Helping some state hospital mental patients make small but necessary changes: transference openings from countertransference traps.

Severely, chronically mentally ill, poor prognosis, long-term patients in state mental hospitals do succeed in moving out of hospitals into community residences. They succeed by virtue of small but critical behavior changes. For some, these changes in behavior follow a treatment strategy that recognizes and corrects treatment impasses that have developed and been maintained by fixed countertransference positions on the part of hospital staff. In the two case examples presented, the historical information necessary to unravel the transference paradigm was part of routine hospital records, corrective action did not entail any major staff interventions, improved behavior led directly to movement out of the hospital, and community adjustment was successful. Improved mental and behavioral functioning was sustained at a year and a half follow-up.