Moving House: On the “Toing and Froing” between Crisis Intervention and a Treatment Unit

This essay tracks the experiences of an excited psychotic woman who moves from a closed crisis unit to an open treatment unit. Initially the move has devastating consequences and she falls apart. After only a couple of days she is transferred back to the closed unit in a hypo-manic, completely excited, state. This is the beginning of a process involving both units. We decide to move her gradually: a couple of hours a day in the closed unit and a couple of hours a day in the open one. At first the only idea we have is to organise regular meetings between the teams. Very soon the idea develops to work more with her transference onto objects and places rather than with her transference onto members of the team. Work with a photo album quickly reduces her excitation. In a second stage we try to explain what went wrong with her first transfer and what worked with the second attempt. To this end we use the conceptual apparatus of Institutional Psychotherapy, the notion of contact (Szondi/Schotte), and Winnicott’s ideas with regard to the transitional object and the continuity of being.

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