Changes in the Administration of Psychotherapy During a Collective Upset

Studies of the therapeutic implications of the social environment of the mental hospital indicate that it is fruitful to view the behavior of patients as a function of the entire social context in which it is embedded. A deeper insight into both individual and social problems can often be obtained if the interpersonal and group organizational dimensions are considered along with the intrapsychic conceptualizations. (1) Given this point of view, it is important to view the behavior of staff members, toward one another and in relation to patients, in the same context. In the classical psychotherapeutic (two-person) situation this problem has been dealt with by focusing on counter-transference phenomena. Although such phenomena exist in all therapeutic situations, they do not provide us with an adequate frame of reference with which to examine staff-patient interaction in the complex role system and administrative organization of the mental hospital. Robert A. Cohen, in discussing the relation between staff tensions and the psychotherapeutic process, suggests that "the social situation may affect psychotherapeutic operations when patient and therapist are part of the same group. In this circumstance, problems which in the usual office situation would be contained within the patient-therapist relationship may now find expression in the patient-staff, staff-staff, and the therapiststaff relationships." (2) This conclusion is also supported by the findings of Stanton and Schwartz in their study of the mental hospital. (7) Changes were noted in symptom behavior in patients as a result of a disagreement between two staff members about how a particular case should be handled. These studies indicate the mutual interaction of patient and staff behavior, and point to the potential value of viewing the behavior of both as a mode of participation in the existing social processes within the institution.