Disguised countertransference in institutions

The manifest reason for the hospitalization of psychiatric patients is that someone decides that they are in danger of suicide or homicide, or that they are unable sufficiently to care for or manage themselves. From another perspective, however, hospitalization can be understood as a consequence of limitations on the part of the family, the community, or the therapist in managing the affects generated in relation to these patients' behavior and communications. In other words, it is possible that patients may be hospitalized primarily because people in their lives (and often they themselves) cannot stand their own reactions to them and to their behavior. A less readily recognizable aspect of the institution, then, may be its use as a place to lock away unacknowledged, or at best uninterpreted problems of unbearable human responses to patients' psychopathology. In therapeutic relationships, where these issues are condensed, such responses are termed countertransference. The connections between individual relationships and institutional behavior are complex and inevitably contentious. In this paper, we suggest that a study of these connections may reveal disguised elements and illuminate some of the parameters of the complex phenomenon of countertransference.