Biomedical subjects

R T Waska

Publications and source records attributed to R T Waska.

11 recordsLinked to original sources

PubMed2001

Schizoid anxiety: a reappraisal of the manic defense and the depressive position.

The author views the manic defense as a combined attempt to control persecutory objects and to save them from the aggressive forces within the ego. Rather than strictly a manifestation of depressive guilt, it is also a defense against the fear of destroying the object and subsequently the self. Therefore, Melanie Klein's depressive position is a hierarchical outgrowth of more primitive schizoid anxieties about killing off the ideal part object. This is contrasted with the depressive guilt of harming the whole and reliable object. The depressive position is a psychic state of worry about loss of the object's love resulting from temporary harm done to the object that can be fixed. The paranoid-schizoid position is a much more hopeless internal situation involving a complete loss of the object and, by extension, the self. A case study is used for illustration.

Adult↗

PubMed2000

Paranoid-schizoid anxiety, triangulation, and oedipal trauma.

The interaction of strong aggressive and libidinal drives, various primitive intrapsychic fantasies linking somatic sensations, body parts, ego, object, and the effects of early environmental stress and trauma all produce a potential crisis in the paranoid-schizoid period of development. Certain innate methods of understanding somatic experiences as well as the interaction between internal and external reality lead to an unconscious triangulation of part objects. A frustrating, stimulating, or punitive "third" that blocks, nullifies, or overgratifies certain wishes then emerges as a pivotal object in the internal landscape. During the paranoid-schizoid, triadic process, there is a fluctuation between separation/individuation and de-differentiation/fusion. If the early triangulation process has been either exceedingly frustrating or overly stimulating in regards to "reaching the third" or "warding off the third," the infantile ego is fixed by aggressive and libidinal forces to de-differentiation experiences rather than to more separate and individuated ways of relating. Therefore, the later oedipal stage will be colored by excessive oral and anal conflicts and will be weighted on the side of primitive maneuvering based on splitting, projection, and introjection. When the child (and later the adult) becomes involved in oedipal situations marked by stimulation or frustration of triadic drives, there can be a regression to the earlier paranoid-schizoid triadic period. A case study was presented in which a patient struggled with a partial working through of these conditions in dreams and in the transference. This pulled her more in the direction of a differentiated Oedipal conflict and whole object functioning.

Adult↗

PubMed2000

Intrapsychic momentum and the psychoanalytic process.

A clinically orientated definition of psychoanalysis is proposed and distinctions are made between interactive counseling, psychoanalytic psychotherapy, and psychoanalysis. Elements of the treatment, such as frequency, diagnosis, and use of the couch are found to be helpful tools rather than defining requirements.

Adult↗

PubMed2000

Hate, projective identification, and the Psychotherapist's struggle.

The relationship between projective identification and aggression is explored through case material in which the psychotherapist felt strongly influenced by the patient's projections. Through a variety of interpersonal and intrapsychic dynamics, the patient evoked an unconscious and conscious sense of hate in the psychotherapist that emerged in a countertransference dream.

Aggression↗

PubMed1999

Bargains, treaties, and delusions.

Using a case example, I have explored a particular type of difficult patient. This individual has typically suffered poor attachment with his maternal object and through projective identification has developed highly conflicted object ties within the ego. These relations produce cycles of intense persecutory and depressive anxieties, forcing the subject to rely on excessive splitting and other primitive defenses. As part of these protective maneuvers, the ego begins to build internal bargains and treaties with the adversarial objects. These repetitious intrapsychic negotiations lead to delusional thought systems that bring on the very anxiety the ego tried to avoid, creating vicious feedback loops with more severe delusional systems and more rigid bargains to strike. For the price of survival, and the maintenance of an intact object, the ego builds and maintains certain relational configurations. These are attempted solutions for fantasies about destructive forces threatening the ego or the object. Self and object protection are the goals. If these intrapsychic bargains break down, fantasies about self and object destruction, loss, or annihilation enter the forefront. Infusing the concept of compromise formation with the ideas of object relations theory allows a better understanding of this highly defended anxiety state.

Acting Out↗

PubMed1999

Projective identification, countertransference, and the struggle for understanding over acting out.

Projective identification is examined as an intrapsychic and interpersonal phenomenon that draws the analyst into various forms of acting out. The therapist struggles to use understanding and interpretation as the method of working through the mutual desire to act out the patient's core fantasies and feelings. Clinical material is used to illustrate the ways in which projective identification affects the analytic relationship. The focus is on methods of using interpretation to shift from mutual acting out to mutual understanding.

