In this major contribution to contemporary psychoanalysis, Stanley Coen illuminates a heretofore undescribed character structure especially resistant to analytic process. Pathologically dependent patients, for Coen, are identified not by surface character traits, but by their response to the intrapsychic demands of analysis. Such patients remain in treatment, sometimes contentedly, sometimes amid rebukes and complaints, but they do not profit from it. Their inability to use insight, especially in the transference, is matched by a proclivity for sadomasochistic enmeshment. In analysis, this tendency translates into a continuing dependent attachment to the analyst. In exploring the genetic roots of pathological dependency, Coen ranges beyond extant trauma theories in describing a pattern of parent-child interaction in which repetitive behavioral enactments substitute for the acceptance and resolution of conflicts, both intrapsychic and interpersonal. In analysis, pathologically dependent patients use the analyst as they have come to use significant others throughout their lives: as part of a defensive structure characterized by repetitive enactments and a refusal to face what is wrong with them. This "misuse of others" is infused with destructiveness, hostility, and rage, and the analyst necessarily becomes the object of these powerful emotions. With such patients, then, the road to therapeutic progress invariably passes through the analysis of mutual transferential and countertransferential hate, the patient's tempting invitations to collusion and avoidance notwithstanding.

In this elegantly written book, eight distinguished psychoanalysts address the ubiquitous phenomenon of guilt. They describe the childhood experiences that form the bedrock of this emotion and delineate various types of guilt, including pre-oedipal guilt, oedipal guilt, survivor guilt, separation guilt, induced guilt, and so on. Noting that guilt, by itself, is neither 'good' nor 'bad,' these master clinicians highlight the adverse (e.g. self-punishment, masochism, irritability) and potentially positive (e.g. reparation, helpfulness towards others) outcomes of guilt. They critically assess previously published findings, review diverse theories, and offer illustrative material from treatment of children and adults. As a result, Guilt: Origins, Manifestations, and Management is replete with clinical pearls and highly useful tips for the management of patients driven by feelings of guilt and remorse.

In this elegantly written book, eight distinguished psychoanalysts address the ubiquitous phenomenon of guilt. They describe the childhood experiences that form the bedrock of this emotion and delineate various types of guilt, including pre-oedipal guilt, oedipal guilt, survivor guilt, separation guilt, induced guilt, and so on. Noting that guilt, by itself, is neither 'good' nor 'bad,' these master clinicians highlight the adverse (e.g. self-punishment, masochism, irritability) and potentially positive (e.g. reparation, helpfulness towards others) outcomes of guilt. They critically assess previously published findings, review diverse theories, and offer illustrative material from treatment of children and adults. As a result, Guilt: Origins, Manifestations, and Management is replete with clinical pearls and highly useful tips for the management of patients driven by feelings of guilt and remorse.

Death is a much avoided topic. Literature on mourning exists, but it focuses chiefly upon the death of others. The inevitable psychic impact of one's own mortality is not optimally covered either in this literature on mourning or elsewhere in psychiatry and psychoanalysis. The Wound of Mortality brings together contributions from distinguished psychoanalysts to fill this gap by addressing the issue of death in a comprehensive manner. Among questions the contributors raise and seek to answer are: Do children understand the idea of death? How is adolescent bravado related to deeper anxieties about death? Is it normal and even psychologically healthy to think about one's own death during middle age? Does culture-at-large play a role in how individuals conceptualize the role of death in human life? Is death "apart" from or "a part" of life? Enhanced understanding of such matters will help mental health clinicians treat patients struggling with death-related concerns with greater empathy.

The ability of psychotherapists to tolerate their own feelings in the clinical situation determines how their patients experience and tolerate their own intense and often distressing affect. Dr. Stanley J. Coen draws on his own struggles with the most difficult and challenging patients in his practice, and finds that affect intolerance, in both patient and therapist, can be mitigated and understood when therapists broaden their emotional range, enabling them to engage in emotionally richer interactions with the patient. The more of their own feelings and wishes that clinicians can take responsibility for, the more they can tolerate, contain, and eventually interpret what patients find emotionally unbearable. Dr. Coen describes, in detail, how he works with difficult patients, trying to engage them as deeply and fully as both they and he can tolerate. Coen focuses on the pragmatic use of affect tolerance in the clinical situation. Real change through treatment requires mobilization of intense feeling, including hate and love. Therapists, too, must contend with their own emotional inhibitions and stalemates, and he suggests collaborative ways to help them. He encourages therapists to broaden their perspectives, consult with colleagues, listen to others, write about their difficulties, work in peer supervision, and perhaps even go back to treatment themselves. He counsels them to study one another s difficult cases in a spirit of collegiality to learn what is most effective for patients. Coen shares his own experiences in troublesome clinical situations to help other therapists identify similar difficulties. He shows how all therapists can be prepared to catch their own vulnerabilities and discomforts with their patients passions, and how they can then subject their feelings to self-scrutiny. By seeking to understand and confront their struggles with the feelings that their patients arouse, therapists can more fully help their patients work out their conflicts and to expand their emotional depth. A"