Love, Hate and Knowledge

The Kleinian Method and the Future of Psychoanalysis

Robert Waska

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367325466
• eBook ISBN: 9780429915949
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book introduces the clinical concept of analytic contact. This is a term that describes the therapeutic method of investigation that makes up psychoanalytic treatment. The field has been in debate for decades regarding what constitutes psychoanalysis. This usually centers on theoretical ideals regarding analyzability, goals, or procedure and external criteria such as frequency or use of couch. Instead, the concept of analytic contact looks at what takes place with a patient in the clinical situation. Each chapter in this book follows a wide spectrum of cases and clinical situations where hard to reach patients are provided the best opportunity for health and healing through the establishment of analytic contact. This case material closely tracks each patient's phantasies, and transference mechanisms which work to either increase, oppose, embrace, or neutralize, analytic contact. In addition, the fundamental internal conflicts all patients struggle with between love, hate, and knowledge are represented by extensive case reports.

Section III

Transference ↔ Counter-Transference Struggles

Chapter Eight

Projective identification and reactions to analytic contact

In a previous publication (Waska, 2005), it was argued that projective identification is a natural, constant element of human interaction, both inside and outside of the psychoanalytic setting. Through case material, this Chapter will explore the different levels of projective identification that surface with patients in the course of their psychoanalytic treatment and how these dynamics colour the emergence or continuation of analytic contact. These different levels of projective identification can all emerge within the course of one case, sometimes representing an evolutional shift in internal conflict and a developmental working through. Other patients seem to rely solely on one level throughout their analytic work, even as they change and grow. Then, there are other patients who dig in with one pervasive form of projective identification as a fortification and retaliation against growth and change.

The differences in these levels or forms of projective identification have to do with how intolerable the patient feels about certain aspects of their inner world and their self↔object phantasies. Some patients want the analyst to take over unwanted parts of themselves until they can better manage and integrate them. Other patients want to dislodge primitive feelings and phantasies that are unthinkable. These are wishes, needs, and phantasies that are not allowed to take shape in their minds for various persecutory and depressive reasons. If the analyst, over time, can assist the patient to put words and thought to these projections, there is a chance the patient will slowly accept them into their minds as tolerable or hopefully even important aspects of their emotional lives. Other patients try to simply amputate unthinkable and unacceptable aspects of their psychology onto the analyst and vigorously reject the analyst’s attempts to explore and acknowledge these dangerous desires, fears, and phantasies. As Steiner (1979) points out, some patients are eventually capable of making contact with these previously jettisoned parts of themselves, but the experience is felt to be overwhelming and unbearable so the patient usually tries to sever the link and works to again project and deny those phantasies. This paper will examine patients struggling with this last more difficult clinical phenomenon. The paper will focus on how it is often one particular self↔object phantasy that is experienced as most unbearable. Along the way, the analyst is often brought into difficult counter-transference acting out of the patient’s projective identification process.

Projective identification is often at the core of the transference and must be consistently interpreted and worked with if the analyst’s acting out is to decrease, if analytic contact is to be preserved, and if the patient’s acceptance of self is to increase.

Case 1

Stacy was asked by her company manager to seek help with her over-eating. She agreed with their assessment and called me for an appointment, telling me she “could never afford an opportunity like this herself, but her company was generous enough to pay for twenty visits.” Stacy weighed close to three hundred pounds and was frequently distracted from her work by visits to the cafeteria or snack food vending machines. She told me, “I always bring candy to work. I can’t picture being there all day without it.” Stacy was thirty-seven and had been single for the past five years. She told me she dated occasionally, but that “most men only want to get into my pants, so it is hard to find someone who is willing to work on a relationship.” Stacy saw herself as attractive, but also told me she felt much more confident and pretty when she weighed less. I was struck by her view of herself as being pursued by men only wanting sex, as she didn’t fit that physical stereotype at all. So, I took note of this as a possible way Stacy distorted her view of herself and her objects for reasons not yet known to us.

This same sort of discrepancy appeared in the way she talked with me. Stacy presented herself as a simple sort of woman, but then she talked philosophically about matters, appearing to be a deep thinker. But, as we went along, it started to look like she in fact lived a rather shallow emotional life. She engaged me in various conversations, but at some point, she would lapse into a more dependent, “what do I do about it doc?” type of relationship. The seemingly important insights she might make or that I interpreted were never really pursued. She didn’t seem to grasp the importance of what she was saying.

