Horikawa Kohei, Horikawa Yuriko
Regal Cooperation of Medical Services Communauté Vent et Arc. Nozoe Hospital.
Seishin Shinkeigaku Zasshi. 2012;114(1):35-41.
The author developed argument that a cause of the present condition of our country, in which psycho-social approaches have not fully spread though its clinical efficacy has been well recognized, is in the medical institution side. Because, our psychiatric reforms over 17 years, that reduced the average duration of hospitalization from about 2156 days to 61 days, has attained by deployment of various psycho-social approaches based on "therapeutic community model" and "psychodynamic team treatment". Furthermore, it has done by the affinity, continuity and complementarities of "psychodynamic team treatment" and psychosocial approaches with following special features. That is, since psycho-social approaches is 1. techniques to acquire the social life skill and to prevent re-hospitalization, 2. the group psychotherapy by facilitating the patient's mutual help capability, 3. based on "acceptance of the disease" by "noticing the diagnosis". Even if the therapeutic orientation or assumption of the psychiatric hospital does not comprehend above all of 1-3, it is important whether it is in the same direction or not. In other words, it is the issue of the medical-economical-management system, medical model and also the kind of psychiatry that is the source of them. Our hospital is for short term hospitalization and in focus on the outpatient treatment with "psychodynamic team treatment" based on "therapeutic community model". That is why our hospital has a potential advantage to take in and utilize the psycho-social approaches. On the other hand, there is the same reason why it is difficult for the traditional psychiatric hospital for long term hospitalization with higher hierarchical "physical medicine model" based on the descriptive psychiatry. The further problem is that both psychiatric hospital staff and psycho-social therapists do not realize it. The most important issue for us is having the recognition and exploring the method not to adapt to a psychiatric hospital but to improve and spread psycho-social approaches to psychiatric hospital.
作者提出论点，认为我国目前的状况是，尽管心理社会方法的临床疗效已得到充分认可，但在医疗机构方面，这些方法尚未得到充分推广。因为，我们17年来的精神病学改革，将平均住院时间从约2156天缩短至61天，这是通过基于“治疗社区模式”和“心理动力团队治疗”部署各种心理社会方法实现的。此外，这是通过“心理动力团队治疗”与具有以下特点的心社会方法的亲和性、连续性和互补性实现的。也就是说，心理社会方法是：1. 获得社会生活技能和预防再次住院的技术；2. 通过促进患者互助能力进行的团体心理治疗；3. 基于“注意到诊断”的“接受疾病”。即使精神病医院的治疗方向或假设没有完全理解上述1-3点，重要的是它是否朝着同一方向发展。换句话说，这是医疗经济管理系统、医学模式以及作为其源头的精神病学类型的问题。我们医院以短期住院为重点，专注于基于“治疗社区模式”的“心理动力团队治疗”的门诊治疗。这就是为什么我们医院在接纳和利用心理社会方法方面具有潜在优势。另一方面，基于描述性精神病学的、具有更高层级“躯体医学模式”的传统长期住院精神病医院也有同样的困难。进一步的问题是，精神病医院工作人员和心理社会治疗师都没有意识到这一点。对我们来说最重要的问题是认识到并探索一种方法，不是去适应精神病医院，而是改进并将心理社会方法推广到精神病医院。
