Containment and its Failure in an out of Hours Emergency Social Work Team

Abstract

This paper begins with an extended discussion of the case of A, a client diagnosed with a personality disorder who tested the ability of the professionals involved in his care to the limits. Despite their best attempts to contain his distress, the out of hours social workers and others involved with A were unable to help him effectively and A died from complications following a diabetic coma. A discussion of theory relevant to A follows: theory relating to personality disorder and the ‘hateful’ client; Freud's concept of the ‘negative therapeutic reaction’; Main's seminal work ‘The ailment’; Bion's theory of containment; and Winnicott's emphasis on attentive waiting. Further case examples are then provided which show both the success and failure of attempts at containment in an out of hours emergency social work setting. The impact of such work on the professionals concerned is highlighted. The paper concludes with an examination of the difficulties that can arise for workers charged with a duty to contain in the context of government policy. The desire for hope and optimism needs to be kept alive in the light of the recognition that even our best attempts will sometimes prove not sufficient.

Keywords:

• personality disorder
• mental health
• containment
• trauma
• crisis
• hope