Post-Kleinian work

1. Introduction

Version followed: Donald Meltzer's model as set out in The Psycho-Analytical Process (1967; Harris Meltzer Trust reissue 2018), which describes the "natural history" of the analytic process in five phases; extended by Explorations in Autism (1975, with Bremner, Hoxter, Weddell, Wittenberg), Sexual States of Mind (1973), Dream Life (1983/84), Studies in Extended Metapsychology (1986), The Apprehension of Beauty (1988, with Meg Harris Williams; aesthetic conflict) and The Claustrum (1992). Technique is taken mainly from Meltzer's 1987 Oslo talk "On Interpretation" and other material published by the Harris Meltzer Trust (harris-meltzer-trust.org.uk), the body that holds and publishes Meltzer's and Martha Harris's work. The full text of the 1967 book and Dream Life is not drawn on; phase content beyond chapter titles and summaries is from secondary summaries and is tagged where it matters. [source: Karnac/HMT tables of contents; Harris Williams, An introduction to the work of Donald Meltzer]

What it is. Post-Kleinian work in Meltzer's line is an intensive psychoanalytic method that treats the analysis as an observable process with its own developmental logic, rather than a sequence of correct interpretations. The analyst observes the transference-countertransference as an unfolding event ("a moving picture, a film"), describes it, and lets meaning emerge. [source: Meltzer, On Interpretation 1987]

How change happens. Infantile parts of the personality, confused with and lodged in internal objects through projective identification, are gathered into the transference, sorted out (where they are, which body zone or function they are confused with), and brought to the threshold of depressive concern for good internal objects; the patient then introjects the analytic function and is weaned. Growth occurs through symbol formation, principally in dream life, and through tolerating the aesthetic conflict (love of the object's beauty versus pain at its unknowable interior). The aim is development, not symptom cure. [source: Meltzer 1967 TOC and Nemas review summary on firingthemind.com; Harris Williams, Post-Kleinian model; Meltzer, On Interpretation]

2. Framework

Format. Individual analysis on the couch (adults) or in a playroom (children), fixed times, consistent room. Meltzer defined analysis by observation of the transference-countertransference rather than frequency, but considered fewer than three sessions a week problematic for adults. [source: Meltzer, On Interpretation] The 1967 model was derived from 5x weekly child analysis. [source: firingthemind.com description of 1967 book] Total length: multi-year; no session count is specified in the sources. [uncertain] Use at once- or twice-weekly frequency is a dilution the sources do not cover; expect the phases to be less distinct. [synthesis]

Session and break cycles. Part II of the 1967 book has a chapter on "the cycle of the process in the individual sessions": each session, week (weekend break) and term (holiday break) recapitulates the larger sequence in miniature. [source: 1967 TOC; content of the chapter: uncertain, reconstructed from secondary knowledge]

Phases (natural history of the process) [source: Meltzer 1967, Part I chapter titles; Nemas review summary; Harris Williams intro]. Phases overlap and recur; they are a map, not a protocol.

