Psychic retreats. Pathological organisations in psychotic, neurotic, and borderline patients

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John Steiner

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Essentially clinical in its approach, this work addresses the issue of patients who feel 'stuck' and resist meaningful contact. The author, an experienced psychoanalyst, employs new developments in Kleinian theory to explore how object relationships and defenses can form complex structures that render both personality and analysis rigid, limiting opportunities for growth and change. These defense systems are described as 'psychic retreats,' where patients withdraw to avoid engagement with the analyst and reality. To contextualize these original concepts, the author builds on established ideas, such as Klein's distinction between paranoid-schizoid and depressive positions, and reviews previous work on pathological personality organizations. Detailed clinical material illustrates how psychic retreats function as a respite from both paranoid-schizoid and depressive anxieties. The author examines these organizations as defenses against unbearable guilt and discusses mechanisms for reversing personality fragmentation, allowing lost parts of the self to be regained and reintegrated. Written for practicing psychoanalysts and psychoanalytic psychotherapists, the book maintains a clinical emphasis throughout, concluding with a chapter on the technical challenges encountered in treating severely ill patients.