Updating Psychotherapy Work with the Future: Futures Thinking and the Futurizing Functions of Containment.

The acceleration of climate change and other global and political crises has created a state of "permacrisis," confronting patients with significant distress about and need to grapple with complex and threatening futures emerging from ecological and social upheaval. A core task of psychotherapy has always been imagining alternative paths and self-definitions to improve future outcomes, formalized in approaches such as "future-oriented therapy" or "future-directed therapy." Now the neurobiological and psychological mechanisms that support the process of thinking about potential futures are better understood. We review the neuropsychiatric basis of the human ability to think about the future and how the evolving field of Futures Thinking/Futures Literacy can be used in psychodynamic treatment to support patients' adaptation to increasing climate and global threats. Describing the four existing modes of Futures Thinking (quantitative forecasting, practicing with futures, experiments of social cocreation, and critical deconstruction of futures), we posit use of the psychodynamically understood process of containment as a fifth mode, essential in strengthening all modes of futures work by allowing individuals to generatively hold difficult or catastrophic possibilities. Applying the work of Bion, Winnicott, and Green, we describe the essential relationship of containment to experiential, emotional, psychological, and neurodevelopmental processes that undergird psychic understandings of time, identity consolidation, and future imagination. Containment has a "futurizing" function embedded within it, which is the creation of hope. The appreciation of containment's central role in engaging potential futures clarifies the therapeutic stance in a time of "permacrisis."