The Large Group: Dynamics and Therapy

By Lionel Kreeger | Go to book overview

7. Psychotherapy in the large group

Rafael Springmann

In this chapter 1 I will try to describe the weekly meetings of patients and staff held at the psychiatric department of Tel- Hashomer Hospital, Israel; the development of these meetings, which occurred hand-in-hand with the maturation of the staff, some of the dynamics of these meetings from the point of view of the patients as individuals and as a group; and some of the aspects in which they are comparable to regular therapeutic groups.

Tel-Hashomer is a general hospital of about 1,000 beds. The psychiatric department was founded about ten years ago as an integral part of the hospital. It consists of two adjacent, mixed, open wards of 23 beds each, and is designed for the assessment and short-term treatment of acute psychiatric patients of all diagnostic categories, the only exceptions being homicidal patients and those whose suicidal drives are too intense to be controlled without physical restraint. Individual patients stay in the hospital for an average of about two months.

From the very beginning, it was clear that one of the cornerstones of such an open department, which relied mainly on cooperation with the patients, had to be a therapeutic atmosphere. However, most of the members of the medical staff were young and inexperienced and could not define such an atmosphere, let alone maintain it. Their attitude toward patients tended to be too permissive on some occasions, too harsh on others, with both extremes leading to a great deal of friction and mutual acting out. It was decided to try to regulate the atmosphere by weekly general meetings of patients and staff. These would provide both sides with an opportunity for controlled ventilation and the

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