My background is in psychiatric nursing and it is through my training as a psychiatric nurse that I came to do a placement at the Crisis Centre, before becoming a Resident Therapist. I did not realise how influenced I was by the implicit and sometimes-explicit assumptions held by the discourses of psychiatry and nursing, nor how some of these attitudes mirrored my own attitudes and ways of coping. Some of the aims of psychiatric nursing are to make people feel better, eliminate symptoms, control feelings, get rid of or suppress difficult feelings, and maintain a 'professional' distance (which involves not becoming involved with or emotionally impacted by the patients). I wanted to think that these were aims I never believed in, but they proved harder to shake off than I realised. They even at times felt more 'sensible' than living with disturbance in the way we do at the Crisis Centre. At times I've longed for the security of psychiatric terminology, hospital procedures, and the certainty (however illusory that is) offered by these ways of thinking about and responding to emotional distress. At times the Crisis Centre has felt like a 'mad' place from which I've wanted to escape.

The response by mainstream psychiatric services is often to treat the feelings felt by the guest and those around them as abnormal and dangerous, something to be somehow got rid of. The anxiety felt by hospital staffs alleviated by adherence to a variety of procedures, which constitute the very fabric of the hospital structure. At the Crisis Centre, we try to hold anxiety from our guests in a different way. We aim to contain it in ways, which give the guests the opportunity to begin to find ways of eventually containing it themselves. Guests need to come to the Crisis Centre generally because they need to be 'inside' somewhere, or something safe. Hospital can provide asylum/sanctuary in a certain way and to a certain extent. Patients are kept physically safer in hospital through the use of external controls, locked doors, seclusion rooms, chemical and physical restraint. Giving sanctuary, a sense of being in a safely bounded space is one function of containment and one which, in my experience, is in some way provided by hospitals, but provided differently by the Crisis Centre. The holding at the Crisis Centre is different in that it is, on the whole not physical, but something more emotional and mental. The 'nursing' provided is a nursing with thinking rather than action. A second function of containment is giving meaning to experiences that feel unbearable and unthinkable. It is in the provision of this second function that the Crisis Centre differs most from hospitals.

This work is Internal, akin to the ways in which mothers contain babies, in Bion's words - "The internal projects a part of it's psyche, namely its bad feelings, into the good breast. Thence in due course they are removed and re-introjected. During this sojourn in the good breast they are felt to have been modified in such a way that the object that is re-introjected has become tolerable to the infants psyche"(Bion, 1962, p.90). Put another way, if the Resident therapist is receptive to the guests state of mind and able to allow it to be evoked in herself, she can then attempt to process it and transform the feelings in herself into something more manageable, eventually enabling the guest to develop the capacity to do this themselves.

Guests come to the Crisis Centre for many apparently different reasons, but a basic 'reason' is that they need help to contain their anxieties, which are usually enormous. Something is amiss and unmanageable and feelings are spilling over. Guests may express their anxieties vividly, perhaps through acting out, psychosomatic or perceptual disturbance. Frequently it is those around the guest who feel this anxiety acutely. Guests who come to the Crisis Centre are so full of anxiety that they need the containing space available in the RT, the team leader, tile milieu and tile physical space of tile house to hold it, bear it and crucially, to process and understand it.

I will now describe my experience with one of our guests, Mary, who came to the Crisis Centre having had several hospital admissions in the past three years after overdose attempts. She was a counsellor herself and found "being on the other side of the fence" very humiliating and difficult. Prior to her initial consultation Mary wrote us a letter expressing how anxious and afraid she was about coming to the centre and what we were going to do to her. It was clear from her phone call and from the initial consultation that relationships were very frightening to her. Having her pain and difficulties seen, felt anxiety provoking for her, not feeling understood left her feeling isolated. She expressed intolerance for being on her own and when at home she would ring up different professionals for help. She was afraid that she would destroy those around her with her neediness and seemed to despair of ever being able to be contained. Her previous therapist had been unable to continue working with her and Mary felt she was too much for everyone. Consequently she tended to hide her difficulties from us and attempted to deal with her difficult feelings in self-destructive and self-defeating ways such as overdosing on prescribed medication, cutting her arms and vomiting.

