Projective Identification in the Clinical setting (Book Review)

Author:  Waska, Robert 
Publisher: Brunner-Routledge
Reviewed By: Charles Most, Vol. XXVI, 4 (Fall 2006), pp. 56-58

In this exciting and well written book, Robert Waska takes the reader into the consultation room of the psychoanalytic framework of a Kleinian analyst. His stated purpose is to focus on what a Kleinian analyst actually says to the patient and how projective identification is utilized in understanding the communications and interpreting those understandings. This book serves to explain in detail what goes on within a Kleinian framework and helps to dispel so many of the misunderstandings and criticisms of Melanie Klein’s early writings, which have had 60 years of reformulations and additions by the numerous analysts who have followed in her tradition. As Roy Schafer’s The Contemporary Kleinians of London (1997) has brought the current narratives of British Kleinians into focus, so has this book brought an American Kleinian narrative into focus. The contemporary Kleinian approach, as I understand it, follows Freudian principles but with an emphasis on destructive aggressive (pregenital), defenses, certain types of anxieties, splitting, envy, loss, depression, states of mind (paranoid-schizoid, depressive), and of course, the function and use of projective identification.

Melanie Klein, a devoted Freudian, elaborated on the concepts of projection and identification and presented the term “projective identification” in 1946. Although a fair degree of controversy has been associated with this concept, it has been an invaluable clinical tool for the Kleinian tradition. Klein believed that during early life, the infant has the ability to develop a particular type of object relations, which she termed the paranoid-schizoid position. Certain anxieties and defenses, first experienced in early life are believed to have continued impact throughout life. Both good and bad parts of the self are believed to be projected into the mother and form the rudimentary development of object relations and integration of the ego. Traditionally, projective identification is believed to be part of normal, healthy development, as well as part of pathological development, and for contemporary Kleinians, a means of communication. According to Waska, projective identification is a form of adaptation, communication, defense, and creative expression with which the analyst and patient struggle to make meaning and sense out of. He believes that it is the most basic and unique form of human communication within interpersonal and intrapsychic forums. Unless it is understood and analyzed as a fundamental element in the relationship, an interminable state of enactment and confusion can take over and possibly prematurely end the analytic relationship.

Communication between Kleinian analyst and patient is developed within countertransference issues, the here and now situation, understanding the content of the anxiety, affects and phantasy, transformation of meaning, showing/explaining, and containment. As in all psychoanalytic work, the process starts with listening, observing and feeling, while attempting to make sense of what is being communicated and suggesting new meaning. The flow of communication, through projective identification, must be accepted, tolerated, and transformed into new meanings that the patients can utilize to better understand themselves. Transforming the patients’ communications and analyst’s countertransference into immediate and direct verbal communications is emphasized by contemporary Kleinians. Waska tells the reader not to idealize the transformative function but to understand that it is common for the analyst to first act out the projective identification, then understand it, and finally to interpret it to the patient.

Waska outlines the principles of interpreting the projective identifications of patients as he cites the many Kleinian analysts and their unique formulations within the tradition. Segal, Spillius, Hinshelwood, Kernberg, O’Shaughnessy, Joseph, Bion, Rosenfeld, Meltzer, and Steiner are cited with clear examples of their thinking in terms of what projective identification is and how they go about gradually explaining and showing through words, the nature and purpose of the patient’s communications through projective identification. Is the projective identification a communication of a state of mind that cannot be verbalized or is it an attack and means to control the analyst? What- ever the communication is, the object relationship that is alive at the moment would be the focus of the articulation. A multilayer narrative about the deepest aspects of the patient’s ego and its link to the object is sought to provide new meanings to the patient’s phastasies and thus mobilize structural change. Waska explains that the early Kleinian interpretations of body parts and body language have been moved away from, and contemporary Kleinians now place more focus on the here and now transferences and resistances. The understanding and working through of projective identifications within the subjective experiences of the paranoid-schizoid and depressive positions provide a bridge to sensitivity and compassion for both participants. The analyst’s task is to be a holding and transformative object as analyst and patient struggle to find the meaning of what is taking place within the consultation room. Examples of interpreting and working with projective identification are cited with specific examples of how these Kleinian analysts work with countertransference, precision of interpretations, the here and now, affect and phantasy, transformation of meaning, containment, silence, interpersonal aspects, modeling, voicing, body language, motivation and goals, extra-transference, loss and separation, timing, and the direction of anxieties and phastasies.

Following the elucidation of the past and current adherents to the Kleinian tradition, Waska takes us into his consultation room and provides detailed examples of his way of thinking, working within the Kleinian tradition and his approach to working with projective identifications. His honesty and self-disclosure point to the humanness of the analytic endeavor as he discusses his technical shifts away from standard or ideal procedures and his struggles to be true to the basic analytic approach of the analysis of the transference and projective identification dynamics, unconscious phastasies, and the principle conflicts regarding destructive and loving forces. While discussing difficult cases, he is honest to discuss his flexibility to keep patients in treatment long enough to begin addressing fragile psychic states. Examples are provided so that the reader can follow his thinking of taking projected and split off elements of paranoid-schizoid phastasies and translating them into more whole object, depressive elements with psychological meaning. His examples of gently interpreting the anxiety and phastasies in the current moment, in the current symbol, in the transference, and in the extra-transference situations provide the reader with an intimate glimpse into the analytic endeavor.

The humanness of the analyst is clarified as Waska takes us into the consultation room with a patient’s hostility, hate, tendency to act out, loss, fear, disappointment, and pathological greed. The hard work of creating a sense of trust and caring within the analytic relationship is explored with numerous case examples. The reality of projective identifications emerging in a piecemeal manner over many hours and the seduction to act out with the patient before realizing what might be happening is pointed out within case material. The discoveries of Klein and those who followed her tradition have provided a sense of confidence in treating patients, but obstacles to progress were recognized similar to those that Freud and the current day analyst confront. It is not easy for the patient to face his or her psychic reality and projective identifications, and resistance is omnipresent. As Waska indicates, if the analyst can understand and give meaning to the projected fragments of the self, an integration takes place and the patient feels less anxious as they feel more understood. The process requires the painful recognition of reality as projections are returned to the self and loss of the object must be faced and mourned. Waska provides the reader with a contemporary view into the Kleinian consulting room, which enriches the tradition, dispels some age old misperceptions and furthers the efforts of all of us to better serve our patients.

References

Klein, M. (1946). Notes on some schizoid mechanisms. The Writings of Melanie Klein, Volume 3. New York: Free Press.
Schafer, R. (1997). The contemporary Kleinians of London. International Universities Press.

Reviewer Note

Charles Most

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