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This is a very clearly and concisely written book about patients who are very difficult to reach. Its great strength lies in the way that Steiner convincingly brings
together detailed clinical description and the theoretical concepts informing his work.
Although drawing centrally on Melanie Klein's concept of projective identification, and on recent Kleinian developments, this is by no means a piece of work which will be useful only to those who work daily with Kleinian concepts. Meaningful links are made to the work of other authors and the whole emphasis is on the ‘fine grain’ of maintaining close contact with the patient's need to involve the analyst in creating psychic retreats — sanctuaries and bastions against unwanted and painful reality. There are findings here which will be of use to practitioners of different orientations.
The book begins with an outline of the theory of psychic retreats as being manifestations of underlying pathological organisations of the personality. In three chapters the account is extended to include more detailed clinical examples of how these processes operate. Steiner reviews the specific kinds of mental pain evaded by subordinating oneself to these organisations. Essentially, both depressive and persecutory anxieties are avoided, but at a devastating cost.
In Chapter 4, Steiner extends his review to work done on narcissistic structures; and in the following chapter he discusses the important role in movements towards recovery of what Bion has called ‘projective identification in reverse’. This is a very interesting discussion of the likely processes involved in psychic repair, linking the recovery of parts of the self lost, through violent omnipotent attacks on thinking, with processes of mourning. This theme is picked up again in Chapter 7, and there is an intervening chapter in which problems of psychotic catastrophe are explored. In Chapter 8, Steiner discusses perverse aspects of psychic retreats, making links with Freud's ide