‘Get me out of this dream!’: making a therapeutic alliance and working in the transference with a psychotic adolescent boy

Abstract

This paper discusses the challenges of struggling to build and maintain a therapeutic alliance with a psychotic adolescent boy who did not share an allied perception of reality with his therapist, and who insisted that his therapist did not exist. The paper poses the question of whether, under such circumstances, it is ever appropriate or tolerable to make transference interpretations. Drawing on detailed clinical material, the author attempts to make sense of how it was possible to make some contact with his patient, given these technical difficulties.

Keywords:

• psychosis
• adolescence
• therapeutic alliance
• transference
• narcissism
• disintegration

Acknowledgements

I would like to express my gratitude to Ryan and his parents for granting permission for the publication of clinical material. I am also grateful to Stephen Baker, Francesca Calvocoressi, Mark Carter, Monica Lanyado, Kate Stratton and Peter Wilson, who read and commented on earlier drafts of this paper.

Notes

1. It is only possible to give a very limited case history in order to preserve the anonymity of the family.