Approximately five years before I saw her, Stacy was hospitalized with psychotic symptoms and medicated. She had stopped the medications twice since then and then had to take herself to the hospital both times, hearing voices and feeling paranoid.

During the first few months of her treatment, we discussed what she called her low self-esteem from being so over-weight. Also, she felt depressed because she hadn’t been in a relationship for quite some time. When I tried to explore the nature of her over-eating, she told me “I know it is a form of emotional eating.” Again, she said this in both an engaging manner that promised curious introspection, but also it sounded like something she had been told in the hospital and was simply repeating.

In one session, Stacy referenced the “hard times” she had growing up, often with not enough food to eat since her family was so poor and “everyone unable to stop fighting.” Then, she said that as an adult, “I often feel bored, tired, or lonely. I don’t know Doc, I just start eating.” In the counter-transference, I felt like she had given me the first comment about her feeling bored and lonely for safe keeping, not making a link to it with the second comment about how she “just starts eating.” In my own mind, I wondered if Stacy put these two states of mind together it might result in anxiety and pain. So, perhaps she kept them apart by leaving the first emotional comment with me, while she kept ownership of the second concrete comment. I was pondering if her use of projective identification kept these two states apart, separate in her mind, with me as the repository of the unwanted link.

As a result of my clinical ideas, I made the missing link by interpreting that she may have grown up feeling the lack of a nourishing, safe object that filled her up emotionally I said, “Maybe without that nourishing, safe feeling in your family, you were left feeling empty and lonely. If so, maybe food was the concrete answer to your emotional hunger. In response to my interpretation, Stacy began to weep and then sob. After a few minutes, she told me important details about her upbringing.

Stacy’s father was a chronic alcoholic who would drink until drunk and then start fighting with his wife. Stacy grew up “watching my parents beat the shit out of each other more times than not.” She said the atmosphere in the home was always tense and unpredictable. Her mother had a psychotic break at some point and was hospitalized. Stacy told me, “Mom was this person in my life who would say I love you in the morning and beat me silly at night.” She went on to describe the violent neighbourhood she grew up in and how she was beaten and almost raped at age twelve by members of the local gang. School was a place she remembered being picked on for her acne and shyness. Finally, Stacy told me how the one “source of warmth I had was two small cats that we found and took home. But, one day after I had them for about a year, one got sick and since we couldn’t afford to take them to the vet, my father gave them both rat poison.” She began sobbing again.

During the last part of this session as well as the next few visits, I continued to pursue the link that seemed to open up this enormous backlog of pain and anguish. I interpreted that the trauma she suffered as a child was still alive inside of her in the sense that she felt empty, scared, and alone. She tried to find safety and soothing in food, but her deep emotional need turned this respite into another source of pain and unhappiness. She didn’t like to be obese, but she didn’t feel she could give up her obsession with food because she would be left with overwhelming loneliness and internal chaos. In response to these interpretations, Stacy replied, “I don’t know if I want to stop over-eating!” I said, “If you don’t know what to replace it with, of course you don’t want to stop it. Together, we need to slowly discover how you can feel safe and strong without that.” At that point, I felt we had made a small yet significant move towards understanding and exploring her unconscious motives and feelings. I also felt we had a long way to go.

My overall view of this patient at this point in the treatment was that while she was vaguely and broadly aware that over-eating was a psychological matter that probably related to environmental and emotional turmoil in her past, Stacy mainly viewed the over-eating as a quick and convenient way of eliminating boredom and loneliness. Stacy didn’t really want to know the extent or depth of those feelings she was trying to eliminate, she just wanted them gone. This was understandable given the overwhelming control they must have had and still had on her inner life.

In the above example, I had to repeatedly re-introduce the discarded link she had given me and when I did, she was able to take it in and re-own it, leading to a great deal of emotional discharge and self-examination. In other words, she related to me by a type of projective identification in which she gave me pieces of her inner world to hold.

However, when I tried to continue this method of offering back what she had given me, she was less able and less willing to take it on. In fact, this was how the rest of her treatment went. I tried to be careful of not going to fast or deep in my interpretative reintroduction of her projections, so as to not overwhelm her. But, even when I was slow going and carefully paced in my analytic approach, Stacy was reluctant to examine herself much more or reexamine the conflicts that she had been able and willing to share. Stacy was quite reluctant to follow up on our brief exploration of her inner life and understand the anxiety and pain she experienced that led to her chronic over-eating.

