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The following papers were presented at the annual Cassel Summer Conference in June 2024, which was entitled ‘Relationships with Reality—Working with Self-Harm, Dissociation and Trauma in Individuals and Institutions’. The conference was hosted by Clinical Lead Dr Kimberley Barlow and Inpatient Lead Dr Miriam Barrett who welcomed professionals, patients and ex-patients to a marquee in the beautiful Cassel gardens where guests enjoyed a delicious lunch alongside these three equally nourishing papers. The authors are a Psychotherapist, a Psychiatrist and two Psychosocial Nurses from the Cassel team.
The Cassel Hospital's inpatient programme is a National Specialist Tier 4 Personality Disorder Service for adults who are in a state of crisis or breakdown resulting from a complex interplay of severe mental health problems, longstanding deprivation, abuse and neglect. It is unique in offering a highly specialised combination of formal psychoanalytic psychotherapy and psychosocial nursing in a therapeutic community setting.
Patients come to the Cassel often having exhausted every other method of treatment. Throughout their 9-month-long stay, patients are expected to play an active role in supporting, challenging—and having fun with!—other patients, and in the general maintenance of their temporary home. As in other shared living spaces, there are rotas for cooking, shopping, cleaning, chairing meetings, looking after visitors and so on. Psychosocial nurses aim to get alongside patients as they tackle these ordinary tasks, offering themselves as emotionally alive sounding boards for the often not at all ordinary feelings they can stir up and the (self-)destructive behaviours which can follow.
The unconscious dynamics underlying patients' difficulties are worked on in a psychotherapy group as well as in individual psychoanalytic psychotherapy sessions, each of these twice weekly. We aim for an overarching culture of enquiry by attending to the kind of splitting that is a hallmar