Axelrod S D, Axelrod J B
Department of Psychiatry, Queens Hospital Center, Jamaica, NY 11432.
Hillside J Clin Psychiatry. 1987;9(2):184-94.
Changes in psychiatric treatment have rendered the "therapeutic community" concept inapplicable to the present day inpatient milieu. In this paper, the quality of staff interactional processes is used as the basis for reconceptualizing the milieu of the short-term psychiatric unit. Patient psychopathology and rapid patient turnover are among the sources of anxiety for the inpatient staff. However, under optimal circumstances staff interaction generates a matrix of relatedness, communication, and stability which becomes a "positive group introject" for staff members. The "positive group introject" enhances the integrative functioning of the unit staff, thereby facilitating patient reintegration and the development of a therapeutic alliance. Failure to establish a "positive group introject" as a countervailing structure to staff anxiety and fragmentation leads to the dominance of pathological forms of staff interaction. These come to characterize a particular ward as a collective entity. Three forms of pathological staff interaction are described; of special interest, because of its seemingly high prevalence on short-term receiving units, is the milieu characterized by the suppression of staff relatedness, affective expression, and communication. The structure of a psychiatric unit can be seen as a function of staff interactional processes, thus the quality of interpersonal relationships, and emotional experience of staff and patients, rather than the specifics of the ward program itself, holds the key to understanding the milieu's efficacy.
精神科治疗的变革已使“治疗社区”概念不适用于当今的住院环境。在本文中，工作人员互动过程的质量被用作重新构想短期精神科病房环境的基础。患者的精神病理学和患者的快速更替是住院工作人员焦虑的来源之一。然而，在最佳情况下，工作人员的互动会产生一种关联、沟通和稳定的矩阵，这对工作人员来说成为一种“积极的群体内化”。“积极的群体内化”增强了病房工作人员的整合功能，从而促进患者的重新融入以及治疗联盟的发展。未能建立“积极的群体内化”作为对抗工作人员焦虑和分裂的结构，会导致病理性工作人员互动形式占主导。这些互动形式成为特定病房作为一个集体实体的特征。本文描述了三种病理性工作人员互动形式；特别值得关注的是，由于其在短期接收病房似乎普遍存在，有一种环境的特点是工作人员的关联性、情感表达和沟通受到抑制。精神科病房的结构可被视为工作人员互动过程的一种功能，因此，人际关系的质量以及工作人员和患者的情感体验，而非病房项目本身的细节，才是理解病房环境效能的关键。
