Publication Date


Document Type

Masters Thesis


School for Social Work


Schizophrenia-Treatment, Schizophrenics-Deinstitutionalization, Hospitals-Emergency services-Utilization, Object relations (Psychoanalysis), Inmates of institutions-Psychology, Theoretical, Schizophrenia, Emergency Department, Object relations, Institutional transference, Holding environment


The purpose of this study was to explore if object relations theory and institutional transference can help explain why some people with schizophrenia overuse the emergency department (ED). Since deinstitutionalization, and the implementation of managed care, high utilization of the ED by people with mental illnesses has become an important, and controversial topic within medical and mental health settings. High utilization negatively impacts both ED staff members, and people with schizophrenia. Specifically, this study examined this phenomenon through the lens of object relations theory, and institutional transference. Object relations theory contributed to an understanding of social relationships in schizophrenia, and how poor object relations impacts the therapeutic alliance. The concept of a holding environment was used to examine the ED as a source of containment for those in crisis. Institutional transference helped to explain why people with schizophrenia may develop transference to the ED instead of transference to an individual therapist. Findings of this research highlight the importance of person-centered care for people with schizophrenia. This thesis calls for a reexamination of our traditional notions of therapy, and connection so that we may better serve those with schizophrenia.




iii, 73 pages. Thesis (M.S.W.)--Smith College School for Social Work, 2015. Includes bibliographical references (pages 68-72)