Gathering of the transference. Goal: establish the setting so that the patient's scattered anxieties and projections collect in the relationship with the analyst; separate the pre-formed transference (preconceptions the patient brings) from the true, present-tense transference. Analyst functions largely as a receptacle for evacuated distress (the "toilet-breast"). Move on when: the analyst is consistently the focus of infantile feeling; acting out outside sessions diminishes; breaks provoke observable reactions in the material. [move criteria: synthesis]
Sorting of geographical confusions. Goal: help the patient see where parts of the self are in phantasy (outside world, inside external objects, inside self, inside internal objects, or the delusional "nowhere"), especially massive projective identification at separations and the pseudo-maturity it produces. Move on when: the patient can recognise the analyst's separateness and bear breaks with less confusion of identity. [source: Meltzer, Mrs Klein's spatial-theological revolution; move criteria: synthesis]
Sorting of zonal confusions. Goal: disentangle confusions between body zones, orifices and their products (e.g. mouth/anus/genital; feeding versus evacuating; infantile versus adult sexuality) so that the feeding function of the object can be distinguished and valued. Move on when: the toilet and feeding functions are distinguished in the material; perverse or polymorphous excitements are recognised as infantile. [source: 1967 TOC; detail uncertain, from secondary knowledge of the book and Sexual States of Mind]
Threshold of the depressive position. Goal: work through concern for, dependence on and envy/jealousy of good internal objects (the internal parents); the patient's adult part takes on self-observation. Move on when: the patient shows sustained concern, gratitude and self-analytic capacity, with Ps↔D oscillation rather than retreat. [source: Nemas summary; Harris Williams, Post-Kleinian model; criteria: synthesis]
Weaning. Goal: ending as a developmental achievement; mourning the external analyst while relying on internal objects; the process comes to be felt as aesthetic. Signs: dreams of children gathering to go home; awareness of others' needs (a "new baby"). [source: Harris Williams intro; Meltzer, spatial-theological; Harris Williams, Rescuing the lost children] How the date is set and how long the weaning period lasts: not specified in the sources. [uncertain]

Later additions to the map (not phases, but lenses applied throughout): two-dimensional/adhesive functioning and dismantling (autism work); claustrum life (intrusive identification into the head-breast, genital or rectal compartments of the internal mother); aesthetic conflict as the developmental core. [source: Meltzer, Autism lecture; The Claustrum and projective identification; Rhode, Afterword]

3. Guiding principles

Follow, don't lead. "Not to lead the patient, but to follow them." Practical meaning: track where the material is going; do not steer to your agenda. [source: On Interpretation]
Without memory and desire. Practical: don't reread notes or set session goals before seeing the patient; wait for associations to arise in you. [source: On Interpretation, drawing on Bion]
The process is the object. Practical: commit to the process, not to any single interpretation; trust its natural history. [source: Rhode quoting Harris Williams; Meltzer 1967]
Observation and description before explanation. Practical: say what is happening; let "because" drop out. [source: On Interpretation; Signs, symbols and allegory]
Tentativeness. Practical: most interpretations carry "a big question mark at the end"; convey your certainty level by tone. [source: On Interpretation]
Tact over timing. Practical: say what you think now, friendly and non-punitive, rather than waiting for a perfect moment (timing can mask timidity). [source: On Interpretation]
Congruence and cover. Practical: test your intuitive fantasy against the material; speak only if it fits and covers the data. [source: On Interpretation]
Countertransference is data. Practical: monitor your own emotional responses as a second data stream alongside observation of the patient. [source: On Interpretation; spatial-theological]
The personality is a family. Practical: address infantile parts and the adult part differently; ally with the adult part. [source: On Interpretation; Counterdreamers intro]
Dreams are primary material. Practical: treat dreams as the guarantee of an authentic transference and the road map to the unconscious process. [source: Harris Williams intro; On Interpretation]
Development, not cure. Practical: judge each move by whether it is developmental or regressive, not whether symptoms lift. [source: On Interpretation; Harris Williams, Post-Kleinian model]
Histories are stories of the inner world. Practical: don't reconstruct the past as fact; treat childhood narratives as current internal-world descriptions. [source: On Interpretation]
Negative capability. Practical: tolerate turbulence and not-knowing until a pattern emerges. [source: Harris Williams, Post-Kleinian model]
Mystery, not secrecy. Practical: respect the object's (and patient's) unknowable interior; distinguish curiosity-as-exploration from intrusion-as-control, in yourself too. [source: Rhode, Afterword]
Containment extends beyond the hour. Practical: expect to stay preoccupied between sessions; this is part of the work. [source: On Interpretation]
No diagnostic selection. Practical: take patients on an experimental basis; diagnosis predicts little. [source: On Interpretation]
No physical contact (except, in Meltzer's view, possibly with very autistic children). [source: On Interpretation]
Your style is your own. Practical: Meltzer explicitly did not recommend imitating his style. [source: On Interpretation]

4. Complete intervention inventory

Note: Meltzer did not write a step-by-step manual. The "steps" below turn his descriptions into operational form; the steps themselves are [synthesis] unless tagged otherwise. All example wording is illustrative, not Meltzer's.

