Working with psychosis: the unconscious impact on clinicians, teams and organisations

SUMMARY Clinical work with people who are seriously unwell and overwhelmed by psychotic functioning can be profoundly rewarding yet uniquely demanding. Beyond visible symptoms lie powerful unconscious forces that affect all involved. Drawing on psychoanalytic theory from Bion, Money-Kyrle, Menzies Lyth and Lucas, this article explores how psychotic processes such as splitting, projection, denial and rationalisation are transmitted to those providing care. Recognising and working with these dynamics not only deepens clinical understanding, enabling meaning to be found in apparently chaotic presentations, but also enhances the capacity to engage therapeutically with distress. Reflective practice, supervision and organisational containment are identified as essential clinical interventions to help clinicians understand the unconscious impact of psychotic processes and to preserve their capacity for thought and compassion.