The idealisation of therapy: fantasy versus reality in clinical practice

In this paper, object-relations theory is used to illuminate problems encountered in the psychotherapeutic management of severely disturbed psychiatric patients. The hazards of idealisation of the psychiatrist by the patient are reported in four case histories. Attention is drawn to the subsequent breakthrough of negative feelings where idealisation had been unrecognised or unwittingly encouraged. Some implications for the more successful management of the transference in patients such as these are discussed.