4.1 Establishing and holding the setting (gathering the transference)

Purpose / when: From the first session onward, and after any disruption. A stable setting lets scattered infantile anxieties collect in the relationship with the analyst. [source: Meltzer 1967, ch. 1 title; Martha Harris's "privileged sequestration"]
Steps: (1) Agree fixed times, frequency (ideally 3 or more a week for adults), fees and the break calendar up front. (2) Keep the room, start and end times and your demeanour constant. (3) Announce breaks well in advance and note them in the material. (4) Treat changes the patient makes (lateness, missed sessions, requests to change times) as material first, logistics second. (5) Write notes right after the session, not before the next one. [steps 1–4: synthesis; step 5: source On Interpretation]
Example language (illustrative): "We'll meet Monday, Tuesday and Thursday at these times. I'll tell you about my breaks well ahead." / "You've been late twice since I mentioned the Easter break; I wonder if that's connected."
Watch for / working: The analyst increasingly appears in the patient's dreams and associations; reactions to weekends become visible; acting out outside sessions lessens. [synthesis]

4.2 Dissolving the pre-formed transference

Purpose / when: Early phase, whenever the patient relates to a preconceived "analyst" (a theory, a former therapist, a cultural idea) instead of the person in the room. The aim is to let these preconceptions "evaporate" so a true transference can form. [source: Harris Williams intro; Wikipedia on Meltzer 1967]
Steps: (1) Notice set-piece expectations: compliance, performance of "being a good patient", theorising about oneself. (2) Describe the expectation as it shows up now, without arguing with it. (3) Contrast it with what is actually happening between you. (4) Repeat as new versions appear; don't expect one interpretation to clear it.
Example language (illustrative): "You seem to be talking to someone who already knows what's wrong with you. I'm not sure that's me yet."
Watch for / working: Talk becomes less rehearsed; fresh emotional reactions to you specifically; dreams begin to arrive. [synthesis]

4.3 Receptive observation (countertransference dreaming)

Purpose / when: Every session; the base state from which all interventions come. Meltzer describes a resting yet highly vigilant state, like "waiting in the dark for the deer", watching for movements that form incipient meaning. [source: Harris Williams intro; Counterdreamers intro]
Steps: (1) Don't plan the session or reread notes beforehand. (2) Let the patient's material evoke your own images, phrases and fantasies. (3) Track two data streams: what the patient does and says, and your own emotional responses. (4) Hold the images loosely until one keeps recurring or fits the material. (5) Test it for "congruence and cover" (4.5) before speaking. [steps 1, 3, 5: source On Interpretation; 2, 4: Counterdreamers intro, operationalised]
Example language: Mostly silent. (Illustrative internal note: "I keep picturing a child pressed against a shop window.")
Watch for / working: Your images become specific to this patient rather than generic. Drowsiness, boredom or a pull towards theory may signal anti-emotional pressure or your own retreat. [synthesis]

4.4 Exploration

Purpose / when: Meltzer's first category of analytic activity, and he says most of what analysts say. Use it to help the patient observe more closely and to fill out the material. [source: On Interpretation]
Steps: (1) Ask for detail on what is vivid or odd (an image, a word, a bodily feeling). (2) Ask about the dream's setting, colours and atmosphere rather than its "meaning". (3) Point out what the patient skipped. (4) Stop once the material starts moving on its own.
Example language (illustrative): "What was the light like in that room?" / "You said 'of course' just then. Of course what?"
Watch for / working: Material becomes richer and more specific. If questions start to feel like interrogation, move to description. [synthesis]

