The Therapist's Container in Practice
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The therapist’s container in practice Natalia Petrovna Solovieva Submitted in partial fulfilment of the requirement of the degree of Master of Health Science School of Psychotherapy Auckland University of Technology September 2007 This dissertation is dedicated to my partner Mark Bond whose love, encouragement and commitment to my work made this writing possible i CONTENTS CONTENTS.................................................................................................................................................I ACKNOWLEDGEMENTS.....................................................................................................................IV ABSTRACT............................................................................................................................................... V INTRODUCTION...................................................................................................................................... 6 CLINICAL PROBLEM .................................................................................................................................. 6 STUDY BACKGROUND : PERSONAL ACCOUNT ............................................................................................ 6 STUDY BACKGROUND : PROFESSIONAL ACCOUNT ..................................................................................... 7 STUDY BACKGROUND : CONCEPTS AND THEORY . THE THERAPIST ’S CONTAINING CAPACITY .................... 9 TAKING THEORY ONE STEP FURTHER : THE THERAPIST ’S ATTACK ON LINKING AND CONTAINING ........... 10 ORGANISATION OF THE STUDY ............................................................................................................... 11 METHODOLOGY................................................................................................................................... 12 INTRODUCTION ....................................................................................................................................... 12 METHODOLOGICAL APPROACH ............................................................................................................... 12 SYSTEMATIC LITERATURE REVIEW ......................................................................................................... 13 Scope of the search........................................................................................................................... 13 EXPERT INTERVIEW ................................................................................................................................ 14 ETHICAL ISSUES ..................................................................................................................................... 15 THEORY BUILDING ................................................................................................................................. 15 CONCLUSION .......................................................................................................................................... 16 CHAPTER ONE: THE CONCEPT OF CONTAINMENT IN THE WORKS OF WILFRED BION AND CONTEMPORARY PSYCHOANALYSTS ................................................................................ 17 INTRODUCTION ....................................................................................................................................... 17 THE ORIGINAL CONCEPT OF ‘CONTAINER -CONTAINED ’ .......................................................................... 17 RELATIONAL VARIATIONS BETWEEN CONTAINER AND CONTAINED ........................................................ 19 DAMAGED CONTAINER ........................................................................................................................... 20 CONTEMPORARY DEVELOPMENTS OF THE CONCEPT OF CONTAINMENT .................................................. 22 Container-contained relational variations ....................................................................................... 22 Types of the container....................................................................................................................... 23 CONTAINING AND INTERPRETING ........................................................................................................... 24 CONTAINING AND HOLDING ................................................................................................................... 26 CRITIQUE OF THE CONCEPT OF CONTAINING ........................................................................................... 27 CONCLUSION .......................................................................................................................................... 28 CHAPTER TWO: THE THERAPIST’S CONTAINING CAPACITY AND ATTACKS ON LINKING.................................................................................................................................................. 29 INTRODUCTION ....................................................................................................................................... 29 CONTAINING , LINKS AND ATTACK ON LINKING IN THE THEORY OF WILFRED BION ................................ 29 THE THERAPIST ’S NEUROSIS AND FEAR OF MENTAL PAIN ....................................................................... 32 OVERIDENTIFICATION WITH THE PATIENT .............................................................................................. 33 THE THERAPIST ’S NEED TO CURE ............................................................................................................ 34 THE THERAPIST ’S NARCISSISTIC ASPIRATIONS ........................................................................................ 35 THERAPIST ’S WORKING THEORY ............................................................................................................ 37 CONCLUSION .......................................................................................................................................... 39 Clinical vignette................................................................................................................................ 39 Summary........................................................................................................................................... 40 CHAPTER THREE: ON ENHANCING THE THERAPIST’S CONTAINING CAPACITY ......... 41 INTRODUCTION ....................................................................................................................................... 41 BION ON ENHANCING THERAPIST ’S CONTAINING CAPACITY ................................................................... 41 OTHER THEORISTS ON ENHANCING THERAPIST ’S CONTAINING CAPACITY .............................................. 43 Preventing therapists’ own neurosis from attacking the containment.............................................. 43 Working through therapists’ overidentification with their patients.................................................. 43 Developing therapists’ reverie.......................................................................................................... 44 CONCLUSION .......................................................................................................................................... 46 CONCLUSION......................................................................................................................................... 47 ii CLINICAL VIGNETTE ............................................................................................................................... 47 SUMMARY .............................................................................................................................................. 48 WHAT I HAVE LEARNED ......................................................................................................................... 49 REFERENCES......................................................................................................................................... 50 APPENDIX A ........................................................................................................................................... 57 iii ATTESTATION OF AUTHORSHIP I hereby declare that this is my own work and that to the best of my knowledge and belief, it contains no material previously published or written by another person or material which to a substantial extent has been accepted for the qualification of any other degree or diploma of a university or other institution of higher learning, except where due acknowledgement is made in the acknowledgements. Signed: _______________________________ Dated: ________________________________ iv ACKNOWLEDGEMENTS I would like to gratefully acknowledge all those who assisted and supported me on this journey. Firstly I would like to express my heartfelt thanks to my supervisor Associate Professor Stephen Appel for his intuitive guidance, wise advice, stimulating discussions, patient editing and words of encouragement when things got too hard. I sincerely thank Neville Symington for sharing his experiences and knowledge, as well as the time taken to accommodate our interview and email communication given his tight schedule. I thank Amber Davies and Andrew Kirby for their invaluable and honest feedback in our group supervision meetings. I would like to extend my thanks to Shoba Nayar for taking time to read my dissertation and provide invaluable editing assistance and advice. To all my friends and colleagues who took time to read each chapter as