Academic journal article American Journal of Psychotherapy

Modern Kleinian Couples Therapy with Emphasis on Psychic Retreats and Pathological Organizations

Academic journal article American Journal of Psychotherapy

Modern Kleinian Couples Therapy with Emphasis on Psychic Retreats and Pathological Organizations

Article excerpt

This paper introduces the Modern Kleinian Therapy approach, examines a case of couples' treatment, and defines the important clinical elements encountered in analytic work with disturbed and disorganized couples. The concepts of pathological organization, psychic retreat, the death instinct, and projective identification are discussed in reference to the treatment of couples.

Modern Kleinian Therapy is a theoretical and clinical approach that utilizes the main elements of Kleinian technique for patients often with more severe psychological disturbance in reduced frequency treatment and in the context of either individual or couples settings. Couples in which one or both partners may be neurotic, borderline, narcissistic, and even psychotic are common in our private practice settings. As a result, therapists are used to being the referee, peacekeeper, policeman, savior, negotiator, translator, decoy, diplomat, provocateur, container, and healer depending on what type of transference profile is bestowed upon the analyst by either each individual and/or by the couple.

However, these transference modes can be difficult to handle because of the rigid projective identification mechanisms found in the pathological organization couples often use to maintain their unique level of psychic equilibrium. Using case material, the author shows how to work with hard-to-reach couples by means of an analytic exploration of the couple's pathological organization, the associated dynamics of the death instinct, and the last resort defense of the psychic retreat.

KEYWORDS: couples therapy; modern Kleinian therapy; pathological organization; psychic retreat; projective identification


This paper offers a theoretical and technical view of how to understand, contain, and transform a couple's chaotic and destructive ways of relating and non-relating by tending to each party's individual phantasies and internal conflicts while also helping to work through the vicious cycle both parties often become enmeshed in as a mutual method of repeating archaic wishes and fears. This mutual system of destructive, repetitive, and static projective identification is often crystalized into a highly resistive and resilient pathological organization (Rosenfeld, 1987; Shafer, 1994; Steiner, 1990).

When this dysfunctional unconscious bargain breaks down, one or both parties in a couple often withdraw into individual psychic retreats (Shafer, 1997; Steiner, 1993), which leaves each of them embedded in highly resistant emotional impasses. As a result, one party or both may need more individual focus before treatment can resume on the couple as a relational unit. Modern Kleinian Therapy is considered to be a helpful method with such hard to reach couples and an approach to gradually working through the intrapsychic and interpersonal elements involved.


Modern Kleinian Therapy (Waska, 2011a; 2011b; 2012a; 2013) is a contemporary hybrid of classical Kleinian psychoanalytic technique and a clinical approach for working with more disturbed or complicated patients in either individual or couples treatment. Modern Kleinian Therapy uses a psychoanalytic focus to understand and work with both internal resis- tances and external roadblocks to psychological integration.

In clinical situations we see many individuals and couples who tend to subsume whatever therapists do or say into their pathological organization (Spillius 1988) with its familiar cast of internal characters. Modern Klein- ian Therapy focuses on the interpretation of this particular transference process by investigating the unconscious phantasy conflicts at play and by highlighting the more direct moment-to-moment transference mobilized by projective identification dynamics (Hinshelwood, 2004; Joseph, 1988, 1989; Segal, 1997). Bion's (1962) ideas regarding the interpersonal aspects of projective identification, the idea of projective identification as the foundation of most transference states (Waska, 2004, 2010a, 2010b, 2010c), and the concept of projective identification as the first line of defense against psychic loss (Waska, 2002; 2010d) difference or separation, all form the theoretical base of this clinical approach. …

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