Integrating the ivory tower and the treatment institution

Although the application of psychoanalysis to the clinical understanding of, and work with, psychotic and personality disordered patients has developed significantly over many years now, the presence of such an approach alongside other treatment modalities in many treatment settings can often be poor and sometimes absent. This in part reflects the complexity of developing both theoretical understanding and clinical technique in relation to these patients and in many settings a combination of interventions might well be the treatment programme of choice. In this paper, the author puts forward a view that in relation to recent developments in contemporary mental health services, specifically in the provision of care and treatment for forensic and anti-social personality disordered patients and offenders, the application of psychoanalysis might have a particularly important role to play. The experiences of staff working with patients and offenders who project their unprocessed internal anxieties and conflicts into the external environment can often be difficult and disturbing. The author argues that this dynamic needs to be understood as a representation of the patient's unmanageable internal world and, as such, careful attention has to be paid to this sometimes toxic impact on staff groups and care institutions. He argues that an application of psychoanalytic principles has a unique role in this reflective task which should be seen as a necessary and crucial part of the treatment process.