This book explores the theoretical and technical aspects of Modern Kleinian Therapy with borderline, narcissistic, and psychotic patients who are in great psychological conflict and who struggle to find stable footing in the relational world. These are the patients who are most taxing and troubling for all therapists as they suffer greatly in life but tend to leave a great deal of suffering in their wake.
Throughout the book, the reader is provided a close up clinical view of what really takes place in psychoanalytic treatment with psychologically disorganized, predatory, or internally terrorized patients who often can barely begin or maintain a therapeutic relationship as they experience it as emotionally threatening, dangerous, and unbearable. Aspects of Kleinian theory are highlighted through examining very personal verbatim accounts from patients of their internal emotional experiences. And, Kleinian concepts and techniques are clinically demonstrated. Change is shown to be possible in situations that initially seem unchangeable and acceptance is shown to be reachable in situations that initially seem unbearable. While success can be fleeting or unreachable, the author shows how to best find the potential for therapeutic success and to learn from the failures or modest achievements so common with more difficult patients. In that sense, this book serves as inspiration and hope to all therapists working with borderline, narcissistic, and psychotic patients.
Dr. Robert Waska's clinical work, now thirty years in the making, focuses on contemporary Kleinian topics including projective identification, loss, borderline and psychotic states, the practical realities of psychoanalytic practice in the modern world, and the establishment of analytic contact with difficult, hard to reach patients. He emphasizes the moment-to-moment understanding of transference and phantasy as the vehicle for gradual integration and mastery of unconscious conflict between self and other.
Preface Acknowledgments Hard-to-Start Treatments, Strained Travels, and Unfinished Journeys Understanding Psychic Shifts Entitled and Demanding Psychotic Distortions of the Good Object A Borderline Account of Disintegration and Eventual Integration John's Story Memories and Timeless Trauma External Motion and Internal Deadness The Descent, Decline, and Eventual Resurrection Analytic Observations and the Analytic Process Taming Destructive Phantasies Translating Destructive Acting Out Pre-Interpretive Containment Name It, Claim It, and Tame It Conclusions About the Author Bibliography Index