Kleinian and contemporary Kleinian analysis

1. Introduction

Version followed: contemporary London Kleinian technique as it stands in Klein's technique papers (especially "The Origins of Transference", 1952), Hanna Segal (Introduction to the Work of Melanie Klein, 1964/1973; "The Curative Factors in Psycho-Analysis", 1962; "Notes on Symbol Formation", 1957), Betty Joseph's here-and-now and total-situation work (Psychic Equilibrium and Psychic Change, 1989, including "Transference: The Total Situation", 1985, and "The Patient Who Is Difficult to Reach", 1975), and John Steiner (Psychic Retreats, 1993, ch. on patient-centred and analyst-centred interpretations; Seeing and Being Seen, 2011). The Melanie Klein Trust's concept entries, reproduced from The New Dictionary of Kleinian Thought (Bott Spillius et al., 2011), are the institutional reference. Bion's containment and the Heimann/Money-Kyrle use of countertransference are included because the Trust treats them as part of the later Kleinian development [source: Melanie Klein Trust, Kleinian technique]. There is no treatment manual. This is a clinical tradition handed on through papers, supervision and workshops such as the Betty Joseph Workshop [source: BPAS, Betty Joseph]. Adapting it to once- to three-times-weekly psychotherapy is marked [synthesis] wherever it appears.

What it is. A psychoanalytic method. The analyst keeps a firm setting and interprets the patient's unconscious phantasies, anxieties and defences mainly as they are lived out in the relationship with the analyst, here and now. Interpretation is "the main tool of analytic therapy" [source: Melanie Klein Trust, Kleinian technique].

How change happens. Klein held that "fundamental changes ... come about through the consistent analysis of the transference" [source: Klein 1952, via IPA Encyclopedic Dictionary]. Interpreting persecutory and depressive anxieties at the point where they are active lowers the need for splitting and projective identification. Projected parts of the self come back. Good and bad experiences of self and others become integrated (movement from the paranoid-schizoid towards the depressive position). The patient becomes able to bear guilt and loss, mourn and make reparation [source: Melanie Klein Trust, Depressive position; Segal 1962]. In Joseph's version, change shows as small shifts in how the patient uses the analyst within the session. In Steiner's version, it shows as emergence from psychic retreats [source: BPAS, Joseph; BPAS, Steiner].

2. Framework

The sources set out no formal phases. Kleinian analysis is open-ended and process-driven. The stages below are a practical organiser [synthesis], built from the concepts the sources do describe.

Format [source: Melanie Klein Trust, Kleinian technique]

Classical: Freud-based setting with frequent sessions (in British practice usually 4–5 per week, 50 minutes), use of the couch and free association. The Trust stresses consistent setting, time boundaries and frequency. (The exact 4–5×/week, 50-minute norm comes from British Psychoanalytical Society training convention, not from the Trust page [uncertain].)
Psychoanalytic psychotherapy adaptation: 1–3 sessions per week, couch or chair [synthesis]. The less frequent the sessions, the more weekend and between-session breaks dominate the transference, so plan to interpret separations more often [synthesis].
Duration: open-ended, usually years. No session count exists in the sources.

Working stages [synthesis]

Assessment/consultation (1–3 meetings). Goals: get a sense of the main anxieties, defences and object relations. Offer one or two trial transference-related interpretations and watch how they are used. Agree the setting. Move on when the patient can use interpretation at least partly, and a frequency and fee are agreed and kept.
Establishing the analytic situation (first months). Goals: the setting holds. The transference is "gathered" (Meltzer's term) from dreams, reports, acting in and the way the patient treats the setting [source: IPA Encyclopedic Dictionary]. Negative transference is taken up early. Move on when the patient's characteristic way of using you (the total situation) can be recognised and talked about.
Working through paranoid-schizoid material (long middle phase). Goals: interpret splitting, projective identification, persecutory anxiety, envy and retreats over and over, as they recur in the transference. Movement shows as more stable contact, less acting out, and projected parts being owned.
Working through depressive anxieties. Goals: bear ambivalence, guilt, loss and separateness; tell real reparation from manic reparation; mourn. Expect regression to paranoid-schizoid functioning or to retreats when depressive pain peaks. Klein and Steiner treat the movement Ps↔D as ongoing, not linear [source: Melanie Klein Trust, Paranoid-schizoid position; Wikipedia, Steiner].
Termination. Goals: work through the ending as a loss, including the revival of earlier anxieties. Criteria [synthesis, based on Klein's depressive-position aims]: the patient can bear separations and mourn them, and holds a more integrated view of self and analyst. Keeping some contact with psychic reality without retreating is more realistic than a 'symptom-free' state.

