치료적 공동사회의 한 변형 一1년간의 추적 ᅳ

An Illustration of a Modified Therapeutic Community in Korea 一It’s One Year Follow-up—

The authors presented a an illustration of the modified therapeutic community, which was organized in Aug. 1981, as a psychiatric inpatient unit of Wonju Christian Hospital, Yonsei University, and was located in one of the strongly culture-bound district in Korea (Kangwon-Do, W o nju). It was an active therapy unit as well as a teaching facility for medical students and nursing students, and was a mixed milieu consisted of 22 to 26 inpatients with heterogenous diagnostic entities. Organization and vicissitude of the therapeutic community was presented in terms of therapeutic team, therapeutic strategies, patient previlige system, and ward activities including community meeting, intensive group psychotherapy family accompanied admission programme, ward round, occupational programme, staff sensitivity meeting etc. Based on the one-year follow-up experience compared with western ones, the authors’ discussion was focused on the predicted modification how the concepts and strategies of therapeutic community could be applied and changed in accordance with the sociocultural characteristics of our country, and several problems were suggested to be examined further, as follows； (1) the patient’s heterogeneity seemed to be rather contributory to increasing therapeutic effect in the mixed milieu, but where, organic brain syndrome, compensation neurosis and antisocial personality disorder seemed to be contraindicated. (2) the patient priviliege system was successfully applicable to our therapeutic community as an organized democracy and several patient’s requirement tasks were developed spontaneously and informally in each step of priviliege system. (3) the patient value system and culture of therapeutic community should be scrutinized in accordance with our sociocultural background. The mostly fiequently confronting and conflict-provoking issues of our therapeutic community were patient’s difficulty in expression of aggression, unresolving strong ambivalence toward the authority figure, and the need for new type of leadership for it’s resolution. (4) the counter-transference reaction seemed to be final problem to be successfully dealt with in the therapeutic community just as in individual psychotherapy, and that was analyzed in 3 system-levels; counter-transference reaction originated from the therapists’ intrapsychic conflict, the one from the interaction between therapists’ subgroups, and the one from the therapeutic community organization as a whole.