Book excerpt: Essentially clinical in its approach, Psychic Retreats discusses the problem of patients who are 'stuck' and with whom it is difficult to make meaningful contact. John Steiner, an experienced psychoanalyst, uses new developments in Kleinian theory to explain how this happens. He examines the way object relationships and defences can be organized into complex structures which lead to a personality and an analysis becoming rigid and stuck, with little opportunity for development or change. These systems of defences are pathological organisations of the personality: John Steiner describes them as 'psychic retreats', into which the patient can withdraw to avoid contact both with the analyst and with reality. To provide a background to these original and controversial concepts, the author builds on more established ideas such as Klein's distinction between the paranoid-schizoid and depressive positions, and briefly reviews previous work on pathological organizations of the personality. He illustrates his discussion with detailed clinical material, with examples of the way psychic retreats operate to provide a respite from both paranoid-schizoid and depressive anxieties. He looks at the way such organizations function as a defence against unbearable guilt and describes the mechanism by which fragmentation of the personality can be reversed so the lost parts of the self can be regained and reintegrated in to the personality. Psychic Retreats is written with the practising psychoanalysts and psychoanalytic psychotherapists in mind. The emphasis is therefore clinical throughout the book, which concludes with a chapter on the technical problems which arise in the treatment of such severely ill patients.