How to use therapeutic environments in the treatment of schizophrenia?:Common ground and areas of disagreement

Abstract

Insight-oriented milieu therapy with psychotic patients aiming at integration of psychosis into a meaningful life context presupposes a specific, dynamic balance of explorative and supportive factors in the milieu. This is a consequence not only of the psychotic patient's difficulties but also of the double demands, made on the patient and the milieu for regression and collaboration, for actualization of the patient's problems and support of the patient's non-psychotic ego in this treatment modality. Therapeutic communities for psychotic patients differ in their ways of establishing this balance, with regard to explicit treatment philosophy, organizational preconditions, and the concrete content of the therapeutic work. This paper outlines the current common ground and the present areas of disagreement in the use of therapeutic environments as agents of changes in schizophrenic patients. The therapeutic environments for psychotic patients go through similar phases in their institutional histories, with comparable critical points and obstacles to the therapeutic task. However, the outcome of this process is dependent on organizational factors. The model of specially designed therapeutic environments was a protest against and a continuation in a new form of a long tradition of asylums. Today we need to call attention to the new editions of the old ideas about the“total” treatment environment, a place for the decisive and complete cure.

Key Words:

• Organization
• Schizophrenia
• Therapeutic community
• Treatment philosophy