1st Edition

Bombs in the Consulting Room Surviving Psychological Shrapnel

By Brett Kahr Copyright 2020
    282 Pages
    by Routledge

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    What does one do when a dangerous paedophile, nearly six feet seven inches in height, threatens to kill you? How does one manage when a brain-damaged, psychotic patient spits on the office floor two hundred times during the first consultation? And what does one say when one member of a warring couple reveals the most horrific acts of sexual cruelty?

    In perhaps his most gripping book to date, Professor Brett Kahr offers colleagues a detailed glimpse into the challenge of working with highly distressed and disturbing individuals in long-term psychotherapy. Kahr explains the ways in which such deeply troubled people hurl "bombs" into the consulting room, leaving considerable "psychological shrapnel" in their wake.

    The book contains five sensitively and compellingly written clinical chapters, followed by several historical chapters which explore the ways in which Donald Winnicott attempted to manage the bombs in his consulting room, often of his own making. Kahr then examines the pioneering contribution of Enid Eichholz (later Enid Balint) who, during the Second World War, created marital psychoanalysis as a means of dealing with couples ravaged by actual wartime bombs. The book concludes with an historico-clinical chapter on how thoughtful and sophisticated classical interpretation can reduce the impact of clinical bombs. Kahr even provides us with an examination of his favourite "top ten" interpretations in the history of psychoanalysis!

    A unique and helpful volume, written by a practitioner steeped equally in psychoanalysis and history, Bombs in the Consulting Room: Surviving Psychological Shrapnel will be essential reading for anyone who has ever felt frightened while treating patients.



    1. The Paedophile Who Threatened My Life.

    2. From the Treatment of a Compulsive Spitter: A Psychoanalytical Approach to Profound Disability.

    3. The Intra-Marital Affair: From Erotic Tumour to Conjugal Aneurysm.

    4. Sexual Cruelty in the Marital Bed: Unconscious Sadism in Non-Forensic Couples.

    5. Committing Crimes without Breaking the Law: Unconscious Sadism in the "Non-Forensic" Patient.


    6. Donald Winnicott’s Struggle with Hate in the Counter-Transference.

    7. "How to Cure Family Disturbance": Enid Eichholz Balint and the Creation of Couple Psychoanalysis.

    8. The Ten Best Interpretations in the History of Psychoanalysis






    Professor Brett Kahr has worked in the mental health field for over forty years. He is Senior Fellow at the Tavistock Institute of Medical Psychology in London and Senior Clinical Research Fellow in Psychotherapy and Mental Health at the Centre for Child Mental Health in London. A Trustee of the Freud Museum London and of Freud Museum Publications, he has written or edited fourteen books, and he has served as series editor for more than fifty-five other titles. He is Consultant Psychotherapist at The Balint Consultancy and works full-time with individuals and couples in London.