Generally, the treatment produced useful progress in the form illustrated earlier, in which she would project an aspect of her feelings and thoughts about her past or present life onto me while she focused on a seemingly unrelated feeling, thought, or situation. I would interpret the projective identification and often Stacy would experience intense affect and then share portions of her internal struggle with me. However, it was difficult for this patchwork cycle to shift to a more steady integration of her psychology, without so much continued reliance on splitting and projection.

Some readers might think it was foolish to approach this type of case from an analytic perspective, citing what I think would be the devaluation or prejudgement of Stacy by saying she was “not psychologically minded, too sick, or better served by suggestion and transference manipulation.” I think this is part of the useless debate that the field has created over the differences between psychotherapy and psychoanalysis and the inflexibility of psychoanalysts in the clinical setting (Waska, 2006a). In fact, Stacy’s lack of psychological maturity was more the result of her over reliance on splitting and projective identification. Suggestion and avoidance of the deeper issues would only reinforce these defences, which have driven her deeper into her destructive eating disorder. Therefore I treated her from an analytic standpoint and strove to help her make new internal links and work through unbearable conflicts that had haunted her since childhood. Sadly, because she could not afford to continue the treatment after her company-sponsored visits expired, our time was limited. This parameter and the degree to which she relied on projective identification to de-link her mind made the treatment slow going and ultimately unsuccessful. However, I do believe this brief encounter Stacy had with her self and her internal world gave her a glimpse of what was really possible for her and an opportunity she might one day revisit.

Case 2

Albert was in his mid-twenties when his father called me and asked to see me along with Albert. After Albert’s parents divorced when Albert was twelve, he lived with his mother until he was eighteen. He barely finished high school and then moved into his father’s where he worked at the family’s small market. Albert was still living with his father when I began seeing him. His father was angry and worried that Albert “didn’t take his job seriously, often stayed in bed, and never did his choirs.” Albert’s father was a traditional Indian man who tried hard to reason with his son and instil a sense of responsibility and caring. Clearly, he was frustrated that his son seemed completely uninterested in anything, let alone working responsibly at the market.

When Albert was six years old, he was diagnosed as Bipolar and given medications. He suffered continuous cycles of depression and manic episodes throughout his youth and was hospitalized several times. He had been in some form of psychotherapy since he was seven years old, either individually or with his family. His father had been the primary caretaker through most of these hard times and my impression was that he was both a loving and dedicated parent as well as a tired and resentful victim to Albert’s relentless moods and negativity. Indeed, fairly soon in the treatment, his father expressed his ongoing frustration and resentment at Albert’s complete disregard for others and for his own responsibilities. After meeting with Albert for several sessions, I was struck by how narcissistic he acted and that while he probably needed the medications he was on, no one in the last twenty years had addressed his narcissistic way of relating.

In the first six months of Albert’s analytic work, which I call analytic in the context of an ongoing pursuit of analytic contact (Waska, 2007), I began to notice a particular counter-transference reaction that mirrored Albert’s father’s frustration. There were countless moments in the sessions where either Albert’s father or Albert would convey some story about Albert’s behaviour that showed his complete disregard for anyone’s feelings other than his own. He wouldn’t get up in the morning unless his father dragged him out of bed. He cursed at his father for asking him to do choirs. He ignored the customers when working at the market. In his relationship to me, Albert told me he could care less about therapy and saw me as useless. He said he attended the sessions to “keep his father off his back.” He elaborated and told me, “the only motivation I have to do anything for anyone is to stop them from hassling me. Otherwise, there is no point in doing anything for anyone. I care about what I want and that is as far as I ever think.” This blatantly narcissistic stance provoked me to start acting like a frustrated parent for a period of time. I found myself lecturing him, getting stem, and ending the sessions feeling angry and moralistic.

So, up to that point in the treatment, I believe Albert related to me using projective identification as the primary transference stance. He did not want to look at himself or have to take accountability for his relationship to others. In this way, he felt free to constantly act out in whatever manner he chose. He succeeded in getting me to do the same. I no longer was examining my feeling or working to express them and learn from them. I had shifted to acting out and reacting to Albert’s behaviours. He did X and I reacted with a Y criticism. We were just going back and forth with each other that way. When I noticed this, I also noted that I was avoiding expressing my most obvious feeling, which was how Albert actually made me feel. Instead of stopping and discussing the way he related to me, the transference relationship, I had ignored that relationship in favour for acting out various conflicts about it.