Criteria for moving between stages, generally [synthesis]. Movement is read in the session, not by session count: (a) how interpretations are received (taken in, used, versus agreed with and emptied out); (b) the balance of persecutory versus depressive anxiety; (c) whether material about the analyst can be thought about rather than enacted.

3. Guiding principles

Consistency of the setting. Keep time, place, frequency and fee steady. Read every deviation as meaningful material [source: Melanie Klein Trust, Kleinian technique].
Receptive but discriminating attitude of mind. Listen openly, then choose what to interpret [source: Melanie Klein Trust, quoting Spillius et al. 2011].
Transference is a total situation. Treat all material (reports of everyday life, dreams, silences, behaviour) as potentially about the current relationship with you [source: Klein 1952; Joseph 1985, via IPA Encyclopedic Dictionary].
Anxiety is the starting point. Find out what the patient is most anxious about right now before choosing what to say [source: Melanie Klein Trust, Kleinian technique].
Interpret at the point of urgency. Address the most active anxiety, even if it is "deep". Taking up anxiety reduces it. (Klein's play-technique writings; exact phrasing not verified online [uncertain].)
Take up the negative transference. Hostility and distrust towards you must be interpreted, not avoided. Klein held that negative and positive transference occur together [source: Melanie Klein Trust; IPA Encyclopedic Dictionary].
Interpret in terms of unconscious phantasy and object relations. Say who is doing what to whom in phantasy, and why, rather than labelling 'defence vs. impulse' in the abstract [source: IPA Encyclopedic Dictionary on Klein; Melanie Klein Trust, Unconscious phantasy].
Here-and-now first, past as it lives in the present. Begin with what is being lived out in the room. Link to history only when it adds meaning (Joseph was cautious about reconstruction before transference analysis) [source: BPAS, Joseph].
You will be used. Expect to be recruited into the patient's defensive system. Watch for it rather than try to prevent it [source: Joseph 1989, via Hinshelwood].
Countertransference is information, checked. Use your feelings as data about projections, but check them against the patient's associations and contain rather than discharge them [source: Melanie Klein Trust; Heimann 1950/1960 via Hinshelwood].
Containment before insight when needed. Some patients must first feel understood before they can understand. Pitch the interpretation accordingly [source: Steiner 1993, via Paniago & Viana].
Watch how interpretations are used. The patient's next response tells you more than their agreement does [source: BPAS, Joseph; Hinshelwood].
Short, simple, live interpretations. Aim for "alive moments of emotional contact", not mechanical "you mean me" translations [source: Spillius 1988 via Hinshelwood; BPAS, Joseph].
Change disturbs. Expect insight to provoke a pull back to the old equilibrium, in both patient and analyst [source: BPAS, Joseph].
Neither push nor give up. With retreats, avoid both forcing and passive resignation [source: Steiner 1993, via Paniago & Viana].
Honesty over cleverness. Be truthful with yourself about your part in what happens [source: BPAS, Joseph Workshop].

4. Intervention inventory

Kleinian work has no exercises or homework. Every 'intervention' is a form of attention, of holding the setting, or of interpretation. All example wording is illustrative unless quoted and cited.

