit clinical theories therapists carry into sessions, not arguing about who handled the moment best. Reading multiple expert responses to the same stuck moment is genuinely useful. It shows how differently trained analysts actually think, something most single-author books on this page can’t offer.
Clinical Psychoanalytic Case Studies with Complex Patients: Watching Experience at Work
Anne Zachary, Routledge, 2023
The most recent book on this page, and the broadest in clinical scope. Six parts cover autism, violence and perversion, psychosomatics, hysteria, dementia, psychosis, and gender dysphoria assessment. Each part is introduced with commentary that places the case material in context.
Zachary is a fellow of the British Psychoanalytical Society and the Royal College of Psychiatrists, spent years at the Portman Clinic specializing in violence and sexual offending, and worked at both the Maudsley and Broadmoor Hospitals. That forensic background shows in the range of the case material, which goes further into genuinely disturbing clinical territory than most of the other books here.
This is less a book to read start to finish than one to pull out when a specific case matches one of its six sections. The gender dysphoria assessment chapter in particular reflects a live, contested area of clinical practice, and readers should expect a specific theoretical position rather than a neutral survey of current debate.
Psychoanalytic Collisions
Joyce Slochower, Routledge, 2014 (2nd ed.)
Slochower writes about the space between the professional ideal a therapist holds and the messier reality of clinical work, and what happens when personal and professional wishes collide with what a session demands. This second edition adds a new chapter on mutual idealization, the ways patient and analyst can each build up an unrealistic picture of the other that the work eventually has to confront.
The collisions she covers range widely: rebuilding collaboration after a real-world crisis disrupts the frame, working through impasses where patient and analyst want fundamentally different things from the treatment. She also covers what she calls “secret delinquencies” – the small compromises and departures from an analyst’s own ideal that rarely get named out loud.
This book is more squarely about the therapist’s own illusions and how they shape the work, for better and worse. Reading it alongside your own case notes is arguably more useful than reading it straight through. Several reviewers describe using specific chapters to work through a stuck case of their own.
Getting From Here to There: Analytic Love, Analytic Process
Sheldon Bach, Analytic Press, 2006
Bach’s subject is what happens with the most difficult patients specifically — those with severe narcissistic, sadomasochistic, and borderline presentations — and what that work does to a therapist’s assumptions about what analytic process actually is. He centers the idea of “attentive presence,” the quality of engaged attention through which an analyst reaches a patient who has trouble trusting anyone, and traces how something like love develops between patient and analyst out of that sustained presence. It’s a more affectively driven and less technical book than several others on this page, closer to a meditation on what makes deep engagement possible with patients who resist connection at every turn. Bach was a training analyst at the New York Freudian Society and a fellow of the International Psychoanalytical Association, working from a broadly relational rather than strictly classical framework.
A Casebook of Psychotherapy Practice with Challenging Patients: A Modern Kleinian Approach
Robert Waska, Routledge, 2015
Classical Kleinian technique was built for patients seen four or five times a week in full analysis. Waska works from what he calls Modern Kleinian Therapy, adapting classical Kleinian ideas about projective identification and enactment for patients are seen once or twice a week. The book is built around a large number of clinical vignettes covering individual work, couples, and the most disturbed and resistant patients. It shows the theory being applied in real time rather than described abstractly.
Waska is an analytic member of the San Francisco Center for Psychoanalysis and has written more Kleinian technique books than anyone else on this page. It’s a genuinely practical entry point into Kleinian thinking about difficult patients for clinicians who don’t have years of Kleinian training already.
Classical and Historical
These four books read differently from the contemporary titles above – the case material is dated, and some of the theoretical framing has since shifted. They’re less something you’d turn to for a current stuck case, and more the foundation this literature actually grew out of.
Worth reading if you want to understand where the field’s current thinking on impasse comes from, rather than as your first stop for practical help.
Difficulties in the Analytic Encounter
John Klauber, Jason Aronson, 1981
Klauber was one of the more influential figures in British psychoanalysis of his generation. He didn’t live to see this collection through to publication, as he died shortly before it came out. It reads as a summary rather than a book written with a reader’s reaction in mind.
The ten papers span two decades of his writing and work through difficulties on three levels: problems intrinsic to the therapeutic situation itself, problems of technique, and difficulties that originate within the analyst rather than the patient. That last category is unusual for its era; turning the lens on the analyst’s own limitations rather than treating difficulty as something located entirely in the patient.
It’s now well over four decades old, and the case material shows it. Its core argument still holds: taking the analyst’s contribution to impasse as seriously as the patient’s shapes the field’s thinking on difficulty today.
Impasse and Interpretation: Therapeutic and Anti-Therapeutic Factors in the Psychoanalytic Treatment of Psychotic, Borderline, and Neurotic Patients
Herbert Rosenfeld, Tavistock, 1987
Rosenfeld was one of the major Kleinian analysts of his generation, working alongside Hanna Segal and Wilfred Bion, and this was his last book before his death in 1986. He argues that psychotic symptoms are intelligible and treatable through psychoanalytic means, and works through how narcissism and projective identification specifically create the impasses that stall treatment.
The book marked a real shift in his own thinking. He gave more weight to trauma and environmental failure in his patients’ histories than his earlier, more classically Kleinian work had. That shift put him at odds with parts of the psychoanalytic establishment at the time.
That controversy is part of why the book still gets read. It reads less like a technical manual and more like a record of an influential analyst revising his own certainties late in his career.
Impasse and Innovation in Psychoanalysis: Clinical Case Seminars
John E. Gedo and Mark J. Gehrie, Analytic Press, 1993
This isn’t built from case reports. It’s four transcribed clinical seminars, each one following a genuinely stuck treatment and the analyst’s attempt to find his way through it. Gehrie introduces and comments on each seminar, addressing how theory and technique interact in the case. Gedo then adds his own notes keyed to specific points in the transcript, often revising his first take on the material.
That dialogic, multi-voice structure is the book’s real distinction. Readers see the same clinical moment interpreted from more than one angle rather than a single authoritative account. Gedo was known for his wit as much as his clinical rigor, which comes through in his commentary.
Dilemmas in the Consulting Room
Edited by Helen Alfille and Judy Cooper, Karnac, 2002
This collection addresses a real gap in the literature. Psychoanalysis has produced enormous theoretical writing on technique, but comparatively little on what actually happens during difficult clinical exchanges. Contributors write about practical dilemmas alongside their own emotional responses to them, covering territory that includes violence, suicide risk, and sustaining a working relationship with a patient. Each paper stays close to a single case rather than surveying a topic, so the reader sees one difficult exchange worked through in real detail rather than a general principle illustrated by example.
Most of the literature on technique stays theoretical. This one doesn’t – it’s built from honest accounts of specific sessions that didn’t go smoothly.