Despite more than 30 years of deinstitutionalization, a significant number of individuals continue to experience prolonged stays in state psychiatric hospitals. Many of these individuals appear to develop an ambivalence or resistance to discharge. This can itself contribute to further delay in discharge planning and implementation. We will describe a group intervention for persons with long stays labeled as "resistant." This effort was guided by the premise that each individual could benefit from personally exploring those aspects of his or her experience that may be contributing to continued hospitalization. The group utilized standard methods of rehabilitation and training with strong emphasis on validating individual needs and feelings, peer support and practical results. After 1 1/2 years of group intervention, 5 of the 7 group members had achieved discharge and initial community success.

Twenty-three nursing staff in a state psychiatric hospital in the eastern United States narrated their experiences in establishing meaningful presence with seriously and persistently mentally ill clients. Interviews were audiotaped, transcribed, and then interpreted using a phenomenological hermeneutic method. The results of interpretation point to clarifying or illustrating that presence is established and maintained in the context of anxiety and uncertainty. Six themes were constructed to describe staff presencing: knowing the uniqueness of individual clients; listening actively with intense focus on the client; engaging several potential channels for change; caring with confidence, creativity, and perceived respect; involving clients optimally; and encountering mutually defined effective change.