Team transference and resistance in the treatment of patients who act out

Abstract

There is more than meets the eye in the splitting of members of a treatment team. The source of these difficulties, when unearthed, revealed that the patients' actions experienced as aggression by the staff, evoked guilt feelings and retaliatory impulses which had to be denied expression. The team member may have failed to carry out an agreed-upon limit because he feared the patient's demands due to reverberation with his own past experences. He may have identified with the omnipotence of the patient and the latter's wish to devalue the therapist.

The writer makes recommendations aimed at preventing repeated treatment failures and possible harm to patients who require firm limits. These include: first, increased frequency of mectings during which the team can express both its positive and negative feelings toward the physician and toward each other; and second, education of the mental health workers concerning unconscious psychodynamics and countertransference paradigms.