4.1 Establishing and holding the setting

Purpose / when: from the first contact onward. A fixed setting makes the transference visible and gives anxieties a stable container [source: Melanie Klein Trust, Kleinian technique].
Steps: (1) Agree fixed days and times, length, fee, holiday and cancellation policy before starting. (2) Start and end on time, every time. (3) Keep self-disclosure, reassurance, advice and extra-session contact to a minimum. (4) Treat lateness, missed sessions, payment and requests to change the frame as material to understand before you decide anything. (5) When you have to change something yourself (holidays), give plenty of notice and expect it to show up in the transference [synthesis for steps 3–5].
Language (illustrative): "We'll meet Monday, Tuesday and Thursday at 10, for fifty minutes. We'll keep to that, because it lets us see what happens to you in relation to it."
Watch for / working when: pressure to bend the frame often marks the point of urgency. It is working when frame breaches can be talked about rather than just acted on.

4.2 Receptive, evenly suspended listening

Purpose / when: throughout. Gathers the material from which the point of urgency and the transference will emerge [source: Melanie Klein Trust, citing Freud 1912 and Spillius et al. 2011].
Steps: (1) Invite the patient to say whatever comes to mind. Don't set an agenda. (2) Listen to sequence, imagery, shifts of topic, tone and silences, as well as content. (3) Register your own feelings and impulses without acting on them. (4) Ask yourself: what is happening between us now, and what is the anxiety? (5) Speak only once you have a hypothesis you can put simply.
Language (illustrative): "Just say whatever comes to mind, even if it seems irrelevant or unpleasant to say."
Watch for: filling silences with questions or reassurance, out of your own anxiety. It is working when you can tell which way the material is pointing.

4.3 Locating the point of urgency (the predominant anxiety)

Purpose / when: before each interpretation. Anxiety is "the starting point" for understanding phantasy [source: Melanie Klein Trust, Kleinian technique]. Interpreting where anxiety is most active is the classic Kleinian rule (point-of-urgency phrasing from Klein's child-analysis writings; not verified verbatim online [uncertain]).
Steps: (1) Identify the most emotionally charged element in the session, which may be off-hand or non-verbal. (2) Name the kind of anxiety: persecutory (for the self: being attacked, invaded, abandoned) or depressive (for the object: having damaged it, losing it). (3) Find what triggered it now (often something in the setting or something you said). (4) Interpret that anxiety first, before content further from it.
Language (illustrative): "When I said we would stop for Easter, you went quiet and started talking about the landlord who won't fix anything. I think the most pressing thing now is a fear that I'm leaving you with something broken."
Working when: anxiety visibly eases or the material deepens after the interpretation, rather than the patient going flat or changing the subject.

4.4 Here-and-now transference interpretation

Purpose / when: the central intervention. Klein: fundamental change comes through consistent analysis of the transference [source: Klein 1952 via IPA Encyclopedic Dictionary].
Steps: (1) Identify the relationship the patient is currently experiencing with you: who you are being taken for, and what the patient feels you are doing. (2) Name the feeling or phantasy and its reason. (3) Keep it short and in ordinary words. (4) Base it on something both of you can observe in the room [source: Steiner 1984 via IPA Encyclopedic Dictionary].
Language (illustrative): "You're telling me about a doctor who just wrote a prescription without listening. I think you're also afraid that's what I'm doing with you today."
Watch for: formulaic 'you mean me' translations, which produce dead moments [source: Hinshelwood on Joseph]. It is working when the patient brings new material, feels something, or disagrees in a live way, not when they just agree.

4.5 Interpreting the total situation (Joseph)

Purpose / when: when the content of what is said matters less than how the patient is using the session and you. Patients use transference "to support their defensive positions" [source: Joseph 1985 via IPA Encyclopedic Dictionary].
Steps: (1) Ask: what is the patient doing with me as well as telling me? (e.g. getting me to reassure, to be clever, to be the critical one, to feel useless). (2) Notice the pressure you feel ("nudging") [source: BPAS, Joseph]. (3) Describe what is being lived out between you, in the present tense, without reconstructing. (4) Track the patient's response moment by moment, and treat it as the next piece of the total situation.
Language (illustrative): "I notice that each time I say something you agree warmly, and then we move on as if nothing has happened. I think it may be safer to keep what I say pleasant and at a distance than to let it really affect you."
Working when: small shifts appear: a less defensive tone, a dropped repetition, a moment of real contact. Joseph looked for change at this micro level [source: BPAS, Joseph].

