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Fox, R. (1988). On Learning from the Patient: By Patrick Casement. London: Tavistock Publ., 1985, 232 pp., $28.00; paperback, $13.95.. J. Amer. Psychoanal. Assn., 36:785-788.

(1988). Journal of the American Psychoanalytic Association, 36:785-788

On Learning from the Patient: By Patrick Casement. London: Tavistock Publ., 1985, 232 pp., $28.00; paperback, $13.95.

Review by:
Richard Fox, M.D.

Our standard model psychoanalytic technique is based on Freud's early psychoanalytic work, including his self-analysis. The consequences of these origins are reflected in the one-sided nature of our model technique, which is based on a one-person psychology. Its limits are strained when we attempt to formulate into theoretical terms something which has long been recognized by the analyst at work—namely that the analytic experience goes beyond the dimension of cognitive insight implied by our model technique.

Patrick Casement, a British analyst, has written a book on psychoanalytic technique which is addressed to the interactional aspects of the therapeutic process. In making his contribution to our understanding of the psychoanalytic process, Casement suggests that the nature of the patient's experience of the therapeutic relationship is at least as important a therapeutic factor as any gain in cognitive insight. To highlight the analyst's participation in the process, Casement suggests we consider: the nature of the analytic presence; the mutual influence of patient on analyst and analyst on patient; and the subjective response of each of the participants, how it is processed and how it is interpreted.

Casement's view of the analytic presence is rooted in Winnicott's notions about the child analysand's finding of and using the object. The model proposed is based on an experiential reenactment rather than an instinctual displacement. It is the responsibility of the analyst to be unobtrusively present for the patient in such a way that he lends himself to be used by the patient in the service of this attempt at reliving.

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