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Clinical Psychoanalytic Case Studies with Complex Patients: Watching Experience at Work
Edited by Anne Zachary
Routledge / Softcover / Oct 2023
9781032065564 (ISBN-10: 1032065567)
reg price: $60.95 our price: $ 54.86
272 pages
In Stock (Ships within one business day)

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.


"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

Table of Contents:


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


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

About the Editor:

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.

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