Being disturbed: Integration and disintegration in the patient and professional relationship

The experience of facilitating reflective practice groups as an application of psychoanalytic thinking in two different acute psychiatric settings, an in-patient ward and a crisis team, is used to explore integration and disintegration in the patient and professional relationship. Antipathy towards one kind of patient is fuelled by their risk-driven intrusion into the institution and minds of professionals with destructive use of their body which mobilizes professional anxiety about being exposed to the shame of failure. Professionals feel most disturbed by patients they consider to be well but abusive and paradoxically less disturbed by the patients they consider most ill but not at risk. Two kinds of patient emerge; one is very visible, in need of ‘eye sight’ observation to prevent death. The other more culturally acceptable patient is almost invisible with a blind eye turned because they are not at immediate risk of loss of life but are at risk of a deadening loss of meaning. The two kinds of patient are divined along the lines of illness and this paper explores some of the unconscious professional countertransference motivation in the need for this split.