What are the underlying clinical and interpersonal dynamics that contribute to unsuccessful outcomes in psychoanalytic and psychotherapeutic treatment? Arnold Goldberg, a prominent psychoanalyst, examines the phenomenon of treatment failure by moving beyond the traditional focus on patient pathology. He argues that failures often emerge from a complex interplay between the therapist's theoretical rigidity, the patient's specific psychological defenses, and the breakdown of the therapeutic alliance. The text provides a framework for clinicians to identify early warning signs of stagnation and to navigate the difficult terrain of therapeutic impasse.

Clinicians and students of psychotherapy frequently cite this work as a necessary, sobering examination of the limitations inherent in clinical practice. Experts highlight the text for its candid approach to professional vulnerability and its focus on the collaborative nature of the therapeutic process.