What is Projective Identification?

Introduction

Projective identification is a term introduced by Melanie Klein and then widely adopted in psychoanalytic psychotherapy. Projective identification may be used as a type of defence, a means of communicating, a primitive form of relationship, or a route to psychological change; used for ridding the self of unwanted parts or for controlling the other’s body and mind.

According to the American Psychological Association, the expression can have two meanings:

  1. In psychoanalysis, projective identification is a defence mechanism in which the individual projects qualities that are unacceptable to the self onto another person, and that person introjects the projected qualities and believes him/herself to be characterised by them appropriately and justifiably.
  2. In the object relations theory of Melanie Klein, projective identification is a defence mechanism in which a person fantasises that part of their ego is split off and projected into the object in order to harm or to protect the disavowed part. In a close relationship, as between parent and child, lovers, or therapist and patient, parts of the self may, in unconscious fantasy, be forced into the other person.

While based on Freud’s concept of psychological projection, projective identification represents a step beyond. In R.D. Laing’s words, “The one person does not use the other merely as a hook to hang projections on. He/she strives to find in the other, or to induce the other to become, the very embodiment of projection”. Feelings which cannot be consciously accessed are defensively projected into another person in order to evoke the thoughts or feelings projected.

Experience

Though a difficult concept for the conscious mind to come to terms with, since its primitive nature makes its operation or interpretation seem more like magic or art than science, projective identification is nonetheless a powerful tool of interpersonal communication.

The recipient of the projection may suffer a loss of both identity and insight as they are caught up in and manipulated by the other person’s fantasy. One therapist, for example, describes how “I felt the progressive extrusion of his internalized mother into me, not as a theoretical construct but in actual experience. The intonation of my voice altered became higher with the distinctly Ur-mutter quality.” However, should one manage to accept and understand the projection, one will obtain much insight into the projector.

Projective identification differs from the simple projection in that projective identification can become a self-fulfilling prophecy, whereby a person, believing something false about another, influences or coerces that other person to carry out that precise projection. In extreme cases, the recipient may lose any sense of their real self and become reduced to the passive carrier of outside projections as if possessed by them. This phenomenon has been noted in gaslighting.

Objects Projected

The objects (feelings, attitudes) extruded in projective identification are of various kinds – both good and bad, ideal and abjected.

Hope may be projected by a client into their therapist, when they can no longer consciously feel it themselves; equally, it may be a fear of (psychic) dying which is projected.

Aggression may be projected, leaving the projector’s personality diminished and reduced; alternatively it may be desire, leaving the projector feeling asexual.

The good/ideal parts of the personality may be projected, leading to dependence upon the object of identification; equally it may be jealousy or envy that are projected, perhaps by the therapist into the client.

Intensity

Projective identification may take place with varying degrees of intensity. In less disturbed personalities, projective identification is not only a way of getting rid of feelings but also of getting help with them. In narcissism, extremely powerful projections may take place and obliterate the distinction between self and other.

Types

Various types of projective identification have been distinguished over the years:

  • Acquisitive projective identification – where someone takes on the attributes of someone else – versus attributive projective identification, where someone induces someone else to become one’s own projection.
  • Projective counter-identification – where the therapist unwittingly assumes the feelings and roles projected outward by the patient, to the point where they identify or unwittingly act out this role within the therapeutic setting.
  • Dual projective identification – a concept introduced by Joan Lachkar. It primarily occurs when both partners in a relationship simultaneously project onto one another. Both deny the projections, both identify with those projections.

A division has also been made between normal projective identification and pathological projective identification, where what is projected is splintered into minute pieces before the projection takes place.

In Psychotherapy

As with transference and countertransference, projective identification can be a potential key to therapeutic understanding, especially where the therapist is able to tolerate and contain the unwanted, negative aspects of the patient’s self over time.

Transactional analysis emphasizes the need for the therapist’s “Adult” (an ego state directed towards an objective appraisal of reality) to remain uncontaminated if the experience of the client’s projective identification is to be usefully understood.