Acting Out↗

PubMed1999

Projective identification, self-disclosure, and the patient's view of the object: the need for flexibility.

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful. (The Journal of Psychotherapy Practice and Research 1999; 8:225-233)

Adult↗

PubMed1998

Self-mutilation, substance abuse, and the psychoanalytic approach: four cases.

While self-injury and substance abuse are difficult symptoms for both analyst and patient to cope with, and relapses are frequent, the emphasis does not have to be on managing crisis. The initial ego support and therapeutic boundary setting in these difficult cases must be matched by psychoanalytic exploration. In working with these patients, I find that, through mutual projective identification processes, the analyst and the patient are frequently resurrecting certain aspects of the patient's archaic phantasy life as defined by various self and object representations. Therefore, the continuous analysis of the transference and the countertransference is certainly essential. However, the additional willingness on the part of the analyst and the patient to explore the frequent and mutual interpersonal/intrapsychic acting out is paramount.

Adult↗

PubMed1998

Intrapsychic outcome in projective identification.

Four possible outcomes of projective identification (Klein, 1946) are identified. First is a parallel sending, receiving, and giving back between both parties. Second, there is an inability to access the receiver, leading to annihilation anxieties. Third is an experience of the receiver not being able to process the message, leading to the sender's fantasy of hurting or destroying the object. Finally, there is the experience of the object becoming outraged at being asked to receive a message and subsequently attacking the sender. These are all fantasy states that come about in the context of the most basic of human communications, the process of projective identification. Projective identification is a fantasy-dominated experience and a dialectical process within both interpersonal and intrapsychic forums. These four potential states are separated for theoretical purposes but are always cross-influencing and creating each other in the unconscious. The situations described between mother and infant are paralleled in the analytic situation, the difference being the chronological and developmental passage of time and the evolution of the original fantasy material.

Adult↗

PubMed1997

Precursors to masochistic and dependent character development.

Due to the extreme states of masochism, dependency, and narcissistic rage that these patients experience, the treatment must be attuned to the inevitable periods of regression and primitive defense. The patient feels compelled to be a servant to the object, yet is furious at this less than equal status. The alternating states of idealizing the object in a masochistic fashion, the anger at the lack of self importance, and the desperate hope for soothing from that object create an externally focused character structure, which generally leads to a pattern of acting out, the lack of internal linking processes, and a scarcity of interpersonal skills that foster mutuality. A fundamental lack of self soothing leads to a perpetual search and craving for the soothing talents of the object. It is often unconsciously believed that compliance and servitude will bring about this gift of soothing from the object. Hans Loewald (1962) had described internalization as a process whereby the child reaches out to take back from the environment what has been removed from him in an ever-increasing manner since his birth. For the forgotten hero, this theory is definitely true. Not only is the treatment of this type of patient one of gradual internalization of new internal object relationships and the working through of the older more pathological ones, but it is a true understanding between patient and analyst of the original nontolerable removal of the uniqueness of the self via reality and/or fantasy states. When this situation is focused upon and worked with, the taking back from the environment can occur in a spirit devoid of former states of envy, hate, resentment, and wild craving that were formally protected and disguised in a facade of dependent masochism. The patient has essentially experienced or perceived his parents, usually the mother, as not providing a soothing function or a proper fit for his developing ego. The patient has then gone about constructing various methods to compensate for this lack. The analyst is often experienced as not providing an adequate soothing function, but this emptiness is warded off from conscious expression with a compromise formation of dependent, masochistic, or narcissistic methods of relating. This style of compromise hides any envy, hunger, or rage and keeps alive the hopes of being rewarded with soothing. The patients expects to be used as a waste disposal unit and believes that this dumping by the object into him is the longed-for love. Ideally, interpretations focus upon the hunger for the soothing function of the object and the drive to obtain it at any cost. The patient will fiercely resist because he believes that in giving up his masochism and dependency, he would expose his envy and narcissistic injury. This patient believes he would then lose any hope of ever receiving the soothing function due to the fantasized destruction of the source of that soothing, his beloved object.

Adult↗

PubMed1997

Projective identification: some clinical considerations.

The projective identification situation is the essence of much of the analytic relationship and can either create a fluid unfolding between patient and analyst leading to structural change, or can lead to the limitation and subsequent eradication of the analytic relationship. Projective identification encompasses and defines the entire transference state and is often the chief resistance. Therefore, unless projective identification is understood and analyzed as a fundamental element in the relationship, an interminable state of enactment and confusion can take over and at times terminate the analytic journey. By the mutual exploration of projective identification situations, the relationship can be freed from potential limitations and constrictions and the analysis can naturally proceed.

Adult↗