Book Review: Psychotherapy: Seeing and Being Seen: Emerging from a Psychic Retreat

Psychotherapy Seeing and Being Seen: Emerging From a Psychic Retreat John Steiner. New York (NY): Routledge; 2013. 196 p. US$42.95Reviewer rating: ExcellentI decided to review this book because its predecessor,1 which I found intriguing and very useful, is highly regarded and frequently cited in the contemporary psychoanalytic literature. John Steiner provides a lengthy introduction summarizing each chapter, preparing the reader well for what follows, and engaging the reader. He repeats this format in each chapter, outlining in more detail what he wants to convey.Steiner discusses clinical situations where patients feel stuck, and where failure to develop impedes the progress of the analysis. He observes that defences are sometimes held onto with great tenacity, and are most resistant to change when they form an organized and coordinated structure. He describes these systems of defences as pathological organizations of personality, which give rise to structures he calls psychic retreats. This book is divided into 3 parts. Part 1 deals with embarrassment, shame, and humiliation. Part 2 deals with helplessness, power, and dominance. Part 3 deals with mourning, melancholia, and repetition compulsion.Part 1 starts with Anxiety of Being Seen: Narcissistic Pride and Narcissistic Humiliation. Steiner describes a patient whose defences were based on fantasies of superiority and admiration, who was very sensitive to being observed. The analytic setting made him feel exposed; he was prone to feeling inferior and persecuted. In Gaze, Domination and Humiliation in the Schreber Case, Steiner suggests that the subject of Freud's famous study failed to find anyone who could understand and contain his distress, leaving him unable to face the humiliation and emerge from his paranoia. Steiner believes that containment requires the analyst to be open to the patient's projections, and to understand the experience evoked in him (the analyst) in a way that retains a relationship with reality. In Improvement and the Embarrassment of Tenderness, Steiner illustrates the narcissistic organization the patient turns to for protection, and his fear that this would be seen through and exposed. In Transference to the Analyst as an Excluded Observer, Steiner describes how the analyst can sometimes be provoked to make judgmental interpretations in response to being excluded and looked down on. Steiner provides an excellent summary of the relation between transference and projective identification, and between splitting and the internal world. Steiner highlights Klein's discovery that what is transferred is not so much an object from the past, but one that exists in the present, as an internal object that is then projected onto the analytic situation. Steiner does not aggrandize himself as a therapist. At the end of a treatment he describes, he clearly entertains doubts about to what extent his patient was helped.Part 2 begins with Struggle for Dominance in the Oedipus Situation. Steiner describes the conflict over power and dominance that can occur in the Oedipal situation, and distinguishes between paranoid and depressive solutions to the Oedipus complex. …

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