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Biomedical subjects

Robert Waska

Publications and source records attributed to Robert Waska.

9 recordsLinked to original sources
PubMed2006

Addictions and the quest to control the object.

Most patients come into psychoanalytic treatment engaged in some form of repetitive, destructive behavior that is an externalization or projection of their internal struggles. One form of this object relational acting-out is the addictions, be they to alcohol, gambling, drugs, sex, procrastination, or other variations. The patient's experience is a "must do-can't stop" one that leaves them both desperate and relieved. Patients come to us wanting help in refraining from these addictive patterns. Sometimes, they are attending a 12-step program or are in a day treatment recovery program but need additional assistance in remaining free from their addictive behaviors. Others seek out psychoanalytic treatment while still involved in their addiction, but wish to stop the behavior and build a more positive plan for their lives. This paper examines the deeper object relational issues that lie behind the addictive process. The transference is often colored by acting-out, by sadomasochistic dynamics, by projective identification, and by fantasies of persecution and loss. Case material is used to explore these specific problems as well as the patient's general difficulties with paranoid-schizoid and depressive functioning.

Adult↗
PubMed2006

Psychoanalysis or psychoanalytic psychotherapy? Shifting the debate from theoretical to clinical with the concept of analytic contact.

There have been numerous books, papers, panels, and debates over the years regarding the differences and similarities between psychoanalysis and psychoanalytic psychotherapy. This article shifts the often circular and political argument from a theoretical tug-of-war to a clinical focus. The author provides clinical material to show that frequency, diagnosis, or use of couch are at best external enhancements to a process of analytic exploration. The case material illustrates the concept of analytic contact, in which the aim of treatment, regardless of setting, is to establish an ongoing investigation into the patient's defenses, phantasies, and internal conflicts that come out of the patient's object relational experiences. Analytic contact is evoked, established, maintained, and protected by the consistent interpretation of transference and extra-transference experiences that occur in the treatment relationship. External issues and life circumstances cannot be avoided and must be given equal focus, but always in the pursuit of understanding their associated underlying object relational phantasies. Clinical matters must take precedence over theoretical ideals in the struggle to establish analytic contact. The analyst consistently seeks, sometimes failing and sometimes succeeding, to understand how the patient either builds on genuine analytic contact or seeks to dismantle it.

Adult↗
PubMed2005

A case study of borderline anxiety and the process of analytic transformation.

Borderline patients present particular treatment problems and require close, devoted understanding of their often chaotic and shifting intrapsychic conflicts. Many of these patients act out, making it difficult to maintain an analytic process. In fact, many terminate early on. When they do stay for longer periods, they exhibit particular constellations of defense, anxiety, and conflict. One extensive case report is used to examine the overlapping cycles of treatment with this population. Frequently, self-destructive acting-out is present in the transference and extra-transference. This acting-out is often followed by the self-destructive, anti-change attitude of the death instinct. These ways of relating to the self and the object are mobilized within the vehicle of projective identification and are best understood as primitive defenses against core fantasies of loss and persecution. These issues of loss and fear are the final and vital phase of treatment with borderline patients, who are often able to make major fundamental changes in their internal sphere, but only if patient and analyst can tolerate and understand these three levels of intrapsychic experience.

Acting Out↗
PubMed2005

Symbolization and the good object.

Some patients struggle with the acceptance of, connection to, or identification with a good object who provides a containment-symbolization function. This is manifested as a standoff, a resistance, and a denial of the good object and, therefore, of the symbolization process that is part of healthy development. This is usually due to troubled family histories and a destructive projective identification process. The ego defensively blocks acknowledgment of any symbolizing capacity within the self and within the maternal object out of envy, fear of rejection, and dread of persecution. Destruction of symbolization and the experience of goodness within the self or in the object provides an artificial respite from the threat of annihilation, yet quickly brings on even greater levels of internal chaos and anxiety. Case material is used to illustrate these points.

Aggression↗
PubMed2004

Greed and the frightening rumble of psychic hunger.

Many patients are desperately struggling with feelings of envy and greed. For some, greed is experienced as a constant hunger, a feeling of being empty and alone. This type of patient can be aggressive or resentful in the way they feel and act. They are determined to take what they feel is rightly theirs. Other such patients are much more conflicted about their greedy phantasies and striving. This paper focuses on patients who are fearful and anxious about the greedy urges that shape their inner world. Case material is used for illustration.

Adult↗
PubMed2003

A mixed bag: the realities of psychoanalytic practice.

For a variety of reasons, psychoanalytic training is done in somewhat of a vacuum. It teaches a theory and a way of practicing that does not always translate well to day-to-day private practice work. The clinical realities of psychoanalytic practice prove the psychoanalytic method to be one that provides help to a wider audience than classical psychoanalytic training programs might suggest. The psychoanalytic approach offers the analyst many special opportunities to work with and help a wide variety of patients. Analysts who accept both the limitations as well as the wide application and broad benefits of the psychoanalytic approach may have a more fulfilling experience than their training experiences might foster. At the same time, the analyst's level of therapeutic skill, the patient's diagnosis, and many multiple external factors create different limitations in the practice and outcome of psychoanalytic work. Extensive case material is used to show the broad range of patients who are helped by the psychoanalytic method. The clinical material also shows the less than perfect, but often good enough outcomes of these difficult cases with often severely disturbed patients.

Adult↗
PubMed2003

Fragmented attachments: the paranoid-schizoid experience of loss and persecution.

The author discusses paranoid-schizoid patients who have yet to deal with whole-object depressive fears of harming one's object. Their paranoid-schizoid anxiety is more a combination of dread, paranoia, and fear of destroying one's object with neediness, envy, and other oral desires. In this part-self and part-object world, destruction is absolute. Ego functions and object relational capacities such as guilt and grief are not yet fully consolidated. The part-object is not only destroyed but is also equally capable of magically resurrecting itself to seek revenge. Fear of annihilation of the self and object, as well as desperate attempts at keeping each other alive, are the primary focus of this early anxiety state. These infantile fears are at the root of certain difficult treatment situations. Within the transition from paranoid-schizoid to depressive, the ego struggles with highly exaggerated and distorted fantasies of persecution, loss, and primitive guilt by resorting to crude and often self-destructive mechanisms. These include splitting, projective identification, and idealization. During the course of analytic treatment, three overlapping phases are distinguishable. Acting out is the main theme of early treatment. As this externalization of internal conflict is analyzed and contained, a second phase of intrapsychic struggle emerges. The patient exhibits a paralyzing battle between certain ego-object ties and the striving of a defensive death instinct. If the analytic relationship is able to withstand passage through these difficult phases, the patient begins to work through more core issues of persecutory loss and annihilation. Case material is used for illustration.

Adult↗
PubMed2002

Craving, longing, denial, and the dangers of change: clinical manifestations of greed.

Greed is the unrelenting and unrealistic search for all the good an object has to offer and, via identification, all the good one can produce and provide. In phantasy, and sometimes in the patient's early developmental environment, the object and the ego demand more from each other than either have to give. Some patients cannot contain their urge to possess all and to be all, so it becomes a part of the interpersonal and psychological relationship with the analyst rather quickly. These patients feel something is owed to them, and they demand to be fed immediately. Other patients try and hide these greedy phantasies by being the opposite of greedy. They strive to be independent and charitable, while having great conflict over deeper desires to be dependent and in possession of an idealized giving object, an all-providing breast. Case material was used to explore these ideas.

Adult↗