In this cohesive, dramatic, and highly readable book, David Garfield establishes a roadmap for the diagnosis and psychotherapeutic treatment of psychotic disorders based on finding, understanding and reordering of unbearable affect. He provides concrete clinical advice, vivid examples, and crisp jargon-free descriptions of theoretical concepts and clinical techniques. Most of all, he demonstrates that it is possible for psychotic patients to take control of their conditions, rebuild family relationships, and establish themselves in the viable productive lives that they have long despaired of achieving.

Reviews and Endorsements

‘Unbearable Affect is that rarest of literary gems, a work of genuine and profound scientific merit that also has a deeply moving story to tell. It traces the progress of a fictional young psychiatrist, Tony Potter, as he immerses himself in the lives and psyches of patients who suffer from the worst kinds of mental torment. Dr Potter’s clinical encounters demonstrate that affect lies at the center of psychosis and must, therefore, be the focus of any meaningful course of psychoanalysis or psychotherapy. Dr David Garfield cuts a path through the thick forest of psychotherapeutic theories and techniques to lead us on a journey of discovery. First, we discover the ordinary within the extraordinary, the real person whose existence has been obscured by the swirling symptoms of psychosis. Next, we go in search of the extraordinary within the ordinary, the great strength, ability and human potential that can survive even the worst psychoses, and which are the foundations upon
which the healing process is built. Young Dr Potter confronts patients suffering from a variety of psychoses, and after each encounter, we learn what the great authors and researchers of the mind have had to say about the condition, and how state-of-the art psychoanalysis and psychotherapy address it.’
– Lester Havens MD, Professor of Psychiatry, Harvard Medical School at The Cambridge Hospital

‘In this cohesive, dramatic, and highly readable piece, David Garfield establishes a roadmap for the diagnosis and psychotherapeutic treatment of psychotic disorders based on finding, understanding and reordering of unbearable affect. He provides concrete clinical advice, vivid examples, and crisp jargon-free descriptions of theoretical concepts and clinical techniques. Most of all, he demonstrates that it is possible for psychotic patients to take control of their conditions, rebuild family relationships, and establish themselves in the viable productive lives that they have long despaired of achieving.’
– Brian Martindale, International Society for the Psychological Treatments of Schizophrenia and Education Committee; Member of the World Psychiatric Association

‘David Garfield’s book on unbearable affect in the psychoses is an immensely practical guide for therapists seeking ways of addressing the overpowering emotional experiences encountered in this area of clinical work. His focus on the affective dimension creates possibilities of empathic connection otherwise impossible to achieve and opens up pathways of understanding and healing.’
– George Atwood, PhD , Professor of Psychology, Rutgers University