Ritual and spontaneity in healthcare and in the organisation of therapeutic communities

The author, following constructivist psychoanalysis, observes a dialectic at work in the therapeutic community between knowledge and authority of the analyst and his/her spontaneity on the one hand, and between the formal and informal roles that therapists adopt in a therapeutic community on the other hand. The key to successful therapy, he suggests, lies in maintaining this dialectic. He then goes on to discuss the function of staff teams in therapeutic communities and the importance of taking into account the patients’ unconscious representations of the team. He stresses the need for leadership in therapeutic communities and in engaging with moral issues and not just clinical ones.