Dynamics of staff interaction in hospital psychiatric treatment of children.

Abstract

HE dynamics of individual therapy; i.e., the processes in the situation T of a therapist and child, has received much attention, thought, and experimentation. Group therapy; that is, the situation of several patients and one therapist, has similarly been the subject of an increasing number of studies and clinical efforts.At a recent psychiatric meeting1 there was a round table discussion on a topic entitled, "The Psychodynamics of Residential Treatment of Children." During this discussion several participants suggested that in addition to direct individual treatment in play or interview sessions with the child, and in addition to concomitant therapy of the parents, there was much to be learned about what went on between other adults and children in a residential treatment center or psychiatric hospital ward for children.It was suggested that the counselors, nurses, and attendants in such situations might constitute, by virtue of the time they spent with such patients and by virtue of the care they gave to them, a valuable therapeutic resource. Perhaps still too frequently, for various reasons avoidable and unavoidable, that part of the staff personnel which has most personal contact with the hospitalized psychiatric patient has not participated as fully2 as it might in clinical conferences or informal discussions with supervising and resident psychiatrists and other professional members of staff. Their recorded observations of the behavia-of patients and their technical assistance in medical procedures and custodial functions have long been utilized, or at least required. The extent to which personnel attitudes affect the patient's emotional state is a matter of general clinical experience3 even outside a psychiatric ward or hospital. The deliberate use of the relationship between patient and nurse by the physician for therapeutic purposes is probably as old as the art of nursing. But its frank acknowledgment as a therapeutic adjunct in psYchiatric literature4 and discussions, and the study of its dynamics and r e k * Presented a t the 1947 Annual Meeting.Meeting of the American Psychiatric Association, Chicago, May 194.6. Rowland (1) and (2) describes the relatively closed caste system characteristic of the social strucNre of a mental hospital employees, emphasizing in particular the closer contact of the nurses and attendants with patients. There is also discussion of types of interaction processes and of prevalent attitudes of conflict between these staff members and the patients.Kimber ( 5 ) places stress on the importance of psychiatric nursing as the treatment needed by most hospitalized psychiatric patients.Reichert (3), in addition to Kimber, are among the few psychiatrists who call attention to the therapeutic possibilities of the attendant-patient and nurse-patient relationship. From personal communication the writer is aware that Sylvester and Bettelheim a t the Orthogenic School, Chicago, are a'so interested in this problem. See also (7) and (6).

A quest for dynamic leadership in the mental health rehabilitation team

“…This approach is certainly conducive to effective teamwork. Szurek (1947) emphasizes that physicians are taught to direct rather than lead. By definition directing means to "command" or "order" (Merriam-Webster, 1971, p. 139).…”

The use of a ward's history in training psychiatric child care workers

“…This view stresses openness and clarity of communication among child care workers, doctors, and patients. The interpersonal dynamics of the entire ward are considered, and interest is primarily on contemporaneous vicissitudes in these dynamics (Szurek, 1947;Stanton & Schwartz, 1954;Montalvo & Pavlin, 1966;Pierce, Trickett, & Moos, 1972;Krohn, Miller & Looney, 1974). A third view, while noting that treatment is affected by emotional relationships among all staff, suggests that emotional climate is largely a function of the organizational properties of the ward, properties such as power constellations, communiction channels, and role definitions.…”

Nursing in the psychiatric treatment of children—Panel, 1961: 3. Nursing in hospital psychiatric therapy for psychotic children.

“…All facets of the ward program are outgrowths of the experience and the philosophy of the Children's Service staff during the past 14 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Under the direction of Dr. S. A. Szurek, there has developed in this time an in creasingly integrated clinical unit.…”