Fra fortolker til container

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Abstract
Changes in the patient population leading to more borderline patients and psychotics are reflected in the transference/countertransference reactions on the ward. Transference changes from whole-object to part-object relationships, »experiencing« yields to use of projective mechanisms, and acting-out and other irrationality than transference increase in amount. Countertransference reactions become to a larger extent the therapist's reaction to the role given him by the patient's transference, rather than his own transference to the patient. The therapist's well-being is determined more by his ability to tolerate disturbed behaviour, aggression, chaos etc., than by countertransference in a stricter sense. The therapist in our earlier therapeutic community functioned to a large extent as interpreter, as a lot of the patients were neurotics and profited from insight. The emergency ward, however, needs a therapist that both can be identification object for borderlines and offer a gratifying and structuring two-person relationship to psychotics. This had led us to believe that the dyadic relationship therapist/patient can better be conceptualized by Bion's »containing-function« (1). By this he means for the therapist to receive the patient's feelings, fantasies, attitudes etc., to carry and contain, and transform it through his own thoughts and feelings (reverie). What was originally projected can then be reinternalized in a detoxified form. This part of the process is according to Bion strongly dependent on a peaceful and good atmosphere in the relationship. It can sometimes be difficult to achive this in an emergency ward. Different problems with being a container, receiving projections, tolerating negative affects etc. are described and discussed.

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