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In reading this rich and multi-faceted exploration of psychoanalytic work with unexpectedly challenging patients who may not seem to have been obviously traumatised, I was reminded of Neville Symington's approach to writing The Analytic Experience (1986):
I am talking of a single reality but coming at it from different perspectives. This is the Hebrew rather than the Greek way of explaining a human phenomenon. The Hebrew way is to go round and round a subject, each time using different images to illuminate what is most profound. (p. 11)
So, using different approaches, the four authors of this book draw on psychoanalytic ideas and religious imagery to consider the mutual frustration and agonising stuckness of working with apparently motivated and intelligent patients who fail—after months or even years of unsuccessful treatment—“to achieve a deeper level of insight, understanding, and relief” (p. xix). Instead, the therapist becomes a scapegoat—using the metaphor of ritual sacrifice—with the strong feelings of guilt, shame, and impotence that such patients cannot own through having suffered deeply damaging but unacknowledged emotional neglect as infants.
Following André Green (1986), the authors suggest in the introduction that such patients experienced early, though not obvious trauma in the “lifeless indifference—by the absence of delight, joy, and vitality—in the mother's early nurturing characteristic of the ‘dead mother’” (p. xx). Unable and perhaps unwilling to acknowledge and mourn such an early loss, these patients continue to suffer through “having
turned away from the primary object both prematurely and in hatred” (Kohon, 1999, p. 80). In the transference relationship, the patient similarly rejects the therapist's attempts to make or sustain emotional contact, and may then elicit hostile and negative responses in turn, so confirming his adverse relational experiences since infancy.
By drawing on multiple perspectives from a wide range of psychoanalytic writ