Unintegration and Containment in Acute Psychosis

This paper draws on material from six years of psychotherapeutic work with a schizophrenic patient in the environment of an art therapy department in a large psychiatric hospital. The author discusses the material with particular reference to the work of Bick, Bion and Meltzer. She proposes that the analytically informed art psychotherapy setting came to constitute a containing object for the patient's unintegrated state of mind. This enabled a shift from intrusive identification to projective identification to take place in his use of the therapist and the setting. The substances and objects in the setting helped to absorb the violence of intrusive identifications which defended against the catastrophic anxieties overwhelming his capacity to think when he was acutely psychotic. Over time images emerged which were used to communicate with the therapist, and the evolution of one particular image, ‘Sleeping Muse’, is traced. The author proposes that this work was helpful to the patient, and questions whether work of this kind is possible in current psychiatric settings.