Hidden Faults: Recognizing and Resolving Therapeutic Disjunctions

Author:  Frankel, Steven A.
Publisher: International Universities Press, 2000
Reviewed By: Kenneth J. Appel, Spring 2003, pp. 23-24

Healers have progressively been aware of, puzzled by, and incredibly industrious in describing the healing relationship. Salient macrovariables are set, setting, and intent. “Set” refers to the frame of mind in which each of the participants enters the relationship, e.g., the healer to heal and the seeker to be healed. “Setting” denotes the physical and psychological environment in which healing occurs, while “intent” relates to the participants’ conscious and unconscious expectations, wishes, and desires.

Psychotherapists seem more driven than other healers to observe, explain, and make successive approximations towards understanding the healing relationship. Interest in the relationship is often stimulated by questions such as: Is relationship in and of itself healing? Is the psychotherapeutic relationship in and of itself healing, and if so how? As a consequence of this intense interest, theories abound and, when persuasive, find their way into mental health, education, and training curricula.

While psychotherapy education and training commonly emphasize the differences between the psychotherapeutic relationship, and relationship in all its other forms, the similarities between them (e.g., the need to be recognized and understood) are frequently taken for granted. Chiefly emphasized is the “specialness” of the therapeutic relationship, how it differs from ordinary social relationships such as friendship, family, pastoral, health, etc. Teachers often fail to attend to relationship as a dynamic energy system that seeks equilibrium, and is subject to vicissitudes, which vary in amplitude and intensity. Steven Frankel approaches these neglected areas in his book Hidden Faults: Recognizing and Resolving Therapeutic Disjunctions (2000).

The query that most interests Frankel is, “...what really happens between human beings, not what we think should happen.” (p. ix) That is, how does one escape determining tendencies which influence how one participates in the therapeutic relationship? In this case “what should happen” relates to fitting experience to theory and then saying, “that is what happened.” The alternative is to let the experience tell the story. When we force theory to fit we may lose the real experience. Frankel’s work is an effort to be more experience-near in the relationship. Bravo! Even so, his effort is also subject to what might be called theoretical determinism, by which I mean that even Frankel’s experience-near approach ends in theory building. However, Frankel attempts to stay as near to the experience as possible.

Frankel began this exploration of what “really” happens in Intricate Engagements: The Collaborative Basis for Therapeutic Change (1995). In that book he limned out his nascent theory of mind and therapeutic change. Among the concepts are the self and object unit model (SO model), multiple simultaneous relationships, and the facilitating relationship. He succinctly reviews this framework in Hidden Faults before elaborating on an important and inevitable element in the relationship: disjunction.

The author welcomes us to the “world of disjunctions” with some wit, inviting us to recognize and utilize disjunctions to enhance and free our therapeutic work from inevitable impasses which block change. Disjunctions occur in therapy; they are unavoidable, just as they are in social relationships. We recognize disjunctions as those times in therapy when the patient and therapist miss and confuse each other, thereby failing to meet in the relational (therapeutic) space. We may miss each other’s meaning or intent, we may be lost or confused, or we may reach a stalemate. Whatever the case, dissonance results, change is blocked, and there is a failure to meet affectively or cognitively. Frankel maintains that disjunctions arise when the patient’s and therapist’s SO constellations are antagonistic and/or dissonant. Recognizing and using disjunction in a collaborative way allows therapy to proceed, often furthering and enriching the work.

Dynamically evasive as they may be, disjunctions can be recognized in therapy by either participant. They may also be recognized when the therapist seeks consultation concerning his/her perception that the therapy is blocked or at a stalemate. On these occasions the therapist may be treated to an “Aha!” experience, and arrive at a new understanding for future work with the patient. However, as indicated by the title “Hidden Faults,” disjunctions are frequently masked by intricate defensive networks. The path to recognition and utilization of dysfunction is strewn with the familiar: resistance, collusion, and outright conscious denial on either or both parts, etc. It is clear from Frankel’s case material that both therapist and patient are subject to such roadblocks. In his clinical material Frankel illustrates several types of disjunction, how he recognized them, the work surrounding this recognition, and the utilization of the disjunction to recommence and deepen the work. The case material he presents invites us to see the way things “really” happen in the relationship, as differentiated from the often oversimplified fitting of data to theory, thereby excluding elements of the experience. What is most striking in these clinical vignettes is Frankel’s ability to be empathic, to listen carefully, and to work in a collaborative manner. His recounting of his experiences with Madge illustrates these qualities, while also presenting a situation with which we are all familiar, i.e., assuming the presenting complaint is a resistance rather than a pathway to deeper work.

Madge came into treatment with the intent to work on her problems regarding her two grown children. Each of them seemed successful in work, but Madge was worried about their apparent slowness and difficulties (as Madge saw it) with relationships. She was most anxious that her mothering might have influenced the current state of affairs. She wanted to know “where had she gone wrong?” How could she be a better parent? Frankel’s intent was quite different. “For me,” he says, “the lifting of Madge’s depression and a lessening of her profound cynicism would mean that ‘real’ change would occur” (p. 3). He regarded her constant need to talk about her children as a diversion, a resistance to deeper work. As a consequence of this difference in intent, the therapy was not satisfactory or productive for either the patient or the therapist. The discrepant intents were potential to creating a fault, a therapeutic disjunction of major proportion. Madge was first to recognize the disabling disjunction. The work had reached a stalemate for her, while Frankel struggled optimistically to forward his interest in the “real work.”

Fortunately, for both parties, there was enough good will to keep the therapy alive in spite of their differences. Frankel’s self examination of his role in this dilemma is compelling. He does not hesitate to reveal his feelings about Madge and the multiple determinants of his “countertransference.” Even though Madge recognized the therapist’s limitations, they were able to work together during the period before the mutual recognition of the fault. This seems a good indicator for collaboration and utilization of the disjunction.

How are disjunctions recognized and agreed upon? Frankel answers this question in the following way:

Taking a collaborative stance helps. Listening carefully and empathetically is imperative. Allowing the patient to review the analyst’s experience is pivotal. Had I been able to say to Madge, for example, that she seemed to skim the surface in her insistence that we stay in the present, we might have had a chance. There would have been room then for her to ask me whether it was not her superficiality but my own that I was concerned about. (p.7)

Once the disjunction is recognized and agreed upon, the patient and therapist resume collaborative work, the therapeutic space re-opens, and the relationship can again demonstrate its healing power. In Madge’s case, the therapy resulted in her being able to have more reasonable expectations concerning her son and daughter. This, in turn, relieved the anxiety and depression that her self-criticism had engendered. Deeper work could now be done if the patient had that intent. But for the time being the matching of her intent and Frankel’s allowed the “surface” problems to be addressed and resolved. It must be noted that in this process the therapist is also healed. Three entities profit from this arduous work: the relationship, the patient, and the therapist.

Other case samples illustrate the variety of disjunctions one may encounter in practice. Though the path to recognition and utilization of disjunction is varied, what does seem invariant is that the examination of disjunction from the SO Unit point of view furthers and deepens the facilitating relationship, and, thus, the therapy.

Steven Frankel welcomes the reader to the word of disjunctions as one would be welcomed to his home. Indeed, through his careful examination of case records and experience, we come to believe that he is thoroughly at home with both his experience and his evolving SO model. We can only look forward to his next invitation to visit other components of his emerging theory.

Reviewer Note

Kenneth Appel has practiced psychotherapy and consultation for the past 40 years. He is a faculty member of the Department of Psychiatry, University of California, San Francisco and is also on the faculty of the California Pacific Medical Center. He lives in New Mexico and practices in San Francisco.

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