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by Mike Fisher

“The behaviour is not the problem, it is the solution. So what is the problem?” (Norma Howes at the TAG conference “Dissociative identity disorder and working with survivors of trauma and ritual abuse” at Swanwick in January 2000). Norma’s statement provides a refreshing perspective indicating that survivor’s behaviour may be less abnormal than we may be used to thinking. It may well be an attempt to regulate some difficult life experiences. It may be that the difference between sanity and madness is less to do with the degree of distress experienced in one’s life and more to do with one’s capacity to express it. Only then can one start to make sense of the confusion, pain, anxiety and fear that is felt.

The importance of “containment” as a means of providing a sense of safety for the client to explore feelings that may otherwise be experienced as overwhelming and confusing cannot be under-estimated. Containment is often about “holding” the alarm, confusion and pain of unfamiliar or overwhelming feelings.

Containment may be described as the capacity of one person to stay with and psychologically and emotionally hold the distress of another person in such a way as to allow it to be coped with. In the words of Patrick Casement in his chapter on key ‘dynamics of containment’ “… what is needed is a form of holding, such as a mother gives to her distressed child. There are various ways in which one adult can offer to another this holding (or containment). And it can be crucial for a patient to be thus held in order to recover, or to discover maybe for the first time, a capacity for managing life and life’s difficulties without continued avoidance or suppression.” (1985)

The counsellor will need to manage his or her own sense of uncertainty and confusion in order to be effective in assisting the client in managing their own feelings. If the counsellor can provide the confidence and presence that enable a client to believe that his or her difficult feelings can be managed, explored and understood then the client is less likely to resort to unsatisfactory coping mechanisms or to escape into a delusional private world.

In order for containment to be effective the counsellor will need to have some sound models of human functioning and an understanding of the developmental process. Without these they will risk being drawn into the client’s state of “alarm and confusion” and absorbing the client’s sense of feeling overwhelmed. The models can provide the map and compass to help work out where in the process the client is, and also where he or she needs to go in their journey of recovery. Models can provide the framework within which you both exist and can also provide the assurance that even if things don’t seem very clear, it does not mean he or she cannot find a way through.

One thing more alarming for the client than his or her own feelings, is other people’s fear of the client’s feelings. A counsellor’s capacity to hold the uncertainty of a client’s situation and his or her “difficult” feelings will be central to sound containment within which the client is enabled to make progress.

Good supervision is essential for the counsellor committed to providing effective containment for their clients, and, where necessary, a counsellor’s own therapy. Another very valuable resource is that of keeping up with the rapidly changing developments in the field of early life trauma studies. These factors together with listening to the client may provide the essential ingredients for containment.


Casement, P (1985) On Learning from the Patient Routledge.

Casement, P (1990) Further Learning from the Patient Routledge.

Wosket, V (1999) The Therapeutic use of Self – Counselling Practice, Research and Supervision. Routledge.

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