Although treatment teams have been examined often in the mental health literature, this literature seldom addresses the crucial property of "teamness"--the key set of intangible phenomena that allow a team to function synergistically as more than the sum of its parts, and with a sense of team identity. In this paper, the concept of the work group is used to develop a framework for understanding the factors contributing to effective team functioning and identity, an their implications for the tasks of team leadership and sociotherapy: "the art of maintaining a social system in which the treatment of an individual patient can best occur" (Edelson 1970). Leadership activities that promote team cohesiveness and boundary maintenance are discussed, and suggestions are provided for ways in which the subjective experiences and emotional reactions of the leader and team members can be used to promote improved task performance and clinical care.
The 15 patients with the highest numbers of assaultive incidents over a one year period in a state mental hospital were identified and information collected regarding a variety of clinical and demographic characteristics. The results showed a group of patients who are relatively young, manifest severe symptomatology that is generally unresponsive to treatment, and have now been hospitalized continuously for greater than four years. The patients experienced the onset of symptoms as teenagers in most cases, showed poor psychosocial adjustment beyond childhood, and had positive family histories for mental illness or alcohol abuse. Patients with psychotic disorders predominated and tended to have positive symptoms rated as severe to very severe on the Global Rating Scale for Psychosis. Patients with nonpsychotic or personality disorders always showed a high frequency of self-injurious behavior in addition to their aggressive behavior toward others. A number of patients had a history of head trauma with EEG abnormalities. This information provides a starting point for subsequent studies examining potential distinctions between this subpopulation of patients and others, the motivation and circumstances of such incidents, and the interaction between the behaviors and their effects on those around them.
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