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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.

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 chapter examines the clinical difficulties faced by analysts when dealing with patients who are struggling with loss, grief, and persecution and the constant sense of failure to win their object's love, acceptance, or forgiveness. Using three case studies, it highlights the many different ways patients control the object: through psychic retreat, by avoiding the persecutory object, or by retraining the object. In her 1940 paper “Mourning and Its Relation to Manic-Depressive States,” Melanie Klein outlines the complexities of depressive conflict and the ways that idealization, a healthy aspect of normal functioning, can become corrupted. Idealization serves to protect the object from envy, greed, and aggression. It serves to protect the ego from a sense of loss and pining. Finally, it creates a feeling of protection from the phantasy of persecution and fears of revenge from a damaged and dying object.