Table Of Content“robert waska augments plentiful clinical material by detailing W
his process as he considers potential interventions. In a move that is all too rare among a M
psychoanalytic writers, he includes even his interpretive failures, supplementing them with s o M e n t s
k
retrospective commentary that both elucidates and provides alternative formulations. Even
a
seasoned clinicians will benefit from a volume that merits a place high on student reading lists.” of
nancy vanderheide, psy.D., president of the Institute of Contemporary Psychoanalysis M
U
o n c e r t a i n t y
One of therapy’s greatest challenges is the moment of transference, when a patient unconsciously M
transfers emotion or desire to a new and present object—in some cases the therapist. During the e
course of treatment, a patient’s projections and the analyst’s struggle to divert them can stress, distort, n i n
t
or contaminate the therapeutic relationship. It may lead to various forms of enactment, in which
s
t
the therapist unconsciously colludes with the client in interpretation and treatment, or it can lead
o h e r a p e U t i c
to projective identification, in which the client imposes negative feelings and behaviors onto the f
therapist, further interfering with analysis and intervention. U
n
Drawing on decades of clinical case experience, Robert Waska leads practitioners through the steps
c p
of phantasy and transference mechanisms and their ability to increase, oppose, embrace, or neutralize
e r a c t i c e
analytic contact. Operating from a psychoanalytic perspective, he explains how to cope professionally r
with moments of transference and maintain an objective interpretive stance within the ongoing matrix t
a
of projective identification, countertransference, and enactment. Each chapter discusses a wide
i
spectrum of cases and clinical situations, describing in detail the processes that invite a playing n
t
out of the patient’s phantasies and the work required to reestablish balance. Refreshingly candid,
y
Waska recognizes the imperfections of analysis yet reaffirms its potential for greater psychological
integration and stability for the patient. He acknowledges the limits and frequent roadblocks of i
n
working with difficult patients, such as those who suffer from psychic retreat, paranoid phantasies,
t
and depressive anxieties, yet he indicates an effective path for resetting the clinical moment and
h
redirecting the course for treatment. e
r
a
robert waska conducts a full-time private psychoanalytic practice for p
individuals and couples in San Francisco and Marin County, California. In addition, e
U
he has taught classes and supervised therapists in the Bay Area and has presented
t
papers in the United States and internationally. Dr. Waska is the author of ten
i
textbooks on psychoanalytic theory and technique and is a contributing author for c
Walton two psychology texts. He has also published more than ninety articles in professional p
Liz journals and serves on the review committee for several journal and book publishers. r
Dr. Waska’s work focuses on contemporary psychoanalytic topics, including projective identification, loss, a
c
borderline and psychotic states, the practical realities of psychoanalytic practice in the modern world,
t
and the establishment of analytic contact with difficult and hard-to-reach patients. He emphasizes the i
c
moment-to-moment understanding of transference and phantasy as the vehicle for gradual integration Interpreting Within the Matrix of Projective
e
and mastery of unconscious conflict between the self and the other.
Identification, Countertransference, and enactment
C
Printed in the USA o
l
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Columbia University Press/New York ISBN: 978-0-231-15153-5 m
b
cup.columbia.edu ia R o b e R t W a s k a
Cover art: Robert Waska
9 780231 151535
Cover design: Julia Kushnirsky
••
MOMENTS OF UNCERTAINTY
in Therapeutic Practice
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Robert Waska
••
MOMENTS OF UNCERTAINTY
in Therapeutic Practice
Interpreting Within the Matrix
of Projective Identifi cation,
Countertransference, and Enactment
COLUMBIA UNIVERSITY PRESS NEW YORK
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COLUMBIA UNIVERSITY PRESS
Publishers Since 1893
New York Chichester, West Sussex
Copyright © 2011 Columbia University Press
All rights reserved
Library of Congress Cataloging-in-Publication Data
Waska, Robert T.
