In this book the author examines the series of connections that give rise to the intimate relationship between environment and individual in the construction of emotional suffering, emphasising both the undisputed pathogenic action of environmental stimuli and the active participation of whoever is obliged to suffer the negative situation. The author shows that the way in which one tries to escape suffering is what often seriously jeopardises growth. Working with Difficult Patients points out the intrinsic link between some forms of mental suffering and the distorted responses that the patient has received from his or her original environment. For this reason the author explores the concept of the emotional trauma in particular, since this trauma, which occurs in the primary relationship, often impels the child into relational withdrawal and towards constructing pathological structures that will accompany him or her for the rest of their life. The chapters are ordered according to a scale of increasing treatment difficulty, which is proportional to the potential pathogenicity of the underlying psychopathological structure.
Franco De Masi is a Training and Supervising Analyst of the Italian Psychoanalytical Society and former President of Centro Milanese di Psicoanalisi and Secretary of the Training Milanese Institute. He is a medical doctor and a psychiatrist who worked for twenty years in psychiatric hospitals. Now he lives and works as a full time psychoanalyst in Milan. Currently his main interests are focused on the theoretical and technical psychoanalytical issues related to severely ill patients. He has published several papers in 'The International Journal of Psychoanalysis' and in the 'Rivista Italiana di Psicoanalisi'. He is author and editor of numerous books including 'Making Death Thinkable'.
ABOUT THE AUTHOR INTRODUCTION PART I CHAPTER ONE What do we mean by difficult patients? CHAPTER TWO Trauma as a source of pathology CHAPTER THREE Trauma in the primary relationship CHAPTER FOUR Defences and psychopathological constructions CHAPTER FIVE Psychic withdrawal CHAPTER SIX The superego in difficult patients CHAPTER SEVEN The unconscious in neurotic, borderline, and psychotic patientsPART II CHAPTER EIGHT The pathology of sexuality CHAPTER NINE The erotic transference: from dream to delusion CHAPTER TEN Is it possible to cure paedophilia? CHAPTER ELEVEN The enigma of transsexualism CHAPTER TWELVE Reflections on the origins of sexual perversions CHAPTER THIRTEEN The perverse fascination of the destructive organisation CHAPTER FOURTEEN Pathological dependences on the Internet CHAPTER FIFTEEN Some problems in treating borderline patients CHAPTER SIXTEEN Elements for the analytic therapy of psychotic patients CHAPTER SEVENTEEN The therapeutic approach to the delusional experience CHAPTER EIGHTEEN The problematic position of the transference in the psychotic state CHAPTER NINETEEN Difficult patients: conclusions NOTES REFERENCES INDEX