4.5 Interpretive comments, formulation and transference interpretation (graded interpretation)

Purpose / when: Meltzer's categories 2–4: comments that enrich the material and stimulate more of it; formulating interpretations that organise material into a picture; definitive transference interpretations. Move up the scale as the evidence accumulates, within a session or across many. [source: On Interpretation]
Steps: (1) Offer small enriching comments that link two elements. (2) When a pattern holds across the material ("congruence and cover"), state the picture descriptively. (3) When the picture clearly lives in the relationship with you, state it in the here and now. (4) Pitch tone to your certainty: most interpretations carry a question mark. (5) Say it now, kindly, rather than holding it back on grounds of timing. (6) Judge the interpretation by what follows, not by agreement. [source: On Interpretation]
Example language (illustrative): Comment: "The locked bicycle and the locked filing cabinet, both today." Formulation: "There seems to be something precious you keep locked away so it can't be taken." Transference: "And I think I'm the one it's locked away from, especially just before a weekend."
Watch for / working: New material such as a dream, a memory or a shift of affect follows. Instant agreement or argument both suggest the interpretation landed on the pre-formed or compliant part. Meltzer says value is known only from consequences. [source: On Interpretation; reading of responses: synthesis]

4.6 Descriptive running commentary

Purpose / when: The default interpretive mode: describe the event unfolding in the room, like a commentator with editorial judgement, rather than explain causes. [source: On Interpretation; Signs, symbols and allegory]
Steps: (1) Describe the sequence of the session: what happened, then what happened next. (2) Leave out "because". (3) Add a value judgement on whether a move looks developmental or regressive. (4) Aim for a description you and the patient can agree on, and let the meaning become clear to both over time.
Example language (illustrative): "As soon as you said you'd felt close to me on Thursday, the conversation moved to your car insurance."
Watch for / working: The patient begins to observe their own moves. Watch for explanatory drift in yourself: if you use causal language, you are probably theorising. [synthesis]

4.7 Addressing different parts of the personality

Purpose / when: The personality is like a family or nursery. Speak in a simple register to infantile parts and adult-to-adult to the adult part, which is your working ally. [source: On Interpretation; Counterdreamers intro; Harris Williams, Rescuing the lost children]
Steps: (1) Identify which part is speaking (helpless baby, scornful adolescent, pseudo-adult, observing adult). (2) Choose language for that part. (3) Enlist the adult part to observe the others. (4) Name gang-like collusions between parts (seduction, threat, betrayal). [steps 1, 2: source; 4: spatial-theological]
Example language (illustrative): To the infantile part: "It's so hard when I go and you're left with nobody." To the adult part: "I think you can see how a little part of you takes over at these moments."
Watch for / working: The patient begins to recognise their own "children". A simple register can feel patronising to a pseudo-mature patient, so check the response. [synthesis]

4.8 Dream exploration

Purpose / when: Throughout the analysis. Dreams are the guarantee of an authentic transference and a road map to the unconscious process. Meltzer required patients to bring dreams. [source: Harris Williams intro; On Interpretation]
Steps: (1) Tell the patient early on that dreams are welcome and important. (2) Prioritise recent dreams; old ones rarely connect to the current session. (3) Ask for the dream again in the patient's words, then explore its visual detail, atmosphere and sequence (4.4). (4) Look for multiple levels (geographical, bodily, historical, relational) rather than a single neat moral, which would be allegory. (5) Connect it to the transference of the current session and week. (6) Track dream continuity across sessions. (7) Use the dream's own images as shared vocabulary. [steps 1, 2: source On Interpretation; 4: Signs, symbols and allegory; 6: Dream Life ch. 11 title; 3, 5, 7: synthesis]
Example language (illustrative): "Tell me the dream again. What did the house look like from outside?" / "The 'glass house' again, like last week, but this time you're outside it."
Watch for / working: A shift from "long anecdotal dreams" to short, condensed, symbolic ones marks progress. Meltzer notes that patients stop dreaming when the analyst is clumsy with dreams. [source: Signs, symbols and allegory; On Interpretation]

