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In her paper, “Good Breast/Bad Analyst: False Dichotomies in Understanding Aggressive Patients,” talks about the difficulties of sitting with patients who are caught in the grip of a terrible need to crush and destroy their treatment and us along with it. These are patients who see red with everything we say or don't say, who come at us like raging bulls, and who seem to feel that they must draw our blood before we draw theirs. We sit in our chairs, trying to hang on, tense, unnerved, sweating, heart pounding. We try to still our minds, to sort through the turbulence inside, to find a thought thread that might guide and steady us, but mostly we just try to survive.
Much has already been said, of course, about such patients and these kinds of clinical dilemmas from many different perspectives. A lot of what has been said has increased our ability to understand, or withstand, the strain and drain of such situations. But what interests Herzig about these kinds of clinical dilemmas is how to understand both the patient's internal state of being and the state that is created between patient and therapist at such times. How do the patient's internal world and the world created between our patients and ourselves interact and influence each other? How do we understand both the mutuality of the unconscious struggle involved in such clinical dilemmas, and its deeply private, personal nature?
Herzig places herself right in the center of contemporary psychoanalytic discussion with her suggestion that several different theories — with emphases that may traditionally have been seen as mutually exclusive — may all have useful things to say about aggression and her patient, Peggy.