[Rapidly changing ego states in inpatient long-term therapy of psychotic adolescents].

The paper reports about some aspects of a major retrospective case study of 43 psychotic adolescents in long term in-patient treatment. One of five items to classify these treatments were rapidly changing ego-states. In 17 patients this phenomenon was seen as having essential repercussions on the therapeutic course. The discussion is centered round the day by day interactions with these patients on the ward. The question is raised, how holding structures and continuity of personal relations can be reached and maintained in view of rapidly changing levels of ego functioning. Much emphasis is laid on the understanding of interpersonal dynamics between nursing staff and patients. Such understanding enables the team to adapt to the patients' needs without being overwhelmed by their impact. A thus reflected shaping of everyday interactions on the ward is highlighted as an essential factor in the treatment of psychotic adolescents. The term "rapidly changing ego-states" refers to the adolescent problem of maturation and separation and to the restating of this problem in a treatment setting. Mental illness evolves to be understood a developmental crisis.