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.