Clinical Psychoanalytic Case Studies with Complex Patients

Anne Zachary is a psychoanalyst and retired consultant psychiatrist in psychotherapy based in the UK. She trained in medicine and psychiatry at the Royal Free Hospital and Friern Hospital and specialised in psychotherapy at the Cassel Hospital. She was locum consultant at the Maudsley Hospital before becoming a consultant at the Portman Clinic and consulted to medium secure units and Broadmoor Hospital. She has a specialist interest in acting out behaviours and risk and a sustained interest in female sexuality. She has a private psychoanalytic practice in SW London.

"Clinical work is at the heart of the many-faceted creature we call psychoanalysis. Psychoanalysis is full of ideas, and ideas about psychoanalytic ideas, its meta-psychology. But again, and again its abstractions need to be earthed in the actual practice of psychoanalytic encounters between analysts and patients. It is this real, human encounter which contains, ultimately, the most moving, interesting and important dimensions of psychoanalysis, nowhere more so than when analysts are challenged by human cases which are enormously difficult to engage with and understand. Often psychoanalysis is the last chance for highly disturbed patients, which ups the ante for patient and analyst alike. Anne Zachary has, therefore, done us all an immense favour in putting together this book of expert clinical work with complex cases, a book that will inform and inspire many different types of readers - patients, analysts, psychologists, psychiatrists, all mental health workers, and those who are simply interested in psychoanalysis and the human spirit. I endorse the book whole-heartedly." - Francis Grier, Training Analyst & Supervisor, British Psychoanalytic Society, Editor-in-Chief, The International Journal of Psychoanalysis."Psychoanalytic Clinical Case Studies with Complex Patients: Watching experience at work edited by Anne Zachary includes a wide spectrum of difficult to treat cases. If you buy this book you will learn about the tragic consequences of the tensions between management in NHS trusts and the front-line clinical personnel. Three chapters convey the hard-won understanding that emerges in the treatment of autistic children and adults. The psychosomatic and hysterical reactions to intergenerational trauma feature in another chapter. The reader will be able to follow the analysis of interlocking psychopathologies within a parental couple that enabled the father to move away from longstanding psychotic functioning. The technical difficulties of working with patients who present with gender dysphoria are examined in another chapter. This book will take the reader through the differential diagnosis of the underlying diseases that contribute to dementia, and a treatment that acknowledged the demented patient’s pain and insight. The reader will also learn about psychoanalytic work with patients who exercise ruthless and/or sadistic violence, and how the clinicians managed their anxieties when working with these patients. I strongly recommend this honest, straightforward book about the disturbing emotional, intellectual and clinical realities encountered when working psychoanalytically with complex patients." - Donald Campbell is a Distinguished Fellow, Training Analyst and Past President of the British Psychoanalytic Society

• DisclaimerThe essence of nurtureForeword by Bob HinshelwoodList of contributorsClinical psychoanalytic case studies with complex patients: watching experience at workAnne ZacharyPART ONE SupportChapter One‘I’m beyond caring’: a response to the Francis Report: the failure of social systems in healthcare to adequately support nurses and nursing in the clinical care of their patientsMarcus EvansPART TWO AutismChapter 2aAffections, words and plays in autistic children: discussion of Maria Rhode's clinical caseLaurent Danon-BoileauChapter 2b'Finding one’s feet': body, affect and identifications in a pre-autistic toddler learning to walkMaria RhodeChapter 3Analysing Miss Daisy: a psychoanalytically informed treatment of an emerging adult autistic womanAlan SugarmanPART THREE Psychosomatics and hysteria Chapter 4Maternal lineage and transgenerational trauma: time and space in the psychoanalytic encounterLouise GylerChapter 5aHysteria and mourning: a psychosomatic caseJonathan SklarChapter 5bHysteria and mourning – a psychosomatic case: discussion of of Jonathan' Sklar's chapterSusan LodenPART FOUR PsychosisChapter 6Psychoanalysis, psychosis and the familyBrian MartindalePART FIVE IdentityChapter 7Finding space to think: technical problems of working with a cohort of trans identified young women Marcus EvansChapter 8aDementia: prelude to Rachael Davenhill's clinical material from elderly patientsMartin RossorChapter 8bDynamics of dementiaRachael DavenhillPART SIX Perversion and violenceChapter 9A state of inbetweenness: the challenges of working with disavowal Stephen BlumenthalChapter 10Aspects of the process of child analysisAngela JoyceChapter 11Peter rabbit was a thief: a case with a background of violence and criminalityAnne Zachary