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White, J. (2013). Catch Them Before They Fall: The Psychoanalysis of Breakdown by Christopher Bollas. Published by Routledge, London and New York, 2012; 143 pp; £70.00 hard-back, £16.99 paperback. Brit. J. Psychother., 29(4):555-557.

(2013). British Journal of Psychotherapy, 29(4):555-557

Catch Them Before They Fall: The Psychoanalysis of Breakdown by Christopher Bollas. Published by Routledge, London and New York, 2012; 143 pp; £70.00 hard-back, £16.99 paperback

Review by:
Jean White

In yet another radical configuration of theory and practice, Christopher Bollas confirms his position as (at the very least) one of the most original thinkers in psychoanalysis today. Catch Them Before They Fall outlines a reasoned and strikingly humane way of working with those analytic patients who are in the throes of an acute breakdown of their existing defence structures. Bollas suggests an equally acute intensification of the psychoanalytic process, not merely in the form of increased analytic attendance and/or double length sessions but also sometimes in the form of three consecutive day-long sessions (9 a.m. to 6 p.m.) over the course of a long weekend. This acts as a form of psychoanalytic pressure cooker in which an irruption of condensed unconscious material can be contained and transformed into a new way of being for the patient, whose breakdown then becomes in effect a breakthrough.

These three-day sessions should proceed without any rupture of the analytic frame. However, the patient may need a temporary support team to be organized, including a GP, a psychiatrist (even if the analyst is a psychiatrist herself, Bollas deems an alternative psychiatric perspective essential), possibly also a social worker, friend or relative to take care of the patient's day-to-day physical needs and even a known and trusted taxi driver who will tolerate silence whilst sparing the patient the need to negotiate their own transport to and from the extended sessions.

It is important to stress that Bollas is not recommending this method for those in a state of acute psychotic decompensation, but rather for those patients in acute crisis because the breakdown of their psychoneurotic ego defences or entrenched characterological defensive structures may have rendered them or may be about to render them temporarily helpless, perhaps depressed, perhaps in a state of acute anxiety and probably in some measure of regression.

[This is a summary excerpt from the full text of the journal article. The full text of the document is available to journal subscribers on the publisher's website here.]

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