Abstract
Success and failure in analysis are concepts that by their very nature are elusive and difficult to pin down. They can be thought about only in relation to implicit or explicit goals, which patient and analyst may or may not share. They rely on some concept of what is normative, which is socially determined and in continual flux. Success and failure are both present in most if not all analyses, and in some important way they mutually define and contextualize each other.
Analysts have a difficult time tolerating failure in their work, and find complicated ways of denying it, disguising it, and assigning it elsewhere. This is often the case even when toleration and exploration of failure in the transference-countertransference is essential to the analytic work with certain patients. Moreover, analysts have difficulty avoiding moral judgments of themselves or others regarding failure, which interferes with its more thoughtful and dispassionate analysis. This is particularly unfortunate in that failure is often a springboard for novel and creative contributions to clinical work and theory, as is exemplified in the work of Freud and many other analysts. Because of the elusiveness and formidable difficulty of the topic, an essay attempting to “analyze” failure will itself both exemplify failure and provide impetus for further thinking.
These are the central arguments to which Arnold Goldberg returns again and again in The Analysis of Failure. The book arises in part from a study group he organized consisting of analysts and therapists who were willing to present and discuss their “failed” cases. The scare quotes are meant to indicate that there was often a lack of consensus on whether or not, or in what ways, the presented cases had in fact failed. Some of the book’s many brief clinical vignettes come from this study group; others are from the author’s extensive experience as a psychoanalytic clinician. The volume is not at all a casebook, however, in that the vignettes are quite brief, are employed specifically to make a particular clinical and/or theoretical point, and quite intentionally do not provide enough information for the reader to follow detailed process or to form his or her own impression of the material. Apart from the vignettes, the bulk of the book consists of the author’s rather free-ranging attempt to survey the topic of failure from myriad vantage points. Only three of the book’s sixteen chapters are based on previously published material.
The chapters fall into three groups. The first five chapters establish the territory to be explored and introduce many of the book’s main themes. Here Goldberg provides an overly brief review (four pages) of work by other psychoanalysts who have pondered these issues. For example, several of the essays in the important collection by Reppen and Schulman (2002) are deservedly mentioned, but greater attention to these and other excellent papers in that volume would have benefited the reader. Though it is beyond Goldberg’s scope to delve extensively into this literature, the coverage of a number of important contributions in this area seemed to me a bit thin.
Chapter 3, “Facing Failure,” begins to take up the issue of analytic goals, the broad categories of how we fail, and, most important, the difficulty analysts have in tolerating and “analyzing” failure—each of these is a leitmotif of the volume. Goldberg writes eloquently about the last of these, as in the following: “Failure has no friends. It is ever searching to be shipped elsewhere. . . . It is difficult to see failure as a friend, but without its regular appearance there can be no hope. Failure drives the engine of improvement, and those who do not know failure or are ever intent on banishing it fail themselves. They cannot go beyond the routine of practice to the arena of innovation. . . . We need to examine and befriend all of the negative aspects of something that is uppermost in our mind to avoid” (p. 30).
There might have been some increase in clarity in this discussion, as well as in the book overall, had the author distinguished more explicitly between two types of analytic failure. There are failures with a capital “F,” in which the analysis ends prematurely, with little or no significant accomplishment, and failures with a small “f,” which are on a smaller scale, may be at least partially resolved, and are inevitable in every analysis.
Regarding the issue of analytic goals, Goldberg makes a number of trenchant observations. He points out that unless there is a defined and achievable goal, it is impossible to discuss failure or to explore the reasons for it. Even more important, he points to the frequent disjunction of goals between analyst and patient, which further complicates efforts to understand failure and what might have been done to prevent it. Goldberg also notes the frequent grandiosity of analytic goals: “Analysis is so open-ended and unlimited in its efforts that it is often doomed to falling short. Thus, one requirement of an analysis is ratcheting down one’s ambitions . . .” (p. 37). In addition, the author views the ever widening scope of patients brought into analysis as another area in which sometimes unrealistic goals are doomed to disappointment.
