[Social workers and physicians--partners in social psychiatry? Assumptions and reality in a social psychiatry model institution].

With the reform of psychiatric and psychosocial care services, new professional groups, apart from the traditionally medical professions, have increasingly found their way into everyday therapy. Social workers in particular have gained significance in complementary fields of treatment. An empirical survey of the everyday situation in a comprehensive community mental health service system focusing on the therapist-couple "physician" and "social worker" collaborating to guarantee continuity of care for long-term treatment, yielded three results: 1. The dual-therapistsystem was convincingly effective for nearly half of the total number of patients; the other patients were attended generally by one therapist, while the second therapist took an active part in treatment only sporadically. 2. Analysis considering the two professional groups involved showed a significant pre-dominance of the physicians, both on a qualitative basis in their function as being the primary therapist as well as in strictly quantitative terms concerning the relations of all therapeutic activities. 3. A comparison of two extreme groups "doctor-patients" and "social worker-patient" revealed significant differences in features of their respective social and clinical case histories. In the course of treatment we found a rapid focusing on and acceptance of the medical therapeut. These results, which also reflect the conflict between social psychiatric claims and everyday reality, are discussed with regard to the self-perception of the professional groups involved and the practice of our department and the cooperative institutions, as well as the expectations of the patients and their relatives, and finally with reference to the various exclusively medical-oriented treatment models which still dominate contemporary psychiatric praxis.