Treating severe depressive and persecutory anxiety states : to transform the unbearable

267 Pages·2010·0.66 MB·English

by  Robert Waska.

TREATING SEVERE DEPRESSIVE
AND PERSECUTORY ANXIETY STATES

TREATING SEVERE
DEPRESSIVE
AND PERSECUTORY
ANXIETY STATES
To Transform the Unbearable
Robert Waska
First published in 2010 by
Karnac Books Ltd
118 Finchley Road
London NW3 5HT
Copyright © 2010 by Robert Waska
The right of Robert Waska to be identified as the author of this work has
been asserted in accordance with §§ 77 and 78 of the Copyright Design and
Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without the prior
written permission of the publisher.
British Library Cataloguing in Publication Data
A C.I.P. for this book is available from the British Library
ISBN-13: 978-1-85575-720-2
Typeset by Vikatan Publishing Solutions (P) Ltd., Chennai, India
Printed in Great Britain
www.karnacbooks.com
CONTENTS
ACKNOWLEDGEMENTS ix
PREFACE xi
INTRODUCTION xiii
PART I: COMBINED PERSECUTORY
AND DEPRESSIVE TRAUMA 1
CHAPTER ONE
Psychoanalysis as defined by the clinical situation:
Establishing analytic contact with acutely
troubled patients 3
CHAPTER TWO
When suffering never ends: The internal experience
of the paranoid and the depressive world colliding 23
v
vi CONTENTS
CHAPTER THREE
When patients face the dual threat of depressive
and paranoid phantasies 41
CHAPTER FOUR
Unresolved depressive and paranoid phantasies:
Certain clinical difficulties 57
CHAPTER FIVE
Longing for the disappointing object and dreading
its return 69
PART II: ANALYTIC CONTACT IN UNTRADITIONAL
CLINICAL SITUATIONS 89
CHAPTER SIX
Low-frequency Kleinian psychoanalysis: Establishing
analytic contact with a new case 91
CHAPTER SEVEN
A Kleinian view of psychoanalytic couples therapy 111
CHAPTER EIGHT
Clinical issues in couples treatment 131
CHAPTER NINE
Optimism as a way to save the self and the object 149
CHAPTER TEN
Why won’t the voices leave me alone: Patients who live
in a world of persecutory anxiety 167
PART III: COUNTER-TRANSFERENCE
AND THE ESTABLISHMENT
OF ANALYTIC CONTACT 183
CHAPTER ELEVEN
Using the counter-transference: Analytic contact, projective
identification, and transference phantasy states 185
CONTENTS vii
CHAPTER TWELVE
The counter-transference
and analytic contact 205
SUMMARY 225
BIBLIOGRAPHY 231
INDEX 239

ACKNOWLEDGEMENTS
I wish to thank all my patients for their willingness to learn and
change, sharing their intimate struggles with me and allowing me
to learn and grow as a clinician. All identities have been disguised
and details of each case have been modified to protect the personal
details involved.
My thanks go out to my wife who is always ready to lend a hand
in whatever way is needed, providing feedback and gentle guidance
with my writing endeavours.
Finally, I appreciate the permission to reprint particular material
that has been previously published in journal form. Chapter Two
has appeared in Issues in Psychoanalytic Psychology (1), Chap-
ter Six in the Bulletin of the Menninger Clinic (2), Chapters Three,
Seven, and Eight in Psychoanalytic Psychotherapy (3), Chapter Ten
in Psychodynamic Practice (4), and Chapter Eleven in the American
Journal of Psychotherapy (5).
1. Waska, R. (2008). When suffering never ends: The internal experience
of the paranoid and depressive worlds colliding. Issues in Psychoana-
lytic Psychology, in press.
ix