Affect Intolerance in Patient and Analyst

by Stanley J. Coen

Overview

The ability of psychotherapists to tolerate their own feelings in the clinical situation determines how their patients experience and tolerate their own intense-and often distressing-affect. Dr. Stanley J. Coen draws on his own struggles with the most difficult and challenging patients in his practice, and finds that affect intolerance, in both patient and therapist, can be mitigated and understood when therapists broaden their emotional range, enabling them to engage in emotionally richer interactions with the patient. The more of their own feelings and wishes that clinicians can take responsibility for, the more they can tolerate, contain, and eventually interpret what patients find emotionally unbearable. Dr. Coen describes, in detail, how he works with difficult patients, trying to engage them as deeply and fully as both they and he can tolerate. A Jason Aronson Book

Product Details

ISBN-13:	9780765703644
Publisher:	Aronson, Jason Inc.
Publication date:	01/31/2003
Pages:	320
Product dimensions:	6.40(w) x 9.28(h) x 1.21(d)

About the Author

Stanley J. Coen, M.D., is a training and supervising analyst at the Columbia University Center for Psychoanalytic Training and Research, clinical professor of psychiatry at the Columbia University College of Physicians and Surgeons, and a member of the editorial boards of the Journal of Clinical Psychoanalysis, and the Journal of Applied Psychoanalytic Studies. He was awarded the Alexander Beller Memorial Prize for Psychoanalytic Writing and the George E. Daniels Merit Award for Excellence in Psychoanalysis. He is the author of The Misuse of Persons: Analyzing Pathological Dependency (1992) and Between Author and Reader: A Psychoanalytic Approach to Writing and Reading (1994). Dr. Coen has lectured widely on clinical issues and on psychoanalysis writing.

Table of Contents

Part 1 What Makes Affect Intolerable for the Patient and Therapist? Chapter 2 Barriers to Love between Patient and Therapist Chapter 3 How to Help Patients and Therapists Bear the Unbearable Chapter 4 Managing Rage and Hate in the Treatment Setting Part 5 What is the Therapist’s Role in Helping the Patient Develop Affect Intolerance? Chapter 6 Dangerous Need and Desire Chapter 7 Perverse Defenses in Neurotic Patients Chapter 8 The Wish to Regress in Patient and Therapist Chapter 9 How Much Does the Therapist at Work Need to Feel? Part 10 Helping Therapist Affect Tolerance through Taking and Writing About our Work Chapter 11 Discussing Colleagues’ Therapeutic Work Chapter 12 Why We Need to Write Openly about Our Clinical Cases Chapter 13 Applications of Child Development Research to Adult Treatment Chapter 14 The Pleasures and Pitfalls of Interpretation

What People are Saying About This

Salman Akhtar

Writing with a striking degree of candor and earnestness, Stanley J. Coen engages us in a dialogue about matters that lie at the heart of our clinical enterprise. He helps us examine and re-examine the barriers to love between patient and therapist, the anxious avoidance of hate between the two parties, the temptations of desire, the vulnerability of need, the labyrinth of regression, the false haven of intellectualization, and the benefit of communicating with colleagues and writing about cases. He advocates passionate involvement in the clinical dyad while maintaining an interpersonal and intrapsychic ambiance of tolerance and containment. The resulting development of powerful affects, regardless of their social acceptability and potentially threatening nature, becomes the ground for interventions that are authentic, credible, and ultimately mutative. Unabashedly given to enhancing our clinical acumen, Coen’s book has the wisdom that results from devotion and beauty that accompanies boldness.

Arnold M. Cooper

Stanley J. Coen, in this passionate and scholarly volume, has undertaken to guide psychoanalysts toward more candid, effective and affective modes of interaction with their patients and communication with each other. Through numerous case examples, Dr. Coen helps us to understand the many ways in which therapists hide, disguise, or misidentify their emotions in a psychotherapeutic situation, and he points to the great therapeutic benefit of an increased awareness. Dr. Coen’s emphasis on affect as centrally guiding our therapeutic efforts will be illuminating to every psychotherapist. It is a pleasure to encounter such clarity and directness in psychoanalytic writing. Dr. Coen’s openness and honesty provides a guide for all of us.

Arnold Richards

Stanley J. Coen has given us a remarkable book. He has provided us with a close look at his work with very difficult patients. We are with him in his consulting room observing his struggle to manage his patients’ feelings and his own. Dr. Coen’s accounts of each therapeutic encounter provides the psychotherapist reader with fresh insights and new approaches that can be applied to their clinical work. Dr. Coen should also be commended for avoiding the polemical, inter-theoretical controversies that often distance us from our primary aim—helping our patients to help themselves and achieve their aims. It is a book that will be found most often chairside in the therapist’s office rather than on the shelf.

Editorial Reviews

This book is an excellent account of Dr. Coen's work with patients who have great difficulty tolerating the affect that is aroused by the usual analytic interventions. This book provides both extremely interesting clinical material and a solid understanding of the importance of increasing our tolerance of our own affect and that of our colleagues and patients.