4.9 Counter-dreaming the patient's dream

Purpose / when: When a dream is brought, let your own imaginative response "counter" it to find a matching symbolisation. This is the analyst's dream-like contribution to meaning. [source: Counterdreamers intro, quoting Meltzer 2005]
Steps: (1) Listen to the dream as images, not text. (2) Notice the image, scene or line it evokes in you. (3) Look for a "match, congruence or counterpoint" between your imagery and the patient's. (4) Put the result into descriptive language rather than explanation; it is acceptable that its meaning becomes clear later. (5) Continue the work after the session, in notes or supervision.
Example language (illustrative): "Listening, I had a picture of a lighthouse keeper who never leaves the lamp room, watching but never going down to the boats."
Watch for / working: The patient picks up and elaborates your image, and a private shared language develops. If your image is generic or literary rather than specific, set it aside. [synthesis]

4.10 Tracking the geography of phantasy

Purpose / when: Mainly in phase 2, then throughout. Locate where a part of the self is in phantasy: the outside world, inside an external object, the internal world, inside an internal object, or the delusional "nowhere". Track its movement and how it is enacted in the transference. [source: spatial-theological]
Steps: (1) Note spatial imagery in dreams and speech (inside/outside, rooms, vehicles, bodies). (2) Ask where the patient feels they are. (3) Link moves of location to events in the analysis, especially separations. (4) Interpret pseudo-maturity as being located inside an adult object. (5) Note what is "teetering" at the edge of delusion; that part may still be won back. [steps 1, 3, 5: source; 2, 4: synthesis, consistent with Meltzer 1967 and The Claustrum]
Example language (illustrative): "In the dream you're driving my car. Since Friday you've been talking as if you were the analyst and I were the patient."
Watch for / working: The patient distinguishes self from object and tolerates being outside. A floating, rather than falling, quality of anxiety suggests delusional-system involvement. [source: spatial-theological]

4.11 Sorting zonal confusions

Purpose / when: Phase 3 work: disentangle confusions between body zones and their functions (mouth and anus, feeding and evacuating, nipple and penis, infantile and adult sexuality) as they appear in the transference and dreams. [source: 1967 ch. 3 title; Sexual States of Mind; detail: uncertain, not verified in the primary text]
Steps: (1) Notice when receiving from the analyst is treated as being soiled, or giving material as excreting. (2) Describe the confusion concretely using the patient's imagery. (3) Distinguish infantile polymorphous excitement from adult sexuality, without moralising. (4) Track the gradual emergence of a valued feeding function. [synthesis]
Example language (illustrative): "When I offer you something, it seems to arrive as if I'd dumped something on you."
Watch for / working: Confusional or perverse excitement lessens; gratitude for what is received appears. [synthesis]

4.12 Receiving and interpreting toilet-breast use

Purpose / when: Especially early on, and whenever the patient evacuates distress into you. The analyst functions as a part-object that receives unwanted evacuations, a cleansing as well as a feeding object. Mental waste-disposal is part of mental digestion. [source: Harris Williams intro; Slater 2016 citing Meltzer 1967 p. 23]
Steps: (1) Allow evacuation; don't immediately hand it back. (2) Register what has been put into you. (3) Later, describe the use made of you. (4) Track whether the patient can begin to value you as a feeding object as well as a receptacle.
Example language (illustrative): "You came in full of everything that went wrong this week, and now that it's with me you feel lighter and want to leave early."
Watch for / working: Evacuation should lessen over time. [source: Slater 2016] If it doesn't, consider idealisation of the toilet function or a split between a "toilet" analyst and a "feeding" figure elsewhere. [synthesis]

