Unbearable Affect: A Guide to the Psychotherapy of Psychosis (Wiley Series in General and Clinical Psychiatry)

What happens when emotion becomes unbearable? In some psychotic patients, delusions, hallucinations, and incoherence are the result, while others suffer from negativism, autism, or emotional paralysis. In this remarkable book, Dr. David Garfield builds on the work of Semrad, Jung, and Bleuler in identifying affect as "the driving force behind all our actions and omissions" and in using emotion as the focus and guide for healing psychotic patients. This is particularly important in an age when antipsychotic drugs and modern neuroscience have rendered many patients less symptomatic, but still dysfunctional.

The book is divided into three sections, which correspond with the three stages of psychotherapy of psychosis. The first section deals with finding and understanding unbearable affect in the initial clinical work with psychosis. Unbearable affect is seen as the focal point around which psychosis turns. The book explores techniques for identifying affect in the patient's first communications; examines the precipitating event that brought the patient to clinical attention; and establishes links among primary mental processes, affect, and psychosis.

The second section outlines techniques for helping patients contain and transform unbearable affect. These include special techniques for dealing with "shame, pride, and paranoid psychoses" as well as persecutory states. This section also addresses the therapist's role as the missing eyes and hands of the patient, and the necessity that the patient make contact with the emotionality of the clinician.

The book's third section is geared toward keeping patients out of psychosis once they have stabilized. It illustrates how healthy emotional change can enable patients to enlist the help of others in difficult affect-laden situations, contrasts theories of change in the psychotherapy of psychosis with the affect-centered approach, and addresses the issue of posttreatment access to the therapist.

Built on a solid theoretical foundation and furnished with clinical experience and practical advice, Unbearable Affect provides a powerful tool through which to approach the healing of psychotic patients. Mental health professionals who work with psychotic patients in hospitals, prisons, shelters, clinics, or private practice will find this sensitive book highly illuminating.

Struggle alongside a young psychiatrist as he learns to understand and help desperately ill mental patients. Unbearable Affect is that rarest of literary jewels, a work of genuine and profound scientific merit that also has a deeply moving story to tell. It traces the progress of a fictional young psychiatrist, Tony Potter, as he immerses himself in the lives and psyches of patients who suffer from the worst kinds of mental torment. Dr. Potter's clinical encounters demonstrate that affect lies at the center of psychosis and must therefore be the focus of any meaningful course of psychotherapy.

Dr. David Garfield cuts a path through the underbrush of psychotherapeutic theories and techniques to lead us on a journey of discovery. First, we discover the ordinary within the extraordinary, the real person whose existence has been obscured by the swirling symptoms of psychosis. Next, we go in search of the extraordinary within the ordinary, the great strength, ability, and human potential that can survive even the worst psychoses, and which are the foundations upon which the healing process is built. Young Dr. Potter confronts patients suffering from a variety of psychoses, and after each encounter we learn what the great authors and researchers of the mind have had to say about the condition, and how state-of-the-art psychotherapy addresses it.

In this cohesive, dramatic, and highly readable account, Dr. Garfield establishes paradigms for the diagnosis and psychotherapeutic treatment of psychotic disorders based on location, understanding, and reordering of unbearable affect. He provides concrete clinical advice, vivid examples, and crisp jargon-free descriptions of theoretical concepts and clinical techniques. Most of all, he demonstrates that it is possible for psychotic patients to take control of their conditions, rebuild family relationships, and establish themselves in the viable, productive lives that they have long despaired of achieving.