For some, psychiatry has wilted in recent years, under the converging pressures of evidence-based medicine, managerialist politics and the political emphasis on public protection. The individual has been subordinated to the group, the validity of narrative and understanding to the reliability of outcome data, and therapeutic continuity to functionalised crisis management. In this stark environment for clinical practice the patient represents risk to the clinician, leading to anxiety, defensive practice, and a dichotomised clinical position of denial of risk or responsibility on the one hand and an overly interventionist approach on the other.

On reading Containment in the Community, one is immediately struck by the juxtaposition of forewords by a psycho-analyst whose writing is familiar to most psychiatrists (Professor R. D. Hinshelwood) and a civil servant with responsibility for government policy on offenders with personality disorder (Nick Benefield). This book sets out to establish a role for psychoanalytic understanding in contemporary psychiatric services, particularly at the interface of psychiatry and the criminal justice system.

The chapters, a series of stand-alone essays most of which describe the authors’ experiences of providing psychodynamic supervision to staff in a clinical setting, are generally grounded and relevant to day-to-day practice, a key aim of the editors. Different readers will probably value different chapters, depending on which are most relevant to their own work, but the pervading themes have general applicability and are consistent: the patients are complex and very disturbed; there is too little room in modern services for dynamic reflection – consequently, the anxieties of staff and patients are not acknowledged; and action (even if ill-considered) is valued much more than thought. At times, I felt uneasy about an apparent premise that all patients are highly disturbed even if this disturbance is not overt, and occasionally the current state (disturbance) of health services was denigrated too much. But for the most part, particularly when the focus was maintained on the dynamic between the patient, the clinician and the structures or institutions within which all operate, these assumptions served their purpose.

I was interested in those chapters that directly considered the assessment of risk, which sought to re-establish the importance of subjectivity and narrative to valid clinical risk management. The two chapters whetted my appetite and I wanted to read more. It was a shame that there was no consideration of prisons, where the dynamic between the offender/patient and the institution is brought into sharpest relief, and where sometimes it is hard for clinicians to maintain their clinical integrity.

This is a good and thought-provoking book and its subject matter is important. Receptive clinicians will find it useful in their daily clinical practice within existing services. Those involved in service development, whether in-patient or community-based, would do well to consider it too.