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The good results obtained with the long-term psychoanalysis of neurotic and personality disorder patients on a outpatient basis have not been paralleled by good results for severe psychotic patients treated on an inpatient basis. However, psychoanalytic thinking and training personnel in this remains an essential tool in institutions, both for the maintenance of a therapeutic milieu and for understanding and improving the work of the therapeutic teams. On the other hand, psychoanalytically oriented group psychotherapy is a basic therapeutic tool in short-term and long-term hospitalization units for psychiatric patients. The well-known experiences of therapeutic communities, today unduly neglected, are an example of its efficacy. We have reported our experience with several controlled group programs that have been underway since 1975 in Bilbao, Barcelona, and Geneva for patients with severe psychiatric disorders in short-term and long-term inpatient and outpatient clinics. The results have been positive from both a clinical and an organizational point of view. A special ward atmosphere develops which is unlike that seen in other units run using different approaches.