Psychoanalysis and Psychiatric Institutions: Theoretical and Clinical Spaces of the Horney Approach

There are two parts to this paper. The first concerns the relationship between the specific Italian situation of psychiatry and psychoanalysis. Deep transformation for many years has characterized psychiatric institutions and the underlying psychiatric culture. The second is an attempt to determine what theoretical and clinical role the Horney approach can occupy in the complex panorama of public psychiatric services.

First we must outline the current dilemma of those who carry out simultaneously the double role of analyst and institutional psychiatrist in Italy. The creation of new possibilities in psychiatric practice has arisen thanks to the new organization of psychiatric assistance. This has been made possible by the far-reaching spirit of renewal that characterized the period between the end of the 1960s and the beginning of the 1970s. A specific national law sanctioned these changes in 1978. The contribution not only of psychiatry but also of other psychological and social disciplines—secretly nourished by the advances of the “depth psychologies”—has determined the passage from an “asylum” model of psychiatric assistance. From a focus on the psychiatric hospital, there has been a shift to what we might call a “territorial” model. The latter foresees psychiatric assistance supplied by multidisciplinary functional units, the mental health departments, which are distributed throughout discrete geographical areas. These departments are made up of diversified structures and services. They must guarantee multiple, differentiated responses to the psychiatric needs of the population. Within the family and social context in which these needs manifest themselves, a complex territorial network is formed that is able to guarantee not only treatment but also prevention and rehabilitation. Hospitalization remains only as one of the means of intervention in this network. It is certainly not the preferred means and in any case it no longer takes place in large psychiatric hos