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. Franco De Masi shows that the way in which one tries to escape suffering is what often seriously jeopardises growth.The aim of Working with Difficult Patients is to point 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.
Consequently, the borderline state and the psychotic state are located at either end of an axis of progressive complexity and difficulty towards change.The author endeavours to set out a panorama of the main psychopathological entities as he has encountered them and indeed still encounters them in his clinical activity, presenting the material according to a criterion that highlights the differences between the individual case histories. A number of chapters in the second part of the book attempt to clarify the various psychic processes that underlie some frequently encountered psychopathologies.
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