An inpatient psychiatric unit in a general hospital allows one to look at the interrelationships of milieu, therapeutic and administrative groups, and group treatment as they operate within larger organizational and societal matrices. This article describes a children's psychiatric unit grounded in transactional analysis, its successes in terms of treatment, and its ultimate demise because of external economic pressures. The treatment of a 10-year-old with Cotard's syndrome–a rare condition characterized by the belief that one is dead–is used to demonstrate the synergistic effects of multiple interdependent therapeutic groups.
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