The Staff Member's Crisis of Control in Psychiatric Residential Treatment:

Abstract

A difficulty encountered in the smooth operation of a psychiatric hospital or residential treatment center is the conflict between freedom and nonpunitiveness and the need for adequate control. Authors examine staff members' difficult adjustment to an open psychiatric hospital for adolescents which has few external controls. Staff members experience a crisis of control which may result in: (1) misuse of standard procedures to gain control; (2) possessiveness of patients; (3) projection of the need for control so that it is seen in neutral situations; (4) regression in the face of countertransference; (5) control of employees below them in the hierarchy. Institutional contributions to this crisis include: (1) the premature requirement for staff competence which results in the therapist's inappropriate reliance on the patient's behavior to reflect it, and (2) the influence of the psychoanalytic model and psychoanalytic neutrality which can make therapists and other staff members feel helpless and irresponsi...