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Waska, R. (2007). WHEN PATIENTS FACE THE DUAL THREAT OF DEPRESSIVE AND PARANOID PHANTASIES. Psychoanal. Psychother., 21(4):315-329.

(2007). Psychoanalytic Psychotherapy, 21(4):315-329

WHEN PATIENTS FACE THE DUAL THREAT OF DEPRESSIVE AND PARANOID PHANTASIES

Robert Waska

A number of patients enter psychoanalytic treatment appearing to suffer from depressive anxieties in which they fear harming their objects, so they try to make amends and find a peaceful solution to perceived conflicts. However, over time these same patients reveal a deeper and darker form of internal chaos in which they are experiencing a combination of paranoid and depressive phantasies of an overwhelming nature. Primitive experiences of loss combine with persecutory feelings to bring about unbearable states of mind. Projective identification and splitting are used defensively but also increase this pathological internal situation. Attempts at reparation fail, leaving the ego to eternal loss and life without forgiveness. Dead and destroyed objects return for revenge, replacing hope with dread. These patients have an immature foothold in the depressive position while still struggling with paranoid conflicts. Rather than finding refuge in pathological organizations or regressing from one position to another, they face the constant threat of both paranoid and depressive experiences without any reliance on good internal objects to sooth, save, or guide them. Melanie Klein's theoretical discoveries in this area are discussed and clinical material is used for illustration.

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