The Power of the Inner Judge: Psychodynamic Treatment of the Severe Neuroses

by Leon Wurmser

This book describes in detail how to effectively treat severely ill but not psychotic patients, by careful psychotherapeutic work on the defenses and the superego. Diverging widely from Kernberg's and Kohut's work with the same broad spectrum of patients, Léon Wurmser demonstrates his flexible and individualized method with clinical material taken directly from actual patient–therapist interaction. The core of the therapeutic work focuses on trauma; forms of defense; conflicts within the superego; and the related affects of guilt, shame, depression, and resentment. Appreciating the complex and individual nature of each case, the author uses the familiar concepts of masochism, aggression, narcissism, and repetition compulsion as descriptions, not explanations, of clinical observations. There are no shortcuts; a genuine understanding that results in real change for the patient requires an in-depth exploration of the material in a nonjudgmental atmosphere. Observing that categories, while necessary, tend to be slowly transformed into words of devaluation, Dr. Wurmser addresses the implicit, and often quite explicit, judgmental spirit directed toward severely ill patients, and cautions clinicians to avoid falling into the role of a judging authority. This is an eloquent accounting of a master therapist's successes and failures, valuable especially for offering effective and decisive interventions in treating traditionally untreatable patients.

356 pages, Hardcover

First published January 1, 2000

Reviews

[William Martin]

Wurmser's brilliant text had a profound impact on my PhD dissertation dealing with depictions of PTSD in British literature. His wisdom about the multifarious ways in which abused children torture themselves as adults is as telling as it is consuming. He shows through various case studies how the Inner Judge lives within these sad individuals until it ultimately takes over every element of their lives. Specifically, he lays out the cartography of unsuccessful relationships that inevitably result in that compulsive nightmare that underwrites their horribly lonely lives, even as it slowly but steadily drowns them over the course of their lifetime. The work is clearly as profound today as when it was published 20 years. Wurmser is simply one of the West's best writers on PTSD, and reading this work is a very worthwhile exercise. Note: some of those reading this work will inevitably begin to suffer chaotic emotional affects as they become enraptured in what they thought were unforgotten memories of their own. They will need to elucidate them as soon as possible. Preferably to an enlightened therapist.