ABSTRACT
This chapter looks at how formal psychoanalytic psychotherapy, with its emphasis on the transference and the inner world, takes place within a therapeutic community at the Cassel Hospital and orientates itself to some of the realities of a specialist in-patient treatment setting. Here both adult and child psychotherapists and nurses work closely and intensively together. Although starting from different theoretical backgrounds and using different methods of intervention, the work of each discipline can inform and enrich the other. There is some sharing of information and of thinking so that, in terms of overall aim and purpose, there is a coming together to treat very difficult patients who may not be treatable elsewhere. Despite the complexities of this setting, one can see that there are aspects of the overall work which are distinctively psychoanalytic. We can see that in the therapeutic community there are different issues from elsewhere for the child psychotherapist about the use of information and about the understanding of fantasy and reality. It is important for the child psychotherapist, as it is for other workers, to know and work with the patients’ perception, adjustment to and conflict about the in-patient setting, and the affective impact of their experience, in particular, the psychodynamic processes operating amongst the patients and in the staff groups (Flynn 1998). The child psychotherapist needs to understand not just the disturbed child or adolescent as they are seen in the individual psychotherapy session, but to learn to deal with tensions about roles between workers and to tolerate severe infantile projections, often of hostility and despair, as they affect them personally. Such efforts by the staff to tolerate primitive psychological processes parallels the efforts of severely disturbed and traumatised patients to tolerate and to work through their problems.
