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Bell, D. (1997). Inpatient Psychotherapy: The Art of the Impossible. Psychoanal. Psychother., 11(1):3-18.

(1997). Psychoanalytic Psychotherapy, 11(1):3-18


Inpatient Psychotherapy: The Art of the Impossible

David Bell

This paper discusses some critical issues that arise in the psychotherapeutic treatment of patients in an in-patient setting. The paper describes aspects of the work of the Adult Unit at the Cassel Hospital, and the difficulties that arise from the less-private nature of the psychotherapeutic treatment in that setting. The author particularly focuses on the relation between the individual psychotherapy on the one hand, and the nursing and community treatment on the other, and argues for the need for clear demarcation of roles between these different functions. This imposes particular stress on the psychotherapist and nursing staff. Examples are given to illustrate this. The author emphasises the importance of maintaining as far as possible a classical psychotherapeutic setting, whilst recognising the necessity for communication between the psychotherapist and the other members of the therapeutic team.

The author also describes the ways in which certain individual psychopathologies can resonate within the institutional structure, causing serious deterioration in the therapeutic work. He particularly focuses on the ways in which the ‘psychotic superego’ can find a home within institutional life.

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