Problems of Role Definition in the Therapeutic Community

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Abstract
THERE IS a significant trend in hospital psychiatry toward a "therapeutic community" or "milieu" approach influenced in large part by the works of Jones,1Wilmer,2Stanton and Schwartz,3and Caudill.4On the one hand many state hospitals are moving away from a purely custodial approach, and on the other hand intensive treatment centers are becoming aware that an exclusive preoccupation with individual psychotherapy sessions does not take into account other important interactions in the patient's life. The patient in a hospital is part of a social system and it is incumbent upon the psychiatrist to influence this system to facilitate therapeutic interactions. The staff on psychiatric wards has extensive contacts with patients and patients with each other. Spontaneous interaction in itself may be helpful, but a planned approach to social factors is potentially more beneficial. Schwartz5has stated that a

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