Hidden Faults: Recognizing and Resolving Therapeutic Disjunctions

Disjunctions. The spectrum of breaches in therapy, from subtle to devastating, when therapist and patient miss and confound each other. Disjunctions may briefly confuse the therapeutic partners, grind the therapy to a temporary halt, or lead to premature termination. Always, they provide inestimable opportunities for therapist and patient to understand each other and bring their work to ever more profound levels.

Hidden Faults explores disjunctions and their place in resolving stalemate and furthering therapeutic progress. Disjunction is a concept that can be used with any psychodynamic system supporting a two-person view of therapy, where the inner life of both participants is available for inquiry and change. Little of significance will happen in therapy if the therapist is not willing to be fundamentally influenced by the patient, since transformation in the therapist is the most powerful sign to the patient of being taken seriously. Dr. Steven Frankel illustrates this central point using extensive case material, showing therapist and patient in their human, often agonizing, struggles to bring about creative change.

The author calls his picture of the mind the self and object unit model. The major activities in working within this structure are recognizing the multiple relational configurations each partner brings to the therapy field, and identifying and resolving the inevitable disjunctions that interfere with therapeutic movement. In contrast to traditional models where the patient's wisdom may be minimized, Dr. Frankel holds that heartfelt initiation from each partner in recognizing and healing failures in rapport leads to developmental momentum and lasting creative change.

Steven Frankel has practiced and taught in the San Francisco Bay Area for over thirty years. He is certified by the American Board of Psychiatry and Neurology in both general and child psychiatry, and has authored many professional articles and two books. His ideas about why psychotherapy so often fails to produce lasting change are developed in his books, Intricate Engagements (Aronson, 1995) and Hidden Faults (The Psychosocial Press, 2000). He teaches and consults widely, drawing on his interest in the subtle factors at work in psychotherapy and the research he has done in child development.

A graduate of Yale Medical School, he was an NIMH research fellow at Stanford University Medical School, and trained in psychiatry at the University of California Mt. Zion Hospital and Medical Center in San Francisco, where he later joined the faculty. Dr. Frankel received his psychoanalytic training at the San Francisco Psychoanalytic Institute, where he is a member of the faculty and Board of Trustees. Additionally, he is a training and supervising analyst at the Psychoanalytic Institute of Northern California in San Francisco, and at the Newport Psychoanalytic Institute in Southern California. He is also an associate clinical professor at the University of California Medical School in San Francisco. He maintains a private practice in Kentfield, California, just north of San Francisco, where he treats adults and children.