Psychoanalytical Therapy in the Hospital Setting. : By Paul Janssen. London and New York: Routledge. 1994. Pp. 204 + ix.

This textbook reports on the cumulative researches of a hospital psychiatrist and psychoanalyst. Paul Janssen's thirty-year career has been concerned with the development of an optimal in-patient treatment setting for borderline and other disorders of early onset, grouped under the title ‘structural ego disorders’ (Furstenau, 1977)1 and which excludes overt psychosis. His work has taken place in Germany where he sought to integrate on one unit orthodox psychiatry, group psychotherapy, individual psychoanalytic psychotherapy and other representational media such as art, music and dance therapy. As such, this book will be of interest to psychiatrists and others working in psychiatric hospitals and therapeutic community-type settings. However, for any clinician interested in the transferential and social-structural implications of the use of group-analysis techniques alongside individual psychotherapy, and the potential effectiveness of this alliance, there are illuminating lessons to be learned from Professor Janssen's mistakes (freely admitted) and his successes.

Janssen's aim was ‘the design of an inpatient setting which truly harnesses and exploits all the elements present in a hospital environment’ (p. 3). He provides a summary of ways in which psychiatrists and therapeutic community pioneers (especially T. F. Main and the Cassel Hospital) have attempted to integrate inter-subjective activity with psychodynamic understanding, and acknowledges the influence of Main and Bion on the formation of his own unit. Balint and Winnicott figure prominently in his theoretical appraisal of borderline conditions. But Janssen is German, and he reveals (not least in a lengthy German bibliography) the extent to which German clinicians have addressed and resolved many of the problems associated with hospital treatment of severe mental illness.