Learning from the Patient

by Patrick Casement, Patrick J. Casement

In one volume, this book presents Patrick Casement's two classic works, On Learning from the Patient and Further Learning from the Patient . The patient's unconscious contribution to analytic work is fully explored. Casement writes with unusual openness about what really happens in the consulting room, including mistakes--his own as well as others'. Everything in psychoanalytic theory and technique is up for questioning and for careful testing in the clinical setting. Casement provides fresh insights on familiar concepts as well as developing a number that are new; every concept is explained and illustrated with clinical examples.

Genres: Psychology, Psychoanalysis, Nonfiction, Counselling

386 pages, Paperback

First published April 1, 1985

Reviews

[Paul Johnston · Rating 5 out of 5]

This is an excellent book. Easy to read and well worth reading! It is about working with patients, so it is more about technique than theory; or rather it focuses on technique and the theory that underlies the technique is discretely referred to rather than dwelt upon. His main message is about learning from the patient in the sense that he believes that on some level the patient knows what he needs from therapy/analysis and the therapist's (demanding!) job is to create a context that enables the patient to get what he/she needs.

[Jack · Rating 4 out of 5]

In “Learning From The Patient,” psychoanalyst Patrick Casement invites the reader to roam around his head as he considers various analytical theories and the interactional experience that goes on between patients and analysts/therapists.

Casement is impressive not only because of the breadth of his theoretical knowledge but because of his deep humility, warmth, openness and candor.

[Piergiorgio · Rating 5 out of 5]

Why do I love this book? Because it is sincere. In sincerity lies the quality of the book, the ability to learn from mistakes. This is why it is informative: Because it's real, it's not a theoretical book. Not so many therapists are able to discuss their thoughts, successes and mistakes with the reader. There is too much conceptual knowledge and few practical knowledge in the majority of psychoanalytic books. This book is an exception.

I want to say that there are too many transference interpretations in the book...everything the patient says about past or the present is interpreted by Casement in the here and now of the transference, as lack of care perceived by the patient.It is an exaggeration, according to me, because there is no place for drives, intrapsychic conflict and extra-transference interpretations...The positive side is the clear description of the importance of containment revealed through clinical examples.

[Dovilė Stonė · Rating 5 out of 5]

It is all too easy to equate not-knowing with ignorance. This can lead therapists to seek refuge in an illusion that they understand. But if they can bear the strain of not-knowing, they can learn that their competence as therapists includes a capacity to tolerate feeling ignorant or incompetent, and a willingness to wait (and to carry on waiting) until something genuinely relevant and meaningful begins to emerge. Only in this way is it possible to avoid the risk of imposing upon the patient the self-deception of premature understanding, which achieves nothing except to defend the therapist from the discomfort of knowing that he does not know.
By listening too readily to accepted theories, and to what they lead the practitioner to expect, it is easy to become deaf to the unexpected. When a therapist thinks that he can see signs of what is familiar to him, he can become blind to what is different and strange.

In summary, therapists have to be able to interpret as well as contain. Passive containment is not enough, as it feeds a phantasy of the therapist being made unable to continue functioning as therapist. Interpretation alone is not enough, particularly if it can be experienced as the therapist maintaining a protective distance from what the patient is needing to communicate. Psychotherapeutic technique has to be able to bring together these two functions, in such a way that the patient can experience a real feeling-contact with the therapist and yet find that the therapist is able to continue functioning.

If theory is to remain alive, rather than being repeatedly demonstrated in relation to each patient, there has to be adequate room for the patient to play with what is around in the session. It is important, therefore, that the therapist does not dominate the analytic work or monopolize insight in the therapy.
If too much certainty is employed by a therapist, this offers a patient what appears to be a short-cut to ‘knowing’. The dangers here are that insight is intellectualized, that understanding rests on a false basis, and that the therapist appears more all-knowing than anyone really can be. There are no short-cuts to pyschoanalytic experience. There is no other path to it than patience, the therapist holding onto the caution of still not-knowing – alongside the dawning sense of beginning to understand.

If only we can wait, the patient arrives at understanding creatively and with immense joy, and I now enjoy this joy more than I used to enjoy the sense of having been clever. I think I interpret mainly to let the patient know the limits of my understanding. The principle is that it is the patient and only the patient who has the answers.
(Winnicott 1971: 86–7)

[anarcho · Rating 5 out of 5]

An immensely practical and readable book on psychoanalytic technique. Though I am a student of humanistic and integrative psychotherapy, not psychoanalysis, I found the concepts presented by the author very useful - especially around countertransference. The case studies from the author's own practice are in-depth and accompanied by valuable commentary. The small headings help with readability and the references to Winnicott and Bion are illuminating. The author manages to convey his relatability and humility effectively throughout the book.

[Oliver · Rating 5 out of 5]

I really loved this. The further I read, the slower I got as I tried to attend with care to every word, as Casement does. I had to stop multiple times to think and reflect and I already know I'll be reading it again.

[Sarah · Rating 5 out of 5]

Excellent.

[Cheryl Blask · Rating 5 out of 5]

Remarkable! Very glad I revisited this wonderful book. A must read (and reread) for any therapeutic clinician.

[Gina Freeman · Rating 4 out of 5]

Easy to read and enjoyed the case studies

[Kat E · Rating 4 out of 5]

Full of case examples which is great for applying the techniques and theories being presented. Recommend to all in training, regardless of psychotherapeutic approach you're looking to work with (this is psychoanalysis).

[Amy · Rating 5 out of 5]

The thoughtfulness with which Patrick Casement reflects on his experiences results in a beautiful work that moves gracefully from specific examples to guiding principles. His voice is clear, firm and gentle. I was in turn intrigued, moved and enlightened.

[Joanna · Rating 5 out of 5]

It was a great great book.

[Princess · Rating 5 out of 5]

Much on derivatives.