Search Results

This chapter examines the variety of interactions and enactments that take place in psychoanalytic treatment, often stemming from the patient's reaction to analytic contact. During the course of every psychoanalytic treatment, there are moments within the transference-countertransference relationship in which the analyst becomes overly involved in the landscape of the patient's phantasies. This leads to the analyst acting out certain aspects of those phantasies, sometimes in isolation but usually in tandem with the patient's acting out of corresponding aspects of his or her phantasies. This situation is all the more predictable when projective identification is the primary dynamic shaping the transference. The chapter uses case material to illustrate the inevitable pull of the patient on the analyst, creating a psychological invitation to play out pieces of the patient's internal life.

This chapter examines how psychoanalytic treatment of Kleinian couples unfolds and the specific theoretical and clinical nuances that emerge. Melanie Klein's discoveries strengthened and expanded Sigmund Freud's clinical work and have become a leading worldwide influence in current psychoanalytic practice. Key Kleinian concepts include the total transference, projective identification, the importance of countertransference, psychic retreats, the container/contained function, enactment, splitting, the paranoid-schizoid and depressive positions, unconscious phantasy, and the importance of both anxiety and defense in the interpretive process. The Kleinian approach regarding total transference, countertransference, and defense are just as important in couples' treatment as they are in individual work. This chapter uses extensive case material to illustrate how Kleinian clinical concepts are utilized in couples work and to demonstrate the confusing, humbling, and trying nature of the therapeutic task.

This book examines the intimate, day-to-day, moment-to-moment clinical experience that unfolds when treating a wide variety of patients in private practice. Each chapter follows a wide spectrum of cases and clinical situations where patients are provided the best opportunity for health and healing through the establishment of analytic contact. The book closely tracks how a patient's phantasies and transference mechanisms work to increase, oppose, embrace, or neutralize analytic contact and, in the process, create difficulties in the interpretive process. It also considers how the analyst is drawn inevitably into playing out various aspects of the patient's phantasies, along with the constantly shifting emotional states produced by transference, countertransference, and the dynamics of projective identification that make the interpretive process prone to instability, fallibility, and uncertainty. The unavoidable pros and cons of interpretive acting out are discussed using material from several psychoanalytic treatments.

Religio-ideological totalism entails an absolute division of humanity into dual categories such as saved/damned, human/subhuman, and godly/demonic. Totalistic “cults” are not necessarily violent, but the psychology of totalism features an impulse to validate an absolute worldview by confronting demonized exemplars of evil as contrast symbols. Anticult confrontations of totalistic movements may themselves take a totalistic and hence persecutory form. This chapter discusses research that documents a cycle of increasing totalization of both the group and the countergroup response, which may escalate out of control to the point that it triggers a violent denouement.

This chapter considers the many factors that must be taken into account when pursuing a line of psychoanalytic interpretation. Using case examples, it explores clinical moments in which interpretive enactment or interpretive acting out occur. The constantly shifting emotional states produced by transference, countertransference, and the dynamics of projective identification make the interpretive process prone to instability, fallibility, and uncertainty. Both patient and analyst must discover, learn about, and change the underlying pathological dynamics that are leaking out in the therapeutic relationship, including in the analyst's style of interpreting. The chapter discusses unavoidable pros and cons of interpretive acting out using with material from several psychoanalytic treatments.

This chapter examines the clinical difficulty of making accurate and helpful interpretations that do not become part of the patient's defensive system. Using one extensive case presentation, it explores how interpretive acting out is inevitable in psychoanalytic treatment. Enactments occur when the patient successfully recruits the analyst to feel and act in certain ways that will confirm their transference phantasy. Confirming the phantasy may often be a simple repetition of prior object-relational struggles, but it can also be an attempt to create something new, a new object experience, not just a detour from old or current anxieties. In other words, motivations behind the projective identification-induced interpretive enactment can be quite varied. But the essential result is that the analyst is no longer functioning as an analyst; he or she is now part of the patient's inner stage of self and object relations. The chapter considers issues of projective identification, countertransference, and the importance of realizing the analyst's transference role in the patient's changing phantasies.

