Containing psychotic patients with fragile boundaries: a single-session group case study

This case study describes a single group psychotherapy session of six individuals suffering from schizophrenia or schizoaffective illness, which was characterized by numerous manifestations of fragile Ego boundaries. Based on these illustrations of fragile Ego boundaries, we explore some of the group's core therapeutic actions against psychosis. We discuss how the group (1) provides access to a structuring auxiliary Ego, (2) acts as a containing object by establishing firm boundaries and by mentalizing patients' psychotic productions, and (3) may become a solid object representation introjected by individuals wrestling with porous Ego boundaries and a poor sense of self. We conclude that, in addition to the known role of group therapy in increasing mature defenses, developing insight and providing social support, the group promotes healthier Ego boundaries, and eventually improves self-differentiation, and also tolerance to interpersonal proximity. This case study clarifies group therapy dynamics with individuals suffering from psychosis.