ABSTRACT
Chapter 9 presents a detailed clinical narrative on change and impasse, examining tape recorded, transcribed sessions in a four-year psychoanalysis. The patient was a creative writer who came to analysis suffering from bouts of suicidal depression and severe obsessional symptoms. He ruminated with long, intellectualizing, obscuring narrations, and paralysis. R was unable to differentiate internal destructive impulses from external destructive forces. He was afraid that “the voice” “inside” made him waste his life. In the third year, R pressured the analyst to read and help edit his stories. Later R attacked the analyst for focusing on his writing because it had caused him pain all along. The analyst prescribed an anti-depressant, and R suddenly tells the analyst that he’ll end the analysis, dismissing the analyst, saying the “drug” has finally “calmed” his “inner voice.” R’s life improved; his relationship with his partner was more open; he was able to use his talent as a writer in a different field to make a living. However, the analyst’s failure to address the negative transference had contributed to the impasse. The observations in two 3-LM reports on specific changes and absence of change corresponded in remarkable detail with the findings from the systematic clinical research.
