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March 1966

Problems of Role Definition in the Therapeutic Community

Author Affiliations

From the Columbia University College of Physicians and Surgeons (Dr. Herz); City College of the City of New York (Dr. Wilensky); and Montefiore Hospital (A. Earle).

Arch Gen Psychiatry. 1966;14(3):270-276. doi:10.1001/archpsyc.1966.01730090046007

THERE IS a significant trend in hospital psychiatry toward a "therapeutic community" or "milieu" approach influenced in large part by the works of Jones,1 Wilmer,2 Stanton and Schwartz,3 and Caudill.4 On the one hand many state hospitals are moving away from a purely custodial approach, and on the other hand intensive treatment centers are becoming aware that an exclusive preoccupation with individual psychotherapy sessions does not take into account other important interactions in the patient's life. The patient in a hospital is part of a social system and it is incumbent upon the psychiatrist to influence this system to facilitate therapeutic interactions. The staff on psychiatric wards has extensive contacts with patients and patients with each other. Spontaneous interaction in itself may be helpful, but a planned approach to social factors is potentially more beneficial.

Schwartz5 has stated that a

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