4.6 Taking up the negative transference

Purpose / when: whenever hostility, distrust, contempt or fear of you shows itself (directly or displaced onto others). Klein saw analysing it as a precondition for reaching deeper layers [source: IPA Encyclopedic Dictionary; Melanie Klein Trust, Kleinian technique].
Steps: (1) Spot displaced hostility (critical stories about other helpers, lateness, 'forgetting' sessions). (2) Interpret it in the transference without counter-attacking or placating. (3) Name the anxiety behind it (e.g. fear of dependence, fear of being controlled). (4) Recognise that positive feelings exist alongside it.
Language (illustrative): "You've been telling me how useless your manager is. I think part of you feels the same about me, and is worried that saying so would damage our work."
Working when: the hostility can be spoken directly and the session survives it. Afterwards, relief or more trust often follows.

4.7 Interpreting unconscious phantasy

Purpose / when: when symptoms, behaviour or imagery express an underlying object relationship. Phantasies underlie every mental process, and interpretation aims to make them conscious [source: Melanie Klein Trust, Unconscious phantasy].
Steps: (1) Translate the material into a relationship: subject, verb, object, motive. (2) Include the impulse and the defence against it. (3) Use the patient's own images and bodily language. (4) Phrase it so the patient can see how they experience a painful relationship and change it in phantasy to avoid pain (Segal's model) [source: IPA Encyclopedic Dictionary citing Segal 1979].
Language (illustrative): "When you felt full after the session you went and binged. It's as if what you got from me had to be swallowed up and got rid of before you could feel you needed it."
Watch for: jargon ("the bad breast"). It is working when the patient recognises the phantasy as theirs and gives associations that elaborate it.

4.8 Interpreting splitting and idealisation

Purpose / when: when people (including you) are all good or all bad, or when the good is kept far away from the bad. Splitting and idealisation characterise the paranoid-schizoid position [source: Melanie Klein Trust, Paranoid-schizoid position].
Steps: (1) Note the split (e.g. ideal analyst / hated partner; or the reverse). (2) Interpret what the split protects: usually the good object from the patient's hostility, or the self from persecution. (3) Bring the two sides closer gradually, without forcing integration. (4) Watch for the split moving onto someone else.
Language (illustrative): "I seem to be the only one who understands you, while your wife can do nothing right. I wonder if that lets you keep me safe from the disappointment you'd feel if I were ordinary too."
Working when: ambivalence can be tolerated ("you're helpful and you also annoy me"), often with sadness.

4.9 Interpreting projective identification and returning projections

Purpose / when: when parts of the self (feelings, capacities) are located in you or others, often with evocative behaviour that induces the matching feeling [source: Melanie Klein Trust, Projective identification].
Steps: (1) Notice what feeling is missing in the patient and present elsewhere (in you, in a partner). (2) Take in and think about it rather than enacting it. (3) Interpret first what the patient feels the other person is like, then (when it can be borne) the patient's own part in it. (4) Return the projected part in small doses. Recovery of projections involves mourning [source: Steiner via Mawson review, "projective identification in reverse"].
Language (illustrative): "Today you sound calm, and I'm the one who feels worried about your exam. I think the worry is very hard for you to keep inside, so it ends up with me."
Working when: the patient begins to own the feeling ("actually, I am frightened"), and is often sadder rather than more persecuted.

4.10 Using the countertransference

Purpose / when: continuously. Countertransference can be a "useful source of information about the patient" in certain circumstances [source: Melanie Klein Trust, Kleinian technique].
Steps: (1) Notice states such as irritation, boredom, hopelessness, cleverness or sleepiness. (2) Separate what comes from you from what may be induced, by checking against the patient's associations [source: Heimann via Hinshelwood]. (3) Sustain the feeling rather than discharge it. (4) If you have already reacted, consider what the patient experienced you doing, and interpret that (Money-Kyrle's point) [source: Hinshelwood on Money-Kyrle 1956]. (5) Don't disclose the feeling. Use it to shape the interpretation [synthesis, consistent with the tradition].
Language (illustrative): "I think a moment ago I was rather sharp with you. You seemed to take it as proof that I'm fed up with you, and you went quiet."
Watch for: treating every feeling as the patient's projection. It is working when the interpretation built from the feeling brings the patient's material alive.

