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Robert Waska is a prolific writer, publishing at least one paper or book every year. Klein in the Trenches contains some previously published material but is mostly original work. The book has three sections, and their status seems unclear. The first three chapters describe analytic work with borderline and/or narcissistic patients. The next four chapters describe the life story of a severely disturbed man who many times was at the brink of suicide, complete breakdown, or massive drug overdose, yet he managed to fashion a productive life from the wreckage. This man had various forms of help along the way and his analytic experience helped him to construct a coherent narrative out of disparate bits. The third section concentrates on technical questions in working with severely disturbed and disturbing patients. It is this third section that lends the book its value.
Stylistically Waska is at his best when he writes about his patients. His theoretical introductions are often filled with Kleinian jargon; for example, concepts such as the death instinct are used uncritically without an attempt at definition. Waska also uses many ideas from other Kleinian authors (e.g., the concepts of psychic retreats, thin- vs. thick-skinned narcissism) without explaining them in depth or integrating them into a coherent theory. One gets the sense that theories are added horizontally rather than integrated vertically. On the other hand, as a clinician, Waska manages to show us his patients in their many facets. Here one feels in the presence of depth psychology.
Waska's practice resembles that of many analysts working in private practice. Many of his patients are quite disturbed and are not ideally suited for psychoanalysis. Waska also offers psychoanalytic couple therapy and judging from this book, many of the couples are equally disturbed and disturbing. His patients seek urgent symptom relief and most are not interested in psychoanalytic treatment specifically. In many case vignettes,