Robert Waska
- Published in print:
- 2011
- Published Online:
- November 2015
- ISBN:
- 9780231151535
- eISBN:
- 9780231525237
- Item type:
- book
- Publisher:
- Columbia University Press
- DOI:
- 10.7312/columbia/9780231151535.001.0001
- Subject:
- Psychology, Clinical Psychology
One of therapy's greatest challenges is the moment of transference, when a patient unconsciously transfers emotion or desire to a new and present object—in some cases the therapist. During the course ...
More
One of therapy's greatest challenges is the moment of transference, when a patient unconsciously transfers emotion or desire to a new and present object—in some cases the therapist. During the course of treatment, a patient's projections and the analyst's struggle to divert them can stress, distort, or contaminate the therapeutic relationship. It may lead to various forms of enactment, in which the therapist unconsciously colludes with the client in interpretation and treatment, or it can lead to projective identification, in which the client imposes negative feelings and behaviors onto the therapist, further interfering with analysis and intervention. Drawing on decades of clinical case experience, this book leads practitioners through the steps of phantasy and transference mechanisms and their ability to increase, oppose, embrace, or neutralize analytic contact. Operating from a psychoanalytic perspective, it explains how to cope professionally with moments of transference and maintain an objective interpretive stance within the ongoing matrix of projective identification, countertransference, and enactment. The book discusses a wide spectrum of cases and clinical situations, describing in detail the processes that invite a playing out of the patient's phantasies and the work required to reestablish balance. It recognizes the imperfections of analysis yet reaffirms its potential for greater psychological integration and stability for the patient. It also acknowledges the limits and frequent roadblocks of working with difficult patients, such as those who suffer from psychic retreat, paranoid phantasies, and depressive anxieties, yet indicates an effective path for resetting the clinical moment and redirecting the course for treatment.Less
One of therapy's greatest challenges is the moment of transference, when a patient unconsciously transfers emotion or desire to a new and present object—in some cases the therapist. During the course of treatment, a patient's projections and the analyst's struggle to divert them can stress, distort, or contaminate the therapeutic relationship. It may lead to various forms of enactment, in which the therapist unconsciously colludes with the client in interpretation and treatment, or it can lead to projective identification, in which the client imposes negative feelings and behaviors onto the therapist, further interfering with analysis and intervention. Drawing on decades of clinical case experience, this book leads practitioners through the steps of phantasy and transference mechanisms and their ability to increase, oppose, embrace, or neutralize analytic contact. Operating from a psychoanalytic perspective, it explains how to cope professionally with moments of transference and maintain an objective interpretive stance within the ongoing matrix of projective identification, countertransference, and enactment. The book discusses a wide spectrum of cases and clinical situations, describing in detail the processes that invite a playing out of the patient's phantasies and the work required to reestablish balance. It recognizes the imperfections of analysis yet reaffirms its potential for greater psychological integration and stability for the patient. It also acknowledges the limits and frequent roadblocks of working with difficult patients, such as those who suffer from psychic retreat, paranoid phantasies, and depressive anxieties, yet indicates an effective path for resetting the clinical moment and redirecting the course for treatment.
Robert Waska
- Published in print:
- 2011
- Published Online:
- November 2015
- ISBN:
- 9780231151535
- eISBN:
- 9780231525237
- Item type:
- chapter
- Publisher:
- Columbia University Press
- DOI:
- 10.7312/columbia/9780231151535.003.0009
- Subject:
- Psychology, Clinical Psychology
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 ...
More
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.Less
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.
Robert Waska
- Published in print:
- 2011
- Published Online:
- November 2015
- ISBN:
- 9780231151535
- eISBN:
- 9780231525237
- Item type:
- chapter
- Publisher:
- Columbia University Press
- DOI:
- 10.7312/columbia/9780231151535.003.0010
- Subject:
- Psychology, Clinical Psychology
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 ...
More
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.Less
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.
Robert Waska
- Published in print:
- 2011
- Published Online:
- November 2015
- ISBN:
- 9780231151535
- eISBN:
- 9780231525237
- Item type:
- chapter
- Publisher:
- Columbia University Press
- DOI:
- 10.7312/columbia/9780231151535.003.0005
- Subject:
- Psychology, Clinical Psychology
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 ...
More
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.Less
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.
Robert Waska
- Published in print:
- 2011
- Published Online:
- November 2015
- ISBN:
- 9780231151535
- eISBN:
- 9780231525237
- Item type:
- chapter
- Publisher:
- Columbia University Press
- DOI:
- 10.7312/columbia/9780231151535.003.0007
- Subject:
- Psychology, Clinical Psychology
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 ...
More
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.Less
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.