4.13 Working with breaks (session, weekend and holiday cycles)

Purpose / when: At every separation. The 1967 book treats the cycle within individual sessions as part of the process; separations trigger projective identification and confusions of identity. [source: 1967 ch. 7 title; mechanism: synthesis consistent with phases 1–2]
Steps: (1) Note material on the last session before a break and the first one after it. (2) Look for pseudo-independence, criticism of the analyst, or identification with the analyst over the break. (3) Interpret the reaction in the transference. (4) Prepare long breaks in advance.
Example language (illustrative): "Over the weekend you seem to have become your own analyst, and I'm returning to find I'm not needed."
Watch for / working: Reactions to breaks become more reflective, and the patient can miss you. [synthesis]

4.14 Recovering from projective identification (countertransference management)

Purpose / when: When the patient's projected state dominates you (as happens with insults, provocation, deadness or seduction). Receive it, recover from it, then use it. [source: spatial-theological]
Steps: (1) Notice that you've been pulled into a role, for example irritated, defensive or placating. (2) Recover internally before speaking; Meltzer concedes that recovery is often late and some enactment is almost inevitable. (3) Distinguish perceptual projection, which you can check against reality, from projective identification, which works through your feelings. (4) Interpret the state from outside it. (5) If you enacted, acknowledge it plainly and examine it.
Example language (illustrative): "I notice I answered you sharply just now; I think I was pulled into being the critical one, and you were left as the one criticised."
Watch for / working: You regain your own mind within the session; the patient's projection becomes thinkable. [synthesis]

4.15 Claustrum work

Purpose / when: When material shows a part of the self living inside the internal mother through intrusive identification. Each compartment has its own signs. Head-breast: pseudo-maturity, omniscience, elitism, joylessness. Genital: excitement, sexual elitism. Rectal: tyranny, sadomasochism, hierarchy, "rubbish tip" imagery. [source: The Claustrum and projective identification; Harris Williams intro]
Steps: (1) Identify the compartment from dream imagery (for example, a breast that turns into buttocks, cramped spaces, prisons, elite institutions), demeanour and the atmosphere of the session. (2) Describe the life lived there and its costs. (3) Expect claustrophobic and identificatory material to alternate. (4) When the patient emerges, expect depressive pain and a rush back inside; stay with the pain rather than reassure it away. (5) Help the patient engage the aesthetic conflict (4.16), which the sources describe as the way out. [steps 1, 3, 4, 5: source; 2: synthesis]
Example language (illustrative): "It sounds as if you have a seat in the boardroom inside my head, where nobody can teach you anything." / "Outside, things feel painful and ordinary, and the old place calls you back."
Watch for / working: Behaviour that looks meaningful but is empty of meaning gives way to genuine curiosity. The head-breast stance is also a particular risk for the analyst. [source: The Claustrum; Harris Williams intro]

4.16 Working with the aesthetic conflict

Purpose / when: When the patient recoils from what moves them (beauty, intimacy, the analyst's mind) or turns mystery into secrecy and intrusion. The conflict is love of the object's beauty versus pain and distrust about its unknowable interior. [source: Rhode, Afterword; Harris Williams intro; Meltzer, aesthetic conflict talk (audio)]
Steps: (1) Notice moments of being moved, followed by deadening, contempt or intrusive "knowing about". (2) Describe the oscillation between awe and the urge to control. (3) Distinguish knowing from knowing about, and explaining from explaining away. (4) Respect the mystery of the other's interior rather than satisfy the demand to know. (5) Hold in mind, for yourself, that the process may be beautiful.
Example language (illustrative): "For a moment you were touched by what I said, then it became something to pick apart."
Watch for / working: The patient can bear not knowing the object's inside and shows gratitude. Anti-emotional retreat may appear as psychosomatic symptoms. [source: Rhode]

