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413 The Difficult Patient – 5 seminars

Course Leaders: D. Carveth, PhD and R. Ruskin, MD

Course Description

The seminar will study difficult cases in analysis by means of presentation and discussion. Patients with severe psychopathology can be impulsive, act out, suffer extreme mood shifts and have more difficulty in reality testing than is typical of hysterical and obsessional neurosis. The seminar will examine difficulties presented by their diagnosis and treatment and evaluate results. The seminar will explore whether such patients have a unique etiology or whether it is a question of the degree of their severity.

Course Objectives

Candidates will learn to:

  1. Formulate the problems of the “difficult patient”: provocative, homicidal, narcissistic, masochistic, suicidal (1.1, 1.2, 4.5c, 4.5f)  .
  2. Observe the commonalities and differences in a broad range of psychopathologies (1.3).
  3. Understand the technical problems posed by patients who are difficult to treat, and to integrate into practice appropriate treatment strategies (4.5).
  4. Observe in themselves the impact of the difficult patient on their countertransference, and to respond appropriately (1.4, 4.2, 4.3).
  5. Expand their exploration of the therapeutic potentials of psychoanalysis (1.2, 1.3).

Seminar 1

The Hateful Patient

Required Reading

Epstein, L. (1977). The therapeutic function of hate in the countertransference.  Contemporary Psychoanalysis, 13, 442-460.

Seminar 2

The Deeply Masochistic Patient

Required Reading

Joseph, B. (1982). Addiction to near-death. International Journal of Psychoanalysis, 63, 449-456.

Seminar 3

A Homicidal Patient

Required Readings

Hanly, C. (1992). On narcissistic defences. The Psychoanalytic Study of the Child, 47, 139-157, 148-156.

Hanly, C. (1998). Reflections on the analyst’s self-disclosure. Psychoanalytic Inquiry, 18, 550-565.

Hanly, C. (2009). On truth and clinical psychoanalysis. International Journal of Psychoanalysis, 90, 363-73.

Porter, M. (1998). On beginning with a borderline patient. In T. Jacobs & A. Rothstein (Eds.) On Beginning an Analysis (pp. 163-178).  Madison, CT: International Universities Press.

Seminar 4

A Suicidal Patient

Required Readings

Hanly, C. (2018). Narcissism, realism and the analytic process. (Unpublished; copies to be provided by teacher).

Calef, V. Weinshel, E.M. (1979). The new psychoanalysis and psychoanalytic revisionism.  Psychoanalytic Quarterly, 48, 470-491.

Seminar 5

Symposium: Overview of the Program

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