To Resume a Stalled Psychotherapy? Psychological Testing to Understand an Impasse and Reevaluate Treatment Options

Abstract

Clinical wisdom holds that psychological testing is a useful tool for consultation when there is a need to untangle and resolve a psychotherapeutic impasse. However, there has been a lack of empirical research in this area, and only a few cases have been published demonstrating how psychological testing can be used toward this end. In this article, the author offers a case illustration of the application of testing with a patient who sought to resume psychotherapy following a previous impasse and premature termination. Specific referral questions for the evaluation are explicated followed by discussion of the test data that answered each of them. The findings pointed not only to intrapsychic and object relational characteristics of the patient that contributed to the impasse but, importantly, alerted the author-therapist to his contributions as well. Treatment implications of the findings are also highlighted.

Acknowledgments

The author thanks Dr. Linda Helmig Bram and Dr. Jed Yalof for their assistance in preparation of the article.

An earlier version of this article was originally presented in the symposium “Difficult Assessment Cases and Then Some: Psychodynamic Perspectives” at the meeting of the Society for Personality Assessment, March 2014, Arlington, VA.

Notes

¹ Identifying information has been disguised.

² Space limitations and my aim to model a referral question-focused approach to test interpretation preclude a more comprehensive review of the data and their synthesis.

³ The Rorschach was administered and scored according to the CS (Exner 2003), although a testing-the-limits “second inquiry” was applied selectively following the standardized administration (described in chapter 3 of Bram & Peebles, 2014). Additionally, the sequence of scores presented in Appendix B includes some notations outside of the CS (e.g., Aggressive Content [AgC]; Meloy & Gacono, 1992).

⁴ See Bram and Peebles (2014) and Lerner (1998) for an explanation of determinant qualifiers such as avoid. Essentially, avoid is noted when the respondent has likely been stirred by chromatic features of the inkblot but is not able to articulate it to be scored as a determinant. This is believed to reflect a similar emotional process in which one is stirred by and reacts to affect without realizing it or being able to verbalize it.

⁵ Notice in the sequence of scores (Appendix B) that she momentarily destabilized cognitively and affectively on Card X-20 (“chaos”; pure C, no form) when her focus shifted back to the big picture (Wv/+) before she could narrow it again for her final response Card X-21.