THE INTROJECTED PSYCHODYNAMIC SITE. A THEORY OF THE THERAPEUTIC PROCESS IN PSYCHODYNAMIC PRACTICE

Abstract

This paper considers some work with a learning‐disabled woman and with the parent of a non‐accidentally injured child, enquiring specifically how each client became effectively therapeutically engaged. It is suggested that psychodynamic practice has lacked an adequate theory to account for such therapeutic engagement in sustained public sector work that directly addresses external reality as well as psychic reality, often with clients with impaired symbolic functioning. Coherent explanation requires the psychoanalytic concept of introjection to be elaborated theoretically in relation to the specific parameters of such practice. The author offers relevant elaboration in the theory of the psychodynamic site. It draws on psychoanalytic theory with especial reference to Donnet's concept of the analytic site, and integrates this with traditional casework theory. ‘Site’ implies ‘setting’ with a multiplicity of elements that includes a characteristic five‐fold frame of reference within which the practitioner listens. With case illustrations, the author argues that in an adequate encounter with the psychodynamic site, the patient discovers and gradually takes in elements of the site until, at a critical point, the site as a whole is introjected. This introjection amounts to the client's effective therapeutic engagement, in which co‐operation at an unconscious level is especially crucial.