4.11 Containment (Bion, as used by Kleinians)

Purpose / when: when the patient evacuates unbearable states and cannot yet think about them. Withstanding the pressure lets you shape an interpretation that helps the patient "feel understood and contained" [source: Steiner 1993 p.162, via Paniago & Viana].
Steps: (1) Let the state reach you without retaliating, collapsing or rushing to reassure. (2) Think about it silently: what is too much for the patient to feel? (3) Put the experience into words that describe it rather than accuse. (4) Accept that containment can bring relief without growth in very disturbed patients [source: Steiner via Paniago & Viana].
Language (illustrative): "It's as if what happened is too much to think about, and you need me to know how unbearable it is."
Working when: the patient calms enough to reflect, or brings material that is more organised.

4.12 Patient-centred vs analyst-centred interpretations (Steiner)

Purpose / when: with patients in a retreat or a persecuted state, who care more about what is in your mind than in theirs, who want to be understood rather than to understand, and who hear patient-centred interpretations ('you are doing X') as blame or being pushed away [source: Steiner 1993 via Paniago & Viana; Wikipedia, Steiner].
Steps: (1) Notice when 'you' interpretations increase persecution or withdrawal. (2) Switch focus to how the patient experiences you: what they think you are feeling, intending, or doing. Steiner described it as addressing what the patient believes the analyst believes [source: Wikipedia, Steiner]. (3) Don't confess or confirm. Describe the patient's picture of you. (4) Return to patient-centred interpretation once the patient can bear to look at their own part. Steiner calls the distinction schematic: a matter of the analyst's attitude more than wording, and not a formula [source: Steiner 1993 p.155 via Paniago & Viana].
Language (illustrative): analyst-centred: "You feel I've decided you're hopeless and I'm just going through the motions." Patient-centred alternative for later: "I think you're trying to make me give up on you, so you don't have to feel how much you need this."
Working when: the patient feels registered and contact increases. Overusing it can collude with avoiding the patient's own responsibility [synthesis from Steiner's caution].

4.13 Recognising and interpreting psychic retreats / pathological organisations

Purpose / when: when the patient seems to cooperate but nothing changes. Withdrawal into a state of minimal anxiety and minimal development. Pathological organisations are "highly resistant to change" [source: Melanie Klein Trust, Pathological organisations; Wikipedia, Steiner].
Steps: (1) Identify the retreat as it appears in the session (a superior, detached, cosy, perverse or 'knowing' state; images of houses, islands, gangs, cults). (2) Describe the retreat and what it protects against (persecutory and/or depressive anxiety). (3) Name the moments of contact and the withdrawal back into it [source: Paniago & Viana on Steiner]. (4) Watch for the analyst being drawn into supporting the organisation [source: Mawson review]. (5) Don't attack the retreat or yield to it. Recognise its power [source: Paniago & Viana on Steiner].
Language (illustrative): "For a moment you seemed upset about your sister. Then you slipped back into a kind of amused distance, as if from there nothing can really touch you, including what I say."
Working when: the patient notices the retreat themselves, emerges more often and stays out longer.

4.14 Supporting emergence: being seen, shame and humiliation (Steiner)

Purpose / when: as the patient comes out of a retreat. "Being seen seems to create an embarrassment which demands urgent relief" [source: Steiner, quoted on BPAS page].
Steps: (1) Expect that progress will feel humiliating, not just relieving. (2) Interpret the fear of being watched and judged by you, often in analyst-centred form. (3) Don't point out the progress triumphantly. (4) Interpret the pull back into the retreat as an escape from embarrassment. (5) Expect that loyalty to the retreat may continue even after progress [source: Paniago & Viana on Steiner].
Language (illustrative): "I think it felt exposing to let me see you upset. Now you're worried I'll be looking down at you for it."
Working when: shame can be talked about and doesn't trigger immediate withdrawal.