This chapter considers how patients will project unwanted, unfinished, and unspoken aspects of their internal self during the course of a psychoanalytic treatment. Using extensive material from several psychoanalytic cases, it highlights the often flawed nature of an analyst's interpretive efforts. The patient can coerce the analyst to act out, via interpretation, various roles in the patient's unconscious phantasy life. This interpretive acting out may be subtle and passive or more aggressive and active. If not monitored, contained, and understood, it can be destructive to the therapeutic situation. However, if properly handled, it can shed important light on otherwise hidden aspects of the patient's internal struggles and conflicts that, up to that moment, could only arise through the process of projective identification. This chapter examines the ways that countertransference can pave the way to a better understanding of the transference and, therefore, more helpful and accurate interpretations of the patient's internal world.

This chapter examines the difficulty of private practice and demonstrates the real-world, on-the-ground truth of psychoanalytic treatment involving hard-to-reach patients. Most analysts encounter a wide variety of patients who present complicated and difficult transference situations. Projective identification is often the primary vehicle in which persecutory and primitive depressive phantasies play out in the interpersonal and intrapsychic realm of the transference. With the more regressed and defensive patient, there can be chaotic and confusing moments in which interpretive acting out by both patient and analyst is common. The analyst can easily stumble within the countertransference, falling into a mutual object-relational enactment. The tool of analytic interpretation is most crucial with these difficult patients. This chapter considers a situation with more troubled patients, in which the treatment quickly stalls, becomes a stage for various enactments between patient and analyst, or simply ends in a quick and messy fashion.

This chapter examines the internalization of the unstable, fragile, or even pathological ideal, as opposed to Melanie Klein's idea of a normal, developmentally stable ideal. In psychoanalytic practice, analysts encounter a variety of patients who operate at different levels of anxiety or desire in regards to their objects. Some patients who exhibit control and conviction about self and object demonstrate borderline and narcissistic disorders that revolve around more persecutory phantasies. There are also patients who face a constant depressive and persecutory threat to themselves and their precious objects. They rely heavily upon idealization and projective identification to traverse their psychological standoff against these overwhelming anxieties. The subsequent defenses that are always in overuse to sustain the brittle ideal self or object and to prevent the aggressive, envious self from breaking through actually cause either the death/damage of the object or the rise of a persecutory object. Often it can be both, creating a dual fear and phantasy of loss and persecution.

This chapter examines two cases in which psychic retreat has been only partly functional and in many cases has sprung a leak, leaving the patient feeling helplessly exposed to the worst aspects of both paranoid and depressive suffering. Both cases illustrate how collapsing or unstable psychic retreats shape the transference and phantasy climate. The first patient seemed caught in an emotional foxhole at the beginning of psychological treatment but slowly has been able to emerge and change the nature of how he views and relates to his objects and consequently to himself. The second case contains material in which there is an ongoing failure of the depressive position and a resulting mixture of primitive depressive and destabilizing persecutory phantasies, which leave the patient trapped in an emotional foxhole. This creates certain transference situations as well as particular countertransference struggles. She seeks refuge in narcissistic defenses and aggressive projective identification, all aimed at coping with anxieties pertaining to phantasies about how her objects were willing or unwilling to protect, serve, praise, and love her.

This chapter examines the different levels of chaos experienced by patients who utilize a psychic retreat. Using clinical material, it illustrates the imperfect nature of psychic retreat and the modest, shaky, halfway house that it offers, providing only a brief breathing space for some patients before the next internal collapse begins. Some patients undergoing psychological treatment attempt to stay within a fortress of control and withdrawal, but their pathological organization breaks down, becoming only partly functional. They fight to erect a temporary foxhole from the overwhelming and often unbearable torments of paranoid and depressive conflicts. The struggle with normal states of splitting, projective identification, and idealization, as well as normal states of grief and guilt, can break down and become unbearable. These overwhelming anxieties lead patients to seek refuge in pathological retreats. These patients are difficult to work with, because they are extremely well defended and rely on static and rigid psychological strategies. The analyst faces a slow, difficult, and precarious journey in helping these types of patients.