Ideas in Practice edited by Bernardine Bishop, Angela Foster, Josephine Klein and Victoria O'Connell. Book Two in Practice of Psychotherapy Series. Published by  Karnac Books, London, 2003;  130 pp; £14.99.

This book presents six papers by members of the London Centre for Psychotherapy which the introduction suggests ‘show working psychotherapists trying to learn from their patients and from themselves’. The prospect of reading how colleagues struggle with and reflect on their work is always intriguing, and this collection succeeded in making me think about my own clinical work and about some of the dividing lines which run between different clinical styles and values.

Vivienne Lewin's chapter provides a useful account of some of the dynamics which may occur when working with a twin and she includes substantial outlines of a few cases. Her reflections on the twin in the transference make her work relevant to therapists who are not actually working with twins and she draws on Klein and Bion to explore the phenomenon of an imaginary twin. There are some interesting references to patients whose main defence is the avoidance of difference, and she quoted the fascinating example of a patient who left when Lewin could not see her at the time identical to that at which her twin was having a session with another therapist. I felt it could have been fruitful to explore this symbiotic relationship in terms of Mahler's theory of separation/individuation. The issues raised by Lewin are also explored in a paper by Anni Bergman (1971) who uses Mahler's theory to develop an exceptionally empathic relationship with a child who insisted on sameness with her mother. Bergman names the dilemma of the child who feels compelled to protect herself against difference: ‘I talked about how difficult it was for her to have me help her, because if I did help her, instead of magically making things turn out right, we became “I” and “you”, which made her afraid of being alone’ (p. 338). I sensed that there is a key difference between how Bergman and Lewin explore this issue with their patients, and that this difference is central to how each of us works.

I found Prophecy Coles's writing coherent and