4.15 Turning a blind eye (Steiner)

Purpose / when: when the patient both knows and doesn't know a painful truth, a disavowal that sustains the retreat [source: Mawson review; BPAS, Steiner].
Steps: (1) Notice facts the patient mentions and then treats as unimportant. (2) Point to both sides, the knowing and the not-knowing, rather than confronting with 'the truth'. (3) Interpret the function: what would have to be felt if the truth were fully known. (4) Check whether you, too, are turning a blind eye [synthesis].
Language (illustrative): "You've told me twice that the bills are unpaid, and each time we went straight on to something else. As if it's known and not known at once."
Working when: the fact becomes fully known and the patient feels the corresponding anxiety, with your help.

4.16 Interpreting envy and attacks on the good object

Purpose / when: when what is good (including your help) is spoiled, belittled or rejected precisely because it is good. Envy attacks the good object and blurs good and bad [source: Melanie Klein Trust, Envy].
Steps: (1) Note the pattern: a good session is followed by devaluation, forgetting or worsening. (2) Interpret first the pain of needing and receiving, then the spoiling. (3) Expect strong guilt and persecution once it is named. Interpret those too. (4) Track the emergence of gratitude, which Klein saw as envy's antithesis [source: Melanie Klein Trust, Envy].
Language (illustrative): "Yesterday something seemed to get through. Today it's as if it never happened. I think it's painful that I can give you something you can't give yourself, so it has to be emptied out."
Watch for: delivering this as an accusation. Pace and tone matter [synthesis]. Working when the patient can acknowledge receiving something and value it.

4.17 Interpreting depressive anxieties: guilt, loss and reparation

Purpose / when: when the patient becomes concerned for the object, feels guilt, fears having damaged you or others, or grieves [source: Melanie Klein Trust, Depressive position; Reparation].
Steps: (1) Recognise depressive anxiety (concern for the other) as different from persecutory anxiety (concern for the self). (2) Name the guilt and the fear of damage without reassuring it away. (3) Help the patient tell real reparation (based on concern for the separate other) from omnipotent 'fixing' [source: Melanie Klein Trust, Reparation; the manic/real distinction is Klein's 1940 concept, not on the Trust page]. (4) Stay with the grief and don't hurry to resolve it.
Language (illustrative): "After being so angry with me on Monday, you seem worried I've been hurt and that you can't take it back."
Working when: guilt leads to concern and hope rather than despair. Guilt should be strong enough to motivate repair but not so overwhelming as to produce despair [source: Melanie Klein Trust, Reparation].

4.18 Interpreting manic and obsessional defences

Purpose / when: when depressive pain is avoided through triumph, contempt, control or denial of dependence. These defend against the depressive position [source: Melanie Klein Trust, Depressive position].
Steps: (1) Spot triumph, contempt or control, especially around breaks and good sessions. (2) Interpret the dependence or loss that is being denied. (3) Expect depressive pain to come next, and contain it.
Language (illustrative): "You said the break was a relief, you'd have more time. I think it's much easier to feel you don't need me than to miss me."
Working when: the patient can feel need and loss directly.

4.19 Interpreting breaks, separations and endings

Purpose / when: before and after weekends, holidays, cancellations and termination. These reliably stir persecutory and depressive anxieties [synthesis; standard Kleinian practice].
Steps: (1) Announce breaks well in advance. (2) Look for disguised references in the sessions around them (absences, abandonment stories, illness). (3) Interpret the patient's experience of your absence, including anger and how they manage it. (4) In the first session after a break, look for how they coped in your absence.
Language (illustrative): "You've told me the neighbours went away and left the dog alone. I think you're also telling me how you feel about my going away next week."
Working when: separations can be felt and named, with less acting out around them.

4.20 Linking present to past

Purpose / when: after the here-and-now has been established, to add depth and meaning. Klein did not favour purely here-and-now interpretation cut off from the past [source: IPA Encyclopedic Dictionary on Klein 1952]. Joseph, conversely, was cautious about reconstruction [source: BPAS, Joseph]. Version choice: this guide follows Joseph's ordering (present first) with Klein's link to the past used sparingly.
Steps: (1) Establish the transference experience first. (2) Make the link only when the patient's own material brings it up. (3) Present the past as a template still active, not as an explanation that closes the matter.
Language (illustrative): "This fear that I'll lose interest once you're not in a crisis sounds like what you described with your mother after your brother was born. It feels just as real with me now."
Watch for: intellectualised 'history lessons' that move away from the anxiety in the room.

