Countertransference in the Residential Treatment of Children—Treatment Failure in a Child with a Symbiotic Psychosis1

In order to understand the complexities of countertransference in residential treatment, one must be willing to study treatment failure. That this represents an unwelcome undertaking is not primarily because our vanity disallows failure, or because it is painful to be reminded of suffering which has gone unrelieved, but in large measure because residuals of the experience persist long after the patient's discharge. The would-be observer feeling still somewhat involved is reluctant to look back. In this way, countertransference raises a barrier to its own examination.

It is well known that treatability is a function of the conjoined answer to two sets of questions, namely: (1) what is our expectable influence on the patient? And, (2) what is his expectable influence upon us? Yet, within the residential treatment center for children, the complex interrelationship of these two sides of the treatment coin needs further study. In particular, the growing proportion of borderline and psychotic children among the patients has added many new and relatively obscure factors to the delicately balanced, intense, and oftentimes disequilibrious interaction between the treatment staff and the child.

The essence of the residential treatment process is that as each child projects his inner world against the macrocosm of the residence, by and large the staff will find within itself the strength to resist stepping into the projected transference roles. For clearly, to the