Psychiatric wards in Hungary and elsewhere in Europe, even with modern concepts, possess features of totalitarian systems: controlling, maintaining a strong hierarchy in the structure, an authoritarian leadership style, regulated autonomy and reduced to one-way communication. Group therapy aims at free communication, empathic leading, cooperation and functional agreements, reflectivity. In this paper we analyze components of this apparent dichotomy in the context of contemporary psychiatric wards. A theoretical definition is given for the possible degrees of hierarchical rigidity on psychiatric wards based on decision-making procedures, the acquisition and distribution of resources and analysis of boundaries and functional features.
Background:Basic features of group psychotherapy for patients with acute psychosis are:focus on the sharing of psychotic experiences;different ways of interactive connections and transpersonal relations between patients and staff members;different realities represented, realized and interpretated by the participants;high risk of self stigmatization;paradoxical tension between the urgency readiness of psychiatric environment and the reflective attitude of group work.Methods:A modified group analytic technique with free-floating discussion (Foulkes) is used to understand psychotic experiences. Group processes and symbolic contents are analysed on structural and communicative perspective.Results:The maintainance of complex group work clAims:clear and stable boundaries;creative possibility of potential space (Winnicott);relational capacity of the stuff;and high level of integration between the group and the institutional system.Conclusion:Co-therapeutic team facilitates integration in both direction:as a part of the group it helps the socialization of group members on the field of psychological work;as a part of the whole stuff of the department it supports connections around the group.The individual team member takes double role in the reality of the group: co-therapist and group member. The integration and conflicts between these roles should be interpretated in the context of the group.
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