4.21 Dreams and reported material read as transference

Purpose / when: whenever dreams or stories about others come up. In the total situation, all such material may reflect the current transference [source: Klein 1952; Joseph 1985 via IPA Encyclopedic Dictionary].
Steps: (1) Ask for associations. (2) Note when and how the dream is told (timing, the manner of telling, what the patient wants you to do with it). (3) Find the current anxiety it expresses and its transference reference. (4) Interpret the anxiety, not every symbol.
Language (illustrative): "You dreamt of a hotel where the staff were polite but no one knew your name. I wonder if that's how it felt coming back here after the break."
Working when: the dream opens up new material rather than being turned into a puzzle to solve.

4.22 Working with concrete thinking (symbolic equation, Segal)

Purpose / when: when the patient treats symbols as the thing itself, e.g. an interpretation is experienced as an actual attack or feeding. Segal: in the symbolic equation, the symbol is "equated with the thing symbolised" [source: Melanie Klein Trust, Symbol formation].
Steps (largely [synthesis]): (1) Notice when words have concrete effects (an interpretation is 'poison'). (2) Interpret the concrete experience of the interpretation itself before its content. (3) Use simple, descriptive language and fewer metaphors. (4) Track the gradual appearance of 'as if' thinking as a sign of depressive-position functioning.
Language (illustrative): "When I spoke just now, it felt as though I had actually pushed something nasty into you."
Working when: the patient can say "it felt like" rather than "it was".

4.23 Monitoring how each interpretation is received

Purpose / when: after every interpretation. The patient's response is the best guide to whether contact was made [source: BPAS, Joseph; Hinshelwood on Joseph].
Steps: (1) Watch the immediate reply: new material, live disagreement, emotion (contact) versus compliant agreement, intellectualising, sleepiness, changing the subject (no contact). (2) Treat the response as the next transference material and interpret that when useful. (3) Note whether your interpretation was heard as criticism, seduction or a gift.
Language (illustrative): "You agreed quickly, and then your voice went flat. I think what I said felt more like a judgement than something to think about."
Working when: the conversation becomes a sequence of live moments rather than a series of statements.

