Book Review: Further Learning from the Patient: The Analytic Space and Process

Patrick Casement has become a notable figure in the world of psychoanalytic psychotherapy. His first book On Learning From The Patient is a best seller. His most recent publication seems to be headed for a similar literary position.

Both have been described as potential classics in their field. Casement was trained as, and is a member of the British Analytical Society.

The major theme of his latest text is Casement's concern regarding psychoanalytic theory and technique, which he considers to be rooted in dogma. In the beginning of the book Casement describes his personal journey from dogmatic certainty to his present open minded position. Chapter 1 is devoted to Casement's concern regarding the "stereotypical" interpretations imposed by psychoanalytic theory. He argues instead for an approach which concentrates at the level of the individual and one that can enable the therapist to offer the patient "creative" interpretations.

Casement goes on to describe the case study of a young girl who was seen by him in the family home in order to show how the patient's difficulties were resolved partly as a direct consequence of a basic alteration in the psychoanalytic ground rules.

In the following chapters Casement documents numerous clinical examples and proposes some therapeutic strategies to counterbalance the inflexibility of psychoanalytic technique. The procedure of "internal supervision" he asserts, enables the therapist to reflect creatively on the patient's material by imagining themselves in the patient's shoes.

In the next two chapters Casement goes on to discuss transference and counter-transference interpretations from the same idiosyncratic perspective. Interpretations he states depend on the individual patient. Some patients will require an early interpretation, others only a tentative one. Furthermore, some patients warrant clearly defined transference interpretations. The cultivation of insightful interpretations can be achieved Casement postulates, if the therapist is prepared to remain in doubt and to employ the techniques of "internal supervision".

In keeping with Casement's flexible model he also deems it appropriate to comply with one patient's request for a boundary alteration while opposing another's.

The dictionary defines dogma as "asserted without truth" and although I find it laudable that he considers it vital for therapists to address the problem of the validity of their interpretations, nevertheless, it is still the therapist, albeit after reflecting on the patient's material, who ultimately decides what is the "truth" for the patient.

The almost blockbuster status of Casement's writing indicates that the idea of psychoanalytic fair play is in general extremely attractive. Yet I am left with the feeling that the book's appeal may to some extent be attributable to his ingenuity to have taken the bull by the tail and appeared to have faced the situation.

Carol Holmes