The Damaged Core Origins, Dynamics, Manifestations, and Treatment

by Akhtar, Salman

• ISBN13: 9780765706706
• ISBN10: 0765706709
• Format: Hardcover
• Copyright: 2009-04-13
• Publisher: Jason Aronson, Inc.

Summary

This comprehensive and tightly argued book deals with the process through which a coherent self evolves, the various ways such development fails to occur, and the therapeutic measures to put things back together. Beginning with the child's early relationships and his or her internalization as the substrate of the self, the text moves on to psychodynamically sophisticated and developmentally anchored descriptions of certain psychopathological syndromes that are widespread and yet inoptimally discussed. Moving from the most severe to the least severe conditions in this realm, The Damaged Core deals with the psychotic core, the schizoid wish to die and be reborn, the fantasies related to unresolved separation-individuation, the sociopathic tendency to lie, and the impact of excessive narcissism on love relations. This book also provides a unique perspective on the treatment of these conditions insofar as it not only elucidates the ways that a therapist listens and talks to his patients but also the subtle but deep impact of his ongoing attitude toward psychotherapeutic work. Even the role the therapist's office silently plays in the conduct of his work is discussed in detail. This book is theoretically sound and contemporary. More importantly, it is clinically generous and provides a number of vignettes to illustrate the ideas proposed. The writing style is a refreshing admixture of scientific scrupulosity, literary elegance, and humane relatedness. Book jacket.

Author Biography

Salman Akhtar is professor of psychiatry at Jefferson Medical College and training and supervising analyst at the Psychoanalytic Center of Philadelphia.

Table of Contents

Acknowledgments	p. xi
Preface	p. xiii
Prologue
Early Relationships and Their Internalization	p. 3
Some Caveats
Relationship with Mother
Relationship with Father
Relationship with the Parental Couple
Relationship with Siblings
Relationship with Grandparents
Relationship with Animals
Relationship with the Inanimate Surround
Other Important Relationships
From Interaction to Internalization
Concluding Remarks
Structure and Dynamics
The Mad Core	p. 33
Hereditary and Constitutional Factors
Environmental Contributions
The Role of Fantasy
Technical Implications
Concluding Remarks
The Schizoid Wish to Die and be Reborn	p. 49
Some Caveats
The Wish To Die, Vanish, and Not-Be
The Wish to be Reborn and to Start All Over Again
A Brief Digression into the Concept of the Death Instinct
Back to the Clinical Realm
Issues of Technique
Concluding Remarks
Three Fantasies Related to Unresolved Separation-Individuation	p. 67
Development Origins of Severe Personality Disorders
Some Caveats
"Someday . . ." and "If Only . . ." Fantasies
The Fantasy of a Tether
The Fantasy of a Long Embrace
Concluding Remarks
Lies, Liars, and Lying	p. 87
The Structure of a Lie
Motivations for Lying
The World of Forgery
Back to the Clinical Realm
Concluding Remarks
Narcissistic Love Relations	p. 99
Narcissism and Romantic Love
Narcissism and Sexuality
Narcissism and Marriage
Concluding Remarks
Holding and Healing
The Analyst's Office	p. 113
Attributes of the Office: Location, Comfort, Authenticity, Constancy
The Waiting Room
Contents of the Office: The Couch, Other Physical Objects
Technical Implications
Concluding Remarks
Listening	p. 135
Between Hearing and Understanding
What Do We Listen To and How?
Variables That Can Alter Listening
Not Listening as a Technical Intervention
Concluding Remarks
Making Interventions	p. 147
Preparatory Interventions
Nonverbal Interventions
Affirmative Interventions
Interpretive Interventions
Reconstructive Interventions
Developmental Interventions
Miscellaneous Interventions
Specific Clinical Challenges
Concluding Remarks
Epilogue
Three Pillars of Therapeutic Attitude	p. 171
Some Caveats
Survival
Vision
Faith
Concluding Remarks
Notes	p. 187
References	p. 197
Index	p. 223
About the Author	p. 229
Table of Contents provided by Ingram. All Rights Reserved.