Therapeutic Environments

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Abstract
A theoretical and therapeutic framework is attempted for work with some chronic or longer-term patients who are being seen in increasing numbers in community psychiatric settings. Work is reviewed with two such groups of patients treated in situations other than traditional dyadic psychotherapeutic relationships: alcoholics seen in a detoxification unit and long-term psychotic patients followed in an outpatient maintenance aftercare program. In both instances the dependent situation between patient and staff which exists during hospitalization is used as the basis for the development of an ongoing outpatient therapeutic relationship with a treatment team associated with a therapeutic facility which remains available, at least symbolically, 24 hours a day, seven days a week. Such "therapeutic environments" appear based upon "pre-object" or predyadic dependence, thereby avoiding regressive dyadic transference phenomena.

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