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The dust jacket of this book carries an intriguing illustration of an empty chair and couch placed close together. The chair is tilted towards the couch; one of its legs looks like an extension from it. Underlying both is a black shadow which, though irregular and blurred in outline, is continuous. By contrast, the couch and chair, whilst separate, appear joined up by the underlying shadow. It is as if there is a kind of dialogue going on, thus depicting the interactional nature of psychotherapy - the principal theme of this book.
What has prompted Casement to write it is to rescue psychoanalytic insights from becoming cliché-ridden, and to enhance and promote our creative learning from patients. This is coupled with a wish that those in caring professions, as well as analysts and therapists, be encouraged to ‘play with’ the ideas put forward and not to feel excluded, as many do, by the esoteric language in which many specialists in the unconscious speak to each other. In the first paragraph of his introduction, Casement refers to the dilemma of student therapists. One of the noteworthy features of this book is the way in which the position and special needs of students and inexperienced therapists are continually being addressed.
An essential part of Casement's thesis is set out in Chapter 2: The Internal Supervisor. This was written after the clinical material comprising chapters 3, 5, 7 and 9, and represents a formulation of one of the prime issues in psychotherapy, namely how to be psychologically intimate with a patient and yet separate. Following Winnicott, Casement invokes the notion of a nursing triad: that is, of the mother who is emotionally held while she holds the baby. The passage is worth quoting:
As with the mother, this holding of the student therapist is first experienced as coming from outside. Transitionally the experience of supervision is usually internalised. Ultimately this needs to develop into an internal support that is autonomous and separate