Changeover of a Mental Hospital Unit into a Therapeutic Community

This paper explores some clinical implications of combining individual and group psychotherapy for children functioning at different levels of ego development. More highly structured children are able to observe the continuity and discontinuity that inevitably exist between the two modalities. Bridging of the two therapeutic contexts—integrating split off object representations—enriches the transference and strengthens the therapeutic alliance. In working with ego impaired children the goal in combining treatment modalities is to provide a therapeutic structure capable of containing unintegrated affects and perceptions. The therapist's challenge is to provide the opportunity to regulate emotional distance while at the same time maintaining the experience of a nurturing relationship. While potential hazards exist, with proper precautions taken, combined treatment can provide significant opportunities to establish or strengthen a therapeutic alliance with children, particularly those most in need and yet most resistant to treatment.