Staff interaction and therapeutic structure on a short-term psychiatric unit.

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.