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The purpose of this paper is to formulate an integrative set of theoretical propositions providing a common frame of reference for the different treatment modalities in the psychoanalytic hospital. Such a theoretical structure should also permit the establishment of clearer boundaries among the various therapeutic modalities utilized in the hospital so that they can be optimally geared to an individual patient's needs. Finally, this frame of reference also may contribute to decreasing the traditional tensions between administrators and clinicians by providing a conceptualization of their actual professional and functional interdependence.
In psychoanalytic theory, the term “structural intrapsychic change” (in the direction of clinical improvement) refers to changes in the relationship between the ego, the id, the superego, and external reality. In clinical terms, this means changes in impulse-defense configurations, that is, changes in the defensive structures which determine the boundaries between ego, superego, and id. Changes in impulse-defense configurations require, according