Difficult Identities: Treating the Psychotic Child

Author(s) : Pia De Silvestris

Difficult Identities: Treating the Psychotic Child

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Through clinical illustrations and theoretical considerations, Difficult Identities discusses the centrality of transference in helping young patients overcome the difficulties in constructing their identity.

At the beginning of our lives, we receive a potential inheritance in the primary relationships with our parents. Both conscious and unconscious in nature, this inheritance is made up of deep identifications, innate or acquired abilities we may or may not pursue, and the facilitations and restrictions that derive from our environment. It may provide an asset for fruitful investments or be a cumbersome, paralysing burden – even an unchangeable fate.

Alternating theoretical reflections with clinical histories, the author explores the ways in which the child appropriates this psychic inheritance, and attempts to transform it to make it their own. This process implies an inevitable cost for parents and children alike, and the child’s symptoms are almost always an expression of the difficulties in reaching a solution. Analytic treatment offers the space in which to discover what makes us feel “unique”, that which makes us who we are.

Addressing topics such as illusion and disillusionment, psychosis, body image and adolescence, internal objects and the super-ego, coupling and loss, this book discusses the forms in which, in today’s society, malaise so often presents itself to the clinician. The author argues for the centrality of transference work in both intra-psychic and interpersonal life, as it is the transference experience that permits the joint work of identity construction to begin. In the context of the transference relationship, the patient can experience their relational needs being met in the encounter with the other; in turn, the other’s desire activates the patient’s capacity to invest on themselves.

About the Author(s)

Pia De Silvestris is a psychotherapist who lives and practises in Rome. She is a full member of the Society for Psychoanalytic Psychotherapy for Children, Adolescents and Couples (SIPsIA) and the Italian Society of Psychoanalytic Psychotherapy (SIPP), and teaches on the training programmes of both societies. She has published widely on psychoanalytic journals, and has co-authored several books in Italian, including Transference in Child Psychoanalysis (1994), Childhood Depression (1997), Transcribing the Unconscious (2002), and Awareness and Self-Analysis (2005).

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