4.17 Two-dimensional and adhesive functioning

Purpose / when: With autistic and mindless states, imitation instead of meaning, or sticking to surfaces (adhesive identification), dismantling of the senses, or obsessional "attacks on meaning". [source: Meltzer, Autism lecture; Explorations in Autism]
Steps: (1) Recognise dismantling: attention scattered across separate senses, and absence of an inner space. (2) Lift the issue out of the concrete and into mental states, especially yours and the patient's. (3) Challenge substitutes for the analyst systematically and patiently. (4) Hold the positive and negative transference together at an infantile level. (5) Look for points of contact where three-dimensional relating briefly appears. Meltzer saw dimensionality shift even within one session. [steps 2–4: source, from a clinical example in the lecture by a colleague's therapy; 1, 5: source]
Example language (illustrative): "We're arguing about whether this pen still counts, and meanwhile the question of whether I'm worth your attention disappears."
Watch for / working: The patient begins to imagine an inside to you, and time becomes linear rather than circular. [source: Autism lecture]

4.18 Listening for signs versus symbols (sincerity)

Purpose / when: Throughout, to distinguish conventional, borrowed language from words the patient means, and allegory from living symbol. [source: Signs, symbols and allegory]
Steps: (1) Notice jargon, clichés and received phrases. (2) Contrast them with moments the patient speaks autonomously. (3) Name the difference gently. (4) Track the growth of the patient's own vocabulary.
Example language (illustrative): "'Abandonment issues' sounds like a borrowed phrase. What was it like on Saturday?"
Watch for / working: More language that belongs to the patient; less "if only" and "what if", and more present experience. [source: Signs, symbols and allegory]

4.19 Weaning work (termination)

Purpose / when: In the final phase, mourn the external analyst while the internal objects take over the analytic function. [source: Meltzer 1967 ch. 5 title; spatial-theological]
Steps: (1) Recognise signs of readiness: self-analytic capacity, concern for others' needs, dreams of children gathering to go home. (2) Discuss and set an ending date well in advance. (3) Work through the grief, the fear of collapse and the triumph. (4) Note the shift to experiencing the process as aesthetic. (5) Support the patient's self-analytic method. [steps 1, 4: source; 2, 3: synthesis; 5: Dream Life ch. 14 title]
Example language (illustrative): "Your dream of the children packing their bags seems to say some part of you feels ready, and some part is frightened to go."
Watch for / working: Ending brings mourning rather than manic flight or collapse. [synthesis]

4.20 Post-session notes, self-analysis and supervision

Purpose / when: After every session, to continue counter-dreaming outside the hour and sustain containment. [source: On Interpretation; Counterdreamers intro]
Steps: (1) Write process notes right after the session. (2) Note your own dreams and images about the patient. (3) In supervision, stay with the clinical material rather than theoretical digressions; the group functions as a "thinking object". (4) Watch for "wisdom of the stairs", interpretations that only come to you later, and use them to build in-session capacity. [source: On Interpretation; Harris Williams intro; Counterdreamers intro]
Example language: Not applicable.
Watch for / working: Over time your in-session responses come faster and more specific. [source: On Interpretation]

