An Island in a Sea of Madness: The Uses of Theory for In-Patient Adolescent Treatment

This paper explores the ways an integrated psychodynamic theory helps practitioners to maintain their therapeutic equilibrium.
I discuss adolescent treatment at Chestnut Lodge Hospital, using case examples of projective identification and splitting
on the milieu. I argue that theory helps the therapist to contain his own reactions to the intense, evocative work, which
in turn helps him to contain the patient. I also discuss the ways theory can help us to make therapeutic use of countertransference
enactments, allowing us to use discursive language to understand previously wordless experience. An integrated psychodynamic
theory allows us to bridge the intrapsychic and intersubjective realms. It both facilitates, and helps us to understand, the
novel attachment the patient forms in psychotherapy. Theory guides us regarding what psychological skills the patient has
failed to master and organizes our efforts to impart these skills to him.