Abstract:
This case study presents psychotherapeutic work with „JD‟, an African male in his mid-twenties with a history of sexual abuse and early deficiencies in maternal provision. The focus of the study is on the difficulty of attempting to comprehend and provide containment (the operationalization of containment), as a trainee therapist working with this particular patient. „JD‟ presented with a number of interpersonal fears, complaints of isolation, an unbearable sense of confusion and uncertainty as well repressed anger and resentment. This clinical combination of difficulties, when mixed in with the author‟s own challenges as a trainee therapist, made therapeutic work challenging. The therapist employed a broadly defined psychodynamic framework, with a particular emphasis on „containing‟ „JD‟s unbearable levels of distress and anxiety whilst attempting to aid in the process of ascribing meaning to his confusing and difficult experiences. This undertaking was a challenging task, given that the concept of containment is not necessarily clear-cut (particularly for a trainee therapist) and in addition, that the patient seemingly lacked a sense of containment whilst growing up. The case study aims to illustrate and explore the challenges of operationalizing and providing the function of containment in psychotherapy with due consideration to the contributions of both the therapist‟s and patient‟s dynamics. In assessing the difficulties involved in attempting to provide containment in this therapy, it becomes apparent that for a beginner therapist the provision of containment is easily complicated by his/her narcissistic anxieties and countertransference reactions. It is proposed that aspects of containment as elaborated by more contemporary theorists may be possible to provide as a trainee therapist, but that working with projective identification as understood by a more classic Bion informed notion of containment is more difficult to master. It seems that this latter capacity is a skill that develops with time and experience. The provision of a holding environment as a possible precursor to the provision of containment appeared to be what was evidenced in this particular therapeutic interchange.