A prior study demonstrated how counsellors may identify and clinically use client projective identification. Additionally, the study specified that splitting and projective identification happen one after the other. Also, the three connected phenomena of transference, countertransference, and projective identification are addressed as the foundation for the therapist’s successful application of the self as a tool in treatment. This is a three-phase therapy procedure that highlights the significance of the timing of treatments.

Wounded Couple

Relationship problems have been linked to the way there can be a division of emotional labour in a couple, by way of projective identification, with one partner carrying projected aspects of the other for them. Thus one partner may carry all the aggression or all the competence in the relationship, the other all the vulnerability.

Jungians describe the resultant dynamics as characterising a so-called “wounded couple” – projective identification ensuring that each carries the most ideal or the most primitive parts of their counterpart. The two partners may initially have been singled out for that very readiness to carry parts of each other’s self; but the projected inner conflicts/division then come to be replicated in the partnership itself.

Responses

Conscious resistance to such projective identification may produce on the one side guilt for refusing to enact the projection, on the other bitter rage at the thwarting of the projection.

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What is Milieu Therapy?

Introduction

Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities.

Outline

Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and the others within the unit, based upon a hierarchy of collective consequences.

Patients are expected to hold one another to following rules, with more senior patients expected to model appropriate behaviour for newer patients. If one patient violates the rules, others who were aware of the violation but did not intervene may also be punished to varying extents based upon their involvement.

Milieu therapy is thought to be of value in treating personality disorders and behavioural problems, and can also be used with a goal of stimulating the patient’s remaining cognitive-communicative abilities.

Organisations known to use milieu therapy include Cassel Hospital, in London, Forest Heights Lodge in Evergreen, Colorado, the United States Veteran’s Administration, and the Kansas Industrial School for Girls in Beloit, Kansas.

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What is the British Association for Counselling and Psychotherapy?

Introduction

The British Association for Counselling and Psychotherapy (BACP) is a professional body for counsellors and psychotherapists practising in the United Kingdom.

Brief History

Originally founded in 1977 as the British Association for Counselling, aided by a grant from the Home Office Voluntary Service Unit, it had emerged from the Standing Conference for the Advancement of Counselling. This body was inaugurated in 1970 at the instigation of the National Council for Voluntary Organisations. It was co-founded by the humanist activist Harold Blackham, and drew on detailed work Blackham had done for a non-religious counselling service for the British Humanist Association, which he led at the time. The organisation’s Chair was Nicholas Tyndall, Chief Officer at the National Marriage Guidance Council (which later become Relate).

In 1978, the headquarters were relocated from London to Rugby courtesy of the National Marriage Guidance Council which provided free accommodation to help the association establish itself. The Association is now located in Lutterworth.

In September 2000, the Association recognised that it no longer represented only those involved in counselling, but also psychotherapy, and changed its name to the British Association for Counselling and Psychotherapy.

In September 2017, the branding was refreshed introducing a new logo, colour scheme, typeface and the slogan “counselling changes lives”, based on a belief in the impact and benefits of the profession. This was Highly Commended in the 2018 memcom membership excellence awards stating that it “found success over various mediums” and “had a clear rationale for the brand relaunch and a strong proposition that counselling changes lives”.

In November 2019, the membership was reported to have surpassed 50,000, prompting the Association to share celebratory and rewarding comments from its members as a way to mark the achievement.

Governance

BACP is a company limited by guarantee and a registered charity, monitored by the Charity Commission to ensure that aims are charitable and funds used for the benefit of its members and communities in which they are active. BACP follows the Charity Commission’s Charity Governance Code as a tool for continuous improvement.

The governing instrument is the Memorandum and Articles of the Association.

The Trustees known collectively as the Board of Governors, govern the Association.

Committees

BACP operates six committees, with volunteer input, to oversee the activities of the association:

  • Audit, Risk and Performance Committee
  • Finance and Policy Committee
  • Membership and Professional Standards Committee
  • Public Protection Committee
  • Remuneration and Governance Committee
  • Research Committee

Operations

BACP works with commissioners and government to promote the counselling professions, seeking to advise and inform national and international policy and procedures concerned with counselling and psychotherapy, offering information and guidance to involved parties. BACP is consulted by government bodies, professional bodies, funding organisations, teaching institutions and many others on important issues concerning counselling and psychotherapy.

