The Contours of Identity: Relational Dynamics in the Psychotherapy of Long-Term Mental Illness

After the waves of change resulting from the biological revolution in psychiatry gradually receded, interpersonal approaches to the study of serious mental illness, long in decline, once again regained currency. The renewed emphasis on subjectivity, spurred in large measure by the burgeoning recovery movement, brought the lived experience of illness to the forefront of research. However, inquiries into psychotherapy paid little heed to the interior world of therapists immersed in the longterm treatment of severe mental illness. Their experiences failed to garner much attention despite the adoption of intersubjective perspectives in broader interpretations of psychotherapy. The purpose of this essay is to look anew at the dynamics that arise in the psychotherapy of major mental illness and recast light on the struggles of both clients and clinicians through an intensive case presentation exploring the contours of identity.