Learning From the Patient: Patrick J. Casement. New York: Guilford, xiv + 386 pp., $35.00.

Learning From the Patient is intended as a textbook on the technique of psychoanalysis and psychoanalytic therapy for beginning students and supervisors. The fact that therapist and supervisor are paired in this fashion already points to the unusual nature of this book. Casement assumes that there is a certain symmetry between the therapeutic and the supervisory relationships in that they are both communicative relationships in which the unconscious of one participant interacts with that of the other. I believe that we have not given sufficient attention to the extraordinary fact that we can learn of the psychic reality of our student' patient even though that patient' psychic reality may be outside of the conscious awareness of our student. In line with this symmetry between the therapeutic and supervisory relationship, Casement believes that it is also necessary to provide a holding environment for one' student. Further, he assumes a certain equivalence between supervising another and supervising oneself. For, instead of speaking of self-analysis he speaks of the internal supervisor.

Learning From the Patient is strongly influenced by the contributions of Bion and Winnicott. These men shared a certain egalitarian attitude with regard to the patient and both appreciated the pervasiveness of paradox in the therapeutic encounter. Casement bases his approach to technique on Winnicott' advice to follow the patient' lead. It is the patient who decides how to make use of the therapist and not the other way around. This egalitarian attitude enables one to examine one' countertransference without prejudice, for it is always an open question as to whose pathology it is. The patient may learn from the therapist but perhaps in even greater measure the therapist learns from the patient.