In Suffering and Sacrifice in the Clinical Encounter, the authors
identify the ways in which some patients seek to create what Freud
termed a "private religion" and unconsciously substitute sacrificial
enactments of scapegoat surrogates to protect them against the pain of
separation, mourning, and loss of primary figures of attachment. They
investigate the function of sacrifice and its relationship to the
breakdown of psychic structure and the development of manic defenses and
pathological narcissism. Such treatments are complex, the "reversed
roles" of victim and perpetrator central to the sacrificial process when
enacted in therapy can trigger feelings of shame, guilt and inadequacy
in the therapist. Perverse, vengeful, and sadistic transference
distortions are explored to enable the therapist to appreciate the true
nature of the patient's hidden traumatic experience, with the necessity
for the working-through of genuine separation and grieving highlighted.
Useful methods are detailed to counter the tendency to become overly
active and inappropriately involved when working with patients who have
deadened their desire to improve. This book is unique in utilising the
dynamic concepts of the effects of trauma and sacrifice, the role of the
scapegoat, and the distinctions between the experience of pain and the
accomplishment of suffering in order to develop a foundational
understanding of such patients. It is a must-read for all practising and
trainee therapists.
