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The walls within: working with defenses against otherness

Online Conference 5-11 July 2021

Mental Health Under Fire: Organizational Intervention in a Wounded Service

This is the story of a crisis intervention in a mental health service that sustained a most distressing and unusually cruel blow -- the murder of four of its staff by a patient-client. We think it is important to tell this story for a number of reasons: The events themselves were of such tragic proportions. Resorting to the notion of social defense can further understanding of the often-enormous strain between mental health delivery systems and their clients. Our approach combined reliance on psychoanalytic insight and open-systems theory. It thus clearly derives from and exemplifies the Group Relations tradition and practice. The model of concentric circles we evolved to understand the nature of the systemic injury applies not only to the system and its environment, but also to our relatedness to the clients. There are many interconnections and cross wiring, making for over-determined choices and dense explanations. Writing this story up is therefore also part of its unraveling.