5. Handling problems

Stuck client / pseudo-cooperation ("difficult to reach"). The patient seems to work, but nothing changes. Joseph describes a split-off part that stands outside the analysis, together with destructiveness aimed at defeating it [source: Hinshelwood on Joseph 1975]. Response: stop interpreting content. Interpret the way the patient uses interpretations, e.g. agreeing and then emptying them out (4.5, 4.23). Look at how you are being recruited (bored, clever, hopeless) [source: Hinshelwood on Joseph]. Try to tell defence against unbearable pain apart from destructiveness for its own sake. Hinshelwood says this is "Not easy!", so take it up in supervision [source: Hinshelwood].
Resistance generally. Treat it as communication about anxiety and as part of the total situation, not as opposition to overcome [source: Paniago & Viana on Steiner; Melanie Klein Trust on defences]. Response: find the anxiety the resistance protects against and interpret it at the point of urgency (4.3).
Psychic retreat / pathological organisation. Response: 4.13–4.15. Avoid both pushing too hard (fails) and passivity (felt as giving up) [source: Paniago & Viana on Steiner]. Use analyst-centred interpretations while the patient is persecuted (4.12). Examine your countertransference, including after sessions [source: Paniago & Viana]. Expect long timeframes: these organisations are highly resistant to change [source: Melanie Klein Trust].
Negative therapeutic reaction (worsening after progress). Response: consider envy of the help (4.16), guilt about getting better, or humiliation of being seen to need help (4.14). Interpret the specific sequence (good session → attack/worsening). The Trust links pathological organisations to the negative therapeutic reaction and interminability [source: Melanie Klein Trust, Pathological organisations].
Overwhelm / persecutory flooding. Response: contain first (4.11). Use shorter, analyst-centred interpretations (4.12). Name the immediate anxiety only, and postpone 'deeper' links. [synthesis:] in less-than-analytic frequency, consider adding a session temporarily or sitting up rather than using the couch. Assess risk explicitly (suicidality, psychosis) and be prepared to step outside interpretation for safety measures. Kleinian sources do not offer a risk protocol, so follow your local clinical governance.
Non-attendance, lateness, frame attacks (the analytic equivalent of non-adherence). Response: treat as transference communication (4.1, 4.6). Interpret the meaning before negotiating. Keep the frame (e.g. charge for missed sessions if agreed) without retaliating [synthesis on fees/policy]. Repeated breaches may express a retreat or negative transference toward dependence.
Ruptures / the analyst's enactments. Joseph held that patients "nudge" analysts into enactments (collusive comfort or unnecessary harshness) and that analysts must scrutinise their own behaviour [source: BPAS, Joseph]. Response: recognise the enactment, then interpret what the patient experienced you as doing (4.10; Money-Kyrle's approach via Hinshelwood). Don't confess at length or apologise to relieve your own guilt [synthesis]. A brief factual acknowledgement of an error (e.g. lateness) followed by interpretation of its meaning is common practice but not specified in the sources [uncertain].
Collusion / the analyst drawn into the organisation. Comfortable sessions, mutual admiration or shared contempt for outsiders. Response: suspect it when sessions feel too easy. Interpret the pleasant arrangement itself. Use supervision or consultation [source: Mawson review on Steiner; BPAS, Joseph].
Interpretations heard as attacks or blame. Response: shift to analyst-centred interpretations (4.12). Check whether the patient is relating concretely (4.22). Look at your tone [synthesis].
Intellectualised analysis / 'Kleinian jargon'. Response: use plain, short sentences. Avoid technical language. Aim for alive contact over completeness [source: Hinshelwood on Spillius 1988; BPAS, Joseph].
Disturbance after real progress. Joseph: psychic change "always causes disturbance" and pulls back toward the old equilibrium [source: BPAS, Joseph]. Response: expect it, interpret the pull back, and don't treat regression as failure.
Despair in the depressive position. Guilt can become overwhelming. Response: interpret both the concern and the persecutory guilt. Support the patient's hope in reparation without reassuring them [source: Melanie Klein Trust, Reparation; synthesis on how].
Lower-frequency practice / psychotherapy settings. The sources assume high frequency. [synthesis:] in weekly work, interpret breaks more, keep interpretations more anchored to observable events, use containment more, and be more cautious with deep phantasy interpretations early on.
Termination problems (premature flight, interminability). Response: interpret flight as escape from depressive pain or dependence (4.18, 4.19). For interminability, consider a pathological organisation (4.13) [source: Melanie Klein Trust]. Set a date well ahead and work through the ending as mourning [synthesis].

Sources

Sources

Books and papers cited

Klein, M. (1952). The origins of transference. IJP 33:433–438. Klein, M. (1955). The psycho-analytic play technique. Klein, M. (1940). Mourning and its relation to manic-depressive states.
Segal, H. (1964/1973). Introduction to the Work of Melanie Klein. Segal, H. (1957). Notes on symbol formation. IJP 38. Segal, H. (1962). The curative factors in psycho-analysis. IJP 43.
Joseph, B. (1989). Psychic Equilibrium and Psychic Change (eds. Feldman & Spillius), incl. "The patient who is difficult to reach" (1975) and "Transference: the total situation" (1985).
Steiner, J. (1993). Psychic Retreats. Steiner, J. (2011). Seeing and Being Seen. Steiner, J. (1984). Some reflections on the analysis of transference: a Kleinian view.
Bott Spillius, E., Milton, J., Garvey, P., Couve, C. & Steiner, D. (2011). The New Dictionary of Kleinian Thought.
Spillius, E. B. (ed.) (1988). Melanie Klein Today, vols 1–2.
Heimann, P. (1950). On counter-transference. Money-Kyrle, R. (1956). Normal counter-transference and some of its deviations.

Not verified from primary text [uncertain]: Klein's exact "point of urgency" wording; Steiner's exact wording for analyst-centred interpretations (taken from secondary summaries); standard session frequency in British training.

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