Commitment under pressure: Experienced therapists' inner work during difficult therapeutic impasses

Interviews were conducted to explore the recall of impasse experiences of 12 highly skilled and experienced therapists. Participants were interviewed in depth individually about a specific impasse from their experience that resolved successfully. The transcribed interviews were analysed using qualitative methodology. The authors found that participants understood their reported impasse experiences as important for their professional development. The category of “helpful subjective presence” describes the mode of being with patients that the participants found therapeutic. The categories of “losing hope” and “difficult feelings in the therapist in the here and now” are processes that threaten the helpful presence. The participants' inner work on the two latter categories is identified as a key to the successful resolution of impasses.