Berättelser om det kränkta rummet. Processen i det terapeutiska rummet och betydelsen av bemötandeförloppet i återhämtningsprocessen vid allvarliga psykiska svårigheter

Sammanfattning: The present thesis involves a process evaluation of what occurred in the treat¬ment of seven young patients in institutional care diagnosed with schizophrenia: what happened in the encounters between staff and patients in a ward environ¬ment designed to provide constant care, and what facilitated or hindered rehabili¬tation efforts. The aim of the process presentation was to portray the treatment process, using a descriptive approach, in terms of the interaction between staff and the ward environment and of the individual psychotherapies. The case study material was compiled from several different sources: question¬naires completed by psychotherapists over a 5-year period, questionnaires filled in during the same period by the carers assigned to the individual patients, a retrospective study of journals and ward notes, interviews with the psychothera¬pists, observations of work on the ward, and observations of and investigative dialogue with patients. Subsequently transcribed into seven narratives on psy¬chosis psychotherapy, this material forms the basis of an analysis of the psycho¬therapeutic encounter. The analysis is made by posing a number of questions about the narratives. These questions are limited to what takes place in the therapeutic relationship, i.e. the encounter between patient and psychotherapist/assigned carer, and focus on therapeutic strategies, approaches, methods and techniques, along with emo¬tional reactions, behaviours, etc. in the patient and corresponding psychological phenomena in the psychotherapist/assigned carer that emerge in the case stud¬ies. The aim of the analysis questions is to categorise these phenomena, identify sequences of such phenomena and attempt to find recurrent patterns of such phenomen. Finally, the results of the analysis are placed in a theoretical frame of reference regarding the natural psychodynamic development process, and the defensive approaches a person adopts when their boundaries are violated are reviewed. Further, the term ‘transfer’ is depicted in relation to developmental psychology. The conclusion of the study is that clear patterns emerge in the patients’ defen¬sive/adaptive strategies which have their equivalent in the adaptive psychothera¬peutic approach of the psychotherapists and other staff. In line with a theoretical working model which identifies eight levels in the transfer process, it is argued that five of these are prominent in psychosis psychotherapy and that these levels have clear equivalents in the psychotherapeutic approach.