Summary of Casement p. (1985) On learning from the patient. Chapters 6 & 7
Casement (1985) uses internal supervision and trial identification to examine some failures and successes to contain. The author also illustrates ‘how insight and analytic holding are helped by an awareness of communication by impact.
Casement (1985) refers to Bion’s definition of containment. According to Casement, Bion views containment as an active process, which involves feeling, thinking, organising and acting. However, the author goes on to mention that he or she was not confining to this definition.
In chapter 6, the author uses the notion of containment as a general term for the management of another person’s difficult feelings, which would otherwise be uncontained. Casement acknowledges the place for medication and hospitalisation for safe environment as forms of treatment. The author displays that sometimes patients do not necessarily need this but will be looking for personal containment. The author likens personal holding to a form of holding a mother gives to a distressed child. Holding for an adult aids recovery and in some cases provides the capacity to manage life and life’s difficulties without continued avoidance or suppression.
The author uses various examples to illustrate some of the dynamics, which operate when the therapist gives into the impulse of using reassurance.
Example 6.1: failure to contain: misuse of supportive action by therapist. The patient, Mr S. sounded extremely depressed in one of the sessions. Mr S. was finding it difficult to see the future and communicated this indirectly to the therapist. This created some anxiety in the therapist as to whether Mr S would cope until the next session, which was 5 days away. The therapist then offered Mr S an extra session at the beginning of the week which turned out to be a misjudgement of the type of containment. Mr S’ initial feelings of gratefulness for being offered another session...