The Association sets and maintains standards for the profession. The Ethical Framework for Good Practice in Counselling and Psychotherapy along with the Professional Conduct Procedure is intended to ensure that members of BACP abide by an accepted code of conduct and accountability. The Association accredits counsellors with the appropriate training and experience via a rigorous accreditation process that requires continued education to maintain accreditation.

In October 2015, the Collaboration of the Counselling and Psychotherapy Professions (CCPP) was announced between BACP, BPC and UKCP. Whilst promising to maintain their unique differences, each organisation expressed their recognition of shared goals and a commitment to improving the nation’s mental health and wellbeing.

In June 2017, BACP presented their Female Genital Mutilation (FGM) research as a paper at the Society for Psychotherapy Research conference in Canada. Key research papers, including the FGM paper and a paper analysing data from the National Audit of Psychological Therapies, were published gold open access.

In March 2018, BACP and the SQA announced a unique partnership which promises to improve access to the counselling profession for students in Scotland through a new BACP Approved Qualification scheme.

Strategic Priorities

Following consultation with their members and stakeholders, BACP identified three key areas for particular focus where the value of counselling has the greatest potential to improve lives.

  • Older people
  • Four nations
  • Children, young people and families

Specialist Interest Divisions

BACP represent and promote specialist areas of interest within the profession by operating seven divisions, each managed by an executive committee of volunteers which run their own meetings and formulate strategies in line with BACP objectives, overseen by the BACP Board of Governors.

  • Children, young people and families
  • Healthcare
  • Workplace
  • Coaching
  • Higher and further education
  • Spiritual and pastoral
  • Private Practice

Regulation

Although counselling and psychotherapy are not statutorily regulated professions, BACP works alongside other associations to advise and appeal to government in attempts to ensure members of the public who access the counselling professions are safeguarded.

The BACP is registered for accreditation under the scheme set up by the Department of Health and regulated by the Professional Standards Authority for Health and Social Care. The Accredited status of the BACP Register is reviewed annually by the Professional Standards Authority to ensure that the highest standards are being met and good practices are being followed.

Publications

Therapy Today

The organisation’s Therapy Today magazine, with a circulation of 44,386 (ABC January-December 2016), is the most widely read specialist magazine for counsellors and psychotherapists in the UK, and has a strong international presence, publishing articles on topics crossing the breadth of counselling and psychotherapy practice, modalities and theoretical approaches.

Journals

The BACP publishes eight member-only journals:

  • Counselling and Psychotherapy Research
  • BACP Children, Young People and Families
  • BACP Workplace
  • Coaching Today
  • Healthcare Counselling and Psychotherapy
  • Private Practice
  • Thresholds
  • University and College Counselling

Notable People

  • Sue Bailey, DBE, Psychiatrist, BACP Vice-President
  • Helen Bamber, OBE, Psychotherapist, BACP Patron 2011–2016
  • Luciana Berger, Politician, BACP Vice-President
  • H.J. Blackham, Founder, and “architect of modern humanism”
  • Fiona Caldicott, DBE, Psychiatrist, former BACP President
  • Cary Cooper, CBE, Psychologist, Honorary BACP President 1976–1979
  • Derek Draper, Psychotherapist, former lobbyist and former editor of the LabourList website
  • Shreela Flather, Politician, former BACP Vice-President
  • Phillip Hodson, Journalist
  • Esther Rantzen, Television presenter, former BACP Vice-President
  • John Rowan, Psychologist
  • Diane Youdale, Psychotherapist, television personality
  • Lynne Gabriel, OBE, BACP Chair 2008-2011, BACP President 2023

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What is the World Council for Psychotherapy?

Introduction

The World Council for Psychotherapy is an NGO with consultative status at the Economic and Social Council of the United Nations. It was founded in 1995, has its headquarters in Vienna, and holds a World Congress every three years with more than a thousand participants.