More often than not the anxiety we nave to contain is anxiety of not knowing, what is happening in the house or to particular guests, what any of it means, what will happen next- in the next hour, over the weekend, when a new guest arrives etc. This anxiety of riot knowing is important and necessary; being able to contain this anxiety is an important part of being an RT. We help if we can allow something creative and new to occur, as opposed to getting locked into repetitive ways of unthinkingly reacting to the distress ('acting in' with the guests' acting out). We have in a way to let the guests use the Crisis Centre as a place to be unknown so they can be known in a different and more profound way. Not just as a label or set of symptoms. Hospital interventions, which are usually employed to lessen or even diminish anxiety in the staff, do not allow the patients to know themselves in any new way. Guests have frequently been inpatients in psychiatric wards prior to coming to the Crisis Centre and are thus used to these kinds of responses. We are often pressurised by guests to respond in this way. This would temporarily prevent the self-destructive act from occurring, but do little to further anyone's understanding of what this act may or may not mean. The anxiety is not understood, the person is not understood or assisted in understanding themselves and a repetitive and unthinking process operates. Learning how to respond in a different way, and in a way where I could be more likely to be left feeling anxious was not, and still at times is not, easy. Knowing when to allow this anxiety to be borne, and when to act to ensure the guests safety is not an easy task, and not one where we have any specific procedure (as in hospitals) to guide us. What we do have is our relationship with the guest, an intuitive sense of the strength of the therapeutic alliance between us; help to think from colleagues and at times other guests and a trust in our own feeling borne out from past experience. It is however because we are not sure that the work or' bearing anxiety has to be done. When to bear not knowing and when not to is a difficult decision. Sometimes not knowing is part of a creative process, but it can alternatively mean being kept in the dark with regards to destructiveness.

The anxiety I have felt in relation to Mary has at times felt different. This feels like a healthier form, occurring when a therapeutic alliance is present. Mary tended to be secretive about her self-destructiveness, maintaining a veneer of a pleasant, coping and co-operative. I sometimes wondered about my lack of anxiety about her. One evening, during the summer break Mary asked to speak to me before bed and let me know she had been storing prescribed medication and had that evening taken more than the prescribed dose. She said she felt desperate and afraid she would take even more in the night. She was very reluctant to be clear about how many she had taken and was equally reluctant to hand in the rest. Pauline, a fellow resident therapist, and I, sat with her for some time talking to her about what was going on and trying to get her to hand in the tablets. It increasingly became apparent to me that for Mary, handing in the tablets would mean preventing us being anxious or concerned about her like our only interest was as nurses, stopping the self-harm from happening to alleviate our anxiety and appease our professional conscience. Segal describes the process by which the child, and by implication, the patient, receives containment.

" When an infant has intolerable anxiety, he deals with it by projecting it into the mother. The mother's response is to acknowledge this anxiety and do whatever is necessary to relieve the infant's distress. The infant's perception is that he has projected something intolerable into his object, but the object was capable of containing it and dealing with it. He can then reintroject not only the original anxiety, but an anxiety modified by having been contained. He also reintrojects an object capable of containing and dealing with anxiety. The containment of the anxiety by an internal object capable of understanding is the beginning of mental stability" (Segal, in Lester M.H. ed., 1975).

On this occasion, Mary needed us to be anxious, to share some of the anxiety she was finding too overwhelming to hold on her own. Voicing these thoughts to Mary seemed to enable her to hand the tablets in and go to bed, knowing we also went to bed with feelings of concern for her.

A major part of my work at the Crisis Centre has involved being receptive and sensitive to the atmosphere /climate of the house. This state of receptivity is akin to what Bion describes as 'reverie' (1962, p.36), a state of being that enables us to empathise with the often non-verbal experiences of the guests. There have been times when the atmosphere has felt difficult to put into words and very powerful. Sometimes it has been as if the house was filled with a kind of noxious gas, something that got into everything in a subtle but invasive way. I have often experienced anxiety in my body- a tension headache, loss of appetite, fatigue or nausea. It can feel that something pervades my whole being, paralysing my capacity to think. These non-verbal experiences can be understood as important communications from the guest and picking them up, bearing the power and intensity of them and finding some way of verbalising the experience is part of the containing work of the Crisis Centre. Something near-sensory and somatic is transformed into something more mental, which can be used for thought.

As resident therapists we have the experience of sharing day to day life with the guests, which includes contact such as mealtimes, evenings and weekends and sharing the physical structure of the house, the living spaces. An important aspect of our role is to bring things that have happened in the house in to the team meetings and house meetings and use insights from the team meetings to give meaning and understanding to everyday contact in the house. The knowledge that we do this provides guests with a feeling of continuity and containment, though they also frequently express resentment about it or experience it as persecuting. Our continual presence and function as a 'bridge' to and from the team to milieu is a threat to the part of the guest who would rather things remained split off, separate and uncontained, and who has an investment in not thinking, making links or understanding. There is, however another part of the guest who increasingly feels safe knowing that we are aware and mindful of aspects of their experiences, which are split off and expressed through acting out in various ways.

I was aware, from a conversation I had with Mary that she had been storing tablets, which she was feeling like taking to suppress her feelings of desperation.

