PART I Reluctant patients and the fight against change: caught between the paranoid and depressive world 1 1 I hear you knocking but you cant come in 3 2 Mistrust of the good object 16 3 Fighting off the good object 32 4 Problems in receiving 49
PART II Greed and the dangers of change 65 5 Melanie Kleins theory of greed 67 6 The frightening rumble of psychic hunger 79 7 The impossible dream and the endless nightmare 91 8 Greed, idealization, and insatiability 106 9 Setting the bar too high 120
PART III Interruptions to the process of change: loss, envy, and the death instinct 135 10 The clinical advantage of the death instinct 137 11 Acting out and the death instinct 152 12 Borderline and psychotic patients 166 13 Oral deprivation, envy, and sadism 182
PART IV Working toward change in the face of overwhelming odds 193 14 A case study of borderline anxiety 195 15 Bargains, treaties, and delusions 207 16 Symbolization and the good object 224
Summary 238 Bibliography 243 lndex 250
Aims to bring hope and clarity to cases involving patients who experience progress as a threat to their emotional well-being. This book addresses the so-called resistant patient the clinicians are familiar with and demonstrates how to understand patients that are resistant to progress. It is useful for the practising psychoanalysts.