Suffering and Sacrifice in the Clinical Encounter
Charles Ashbach, Karen Fraley, Paul Koehler & James Poulton

Read the Table of Contents, Foreword and Introduction (32 pages) by clicking here.

Read the authors’ thought-provoking blog – The Virus, Suffering, and Sacrifice – that links their book to current world events.

Dr. Ashbach is a member of the 
CONSORTIUM/THINK-TANK ON VIOLENT POLITICAL EXTREMISM
(War, Genocide and Terrorism)
 

Suffering and Sacrifice in the Clinical Encounter

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Suffering and Sacrifice in the Clinical Encounter is an exploration of the long standing clinical problems of intense resistance to what Freud (1923) termed the "negative therapeutic reaction" or NTR.

It offers clinicians a new paradigm for understanding the "battles" of especially traumatized patients and how the treatment is structured along religious and mythical lines associated with "human sacrifice." 

ABOUT SUFFERING AND SACRIFICE IN THE CLINICAL ENCOUNTER

In Suffering and Sacrifice in the Clinical Encounter, the authors identify how some patients seek to create what Freud termed a 'private religion'--and unconsciously substitute sacrificial enactments to protect them against the pain of separation, mourning, and loss of primary figures of attachment.

They investigate the function of sacrifice in its relationship to the breakdown of psychic structure and development of manic defenses and pathological narcissism. The 'reversed roles' of victim and perpetrator-- central to the sacrificial process--when enacted in therapy can trigger feelings of shame, guilt and inadequacy in the therapist.

Perverse, vengeful, and sadistic transference distortions are explored to enable the therapist to appreciate the true nature of the patient's traumatic experience--allowing for the working-through of genuine separation and grieving. Methods are detailed to counter the tendency to become overly active and inappropriately involved when working with patients who have deadened their desire to improve.

This book is unique in utilising the dynamic concepts of the effects of trauma and sacrifice, the role of the scapegoat, and the distinctions between the experience of pain and accomplishment of suffering in order to develop a foundational understanding of such patients. It is a must-read for all practising and trainee therapists.

ABOUT THE AUTHORS

Charles Ashbach is a licensed clinical psychologist in the Philadelphia area. His Ph.D. is from Temple University and has post-doctoral certification from the Washington School for Psychiatry. He is a founding faculty member of the International Psychotherapy Institute (IPI), Bethesda, MD and is co-author of the books: Object relations, the Self and the Group as well as co-author of Suffering and Sacrifice in the Clinical Encounter. 

Karen Fraley, LCSW, BCD, is a licensed clinical social worker in private practice in Exton, Pennsylvania, a fellow member of the Pennsylvania Society for Clinical Social Work, and a member of the national faculty of the International Psychotherapy Institute (IPI). She is a founding member of the Philadelphia Psychotherapy Study Center and teaches seminars in object relations theory and practice.

Paul Koehler, LCSW, a clinical social worker in private practice in Doylestown, PA. Paul earned his BA from Gettysburg College and his MSW from the University of Pennsylvania. He completed training programmes at the Institute for Psychoanalytic Psychotherapies and at the Washington School of Psychiatry. He is currently a faculty member of the International Psychotherapy Institute, Washington, DC.

James Poulton, PhD, is a psychologist in private practice in Salt Lake City, Utah, an Adjunct Assistant Professor in Psychology at the University of Utah, and a member of the national faculty of the International Psychotherapy Institute (IPI). He currently serves on the Steering Committee for IPI’s Psychoanalytic Psychotherapy Program,, and is the author of Object Relations and Relationality in Couple Therapy: Exploring the Middle Ground. 

PRAISE

  1. Caroline Sehon, MD, FABP Director, International Psychotherapy Institute: "Suffering and Sacrifice in the Clinical Encounter makes a truly unique contribution to the clinical challenges of working with patients gripped by developmental loss and trauma. 

  2. Giuseppe Civitarese, member of the American Psychoanalytic Association and Italian Psychoanalytic Society, from the Foreword: The theory employed is rich and versatile, the clinical vignettes extremely vivid and instructive. The style of the book is happily communicative and allows a pleasant and rewarding read. 

  3. Jack Novick and Kerry Kelly Novick, authors of ‘Fearful Symmetry: The Development and Treatment of Sadomasochism’ and ‘Freedom to Choose: Two Systems of Self-Regulation.’ This wide ranging book goes a long way in answering what Leon Wurmser called “the riddle of masochism.” The authors remind readers of the deep philosophical and humanistic roots of psychoanalysis, while bringing their thinking squarely into the clinical situation.