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

Abstract

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.