On projective identification, containment, and feeling special: some thoughts about hospice nurses' experiences

This discussion is derived from a qualitative research study that examined the benefits of small group supervision for hospice nurses. Sigmund Freuds beliefs about early human development, Melanie Klein's theories of projective identification, and the later developments by Wilfred Bion concerning the container and contained, form a framework for understanding events. Alternative ideas are drawn from early psychoanalytic research with nurses. Individual comments from hospice nurses illustrate the profundity of working with issues of serious illness, while the work of a hospice nurse is illustrated with a single clinical narrative. The discussion poses questions rather than offering answers to the complexities of human service. It shows how some people throughout the event of serious illness may signal their readiness to make important changes in their lives or, conversely, intensify normal unhelpful modes of communicating with others. With the support of other members of the team, a hospice nurse was able to help a man ill with cancer to decide how to live the brief life that was left to him and make closer relationships. Thoughtful work discussions also seem to offer much to hospice nursing practices in the way of learning and support.