The impact of the therapeutic environment

This paper emphasizes the impact of the setting, space, and general physical properties of the clinic upon the difficult patient's profound neediness and absence of inner regulatory structure. Moreover, the clinic's administrative style and requirements often related to fiscal restraints, demands for accountability for both how funds are spent and treatment outcome, all impinge upon the patient. Humanizing clinics so they have the capacity for psychotherapeutic holding and provision of safety for difficult patients are discussed in detail in this contribution.     

Family system functioning: behavior in the laboratory and the family treatment setting

The Family System Functioning (FSF) scale is a new instrument for measuring dimensions of the intrafamilial environment thought to be important in recovery from major psychiatric illness. Modest statistical correlations were obtained when FSF ratings of laboratory-based family interactions were compared with researcher-guided therapist ratings of FSF based upon the family's behavior in family therapy sessions during the subsequent month. The data from these two settings provide support for the validity of some of the scales. Because of the modest size of the correlations, however, behavior in the laboratory setting may not always be an accurate indicator of how the family will behave in the early weeks of family therapy.