When therapeutic worlds collide? On Bion's concept of reversible perspective: A brief review and clinical case illustration

Abstract

In this paper, the author, after reviewing Wilfred Bion's concept of reversible perspective, illustrates how the deployment of the mechanism invariably distorts the psychotherapeutic relationship. It is suggested that reversible perspective operates principally to attack awareness of the therapist–patient relationship, the therapeutic boundaries of treatment, and the aims and goals of psychotherapy. In the clinical case under discussion, the author demonstrates how projective identification is utilised by the patient in order both to confirm a sense of narcissistic omnipotence and to defend against awareness of profound psychological distress, in relation to the serious illness of a family member. In this sense, as Bion had pointed out, reversible perspective appears to emerge from the psychotic part of the personality, in order to combat certain types of mental pain and distress that are felt to be intolerable to the individual. The author also suggests a linkage between addictive behaviours and the mechanism of reversible perspective.