Malignant Rapprochement and Abandonment of the Container Function in Acute Psychiatric Settings

Abstract

Acute psychiatric settings afford a limited time to spend with often complex patients presenting with a multitude of competing issues.  While patients bring with them internalized templates which may lead to forceful language and behaviors, recreating potentially re-traumatizing and uncontaining experiences, clinicians themselves bring their own institutional pressures seeking to subjugate patients to devitalized roles, limiting the potential for connectedness and healing.  As both parties bring to the encounter the harshness of their own internal object world, what may take place is a form of malignant rapprochement.  This term denotes a ground on which a complex patient with a vocabulary necessarily stilted by circumstance encounters a provider who may only be able to provide a form of pseudo-understanding, predicated on superego and internalized pressures not to allow more than a minimal aliquot of vitality to the individual being seen.  Such settings may be utilized unconsciously by patients to refuel their own destructive object relations paradigms, as opposed to serving as locations where change may be facilitated.  Awareness of these dynamics may allow for an emphasis on even momentary attunements, allowing for space to think and relate in humane manners, irrespective of setting.