Objectives

The main objectives of the association are the promotion of psychotherapy on all continents (based on the principles in the Strasbourg Declaration on Psychotherapy in 1990), to improve the conditions of patients, to cooperate with national and international organizations to improve crisis management and peacekeeping, and to unify world training standards. Members are both psychotherapists and organisations. President of the WCP is Alfred Pritz.

The World Certificate for Psychotherapy (WCPC) is only awarded on the basis of recognized psychotherapy training and aims to encourage mobility within the profession. Each year, together with the city of Vienna, the Council awards the International Sigmund Freud Award for Psychotherapy.

What is the European Association for Psychotherapy?

Introduction

The European Association for Psychotherapy (EAP) is a Vienna-based umbrella organisation for 128 psychotherapist organisations (including 28 national associations and 17 European associations) from 42 countries with a membership of more than 120,000 psychotherapists.

Outline

Individual members may also join the organisation directly rather than through one of its member organisations.

The EAP has sponsored much of the European effort from the mid-1990s toward the professionalisation of psychotherapy and the formation of pan-European training standards, ethics and guidelines.

A submission to the European Commission to establish the Common Training Framework for the Profession of Psychotherapist is currently in process (2021).

The President of EAP is Irena Bezić (Croatia); the general secretary of the EAP is Prof. Eugenijus Laurinaitis (Lithuania).

The association is based on the Strasbourg Declaration on Psychotherapy of 1990 whereby the EAP promotes the need for high standards of training on a scientific basis, and fights for free and independent exercise of psychotherapy in Europe. Important activities include:

  • Creating a collaborative democratic forum for all European national and method-based professional associations in psychotherapy.
  • Establishing pan-European professional post-graduate training standards consisting of a minimum of 2,400 hours, over a minimum of four years, of specialist training, with a significant component of supervised practice.
  • Awarding the European Certificate of Psychotherapy (ECP): The aim of the European Certificate of Psychotherapy is to implement a comparable standard of training and mutual recognition of training across Europe.
  • Building the Register for ECP Psychotherapists: creating a searchable database of the availability of over 5,000 psychotherapists in Europe.
  • Promoting EAP Ethical Guidelines: The EAP has developed ethical guidelines to protect patients and is establishing these across Europe.
  • EAP is also a founding member of the World Council for Psychotherapy (WCP).

Publication

Publication of the International Journal of Psychotherapy ISSN 1356-9082, a professional journal with 3 issues per annum.

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An Overview of Cassel Hospital

Introduction

The Cassel Hospital is a psychiatric facility in a Grade II listed building at 1 Ham Common, Richmond, Ham in the London Borough of Richmond upon Thames. It is run by the West London NHS Trust.

Brief History

The Hospital

The hospital was founded and endowed by Ernest Cassel in England in 1919. It was initially for the treatment of “shell shock” victims (aka combat stress reaction). Originally at Swaylands in Penshurst, Kent, it moved to Stoke-on-Trent during the Second World War. In 1948 it relocated to its present site at No. 1 Ham Common, Ham.

The Building

The present hospital was originally a late 18th-century house known as Morgan House after its owner, philanthropist and writer, John Minter Morgan. Morgan died in 1854 and is buried in nearby St Andrew’s Church, Ham. In 1863 it became home to the newly married Duc de Chartres. In 1879 it became West Heath Girls’ School. The school moved to its present site in Sevenoaks, Kent in the 1930s, and the building became the Lawrence Hall Hotel until its purchase by the Cassel Foundation in 1947. The building was Grade II listed in 1950.

Facilities

The hospital developed approaches informed by psychoanalytic thinking alongside medicinal interventions, techniques of group and individual psychotherapy. It was here that Tom Main along with Doreen Wedell pioneered the concept of a therapeutic community in the late 1940s. Together they pioneered & developed the concept of psychosocial nursing. By promoting and being proud of the role of the nurse – rather than try to imitate therapists; working alongside the patient in everyday activities, Weddell & Main developed a whole new way of working that reduced dependence upon services and fostered patient’s working collaboratively. Nurses were supported and taught to understand their reparative need, to challenge their sense of omnipotence and to rely on the patient group as the most useful resource. In 1948 Eileen Skellern came for her training and joined the staff in 1949.

