ABSTRACT
This chapter illustrates the pivotal function of projective identification within the therapeutic milieu of the hospital. It provides detailed description of crises in the treatment of two patients undergoing long-term inpatient psychiatric treatment. These patients suffered from very different psychiatric illnesses; hence their cases illustrate some features of hospital treatment that cut across different types and degrees of severity of psychopathology. Lucia's diagnosis on admission was severe personality disorder with predominantly narcissistic and borderline features; mixed substance and alcohol abuse; and minor depressive disorder, with a relatively unpredictable suicidal potential linked to severe emotional crises. Ralph was a single man in his early twenties, with a history of a severe behaviour disorder that had started in early adolescence, characterized by truancy, rebelliousness, school failure, and violent fights with other youngsters and teachers, all of which led to his having been expelled from several schools.
