Inpatient treatment for anorexia nervosa can be necessary for medical, psychosocial or psychotherapeutic reasons. In general, these patients are characterized by "negative" selection characteristics (illness duration, failures of previous treatments, unfavourable natural milieu, poor motivation, etc). An inpatient treatment program, in which 145 female patients have been admitted, is described. It consists of two phases: a first "symptom directed" phase aiming at weight restoration and normalization of eating, based mostly on behavior therapy principles; in a second "problem oriented" phase, patients are oriented either towards outpatient treatment (family therapy, individual psychotherapy), or, in the majority of the described cases, to an inpatient psychotherapeutic community program. The difficulties of this approach and some outcome results at long-term follow-up are discussed.
The purpose of this paper is to reflect on and to compare various psychoanalytic models which are used in the conceptualisation of the processes occurring in small psychotherapeutic groups. Three tendencies are roughly differentiated: (1) the tendency to analyse the individual patient in the group (Slavson, WolfsonandSchwartz, Kuiper); (2) the tendency to stress the importance of the group as a whole (Bion, Ezriel, WhitakerandLieberman), and (3) the tendency to consider the group more as a network of interpersonal relations (Foulkes). For each model the following aspects are analysed: the importance of the group or the individual; the role and the attitude of the therapist, and the factors which are considered therapeutic.
This research examines empirically: 1) The existence and delimitation of a clinical neurasthenic neurotic syndrome as defined by van Dantzig & Waage (1962), consisting of feelings of impotence, fatigue, exhaustion and accompanying functional complaints, by means of a hierarchical cluster analysis of the rating answers to a questionnaire. 2) The relation between neurasthenic neurosis and character traits relating to different neurotic personality types and a psychopathic personality type. The results do not confirm the existence of this theoretically defined neurasthenic neurosis, but we find a cluster of somatic complaints which can easily be identified with what most authors consider as a neurasthenic syndrome. This empirically found neurasthenic syndrome has a significant positive relation with an anal-obsessive character trait "over-tidiness and over-cleanliness" and not with a neurotic-inhibited obsessoid character in general, other specific neurotic character traits, or a psychopathic character. On differentiating between patients presenting the syndrome for more or less than 6 months, it is seen that in the category of more than 6 months there is a tendency to an increase of a neurotic-inhibited obsessoid character in general, an anal-obsessive character trait "over-tidiness and over-cleanliness" and a so-called psychasthenic character relating to an intense ego-ideal and narcissistic tendencies.
The authors tried to assess whether differentiating aspects of the treatment ideology of two therapeutic communities (psychoanalytic-psychotherapeutic and orthopedagogical were realised in the actual psychosocial milieux of the communities. Hypotheses were constructed about the differences in treatment ideology between the two communities, on the results on the Ward Atmosphere Scale Form C, which measure many aspects of the psychosocial milieu. The results show differences in the hypothesised direction, and confirm the accomplishment of differences in treatment milieu between the two therapeutic communities.Since World War II, there has been a tendency to stress the role of the psychosocial milieu of the ward as an important factor in the therapeutic process of residential psychiatric treatments. Stanton & Schwartz (1954) Caudill (1958) and Goffman (1961) described the negative effects on the therapeutic process of the informal organisation of the ward. Jones (1953) andFoulkes (1957) were the first to develop the psychosocial milieu of treatment wards in such a way that it would have an optimal therapeutic effect and so become a therapeutic community. Since then, several authors have developed different kinds of therapeutic communities with different purposes.
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