Moments of uncertainty in therapeutic practice : interpreting within the matrix
of projective identifi cation, countertransference, and enactment / Robert Waska.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-231-15152-8 (cloth : alk. paper)—ISBN 978-0-231-15153-5
(pbk. : alk. paper)—ISBN 978-0-231-52523-7 (e-book)
1. C0untertransference (Psychology) 2. Acting out (Psychology)
3. Projection (Psychology) 4. Psychoanalysis. I. Title.
[DNLM: 1. Countertransference (Psychology)—Case Reports.
2. Acting Out—Case Reports. 3. Projection—Case Reports.
4. Psychoanalytic Therapy—method—Case Reports. WM 62]
RC489.C68W37 2011
616.89'14—dc23 2011011805
Columbia University Press books are printed on permanent and
durable acid-free paper.
This book is printed on paper with recycled content.
Printed in the United States of America
c 10 9 8 7 6 5 4 3 2 1
p 10 9 8 7 6 5 4 3 2 1
References to Internet Web sites (URLs) were accurate at the time of writing.
Neither the author nor Columbia University Press is responsible for
URLs that may have expired or changed since the manuscript was prepared.
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CONTENTS
Preface vii
Acknowledgments x v
Introduction 1
SECTION 1. INTERPRETIVE ACTING OUT
1. Containing, Translating, and Interpretive Acting Out:
The Quest for Therapeutic Balance 11
2. Slippery When Wet: The Imperfect Art of Interpretation 33
3. Interpretive Acting Out: Unavoidable and Sometimes Useful 54
4. Enactments, Interactions, and Interpretations 77
SECTION 2. DIFFICULT AND JAGGED: IMPERFECT
CLINICAL SITUATIONS
5. Kleinian Couple’s Treatment: A Complicated Case 99
6. Failures, Successes, and Question Marks 122
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vi Contents
SECTION 3. THE EMOTIONAL FOXHOLE
7. Different Ways of Controlling the Object 147
8. Taming, Restoring, and Rebuilding, or Sealing Off, Burying, and
Eliminating the Object: Two Ways of Controlling the Other 162
9. Two Varieties of Psychic Retreat: The Struggle with Combined
Paranoid and Depressive Confl icts 184
10. Trapped in an Emotional Foxhole: Coping with Paranoid
and Depressive Confl icts 205
Discussion 223
Bibliography 233
Index 239
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PREFACE
THIS BOOK INVITES the reader to accompany a Kleinian psychoanalyst
as he shares the intimate, day-to-day, moment-to-moment clinical expe-
rience that unfolds when treating a wide variety of patients in private
practice. The author creates a genuine, user-friendly, experience-near
atmosphere in which the reader has the chance to see how a modern
psychoanalytic practitioner actually conducts Kleinian treatment. The
nuts-and-bolts approach of the “he said/she said” dialogue opens a wide
window into the actual clinical exchange.
The general public—not to mention students currently studying in
the fi eld of psychology—can sometimes have the false impression that
Freud is “old hat,” ancient, outdated, or even silly and useless. However,
when helping patients maneuver through their complex and painful
problems, many of Freud’s discoveries and basic theoretical tenets re-
main powerful.
Likewise, Melanie Klein’s original thinking in her work with children
and adults is sometimes seen as outdated or out of pace with the mod-
ern therapeutic climate. Again, when working intensely with neurotic,
borderline, narcissistic, and psychotic patients, Klein’s highly original
elaboration of Freud’s work still proves vital in the analytic setting. This
volume provides a wealth of clinical material to illustrate this point.
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viii Preface
Some of the most popular or prevalent perspectives in psychoanalysis
today owe a great deal to Klein’s discoveries, have compatible aspects
of theory and technique, or dovetail in important clinical constructs.
