Abstract
It is long established that teaching and treatment get along well together. It is also definite that the treatment of emotional disturbances, severe enough to warrant hospitalization, is best accomplished on a ward basis. The ward becomes for everyone concerned staff and patients a new environment that can be therapeutic for the patient and a learning experience for the staff.
On the ward, even if each patient has his own doctor, he is also treated by multiple therapists, each member of the staff, in his role, being therapeutic or the contrary. Groups have always existed, structured or not, in hospitals. Modern psychiatrists have not invented groups: they have used them for diagnosis, therapeutic and teaching purposes.
The service has for its primary function to observe, understand, communicate, interpret behaviour of all those who interact on the ward be they doctors, nurses or patients. This situation, as far as the teaching programme is concerned, has the main advantage of reducing the subjective distance between normal and pathological behaviour. As far as the treatment programme is concerned, this situation multiplies the emotional experience of personal relationships that can be corrective of past difficulties in this field.
Insight as we know is hard to gain, strong defence mechanisms are at play, patterns of behaviour are entrenched, resistances operate against interpretation and insight, both for the patient and the student. In a person to person relationship, interpretation is often crude, if we may say, too verbal, leaving too little way out for the individual self pride. Group techniques have the immense advantage of eliciting repetitive patterns of behaviour worthy of interpretation, of relying mostly on non-verbal interpretations prior and preparatory to verbal ones, of allowing time, possible escape and limited acting-out in the way of increased motor activity to help patient and student digest his new experience in dealing with others and profiting of same.
Oftentimes, we came to realize that if, in the past, ward therapy had dwindled in its efficiency, the reason was that it was not prolonged enough, the staff was not integrated enough, a single personality (chief of service mostly) was influential in maintaining the group, while interchangeability of roles, equal participation in the group (each in his—or her specific function), maintenance of a core of stable personnel, reliance on all patients rather than on a very verbal one, were factors of success.