ABSTRACT
Second only to announcements of suicidal or homicidal intent, the phrase ‘‘I’m not getting any better,” is perhaps the most unsettling that an analyst hears from a patient. That the literature on therapeutic technique abounds with vigorous rationales for dealing with this assertion merely underscores the sense of personal threat that it elicits in the bosom of the practicing psychotherapist. 1 Let us begin, by all means, with the candid admission that as professional persons who take our work seriously and are concerned with the therapeutic interaction rather than the mere execution of technical ploys, we do care about the patient’s well-being and we are concerned when he asserts that his condition is not improving under our ministrations. Simply to dismiss the patient’s complaint as a “nasty dig” at the therapist, or to treat it as an instance of infantile blame-shifting is both an insult to the patient and an abrogation of our therapeutic responsibility to examine our own behavior, techniques, and (most important of all) the underlying assumptions and attitudes that we bring to our interactions with a particular patient.
