Moments of Uncertainty in Therapeutic Practice

One of therapy's greatest challenges is the moment of transference, when a patient unconsciously transfers emotion or desire to a new and present object—in some cases the therapist. During the course of treatment, a patient's projections and the analyst's struggle to divert them can stress, distort, or contaminate the therapeutic relationship. It may lead to various forms of enactment, in which the therapist unconsciously colludes with the client in interpretation and treatment, or it can lead to projective identification, in which the client imposes negative feelings and behaviors onto the therapist, further interfering with analysis and intervention.

Drawing on decades of clinical case experience, Robert Waska leads practitioners through the steps of phantasy and transference mechanisms and their ability to increase, oppose, embrace, or neutralize analytic contact. Operating from a psychoanalytic perspective, he explains how to cope professionally with moments of transference and maintain an objective interpretive stance within the ongoing matrix of projective identification, countertransference, and enactment. Each chapter discusses a wide spectrum of cases and clinical situations, describing in detail the processes that invite a playing out of the patient's phantasies and the work required to reestablish balance. Refreshingly candid, Waska recognizes the imperfections of analysis yet reaffirms its potential for greater psychological integration and stability for the patient. He acknowledges the limits and frequent roadblocks of working with difficult patients, such as those who suffer from psychic retreat, paranoid phantasies, and depressive anxieties, yet he indicates an effective path for resetting the clinical moment and redirecting the course for treatment.

Robert Waska conducts a full-time private psychoanalytic practice for individuals and couples in San Francisco and Marin County, California. In addition, he has taught classes and supervised therapists in the Bay Area and has presented papers in the United States and internationally. Dr. Waska is the author of ten textbooks on psychoanalytic theory and technique and is a contributing author for two psychology texts. He has also published more than ninety articles in professional journals and serves on the review committee for several journal and book publishers. Dr. Waska's work focuses on contemporary psychoanalytic topics, including projective identification, loss, borderline and psychotic states, the practical realities of psychoanalytic practice in the modern world, and the establishment of analytic contact with difficult and hard-to-reach patients. He emphasizes the moment-to-moment understanding of transference and phantasy as the vehicle for gradual integration and mastery of unconscious conflict between the self and the other.

Nancy Vanderheide, Psy.D., president of the Institute of Contemporary Psychoanalysis:
Robert Waska augments plentiful clinical material by detailing his process as he considers potential interventions. In a move that is all too rare among psychoanalytic writers, he includes even his interpretive failures, supplementing them with retrospective commentary that both elucidates and provides alternative formulations. Even seasoned clinicians will benefit from a volume that merits a place high on student reading lists.