Reflective practice, team polarisation, and therapeutic containment in inpatient forensic psychiatric care: a targeted narrative review

Inpatient forensic psychiatric care is characterised by severe mental disorders, elevated risks of violence, and coercive interventions. The recurring difficulties emerging in these settings may be better understood not as problems attributable to individual patients or healthcare professionals but as multilevel issues within teams, wards, and organisations. Excessive emotional burden on staff, team polarisation, inconsistent clinical practices, and drifts towards restrictive interventions may reflect breakdowns in reflective capacity and the weakening of therapeutic containment across these organisational levels. This targeted narrative review examined whether psychodynamic perspectives may offer a useful framework for understanding such difficulties. English-language, peer-reviewed articles were searched from February to March 2026 using PubMed/MEDLINE, PsycINFO, Scopus, and Web of Science. Where necessary, foundational literature in psychoanalysis and psychodynamic psychiatry was consulted. This review suggests a multilevel framework spanning staff, team, ward, and service levels. This framework may help identify factors that undermine therapeutic containment and may complement trauma-informed, recovery-oriented, and risk-focused approaches in forensic inpatient care. Further empirical research is required to ascertain whether this perspective has practical value in clinical settings.