On Containment: a psychoanalytic view
Like “holding”, which I explored in a recent note, “containing” is a core practice in psychoanalysis, and psychotherapy generally. The idea is simple, the practice less so. That said, whether in our capacity as good-enough parents or partners or friends, we all know something about containment.
In On Learning from the Patient, Patrick Casement writes, “There are times when people cannot cope with their own feelings without some assistance. We could then think of these feelings as spilling over towards others.” Casement notes that in the psychoanalytic view this “spilling over” amounts to an unconscious communication that a person needs help containing unmanageable feelings. So, by “containment” we mean helping someone manage difficult, overwhelming feelings.
Imagine being with someone suffering from paranoid delusions. They’re pacing the room, anxious and fearful, running down the list of people conspiring against them. Your invitation to sit down is interpreted as an attempt to control them, as are your other attempts to interrupt the stream of paranoid talk in the hope of joining with them, so that you can hold and help contain what is clearly an overwhelming experience.
Sometimes a person needs more containment than a therapist can provide. Medication or a stay in a hospital can then help establish containment, but they are rarely a substitute for the containment provided by being in relationship. Some clinicians are too quick to recommend medication. In doing so, we may unconsciously (and unhelpfully) communicate to the patient our own fear of being overwhelmed by their feelings. Other clinicians may be too slow to recognize that our patient needs more containment than we can offer. In these cases, we may overestimate our power to help, or resist accepting that our patient is as ill as they are.
Fortunately, these are outlier cases for most therapists. More often, we are sitting with someone who is going through something that feels unbearable, like a divorce they don’t want, the suicide of their 14-year-old son, the loss of a partner to cancer. What should you do? What should you say—how do you show up for a patient or friend who has just lost their daughter to suicide? Helping contain a person’s overwhelming feelings without being either intrusive or neglectful (or reassuring) is challenging, to say the least.
Most of us aren’t very good at it. This is bad news, because the failure to help someone contain their feelings confirms their fear that their feelings are actually unmanageable. Casement writes, “It is only when these feelings can be admitted within a relationship that the underlying phantasy can begin to be modified.” For instance, someone who struggles with emotional dysregulation had parents who could not contain their feelings, leading them to believe their feelings were intrinsically unmanageable—which only compounded their dysregulation. But this underlying phantasy changes as they have the reliable experience that their feelings are workable after all, since their therapist is able to be with them without shaming them or abandoning them.
The first thing is to be able to manage our own feelings. The better we’re able to do that while being present and empathetically engaged with someone whose feelings are spilling over toward us, the better our chances of conveying that their feelings are workable. It’s amazing how settling—how containing—this experience is for patients. No doubt many therapists have had the experience of weathering angry attacks (without retaliating) for much of a session, then noticing toward the end that their patient is more calm and relational. Since we survived their feelings, perhaps, they think, they can too.