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Kernberg, O.F. (1994). Psychic Retreats. Pathological Organizations in Psychotic, Neurotic, and Borderline Patients: By John Steiner. London/New York: Routledge/The Institute of Psycho-Analysis. 1993. Pp. 162+xiii.. Int. J. Psycho-Anal., 75:159-162.

(1994). International Journal of Psycho-Analysis, 75:159-162

Psychic Retreats. Pathological Organizations in Psychotic, Neurotic, and Borderline Patients: By John Steiner. London/New York: Routledge/The Institute of Psycho-Analysis. 1993. Pp. 162+xiii.

Review by:
Otto F. Kernberg

In this book, John Steiner makes a fundamental contribution to our understanding of patients in psychoanalytic treatment whose dominant characteristic over an extended period of time is their emotional unavailability in the transference. The 'psychic retreats' of the title graphically describes the subtle but dominant, profoundly pathological, pervasive, and often difficult to diagnose unavailability in the transference responsible for psychoanalytic stalemate. Steiner calls these conditions 'pathological organizations'.

His theoretical formulations derive from the analysis of narcissistic resistances, particularly the activation of a pathological grandiose self in the transference, characterised by the patient's persisting unconscious denial of dependency on the analyst and of the latter's existence as an independent being, resistances originally described by Abraham (1919) and Riviere (1936), and later expanded into a full theory of the effects of 'destructive narcissism' by Rosenfeld (1971). In fact, Steiner's 'pathological organizations' overlap largely with these narcissistic resistances in the transference, although he widens his database to include psychotic and perverse organisations. Indeed, his concept of pathological organisation covers a broad spectrum, including some neurotic patients with severe sado-masochistic transferences, the entire field of borderline personality organisation, and those descriptively psychotic patients who are still reachable with a psychoanalytic approach.

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