Review by  P. Garvey.
(1999) Psychoanalytic Psychotherapy

Enormously influenced by Bion, Caper draws on Freud, Klein, Strachey  and contemporary analysts to follow the development of a number of crucial interrelated theoretical concepts.  Caper writes with clarity and lightness of touch synthesising ideas and untangling confusions in a delightfully direct style free from fluff or wordiness.  Points are made with impact and ideas given zing by being described from unexpected angles or with a reversal of perspective.  For example, Caper on transference;  "the relationships that the patient seems to have had with his objects in the past are a 'repetition' of the patient's present relationship with the analyst." I found Caper's writing on theory full of memorable images and unexpectedly more vivid and alive than his patients' material.

The book is a compilation of a number of separate articles, most of which have been published before, between 1994 and 1998.  Despite some ideas being repeated, the articles work well as a book as the chapters explore the processes of introjection and projection in increasing depth.

Caper contrasts psychoanalysis with suggestion (early psychoanalysis and many current psychotherapies).  Without mincing words, he describes the suggestionist as someone actively working to seduce the patient away from facing the truth; encouraging splitting, discouraging thought, evading rather than confronting problems and "constrained by the straight jacket into which he has allowed himself to be tied by his own and the patient's narcissism." Not that psychoanalysts are free from this sort of behaviour but, as Caper emphasises, the point in analysis is to explore the forces that support suggestion.  Much of the book is an investigation into what Caper refers to as "the mind-numbing pull that operates on the analyst ... to enjoy the intimacy and sense of power of a narcissistic merger instead of treating the patient's state of mind as an object of knowledge".

If he is to resist infection from the patient, the analyst needs a mind of his own with a relationship to his own internal objects, which crucially include a longing for the kind of knowledge psychoanalysis brings and an awareness of its limitations.  Analysts with anxieties about their own omnipotent destructiveness will be vulnerable to the patient's superego, become preoccupied with moral considerations and need the reassurance that is brought by a cure or by a good relationship with the patient.  Caper likens the analyst to a tank commander in the first world war who had to walk in front of the tank and who, if he did not get hit by the enemy fire, was in danger of being run over by his own tank.

Pathological states must be recognised for what they are, confusing them with primitive states is, in Caper's view, evasive.  Referring to Segal's work on symbol formation and Bion's alpha screen, Caper makes a clear differentiation between unconscious phantasies,  the building blocks of learning from experience, and omnipotent unconscious phantasies, unmodifiable by experience.  He elaborates these ideas further and makes a very useful distinction between paranoid schizoid and depressive kinds of identification and the resulting two very different types of internal objects. He links this to the resolution of the Oedipus complex and introduces the idea of a paranoid schizoid resolution of the Oedipus complex.

To the patient their delusion may be a fact and unconnected to any other idea.  If the analyst can treat it as an idea rather than a fact, it has connections, as "no idea is an island" and if these can be made it becomes something that can be thought about. Caper explores the analyst's task of converting these beta elements (delusions) into alpha elements (meaningful ideas).  He divides alpha function into two types; synthetic and analytic, and correspondingly divides beta elements into two types; raw physiologic sensation versus unbearable states of mind. I found these divisions very helpful, although the closer the focus on what goes on,  the more questions I found raised in my mind.

With his direct and sympathetic approach to the difficulties and loneliness of the analytic process, Caper's points hit home.  His capacity to tease out confusions and put things clearly, succinctly and with wit makes this book persuasive and a pleasure to read.  At times I feared I was being carried along by Caper too easily, particularly as  occasionally he does not agree with himself, (probably due to the book being a collection of sequential papers.)  For example Caper says that  "a real interpretation can be distinguished from a pseudo interpretation in that it does not make the patient feel that he should think or be a certain way".  This ignores  points he makes later in his interesting chapter on transformations, what the patient does to the analyst's interpretation. Elaborating the idea of what an interpretation should be, Caper recommends that "Interpretation should convey no more exhortation or suggestion about what the patient should feel or do than a line call in tennis. While I feel this is an important idea, Caper's choice of analogy contains the essence of my unease, is a linesman's call really so free of implication of what it should have been?

This criticism is in no way intended to detract from my view that this book the clearest exposition of theory and practice that I have read, and without doubt the most pleasurable.  I hope everyone will read it  for themselves.

Penelope Garvey