Hierarchy and/or Reflectivity: the Role of Groups in the Function of Psychiatric Wards

Abstract

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.

Clinical Psychologists' Experiences of Reflective Staff Groups in Inpatient Psychiatric Settings: A Mixed Methods Study

“…It is also argued that reflection can assist staff in dealing with difficult feelings aroused by the inpatient context (Holmes 2002;Kurtz 2005), and reflective ability has been linked to increased resilience in stressful and upsetting situations (Trowell, Davids, Miles, Shmueli, & Paton 2008). Therefore, regular space for reflective processes such as groups is important for both staff satisfaction and the functioning of the unit (Kurtz 2005;Terenyi, Kis, & Eszik 2004;Thorndycraft & McCabe 2008). The importance of a reflective 'system' is reinforced by its inclusion in health and social care policy guidelines alongside increased attention on staff wellbeing and support (Department of Health 2002;National Institute for Mental Health in England 2003).…”

Problem Stvaranja Grupe Kao Cjeline U Grupi Koja Se Odvija U Psihijatrijskoj Instituciji

“…Another aspect of the social setting relates to the organizational dynamics that determine the environment as a living system (9). What characterizes psychiatric departments (from the perspective of Bion's assumptions) is that they nurture a culture of care, dependency, undifferentiation, where there is no room for the development of autonomy, and separation is not fully worked through (12). Especially when conflicts and changes are present in the institution, such dynamics spills over into all aspects of the system, affecting the group's sense of security (9).…”