In his overview of the major ways in which analysts are prone to fail their patients, Goldberg includes not doing something that should be done, doing what should not be done, doing something wrong, and, finally, offering the wrong treatment. The last of these, offering the wrong treatment, becomes something of a point of emphasis throughout the book. Goldberg is forthright in his criticism of the reluctance of analysts to consider nonanalytic treatments as adjuncts or alternatives to psychoanalysis. Here he includes various modes of psychotherapy, including cognitive therapies, and of course psychopharmacology. He is similarly critical of the reluctance of analysts to consider less traditional, or even nontraditional, modes of analytic intervention, including self-disclosure, variations in frequency, and face-to-face treatment versus use of the couch.
Goldberg makes a strong plea for the various schools of psychoanalytic thought to talk to, rather than past, one another. He wisely recognizes, however, that at times it is the very conviction of the analyst about his own point of view that makes the work possible and successful.
The next six chapters elaborate the points brought up earlier and attempt something of a taxonomy of the timeline and causes of failure. This group of chapters is the most repetitive and least instructive of the three. In the punningly titled “On Losing One’s Patience,” Goldberg discusses how analysts can come to lose their patients as well as their patience. The last of these chapters, “How Does Analysis Fail?” provides something of a transition to the final grouping. It explores the interesting clinical observation that some patients gain insight but do not change, while others change but do not seem to gain insight. In some instances, the patient may change in ways that seem unrelated to the initial goals of treatment, while those goals remain unchanged. Each of these situations raises interesting questions for a consideration of clinical success or failure.
The last five chapters of the book are clinically the richest and most probing. This is also the most personal part of the book in that the author refers movingly to struggles with mentors and the gradual development of his own views, and doubts, about theory and technique. While in earlier chapters he attempts to avoid any particular theoretical investment, here he is more openly writing from his preferred perspective of self psychology. He offers cogent discussions of empathy and the ways it is frequently misunderstood. While many discussions of analytic failure focus on transference-countertransference as the main crucible of failure, Goldberg, not surprisingly, views failure more from the perspective of empathy, its misunderstanding, and its failure. It is what the analyst does with his empathy, as well as his capacity to modify and sustain it, that Goldberg views as most germane to the understanding of analytic failures. The book ends with a compelling vignette from his own work in which, after prolonged struggle and various attempts to avoid the experience of failure, he comes to understand that his patient needs him to more fully experience the failure and, rather than avoiding it or attempting to compensate for it, to analyze it. Both the content and the probing and affectively engaged presentation of this vignette suggest to me that the experience may have in large measure inspired formation of the study group and the book that has resulted.
In chapter 12, “Max and Me,” Goldberg delves further into the issue of analytic goals, bringing to bear his own attempts to forge the teachings of his mentors into his own personal synthesis. (Max Gitelson is the “Max” of the title.) While some authors foreground self-understanding (“content”) and others privilege self-cohesion (“form” or “process”), Goldberg sees both as necessary, in varying degrees, for different patients. He also allows for the individuality of the analyst in considering this equation. But along with self-understanding and self-cohesion as goals for analytic treatment, he wants to include some aspect of permanent change, often referred to as structural change. Such change, or on-going stability, has the effect of furthering both self-understanding and self-cohesion.
And yet Goldberg then makes the interesting statement, echoing Tip O’Neill, that “analytic treatment, like politics, is local”; by this he means that analysis “can make no claim to permanently insulate a person from the unexpected, innumerable vicissitudes of life . . .” (p. 157). Here again the author is cautioning against excessive and unrealistic goals that need to be ratcheted down. The goals and success or failure of psychoanalysis should always be attached to such modifiers as “for the time being,” “as of now,” and “for this particular patient.”
