Klein in the Trenches

Working with Disturbed Patients

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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.

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Preliminary Material
页码: i–xiii
Understanding Psychic Shifts
页码: 1–12
Entitled and Demanding
页码: 13–29
Psychotic Distortions of the Good Object
页码: 31–51
John’s Story
页码: 53–72
Memories and Timeless Trauma
页码: 73–85
External Motion and Internal Deadness
页码: 87–97
Taming Destructive Phantasies
页码: 117–134
Translating Destructive Acting Out
页码: 135–152
Pre-Interpretive Containment
页码: 153–169
Name It, Claim It, and Tame It
页码: 171–184
Conclusions
页码: 185–187
About the Author
页码: 189
Bibliography
页码: 191–197
Index
页码: 199–203
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
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