Book excerpt: This book focuses on problematic situations in therapy mpasses, wounding, and ruptures. Based on the author's extensive clinical experience with therapists and patients in impasses, as well as her survey questionnaire of other therapists Elkind views impasses, wounding and ruptures as unavoidable pivotal events in therapeutic relationships. She offers numerous vignettes of consultations she has provided to patients and therapists grappling with a diverse range of problems. Elkind introduces uniquely humanizing theoretical concepts such as, primary vulnerability and problematic relational modes to provide a framework for understanding and working with relational knots between therapists and patients.