Containment: Therapeutic Process and Practical Implications in Healthcare

Containment can be viewed as a pattern of communicating mental experiences. Individuals undergo difficult and traumatic experiences that result in overwhelming emotions (Gibson, Till, and Adshead, 2019). The inability to contain these feelings can result in challenges in integrating with people. Containment is a concept that arises from early childhood in the relationship between the child and the mother. The child is taught to handle difficult emotions by the mother through different actions and experiences. Containment is also present during therapy and occurs when the therapist listens to the distressing inner experiences of the patient and provides feedback that fosters growth and understanding.

The process of containment starts with the patient sharing their experiences with the practitioner. This sets the stage for the therapist to listen and generate appropriate feedback for the client. The emphasis is on empathy because it enhances respect and trust between the patient and therapist. Most people still hold the fantasy that difficult feelings can only be dealt with using avoidance (Casement, 2014). For containment to occur, the individual must accept unmanageable feelings (Adimando, 2018). This allows the patient to share with the practitioner, which enhances the recovery process. Therapists should ensure that they have insight into the issues that are being re-enacted with them during the process.

In such a way, containment is considered a central element of therapeutic relationships and nursing practice. Thus, in situations when people cannot cope with their feelings without assistance, it becomes a central factor impacting the success of interactions between a client and a caregiver (Casement, 2014). Thus, high levels of trust and the ability/inability to contain are critical for creating the basis for sharing and interaction for better outcomes (Casement, 2014). Under these conditions, containment becomes central for the practice and interactions as the idea necessary for fostering better relations and mutual understanding between a client and a therapist (Fite et al. 2019). At the same time, the effective containment process ensures that better outcomes will be attained and no worsening of the situation will be observed (Casement, 2014). For this reason, it is one of the essential aspects given much attention.

Furthermore, there is a tendency to view the containment process in terms of person-centredness. The concept implies that a patient or client is put in the centre of the care delivery (McCance, McCormack and Dewing, 2011). For this reason, the cooperation is organised in ways helping to guarantee the highest comfort levels to patients and ensure they are secured and protected. It means that the process of containment can be understood in terms of the given paradigm. The feelings and emotions of a client are essential for aligning interactions with the person and promoting better outcomes. The synergy between containment and person-centredness is one of the pillars of modern practice (McCance, McCormack and Dewing, 2011). It helps to ensure that all parties will interact effectively and avoid barriers preventing them from sharing and discussing information.

Discussing the issue, it is possible to speak about vulnerability and psychological trauma. For instance, trauma is described as a series of events that are emotionally harmful or life-threatening (Newland et al., 2022). They might impact the development of vulnerability or the high risks of being exploited adults face (Newland et al., 2022). Thus, to consider these aspects, the idea of trauma-informed practice becomes topical as it allows to build trust relations with vulnerable populations. At the same time, it can be viewed in terms of the containment process. The necessity to handle complex emotions leads to the development of constraints that might affect the collaboration between a therapist and a client. For this reason, it is possible to admit the multi-dimensional nature of the concept and its importance for various practices arising from the problems affecting healthcare nowadays.

The existing research also evidences that containment can be associated with managing distress in patients. For instance, the inability to contain distress is one of the factors preventing individuals from entering meaningful cooperation with therapists (Damery et al., 2019). Clients acquire the idea that managing emotional issues require cooperation with a specialist who can help to understand feelings and manage them. In such a way, the containment process is essential for managing distress as it creates the basis for sharing (Damery et al., 2019). Moreover, it impacts the clients’ vision of themselves and their ability to ask for help and assistance. Under these conditions, containment is aligned with other ideas and aspects of therapeutic relations, which proves its critical importance and the necessity to consider it.

In such a way, containment plays a critical role in modern practice. At the same time, therapeutic relationships are central to achieving containment and better treatment outcomes (Böhmer and Krüger, 2019). Furthermore, distressing feelings might culminate during a crisis, which will result in new complex issues (Missouridou et al., 2022). Under these conditions, aligning effective sharing is essential and leads to enhanced outcomes in crises. However, the problem is that in many situations, containment is avoided (Weightman and Smithson, 2019). It introduces the need for the development of the capacity for containment and the ability to initiate and monitor the process. The current research proves the critical role of this phenomenon and the necessity to focus on understanding its major aspects to avoid poor outcomes.

Self-awareness is a crucial aspect for all healthcare providers. The concept can be described as the cognitive exploration of own thoughts, beliefs, feelings, values, and feedback from others. The Johari window was developed in the 50s and can be used to develop self-awareness. The system focuses on four forms of the self, which are the public self, the private hidden self, the blind self, and the undiscovered self (Rasheed, 2015). The goal of therapy is to increase the size of the open area (public self) by reducing the blind space. This is because the blind self represents what is known about a person by others but is unknown by the individual.

