1st Edition

Clinical Psychoanalytic Case Studies with Complex Patients Watching Experience at Work

Edited By Anne Zachary Copyright 2024
    226 Pages 4 B/W Illustrations
    by Routledge

    226 Pages 4 B/W Illustrations
    by Routledge

    Clinical Psychoanalytic Case Studies with Complex Patients is a collection of key case studies that provides a rich resource of information and inspiration for clinicians working psychoanalytically with complex and disturbed patients in a range of contexts.

    The book is presented in six parts, each introduced with commentary that puts the material into context. It covers a range of topics including autism, violence and perversion, psychosomatics, hysteria, dementia, psychosis and assessment of gender dysphoria. Each chapter presents either a single case study or a selection of case vignettes, examines necessary context and presents additional detail about subsequent treatment. The depth and range of the cases presented provide key insight into and detailed consideration of risk assessment, safe settings and other important preliminary issues.

    Clinical Psychoanalytic Case Studies with Complex Patients will be of great interest to psychoanalysts in practice and in training, psychoanalytic psychotherapists and other clinicians seeking an introduction to psychoanalytic work.


    The essence of nurture

    Foreword by Bob Hinshelwood

    List of contributors

    Clinical psychoanalytic case studies with complex patients: watching experience at work

    Anne Zachary

    PART ONE Support

    Chapter 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 patients

    Marcus Evans

    PART TWO Autism

    Chapter 2a

    Affections, words and plays in autistic children: discussion of Maria Rhode's clinical case

    Laurent Danon-Boileau

    Chapter 2b

    'Finding one’s feet': body, affect and identifications in a pre-autistic toddler learning to walk

    Maria Rhode

    Chapter 3

    Analysing Miss Daisy: a psychoanalytically informed treatment of an emerging adult autistic woman

    Alan Sugarman

    PART THREE Psychosomatics and hysteria

    Chapter 4

    Maternal lineage and transgenerational trauma: time and space in the psychoanalytic encounter

    Louise Gyler

    Chapter 5a

    Hysteria and mourning: a psychosomatic case

    Jonathan Sklar

    Chapter 5b

    Hysteria and mourning – a psychosomatic case: discussion of of Jonathan' Sklar's chapter

    Susan Loden

    PART FOUR Psychosis

    Chapter 6

    Psychoanalysis, psychosis and the family

    Brian Martindale

    PART FIVE Identity

    Chapter 7

    Finding space to think: technical problems of working with a cohort of trans identified young women 

    Marcus Evans

    Chapter 8a

    Dementia: prelude to Rachael Davenhill's clinical material from elderly patients

    Martin Rossor

    Chapter 8b

    Dynamics of dementia

    Rachael Davenhill

    PART SIX Perversion and violence

    Chapter 9

    A state of inbetweenness: the challenges of working with disavowal

    Stephen Blumenthal

    Chapter 10

    Aspects of the process of child analysis

    Angela Joyce

    Chapter 11

    Peter rabbit was a thief: a case with a background of violence and criminality

    Anne Zachary


    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