Containment in a therapeutic community: The joined effort of patients and staff

摘要

Many patients who suffer from severe mental illness tend to project their inner conflicts onto others, thus externalizing their inner drama and making it interpersonal. As Hinshelwood noted, this is very challenging for mental health workers, who experience confusion and can become involved in disputes. Hinshelwood suggests that psychodynamic understanding may allow therapeutic containment of such situations, instead of "falling victim" to the pathological, unconscious process. This study illustrates such efforts from the work in a therapeutic community for adolescents. It is proposed that, because psychological insight is formulated gradually, some level of enacting the patient's inner drama cannot be avoided. In the therapeutic community, patients are involved in their peers' therapy. The unique therapeutic opportunities it offers both for the "contained" patient and for those taking part in the process are discussed. This article was written by the therapist and reflects his perspective.