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In Affect Intolerance in Patient and Therapist, Stanley Coen describes the predicament of patients who experience this condition and the situation of the therapist who attempts to help them. The book draws on and reworks issues Coen has dealt with in previous articles and books and adds new material. Coen's overall conclusion is that a patient's inability or unwillingness to tolerate affect requires, of the therapist who hopes to effect change, alterations in expectations and an exquisite ability to tolerate strong affects himor herself. “It is a major premise of this book,” says Coen, “that both patients and therapists have difficulty tolerating intense affects, loving and hating, and a central aim of this book is to help both to do so …”; therapists must be prepared to bear what their patients cannot, and the “therapist's most essential task is to persist in feeling with and for patients their terrors of their own feelings and of their needs for the therapist” (pp. xxii, xxv). The patient will not be able to tolerate these affects if the therapist cannot.
The book is divided into three parts: What Makes Affect Intolerable for Patient and Analyst?; What Is the Therapist's Role in Helping the Patient Develop Affect Tolerance?; and Helping Therapists' Affect Tolerance through Talking and Writing about Our Work. In discussing barriers to love in the first chapter, “Barriers to Love between Patient and Analyst,” Coen points in blame to the therapeutic ego ideal of most analysts, which remains intolerant and critical of the analyst's having loving and hating feelings toward patients. In addition, whatever fixates