Holding and Belonging: Relational Approaches to Recovery in Young People Experiencing Psychosis- 1:30-2pm The Holding Environment in Fragmented Systems: Reflections on Therapy in First-Episode Psychosis - Priyanka Padidam, LSW, Madeleine Andrews, LSW
- 2-2:30pm Held Apart: Loneliness, Psychosis, and the Work of Recovery - Gil Grunfeld, MSc, MA
The Holding Environment in Fragmented Systems: Reflections on Therapy in First-Episode Psychosis - Priyanka Padidam, LSW, Madeleine Andrews, LSW
What does a holding environment look like in a fragmented system? In our roles as community-based therapists at a community mental health center, we work exclusively with young people who have been identified as experiencing psychosis for the first time in their lives. All of our participants are Philadelphia residents on Medicaid who are navigating a variety of the city’s structures and systems in and outside of our program. Psychosis, which is often understood in contexts of fragmentation and dissociation, is diagnosed in individuals, but it is intertwined with individuals’ experiences of their families, neighborhoods, and city – structures that themselves are ripe for fragmentation.In this context, we have found the Winnicottian concept of the 'holding environment' to be imperative as we strive to be stable, predictable, and empathic containers for clients. But our individual ability to create a holding environment is limited by fragmentation and dissociative elements in the systems to which we are bound. When, as a result, our own fragmentation arises, pressure mounts to pull in external and literal holding environments (i.e. hospitalization, or at times, medication) as an attempt to protect ourselves and our clients from falling to pieces without a safety net. These temporary holding environments function as last-ditch, often coercive attempts to protect people within a malfunctioning environment. In a city where presenting as psychotic puts one at greater risk of becoming unhoused, arrested, or killed, and within a mental health system that largely functions to protect itself and manage risk, these efforts create further social isolation by weakening trust in one’s social and familial supports and the mental health system at large. It is our observation that these responses to psychotic experiences end up creating psychotically organized systems, as well as dissociation and fragmentation in the inner life of the therapist. We hope to increase understanding of these (dis)organizations through investigating both clinical and agency-level instances that reveal the simultaneous necessity and insufficiency of the holding environment.
Held Apart: Loneliness, Psychosis, and the Work of Recovery - Gil Grunfeld, MSc, MA
This presentation integrates theoretical insights with contemporary research to examine loneliness in psychosis, with particular attention to early psychosis experiences in youth. Drawing on a recently published integrative review, the presentation highlights underexplored developmental processes (e.g., narrative identity, stigma, social preferences) that can shape the course of recovery. Building on this foundation, findings from an ongoing mixed-methods study illustrate how these processes operate in daily life. The presentation concludes by considering clinical implications for psychotherapy, with particular attention to supporting meaning-making, trust, and relational connection as central to recovery.
