Am J Psychiatry 1980; 137:1404-1409
Copyright © 1980 by American Psychiatric Association
A psychoanalytic approach to a therapeutic impasse with an impulsive adolescent: permission to speak the unspeakable
A Hoffer, R Goettsche and F Linden
The authors describe an impasse in the therapy of an impulsive,
intermittently psychotic adolescent boy and demonstrate the usefulness of
understanding the impulsive behavior according to the classical
psychoanalytic definition of "acting out." Rather than being viewed as a
random breaking through of impulses, this impulsive behavior can best be
understood and clarified in the course of intensive psychotherapy as
classical acting out under the influence of the therapy and the
transference. With impulsive patients of this type they have observed a
strong tendency to abandon this basic psychoanalytic formulation and the
use of the verbal interventions that follow from them. Such patients often
need encouragement to remember and express their painful feelings in words
instead of repeating the entire emotional experience in action. The authors
also describe the resistances within the treatment team that interfered
with the development and utilization of this basic psychoanalytic
formulation.
