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This is a complex and demanding work which deserves a wide audience across the different disciplines working with mental illness whether in child or adult mental health services, community mental health or private psychotherapeutic practice.
Williams has gathered together his papers (including two written jointly with Murray Jackson) over the last 15 years to argue for a better understanding of the internal world and suffering of the psychotic patient and for a central place for psychoanalytic thinking in modern psychiatric care of the seriously mentally ill. Most of the papers have been previously published in this Journal, in the International Journal of Psychoanalysis or as chapters in the books of other analysts.
His own thinking about psychosis, from an object-relations framework, owes much to his time spent at the Maudsley Hospital with Murray Jackson, where Henri Rey influenced a generation of psychiatrists and psychotherapists. Here there existed through the 1960s to the 1980s a unit providing ‘an opportunity for long-term intensive psychodynamic study and treatment of a significant number of first episode and relapsing psychotic conditions’ (p. 232). Williams states:
The individual psychotherapy of such seriously disturbed patients is best approached as the undertaking of a team comprising complementary skills. The combined abilities of such a team … can create a milieu in which patients discover a container for their disturbed self and from which, in the best cases, they may progress towards an autonomous existence. (p. 228)