Therapeutic and counter-therapeutic factors in acute ward settings

Summary

Recent reports suggest that many patients view their admission to a psychiatric acute unit as an unrewarding, distressing or undermining experience. Whilst it could become genuinely therapeutic, in the sense that it could be an opportunity for self-reflection, personal exploration or change, it is often endured as a traumatic event in one's life that should best be forgotten.

This paper explores a psychodynamic understanding of this multi-personal environment in which transference phenomena develop and are usually ‘acted out’. The admission process is examined, as well as the importance of understanding the support and attachment to fellow patients, staff-patient tensions, and relationships between staff and management. Issues about violence and fear, locked wards, and reflective interventions on a unit are discussed, focusing on how to maximise therapeutic opportunities. The multi-disciplinary ward-review is also scrutinised in this light.