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The Damaged Core: Origins, Dynamics, Manifestations, and Treatments
Akhtar, Salman
Jason Aronson / Rowman & Littlefield / Softcover / 2010-12-01 / 0765706717
price: $59.50 (may be subject to change)
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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 their 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. Going from the most severe to the least severe conditions in this realm, the book 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. The book also provides a unique perspective on the treatment of these conditions in so far 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. The 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.

--- from the publisher


"Salman Akhtar uses his considerable skills as a psychoanalytic theoretician, clinician, and teacher to bring further clarity to the understanding and treatment of severe psychopathological conditions. His capacity to integrate a vast amount of information is impressive. He demonstrates the theoretical plurality that has marked psychoanalysis for the last two decades. He begins with the fundamental psychological issue for all severe psychopathological conditions, a damaged core, and follows it through development while addressing many theoretical and clinical issues. Most importantly, the reader is led to a greater appreciation of how patients are helped. This is a book of great value for anyone interested in severe psychopathology and its treatment."—Melvin Bornstein, MD, Editor, Psychoanalytic Inquiry

"In this scholarly and comprehensive volume, Salman Akhtar writes beautifully about the most complex subject in psychoanalysis, which is at the heart of our desire to understand our patients; the formation of the self. Special attention is given to the processes of separation and individuation and Akhtar's careful examination of the environment created by the psychoanalyst adds a dimension that goes beyond words. The developmental process is explicated in clear language and illustrated with a series of clinical vignettes that capture the complexity of the human mind."—Anni Bergman, PhD, author of Ours, Yours, Mine: Mutuality and the Emergence of the Separate Self

About the Author:

Salman Akhtar is professor of psychiatry at Jefferson Medical College and Training and Supervising Analyst at the Psychoanalytic Center of Philadelphia.

Table of Contents:


1. Early Relationships and Their Internalization

Structure and Dynamics
2. The Mad Core
3. The Schizoid Wish to Die and Be Reborn
4. Three Fantasies Related to Unresolved Separation-Individuation
5. Lies, Liars, and Lying
6. Narcissistic Love Relations

Holding and Healing
7. The Analyst's Office
8. Listening
9. Making Interventions

10. Survival, Vision, and Faith: Three Pillars of Therapeutic Attitude

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