The hospital formally established a research department in 1995 and has collaborative relationships with University College London, Imperial College and the Centre for the Economics of Mental Health at the Institute of Psychiatry, London. It is now a psychotherapeutic community which provides day, residential, and outreach services for young people and adults with severe and enduring personality disorders.

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What is Milieu Therapy?

Introduction

Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities.

Outline

Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and the others within the unit, based upon a hierarchy of collective consequences. Patients are expected to hold one another to following rules, with more senior patients expected to model appropriate behavior for newer patients. If one patient violates the rules, others who were aware of the violation but did not intervene may also be punished to varying extents based upon their involvement.

Milieu therapy is thought to be of value in treating personality disorders and behavioural problems, and can also be used with a goal of stimulating the patient’s remaining cognitive-communicative abilities.

Organisations known to use milieu therapy include:

  • Cassel Hospital, in London, UK.
  • Forest Heights Lodge in Evergreen, Colorado, US.
  • The United States Veteran’s Administration, US.
  • The Kansas Industrial School for Girls in Beloit, Kansas, US.

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A Brief Overview of Hollymoor Hospital

Introduction

Hollymoor Hospital was a psychiatric hospital located at Tessall Lane, Northfield in Birmingham, England, and is famous primarily for the work on group psychotherapy that took place there in the years of the Second World War. It closed in 1994.

Refer to Group Analysis.

History

Construction and Expansion

The hospital, which was designed by William Martin and Frederick Martin using a Compact Arrow layout, was built as an annexe to Rubery Lunatic Asylum by Birmingham Corporation and opened 06 May 1905. During the First World War, Hollymoor was commandeered and became known as the 2nd Birmingham War Hospital.

The Northfield Experiments

During the Second World War, the hospital was again converted to a military hospital in 1940. In April 1942 it became a military psychiatric hospital and became known as Northfield Military Hospital. In 1942, while Northfield was serving as a military hospital, psychoanalysts Wilfred Bion and John Rickman set up the first Northfield experiment. Bion and Rickman were in charge of the training and rehabilitation wing of Northfield, and ran the unit along the principles of group dynamics. Their aim was to improve morale by creating a “good group spirit” (esprit de corps). Though he sounded like a traditional army officer Bion’s means were very unconventional. He was in charge of around one hundred men. He told them that they had to do an hour’s exercise every day and that each had to join a group: “handicrafts, Army courses, carpentry, map-reading, sand-tabling etc…. or form a fresh group if he wanted to do so”. While this may have looked like traditional occupational therapy, the real therapy was the struggle to manage the interpersonal strain of organising things together, rather than simply weaving baskets. Those unable to join a group would have to go to the rest-room, where a nursing orderly would supervise a quiet regime of “reading, writing or games such as draughts… any men who felt unfit for any activity whatever could lie down”. The focus of every day was a meeting of all the men, referred to as a parade.

“.. a parade would be held every day at 12.10 p.m. for making announcements and conducting other business of the training wing. Unknown to the patients, it was intended that this meeting, strictly limited to 30 minutes, should provide an occasion for the men to step outside their framework and look upon its working with the detachment of spectators. In short it was intended to be the first step towards the elaboration of therapeutic seminars. For the first few days little happened; but it was evident that amongst patients a great deal of discussion and thinking was taking place”

The experiment had to close after six weeks as the military authorities did not approve of it and ordered the transfer of Bion and Rickman (who were members of the Royal Army Medical Corps). The second Northfield experiment, which was based on the ideas of Bion and Rickman and used group psychotherapy, was started the following year by Siegmund Foulkes, who was more successful at gaining the support of the military authorities. One of the military psychiatrists involved in the project was Lieutenant Colonel T.F. Main, who coined the term therapeutic community, and saw the potential of the experiments in the development of future therapeutic communities.