Another guest expressed in the house meeting later that day feeling worried that Mary was feeling self-destructive. Mary initially remained silent but later rather unconvincingly said there was nothing to worry about. I then shared with the rest of the house my knowledge of the tablet storing and my view that there was in fact cause for worry. I felt anxious whilst saying this, as if I'd somehow betrayed Mary and forced her to acknowledge things were not ok. At times in relation to her 1 felt at risk of being 'seduced' by the part of Mary that did not want thinking and understanding, into believing things are better left unsaid. Wishes and attempts to 'keep us in the dark' are a common occurrence. We have to strike a balance between accepting not knowing and the anxiety of that and being firm about the limit of our capacity to tolerate being kept in the dark which is often done by the less healthy aspect of the guest. We need to get help to stay with our desire to help the healthier part of the guest rather than collude with and 'help' the more destructive part. At times we must insist on, for example, cuts being shown to us, ambulances being called, tablets being handed in. Earlier in her stay my relationship with Mary felt fragile. She voiced feeling threatened and afraid of me, I felt at times I was persecuting her by encouraging discussion of her secret self-destructive actions. Over time I've learnt that this is appreciated, at least by a part of Mary who feels relieved of the burden of her secrets and helped by making sense of her self-destructiveness. I had to keep in mind the Mary who really was afraid of her self destructiveness and needed help with it, not denial of it which had been her own way of attempting to deal with it in the past.

Frequently, because of their past experiences, guests are in a state of mind which feels persecuted by and persecuting of containing. A major part of my work as an RT is to think about the ways different guests use me as a container, and/or attack my capacity to be this. Guests want different things from the Crisis Centre, for a part of guests the Crisis Centre can be a kind of theatre to act out in, and get others to act into, not a place where understanding and thinking can take place. This aspect of the guest prefers action to thought, another part of the guest wants understanding and help to make sense of their feelings and the predicament they find themselves in. Sometimes it feels as if we are being used mainly or only as dustbins for unwanted feelings or experiences.

Mary would frequently leave me feeling like this. She would often be silent in her team meetings, or drop hints about some self-abuse. At times it felt that she was very drowsy and we feared she'd taken an overdose. I often felt confused, anxious and overwhelmed, and the possibility of making any helpful contact felt hopeless. I felt that Mary would not allow me to think with her or contain her. Neglected by her parents Mary was brought up to believe that there is no one with a capacity to contain her, or no possibility of being contained without being hurt. The people in her life who should have been containing appeared to have failed her. As her stay proceeded, when our relationship developed there were times when I was allowed to take in, digest and feed back in a more processed form, the feelings being communicated to me. Mary became more able to let me know what was happening with her and became less deceitful about issues such as her tablet-storing, cutting and binging and vomiting. She became more able to allow good contact and thinking without that having to be immediately attacked.

Guests use projective identification to get rid of unwanted feelings or aspects of themselves, but also as a means of communicating. Throughout a stay these moments will ebb and flow, sometimes I have felt used as a dustbin, while other times as a thinking, processing human, who is allowed to contain in a helpful and insight giving way. We therefore have to bear the evacuation and the communication, which requires flexibility and adaptability and being (as far as is possible) in a state of reverie which allows us to sense what state of mind the guest is in and what they are needing from us. Often interpretation alone is not helpful as it can be experienced by the guest, when in a particular state of mind, as the RT maintaining a protective distance from what the guest is needing to communicate or trying to force feelings back that the guest is unable to tolerate.

The Guest benefits if they feel the whole milieu is containing them rather than just their team, or just an individual RT. In order to contain effectively an expansion is needed, in terms of the number of people aware of and thinking about what is going on. In the Wednesday meeting all the team leaders, resident therapists and students discuss and think about what is going on in the house and with particular guests. In this way our thinking space is expanded.

In the eighteen months I have been a resident therapist I have learnt a great deal about containing anxiety and what this means, in particular the difference between physical, concrete containment and psychic containment. I feel I've developed a greater capacity for reflection and a growing ability to tolerate psychic pain in myself and expressed by others. I think I am less prone to resorting to nurse mode as a defence, trying to 'make things better', and experiences of getting through difficult times has given me greater faith in my ability to recover my capacity for thinking. Being helped to develop my own psychic space by sharing my anxiety and by thinking with others has expanded my capacity to contain my own anxiety and thus enabled me to be in a better position to contain the guests. Increasingly the Crisis Centre has become my home as well as my workplace, and I've realised the importance of limit setting to be able to sustain myself and continue living and working here. I have learnt that containing involves being able to acknowledge and bear the fact that feelings cannot be taken away and that by responding with understanding rather than action can allow the potential for something new and creative to occur in the guests and myself.