Therapeutic paradox – the patient culture and the formal treatment programme in a therapeutic community

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Abstract
Data collected by participant observation in a day hospital are used to examine the complex relationship between informal patient interaction and the formal group therapy programme of this therapeutic community. It was evident that staff might view apparently similar informal patient activities in quite different lights, as either complementary or as detrimental to the work of the formal groups. This apparent inconsistency in staff prescriptions was turned to a therapeutic purpose. Staff would point out to patients the "paradox" of the constant inconsistency of prescriptions for behaviour in daily life: parallels were drawn with the contingent and defeasible prescriptions to which patients were subject in most spheres of human activity. In learning to cope with incipiently contradictory prescriptions inside the day hospital it was felt that patients might learn to cope with incipiently contradictory prescriptions in their relationships outside the day hospital.

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