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6: Loss and Primitive Methods of Relating: Difficulties in the Analytic Encounter

Waska, Robert Karnac Books ePub

CHAPTER SIX

Loss and primitive methods of relating: difficulties in the analytic encounter

Some patients come into treatment and show us, through transference enactments and through gradual working through of their deeper phantasies, that they see most important interactions and close relationships as contaminated in some way by the experience of loss. If we are able to work with them for a while, it also becomes evident that many of these patients have also experienced actual traumatic loss in their early development. This may be the divorce of parents, death of a caretaker, or separation from an important care-taker. It may be in the form of ongoing loss of a protective and trustworthy parent, as in the case of abuse or neglect. In any case, there is often a combination of external and internal experiences of loss and trauma. Analysis shows that the external and the internal influence each other in synergistic ways that often bring about greater and greater states of misery, defensiveness, and anger.

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4: Vulnerability, Union, and the Return of the Bad Object

Waska, Robert Karnac Books ePub

CHAPTER FOUR

Vulnerability, union, and the return of the bad object

In optimal development, a child is brought up in a family that respects the child's needs and natural vulnerabilities. Even if the parents do not fully understand the child's oral striving and the inherent mix of hostility, love, greed, and giving that children exhibit, they can respect these feelings. Acknowledgement, respect, and curiosity on the care-givers' part leave a sense of being wanted and feeling safe and fulfilled in the child's developing ego. This positive cycle can be seen with adult patients in the transference. If the analyst respects the patient's day-to-day display of envy, despair, altruism, desire, competition, and so forth, and appreciates it all with curiosity, the patient usually feels cared for and is able to continue exploring him/herself in a vulnerable and honest manner.

The paranoid–schizoid patients I am describing have not been so fortunate in their childhood histories. Consequently, their transference experiences tend to be much more guarded, rocky, and mistrusting. The next case example, “Mr E”, shows how one such patient grappled with his phantasies of loss, judgement, and attack. In the early stages of treatment, he tried to protect himself from these dangers by being super self-sufficient and independent. If he did not need me, I could not hurt him. Instead of the partial loss/atonement and restoration of object/healing of relationship that is typical of depressive-position phantasies, Mr E warded off phantasies of an ideal, yet fragile object that splintered and broke down in a permanent way. This left him lost, forsaken, and in danger. In this empty state, he felt he was then at the mercy of judgmental and angry objects working to control and destroy him.

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9: Working with the Concrete Thinking of Narcissism

Waska, Robert Karnac Books ePub

CHAPTER NINE

Working with the concrete thinking of narcissism

Masochistic patients test the analyst's ability to provide relief, understanding, and integration through interpretation because they tend to be concrete and situation-focused. Part of this is attributable to the vicissitudes of the paranoid–schizoid position, where much is felt as concrete, all-or-nothing entities that are not linked to one another. Part of this is also the nature of the masochistic patient's internal-object relations and their phantasies that skew perception in peculiar ways.

Paranoid–schizoid masochistic patients often feel ignored, abandoned, or persecuted if the analyst tries to broaden their focus from a repetitious lament to an exploratory curiosity. Looking at the transference will evoke confusion, bitterness, and complaint since they feel that the analyst is blaming them for their problems and not seeing how the world is at fault. These are patients who in one sense claim they are to blame for everything and at the same time refuse to take responsibility for anything.

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7: Maintenance of Hope: The Working-Through Process

Waska, Robert Karnac Books ePub

CHAPTER SEVEN

Maintenance of hope: the working–through process

The patient discussed in this chapter, Mr X, is much higher functioning than was Larry, the patient discussed in chapter six. Indeed, Mr X is often negotiating the border between the paranoid–schizoid and the depressive positions. However, he still fears he has caused irreparable damage to the object and that the object will seek drastic revenge.

“Mr X”

Mr X came to treatment for help with relationship problems. He was struggling to understand his turbulent relationship with his girlfriend. As with other women he had dated, Mr X felt that he could rescue her and educate her with his superior intellect and talent. After a short while, she became a burden and he didn't know how to get rid of her.

Following an initial evaluation, we agreed on a psychoanalytic treatment: meeting four times a week, using the couch. Mr X had been to several therapists over the years, but never in long–term psychoanalytic work.

His father, as Mr X recalls, was an overbearing, harsh, and angry man who wanted things done his way. He would get drunk and would frequently push Mr X, his brother, and his mother around. He would yell and slap my patient when drunk and generally lecture or scold him when sober. Mr X was told he was a “weak excuse for a man”.

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5: Love, Hate, and the Dread of Impending Annihilation

Waska, Robert Karnac Books ePub

CHAPTER FIVE

Love, hate, and the dread of impending annihilation

Three short case reports are used in this chapter to show ways that paranoid—schizoid patients fight off the supportive presence of the analyst in order to avoid persecutory experiences of loss. This makes for difficult countertransference issues, chronic resistance to treatment, and premature termination and aborted treatments. These patients suffer a great deal. They dread being misunderstood, as this equates to being abandoned and betrayed. This fear of a nameless dread leads to subtle or not so subtle demands for agreement at all costs. This leads to an air of domination and submission in the treatment process. These patients cannot tolerate separateness, and they desire an idealistic state of agreement between ego and object. Envy and excessive projective identification play a large part of the dysfunctional interactions with the analyst and other major figures in their lives. Thinking is necessary for a working-through process. However, for these patients, thinking is anxiety provoking as it brings them into awareness of the differences between self and object. This triggers the phantasies of loss and attack. All this promotes a jerky and hard-to-contain pattern of “I want you—stay away and leave me alone” kind of transference.

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