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Suffering and Sacrifice in the Clinical Encounter offers a new paradigm for understanding the impasses and failures in the psychotherapy process for patients entrenched in self-blaming and masochistic patterns of behavior. Based on object relation theory, and including anthropological and mythological perspectives, multiple clinical examples are presented to illustrate successful therapeutic techniques. Each chapter includes the results of clinical observation, the examination of appropriate theory, and the especially powerful function of the “reversible perspective” where the patient seeks to change roles with the therapist. The work is a collaboration by four eminent teaching faculty from the International Psychotherapy Institute – Charles Ashbach, Karen Fraley, Paul Koehler, and James Poulton – each with decades of experience in clinical practice, the study of psychopathology and therapeutic technique, and teaching and supervision.
Read the authors’ thought-provoking blog – The Virus, Suffering, and Sacrifice – that links their book to current world events.
Charles Ashbach, Karen Fraley, Paul Koehler & James Poulton
Paperback, e-Book, Print & e-Book
Psychoanalysis, Psychoanalytic Theory
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.
Charles Ashbach, PhD, has been on a psychotherapy journey for over 35 years spanning a wide spectrum of theoretical orientations, leading him ever deeper into the study, treatment and mysteries of the mind. He is co-author of Object Relations, the Self and the Group and the author of numerous articles and publications. He is chair of the Philadelphia chapter of the International Psychotherapy Institute (IPI), and founding faculty member of the national IPI system. He has been active in teaching and training therapists throughout the United States and Europe for many years and has sought to bring a more dynamic, creative and imaginative approach to the difficulties involved in becoming an alive co-traveller in the therapeutic enterprise.
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.
About the authors
Trauma, resistance, and sacrifice
Charles Ashbach, Karen Fraley, Paul Koehler, and James Poulton
The scapegoat sacrifice: repeat or reprieve?
Documenting parricide: Abraham, Isaac, and Hans
Into the arms of the god-object: the seductive allure of timelessness
Clinical factors in the treatment of the traumatised, resistant patient
Charles Ashbach, Karen Fraley, Paul Koehler, and James Poulton
FIRING THE MIND MEMBERS