Containment? An investigation into psychoanalytic containment and whether it is provided by staff in an NHS institution in relation to someone with a diagnosis of personality disorder.

Abstract

This research investigated the psychoanalytic idea of containment in the context of NHS staff responses to a person diagnosed with personality disorder. The aim was to identify what, if any, containment was provided by staff for someone diagnosed with personality disorder by recording staff responses to an assessment and analysing the discourse. The research was undertaken with participants selected to represent a cross section of staff in the organisation and included senior and junior, clinical, administrative and managerial staff.

The discourse analysis of the interviews examined defences against containment such as splitting, projective identification and idealisation and the positions people occupied in relation to the material and the researcher, as well as looking for examples of containment. Reflexivity was a key part of the methodology, forms a significant part of the thesis and is used to contribute to the discussion. Reflexivity, findings from the review of the literature and the analysis of the interviews form the basis of the discussion and conclusions.

The research showed that containment, in its psychoanalytic sense, is often avoided and defended against. Key difficulties with developing the capacity for containment were found to be: conflict between the personal and professional in staff and anxiety in relation to the power of others in the organisation. Suggestions are made for how changes could be made within the organisation and how this could benefit both staff and people who use services. Changing the approach to containment could save costs as some repeat admissions could be avoided and staff satisfaction enhanced. The conclusions from the research make a contribution to clinical practice in NHS settings, to the psychoanalytic theory of containment and to the methodology of psychoanalytic discourse analysis. Recommendations for further research include more psychoanalytic discourse analysis to identify defences in text and research evaluating reflective staff groups.