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by Matti Keinänen, New York, Nova Science Publishers, Inc, 2006, 196 pp
Back in 1988, I was involved with the APP in organising a conference on Psychoanalytic Psychotherapy Services in Europe. The presentations given at that meeting had a profound effect on many APP members and a couple were published in Psychoanalytic Psychotherapy1. Our eyes were opened to the fact that in the public sector some countries were considerably in advance of the UK in the provision of psychoanalytic therapy services as were the systems within which they operated. We were also made aware that, especially in Scandinavia, it had been found to be feasible to adapt psychoanalytic understanding to public sector work with psychosis in a more systematic way than that provided by the occasional exceptional service in the UK.
This book, from a Finnish author, is a further example of psychoanalytic therapy being applied to the public sector and brings a sophisticated and rich mixture of theory and practice.
The core of the book is a series of papers explicating a model focussing on the developmental stages through which the mind develops its representational capacity, integrating the work of the semiotician Charles Pierce with that of many well known psychoanalytic writers in this field (especially Stern, Segal, Fonagy, Kernberg and Ogden).
The clinical setting that illustrates the practical utility of this theoretical framework is the psychoanalytic component of the psychotherapy service for students in the University of Turku. Most of the patient therapies described are with variants of borderline psychopathology.
Keinänen emphasises the epigenetic development of semiosis starting with what he calls (after Pierce) the “index stage”, in which the mind starts to bind experience originating in the bio/physiological processes leading to pleasurable and discomforting sensations emanating from the body. This is followed by the “iconic stage” in which images a