Self-awareness is essential because it enables nurses to create an environment that fosters therapeutic relationships with patients. This is beneficial because these relations can aid the recovery process. Another advantage is that self-awareness helps nurses to engage in healthy behaviours, which results in better client care (Taylor, LeBlanc, and Nosik, 2019). Enhancing self-awareness can also help nurses to improve their communication with patients (Howe, 2011). The nurses can direct the message toward the needs of the patient, which can create a therapeutic environment (Carpenter et al., 2017). The use of a reflective diary can ensure the development of self-awareness. This is because reflections provide the opportunity to look back and analyse the events for growth and development (Reljić, Pajnkihar, and Fekonja, 2019). Therefore, self-awareness is vital in ensuring that patients receive the best care.

In the education context, self-awareness is an essential factor necessary for acquiring new knowledge and integrating it into practice. For instance, the Johari Window model stimulates thinking and integrates analytical information into a meaningful framework (Lowes, 2020). As a result, individuals acquire a chance to develop new skills and an enhanced understanding of the current information. The value of data continues to increase every day, meaning that specialists who can process feedback from others, their feelings and emotions can succeed better compared to others ones (Lowes, 2020). Under these conditions, tools such as the Johari window acquire the top priority as the approaches help to structure thoughts, outline the areas requiring improvement, and start working on them. It is also a basis for more structured learning and the acquisition of new professional skills.

The importance of self-awareness to nurses and other medical staff is evidenced by numerous research works devoted to the topic. Thus, recent data shows that clinicians accept the critical importance of the concept and view it as one of the integral parts of their work (Younas et al., 2020). Self-awareness increases nurses’ confidence in managing complex situations and providing competent care when it is required (Younas et al., 2020). It means that high self-awareness levels can be associated with better results attained due to the ability to analyse the existing competencies and accept feedback from colleagues (Younas et al., 2020). Additionally, most nurses are ready to implement tools for cultivating high awareness levels as it helps to improve relations with patients and patient care (Younas et al., 2020). In such a way, both a nurse and a patient benefit from a specialist’s ability to evaluate his/her strengths and thoughts.

Self-awareness can also be associated with portfolio development. The tool provides a specialist with the opportunity to monitor and document his/her achievements and personal and professional growth (Jack and Smith, 2007). It means that self-awareness enables nurses to identify their strengths and the areas that should be developed (Jack and Smith, 2007). At the same time, the lack of discipline and the absence of a systemic approach can lead to undesired outcomes. Under these conditions, cultivating self-awareness should be supported with portfolio development as one of the tools to fix all changes and outline areas for improvement (Jack and Smith, 2007). Furthermore, the concept comprises cognitive, affective, and behavioural concepts, meaning nurses should focus on their cultivation to ensure that better care outcomes are attained (Jack and Smith, 2007). In such a way, promoting awareness through portfolio development is one of the ways to enhance practice.

In such a way, because of its importance, self-awareness is viewed as an integral part of the nursing practice. Being self-aware is a must for personal and professional growth (Rasheed et al., 2021). Self-awareness is also a central element of competency, stress management, and professional interactions (Rasheed et al., 2021). However, in many cases, nurses lack tools to measure their self-awareness levels, meaning there is a need for a specific scale (Rasheed et al., 2021). It would help to measure the existing levels and ensure the necessary measures are accepted to promote better outcomes and ensure there is a basis for future improvement. Otherwise, there is a high risk of using insufficient measures and practices to analyse the existing experience and determine whether additional measures to improve skills or knowledge are required.

Altogether, self-awareness is critical for modern nurses. It is directly correlated with the quality of care and outcomes (Sutton, 2016). Furthermore, nurses with high self-awareness levels can work in diverse settings and consider patients’ cultural backgrounds (Kaihlanen, Hietapakka and Heponiemi, 2019). Under these conditions, it is essential to focus on cultivating the desired self-awareness levels. Its development in the future can be accomplished by using diaries with reflections and portfolio development. These tools help to structure a person’s thoughts, ideas, perceptions and competencies and outline the areas that require improvement in the future. Nurses who realise their strengths are more confident about working in various settings and show better results. For this reason, focusing on this aspect is essential for the practice and the relations between the nurse and a patient. Specialists can also use specially-developed scales and questionnaires that might help to determine the current awareness levels and create a plan for future improvement if necessary.

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