The Future of Psychotherapeutic Environments: Learning from Experience at a Swedish Therapeutic Community

Ten years’ experience in a Swedish therapeutic community outside the organisation and culture of the psychiatric services is summarised with reference to a longitudinal prospective study. This therapeutic environment proved to be better suited to patients’ needs, and the organisation and setting were more in accord with the treatment philosophy than at other units with which it was compared. It was possible to identify different phases in the history of the therapeutic community and the development of patients. The patient group as a whole have shown improvement in psychiatric terms, as well as with regard to psychosocial interpersonal and emotional functioning. The more lasting personality traits have not, however, altered. Difficulties in the work, and obstacles to change, appeared to derive from: the therapists’ tendency to disregard problems in the relationship; not enough work focused on separation and negative, hostile feelings. Termination of treatment was a strain which the patients found difficult to manage. The period subsequent to the stay at the therapeutic community was decisive for the long-term outcome. Today, it is necessary to amend our concepts of a decisive and complete cure.