In chapter 15, “Self Psychology and Failure,” the author makes some of his most important clinical points. There is, for example, a cogent discussion of the self psychological concept of structure-building through nontraumatic deidealization. But for me the main clinical point is the inadvisability of the analyst’s apologizing for, or in some way attempting to compensate for, some of the more unavoidable failures that occur in analytic work. He disparagingly refers to such maneuvers as “optimal gratification,” as against optimal frustration or disappointment and its more or less successful analysis. Here is Goldberg in his own words, in another example of his writing at its best:
Some of the failed experiences in psychotherapy and psychoanalysis must be seen as necessary reenactments of childhood experiences, as transference phenomena of self-object failures. Too often, the countertransference positions that demand an acknowledgment and acceptance of these transference configurations are resisted by therapists in the form of a denial, an apology, or perhaps compensation. . . . This may be explained by a theoretical need for a relationship or some form of interaction, thus again to avoid the therapist’s acceptance of failure. Only the latter opens the door to a proper analytic investigation of failure based upon early traumatic deidealization [pp. 202–203].
In concluding, Goldberg writes that “there can be no doubt that this book is a failure” (p. 215). Among other self-criticisms, he goes on to say that he has failed clearly enough to define failure. He has failed at listing the cause or causes of analytic failures. He has failed to provide “any helpful direction as to how to either avoid or correct failure” (p. 215). He then says that, on the other hand, “the book could claim to be a success of sorts” (p. 215). It has clarified some of the problems with the definition and very concept of failure, by showing that it means different things at different times to different people, and that it is based on a normative scale that is a social construction of a particular time and place. Since some patients will get better no matter what the technique or who the analyst, and others will not get better with any analyst or technique, it becomes difficult to identify specific causes of failure. And yet the effort to think through these issues, and to see the possibility of failure as residing at the core of the work we do, has considerable value. “At the very least, this book may succeed in letting failure come out of the darkness and allowing its presence to be acknowledged. . . . At long last, it should be an opportunity. The success of this book rests on its embrace of failure” (p. 217).
It seems unusual, and perhaps a bit defensive, for a book to offer its own critical assessment, but it is one with which I mostly agree. The book does offer a valuable addition to the currently available literature on analytic failure, and it has the considerable virtue of attempting to normalize failure and to situate it as a proper and necessary focus of analytic inquiry. It clarifies the nature of analytic goals, and usefully deconstructs those that are unrealistic and grandiose. And despite the author’s claim to the contrary, it may help analysts avoid or at least mitigate certain kinds of failure, as well as to make better use of the failures that do occur, failures that perhaps are unavoidable and even desirable.
And yet, despite these considerable virtues, at times I wished that the book would have gone further. With the possible exception of the vignette that ends the book, I found that the presentation and discussion of most of the cases stays too much on the surface. I think most analysts will want more richly textured and detailed accounts of the analyst’s and the patient’s attempts to deal with impending failure. As an example of what I mean, the author comments several times that there were “no significant countertransference issues” (p. 125). Not only does this sound a bit old-fashioned, at least to my ears, but perhaps more seriously it discourages and cuts off any independent evaluation by the reader.
And, finally, there is at times a rushed quality to the writing, making the author’s argument difficult to follow; indeed, the argument can appear to break off in mid-thought, or the author’s purpose in presenting a vignette is not developed in the discussion and remains unclear. Since at other times the discussion is trenchant, compelling, and easy to follow, and since at least a few of the vignettes seem to go deeper and to elicit more thoughtful and probing discussion, this unfinished and insufficiently focused quality is surprising.
Despite its weaknesses, though, the book is a welcome addition to the literature on analytic failure, and it will undoubtedly spur further thinking and discussion among its readers. While there is considerable repetition, and considerable variation in the quality of the chapters, every chapter offers some useful and interesting observations, reflections, and clinical material. While readers with a particular interest in this topic will want to read the entire book, others will derive much of the benefit from a careful reading of selected chapters.