5. Handling problems

Patient brings no dreams. Meltzer required dreams and would end the work if a patient refused to bring them. [source: Harris Williams intro] Practical response: (1) Say early on that dreams matter. (2) Check your own handling, since Meltzer notes patients stop dreaming when the analyst is clumsy with dreams. [source: On Interpretation] (3) Treat dream fragments, daydreams and the session's imagery as dream-equivalents. (4) Interpret the withholding in the transference. [3–4: synthesis] Ending the work over this is Meltzer's personal practice; most practitioners will not adopt it. [synthesis]
Stuck or compliant process (pseudo-analysis). Signs: agreeable sessions, borrowed language, nothing new. Responses: describe the compliance as an event in the room (4.6); look for a head-breast claustrum stance or a pre-formed transference (4.15, 4.2); distinguish signs from symbols (4.18). Check yourself for routine, theory-driven interpretations; return to not planning and to receptive observation (4.3). [source: Harris Williams intro on head-breast danger to analysts; Signs, symbols and allegory; steps: synthesis]
Resistance as negativism or attacks on meaning. Obsessional debates and "mind dervishing": lift the issue out of the concrete and into what is happening to your mind and time; challenge substitutes for the relationship systematically. [source: Autism lecture clinical example] Anti-emotional retreat from being moved: name the oscillation (4.16). [source: Rhode]
Overwhelm or flooding. Receive the evacuation (4.12) without immediately handing it back. Use a simple register for the infantile part and enlist the adult part (4.7). Slow down, describe, and avoid deep transference interpretations until the patient can take them in. [synthesis] On emerging from the claustrum, expect depressive pain and a rush back: stay with it rather than reassure. [source: The Claustrum]
Non-adherence to the setting (missed sessions, lateness, wanting to cut frequency). First treat it as material, especially around breaks (4.13). Keep the setting stable and do not renegotiate in the heat of the moment. If frequency must drop below three times weekly, say plainly that the process will be different. [source: On Interpretation on frequency; rest: synthesis]
Ruptures and analyst enactment. Expect some enactment, since Meltzer concedes it is almost inevitable. [source: spatial-theological] Recover, acknowledge plainly, and examine the enactment as joint material (4.14). Avoid an "Olympian voice", which invites idealisation and submission, and the opposite, over-parental gratification, which fosters dependence. [source: On Interpretation] Repair by tone: friendly and non-punitive. [source: On Interpretation]
Idealisation or erotisation of the analyst. Locate it geographically or zonally: is the patient inside you (geographical confusion) or treating you as a sexual object (genital claustrum, zonal confusion)? Describe without either gratifying or rebuffing it. [synthesis from 4.10, 4.11, 4.15]
Tyrannical or sadomasochistic transference (rectal claustrum, gang-like internal organisation). Name the hierarchy and the submission; don't comply with or fight the tyranny; address the internal gang's seduction of dependent parts (4.7). [source: The Claustrum; spatial-theological; steps: synthesis]
Psychotic or delusional parts. Work first with parts not caught in the delusional system. Try to win back parts still "teetering" at its edge; Meltzer doubts that parts already settled there can return. [source: spatial-theological] Fit with the patient's psychiatric care and risk management is not addressed in the sources; arrange it separately. [synthesis]
Analyst-side problems. Head-breast omniscience ("I already know this patient"): treat each session as new. [source: Harris Williams intro] Theory as refuge from memory and desire: return to observation. [source: Harris Williams, Rescuing the lost children] Strain from between-session preoccupation: Meltzer acknowledges this strain on analysts and their families. [source: On Interpretation] Use supervision and your own analysis. [synthesis] "Wisdom of the stairs": use post-session notes and build your in-session imaginative contact over time (4.20). [source: On Interpretation]
Termination problems (manic flight or clinging). Read readiness from dreams and self-analytic capacity rather than symptoms (4.19). Interpret flight as triumph over dependence, and clinging as a geographical confusion that keeps the patient "inside" the analysis. [synthesis]
Lower-frequency or brief settings. Meltzer's model assumes intensive analysis. At once- or twice-weekly frequency, expect a weaker gathering of the transference, use the phases as a lens rather than a sequence, and give dreams and breaks more weight. [synthesis; not addressed in sources] [uncertain]
Risk and safety (self-harm, suicidality). The sources do not address this. Apply standard clinical risk protocols alongside the analytic stance. [synthesis]

Sources

Sources:

Books cited (full text not drawn on): Meltzer, The Psycho-Analytical Process (1967; HMT 2018); Meltzer, Sexual States of Mind (1973); Meltzer, Bremner, Hoxter, Weddell & Wittenberg, Explorations in Autism (1975); Meltzer, Dream Life (1983/84; HMT 2018); Meltzer, Studies in Extended Metapsychology (1986); Meltzer & Harris Williams, The Apprehension of Beauty (1988); Meltzer, The Claustrum (1992); Meltzer, Sincerity and Other Works (1994).

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