Psychic Retreats: Pathological Organizations in Psychotic, Neurotic, and Borderline Patients

Psychic Retreats: Pathological Organizations in Psychotic, Neurotic, and Borderline Patients

Psychic Retreats: Pathological Organizations in Psychotic, Neurotic, and Borderline Patients

Psychic Retreats: Pathological Organizations in Psychotic, Neurotic, and Borderline Patients


Essentially clinical in its approach, Psychic Retreats discusses the problem of patients who are 'stuck' and with whom it is difficult to make meaningful contact. John Steiner, an experienced psychoanalyst, uses new developments in Kleinian theory to explain how this happens. He examines the way object relationships and defences can be organized into complex structures which lead to a personality and an analysis becoming rigid and stuck, with little opportunity for development or change. These systems of defences are pathological organisations of the personality: John Steiner describes them as 'psychic retreats', into which the patient can withdraw to avoid contact both with the analyst and with reality.To provide a background to these original and controversial concepts, the author builds on more established ideas such as Klein's distinction between the paranoid-schizoid and depressive positions, and briefly reviews previous work on pathological organizations of the personality. He illustrates his discussion with detailed clinical material, with examples of the way psychic retreats operate to provide a respite from both paranoid-schizoid and depressive anxieties. He looks at the way such organizations function as a defence against unbearable guilt and describes the mechanism by which fragmentation of the personality can be reversed so the lost parts of the self can be regained and reintegrated in to the personality.Psychic Retreats is written with the practising psychoanalysts and psychoanalytic psychotherapists in mind. The emphasis is therefore clinical throughout the book, which concludes with a chapter on the technical problems which arise in the treatment of such severely ill patients.


Roy Schafer

One can only admire the fine empathy, subtle understanding, impressive patience and refreshing candour that run through these pages. Beyond admiration, however, any careful reading of John Steiner’s work should add significantly to the clinical resourcefulness of analyst and psychotherapist alike. of particular value is Steiner’s interpretive approach to the inevitably painful and disheartening stretches in therapeutic work with deeply disturbed patients—just the kind of work that, throughout our careers, we mental health professionals must confront time and time again.

Steiner convincingly portrays a subgroup of these difficult-to-treat patients as unable to tolerate the pain of either the paranoid-schizoid position or the depressive position. Consequently, they take refuge from the world of real relationships; they establish for themselves psychic retreats within which they feel protected even though often still in pain. in a perverse way, they even seem to be able to find narcissistic and masochistic gratifications in these retreats. This they do by erecting pathological organizations of defences and fantasized object relations, using for their building materials a goodly amount of projective identification, idealization, serious compromise of their sense of reality and, for the sake of a sense of safety, abject submission to the very organization that they have contrived in the internal world. Understandably, then, they experience the therapist’s interventions as both threatening their safety and limiting their gratifications, and so they set themselves against the very person to whom they have turned for help.

In large part these patients have retreated from the painful difficulties that lie in the way of their mourning the loss that must be experienced when they separate from their primitively conceived internal objects. Steiner has much to teach about the experiences of devastation that often accompany mourning the ‘loss’ of objects from whom, psychically, one is separating. Equally instructive in his delineation of the . . .

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