Smith ScholarWorks Theses, Dissertations, and Projects 2015 The emergency department as a holding environment : using object relations theory and institutional transference to explore schizophrenia and emergency department overuse Caroline B. Schnell Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Schnell, Caroline B., "The emergency department as a holding environment : using object relations theory and institutional transference to explore schizophrenia and emergency department overuse" (2015). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/724 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact
[email protected]. Caroline Schnell The Emergency Department as a Holding Environment: Using Object Relations Theory and Institutional Transference to Explore Schizophrenia and Emergency Department Overuse ABSTRACT The purpose of this study was to explore if object relations theory and institutional transference can help explain why some people with schizophrenia overuse the emergency department (ED). Since deinstitutionalization, and the implementation of managed care, high utilization of the ED by people with mental illnesses has become an important, and controversial topic within medical and mental health settings. High utilization negatively impacts both ED staff members, and people with schizophrenia. Specifically, this study examined this phenomenon through the lens of object relations theory, and institutional transference. Object relations theory contributed to an understanding of social relationships in schizophrenia, and how poor object relations impacts the therapeutic alliance. The concept of a holding environment was used to examine the ED as a source of containment for those in crisis.