The American relational school has embraced such Kleinian concepts
as projective identifi cation and, in its own way of conceptualizing and
utilizing this idea, has come to make regular clinical use of it. While op-
erating from viewpoints sometimes quite in opposition to the Kleinian
approach, relational analysts such as Seligmann, Cooper, Altman, and
Aron nevertheless include the Kleinian cornerstone of projective identi-
fi cation in their theoretical and technical methods.
Mitchell (1995) has written extensively about the common ground
and contemporary importance of both the interpersonal/relational
schools and the Kleinian tradition. He notes that while emerging from
quite different starting points, they arrive at perspectives on the concept
of analytic interaction that complement each other. He outlines how
Klein took Freud’s ideas of the life and death instincts seriously, seeing
the infant as struggling with biologically rooted, instinctually driven un-
conscious forces. However, Klein’s followers, especially in the last few
decades, have emphasized the value of the environment alongside that
of the biological, unconscious aspects of the patient’s psychology.
Here, Kleinian theory and technique also dovetail with the current
interest in attachment theory. Fonagy and Target both espouse a more
attachment-based version of Klein’s discoveries. Modern Kleinian think-
ers value the signifi cance of the internal phantasy interaction between
self and object as well as the external environmental interaction be-
tween infant and caretaker. This is echoed in the sharp focus that Klein-
ians place on the interpersonal interaction between analyst and patient.
Melanie Klein focused on both the environment and on the internal
landscape of the self and object, but she emphasized the importance of
relationships in the mind of the infant and the patient. Fairbairn, Win-
nicott, and others put the emphasis on actual external interactions with
real people in real time, while the Kleinian school considers the uncon-
scious relationship between self and object—as colored by the paranoid-
schizoid position and the depressive position—to be the bulk of the in-
dividual’s subjective experience in life. In looking at these unconscious
processes, Klein discovered the dynamics of projective identifi cation, in
which aspects of the self are communicated or expelled into the object
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Preface ix
for a variety of motives. One mind puts its contents into the mind of
another, in the form of a profoundly intense, intimate interaction. For
Melanie Klein, this was purely an unconscious phantasy process.
However, my own contemporary Kleinian approach as well as the
more modern stance currently held by most Kleinian analysts has been
to expand this internal view of projective identifi cation to the more in-
clusive view of its being both an intrapsychic and an interpersonal, in-
teractional process. This interpersonal expansion of Klein’s landmark
discoveries began with the work of Bion, evolved from there to my own
work, and is now foremost in the current views of Betty Joseph. This
more inside/outside, unconscious/interaction view of projective identi-
fi cation has spread from its birth in the Kleinian tradition to become one
of the main aspects of many relational, interpersonal, and even modern
Freudian approaches.
In fact, Klein’s powerful concept of projective identifi cation is now
being integrated into most of contemporary psychoanalytic culture. At
a 2009 scientifi c meeting at a psychoanalytic institute, a paper entitled
“A Neuropsychoanalytic Perspective on Unconscious Communication”
was delivered. This presentation included a discussion of how projec-
tive identifi cation, from a more Kleinian perspective, is part of an intri-
cate mix of factors colored by elements of neuroscience and attachment
theory. Interestingly, a major proponent of the relational school spoke
of the “sensational contribution” of the paper—as well as its substantial
difference from his own point of view. Betty Joseph’s modern Kleinian
work was brought up in the audience discussion as pivotal for the argu-
ment. The close connection between projective identifi cation and the
mirror-neuron system was noted as well.
Enid Young is one of several contemporary Kleinians writing about
and lecturing on the elements in neuroscience and brain function that
complement original and current Kleinian theory. Studies in infant de-
velopment are also beginning to confi rm Melanie Klein’s own work with
infants and young children. Klein’s ideas about the infant’s capacity
for strong object-relational connections at an early age have now been
proven by observational studies and developmental research.
Other aspects of Kleinian theory and technique that stand the test of
time and now fortify many other contemporary psychoanalytic schools
are the concepts of countertransference, enactment, and interpretation.
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