The organization of the ward treating psychotic patients

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Abstract
A chaotic treatment environment seems to be associated with a low level of intrapsychic development and social maturation of its psychotic patients. And vice versa: a well-organized external milieu may internalize and help intrapsychic structure formation. In an institutional setting, an adequate organizational environment is a necessary but not by itself sufficient precondition for successful therapy. The prime goal of organization development is to make the curative, ego-building process possible. This presupposes adequate organizational structures (e.g., a weekly timetable, treatment planning and execution, conflict solution, dyadic and triadic encounters), which encourage and motivate democratic leadership style, functional team work, and adequate environmental relations. Residents with severe psychopathology have both a destructive and a constructive influence on their treatment organization. A good therapeutic milieu, its staff, and its residents oppose and contain the former and nurture the latter. The consequences of these ideas and hypotheses are illustrated with some clinical vignettes and practical experiences in a therapeutic community for acute patients.

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