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Absolute Truth and Unbearable Psychic Pain is a volume edited by Allan Frosch on the challenges of working with concrete patients in psychoanalysis and psychoanalytic psychotherapy. In the preface, Fredric Pearlman well captures the clinical challenge: “The patient's ideas and feelings are thus experienced as … facts of life; inescapable, fundamental, and absolutely true …. Any effort to interpret the patient's reality as a construction, forged of fact and fantasy, and shaped by forces beyond the patient's immediate grasp are, naturally enough, apt to appear to the patient as foolish or superfluous (at best) and as hostile, destructive, or crazy (at worst). Persistent efforts at interpretation are likely to eventuate in unproductive conflicts between patient and analyst about ‘reality’.” (p. xvi) The contributors to this volume tackle this difficult challenge from a variety of theoretical perspectives, contemporary Freudian, contemporary Kleinian, and Winnicottian.
In the introduction, Allan Frosch defines concreteness as “desymbolized thinking” in which “things are what they are.” (p. xix) Such concreteness is understood as a defense against unbearable psychic pain. Thus, the very process of psychoanalytic interpretation, interpreting the underlying meaning of a manifest content from different perspectives to arrive at a latent content, constitutes a threat to the patient's defensive organization and so exacerbates the patient's literal-minded and passionate conviction in an absolute unchanging reality.
Maxine Anderson, utilizing a contemporary Kleinian framework, articulates the challenges of containing the negative countertransference that can be induced by working with defensively concrete patients, especially angrily critical ones. “When we are encumbered by fear, anxiety, or rage we feel pressured and defensive but also probably unable to conceptualize that we are being tormented by fear, pressured by anxiety, or swept away by rage …. we feel concretely “trapped