Finally, at about the sixth month of meeting with Albert and his father, I was able to begin interpreting this projective identification-influenced counter-transference situation. Before I was about to do this, I noticed I was anxious and realized I was feeling like I was finally going to stand up to Albert and be honest with him, in a way that no one before. During one session, Albert was ignoring me completely and when he did speak, it was in a brief, condescending manner. His father desperately tried to use logic and common sense to break through this wall, to no avail. Just about when I would normally launch into a lecture about how he “should” do things differently, I stopped myself and interpreted my observation of the transference relationship. I said, “You Eire treating me rudely. You are being cold and mean in the way you are talking to me.” Albert’s father seemed both shocked and immediately in agreement. Albert looked surprised and taken off guard. He said, “What exactly do you mean?” I repeated myself, emphasizing that his attitude and way of speaking to me was clearly lacking in any respect or caring. He said, “Ok. I think I see that.” He said this in a thoughtful and genuine way, different from how he usually related. Over the next few weeks and months, Albert told me that “the being rude thing is not what I want to be doing. But, I never knew that I was doing that. No one ever told me. I thought it was about getting up in the morning or not working hard enough.”

So, what started to come out in these conversations was that Albert truly thought everyone around him was simply angry he wasn’t fulfilling various tasks. This was something he saw as a nuisance because there were tasks he wasn’t interested in and therefore he deliberately chose to not do them. He felt everyone’s anger was merely annoying. The idea that others felt personally effected by him and emotionally injured was new information.

This breakthrough was slow and choppy. It was common for Albert and his father to return in the following session and begin as they did in the very beginning of treatment. Albert would be quiet in a distant and aloof way while his father complained about the latest incident of irresponsibility or laziness. Albert would answer in one or two word sentences that sounded dismissive at best. I would ask Albert if he realized how he was interacting with his father. He would answer me with a one-word or two-word grunt. At that point, I was aware that I was about to resort to some sort of parental lecture as I had come to do. Now, instead, I told Albert that he was relating to me in the same way he was relating to his father, rude and dismissive. Then, he would seem to wake up and say, “I didn’t realize I was doing that. That is something I want to change.” I took these comments with a grain of salt, since his father was regularly threatening to throw him out of the house, which would essentially render Albert homeless. At this point, Albert’s mother did not want him around because of the same negative attitude and lack of respect his father complained of. So, I did wonder how much of Albert’s motivation came from not wanting to be thrown out. However, much of what he said seemed genuine, if only momentarily.

So, I was now working with this new clinical assumption that Albert was provoking me to be like a lecturing parent in order to avoid exploring this more core narcissistic stance he took with his objects. When I realized my counter-transference part of this projective identification system, I could begin to interpret these ideas and we began to explore his lack of attachment to me and others.

An example of this emerged when his father was talking about how Albert acted disrespectful and lazy around the market and how this made him feel that Albert was oblivious to all the love and hard work he did on Albert’s behalf. As it often did, their exchange went nowhere, with Albert presenting himself as aloof and distant. But, when his father repeatedly used the term “lack of respect,” Albert agreed to “start showing respect.” His father was relieved to hear this, but I felt suspicious. There was something artificial about Albert’s comments and tone. So, I asked him some questions and what came out was that Albert thought that respect meant doing the choirs his father wanted instead of ignoring them. I said that there was a difference between agreeing to do the choirs and emotionally respecting his father. I said that one involved doing something to get his father off his back and the other involved actually caring about the needs of the other person enough to want to do something for them. Albert immediately replied, “Oh! I didn’t realize you were talking about that. I am only motivated to do those things so he will stop being angry. I don’t really care about his needs, since they aren’t mine.” This was a stark moment in seeing how thick Albert’s internal walls were. There was no connection or attachment in that moment, only cold, stony reality. I said, “So, here is an example of you not feeling anything for others, not caring for us. This is the real core reason everyone is upset with you. You treat me this way in ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• INTRODUCTION
• SECTION I: ANALYTIC CONTACT
• SECTION II: KNOWLEDGE, REPETITION AND RESOLUTION
• SECTION III: TRANSFERENCE ↔ COUNTER-TRANSFERENCE STRUGGLES
• REFERENCES
• INDEX