Bombs in the Consulting Room

Book excerpt: What does one do when a dangerous paedophile, nearly six feet seven inches in height, threatens to kill you? How does one manage when a brain-damaged, psychotic patient spits on the office floor two hundred times during the first consultation? And what does one say when one member of a warring couple reveals the most horrific acts of sexual cruelty? In perhaps his most gripping book to date, Professor Brett Kahr offers colleagues a detailed glimpse into the challenge of working with highly distressed and disturbing individuals in long-term psychotherapy. Kahr explains the ways in which such deeply troubled people hurl "bombs" into the consulting room, leaving considerable "psychological shrapnel" in their wake. The book contains five sensitively and compellingly written clinical chapters, followed by several historical chapters which explore the ways in which Donald Winnicott attempted to manage the bombs in his consulting room, often of his own making. Kahr then examines the pioneering contribution of Enid Eichholz (later Enid Balint) who, during the Second World War, created marital psychoanalysis as a means of dealing with couples ravaged by actual wartime bombs. The book concludes with an historico-clinical chapter on how thoughtful and sophisticated classical interpretation can reduce the impact of clinical bombs. Kahr even provides us with an examination of his favourite "top ten" interpretations in the history of psychoanalysis! A unique and helpful volume, written by a practitioner steeped equally in psychoanalysis and history, Bombs in the Consulting Room: Surviving Psychological Shrapnel will be essential reading for anyone who has ever felt frightened while treating patients.