Psychologist-Psychoanalyst

Stanley J. Coen has given us a remarkable book. He has provided us with a close look at his work with very difficult patients. We are with him in his consulting room observing his struggle to manage his patients’ feelings and his own. Dr. Coen’s accounts of each therapeutic encounter provides the psychotherapist reader with fresh insights and new approaches that can be applied to their clinical work. Dr. Coen should also be commended for avoiding the polemical, inter-theoretical controversies that often distance us from our primary aim—helping our patients to help themselves and achieve their aims. It is a book that will be found most often chairside in the therapist’s office rather than on the shelf.

Arnold D. Richards M.D.

Writing with a striking degree of candor and earnestness, Stanley J. Coen engages us in a dialogue about matters that lie at the heart of our clinical enterprise. He helps us examine and re-examine the barriers to love between patient and therapist, the anxious avoidance of hate between the two parties, the temptations of desire, the vulnerability of need, the labyrinth of regression, the false haven of intellectualization, and the benefit of communicating with colleagues and writing about cases. He advocates passionate involvement in the clinical dyad while maintaining an interpersonal and intrapsychic ambiance of tolerance and containment. The resulting development of powerful affects, regardless of their social acceptability and potentially threatening nature, becomes the ground for interventions that are authentic, credible, and ultimately mutative. Unabashedly given to enhancing our clinical acumen, Coen’s book has the wisdom that results from devotion and beauty that accompanies boldness.

Salman Akhtar

Stanley J. Coen, in this passionate and scholarly volume, has undertaken to guide psychoanalysts toward more candid, effective and affective modes of interaction with their patients and communication with each other. Through numerous case examples, Dr. Coen helps us to understand the many ways in which therapists hide, disguise, or misidentify their emotions in a psychotherapeutic situation, and he points to the great therapeutic benefit of an increased awareness. Dr. Coen’s emphasis on affect as centrally guiding our therapeutic efforts will be illuminating to every psychotherapist. It is a pleasure to encounter such clarity and directness in psychoanalytic writing. Dr. Coen’s openness and honesty provides a guide for all of us.

Arnold M. Cooper

Stanley J. Coen, in this passionate and scholarly volume, has undertaken to guide psychoanalysts toward more candid, effective and affective modes of interaction with their patients and communication with each other. Through numerous case examples, Dr. Coen helps us to understand the many ways in which therapists hide, disguise, or misidentify their emotions in a psychotherapeutic situation, and he points to the great therapeutic benefit of an increased awareness. Dr. Coen's emphasis on affect as centrally guiding our therapeutic efforts will be illuminating to every psychotherapist. It is a pleasure to encounter such clarity and directness in psychoanalytic writing. Dr. Coen's openness and honesty provides a guide for all of us.--Arnold M. Cooper

Stanley J. Coen has given us a remarkable book. He has provided us with a close look at his work with very difficult patients. We are with him in his consulting room observing his struggle to manage his patients' feelings and his own. Dr. Coen's accounts of each therapeutic encounter provides the psychotherapist reader with fresh insights and new approaches that can be applied to their clinical work. Dr. Coen should also be commended for avoiding the polemical, inter-theoretical controversies that often distance us from our primary aim--helping our patients to help themselves and achieve their aims. It is a book that will be found most often chairside in the therapist's office rather than on the shelf.--Arnold D. Richards M.D., editor, Journal of the American Psychoanalytic Assocation

Writing with a striking degree of candor and earnestness, Stanley J. Coen engages us in a dialogue about matters that lie at the heart of our clinical enterprise. He helps us examine and re-examine the barriers to love between patient and therapist, the anxious avoidance of hate between the two parties, the temptations of desire, the vulnerability of need, the labyrinth of regression, the false haven of intellectualization, and the benefit of communicating with colleagues and writing about cases. He advocates passionate involvement in the clinical dyad while maintaining an interpersonal and intrapsychic ambiance of tolerance and containment. The resulting development of powerful affects, regardless of their social acceptability and potentially threatening nature, becomes the ground for interventions that are authentic, credible, and ultimately mutative. Unabashedly given to enhancing our clinical acumen, Coen's book has the wisdom that results from devotion and beauty that accompanies boldness.--Salman Akhtar, MD, is professor of psychiatry at Jefferson Medical College and training and supervising analyst at the Psychoanalytic Center of Philadelphia, Pennsylvania.

From the Publisher

Stanley J. Coen has given us a remarkable book. He has provided us with a close look at his work with very difficult patients. We are with him in his consulting room observing his struggle to manage his patients’ feelings and his own. Dr. Coen’s accounts of each therapeutic encounter provides the psychotherapist reader with fresh insights and new approaches that can be applied to their clinical work. Dr. Coen should also be commended for avoiding the polemical, inter-theoretical controversies that often distance us from our primary aim—helping our patients to help themselves and achieve their aims. It is a book that will be found most often chairside in the therapist’s office rather than on the shelf.

Arnold Richards