In this book the author examines the series of connections that give rise to the intimate relationship between environment and individual in the construction of emotional suffering, emphasizing both the undisputed pathogenic action of environmental stimuli and the active participation of whoever is obliged to suffer the negative situation. De Masi shows that the way in which one tries to escape suffering is what often seriously jeopardizes growth.
Working with Difficult Patients points out the intrinsic link between some forms of mental suffering and the distorted responses that the patient has received from his or her original environment. For this reason the author explores the concept of the emotional trauma in particular, since this trauma, which occurs in the primary relationship, often impels the child into relational withdrawal and towards constructing pathological structures that will accompany him or her for the rest of their life. The chapters are ordered according to a scale of increasing treatment difficulty, which is proportional to the potential pathogenicity of the underlying psychopathological structure. Consequently, the borderline state and the psychotic state are located at either end of an axis of progressive complexity and difficulty towards change.
The author sets out a panorama of the main psychopathological entities as he has encountered them and indeed still encounters them in his clinical activity, presenting the material according to a criterion that highlights the differences between the individual case histories. A number of chapters in the second part of the book attempt to clarify the various psychic processes that underlie some frequently encountered psychopathologies.