치료공동체로의 재구성에 따른 평가와 문제점

Implementation of the Therapeutic Community in a Psychiatric Ward; Assessment of the Changes and its Problems

After a custodial or medical oriented psychiatric ward was reconstructed into a therapeutic community, an analysis was made of the changes perceived by the patients and staff progressively over a specified time period. The group studied were psychiatric patients of the Korean Veterans Hospital which were comprised monthly of chronic patients with long admittance histories from June of 1985, a reconstruction to the therapeutic community system has been carried out. To put this system into practice, Community meeting and the patient Privilege System were also introduced. The patients who previously lived in nonsystematized ward were organized into therapeutic staff-patient after meeting and subgroup. Music therapy, art therapy, work therapy and numerous other types of therapeutic progrems were adopted. To study the positive effects on treatment by this system changes, the Ward Atmosphere Scale(WAS- ;Moos, 1974) was applied to patients and staff monthly. The above results were analysed by the ANOVA method. And the success and problems relating to the compositional variables within the system were discussed The results were as follows; 1) After reconstruction of the conventional ward into a therapeutic community, both the patients and staff showed a positive response to the ward environment. The staff exhibited much expectation for the results of the progrem, which were showed by signigicant increase of total score and involvement, spontaneity, autonomy score among the subscale items of WAS in staff. 2) Bringing the realization of the therapeutic community into focus, with the exception of severely regressed patients, active participation in the ward activity program and a general increase in the activity of the patients was seen. An increase in the tolerance of the patients complaints was showen, and the staff had time for active discussion of the ward. 3) Due to an insufficent understanding of the therapeutic community, resistance and anxiety to the modification of conventional ward system was showen by the staff. And many problems were exposed such as an increase in the staff dissatisfaction and desires caused by an increase in loading due to the diverse ward activity program and insufficient ability to communicate, also, activation of patients without motivation for discharge or recovery.