Northfield Military Hospital was the setting for Sheila Llewellyn’s novel Walking Wounded, published in 2018.

Decline and Closure

Poet Vernon Scannell was a patient at the hospital in 1947. By 1949 Hollymoor Hospital was recognisably distinct from Rubery Hill Hospital. It held 590 patients, falling slowly to 490 by 1984, and then dropping rapidly to 139 by 1994. After the introduction of Care in the Community in the early 1980s, the hospital went into a period of decline and closed in July 1994. It was subsequently largely demolished.

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What is Group Analysis?

Introduction

Group analysis (or group analytic psychotherapy) is a method of group psychotherapy originated by S.H. Foulkes in the 1940s. Group psychotherapy was pioneered by S.H. Foulkes with his psychoanalytic patients and later with soldiers in the Northfield experiments at Hollymoor Hospital. Group analysis combines psychoanalytic insights with an understanding of social and interpersonal functioning. There is an interest, in group analysis, on the relationship between the individual group member and the rest of the group resulting in a strengthening of both, and a better integration of the individual with his or her community, family and social network.

Deriving from psychoanalysis, Group Analysis also draws on a range of other psychotherapeutic traditions and approaches: systems theory psychotherapies, developmental psychology and social psychology. Group analysis also has applications in organisational consultancy, and in teaching and training. Group analysts work in a wide range of contexts with a wide range of difficulties and problems.

Method

Group analysis is based on the view that deep lasting change can occur within a carefully formed group whose combined membership reflects the wider norms of society. Group analysis is a way of understanding group processes in small, median or, large groups. It is concerned with the relationship between a person and the network of activity in the many groups of which he or she might belong. Through these group processes we can explore what bearing the public and private aspects of a person’s life have on one another, and the dialectic between group and personal development. Group members are supported, through shared experience and joint exploration within the group, in coming to a healthier understanding of their situation. Problems are seen at the level of group, organisation or institutional system; not solely in the individual sufferer, as they do in prevailing medical models. Problems within are recast as obstacles without. The way in which the group functions is central to this. Democracy and co-operation are the pillars through which group-mediated solutions to problems can flow in ways that are enduring. It is based on the principles developed by S.H. Foulkes in the 1940s and is rooted in psychoanalysis and the social sciences.

Group analysis is the dominant psychodynamic approach outside the US and Canada. It is an approach that views the group as an organic entity and insists that the therapist take a less intrusive role, so as to become the group’s conductor (as in music) rather than its director. The group is seen as not merely a dynamic entity of its own, but functions within a sociocultural context that influences its processes. In group analytic technique, the therapist weans the members from excessive and inappropriate dependency towards becoming their own therapists – both to themselves and to the other group members.

The Group Analytic Society and the Institute of Group Analysis were organisations established by Foulkes and others to promote Group Analysis and to train practitioners.

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What is the World Council for Psyhcotherapy?

Introduction

The World Council for Psychotherapy is a non-governmental organisation (NGO) with consultative status at the Economic and Social Council of the United Nations.

It was founded in 1995, has its headquarters in Vienna, and holds a World Congress every three years with more than a thousand participants.

Objectives

The main objectives of the association are the promotion of psychotherapy on all continents (based on the principles in the Strasbourg Declaration on Psychotherapy in 1990), to improve the conditions of patients, to cooperate with national and international organisations to improve crisis management and peacekeeping, and to unify world training standards. Members are both psychotherapists and organisations. President of the WCP is Alfred Pritz.

The World Certificate for Psychotherapy (WCPC) is only awarded on the basis of recognised psychotherapy training and aims to encourage mobility within the profession. Each year, together with the city of Vienna, the Council awards the International Sigmund Freud Award for Psychotherapy.

World Congress for Psychotherapy

  • 1996 Vienna.
  • 1999 Vienna.
  • 2002 Vienna.
  • 2005 Buenos Aires.
  • 2008 Beijing.
  • 2011 Sydney.
  • 2014 Durban.
  • 2017 Paris.
  • 2020 Moscow.
  • 2022 Moscow.

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