This book explores David Rosenfeld's pioneering work with severely disturbed patients, to show what it means to work and think as a psychoanalyst about transference and the internal world of a psychotic patient, with all the difficulties involved in continuing to treat and engage with even severely ill patients. As Rosenfeld suggests, to be a psychoanalyst is to think about transference, the patient's internal world and projective identifications onto the therapist and onto persons in the external world.In particular, the author examines patients who express their mental state through fantasies about their body image. For example, the fantasy of an emptying of the self is discussed through the case of the patient Pierre, who asserts that he has no more blood or liquids in his body. Similarly, the fantasies of a young man who says that bats are flying out of his cheeks incarnate the anxiety of his first months of life expressed through his body. Indeed, Rosenfeld's particular focus is on the importance of the first months and years in the life of these patients. For the treatment of severely disturbed patients he maintains that it is both useful and necessary to supervise these clinical cases, since psychoanalysts are only human beings who may receive powerful projections on a psychotic level from these patients. Rosenfeld persuasively suggests that psychoanalysts can only write papers about countertransference once they have been able to put into words and decode what the patient has inoculated with these projections. Without this, the psychoanalyst can become ensnared in powerful projections and unable to decode what the patients oblige them to "feel" happened to them at a time when they had no language to express it in words. The book is the result of many years of experience studying and supervising in Paris, London, and America.
