In Suffering and Sacrifice in the Clinical Encounter, the authors identify the ways in which some patients seek to create what Freud termed a “private religion” and unconsciously substitute sacrificial enactments of scapegoat surrogates to protect them against the pain of separation, mourning, and loss of primary figures of attachment. They investigate the function of sacrifice and its relationship to the breakdown of psychic structure and the development of manic defenses and pathological narcissism. Such treatments are complex, the “reversed roles” of victim and perpetrator central to the sacrificial process when enacted in therapy can trigger feelings of shame, guilt and inadequacy in the therapist. Perverse, vengeful, and sadistic transference distortions are explored to enable the therapist to appreciate the true nature of the patient’s hidden traumatic experience, with the necessity for the working-through of genuine separation and grieving highlighted. Useful methods are detailed to counter the tendency to become overly active and inappropriately involved when working with patients who have deadened their desire to improve.
This book is unique in utilising the dynamic concepts of the effects of trauma and sacrifice, the role of the scapegoat, and the distinctions between the experience of pain and the accomplishment of suffering in order to develop a foundational understanding of such patients. It is a must-read for all practising and trainee therapists.
Karen Fraley, LCSW, BCD, is in private practice in Exton, Pennsylvania. She is a fellow of the Pennsylvania Society for Clinical Social Work and a member of the national faculty of the International Psychotherapy Institute (IPI). She currently co-chairs the IPI’s Clinical Consultants in Psychotherapy Program and serves on the Steering Committee for the IPI’s Psychoanalytic Psychotherapy Program. She is a founding member of the Philadelphia Psychotherapy Study Center and teaches seminars in object relations theory and practice. She contributed to the book Tuning the Therapeutic Instrument: Affective Learning of Psychotherapy edited by Jill and David Scharff and has published an article about Bion’s model of the mind.
A native of Pittsburgh, Paul Koehler received his bachelor of arts from Gettysburg College and his Master of Social Work from the University of Pennsylvania. He subsequently completed certificate training programs at the Institute for Psychoanalytic Psychotherapies, in Philadelphia, and the Washington School of Psychiatry, in Washington, DC. Paul has been a faculty member of the International Psychotherapy Institute since 2002 and is past chair of its core training program. Paul’s interests include literature and mythology, writing, music, lutherie, health and fitness, and the Pittsburgh Steelers. Paul is in private practice in Doylestown, PA.
Dr James Poulton is a psychologist in private practice in Salt Lake City, Utah, an Adjunct Assistant Professor in Psychology at the University of Utah, and a member of the national faculty of the International Psychotherapy Institute (IPI), based in Washington, DC. He currently serves on the Steering Committee for IPI’s Psychoanalytic Psychotherapy Program, is the chair of its Curriculum Committee, and is the past co-director of its Salt Lake City Chapter. He has written numerous articles and chapters on psychological treatment and theory, and is the author of Object Relations and Relationality in Couple Therapy: Exploring the Middle Ground and co-author of Internalization: The Origin and Construction of Internal Reality. He has also co-authored two books on the history of art in the American West: LeConte Stewart: Masterworks and Painters of Grand Teton National Park.
Caroline Sehon, MD, FABP Director, International Psychotherapy Institute –
‘Suffering and Sacrifice in the Clinical Encounter makes a truly unique contribution to the clinical challenges of working with patients gripped by developmental loss and trauma. The authors sound a humanitarian plea for analytic therapists to learn ways to leverage their painful countertransference responses with such “difficult to reach” patients. Through many diverse theories and evocative clinical illustrations, these four highly dedicated and skilled therapists offer singular ways of thinking about, and working with, such patients whose early dependency longings went unheeded, tragically, from the beginning of life. The authors describe the transformative potential achievable if patients could bravely enter a therapeutic relationship where genuine psychic contact can be supported and contained; where suffering and sacrifice can be investigated and symbolized; and where mourning of traumatic loss can be facilitated and reworked. This collection belongs in the library of students and psychoanalytic practitioners who are committed to helping traumatized patients refind renewal, hope, and aliveness.’
Giuseppe Civitarese, member of the American Psychoanalytic Association and Italian Psychoanalytic Society, from the Foreword –
‘The theory employed is rich and versatile, the clinical vignettes extremely vivid and instructive. The style of the book is happily communicative and allows a pleasant and rewarding read. I can only recommend reading this fascinating and brilliant book to all analysts, psychotherapists, and scholars of human sciences interested in using psychoanalysis to understand humanity and alleviate psychic suffering.’
Jack Novick and Kerry Kelly Novick, authors of ‘Fearful Symmetry: The Development and Treatment of Sadomasochism’ and ‘Freedom to Choose: Two Systems of Self-Regulation’ –
‘This wide ranging and scholarly book goes a long way in answering what Leon Wurmser called “the riddle of masochism.” The authors remind readers of the deep philosophical and humanistic roots of psychoanalysis, while bringing their thinking squarely into the clinical situation and the complexities introduced in the therapeutic relationship by sadomasochistic dynamics.’
Alexandra Maeja Raicar, Attachment, November 2022 –
I have experienced this book as thought-provoking, offering a feast of psychoanalytic ideas and language, rich in Western classical and biblical allusions and paradoxes.